Search Results

Muscle fatigue is the cause of the leg cramps. It usually happens at night and can wake you up from sleep. Varicose veins (dilated veins) in the legs resulting from the enlarged uterus pressing on the pelvic vessels may aggravate the condition. When a leg cramp hits, immediately stretch out the leg and bend the toes towards the shin. Massage it until the cramp is gone. Taking a glass of milk for extra calcium and eating a banana for potassium before bed may help. You should wear tight stockings if you have varicose veins. Avoid standing or sitting with your legs crossed for long periods of time.

What is it? Chlamydia is a very common sexually transmitted disease, caused by the bacteria, Chlamydia trachomatis. It can infect both men and women during vaginal, anal or oral sex. It can also be spread by sharing unclean sex toys. Chlamydia can be transmitted to the new-borns during delivery and cause serious eye and lung infections. Chlamydia usually infects the cervix (neck of the womb), urethra (urinary passage) and occasionally rectum, throat and eye. Symptoms and signs Chlamydia infection is usually asymptomatic. As a result, patients often spread the disease without realising it. These patients are also less likely to be diagnosed with the disease and thus may miss the opportunity for early treatment. The incubation period of the disease varies from 2-21 days after exposure. Symptoms in women include · Abnormal smelly yellowish vaginal discharge · A burning sensation while urinating · Pain during intercourse · Lower abdominal pain, nausea, or fever. · Bleeding between periods Symptoms in men include: · Discharge from the penis · A burning sensation when passing urine · Burning or itching around the opening of the penis · Occasional pain and swelling in one or both testicles · Pain, discharge, and/or bleeding from the rectum. Chlamydia if left untreated can travel up the upper genital tract, causing pelvic inflammatory disease (PID) resulting in infertility or ectopic pregnancy. In men, testicular infection and low sperm count may result. Diagnosis Laboratory tests are usually done from swabs collected from the urinary passage, vaginal and cervical discharge and rectum or throat. Blood tests are not recommended as they can be non-specific and can give false positive results. The tests should be done 24 hours after exposure and repeated two weeks later. A retest should also be done two weeks after completing the treatment to ensure that the bacteria is completely cleared. Treatment Chlamydia can be treated and cured with antibiotics. Couple should be treated together. They should abstain from sexual activity for one week after finishing the antibiotics. Reinfection can occur and should be treated promptly.

Coffee is the most popular drink in the world. Some consume it in the morning for its gentle stimulatory effect while others who are addicted to it claim that it helps the brain stay alert and concentrate better. In are cent workshop, I was asked whether drinking coffee will affect fertility. Medical research on this issue is conflicting. Some studies indicated that coffee diminished fertility while others found no such connection. One study even suggested that consuming 3 to 7 cups of coffee a day improves fertility! Why is there so much discrepancy? One reason could be due to the timing of the study. Caffeine is broken down in the body at different rates during different phases of menstrual cycle. Its metabolism decreases in the second half of menstruation when fertilisation, implantation and early embryonic development may take place. This may result in an increase in the levels of caffeine in the body and thus the interpretation of results. Another possible reason could be that some women break down caffeine faster than others and so may be less prone to the possible negative effects of caffeine. At present, the general consensus of medical opinion is that consuming caffeine in moderation would not affect fertility. Having 2-3 cups of coffee a day during fertility treatment is considered alright according to the Nurses’ Health Study by the Harvard School of Public Health when 18,555 participants were surveyed. What about the effect of coffee on theunborn child? According to American College of Obstetricians and Gynaecologists, pregnant women are advised not to take more than two cups of coffee and 1-2 regular cups of caffeinated drinks per day. Caffeine can pass through the placenta to the foetus which does not have the ability to metabolise it.  This may result in miscarriage,preterm birth and growth restriction (baby with low birth weight). If you do not want to take a chance while undergoing fertility treatment or during pregnancy,either give up coffee altogether or change it to decaffeinated drink.

