Pregnancy is no longer just a dream

27 May 2020

Infertility is a constant anguish in the heart of couples who want to have their own child. In fact, maybe they are not incapable of having children, they may just need assistance and treatment to conceive. With timely advice from doctors, understanding of the cause and customised Assisted Reproductive Technology (ART) treatment, getting pregnant is no longer just a dream.

Infertility is the failure of a couple to conceive after one year of regular sexual activity without contraception. One in seven couples who have regular sex for a year without contraception experience delay in conception noted Dr Farah Leong Rahman, Consultant Obstetrician & Gynaecology and Fertility Specialist, Sunway Medical Centre.

Infertility can be divided into two types – primary and secondary infertility. Primary infertility is in couples who have never had children, and secondary infertility is in couples who have conceived, including miscarriages or ectopic pregnancies, and then are unable to conceive again.

Dr Farah reveals that infertility is not just a woman’s problem. There are many causes of infertility, which can be male or female factors, or caused by unknown factors. Unknown factors of infertility with the absence of health problems in both partners accounts for 25% of cases. Therefore, men and women should consult a doctor and have their fertility assessed as soon as possible if they find it difficult to conceive for a long time.

So, when should couples ask for help from a doctor? If a couple has been trying to conceive for at least a year with no results, it is recommended to seek medical attention, Dr Farah said.

Women over the age of 35 who have been trying to conceive for the past six months with no results should consult a doctor as soon as possible, as the chance of a woman getting pregnant after the age of 30 is gradually decreasing every year.  

“You should also seek medical attention as early as possible if you are having problems with sex or ejaculation, have painful periods or heavy or light menstruation, or have had any surgery related to the female reproductive system such as ovarian surgery. Maybe you don’t have any infertility issues, but it’s best to consult a doctor to make sure everything is okay,” Dr Farah said.

The main cause of female infertility is ovulation problems. If you can’t ovulate, there are no eggs to fertilize. A woman who is unable to ovulate normally will usually experience irregular or no menstrual flow.

Besides this, female infertility can be caused by pelvic inflammation, endometriosis or blocked fallopian tubes due to surgery to treat ectopic pregnancy, physiology problems in the uterus, and fibroids.

Age, stress, poor eating habits, intense physical training, being overweight or underweight, smoking, drinking, contracting sexual transmitted diseases and hormonal changes due to health problems are also factors that increase the risk of female infertility.

Meanwhile, the most common cause of male infertility the production of sperm. In this case, the number of sperm is too low or not able to produce sperm at all, or the sperm is unable to move normally or is deformed, resulting in the sperm not being able to effectively reach the egg and fertilize it.  

Men’s overall health and lifestyle are among the factors that increase the risk of infertility such as alcohol consumption, drug use, smoking, age, health problems, exposure to environmental toxins such as pesticides and lead, and undergoing radiation therapy and chemotherapy.

Dr Farah disclosed that age is indeed an important factor that affects fertility, and that is because women are born with a fixed number of eggs in their ovaries, and those eggs gradually decrease with age.

Most women are born with about two million eggs, which dwindles to about 400,000 by puberty, and drops further by age 30, and even more after age 35. The quality of the eggs also deteriorates with age. Therefore, older women who want to have a baby, it is advisable to consult a doctor as early as possible so that the problem can be identified and be treated accordingly.

Dr Farah revealed three factors that contribute to the success of a pregnancy. Besides the need to have good quality sperm and eggs, it is also important that the female reproductive system is normal.

When an infertile couple comes to consult a doctor, the doctor can generally find out the cause of the couple’s infertility by conducting a complete fertility assessment. If there are no obvious problems, further tests will be required.

A sperm test will be conducted for men, which is designed to check for problems with the sperm such as low numbers or if the sperm is not functioning normally. For women, it must be determined if they ovulate regularly every month. The doctor will perform ultrasound scans on them to ensure that their ovaries, uterus and fallopian tubes are in good condition. Ultrasound testing can detect the presence of fibroids, polycystic ovaries or cysts in the reproductive system.

Another test is a tubal patency test, which ensures that the fallopian tubes are not blocked so that the binding of the egg or sperm is not obstructed.

Women who are concerned about not having enough eggs, a blood test called Anti-Müllerian Hormone can be done. The test gives an idea of the amount of egg reserves.

Dr Farah reminds that adopting a healthy lifestyle can improve the chances of pregnancy. It is important to maintain healthy eating habits, exercise, quit smoking and drinking, and maintaining an ideal weight. Of course, it is also important to have sex three times a week.

After testing and considering potential problems, the doctor will develop a tailored treatment for the patient. The doctor will consider factors such as the partner's age, especially the woman's age, potential problems, previous treatments, and the couple’s readiness to begin treatment.

Dr Farah emphasises that each couple's treatment is different and that the doctor will recommend the treatment that is most appropriate for them, based on their needs and test results.

There are different treatments for infertility. Essentially, all treatments are designed to optimise the “meeting” and bonding of sperm and egg for successful conception.  

“Infertility can be treated in a wide range of ways, including enhancing the chances of natural conception, or assisted by a range of assisted reproductive technologies. The easy way to do this is to have the woman take a pill to ensure the egg grows and then have an ultrasound scan to track the growth of the egg and suggest the best time to have sex to increase the chances of natural conception,” said Dr Hoo Mei Lin, Consultant Obstetrician & Gynaecology and Fertility Specialist, Sunway Medical Centre.

