What if you meet a doctor who was more a friend than someone whom you meet for a consultation? Life would be easy for people if they could convey their problems just over a small discussion . There are many doctors in this specialty but not everyone seems to be as approachable as Dr Agilan is. Let us hear more from fertility specialist in Kuala Lumpur about his specialisation, infertility, male infertility and laparoscopic surgery.
Dr Agilan on his profession
GetDoc: Hello Doctor, we are glad to have this interview. Can you start by telling us a bit about your educational background?
Dr Agilan: After I graduated from University of Malaya, I did my early training in Kota Kinabalu. I was there for a total of 8 years; in fact I actually applied to go there. The reason I was there because I could get great exposure and lots of training. It was an important time as I started to learn to customise care-plans for my patients. I was initially working in Obstetrics and Gynaecology, and I developed an interest in treatment of Infertility. When I see the outcome of treatment in those patients; it was rewarding to see them get their problems solved.
Because of this focus in treatment of infertility, I am able to dedicate all my time to help my patients solve their problems. Each patient is different; yes you can say they are all coming in for the same problem. But each one is unique in terms of their condition. I will give individualised care for each of my couples and when they get pregnant, the satisfaction is immense. It doubles or triples especially after the baby is born, the feeling is fantastic.
GetDoc: What do you do to uplift unmotivated couple’s spirits and confidence?
Dr Agilan: A couple starts a fertility journey when they come and see a doctor and that’s when the doctor starts building a bond with them. It is actually not very mechanical as it sounds. As a doctor, it is up to me to make my patients understand what the problem is, what the outcome is going to be like. It is necessary to be very truthful. I need to tell the patient where there are in terms of their fertility and what’s their chances are to conceive successfully. This approach helps the couple to make an informed decision about their treatment plan and also helps them to take their next step.
Some of them, even after an unsuccessful attempt tend to have a positive frame of mind because they have fully understood their chances. This helps them to remain calm in spite of failed attempts.
As for me, I keep in touch with my patients via email. This keeps them updated with their treatment plan. I do not like to give false hopes or offer treatments which are not appropriate for my patients. It is against my principles and ethics. I feel in this way, my patients are able to cope with the situation better.
GetDoc: How do you differentiate yourself from your peers?
Dr Agilan: Being a new generation fertility doctor, I am kind of tech-savvy (laughs); I like to keep my communication ongoing with my patients. I email them, clear all their misconceptions. In this way, the couple is very relaxed when going through the treatment. I think this approach holds good for any field, personal care is very important.
Because I am in regular touch with them, I can update them on the treatment plan; there is proper dissemination of information. This makes me very approachable to patients, so they can ask their queries to me without any hitch. I do blog write-ups, newspaper write ups so that I can share correct information with the people. I am also trying to use social media to help me in this mission.
As a doctor, I am only trying to optimise their fertility. But no one can change your luck; however, I would like to give them hope of having the baby, not false hopes. That’s how I plan my care, the way I speak to my patients. I am sure my peer will do the same, but this is what I think I do differently. While on their fertility journey, it is important for the couples to keep going and only then will they reach the ultimate goal of delivering a baby. Most of the time, this issue is not addressed, the couples lose tempo during the course of the treatment and fail to reach their end goal. And I think this is what makes me different.
Dr Agilan on Infertility
GetDoc: What do you think are the main causes of infertility in Malaysia?
Dr Agilan: Well, the main cause is environment-related, the most common ones being smoking, obesity, alcohol and the food that we take. Let me briefly tell you about each of these reasons.
Smoking – If you have been smoking for the past 20 odd years, it certainly affects the sperm count and most importantly affects the quality of the sperm. Even if the count is good, the quality of those sperms may not be good and this results in an inability to impregnate. Smoking also damages the number and quality of a woman’s egg.
Alcohol – Although alcohol is said to be good for health, it is only good when consumed in small quantities. The problem arises when you binge drink, say over the weekend. Even if you have not been drinking regularly, if you suddenly go full throttle on one particular day, it will have an effect similar to smoking.
Obesity – Obesity is clear cut, it basically reduces sperm production. To produce sperms, the male hormone testosterone is needed (for sperm production). But when you are obese, the male hormone is changed to a female hormone in the body, resulting in an imbalance of these 2 hormones and thus leads to decreased sperm production. As for a woman, obesity may be linked to a condition called PCOS which gives rise to infertility.
Food – You can link back food to obesity. The amount of processed food available in the market, the amount we consume these days is too high, all this tends to cause decreased sperm count and sperm quality. You need to strike a healthy balance between eating healthy food and processed food, since complete exclusion of processed food from diet has become unavoidable these days.
GetDoc: What about stress, Doctor?
Dr Agilan: Now, stress is yet another issue or so we think. I would like to put it this way – stress actually has no direct effect on the sperm but what happens is it results in erectile dysfunction and this can lead to infertility. Stress does play a part but is not the major reason.
There is another less common cause of infertility but it still is an important one – medication. Medication for diabetes or joint pains can have some temporary effect on sperm quality. We need to see what kind of medicines people are actually taking and see if we can improve it by any other means.
Sometimes , body builders take in male hormone to build muscle, but this actually switches off their natural sperm production. It can take about 1-2 years to reverse those effects. I always caution my patients about this male hormone medication – What usually happens is, men check their hormone levels, and when they find that it is low, they tend to assume that the low hormone level is causing them to produce lesser sperms. They think they can make it better if they consume hormone tablets. This is where they are erring and we need to correct such misconceptions. Taking such medication will only cause the switching off of the natural sperm production in the body and that is dangerous. I always advise my patients not to take the male hormone unless their own body is not producing it.
