Subfertility - Medical Hub
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Having a problem getting pregnant?

There are many steps and a whole range of processes that can be taken to help conception – not just going for “test-tube” baby procedure, as soon as you cannot get pregnant when you want to!

Most healthy couples take up to a year of regular sexual activity to conceive. Hence, see a gynecologist for a review and plan a course of action, only after a reasonable period of trying, e.g. 6 months without success. Your husband need not come along for the first visit if he is busy.

Of course, if a physical problem or disease is found, treatment is needed. Where surgery can help, this is usually performed by key-hole/ laparoscopy/ MAS approach.

Simple measures to improve chances include a healthy lifestyle and best coital timing. It helps to improve sperm quality by cutting down on (or eliminating) smoking and alcohol intake, keeping the scrota cool and taking antioxidants & androgens.

Analysis and culture of a seminal specimen is needed to gauge male status and if needed, a hormone profile. Testicle varicosities, erective/ ejaculatory dysfunction or infections may need to be treated. Sperm entry problems due to the cervix, immune system or uterine position, can be overcome by Intra Uterine Injection (IUI) of enhanced seminal fluid.

normal reproductive tract and ovulation are requisites. The former may be assessed by means of ultrasound (US), hysterosalpingography (HSG) or minimal access surgery (MAS).   Ovulation can be induced by clomiphene citrate and confirmed by urine test (LH kits).

Recombinant gonadotrophins (rFSH) is more precise for ovulation induction. It is more effective (and at lower dose) and purer than urinary preparations. It is used either by itself or in combination with clomiphene citrate. About 2 weeks of treatment with daily injections for 10 to 12 days is required, and support of the second half of your cycle by a progestogen is helpful. For better results, especially if egg collection is the objective, “down-regulation” from second day of pre-treatment cycle or shorter duration “antagonists” may be used. Monitoring of response is by ultrasound and/or blood tests.

Screening tests like hemoglobin and blood counts, hemoglobin electrophoresis, blood group, venereal diseaes, and the immune status of rubella, hepatitis B, human immune deficiency virus, chlamydia and toxoplasma, urine analysis, papanicoloau smear and hormone profile may be needed prior to any treatment.

If all is well, a few cycles of each method is best prior to contemplating In-Vitro Fertilisation (IVF).  IVF is best done in conjunction with Intra-Cytoplasmic Sperm Injection (ICSI) in event of low sperm count. You may need various procedures like oocyte retrieval, oocyte and sperm preparation, gametes and embryo culture, embryo transfer and freezing of excess embryos for future use. It is generally quite a taxing process when it comes to IVF/ICSI – so do check with your gynecologist prior to embarking on it.

Dr Alex Ooi is an Obstetrician and Gynecologist with vast experience – including in subfertility and counselling. He has served on the Mount Elizabeth Hospital Medical Advisory Board and was Chairman of the Minimal Access (“keyhole”) Surgery group, which revamped the operating theatres and initiated educational activities in Minimal Access Surgery. He has also been a Visiting Consultant to Fudan University in Shanghai and several other hospitals in the region.

Dr Alex Ooi Koon Hean
MBBS (Singapore), MRCOG (UK), M Med (O&G)(Singapore), FAMS (O&G)
Specialty: Obstetrics & Gynaecology
Clinic: Alex Ooi & Associates OBGYN Consultants
Address: 3 Mt Elizabeth, #11-07, Mount Elizabeth Medical Centre, Singapore 228510

Tel: +65 6738 8331
Fax: +65 6734 8896
Website: and