Women Infertility

One reason couples are having difficulty in conceiving is that they are starting to have their families at a later age. There is no avoiding the fact that fertility is age related.

Women (and men) in their 20s and early 30s are in their prime as far as fertility is concerned. Statistics show that after 35 years of age the fall in fertility rate is rather steep with increasing risk of chromosomal abnormalities and miscarriage. The decline in egg quality (and their husband’s sperm quality) with age is deemed the most likely cause. Babies conceived naturally during the early part of their reproductive life generally are exposed to lower risk of genetic disorders. Health problems for the younger mothers tend to be lower too.

Couples are getting married later than before and the average age for women has been pushed from mid 20s to early 30s. This seems to result in a lower fertility rate and higher risks of pregnancy related problems in women. The stresses associated with a highly urbanized society, unfortunately, work towards reducing the chances of conceiving and bearing a child.

Couples starting out late should consider embarking early on investigations, if not treatment for infertility. It is not easy to pinpoint the problem as conceiving a baby is multi-faceted. Specialists have to conduct a series of basic test to determine if there is an underlying problem. All too often there is no logical explanation for inability to conceive. Simple tests, initially ultrasound examinations and blood test, focus on detection of common conditions. Lifestyle changes may at this stage be all that is necessary.

More specialized and elaborate tests may be needed later. In general, early tests are non-invasive. As they get more elaborate, “invasive” procedures like special X-rays (hysterosalpingograms), hysteroscopy and laparoscopy may be needed.

The test-tube baby program or In Vitro Fertilization (IVF ) has taken prominence over the last decade. Despite the relatively high success rates, IVF is not the recommended first line treatment and certainly should never be viewed as a shortcut - the quickest way to getting a pregnancy. Simpler options to treat underlying problems need to consider first. Often timing of intercourse (especially with couples both holding jobs requiring regional travel) is all that is necessary. For others, treating common problems such as infections, endometriosis and minor problems of the ovary and uterus (for women) and semen problems (for the male partner) need to be looked into.

It is true that the success rate of IVF is greatly dependent on the age of the couple. While this is a good reason to recommend IVF early it should not be till common treatable problems for both parties are excluded.

In Vitro Fertilization is a process where eggs collected from the wife is fertilized by the husband’s sperm outside the body of the woman, in the test tube (or glass petri dish) in a laboratory (hence the term “in vitro”). The fertility specialist will prescribe hormonal medications to stimulate the ovaries with the aim of retrieving several good quality eggs. Sperm is placed in the same dish to fertilize the egg in IVF or in the case of Intra-cytoplasmic Sperm injection (ICSI ), a healthy looking sperm is selected and injected in each egg.

IVF is supervised strictly under the regulations of Ministry of Health Singapore. The maximum number of embryos that can be transferred is two. Only a small number of gynecologists are certified as fertility specialists and licensed to do IVF . It is prudent to check with your family doctor or the Ministry of Health if the specialist is indeed so licensed. Licensing is strict for patients as well and IVF in Singapore is only for legally married couples up to the age of 45 (for the female partner). At the moment there is no upper limit in the age of the male partner.

Apart from medical treatments, couples have to take note of their general health. They should try to reduce the stress level and adopt an optimistic mind set. They should cut down on substance abuse such as alcohol, nicotine and caffeine. Studies have shown that women who drink less are more likely to get pregnant within six months compared to those who drank more. Smoking is also harmful to women as it brings on an early menopause. They can also opt for health supplements to improve general health and subsequently reproductive health.