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I am 40 years old and have been married for 10 years with 2 children. Recently, I experienced some difficulty in erection. Will any change in lifestyle help me overcome this problem? I am not keen on taking medicine? You are suffering from erectile dysfunction (ED) or 'impotence.' This is the inability to keep the penis erect or firm enough for sexual intercourse. Don’t ignore it as this can be an early warning sign for more serious health problems such as diabetes and cardiovascular disease. There are many causes of ED. But the most common lifestyle-related causes are smoking, obesity and stress. Making lifestyle changes may improve ED and your overall health. These include: 1. Exercise regularly: A study from Harvard University showed that a 30- minute walk a day would reduce the risk of ED by 41%. Other studies suggested that moderate exercise helped obese men with ED improve their sexual performance. Kegel exercises, by strengthening the pelvic floor muscles, can improve erection. 2. Eat a well-balanced diet: In the Massachusetts Male Aging Study, eating a diet rich in fruit, vegetables, whole grains, and fish and reducing the intake of red and processed meats and refined sugar, lessened the likelihood of ED. Food fortified with vitamins, especially Vitamin B12, helps ED in older people. 3. Regular medical check-ups: Reduction of blood sugar, cholesterol, triglycerides and blood pressure have been known to help lower the risk of ED. 4. Maintaining a healthy weight: This is a good strategy for avoiding ED. Obesity raises risks for vascular disease and diabetes, the two major causes of ED. 5. Stop smoking and avoid excessive alcohol consumption. 6. Reduce stress: Learn how to relax. Give yourself some "quiet time "and get enough rest and sleep. This will help your body recover from stressful events and ED.

I am 53 years old and haven’t had a period for three years. But I suddenly got my period again last week. Is it normal? Do I need to consult a gynaecologist? Any examination required? You are having bleeding after menopause, which is not normal, even if it is just spotting.  The cause is usually minor, but cancer is always a possibility and must be ruled out. You have to consult a gynaecologist as soon as possible.The common causes are as follows: Inflammation and thinning of the wall of the vagina (atrophic vaginitis) or womb lining (endometrial atrophy) due to a very low female hormone( oestrogen) level. Non-cancerous growths of the neck of the womb( cervical  polyps) or the womb lining(endometrial polyps) Thickened womb lining (endometrial hyperplasia) : if left untreated, this can lead to development of womb cancer (endometrial cancer) Cancer of the vulva, vagina, neck of the womb(cervical cancer), womb lining(endometrial cancer) and ovary Bleeding from the urinary bladder  or rectum To find out the cause, the gynaecologist may perform the following examinations: Pelvic examination: An instrument (speculum) is introduced into the vagina to look at the wall of the vagina and cervix. Swabs may be taken from your vagina and/or cervix to rule out any infection. A pap smear will also be done at the same time. Vaginal ultrasound scan: This is performed by gently inserting a fine ultrasound probe into your vagina, to look at the lining of the womb and for tumour masses in the womb and ovaries. Hysteroscopy: This is performed by passing a thin fine telescope (hysteroscope) through the cervix into the womb to look at its lining and remove a small sample of tissue for examination under microscope(endometrial biopsy). Appropriate treatment will be given depending on the cause of your bleeding.

Sitting on the wheelchair with teary eyes and occasional sobs, she gazed patiently at her baby in the incubator at the neonatal intensive care unit (NICU). The baby weighing 1.2 Kg. looked no bigger than a kitten. It was thin and pale with loose, dry skin. It lay floppily with a number of tubes and wires attached to the monitoring machines. It cried feebly at times. M, 34 just had a Caesarean section(C-section) 2 days ago .This was her first pregnancy . It was apparently normal until at 28 weeks of gestation when the levels of the fluid surrounding the baby (amniotic fluid) were found to be low. The growth of the baby had slowed as well. The estimated weight of the baby was at the 10th percentile with the measurement of abdomen 2 weeks behind that of the head. The baby was diagnosed as having intrauterine growth restriction (IUGR) a condition in which the baby was small for the gestation.I asked M to come for frequent check-ups so that the baby’s growth can be monitored by ultrasound scans regularly. Her baby’s heart beats were also measured electronically by cardiotocograms (CTG) to ensure adequate oxygen supply. Steriod injections were also given to help improve the baby’s lung function. At the 33rd week of her pregnancy, CTG indicated that the oxygen supply to the baby was diminishing. The blood flow to the baby’s brain was reduced by Doppler flow studies.  I discussed the gravity of the situation with M and her husband and decided that the baby should be delivered by C-section. The baby was born with a low Apgar score indicating its poor physical condition at birth. It was admitted to NICU in the incubator straight away for immediate medical care.Intrauterine growth restriction (IUGR) is a condition where the unborn baby does not grow at the normal, expected rate. The estimated weight of the baby is less than that of 90% of those with the same gestational age. It occurs in about 2 to 3 percent of all pregnancies and results from diminished supply of the nutrients and oxygen to the baby.Although some IUGR babies are small because of genetic factors, majority are due to other causes which include: Mother having : Pregnant for the first time or for the fifth time or more Under the age of 15 or over the age of 35 High blood pressure Chronic kidney diseases Diabetes Heart or respiratory diseases Anaemia Infection from viruses ,bacteria or parasites Alcohol, cigarette  and drug abuse Reduced blood flow to  the womb and placenta: Minor detachment of placenta before delivery Low lying placenta with bleeding Placental insufficiency Unborn  baby  having Infection Birth defects Genetic abnormality When IUGR is severe, the foetal oxygen supply is critically compromised. This may cause foetal death. In less severe case, the baby may have problems after birth. These include: Difficulty in breathing from inhalation of the first faeces(meconium)  before or during delivery Low blood sugar Difficulty in maintaining the body temperature Low resistance to infection Increase in  red blood cells resulting in abnormal  clotting problems Developmental  and learning disorders during childhood Management of IUGR depends on its onset and severity. Careful monitoring of the growth of the foetus using ultrasound and Doppler flow studies and optimal timing for delivery are important in achieving good outcome. It was quite an ordeal for M to watch her baby suffering in the incubator.  Her face finally brightened up with smiles when it finally left the NICU after 2 weeks. When I saw her 6 weeks after the baby was born, it had put on a remarkable amount of weight and both mother and baby were doing well. “Doc, thanks for your timely intervention,” she said” thanks for letting me understand what motherhood really means.”I could see immense joy in her.

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.