Category: For Her

Dr Tan Sue Yee is a lecturer at the International Medical University – she specialises in matters related to healthy diets and good nutrition – and an active member of the Nutrition Society of Malaysia. She is also the mother of Yong En, who will turn 4 this August, and Yong Hui, who just turned 5 months old in April. Dr Tan exclusively breastfed Yong En – this means offering her daughter only breast milk and not other kinds of milk for the first 6 months of life – and continued breastfeeding for nearly 2 years (even after her daughter started on complementary food at 6 months onwards), and she is currently doing the same with Yong Hui.

When HealthToday caught up with her recently, it was a perfect opportunity to ask her, “You’re a mother who breastfeeds both her darlings, so what was the experience really like?”

Mommy’s getting ready

Experts always tell mothers who are expecting their first baby to research as much as they can on breastfeeding. This helps to clear any doubt or confusion.

Dr Tan says, “I am on the panel of a programme called MyNutriBaby, which is spearheaded by the Nutrition Society of Malaysia to provide information and resources for mothers who wish to optimise their children’s nutrition. In this programme, I have the opportunity to work with Pn Fatimah Salim, a lactation specialist.

“I was carrying Yong En when we first met, so I peppered Pn Fatimah with so many questions! What was it like? What can go wrong, and how can I overcome the problem? What if the baby cries? How do I know when baby is hungry or full?

“Pn Fatimah was patient and kind enough to answer my questions, so when Yong En finally arrived in this world, I had a good idea on how to do things right.”

The experts are right: it is good to look up breastfeeding or discuss the matter with lactation specialists, mothers who have breastfed, etc. However, Dr Tan points out that it is important to get the correct information from reputable sources. Like everything else, breastfeeding has its share of misconceptions and urban legends! Interested or curious moms (and dads) can start with www.mynutribaby.org,my, the website of the programme Dr Tan participates in.

The first time

Welcome the baby with the best food Mom can provide: breast milk. So say the experts, who advise moms to breastfeed as soon as possible. Cradle the baby close – bare skin contact is preferred – and, if the baby does not instinctively reach for the nipple, gently guide the baby’s mouth to the right place.

“With my eldest, Yong En, everything went smoothly. Yong Hui, however, needs some guidance in getting the first time right – it took about 40 minutes before she could breastfeed properly,” says Dr Tan. “Believe it or not, I wasn’t too upset. I guided her and I was actually overjoyed when Yong Hui finally succeeded in latching on to my breast!”

Babies are just like their parents, they are born with their own personalities and quirks. Some learn fast, while others need a little nudge and guidance in the right direction. Therefore, if your baby takes some time to latch properly, Dr Tan advises patience. Relax to the calming sound of your little one’s heart beating against your skin. Your baby will get the hang of it soon. If you need any help, contact the nurse. Many baby-friendly maternity wards have nurses and lactation specialists who are always willing to lend a helping hand.

Breastfeeding on demand

The baby will probably get hungry every few hours, so mothers should observe for hunger cues – such as tears, grasping movements reaching towards the mother’s nipple, etc – and breastfeed when the cues are present. This practice is called “breastfeeding on demand”.

Many new mothers may find it challenging to switch from a past routine, in which they were always on the move, into one where they are now – as some mothers smilingly put it – their baby’s amazing milk factory. They will find themselves breastfeeding often – not surprising, as Dr Tan explains that a baby’s stomach has a small volume, so the baby will get hungry quickly.

She adds, “To many mothers, breastfeeding on demand may seem tiring or confining, but in my experience with both my kids, it is not so bad! Breastfeeding is an opportunity to bond with the little ones, an experience that is both emotionally rewarding and satisfying.”                               

