Worried about Infertility? A Fertility Specialist Offers 5 Important Advice

WORDS DR AGILAN ARJUNAN

FEATURED EXPERT
DR AGILAN ARJUNAN
Consultant Obstetrician & Gynaecologist and Fertility Specialist
evelyn Fertility & Women Specialist Clinic
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Infertility, a condition affecting millions of couples worldwide, remains a complex and emotionally challenging issue today.

The inability to conceive a child naturally has profound implications for individuals and couples, leading to feelings of frustration, sadness, and even societal stigmatization.

In Malaysia, the fertility rate is continuously declining. The fertility rate in 2023 is 1.924 birth per woman, a 0.88% decline from 2022.

Even though the topic of infertility has been written and spoken widely for many years, I noticed that many couples still face dilemmas in their fertility journey. In this article, I will highlight 5 things that you need to know about infertility.

DO YOU BELIEVE THAT YOU SUFFER FROM INFERTILITY?

Before you start worrying that you have infertility, you need to carefully assess your trying-to-conceive or TTC circumstances.

In general, a couple would suspect they might have infertility after consistently trying to conceive for about a year or at least about 6 months if the female partner is more than 35 years of age. The key factor in this time frame is that the couple has been able to perform unprotected intercourse during her fertile window.

When a couple is suffering from painful vaginal intercourse (vaginismus) or erectile dysfunction, they are not necessarily infertile.

For these couples, pregnancy has not happened yet simply because there is no chance for the sperm and egg to meet for fertilization to occur.

In my experience, couples in these circumstances have a very good chance to get pregnant, provided that there are no other major infertility factors.

When the female partner has an irregular period cycle, especially those with polycystic ovarian syndrome (PCOS).

A woman will have an irregular period cycle when the ovulation of her egg is erratic or irregular.

For example, if she ovulates later than 2 weeks after the start of her period cycle, say about 3 weeks, her next period likely will start 5 weeks after the current period cycle.

Usually, period starts about 2 weeks after ovulation. However, if her ovulation does not follow any pattern at all, it becomes nearly impossible to know her ovulation date or commonly known as fertile window.

Thus, these couple are not actually facing infertility but merely could not identify their fertile window.

Once the woman’s ovulation is induced with acceptable regularity, her chances to get pregnant are pretty good.

However, if you are suffering from PCOS, please discuss your condition with a fertility specialist.

ARE YOU DOING THINGS CORRECTLY?

Once a couple has recognized that they are facing infertility, they can be overwhelmed with many suggestions on what to do. The internet is flooded with many such posts, some from a reliable source and some are not.

Your first step should be to choose a fertility clinic and start your basic fertility tests.

Attend the session together, not the female partner first and the male partner later.

Basic tests should include a semen analysis for the male partner, an egg reserve test, a pelvic ultrasound scan, and probably a fallopian tube patency test (hysterosalpingography) for the female partner.

An egg reserve test can be done via an ultrasound scan to count the antral follicles count. It can be supplemented with a blood test called anti-Mullerian hormone (AMH). It is important for two reasons:

  • It helps to determine the order of priority of treatment options. When the egg reserve is low, the couple might opt for an in-vitro fertilization (IVF) straight away or perhaps decide to do intra-uterine insemination (IUI) once or twice and continue with an IVF without much delay.
  • The egg reserve helps you and your fertility specialist to manage your fertility journey timeline more effectively. If your egg reserve is low even when you are younger, it is probably wise to start your IUI or IVF treatment earlier than later. However, if your egg reserve is good and you are young, your fertility doctor might try simpler options such as ovulation induction and timed sexual intercourse.
WILL HORMONE TESTS HELP YOU?

The answer to this question lies in your own fertility history.

Many traditional hormone tests such as follicle stimulating hormone (FSH), luteinizing hormone (LH), and ‘day 21’ serum progesterone blood tests are not helpful to many young women. In a healthy, young woman with a regular period cycle and normal egg reserve, I do expect these tests to be normal. It does not necessarily add any valuable information.

However, some hormone tests are needed based on your clinical history, such as tests for thyroid function, serum prolactin, and serum insulin levels.

Rarely, a genetic test is needed for couples with recurrent miscarriages or for a male partner with zero sperm count (azoospermia).

WHAT ABOUT THE MALE PARTNER?
The male partner is equally as important as the female partner.

Although only a semen test is required for the male partner, it does not mean he contributes little to the success of the infertility journey. After all, 50% of the embryo is contributed by his DNA!

