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Infertility Treatment

What are the Treatment Options for Infertility in Singapore?

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.

Medical Treatment for Fertility

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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2. Surgical Treatment for Fertility

Surgical options usually arise when the cause of infertility is an underlying gynaecological condition, for example, endometriosisfibroids 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.

How fertilisation happens

  1. A mature egg is released from the ovary during ovulation (day 14 of 28-day cycle)
  2. The released egg is caught by the fimbriae of the fallopian tubes and travels up the fallopian tube into the uterus.
  3. If a sperm is present, fertilization of the egg by the sperm happens in the fallopian tube. The fertilized egg then continues to travel to the uterus.
  4. Finally, the fertilized egg reaches the uterus and embeds itself in the uterine lining, in a process known as implantation.

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.

How does Surgery Improve Fertility?

Starting with the ovaries, certain ovarian cysts and fibroids can disrupt ovulation and egg delivery, and undergoing surgery to remove these abnormalities can help to improve these two aspects.

At the fallopian tubes, there may be inflammation that could be caused by infection or endometriosis. The inflammation can affect egg collection by the fimbriae at the end of the fallopian tube, as well as the motility of the entire tube transporting the egg, affecting egg delivery. As a result, fertility may be disrupted. Surgery then becomes a key factor in removing the infection or treating the endometriosis to reduce the inflammation.

Did you know?

Endometriosis is known to be a huge cause of fertility problems, affecting 40 to 50% of the sub-fertile population. When left untreated in the early stages, surgery may become the only option to improve the condition. Sometimes, the presence of fibroids blocking the fallopian tubes can also interfere with egg collection. Removal of these fibroids will be essential to improve the environment for conceiving.

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.

Surgical Treatment Options

A. Laparoscopic Surgery (Keyhole Surgery)
As the ovaries, fallopian tubes, and uterus are located in the pelvis at the bottom part of the abdomen, laparoscopy, a minimally-invasive surgical procedure, is usually performed to examine these reproductive organs to detect any abnormalities that might be affecting the woman’s ability to conceive. Laparoscopy provides the doctor with better visibility than an ultrasound scan.

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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B. Hysteroscopic Surgery
Hysteroscopic surgery is another technique of minimally-invasive surgery that is performed through the vaginal. A hysteroscope, which is similar to a laparoscope, is inserted through the vagina and cervix and into the uterus.

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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C. Open Surgery (Laparotomy)
Open surgery or laparotomy is the traditional method of surgery where a large incision of about 8 to 10cm is made at the abdomen. Due to the large incision, post-surgery pain varies and the patient may have to stay in the hospital for about a week. Recovery process is slower and the post-operative scar is usually large and obvious. Also, in open surgery, a lot more body tissue is exposed to the external environment, increasing the risk of adhesions and infections.

Open surgery may only have to be performed when there are multiple big fibroids e.g. at least 4 to 5 fibroids, with each measuring about 4 to 5cm. However, open surgery is often avoided whenever possible as it has been shown to result in more post-operative adhesions, which then further impacts fertility.

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Summary of Treatment Option Rating Scale

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Medical Treatment

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Laparoscopic Surgery (Keyhole Surgery)

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Hysteroscopic Surgery

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Laparotomy Surgery

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FAQs

What are the options for infertility?

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).

Infertility in men

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.

Fertility

Need to consult a fertility specialist?

Our female fertility doctors are located at central locations in Singapore for easy and quick access.

Incorporated in 2005, Singapore Medical Group (SMG) is a healthcare organisation with a network of private specialist providers across four established pillars - Aesthetics, Diagnostic Imaging & Screening, Oncology and Women's & Children's Health. Within Singapore, SMG has more than 40 clinics strategically located in central Singapore and heartland estates. Beyond Singapore, SMG also has an established presence in Indonesia, Vietnam and Australia. Learn about our privacy policy here.

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