31.MAY.2019 6 MIN READ | 6 MIN READ

What are common beliefs surrounding fertility issues, and how true are they?

Have you and your partner been trying to conceive for what seems like ages with no luck? Well, you’re not alone. Infertility is a common problem that can cause a crippling psychological impact, and no doubt you would have scoured the internet or received advice from well-meaning family or peers. Let’s take a look at how true the 5 common things you may have heard about infertility are.

1. Infertility is a woman’s issue

It is true that when a woman is having difficulties conceiving, it can be due to issues with her reproductive system. Examples include problems with ovulation, blocked fallopian tubes, polyps or fibroids and endometriosis. Endometriosis is a condition in which the tissue from the uterine lining is found outside the womb such as the ovaries and fallopian tubes. Inflammation from endometriosis may damage the sperm or egg or interfere with their movement through the fallopian tubes and uterus, making it difficult for the woman to conceive.

However, it is also important to note that infertility may stem from the male reproductive system too. According to the World Health Organisation, general semen quality is getting poorer globally over the years. To back that up, healthcare institutions in Singapore saw an exponential increase in the number of men seeking fertility treatments over the past few years.

On average, the female factor is found in one-third of cases of infertility, male factor in one-third, and a combination of male and female factor in the remaining one-third.

2. Infertility is linked to a woman’s age

Fertility and a woman's age
Age indeed plays a significant role in a woman’s fertility. From the medical standpoint, a woman is considered infertile if she is having regular sex 2 – 3 times a week and still unable to conceive after 12 months.

Once a woman is over 35 years old, her chances of conceiving naturally fall by half; and by the age of 41, her chances would have dropped to a mere 4%. Women are generally born with an estimate of 1 million eggs, which slowly decreases over the years. By the age of 35, the number of eggs would be down to 50,000 and by menopause, 1,000 or less. The cell division process that occurs during ovulation may become abnormal and this leads to an increased risk of miscarriage or giving birth to a child with a genetic disorder.

However, infertility can affect young women too. For instance, women under the age of 40 with primary ovarian insufficiency (wherein her ovaries stop working normally due to depletion or dysfunction of ovarian follicles) or those suffering from polycystic ovarian syndrome (which is a hormonal imbalance that interferes with normal ovulation) will find it challenging to conceive.

3. You should see a doctor the moment you feel that you might be infertile

Sometimes paranoia gets the better of us, and we might jump the gun and assume we are infertile after a few months of trying. However, you should only be concerned if:

  • You have been trying to conceive for 12 months. This means having sex 2 – 3 times a week.
  • You are over 35 and have been regularly trying to get pregnant for 6 months.
  • You have a low sperm count, wherein you have less than 15 million sperm per millilitre. This could happen if you suffer from varicocele, a condition in which the veins in the loose skin that holds the scrotum is enlarged. Since this prevents the normal cooling of the testicle, it may lead to reduced sperm count and movement.
  • You are still at an early stage of trying to conceive, and would like to check for problems like polyps, endometriosis, or sperm count issues. When problems are rectified early, in vitro fertilisation (IVF) may not be necessary.

4. The only solution to infertility is IVF

Fertility options
“So, are you going to go for IVF?” This may be a question an infertile couple may commonly receive when they break the unfortunate news.

Many people are unaware that there are more options than IVF for infertile couples, which is why couples are recommended to go for fertility screenings. Depending on the fertility wellness of the couple, the doctor can recommend a method that will be the most suitable for them, such as:

  • Advising a precise intercourse timing to increase the chances of conceiving.
  • Trying intra-uterine insemination (IUI), a form of artificial insemination that involves placing the sperm inside a woman’s uterus to facilitate fertilisation. This option is less complicated and less expensive than IVF.
  • Surgery, which can be used to improve sperm count if the cause is a blockage of sperm transport in the genital tract.
  • Prescribing anti-oxidants such as Vitamin C and Vitamin E to male patients to increase their sperm count and quality.
  • Going for IVF, in which the egg and sperm are fused in an external laboratory environment. IVF is necessary when the fallopian tubes are blocked, or when surgery to treat low sperm count is ineffective. If couples have tried other types of treatment and have not been successful, they may also consider having IVF.

It’s been over 40 years since the first IVF baby, and more than 8 million babies have since been born through this method. However, it is important to come to IVF consultation with an open mind and realistic expectations. There are multiple tests and consultations to go through to have a better understanding of the risks, requirements, and procedure. With a 30 – 40% rate success per cycle, some may require more than one cycle to be successful.

5. My overall health does not affect my fertility

Couples should optimise their general health when they are trying to conceive. Not only can this improve chances of becoming pregnant, but also lower the risk of complications developing. Eating sensibly and having regular exercise are strongly recommended.

Some factors that can affect your chances of having a baby include:

  • Caffeine intake – Caffeine is one of the most popular methods of combating fatigue. However, women who consume caffeine in excess (ie. around 5 cups a day) may take longer to get pregnant. In one study, those who consume the most caffeine had a 45% risk of waiting more than nine months before becoming pregnant.
  • Alcohol consumption – Alcohol poses a risk for women who are trying to get pregnant as it decreases conception rates and increases the risk of miscarriage. While it has no known ‘safe dosage’, you might want to think twice before taking that second or third glass of wine if you’re trying to conceive. It has also been shown to cause male infertility as well.
  • Smoking – Smoking has been proven to lower men’s sperm count as well as increase the likelihood of a premature birth or miscarriage for women. Scientists have also found that women who are constantly exposed to second-hand smoke, either as adults or children, are more likely to have issues with fertility or suffer a miscarriage.
  • Stress – Stress on both men and women can affect their chances of conceiving. When women are highly stressed, they are less likely to regularly ovulate (release eggs). As for men, stress can affect their energy level and libido.

Infertility can be incredibly frustrating. However, it doesn’t necessarily mean you can never get pregnant. Consultations with fertility experts can provide you with valuable insights on the multitude of options and solutions available to help you conceive your little bundle of joy.

 

Article reviewed by Dr Lim Min Yu, obstetrician & gynaecologist at Gleneagles Hospital

References

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University of Rochester Medical Centre. (2008, December 5). Second Hand Smoke Raises Odds of Fertility Problems in Women. Retrieved March 29, 2019 from https://www.urmc.rochester.edu/news/story/2309/second-hand-smoke-raises-odds-of-fertility-problems-in-women.aspx

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31.MAY.2019
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Lim Min Yu
Obstetrician & Gynaecologist
Gleneagles Hospital

Dr Lim Min Yu is an obstetrician & gynaecologist at Gleneagles Hospital, Singapore.