Dr Tan’s tips for a less stressful breastfeeding on demand experience:

• Rest, even sleep, while breastfeeding. Babies tend to cuddle up for a nap after filling their tummies, so why not join them in dreamland?
• Play your favourite calming music or catch up on your favourite shows or books while breastfeeding. Make the experience more enjoyable by having drinks and snacks within easy reach.
• Breastfeed on a comfortable chair with good back support.
• Stay positive. Instead of groaning and focusing on the stress and exhaustion, think of the feelings of calm and joy you experience when you breastfeed your baby. If it makes you feel better, think also of the benefits you are getting. Breastfeeding helps new mothers lose those post-pregnancy kilos!
• Give and take a little. Because you are now breastfeeding on demand, you may not be able to keep the house as tidy as you used to, and sometimes you may not have the time or energy to cook or do housework. This is fine; don’t get worked up over it. Just ask your partner and other family members to help. You may be surprised at how willing they can be to give the new mother a helping hand as well as lots of emotional support!

Night feeding

Babies get hungry at night too, so experts advise mothers to be prepared to breastfeed at night too.

The bane of every mother contemplating breastfeeding: having to wake up at ungodly hours of the night to the cries of a hungry baby, not to mention feeling a considerable degree of resentment for the slumbering hubby… especially if he is the one who wakes up the mother and tells her to go feed the baby as the baby’s crying is interrupting his sleep!

“It’s not easy,” said Dr Tan with a laugh, “but it’s not impossible either. For me, when I choose to breastfeed, it is a commitment I have made to myself and my babies. It is my choice, to do something that I know is best for my children, so I always try to focus on the positive aspects of what I am doing.”

Furthermore, night feeding is also important for a mother to have a more successful breastfeeding experience, as mothers produce more milk at night.

Night parenting tips for new moms:

• Have realistic expectations. Some babies may need more feeding throughout the night, others less. If your baby falls into the first group, make adjustments to accommodate night feeding. For example, you can try catching more naps during the day.   
• You can wake the baby for a breastfeeding session before you go to sleep. That way, your baby will feel hungry a bit later, thus giving you some decent amount of sleep before your night feeding sessions start.                                                
• Try to offer both breasts, so that your baby will have a full tummy each time. 
• Check your baby’s diapers each time before a feed, and change them if necessary. Babies sleep easier when their diapers are dry and comfortable.
• Have the baby sleep in the same room so he or she is closer to you, to make night feedings more convenient.
• When things get tough, remember why you wanted to breastfeed, and revisit your goals if you need some extra motivation. Also, if you approach night feedings with a positive attitude, you may begin to appreciate how each session is a peaceful moment for just the two of you – magical moments that you will cherish for life.

The importance of support

Experts point out that a breastfeeding mom’s chances of success improve significantly if she receives support from the people around her, especially her spouse and close family members.

Dr Tan agrees. “My husband was – is! – fantastic when it comes to supporting me,” she gushes. “My mother and mother-in-law are fabulous too. They help me around the house, as well as encouraging me and keeping my spirits high!”

If your husband, parents or in-laws do not share your views on breastfeeding, Dr Tan recommends involving them in your medical appointments, antenatal/parenting classes, etc. She frequently gives talks on child nutrition, and she has seen doubtful attendees eventually becoming interested in breastfeeding once the topic is discussed. “Often, their doubts or reluctance come from having incomplete or inaccurate information,” she says. “But when they learn of the benefits of breastfeeding, they often come around!”

Milk supply woes

Experts say that the more you breastfeed on demand, the more milk your body will produce, so there should not be any supply shortage problem.

Dr Tan never encountered any milk supply issues while breastfeeding both her daughters.

First, she addresses some common misconceptions. Women can breastfeed even if they have small breasts, flat nipples or inverted nipples. Breast milk production is regulated by hormones, and is not affected by breast size or nipple shape.

“If a mother is unable to produce breast milk, often it is not an issue of inadequate breast milk; usually it’s due to stress or the baby not latching properly to initiate the ‘let down’ which releases milk,” explains Dr Tan. A family member once found that she could not produce enough milk for her baby, but once the other family members cared for the baby to give her some time to compose herself and relax, she could breastfeed the next time she tried. “Some mothers, especially first-time mothers, can become anxious or worried when they try to breastfeed, and the stress affects the hormones and hence breast milk flow.”

