Not abnormal, just different

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By Dr Liza Ling Ping,

Consultant Obstetrician & Gynaecologist and Fertility Specialist

Puberty is when many young girls notice changes in their body. This normally occurs between the ages of 10 to 14 years old. Although puberty is the natural life transition from childhood to adulthood, many young girls are uncomfortable discussing it openly.

If adult women are apprehensive consulting a gynaecologist for their ‘female’ problems, just imagine how young girls would feel when they face problems with puberty changes or gynaecological issues. Gynaecological problems in adolescents and children are different from that of adults, therefore the approach needs to be knowledgeable, skillful and tactful to ensure patients and parents feel safe and comfortable.

In younger girls between 12 months and 4 years old, labial adhesion and vulvovaginitis are the most common cause for parents to bring their child to see  a doctor. Labial adhesion and vulvovaginitis are common conditions and easily treated.

For adolescents, many girls seek help with heavy or painful periods. Some may experience irregular periods, especially in the first 1-2 years after menarche (first menstrual bleed). Girls should also seek help if they experience primary or secondary ammenorrhoea (absence of a period or if the period suddenly stops).

Sometimes parents are concerned when their child have delayed menses or delayed development of secondary sexual characteristics (eg. breasts and pubic hair development).  If by 14 years old, your daughter has not shown any secondary sexual development or has not had her period by 16, it could be a sign of developmental issue. Menstrual irregularities should be diagnosed and addressed early to prevent complications such as infertility, anaemia (lack of blood) and heamorrhage (excessive bleeding).

More complex conditions such as precocious puberty, abnormality of the genital tract- eg MRKH (absent uterus), OHVIRA syndrome, or disorders of sexual differentiation-eg androgen insensitivity syndrome (AIS), Sywer syndrome requires great knowledge and understanding in order to help both patients and families understand the conditions. Patient and parents also need to be reassured that their lives can be enjoyed and not let these conditions discourage them.

Sometimes, parents will request to stop the menses of their daughter completely, in cases of developmental delay or cerebral palsy. This can be done using reversible treatments such as Mirena IUCD or other medications, until they are able to cope with menses, thus giving both parents and the adolescent some peace of mind.

It is important to be open with your children so that they are comfortable talking about what is happening to their bodies and about any symptoms they may experience. Most of the conditions are treatable.

However, these symptoms are best addressed at an early stage, so as not to miss the opportunity for counselling and early intervention to help adolescents understand that they are not abnormal, just a little different.


Letting It Out

Letting It Out
By Choy Xue Min, Registered Counsellor



As a counsellor for patients undergoing fertility treatments, tears are a part and parcel of my work. Some are tears of joy; others are tears of frustration and sadness.

When a couple does not succeed in becoming pregnant after undergoing IVF, it is common for them to shed tears, especially the woman. After an anxiety-ridden 2-week wait, some women may feel overwhelmed with sadness when their pregnancy test comes out negative. This is when they tend to cry, in front of the doctor, nurses and counsellor.

It is normal to feel sad, as sadness is among the 6 universal feelings. The other universal feelings are anger, surprise, fear, disgust and happiness. When we are sad, we may feel the need to cry, but we tend to hold back our tears out of embarrassment or to avoid negative judgement or unnecessary attention.

Speaking to a counsellor allows you to let out your emotions without the fear of being labelled as weak or attention-seeking. Crying is not a sign of weakness. Physiologically, it helps to release pent-up emotions and eliminate stress hormones from your system, which is why you always feel better after a good bout of crying.

Tears shed are not of sadness alone. During our support group meetings for IVF couples, I sometimes see the husband or wife shedding tears of joy or appreciation for one another. The IVF journey is not an easy path, and it is always the love for each other that makes the journey less dreadful.

Husbands usually do not cry when receiving sad news about unsuccessful pregnancies, but they undoubtedly feel the pain just as much. However, they have to remain strong and steadfast in order to provide emotional support to their wives in those crucial moments.

