In our webinar, we spotlight the main male and female infertility issues in the UAE and how advances in treatments and assisted reproductive technology (ART) have helped couples realize their dream of becoming parents.
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See more videos at https://gulfnews.com/videos
Read more Gulf News stories here: https://bit.ly/2HLJ2km
#pregnancy #infertility #health
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NewsTranscript
00:00Welcome to this Gulf News webinar on infertility and high-risk pregnancies.
00:05I hope you're all well today. I'm your moderator for this session.
00:08My name is Emma Brain. I'm a British presenter and reporter
00:12who's been working across media platforms in the UAE since 2003.
00:17Let me introduce our expert panelists for you today,
00:21who'll be sharing their insights on the reasons for infertility and treatments
00:25and how we can avoid and manage high-risk pregnancies.
00:29First up, Dr. Prashanth Hegde. He's a specialist obstetrician and gynecologist,
00:34a gynecology laparoscopic surgeon at Fumbe University Hospital.
00:40We also have Dr. Ahmed Fakih. He's the consultant reproductive endocrinologist
00:46and infertility specialist at Fakih IVF Fertility Center,
00:51who we welcome from Lebanon today. Thank you very much for joining us.
00:54We've got Dr. Nadia Najari. She's a consultant,
00:58reproductive medicine at Berjial Hospital in Abu Dhabi.
01:02Dr. Hoda Solomon, a consultant of obstetrics and gynecology at Al-Zahra Hospital in Dubai.
01:09Unfortunately, Dr. Hoda is currently in a surgery.
01:12She will hopefully join us a little bit later on in the session,
01:16as I'm sure we can all understand these things happened.
01:19We've got Dr. Roya Poghaban, a specialist of reproductive endocrinology
01:24and infertility specialist of obstetrics and gynecology at the Roya Medical Center.
01:31Good afternoon to you all. I hope you're all well.
01:33And our topic today focuses on infertility and high-risk pregnancies.
01:38So let's start off with a question for everyone to weigh in on.
01:41And my first question is, so a scenario that many couples might find themselves in.
01:47They've been trying to conceive naturally for some time, but nothing is happening.
01:52What should they look at first? Dr. Ahmed, let's start with you.
02:01Oh, Dr. Ahmed, I cannot hear you for some reason.
02:07He's not muted.
02:12Dr. Ahmed, could you unmute yourself, please?
02:22Hi, Emma. Can you hear me now? Yes, I can hear you. Sorry.
02:25I think everyone has to unmute themselves. Yes, we did go down and send that.
02:31So the scenario is many couples might find themselves,
02:34they've been trying to conceive naturally for some time, nothing's happening.
02:38What should they be looking at first?
02:41First, you have to look at the age of the couple
02:45and the duration of how long they've been trying for.
02:48If they're less than 35 and they don't have any medical conditions
02:53and they maintain a healthy lifestyle, they can try up to one year.
02:58Above the age of 35, we like to lower the duration to about six months.
03:03So if you've been trying for six months and you don't get pregnant up to the age of 35,
03:07you should have at least three basic tests.
03:10One is for the husband, which is a general test, just a semen analysis,
03:15where you check the parameters of the sperm.
03:21For the female partner, there are two important tests you have to do.
03:26One is to check her ovarian reserve and one is to check that she ovulates on her own,
03:33that she ovulates every month.
03:37Most women who have regular cycles would be ovulating on their own.
03:41A small percentage will not be ovulating.
03:45This is why you need to check.
03:46And you need to check the tubal status to make sure that the sperm and the egg can actually meet.
03:52This is usually the basic preliminary workup that couples who've been trying for a while
03:59and not getting pregnant should undergo.
04:01Okay.
04:02Dr. Nadia, would you like to add to that?
04:04What would your advice be?
04:06Sorry, Dr. Nadia, can you just make sure you're unmuted, please?
04:11There we go.
04:16I still can't hear you.
04:18I'm sorry, Dr. Nadia.
04:29While we sort that out, Dr. Prashant,
04:31would you like to continue?
04:33Yeah, good afternoon.
04:34Am I audible?
04:36Yes.
04:36Yeah, good afternoon.
04:38Greetings from Tumde University Hospital.
04:41Just to add on to what Dr. Ahmeda already mentioned,
04:44the most important aspect is evaluation of the couple.
04:48Because infertility is quite tragic for the simple reason it causes emotional,
04:54devastating emotional trauma for the couple for a long time.
04:57Emotional, devastating emotional trauma for the couple
05:00for their inability to fulfill the biological role of their infant.
05:04So from that point of view, so as was rightly pointed out,
05:08depending upon the age, they can wait for a couple of months to a year.
05:12And when pregnancy is not happening, so they need to seek medical advice.
05:17As healthcare providers, we look at their profile, evaluation of the couple.
05:23Most of the time, we do get the woman partner coming
05:27and saying that she is not able to conceive.
05:29So evaluation has to be always based on the couple.
05:34We need to quickly look into the history aspect of it,
05:37along with their age, along with their menstrual history.
05:41And even for the male, about their habits,
05:44all those criteria has to be taken into consideration
05:48to roughly reach at a point about the possible causes.
05:52As Dr. Amath rightly mentioned, for a woman who is having a regular menses,
05:58we assume her to be ovulating.
06:00We'll not be focusing too much on the tests related to.
06:04So once we evaluate the patient based upon the history and examination,
06:09the tentative possible diagnosis will be able to reach it.
06:14And based upon that, then we will advise them a couple of tests.
06:17The first and foremost investigation, as was rightly put out,
06:21is the semen analysis for the husband.
06:24Because around 40% of the causes related to infertility
06:28lies with the male partner.
06:30So once we are sure that this is not the cause,
06:33then we can focus more on the female partner,
06:36where a couple of the tests depending upon,
06:38again, on the profile of the woman, her history,
06:41and the risk factors, so-called risk factors, if at all any.
06:45So then we can focus our investigation based upon that.
06:49And once we have the investigations along with the history examination,
06:53so our further management or care plan will be decided,
06:57and the patient will be counselled accordingly.
07:00Okay. Thank you, Dr. Prashant.
07:02Dr. Nadia, let's see if we've got some audio from you now.
