Dr Helena Lim qualified as a doctor from Universiti Kebangsaan Malaysia in 1999. She obtained her specialist degree in the UK in 2006 and completed her master degree in Obstetrics & Gynaecology in the same year. She has been a Consultant in Obstetrics & Gynaecology with special interest in Fertility since then.

MD (UKM), MRCOG (UK), MOG (UKM)

Dr Helena Lim qualified as a doctor from Universiti Kebangsaan Malaysia in 1999. She obtained her specialist degree in the UK in 2006 and completed her master degree in Obstetrics & Gynaecology in the same year. She has been a Consultant in Obstetrics & Gynaecology with special interest in Fertility since then.

More About Dr Helena Lim Yun Hsuen

Dr Helena studied medicine at Universiti Kebangsaan Malaysia between 1994-1999. After completing her internship at Hospital Kuala Lumpur, she joinned Universiti Kebangsaan Malaysia as a trainee lecturer at the Department of Obstetrics & Gynaecology, which is one of the prestigious training hospitals in Malaysia. As a trainee and registrar, she was actively involved with acaedemic & reasearch work in Obstetrics and Gynaecology. In 2005, She left Malaysia to continue her training in Exeter, UK.

She obtained her specialist qualification (MRCOG) in 2006 and completed her master degree in Obstetrics & Gynaecology the same year. Upon returning to Malaysia in 2007, she re-joined Universiti Kebangsaan Malaysia as a lecturer. She was responsible for teaching of students, resident doctors and post-graduate students, and to this day, maintains an active interest in research and training. During this period of time, she discovered her interest in infertility and has actively pursued further training in this field. In 2011, She was awarded a certificate in Assisted Reproductive Technique from National University of Singapore.  She is regularly invited to speak at public forums as well as at medical conferences.

In 2012, Dr Helena left Universiti Kebangsaan Malaysia and joined KL Fertility & Gynaecology Centre to focus on infertility.

Dr Helena is especially interested in  the impact of nutrition, stress and psychology on fertility.  Apart from fertility, her other research focus was on ectopic pregnancy, in which she has done extensive research which has been published in international and local medical journals. Dr Helena is actively involved in the Obstetrical & Gynaecological Society of Malaysia and held the post of the Assistant Honorary Secretary from 2007-2009. She is also passionate about educating the general public on issues on pregnancy and parenting, and had published a book entitled ‘Mummy’s Secret- Your comprehensive Guide to pregnancy & parenting’ recently. In 2009, Dr Helena and her colleagues started a website: www.pitterpatter.com.my for pregnant couples and young parents. She continues to be actively involved in contributing educational articles to magazines and websites related to infertility, pregnancy & parenting.

Fresh sperm contains not only live sperm, but also dead ones, along with secretions from the prostate gland and seminal vesicles. These secretions are designed to protect the live sperm from the acidic environment of the vagina and are necessary in normal intercourse. However, if these dead sperm and secretions are not removed, they can cause severe cramping when the sperm is injected into the uterus during the IUI procedure.

The process of sperm washing for IUI begins when the semen is diluted with a nutrient rich solution to speed up the movement of the sperm. After allowing time for the nutrients to work, the secretions and dead sperm are washed out by spinning the mixture in a centrifuge machine. A small volume containing the best sperm is now ready for the IUI to be done.

Sperms which are slightly “weak” can benefit from this washing procedure to increase their motility (movement) before IUI, but when the sperm count is very low or movement is extremely slow, the washing procedure and IUI may have no benefit. ICSI is then the only option.

One final point to remember is that at room temperature, good sperm can survive up to four hours, so sperm can be produced in the comfort of your home and brought in to the clinic within about an hour after production. Remember not to cool it in the refrigerator or ice box, as cold kills sperm. Keeping it in your pocket or handbag is sufficient.

Because of this low pregnancy rate, doctors usually recommend that IUI needs to be repeated a number of times. There is no consensus on how many times you should do IUI before accepting that it is not working for you. However, the generally accepted figure is approximately three attempts.

The low success rate of IUI is due mainly to the many unknown factors inherent in this treatment. For example we have no idea if the eggs have been picked up by the fallopian tube, if the tube is functioning normally to transport the eggs down to the uterus and whether the sperm is actually fertilizing the eggs and embryos being created.

It is for this reason that after two to three failed attempts at IUI, it is recommended that the next course of treatment is IVF.

