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My daughter, 20, is going to have a 5 cm ovarian cyst removed by keyhole surgery. The doctor tells her that she can be discharged the same day. May I know more about keyhole surgery? What are the complications? What should I look out for should complications occur? Keyhole surgery or laparoscopic surgery is also known as minimally invasive surgery (MIS). It is a recent surgical technique in which operations are performed through small cuts, usually between 0.5 cm to 1.5 cm, on the tummy. For removal of the ovarian cyst, your daughter will be put under general anaesthesia and her tummy inflated with carbon dioxide through a fine needle. When her abdomen is sufficiently distended, a fine 5- 10mm diameter telescope is inserted inside the abdomen via a tiny cut at the belly-button to allow for magnified views of the reproductive organs. Additional instruments are then introduced to remove the cyst. There are a number of advantages to the patient using laparoscopic surgery compared with the usual open method. They are as follows: · Pain and bleeding are less due to smaller cuts. · Recovery times are shorter. · The hospital stay is shorter and the patient can go back to work earlier. · The internal organs are less exposed to the air thus reducing the chances of infections. But there can be complications too though they are very rare, usually less than 1 %. These include: · Injuries from the trocar, an instrument used to pierce the tummy. This sharp pointed tool, which stabs into the tummy blindly could cause large amount of bleeding from the blood vessels in the abdominal wall. The small and large bowels can also be damaged during the process. This can be serious and life threatening if it is not recognised and treated early. The urinary bladder can also be injured resulting in urinary infection or leakage. · Adhesion formation in the abdominal organs remains a major, unsolved problem. Adhesions are tough bands that bind tissue to organ after surgery. They can lead to chronic tummy pain and blockage of the bowels resulting in repeated vomiting and abdominal distension. Surgery has to be done to overcome the obstruction. · Umbilical hernia and wound infection The risk of injuries is increased in patients who have blood clotting problems, are either too fat or too thin or have prior abdominal surgery such as caesarean section or appendicetomy. After the ovarian cyst is removed, your daughter may feel pain and fullness in her tummy and aches over the shoulders. This should improve in a day or two. You should watch out for the following signs or symptoms and call the doctor immediately if she has: · Heavy bleeding from the incisions · Fever or chills · Problems with urination or bowel movements · Heavy vaginal bleeding · Severe or increasing abdominal pain · Vomiting · Redness or discharge from the skin incisions · Shortness of breath or chest pain

I am trying to conceive for the past 2 years. My doctor told me that the mucus secretion of my cervix during ovulation was scanty and thick and this could be hostile to the sperm. What are the reasons for scanty mucus? Any treatment? In normal menstrual cycle, a copious amount of transparent clear mucus is produced by the cervix during ovulation. The mucus guides and helps the sperm swim through the vagina into the cervix and beyond and provides nutrients which the sperm needs for the long journey ahead. But in some cases, it may turn hostile to the sperm by immobilising and/or killing the sperm before it has a chance to meet the awaiting egg. This condition is called cervical hostility. Causes of scanty mucus include: • Vaginal infection, usually from sexually transmitted diseases: The vaginal fluid becomes tainted, killing or damaging sperm as they enter the vagina. • Cervical infection, also from sexually transmitted infection: This will damage the glands that produce the cervical mucus. • Acidic cervical mucus: The inflammatory cells resulting from bacterial or yeast infections will make the cervical secretions too acidic and hostile to the sperm. • Anti-sperm antibodies: In this uncommon condition, cervical mucus contains anti-sperm antibodies which will immobilise or attack the sperm. • Trauma to the cervix: Electro-cautery, cryosurgery or biopsy of the cervix may damage the cervical glands that produce the mucus. • Medications: Fertility drugs such as clomiphene, may cause scanty by affecting the production by cervical glands. Treatment includes: Eating a diet high in vegetables Cutting down the consumption of processed foods, soda, meat, dairy products and sugar Drinking an adequate amount of water to hydrate the body Cessation of drugs that may be causing scanty mucus Treating the infection using antibiotics and/or antifungal agents Patients with anti-sperm antibodies may be treated with a course of steroids Employing advanced reproductive technology (Intrauterine insemination and in-vitro fertilisation) to bypass the cervix

