I find myself asking this question all the time now as a 30 year old newly-wed. I foresee children in my near future and my husband and I openly talk about this topic, but it often boils down to the million-dollar question:
Now, or Later?
The recent MaybeBaby – Now or Later? Hi-tea chat session at Novotel Singapore Clarke Quay on 25 October left me realising that I have been asking the wrong question all this while.
There is so much more to question than simply, “Am I ready now??” (to which, the reply is either a ‘Yes’ or ‘No’, or ‘I don’t want to think about it’ – which means, “let’s postpone this topic to later”). To be honest, there are even more fundamental assumptions to question, albeit slightly uncomfortable reality-shaking ones. Even before “Am I ready”, are the questions:
1. “Can I?” or “Can he?”
Dr. Peter Chew, chairman of aLife and senior consultant obstetrician and gynaecologist with Gleneagles Hospital enlightened the 160 couples with facts regarding fertility, driving home the point that preparing for a child takes mental and physical preparation and time.
His lively and humorous presentation made us wish we took biology classes more seriously back in school where we learnt WHAT our reproduction organs do. He candidly addressed HOW they work, crucial elements that would ensure a successful fertilisation process, and the likely infertility issues a couple might face.
With one in 5 married couples affected by fertility issues, education on what it takes to be able to conceive is half the battle won. Some couples start a little too late, and are disappointed when they realise they cannot conceive when they are finally ready to want a child.
This was an important lesson Diana Ser, celebrity host and mum, experienced and shared with the audience. Taking her colleague Pan Ling Ling’s advice to “try now!”, she soon found out that she experienced difficulties in conceiving her first child. She went through with her doctor all available options – various fertility treatments – even considering adoption, to become a mother.
Profoundly put, Diana shared that “having a child is the most humbling experience in my life. We think, in our work and life that we’re big shots, but when you can’t have your first child, it makes you wonder, Who am I?” She now has three beautiful children, and recalled the moment she found out she was pregnant with her first, “It was quite dramatic. I found myself on my knees crying!” Taking care of her health helped her conceive number two and three more easily.
Because of the narrow fertilisation period, Dr. Peter Chew explained it was important the couple stayed healthy, happy and relaxed.
Intimacy and/or medical problems would be the typical causes of infertility. For maximising baby-making, he recommended:
- Banishing laptop and working devices from the bedroom
- Increasing sensual activities like massages, cuddling and relaxing
- Not leaving baby-making to the very last thing in the day (who’s still has the energy?!)
- Reducing alcohol (which shrinks the testes by 50%)
- Swimming (for men) instead of running or biking; wearing boxer shorts and importantly, not placing laptops on your lap! (Keep it cool, guys!)
- Doing the Fertility Index online (Are you in the green or red zone?)
Evidently, preparing to have a baby is a process and a build-up. While various fertility treatments are available, the truth is - after 10 years of medical technology, Assisted Reproduction Treatment (ART) fertility rates have only marginally increased.
Miracle cases exist where a couple’s emotional (and financial) strength pays off after numerous attempts through artificial means, but as the panel guest put succinctly, “Starting early saves you a lot of heartache and money; rather than doing the fertility treatment at a later age, where conception chances could be lower.”
2. “Can We?”
Then comes the cost of raising a child.
“Am I financially ready? What does financially ready look like? Can I cope emotionally with a career? Will it rock our marriage? Can we really do it?”
During the lively Q&A session, the audience anonymously directed questions to the panel. One pertinent concern raised was, “How much do I need to be ready to have children?”
According to guest panellist, Paul See, financial services director of PIAS said, “You need about $5k to $10k in your bank account for the check-ups and delivery. After which, as long as both parents can sustain themselves, they should be able to cope well. The fundamental of raising baby is managing your expectations as a parent and making some adjustment in your lifestyle. The government Baby Bonus and the available grants would help in bringing up your first child too.”
There are also other ways to save costs. Breastfeeding cuts down milk powder costs and using hand-me-down toys and clothes saves a chunk of money. Mingling with other parents reveals the many tricks and tips heavily used by others to lower costs.
Another panellist, Fred Then, entrepreneur and business coach, humorously pointed out, “It is the ego of parents that get in the way. The child does not ask for much - they usually end up playing with plastic lids and ordinary objects, oblivious to the mountain of toys (and money spent on those) piling up in the playroom.”
