Ms Amelia Yap went to great lengths to have her four-month-old son Xavier, including tracking her menstrual cycle and making lifestyle and dietary changes.
Although she struggled with infertility for several years, she did not want to consider in-vitro fertilisation (IVF) treatment because of her Catholic faith, which prohibits fertility techniques aimed at making babies outside of sexual intercourse within marriage.
Some couples who have problems conceiving prefer to try less invasive medical procedures than IVF for financial reasons, a fear of needles or a preference for natural conception, industry professionals say.
IVF, which is probably the best-known of the Assisted Reproduction Technology (ART) treatments used to treat infertility, involves retrieving a woman's eggs to fertilise in a laboratory with a man's sperm. One or more resulting embryos are implanted in the woman's womb.
Some couples are pursuing other options such as making lifestyle changes, including losing weight, switching to more nutritious diets and quitting smoking; reducing stress; or opting for Traditional Chinese Medicine (TCM) or acupuncture treatments.
Ms Yap, who works in pharmaceutical research, faced higher odds against conceiving naturally.
"I found out I had PCOS (polycystic ovary syndrome) before I got married. We knew it was going to be difficult to conceive. We tried for about four years before we had our baby," says the 34-year-old.
PCOS is a hormone disorder affecting fertility, with symptoms including irregular periods, weight gain and difficulty with weight loss.
Ms Yap tried different approaches before getting pregnant.
About two years ago, she and her husband, engineer Sam Wong, 34, signed up for a natural fertility programme by FertilityCare Singapore. Using the private centre's Creighton model of natural family planning to track the changes in her menstrual cycle, the couple discovered that she ovulated later than they thought. She also followed a regimen that included taking the fertility medication Clomid, as well as hormone injections.
She made lifestyle changes and lost 9kg over three years, which eased the PCOS symptoms that affect fertility. Besides restricting her carbohydrate intake, she cut out white sugar and avoided sweet fruit such as mangoes.
She thinks it was a "combination" of these methods that enabled her to conceive.
While being healthy is conducive to conceiving, not all doctors agree on the impact of various lifestyle changes or non-medical approaches that claim to boost one's fertility.
Dr Serene Lim, associate consultant, Department of Obstetrics and Gynaecology, Singapore General Hospital (SGH), advises that couples trying to conceive should have sexual intercourse every two to three days; limit their alcohol intake; avoid smoking, including passive smoking; and maintain a healthy weight, aiming for a Body Mass Index of between 18.5 and 23.
As fertility decreases as one ages, Dr Lim adds: "It may be wiser to move on to more definitive methods of conceiving and seek medical evaluation if the couple have not had any success after six to 12 months of trying for pregnancy."
The success rates for IVF are greatly dependent on the woman's age.
Married couple Teo Caiqun, 32, and Issac Wong, 30, have been trying to conceive only in recent months. Mr Wong, who works in technical sales and support in the engineering industry, says they want to be "well-prepared" for natural conception.
To this end, they were among six couples who attended a weekend event earlier this month, which was billed as a "fertility wellness staycation".
The event, which included a one-night stay at a hotel in the Central Business District, was organised by BeNatural, a natural fertility centre that has a multi-faceted approach in guiding couples to enhance natural conception.
Its programme included informational talks about fertility; demonstrations of a form of acupressure, a kind of TCM therapy; and a session called "fertility yoga" that reportedly reduces stress and increases blood flow to the reproductive areas of the body.
There was also a tango class aimed at encouraging the couples to bond, as well as a talk on nutrition, where a smoothie was made using ingredients such as maca powder, a Peruvian food that allegedly boosts fertility.
Ms Teo, a civil servant, appreciated the programme's "holistic" approach.
"The important thing is to start taking care of yourself, healthwise, by paying more attention to your diet," she adds.
However, SGH's Dr Lim casts doubt on the efficacy of claims to boost fertility through TCM or specific foods and exercises.
She says: "It is unclear if TCM or acupuncture improves fertility. Some research has suggested that TCM or acupuncture can help improve semen parameters and female infertility, although other studies have not found this to be the case.
"In addition, the relationship between stress and fertility is unclear... There are confounding factors that come into play, for example, stress may reduce fertility by reducing sexual frequency."
She adds: "While eating a balanced diet rich in antioxidants may help to improve fertility for both men and women, generally there is insufficient good-quality research done to prove or disprove the effectiveness of eating specific foods in improving fertility. Also, it is not proven if certain types of exercise are better than others for boosting fertility."
In contrast, Dr Paul Tseng, a fertility specialist, obstetrician and gynaecologist at the private Virtus Fertility Centre, says there are some "immeasurable" factors that contribute to the difficulty in becoming pregnant, such as stress, for instance, which can "inhibit" conception.
He says, for example, that acupressure and other methods that increase the blood flow to the uterus, and eating certain foods, such as folic acid-rich asparagus, can "enhance the chances of getting pregnant".
Dr Roland Chieng, medical director at Virtus Fertility Centre, says: "I will often recommend TCM treatment for select patients to optimise results. These two methods can go well hand in hand, as Western treatments provide advanced solutions to identify and address the causes of infertility that TCM will not be able to do, and acupuncture can act as a supplementary method for patients to increase their chances of success before treatment (such as IVF)."
TCM embraces lifestyle changes as well, says Ms Huan Chew Ting, a TCM physician at Thomson Chinese Medicine. Besides prescribing herbal tonics and acupuncture, she recommended that one of her clients, Mrs Toh, a finance officer, avoid "cooling" drinks, such as the bubble tea she used to drink daily, because her body had too many "cooling" elements.
The 37-year-old had previously endured 31/2 years of both Western and Chinese fertility treatments. These included two rounds of intrauterine insemination (IUI), a fertility treatment that involves placing a prepared sperm sample inside a woman's uterus to facilitate fertilisation; having injections of fertility drugs; taking TCM tonics; and keyhole surgery to remove cysts in her abdominal area that could have affected fertility.
She and her 36-year-old husband, who works in logistics, decided against IVF as they felt it was too expensive. The average cost of one IVF cycle in Singapore is about $12,000, though government subsidies of up to 75 per cent are available for Singaporean couples.
Mr and Mrs Toh have spent at least $7,000 on these other methods.
Mrs Toh, who declined to be identified in full, says: "It was a long and tiring journey, with a lot of disappointment.
"We really wanted kids. We like kids. My husband is also an only child, so the pressure is even more intense."
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