Comprehensive Guide to Infertility

Infertility is a complex medical condition defined as the inability to achieve pregnancy after 12 months of regular, unprotected sexual intercourse or after six months for women over 35 years old. It affects approximately 15% of couples in Singapore, and continues to be an increasing problem due to the trend of couples delaying marriage and childbearing.

What Are the Types of Infertility?

Infertility can be categorised into two main types: primary and secondary infertility.

Primary Infertility

Primary infertility refers to a situation where a couple has never been able to conceive despite having regular, unprotected intercourse for at least a year. This type of infertility indicates that the couple has not experienced a previous pregnancy, and the underlying causes may include issues with ovulation, sperm quality, fallopian tube function, or other reproductive health concerns.

Secondary Infertility

Secondary infertility occurs when a couple who has previously conceived and had a child is now unable to achieve pregnancy again after a year of trying. This can be due to factors such as age-related fertility decline, complications from previous pregnancies, or new health issues affecting either partner’s reproductive system.

Signs and Symptoms of Infertility in Men

Common symptoms of infertility in men include:

• Testicular Pain and Swelling: Persistent discomfort or swelling may indicate infections or varicocele, conditions that impact sperm quality and fertility.
• Inability to Maintain an Erection: Erectile dysfunction can prevent successful intercourse, which hinders the chances of conception.
• Ejaculation Problems: Issues such as retrograde ejaculation or premature ejaculation can prevent sperm from reaching the egg, impacting fertility.
• Small, Firm Testicles: This could be a sign of conditions like Klinefelter syndrome or other testicular issues that affect sperm production.

Signs and Symptoms of Infertility in Women

Common symptoms of infertility in women include:

• Painful, Irregular, or Absent Periods: These menstrual issues may suggest underlying conditions like polycystic ovary syndrome (PCOS) or thyroid disorders that interfere with ovulation.
• Hormonal Fluctuations: Symptoms such as excessive hair growth and severe adult acne might indicate hormonal imbalances that can negatively affect fertility.
• Sexual Dysfunction: Problems with arousal or painful intercourse can make conceiving challenging, and may be related to certain gynaecological conditions.

Common Causes of Infertility

Infertility can affect both men and women almost equally. Here are possible causes of male and female factor infertility:

Female Infertility

• Ovulation Disorder: Ovulation disorders are one of the most common causes of infertility in women. Conditions such as polycystic ovary syndrome (PCOS) or hormonal imbalances can affect the release of eggs.
• Fallopian Tube Obstruction: Blocked or damaged fallopian tubes can prevent sperm from reaching the egg or stop a fertilised egg from reaching the uterus. This is often caused by pelvic inflammatory disease or prior surgeries.
• Uterine or Cervical Abnormalities: Conditions such as fibroids, polyps, or structural abnormalities in the uterus or cervix can make it difficult for a fertilised egg to implant or for sperm to travel through the cervix.
• Ageing: Women's fertility peaks in their late teens to late 20s, but begins to decline around age 30, with a more significant drop in the mid-30s. By age 45, natural conception becomes highly unlikely due to a diminished number of viable eggs.

Male Infertility

• Low Sperm Count: A low sperm concentration in semen can reduce the likelihood of fertilising an egg. Genetic factors, hormonal imbalances, or lifestyle choices can cause low sperm count.
• Reduced Sperm Motility: Even if the sperm count is normal, poor sperm motility (the ability of sperm to move optimally) can prevent the sperm from reaching and fertilising the egg.
• Impaired Sperm Quality: The shape and function of sperm are critical for fertility. Abnormally shaped or damaged sperm are less likely to fertilise an egg successfully.
• Certain Environmental Factors: Exposure to toxins, such as heavy metals, radiation, or heat (e.g., frequent use of hot tubs or saunas), can affect sperm production and quality.
• Ageing: Male fertility declines with age, though less dramatically than in women. Studies show men over 40 have a lower probability of conception compared to younger men due to reduced testosterone and increased DNA fragmentation in sperm. Sperm quantity and quality gradually decrease after age 35, with significant changes after age 45.

How Is Infertility Diagnosed?

Infertility screening involves a series of tests and evaluations to diagnose infertility in both men and women. These tests help identify underlying causes and guide treatment options.

For women, common diagnostic tests include ovulation testing, hormone level assessments, and imaging like ultrasounds or hysterosalpingography to check the fallopian tubes and uterus. On the other hand, men may undergo semen analysis, hormone testing, and imaging to evaluate sperm health and the reproductive organs.

Infertility Treatments

Infertility treatment options include a range of approaches tailored to individual needs. Common treatments include in vitro fertilisation (IVF), superovulation intrauterine insemination (SOIUI), and egg freezing, which are designed to address different fertility challenges. A fertility specialist can provide personalised guidance and recommend the most appropriate treatment option based on your specific needs.

Infertility is a complex issue that affects many couples in Singapore and around the world. It is essential to seek medical guidance as early as possible when facing difficulties conceiving.

If you are dealing with infertility issues, GynaeMD Women's and Rejuvenation Clinic is here to provide tailored solutions for your unique needs. Led by Dr Christopher Ng, our clinic offers a range of fertility services, from initial assessments to advanced treatments like IVF and SOIUI.