Author Archives: helenalimyh

Our IVF Journey

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One of the most important lesson that I have learnt from my mentor in IVF is that IVF is equivalent to an exam. The likelihood of passing an exam (aka. achieve a pregnancy) is increased if you are prepared for it. Half of the battle is won not during the battle itself but during the preparation for the battle.

As a seasoned student (I have been through many exams including my professional exams), I could not agree more. A famous Chinese military general, strategist and philosopher, Sun Tzi (600 B.C.), who authored the famous book ‘the Art of War’ had clearly illustrated and emphasized the importance of being ‘prepared’ as the secret of a victory.

Therefore, before you embark on your journey of IVF, would you join the wining team by preparing yourself for the battle?

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The benefits of acupuncture in IVF

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Restoring balance

The benefits of acupuncture in IVF

In recent years, acupuncture has become an increasingly popular complementary treatment for those suffering from infertility, especially women undergoing IVF treatment. But what’s behind the buzz and does it actually work? Let’s examine the known facts.

What is acupuncture?

Acupuncture is a form of traditional Chinese medicine (TCM) and healing method that has been used for thousands of years across the world to treat a variety of ailments. It involves the gentle insertion of thin, sterile needles that are inserted into the skin at strategic points of the body to provide stimulation.

According to TCM practitioners, there are more than 2,000 acupuncture points on the human body, which are connect to 14 major pathways or meridians. These meridians conduct “qi,” which is a form of energy or life force that is believed to regulate our spiritual, emotional, mental and physical balance. Poor health habits can disrupt the proper flow of qi, leading to various ailments, including pain and infertility.

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Benefits for those undergoing IVF

As acupuncture works on the principle of restoring balance, here’s how it can help:

Reduces stress – By lowering the levels of stress hormones released into the blood stream, acupuncture can help restore the body’s hormonal and neurochemical balance.

Improves blood flow – Stimulation at strategic points can increase blood flow to the ovaries and uterus, which increases chances for the egg to be implanted, nourished and carried to term.

Relieves aches – By alleviating existing aches and pains, acupuncture can provide further relief and stress reduction.

Relieves anxiety – By helping to treat conditions like anxiety and insomnia, which can have devastating long-term effects to wellbeing, acupuncture helps restore the body’s delicate balance.

Few side effects – Unlike some forms of Western treatment, which can be invasive and causes undesirable side effects, acupuncture has relatively few to no side effects other than causing bruising at the needle site.

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Scientific research

Some experts in complementary medicine have cautioned that the positive effects of acupuncture may actually be due to a “placebo effect” that is caused by patients expecting acupuncture to work. To understand the phenomenon better, some scientific studies have been carried out to review the benefits of acupuncture in infertility treatments.

One study, jointly-conducted by the University of Maryland’s School of Medicine, Georgetown University School of Medicine, Washington and the University of Amsterdam, Holland, compared the results of needle acupuncture in women receiving IVF, against women who received fake treatments and no treatments at all.

The results were very positive, as according to the study, “IVF with acupuncture increased the odds of pregnancy by 65% (according to early evidence on ultrasound), increased the odds of ongoing pregnancy by 87% (according to ultrasound evidence of pregnancy at 12 weeks) and increased the odds of a live birth by 91% compared with IVF on its own.”

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Conclusion

The researchers concluded that their results suggest that, “Acupuncture given with embryo transfer, improves rates of pregnancy and live birth in women who are undergoing in vitro fertilisation.” While their findings are significant and clinically relevant, the researchers consider them to be “somewhat preliminary” and call for further investigation in the link between pregnancy rates and the effect of acupuncture.

With these encouraging facts and figures, there is no wonder why more and more couples are choosing to include acupuncture in their infertility treatment routine. If you’re interested to find out more about using acupuncture as a complementary form of treatment, don’t hesitate to bring it up to your doctor.

 

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Exercise and how it affects pregnancy rates

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Getting it just right

Exercise and how it affects pregnancy rates

We all know that staying physically active is beneficial to our overall health and wellbeing. But did you know that the right amount of exercise can also improve your chances of conceiving? Here’s why.

Firstly, regular exercise is known to help optimise the reproductive system. It does this by stimulating the endocrine glands, which releases hormones that help your eggs to grow. Secondly, exercise can enhance your metabolism and circulation, which in turn optimises your egg production.

Thirdly, exercise can help you manage or achieve an ideal body weight. Since being overweight or obese can impair fertility in both men and women, weight management is widely known and used to prevent and treat infertility. And lastly, regular workouts also help to relieve stress, which in itself can inhibit fertility.

