infertility FAQs

Quick Facts About Infertility

  • Infertility is NOT an inconvenience. It is a disease of the reproductive system that impairs the body's ability to perform the basic function of reproduction.
  • Infertility affects about ten percent of the reproductive-age population (Source: National Survey of Family Growth, CDC 1995).
  • Infertility affects men and women equally.
  • Most infertility cases, 85% to 90%, are treated with conventional medical therapies such as medication or surgery.
  • While vital for some patients, in vitro fertilization (IVF) and similar treatments account for less than 3% of infertility services.
  1. What is Infertility?

    Infertility is a disease of the reproductive system that impairs one of the body's most basic functions: the conception of children.

    Conception is a complicated process that depend on many factors: the production of healthy sperm by the man and healthy eggs by the woman; unblocked fallopian tubes that allow the sperm to reach the egg; the sperm's ability to fertilize the egg when they meet; the ability of the fertilized egg (embryo) to become implanted in the woman's uterus; and sufficient embryo quality.

    Finally, for the pregnancy to continue to full term, the embryo must be healthy and the woman's hormonal environment adequate for its development.

    When just one of these factors is impaired, infertility can result.
  2. What Causes Infertility?

    No one can be blamed for infertility. About one-third of infertility cases can be attributed to factors that affect men, and another one-third to factors that affect women. For the remaining one-third of infertile couples, infertility is caused by a combination of problems in both partners or in about 20 percent of cases, is unexplained.

    The most common male infertility factors include azoospermia (no sperm cells are produced) and oligospermia (few sperm cells are produced). Sometimes, sperm cells are malformed or they die before they can reach the egg. In rare cases, infertility in men is caused by genetic diseases such as cystic fibrosis or chromosomal abnormalities.

    The most common female infertility factor is an ovulation disorder. Other causes of female infertility include blocked fallopian tubes, which can occur when a woman has had pelvic inflammatory disease or endometriosis (a sometimes painful condition causing adhesions and cysts). Congenital anomalies (birth defects) involving the structure of the uterus and uterine fibroids are associated with repeated miscarriages.
  3. How is Infertility Diagnosed?

    Couples are generally advised to seek medical help if they are unable to achieve pregnancy after a year of unprotected intercourse. Women above the age of 35 years old should seek help after 6 months of unprotected intercourse if they are unable to get pregnant.

    The fertility doctor will conduct a physical examination of both partners to determine their general state of health and to evaluate physical disorders that may be causing infertility. Usually, both partners are interviewed about their sexual habits to determine whether intercourse is taking place properly for conception.

    If no cause can be determined at this point, more specific tests may be recommended. For women, these include an analysis of reproductive hormones levels and ovulation, an x-ray of the fallopian tubes and uterus, and laparoscopy. For men, initial tests focus on semen analysis.
  4. How is Infertility Treated?

    Couples should consult a fertility doctor to assess their fertility treatment options in Singapore.

    Most infertility cases -- 85 to 90 percent -- are treated by a fertility doctor with conventional therapies, such as drug treatment or surgical repair of reproductive organs.

    Couples can also choose to consult a fertility doctor and go for assisted conception, also known as fertility treatments, like intrauterine insemination (IUI) and in vitro fertilisation (IVF).
  5. What is Intrauterine Insemination (IUI)?

    Intrauterine insemination (IUI) involves the fertility doctor preparing the male partner’s sperm in the laboratory and placing the mobile and healthy sperm into the woman's uterus at the time of ovulation. IUI can be performed with the sperm of the male partner or with donor sperm.
  6. Does Intrauterine Insemination (IUI) Work?

    The success of IUI depends on 2 factors:
    • The indication for IUI (the reason it is being performed)
    • Whether performed in a drug-stimulated or natural (drug-free) cycle

    The success rates of IUI are generally higher if
    • Performed to overcome the problem of lack of sperm
    • Used for cervical mucus hostility when sperm are killed within the cervix
    • Intercourse is not occurring normally due to cases like ejaculation dysfunction
    • Drug-stimulated cycle (superovulation intrauterine insemination)

    Assuming a good response is being maintained, up to three cycles of IUI may be attempted for most couples. Subsequently, the fertility specialist in Singapore will review the treatment. Couples can consider further IUI treatment or move on to other forms of fertility treatment at that stage.
  7. What is in Vitro Fertilization (IVF)?

    In infertile couples where women have blocked or absent fallopian tubes, or where men have low sperm counts, in vitro fertilization (IVF) offers a chance at parenthood to couples who until recently would have had no hope of having a "biologically-related" child.

    In IVF, the fertility specialist will surgically remove eggs from the ovary and mix them with sperm outside the body in a Petri dish ("in vitro" is Latin for "in glass"). After about 40 hours, the eggs are examined to see if they have become fertilized by the sperm and are divided into cells. These fertilized eggs (embryos) are placed in the women's uterus, bypassing the fallopian tubes.
  8. What is Intracytoplasmic Sprm Injection (ICSI)?

    ICSI is used when the male partners' sperm is suboptimal when previous standard IVF treatment has been associated with a low fertilisation rate and occasionally used if only a few eggs are available. With ICSI, a single motile sperm is isolated from the male partner's sperm and the tail of the sperm is cut to immobilise the sperm. The sperm is aspirated into a very fine glass needle (about one-tenth of the diameter of a human hair at its tip). The sperm is then injected directly into the centre of the egg and the needle withdrawn. A very small percentage of eggs can be damaged by the injection procedure but this is more than offset by the increased fertilisation rate.
  9. Does in Vitro Fertilization (IVF) Work?

    Introduced in Singapore in 1983, IVF/ICSI currently accounts for about 99% of ART procedures. The average live delivery rate for IVF in 2000 was 29.9% per retrieval--a little better than the 20% chance in any given month that a reproductively healthy couple has of achieving a pregnancy and carrying it to term.

    The desire to have children and be parents is one of the most fundamental aspects of being human. People should not be denied medically appropriate treatment to fulfil this goal.

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