Preconception Screening & Fertility Treatment

Fertility Screening & Treatment

Conceiving a child can be challenging for couples facing infertility. Fortunately, the continual advancements in medical science provide opportunities to realise the cherished dream of parenthood. In Singapore, there is a diverse range of fertility screening and treatment options.

Fertility/Preconception Screening Procedures

Fertility treatments and preconception screening consist of a spectrum of medical interventions to address challenges in conception and improve the health and reproductive capabilities of both partners. The following are some procedures that may be recommended to help you achieve pregnancy.

Blood tests

The follicle-stimulating hormone (FSH) Test

The FSH test evaluates the ovarian reserve, indicating the count and quality of a woman’s eggs. The test is typically conducted through a blood sample on specific menstrual cycle days. A higher FSH level on specific cycle days may suggest diminished ovarian reserve, providing valuable insights for fertility assessment.

Luteinizing hormone (LH) test

The Luteinizing Hormone (LH) Test evaluates LH levels, which are crucial for ovulation in women. This test involves a simple blood sample, usually taken on specific menstrual cycle days. Monitoring LH levels helps identify the optimal time for conception, as a surge in LH precedes ovulation.

Estradiol test

The Estradiol Test measures estradiol, a hormone that influences reproductive health in women. This blood test involves collecting a sample, typically during specific menstrual cycle days, to assess hormone levels. Insights into ovarian function and hormonal balance help guide fertility assessments, personalising treatments based on the woman’s reproductive health.

Anti-mullerian hormone (AMH) Test

This test measures the ovarian reserve and provides insights into a woman’s egg supply. It can be conducted at any time during the menstrual cycle. Elevated or diminished AMH levels may indicate potential fertility challenges, guiding doctors in personalising fertility treatments.

Thyroid function tests (TSH, T3, T4)

Blood samples are taken to evaluate hormone levels: TSH regulates thyroid function, while T3 and T4 indicate hormone production. Evaluating the hormones helps identify thyroid disorders that may affect fertility. Timely detection and management of thyroid imbalances contribute to improved reproductive outcomes.

Ovulation monitoring

Basal Body Temperature (BBT) Charting

Tracking daily basal body temperature helps pinpoint the ovulation window. Women record their temperature upon waking each morning using a special thermometer. A slight increase in temperature indicates ovulation, helping predict the most fertile days. Identifying the optimal time for conception can increase the chances of successful pregnancy.

Ovulation Predictor Kits (OPKs)

These kits detect a surge in luteinising hormone, signalling impending ovulation. When using a kit, a woman collects a urine sample and applies it to the strip. The kit then indicates whether the LH surge is occurring, indicating the optimal time for conception. 

Transvaginal Ultrasound

Monitoring follicle development through ultrasound ensures the timely release of eggs. A probe is inserted into the vagina to capture detailed images of the uterus, ovaries, and surrounding structures. Transvaginal Ultrasound is a valuable tool in fertility screening, providing real-time insights into reproductive anatomy.

Semen analysis

A semen analysis assesses male reproductive health by examining the quality and quantity of sperm in the semen. A semen sample is collected through ejaculation, either at a clinic or in the privacy of one’s home, and then analysed. The fertility assessment includes evaluating sperm count, motility, and morphology.

Pelvic ultrasound

Imaging the pelvic organs identifies structural abnormalities in the uterus and ovaries that may hinder conception. It is typically performed externally on the abdomen or internally through the vagina (transvaginal ultrasound).

Hormone level testing

Testing progesterone and prolactin levels aids in confirming ovulation and identifying hormonal imbalances. A blood sample is collected to measure hormone levels at specific times in the menstrual cycle. Progesterone testing confirms ovulation, while prolactin testing identifies hormonal imbalances that may affect fertility

Hysteroscopy

This endoscopic procedure visually inspects the inside of the uterus for abnormalities. A scope with a light and camera is inserted into the uterus through the cervix. This enables doctors to diagnose and treat various uterine conditions, such as polyps or fibroids, that may affect fertility

Sperm DNA fragmentation testing

Assessing sperm DNA integrity helps identify potential male infertility issues. This specialised test examines DNA damage within the sperm cells, usually through a semen sample. High levels of fragmentation may indicate reduced sperm quality, potentially impacting fertility

Endometrial biopsy

Endometrial biopsy is a diagnostic procedure that samples the uterine lining to evaluate its receptivity for embryo implantation. A thin and long catheter is inserted through the cervix into the uterus, and a small tissue sample is collected. This minimally invasive procedure provides insights into endometrial health and helps doctors assess factors that may impact successful implantation.

