KUALA LUMPUR, Dec 31 — Male infertility is still treated as a taboo in many Malaysian households, but clinicians at Hospital Canselor Tuanku Muhriz (HCTM) UKM say more men have begun seeking assessment in recent years.
This is a shift from what was once seen largely as a “women’s problem” into a couple’s issue that requires earlier, shared investigation.
Assoc Prof Dr Abdul Kadir Abdul Karim, head of the Advanced Reproductive Centre (ARC) at HCTM, said more than a decade ago, women were usually the ones who took the initiative to seek fertility treatment, even though infertility often involved both partners.
“In the past, when couples came for treatment, it was just the women who took the initiative,” he said during a Media Day 2025 programme at HCTM UKM, a university hospital, on December 17, describing a pattern where “the burden” was often placed on the female partner.
That pattern has changed in recent years, Dr Abdul Kadir said, with men increasingly willing to discuss fertility issues and be assessed.
“In the past 10 years or so, we can see more men opening up,” the obstetrics and gynaecology (O&G) and reproductive medicine specialist said. Dr Abdul Kadir said he was unsure whether the shift was generational, but greater openness has led to more male patients being identified with fertility factors.
Data from ARC’s own caseload show that male factors are a major contributor among couples seeking treatment. “If we look at the male factor at our own centre, ARC, based on our analysis, around 75 to 80 per cent will have a male factor,” he said.
At the ARC, male infertility cases typically involved men aged 28 to 45.
Because of this, male assessment plays a central role in determining treatment pathways. “Some cases need to go straight to in vitro fertilisation (IVF), and some cases might be suitable for intrauterine insemination (IUI),” Dr Abdul Kadir said.
Dr Abdul Kadir said one of the first challenges is getting men to attend clinic appointments. “When we do the analysis to decide the type of treatment, men sometimes find it difficult to come to ARC,” he said.
The starting point for evaluation is usually semen analysis, which is assessed using World Health Organization (WHO) reference standards.
If semen parameters do not meet WHO benchmarks, clinicians categorise the case as male factor infertility and assess its severity. “Anything that does not reach the standard, we will call it a male factor,” Dr Abdul Kadir said.
For milder cases, doctors may first recommend lifestyle changes and conservative measures. “If the level is okay or just a bit low, maybe we can tell the male partner to take supplements, or stop smoking, or avoid wearing tight clothing, and then we will see if there is any improvement,” he said.
If there is no improvement or if patients choose not to pursue such measures, treatment escalates based on the severity of the findings. “If there is no improvement or they don’t want to take supplements, then we can go straight to the treatment stage,” he said.
Dr Abdul Kadir said he usually recommends in vitro fertilisation when sperm counts are very low. “Usually I will offer IVF straight away if the sperm count in the sample is less than five million,” he said. While intrauterine insemination may still be possible, he noted that the likelihood of success is lower.
“It’s not that IUI cannot be done, but the probability is reduced,” Dr Abdul Kadir said.
Some cases require more complex intervention, including procedures to retrieve sperm directly because ejaculation is not possible for medical reasons. “There are some cases that need both IVF and treatment on the male side, for us to find the sperm, because they cannot release sperm naturally,” he said.
The WHO’s semen analysis standards assess sperm count, movement and shape, with reference levels including at least 16 million sperm per millilitre, 30 per cent progressive motility, and 4 per cent normal forms. Results below these levels are considered male factor infertility.
The WHO’s threshold of 16 million sperm per millilitre is used to classify male factor infertility, while lower cut-offs such as 5 million are used at ARC to guide treatment decisions, with very low counts making IVF more likely than simpler options like IUI.
National data underscore the scale of male fertility issues in Malaysia.
In April 2023, then Deputy Minister for Women, Family and Community Development Aiman Athirah Sabu told the Dewan Negara that 60 per cent of sperm analyses conducted by the National Population and Family Development Board (LPPKN) showed abnormal results, pointing to an “alarming” level of male infertility among Malaysian couples.
In July 2020, LPPKN director-general Abdul Shukur Abdullah was reported as saying that 95 per cent of men with normal sexual intercourse were unaware they might have fertility problems, which can stem from sperm abnormalities, medical conditions, infections, lifestyle factors like smoking or drug use, environmental exposure, or cancer and its treatment.
Dr Abdul Kadir said earlier male assessment can help couples avoid misplaced blame and unnecessary delays in care. “If we look at the public now, people are more open to have these conversations and come forward.”
