6733 8810 
Infertility
Dr Christopher Ng
Consultant Obstetrician & Gynaecologist
MBBS (Imperial College, UK), MMed (O&G) (S’pore), FRANZCOG (Aust-NZ), FAMS (O&G) (S’pore)
Infertility Treatment
Infertility can affect both men and women and may be due to factors such as hormonal imbalances, structural abnormalities or underlying medical conditions. Infertility treatments aim to address these issues through fertility medication, lifestyle changes, surgical procedures and assisted reproductive technologies like in-vitro fertilisation (IVF).
Medically reviewed by Dr Christopher Ng, Consultant Obstetrician & Gynaecologist
What is Infertility?
Infertility refers to the inability to conceive after one year of regular unprotected sexual intercourse. In order to get pregnant, a woman’s ovary must first release a mature egg (ovulation) which then needs to be fertilised by a man’s sperm. The fertilised egg (embryo) then travels down the fallopian tube and implants itself into the uterus. Anything that impairs any part of this intricate process can result in infertility.
Types of Infertility
Primary Infertility
This applies to couples who have not been pregnant before and have not been able to conceive after at least one year of unprotected sex.
Secondary Infertility
This applies to couples who have previously conceived but are now unable to do so again after a year of trying.
Possible Signs of Infertility in Women
Inability to Conceive
The inability to get pregnant after one year of regular unprotected sex is a primary indicator of infertility.
Painful, Irregular or Absent Periods
Menstrual cycle irregularities including heavy periods, painful periods (dysmenorrhea) or missed periods may indicate hormonal imbalances or not ovulating more commonly associated with conditions like polycystic ovary syndrome (PCOS).
Pain During Intercourse (Dyspareunia)
Experiencing pain during sexual intercourse may be a sign of underlying conditions such as endometriosis or pelvic inflammatory disease which can cause infertility.
Changes in Hair Growth or Texture
Thinning hair or excessive facial or body hair growth can indicate hormonal imbalances that might affect fertility.
Possible Signs of Infertility in Men
Testicular Pain and Swelling
Discomfort or swelling in one or both testicles may indicate underlying issues like a varicocele, infection or other medical conditions hampering sperm production.
Erectile Dysfunction
Some conditions that cause erectile dysfunction may affect one’s sperm count, such as hormonal disorders, diabetes or structural abnormalities.
Ejaculation Problems
Issues such as premature ejaculation, retrograde ejaculation or absence of ejaculation can all contribute to difficulties in the female partner conceiving.
Common Causes of Infertility in Men & Women
Infertility can affect either the man or the woman, or both. Here are some common causes of female infertility and male infertility:
Female Infertility
Ovulation Disorder
The disruption of ovarian function may be due to factors like excessive exercise, eating disorders or hormonal disorders including Polycystic Ovary Syndrome (PCOS), hyperprolactinemia, hyperthyroidism and hypothyroidism.
Fallopian Tube Obstruction
This is when the fallopian tubes are blocked, preventing the egg from travelling down the fallopian tube and into the uterus. This may be caused by pelvic inflammatory disease, endometriosis or a past history of ectopic pregnancy.
Uterine or Cervical Abnormalities
These abnormalities can contribute to infertility by disrupting the implantation process or obstructing sperm transportation. These include uterine adhesions, uterine septum and cervical stenosis (narrowing of the cervix).
Ageing
Women past their mid-thirties often have a harder time conceiving due to the diminishing number of eggs and their deteriorating quality.
Male infertility
Low Sperm Count
When there is an abnormally low sperm count, the chances of fertilisation are reduced as there are fewer sperms available to fertilize the egg.
Reduced Sperm Motility
When sperms are not able to swim effectively, it is more challenging for them to reach and fertilise the egg.
Impaired Sperm Quality
This is characterised by poor morphology of the sperm (shape) and abnormal DNA , both of which can further hinder the ability of sperm to successfully fertilise an egg.
Overexposure to Certain Environmental Factors
Frequent exposure to toxic chemicals, radiation and heat can affect sperm production. Heavy alcohol consumption and smoking may also result in reduced sperm quality and quantity.
