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 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.

Male Factor Infertility

“From the cold shoulder treatment downright to open and unabated rebuke, I have witnessed my fair share of men chastise their wives for the inability to conceive.”

– Dr Navdeep Singh Pannu

Dr Navdeep knows from his experience that men are as culpable to be the reason behind why a couple is unable to conceive. In this interview, he explains the reasons for infertility in men and the possible treatment for the condition.

The odds

It is not uncommon for the burden and blame of infertility to fall squarely on the shoulders of the female gender. The fact is, about half the time, men contribute to the problem. According to Dr Navdeep, male factor infertility is responsible in about 30 percent of couples with infertility, and male and female factors together contribute to the problem in another 30 percent.

The right conditions

Differing from women who are born with a reserve of eggs in their ovaries, a man’s testicles, through a process called spermatogenesis, produce millions of new sperm every day. Consequently, male fertility depends on the body making normal sperm and delivering them. However, producing mature and healthy sperm that can travel depends on many things. The following are the main causes for male infertility:

(i) Sperm disorders
Sperm disorders can arise from the genetic makeup that one is born with. Chromosomal abnormalities may interfere with spermatogenesis. When this happens, it leads to deficiencies in semen and semen quality. The most significant of these are low sperm concentration or count (oligozoospermia), poor sperm motility or movement (asthenozoospermia) and abnormal sperm morphology or shape (teratozoospermia). As high as 90% of male infertility problems are related to count, and there is a close association between abnormal semen parameters and sperm count.

(ii) Hormonal problems
Hormones produced by the pituitary gland tell the testicles to make sperm. The follicle stimulating hormone (FSH) stimulates the production of sperm and the luteinizing hormone (LH) stimulates the testes to secrete the male sex hormone, testosterone. High levels of FSH and LH can indicate a failure of testicular function, whilst inadequate levels may indicate that the testes may not be receiving adequate stimulation. Testosterone produced by the testes stimulates sperm production and is required for sperm motility; while elevated levels of the hormone prolactin may result in abnormal semen production.

(iii) Varicoceles
A varicocele happens when veins become enlarged inside the scrotum. Out of 100 infertile men, 40 may be affected. The condition causes low sperm numbers because blood flows back into the scrotum from the belly, making the testicles too warm for making sperm.

(iv) Other causes
Other causes of male infertility may include male reproductive tract blockages from repeated infections, surgery (such as vasectomy), swelling or developmental defects. Certain medications given to treat health problems may change sperm production, function and delivery. The presence of antisperm antibodies may cause ‘Immunologic Infertility’ where a man’s body makes antibodies that attack his own sperm. Erectile disfunction (ED) and decreased libido may also affect male fertility, as will disorders that upset ejaculation.

In some cases, male infertility can be caused by environmental factors which are less obvious such as exposure to excessive heat due to one’s occupation, as the case with truck drivers, welders, or firefighters, or habits, such as excessive use of the hot tub or tight clothing. Infertility in men can also be triggered by stress, obesity or an obsession with certain exercise regimes.

Tests and treatment

Male fertility diagnosis starts with a full history and physical exam in addition to blood work and semen tests. A full history-taking will include childhood illnesses, current health problems or medications that might harm sperm production. You will also be asked about your lifestyle habits and preferences which may have an effect on male fertility. The physical exam will look for problems within the male reproductive tract.

Semen analysis is a routine lab test. This test will reveal sperm volume, count, concentration, movement and structure. A blood sampling will provide information on hormone levels to learn how well the testicles are producing sperm. Other tests and procedures that involve ultrasound and/or a biopsy may also be conducted.

The treatment for infertility is dependent on the cause of the infertility. Many problems can be rectified with lifestyle tweaks, drugs or surgery, and this would allow conception through normal sex. In instances where the sperm count is too low to enable natural conception, Assisted Reproductive Technique (ART) such as Intrauterine Insemination (IUI) and In Vitro Fertilisation (IVF) could be viable options. In conditions where there is no viable sperm, options that involve the use of donor sperm could be considered.

Egos aside

Not all male infertility is permanent or untreatable; it is not uncommon to treat infertility in men through one or a combination of actions. The pervasive issue though, according to Dr Navdeep, is the denial on the part of the male partner. He emphasised, “Having a baby is a couple effort and therefore it is important for both partners to assume equal responsibility from conception right through to child-rearing.”

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 03-62871209/03-62871000 (Thomson Hospital, Kota Damansara) or email ask@drnavdeepfertility.com to make an appointment to consult with Dr Navdeep.

#DrNavdeepSinghPannu #FertilitySpecialist #MaleInfertility #MaleFertility #AssistedReproductiveTechnique #FertilityTreatment

Caring for Male Fertility

Caring for Male Fertility

Care steps
Sperm health can be vulnerable to lifestyle and environmental circumstances. Thus, to protect your fertility, you will need to be aware of factors that may impede sperm potency. The following are steps that you can take to care for your male fertility.
•Maintain a healthy weight by opting for an antioxidant-rich diet that improves your BMI and sperm health.
•Start yourself on moderate physical activities which will further increase your levels of powerful antioxidant enzymes to help protect sperm.

•Infertility in men can also be caused by sexually transmitted infection. It is important that you are aware of this and take the necessary steps to avoid infection.

•Manage your stress levels as stress can decrease sexual function and intervene with the hormones needed to produce sperm.

•If you smoke, quit. Research has shown that men who smoke are more likely to have low sperm counts.

•Heavy drinking can cause impotence and decreased sperm production because alcohol reduces testosterone production. If you drink, do so in moderation.

•Certain medication such as blockers, antidepressants and antiandrogens can contribute to fertility issues. Anabolic steroids too can have the same effect. Do talk to your doctor about the medications that you are on.

•Exposure to toxins and pesticides can affect sperm quantity and quality. If you work with toxins, take the necessary safety precautions including wearing protective clothing.

•Increased scrotal temperature can hinder sperm production. To keep things “cool”, wear loose-fitting underwear, avoid saunas and hot tubs, and limit scrotum exposure to warm objects such as laptops.

Seeking help

If you have adopted healthy lifestyle practices to promote your fertility but still have not achieved the desired results after a year of unprotected sex, you might consider being evaluated for infertility. A fertility specialist can help identify the cause of the problem and provide treatments that place you and your partner on the road to parenthood.

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 03-62871209/03-62871000 (Thomson Hospital, Kota Damansara) or email ask@drnavdeepfertility.com to make an appointment to consult with Dr Navdeep.

#DrNavdeepSinghPannu #FertilitySpecialist #MaleInfertility #MaleFertility #AssistedReproductiveTechnique #FertilityTreatment