07:05Would you like to add to that?
07:09We still got no audio at the moment.
07:12I'm not sure what's happening.
07:13So Dr. Roya, I'll ask you to weigh in on that, please.
07:17What's your opinion?
07:19Yes, good afternoon.
07:21So, yeah, actually, about the primary analysis,
07:26I want to add that, like, 40% they will have,
07:30like, let's say, after one year trial if they don't get pregnant.
07:33So we're going to start a workup to see what's the reason.
07:37So I want to add one note here,
07:38that sometimes they come and they say,
07:40we checked and there is no reason.
07:42I mean, unexplained infertility doesn't mean that there is no reason.
07:46It means there is a reason,
07:47which is far beyond what we can find out easily.
07:51So, like, 40% they will have male factor criteria, like, reasons.
07:5740% they will have female problems,
07:59like anovulation or endometriosis or aging most of the time.
08:06Older age simply is a very, very important factor in infertility.
08:11And 20%, we will not find anything in our primary investigations.
08:15So this 20%, which we call unexplained infertility,
08:19it doesn't mean that they don't have any reason or there is not any reason.
08:23It means the reason is very in microscopic level,
08:26which we cannot find out with our ordinary tests.
08:29And most of the time, even we are not able to find out what's the reason
08:33and just we go directly to the treatment.
08:37OK, fantastic. Thank you so much.
08:39Dr. Nadia, can we have some oil here for you?
08:43I hope it works.
08:45Oh, there you are. Excellent.
08:46OK. So for you, I'm going to move on to our next question.
08:52So what are the main causes of infertility and how can we preserve fertility?
09:00The main cause of the fertility, we have a female side and we have the male side.
09:08The main cause could be ovarian problems like PCOS, polycystic ovary syndrome,
09:16so that the patients are not ovulating regularly.
09:20It could be the tubes, like my colleagues are told, there could be adhesions.
09:26It could be, for example, that the uterus, the womb,
09:30is not functioning well because of the fibroids or polyps or something else.
09:39The male factor, so the male side could be the quality of the sperms.
09:47It could be also that the quality is not good,
09:50like the numbers or the movement of the sperm or the morphology.
09:56It could be also that psychologically the couple cannot have normal sexual intercourse.
10:05This could be both, black and white.
10:16Sorry, Dr. Nadia, continue.
10:18Yeah, this is the cause that could lead to infertility.
10:26The couple, normally, they have to come if they're married and after six months,
10:32if they are older than 55, they have to see their gynecologist,
10:37and they have to come to the clinic to investigate and to check what is the problem.
10:44Okay, fantastic.
10:46We now welcome Dr. Hoda to our session.
10:49Good afternoon, Dr. Hoda.
10:50How are you?
10:51I'm fine, thank you.
10:52Sorry, I was started already.
10:54I was just doing a section at the moment, so just finished now.
10:57Successful surgery?
10:59Yes, we had a lovely, lovely, cute baby boy.
11:02Fantastic, healthy baby, healthy mother.
11:06Amazing to hear that.
11:07So we've just gone through a couple of the questions so far.
11:10We've been talking about couples that are unable to conceive naturally,
11:15but nothing's happening.
11:16What should they look at first?
11:18And now the causes of infertility.
11:22What for you are the main causes of infertility?
11:25What are you seeing?
11:26Well, infertility, the causes of infertility are like a lot.
11:31Some of them are due to female factors, and some of them are due to male factors.
11:35So about 40, 50% are female factors, maybe around 40% are male factors.
11:41And then 10%, 10 to 15, we call unexplained infertility,
11:45where we can't find a reason, either in the male or in the female.
11:50Most of the causes that I see with infertility are due to anovulation,
11:58like the ovaries are not producing proper eggs.
12:03As my colleague said, it can be probably due to polycystic ovarian disease,
12:07or just ovaries being lazy, or the woman is a little bit overweight,
12:11so which disturbs the hormones.
12:14And the treatment, I want to reassure people,
12:16the treatment of this type of infertility is usually successful.
12:20And we just induce ovulation, and it usually leads to healthy pregnancy.
12:25The other factor is the tubal factor, when the fallopian tubes,
12:28where the egg and the sperm move, sometimes if it is obstructed,
12:33then pregnancy won't happen.
12:34And in this case, we normally refer them to the fertility center for IVF,
12:40in vitro fertilization and eczema.
12:42Okay, fantastic.
12:43And Dr. Ahmed, this is where I'm going to come back to you,
12:45because obviously, one of your specialties,
12:48what are the current treatments available for people that need assisted reproduction?
12:56There are many available treatment options.
12:59Some are straightforward, and some are more aggressive.
13:04Obviously, the treatment will depend on the cause of infertility.
13:10Like Dr. Huda and Dr. Roya and Dr. Nadia previous talked about,
13:16if the patient's problem of infertility is that she doesn't ovulate properly,
13:22treatment is straightforward.
13:23You just induce the ovulation.
13:26If you have a problem with the tubes, for example,
13:28where the sperm and the egg cannot meet,
13:31then you have to go to treatments like in vitro fertilization,
13:36where the tube is the organ that allows the sperm and the egg
13:40to actually meet and fertilize.
13:42So if it's not functioning or they're blocked,
13:45you'll have to do this in the lab.
13:47This is where IVF comes in.
13:49Depending on the semen parameters, if you go to the male side,
13:54if the semen parameters are very good,
13:58in my opinion, intrauterine insemination will not help.
14:03If the semen parameters are suboptimal, IVF becomes the best option
14:10because then you're able to actually force fertilize the egg
14:15with a procedure called intracytoplasmic sperm injection.
14:19If the semen parameters meet the criteria for intrauterine insemination,
14:25then you can offer the patient something in between,
14:29inducing the ovulation with intrauterine insemination
14:32rather than to go to the most aggressive treatment like IVF.
14:37Okay, fantastic.
14:38And at this point, I just want to go through
14:40a couple of little housekeeping scenarios for our viewers.
14:44If you would like to ask a question during the webinar,
14:48please type it in for us.
14:49You can click on the questions tab at the bottom of your screen.
14:53You can use the chat feature to make a comment.
