Starting a family is a deeply personal and eagerly anticipated milestone for many women. But the journey to motherhood isn’t always a smoothly sailing ride. Female infertility can rock your boat. It affects many women in our community and often causes emotional distress and uncertainty.

This article will shed light on this complex issue as we provide essential information for you who may be struggling to conceive or are generally concerned about your fertility. We also offer tips on how to improve fertility naturally and navigate the emotional challenges that often accompany this journey.

Understanding Female Infertility

Infertility is a topic that many women find difficult to discuss, but it’s more common than you might think. In simple terms, female infertility refers to the inability to become pregnant after trying for a year or more of regular, unprotected sexual intercourse.

For women over 35, doctors often recommend seeking help after six months of trying because fertility naturally declines with age. It’s important to highlight the fact that infertility is not just a “women’s issue”. It can affect both partners and in about one-third of cases, it’s a combination of male and female factors.

When should you consider the possibility of infertility?

The following are signs that you need to watch out for, as these can indicate infertility.

1. If your menstrual cycles are very unpredictable or you don’t get periods at all. It might indicate an ovulation problem.
2. If you experience severe pain during menstruation. It could be a sign of conditions like endometriosis.
3. If you are over 35 and have been trying to conceive for six months without success. This is worth discussing with a doctor.
4. If you have had certain medical conditions or treatments like chemotherapy. These can also impact fertility.
5. If you have vices and other health factors. Examples are smoking, excessive alcohol drinking, and being overweight/underweight. All these can affect your ability to conceive.

It doesn’t necessarily mean that if you are experiencing one or more of these signs that you are infertile. Many women with these issues go on to have healthy pregnancies. However, they are good reasons to check in with your gynaecologist or a fertility specialist.

Common Causes and Risk Factors of Female Infertility

Every woman’s situation is unique. But there are several factors that can contribute to fertility challenges. Here is what you should know about the potential causes and factors of female infertility.

1. Ovulation Disorders – This is one of the most frequent causes of infertility in women. If you are not ovulating regularly, it becomes difficult to time conception. Conditions like PCOS can disrupt normal ovulation.
2. Age-Related Factors – As women age, the quantity and quality of eggs decrease. This process accelerates after age 35, which is why doctors often advise not to delay asking for medical help if you are in this age group.
3. Fallopian Tube Issues – If your fallopian tubes are blocked or damaged, it can prevent the egg and sperm from meeting. It may be caused by previous infections, surgeries, or conditions like endometriosis.
4. Uterine or Cervical Abnormalities – Sometimes, the shape of the uterus or issues with the cervix can make it harder for an embryo to implant or for sperm to reach the egg.
5. Endometriosis – This condition, where tissue similar to the uterine lining grows outside the uterus, can affect fertility in several ways. It’s quite common and often underdiagnosed.
6. Hormonal Imbalances – Conditions affecting the thyroid gland or other hormonal disorders can interfere with the regular menstrual cycle and ovulation.
7. Unexplained Infertility – In some cases, despite thorough testing, no specific cause is found. This can be frustrating, but it doesn’t mean there’s no hope.

Many women with these issues do conceive, sometimes with medical help and sometimes naturally.

Diagnosing Infertility

If you have been trying to conceive without success, you might be wondering what the next steps are. In Singapore, we’re fortunate to have access to world-class healthcare facilities that can help diagnose and treat fertility issues.

When to See a Doctor

• If you are under 35 and have been trying to conceive for a year without success
• If you are 35 or older and have been trying for six months
• If you have irregular or painful periods, or other symptoms that concern you

What to Expect at Your First Appointment

Your doctor will likely start with:

1. A detailed medical history. Be prepared to discuss your menstrual cycle, sexual habits, birth control use, and any previous pregnancies or health issues.
2. Physical examination. This may include a pelvic exam to check for any obvious physical issues.

Common Diagnostic Tests

1. Blood Tests to check your hormone levels including:
   1. FSH or Follicle Stimulating Hormone)
   2. LH (Luteinizing Hormone)
   3. Estradiol
   4. Progesterone
   5. Thyroid hormones
2. Ultrasound to visualise your ovaries and uterus and check for cysts, fibroids, or other abnormalities
3. Hysterosalpingogram (HSG) to check if your fallopian tubes are open
4. Ovulation testing to confirm if you’re ovulating
5. Laparoscopy to look for issues like endometriosis

Interpreting Results

Your doctor will explain what the test results mean for your fertility. Don’t hesitate to ask questions. Your aim should be fully understanding your situation so you can only make informed decisions.

What Happens Next

Based on the diagnosis, your doctor may:

• Recommend lifestyle changes
• Prescribe medications to help with ovulation
• Suggest further testing
• Refer you to a fertility specialist for advanced treatments

Remember:

1. Bring your partner along if possible. Male factors contribute to about 40% of infertility cases, so your partner may need testing too.
2. Keep a record of your menstrual cycles and any symptoms to share with your doctor.
3. Don’t be embarrassed to discuss intimate details. Your healthcare providers are professionals and this information is crucial for accurate diagnosis.
4. In Singapore, you can start by consulting your regular GP or gynaecologist. They can provide initial assessments and refer you to specialists if needed.
5. Some tests might be covered by MediSave or your health insurance. Check with your provider about coverage options.

