While many may think that going for fertility treatment means undergoing IVF, that is not the case. Fertility treatment options in Singapore can be categorized briefly into medical treatment, surgical treatment and Assisted Reproductive Techniques (ART), which includes in-vitro fertilization (IVF) and intra-uterine insemination (IUI).
There are also different treatments available for male and female infertility. For male infertility, the fertility specialists can provide medications to improve sperm quality and count. Improving the sperms can help to increase the chances of conceiving without IVF sometimes, and even if IVF is required, better quality sperms can help to improve the success rates. The rest of the fertility treatment options described here are mainly used to address female infertility issues.
A. Well-timed Sexual Intercourse
The first-line measure to improve chances of pregnancy would be to time sexual intercourse with ovulation, which is also the woman’s fertile period. On average, chances of pregnancy are 10-12% if the intercourse is well-timed.
Ovulation can be tested with ovulation test kits, which are available in convenience stores and retail pharmacies. However, ovulation can be more accurately tracked by the gynaecologist or a fertility specialist in a process known as follicular tracking. During follicular tracking, the gynaecologist will conduct non-invasive ultrasound scans to track the development of the egg. This requires 1-2 visits to the gynaecologist for the scans in the first 2 weeks of the menstrual cycle to best determine the ovulation time point.
B. Use of Clomiphene
Clomiphene is a medication that is used to help the body produce eggs, so that there is a higher chance of the woman producing at least 1 egg per month. This medication benefits those with irregular periods or do not ovulate regularly. Clomiphene usage is always coupled with follicular tracking for optimal results.
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Surgical options usually arise when the cause of infertility is an underlying gynaecological condition, for example, endometriosis, fibroids or ovarian cysts. These conditions can impact ovulation, fertilisation of the egg, delivery of the egg to the uterus, and implantation of the fertilised egg. To understand why there is an impact, we have to first understand how fertilization happens.
Therefore, any physical disruptions in any of the parts of the reproductive system mentioned above could have an impact on fertility, and might need to be managed surgically.
At the uterus, there may also be congenital abnormalities like a uterine septum, which is a thin wall dividing the uterus into half. This condition can lead to implantation failure or early miscarriage. Another problem that could also occur in the uterus is intra-uterine adhesions. This can be caused by inflammation or infection after a Dilation and Curettage (D&C) procedure, resulting in the uterine walls sticking together and affecting implantation and pregnancy.
While uterine fibroids are generally harmless, they can sometimes affect implantation of the egg. Depending on their position and size, submucosal and deep intramural fibroids have been thought to have an impact on fertility.
During a laparoscopic surgery, a few small incisions of 0.5 to 1cm are made at the abdomen where thin surgical instruments inserted. Most gynaecological conditions like cysts, fibroids and endometriosis that require surgery are done laparoscopically, except for the removal of submucous fibroids where hysteroscopic surgery may be more ideal due to the location of the fibroids.
Laparoscopic Surgery OR Open Surgery (Laparotomy)?
Laparoscopic surgery is becoming an increasingly popular option over open surgery for several reasons. As the incisions are small, post-surgery pain is significantly reduced. This results in a shorter hospital stay and cost savings. Sometimes, patients may even be able to go home on the same day as the surgery. Recovery is also a lot faster and scars are smaller and less obvious. From a surgical aspect, due to the principles of magnification and microsurgical techniques, there is better tissue handling and control, allowing for a gentler procedure.
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Hysteroscopic surgery is performed under general anaesthesia is preferred over laparoscopic surgery when detecting and treating abnormalities in the interior parts of the uterus. The rule of thumb for deciding between laparoscopy and hysteroscopy is largely dependent on the ease of access to the operative site so as to achieve minimal tissue damage.
For example, submucous fibroids that protrude into the womb cavity and impede implantation are often removed through a hysteroscopic procedure so that the surgeon would not have to cut through the uterus in order to gain access and remove the fibroids. Hysteroscopic surgery can also be performed to remove uterine septum and intra-uterine adhesions.
The recovery time for hysteroscopic surgery is fast and most patients are able to go home on the same day of the surgery. As there are no abdominal wounds, post-surgery pain is very minimal and there are no obvious scars. Also, wound infections are unlikely to develop.
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