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.

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IMG_1434When 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.

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IVF Success with poor sperms & eggs


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.

High Prot

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.


IVF after the age of 40 & Gender selections

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.

When can I try another IVF after my recent failed IVF?

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Question: I have recently failed my IVF, when can I try IVF again?

Dr Helena’s Answer:

The world of IVF is a roller coaster for many patients. As much as IVF brings loads of joy with the success of pregnancies, at the flip side of the coin, IVF can also potentially fail, and left one wonders why it didn’t work.


There are many reasons why an IVF didn’t work out. It is sometimes impossible to find out the exact cause because most of the time, the existing science or technology may not be able to fully pin point the cause, for example, the endometrial receptivity. Science told us that almost 60-70% of the failure rates was caused by chromosomal abnormality of the embryos. This had been one of the reason why the uptake of Pre-implantation genetic screening tests had been rapidly increasing for the last couple of years. However, even in the presence of chromosomally normal embryos, the implantation rate is still ranging between 60-70%, leaving 30-40% of failure rate unanswered.

When your first IVF didn’t work out, one may need to ask what was the cause, find out the solution and then decide on the timing of your next IVF journey. Remember IVF failure sometimes gives the doctors valuable information and insight into your fertility problems. Rushing into another IVF immediately without realigning your strategies may not be the best solution for your problem.


If you have some embryos frozen during your first IVF cycle, you would not need to repeat another IVF cycle. All you need to do is to have the frozen embryos thawed and transfer during the next cycle. This can be done either with medicated cycle or under natural menstrual cycle. This can be done the following cycle after taking a break of a month.


However, if you have no embryos frozen and needed to start another IVF all over again, the earliest one could start the injections would be after a month of break. This is to let our body recover after the previous rounds of hormonal injections. This period of break also gives us plenty of opportunities to look back at the previous failed IVF, identify what are the possible causes and take measures to improve our body condition before the next IVF.


Choosing your IVF Centre



Question: We are thinking of having an IVF but we are not sure which IVF Centres we should choose. Are all IVF Centres the same? What are the factors we should take into consideration?

Dr Helena’s Answer:

The world of Assisted Reproductive Medicine had evolved rapidly and the demand for reproductive services had increase by leaps and bounce as fertility rate in many countries had dropped dramatically. In Malaysia, the demand for fertility services had led to the establishment of many fertility centres.

However, are all fertility centres and fertility the same? What are the factors and issues we need to consider when choosing a fertility unit or a particular Doctor?

Here are some useful tips on how you choose your doctor and the fertility centre

(1) Does the fertility centre has good reputation for its success rates and quality control?

Unlike in other countries such as Australia or UK, in Malaysia, there is no compulsory reporting system for a fertility unit’s success rates and live birth rates. Therefore, it is extremely hard to get information about a particular Centre’s success rates. Some centres do publish their rates on their website, but again these rates are not verified by authorizing bodies and the way of calculation of success rates differs from one centre to another, making it very difficult to compare apple to apple. Therefore, it maybe worthwhile to check with people you know who had been through IVF at these centres, to gather more information about a particular centre

Due to a recent incidence of mixing-up patient’s gametes in one particular centre in Singapore, many countries such as Singapore had now made it mandatory to have international accreditations for the fertility centres in order to have license to operate. Although this has not been the case in Malaysia, a small number of reputable IVF centres had been granted international accreditation after going through robust auditing process. One of the example of this accreditation is called RTAC Certification. The Reproductive Technology Accreditation Committee (RTAC) is a subcommittee of the Board of the Fertility Society of Australia and reports directly to that Board. It is charged with the responsibility of setting standards for the performance of ART through an audited Code of Practice and the granting of licences to practice ART within Australia. It further licences an International Version of the Code of Practice for the use by Certifying Bodies in countries outside Australia and New Zealand. These are some important markers to ensure good quality control and would serve as one of the key deciding factors for patients when they choose a particular IVF centre.


Rtac Certificate (2017-2020)

(2) Does the fertility centre has qualified doctors and lab scientists?

Fertility doctors are mainly Gynaecologist with special interest and training in Fertility. The lab scientists are called embryologists and their training involved reproductive lab sciences. It maybe worthwhile checking the doctors and embryologists qualifications to ensure they have the appropriate training to handle your IVF.


MKF Opening May -17-918

(3) Does the team at the Fertility Centre make you feel comfortable?

Fertility journey can be a daunting experience and hence a professional team who makes you at ease is important to support you through this journey. A team who is genuinely concerned about your wellbeing, sincere about helping you in every step of your fertility journey is the backbone to your fertility success


(4) Did the doctor spend enough time assessing your fertility issues and personalized your treatment plan?

Many people has a misconception that IVF is a standard cookbook and the doctor/ fertility centre just need to follow the recipe to achieve a pregnancy. Whilst this conception is true to some extent when it involves standard operating procedures in IVF, however, there are areas with subtle differences which can make a whole lot of difference to the outcome of an IVF. Variation such as choices in types of protocols used in patients, dosage and types of medications, clinical monitoring, protocols in the fertility lab and decisions on the timing of embryos transfers are some of the examples. A good IVF Doctor would be able to critically analyze a couple’s fertility problem and personalize the treatment plan for individual needs


(5) Does the fertility centre has new technology which has been proven useful clinically?

