September 13, 2022
Why Mental Health During Fertility Treatment is important?

Mental Health During Fertility Ways to Boost Your Mental Health During Fertility Treatment To hear that you can’t get pregnant is heartbreaking and upsetting. It can disturb your mental health and cause distress. The worst part is, it may even lead to depression and anxiety. Thus, taking care of your mental health during fertility treatment is very important. It helps to ease your path to parenthood. There are many ways to boost your mental health. But first, let us understand about infertility. Then, let us look into how that can lead to stressful situations. “I’ve seen patients who have had suicidal thoughts after a failed IVF. Some couples even ended up separating after a failed fertility procedure. The mental toll a couple endures from infertility is tremendous. Mental health issues due to infertility are real; it is not a non-issue to be taken lightly.” Dr Navdeep Singh Pannu Understanding Infertility People consider children as the core that completes a family. The societal pressure and stigma may affect your mental health during infertility treatment. Generally, infertility is defined as the inability to conceive. If the couple could not get pregnant after 12 months of frequent unprotected sexual intercourse, the couple may have problems related to infertility. The World Health Organization (WHO) also pointed out that 8-12% of couples worldwide experience infertility. This means about 48 million couples and 186 million individuals may experience infertility problems. Common Misconception There is a common misconception surrounding infertility. Infertility is often called the women’s issue. This is because typically infertility is assumed to be mostly caused by women. In contrary, men cause up to 30% of infertility and women cause up 30% of infertility cases. Another 30 % of infertility issue are caused by both sexes and the rest is due to unknown reasons. How to Deal with issues of mental health during infertility treatment and the challenges? There are various reasons why many couples are more open to go for infertility treatments nowadays. Some of the reasons include planning for a late pregnancy, development of more successful infertility treatment techniques, or the increase in awareness of the available treatments. Although the success rate of infertility treatments has increased significantly, you should understand that they aren’t always 100% successful. There are times things don’t work out as how we planned. This may affect your mental health in various ways. You might feel lonely and struggle in silence. You might not share your problems with others because you do not want them to pity you. You may also view infertility as a wish you cannot fulfill. This can lead to depression, anxiety, isolation, and loss of control over your lives. This condition is somehow similar to those who are diagnosed with cancer. The US National Library of Medicine, National Institutes of Health (2018, March) has shown that mental health problems range between 25% and 60% worldwide. Furthermore, a study in Malaysia showed that women are 1.5 to 3 times more likely to suffer from mental health problems than their male counterparts (Sham, et al., 2020). This is because people often associate infertility with women. They blame women as the main reason for infertility. This has been challenging for many women and it takes a huge toll on their mental health. Thus, it is important to look into the issue concerning mental health and fertility. Common factors that cause mental health issues Parenthood is one of the major transitions in adult life for both men and women. When you cannot get pregnant, it puts you under tremendous stress. Some of the problems in mental health during fertility treatment happen because of: –          Treatment-linked factors –          Social factors –          Personal factors Treatment-linked factors Infertility treatments is a long process. This may affect your mood and well-being. If you are mentally not healthy, it can affect your infertility rate and success chances. The mood swing during infertility treatment usually happen due to medications. During the treatment, you might have to take medications that causes hormonal imbalance. This can affect your mental health and may lead to anxiety and depression. On the other hand, some couple may resort to the habit of taking alcohol or drugs to handle their pain and frustrations. These unhealthy habits can have negative impact on not only your overall physical health, but also mental health. Social factors We live in a society where we see many family-oriented contents in medias. It may not seem like a big impact, but it’ll indirectly cause distress. For those who are yearning for a child, it may be difficult to control your emotions when you see parents with their children in public places. Sometimes, you may remember about your infertility problems when watching family-oriented movies. This may make you sad, lower your self-esteem and can also lead to depression.  Personal factors Infertility can have a great impact on your identity especially if you have always dreamt to be a mother. Many women often begin to imagine themselves as mothers long before they actually try to have children. This is influenced by cultural and societal messages that idealise motherhood. When this imagined self of a parent does not happen, it may result in the feeling of loss of control in their life.   Infertility can also lead to changes in physiological state. When you’re depressed or stressed, a system in your body controls responses to stress. It will then affect your reproductive functions. This shows how a disturbance in your mental state can have physical effects on your body and cause trouble to get pregnant. How can you manage your Mental Health During Fertility Treatment? I have been a fertility doctor for many years. Throughout the years, I have seen the negative impacts of stress, depression, and anxiety on a couple going through infertility. I truly feel that this issue needs to be addressed at the earliest for both men and women. There are many available options

