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.

Food for fertility

Conceiving a child starts with both parents’ health, so couples should embark on a healthy diet and take the appropriate supplements before trying to get pregnant.

THERE is significant data to suggest that the relationship between nutrition and fertility is consequential in promoting conception.

Results from studies examining the role nutrition plays in improving fertility in men and women underpin that healthy food choices can positively affect the state of reproductive functions.

Even more pertinent is mounting evidence that couples with good nutritional profiles had a healthy pregnancy and positive foetal development.

Researchers from the Harvard T.H. Chan School of Public Health and Harvard Medical School in the United States recently published research done on the impact of diet on fertility.

Their findings reaffirmed that nutrients such as folic acid, vitamin B12 and omega-3 fatty acids, as well as diets built on vegetables, fruits, herbs, nuts, beans and whole grains, had a positive impact on women attempting to get pregnant naturally. The same dietary prescription was also found to improve the quality of semen among men.

Conversely, unhealthy diets such as those rich in red and processed meats, potatoes, sweets and sweetened drinks were found to be negative for fertility health in both genders.

With couples undergoing assisted reproductive techniques, it was found that women may be more likely to conceive if they are on an antioxidant-rich diet.

A study conducted in Netherlands on pre-conception diets and their association with the chances of getting pregnant in women undergoing fertility treatment, suggested that obese women and men (defined as having a body mass index of more than 30) and those suffering from poor nutrition (those with a body mass index of less than 20) could suffer heightened risks of infertility.

Closer to home, studies have revealed that in addition to avoiding certain types of vegetables and fruits due to food taboos or the lack of nutrition knowledge, pregnant women in Malaysia do not consume enough of this important food group.

In some of my own patients, observance of a healthy diet leading to the reduction of 10% of their body weight if they are obese, has led to their success in conceiving naturally.

In other instances, a prescription of supplements taken over a few months, coupled with better dietary choices, seems to have made all the difference. I have also had cases where husbands have been successful in improving their sperm count simply by observing a healthier diet and exercise.

Undergoing fertility treatments can be tough physically and psychologically, so it is crucial for couples to support one another all the way.
 
In fact, the MCO has also brought forth favourable outcomes that illustrate the importance of balancing mind, body and soul.Quite a number of couples under my care have found themselves in the family way without the need of any assistance during this period.The increased time spent together at home may have given them the opportunity to reconnect, while the time saved from commuting due to working from home might have given them more time for exercising and preparing healthier home-cooked meals.

What to eat

Aside from factors such as age and genetics, which we cannot control, nutrition is a factor that is well within our purviews to manage.

Simply put, the diet one observes during pregnancy is the same diet that should be practiced before pregnancy.

And fathers-to-be are not exempt either!

Fruits and vegetables are rich in antioxidants and are great for general wellbeing.

The healthier a couple is, the better their chances are to conceive.

Hence, ensure that at least half your plate at every meal is composed of fresh fruits and vegetables of any type, and avoid over-frying your vegetables.

Plant-based fats, taken in moderation, can help promote regular ovulation and general fertility.

Trans fats, on the other hand, should be avoided.

These can be found primarily in foods such as commercial baked and snack foods, animal products, fried foods and certain margarines.

This type of fat can cause insulin resistance that could inhibit ovulation.

Instead, indulge in more complex, but good carbohydrates rich in fibre, like whole grains.

For protein, zinc and iron, eat more eggs, fish and meats that have been trimmed of fat.

Fish and egg yolks are an excellent source of DHA (docosahexanoic acid) and omega-3 fatty acids that help develop a baby’s nervous system.

Plant protein from beans, nuts, seeds and tofu are also packed with healthy fats.

Also, consume one or two servings a day of whole milk or other full-fat dairy foods, such as yoghurt, and less of non-and low-fat dairy.

With sugar, less is more and it would be prudent to cut down on sugar intake.

Drink coffee and alcohol in moderation and opt for whole foods over processed options.

I encourage couples – yes, both husband and wife, not just the wife – to take a daily multivitamin that contains at least 400mcg of folic acid and 40 to 80mg of iron, as well as pre-natal vitamins like vitamins C and E, selenium, and zinc.

In addition to what can be ingested, it is encouraged that we get a daily dose of vitamin D3, either by simply stepping out into the sun, especially in the morning, or from supplements if daily sun exposure is not possible.

Adequate intake of this vitamin improves the immune system and enhances fertility potential.

Mind and body

In addition to nutrition, stress management is also an important aspect of a healthy lifestyle.

Most of us are prone to work stress and I often advise couples to compartmentalise.

Don’t take your work home with you, and vice versa, don’t allow home concerns to affect you at work.

Talk to your doctor if you are feeling overwhelmed – don’t feel embarrassed or apprehensive about getting help.

Proper and adequate sleep is another important aspect of our general wellbeing.

Alongside repairing damage in our bodies, sleep is our best detox for a balanced hormonal profile.

So be sure to get six to eight hours of quality sleep.

If you are having trouble sleeping, you could take a melatonin supplement an hour or two before going to bed.

Exercise and good nutrition go hand in hand.

