UNDERSTANDING FERTILITY
What is Infertility?
The total fertility rate (TFR) was at 1.6 in Malaysia (in 2022)4 and 0.97 in Singapore (in 2023)5. Following the trends of the past decades, it is expected to fall even further. This TFR score refers to the number of babies being born per woman in her reproductive years, and compared to about 4 decades ago this number has dropped significantly in both countries, signalling potential fertility issues.
2American Society for Reproductive Medicine (ASRM). Prevalence of infertility in the United States as estimated by the current duration approach and a traditional constructed approach. 2013. Available at: https://www.fertstert.org/action/showPdf?pii=S0015-0282%2812%2902449-1
3 CDC on Infertility. Available at: https://www.cdc.gov/reproductive-health/infertility-faq/index.html#:~:text =For%20public%20health%20data%20collection,6%20month s%20of%20unprotected%20sex. Accessed July 2024.
4 Department of Statistics Malaysia on Total Fertility Rate 2022 “storage.dosm.gov.my/demography/vitalstatistics_2022.pdf”
5 Resident Total Fertility Rate for 2023 Rate’ https://www.singstat.gov.sg/-/media/files/visualis ing_data/infographics/population/total-fertility-rate.ashx
Am I Fertile Enough?
Infertility is defined as the inability to conceive after 12 months of unprotected sex1. However, if your partner is 35 years old or over, you or your partner may be considered infertile if you haven’t conceived after 6 months of unprotected sex. Infertility may take place due to medical reasons like ovulation disorders, pre-existing conditions or even other reasons like stress, age, or a combination of factors. Sometimes, a couple who has already had a child can have trouble conceiving again. This is called secondary infertility. While men stay fertile for a longer period than women, the quality and number of their sperm substantially decline with age 2,3.
Live Birth Rate Declines After Age 35
Am I Too Old to Get Pregnant?
A woman’s peak reproductive years are between their late teens and late 20s. Fertility starts to decline by age 30, becoming more rapid during the mid-30s and by 45, getting pregnant naturally almost impossible for most women. As women get older, their bodies undergo natural changes that can make getting pregnant more difficult. These include:
Number of eggs declining
Women are born with around 1–2 million eggs. This numbercontinually declines from birth4. At 37 years old, there are around 25,000 eggs left5
Quality of eggs declining
as a woman ages, there’s a greater chance that her eggswill have an abnormal number of chromosomes which can affect the health of embryos6
Gradual exposure to diseases
As time passes, the reproductive system is more exposed to diseases that can affect fertility, such as endometriosis7
Irregular ovulation
A woman’s menstrual cycle can become shorter and irregular with age8
Sex drive declining
This may mean that you have sex less frequently as you get older9
1. Infertility FAQs. (n.d.). Centers for Disease Control and Prevention. https://www.cdc .gov/reproductivehealth/infer tility/index.htm#:~:text=In %20genera l%2C%20infertility%2 0is%20defined,6%20months%20of%20unpro tected%20sex.
2. Dunson D, et al. Hum Reprod 2002;17(5):1399–1403.
3. Harris I, et al. Rev Urol 2011;13(4):e184–e190
4. The American College of Obstetricians and Gynecologists Committee on Gynecologic Practice and The Practice Committee of the American Society for Reproductive Medicine. Fertil Steril 2014;101(3):633–634.
5. The American College of Obstetricians and Gynecologists Committee on Gynecologic Practice and The Practice Committee of the American Society for Reproductive Medicine. Fertil Steril 2014;101(3):633–634.
6. American Society for Reproductive Medicine (ASRM). Age and fertility. A guide for patients. 2012. Available at http://www.reproductivefacts.org/globalassets/rf/news-and-publications/bookletsfact-sheets/english-fact-sheets-and-info-booklets/Age_and_Fertility.pdf. Accessed: February 2018.
7. The American College of Obstetricians and Gynecologists Committee on Gynecologic Practice and The Practice Committee of the American Society for Reproductive Medicine. Fertil Steril 2014;101(3):633–634.
