The Straits Times Life, 5 Nov 2023, More resort to womb massages, catered meals, even ‘sperm guides’ for fertility boost (https://www.straitstimes.com/life/the-great-singapore-fertility-chase-more-resort-to-womb-massages-catered-meals-which-boost-fertility-even-sperm-guides)

Some couples in Singapore are going beyond conventional fertility procedures like IVF (in-vitro fertilisation) in their quest for conception.

They are opting for womb massages mixed with moxibustion, a technique in traditional Chinese medicine (TCM) that involves burning herbs near the skin; oxygen therapy said to enhance baby-making odds; catered meals which claim to improve fertility; and even a “sperm guide” that reduces post-coital semen leakage.

Demand has surged for both medical and non-medical fertility services and products in recent years, boosted by the pandemic, which provided downtime for these.

Powered by societal changes and the rocketing of the wellness industry, a Great Singapore Fertility Chase is under way as, ironically, the country’s total fertility rate sank to a record low of 1.04 in 2022.

In ageing Singapore, the total fertility rate has remained far below the replacement rate of 2.1 for many years.

Citizen births further fell 4 per cent from 31,713 in 2021 to 30,429 in 2022, the Year of the Tiger in the Chinese lunar calendar, which is associated with fewer births.

There has also been a spike in demand for assisted reproduction treatments (ART) nationwide.

Responding to queries from The Straits Times (ST), a Ministry of Health spokesperson says the number of ART cycles, including IVF cycles, undergone by women annually during the five-year period of 2017 to 2021 increased from about 7,700 to 10,800.

IVF is a fertility treatment where eggs are combined with sperm in a laboratory.

Hospitals such as KK Women’s and Children’s Hospital (KKH) and Singapore General Hospital (SGH) have seen a steep rise in such treatments in recent years.

Dr Hemashree Rajesh, senior consultant at the department of obstetrics and gynaecology at SGH, says: “Between 2020 and 2022, we had an almost 40 per cent increase in the number of fresh IVF cycles.”

At KKH, the number of IVF cases performed at its KKIVF Centre, the largest fertility centre in Singapore which marks its 30th anniversary this year, increased 60 per cent in the 10 years from 2013 to 2022.

This figure peaked in 2021, a pandemic spike due in part to a ban on overseas travel, which may have prompted more patients to embark on fertility treatments locally, says Dr Liu Shuling, director of the centre.

While declining to provide specific figures, Dr Liu says the general upward trend could be attributed to factors such as increased awareness about fertility and more couples starting families at a later age.

Later marriages have been recorded in Singapore’s most recent statistics.

The median age at first marriage for grooms was 30.7 years in 2022, inching up from 30.1 years a decade earlier. For brides, it was 29.3 years in 2022, rising from 28 years in 2012.

Increasing maternal age raises the risk of pregnancy complications and could prolong the time needed to get pregnant. Studies also suggest that the father’s age at the time of conception might pose health risks for their offspring.

Couples aged 35 and older are usually advised to consult their healthcare providers if they have not been able to conceive after six months to a year of regular, unprotected intercourse.

“We have been seeing more women above 40 years old seeking treatment at our KKIVF Centre since 2020,” says Dr Liu, adding that increased government subsidies have played a role here.

From January 2020, the Ministry of Health lifted the previous age limit of 45 years old for women to undergo ART treatments and removed the cap on the number of ART cycles for all women.

There are also considerable government subsidies for ART and intrauterine insemination (IUI) treatments, amounting to up to 75 per cent in co-funding, at public assisted reproduction centres. IUI is a procedure that boosts the chances of pregnancy by placing specially prepared sperm directly in the uterus.

Two sides of the same coin

The Great Singapore Fertility Chase has come about because the reality of more older Singaporeans giving birth has a bearing on the flurry of fertility services and products on offer now, as well as the country’s historically low fertility rates, observers say.

Dr Tan Poh Lin, a senior research fellow at the Institute of Policy Studies who researches local family and population issues, says these phenomena are “two sides of the same coin”.

“With an older median age at marriage, more people are having children later. The fertility rate tends to drop with the rising age of childbearing and there is a growing group of women seeking fertility aid,” she notes.

The upside to this development, she says, is that it could also open up the space for “once-taboo” conversations about fertility issues.

For example, ovulation disorders and low sperm motility, which refers to the ability of sperm to move efficiently, have previously not been brought out into the open.