M could not control her emotions. She gave me a big hug. With tears rolling down her cheeks, she exclaimed, “Doc, thank you for presenting me with such a wonderful gift.”  This was the first time she was pregnant after a first attempt on intrauterine insemination, an assisted reproductive technique. M ,a 38 year-old lawyer  had been married for 8 years and trying to conceive naturally but unsuccessfully for the past 7 years. She had a mild degree of endometriosis, a condition where there is a back flow of menstrual blood in the pelvic cavity. The endometriosis was treated with laparoscopic surgery, in which a telescope is introduced into the abdomen. She  had medications subsequently for 3 months. Her husband’s sperm  count was normal except for a slight decrease in the sperm motility. After numerous failed attempts with fertility drug treatment and timed sexual intercourse at the ovulation period, the couple decided on the regime of super ovulationand intrauterine Insemination (SO-IUI) What Is SO-IUI? It is an assisted reproductive technique in which two to three ovarian follicles (watery sacs in the ovary containing the eggs) are stimulated and brought to maturation and ovulation. A sample of prepared sperm is then placed directly into the uterus for the sperm to swim up the fallopian tube and fertilize the egg. This procedure will enhance conception for couples with mild endometriosis and mild sperm problem as in M’s case. It is also suitable for the patient whose cervix (neck of the womb) does not secrete good mucus during ovulation. The patient must have normal and patent fallopian tubes Fertility drugs are usually given for 10days or more to produce between two to three mature follicles. These drugs(gonadotrophins) are given as injections alone or in combination with oral fertility drug such as Clomiphene. Ultrasound scans are done at intervals to determine the number and size of the follicles before another injection (HCG) is given for final maturation and subsequent ovulation of these follicles. On the day of the insemination, the semenis prepared in the laboratory and the motile fraction harvested and placed into the uterus using a fine catheter through the cervix. Occasionally, the procedure may be discontinued because of poor response or over response of the ovary. Whilst M was jubilant with the pregnancy, I warned her about the risks of miscarriages, foetal abnormalities and premature birth which are increased in older mother. She is now in her second trimester and the pregnancy is normal so far. The couple feel reassured every time I show them the baby moving inside the womb using the ultrasound machine.

I am 30 years old. Recently, I went for a fertility checkup as I am planning to have a baby. The gynecologist suggested a  AMH blood test ? What is it? Anti-Mullerian Hormone (AMH) blood test one of the fertility tests to assess the ovarian reserve. The hormone is produced by the cells in the growing egg sacs (ovarian follicles). Every woman is born with a fixed amount of ovarian follicles. When a woman grows older, the number of follicles decreases. The levels of the AMH also decline until it becomes undetectable near the menopause Because the levels of AMH correlate with the number of follicles, the test is generally a good indicator of the ovarian reserve. It gives some insight into the remaining quantity of eggs and number of fertile years you may have, but does not tell us about the quality of these eggs. The test is useful in the following situations: •      You want to know if your ovarian reserve is appropriate for your age •         In fertility treatments, low levels of AMH could indicate a potentially poor response to medications and high levels may indicate an exaggerated response. •          You want to know how chemotherapy or ovarian surgery has affected your future fertility

