Author Archives: helenalimyh

Fresh embryo transfer versus frozen embryo transfer

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8c-embryo1

 

Recently, a few patients came in with some information from the internet with regards to frozen embryos transfers. These information suggested that Frozen embryo transfers has a higher pregnancy rates compared to fresh embryo transfers. Therefore, the patients requested to undergo the IVF cycle so that they can freeze all the embryos and have the embryos transfer back in later cycles.

 

This practice is not something new. With the vast improvement in freezing technology using a new technique called ‘vitrification’ or rapid freezing method, the survival rates of embryos after freezing and thawing is close to 95%. Therefore, in a reasonably good IVF cycle, apart from having 2 embryos to transfer back during the fresh cycle, majority of patients would have good number of embryos to be frozen which can be used during the next cycle. It is not unusual to find that if the patients did not manage to get pregnant during the fresh cycle, when they come back for frozen embryo cycle, the pregnancy rates are close to 80-90%. A recent study conducted at KL Fertility Centre which looked at success rates of fresh cycles and frozen cycles of all women under the age of 42 and the statistic showed a 1.4x higher pregnancy rates for frozen embryos transfers. There is also significant lower miscarriage rate whereby there is a 2.5x reduction of miscarriage.

 

This finding coincides with the recent paper published in Fertility & Sterility, one of the world leading medical journal in Fertility. This paper consists of a meta analysis of a few studies which looked at the pregnancy rates for Fresh embryo transfers versus Frozen embryo transfers and the result showed a significant higher pregnancy rate in Frozen embryo transfers and a lower miscarriage rate. The results favoring Frozen Embryos Transfers instead of fresh embryo transfer may be related to the adverse effects of Controlled Ovarian Hyperstimulation (the drugs we used to stimulate your eggs to grow) on endometrial receptivity (which is the term we used for how ready your womb to accept the embryo for implantation) , as well as the improved results that can be achieved with current cryopreservation methods (which is the rapid freezing method, or vitrification).  (Rogue M at el. Fresh embryo transfer versus frozen embryo transfer in in-vitro fertilization cycles: a systematic review and meta-analysis. Fertil Steril. 2013 Jan;99(1):156-62)

 

So, for those who have not been successful during the fresh cycle, please be reassured that when you come back for your frozen cycle, there is a higher chance of getting pregnant. Please do not beat yourselves up and turn the disappointment of the failed fresh cycle into a long-term grief. If you keep moving on, you will get there!!!!

Cumulative Pregnancy Rates for IVF

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I absolutely LOVE to give my patients the news they wanted to hear. ” Yes, Madam XYZ, your pregnancy test is positive”, and I live on the thrills of having them laugh with tears of delights and relief. However, on the flip side of the coin, I HATE to give them the news they dreaded most, which is when the test result is negative.

 

This is the reality of IVF, you win some battles, and you lose some. We rejoice with the patients’ victories and we weep for their defeats.

 

For those battles that we lost, what is the next step forward?

 

We talked about the overall success rates of ONE IVF a few days ago and  we know for sure that if you have a good number of embryos from the result of ONE IVF, the chance of you getting pregnant with the subsequent Frozen embryo transfer is extremely likely, especially if you are under the age of 35. In fact, there is some evidence to suggest that Frozen embryo transfers yields a higher pregnancy rate compared to fresh embryos transfers

(Rogue M at al. Fresh embryo transfer versus frozen embryo transfer in in-vitro fertilization cycles: a systematic review and meta-analysis. Fertil Steril. 2013 Jan;99(1):156-62)

However, if you have no embryos frozen, what is your option?

This chart below showed a cumulative live IVF births from a study conducted in Australia.

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.

 

 

Cumulative Birth Rates

 

The Reality of IVF

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pregnant woman

 

 

 

 

 

 

 

 

 

 

Many couples choose their Fertility doctors because of their preference towards a characteristic of the doctor, however, many more choose to undergo their IVF treatment under a doctor or a centre because of the perceived success rates of the doctor or a centre. A published survey in the UK revealed that success rate of a centre or a doctor is the key determining factor for the decision of going through IVF in a particular Fertility Centre.

