Family Planning and Antenatal

What is Family Planning?

Family planning is a process that helps individuals or couples make informed decisions about their reproductive health. It involves using different methods to control the number and spacing of pregnancies. Family planning can include counselling, education, and the use of contraception.

Who is Suitable for Family Planning?

Family planning suits everyone, regardless of age, sex, marital status, or sexual orientation. It is especially important for people who are sexually active and not ready to have children. Women with medical conditions that could affect pregnancy or taking medications that could harm a developing foetus should also consider family planning.

What are the Benefits of Family Planning?

There are many benefits to family planning, including the following:

• Reducing the risk of unintended pregnancies: Family planning methods, such as hormonal contraceptives and barrier methods, can prevent unintended pregnancies.
• Improving maternal and child health: Family planning can help women plan their pregnancies, leading to better prenatal care, healthier pregnancies, and better birth outcomes.
• Empowering women: Family planning allows women to take control of their reproductive health and make informed decisions about their bodies and lives.
• Reducing the spread of sexually transmitted infections (STIs): Condoms are an effective method of family planning that can also reduce the risk of STIs.

What are the Types of Family Planning?

Many types of family planning methods are available, and individuals should choose the method that best suits their needs and preferences. 

• Hormonal methods: Hormonal methods of family planning include birth control pills, patches, injections, and vaginal rings. These methods work by preventing ovulation, thinning the uterus lining, and thickening cervical mucus. To start using hormonal contraceptives, you must schedule an appointment with your doctor, who will discuss your medical history, assess your eligibility for hormonal methods, and prescribe the appropriate method. You will need to take or use the method as directed, usually on a daily or weekly basis, depending on the type of method.
• Barrier methods: Barrier methods of family planning include condoms, diaphragms, and cervical caps. These methods work by preventing sperm from reaching the egg. To use a barrier method, you will need to purchase the method from a pharmacy or other retailer and follow the instructions for use. For example, condoms should be used every time you have sex, while diaphragms and cervical caps must be inserted into the vagina before sex and left in place for several hours after sex.
• Intrauterine devices (IUDs): IUDs are small, T-shaped devices inserted into the uterus. They can either be hormonal or non-hormonal and can provide long-term contraception. To get an IUD, you must schedule an appointment with your doctor, who will insert the device into your uterus during a quick office procedure. IUDs can remain in place for several years, depending on the type of device.
• Sterilisation: Sterilisation is a permanent form of contraception that involves surgical procedures, such as tubal ligation for women or vasectomy for men. To get sterilised, you must schedule a surgical procedure with your doctor, during which the appropriate procedure will be performed to prevent future pregnancies.

It is essential to follow the instructions for using your chosen family planning method carefully to ensure that it effectively prevents unintended pregnancies. You should ask your doctor for more information and guidance if you have any questions or concerns about the procedure.

Contraceptive Implant

What is Implanon?

Implanon is the brand name for the contraceptive implant containing the hormone Etonogestrel, a hormone similar to the hormone progesterone, which is naturally produced by the female body.

This form of contraceptive is highly effective and lasts up to three years. It is an ideal method for young women leading busy lifestyles requiring safe and effective contraception.

How Effective is the Implanon Contraceptive?

Implanon is at least 99.7% effective.

This means that if 1,000 women use Implanon for a year, it is possible that three women could become pregnant.

How Does Implanon Work?

The Implanon implant slowly releases progestogen into the bloodstream to prevent pregnancy for up to three years. The implant works by:

• Preventing ovulation (egg release from the ovary),
• Thickening the mucus of the cervix so that sperm cannot enter the uterus (womb), and
• Changing the lining of the uterus, thereby making it unsuitable for pregnancy.

Some medications can reduce the effectiveness of Implanon. It is important to inform doctors you have an Implanon when another medication is prescribed.

About the Implanon Procedure

The Implanon insertion procedure is quick and simple.

Using a small flexible rod, a contraceptive implant is inserted under the skin of the upper arm. During the procedure, your arm is under a local anaesthetic.

