However, if you have no embryos frozen, what is your option?
This chart below showed a cumulative live IVF births from a study conducted.
This study looked at all the women under the age of 42, who are going through IVF.
The study revealed that the pregnancy rate is around 40% in this group of women after they completed their first cycle of IVF. For those women who did not get pregnant the first round and went on having the second round of IVF, there were another 20% who got pregnant after the second round. Therefore, by the 4th IVF cycle, around 80% of women would have achieved a live birth.
This statistic clearly shows that if you persevere and keep moving on, chances of you getting pregnant by the end of the 4th IVF is around 80%.
Therefore, it is not unusual for Fertility doctors to encourage our patients to keep moving on because the statistics had clearly show us the evidence.
To improve your chance of pregnancy for the next IVF, it is important to improve the quality of your eggs and sperms by eating healthy and improve lifestyle, quit habits which can potentially jeopardize your success rates such as smoking, alcohol and stress. Speak to your fertility doctor about what are the other options in your IVF treatment.
Question: I am a person who is fearful of pain. I gathered that going through IVF will required multiple injections, surgery and other procedures which are painful. Is it true?
Dr Helena’s answer:
IVF sounds daunting to many people. A lot of us have perceptions that it is extremely expensive. Some of us thinks that it would bring us a lot of inconvenience, such as having to go to hospital everyday, lay in bed for a few months, quit our job and etc
One of the greatest fear many had was the perception of pain associated with IVF procedures. The thought of having daily injections made most of us wanting to run away and hide from the doctors. Some people are scared thinking about the egg retrieval procedures. Some are dreading the embryo transfer procedure, thinking that it would bring great pain and discomfort. Some dread the injections which are taken after the procedure, which are the progestogen injections, aimed to support the lining of the uterus whilst the embryos are implanting.
However, with the new development and breakthroughs in the world of reproductive medicine, IVF procedures had become more and more comfortable and easy to management, with minimal disruption to daily life.
First and foremost, the durations of injections had been shortened significantly with the use of antagonist injections in IVF. This method of doing IVF is called the antagonist cycle or the short protocol. So, instead of having 3 weeks of injections in the agonist cycle or long protocol, the advent of antagonist injections had lead to a shortened period of 10-12 days of injections. This had greatly reduce the discomfort one needs to go through with injections.
The use of self-administered FSH injection pens with extremely fine needles, had significantly cut down the pain one experienced during injections. This self- administered injections pens are given to patients to take home, and the injections are administered by patients themselves, so patients do not need to come to the clinic or hospital to have their daily injections. The needles used are similar to the ones used in the insulin injection pens, which is extremely fine and almost painless.
There is also another long acting FSH injection which given at the beginning of an IVF cycle and can last for 7 days. After the initial injection, the patient need not take FSH injection for the next 7 days, which significantly cuts down the number of injections required.
The egg retrieval procedure which usually happened after 10-12 days of injections involved having a light sedation in an operating theatre. In the past, the use of certain sedations such as Valium, Dormicum or pethidine administered by the IVF doctors whilst performing the egg retrieval procedure had appeared to be increasingly unsafe. In many IVF units, a proper IVF operating theatre with a trained Anaesthetist giving sedation during the egg retrieval procedure is becoming a norm and deemed acceptable in terms of safety. One of the advantage of the involvement of an Anaesthetist is that egg retrieval procedure is becoming almost painless, and hence optimizing patient experience in IVF.
Embryo transfer procedure is usually carried out 3-5 days after the egg retrieval. During the procedure, the embryos which were created following fertilization of the retrieved eggs with sperms are replaced into the uterus. This procedure is performed without anaesthesia or sedation, is relatively pain free. The experience is almost the same as having a cervical smear. Therefore, women should not feel fearful about having an embryo transfer.
After the embryo transfer, to support the uterus lining and to ease implantation, a
Progestogen is prescribed. In the past, progestogen is administered by injections. These injections are usually painful and cause local irritations, which is uncomfortable and unacceptable to many. With the advent of effective oral and vaginal suppository preparations, studies had shown that these forms of progestogen are equally effective in delivering progestogen to uterus, injectable progestogen had slowly becoming a thing of the past in many IVF centres. This has also greatly cut down the pain experience in IVF
In conclusion, with rapid modernization in reproductive medicine & technology, IVF had become relatively painless. It is importantly to find out more information on IVF before you embark on this journey.
Question: My Husband & I had been married for 8 years, we have tried many different methods of getting pregnancy with no avail (except IVF). The reason I have not attempted IVF is because I heard that it is extremely expensive with low success rates, is this true?
Dr Helena’s Answer: Many people have a lot of myths and misunderstanding about IVF. In fact, IVF started in the 1970’s with many controversies. It used to be regarded as cultic practice in science, intertwined with many religious, social and ethical controversies
However, many years had gone by and IVF had progressed in leaps and bounds in its technology and approach, proving to the world its value and safety. At the turn of this century, reproductive doctors and scientists had achieved many new innovations and breakthroughs, to make IVF more accessible and safer. Hence, IVF had gradually become the mainstream in reproductive science, making the dreams of having children a reality for many couples
However, it is not unusual to find that people are still weary about IVF, and there are still myths and misconceptions surrounding IVF.
One of the myths about IVF is that it’s extremely costly. We hear stories that people had to ‘loose an arm or a leg’ to be able to afford IVF.
The truth is that IVF cost had reduced remarkably for the last 10-20 years, thanks to many creative innovations, especially in the advent of cost effective medications, culture mediums and lab equipments. The advent of a new freezing technique, called vitrification, allows IVF scientists to freeze embryos more effectively to allow storage of excessive embryos, to be used later, cutting down the need to repeat another IVF cycle, making IVF more cost effective.
The cost of IVF in Malaysia is generally ranging between RM12,000-RM20,000. The price range varies because of differences in clinical and laboratory settings, medications used and etc
The success rates are generally good depending on the age of the women. For women aged below 35, the success rate is about 60-80%. For women above the age of 35 but below the age of 40, the success rate is around 50%. The success rate fell dramatically after the women crossed 40 years of age.
There is recent study on Danish population about the cost effectiveness of IVF. The study followed almost 20,000 Danish women undergoing fertility treatments including IVF. Within three years, 65% of the women had given birth, with the figure rising to 71% within five years.
Therefore, it is important to find out more about IVF before deciding on or against it.
Can IVF Cause Cancer?
Today’s post addresses a question that I am often asked at the clinic – Can IVF cause cancer?
This concern very likely stems from a study done 12 years ago, which has since been well-publicised. It reported that the use of Clomid, which is a fertility medication widely used to treat ovulatory dysfunction in women, might increase the risk of breast and uterine cancer.
Understandably, this has caused some infertility patients to wonder if the treatments they will undergo are safe. Therefore, today I’d like to reassure you by providing references to other studies on the subject.
It’s important to note that since that study was first published, more studies have been conducted and most have found no significant link between Clomid use and cancer risk. One such study, which in fact offers the strongest evidence that Clomid and other ovarian-stimulating drugs do not increase the risk of ovarian cancer, comes from the Cochrane Review.
Published in 2013, the review looked at studies from 1990 to February 2013 that involved 182,972 women. The review not only found no evidence of increased ovarian cancer in women who use any fertility drug, but also pointed out that studies claiming there is an increased cancer risk were unreliable. This is because their sample sizes were too small for drawing conclusions and they did not take into consideration other potential risks for cancer.
For example, if a woman has never experienced pregnancy, her risk of cancer increases. Certain causes of infertility can also cause an increased risk of cancer, for example obesity, PCOS and endometriosis. So in fact, the increased risk of cancer noted in those studies may not be related to the medications at all.
In fact, ironically, some studies showed a decreased risk of developing breast and uterine cancer among infertile women on Clomid, in comparison to infertile women who did not seek treatment for infertility.
