“The sperm and egg do not wait for weekends.”
This was shared by Dr Rajesh Hemashree, Senior Consultant, Department of Obstetrics and Gynaecology, Singapore General Hospital (SGH), at I Love Children’s (ILC) fertility wellness talk, held at Hillion Mall in September. The talk was part of ILC’s Know Your FERTILITY WELLNESS 2018 campaign.
According to Dr Hemashree, couples are encouraged to do routine tests before trying to conceive. This is to ensure that there are no obstacles preventing them from conceiving or achieving a healthy pregnancy.
Some of these checks would include blood tests for the husband and wife to check for thalassemia, immunity to rubella, ovarian reserve, tube tests to check if the wife's fallopian tubes are not blocked and a semen analysis for the husband.
What is secondary infertility?
Secondary Infertility is a terminology used when a couple tries for a second baby and nothing happens despite:
1) The couple having a child before
2) The husband having fathered a child before
3) The wife having gotten pregnant before
Why does it happen?
Secondary infertility happens for a variety of reasons. In women, cysts and fibroids, PCOS1 and block tubes are contributing factors and for men, it’s the quality and quantity of the sperm. Sometimes it is due to advancement in age, other times it is due to certain medications or lifestyle factors.
Treatment for Secondary Infertility
A gynaecologist could do the tests for the husband and wife. Once the cause is found, get it treated based on your gynaecologist’s recommendation.
Medications are available to treat low sperm count and irregular menses and if there is a blocked fallopian tube, a minor surgery can be done to correct it.
In some cases, IUI2 or IVF3 will be recommended. The duration of treatment depends on the course of treatment.
“IVF is an emotional roller-coaster for the wife as she’s the one taking the hormones,” shares Dr Ethiraj Balaji Prasath, Chief Embryologist, Thomson Fertility Centre’s IVF Lab.
“She has to inject herself once a day for two weeks. Going through the IVF process can be tormenting for both husband and wife,” advises Dr Balaji. He also shared with couples to try early so they don’t have to go through this process.
There are several steps in the IVF process. First, the wife has to undergo hormonal stimulation to produce more eggs. Next, these eggs are retrieved from the wife and kept in an incubator in the IVF lab. Meanwhile, the husband will be asked to produce the semen sample.
His semen sample has a mixture of good, poor and dead sperm. The good sperm (good swimmers) are isolated and used to inseminate the eggs.
The inseminated eggs are then placed back into the incubator for the next 18 to 20 hours undisturbed for fertilisation to occur. Once fertilisation has been checked, they are again left undisturbed in the incubator until the embryos are formed. The embryo will then be placed back into the wife’s uterus. Any extra usable embryos will be frozen for patient’s future use.
Estimated IVF treatment Cost
“At KK Women's and Children's Hospital (KKH), the estimated cost for one IVF cycle and embryo transfer for a Singapore Citizen ranges from S$12,000 to $16,000,” shares Dr Chua Ka-Hee, Associate Consultant, Department of Reproductive Medicine, KK Women’s and Children’s Hospital (KKH).
There is co-funding from the government for Assisted Reproduction Technology treatments done in government hospitals for women below 40 years old. Couples can also withdraw up to $6,000 for their first treatment cycle for Assisted Conception Procedures at private or government hospitals.
IVF treatments are intensive, expensive and not without its risk, hence the gynaecologist will check if the couple needs to go through the IVF process. Sometimes, the IUI5 process may work just as well.
Dr Chua also shares that the success rate for IVF for women in their 30s is approximately 30%.
Dr Peter Chew, a gynaecologist for over 40 years shares his insights about PCOS.
PCOS is a common cause of infertility and affects 10% of all women. This is a condition where the woman is perfectly healthy but has more male hormones. This causes her to have irregular menstrual cycles, where in one month the flow can be very little, and on the other, extremely heavy.
The exact cause of PCOS is unknown but excess insulin, low grade inflammation, and heredity may play a role.
Treatment for PCOS
PCOS is diagnosed through a hormone blood test and pelvic ultrasound examination. It can be treated through medication. If left untreated, it can lead to health issues like diabetes and heart diseases. It also increases the risk of breast and ovarian cancer.
Curing and recurring PCOS
PCOS is an interesting condition where there is no timeframe to cause it. When the woman is pregnant and delivers, some may go into remission but there are others whose condition will progress and develop PCOS again. The recurrence rate for PCOS is very high
Getting pregnant with PCOS
The women can still get pregnant if she has PCOS. For the pregnancy to carry on, it will help if she reduces weight (if overweight), cutting down on smoking and alcohol.
It will be best for them to be carefully monitored, especially during the first three months of pregnancy. It is very important to make sure that there is no bleeding.
In the second and third trimesters, the blood pressure must be monitored. Patients tend to have higher blood pressure due to the increase in weight. Sometimes it can lead to gestational diabetes.
I Love Children thanks Dr Hemashree, Dr Balaji, Dr Chua and Dr Chew for their contribution at the Know Your Fertility Wellness 2018 campaign roadshow talks.
1 Polycystic ovary syndrome (PCOS)
2 Intrauterine insemination (IUI) is a fertility treatment that involves placing sperm inside a woman's uterus to facilitate fertilisation.
3 In vitro fertilisation (IVF) is a process of fertilisation where an egg is combined with sperm outside the body, in vitro.