She recommends relaxation methods such as listening to music or even getting some “me time” to calm one’s nerves before trying again.

On the other hand, hormone imbalance could affect breast milk production (although this is not a very common occurrence). If all efforts to calm down still fail to resolve the milk supply issue, it may be worthwhile to see a doctor to investigate the matter further. For issues of baby latching, seek the help of a lactation specialist.

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Time can pass very quickly when one is a mother. It seemed like it was only yesterday when one’s child was just an adorable baby, and she seems to be growing up so quickly with every day!

Also, just around the corner is the end of the mothers’ maternity leave. While some mothers may welcome a return to a familiar routine, most may experience a twinge of concern about how they can continue to breastfeed their little ones when they return to work.

It’s best to get prepared early

“Getting everything in place early helps the mother resume work knowing that her baby is in good hands,” Dr Tan Sue Yee says. “It also allows the mother and her baby to transition smoothly into a new routine that allows the baby to continue to receive the goodness of breast milk.”

What is the new routine like?

Generally, life on a working day for Mom and her baby can go about like this:

• Mom breastfeeds her baby before she goes to work.
• When she drops off her baby at the babysitter, she also drops off a day’s supply of expressed breast milk for her baby. Moms have a good idea by then how much milk their baby needs in a day, but it is good to leave some extra in case Mom is late in picking up her baby due to traffic jams, etc.
• The babysitter cares for the baby. She stores the expressed breast milk properly in the fridge, thaws and warms the breast milk to give to the baby.
• Mom comes home after a day’s work and breastfeeds the baby.

There are a few things Mom (and Dad) should look into before it is time to go to work.

#1 Decide how to express breast milk.

A breast pump is a popular option, as it allows Mom to collect and store her breast milk, which can then be fed to the baby by the caregiver while Mom is at work. The other option is to express breast milk by hand. Moms prefer breast pumps due to the convenience offered by these devices.

Dr Tan explains that there are two main types of breast pumps available: manual (that requires Mom to keep squeezing a handle to collect breast milk) and electric-powered ones. These breast pumps have either a single pump, which collects milk from one breast at a time) or double pumps, which collect milk from both breasts at the same time. Prices may vary depending on the brand and the features of the breast pump, but it is not always necessary to get the most expensive one. Many Moms have gotten by just fine with manual pumps or more inexpensive electric-powered ones.

There are many breast pumps available in the market, so how does one choose? Dr Tan advises Moms to ask family members or friends who have breastfed for recommendations. They can even borrow breast pumps from these people for ‘test runs’.

Some criteria to consider when choosing a breast pump are:

• Is it comfortable to use?
• Do you find it easy to use?
• Do you find it easy to clean and sterilize?
• Are you comfortable with the amount of noise it produces?
• And, of course, is its price within your budget?

Note that it is a good practice to sterilize breast pumps before use. This can be done by using a sterilizer or just immersing the breast pump in boiling water for 10-15 minutes. After use, wash the breast pump immediately. Doing all this helps reduce the risk of germs contaminating expressed breast milk.

#2 Learn how to store and prepare expressed breast milk for your baby.

Dr Tan Sue Yee explains that there is a simple art to storing breast milk: label the date of collection (and the baby’s name too, if the baby’s caregiver has more than one young charge to care for) on the container. When storing breast milk in the fridge, place the newest ones at the back. This way, Moms will always use the older milk first and there is less chance of milk still being kept after it has spoiled.

Breast milk should be kept in the coldest part of the fridge or freezer. The table below shows how long breast milk can keep at certain temperatures.

• Room temperature – 4 hours
• The regular space in the fridge (2-4°C) – 8 days
• The freezer (0°C and below) – 2 weeks

“This is why labeling the date of collection properly and accurately is important,” Dr Tan says. “We don’t want to store spoiled milk and accidentally give it to the baby.”

