There is a lot written about fertility online these days. Unfortunately, not all of it is true. And if you’re researching online to find answers to your own fertility issues, it’s easy to get confused or misled.
In this post, Dr Lim Min Yu, Medical Director at ACRM, helps to debunk some common myths about fertility, and explains what’s real and what’s not.
Click on any of the categories below to reveal links to each myth
Myth 1: It’s easy to get pregnant
Fact: A healthy couple aged 35 and under only has about a 20 percent chance of getting pregnant each month.
There are actually several conditions that need to happen in order for a couple to conceive. The woman needs to ovulate and her endometrial lining must be thick and ready to receive an embryo. The sperm must make it through several barriers to just reach the egg, and there are no guarantees it will fertilize, or implant. Timing and conditions must be just right.
Couples 35 and younger who have been trying for 1 year without any success should seek expert advice. Couples over 35 should try for 6 months and then see a specialist if conception has not occurred.
Myth 2: It’s a “woman problem”
Fact: The problem could lie with the woman (30% chance), man (30% chance) or both (30% chance). Finally, the remaining 10% of infertility is unknown.
I often see female patients in my clinic without their partners. They want to be investigated first, because they are convinced that the difficulty in conceiving must be because of them.
My advice to couples is to come for an initial consultation together, in order to avoid unnecessary delays and get an accurate diagnosis of the problem.
Myth 3: IVF is the best fertility treatment
Fact: There are many medical treatment options for infertility, and “best” varies from couple to couple. Your specialist will provide personalised recommendations based on your unique circumstances.
Many couples are surprised to discover that treatment options for infertility does not begin and end with IVF. After a couple undergoes fertility testing to determine the cause (or causes) that are contributing to their inability to conceive, your specialist may recommend a course of treatment that often begins with basic treatments. These include timed intercourse with an oral medication. If that treatment does not result in a successful pregnancy, the next step is intrauterine insemination (IUI). This is where healthy sperm is directly injected into a woman’s uterus. It takes just minutes and the patient can return to her regular activities afterwards.
Myth 4: I just need to relax
Fact: Relaxing will definitely help with your overall wellbeing, but it’s likely that there are other additional reasons causing your infertility.
We know that infertility can cause stress, but what is less clear is whether stress causes infertility. While it’s possible that your environment can be so physically and emotionally stressful that it’s preventing you from conceiving, it’s more likely that there are other reasons in addition to stress that are is causing your infertility. Your physical, reproductive health is unlikely to be fixed by positive thinking, a holiday, or changing your mindset.
Myth 5: I don’t need to watch my diet when trying to get pregnant
Fact: Being overweight can pose health risks for mother and baby.
Repeated studies have shown that overweight men and women are more successful conceiving naturally after losing even a small amount of weight. Being overweight can pose health risks for the mother and the baby including gestational diabetes and an increased chance of heart disease. Overweight women also have a higher rate of miscarriage.
Myth 6: I can wait until I’m 40
Fact: Around age 35, a woman’s chances rapidly decline.
The most important predictor of successful pregnancy is a woman’s age. Women are born with all the eggs they will ever have. As one gets older, the quality and quantity of a woman’s egg supply will reduce. Around age 35, the rate of decline rapidly accelerates. Most women are unable to get pregnant when they reach their mid-40s, a few years before menopause.
Myth 7: Age only affects women’s fertility, not men’s
Fact: By 40, men experience a decrease in semen volume and motility.
Although men continue to make new sperm into their 90s (the oldest father on record is 96!), like female infertility, male infertility rates increase with age. After the age of 40, a man is likely to start experiencing decreases in semen volume and motility.
Myths for Women
Myth 8: I can’t get pregnant during my period
Fact: While rare, it’s possible to get pregnant during your period.
While you are most likely to conceive by having sexual intercourse a few days before and during ovulation, it is still possible to get pregnant during your period. Sperm can survive in the uterus up to five days, and if you have sex near the end of your period, there’s a possibility that sperm can fertilize an egg after it is released during ovulation. Overall, this occurrence is rare, but it’s more likely to occur in women with shorter menstruation cycles.
Myth 9: If I have IVF, where multiple eggs are collected in a cycle, my menopause will happen sooner
Fact: Menopause occurs when there are less than a thousand eggs in a woman’s ovaries. As IVF only collects eggs that would have developed and died off for that particular month, it does not accelerate the onset of menopause.
A woman is born with all the eggs she will ever have. These eggs are stored in her ovaries. Every month, a small group of eggs get activated — or “wake up” — and become available to grow. Out of that group, the normal process is that one becomes the egg that will be released that month, while the rest don’t develop all the way and die off within a few weeks. Some women have a higher egg count, or more follicles, while others have fewer.
When a woman has IVF, the hormone medication is only capable of stimulating the group of eggs that are already activated – that are destined to be gone, one way or another, by the end of the month. Even for a woman who has 20 eggs collected in an IVF cycle, we don’t, for instance, go in and “wake up” an extra 20. Every month, a woman loses the amount she is going to lose whether they are collected or not, and every month a new group will be activated.
