This is a simple review from the latest issue of Human Reproduction. Despite at odd with NICE Guidelines, it is worth reading. Selective scanning is still indicated in potential difficult embryo transfer to avoid excessive truma to the cervix and emdometrium which may have negative impact to the outcome. Majority of patient require reassurance during embryo transfer which can be an additional advantage of scanning.
Dr Suhaimi Hassan
Human Reproduction 2008;23:1101-6
Testing whether using abdominal ultrasound at the time of embryo transfer to guide replacement improves pregnancy rates by at least 5 percent.
MedWire News: Study findings indicate that abdominal ultrasound to guide embryo transfer does not improve pregnancy or live birth rates.
"This outcome is at odds with the UK's National Institute for Clinical Excellence (NICE) recommendations for fertility treatment," Andrew Drakeley (Liverpool Women's Hospital NHS Foundation Trust, UK) and colleagues note.
The NICE recommendation was based on pooled data fro 2051 women, whereas the current study involved 2295 women.
The women, all of whom underwent IVF or ICSI, were randomly assigned to ultrasound-guided embryo transfer (n=1142) or normal transfer.
The researchers found no significant difference in clinical pregnancy or live birth rates between the two groups. The clinical pregnancy rate was 22 percent with ultrasound-guided transfer and 23 percent for normal transfer. And the live birth rates were 20 percent and 21 percent, respectively.
The researchers call for the current Cochrane review on the use of ultrasound in embryo transfer to be updated using this data.
They comment: "By insisting on abdominal ultrasound-guided embryo transfers, assisted conception clinics would have to purchase abdominal probes and have a machine available, plus a practitioner experienced in abdominal ultrasound present for the embryo transfer, allowing additional time for the ultrasound component of the procedure.
"This all adds to the cost of the treatment cycle and is usually passed onto the patient or funding body."
Wednesday, April 30, 2008
Sunday, April 13, 2008
Kehamilan Bagi Wanita Berumur
Dr Suhaimi Hassan
Setiap tahun di UK terdapat 12000 wanita hamil apabila berumur lebih dari 40 tahun. Jika mereka sudah berumur tetapi sihat, maka tidak ada sebab mengapa mereka tidak boleh menjadi hamil. Tetapi perlu dingat bahawa komplikasi semasa hamil adalah tinggi jika wanita sudah berumur.
Kemungkinan menjadi hamil adalah berkurangan jika wanita berumur lebih dari 40 tahun. Ini adalah disebabkan telur-telur yang terdapat di ovari adalah berkurangan dan punyai kualiti yang menurun.
Data data kejayaan kehamilan dari HFEA, UK dari tahun 1991-2004 bagi wanita yang alami rawatan IVF apabila berumur lebih dari 40 tahun adalah seperti berikut:
Umur Wanita/Kadar Lahir hidup (Live birth rate)
40 tahun 10.2%
41 tahun 7.8%
42 tahun 5.7%
43 tahun 3.8%
44 tahun 2.5%
45 tahun 1.9%
Ini adalah data data dari UK dan anda perlu berbincang dengan doktor di klinik anda untuk mengetahui kadar tempatan.
Selain dari kemungkinan kehamilan yang rendah, wanita berumur juga mempunyai risiko kecacatan kromosom (chromosomal abnormalities). Kemungkinan mendapat kandungan Sindrom Down adalah seperti berikut.
Umur wanita/Kemungkinan Sindrom Down
35 tahun 1 dalam 365
40 tahun 1 dalam 100
45 tahun 1 dalam 30
Wanita golongan ini juga mempunyai kemungkinan kelahiran mati (stillborn) adalah tinggi. Keguguran juga mudah terjadi. Bagi mereka berumur 35-45 tahun kemungkinan keguguran adalah dalm lingkungan 20-35% dan mereka yang berumur lebih dari 45 tahun kemungkinan keguguran adalah 50%.
Semasa hamil wanita berumur juga mempunyai masalah perubatan seperti darah tinggi, diabetes, kandungan tidak cukup bulan, perdarahan selepas bersalin, thromboembolism dan kadar kematian 5 kali lebih ganda jika dibanding dengan wanita berumur bawah dari 40 tahun. Mereka juga berkemungkinan mengalami kelahiran secara Forcep atau Pembedahan Caesarean.
Wanita yang berumur, adalah baik berbincang dengan doktor jika anda ingin mencuba untuk menambahkan jumlah keluarga. Anda perlu faham akan risiko yang anda akan alami.
Setiap tahun di UK terdapat 12000 wanita hamil apabila berumur lebih dari 40 tahun. Jika mereka sudah berumur tetapi sihat, maka tidak ada sebab mengapa mereka tidak boleh menjadi hamil. Tetapi perlu dingat bahawa komplikasi semasa hamil adalah tinggi jika wanita sudah berumur.
Kemungkinan menjadi hamil adalah berkurangan jika wanita berumur lebih dari 40 tahun. Ini adalah disebabkan telur-telur yang terdapat di ovari adalah berkurangan dan punyai kualiti yang menurun.
Data data kejayaan kehamilan dari HFEA, UK dari tahun 1991-2004 bagi wanita yang alami rawatan IVF apabila berumur lebih dari 40 tahun adalah seperti berikut:
Umur Wanita/Kadar Lahir hidup (Live birth rate)
40 tahun 10.2%
41 tahun 7.8%
42 tahun 5.7%
43 tahun 3.8%
44 tahun 2.5%
45 tahun 1.9%
Ini adalah data data dari UK dan anda perlu berbincang dengan doktor di klinik anda untuk mengetahui kadar tempatan.
Selain dari kemungkinan kehamilan yang rendah, wanita berumur juga mempunyai risiko kecacatan kromosom (chromosomal abnormalities). Kemungkinan mendapat kandungan Sindrom Down adalah seperti berikut.
Umur wanita/Kemungkinan Sindrom Down
35 tahun 1 dalam 365
40 tahun 1 dalam 100
45 tahun 1 dalam 30
Wanita golongan ini juga mempunyai kemungkinan kelahiran mati (stillborn) adalah tinggi. Keguguran juga mudah terjadi. Bagi mereka berumur 35-45 tahun kemungkinan keguguran adalah dalm lingkungan 20-35% dan mereka yang berumur lebih dari 45 tahun kemungkinan keguguran adalah 50%.
Semasa hamil wanita berumur juga mempunyai masalah perubatan seperti darah tinggi, diabetes, kandungan tidak cukup bulan, perdarahan selepas bersalin, thromboembolism dan kadar kematian 5 kali lebih ganda jika dibanding dengan wanita berumur bawah dari 40 tahun. Mereka juga berkemungkinan mengalami kelahiran secara Forcep atau Pembedahan Caesarean.
Wanita yang berumur, adalah baik berbincang dengan doktor jika anda ingin mencuba untuk menambahkan jumlah keluarga. Anda perlu faham akan risiko yang anda akan alami.
Sunday, April 6, 2008
Kandungan Berbilang-Latar belakang dan statistik
Dr Suhaimi Hassan
Berikut adalah statistik yang anda perlu tahu mengenai kandungan berbilang yang terdapat pada pasangan pasangan yang telah menjalani rawatan IVF di UK. Risiko ini terjadi bila 2 embrio di pindahkan kedalam rahim bagi mereka yang berumur 39 tahun kebawah dan pemindahan 3 embrio bagi mereka berumur 40 tahun keatas. Peratusan ini akan meningkat jika lebih dari 3 embrio dipindahkan kedalam rahim.
THE SCALE OF MULTIPLE BIRTHS
- 1 in 80 births following natural conception in the UK are multiples
- 1 in 4 births after IVF in the UK result in either twins or triplets
- 40% of IVF babies are twins
The numbers of multiple babies has risen significantly:
• In 1995 just over 2600 IVF babies were born as part of a multiple birth
• In 2003 more than 3700 IVF babies were born as part of a multiple birth – a rise of more than 41%
Fertility treatment is thought to be the main factor behind the increasing number of babies born as multiples in the UK
• In 1978, 11941 babies were born as part of a multiple birth
• In 2003, 18395 babies were born as part of a multiple birth
RISKS
126 IVF babies die each year as a consequence of having been born in a multiple birth, of these
51 are stillbirths
42 are deaths in the first week of life
33 are deaths later in the first year of life
these figures do not include miscarriage or fetal reduction
Risk for twins babies
Proportion born prematurely with low birthweight 50%
Death in the first week of life 5x higher
Cerebral palsy 4x higher
pre-eclampsia (for mothers) 3x higher
(The above figures are in comparison to singleton births. In triplets the risk increases by 90%, 9X, 18X and 9X higher respectively)
Identical twins have a significantly increased risk of congenital abnormalities
Risk for mothers with multiple compared to singleton:
-pre-eclampsia 3x higher
-diabetes 2 – 3x higher
-coronary heart disease 2x higher
death from cardiovascular causes 7 – 11x higher
Risk of death, although low, is doubled for women expecting
twins
-Up to 25% of women carrying more than one baby suffer from
pregnancy induced high blood pressure and are 2-3 times more
likely to get diabetes
Sources:
1)HFEA Register
2)Sattar N & Greer I BMJ 2002: 3255 pg 157-160
3)Oakley L & Doyle P, London School of Hygiene and Tropical
Medicine
Berikut adalah statistik yang anda perlu tahu mengenai kandungan berbilang yang terdapat pada pasangan pasangan yang telah menjalani rawatan IVF di UK. Risiko ini terjadi bila 2 embrio di pindahkan kedalam rahim bagi mereka yang berumur 39 tahun kebawah dan pemindahan 3 embrio bagi mereka berumur 40 tahun keatas. Peratusan ini akan meningkat jika lebih dari 3 embrio dipindahkan kedalam rahim.
THE SCALE OF MULTIPLE BIRTHS
- 1 in 80 births following natural conception in the UK are multiples
- 1 in 4 births after IVF in the UK result in either twins or triplets
- 40% of IVF babies are twins
The numbers of multiple babies has risen significantly:
• In 1995 just over 2600 IVF babies were born as part of a multiple birth
• In 2003 more than 3700 IVF babies were born as part of a multiple birth – a rise of more than 41%
Fertility treatment is thought to be the main factor behind the increasing number of babies born as multiples in the UK
• In 1978, 11941 babies were born as part of a multiple birth
• In 2003, 18395 babies were born as part of a multiple birth
RISKS
126 IVF babies die each year as a consequence of having been born in a multiple birth, of these
51 are stillbirths
42 are deaths in the first week of life
33 are deaths later in the first year of life
these figures do not include miscarriage or fetal reduction
Risk for twins babies
Proportion born prematurely with low birthweight 50%
Death in the first week of life 5x higher
Cerebral palsy 4x higher
pre-eclampsia (for mothers) 3x higher
(The above figures are in comparison to singleton births. In triplets the risk increases by 90%, 9X, 18X and 9X higher respectively)
Identical twins have a significantly increased risk of congenital abnormalities
Risk for mothers with multiple compared to singleton:
-pre-eclampsia 3x higher
-diabetes 2 – 3x higher
-coronary heart disease 2x higher
death from cardiovascular causes 7 – 11x higher
Risk of death, although low, is doubled for women expecting
twins
-Up to 25% of women carrying more than one baby suffer from
pregnancy induced high blood pressure and are 2-3 times more
likely to get diabetes
Sources:
1)HFEA Register
2)Sattar N & Greer I BMJ 2002: 3255 pg 157-160
3)Oakley L & Doyle P, London School of Hygiene and Tropical
Medicine
Saturday, March 22, 2008
Rawatan PGD Untuk Pembawa Thalassaemia
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Thalassaemia adalah penyakit kecacatan darah. Thalassaemia merupakan keadaan yang diwarisi, iaitu diwariskan dari keluarga kepada anak. Akibat kecacatan gene pada kromosom, haemoglobin pada sel darah merah menjadi tidak normal. Mereka yang mempunyai penyakit Thalassaemia tidak dapat menghasilkan haemoglobin yang mencukupi dalam darah mereka.
Haemoglobin adalah bahagian sel darah merah yang mengangkut oksigen daripada paru-paru keseluruh tubuh. Semua tisu tubuh manusia memerlukan oksigen. Akibat kekurangan sel darah merah yang normal akan menyebabkan pesakit kelihatan pucat kerana paras haemoglobin (Hb) normal yang rendah dipanggil anemia.
Sel darah merah bertugas membekalkan oksijen kepada tisu dalam badan manusia. Kekurangan sel darah merah bagi membekalkan oksijen akang mengakibatkan pesakit thalassaemia berasa lesu, tidak bermaya, dan mungkin sesak nafas sekiranya paras hemoglobin semakin menurun.
Terdapat dua jenis talasemia iaitu:
Thalassaemia minor : Thalassaemia minor merujuk kepada mereka yang mempunyai kecacatan gene thalassaemia tetapi tidak menunjukkan tanda-tanda thalassaemia atau pembawa.
Thalassaemia major : Thalassaemia major merujuk kepada mereka yang mempunyai baka thalassaemia sepenuhnya dan menunjukkan tanda-tanda thalassaemia.