While regular moderate exercise can have positive effects on fertility and conception, the opposite is true for vigorous exercise.  According to a 2009 study in Human Reproduction, and a Harvard study of elite athletes, vigorous exercise is linked to reduced fertility and pregnancy rates. Therefore, when it comes to exercise and fertility, it is possible to have too much of a good thing.

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While there are no guidelines for women to follow when it comes to workout intensity for fertility, there is a way to strike a balance. Studies have shown that women who exercised moderately for at least 30 minutes a day can reduce their risk of infertility due to ovulation disorders. Evidence also suggests that moderate regular exercise can positively influence assisted reproductive technology (ART) outcomes. But what is the right amount of exercise?

If you’re already at your ideal weight, it is safe to stick to your regular routine, but keep it to half an hour maximum per day. Studies had shown that vigorous aerobic exercise of more than 4 hours per week reduces the chance of pregnancy in women going through IVF. If your cycle is still irregular and you haven’t conceived after a few months, you might want to cut back on the intensity of your workouts. However, if you’re underweight, focus on gaining weight and increasing your body fat to the recommended amount of over 12%. If you exercise regularly, cut back on the frequency and opt for a less vigorous routine.

Meanwhile, if you’re overweight, work on cutting down on your calories with healthy eating. You can also increase your exercise routine gradually to achieve your ideal weight. Lastly, if you’re undergoing fertility treatments, it is best to avoid high-impact exercises, as they can be detrimental to your ovaries, which have been enlarged by fertility drugs.

Still have doubts on where to begin? Before you step up your exercise routine, start by speaking to your doctor. If you’ve been having trouble conceiving, your doctor will need to assess your condition first. This includes your age, cycles, ovulatory status, the condition of your uterus and tubes, as well as your partner’s sperm. Once certain conditions have been identified or ruled out, your doctor will be able to advise you on whether the underlying cause may be too little or too much exercise.

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Daddy beware- How paternal age affects reproduction and offspring

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Daddy beware

How paternal age affects reproduction and offspring

 

When it comes to discussions on fertilisation and reproduction, there is often an emphasis on the mother. This includes her age, which is also known as “maternal age.” This is quite understandable, because multiple studies have been conducted on women’s health and the effects it can have on the pregnancy and baby. And the bulk of the research shows that women over 35 do have a higher risk of infertility, pregnancy complications, spontaneous abortion, congenital anomalies and perinatal complications.

But what about paternal age? How come it’s rarely discussed? Could the age of the father have an effect on reproduction and the health of the baby both in vitro and after birth? The answer is – Yes, it’s possible.

Today, however, late fatherhood has become more commonplace. In fact, in Hollywood it has become a trend, with celebs like Steve Martin, George Lucas, Jeff Goldblum and Robert DeNiro fathering children in their 60s. And it’s not just celebs that are having children later in life.

In the last decade, we’ve seen a rising number of men becoming fathers for the first time at an advanced age. This is largely due to the increase in life expectancy, the use of contraceptives, delayed marriages and so on. Arguably, there are various social advantages to having children at a later age. For example, older fathers are often more advanced in their careers and are better equipped to provide financial security to the family. But what about potential risks? Do they outweigh the advantages?

Despite this rising trend of delayed fatherhood, research on the effects of paternal age on reproduction and offspring has been lacking. However, there is a growing body of literature on the topic, and they point to several risk factors that couples must be aware of and take into consideration.

Firstly, studies have shown the negative effects of paternal age to sperm quality and testicular function. In addition to this, older men have an increased risk of male infertility, which can adversely impact reproductive and fertility outcomes, including the success rates of treatments like IVF/ICSI.

 

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Research also indicates that children conceived by men over the age 40 might face a higher risk of miscarriage; preterm birth; birth defects such as the bone growth disorder achondroplasia; disorders like autism, schizophrenia and bipolar disorders, as well as childhood leukemia.

But why do the risks for these health conditions increase with paternal age?

Researchers believe that these health conditions might be caused by age-related genetic mutations and chromosomal abnormalities, which in turn results in genetic mutations that are then inherited by the offspring. With these facts in mind, it’s essential for couples, especially those facing fertility issues, to consider the links between advanced paternal age and the potential risks to conception and the health of their offspring.

But, if you’re a man in your 40s or older who is considering fatherhood, or are concerned about your reproductive health, don’t hesitate to speak to your doctor. It’s best to address your worries and find out more about the potential risks involved.

Kate realised that having a child with a really tall father did have its advantages.

Kate realised that having a child with a really tall father did have its advantages.

