Written by Dr. Gavin Yong Kok Weng
Obstetrician and Gynecologist, Gleneagles Kota Kinabalu Hospital
According to the Vital Statistic Malaysia 2017 report, the national fertility rate in 2016 is the lowest ever recorded since the formation of Malaysia in 1963, with fertility rate per women aged 15 to 49 in 2016 was 1.9 babies, a decrease from 2.0 babies in 2015.
The total fertility rate in Malaysia has been below the replacement level of 2.1 babies, which is the average number of babies born per woman throughout her reproductive life has been insufficient to replace herself and her partner.
CONSULT A FERTILITY EXPERT.
Couples are advised to consult a fertility expert if they have difficulty starting a family. Conception occurs when a sperm cell from a fertile man swims up through the vagina and into the uterus of a woman and joins with her egg cell as it travels down one of the fallopian tubes from the ovary to the uterus.
If a woman is unable to conceive naturally, she and her husband can opt for fertility treatments. In a normal unstimulated menstrual cycle, around 30 primordial follicles will be recruited and stimulated to grow.
However, only one of the follicles will eventually become the dominant and develop into Graafian follicle. While the dominant follicle develops into Graafian follicle, it will suppress the growth of other follicles, and subsequently causing them to degenerate. Thus, during a normal menstrual cycle only one egg will become a fully mature Graafian follicle. When the maturing Graafian follicle reaches 16mm in size, there will be a risk of LH hormone release and triggers ovulation at mid-cycle.
In a stimulated ovarian-induction cycle, fertility drugs are used to stimulate the ovaries to enhance growth and maturation of multiple follicles and yield more eggs with better quality. Therefore, several follicles will develop into mature Graafian follicles at the same time and ovulate at the mid-cycle.
There are two basic types of medication that are used to induce ovulation. Treatment with these drugs has the potential to result in pregnancy if the woman has good quality and quantity of eggs in her ovaries, and if other causes of infertility are not present.
OVARIAN STIMULATION USING CLOMIPHENE FOR IUI OR TIME INTERCOURSE
Clomiphene Citrate starts on Day 3
Egg tracking by ultrasound on Day 12
Timed coitus or IUI 24 hours later
Pregnancy test 2 weeks later
This is a simple treatment whereby the ovaries are stimulated with oral drugs (clomiphene citrate) to produce 2 or 3 eggs and allow fertilisation to occur at timed intercourse. This is the best choice of treatment for those with uncomplicated hormonal disorder and PCOS (polycystic ovarian syndrome).
In this treatment, clomiphene citrate is given daily from Day 3 to Day 7. Follicular tracking by transvaginal scan is done to monitor the growth of the follicle from Day 12 of menses and every 2 days until follicles are mature. Mature follicle is defined as follicle that reaches the size of 17mm – 18mm. When the follicles mature, the treated couple is advised to have timed intercourse or IUI is performed. After two weeks, urine or serum pregnancy test will be carried out to confirm the pregnancy.
OVARIAN STIMULATION USING INJECTABLE FSH FOR IVF (CONTROLLED OVARIAN HYPERSTIMULATION)
Injectable medication used for stimulating the ovaries is follicle stimulating hormone (FSH). FSH is more potent than Clomiphene and will cause many eggs to grow and mature. The aim is to produce 5 to 15 mature eggs for IVF cycle. It’s also known as Controlled Ovarian Hyperstimulation (COH). When the follicles have reached optimum size of 17mm, HCG injection is given to trigger ovulation.
There are three protocols for COH that are used to produce many quality eggs during IVF treatment, namely the long protocol and antagonist protocol. Options of the protocol is determined by IVF Specialist and depends on the female’s age, hormone levels and number of eggs.
For further information, or to make an appointment with Dr. Gaving Yong, please call (088) 518 888 or email [email protected]
Gleneagles Kota Kinabalu is the centre of excellence in Women and Children Care. The health issues of women and children need to be treated with specialÂ sensitivity and understanding. Our dedicated team of doctors are highly skilled in the area of Obstetrics, Gynaecology and Paediatrics and are supported by qualified nurses trained in Neonatal Intensive Care, Midwifery & Lactation, Paediatric and Gynaecology nursing.
This multi-disciplinary team is committed to providing tailored treatment in a family-focused and soothing environment.