Help to usher in the stork
JUNE CHEONG looks at lifestyle changes and fertility treatments that can help a couple conceive

Lifestyle Choices
Call it old school but living a good, "clean" life does reap its rewards.

Doctors Mind Your Body spoke to said couples trying to conceive should abstain from alcohol and cigarettes and control their weight.

Professor P.C. Wong, the head and senior consultant at the reproductive endocrinology and infertility division of the obstetrics and gynaecology department at the National University Hospital, said: "In men, smoking affects sperm production negatively.
 
"In women, smoking results in a delay in conception. The contents of cigarette smoke have been found to damage eggs, reduce fertilisation and cause miscarriages and other pregnancy complications."

Keeping your weight within a healthy range can also improve your chances of having a baby.

Dr Sheila Loh, the clinical director of Raffles Fertility Centre at Raffles Hospital, said a body mass index of below 18 and above 25 may be linked to ovulatory disorders. She added that for men, obesity may affect sperm mobility.

Dr Suresh Nair, a consultant obstetrician and gynaecologist and the medical director of Parkway Fertility Centre at Mount Elizabeth Hospital, said: "For individuals who are overweight even a 10 per cent reduction in weight significantly improves pregnancy potential."

Medication
There are fertility drugs like Clomiphene, as well as injections of natural hormones like follicle stimulating hormone (FSH). They may be combined with other methods like intra-uterine insemination.

Oral fertility drugs like Clomiphene help the female patient to ovulate and may be used in conjunction with intra-uterine insemination to facilitate conception. It is often prescribed to women who have polycystic ovary syndrome or other problems with ovulation.

For those who do not respond to oral medication injections may be used. FSH injections, which stimulate egg production and ovulation, may be used.

Examples arc Gonal-f and Puregon, brands of a synthetic form of the natural hormone FSH.

Dr L. C. Cheng, a consultant obstetrician and gynaecologist and the managing director of Thomson Fertility Centre, said Gonal-f can be used for women who do not ovulate and are resistant to oral fertility drugs, and for those who fail to get pregnant despite ovulating normally.

It is also used in high doses during IVF to stimulate the growth of 10 to 15 eggs.

Intra-uterine insemination
Timing is key in this procedure, which involves placing viable sperm in the woman's uterus when she is ovulating. The sperm comes from the partner or a donor.

Dr Loh Seong Feei, the head and senior consultant at the department of reproductive medicine at KK Women's and Children's Hospital, said sperm donors are between 18 and 40 years of age. Donors are carefully screened for their background, social habits, health and physical characteristics and tested for sexually transmitted diseases, hereditary and chronic illnesses.

The active sperm from the woman's partner or donor is collected and concentrated.

Seminal proteins that may cause uterine contractions are removed. The doctor then injects the sperm high into the woman's uterus around the time of ovulation.

Signs of ovulation can be detected by a urine test kit, blood test or ultrasound.

Intra-uterine insemination may be done when the woman is on ovulatory medication.

Dr Loh said the woman must have a normal uterus and fallopian tubes while the sperm must be of sufficient quality and quantity. She said the average success rate is about 12 to 15 per cent for each attempt.

Assisted reproductive technology
This is the treatment used when other techniques are unsuccessful or not appropriate.

Assisted reproductive technology, or ART, describes a variety of fertility treatments which involve removing eggs from a woman's body, mixing them with sperm in a laboratory and replacing the embryos in the woman s body.

Common methods include in-vitro fertilisation (IVF) and intracytoplasmic sperm injection (CSI).

IVF is used if a woman's fallopian tubes are blocked or damaged, if she has severe endometriosis or a severe fertility problem or if the man has poor sperm quality.

It is often offered if the couple has failed several attempts at intra-uterine insemination.

The woman is given higher doses of FSH injections to stimulate the production of multiple eggs, which are collected via a needle that "sucks" the eggs out.

The collected eggs are united with sperm in a laboratory by an embryologist and nurtured into embryos.

After two to five days, the healthy embryos are put back in the woman's womb to, hopefully, grow into babies.

Dr Loh said: "IVF doubles the couple's chances of conception, regardless of their age."

She added that although IVF has a much higher success rate, at an average of 30 to 40 per cent per attempt, this must be weighed against its risks like more injections, more stress, higher chance of multiple pregnancy and
ovarian hyperstimulation syndrome, where the woman gets very bloated with water retention and in rare situations, breathlessness.

ICSI is often used for couples who have severe fertilisation problems or if the man has very poor sperm quality.

In ICSI, a single sperm is injected into each mature egg and the resultant embryos are transferred to the uterus.

In Singapore the Government co-funds up to 50 per cent of the costs of a fiesh ART cycle, up to $3,000 per cycle for a maximum of three cycles, subject to the couple's eligibility.