There are two other studies, with substantial sample sizes, which included 25,108 women from the Netherlands who received IVF treatment between 1980 and 1995, found that there was no increased risk of breast cancer. Another study, by the Institute of Child Health at University College London, which involved over 250,000 British women undergoing IVF between 1991 and 2010, also found no increased risk of breast or uterine cancer in those patients. However, they learned that IVF patients had a slightly higher risk of ovarian cancer – 15 in 10,000 odds, as compared to women who had never undergone IVF, who had 11 in 10,000 odds.
So as a consensus, from the studies quoted above and others like them, you can rest assured that fertility drugs like Clomid do not increase your risk of developing breast or uterine cancer. However, because infertility itself is a cancer risk factor, it is best that you undergo the necessary follow-up after your infertility diagnosis.
Should you have any concerns on the medications and treatments for infertility, please don’t hesitate to speak to your infertility consultant.
Endometrial scratching to improve IVF success rates
Couples who are struggling with infertility often seek In-Vitro Fertilisation (IVF) treatment in order to improve their chances of starting a family. But what happens when you have gone through multiple unsuccessful IVF cycles? Is there something else you can try?
Many patients who’ve experienced this first hand, have asked me this question, eager to try out something new to enhance their chances in the next IVF cycle. Therefore, today, I’d like to tell you more about a procedure called endometrial scratching, which has become increasingly popular in recent years.
What is it?
Endometrial scratching is a procedure that involves agitation of the endometrium, which is the mucus membrane that lines the uterus. For conception to occur, a fertilised egg has to successfully implant itself into the wall of the uterus. Sometimes, implantation fails, usually due to the quality of the embryo or the receptivity of the endometrium. In endometrial scratching, a fertility specialist passes a special thin catheter or pipille through a woman’s cervix. The pipille is then moved up and down to gently make tiny scratches or scrapes in the uterine lining. The similar effect can also be achieved by introducing a hysteroscope through the cervix to visualised the lining of the uterus during polyps removal.
Why is it done?
In theory, endometrial scratching is believed to trigger the uterus to repair itself and develop a new lining, which will be more receptive to an embryo implanting. While the effectiveness of the procedure needs further investigation, studies that have been done on endometrial scratching in recent years have shown encouraging results.
One such study was conducted by the University of Nottingham, UK, which involved 158 women who had undergone unsuccessful IVF procedures. The women were divided into two groups, with one group given the endometrial scratching procedure. As a result, they found the women who had undergone the scratching procedure achieved a 49% pregnancy rate, compared to 29% in the other group.
In another study involving 1000 women, presented at the annual meeting of European Society of Human Reproduction and Embryology (ESHRE), endometrial scratching is said to increase pregnancy success rates for couples trying to conceive naturally or with Intrauterine Insemination (IUI).
When is it done?
The endometrial scratching procedure is usually recommended for patients who’ve experienced multiple unsuccessful IVF cycles or Intracytoplasmic Sperm Injection (ICSI) treatment. The procedure is best performed prior to a woman’s period or right after the period. It is done before an IVF or frozen embryo transfer (FET) cycle begins.
Does it hurt?
While the endometrial scratching procedure has been described as generally painless, requiring no anaesthetic, some women do experience discomfort during and after the procedure. The pain is similar to period cramps and there may be slight bleeding afterwards. To help with possible discomfort, patients are advised to take over-the-counter pain medication about an hour before undergoing the scratching procedure.
If you’ve gone through several IVF attempts and are keen on learning more about endometrial scratching, take the next step and ask your fertility specialist if it is right for you.
What you should know about AMH
When you seek medical advice for infertility issues, one of the hormone tests that you be advice to take is the Anti-Mullerian Hormone or AMH test. This test measures the AMH levels in your blood, which helps doctors determine your ovarian or egg reserve.
In this post, I’ll explain what egg reserves and AMH tests are, as well as what you can do if your AMH levels are low:
About egg reserves
Humans are born with a limited amount of eggs. To be precise, a girl is born with between one to two million immature eggs or follicles in her ovaries. But not all these follicles will survive into adulthood. In fact, throughout a woman’s life, the majority of her immature eggs will die in a natural process called atresia.
Did you know that by the time a girl has her first period, only about 400,000 follicles are left? And with each subsequent period, she loses about a thousand follicles, while just one matures into an ovum or egg. This means, throughout her reproductive life, a woman will develop only about 400 ovum. The number of developing follicles a woman has left, is called her “ovarian or egg reserve.”
Egg reserves and the quality of those eggs vary from one woman to another, due to factors such as age and infertility. Over time, both the quantity and quality of a woman’s eggs gradually decreases. Therefore, when seeking treatment for infertility, it is important for a woman to gain insight into the remaining quantity of her egg reserve and fertile years.
What is AMH?
When follicles develop in a woman’s egg reserve, her body release the Anti-Müllerian Hormone (AMH). AMH levels, therefore, can give us a good idea of the state of a woman’s ovarian reserve. Since AMH levels are determined by the number of developing follicles in a woman’s ovaries, low AMH levels are an indication that the ovarian reserve is depleted.
Fewer developing follicles mean slimmer chances for a mature and healthy egg to be released and fertilised. As such, when a woman knows the state of her egg reserve, she can determine how urgently she requires treatment.
While egg reserves generally decline in the mid to late 30s, leading to low AMH, age is not the only factor. Environmental factors can also cause low AMH, such as cancer treatment and inherited genetic causes. AMH levels can be easily assessed with a blood test, but like most diagnostic tests, it has its limitations. For example, it cannot indicate the quality of the eggs that are left, which requires a separate test. However, as AMH levels remain fairly constant in a woman’s cycle, she can have the test at any time.
What Can’t AMH tells you
As much as we would like to believe that AMH is ‘the ultimate test’ for ovarian reserves, however, it only tells us some aspect of your fertility performances but not all. AMH does not tell you the quality of your eggs. Therefore, some women who have plenty of eggs and high AMH level may not perform well in an IVF treatment cycle because of poor egg quality.
For women who take oral contraceptive pills, AMH level may not be a true reflection of their ovarian reserves. Those who were taking the pill had 19 percent lower levels of AMH and 16 percent fewer early-stage follicles.
Recently, there has been clinical studies which reported that there is a significant variation in serum AMH levels across the menstrual cycle regardless of ovulatory status. This variability, although statistically significant, is not large enough to warrant a change in current clinical practice to time AMH measurements to cycle day/phase.
What you can do
If you should take an AMH test and find that your level is low, do not lose heart! Your AMH level is just one piece in a complex jigsaw puzzle. Your best course of action is to discuss matters with your infertility specialist. Ask your doctor how you can protect your egg count and health, as well as discuss the best possible solution to your problem. For example, DHEA supplementation and well-managed IVF protocols have been shown to be effective in improving IVF pregnancy rates in women with low AMH. Maintain a positive outlook and don’t give up on your dreams of having a baby!
Can IVF bring on early menopause?
One of the most common question patients like to ask about IVF is that whether the treatment itself will bring on Menopause earlier. This is probably by far one of the greatest myths about IVF which we would like to clarify.
A woman’s ovaries contain immature eggs sacs known as follicles, which have the potential of developing into mature eggs. However, most of these follicles will be lost without having fulfilled their purpose.
Women are born with millions of eggs in their ovaries. These eggs are quiescent in the ovaries until the women reach the age of menarche (when they get their first menses). At that time, the eggs in the ovaries started to come up after hibernating for 10-16 years. This is due to a pulsatile release of hormones from the organs below our brain called hypothalamus and pituitary. So, at the start of our menses, our ovaries will recruit around 10-20 eggs at one go. However, after the menses, our body will only choose one egg to grow. The rest of the eggs will regress and die off. With the help of our hormones, the particular ‘chosen’ egg with grow to a certain size and maturity, and then ovulation will occur. Hence, we only release one mature egg every menstrual cycle.
