For newlyweds who have settled in their new homes, we’re sure the next thing on your agenda is having a plus one for your little family. But trying to conceive is – of course – not as easy as waiting for a stork to deliver a baby to your doorstep.
In fact, up to 15 per cent of Singaporean couples fail to conceive a baby within 12 months of trying, according to HealthXchange. Overall fertility rates in Singapore in 2020 have even fallen to a historic low of 1.1 births per woman as compared to 1.82 back in 1980.
However, those struggling with infertility should not be disheartened. There are many ways to improve conception chances. Now you’re probably thinking of well-known third-party fertility procedures such as intrauterine insemination (IUI) or in-vitro fertilisation (IVF). But these are not your only options.
Stanford University PhD graduate Dr Benjamin Tee and Dr Lim Min Yu, an obstetrician and gynaecologist, recently spoke with theAsianparent on how to improve conception chances, and shared more about a non-invasive method: the twoplus Sperm Guide.
Main causes of infertility in men and women
Before we get into what can help increase your chances of conception, Dr Lim breaks down the leading causes of infertility in females and males.
“Conditions such as infection can cause scarring of the fallopian tubes, which will lead to difficulties in conceiving as the sperm meets the egg in the fallopian tubes,” said Dr Lim who is also the president of the Obstetrical & Gynaecological Society of Singapore.
“This is a debilitating condition where cells from the uterine lining (endometrium) grow outside the womb, in the pelvis and around the ovaries and fallopian tubes,” Dr Lim told theAsianparent.
He added, “Affecting roughly 10 per cent to 15 per cent of women of reproductive age, patients with this disease have a significantly lower chance of getting pregnant.
"The American Society of Reproductive Medicine, on the other hand, notes that endometriosis is prevalent in 50 per cent of infertile women, with as many of 30 per cent to 50 per cent of patients experiencing infertility due to factors from a distorted pelvis to scarred/blocked fallopian tubes to impaired embryo implantation and altered egg quality.”
Dr Lim said, “Uterine polyps are overgrowths of the endometrium that extend into the uterine cavity, also known as endometrial polyps (EP). Affecting between eight and 35 per cent of women, the prevalence of EP increases with age and has been reported in 15 per cent to 24 per cent of infertile women.
“While the cause of polyp-associated infertility is unclear, researchers believe that they can impair the implantation of the embryo.”
“These are growths from the muscle of the uterine walls. A common gynaecological condition that presents during childbearing years, it affects 20 per cent to 30 per cent of women and is found in five per cent to 10 per cent of infertile patients,” he shared.
Dr Lim also said that fibroids can affect fertility and the chance of successful embryo implantation.
“A male factor contributes to 40 per cent to 50 per cent of cases and affects seven per cent of men. In most cases, male infertility is caused by deficiencies in the semen, including low sperm concentration, poor motility, or abnormally-shaped sperm,” he explained.
Dr Lim said, “If a doctor finds no obvious problem, such as blocked fallopian tubes or a male factor, the couple is classified as being unable to conceive due to ‘unexplained infertility’, which affects up to 15 per cent to 30 per cent of infertile couples.”
How to improve conception chances
For couples who still want to keep trying without immediately going for third-party fertility procedures, Dr Lim shared a few ways to improve the chances of conception.
1. Having frequent, regular sex
In simple words, Dr Lim said, “When trying to conceive, the Royal College of Obstetricians (RCOG) and other professional bodies recommend Nike’s world-famous slogan: Just Do It!”
The RCOG also recommends that couples have unprotected sex at least twice or thrice a week. This is because sperm can survive in the female genital tract for at least two or three days. The accumulated semen and sperm increase the chances of conceiving.
While having more sex is simple enough, there are still many couples who find themselves too busy or preoccupied to do it three times a week.
2. Taking your temperature
“If you prefer to optimise the timing of intercourse rather than increase the frequency of sex, the woman can try taking her temperature daily as this increases by 0.3C when she ovulates,” advised Dr Lim.
He added, “Unfortunately, this isn’t very exact as the temperature fluctuations are tiny and home thermometers aren’t very accurate. The method works best if you take your temperature at the same time each day.”
3. Don’t stress
We know. Being told not to be too stressed out is easier said than done.
Temperature reading and ovulation tests can help in predicting fertile windows. But setting such dates for sex can put unnecessary pressure on you and your spouse.
“This pressure may lead to performance anxiety in men or increased stress levels in women, which may alter ovulation cycles. So if these options don’t work for you, avoid using them, or speak to your doctor about suitable alternatives,” said Dr Lim.