In my opinion, the first fertility test that needs to be done is a semen analysis. This test may provide valuable information about his fertility status and provide the fertility specialist with enough time to improve male infertility while at the same time focusing on the female partner.

I will do a semen analysis for all male partners regardless of their medical history. This is because there are no symptoms of male infertility. Seemingly healthy and well-built men may have azoospermia.

If a men’s semen analysis is normal, does that mean everything is okay with him? The answer is no.

A semen analysis does not necessarily indicate the actual quality of his fertility health.

For example, a cigarette smoker’s semen analysis results may be normal, but his sperm DNA fragmentation test—which look for the amount of damage to the DNA in his sperm—may indicate that there is higher damage to the genetic material carried by his sperm cells. The higher the DNA damage, the higher the likelihood of infertility and even miscarriage rate.

Thus, men should remember to take care of their general health and stop or reduce activities that may impair their fertility because there is no one test that can accurately assess their fertility health.

IS IVF THE ONLY SOLUTION?
An overview of the IVF process. Click for a larger, clearer image.

Over 40 years of IVF treatment performed globally had led to over 8 million babies born worldwide. It is more common in countries like Denmark.

However, IVF is not the only option to get pregnant.

The first logical step is to try to identify the root cause of your infertility. Once this is done, take the necessary steps to make improvements which may help increase your chances of natural conception. However, in one-third of couples, there is no obvious cause of infertility found.

If there is no major or obvious infertility factor and the fertility tests are normal, the couple could start with an intra-uterine insemination (IUI) at least twice before considering an IVF treatment.

A word of caution: IUI could be the first treatment option for many couples, but the treatment choice should be tailored to your own fertility history, age factor, and financial capability.

IVF treatment could be the first option for couples suffering from bilateral blocked fallopian tubes or severe male factor infertility.

You should consider IVF as the first option if your egg reserve is low or if the female partner is older.

Ultimately, there is no clear and straightforward algorithm for determining the choice of fertility treatment.

In many instances, the choice is done based on financial burden rather than scientific factors.

CLOSING WORDS

I hope this article will help you at least do a preliminary assessment of your own fertility status and help you plan your fertility journey effectively to save time and money. The journey towards parenthood is not an easy path but definitely rewarding.

Planning to Have a ‘Dragon Baby’ in 2024? Here’s How to Start on a Right Note!

WORDS LIM TECK CHOON

FEATURED EXPERT
DR CHONG KUOH REN
Consultant Obstetrician & Gynaecologist and Fertility Specialist
TMC Fertility

To the Chinese, 2024 marks the auspicious Year of the Dragon. The dragon symbolizes courage, wisdom, and success—qualities that most couples would like to hope for their child. Hence, many would plan to have a ‘dragon baby’ come the next year!

“Planning for parenthood however, requires a lot more than just jumping into the process of baby-making,” says Dr Chong Kuoh Ren with a laugh.

As it is never too early to plan, he offers some tips for parents to have a healthy pregnancy and baby in 2024.

START WITH A PRE-PREGNANCY HEALTH CHECK

“A preconception checkup is a good idea, even if this isn’t your first pregnancy,” Dr Chong states.

Such a checkup typically involves a health review of the aspiring parents, with the doctor screening them for the presence of chronic conditions such as diabetes, hypertension, and more.

“According to the Malaysian Ministry of Health, these health screenings should be carried out at least 3 months before you’re planning to conceive,” he adds.

Dr Chong further adds that couples can further opt for genetic counselling if they are concerned about potentially passing on genetic disorders to their future offspring.

“Genes that cause genetic medical conditions such as thalassemia can be identified with a simple blood test. Having this knowledge can help you make better decisions about your pregnancy,” he elaborates.

GET YOUR BODY ‘BABY-READY’

Dr Chong mentions that there is no foolproof diet or exercise plan that will help one conceive.

“Nonetheless, a well-rounded diet and ideal body weight can have an impact on your pregnancy,” he says.

Such a diet should be balanced and filled with fruits, vegetables, lean proteins, and whole grains in order to provide essential nourishment for both mom and the future baby.

“Multivitamins are also a great way of providing this nourishment, especially folic acid,” he adds.

Folic acid aids in the formation of red blood cells and helps tissues grow. In pregnancy, folic acid is crucial in preventing neural tube defects, which refer to birth defects of the brain, spine, and spinal cord.