But of these many follicles, only one of them will become dominant and mature. The others that do not get a chance to mature and release an egg, will simply disintegrate and be lost in a natural process called atresia. The loss of these follicles during each menstrual cycle means that several undeveloped eggs are also lost.
Therefore, throughout a woman’s reproductive life, her ovaries will release only around 400 eggs, despite being born with millions of eggs. So basically, we ‘wasted’ around 12-20 each menstrual cycle, until the day when we reach menopause, whereby there is NO eggs in our ovaries
So if a woman can naturally produce only one egg per menstrual cycle? How do IVF specialists harvest several eggs at once?
For a woman who is undergoing an IVF treatment, the use of injectable fertility drugs (hormonal drugs) will stimulate her ovaries to overcome the natural tendency of choosing one dominant egg and ‘wasting’ other eggs produced during this particular cycle. In this scenario, the hormonal injections will stimulate all the eggs recruited during this particular cycle to grow simultaneously. Once these eggs reached a certain size and maturity, they are being harvested during an egg retrieval procedure
When a woman undergoes IVF, she will be prescribed with injections containing FSH. The amount given will be several times higher than what her body would naturally produce. This high amount of FSH will stimulate a lot more follicles than usual and help more of them to mature into eggs. An important thing to understand is that FSH will only act on the follicles that a woman’s body will naturally produce each month. Therefore, there is no depletion of the overall egg supply. And when those eggs are harvested during an IVF treatment, they have actually been spared from atresia that would have occurred during that menstrual cycle.
It is also important to note, that whether or not they undergo IVF, women who struggle with infertility are usually already at risk of having poor ovarian reserve and reaching early menopause. One of the tests that can be used to detect low ovarian reserve is the Anti-Mullerian Hormone (AMH) blood test. Egg reserves and AMH levels usually decline with age and can be affected by environmental factors such as cancer treatment or ovarian surgery, as well as inherited genetic causes, endometriosis, tumors, immunological conditions and high body mass index.
With that in mind, studies conducted by research teams around the world, including the British Fertility Society, Queensland University, Australia, and Cornell University, US have confirmed that IVF, even with multiple cycles, does not lead to egg depletion nor early menopause.
Having studied hundreds of IVF patients through the years, these researchers have concluded that IVF does not affect the timing or severity of menopause symptoms. In fact, many IVF patients reach menopause at the average age of just over 50, which is comparable to most national averages and closely resemble that of their own mothers’. The studies also found that most respondents had given birth to at least one child as a result of IVF.
Dr Helena Spoke against Child Marriage & Advocated for Women’s Right on TV2, ‘What Say You Programme’
The occurrence of identical twins after a single embryo transfer
Even after many years of being a doctor, it still brings me immense joy to announce to my patient that she is indeed pregnant following a successful infertility treatment. And sometimes, the happiness is multiplied, as there isn’t one, but two buns in the oven!
In general, it is widely known that the occurrence of multiple births is much higher following assisted reproductive technologies (ART) as compared to incidences of twins in natural or spontaneous pregnancies. This is directly related to the number of embryos transferred back to the uterus. In general, if 2 embryos are transferred back into the uterus, the chance of having twin pregnancies is around 20-30%. As we all know, twin pregnancies carries more risks to the expecting mother as well as the babies. The risks of miscarriage, bleeding in pregnancy, high blood pressure, diabetes in pregnancy, Placenta Praevias, Caesarean Sections are some of the significant obstetric risks. The babies are also at risk of preterm births, stillbirths and complications associated with preterm deliveries such as cerebral palsies.
Therefore, in many countries especially in the west, it is mandatory that the patients are informed of these risks before an embryo transfer. Some countries had restricted the number of embryos transferred to one. This move had significantly reduce the incidence of twins following an IVF and had reduced the economic burden associated with medical care of pregnancies associated with twins
However, in recent years, it had been reported that there is a higher incidence of identical twins following single embryo transfer.
While the incidence of fraternal twins following the transfer of two embryos is an easily understandable consequence of IVF, the causes for identical twins after ART remain speculative at best. However, there is some evidence that attributes the phenomenon to the micromanipulation techniques, length of culture and culture medium used during treatment, as well as the genetics of the parents.
Identical twins, also known as monozygotic twinning or MZT, occur when an egg and a sperm unite to form a single zygote that divides into two embryos or separate individuals. It is a rare phenomenon, which occurs in only about 1% of natural conceptions. However, in assisted conceptions, the occurrence of monozygotic twinning almost doubles.
The splitting of the zygote into separate embryos can occur at any time during the first 2 weeks after fertilisation. However, the timing of the split will influence the type of identical twin. For example, in around 1/3 of MZT cases where the split occurs within 72 hours of fertilisation, the result is two placentas and two amniotic sacs. In the remaining 2/3 of MZT cases, the splitting occurs 4-8 days after fertilisation, resulting in one placenta and two amniotic sacs. And in about 5% of MZT cases, where splitting occurs 8-13 days after fertilisation, the outcome is one placenta and one amniotic sac. In very rare cases, the outcome is conjoined twins.
Although the prospect of having twins is certainly exciting, couples must also understand that twin pregnancies are considered high risk. They can lead to various pregnancy complications with long-lasting and even permanent effects for the children. These include caesarean section, premature birth, low birth weight, Twin-Twin Transfusion Syndrome (TTTS), pre-eclampsia, gestational diabetes, fetal abnormalities and congenital abnomalies. In view of the complications that can arise from a twin pregnancy, do speak to your infertility consultant about the risks involved should you have any worries.
PCOS – What you should know
As a fertility doctor, I see women who are troubled by Polycystic ovary syndrome (PCOS) on a daily basis. Most of them come to see me because they have difficulty in trying to conceive and some of them have irregular menses, but many of them are unaware of their condition. Polycystic ovary syndrome (PCOS) is a relatively common health problem, affecting an estimated 1 out of 10 women of childbearing age. However, many women who come to see me are either unaware or misinformed about PCOS. To help dispel some of the misconceptions about PCOS, in today’s blog I’ll be explaining what PCOS is, what causes it and how it can be treated.
What is PCOS?
PCOS is a condition whereby small ‘cysts’ develop on a woman’s ovaries. In actual fact, these ‘cysts’ are not actually cysts per se, but are ovarian follicles which contain eggs. A healthy young woman will usually have about 5-10 follicles in each ovary, however, in the case of PCOS, each of the ovaries contain more than 10-12 follicles. Although these follicles are a sign of abundance in egg numbers, they cause the body to have hormone imbalances. Because hormones are chemical messengers, responsible for triggering various different processes in our bodies, when a hormone imbalance occurs it causes detrimental chain reactions.
For example, PCOS can cause the ovaries to produce more androgens (male sex hormones), which disrupts ovulation, causes irregular periods, as well as causes acne and extra body or facial hair. PCOS can also cause insulin resistance, which increases blood sugar levels and can cause diabetes over time.
Other health issues caused by PCOS are metabolism problems, heart disease and infertility. If you have a family history of PCOS, on either your mother or father’s side, your chance of getting it is much higher.
Most women with PCOS share a number of common symptoms such as weight gain or trouble losing weight; extra facial or body hair (especially on the face, chest, belly and back); hair thinning on the scalp; irregular, few or no periods; heavy periods; fertility problems and depression. You may have many or just a few of these symptoms.
In order to diagnose PCOS, your doctor will begin by asking you a series of questions about your health, symptoms and menstrual cycles. This will be followed by a physical exam, which will look for excessive body hair and high blood pressure, as well as take note of your body mass index (BMI). Next, some of your blood will be drawn to test your blood sugar, insulin and other hormone levels. Finally, you may have a pelvic ultrasound to look for cysts on your ovaries. Early diagnosis and treatment is crucial, as it can help you to control the unpleasant symptoms of PCOS, as well as prevent long-term health problems.