Family Planning Procedure

Starting family planning involves several steps to ensure that you make informed decisions about your reproductive health. Here are some tips to help you get started:

• Schedule an appointment with your doctor: Your doctor can help you choose a family planning method that is right for you based on your health history, lifestyle, and preferences. They can also provide information about different methods' benefits and potential side effects.
• Discuss your options: Talk to your doctor about the different family planning methods available, including hormonal methods, barrier methods, intrauterine devices (IUDs), and sterilisation. Consider the pros and cons of each method and choose the one that best fits your needs and preferences.
• Consider your timing: If you are not ready to have children, it is essential to choose a family planning method that is effective in preventing unintended pregnancies. Some methods, such as hormonal contraceptives, require daily use, while others, such as IUDs, can provide long-term contraception.
• Use protection: If you are sexually active and not ready to have children, it is essential to use protection every time you have sex. Condoms are an effective method of family planning that can also help prevent the spread of sexually transmitted infections.
• Follow up with your doctor: It is important to follow up with your doctor regularly to ensure that your family planning method works effectively and to discuss any concerns or questions.

Family planning can be a significant step in taking control of your reproductive health. By working with your doctor and considering your options carefully, you can choose a family planning method that is right for you and enjoy the benefits of family planning, including improved maternal and child health, reduced risk of unintended pregnancies, and empowering yourself to make informed decisions about your body and your life.

Fertility Treatments

What are Fertility Treatments?

Fertility treatments are medical procedures or techniques to help couples conceive a child. These can include methods such as in vitro fertilisation (IVF), intracytoplasmic sperm injection (ICSI), and artificial insemination. They may also include medications to stimulate ovulation and surgery to correct reproductive issues. The goal of fertility treatments is to increase the chances of pregnancy and live birth.

Who is Suitable for Fertility Treatments?

Fertility treatments can be suitable for individuals or couples having difficulty conceiving a child.

There are various reasons why someone might have trouble getting pregnant, including

• issues with ovulation,
• problems with the reproductive organs, or
• problems with the sperm.

Some people may have been diagnosed with conditions such as

• polycystic ovary syndrome (PCOS),
• endometriosis, or
• a low sperm count.

Others may have unexplained infertility. Usually, couples or individuals trying to conceive for at least a year without success may be considered for fertility treatments. However, earlier care may be warranted if you are a female 35 years or older or have any other possible fertility concern.

Fertility treatments are not guaranteed to work. Success rates can vary depending on factors such as the underlying cause of infertility, the age of the individual or individuals, and the specific treatment being used.

Benefits of Fertility Treatments

Fertility treatments can offer several benefits to individuals and couples with difficulty conceiving. Some of the potential benefits include the following:

• Increased chances of pregnancy: Fertility treatments can increase the chances of pregnancy and live birth by addressing underlying issues with ovulation, sperm, or the reproductive organs.
• Tailored treatment options: Different fertility treatments can address different causes of infertility. For example, in vitro fertilisation (IVF) may treat blocked fallopian tubes, while intracytoplasmic sperm injection (ICSI) may treat a low sperm count
• Timing options: Some fertility treatments, such as ovulation induction and artificial insemination, can be timed to increase the chances of conception.
• Preservation of fertility: Some fertility treatments, such as egg freezing, can preserve fertility for individuals who may want to delay childbearing for personal or medical reasons.
• Emotional support: Fertility treatments can give emotional support to couples struggling with the stress and disappointment of infertility. Other support methods, such as counselling, are available.

Types of Fertility Treatments

Several types of fertility treatments can be used to help couples conceive a child. The three main types are:

• medicines
• surgical procedures
• assisted conception

Infertility Treatment for Women and Men

Depending on the test results, different treatments can be suggested. Eighty-five to 90 per cent of infertility cases are treated with medications and/or surgery.

Various fertility drugs may be used for women with ovulation problems. Talking with your doctor about the drug to be used is essential. You should understand the drug’s benefits and side effects. Depending on the type of fertility drug and the drug dosage used, multiple births (such as twins) can occur in some women.

If needed, surgery can be performed for conditions such as uterine polyps, uterine fibroids, and endometriosis. Sometimes, a man has an infertility problem that surgery can correct.

A complex collection of factors can cause infertility; thus, one treatment does not suit all.

Significant advances have been achieved in assisted reproductive technology, and while IVF may be the best treatment for many patients, other fertility treatments may be more appropriate for some patients.

