Let us continue with AskMeDoctor! Episode 4, Part 2 – on Fertility. Similar to the first part (menopause), we have Dr. Tan Cheng, an Obstetrician and Gynaecologist from Tung Shin Hospital, Kuala Lumpur. Dr. Tan Cheng answers all your questions on fertility in both women and men.
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Q1: How long should a couple try to conceive naturally before they seek medical advice?
Dr. Tan Cheng: Normally, we would say that, if women of reproductive age have not conceived after one year of unprotected sexual intercourse, then we will term this as infertility.
One thing that you may bear in mind is, let’s say that if a couple is having regular sexual intercourse and the lady is less than 40 years of age, 80% of them will actually conceive within the first year and the remaining of them will conceive during the second year, which means that 90% of couples will conceive within two years of trying.
So what we normally advise is, give it one or two years. If they really cannot conceive within those first two years, please come for a check-up to determine if there are any causes that can lead to infertility.
Q2: How do you diagnose infertility in men and women?
Dr. Tan Cheng: For men, it is very easy.
- Men | Sperm Tests
For men, generally speaking, all you need is a sperm test. Now, before you go to the lab to have the sperm test done, we will advise you to avoid any sexual intercourse two to three days prior to that. And that is all.
With this sperm test, we can tell whether the sperm is normal or not.
- Women | Hormone Tests, Check Fallopian Tube
Now for women, there will be a few tests. The first test is a series of hormone tests to see whether the lady is ovulating. Now, a female will have menses every month.
Supposedly, if the menses are occurring regularly, by right, you are ovulating every month. But if the menses are not occurring regularly, it is likely that you are not ovulating every month, and that may be the cause of you having trouble getting pregnant. So, the first test is to see whether you are ovulating.
The second test is to see whether the tube is functioning. If a lady is ovulating monthly but both of the fallopian tubes, which connect from the ovary to the uterus, are not functioning, it means that the eggs will not reach inside the womb and she will not be able to get pregnant.
So, can it be done in one session of consultation?
Yes and no. In terms of infertility testing for women, it comes in two different stages.
The first test is actually to test whether the lady is ovulating or not. Normally, it is done through a blood test. And blood tests are done at two different settings. One is during day 2 of menses, while the other is during day 21 of menses. Now this is to look at the variations of the hormones, to see whether she is ovulating.
The second part is actually the imaging study, to look at the function of the fallopian tubes to see whether the tubes are patent or not. It can be done by hysterosalpingogram, which is known as HSG, and this is normally carried out in the radiology department.
Q3: If a man exercises regularly, eats healthily and is able to ejaculate, can he still be infertile? What are the main causes of infertility?
Dr. Tan Cheng: Yes, you’re right. Even if he is able to ejaculate, we still do not know whether there are enough sperms inside. So when you do a sperm test, there are few things we will look at:
- Sperms Concentration
- Total Sperm Count
- Semen Volume
- Motility of Sperm (how much sperms are moving around)
- Vitality of Sperm (how many sperms are alive)
- Shape of Sperm (the morphology of sperms)
Q4: What are the common treatments?
Dr. Tan Cheng: The treatment for infertility actually depends on the causes. Now, let’s look at the data for the causes:
- 25% of infertility is actually unexplained, which means that all the investigations came back as normal.
- 25% is also due to ovulatory disorder, which means that the lady is not ovulating properly.
- 20% is due to tubal damage; that means fallopian tubes are not functioning properly.
- 30% is due to the male factor, which means that the man is the cause of the infertility.
- And the remaining 10% is due to other disorders, such as uterine or peritoneal disorder. Add up all together, about 40% of disorders are found in both men and women.
So, these are the common causes.
Based on the causes that we treat accordingly, if the sperm is the issue, we will look at the parameter of the sperms; if they are a little bit abnormal or completely no sperm at all.
If in the seminal analysis, we find that there is no sperm at all, then you have to find out what the cause is; whether it is tubal blockage or whether the genetic profile of the man is normal. Based on either of these, we will discuss further.
If it is just a minimal dysfunction, let’s say if the sperm parameter is just a little bit out of the normal range, there are supplements that can help to improve the parameter of sperms.
Coming to the ladies, if the main issue is ovulation disorder, it means that the lady is not ovulating normally. We do have medications to help the lady to ovulate on time. We do frequent scans and calculate for her when she is likely to ovulate. And also, we can tell her when it is the best time to have sexual intercourse.
Now if the tube is the problem, let’s say both tubes are not functioning, then unfortunately, there is nothing much we can do but to go for the ART (assisted reproductive technology), such as IVF to help to achieve pregnancy.
There are different causes and different treatments relating to infertility. So, that is why it is very important that we have these sessions as more women and men will have more knowledge about this.
Q5: If a woman has gone through chemotherapy and radiation therapy before because of cancer, will it lead to infertility?
Dr. Tan Cheng: Yes, we know that there are a lot of chemotherapy agent and radiotherapy that can be gonadotoxic. Gonadotoxic means harmful to eggs, harmful to sperms.
Alkylating chemotherapy agents, for example, cyclophosphamide is well-documented to cause reduction in the ovarian reserve.
Other agents also, such as methotrexate and 5-fluorouracil, are the common chemotherapy drugs. They can also lead to a high incidence of amenorrhoea, which means no menses thereafter.
So normally, for those who require a chemotherapy or radiotherapy session, the doctors will tend to discuss fertility desire; whether they want to have any more children after this.
There are options to cryopreserve or freeze the eggs, freeze the ovarian tissues. If you already have a partner or a husband, you can choose to freeze your embryo for a later usage after completion of chemo or radiotherapy.
But you have to understand that this facility is not widely available in every hospital. Only bigger hospitals will have this facility.
Q6: Is it true that too much masturbation can cause infertility?
Dr. Tan Cheng: The statement that masturbation leads to infertility is actually a myth. There are data that actually show that we can achieve optimum semen quality, sperm quality if you have two or three days of no ejaculation.
So, it is actually not the correct statement.
Q7: Is it true that women should avoid lifting heavy objects or avoid getting involved in extreme sports because it may dislocate the womb?
Dr. Tan Cheng: Not true for dislocation of the womb. But for extreme athletes, for example, gymnasts, it is possible to have irregular menses or no menses at all. This is known as athletic amenorrhoea.
So when the athletes eat a bit too little and exercise too intensively, the body will go into a starvation mode. And once the body is in a starvation mode, it will disrupt the production of the hormones and therefore, it will disrupt your menstrual cycles and make it difficult to get pregnant.
It might disrupt but it does not mean these women will be infertile.
Yes, as soon as you exercise at a normal pace and start eating moderately, your body will have enough nutrients and reproductive hormones will start to kick in again and everything should go back to normal.
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