When it comes to preparing the breast milk for the baby, it is pretty simple.

• Thaw and warm the milk by placing the container in a bowl of warm water.
• Moms may find fatty blob-like globules in the milk. This is normal, as they are just milk fat that has become separated from the rest of the milk. Just shake the milk gently and the appearance of the milk will be back to normal.
• If the milk has a soapy or metallic smell, it is still fine to be consumed. On the other hand, do not use breast milk that smells sour or rancid – such a smell is a sign that it has spoiled.
• Moms can test whether the milk is ready to drink by tipping a few drops onto the inside of their wrist. If the milk feels lukewarm, it is ready for the baby’s tummy.
• A word of caution: do not use a microwave to thaw or warm the milk! Doing so creates pockets of heat in the milk which can scald the baby’s tongue and mouth. Also, discard any leftover milk.

#3 Prepare your baby for this new way of feeding.

Babies need some time to get used to new things – sometimes even longer than adults! – so about 2 weeks before Mom goes back to work, she can introduce feeding expressed breast milk to her baby. Dr Tan recommends, if possible, to get someone else to feed the baby during these sessions,  so that she would be comfortable being fed by another person once Mom goes back to work.

Dr Tan explains that, to do this, Moms can start by replacing one breastfeeding session with expressed breast milk, and slowly replace more breastfeeding sessions as the days pass.

#4 Find the right person to care for your baby.

The right person isn’t just someone who is good with the baby – she must also understand how to store and prepare breast milk. “A friend of mine once placed her daughter under this babysitter’s care,” Dr Tan recalls, “only to discover, when she went back to retrieve something she left behind, that the babysitter boiled the expressed milk directly in a pot!”

Therefore, Moms should take time to talk with a prospective babysitter or the family relative who will care for the baby. Feel free to demonstrate on how to store and prepare expressed breast milk, if that will help them understand better. If the babysitter is not working out, they should not hesitate to look for one that is more understanding about their baby’s needs.

#5 Other things to do

Moms should also check to make sure that they can comfortably express breast milk back at their workplace.

• It won’t hurt for the Mom to let the employer or her immediate colleagues know that she wants to take some time out every day at work to express breast milk. This may sound daunting, but Dr Tan assures Moms that there are many women today who express breast milk while at work, so there is usually strong support for such Moms at the workplace.
• Some workplaces have special rooms for Moms to do this. If the Mom’s workplace does not have this facility, however, she can make enquiries in advance. Are there any places that she can use, such as an unoccupied meeting room? (Storerooms are not recommended, but they are an option if the employer does not provide any other option.)
• Does the pantry have a refrigerator that the Mom can use to keep her expressed breast milk, and will her colleagues be comfortable if she does this? Is the temperature of the fridge right? Moms can bring cooler bags containing ice packs to store their breast milk if there is no available storage at work.
• Last but not least, take plenty of pictures of the baby on the phone. Looking at them will make the temporary separation from the baby much easier to bear! “And stimulation the production and flow of breast milk too!” adds Dr Tan.

#6 And, of course, breastfeed when you’re back from work.

Even when the baby is comfortable with being fed expressed breast milk, there is always time and place for breastfeeding. After all, breastfeeding also provides emotional benefits for both Mom and her baby, and many Moms find that breastfeeding their precious little darling is a great way to de-stress after a hard day’s work.

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The longer a couple wait to have a child, their risk of having a baby that carries a genetic disease (Down syndrome, Patau syndrome, etc) increases. This is because the egg and the sperm both have a higher chance of becoming defective as one ages. This is especially documented in women. Table 1 shows the risk of a woman bearing a child with Down syndrome as she ages.

Table 1. A woman’s risk of bearing a child with Down syndrome

Many fertility centres offer genetic screening service as an add-on to various fertility treatment packages. While it is not compulsory, it may be worth considering in the following situations:

• Parents-to-be with a family history of genetic disorders and birth defects.
• Parents-to-be who are aged 40 years or older, especially the mother-to-be.
• Mothers-to-be with a history of miscarriages or have previous children with birth defects, mental handicap or genetic disorders.