“The cheapest form of entertainment to your child is playtime with mum and dad,” Diana piped in with her experience of a friend who tries to make what her children want. “If they want McDonald fries, she would try to make it for them instead”, preferring to focus on spending time with them instead of spending money on them. “You can be a good parent on a fairly low budget,” Fred concluded.
3. “What happens if not Now?”
“We often wait for the stars to be aligned,” Joni Ong, president of I Love Children, echoed a familiar voice in many heads. The mother of the first IVF (In-vitro Fertilisation) identical twins in Singapore would know - she seek treatment early to conceive. Work, finance, energy, health, personal freedom would be things that some find hard to ‘give up’, but in return children seem to be able to elevate our lives to the next level.
“How you bring up your children is a reflection of you - the bad stuff and the good stuff. You see so many things about yourself that you become a better person. When you have a family, you become more motivated to work and do better. This can change the way you approach your work totally,” shared Fred. As for Diana, it transformed her relationship with her husband. “The link in my marriage now can’t be undone. That’s what parenthood did for me.”
Personal growth aside, the biology clock would continue to tick for men and women. Dr Chew reminded the audience that the optimal baby-making age for women would be between 22 to 26 and below 35 for men.
He and the other panel guests concluded the afternoon session, “Children…Now or Later? Yes, it’s Now!”
So what did some couples take-away from the Hi-tea chat?
“It’s really important to start early. It’s not really when you want children, you can have them immediately.” ~ Couple in their early 30s
“Firstly, don’t over-invest in the first child if you’re planning for the second and third! Secondly, being married doesn’t complete the family without a child.” ~ Couple in their late 30s
“The talk was enlightening and we gained a lot of medical facts from Dr Chew. After listening to the panel chat, we are now more prepared to plan for baby!” ~ Newly-wed couple in their late 20s
Questions & Answers below…
Many questions were raised during the chat session that the panel did not have the time to answer. Here are the questions and answers provided by the panellists.
1. Many people seem to consider career stability or other pursuits in their decision when planning for baby. What is your take on this?
There’s nothing wrong in pursuing your career to reach some form of financial stability. However, do bear in mind that with each passing year, the chances of natural conception per month decline for both males and females. Don’t let climbing the corporate ladder delay baby planning. You can enjoy your pregnancy and baby even while pursuing a good career. It’s about managing expectations and discussing the options with your spouse.
2. My wife and I are working.. what are the options of taking care of infant, other than getting a maid or having parents to take care for us? We are not staying with parents and our parents are too old for taking care of infants.
Infant care is an option. The other alternative is to find reliable baby-sitters through recommendations. If you are comfortable with living with one income, you can decide who could stay home for a period of time to look after baby. You can also seek out flexible work arrangements with your current employer and work out a feasible plan for both parties.
Answers provided by Mrs Joni Ong, president of I Love Children.
Fertility & Pregnancy
1. Is it possible that ovulation prediction kit (OPK) test shows negative but we may still be ovulating?
The OPK can give false positive (i.e. patient not ovulating but the test is positive) as well as false negative result.
2. Does oral sex kills sperm?
Saliva, if used as lubricant for vaginal sex, can affect the motility and viability of the sperm.
3. What is basal temperature and how do you measure it?
The basal body temperature (BBT) is your lowest body temperature in a 24-hour period. It should be taken when you wake up in the morning before getting out of bed to brush your teeth.
4. Does taking birth control pills for years and then stopping the pills when you are trying to conceive, affects fertility? How long does it take for the birth control pills to "wear off" in the body?
It does not have any bearing how long you take the pills and then stopping them immediately to try to conceive. There is no “wearing off” period. You can try for baby as soon as you are “off” the pills.
5. Should caffeine be avoided to conceive? Any advice on products like maca powder and goat weed?
Moderation is key. One to two cups a day is fine. Maca and goat weed are herbal supplements that may help improve female fertility.
6. s there medical evidence to prove the effectiveness of acupuncture and TCM for fertility? If acupuncture is good for fertility, what is the recommended frequency?
There are instances where acupuncture and TCM may boost the chances of fertility. You should see your doctor for further advice.
7. Is there a max age to try conceiving?
There is no maximum age when trying to conceive, but do bear in mind that fertility declines with age for both male and female. Try for baby earlier in life to avoid complications that come with age.
8. Will the chance of conceiving be reduced if you have inverted/ retroverted uterus?
No, retroverted womb is present in 20 % of normal females. It has no relationship to infertility.
