My Fertility Journey [Part 10]

 

Stork-01

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.
Fertilization.

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.

 

 

Types of PGD Screenings

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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.

PGD-NGS
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’.

Counselling and Fertility

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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 counsellor@tmclife.com to make appointment or seek further clarification regarding our counselling services.

The types of Counselling Services include:

  1. Pre-IVF counselling session (Complimentary) – (Available 16th May onwards)
  2. IVF Psychological Support Programme for Couple (3 sessions) – (Available 16th May onwards)
  3. Counselling for third party reproduction
  4. 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
    • Parenting
    • Intrapersonal matters such as low self-esteem

Acronyms that you should know when you are TTC.

acronyms

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.

2WW
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.

AF
Aunt Flo, After Flo, Period, or Menstrual Cycle.

AH
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.

AI
Artificial/Assisted Insemination. Where semen is injected into the vagina or uterus.

ART
Assisted Reproductive Technology. Essentially any conception assistance that isn’t sex. Examples would be IVF or IUI.

AMH
Anti-Mullerian Hormone. The hormone that predicts ovarian reserve (that is, the number of eggs you have left in your ovaries).

Baby Dust
That magic something that ensures the whole pregnancy process goes as planned.

BBT
Basal Body Temperature. Helpful for temperature charting to predict ovulation.

BCP/OCP
Birth Control Pills.

BD
Baby Dance, otherwise known as sex.

Beta
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.

BFN
Big Fat Negative. When you take a pregnancy test and you’re not pregnant. :(

BFP
Big Fat Positive. What we’re all looking for – when you take a pregnancy test and it is positive. High five!

BW
Bloodwork. Getting bloods drawn is a fairly frequent occurrence if you’re working with assisted reproduction.

CB
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.

CD
Cycle Day. The day of your cycle. The first day of your period is CD1.

CM
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.

DH
Dear Husband.

DHEA
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.

DOR
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.

DPO
Days Post-Ovulation.

DPR
Days Post-Egg Retrieval.

DPT
Days Post-Transfer. Often it will have a number in front – 5DPT would be 5 days post transfer.

DP3DT
Days Post 3-Day Transfer. This refers to an embryo that was transferred on Day 3 after egg retrieval.

DP5DT
Similar to the above, except a 5 Day old blastocyst was transferred.

DW
Dear Wife.

E2
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.

ENDO
Endometriosis is a common condition where tissue that behaves like the lining of the womb is found outside the womb.

ER
Egg Retrieval. Where, after being stimulated with hormones during an IVF cycle, the eggs are retrieved from the ovaries.

ET
Embryo Transfer. Where, after being fertilised and allowed to cleave during an IVF cycle, the embryo is transferred to the uterus.

EWCM
Egg White Cervical Mucus. The kind of cervical mucus where, around ovulation, it takes on a consistency like egg whites.

FET
Frozen Embryo Transfer. Where a frozen embryo is thawed and transferred to the uterus.

FF
Fertility Friend is an app for tracking fertility.

Frostie
Is a frozen embryo.

FSH
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.

GnRH
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.

GTT
The Glucose Tolerance Test is a tool used to diagnose high blood glucose during pregnancy, otherwise known as gestational diabetes.

hCG, HCG
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.

hMG, HMG
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.

HPT
Home Pregnancy Test.

HSC
Hysteroscopy is a procedure used to examine a womb for fibroids, polyps or adhesions by inserting a narrow camera through the cervix.

HSG
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.

ICI
Intracervical Insemination is an artificial insemination procedure, which involves placing sperm directly into the reproductive tract to improve the chances of pregnancy.

ICSI
Intra-cytoplamic Sperm Injection. This is where a single sperm is inserted into an egg to aid fertilisation.

IUI
Intra-uterine Insemination is a form of assisted conception. Sperm is placed in the uterus near the egg at the time of ovulation.

IVF
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.

LH
Luteinizing Hormone is released to encourage your ovary to ovulate.

LP
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.

MC
Miscarriage.

MF
Male Factor Infertility.

O, OV
Ovulation.

OB
Obstetrician.

OB/GYN
Obstetrician/Gynecologist.

OC
Oral Contraceptives.

OHSS
Ovarian Hyperstimulation Syndrome is an occasional side effect of IVF. Your ovaries overreact to the stimulants and produce too many follicles.

OPK/OPT
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.

OTC
Over the Counter. Typically refers to medication.

PCOS/PCOD
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.

PGD/PGS
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.

PMS
Pre-menstrual Syndrome.

POAS
Pee On A Stick. Typically associated with pregnancy tests or OPKs.

RE
Reproductive Endocrinologist.

SA
Semen Analysis. A sample is taken and a few different factors are checked to rule out male infertility.

TSH
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.

TTC
Trying To Conceive.

Know more acronyms that we don’t? Comment below and we will add it to the list!

7-Ways to Increase Male Fertility

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Infertility affects men and women equally. Here’s 7-ways to increase Male Fertility.

1. De-Stress:
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.