The cost varies. Screening for rare genetic mutations usually cost more, as the specimen may have to be sent to laboratories overseas for analysis.

Types of genetic screening

• Pre-conception genetic screening. This checks whether the parents are carrying genes that put any child they conceive at risk of developing a genetic disorder.
• Pre-implantation genetic screening. A sample of cells is carefully extracted from the foetus at the early stage of pregnancy to determine whether there is any genetic abnormality present.
• Prenatal genetic screening. This is to test whether the baby has genetic disorders. More recent methods such as non-invasive prenatal diagnosis (NIPD) allow for less invasive screening with lower risk to the child one is carrying.

Each type of screening is not 100% accurate, so there is a possibility that a baby is born with a genetic disorder despite having negative results, or vice-versa. Depending on the risk, the fertility specialist may encourage the parents to take one or more, maybe even all three types of screening.

The benefits of screening

Knowledge is power, as the saying goes. Indeed, knowing that there is a possibility of the child having a genetic disorder allows the parents to be emotionally prepared to raise a special needs child when the time arrives. The parents have time to consult in advance specialists on the needs of the child, make arrangements for the child’s education and caregiving needs, and even make necessary financial arrangements. By having the time to consult necessary experts and advisors, parents will not be caught unaware when the child arrives into their lives.

Also, by being emotionally prepared to raise the special needs child, the parents would be less likely to face conflicts and challenges that could come in the way of their relationship. 

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For every mother-to-be, she will do all in her power to ensure the safety and well-being of the little one she is carrying. However, many often overlook one important aspect of protection: immunization. 

Women are generally encouraged to get immunized before pregnancy, as not all vaccines are safe during pregnancy. Doing so allows her to build up a store of antibodies and strengthen her immune system before pregnancy (which is when the immune system is naturally weaker than normal). If she has not been able to get herself immunized prior to pregnancy, it is advisable to do so post-pregnancy, as most vaccines are safe during breast-feeding. However, healthcare practitioners will ultimately decide if the benefits of getting immunized outweigh the risks to the mother and baby.

The following few vaccines are considered safe for pregnant women who may have a risk of infection:

• Hepatitis B – Hepatitis B is a serious infectious disease commonly transmitted from an infected mother to her child during childbirth. It affects the liver, and can be potentially life-threatening. Women who yet to receive this shot when they were younger, and are found to be at high risk of contracting this disease while  testing negative for the virus can receive this vaccine.
• Influenza – A bout of serious influenza infection can cause severe complications during pregnancy. The influenza quadrivalent vaccine can protect the mother from a serious infection during pregnancy. It can be received before pregnancy, or at any stage of pregnancy, or after pregnancy. It is quite safe for both the mother and her baby.
• Tetanus/ Diphtheria/ Pertussis – This combination vaccination, also referred to as the adult DTaP (diphtheria, tetanus, acellular pertussis) vaccine is recommended in the third trimester of pregnancy, ideally between 27 and 32 weeks of gestation. Newborns are too young to receive vaccinations against these three potentially life-threatening diseases, so it is up to the mother and the other adults around the newborn child to protect him or her from these diseases. Women who have not received this shot should consult the doctor on the possibility of getting it.

For most of the other adult vaccines, their safety during pregnancy has yet to be established. It is best to discuss them with your doctor, so your doctor can then assess the benefits against the risks of these shots for you.

References:

1. BabyCenter. Available at www.babycenter.com

2. Centers for Disease Control and Prevention. Available at www.cdc.gov

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Motherhood is an exciting and joyous experience for many women, but it comes with its own share of challenges. A new mother will have more specific requirements in the first two years after delivery, wherein her body will be working extra hard to meet the demands of lactation, sleepless nights and adapting to a new routine.  Her body will also need to recover from delivering the baby, especially if the delivery was difficult.