A timely decision

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A timely decision

How age affects your chances of IVF success

Have you been seriously considering In vitro fertilisation or IVF treatment? If you have, it’s best that you understand how your age can affect your chances of success. This is so that you can make an informed decision on when to begin. But before we get into that, let’s take a brief look at IVF and what it entails.

For some couples facing fertility problems, IVF is a viable method that can help them to conceive. During IVF, a woman’s ovaries are stimulated and an egg is removed to be fertilised with sperm in a laboratory. Once fertilised, the egg becomes an embryo, and it is returned to the woman’s womb to develop.

Studies have shown that the success of IVF treatments can be affected by a woman’s age. This is because it’s an inescapable fact that a woman’s fertility declines as she grows older. So if you were to undergo IVF using your own eggs, your chances of conceiving would be higher if you were younger.

According to the Human Fertilisation and Embryology Authority (UK), in the most recent study conducted in 2010, on average, the percentages of live births resulting from women having IVF using their own fresh eggs are: 32.2% for women aged under 35, 27.7% for women aged between 35–37, 20.8% for women aged between 38–39, 13.6% for women aged between 40–42, 5.0% for women aged between 43–44 and 1.9% for women aged 45 and over.

As you can see from the statistics above, a woman’s fertility begins to decline at around age 30 and this exacerbates at about age 38. By the time she is 44, her chances of having babies via IVF with her own eggs is nearly nonexistent at less than 2%. This is why women above the age of 42 are generally discouraged from undergoing IVF, as the success rate is considered far too low.

Most IVF clinics also have an age limit for IVF treatments that use a woman’s own eggs. This is because the age of the eggs is crucial, not the age of the uterus. But, why is egg age so important? Two words – quality and quantity.

 

'It's my biological clock.'

‘It’s my biological clock.’

But what is egg quality? In fertility, an egg’s quality refers to its chromosomal status. As a woman’s age increases, the risk of chromosomal abnormalities in her eggs also rises. During IVF, we hope to obtain multiple healthy embryos, whereby the best ones will be selected for transfer into the mother’s uterus. But before embryos are transferred, we need to check their chromosomal status. Therefore, the embryos undergo Preimplantation Genetic Screening or PGS, which checks for chromosomal normalcy. On average, healthy embryos with normal chromosomes have a much higher potential for implantation and live birth.

Meanwhile, egg ‘quantity’ refers to how many eggs are left in a woman’s ovaries. As such, her egg quantity is often called her “ovarian reserve”. Although egg quantity doesn’t greatly impact the chances of a natural conception, in IVF, egg quantity may influence a woman’s response to ovarian- stimulating medications.

So if you’re considering IVF, don’t hesitate to ask questions and seek the advice of a fertility consultant. The information you receive can help you make a decision on when best to start your treatment.

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Fertility on Ice – Learn about Egg Freezing

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Fertility on ice

What you should know about egg freezing

We often hear of the expression “ticking biological clock,” but what does this actually mean for a woman? Well, here are the facts and figures. As a woman, you were born with about one to two million immature eggs or follicles, and these begin to die off as soon as you leave your mother’s womb.

By the time you’ve reached puberty, you’ll only have about 400,000 follicles left, and with each menstrual cycle, you’ll lose thousands more. Due to the loss of follicles throughout your reproductive life, when you’ve reached your mid 30s, your fertility would have sharply declined. And in your late 40s, any follicles that remain are unlikely to mature due to the hormonal changes brought on by menopause.

Now that you understand a little more about eggs, let’s find out why some women choose to freeze theirs and what it entails.

What is it?

Just as the name suggests, in egg freezing, a woman’s unfertilised eggs are frozen through a process called vitrification. This is done so that the eggs can be stored for many years. When a woman is ready, the eggs can be thawed and fertilised with sperm. Once the egg has developed into a healthy embryo, it can be transferred to the woman’s uterus for a chance of pregnancy.

 

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Why?

Some women choose to freeze their eggs because they are currently not in the position to become pregnant and they want to preserve their healthiest eggs. One of the leading reasons for egg freezing is serious illness. For example, a woman who is undergoing cancer therapy may worry about the impact of the treatment on her fertility. As such, she may have her healthy eggs removed and frozen for future use before she undergoes treatment.

Other women, on the other hand, may be concerned about age-related infertility. Though a woman may be at her most fertile between her 20s and early 30s, for some women, childbearing is unavoidably delayed due to education, career or personal goals. Through egg freezing, a woman can store her healthy eggs for use in the future, enabling her to start a family when she is ready. A woman’s age when her eggs are frozen also affects her chances of conceiving later in life. For example, if she opts to freeze her eggs during her late 30s, her chances of pregnancy are significantly lower.

