Route to Parenthood

Boosting your chances of pregnancy

Did you know that humans are among the least fertile species on earth? For some couples, conceiving a child is relatively simple. However, that does not apply to everyone.

Conception difficulties are more common than you would imagine.

Age does play a role in the reproductive game. The ideal age for conception for women is between 22 and 26 years of age. For every year after 30 years old, the chances of conception decline by 2.5% and this drastically declines after 40 years of age.

Statisticians have estimated that the chances of conceiving are about 10% per month for a couple in their forties even if tests do not detect any abnormalities. The American Society of Reproductive
Medicine guidelines have shown that the chances of conception at age 46 are less than 1% even with In Vitro Fertilisation (IVF).

If you haven’t conceived after 12 months of trying, (or six months if you’re 35 years or more), it may be time to consider seeking medical advice. You should seek advice earlier if you are on long term
medication for a medical condition such as thyroid disorder, diabetes, depression or autoimmune disorders.

About one in ten couples experience difficulties conceiving. Fertility treatment can bring you a step closer to your dreams of having a child. There are many different treatment options available.

They include:

1. Lifestyle modification

“The most important correctable factors for fertility are weight control,
abstinence from smoking and alcohol for both husband and wife, and optimisation of the female pelvic organs through the removal of cysts, fibroids, scars (adhesions) and damaged fallopian tubes,” said Dr Sheila Loh, Specialist in Obstetrics & Gynaecology at Raffles Women Centre.

Body mass index below 18 and above 25 may be associated with ovulatory disorders in women. Obese men may also have poorer sperm mobility. If you’re a smoker, it’s time to stop. Smoking causes accelerated ageing of a woman’s eggs and if the husband also smokes, chances of conception in an IVF cycle would be significantly lower as compared to non-smokers.

2. Reproductive surgery

There are a variety of structural causes of female factor infertility that have surgical solutions. For example, reproductive surgery and diagnostic procedures can correct tubal obstruction, endometriosis, uterine fibroids, and scarring from pelvic inflammatory disease.

3. Medications to induce ovulation

Examples include Clomiphene, Metformin and Gonadotrophins. According to Dr Koh Gim Hwee,
Specialist in Obstetrics & Gynaecology at Raffles Women Centre, Clomid (Clomiphene Citrate) is the most common and most useful drug for treatment of ovulation problems in women. However, it is not useful for women who are already ovulating and when the infertility is related to other problems. Clomid is safe provided its use is monitored because some women do develop cysts after taking Clomid. “The cysts are usually benign and the result of an underlying problem of the ovary. It is not directly due to the medication itself,” Dr Koh added.

4. Artificial insemination or IUI

The purpose of the Intra Uterine Insemination (IUI) programme is to place some of the good quality sperms into the uterus at the time the wife releases her eggs. Hence, to ensure optimum chances at IUI, the woman must have a normal uterus and patent fallopian tubes. Her husband’s sperms
must also be of sufficient quality and quantity.

“Chances are also higher if she is below 37 years of age and the treatment is performed together with super-ovulation, i.e. medications to induce more than one egg,” said Dr Loh. Average success rate is about 12-15% per attempt.

5. IVF

IVF is the general term covering all the various programmes that involve the help of a scientist to fertilise the eggs in the laboratory.

A couple needs this treatment if they have blocked or damaged fallopian tubes, severe endometriosis or if the doctor suspects a fertilisation problem e.g. older women, women with fewer eggs or failed IUI treatment. This treatment is also suitable if the husband has poor sperm quality.

IVF outcome is most dependant on the egg quality. Dr Loh stressed that although IVF has a much higher success rate, at an average of 30-40% per attempt, this must be weighed against its risks - more injections, more stress, higher complication rate of multiple pregnancy and ovarian hyperstimulation syndrome (where the woman gets verybloated with water retention and in rare
situations, breathlessness). IVF is also a more lengthy and expensive treatment when compared to IUI.

IVF is used for severe infertility factors or as a last resort if simpler treatments fail. HN

 

Male Infertility

Studies have shown that male infertility is on the increase because of declining sperm quality and counts. According to Dr Fong Yan Kit, Specialist in Urology at Raffles Surgery Centre, factors that can affect sperm health include:

a. Varicocele (an abnormal enlargement of the veins in the scrotum draining the testicles) as it elevates the intrascrotal temperature
b. Drugs, smoking and alcohol
c. Previous infection of the testis and prostate
d. Exposure to strong radiation
e. Stress

Even if you are facing male fertility issues, all hope is not lost. Dr Thong Pao Wen, Specialist in
Obstetrics & Gynaecology at Raffles Women Centre, shares with us the following ways to improve their sperm quality:

a. Stop smoking
b. Take a regular supplement containing essential vitamins, minerals and anti-oxidants
c. Prevent overheating of the scrotum by avoiding tight underwear or long stays in the sauna
d. Avoid excessive pressure on the scrotum (e.g. long distance cycling).
e. Learn to relax and prevent excessive stress. Eat well and sleep well
f. Maintain a healthy weight as being over or under-weight can influence estrogen and testosterone levels
g. Stop using recreational drugs and alcohol
h. Stop using body building anabolic steroids as it can cause testicular shrinkage
i. Avoid over intensive exercise which can cause a testosterone deficiency
j. Avoid environmental hazards like radiation, pesticides, heavy metals, lead or paint