8. American Society for Reproductive Medicine (ASRM). Age and fertility. A guide for patients. 2012. Available at http://www.reproductivefacts.org/globalassets/rf/news-and-publications/bookletsfact-sheets/english-fact-sheets-and-info-booklets/Age_and_Fertility.pdf. Accessed: February 2018.
9. The American College of Obstetricians and Gynecologists Committee on Gynecologic Practice and The Practice Committee of the American Society for Reproductive Medicine. Fertil Steril 2014;101(3):633–634.
1. Infertility FAQs. (n.d.). Centers for Disease Control and Prevention. https://www.cdc .gov/reproductivehealth/infer tility/index.htm#:~:text=In %20genera l%2C%20infertility%2 0is%20defined,6%20months%20of%20unpro tected%20sex.
2. Dunson D, et al. Hum Reprod 2002;17(5):1399–1403.
3. Harris I, et al. Rev Urol 2011;13(4):e184–e190
4. The American College of Obstetricians and Gynecologists Committee on Gynecologic Practice and The Practice Committee of the American Society for Reproductive Medicine. Fertil Steril 2014;101(3):633–634.
5. The American College of Obstetricians and Gynecologists Committee on Gynecologic Practice and The Practice Committee of the American Society for Reproductive Medicine. Fertil Steril 2014;101(3):633–634.
6. American Society for Reproductive Medicine (ASRM). Age and fertility. A guide for patients. 2012. Available at http://www.reproductivefacts.org/globalassets/rf/news-and-publications/bookletsfact-sheets/english-fact-sheets-and-info-booklets/Age_and_Fertility.pdf. Accessed: February 2018.
7. The American College of Obstetricians and Gynecologists Committee on Gynecologic Practice and The Practice Committee of the American Society for Reproductive Medicine. Fertil Steril 2014;101(3):633–634.
8. American Society for Reproductive Medicine (ASRM). Age and fertility. A guide for patients. 2012. Available at http://www.reproductivefacts.org/globalassets/rf/news-and-publications/bookletsfact-sheets/english-fact-sheets-and-info-booklets/Age_and_Fertility.pdf. Accessed: February 2018.
9. The American College of Obstetricians and Gynecologists Committee on Gynecologic Practice and The Practice Committee of the American Society for Reproductive Medicine. Fertil Steril 2014;101(3):633–634.
Does Age Affect Male Fertility?
Unlike women, whose fertility significantly declines after the age of 35, men’s fertility doesn’t decline until they are much older. Although sperm quality deteriorates as men age, this does not create a problem until after the age of 32.
Signs and Symptoms of Infertility
How common is infertility between the two genders?
Pregnancy may be elusive due to infertility, which can affect both genders. Infertility isn’t necessarily a permanent condition and it doesn’t mean that having a child is impossible. You may just need a little help from a fertility specialist to get there.
Symptoms of Female Infertility
- Often asymptomatic
- Heavy or painful periods
- Irregular or absent periods
Symptoms of Male Infertility
- Often without symptoms
- Erectile or ejaculation issues
- Testicular pain
Signs of Female Infertility
01
Pain during sex
This may be an underlying health problem such as infections, endometriosis and fibroids22.
02
Heavy, long or painful periods
03
Irregular menstrual cycle
01
Pain during sex
This may be an underlying health problem such as infections, endometriosis and fibroids22.
02
Heavy, long or painful periods
03
Irregular menstrual cycle
Signs of Male Infertility
01
Hormonal imbalances
Testosterone is critical in sperm production and is a key hormone for male fertility. Reduced testosterone leads to reduced sperm, affecting the chances of fertilisation of the oocytes leading to infertility. Erectile dysfunction – It might happen due to a mix of hormonal changes, physical or psychological factors.
02
Problems with ejaculation
Having difficulty ejaculating or a drop in volume of ejaculate is a sign of an underlying issue affecting male fertility.
