By 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.
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.
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.
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.
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.
By Dr. Navdeep Singh Pannu, Consultant O&G and Fertility Specialist.
Every expectant parent wonders if their babies are normal and healthy. The truth is that all women have a risk of a pregnancy with abnormal chromosomes, particularly if the woman is above 35 years old.
In the past, pregnant women above 35 may be tested with chorionic villus sampling (CVS) or amniocentesis for chromosome abnormalities, such as Down ’s syndrome. However, they will have to make the painful decision to either keep or stop the pregnancy when the babies are found to be abnormal.
Pre-implantation genetic diagnosis (PGD), also known as Pre-implantation Genetic Screening (PGS) eliminates the dilemma of deciding on pregnancy termination in the event the tested fetus turns out to be abnormal, as only chromosomally normal embryos are replaced into the womb. PGD is highly recommended for women above 35, patients with inherent genetic diseases, recurrent miscarriages and IVF failures, or sexually-related diseases.
PGD is done in conjunction with an IVF cycle. With PGD, one or two cells are taken from the embryo on Day 3 or 5, and assessed for chromosomal defects that may lead to miscarriages or genetic disorders. This technique ensures only embryos that are healthy will be selected for transfer into the uterus for implantation, improving the likelihood of a successful pregnancy and the birth of a normal baby.
PGD – FISH
Fluorescent In-Situ Hybridization (FISH) is the first technique used to detect numerical chromosomal abnormalities such as Down ’s syndrome, Patau Syndrome or Edward’s Syndrome. It can also be used to detect abnormalities in the sex chromosomes (X & Y) such as Turner ’s syndrome, Klinefelter’s Syndrome and Super Female XXX. Newer tests are now available as this test has its limitations.
PGD – PCR
A technique known as Polymerase Chain Reaction (PCR) is usually performed to detect genetic disorders such as Alpha-thalassaemia, Beta-thalassaemia or Haemophilia. The PCR technique involves a highly sensitive analysis of the embryo’s DNA to check for abnormalities.
PGD – Micro-array CGH (24-Chromosome Aneuploidy Screening)
This screening is usually recommended for women, usually above 35 of age, with recurrent miscarriages. Most fertilty centres are only able to screen 5-12 chromosomes. TMC Fertility Centre is the first centre in Asia to offer the Microarray CGH (aCGH) PGD, which enables us to screen all 24 chromosomes (including the sex chromosomes) at the same time.
This helps to confirm that the embryo has the correct number of chromosomes before transferring to the uterus, leading to a successful pregnancy and increasing the likelihood for a couple to have a normal and healthy baby. This is particularly helpful in women in higher age groups, as abnormal embryos increase with the patients’ age. The success rates of a 40 year-old woman, is almost similar to a 28 year old-woman if chromosomally normal embryos are replaced after PGD testing.
The Next Generation Sequencing (NGS) PGD is the most advanced pre-implantation screening to date, with each sample given an additional molecular code to eliminate the possibility of errors. The DNA collected from the embryo is tested directly, without the use of lights or markers as with earlier PGD screenings.
The PGD-NGS tests all 24 chromosomes with a single cell from the embryo, and contains information that indicates not just the condition of the embryo but the potential health risks of the child decades down the line. NGS is expected to change the world of genetics in time to come, offering uncannily accurate predictions of a person’s health conditions even before birth, fully embodying its name as a screening of the ‘next generation’.
Infertility especially for the childless couple can have a significant social, marital, physical and emotional impact. You may have experienced multiple disappointments in your attempts to conceive. You may have taken a courageous step to seek medical assessment and treatment for your fertility condition. You are a, or rather you were a healthy individual but now you feel like a patient because you have to be in and out of the hospital so often. But you endure this journey because the fertility treatment offers you and your spouse the hope of fulfilling the desired family unit. Nevertheless, the use of assisted reproductive technology such as IVF can be psychologically taxing. Anxiety and being depressive are the two common emotional disturbance that often affect the women. The most stressful period during the IVF treatment will be during the waiting period before the pregnancy test, the waiting period on the outcome of fertilization and during the egg retrieval time.
We know this whole experience can be overwhelming. Thus it is important that you manage the impact whether is emotional, marital or physical constructively. This is to ensure that you maintain a general wellness and functionality despite the stress of pursuing parenthood.