I am 34 weeks pregnant. Recently, I noticed swelling over my feet especially towards the end of the day. Is it normal? Is there anything in my diet that can help reduce the swelling? Fluid retention is common during pregnancy. This is because your body is holding more water than normal due to the hormonal changes. The extra water tends to collect in the legs towards the end of the day, especially if you have been standing for a long time. The gradual swelling is usually mild and not harmful to you or your baby, but it can be uncomfortable if severe. But if you have sudden swelling over your face, hands and feet. You should seek medical attention early as it may be a sign of hypertensive disorders of pregnancy and could have serious consequences. With reference to the diet, the swelling may be reduced if you: · Eat a balanced diet so that you put on a healthy amount of weight during pregnancy. Your diet should include protein such as lean meat, fish, eggs, or beans · Eat more citrus fruits, apples, strawberries, broccoli, cabbage, tomatoes, sweet corn and parsley as these are rich in vitamin C. They are natural diuretics and help you pass water out of your body · Drink plenty of water. This will expand the blood volume that carries oxygen and nutrients to your baby · Reduce the salt intake and avoid adding additional salt to the meal. Cut out pre-packaged, highly processed foods, as they are usually high in salt. Salt causes your body to hold on to more fluid. · Cut down your intake of tea, coffee and cola as the caffeine in these drinks may affect the absorption of vitamin C, a natural diuretic in your diet.

I am 40 years old and have 2 children. I have suffered from endometriosis for the past 7 years. 5 years ago, I had a “chocolate cyst”removed by open surgery and another one on the opposite ovary removed by key-hole surgery 3 years later. Recently, I started to have menstrual pain and backache again. Is there anyway of preventing endometriosis from recurring? What are my treatment options? Endometriosis is a chronic and progressive disease where the lining of the womb (endometrial tissues) is spilled into the surrounding organs-- fallopian tubes, ovaries and the back of the womb. These endometrial tissues respond cyclically every month to the female hormone, oestrogen, from the ovary and bleed during menstruation. The surrounding areas become irritated by the blood and form scars in the pelvis causing backaches, abdominal cramps during menstruation and pain during sexual intimacy. There is no definitive cure for the disease which will only regress after menopause when there is little or no circulating oestrogen The treatment for endometriotic cystslis surgical removal. But the recurrence rate is high,ranging from 20-50% within 5 years after surgery. How fast the disease recurs depends on the following factors: • Severity ofthedisease at the time of surgery • Completeness of the surgery • Use of suppressive hormonal treatment after operation There are a number of hormonal treatment options that may be used to delay the recurrence. Which option is right for you will depends on your condition. By reducing the levels of blood oestrogen, the chances of endometriosis recurrence are reduced. This can be done using oral contraceptive pills or a GnRH agonist. Recent studies have shown that insertion of Mirena, a hormone impregnated intrauterine contraceptive device (IUD) can be effective for delaying the recurrence. Some women may also choose to use an aromatase inhibitor to stop all production of oestrogen. If medical treatment fails, the surgical removal of the uterus (hysterectomy) with or without removal of the ovaries (bilateral oophorectomy) may be the last resort. See also the articles“ How does GnRH agonist work and what are the side effects?”under Q&A and “Endometriosis”under Gynae conditions

I am 6 weeks pregnant. This is my first pregnancy. 3 days ago, I came into direct contact with my colleague who was diagnosed with chickenpox today. I do not have any past history of chicken pox. What are my chances of catching the disease? What should I do? Chicken pox is a highly contagious viral infection. If you have not had it before and have had direct contact with an infected person, it is very likely that you may get it. The symptoms usually show up 14 to 16 days after exposure although this may vary between 10 to 21 days. You may have mild flu-like symptoms, followed by an itchy rash. The rash starts out as little red bumps, first on your face, chest, or abdomen, and gradually spread to other parts of your body. The rashes will form blisters which get larger and eventually dry outwith scabs. The moment you are exposed to the person with chicken pox, call your obstetrician right away. He or she will make special arrangements to see you so that you will not infect other pregnant women in the clinic. You may be treated with medicine that has chickenpox antibodies. It’s important to get treatment within 4 days after your exposure. This will help prevent the infection or make it less serious. If you start to have symptoms, you will be given an antiviral medicine call acyclovir that will kill the chickenpox virus. Studies have shown that acyclovir is safe during pregnancy. If you start to get serious complications such pneumonia, you will be hospitalized and given a higher dosage of acyclovir intravenously.

HPV (human papillomavirus) is a common sexually transmitted disease. Generally, the infection is not associated with infertility but can cause precancerous and cancerous cells to grow in the cervix (neck of the womb). This may reduce a woman's chances of conception or maintain a pregnancy. Precancerous cells can be treated relatively easily if they are detected early. But the treatment may, in some cases, lead to fertility problems later on. When precancerous tissue is found in the cervix it needs to be removed. There are several ways of doing this. The tissue may be removed by laser biopsy as in your case, freezing or burning. These treatments may leave some scarring of the cervix, which could, in future, prevent the access of sperm to swim up the genital tract. The production of cervical mucus may also be reduced. Sperm need a certain amount of cervical mucus during ovulation to help them on their way to meet the egg. If too much cervical tissue is taken away, the cervix may be weaken and becomes “incompetent”. This will increase the risk of miscarriage at second trimester or premature labour. Since there are no trace of HPV since 2015, you should not delay trying to conceive.