On paper, the golden rules for new mothers seem simple enough:  adequate rest, a daily nutrient-rich and balanced diet, and regular exercise. In reality, however, the new mother may be trying to get used to night feedings, lack of sleep and more. The golden rules, therefore, may seem like tall orders sometimes! Fortunately, supplementation may help support her efforts to obtain enough nutrients to recover from delivery, produce enough breast milk and stay healthy for both herself and her baby.

Among the supplements that can help post-natal recovery are:

In addition to diet and supplementation, it is also very important to consume plenty of fluids, which can help overcome dehydration caused by labor and lactation. An adequate intake of fluids can also help keep constipation at bay. Most women dread the effects of passing motion after delivery. Constipation can add to their discomfort.

These simple measures can go a long way in improving the health and well-being of mothers after child-birth.

Important note: Any medication and/or supplementation taken should be with the proper consent of your healthcare provider. Also, you should strive to follow the golden rules – the supplements help to fill any gaps in your efforts, not to replace your healthy lifestyle altogether!

References: 

Health Pages. Available at www.healthpages.org

 SF Gate. Available at www.healthyeating.sfgate.com

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Dr Kiren Sidhu   Consultant Obstetrician and Gynaecologist, Pantai Hospital Kuala Lumpur

John Lennon once said, “Life is what happens while you are busy making other plans.” This can be true for most of us. We juggle the need to have a career that provides both fulfilment and enough income to support ourselves as well as seeking that elusive life-work balance. For many women, this tends to cause them entering motherhood at an older age compared to their own mothers and grandmothers.

This is a phenomenon widely noted and even studied in developed countries such as the USA, UK, Japan and even Singapore. While we do not have any statistics to show us how prevalent this phenomenon is in Malaysia, there are strong indications that Malaysian women, in general, are having their first baby at an older age.

Dr Kiren Sidhu, a consultant obstetrician and gynaecologist, tells us, “If I see 20 pregnant women a day in my clinic, easily about 15 of them would be above the age of 30 and having their first baby, and of these 15, about 8 would be above 35 years old.” She adds that it is not uncommon these days for women to defer childbearing to an age when they are more comfortable.  

This phenomenon is not without a few risks. But in order to understand those risks, let us first take a look at the impact of one’s age on the development of our egg and sperm cells.

The fertility process

In the female reproductive system, the egg cells are formed in the ovaries. Each ovary is made up of a very large number of follicles. Egg cells form and develop within these follicles, and one fully mature egg would be produced each month.

Therefore, a woman’s fertility rate is closely linked to the number of follicles present in her ovaries. Unfortunately, studies have shown that, with age, the number of follicles present actually decreases.  

Also, the genetic materials present in the egg cells become increasingly flawed the further the woman ages.

“The older you are, the greater are the chances that the baby inherits these flawed genetic materials, significantly increasing the risk of the baby being born with chromosomal abnormalities (Down’s syndrome, Edward’s syndrome, Patau syndrome and such),” says Dr Kiren. She shares the following estimated risk of Down’s syndrome, which increases with maternal age:

There is also an increased risk of ectopic pregnancy (the baby developing in the fallopian tube instead of the uterine wall, a state that can endanger the mother’s life) and spontaneous abortion. Women who become mothers over the age of 40 also face a higher risk of longer labour, awkward positioning of their baby during birth and foetal distress.

It’s not just a woman’s dilemma

Dr Kiren points out that men also face the problem of increasingly flawed genetic material duplication in their sperm cells as they grow older. The older the father is, the higher the risk of autism, epilepsy, learning difficulties, schizophrenia and such.

A complicated dilemma

Unfortunately, there is no easy solution for someone who wants to have a baby at an earlier age but could not due to reasons related to high cost of living or career. Change could come, says Dr Kiren, only when there is a work culture that allows flexible hours, longer maternity leave, and better work-life balance.  