TMC Fertility Centre offers professional counselling services. We encourage you to take advantage of the available resources to address your emotional needs during this time of uncertainties.
Counselling gives you a non-judgemental and supportive space to talk through your experiences, concerns & frustrations. Counselling provides you the person-centered environment which allow you to learn more about yourself and your relationship with others at your own comfortable pace. Along the counselling process, you may develop new ways of looking at your treatment and at any challenges faced. Depending on your circumstances, counselling helps you to gain insights and clarification, in which you are empowered to make your own decision without any values and belief imposed on you by well-intentioned family members and friends. Counselling helps you to manage your stress, anxiousness and depressive mode via psychoeducation and various body-mind techniques. It improves your communication with your spouse and family. Ultimately, counselling aims to lift your confidence to cope effectively with either your own resources or newly acquired tool.
Having say that, seeing a counsellor can be a big step. It is normal to feel nervous or a bit embarrassed. But seeing a counsellor doesn’t mean you are weak or insane because your emotional health is equally important as your physical health. In fact, your physical health and emotional health is interrelated. Thus looking after your emotional health will contribute to better physical health and vice versa.
Counselling is for people of all ages and background. Counselling can be initiated at any stage of patient’s journey. But to benefit most from the counselling relationship, you need to participate actively by being open and honest with the counsellor, by attending sessions on time, and by making efforts in behavioural changes, when applicable.
How to make appointment with the counsellor?
Please call our general line +603 6287 1000 or send an email to firstname.lastname@example.org to make appointment or seek further clarification regarding our counselling services.
The types of Counselling Services include:
- Pre-IVF counselling session (Complimentary) – (Available 16th May onwards)
- IVF Psychological Support Programme for Couple (3 sessions) – (Available 16th May onwards)
- Counselling for third party reproduction
- Therapeutic Counselling for individual and couple on various issues such as:
• Intimate relationship/ conflict
•Grief and loss: IVF faillures, miscarriage, still birth etc
• Emotional distress: anxiety, depression etc
• Intrapersonal matters such as low self-esteem
For the uninitiated the whole fertility process can be a hard pill to swallow, after you have seen your Fertility Specialist, you go home and decide to do some research on the internet. Just to be bombarded by shorts and acronyms like HCG, PCOS, ENDO, and of course TTC. Below is a list of commonly used acronyms in fertility.
2 Week Wait. It’s that time between post IVF transfer and taking a beta test to prove pregnancy. It’s a nervous time, hoping the transfer is successful.
Aunt Flo, After Flo, Period, or Menstrual Cycle.
Assisted Hatching. It’s an IVF term, where an embryologist will create a small hole in the embryo shell before transfer. It’s thought that embryos who have assistance hatching are more likely to implant.
Artificial/Assisted Insemination. Where semen is injected into the vagina or uterus.
Assisted Reproductive Technology. Essentially any conception assistance that isn’t sex. Examples would be IVF or IUI.
Anti-Mullerian Hormone. The hormone that predicts ovarian reserve (that is, the number of eggs you have left in your ovaries).
That magic something that ensures the whole pregnancy process goes as planned.
Basal Body Temperature. Helpful for temperature charting to predict ovulation.
Birth Control Pills.
Baby Dance, otherwise known as sex.
The beta is a pregnancy test taken after the 2WW. It measures the levels of the hormone beta-hCG via a blood test, as it is the first measurable sign of implantation.
Big Fat Negative. When you take a pregnancy test and you’re not pregnant. :(
Big Fat Positive. What we’re all looking for – when you take a pregnancy test and it is positive. High five!
Bloodwork. Getting bloods drawn is a fairly frequent occurrence if you’re working with assisted reproduction.
Cycle Buddy. When you have a friend with a similar cycle to you, and you both run through similar IVF/IUI journeys at the time.
Cycle Day. The day of your cycle. The first day of your period is CD1.
Cervical Mucus. Your body produces a mucus around the cervix. It’s typically used to prevent any bacteria moving between the vagina to the uterus. When you’re ovulating estrogen alters the mucus to become sperm friendly, which allows the sperm to move quickly through the uterus to the fallopian tubes.
