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Fertility Screening for Couples


As the saying goes; it takes two to tango, the same applies to having a baby. This is why infertility investigation and treatment is best done as a couple.

More and more couples are choosing to start their families later and many are finding out they may having trouble conceiving.

The reason behind this is fertility decreases as a woman gets older. Even the success of assisted reproductive methods such as in-vitro fertilisation (IVF) decreases as well.

Couples are encouraged to seek infertility screening earlier if they are still not able to conceive despite having regular unprotected sexual intercourse during the woman’s fertile period (during ovulation). Fertility screening for couples might allow for any underlying issues to be detected and treated earlier to the chances of success.

This bit is a little lengthy but all factors play an important role. Besides obtaining a thorough medical history from the couple, which includes their age, duration of trying for a baby, sexual history, any history of sexually transmitted diseases, history of previous surgery, history of previous pregnancies/miscarriages and menstrual history, other tests may be included in a infertility assessment.

What kind of tests are used for couple’s fertility screening?
1. Hormonal blood tests

Various hormonal blood tests may be looked at such as follicle stimulating hormone (FSH), luteinizing hormone (LH), and estradiol (E3).

There are many more hormones that are investigated but there are just too many to list here. These hormonal blood tests aid in identifying why a woman may not be menstruating, or having irregular periods, or even recurrent miscarriages.

2. Ultrasound pelvis

An ultrasound of the pelvis will be useful in looking at the woman’s uterus and ovaries. This can detect conditions that can affect fertility including polycystic ovarian syndrome, fibroids, and pelvic infections.

3. Hysterosalpingogram

A hysterosalpingogram or HSG is a dynamic x-ray of the uterus and fallopian tubes which is performed by injecting dye into the uterus via the cervix.

It is used to assess the anatomy of the endometrial lining of the uterus and to assess if there is any blockage of the fallopian tubes.

4. Semen analysis

Semen analysis is a very important test and should be done early in the screening. The test encompasses sperm count, sperm movement and sperm quality, among many other things. Essentially this identifies if the sperm is good enough in quality and number to have a good chance of fertilising an egg.

What should you do if you have been trying for a baby and have been unsuccessful?

If you and your partner have been trying actively for at least 1 year (woman’s age under 35 years old) or 6 months (woman’s age >35 years old) and have not been successful, you should both see a medical professional for further infertility screening as the earlier you pick up a problem, the earlier you can rectify it. Remember, fertility starts to decline as you get older and drastically declines after the age of 35 years old.

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Super Foods To Eat During Your Pregnancy

First of all, congratulations on being pregnant!

smiling pregnant woman holding her tummy on couchWelcome back mommies to be! In continuation from my previous article, foods to avoid during pregnancy, we shall now move on to the brighter side – which is food that you should be eating more of during pregnancy a.k.a pregnancy superfood!

This is especially important when selecting quality food if you are still suffering from morning sickness, gaining weight too fast or not gaining enough weight – make every calorie and nutrient intake count. If you are already eating well, then the list below can be extra tips to add on to your already healthy and nutritious diet.

Aside from the foods mentioned in my previous article, all other foods are generally safe to consume during pregnancy. There are certain food that may contain more nutrients that are optimum during pregnancy for both you and your unborn child. The list below is just a general guide; feel free to add more types of food to your personal list of superfoods.

Super Foods to Eat During Pregnancy
1. Beans – such as chickpeas, lentils, black beans and soy beans.

They contain fibre, protein, iron, folate, magnesium, calcium and zinc which not only aid in the growth of your unborn baby but also help to combat constipation and prevent haemorrhoids in expecting mothers, especially in the later stages of pregnancy.

2. Meat– lean cuts of beef, chicken, pork and lamb.

grilled chicken breastPack full of protein, vitamin B6, B12 and niacin as well as zinc and iron in highly absorbable forms which is essential for providing raw materials and building new cells for your unborn child. In addition, beef is also rich in choline which is required for brain development.

During pregnancy, your daily iron needs double so it is important to include plenty of iron-rich foods. Low irons will make you feel tired easily and may also lead to premature delivery.

3. Pasteurized cheeses such as cheddar, mozzarella, edam, etc

shredded cheddar cheeseCheeses are excellent sources of calcium, phosphorus, and magnesium that is vital in the growth and health of yours and your unborn baby’s bones, plus vitamin B12 and protein which is essential in cell growth. You can opt for the low fat selections to save on calories, fat and cholesterol.

