A Greater Chance of A Healthy Baby with Pre-Implantation Genetic Testing (PGT)

pgt coverNaturally, every parent-to-be wants a healthy child. Unfortunately, the chance of producing abnormal embryos becomes much higher as women age, as fertility rates fall after 35. Pre-implantation genetic testing (PGT), a premium service offered by TMC Fertility Centre, helps to identify the “chromosomally normal” embryos that are the healthiest, to be implanted during an IVF cycle.

How is PGT testing done? Embryos fertilised in the lab will divide into individual cells known as blastomeres. A blastomere is then collected through a biopsy and tested for genetic and chromosomal abnormalities. PGT will help to identify if genetic/chromosomal abnormalities are present in IVF embryos. This in turn helps couples make informed decisions about what to do during the IVF process. Embryos unaffected by genetic or chromosomal abnormalities are then selected for transfer to the uterus.

According to fertility specialist Dr Navdeep Singh Pannu, there are two main types of PGT to suit the needs of different couples. Next Generation Sequencing (NGS) or 24-chromosome aneuploidy screening is usually recommended for women above 40 or who have had recurrent miscarriages. All 24 chromosomes can be screened at the same time to confirm that the embryo has the correct number of chromosomes before being transferred to the uterus. In fact, TMC Fertility is the first in Asia to offer this technology.

For couples that have inherited genetic problems, the polymerase chain reaction technique detects certain common genetic disorders, such as haemophilia, alpha-thalassemia or beta-thalassemia, through a highly sensitive analysis of the embryo’s DNA.

However, Dr Navdeep explains that sometimes, structural problems such as cleft lip palates are unavoidable – these occur even in healthy embryos. But he can ensure that there will be no chromosomal abnormalities, an increased implantation rate and a higher chance of success.

Dr Navdeep Singh Pannu

Dr Navdeep Singh Pannu
Obstetrician & Gynaecologist and Fertility Specialist at TMC Fertility & Women’s Specialist Centre (http://www.tmcfertility.com).

For more enquiries or to schedule an appointment, please call: +60 3 6287 1000 or email us at enquiries.ivf@tmclife.com

24-hour Careline : +60 18 2111 088 | +60 16 2111 357 | +60 18 2111 405

Common Infertility Problems Among Women : Part 2 – Your Treatment Options


Your Treatment Options

Endometriosis and PCOS
The treatment options for the gynaecological medical conditions mentioned, depends very much on the diagnosis and severity of the condition.

“For patients who have been diagnosed with PCOS or endometriosis, medication will usually be the first line of treatment,” says Dr.Nurhazinat. One treatment example is the prescription of hormone treatments to regulate your menstrual cycle. Aside from that, the doctor would also advice the patient to maintain a healthy weight and go on a healthy diet.

“However, if medications are not a suitable treatment or was not a successful one, the following treatment option would be surgery,” she explains. “For patients with PCOS, a surgery known as ovarian drilling will be performed. This surgery will help to regulate your hormones, induce ovulation and regulate your menstrual cycle.”

As for patients with endometriosis on the other hand, a laparoscopic procedure will be performed to treat the condition.” At the same time, if a doctor suspects other fertility issues such as one which involves your fallopian tube, the doctor will be able to check on that as well,” adds Dr. Nurhazinat.

Ovarian Cysts
For patients diagnosed with ovarian cysts, treatments can range from medication such as hormonal pills to surgery. For some, the cysts may even go away on its own.

However, if it doesn’t and becomes a cause for concern, your doctor will perform a surgery to remove the cyst and this increases your chances of getting pregnant.

Pelvic Inflammatory Disease
“For patients with PID, a doctor will usually prescribe antibiotics to treat the condition,” she says. However, if the treatment of antibiotics was not able to treat the condition, a laparoscopic surgery may be advised.

Uterine Fibroids
Treatment for uterine fibroids depends very much on the severity of your condition such as the size of the fibroids, its position and the symptoms it causes which can include heavy periods.

“If the fibroid is small, less than three centimetres and does not present much symptoms which is affecting the patient’s quality of life, then the doctor will most probably observe the patient’s situation before proceeding with treatment,” explains Dr. Nurhazinat. “However, if the fibroid is above five centimetres in size and causes symptoms which affects a patient or situated close to the endometrium lining, then the doctor may perform a surgery to remove the fibroids. This will increase a patient’s chance of conceiving.”

Conceiving a baby

After seeking treatment, the next aim is to get pregnant.

Firstly, Dr. Nurhazinat clarifies that, “For a healthy woman who does not have any gynaecological medical conditions, her chances of getting pregnant is not 100 percent but about 10 to 20 percent each month. Hence, our aim as a medical expert is to achieve this for our patients as well.”

