Treatment is directed at the underlying
Damaged or blocked tubes
Under certain circumstances, surgery
or cannulation of the tube may ‘open’
up the tubes. If despite treatment, there
is no conception or the tubes cannot
be unblocked, then in-vitro fertilisation
(IVF) will be the treatment of choice.
Problems with ovulation
Problems with ovulation such as
polycystic ovary syndrome (PCOS).
Patients with PCOS who are overweight
should lose weight as this may lead
to resumption of ovulation. Ovulation
induction with clomiphene, letrozole or
FSH injection may also be used.
Patient with large endometriotic
cysts (>5 cm) or with severe pain
may consider surgery. If there is still
no conception 6-12 months postsurgery,
then IVF may be the next
step. As endometriosis tends to recur,
it is advisable to consider medical
treatment to prevent recurrence if
fertility is not desired.
If the cyst is not large or there is a
recurrent cyst after surgery, then IVF
should be considered. This is because
repeated operations can reduce the
ovarian reserve as ovarian tissue may
be removed during surgery.
Fibroids and polyps
Fibroids and polyps that distort the
womb cavity can be removed through
the hysteroscope, a telescope that
allows visualisation of the womb cavity.
The camera is introduced through the
Premature ovarian failure
Premature ovarian failure such that
eggs are no longer released. Under
these circumstances, an egg donor or
embryo donor is necessary as there is
no treatment of this condition. Prior to
any cancer therapy, women and men
are counselled about how they can
preserve their fertility. Men can bank
their sperm and women can bank their
eggs, ovarian tissue or embryo for
The number and quality of eggs
diminish with age. There is no
medication that can reverse the effects
of age and that is why for women older
than 35, infertility investigations may
commence after six months of trying.
Low or no sperm
Hormonal or chromosomal tests may
be performed to find the underlying
cause. In a small percentage of men, the
cause is hormonal and replacement of
hormones may allow the resumption of
For men with low sperm count,
intracytoplasmic sperm injection
where sperms are injected directly into
the egg at IVF will give the sperm the
opportunity to fertilise the egg.
For men with no sperm, sperm may
be obtained directly from the testis
or eididymis. As the number of sperm
retrieved are low, IVF/ICSI is necessary.
For those where no sperm is retrieved,
sperm donation can be considered.
For men with erectile dysfunction,
psychosocial counselling and
medication like Viagra may be helpful.
Intrauterine insemination (IUI)
This is a treatment where washed
sperm is introduced into the womb
with a cannula at the time of ovulation.
This is indicated for women with
patent tubes, with mild sperm problem
or couples with problem of nonconsummation
or erectile dysfunction.
IUI may also be performed together
with ovulation induction with hormonal
injection. This is ideal for couples where
the women are younger (<35) with
patent tubes and no or mild male factor
problem. This may also be for couples
with ovulation problems or where no
known cause is found.
In-vitro fertilisation (IVF)
IVF is a procedure where eggs are
retrieved from a woman and are
inseminated with the husband’s semen
in the laboratory. The resultant embryo
is then placed back into the womb.
To make IVF more efficient, hormonal
injections are given to the woman to
induce more eggs so that it allows for
more opportunities for the eggs to
be fertilised. IVF is indicated for the
Despite advances in IVF, the chances
of conception vary from 20-35 percent
depending on a woman’s age. In
Singapore, IVF is not allowed once a
woman is over 45 because the chance
of success is very poor.
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