 

Therefore, all IVF doctors and centres strive very hard to increase the success rates of their patients. We emphasize on the patients’ lifestyle and age, in hope to get them to come at a younger age and in a better state of body fitness, so that we can obtain better eggs and sperms and hence make better embryos. We improve our laboratory environment and technology to mimic the uterus environment to yield a better fertilization and growth rate. We pat our own shoulders when we produce good quality embryos. And then we transfer the good looking embryos into the uterus and we wait……

 

10-12 days later, we either rejoice with the patient for a positive result, or we put on a very sad and sorry face to deliver the bad news

So what happened in between the time after we put those embryos back into the uterus until the time we test for pregnancy?   The answer to this is that nobody knows.

As doctors we placed the embryos back, and nobody actually knows when and how the embryos get implanted, and what determines whether the embryos will get implanted or not.

This is the Holy Grill of the science and wonders of IVF

Many people had tried various things, complete bed rest, baby aspirin, steroids, hanging the legs up and etc etc etc.

Studies after studies failed to show any good recommendation on what we should do to improve the implantation rates. Some people believe that by performing a Pre-implantation Genetic diagnosis (PGD) can improve the implantation rates. There is some logic behind this: by selecting the normal chromosomal embryo to put back into the uterus, the chance of implantation increases. However, years had gone by with such a practice being implemented in some centers and there is only a marginal increment in pregnancy rates.

A recent study conducted at KL Fertility Centre (Monash IVF, KL) showed some interesting data.

We looked at all the women going through one IVF and divide them into 3 different groups by age.

Women who are under the age of 35 have 60% chance of getting pregnant during the fresh cycle when we put back the embryos into their uterus.

If they do not get pregnant during the first round and have good embryos which can be frozen and to be used in a later date, the chance of them getting pregnant by replacing 1-2 frozen embryos is around 60%.

By the time this group of women exhausted all their embryos which were produced by ONE IVF treatment, the likelihood of them having at least one baby is around 80%.

This translates that 4 out of 5 couples who are under the age of 35 will get pregnant with just ONE IVF attempt.

The success rate is about 60% in women between the age of 35-40 with the same trend observed.

Even for the group of women who are in the range of over 40 years of age, the success rate is close to 30%.

This certainly have a significant impact on the way we think….we now know that the chance of pregnancy is extremely good by just having ONE IVF without even having to subject the embryos to expensive and potentially hazardous pre-implantation genetic testing.

 

The key thing is to just keep moving on!!!!!

 

klfc_successrate_infographic-v2-b (2)

Success Rates of IVF

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pregnant woman 2

 

A published survey from the UK showed that the success rates of a particular Fertility Centre is a key factor for patients  in deciding which Fertility Centre they choose.

Therefore, it is not unusual for patients to ask me what is the success rate of IVF in my centre. In places like UK, it is mandatory to submit the centre’s data to the authority (Human Fertilisation & Embryology Authority, HFEA) for publication and regulation. However, in Malaysia, these data are not readily available.

The data from most clinics in the UK suggested that most of the centres were about the same in terms of the success rates. According to the HFEA, an individual centre’s success rates can be affected by:

  • the type of patients a clinic treats e.g., their age, diagnosis and length of infertility
  • the type of treatment a clinic carries out
  • a clinic’s treatment practices

A clinic that treats proportionately more patients with complicated diagnoses may have a lower average success rate than clinics that treat more patients with common fertility issues.

Clinics may have higher success rates for treatment if they treat women who are not infertile but who have no male partner and are using donated sperm in their treatment.

Quoted : http://www.hfea.gov.uk/fertility-clinics-success-rates.html#11

A comparison of KL Fertility centre’s data suggested the same trend:

klfc_successrate_infographic-v2-b (2)

 

 

The chart above showed that if you are under the age of 35 and attempts one IVF, your chance of getting pregnant by putting back 1 or 2 embryos during the same cycle is around 60%.

If you do not get pregnant during the fresh attempt and have enough good quality embryos frozen resulting from that particular IVF cycle, your chance of pregnancy by having a frozen embryo transfer is around 60% as well.

Hence, if you look at the pool of patients under the age of 35, taking into account of both fresh and frozen embryo transfer, the success rate is around 80%.

This translates that 4 out of 5 couples who are under the age of 35 will get pregnant with just  an IVF attempt.

Therefore, if you have not been successful during the fresh embryo transfer cycle and have enough embryos frozen, you can be reassured that your chance of pregnancy is extremely likely during the frozen embryo transfer!!!