14:56But if you'd like to ask a question,
14:58please make sure it's in the questions tab.
15:00I've also asked our panelists if they can keep their responses
15:04as short as possible because of our time constraints.
15:07But if you would like more information on them
15:09or the medical practices that they represent,
15:11you can click on the links to the top of your screen
15:14that says speakers and booths.
15:16And if you right click to open a new tab,
15:19the webinar will stay open as well.
15:21Finally, we've got a poll running as well.
15:23So please take the time to record your vote on that
15:26so we can get a feel for your views.
15:29Coming back to our discussion,
15:31I've got a question that I'm going to direct to Dr. Hoda.
15:35So what can be done to make sure a pregnancy runs smoothly
15:39and that a mother doesn't run into any complications there?
15:44Dr. Hoda, if you would like to answer that question, please.
15:51Sure.
15:53To be honest, we can't say 100%
15:57that this woman is going to have an old, non-eventful pregnancy
16:01and it won't be complicated.
16:04But the trick here is to actually diagnose
16:07and pick up any complication and manage them properly.
16:11Absolutely, if, let's say, if the woman starts the pregnancy
16:15with a very low BMI, very thin laser, or a very high BMI,
16:18then we will expect, obviously, troubles.
16:21If the patient or if the woman starts the pregnancy
16:25and she's got diabetes from before, or high blood pressure,
16:29or any kidney disease, or whatever,
16:31then obviously, she will need an intensive follow-up
16:36and management of the condition.
16:38Usually, the best thing to do is just to keep on
16:41with the antenatal visits, not skip any of them,
16:45so that we can pick up any abnormality, then deal with it.
16:49For example, if we pick up gestational diabetes,
16:53which happens, actually, in this area a lot,
16:56because of maybe the eating habits,
17:00so it's not anything to worry about.
17:04It's okay to pick it up and manage it
17:07before it causes any troubles to the woman or to the baby.
17:11The same, we need to do progressive scans
17:14to monitor the baby's growth
17:16and detect any abnormality or problem in the growth,
17:20any abnormality in the blood pressure, and so on.
17:23The best advice to give is just,
17:25please stick to the regular antenatal care
17:29and don't skip appointments, don't skip scans.
17:32If you have any problem whatsoever,
17:35don't hesitate to report it to your doctor,
17:37because it can be a very important problem
17:39that you may think it's not that important,
17:41but just talk to your doctor.
17:43Okay, Dr. Hoda, thank you very much for that one.
17:46My next question is directed to you, Dr. Nadia.
17:49Are there specific scenarios
17:52that would automatically put a woman into danger
17:55for having a high-risk pregnancy?
18:01First, the patient can be in high-risk pregnancy
18:06if he's obese.
18:09If he is having, for example, twins pregnancy,
18:13twin pregnancy, or triplets,
18:15if you transfer more than one, he is at high risk.
18:19High-risk pregnancy is, for example,
18:22if the patient has already problems in the past,
18:27like preeclampsia is like a toxic pregnancy,
18:32or hypertension, so high blood pressure,
18:36so they are all at high risk,
18:38or if they have cesarean or any operations in the uterus,
18:43so this can put the patient in high risk.
18:48Okay, fantastic.
18:49And up next, Dr. Prashanth, I'm coming to you.
18:53What could turn a low-risk pregnancy
18:56suddenly into a high-risk pregnancy?
18:58What could we see is going wrong there?
19:02Yeah, see, the objective of antenatal care
19:06or prenatal care is to see that the woman
19:08passes through the ages of the pregnancy
19:11with the least possible risk, both the woman and the mother.
19:14When I say that, each pregnancy carries
19:16some amount of risk, sometimes no, sometimes not no.
19:20We broadly categorize the risky pregnancies
19:24as low-risk and high-risk.
19:2690% of the pregnancies come to the low-risk category,
19:3010% comes to the high-risk category.
19:32Some of the high-risk factors,
19:33my previous speaker has already mentioned.
19:35What I want to emphasize here is
19:37a preconceptional assessment
19:40is going to find out the risk factors.
19:43There may be some risk factors
19:45which are already pre-existing prior to conception
19:48where we are very clear what we are facing through
19:51or the woman is going to face
19:53what complications can be there.
19:55Some of the factors which may not be pre-existing
19:58which appears during the course of the pregnancy.
20:02So once we have the clarity on that,
20:04the pre-existing conditions could be medical problems
20:07like she is already having higher blood pressure,
20:10she is known diabetic,
20:11she may be a known case of epilepsy,
20:14she may be a case of bronchial asthma
20:16or blood disorders,
20:17cardiac disease,
20:18renal disease.
20:19So here we know that there is a definite risk
20:22because of the pre-existing medical condition.
20:25The other category what we are looking at,
20:27she is a healthy mother to conceive with
20:30and something appears during the course of pregnancies,
20:34very specific to pregnancy
20:36like gestational hypertension,
20:38increased blood pressure starts shooting up
20:40from 6th or 7th month,
20:42diabetes starts appearing exclusively during pregnancy
20:46and maybe some other conditions
20:48like placenta atrivia
20:50or multi-fetal gestation,
20:53higher order birth,
20:54veins,
20:54triplets
20:55or even it could be the previous pregnancy,
20:58premature births,
21:00there is a higher risk of she going for preterm
21:03or premature births
21:05or it could be in the very early part of the pregnancy,
21:07the first three months bleeding tendencies,
21:10bleeding during the early part of pregnancy
21:12with a higher risk of the woman
21:14going for a miscarriage
21:15or abnormal pregnancies
21:17like ectopic pregnancy,
21:18molar pregnancy.
21:19So the list is huge.
21:21So depending upon the stratification
21:23as I already mentioned,
21:24is she a low risk prior to pregnancy?
21:27We expect the pregnancy to go with a lower risk.
21:31Having said that,
21:32sometimes unexpected events can happen.
21:34Any low risk pregnancy
21:36within days or weeks
21:37or even within hours
21:38can turn into a high risk pregnancy.
21:40So we need to have the assessment
21:42done well in advance.
21:44Ideal situation,
21:45all pregnancies has to be planned
21:48with the prenatal consultation
21:52and counseling without sedation.
21:54Okay, fantastic.
