IN Malaysia, the prevalence of infertility problems among young married couples has been on the rise. We spoke with Dr Haris Njoo Suharjono, a consultant gynaecologist and fertility specialist at Sunfert International Fertility Centre (Sunfert). Dr Haris was gazetted as a reproductive medicine specialist in 2005 and has been practising in this field of medicine ever since. He sat down with us and gave insights into the current sexual health of couples, preconception care, and infertility diagnosis and treatments.
According to Dr Haris, the lifestyle changes of modern couples are causing a shift in sexual health. They are getting married and starting families later in life, choosing instead to focus on their careers and individual growth. Couples who seek his help are trying for children in their late 30s, where chances for infertility issues begin to appear. He goes on to explain that a woman’s fertility starts to reduce in her early 30s, further declining once she passes 35. Simultaneously, the risk of pregnancy complications also increases with their age.
Dr Haris asserts that many people are still unaware or reluctant to seek medical help, attributing it to the lack of sex education in Malaysia. He also referred to social stigmatism as another prominent issue surrounding infertility in both men and women. Further elaborating that in society, there is a negative societal expectation and perception towards people who face problems in having children. Couples that have consulted Dr. Haris feel that it places their masculinity or femininity into question. The stress and anxiety from peers who have had children of their own and expectations of family members further contribute to the problem and can even negatively affect hormone production and fertility.
During our conversation, Dr Haris advised that active couples should be aware of two things: preconception care and fertility signals. Preconception care refers to healthy lifestyle changes such as receiving adequate sleep and exercise, following a balanced diet with a high protein intake, maintaining an optimum body weight, and avoiding smoking and recreational drug use among others. These changes can result in positive effects on ovulation and promotes sex hormone production such as progesterone.
Besides personal health and wellness, it is also important for women to understand their own bodies and their fertility signals. Natural family planning, as Dr Haris explains, relies on timing three body signals: ovulation during menstrual cycles, the rise in body temperature after ovulation, and cervical secretions before and after the fertile period. Another method that women can use to monitor her ovulation is by checking her urine for a surge of the luteinising hormone (LH). These urine test kits are easily available in pharmacies. Simply check your urine LH levels every morning on a daily basis a few days before your mid cycle. Once the test is positive, couples can try on the same or next night.
Additionally, couples should be aware of the various bodily deficiencies that can have an effect on fertility and the child’s health. Under proper medical guidance, fertility specialists like Dr Haris may prescribe nutritional supplements that can be used to help improve and promote a healthy pregnancy.
By understanding the effects of supplements such as folic acid and vitamin D couples can plan how to increase their chances of conception. He explains that folic acid is normally recommended to women before pregnancy as it promotes fertility and helps protect a developing fetus from abnormalities affecting the nervous system.
On the other hand, Vitamin D deficiency affects many different types of cells in different organs in the body and is found to be associated with infertility in both men and women. Hence, supplementing it can aid in fertility.
Sunfert offers fertility assessments for couples to identify any possible reasons for difficulties to conceive. During their visit, Dr Haris first obtains a thorough clinical history from the male and female partners. This helps him provide a basis for their medical history that may be relevant to their infertility problems. He considers factors such as the duration of infertility, previous gynaecological problems or surgery, menstrual history, difficulties with intercourse, and smoking with intercourse, and smoking history.
For male partners, they will undergo a semen test to measure the health of their sperm. As for female partners, a pelvic examination and scan is conducted to provide a visualisation of the reproductive organs in the pelvic region, serving as a visual indicator of their fertility health. In addition, blood tests may also be conducted to identify problems such as thalassemia carrier status or hormonal imbalance.
Sunfert uses advanced technologies to assess their patients’ fertility status. Anti-Mullerian Hormone (AMH) testing is currently the industry standard and a reliable indicator for assessing women’s egg reserves. By understanding and tracking AMH levels, it provides couples with a deeper understanding of a woman’s reproductive health and lifespan. With this information, women can be advised to plan ahead with starting a family sooner or consider procedures such as egg freezing. Couples may also be offered Genetic Carrier Screening, which allows Sunfert to screen up to 300 types of genetic diseases. This genetic test allows the centre to know if both partners carry genes for certain genetic disorders as well as the chances of their children inheriting said conditions. In such scenarios, Sunfert also offers Preimplantation Genetic Testing for Monogenic Disease (PGT-M) which can be used for couples to screen and select healthy embryos for implantation, thus preventing the disease from being inherited.
With these results, couples will be advised on the best treatment options, ranging from active trying with fertility tablets and timed intercourse to reproductive keyhole surgery and in vitro fertilisation (IVF) for definite problems.
Sunfert International Fertility Centre has a branch in Kuching, serving the community through reproductive health services. Sunfert’s aim is to provide his patients with the support and knowledge they need to start this new and exciting chapter in their lives through scientific medical tests, procedures, and treatments. We believe that bearing a child should not be a burden, that is why Sunfert offers programmes tailored to the communities that they serve. If you or someone you know is facing infertility issues, contact Sunfert to seek consultation or a preconception checkup, and ask them about their IVF Gawai Offer. (KKLIU: 2113/2022)
Consultant gynaecologist and fertility specialist Dr Haris Njoo Suharjono has an MD (UKM), FRCOG (UK), and is a Fellow in Reproductive Medicine (UK/Mal).