Dihydroepiandrosterone is a hormone that can be taken as a supplement. It’s naturally occurring in most women and converts into androgens (like testosterone). It’s used to improve outcomes for women experiencing Diminished Ovarian Reserve.
Diminished Ovarian Reserve. A condition where a woman will have a low number of eggs in her ovaries, or impaired development of existing eggs. It’s thought to be one of the main causes of infertility.
Days Post-Egg Retrieval.
Days Post-Transfer. Often it will have a number in front – 5DPT would be 5 days post transfer.
Days Post 3-Day Transfer. This refers to an embryo that was transferred on Day 3 after egg retrieval.
Similar to the above, except a 5 Day old blastocyst was transferred.
Estradiol. Estradiol is the primary female sex hormone. Most importantly, as your follicles grow it triggers hypothalamic-pituitary events that lead to a luteinizing hormone surge which induces ovulation. It will be one of the hormones measured frequently during an IVF round.
Endometriosis is a common condition where tissue that behaves like the lining of the womb is found outside the womb.
Egg Retrieval. Where, after being stimulated with hormones during an IVF cycle, the eggs are retrieved from the ovaries.
Embryo Transfer. Where, after being fertilised and allowed to cleave during an IVF cycle, the embryo is transferred to the uterus.
Egg White Cervical Mucus. The kind of cervical mucus where, around ovulation, it takes on a consistency like egg whites.
Frozen Embryo Transfer. Where a frozen embryo is thawed and transferred to the uterus.
Fertility Friend is an app for tracking fertility.
Is a frozen embryo.
Follicle-Stimulating Hormone promotes the formation of eggs in an ovary. It is used as a guide to indicate the quality of eggs on CD3, which can be used to predicate whether an IVF round should go ahead or not.
Gonadotropin-Releasing Hormone is also known as a luteinizing hormone which is responsible for the release of FSH and LH from the anterior pituitary gland.
The Glucose Tolerance Test is a tool used to diagnose high blood glucose during pregnancy, otherwise known as gestational diabetes.
Human Chorionic Gonadotropin is a hormone produced in a placenta during pregnancy. It tells the ovary to continue producing estrogen and progesterone which help the lining of your uterus stay intact.
Human Menopausal Gonadotropin (also known as Menotropin) is hormonally active medication used to treat infertility. It contains equal amounts of LH and FSH and is used to help stimulate ovulation.
Home Pregnancy Test.
Hysteroscopy is a procedure used to examine a womb for fibroids, polyps or adhesions by inserting a narrow camera through the cervix.
Hysterosalpingogram is a procedure to ensure the fallopian tubes are clear. It’s done by injecting a dye into the cervical canal and then taking an xray as the dye moves around the uterus into the fallopian tubes.
Intracervical Insemination is an artificial insemination procedure, which involves placing sperm directly into the reproductive tract to improve the chances of pregnancy.
Intra-cytoplamic Sperm Injection. This is where a single sperm is inserted into an egg to aid fertilisation.
Intra-uterine Insemination is a form of assisted conception. Sperm is placed in the uterus near the egg at the time of ovulation.
In Vitro Fertilization. This is a form of assisted conception, where an egg is removed from an ovary and fertilised with sperm in a laboratory. The embryo is then transferred to the womb to grow and develop.
Luteinizing Hormone is released to encourage your ovary to ovulate.
Luteal-Phase is the second half of a menstrual cycle that occurs after ovulation. It’s the phase where fertilisation and implantation are likely to happen.
Male Factor Infertility.
Ovarian Hyperstimulation Syndrome is an occasional side effect of IVF. Your ovaries overreact to the stimulants and produce too many follicles.
Ovulation Predictor Kit/Ovulation Predictor Test. Both work by measuring the amount of luteinzing hormone (LH) in your urine. A surge of LH is an indicator of ovulation.
Over the Counter. Typically refers to medication.
Polycistic Ovarian Syndrome/Polycistic Ovarian Disease is a hormone imbalance which interferes with periods and other fertility aspects. It’s thought to be the leading cause of infertility.
Pre-implantation Genetic Diagnosis/Pre-implantation Genetic Screening. This is where an embryo that has grown to Day 5, blastocyst level is sampled and the cells are tested for chromosomal abnormalities.
