The time is always right to do what is right; Time waits for no one; It takes time to build a castle.

There are many proverbs about time. One thing for sure, time does fly and it’s already the third month of 2018!

Time can be a friend or enemy. For those with family and children, it’s fun to watch your little ones grow.

For those who are in the midst of their parenthood journey, time can be their greatest fear with each passing year.

There are many couples who, despite years of trying, have not fulfilled their dream of expanding their family, but have kept their hopes high and persisted in their journey towards parenthood.

For some, their goal has been achieved.

I’m going to share a few heartening real patient experiences that can hopefully help you on your own journey.

Vaginismus

Mr and Mrs Jacob (not their real names) walked into my consultation room sometime in late 2016.

They were a bit hesitant when they were in the room. They slowly took their seats and looked at each other, probably deciding who and how to start the conversation.

I broke the silence by greeting them first. “Good morning, How can I help you?”

“Doc, we have been married for seven years,” the husband started. “We have not got pregnant yet.”

“Have you both carried out any fertility tests to find out why?” I asked.

Both of them looked at each other. It took a few seconds before the wife started talking.

“We have not managed to have sex since our marriage because I have vaginismus (painful contractions or spasms of the vagina),” she said with some difficulty.

“Well, if that’s the main reason, then the treatment is very easy!” I said with enthusiasm.

I could see that they did not believe my reply.

“Really, doc? I thought we have a major issue,” said the wife.

“Not necessarily. Let us go through an initial fertility assessment to make sure I don’t miss anything else,” I explained.

They went through the assessments. I did an abdominal ultrasound scan for the wife to look at her womb and ovaries. Her husband did a semen analysis (sperm test). Since her periods are quite regular, no other hormonal test was needed initially.

In the afternoon, we met again to go through the semen analysis report.

“Since there is no major fertility issue that needs correction at the moment, lets do an IVI,” I said.

“What’s an IVI, doc?” the husband asked.

“IVI means Intra-Vaginal Insemination. It is the process of injecting sperm into the vagina using a fine tube during a woman’s fertile period,” I explained.

“You can even do it at home, every month,” I added.

“If the issue is no sexual intercourse, IVI will help you deposit sperm into her vagina.”

I went on to explain how they can do the IVI at home.

I even taught them how to monitor her ovulation based on clinical symptoms and using a urine ovulation test kit.

I could see signs of relief on their faces upon hearing the solution to their problem. Furthermore, they were still “in control” of their fertility journey, albeit with a very small modification.

Two months later, I received an e-mail from the couple: “Thank you: I am pregnant!”

Azoospermia

Mr Hazmi (not his real name) walked into my clinic in 2017. He was holding a file in his hand. He came alone without his wife.

I started the conversation in my usual manner: “Hi Hazmi, take a seat. How can I help you?”

Hazmi placed his file on my table and said, “Doc, the problem is with me.”

He went on to explain that he and his wife have been trying for a child for five years. They were in their early 30s, so they didn’t think that they had a major fertility issue.

His wife followed a few fertility tips they read on the internet. She also tried a few natural remedies to help her with her fertility.

Three years passed and they decided it was time to visit a fertility doctor.

His wife’s fertility test did not reveal any remarkable abnormalities. His sperm test showed azoospermia (no sperm cells seen in the ejaculate).

They could not believe the result.

He went to two different fertility centres and repeated the test.

Unfortunately, they kept seeing the same result.

He was referred to a urologist and claimed he was given some injections to boost sperm production, which did not work.

“Doc, I feel very frustrated and disappointed. It’s hard to believe that all this while I was the issue.”

He was visibly very frustrated and probably a little embarrassed knowing that the issue is with him and that he had put his wife through a lot of tests.

“Hazmi, we can’t turn back time. No use worrying about the past. You are here today hoping to find an answer,” I said, trying to lift up his mood.

Further medical evaluation did not reveal anything significant apart from a smaller testicular size, indicating a possible problem with sperm production.

I did a few hormone tests for him. A week later, we reviewed the blood test and I said to him, “Well, based on all the facts that we have, it looks like you may end up needing a small surgical procedure to retrieve sperm directly from the testicle.”

He looked a bit worried once I mentioned the word surgery.

I quickly added, “But let me see if I can avoid it. I’m going to start you on some medications, oral and injections, to push sperm production. I know you have done it before, but let me try that once again.”

Hazmi agreed and we started on our journey to push sperm production.

After the first month, still no luck. On the second month, we noticed few sperms in his ejaculate.

I continued his treatment, and by the fourth month, he had 400,000 sperms in his ejaculate.

Meanwhile, an assessment of his wife returned all normal.

“Hazmi, it looks like we may finally be able to avoid the surgery after all,” I told him.

“But you still need an IVF (in-vitro fertilisation) unfortunately,” I added.

The couple agreed to an IVF the following month.

About a month and a half later, they visited me again because the wife had missed her period.

They were concerned that she may have had an ovarian cyst that was delaying her periods.

I asked, “Have you done a urine pregnancy test?”, to which Hazmi replied, “Doc, I’m sure we are not pregnant.”

I proceeded with an ultrasound scan. What we saw surprised us all. There was a foetus measuring five weeks!

“Well, nothing is impossible,” I said while the couple cried tears of joy.

Low egg reserve

I saw Mr and Mrs TJM in early 2017. The first time we met was at one of my fertility forums.

I remember them because they sat in the first row and asked many questions regarding endometriosis. They were in their mid-30s.

I met them again a month later in my clinic. True enough, she had been diagnosed with endometriosis and had two previous surgeries for endometriotic ovarian cysts.

Her latest egg reserve test (AMH blood test) showed low egg reserve.

Endometriosis had reduced her egg count even though she is still young. They were very worried that she may go into menopause soon before getting pregnant.

“She is not menopausal yet. Let’s try our best to get her pregnant. The chances are low, but never zero,” I said in an attempt to give them some hope.

After an initial fertility assessment, we agreed to proceed with an IVF to maximise her chances of pregnancy.

To their surprise, I did not immediately start their IVF treatment.

“Let’s do something to improve your egg quality first before starting IVF,” I told the couple.

They were started on some vitamins, including DHEA.

As they are strong believers in traditional medicine, they followed up with a Chinese traditional medicine centre to improve her fertility.

After two months, IVF was started. The IVF protocol was changed to minimise cost.

Four eggs were retrieved. Unfortunately, they had only one viable embryo, which was frozen.

They were quite disappointed with the outcome. “You have not finished your IVF yet, there is still hope,” I consoled them.

She went through uterine scratching prior to a frozen embryo transfer (FET).

FET was done in a natural period cycle. A single embryo was transferred into her womb. She was given supportive medications.

About two weeks later, my nurse told me that her urine pregnancy test was positive.

She came back two weeks after that for an ultrasound scan and saw a beautiful picture of her baby.

She was nearly seven weeks pregnant. She had finally found her golden embryo.

The fertility journey is like a rollercoaster ride. There are up and downs, and you will never know when your journey will come to an end. One thing is for sure, there is no harm in being persistent in trying to reach your goal.


Dr Agilan Arjunan is an obstetrician and gynaecologist, and fertility specialist. For more information, e-mail starhealth@thestar.com.my.