Additionally, intrauterine insemination (IUI) assisted reproduction is a treatment that allows doctors to place a man's sperm into a woman's uterus at the right time to accelerate fertilization, while in vitro fertilization (IVF) involves collecting sperm and eggs, fertilizing them in a laboratory, and then transferring the embryos into the womb.

With the advancement of technology, IVF has a higher success rate and relatively fewer side effects than before.

“Current IVF technology has better freezing technology that helps minimise the chances of potentially damaging frozen embryos. Whether you transplant fresh or frozen embryos, the chances of getting pregnant are the same. Some IVF centres overseas even only transfer frozen embryos because this method is safer for the mother,” Dr Hoo said.

Furthermore, embryoscope today allows doctors to monitor the growth patterns of embryos without disturbing them.

“In the past, we had to remove embryos from the incubator at specific times for observation. This exposes the growing embryos to potentially damaging situations such as temperature fluctuations. Now, by observing how embryos grow, we are able to choose the best embryo to insert into the womb and improve the chances of pregnancy,” Dr Hoo said.

Preimplantation Genetic Testing (PGT) also allows for prior genetic testing of the embryos.

The latest drug regimens are able to minimise the side effects of drugs. Ovarian Hyperstimulation Syndrome (OHSS) is a major complication in IVF. This condition is caused by simultaneous growth of multiple follicles during ovulation, resulting in an increased estrogen level and an imbalance.

In the past, many women have been hospitalised and even in ICU for this reason. But with the introduction of latest drug treatment programmes, this problem has been reduced significantly. Dr Hoo emphasised that the success rate of IVF ultimately depends on the person receiving the treatment.

“This therapy is designed to optimise the ability to get pregnant. In other words, the doctor is ‘fighting’ with your ‘physique’. The success rate has to do with age,” Dr Hoo said.

The success rate of IVF treatment for women under the age of 35 is about 60%, and the rate drops to about 20% above the age of 40. If a woman has reached menopause, this treatment is no longer viable. A man’s age is also important. As he gets older, his ability to get his wife pregnant decreases. In fertility treatment, 60% of the problem lies with the man.

Preimplantation Genetic Testing (PGT) is a test performed in conjunction with IVF. Dr Hoo noted that PGT is a method used to check the embryonic chromosomes.

“Typically, after cultivating the embryo for five days, the embryo will have about 250 to 300 cells and we will extract about 10 cells for genetic testing,” she said.

Embryos implanted in the mother’s womb using normal chromosomes not only increases the chances of pregnancy but also reduces the chances of miscarriage. This technique screens genetically normal embryos before they are implanted into the uterus.

For women who have repeatedly failed to conceive after an embryo transfer, their pregnancy rate through IVF can increase by another 20% and especially for women in their 30s and 40s, it can be increased to 50% to 70% which is close to the pregnancy rate of young women.

This method removes embryos that carry genes of serious genetic diseases and selects normal embryos for transfer, ensuring that the child is free of genetic diseases such as thalassemia.

“About 30% of Asians carry the gene, and if both partners carry it, the affected child will not survive. Pregnant women are also at risk of stillbirth or repeated miscarriages. This can be avoided with this test,” Dr Hoo said.

If infertility is in the sperm, it can be treated with intracytoplasmic morphologically selected sperm injection (IMSI) and intracytoplasmic sperm injection (ICSI) assisted reproductive technologies. These methods are used to select the best sperm to be injected into the egg, prompting it to fertilize and form a baby.

The difference between these two treatment options is that IMSI is a digital amplification of the sperm pattern for the purpose of selecting the best quality sperm. This helps to increase the ability to make embryos, as well as a higher pregnancy rate.

So, which assisted reproductive technology is most recommended and has the highest rate? Dr Hoo said the treatment plan recommended by the doctor is tailored to individual problems and the needs of the couple. Therefore, there is no such thing as the best option; only the most suitable one.

Tips for Pregnancy Preparation

If you have been trying to conceive but always fail, here are some tips from Dr Hoo Mei Lin to prepare yourselves for pregnancy:

• Visit your doctor to ensure you are fit and healthy
• If you have any health problems, do not stop taking your regular medication without consulting your doctor because you need to be healthy to have a healthy baby
• Make sure that your vaccinations are up to date. Check yourself for Rubella and Hepatitis B. Doctors also recommend that you get a flu shot once a year. If you get Rubella while pregnant, it will likely affect the baby’s health, leading to deafness, blindness and developmental delays. Influenza H1N1 during pregnancy, can also be fatal.
• Start taking folic acid. This help with the development of the baby.
• Quit smoking and avoid alcohol
• Don’t stress. Have regular sex instead of trying to time your sexual activity with your ovulation periods. Have sex 10 days after you start your period, and every three days for two weeks.
• Reduce caffeine intake. Limit to two cups a day.
• If you are under 35 years old and have no other problems, see a fertility doctor if you are not pregnant within a year.
• Those 35 years old and older who experience menstrual pain or heavy menstrual bleeding, who have had surgery (especially ovarian surgery) or have problems with their sex life, should seek medical attention especially if you have been trying for about six months.

Source: Sin Chew Daily

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