4. Eggs

Eggs are a good supply of protein and contain plenty of vitamins and minerals. Certain brands of eggs also contain additional omega-3-fats which is needed for brain and vision development. It is recommended not to eat more than 1 egg/day and make sure they are cooked thoroughly before eating them. If you find the aroma of cooked eggs nauseating, then try hard boil eggs instead.

5. Milk and yoghurt

These contains excellent source of calcium and phosphorus which are essential in building healthy strong dense bones in both mother and child and also vitamin D which promotes calcium absorption and deposition into bones.

Yoghurt is a fantastic alternative source if you do not like to drink milk or if you have lactose intolerance plus it is packed with protein, folic acid and probiotics (good bacteria) which are good for your gut as well as preventing yeast infections which can unfortunately be quite common during pregnancy. If you are worried about calories, you can opt for the low fat milk or low fat yoghurt choices.

6. Whole grains – such as enriched whole grain breads and cereals

These are fortified with folic acid, vitamin Bs, iron, zinc and also have more fibre than white bread and rice. As they are complex carbohydrates, they will also keep you feeling full for longer.

7. Oils and fats

grilled salmon served with vegetablesThe fattier seafood such as salmon, cod, and haddock contain essential Omega 3 and omega 6 fatty acids. Make sure they are cooked well and it is recommended to stick to no more than 2 or 3 servings of low mercury fish per week.

Nuts are also another good alternative form of unsaturated, heart-healthy fats. However, as they are high in fat and calories, do not go nuts about nuts.

These oils and fats are good for your baby’s brains and eyes development.

8. Soy food – such as tofu

For vegetarians, soy food is an excellent source of protein, iron, calcium, magnesium, vitamin A and vitamin K. Vitamin K is essential for normal blood clotting, especially after childbirth.

9. Fruits and vegetables

Fruits and vegetables are a super source of vitamins A, B, C, folic acid, iron, and calcium. You can eat them raw or cooked! Deeper, darker coloured vegetables signal higher vitamins contain. Although red meat is rich in iron, it is not the only source. Look out for alternatives in green leafy vegetables such as spinach.

Examples of super food fruits and vegetables include:

Berries – such as strawberries, blueberries, raspberries, and even avocado. (I just found out that avocado is a large berry!)
These are packed with carbohydrates, vitamin C, potassium, beta- carotene, folate and fibre. Berries also contain phytonutrients which acts as antioxidants that protect cells from damage. If you consume berries after an iron-rich meal, their vitamin C will help boost iron absorption too. Also, berries are helpful in fighting morning sickness too.

Broccoli contains folate, fibre, calcium, lutein, zeaxanthin, vitamin A, carotenoids which promotes healthy vision, and potassium which helps in fluid balance and normal blood pressure. The ‘floret’ part of the broccoli is the most nutritious part but other parts like the stalk and stem are nutritious too so do not waste them.

Steaming rather than boiling helps to preserve the nutrients.

Rich in potassium, bananas are good for reducing fluid retention and maintaining a healthy fluid balance. They also contain tryptophan which helps to promote sleep. It is a great starchy, energy – boosting snack. Also an easy eat if you are feeling nauseous from your morning sickness.

pregnant woman holding tummy with hands in a heart shape

While you are pregnant, try to ensure that everything you eat will have some sort of beneficial effect on either yourself or your baby. Once you have overcome your morning sickness (usually after the 1st trimester), enjoy your pregnancy and enjoy what you eat. Also, do not forget to stay hydrated and aim to drink at least eight glasses of water a day. This not only keeps you hydrated, but also helps to prevent constipation and urinary tract infections.

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Foods to Avoid During Pregnancy

First of all, congratulations on being pregnant!

pregnant woman smiling holding belly
For most of you who have just found out you are pregnant, especially newly mums-to-be, you must have a lot of questions including:

  • What foods should I avoid?
  • What foods should I eat to enhance the growth and wellbeing of my baby?

Furthermore, you may already have advice from friends and families on what you should and shouldn’t be eating.

It’s important to eat a healthy and well balanced meal even more so when you are pregnant.

This is because your baby will start absorbing the nutrients, vitamins and minerals that you eat which are essential for development.

Also, as pregnancy affects your immune system, you and your unborn baby are more susceptible to food borne illness such as Listeria, Toxoplasmosis and Salmonella which can infect your baby and cause serious health issues and even miscarriages. (Although listeriosis, caused by listeria, is a very rare infection, it is essential to avoid certain types of food that may contain listeria as even a mild form of the illness in a pregnant woman can have serious effect on a newborn baby, or even causing miscarriage or stillbirth.)