In the meantime, here are some options to consider if you are most likely to have children only after 30.

• Devise a personal life plan encompassing your career and lifelong goals – including having a family at an age you are comfortable with (ideally, before 40) – and use it as a guide to chart the course of your life.  
• Live a healthy lifestyle. Dr Kiren points out that daily balanced meals and regular exercise can boost fertility and help cut down the risk of medical conditions such as diabetes.
• Freeze until needed. Egg cells and sperm can be cryogenically frozen at a fertility centre when one is between 20 to 30 years old, to be used at an older age when one is ready to have a child. The cost can be high for some people, however.

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Dr Eeson Sinthamoney Consultant Obstetrician, Gynaecologist and Fertility Specialist

A sad fact of life is that biology is not feminist in nature. Women may have come a long way when it comes to attaining equal rights and becoming more independent, but human biology remains primordial. A woman’s peak fertility period is still in her late teens to her twenties – a time when she may not be ready to become a mother. By the time she is 35 (ironically the age when she may be ready to settle down), a woman’s chance of conceiving per month decreases by half. By age 45, natural fertility is reduced to only one percent.

Ah, but just imagine never having to worry about ‘baby panic’ or the biological clock counting down after hitting the big three-oh: being able to focus on establishing a career, working toward financial stability or emotional readiness. What’s more, if Mr Right is taking his time to show up, it’s no big deal – a lady can wait and not have to settle for less.

If that sounds great, well, these choices are now increasingly possible, thanks to advances in a procedure called egg freezing.

A woman may still have it all

Just like its name states, the procedure involves storing extracted eggs in a very cold environment. The very low temperature keeps the eggs in suspended animation, so that when they are thawed (even years down the road), they can be used to conceive a baby.

Fertility specialist Dr Eeson Sinthamoney explains that, traditionally, egg freezing is viewed as a method to preserve the fertility of women who are about to undergo chemotherapy or other forms of treatment that would affect their ability to produce healthy eggs in the future.

This is still true today, but egg freezing has evolved to become a solution for every woman who wishes to preserve her fertility.

The evolution is made possible because recent improvements made to egg-freezing technology have improved its chances of success.

Dr Eeson explains that, in the past, the freezing process could cause ice crystals to form in the eggs, damaging their structure and making them unusable when thawed.

This changed when a technique called vitrification was developed recently. The technique freezes the eggs very rapidly in order to prevent ice crystal formation. “The eggs can survive better because there is less damage,” Dr Eeson says. As a result, the success rate of egg freezing has improved tremendously. Dr Eeson describes this development as a ‘game-changer’ when it comes to preserving a woman’s fertility.

There’s still a catch

Unfortunately, there’s never a foolproof solution. Dr Eeson notes that there are many other factors determining the odds of success.

For example, the eggs that were harvested may already have some abnormalities in them that prevent a successful pregnancy. “The best time for egg freezing to take place is when the woman is in her late twenties to early thirties,” Dr Eeson says. Any later and it may be harder for the fertility specialist to extract enough healthy eggs for future use. This is because a woman is born with only a fixed number of eggs, which decreases as she grows older, and the eggs may also contain more abnormalities as time goes by.

Also, some eggs may be more susceptible to damage compared to others. Fertility specialists do not have a reliable way to ensure that all harvested and frozen eggs are normal or will be able to withstand the freezing process. Hence, there is no guarantee of a healthy pregnancy. 

What is the procedure like?

1. The first step is always a consultation, during which the fertility specialist will review the procedure thoroughly with the client. The specialist will also discuss the risks and address any concerns the client may have.
2. The fertility specialist will then conduct a pre-screening test, called the ovarian reserve testing. This is a simple blood test, usually taken on day three of the menstrual cycle, in which the blood sample is used to measure the levels of anti-Müllerian hormone present. The results will give the fertility specialist a good idea of the woman’s ovarian reserve, which is the number of eggs remaining in her ovaries.
3. Once all is in order, the client will receive fertility injections to stimulate the production of a large number of eggs.
4. When the time is right, the fertility specialist would retrieve the eggs while the woman is under deep sedation. This is done using a needle under the guidance of an ultrasound.
5. The eggs will then be frozen. Special chemicals called cryoprotectants may be used to prevent ice crystal formation.

