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Take stock, if the stork seems to tarry with the passing years.
Do not wait too long to see a doctor if you have trouble conceiving. Chances of reproduction diminish with age.
Beyond 45, a woman is no longer eligible for assisted reproduction programmes here. Besides, it may take years for a couple to have a child even with the help of a fertility clinic.
Fertility treatments range from counselling on issues such as expectations, timing and relationships, to the use of fertility pills, artificial sperm insemination and in-vitro fertilisation (IVF), in which the wife’s eggs and husband’s sperm are put together outside the body.
Extensions of the IVF technique include intracytoplasmic sperm injection, assisted hatching and blastocyst transfer for couples who are still unable to conceive despite the more conventional methods.
As multiple births can affect the health of both the mother and baby, not more than three fertilised eggs can be placed in the womb at one go for those who undergo IVF in Singapore.
Four fertlised eggs are allowed under certain conditions, such as when the woman is above 35 years old and has gone through at least two unsuccessful cycles.
Advancements in IVF technology means there is a higher chance of conception and lower chance of multiple births these days.
For example, in blastocyst transfers, the fertilised eggs are developed in the laboratory for five days until they reach the blastocyst stage, instead of the usual three days, before being transferred.
Doctors can select the healthier embryos as the weaker ones would have stopped growing before the blastocyst stage. Day five embryos have a 20 to 25 per cent chance of implantation versus 10 per cent for a day three embryo, said Dr Cheng Li Chang, the managing director of Thomson Fertility Centre.
One can transfer two blastocysts instead of three day three embryos and reduce the chance of multiple births, he added.
 IVF criteria
Women are eligible for IVF when they have conditions such as blocked fallopian tubes, endometriosis or premature ovarian failure.
For couples who do not seem to have medical problems, they must have been married for at least three years and have tried alternative means of fertility management for a year. This will not apply to women above 35 years of age.
It costs between $7,000 and $14,000 for each IVF treatment. The Government co-funds for IVF treatments by paying up to $3,000 for each cycle, for a maximum of three cycles.
Medisave can be used to pay for the remainder. Couples can use $6,000 from their Medisave for the first IVF attempt, and $5,000 and $4,000 for the next two.
With the introduction of the co-funding scheme in 2008, the number of couples seeking IVF treatment has gone up.
At theIVF centre in KK Women’s and Children’s Hospital (KKIVF), 1,200 women were treated last year, up from the 770 in 2008.
“It is important to identify the problem that causes infertility to maximise the success of fertility treatment,” said Dr Loh Seong Feei, the director of the KKIVF Centre and National Sperm Bank.
Although fertility programmes may offer the highest success rates, simple measures like the induction of ovulation, surgical correction of endometriosis or the removal of polyps may help women to conceive naturally, he added.
 Helping hand from science
Superovulation
■ Two to three eggs are brought to maturation and ovulation is induced using hormones.
■ Usually combined with intrauterine insemination, which is when sperms are placed directly into the uterus using a catheter or tube.
In–vitro fertilisation
■ Putting the eggs and sperm together in the laboratory so as to allow fertilisation to occur.
■ After fertilisation, the embryos are allowed to grow over a few days before being placed in the uterus.
■ Suitable for women who have irreparably damaged or blocked fallopian tubes or who failed to conceive with superovulation and intrauterine insemination.
■ Extensions of the IVF technique include intracytoplasmic sperm injection, assisted hatching and blastocyst transfer.
Intracytoplasmic sperm jab
■ Injecting a single sperm into each egg to allow fertilisation to occur in the lab.
■ Recommended if the man has very poor quality sperm or if the woman is above 40 years of age as they may have fertilisation problems due to hardening of the zona, or outer layer, of her eggs.
Assisted hatching
■ Using special solutions to break down the zona layer of the fertilised embryo so that it can be successfully implanted in the womb.
■ Recommended if embryos have an overly thick zona layer.
Blastocyst transfer
■ The transfer of five to six-day-old embryos at the blastocyst stage, instead of when the embryos are just two to three days old.
■ Reduces the need to implant more embryos and cuts down on multiple births.
■ Suitable for embryos that can survive past the three-day stage outside the body.
Sources: Dr Cheng Li Chang, managing director of the Thomson Fertility Centre; and Dr Loh Seong Feei, director of the KKIVF Centre and National Sperm Bank.
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