Positive lifestyle changes can have a profound effect in treating PCOS. They not only reduce the unpleasant symptoms that you may experience, but also help prevent long-term health issues. To kick start your PCOS treatment, fit in moderate to vigorous exercises to your daily routine, such as walking, swimming, aerobic dancing and bicycling.
You should also eat a healthier diet, comprising of lots of vegetables, fruits, nuts, beans and whole grains. You should also reduce your intake of high calorie food which are high in saturated fat and carbohydrate. These life style changes will improve your weight and reduces insulin resistance. If you are a smoker, quite smoking as it causes you to have higher androgen levels. Most polycystic women will also benefit from weight loss, which can help balance out your hormones and regulate your ovulation and menstrual cycle.
In addition to lifestyle changes, your doctor may prescribe you with medication to help reduce any symptoms you might be suffering, as well as to help you get pregnant. The common medications are ovulation inductions drugs, such as Clomiphene Citrate (Clomid) or FSH hormones injections. This will help you to ovulate naturally and increase your chance of pregnancy. Your doctor may also prescribe Metformin, which is a medication to reduce insulin resistance. This in turn will help to reduce weight, increase natural ovulations and reduces the androgenic effects of PCOS.
Laparoscopic ovarian drilling was once a popular surgery in reducing the effect of high androgens in PCOS patients. However, recent studies revealed that the effect of laparoscopic ovarian drilling is short-lived, i.e. the menstrual irregularity returns after a few months. On top of that, laparoscopic ovarian drillings has other adverse effects on women’s fertility, such as premature ovarian failure, adhesion formations causing tubal obstructions etc. Laparoscopic ovarian drilling is invasive and expensive especially in private settings. Therefore, it has become difficult to justify its cost against its effectiveness.
In some women, whereby there are other associated problems such as tubal obstructions or husbands’ sperms are weak or low in numbers, an IVF (In-vitro Fertilisation) treatment may be necessary and cost effective to achieve a pregnancy
Should you have any questions or concerns about PCOS and how it is affecting your health and chances of conceiving, as always, don’t hesitate to speak to your fertility consultant.
The loss of a pregnancy or miscarriage is something that most couples rather not think of. However, it’s important for couples to understand why miscarriages can happen, especially as it can be caused by various factors and steps can be taken to lower the risks. The common causes of miscarriage are anatomical causes (like uterine abnormality), genetic causes, immunological disorders and hormonal imbalance. In this article, I will address one of the most common types of hormonal imbalance known today – insulin resistance.
Insulin resistance is a condition whereby levels of sugar, estrogen and testosterone in the blood are raised, while progesterone levels are lowered. The result is an excess of glucose in the bloodstream, which leads to prediabetes, diabetes and other serious health disorders. In pregnancy, insulin resistance causes a variety of concerns, such as delayed fetal growth and gestational diabetes.
Several scientific studies have also found that insulin resistance can lead to miscarriage. One such study was carried out by a team of researchers at the Reproductive Medical Centre, Peking University, People’s Hospital, Beijing, China. After examining 107 patients that achieved their first pregnancy after infertility treatment, they came to the conclusion the risk of miscarriage can be directly linked to insulin resistance.
A team from the Obstruction & Gynecology Department, Babol University of Medical Science, Babol, Iran offered similar findings, when they proved that women with elevated insulin levels are at a higher miscarriage risk. As worrying as this is, it must be noted that insulin resistance doesn’t just heighten the risk of miscarriage; in fact, it has been shown to increase the risk of multiple miscarriages.
Several published studies have confirmed this, such as one by a team from the Department of Obstetrics and Gynecology at Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou. After investigating the differences in insulin resistance between women with recurrent miscarriage and those with normal pregnancy, they concluded that insulin resistance increases the risk for recurrent miscarriage during the first trimester of pregnancy.
The crucial link between insulin resistance and recurrent miscarriage was echoed in a prospective clinical study by a team of researchers from the Department of OB & GYN, Shiraz Medical University, Iran. Their study found that 39% of women with recurrent miscarriage have abnormal oral glucose tolerance test (OGTT) results. The OCTT, which measures the body’s ability to use glucose, is often used to check for insulin resistance and gestational diabetes.
Meanwhile, a team from the Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, University of Tennessee Health Science Center, Memphis, USA concluded that 27% of women with repeat miscarriage have high fasting insulin, despite normal glucose levels.
Insulin resistance is also associated with Polycystic Ovarian Syndrome or PCOS, which is why women with PCOS struggle with infertility. The condition raises levels of estrogen and testosterone in the body, while lowering progesterone levels. This interferes with the normal development of follicles in the ovaries, causing problems with ovulation.
However, if you have PCOS or insulin resistance and wish to undergo infertility treatment, hope is not lost. There are steps you can take to improve your insulin resistance sensitivity through lifestyle changes or medical intervention, before you undergo infertility treatment. Please don’t hesitate to speak to your infertility consultant should you have any concerns about insulin resistance. Your doctor can advise you on ways to reduce your risks and increase your chances for a safe pregnancy.
What do mental health, HIV, and erectile dysfunction have in common? These are just some well-known medical conditions that are still highly stigmatised. Why are some medical conditions stigmatised and how did some of them manage to break the stigma? Upper GI and Bariatric Surgeon Dr Reynu Rajan shares her experience dealing with bariatric patients in the face of weight-bias and discrimination, while Fertility Specialist Dr Helena Lim shares what it’s like to help patients overcome the taboo of infertility.
Parenting Adventures is about brutally honest discussions in the world of parenting. In this sixth episode, we explore the subject of infertility. How do couples recover from the grief of knowing they may never have children? Why are they not open to the option of adopting or using a donor? We find out from a fertility specialist and, we will also hear from someone who didn’t take her infertility diagnosis as the final result, and did everything she could to become a mother.
Do click on this link to hear the podcast:
A weighty issue
How a woman’s weight impacts the risk of miscarriage
A miscarriage is a devastating experience for couples, perhaps even more so for those who have struggled with infertility and gone through the initial joy of a successful fertility treatment. Statistics have shown that in both natural and IVF conception, about one in six pregnancies will end in a miscarriage before the 20th week, with the rate being higher in older couples.
Understandably, couples are frightened of miscarriages and would rather not think or talk about it. However, it is important for couples to understand why miscarriages happen, as well as what they can do to reduce their risks.
Although the exact reason for a miscarriage is often unexplainable, it can occur due to a number of reasons. These include chromosomal abnormality, improper implantation of the egg and maternal health problems or trauma. The mother’s age also plays a significant role, as does her lifestyle, which includes exposure to stress, smoking, drug use, malnutrition, excessive caffeine, radiation and toxins.
Another well-studied factor than increases a woman’s risk for miscarriage, is her weight. As these studies indicate, if the mother is obese or underweight, this increases her risk of not only infertility, but miscarriage as well, regardless of the method of conception.
According to researchers at the Department of Obstetrics and Gynaecology, University of Adelaide, Australia, being overweight increase a woman’s risk of miscarriage by 29%, while being obese can increase the risk by 71% or more. However, for women undergoing assisted reproduction, researchers at the Assisted Fertilization Center, Brazil concluded that maternal obesity could increase the risk of miscarriage by up to 1330%.
Obesity also compounds miscarriage rates in women with PCOS. The Department of Obstetrics and Gynecology, Faculty of Medicine, Erciyes University, Turkey found that the miscarriage rate in obese women with PCOS is about nine times higher than average.
And while miscarriage is often the result of an unhealthy fetus, researchers from the Department of Obstetrics and Gynecology, Stanford Hospital and Clinics, CA, USA found that the risk of miscarriage of a healthy fetus is significantly higher in obese women (with BMIs of 25 or more).
While obesity has been identified as a risk factor for spontaneous miscarriage, the mechanism for it remains unclear. But a study by The Academic Unit of Reproductive and Developmental Medicine, The University of Sheffield and Sheffield Teaching Hospitals, Sheffield, UK points to the endocrinological changes in obesity as possibily causing complex adverse effects including circulating adipokines, sex steroids and insulin resistance.