Kita mempunyai gene yang berpasangan ia itu sejumlah 23 pasangan gene didalam sel tubuh kita. Setiap satu dari pasangan gene tesebut datang dari ibu dan bapa kita. Apabila kita mempunyai anak, gene dari pasangan suami dan isteri akan diturunkan kepada anak anak untuk mengembalikan semula gene kita kepada 23 pasangan. Gene-gene ini terdapat didalam semua sel kita dan ia memberi kod-kod tertentu pada kita termasuk sifat-sifat seperti warna kulit dan sebagainya. Ia juga boleh menentukan penyakit penyakit seperti thalassaemia.
Sekiranya salah seorang ibu atau bapa adalah pembawa, keadaan berikut boleh berlaku.
Peratusan risiko untuk setiap kehamilan;
— 50% kemungkinan adalah pembawa
— 50% kemungkinan adalah normal
— Tiada anak yang menghidap thalassaemia(thalassaemia major)
Sekiranya kedua-dua ibu dan bapa adalah pembawa keadaan berikut boleh berlaku;
— 25% kemungkinan anak mereka adalah pesakit talasemia
— 50% kemungkinan anak mereka adalah pembawa
— 25% kemungkinan anak mereka adalah normal
Biasanya anak-anak pembawa thalassaemia kelihatan normal sewaktu dilahirkan. Bagaimanapun, mereka akan mulai mengalami masalah anemia yang serius apabila mencapai usia di antara 13 hingga 18 bulan.
Saringan ujian darah untuk thalassaemia boleh dijalankan di semua klinik dan hospital, sama ada kerajaan atau swasta. Jalanilah ujian darah tersebut untuk mengetahui status penyakit anda. Jika kita didapati menjadi pembawa pada gene gene thalassaemia, maka jika kita punyai pasangan yang juga pembawa, kemungkinan mendapat anak thalassaemia adalah 25% (lihat risiko seperti diatas).
Jika ini terjadi pada anda, anda mempunyai pilihan:
1) Meneruskan kandungan dan menerima apa sahaja anak yang anda perolehi.
2) Melakukan ujian kordosentesis pada peringkat awal kandungan. Ujian ini melibatkan pengambilan sel sel korion (sel uri peringkat awal) dengan mengunakan jarum halus. Jika kandungan punyai penyakit thalassaemia, maka proses keguguran boleh dilakukan. Proses ini mungkin tidak sesuai atau tidak boleh diterima oleh setengah golongan masyarakat.
3)Proses Pre-Implantation Genetic Diagnosis (sila lihat artikel lepas). Proses ini mungkin dapat diterima kerana ia tidak melibatkan pengguguran kandungan.
Di Malaysia terdapat 14000 pesakit thalassaemia (sumber Kementerian Kesihatan). Jika pasangan punyai sejarah keluarga yang berkemungkinan punyai thalassaemia, mereka sepatutnya digalakan untuk melakukan ujian saringan untuk memastikan status pembawa penyakit.Saturday, March 15, 2008
(FOR DOCTORS) Consensus On Fertility Treatment & PCOS
An international panel of specialists has produced a consensus report on fertility treatment related to polycystic ovarian syndrome (PCOS).
The report was drawn up following a 2-day meeting held in March 2007 in Thessaloniki, Greece, at which specialists reviewed and discussed published data with the aim of reaching agreement regarding the management of women with infertility and PCOS.
The meeting was sponsored by the European Society for Human Reproduction and Embryology (ESHRE), the American Society for Reproductive Medicine (ASRM), and pharmaceutical developer Organon.
The consensus report, published in the latest issue of the journal Fertility and Sterility, consists of seven sections covering: lifestyle modification, clomiphene citrate, insulin-sensitizing agents, gonadotropins/GnRH analogues, laparoscopic ovarian surgery, IVF, and ovulation induction/homologous artificial insemination. Each of these sections ends with a number of practical summary points.
The report then ends with a series of overall conclusions. These include the following:
1.Evaluation of women with presumed PCOS desiring pregnancy should exclude any other health issues in the woman or infertility problems in the couple.
2.Preconceptional counseling emphasizing the importance of lifestyle, “especially weight reduction and exercise in overweight women, smoking, and alcohol consumption,” should be provided before any intervention is initiated, the report states.
3.The recommended first-line treatment for ovulation induction remains the anti-estrogen clomiphene citrate (CC).
4.Recommended second-line intervention should CC fail to result in pregnancy is either exogenous gonadotropins or laparoscopic ovarian surgery (LOS). It is pointed out that both have clear advantages and disadvantages, and that the choice must be made on an individual basis.
5.Recommended third-line treatment is IVF because this treatment is effective in women with PCOS. More data on the use of single-embryo transfer in women with PCOS undergoing IVF are awaited, the report states.
The report also identifies a clear need for the development of more patient-tailored approaches for ovulation induction, based on the initial screening characteristics of women with PCOS. It could be that, in certain well-defined subsets of patients, the first-, second-, and third-line treatment recommendations (above) would not apply.
Other conclusions are that the use of metformin in PCOS should be confined to women with glucose intolerance, and that routine use of metformin in ovulation induction is not recommended. In addition, there is currently insufficient evidence to recommend the use of aromatase inhibitors in routine ovulation induction.
The final overall conclusion states: “Even singleton pregnancies in PCOS are associated with increased health risks for both the mother and the fetus.”
Note:
I would also recommend you to read another article by Murizah Mohd Zain et al (Fertility Sterility 2008) from The Adelaide University School of Reproductive Health on the importance of clomiphene as the first line of treatment.
The group assigned 115 newly diagnosed women with PCOS who were naïve to treatment to three groups.
Group 1 received 500 mg of metformin three times a day
Group 2 received CC at an incremental dose
Group 3 received both medications.
The Group reported that ovulation rates with metformin treatment of 23.7 percent, compared with 59.0 percent with CC group, and 68.4 percent with metformin and CC combined. Significant differences were seen between CC and metformin treatment and between combination and metformin treatment, but not between CC and combination treatment.
Ovulation induction led to pregnancy rates that were higher with combined therapy and CC than with metformin, at 21.1 percent and 15.4 percent versus 7.9 percent, respectively.
This led to respective live birth rates of 18.4 percent and 15.4 percent versus 7.9 percent. The group noted that the differences among the three groups in pregnancy and live birth rates did not reach statistical significance.
However the study demonstrated that CC is superior to metformin in inducing ovulation in anovulatory women with PCOS. Adding metformin to CC does not significantly increase the ovulation, pregnancy, and live birth rate.
The report was drawn up following a 2-day meeting held in March 2007 in Thessaloniki, Greece, at which specialists reviewed and discussed published data with the aim of reaching agreement regarding the management of women with infertility and PCOS.
The meeting was sponsored by the European Society for Human Reproduction and Embryology (ESHRE), the American Society for Reproductive Medicine (ASRM), and pharmaceutical developer Organon.
The consensus report, published in the latest issue of the journal Fertility and Sterility, consists of seven sections covering: lifestyle modification, clomiphene citrate, insulin-sensitizing agents, gonadotropins/GnRH analogues, laparoscopic ovarian surgery, IVF, and ovulation induction/homologous artificial insemination. Each of these sections ends with a number of practical summary points.
The report then ends with a series of overall conclusions. These include the following:
1.Evaluation of women with presumed PCOS desiring pregnancy should exclude any other health issues in the woman or infertility problems in the couple.
2.Preconceptional counseling emphasizing the importance of lifestyle, “especially weight reduction and exercise in overweight women, smoking, and alcohol consumption,” should be provided before any intervention is initiated, the report states.
3.The recommended first-line treatment for ovulation induction remains the anti-estrogen clomiphene citrate (CC).
4.Recommended second-line intervention should CC fail to result in pregnancy is either exogenous gonadotropins or laparoscopic ovarian surgery (LOS). It is pointed out that both have clear advantages and disadvantages, and that the choice must be made on an individual basis.
5.Recommended third-line treatment is IVF because this treatment is effective in women with PCOS. More data on the use of single-embryo transfer in women with PCOS undergoing IVF are awaited, the report states.
The report also identifies a clear need for the development of more patient-tailored approaches for ovulation induction, based on the initial screening characteristics of women with PCOS. It could be that, in certain well-defined subsets of patients, the first-, second-, and third-line treatment recommendations (above) would not apply.
Other conclusions are that the use of metformin in PCOS should be confined to women with glucose intolerance, and that routine use of metformin in ovulation induction is not recommended. In addition, there is currently insufficient evidence to recommend the use of aromatase inhibitors in routine ovulation induction.
The final overall conclusion states: “Even singleton pregnancies in PCOS are associated with increased health risks for both the mother and the fetus.”
Note:
I would also recommend you to read another article by Murizah Mohd Zain et al (Fertility Sterility 2008) from The Adelaide University School of Reproductive Health on the importance of clomiphene as the first line of treatment.
The group assigned 115 newly diagnosed women with PCOS who were naïve to treatment to three groups.
Group 1 received 500 mg of metformin three times a day
Group 2 received CC at an incremental dose
Group 3 received both medications.
The Group reported that ovulation rates with metformin treatment of 23.7 percent, compared with 59.0 percent with CC group, and 68.4 percent with metformin and CC combined. Significant differences were seen between CC and metformin treatment and between combination and metformin treatment, but not between CC and combination treatment.
Ovulation induction led to pregnancy rates that were higher with combined therapy and CC than with metformin, at 21.1 percent and 15.4 percent versus 7.9 percent, respectively.
This led to respective live birth rates of 18.4 percent and 15.4 percent versus 7.9 percent. The group noted that the differences among the three groups in pregnancy and live birth rates did not reach statistical significance.
However the study demonstrated that CC is superior to metformin in inducing ovulation in anovulatory women with PCOS. Adding metformin to CC does not significantly increase the ovulation, pregnancy, and live birth rate.
Sunday, March 2, 2008
Memilih Jantina Anak Anda!!!
Dr Suhaimi Hassan
Secara statistik, kemungkinan mempunyai anak lelaki atau perempuan dalam kandungan adalah dalam kadar 50%. Tetapi secara praktik, terdapat 102 hingga 106 anak lelaki yang dilahirkan bagi setiap 100 anak perempuan. Tidak pula diketahui sebabnya kenapa lebih anak lelaki yang dilahirkan dari anak perempuan?
Buat masa ini terdapat ujian ujian perubatan yang hampir tepat yang boleh memberi peluang kepada pasangan menentukan jantina didalam kandungan. Bagaimanapun memilih jantina boleh mengundang kontroversi terutama jika ia tidak punyai kaitan dengan isu perubatan. Pemilihan jantina seperti ini adalah disebabkan faktor faktor seperti
-keinginan mempunyai keseimbangan anak anak perempuan dan lelaki dalam keluarga yang di panggil ‘family balancing’
-keinginan mendapat anak dari jantina yang sama akibat kematian anak kesayangan
-akibat masalah sosio-budaya dan ekonomi dimana anak dari satu jantina dianggap lebih penting.
Pemilihan jantina tanpa sebab sebab perubatan boleh juga menyebabkan perubahan pada demografik kependudukan sesebuah negara. Jika pemilihan jantina tidak dibataskan akibatnya satu jantina akan melebehi dari satu jantina yang lain. Ini berkemungkinan akan mengakibatkan masalah sosial dan ekonomi pada masa akan datang walaupun ia belum lagi dibuktikan.
Kebanyakan negara seperti di UK dan banyak negara di Eropah tidak membenarkan pemilihan jantina dilakukan tanpa sebab sebab perubatan. Malaysia boleh juga mengambil langkah yang sama dengan pengharaman pemilihan jantina jika tidak mempunyai sebab sebab kesihatan. Bagaimanapun di Amerika Syarikat dan Eropah Timur prosedur ini boleh dilakukan.
Pemilihan jantina boleh dilakukan jika ia punyai sebab sebab perubatan. Terdapat banyak penyakit penyakit keturunan seperti Haemophilia dan Duchene Muscular Dystrophy yang mana hanya terjadi pada anak lelaki. Anak anak peremuan dari pasangan yang punyai penyakit keturunan ini adalah normal atau hanya menjadi pembawa penyakit, tetapi adalah sihat. Sudah pastilah pasangan yang mempunyai penyakit keturunan seperti ini inginkan anak perempuan untuk mengelakkan dari mendapat penyakit.
Jantina kandungn ditentukan semasa proses fertilisasi berlaku antara sperma dengan telur. Sperma mempunyai kromosom X atau Y dan semasa fertilisasi dengan telur, yang mempunyai kromosom X, proses fertilisasi ini akan menghasilkan samada embrio lelaki (XY) atau perempuan (XX).
Terdapat beberapa teknik perubatan dapat dilakukan untuk memilih jantina.
1)Teknik Ericsson
Teknik ini sangat mudah dan melibatkan proses centrifugation dimana sperma sperma X di asingkan dengan sperma Y. Sperma yang telah dipisahkan mengikut kromosom X atau Y akan dimasukan kedalam rahim melalui kaedah permanian hadas atau Intra Uterine Insemination (IUI). Keberkesanan teknik ini dilapurkan dari 0% hingga ke 60% kejayan dalam menentukan jantina.