Myth 10: I already have a child so I don’t have a problem with fertility
Fact: Fertility declines with age and many other factors. Hence, your fertility could have changed by the time you’re ready to have your next child.
The medical term for difficulty conceiving after a previous pregnancy is secondary infertility. We know that a woman’s fertility declines with age, and you are now older than when you had your first baby. Besides age, other causes of secondary infertility include an internal complication because of the previous pregnancy, weight gain, and male factor (also due to age).
For women 35 and younger we recommend trying to conceive for 1 year before seeing a specialist, and for women 35 and up, trying for 6 months.
Myth 11: If my mother had an easy time getting pregnant, I will too
Fact: Every woman is different. But there are some inherited genetic conditions that could impact fertility.
Every woman is different. The ability to get pregnant and/ or how easy it will be to get pregnant is not completely inherited. However, research has shown that some conditions that may make it more difficult to get pregnant, like PCOS and premature ovarian insufficiency (POI), have genetic components and therefore could be inherited.
Myths for Men
Myth 12: Briefs can hurt a man’s fertility
Fact: There is no research that indicates that briefs (or any other underwear) have an impact on fertility.
Temperatures in the scrotum are usually a few degrees lower than normal body temperature. Temperatures higher than that can reduce male fertility. Some research has shown that briefs cause a slightly higher temperature However, there is no research that says this affects fertility. It is recommended that men avoid places with high temperatures, such as saunas and hot tubs, as they can affect sperm production and thus fertility.
Myth 13: Taking steroids to improve physique won’t affect my fertility
Fact: Steroids are illegal and actually reduce sperm count and testicular size.
Many men who go to the gym are tempted to take anabolic steroids, as these promote rapid growth of muscles. However, you should steer clear of these drugs as they are illegal and they reduce sperm count and testicular size. Men on steroids may also have difficulty with erections. Even worse, some of these changes may be irreversible. Regular exercise contributes to general health, but extremes such as using steroids are bad for your health.
Seeking Treatment Myths
Myth 14: Treatment is too expensive
Fact: In Singapore, government grants and Medisave make fertility treatment affordable for couples.
We all agree that the costs of treatment are an important consideration and at ACRM we offer comprehensive financial counseling to every couple. Eligible couples can also use Medisave for assisted conception procedures. If you choose to have treatment at a restructured hospital, some patients may also be able to access co-funding.
Myth 15: Every fertility center is the same
Fact: A doctor’s experience, expertise and consultation style can differ significantly.
It is very important for anyone considering fertility treatment to do a bit of homework. Factors that you should consider include the doctor’s experience and expertise. Consultation styles can widely vary, with some doctors having a more traditional, prescriptive approach (“do what I say, I am the doctor”). At ACRM, we believe in a consultative approach, providing you with advice to empower you to reach an informed decision about your treatment choices. We also believe in personalising treatments. Some centres may run heavily protocolised treatments, without personalisation. Convenience should be on your checklist as well. During treatment, regular monitoring is necessary and traveling long distances every other day for up to a week will only add to your stress level.
Myth 16: Lifting my legs in the air for 20 minutes after having sex will help me get pregnant
Fact: There is no evidence that says this improves your chances of conceiving.
While in theory this may sound like a good idea — the logic being that this will tip your pelvis and help the sperm find their way to your egg — all it will probably do is make your legs numb from all the blood rushing away. While there is no harm to tilt your pelvis after sex, for example by placing a pillow under your hips, there’s no need to hoist any body parts into the air for any extended period of time. Similarly, handstands are not required.
Myth 17: Having sex in the missionary position is the only way to conceive
Fact: Have fun! Your position does not matter.
Just because you’re trying to conceive doesn’t mean sex can’t be fun. As long as there is penetration (the deeper the better) and your partner ejaculates in you, the actual position you do it in doesn’t matter. Have fun! Try out new positions and bring back your old favourites. If you do require additional lubrication, be sure to check that the brand is safe for conceiving. There are brands of lubricant formulated for those trying to conceive.
Myth 18: I need to have sex 2 to 3 times per day around the time of ovulation in order to conceive
Fact: Having that much sex would lead to a reduction in sperm count in subsequent ejaculations. Having sex 2-3 times per week is sufficient.
Most couples would find it exhausting to have sex 2 to 3 times per day for 3-5 days in a row! After having sex, there is a period of time where it is impossible to have another orgasm and ejaculate again. This is known as the refractory period. The refractory period varies widely between individuals, but can last minutes to days. Having such frequent ejaculation would lead to a reduction in the sperm count in subsequent ejaculations. Instead, having sex 2 to 3 times per week (not per day!) when a couple is trying to conceive is sufficient.
Navigating your fertility journey can be overwhelming, but it doesn’t have to be. Broadly speaking, the same sensible things that make you a healthy adult are likely to help you conceive a healthy baby. Having said that, if you have been trying for 6 months to a year without success, it might be time to seek medical treatment.