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.

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“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.

Mental Health During Fertility Treatment 1
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. 

Mental Health During Fertility Treatment 2
Parents with Their Child

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 for you to choose to manage your mental health during fertility treatment. Here are a few options that you can try to manage your mental health:

Uplift – Mind/ Body Program

Uplift's Mind/Body programme is designed to help you cope up with the physical and emotional impact of infertility. The chances of a successful pregnancy are slim if you’re exhausted emotionally and mentally. This programme will help you to control your emotions. Not only that, but your physical and physiological symptoms caused by stress will also be addressed. You'll learn relaxation techniques, good lifestyle habits, and psychological techniques to challenge your negative thoughts and turn them into a positive outlook. 

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Relax and Calm Your Mind

Fertility Coaching

You can also try to take up fertility coaching if you are feeling alone, isolated and overwhelmed. Our fertility coach, Joyce Simson is ready to help you to cope with failed fertility treatments. She will help you to understand and process your emotions so that your life is less stressful. Fertility Coaching is truly a great help to get that extra mental and emotional support while you figure out ways to overcome your fertility struggles. 

Hypnotherapy

Hypnotherapy is another option that you can consider to manage your mental health during fertility treatment. While hypnosis may not directly help you to get pregnant, it will aid the process. Hypnotherapy can slowly reduce your anxiety level around fertility treatments. This therapy also increases positive thinking and relaxes thoughts of self-doubt and self-blame.

You Are Not Alone

My fertility team and I have put our hearts and soul into helping you get pregnant. We always give our best to help our patients. However, sometimes, things do not turn out as how we planned. When the patient failed to get pregnant, my team and I feel sad and share the same emotions as them. The feeling of loss can be overwhelming for us as well. We understand how devastating this whole journey is for you.

For those of you who are suffering from depression and anxiety due to infertility treatments, you should know that we, the fertility team, are on the same team as you. We always hope for the best for everyone who enters our clinic. If you're feeling overwhelmed by the procedures of fertility treatments, my advice is to stop and seek the help you need. Acknowledge your feelings and do not push them aside. Talk to someone and let out your frustration. You don't have to struggle alone and in silence. Always remember that you are not alone and it is important to find the necessary help you need to take care of your mental health during fertility treatments  

In conversation with BFM 89.9 on Mental Health and Infertility “When trouble conceiving affects your mental health” I had the opportunity to speak on BFM recently where I shared my personal insights on the topic of “When trouble conceiving affects your mental health”.”.

You may listen to the interview here: When Trouble Conceiving Affects Your Mental Health

If you want to know more about the process or have specific questions to clarify, do list them down and call 03-80699333 (TMC Fertility & Women’s Specialist Centre, Puchong) or email ask@drnavdeepfertility.com to make an appointment to consult with Dr. Navdeep. 

Mental Health and Fertility: It doesn’t have to be a silent struggle

“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

Infertility affects the social and personal aspect of a person’s life. One of the most difficult emotional consequences of infertility is the loss of control over one’s life. The inability to conceive causes much distress, along with depression and anxiety.

This article/discussion aims to define the parameters of the issue, discuss the facets of how mental health is associated with fertility and the available ways of how the circumstance can be managed.

1. Introduction: Quick Overview of Infertility

Children are viewed as an integral part of our family units; so, a couple who has not been able to conceive after a few years of marriage is subject to much social scrutiny. Infertility is perceived as a problem across virtually all cultures and societies. It has been indicated by the World Health Organization (WHO) that 8-12% of couples worldwide experience infertility (World Health Organization, 2020). In recent years the numbers seeking treatment have dramatically increased.

As defined by WHO (2020, Sept), infertility is a disease of the male or female reproductive system defined by the failure to achieve pregnancy after 12 months or more of regular unprotected sexual intercourse. Estimates suggests that between 48 million couples and 186 million individuals live with infertility globally.