2)Microsort (http://www.microsort.net/)
Teknik ini masih dalam kajian di Amerika dan merupakan modifikasi dari Teknik Ericcson. Ia melibatkan analisa sperma melaui teknologi DNA dimana Sperma X dipisahkan dari Sperma Y. Sperma yang dipisahkan akan difertilisasikan melalui kaedah IVF/ICSI. Teknik ini dapat meningkatkan Sperma X sehingga 88% didalam suatu sampel sperma dan sehingga 73% bagi Sperma Y.
3)Proses Pre-implantation Genetic Diagnosis (Sila lihat Artikel Yang Lepas)
Proses ini adalah lebih tepat didalam menentukan kejayaan dalam penentuan jantina.
Kebanyakan Pakar Perubatan tidak mengalakkan pemilihan jantina kerana mengangapnya tidak beretika. Kaedah ini hanya sesuai untuk mengelakkan dari penyakit keturunan.
Secara statistik, kemungkinan mempunyai anak lelaki atau perempuan dalam kandungan adalah dalam kadar 50%. Tetapi secara praktik, terdapat 102 hingga 106 anak lelaki yang dilahirkan bagi setiap 100 anak perempuan. Tidak pula diketahui sebabnya kenapa lebih anak lelaki yang dilahirkan dari anak perempuan?
Buat masa ini terdapat ujian ujian perubatan yang hampir tepat yang boleh memberi peluang kepada pasangan menentukan jantina didalam kandungan. Bagaimanapun memilih jantina boleh mengundang kontroversi terutama jika ia tidak punyai kaitan dengan isu perubatan. Pemilihan jantina seperti ini adalah disebabkan faktor faktor seperti
-keinginan mempunyai keseimbangan anak anak perempuan dan lelaki dalam keluarga yang di panggil ‘family balancing’
-keinginan mendapat anak dari jantina yang sama akibat kematian anak kesayangan
-akibat masalah sosio-budaya dan ekonomi dimana anak dari satu jantina dianggap lebih penting.
Pemilihan jantina tanpa sebab sebab perubatan boleh juga menyebabkan perubahan pada demografik kependudukan sesebuah negara. Jika pemilihan jantina tidak dibataskan akibatnya satu jantina akan melebehi dari satu jantina yang lain. Ini berkemungkinan akan mengakibatkan masalah sosial dan ekonomi pada masa akan datang walaupun ia belum lagi dibuktikan.
Kebanyakan negara seperti di UK dan banyak negara di Eropah tidak membenarkan pemilihan jantina dilakukan tanpa sebab sebab perubatan. Malaysia boleh juga mengambil langkah yang sama dengan pengharaman pemilihan jantina jika tidak mempunyai sebab sebab kesihatan. Bagaimanapun di Amerika Syarikat dan Eropah Timur prosedur ini boleh dilakukan.
Pemilihan jantina boleh dilakukan jika ia punyai sebab sebab perubatan. Terdapat banyak penyakit penyakit keturunan seperti Haemophilia dan Duchene Muscular Dystrophy yang mana hanya terjadi pada anak lelaki. Anak anak peremuan dari pasangan yang punyai penyakit keturunan ini adalah normal atau hanya menjadi pembawa penyakit, tetapi adalah sihat. Sudah pastilah pasangan yang mempunyai penyakit keturunan seperti ini inginkan anak perempuan untuk mengelakkan dari mendapat penyakit.
Jantina kandungn ditentukan semasa proses fertilisasi berlaku antara sperma dengan telur. Sperma mempunyai kromosom X atau Y dan semasa fertilisasi dengan telur, yang mempunyai kromosom X, proses fertilisasi ini akan menghasilkan samada embrio lelaki (XY) atau perempuan (XX).
Terdapat beberapa teknik perubatan dapat dilakukan untuk memilih jantina.
1)Teknik Ericsson
Teknik ini sangat mudah dan melibatkan proses centrifugation dimana sperma sperma X di asingkan dengan sperma Y. Sperma yang telah dipisahkan mengikut kromosom X atau Y akan dimasukan kedalam rahim melalui kaedah permanian hadas atau Intra Uterine Insemination (IUI). Keberkesanan teknik ini dilapurkan dari 0% hingga ke 60% kejayan dalam menentukan jantina.
2)Microsort (http://www.microsort.net/)
Teknik ini masih dalam kajian di Amerika dan merupakan modifikasi dari Teknik Ericcson. Ia melibatkan analisa sperma melaui teknologi DNA dimana Sperma X dipisahkan dari Sperma Y. Sperma yang dipisahkan akan difertilisasikan melalui kaedah IVF/ICSI. Teknik ini dapat meningkatkan Sperma X sehingga 88% didalam suatu sampel sperma dan sehingga 73% bagi Sperma Y.
3)Proses Pre-implantation Genetic Diagnosis (Sila lihat Artikel Yang Lepas)
Proses ini adalah lebih tepat didalam menentukan kejayaan dalam penentuan jantina.
Kebanyakan Pakar Perubatan tidak mengalakkan pemilihan jantina kerana mengangapnya tidak beretika. Kaedah ini hanya sesuai untuk mengelakkan dari penyakit keturunan.
Sunday, February 24, 2008
Pre-Implantation Genetic Diagnosis (PGD)
Dr Suhaimi Hassan
Salah satu 'myth' mengenai rawatan IVF adalah ianya hanya sesuai untuk pasangan yang mempunyai masalah ketidak suburan. Sebenarnya ianya juga sesuai untuk pasangan yang tidak mempunyai masalah ketidak suburan seperti mereka yang mempunyai masalah penyakit keturunan. (sila lihat dibawah antara penyakit yang telah dirawat dengan kaedah PGD)
Ada pasangan yang mempunyai penyakit keturunan atau pembawa penyakit keturunan seperti cystic fibrosis, thalassemia, haemophilia dan achondroplasia, yang boleh dibawa kepada zuriat. Akibatnya anak anak juga berkemungkinan akan mengidap penyakit sama seperti mereka.
Sebelum teknologi PGD bermula, salah satu cara untuk mengelakan penyakit keturunan yang boleh membawa maut pada zuriat ialah dengan mengelakkan dari mengandung. Satu lagi cara lain ialah dengan meneruskan kandungan sambil melakukan ujian amniosentesis atau chorionic villus sampling pada peringkat awal kandungan dari 11 hingga 16 minggu. Ujian ini melibatkan satu suntikan diperut yang bertujuan mengambil air mentuban atau mengambil sel sel chorion (sel-sel uri diperingkat awal). Sel sel tersebut akan dikulturkan sebelum dianalisakan dengan kaedah genetik untuk menentukan samada anak didalam kandungan sihat. Ujian ujian ini boleh menyebabkan keguguran(0.5%) pada kandungan apatah lagi jika kandungan itu adalah sihat. Jika keputusan ujian menunjukan bayi dalam kandungan mempunyai penyakit keturunan, maka ibu terpaksa mengugurkan kandungan. Ia boleh memberi kesan emosi yang teruk. Bagi masyarakat yang tidak boleh melakukan pengguran ia amat menyulitkan.
Kaedah PGD dilakukan sebelum implantasi embrio (kandungan) berlaku. Jadi ia dapat mengelakkan pasangan daripada melakukan penguguran dan dapat juga mengelakkan tekanan emosi akibat punyai kandungan abnormal.
Untuk pasangan melalui ujian PGD, mereka perlu melalui proses rawatan IVF walaupun mereka tidak punyai masalah ketidaksuburan. Proses ini melibatkan pasangan wanita menerima suntikan ubat untuk merangsang ovari menghasilkan telur telur yang matang. Telur yang matang akan disenyawakan dengan sperma untuk menghasilkan embrio dipiring kultur. Embrio yang terhasil akan mula membahagi kepada sel sel blastomere. Pada hari ketiga embrio dijangka punyai antara 5 hingga 10 sel sel blastomere.
Dalam proses PGD salah satu dari sel blasomere pada embrio akan diambil melalui satu proses manipulasi injeksi mikro yang rumit. Sel blastomere tersebut akan dianalisa melalui proses genetik. Dengan kaedah ini, embrio embrio yang normal dapat dikesan. Dua embrio yang normal boleh di pindahkan kedalam rahim untuk implantasi. Embrio selebihnya yang normal boleh dibekukan untuk kegunaan akan datang. Bagi embrio embrio yang punyai penyakit keturunan setelah diuji, ia tidak digunakan. Jadi penyakit keturunan dapat dielakkan
Ujian PGD juga punyai risiko tertentu. Proses mikromanupulasi embrio boleh merosakkan embrio yang diuji (0.5%). Kadang kadang embrio yang diuji tidak memberi apa apa signal genetik, maka embrio tersebut tidak sesuai diguna (5%). Kadang kadang diagnosa adalah tidak tetap. Sehingga kini terdapat 7 kes seluruh dunia yang dilapurkan dimana diagnosis genetik tidak tepat.
Kemungkinan berjaya dalam rawatan adalah dalam lingkunan 30%. Kejayaan rawatan PGD bergantung pada beberapa faktor seperti umur pasangan wanita serta faktor fertiliti.
Antara penyakit yang boleh dilakukan ujian PGD:
Achondroplasia
Alpha Thalassemia
Alzheimer (early onset)
Beta Thalassemia
Charcot Marie Tooth Neuropathy
Cystic Fibrosis
Duchenne Muscular Dystrophy
Familial Adenomatous Polyposis
Fanconi Anemia
Gaucher Disease
Haemophilia A & B
Neurofibromatosis
Osteogenis Imperfecta
Polycystic Kidney Disease
Sickle cell
Spinal Muscular Atrophy
Tay Sachs
Tuberous Sclerosis
Dan lain lain lagi (sehingga ini terdapat lebih dari 40 penyakit yang boleh diuji)
Salah satu 'myth' mengenai rawatan IVF adalah ianya hanya sesuai untuk pasangan yang mempunyai masalah ketidak suburan. Sebenarnya ianya juga sesuai untuk pasangan yang tidak mempunyai masalah ketidak suburan seperti mereka yang mempunyai masalah penyakit keturunan. (sila lihat dibawah antara penyakit yang telah dirawat dengan kaedah PGD)
Ada pasangan yang mempunyai penyakit keturunan atau pembawa penyakit keturunan seperti cystic fibrosis, thalassemia, haemophilia dan achondroplasia, yang boleh dibawa kepada zuriat. Akibatnya anak anak juga berkemungkinan akan mengidap penyakit sama seperti mereka.
Sebelum teknologi PGD bermula, salah satu cara untuk mengelakan penyakit keturunan yang boleh membawa maut pada zuriat ialah dengan mengelakkan dari mengandung. Satu lagi cara lain ialah dengan meneruskan kandungan sambil melakukan ujian amniosentesis atau chorionic villus sampling pada peringkat awal kandungan dari 11 hingga 16 minggu. Ujian ini melibatkan satu suntikan diperut yang bertujuan mengambil air mentuban atau mengambil sel sel chorion (sel-sel uri diperingkat awal). Sel sel tersebut akan dikulturkan sebelum dianalisakan dengan kaedah genetik untuk menentukan samada anak didalam kandungan sihat. Ujian ujian ini boleh menyebabkan keguguran(0.5%) pada kandungan apatah lagi jika kandungan itu adalah sihat. Jika keputusan ujian menunjukan bayi dalam kandungan mempunyai penyakit keturunan, maka ibu terpaksa mengugurkan kandungan. Ia boleh memberi kesan emosi yang teruk. Bagi masyarakat yang tidak boleh melakukan pengguran ia amat menyulitkan.
Kaedah PGD dilakukan sebelum implantasi embrio (kandungan) berlaku. Jadi ia dapat mengelakkan pasangan daripada melakukan penguguran dan dapat juga mengelakkan tekanan emosi akibat punyai kandungan abnormal.
Untuk pasangan melalui ujian PGD, mereka perlu melalui proses rawatan IVF walaupun mereka tidak punyai masalah ketidaksuburan. Proses ini melibatkan pasangan wanita menerima suntikan ubat untuk merangsang ovari menghasilkan telur telur yang matang. Telur yang matang akan disenyawakan dengan sperma untuk menghasilkan embrio dipiring kultur. Embrio yang terhasil akan mula membahagi kepada sel sel blastomere. Pada hari ketiga embrio dijangka punyai antara 5 hingga 10 sel sel blastomere.
