Happy Birthday Louise – 25th July 2020

“The IVF procedure, first used in 1978 gave the Browns their first daughter and it will continue to give to give couples around the world hope to build a family.”
 Dr Navdeep Singh Pannu

“Yes, I do remember the first time I performed the In vitro fertilisation (IVF) procedure. It was in 2011. I was nervous then and still am now, anticipating the outcome after each procedure,” shared Dr Navdeep Singh Pannu responding to the question as to whether he remembers the first time he did the IVF procedure.

“I have done close to 1000 IVF procedures since. When the results are positive, it is a high all around. When it is not, it can be an emotionally very stressful for everyone involved,” said Dr Navdeep.

Dr Navdeep was commenting on the upcoming birthday of Louise Brown on 25th July, the world’s first baby conceived via the IVF procedure. “On 10 November 1977 in a hospital in Oldham UK, over 40 years ago, the egg and sperm united in a petri dish by scientist Dr Robert Edwards and gynaecologist Dr Patrick Steptoe, had divided into eight cells.”

It was implanted in Lesley Brown, and after nine years trying and failing to conceive due to blocked fallopian tubes, she became pregnant. 38 weeks later, Louise Joy Brown, the world’s first IVF then known as a test tube baby was born.

“Interestingly, 67 days after the birth of Louise Brown, Kanupriya Agarwal alias Durga was born in West Bengal, India, as a result of a similar procedure conducted by Dr Subash Mukhopadhyay,” added Dr Navdeep.

Unfortunately, Dr Subhash had taken his own life, due to the dejection of not being allowed to share his achievements with the international scientific community.

“More than 8 million IVF babies and counting later, the IVF technique continues to achieve tremendous advancements,” said Dr Navdeep who was scheduled to perform five IVF procedures on the day this interview took place.

“There are discoveries made every day and these achievements are taking us closer to achieving higher pregnancy rates and healthier pregnancies,” said Dr Navdeep paying homage the technique.

“What we know now is only a drop in the ocean. Science is evolving at a break neck speed,” said Dr Navdeep pointing out that there could come a day when a womb may not be needed to implant an embryo in.

“Each advancement made is a chance for someone to hold that baby that they so wish for. To me that will always be magical and I am invested to make that moment come true for couples.

A very happy “Birth Day” to all babies born via IVF and for the many more who will come into this world through this procedure.

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.”

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.

  1. 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.
  2. 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.
  3. 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.
  4. 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: https://www.youtube.com/watch?v=zmoBI5m2_uw&list=WL&index=224&t=206s
  5. 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.

– Dr Navdeep Singh Pannu

Dr Navdeep Singh Pannu can be contacted at 03-62871209/03-62871000 (Thomson Hospital, Kota Damansara), at 03-8076 7111 (TMC Fertility Puchong) or email ask@drnavdeepfertility.com

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