Fertility Assessment & Services

The journey to parenthood can be challenging and frustrating for couples struggling to conceive. Many factors can influence fertility, and understanding these can be the first step toward finding a solution.

Learn how a fertility assessment can help, who might benefit from it, and the available treatments that can bring couples closer to achieving parenthood.

What is a Fertility Assessment?

A fertility assessment is a detailed evaluation of both partners’ reproductive health. It calls for a series of tests and procedures aimed at identifying any potential causes of infertility, which can range from hormonal imbalances to structural abnormalities.

For many couples, a fertility assessment is the first step in their journey to understand why they may be having trouble conceiving and what can be done to help.

Who is it for?

Fertility assessments are generally recommended for couples who have been trying to conceive for over a year without success. However, some individuals may consider a fertility assessment sooner, especially if they have specific health conditions or risk factors.

For women over 35, it’s advised to seek an assessment after six months of unsuccessful attempts at conception. Additionally, those with a history of irregular menstrual cycles, endometriosis, or polycystic ovary syndrome (PCOS) or who have had recurrent miscarriages may benefit from an earlier evaluation.

Fertility Assessment Procedures

The procedures involved in a fertility assessment generally include the following:

Medical History and Physical Examination

This first step thoroughly discusses both partners' health history, lifestyle habits, and any underlying or past health conditions that may influence fertility. A fertility specialist will inquire about the following:

Menstrual and Sexual History: For women, details about the menstrual cycle, including frequency, regularity, and any symptoms of discomfort, can provide insight into ovulatory health and reproductive function. For men, sexual history, including any history of erectile dysfunction or ejaculatory issues, is also relevant.
Lifestyle Factors: Lifestyle choices, such as smoking, alcohol consumption, exercise habits, and nutrition, can significantly impact fertility in both men and women. High stress levels, exposure to toxins, or poor diet can also influence reproductive health.
Past Medical Conditions and Surgeries: A history of reproductive or sexually transmitted infections, surgeries involving the reproductive organs, or hormonal disorders like polycystic ovary syndrome (PCOS) and thyroid conditions can play a role in fertility.

After discussing these details, a physical examination may be conducted to identify any visible or palpable signs that could affect fertility. This examination can include checking for abnormalities in the reproductive organs or signs of hormonal imbalance, like excess facial hair or acne in women, which may indicate PCOS.

Hormonal Testing

Hormones regulate the reproductive system, and imbalances can disrupt the processes necessary for conception. Blood tests are used to measure various hormone levels in both partners, depending on individual needs and symptoms. Key hormones tested may include:

Follicle-Stimulating Hormone (FSH) and Luteinising Hormone (LH): These hormones regulate ovulation in women and sperm production in men. Abnormal levels can indicate issues with ovulation or sperm production.
Estradiol: For women, estradiol, a form of oestrogen, is essential for egg maturation and reproductive health. Testing estradiol levels can help gauge ovarian function.
Progesterone: This hormone is essential in preparing the uterus for a fertilised egg and is often measured during the luteal phase (the second half of the menstrual cycle) to confirm ovulation.
Testosterone: In men, testosterone is critical for sperm production, and imbalances can reduce sperm quality. Low testosterone levels may also cause decreased libido and other symptoms.
Thyroid Hormones: Thyroid function can significantly impact fertility, as thyroid imbalances can disrupt menstrual cycles, ovulation, and sperm production.

Ovulation Tracking

For women, tracking ovulation is a crucial aspect of assessing fertility. Knowing if and when ovulation occurs helps identify whether the body is releasing eggs regularly, which is essential for conception. Methods for tracking ovulation include:

Basal Body Temperature Charting: A woman's basal body temperature (BBT) rises slightly after ovulation. By measuring BBT each morning, a pattern can reveal whether ovulation is occurring.
Ovulation Predictor Kits: These over-the-counter tests measure luteinising hormone (LH) levels in urine, which surges just before ovulation. A positive result indicates the ideal time for conception.
Ultrasound Scans: Serial ultrasounds may be done to visualise the ovaries and detect the release of an egg, providing a clear picture of the ovulatory process.

Semen Analysis

For men, a semen analysis is a fundamental part of a fertility assessment. This test examines various parameters of sperm health, including:

Sperm Count: A high sperm count increases the chances of fertilising an egg. A low count (oligospermia) can reduce these chances.
Sperm Motility: This refers to the sperm's ability to swim toward the egg. Poor motility (asthenozoospermia) may prevent sperm from reaching and fertilising an egg.
Sperm Morphology: Sperm shape and structure (morphology) are important for fertilisation. Abnormal morphology (teratozoospermia) can impair the sperm's ability to fertilise the egg.

A semen analysis provides a comprehensive overview of sperm health and can identify specific factors that may contribute to male infertility.

Imaging Studies

Imaging studies are used to examine the reproductive organs more closely, helping to detect structural abnormalities that may interfere with fertility. Common imaging studies include:

Ultrasound: Transvaginal ultrasounds allow doctors to examine the uterus and ovaries in women, helping to identify cysts, fibroids, or polyps that may impact fertility.
Hysterosalpingogram (HSG): An HSG is a specialised X-ray that uses a dye to visualise the uterus and fallopian tubes. This test helps detect blockages, which may prevent the egg and sperm from meeting or prevent a fertilised egg from attaching to the uterus.
Sonohysterography: This ultrasound procedure involves injecting saline into the uterus to help visualise its shape and lining, allowing for the detection of abnormalities like polyps or fibroids.