Dalam proses PGD salah satu dari sel blasomere pada embrio akan diambil melalui satu proses manipulasi injeksi mikro yang rumit. Sel blastomere tersebut akan dianalisa melalui proses genetik. Dengan kaedah ini, embrio embrio yang normal dapat dikesan. Dua embrio yang normal boleh di pindahkan kedalam rahim untuk implantasi. Embrio selebihnya yang normal boleh dibekukan untuk kegunaan akan datang. Bagi embrio embrio yang punyai penyakit keturunan setelah diuji, ia tidak digunakan. Jadi penyakit keturunan dapat dielakkan
Ujian PGD juga punyai risiko tertentu. Proses mikromanupulasi embrio boleh merosakkan embrio yang diuji (0.5%). Kadang kadang embrio yang diuji tidak memberi apa apa signal genetik, maka embrio tersebut tidak sesuai diguna (5%). Kadang kadang diagnosa adalah tidak tetap. Sehingga kini terdapat 7 kes seluruh dunia yang dilapurkan dimana diagnosis genetik tidak tepat.
Kemungkinan berjaya dalam rawatan adalah dalam lingkunan 30%. Kejayaan rawatan PGD bergantung pada beberapa faktor seperti umur pasangan wanita serta faktor fertiliti.
Antara penyakit yang boleh dilakukan ujian PGD:
Achondroplasia
Alpha Thalassemia
Alzheimer (early onset)
Beta Thalassemia
Charcot Marie Tooth Neuropathy
Cystic Fibrosis
Duchenne Muscular Dystrophy
Familial Adenomatous Polyposis
Fanconi Anemia
Gaucher Disease
Haemophilia A & B
Neurofibromatosis
Osteogenis Imperfecta
Polycystic Kidney Disease
Sickle cell
Spinal Muscular Atrophy
Tay Sachs
Tuberous Sclerosis
Dan lain lain lagi (sehingga ini terdapat lebih dari 40 penyakit yang boleh diuji)
Friday, February 8, 2008
WHY MY MIRACLE BABY WAS THE BEST CHRISTMAS PRESENT EVER
The Evening Telegraph, Friday, April 6,2007
Tom and Elaine Musson met and married in just a few weeks but, though they found love swiftly, time was not on their side when it came to starting a family. In fact, Elaine, who was in her 40s, had given up hope, especially when fertility treatment hit problems. But miracles do happen, as Wendy Roberts discovered.
WHEN Tom and Elaine Musson swapped numbers in a crowded bar, they never envisaged planning their wedding nine weeks later.
But after a whirlwind romance, the pair set a date and exchanged marriage vows. Life was looking perfect for the couple. But it’s been even better since their baby son, Jacob Alexander Gabriel, was born on Christmas Day. “We weren’t looking for love and we’d certainly ruled out ever having children,” said 44-year-old Elaine. “Now we’re married and have a lovely baby boy. It’s absolutely amazing,” she smiled. “He came on Christmas Day. He was the greatest gift we could have received. “These last months have been wonderful for us and Jacob is the most beautiful, contented baby. He’s adorable.” Elaine and Tom Musson, 46, of Scaddows Cottage, Ticknall, still cannot believe how much their lives have changed in the last three years.
Just finding each other and falling in love, they say, is nothing short of a miracle. But they believe having Jacob is their biggest achievement – especially when you hear how they needed intricate fertility treatment to get him. “Our wedding day was very quiet,” said Elaine. “We invited eight of our friends to Burton Register Office, and enjoyed a simple ceremony. Afterwards, we went to a bar for champagne. It was lovely.” Elaine and Tom started to try for a baby but it wasn’t long before they realised something was wrong. “We tried getting pregnant for a few months, and then I started thinking about my ticking body clock,” said Elaine, a psychiatric nurse. “I went to see the doctor, who ran a few tests.” News that Elaine’s fallopian tubes were blocked came as a shock. Elaine underwent treatment to try to clear them.
She said: “At my age, we were told that we’d have to pay for any kind of fertility treatment, but we had savings.” But Elaine became pregnant straightaway – and naturally. “I was over the moon,” she said. “It was great news. I could hardly believe it.” Then disaster struck. At six Weeks pregnant, Elaine had a miscarriage. The couple decided to invest £6,000 in a course of fertility treatment with CARE Fertility in Nottingham. They were advised to have IVF, where an egg is combined with sperm in a laboratory dish. If the egg fertilises, the resulting embryo is transferred into the woman’s uterus. Usually more than one egg is fertilised to give couples a better chance of having a baby. ICIS (Intracytoplasmic Sperm Injection) was also recommended. This is a procedure in which a single sperm is injected directly into an egg.
The couple were given an appointment at Derby City General Hospital, where CARE has a satellite unit. Elaine said: “It was quite daunting, because it was all so new. I felt a bit stressed because I knew time was against me. I was 43 at the time.” Almost as soon as Elaine and Tom started their first course of treatment doctors decided to abandon it. Elaine was not responding to the course of drugs she was taking and there was no chance the treatment was going to be successful. “It was a slap in the face,” said Elaine. “I was disappointed, but I knew that the doctors were right in their decision.
“We agreed to try again the following month with a higher dose of medication.” Elaine quit her nursing job to concentrate on the treatment and Tom did as much as he could to support his wife. “It was very stressful when we discovered that only one egg was good enough to be fertilised,” she said. “Some women produce loads of great eggs, but we just had one.” Elaine admits that she thought the treatment would probably fail, but piled all her hopes on her one embryo. “The doctors said it was a very healthy embryo, but I shouldn’t get too excited,” she said. “I was told to rest for two weeks and then return to hospital for a pregnancy test.” Their wait was well worth it because the news was good.
Elaine and Tom were told they were expecting a baby. “I knew already,” laughed Elaine, “because I’d done a pregnancy test at home. “I was so happy. We felt so lucky. This tiny embryo was our baby and I was so grateful. I was so surprised because our chances were very slim.” Elaine took things easy over the next few months and made sure she looked after herself. But at week 32 of her pregnancy, doctors started to worry about the baby. A scan showed that he was not growing properly and medics were worried that Elaine’s placenta was not functioning properly.
On Christmas Eve, it was decided that Elaine should be induced at the City General. She said: “I was nervous, because the baby was only just 35 weeks, but I knew I had no choice. The baby needed to be born because it wasn’t getting what it needed from me.” On Christmas Day 2.30pm, baby Jacob was born by Caesarean section, weighing 4lbs 6ozs. “We missed our Christmas dinner,” laughed Tom. “But we had more important things to do. Our son was born and that was just amazing. “We felt very blessed. We never dreamed we’d ever have a baby. He was lovely.” Elaine and Jacob stayed in hospital together for a week. Elaine came home on New Year’s Day and Jacob moved to the neonatal unit. She said: “It was hard leaving him, but he needed extra care. He wasn’t feeding too well and the doctors needed to keep an eye on him. ”When Elaine brought him home, on January 6, she was the proudest mother alive. And since then, she has enjoyed every single moment with her precious son. Jacob is now 12 weeks old and weighs a healthy 10lbs 2oz. Life couldn’t be more perfect for us,” said Elaine. “I love being a mum –it’s the best thing. If someone had told me that by 2007, I’d be married with a baby son I’d have laughed and laughed – but it’s no joke.”
Dr Suhaimi Hassan, who performed both Elaine’s egg collection and embryo transfer at CARE Fertility, said: “We are absolutely delighted to have been able to assist Elaine and Tom in achieving their dream to become a family and wish baby Jacob and his parents every happiness.”
WENDY ROBERTS
THE EVENING TELEGRAPH
Tom and Elaine Musson met and married in just a few weeks but, though they found love swiftly, time was not on their side when it came to starting a family. In fact, Elaine, who was in her 40s, had given up hope, especially when fertility treatment hit problems. But miracles do happen, as Wendy Roberts discovered.
WHEN Tom and Elaine Musson swapped numbers in a crowded bar, they never envisaged planning their wedding nine weeks later.
But after a whirlwind romance, the pair set a date and exchanged marriage vows. Life was looking perfect for the couple. But it’s been even better since their baby son, Jacob Alexander Gabriel, was born on Christmas Day. “We weren’t looking for love and we’d certainly ruled out ever having children,” said 44-year-old Elaine. “Now we’re married and have a lovely baby boy. It’s absolutely amazing,” she smiled. “He came on Christmas Day. He was the greatest gift we could have received. “These last months have been wonderful for us and Jacob is the most beautiful, contented baby. He’s adorable.” Elaine and Tom Musson, 46, of Scaddows Cottage, Ticknall, still cannot believe how much their lives have changed in the last three years.
Just finding each other and falling in love, they say, is nothing short of a miracle. But they believe having Jacob is their biggest achievement – especially when you hear how they needed intricate fertility treatment to get him. “Our wedding day was very quiet,” said Elaine. “We invited eight of our friends to Burton Register Office, and enjoyed a simple ceremony. Afterwards, we went to a bar for champagne. It was lovely.” Elaine and Tom started to try for a baby but it wasn’t long before they realised something was wrong. “We tried getting pregnant for a few months, and then I started thinking about my ticking body clock,” said Elaine, a psychiatric nurse. “I went to see the doctor, who ran a few tests.” News that Elaine’s fallopian tubes were blocked came as a shock. Elaine underwent treatment to try to clear them.
She said: “At my age, we were told that we’d have to pay for any kind of fertility treatment, but we had savings.” But Elaine became pregnant straightaway – and naturally. “I was over the moon,” she said. “It was great news. I could hardly believe it.” Then disaster struck. At six Weeks pregnant, Elaine had a miscarriage. The couple decided to invest £6,000 in a course of fertility treatment with CARE Fertility in Nottingham. They were advised to have IVF, where an egg is combined with sperm in a laboratory dish. If the egg fertilises, the resulting embryo is transferred into the woman’s uterus. Usually more than one egg is fertilised to give couples a better chance of having a baby. ICIS (Intracytoplasmic Sperm Injection) was also recommended. This is a procedure in which a single sperm is injected directly into an egg.
The couple were given an appointment at Derby City General Hospital, where CARE has a satellite unit. Elaine said: “It was quite daunting, because it was all so new. I felt a bit stressed because I knew time was against me. I was 43 at the time.” Almost as soon as Elaine and Tom started their first course of treatment doctors decided to abandon it. Elaine was not responding to the course of drugs she was taking and there was no chance the treatment was going to be successful. “It was a slap in the face,” said Elaine. “I was disappointed, but I knew that the doctors were right in their decision.
“We agreed to try again the following month with a higher dose of medication.” Elaine quit her nursing job to concentrate on the treatment and Tom did as much as he could to support his wife. “It was very stressful when we discovered that only one egg was good enough to be fertilised,” she said. “Some women produce loads of great eggs, but we just had one.” Elaine admits that she thought the treatment would probably fail, but piled all her hopes on her one embryo. “The doctors said it was a very healthy embryo, but I shouldn’t get too excited,” she said. “I was told to rest for two weeks and then return to hospital for a pregnancy test.” Their wait was well worth it because the news was good.
Elaine and Tom were told they were expecting a baby. “I knew already,” laughed Elaine, “because I’d done a pregnancy test at home. “I was so happy. We felt so lucky. This tiny embryo was our baby and I was so grateful. I was so surprised because our chances were very slim.” Elaine took things easy over the next few months and made sure she looked after herself. But at week 32 of her pregnancy, doctors started to worry about the baby. A scan showed that he was not growing properly and medics were worried that Elaine’s placenta was not functioning properly.
On Christmas Eve, it was decided that Elaine should be induced at the City General. She said: “I was nervous, because the baby was only just 35 weeks, but I knew I had no choice. The baby needed to be born because it wasn’t getting what it needed from me.” On Christmas Day 2.30pm, baby Jacob was born by Caesarean section, weighing 4lbs 6ozs. “We missed our Christmas dinner,” laughed Tom. “But we had more important things to do. Our son was born and that was just amazing. “We felt very blessed. We never dreamed we’d ever have a baby. He was lovely.” Elaine and Jacob stayed in hospital together for a week. Elaine came home on New Year’s Day and Jacob moved to the neonatal unit. She said: “It was hard leaving him, but he needed extra care. He wasn’t feeding too well and the doctors needed to keep an eye on him. ”When Elaine brought him home, on January 6, she was the proudest mother alive. And since then, she has enjoyed every single moment with her precious son. Jacob is now 12 weeks old and weighs a healthy 10lbs 2oz. Life couldn’t be more perfect for us,” said Elaine. “I love being a mum –it’s the best thing. If someone had told me that by 2007, I’d be married with a baby son I’d have laughed and laughed – but it’s no joke.”
Dr Suhaimi Hassan, who performed both Elaine’s egg collection and embryo transfer at CARE Fertility, said: “We are absolutely delighted to have been able to assist Elaine and Tom in achieving their dream to become a family and wish baby Jacob and his parents every happiness.”
WENDY ROBERTS
THE EVENING TELEGRAPH
IT'S A MAN THING (or are men really from Mars???...)
Marsali McDonald PhD
Senior Clinical Counsellor
CARE Fertility
Nottingham, UK
''He doesn't talk to me!''
''I never know what he's feeling!''
''I just don't understand him!''
''Men! Can't live with them-can't live without them!''
It's well known that infertility and the stress of treatment can drive couples apart. Communication can break down, couple end up feeling unheard and misunderstood by their partner-and resentments can build up. They stop talking to each other and start bickering and in some cases seperating.
