KOTA KINABALU: Don't wait too long to start a family – that's a message from Consultant Obstetrician, Gynaecologist and Fertility Specialist, Dr Cheong Yee Tsing in tandem with the ongoing Hope for a Child campaign.The awareness drive, initiated by the Malaysian Society for Assisted Reproductive Technology (MSART) ends in December this year.She said many are not aware that age is a risk factor for both male and female infertility, among others.
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"After about the age of 30, a woman's fertility potential gradually declines even under normal circumstances. And this translates to the treatment outcome also."Two things to remember – the older you are, the poorer the chances of conception.
Secondly, the longer you wait, the lower the chances of success when you go for fertility treatment."So age does matter. For example, if I have two patients aged 28 years and 42 years seeking treatment, the younger woman will have higher chances of success. Likewise, men older than age 40 may be less fertile than younger men," she said in an interview.
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Enlightening further, Dr Cheong said age is among the Top Five Risk Factors for Infertility, the others being weight, tobacco smoking, excessive alcohol use and too much exercise."A man's sperm count may be affected if he is overweight while in the case of an underweight woman (following a restrictive diet), she is at risk of infertility too.
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"Alcohol use makes it more difficult to become pregnant," she shared, adding that miscarriages are more frequent in women who smoke.However, moderate alcohol use does not appear to decrease male fertility, it was pointed out.Citing some studies, Dr Cheong said excessive exercising has been associated with ovulation problems.Globally, the prevalence of infertility is estimated to be 9.6pc, according to her. The World Health Organisation (WHO) defines infertility as a disease of the reproductive system measured by the failure to achieve a clinical pregnancy after 12 months or more of regular, unprotected sexual intercourse.At this point, the fertility specialist dispelled at least four myths about infertility beginning with the misconception that fertility issues are more likely to affect women than men. The truth is that conception difficulties are just as likely to affect men as they do to women. "In fact, male fertility problems are on the rise globally, in Malaysia and even in Sabah." The other myth is: If men ejaculate, they are fertile."Not necessarily so," said Dr Cheong. "Men may have a very low sperm count, low sperm motility or poor quality sperm, and still ejaculate. In some cases, we checked the ejaculate (seminal fluid), and found there was no sperm in it. The only way of knowing what the ejaculate contains is through laboratory analysis." The third myth among parents is: Our first baby was easily conceived, so we do not expect any problems with the second. While there is cause for optimism, the doctor said things may also have changed since then. "We have to do a re-check as some couples are diagnosed with secondary fertility problems. There are cases where after the first child is already six or eight years old, the mother still can't get pregnant."Last but not least, another myth is that fertility treatments go against nature. "As fertility specialists, we don't agree. We are just removing the problem (that causes conception difficulties) and thus improve their chances of conceiving."How is infertility diagnosed?Dr Cheong said tests for male infertility to determine whether a man is producing enough healthy sperm (or having low sperm count or low motility), include general physical examination, semen analysis (for quantity, colour and presence of infections or blood), and hormone testing."There is more to it – male problems that could lead to infertility could be medical disorders like mumps, varicocele (swelling in the testes), testicular cancer and diabetes."Other factors include surgery or injury, overheating of the male reproductive organs, fatigue or too much stress, smoking and alcoholism," she said.Similarly, there are tests for female infertility to determine whether a woman is releasing healthy eggs regularly, and if her reproductive tract allows the eggs and sperm to pass into her fallopian tubes for fertilisation. These include ovulation testing, laparoscopy, hormone testing and pelvic ultrasound to look for possible uterine or fallopian tube disease.The fertility specialist explained that laparoscopy (or key-hole surgery) is a procedure performed under general anaesthesia, saying it involves making a small incision beneath a woman's umbilicus (navel) and inserting a thin viewing device to examine the fallopian tubes, ovaries and inner lining of the uterus. This, she said, is to ensure the tubes are not blocked.Women often ask Dr Cheong – How do I know whether I am fertile?"You have to rule out at least four factors – you have no ovulation disorder, no fallopian tube disorder, no changes to the uterus or cervix, and neither do you have polycystic ovarian syndrome."Basically, polycystic ovarian syndrome is a hormonal problem. It is characterised by the presence of a lot of small eggs in the ovaries but these are unable to grow normally and get matured and released," she elaborated.Asked on the success rate of assisted reproductive technology (ART) for fertility treatment, the fertility specialist quoted a Danish study which found that within five years of starting such treatment, almost 70pc of couples had succeeded in having at least one child. "In Malaysia, the in-vitro fertilisation (IVF) success rate is about 55pc. However, it depends on individual cases and cause of the infertility," she said.
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Answering a question on surrogacy, Dr Cheong said this practice is not acceptable to most of the major religions in this country. "If patients were to ask me about it, I would say it is not allowed in Malaysia. This is the true advice I would give."In a surrogate arrangement, a woman agrees to become pregnant and bear a child for another person and to surrender it at birth. It is common knowledge that some childless couples go to India for the purpose. Such a surrogate pregnancy, she added, can also potentially lead to many legal dilemmas for the persons involved.