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So, you decided to start trying for a BABY

The FIRST STEP is to prepare both your bodies for conceiving and take the following actions:-

  • Stop birth control;

  • Schedule a check up for you and your partner - find out if you need to take additional supplements or medication;

  • Eat healthy - start a Pre-pregnancy Diet, avoid alcohol as much as possible, moderate caffeine intake, etc; 

  • Follow healthy lifestyle habits - exercise regularly to promote blood circulation, avoid smoking, stressful environments or sleeping late.

The NEXT STEP is the fun part - have sexual intercourse...if you are having sex regularly and not falling pregnant, you need to:-

  • Time your sex during your fertile window - you can use apps such as Flo or CLUE to track your cycle and identify your fertile window;

  • Be super relaxed when having sex - play some music, enjoy each other before actually having intercourse....whatever calms the female partner down and puts her in a very relaxed mood;

  • Consider different sexual positions that can make it easier to get pregnant. There is, however, no clear scientific claim to any position being the most effective. Stay in bed after intercourse or lady to put her feet up or Viparita Karani after ejaculation.

Diagnosing Infertility

If you are still not pregnant after 6 months of trying correctly (i.e., sex during fertile window), you should carry out a more thorough fertility assessment. In Singapore, you can do this at the polyclinic (which will likely refer you to public hospital) or directly with private OB-GYN.

Read on to find out about:

  • Tests for women;

  • Tests for men;

  • Male and female infertility

  • What causes the female body to produce unhealthy eggs

  • What causes the male body to produce unhealthy sperm

  • What can cause the egg to be unsuccessfully transported to the womb (in the female body)?

  • What can cause the sperm to be unsuccessfully transported to the female womb (from the male body)?

  • What can prevent the embryo from implanting in the womb (in the female body)?

  • How can you try to boost your fertility?

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Tests for Women

As the child-bearer, ladies have more tests to undergo than men. We not only need to make sure our eggs are of good enough quality, but the womb to house the growing embryo must also be in good condition.

  • Physical examination of your vital signs, heart, lungs, breast, abdomen, cervix, uterus, and ovaries.

  • Pelvic ultrasound to check for fibroids, endometriosis, polyps or cysts on her womb lining. This is because the surface area for the fertilised egg to latch itself to is reduced when there are other growths on the lining. The pelvic ultrasound will also check your ovaries for abnormalities.

  • Pap smear if this has not been done within the last 3 years to check for abnormalities in the cervix.

  • Blood tests will also be done. In addition to the test for HIV, Hepatitis B and C, blood is also tested for other things like hormones (Follicle Stimulating Hormone (FSH), Luteinising Hormone (LH), Estradiol, Testosterone, Prolactin, Progesterone), thyroid function and Serum Anti-Müllerian Hormone (to assess your ovarian reserve). You might be called back to the clinic for an additional blood test at the time of your ovulation to check for ovulation disorders.

  • Hysterosalpingogram (HSG), a type of X-ray of the fallopian tubes and uterus might also be ordered by your doctor. An HSG is a short 15-30 minute procedure that is either performed in the clinic or at an imaging centre where a thin catheter (tube) is inserted through the vagina into the cervix and subsequently the womb of the woman. Medical dye is pumped through the tube and an ultrasound or X-ray is then performed over the woman’s pelvic area for the gynaecologist to visualize the uterus, ovaries and fallopian tubes. If the fallopian tubes are open, the dye will flow through the tubes and be visible in the abdominal cavity. If the fallopian tubes are blocked, the dye will be retained in the uterus or fallopian tubes, depending on the location of the blockage. The procedure is slightly uncomfortable, and many women have described it as feeling like menstrual cramps.

Tests for Men

  • Physical examination of your penis and scrotum.

  • Semen Analysis where you will be asked to ejaculate into a cup after abstaining from ejaculation or intercourse for at least 3-6 days. Semen can be collected at home and brought to the lab within 2 hours. Alternatively, there may be a room at the clinic where you can ejaculate. The semen analysis checks your sperm count (whether the number is high enough or not), morphology (whether they are all shaped correctly), and motility (whether they move correctly or not).