Women who are underweight, with a BMI of under 20, also face an increased miscarriage risk. A study by researchers at the German Cancer Research Centre found that pregnant women who were underweight faced a 70 % higher risk of having a miscarriage.
Therefore, it can be concluded that among intrauterine environmental factors, nutrition appears to play the most critical role in influencing placental and fetal growth. Since maternal undernutrition or overnutrition during pregnancy can impair fetal growth, women must adopt healthier diets and incorporate exercise to lower their risk of miscarriage.
If you have any concerns regarding miscarriage, especially after IVF, please do not hesitate to consult with your fertility consultant for advice.
Dr George Lee returns to discuss the latest medical news. Expect deep insights delivered with generous humour. Dr Helena Lim joins him this week to discuss period-tracking apps and whether it makes her work as a Consultant Obstetrician and Gynaecologist easier, or more difficult.
Dr George Lee is a renowned Urologist who dealt with male issues, whereas Dr Helena Lim is a Fertility Specialist
Find out more about what they have to say:
What you should know about PGD & PGS
If you and your partner have been struggling with fertility issues and are seriously considering In-Vitro Fertilisation or IVF, the consideration of whether you should be undergoing PGD and PGS on top of an IVF can be quite daunting. This is because, in normal IVF procedures, the best embryos are selected based on their appearance and morphology only. Therefore, the genetic content of those embryos or any chromosomal abnormality cannot be detected. However, by undergoing PGD and PGS, you will be able to screen your embryos for any potential genetic and chromosomal issues. However, before we jump into the band wagon of having PGS or PGD, there are a few things we need to consider.
What is PGS?
PGS stands for Pre-implantation Genetic Screening. In PGS, a cell is taken from an embryo which was created following an IVF procedure, so that it can be tested for chromosomal abnormalities before the embryo is transferred to the womb. This test will be able to tell us whether the embryo has normal sets of chromosomes. However, it will not be able to tell us whether this embryo has a genetic problem or not.
It is important to note that not all the patients going through an IVF required a PGS. You may want to consider it if:
- You are of advanced maternal age, whereby embryos may show greater levels of chromosomal abnormalities.
- You have had recurrent miscarriages.
- You have had repeated IVF failure.
- Either of you has a chromosome rearrangement.
The PGS procedure involves:
1. You will undergo a normal IVF treatment and your eggs will be collected and fertilised.
2. An embryo is grown in the laboratory for a few days.
3. An embryologist will perform a biopsy and remove a few cells, usually on day 3 or 5.
4. All 24 chromosomes are analysed (22 non-sex chromosomes and two sex chromosomes X & Y).
5. If the embryo is normal, it will be transferred into your womb.
6. Any remaining unaffected embryos can be frozen for later use.
7. Affected embryos will be allowed to perish.
What is PGD?
PGD is an abbreviation for Preimplantation Genetic Diagnosis. In PGD, a cell is taken from an IVF embryo so that it can be tested for a specific genetic condition before the embryo is transferred to the womb. It can be used to test for any genetic condition that is known to be caused by a specific gene.
At present, PGD is used to screen for more than 250 genetic conditions, such as Huntington’s disease, Cystic fibrosis, Thalassaemia, Duchenne muscular dystrophy and Fragile-XPDG to name but a few. Therefore, PGD enables individuals with an inheritable genetic condition to avoid passing it on to their children. The PGD process is more tidious and challenging compared to PGS. It is used to test for a specific genetic disease which is known to your family, i.e. you or your partner is confirmed a carrier of a specific gene at a certain point of the chromosome. You need to bear in mind that by performing a PGD, it does not mean that screening of ALL genetic diseases are performed at the same time. This is because human beings have millions of gene and it is impossible to screen ALL of the genes in one go.
However, not all IVF patients need to undergo PGD. You may want to consider it, or your specialist may recommend it to you if:
• You or your partner (or both) are carriers of single gene mutations.
• You ended a previous pregnancy due to a serious genetic condition.
• You have a child with a serious genetic condition.
• Either of you has a family history of a serious genetic condition or chromosome problems.
The PGD procedure involves
1. You will undergo a normal IVF treatment and your eggs will be collected and fertilised.
2. An embryo is grown in the laboratory for a few days, until it has divided into around 8 cells.
3. An embryologist will remove one or two of the cells from the embryo.
4. The cells are tested to see if the embryo has a gene that causes a genetic condition.
5. If the embryo is free of any genetic condition, it is transferred to the womb.
6. Any remaining unaffected embryos can be frozen for later use.
7. Affected embryos will be allowed to perish.
Since PGD and PGS help detect genetic conditions and chromosomal abnormalities, they help IVF patients to decide if they wish to continue with pregnancy.
The Pros and Cons of PGD and PGS
Before you decide on undergoing PGD or PGS, your fertility consultant will explain their pros and cons to you, which include:
- They can detect an inherited chromosomal or genetic issues and help prevent passing chromosomal or genetic diseases to the next generations
- They are a form of early detection of chromosomal or genetic problems before the embryo is transferred back into the uterus.
- They help increase a couple’s chances of conceiving a healthy child.
- It allows older women to still have viable children.
- There is a risk that embryos may be traumatized or destroyed due to damage during the biopsy process.
- There is always a possibility of an undetected disease, as no form of testing can guarantee 100% accuracy
- The test is expensive
- You may not have any embryos to transfer after the IVF & PGD/PGS , which is frustrating for patients because after investing time, money & effort, the result can be disappointing
- There is no guarantee that an embryo which had been screened will definitely get implanted after being transferred into the uterus. Therefore, there is no guarantee that a PGS/PGD embryo will give you a life birth.
If you and your partner are interested in or have any concerns about PGD and PGS, be sure to speak to your fertility specialist to address concerns, inquiries and options.
A good reason to keep moving
Bed rest after embryo transfer negatively affect IVF success
After every embryo transfers, my patients are generally surprised when I ask them to get up from bed to walk almost immediately. Most of them looked at me with disbelief: ‘Doctor, will my embryos fall out?’. Some of them refuted me by telling me that their friends had to lie on bed for 2 weeks after the embryo transfers to ensure that the embryos ‘sticks’. There are some who refused to get out from my operating bed and few had demanded to be warded for 2 weeks.
Well, I can’t blame them for asking that, can I? After all, the internet is full of stories of having to lie in bed to ensure the best outcome for the IVF.
However, is this really true? Does bed rest positively influence the outcome of the IVF? Is this scientifically proven?
Since the birth of the first IVF baby back in 1978, numerous medical advancements have been made to help IVF patients achieve the best outcomes. Among them are procedures like ovulation induction, egg retrieval and sophisticated laboratory techniques. While these primary procedures have been tried and tested, some of the simpler procedures, such as bed rest immediately after an embryo transfer, have not been scientifically proven.
It is generally believed that bed rest, or the reduction of physical activity right after an embryo transfer procedure, is beneficial as it can reduce a woman’s stress levels and aid implantation. However, there is a study that shows bed rest after embryo transfer can be potentially detrimental!
The 2011 study, which was conducted by a team of researchers from Universidad de Valencia, Valencia, Spain, involved 240 patients between the ages of 25 and 49 years old. They were undergoing their first IVF cycle using donated eggs at a private IVF centre. The objective of the study was to evaluate the influence of just 10 minutes of bed rest after embryo transfer on the achievement of live births, as well as implantation and miscarriage rates.
The patients were divided into two groups – the R (Rest) and NR (No Rest) groups. Those in the R group were given ten minutes of bed rest after embryo transfer by being moved from the operating room with the help of a stretcher or in a lying-down position. Meanwhile, those in the NR group had no bed rest and were allowed to ambulate (move around) immediately after their procudure.
