Fertility myths: what Singapore's hospitals say about timing, age, TCM and clinics

Most fertility myths are about tricks, and what Singapore's hospitals advise is simpler. KKH advises sex every 2 to 3 days through the month, and says lying still afterwards or choosing a position makes no difference. If you're over 35, SingHealth says to see a doctor after 6 months of trying, not a full year.

How to improve your chances of conceiving, step by step

1. Have sex every 2 to 3 days through the month. KKH's fertility centre advises this because ovulation is hard to predict. The ovulation calculator shows your likely fertile days if you want to aim for them too.
2. Get up whenever you like afterwards. KKH says neither the position you use nor resting after sex boosts your chances, because sperm reach the fallopian tubes within minutes.
3. Pick a fertility-friendly lubricant if you need one. KKH says common water-based ones may affect how sperm move or survive, and suggests hydroxyethylcellulose-based ones instead.
4. Start folic acid before you try, since KKH recommends it from before conception up to 12 weeks of pregnancy. Our prenatal vitamins guide covers which to buy.
5. Work towards a healthy weight, both of you. KKH says a BMI above 25 reduces a woman's fertility and often affects ovulation. In men, obesity can affect sperm.
6. Stop smoking and vaping, both of you. KKH says many smoking-related fertility problems reverse within a year of stopping. Our alcohol and smoking guide lists free help to quit.
7. Skip alcohol and keep coffee moderate. KKH says the safest advice for a woman trying to get pregnant is no alcohol at all. It finds no consistent link between caffeine and fertility problems.
8. Keep his groin cool, since KKH says repeated heat from tight bottoms or hot surroundings can lower sperm count and quality. Comfortable underwear and breaks from the heat help.
9. Tell your doctor about any TCM or supplements you take. KKH asks couples to discuss TCM with their clinician, and HealthHub warns that mixing Chinese medicine with other products unsupervised may be dangerous.
10. Book a fertility check on time, together. SingHealth says to see a doctor after a year of trying if you're under 35, or after 6 months if you're over 35, and that you'll both be tested.

Fertility myths and what Singapore's hospitals say

Here's each myth next to what Singapore's hospitals and HSA say.

Our trying to conceive guide covers coping with the stress of trying, and the fertile window guide covers timing sex to ovulation.

Age, his sperm and IVF

Age matters for both of you. SingHealth says a woman's fertility starts to fall at 34, drops further at 37 and falls sharply after 40. KKH says natural fertility after 45 is almost zero. Men over 40 lower a couple's chances too, KKH adds, more so when the woman is also older.

Sperm problems are common. SingHealth says they may have no obvious signs, and NUH says male factors account for 30 to 50% of fertility issues in couples. KKH says low count, poor movement and abnormal shape are the most common problems in Singapore men. For the semen test, SingHealth says he'll need to avoid ejaculating for 3 to 5 days beforehand.

IVF can't make up for age. In HealthHub's report of the 2021 Marriage and Parenthood Survey, over 70% of people wrongly thought IVF has very high success rates for women above 40. HealthHub's own figures put success at about 6% for women 40 and above, and SingHealth says no proven treatment reverses the effects of age. Our IVF in Singapore guide has the rates by age and the co-funding.

Already have a child? KKH says age, or conditions such as endometriosis that develop after a pregnancy, can make the next one harder, and our secondary infertility guide covers it.

TCM, acupuncture and fertility supplements

Chinese proprietary medicines (CPM) are TCM remedies sold as finished pills, capsules or tablets. HSA doesn't allow a CPM to claim it prevents, eases or cures infertility, or helps with conception and pregnancy. HealthHub says a common misconception is that Chinese medicine is safer because it's natural. Most CPM ingredients haven't been tested for interactions with western medicines, it adds.

If you want to try TCM, buy only CPM listed with HSA, HealthHub advises, and not from websites or well-meaning friends. Read the label first. Some list pregnancy as a reason not to take them. See a practitioner registered with the TCM Practitioners Board, which has a public register you can search. The board says registered TCM physicians can also practise acupuncture.

On acupuncture for fertility, the NHS says there's no evidence that complementary therapies for fertility problems work. NICE wants more research before it can recommend them. The NHS offers acupuncture only for a few conditions, such as long-term pain and migraine-type headaches. If you go ahead anyway, tell your acupuncturist about your medicines and any IVF, as the NHS advises.