Contrary to popular belief, infertility is not just a women’s issue. Up to 30 percent of infertility cases are due to men, 30 percent due to women, another 30 percent being due to both genders, and 10 percent due to unknown causes. Based on these statistics, men contribute to the cause about half of the time.

2. Rising Numbers of Mental Health Issues due to Infertility

Image credit: news-medical.net

In recent years, the number of couples seeking treatment for infertility has dramatically increased due to factors such as postponement of childbearing, development of newer and more successful techniques for infertility treatment and increasing awareness of treatments available.

As with all treatments, infertility treatments are not always successful. From what I have seen, failed fertility treatment outcome not only affects women, but men too, especially if it was caused by male factor infertility. Increasing participation in fertility treatment has inspired investigation into the psychological ramifications of infertility.

For a couple going through infertility, it is mostly a lonely journey. Oftentimes, I see couples struggle silently because they do not want to be viewed as inadequate and do not want people sympathising with them. It is said that patients going through infertility consider it as a non-fulfilment of a wish for a child and therefore, have profound feelings of depression, anxiety, isolation and loss of control, levels of which can be compared to patients who have been diagnosed with cancer.

According to the US National Library of Medicine, National Institutes of Health (2018, March), the overall prevalence of psychological problems among infertile couples around the world is estimated to be as high as 25% - 60%. In Malaysia, a study by a team from UiTM found that the level of anxiety, stress and depression among women going through infertility was 1.5 to 3 times higher than their male partners (Sham, et al.,2020). This is mostly due to the stigma surrounding infertility where women are most times blamed for not having the ability to procreate. With the high prevalence of mental health issues among couples going through infertility, it is so important to address and fix these issues.

3. Infertility and Its Psychological Impact

 Parenthood is one of the major transitions in adult life for both men and women. The inability to conceive children is a stressful situation for couples and can cause much anxiety.

There are several causes of psychological disturbances for couples going through infertility which include:

  1. Treatment-linked factors
  2. Social factors
  3. Personal factors
 
Treatment-linked factors

Prolonged exposure to intrusive infertility treatments affects mood and well-being, which further affects infertility. Infertility treatments and drugs also cause fluctuating hormones. Going through cycles of infertility treatments with much pain but no gain causes further anxiety and depression. I have seen some patients resorting to alcohol and even drugs as a form of release from pent-up feelings and frustrations.

Social factors

Image credit: healthcare.utah.edu

 

For a childless couple, it is hard to go out in public without constantly seeing parents and children. We live in a pro-natal society where emphasis on families with children is everywhere – commercials, TV shows and movies. As such, a couple is often reminded that they are not a ‘member of the club’. These feelings are quite complex and can be an emotional trigger to feelings of low self-esteem and depression.

Personal factors

Infertility can have a profound impact on the identity of a person as it is seen as the disruption to the expected development shift to parenthood. Women especially often begin to imagine themselves as mothers long before actually trying to have children. This is influenced by cultural and societal messages that idealise motherhood. When this imagined self of a parent is withdrawn, it may result in the feeling of a loss of control, threaten their imagined future and feel like an assault on their ability to self-actualise.

Stress, depression and anxiety not only affect the psychological state of a person, but also their physiological state. When we are depressed or stressed, the body responds by elevating levels of prolactin in the body and there will be disruption of the hypothalamic-pituitary-adrenal axis and thyroid dysfunction. Luteinizing hormone, a hormone that regulates ovulation, starts to become abnormal and this adversely affects reproductive function. The effect of a person’s mental health on their physical body is so profound that it impacts the ability to conceive.