Mr Tim Kwan, managing director of Virtus Health Asia, which runs Virtus Fertility Centre Singapore and another recently launched fertility centre, IVF(SG), says: “The rise in demand in fertility services aligns with global trends, where fertility health is on a decline due to changes in lifestyle and environmental factors.”

Besides age being a big factor in female fertility, severely impacting egg quality, an increasing number of men also have poor sperm quality, due to hormonal or other problems, in line with worldwide data concerning male infertility and falling sperm counts, he says.

“Beyond early diagnosis and treatment options if needed, couples who are looking to start a family should also adopt good lifestyle habits to improve their fertility health in general,” he adds.

Sociologist Nilanjan Raghunath of Singapore University of Technology and Design notes that loosely defined “fertility wellness” services and products are part of the ever-growing wellness industry, which is worth billions of dollars globally.

“There is a willingness to try non-invasive treatments, and word spreads via social media like TikTok and YouTube. Some of these customers also have more disposable income,” she says.

No harm trying

Sharon, not her real name, acknowledges that her difficulty in conceiving could be “age-related”. Having endometriosis – a condition in which tissue similar to the lining of the uterus, or endometrium, grows outside the uterus – also made it harder for her to get pregnant.

Now 44, the married white-collar professional underwent “more than 10 cycles of IVF” while trying to conceive for four years.

Frustrated, she decided in 2022 to complement having IVF with “womb therapy” massages that were advertised on her social media feed. She had two rounds of such fertility massages, going twice a week for four weeks each time.

“I can’t really say whether they worked or not. I needed to try something different. I thought there was no harm in trying it and my doctor concurred,” says the new mother of a three-month-old daughter.

She had signed up at Highlander Fertility Wellness Centre, which offers womb therapy that “focuses on balancing and cleansing women’s wombs with the combination of herbal remedies, womb massage and a moxibustion device”, says its founder Wendy Liu, 40.

A package for 15 sessions starts at $2,888 at the centre, which began operating in 2003.

“In recent years, the demand for our fertility services has surged, notably since the onset of the pandemic. More women are turning to unconventional methods, such as massage and herbal remedies, following unsuccessful attempts with traditional fertility treatments,” says Ms Liu, without citing actual take-up figures.

“This increasing demand is propelled by a growing awareness of the time-sensitive nature of fertility. Many women are no longer willing to wait for years before seeking assistance. Our approach emphasises the importance of a strong reproductive foundation, a critical factor even in assisted reproductive techniques like IVF.”

Providers of such unconventional fertility services do not claim to be medical professionals. But the increasing popularity of such treatments raises questions about the veracity of their claims to boost chances of conception, observers say.

At twoplus Fertility, a Singapore-based company which sells fertility services and products online, business is booming.

Co-founder Benjamin Tee says the company has grown its customer base from 100 in 2021 to 10,000 in 2023.

One of its bestsellers is a “sperm guide”. Inserted vaginally, it is billed as a fertility aid that minimises leakage post-sex, so more semen is deposited as close to the cervix as possible. Prices start at $98.

The Applicator and the Applicator Extra are insemination syringes priced from $78.

Dr Tee, 41, who is also an academic in material science at National University of Singapore, says: “The Applicator allows for insemination without needing to have sexual intercourse. Many couples who are trying to conceive say having to have sex multiple times during their fertile window causes a great deal of stress.

“With the Applicator, if they are not in the mood to have sex during their fertile window, they can replace having sexual intercourse with at-home insemination. This allows them to separate having sex to conceive from having sex for pleasure, so sex is no longer scheduled and mechanical and retains its spontaneity.”

The company also launched a “Meals for Fertility” service in July, with 3,000 meals bought and consumed by those hoping to be in the family way soon.

Based on the nutrient-rich Mediterranean diet, a Couple Plan of lunch or dinner, delivered five times a week to the home, costs $190. The meals feature ingredients like extra virgin olive oil, salmon, black barley and spinach.

Dr Tee says he and his wife experienced five years of “unexplained infertility” before they conceived their son, now three, which provided the motivation for his business.

He attributes the burgeoning demand for his products to their relatively low cost and the privacy and ease afforded by online shopping, compared with getting a fertility procedure done in a clinic.

For comparison, at the KKIVF Centre, the estimated cost for one IVF cycle, including an embryo transfer, is $12,000 to $16,000, although the bulk of this cost can be claimed from government schemes like MediSave, says centre director Dr Liu.

At SGH, on average, an IUI cycle costs less than $1,000 and an IVF cycle costs around $15,000, says Dr Rajesh.