21:55Thank you, Dr. Prashanth.
21:56Next, I'm going to come to Dr. Ahmed.
21:59When it comes to assisted reproductive technology,
22:03how does it all work
22:04and what do you think have been
22:06the biggest advancements in this field?
22:11There have been lots of advances in the field.
22:16One of the biggest advances
22:18is the advent of the next generation sequencing,
22:21which is currently the platform
22:23where we're able to diagnose
22:27genetic conditions in the embryo
22:29prior to implantation,
22:32whether it's a known disease
22:34that's running in the family
22:35or whether it's just to check
22:38for to make sure that
22:40the baby we are transferring is healthy.
22:43So genetic testing, I would say,
22:45is one of the biggest advances in the field
22:47and the field is bombarding rapidly
22:51and very fast.
22:53Another advancement is the introduction
22:57of the micro dissection
22:59testicular sperm extraction,
23:01which is a treatment offered
23:03for males who have zero sperm.
23:06In the past, if you had zero sperm,
23:10your chances of pregnancy were extremely small,
23:13even with the treatments we can offer you.
23:15Today, we can offer them a surgical procedure
23:19where depending on the condition,
23:21you have about 40 to 50% chance
23:23of actually recovering sperm.
23:26So this also is a big advancement, in my opinion.
23:30And there's lots of other advancements
23:32that are happening that we don't really see,
23:35but these happen at the level
23:37of the embryology lab.
23:39Lots of advancements in the media solutions,
23:42in the incubators,
23:44in the monitoring where the embryos
23:47have a higher chance of developing better,
23:51higher chance of being better quality,
23:54a higher chance of them implanting.
23:56So in my opinion,
23:58these are the main advancements
24:00that have happened in the past 10 years.
24:02Fantastic.
24:04And Dr. Royer,
24:05I'm going to come to you
24:06with the same question for you.
24:08What have you seen
24:09that have been the biggest advancements
24:11in technologies,
24:13in reproductive technologies?
24:17So should I answer?
24:19Yes, please.
24:20Okay.
24:21Yeah.
24:21One of, as Dr. Ahmed actually named two of them,
24:26the third one actually is the technology
24:29of vitrification and egg freezing.
24:32Actually, around from 2008, 2009,
24:36we are able mostly to do this new technique
24:40of vitrification, which is fast freezing.
24:42Before that, the freezing technology
24:45was just the method of slow freezing,
24:48which were reducing
24:51and compromising the quality of the eggs
24:53after sowing them.
24:55But since like, it's not like,
24:57it's about like 10 years now
24:58or a little bit more than 10 years
24:59that we have access to the vitrification,
25:02which is like,
25:03we can freeze the eggs
25:06and keep the quality almost like 90% of them.
25:10We can assure the patient
25:12that they will survive after sowing them.
25:15So they can go for the fertility preservation
25:17if they want to postpone their fertility
25:20or if they are planning to get pregnant
25:22after 35 years old,
25:24or if they are having a condition,
25:26they need to do chemotherapy
25:27or any like immune problem,
25:29they need immunosuppressive therapy
25:31and chemotherapy,
25:32they have the option to do,
25:34to freeze some of their eggs
25:36and keep them for the later to use it.
25:39And I think this is like
25:40one of the most advanced,
25:42like most new and advanced technologies
25:44that it's really helps a lot
25:46in preserving fertility.
25:48And I also wanted to ask you
25:50about the chances of multiple pregnancies
25:54with IVF these days,
25:55because in the past, you know,
25:57you used to implant lots at the same time
26:00and the chances of a multiple was high.
26:02How has that changed?
26:04No, no, we can't like,
26:05we are encouraging people,
26:07especially if they are,
26:08the age is less than 35 years old,
26:10we are encouraging them to
26:11for the single embryo transfer,
26:13especially if we are doing genetic testing.
26:15So I know we have more access
26:18to do genetic testing for the patients
26:20and we can choose the best embryo,
26:22the normal one.
26:23And then we are sure the lining is good,
26:25the embryo is good.
26:26We don't need to transfer
26:27more than one embryo.
26:29So we just transfer one by one,
26:30especially we have,
26:33now it's allowed to do embryo freezing.
26:36If you have any surplus embryo,
26:37we can freeze.
26:39Sometimes like the lowest changes,
26:42sometimes they don't allow
26:43to freeze surplus embryos,
26:44but now it's allowed
26:48and we can just freeze one embryo
26:50and we can, sorry,
26:51we can transfer one embryo
26:52and we can free surplus embryos.
26:56And the other thing is that
26:58like we have to already before IDF,
27:01we have to speak with the patient
27:02because most of the patients,
27:03they come and they ask for multiple,
27:05for twins especially,
27:06because they think it's like really nice.
27:08They get one time pregnant
27:10and then they have two baby
27:12and they are gone.
27:13But it's not like that.
27:14Really, when you go to the complications
27:16and when you look at like 20% preterm labor
27:19or the consequences on the baby,
27:22they can just have like cerebral palsy,
27:25they can have lots of complications
27:27and kidney problems.
27:29They can have lots of problems
27:30just because of their premature delivery.
27:34That's why we are encouraging,
27:36we are speaking with the patients
27:37before going to IDF
27:39to make sure we convince them
27:41to go for single embryo transfer,
27:43except if the age is like really like
27:46older than 38
27:48and we want to transfer whatever we have
27:50and to see which one will grow.
27:52And if we are sure that the quality
27:53of the embryos are good,
27:55we prefer to go for single embryo transfer
27:58to prevent from multiple pregnancy.
28:00Actually, even when we are transferring one,
28:03there is a small chance
28:04that this one embryo is split to two.
28:07And again, we have twins
28:09with transferring one embryo.
28:10This is how we have like identical twins.
28:13They are all from one embryo.
28:15But the chances are very low,
28:17maybe one in 200
28:18and like it's like negligible is fine.
28:22Okay, thank you so much.
28:25And we're just gonna give you a quick update
28:28on the poll that we've got running.
28:29Our poll today is what causes infertility
28:32and your choices are genetic factors
28:35or environmental factors.
28:36And so far, 54% of our viewers
28:39think it's genetic
28:40and 46% think it's environmental.
