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Whether it is things to know before trying to conceive, about fertility treatments or if certain conditions would affect your fertility, this article is for you!

We invited doctors from KK Women’s and Children’s Hospital (KKH) and Singapore General Hospital (SGH) to answer these commonly asked questions from the public.

 

Here are 8 things to know before trying to conceive:

1. Is there a better time of the day to have intercourse to conceive?

Dr Chua Ka-Hee, Consultant in the department of Reproductive Medicine in KKH says anytime is good! There is no difference in terms of chances of conception between having intercourse during daytime or night time.

 

2. How soon after birth, can you try for another baby?

“It depends on the mode of delivery”, shares Dr Andy Tan Wei Keat, Consultant in the department of O&G in SGH. “If your previous baby was delivered by caesarean (C- section), you are advised to wait for 12 months; If delivered by Natural Vaginal Delivery (NVD), based on the couple’s desire, I suggest a six-month interval to encourage breast feeding.”

 

3. How soon after removing a fallopian tube due to an ectopic pregnancy, can you try to conceive again?

Dr Chua advises patients who’ve had an ectopic pregnancy surgery, to try and conceive again in about two to three months, provided they have been reviewed by their doctor and given the all-clear.

 

4. Any food/ supplements to improve sperm quantity and quality?

“Supplements which may improve sperm quality include L-carnitine, coenzyme Q10, zinc, selenium and antioxidants. They are found naturally in food such as leafy vegetables, nuts and fatty fish. Having a healthy lifestyle is just as, if not more important, than eating specific foods. Try to abstain from unhealthy habits such as smoking or taking excessive alcohol. Try to get sufficient sleep and exercise.” shares Dr Chua.

 

5. When should you realistically start to worry about infertility?

Dr Chua advises couples to consult a fertility doctor if the couple is younger than 35 years of age and has not conceived after one year of trying. Patients older than 35 years of age have a sharper decline in their fertility, so they should see a doctor if they have not conceived after trying to conceive for six months.

 

6. How soon should you take a pregnancy test for the most accurate results?

Dr Tan says, if one misses her period for about one to two weeks, she should consider having a Urine pregnancy test (UPT).

 

7. Advice for couples with repeated miscarriages

“Most miscarriages are due to genetic abnormalities in the baby, and not due to what the parents did or did not do”, shares Dr Chua. “After two or three miscarriages, further investigations can be conducted to look for rare conditions in the parents which may contribute to the repeated miscarriages.”

 

8. Hospital waiting time during the current safety measures.

According to Dr Lily Kho, Consultant in the department of O&G in KKH, “The waiting time for an antenatal visit at KK Women's and Children's Hospital (KKH), is not affected by safety measures.

As with most places in Singapore currently, when patients visit KKH, they would also need to undergo safety measures as such temperature screening, safe entry check-in, etc, before they can enter a premise. Therefore, patients should try to buffer some time to undergo these measures. Please visit www.kkh.com.sg/visitorregistration for more information about KKH’s visitation policy and safety measures.”

 

 

Here are 5 things to know about Fertility Treatments

1. What is the percentage of couples with unexplained infertility, successfully conceiving through Assisted Conception Procedures (ACP)?

According to Dr Chua, couples with unexplained fertility have a good chance of success as they do not have any major fertility problem. The other major determinant of success is the age of the wife, therefore younger women will have higher success rate of conception through ACP.

 

2. Are there any supplements to increase the chances of conceiving through ACP?

Dr Chua shares, “The most important supplement for women is folic acid. Other supplements, e.g. coenzyme Q10, calcium, vitamin E, do not have strong evidence that they are beneficial, but there is no harm taking them if patients wish to do so.”

 

3. What is the duration for an IVF treatment cycle?

“The antagonist cycle is the most common type of IVF cycle, because it is patient-friendly without compromising on pregnancy outcomes. The typical antagonist cycle takes about 10 – 14 days from the start of injections to the egg collection, mirroring the hormonal changes in a natural ovulatory cycle,” shares Dr Serene Lim Liqing, Consultant in the department of O&G in SGH.

Dr Lim adds, “Sometimes your IVF doctor may prefer to use the long cycle. This takes about four weeks from the start of injections to the egg collection.”

