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Once taboo, men in Asia increasingly turn to fertility treatments

Better access to care and eroding prejudices give hope to childless couples

A Tokyo fertility clinic conducts in vitro fertilization: Treatment for male infertility is becoming more common in Japan. (Photo by Keiichiro Sato)

TOKYO/HONG KONG -- Infertility is often seen as a problem for women in some of the Asia Pacific’s more conservative societies, but medical science begs to differ and men in the region are waking up to the fact that it affects them as well.

Men account for nearly half of all cases of infertility, according to the World Health Organization. A 2017 report found that 24% of infertility cases were attributed to the male partner, and another 24% were due to problems with both partners.

For couples who have difficulty conceiving, testing both partners, rather than just women, can reduce the time and money spent on fertility treatments. Greater access to diagnosis and treatment for men are also helping.

"I was shocked to learn that I was responsible," said a 40-year-old Tokyo man of the struggle he and his wife had in having a child. He and his wife visited a fertility clinic three years ago after years of trying unsuccessfully to conceive. The man discovered two problems: a low sperm count and malformed sperm.

The couple was able to conceive through artificial insemination. They now have a son. "I couldn’t have gone to the clinic alone," the man said. "For men, fertility treatment poses a big psychological hurdle."

If couples are healthy but unable to conceive, many men are reluctant to seek medical help. "I should have consulted a doctor earlier,” he said. “Many people assume that the cause of infertility lies with women."

Although many men are reluctant to seek out fertility treatments, a more open attitude can help reduce the time and cost for couples seeking children. (Photo by Ken Kobayashi)

Companies are embracing new technology to help men diagnose themselves. Recruit Lifestyle, a Tokyo-based company, has developed a testing kit that allows users to monitor the condition of their sperm using a smartphone camera.

The user downloads an app, mounts a lens that comes with the kit onto a smartphone, puts a drop of semen on the lens and takes a video of the sample for about 1 to 2 minutes. This allows the user to measure the concentration of the sperm and their ability to move about.

The company says that with the kit, users can compare their results with the reference values given by the WHO to decide whether to seek fertility treatment.

Dantte, a Tokyo-based startup that runs a semen testing service uses more sophisticated screening technology. Its service analyzes not only the sperm count and their movement but also hormone levels. The user sends a semen sample by mail and can see the results on a personalized webpage in about three weeks.

Technologies for use in clinics are also being developed. Olympus announced in March plans to develop software that uses artificial intelligence to help doctors analyze sperm under a microscope.

Doctors are also adjusting their practice to help men deal with infertility, a problem that many find embarrassing.

Wei Siang Yu, a Singaporean celebrity TV doctor based in Shanghai, is setting up, a platform for confidential internet and face-to-face consultations for men who are embarrassed to discuss issues like erectile dysfunction or a past history of sexually transmitted disease in front of their partners.

“You need to have a more male-friendly service provider,” Yu said. “The starting point is not in the IVF center with your wife.”

In the early 2000s, Yu hosted TV and radio shows in Singapore advising couples how to conceive. He also founded a web startup, Borderless Healthcare, which is producing his new consulting service. Last year he took to the airwaves in China with similar programs he says attract 75 million viewers.

“China is a very stressful, competitive society,” he said. “Many men drink too much and nutrition is not always so good. Many are also waiting longer to have a second baby. By the time they reach 40, about 40% of them suffer erectile dysfunction problems.”

Products from baby goods manufacturer Pigeon on sale in China.

Japan has the highest number of fertility procedures in the world. In 2016, just under 450,000 procedures were performed, more than triple the number conducted 10 years earlier, according to the Japan Society of Obstetrics and Gynecology. However, treatments such as in vitro fertilization are not covered by health insurance. Procedures cost 300,000 to 400,000 yen ($2,700 to $3,600) each, and often run to around 2 million yen before a child is conceived. By exclusively focusing on the woman, many treatments are ineffective, driving up the cost.

That is beginning to change. "The number of fertility treatments for women remains flat, but that for men is increasing," said Yasushi Yumura, an associate professor at Yokohama City University who specializes in male infertility. The number of male patients visiting the university's medical center for consultations about infertility has risen by a third to 240 over the last three years.

Dr. Mark Bowman, medical director of Sydney-based in vitro fertilization group Genea, believes the prevalence of male infertility in the region is rising. He blames a variety of factors like genetic issues, men having children later in life, smoking, bad diet, pesticides and other pollution.

“Worldwide, there’s an increasing incidence of male factor infertility that may well be as a result of environmental impact,” he told Nikkei Asian Review. “In different parts of Asia, that’s going to be a challenge.”

That makes tackling the issue problematic. “It’s not a case of pressing one button,” Bowman said. “You are often trying to address multiple issues, such as pollution, cigarette smoking and a diet that’s not fantastic.”

And sometimes it is simply a matter of a man not producing sperm in sufficient quantity. “As doctors, we are frustrated by the fact that most of the time there’s not a lot you can do to improve his sperm count,” Bowman said. “Some people are just born with fewer workers on the factory floor turning out production.”

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