Dr Navdeep
July 30, 2020
How technology is changing pregnancy for women over 40

The New Straits Times Letter to the Editor, 28 July 2020, features Dr Navdeep’s thoughts on advancements in fertility treatment, defining infertility as a disease, and his commitment towards helping couples build a family. LETTERS: Advancements in fertility treatments and technology are helping more and more women who are facing age-related infertility achieve their dreams of having a baby. Developments in procedures and technologies in fertility science complemented by laboratories that adhere to the highest standards ensure the best chances of creating and growing embryos to facilitate pregnancies. Procedures such as Preimplantation Genetic Testing (PGT) ensure that the best embryo can be selected for transfer, and Endometrial Receptivity Analysis helps doctors determine the best time to transfer the embryo. Improvements in medication has reduced injections needed to be administered to women in preparation for In-Vitro Fertilisation (IVF) from six weeks to 10 days. These have contributed to increased success in pregnancy and decrease in miscarriages. In fact, the success rate of pregnancy through IVF is almost 60 per cent now compared with 20 per cent previously. Still, how is it possible that women in their 40s and above can conceive? Most age-related infertility problems in women are due to germ cell deterioration. By the time women turn 40, their ovarian reserve or eggs are reduced markedly. However, the uterus remains functional. Therefore, for women above 50 to conceive, an egg from a donor is artificially inseminated by the husband’s sperm to create an embryo. The embryo is implanted in the woman’s womb, which carries the baby to term. While it is a possibility, advanced age pregnancy may not be for everyone. Ethically, fertility specialists first need to determine if the woman is healthy enough to carry a child. For this reason, early pregnancy (preferably between 20s and 30s) is the ideal convention. If a woman is not ready to have children in her 20s or even 30s, she can ensure her chances of having a healthy embryo years later by preserving her eggs while she is young with oocyte cryopreservation or egg freezing. However, when it comes to fertility, the fundamental message is: don’t wait until it becomes a challenge. To be exact, couples should see a fertility specialist after six to 12 months of trying but failing to conceive. Fertility is a potentially treatable problem. The problem lies in the fact that infertility is generally not considered a medical problem. Instead, it is seen more as a social issue. Infertility may not be a life or death case but it is a long-term (chronic) condition. People can be childless for life and this can contribute to mental and emotional health problems, marriage breakdowns and career failures. For a long time, infertility wasn’t even considered a disease. It was only in 2009 that the World Health Organisation and the International Committee for Monitoring Assisted Reproductive Technology defined infertility as “a disease of the reproductive system”. The right to procreation must be seen from a broader perspective. Besides its importance to the survival of mankind, children are imperative for a nation. Dr Navdeep Singh Pannu Fertility Specialist Puchong, Selangor Source : New Straits Times https://www.nst.com.my/opinion/letters/2020/07/612116/how-technology-changing-pregnancy-women-over-40 This blog is intended for educational purposes only. All contents here is general in nature and does not take into account your personal circumstances. Please consult with your health care professional to ensure you get the right diagnosis and treatment. (Everybody has a chance to build a family) by Dr Navdeep

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Happy Birthday Louise
July 25, 2020
Happy Birthday Louise – 25th July 2020

“The IVF procedure, first used in 1978 gave the Browns their first daughter and it will continue to give to give couples around the world hope to build a family.” – Dr Navdeep Singh Pannu “Yes, I do remember the first time I performed the In vitro fertilisation (IVF) procedure. It was in 2011. I was nervous then and still am now, anticipating the outcome after each procedure,” shared Dr Navdeep Singh Pannu responding to the question as to whether he remembers the first time he did the IVF procedure. “I have done close to 1000 IVF procedures since. When the results are positive, it is a high all around. When it is not, it can be an emotionally very stressful for everyone involved,” said Dr Navdeep. Dr Navdeep was commenting on the upcoming birthday of Louise Brown on 25th July, the world’s first baby conceived via the IVF procedure. “On 10 November 1977 in a hospital in Oldham UK, over 40 years ago, the egg and sperm united in a petri dish by scientist Dr Robert Edwards and gynaecologist Dr Patrick Steptoe, had divided into eight cells.” It was implanted in Lesley Brown, and after nine years trying and failing to conceive due to blocked fallopian tubes, she became pregnant. 38 weeks later, Louise Joy Brown, the world’s first IVF then known as a test tube baby was born. “Interestingly, 67 days after the birth of Louise Brown, Kanupriya Agarwal alias Durga was born in West Bengal, India, as a result of a similar procedure conducted by Dr Subash Mukhopadhyay,” added Dr Navdeep. Unfortunately, Dr Subhash had taken his own life, due to the dejection of not being allowed to share his achievements with the international scientific community. “More than 8 million IVF babies and counting later, the IVF technique continues to achieve tremendous advancements,” said Dr Navdeep who was scheduled to perform five IVF procedures on the day this interview took place. “There are discoveries made every day and these achievements are taking us closer to achieving higher pregnancy rates and healthier pregnancies,” said Dr Navdeep paying homage the technique. “What we know now is only a drop in the ocean. Science is evolving at a break neck speed,” said Dr Navdeep pointing out that there could come a day when a womb may not be needed to implant an embryo in. “Each advancement made is a chance for someone to hold that baby that they so wish for. To me that will always be magical and I am invested to make that moment come true for couples. A very happy “Birth Day” to all babies born via IVF and for the many more who will come into this world through this procedure. This blog is intended for educational purposes only. All contents here is general in nature and does not take into account your personal circumstances. Please consult with your health care professional to ensure you get the right diagnosis and treatment. (Everybody has a chance to build a family) by Dr Navdeep