Thyroid function testing

Besides routine screening, additional thyroid function tests may be necessary to address potential fertility-related thyroid issues.

Pelvic laparoscopy

Pelvic laparoscopy is a minimally invasive surgical procedure used to examine pelvic organs for conditions affecting fertility. Small incisions are made, and a laparoscope is inserted to visualise the pelvic area. This procedure gives insight for doctors to diagnose and treat issues which can impact female fertility, such as endometriosis or scar tissue.

Immunological testing

Immunological testing assesses autoimmune factors that may affect male and female fertility. A blood sample is collected to analyse the presence of antibodies or immune system irregularities. This specialised test helps identify immune-related challenges that might hinder successful conception and guide interventions to improve the chances of a healthy pregnancy.

Factors that affect fertility

  1. Age: Fertility declines with age, particularly for female partners. Women are most fertile in their 20s and early 30s, and fertility decreases gradually afterwards, with a more significant decline after age 35.
  2. Irregular menstrual cycles: Irregularities in menstrual cycles can indicate hormonal imbalances or ovulatory issues, affecting fertility.
  3. Health conditions: Conditions such as polycystic ovary syndrome (PCOS), endometriosis, and uterine fibroids can interfere with fertility.
  4. Weight: Being underweight or overweight can affect the chances of conception. Maintaining a healthy weight is best for optimal reproductive health.
  5. Smoking and alcohol: Drinking or smoking excessively can negatively affect fertility in both male and female partners.
  6. Sexually Transmitted Diseases (STDs): Untreated STDs can lead to pelvic inflammatory disease (PID), impacting fertility.
  7. Stress: Chronic stress may interfere with hormonal balance, affecting ovulation and sperm production.
  8. Environmental factors: Exposure to certain chemicals, toxins, and pollutants can adversely affect fertility.
  9. Lifestyle factors: A poor diet, a lack of exercise, and excessive caffeine consumption can contribute to fertility challenges.

Couples experiencing difficulty conceiving should undergo thorough fertility screening to identify and address any specific factors contributing to their challenges.

Fertility in men

These factors may impact sperm production, quality, and overall reproductive health. Common influences on male fertility include:

  1. Sperm count: The number of sperm in a semen sample is critical. Low sperm quantity can reduce the chances of successful fertilisation.
  2. Sperm motility: Sperm must have proper motility (movement) to reach and fertilise the egg. Poor sperm motility can hinder conception.
  3. Sperm morphology: The shape and build of a sperm can affect its ability to penetrate and fertilise the egg.
  4. Varicocele: An inflammation of the veins that drain the testicle, negatively impacting sperm production and quality.
  5. Hormonal imbalances: Disruptions in hormone levels, particularly testosterone and FSH (follicle-stimulating hormone), can affect sperm production.
  6. Genetic factors: Certain genetic conditions that lead to infertility are Klinefelter and Turner syndrome.
  7. Testicular disorders: Conditions affecting the testicles, such as infections, trauma, or surgery, can impact sperm production.
  8. Lifestyle factors: Unhealthy lifestyle choices, including smoking, excessive alcohol consumption, drug use, and obesity, can harm sperm health.
  9. Heat exposure: Long-term exposure to high temperatures, such as from hot baths, saunas, or tight underwear, can affect sperm production.
  10. Occupational exposures: Exposure to certain occupational hazards, such as chemicals or radiation, may impact male fertility.
  11. Sexual dysfunction: Erectile dysfunction or other sexual disorders may affect a man’s ability to conceive with his partner.
  12. Age: While men can produce sperm throughout their lives, advanced paternal age has been associated with a gradual decline in sperm quality.
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Fertility treatment procedures

Once the preconception screening identifies potential challenges, various fertility treatment options can be explored.

