Know Your Fertility Wellness
Many of us are familiar with the importance of regular health screenings for our physical well-being. The same, however, cannot be said for our fertility wellness even though they are crucial in determining our family planning journey.
To help shed some light on the purpose and benefits of fertility health checks, we sat down with Dr Steven Teo, an Obstetrician, Gynaecologist and IVF-accredited doctor from Thomson Fertility Centre. Prior to this appointment, Dr Teo practiced at KK Women's and Children's Hospital (KKH) for over 10 years.
He specialises in advance laparoscopy to complement fertility treatment, looks after pregnant mothers and manages common gynaecological conditions such as fibroids, endometriosis and menstrual disorders.
What is a fertility health check?
A fertility health check is a specific type of health screening program that couples can enroll in, to determine if they are affected by any conditions that might impede on their chances of a natural conception. It encompasses three main parts. The first is an interview with both the husband and wife focusing on their medical histories. This is to check if there are any known or suspected factors that might affect their fertility. For the discerning specialist, these interviews alone can flag out majority of common fertility issues in couples.
Second is a thorough pelvic examination, inclusive of an ultrasound scan. Third is a panel of lab tests assaying the female's hormonal profile and the male's semen analysis. Together with the interviews, these detailed analyses will allow couples to have a snapshot of their current reproductive potential. If there are any causes of concern, fertility treatment options will also be discussed.
Why should couples go for a fertility health check?
While it may be considered as a health screening program for those intending to conceive, the specialised fertility checks can provide these couples with an idea of their fertility potential at the point in time.
The checks can be diagnostic of fertility concerns and provide more comprehensive details and treatment options. This is especially relevant for couples who have existing medical conditions and would like to find out if their conditions have any impact of their fertility potentials. Examples of such medical concerns would be excessive menstrual cramps, pelvic pain and irregular menstrual cycles.
Who should go for a fertility health check?
Couples who are intending to conceive or if they have been trying for six to 12 months and are unsuccessful can choose to go for the fertility health check.
Of late, Dr Teo has seen a rise in the trend of couples coming in for a pre-marital health screening programme that includes a fertility check. This is a justifiable trend as such fertility health checks are non-invasive tests, yet can help couples with their family planning. For example, couples may get results that lead them to not delay having children. Fertility health checks are also beneficial for women above of age 35 years and trying to conceive.
Last but not least, women with symptoms suggestive of reproductive conditions, such as pelvic cramps, painful periods or irregular cycles, should be screened too.
Where can couples do a fertility health check?
Ideally, couples can visit a gynaecologist in a clinic or hospital. There are affordable packages available. Fertility checks should be done by gynaecologists who have the expertise and skill set to perform targeted examination and tests which aims to identify any medical issues that might cause couples fertility issues. Thus the saying if you are not looking for it, you probably won’t see it.
At I Love Children’s “Know Your FERTILTY WELLNESS” campaign lunchtime talks at Chevron House, 2 June 2016, Dr. Steven Teo, IVF Clinician of Thomson Fertility Centre, answered many fertility-related questions.
1) What if my wife is not comfortable with going for a fertility health check?
Fertility health checks should be conducted with both spouses present. However, the female plays a bigger role. The nature of fertility problems can be grouped into five main categories – the egg, fallopian tube, womb, pelvis and sperm (majority belong to the female).
2) What if my husband is not comfortable with going for a fertility health check?
The harsh truth is that having a normal semen count is a rarity nowadays at fertility centres. Most semen samples analysed have at least mild defects. Hence, again, it is important for both spouses to be present for a fertility health check.
3) How much does a fertility health check cost? Is it cheaper to get a referral from a polyclinic?
The fertility health check package ranges from fertility clinics to hospitals. You need to check with your doctor for the prices. These packages are not subsidised even with a referral from a polyclinic or if you walk in as a private patient. It also cannot be paid through Medisave.
4) How long do couples have to wait before they can get their results for the fertility health check?
For most cases (80 -90% of the time), couples will have an idea of if there are any serious medical problems that could impact their fertility at the end of a 30-minute consultation. However, with the hormonal assays, depending on the time of your period which you turn up for the assessment, it may be a 2 to 4-week wait before you get your results. The results of a semen analysis will be available within a week.
5) Is it necessary for men to provide the semen sample on-site? Or can it be done at home?
The ideal situation is for men to produce the semen sample on-site as all fertility facilities would have private rooms for this procedure. However, men can also choose to produce it at home and bring it to the centre for processing within one hour. Do bear in mind that the sample must be handed in personally and is extremely time sensitive – the one-hour time window is crucial.
6) Are there any food or drink restrictions for men to take note of before providing the semen sample?
There are no food or drink restrictions. However, sperm production is an ongoing process so if it is used up before the provision of the sample, the sample will be less in terms of quantity. It is thus recommended that men ejaculate three days before giving a sample and then go to the centre to give a fresh sample on the day itself.
7) What can be done for men to have a healthy sperm count?
The general health tips include having a healthy lifestyle, avoiding smoking and excessive alcohol consumption. For men who are taking medication, it will be wise to discuss with the specialist to determine if these medications can have an impact on sperm quantity. Additionally, prolonged, daily exposure to heat can also impair the quality of sperms. There is a good reason why the testicles are located outside of the male body. Sperm production requires a slightly lower than the core body temperature to be at its optimum.