Oyster is rich in selenium and zinc. Selenium is an antioxidant which helps in sperm motility while zinc is important in improving the quantity and quality of the sperm. Zinc also helps in maintaining the quality of the egg . While taking oyster is good for fertility , you should consume it in moderation.

Q. If IVF fail? What can be the other options we can do? A. IVF is only one of the ways of treating infertility. There are many other ways depending on the cause. Q. Hi Dr Chew, my husband is on Tegreto. Can he still take multivitamin such as comples B with folic acids etc together or he need to have a 2 hrs break in between? A. Tegretol is a common brand name for Carbamazepine. It is an anticonvulsant and a mood stabilizer. It can be taken with multivitamin without any break in between. Q. How long after should we try again for a baby after D & C? A. For D&C, I presume you mean evacuation of the womb after miscarriage. You can try to conceive after 3 months. This is to allow your wife to recuperate from the physical and emotional stress of miscarriage. Q.I am a male type 1 diabetic since 3 years old and currently I am 33 years old. Will it affect my fertility? Should I consider a fertility check after 3 months of unprotected sex? A. Diabetes can affect fertility. You should have the fertility check after 3 months of unprotected sex. Q. Can man having slimming pills affect fertility? A. there are many types of slimming pills. Some may affect fertility. Q. I used to take diane for my acne condition. I had it for about 6 months and stop after my skin condition gets better. Ever since I stop diane my menstrual cycle is irregular. My menses doesn’t come every month. Shortest is 2 months one time longest can get up to 4 months one time. May I know is there any problem to my health? Does it affect fertility? A. When you are on Diane, which is an oral contraceptive pills, you would have so called “normal periods” . This is not the “natural menstrual periods” resulting from normal ovulation. After you stop the medication and your menstrual cycle becomes irregular. You should go and have a health check . This may indicate hormonal upset and definitely will affect your chances of conception. Q. Are there foods for women to eat to encourage more eggs (chances of twins)? A. Not that I know of. Q. What are your views of TCM? A. TCM such as acupuncture has been proven to be useful in infertility treatment. Q. What about freezing eggs? What’s the procedure like? A. Egg freezing is a complex procedure. It involves stimulation of the ovary with medications , surgical retrieval of eggs under ultrasound guidance, selection of good quality eggs under microscope and finally storage at very low temperature under very stringent conditions. Q. What food helps to increase level of progesterone? A. Not that I know of .There are some herbs that purportedly can raise the levels of progesterone. Q. I am 23 years old female and have been trying for a baby with my husband for 1 year but there is no result. We are healthy, what could be the issue? A. You should have a fertility health check to find out the cause and get appropriate advice. Q. If my husband does not have much strength and low sex drive except in the morning. How do improve? A. Try to have intimacy in the morning or after a good rest especially during your ovulation period. Q. If we have been having sex for 5 months and often during fertile and ovulation period, is there any problem with our fertility? A. You should have a fertility health check to find out the exact cause and get appropriate treatment. Q. Can we have coffee and tea during pregnancy? A. Yes. You can have them in moderation. Q. How would ovarian cyst affect pregnancy? A. Pl refer to our article “ovarian cyst pregnancy” under “pregnancy “ in our website. Q. How to increase chance of pregnancy? A. Pl refer to the article ”Tips for Women Trying to Conceive” under “pre-pregnancy”. Q. What is the purpose of pre conception checkup? What is covered generally? A. Pl refer to the article “preconception examination “ under “pre-pregnancy”.

I am 34 year old. Married for a year. My Semen Test showed that it is very viscous with a delay in liquefaction. Why is it so? When semen is ejaculated ,it is thick and gel like. This is to help it adhere to the neck of the womb(cervix). The semen eventually liquefies within 15-20 minutes, setting free the sperm and enabling them to swim up the genital tract. A viscous semen with delayed liquefaction may affect your fertility as it may indicate infection of the testis, seminal vesicles( a pair of tube-like glands,behind the urinary bladder) and the prostate gland, (a walnut-sized gland located between the bladder and the penis). Both the seminal vesicles and prostate gland contribute and secretes most of the seminal fluid that nourishes and protects sperm. Most of the time, the infection of these organs is due to sexually transmitted diseases such as Mycoplasma, Chlamydia and Gonococcus. Early treatment of the infection is important to correct the abnormality of the semen. Anti-inflamatory medications and diuretics (pills that help rid your body of salt (sodium) and water) are also helpful.