 

Age and IVF success rate

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Many couples went through IVF in hope to have a child. Many view this treatment as the last resort to having a child. Therefore, it is not unusual for me to encounter couples who had exhausted ALL forms of treatment and landed in my clinic after many frustrating years. Some had come a bit too late….

Part of my job as an IVF specialist includes constantly being asked by patients on their chances of pregnancy by IVF.

This is definitely a relevant question. IVF is an expensive treatment and certainly after spending XYZ amount money on this treatment, you would like to know what is your chance of pregnancy.

In general, the chance of pregnancy depend on 3 most important factors: The woman’s age, the number of years of subfertility & whether there had been any pregnancies in the past.

Out of these three factors, the most important and relevant factor would be a woman’s age.

Studies had shown that after the age of 35, the chance of women getting pregnant naturally as well as through Fertility Treatment declined gradually. There is a further sharp declined after the age of 40.

I do not mean to press the panic button for all the women over the age of 35. However, I strongly feel that this is an important message which many Fertility Specialists like us had not been shouting loud enough to educate the general public.

Studies from Australia & US had shown that the success rate of an IVF is around 50% before the age of 35. The success rate drops thereafter and hit the range of 20-30% by the time the woman turns 40. The chance of pregnancy after the age of 44-45 is close to 0%.

The reason for a lower success rate after the age of 35 is a combination of the fact that age is associated with decrease number of follicles and quality of the eggs. For women, we are born with millions of eggs and the process of recruitment and activation of eggs started as we reached puberty. The number of eggs in our ovaries go down as we aged. By the time we each menopause, the eggs were completely depleted in our ovaries. Therefore, at the age of 35, we are expected to be producing less number of eggs. As we age, the quality of eggs also decrease and there is higher likelihood to produce eggs with abnormal chromosomes. Therefore, there is a higher risk of miscarriage and fetal anomalies.

 

 

 

 

A Ray of Sunshine

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I received a call from Mrs Sunshine, one of my IVF patient, who informed me that she had delivered her baby a week ago via Caesarean section at 34 weeks due to severe intrauterine growth restriction. Although the baby was small in size, she was doing very well in the neonatal ICU, not requiring ventilation and was discharge after 3 days.

In December 2012, Mrs Sunshine came to see me for fertility assessment and treatment following 2 miscarriages (recurrent miscarriages). She is a slim and graceful lady with a beautiful smile. Along with her is her loving and understanding husband. They lived in Raub Pahang and every appointment required them to drive more more than an hour to get here.

Her previous 2 pregnancies ended at 5-8 weeks respectively with no evidence of fetal heart beat. Blood tests revealed no abnormalities. She decided to have an IUI under my care but unfortunately she did not get pregnant.

At that time, she started a blog called Wishing for a Sunshine: http://wishingforasunshine.blogspot.com/, which I was not aware of initially. In her blog, she carefully recorded her struggles with Fertility Treatment and all the ups & downs along the way. This is the first time, as a Fertility Specialist,  I am able to have a clear insight of the perspective of a patient going through fertility treatment under my care. As a female fertility specialist, I always pride myself to think that I would understand how a woman feel especially in terms of the desire to have a child, but what strikes me is that sometimes, there are still certain personal struggles one faced whilst going through fertility treatment. As a doctor, I can now understand that comforting and reassuring words which I said, could give patients such confidence to move forward in the quest of having a child.

She went on with an IVF under my care and successfully got pregnant and have a few embryos frozen for later use. Although her pregnancy had not been easy, but it all turned out well eventually. 

Months after her IVF, my other patients told me about her blog, which was very widely read by many. These patients unanimously told me how her story had greatly inspired them, motivated them to move on with Fertility Treatment.

Although Mrs Sunshine was wishing for a sunshine in her womb, but in fact, she herself had turned out to be a sunshine giving rays of hope for many threading the same journey.

My congratulations to Mrs Sunshine and a big thank you to her for blessing others in her special way!

New Year Surprises

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Giggle baby

My New Year was filled with a few good news, which is definitely a good way to start a brand new year.

A patient of mine, Madam P, gave birth to a baby girl vaginally after an induction of labour. Madam P was a patient with severe Polycystic Ovary Syndrome, who had come to see me in a very depressed condition. She had consulted 5 different gynaecologists before, and was told that she will never get pregnant. At that time, she was already married for 7 years. She was obese, stressed and depressed. She hardly have any menses. Most of the time, she needed medication to induce menstruation.

