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1. Can endometriosis be detected early or must we only perform the scan together with surgery? Was told by a professional that it is a one time process. Early detection of endometriosis is by clinical suspicion based on history and physical examination and confirmed by laparoscopy. Early stage without endometriotic cyst cannot be seen by ultrasound scan. 2. Typically, my menses is around 30-35 days but around 3 times a year, it will be longer than 40 days i.e 40 plus and 50 plus days. I have went through all medical checks, no issues. Doctor also ruled PCOS out. What could be the root cause other than stress? There are many causes of irregular periods and Stress and PCOS are some of the causes. Thyroid glands dysfunction (hypo- or hyperthyroidism), increased milk hormone (prolactin) from the pituitary, chronic medical illnesses like diabetes or kidney problems are some of the causes of irregular menses. 3. How long would you recommend couples in early 30s to try naturally before taking ART? There is no hard and fast rule on how long one should try naturally before resorting to ART. It depends on the cause of infertility. For example, if the tubes are blocked, one should resort to ART straightaway. Normally, if the female is in early 30s , she should try naturally for about 6 months without contraception. If conception does not occur, she should seek medical help to find out the cause so that appropriate treatment can be given. 4. How long after conceiving then you will have early pregnancy symptoms? Normally you get your period about 4 weeks from the start of your last period, but if you're pregnant, the sign at this point is a missed period. Many women still feel fine after getting overdue for a week, but others may notice sore breasts, fatigue, frequent urination, and nausea. 5. My wife is undergoing TB treatment, what is the risk of pregnancy? If the TB responds to the treatment and after doctor has declared her well after treatment , she can try to get pregnant. However, if she is pregnant and treatment is in progress, then you should consult the chest physician with regards to the safety profiles of the medications with reference to the unborn foetus. 6. Can adenomyosis be treated? Please refer to the website article on Q & A about adenomyosis. 7. What are the tests that you will suggest for the couple before trying for a baby?Please refer to the Q&A fertility tests in the website. 8. What are the possible causes for non fertilization during ICSI? Few reasons: Technical failure, Poor egg quality, Poor sperm quality, The egg may not have survived after the injection, The DNA of the sperm head may remain ‘locked’, The egg may not have been activated and didn’t participate in the intracellular steps of fertilization. 9. If ovulation tests (ovulation test kit) was done daily during the female’s ovulation period (using menses calender app) but the result always negative. What could be the possible reason? Few reasons: The OPK is faulty, Urine does not contain enough LH, Technical fault, Luteinized Unruptured follicular syndrome. Please refer to the Q&A on ovulation kit. 10. If the menses is regular (average 36 days for every cycle) but flow is very little, does it affect the plantation of the embryo or fertility? Is there anyway to improve the menses flow? Scanty flow may indicate a thin uterine lining and this may affect implantation of the embryo. It may indicate dysfunction of ovulation or poor corpus luteal formation You should find out the cause and treat it appropriately. 11. After miscarriage, does it affect chances of conception? Usually, one previous miscarriage does not affect chances of having a subsequent pregnancy. But if there are 2 or more recurrent miscarriages, subsequent chances of conception may be affected 12. What can I do to regulate my cycle? You should find out the cause of the irregular periods so that appropriate treatment can be given. Please refer to the article on Q&A irregular periods in our website. 13. My wife got pregnancy 8 weeks and 4 days over, but no vomiting. Is it problem or no worries, please guide me. About 20 % of pregnant women has no vomiting. As long as the baby is viable with the presence of heart beats, do not worry. 14. Is it unadvisable to go to Japan if you’re planning to conceive? Also does mint or alcohol affect sperm count? There is no reason to advise you against travelling to Japan if you are planning to conceive.Alcohol do affect sperm quality and quantity if you take it in excess. 15. Does anything affect egg count? Egg count can be affected by many factors such as age, life styles, STDs,BMI, endocrine diseases and medications. 16. What are the chances of natural pregnancy if one is diagnosed with teratozoospermia? Morphology is only 1%. Must we go thru ART or can still try natural? It depends on the quantity of the sperm. E.g. 1% of 100 million/ml is better than 10% of 1million/ml.Besides, this percentage can change day by day and varies from laboratory to laboratory. You can still try naturally. 17. What is the main cause of ED problem, how to overcome the ED? What is testosterone symptom that affect man? Please refer to the article in our website Q&A Erectile dysfunction. 18. My wife in early 40s, her period is reduce from 7 days to now 2 days since recently? What is the cause? Please refer to the article in our website Q&A scanty periods. 19. What happens if the morphology is only 2%? Is there any treatment? Morphology is about the shape of the sperm.If the sperm is misshaped, it can’t penetrate the egg effectively and so conception becomes compromised. To improve: Regular exercise, Balanced diet with plenty of vitamins, antioxidants and micronutrients like zinc and selenium, Avoid processed food, Reduce exposure to chemicals and pesticides, Stop smoking and reduce alcohol intake, Avoid heat like spa, hot baths, saunas, Check for varicoceles. Varicoceles are varicose veins around the testicles.