4. Different Management Strategies that can be Helpful in the Treatment of Mental Illness associated with Infertility

 Through my years as a Fertility doctor, I have seen the negative impacts of stress, depression and anxiety on a couple going through infertility, which is why I truly feel that mental health issues relating to infertility for both men and women need to be addressed at the soonest. With more and more people these days seeking infertility treatments, there are more interventions available to help with mental health issues. Here are just some interventions that couples can look for:

Image from: drnavdeepfertility.com

 
a) Uplift – Mind/ Body Program

Uplift’s Mind/Body program is designed to help individuals or couples who are participating in fertility treatments cope with the physical and emotional impact of infertility. Stress and depression disrupt the natural harmony of the body which reduces chances for a successful pregnancy.
The goal of the program is to help improve a person’s sense of control, decrease both physical and psychological symptoms of stress and help decrease the intense lows of infertility. Skills that are taught include relaxation techniques, good lifestyle habits and psychological techniques such as learning to challenge recurrent negative thoughts.

b) Fertility Coaching

Our Fertility Coach, Joyce Simson, helps couples journey through the loss of a failed fertility treatment which can be quite overwhelming and isolating. Her work is about helping couples look deeper into themselves and process their emotions. Fertility Coaching is truly a great help as couples get that extra mental and emotional support while navigating through their fertility struggles.

c) Hypnotherapy

Hypnotherapy is another form of intervention that couples may consider. While hypnosis may not directly help a couple get pregnant, it will aid the process. It can help alleviate intense anxiety around fertility treatments, increase positive thinking and relax thoughts of self-doubt and self-blame.

 Acknowledge your feelings and seek the right help

My Fertility team and I, having vested our heart and soul into helping couples conceive get deeply affected by negative fertility treatment results. We always put our best foot forward in hopes of helping couples achieve that dream of a baby in their arms, but sometimes it just doesn’t happen. At times my team of embryologists, nurses and myself included goes through the same motions and roller coaster of emotions that our patients go through when there is a negative fertility treatment outcome. The sense of loss can be quite overwhelming for us too.

As such, we truly understand how devastating it would be for couples to go through cycles of infertility treatments without achieving the goal of cuddling that baby so wished for. The grief can be somewhat similar to one who has lost a child.

Image credit: everydayhealth.com

To a couple going through depression and anxiety from failed fertility treatments, know that we, the Fertility team, are on the same team as you and we always hope for the best for every couple who walks into our clinic. If you are feeling overwhelmed by the motions of your fertility treatments, my advice is to stop and take a break to seek the help that you need. The first step is to acknowledge what you are feeling; don’t brush it aside. There is help available. Talk to someone; vent out your frustrations. You do not need to struggle alone and silently.

 

When Trouble Conceiving Affects Your Mental Health

In conversation with BFM 89.9 on Mental Health and Infertility “When trouble conceiving affects your mental health” I had the opportunity to speak on BFM recently where I shared my personal insights on the topic of “When trouble conceiving affects your mental health”.

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.

 

Congratulations TMC Fertility

Congratulations TMC Fertility

We are honoured that TMC Fertility has been awarded as the 2021 Malaysia Fertility Center Company of the Year by Frost & Sullivan!

TMC Fertility received the Malaysia Fertility Center Company of the Year award for the third consecutive year.

This could not have been achieved without the commitment and dedication of all the doctors, nurses, embryologists, and staff in TMC Fertility. I sincerely thank all of my teammates for working relentlessly to provide the best treatment for all the patients.

We have done our best to ensure that all the patients are treated with utmost care and also strive to include the best technology to assist your fertility journey with us.

We thank each and every patient of ours from the bottom of our hearts. Your support means a lot to us!

Thank you

Sincerely,
Dr. Navdeep Singh Pannu
Medical Director
TMC Fertility Center

Seeking hep with infertility

Seeking Help with Infertility

A marriage followed by a beautiful home with two kids – ultimately, this would be every couple’s dream of an ideal life. However, things don’t always go as planned. For some couples, conceiving a child is not as straightforward as expected.

“Infertility treatments have come a long way from what they used to be. There are many ways a couple can get that much-needed help. All they have to do is take that step to seek it,” said Dr Navdeep when asked on his views about couples having trouble conceiving.

Infertility: An invisible disease

Often times, couples do not realise that they have a problem with infertility at all until they really start trying to conceive.

According to the World Health Organization (WHO), infertility is a disease of the male or female reproductive system defined by the failure to achieve a pregnancy after 12 months or more of regular unprotected sexual intercourse.

