A look at infertility
Let's take an in depth look at infertility...
About 15 percent of couples in Singapore do not get pregnant successfully within 12 months of trying to conceive (or TTC).
Toh Kay Lee, age 39, had been trying for a baby for almost a year and when she couldn’t conceive, she began to blame herself for being infertile. However, after both her and her husband went for a medical exam, it was determined that Kay Lee’s husband was the infertile one.
theAsianparent answers common questions about infertility.
What is infertility?
Infertility is the inability of a man or a woman to contribute to conception. It also refers to the state of a woman who miscarries while being pregnant. The common misconception of infertility is that only women can be infertile. In another one third of cases, infertility is due to the man (male factors).
How common is infertility?
Generally, worldwide, it is estimated that one in seven couples have problems conceiving, with the incidence similar in most countries independent of the level of the country’s development. In Singapore, infertility affects about 15 per cent of the population.
What are the risk factors that bring on infertility?
There are many factors that contribute to infertility, however, they differ accordingly to women and men.
- The risk factors for men are – alcohol, drugs, smoking, age, radiation or chemotherapy, health problems.
- The risk factors for women are – alcohol, drugs, smoking, age, stress, poor diet, weight problems, sexually transmitted diseases, health problems that interfere with hormonal changes and even athletic training.
Infertility in Singapore
There are three main problems causing infertility in Singapore, noted Dr Sheila Loh, consultant obstetrician and gynaecologist at Raffles Hospital. “Endometriosis, ovulation problems (this could be polycystic ovaries or hormonal imbalance) and male factors.
In endometriosis, cells that normally grow inside the uterus (womb) instead grow outside the uterus. The cause is unknown. In polycystic ovary syndrome, women have either irregular or no menstrual periods. It affects 5-10 per cent of women of reproductive age.
Causes and treatments for infertile men
There are many treatments available and the choice of treatment depends on the cause and also the individual’s level of comfort on it.
Deficiency of two hormones from the pituitary gland – luteinising hormone (LH) and follicular stimulating hormone (FSH) – can occur either congenitally or as a side effect of treatment of other disorders. Usually the patient will present with azoospermia (absence of sperm in ejaculation) and androgen deficiency. Treatment with synthetic LH and FSH readily kick-start the sperm producing function of the testes and spontaneous pregnancies are common after treatment.
Blockages of sperm transport as a result of disorder of development of the genital tract, a previous bad infection or a previous vasectomy.
This occurs in about 6 per cent of men with infertility. A bypass surgery is sometimes possible depending on the level of obstruction. Otherwise, sperm can be readily obtained by surgery for use in in-vitro fertilisation (IVF) to achieve pregnancy.
Medical therapy such as anabolic steroids and cytotoxic therapy
Sperm production usually recovers with cessation of therapy or change of medication.
The reason for the occurrence is usually not obvious. Sperm antibodies interfere with fertility by reducing sperm motility and severely affecting fertilisation. Pregnancy chances increase with therapy targeted at the sperm antibodies, however in some cases IVF is necessary for a good result.
Disorder of sexual function
This includes failure of sexual intercourse because of inadequate penile erection, failure of ejaculation, low sexual frequency and poor timing of sexual intercourse. Frequently, these conditions respond to treatment including proper counselling.
What is IVF?
In-Vitro Fertilisation (IVF) involves putting the eggs and sperm together. By natural selection, the egg will usually allow only one sperm to enter and this usually leads to the fertilisation process in the laboratory. After fertilisation, the embryos are allowed to grow for a short period of time before being placed into the uterus. A successful pregnancy can be confirmed about 2 weeks later.
Who is suitable for IVF?
IVF is the only fertility treatment for women with irreparably damaged or blocked fallopian tubes. IVF is also offered when infertile women cannot conceive with simpler methods of treatment for conditions such as endometriosis, ovulation dysfunction, unexplained infertility, sperm disorders and immunological problems.
The success rate of IVF treatment in KK Women’s and Children’s Hospital is about 30-35% per cycle and the take-home-baby rate is about 25-27%. Additional embryos frozen further enhance the pregnancy chances in many of the patients.
What is ICSI?
Intra-Cytoplasmic Sperm Injection (ICSI) involves injecting a single sperm into each egg to allow fertilisation to occur in the laboratory.
Who is suitable for ICSI ?
ICSI is recommended if the husband has poor quality sperm or if you have had difficulties with fertilisation in the past.
It is natural to feel a little bit discouraged and upset with yourself if you find out that you are infertile. However, remember that you are not alone. It also absolutely does not mean that you will never hear the sweet footsteps of children. If all else fails, adoption and foster parenting are always viable options for you to consider consider.