In general, most foods are safe to consume during pregnancy. However, there are some foods that should be avoided during pregnancy as it can be detrimental to the unborn baby’s health.

Foods to Avoid During Pregnancy:
1. Raw meat and seafood

Due to the risk of contamination with parasites and bacteria such as toxoplasmosis and salmonella, undercooked or raw seafood, beef or poultry should be avoided.

Unfortunately, this includes sushi and sashimi as well. For all of mummies-to-be who has sushi cravings, the safest way to enjoy sushi is to opt for the vegetable or fully cooked seafood options such as fully cooked eel (unagi) or shrimp (ebi).

raw sushi and roll

2. Fish containing mercury

Fish is nutritious as it’s packed full of omega 3 fatty acids, vitamin B and also a good source of lean protein. However, certain fish (commonly the large fishes) such as shark, swordfish, king mackerel and tilefish can be contaminated with high levels of mercury which has been linked to developmental delays and brain damage in the newborn.

Most other type of fish has generally lower amount of mercury, but should still be eaten in moderation during pregnancy.

3. Raw shellfish

Undercooked or raw shellfish such as oysters, clams and mussels should be avoided during pregnancy. Although cooking helps prevent certain types of infection, it does not prevent the algae –related infections that are linked to red tides which can cause an individual who consume shellfish containing red tide toxins to become very ill with neurotoxin shellfish poisoning. Hence, it is generally advisable not to eat raw shellfish, regardless of whether you are pregnant.

raw oysters on platter

4. Smoked seafood and deli meat

Refrigerated smoked seafood such as salmon, trout, tuna, mackerel, whitefish, cod and also deli meat such as ham, turkey, salami and hot dogs should be avoided as it could be contaminated with listeria, which can be harmful to the unborn baby leading to infection and even miscarriage.

These are safe for consumption if they are cook as part of a meal, like a casserole or heated until it is steaming hot before consuming. In addition, smoked seafood contains high level of salt which could be harmful to both mother and baby during pregnancy. Only canned smoked fish or seafood is safe to eat during pregnancy.

5. Pate

All types of refrigerated pate including vegetable pate should be avoided as they may contain listeria. Another reason to avoid eating meat pate is it usually contains liver which has high levels of vitamin A and is not recommended during pregnancy.

pate platter

6. Raw eggs

Homemade sauces such as Caesar dressings, mayonnaise, hollandaise sauces and homemade desserts such as homemade ice cream or custards should be avoided as they are usually made with raw eggs which could contain Salmonella.

Commercially manufactured ice cream and sauces are made with pasteurized eggs which do not increase the risk of salmonella. Eggs should be cooked well until the egg whites and yolks are firm before consuming.

cracked raw egg with yolk

7. Cheese

Cheese is a great source of calcium and most types of cheese are safe to eat during pregnancy. There are a few types of cheese which are not safe to eat as they are more prone to being contaminated with listeria which can be harmful to your unborn baby. The types of cheese that are not recommended during pregnancy include:

    1. Soft, mould ripened cheeses such as brie, camembert, cambozola and chevre
    2. Blue-veined cheeses such as Danish blue, Roquefort, bergader, blue wensleydale, Shropshire blue, dolcelatte, gorgonzola and tomme.
    3. Soft, unpasteurised cheese such as goat’s and sheep’s cheeses.

soft cheese platter

Soft, mould –ripened or blue veined cheeses are not safe to eat during pregnancy as they are more likely to be tainted with listeria as these types of cheese are moister and less acidic than other types of cheeses. They can only be eaten if they are cooked thoroughly, such as in an oven until they are piping hot throughout. All hard cheeses, and soft processed cheeses made with pasteurised milk are safe for consumption during pregnancy.

8. Unpasteurized milk

Unpasteurized milk may contain listeria so stick to pasteurized or ultra-heated treated (UHT) milk. If only unpasteurized milk is available, boil it before consuming. Do not consume any types of food made from unpasteurized milk.

9. Vitamin A

Vitamin A is an essential nutrient and has several important functions such as helping cells to replicate, essential for good vision and also plays an important role in growth, reproduction and immunity during pregnancy.

However, high levels of vitamin A intake during pregnancy have been linked to multiple birth defects in the newborn.