How?

Much like the early stages of IVF, the egg freezing cycle takes about 10-12 days. The woman will give herself daily shots of hormone injections, which stimulate her ovaries and ripen her eggs. When her eggs have matured, they are removed using a special needle that is inserted through her vagina. An ultrasound is used to help guide the needle and the woman is sedated, so she will not feel any pain. Once retrieved, the eggs are immediately flash frozen.

 

Is it safe?

In a word – yes! To date, more than 300,000 children have been born worldwide from frozen embryos and studies conducted in recent years have shown that the use of frozen eggs does not increase pregnancy complications or birth defects.

If you’d like to learn more about egg freezing and the costs involved, don’t hesitate to speak to a fertility specialist.

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Fight Oxidative Stress

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Fight Oxidative Stress
The effects of alcohol, smoking and pollutants on women’s fertility
We all know that the excessive intake of alcohol, smoking and environmental pollutants are bad for our health, but can they negatively impact a woman’s chances of getting pregnant? The answer is a resounding (and unsurprising) yes! Here’s why – Firstly, as toxicants, they cause our bodies to produce Reactive Oxygen Species or ROS, which are highly-reactive ions and molecules that contain oxygen. ROS are a lot like free radicals, and they are both known to wreak havoc in our bodies by damaging proteins and impairing their function.
Usually, our bodies are able to neutralise the harmful effects of ROS and free radicals with antioxidants. However, when an imbalance in the production of ROS and free radicals occurs, our bodies are unable to cope. As a result, our bodies undergo what’s called – oxidative stress. Oxidative stress is a physiological condition that’s linked to a variety of health issues, including neurodegenerative disorders such as Alzheimer’s disease; cancer; heart problems; blood vessel, gut and vision disorders; lung conditions; chronic fatigue syndrome; kidney, autoimmune, arthritis and inflammatory disease; diabetes; pancreatitis and more.
There is also mounting evidence on the negative effects of oxidative stress on male subfertility, including decreased sperm motility and numbers. And now, findings indicate that oxidative stress can increase the risk for female infertility, as well as delaying pregnancies and lowering pregnancy rates. It can even lead to pregnancy complications like preeclampsia and even miscarriage.
While the field is currently understudied and there is so much more to discover, there is no denying that it is crucial for us to gain a better understanding of how to combat oxidative stress. “If we can identify factors that can be modified to decrease oxidative stress in women, it may be an inexpensive and non-invasive treatment for infertility,” states a study called The Impact of oxidative stress on female fertility by Elizabeth H. Ruder, Terryl J. Hartman, and Marlene B. Goldmanc.
But does this mean we have to play the waiting game for more research to be conducted on the subject? While it may be a few years time before scientists can identify the factors that can be modified to fight oxidative stress, there are steps you can take right now.
We know that oxidation occurs when we’re exposed to toxins, chemicals and stress. Therefore, it would be highly beneficial for you to minimise your exposure to triggers that are present in your lifestyle, foods and environment. Numerous studies have also shown the benefits of a healthy and varied diet, which is supplemented with multivitamins and antioxidants.
In addition, you can maintain your reproductive health by limiting caffeine and alcohol intake, quitting cigarettes, getting adequate exercise, learning ways to manage daily stress and maintaining a healthy body weight. By taking these steps and making crucial lifestyle changes, you can significantly enhance your fertility and boost your chances of conception. Not sure where to begin? Don’t hesitate to speak to a healthcare professional to get on the right track.

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Daddy’s Diet

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Men's health

Daddy’s Diet

How a fathers’ lifestyle influences the health of future generations

We all know that a woman who is trying to conceive should eat a healthier and more nutritious diet. In addition, she should abstain from drugs, alcohol and cigarettes. This is because these factors can affect her chances of becoming pregnant, as well as have a negative effect on her developing fetus should she fall pregnant. Even a woman’ level of emotional stress could influence her fertility and pregnancy success. But does the same apply to men? How does a man’s lifestyle affect conception and the health of his offspring?

Unlike women, men’s reproductive health is under-emphasised and men are largely left out of pre-conception planning. This is despite the fact that male infertility is on the rise, with lower sperm counts and damaged sperm becoming more prevalent. Now, however, new studies are beginning to show that a father’s lifestyle can impact the possibility of pregnancy, as well as the long-term health of his children.

More than genes

Though the saying goes, “It’s all in genes,” scientists have discovered there’s more to our genetic inheritance than that. Beyond our DNA code is epigenetics, which can be defined as, “a heritable layer of biochemical information associated with DNA, and transmitted via the sperm and egg.”