At least three 30-minute sessions a week for starters will have you feeling the positive effects.

From high-intensity interval training (HIIT) or swimming to brisk walking around your housing area after work, there are a variety of options you can chose from to best suit your time and physical profiles.

Consult your doctor on the routines that would best fit you.

Plan early

Couples must be aware that getting pregnant is not a given thing in a marriage.

Poor nutritional choices and unhealthy habits may compromise fertility and our chances of building a family.

I would like to encourage couples to consider undergoing a pre-conception consultation even before you decide to have a baby.

This consultation can be done with and by your family doctor to ascertain the state of your general and fertility health.

Any problems can then be detected early on and measures to deal with them can be planned and carried out.

This consultation should be done sooner rather than later, regardless of when you decide to have a baby.

This is as lifestyle alterations usually take some time before any effect is noticed.

It is also imperative for any pre-existing conditions such as asthma, diabetes, oral health and obesity to be effectively controlled in order to maximise your chances of having a baby.

I cannot emphasise enough that a healthy pregnancy begins with a healthy lifestyle.

And it’s not just your health that will be affected.

Your child’s nutritional profile starts from the womb and is enhanced throughout their lifetime, so your health and nutrition directly affects them from conception onwards.

Be there for one another

Infertility treatments can be daunting and couples undergoing them may experience worry and insecurity.

The most common fertility treatment side effects are bloating, headache, breast tenderness, upset stomach, hot flashes and mood swings.

This, in addition to the stringent demands of when the drug and procedures must be administered, weigh heavily on one’s physical and psychological state.

It is important that couples support each other through this process, alongside observing a healthy lifestyle and diet.

Pregnancy can also be a time of confusing and conflicting emotions, more so for couples who conceive with the help of fertility treatments.

Share these feelings with each other and be assured that you can discuss any issues with your doctor if you feel the need to do so.

Building a family should be an exciting and enriching experience.

Therefore, do surround yourself with the company of family and friends who can help you stay upbeat and optimistic.

On that note, let’s strive to get the basics of a healthy lifestyle right, not just for your future family, but also yourselves individually.

I do look forward to the baby photos of 2021.

Dr Navdeep Singh Pannu is a fertility specialist. For more information, email starhealth@thestar.com.my. The information provided is for educational purposes only and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

Source : The Star | Malaysia News

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.

How technology is changing pregnancy for women over 40

The New Straits Times Letter to the Editor, 28 July 2020, features Dr Navdeep’s thoughts on advancements in fertility treatment, defining infertility as a disease, and his commitment towards helping couples build a family.

LETTERS: Advancements in fertility treatments and technology are helping more and more women who are facing age-related infertility achieve their dreams of having a baby.

Developments in procedures and technologies in fertility science complemented by laboratories that adhere to the highest standards ensure the best chances of creating and growing embryos to facilitate pregnancies.

Procedures such as Preimplantation Genetic Testing (PGT) ensure that the best embryo can be selected for transfer, and Endometrial Receptivity Analysis helps doctors determine the best time to transfer the embryo.

Improvements in medication has reduced injections needed to be administered to women in preparation for In-Vitro Fertilisation (IVF) from six weeks to 10 days. These have contributed to increased success in pregnancy and decrease in miscarriages.

In fact, the success rate of pregnancy through IVF is almost 60 per cent now compared with 20 per cent previously.

Still, how is it possible that women in their 40s and above can conceive? Most age-related infertility problems in women are due to germ cell deterioration.

By the time women turn 40, their ovarian reserve or eggs are reduced markedly. However, the uterus remains functional.

Therefore, for women above 50 to conceive, an egg from a donor is artificially inseminated by the husband’s sperm to create an embryo.

The embryo is implanted in the woman’s womb, which carries the baby to term. While it is a possibility, advanced age pregnancy may not be for everyone. Ethically, fertility specialists first need to determine if the woman is healthy enough to carry a child.

For this reason, early pregnancy (preferably between 20s and 30s) is the ideal convention. If a woman is not ready to have children in her 20s or even 30s, she can ensure her chances of having a healthy embryo years later by preserving her eggs while she is young with oocyte cryopreservation or egg freezing.

However, when it comes to fertility, the fundamental message is: don’t wait until it becomes a challenge. To be exact, couples should see a fertility specialist after six to 12 months of trying but failing to conceive. Fertility is a potentially treatable problem.

The problem lies in the fact that infertility is generally not considered a medical problem. Instead, it is seen more as a social issue. Infertility may not be a life or death case but it is a long-term (chronic) condition.

People can be childless for life and this can contribute to mental and emotional health problems, marriage breakdowns and career failures.

For a long time, infertility wasn’t even considered a disease. It was only in 2009 that the World Health Organisation and the International Committee for Monitoring Assisted Reproductive Technology defined infertility as “a disease of the reproductive system”.

The right to procreation must be seen from a broader perspective. Besides its importance to the survival of mankind, children are imperative for a nation.

Dr Navdeep Singh Pannu

Puchong, Selangor

Source :

Article  to post on website :

https://www.nst.com.my/opinion/letters/2020/07/612116/how-technology-changing-pregnancy-women-over-40

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.