  • Blood tests for infections such as Hepatitis B and C, Syphilis, Human Immunodeficiency Virus (HIV). Infection screening is a mandatory requirement by the Ministry of Health for all patients enrolling in IVF programmes. The test results for HIV are valid for 6 months. The test results for the other diseases are valid for 1 year.

Once the results from the tests are out, your fertility doctor will discuss with you the results and, if any abnormalities arise, the corresponding treatment options you and your spouse can opt for.

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Tests for Men

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Male and Female Infertility

A few things need to take place before a successful pregnancy can take place:

  1. The female body needs to produce a healthy egg

  2. The male body needs to produce healthy sperm

  3. The female ovaries needs to release the healthy egg and the egg needs to be successfully transported to the womb

  4. The male testes need to successfully release the healthy sperm into the female’s womb (through sexual intercourse)

  5. The healthy egg needs to meet a healthy sperm to form an embryo

  6. The embryo needs to successfully implant itself in the female’s womb

If any of the above events fail to take place, infertility results.

What Causes the female body to produce unhealthy eggs?

There are many possible reasons why some women are unable to produce healthy eggs. The reasons can be roughly fit into 2 categories:

  • Problems with Ovulation

There are many reasons behind irregular ovulation. Most are linked with hormonal imbalances caused by endocrine disorders, such as thyroid disorders, hypothalamic dysfunction, or Polycystic Ovarian Syndrome.

Our endocrine system is a network of glands that release chemical messengers in our body. Known as hormones, these chemical messengers regulate to bring balance to our bodies. For example, when we eat our meals, insulin is released from our pancreas to activate the absorption of sugar in our bloodstream. Similarly, hormones are released from our ovaries and other glands to regulate the menstrual cycle of females and sperm production in males. If there is an issue with any part of our endocrine system, especially the hormones affecting our reproductive organs, fertility is affected.

Polycystic Ovarian Syndrome (PCOS) is a common hormonal imbalance that affects the development and release of eggs from the ovaries. A woman can have PCOS if her ovaries appear polycystic in a pelvic ultrasound, she has irregular periods, or has abnormal levels of male hormones in her body.

  • Problems with Egg Quality and Ovarian Reserve

All females are born with a fixed supply of eggs inside their ovaries. As a woman ages, this supply gradually decreases until menopause. Some factors, such as lifestyle and diet, environmental factors, medical issues, and genetics, can accelerate this decrease in supply. Some women (under 40 years old) suffer from premature ovarian failure. With lower estrogen production in their bodies, the body does not ovulate, resulting in infertility.

Poor egg quality can also be defined by abnormal eggs. Eggs with genetic defects can become fertilised, but the pregnancy may not progress.

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What causes the male body to produce unhealthy sperm?

Abnormal sperm production or function can be due to lifestyle choices such as alcohol, cigarette or drug use, genetics or defects such as undescended testicles, health problems such as diabetes, high blood pressure or depression, or infections such as chlamydia, gonorrhea, mumps, or HIV. Enlarged veins in the testes (varicocele) also can affect the quality of sperm. In addition, frequent exposure to heat, such as in the use of saunas, hot tubs, or having hot showers, can raise the body temperature and affect sperm production.

What can cause the egg to be unsuccessfully transported to the womb (in the female body)?

When released from the ovary, the egg is transported down the fallopian tubes to the womb. If there is an obstruction in the fallopian tubes, the egg is unable to reach the womb. Just like how traffic flows on our roads. If there is an obstruction, a traffic jam can occur. If the road is closed, vehicles cannot pass through.

 

Fallopian tubes can be physically blocked or damaged by scarring. Scarring can be caused by a variety of factors, such as pelvic inflammatory disease (PID) from sexually transmitted diseases (STDs) like Gonorrhea and Chlamydia. Fallopian tubes can also be blocked by liquids that change the shape of the tubes. Called hydrosalpinx, this condition can be caused by previous surgeries, infections and endometriosis.

