Singapore has recorded one of the lower fertility rates in recent years, a trend that reflects shifting social priorities, changing career paths, and the realities of modern life. As an obstetrician and gynaecologist, I have spoken about my own thoughts and experiences as an obstetrician and gynaecologist supporting couples on their fertility journey (Please hyperlink this article Accepting God’s gift of life – Catholic News)
I regularly speak with patients navigating these decisions — balancing personal and professional goals with questions about when, or whether, to start a family.
This article aims to provide a factual overview of how fertility changes over time, what couples may wish to consider when planning ahead, and when it may be worth seeking medical guidance. It is not intended to influence decisions or any particular path, but to help readers approach these conversations with a clearer understanding of the relevant factors.
The Biological Timeline of Fertility
| Age Range | General Fertility Considerations | What This May Mean |
|---|---|---|
| 20s | Fertility is generally at its highest during this decade. | Conception may occur more readily; fewer age-related complications. |
| Early 30s | Fertility begins a gradual decline, though many couples will conceive without difficulty. | Although fertility potential should still be good during this period, couples embarking on fertility journeys are still encouraged to go for fertility screening and early review to optimize their pre-conception health. |
| Mid-to-late 30s | The rate of decline becomes more noticeable from around age 35. Pregnancy after the age of 35 is considered pregnancy in Advanced Maternal Age, and requires monitoring and specialist care. | Optimizing your natural fertility is critical to conception – couples are advised to consider pre-conception fertility screenings, and to seek specialist advice after 3-6 months of trying unsuccessfully. |
| 40s | Fertility potential declines rapidly, and some women will start to experience signs of perimenopause. Pregnancy after the age of 40 is considered pregnancy in Very Advanced Maternal Age, and requires close monitoring and specialist care. | Although spontaneous pregnancy is possible, early consultation with a specialist is generally recommended. |
It is worth noting that male fertility also declines with age, though the pattern differs from female fertility. Sperm quality and quantity may be affected from the mid-40s onward, and this can be a relevant factor for couples to consider together.
Fertility decline does not mean that spontaneous pregnancy later in life is not possible. However, it may take longer to conceive, and the likelihood of requiring medical support may increase. Being aware of this timeline allows couples to make decisions that reflect both their personal circumstances and biological factors, rather than being caught off-guard by them. Detecting potential fertility reducing factors early also allows couples to have more options for optimizing their natural fertility potential, as well as considering assisted reproduction techniques, where applicable.
Balancing Career, Lifestyle, and Family Planning
For many couples in Singapore, the years between their late twenties and mid-thirties represent both an active period of career development and a biologically relevant window for family planning. The tension between these two realities is one of the most common concerns raised in preconception consultations.
There is no universally applicable answer to how these competing priorities should be balanced. What may be helpful is recognising that planning ahead — even if a family is not yet on the immediate horizon — allows couples to make more considered decisions rather than reactive ones.
Some practical considerations that couples in this situation may find worth discussing:
These are not decisions that need to be made immediately or all at once. They are, however, conversations that may be worth initiating earlier rather than later.
The Role of Support Systems
Parenthood in a dual-income household — which describes the majority of Singapore families — rarely operates without some form of external support. Extended family members, professional caregivers, and community networks all play a role in making parenthood workable alongside professional commitments.
At an institutional level, employer policies on parental leave, flexible working arrangements, and childcare support can meaningfully influence how families experience the transition to parenthood. Couples considering this transition may find it useful to understand what support is available to them through their employers and through national schemes.
These structural factors do not determine whether to have children, but they are practical considerations that affect how the experience unfolds. Factoring them into planning discussions may reduce some of the uncertainty involved.
Preconception Consultations: What to Expect
A preconception consultation is a medical appointment designed to be conducted before a couple begins trying to conceive. It is an opportunity to review health factors that may be relevant to fertility and pregnancy, and to raise any questions about the process.
Learn more about pre-pregnancy care
Such consultations are not only for couples who are about to try to conceive. They may also be helpful for those who are planning ahead and want to understand their current health status in the context of future family planning.
If you have been trying to conceive without success for 12 months (or 6 months if you are over 35), a referral to a fertility specialist is generally recommended.
Lifestyle Factors That May Be Relevant to Fertility
While many aspects of fertility are determined by biological factors outside an individual’s control, certain lifestyle factors may play a supporting role. The following are areas that are commonly discussed in preconception settings:
- Body weight: Both significantly low and high body weight have been associated with changes in hormonal balance that may affect ovulation and fertility. Maintaining a body weight within a healthy range is generally considered supportive.
- Diet: A varied diet with adequate intake of key nutrients — including folate, iron, and vitamin D — is commonly recommended in the preconception period.
- Smoking: Smoking has been associated with reduced fertility in both men and women, and is generally advised against in the preconception period and throughout pregnancy.
- Alcohol: Current guidance in Singapore and internationally generally advises avoiding alcohol when trying to conceive and during pregnancy.
- Stress: Chronic stress may affect hormonal regulation, though the direct relationship between stress and fertility is complex. Managing stress through sustainable means is broadly supportive of general health.
- Exercise: Regular, moderate physical activity is generally associated with positive health outcomes. Excessive exercise at very high intensity may, in some cases, affect hormonal function and should be discussed with a doctor.
These factors are worth discussing with a medical professional in the context of your individual health history, rather than acting on general guidance alone.
In my experience, many couples benefit most from having these conversations early — not because there is urgency in every case, but because understanding the relevant factors tends to reduce anxiety and support decision-making over time.
The most consistent observation I would share is this: access to clear information, at the right time, tends to be more helpful than waiting until a concern arises. If you have questions about your fertility or family planning options, a preconception consultation is a reasonable starting point.
- Dr Samantha Yeo
Looking Ahead
Singapore’s fertility trends are shaped by a range of social, economic, and personal factors. While these trends reflect genuine complexity, the information available to support family planning decisions has also grown considerably.
For couples who are considering parenthood — whether in the near term or further ahead — access to accurate information and timely medical guidance can support more considered decision-making. The questions involved are personal, and there are no universal answers. What a preconception consultation can offer is clarity about your individual circumstances, so that whatever decisions you make are grounded in your own health picture.
