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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Normal Fertility

by Dr Agilan Arjunan , KL Fertility Centre ( Malaysia)

1.Normal Pelvic Anatomy

Female reproductive organs consist of uterus (womb), Fallopian tubes and ovary. The uterus / womb is a hollow,peared-shaped organ with thick muscular wall. It is subdivided into corpus (body) and cervix (neck). The top portion of corpus is called fundus. The inner part of corpus is the cavity, where the embryo / foetus develops during pregnancy. The inner lining of the cavity is called the endometrium.

Every month, endometrium thickened in preparation for potential pregnancy and sheds during menstruation if pregnancy does not occur. The cervix (neck) allows sperm to enter the corpus during fertile period of a woman. The Fallopian tubes are the channel that connects the ovaries to the uterus. The inner lining of the fallopian tubes is made up of finger like projections called the cilia. These cilia are important in assisting the movement of the female eggs (oocyte) towards the uterine cavity and the sperms towards the oocytes. The ovary are oval-shaped paired glands that are attached to each sides of the uterus. Every month, one of the ovaries releases an oocyte / female egg. The ovary also produces female hormones oestrogen and progesterone.

2.Normal menstrual cycle

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Normal menstrual cycle length (from beginning of one period till the beginning of next period) average between 21-35 days. If you are menstruating regularly, most probably you are ovulating.
The first day of your bleed is considered Day 1 of your menses. A woman may bleed for 4-7 days, but it varies for every woman. During the bleeding phase of your menses, the endometrial lining is shed and becomes thin. The ovary now produces female hormone called Oestrogen, which slowly thickens the endometrial lining. At the same time, the ovary also produces and develops few early stage eggs or oocytes. Subsequently, only 1 egg or oocyte will mature every month. By mid-cycle (approximately day 14 in a woman with 28 days menstrual cycle), the matured egg or oocyte will be released into the Fallopian tube. This is also called ovulation. The ovary now will secrete female hormone called Progesterone, which will support the pregnancy if it happens. If there is no pregnancy, the endometrial lining will began to shed and menstrual bleeding will start and the woman will be in her Day 1 menses again.

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PCOS and Fertility Series Part 2

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

PCOS : Suffering In Silence.

Part 2: “So what?”

Get your facts right and you don’t have to suffer in silence anymore

Dear readers, welcome back !.

In Part 1: “Oh, what is it?” , you have learned about what is PCOS and how you get to know if you have PCOS. In this part 2 of my education series, I would continue with how PCOS can affect your health . Ready?

General Health Consequences 

PCOS can lead to general health condition known as metabolic syndrome. Metabolic syndrome consist of a cluster of problems, namely high blood pressure, high blood sugar level, increased fat around the waist and increased body cholesterol level. This occurs because PCOS leads to insulin resistance.

Insulin resistance is a condition where the body does not respond appropriately to a given level of body insulin. Insulin in a natural body hormone, produced by the pancreas,  that regulates metabolism in our body. Insulin regulates sugar level by controlling the intake of sugar into our muscle and fat cells and also production of sugar from the liver. Hence, in PCOS, the body cells does not respond to insulin as they should be. This leads to sugar not being utilised by muscle and fat cells properly and it also increases production of sugar by the liver. This leads to increased sugar level in our body.  Insulin resistance also leads to increased fat release into our circulation from fat cells.

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This phenomenon of insulin resistance puts a woman at increased risk of developing Type 2 Diabetes Mellitus , increased blood pressure and high cholesterol. The combination of all this will finally increase the risk of heart disease.

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PCOS and Fertility Series Part 1

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

PCOS : Suffering In Silence.

Part 1: “Oh, what is it?”

‘Get your facts right and you don’t have to suffer in silence anymore’

The month of March is very special for women. We celebrate International Women’s Day on 8th of March and the theme for 2016 is ‘Pledge For Parity’ . Various topics that revolves around women would have been discussed. The education process should not just stop in March, therefore I am going to educate you today about a condition that plagued women for over 75 years now.

I do not wish to take much of your time with a lengthy write up, so this educational write up is divided into 3 parts.

Part 1: “Oh, what is it?”

Part 2: “So what?”

Part 3: “ I see, what can I do to help myself?”

 Hope this benefits all of you.

PCOS (PolyCystic Ovarian Syndrome) is a condition that has been diagnosed for over 75 years ago but yet many women still has little understanding of PCOS , let alone combat it.

Just a few days ago I saw a couple who were married for 8 years and trying to conceive for nearly 6 years. She had seen a few general doctors over the years and was told that she has ‘imbalanced hormones’. She was given tablets to induce her periods and to make her ‘eggs’ to grow.

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Sperm and Male Infertility Reconstructed.

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

Male infertility has gained some traction in the last few years. We can see more mainstream media writing about male infertility. When we look at the male infertility, the majority of the problem is with sperm quality. This means majority of men can produce sperm but with reduction in quality. The quality parameters that are commonly used to assess sperm are sperm density, sperm movement, viability of sperm and percentage of normal-looking sperm. For men with sperm quality problems, depending on severity, sometimes dietary supplements and life style changes alone could able to help them father their child. However, a significant majority would still need some form of fertility treatment such as IUI (Intra-Uterine Insemination) or IVF (In-Vitro Fertilisation).

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