What is infertility?
Fertility is a person's ability to conceive children. In general, when a woman is unable to get pregnant even after at least one year of unprotected sex, she is considered to have infertility issues.
How common is infertility in Singapore?
According to SingHealth’s website, around 15% of couples in Singapore face challenges conceiving within 12 months of trying for a baby. Among these cases, female infertility accounts for about 39% while male infertility contributes to 20%, and both partners are responsible for 26% of cases.
What are the main causes of infertility?
Age-related challenges:
Fertility generally declines with age, especially for women, with a notable decline in conception rates after the age of 35. Men also experience a gradual decline in fertility as they grow older.
Medical conditions:
Certain medical conditions pose challenges to fertility. Conditions such as polycystic ovary syndrome (PCOS) in women and low sperm count in men can affect reproductive capabilities. Additionally, chronic diseases, hormonal imbalances, and obesity may contribute to fertility issues.
Lifestyle factors:
Unhealthy lifestyle choices can have detrimental effects on fertility in both men and women. Poor lifestyle habits such as smoking, excessive alcohol consumption, poor dietary habits, and a sedentary lifestyle can negatively impact reproductive health.
Environmental factors:
Exposure to environmental toxins and pollutants is a contributing factor to fertility challenges. These environmental factors may include specific chemicals, radiation, and prolonged exposure to excessive heat.
When should you consult a healthcare provider?
It is recommended for couples to consult a healthcare provider regarding fertility concerns if they have been unable to conceive after one year of unprotected sexual intercourse.
However, there are exceptions to this guideline, including:
Women aged 35 or above, who have engaged in unprotected sex for six months without achieving a successful pregnancy.
Women who suspect they may have underlying issues affecting fertility, such as irregular menstrual cycles.
Individuals diagnosed with specific conditions known to reduce fertility, such as polycystic ovary syndrome (PCOS).
What are the treatments for infertility?
There are three main types of fertility treatment:
Medicines
Purpose: Stimulates the monthly release of an egg (ovulation) in women who experience irregular ovulation or are unable to ovulate.
Example: Clomifene
Surgical Procedures
Purpose: Addresses specific anatomical issues, such as blockages or endometriosis, through surgical interventions, enhancing the chances of successful conception.
Examples: Fallopian tube surgery, laparoscopic surgery for endometriosis, and surgical sperm retrieval (MESA/TESE).
Assisted Conception
Techniques: Intrauterine Insemination (IUI) and In Vitro Fertilisation (IVF)
Purpose: Involves Assisted Reproductive Technologies (ART) to facilitate conception. IUI entails the direct introduction of sperm into the uterus, while IVF combines eggs and sperm outside the body, with the fertilised embryos subsequently implanted into the uterus. These methods provide solutions for couples facing various fertility challenges.
While infertility treatment involves the above approaches to help couples conceive when facing challenges in achieving pregnancy, fertility preservation aims to safeguard reproductive capabilities for individuals facing factors that may compromise fertility.
What is fertility preservation?
Fertility preservation is the process of saving or protecting eggs, sperm, or reproductive tissue to allow individuals to have biological children in the future.
When should you consider fertility preservation?
Fertility preservation is a proactive approach to safeguard the reproductive potential of individuals who may face challenges conceiving naturally in the future. Several scenarios may warrant consideration of fertility preservation:
Medical treatments: Individuals undergoing medical treatments such as chemotherapy, radiation, or surgeries that can affect fertility should consider preservation options. as these treatments may harm the ovaries or testes, increasing the risk of infertility.
Age-related concerns: Women and men planning to delay childbearing due to career, education, or other personal reasons may consider fertility preservation, as female fertility generally declines with age, particularly after the age of 35.
Genetic conditions: Individuals with genetic conditions or a family history of early menopause, infertility, or other reproductive issues may consider fertility preservation as a proactive measure.
Gender confirmation procedures: Those undergoing gender confirmation procedures may choose fertility preservation before hormone therapy or surgeries that could impact fertility, allowing them to have biological children in the future.
Reproductive health conditions: People with certain medical conditions affecting fertility, such as polycystic ovary syndrome (PCOS) or endometriosis, may consider fertility preservation if they anticipate challenges in conceiving naturally.
Social egg freezing: Some women freeze their eggs for social reasons, such as not having a partner or delaying family planning while preserving the option to have biological children later in life.
Military deployment or high-risk occupations: Individuals in professions with a high risk of injury or those facing extended periods away from home, such as military personnel, may consider fertility preservation due to uncertainties about their future reproductive health.
What fertility-preserving options are available?
Several fertility-preserving options are available to address the unique needs of both males and females.
Fertility-preserving options for males include:
Sperm cryopreservation: Semen is frozen and stored through cryopreservation for future use.
Gonadal shielding: Shielding the testicles from radiation during cancer or other treatments, utilising modern techniques to focus radiation on specific areas while protecting the testicles with a lead shield.
Fertility-preserving options for females include:
Embryo cryopreservation (aka embryo freezing): This method is the most common and successful option for preserving a female's fertility. Eggs are harvested from the ovaries, fertilised with sperm through IVF, and resulting embryos are frozen for future use. It is important to note that social embryo freezing - the act of freezing embryos without medical indication for future use, is currently not permitted in Singapore.
Oocyte cryopreservation (aka egg freezing): Female eggs are frozen and stored for potential later use.
Egg Storage Room at Thomson Fertility Centre.
Gonadal shielding: This process is similar to gonadal shielding for males. Steps are taken, such as aiming rays at a small area or covering the pelvic area with a lead shield, to protect the ovaries from radiation.
Ovarian transposition: It is a surgical procedure in which the ovaries are moved to a different location within the pelvis. The primary goal is to protect the ovaries from the effects of radiation therapy. This procedure is commonly considered in situations where a person is undergoing pelvic radiation as part of cancer treatment.