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Know Your Fertility Wellness Campaign 2021 was held online through Zoom and live-streamed on Facebook. Two sessions were held, catch the highlights here:

Had a question that was not answered during the webinar on 12 November 2021? KK Women's and Children's Hospital fertility specialists, answer those questions in this article.

Dr Ee Tat Xin (L) and Dr Wong Keryi (R)


Questions on Male Fertility by Dr Ee Tat Xin, Consultant in the Department of Reproductive Medicine. 

1. Does premature ejaculation affect fertility, are there any cure?

Any ejaculatory disorder can impede fertility, and that includes premature ejaculation (PE). A person suffering from premature ejaculation may not be able to successfully penetrate the vagina before ejaculation, hence insufficient sperm will be deposited.  PE can be treated by medication or behavioural therapies such as the start-stop technique, squeeze technique or distraction technique.


2. Does paternal age affect chances of conceiving?

Age-dependent decreases of fertility in couples are usually attributed to female ageing, and indeed the strong female age effect, and the fact that male and female ages are correlated, makes it difficult to study male age effect on fertility.

The quality of the sperm is not as affected by a person’s age, as compared to the quality of eggs. However, there is increasing evidence to show a slight decline in sperm quality with age. Men aged older than 40 years contribute to reduced fertility and fecundity (maximum potential reproductive ability) of a couple, especially when the female partner is also of advanced age. There are also observations that sperm DNA damage is significantly higher in older men and that it is detrimental to reproductive outcomes. In addition, there may be an increased incidence of sexual dysfunction in older men.


3. Does having sex every two to three days affect sperm quality?

Having sex every two to three days is ideal. Firstly, a gap of two to three days will allow the testes, the time to refill the storage in the male reproductive system, ready for the next ejaculation. Secondly, if the sperm is stored for a longer period of time, it may lose its motility. Hence regular clearing of sperm will ensure the older sperm is eliminated and thus not affect the quality of the sperm.


4. How is testosterone deficiency syndrome treated?

Testosterone deficiency syndrome is typically seen in elderly males but may occur in younger patients too. It is a multifactorial condition for which treatment is not as simple as just replacing testosterone. The cause will need to be investigated and the treatment options will aim to treat it. Also, if fertility is desired in males with testosterone deficiency syndrome, they may undergo medication therapy, surgical retrieval of sperm, in-vitro fertilisation (IVF), or a combination of the above.


5. How do I make an appointment for a male infertility specialist in a Government hospital?

If the couple is eligible and intends to obtain subsidies from the government for treatment of infertility (male and female), they would need to go to a polyclinic to get a referral to visit any of the public hospitals offering fertility services such as KKH.

Furthermore, should their conditions call for it and if they are eligible, they can receive government co-funding for their IVF treatment in these same hospitals. If they are intending to visit a public hospital as a private patient, they can just call the appointment hotlines of these hospitals to make an appointment directly.


Questions on Female Fertility by Dr Wong Keryi, Associate Consultant in the Department of Reproductive Medicine. 

1. How does hypothyroidism affect fertility and what are the treatments available?

In females, hypothyroidism can lead to irregular cycles and hence reduce their fertility. Untreated hypothyroidism can also lead to an increased risk of miscarriages. Hypothyroidism in men has also been found to cause erectile dysfunction, low libido and abnormal sperm criteria.

Treatments usually involve medications to correct thyroid function and are usually managed by an endocrinologist.


2. How do you track ovulation with irregular menstrual cycles?

Irregular menstrual cycles are usually caused by non-ovulatory cycles; therefore, it is not possible to track ovulation. We suggest that women with irregular  menses seek further medical advice.


3. What are the fertility complications for women with a retroverted uterus? Any treatment to help with conception?

A retroverted uterus is a normal variant of a uterus position and does not have any implications to fertility. No treatment is required.


4. What can be done to ease the pain during penetration for females?

This will depend on the cause of pain during penetration, which can be due to physical or psychological causes or a combination of both. More lubrication during sexual intercourse or longer foreplay may help. However more severe pain symptoms will need assessment for more targeted therapy.


5. Can I get pregnant naturally with cysts and fibroids?

Ovarian cysts are common in women. Most ovarian cysts in women of the reproductive age group are benign and some may resolve on their own. Ovarian cysts do not cause infertility, unless in rare cases when the ovarian tumours are secreting hormones. However, if the ovarian cysts are large and/or there are concerns for cancer, we will advise that treatment be given first before the woman starts to conceive.

Very big fibroids or if they are located within the endometrial cavity may interfere with the implantation of the embryo or obstruct the fallopian tubes. Otherwise, women with fibroids can conceive naturally.


6.  Does scarring affect implantation?

Yes, intrauterine adhesions or scarring can affect implantation.


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