It is advisable not to eat liver or liver containing products such as liver pate, liver or haggis as they contain high levels of vitamin A. Another reason why pregnant women or those who are trying to conceive should avoid the acne drug, isotretinoin, also known as ‘accutane’, including the topical tretinoin, due to its high content of vitamin A.

topical tretinoin cream in squeeze tube

10. Unwashed vegetables and fruits

Make sure you wash all vegetables and fruits thoroughly before eating. Doing so will eliminate any harmful bacteria or toxoplasmosis which may be found in the soil where your fruits and veggies were grown.

11. Caffeine

Caffeine can be found in many common drinks and foods including coffee, tea, chocolates, soft drinks, energy drinks and even some over-the-counter (OTC) medications such as headache, flu and allergy remedies.

In general, the amount of caffeine intake during pregnancy is still controversial but it is advisable not to consume more than 200mg of caffeine per day as there are studies that show that consuming 200mg or more of caffeine a day increases the risk of miscarriages and stillbirth.

Also caffeine is a stimulant so it can increase your heart rate, makes you feel jittery and also causes insomnia. Caffeine can also contribute to heartburn and also increase the need to urinate due to its diuretic properties.

Another reason to cut down on coffee and tea is because it contains compounds called phenols which can make it harder for your body to absorb iron which is important in pregnancy as many pregnant women already have low iron levels.

If you have coffee or tea, it is better to have it between meals so it has less effect on iron absorption.

On average, 1 mug of instant coffee contents 100mg of caffeine, 1 mug of filter coffee contents 140mg of caffeine, 1 mug of black tea contents 75mg of caffeine, 1 can of coke contents 40mg of caffeine and 1 bar of 50mg chocolate contents 50mg of caffeine. So, if you were to have 2 mugs of instant coffee in a day, you would have reached your daily limit. If possible, substitute caffeinated drinks with milk, fruit juice and water.

cup of coffee with beans

12. Alcohol

It is advisable not to drink alcohol during pregnancy as there is no known safe amount of alcohol intake during pregnancy. It is safer to avoid alcohol completely during pregnancy as alcohol intake during pregnancy may lead to miscarriages, stillbirth, long term medical problems and birth defects in the newborn. Heavy intake of alcohol during pregnancy can lead to a group of defects in the baby known as foetal alcohol syndrome which is a lifelong condition and includes behaviour and attention problems, heart defects, abnormal facial features, developmental delays, low birth weight and poor growth.

colorful alcoholic drinks

When you are pregnant, you want what’s best for your unborn baby and what you eat and drink will be absorb by your baby and have an effect on your baby’s health, possibly forever. This is when you should pay most attention to what you eat especially what to avoid as some food may present as a danger to your unborn baby.

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First Period After Pregnancy

One of the amazing benefits of pregnancy is the 9 month long break from having your period. But when your period vacation is over, you may have questions like:

“When will you have your first period after pregnancy?”
“What if I’m breastfeeding?”
“What if I’m not breastfeeding?”
“Will my period change after pregnancy?”

There is no simple answer to these questions as every women’s body is different. It’s difficult to say exactly when your period will return and it also depends on how long you breastfeed your baby.

By the end of this article, you will gain a better understanding of your period after pregnancy.

When should I expect my first period after pregnancy?
After pregnancy, your period may return anytime between 5 to 12 weeks after delivery or even longer if you are breastfeeding.

If you are exclusively breastfeeding (i.e – baby is only on breast milk, day and night), it may take longer for your period to return, from a few months to even up to 1 year.

Eventually, even if you are breastfeeding your period will return.

If you are supplementing with baby formula, or exclusively on baby formula, then your period will return much earlier.

Hence, the longer and more often a mother is breast feeding, the longer it may take before her period returns.

Will there be a change in my period after pregnancy?
Some women find that their period is similar to before while others may find that their menstrual cycles have changed and now have very irregular periods.

Some women experience longer periods, heavier bleeding, heavier cramps, or even missed periods.

These changes are due to the hormones that drive your menstrual cycle. Don’t forget your body has had a long vacation from having a period. As your body adjusts from pregnancy mode back to normal, it will take time for your menstrual cycle to get back on track.

Occasionally hormonal changes during menstruation may cause reduction in breast milk production and a slight change in the taste of the breast milk. However, these changes are not significant and usually do not affect breastfeeding.

If you are experiencing irregular periods, it is a good idea to keep a period calendar or menstrual cycle calendar. If you have any concerns regarding your menstrual period after delivery, please seek further advice from your doctor.