03
Other issues
Swollen, painful or tender testicles may be caused by an infection, which can impact sperm quality, therefore a cause for infertility.
01
Hormonal imbalances
Testosterone is critical in sperm production and is a key hormone for male fertility. Reduced testosterone leads to reduced sperm, affecting the chances of fertilisation of the oocytes leading to infertility. Erectile dysfunction – It might happen due to a mix of hormonal changes, physical or psychological factors.
02
Problems with ejaculation
Having difficulty ejaculating or a drop in volume of ejaculate is a sign of an underlying issue affecting male fertility.
03
Other issues
Swollen, painful or tender testicles may be caused by an infection, which can impact sperm quality, therefore a cause for infertility.
2 American Society for Reproductive Medicine (ASRM). Fibroids and fertility. Fact sheet. 2015. Available at: http://www.reproductivefacts.org/globalassets/rf/news-and-publications/bookletsfact-sheets/english-fact-sheets-and-info-booklets/fibroids_and_fertility_factsheet.pdf. Accessed: February 2018.
3 American Society for Reproductive Medicine (ASRM). Endometriosis and infertility: A committee opinion. 2012. http://www.fertstert.org/article/S0015-0282(12)00585-7/pdf. Accessed: March 2018.
4American Society for Reproductive Medicine (ASRM). Medications for inducing ovulation. A guide for patients. 2016. Available at: http://www.reproductivefacts.org/globalassets/rf/news-and-publications/bookletsfact-sheets/english-fact-sheets-and-info-booklets/booklet_medications_for_inducing_ovulation.pdf. 2014. Accessed: February 2018. 5 Martyn F, et al. Human Reproduction 2014;29:2092–2098. 6American Society for Reproductive Medicine (ASRM). Endometriosis and infertility: A committee opinion. 2012. http://www.fertstert.org/article/S0015-0282(12)00585-7/pdf. Accessed: March 2018.
7American Society for Reproductive Medicine (ASRM). Age and fertility. A guide for patients. 2012. Available at: http://www.reproductivefacts.org/globalassets/rf/news-and-publications/bookletsfact-sheets/english-fact-sheets-and-info-booklets/Age_and_Fertility.pdf. Accessed: February 2018.
The journey is different for everyone
Fertility can be a challenging subject and acknowledging that you may need some assistance can be painful. However, seeking help to conceive is a brave and positive step forward. As age has a strong impact on fertility (with a woman’s fertility decreasing as she gets older), the sooner you seek help the closer you can be to having a baby of your own.
This video is about Liyana and Amirul's fertility journey. Their story is not just about the struggle with infertility; it's a testament to the strength found in partnership, and the enduring human spirit's ability to hope against all odds.
When to seek help?
Did you know, while a fertile 30-year-old woman has about a 20% chance of getting pregnant during each cycle, by age 40 those chances have dropped to about 5%.1
For couples below 35 years old, you should seek advice from fertility specialist after 1 year of trying.1
For couples who has the below history, you should seek advice from fertility specialist sooner than a year.2:
Women
Irregular menses
History of endometriosis
History of tubal ligation, ectopic pregnancy and pelvic infection
Recurring miscarriages
Men
Abnormal semem analysis, erectile or ejaculatory problems
History of vasectomy
1 CDC on Infertility. Available at: https://www.cdc.gov/reproductive-health/infertility-faq/index.html#:~:text=For%20public%20healt h%20data%20collection,6 %20months%20of%20unprotected%20sex. Accessed July 2024.
2 Not pregnant yet and when to seek help. Cleveland Clinic Health Essentials. Available at “https://health.clevelandclinic.org/not-pregnant-yet-when-to-seek-help”. Accessed July 2024.
Disclaimer : The information provided by Merck is not a substitute for professional medical care or advice and intended for educational purposes only and should be used only as an aid in understanding the medical condition and treatment. A physician or another healthcare professional should always be consulted for any health problem or medical condition.