8) Are there any tips on increasing the sperm count in men over 35 years of age?
Unfortunately, when you have an undesirable sperm analysis, it is quite difficult to reverse it. Most of these changes are permanent and even if it is reversed, it tends to fluctuate in terms of quality and quantity. There are some supplements and hormonal therapy that might benefit some individuals. This has to be explored with a fertility specialist to determine if one is suitable to attempt such treatment.
9) Is there specific food for men to eat to increase their sperm count?
Certain medication can increase the hormone stimulation for sperm production but these are prescriptive medication. In terms of supplements, there are many available, but none is proven superior to the rest for all patients to increase pregnancy rates.
10) When is the best time for women to do the hormonal assays?
Hormonal assays are dependent on the timing of the woman’s menstrual cycle because they are time sensitive blood tests. Generally, the hormonal assays are split into two batches. The first test will be done on the second or third day of the menstrual cycle and the second test will be done in the later half of the period –around day 21 or 23 depending on the menstrual cycle.
For females who do not get regular periods or have long menstrual cycles; meaning they get their menstrual cycles once every couple of months, the second blood test can be foregone. This is because the second blood test is to test for ovulation and if you are not regularly getting your period, then that itself is a sign that you are not ovulating regularly.
11) Are there any food or drink restrictions for women to take note of before going for the hormonal assays?
There are no food or drink restrictions. However, women should stop taking any hormonal medication such as contraceptive pills prior to going for the hormonal assays because such medication will affect the results.
12) What is the difference between fertility health checks and pre-pregnancy checks?
Pre-pregnancy checks essentially only determine if the female is fit enough to carry the pregnancy to full term. Fertility health checks up however, check for fertility-related issues as well as the female’s ability to carry a pregnancy to full term.
13) When is it considered a dangerous age range for a couple to have a baby?
As a woman ages beyond 35 years old, the risk of her eggs being abnormal starts to increase rapidly. In fact, if you conceive after the age of 45, there is statistically, a 1 in 2 to 3 chance of having a failed pregnancy.
14) What are the chances of conceiving a healthy baby at the ages of 30-34 for women?
Your chances are still good depending on your health profile. Generally, your chances are better the younger you are. Of course, this should be balanced against the readiness of the couple to start a family.
15) When is the best time to have intercourse?
If you trying to conceive and you are naturally ovulating, the first week of your period from the day you start and the last week of your period are the least fertile periods. So it’s best to have intercourse every 2 to 3 days in the second and third weeks of your period.
16) How long should a woman wait for after suffering a miscarriage to try conceiving again?
There are no exact restrictions to this. But we usually advise women to only start trying to conceive after the second or third menstrual cycle following the miscarriage, depending on the circumstances surrounding the miscarriage. This is so that the body and the mind are ready to take on another pregnancy.
17) What are the reasons for a healthy couple trying to conceive during their fertile time but not being successful?
Statistically, a young, healthy couple has an average of 20% chance of a pregnancy every month that they try (i.e. 80% chance of failure every month). This, however, does not mean there is a problem, unless you remain unsuccessful after six to 12 months.
18) Why is there only a 20% chance of conceiving each month?
This may be nature’s way of allowing population growth. Women may not ovulate every month even if they have regular menstrual cycles. And not every sperm that a man produces is normal. Additionally, there is a very high attrition rate from when the sperm is deposited in the cervix all the way until it reaches the egg. Furthermore, you will only conceive when your body is ready. For instance, if you have had recent stressful illnesses or life events, your body may not be ready to conceive.
19) Does getting my menstrual cycle regularly mean I am ovulating normally?
Ovulation does lead to regular menstrual cycles. However, getting your menstrual cycles regularly does not necessarily mean you are ovulating. For example, if a woman is taking contraceptive pills, she will have regular periods but she will not be ovulating.
20) Does a miscarriage mean it will be more difficult to conceive later on?
Having one miscarriage does not mean that your chances of successful future pregnancies are reduced. In fact, statistically, about 10% to 20% of all pregnancies end up in failure. However, if you have had two or three miscarriages consecutively, there might be a problem with your body rejecting the pregnancy and you should consult with your gynaecologist.
21) Why do women have fibroids?
Fibroids are very common benign tumours. They grow from the muscle wall of the womb. Most of these fibroids do not cause problems. It is only a problem if the fibroids grow bigger (rapidly) or are located in specific areas like within the womb cavity. Common symptoms related to fibroids include heavy menstrual bleeding, pain and possibly miscarriage or infertility.
22) Following a fertility health check-up and successful conception, how long should a couple wait before going for another one?
After a successful pregnancy, couples who have had no major issues picked up at their first fertility health screen can try to conceive naturally and should allow themselves a year to do so. However, if there were medical issues picked up at the first fertility health screen, they should follow up with their Gynaecologist when they are ready to start trying for the second pregnancy.
I Love Children thank Dr Steven Teo, for his valuable input.
Sign up by June 2016 to receive a fertility health check or click here to sign up for free fertility-related lunchtime talks at HarbourFront Centre between 15 to 17 June 2016!