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September 13, 2022
The Cost of Egg Freezing & More

All About Egg Freezing: The Process, Aftercare, and The Cost of Egg Freezing Growing up, women would have come across people saying, “don’t get pregnant too late, or you won’t have healthy babies.” Did you know that you can have healthy babies while going through a safe pregnancy even if you are “too late” for that? Egg Freezing, also known as Oocyte Cryopreservation is a process where a woman’s eggs are retrieved, frozen, and stored for future use. It helps women to preserve their fertility so that they can achieve pregnancy later in life. Understanding the process, aftercare, and cost of egg freezing is crucial before taking the decision to preserve your fertility and opt for the egg freezing procedure. Understanding Egg Freezing  It can be harder for women in their late 30s to get pregnant. As women get older, their number of eggs decreases until they reach menopause. Menopause is when a woman’s period stops and her hormonal level drops. During puberty, women have up to an approximation of 250,000 eggs. By the age of 40, the number gradually reduces to less than 25 000 eggs, followed by a rapid decline until menopause. The number of quality eggs also decreases after a woman reaches her 40s. This can also mean that this number can lead to miscarriage and abnormal babies. This is probably why you hear people say to not get pregnant late. Do not worry, because, with egg freezing, you have a chance of a successful and healthy pregnancy. If you start preserving eggs at a young age, you are likely to conceive a healthy baby later in life. Before we go into the details, here is a brief explanation of the process of egg freezing. When you are considering freezing your eggs, you will have to consult a fertility specialist. During the consultation, the fertility specialist usually will brief the process and procedures involved and conduct relevant medical tests. The fertility specialist will also explain to you the cost of egg freezing and aftercare. After a few years, when you are ready to start a family, you can contact your fertility specialist to go through the process of fertility treatments such as intrauterine insemination (IUI) or in vitro fertilisation (IVF). Who should do Egg Freezing? You may come from different social and cultural backgrounds, and wonder if you can do egg freezing. You may consider egg freezing and preserving your fertility if you have reasons such as below: • You are pursuing education or stepping up on your career ladder so you wish to delay childbearing. • You have personal goals or are not just ready to conceive yet. • You may not be in a relationship yet and are waiting for the right partner to come along. • You may be having autoimmune diseases such as Lupus, or rheumatoid arthritis. Autoimmune disease refers to a condition where the immune system attacks your own body and this may result in fertility issues later. Thus, you can consider freezing your eggs before starting medication for these diseases. • You may want to save the eggs before undergoing cancer treatment. Undergoing chemotherapy can potentially harm fertility. Thus, your doctor may advise you to opt for egg freezing to preserve your fertility before undergoing treatments. • You are considering storing frozen eggs rather than frozen embryos for future IVF procedures due to religious or moral reasons. What Will You Go Through During the Egg Freezing Process?   There are 3 main steps involved in egg freezing which can be divided into pre, during and post-egg freezing. In pre-egg freezing, you will go through fertility consultation and assessment which will then be followed by preparation and observation. Once the eggs are matured, the eggs will be collected using a simple procedure called egg retrieval. The post-egg freezing phase involves the freezing and storing of the eggs. Here is a detailed explanation for each step so that you can get ready and prepare yourself to undergo the egg freezing procedure.  1. Fertility Consultation & Assessment The first step in the egg freezing process is to find a fertility clinic or book a consultation with a fertility specialist and understand the cost of egg freezing and aftercare. During the consultation, the fertility specialist will look into your medical records and explain the procedure thoroughly.  After the explanation, the fertility specialist will conduct additional tests such as blood tests and ultrasounds. The blood test is done to determine the level of anti-Mullerian hormone (AMH) while transvaginal ultrasound is done to assess the number of eggs available. The fertility specialist will then discuss the results of the assessment with you.  Don’t be afraid to ask questions and clear all your doubts during the consultation session. It is important for you to properly understand the procedures before heading on to the next step.  2.Preparation After the consultation, the fertility specialist will schedule a different date to conduct the egg retrieval procedure. Egg retrieval is a process where eggs are collected from your ovaries. For this process to flow smoothly, the fertility specialist will guide you through the steps for daily hormone injections for the next 10 days. This injection is given to stimulate the ovaries.  3. Observation During the observation, the fertility specialist will monitor the progress of the eggs’ growth with an ultrasound, about two to three times during the injection phase. This process will require you to frequently visit your specialist, so it is best if you can allocate your time well for the appointments.  4. Egg Retrieval Before the egg retrieval day, the fertility specialist may ask you to not consume food or drinks after midnight. On the day of egg retrieval, you will be put under sedation. The doctor will then conduct vaginal ultrasound, where a needle with a suction device is inserted through the vaginal wall into the ovary. The device then extracts the eggs from the ovary. This process will roughly take about 15 minutes. After the retrieval, you might

