Fertility isn't always a guarantee. Our expert from KK Women’s and Children’s Hospital (KKH) help shed light on common reasons why fertility fails.
In theory, getting pregnant seems easy. Yet, why does fertility fail?
You begin with a sperm and an egg. Get them to meet, form an embryo, implant into the uterus and grow. Sounds simple, however for some this can be incredibly challenging.
"The reason is that
fertility is more than just enabling the sperm to meet the egg. It requires a whole series of serendipitous events just to create the perfect environment for the embryo to grow and mature into a fully formed baby," explained Dr Liu Shuling, Senior Consultant from the Department of Reproductive Medicine and Director of KKIVF Centre at KK Women’s and Children’s Hospital (KKH), who help shed some light on the process.
KKH is a member of the SingHealth group.
"While some of these events are out of our control, there are still many things we can do to influence the final outcome," Dr Liu added.
Let us try to break it down for you!
Common factors affecting fertility in men and women
For men
1. Sperm quality
What happens:
During sexual intercourse, millions of forward-moving sperm are deposited into the vagina. Sperm need to swim from the vagina, through the cervix, into the uterus and fallopian tube before reaching the egg to fertilise it. While the egg only needs one sperm to create an embryo, many things can hinder the sperm in its marathon journey.
What you can do:
What can we do to give the sperm the best chance of reaching its finish line to the egg?
Lifestyle factors play an important role in ensuring that there is sufficient and fast forward-moving sperm.
Smoking, heat from saunas and hot baths, poorly controlled medical problems and obesity can reduce the number of fast forward-moving sperm.
Regular clearing of sperm (every two to three days) will also ensure that every ejaculate contains the healthiest sperm.
As sperm can survive longer than the egg, it is always better to start the sperm marathon before the egg is released from the ovary.
But first, get as healthy as possible:
Apart from avoiding hot baths and saunas, it is also important to
have regular sexual intercourse every two to three days to ensure sperm availability regardless of when ovulation occurs.
When to seek help:
Despite these efforts, fertility treatments like
in-vitro fertilisation (IVF) and intracytoplasmic sperm infection (ICSI) will benefit men with a poor sperm count.
For men with no sperm in their ejaculate, they should seek fertility treatment to find out if surgical retrieval of sperm can help. There is also a National Sperm Bank available for married couples who do not have sperm to achieve a pregnancy.
For women
2. Quality of eggs
What happens:
Ovulation occurs when the egg is released from the ovary. This usually happens two weeks before the next expected menses.
Ovulation can be regular and predictable for some, variable and unpredictable for others, or even missing in some women. It is also easily affected by external factors like stress, weight and medications.
Even if ovulation happens, it is difficult to pinpoint the exact time and the egg deteriorates within 24 hours of ovulation.
What you can do:
How then should we predict ovulation?
The goal should be to achieve ovulation by maintaining a healthy BMI and lifestyle, and just wait for it to happen.
We know that ovulation can be unpredictable like the weather, and many have tried to invent ways to predict this event. What may be easier is to have regular deposition of sperm (with regular sexual intercourse) regardless of ovulation day. This way, we do not need to know exactly when ovulation happens.
When the woman gets older, the number and quality of eggs will reduce.
Menopause is when no more eggs can be produced by the ovaries. As such,
the best way to improve egg quality would be to stay as healthy as possible, and to start your family as early as you can.
When to seek help:
If you have irregular menses, this is a clue that ovulation might be variable or missing. You should still have regular sexual intercourse, but also seek fertility advice if you are unable to get pregnant after six months of trying.
Some women may need oral medications, while others might need injections to help with ovulation. Egg donation is also an option for women who are unable to produce eggs despite medical treatment.
3. Blockage of the fallopian tube
What happens:
The fallopian tube is the place where the sperm meets the egg. After fertilisation of the egg, the embryo will be pushed back into the uterus for implantation into the lining of the womb.
The fallopian tube can sometimes get blocked or swollen with fluid, making it difficult for the sperm to meet the egg.
This can happen because of previous infections, surgeries or conditions such as
endometriosis. The embryo can also get trapped inside the fallopian tube resulting in an
ectopic pregnancy.
Type of help available:
Treatment of fallopian tube issues will usually require surgical intervention. Alternatively, IVF is also an option for these women as the process of fertilisation is done in a laboratory.
4. Understanding the uterus
What happens:
Once the embryo is created, it is supposed to implant into the womb lining (endometrium) on day six or seven after ovulation. If it implants properly and continues to grow, it will result in a pregnancy and eventually a baby.
The womb lining is supposed to be sufficiently thick and charged by hormones (from ovulation) for embryos to successfully implant.
It is common to have small growths in the uterus such as polyps or fibroids, but not every one of them will affect fertility and pregnancy. Women with these issues can still achieve successful pregnancies.
When to seek help:
Problems of the womb lining, e.g. endometrial hyperplasia (pre-cancer of the womb lining) and adhesions (scarring of the womb lining) can affect implantation and reduce pregnancy success.
Large endometrial polyps,
fibroids and adenomyosis of the uterus can also affect fertility.
If you have any of these conditions, it would be recommended to
seek advice from fertility doctors to explore the treatment options available to improve fertility.
For men and women
5. Power of the mind
What happens:
While physical health is a key component of fertility,
emotional well-being is as equally important. Getting pregnant can cause anxiety for some couples, so while it may be difficult to be totally stress-free, find ways to maintain your mental health.
What you can do:
Playing your favourite sports could be one simple way to destress while keeping fit. Consider integrating enjoyable hobbies or relaxing activities into your daily schedule.
While getting pregnant can often seem challenging and difficult for some, it is important to know that you are not alone and many couples often face the same troubles and frustrations as you.
Remember that there are many aspects of fertility that remain in your control and achieving simple goals such as having regular sex, staying healthy and stress-free can take you a long way in your pregnancy journey.
When to seek help:
However, if you are still facing difficulties despite
six to 12 months of regular intercourse, it may be time to get some help and seek professional advice from a healthcare professional or fertility specialist.
Ref: H24
Related articles:
Embarrassing Fertility Questions Answered!
Preconception Screening: What It Is and Why It Matters
Is There an Ideal Weight for Conceiving?
Nutrients Needed for Conception
IVF (In-Vitro Fertilisation): When Is It Necessary?
