Ask a Fertility Specialist: Dr Eeson Sinthamoney from Sunfert International Malaysia

dr. Eeson Sinthamoney replied 3 years ago

Pre-implantation genetic screening (PGS) is the 'gold standard' method of embryo selection. It involves culturing the embryo to day 5 or 6 when it is called a blastocyst. A few cells are then taken from the blastocyst and some sophisticated tests are done to show if these embryos are genetically normal or not. The reason for this is because a gentically normal embryo has a greater potential to implant (make you pregnant) and also reduce the risk of you having a miscarriage. When these genetic tests are done (called PGS or now PGT – A), we will be able to differentiate the genetically normal embryos from the abnormal embryos. Your time take to get pregnant is therefore reduced.

When we look at the genetics of the embryo – we can also know if the embryo is male or female, but this is a subsidiary finding of doing these sophisticated tests. By the way – these tests will also identify the problem embryos like those that cause 'Down Syndrome' – so these kind of genetic conditions are avoided.

dr. Eeson Sinthamoney replied 3 years ago

Pre-implantation genetic screening (PGS) is the 'gold standard' method of embryo selection. It involves culturing the embryo to day 5 or 6 when it is called a blastocyst. A few cells are then taken from the blastocyst and some sophisticated tests are done to show if these embryos are genetically normal or not. The reason for this is because a gentically normal embryo has a greater potential to implant (make you pregnant) and also reduce the risk of you having a miscarriage. When these genetic tests are done (called PGS or now PGT – A), we will be able to differentiate the genetically normal embryos from the abnormal embryos. Your time take to get pregnant is therefore reduced.

When we look at the genetics of the embryo – we can also know if the embryo is male or female, but this is a subsidiary finding of doing these sophisticated tests. By the way – these tests will also identify the problem embryos like those that cause 'Down Syndrome' – so these kind of genetic conditions are avoided.

dr. Eeson Sinthamoney replied 3 years ago

As long as you are otherwise healthy, there should be no significant risk to yourself because of the pregnancy. However there is an increased risk of certain abnormalities in the baby such as Down Syndrome. This can be detected later at about 11 to 12 weeks of pregnancy by doing certain special screening tests for abnormalities.

dr. Eeson Sinthamoney replied 3 years ago

We need to make a distinction between recurrent miscarriages and infertility.

If you are able to get pregnant easily but have a miscarriage then the problem is recurrent miscarriage. There are certain tests that should be done to identify the cause. A true bicornuate uterus is not a cause for recurrent miscarriages. However it is VERY important to know how the bicornuate uterus was diagnosed.

Sometimes a uterine septum can be confused with a bicornuate uterus. A septum can be the reason for recurrent miscarriage.

If you are having difficulty in conceiving (in addition to the recurrent miscarriage), then IVF may be an option.

dr. Eeson Sinthamoney replied 3 years ago

There are many symptoms associated with PCOS. The most common one is irregular cycles. Irregular cycles are due to non-ovulation. If your cycles are not regular, this is the most likely reason for you not being pregnant. That said, there are many other causes and it would be best if you sought an opinion. Remember that age is everything. The younger you are, the easier it is to conceive.

dr. Eeson Sinthamoney replied 3 years ago

Yes IVF would be a good option in your situation as you have endometriosis and only one tube. Other options like intrauterine insemination may be a rather inefficient option since it requires tubes to be patent and certainly having only one tube makes conception less likely successful.

dr. Eeson Sinthamoney replied 3 years ago

"Insemination" or also called "intrauterine insemination" involves placing specially prepared sperm from your husband into the uterine cavity at around the time of ovulation. You may have also been given some medication before this to stimulate the ovaries to produce two extra eggs. Therefore by placing a concentrated number of sperm in the cavity nearer to the tubes and with more than the usual one egg, this will increase the chances of pregnancy.

That said, international data show pregnancy rates with IUI approx 20 to 25% max per attempt.

IVF is very different because after we stimulate the ovaries to produce about 10 eggs, we then have to retrieve these eggs, inseminate (or inject) them with sperm, to form an embryo and then to culture the embryo for about 5 days before we transfer the embryo back into the womb.

Pregnancy rates with IVF can reach 50 to 60% depending on age and number of embryos transfered.

Therefore in IUI, fertilization cannot be seen or confirmed. But in IVF, we make fertilisation happen and observe further development of embryo before placing the embryo back into womb.

dr. Eeson Sinthamoney replied 3 years ago

Although it would depend on the type of surgery and type of cyst, the two important issues that need to be considered in yourself are:

a. Fallopian tubes – Are they still normal patent or blocked? Because tubal damage when you have cysts is very common

b. Egg numbers – Ovarian reserve is the total number of eggs left in your ovary. This can be reduced when you have cysts especially Endometriosis. The egg numbers fall even more after surgery unfortunately. With lower egg numbers, getting pregnant can become more difficult.

Do a simple blood test called AMH – this is very important.

dr. Eeson Sinthamoney replied 3 years ago

Yes you can certainly check for STD and HIV now. The window period using the newest tests is now very short, sometimes just a few days. Therefore it is now safe for you to get pregnant.