She told me that she was discriminated from her relatives as she was not able to get pregnant. Relatives stopped inviting her to weddings and baby showers as they feel that she was infertile, which may bring bad luck to other couples.

One unique thing which strikes me about Madam P is her husband Mr A, a very loving and supportive husband, who literally stood by her throughout this special journey.

The first thing I told Madam P is that she needs to lose weight and bring down her sugar level. Madam P is a high-flying executive in a bank, and the pressure of work caused her to eat for comfort. This causes a spiraling vicious cycle on her body image and stressed her even more.

It took me a few months to convince her to see a dietitian to change her habit of eating and reluctantly she signed up for gym to lose some weight.

Along the way, she went into depression, requiring clinical psychologist’s support.

Six months along the way, she decided to quit her job and change her lifestyle. She started cooking at home so that she can eat healthily, spend more time with her dogs, exercise and to pursue fertility treatment.

I went on with her and started an IUI cycle which did not work out. She attempted an IVF cycle but the follicles failed to grow. She was devastated.

She stopped seeing me for  4-5 months, and then one day she appeared at my clinic again.

At that time, her father had passed away unexpectedly at the age of 60 due to a heart attack. Suddenly, it threw things into perspective for her: She told me that she is going to go all out to have a baby, for the sake and the remembrance of her dad, who had supported her throughout this journey but have not lived to see this dream of hers coming true. She felt that this was the only thing she can do to keep her dad alive in her heart.

She gritted her teeth and started a weight loss programme with the help of a dietitian and a gym instructor, and managed to lose 15 kgs within 2-3 months. Her period started to become regular again. Upon her return from India for the prayers of her late father, we noticed that things beginning to change for her. She was also seeing an acupuncturist to  prepare her body prior to an IVF.

I scanned her as part of my assessment prior to IVF, and I was delighted to see a growing follicle which was just about to ovulate. I suggested an IUI for that particular cycle.

Lo and behold, she got PREGNANT!!!!

We could not believe our eyes when we saw the urine pregnancy test, which was further confirmed by the blood test result.

P & A was over the moon, and of course the rest was history.

This whole journey took us two years and it ended up with a sweet victory.

The point I wish to bring forward to many of you who are out there and still struggling with trying to have a baby is:  Nothing is impossible. The key thing is to keep moving forward and do the right thing. Like Madam P, she was told that she could never get pregnant but yet she did not give up, even though she have had some setbacks with Fertility Treatment.

The story of P had definitely inspired me, and taught me a good lesson about life. I hope it will be the same for you!

The History of Monash IVF in Malaysia

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Some of my colleagues and friends were curious: how did my life change after the IVF unit I was working at became part of Monash IVF, one of the oldest and prestigious IVF in the world?

I must admit that I was very proud to be one of the members of such distinguished establishment. I started working at KL Fertility Centre way before this unit merged with Monash IVF and I was here to witness this transition and was feeling very blessed to be involved in the whole journey.

First and foremost, let us look through the history of Monash IVF and how this humble little unit had made such significant impacted to the world of IVF:

With over 40 years of experience, over 20,000 babies and pregnancy rates among the best in the world, Monash IVF is the leading fertility research and treatment centre in Australia. They continue to achieve many world firsts in IVF and related technologies since the work of their pioneers who achieved the first IVF pregnancy in the world in 1973. Amazingly, 12 out of the first 15 IVF babies in the world are Monash babies. Some of the team’s groundbreaking achievements of Monash IVF include:

(1)World’s first IVF pregnancy in 1973. This was the first time scientist had proven that conception can be achieved outside human body and the resulting embryos can be placed back into the womb and resulted a pregnancy. However, this pregnancy ended with an ectopic and had to be terminated. Following this breakthrough, the Cambridge group in the UK used the similar technique to achieve the first IVF life birth. Louise Brown was the first baby born through IVF.

(2) World’s first microinjection (ICSI was developed as a result of this work) in 1980

(3) World’s first frozen embryo birth in 1984

(4) World’s first frozen embryo twins in 1985

(5) World’s first donor egg baby in 1983

(6) World’s first pregnancy and birth from a sperm retrieval operation for azoospermia in 1986

(7) Australia’s first surrogate birth

(8) Australia’s first open testicular biopsy twins

(9) Australia’s first blastocyst baby

Having boasted so much on the history of Monash IVF, so what does it mean to the unit I am working at? How does it change my life for the better? how does it assist me in helping my patients to improve their chance of pregnancy? I asked myself the same questions as the unit was going through the process of merging. Then came 1st of January 2013, the truth unveil itself.

