Which Treatment Will I Need ?

by Dr Agilan Arjunan, Fertility Specialist, KL Fertility Centre (Malaysia)

Which Infertility Treatment Will I Need ?

Treatment options can be divided into treatment for male infertility and treatment for female infertility.

Male Infertility:

Reduced sperm quality. 

According to world standard (World Health Organization) , sperm quality is taken as ‘normal’ when the sperm concentration is > 15 million/ml, motility is  > 40% , normal form is > 4% , vitality > 58%.

When the semen analysis shows values less than this, it is considered ‘low’ in sperm quality. How to improve sperm quality?

Treatments that can be offered are lifestyle changes (such as stop smoking, reduce alcohol intake, reduce weight and stress) and oral medication called anti-oxidants.

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Research had shown that high level of reactive oxygen spesis (ROS) and low level of antioxidant in the semen reduces sperm quality. Supplementing men with oral antioxidants improves sperm quality especially motility. There are many antioxidant such as vitamin C, vitamin E, L-carnitine, Co-enzyme Q, zink and selenium. Your doctor will give a combination of these antioxidants.

2. Azospermia ( no sperm)

When there is no sperm found, it could be due to obstruction in the channel that sperm passes through (vas deferans) or due to low or no sperm production in the testis. Your doctor will do some blood test on male partner and examine the testicles to arrive to a diagnosis.

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Treatment Options To Make Me Pregnant ?

by Dr Agilan Arjunan, Fertility Specialist , KL Fertility Centre ( Malaysia) 

Treatment Options To Make Me Pregnant

A) Ovulation Induction (OI)

This method involves giving you medicine in the form of oral pills or injections to stimulate growth of eggs/oocytes in the ovary. The duration of the medication depends whether its a oral pill or injections. For example, oral pill such as Clomifene Citrate is taken from Day 2-6 of menses while injections such as Humog or Menopur is injected from day 2 till day 9/10. During this time, regular ultrasound scan will be performed to assess the growth of the follicles that contain the egg/oocyte. Once the follicles has grown to the desired , hCG injection (trigger injection) will be given to assist with ovulation.

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B) Timed-Sexual -Intercourse (Timed SI)

This can be done with or without OI (refer above). If done without OI, it is known as natural cycle Timed SI. Regular ultrasound scans will be done to assess the growth of the follicle. Once desired size is achieved, trigger injection may/may not be given. Couples are generally will be asked to have sexual intercourse 24-48 hours after the trigger injection. If no trigger injection given, couple are normally advised to have sexual intercourse once the follicles has grown to appropriate size.

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How To Improve My Chances of Becoming a Father?

by Dr Agilan Arjunan, Fertility Specialist , KL Fertility Centre (Malaysia)

How To Improve My Chances Of Becoming A Father

Treatment options for infertility can not guarantee a 100% success. However, YOU and your partner can help to improve the success rate. Every effort and step to achieving your goal of holding your little sunshine is worth trying. There are some aspects where the male and female partners can play a role.

1. How long should I practice abstinence before sexual intercourse?

Not too long! You should aim to have sex 2-3 times a week during female’s fertile period and sex every 1 or 2 days intervals during fertile window .

2. Can obesity affect my fertility?

Yes it can. Obesity (BMI > 30kg/m2) can reduce sperm production. Aim to have an ideal BMI of 19-24 kg/m2. Antioxidants such as Vitamin C and vitamin E have been found to improve sperm count and sperm motility.

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3. Should I stop smoking?

Absolutely. Smoking has been shown to reduce sperm quality. Stopping smoking will help to improve sperm quality and you should stop now! Recreational drugs such as anabolic steroids and marijuana will also impair sperm function.

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How To Improve My Chances of Getting Pregnant ?

by Dr Agilan Arjunan, Fertility Specialist, KL Fertility Centre (Malaysia)

How To Improve My Chances of Getting Pregnant

Treatment options for infertility can not guarantee a 100% success. However, YOU and your partner can help to improve the success rate. Every effort and step to achieving your goal of holding your little sunshine is worth trying. There are some aspects where the male and female partners can play a role.

  1. Knowing your most fertile period ( fertile window).

Fertile window is the time in the month when the women is most likely to become pregnant. This window is usually the 6 days interval ending on the day of ovulation. Ovulation occurs about 14-days prior to next period , so in a woman with 28-days period cycle, ovulation occurs on day 14 of her menses (Day-1 is when the woman starts to bleed).

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2. Knowing when you will ovulate (releasing the egg into the Fallopian tube).

The knowledge of when you might ovulate will help you increase your chances of getting pregnant naturally. Methods you can use are:

a) Cervical mucous changes: Cervical mucous and vaginal discharge will increase 5-6 days prior to ovulation and peaks 2-3 days before ovulation. When you are nearing ovulation, cervical mucous will be more abundant, takes on a more raw-egg-white-like consistency. It will also be more stretchy in between your fingers.  This method is easy to do and also helps you know your body better.

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What is infertility ?

by Dr Agilan Arjunan , KL Fertility Centre ( Malaysia)

1.What is infertility ?

Infertility is defined as inability to conceive after 1 year of unprotected sexual intercourse.

2.How do I know if I have problem of infertility?

If you have difficulty to get pregnant after having unprotected sexual intercourse with your partner over the last 1 year, you may have problem with infertility. However, you must bear in mind that if given more time (ie another 1 more year), you may have a chance to get pregnant on your own. This time limit will also depend on your age. If you are younger (ie age less than 25 years), you may want to give a bit more time to yourself. If you are older, then seeking medical advice earlier than later may benefit you. If you are known to have medical condition that predisposes you to infertility (ie endometriosis) , you may want to seek a fertility specialist earlier (ie after 6 months of trying to conceive on your own).

3. What to do next?

If you have problem with infertility, first of all do not panic. There are help around you. The most important thing to do is to have a discussion with your partner about you concerns. Both of you need to make an informed decision about seeking help for infertility. This is an important and crucial step to take because investigation and treatment for infertility involves both male and female. In addition to that, both male and female partner with need each others support to go through this successfully.

4.Where do I find the right Fertility Consultant?

There are many Fertility consultants. The right one for you will depend on your expectation of the doctor and what the doctor can actually offer you. The set-up of a fertility clinic can differ widely.  Some are stand alone clinic with or without fertility laboratory ( fertility laboratory is needed for treatments such as Intra-utrine Insemination /IUI and In-vitro Fertilization/IVF) .

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