You could “do it like they do on the Discovery Channel” every night and still have no baby after all that effort. What’s affecting your fertility? What can you do about it?

Even if you had the space to do IT, getting a baby out of the process is not a guarantee. Up to one in six Singaporean couples will experience difficulties when trying for a baby, and up to a third of couples will have difficulties conceiving.

And after discounting the woman’s age, says Dr Roland Chieng, medical director at Virtus Fertility Centre Singapore, male infertility is the single biggest obstacle a couple may face when they are trying to conceive. What other fertility problems do couples in Singapore face?


1. Endometriosis

“This is a common fertility issue in Singapore, affecting one in 10 women, especially women over the age of 30 who have not yet had children,” Dr Chieng explains. “It can alter the uterine environment, making it difficult for a fertilised embryo to implant. It may also affect the quality of the egg produced for fertilisation.”

How it is diagnosed: Endometriosis is diagnosed and treated via laparoscopic surgery. This is a keyhole operation where the surgeon inspects the abdominal cavity through a small incision in the navel to confirm the diagnosis. At the same time, the surgeon can remove excess endometrial tissues to restore normal pelvic anatomy.

Possible solution: You may be able to conceive naturally after this minor surgery. Treating endometriosis via laparoscopic surgery can also increase your chance of success with reproductive treatments.

(See also: Endometriosis: What You Need to Know)

2. Fibroids

“These are abnormal growths of muscular tissue in the womb that can block the fallopian tubes or stop a fertilised egg from implanting,” says Dr Seng Shay Way, a specialist in obstetrics and gynaecology at the Raffles Women’s Centre, Raffles Hospital.

How it is diagnosed: Through a pelvic ultrasound.

Possible solution: Removing the fibroids via surgery can improve fertility.

3. Polycystic Ovarian Syndrome (PCOS)

“PCOS is a hormonal condition that affects up to one in five women of reproductive age. It can make it more difficult to become pregnant naturally,” says Dr Chieng. “PCOS affects a woman’s fertility because the ovaries of women diagnosed with PCOS contain small cysts or follicles which may not produce eggs that are capable of being fertilised.”

How it is diagnosed: Through a blood test.

Possible solution: The most common treatment is ovulation induction. This stimulates ovulation and therefore increases the chance of a natural pregnancy.

(See also: PCOS and Fertility)

4. Early Menopause

“Once you have reached menopause, pregnancy is not possible. In the lead up to menopause (perimenopause), it can be very difficult to become pregnant,” says Dr Seng. “If your mother had an early menopause, your chances of having the same are much higher. It may be worth talking to a healthcare professional about your future plans for pregnancy.”

Possible solution: There is no treatment but IVF can be considered.

(See also : IVF in Singapore: Is it More Affordable Now?)

5. Low Sperm Count Or Poor Sperm Quality

“If there aren’t as many sperm as usual in the male ejaculate, the chances of a sperm fertilising an egg will be reduced,” says Dr Seng. “Poor quality sperm may be unable to reach the egg and break through the membrane to fertilise it. Your partner should wear loose underwear to make sure his testicles don’t get too hot. This could lead to lower sperm production.”

How it is diagnosed: As part of a semen analysis test.

Possible solution: Treatment will depend on the cause of the problem. And, if no cause is found, either intra uterine insemination (IUI) or IVF can help to improve chances of pregnancy.

6. Erectile Dysfunction

“If the man has trouble getting or maintaining an erection, whether for physical or psychological reasons, he’ll find it difficult to have sex,” Dr Seng explains.

How it is diagnosed: Erm it’s pretty obvious!

Possible solution: There are medications available to treat this problem effectively.

(See also: What You Need To Know about Male Fertility)

7. Fallopian Tube Problems

“A blockage in your fallopian tubes can prevent sperm from getting to the egg,” Dr Seng explains. “The most common cause of blocked fallopian tubes is a chlamydia infection that has been left untreated. Chlamydia is a common infection that is easily transmitted by unprotected sex. Your tubes could also be blocked as a result of severe endometriosis.”

How it is diagnosed: A hysterosalpingogram (HSG) is an x-ray exam in which a dye is injected through the cervix to the uterine cavity. A doctor or a radiologist then observes if the dye flows smoothly into the tubes, out to the abdominal cavity, or if there are any blockages.

Possible solution: Surgery is the best option to unblock the tubes. But if the tubes are too severely damaged, they have to be removed. You will then have to go through IVF treatments to try to conceive.

Unfortunately, there are certain instances in which there is no reason as to why a couple is unable to conceive. “Sometimes, all clinical tests will be reported as normal but after years of trying, you’re not pregnant,” says Dr Seng. “This can be very frustrating and distressing because there is nothing to focus on that can be rectified or treated.”

However there’s no need to despair. As Dr Seng assures, an estimated “one third of couples with unexplained infertility will get pregnant naturally within three years without intervention.”

5 Ways to Improve Your Chances of Conception

What can couples do to avoid or prevent these conditions and improve their chances of conception? Dr Seng advises the following lifestyle changes:

1. Reduce Alcohol

Drinking too much alcohol can affect fertility in both men and women. Clinical guidelines advise a maximum of one to two units per day for women and three to four units per day for men, whether you are trying to conceive or not.

2. Stop Smoking

Compared to non-smokers, men who smoke can have a lower sperm count and/or a higher number of abnormal sperm. In women, smoking can affect fertility and trigger early menopause. It can also increase the risk of miscarriage and early onset of labour.

3. Check your Medication

If you or your partner are taking any medication, check with your doctor that it won’t reduce your fertility. There may be alternatives available.

4. Watch your Weight

Being underweight or overweight can alter your menstrual cycle and reduce your chances of conception. Overweight men can have a lower sperm count and poor sperm quality.

Finally…

5. Don’t leave it Too Late!

“Women are born with a lifetime’s supply of eggs and the number reduces gradually with age. After 38 to 40 years of age, the rate of loss is much faster and the quality of the eggs also declines. If you are over 35 years of age, it’s a good idea to visit the doctor after six months of trying. If you’re over 40, ask the doctor for advice when you start trying to conceive. Less is known about fertility in older men but it’s thought to decline from around the age of 40 too,” Dr Seng advises.