Most expectant women would like to know whether their unborn babies have any genetic abnormalities. Now, there are screening tests available to evaluate such risk. These tests, usually done between the late first trimester and early second trimester of pregnancy, involve measuring the level of certain substances in the maternal blood and doing an ultrasound scan of the baby. The data are then used to calculate the risk. Common screening tests are as follows: NIPT NIPT or Non-Invasive Prenatal Test: This is the latest and most accurate screening test. During pregnancy, maternal blood contains genetic material (DNA) from the foetus. These cell-free DNA fragments can be analysed for chromosomal disorders. The test is done by taking maternal blood at about 10 weeks of pregnancy and screened for common foetal chromosome anomalies such as trisomy 21 (Down syndrome), trisomy 18 (Edwards syndrome) ,trisomy 13 (Patau syndrome ) and sex chromosome abnormality. The accuracy for screening for Down’s syndrome is 99 %. OSCAR test OSCAR stands for "One-Stop Clinic for Assessment of Risk". It is a screening test for Down's syndromes and is done during 11th –13th weeks of gestation. It consists of the measurements of nuchal translucency of the foetus (NT) and maternal serum level of Pregnancy Associated Plasma Protein-A (PAPP-A), and free beta-human Chorionic Gonadotropin (free beta-hCG). The risk is then computed based on the maternal age and the gestational age of the foetus. This test has an accuracy rate of approximately 92%. Triple test Blood is taken from the mother between 14 to 18 weeks of gestation and three hormones --alpha-fetoprotein(AFP), human chorionic gonadotrophin (HCG) and oestriol –are measured .A risk value is calculated according to maternal age and the gestational age of the foetus. As its accuracy rate is around 70%, this test is less commonly done nowadays. Nuchal Translucency (NT) The NT test involves a detailed ultrasound scan of the baby at 11- 14 weeks of the gestation .The thickness of the fluid collection behind the baby’s neck is then measured. A thickened NT of 3.5mm or more is associated with chromosomal abnormalities The accuracy of the NT test alone is about 80%. The screening tests pose no risk to the mother and the baby. But they are not diagnostic. They only assess the degree of risk the baby may have and do not indicate that the baby actually has the problem. They can also give false positive results. That means they can be wrong and could mislead the expectant parents to believe their unborn babies might have genetic abnormalities. The only way to know the truth is to do the invasive diagnostic tests such as amniocentesis or chorionic villus sampling (CVS), which carry the risk of foetal injuries and miscarriage. (REFER Down’s syndrome article) The decision to go through genetic screening tests would depend entirely on the expectant mother and her spouse as a positive result could lead to anxiety, stress and conflicting emotions. The couple should think through carefully whether to carry on further diagnostic tests should the result be positive.

Q. I just delivered my baby 2 months ago. I had diabetes during the pregnancy (gestational diabetes GDM) and my blood sugar levels are now normal. Will I get GDM again in my next pregnancy? My obstetrician also warns me that I may get type 2 diabetes later in life. What should I do to minimize the risk? A. Yes, you can get GDM again and type 2 diabetes later in life. The risk for GDM varies from 30 to 50 percent and that of diabetes later in life, 60%. Your risk is increase if You remain overweight or obese Your blood sugar levels during your last pregnancy were high, requiring insulin injections GDM was diagnosed early in previous pregnancy. To lower your chance of getting gestational diabetes and type 2 diabetes subsequently, You should breastfeed your baby. Breastfeeding has a good effect on glucose metabolism .There is associated weight loss with a reduced risk of developing type 2 diabetes and cardiovascular disease. It also helps prevent childhood obesity and decrease your child's risk of diabetes. You should maintain a healthy weight by Eating healthy foods. Limit the saturated fat. Choose lean meat, skinless chicken and low fat dairy foods. Cut down processed and fried foods. Choose foods high in fibre .Eat plenty of vegetables, beans, nuts, fruits, wholegrain breads and cereals. Watch the size of the food portion. Being physically active .Regular exercise can keep your blood sugar level down .Aim for 30 minutes of moderate activity 3-4 times a week. You should be aware of the symptoms of high blood sugar (hyperglycaemia), which could be a sign that your diabetes has returned. These are: • increased thirst • The need to urinate frequently • Tiredness A Fasting blood glucose test and an HbA1c test (a measure of average blood sugar levels over a period)should be done at least once a year to check whether or not you have developed type 2 diabetes

Q. I am 28 years old and am six weeks pregnant. This is my first pregnancy. I am having “menses” for the past few days. The bleeding is not heavy. Is this normal? Shall I see a doctor? A. When you are pregnant, you should not have “menses” or bleeding from the vagina. Any bleeding in early pregnancy can be worrying as it may be a symptom of miscarriage or ectopic pregnancy (pregnancy outside the womb).You should see your obstetrician straight away. About 20-30% of women experience some degree of bleeding in early pregnancy. If the bleeding is slight, it is called threatened miscarriage. A threatened miscarriage does not necessarily mean that you are going to miscarry. If the bleeding settles down, there is a good chance that all is well and your baby is fine. However, if you have menstrual cramps with heavy bleeding and clots or tissues passing out through the vagina, miscarriage is imminent. The majority of miscarriage occurs in the first trimester. Ectopic pregnancy usually occurs in the fallopian tube. It can be life threatening as it causes internal bleeding when the fallopian tube ruptures. Symptoms include severe cramping or sharp pain in the lower abdomen, fainting attacks and shoulder pain. The chances of an ectopic pregnancy increase if you have a past history of Sexually transmitted diseases, abortion or pelvic surgery.