The diagnosis of infertility in women can certainly be overwhelming. But remember that you are not alone in this journey. Many couples go through this process every year. Just by having the right medical support and information, you will be equipped to understand your fertility status and explore your options for building a family.

Treatment Options

Once you have been diagnosed with infertility, your doctor will discuss treatment options with you. Sometimes, simple adjustments to your lifestyle can improve fertility. Your doctor may suggest you to maintain a healthy weight, reduce stress, or quit smoking (if you do).

Here are the common treatments for infertility in women:

1. Medications for Ovulation Induction
   1. Clomiphene citrate (Clomid) to stimulate ovulation
   2. Gonadotropins are injectable hormones that stimulate the ovaries to produce multiple eggs
   3. Metformin is often prescribed for women with PCOS to improve ovulation
2. Intrauterine Insemination (IUI)
   1. This is a procedure where sperm is placed directly into the uterus during ovulation and is often combined with ovulation-inducing medications
3. In vitro fertilisation (IVF)
   1. Eggs are retrieved from the ovaries and fertilised with sperm in a lab
   2. The resulting embryo is then transferred to the uterus
   3. IVF is widely available in Singapore and has good success rates
4. Intracytoplasmic Sperm Injection (ICSI)
   1. A specialised form of IVF where a single sperm is injected directly into an egg
   2. This is useful in cases of male factor infertility
5. Surgical Procedures
   1. Laparoscopy may be performed to remove endometriosis, scar tissue, or fibroids
   2. Tubal surgery may also be done to mend blocked fallopian tubes
6. Donor Eggs or Sperm
   1. This is an option for those with poor egg or sperm quality
   2. This process is regulated in Singapore and anonymity is maintained
7. Surrogacy
   1. It is not legal in Singapore but some couples explore this option overseas

What are Some Important Considerations?

1. Ask your doctor about success rates for different treatments, considering your situation.
2. Fertility treatments can be expensive. You can use MediSave for some fertility treatments like IVF and IUI. There are also co-funding schemes available for eligible couples. Read more details on Marriage and Parenthood Schemes.
3. Some treatments increase the chance of twins or triplets. So discuss the risks with your doctor.
4. Undergoing fertility treatments may cause stress. Many women’s clinic in Singapore offer counselling services.
5. Some treatments may take several cycles. So discuss the expected timeline with your doctor.

Lifestyle Changes and Tips for Conception

Here are the changes to lifestyle and strategies you can adopt to improve your chances of getting pregnant. Sometimes the smallest adjustments that you do significantly impact your rate of conception.

1. Maintain a healthy weight. Aim for a BMI between 18.5 and 24.9.
2. Eat a balanced diet and include foods rich in folic acid, iron, and omega-3 fatty acids.
3. Drink plenty of water. Limit caffeine and avoid alcohol.
4. Exercise regularly. Try activities like brisk walking and swimming. If not, you can do yoga. Just don’t do extreme or intense workouts.
5. Manage stress effectively. Join support groups for women trying to conceive.
6. Quit smoking and avoid second-hand smoke. If your partner smokes, encourage them to quit too.
7. Be cautious with household chemicals and pesticides. If possible, go organic.
8. Use a period tracking app or keep a calendar to predict ovulation. Also learn to recognise signs of ovulation, like changes in cervical mucus.
9. Have regular unprotected sex throughout your cycle. The “fertile window” is typically 5 days before ovulation and the day of ovulation.
10. Use ovulation prediction kits. These can help pinpoint your most fertile days. They are available at most pharmacies in Singapore.
11. Maintain a consistent sleep schedule. It’s important that you get quality sleep.
12. Schedule a preconception check-up for a full health assessment. Make sure your vaccinations are up-to-date and discuss any medications you’re taking.
13. Start taking prenatal vitamins. Folic acid is particularly important. Consult your doctor if there are other supplements you might need.
14. Be mindful of lubricants, as some lubricants can interfere with sperm motility.
15. Maintain a healthy sex life. Regular sex (2-3 times a week) can improve your chances of conception. Try to keep sex enjoyable and not just goal-oriented.
16. Be patient. Conception can take time, even for healthy couples. If you’re under 35, consider medical help after a year of trying. If you are over 35, consult a doctor after six months.

Conclusion

We want to remind you that if you are diagnosed with female infertility, there are many options available to help you on your path to parenthood. It doesn’t matter whether you’re just starting to consider your fertility or have been trying for a while. It is best that you seek support from medical professionals and loved ones.

Stay hopeful and take care of yourself. Your well-being is the most important thing as you navigate this journey.

Are there concerns you want to talk about? Our gynaecologist is open to discuss them with you, without judgement. Find our contacts here.

References

https://my.clevelandclinic.org

https://www.betterhealth.vic.gov.au

https://www.nichd.nih.gov

https://www.ncbi.nlm.nih.gov