I Want A Baby

Whether you prefer to conceive the natural way or want to tap on the latest fertility treatments available in Singapore, here are useful tips to know to start or increase your family.

What should I be aware of if I want to conceive naturally?

The general rules recommended to help couples conceive naturally are:

• Sexual intercourse every 2 to 3 days to optimise the chance of pregnancy.
• Avoid excessive alcohol consumption. This reduces the risk of harming a developing foetus in the mother.
• In men, excessive alcohol intake can be detrimental to semen quality.
• Avoid smoking or second hand smoke. Smoking can reduce fertility in women and affect semen quality in men. Passive smoking is also likely to affect a women's chance of conceiving.
• Having an optimal body weight, or take steps towards achieving it through a healthy lifestyle, exercise and a balanced diet.

Tips: Women who have a body mass index (BMI) of more than 29 are likely to take longer to conceive. Losing weight will help them to ovulate better and increase their chances of conception. In underweight women (BMI less than 19) who do not menstruate regularly, increasing their body weight is likely to improve their chances of conception.

How long should I wait before I seek the help of a specialist?
As a rule of thumb, most would agree that you should seek medical treatment if you fail to conceive after one to two years. In practice, there's no wrong or right amount of time to wait before going to see your gynaecologist.

If you are advanced in age, eg. 35 years and above, or if your doctor suspects that you suffer from any condition that may affect your fertility, he/she may initiate the relevant investigations even before you have tried to conceive for a year.

Will endometriosis impact my ability to get pregnant?
Endometriosis, whereby the tissue that normally grows inside the womb implants and grows elsewhere (usually pelvis), can cause changes in the abdominal cavity. This may make it a hostile environment for the sperm and the egg to fertilise, which decreases your chances of getting pregnant. In severe cases, scarring from endometriosis can cause structural damage to fallopian tubes.

What are the latest / new fertility treatments available now?
Fertility treatment can be divided into assisted conception programmes (ACP) and reproductive surgery (surgical procedures to treat women who have physical problems that interfere with fertility).

Latest ACP advances include:

• Intracytoplasmic Sperm Injection (ICSI) can overcome severe male factor infertility. This in-vitro fertilisation (IVF) procedure is when a single sperm is injected directly into an egg.
• Blastocyst culture. The embryos are cultivated for a longer time (Day 5-7) in the lab to allow the development/natural selection of a better embryo for a higher implantation/pregnancy rate.
• Laser assisted hatching: For embryos with thick shell (zona pellucida) which may affect hatching/implantation, and for patients with repeated failures, laser assisted hatching may improve implantation and pregnancy rates.
• In KKIVF Centre (KKIVF) at KK Women's and Children's Hospital, a new catheter is being used to transfer embryos into the womb. The catheter can be seen clearly with ultrasound. It allows the precise placement of the embryos, resulting in higher success. In reproductive surgery, advances in instrumentation and optics allow the gynaecologists to correct blocked fallopian tubes, remove endometriosis and correct the environment in the womb through tiny (less than 1cm) incisions in the abdomen.This can help infertile patients conceive naturally instead of having to go through the test tube baby programme.

Do certain fertility treatments result in multiple births?
Many treatments increase the chance of pregnancy by increasing the number of a woman's eggs or by placing more than one embryo into the womb. So, many fertility treatments result in multiple pregnancy and multiple births.

At the KKIVF Centre, the good lab condition improves the production of better quality embryos, so fewer embryos are placed into the womb, without compromising the treatment's success. For patients fearful of multiple births, KKIVF also has the blastocyst culture programme (see above). As a blastocyst has a higher likelihood of getting attached to the womb and developing, it is possible to place one blastocyst into the womb, eliminating the risk of multiple births.

Can the treatments cause cancer?
At present, there's no clear evidence that it does. It is also not clear whether any cancers are related to infertility in some way, rather than IVF treatment.

There are many theories that suggest how these treatments increase the risk of particular types of cancer. IVF increases the levels of hormones that stimulate the ovaries, such as gonadotrophin. The ovaries produce female sex hormones, estrogen and progesterone. Anything that affects these hormone levels could affect the risk of hormone related cancers, like breast cancer. Some theories argue that you produce more eggs (ovulate) because your ovaries are stimulated by the fertility treatment and that this might increase ovarian cancer risk. It is true that women who had IVF may have had closer medical supervision, so if they developed a breast cancer, it was more likely to have been found earlier. Or it may be that the hormonal changes during pregnancy or fertility treatment stimulated the growth of cancer that was already there, rather than causing it. Studies are thus non-conclusive. It is wise to monitor your health following any IVF treatment.

Thursday, July 17 2009

Article contributed by Dr Leong Seong Feei and Dr Tan Heng Hao, KK Women's and Children's Hospital