Singapore’s total fertility rate fell to a historic low of 0.87 in 2025. Contributing factors include delayed marriage, high living costs, career prioritization, and biological limits that exacerbates with age. Around 15% of couples face infertility challenges and a subset of that experience unexplained infertility. This affects roughly 10–15% of infertile couples in Singapore. Rising maternal age also further reduces fertility and often worsens conception difficulties.
What is unexplained infertility?
Unexplained infertility is a diagnosis given to couples who have been:
Actively trying to conceive (i.e. having sexual intercourse 2-3 times a week)
For at least 1 year (<35 years old) or 6 months (>35 years old) without success
Identified with no specific cause for infertility having undergone complete fertility evaluations
Common causes of unexplained infertility
Unexplained infertility occurs when standard tests show no identifiable cause for a couple's inability to conceive. Hence, medical professionals generally attribute it to subtle, underlying issues that standard fertility tests cannot routinely measure such as:
Vaginal microbiome imbalance
Subtle eggs and/or sperm quality issues
Ovulatory dysfunction such as irregular or absence of ovulation
Mild or silent endometriosis
Luteal phase abnormalities
Uterine lining abnormalities
Immune system issues
Poorly timed intercourse
Lifestyle factors such as emotional stress, smoking, alcohol consumption or obesity
A combination of these factors may play a role in unexplained infertility, but further research is needed to better understand the condition.
Treatment for unexplained infertility
Some of the western treatment options for unexplained infertility include:
Assisted reproductive technology
Intrauterine insemination (IUI)
In vitro fertilization (IVF)
Intracytoplasmic sperm injection (ICSI)
Ovulation induction therapy
Promoting lifestyle changes
Having a well-balanced diet
Maintaining a healthy weight
Exercising and managing stress
Reducing alcohol and caffeine intake
Quiting smoking
Traditional Chinese Medicine (TCM) perspective on unexplained infertility
TCM believes that the root cause of unexplained infertility lies in the dysfunction of the internal organs, disharmony of Qi and blood, and the obstruction of the uterine environment. Although modern medical examinations may reflect normal results, TCM can analyze and regulate the condition through holistic diagnosis, focusing on the four core pathogenesis mechanisms of "deficiency, stagnation, phlegm, and blood stasis." According to TCM theory, there are a few causes for unexplained infertility.
They are mainly:
Kidney yin, yang and essence deficiency
Liver stagnation
Spleen deficiency
Qi and blood deficiency/stasis
Hence, the herbs used to improve fertility usually involve:
Nourishing the kidney
Walnuts
Mulberries
Wolfberries
Chinese yam
Nourishing the spleen
Dangshen
Red dates
Soothing the liver
Rose buds (Used before ovulation)
Pomegranate (Used after ovulation)
The use of herbs can help regulate menstrual cycle and hormonal balance, stimulate ovulation for women with irregular ovulation, improve egg quality, uterine receptivity and sperm quality.
Besides herbal medication, TCM management involves a combination of techniques such as
Acupuncture
Improve blood flow to the reproductive organs
Improve sperm and egg quality
Regulates hormones
Reduce stress
Restore balance to the flow of qi and blood
Moxibustion
Warm the uterus
Regulates menstrual cycle
Lifestyle modifications
Ensure balance diet
Eating fresh food daily
Exercise regularly
Stress and emotional management through engaging stress reduction techniques
Reduce intake of processed food, cold and raw food, sugary food and drinks, fried and fatty food
Dietary therapy
Intake of healthy fats
Avocado
Nuts and seeds (eg. Walnuts, Chia seeds, Flaxseeds)
Intake of lean proteins
Fish rich in omega-3 (eg. Salmon)
Chicken
Eggs
Beans and lentils
Intake of whole grains
Quinoa
Oats
Brown rice
Intake of low-fat milk
Intake of dark leafy vegetables
Intake of berries
Raspberries
Blueberries
Conclusion
Awareness and education are important in helping individuals and couples understand that unexplained infertility is a recognized medical condition, and that there are various approaches that can support the fertility journey. Every fertility journey is unique, and with the right support, guidance, and individualized care, individuals and couples can navigate this challenging journey with hope and resilience.
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