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Know Your Fertility Wellness Campaign 2021 was held online through Zoom and live-streamed on Facebook. Two sessions were held, catch the highlights here:

Had a question that was not answered during the second webinar? Dr Janice Tung, a consultant at Thomson Fertility Centre, answers those questions in this article.

Questions on male fertility

1. What are the reasons for my husband to get a cut on his penis after intercourse? Could stitches after my delivery 5 years ago be the reason?

It is very unlikely as the stitches used after delivery are usually self-absorbable and would not be present after 5 years. Certain stitches can be more long-lasting, but these are usually employed in pelvic floor repair surgeries for vaginal prolapse. If your husband has a blister or abrasion after intercourse, please consult a urologist to see if there are other underlying causes. Sometimes, it can happen if it's too dry or there's insufficient vaginal lubrication and excessive friction.

 

2. Can poor sperm morphology improve? If so, what are the ways to improve this sperm perimeter?

It may. General advice is: 

A) Keep testes cool by avoiding hot showers/spas, tight-fitting underwear, laptop on the lap and excessive cycling.

B) Take an antioxidant vitamin daily. Vitamins should contain Vitamin A/C/E/zinc/selenium/inositol

C) Avoid smoking, excessive drinking and caffeine (limit to one cup/day)

 

Questions on female fertility

3. Can a retroverted womb be the reason I am not getting pregnant?   

No, a retroverted womb can be found in about 15% of women and is also considered a normal variant. However, if it is associated with the presence of endometriosis or adenomyosis, it may be associated with difficulty conceiving due to these conditions (and not because of the retroverted womb).

 

4. Is safe to try an advance non-invasive treatment like Tesla machine, for PCOS patients to burn fats while trying to slim down?

It should be safe for the reproductive organs (i.e. the womb and ovaries). Aside from that, ladies should ensure that they are well aware or well-informed of the efficacy and general safety of these fat-burning treatments before committing themselves to it.

 

5. Does the size of the egg matter to lead to ovulation? How do we grow egg size?

Follicles are thought to contain eggs ready for maturation and ovulation when they are about 16-18mm in diameter. If a woman is naturally ovulating, she should usually have one follicle growing as such before ovulation.

In IUI or IVF cycles, stimulating hormone medications are given to cause follicular growth, which will be observed on the ultrasound scans your doctor performs, and the medications titrated accordingly. Aside from these stimulating medications, there are no other alternatives to "growing egg size". Certain supplements may help with egg quality issues, such as CoQ10 enzyme and DHEA, in some ladies.

 

6. Will cysts and fibroids affect the growth of the fetus?

Ovarian cysts are unlikely to affect the growth of the fetus. Fibroids, if very large, may rarely cause growth restriction of the fetus.

 

7. Is it possible to not be ovulating even with a regular menstrual cycle?

Yes, a minority of women with reported regular menstrual patterns, may not be ovulating.

 

8. How do low progesterone levels and high prolactin affect fertility?

If the prolactin is truly significantly high, and the mid-luteal progesterone level (usually measured a week before the next predicted menses) is low, this would indicate that the lady is not ovulating which will affect fertility, and the underlying reason for not ovulating could be the high prolactin which may require treatment first.

 

9. Any diet recommendations for endometriosis ladies to reduce menstrual cramps?

In general, a pro-inflammatory diet including processed sugars, fried foods, toxins such as alcohol and caffeine may be avoided. An anti-inflammatory diet rich in antioxidants including wholesome healthy grains, leafy vegetables, fruits rich in Vitamin C and E, probiotics, fish oil and turmeric may be encouraged.

 

10. How many times of intercourse do couples need during the ovulation period?

The critical period is 5-7 days before ovulation. Since the recommended frequency is every other day, that would equate to three times of intercourse. However, since the ovulation window is not always exact in every cycle and may be delayed in some cycles, to ensure further coverage, the period of trying should usually be extended, and that means about six times of intercourse, every other day beginning from 5 to 7 days before the predicted ovulation window.

 

For both male and female

11. Are there any complications in trying to conceive if both husband and wife are from the same blood group?

No. Babies are at an infrequent/uncommon risk of severe jaundice due to ABO incompatibility if husband and wife are of different blood groups, but even if they are of the same blood group, the risk of jaundice also exists from minor blood antibody incompatibility. This is an inherent risk and is not thought to be a complication in trying to conceive.

 

12. What are the recommended supplements or vitamins to improve fertility for both men and women?

The modern diet in young men and women is generally relatively unvaried and unwholesome, so a multivitamin supplement, in addition, may be a good idea to ensure an adequate amount of micronutrients and vitamins.

For men - a general men's multivitamin would usually contain antioxidant Vitamins A/C/E/zinc/selenium and fish oil.

For women - Vitamin D, CoQ10 enzyme, probiotics. Folic acid is a recommended supplement for early pregnancy, but not for fertility.

 

Questions on fertility health checks and treatments

13. What’s the validity of a fertility check? How often should we get ourselves checked?

Blood tests such as the egg count / AMH level may only be relevant for a short duration of time (even as short as 3 months in older ladies), while a thyroid screening test may be relevant for a year or two.

Scans, depending on when they are performed in the cycle and how detailed, may be valid for half a year to a year. A tubal patency check may be good for a year or two if there were no incidents such as pelvic infection or womb surgery in between. As such, you should discuss prior results of any fertility or health checks you have done with your doctor and whether there's a need to repeat them.

In general, after the first basic fertility check, if you have been trying with no success for another half a year to a year (depending on your age or egg count), you should have a review with your doctor again.

 

14. How many cycles can one go through for letrozole?

It may be indefinite. However, in general, if the pregnancy was to occur, it should be within 4 to 6 cycles of letrozole (where ovulation is certain).  

 

15. Any side effects in taking Clomid for a long period?

Long duration of Clomid (up to 9-12 cycles) may be associated with borderline ovarian tumours.

 

16. How long does an IVF treatment take? What can I do after a failed IVF treatment?

A short antagonist IVF cycle will usually be completed within a monthly cycle. You should discuss with your spouse, IVF doctor and sometimes the embryologist, to make an informed decision regarding your next step.

 

17. Are there any further tests that can be done to investigate why I have multiple failed transfers?

There is a multitude of tests that may be done and these should be discussed with your doctor. In general, multiple failed transfers may be attributed to the genetic viability of the embryos, which we usually can't do anything about, except for the selection of genetically normal ones (if we have a sufficient number of embryos for screening in the first place). Tests on the health and suitability of the womb and its lining for embryo implantation may be done and treatment recommended to optimise conditions for future transfers.

 

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