Normal menstruation is the result of the shedding of the lining of the womb (endometrium) together with the blood. To facilitate the flow, anticoagulants are released by the body to keep the menstrual blood thin and fluid. If the menses are heavy and the blood is expelled too quickly, anticoagulants do not have enough time to work. As a result, blood clots will form. These clots are usually bright red or dark in colour. They are often released on the heavy days of menses and make the menstrual blood look thick. Occasional blood clots during menstruation is normal and is not a cause for concern. However, if this occurs repeatedly and is accompanied with heavy bleeding, severe anaemia, where there is a lack of oxygen carrying red blood cells may result. Some women are so accustomed to heavy menses that they may not notice the severity of the condition. Over time, excessive blood loss may lead to weakness , fatigue ,heart failure and even death. Thus, it is important to find out the underlying cause so that appropriate treatment can be given immediately. Common causes include: • Hormonal imbalance. In a normal menstrual cycle, there is a balance between two hormones-- oestrogen and progesterone --secreted by the ovary. These hormones regulate the growth of the endometrium. If hormonal imbalance occurs from irregular or defective ovulation, endometrium may grow in excess and shed by way of heavy bleeding. • Uterine fibroids. These are muscle growths of the womb. They can cause heavy or prolonged menstrual bleeding by increasing the surface area of the endometrium. • Adenomyosis. This occurs when the glands from the endometrium become embedded in the uterine muscle, causing enlargement of the uterine cavity and thus the bleeding surface. • Endometriosis: This is due to the backflow of the menstrual blood into the pelvis. • Chronic pelvic infection: This usually results from sexually transmitted diseases • Polyps: These are small, non-cancerous growths on the endometrium. • Intrauterine device (IUD). Heavy menses is a side effect of the non-hormonal intrauterine contraceptive device. • Cancer. Uterine cancer, ovarian cancer and cervical cancer can cause excessive menstrual bleeding. • Other medical conditions including thyroid problems, bleeding disorders, liver and kidney diseases may be associated with heavy menses Treatment: Appropriate treatment is given depending on the cause of the bleeding and its severity. It may include the following 1.Medications • Iron supplements with multivitamins to correct the anaemia • Pain killers, tranexamic acid and oral contraceptive pills have been used to reduce blood clots 2.Insertion of Mirena, an intrauterine contraceptive device (IUCD) impregnated with progesterone. The hormone will reduce the thickness of endometrium. 3.Surgical Treatment • Dilatation and Curettage (D&C ): This will remove the endometrium for microscopic examination. • Hysteroscopy. A surgical procedure when a telescope is introduced into the womb to remove polyps and fibroids • Endometrial ablation or resection using hysteroscope to burn off or remove whole or part of the endometrium. • Hysterectomy. This involves removing the entire womb surgically.