I am 38 and have been married for 3 years. I had 2 miscarriages over the past 2 years. My doctor told me that it was due to my age and my baby’s bad “genes” called “aneuploidy”. I don’t quite understand. What is aneuploidy? Why should age have anything to do with bad gene? Aneuploidy refers to abnormal number of chromosomes in a cell. Chromosomes are organised structures in the nuclei of the cell. They contain DNA or genetic materials. Normal cells have 46 chromosomes comprising 23 chromosome pairs-- half from the mother and half from the father. Normally, the egg and sperm have 23 chromosomes each. When the egg is fertilized, the foetus has a total of 46 chromosomes. With advancing age, random error of cell division becomes more common. This results in a cell with either an extra or missing chromosome. The foetus may have cells with three copies of a particular chromosome (resulting in 47 total chromosomes) or one copy of a particular chromosome (resulting in 45 chromosomes). An extra copy of a chromosome is called a trisomy; a missing copy is called a monosomy. Changes in the number of chromosomes in the foetus or aneuploidy can affect the outcome of a pregnancy. Some aneuploidies can result in a live birth, but majority are lethal and result in miscarriages in the first trimester. It is estimated that more than 20 percent of pregnancies may have an aneuploidy, which usually does not recur in future pregnancies.

Q. I am 30 years old and single. Recently, I found a lump in my left breast while bathing. It moves freely and is not painful . I am worried it could be cancer. What should I do? A. Although most lumps in the breast are usually non-cancerous, you should seek medical advice and have them checked. The doctor will confirm the presence or absence of the lump/s. He will also take note of the following: · The size, shape, contour, mobility and sensitivity of the lump/s. · Presence of lump/s in the other breast and in the armpits · The feel or appearance of the skin over the breast. The skin may be puckered, look scaly, inflamed or have dimples · Presence of retracted nipples · Bloody discharge from the nipples Further tests such as mammography or ultrasound of the breasts may be done to ascertain the nature of the lump. Common non-cancerous breast lumps include: (1)Fibrocystic breast disease Cyclical levels of the hormones during normal menstrual cycles can cause changes in the breast which may be lumpy and tender just before menses. The lumps are milk ducts and surrounding tissues that grow and swell rapidly under the influence of the hormones. They may be hard or rubbery and the breast tissue may be thickened. After menopause, these types of breast changes do not happen as there is no more hormonal stimulation. (2)Fibroadenomas. These are commonly found in women between 20 to 30. They are solid, painless, round, and rubbery and move freely. They are due to excessive growth of the milk glands and surrounding breast tissue. (3) Intraductal papillomas These are small growths in the lining of the milk duct near the nipple. They usually affect women between 45 to 50 years old and can produce bloody discharge from the nipple. (4) Breast infection (Mastitis) This often occurs during breastfeeding and is caused by bacteria that enter the milk ducts through the nipple. The infection may cause a painful lump and the skin over it may feel warm and red.

I had an abortion when I was a teenager. I am now 27 years and plan to get married next year. I am worried whether the abortion will impact on my fertility. what should I do? A: I presume you had an induced abortion or termination of pregnancy. This is usually done under general anesthesia in the first three months of pregnancy by a procedure called dilatation and curettage (D&C). Metal dilators of various size are introduced through the vagina to force open the cervix (neck of the womb). When the cervix is dilated to about 6-10 mm in diameter, a plastic tube is inserted into the uterus (womb) and connected to a suction pump. Vacuum is then created and the foetus sucked out in pieces. Complications can occur during the procedure and they can be divided into early and late complications Early complications include; Infection of the womb with patient having fever, Excessive Bleeding from injuries to the cervix and the uterus, Perforation or puncturing of the uterus by the instruments, Complications from general anesthesia, Injuries to surrounding organs like urinary bladder and the intestines, Shock and death from severe infection. Late complications include; Anemia, a condition in which there is a lack of blood, resulting in general body weakness, Chronic pelvic infection with lower abdominal discomfort, Laxity of cervix causing repeated miscarriages, Ectopic pregnancy, a life-threatening condition in which the fetus grows outside the uterus, usually in a fallopian tube, Infertility, Psychological problems, emotional upset, “anniversary” syndrome, Link to Breast cancer. Fertility can be affected if there is excessive damage to the lining of the uterus from overzealous scrapping (curettage). The will cause scanty or absence of menstruation (Asherman's syndrome) if there is pelvic infection causing blockage of fallopian tube if there is laxity of cervix causing repeated mid trimester miscarriages. You should have a preconception check to assess your fertility potential. You can also do a self-test using the fertility index in our website.