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Infertility
In Singapore, infertility affects around 15% of couples, and both female and male factors play a role in its development. Fortunately, there are various treatment options for infertility, from lifestyle modifications to advanced medical interventions such as in-vitro fertilisation (IVF). A consultation with a fertility doctor will help you discover the best options for your situation.
Dr Michael Wong, Medical Director & Senior Consultant Urologist
FAMS (Urology), FICS (USA), FRCS (Edinburgh), M Med (Surgery), MBBS (S’pore)
Dr Michael Wong was a faculty member at the World Congress of Endourology in Abu Dhabi. Seen here with great friends; Prof Chandru Sundaram from Indiana University and Dr Png Keng Siang from Singapore
What Is Infertility?
A fertile couple in their 20s having regular sex has around a 1 in 4 chance of getting pregnant each month. Conversely, infertility is defined as the inability to conceive even after a year. The sharp rise in infertility cases in Singapore is mainly due to people delaying marriage and starting a family past their prime childbearing years, causing the quality of both egg and sperm to be lower.
However, it must be noted that even though much of the discussions around infertility tend to be centred on women, it is estimated that of the 1 in 7 couples who struggle with infertility, 50% to 60% are actually attributed solely or in part to the man – something that should not be overlooked.
Infertility is classified into two main types based on a couple’s reproductive history:
- Primary Infertility - When a couple has never achieved a pregnancy despite having regular, unprotected intercourse for at least one year (or six months if the woman is 35 or older).
- Secondary Infertility - When a couple who has previously conceived (whether it resulted in a live birth, miscarriage, or termination) is unable to conceive again after a year of trying.
Infertility does not always present obvious symptoms. Many individuals only discover fertility challenges when they begin trying to conceive.
Signs and Symptoms in Men:
- Sexual Function Issues - Problems with ejaculation (premature, delayed, or retrograde), difficulty maintaining an erection (erectile dysfunction) or reduced sexual desire.
- Pain, Swelling or Lumps - Any pain, swelling or lumps in the testicular area may indicate underlying conditions like varicoceles (enlarged veins in the scrotum).
- Hormonal Imbalances - Signs such as changes in hair growth, voice alterations or breast enlargement (gynaecomastia) may suggest problems affecting sperm production.
- Abnormal Semen Analysis - This is often a key indicator of male infertility, showing a low sperm count, poor motility (movement) or abnormal sperm morphology (shape).
- Recurrent Infections - Frequent urinary or reproductive tract infections can also affect sperm quality or sperm delivery.
- Underlying Conditions - Pre-existing conditions such as diabetes or high blood pressure can also contribute to male fertility issues.
Signs and Symptoms in Women:
- Irregular or Absent Menstrual Cycles - Cycles shorter than 21 days, longer than 35 days, or complete absence of periods (amenorrhoea) may indicate ovulation problems.
- Painful Periods - Severe menstrual pain (dysmenorrhoea) can be a sign of endometriosis, which may affect fertility.
- Hormonal Symptoms - Excess facial hair, acne or skin changes, reduced sex drive or unexplained weight fluctuations may suggest conditions like polycystic ovary syndrome (PCOS).
- Recurrent Miscarriages - Multiple miscarriages may point to underlying fertility issues.
- Pain During Intercourse - Painful sex (dyspareunia) may be linked to endometriosis or pelvic inflammatory disease.
What Are TheCauses of Infertility?
Sperm Count
If a man has a low sperm count, the chances of one of his sperm fertilising an egg decrease drastically. According to the World Health Organisation, a healthy man’s semen should contain a minimum of 15 million sperm per millilitre. The normal volume of ejaculate should also be at least 1.5 millilitres.
Sperm Quality
Sperm quality is determined by morphology (size and shape), motility, and genetic material. Abnormally shaped sperm may fail to penetrate an egg, while good motility (to swim well) is necessary for reaching the egg. Healthy genetic material is also crucial, as high DNA fragmentation reduces the chances of conception.
Urogenital Conditions
Conditions such as varicoceles, retrograde ejaculation, and azoospermia can cause male infertility by affecting sperm production or transport in the reproductive tract.
Medical Conditions
Certain medical conditions and medications can affect a man’s fertility. As such, men should ensure that their medical problems are well-controlled when trying to conceive.
Immunologic Infertility
This occurs when antibodies mistakenly target and destroy sperm cells, reducing their motility or causing functional abnormalities. Although this is uncommon, it can hinder fertilisation by preventing sperm from reaching and penetrating the egg.
Hormonal Changes and Obstructions
Hormonal imbalances, such as low testosterone levels or high prolactin levels, can interfere with sperm production and quality, leading to infertility. Blockages in the reproductive tract can also prevent sperm from reaching semen.
Sexual Dysfunction
Conditions such as
Environment & Lifestyle Factors
Sperm are very sensitive to heat – there is a reason why testicles are located outside of the body, in order to preserve sperm in a cooler temperature where they thrive.
As such, men who are trying to conceive should cut down on:
Hormonal/Ovulation Disorders
Ovulation disorders are the most common cause of female infertility. Conditions like PCOS or hypothalamic dysfunction can disrupt regular ovulation. These disorders may lead to irregular or absent menstrual cycles, reducing the chances of pregnancy.
Damaged or Blocked Fallopian Tubes
The fallopian tubes transport eggs from the ovaries to the uterus. However, blockages or damage, often caused by pelvic inflammatory disease, infections or previous surgeries, can prevent sperm from reaching the egg or block the fertilised embryo from reaching the uterus.
Uncontrollable Medical Conditions
Chronic conditions, such as diabetes, thyroid disorders or autoimmune diseases, can interfere with reproductive function. These conditions may affect ovulation patterns, egg quality or the uterine environment.