Pee On A Stick. Typically associated with pregnancy tests or OPKs.
Semen Analysis. A sample is taken and a few different factors are checked to rule out male infertility.
Thyroid Stimulating Hormone is a hormone secreted by the pituitary gland. It plays a significant role in reproduction and pregnancy. There has shown to be an increase in miscarriages when the TSH levels are off the scale.
Trying To Conceive.
Know more acronyms that we don’t? Comment below and we will add it to the list!
Infertility affects men and women equally. Here’s 7-ways to increase Male Fertility.
Relaxation exercises and meditation may help boost male fertility by reducing stress.
2. Nutrition Pointers:
Increased intake of fresh fruits and vegetables rich in nutrients is an important part of the fertility boosting routine.
3. Control Chemical Exposures:
Control/limit food/products that contains high amount of chemicals, pesticides, insecticides, and synthetic chemicals.
4. Kick The Habit:
The only solution is to quit bad habits like drinking and smoking. Electronic Cigarettes counts as smoking as well.
5. Herb Power:
Certain herbs possess the power to improve fertility naturally. Consult your Fertility Specialist and TCM Practitioner for more details.
6. Exercise Regularly
Exercise can work wonders in boosting libido and sperm production.
7. Spice It Up!
Regular sex is also an essential part of boosting fertility in men.
British actress ALICE EVANS reveals her struggle to have a baby at 38 – and how her family is now the real life Fantastic Four
Alice Evans and Welsh star Ioan Gruffudd were living the Hollywood dream.
The two British actors met on the set of the Disney hit 102 Dalmatians, soon became a couple and married. Ioan landed starring roles in Fantastic Four and his own TV series, Forever, while Alice worked constantly in hit shows such as Lost and The Vampire Diaries.
Yet behind the success was a secret heartache as they fought – and failed – to start the family they both longed for.
Today, in a brave and extraordinarily candid account, Alice, now 44, writes about the highs and lows of their desperate journey through IVF – and issues a warning to the millions of young women like her who might be tempted to leave it late to start a family…
I ALWAYS knew I would have children. And by that I don’t mean I always hoped or dreamed. No, I knew. Because having children – or so my 13-year-old self thought – was inevitable.
It would happen, on schedule, after I was done chasing all the important things I wanted in life: to become an actress, learn foreign languages, live in France, find a man who loved me as much as I loved him, and, obviously, meet Shakin’ Stevens.
It was optimistic of me to want all those things, as I grew up in a very ordinary family in an ordinary house in Bristol and went to a pretty rough comprehensive where learning how to avoid being beaten up was a skill that served you a lot better than planning a career.
But I had it all planned out. By the age of 50, I would kick back and watch my large brood of kids running around – so I’d better make sure I had the money for that before I did something stupid like have unprotected sex.
How very wrong I was. The fact is that Ioan and I left it late – very late – to start our family. And the worst thing is, it was deliberate.
Looking back I ask myself how could we have been so complacent about the simple facts of life. But that’s what they say: When you make plans, God laughs.
So we found ourselves playing a traumatic and expensive IVF lottery game that we were lucky to win.
And if just one person reading this makes a decision to start trying for a baby at 33 instead of 36, or if a single woman makes enquiries about the best way to freeze her eggs, then sharing my story will have been worth it.
Until I started trying for a baby at 37 life had been going according to plan. I managed the acting and the travel parts of my goals, knocking on doors until they finally opened, and slowly climbed the career ladder.
I also met my decent man along the way –Ioan – who did, unbelievably, turn out to love me as much as I loved him.
As soon as we’d established that we both felt the same way, we got straight down to the exciting process of making the hordes of babies we both knew we wanted.
Actually I just made that bit up. Of course we didn’t.
Acting jobs are like buses – none come and then three arrive all at the same time, usually shooting on opposite sides of the world.
Finding the time to chat on the phone becomes complicated, let alone finding time to… well, you know what I mean.
There’s never a right time to breathe that long sigh of relief that says: ‘I think I’m ready now.’
We were delusional about a woman’s dwindling chances of getting pregnant after 35. That’s not anti-feminist, by the way – it’s just the plain truth.