Dr Chong also highlights vitamin D, which is important for improving the quality of both egg and sperms. In pregnant women, vitamin D can prevent premature delivery.

Meanwhile, regular exercise will not only strengthen your body, but also help you manage your body weight sustainably. “You don’t have to do anything extreme, just focus on having some physical activity throughout the week. Simply doing 30 minutes of moderate exercise, such as brisk walking or gardening, can go a long way in helping you stay fit,” says Dr Chong.

DITCH UNHEALTHY HABITS

Don’t wait until one is pregnant to quit habits such as smoking and excessive drinking of alcohol.

“Smoking, especially, can adversely impact your chances of conceiving as it is linked to fertility issues in both men and women,” says Dr Chong. “Newer research has shown that secondhand smoke can increase foetal risk factors too.”

Excessive drinking is linked to lowered sperm counts and abnormal eggs.

TRACK THE MENSTRUAL CYCLE

This helps to identify the woman’s most fertile period — and in turn, help her to get pregnant faster.

Overview of the menstrual cycle. Click for a larger, clearer version.

“Start recording when your period starts and ends from month to month.” Dr Chong advises.

This will give one an idea of how long her cycles are.

While the average menstrual cycle is around 28 days, many doctors say the healthy range can be anywhere from 21 to 35 days.

“Cycle tracking can be trickier for women who have irregular periods in the first place,” Dr Chong concedes. “Broadly speaking, the general advice is to keep having sex every 2 to 3 days, so you don’t have to do all these calculations. I’d strongly advise consulting a specialist in these cases though, as irregular bleeding might be a symptom of more serious underlying issues.”

CAN’T CONCEIVE NATURALLY? DON’T DESPAIR, SEEK HELP

Dr Chong adds that couples should also not shy away from communicating with health professionals — and each other — if they continue to have problems conceiving.

Keep the Hope of Pregnancy Alive in Spite of Breast Cancer

WORDS LIM TECK CHOON

FEATURED EXPERT
DR CHRISTINA LAI NYE BING
Consultant Clinical Oncologist
Sunway Medical Centre
WHY IS BREAST CANCER SO PREVALENT AMONG YOUNGER WOMEN THESE DAYS?

Aside from unhealthy diet and exposure to cancer-causing chemicals or carcinogens in the environment, Dr Christina Lai Nye Bing shares that one possible factor is that women are choosing to marry and have children at a later age.

This somewhat paradoxical concept can be explained by the link between breast cancer and the female sex hormone oestrogen.

“Breast cancer is a hormone-related cancer, and high levels of oestrogen in the body increases the risk of breast cancer as it encourages cancer cells to grow by promoting cell division and reproduction,” Dr Christina explains. “Women in the previous generation who get married and have children earlier have a lower risk of breast cancer, as the oestrogen in their body decreases when they are pregnant and choose to breastfeed.”

FEATURED EXPERT
DR HOO MEI LIN
Consultant Gynaecologist and Fertility Specialist
Sunway Medical Centre
IS PREGNANCY IMPOSSIBLE AFTER CHEMOTHERAPY?

Given that chemotherapy plays a big part in the treatment regime of many women with breast cancer, this raises the concern of whether the dream of having a family in the future an impossible one for them.

The unfortunate truth is that chemotherapy affects a woman’s fertility, with a 40% to 80% chance of early menopause.

The ovaries stop producing eggs upon menopause, so with that, the dream dies… or does it?

While Dr Hoo Mei Lin admits that the damage to the ovaries due to chemotherapy is irreversible, there is still a glimmer of hope.

“Patients can plan ahead, as conservation methods such as embryo freezing, egg freezing, and ovarian tissue freezing are available to enable patients to fulfil their wish of having children,” she shares.

Egg and ovarian freezing are suitable options for women that do not have a partner prior to having to undergo chemotherapy.

KEEP THE DREAM ALIVE

Dr Hoo advises breast cancer patients to have an open mind about their future and even consider having children.

After all, breast cancer patients under the age of 45 have an 80% survival rate after treatment!

“With the rapid advances in medical technology today, there is hope for breast cancer patients and survivors to plan their future. Technologies like egg and embryo freezing gives them the opportunity to have children in the future,” she says.

When it comes to cancer diagnosis, the focus is often about treating it, making fertility an afterthought. However, with the advancement in medical technology, surviving a cancer diagnosis is becoming increasingly successful hence, it is important to speak to your doctor as there are ways to help preserve fertility.