Fertility treatment in Singapore

A menstrual cycle that is too long (35 days or more), too short (less than 21 days), irregular or absent can mean that you are not ovulating and may have an ovulation disorder. This happens in 1 out of 4 infertile couples and is the commonest cause of infertility in women. The common causes of anovulation are – 

Polycystic ovary syndrome (PCOS)

PCOS is one of the most common hormonal conditions affecting 1 out of 10 women during their reproductive years, disrupting the cyclical hormonal secretion and altering the menstrual  cycle. Insulin resistance and the resulting excess male hormone is the underlying issue and this results in the common symptoms such as irregular infrequent periods. Some women have  acne and/or abnormal hair growth as well. Most but not all patients complain of  weight gain. 

Hypothalamus/pituitary gland problems

The hypothalamus and pituitary are the parts of the brain that help orchestrate the secretion of reproductive hormones that stimulate egg growth and ovulation (the release of egg). Excessive  stress, significant weight changes or extremes of  body weight and certain medications. can result in hypothalamic -pituitary dysfunction resulting in irregular or absent periods

Premature ovarian failure

A woman’s fertility gradually declines from its peak in the twenties until menopause, which is around the age of 50.  This is caused by a gradual reduction in the number of eggs in the ovaries. For some women, autoimmune disease, genetic disorders or exposure to certain cancer therapies result in menopause prior to the age of 40. This is called premature ovarian failure and affects around 1% of women in the reproductive age group. 

Age

Advancing age is one of the most common causes of female infertility. With age, both the number and quality of eggs in the ovaries decline, resulting in poorer quality embryos and hence a reduction in implantation. If you are a woman over 35 and have not been successful in conceiving after 6 months of regular unprotected sex, you should consider fertility investigation and treatment.

The fallopian tubes are the meeting ground for the egg and sperm and where fertilization happens. The tubes are also instrumental in pushing the embryo into the uterus for implantation. Damaged or blocked fallopian tubes prevent the sperm from reaching the egg, or may prevent a fertilised egg (embryo) from being transported to the uterus. Fallopian tubes can become blocked or damaged due to inflammation from sexually transmitted infections. Conditions like endometriosis or prior tubal surgery can also damage the fallopian tubes. Women with damaged fallopian tubes are at risk of having an abnormal implantation resulting in an ectopic pregnancy. 

Common gynecological disorders such as  adenomyosis, endometriosis and uterine fibroids can prevent successful implantation. Congenital uterine duplication disorders such as uterine septum also increase the chance of infertility.

Low sperm count or quality may result from lifestyle choices, such as smoking, excessive alcohol, taking certain medications, heat exposure  and chronic illnesses. In many cases, however, we are unable to ascertain a reason for the sperm issues.

With the uber stressful times that we are living in, erectile dysfunction and ejaculation problems in men are on the rise. Changes in the sleep pattern like very late nights also have a negative  impact on hormonal secretion and are more likely to result in sexual dysfunction in men. 

Conditions like sexually transmitted infections may cause blockage of the vas deferens and result in disruption of sperm transport. Autoimmune disorders are on the rise and can contribute to male infertility as well. Chronic health problems like Diabetes and hypertension,  as well as medications used to treat them can contribute to male infertility.  

Ovulation induction involves giving medication or injections to induce ovulation in women who do not ovulate regularly and is often combined with other medications or supplements like Inositol. This is the first-line  treatment for women with irregular cycles, hormonal problems or PCOS. In most women, the doctor will monitor the cycle using ultrasound scans to assess the response to the medication and ascertain the time of ovulation.

Again, depending on the actual cause of infertility, various medications can be used in women with fertility issues.

For some women, especially those with tubal blockage, endometriosis or uterine fibroids in certain locations, laparoscopic surgery is needed to optimize fertility. This may or may not be followed by fertility procedures such as IUI or IVF.

In-vitro means outside the body. Fertilization is the meeting of egg and sperm. In IVF, the meeting of the egg and sperm happens in the lab, outside the body. This involves giving injections for 10-12 days to the woman, enabling multiple egg development. A special needle is used to extract these eggs via the vagina under anesthesia. The eggs are then fertilized using the partner’s sperm and kept in an incubator in very controlled conditions. The fertilized embryos are then transferred to the uterus using a very thin cannula.

Double stimulation (DuoStim) is done by performing two hormonal stimulations and two egg retrievals consecutively in one cycle.. It is sometimes offered to patients who have low ovarian reserve or those who require urgent collection of their eggs (e.g. cancer patients). 

Intrauterine insemination (IUI), sometimes referred to as Artificial insemination (AI), is an infertility treatment used in mild male infertility. It is an option considered before attempting complex treatments, such as In Vitro Fertilization (IVF). IUI is a relatively simple procedure that involves selecting the best sperm from the semen in the lab and injecting these  directly into your partner’s uterus around the time of ovulation . This aims to select the best sperm, increase the chances of the sperm and egg meeting and hence fertilization and pregnancy.

Our urology specialists may perform surgeries including Laparoscopic Varicocoelectomy, Vas Epididymis Exploration, and Surgical Sperm Retrieval.