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August 17, 2022
Malaysia, Where Dreams (for Baby) Come True

One in four couples, one in six couples – the ratios may vary by country, but I know for a fact that infertility is a real and present predicament for affected couples across the globe. A New York Times headline expressed it aptly: “Even when it ends with a healthy baby, a long struggle to conceive may exact a brutal toll”. The emotional baggage of infertility draws a parallel only to the paramount but less-discussed effects the condition has on human rights. Every person has the right to attain the highest standard of physical and mental health – a right ascribed for by the World Health Organization (WHO) – and with this, the right to decide on the number, timing and spacing of their offspring. As a practitioner, I attest to the roller coaster and heartbreak moments that couples endure; the mental breakdowns and relationship breakups the malady unleashes, situations for which the WHO recognises the importance of high-quality services for reproductive health. Such impetus has paved the way for great strides to be made in the field of fertility treatment. Travelling for Hope With the passage of time, fertility treatment broke new arena. New methods have been developed, bringing smiles to couples; but with this came long waiting lines and trumped-up costs of treatment. The unavailability of treatment facilities in some countries or legal requirements that did not support artificially aided conception, necessitated the migration for fertility treatment to more hopeful pastures. With time being a precious if not crucial consideration for trying couples, where chances significantly diminish with a woman’s age, many are willing to cross continents; a reason for the rise in ‘Fertility Tourism’. Over the decade, the travel boon to countries that offered fertility treatment as well as a holiday came to be known as ‘Fertility Vacations’. While the sun, sea and sand are a bonus, the focus is still to leave pregnant, and this is where Malaysia is making our mark. The Malaysian Mark Malaysia’s healthcare system has undergone considerable transformation since our Independence from the British in 1957. Malaysians enjoy the synergistic and robust relationship that exist between our public and private medical sectors, a result of the government’s relentless commitment to public health. The 2019 International Living Annual Global Retirement Index ranked Malaysia first in the ‘Best Healthcare in the World’ category for our world-class healthcare services and sophisticated infrastructure, making special mention of the well-trained doctors and flawless communication in English. In 2020 and for the fourth consecutive year, the Medical Travel Awards awarded Malaysia the ‘Health and Medical Tourism: Destination of the Year’ title. In the same year, Malaysian healthcare received 26 ‘Global Health Asia Pacific Awards’, including in the ‘Stellar Covid-19 Achievement of the Year’ category. These are just the latest from a string of awards Malaysia has achieved in the last 10 years. In 2009, 35 medical tourists arrived in Malaysia. In 2018, this number grew to 1.8 million arrivals. Among these were a fast-growing number of arrivals for fertility treatment. The fertility treatment segment of the medical tourism market is projected to grow the fastest over the forecast period of 2021-2026 and expected to record a CAGR of 9.7% as it attracts couples from neighbouring countries, especially those within a six-hour plane ride. Chart 1: Number of people who travelled to Malaysia for healthcare from 2011 to 2019 (in 1,000s) Source: Statista. (2021). Number of medical tourists to Malaysia 2011-2019. Chart 2: Medical Tourists Arrivals in Malaysia in comparison to selected countries Source: Medical Tourism Facts and Figures 2018, International Medical Travel Journal (“IMTJ”) Malaysia is a multi-racial country known for our hospitality, sumptuous food and rich culture. With excellent doctors, state-of-the-art facilities and a quality healthcare system, couples are making Malaysia a destination to make their dreams of building a family come true. For more help and information, contact the Malaysia Healthcare Travel Council (MHTC), which will guide you through the necessary processes and procedures. Alternatively, you could also contact the healthcare providers directly. About the author Dr. Navdeep Singh Pannu is a Fertility Specialist whose effervescent personality and positive attitude continue to be a source of comfort to couples on their quest to build a family. He is the Medical Director of TMC Fertility and Women’s Specialist Centre. Source : https://medicaltravelasia.com/malaysia-where-dreams-for-baby-come-true/   [siteorigin_widget class=”WP_Widget_Block”][/siteorigin_widget]

