The British Medical Journal published a new paper that said that fertility treatment facilities must be more transparent about the treatments offered. While this applies to the UK, what is the fertility treatment like in Malaysia? We speak to fertility specialist Dr Helena Lim who walks us through the whole process from start to end.
Recently, a large study of 1.8 million Danish women found that hormone contraceptives cause a small but significant increase in the risk for breast cancer. We speak to consultant obstetrician & gynaecologist Dr Helena Lim to find out if women should be alarmed.
http://www.bfm.my/dr-helena-lim-contraceptives-and-breast-cancer-risk.html
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Period pain, a taboo topic that needs to be talked about. 80 percent of women have experienced menstrual cramps at some stage of their journey between puberty and menopause. Among them, 20 percent have pains severe enough to interfere with daily tasks and activities. Today, we have Dr Helena Lim, Consultant Obstetrician and Gynaecologist with us to bust myths about period pains and tell us how to survive through it all.
http://www.bfm.my/helena-lim-menstruation-survival-guide.html
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When it comes to family planning, women bear a disproportionate amount of the responsibility. There are very few male methods for family planning that are both practical and effective. Consultant obstetrician and gynaecologist Dr Helena Lim explores what’s on the horizon for safer and better family planning methods.
https://www.bfm.my/sharing-responsibility-for-family-planning
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Question: My doctor told me that my husband’s sperm and my egg quality were poor. Does it mean that I have no chance of getting pregnant with IVF?
Dr Helena’s Answer:
To achieve a successful pregnancy, may it be naturally or through assisted reproduction techniques, requires some basic pre-requisite factors:
(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.
Question: I am current 40 years-old and would like to know what is my chance of getting pregnant with IVF. Can I choose the gender of my baby when I go through an IVF
Dr Helena’s Answer:
One of the biggest single determining factor for IVF success is the woman’s age. Before the age of 35, the IVF success rate is around 60-80%. After the age of 35, the success rate drops to 40-60%. The success rates of IVF drop drastically after the age of 40 to about 20-30% and then 1-2% after 45.
The reason for this is because as women aged, the number of follicles produce each menstrual cycle drop drastically. The quality of eggs also deteriorate as we age. As we aged, the division of chromosomes in our ovaries can become more imperfect, resulting production of eggs with faulty sets of chromosomes, leading to increase number of abnormal eggs and henceforth abnormal embryos.Therefore, women over the age of 40 has a lower rate of pregnancy with each individual IVF cycle, compare to their younger counterparts
This is a macroscopic view of the general population of women after the age of 40. However, an individual’s success rates is also dependent of her body condition, her ovarian reserves and her uterus receptivity. No two women at the age of 40 is exactly the same. A healthy 40 year-old woman with good ovarian reserves is more likely to produce good number of good quality embryos. Her counterpart who smokes and drinks, eats badly and have poor ovarian reserves is more likely to fail her IVF attempts.
Recently, advances in Pre-implantation Screening (PGS) tests allowed us to biopsy embryos at blastocyst stage to select embryos which is normal in chromosomal make-up before embryo transfer. This test is extremely useful in determining which embryo is more likely to get our patients pregnant. However, like all the tests in this world, it comes with its problems as well. First and foremost, PGS is still expensive, and this test can only be done on embryos created from IVF, which then increase the cost of the IVF cycle. If the embryos tested showed that all the embryos are abnormal, there is no way we can change or treat these embryos and make them chromosomally normal. And therefore, some patients may end up not having any embryos which is suitable for transfer after an IVF with PGS. However, if this is the scenario, the couple can then move on quickly to another cycle of IVF to collect more embryos for PGS, hence, shortening the time required to find the ‘right’ embryo to achieve pregnancy.
Although this technology is able to reveal the gender of the embryo, one must realize that the use of such technology to perform gender selection in STRICTLY Prohibited in this country and also most countries in this world. It is important to note that IVF and PGS are technologies to help couples to achieve a healthy pregnancy and must not be misuse for ones’ whims and fancies. Science and technology should be use sensibly to maintain and restore nature’s balances and any manipulation as such can potentially tip off the balance and create potential disasters to mankind.
Dr Helena Lim 