Seeing their wives undergo the treatment with perseverance and determination often touches the husbands, creating a stronger bond between them in the process. Having a shared goal, in this instance of wanting a baby, is a strong connecting factor for a couple, thus it is important for both the husband and wife to be equally committed to treatment.

So if you are feeling tearful, don’t be afraid to let it flow. Keeping it cooped up will only aggravate your pain and sense of loneliness. Speak to a counsellor or join our support group to meet others. Just remember that you need not walk alone.


Choy Xue Min is a Registered Licensed Counsellor with a Master degree in Counselling Psychology from Universiti Kebangsaan Malaysia (UKM). Passionate about helping couples and families maintain harmonious relationships, she is a certified Trainer for the’ Journey to Intimacy’ workshop by Dr Huang Wei-Jen from Northwestern University, USA, as well as a Trainer for Mental Health Facilitator Program by the National Board for Certified Counselors, USA. The mother of two boys believes in the concept of mindfulness and encourages assertive communication in any form of relationship.


My Fertility Journey [Part 12]


He’s here!

It’s been a week since our little man arrived, and wow, nobody was joking about all the sleepless nights.

Labour was intense and terribly painful, and nothing compared to the bout of Braxton Hicks I got hit with earlier.  But a little support can go a long way and I’m so thankful Adam was by my side. I don’t know how I would have gotten through those ten excruciating hours without him, let alone not go into a panicking frenzy when my water broke while I was grocery shopping! But that’s a story for another day. Maybe when I’ve clocked in more than two hours of sleep a night. Though I doubt that will be anytime soon.

Hearing that little cry at the very end of all the pushing was the most relieving thing the both of us has ever heard.

We’re all in recovery mode now. Well, except Daniel. He seems to be just as excited about finally being in the world as his mommy and daddy are about him too.

The names of the characters in this article has been changed to protect the privacy of the original person

My Fertility Journey [Part 11]


What are the chances?

After checking in with you guys last, I went into labour – or at least I thought I was going into labour.

As it turned out, I had a case of Braxton Hicks. I’m a rookie, so obviously, I went into panic. I was in the middle of my morning walk when it happened. I rushed to see my doctor and he confirmed it: false labour.

I’m home now and resting, just as the doctor ordered.

Part 10 Here!

The names of the characters in this article has been changed to protect the privacy of the original person.

My Fertility Journey [Part 10]



Hi guys!

Time really does fly, huh? The last nine months have been a rollercoaster ride for me. So, I’m really sorry if you haven’t heard from me in awhile. There have been mostly good days, and some bad ones. But that’s what makes pregnancy such a life changing experience, isn’t it? You begin to learn things about yourself that you never knew before. You discover new strengths and make peace with old weaknesses. You come to terms that this is the beginning of a new version of the rest of your life.

I’ve enjoyed every moment of my pregnancy. Even the painful, nauseating ones. But I’m anxious and excited to finally meet the tiny person I’ve been carrying around inside me all this while. Though if there’s one other person who’s more excited than me, it’s Adam. He’s been on a thorough hunt for all things Ferrari for our little one. I can’t say I’m 100 per cent for our boy being a Formula 1 driver just yet. Maybe if he agrees to be in onesies till he’s eight? I’m kidding.

I have a feeling I’m going to miss this whole experience. From the cravings and not feeling guilty about giving into them to seeing my little tot grow inside of me, feeling him kick around and stretch. It’s like he’s almost hinting he cannot wait to come out. I guess it’s true what they say: enjoy every moment while it lasts.

Part 9 Here!
The names of the characters in this article has been changed to protect the privacy of the original person.

When will the stork arrive with our baby?

Stork-01By Dr. Liza Ling Ping, Consultant O&G and Fertility Specialist

 Marriage is a joyous occasion that unites a couple, with the well wishes from family and friends! The celebration may carry on for few days, and for the couple honeymoon begins. Weeks and months later, the good news like `Honey, I am pregnant!’ is one to celebrate again. However for some couples, it can be frustrating and depressive to find a pregnancy test positive elusive, despite trying very hard.

