Infertility

Infertility refers to difficulty conceiving despite regular sexual intercourse without using birth control. 80 out of 100 couples conceive within a year of trying, and 92 out of 100 within 2 years of trying. 

Although there is no definite cut off, the general recommendation is that if you are younger than 35 years old and have been trying for a year, or if you are 35 years and older and have been trying for 6 months – it is time to seek help from a gynaecologist. 

If you know that you have certain risk factors that can result in you having a higher chance of having fertility issues, you should seek help earlier. Infertility treatment are common in Singapore.

• Age: this is the single largest determinant of fertility; the older you are, the sharper the decline in fertility
• Polycystic ovary syndrome (PCOS)
• Body mass index (BMI) too low or too high
• Intense exercise 
• Medical issues e.g. diabetes, kidney disease etc 
• Premature ovarian insufficiency (previously known as premature menopause)
• Endometriosis
• Pelvic inflammatory disease: may cause scarring, hydrosalpinx etc 
• Uterine fibroids: in certain locations 
• Endometrial polyps

• Undescended testes
• Testicular tumours 
• Current or previous infections e.g. sexually transmitted infections (STIs), mumps
• Varicocele
• Previous surgeries e.g. to testes, inguinal hernia repair etc
• Genetic conditions that affect sperm development e.g. Klinefelter’s syndrome 
• Medications, previous chemotherapy, steroids for bodybuilding
• Lifestyle factors: being overweight, smoking

• Ultrasound scan: to check for uterus and ovarian abnormalities
• Vaginal swabs: to check for sexually transmitted infections (STIs)
• Blood tests: to check your ovarian reserve, blood count, thalassemia, communicable diseases e.g. Hepatitis B/syphilis/HIV, immunity to chickenpox/rubella (to see if you require pre-pregnancy vaccinations)
• Hysterosalpingogram: check the patency of your fallopian tubes 
• Pap smear/HPV test: if it is not up-to-date

• Semen analysis: to check for sperm count, motility and morphology

It depends on the cause. 

As a broad overview, there are varying degrees of assisted reproductive techniques:

• Timed sex according to ovulation
• Ovulation induction and timed sex 
• Artificial insemination (Intrauterine insemination, or IUI)
• In-vitro fertilisation (IVF)

Depending on the results of your investigations, your gynaecologist will discuss the infertility treatment options that are suitable for you.