5 Questions about Infertility, Answered

OBGYN, Dr Christoper Ng, of GynaeMD Women’s & Rejuvenation Clinic, sheds some light on some frequently asked questions about infertility.

GynaeMD Women’s & Rejuvenation Clinic, founded by Dr Christopher Ng, integrates obstetrics, gynecology and aesthetic services to holistically cater to female health and wellness. Dr Ng and his team is dedicated to providing personalised and person-centered medical care with safety, honesty and integrity. Underscoring this mission its logo: a lotus flower. The bloom symbolises purity and is associated with good fortune, rebirth, fertility and good health.

What is infertility and how long should a couple try before seeking help?

On average, it can take up to 12 months for a young couple conceive. In most cases, about 2 in 10 couples who are trying to get pregnant successfully do so within a year. Infertility happens when a couple cannot conceive despite having regular unprotected sex for one year. At this stage, it is helpful to seek medical advice. However, couples who are older – particularly if the maternal age is above 35 – may consider seeking help after six months. This is because fertility decreases significantly in older couples and the sooner treatment is sought, the better the chance of conception.

What are the main causes of infertility?

There are many reasons for infertility and a common misconception is that infertility is mainly a ‘woman’s problem’. However, both men and women may have conditions that contribute to the inability to conceive. About 10% to 15% of couples are infertile.

Some common reasons for infertility include:

• Age: A woman’s fertility starts to decline in her late 20s and early 30s and decreases even more after age 35 years. In men, sperm health and sperm levels decrease after the age of 40.
• Chronic diseases: Thyroid disorders as well as chronic liver and kidney disease can reduce fertility because they interfere with hormone levels and disrupt ovulation. Infection from a sexually transmitted disease (STD) also may cause tubal damage and blockage.
• Excess weight: Obesity can cause hormonal imbalances. In women, this can lead to problems with ovulation. Obesity is also associated with poly-cystic ovary syndrome (PCOS), a common cause of infertility. In men, obesity is linked with low sperm count and/or poor sperm health.
• Defects of the reproductive organs: Undescended testicles, enlarged veins in the testes (varicocele), abnormalities with the opening of the cervix, polyps or fibroids in the uterus, blockages to the fallopian tube or sperm duct can all interfere with successful conception.

What can we expect from a fertility assessment?

A fertility assessment is aimed at understanding the causes for infertility. It will include a thorough physical exam, medical history and discussion about the frequency of sexual intercourse. For men, the assessment will comprise a semen analysis that determines the number, shape, movement and health of the sperm. Women will undergo a comprehensive history on menstrual function as well as pregnancy, STD and birth control use. There may be tests to monitor the ovulation cycle. Additionally, your doctor may wish to order screenings to check for tubal blockages, physical abnormalities and other issues in the reproductive organs.

What are the common treatments for infertility and how successful are they?

Treatments will depend on the type of problem identified.

• Ovulation Induction: If infertility is due to problems with ovulation, there are medications that can be used to stimulate ovulation and/or eggs to develop. Most women on this regime will begin to ovulate regularly and – barring other problems – more than half of will get pregnant within six treatment cycles.
• Surgery: If there are blockages identified, such as in the fallopian tubes or sperm ducts, surgery may be performed. Surgery also may be carried out to remove uterine growths such as polyps, fibroids and adhesions. The success of surgery depends on the type and extent of the problem.
• Assisted Reproductive Technologies: A procedure known as Superovulation Intrauterine Insemination (SOIUI) may be recommended for mild male factory infertility, mild endometriosis, and infertility due to cervical issues. It is also an option for those who have not been successful with ovulation induction. In this procedure, medications are given to the women to stimulate the growth of eggs. On insemination day, a fresh sample of the male’s semen is obtained and prepared before it is injected directly into the womb. Medications are also given to improve the chances of implantation and pregnancy. The success rates are at about 12% to 15% per cycle or 26% to 30% after three cycles.
• In Vitro Fertilization (IVF): For IVF, medication is given to stimulate the production of eggs. It is offered when there are tubal problems, severe sperm issues and when all other treatments fail. These eggs are extracted when they are mature and combined with healthy sperm. Fertilized eggs (embryos) are then transferred to the woman's uterus so they can implant. Extra embryos may be frozen and stored for later use. The overall pregnancy rate is about 30% to 35% per cycle with live birth rates at around 25% to 27% per cycle. The overall success rates vary with the cause of infertility and the age of female partner.
• Intracytoplasmic Sperm Injection (ICSI): ICSI is similar to IVF except that a single sperm is injected directly into each individual egg to increase the chances of successful fertilisation. This may be a good option if there are severe problems with the man's sperm.

How can a couple best prepare for family planning to increase the chances of conception?

The best way to increase the chances of conception is to start a family early when the couple is young. It is advisable for couples to visit their gynaecologist for preconception planning up to a year in advance. This helps determine their overall health and rules out potential risks. For example, infections such as chickenpox (varicella), German measles (rubella) and hepatitis B can be dangerous for an unborn baby. If immunisations are not complete or potential mothers are not sure if they are immune to certain infections, it is advisable to do vaccinations at least one month before they try to conceive. Routine pap smears and cervical cancer vaccination before conceiving should also be done. This check-up can also help ensure that any pre-existing conditions are well managed.

Healthy lifestyle, regular exercise, eating a well-balanced diet, consuming pre-conception vitamins along with folate and avoiding alcohol and smoking can also boost the chances of fertility.