Singapore's Infertility Crisis: Causes, Challenges, and Hopeful Solutions in 2022

Infertility, a condition affecting approximately one in six couples worldwide, has become increasingly prevalent in Singapore. As the country's fertility rate plummeted to an all-time low of 1.05 children per woman in 2022, social and economic factors have played significant roles in this downward tr. However, the issue exts beyond societal changes; it also encompasses biological challenges.

Infertility is defined as a couple's inability to conceive after at least one year of regular sexual intercourse without contraception. It's estimated that about 15 of couples face this challenge. Remarkably, both men and women contribute equally to the causes of infertility. The World Health Organization reports that approximately half of all cases are attributed to male factors, while the other half involve female factors.

Dr Judith Ong, an Associate Consultant in the Division of Reproductive ocrinology and Infertility at National University Hospital NUH, underscores the complexity involved in conception:

Reproductive success hinges on a series of steps. Firstly, eggs from one of the ovaries must be released, then journey through the fallopian tube, be fertilized by sperm to form an embryo, and finally successfully implant into the uterine lining.

The equal contribution of male and female factors underscores the importance of investigating infertility as a partnership issue.

Age plays a pivotal role in fertility. Declines are observed in both men and women. By age 40, men's sperm quality begins to deteriorate significantly, while for women, peak reproductive years occur during their late twenties and early thirties.

To optimize fertility, Dr Ong recomms several general measures:

• Supplementation with folic acid by the woman

• Regular physical activity

• Mntning a healthy body mass index BMI under 25

• A balanced diet

• Quitting smoking and limiting alcohol consumption to one or two units weekly

Couples facing infertility often seek medical intervention. Several treatment options are avlable deping on the underlying causes:

1. Assisted Reproductive Technology - This encompasses methods such as Intrauterine Insemination IUI or artificial insemination, which involves collecting and processing sperm before placing it into a woman's uterus during ovulation.

2. In Vitro Fertilization IVF - This more invasive procedure involves stimulating the ovaries with hormones to produce eggs, then retrieving them through surgery on a day in clinic setting. The retrieved eggs are fertilized in vitro using the husband's sperm and ing embryo is implanted into the uterine lining.

The causes of infertility can be diverse:

• Age: Fertility declines after age 40 for men and after age 35 for women.

• Hormonal Imbalances: Issues with brn signaling to reproductive organs

• Sperm Production: Genetic or acquired abnormalities affecting male sperm production

• Obstructed Sperm Passage: Problems with ejaculatory or urinary tracts in males, and blockages of fallopian tubes in females.

In cases where fertility is not restored through traditional methods:

3. Experimental Gene Therapy - Under investigation at NUH, this cutting-edge technique involves the introduction of new genes into an embryo to correct genetic defects before birth. This offers hope for treating otherwise incurable diseases in unborn babies.

Couples who have exhausted conventional treatment options can explore gene therapy as a potential solution, seeking guidance from Dr Judith Ong and her team.

The Reproductive ocrinology Infertility Division at NUH Women's Centre provides comprehensive fertility assessments and various forms of assisted reproductive technology. With the growing scientific advancements like experimental gene therapy, hope for parenthood remns alive even in the face of infertility challenges.

Please download the full infographic here for further reading and discussion points.

References:

• National University Health System: Hope for Infertility: New Frontiers and Innovative Solutions

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