4. Using ovulation test strips
Ovulation test strips work by detecting spikes in the luteinising hormone and oestrogen levels to predict when you might be ovulating, said Dr Lim. They are pretty easy to use but can be considered expensive for others in the long term.
5. Avoid fertility apps
Dr Lim said many fertility apps predict a woman’s ovulation windows, but they’re usually incorrect. A study has even found that only nine out of 33 fertility apps were accurate, so the doctor advises that you are better off without them.
Most common fertility treatments
If you find yourself trying out different ways to improve your conception chances without any luck after 12 months, Dr Lim may recommend other medical interventions available. As mentioned before, the two most common fertility treatments are IUI and IVF.
For an IUI, prepared sperm is inserted directly into the uterus using a catheter, cutting down the time and distance sperm cells have to travel to the egg. The doctor noted that IUI is a “simpler and cheaper procedure” than IVF.
However, it is also important to add that IUI is ineffective in women with blocked fallopian tubes. It offers a five per cent to 15 per cent chance of live birth.
Common side effects
“Common side effects of IUI can include discomfort when the catheter is passed through the cervix into the uterus. Some women may also experience some mild cramping after IUI as the catheter can irritate the uterus during insertion,” said Dr Lim.
If women fail to get pregnant after IUI, they may proceed to IVF instead. Dr Lim said, “IVF treatment involves a combination of medicines and surgical procedures to help sperm fertilise an egg and implant the egg in your uterus.”
“In the first 10 to 14 days of an IVF cycle, a woman needs to undergo daily hormone injections. She will be visiting the clinic every two or three days for blood tests and ultrasound scans to see if she is responding well to the hormones,” he said.
A woman should be ready for egg collection after about two weeks. This is done surgically, under sedation, and the eggs are then extracted and sent to the lab.
Meanwhile, the husband’s sperm is collected on the same day and used to fertilise the extracted eggs. Dr Lim continues to explain, “The eggs divide and become embryos, one or more of which are transferred into the uterus with a catheter, and pregnancy tests done two weeks after that. In short, an entire IVF cycle from start to finish takes about a month, or until you’ve used up all your frozen embryos.”
Although, the doctor advised that couples can’t really rely on it to start a family. While IVF offers up to a 20 to 35 per cent success rate, this decreases with age.
Common side effects
“As for IVF, daily hormone injections can result in pain, swelling and/or bruising. The increased hormone levels can also affect a woman’s mood and emotions,” Dr Lim told theAsianparent.
He added, “In terms of potential complications, IVF is associated with a condition called ovarian hyperstimulation syndrome or OHSS where the abdomen can become bloated due to fluid build-up. If this occurs, patients may have to have the fluid drained. Severe OHSS is potentially life-threatening, although modern IVF protocols have dramatically reduced the incidence of OHSS.”
Other ways on how to improve conception chances
Your options don’t stop there! There is another non-invasive way to help you in your chances of conception. Another method couples can try before resorting to third-party medical procedures are at-home aids such as the twoplus Sperm Guide.
“Worn during sex, this device is safe for use and designed to channel as much semen to the cervix as possible. It also keeps semen from spilling out, so that women don’t need to keep their legs in the air or place a pillow under their bum after sex in the hope of improving their chances of conception,” said Dr Lim.
The twoplus Sperm Guide was actually developed by Dr Benjamin Tee himself after he and his wife faced unexplained infertility.
“My wife and I tried conceiving for several years in our early 30s. We had all sorts of medical checks and were diagnosed with unexplained infertility — defined as an inability to conceive after a year despite having no obvious medical problems,” he shared.
“Since we were eager to start a family, my wife underwent many fertility treatments from Traditional Chinese Medicine (TCM) to IUI and IVF,” said Dr Tee. “Although she did get pregnant after IVF, I realised how impersonal, emotional and physically taxing these medical procedures were.”
“Considering how inaccessible, impersonal and painful the fertility procedures were, Prusothman (the co-founder of twoplus) and I wanted to create something couples could use at home while preserving the intimacy of the experience. To do this, we consulted with top fertility scientists and clinicians at Stanford Hospital and built a team of biomedical engineers to develop the twoplus Sperm Guide,” he said.
“Soft, comfortable and drug-free, the device is as easy to insert as a tampon and can be used during coitus. After intercourse, the twoplus Sperm Guide captures the ejaculate, keeping it within the vaginal tract. This allows women to continue with their day to day activities, as the device is kept within the vagina for at least an hour,” Dr Tee added.
When asked if he has used it with his wife when trying to conceive, Dr Tee said they did not as she was already pregnant when it was in development. While the couple is not thinking about having another baby soon, he said he would definitely use the device to increase their chances of conception.
This article was first published in theAsianparent.