According to Sarah Kimmins, PhD, who holds a Canada Research Chair in Epigenetics, Reproduction and Development and is an Associate Professor at McGill University, Montreal, “We are now beginning to understand that sperm epigenome contains a lifetime memory of paternal experiences. Everything is a man’s daily lifestyle, including his environment, diet, exercise, alcohol and smoking have the potential to disrupt (or support) the setting of the sperm epigenome, which is then passed on to future generations.”
Danger of chemicals

Besides lifestyle, says Kimmins, other factors that can contribute to male infertility are “Chronic conditions like obesity, cardiovascular disease and metabolic disorders, as well as paternal age and heightened stress.” Furthermore, the researchers at McGill University also believe that, “Reduced fertility may be in part attributable to the dramatic increases in chemical production and consequent human exposure.”

Their studies show that there are now about 80,000 chemicals registered for commercial use. We are exposed to these chemicals daily, be it at work, in household products, in the environment, as well as food and cosmetics. As an alarming result, high levels of common toxicants, like bisphenol A and phthalates can now be detected in urine and blood analysis of not just adults, but children too.

While only a handful of research groups worldwide are addressing the cause and effect of lifestyle and chemical exposure to human infertility and epigenetic inheritance, it is becoming increasingly that a father’s way of life plays a vital role in determining his child’s development and health. As such, Kimmins suggests that, “Men should become more involved in pre-conception planning and young men must be educated that their choices today may influence health beyond their own.”

Unravelling a Mystery

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Unravelling a Mystery

Epigenetics as a possible cause for male infertility

One of the common problems subfertile couple faced is the issue concerning sperm quality and quantity.  In the past, male issue had deemed to be responsible for 15-20% of the reason for subfertility. However, over the last 10 years, this issue had become more prevalent and it is estimated that around 40-50% of couples are suffering from male fertility issues.

A recent study in French men between 1989 and 2005 found a significant widespread declines in sperm quality , with average sperm counts falling while percentages of abnormally formed sperm rose. These findings are a “serious public health warning,” the authors wrote. The same findings were observed world wide suggesting a global decline in male fertility.

What can possibly be the culprit causing such decline? Could it be the air we breathe? Could it be the water we consume? Could it be the pesticides, fertilizers, genetically modified food and etc?

There is no straightforward answer to this.

According to a 2011 study called Starting Families Asia, which surveyed 1000 women from 10 countries (including Malaysia), there is a widespread lack of knowledge about male fertility issues throughout Asia. The study showed that, “51% of women do not know that a man may be infertile even if he can achieve an erection, and 49% do not realise that a man may be infertile even though he produces sperm.”

Despite the lack of awareness, male infertility is a common problem, affecting 1 in 20 men. And among married couples struggling with infertility, 40% of the cases may be attributed to the man. Though it has been extensively studied, male infertility remains a complex problem and the underlying causes are usually unknown. However, a study by researchers at the University of Southern California (USC) has suggested that the underlying cause for male infertility is epigenetics – the way that DNA is processed and expressed.

The consequences of epigenetic modification

Epigenetics are processes that alter gene activity, without changing the DNA sequence. They have a vital role to play in the body’s many processes, including those involved in conception, such as implantation, placentation and fetal growth. When these epigenetic processes are modified, due to genetic and environmental factors, the consequences are usually unfavourable.

To identify the link between epigenetic modification and male infertility, USC researchers studied the epigenetic state of DNA from semen samples of male patients at an infertility clinic. Their findings showed that, “Sperm DNA from men with low sperm counts or abnormal sperm had high levels of methylation. However, DNA from normal sperm samples showed no abnormalities of methylation.”

DNA methylation is the result of biochemical changes that happen during epigenetic reprogramming, and according to Rebecca Sokol, M.D., MPH, Pofessor of Obstetrics and Gynecology at the Keck School of Medicine of USC, “Disturbance of epigenetic programming can result in abnormal gene activity or function, even if there is no change in DNA sequence.”

The findings of this ground-breaking study show that there is a link between epigenetic defects and abnormal semen development. In addition, says Sokol, “It is plausible to speculate that male infertility may be added to the growing list of adulthood diseases that have resulted from fetal origins.”

Conclusion

As the results of this study point to underlying mechanisms that can cause epigenetic changes, the next step is for researchers to identify what causes these changes to sperm DNA. Once they have been identified, we will be one step closer to preventing certain types of male infertility. At present, it is believed that one of the possible causes of epigenetic alterations is chemical exposures. It has even been suggested that exposure to chemicals as a fetus may lead to adult diseases.