28:44So we'll give you the results of the poll
28:47at the end of the session.
28:49Dr. Nadia, I'm gonna come to you next
28:52if that's okay.
28:53Obviously, all of this can be a very long,
28:56costly, emotional journey
28:58having IVF treatments.
29:00Do you think there's enough
29:01psychological support for patients?
29:05Unfortunately, no.
29:07The patient they want to have a child
29:10are really in trouble
29:11because they cannot speak
29:13about their emotion with nobody.
29:15And they will come to us
29:17and there is the step
29:19that we invest at least one hour
29:23to discuss with them
29:24and to know why they want to have children
29:27and which problem.
29:28And if you speak to them,
29:30sometimes they cry
29:32and sometimes they will really tell
29:35all the emotions to us.
29:37Normally, we need a psychologist
29:42assisting the patients.
29:43But having a psychologist
29:46for some patients is no way
29:48because there will be perhaps
29:52they will feel they are not normal.
29:54The pregnancy, to don't have a child
29:57is a very difficult situation for the couple.
30:01It's like they lose somebody
30:04but they cannot grieve.
30:08They have a grave,
30:09but they cannot show it.
30:10They are not happy if their friends,
30:12they got another child
30:13because they feel ashamed,
30:15they feel bad
30:17that they are not happy for the others
30:20and they feel bad.
30:21So psychology is important
30:23in the infertility centers
30:27and the patient says
30:29we have to help them,
30:32especially the pregnancy rate
30:34is not so high.
30:35It's not 100%.
30:36Even if they will go for IVF,
30:38it's not a guarantee for a pregnancy.
30:42And if they come to us,
30:45I hope they have a big hope,
30:47but if they don't have a child,
30:48they are really sometimes
30:50a very going down.
30:52And here is the IVF centers.
30:55We take care of these people
30:59and we have more contact with them.
31:01Thank you, Dr. Nadia.
31:03Lots to consider on that one.
31:05I'm going to come to Dr. Hoda next.
31:08If a pregnancy is
31:10or becomes high risk,
31:12what do you normally do
31:13to ensure a successful outcome
31:15of a healthy baby and mother?
31:17What are the kind of things
31:18that could go wrong
31:21in a high risk pregnancy
31:22and how do you make sure
31:23that we both have a healthy pair
31:25at the end of it?
31:27Well, as I explained before,
31:29any pregnancy can start as low risk
31:31and then becomes,
31:33it turns into highest pregnancy
31:35during the journey.
31:36So as long as the patient
31:38comes for follow-ups,
31:39we can pick up the highest pregnancy
31:41or the pregnancy that has turned
31:45has a high risk.
31:46For example, the placenta previa,
31:48which is the low-lying placenta.
31:50If the woman comes in early pregnancy,
31:53obviously it is not being diagnosed
31:55that early,
31:55but around the 20-week scan,
31:57we diagnose low-lying placenta.
31:59We explain to the patient
32:01that she can have bleeding at any time.
32:03We counsel her and explain to her
32:06what to do in case of bleeding.
32:07And, you know,
32:10we give her enough support,
32:12psychological and even like
32:16get the blood ready for her
32:17in the hospital just in case
32:19and explain to her
32:21what can happen if she starts bleeding,
32:25that she may have a preterm delivery,
32:27talk to the pediatricians, everything.
32:29This is one example.
32:31Another example,
32:32if the woman starts the pregnancy,
32:35everything was fine
32:35and then she started to have
32:38high blood pressure.
32:39For example,
32:40this is another condition
32:41that needs great attention
32:43because it can end up
32:45with, you know,
32:46convulsions or with problems
32:48to the baby or to the mother.
32:49So again, we have to always check
32:53the woman and her baby
32:54and the blood pressure.
32:55And if there is any doubts,
32:57we take it further,
32:59another step further.
33:00We do blood tests and we check
33:01and even sometimes we admit
33:02the patients with us
33:04for monitoring the blood pressure.
33:07If at any point we think
33:10that the baby's growth
33:11is not that great,
33:13like sometimes the baby's growth
33:15is a little bit smaller than we expect.
33:17So again, we need to do some tests
33:20to see why there is a lag in growth
33:21and then assess all the baby
33:24and time the delivery
33:26in time to avoid prematurity,
33:28but in the same time
33:29to avoid the baby staying there
33:31and becoming in danger.
33:32So it's really the follow-up
33:35and the good pickup of the conditions.
33:39Like as I talked before
33:41about the gestational diabetes,
33:42if the woman develops diabetes
33:44and it's not being controlled,
33:46there is always a risk
33:48that the baby will be very big.
33:50The water around the baby
33:51will be a lot of water.
33:53So it can create a problem
33:55during delivery.
33:56So if we pick it up,
33:58as we usually do,
33:59then we can give her
34:00the proper treatment,
34:01refer her to the endocrinologist
34:03and like create a joint care
34:04between us and the endocrinologist
34:06to manage the sugar.
34:08So it's every condition
34:10has its management
34:12and we should be able to pick
34:14and hopefully reach the safe,
34:18you know, the outcome
34:20for a healthy mother
34:21and a healthy baby.
34:22Thank you very much, Dr. Hodder,
34:23for that.
34:24And I'm just going to take a look
34:25at our second poll results
34:27that are running,
34:29which is,
34:29is there enough awareness
34:30about assisted reproductive technology
34:33in the UAE?
34:3445% of you think yes,
34:3756% of you think no.
34:39That one's changing by the second.
34:42Up next, I've got a question
34:44for Dr. Prashant.
34:46Following on from the question
34:47that we asked Dr. Hodder,
34:48are there conditions
34:50during pregnancy
34:51that can leave the baby
34:52and the mother at risk
34:54for post-pregnancy issues?
35:01Dr. Prashant,
35:02I need you to unmute yourself, please.
35:07There we go.
35:09Can you repeat the question?
35:11So the question for you was,
35:13are there conditions
35:14during pregnancy
35:15that can leave the baby
35:17and the mother at risk
35:18for post-pregnancy complications?
35:22Depending upon the risk factors,
35:25depending upon the high risk
35:27condition associated
35:28with the pregnancy,
35:29yeah, some of them,
35:30even post challenges,
35:32post delivery.