I am six months pregnant. Recently, I visited my friend in Shanghai. I saw her secretary wearing a suit which is supposed to protect her unborn foetus from irradiation. She told me that this type of garment is very popular in China and suggested that I should buy one before going back. I have my doubts. Is it necessary? Does it really protect the foetus from irradiation? A The radiation you referred to is probably the background radiation, which is present in our environment and around us all the time. The radiation comes from the soil and cosmic radiation from the sun and outer space as well as from our own inventions such as televisions and computers. It is usually of low energy. According to the World Health Organization, the Food and Drug Administration and the Federal Communications Commission of USA, exposure to this radiation has not been shown to have any negative effects on human health. There is also no conclusive evidence that low levels of radiation from everyday devices is harmful to the unborn child. The Federal Trade Commission (FTC) in the US has advised consumers to avoid products that claim to “shield” users from this type of radiation. It is interesting to note that a recent report (2018) conducted by a Chinese Academy of Sciences recommended laboratory found that the anti-radiation clothing, which has been popular with pregnant women in China actually increased radiation exposures by trapping them in the body like a greenhouse. The researcher found that though the garments proved effective in blocking 90 per cent of electromagnetic waves coming from the front, they let in radiation from other parts of the body not covered by the clothing. The study concluded that this type of clothing actually intensifies the radiation as the electromagnetic waves have no outlet to be dispersed once they get inside the garment from other directions. I would not advise you to use the so called anti-radiation suit.

Q. I am 50. My menses is getting very irregular. Recently, I experienced sudden episodes of warmth around my neck and face followed by sweating for a few minutes. These happen more frequently in the evenings and nights. I also notice redness over my face at the same time. Am I suffering from hot flashes? What are the causes? How long will it last? Is there any way of treatment without taking medications? A. You are having hot flashes, which together with sweating, are the two most common symptoms of women undergoing menopause. Hot flashes can appear suddenly and can occur several times a day. Besides feeling warm and sweaty, your heart may beat slightly faster than usual with occasional tingling in the fingers. Some women have hot flashes for a few months while others can suffer for years. The exact cause of hot flashes remains unclear but hormonal changes in the body at or around menopause may cause the blood vessels near the skin's surface to dilate. This reaction can be triggered by several factors including: Spicy foods, Hot drinks, Alcohol, Coffee, Smoking, Stress and anxiety, Tight clothing, Warm environment. To manage hot flashes, it is important to identify the trigger. Keeping a journal is useful. Take note of each incident, including what foods are being taken before the hot flash. This will help narrow down the trigger . If the symptoms are mild, hot flashes can be managed with lifestyle changes which include: Having comfortable loose cotton clothing, Keeping a fan or air conditioner on while sleeping, Using cotton bed sheets and chilled pillows, Having an ice pack on your bedside table, Drinking ice water, Avoiding spicy foods, alcohol and coffee, Stopping smoking, Reducing stress by regular exercise or by doing yoga or meditation, Avoid hot and crowded areas. In severe cases when the quality of life is affected, medications may have to be prescribed.

I am in my 38th week of my pregnancy. This is my first pregnancy and my blood pressure had increased from 120/70 to 140/90 over the last 3 weeks in spite of taking medications. My obstetrician suggested that I should be induced soon. What is induced labour? How is it done? Are there any risks? A. An induced labour is one that is started artificially by your obstetrician who probably thinksthat your baby would benefit from an earlier rather than later delivery. This is because hypertension may affect the placental function and threaten your baby’s well being. Other medical reasons for induced labour include: Prolonged pregnancy When the pregnancy is overdue for one week or more, there is an increased risk of foetal compromise and stillbirth. Ageing of the placenta will reduce the oxygen supply and nutrients to the foetus. Premature rupture of membranes When the membranes covering the foetus are ruptured prematurely before labour starts, there is an increased risk of infection to both the mother and the baby. Diabetes and chronic renal diseases, which will affect foetal growth. Intrauterine growth restriction This is a condition in which the foetus fails to grow at the expected pace. Intrauterine infection The well being of both the mother and child is jeopardized. Placental abruption The placenta peels away from the inner wall of the uterus before delivery either partially or completely. The methods of induction commonly done locally are as follows: Membrane sweep The membranes surround the foetus and hold the amniotic fluid in. During the membrane sweep, the obstetrician sweeps his finger around the opening of the cervix (neck of the womb). This may stimulate labour to start. Prostaglandin Prostaglandin is a substance that causes the cervix to soften and may stimulate contractions. It is inserted vaginally as a tablet, pessary or gel. Artificial rupture of membranes (ARM) The membranes are broken by the obstetrician using a long thin rod with a small hook at the tip. Oxytocin Oxytocin is a hormone that causes uterine contractions. It is given into the vein via a drip. Risks of induction include: A need for caesarean section(C.S) If labour does not progress or if foetal distress occurs during induction, emergency CS may have to be done. Prostaglandins and oxytocin may cause over-stimulation of the womb which becomes very hard with frequent and prolonged contractions. This could lead to foetal distress. Premature birth Inducing labour too early might result in a premature birth. Infection Sweeping and rupturing the membranes may increase the risk of infection for both mother and baby. Umbilical cord prolapse ARM increases the risk of the umbilical cord slipping into the vagina before delivery. This may cause foetal asphyxia. Uterine rupture This is a rare but serious complication in which the baby bursts through the wall of the uterus into the mother's abdominal cavity. Most cases occur in a scarred uterus from previous surgery. An emergency C-section is needed to prevent life-threatening complications. Bleeding after delivery Induction increases the risk that the womb would not contract properly after birth. This can cause serious bleeding after delivery. Inducing labour is a serious decision. You should plan and discuss the pros and cons with your obstetrician, so as to make the best choice for you and your baby.