9. With age, quality of sperm decreases. How does the quality of the sperm affect the chances of pregnancy or the health of the foetus or the baby eventually?
Sperm quality and quantity decline after 35. Depending on the age of the spouse, the chances of natural conception will decline after she passes 26 years, as the optimal age for women to conceive naturally is between 22 to 26. Miscarriages happen even in younger women. It’s the body’s natural way of aborting an unhealthy foetus.
10. What diet will help increase quality of sperm for a 40 year old?
According to the American Society for Reproductive Medicine, a healthy diet that includes plenty of fish, vegetables, and whole grains will help increase quality of sperm. A diet high in trans fats may lower the number of sperm.
11. What and when is the ovulating period? How about the case for irregular menstruation?
The ovulation period can be assessed even if the periods are irregular by:
- Basal Body temperature
- Ovulation prediction kits
- Vaginal ultrasound examination
12. For varicocoele cure, is Gleneagles the only hospital with the expert help? Which other hospital can a person go? Is masturbation good for sperm?
Any hospitals in Singapore should be able to provide help with a varicocoele condition. Masturbation does not affect sperm quality.
13. Does IPL hair removal affects fertility. Does it apply to male and/or female?
IPL hair removal does not affect male or female fertility.
14. Is pre-conception check (KK Hospital) good for trying couples?
Pre-conception checks are recommended for couples who are trying for baby. Any re-structured hospitals and private medical centres in Singapore would be able to provide this service.
15. What are the possible causes of failure in IVFs?
There are many causes of failed IVF:
- the ovary may fail to respond to the drugs;
- the egg may not be retrieved during the procedure;
- the quality of the egg retrieved may be of lower grade;
- failure of the egg to be fertilized;
- the fertililsed egg may fail to get implanted in the womb.
16. What is the recommended resting period between IVFs?
There is no hard and fast rule as to the rest period between IVFs. A three- to six-month of rest period is advised for the patient to grief over the failure, but there are women who would try again without any break.
17. Does chronic disease affect fertility?
There are many chronic diseases e.g. Diabetes, heart diseases that affect fertility. Seek medical advice and go for pre-conception checks when trying for baby.
18. My menses cycle is irregular and I'm having a hard time conceiving. My doctor told me that I may not be releasing eggs during ovulation because I'm still breastfeeding my 19month daughter. I have never heard about this. Is this true?
Breastfeeding is a “natural contraception”. However, this does not mean that you cannot get pregnant when you are nursing your child. During breastfeeding, there could be months that you may not be releasing eggs therefore, you will not be able to get pregnant.
19. Which ovulation kit is good?
All ovulation kits in the market serve its purpose of detecting the LH surge.
20. What is the advice for ladies who are currently on anti-psychotic treatment but would like to plan for pregnancy?
You should consult your doctor with regards to the safety of the drug while you are planning for your baby. It is also important to treat your existing condition. Work with your doctor for his/her advice.
21. Any tips for a baby boy? I read about the pH levels in a woman at time of fertilisation of the egg. What's it about and what is the best pH level for a boy?
Studies on sex selection of the baby based on the pH levels and the timing of ovulation have not been consistent, with some showing some correlation and others showing just the opposite.
22. How bad is second hand smoke exposure during pregnancy and is it best for the husband to quit smoking entirely?
Firstly, smoking is unhealthy for any person and its harmful effects to the mother and baby are well known. Second hand smoke during pregnancy can affect the baby's physical and mental development just as well.
23. Will pregnant mum/ baby get sick easily when around pets?
Being around domestic pets when pregnant does not cause any harm to the mother and baby. However, be mindful of the medical condition called toxoplasmosis which is caused by the parasite toxoplasma gondii from cat feces. The parasite can caused miscarriage, stillbirth and foetal abnormalities.
24. What is the estimated price of IVF treatment?
In a private hospital*, the cost is between $15k to $20k per fresh IVF cycle.
Note: Dr Peter Chew is from private practice and his advice is based on private hospital rates.
25. What is a good estimate of the cost, during the period of pregnancy till delivery?
This varies widely as it is dependent on the fees charged by the obstetrician, paediatrician, the private hospital and the type of room the patient chooses.
Answers provided by Dr Peter Chew, chairman of aLife, a non-profit organisation promoting reproductive health and family life and board member of I Love Children. For more information, visit www.alife.org.sg or contact aLife @ 6258-8816 for the Fertihelp Programme.