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Did You Know?

After sex, a man’s sperm travels through the narrow lower part of the
uterus (womb) called cervix into the womb and up into the Fallopian

How does conception take place naturally?

After sex, a man deposits sperm in the vagina. The sperm travel through the narrow lower part of the uterus (womb) called cervix into the womb and up into the Fallopian tubes. If this happens at a time when the woman has released an egg (near ovulation), fertilization may occur in the Fallopian tubes. The resulting embryo moves back to implant in the womb.
The cervix naturally limits the number of sperm that enter the womb, and only a few actually reach the Fallopian tubes and can fertilize an egg. Therefore, for pregnancy to occur:
  • the woman must release at least one egg from her ovary or ovaries (i.e. she must be ovulating)
  • the eggs must be able to enter the Fallopian tubes (i.e. the tubes must be patent)
  • the man must release sperm that are capable of travelling through the cervix and the womb to reach the Fallopian tubes
  • the uterus (womb) must allow the embryo(s) formed to implant


What is Infertility?

Infertility is the inability of a couple to achieve a pregnancy after 12 months of unprotected sexual intercourse. However, if the woman is older than 35 years, the couple are said to have infertility after 6 months of unprotected sexual intercourse.


The life table of fertility

For young couples (female age less than 35 years) with no known cause of for infertility who have regular unprotected sex, the relationship between the duration of sexual relationship and percentage of couples achieving pregnancy is as follows:
1month  – 23%
3 months  – 50%
6months – 70%
12months  – 85%
24 months – 93%
As many as 30% and 15% of couples do not achieve pregnancy after 6 months and one year respectively.


What are the causes of infertility?


Female Factors

With advancing age, a woman loses most of her functional eggs. Beyond 35 years, the proportion of her functional eggs available declines sharply. This is termed diminishing ovarian reserve (DOR).  For the woman aged between 20s and the early 30s, her chance of conceiving every months from unprotected sex is about 25%. This reduces to less than 10% for the woman close to 40 years old.


Ovulation Problems
If a woman does not ovulate (release at least one egg each month), she cannot get pregnant. Conditions that can cause this problem include Polycystic Ovary Syndrome (PCOS), Thyroid disease and other hormonal disorders, overweight or underweight.


Damaged or Blocked Fallopian tubes
Pregnancy starts in the Fallopian tubes where egg and sperm meet. Therefore blockage or damage to the Fallopian tubes can lead to infertility or ectopic pregnancy. Such blockages or damages to the Fallopian tubes may occur from endometriosis, sexually transmitted infections and any surgery in the pelvis.


Cervical/Uterine Abnormalities
Uterine (womb) abnormalities may interfere with implantation of the embryo or increase the risk of miscarriage. These abnormalities include scaring of the womb lining called endometrium, endometrial polyps, fibroids, adenomyosis or abnormalities in the uterine shape.


Peritoneal Abnormalities
The peritoneum is the lining to the surfaces of the internal organs. This can be damaged through scarring or endometriosis. Endometriosis is the presence of tissue that normally lines the womb cavity outside the cavity. It could be on the ovaries, peritoneum and the womb.


Male Factors

Problems with the male partner significantly contribute to the cause of infertility. In a third of infertility cases, the cause is from the man, and in another third, it is from a combination of factors associated with both the man and the woman. The problems associated with the man manifest as either no sperm ejaculation (azoospermia) or poor quality of sperm in the ejaculate(measured by the amount, movement and shape of sperm). Azoospermia may be from non- sperm production or  blockage to the passage. Diabetes and other medical conditions or medications could be the cause.


Unexplained Infertility

When a thorough systematic evaluation of both partners with standard diagnostic tests such as semen analysis, evaluation of uterine cavity, tubal patency and ovulation fail to establish a known cause for the infertility, the couple are said to have unexplained infertility. These constitute about 10% of couples with infertility cases.

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