So what goes wrong? I suppose the nub of it is that men and women tend to deal differently with stress and emotional pain. Research into how men and women express feelings of grief clearly shows that they do that in very different ways. One is not better than the other: they are just different and once we recognise that it's easier to understand what is going on for the other person.
The loss of fertility, failed treatments, ectopic pregnancies, miscarriages and infant death are all pretty profound events that result in feelings of grief for both men and women. They just don't necessarily show it in the same way.
Generally speaking men have a problem solving approach to life. Got a problem? Find a solution. If there is no solution to the problem do not waste time worrying about it. Put your energy into something constructive, like going back to work or building a garage. Women on the other hand, tend to deal with problems by talking about them. It does not matter that talking about them is not going to solve them. The act of talking it through is helpful in itself. Men need to do. Women need to talk.
Ther is no solution to a failed treatment. She can't understand how, an hour after hearing that treatment has failed, he is out digging the foundations for a new patio. She interprets that as him not caring. She wants to talk about it. He knows that talking about it will not change the situation and he feels inadequate and frustrated. There is nothing he can do to solve the problem. So he goes out and digs deeper foundation. She doesn't want him him to find a solution. She just want him to sit and talk to her to share his feelings. When he dissapears out into the garden again she thinks it is because he doesn't really care. And so the merry dance goes on.
And the whole nature of fertility treatment can make it worse. Men the 'doers' have so little to do here. Once he has produced his sample he can feel redundant. It is the women who takes the drugs, has the blood tests, scans and nurtures the embryos. What can a bloke do other than sit around feeling like a bit of a spare part!If it is his 'problem' that can intensify his feelings of powerlessness. If he has a low sperm count or no sperm, if donor sperm is used, he has even less to do. He can feel humilated as well as redundant. Being infertile can dent the confidence of the most self assured of us. It hacks at the roots of our self esteem and sense of who we are. Fertility can still be confused with virility in some people's minds. So infertile men can feel acute shame, guilt and inadequacy. If it wasn't for him, his partner wouldn't have to go through the wretched treatment.
And all this to the fact that men generally do not talk about how they are feeling-and women need to talk about it-and you have a powerful cocktail of potential misunderstandings.
So the next time he goes into the garden shed to hammer nails into something, it's not that he doesn't care. It is just a man thing. And the next time she asks you to sit down and talk about it, she is not expecting you to magic up a solution. It is just a woman thing
Perhaps there is room for both these ways of dealing with our feelings and we can meet somewhere in the middle. And VIVE LA DIFFERENCE!!!!!
Senior Clinical Counsellor
CARE Fertility
Nottingham, UK
''He doesn't talk to me!''
''I never know what he's feeling!''
''I just don't understand him!''
''Men! Can't live with them-can't live without them!''
It's well known that infertility and the stress of treatment can drive couples apart. Communication can break down, couple end up feeling unheard and misunderstood by their partner-and resentments can build up. They stop talking to each other and start bickering and in some cases seperating.
So what goes wrong? I suppose the nub of it is that men and women tend to deal differently with stress and emotional pain. Research into how men and women express feelings of grief clearly shows that they do that in very different ways. One is not better than the other: they are just different and once we recognise that it's easier to understand what is going on for the other person.
The loss of fertility, failed treatments, ectopic pregnancies, miscarriages and infant death are all pretty profound events that result in feelings of grief for both men and women. They just don't necessarily show it in the same way.
Generally speaking men have a problem solving approach to life. Got a problem? Find a solution. If there is no solution to the problem do not waste time worrying about it. Put your energy into something constructive, like going back to work or building a garage. Women on the other hand, tend to deal with problems by talking about them. It does not matter that talking about them is not going to solve them. The act of talking it through is helpful in itself. Men need to do. Women need to talk.
Ther is no solution to a failed treatment. She can't understand how, an hour after hearing that treatment has failed, he is out digging the foundations for a new patio. She interprets that as him not caring. She wants to talk about it. He knows that talking about it will not change the situation and he feels inadequate and frustrated. There is nothing he can do to solve the problem. So he goes out and digs deeper foundation. She doesn't want him him to find a solution. She just want him to sit and talk to her to share his feelings. When he dissapears out into the garden again she thinks it is because he doesn't really care. And so the merry dance goes on.
And the whole nature of fertility treatment can make it worse. Men the 'doers' have so little to do here. Once he has produced his sample he can feel redundant. It is the women who takes the drugs, has the blood tests, scans and nurtures the embryos. What can a bloke do other than sit around feeling like a bit of a spare part!If it is his 'problem' that can intensify his feelings of powerlessness. If he has a low sperm count or no sperm, if donor sperm is used, he has even less to do. He can feel humilated as well as redundant. Being infertile can dent the confidence of the most self assured of us. It hacks at the roots of our self esteem and sense of who we are. Fertility can still be confused with virility in some people's minds. So infertile men can feel acute shame, guilt and inadequacy. If it wasn't for him, his partner wouldn't have to go through the wretched treatment.
And all this to the fact that men generally do not talk about how they are feeling-and women need to talk about it-and you have a powerful cocktail of potential misunderstandings.
So the next time he goes into the garden shed to hammer nails into something, it's not that he doesn't care. It is just a man thing. And the next time she asks you to sit down and talk about it, she is not expecting you to magic up a solution. It is just a woman thing
Perhaps there is room for both these ways of dealing with our feelings and we can meet somewhere in the middle. And VIVE LA DIFFERENCE!!!!!
Wednesday, January 30, 2008
(FOR DOCTORS) Sperm Freezing Preserves Male Fertility In Cancer Patients
Source: Journal of Fertility and Sterility Jan 2008
Assessing the use rate and assisted reproductive technology outcomes of cryopreserved semen from male cancer patients.
Researchers believe that semen cryopreservation (SCP) is a viable option for preserving fertility among men who have undergone cancer treatment.
N. Casteren (University Medical Center Rotterdam, The Netherlands) and team assessed the assisted reproductive technology (ART) outcomes of 557 male cancer patients who underwent SCP. The men were then followed-up for an average of 7 years.
Following cancer treatment, 218 (39 percent) of the men returned for semen analysis. Motile cryopreserved sperm were observed in 71.1 percent of samples. In all, 42 (13.3 percent) men requested the use of banked sperm and 29 (7.5 percent) requested its disposal.
Among the 37 men who underwent 101 ART cycles, around 54 percent achieved a successful pregnancy. Clinical pregnancy rates were 30.1, 25.0, 22.2, and 14.3 percent following IVF, ICSI, frozen embryo transfer, and intrauterine insemination (IUI) treatments, respectively.
Women who underwent IVF treatment using cryopreserved sperm also had over twice the number of active pregnancies per number of embryo's transferred compared with the other three treatments. ICSI live birth rates were also 54 percent higher than those for frozen embryo transfer and IUI and 28 percent higher compared with IVF treatments.
No correlation was observed between the SCP storage time and pregnancy rates, the researchers note.
"We strongly recommend discussing SCP with all men at risk of becoming infertile after receiving gonadotoxic treatment," conclude Casteren et al.
Comment:
It is my believe that it is good medical practice to cryopreserve sperms prior to gonadotoxic treatment. It is my practice to offer sperms cryopreservation at diagnosis for all patients in whom fertility will be an issue. It is difficult to predict how much sperms would be affected by chemotherapy which can be from azoospermia to moderate or severe oligozoospermia. However data on effect of gonadotoxic treatment on successful pregnancy outcome is limited.
Although chemotherapy does have the potential to damage the sperm DNA, Arnon et al, in their review in Human Reproduction Update 2001, vol 7, page394-403, note that they did not find any increase in genetic defects or congenital malformations in children conceived to parents who has previously undergone chemotherapy. This has been further reinforced by a review by Meirow and Schiff (2005) who noted that there was no increase in miscarriage or congenital abnormalities in children born to parents sometime after their chemotherapy has been completed. Usually my advice to patients undergoing chemotherapy is that they should avoid pregnancy for duration of chemotherapy and for 12 months afterward. (This duration is just arbitrary and merely a personal opinion)
Also there is no difference in success rate for pregnancy outcome using either fresh or cryopreseved sperms. The biggest review I could find in the literature was published by Schmidt et al (2004), who followed up 67 couples who were having assisted reproduction following the treatment of the male partner for either a testicular tumour or a lymphoma. They reported the use of cryopreserved sperms in 58% of couples and did not notice any significant difference in the success of the delivery rate between fresh or cryopreseved sperms.
In summarry, although chemotherapy would have theoretically caused some degree of damage to sperm DNA, it appears that if pregnancy is delayed until the year after completeing chemotherapy, then it's outcome is not specifically affected. One of the greatest advantage for sperms cryopreservation is that it can be used as backup if men become azoospermic following chemotherapy.
Assessing the use rate and assisted reproductive technology outcomes of cryopreserved semen from male cancer patients.
Researchers believe that semen cryopreservation (SCP) is a viable option for preserving fertility among men who have undergone cancer treatment.
N. Casteren (University Medical Center Rotterdam, The Netherlands) and team assessed the assisted reproductive technology (ART) outcomes of 557 male cancer patients who underwent SCP. The men were then followed-up for an average of 7 years.
Following cancer treatment, 218 (39 percent) of the men returned for semen analysis. Motile cryopreserved sperm were observed in 71.1 percent of samples. In all, 42 (13.3 percent) men requested the use of banked sperm and 29 (7.5 percent) requested its disposal.
Among the 37 men who underwent 101 ART cycles, around 54 percent achieved a successful pregnancy. Clinical pregnancy rates were 30.1, 25.0, 22.2, and 14.3 percent following IVF, ICSI, frozen embryo transfer, and intrauterine insemination (IUI) treatments, respectively.
Women who underwent IVF treatment using cryopreserved sperm also had over twice the number of active pregnancies per number of embryo's transferred compared with the other three treatments. ICSI live birth rates were also 54 percent higher than those for frozen embryo transfer and IUI and 28 percent higher compared with IVF treatments.
No correlation was observed between the SCP storage time and pregnancy rates, the researchers note.
"We strongly recommend discussing SCP with all men at risk of becoming infertile after receiving gonadotoxic treatment," conclude Casteren et al.
Comment:
It is my believe that it is good medical practice to cryopreserve sperms prior to gonadotoxic treatment. It is my practice to offer sperms cryopreservation at diagnosis for all patients in whom fertility will be an issue. It is difficult to predict how much sperms would be affected by chemotherapy which can be from azoospermia to moderate or severe oligozoospermia. However data on effect of gonadotoxic treatment on successful pregnancy outcome is limited.
Although chemotherapy does have the potential to damage the sperm DNA, Arnon et al, in their review in Human Reproduction Update 2001, vol 7, page394-403, note that they did not find any increase in genetic defects or congenital malformations in children conceived to parents who has previously undergone chemotherapy. This has been further reinforced by a review by Meirow and Schiff (2005) who noted that there was no increase in miscarriage or congenital abnormalities in children born to parents sometime after their chemotherapy has been completed. Usually my advice to patients undergoing chemotherapy is that they should avoid pregnancy for duration of chemotherapy and for 12 months afterward. (This duration is just arbitrary and merely a personal opinion)
Also there is no difference in success rate for pregnancy outcome using either fresh or cryopreseved sperms. The biggest review I could find in the literature was published by Schmidt et al (2004), who followed up 67 couples who were having assisted reproduction following the treatment of the male partner for either a testicular tumour or a lymphoma. They reported the use of cryopreserved sperms in 58% of couples and did not notice any significant difference in the success of the delivery rate between fresh or cryopreseved sperms.
In summarry, although chemotherapy would have theoretically caused some degree of damage to sperm DNA, it appears that if pregnancy is delayed until the year after completeing chemotherapy, then it's outcome is not specifically affected. One of the greatest advantage for sperms cryopreservation is that it can be used as backup if men become azoospermic following chemotherapy.
Sunday, January 20, 2008
BANK SPERMA: DIMANA KEPERLUANYA?
Dr Suhaimi Hassan
Apabila sahaja disebut pasal Bank Sperma, maka ia sering menimbulkan kontroversi. Secara rambang, apabila penulis berbincang dengan masyarakat dari pelbagai golongan, secara umum konsep bank sperma adalah terlalu samar dan tidak difahami sepenuhnya.
Apakah yang di maksudkan dengan Bank Sperma atau apakah matlamat nya? Ia mempunyai tiga matlamat asas. Pertama, matlamat asas Bank Sperma adalah sebagai pusat rujukan dan penyelarasan bagi penderma dan penerima sperma. Faktor inilah yang menyebabkan ianya menimbulkan kontroversi. Kedua, ia juga bermatlamat untuk pembekuan sperma bagi individu-individu tertentu untuk kegunaan pada kemudian hari. Ketiga, ia juga boleh dikembangkan sebagai pusat penyelidikan dan kajian sperma serta ketidaksuburan (infertiliti) yang disebabkan oleh faktor lelaki.
