Infertility Factors: What Couples Should Know

Infertility, defined as the inability to conceive after a year of regular, unprotected intercourse, is an increasing concern among couples in Singapore. For many, the struggle to conceive brings about feelings of anxiety and uncertainty over what steps to take next. However, there are effective ways to understand the underlying causes and explore treatment options that can bring hope and clarity.

Dr Christopher Ng, Medical Director at GynaeMD Women's and Rejuvenation Clinic, offers a compassionate and tailored approach to supporting couples on their fertility journey. Read on to learn the common signs of infertility in both men and women, as well as the diagnostic tests and treatment options available to help manage this condition.

Statistics on Male vs. Female Infertility in Singapore

Infertility affects both men and women. In about 40% of cases, the cause is linked to issues in the male reproductive system, while another 40% are related to female factors. The remaining 20% arise from a combination of male and female issues or remain unexplained despite evaluation.

Furthermore, research from Singapore’s National University Hospital shows that approximately one in six couples experience difficulties conceiving. These findings highlight why medical professionals recommend comprehensive fertility assessments for both partners when pregnancy proves difficult to achieve.

Common Infertility Causes

The causes of infertility are generally categorised into male and female factors.

Female Infertility Causes

Women may experience infertility due to a range of issues, such as:

• Ovulation Disorders – Ovulation disorders disrupt the release of eggs from the ovaries, making conception difficult. Conditions such as polycystic ovary syndrome (PCOS) and thyroid dysfunction can prevent regular ovulation.
• Fallopian Tube Blockages – Blocked fallopian tubes prevent the sperm from reaching the egg, making natural conception nearly impossible. This condition may result from pelvic inflammatory disease (PID), endometriosis, or previous surgery.
• Endometriosis – Endometriosis occurs when tissue similar to the lining of the uterus grows outside the uterine cavity and invades the ovaries, fallopian tubes and other pelvic tissues. This condition affects roughly 10% of reproductive-age women worldwide, including many in Singapore.
• Uterine Abnormalities – Abnormalities such as fibroids, polyps, or structural anomalies can interfere with embryo implantation or disrupt the uterine environment, leading to infertility.

Male Infertility Causes

Male infertility can result from various factors, including:

• Sperm Disorders – Sperm disorders are among the most common causes of male infertility. These disorders can consist of low sperm count, poor sperm motility and abnormal sperm morphology or shape.
• Obstructions – Blockages in the male reproductive tract, such as the vas deferens (the tube that carries sperm), can prevent sperm from being ejaculated, leading to infertility. These blockages may result from infections, surgery, or congenital abnormalities.
• Hormonal Imbalances – Hormonal imbalances can significantly impact sperm production and male fertility. Conditions such as hypogonadism or thyroid disorders can lead to reduced testosterone or FSH/LH levels and impaired sperm production.
• Lifestyle Factors – Smoking, heavy alcohol use, obesity and exposure to environmental toxins can negatively impact sperm quality and reproductive health.

Diagnostic Tests for Infertility

For an accurate diagnosis of infertility, doctors often begin with a thorough medical history and physical examination, followed by specific tests tailored to the individual's needs. Couples may undergo a thorough diagnostic workup, including:

• Semen Analysis – This laboratory test assesses the overall health and quality of a man’s semen, focusing on sperm count, motility and morphology. Beyond measuring these parameters, it also helps identify potential sperm production issues or other underlying causes of male infertility.
• Transvaginal Ultrasound – Using a specialised ultrasound probe, this test provides detailed images of the pelvic organs, including the uterus, ovaries, fallopian tubes and cervix. It helps detect abnormalities such as ovarian cysts, uterine fibroids or polyps that may hinder conception.
• Hormonal Blood Panels – A series of blood tests is performed to measure key reproductive hormones, including oestrogen, progesterone, FSH, LH, AMH and thyroid hormones. These results provide insight into ovulation, ovarian reserve and overall hormonal balance.
• Hysterosalpingography (HSG) – This specialised X-ray procedure evaluates the condition of the fallopian tubes and uterine cavity. A contrast dye is gently introduced into the uterus, allowing doctors to check for blockages, scarring or structural irregularities that could affect fertility.
• Laparoscopy – A minimally invasive surgical procedure, laparoscopy allows direct visualisation of the pelvic organs through a small incision in the abdomen. It is commonly used to diagnose and sometimes treat conditions such as endometriosis, fibroids or adhesions that may contribute to infertility.

Treatment Options and Support at GynaeMD

We offer a wide range of treatment options to support couples on their fertility journey. These include:

• Ovulation Induction – This treatment involves the use of fertility medications to stimulate the ovaries, promoting the growth and release of eggs. Supporting regular ovulation helps increase the likelihood of conception, especially in women who experience irregular or absent cycles.
• Intrauterine Insemination (IUI) – During IUI, specially prepared sperm is placed directly into the uterus at the time of ovulation. This approach helps bring sperm closer to the egg, improving the chances of fertilisation. It is often considered a simpler and less invasive option compared to in vitro fertilisation (IVF).
• In Vitro Fertilisation (IVF) – IVF is an assisted reproductive technique in which eggs are collected and fertilised with sperm outside the body in a controlled laboratory setting. Once fertilisation occurs, the resulting embryo is transferred into the uterus. IVF is commonly used in cases of blocked fallopian tubes, ovulation problems or unexplained infertility.
• Intracytoplasmic Sperm Injection (ICSI) – A more specialised form of IVF, ICSI involves injecting a single sperm directly into an egg to facilitate fertilisation. This technique is particularly beneficial when male infertility is due to low sperm count, poor motility or abnormal morphology.
• Surgical Interventions – In some cases, surgery is recommended to correct anatomical conditions that hinder conception. Procedures may be performed to remove fibroids, treat endometriosis, repair tubal blockages or address other structural issues affecting reproductive health.
• Egg Freezing (Oocyte Cryopreservation) – This procedure allows women to preserve their fertility by retrieving, freezing and storing eggs for future use. It is often chosen by those who wish to delay childbearing for personal, medical or professional reasons, offering greater flexibility for family planning later in life.

Holistic Care for Both Partners

Infertility is more than a medical concern; it affects emotional and psychological well-being. What sets our clinic apart is its emphasis on supporting both partners, empowering them to take control of their fertility journey.

GynaeMD provides various holistic services, including:

• Emotional counselling and wellness coaching
• Lifestyle and nutritional advice to optimise reproductive health
• A private, non-judgmental environment that encourages open dialogue.

Whether you are just starting to explore your fertility options or considering assisted reproductive techniques, Dr Christopher Ng is here to help every step of the way.