For the particular population of women and men who will require cancer-related therapies that may threaten their long-term fertility, various treatments may decrease the chances of infertility post-treatment or offer them a chance of having genetic children of their own in the future if their fertility is permanently impaired. I always aim to see them at very short notice to be able to counsel them regarding the options available thoroughly.

We also provide counselling for fertility options for single women and same-sex couples.

Assisted Reproductive Technology (ART)

Assisted Reproductive Technology (ART) uses unique methods to help infertile couples. ART involves handling both the woman’s eggs and the man’s sperm. Success rates vary and depend on many factors. ART can be expensive and time-consuming. But ART has allowed many couples to have children that otherwise could not have been conceived.

• In vitro fertilisation (IVF) is a procedure made famous with the 1978 birth of Louise Brown, the world’s first “test-tube baby.” IVF is often used when a woman’s fallopian tubes are blocked or a man has a low sperm count. A drug is used to stimulate the ovaries to produce multiple eggs. Once mature, the eggs are removed and placed in a culture dish with the man’s sperm for fertilisation. After about 17 hours, the eggs are examined to see if they have become fertilised by the sperm. The fertilised eggs are kept in specialised conditions to allow cell development and to grow through to an embryo stage. These embryos are then placed in the woman’s uterus, thus bypassing the fallopian tubes.
• Intracytoplasmic sperm (ICSI) is an additional step in the IVF process that is sometimes required. It involves injecting a single sperm into the egg cell using fine micro-manipulation equipment. It can help to overcome many severe sperm problems.

Ovulation Induction (OI)

This involves taking medication such as tablets or injections to induce ovulation. Then, you will be advised of the optimal time to have intercourse. This is an appropriate treatment for women who do not regularly ovulate. It is of minimal benefit to women who already naturally ovulate each month.

Intrauterine Insemination (IUI)

Intrauterine insemination (IUI) is a fertility treatment involving placing sperm into the woman's uterus using a thin, flexible tube (catheter) during ovulation. The goal is to increase the chances of pregnancy by getting the sperm closer to the egg so that fertilisation is more likely to occur.

IUI can treat various infertility issues, such as mild male factor infertility (low sperm count or poor sperm motility), cervical mucus problems, sexual function problems and when donor sperm is required.IUI is a relatively simple and non-invasive procedure performed in the clinic. The process typically takes only a few minutes and is generally painless.

In Vitro Fertilisation (IVF)

It involves stimulating the ovaries to release more than one egg for the treatment month with fertility medication. Then right before ovulation, the eggs are collected under general anaesthesia via a minor procedure called egg collection or oocyte pick-up (OPU), involving a fine needle through the vagina. The eggs are then fertilised with the sperm by either immersing them in the sperm or by selecting the sperm and injecting it into the egg (ICSI). The fertilised egg (embryo) is then cultured in the laboratory for 2-5 days and inserted back into the uterus to await implantation (attachment to the uterus).

Operative Laparoscopy or Hysteroscopy

This is a day procedure under general anaesthesia where pelvic pathology that may compromise fertility (such as endometriosis, polyps, or fibroids) is treated. An overnight hospital stay may be required following laparoscopy.

Fertility Treatments Prognosis

The prognosis for fertility treatments can vary depending on various factors, including the underlying cause of infertility, the age of the individual or individuals, and the specific treatment being used.

In general, fertility treatments such as ovulation induction, artificial insemination, and intrauterine insemination (IUI) have lower success rates compared to more advanced treatments such as in vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI).

Fertility treatments have a higher success rate for couples with a specific identifiable cause of infertility. For example, a blocked fallopian tube can be treated with IVF with a high success rate. However, the success rate is slightly lower for couples with unexplained infertility.

Success rates can also vary depending on the woman's age. The younger a woman is, the higher the chances of success with fertility treatments.