Fertility declines with age, more for women than men. Acknowledging the fact that getting the right help for infertility can be a somewhat time-sensitive matter, Dr Navdeep suggests that a couple seeks professional help from a Fertility Specialist within 6-12 months after trying to conceive without a positive outcome.

However, one should seek immediate help if one feels there could be some underlying medical condition. For a woman, if she has irregular menstrual cycles or heavy, long and painful periods, it is reason enough to send alarm bells ringing to have it checked by a specialist immediately. There could be a possibility that she may have Endometriosis or Polycystic Ovarian Syndrome (PCOS) that needs to be addressed as early as possible to enable conception.  

A common misconception is that infertility is mostly a woman’s issue. It is truly a myth. Almost half of the time, it proves to be a male-related issue. If a man has problems with ejaculation or erectile dysfunction (ED), he should not wait to have it checked as it could be a major contributing factor to infertility.

Sense of awareness

 Why does a couple not seek professional help with infertility? According to Dr Navdeep, since infertility is not a matter of life and death, some don’t feel the urgency for it. They put it off as something that would happen eventually, but many a time, it doesn’t happen due to underlying medical conditions that need to be addressed.

This is why Dr Navdeep feels that it is important for couples to educate themselves on infertility so that no time is wasted on achieving pregnancy. The time and age factor cannot be overstressed here.

A taboo subject

Sometimes, religious sentiments and cultural taboos are also reasons why a couple does not take that step forward to get an IVF (in vitro fertilisation) done. “Some of them see IVF as an unnatural way of conception. While I see IVF as a God-sent method to help many childless couples conceive and hold that little precious one in their arms, I respect their point of view and religious beliefs,” said Dr Navdeep.

These couples, however, come in to seek help to boost their fertility through medications and supplements. They are also in acceptance of achieving a pregnancy through Intra Uterine Insemination (IUI) which is a procedure that involves the placing of sperms inside a woman’s uterus to facilitate fertilisation.

A burden on the pocket

 Ranging from about RM15,000 to RM20,000, IVF can be quite a heavy burden on the pocket. Unlike other medical procedures, IVF is not covered by insurance and the monetary burden can hurt couples who are just starting their married lives.

Empathising on this situation, Dr Navdeep was pleased to advise couples that the government has recently allowed for the withdrawal of the EPF Account II for the purpose of fertility treatments.  In this new development, legally married couples below the age of 55 can make withdrawals for the IVF, IUI and ICSI (Intracytoplasmic Sperm Injections) procedures. Apart from that, the government also allows for tax relief of up to RM6,000 on expenses incurred for medical treatments of serious illnesses, which include expenses incurred on fertility treatments.

At the crossroads: Career or pregnancy?

 Many career women have stood at this crossroads in their lives: get pregnant now or focus on their career and delay pregnancy. It is a tough choice and totally unfair to women to have to choose between the two.

To this, Dr Navdeep suggests egg freezing for women when they are at a younger age (around 25-30 years old) so they can plan to get pregnant later without compromising the quality of the eggs and reducing the chances of pregnancy. While preserving eggs does not necessarily guarantee conception, one thing certain will be access to better quality embryo when the woman is ready to get pregnant.

 The right support

 Trying to conceive can be an absolutely trying time in a relationship. Couples who have been trying to conceive for a long time can start to grow impatient. Helplessness may play out in the form of arguments, dissatisfaction or resentment.

To these couples, Dr Navdeep advises that they keep calm and seek the right support. With the support offered by Fertility Counsellors at his center, a couple’s fertility journey need not be such a lonely one. Couples can seek the assistance of a counsellor when they feel ‘stuck’ or overwhelmed by the options and decisions they need to make, or if they feel like they just want to have someone to whom they can express their feelings.

A decade of change

Infertility treatment has advanced so much from what it used to be a decade ago. Many childless couples have had the opportunity to hold that little precious one of their own, something they probably thought they’d never be able to do.