Apabila penulis mengajukan soalan pada pasangan yang dikaitkan dengan isu-isu ketidaksuburan atau infertiliti selalunya pasangan wanita dipersalahkan. Sebenarnya faktor lelaki menyumbangkan kira-kira hampir satu pertiga dari kesemua penyebab atau punca ketidaksuburan. Terdapat pasangan lelaki yang tidak mampu menghasilkan sperma yang mencukupi secara normal. Antaranya termasuklah ketiadaan sperma dalam cairan mani atau azoospermia, kurang jumlah sperma yang mencukupi atau oligoszoospermia dan jumlah sperma yang berbentuk abnormal terlalu banyak yang juga dipanggil teratozoospermia. Pasangan lelaki yang begini selalunya amat sukar atau langsung tidak berkeupayaan menghasilkan zuriat jika tidak mendapat rawatan.
Bagi pasangan lelaki yang punyai oligozoospermia atau teratozoospermia, kemungkinan mendapat zuriat secara normal masih ada tapi adalah tipis. Pasangan ini boleh dibantu dengan kaedah persenyawaan luar rahim atau IVF dimana telur yang dihasilkan dari rawatan pasangan wanita diberi suntikan mikro atau ICSI dengan sperma suami untuk membantu persenyawaan.
Bagi pasangan lelaki yang azoospermik pula, mereka tidak boleh mendapatkan zuriat secara normal. Sperma pasangan lelaki ini boleh diperolehi melalui cara pembedahan pada buah zakar dan jika berjaya, maka sperma kemudiannya disenyawakan dengan telur isteri juga melalui kaedah IVF dan ICSI
Bagi sebahagian lelaki azoospermik lain pula, jika tidak berjaya memperolehi sperma melalui kaedah pembedahan, mereka perlu menerima hakikat yang mereka tidak akan punyai anak sendiri . Ia juga tidak bermakna pasangan tidak boleh hidup bahagia tanpa cahayamata kerana mereka telahpun melakukan ikhtiar melakukan rawatan walaupun tidak berjaya. Harus diingatkan disini bahawa dengan mencari pasangan yang lain tidak akan menyelesaikan masalah kerana masalah yang sama tetap akan berulang dengan pasangan baru. Alternatif lain adalah samaada dengan mengambil anak angkat atau melakukan rawatan permanian hadas (intra uterine insemination) ataupun IVF dengan mengunakan sperma penderma dan disenyawakan dengan telur yang diperolehi dari isteri .
Bagi masyarakat Islam ianya jelas dimana pendermaan dan penerimaan sperma adalah haram. Mereka yang beragama Roman Katolik dan Yahudi Ortodok juga tidak dibenarkan oleh agama masing masing. Umat Islam juga dilarang menggunakan sperma suami yang dibekukan apabila suami meninggal dunia.
Walaupun pendermaan dan penerimaan sperma tidak boleh diterima oleh kebanyakan masyarakat di Malaysia namun terdapat juga golongan masyarakat yang boleh menerimanya dan kita tidak boleh mendikriminasikan mereka dan perlu menghormati cara mereka jika ianya dibenarkan oleh masyarakat mereka dan selagi ia tidak melanggar undang-undang.
Penderma sperma selalunya adalah lelaki yang sihat dan berumur antara 18 hingga 45 tahun. Secara am, mereka adalah bersifat anonymous atau tidak mengenali antara satu sama lain dengan penerima.. Mereka mestilah sihat dan tidak punyai penyakit keturunan. Sebelum dibenarkan menderma, mereka akan disaring dengan ujian saringan penyakit berjangkit saperti hepatitis B dan C, HIV, CMV, gonorrhoea dan syphilis. Mereka juga perlu melakukan ujian karyotype bagi memastikan mereka tidak punyai penyakit keturunan. Ini adalah untuk mempastikan penerima sperma atau zuriat yang dilahirkan kelak tidak menghadapi risiko penyakit berjangkit atau penyakit keturunan. Pihak Bank Sperma juga perlu mengambil latar belakang penderma termasuk sejarah perubatan dan keluarga serta sifat fizikal mereka saperti ketinggian, warna kulit, rambut dan mata serta kumpulan etnik supaya mereka akan dapat pasangkan dengan penerima sperma. Sperma akan juga dikurantin selama 6 bulan sebelum dibenarkan digunakan. Perlu diingatkan bahawa dengan melakukan ujian ujian dan pemilihan yang ketat, Bank Sperma masih tidak boleh mempastikan bahawa zuriat yang dihasilkan tidak punyai masalah kesihatan. Pasangan perlu juga faham bahawa rawatan dengan menggunakan sperma penderma tidak semestinya berjaya dan kadar kejayaannya hanyalah dalam sekitar 30 peratus sahaja dengan mengguna kaedah IVF.
Pengunaan sperma penderma boleh mengundang kontroversi. Masalah yang perlu dihadapi ialah sedikit kemungkinan anak-anak yang dihasilkan melalui kaedah ini bertemu dengan anak-anak lain pasangan yang menerima sperma penderma yang sama dimasa akan datang. Ini adalah kerana sperma penderma dibenarkan diberi kepada lebih dari satu penerima kerana tidak ramai lelaki yang ingin menjadi penderma. Kemungkinan anak anak penderma bertemu dan berkahwin dengan anak penerima juga boleh berlaku.
Di negara barat masalah ini dapat diatasi, dimana semua penderma dan penerima mengikut undang-undang disana perlu mendaftar dengan pusat pengumpulan data. Pusat ini akan dirujuk oleh anak-anak hasil dari rawatan tersebut apabila dewasa kelak untuk memastikan mereka tidak punyai talian darah. Kontroversi perdermaan sperma juga melibatkan undang-undang yang amat menyulitkan akibat dari penghasilan zuriat kelak. Ini juga menambahkan lagi kesulitan apabila sperma penderma digunakan oleh wanita tunggal yang inginkan zuriat dan juga wanita lesbian. Cara hidup begini walaupun normal bagi masyarakat di Barat, ia sama sekali tidak sesuai di negara kita.
Sperma penderma mungkin sesuai digunakan jika pasangan lelaki punyai penyakit keturunan. Ia dapat mengelak pasangan yang berpenyakit keturunan dari menurunkan penyakit kepada zuriat mereka kelak. Walaubagaimanapun sebagai alternatif, bagi masyarakat yang tidak dibenarkan menggunakan sperma penderma, mereka boleh melakukan pemeriksaan genetik sebelum implantasi atau Pre Implantation Genetic Diagnosis (PGD). Teknologi terbaru ini membolehkan pakar perubatan mengesan penyakit-penyakit genetik dalam embrio ang dihasilkan dengan kaedah IVF, sebelum pemindahan embrio dilakukan. Teknik ini dapat mengesan embrio yang tidak punyai penyakit keturunan untuk dipindahkan kedalam rahim.
Kerajaan perlu memastikan samaada pendermaan sperma dibenarkan atau tidak di negara ini. Malaysia boleh mengambil langkah saperti Jerman, Austria, Jepun dan banyak Negara Islam termasuk Turki yang mengharamkan pengunaan sperma perderma. Langkah seperti ini adalah lebih mudah kerana walaupun undang undang yang ketat boleh digubal tapi jika penyelengaraannya lemah, ia akan merumitkan lagi keadaan Di Itali pembekuan sperma samada dari penderma atau sperma suami diharamkan sama sekali.
Malaysia juga boleh mengambil langkah seperti di Amerika Syarikat dan United Kingdom membenarkan penggunaan sperma derma. Jika kerajaan ingin membenarkan pendermaan sperma, ia bukan sahaja perlu undang-undang yang ketat, tetapi juga penyelengaran yang baik supaya ia tidak disalah-gunakan. Satu lagi masalah yang akan dihadapi oleh kerajaan dimana pendermaan sperma akan menjadi satu ‘industri’ dengan pembayaran yang lumayan seperti di Eropah Timur. Kerajaan perlu juga menyediakan pusat pengumpulan data bagi mengumpul semua nama penerima dan penderma untok dirujuk oleh zuriat yang dihasilkan kelak. Malaysia boleh mengunakan model dari UK dimana semua unit yang menyediakan rawatan pendermaan sperma di kawal ketat oleh satu badan bebas. Unit unit yang tidak mengikut syarat yang ketat tersebut akan ditarik balik lesen mereka. Setiap tahun terdapat 1300 kanak-kanak lahir dari rawatan mengunakan sperma derma di UK. Undang undang di sana juga jelas dimana penderma tidak punyai apa-apa hak penjagaan terhadap anak yang akan dilahirkan kelak.
Bank Sperma juga berfungsi untuk membekukan sperma sperma bagi lelaki yang punyai masalah tertentu saperti barah. Fungsi seperti ini lah yang perlu di galakkan oleh Bank Sperma di Malaysia. Oleh kerana taraf kesihatan negara bertambah baik maka jangka hayat rakyat juga sudah meningkat. Mengikut statistik di Barat satu pertiga dari kita akan mendapat barah. Barah juga boleh terjadi pada peringkat remaja seperti barah darah seperti leukemia, dan barah linfa saperti Hodgkin Lymphoma dan barah buah zakar dipanggil seminoma. Lelaki yang mempunyai barah tersebut akan mendapat rawatan samada kemoterapi atau radioterapi. Rawatan seperti ini boleh merosakan proses pembentukan sperma. Ia boleh menyebabkan mereka menjadi oligozoospermia atau azoospermia. Jadi lelaki tersebut harus digalakkan oleh doktor untuk melakukan pembekuan sperma mereka sebelum rawatan kemoterapi atau radioterapi. Oleh kerana teknologi rawatan barah sangat baik buat masa ini, apabila pasangan lelaki sembuh kelak, sperma yang dibekukan akan dapat digunakan buat masa hadapan. Perlu di ingat, jika sperma kembali kepada normal selepas rawatan kemoterapi atau radioterapi, ia mungkin tidak sesuai digunakan lagi. Ini ialah kerana proses rawatan barah punyai potensi merosakan kandungan genetik didalam sel sel sperma dan ini mungkin menyebabkan risiko kecacatan pada bayi yang bakal dilahirkan. Bagi setengah pasangan lelaki seperti ini penggunaan sperma yang dibekukan sebelum rawatan barah adalah lebih selamat jika dibanding dengan sperma segar.
Sperma juga perlu dibekukan untuk kegunaan masa akan datang terutama bagi lelaki yang mempunyai pekerjaan yang berisiko tinggi yang boleh memudaratkan proses penghasilan sperma saperti pekerja di pusat radiasi atau setengah ahli sukan lasak seperti sukan udara dan sukan berkuda. Sudah menjadi satu trend di Barat dimana ahli sukan lasak membekukan sperma mereka kerana kemungkinan mendapat cedera pada buah zakar sangat tinggi. Apabila berlaku kecederaan, proses pembentukan sperma boleh terbantut.
Sperma juga boleh dibekukan sebelum proses vasektomi. Biasanya vasektomi dilakukan apabila pasangan merasakan keluarga mereka sudah lengkap. Ia merupakan proses kontrasepsi yang mungkin berkekalan sama seperti ‘tubal ligation’ pada pasangan wanita. Kadang-kadang situasi keluarga tidak boleh diduga seperti penceraian, punyai pasangan baru atau kematian anak. Jadi sperma yang dibeku boleh diguna sebagai alternatif dikemudian hari kelak.
Bank Sperma juga adalah sebahagian dari unit rawatan reproduktif secara keseluruhanya. Jadi ia boleh juga dijadikan sebagai satu pusat penyelidikan terutama sekali bagi meningkatkan lagi keberkesanan rawatan IVF yang disebabkan oleh faktor lelaki.
Kementerian Kesihatan Malaysia perlu mengubal undang undang khusus berhubung Bank Sperma di Malaysia. Ia juga akan mengawal penyalahgunaan fungsi Bank Sperma. Oleh kerana tiada undang-undang yang spesifik pada masa ini mengenainya maka tidak ada sebarang penyelengaraan yang sistematik bagi unit-unit Bank Sperma samaada di hospital awam atau swasta untuk berfungsi dengan berkesan.
Bank Sperma yang punyai ciri-ciri yang jelas boleh memberi manafaat kepada masyarakat. Ia juga memerlukan penyelengaraan yang sistematik untuk mengelak daripada penyalah-gunaan.
Apabila sahaja disebut pasal Bank Sperma, maka ia sering menimbulkan kontroversi. Secara rambang, apabila penulis berbincang dengan masyarakat dari pelbagai golongan, secara umum konsep bank sperma adalah terlalu samar dan tidak difahami sepenuhnya.
Apakah yang di maksudkan dengan Bank Sperma atau apakah matlamat nya? Ia mempunyai tiga matlamat asas. Pertama, matlamat asas Bank Sperma adalah sebagai pusat rujukan dan penyelarasan bagi penderma dan penerima sperma. Faktor inilah yang menyebabkan ianya menimbulkan kontroversi. Kedua, ia juga bermatlamat untuk pembekuan sperma bagi individu-individu tertentu untuk kegunaan pada kemudian hari. Ketiga, ia juga boleh dikembangkan sebagai pusat penyelidikan dan kajian sperma serta ketidaksuburan (infertiliti) yang disebabkan oleh faktor lelaki.