My friend tells me that drinking tea or coffee may affect my chances of conception. I am drinking 2 cups of coffee a day. How much caffeine do they contain? Will I get infertile as a result? Tea and coffee contain caffeine which is a stimulatory drug to the nervous system. Researchers have suggested that its consumption may also affect the reproductive system. In animal studies, caffeine has been shown to affect the maturation of egg. This may be a cause of infertility. In humans, one study showed that women who drank more than a cup of coffee a day have a 50% reduction of achieving conception compared to women who drank less. In patients undergoing in vitro fertilization (IVF), some researchers demonstrated that women who had a small cup of coffee (50 mg of caffeine) were likely to have decreased live birth rates. But these studies are not substantiated by many others. Although there is no clear link between caffeine and infertility at present, many experts consider it safe to consume 200 to 300 milligrams (mg) of caffeine daily while trying to conceive. The amount of caffeine in a serving of coffee or tea varies widely, depending on the type of beans or tea leaves, how it is prepared and brewed and also on the size of the cup served. Below is the rough guide of the caffeine contents; 350ml of instant coffee 100mg 350ml of filter coffee 140mg 350ml of tea 75mg One can of cola 40mg One can of energy drink 80mg To manage your caffeine intake, it is important to note that there are other sources of caffeine such as cola, energy drinks, chocolate, and coffee ice cream. Caffeine is also present in over-the-counter products, including headache, cold, and allergy medications.

I am 30, married for 2 years with no children. I do not have much sexual desire and will use all sorts of excuses to avoid intimacy with my husband. This often results in conflicts between us. Am I suffering from frigidity? What are the causes? A woman's sexual desire is quite complex and involves the interaction of 3 components – biological, social and psychological. 1. The biological component refers to the spontaneous sexual interest. 2. The social component includes expectations, beliefs and values about sex. 3. The psychological component relates to the motivation the woman has with regards to intimacy. Frigidity refers to a condition in which a woman will not start, or respond to her partner's desire for sexual activity. When it causes distress to you and affects your marital relationship, it becomes a sexual disorder known as Hypoactive sexual desire disorder (HSDD) or inhibited sexual desire (ISD). There are many causes of HSDD. They include the following: Physical causes · Medical illnesses such as diabetes, high blood pressure and heart disease · Painful sex from endometriosis or pelvic infection · Medications: Some antidepressants and oral contraceptive pills are libido killers. · Alcohol and tobacco · Surgery to the breasts or genital tract can affect the body image and desire for sex. · Physical exhaustion and mental fatigue Hormonal causes · Menopause: Oestrogen levels drop during the transition to menopause. This can cause reduced sexual desire and dry vagina resulting in painful sex. · Pregnancy and breast-feeding. Hormonal changes during and after pregnancy and during breast-feeding can reduce sexual desire. Psychological causes · Relationship problems such as conflicts, anger and mistrust · Anxiety or depression · Stress from work · Strict family attitudes towards sex or rigid religious beliefs · Poor body image and low self-esteem · History of physical or sexual abuse · Previous negative sexual experiences As you have low sexual drive, it is important that you consult your gynaecologist to find out the cause so that appropriate treatment can be given.

