by Dr Agilan Arjunan, Fertility Specialist & Gynaecologist , KL Fertility Centre ( Malaysia)
“The time is always right to do what is right” , “ Time waits for no one” , “ It takes time to build a castle” .
There are many proverbs about time . One thing for sure, time does fly and it’s already 2018 !
Time can be your good friend or enemy. For those with family and children, it’s fun to watch your little ones grow.
For those who are in the midst of their parenthood journey , time can be their greatest fear with each passing year.
There are many couples who kept their hopes high and persisted in their journey towards parenthood. They did achieve their goal .
I’m going to share some spirit-lifting real patient’s journey which will inspire your own journey.
Mr & Mrs Jacob (not their real name) walked into my consultation room sometime in the late 2016.
They were a bit hesitant when they walked into my room. They slowly took their seats . They looked at each other probably deciding ‘who’ and ‘how’ to start the conversation.
I broke the silence by greeting them first ,“ Good morning, how can I help you?”
“ Doc, we have been married for 7 years,” the husband started. “We have not got a child yet” .
“ Have you both done any fertility test?” I asked.
Both of them looked at each other. It took a few seconds before his wife finally started talking.
“ We have not managed to have sex since our marriage” his wife said with some difficulty.
“ Well, if that’s the main reason, then the treatment is very easy !” I said with enthusiasm.
I could see that they both couldn’t believe my reply.
“Really, doc? We thought we had a major issue” said the wife.
“Not necessarily. Let us go through some basic fertility assessment to make sure we don’t have other issues” I explained.
They went through the initial basic fertility assessments. I did an abdominal ultrasound scan for the wife to look at her womb and ovaries.
The husband did a semen analysis (sperm test).
Since her periods are quite regular, no other hormonal test was needed.
In the afternoon, we met again to go through the semen analysis report.
“ Since there is no major fertility issue that needs correction at the moment , lets do an IVI” I said.
“What’s an IVI doc?” the husband asked.
“IVI means an Intra-Vaginal Insemination. It is a process of injecting sperm into your wife’s vagina using a fine tube during her fertile period” I explained.
“ You can even do it at home, every month” I added.
“If the issue is no sexual intercourse, IVI will help you to deposit sperm into her vagina”.
I went on to explain how they can do the IVI at home. I even taught them how to monitor their ovulation based on clinical symptoms and using a urine ovulation test kit.
I could see a sign of relief in their faces upon hearing the solution for their problem. Furthermore, they are still ‘in-control’ of their fertility journey, of course with a very small modification.
Armed with a new direction, the couple thanked me and left my office.
2 months later, I received an email from the couple.
The subject title of the email said it all “ Thank you : I am pregnant!”.
Mr Hazmi (not his real name) walked into my clinic in 2017. He was holding a file in his hand. He came alone without his wife.
I started the conversation in my usual manner, “ Hi, Hazmi, take a seat. How can I help you?”
Hazmi placed his file on my table and said , “Doc, the problem is with me .”
He went on to explain that he and his wife had been trying for 5 years to conceive. They were working and living in overseas at that time.
They are in their early 30s’, so they didn’t think that they had a major fertility issue.
His wife was following several fertility tips that she read on the internet . She tried a few natural remedies to help her with her fertility.
3 years passed by and they finally decided it was time to visit a fertility doctor. His wife’s fertility test did not reveal any remarkable abnormalities.
His sperm test showed Azoospermia (Azoospermia is when there is no sperm cells seen in the ejaculate).
They could not believe the results. They went to two different fertility centres and repeated the test. Unfortunately, the results were the same.
He was referred to a urologist and claimed some injections to boost sperm production were given but it did not work.
“ Doc, I feel very frustrated and disappointed. It’s hard to believe that all this while I am the issue”
He was visibly very frustrated and probably embarrassed knowing that the issue is with him and he had to put his wife through a lot of tests.
“ Hazmi, we can’t turn back time. It’s no use worrying about the past. You are here today hoping to find an answer and that’s what exactly I am going to do!”, I said trying to lift up his mood.
Further medical evaluation did not reveal anything significant apart from the smaller testicular size indicating a possible problem with sperm production.
I did several hormone tests for him.
A week later we reviewed the blood test and I said to him, “Well, based on all the facts that we have collected, it looks like you may end up needing a small surgical procedure to retrieve sperm directly from the testicles”.
He looked a bit worried once I mentioned the word ‘surgery’. I quickly added on, “But let me see if I can avoid it. I’m going to start you on some medications, oral and injections, to push sperm production. I know you have done it before, but let me try that once again”.
Hazmi agreed and we started on our journey to increase his sperm production. After the first month, we had no luck.
On the second month of treatment, we noticed few sperms in his ejaculate. I continued his treatment and by the fourth month, he had 400 000 thousand sperms in his ejaculate.
Meanwhile, fertility assessment of his wife were all normal.
“Hazmi, looks like we may finally be able to avoid the surgery after all,” I told him and he smiled.
“But, you still need an IVF ,” I added on.
The couple agreed to proceed with an IVF the following 1-2 months.
About a month and a half later, the couple visited me again because his wife had missed her period. They were concerned that she may have an ovarian cyst which is delaying her periods.
I asked , “Have you done a urine pregnancy test?”, to which Hazmi replied , “Doc, I’m sure she is not pregnant”.
I proceeded with an ultrasound scan . What we saw surprised us all. There was a foetus measuring 5 weeks!
“ Well, nothing is impossible,” I said while the couple cried tears of joy.
Low egg reserve ( Endometriosis)
I had seen Mr & Mrs TJM in early 2017. The first time we met was during one of my fertility forum.
I remembered them because they sat in the first row and asked many questions regarding endometriosis. They were in their mid-30s.
I met them again a month later in my clinic. True enough, she had been diagnosed with endometriosis and had two previous surgeries for endometriotic ovarian cysts.
Her latest egg reserve test (AMH blood test) showed low egg reserve.
Endometriosis had reduced her egg count even though she was still young.
They were very worried that she may go into menopause soon before getting pregnant.
“She is not menopausal yet. Let’s try our best to get her pregnant. The chances are low, but its never zero” I said in an attempt to give them some hope.
The husband’s sperm analysis was acceptable.
After the initial fertility assessment, we agreed to proceed with an IVF to maximise her chances to get pregnant.
To their surprise, I did not immediately start their IVF treatment.
“Let’s do something to improve your egg quality first before starting the IVF,” I told the couple.
They were started on vitamins including DHEA . Since they were strong believers in traditional medicine, they added on remedies by a Chinese traditional medicine centre to improve her fertility.
After two months, IVF was started. The IVF protocol was changed to minimise her cost.
Four eggs were retrieved. Unfortunately they had only one viable embryo which was frozen.
They were quite disappointed with the outcome.
“You have not finished your IVF journey yet, there is still hope,” I consoled them.
She went through a uterine scratching prior to a frozen embryo transfer (FET).
FET was done in a natural period cycle. A single embryo was transferred into her womb.
She was given supportive medications.
About 2 weeks later, my nurse told me that her urine pregnancy test was positive.
She came back 2 weeks after that for an ultrasound scan and saw a beautiful picture of her baby.
She was nearly 7 weeks pregnant!
She had finally found her golden embryo.
Fertility journey is like a roller coaster ride. There are up and downs and you will never know when your journey will come to an end.
One thing for sure, if you persist, you will finally reach your goal !
Good luck !