The Female Reproductive Anatomy

Before we delve further into the world of infertility, let's have a look at the female reproductive system. The female reproductive anatomy consists of two main parts, namely, the external female genital organs (vulva) and the internal female genital organs. The internal organs include the vagina, cervix, uterus, fallopian tubes and ovaries.

The vagina is a passage which allows the escape of the menstrual flow, received the penis and the ejected sperm during sexual intercourse and provides an exit for the baby during delivery. The cervix lies at its upper part.

The cervix is the base of the uterus. It the passage through which sperm travel to meet the egg, to allow bleeding when menstruation occurs and exit for the baby during delivery. The main function of the uterus is to act as a nurture room for the developing foetus during the whole course of pregnancy. It is also supports the bladder and the bowel. The bladder sits in front of the uterus, and the bowel sits behind it. The lining of the uterus, the endometrium, will shed each month as menstrual blood if no fertilisation occurs.

The fallopian tubes are two very fine tubes which are lined with tiny hair called cilia leading from the uterus to the ovaries. The ends of the tube lying next to the ovaries have a finger-like structure named fimbriae. At ovulation, the fimbrae will catch the egg into fallopian tube after it is released from the ovary. The beating wave of cilia in the fallopian tube will move the egg to the uterine cavity through the tube. They are a path in which an egg will travel through in order to reach the male sperm which was released from the male.
 

The ovary is the egg-producing organs in female, often found in pairs at the fimbriae ends. It is oval in shape. Usually each ovary takes turns to release eggs every month. However, if there was a case where one ovary was absent or dysfunctional then the other ovary would continue providing eggs to be released.

First Visit and Initial Investigation

Couples should seek help from a fertility specialist if they can’t conceive:

·         after 12 months of trying, if they are less than 30 years of age  

·         after 6 months of trying, if they are between 30-34 years of age

·         after 3 months of trying, if they are 35 years of age or more

When a couple with an infertility problem first visits a gynaecologist or a fertility specialist, the doctor will need to assess the situation and decide where the problem may lie. The doctor will initially go through with the history, checking relevant details such as regularity of menstrual cycles, previous pelvic infections or surgeries, frequency of intercourse, etc. A gynaecological examination is next to pick up any abnormality.

Subsequently both partners will be tested to check their respective fertility. Approximately 40% of problems will relate to the male partner, 40% to the female, 15% will be unexplained (no problem can be found) and the remaining 5% will be miscellaneous rare causes.

 

Basically, to get pregnant you need good sperm, good eggs, a healthy uterus and healthy fallopian tubes, at least one, so the tests are designed to check these. All these tests can be completed within one menstrual cycle, which is around one month.

Most fertility specialists start with an ultrasound scan of the pelvis to directly visualize the uterus and ovaries. Any abnormalities of these will easily be seen and if relevant, be acted upon. This scan is usually performed during the woman’s menstruation, along with a blood test, to assess hormonal imbalances that can contribute to infertility. The combination of these two tests gives the doctor a good idea of the ovarian reserve, a term used to describe her fertility potential.

Subsequently, another ultrasound scan around the time of ovulation may be performed to assess the receptivity of the endometrium (lining of the uterus) to an embryo and exclude any problems that may decrease this such as polyps or fibroids.

At any time, and after 2-5 days of abstinence from sexual intercourse, a check of the husband’s sperm count and quality can be performed.

These three simple tests would have checked the quality of sperm, egg and uterus and can all be completed within the first two weeks of the period.

Now all that is left is a check of the fallopian tubes. This is slightly less easy than the above tests, so it is usually left for last. One of two methods may be suggested, either a hysterosalpingogram (HSG) or a laparoscopy. A hysterosalpingogram is a test done in the radiology department and the patient is awake. It involves a procedure similar to the taking of a pap smear. A dye is injected into the uterus and over the next minute or so, it makes its way through the fallopian tubes and demonstrates whether these are open or blocked. The whole procedure takes less than five minutes and involves no surgery.

 

A laparoscopy is a surgical procedure done under a general anaesthetic. A telescope (laparoscope) is inserted into the patient’s abdomen through a small cut at the navel and the doctor can directly see the tubes, ovaries and pelvis. Any small problems encountered can be dealt with immediately such as ovarian cysts. There are advantages to directly visualising a woman’s reproductive organs, but the necessity for a general anaesthetic, surgery and the associated risks makes this the second choice for most doctors. A hysterosalpingogram (HSG) will often be enough.

 

There are advantages & disadvantages to each procedure and the doctor will recommend the one most suitable for each individual.

Only after the tests are complete can a treatment plan be formulated, but with a little planning, everything can be completed within a month and the couple is ready to commence on their road to a baby!

 

 

Fertility Specialists

So you and your husband finally decided to seek professional help for your inability to reproduce. Who should you see? Would a normal gynaecologist suffice or should you consult a real fertility expert? I say go for the latter. You'll sleep better at night knowing you have seen the best, if not, one of the best fertility doctors in the country.

