Successful pregnancy is dependent on a healthy egg being fertilised by a healthy sperm, and subsequently being implanted in the woman’s womb. Infertility can be due to a problem with any of these factors.
Male infertility happens when 1) there is a problem in the production of healthy sperms or 2) when the sperm cannot be properly transported to the egg. The signs that point to a problem with sperm production include:
- Low sperm count
- Sperms with low quality upon visualisation e.g. low motility or abnormal sperm structures
- Low testosterone count, which could lead to decreased facial or body hair and gynaecomastia (man-breasts)
The signs of issues with sperm delivery include:
- Erectile dysfunction i.e. issues with erection during sex
- Blocks in the sperm ducts
Female infertility happens when 1) there are problems in the production of a healthy egg, 2) when the egg cannot be properly transported from the ovaries to the womb or 3) when the fertilised egg is unable to implant itself in the womb.
A possible cause of egg production problems would be hormonal imbalances, which could be stress-induced or natural e.g. polycystic ovary syndrome (PCOS). Even when a healthy egg is produced, it needs to successfully travel from the ovaries to the womb through the fallopian tubes. If the fallopian tubes are blocked, the egg will not be able to reach the womb to be fertilised by the sperm.
Finally, even when the healthy egg is able to reach the womb successfully, it needs to be fertilised by the sperm AND be able to implant itself in the lining of the womb. This implantation could be affected when a woman has fibroids, endometriosis, polyps or cysts on her womb lining. This is because the surface area for the fertilised egg to latch itself to is reduced when there are other growths on the lining. Just imagine a bench that is fully seated with people with just a small gap. Wouldn’t it be difficult to squeeze another person on that bench? There’s a high chance that the next person who comes along will walk away without a seat. Similarly, if there is reduced space for implantation, the chances of the fertilised egg implanting itself is reduced.
The cause of infertility will greatly impact the treatment option used to improve the chances of conceiving. For example, in the case of blocked sperm ducts, there is a high chance that IVF is required as there is no way for the sperms to be delivered to the egg naturally unless the ducts are unblocked.
To better understand the fertility status of the couple, the gynaecologist will usually perform the following during a fertility check-up:
1. Comprehensive history taking
This involves the gynaecologist asking about the couple’s medical conditions, as well as more intimate questions on the period of time which they have been trying to conceive for and the frequency of sexual intercourse. While some couples may be more shy to voice their issues, it will be highly useful to share the necessary information with your gynaecologist.
2. Ultrasound of the woman’s womb
The ultrasound screening is used to check for any abnormalities in the womb, such as the presence of fibroids, polyps, endometriotic masses etc. This is especially important for women who have never been examined by a gynaecologist before, as they could have underlying gynaecological problems that were previously undetected. The ultrasound can be performed either trans-abdominally or trans-vaginally, depending on what the gynaecologist deems more suitable.
Transabdominal ultrasound scan of the womb
3. Blood tests for the woman (if required)
This could include blood tests for specific female hormones or even thyroid hormones to determine if there are any underlying hormonal imbalance issues.
4. Fallopian tube check via a Hysterosalpingogram (HSG)
A HSG procedure is a short 15-30 minute procedure that is either performed in the clinic or at an imaging centre where a thin catheter (tube) is inserted through the vagina into the cervix and subsequently the womb of the woman. Medical dye is pumped through the tube and an ultrasound or X-ray is then performed over the woman’s pelvic area for the gynaecologist to visualize the uterus, ovaries and fallopian tubes.
HSG used to check if the fallopian tubes are blocked
5. Sperm test for the man
The husband will be given specific instructions on how to collect his sperms in a bottle, to be sent for analysis by the laboratory. The semen analysis can provide insights on sperm count, sperm motility and sperm structure.
It is recommended that the couple goes for the first consultation together. However, in the event that the couple’s schedules cannot match, it is highly advisable for the woman to come and see the gynaecologist first to avoid further delay in getting a fertility screening.
Based on the fertility test results, the gynaecologist can confirm if there is indeed a fertility problem, and if the problem can be corrected. He or she will then go through the various fertility treatment options with the couple or refer the couple to a gynaecologist who sub-specialises in fertility.
One of the biggest misconceptions that many people have is that IVF is the only option available after a fertility test. However, there are other options that couples may try even before exploring IVF. For example, ovulation stimulation and intra-uterine insemination. One of our gynaecologists even observed that out of 10 patients who seek help for fertility issues, only 2–3 go on to IVF. Therefore, do not be resistant to seeking help if fertility is an issue.
Any gynaecologist or doctor in a fertility clinic can perform a fertility assessment. However, a gynaecologist who sub-specialises in fertility will be able to customise your care with the key objective of increasing your chances of pregnancy within the shortest timeframe possible. These fertility experts are often also IVF certified, and if need be, will be able to see you through your entire fertility journey should you require IVF. SMG Women’s Health has 2 highly experienced IVF clinicians (Dr Cathryn Chan & Dr Fong Yang) in our network of gynaecologists.
While there is still a strong stigma tied to infertility problems in Singapore and beyond, it is heartening to see more women speaking out about their problems and encouraging one another with their stories. For those facing issues with conceiving, remember, it is perfectly acceptable to seek medical help at a fertility clinic. Don’t miss the timing for the highest chances of conceiving.