After seeking treatment, your doctor may advice you to try conceiving the natural way. “Generally, the patient will be advised to try this method for about six months to a year. However, this also depends on the woman’s age,” she says. The reason why fertility specialist have taken your age into account, is because, as you get older, this will decrease your chances of getting pregnant.

So, what is the next step if you were not able to conceive within the period of time as discussed with your doctor?

Dr.Nurhazinat says that, “If the patient and her partner has tried every other method but was not able to conceive, medical assisted reproduction will be suggested. Treatment options such as intrauterine insemination (IUI) and In-Vitro Fertilisation (IVF) will be explored.”

The former, IUI is a fertility treatment which involves injecting the sperm into the woman’s uterus to facilitate fertilisation. The latter, on the other hand, is a treatment which involves combining the ovum and sperm in a procedure which will be conducted in a procedure which will be conducted in a laboratory. After the ovum and sperm has been fertilised and becomes embryo, the fertility specialist will then, place the embryo in the womb and the couple’s pregnancy journey will continue as normal.

Gynaecological medical conditions can occur at any stage of your life. “What is most important is that you are able to control the disease,” says Dr. Nurhazinat.

Her parting advice to women is, “Go for regular health check-ups which should be annually or once in every two years. If you have been diagnosed with a medical condition, seek treatment as this help to increase your chances of getting pregnant.”

As for couples who are planning to start a family, she says, “start family planning as early as possible but of course, it is important to ensure that both husband and wife are ready to embark on this journey. You should also maintain a healthy weight, lifestyle and have a moderate intake of alcohol.”
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Dr. Nurhazinat Bt Mohamed Yunus is an Obstetrician & Gynaecologist and Fertility Specialist at TMC Fertility & Women’s Specialist Centre (http://www.tmcfertility.com). For more enquiries or to schedule an appointment, please call: +60 3 6287 1000 or email us at enquiries.ivf@tmclife.com

24-hour Careline : +60 18 2111 088 | +60 16 2111 357 | +60 18 2111 405

Common Infertility Problems Among Women

WhatsApp Image 2019-03-22 at 12.03.04 PMA healthy reproductive system is essential to increase one’s success of conceiving a child. 30 percent of women have infertility issues and treatment will most probably be needed if you would like to have a baby.

There are many reasons which can cause a woman to become infertile. Among them are gynaecological medical conditions. Consultant Obstetrician and Gynaecologist and Fertility Specialist from TMC Fertility Centre which is located in Thomson Hospital, Dr. Nurhazinat Bt Mohamed Yunus shares about common gynaecological medical issues which can cause infertility.

The Possibilities
From endometriosis to Polycystic Ovarian Syndrome (PCOS), these gynaecological medical conditions may sound familiar to many. However, did you know that it can lead to infertility if left untreated?

Though, before understanding the different medical conditions, Dr. Nurhazinat believes that it is best to learn about the symptoms that every woman should look out for.

“Any abnormal symptoms related to a woman’s reproductive system can be a sign of a gynaecological medical condition,” she says.

There are a few common symptoms you should be aware of. Dr. Nurhazinat explains that they include:

  • A short menstrual cycle of 24 days or less
  • An infrequent menstrual cycle which can take about 40 days for one cycle
  • Severe pain during your period which will require medical attention or a day off from work
  • Heavy bleeding (which usually requires about four to five changes of sanitary pads daily)
  • A long menses duration of 10 days or more

“If you are experiencing any of the symptoms above, this can indicate a possible underlying gynaecological medical condition,” she says.

Common Gynaecological Medical Conditions
“There are five common causes of the symptoms as mentioned,” says Dr. Nurhazinat.

The common medical conditions which can cause infertility includes:

  • Endometriosis – This condition occurs when a tissue found in your uterine lining, grows outside of your uterus. Endometriosis can cause severe pain especially during your period.
  • Ovarian Cysts – Ovarian cysts are sacs that are filled with fluid, which can be formed in the ovaries.
  • Polycystic Ovarian Syndrome (PCOS) – When your hormones are imbalanced, this can lead to PCOS. What happens is that the ovaries will grow small cysts, forming like a chain of pearls.
  • Uterine Fibroid – Often occurs during childbearing years, uterine fibroids are non-cancerous growths.
  • Pelvic Inflammatory Disease (PID) – PID occurs when the cervix is infected with bacteria due to a sexually transmitted disease. This includes cases such as gonorrhea and chlamydia.

“Besides these five conditions, there are also other less common conditions which you should also be aware of such as endometrial polyps,” she highlights. If you have been diagnosed with any of these conditions, treatment is widely available.