35:33For example,
35:33if the mother's blood pressure is higher,
35:37again, it depends upon
35:38whether the high risk factor
35:40appeared during pregnancy
35:41or it was pre-existing.
35:43Okay, so the blood pressure,
35:46the higher blood pressure
35:47which appeared during pregnancy,
35:49what we call it as gestational hypertension,
35:51preeclampsia or eclampsia,
35:54even after the birth of the baby
35:56or the completion of the pregnancy
35:57still carries some risk for the mother
36:00because one of the worst complications
36:02of higher blood pressure is eclampsia.
36:05That means she starts
36:06throwing convulsions or twits
36:08which can even happen
36:10during the process of delivery
36:11or even a couple of days
36:13or weeks after delivery.
36:16So we have to,
36:16it is not only our objective
36:18is to see that the mother
36:20and the baby is fine
36:23till the point of delivery,
36:24even we need to see after.
36:26Similarly, if the diabetes
36:29is pre-existing
36:31prior to pregnancy,
36:33diabetes continues to be there
36:35as it was there before the pregnancy.
36:37So in that condition,
36:38we have to see that
36:39the mother's blood sugars
36:40are well controlled.
36:43We have to counsel the mother
36:45for the possible adverse effects
36:48for the baby because of diabetes
36:50because these babies
36:51are more prone to develop hypoglycemia
36:54that is their blood sugars
36:56are drastically going to drop
36:58sometimes after the birth
37:00or the baby after the delivery
37:02can have respiratory distress syndrome,
37:04difficulty in breathing.
37:06And so there are related complications
37:10depending upon the high-risk nature
37:12of the pregnancy.
37:13So the care for the mother
37:16and the baby will be customized
37:17depending upon the high-risk nature
37:20of the pregnancy we are dealing with.
37:22So accordingly,
37:23we have to counsel the mother
37:25and the father
37:26to take care of the mother
37:28and to take care of the baby.
37:29Thank you, Dr. Prashant,
37:31for your answer on that one.
37:33Up next, I'm going to come to Dr. Ahmed.
37:35Obviously, there's a lot of pressure
37:37when it comes around to the implantation
37:40and hoping for a successful
37:43implantation for IVF pregnancy.
37:45What would cause an implantation failure
37:48or cause the pregnancy
37:50to miscarry during IVF?
37:54There's lots of conditions
37:56that could affect implantation.
37:59In general, for you to have
38:00a successful implantation,
38:02you need to have
38:03a very good quality embryo
38:05and a very good quality endometrium.
38:08Endometrium is the part of the uterus
38:10where implantation happens, okay?
38:13So if you have a problem
38:15with one of these conditions
38:17and the IVF fails, for example,
38:19it's easy to say that
38:21the reason the IVF failed
38:22is probably because you have
38:23a problem with the uterus
38:25or you have a problem
38:26with the quality of the embryo.
38:27The difficulty comes
38:29where the embryo is very good
38:32and the lining is very good.
38:35And then these are the frustrating
38:38cases for the physician
38:40and the patient
38:41because the embryo is very good,
38:42the lining is very good,
38:44and still pregnancy didn't happen.
38:46It's important to think of IVF
38:49when you look at success rate about IVF
38:51to look at the cumulative pregnancy rate,
38:54especially now that we're taking condition,
38:57we're taking measures
38:58to decrease the number of embryos we transfer.
39:01So it's different
39:03when someone transfers three embryos
39:05and when someone transfers one embryo.
39:07So when you look at the success rate of IVF,
39:10the counseling is very important
39:11where you explain to the patient,
39:13I'll put them back one at a time,
39:15but the time to pregnancy could be longer.
39:18You might not get pregnant
39:20from the first transfer,
39:21you might get pregnant from the second,
39:22maybe from the third,
39:24but if you do get pregnant,
39:26your pregnancy is a lot safer
39:28and a lot healthier.
39:30So the discussion should be revolving
39:33around the cumulative pregnancy rate
39:37rather than the pregnancy rate per transfer.
39:40It all depends on how you counsel the individual,
39:42but there's lots of causes
39:44for implantation failure.
39:47You could have a problem with the uterus,
39:50problem with the embryo,
39:51you could have a maternal condition
39:52that causes it,
39:54you could have conditions
39:55where the uterus,
39:56the endometrium doesn't develop properly.
40:00It's a very big chapter
40:01that you can't really answer
40:04in a few minutes.
40:06Okay, thank you so much for that.
40:08And my next question is for Dr. Roya,
40:11and I know we kind of touched on it
40:13a little bit earlier.
40:14Are you seeing more and more women
40:16choosing to harvest and freeze their eggs these days,
40:21whether they've put their career first
40:23or they've just delayed having children
40:26or their marriage isn't great
40:29or they're just single
40:30and they want to give themselves time.
40:31Are you seeing a rise in that?
40:33Is this available to anyone?
40:35And what are the sorts of approvals
40:37that need to be obtained for this?
40:40Actually, case by case,
40:42we write to the Ministry of Health
40:44and we get approval for the freezing.
40:47So egg freezing,
40:49actually, mostly they allow
40:52for the embryo freezing is little,
40:54but the regulations are different
40:56because when we freeze the embryo tomorrow,
40:59if the couple, they get divorced
41:01and there is problem who will own the embryo,
41:04how they will use this one.
41:06But for egg, like egg freezing,
41:07sperm freezing is completely different.
41:11So from the ethical view or legal view,
41:14most of the time we get the approval
41:17if really like the age
41:18and the factor of which we are
41:21considering egg freezing is correct.
41:23Normally, they give approval from Ministry of Health.
41:27Okay, fantastic.
41:28And thank you very much to all our panelists
41:30for those answers.
41:31I'm gonna go to some of our audience questions
41:36at the moment.
41:37And Dr. Nadia, I'm gonna come to you with this one.
41:41No, sorry.
41:41I'm gonna do the first one to Dr. Hoda,
41:45if you could answer this one.
41:46I just had a laparoscopic surgery.
41:48Is there a chance for me to get pregnant?
41:53Of course, there is a chance,
41:55but the question,
41:58what laparoscopic surgery did she have?