Young couples seeking a boost

It is not only older women who come for fertility treatment. Younger women are also stepping forward, says Dr Rajesh.

Property agent C. Tan, 35, is among the 30somethings taking ownership of their fertility, even before conception issues surface.

Neither she nor her 37-year-old husband, who both underwent fertility checks, had any red flags, but they wanted to start a family as soon as possible.

They started prioritising their health, going to the gym four times a week, rather than once. She came across an influencer talking about the sperm guide and figured it might give them “an extra boost”.

She says: “Even though I was not infertile, the inability to conceive during the months when we started trying made me feel that I was infertile. I think many women experience this.”

The World Health Organisation describes infertility as a disease of the male or female reproductive system defined by the failure to achieve a pregnancy after 12 months or more of regular, unprotected sexual intercourse.

Ms Tan and her husband used the conception aid towards the end of a year of trying to conceive, and their daughter is now a year old.

At the Fresver Beauty salon chain, which has four outlets islandwide, business development manager Anna Goh says its “mud moxibustion womb and ovary treatment” has seen increased demand in the past two years, from women as young as early 20s.

The treatment, which includes a massage and a herbal mask, is targeted at “overall womb health”, and helps alleviate period cramps and irregular menstrual cycles, she says. It costs $49 for first-time customers.

Women in their 20s to 40s are among the clientele at Babies Bliss at Plaza Singapura, says founder Angelia Ng.

Founded in 2019, the company offers fertility-related services such as fertility massages, hyperbaric therapy using pure oxygen, and heated “infra-wellness therapy”.

It has seen a 20 per cent rise in demand in recent years, with many clients taking up a six-month customised package that costs about $7,000.

Ms Ng says her customers in their early 20s take a proactive approach to wellness, including their fertility.

“Their mentality is slightly different. Some might want to prepare their body for pregnancy even before marriage. Their friends and others have been talking about fertility challenges,” she says.

“It’s like how we don’t take supplements or exercise only when we are diagnosed with a condition. It’s more preventive.”

Do they really help?

Doctors interviewed by ST expressed caution about such non-medical fertility services.

KKIVF’s Dr Liu says: “We should try to reduce the use of adjuvant (extra) treatments because they have not been proven to be beneficial. If the benefits are real, they would have been included as standard treatments.”

She still encourages aspiring parents to try natural conception first and have regular sex, while maintaining a healthy lifestyle. “Despite advances in technology, fertility treatments are not without their complications, so we would not offer them to all couples,” she says.

“For example, if a woman’s test result shows a low ovarian reserve, it does not mean that she will be sub-fertile; she might still get pregnant easily. But because of the abnormal result, she might go for treatments earlier than necessary, which can increase her stress tremendously.”

Physician Seah Ai Wei, head of Thomson Chinese Medicine, also cautions against the “ad-hoc” use of elements of traditional Chinese medicine.

“Within TCM practice, there are techniques like acupuncture to improve blood flow to reproductive organs to enhance fertility wellness. (But) patients may not be able to reap their full benefits based on an ad-hoc use of TCM treatment methods,” she says.

She adds that TCM is not only a viable option for couples trying to conceive, but can also be used to complement other assisted reproductive therapies.

It is important to check that one’s TCM physician is accredited by the Traditional Chinese Medicine Practitioners Board, she adds.

Not all doctors are unconvinced by these unconventional methods.

Some, like Dr Anupriya Agarwal, an obstetrician and gynaecologist at Mount Elizabeth Hospital, say that there could be some merit to some commercially available methods.

Preliminary studies suggest that hyperbaric oxygen may improve implantation by improving endometrial receptivity, for instance, though Dr Agarwal adds that more robust studies are required.

Endometrial receptivity refers to how prepared the uterine lining is for the implantation of an embryo.

While warning against the peddling of “false hope” to patients with serious fertility issues, she cites a British study, reported in 2019, in which about one in six couples who had been unsuccessful with medical treatments like IVF or intracytoplasmic sperm injection went on to have a baby.

The population-based retrospective cohort study, authored by researchers at the University of Aberdeen in Scotland, involved more than 2,000 patients.

Conception, much like birth and death, remains a mystery.

As Dr Roland Chieng, medical director of Virtus Fertility Centre Singapore and a specialist in obstetrics and gynaecology, puts it: “Just like unexplained infertility, which affects between 10 and 30 per cent of the population, we often don’t know how or why conception after a period of infertility occurs, but we celebrate the miracle.”