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 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

 

EmbryoGlue in Aiding Implantation

EmbryoGlue in Aiding Implantation

The Many Possibilities

"It is the little things that we do in combination that add up to become one big, happy success story," said Dr Navdeep when asked about the usage of EmbryoGlue in his IVF procedures. He added, "If one thing doesn't work and there is a possibility that something else might, then why not, especially if it is for the benefit of making a couple’s dream of conceiving a child come true."

The IVF process is often a journey of hope for couples. For Dr. Navdeep, he is committed to ensuring that they are provided with significant medical procedures options. Considering the amount of effort put in by a couple, including the physical and emotional challenges they go through in the whole IVF process, Dr. Navdeep and team take every possible step to help couples achieve their goal of becoming proud parents.

With time and money being two of the most important considerations for a couple going through an IVF, add-ons such as EmbryoGlue, which helps increase chances of implantation, play a very important role in contributing to the success of an IVF. Knowledge is key and knowing such an option is available lets a couple be more prepared on what to expect at the end of the whole IVF journey.

Implantation after an Embryo Transfer

Embryo transfer is probably one of the highest points in an IVF process for most people. It is the last step before the two-week wait period begins, before one knows if the transferred embryo has implanted and hopefully hears those magical words of “Congratulations, you’re pregnant.”

So, what really happens inside the womb after an embryo transfer? After this procedure, the embryo is expected to naturally implant itself in the womb. The embryo moves around the womb before stabilising at one point. A chemical reaction occurs between the embryo cells and the womb lining where the embryo embeds itself into the womb lining. All conditions need to be perfect here, where the inner lining of the womb and embryo have to be in sync. This is when the embryo attaches to the endometrial blood supply and a person eventually becomes pregnant. At this point, the hormone progesterone enriches the uterus lining and helps sustain the growing embryo.

Implantation, however, may not always occur naturally as expected. There could be a number of factors affecting implantation of the embryo. This includes unhealthy embryos where an embryo looks good in the lab but may have defects, causing it to stop growing. Apart from that, unreceptive womb lining is another reason why implantation may not occur where deranged hormones cause the womb lining to be out of sync with the embryo.

A Beneficial Add-on

The EmbryoGlue is known to be an add-on that helps increase the chances of pregnancy. So, what is the composition of the EmbryoGlue and how does it work?

  • It is not an actual glue, but it acts like glue by increasing the chances of implantation of the embryo to the womb.
  • It is an implantation promoting transfer medium that consists of a high concentration of hyaluronan and recombinant human albumin, both of which promote implantation.
  • It is uniquely developed to mimic the conditions in the female uterus in order to help embryos implant after an embryo transfer.
  • Before the embryo transfer is to take place, the embryos are taken out from the incubator and placed in a medium enriched with EmbryoGlue for a duration of between 30 minutes to 3 hours. This is to bind the substance to the embryos.
  • The EmbryoGlue causes the embryo transfer medium to thicken, becoming more similar to the uterine fluids. The thickening of the medium improves its ability to mix with the uterine fluids which helps to prevent the embryo from drifting.
  • The EmbryoGlue acts as an adhesive for the embryo as it implants itself in the wall of the womb.
  • The EmbryoGlue seems to be highly beneficial for women above the maternal age of 42 and with a history of implantation failures after IVF.

Seeing some increase in pregnancy rates with the usage of EmbryoGlue, Dr. Navdeep has chosen to use the EmbryoGlue consistently for all of his IVF cases in his center regardless of patients’ age and history. It is his part in doing whatever it takes to help couples realise their dream of conceiving that child so wished for.

Costing only about a few hundred ringgit, the EmbryoGlue is quite affordable and worth using considering its benefits. 

Since the EmbryoGlue’s medium conditions are quite similar to that of the uterine fluids, there has been no known risks to the embryo or the patient from its usage.

Getting It Right at the First Attempt

Going through the whole IVF journey can be physically and emotionally challenging for a couple; it is really no walk in the park. With this in mind, Dr. Navdeep believes in doing everything possible to get it right the first time an IVF procedure is carried out. Weighing its benefits, couples undergoing IVF can rest assured that adding on the EmbryoGlue during the embryo transfer stage helps in enhancing implantation. Although this does not guarantee a pregnancy, it certainly helps to increase the chances of a couple hearing, "You're pregnant", words they have been so eagerly awaiting to hear. 

You are sure to have many questions. In addressing infertility, the sooner you have them answered, the better. Do list them down and call 03-8069 9333 (TMC Fertility & Women’s Specialist Centre, Puchong) or 03-62871000 (Thomson Hospital, Kota Damansara) or email ask@drnavdeepfertility.com to make an appointment to consult with Dr Navdeep.

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.

IVF Technology: Time-lapse Incubator

An Up-Close and Personal View of the Secret Life of Embryos

“I want to do everything possible within my control to ensure that

every step of the IVF process is done right.” 

-Dr Navdeep Singh Pannu-

Every process counts

When a couple is faced with the option of in vitro fertilisation (IVF), it is likely that all other significant measures to conceive have failed. In such an instance, I want to do everything possible within my control to ensure that every step of the IVF process is done right.