Fertility Treatment Risks

Fertility treatments can have certain risks that should be considered before any procedure. Some of the potential risks associated with fertility treatments include

• Multiple pregnancies: Certain fertility treatments, such as ovulation induction and in vitro fertilisation (IVF), increase the chances of having twins or multiple other pregnancies. These pregnancies can be high-risk and may require close monitoring and early delivery.
• Ovarian hyperstimulation syndrome (OHSS): Ovarian hyperstimulation syndrome can be a  severe complication that can occur with ovulation induction and in vitro fertilisation (IVF). It occurs when the ovaries become swollen and painful due to the growth of multiple follicles. Symptoms can range from mild to severe and, in rare cases, life-threatening.
• Ectopic pregnancy: Ectopic pregnancy is a severe condition when a fertilised egg implants outside the uterus. It is an uncommon complication of fertility treatments but can be life-threatening if not treated promptly.
• Miscarriage: Fertility treatments do not guarantee a successful pregnancy, and miscarriage can still occur even with fertility treatments.
• Emotional stress: Fertility treatments can be emotionally stressful and can take a toll on individuals and couples, especially if they don't result in a successful pregnancy.
• Cost: Fertility treatments can be expensive and not covered by insurance.

Delaying Fertility Treatments

Delaying fertility treatments can impact the chances of success and the overall outcome of the treatment.

The chances of success with fertility treatments decrease as a woman ages. The quality and quantity of a woman's eggs decline as she ages, and the risk of miscarriage and chromosomal abnormalities in the embryo increases. This is why fertility treatments are often more successful in younger women.

Therefore, if the treatment is delayed, the eggs will be older and less likely to fertilise and develop into embryos.

Delaying fertility treatments can also prolong the emotional stress and disappointment of infertility for couples. The longer a couple waits for treatment, the longer they have to deal with the emotional and psychological stress of infertility.

It's important to note that infertility can have multiple causes, some of which may be reversible. Therefore, it is essential to consult a Reproductive Endocrinologist (RE) when the couple starts having difficulty conceiving.

Antenatal Care

What is Antenatal Care?

Antenatal care, or prenatal care, is the regular medical and nursing care recommended for women during pregnancy. It includes a series of check-ups and tests to monitor the health of the mother and the developing foetus, as well as counselling and education about pregnancy and childbirth. 

Antenatal care aims to identify and treat potential problems early on, ensuring a healthy pregnancy and delivery.

Why is Antenatal Care Important?

Antenatal care is important because it:

• Allows for early identification and management of potential health problems during pregnancy, such as gestational diabetes, hypertension, or pre-eclampsia.
• Includes regular check-ups and tests to monitor the growth and development of the foetus, such as ultrasound scans and non-invasive prenatal testing (NIPT).
• Provides education and counselling on a wide range of topics related to pregnancy and childbirth, such as nutrition, exercise, labour and delivery, breastfeeding, and postpartum care.
• It helps reduce the anxiety and stress women may experience during pregnancy.
• Helps to coordinate care between obstetricians, midwives, and other doctors, as well as connecting new parents with support services as needed.
• Has been linked to better outcomes for both mother and baby, such as fewer premature births, low birth weight, and infant mortality.
• It offers a way for a woman to build a relationship with her doctor, which can be helpful when giving birth. This relationship can be especially beneficial for women who are anxious or have complicated pregnancies.

What to Expect During Pregnancy?

During pregnancy, a woman can expect to experience a wide range of physical and emotional changes as her body adjusts to the growing foetus. Some of the most common changes that women experience during pregnancy include:

• Nausea and vomiting
• Fatigue
• Breast changes
• Mood changes
• Cravings and aversions
• Constipation
• Heartburn and indigestion
• Back pain
• Swelling
• Changes in the skin
• Weight gain
• Vaginal discharge

Every pregnancy is different, and not all women will experience all of these symptoms. It is also essential to have regular antenatal check-ups with a doctor to ensure that both mother and the baby are healthy throughout the pregnancy.

Tips for a Health Pregnancy

To have a healthy pregnancy, it is essential to:

• Get early antenatal care
• Eat a healthy diet
• Take antenatal vitamins
• Avoid alcohol, tobacco, and drugs
• Get regular exercise
• Get enough sleep
• Manage stress
• Follow the doctor's instructions

Consult with our doctors to determine which healthy habits will most benefit you during your pregnancy.