My first pregnancy ended up as a miscarriage and an evacuation of uterus was done a month ago. Can I try again to conceive after my first menses? The emotional impact of miscarriage to the woman is always a mixed one. It is natural for you to want to conceive right away after going through the heartache of losing a baby. On the other hand, you may also experience apprehension, anxiety, sadness, guilt and even anger after the miscarriage. Whatever feelings you may have, it is important that a rational decision be made when you are physically and emotionally ready. From the medical standpoint, patient is encouraged to wait for 2-3 menstrual cycles for the womb to recover and for its lining to become healthy before trying to conceive. The World Health Organization (WHO) advises a waiting period of at least six months. But a recent study in Scotland suggests otherwise. The researchers found that there was no medical advantage of such a delay. Their data showed that the sooner a woman conceived again, the better her chances of having a healthy pregnancy. The women were less likely to miscarry again or had other pregnancy-related complications compared with those who waited for a longer period of time. A consensus among the gynaecologists as to how long a patient should wait before trying to conceive is yet to be reached. Many women are concerned whether a repeat miscarriage will happen. Statistics have shown that at least 85% of women will go through a successful pregnancy subsequently. Although there is nothing you can do to prevent a miscarriage, preparing yourself for the next pregnancy by making healthy lifestyle choices is important. Eating a balanced diet, maintaining a healthy weight by regular exercise and taking prenatal vitamins and folic acid supplement will help improve the chances of a healthy pregnancy.

I am 28. I have been suffering from bloated stomach and tender breasts about one week before menses for the past few years. These symptoms disappear soon after menstruation begins. My friends tell me I am also grouchy at times and they can almost predict when my period is coming. Am I suffering from PMS? Anything I can do to help relieve my symptoms? I don't like to take medicines. You are suffering from PMS or premenstrual syndrome with physical, psychological and behavioural symptoms which appear one to two weeks before your monthly periods and gradually improve or disappear when menstruation starts. About 10 % to 20% of women of childbearing age have PMS. The symptoms are often mood-related and include feelings of unhappiness and extreme grouchiness. Abdominal bloatedness, breast tenderness, weight gain, fatigue, headache and loss of sexual desire are common. The cause of PMS is not well understood. Studies have suggested that fluctuating levels of hormones and brain chemicals are important in the causation. Dietary and drinking habits, stress and lack of exercise are also contributing factors. A wide range of medications including painkillers, oral contraceptive pills and antidepressants have been used to treat PMS with varying degrees of success. Lifestyle changes may relieve some of the symptoms of PMS without medication. These include: A healthy diet Eat plenty of fruits, vegetables and whole grains. Taking plenty of high fibre food like fruits and vegetables, and whole grains, such as brown rice, oatmeal and rye bread will reduce PMS symptoms Increase intake of calcium and vitamin D. Studies have shown that women with high intakes of calcium and vitamin D are less likely to develop PMS. It is suggested that calcium works in the brain to relieve depression or anxiety and vitamin D may influence emotional changes. Cut down on sugar and salt. Fluctuating female hormones may cause the woman to have craving for sugar and reduce levels of the chemical serotonin in the brain. These changes may affect a woman's mood and trigger PMS symptoms. Increase intake of salt may worsen the symptoms of bloated-ness and water retention from PMS Reduce intake of alcohol. Alcohol consumption has been linked with PMS. Reducing the alcohol intake will relieve some PMS symptoms. Good eating habits Eating regular smaller meals will help reduce bloatedness. Skipping a meal may make the woman more irritable as blood sugar levels plummet. Drinking plenty of water will hydrate the body and relieve the symptoms of headaches and tiredness. Regular exercise Maintaining a healthy body weight may help prevent PMS as evidence suggests that overweight or obese women are more likely to have the symptoms Reduce stress Stress may intensify PMS symptoms. Exercise such as yoga, Pilates and deep breathing are ways to relax your mind and reduce stress. Quit smoking A recent study has shown that smoking, especially in the teens or early 20s, may increase the risk of PMS. Adequate rest and sleep Feeling tired is a sign of PMS. Proper rest helps PMS Psycho-therapy Psychological symptoms, such as feeling depressed or emotional, may be alleviated with the help of psychologist. Cognitive behavioural therapy (CBT) helps solve problems such as anxiety and depression.

