Infertility can feel like an emotional labyrinth, where the path to parenthood is obscured by uncertainty and longing. Whether it is a hidden health issue or a complex interplay of factors, infertility can result from various underlying factors affecting both men and women. As such, knowing the causes and exploring the range of available treatments is essential for those on this journey. This article explores the various aspects of infertility treatment in Singapore, offering a detailed overview of causes, diagnostic methods, treatment options, and support available for those navigating this challenge.
Causes of infertility for women and men
Infertility in women can result from a variety of factors. It is a known fact that female fertility naturally declines with age, particularly after the age of 35. Certain conditions like Polycystic Ovary Syndrome (PCOS) and hypothalamic dysfunction can disrupt normal ovulation, preventing eggs from being released. PCOS is characterized by irregular menstrual cycles and elevated androgen levels, while hypothalamic dysfunction affects the hormones that control ovulation.
Blockages or scarring in the fallopian tubes, often due to infections or pelvic inflammatory disease, can hinder the egg’s journey to the uterus. This blockage can prevent fertilization or implantation of the embryo.
Conditions such as fibroids (benign tumors in the uterus) and endometriosis (where uterine-like tissue grows outside the uterus) can interfere with implantation and cause pain, irregular bleeding, and in some cases, infertility as well.
On the other hand, infertility in men is often related to sperm quality and production. A low sperm count or reduced motility can affect the sperm’s ability to reach and fertilize the egg. This can result from genetic factors, hormonal imbalances, or environmental factors. Conditions like varicocele (enlargement of veins within the scrotum) and hormonal issues, such as low testosterone or elevated levels of other hormones, can also affect sperm production and quality, too.
For some people, however, infertility is something that cannot be easily attributed to specific causes. Unexplained infertility means that standard tests and evaluations do not reveal any apparent issues with either partner. This can be particularly frustrating and may require more advanced diagnostic techniques or treatments.
Initial evaluation and diagnosis
Proper diagnosis is crucial for effective infertility treatment. The process typically includes:
- Medical history and physical examination: A thorough medical history and physical examination provide initial insights into potential causes of infertility. This includes reviewing menstrual cycles, sexual history, and any previous medical conditions or treatments.
- Diagnostic tests: For women, these may include blood tests to measure hormones like Follicle-Stimulating Hormone (FSH), Luteinizing Hormone (LH), and estradiol. Diagnostic tests such as hysterosalpingography (HSG), an X-ray procedure using contrast dye, and ultrasound imaging (transabdominal or transvaginal) can also be used to evaluate the fallopian tubes and uterine cavity for blockages or abnormalities.
- For men, diagnostic tests include semen analysis and hormone testing. The former assesses sperm count, motility, and morphology while the latter tests for hormones such as testosterone and Follicle-Stimulating Hormone (FSH) to identify hormonal imbalances affecting sperm production.
Genetic testing and other assessments: Genetic testing can identify chromosomal abnormalities or genetic conditions that may impact fertility. Other assessments, such as testicular biopsy or additional imaging, may be recommended based on the initial findings.
Non-surgical treatments
For those who do not want to go under the proverbial knife, there are various non-surgical treatments to address infertility.
Maintaining a balanced diet and regular exercise is on top of the list. These two can help regulate weight and hormonal levels, which are crucial for fertility. Stress can also impact reproductive health, so incorporating stress-reducing activities like meditation or counseling can be beneficial.
There are medications that can address hormonal imbalances and stimulate ovulation, too. Clomiphene citrate and Letrozole can stimulate the ovaries to release eggs, and these are commonly prescribed for women with irregular ovulation. Gonadotropins, which are injectable hormones, can be used to stimulate ovarian function. Thyroid hormones may be prescribed if thyroid imbalances are affecting fertility.
Assisted Reproductive Technologies (ART) can also help. These encompass various techniques designed to assist with conception. Some examples include:
- Intrauterine insemination (IUI): This procedure involves placing sperm directly into the uterus during ovulation to increase the chances of fertilization. It is often used when there are issues with sperm quality or unexplained infertility.
- In vitro fertilization (IVF): IVF involves the use of eggs that have been fertilised separate from the body and then implanting the embryos into the uterus. This procedure is often recommended for women with blocked fallopian tubes, severe male infertility, or unexplained infertility. The IVF process includes ovarian stimulation, egg retrieval, fertilization, and embryo transfer.
- Intracytoplasmic sperm injection (ICSI): A variation of IVF, ICSI involves injecting a single sperm directly into an egg to enhance fertilization. It is used in cases of severe male infertility or when previous IVF attempts have failed.
- Egg/sperm donation: Donor eggs or sperm may be used when one partner has fertility issues that cannot be overcome with other treatments. Donor gametes are carefully screened to ensure safety and compatibility.
Surgical treatments
When non-surgical treatments are insufficient or not working, there are surgical options that you can consider.
Laparoscopy is a minimally invasive procedure used to diagnose and treat conditions such as endometriosis and ovarian cysts. It involves small incisions and the use of a laparoscope (a thin tube with a camera) to view and treat abnormalities inside the pelvis. Some notable benefits of this method include shorter recovery time and reduced scarring.
Hysteroscopy involves inserting a thin, flexible instrument into the uterus through the vagina. It is used to diagnose and treat conditions affecting the uterine lining, such as polyps or fibroids. This procedure can help improve implantation and overall fertility.
Surgical interventions may be necessary to address structural problems like blocked fallopian tubes or varicocele. Procedures to repair or reconstruct these issues can improve fertility outcomes.
Advanced and experimental treatments
Aside from the conventional methods described above, there are emerging treatments and technologies that offer new possibilities for those facing infertility:
- Genetic screening and preimplantation genetic testing (PGT): PGT involves checking abnormalities in embryos that affect the genes before implantation. This step provides the guarantee that only healthy embryos are transferred, reducing the risk of genetic disorders and improving the chances of successful pregnancy.
- Stem cell therapy: Stem cell therapy is an experimental approach that involves using stem cells to regenerate or repair damaged reproductive tissues. While still in the research phase, it holds promise for addressing certain types of infertility in the future.
- Ovarian tissue cryopreservation: Ovarian tissue cryopreservation involves freezing ovarian tissue for future use. This technique is particularly useful for cancer patients who wish to preserve their fertility before undergoing treatments that could impair ovarian function.
Aster Gynaecology – Dr Ng Kai Lyn | Female Gynaecologist | Women’s Health Specialist | Laparoscopy Specialist Singapore
38 Irrawaddy Road #06-58
Mount Elizabeth Novena
Singapore 329563
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