42:01Usually, we prefer surgeries with laparoscopies
42:04to decrease the scar tissue after the surgeries,
42:06which can decrease, obviously,
42:08the chances of getting pregnant.
42:10So it depends on the type of the surgery she had.
42:14And I think we normally advise the woman
42:19after any surgery,
42:20if they try for pregnancy and it doesn't happen,
42:23to check for tubal patency,
42:25make sure that the tubes are open.
42:27So it's a very simple test.
42:29We just inject the dye in the tubes
42:31and they take an x-ray
42:32and make sure that the tubes are open.
42:35If they're open,
42:36then I can safely reassure the patient
42:39that her chances of fertility
42:42are not being affected
42:43by her laparoscopic myomectomy.
42:46Thank you so much.
42:46And the next question I'm gonna send to Dr. Nadia.
42:49For women who have PCOS,
42:52the AMH report shows higher readings.
42:55What tests can we do
42:56to understand the accurate ovarian reserve?
43:04Accurate ovarian reserve,
43:06my opinion is we do ultrasound is the easiest way.
43:09So we do vaginal ultrasound
43:10and we see the follicles.
43:13And then we see how many follicles we have
43:15in the right side and left side.
43:17And EFC is the name,
43:19so arterial follicle count.
43:22And so then we have an idea.
43:24The other test is anti-malarial hormone.
43:27This hormone is produced from small,
43:30for the X.
43:31And then if we have AMH is high,
43:35this hormone is high.
43:36So indirectly we expect to have more X.
43:40It's an indirect test.
43:43I prefer to do both.
43:46But if the patient is cash payer,
43:48so ultrasound may be enough
43:51to see how is the ovarian reserve.
43:54PCOS is a syndrome,
43:56so polycystic ovarian syndrome.
43:59So it's like a symptoms that we,
44:03for the definition,
44:03there's symptoms that we have to see
44:07and then we know there's PCOS.
44:09One of them is the morphology of the ovaries.
44:12So if we do ultrasound,
44:13we see this morphology that we have
44:14more than 10 follicle per side
44:16and they are like,
44:19they are small.
44:20And the other thing is,
44:23the second point is,
44:27if we have hyper-androgenemia,
44:30so it means a lot of testosterone
44:33and the male hormone in the blood,
44:35you can see the blood results.
44:38Or we can see the patient in the face,
44:40for example, she has acne,
44:41or she has a lot of loss of hair
44:46and she has hair in the face.
44:49So then we can,
44:50if two of these three parameters are there,
44:56we discuss our PCOS.
44:58Okay, thank you so much.
44:59Dr. Prashant, this one is for you.
45:01What should you do
45:03if your HCG level is low during pregnancy?
45:09Yeah, so HCG is one of the hormone
45:15which we measure in the early pregnancy.
45:18So it varies from
45:20depending upon the duration of pregnancy.
45:22In the early weeks of pregnancy,
45:24we expect it to be low
45:25and in a normal pregnancy,
45:28the hormone level usually doubles
45:30in a matter of two days.
45:32It is indirectly an indication to say
45:34that the pregnancy is going the normal way.
45:37So suppose if it is not happening
45:40and the levels are not raising
45:42to the expected level,
45:44then we suspect there is some abnormal
45:47type of pregnancy.
45:49It could be the ectopic pregnancy.
45:51That means the pregnancy is not situated
45:54inside the womb.
45:55So it is outside the uterus.
45:58So it could be in the tube,
45:59it could be in the ovary.
46:01And these conditions can be really critical
46:04for the patient if it is undiagnosed.
46:06So one of the factors
46:08when the HCG levels are lower,
46:11it could indicate an abnormal pregnancy
46:14or a failed normal pregnancy,
46:16what we call it as a missed abortion
46:18or heading towards an abortion.
46:21So on the other side,
46:22if the HCG levels are extensively higher,
46:25that also suggests an abnormal pregnancy
46:27like molar pregnancy
46:29or it could be a normal pregnancy
46:32with twins or triplets.
46:33So beta-HCG is a hormone
46:36indicative of pregnancy.
46:38Depending upon the weeks of pregnancy
46:40or the duration,
46:41we have a reference range,
46:43a normal range.
46:44Anything below is considered as lower.
46:47Again, indicative of a failing pregnancy
46:49or an ectopic pregnancy.
46:51Higher, extremely higher,
46:53very high values also suggest
46:55some problem with the pregnancy.
46:58Okay, thank you very much, Dr. Prashant.
47:00And Dr. Royer,
47:01I'm going to come to you with this one.
47:03I'm 32 years old.
47:05I have dilated fallopian tubes
47:08and the doctor's advice
47:09is to remove or clip my tubes.
47:12I have endometriosis as well.
47:14Is removing the clips
47:16going to help for a successful IVF treatment or not?
47:25So basically they're saying
47:26they're 32 years old.
47:28They have dilated fallopian tubes.
47:32The doctor has advised
47:33to remove or clip the fallopian tubes.
47:37They've also got endometriosis,
47:39but they're asking
47:40if I have the clips
47:42and then remove them,
47:44can I have a successful IVF treatment?
47:48Actually, yeah.
47:49When we have like this dilated tube,
47:51like we call it hydrosalting.
47:53So normally this tube is filled
47:55with some fluid,
47:56which sometimes they are not healthy
48:00and like inflammation or anything.
48:04So this tube is connected to the uterus.
48:06So when we put the embryo inside the uterus
48:11during the IVF,
48:12it is faced to this,
48:14let's say dirty fluid.
48:15And so we prefer to lock
48:19and to cut the tube
48:22and separate it from uterus.
48:23So to make sure that inside the uterus,
48:26we have very clean
48:27and untouched environment
48:29and we can place the embryo.
48:33And not only that,
48:35normally because of this condition happens
48:39because of the like chlamydia infections
48:42or the other like infections,
48:44we prefer to do proper antibiotic therapy
48:46at least one month before going for the IVF
48:49to make sure that we have very healthy
48:52and clean endometrium.
48:54And then we go and do IVF
48:55and we put the embryo inside
48:57and to make sure that the implantation will happen.
