Q & A - Talk and Movie event 29 Oct 2016

1. Is there any side effects for taking hormones pills? Like pills to increase progesterone level. Does taking hormones pills increase breast cancer rate? There are various types of hormone pills. Some are given during the treatment of infertility to support the pregnancy, while others are used in contraception. Like all medications, they have various side effects. You can also refer to the article “contraceptive pills” in our website.

2. How do you calculate ovulation from your menstruation date? It depends on whether the menstrual cycle is regular or not. If it is a regular cycle, ovulation date can be calculated as 14 days +/- 2 to 3 days prior to the expected date of the next menses.

3. Does history of STD (Gonorrhoea) affects female reproduction? Gonorrhoea is a common sexually transmitted disease (STD). It can cause inflammation of the fallopian tubes resulting in blockage and infertility.

4. How much does it cost to do the checks at the clinic or hospital? You can find out the cost from restructured hospitals (KKMH, NUH and SGH) as well as private hospitals and gynaecologist's clinics.

5. Is it important to store the cord blood? Please refer to the article “cord blood stem cells” in our website.

6. What is the recommended daily intake for folic acid and zinc for men to increase sperm mortality and count? Folic acid and zinc are important nutrients for sperm production, maturation and functions. There is no recommended daily dose for folic acid and zinc to improve sperm functions. But some experts have suggested that daily intake of 700mcg of folic acid and 15 mg of zinc could improve sperm quantity and quality.

7. I work near radars. Does it affect fertility? Studies have shown that exposure to radiofrequency fields during work with radiofrequency equipment and radar can cause a reduction of sperm motility and increase of abnormal sperm.

8 .Does taking long term gastric medication impact fertility? Most gastric medications do not affect fertility. But cimetidine, which reduces gastric acid may cause a decrease in sperm production.

9. Does cycling every day for an hour affect my sperm quality? Does padded shorts help? Researches have suggested that cyclists are more likely to have lower sperm count and abnormal sperm compared to those who lead a sedentary life. This is especially so for cyclists who regularly ride longer distances. Many contributory causes such as raised temperature from tight clothing, seat friction and riding pressure have been suggested for the low sperm count.Padded shorts may not help if you already have low sperm count.

10. Does low potassium level affects pregnancy rate? There are many causes of low potassium levels in the blood. If it is due to temporary causes such as diarrhoea and vomiting, fertility would not be affected. If it is due to chronic health issues such as kidney problems or diabetes, fertility may be affected. It is important for you to consult your health care provider to find out the cause of low potassium and get it treated accordingly .

10a. Does endometrial scratch improves chance of implantation? I presume you mean endometrial biopsy, which is a procedure using a fine instrument to sample the lining of the womb (endometrium) in the second half of the menstrual cycle. The result may indicate whether the hormone, progesterone is adequate enough to support implantation of the fertilised egg. As it is an invasive procedure, it is usually replaced by measuring the blood levels of the progesterone nowadays

11. Does coffee or tea affect fertility? Pl refer to our article (KEEP THIS QUESTION AFTER OUR ARTICLE IS RELEASED)….. 11a. Besides Viagra how can one overcome erectile dysfunction? Is there a negative effect to taking too much Viagra? There are many causes of ED. You should find out the cause and treat it appropriately. Taking too much drug without medical guidance is not a good practice.

12. Will birth control methods like IUD/IUS affect fertility? After removal of IUD/IUS, how soon can you start trying for a baby? IUD and IUS are used for contraception. You can start trying for baby straight away after removal.

13. I am diagnosed with pcos but managed to have my first child after consuming clomid. What are my chances of having the second child? PCOS may recur as there are some genetic basis of this condition. You may require treatment with clomid again if you want to conceive again.

14. Where can we get our sperm check? You can have a sperm check in gynaecologist’s clinic in restructured hospitals and in private hospitals.

15. Does good health means good sperm? Generally, a healthy body will produce good sperm.

16. How do you improve sex drive? Sex drive or libido refers to a person's desire for sexual activity. It differs in male and female and is influenced by biological, psychological and social factors. To improve the sex drive, it is important to identify reasons that cause its decline and try to rectify with appropriate method.

17. Is 26 days cycle considered short and the flow is not a lot signs of concerns? Menstrual cycle that occurs every 26 days is considered as normal. As long as the menses are regular and the amount of flow does not change abruptly, there is no sign of concern. In doubt, please consult your gynaecologist.

18. Does bulky uterus affect fertility and how does it affect? It depends on the cause of “bulky uterus”. If it is due to big uterine fibroids or adenomyosis (refer article in our website), fertility may be affected.

19. What checks should a newly married couple go for when trying for a baby? Pl refer to the article “preconception examination” in our website.

20. Why does more red meat intake lower sperm count whereas more intake of vegetables increase sperm count? Is there any substance in the red meat that reduce sperm count? Some studies have found that taking too much red meat may lower the sperm count and suggested that the chemicals, possibly pesticides found in red meat may interfere with male hormone production and affect fertility. Vegetables and fruits have lots of vitamins and trace minerals which are important nutrients for sperm production.

21. How do we differentiate whether the fertility problem is at the ovulation or implantation stage? What are the treatment approaches for each stage? Ovulation can be determined by various methods (refer to the article “fertility awareness “in our website). Fertility problem due to ovulation malfunction can be treated by various medications including clomiphene and gonadotrophin injection. Implantation problem can be discerned during IVF cycle where fertilised eggs fail to develop after embryo transfer. Various drugs such as progestogens have been used to improve the lining of the womb to improve implantation.

22. I have a poor sperm morphology and good sperm movement rate, how to improve sperm morphology? Sperm morphology refers to the appearance and shape of the sperm. Abnormal shaped sperm is an indication of poor sperm development and can be due to genetic cause, exposure to toxic chemicals, increased testicular temperature and infection. It is important to find out the cause so that appropriate treatment can be given.

23. What is sperm agglutination? Sperm agglutination refers to sperm sticking together or “clumping” due to infection or the presence of sperm antibodies. This will reduce or inhibit sperm’s movement and its ability to fertilize the egg.

24. If husband has diabetes and is taking medication, does it affect the health of new born? If the sperm is healthy, it should not affect the health of the new born.

25. What sexual position is the best to conceive? Missionary position will help the sperm to gravitate towards the neck of the womb and may improve chances of conception.

26. To clarify, the best time to check ovarian cysts is during or right after menses? To find out whether the ovarian cyst is functional or not, vaginal ultrasound examination is done during or soon after menses.

27. For having large fibroid over 5cm, must I operate to remove them? Understand it will be difficult to deliver naturally after that? For large fibroid of over 5cm, surgical removal would depend on whether it is symptomatic or not. Pl refer to the article “fibroid”. Mode of delivery of the baby after surgical removal of fibroid depends on many factors including whether the fibroid has entered the uterine cavity. The attending obstetrician should be the one to advice.

28. Will ovarian cyst surgery affect conception chances? Removal of ovarian cyst may cause damage to adjacent tissues in the ovary and may thus affect fertility.

29. If wife go toilet to wash immediately after sex, will it wash away the sperm and affect chances of pregnancy? To increase chances of conception, it is advisable for the female to lie on her back for about 30 minutes for the sperm to swim up the genital tract.