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Making Babies a Reality
July 18, 2020
Making Babies a Reality

Dr Navdeep Singh Pannu is a fertility care specialist with extensive experience in reproductive medicine including assisted reproductive treatments and technologies. Ingrained with the belief that infertility is treatable, he has helped hundreds of couples conceive including many women in the advanced age group as well as men with severe infertility issues who had given up almost all hope of having a child of their own. “There are so many options today that addresses the various causes of infertility and it is only getting better with time. No matter what the issues are and whether it is male or female infertility, there is a way to have your own baby,” he emphasised. If there are no immediate indications of severe infertility issues, Dr Navdeep prefers to take a conservative approach by helping couples try to conceive naturally before attempting assisted reproductive procedures like in vitro fertilisation. “If we can help a couple conceive naturally, then why not? Sometimes what they need is a little help like Ovulation Induction, which encourages eggs to mature and ovulate or they could just need fertility-sparing surgery to fix a problem that is impeding pregnancy.” Having a progressive outlook, Dr Navdeep embraces his patient’s own fertility care preferences such as natural treatments that help with conception to birthing, from acupuncture to Chinese herbal medicines. “Battling with infertility issues can be stressful. You are not only dealing with personal stress, but also from the external environment like family and friends. I believe that if it helps patients to relax, and take care of their body and mind, then it can only promote their chances of conceiving. Of course, I do keep a close eye on all treatments.” An unwavering focus on the safety and comfort of his patient is a common theme throughout Dr Navdeep’s practice. “I don’t believe in putting patients in the way of unnecessary danger, especially from treatments. I don’t encourage taking risks such as implanting more than two embryos at a time. It is more important to me that the mother has a safe and comfortable pregnancy and her baby is healthy. Any other outcome is heartbreaking.” As someone who has had his own experience with infertility, Dr Navdeep knows how challenging the journey to become parents can be. Always there to support his patients and to provide the best care possible, he always makes himself available to his patients at any time, including weekends. “I’m more than happy to be there for these couples. For me, there is nothing more rewarding than to see a couple who were unable to conceive, finally have the child they have always dreamed about.” You are sure to have many questions. In addressing infertility, the sooner you have them answered, the better. This blog is intended for educational purposes only. All contents here is general in nature and does not take into account your personal circumstances. Please consult with your health care professional to ensure you get the right diagnosis and treatment. (Everybody has a chance to build a family) by Dr Navdeep  

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Root-Cause-title
July 7, 2020
Fertility Care – Details by Issues

