Q I am 36 years old and have been married for five years. My husband is 39 years old and we have been planning for a baby since we got married. I have irregular spotting.
What are the options available to us to have our own children?
A As you have been trying to conceive for five years without success and are now 36 years old, it is important that you seek the advice of a fertility specialist as soon as possible.
Early evaluation and treatment is important because fertility declines rapidly after a woman hits 35.
Reasons for irregular spotting can range from benign growths in the womb or cervix, such as endometrial or cervical polyps, to more serious cancerous or pre-cancerous growths in the womb or cervix.
Some of the above problems can affect fertility and may be serious hazards to one's health.
A gynaecologist can perform a detailed pelvic examination, Pap smear and pelvic ultrasound to ascertain the cause of the irregular spotting.
Meanwhile, a fertility specialist can examine the cause of your infertility, so that treatment can be tailored accordingly.
Causes of infertility include anovulation, or the failure of the ovary to release an egg; blockage of the fallopian tubes; endometriosis, a condition where the cells of the uterine lining are deposited outside the uterus; and abnormal quantity, form, structure or function of your partner's sperm.
Sometimes, relatively simple measures can help you to conceive, such as by inducing ovulation with medication. Other measures include minimally invasive surgery to treat endometriosis, blocked fallopian tubes and endometrial polyps, as well as medication to improve the quality of sperm.
Sometimes, a low sperm count is linked to varicocele (distended veins near the testes). A simple operation to remove the distended veins can help to improve sperm count.
If these simple measures fail, you may have to try assisted conception.
There are two main methods of assisted conception. The first is intrauterine insemination, usually with super-ovulation - where medication is used to stimulate the production of two or three eggs. The doctor will monitor the follicles which contain the eggs. When the follicles are of the right size, ovulation is induced and the man's sperm is processed in the laboratory and placed in the wife's womb.
This method is suitable only for mild infertility, where the woman does not have blocked fallopian tubes or severe endometriosis, while the man has to have relatively good-quality sperm.
For severe infertility, or if all else fails, the couple would have to resort to in-vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI).
In the IVF/ICSI programme, the ovaries are stimulated to produce eggs in a controlled manner. The aim is to stimulate about 10 to 15 follicles to grow.
When the follicles are of the right size, the eggs within will be induced to mature. They are then aspirated out of the body with a thin needle in a day-surgery procedure. Fertilisation will then take place in the laboratory and the embryos which result will be placed in the womb.
Only one to three embryos will be placed at one go, and any extra embryos will be frozen for future use.
Dr Loh Seong Feei, medical director of Thomson Fertility Centre
Brought to you by Thomson Fertility Centre
This article was first published on June 12, 2014. Get a copy of Mind Your Body, The Straits Times or go to straitstimes.com for more stories.