To be fair though, the costs of IVF have remained almost constant in the past decade, due mainly to the fact that doctors realize the burden of finance and have instituted measures to reduce costs. While some of the cost-savings may not result in any substantial change to the quality of the IVF cycle, patients have to remember that beyond a certain point, the chances of achieving a healthy live birth may be affected.

The total cost of an IVF cycle can be broken down into three large groups. The first is the cost of the hormonal medications which are required to stimulate a woman’s egg production. Due to the complexities of the process, these hormones are produced by only a handful of companies worldwide and are costly.

Secondly, the IVF laboratory takes responsibility for nurturing the sperm and eggs and generating embryos which eventually become your baby. Maintaining high standards and investing in the highest quality equipment and materials is a costly proposition. Any compromises here risk the success of the whole IVF cycle.

And finally, it is the human touch that puts all this technology together. In the search for ever-higher pregnancy rates, there is no substitute for experienced and highly skilled staff, along with the constant upgrading of skills and equipment. These human resource and investment costs eventually do add-up.

As with anything else, higher levels of training, investment and raw materials usually add-up to higher IVF costs. And higher quality explains why some IVF clinics have consistently high pregnancy and delivery rates. Every IVF unit has pregnancies, it is just a matter of how many.

2. Choose your IVF centre and fertility doctor wisely
Remember that there are no rules on the web and that not everything you see there is necessarily true. This is especially true of the IVF forums.

3. Be philosophical
Always remember that IVF is not 100% successful. While the best units have high pregnancy rates, there is always a possibility that it may not work this time around. You can’t change the pregnancy rate, so being philosophical about the outcome significantly reduces the stress of IVF and this in turn may actually increase your chances!

4. Find a friend
As you go through your IVF cycle, it always helps to have someone to talk to and share the burden. Often it is your partner, but equally it may be a good friend or relative.

5. Get your man in shape
Your baby carries your husband’s chromosomes and genes as well as yours. Therefore anything that may cause damage to his sperm will result in poorer IVF success rates, or in miscarriage. He should reduce or stop smoking, binge drinking, hot saunas or baths for the three months leading up to your IVF and focus on getting adequate nutrition as well as keeping his weight within the normal range. Same things you should be doing too!

6. Stress, stress, stress
Find ways to reduce stress. It is natural for stress levels to increase during your IVF cycle so plan to do it when work is a little less busy. Light exercises such as stretching, yoga, swimming or walking promote a feeling of wellness as does indulging in a hobby.

7. Feel-good hormones
Keeping up your spirits by being active, both mentally and physically, helps maintain good levels of feel-good hormones called endorphins. These in turn counteract the effects of stress. It is believed that acupuncture also works by the same mechanism.

8. Don’t delay IVF
The longer you delay, the lower your pregnancy rate. Once you have decided that IVF is your next move, it is best to start soon. This is especially true if you are above 35 years of age, your husband is above 45, or you have had ovarian damage eg ovarian cysts or endometriosis.

According to research, being overweight can affect your ability to become pregnant. It could also lead to complications in your pregnancy and for your baby. Once pregnant, if you are overweight you are at risk for hypertension (high blood pressure), gestational diabetes, Cesarean section, and having a large baby.

If at all possible, getting your weight into a healthy range (lowering your BMI) will improve your overall health, increase your chances of getting pregnant without intervention, and provide you with a better chance of a healthy pregnancy with a positive outcome.

PERFECT FIT is a team of energized professional weight management and education coaches dedicated to helping individuals look good, feel great and achieve optimal health. The Perfect Fit weight loss solutions team are the best in the game. We all live and breathe weight management.

We sell results not memberships!

Our team draws on Heatlthpointe, a proven weight management system with over 30 years of scientific research and which has helped thousands of people worldwide achieve and maintain their individual weight loss goals.

We are focused on providing proper guidance and education on the right type of food, no hunger, no heavy exercise, no drugs and very fast and sustainable results.

Visit us at www.perfectfit-hp.blogspot.com for more details.

Make an appointment with us for a free consultation by calling 6012 395 0801 (Bernard) or 6012 200 2062 (Pam) or email us your details at enquiries@perfectfit.com.my

If you smoke, or your partner does, you could be seriously jeopardizing the quality of embryos generated by IVF or ICSI. Cigarette smokers have repeatedly been shown to have poorer quality eggs or sperm and this in turn affects the number and quality of the embryos that subsequently develop. Pregnancy rates can be up to 30% lower and miscarriages can be almost doubled for heavy smokers.

The link between alcohol consumption and IVF has taken longer to prove, but we now know that women who drink more than twice a week, even moderately, reduce their chances by up to 20%.