(1) Improvement in recording, reporting and self-auditing for Quality Control

The unit was required to do thorough reporting on monthly basis. The Head Quarters in Australia requires us to report every cases of Fertility Treatment (IUI, IVF, ICSI) and to report the statistics of our success rates. The Headquarter pay meticulous attention to the success rates of the unit and will flag up unusual occurrences and this is most important for our quality control.

(2) Setting standards

Another important aspect of Monash IVF’s involvement in our daily practice is to standardize our practice and to set standards on the process of performing IVF, including the patients’ treatment cycle as well as the standard of the laboratory. This is to ensure that our standard of care is comparable to the standard of care in Australia.

(3) Technology transfer especially for the embryology laboratory

Regulation and transfer of technology for the embryology laboratory is one of the key component of involvement Monash IVF. The chief scientific director, Dr Tiki Osianlis from Monash IVF came and spent some time in our laboratory to look through the laboratory workflow and process. Her enthusiasm and her professionalism was inspiring and encouraging for our embryologists. Her continuous involvement includes supporting our embryologists with the latest information and technology to further improve the performance of of laboratory.

Tiki

Dr Tiki Osianlis (middle) with our embryologists

(4) Research

Monash IVF had been and is still actively involved with Research in Human Reproduction. Many current technologies involved in IVF today was the result of research of yesterday by a group of researchers from Monash IVF. Some of the key research areas we are involved in can be found under this link: http://monashivf.com/category/research-and-education-foundation/research-interests/ Some of the recently completed research by Monash IVF can be found under this link: http://monashivf.com/category/research-and-education-foundation/completed-projects/

(5) Sharing of information and scientific data

Our direct link with Monash IVF provides us with an excellent opportunity to be involved with research. As a centre located in the heart of South East Asia with heterogeneous group of patients from various ethnicity, KL Fertility Centre serves as an excellent partner in providing scientific data to further strengthen the power and significance of the study.

Contraception – women’s right to choose

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women with pills

Contraception – women’s right to choose

If anyone were to ask me which story I would like to share when it comes to stories on prescribing contraception, I would not hesitate to tell you my experience while training under the legendary Professor A.

Professor A is a famous senior professor attached to the unit where I was training to be an Obstetrician & Gynaecologist. She was one of the first female obstetricians in this country, who is highly respected and well loved for her integrity and discipline. In many ways she was my teacher and mentor. However, she was not the easiest boss to please: she expected nothing less than perfection from her trainees. I can still recall the days whereby I woke up at 5.00am every morning and arrive at the hospital at the wee hours of the day, woke patients up from their beds to obtain the latest updates and progress on their medical conditions. By 8.00am sharp, Professor A would have arrived at the ward, fresh and energetic, to start the consultant ward rounds. Professor A would expect us to know A to Z about the 20-30 patients under our care. She would get extremely upset if we flipped the notes to gather information in front of her. And honestly, it was a great challenge to remember every single detail of these patients without getting our facts mixed up. But Professor A is no fool as she could remember every single detail of these patients, and she would not hesitate to point it out directly, which sometimes could be quite embarrassing for us in front of everyone else.

It was a scary and challenging period of our lives. To survive the wrath of Prof A, we worked so hard to make sure that we meet her standard. One of the most important aspects of our presentation is our counseling on contraception. Professor A would expect us to have counseled the patients and their husbands regarding the choice of contraception and she would expect that the discussion ended with the couple making the most reasonable choice. If any single part of these steps were missed, Professor A would get extremely upset.

It was a great challenge, to wake patient up at 5.00am in the morning and bombard them with all the choices of contraception and expect them to make the decision at such wee hours of the day, and many of these patients may have just returned from the labour suite after going through long and difficult labour…..Many of them would have looked at us like a zombie as we rattled through all various choices of contraception. Some would even be irritated and ignored us. Sometimes, we even get sarcastic remarks and angry statement from the husbands. But the job needs to be done. And I must admit that sometimes when we did not get the answer from the patients, we lie through our teeth in front of Professor A……It was our survival instinct….

When I looked back at this period of my professional life, I used to wonder what kind of impression I have made upon these patients with regards to contraception. Many times I wished that this information could have been imparted to them while they were still pregnant so that they could have time to digest and discuss this information with their partners. I have also secretly wished that I have opportunity to sit down with their partners to help them to make an informed choice.

