As Singaporeans choose to marry later and to wait for financial stability before starting a family, it is inevitable that we see a decline in our total fertility rate. This is because fertility starts to decline once we pass the age of 30. With regular sexual intercourse, women will have about a 20% chance of becoming pregnant each month in her 20s, but this figure drops to 15% in her 30s and, finally, to 5% when she crosses into her 40s.
That said, 80% of all couples will still be able to become pregnant after a year of trying. If the couple is unable to conceive after 12 months of trying, they should seek medical advice as there may be some underlying problem. Couples above the age of 35 should seek help earlier, after half a year of trying as, given their age, time is even more of the essence.
Contrary to popular belief, male and female factors contribute equally to subfertility. About one third of all cases are due entirely to female factors, a third due to male factors, and a third due to a combination of male and female factors.
For the females, a gynaecological consultation is vital to assess for any preexisting medical conditions and for direct causes of subfertility like anovulation and tubal patency. Proper management of these conditions is important to facilitate conception and to minimise pregnancy complications. Certain medications for pre-existing condition may need to be adjusted or changed to minimise fetal risk. Gynaecological conditions like uterine fibroids, polyps and ovarian cysts may need to be treated before conception.
For the males, the sperm quantity and quality can be assessed by semen analysis, an inexpensive and non-invasive test. Any issue should be thoroughly investigated and treated to improve the sperm quality.
Besides medical treatment for subfertility issues, lifestyle changes for the couple may be paramount for conception and a healthy pregnancy. Excessive work stress and working hours often prevent couples from having regular sexual intercourse, therefore certain adjustments and greater effort may be necessary to allocate time together. They should try to have a balanced diet with more vegetables and fruits while decreasing fatty and sugary food. Alcohol and caffeine intake should be moderated. Regular exercise and enough sleep are also essential for general physical well-being, as lack of sleep is associated with hormonal disturbance which in turn affects ovulation and sperm quality, as well as weight gain.
Subfertility is often due to a combination of factors which can be treated. But even when natural conception remains elusive, there are many assisted reproductive therapies available to help couple achieve their dream of having a baby!