So you’ve given up alcohol and caffeine, dropped the excess weight, and together with your spouse, have been burning the midnight oil. The mission: to make a baby. It’s been months of hard – albeit enjoyable! – work but the pee stick is still showing a negative. What’s wrong? Are you infertile?

First, take heart. You are not alone. Worldwide statistics indicate that in general, one in seven couples suffer from infertility. Infertility refers to the inability to conceive after 12 months of trying if the female is less than 35 years, or six months of trying if the female is over 35 years.

In Singapore there may also be the problem of ‘lack’ of trying, quipped Dr Kelly Loi, an Obstetrician and Gynaecologist with the Health & Fertility Centre for Women at Paragon.


Here, the total fertility rate (TFR) – which measures the average number of children that a woman would bear in her lifetime – has fallen to an all-time low of 1.16. This is way below the replacement level of 2.1.

Unfortunately, this state of affairs is one seen in many developed countries. “As the population becomes more educated, there is a change of values and priorities. Career achievements and lifestyle desires take precedence over other issues. Starting a family takes a backseat and having children is seen as a sacrifice,” explained Dr Loi.

Then there’s the question of fertility.

Fertility problems may arise due to problems in either the female or male reproductive systems, or sometimes in both. One third of cases may be attributed to the male, another third to the female. Female infertility reasons can broadly be divided into:

1) ovulation disorders, like those caused by polycystic ovaries or increasing age

2) endometriosis, and

3) tubal disease

In secondary infertility where a woman managed to conceive previously, it is possible that she had an underlying health problem when she conceived before, but was fortunately not affected then.

Tubal disease can occur as a result of infections or previous surgery resulting in adhesions and damage to the fallopian tubes. Treatments for cancer – such as chemotherapy and radiotherapy – may also damage fertility. In such cases, sperm and eggs can be frozen before treatment starts (known as fertility preservation) in order to prolong fertility.

 

Often there is a mixture of both male and female factors. “Obviously it is a sensitive issue, but the men who make it to my clinic with their wives have probably thought it through and are usually open to having fertility tests,” shared Dr Loi, who answers more questions about the state of fertility in Singapore.

We hear of more and more women having miscarriages these days. Why?

Around 15-20% of pregnancies end in a miscarriage. It is probably being reported more as couples these days plan for babies actively and know very early on that they are pregnant. So when the pregnancy fails they know they have had a miscarriage. In the past, when couples did not plan so actively, they may not have known they were pregnant and a miscarriage may have been taken as a heavier than usual period. But there may also be an increase in the number of miscarriages now because more women are delaying child bearing to an older age and we know that the risk of miscarriages increases with age.

Is youth really a factor in fertility?

It is certainly true that younger women have a better ovarian reserve i.e. better number of healthy eggs, and are less likely to have problems conceiving. But they may also encounter difficulty if they have had multiple sexual partners previously and suffered from sexually transmitted infections resulting in blocked fallopian tubes.

What are the best ways for a couple to improve their fertility and their chances of conceiving?

They should start trying for a family as soon as they are ready as age has a major impact on the success of fertility treatment. A healthy diet and lifestyle are always beneficial.

Couples should:

• Maintain a normal weight, exercise and eat a diet rich in fruits, vegetables and antioxidants
• Stop smoking – smoking impairs sperm quality and female smokers are 1.6 times more likely to be infertile
• Limit alcohol intake to two drinks per day
• Use lubricants (if they use them) which will not hinder conception

Women should:

• Limit coffee intake to one cup a day; high levels of caffeine are associated with decreased fertility and an increased risk of miscarriage
• Take folic acid to prevent certain birth defects

Men should:

• Wear loose-fitting undergarments
• Avoid extremely hot temperatures, such as hot tubs or saunas

What are the chances like for women over 35 to conceive and give birth to a healthy baby?

The likelihood of conceiving falls from 20% a month in a woman’s late 20s to 8% in the late 30s. The likelihood of conceiving in one year falls from 86% to 65% respectively. Even the success rate of artificial reproductive treatment is not spared and pregnancy rates fall with increasing age from over 40% in women less than 35 years to just 10% in women over 40 years.

Women under the age of 35 years have about a 15% chance of miscarriage while those 35-45 yrs old have a 20-35% chance of miscarriage. As the risk of foetal abnormalities increases with age, it is important for women to see an obgyn early in their pregnancy and to undergo the various antenatal screening investigations available if they wish to know their risks.

What’s your take on alternative therapies for fertility?

Stress may play a part in affecting fertility, especially if it leads to tiredness and a decreased libido. So couples should look into their own lives to find time to give their minds and bodies a respite from the stresses of daily life. If they feel more relaxed and happier, they will be healthier overall and that may certainly help them become more “productive”. So as long as the alternative therapies help reduce their stress levels, they may be beneficial in that sense.

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