Infertility is the failure to conceive even after a year of actively trying for a baby with your partner. You have had unprotected sex 2-3 times during your fertile periods but to no avail.

The general rule of thumb to consider seeking medical help for fertility would be:

• For women below 35 years old, who have been unable to conceive after 1 year of trying.
• For women above 35 years old, who have been unable to conceive after 6 months of trying.
• For women with underlying gynaecological conditions, the risk of infertility is higher, and hence, they will need to seek help even before the 6-month mark.

Some of the signs of infertility in women are irregular periods, painful or heavy periods, no periods, hormone fluctuations (acne, reduced sex drive, facial hair growth, hair loss, weight gain, etc.), and pain during sex.

Some of the signs of infertility in men are changes in sex drive, testicular pain or swelling, erectile dysfunction, and issues with ejaculation.

A gynae who specializes in fertility would be able to assess you/your partner and recommend the various courses of action that can be taken. It will all begin with a fertility assessment, also frequently referred to as a fertility work-up or fertility check. Subsequently, based on your specific condition and priorities, your gynaecologist will discuss the most suitable options for you and your partner.

Medical Treatment of Infertility in Women
A. Well-timed Sexual Intercourse
The first-line measure to improve the chances of pregnancy would be to time sexual intercourse with ovulation, which is also the woman’s fertile period. On average, the chances of pregnancy are 10-12% if the intercourse is well-timed.

Ovulation test kits, available in convenience stores and retail pharmacies, can be used to test ovulation. However, a gynae or fertility specialist can more accurately track ovulation in a process known as follicular tracking.

B. Use of Clomiphene
Clomiphene is a medication that helps the body produce eggs, so there is a higher chance of the woman producing at least one egg per month. This medication benefits those with irregular periods or who do not ovulate regularly. Clomiphene usage is always coupled with follicular tracking for optimal results.

Surgical Treatment of Infertility in Women
Surgical options usually arise when the cause of infertility is an underlying gynaecological condition, for example, endometriosis, fibroids or ovarian cysts. These conditions can impact ovulation, fertilisation of the egg, delivery of the egg to the uterus, and implantation of the fertilised egg.

C. Laparoscopic Surgery (Keyhole Surgery)
As the ovaries, fallopian tubes, and uterus are located in the pelvis at the bottom part of the abdomen, laparoscopy, a minimally-invasive surgical procedure, is usually performed to examine these reproductive organs to detect any abnormalities that might be affecting the woman’s ability to conceive. Laparoscopy provides the doctor with better visibility than an ultrasound scan.

D. Hysteroscopic Surgery
Hysteroscopic surgery is another technique of minimally-invasive surgery that is performed through the vaginal. A hysteroscope, which is similar to a laparoscope, is inserted through the vagina and cervix and into the uterus.

Hysteroscopic surgery is performed under general anaesthesia and is preferred over laparoscopic surgery when detecting and treating abnormalities in the interior parts of the uterus. The rule of thumb for deciding between laparoscopy and hysteroscopy largely depends on the ease of access to the operative site to achieve minimal tissue damage.

E. Open Surgery (Laparotomy)
Open surgery or laparotomy is the traditional method of surgery, in which a large incision of about 8 to 10cm is made in the abdomen. Due to the large incision, post-surgery pain varies, and the patient may have to stay in the hospital for about a week. The recovery process is slower, and the post-operative scar is usually large and obvious. Also, in open surgery, more body tissue is exposed to the external environment, increasing the risk of adhesions and infections.

Open surgery may only be performed when there are multiple big fibroids, e.g., at least 4 to 5 fibroids, with each measuring about 4 to 5cm. However, open surgery is often avoided whenever possible as it has been shown to result in more post-operative adhesions, which then further impacts fertility.

For male infertility, fertility specialists can provide medications to improve sperm quality and count. Improving the sperms can help to increase the chances of conceiving without IVF sometimes, and even if IVF is required, better quality sperms can help to improve the success rates.