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What can cause the sperm to be unsuccessfully transported to the female womb (from the male body)?

Similar to how eggs can be unsuccessful in its travels from the ovaries to the womb, sperm can also be unsuccessful in its movement into the womb. There are 2 key reasons for it:

 

  • The vas deferens that transports the sperm to the penis can also be blocked or damaged by scarring. Severe genital or urinary infections, injury during scrotal or inguinal surgery and birth defects are some of the common causes.

 

  • Sexual problems, such as premature ejaculation and erectile dysfunction, can also cause infertility. The causes may be psychological or due to health conditions such as heart problems, diabetes and/or obesity.

What can prevent the embryo from implanting in the womb (in the female body)?

Implantation failure is when a fertilised egg is unable to implant in the womb. This usually suggests that the conditions in the womb are not conducive for the fertilised egg to implant itself. The presence of polyps, fibroids and scar tissue can disrupt the fertilised egg. An endometrium lining that is too thin or too thick is also an unconducive environment for implantation. Endometriosis (a condition where tissue that forms the lining of your uterus, the endometrium, grows outside of your uterine cavity) and adenomyosis (a condition where endometrial tissue grows inside the muscles of the uterus, making the uterine walls grow thicker) also make it difficult for the fertilised egg to implant in the womb.

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How can you try to boost your fertility?

There are many things ladies and men can do to boost their fertility. Many have found the book “It starts with the egg” by Rebecca Fett a good reference to understand what to avoid and what supplements to take if you are trying to conceive naturally. While the list below is by no means exhaustive, what might affect most might not affect you and vice versa.

Things to do or increase

A healthy lifestyle tends to improve fertility. The following are some healthy ways to improve your lifestyle:

 

  • If you smoke, quitting will improve your chances of a successful pregnancy

  • Reduce consumption of alcohol and caffeine

  • Follow a healthy diet, such as the Mediterranean diet, that is rich in green leafy vegetables, fruit, healthy unsaturated fats and oils, legumes, lean meat, and seafood proteins, together with low-glycemic (slower to digest) whole-grain carbohydrates and avoiding processed foods can help to improve fertility by reducing hormonal disruptions and inflammation in the body. 

  • As being overweight or underweight has been associated with infertility, achieving your ideal weight helps to better your chances of getting pregnant. The amount of fat stored in the female body has an influence over menstrual function.

  • Exercise moderately. Increasing physical activity not only can help to lose weight (if you are overweight), but it also can help to increase energy levels and promote cell renewal. However, moderation is key. Excessive high intensity exercise can decrease fertility in some men and women.

  • Another surprising factor that may impact your chance of conceiving and carrying to term is the health of your teeth. Gum disease is caused by bacteria building up between the teeth and gums, causing soreness and sometimes bleeding. Bacteria from gum infections can potentially travel into the amniotic fluid and cause a local immune response. This increases the risk of miscarriage or premature birth.

  • Take time to relax. Stress has been shown to be linked to lower fertility, possibly due to the hormonal changes that occur when you feel stressed.

In addition to lifestyle changes, taking supplements can help to ensure that your body has all the nutrients it needs. Start taking the supplements as soon as possible (preferably 3 months before you start trying for a family). Most supplements can continue to be taken until after your baby is born, stopping only when you have chosen to stop nursing.

 

  • A multivitamin, especially one that is suitable as a prenatal vitamin for ladies, not only helps to prevent birth defects (such as folate in preventing spinal defects), but also helps to restore the function of the ovaries and boost egg quality. Some vitamins can also reduce the risk of miscarriage. Prenatal vitamins are also available for men. These vitamins for men are formulated to support healthy sperm production. They often contain supplements such as zinc, selenium, Vitamin C and Vitamin E.

  • Folate or folic acid is a B vitamin that the body needs and its deficiency can affect egg quality. Folate is an important vitamin for making new copies of DNA, for cell division and development. These processes play huge roles in early pregnancy by encouraging proper cell division and growth, reducing risks of miscarriage and birth defects.