Possible Pregnancy Complications

Pregnancy can be a joyful and exciting time, but it can also come with certain complications that can be dangerous for both the mother and the baby. Some possible pregnancy complications include:

• Miscarriage: A miscarriage is the loss of a pregnancy before 20 weeks. About 10-25% of all pregnancies end in miscarriage.
• Ectopic pregnancy: An ectopic pregnancy occurs when the fertilised egg implants outside the uterus, usually in the fallopian tubes. This is a severe condition that requires immediate medical attention.
• Preterm labour: Preterm labour occurs before 37 weeks of pregnancy. Preterm birth is associated with several health problems for the baby, such as respiratory distress and developmental delays.
• Placental abruption: Placental abruption occurs when the placenta separates from the uterus before delivery, which can cause bleeding and can be life-threatening for both the mother and the baby.
• Gestational diabetes: Gestational diabetes is a type of diabetes that develops during pregnancy. It can cause high blood sugar levels, which can be dangerous for the mother and the baby.
• Preeclampsia: Preeclampsia is a severe condition that can occur during pregnancy and is characterised by high blood pressure and protein in the urine. If left untreated, it can lead to serious health problems for the mother and baby.
• Stillbirth: A stillbirth is the loss of a baby after 20 weeks of pregnancy.
• Congenital disabilities: Some congenital disabilities, such as neural tube defects, can occur during pregnancy, which affects the baby's brain and spinal cord.
• Group B streptococcus (GBS) infection: GBS is a bacterial infection that can occur during pregnancy and cause serious illness in newborns.
• Postpartum Haemorrhage: excessive bleeding after childbirth, which can be life-threatening if not treated quickly.

Most pregnancies proceed without complications. It is crucial to have regular antenatal check-ups to detect any potential problems early on and to follow the doctor’s instructions to ensure a healthy pregnancy and delivery.

Antenatal Screening and Counselling

Antenatal care includes regular medical visits, screening tests, and diagnostic tests to help assess your health status and keep you and your baby healthy during pregnancy.

The routine visits to the doctor are scheduled so any problems present may be recognised and treated well in advance. These visits also educate you on handling various aspects of your pregnancy. Your doctor will discuss healthy eating, activity, screening tests necessary and what can be expected during labour and delivery.

There are several antenatal tests to assess the development of the baby in your womb. Antenatal tests are done at a stipulated time, from 8-10 weeks of gestation to 20 weeks. Before an examination, counselling will assist you in deciding the type of test based on the advantages and disadvantages of each.

Antenatal screening tests such as ultrasound and first-trimester and second-trimester screening are done to determine whether your baby is at risk of having a particular genetic condition such as Down's syndrome or other abnormalities. You should have antenatal screening done mainly if you have the following conditions:

• One of your near relatives or your previous child has a severe genetic anomaly
• If you or your partner are "carriers" of a faulty gene
• You are in your mid 30's or older
• Long-term exposure to chemical or other harmful environmental agents

However, it is always better to have antenatal screening tests done, irrespective of age or family history.

First Trimester Screening

The first-trimester screening, including blood tests and an ultrasound examination, is done between 11 and 14 weeks of gestation. It is done to detect the risk of abnormalities such as Down's syndrome and trisomy 18. 

The blood tests determine the level of pregnancy-associated plasma protein-A and human chorionic gonadotropin in your blood.

The nuchal translucency screening test, ultrasound examination, measures the thickness of the back of the foetal neck. Ample space or increased space indicates Down's syndrome, trisomy 18 or other chromosomal abnormalities. 

If first-trimester screening tests are positive, your doctor may suggest a more detailed examination at around 20 weeks of pregnancy.

Second Trimester Screening

During this period, multiple marker screening is done to screen for Down's syndrome, trisomy 18 and neural tube defects. The test measures the concentration of alpha-fetoprotein and hormones estriol, human chorionic gonadotropin, and inhibin-A in the mother's blood. These tests are done between 15 and 20 weeks of gestation.

Combined Screening

The combined reports of the first and second trimesters may yield more helpful information about diagnosing Down syndrome.

Suppose the screening tests indicate a problem in the baby. Further diagnostic tests such as detailed ultrasound, amniocentesis, chorionic villus sampling and cordocentesis may be done to check whether the baby has a defect.

After the screening, genetic counselling will support you with other decisions if your baby is found to have an increased risk for developing a chromosomal abnormality or if a problem is detected with diagnostic testing. Genetic counselling provides you with the chance to discuss the following issues:

• The outcome of the results of antenatal tests
• Options available
• Additional testing, its advantages and disadvantages
• The course of action that can be taken