IVF world is always full of excitement with advent of new technology everyday. As much as we would like to embrace all the new technologies by investing on new machines and lab equipment, which in turn would increase the cost of IVF for patients, one need to ask whether these new technologies are proven useful clinically. Therefore, it is important to find out whether the added tests/ technology on the standard IVF is indicated for your condition. It is important to discuss with your doctor the risk and benefit of the extra tests/ technologies before going through your IVF.



Do IVF Babies have higher risk of abnormalities?


Question: We are thinking of going through an IVF, but we are concerned whether IVF babies have higher risk of abnormalities. We are also concerned that IVF babies are less healthy than their counter-parts and have shorter life-span, is it true?


Dr Helena’s answer:

Since the advent of IVF and Assisted Reproductive Technology, there had been constant debates on its safety and implication towards the health of the next generation. One of the biggest concerns is whether these fertility treatment will give rise to increase risk of congenital abnormalities in babies born as a result of IVF.

These debates and concerns are certainly valid. After all, the process of IVF in creating life outside human body in a Petri dish and then putting them back into the human body to let it grow into a baby is certainly mind blowing. How would we ensure that the doctors and scientists know what they are doing? And mind you, the IVF process were the results of many trials and errors. What makes you think the product (which is the baby), is not plagued with defects and errors?

Intensive research in the early years, and a thriving population that has now grown to more than 5 million IVF children worldwide, have reassured scientists, but they have not stopped studying and trying to improve the process.

Recent discoveries in epigenetics – the study of how environmental factors can affect gene activity, and how a person’s risk of getting chronic diseases is “programmed” into them before they are even born – have opened up new possibilities.

Much of today’s research stems from the Barker hypothesis, which proposes that birth weight may be linked to the likelihood of getting certain diseases. IVF babies are known to have lower average birth weights – even if the difference, at about 20-30 grams, is small. Scientists are now investigating whether IVF conception equates with more hospital admissions, and an increased risk of cardiovascular disease, high blood pressure and diabetes in later life. However, there is no good evidence as yet to suggest likewise

A recent study by the Human Fertilization and Embryology Authority, which linked 106, 381 HFEA register records from 1992-2008 to the UK’s National Registry of Childhood Tumours (NRCT) is one of the largest population-based linkage studies ever carried out. This study has found no association between ART and childhood cancer. This finding offers comfort to those patients facing the difficult decision about whether to undergo fertility treatment or not.

In 2012, scientists at the University of California, Los Angeles (UCLA) looked at birth defects among infants born both via IVF and conceived through natural means in California, which has the country’s highest rate of IVF use. They included babies born after IVF and other assisted reproductive treatments such as couples’ use of fertility-enhancing drugs and artificial insemination.

Among 4795 babies born after IVF and 46,025 infants who were conceived naturally, 3,463 babies had congenital birth defects. Even after controlling for factors that can affect such birth defects, such as mother’s age, and race, which can influence rates of genetic and environmentally driven developmental disorders, 9% of infants born after IVF had birth defects compared to 6.6% of babies who were conceived naturally. Overall, the babies born after IVF were 1.25 times more likely to be born with abnormalities. The researchers did not find a link between birth defects and other fertility treatments like artificial insemination or ovulation induction.

It’s possible that the higher rate of abnormalities with IVF is due in part to whatever was contributing to infertility in the first place, say the researchers. But some of the researchers’ view was the fact that an increase was not seen among babies conceived using artificial insemination or ovulation induction suggests that process of IVF itself, in which eggs are removed from a woman, fertilized in a dish with sperm and then allowed to develop into embryos, which are transplanted back into the womb, is the primary culprit.

However, another more recent study in 2016 by researchers from the University of Adelaide and the University of Melbourne. The study reviewed all assisted reproduction technologies carried out in South Australia over a 16-year period from 1986 to 2002.

This was linked to data on birth outcomes from the South Australian Birth Defects Register (SABDR). The register includes a record of all live births, stillbirths, terminations, birth weight and congenital defects. Birth defects were also followed up for five years. The researchers looked at the statistical link between maternal factors and birth defects, and compared this between babies either conceived naturally or by IVF and ICSI. The study found no statistically significant increase in birth defect. There was some suggestion by the press that this study suggest that IVF reduces the incidence of birth defect in women after the age of 40, but was refuted by the research group due to its misleading nature.

With the advent of Pre-implantation genetic screening (PGS) & Pre-implantation genetic diagnosis (PGD), which is fast gaining popularity, scientist can now screen embryos to exclude chromosomal and genetic abnormalities. The use of these technologies may further decrease the incidence of birth defect and congenital abnormalities associated with chromosomal defects or genetic issues. However, more long term data is required to support this hypotheses.


In conclusion, although there had been great hypothetical concerns about the risk of cancers & birth defects amongst babies born following Assisted Reproductive Technologies (ART), the actual link is difficult to establish due to many confounding factors such as parental age, the cause of infertility and etc. the actual incidence of childhood cancers and birth defects are small and should not be a great stumbling stone to those who are considering going through fertility treatment to have their babies