If you consume four or more cups of coffee, tea or other caffeine containing beverage, this again adversely affects the IVF cycle, reducing pregnancy rates by up to a quarter.

It goes without saying that a nutritionally deficient diet results in poor outcomes, whether naturally or by IVF. Eat healthy, take at least five colours of fruit & vegetables daily, drink plenty of water and avoid food fads. The addition of a good multivitamin & mineral supplement is also recommended, along with daily folic acid.

Stress changes bodily functions and reduces the ability of IVF embryos to implant successfully into the uterus. While it may sometimes be unavoidable, especially in the office, make time for stress relieving activities to counteract the negative effects. Gentle exercise eg swimming or yoga, engaging in a hobby and making sure that you get adequate rest are all important tools in managing stress effectively.

It has been conclusively demonstrated that overweight women take longer to conceive whether naturally or by IVF, and at the same time, suffer more miscarriage. If you are obese, be prepared to accept almost 30% reduction in the ability of IVF to get you pregnant.

It is clear that you can influence your ability to get pregnant, either naturally or by IVF, by making healthy lifestyle choices. This could make the difference between success and failure. So make a start by taking charge of your lifestyle and boost your chances of a successful pregnancy, whether naturally or by IVF.

Yet ICSI is only a recent development in the field of reproductive medicine, having only been developed in the early nineties. So what did doctors and patients do before the ICSI era to counter male infertility?

The widespread availability of ICSI has reduced our focus on medical and lifestyle means to address this problem. General measures such as the reduction of body weight in obese men, cessation of smoking and alcohol, and good nutrition used to be the first line of treatment. Medical treatment, either with pharmaceutical medicines or herbal alternatives was the second line of therapy. With these two measures, a significant proportion of men were able to father children naturally.

At our clinic, we still focus on these relatively easy measures in an initial attempt to help improve sperm parameters, and only recommend ICSI if these measures fail to show benefit. Even when ICSI becomes necessary due to very poor sperm, there is good evidence to show that lifestyle and nutrition play a very important role in ensuring a good outcome. It appears that a combination of vitamins, minerals and antioxidants prevent damage to the DNA of sperm (the genes) and hence the sperm selected for injection into the egg by ICSI will be more “healthy” and give significantly better embryos.

As ICSI is an expensive treatment modality, it should be reserved as the last line of treatment, after easier alternatives have failed.

When we remove eggs from a woman’s body to create embryos in the laboratory, there are two available techniques. One is IVF in which the sperm is introduced to the egg without any further manipulation of either. A large number of rapidly moving and normal sperm are necessary. All of these will bind to the thick wall of the egg (called zona pellucida) and eventually one of these will penetrate the egg and fertilise it.  The video below shows the process of an IVF procedure.

But what happens when the sperm is not enough (low count), not motile (i.e. mostly dead), move very slowly (slow progressive motility) or mostly abnormal? In this situation, the sperm is unable to bind to the egg and penetrate it, and thus no fertilization occurs. Without fertilization, there is no embryo to transfer & consequently no chance of getting pregnant.

We utilize ICSI when we need to overcome these sorts of sperm problems. As each egg needs only one normal live sperm to fertilise it, we are able to choose the best few sperm from the male partner’s sample and use these to fertilise all the eggs.

The ICSI technique was developed in 1991 and has since helped millions of men father their own child. Prior to ICSI, if there was a sperm problem or if it failed to fertilise eggs in an IVF cycle, the couple would have had no choice but to consider adoption or use donor sperm.

ICSI therefore is only a technique for generating embryos. The resulting embryos are the same as in IVF and there is therefore no difference in pregnancy rates. The belief that ICSI gives higher chances of pregnancy is wrong.

This is a video of the process of ICSI (Intracytoplasmic Sperm Injection) as it is performed. We use ICSI when all other measures have failed to benefit the male partner who has poor sperm.

In ICSI, a single sperm is injected into the woman’s egg to cause it to fertilise and become an embryo.  The first part of the ICSI technique is to immobilize the egg. The pipette (fine glass tube) on the left can be seen holding the egg by suction.

The ICSI injector on the right then picks up a single sperm and slowly penetrates the thick wall of the egg and deposits the sperm within it.

Finally the egg is released and will then spend a further three to five days inside an incubator which mimics the woman’s body. Here it will slowly develop into an embryo.

Once the ICSI injection is done, there is no difference in the development of the embryo when compared to IVF. The pregnancy rate with ICSI is also similar to that with IVF.

The whole ICSI process is performed under a high powered microscope so what you see in the video above is magnified 400 times.