The study’s findings revealed that the live birth rates were significantly higher in the NR group (56.7%) than in the R group (41.6%). The NR group also had lower miscarriage rates (18.3%) as compared to the R group (27.5%). Although the implantation rate was higher in the NR than in the R group, the researchers noted that the difference did not reach statistical significance. Meanwhile, neonatal characteristics like height, weight and Apgar score were similar in both groups.
Therefore, the researchers concluded that bed rest immediately after embryo transfer has no positive effect, and in fact can be negative for the outcome of IVF. They surmised that this could be due to the common anatomical position of the uterus, as concluded by another study.
It is believed that the force of gravity could cause the loss of newly-transferred embryos. However, since the cavity of the uterus is in a more horizontal position when a woman is standing than when she is lying down, a horizontal position after embryo transfer would not be beneficial.
As a result of their findings, the researchers suggest that IVF clinics change their practice of encouraging bed rest after embryo transfer. They also call for more research to be conducted on the physiological or psychological reasons for the benefits of no bed rest after embryo transfer.
The results of such studies provide us with more clues on how best to maximise IVF success. Should you have any questions or concerns about IVF procedures, as well as what to do or not do after an embryo transfer, don’t hesitate to speak to your fertility specialist.
Baby in the making- Study shows 3 out of 4 couples undergoing IVF will have a baby within five years
There are various causes for infertility, including endometriosis, polycystic ovary syndrome, damaged fallopian tubes and ovulatory problems in women, and low sperm count and motility or problems with erections or ejaculating in men. Unhealthy lifestyle habits such as smoking, illnesses like diabetes, as well as being overweight are also contributing factors.
In most cases, infertility can be treated, but for many couples who are struggling with infertility, In-Vitro Fertilisation (IVF) is their best option. Couples undergoing IVF are often faced with uncertainty and wonder – What are our chances? When will we have a baby? Some undergo IVF multiple times without success, and as they are unsure of their chances, they end up giving up.
There has always been a debate on how best to measure the success of fertility treatments, however, now a Danish study is providing realistic information that’s reliable for the long-term prediction of treatment.
The long-term study was conducted by researchers at the Copenhagen University Hospital, who referred to rigorous registry records. Denmark is one of the few countries in the world where such a study could be carried out, due to their practice of keeping detailed records that link all fertility treatments to all live births.
The researchers analysed nearly 20,000 Danish couples from 2007 and 2010, following them from the moment they started their fertility treatments. The study’s findings were recently presented at the European Society of Human Reproduction and Embryology (July 2016).
The team found that more than half of the women (57%) had their baby as a result of treatment within two years, 65% had children within three years and 71% within five years. This means that almost 3 out of 4 couples undergoing IVF will eventually become parents within five years, whether as a result of the treatment or following natural conception.
The study also found that while most causes of infertility can be overcome, the odds of conception are heavily influenced by a woman’s age. They found that in women under the age of 35, about one in three IVF cycles were successful and 80% had children within five years.
However, the total birth rates fell to 61% in those between 35 and 40 years old; and fell again to 26% in women aged 40 and over. The study also revealed that women with a Body Mass Index under 30 and didn’t smoke also had better outcomes.
These figures provide encouraging news for couples who are seeking or embarking on fertility treatments, as they reveal that their chances of having a baby are good. According to study presenter, Dr Sara Malchau, “We are now able to provide couples with a reliable, comprehensible, age-stratified long-term prognosis at start of treatment”.
Although individual prognosis and factors play a role in the success of IVF treatments, this study has shown that overall, IVF treatments are working, but they take time. Therefore, couples may need several treatment cycles for their best chance at conception.
I am extremely pleased and excited to announce the arrival of my book: “Catching My Baby Dust’, which came to a reality after many months of hard work. This book consist of inspiring true stories on the journeys couples had been through in trying to have a baby. Many of these stories detailed the trials and tribulations of their Fertility journeys. These stories are deeply touching and in many ways humbled me as a Fertility Specialist.
Here is the small note I have written for the publication of this book:
Welcome to the first edition of ‘Catching My Baby Dust’. As the Chief Editor of this book, I would like to thank you for taking your time to read this special book, which is extremely close to my heart.
As a Fertility Specialist, I have the opportunity to work with women who are from various backgrounds, ethinicities & educational levels. They have one thing in common: They all want to have a baby.
As a mother of three, I can fully understand their desire to have these little bundle of joy in their arms, and how these tiny little babies would complete and fulfill their lives. However, the reason that they are sitting in my clinic is that pregnancies did not happen naturally, and therefore they are here to seek guidance and assistance.
I must say that I feel privileged that I can do something to help them. My greatest pleasue of my daily life is to help these patients to identify the issues which prevent them from conceiving naturally and rectify their problems. Some need just a little bit of reassurance and things happenned. Unfortunately, some need much more than reassurance. And the good news is that most will eventually have a baby in their arms following fertility treatments.
Throughout these journeys, I have come across many women who had deeply touched me with their perserverance and determination which greatly humbled me. Some of these stories bring tears to my eyes and I hereby express my greatest gratitude to them by agreeing to share their stories with people out there who are trying to conceive.
I would like to thank my senior colleague, Dato Dr Prashant Nadkarni, the Medical Director of KL Fertility Centre for his valuable input. My co-editors, Dr Natasha Ain Mohd Nor & Dr Agilan Arjunan, who shared my passion in the field of fertility and had worked fervently in making this book a reality.
I would like to take this opportunity to thank Ms Sylvia Khoo, the director of Pitter Patter Sdn Bhd, Ms Adline A Ghani and Ms Lee Siew Fong helped us to co-ordinate the production of this book.
Last but not the least, I would like to thank all the readers for their constructive comment to further improve the quality of this book.
Dr Helena Lim Yun-Hsuen
Catching My Baby Dust
The Unknown Factor
Ethnicity can affect IVF success rates
For many couples who struggle with infertility, artificial reproductive techniques (ART) like In-Vitro Fertilisation (IVF) and Intracytoplasmic Sperm Injection (ICSI) are their only options in the hopes of conception and starting a family of their own. However, if you are considering IVF, it is important for you to learn about IVF success factors that can either boost or hinder your chances at pregnancy.
The main factors that may impact IVF success are age, especially of the mother; a history of previous pregnancies or miscarriage with the same or different partner; the type of fertility problem; lifestyle habits; the use of donor eggs and the fertility clinic chosen. However, several studies have contributed another factor for IVF success – a woman’s ethnicity.
In an observational cohort study conducted by the Nottingham University Research and Treatment Unit in Reproduction (NURTURE), UK, it was found that live birth rates following IVF treatment was significantly lower in Asian and Black women, as compared with white European women.
The study involved 1517 women, of which 1291 were white Europeans and 226 belonged to ethnic minorities. All these women underwent their first cycle of assisted reproductive technology between 2006 and 2011.
Despite sharing favourable chances of conceiving, such as the quality of their egg reserves, only 35% of Asian and Black women successfully conceived and gave birth after IVF, as compared with 44% of white women who were treated at the same clinic during that period.
The researchers at NURTURE are unsure why this is, but suggest that it could be down to genetics, as well as social and environmental factors. According to lead researcher, Dr Walid Maalouf, “Further research into genetic background as a potential determinant of IVF outcome, as well as the influencing effects of lifestyle and cultural factors on reproductive outcomes is needed.”
NURTURE’s findings are supported by a research conducted at the University of Kansas-Wichita, USA. The researchers there state that while the average birth rate after IVF using fresh eggs is 25.7%, this figure conceals the wide variation in the success rates for different ethnic groups.
After studying the records of more than 80,000 IVF treatment cycles carried out between 1999 and 2000, they found that the birth rate for black women was 18.7%, 20.7% for Asian women, 26.3% for white women and 26.7% for Hispanic women. They also learnt that black women had the highest miscarriage rate of 22%, compared to 13.9% for white women, 16.4% for Hispanic and 16.2% for Asian women.