Time-lapse Incubator

 The Time-lapse Incubator is a less talked about advancement in IVF but to me personally, the value of this technology is immense as it is obvious. To understand its role, it is important to know where in the IVF process the Time-lapse Incubator lends its pertinence.

During IVF, mature eggs are retrieved from ovaries and fertilised outside the uterus. The fertilised eggs, now embryos, are placed in a substance that supports their growth. The embryos are subsequently placed in an incubator under a carefully controlled environment.

At regular intervals, the incubator is opened and an embryologist monitors the embryos’ morphology. He or she checks the number of cells and if they are dividing appropriately as well as monitors other significant markers. However, there is a predicament.

On the one hand, we want to observe as much as possible the developing embryos to be able to select the best to transfer or deselect those with a lower implantation potential. On the other hand, each time the incubator is opened, the highly controlled environment the embryo is in is disturbed.  This is a conundrum that the time-lapse technology effectively addresses.

Observing safely to increase selection success

The use of time-lapse technology in an IVF lab allows embryos to remain in the incubator while a camera continuously takes images of their development. The images are put together into a film and the embryos can now be consistently observed minus the stress of handling.

Time-lapse technology enables the documenting of events which may otherwise be missed in traditional observation such as the dynamic morphology of embryo development, its patterns and morphokinetics. These events tell us a lot about the developmental potential of an embryo.

The information gained from using time-lapse technology guides us in selecting embryos that are developing normally and in determining the optimum time for transfer within the five-day observation period, thus increasing the chances of a successful pregnancy.

Strides for better IVF success rates

The success of an IVF procedure is never guaranteed, as with any other Assisted Reproductive Technology (ART) interventions. However, the IVF process is made up of several procedures and experience has shown me that the compounded success of each process positively contributes to eventual success.

The Time-Lapse Incubator is part of the IVF process that I prescribe for patients under my care and it has been instrumental in empowering decisions that have brought couples closer to their hope of building a family.

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.

EPF Withdrawal for IVF: A Step Forward on the Journey for Baby

Anything but Simple

I was recently asked, “How do couples finance their infertility treatments?”  My answer to this was, “In just every way possible.”

I have witnessed family ‘crowd-funding’ where grandparents, parents, siblings, aunts, uncles and cousins came together to pool resources for a couple to undergo fertility treatment, notwithstanding the number of cycles it may or could take. In other cases, couples dipped into their life savings, took out personal loans and used credit services.

The next question that followed was, “Why do people take such extreme measures to finance fertility treatments?” My answer was simple, “They want a baby and they will do everything in their power to realise that dream.”

Nonetheless, as a fertility specialist, I can attest that the journey for a baby is anything but ‘simple’ – physically, emotionally and financially.

A Deeper Concern

In the latest development, the Malaysian Government has stepped in to provide an alternative to finance fertility treatments. Couples are now able to fund In Vitro Fertilisation (IVF) treatments by withdrawing from their Employee Provident Fund (EPF).

This decision, though, comes from a deeper concern. According to figures released by the Department of Statistics, the fertility rate in 2019 registers at 1.8 babies per woman (down from 1.9 babies in 2017) and a drastic decline from 4.87 in 1970.

In broader terms, this implies that the number of children produced by a woman during her reproductive years is insufficient to replace herself and her partner, a clear and present sign that dropping fertility rates threaten national productivity.

No Short Cuts

To couples battling infertility, the option to take from their EPF savings is a much-welcomed move. However, this does not alleviate the fact that addressing infertility can be as complicated as it is straightforward.

There are no short cuts to treating infertility and I elect to stay with proven methods that bring the best results. For over a decade, I have journeyed with hundreds of couples to build a family, but despite the best prognosis, we have had our fair share of ‘-ve’ results.

Thus, it gives me no pleasure to caution that at the end of the day, there is no guarantee; and if one is to cash out one’s retirement fund, one must do so with eyes wide open.

Financial Reprieve

That said, the EPF withdrawal option is a move in the right direction. There are no limits set as to how much one can withdraw. Legally married couples below the age of 55 years can apply to withdraw from their Account 2 savings for the following fertility treatment(s):-

  • Intrauterine insemination (IUI)
  • In Vitro Fertilisation (IVF)
  • Intracytoplasmic Sperm Injection (ICSI)

The process of reimbursement is fairly straightforward, and one that we will assist with. However, couples are advised to enquire and/or discuss with EPF should they have questions.

https://www.kwsp.gov.my/member/withdrawals/partial/health#Fertility_Treatment

You are sure to have many questions. In addressing infertility, the sooner you have them answered, the better. Do list them down and call 03-80699333 (TMC Fertility & Women’s Specialist Centre, Puchong) or 03-62871209 (Thomson Hospital, Kota Damansara) or email navdeep@tmclife.com to make an appointment to consult with Dr Navdeep.

