Fertility

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Dr. Pamela Tan, an obstetrics and gynaecology specialist from Thomson Fertility Centre was guest speaker at I Love Children’s Know Your FERTILITY WELLNESS talk, “Why Can’t I Get Pregnant?” held at the Waterway Point on 16 July 2017.

According to Dr. Tan, one in 6 couples face difficulty in conceiving as the Journey to conception is not a simple one. There are several factors that can result in couples struggling to conceive if they occur during this journey.

The key players in natural conception:

Egg
Natural conception starts with ovulation. Eggs from the ovaries must first be released. These eggs then travel down the fallopian tube which must be normal and unblocked. 
 
Sperm
Next, sufficient, normal sperm must be deposited. The sperms then swim up the fallopian tube to meet the egg that is travelling down. Upon meeting each other, fertilisation occurs and transforms the egg into an embryo.
 
Implantation
The last part of this process is for the embryo to travel into a healthy, normal uterus for implantation to occur. 
 

“Before you even try to conceive, consider a pre-conception fertility health check-up. These check-ups help to optimise a couple’s chance at natural conception by detecting medical conditions, reproductive problems and menstrual problems and correcting them early.” – Dr. Pamela Tan

 

1) Ovulation problems

Women who are not in the pink of health will most probably not ovulate well. Factors such as weight – being both underweight and overweight, excessive exercising and high stress levels hinder the body from ovulating. 

Doctor’s Tip: To know if you are ovulating, observe your menstruation cycles. If you regularly get your period every 28 days +/- a few days, chances are high that you are ovulating well.

“Don’t be too hung up over only having intercourse when you are ovulating. Trying to catch your monthly fertility window can be stressful. So just DO IT regularly two to three times a week and you will definitely catch your fertility window.” – Dr. Pamela Tan

2) Blocked fallopian tubes

Blocked fallopian tubes obstruct the sperm from meeting the egg. The most common reason behind blocked fallopian tubes is previous infections and medical conditions like endometriosis, which distort the anatomy of the tube. 

Doctor’s Tip: A hysterosalpingogram – an X-ray of the uterus and fallopian tubes can help to diagnose blocked fallopian tubes.

  

3) Conducive Uterus

The uterus’s role is crucial; if the environment in the uterus is unfavorable, implantation of the embryo will not occur.

Such unfavorable environments can be caused by medical conditions like fibroids or polyps that protrude into the body of the uterus, affecting its anatomy.

Doctor’s Tip: Go for a fertility health check to diagnose and treat unfavourable environments in the uterus early before trying to conceive.

 

4) Super Sperm

The sperm that are deposited must be of a good quality and of a sufficient amount. They must also be deposited when the woman is ovulating; when the egg has been released from the ovary and is travelling down the fallopian tube. 

 

 

Sperm Facts

By Dr. Serene Lim, Associate Consultant, Singapore General Hospital

Did you know?

  • Smoking causes genetic damage to the sperm and can subsequently increase the chances of a baby having an abnormality.
  • Despite men still being able to produce sperms when they are older, age affects the amount produced and its function. This means that the time it takes for older men to conceive with their spouses is lengthened considerably as compared to younger men.
  • More than *40 units of alcohol can result is a reduced sperm count, libido, and testosterone level as well as cause erectile dysfunction.
  • There are certain lubricants that might damage sperms. If you are intending to conceive and need a lubricant, approach your doctor or pharmacist for sperm-friendly ones.
  • Obesity can reduce sperm count and testosterone level as well as affect sperm quality.

“It takes 70 days to produce sperms. So, while men are encouraged to start eating healthy and having an overall better lifestyle, they cannot expect overnight changes. However, they will certainly see their good lifestyle choices pay off in the long term.” – Dr. Serene Tan

*40 units of alcohol is about 7 pints of beer or 14 small glasses of wine per week. 

 

Questions and Answers

1) I am 36 now and did a fertility health check-up 2 years ago.  The results were favourable but we are unable to conceive. If I plan an Intrauterine insemination (IUI) procedure, do I need to do the check again?

Yes, you do need to do the fertility health check again. This is because your fertility results from two years ago can greatly differ from your current fertility functions in terms of your ovarian reserve, egg quality and state of your fallopian tubes among other things.

 

2) What can I do to increase my fertility?

Regardless of whether you are a man or a woman, look after yourself. Adopt a heathy diet, a good lifestyle, manage your stress levels, maintain a healthy weight and exercise.

It sounds basic but these are the fundamental building blocks of good health and being in the pink of health translates to better chances of conception.  

 

3) Our fertility health check-up found no abnormalities. What are other conditions that could hinder pregnancy?

85% of couples will conceive naturally after one year of trying. If you are less than 35 years old and have been trying for more than a year without success, seek medical help. If you are above 35 years old and have been trying for 6 months without success, it is worth while seeking medical advice as it is best not to delay. 

For couples who have gone through a thorough fertility check and have unexplained subfertility, they have the options of continuing to try naturally as up to 93% of couples will eventually get pregnant after trying for two years, or proceeding to assisted reproductive technology for a more successful per cycle pregnancy rate.

 

4) What is your advice on the use of ovulation kits?

Ovulation kits are like a calendar. They help you to gain a better awareness of the time you are ovulating.

However, practice caution as ovulation kits can produce false positive rates. This means that the kit may show you a positive result when you are not ovulating.

 

5) Can I go for a foot and body massage while trying to conceive?

There is no scientific research thus far that associates massages with the inability to conceive.

 

6) If my monthly menstrual cycle is more than 30 days, does it mean I am not always ovulating?

The length of a menstrual cycle varies from person to person. What is more important is that your period intervals are regular.

 

8) If Clomid good for fertility? How long can I consume this medication?

Clomid is a tablet taken from day two to six of a woman’s period to help her ovulate. It is particularly useful for those with chronic ovulation problems like polycystic ovarian syndrome.

However, there have been some patients who are very resistance and will not ovulate with just Clomid. A progesterone blood test can check that you are ovulating on the dose of clomid prescribed. In general, 6 cycles of clomid is prescribed. If you still do not get pregnant after 6 months, you will need to discuss with your doctor on other options. 

 

9) Will a recurring UTI condition cause a reduced fertility rate?

No, it will not. However, a recurring UTI is still a significant problem and it may cause associated problems in pregnancy when you do conceive, such as pre-term labour and pre-term delivery. Do speak to your doctor about it.

 

I Love Children thanks Dr Pamela Tan, obstetrics and gynaecology specialist from Thomson Fertility Centre and Dr Serene Lim, Associate Consultant, Singapore General Hospital for their valuable input.

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