Ask a Fertility Specialist: Dr Lim Lei Jun from Sunfert International Malaysia

dr. Lim Lei Jun replied 2 years ago

Hi, some couple experience difficulty to conceive after successful pregnancies previously. This is termed secondary subfertility. Women under 35 year old can continue to try for upto 1 year whilst women 35 and above should consult a fertility doctor if they have been tyring without success for 6 months.

IVF can be an option for you however you may want to consult your doctor about possible reasons and treatment options for you.

Women's age is one of the most important factors in IVF success. 35 year old women generally has more than 50% of success with IVF treatment.

All the best to you.

dr. Lim Lei Jun replied 2 years ago

You are experiencing what we call post-coital bleed.

It is not your menstruation as you are well aware.

I suggest that if it's persistent, see your doctor for a pelvic examination. A polyp at the cervix can present as contact bleeding after sex. Usually can be easily removed in the clinic unless it is large, then it may be better removed in the operating room. Sometimes, inflammation of the cervix can also present as such. Therefore, an assessment is necessary to differentiate.

Doctor can also do a vaginal scan to look at the lining of the womb if there could be any polyp within. This is best done prior to ovulation as the appearance of the womb lining changes after ovulation.

All these conditions are benign and treatable, most important is to get it assessed.

dr. Lim Lei Jun replied 2 years ago

Dear Madam,

It's not uncommon to have menstrual cycle disruption occasionally, do monitor your next 3 menstrual cycles, if they are less than 21 days interval (this is calculated by the number of days in between the first day of the two cycles), you may require some hormonal intervention to regulate your cycles.

Normal cycle length varies between 28 – 32 days. At mid forties, when our ovarian reserve reduce, we experience shorter cycles ie 23-25 days. This does not require treatment unless it is heavy (soaking 1 pad within 2 hours with large clots) or prolonged( more than 1 week).

Extreme stress can impact our menses too. So please do have some stress management strategies ie adequate rest, balanced diet and average amount of physical activities to help to cope better.

Vaginal discharge which does not cause trouble like itch, malodour, or blood stained are not a cause of concern. Vaginal discharge varies throughout our cycle. During period, we discharge blood, then relative dry till mid cycle, we have watery discharge around ovulation, which is followed by slightly cloudy sticky discharge till the next period.

Stay well.

dr. Lim Lei Jun replied 2 years ago

1. If you have been trying to get pregnant for more than 1 year, I would advise that you visit a fertility specialist soon. We recommend women over 35 years old to visit a fertility specialist if they have been trying for more than 6 months. Fertility is time sensitive – a 41 year old has the chance to get pregnant albeit the chance of requiring assistance ie. IVF increases in view of narrowing of fertility window. Women are born with finite eggs and this reduces with age.

2. I see that you are experiencing an abnormal uterine bleeding, since your obgyn has excluded any pathology, and it is the 1st episode, you can choose to observe for the time being. It could be dysfunctional bleeding, although some women experience ovulation bleed but it's typically a light bleed. If it recurs again then you may require further evaluation such as hysteroscopy to exclude endometrial (selaput rahim) lesion.

Stay well,
Dr Lim

dr. Lim Lei Jun replied 2 years ago

Hi, if you have been trying for more than 1 year and experience problems conceiving, do visit a fertility specialist for further assessment for you and your spouse.

Your pain over your hip and bleeding after sex require a gynaecological assessment which include pelvic ultrasound of your womb and ovaries , speculum and vaginal examination to assess your cervix and vagina.

Keep well.

Dr Lim

dr. Lim Lei Jun replied 2 years ago

Thanks for the enquiry. Azoospermia means absence of sperm in the ejaculate. This can be due to
1. blockage of communicating ducts or
2. defective sperm production in the testicles.
3.
In order for the doctor to know the problem, we need to examine your husband and perform some blood tests like FSH and testosterone to ascertain the reason. However, if there is permanent defect in sperm production, then the doctor cannot do anything to improve this.

Do see your doctor for further evaluation.

Thank you.

dr. Lim Lei Jun replied 2 years ago

Hello. Before planning for IVF, make sure you and your spouse have seen a fertility specialist for a comprehensive assessment.

a. Any gynaecological condition which need to be addressed ie. endometrial polyp or submucosa fibroid, which may need surgery before embryo transfer.
b. Any medical condition ie. Diabetes or thyroid disease need to be optimised prior to IVF.
c. Taking supplements ie. Folic acid 0.4mg, Vitamin D 1000iu daily and your spouse might also want to take some antioxidants ie. multivitamins which has vitamin A, C, E, Zinc and selenium to boost the sperm quantity and quality.
d. Take a well balanced diet, avoid processed and fast food.
E. Regular exercises help to maintain weight, improve mood.
f. Take adequate rest.
g. Stop or reduce smoking and alcohol.

I wish you success in your treatment.

Stay well, Dr Lim.

dr. Lim Lei Jun replied 2 years ago

Some ladies can experience headaches with hormones, aka hormonal headaches. Your options are

1. Trial of a lower dose pills. Dicuss with your doctor about options for a lower dose pills ie Mercilon or Loette. See if you headaches ease off.
2. Use non hormonal methods. Ie Copper IUCD if you are keen for long term contraception and have no issues with heavy painful periods.
3. Progestogen only method. This is available in the form of 3 monthly injections, implants( Implanon for 3 years) or IUS(MIRENA) for 5 years, MIRENA is also like an IUCD, it works very well for women with heavy painful periods and wish to have contraception.
4. Barrier method ie condoms

Hope you are well.

Thank you

dr. Lim Lei Jun replied 2 years ago

Home pregnancy test normally becomes negative 3 weeks after the end of a miscarriage.

If your period hasn't come and your home pregnancy test is faintly positive, please see a doctor who can do a blood test to determine the level of your pregnancy hormone with an ultrasound. There is a possibility that there is a new pregnancy.

Hope this helps.