Understanding Fertility

Having a baby is one of the most important steps we take in life but for some it is not an easy path. To understand more about fertility and trying to conceive we interview Fertility Specialist Dr. Arasu Muthusamy, MRCOG (Oxford London), Medical Director of Fertility Associates Malaysia.

Malaysian couples are having their children later in life, and today 1 in 6 couples will experience infertility. The sooner you start your journey towards having a family the better your chances of success and the less likely you are going to need assistance to get there.

Table of Contents

What are the main factors that stop couples from seeking professional help?

There are a number of reasons couples delay seeking fertility help. However, once they talk to a specialist they can begin to understand why it’s not happening and start making plans and taking steps.

Give yourselves the best chance of having a baby – see a specialist sooner rather than later.

I frequently see couples who have left seeing a fertility specialist as the very last resort. They’ve spent months or even years trying naturally or trying other forms of assistance before seeking advice from a fertility specialist. Discovering fertility problems early means earlier treatment and a better chance of a successful pregnancy.

Privacy is important – Being faced with the inability to conceive naturally can be a devastating experience. Fertility is a topic we find hard to talk about, even with our close family and friends. After talking to a fertility specialist, couples can feel reassured that their journey will be private and confidential.

There are a range of pathways to a child – Often, couples are worried that once they see a fertility specialist they will automatically need In Vitro Fertilisation (IVF) to have a baby. In reality, there are many fertility treatment pathways ranging from relatively simple treatments to the more complex. Some couples may just need a little bit of help with some basic treatments and others could need more advanced reproductive assistance such as IVF.

Can couples conceive naturally if they have a medical condition tied to their infertility?

Natural conception is dependent on a number of factors (sperm, eggs and uterus) coming together at the perfect time. If there is a condition affecting one or more of those factors the chance of conception is dramatically reduced.

Infertility is usually defined as not becoming pregnant after a year of trying, but some couples know or suspect they are infertile before this i.e. irregular period or no ovulation. For some people infertility is absolute i.e. there may be no sperm, or the woman’s fallopian tubes may be blocked. In the case of absolute infertility conceiving naturally is not an option. However, with the advances in technology, treatment can give most infertile couples a good chance of having a child.

What are the common causes of infertility?

There are many reasons for pregnancy not happening:

30% is attributed to female fertility
30% points to male fertility
20% of cases points to problems with both partners
20% of cases are unexplained infertility

Common causes of infertility for women include tubal problems, endometriosis, ovulation disorders, polycystic ovaries, recurrent miscarriage, hormonal problems and autoimmune disorders. Male infertility can be caused by the following; Failed vasectomy removal, blocked ducts due to infection, absence of vans deferens, certain medications such as steroids, undescended testes in childhood, autoimmune (antibody) disorders and Variocose veins around the testes.

A large majority of couples will not have a clear-cut infertility diagnosis – over 50% in fact. This can be difficult, as often ‘making a plan’ feels like the best thing you can do. However, a diagnosis of unexplained infertility can often have better outcomes, as the couple usually have normal tubes and sperm and ovulation is occurring.

If you’re concerned, don’t delay – talking to a fertility specialist is the best thing you can do to help you understand your options.

How long should couples try to conceive naturally before seeking medical intervention?

For women under 35 years of age with no pre-existing medical conditions that may affect fertility, a year is a good amount of time to try to conceive naturally. For women over the age of 35, they should not wait any longer than 6 months before seeking help from specialist.

Age is the most important factor when trying to have a baby. A 25-year-old female has a 25% chance of conceiving naturally per month, however at 35 years this falls to 16% and at 41 years it drops again to less than 5%. Every year counts when you are getting into your late 30’s. The sooner a couple sees a specialist for help the better their chances are to get pregnant.

Fertility Associates has developed the Biological Clock app to help couples know what their chances of success both naturally and with treatment are according to their age and how long they have been trying. To work out your chances of success the app is free through the website (www.fertilityassociates.com.my) and as a free iPhone or iPad App. Search for ‘Fertility Associates’ on iTunes to download it.

Many childless couples yearning for kids simply cannot afford fertility treatments. Is there a more affordable way that they can go about it?

Fertility treatments can range in costs, from RM500 for the basics right up to RM20,000 for the most advanced of treatments. Treatment depends on how much intervention is needed to give you the best chance of having a baby.

The more advanced treatments such as IVF often provide a much bigger chance of success as they reduce some of the factors that may be influencing a couple’s fertility. There are a number of options for couples going through treatments. Clinics such as Fertility Associates offer easy-payment packages, split payments and package deals helping couples cope with the treatment costs.

What are the most popular fertility treatments in Malaysia and what are the success rates of said treatment/treatments?

Across Malaysia there is no central database to track fertility treatments. Treatment pathway is driven by the diagnosis of the infertility issues. Depending on the diagnosis and factors involved, the treatment that is likely to give the patients the best chance of success would be chosen. For some there are multiple pathways but for others their options are limited by their diagnosis.

Often couples seek specialist treatments too late after years of trying to conceive, these couples often need more advanced fertility treatments such as In Vitro Fertilisation (IVF) and Intra Cystoplasmic Sperm Injection (ICSI). With age the quality of both eggs and sperm decreases therefore couples should try for a child sooner rather than later.

Many causes of infertility, such as male infertility, tubal damage, endometriosis, ovulation problems and unexplained infertility can be successfully treated with IVF. For example, IVF can help a 35-year-old couple after a year of trying, with about a 40% chance of conception per cycle. This is double their chances of conceiving naturally per month. While most people think about IVF one cycle at a time, the overall chance of having a child depends on the number of cycles you are prepared to do.

What is the recommended first step for those struggling to conceive?

The best first step is to see a specialist in advance and undergo fertility screening. Understanding your fertility early on, even before you are ready for a family can help you identify any issues early so something can be done about it. If it is found that you or your partner need some form of treatment, then you are likely to have a better chance compared to if you delay your visit to the specialist. Fertility screening is similar to having a health screen. For both men and women there are a range of tests that can help check your fertility to help you plan your future.

For Women – These tests help predict if a woman may have a faster biological clock and therefore will lose their fertility sooner than expected. The tests available estimate what is called ‘ovarian reserve’ by measuring the number of egg follicles developing at a particular time. Testing of your ovarian reserve involves doing a blood test for the hormones FSH and estradiol between day 2 and day 4 of the cycle, a pelvic ultrasound and/or performing a blood test for Anti-Mullerian Hormone (AMH) that can be done anytime of the month.

For Men – A semen analysis looks at the number of sperm, their shape and their ability to move. A single test does not give the whole story, which is why Fertility Associates Malaysia offers these tests as part of a fertility screening package including a consultation with a fertility specialist.