 

4. Can a woman go for vigorous exercises before a frozen transfer?

Dr Lim shares, “Research in women undergoing a fresh IVF cycle found that exercising for more than four hours a week was associated with higher chances of implantation failure or pregnancy loss, and lower chance of a live birth. There are also concerns that excessive jerking movements during certain types of exercise can precipitate torsion (i.e twisting) of enlarged stimulated ovaries during IVF which can cut off their blood supply and put them at risk. Overexertion of the arms and legs can also take away blood from the ovaries and uterus.

On the other hand, bedrest after an embryo transfer did not lead to better pregnancy outcomes and may reduce pregnancy chances by affecting blood flow to the uterus. It may also lead to an increased risk of deep vein thrombosis.

Not much research has been performed to guide recommendations for exercise during a frozen transfer cycle. But extrapolating from the above data, it may be advisable to avoid excessive exercise before a frozen embryo transfer. Too much exercise can also interfere with the reproductive hormones and lead to ovulatory dysfunction. It is best to stay active during an embryo transfer cycle by doing light to moderate exercise (e.g walking, yoga/ pilates, low- intensity swimming), two to three times a week, up to 30 minutes each session. Exercise can alleviate stress during your frozen transfer cycle, and avoid excessive weight gain and reduce complications when you eventually get pregnant.”

 

5. Any advice for a wife with PCOS and fibroid, while her husband has azoospermia?

“The most important factor, in this case, is lack of sperm. If azoospermia is confirmed on two semen samples, the husband would have to go for surgery to retrieve sperm. Subsequently, the wife has to undergo in-vitro fertilisation (IVF) using the surgically-retrieved sperm. Wife’s fibroid may also need to be removed surgically depending on the size and location,” advises Dr Chua.

 

 

Will these 5 conditions affect fertility?

1. Does keyhole surgery for ovarian cyst affect egg count?

Dr Lim shares, “Surgery for ovarian cysts can reduce the egg count and the number of eggs retrieved from the operated ovary during the IVF. The decision to operate on an ovarian cyst in a woman who is trying to conceive depends on multiple factors, including the size of the cyst, whether the cyst is causing symptoms, potential for the cyst to cause complications such as ovarian torsion (i.e twisting) and rupture, degree of suspicion of cancer, previous ovarian surgery, the woman’s age and baseline ovarian reserve (i.e egg count), whether presence of the cyst may affect egg retrieval during IVF, and presence of male infertility factors.”

 

2. How does Thyroid level affect fertility?

“An underactive thyroid (hypothyroidism) can interfere with ovulation and lead to increased risk of miscarriage and preterm birth,” shares Dr Lim.

Dr Lim adds, “An overactive thyroid (hyperthyroidism) is associated with an increased risk of miscarriage, as well as pregnancy complications such as preterm birth, pre-eclampsia and growth restriction in the baby.

The presence of thyroid antibodies indicates an immune imbalance which is associated with failed implantation and pregnancy loss. The mechanism linking thyroid autoimmunity and reduced pregnancy success is uncertain.”

 

3. Does being underweight affect fertility?

Dr Lim says, “Being underweight can affect ovulation and cause irregular periods.”

 

4. Are your chances of ovulation reduced if one of your ovaries is smaller than the other?

Dr Tan says, your chances are not reduced if your period is regular monthly.

 

5. Does varicocele affect fertility?

According to Dr Chua, the relationship between varicocele and low sperm count is not straightforward. He also added, “Yes, large varicoceles may reduce the quality and quantity of sperm. However, surgery to remove the varicocele may not necessarily improve sperm count.”

 

I Love Children thank Dr Chua Ka-Hee and Dr Lily Kho from KK Women’s and Children’s Hospital and, Dr Serene Lim Liqing and Dr Andy Tan Wei Keat from Singapore General Hospital for their valuable input.

If you would like to hear them in action, catch the video highlights of the Know Your Fertility Wellness Campaign, featuring these four doctors here!

If you are trying to conceive and would like to join a fertility support group, consider I Love Children’s Fertility Support Group Singapore on Facebook for the much-needed peer support.

 

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