Infertility

                                                                                                            chinese
Infertility, defined by WHO is the inability to conceive a child. A couple may be considered infertile if, after two years of regular sexual intercourse, without contraception, the woman has not become pregnant (and there is no other reason, such as breastfeeding or postpartum amenorrhoea). Primary infertility is infertility in a couple who have never had a child. Secondary infertility is failure to conceive following a previous pregnancy. Infertility may be caused by infection in the man or woman, but often there is no obvious underlying cause. Women who are able to get pregnant but unable to stay pregnant are also considered to be infertile.

Infertility is a rather common problem affecting about 10% of the women in United States according to Centers for Disease Control and Prevention. Infertility is not limited to woman only; men may also have infertility problems.

Risk factors to infertility in women:

• Age
• Stress
• Poor diet
• Excessive physical activity
• Overweight
• Underweight
• Smoking
• Excessive usage of alcohol
• Sexually transmitted infections
• Diseases that can cause hormonal changes

How long should a woman try before getting help?

Women younger than 35 years old: 1 year

Women older than 35 years old: 6 months

When consulting a doctor, please inform your doctor if you have the following symptoms:

• Irregular or missing menstrual cycles
• Painful periods
• Endometriosis
• Pelvic inflammatory disease
• More than one miscarriage

What causes infertility in men?

• Autoimmune disorders, such as antiphospholipid syndrome (APS)
• Cancer or tumor
• Clotting disorders
• Diabetes
• Growths (such as fibroids or polyps) in the uterus and cervix
• Birth defects that affect the reproductive tract
• Excessive exercising
• Eating disorders or poor nutrition
• Use of certain medications, including chemotherapy drugs
• Drinking too much alcohol
• Obesity
• Older age
• Ovarian cysts and polycystic ovary syndrome (PCOS)
• Pelvic infection or pelvic inflammatory disease (PID)
• Scarring from sexually transmitted infection or endometriosis
• Surgery to prevent pregnancy (tubal ligation) or failure of tubal ligation reversal
• Thyroid disease
• Too little or too much of certain hormones (PubMed Health, 2012)

What causes infertility in women?

• Environmental pollutants
• Being in high heat for prolonged periods
• Birth defects
• Heavy use of alcohol, marijuana, or cocaine
• Too little or too much hormones
• Impotence
• Infection
• Older age
• Cancer treatments, including chemotherapy and radiation
• Scarring from sexually transmitted diseases, injury, or surgery
• Surgery to prevent pregnancy (vasectomy), or failure of vasectomy reversal
•  Retrograde ejaculation
• Smoking
• Use of certain drugs, such as cimetidine, spironolactone, and nitrofurantoin (PubMed Health, 2012)

Services available from most hospital include :

•  Infertility Screening
• Semen Analysis
• Evaluation by Fertility Specialist
• Ovulation Induction and Monitoring
• Super-ovulation and Intrauterine Insemination (SO-IUI)
• In-vitro Fertilisation (IVF)
• Intra Cytoplasmic Sperm Injection (ICSI)
• Blastocyst Transfer
• Cryopreservation of Sperms and Embryos
• Advanced Infertility Laparoscopic and Hysteroscopic Surgery

Fertility Treatment & Procedures

1. IVF and ICSI (In-vitro fertilisation and intracytoplasmic sperm injection)

This is the most advanced form of fertility treatment. It involves the extraction of the egg and combining it with the sperm in the laboratory. Fertilisation can be achieved naturally when a sperm penetrates the egg ‘shell’ or with assistance in the case of ICSI. In ICSI, a single sperm is injected into the egg with a fine glass needle.

2. Biastocyst Culture and Transfer

A blastocyst is an embryo that has developed about 5 days after fertilization. By this time it has developed from a single cell to a hollow ball of cells, with a ‘clump’ of cells in the cavity. In Blastocyst transfer, embryos are cultured in the laboratory for five days after fertilisation.

Only one or two Blastocysts are transferred to reduce the risk of multiple pregnancy as they have a higher probability to implant. It is important to note that many embryos die before they reach the blastocyst stage. You should first discuss with the doctor whether Blastocyst transfer is suitable for you.

3. Assisted Hatching (AH)

 AH benefits women who are over 40 or women who fail to get pregnant despite repeated embryo transfers with good quality embryos. Implantation occurs after the embryo ‘hatches’ from the gel-like shell and attaches itself to the wall of the womb. In some women, the shell may be too thick or tough and traps the embryo inside.

Making controlled cuts on the shell of the embryo just before replacing them in the womb, makes it easier for the embryo to hatch thereby improving the chance of pregnancy.

4. Embryo Freezing

Patients who have spare embryos after embryo transfer can choose to freeze their remaining good quality embryos for a subsequent embryo transfer. The cost of a thaw cycle is much less than a fresh cycle with no decrease in chance of pregnancy if 3 embryos are transferred.

5. MESA / TESE

Some men who had been vasectomised previously or have an obstruction in their spermatic ducts will have no sperm in their ejaculate. Sperm can then be surgically extracted by an operation such as micro-epididymal sperm aspiration (MESA) or Testicular sperm extraction (TESE). Testicular sperm has very poor motility and must be combined with the ICSI procedure to fertilise an egg.

Email your personal profile and medical history to us at enquiry@sgmedical and we will recommend a health screening package to meet your stage of health.