As I become more mature professionally, I began to actively discuss contraception with these patients while they attend the antenatal clinics. Professor A had taught me that contraception is such an important issue which many of us have neglected because we thought it is not important. Many patients who were not ready to be pregnant again physically or mentally came back to us pregnant at the most inconvenient period of their lives, putting themselves and their pregnancies at risk, and causing sleepless nights for the managing obstetricians. Education, like Professor A stressed, is the only solution to this vicious cycle.

Therefore, I strongly believe that education on contraception should be incorporated in our women’s health education and sex education. Education is to help individuals to make informed choices and should not be deemed as promoting casual sex or immoral conducts. Education on contraception should be viewed as part of health education rather than something that one needs to discretely find information on.

Let us make contraception a valid and conscious choice for all.

Contraception and its myth

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contraceptive pills

 

Contraception and its myth

Being a modern woman in the 21st century, I faced many challenges in various aspects of education, family & career. Working as an obstetrician and gynaecologist in a busy university hospital, I have experienced numerous personal struggles in striking a balance between my ongoing educations, career pathways and raising a young family.

Pregnancy and parenthood is a beautiful journey and brings enormous joy to every couple. However, if a pregnancy occur at an un-timely period, it could potentially throws life into disarray causing unnecessary stress and challenge to a couple. Therefore, planning a pregnancy is very important especially in this modern era. The advent of contraceptive pills since 50 years ago had revolutionized the concept of family planning and empowers modern couples to take control of their fertility and pregnancy. It gives them the choice to decide on the timing of pregnancy and plan ahead to ensure that they can embark on the journey of pregnancy and parenthood at the most suitable time of their lives.

Contraceptive pill is an excellent choice of contraception as it is convenient, reliable and safe. Apart from being an effective means of contraception, contraceptive pills have many beneficial side effects which can significantly improve the quality of life of a woman. By taking contraceptive pills, women faced less undesirable body and emotional changes associated with menstruation such as premenstrual symptoms (PMS), painful menstruation (dysmenorrhoea) and heavy menses (menorrhagia). Contraceptive pills also have the benefit of regulating a woman’s menstrual cycle, improving the skin quality, reduces the risk of benign breast and ovarian cyst, and reduces the risk of ovarian and womb cancers in the long run.

However, there are still so many myths surrounding contraceptive pills amongst the society which inhibits the use of contraceptive pills as an effective means of contraception. Day and night, I have seen patients from various age groups who walked into my clinic requesting for termination of pregnancy as a mean of contraception. After lengthy counseling, most of these women, desperate and determined to get rid of their pregnancies, left my clinics and walked into the unknown darkness, seeking for termination of pregnancies elsewhere. And it crushed my heart to think of these women, vulnerable because of their circumstances, ended up at some secret places, mostly illegal and unsafe, to get rid of their own flesh and blood. I have also seen many women, who ended up at the hospital, almost losing their lives, after an unsafe abortion.

During the counseling, I always asked these women why they did not take precautions to prevent pregnancies. Many told me that their mothers or aunts or somebody they know said that contraceptive pills can cause cancers. They were also convinced that once one takes contraceptive pills, it will adversely affect their fertility in the future. Some even suggested that contraceptive pills are toxic to the body.  However, none of them realized that having a termination of pregnancy have more immediate and long term side effects which can adversely affect their health and future pregnancies. Some even lost their lives during or after a termination of pregnancy.

So, as a gynaecologist and an educator, I always ask myself: what is my role in this circumstance. How do I get to the root of the problem without ruffling too many feathers along the way? There were so many controversies surrounding the introduction of the topic of contraception into our sex education programme. Then, where do we start? How do we reach out to the women in various age groups, education background, socioeconomic status and different ethnicity and religions?

I believe that we are all responsible in playing our parts in this matter. As a gynaecologist, my role is to educate the general public on the various issues surrounding contraception and to rectify the misconceptions and myths. Therefore I jumped at the chance when I was invited to write something on this platform about contraception. Although this effort may be small in comparable to all the wonderful things that our activists from the Non-government Organizations have done to advocate the women’s right in sex education & contraception, I sincerely hope that this small contribution can make some differences. Some information about contraception can also be found on the platform written by myself and my colleagues at www.pitterpatter.com.my.

Let us make contraception a valid and conscious choice for all.