Apabila penulis mengajukan soalan pada pasangan yang dikaitkan dengan isu-isu ketidaksuburan atau infertiliti selalunya pasangan wanita dipersalahkan. Sebenarnya faktor lelaki menyumbangkan kira-kira hampir satu pertiga dari kesemua penyebab atau punca ketidaksuburan. Terdapat pasangan lelaki yang tidak mampu menghasilkan sperma yang mencukupi secara normal. Antaranya termasuklah ketiadaan sperma dalam cairan mani atau azoospermia, kurang jumlah sperma yang mencukupi atau oligoszoospermia dan jumlah sperma yang berbentuk abnormal terlalu banyak yang juga dipanggil teratozoospermia. Pasangan lelaki yang begini selalunya amat sukar atau langsung tidak berkeupayaan menghasilkan zuriat jika tidak mendapat rawatan.
Bagi pasangan lelaki yang punyai oligozoospermia atau teratozoospermia, kemungkinan mendapat zuriat secara normal masih ada tapi adalah tipis. Pasangan ini boleh dibantu dengan kaedah persenyawaan luar rahim atau IVF dimana telur yang dihasilkan dari rawatan pasangan wanita diberi suntikan mikro atau ICSI dengan sperma suami untuk membantu persenyawaan.
Bagi pasangan lelaki yang azoospermik pula, mereka tidak boleh mendapatkan zuriat secara normal. Sperma pasangan lelaki ini boleh diperolehi melalui cara pembedahan pada buah zakar dan jika berjaya, maka sperma kemudiannya disenyawakan dengan telur isteri juga melalui kaedah IVF dan ICSI
Bagi sebahagian lelaki azoospermik lain pula, jika tidak berjaya memperolehi sperma melalui kaedah pembedahan, mereka perlu menerima hakikat yang mereka tidak akan punyai anak sendiri . Ia juga tidak bermakna pasangan tidak boleh hidup bahagia tanpa cahayamata kerana mereka telahpun melakukan ikhtiar melakukan rawatan walaupun tidak berjaya. Harus diingatkan disini bahawa dengan mencari pasangan yang lain tidak akan menyelesaikan masalah kerana masalah yang sama tetap akan berulang dengan pasangan baru. Alternatif lain adalah samaada dengan mengambil anak angkat atau melakukan rawatan permanian hadas (intra uterine insemination) ataupun IVF dengan mengunakan sperma penderma dan disenyawakan dengan telur yang diperolehi dari isteri .
Bagi masyarakat Islam ianya jelas dimana pendermaan dan penerimaan sperma adalah haram. Mereka yang beragama Roman Katolik dan Yahudi Ortodok juga tidak dibenarkan oleh agama masing masing. Umat Islam juga dilarang menggunakan sperma suami yang dibekukan apabila suami meninggal dunia.
Walaupun pendermaan dan penerimaan sperma tidak boleh diterima oleh kebanyakan masyarakat di Malaysia namun terdapat juga golongan masyarakat yang boleh menerimanya dan kita tidak boleh mendikriminasikan mereka dan perlu menghormati cara mereka jika ianya dibenarkan oleh masyarakat mereka dan selagi ia tidak melanggar undang-undang.
Penderma sperma selalunya adalah lelaki yang sihat dan berumur antara 18 hingga 45 tahun. Secara am, mereka adalah bersifat anonymous atau tidak mengenali antara satu sama lain dengan penerima.. Mereka mestilah sihat dan tidak punyai penyakit keturunan. Sebelum dibenarkan menderma, mereka akan disaring dengan ujian saringan penyakit berjangkit saperti hepatitis B dan C, HIV, CMV, gonorrhoea dan syphilis. Mereka juga perlu melakukan ujian karyotype bagi memastikan mereka tidak punyai penyakit keturunan. Ini adalah untuk mempastikan penerima sperma atau zuriat yang dilahirkan kelak tidak menghadapi risiko penyakit berjangkit atau penyakit keturunan. Pihak Bank Sperma juga perlu mengambil latar belakang penderma termasuk sejarah perubatan dan keluarga serta sifat fizikal mereka saperti ketinggian, warna kulit, rambut dan mata serta kumpulan etnik supaya mereka akan dapat pasangkan dengan penerima sperma. Sperma akan juga dikurantin selama 6 bulan sebelum dibenarkan digunakan. Perlu diingatkan bahawa dengan melakukan ujian ujian dan pemilihan yang ketat, Bank Sperma masih tidak boleh mempastikan bahawa zuriat yang dihasilkan tidak punyai masalah kesihatan. Pasangan perlu juga faham bahawa rawatan dengan menggunakan sperma penderma tidak semestinya berjaya dan kadar kejayaannya hanyalah dalam sekitar 30 peratus sahaja dengan mengguna kaedah IVF.
Pengunaan sperma penderma boleh mengundang kontroversi. Masalah yang perlu dihadapi ialah sedikit kemungkinan anak-anak yang dihasilkan melalui kaedah ini bertemu dengan anak-anak lain pasangan yang menerima sperma penderma yang sama dimasa akan datang. Ini adalah kerana sperma penderma dibenarkan diberi kepada lebih dari satu penerima kerana tidak ramai lelaki yang ingin menjadi penderma. Kemungkinan anak anak penderma bertemu dan berkahwin dengan anak penerima juga boleh berlaku.
Di negara barat masalah ini dapat diatasi, dimana semua penderma dan penerima mengikut undang-undang disana perlu mendaftar dengan pusat pengumpulan data. Pusat ini akan dirujuk oleh anak-anak hasil dari rawatan tersebut apabila dewasa kelak untuk memastikan mereka tidak punyai talian darah. Kontroversi perdermaan sperma juga melibatkan undang-undang yang amat menyulitkan akibat dari penghasilan zuriat kelak. Ini juga menambahkan lagi kesulitan apabila sperma penderma digunakan oleh wanita tunggal yang inginkan zuriat dan juga wanita lesbian. Cara hidup begini walaupun normal bagi masyarakat di Barat, ia sama sekali tidak sesuai di negara kita.
Sperma penderma mungkin sesuai digunakan jika pasangan lelaki punyai penyakit keturunan. Ia dapat mengelak pasangan yang berpenyakit keturunan dari menurunkan penyakit kepada zuriat mereka kelak. Walaubagaimanapun sebagai alternatif, bagi masyarakat yang tidak dibenarkan menggunakan sperma penderma, mereka boleh melakukan pemeriksaan genetik sebelum implantasi atau Pre Implantation Genetic Diagnosis (PGD). Teknologi terbaru ini membolehkan pakar perubatan mengesan penyakit-penyakit genetik dalam embrio ang dihasilkan dengan kaedah IVF, sebelum pemindahan embrio dilakukan. Teknik ini dapat mengesan embrio yang tidak punyai penyakit keturunan untuk dipindahkan kedalam rahim.
Kerajaan perlu memastikan samaada pendermaan sperma dibenarkan atau tidak di negara ini. Malaysia boleh mengambil langkah saperti Jerman, Austria, Jepun dan banyak Negara Islam termasuk Turki yang mengharamkan pengunaan sperma perderma. Langkah seperti ini adalah lebih mudah kerana walaupun undang undang yang ketat boleh digubal tapi jika penyelengaraannya lemah, ia akan merumitkan lagi keadaan Di Itali pembekuan sperma samada dari penderma atau sperma suami diharamkan sama sekali.
Malaysia juga boleh mengambil langkah seperti di Amerika Syarikat dan United Kingdom membenarkan penggunaan sperma derma. Jika kerajaan ingin membenarkan pendermaan sperma, ia bukan sahaja perlu undang-undang yang ketat, tetapi juga penyelengaran yang baik supaya ia tidak disalah-gunakan. Satu lagi masalah yang akan dihadapi oleh kerajaan dimana pendermaan sperma akan menjadi satu ‘industri’ dengan pembayaran yang lumayan seperti di Eropah Timur. Kerajaan perlu juga menyediakan pusat pengumpulan data bagi mengumpul semua nama penerima dan penderma untok dirujuk oleh zuriat yang dihasilkan kelak. Malaysia boleh mengunakan model dari UK dimana semua unit yang menyediakan rawatan pendermaan sperma di kawal ketat oleh satu badan bebas. Unit unit yang tidak mengikut syarat yang ketat tersebut akan ditarik balik lesen mereka. Setiap tahun terdapat 1300 kanak-kanak lahir dari rawatan mengunakan sperma derma di UK. Undang undang di sana juga jelas dimana penderma tidak punyai apa-apa hak penjagaan terhadap anak yang akan dilahirkan kelak.
Bank Sperma juga berfungsi untuk membekukan sperma sperma bagi lelaki yang punyai masalah tertentu saperti barah. Fungsi seperti ini lah yang perlu di galakkan oleh Bank Sperma di Malaysia. Oleh kerana taraf kesihatan negara bertambah baik maka jangka hayat rakyat juga sudah meningkat. Mengikut statistik di Barat satu pertiga dari kita akan mendapat barah. Barah juga boleh terjadi pada peringkat remaja seperti barah darah seperti leukemia, dan barah linfa saperti Hodgkin Lymphoma dan barah buah zakar dipanggil seminoma. Lelaki yang mempunyai barah tersebut akan mendapat rawatan samada kemoterapi atau radioterapi. Rawatan seperti ini boleh merosakan proses pembentukan sperma. Ia boleh menyebabkan mereka menjadi oligozoospermia atau azoospermia. Jadi lelaki tersebut harus digalakkan oleh doktor untuk melakukan pembekuan sperma mereka sebelum rawatan kemoterapi atau radioterapi. Oleh kerana teknologi rawatan barah sangat baik buat masa ini, apabila pasangan lelaki sembuh kelak, sperma yang dibekukan akan dapat digunakan buat masa hadapan. Perlu di ingat, jika sperma kembali kepada normal selepas rawatan kemoterapi atau radioterapi, ia mungkin tidak sesuai digunakan lagi. Ini ialah kerana proses rawatan barah punyai potensi merosakan kandungan genetik didalam sel sel sperma dan ini mungkin menyebabkan risiko kecacatan pada bayi yang bakal dilahirkan. Bagi setengah pasangan lelaki seperti ini penggunaan sperma yang dibekukan sebelum rawatan barah adalah lebih selamat jika dibanding dengan sperma segar.
Sperma juga perlu dibekukan untuk kegunaan masa akan datang terutama bagi lelaki yang mempunyai pekerjaan yang berisiko tinggi yang boleh memudaratkan proses penghasilan sperma saperti pekerja di pusat radiasi atau setengah ahli sukan lasak seperti sukan udara dan sukan berkuda. Sudah menjadi satu trend di Barat dimana ahli sukan lasak membekukan sperma mereka kerana kemungkinan mendapat cedera pada buah zakar sangat tinggi. Apabila berlaku kecederaan, proses pembentukan sperma boleh terbantut.
Sperma juga boleh dibekukan sebelum proses vasektomi. Biasanya vasektomi dilakukan apabila pasangan merasakan keluarga mereka sudah lengkap. Ia merupakan proses kontrasepsi yang mungkin berkekalan sama seperti ‘tubal ligation’ pada pasangan wanita. Kadang-kadang situasi keluarga tidak boleh diduga seperti penceraian, punyai pasangan baru atau kematian anak. Jadi sperma yang dibeku boleh diguna sebagai alternatif dikemudian hari kelak.
Bank Sperma juga adalah sebahagian dari unit rawatan reproduktif secara keseluruhanya. Jadi ia boleh juga dijadikan sebagai satu pusat penyelidikan terutama sekali bagi meningkatkan lagi keberkesanan rawatan IVF yang disebabkan oleh faktor lelaki.
Kementerian Kesihatan Malaysia perlu mengubal undang undang khusus berhubung Bank Sperma di Malaysia. Ia juga akan mengawal penyalahgunaan fungsi Bank Sperma. Oleh kerana tiada undang-undang yang spesifik pada masa ini mengenainya maka tidak ada sebarang penyelengaraan yang sistematik bagi unit-unit Bank Sperma samaada di hospital awam atau swasta untuk berfungsi dengan berkesan.
Bank Sperma yang punyai ciri-ciri yang jelas boleh memberi manafaat kepada masyarakat. Ia juga memerlukan penyelengaraan yang sistematik untuk mengelak daripada penyalah-gunaan.
Friday, January 11, 2008
IN VITRO MATURATION (IVM): A CHEAPER AND SAFER ALTERNATIVE TO IN VITRO FERTILIZATION (IVF)?
Dr Suhaimi Hassan
Since the birth of Louise Brown in 1978, in vitro fertilization (IVF) has advanced tremendously and has proven to be a very successful treatment for infertile couples. However, there are some drawbacks to this mode of treatment which may deter many women from treatment.
In vitro maturation (IVM) was first introduced by doctors in Denmark in the late 1990s. It is a revolutionary treatment technique developed to help couples with infertility problems which could potentially lead to cheaper and safer treatment compared to the conventional in vitro fertilization (IVF). To date there are about 400 babies who have been born worldwide using IVM compared with around two million by IVF
Infertility involves 1 in every 7 couples after 1 to 2 years of trying to conceive. It can be due to male or female factor or a combination of both. Treatment differs and can be as simple as timed coitus or a more technological demanding process like the IVF.