The entire procedure would take about 10 to 14 days, and would not disrupt the woman’s normal routine much, says Dr Eeson.

For a reasonable annual fee, the fertility centre will store the eggs until they are needed.

Frequently asked questions

• How long can the eggs keep?
  They can keep for a long time, Dr Eeson says. In fact, the actual limiting issue is the age of the woman when she wants to be a mother. Most fertility specialists would prefer that the woman uses her frozen eggs before she turns 50, as pregnancy at age 50 and above has its share of potential complications.
   
• What happens if the frozen specimens end up missing or damaged?
  Consent forms will have to be signed before any procedure takes place to define what the fertility centre will and will not be held accountable for. Generally, the fertility centre will not be held accountable for any damages that are caused by what’s known as ‘acts of God’: natural disasters and other events that cannot be avoided by any amount of foresight or precautionary measures. If you suspect that the fertility centre has been negligent, you should consult a lawyer for further action.

What happens if the fertility centre goes out of business? What will happen to the frozen eggs?
To the best of Dr Eeson’s knowledge, there are currently no laws or regulations in Malaysia that set out the course of action required when a fertility centre closes shop. To date, no one in Malaysia has had to face such a situation.

Normally, an ethical fertility centre will make arrangements for another fertility centre to take custody of its frozen specimens. Perhaps the best course of action is to ask the fertility centre about this beforehand, as each centre may have its own contingency plan for such a situation.

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Travelling can be a pain – literally – when you’re having your period. Painful cramps and heavy bleeding definitely take the joy out of travelling and make your life miserable. So, it’s best to delay your period when you’re travelling.

How do we do that?

In the past, our mothers and grandmothers had to rely on home remedies like vinegar, tamarind and coriander seeds. These were unpredictable methods, as they were only effective at times.

Fast forward to the present, you can ask your doctor for birth control pills to delay your period. Below is a general overview of how to use these pills, but do check with your doctor or pharmacist before you commence. Different brands of birth control pills may come with different instructions.

The regular birth control pills come in packs of 28 pills each. Twenty-one of these pills are ‘active’ as they contain hormones that prevent the release of an egg from your ovary. (This is why you are unable to become pregnant when you take these pills).

The remaining 7 pills are ‘inactive’ and do not contain any hormones. Just skip these pills and take the active pills from the next pack instead.

With advice from your doctor, you may continue taking active pills for 6 weeks. Then, take the inactive pills for 3 or 4 days during week 7. You may even take the active pills for 9 weeks in the next cycle and for 12 weeks in the following cycle.

You must continue taking the pills as per your doctor’s instruction – preferably, at the same time everyday. Do quit smoking before you take birth control pills to prevent blood clots and breakthrough bleeding.

No more periods!

Just a minute! Although you don’t get your period when you take the active pills continuously, you may have some spotting. Do not be alarmed. This is normal in the first few months. Your body will adjust over time and the spotting will slowly reduce. If you have unexpected bleeding or other side effects like bloating and stomach pains, consult your doctor.

Other medication

Other than birth control pills, your doctor may also suggest you take norethisterone to delay your period. You need to take 3 norethisterone pills a day, starting 3 days before you get your period. So, you have to continue taking 3 pills a day for as long as you need to delay your period. You will get your period 2 to 3 days after you stop taking the pills.

You should be aware that norethisterone does not prevent pregnancy. You must also discuss with your doctor if this medication is suitable for you due to risk of blood clots, varying efficacy   and side effects.

References: 1. Mayo Clinic. Available at www.mayoclinic.org 2. Natural Fitness Tips. Available at www.nftips.com 3. NHS. Available at www.nhs.uk

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