The journey to achieving that little blessing could not have been an easy one. Each couple going through infertility has their own different story to tell. One thing for sure, most of them have gone through many ups and downs. To this, Dr Navdeep emphasises that the journey to achieving pregnancy does not have to be an isolated one. There is much more support these days as compared to how it used to be. All they have to do is take that step to seek the help they need. A journey of a thousand miles begins with that one step.

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.

Preserving infertility

Preserving Fertility

For the 7 over billion people on planet Earth, the year 2020 will be anything but normal. However, in spite of quarantines, the pandemic has done more in this year than the last one hundred to bring us together as one global nation. As the year closes, Dr Navdeep shares his conviction on preserving fertility for the nation as he reinstates his firm and steadfast belief that nobody is infertile.

Pressing Predicament

In 2018, it was revealed that the fertility rate in Malaysia was at its lowest in the last 55 years. At 1.8 babies per woman, it was a 1.3% drop from 2017, which recorded 1.9 babies per woman. Plainly put, this implies that the number of children produced by a woman during her reproductive years is insufficient to replace herself and her partner.

Whilst it is true that the age factor constitutes to female infertility, it is only one facet of infertility. There are other causes that afflict men and women, some of which are beyond our control but many of which are well within our responsibility.

Thus, it is very possible for us to preserve the state of fertility of our nation, of course spurred by the coming together of policy and people to make it happen.

Powerful Possibilities

Recently, we have seen a dramatic rise in countries actively taking up the banner to protect and restore national birth rates. These include initiatives by governments, private organisations and people from all walks of life.

A report in the Financial Times in November of this year highlighted the Japanese Prime Minister’s call for in vitro fertilisation to be covered on the national health insurance to raise Japan’s fertility rate, which stood at 1.36 children per woman in 2019.

In January this year, Prime Minister Viktor Orban announced that Hungary will provide free in vitro fertilisation treatment to couples at state-run clinics to address the country's population that has been falling steadily for four decades.

Down south, Singapore’s dropping birth rates have prompted its government to encourage privately run companies, organisations and community groups to come together to promote the value of family, alongside government programmes that help couples marry, start and bring up their families.

Similarly in the United Kingdom,  private organisations are mooting ideas and initiatives to make the UK the safest place in the world to give birth vis-a-vis pre-conception campaigns.

On the home front, the availing of Employee Provident Funds for fertility treatment is a sign that something has to be done to arrest the birth rate downward spiral.

Probable Premises

For no lack of trying, addressing infertility is and continues to be a daunting task. The truth of the matter is infertility is multifaceted and we must be aware of all probable premises. There really is a lot more, besides women having babies later, that adds up to falling birth rates.

Endometriosis, a painful disease encountered by women, can lead to infertility. Often times, sufferers, find it difficult to get a medical professional to pay attention to their complaints. Endometriosis is a very real threat to infertility and we should pay more attention to patients with complains of bad stomach cramps.

Polycystic Ovarian Syndrome (PCOS), also a common occurrence, affects how the ovaries work and impedes ovulation, thus leading to infertility. Unfortunately, unless a patient sees a doctor, PCOS can go largely undetected.

For those who know me, you would know my position on male infertility. Although there is rising awareness among couples that both husband and wife may be party to infertility, there are still gentlemen who are blindsided by the fact that they could be the cause of the condition. I believe that with adequate awareness, more couples will step forward together to get themselves checked.

Other troubling factors include diseases such as cancer. As many as 10 percent of cancer diagnoses are made to those under the age of 45 and aggressive treatments may result in infertility or sterility for some. In such scenarios, it is important that we are aware of our fertility options such as Oocyte Preservation.

Not the least is the ubiquitous question of lifestyle. There is an alarming concern about maladies such as diabetes, hypertension and obesity. Observing a healthy and balanced lifestyle from the time one is a child is the only way to transcend these problems – but can we opt to choose health over unhealthy nutritional habits?

