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

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:

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, lighted 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

• Can infertility be prevented?

  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.

• How common is infertility in Singapore?

  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.

• How can one improve his/her fertility?

  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.

• Do women still get a period if they are infertile?

  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).

• Can using steroids for bodybuilding cause infertility?

  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.