Pregnancy in the Time of Covid-19

Dear Patients and Friends, I know that a lot of you are worried about the wellbeing of the baby you are carrying and yourself at this time. Many of you have reached out to me in the recent weeks with your concerns about the impact of Covid-19 on your pregnancy or on your journey to becoming pregnant: Can your baby (foetus) get Covid-19 if you have it? What are the risks to your baby if you are infected? Should you continue with fertility treat-ment during this pandemic? And so on… As a doctor, I understand the need for answers. In my profession, I am trained to look at the evidence when dealing with a patient and to in-form my decisions. So, I find knowledge comforting in times of uncer-tainty. The challenge with a newly discovered virus is that it is impossi-ble to obtain credible and conclusive data that is constructive, medically. Preliminary findings that surface while dealing with a contagion in real time are generally considered unreliable because it so often changes from one day to the next. What we know so far is: • There is no evidence that pregnant women are at an increased risk of having Covid-19. However, there is concern over changes in the immune system during pregnancy, especially in the third trimester. • Being pregnant doesn’t increase women’s risk of developing se-vere symptoms. Most pregnant women who are infected will ex-perience between mild and moderate symptoms, just like every-one. Some may have more severe symptoms like breathing diffi-culties and therefore, need to be monitored closely. • While there are reports circulating of risk of pre-term labour and other complications, there is not enough data to confirm this. • Transmission of the virus from mother to baby, though probable, cannot be determined. There have been cases of newborns in-fected with the virus but it is unclear whether these babies were infected in the womb or during or after birth. While the lack of verifiable data can be disconcerting, take comfort that we have enough information to fight this virus. If you are concerned about the impact of the virus on your pregnancy, my advice is don’t worry about what may happen. Instead, focus on what you can do to prevent contracting the virus. Do not compromise on taking the follow-ing precautionary measures, however extreme it may seem to you: Wash Your Hands Washing with good old soap and water destroys the virus. Sanitisers work too when washing facilities are not available, but it is best to lather up with soap and water as much as possible. Keep Your Hands Away from Your Face This reduces the possibility of transmission if you have unknowingly touched an object or surface covered with the virus. Stay at Home As an added precaution, pregnant women should especially avoid going out at this time. Other than doctor’s appointments, try to stay at home. Social Distancing Maintain a distance of 1 – 2 metres from others as asymptomatic people can unknowingly transmit the virus. Family members in charge of buy-ing groceries or food should wash up and change into clean clothes im-mediately upon reaching home. Disinfect Your Groceries and Supplies Husbands or family members should help to disinfect groceries and supplies once they return from the store. If you are not sure what to do, this video by Dr Jeffrey VanWingen is a good guide to fol-low: Grocery Shopping Tips in COVID-19 Wear a Mask There has been a lot of debate about whether we should use a mask when we are out. My advice is to wear a mask. It is an added defence against virus transmission. A 3-ply or an N95 mask is preferred; other-wise any face mask is an acceptable alternative. I know that many of you have had a tough journey to become preg-nant. What is going on now may feel unfair after all the struggles you have gone through. Take comfort in the fact that we have the power to be steps ahead of this if we follow the precautionary measures. As for fertility treatments, my advice to patients who are in the middle of a fertility cycle is to freeze your eggs or embryo and do the implanta-tion when the dust settles. If you would like to discuss your options at this time, please do get in touch with me and I will walk you through it. As always, I am here for you throughout your journey to becoming par-ents. Please feel free to contact me with any of your concerns and I will do my best to help guide you in this trying time. Take care and keep yourself and each other safe. 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 #DrNavdeepSinghPannu #StayAtHome#Covid-19Pandemic

Hope for Women with Polycystic Ovarian Syndrome (PCOS)

