Published on 25 July 2023

    Infertility affects up to 15% of couples. Medical treatments such as IUI and IVF can help increase the chances of a successful pregnancy.

    For many married couples, starting a family is considered a natural progression in their shared journey. 

    However, in recent years, Singapore has experienced a significant decline in fertility, resulting in the country's fertility rate plummeting to a historic low of 1.05 in 2022.

    This decline in fertility rate can largely be attributed to social factors – such as rising income, attitude changes, higher education levels – which might deter couples from starting a family.

    But there is another major reason why married couples might not have children: infertility.

    Defined by the World Health Organization (WHO) as a couple's inability to conceive after one year of regular, unprotected sexual intercourse, infertility currently affects about 15% of couples in Singapore. The causes of infertility are relatively evenly split between male and female factors.

    Dr Judith Ong, Associate Consultant, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynaecology, NUH  explained, “Achieving pregnancy is a complex series of steps that involve a woman’s ovaries releasing an egg from one of the ovaries, then travelling through the fallopian tube, being fertilised (or joined) by the man’s sperm to form an embryo and attaching to the womb lining successfully (implantation).”


    “The relatively equal contribution of male and female factors to the cause of infertility highlights how crucial it is to investigate infertility as a couple,” Dr Ong added.Factors affecting fertilityAge is a significant determinant of fertility, affecting both men and women. The quantity and quality of a man’s sperm decreases as he gets older, particularly beyond the age of 40. Similarly, women experience a decline in the number and quality of eggs as they age. “A woman’s best reproductive years are in her 20s. Thereafter, fertility gradually declines, particularly after the age of 35,” said Dr Ong.Apart from epidemiological factors such as age, the common causes of infertility are: In-Vitro Fertilisation (IVF) is another ART that is widely used. This method stimulates a woman’s ovaries with injections to produce eggs that are subsequently retrieved during a day surgery procedure. The retrieved eggs are then fertilised in a laboratory using the husband’s sperm, and the resulting embryo is implanted back into the uterus. Nonetheless, there are steps that one can take to try and improve their chances of having a child.Dr Ong elaborated, “General measures to optimise fertility involve supplementation such as folic acid for the woman, regular exercise, maintaining a healthy body mass index (BMI 25 or less), balanced diet, smoking cessation and limiting alcohol intake to 1-2 units per week.”Getting help for infertility The good news for couples who are infertile is that there are several treatment options to help them conceive.The first step of this process involves the couple undergoing a thorough assessment of their reproductive health.“For men, these tests may include a semen analysis, blood tests to assess hormone levels, and ultrasound imaging of the testes and scrotum,” Dr Ong said.“Women may undergo blood tests to evaluate ovarian function and hormone levels, swabs to test for sexually transmitted infections, pelvic ultrasound imaging, and a hysterosalpingogram (X-ray) to check for fallopian tube blockages.”Depending on the underlying causes of infertility, treatment options can include medications to balance hormones, antibiotics to treat infections, fertility drugs to help women ovulate, and surgical procedures to address issues such as varicoceles in men, or endometriosis in women.For couples suffering from sexual dysfunction, psychosexual counselling can be an effective treatment option.Sometimes, however, a couple might require assisted reproductive technology (ART) to help them overcome their fertility issues. One of the most common ARTs is that of Intra-Uterine Insemination (IUI), or artificial insemination. This procedure involves the collection and processing of sperm, which is then placed into the woman’s uterus during ovulation. In-Vitro Fertilisation (IVF) vary with age Success rate ~ 40 % to 50 % Stimulatewoman’s ovaries  with injections to produce eggs Retrieve eggs via a day surgery procedure Collect spermon the same day to fertiliseretrieved eggs in a laboratory Implantresulting embryo into the uterus Success rate Collect  and process  s sperm can increase up to 20%  when combined with fertility medication. ~10  %  to 12     % Place processed sperminto the woman’s uterus during ovulation Intra-Uterine Insemination (IUI) Causes of infertility AgeAbnormalhormonal productionby the brainLack ofsperm productionwhich can be inherited or acquiredObstruction ofsperm passageMedications, Chemotherapy, testosterone or steroid usage AgeProblemswithovulationBlockageoffallopian tubesLowegg countsAbnormalitiesin the womb liningMedications: Chemotherapy FEMALE MALE Fertility gradually declines after the age of 40 after theage of 35 Quality and quantity of sperms and eggs Age WOMEN MEN Causes of infertility PREGNANT NOT PREGNANT bothfemale & malefactors 30 % + female factors 30 % 30 % male factors no obvious reasons 10 %

    Ultimately, by seeking help and exploring the many available treatment options for infertility, couples can increase their chances of achieving a successful pregnancy and starting a family.

    The  Reproductive Endocrinology & Infertility Division at NUH Women's Centre offers comprehensive fertility assessments and a range of ART options.

    In consultation with Dr Judith Ong, Associate Consultant, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynaecology, NUH.

    Please download the full infographics here.

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