by Dr Agilan Arjunan , KL Fertility Centre ( Malaysia)

1.What is infertility ?

Infertility is defined as inability to conceive after 1 year of unprotected sexual intercourse.

2.How do I know if I have problem of infertility?

If you have difficulty to get pregnant after having unprotected sexual intercourse with your partner over the last 1 year, you may have problem with infertility. However, you must bear in mind that if given more time (ie another 1 more year), you may have a chance to get pregnant on your own. This time limit will also depend on your age. If you are younger (ie age less than 25 years), you may want to give a bit more time to yourself. If you are older, then seeking medical advice earlier than later may benefit you. If you are known to have medical condition that predisposes you to infertility (ie endometriosis) , you may want to seek a fertility specialist earlier (ie after 6 months of trying to conceive on your own).

3. What to do next?

If you have problem with infertility, first of all do not panic. There are help around you. The most important thing to do is to have a discussion with your partner about you concerns. Both of you need to make an informed decision about seeking help for infertility. This is an important and crucial step to take because investigation and treatment for infertility involves both male and female. In addition to that, both male and female partner with need each others support to go through this successfully.

4.Where do I find the right Fertility Consultant?

There are many Fertility consultants. The right one for you will depend on your expectation of the doctor and what the doctor can actually offer you. The set-up of a fertility clinic can differ widely.  Some are stand alone clinic with or without fertility laboratory ( fertility laboratory is needed for treatments such as Intra-utrine Insemination /IUI and In-vitro Fertilization/IVF) .

Some are within a hospital with fertility laboratory. If the fertility clinic has a in-house fertility laboratory and operating theatre , it may be of benefit to you. This is because many woman with infertility has endometriosis or adenomyosis and surgery may be needed in the treatment of infertility for those woman. So, the right fertility consultant for you will depend on the cause of your infertility and the treatments that are needed.

5. Can i just see a family doctor / general doctor in clinic?

You can see a general practitioner (GP) who knows which initial investigation to be done correctly. If initial investigations are not done at the appropriate time (ie some blood test are done on Day 2 of menses), you may end up repeating fertility investigation when you see a fertility consultant.

6.Should i do anything before seeing a Fertility Consultant?

You just have to relax ! A fertility consultant will be able to guide you through your journey to parenthood. However, if you have your previous fertility investigations or treatment records, please bring it along .

7.What test/s my partner and I will need?

For male partner , a semen analysis will be done to assess the sperm count, how fast sperm moves, how normal are the sperms and the viability of sperms. Depending on semen analysis results, further test may or may not be needed.

For female partner, blood tests are usually done on day 2 or 3 of menses to assess ‘ovarian reserve’ (ovarian reserve means ability of the ovary to produce female eggs). Blood test also may be done around day 21 (mid-cycle) of menses to asses ovulation. A test to assess patency of fallopian tube will be arranged around after your menses. Ultrasound scan to look at your womb and ovaries will be done routinely.  Further test such as hysteroscopy      ( looking into the womb with a telescope) may be needed. Your fertility consultant will advise you.

8.What are the treatment options?

Treatments options depend on the cause of infertility. For male infertility, depending on the sperm count, treatments such as IUI or IVF maybe needed. If there is no sperms for male partner and its probably due to obstruction, sperm can be retrieved via a minor surgery to the testis (TESA/TESE), and IVF/ICSI can be done.

For female infertility, bilateral blocked fallopian tubes will need IVF/ICSI. If ovulation is the cause, ovulation pills or even IUI can be done. However, there are couples with unexplained infertility, in such a case, IUI or IVF maybe needed. More information is available in the ‘Treatment Options’ page.

9.Can i do anything to improve my chances of getting pregnant?

Yes you can! There are some lifestyle modifications that you can do to improve your chances of getting pregnant. The important thing to remember is that you and your fertility consultant need to work together to achieve success.

More information available in the ‘How To Improve My Chances of Getting Pregnant’.