Knowing Why: Root causes of infertilityInfertility can be caused by a single issue or a culmination of a few issues. In seeking treatment, it is important to help couples identify the root cause of infertility. This enables possible options to be drawn out and via constructive discussions, help couples derive solutions that they are comfortable with. Common ConditionsThe following are some common conditions that could impede a couple’s chance to conceive. Female AgeWomen are born with a lifetime supply of eggs, and these gradually decrease, in both quality and quantity, with age. The number of eggs that a woman is endowed with at the point of her first menstrual cycle averages 300,000-400,000. As she grows older, the number of eggs decreases. By age 30, the egg count stands between 39,000-52,000, and by age 40, it drops to between 1,200-9,000.In determining fertility, a woman’s ovarian reserve must be of a level that facilitates pregnancy.Test(s) we runAnti-Mullerian Hormone (AMH) TestThe Anti-Mullerian Hormone (AMH) test is a laboratory test conducted to assess a woman’s ovarian reserve or egg count. AMH is a hormone secreted by cells in developing egg sacs or follicles. The level of AMH in a woman’s blood is generally a good indicator of her ovarian reserve.How we treat35 – 45 years: In vitro fertilisation (IVF) | Preimplantation Genetic Testing (PGT) | Endometrial Receptivity Assay (ERA)Above 45 years: In vitro fertilisation (IVF) with donor eggs |Preimplantation Genetic Testing (PGT) | Endometrial Receptivity Assay (ERA) Sperm CountInfertility does not only affect women. In 40 per cent of couples with infertility, the male partner is either the sole cause or a contributing cause of infertility. This is most often due to problems with sperm production or sperm delivery.In male fertility, a normal semen analysis result would show a sperm count of at least 15million sperm per mL, with at least half showing forward progressive movement.Test(s) we runSperm Analysis TestA Sperm Analysis Test is a laboratory test conducted to accurately measure the number of sperm, their motility (ability to move), their morphology (size and shape), and the volume and consistency of the ejaculated semen sample.How we treatNormal: Ovulation Induction | Time-Sexual IntercourseAverage: Intrauterine Insemination (IUI)Poor: In vitro fertilisation (IVF) | Intracytoplasmic sperm injection (ICSI)Azoospermia: In vitro fertilisation (IVF) with donor eggs | Intracytoplasmic sperm injection (ICSI) Fallopian Tube ObstructionCommon reasons for blocked fallopian tubes include scar tissue, infection, and pelvic adhesions. If a fallopian tube is blocked, the passage for the sperms to get to the egg, as well as the path back to the uterus for the fertilised egg, is obstructed.Tubal factor infertility accounts for about 25 to 30 per cent of infertility cases. The condition includes cases of completely blocked fallopian tubes, and cases where just one tube is blocked or scarring narrows the tubes.Test(s) we runHysterosalpingogram (HSG) X-rayA Hysterosalpingogram (HSG) is a procedure that uses an X-ray to look at the fallopian tubes and uterus. It usually takes less than five minutes and the patient can go home the same day.LaparoscopyLaparoscopy is a surgical procedure that allows a doctor to see inside the body. When the procedure is part of fertility testing, the doctor is evaluating the structures of the reproductive system, including the ovaries, fallopian tubes, and uterus. The procedure is normally conducted as a daycare procedure.How we treatIn vitro fertilisation (IVF) Uterine FibroidsUterine fibroids are benign lumps of tissue which grow in the muscular part of the uterus. They are very common; up to 40 per cent of women have at least one fibroid, and they tend to increase with age. They are not cancerous or otherwise at all harmful to health.The vast majority of fibroids does not affect fertility and does not need any treatment. The critical aspect affecting fertility is whether the fibroid is distorting the lining of the uterus or if it is located inside the uterus itself.Test(s) we runUltrasound ScanAn ultrasound scan is used to confirm the presence of uterine fibroids. It uses sound waves to get a picture of the uterus to confirm the diagnosis and to map and measure fibroids.How we treatLaparoscopic Surgery | Myomectomy Polycystic Ovarian Syndrome (PCOS)Polycystic Ovarian Syndrome (PCOS) occurs when the ovaries develop numerous small collections of fluid (follicles) and fail to regularly release eggs resulting in irregular menstrual cycles.As many as 25 per cent of women of childbearing age have PCOS, but most do not even know that they have it until they begin trying to get pregnant.Test(s) we runUltrasound ScanAn ultrasound scan can indicate the presence of these follicles.Blood TestsBlood tests can reveal changes, with higher levels of testosterone and Luteinising Hormone (LH) (often in conjunction with a higher LH to Follicle Stimulating Hormone (FSH) ratio) found compared to those of women with normal cycles. These levels may vary considerably and are best assessed early in the menstrual cycle (if there is one). Blood tests may also indicate a change in blood glucose and insulin levels.Pelvic ExamA pelvic exam is also conducted to confirm the diagnosis.How we treatLaparoscopic Ovarian Drilling (Ablation) | Ovulation Induction | In vitro fertilisation (IVF) This blog is intended for educational purposes only. All contents here is general in nature and does not take into account your personal circumstances. Please consult with your health care professional to ensure you get the right diagnosis and treatment. (Everybody has a chance to build a family) by Dr Navdeep  

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