  • Iron supplements can improve ovarian functions. Taking iron with vitamin C helps to increase its absorption. Some experience nausea or digestive issues from taking iron tablets and this can be prevented by taking chelated iron, or iron supplements that are labeled “easy to absorb”.

  • Vitamin D is produced in the body by cells in the skin when we are exposed to sunlight. With increased use of sunblock, we can inadvertently be deficient to Vitamin D. Taking a Vitamin D supplement of at least 2,000 international units (IU) can help. Alternatively, get more sun exposure, in the mornings or evenings, but avoid the harsh sun of the afternoon.

  • Other supplements that are good for pregnancy are Vitamins B12 and B6 that help in boosting fertility by increasing cellular function. Vitamins A, C and E, Coenzyme Q10 are known antioxidants that can help to prevent oxidative damage to eggs and are generally good for health. Zinc, Selenium and iodine can help with proper thyroid function. 

Things to avoid or reduce

In addition to building up the body through healthy lifestyles and supplements, it’s also important to reduce exposure to toxins that we are exposed to in our environments.

  • Bisphenol A (BPA) can interfere with the activity of estrogen, testosterone, thyroid hormones, and insulin, all of which can affect egg development and fertility. BPA can be avoided by reducing the use of plastics, canned food and drinks, and paper receipts. BPA most often enters the body when people consume food and drinks that have been packaged or stored in a material that leaches BPA. Small amounts can also be absorbed through the skin from contact with products coated with BPA, such as thermal paper receipts. By either path, BPA makes its way into the bloodstream and then into various tissues. To reduce the inadvertent exposure to BPA, wash your hands immediately after handling, particularly before eating.

  • Phthalates are known reproductive toxins often found in fabric softeners, cleaning products, cosmetics, nail polish, and fragrances. They can also be found in soft, flexible plastics such as polyvinyl chloride (PVC). They can be absorbed through the skin or inhaled from the air. Research has shown that phthalates can interfere with healthy egg development and impair embryo survival. To avoid phthalates, choose products that are made with plant-based natural ingredients, labeled “phthalate-free” or look at the ingredient list to check for the word “phthalate” buried in a long chemical name, such as di-n-butylphthalate (DBP) or diethyl phthalate (DEP).

  • Taking less simple carbohydrates and sugars can help to balance blood sugar and insulin levels. As diabetes can affect fertility, eating more complex carbohydrates can prevent sugar spikes in our blood, preventing the sugar and insulin from disrupting the balance of hormones that regulate the reproductive system. Evidence suggests that this hormonal imbalance caused by sugar and insulin is a possible cause of PCOS.

  • Trans fats are often found in commercial baked and fried foods, such as doughnuts and cookies. As trans fats are linked to a variety of health problems, it is important to be careful with it. Look at the ingredient list to spot “hydrogenated” or “partially hydrogenated” oil (code for trans fat) in addition to “0g trans fat” in the nutrition label.

  • Reduce exposure to heavy metals, such as lead, arsenic, cadmium, and mercury.

  • Mercury can be present in seafood, especially fish. Choose fish that have a lower likelihood of having mercury such as salmon, shrimp, cod, and sardines. Larger fish, such as shark, swordfish and king mackerel tend to have higher levels of mercury.

  • As for lead, arsenic, and cadmium, if your job does not expose you to these chemicals, exposure to them is rare as Singapore has strict exposure controls in place. Singapore's water distribution network also does not use lead or lead jointing..

  • Heavy metals are naturally occurring contaminants. It is not possible to eliminate them from our food entirely, hence limits are set by the Singapore Food Agency based on internationally accepted limits.

  • Men may want to avoid keeping their cell phones in their pockets to reduce the exposure of their sexual organs to radiation.

  • As elevated temperatures can impair sperm production, men can also consider avoiding hot showers or soaking in hot tubs, saunas, and jacuzzis.