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Dr. Nurhazinat Bt Mohamed Yunus is an Obstetrician & Gynaecologist and Fertility Specialist at TMC Fertility & Women’s Specialist Centre (http://www.tmcfertility.com). For more enquiries or to schedule an appointment, please call: +60 3 6287 1000 or email us at enquiries.ivf@tmclife.com

24-hour Careline : +60 18 2111 088 | +60 16 2111 357 | +60 18 2111 405

 

Congratulations, You Are Now Married! What’s Next?

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By Dr. Chong Kuoh Ren

Getting married is one of the biggest commitments you will make in a lifetime. After the flurry of the wedding has died down and you have settled into a new routine, the realities of married life will begin unveiling themselves. One of them will surely be about having children.

While having children will spell further commitments in terms of time, finances and energy, the pitter-patter of little feet can be a great source of joy. Watching your little one grow and teaching him or her about life is also an enriching process for you as a couple and you child.

Some couples may feel they are not prepared to have children, preferring to enjoy a prolonged honeymoon until later when they are ready financially and emotionally. The question is, how ready is ready?

Until you get a promotion? Finish furthering your education? Buy your own house? Finish your car installments? Or until you feel you can cope with the responsibilities of caring for another life apart from your own?

It is a false notion that a couple needs RM1 million in the bank before having children. While it is not wrong to be prepared before you begin a new (and lifelong!) journey of parenthood, waiting too long may not be advisable.

Consider these:

  • Having a baby and bringing up a child together will create an inseparable bond with your spouse. This will invariably strengthen your marriage.
  • The older you are, the less healthy your eggs and sperm become. Women in particular should start a family before the age of 35 while she still has decent ovarian reserves.
  • Eggs and sperm quality is less optimum as you age. The risks of miscarriages, stillbirths or birth abnormalities also increase from 30 years of age.
  • It is easy to lose track of time; and one year of ‘taking it easy’ may become five or ten years before you realise it.

Without the use of family planning methods, a healthy couple should conceive naturally within one year of unprotected intercourse. When that does not happen, it would be advisable to check the reproductive systems of both spouses to find out what is wrong.
Even if you are not ready to conceive, women (at any age) may want to get a gynaecologist or fertility doctor to check their ‘fertility health’ , i.e. any structural problems of the womb (fibroids, polyps), tubes (blockage) and ovaries (cysts) and ovarian reserves (number of eggs left). Early identification of potential problems means steps can be taken to plan your future pregnancy timetable.

Note: Dr. Chong Kuoh Ren is an Obstetrician & Gynaecologist and Fertility Specialist at the TMC Women’s Specialist & Fertility Centre Puchong (http://www.tmcfertility.com). For more enquiries or to schedule an appointment, please call: +60 3 6287 1000 or email us at enquiries.ivf@tmclife.com

24-hour Careline : +60 18 2111 088 | +60 16 2111 357 | +60 18 2111 405

Let’s Talk Eggs

Time stops for no man or woman.  This is especially true for our eggs as age impacts negatively on both the number and quality of eggs that women have. Women may want to put their fertility on hold for personal reasons or may want to preserve their ability to have a biological child in the face of a cancer diagnosis which involves chemotherapy or radiation to her pelvis.

Dr Hoo Mei Lin, Consultant Obstetrician & Gynaecologist and Fertility Specialist from TMC Fertility Centre Kota Damansara, shares with us her thoughts and views on egg cryopreservation. “A woman is at her most fertile between the ages of 20-35.  If we are busy living life, pursuing our dreams and careers, this may mean that when a woman is ready to start a family, she may experience difficulties conceiving as our fertility reduces quite drastically after 35. Many women face the unenviable decision. Do I put my dreams on hold? Do I settle for Mr Right Now or do I wait for Mr Right? Will I be able to have kids later?” says Dr Hoo.

Wouldn’t it be great if we can stop time? 

Science has now made it possible to do just that.  Egg cryopreservation or egg freezing could be your answer.  “Freezing your eggs when you are at your peak in your fertility will mean that when you aim to get pregnant at a time of your choice, you will still have eggs at its optimum.  The process involves 2-6 weeks of injections to stimulate egg production. The primary goal is to freeze 15-20 eggs for each baby you plan to have. The eggs are then vitrified and then frozen. You may experience bloating and cramps during the whole process. The procedure is not cheap but then again, what is the price you would put on ensuring your fertility?” explains Dr Hoo.

While egg freezing does not guarantee a baby, it is certainly a reliable insurance plan. Aren’t the experts always saying one should not ‘put all your eggs into one basket’?

Dr Hoo Mei Lin is a Fertility Specialist at TMC Fertility and Women’s Specialist Centre Kota Damansara. For more enquiries or to schedule an appointment, please contact +603 6287 1000, visit www.tmcfertility.com or email enquiries.ivf@tmclife.com

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

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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.