I am a first time mum. My breasts sagged after pregnancy. Could the sagging be due to breast feeding? Can I use natural cream or supplements to help restore the shape of my breasts? The breasts are attached to the chest wall by supporting ligaments. During pregnancy, increasing levels of hormones cause the breast tissues to grow. As a result, the breasts become enlarged, swollen and heavy. They then drag and stretch these ligaments resulting in sagging breasts after pregnancy. Other factors that contribute to sagging breasts include aging and smoking, — both of which reduce skin elasticity. Being overweight and having large breasts have a similar effect. Studies have shown that breast feeding does not result in sagging breasts. Many nutritional supplements in the form of creams and pills are marketed as a natural method of breast enhancement. They usually contain a variety of herbs with weak stimulatory effect on breast tissues. These plant-derived substances known as phytoestrogens are often marketed as having the potential benefits on breast health. Though some of them may firm up the breasts temporarily, scientific studies have proved their ineffectiveness. Besides, there are no long-term safety profile on these products. The safe and healthy ways to enhance breast appearance include; · Maintaining a correct posture · Eating a healthy diet · Doing exercises to develop your chest muscles.

My first pregnancy ended in caesarean section because my baby was in a breech position. I am now in the last trimester of my second pregnancy. The baby is in a head- down position. I am very keen to experience a normal vaginal birth. Can I try? What are the risks? In general, vaginal delivery has physical and emotional benefits for mother and baby. They include: · reduced blood loss, · less post-delivery complications such as wound infection and pain, · shorter recuperative period, · decreased risks in future pregnancies of placental problems, · positive emotional experience of achieving a vaginal delivery. But for a vaginal delivery after caesarean section (CS), one has to consider the risk of uterine scar rupture. A CS scar in the uterus is the weakest part of the womb. The stretching that occurs during pregnancy and the strong contractions of labour can cause the scar to become thin and split open, a condition called uterine rupture. It may be life threatening as it can cause massive bleeding and injuries to neighbouring organs like bladder and intestines. An immediate CS has to be done and blood transfusion and possible hysterectomy (removal of the uterus or womb) may be required to save the mother’s life. Sometimes, the baby may not be delivered in time and foetal death or brain injuries may occur. Luckily, the incidence of uterine rupture is low, occurring in 0.5% in spontaneous labour and increasing to 2% in induced labour using medications like prostaglandins or oxytocin. Research has shown that women who try to deliver vaginally after a CS can achieve a success rate of 60-80 % The choice of vaginal delivery after a CS has to be individualised. Your obstetrician may allow you to have vaginal birth if: · You have an uncomplicated pregnancy, · You have a lower segment CS, · You do not have the same reason as for the previous CS. To maximise your chances of having a vaginal birth, your obstetrician may · Allow labour to start naturally without induction, · Let your water bag break spontaneously, · Avoid using medications to induce or ‘speed up’ labour, · Monitor the foetal heart rate continuously and closely during labour. Since you have expressed a desire to experience a vaginal birth after a previous caesarean section, you should consult your obstetrician and follow his/her advice.

Normal menstrual period occurs every 21 to 35 days and lasts about 5 days. Vaginal bleeding in between periods or intermenstrual bleedingis abnormal. Vigorous exercise, unless resulting in undue stress, is perhaps not the reason for the bleeding. Most cases of intermenstrual bleeding are due to non-cancerous and treatable causes. Occasionally, it may be due to cancer or pre-cancer. Thus it has to be assessed and treated promptly. Common causes of intermenstrual bleeding include: Pregnancy complications: Miscarriage and ectopic pregnancy. Hormonal imbalance from emotional or work-related stress. Cervical or endometrial polyps: These are benign or non-cancerous growths in the cervix (neck of womb) or lining of the womb. Hormonal contraception: Irregular bleeding can happen during the first three months of taking hormonal contraception in the form of pills, vaginal rings, skin patches, implants or injections. Infection of the cervix from sexually transmitted diseases. Uterine fibroid: This is a muscle growth of the womb. It it protrudes into the uterine cavity, it can cause heavy and irregular bleeding. Polycystic ovary syndrome (PCOS): The irregular or absent ovulation in this condition may result in irregular bleeding. Cervical cancer or pre-cancer may cause irregular bleeding, especially bleeding after sex. Uterine cancer: this is more common in older women, who may present with abnormal bleeding during menopause.