 

There are about 40 fertility specialists scattered all over Malaysia. Here are some of the fertility specialists practising in the Klang Valley:

Dr. Colin Lee & Dr. Leong Wai Yew

Alpha Fertility Centre
Website: http://www.alphafertilitycentre.com

Dr. Haris Hamzah

Subang Fertility Centre, Sime Darby Medical Centre
Website: http://www.subangfertility.com

Dr. Paul Tay Yee Siang

Prince Court Medical Centre
Website: http://www.princecourt.com

Dato’ Dr. Prashant Nadkarni

KL Fertility & Gynaecology Centre
Website: http://www.klfertility.com

Dr. Surinder Singh

TMC Fertility Centre, Tropicana Medical Centre
Website: http://www.tropicanamedicalcentre.com

Dr. Tee Swi Peng

Metro IVF, Metro Maternity Hospital
Website: http://www.metro.com.my

Dr. Wong Pak Seng

Sunfert IVF, Sunway Medical Centre
Website: http://www.sunfert.com

Dr. Zamri Abd. Rahim

DEMC Specialist Hospital, Shah Alam
Website: http://www.demc.com.my

Professor Dr Zainul Rashid Mohd Razi
Professor Madya Dr Mohd Hashim Omar

Medically Assisted Conception Unit (MAC), UKM Medical Centre
Website: http://www.ppukm.ukm.my

So take your pick. Which one does your heart desire? The deciding factor would be cost and success rates. The links have been provided, it's now up to you to do the research on which doctor would be the best for you.

Infertility Rates in Malaysia

According to a survey conducted by the National Population and Family Development Board (LPPKN), the total fertility rate in Malaysia has declined from 2.8 in 2004 to 2.4 in 2010. (Total fertility rate is defined as the average number of babies born to women during their reproductive years.) The Health Ministry recently estimated there were about 350,000 couples in Malaysia aged between 20 and 40 who experienced some form of infertility, and the number seem to be increasing.  

So what is infertility? Infertility is defined as the inability of a couple to conceive a child after a year of regular unprotected intercourse or the inability to carry pregnancies to a live birth. Regular intercourse means an average frequency of two times per week. If the female partner is above 35 years old, they should consult a doctor after trying for 6 months because pregnancy rate declines for women over 35 years of age. Causes of infertility can be broadly divided to male factor only (35%), female factor only (35%) or combined (20%). In 10% of couples, no causes can be identified (unexplained).

As a woman gets older, her fertility reduces. This is more apparent once she crosses the age of 35. The risk of miscarriage also increases with age. For women below 25 years of age, the miscarriage rate is 7%. For those between the ages of 25 to 35, the miscarriage rate is between 10% to 15%. For ages 36 to 40, the miscarriage rate is between 20% to 25%. For women above 40 years of age, the risk rises sharply to between 30% and 50%.

In order to conceive, both partners should lead a healthy lifestyle, reduce stress levels, consume a healthy diet and avoid toxins such as smoking, excessive alcohol or caffeine. Stress and hectic urban lifestyle were reasons contributing to infertility.

It is important to seek help early if there is a suspicion of problems such trying without success for more than a year, history of surgery to the reproductive organs or women who are attempting a pregnancy at a more advanced age (more than 37 years). The couple would be advised to undergo thorough investigations such as semen analysis, pelvic ultrasound, hormonal blood tests or if necessary diagnostic keyhole surgery (laparoscopic surgery) to look at the internal female organs.

Here's a video of a normal female reproductive system...

I Wanna Be A Mommy...

You meet the man of your dreams. Fall in love. Get married. Naturally, the next step after getting married is to start a family. Some might want a baby immediately, others might want to wait for a while until their finances are stable as the cost of raising a child is not cheap, or for what ever reason. Some might be lucky & conceived on their first try, some might even conceive without even trying. Others might not be so lucky.
 

The ‘unlucky ones’ tries month after month after month and still fails to get pregnant. They tried each and every method and trick known to mankind. Buy ovulation prediction kits, consult sinseh, feng shui masters, ustaz, bomoh, pawang, bidan, shaman, medicine man, monk, priest, eat this, eat that, don’t eat this, don’t eat that, you name it, they’ve tried it all.

“Lie in bed for 30 minutes after you make love!”

“Prop your butt up on a pillow after you make love!”

“Put your legs up against the wall after you make love!”

These are some of the unsolicited advice/tips given by society in general to those who are trying to conceive. After about six months or so of trying without luck, it starts to get frustrating. Especially when others around you are getting knocked up left, right and centre. Boo-hoo. Don’t get me started on nosy relatives.

Trying without luck month after month after month is emotionally draining. By this time your heart aches and bleeds for a baby. It is also a very lonely journey especially if everyone else around you has no problem conceiving. Infertility is still not openly discussed in this country so you feel as though no one understands what you’re going through.  Sometimes there are no more tears left to cry. You desperately want to become a mommy, but luck is just not on your side. And your biological clock is ticking. Chances for a woman to conceive and produce good quality eggs declines as she gets older. Meaning, the older you become, the more difficult it is for you to get pregnant.

The best thing to do is seek professional help and opinion in finding out why it is so damn difficult for you to get pregnant.