“There are treatment options that improve ovulation, and alongside lifestyle alterations, women who have PCOS may be able to get pregnant.” Unknown Cause Described by Italian doctor Antonio Vallisneri in 1721, the exact causes of Polycystic Ovarian Syndrome (PCOS) are not known, but it is postulated that environmental, lifestyle and familial factors may predispose a woman to get PCOS. However, with the option of treatments that improve ovulation alongside lifestyle alterations, women who have PCOS may be able to get pregnant. The Regular Cycle Having regular menstrual cycles is a sign that important parts of the female body are working normally. The menstrual cycle provides the body with important chemicals called hormones which are important to keep one healthy. It also prepares the body for pregnancy. For sufferers of PCOS, hormonal imbalances cause irregular menstrual cycles, which means that ovulation does not take place as and when it should. This impedes and reduces the chances of one becoming pregnant. Normal Circumstances Under normal circumstances, the pituitary gland, located at the base of the brain, produces hormones that direct the function of the ovaries. Each month, the gland secretes the Follicle Stimulating Hormone (FSH) and Luteinising Hormone (LH) into the bloodstream. When these hormones reach the ovaries, immature eggs start to mature, expanding the size of the follicles that hold the eggs. As the eggs mature, the follicle secretes estrogen which is the main female sex hormone. Once the amount of estrogen reaches a certain level, the follicle opens, releasing the egg in a process called ovulation. The free egg travels down through the fallopian tube where it awaits fertilisation. Eventually, the remaining follicles and eggs dissolve. If the egg which has been released is not fertilised, the egg and the lining of the uterus are shed in the next menstrual period. The Disrupted Cycle If one has PCOS, the pituitary gland may release abnormally high levels of LH into the bloodstream. As a result, the follicles do not mature and subsequent ovulation and menstruation fail to take place. The immature follicles do not dissolve and remain as fluid-filled sacs or cysts. This disrupts the menstrual cycle. Increased levels of LH also lead to excess production of the male hormones testosterone and androgens. This circumstance further impedes ovulation. As a result, sufferers of PCOS experience irregular menstrual cycles, making it difficult for them to get pregnant. Externally visible conditions brought on by excess male hormones, such as increased hair growth on the face and body, are also seen in women who suffer from PCOS. Insulin Resistance Subsequently, higher levels of insulin may also be found in the bloodstream as women with PCOS tend to be insulin resistant. This means their cells are unable to make efficient use of insulin which is produced from the pancreas to metabolise sugar for energy. When cells do not use insulin efficiently, the body’s demand for insulin increases and the pancreas makes even more insulin. Extra insulin sets off the ovaries to secrete more male hormones. In addition to infertility concerns, insulin resistance may trigger increased weight issues and heighten the risk of Type 2 diabetes and cardiac-related diseases. Options available With the option of treatments that improve ovulation alongside lifestyle alterations, women who have PCOS may be able to get pregnant. These include: (a) Birth control pills can help regulate menstrual cycles and help address PCOS symptoms such as excess hair and acne. Metformin commonly known as Glucophage is a medication used in the treatment of Type 2 diabetes. In PCOS sufferers, it improves insulin levels. It can also help in reducing weight, lower sugar levels and restore the regularity of menstrual cycles. Clomiphene is a fertility medication for ovulation induction and its use increases the chances for pregnancy to take place. (b) Surgery may be an option of choice to improve pregnancy chances if the ovulation induction with Clomiphene is unsuccessful. A procedure called Ovarian Drilling, a method that entails for small holes to be made in the ovary with a heated needle, may be administered to restore regular ovulation. Subsequently, Intra-uterine Insemination (IUI) and In-vitro Fertilisation (IVF) are the other options available if initial methods prove unsuccessful. (c) Reducing excess weight has shown to improve blood sugar levels and increase the chances of having a healthy pregnancy. Even a 10 per cent weight reduction can help regulate menstrual cycles and improve symptoms. It also improves cholesterol levels, lowers insulin and reduces the risk of heart disease and diabetes. Lifestyle modification Treatment is normally applied with advice on lifestyle modification, which includes weight reduction necessitating a low carbohydrate diet and workout plan. In line with this, a low glycemic index diet plan will help one get carbohydrates and sugars from fruits, vegetables and grains. As for exercise and workouts, a moderate exercise commitment of at least three times a week can make a significant difference. Consultation 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

The Time is Now

“I always say this–time is not your friend when it comes to fertility. This is one thing that time will not cure. So, if having children is im-portant to you, don’t wait for your career to take off or to have a better home to start a family.” When it comes to having children, time is of the essence, says fertility specialist Dr Navdeep Singh Pannu. Whether it is planning for a family or dealing with fertility issues, the time is now. “I always say this–time is not your friend when it comes to fertility. This is one thing that time will not cure. So, if having children is important to you, don’t wait for your career to take off or to have a better home to start a family.” It is well established that the primary cause of infertility is driven by de-lay in getting married and in having kids, followed by stress, lifestyle and ignorance (you know you have a problem but don’t do anything to address it). “Time plays a part in all of the above because essentially, priorities are elsewhere. People often believe that there will always be opportunities to have children later. The reality is that fertility potential diminishes as time goes by.” One of the main reasons is that the women’s ovarian reserve or egg count progressively depreciates with the passage of time. In addition to difficulty conceiving, there is an increased risk for miscarriages due to this. “There is also a higher possibility of having an abnormal child. Even the percentage of embryos produced via IVF with the correct number of chromosomes decreases with advancing age.” Men can equally contribute to the delay by leading an unhealthy life-style. “For example, smoking is one of the greatest contributors to infer-tility problems. Men who inject steroids are another group that suffers from infertility,” shared Dr Navdeep. The other issue is the tendency, for both men and women, to ignore other potential causes. By not submit-ting to a check-up as early as possible, they are delaying timely treat-ment that could increase the chances of getting pregnant. “Dealing with fertility issues early is as important, if not more, as planning for a family early. It saves precious time, increasing the span of time for fertility po-tential, thus boosting the chances of having a child.” 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