Another US study, by researchers at the University of California, confirmed that Asian women had a lower pregnancy rate than non-Asians. The study looked at 1,200 IVF treatment cycles and found that the birth rate for Japanese, Indian and Chinese patients is about 60 per cent that of white women. However, the team stressed that the differences did not apply to natural conception.
Like the NURTURE team, the US teams are unsure of the reasons for these differences. According to Marion Damewoood, president of the American Society for Reproductive Medicine (ASRM), “The findings were preliminary but important, and we need to further explore these apparent racial differences to see if we can better understand and hopefully address their causes.”
While Asian couples may find these results worrying, it is crucial for all couples to be counselled on their realistic probabilities for IVF success. Based on these findings, Asian women are encouraged to seek treatment earlier to improve their chances of pregnancy.
Hard facts on a common bean
The impact of soy-based foods on fertility
Soy-based food products, like soy milk and tofu, are often considered a healthy alternative to meat and dairy. However, numerous scientific studies have shown that soy can actually cause unwanted side effects and more alarmingly, negatively impact fertility.
The main reason why soy is bad for fertility is that it contains phytoestrogens. This plant-based chemical mimics estrogen and disrupts the body’s endocrine function. Although few people realise the dangers of soy, this knowledge is not exactly new. Scientists have known about the ill-effects of soy since at least the early 1990s.
A study conducted in 1992 by the Swiss Health Service estimated that drinking two cups of soy milk per day has the same effect as taking one birth control pill. Then, a study published in 2000 by the Departments of Preventive Medicine and Obstetrics and Gynecology, University of Southern California, Los Angeles, USA found that soy decreases luteal estrogen levels and lengthens menstrual cycles.
Meanwhile, a 2005 study conducted by researchers at the National Institute of Environmental Health Sciences, North Carolina, USA found that soy causes miscarriage and infertility in mice. Another study, conducted by the Harvard Public School of Health in 2008, found that men who drank one cup of soy milk per day had a 50% lower sperm count than men who didn’t take soy.
Because soy has been proven to cause abnormal menstrual cycles, altered ovarian function, early reproductive deterioration and subfertility/infertility, it is considered particularly harmful for women and men who are trying to conceive. Women who are pregnant or breastfeeding and infants are also discouraged from consuming soy-based products.
But even if you rarely eat tofu or drink soy milk, you’re not completely out of the woods. In fact, you may be consuming soy in other forms. These days, many processed and refined foods contain soybean oil, soy flour, soy lecithin or soy protein. Therefore, you may not know that you’re actually eating soy-based foods as they’re hidden away in the ingredients list.
It is important to note, however, that traditional fermented soy products, like miso and tempeh, may be beneficial to health. But the high intake of processed soy has a less desirable effect on health. Therefore, if you’re trying to get pregnant, it is best for both you and your partner to exclude soy from your diets. If you have any doubts or questions, as always, be sure to consult with your fertility consultant.
The dairy seesaw
How dairy may lower or increase your risk for infertility and miscarriage
Dairy is a good source of calcium, protein, vitamin D and phosphorus, which is why pregnant women are often advised to include dairy in their diet. After all, these nutrients are essential for a baby’s developing bones, teeth, muscles, heart and nerves. However, some studies have shown that some dairy products can be good for you, while others can be bad. So before you reach for that glass of milk or bowl of ice cream, let’s weigh the pros and cons of dairy.
According to an eight-year Harvard study involving around 18,000 women, the moderate consumption of high-fat dairy products like ice cream, whole milk, yogurt and cheese is considered fertility and pregnancy friendly. This is because whole milk contains a complete protein that is important for egg quality. Their findings showed that dairy could reduce the risk of anovulatory infertility by more than 50%. and lower the risk of miscarriage by 33%.
Meanwhile, another study by the Laboratory of Experimental Endocrinology, University of Crete, School of Medicine, Heraklion, Greece, has found that dairy may reduce the body’s unwanted immune response, which secretes antibodies that affect the fetus and can cause recurrent miscarriages.
While the moderate intake of dairy is beneficial, the high consumption of milk has been linked to a decrease in fertility. This is because excess protein intake (more than 120 grams a day) can cause embryo implantation problems. In addition, women with dairy intolerance and allergies are more likely to miscarry.
However, many people are unaware that they are lactose intolerant. According to the Physicians Committee of Responsible Medicine, 75% of the world’s population is lactose intolerant. A study published by the European Journal of Obstetrics, Gynecology, and Reproductive Biology (2001) also found that eating butter and oil can double a woman’s risk for miscarriage.
What about low fat dairy?
It is known that full-fat dairy foods contain the female hormones estrogen and progesterone. But when fat is skimmed from the milk, the process removes these hormones and leaves behind male hormones or androgens, which impairs ovulation. The same Harvard study mentioned above found that low fat dairy can increase the risk of ovulatory infertility by 85%.
Milk and hormones
While we’re on the subject of hormones, it is important to note that because animal milk contains hormones, high intake of dairy may disrupt your own hormonal balance. Some of the fertility issues that can be associated with hormone imbalance are PCOS, Endometriosis and male infertility.
A study conducted by researchers from the Cancer Epidemiology Centre, The Cancer Council Victoria, Melbourne, Australia has found that women who eat high amounts of dairy can have 15% higher estrogen levels, which may influence circulating concentrations of estradiol. Estradiol is a form of estrogen that while is necessary for many processes in the body can also cause harm to pregnancy and unborn babies.
Milk and inflammation
In traditional Chinese medicine, dairy is believed to be ‘damp’ and cause inflammation, which hampers fertility and causes problems in getting pregnant. However, in Western medicine, several studies have been found that dairy can help reduce inflammation.
For example, researchers from the Department of Nutrition and Biochemistry, School of Public Health, Tehran University of Medical Sciences, Iran discovered that probiotic yogurt can lower one marker of inflammation by 29%.
A similar study by the Department of Nutrition Science-Dietetics, Harokopio University, Athens, Greece also identified an inverse association between dairy products consumption and levels of various inflammatory markers among healthy adults. They found that dairy lowers inflammatory markers by as much as 16%.
These findings are supported by another study by the Department of Nutrition, University of Tennessee, Knoxville, USA, which found that calcium and dairy consumption can reduce tissue oxidative and inflammatory stress.
From the findings above, we can conclude that the moderate consumption of whole dairy products is beneficial to fertility and pregnancy. However, if you’re feeling uncertain, don’t take the drastic step of cutting dairy out of your diet completely. Instead, speak to your fertility consultant about how much dairy you should be consuming.
The right balance
Benefits of a high protein, low carb diet on fertility
Maintaining a well-balanced and healthy diet is highly recommended, especially when you’re trying to have a baby. But did you know that a high protein, low carb diet could help to boost your fertility? That is precisely what a study by the Delaware Institute for Reproductive Medicine (DIRM) in Newark, New Jersey, USA has found.
The study, which was conducted between January 2010 and December 2011, looked at 120 patients who participated in assisted-reproduction therapy programmes at the DIRM. The patients were asked to keep diet diaries and document what they ate, prior to undergoing an embryo transfer.
According to the head researcher, Dr Jeffrey B. Russell, they wanted to understand why their thin and healthy patients had poor quality embryos. After analysing his patients’ diet diaries, he was surprised to see that a large percentage of the women were eating more than 60% carbs each day and 10% (or less) protein. Those who ate like this were found to have poor quality embryos.
Meanwhile, patients whose daily protein intake was 25% or more of their diet and whose carbohydrate intake was 40% or less of their diet, had four times the pregnancy rates of other patients who ate less protein and more carbs daily.
While no differences were found in the body mass index (BMI) of either group, there was a significant difference in egg and embryo quality. “Protein is essential for good quality embryos and better egg quality, it turns out,” said Dr. Russell.
