The definition of infertility by the World Health Organisation (WHO) is a couple’s inability to conceive after one year of regular, unprotected sexual intercourse.
Infertility is more common than you think.
Globally, 15% of couples are infertile. In Singapore, 1 in 6 couples are affected by infertility; 39% of these cases are due to female infertility factors, 20% are due to male infertility factors, 26% are due to a combination of both, and 15% of these cases have no obvious cause for infertility (unexplained fertility).
Infertility for couples can be affected by many risk factors, some of which includes lifestyle, diet, weight, age, medical conditions, stress and sleep. For women, fertility can also be affected by age; whereby after the age of 35, there are fewer eggs and deteriorating egg quality. However, it is possible that infertility still occurs in women in their early 20s, which can be due to other causes that require medical investigation, or alternative treatments. For men, it is the low sperm count (defined as <15 million sperms per ml), abnormal sperm function, or blockages that affects fertility.
1) Change Your Diet
Did you know that regular intakes of sugar-sweetened beverages were associated with reduced fertility in men and women, by up to 50%?
The influence of diet and other lifestyle choices on fertility should not be overlooked. Whether combined with fertility treatments or on its own, changes in diet can have a significant and measurable effect on fertility.
Ideally, those trying to get pregnant should begin making some adjustments to their diet well in advance of conception (ideally three months). This may involve supplements. During a fertility check, blood analysis may sometimes reveal nutritional deficiencies that may negatively impact fertility as well as the ability to carry a pregnancy to term.
2) Consider Alternative Treatments
Traditional Chinese Medicine (TCM):
For infertility, it is believed that imbalance of the 3 body’s organs; namely the kidney, liver and spleen, could affect conception for both men and women, and disrupt the menstrual cycle of a lady. Irregular menstrual cycles are also associated with ovulatory dysfunction. Male infertility is usually associated with various forms of “kidney” deficiency, and this also occurs as one ages.
Here are some examples (non-exhaustive) of imbalance in your body’s organs that could affect fertility:
- Kidney-Yin deficiency
- Kidney-Yang deficiency
- Blood and Qi deficiency
- Blood and Qi stagnation
- Liver Qi stagnation
- Phlegm and dampness
TCM can also help with unexplained fertility by assessing the body constitution and internal balance of an individual. TCM treatments (e.g. acupuncture, herbal medicines, moxibustion) are then advised, and can be used to prepare the body for conceiving. 1 TCM treatment cycle will typically last 3 menstrual cycles, and some may require 2-4 TCM treatment cycles (up to 1 year) to increase IVF/IUI success or boost chances to conceive naturally.
Liver Qi stagnation (a possible cause for infertility) is closely associated with stress and negative emotions. This is especially relevant in Singapore, where jobs are highly stressful in nature and long hours of work. So, stress management is also key in tandem with TCM to improve body constitution.
During this time of preparation, diet and lifestyle management is important to boost your body’s balance, which is where our PULSE+ dietitians can help to advise on an integrative diet approach from both TCM and Western perspectives.
It is worth noting that receiving IVF treatment can be a very stressful and anxiety-provoking experience as women have to go through daily hormonal injections which can be painful, as well as multiple transvaginal ultrasound scans which some may find intrusive.
Having to support their partner through these procedures may also be stressful on men and long term infertility may also put a strain on the couple’s relationship. Additionally, the high cost of IVF treatment is an added stress to many.
Stress, if unmanaged properly, can lead to reduced ability to conceive. Seeing a psychologist will be beneficial in allowing couples to navigate the emotional impact of infertility. Therapy is a safe space where individuals, and couples can express and process their feelings, work through some of the challenges encountered, learn and develop strategies to manage stress and regulate emotions effectively.
3) Change Your Lifestyle
Weight is an important consideration on fertility. Being significantly overweight or underweight can cause your body to produce more or less of the hormones that regulate ovulation in women, and sperm production in men.
The quantity and distribution of body fat affects fertility as the reproductive system is dependent on a delicate balance of hormones to function and a low or high body weight disrupts this balance.
Higher body fat is linked to insulin resistance and also leads to increased levels of estrogen, which could result in heavier periods. Hormonal changes triggered by excess weight and body fat also increase the risk of anovulation (when no egg is released by the ovaries).
Women with a BMI above 27 are three times more likely than women in the normal weight range to be unable to conceive because they don’t ovulate.
For those who do ovulate, the quality of eggs is affected too. If you are underweight, insufficient body fat could also cause irregular menstrual cycles or none at all (amenorrhea); this decreases a woman’s monthly chance of ovulation and reduces fertility.
For males, excess weight not only reduces sperm quality, but it also changes the physical and molecular structure of sperm cells. Sperm quality can also be affected by smoking, excessive alcohol intake, frequent exposure to heat, physical inactivity, and exposure to environmental pollutants and radiation.
For those considering IVF, IVF is not recommended if your BMI is below 19, or over 30. Being overweight (≥25 BMI) or underweight increases conception duration by 2 and 4 times respectively, and negatively affects IVF success rates.
Excess weight also makes it difficult to monitor ovaries, and may increase chances of complication during egg retrieval.