Improving the Odds
“There are no guarantees in fertility treatment but Dr Navdeep Singh Pannu believes the right treatment at the right time will greatly improve a patient’s chance of conceiving. He outlines the treatment options available to would-be mothers, especially those who have had the disappointment of multiple miscarriages or failed embryo transfers.” For some couples, having a child can be a difficult process beset by physiological hurdles. According to statistics, up to 25% of clinical pregnancies end in failure but Dr Navdeep Singh Pannu, a fertility expert with over a decade’s experience, firmly believes that the combination of the right treatment at the right time can greatly improve a couple’s chances of having a child. “For an IVF process to be successful, there must be two main things. Firstly, there must be a ‘chromosomally normal’ embryo where the number of chromosomes is perfectly normal. If it is not, it will lead to failure of the procedure or worse, a miscarriage,” explained Dr Navdeep. “Chances of miscarriage increase as women grow older. As you know, as women age, they begin to lose their best eggs. Thus, when they conceive, there is a high chance that the embryos may be abnormal. A good example would involve Downs Syndrome which increases dramatically with women over the age of 40. It can affect 1 in every 100 babies born by mothers in this age group.” Reasons for Failure “Chromosome abnormality is the main reason why women have miscarriages,” said Dr Navdeep. Another possible reason is when a woman suffers from blood disorders which affect the immune system. A condition that can occur is anti-phospholipid syndrome where abnormal clots form behind a growing placenta which can lead to miscarriages. “Women with underlying health issues, such as uncontrolled diabetes or thyroid problems, face an increased likelihood of miscarriages,” he stated. Structural abnormality of the womb can also be a contributing factor in miscarriages. The womb should be of normal shape and dimension with a smooth inner lining. If the womb is of abnormal shape or if the woman has a polyp or uterine fibroid making the womb lining irregular, these factors can also cause miscarriages.” A Question of Timing “The first part is to assess why exactly a woman is having difficulty conceiving. Once this has been ascertained, the mode of treatment can be personalised accordingly with the ultimate aim of increasing the patient’s chances of conceiving,” explained Dr Navdeep. “Four main areas that we look at are the sperm test, the ultrasound scan of the womb and ovaries, an X-Ray called hysterosalpingogram to look for blocked fallopian tubes and hormonal blood test. We will first correct any problems or abnormalities here before commencing with any form of further treatment.” Here are various treatment options available. “Firstly, we can advise couples of the optimum time to have intercourse, which is when the woman is at her most fertile. We can also prescribe hormonal medications, which have been around for a long time, to increase the production of eggs in a woman. The patient is then scanned to determine the best time for intercourse to increase the chances of conception,” he stated. Another form of treatment is intrauterine insemination where the husband’s sperm is processed and injected directly into the womb. This procedure can increase the success rate of conceiving by 15% to 20%. The Test Tube Option Subsequently, there is In Vitro Fertilization (IVF) or popularly known as ‘test tube baby’. This is where a woman is given injections for 10 days, after which her eggs are then extracted under anaesthesia. Sperm is injected directly into the eggs to ensure fertilisation and five days later, the embryo is transferred into the womb. If this normal IVF process is not successful, there are two other options available to patients. “First is Pre-implantation Genetic Testing (PGT) where we determine which are the best embryos to be transferred. A small amount of cells are extracted from each embryo for chromosome analysis which will help determine if the embryos are healthy,” outlined Dr Navdeep. The other option is Endometrial Receptivity Analysis (ERA). This method will help determine the best time frame for implantation of the embryos in women. “Basically, PGT will help determine the best embryos while ERA will signal the best time to transfer these embryos. Studies have shown the combination of these two procedures can increase conception rates by up to 80%,” added Dr Navdeep. Balancing Act According to Dr Navdeep, these treatment options are recommended for women who have had recurrent transfer failures and failed to conceive despite healthy embryos being transferred. They are also recommended for women who have had multiple miscarriages due to an abnormal foetus. Another group are those with a family history of genetic problems such as cystic fibrosis, thalassemia and many more who want to avoid passing on these hereditary problems onto their offspring. Family balancing is where a patient can select the gender of the offspring based on the chromosome test. This is done when couples are seeking to avoid passing on gender-based hereditary problems or when they wish their offspring to be male or female. Other tests and procedures include Endometrial Microbiome Metagenomics Analysis (EMMA) where a woman’s womb lining is tested for ‘good’ bacteria that will help facilitate conception. Patients with an imbalanced bacterial flora will be prescribed probiotics to correct the situation. Another procedure is known by the acronym ALICE which stands for Analysis of Infectious Chronic Endometritis. As many as 30% of women have chronic infection of their womb linings. This imbalance of bad bacteria can cause implantation failure which could be corrected with a course of antibiotics. Dr Navdeep has had a number of success stories utilising the above-mentioned treatment methods. Citing a patient in her 40s who approached him after experiencing repeated miscarriages despite having healthy embryos, Dr Navdeep shared that he administered more detailed tests which helped identify the correct window for transfer. “She recently gave birth to healthy twins,” he reported. “There can be no better
