In South Asian societies, having children is often viewed as a key milestone in marriage. When couples remain childless, women are frequently blamed. However, recent studies show that male infertility plays a significant role and is now recognized as a public health concern in Sri Lanka and around the world.
More Men Are Stepping Forward
Male infertility accounts for nearly 40–50% of infertility cases globally, according to medical professionals. In the past, cultural stigma made it difficult for men to admit they were struggling with fertility issues. But this is changing.
“There’s now a visible rise in cases, mostly because men are more willing to come forward,” said Prof. Sanath Lanerolle, Senior Consultant in Obstetrics and Gynaecology at Castle Street Hospital for Women. He explained that better access to healthcare and increased media awareness have helped reduce the shame often associated with male infertility.
Despite the progress, the emotional toll remains. “When men learn they are infertile, it impacts their sense of masculinity. They delay getting medical help because of fear and denial,” he said.
Why Does Male Infertility Happen?
There are many reasons why men may become infertile. One of the most common causes is a low sperm count, known medically as oligospermia. The World Health Organization (WHO) considers at least 15 million sperm per milliliter of semen as the minimum for normal fertility.
Weak sperm that cannot swim properly or have abnormal shapes may also struggle to reach and fertilize an egg. Sperm with head or tail deformities are less effective, which impacts a man’s ability to conceive.
Genetic disorders like Klinefelter Syndrome can also result in low-quality sperm. Hormonal imbalances, especially low testosterone levels, contribute as well.
Diseases and infections that affect the testicles are another major concern. Varicocele, which is the swelling of veins inside the scrotum, and hydrocele, which is fluid buildup around the testicles, can lower sperm production. Infections like mumps during childhood can lead to a condition called mumps orchitis, which inflames the testicles. Sexually transmitted infections such as gonorrhea or syphilis also pose risks.
Environmental and occupational factors further add to the problem. Working in hot environments, exposure to toxic chemicals, or frequent contact with pesticides—especially in agricultural regions like Nuwara Eliya—can raise the risk of infertility.
Modern Lifestyles Under Scrutiny
Lifestyle choices are increasingly linked to male infertility. “Smoking, alcohol consumption, obesity, and stress can all reduce fertility,” Prof. Lanerolle explained. He noted that modern life often includes long working hours, night shifts, and lack of sleep, which disturb the body’s natural rhythms and lower sperm quality.
Endocrine Disrupting Chemicals (EDCs), found in plastics and many household products, are also known to interfere with hormone function. The WHO reports that sperm counts have dropped by more than 50% globally over the past 40 years. However, data specific to Sri Lanka is still lacking due to limited local research.
The Hidden Cost of Delay
Late marriages and delaying parenthood further worsen the problem. Fertility naturally declines with age, especially after 40. “It’s a national issue,” said Prof. Lanerolle. “Young people tend to postpone parenthood, not realizing how much this affects their chances later.”
Infertility symptoms may not always be obvious. But signs include problems with sexual function, pain or swelling in the testicles, unusual breast growth, frequent infections, or difficulty conceiving after a year of unprotected sex.
Barriers to Treatment
One of the biggest challenges is that many men are unwilling to undergo diagnostic tests such as seminal fluid analysis. “Many never return with the report,” Prof. Lanerolle noted. The reluctance often stems from denial or embarrassment.
Another issue is cost. Advanced fertility treatments like Intra-Cytoplasmic Sperm Injection (ICSI) or In Vitro Fertilization (IVF) are expensive. “Most low and middle-income families cannot afford these services,” he said. “The government should consider subsidizing these treatments or offering them free in public hospitals.”
Available Treatments and What to Expect
Treatment depends on the cause. If the problem is structural, like a varicocele, surgery may help. Infections can be treated with medication. Hormone treatments can correct imbalances. If these methods don’t work, assisted reproductive technologies may be used.
−Options include:
−Surgery to fix physical blockages
−Antibiotics for infections
−Hormone therapy
−Intra-Cytoplasmic Sperm Injection (ICSI)
−In Vitro Fertilization (IVF)
However, access to these treatments remains limited for many Sri Lankans due to financial constraints.
Practical Advice for Men
Prof. Lanerolle offered several tips for young men hoping to improve their fertility:
−Try to conceive between the ages of 20–35, when sperm quality is highest.
−Quit smoking and reduce alcohol use.
−Exercise regularly and maintain a healthy weight.
−Reduce stress and get at least 8 hours of sleep.
−Avoid prolonged heat exposure, such as frequent hot baths or tight clothing.
−Eat a balanced diet and avoid processed foods.
Foods believed to support fertility include pomegranates, lentils, oysters, tomatoes, spinach, bananas, garlic, and dark chocolate. On the other hand, avoid high caffeine, soy products, and saturated fats.
Breaking the Stigma
“In Sri Lanka, infertility is often viewed only as a woman’s issue,” said Prof. Lanerolle. “We need to change that mindset. Male infertility is real and treatable, but it starts with acceptance.”
He called for more public awareness, improved healthcare services, and policy reforms to ensure fertility care is accessible to all. Recently, Castle Street Hospital restarted its sperm bank after a 15-year gap—one small but important step in the right direction.
Conclusion
Infertility is no longer just a private issue. It’s a public health concern that requires urgent attention. With education, awareness, and support, both men and women can face these challenges together. The key is early intervention and removing the shame that surrounds male reproductive health.
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