49:01So they can try,
49:03like let's say they can try
49:04one time embryo transfer
49:07even without doing it,
49:09without doing the surgery.
49:10If it doesn't happen,
49:11they can go and do surgery.
49:12But what is recommended
49:14is to do it before
49:17even the first trial of IVF
49:19to make sure that the success rate will be higher.
49:22Okay.
49:23Thank you very much, Dr. Roya.
49:25Dr. Nadia, I'm going to come to you for this one.
49:28I'm approaching 40.
49:29I haven't been able to conceive with fibroids.
49:33What is the lowest risk fibroid procedure
49:36to embark on that offers
49:38or leaves the greatest chance of conception?
49:43You are 40.
49:44So if you are 40,
49:46we have to think about the ovarian reserve
49:49and of the chance of the pregnancy.
49:51And about the fibroids,
49:53again, where is this fibroid?
49:57How big is the fibroid?
49:58How many fibroids do we have?
50:00Because here it is a little bit tricky.
50:04So the lady, she has ovarian reserve
50:07perhaps it's not very high.
50:08And the chance is perhaps not as high
50:11as if you are less than 40
50:13and the operation has risk.
50:15If we have big fibroids
50:18of, for example, more than three centimeters
50:20and we have more than three,
50:21so it's recommended
50:23if you have good ovarian reserve
50:24to go for operation.
50:26Which kind of operation we have?
50:28We could be,
50:30if the fibroid is very, very big,
50:33so it will be laparotomy.
50:35But normally we try to do it per laparoscopy
50:38if the fibroid is not as big.
50:41It was very big.
50:42And if the fibroid sometimes is very, very small,
50:45but it is in the cavity,
50:47it's mean if in the wall
50:49and in the middle of the lining,
50:51here it has to be removed per hysteroscopy.
50:56Thank you so much, Dr. Nadia.
50:58Dr. Ahmed, nice to have you back.
51:00And I've got one for you.
51:01And there's two questions here
51:03kind of along the same lines.
51:06Heartbreaking actually.
51:07I've been married four years.
51:08I've had one miscarriage.
51:10I'm 28 years old.
51:12I failed one IUI and three failed IVF trials.
51:17What do I do next?
51:22We need to know more information.
51:24For example, how her ovarian reserve is,
51:27how her husband's semen parameters is,
51:30and how the uterus looks.
51:32Has she had any workup done or not?
51:36She meets the definition
51:37for recurrent implantation failure.
51:39But for me to be able
51:40to answer this question accurately,
51:43I need to know what she was told,
51:45why it failed.
51:48Was there a cause or wasn't there a cause?
51:51Were the embryos good?
51:53Was the lining good?
51:54Did she have genetic testing done?
51:56Did she have a hysteroscopy done?
51:58It's difficult to advise her what to do
52:01without knowing the full history.
52:04So let's assume she has what we refer to
52:07as unexplained recurrent implantation failure,
52:11where she's put at least three or four embryos
52:15back during those three cycles.
52:17They're all very good quality.
52:18The lining is very good quality.
52:20She's had genetic testing done
52:22prior to embryo transfer,
52:25and she still had a failure.
52:27Now she needs to have,
52:28there's certain measures we do for these patients.
52:32For example, we can do diagnostic hysteroscopy
52:35with endometrial scratching.
52:37This should help increase her chances of implantation.
52:43We can give her low molecular weight heparin
52:46after transfer.
52:47This has been shown in people
52:49with unexplained recurrent implantation failure
52:53to be beneficial.
52:55It's really difficult for me to answer this question
52:58without having the full picture.
53:00I would advise this couple to visit a fertility clinic
53:05to get a second opinion or something
53:08because I really can't be of real help
53:12if I don't know the full history.
53:16Okay, thank you.
53:16But these are all the steps they need to go through
53:19to go and find out what's going on.
53:22So it is a great help.
53:24This one is going to Dr. Huda.
53:27We've got a question here that says,
53:28is pregnancy after one miscarriage considered high risk?
53:33And what extra care should I be taking?
53:37Well, one miscarriage is not a warning thing.
53:42The chances of miscarriage in the general population
53:45are around 15 to 20%.
53:47So I'm saying, what I'm saying,
53:49maybe five to six patients get pregnant,
53:51one of them will miscarry.
53:53So to have one miscarriage is,
53:56it can be just bad luck.
53:57So I would want to reassure her,
54:00and let's try again.
54:02Usually she can't be unlucky twice.
54:05But if, God forbid, three miscarriages happen,
54:10then yes, that would be a high risk pregnancy.
54:12You have to check some antibodies in the blood
54:16and do some other tests.
54:18And obviously we are going to start here
54:20with some medications like aspirin
54:22and some injections to thin the blood,
54:24to increase the blood going to the baby.
54:26But one miscarriage, I can reassure her,
54:29I really advise her to try for a pregnancy again.
54:34Thank you very much, Dr. Huda on that.
54:36And I'm now going to look at the results
54:38for our final poll for today,
54:41which is, what's the common complication
54:44to watch out for during a normal pregnancy?
54:46And we asked you, was it gestational diabetes
54:49or gestational hypertension?
54:50And 67% of you think it's diabetes,
54:54and 33% think it's hypertension.
54:58So those are the three polls that we've had running today.
55:01So thank you all for your inputs on those.
55:04I'd like to say thank you so much
55:06to all our panelists today.
55:08It's been an absolutely fantastic session.
55:11Very, very informative.
55:12Lots of amazing questions from all of you as well.
55:15And unfortunately, that is all the time we have for today.
55:19And let me remind you that all the information
55:21you need on our speakers and their clinics and hospitals
55:24can be found using the speakers and booths links
55:27to the top left of your screen.
55:30And if you'd like to read more about today's topic,
55:32we'll have a follow-up story.
55:34So keep an eye out for that on gulfnews.com.
55:37I'd like to thank all our speakers for their time today.
55:40Very, very informative, fascinating stuff.
55:42But make sure you do get in touch with them
55:44if you need more information.
55:46Thank you to all of you.
55:48It's been an absolute pleasure having you.
55:50And we'd like to thank you, dear viewers,
55:52for joining us as well.
55:53And until the next webinar,
55:55we'd like to say goodbye for now.