This conclusion was made after the research team assessed embryo development after five days of culture or at the blastocyst stage. It was found that 54.3% of patients whose daily protein intake was greater than 25% had an increased blastocyst formation. Meanwhile, patients whose daily protein intake was less than 25% had 38% blastocyst formation. The study also found that pregnancy rates significantly improved in patients with greater than 25% daily protein intake.
Due to these findings, Dr. Russell and his colleagues at DIRM have made it a requirement for their patients to eat a diet consisting of 25% to 35% protein and 40% or less carbs for three months, before beginning their IVF cycles. So if you are looking to ensure the health and quality of your eggs, it is best to start changing your diet to include more proteins and less carbs.
However, it is important to keep in mind that it’s not just about the right amount of protein, but the right kinds too. It is best for you to load up on low mercury fish and seafood like pomfret, sardine, salmon, tilapia, shrimp, shellfish, tuna (canned light) and cod; skinless chicken or turkey; eggs and lean beef, as well as fresh and full cream milk, cheese and yogurt. If you’re vegetarian, your best sources of protein are legumes like beans and lentils; nuts and seeds; as well as organic soy products like edamame and tofu.
Up in smoke
How smoking affects fertility in both men and women
We all know that smoking is a bad habit and it can put us at risk of heart, vascular and lung disease, as well as cancer. But, did you know that according to the Centers for Disease Control and Prevention (CDC), smoking can lead to fertility problems in both men and women? Additionally, numerous studies have shown that smokers take longer to conceive – but that’s just the tip of the iceberg!
Cigarettes are so harmful because they contain over 7,000 chemicals, including formaldehyde, nicotine, cyanide and carbon monoxide. Needless to say, these chemicals are very harmful to the body and they can spread to all your internal organs. With regards to fertility, they can cause permanent damage to eggs, sperm and the genetic material they contain.
It comes as no surprise, therefore, that both male and female smokers have twice the risk of infertility as compared to non-smokers. According to the American Society for Reproductive Medicine (ASRM), available biological, experimental and epidemiological data shows that 13% of infertility cases may be attributable to smoking. Worse still, cigarettes are addictive and the more you smoke in a day, the higher your risk for fertility problems.
We know that a pregnant woman should never ever smoke, as it can cause miscarriage, pregnancy complications and birth defects. But a woman should be concerned about the effects of smoking well before she is pregnant. In women, cigarette smoke can accelerate the loss of eggs. This in turn leads to the early onset of menopause, which can be made faster by up to four years states the ASRM.
Smoking therefore adversely affects a woman’s chance of success if she undergoes IVF, as fewer eggs will be retrieved. Women smokers are also more likely to develop pregnancy complications like miscarriage, ectopic pregnancies and preterm labour. Cigarettes are equally harmful to men, as they cause hormonal imbalance, sperm abnormality, erectile dysfunction, as well as decrease sperm count, motility and ability to fertilise eggs.
But beyond that, men who smoke also put their non-smoking partners at risk. Research has shown that non-smoking women, who are constantly exposed to second-hand cigarette smoke, can suffer from a higher risk of infertility as well.
Therefore, if you have plans of starting a family, it is best for you (and/or your partner) to kick the smoking habit immediately. Fortunately, it is believed that most of the negative effects of smoking can be reversed within about a year of quitting. However, it is important to bear in mind that once a woman’s eggs have been lost, they cannot be retrieved.
How alcohol affects fertility in both men and women
You’ve probably heard of the saying, “Drink to your health,” but when it comes to safeguarding your fertility, moderation is definitely key in alcohol consumption. Women usually swear off alcohol once they find out they’re with child, but in truth, it is best for them to abstain from alcohol as soon as they’re ready to start a family. And it’s not just women who should keep tabs on their alcohol intake!
A growing number of scientific studies have shown that as little as one alcoholic drink a day can lead to detrimental effects in one’s chances at conceiving. For example, according to a study published in the American Journal of Epidemiology in 2004, alcohol can shorten a woman’s follicular phase and menstrual cycle.
Meanwhile, a 2009 study conducted at Harvard University found that in couples undergoing IVF, women who drank more than six units of alcohol per week were 18% less likely to conceive, while men were 14% less likely. This finding was supported by a study published in 2011 in the Annals of Epidemiology. Entitled ‘Alcohol, Smoking, and Caffeine in Relation to Fecundability, with Effect Modification by NAT2,‘ it concluded that alcohol intake was significantly associated with reduced fertility.
The study, which followed 319 women over an average of 8 menstrual cycles and 124 pregnancies, discovered that women who drink alcohol once a day can experience a 30% reduction in fertility, while those who took more than one alcoholic drink a day experienced a 50% reduction.
Another study published in 2011, entitled ‘Effect of alcohol consumption on in vitro fertilization,’ published in the Journal of Obstetrics and Gynecology found that drinking before becoming pregnant can lower live birth rates by up to 21% in IVF patients.
This prospective cohort study involved multicycle analyses with final models adjusted for potential confounders that included cycle number, cigarette use, body mass index, and age. From the 2,545 couples studied, it was found that women who drink at least four drinks per week had 16% less odds of a live birth rate compared with those who consumed less alcohol.
Although there is a link between drinking and fertility, researchers still do not know exactly how alcohol impairs fertility, says Dr Anthony Rutherford, a consultant in reproductive medicine and Chairman of the British Fertility Society.
However, it is clear to researchers that alcohol doesn’t just affect female fertility. According to Dr Patrick O’Brien, spokesperson for the Royal College of Obstetricians and Gynaecologists, “Excessive alcohol lowers testosterone levels and sperm quality and quantity in men. It can also reduce libido, and cause impotence.”
Fortunately, however, any damaging effects alcohol has on fertility can be quickly reversed by reducing alcohol intake or abstaining from it, as well as getting proper nutrition and leading a healthier lifestyle. Therefore, before you raise your glass next time, spare some thought over how it can stand in the way of your goals of starting a family.
(1) good quality and quantity of eggs and sperms to make good quality embryos
(2) a conducive uterus environment for implantation
In some cases whereby the husband’s sperms were poor in quantity & quality, whereby natural conception is virtually impossible, a Intracytoplasmic sperm injection (ICSI) technique to fertilize eggs during an IVF cycle overcomes certain degree of difficulty to create an embryo. However, if the sperms are extremely poor in quality, there are good scientific evidence to suggest that Fertilization and cleavage rates, quality of embryos as well as blastocyst development rates were significantly reduced, as semen quality decreased.
An IVF cycle can also be unsuccessful if egg quality is poor even with good numbers of eggs (and embryos). Egg quality reflects about 95% of the final quality of an embryo. Poor egg quality, therefore, always leads to poor embryo quality. The quality of sperm, while not unimportant, is nowhere near as important as egg quality.
Embryos from low-quality eggs often fail to develop properly. In an IVF cycle, embryos are observed for 3 to 5 days as they grow, before they are transferred into the uterus. On the third day, good-quality embryos should reach 6- to 8-cell stage, and have a more or less regular shape. Embryos that don’t reach this stage within the first few days of development cannot be used for embryo transfer. In addition, some embryos that do reach this stage may be aneuploid (have chromosomal abnormalities). Aneuploid embryos, if they implant at all, are usually miscarried early in the pregnancy, thus also resulting in “failed” IVF.
Therefore, as many of our patients already know, it is not just the number of eggs that is important. The quality of eggs is also crucial for the success of IVF.
Although some people are born to have poor sperms or eggs, majority of poor sperms and eggs can be improved by various means. Change of lifestyles such as stop smoking, stop alcohol intake, exercise moderately, weight reductions, good quality sleep, good nutrition by taking balanced diet, taking food rich in anti-oxidants, acupuncture and etc are some of the strategies one can employ to improve sperms and eggs quality.
Numerous studies had shown that with these improvements in lifestyle, the success rates of IVF in these group of patients improve remarkably.
Therefore, if your doctor had commented that your sperms and eggs are not good in quality, it maybe a good idea to look into your lifestyle and food intake to improve your chances of pregnancy