Had a question asked during I Love Children's Know Your Fertility Wellness Campaign webinar on 6 November 2020 that was not answered live?
Good news! We invited the featured experts back to answer those questions!
The following questions are answered by Dr Janice Tung, Consultant O&G at Thomson Fertility Centre:
I have had 2 failed IVFs, is there any way to achieve a successful pregnancy?
Unfortunately, this question is complicated. You should have an in-depth discussion with your doctor. You should fully comprehend your fertility challenges, the IVF processes and treatment recommendations and your doctor should help you do this. The success of any IVF cycle may depend on a tripartite partnership - the couple, clinician and embryology laboratory, and communication and trust are important.
We’ve had 2 miscarriages, my wife is now 35 years old, would IVF or IUI be recommended? /How will the doctor decide if IUI or IVF is the way to go?
Several factors need to be taken into consideration - when the miscarriages occurred, if possible reasons behind the miscarriages had been looked into, and how long it took the couple to achieve pregnancy each time. Neither IUI nor IVF are treatments to be recommended on the basis of reducing the risk of miscarriage alone, since they do not. In certain rare genetic causes of recurrent miscarriages, IVF and genetic diagnosis of the embryos before transfer may avoid some related miscarriages.
We are both 35 years and below, my husband has low sperm count, how long should we continue to try naturally before seeking treatment?
Depending on how low the sperm count is, it may not be prudent to continue trying naturally for long at all. Evaluating the causes of low sperm count as well as repeating the analysis to confirm the diagnosis is important. The sperm count may deteriorate further with time, while the lady’s age and ovarian reserves may significantly impact on the success of IVF when you eventually decide on IVF treatment. IVF treatment remains the best-recommended option for couples with severely low sperm count.
What is the recommended BMI for couples going through fertility treatments?
BMI affects not only the success rates of fertility treatments but natural conception as well, the overall health of the pregnancy and risk of miscarriages. The lady should not be too underweight (BMI of less than 18.5), or severely overweight (BMI of more than 30). The ideal BMI for couples undergoing fertility treatments is the same as that for health (BMI 18.5 to 22.9), though fertility treatments may generally be carried out regardless of BMI. While there is no actual recommended cut-off, ladies with a BMI of more than 35 may be routinely refused IVF treatment in many fertility centres.
What is the possible treatment for males with low sperm count and morphology?
IUI treatment may aid in males with mildly low sperm count and quality, while IVF treatment is the best-recommended option for those with moderately to severely low sperm count and quality.
Are there any side effects or dietary restrictions when one is going through fertility treatments?
The side effects of fertility treatments include those of the hormonal medications that are given, as well as a small risk of multiple pregnancies (i.e. twins/triplets) and overstimulation of the ovaries. There are no dietary restrictions per se for fertility, we recommend healthy lifestyle habits such as avoiding smoking, excessive drinking and limiting caffeine intake to 1 cup a day for both husband and wife.
Any advice on how to pick the right fertility centre for us?
As above. The success of an IVF cycle depends on a tripartite partnership - the couple, clinician and embryology laboratory, and communication and trust are important. You should be comfortable with your doctors, the staff, as well as the processes and workflow of the centre. Some couples do specifically communicate with the embryologist in charge of their case, and your centre should allow this, in order to have more understanding of decisions regarding embryo storage and transfer.
Does teratozoospermia affect IVF success rate? Is there an alternative treatment?
The general answer would be no. Multiple factors affect IVF success rate, including poor sperm quality. Men with teratozoospermia however may father children even without medical assistance in many cases. Sperm quality may be improved by general advice to keep the testes cool, taking antioxidant multivitamins as well as healthy lifestyle habits such as avoiding smoking, excessive alcohol and limiting caffeine intake. IUI treatment may aid in males with mildly low sperm count and quality,
Should we stop intercourse while going through IVF?
Most certainly not, not entirely. Your doctor will advise you of certain timepoints where abstinence may be necessary.
How many times can we do IVF?
There is no specific limit, although the financial resources required for multiple IVF attempts are significant, and that is usually the limiting factor in many cases. In general, however, success rates have been shown to decrease after the fourth IVF cycle (a cycle is counted when there is an egg retrieval procedure done).
We’ve been trying for baby number 2 for 3 years, fertility health check results came back normal, we lead a healthy lifestyle too. What else can we do?
Do seek further advice from your doctor, with all the relevant results. If a comprehensive assessment has been done, and your fertility challenge remains unexplained, you may wish to move on to further treatments with IUI or IVF, depending on your age. You may also consider a concurrent or prior TCM approach with an experienced TCM practitioner.
The following questions are answered by Dr Ethiraj Balaji Prasath, Chief Embryologist at Thomson Fertility Centre:
Is there a difference in IVF success rates between frozen and fresh cycles?
Yes. Nowadays we see a global trend in frozen embryo transfers having higher success rates.
What are the reasons for failed fertilisation?
In conventional insemination, fertilization is failed due to 1) failure of interaction between sperm and egg, 2) the outer shell of the egg is very thick, 3) sperm abnormalities.
The following questions are answered by Physician Ho Chin Ee from Thomson Chinese Medicine:
How soon does TCM take effect to complement conception?
Unfortunately, there is no definite answer to this. In fact, we have couples who took only one menstrual cycle to couples who could take beyond a year. For patients who intend to undergo treatment using Assisted Reproductive Technology (ART) like IVF and IUI, we will encourage them to start their TCM treatment 3 months before the ART treatments.
How can TCM improve low morphology and motility of sperm?
Through the use of TCM herbal medicine, acupuncture and sometimes moxibustion, it has been observed that low morphology and motility of sperm can be improved. From a TCM perspective, these individuals will have some underlying lying imbalances in the body, and the abovementioned treatment modalities will be used to address the underlying issues, thereby improving the morphology and motility of sperm.
What is the estimated cost for TCM treatments?
In Thomson Chinese Medicine, acupuncture is priced at $85/session, and herbal medicine is priced at $12/day.
Are there any side effects or dietary restrictions when one is going through TCM treatment?
For acupuncture, some may find the needling uncomfortable, but it is acceptable by most. For TCM herbal medicine, some may find the taste unpleasant, but it gets better over time. Patients should inform TCM physicians of their medical history and the drugs that they are currently taking so that TCM physicians can tailor the treatment accordingly to minimise the possibility of side effects. For dietary restrictions, we generally encourage patients to avoid cold and/or raw food, as well as spicy, fried and greasy food while going through TCM treatment. This is because TCM is not just a treatment, but also a lifestyle. Our lifestyle habits are going to affect treatment efficacy.
Are Vegetarian and Halal treatments available?
While most of the TCM herbal medicines are not Halal certified, patients can inform TCM physicians of their dietary restrictions. As most TCM medicines are plant-based or minerals, TCM physicians can avoid using animal parts while prescribing herbal medicine for you. Alternatively, patients may also opt for acupuncture treatment.
Can TCM treatment help ladies with Thyroid and PCOS to conceive?
Yes, we do see patients with thyroid and PCOS issues as well, and some of them do get pregnant successfully. TCM treatment provided for these ladies is on top of the existing WM treatment that they are receiving.
I Love Children thank Dr Tung, Dr Balaji and Physician Ho for their valuable advice.
Need peer support while trying to conceive? Join I Love children’s Fertility Support Group Singapore today!
Read the highlights of both Know Your Fertility Wellness campaign sessions in the links below:
- 6 Nov with Thomson Fertility Centre + Thomson Chinese Medicine: Boosting Fertility – Western Medicine and TCM
13 Nov with KK Women's and Children's Hospital + Singapore General Hospital: Understanding Your Fertility