Ask a Fertility Specialist & Gynaecologist: Dr Farah Leong Rahman from Sunway Medical Centre Malaysia

dr. Farah Leong Rahman replied 2 years ago

Firstly, it is very good that you are taking an initiative to find out why you are still not pregnant. Generally, 80% of woman will be pregnant in the first year if they have regular unprotected sex e and the remaining will be successful in the second year. Therefore, it is reasonable to start investigating if you have been unsuccessful after a year. Before jumping to IVF, we need to find out if there is a problem with your husband or you. Bear in mind, about 25% of couples have no problems at all where we call it "unexplained fertility". I will need to do a series of tests for example semen analysis, hormonal profile and an ultrasound. Age is the most important predicting factor in a successful treatment and it is good that you are 32 years old. The older you get the number and quality of eggs reduce. Please do see a fertility specialist and have a chat so we can answer all your queries or concerns

dr. Farah Leong Rahman replied 2 years ago

You did the right thing by going for a fertility check as we recommend couples to start checking if they have yet to be pregnant after a year. The size and nature of the cyst are important as it will determine if surgery is warranted. In most cases if the cyst is small, you don't need to undergo any intervention and patients can get pregnant with presence of cyst. But I wonder if other fertility check such as semen test and hormonal profile has been carried out as it necessary as well. Please discuss with a fertility specialist and we will tailor each treatment which is necessary to you and your husband.

dr. Farah Leong Rahman replied 2 years ago

Some vaginal discharge can be normal but if you have any abnormal discharge like greenish colour, or abnormal smell it may indicate an infection. Other signs and symptoms of infection is fever and abdominal pain. If with treatment, the infection persists then perhaps removing the IUCD may be a good idea. Please do visit the doctor so we can assess your condition better.

dr. Farah Leong Rahman replied 2 years ago

According to the body mass calculation, yours is 27.9 which is in the ideal range but if there is a sudden weight gain, it can also affect your periods. You are having irregular periods and this warrants a visit to the doctor. The doctor will need to ask you further questions and carry out examination. An ultrasound will need to be performed in order to exclude any fibroids, polyps or cysts. If need to, the doctor will offer some hormonal tests as well. Please do visit the doctor so that we can understand your condition better.

dr. Farah Leong Rahman replied 2 years ago

Sorry to hear that your husband and you have been having difficulty getting pregnant. It is good that you have met the fertility doctor in order to find the underlying problem. 25% of the fertility cases are unexplained meaning no problem with either partner in terms of sperm, no blockages in tube. However, in these group of patients they require assisted reproductive techniques such as IVF (in-vitro fertilisation) to help them get pregnant. I hope you will speak to the fertility doctor and discuss regarding options. Good luck and don't give up!

dr. Farah Leong Rahman replied 2 years ago

Sorry to hear that you were diagnosed with molar pregnancy. Molar pregnancy is not cancer but it needs regular follow up and serial Beta-Hcg monitoring as it can persist and there is a small risk of cancer. Therefore, please do follow up as per your doctor's advise. You can start trying for a baby but only after a series of Beta- HCG is normal. Good luck!

dr. Farah Leong Rahman replied 2 years ago

Any bleeding during pregnancy is not normal but a thorough examination including a pelvic examination and an ultrasound is warranted. During a pelvic examination, the doctor will look for any causes that could be the reason for bleeding such as low lying placenta, polyp, cervical erosion or any lesions on the cervix. The alarming symptoms would be excessive bleeding or fresh /red bleeding associated with abdominal pain. If no cause has been found then we will call the condition " indeterminate antepartum haemorrhage". And she will need to be followed up closely until delivery.

dr. Farah Leong Rahman replied 2 years ago

Sorry to hear that you have suffered from 2 previous miscarriages. Knowing that you are pregnant for the third time tells me that you have no problems getting pregnant (meaning no problems with sperm or your fallopian tubes). In majority of the cases, miscarriages happen due to the baby being unhealthy or abnormal and therefore unable to implant well. Having said that, it is important to determine how far along in your pregnancy did the miscarriage occur e.g whether is it a first or a second trimester loss. The risk of miscarriage is highest among couples where the woman is more than 35years of age due to abnormal or unhealthy babies as this is linked with an increased in maternal age. Other conditions that can cause a miscarriage are underlying medical conditions such as antiphospholipid syndrome or thyroid disorders, ongoing infection, genetic factors, problems with the womb or the cervix. Please have a balanced and a healthy diet throughout pregnancy. All the best!

dr. Farah Leong Rahman replied 2 years ago

Painful periods are called "dysmenorrhoea" and it can be divided into primary and secondary. Primary is where no cause is found and is solely due to period cramps. Secondary is where the pain is due to either endometriosis, adenomyosis, pelvic inflammatory disease and so forth. Generally, we will perform an ultrasound to see if there is any presence of cysts, fibroids or any other abnormalities. From your story,it seems that the pain is affecting your quality of life. There are many medications from painkillers to hormonal treatment to help you with the pain. Any woman should not suffer with period pain. Please do visit the gynae so that we can ask you further relevant questions, perform a scan and discuss options with you.

dr. Farah Leong Rahman replied 2 years ago

Firstly, I need to know what fertility treatment you are undergoing what medications are you taking. Generally, any fertility hormone medications that are given to stimulate the growth of eggs (especially in an in-vitro fertilisation IVF procedure) can cause risk of hyperstimulation. This is because there are many eggs being stimulated and high levels of hormones in the body. Some of these symptoms include nausea, vomiting, bloatedness, tummy pain and in worse case scenarios difficulty breathing and abdominal distension. Please do see the doctor so that the doctor can assess the severity of your condition.

dr. Farah Leong Rahman replied 2 years ago

There is always a possibility of a natural conception even if the chances are low. If you have undergone IVF for the first pregnancy, do you still have any embryos left being frozen? If you do I would recommend putting back the embryos into your womb meaning "frozen embryo transfer". Do not worry if you have no embryos left. We need to look back as to why you require IVF to get pregnant in the first place – was it problem with the sperm? problem with the fallopian tubes? Since you needed assisted reproductive techniques such as IVF to conceive the first time, there is a likelihood that you may require it too this time. And how old are you now since your last pregnancy as age has a great impact on fertility. Generally, fertility rate declines as women age. Please do visit the fertility doctor and have a discussion regarding your future pregnancy plan.