Genetic Testing

In some instances, genetic testing may be advised to rule out inherited conditions that could impact fertility or pregnancy outcomes. Genetic testing is recommended for:

Genetic testing can include karyotyping (analysing chromosome structure) and screening for specific genetic mutations. In some cases, preimplantation genetic testing (PGT) can be conducted in conjunction with IVF to screen embryos for genetic conditions before implantation.

Factors That Affect Fertility in Women

A woman’s fertility can be influenced by a variety of factors including:

Age: Fertility naturally diminishes with age, especially after age 35, as both egg quality and quantity diminish.
Hormonal Disorders: Conditions like PCOS and thyroid imbalances can disrupt ovulation, making it hard to conceive.
Endometriosis: This condition happens when tissue akin to the uterine lining develops outside the uterus, potentially causing pain and infertility.
Uterine or Tubal Abnormalities: Blockages or scarring in the fallopian tubes or irregularities in the uterus can prevent the fertilised egg from implanting.
Lifestyle Factors: Overconsumption of alcohol, smoking, and high levels of stress can negatively affect fertility.

Factors That Affect Fertility in Men

The following factors impact men’s fertility as they can interfere with sperm production, health, or delivery:

Age: Although less pronounced than in women, age can affect sperm quality, including sperm motility and morphology.
Hormonal Disorders: Low testosterone levels or other hormonal disruptions can affect sperm production.
Structural Issues: Blockages in the reproductive tract or enlarged veins within the scrotum can hinder sperm delivery.
Lifestyle Factors: Smoking, excessive alcohol use, drug use, and poor diet can reduce sperm quality. Additionally, exposure to environmental toxins can also harm sperm.
Medical Conditions: Chronic health conditions like diabetes, as well as past infections or surgeries, may contribute to infertility.

Fertility Treatment Procedures

Treatments can be recommended once the fertility assessment identifies the factors affecting conception. Common fertility treatments include:

Medications: Fertility medications, such as Clomid and letrozole, are often the first line of treatment for stimulating ovulation in women who have irregular cycles.
Intrauterine Insemination (IUI): This procedure involves inserting sperm directly into the uterus to improve the chances of fertilisation.
In-Vitro Fertilisation (IVF): IVF is a minimally invasive procedure done by retrieving eggs from the ovaries, artificially fertilising them with sperm in a lab, and transferring the resulting embryos to the uterus.
Intra-Cytoplasmic Sperm Injection (ICSI): Often used with IVF, ICSI is a procedure to inject a single sperm directly into an egg, which is helpful for men with low sperm count or poor sperm motility.
Surgery: For conditions like endometriosis or tubal blockages, surgery may be recommended to improve fertility.

Fertility Assessment & Services in Singapore

For couples struggling to conceive, a fertility assessment can provide invaluable insights into potential barriers to pregnancy and identify appropriate treatment.

Pacific Healthcare Specialist Centre offers fertility assessment and services in Singapore. We also provide a range of fertility treatments tailored to each couple’s needs, combining expertise with personalised care to support couples on their journey to parenthood.

Frequently Asked Questions

Can lifestyle changes improve fertility?

Yes, lifestyle changes can positively impact fertility for both men and women. Maintaining a healthy weight, reducing alcohol consumption, quitting smoking, and managing stress can all improve reproductive health. Eating healthily and maintaining regular exercise are also crucial for optimising fertility.

Does insurance cover fertility treatments?

Coverage for fertility treatments will depend on the insurance provider and plan. While some plans may cover certain diagnostic procedures or medications, others may not cover more advanced treatments like IVF. Check with your insurance provider to find out what is covered and what other expenses to expect.

What is the success rate of fertility treatments?

Success rates for fertility treatments vary based on factors like age, underlying health conditions, and the type of treatment. For example, IVF success rates generally decrease as the woman’s age increases. A fertility specialist can give a more accurate estimate based on an individual’s circumstances.

How long does it take to complete a fertility assessment?

A comprehensive fertility assessment can take anywhere from a few days to several weeks, depending on the specific tests needed. Initial consultations and basic tests can often be completed quickly, while more in-depth assessments, such as genetic testing, may take additional time.

What are the risks of getting fertility treatments?

While fertility treatments are generally safe, they may carry certain risks. Fertility medications can sometimes lead to ovarian hyperstimulation syndrome (OHSS), which causes the ovaries to become swollen and painful. Assisted reproductive techniques, like IVF, carry a small risk of multiple pregnancies, as well as the possibility of ectopic pregnancy.

Please discuss potential risks and side effects with your healthcare provider before beginning any treatment.

Fertility Assessment & Services

What is a Fertility Assessment?

Who is it for?

Fertility Assessment Procedures

Medical History and Physical Examination

Hormonal Testing

Ovulation Tracking

Semen Analysis

Imaging Studies

Genetic Testing

Fertility Treatment Procedures

Fertility Assessment & Services in Singapore

Frequently Asked Questions

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