There can be genetic reasons also for infertility. In some cases, IVF is still possible as long as we managed to get some sperm from the male partner. There is a solution to each of these problems; all the patients need to do is discuss their options with the doctor.
GetDoc: Is there hope for cancer patients, who have to take lot of medications, can they have a baby later in life?
Dr Agilan: Male Cancer patients, especially young-aged, actually can have a baby in the future through fertility treatment if they have done something called Fertility Preservation. After puberty, if there is any malignancy, say cancer, treatment will destroy the sperms. So they must speak to their oncologist and freeze the sperms. After probably 10 years, they can come back and use a fertility treatment and have a child of their own. Healthy sperms can be frozen for a long time.
We offer Fertility preservation at KL Fertility Centre, but not everyone is aware that something like this exists; something like sperm freezing can be done. I am talking to oncologists and other practitioners to spread the awareness. It is widespread in countries like England but not widely practised in Malaysia.
Freezing is a blessing in fact; you can freeze eggs, sperms much earlier in life and come back later to get it placed back into the uterus. Freezing is quite popular among celebrities overseas.
Social freezing is a topic recently gained attention in media – women freeze their eggs when they are young, then when they are ready to have a baby they use their frozen eggs to conceive via IVF. However, this does not guarantee a successful pregnancy.
Dr Agilan on Male Infertility
GetDoc: In the past, women have always been blamed for infertility. But now, there is some acceptance that men also can be a reason why a couple cannot get pregnant.
Dr Agilan: It is certainly inhuman to blame the woman always for inability to produce children. The percentage of male infertility cases is as high as 40% in countries like Australia and the US. We do not have official statistics for Malaysia but from the IVF we have conducted so far, at least 50% of the cases are due to the male’s infertility. So when I do the assessment for couples, I assess both the male and the female equally in all aspects for infertility. They both can be the contributing factor.
GetDoc: There is a stigma in Malaysian society for men that prevent them from accepting their fertility condition.
Dr Agilan: It is not as bad as it used to be earlier, awareness has caused this situation to improve. I have had men coming in for check-up, even before they plan to get married. It is heartening to see men check their fertility, and ensure that this doesn’t become a problem in the future. However, it is not as good as I wish it would be. There is still a stigma as you mention, it becomes a slap on the ego that a man is unable to make his wife pregnant.
The thing is people do not know whom to consult with – which specialist to check with. And this was one main reason why I started the Male Fertility Assessment Programme. Some men come in for a consultation, some follow up after their consultation some don’t, and there are some who continue to keep in touch via email. At least, this gives them a window of opportunity to know for themselves what’s going on. Being a male myself, my male patients find it easier to communicate with me.
Dr Agilan: It is a very simple programme for someone who wants to know where he is in terms of his fertility. They can do the sperm tests elsewhere or at my centre and share the reports with me. I usually assess the test reports they bring, but sometimes need to repeat the test. If they haven’t done any test, they can very well get themselves tested here. We offer free consultation for the test reports that they bring in. They can check our website for more details on this programme.
GetDoc: Who are the people that you are looking to address?
Dr Agilan: In the case of women it is pretty much clear-cut, fertility starts to decline after say 35 yrs. But men do not have a “biological clock” like women do. Actually, nowadays a lot of men come in to consult with are younger with a poor the sperm quality. People need to understand that not all men who produce sperm can make a woman pregnant; it is the quality that matters. A majority of men can produce sperm, but poor quality; there is a small percentage of men that cannot produce sperm. These are the two groups of people I am looking to help with my expertise.
Dr Agilan on Laparoscopic Surgery
GetDoc: What is laparoscopy?
Dr Agilan: Laparascopy surgery is a surgical technique which involves insertion of a narrow telescope-like instrument through a small incision (usually 0.5 – 1.5 cm) on their abdomen. Typically there will be between 2-4 such small holes on their abdomen. This allows visualisation of the abdominal and pelvic organs including the area of the uterus, fallopian tubes and ovaries.
GetDoc: Why is laparoscopy used for in women with infertility?
Dr Agilan: We can use Laparoscopy to determine whether the patient has scar tissue / adhesions, endometriosis, fibroid and other abnormalities of the uterus, fallopian tubes and ovaries. However, not all women with infertility need a laparoscopy as part of their assessment.
If any defects are found then they can be corrected at the same time.
GetDoc: Should patients with cysts, small growth of fibroid or even endometriosis go for corrective surgery to get pregnant?
Dr Agilan: Patients may have ovarian cysts, fibroid or even endometriosis, which affects their chance of pregnancy. Sometimes, corrective surgery is needed but not in all cases. In a fertility centre, we know what the next step is for the patient. As a fertility specialist, I look at the whole picture, so let’s say if your next step isn’t going to change, I don’t do surgery. After surgery, patients will rest at least for a month before resuming their fertility treatment. Sometimes patients do get pregnant even without starting the IVF treatment.
Couple should seek fertility specialist’s advice before any fertility-related surgery, as we will suggest the treatment plan based on patients’ need. Key point is even if the woman has a pathology, doesn’t mean they have to remove it. Generally surgery is quite safe, however every surgery has a risk and it is very real.
Patients can try to improve their fertility health by using supplements. There are many supplements in the market. They have improved the sperms quality in general.
Improving sperm quality doesn’t mean they will get pregnant. From the microscope, the sperms looks fine, however we are not sure whether the sperm is genetically improved. Hopefully in near future, we can have more research or papers to prove that.
That was very insightful! For more information, hop on to your fertility specialist in Kuala Lumpur, Dr. Agilan’s Facebook educational pages and his blog:
- Fertility Initiative is dedicated to disseminate information about care of women who faces difficulty conceiving naturally.
- Male Fertility Initiative is dedicated for men to help them achieve fatherhood.
This article was first published here.