Ovulation prediction kit (OPK) measures the Luteinizing Hormone (LH) in your urine. Small amount of LH is present in the urine every day and its level gradually increases as ovulation approaches. The LH surges within 24 hours before ovulation and OPK is positive the day before you ovulate. But some conditions could give you false positive result. These include Polycystic ovarian syndrome(PCOS) where there is a raised blood level of the LH Premature menopause where the ovary ages prematurely  in women below the age of 35 Perimenopause or menopausal transition where the level of LH is high

Recently, a husband consulted me on the use of vibrator, a sex-toy for his wife who had low sexual desire. I advised him that as long as the wife was comfortable using it, and it achieved the desired result, it was fine to continue. The history of the vibrator is interesting.  It was created as a medical treatment for “hysteria” in women in the conservative Victorian age in England. At that time, women with a variety of emotional complaints ranging from depression to anxiety were labelled as having “hysteria”. These psychological issues were often overlooked by the medical community then. But some good did arise from the medical use of the vibrator. For women of the Victorian period, many could have experienced an orgasm for the first time as the knowledge of foreplay and the importance of female sexual pleasure were non-existent. For these patients, enjoying sexual satisfaction might have positive effects for them mentally and physically. Nowadays, vibrators have been used as an aid for the treatment of women with low sexual desire. Studies have found that vibrators do produce higher levels of arousal, lubrication, and orgasm.

Is it necessary to have a “ warm up” and  a “cool down” routine for exercise? I am a beginner and intend to go to gym soon. I am a first time mum in my second trimester. Do not rush into your exercise routine straight away without starting with a “ warm up” and  ending with a “cool down”. You might injure your "cold" muscles. Warming up pumps nutrient-rich, oxygenated blood to your muscles as it speeds up your heart rate and breathing. A good warm-up should last five to 10 minutes and work all major muscle groups. After your workout, it's best to spend five to 10 minutes cooling down through a series of slow movements. This helps prevent muscle cramps and dizziness while gradually slowing your breathing and heart rate. Please refer to the article “Exercise during pregnancy” under “Pregnancy”.

N looked perplexed and anxious when I told her that she had human papilloma virus (HPV) in her cervix confirmed by a tissue biopsy. "But how could it be?" she asked. “My husband uses the condom all the time. From what I read in the media, the condom is supposed to prevent sexually transmitted diseases (STDs). Now I am confused.” Like N, many people are under the impression that condoms can prevent all STDs. This is a misconception. Studies have shown that condoms can only reduce the transmission but cannot completely eliminate the infections. An authoritative study in the US released in 2001 has shown that even with correct and consistent use of condoms, transmission of HIV can only be prevented in 85% of cases. The same study also showed that condom was ineffective in the prevention of genital herpes, syphilis, chancroid, and the human papilloma virus (HPV). “So why should the condom fail?” N asked. “There are 2 main reasons,” I explained. “Firstly, STDs are transmitted primarily in 2 ways—via bodily fluids, in infections such as gonorrhoea and chlamydia, and by skin to skin contact like HPV, genital herpes and syphilis. In the latter group of diseases, if the infected area is exposed and not covered completely by the condom, infections can occur. Secondly, there may be flaws in the condom. Not all condoms that are passed for sale are perfect. A very small proportion may be defective. Between the time of production and the time of use, the condom could be subjected to various environmental conditions such as heat that can cause its quality to be compromised. The condom can also break during sex or may slip out during or after sex. All these factors contribute to the failure of condom in preventing STDs.” After listening attentively to my explanation and the reassurance that most HPV infection would be cleared off by her own immune system naturally over time, N left my consultation room with a sigh of relief.