Reproductive Medicine | Pantai Hospital Kuala Lumpur

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Reproductive medicine is a field that specialises in the treatment and wellness of the male and female reproductive systems, ranging from conditions related to puberty, family planning, contraceptive, infertility, sexual dysfunctions, and any reproductive system diseases. Due to the wide range of conditions treated by a reproductive specialist, it is common for your doctor to collaborate with specialists from other fields such as such as obstetrics, gynaecology, urology, paediatrics, and oncology.

List of conditions:

Infertility

What is it?

The inability of couples of child-bearing age to conceive after having regular, unprotected sex. For pregnancy to occur, the ovary or testes must receive the appropriate hormonal stimulation to produce healthy ova or sperms and the ovum has to be released by the ovary to be fertilised by the sperm. The fertilised egg must then be able to pass through the fallopian tube and be implanted in the uterine wall. As such, a disruption in any of these processes can be a factor for infertility. Here are some examples of conditions that may cause infertility:

Ovulation disorders - polycystic ovary syndrome (PCOS), hypothalamic and pituitary gland disorders, thyroid disease
Egg count and quality disorders - primary ovarian insufficiency, genetic or chromosomal disorders leading to a non-viable foetus - Uterine disorders: uterine fibroids or polyps, scarring from pelvic infection, appendicitis, endometriosis, or surgery
Fallopian tube blockage - pelvic inflammatory disease (may be caused by some STIs), salpingitis, scarring from endometriosis, hydrosalpinx, fibroids
Sperm production disorders - low sperm count (oligospermia), absence of sperm (azoospermia), malformed sperm, hypothalamic and pituitary gland disorders, genetic disorders
Testicular disorder - testicular torsion, cancer, undescended testicles, orchitis, spermatocele, vasitis, varicoceles, testicular trauma
Sperm delivery problems - premature ejaculation, retrograde ejaculation

There are also many factors that may affect fertility like STIs, autoimmune disease, obesity, cancer, or substance abuse. Your doctor should also account for these factors in your diagnosis.

How is it diagnosed?

In males, diagnosis may include hormone or genetic testing, semen analysis, testicular biopsy, imaging of the reproductive organs, or MRI of the brain to check for pituitary gland tumours. In females, diagnosis can involve ovulation testing, thyroid function test, pelvic exam, hysterosalpingography, ovarian reserve test, hormone test, imaging test like pelvic ultrasounds, hysteroscopy, laparoscopy.

How is it treated?

Fertility treatments often begin with lifestyle modifications (diet, weight, smoking, drugs, etc.), medication to address hormonal issues or infections, or surgery to correct issues in blockage or scarring. Additionally, in females, your doctor will likely educate you on how to track your ovulation through basal body temperature, cervical mucus texture, and predicting ovulation using home kits. If these methods are ineffective, your doctor may suggest assisted reproductive technology (ART).

List of ART procedures

Fertility drugs to induce ovulation or improve sperm count.
Intrauterine insemination (IUI)

Semen from the male donor is collected, washed, and concentrated to obtain high quality sperm. The sperm is inserted via a catheter into the uterus close to the fallopian tube. The female may be required to also use fertility drugs to ensure ovulation occurs during IUI. This increases the chances of fertilisation because it removes the challenge of sperm delivery, low sperm count, ejaculation or erection dysfunction, or blockage from cervical mucus.
In-vitro fertilisation (IVF)

Eggs are first obtained from the ovaries of the female donor and this is done by using hormone medications to stimulate ovulation followed by retrieval using a thin needle. Sperm from the male donor is then introduced to the eggs for fertilisation. If fertilisation is successful, the embryo is placed inside the uterus. Pregnancy occurs if implantation of the embryo on the uterine wall is successful. Unlike IUI, fertilisation occurs outside the body in IVF and is offered as an option for patients with conditions like fallopian tube disorders, endometriosis, PCOS, uterine fibroids, sperm impairment, ejaculation problems.
Intracytoplasmic sperm injection (ICSI)

A form of IVF but unlike conventional IVF where thousands of sperm are placed next to an egg and the sperm has to fertilise the egg on its own, fertilisation in ICSI is done through injection of a single sperm cell into the egg. If successful, the embryo will be transferred into the uterus for implantation. ICSI will be recommended if the patient hasn’t been successful with traditional IVF or if the patient is using a donor or frozen eggs or sperm.

The above ART procedures may not be effective for everyone hoping to conceive. In such cases, your doctor can further advise you on other alternatives like using donor eggs, donor sperm, donor embryos, or even using a surrogate. Your reproductive specialist will advise you on the possible treatments you may consider, along with any risks and concerns you may have.

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