The chances of getting pregnant quickly does depend on age.  Women are most fertile between the ages of 20 and 24. Around the age of 30, fertility starts to decline for women and will decline more steeply from 35 years of age onwards. By age 40, the chance of getting pregnant is less than 5% per menstrual cycle.  For men, the decline in fertility is more gradual compared to women. Most men will remain fertile into their 50s and beyond. However, the number of men with sperm problems also increase with age.

The best chance of getting pregnant is regular intercourse. Over 80% of couples will conceive within the first year of regular intercourse and no contraception practice. Regular intercourse means making love every 2 to 3 days throughout your cycle. If by doing so, you are still not successful in conceiving after a year, it is recommended that you should seek help from your doctor. But if you are over 35 years old, it is important to ask for help sooner.

Infertility was once thought as just a women’s problem, it can also be attributed to men’s problem.  Infertility affects both men and women equally. There are many contributing factors to infertility and 25% of infertile couples may have more than one contributing factors. Approximately 40% of infertile couples the sole cause arises from the male partner.

The common causes of female infertility are ovulation problems and blocked fallopian tubes usually due to infections. Other causes such as endometriosis, uterine fibroids and endometrial polyps may also affect female fertility. Low sperm count, less progressive sperm movements and high abnormal sperm numbers contributes to male infertility. Smoking and overweight are other contributing factors affecting both male and female fertility.

There are many fertility treatment options available and it is best to discuss with your doctor the most suitable and favourable outcome for you. However, there are some couple who will need to be referred to center specializing in assisted reproductive techniques to help them conceive. For ovulation problems, fertility drugs such as clomiphene citrate or gonadotrophin injections can help induce and trigger release of more eggs per menstrual cycle. Intrauterine insemination (IUI) can be offered with fertility drugs to increase the chance of pregnancy by injecting your partner’s sperm or donor’s sperm into your uterus through a thin flexible tube. IUI is feasible only in situation where at least one of the fallopian tubes is patent.

If a woman has both tubes blocked or diseased (e.g: dilated with fluid-hydrosalphinx) or a man has very poor sperm quality, invitro-fertilization (IVF) or intracytoplamic sperm injection (ICSI) are more suitable treatment options and for many couples, gives them the best chance of having a baby.

What is IVF? IVF involves fertilizing egg/eggs outside the body, using your own eggs and sperms, or using donated eggs or sperms. If there is any concern on sperm quality, ICSI is carried out for fertilization process, where one sperm is injected into one egg. The procedures for IVF are quite complicated and are performed by highly trained personnel and fertility specialists.

To make it simple, the following are IVF processes to getting pregnant.

Step 1.
Ovulation induction.

In this step, you will be given fertility hormones known as gonadotrophin that will increase the number of eggs produced. Your fertility specialist will monitor your follicle growth progress through series of vaginal ultrasound scans and some blood test.

Step 2.
Egg retrieval.

Once follicles have achieved a certain size, the next step is to collect your eggs using ultrasound guidance while you are sedated. A thin needle is attached to the ultrasound probe and inserted through the upper vagina to collect the eggs from follicles on each ovary.

For men, you will be asked to provide a sperm sample after the retrieval of your partner’s eggs.

Step 3.

The following step is fertilizing the egg, by mixing the most active sperms with the eggs and cultured in an incubator. These are performed in the laboratory. The eggs that are successfully fertilized will now form embryos. The embryologist will monitor the development of the embryos and the best will be chosen for transfer. Any surplus usable embryos can be frozen for future use.

Step 4.
Embryo transfer.

This is the final step using ultrasound guidance performed via abdomen. This is normally a pain-free procedure which does not require sedation. A speculum is inserted into the vagina, similar to having a cervical smear taken, to visualize the cervix. The embryo(s) are transferred through a small special tube which is passed through the cervix into the uterine cavity.

Two weeks later, a blood test will be carried out to see if you are pregnant.

Many couples face problem in conceiving and are too shy or ashamed to seek help because of the stigma that is attached as being barren. With the current advancement in medical knowledge and technology, there are many treatment options available to help you conceive. Do consult your doctor early if you have problem conceiving.