Ageing
Like women, men also experience a decline in fertility as they age, albeit to a lesser extent. As men get older, the quality and quantity of sperm also decreases.
How is Infertility Diagnosed?
Your fertility gynaecologist will first review you and your partner’s medical history and lifestyle. He or she will then perform various diagnostic tests in order to assess your hormone levels and the state of your reproductive organs. Other tests may include a semen analysis, laparoscopy, ovarian reserve testing for example.
In particular, fertility assessments for women include:
Medical History
A comprehensive medical history review can address potential issues such as past surgeries, infections or menstrual irregularities.
Ultrasound Scans
Pelvic ultrasound scans can assess the health of the ovaries, uterus and fallopian tubes.
Blood Test
Blood tests can measure hormone levels, check whether ovulation has occurred, and screen for conditions like thyroid disorders that may impair fertility.
Hysterosalpingogram (HSG)
This evaluates the shape of the uterine cavity and the patency (openness) of the fallopian tubes by injecting a dye into the uterus and taking X-ray images.
Ovarian Reserve Testing
Measuring one’s Anti-Mullerian Hormone (AMH) levels can provide information about the number of remaining eggs one has and also determine if one’s ovaries are ageing too quickly.
Hormone Testing
Hormone tests measure levels of important reproductive hormones like FSH, LH, oestradiol, progesterone and prolactin, which help evaluate ovarian function and ovulation.
Laparoscopy
Here, a camera is inserted through a small incision in the umbilicus to visualise the pelvic organs directly.
Hysteroscopy
This involves the insertion of a thin, illuminated tube (hysteroscope) into the uterus through the cervix to examine the uterine cavity and identify the presence of any uterine and cervical abnormalities.
When Should I Visit a Fertility Clinic?
You should seek medical attention from a fertility doctor if you are below 35 years old and have not gotten pregnant after a year of regular sexual intercourse without the use of contraception; or if you are above 35 years old and have not gotten pregnant after 6 months of regular sexual intercourse without the use of contraception. However, if you have any known fertility issues, it may be advisable to seek medical attention earlier.
How is Infertility Treated?
Fortunately, many cases of infertility can be treated with the help of a fertility doctor. Assisted reproduction techniques such as Superovulation Intra-Uterine Insemination (SOIUI) and In-Vitro Fertilisation (IVF) are available to improve infertile couples’ chances of conceiving.
IVF
This is a well-established assisted fertility treatment that involves the woman’s egg being retrieved from the ovaries and combined with a man’s sperm at a laboratory in the fertility clinic. The embryos are then allowed to grow for a few days and one or two high-quality embryos will be transferred into the uterus thereafter.
SO-IUI
This is a combination of superovulation and intrauterine insemination. It is a type of artificial insemination whereby washed and enhanced sperms will be injected directly into a woman’s uterus during her ovulation period. This cuts down on the time and distance that the sperms need to travel, making it easier to fertilise the egg.
Besides IVF and SO-IUI, there are other assisted reproductive technologies (ART), such as:
Intracytoplasmic Sperm Injection (ICSI)
This is often combined with IVF. A single healthy sperm is injected directly into an egg to facilitate fertilisation. ICSI is particularly useful in cases of severe male infertility.
Donor Eggs or Sperm
If a couple cannot conceive with their own eggs or sperm, donor eggs or sperm may be used. This option is helpful for individuals with genetic concerns or those who do not have any eggs or sperms left.
Egg, Sperm, or Embryo Freezing
Eggs, sperm, or embryos can be frozen for future use. This is beneficial for individuals undergoing treatments like chemotherapy that may affect future fertility or for those who wish to delay childbearing.
What Happens After Infertility Treatment?
Hormone supplements are usually prescribed to support implantation. About two weeks later, a blood test will be performed to confirm if the woman is successfully pregnant. If pregnancy is confirmed, the rest of her obstetric care is to look out for potential complications and to ensure a safe delivery.
The amount of time needed to achieve pregnancy also varies widely. A single IVF cycle typically takes two weeks from ovarian stimulation to embryo transfer. Multiple cycles or additional fertility treatments will extend this timeframe.
