SINGAPORE, Aug 25 — Having led what he considered to be a healthy lifestyle, Mr Mimrah Mahmood was shocked when he learned that he had a low sperm count a year after trying for a baby with his wife naturally.

The 41-year-old permanent resident from the Maldives does not smoke or drink alcohol. With his big frame, most people would describe him as athletic, so it came as a surprise to friends and family that he had to grapple with infertility.

The vice-president for Asia Pacific at a consumer intelligence firm added: "During the doctor’s appointment (in 2015), it was a big shock for my wife as well, because I don’t think she ever thought that our troubles conceiving would be because of me. She had been concerned she might have an undiagnosed issue.”

One reason for her assumption? Among the already sparse conversations around infertility, most were — and still are — women-centric.

Fertility clinics and researchers told TODAY that male infertility is on the rise as more men get diagnosed with various conditions such as low sperm count and poor morphology — which affects the sperm’s ability to swim. This is due to a variety of reasons from smoking to climate change.

Yet, because of the conventional thinking that fertility is not typically linked to men, it deters some men from getting themselves tested and diagnosed. Or they find it tough to admit that they may have a problem, experts and a support group said.

Ms Kimberly Unwin, vice-president of Fertility Support SG, said: "It is common for men to be more hesitant to seek help when dealing with infertility, particularly when the issue is related to sperm quality or other male-specific factors.

"This reluctance often stems from societal expectations and cultural norms that discourage men from showing vulnerability or expressing emotions about such sensitive topics.”

As it was, three men approached by TODAY declined to be interviewed for fear of public scrutiny and the fear of being trolled or bullied online due to their conditions.

Ms Unwin said that Fertility Support SG is a non-profit organisation that provides several initiatives to support men dealing with infertility, such as through support groups, providing resources and running awareness campaigns.

They also organise seminars by experts and sharing sessions for men facing fertility issues.Although Mr Mahmood was open with his experiences, he let on that some friends and family members did not know how to make sense of his diagnosis.

"In their head, if you’re very masculine or muscular, you shouldn’t have a sperm count problem,” he added.

"Some will also try to ‘justify’ my infertility — that I might have had a sports injury or something — even though our doctor told us that there’s no real way to determine the cause.”

As for Mr Adrian Ang, 37, a Singaporean known by his moniker "Xiao Ming” in the videos of digital content platform SGAG, his fertility woes were a secret between him and his wife for over a year.

The co-founder and chief creative officer of a media firm told TODAY that he felt "shocked and helpless” when he learnt that his sperm has poor morphology and low motility. This means that his sperm has trouble swimming and is shaped abnormally, making it difficult to fertilise an egg naturally.

"It was a shock because I never thought that there would be something wrong with my body. Then helplessness (seeped in) because I didn’t know who I could turn to in order to seek help and talk about this,” he recalled of his diagnosis in 2018.

Like Mr Mahmood, Mr Ang struggled with a sense of guilt — even though they were the ones with infertility problems, it was their wives who had to go through the ordeal of in-vitro fertilisation (IVF) to conceive.

"As much as I felt really bad and guilty, I also had to be strong for her at the same time — there were a lot of conflicting feelings,” he added.

He wallowed in self-pity "for quite a bit”, he confessed, but he pulled himself together by focusing on his wife and the end goal of their fertility journey — to have a child.

"Like most men, I kind of dealt with it myself because there was no support group then, unlike (Fertility Support SG) now. I don’t have friends who have openly shared that they have been through this journey,” Mr Ang added.

"But what helped was that my wife and I are open in sharing our feelings and challenges.”

Mr Mahmood, said that to manage his sense of guilt, he tried to make his "contribution” equal to his wife’s.

"I would say that physically, IVF is 98 per cent on Fifi (his wife) and 2 per cent me since I merely contribute the sperm. But I do my best by always being at medical appointments and making the bookings and arrangements to do my part in any way possible.”

It might have been a tough journey, especially mentally, but both men said that it all feels worthwhile when they see their children’s smiles now.

Mr Mahmood is a father of three children conceived through IVF and Mr Ang has a son who was conceived naturally after three failed IVF attempts.

The KK Women’s and Children’s Hospital has seen a more-than-40 per cent jump in the number of IVF cases between 2014 and 2023.

Dr Chua Ka-Hee, a consultant from the hospital’s department of reproductive medicine, said that with couples required to undergo "several investigations” before IVF, this has increased the number of male infertility cases being uncovered and diagnosed.

He added that about 15 per cent of couples in Singapore are not fertile, of which one-third is due to factors stemming from the men.

The most common factors are low sperm count, poor sperm movement and abnormally shaped sperm.

This is due to several reasons, including smoking and heavy alcohol consumption. Certain medications can also affect sperm production, he added.

There are also environmental factors.

Dr Huang Zhongwei and his team found that men who were exposed to extreme heat 15 to 69 days before their semen was collected had low sperm concentration and low sperm count.

Dr Huang is from the Yong Loo Lin School of Medicine at the National University of Singapore.

Dr Roland Chieng, medical director and gynaecology specialist at Virtus Fertility Centre Singapore, a private practice, said that even though more cases of male infertility are coming to the fore, the stigma might still lead to under-diagnosis in some cases.

"Sometimes, without a test and diagnosis, men might blame their partner for infertility issues, avoiding the possibility that they could be a contributing factor.”

After diagnosis, it might bring about feelings of shame, inadequacy and embarrassment, Dr Chieng added.

He noted as well that some men are uncomfortable being tested because the semen analysis requires them to provide a semen sample, so they may feel that the procedure is embarrassing or intrusive.

Even after being diagnosed, men often internalise their struggles and hesitate to seek help, Ms Unwin of Fertility Support SG said.

They make up about just 3 per cent of the more than 8,000 people that the organisation has helped.

Dr Huang, who is also a consultant at the National University Hospital, wants to assure parents planning to have a child that there are medical treatments to help men overcome infertility.

For example, men going through treatments such as chemotherapy may consider sperm banking before that. Those who are unable to produce sperm in their semen might need surgical retrieval or donor sperm instead.

Normalising conversations around male infertility would help make information more accessible and also make men feel less ashamed of their diagnosis, Mr Ang said.

Pointing to the countless comments and messages of love and support when he first went public on social media with his diagnosis in 2019, Mr Ang is hoping that people with influence who share their experiences can provide other couples with the courage needed to traverse their fertility journey.

He added: "IVF is an emotional roller-coaster of hope and risks of disappointments.

"Keeping the diagnosis to ourselves is not good when a lot of courage is needed for every couple’s journey to have their own child.” — TODAY