Persevering Preservation

Taking care of one’s health, educating the young and couples on preconception health and paying more attention to women and men’s health issues that could potentially lead to infertility could make all the difference in building a thriving population for our country.

The advancements and strides made in Assisted Reproductive Techniques (ART) over the decade offer much hope to couples but the pressing issue is how this help would be made accessible to those in need. Surely, concerted and complementary efforts from both government and private practices could pave the way for us to see exponential benefits.

A curative approach could mean that fertility services are made the mainstay in all government hospitals as with subsidised options for costlier procedures.  A preventive approach could come in the form of fertility preservation awareness in schools, whilst an intent to encourage couples to have larger families could come in the form of better and bigger tax rebate incentives.

It would also do well if insurance organisations consider making infertility coverage pertinent as should medical practitioners be in the timely referral of patients for fertility-related specialist help.

Personally, I believe that nobody is infertile.  We all just need a little help along the road of building a family.

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, which has been recently awarded the 2020 Malaysia Fertility Company of the Year by Frost and Sullivan 2020 Best Practices Awards.

For more information, call 03-8069 9333 (TMC Fertility & Women’s Specialist Centre, Puchong) or 03-62871000 (Thomson Hospital, Kota Damansara) or email ask@drnavdeepfertility.com

 

Improving the Odds

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 vindication for the treatment than a successful pregnancy.”

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 +6-03-62871000 (Thomson Hospital, Kota Damansara) or email ask@drnavdeepfertility.com to make an appointment to consult with Dr Navdeep.

Making Babies a Reality

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.

Do list them down and call 03-8076 7111 (TMC Fertility & Women’s Specialist Centre, Puchong) or 03 62871209 (Thomson Hospital, Kota Damansara) or email ask@drnavdeepfertility.com to make an appointment to consult with Dr Navdeep.

 

Root-Cause-title

Fertility Care – Details by Issues

Knowing Why: Root causes of infertility
Infertility 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 Conditions
The following are some common conditions that could impede a couple’s chance to conceive.

  1. Female Age
    Women 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 run
    Anti-Mullerian Hormone (AMH) Test
    The 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 treat
    35 – 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)
  2. Sperm Count
    Infertility 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 run
    Sperm Analysis Test
    A 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 treat
    Normal: Ovulation Induction | Time-Sexual Intercourse
    Average: Intrauterine Insemination (IUI)
    Poor: In vitro fertilisation (IVF) | Intracytoplasmic sperm injection (ICSI)
    Azoospermia: In vitro fertilisation (IVF) with donor eggs | Intracytoplasmic sperm injection (ICSI)
  3. Fallopian Tube Obstruction
    Common 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 run
    Hysterosalpingogram (HSG) X-ray
    A 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.
    Laparoscopy
    Laparoscopy 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 treat
    In vitro fertilisation (IVF)
  4. Uterine Fibroids
    Uterine 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 run
    Ultrasound Scan
    An 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 treat
    Laparoscopic Surgery | Myomectomy
  5. 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 run
    Ultrasound Scan
    An ultrasound scan can indicate the presence of these follicles.
    Blood Tests
    Blood 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 Exam
    A pelvic exam is also conducted to confirm the diagnosis.
    How we treat
    Laparoscopic Ovarian Drilling (Ablation) | Ovulation Induction | In vitro fertilisation (IVF)

You are sure to have many questions. In addressing infertility, the sooner you have them answered, the better. Do list them down and call 03-8076 7111 (TMC Fertility & Women’s Specialist Centre, Puchong) or 03-62871209 (Thomson Hospital, Kota Damansara) or email ask@drnavdeepfertility.com to make an appointment to consult with Dr Navdeep.

 

Nobody Is Infertile

Standfirst: Fertility specialist Dr Navdeep Singh Pannu
talks babies, the myth about infertility, advancements and obstacles in the field, the importance of now and the joy that only parents feel.

