All about infertility and what couples can do to improve their odds of conceiving

In 2020, Singapore’s total fertility rates (TFR) fell to a historic low, with only 1.1 births per woman, compared to 1.82 in 1980. The pandemic had a part to play in this dip, as some Singaporeans postponed their marriages and plans for parenthood.

An ideal TFR is said to be 2.1 births per woman which is the rate required to maintain a society’s population size. The low TFR in developed countries like Singapore are predominantly due to couples choosing to focus on their education and careers first, while postponing starting a family.

As age plays a major role in female fertility – both quality and quantity of eggs decrease as women age – infertility levels are on the rise as women have babies later in life.

What causes infertility?

Dr Lim Min Yu, President of the Obstetrical & Gynaecological Society of Singapore; Consultant Obstetrician and Gynaecologist with Astra Women’s & Fertility Specialists. Photo courtesy of Dr Lim Min Yu.

In addition to age, there are several other causes of infertility, says Dr Lim Min Yu, President of the Obstetrical & Gynaecological Society of Singapore; Consultant Obstetrician and Gynaecologist with Astra Women’s & Fertility Specialists.

“Medical causes of infertility include tubal disease, endometriosis, polyps, fibroids, as well as male infertility. Notably, between 40 to 50%, or nearly half of all infertility cases are due to male factor infertility, which affects up to 7% of men,” explains Dr Lim.

“Most cases of male infertility are caused by deficiencies in the semen including low sperm concentration, poor motility, or abnormally-shaped sperm.”

Although male factor infertility accounts for almost half of all infertility cases, in most Asian societies, women still bear the greater burden of infertility as male fertility issues are considered a taboo topic.

Studies show that up to 15% of Singaporean couples fail to conceive within 12 months of trying, of which 15-30% of cases are due to ‘unexplained infertility’, where the underlying medical causes for the couple’s infertility cannot be determined.

How can couples improve their odds of conceiving?

Before resorting to medical interventions, Dr Lim suggests that couples should optimise the timing of the intercourse and have more frequent intercourse with their partner.

“Couples who don’t want to rely on ovulation tests or temperature readings can visit a clinic for an ultrasound scan, which will help predict when ovulation may happen,” he says.

There are also at-home aids such as the twoplus fertility Sperm Guide, which has been designed to bring as much sperm to the cervix as possible.

The Twoplus Fertility Sperm Guide, which has been designed to bring as much sperm to the cervix as possible. Photo courtesy of Twoplus Fertility.

“The device is as easy to insert as a tampon and can be used during coitus. After intercourse, the twoplus Sperm Guide captures the ejaculate, keeping it within the vaginal tract. This allows women to continue with their day to day activities, as the device is kept within the vagina for at least an hour. As it sits in the deeper region of the vaginal tract, semen is closer to the cervix, thus increasing chances for fertilisation as they have higher chances of entering the cervix to the fallopian tubes,” explains Dr Lim.

Practising a healthy and balanced lifestyle can also help improve a couple’s odds of conceiving.

Says Dr Lim, “Quit smoking and do at least 150 minutes of moderate exercise every week. However, women should avoid overexercising as very low body fat can interfere with menstruation. Men who enjoy hot baths and saunas and cycling should also cut back on these, as regularly soaking in hot water and long-term use of lycra shorts can raise the temperature of your testicles, killing sperm cells.”

What are treatment options for infertility?

Couples who fail to conceive after 12 months of trying or are diagnosed with underlying medical conditions may be recommended fertility treatments; two of the most common being intrauterine insemination (IUI) and in vitro fertilisation (IVF).

IUI works by inserting prepared sperm directly into the uterus using a catheter, cutting down the time and distance that sperm cells must travel to the egg. While IUI is simpler and cheaper than IVF, it may not be effective for women with blocked fallopian tubes.

IVF is a much more complex and demanding procedure, both physically and financially, and typically recommended for women with blocked fallopian tubes, endometriosis, unexplained infertility as well as male infertility factors. It involves a combination of medicines and surgical procedures to help sperm fertilise an egg and implant the embryo in the woman’s uterus.

In the first 10 to 14 days of an IVF cycle, the woman has to undergo daily hormone injections, visiting the clinic every two to three days for blood tests and ultrasound scans to see if she is responding well to the hormones. About two weeks later, the egg is retrieved surgically, while under sedation.

The husband’s sperm is also collected on the same day and used to fertilise the extracted eggs in the lab. Once fertilisation occurs, the embryo(s) are transferred into the uterus using a catheter, and pregnancy tests are done about two weeks after that. If there are remaining viable embryos, they are kept frozen in the lab. The entire IVF cycle from start to finish takes at least a month, or until all frozen embryos have been utilised.

“However, it must be noted that while the chance of a successful IVF-assisted live birth is 32% in women under 35, the odds dip to 19 to 25% for women between 35 to 39 years, with percentages plummeting to only 4 to 5% after the age of 45,” adds Dr Lim.

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