Gynaecological Conditions
Several gynaecological conditions, such as endometriosis (where uterine tissue grows outside the uterus) or uterine fibroids (non-cancerous growths in the uterus), can cause inflammation and scarring. This may disrupt embryo implantation or affect the uterine environment, leading to fertility challenges.
Age
Female fertility naturally declines with age due to a decreased number and quality of eggs. Women over 35 may experience a decrease in fertility, with a more pronounced decline after 40. This age-related decline can make conception more difficult and increase the risk of miscarriage and other pregnancy complications.
Consult our fertility doctor to give you and your partner a better chance of starting a family.
What Are theDiagnostic Tests for Fertility Evaluation
Medical History and Physical Exam
The doctor will inspect the scrotal area for lumps or irregularities and review the patient’s medical history and conditions that may affect fertility.
Semen Analysis
The patient ejaculates into a container, and the semen sample is sent to a laboratory to identify sperm quality or detect issues with sperm production.
Transrectal Ultrasound
A small, lubricated probe is inserted into the rectum to visualise the prostate, seminal vesicles, and testicles, helping identify blockages or abnormalities.
Testicular Biopsy
A needle extracts tissue samples from the testicles for lab analysis to determine if sperm production issues are due to a blockage or abnormal sperm transport or delivery.
Scrotal Ultrasound
High-frequency sound waves generate images of the scrotal region to detect abnormalities like varicoceles, tumours, infections, cysts, or blockages in the testicles or surrounding structures.
Hormone Testing
A blood test can measure different hormone levels, such as testosterone and follicle-stimulating hormone (FSH), and detect any issues that affect sperm production and fertility.
Post-Ejaculation Urinalysis
This test detects the presence of sperm in the urine, which may indicate retrograde ejaculation, low sperm volume, or issues related to sperm movement.
Genetic Tests
This test identifies congenital or inherited syndromes that may affect sperm production or function, often recommended for patients with severely low sperm concentration due to Y chromosome alterations.
Hormone Blood Tests
Hysterosalpingogram (HSG)
Transvaginal Ultrasound
Infertility can be a source of stress, but you are not alone.
Fertility specialists offer tests and treatments for both partners.
Schedule a consultation and take the first step towards building your family.
What Are theTreatments for Infertility?
Treatment is individualised based on the underlying problem
Medication
Fertility medicines can help stimulate ovulation in women with ovulation disorders or support egg development during assisted reproductive treatments such as in vitro fertilisation (IVF). These medicines are prescribed and monitored closely by doctors to ensure safety and effectiveness.
Surgery
Surgical procedures may be recommended to correct structural problems, such as removing uterine fibroids, repairing blocked fallopian tubes or treating endometriosis. Minimally invasive techniques, like laparoscopy, are often preferred to enhance recovery and improve outcomes. This option is typically considered when less invasive treatments are ineffective.
Sperm Retrieval Procedures
For men with certain conditions—such as blockages that prevent sperm from appearing in the semen (obstructive azoospermia)—specialised techniques can retrieve sperm for use in assisted reproductive treatments. Common approaches include testicular sperm extraction (TESE) or percutaneous epididymal sperm aspiration (PESA).
Intrauterine Insemination (IUI)
In this procedure, the man’s processed semen sample will be directly placed into the woman’s uterus to increase the chances of fertilisation and conception. The main goal of an IUI is to identify and concentrate the number of healthy sperm and reduce the distance between the sperm and the egg in the fallopian tube, thereby increasing the chances of fertilisation. This is also done when the woman is ovulating. Though it is a less invasive and cheaper option, IUI is only more suitable for men with mild to moderate low sperm counts.
In Vitro Fertilisation (IVF)
During the procedure, fertilisation is done manually in a lab, with the selected embryo(s) being transferred into the woman’s uterus thereafter. The IVF procedure comes in 4 main steps: (1) Ovary Stimulation (to produce multiple eggs), (2) Egg Retrieval, (3) Fertilisation, and (4) Embryo Transfer. Men with severely low sperm count should opt for an IVF treatment.
Other Assisted Reproductive Technologies (ART)
In addition to IUI and IVF, other assisted reproductive technologies (ART) may be recommended in certain cases. These include intracytoplasmic sperm injection (ICSI), where a single sperm is injected directly into an egg to facilitate fertilisation, and testicular sperm extraction (TESE), where sperm are surgically retrieved from the testicles.
Why Choose Our Clinic for Infertility Treatment?
At the International Urology, Fertility & Gynaecology Centre, we offer a unique opportunity for couples suffering from infertility to have a joint consultation with both our specialists –
This allows for the concurrent assessment of both the urological and fertility aspects of the man and the woman; which then allows for the efficient diagnosis and treatment of the root problem. After all, the two disciplines are often intricately linked.
FAQs About Male and Female Fertility
How can I boost my fertility?
Can an infertile man still have a baby?
How can I check if my sperm is healthy?
At what age does a woman stop being fertile?
How do you test a woman’s fertility?
Do women still get a period if they are infertile?
Can using steroids for bodybuilding cause infertility?
How does age impact male fertility?
Dr Michael Wong is the medical director and senior consultant urologist at the International Urology, Fertility and Gynaecology Centre. With advanced training in urology, fertility and minimally invasive surgery from leading centres in the USA, he is internationally recognised for his expertise. He is internationally recognised for his expertise and has co-founded Singapore’s first joint urology–gynaecology clinic for couples, where both partners are evaluated together. His practice integrates evidence-based approaches to male and female infertility care.
Let us help you
Restore your urological health.
Make an appointment with Dr Michael Wong to receive a tailored, supportive and targeted care plan.
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