Tips to Improve One’s Fertility
Certain lifestyle changes can help improve fertility among men and women. They include:
Stop Smoking
Smoking can affect the quality of eggs and sperms.
Limiting Alcohol Intake
Excessive alcohol consumption can reduce fertility in men and women.
Having a Healthy Diet
Eating a well-balanced diet rich in fruits, vegetables, whole grains, and lean proteins improves one’s overall health.
Managing Stress
Chronic stress can affect one’s hormonal balance and fertility.
Taking Supplements
Certain vitamins and minerals such as folic acid, vitamin D, and zinc can improve reproductive health. Consult your doctor on what supplements you can take.
Exercising Regularly
Staying active helps maintain a healthy weight and improves overall reproductive health.
Getting Adequate Sleep
Quality sleep is crucial for hormone regulation and overall health, both of which are essential for fertility.
FAQs on Infertility
Sometimes, but not always. While lifestyle factors can be changed (such as weight loss or avoiding certain environmental risks); other causes of infertility that are genetic in nature, for example, cannot be prevented. In such cases, medical treatment will be required.
Infertility is a common problem in Singapore that affects about 15% of couples. Generally speaking, both male and female factors contribute almost equally to infertility.
Besides ensuring that one is in good overall health through an optimal diet and lifestyle, going for a fertility assessment earlier on and receiving appropriate fertility treatments and other medical interventions (if needed) can significantly increase one’s chances of conception.
Yes, some women can still have regular menstrual periods even if they are infertile. Menstruation does not necessarily mean that ovulation is occurring or that the reproductive system is functioning optimally (e.g. blocked fallopian tubes, uterine abnormalities, low ovarian reserve).
Prolonged steroid use can affect fertility in both men and women. In men, steroids can reduce sperm production and lead to testicular atrophy. In women, steroids can disrupt menstrual cycles and one’s hormone balance, potentially impacting fertility.
Infertility Services We Provide
From routine women’s health needs to complex medical issues, our clinic is here to support you.
Call us at 6733 8810 or message us by clicking the button.
Dr Christopher Ng
Consultant Obstetrician & Gynaecologist in Singapore
Qualifications & Credentials
- Bachelor of Medicine, Bachelor of Surgery (Imperial College, UK)
- Master of Medicine in Obstetrics and Gynaecology (Singapore)
- Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists
- Fellow of the Academy of Medicine, Singapore (Obstetrics & Gynaecology)
Dr Christopher Ng is a dedicated obstetrician and gynaecologist with over two decades of experience. Having been educated and trained in Singapore, the UK and the US, Dr Ng brings with him a wealth of experience and medical knowledge that puts his patient’s wellbeing to the fore.
Dr Ng also complements his practice with aesthetics and has obtained Certificates of Competence in all aesthetic procedures recognised by the Singapore Medical Council Aesthetic Practice Oversight Committee.
With over 30 years of dedicated service in the field of women’s health and rejuvenation, Dr Ng remains steadfast in his commitment to provide compassionate, personalised and effective care to all his patients.
Dr Christopher Ng is a dedicated obstetrician and gynaecologist with over two decades of experience. Having been educated and trained in Singapore, the UK and the US, Dr Ng brings with him a wealth of experience and medical knowledge that puts his patient’s wellbeing to the fore.
Dr Ng also complements his practice with aesthetics and has obtained Certificates of Competence in all aesthetic procedures recognised by the Singapore Medical Council Aesthetic Practice Oversight Committee.
With over 30 years of dedicated service in the field of women’s health and rejuvenation, Dr Ng remains steadfast in his commitment to provide compassionate, personalised and effective care to all his patients.
1 Orchard Boulevard, #04-03A Camden Medical Centre, Singapore 248649
Phone:+65 6733 8810
Fax:+65 6733 8850
After Office:+65 6535 8833
Email:gynaemd@singnet.com.sg
Mon - Friday:0900h to 1730h
Saturday:0900h to 1300h
Lunch Break:1300h to 1400h
Closed on Public Holiday and Sunday