Navigating Infertility: Strategies, Solutions, and Hope in Singapore

Infertility, a common issue affecting up to 15 of couples globally and particularly prevalent in Singapore where the fertility rate has plummeted to an historic low at 1.05 children per woman in recent years. This decline is attributed largely to social factors including rising incomes, changing attitudes towards parenthood, and higher levels of education which can discourage people from starting families.

Infertility is medically defined by the World Health Organization WHO as a situation where couples are unable to conceive after one year of regular, unprotected sexual intercourse. The condition equally impacts both men and women with underlying factors contributing significantly to fertility issues.

Dr Judith Ong, an Associate Consultant at NUH's Division of Reproductive ocrinology and Infertility in the Department of Obstetrics and Gynecology, explns that achieving pregnancy is a multi-step process involving:

1. The ovaries releasing one egg from each ovary,

2. This egg travelling through the fallopian tubes,

3. Being fertilized by sperm to form an embryo,

4. And finally successfully implanting in the uterine lining.

The impact of age on fertility cannot be overstated, Dr Ong notes. As men age, particularly after 40 years old, there is a notable decrease in both the quantity and quality of their sperm production. Similarly, women experience a decline in egg numbers and quality as they reach reproductive maturity which typically occurs in their 20s.

Apart from biological factors like age, common causes for infertility include:

1. Age - Both men and women see a gradual decline in fertility post-peak reproductive years.

2. Epidemiological Factors such as lifestyle choices e.g., smoking, unhealthy diet.

3. Hormonal Imbalance in the body affecting men’s sperm production or disrupting women's ovulation process.

4. Anatomical Obstructions that can block sperm passage in males or cause issues with fallopian tubes in females.

5. Medications and Chemicals like chemotherapy, testosterone usage or steroid treatments impacting fertility.

There are several avenues couples experiencing infertility can pursue:

1. Supplementation: Folic acid intake for women, mntning a healthy BMI Body Mass Index, regular exercise, balanced diets, abstning from smoking and limiting alcohol consumption to moderate levels.

2. Thorough Medical Assessment: For men this may involve semen analysis, hormone level tests, and ultrasound imaging of testicles or scrotum; while females undergo blood tests for hormone levels, fallopian tube examinations laparoscopy, pelvic sonogram, or hysterosalpingography to assess egg health and womb lining quality.

Potential Solutions:

1. Assisted Reproductive Technologies ART: In Vitro Fertilization IVF which involves fertilizing eggs outside the body before implanting them in the uterus; Intracytoplasmic Sperm Injection ICSI, where a single sperm is injected directly into an egg, and Intrauterine Insemination IUI where sperm is introduced directly into the uterus during ovulation.

2. In Utero Gene Therapy: Experimental treatment that may offer hope for unborn babies affected by life-threatening diseases through genetic correction before birth. This innovative approach holds potential in treating conditions that are otherwise incurable, offering a future of hope to parents worldwide.

For those facing infertility challenges, the Reproductive ocrinology Infertility Division at NUH Women's Centre offers comprehensive fertility assessments and various ART options tlored to individual circumstances and needs.

In collaboration with Dr Judith Ong, Associate Consultant in Obstetrics and Gynecology at National University Hospital, highlights the journey couples face towards parenthood and the resources avlable for them.

Please visit our website for more information or to download full infographics related to fertility support.

National University Health System
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