How long does it take for the right sperm to meet the egg? For those below 35, a year is a acceptable period of time, but for those older, six months with no success means it’s time to see the doctor. — AFP
According to The Lancet medical journal, fertility health is declining globally, with rates in more than half of all countries and territories in 2021 below population replacement level.
By 2100, 97% of countries will have fertility rates below what is needed to sustain their population size.
This means that the populations in those countries will not grow, and will have a higher proportion of senior citizens and a shrinking workforce.
This phenomenon will have far-reaching economic consequences for such countries if not addressed systematically.
Apart from changing government policies to be more pro-natal, the most crucial change must start with you.
Yes, your fertility mindset is the single most important factor in determining a country’s fertility rate and future.
Here are some things to consider when you’re thinking about starting a family.
Time is of the essence
How long should you allow yourself to try to conceive before seeking any medical help?
Traditionally, it is a year.
However, it would be best to remember that this time frame is given to younger women.
If you are younger than 30 years old and have no underlying health conditions that may affect your fertility, allowing a year to conceive naturally is acceptable.
Once you hit the age of 35, you should be seeking a fertility expert’s help after six months of unsuccessfully trying to conceive naturally.
In my fertility practice, I see a significant number of younger women facing infertility with low egg reserve, as well as men with fertility issues.
Even among younger couples who undergo in vitro fertilisation (IVF) treatment, lower quality embryos are sometimes generated.
This again emphasises the rate of decline of a woman’s egg quality and a man’s semen quality.
So, you should do your basic fertility tests early.
If there are no major infertility issues identified, you can give yourself more time to conceive naturally.
To all men who are planning to start a family, I suggest you do a semen analysis before starting your family planning.
Fertility preservation
Finding a life partner is sometimes not a straightforward affair.
Finding the right person may take years or a few heartbreaking experiences.
Unfortunately, both female and male reproductive capacities will continue to decline with age.
While men continue to produce sperm throughout their lives, women have a set number of eggs that will deplete with every menstrual cycle.
However, medical technology allows a woman to consider freezing her eggs.
This offers her the opportunity to safeguard her fertility and maintain the option of having a child in the future.
Egg freezing is also an option for women with underlying medical conditions that prevent them from starting a family sooner.
So, you do not have to worry about losing your golden fertility window because you can freeze your fertility.
Understanding fertility treatments
Fertility treatments have seen years of advancements.
New scientific discoveries have enabled doctors and fertility scientists to develop interventions that improve fertility outcomes.
You will be able to find many fertility treatments or intervention options.
However, not all the options available are scientifically researched.
The current information age further increases the confusion about which treatment options are better.
I strongly urge couples who are seeking fertility treatment to filter wisely all the information that is available online regarding fertility treatments.
If in doubt, the best way to go would be to set up a consultation with a fertility specialist who will be able to guide you on the right path.
You can also visit the websites of fertility institutions or societies such as the European Society of Human Reproduction and Embryology (ESHRE) or the American Society of Reproductive Medicine (ASRM), to read the available patient information.
Listen to podcasts or videos from accredited fertility specialists offering advice about fertility treatment options.
Protect yourself against online scams that aim to sell you products that are not effective.
Be more vigilant in selecting the source of your fertility advice.
This will surely save you time and money.
Avoiding unnecessary tests
Times have changed; you do not have to do a lot of the traditional tests, especially hormonal blood tests, nowadays.
Egg reserve for a woman can be assessed by doing an Anti-Mullerian (AMH) blood test.
Only a few may need additional hormonal tests such as thyroid function or fasting insulin.
Tests for follicle-stimulating hormones (FSH), luteinizing hormones (LH) and luteal phase progesterone levels are not first-line tests any more.
For the male partner, apart from semen analysis, hormonal tests are usually not necessary.
Not all men need to do a testosterone hormone blood test.
Even with azoospermia (where there is no sperm in the ejaculate), most men’s testosterone levels will be normal.You should always understand why you are subjected to a certain blood test.
The best way to do this is by asking “why”.
IVF is not the last option
Many of you facing fertility issues may have tried treatments such as ovulation induction or intra-uterine insemination (IUI) with no success, and are now facing the prospect of needing an IVF treatment.
Even though IVF may appear to be the last treatment option, it is not always the case.
Some of you may need IVF sooner rather than later.
For those couples with moderate to severe endometriosis, damaged Fallopian tubes, low egg reserve and poor semen quality, it is better to do an IVF treatment directly after medical interventions to maximise your fertility health.
For example, if your semen quality is poor, you can begin treatment for male infertility and IVF can be started once you have achieved satisfactory improvement.
If you have low egg reserve, you can start with supplements to help improve your egg quality before starting an IVF treatment.
The point is that your treatment pathway may differ from another couple’s journey, depending on your own fertility circumstances.
I advise you to gather the necessary information from your fertility clinic to help you decide your treatment path.
In summary, 2025 can be a positive year for most of you on your journey towards parenthood.
You cannot change your past, but you can decide how your future will be.
Be more proactive, get the correct information from a credible source and step forward with confidence.
All the best to you.
Dr Agilan Arjunan is an obstetrician and gynaecologist, and fertility specialist. For more information, email starhealth@thestar.com.my. The information provided is for educational purposes only and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