Penjagaan Kesuburan Lelaki

Langkah penjagaan

Kesihatan sperma boleh dipengaruhi oleh gaya hidup dan keadaan persekitaran. Untuk menjaga kesuburan, anda perlu ambil tahu tentang faktor-faktor yang boleh menjejaskan kualiti sperma. Berikut adalah langkah-langkah yang boleh diambil untuk menjaga kesihatan sperma:

  • Mengekalkan berat badan yang sihat dengan memilih diet yang kaya dengan antioksidan untuk menjaga BMI dan kesihatan sperma anda.
  • Libatkan diri anda dengan aktiviti fizikal pada tahap sederhana yang akan meningkatkan tahap antioksidan yang boleh membantu melindungi sperma.
  • Ketidaksuburan lelaki boleh juga disebabkan oleh jangkitan penyakit kelamin. Amat penting untuk anda menyedari tentang perkara ini dan mengambil langkah-langkah sewajarnya untuk mengelakkan jangkitan.
  • Uruskan tahap tekanan psikologi anda kerana ianya dapat menurunkan fungsi seksual dan menjejaskan hormon yang diperlukan untuk menghasilkan sperma.
  • Sekiranya anda merokok, mohon berhenti. Penyelidikan menunjukkan bahawa lelaki yang merokok lebih berpotensi untuk mempunyai bilangan sperma yang rendah.
  • Masalah mati pucuk dan penurunan pengeluaran sperma boleh dialami oleh mereka yang minum arak atau alkohol berlebihan kerana ianya menjejaskan pengeluaran testosteron. Jika anda minum alkohol, amalkan kesederhanaan.
  • Ubat-ubatan tertentu seperti ubat anti-depresi dan anti-androgen boleh menjejaskan kesuburan. Steroid anabolik juga boleh memberi kesan yang sama. Anda dinasihatkan untuk berunding dengan doktor tentang ubat-ubat yang anda ambil.
  • Pendedahan kepada toksinboleh mempengaruhi kuantiti dan kualiti sperma. Sekiranya pekerjaan anda melibatkan bahan-bahan ini, ambil langkah keselamatan yang sewajarnya seperti memakai pakaian pelindung.
  • Peningkatan suhu skrotum  akan menghalang pengeluaran sperma. Untuk memastikan suhu “sejuk”, pilih pakaian dalam yang tidak ketat, elakkan sauna dan tab mandi panas dan kurangkan pendedahan skrotum kepada objek panas seperti komputer riba.

Mencari bantuan

Anda mungkin telah pun mengamalkan gaya hidup sihat untuk meningkatkan kesuburan, tetapi jika setelah setahun anda melakukan hubungan kelamin tanpa perlindungan dan masih tidak lagi mendapatkan hasil yang diingini, anda dinasihati untuk merujuk kepada pakar kesuburan untuk menjalani peperiksaan. Pakar kesuburan dapat membantu mengenal pasti punca masalah dan memberi rawatan yang sesuai untuk meningkatkan peluang anda untuk mendapat cahaya mata.

All About Egg Freezing

Egg freezing or oocyte cryopreservation is a process where a woman’s eggs are harvested, retrieved, frozen and stored for future use. It helps women to preserve their fertility so they can achieve pregnancy later in life through in vitro fertilisation (IVF) as their eggs can be frozen and stored for an indefinite time.

As women get older, their number of eggs decreases until they reach menopause while their uterus remains functional well into their 50s. At puberty, there are approximately 250,000 eggs, which reduce to less than 25,000 by age 40, followed by a rapid decline until menopause. There are also a fewer number of quality eggs remaining after 40 which results in increased chances of miscarriages and abnormal babies. Preserving a woman’s eggs when she is young significantly increases the chances of a successful pregnancy and having a healthy baby later in life.

There are a number of reasons for women to consider egg freezing and preserving their fertility:

  • They need to delay childbearing in order to pursue educational, career or other personal goals.
  • They may want to save their eggs before undergoing cancer treatment.
  • They prefer to store frozen eggs then frozen embryos for future IVF procedures, for religious or moral reasons.

The Egg Freezing Process :

1.Fertility Consultation & Assessment

The fertility specialist will order a blood test to determine the level of anti-Mullerian hormone (AMH) and do a transvaginal ultrasound to assess your ovarian reserve or the number of eggs. During the consultation, the fertility specialist will go over the results of the assessment, advise you on the potential outcome, take you through the two-week egg freezing process and what you can expect.

2.Preparation

You will be briefed on the process of preparing for egg retrieval including how to self-administer daily hormone injections for 10 days to help stimulate the ovaries.

3.Observation

The fertility specialist will monitor the progress of the eggs’ growth with an ultrasound, about two to three times during the injection phase.

4.Retrieval Day

While you are under sedation, a fertility specialist will remove the matured eggs by inserting a needle through your vaginal wall in only 15 minutes.

5.Frozen & Stored

Your eggs are frozen in liquid nitrogen in a lab by a team of expert embryologists and safely stored in the storage facility.

6.Defrost & Fertilise

When you are ready to get pregnant, your eggs will be taken out of storage, thawed and fertilised with your partner’s sperm to create an embryo. Through IVF, the embryo will be implanted into your womb to help you achieve 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 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.

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.”