Fertility supplements are no different. HSA says health supplements don't need its approval before they're sold, and can't be promoted to treat or prevent any disease. KKH warns that some energy drinks and supplements contain anabolic steroids or testosterone, which may affect sperm. Ask a doctor or pharmacist before you add anything. Once you're pregnant, our guide to safe medicines in pregnancy helps.

How to choose a fertility clinic in Singapore

Singapore's public assisted reproduction centres are at KKH, NUH and SGH, HealthHub says. MOH's co-funding for IVF applies at these public centres, and HealthHub says MediSave works at both public and private ones (the amounts are in our IVF guide).

• KKH's KKIVF Centre sees couples as a pair with a fertility specialist. Book on 6294 4050.
• NUH offers IVF with ICSI and genetic testing of embryos, its page says. Call its Clinic for Human Reproduction on 6774 5336.
• SGH's Centre for Assisted Reproduction has over 30 years of experience and more than 2,500 babies born through assisted reproduction, SGH says. Call 6321 4377.

At KKH, citizens and PRs referred by a polyclinic or a CHAS GP get subsidised rates, and self-referred patients don't, its charges page says. Under MOH licensing rules, any centre that collects eggs or transfers embryos needs an Assisted Reproduction Service licence, while a clinic that only does IUI needs an Outpatient Medical Service licence.

Questions to ask any clinic:

• Do you hold an Assisted Reproduction Service licence from MOH?
• What are my chances per cycle at my age? HealthHub says IVF success depends on the woman's age.
• Can I have a fully costed plan, with scans and medicines included? The NHS advises asking for one.
• Will you assess both of us first? NUH says a thorough evaluation of both partners is essential before IVF.
• Could IUI come before IVF? HealthHub says IUI is usually the first line of treatment.
• What counselling do you offer during treatment?

When to see a doctor

NUH says you can start with a gynae or go straight to a reproductive specialist. A GP or polyclinic doctor can refer you. Go if:

• You're under 35 and not pregnant after a year of trying, or over 35 after 6 months (SingHealth).
• Your periods are irregular or have stopped (NUH). HealthXchange says to get advice after 6 months of trying if your periods are irregular.
• You've had an operation on your ovaries, tubes or womb, or you've had miscarriages (SingHealth).
• You've had pelvic infections, fibroids, ovarian cysts or blocked tubes (SingHealth).
• Sex is painful or difficult, or he has trouble with erections or ejaculation (KKH).
• He has pain, swelling or lumps in the testicles, low libido, or a low sperm count on an earlier test (SingHealth).
• Either of you has had a sexually transmitted infection or cancer treatment (SingHealth).

If you're newly pregnant and have strong tummy pain or heavy bleeding, KKH says to go straight to its Urgent O&G Centre or your nearest emergency department. The centre is a 24-hour walk-in service at Basement 1, Women's Tower. For an emergency, call 995. Our guide to bleeding in early pregnancy lists where to go at each hospital.

Frequently asked questions

What are the most common fertility myths?

Lying with your legs up after sex, saving up sperm, the pill harming fertility, and IVF working at any age. Singapore's hospitals and HealthHub say none of these hold. What helps, KKH says, is sex every 2 to 3 days and a healthy weight for both of you.

Does TCM help with fertility in Singapore?

HSA doesn't allow Chinese proprietary medicines to claim they treat infertility or help conception. If you try TCM, see a practitioner registered with the TCM Practitioners Board and buy only HSA-listed products. Tell your doctor what you take, as KKH and HealthHub advise.

Does acupuncture for fertility work?

The NHS says there's no evidence that complementary therapies for fertility problems work, and NICE says more research is needed. If you still want acupuncture, see a registered TCM physician and mention any fertility treatment.

How do I choose a fertility clinic in Singapore?

Check it holds MOH's Assisted Reproduction Service licence. Then ask for your chances at your age, a fully costed plan, and whether you'll both be assessed. MOH's co-funding applies at the three public centres, and at KKH a polyclinic referral gets citizens and PRs subsidised rates.

Does lying down after sex help you get pregnant?

No. KKH says resting after sex, or any particular position, doesn't boost your chances. Sperm reach the fallopian tubes within minutes.