Ovulation Induction

Ovulation induction is a procedure to stimulate the ovaries to release eggs. It involves medication, such as Clomiphene or Gonadotropins, to regulate and enhance egg production. Monitoring through ultrasounds and hormone tests helps determine the best timing for intercourse or assisted reproductive techniques, increasing the chances of conception.

Intra-Uterine Insemination (IUI)

Intra-uterine insemination (IUI) involves placing sperm directly into the uterus, enhancing the chances of fertilisation. IUI is a simple, minimally invasive procedure often used in conjunction with ovulation-stimulating medications to improve conception rates.

In-Vitro Fertilisation (IVF)

In vitro fertilisation (IVF) is an assisted reproductive technique where eggs and sperm are combined in a laboratory to fertilise outside the body. The resulting embryos are then transferred into the uterus. IVF involves controlled ovarian stimulation, egg retrieval, fertilisation, and embryo transfer to increase the chances of conception.

Intra-Cytoplasmic Sperm Injection (ICSI)

Intra-Cytoplasmic Sperm Injection (ICSI) is a fertility treatment where an individual sperm is directly injected into an egg in the laboratory. It is often used in conjunction with In-Vitro Fertilisation (IVF) to address male infertility or improve fertilisation rates. ICSI enhances the likelihood of successful conception in cases of severe sperm abnormalities.

Egg, sperm, and embryo cryopreservation

Egg, sperm, and embryo cryopreservation involve freezing reproductive cells for future use. In this fertility preservation method, eggs, sperm, or embryos are carefully frozen and stored. The process prevents ageing and preserves fertility potential, allowing individuals or couples to use the stored cells for conception later.

Blastocyst culture and transfer

Blastocyst culture and transfer is an IVF technique where embryos are cultured until they develop into blastocysts before being transferred into the uterus. This extended culture period allows for better embryo selection, enhancing the chances of successful implantation and pregnancy during assisted reproductive treatments.

Laser assisted hatching

Laser-assisted hatching is an IVF technique in which a laser creates a small opening in the outer layer of an embryo. This technique facilitates the embryo’s hatching process, increasing the likelihood of successful uterine implantation during treatments.

Fertility Treatment for Endometriosis

Endometriosis can be a barrier to conception. It is a condition where tissue akin to the uterus lining grows outside the uterus. Treatment options for endometriosis-related infertility may include the following procedures.

  1. Laparoscopic Surgery: Surgical removal of endometrial tissue, cysts, or adhesions can improve fertility by restoring normal pelvic anatomy.
  2. In-Vitro Fertilisation (IVF): Assisted reproductive techniques, such as IVF, can be used to bypass endometriosis-related obstacles and enhance the chances of conception.
  3. Ovulation Induction: Medications to stimulate ovulation may be prescribed to improve fertility in women with endometriosis.
  4. Hormonal Therapy: Birth control pills, gonadotropin-releasing hormone (GnRH) agonists, or progestin therapy may help manage symptoms and improve fertility.
  5. Fertility Preservation: In severe cases where fertility is compromised, options like egg freezing may be considered before surgery.
  6. Pain Management: While not directly related to fertility, managing pain associated with endometriosis can enhance the overall well-being of individuals undergoing fertility treatments.

Your fertility and reproductive specialist will plan the ideal treatment approach based on the severity of endometriosis and your fertility goals.

What is the cost of fertility treatment in Singapore?

The fertility treatment and screening cost in Singapore can vary based on the clinic, the specific procedures involved, and your doctor’s expertise. Generally, it includes consultation fees, screening tests, medications, and the chosen fertility treatment. Couples should inquire about costs upfront and consider potential additional expenses. 

Frequently Asked Questions

Preconception screening involves assessing the health of both partners attempting to conceive. It helps determine any underlying issues that may affect fertility or pose risks during pregnancy, allowing for proactive management.

 

Fertility status can be assessed through various tests, including hormonal evaluations, semen analysis, and imaging studies. Consulting with a fertility specialist is essential for personalised guidance based on individual circumstances.