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March 17, 2022
Understanding Endometriosis and Its Effect on Fertility

Endometriosis Understanding Endometriosis and Its Effects on Fertility “Endometriosis is one of the more common causes of infertility. Period pain is a significant symptom of this disease. But because many women experience painful menstruation, there is a widespread belief that menstrual pain is ‘normal’. This poses a barrier for the prompt diagnosis of this disease.” Dr Navdeep Singh Pannu In recent years, the infertility rate has been rising globally due to the prevalence of various health issues in women. According to WHO, Endometriosis affects roughly 10 percent (190 million) of women in the reproductive age category.  What is Endometriosis?   Image credit: bloominuterus.com Endometriosis occurs when the uterine tissue (endometrium) grows outside of the uterus, usually around the pelvic area. During menstruation, this tissue reacts to hormones; it grows and bleeds the same way the uterine tissue does. However, since the tissue is outside the uterus, it can’t shed and exit through the vagina. Instead, the tissue settles in other places and starts new growths and inflammation, which leads to the accumulation of scar tissue causing severe pain.  Endometriosis and Fertility About 30 – 50 percent of women with Endometriosis may face difficulties in conceiving. Some patients find out about their condition when they have trouble getting pregnant. Endometriosis affects fertility due to: Tissue overgrowth around ovaries that prevents eggs from entering the fallopian tubes; Endometriosis forming outside the fallopian tubes causing adhesions; Endometriotic cysts (or chocolate cysts) producing chemicals and other substances that are strongly linked to a lower density of ovarian follicles from which mature eggs are released.  Treating Endometriosis Image credit: buro247.my Painful periods, chronic pelvic pain, painful intercourse, and ovarian cysts – these are just some of the symptoms that women with Endometriosis live with. Endometriosis is a progressive disease and not 100 percent treatable. There is no magic pill that can be given to a patient to make Endometriosis disappear. However, Endometriosis can be managed. Although it is a long-term condition that can have a significant impact on a person’s life, there are treatments that can help.  In general, treatment for endometriosis includes: 1. Pain medication NSAIDs (Nonsteroidal anti-inflammatory drugs), such as ibuprofen or other over-the-counter analgesics to provide symptomatic relief. 2. Hormone therapy Oral contraceptives, with combined estrogen and progestin hormones, prevent ovulation and reduce menstrual flow. Gonadotropin-releasing hormone agonist, which stops ovarian hormone production, creating a sort of temporary ‘medical menopause’. Progestin – Visanne (dienogest), a hormonal contraceptive that is used to reduce pain and the size of endometrial lesions, which helps reduce pelvic pain and painful monthly bleedings. Androgen Receptor Agonist, Danazol, a synthetic derivative of testosterone (a male hormone) that helps stop the body from releasing hormones that bring about period. 3. Surgical techniques Laparoscopy – Also used to diagnose Endometriosis, laparoscopy is a minor surgical procedure in which a laparoscope is inserted into an incision in the abdominal wall. Using the laparoscope to view the pelvic area, the doctor is able to remove the endometriotic tissue. Laparotomy – A more extensive surgery to remove as much of the displaced endometriotic tissue as possible without damaging healthy tissue. Hysterectomy – In more severe cases, some or all of the reproductive organs are removed if they are damaged or have endometriosis tissue on them. Whether or not one should have surgery depends on the age and severity of the case. However, taking into consideration that a surgery to treat endometriosis could damage ovarian tissue which may then reduce a person’s ovarian reserve, doctors put forth this option only if necessary. For patients hoping to eventually conceive, doctors may suggest that they freeze their eggs before an Endometriosis surgery is carried out. This allows for the eggs to be preserved for future use.  Knowledge is Key, Be Empowered Image credit: theguardian.com Living with Endometriosis is tough, especially for a woman in her reproductive age. If you have been diagnosed with Endometriosis, my advice is to get as much information as you can before deciding on your next course of action. Knowledge is key and having the right information about the disease will empower you to take a step in the right direction.  You are sure to have many questions. In addressing infertility, the sooner you have them answered, the better. Do list them down and call +6-03-80699333 (TMC Fertility & Women’s Specialist Centre, Puchong) or email ask@drnavdeepfertility.com to make an appointment to consult with Dr Navdeep. Let’s take the self-assessment quiz for the risk of endometriosis.  

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