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!

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

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

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

Making Babies a Reality

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

Fertility Care – Details by Issues

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

Fertility and Nutritional Wellbeing

Dr Navdeep Singh Pannu and Dr Arifah Binti Mohd Amin share their professional medical insights. Couples who undergo fertility treatments face physical and psychological demands that can be disconcerting and unsettling. Worse still, societal prejudices can make infertility, as prevalent as it is, the loneliest club to belong to.  In this casual conversation, Dr Navdeep Singh Pannu, Medical Director of TMC Fertility and Women’s Specialist Centre and Dr Arifah Binti Mohd Amin, Obstetrician and Gynaecologist (with special interest in Nutritional and Integrative Medicine)  share their extensive experience and lend their professional insights into how good nutrition forms the building blocks that positively impacts one’s journey towards building a family.  Q: Having a baby is a celebrated experience for a couple. Do share an indelible moment or experience close to your heart. Dr Navdeep: In February this year, I handed a 52-year old patient her first child. It was hard to tell at that very moment, who was more excited.  After having journeyed with a couple through fertility treatments, it is a defining moment of joy when we see a ‘+’ sign, and when I am able to hand the baby over to its parents.  It is important to note that prior to the joy of holding your baby, the journey towards having a baby can sometimes be tumultuous. To me, it is important that I am with my patients every step of the way, and this is what keeps me coming back day after day. Dr Arifah: I have lost count of the number of patients I have had who experienced emotional instability caused by the process of having a baby. Some come in for postnatal check-ups feeling depressed, dispirited and dejected. I was desperate to help them, and this was a key reason why I furthered my knowledge in nutrition. I am convinced, now more than ever, that proper nutrition is essential to fertility and a healthy motherhood.  This is a great motivation to me.  Being able to help my patients be healthy gives me a sense of joy and purpose. Q: We know that there is a rise in the cases of infertility. Is infertility a growing concern? Dr Navdeep: Yes, there is concern that infertility is becoming prevalent. Whilst the causes for infertility is unexplained, my personal experience indicates that our state of health plays a big part in the bigger picture. We have to pay more attention to inculcating a healthy lifestyle in our children from the time they are babies. Poor nutritional choices and unhealthy habits may compromise fertility and our chances of building a family. Dr Arifah: As a working woman, I know the demands and stresses of a career.  I am also aware that infertility can be caused by both or either partner. However, I want women to know that the choice we make to focus solely on our careers can chip away at our fertility window. The fixation on getting the house in order can give rise to overwhelming financial demands and upstage plans to start and raise a family. These are very real and present issues and many households face them. Q: In your opinion, what are some of the misconceptions that surround infertility? Dr Navdeep: I have come across many but the one that stands out the most is ‘it is always the woman’s fault’.  To me, this is very concerning. Sometimes the husband is so confident that it is so, he does not even come in for an evaluation. I have treated cases that would beg to differ. Whilst the causes of infertility can sometimes be unexplained, in most cases both parties share the odds that the problem is due to either one of them.  There are also instances when the source of the problem could be attributed to both partners. Dr Arifah: In my opinion, our belief structures and customs can be a proponent of myths. Amongst those that I have come across are that some fruits are ‘hot’ and some are ‘cold’. Watermelons, for instance must be avoided as they are deemed to make the womb cold. Others are inspired by astronomy, such as whether it is a half or full moon. As the term itself suggests, the efficacy of myths is difficult to prove scientifically. Q: In your experience, what are the primary causes of infertility? Dr Navdeep: For men, it is normally a low sperm count. Unhealthy lifestyle choices such as smoking, vaping and alcohol consumption as well as excessive body weight can also have negative effects on fertility. Infertility in a woman can be caused by Polycystic Ovarian Syndrome (PCOS), irregular period cycles, endometriosis and pre-existing medical issues amongst others. These conditions are treatable either with medication or lifestyle tweaks. Dr Arifah: Predisposing medical conditions such as obesity, diabetes and hypertension are some of the known causes. Oxidative stress is another concern where there is an imbalance between free radicals and antioxidants in the body. Similar to those mentioned by Dr Navdeep, these conditions too can be relieved by a conscious decision to observe a healthier diet and lifestyle. Q: What is the one thing that couples take for granted when trying to get pregnant? Dr Navdeep: Couples sometimes think that getting pregnant is a ‘given thing’ in a marriage. I would like to encourage couples to consider undergoing Pre-Conception Consultation even before you decide to have a baby. This consultation can be done with and by their family doctor and it ascertains your state of health. Anomalies if any, can be duly detected and measures to deal with the condition put on track. Don’t wait until you decide to have a baby to get checked as lifestyle alterations could take some time before any effect is noticed. Dr Arifah: Every individual should make it a habit to attend annual health check-ups. I wish this fact could be emphasised right from school, in fact, better still, integrated into the education curriculum. Also, we should be open to visiting a dietician or a nutritionist

We Are In This Together

In medical school, I was taught how to deal with various emergencies. This included situations that involved endemics, epidemics and pandemics. Even with that knowledge in hand, I never would have fathomed that I would witness a pandemic of such gargantuan proportions in my lifetime. The World Health Organisation (WHO) reports, that the Covid-19 virus has afflicted almost 2 million people and caused the untimely deaths of over 100,000 individuals. Amidst these monumental figures are many whom have recovered, a distinct and present sign that there is hope. Even as scientists and medical healthcare experts across the globe work tirelessly, there is still so much more that is not known about the virus. I am inspired to see industry players coming together to share information and expertise in a bid to flatten the curve and seek out a cure. I am also encouraged by the collective and cohesive measures undertaken by the medical and healthcare fraternity in Malaysia to provide care and comfort to those who are ill. I am confident that there is an immense sharing of resources within the industry to ensure that every possible action is taken to halt the spread of the virus. Up until a few weeks ago, I know that many of us would have had the notion that the calamity in Wuhan, China “would not happen to me”. As the virus arrived at the doorsteps of what is now over 200 countries, first starting as a trickle but rapidly escalating into a deluge, we must rethink our views and perspectives on health and hygiene. From being mindful of our diet choices to embracing basic routines such as wearing a mask when we are unwell, we must realise that our individual state of health can have dire effects on another person. The Movement Control Order (MCO) or Extended Movement Control Order (EMCO) imposed in our country may be less than convenient but it is a mitigative effort that is absolutely necessary. The men and women enforcing the order risk their welfares to keep our health and wellbeing safe, and the last thing they need is for their efforts to be met with indignance. I would like to take this opportunity to thank everyone working at the frontlines of this crisis. From the medical practitioners and allied health staff members who persevere around the clock to save lives, to those involved in the provision of critical services such as food, pharmaceutical, security, sanitation, communications, finance, transportation and the likes. What you do is extremely important to provide a sense of normalcy to our daily lives. I remain hopeful, even when I have been chided for being too optimistic, in what can be a negative world. I firmly believe that when we value life, we will have hope that tomorrow will be better than today. Let us keep spreading a message of hope and do our bit to keep 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

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