Couples experiencing difficulties conceiving, irregular menstrual cycles, or a history of conditions such as endometriosis may benefit from fertility screening.

If natural conception doesn’t occur after a year of regular, unprotected intercourse (or six months for women over 35), it’s advisable to seek fertility evaluation. Individual circumstances and medical history play a role in determining when to consider fertility treatments.

 

Non-invasive fertility treatments, such as ovulation induction and intrauterine insemination (IUI), are available. Their effectiveness is contingent on the underlying cause of infertility, and a fertility specialist can guide individuals on the most suitable options.

Various factors, including age, the cause of infertility, and the chosen treatment, can influence success rates. A fertility specialist will provide realistic expectations based on individual circumstances.

SWC Medical Group recognises the emotional challenges of fertility treatments. It offers comprehensive support services, including counselling and support groups, to help individuals navigate the emotional and psychological aspects of the fertility journey.

SWC Medical Group understands the financial implications of fertility treatments and may offer financing options or guidance on available financial assistance programs.

When selecting a fertility clinic or specialist, consider their success rates, experience, available services, and patient reviews. Open communication and a comfortable doctor-patient relationship are key.

Managing stress and anxiety is vital during fertility treatments. SWC Medical Group provides support services and encourages open communication to address emotional well-being throughout the fertility journey.

Our Specialists

Dr Serene Lim

Obstetrics & Gynaecology, Fertility

Dr. Serene Lim is a Consultant Obstetrician and Gynaecologist at SWC Serene Fertility & Women’s Clinic. With over 15 years of expertise, she graduated from the National University of Singapore in 2006 and underwent specialist training at Singapore General Hospital (SGH). She is also a member of the Royal College of Obstetricians and Gynaecologists (London) since 2012.

Dr Lim is a fully accredited fertility specialist and provides comprehensive treatments including ovulation induction, intra-uterine insemination, in-vitro fertilisation (IVF), and fertility preservation, such as egg freezing.

Dr Chua Kah Mui Eunice

Obstetrics & Gynaecology, Fertility

Dr. Chua Kah Mui Eunice is an accomplished Obstetrics, Gynaecology, and Fertility specialist, specialising in IVF and assisted reproduction treatments. She graduated from the National University of Singapore in 1985 and pursued postgraduate training in London.

Dr. Chua began her medical career at Singapore General Hospital in 1985, later working at KK Women’s and Children’s Hospital and Alexandra Hospital. She joined the Department of O&G at Singapore General Hospital and practised until 1995 before establishing a private practice.

Dr Paul Tseng Seng Loke

Obstetrics & Gynaecology, Fertility, Urogynaecology

Dr. Paul Tseng Seng Loke is an experienced Obstetrics & Gynaecology specialist. After working as a consultant at Singapore General Hospital, he established his private practice in 1995.

His expertise lies in Urogynaecology, focusing on female incontinence, pelvic floor dysfunction, and sub-fertility management. A National University of Singapore graduate, he earned his Master of Medicine (O&G) in 1987 and became a Fellow of the Academy of Medicine, Singapore, in 2003.

Why choose
Singapore Women's & Children's
Medical Group?

Full spectrum of Obstetrics & Gynaecology and tertiary Paediatric services

We offer a full suite of Obstetrics & Gynaecology sub-specialties and are able to treat a wide range of paediatric medical conditions.  Apart from the general Obstetrics & Gynaecology, our Obstetrics & Gynaecology specialists have competencies in managing sub-specialties services such as maternal fetal medicine, fertility, gynae-oncology and urogynaecology. Our Paediatric specialists provide medical services in general paediatric and sub-specialise in neonatology, neurology, child development, as well as allergy, immunology and rheumatology.

Team of experienced medical specialists

Both our Obstetrics & Gynaecology and Paediatric medical specialists have proven track records and diverse sub-specialties expertise and these allow us to provide comprehensive, co-ordinated and convenience care through cross referrals and joint management of our patients.

Dedicated management team

Our Group Chief Executive Officer, Directors and management team are actively involved in the management of our medical clinics, which enables us to respond quickly to the requirements of our patients and to make decisions promptly.