Hope after 50

“There has been quite a number over the years. My oldest patient was 52. She had tried fertility treatments in four different countries before she came to me and asked me to try,“ he shared. Attributing these successes to luck, Dr Navdeep says he could not really explain why it worked with him other than having the help of the latest advancements in fertility treatments and technology to boost the chances of pregnancy. “One thing we do is keep ourselves abreast of the latest developments in procedures and technologies in fertility science. We also have a good lab that adheres to the highest standards and measures to ensure the best chances of creating and growing embryos to facilitate successful pregnancies.”

Procedures such as Preimplantation Genetic Testing (PGT), which ensures that the best embryo can be selected for transfer, Endometrial Receptivity Analysis (ERA), which helps doctors determine the best time to transfer the embryo plus improvements in medication, which has reduced the injections needed to be administered to women in preparation for IVF from six weeks to just 10 days, have all contributed to increased success in pregnancy and decrease in miscarriages. “Success rate of pregnancy through IVF is almost 60% now compared to 20% previously.”

Still, how is it possible that a woman who is in her 50s and above is able to conceive? “The uterus remains completely functional in most women of advanced age. Most infertility problems in women are due to germ cell deterioration, which is related to ageing. By the time women turn 40, their ovarian reserve or eggs reduce markedly. For women above 50 to conceive, they need an egg donor whose eggs will be inseminated by the husband’s sperm to create an embryo. The embryo is then implanted in the woman’s womb, which carries the baby to term,“ explained Dr Navdeep.

While it is a possibility, advanced age pregnancy is not for everyone, he cautions. Just because it can be done, doesn’t mean it should be done. Ethically, fertility specialists first need to ascertain if the woman is healthy enough to carry a child. “We don’t want a woman having difficulties during pregnancy or we would be creating another problem.”

The Earlier the Better

For this reason, Dr Navdeep still emphasises the ideal convention - early pregnancy (preferably between 20s and 30s). “The older you are, not only does your chances of getting pregnant decrease, the possibility of having an abnormal child increases.” If for some reason, a woman is not ready to have children in her 20s or even 30s, she can still ensure her chances of having a healthy embryo when she is ready to have children years later by preserving her eggs while she is still young with oocyte cryopreservation or egg freezing. “When it comes to fertility, the fundamental message is –don’t wait until it becomes a challenge,” asserted Dr Navdeep.

Similarly, he also stresses the need to deal with fertility problems as soon as the warning signs are apparent. To be exact, couples should see a fertility specialist after six to twelve months of trying but failing to conceive. “Here’s the truth: nobody is infertile; some people just need a little bit of help, that is all. Fertility is a potentially treatable problem. We have many tests these days to investigate the cause and to treat the problems such as sperm analysis, transvaginal ultrasound to check fertility potential, hormonal tests and fallopian tube assessment to see if there are any blockages affecting the chances for pregnancy.”

Shifting Perceptions

The downside is everything comes with a dollar sign. It is the only limiting factor when it comes to infertility, admits Dr Navdeep. “It is sad because there are so many things we can do to help increase the success rate of pregnancy but the constraint often is the couple’s financial status.”  According to him, the problem lies in the fact that infertility is generally not considered a medical problem. Instead, it is seen more as a social issue. “It may not be a life or death case, but the fact is infertility is a long-term condition. People can be childless for life and this can contribute to mental and emotional health problems, marriage breakdowns and career failures. There needs to be a shift on how infertility is perceived overall by the medical fraternity and especially, insurance companies. Ideally it should be treated as a chronic disease and insurance policies should allocate a certain amount of money for fertility treatments.”

Making Dreams Come True

Though he will soon be leading TMC Fertility Centre as the newly appointed Medical Director when its new centre opens in Puchong in the first quarter of 2020, Dr Navdeep says his career goal has not changed since specialising in fertility treatment and investigation; and it likely won’t in the future because for him it has always been about helping as many couples as possible to be blessed with children as he and his wife was 16 years ago. “When you see patients who have been trying for years finally get pregnant and feel the overwhelming happiness when you deliver their baby, there is just nothing like it. It is moments like this that drive me every day.”