The whole of my 38th year was spent reading studies about fertility, taking my morning temperature, planning ovulation graphs, standing on my head after sex, and fastidiously avoiding tea, coffee, alcohol, pineapple pizza and anything else I’d read about that might possibly prevent pregnancy.
Each month I excitedly ran to the bathroom at least five days before my period was due with a white stick in hand, and waited, my heart beating practically out of my chest for that second little red line to come up. And each month it didn’t.
I went to acupuncturists who told me they could ‘revitalise my eggs’ (b******t), a dietician who told me to cut out dairy (even worse – one of the best long-term studies ever done shows drinking one to two glasses of whole milk a day correlates with higher pregnancy rates).
Well-meaning but ill-informed friends swore I just needed to ‘relax’, which, when you’re trying to quell a rising panic, is kind of ridiculous.
Months went by but it seemed like years. I didn’t have a clue what to do or where to turn.
Mum had passed away unexpectedly a few years earlier and Dad had a new wife and new kids. My best friends had all done the sensible thing and had their children in their early 30s.
Then one day I found myself reading The Stork Club, Imogen Edwards-Jones’ brilliant account of her struggles with infertility.
Next thing I knew I was on the phone to her, sobbing uncontrollably; she understood and told me: ‘Alice, go see a doctor. A real doctor.’
Six days later I found myself lying on a padded table with a large piece of tracing paper over my naked bottom half, while a doctor slid a probe the size of a small rolling pin into my nether regions to look at my ovaries.
The blood tests had already revealed that my healthy eggs were few and far between, but this test – the antral follicle count – was the clincher.
Fifteen follicles (indicating the possibility of 15 eggs) was more or less what the doctor was expecting for somebody of my age.
Ten follicles would be about the lowest he’d need to do an IVF cycle with a decent chance of success.
We stared a big screen on the wall that showed my magnified uterus and watched open-mouthed as he started counting the black holes that represented my follicles. I had eight.
It became a journey of decisions. A round of IVF would cost upwards of £7,000 and we had about a 20 per cent chance of success.
I’d also mistakenly bought into the myth that the world is full of orphanages with lots of unwanted babies desperate for childless couples.
In fact, the waiting list to adopt a baby from China turned out to be upwards of five years. The average expense is about £35,000.
Adoption in the US is probably worse, full of hidden fees, false promises, lawyers and shady agencies, and the simple fact is this: there are many more desperate childless couples than there are babies who need them.
Adopting was more expensive and even less likely to succeed than IVF. So there we were – £7,000 and a 20 per cent chance of winning. Take it or leave it. We took it. And we won.
Seeing a faint red line one Saturday morning after I’d decided in my head the IVF cycle had clearly not worked was one of the most breathtaking moments of my entire life.
Ioan didn’t believe it. He said I’d been staring at it for so long that I was seeing things that weren’t there.
The next day there was a slightly darker line (we’re still talking shades of snow here) and the next one looked like it might be pink… until finally there it was. A second red line, staring back at me, unmistakeable.
Extremely high blood pressure earned me total bed rest for the last two months of the pregnancy and then there I was, in a hospital bed, sweating and screaming and writhing about – just like on television.
A mere 40 hours later Ella arrived, a 6lb 2oz lobster-red baby-alien.
Instantly none of my other plans mattered. This was the thing I should have done years ago. The only thing.
It was as close to being in heaven as I’d ever get. Neither of us had any doubt about the fact we wanted a second child, yet, despite what we had just been through, the luck of being part of that 20 per cent went to our heads and we thought it was OK to wait a year before starting the whole IVF process a second time.
This time our first cycle failed. As did our second. Our third didn’t even produce any eggs to fertilise. Our fourth gave us a few to freeze.
It wasn’t working. Finally, physically, mentally (not to mention financially) depleted, we decided sadly that cycle eight would be our last.
Elsie Marigold Evans-Griffith was born on September 13, 2013. She has her dad’s big brown eyes but not his unfeasibly long tongue, thank goodness.
I’m writing now because if we’d started trying even three years earlier we might have avoided everything I’ve just told you about.
I know how lucky I am. I won the lottery. I get to kiss goodnight to the two most precious human beings I’ve ever met.
My goal now is to get the word out. Don’t wait until it’s too late.
As for Shaky – I guess some things just aren’t meant to happen…