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Vaginal Bleeding & Spotting in Early Pregnancy

While most pregnancies will be smooth with few complications, up to 1 in 5 (20%) pregnant women experience some spotting or vaginal bleeding during the 1st trimester of pregnancy (a.k.a. early pregnancy).

First trimester vaginal bleeding is defined as vaginal bleeding during the first 12 weeks of pregnancy.

In early pregnancy, you may experience some light vaginal bleeding when your developing embryo implants itself in the womb (a.k.a. implantation bleeding). This kind of vaginal bleeding is completely harmless and often happens around the time when your first period after conception would have been due.

If you are NOT pregnant and having vaginal bleeding, please refer to my other article abnormal vaginal bleeding.

5 Causes of Vaginal Bleeding & Spotting in Early Pregnancy
1) Miscarriage

Miscarriage occurs when the pregnancy ends before the 24th week of pregnancy and are relatively common. Up to 1 in 5 pregnancies ends in a miscarriage during the first trimester.

Common symptoms of miscarriage include vaginal bleeding and abdominal pain. However, some missed carriages may have no symptoms.

Miscarriages can be further categorized as threatened, complete, incomplete or missed and also further classified as sporadic or recurrent (>3 miscarriages).

Threatened Miscarriage
Incomplete Miscarriage
Complete Miscarriage
Missed Miscarriage
There are several risk factors for miscarriage:
Endocrine Disorder
Maternal Age

Other less common risk factors include occupational chemical exposure or radiation exposure.

2) Ectopic Pregnancy

Ectopic pregnancy occurs when a fertilized egg implants outside the womb – for instance in the fallopian tube, ovary, etc. This can cause vaginal bleeding but is more commonly associated with abdominal pain.

All pregnant women with vaginal bleeding with or without abdominal pain should have an ultrasound scan performed to identify the location of the pregnancy. Early diagnosis of ectopic pregnancy is key to preserving fertility, and preventing complications, some which can be fatal.

diagram of ectopic pregnancy

An ectopic pregnancy is when a fertilized egg implants in the fallopian tube instead of the uterus or womb.

Risk factors for ectopic pregnancy
  1. Having a copper or hormonal intrauterine device (IUD)
  2. Previous history of ectopic pregnancy
  3. History of genital tract infection, including pelvic inflammatory disease, Chlamydia, gonorrhoea, etc.
  4. Previous history of any fallopian tube surgery
  5. Current pregnancy conceived via In vitro fertilization (IVF)
  6. Smoking
3) Local Causes: Cervical polyps, Cervical cancer

The majority of cervical polyps are non-cancerous or benign, and are common during pregnancy.

Most of the time they do not cause any symptoms or problems and it’s likely that you wouldn’t even notice if you had one.

However. occasionally these polyps can start to bleed on their own or through physical contact such as during sex. Usually, polyps will get smaller and resolve after delivery and surgery is not needed during pregnancy unless there is constant bleeding or significant symptoms of discomfort.

Vaginal bleeding is rarely caused by changes in the cervical cells (i.e. pre-cancerous to cancerous changes). If this is suspected during examination, a pap smear test may be performed. In most cases this should not affect your pregnancy and can be delayed until after the birth.

cervical polyp in ultrasound scan

A cervical polyp as seen on an ultrasound scan. Credit: Wikipedia

4) Bleeding After Sex

During pregnancy, the cervix softens and the blood supply to the cervix increases. As a result, sexual intercourse can cause light bleeding ranging from a few hours to several days after sex.

However, you should always inform your doctor if you experience any bleeding during pregnancy as the episode of bleeding may be unrelated to the cervical changes.

5) Unexplained Bleeding (in a Normal Pregnancy)

In about 1/3 of pregnant women, the cause of vaginal bleeding is unknown. In these cases, all investigations including ultrasound scans appear normal and the baby appears healthy and is developing well.

The bleeding may or may not happen again during the pregnancy but if you start to bleed again, it is advisable to see your doctor for an evaluation.

In summary, if you are pregnant and you are experiencing any vaginal bleeding with or without abdominal pain, I would strongly advise you to see a doctor for further evaluation.

Some preconception advice to help reduce the risk of miscarriage or ectopic pregnancy include:

doctor with stethoscope
  • To have a pap smear test performed before getting pregnant as it would make it easier for the doctor attending you to know your updated pap smear status.
  • Screen for any sexually transmitted infection (STI) especially if you are at risk of any before getting pregnant.

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