BY: Mary Lim

THE bad news is that infertility is on the increase. Dr Ann Tan, director of Women & Fetal Centre, reckons it could be so for the next few years.

She says: "Couples are starting families later, so women are delaying motherhood. As these women get older, they will find it increasingly tougher to become pregnant because of the decline in amount and quality of eggs. They are also likely to experience fertility problems such as endometriosis."

The good news is there are medical breakthroughs in infertility treatments, especially in-vitro fertilisation (IVF), which offer hope to childless couples.

Says Dr Tan: "Pregnancy rates have increased in recent years with better techniques and medications in IVF treatments. Besides more refined drug regimens, they can be attributed to more effective understanding of the female physiology."

In fact, there are now more couples opting for fertility treatment at KKIVF Centre compared to five years ago, reveals Dr Loh Seong Feei, head and senior consultant of reproductive medicine unit at KK Women's and Children's Hospital. KKIVF, which provides testing, diagnostic and treatment procedures, performed 550 fresh assisted reproductive technique (ART) treatment cycles and 280 thaw ART cycles in 2006.

Thawed cycles involve embryos which were harvested to be frozen and stored in case the patient has to undergo a future cycle. 

Its pregnancy rate in the same year hit 60 per cent among women below 30 years, 45 per cent among those aged 30 to 39 years, and nearly 15 per cent for those between 40 and 44 years.

Fertility treatments include:

Blastocyst Culture

The retrieved fertilised egg is allowed to develop into an embryo in the laboratory over five or seven days, unlike the typical three days.

Blastocysts have a very thin outer layer and therefore do not require assisted hatching, so they are more likely to get
implanted into the uterine cavity and therefore result in a successful pregnancy.

- Available since 2000
- Suitable for women with many eggs but who cannot conceive.

Laser Assisted Hatching

This involves piercing a hole in the zona pellucida (the protective layer which prevents more than one sperm from fertilising the egg) to help the embryo to hatch and implant itself within the uterine wall.

With a specially designed computer assisted laser, the opening is more accurate and allows for improved pregnancy rates.

- Available since 2001
- Suitable for older women (the zona pellucida thickens with age) and those whose previous IVF attempts failed.

Pre-implantation Genetic Diagnosis

Embryos are tested for common chromosome abnormalities. Only healthy embryos will be used to attempt a pregnancy. Each IVF cycle, therefore, offers a higher rate of implantation and reduced risk of conditions such as Down syndrome.

- Will be available in August 2008
- Suitable for women whose previous attempts to conceive failed due to chromosome abnormalities.

Ultrasound-guided Embryo Transfer

In this procedure, embryos are transferred into the womb with a catheter. As the catheter can be seen clearly with ultrasound, the embryos are therefore placed more accurately to increase the chances of pregnancy.

- Available since 2006
- Suitable for women who cannot conceive due to low implantation rates.

What causes infertility

Men

• Abnormal-shaped sperm, which fails to fertilise the egg.
  
  
• Poor sperm quality, such that it cannot swim through the cervix to meet the egg in the fallopian tube.
  
  
• Low sperm count - less than the 20 million sperm per millimetre of semen produced by fertile men.
  
  
• Azoospermia, the inability to ejaculate sperm due to testicular failure or obstruction.

Women

• Ovulation disorder, like polycystic ovarian disease (caused by hormonal imbalance and leads to the growth of cysts on the ovaries, thereby affecting a woman's ability to conceive).
  
  
• Damaged or blocked fallopian tubes, which prevents the egg and sperm from meeting.
  
  
• Endometriosis, where the tissue lining the inside of the uterus attaches to ovaries or fallopian tubes and disrupts ovulation.

This article was first published in Health & You, The Straits Times on July 2, 2008.