The current IVF treatments use daily injections of medications to induce the development of multiple follicles in the ovaries in the hope of making the eggs mature faster within the follicles. Once the follicles are of appropriate size, the mature eggs within the follicles are harvested and then fertilised with sperm in the laboratory to create embryos.
IVM does not involve stimulation of ovaries by daily drugs injections. Only minimal medications are required. Therefore the eggs within the ovarian follicles are not mature. The immature eggs are harvested in a similar way to the IVF technique, and kept in the laboratory’s Petri dish for 24 to 48 hours until they are mature. Following maturity, the eggs are then fertilized by micro injecting sperm directly into them by a process called ICSI or intra cytoplasm sperm injection. Hence the eggs maturation happens in the laboratory rather than the ovaries. This is the basis of IVM treatment. Two or three days after fertilisation, the developing embryos are transferred to the mother’s womb. The treatment is also expected to be shorter than IVF.
In IVF, the ovaries are stimulated with medications such as gonadotrophins to increase the number of mature eggs. As result of this, there is high cost involved as the drugs are very expensive. The women require daily injection with the medications and frequent monitoring which can be a nuisance. There are potential side effect from the medications which can cause abdominal bloating, breast tenderness and mood swing. There is possible link to ovarian cancer which has not been quantified and may deter many women from having treatment.
The most important well-recognised danger to the women undergoing IVF treatment is ovarian hyper stimulation syndrome (OHSS). The most severe form occurs in 1 % of women undergoing treatment especially those with polycystic ovary syndrome (PCOS). Those with ovarian hyper stimulation syndrome as results of daily injections with medications will produce too many eggs which may be associated with ovarian enlargement, abdominal distension, accumulation of fluid in the abdomen and blood in the body to be concentrated. These conditions if severe can be fatal. It is more likely to happen in young women with polycystic ovary syndrome (PCOS), a leading cause of infertility. Women with polycystic ovary syndrome (PCOS) are usually obese, have irregular menstrual cycle and infertile.
In IVM all the risks associated with IVF are being minimised. It is presently a useful procedure for two groups of women: those who are fertile, with normal cycles, who don't need stimulating hormones to help them to become pregnant, but who are undergoing IVF because their partners have impaired sperm, and for women with polycystic ovarian syndrome (PCOS) who are at an increased risk of developing ovarian hyper stimulation syndrome (OHSS) during IVF hormone treatment.
In IVF, one of the main factors affecting the success rate is the age of the women. This is likely to be the case in IVM. Generally women who are less than 35 years tend to respond better. The other important factor is the number of immature eggs collected. The more number of eggs collected, the more embryos are produced, and therefore the greater the choice of embryo selection for transfer. About 70% of the immature eggs retrieved will be successfully matured in the laboratory. But only 60% of the mature eggs, following fertilisation will develop into embryos.
The major disadvantage in IVM is its success rate which is only between 20 to 25%. This figure is very low compared to IVF which can be as high as 45%. However IVM is at the infant stage. When IVF started in the 1980s the success rate then was only 14%. Another major shortcoming with IVM is that the cultured mature eggs have hardened egg shells. As result of this, insemination can only be done by micro injection of sperm into the egg or ICSI. Finally the culture media use to nurture the eggs to maturity need to be improved. It is hope that by improving the culture media, the percentage of mature eggs per cycle of treatment would improve.
IVM is a potentially cheaper, shorter and a safer option of treatment for infertility. However, its usefulness is presently limited to only a few groups of patients. More research is needed to support its use. It’s now up to the scientists to explore this revolution in fertility treatment.
Summary
1. IVF is more expensive than IVM. The cost of treatment ranges between RM15000 to RM18000 while IVM may cost only around RM5000 to RM8000 per treatment cycle.
2. All risks associated with IVF are less in IVM especially Ovarian Hyperstimulation Syndrome (OHSS)
3. IVM is a new technology and hence the success rate is low compared to IVF. More research is needed to support its use.
4. IVF will remain the mainstay of treatment for infertile couple while IVM may be suitable to certain groups.
Since the birth of Louise Brown in 1978, in vitro fertilization (IVF) has advanced tremendously and has proven to be a very successful treatment for infertile couples. However, there are some drawbacks to this mode of treatment which may deter many women from treatment.
In vitro maturation (IVM) was first introduced by doctors in Denmark in the late 1990s. It is a revolutionary treatment technique developed to help couples with infertility problems which could potentially lead to cheaper and safer treatment compared to the conventional in vitro fertilization (IVF). To date there are about 400 babies who have been born worldwide using IVM compared with around two million by IVF
Infertility involves 1 in every 7 couples after 1 to 2 years of trying to conceive. It can be due to male or female factor or a combination of both. Treatment differs and can be as simple as timed coitus or a more technological demanding process like the IVF.
The current IVF treatments use daily injections of medications to induce the development of multiple follicles in the ovaries in the hope of making the eggs mature faster within the follicles. Once the follicles are of appropriate size, the mature eggs within the follicles are harvested and then fertilised with sperm in the laboratory to create embryos.
IVM does not involve stimulation of ovaries by daily drugs injections. Only minimal medications are required. Therefore the eggs within the ovarian follicles are not mature. The immature eggs are harvested in a similar way to the IVF technique, and kept in the laboratory’s Petri dish for 24 to 48 hours until they are mature. Following maturity, the eggs are then fertilized by micro injecting sperm directly into them by a process called ICSI or intra cytoplasm sperm injection. Hence the eggs maturation happens in the laboratory rather than the ovaries. This is the basis of IVM treatment. Two or three days after fertilisation, the developing embryos are transferred to the mother’s womb. The treatment is also expected to be shorter than IVF.
In IVF, the ovaries are stimulated with medications such as gonadotrophins to increase the number of mature eggs. As result of this, there is high cost involved as the drugs are very expensive. The women require daily injection with the medications and frequent monitoring which can be a nuisance. There are potential side effect from the medications which can cause abdominal bloating, breast tenderness and mood swing. There is possible link to ovarian cancer which has not been quantified and may deter many women from having treatment.
The most important well-recognised danger to the women undergoing IVF treatment is ovarian hyper stimulation syndrome (OHSS). The most severe form occurs in 1 % of women undergoing treatment especially those with polycystic ovary syndrome (PCOS). Those with ovarian hyper stimulation syndrome as results of daily injections with medications will produce too many eggs which may be associated with ovarian enlargement, abdominal distension, accumulation of fluid in the abdomen and blood in the body to be concentrated. These conditions if severe can be fatal. It is more likely to happen in young women with polycystic ovary syndrome (PCOS), a leading cause of infertility. Women with polycystic ovary syndrome (PCOS) are usually obese, have irregular menstrual cycle and infertile.
In IVM all the risks associated with IVF are being minimised. It is presently a useful procedure for two groups of women: those who are fertile, with normal cycles, who don't need stimulating hormones to help them to become pregnant, but who are undergoing IVF because their partners have impaired sperm, and for women with polycystic ovarian syndrome (PCOS) who are at an increased risk of developing ovarian hyper stimulation syndrome (OHSS) during IVF hormone treatment.
In IVF, one of the main factors affecting the success rate is the age of the women. This is likely to be the case in IVM. Generally women who are less than 35 years tend to respond better. The other important factor is the number of immature eggs collected. The more number of eggs collected, the more embryos are produced, and therefore the greater the choice of embryo selection for transfer. About 70% of the immature eggs retrieved will be successfully matured in the laboratory. But only 60% of the mature eggs, following fertilisation will develop into embryos.
The major disadvantage in IVM is its success rate which is only between 20 to 25%. This figure is very low compared to IVF which can be as high as 45%. However IVM is at the infant stage. When IVF started in the 1980s the success rate then was only 14%. Another major shortcoming with IVM is that the cultured mature eggs have hardened egg shells. As result of this, insemination can only be done by micro injection of sperm into the egg or ICSI. Finally the culture media use to nurture the eggs to maturity need to be improved. It is hope that by improving the culture media, the percentage of mature eggs per cycle of treatment would improve.
IVM is a potentially cheaper, shorter and a safer option of treatment for infertility. However, its usefulness is presently limited to only a few groups of patients. More research is needed to support its use. It’s now up to the scientists to explore this revolution in fertility treatment.
Summary
1. IVF is more expensive than IVM. The cost of treatment ranges between RM15000 to RM18000 while IVM may cost only around RM5000 to RM8000 per treatment cycle.
2. All risks associated with IVF are less in IVM especially Ovarian Hyperstimulation Syndrome (OHSS)
3. IVM is a new technology and hence the success rate is low compared to IVF. More research is needed to support its use.
4. IVF will remain the mainstay of treatment for infertile couple while IVM may be suitable to certain groups.
Thursday, January 3, 2008
I CAN'T SEEM TO STOP CRYING
Marsali MacDonald PhD
Senior Clinical Counsellor
CARE Fertility
Nottingham, UK
COPING WITH A FAILED TREATMENT
Grief is our natural response to losing something precious. What then could be a more normal reaction to the devastating news that you are not having a baby than to cry as though you will never stop? Crying is a perfectly healthy expression of grief and is the most healing way to relieve the pain of loss.
Yet, when people talk about ''not being able to stop crying'' it is as though that is somehow weak and shameful-something that must be stopped. People often say that they hold back the tears because, if once they started, they would cry forever; OR if they let go of the desperate feelings inside they would 'blow apart' OR 'go mad'. Very scary feelings-but no one ever went mad from crying.
It is part of our 'stiff upper lip' tradition. I suppose, that makes us think that any expression of emotion is not acceptable. Strictly for wimps! We grow up being told that 'big boys dont cry'-and neither really, do 'big girls', so we learn early on to hide our most natural feelings. And when bad things happen to us the pain builds up inside until it feels intolerable-while we go about our daily business pretending that we are fine.
Probably one of the worst things about a failed treatment is that few people have any idea of the pain involved. Family and friends, if they know at all, seldom have any real appreaciation of the enormity of your loss. In some ways a failed treatment can be worse than a more obvious loss-one that is acknowledged by society-because its significance goes unrecognised and you are left to cope with that gut wrenching empitiness on your own.
Perhaps it is because the loss is not recognised for what it is that so many couples feel that they should not be feeling as bad as they do; that they should 'get a grip' and get on with life as though nothing has happened. And their pain is compounded by the feeling that they should not really be so distressed. But without doubt, a failed treatment is an enermous loss. It is not just the loss of those embryos, real and life, with all their potential for beautiful childhood-it is the confirmation of the loss of fertility-and for the future without children. That is more loss than many people have to cope with in a lifetime.
But your feelings are real; your grief is valid. Do not minimise your loss and marginalize your feelings. Let yourselves grieve for those children who will never be: for those loss embryos, for the loss of your hopes. By letting yourselves grive you are acknowledging how important those embryos were-in themselves as potential children-and to you as their potential parents. Their existence, however brief, was priceless-and what more appropriate response to their loss than to cry as though you will never stop?
Crying would not change what has happened; the scar will always be there. But grieving, however long it takes, will heal the wound and, in time , the pain will abate.
Senior Clinical Counsellor
CARE Fertility
Nottingham, UK
COPING WITH A FAILED TREATMENT
Grief is our natural response to losing something precious. What then could be a more normal reaction to the devastating news that you are not having a baby than to cry as though you will never stop? Crying is a perfectly healthy expression of grief and is the most healing way to relieve the pain of loss.
Yet, when people talk about ''not being able to stop crying'' it is as though that is somehow weak and shameful-something that must be stopped. People often say that they hold back the tears because, if once they started, they would cry forever; OR if they let go of the desperate feelings inside they would 'blow apart' OR 'go mad'. Very scary feelings-but no one ever went mad from crying.
It is part of our 'stiff upper lip' tradition. I suppose, that makes us think that any expression of emotion is not acceptable. Strictly for wimps! We grow up being told that 'big boys dont cry'-and neither really, do 'big girls', so we learn early on to hide our most natural feelings. And when bad things happen to us the pain builds up inside until it feels intolerable-while we go about our daily business pretending that we are fine.
Probably one of the worst things about a failed treatment is that few people have any idea of the pain involved. Family and friends, if they know at all, seldom have any real appreaciation of the enormity of your loss. In some ways a failed treatment can be worse than a more obvious loss-one that is acknowledged by society-because its significance goes unrecognised and you are left to cope with that gut wrenching empitiness on your own.
Perhaps it is because the loss is not recognised for what it is that so many couples feel that they should not be feeling as bad as they do; that they should 'get a grip' and get on with life as though nothing has happened. And their pain is compounded by the feeling that they should not really be so distressed. But without doubt, a failed treatment is an enermous loss. It is not just the loss of those embryos, real and life, with all their potential for beautiful childhood-it is the confirmation of the loss of fertility-and for the future without children. That is more loss than many people have to cope with in a lifetime.
But your feelings are real; your grief is valid. Do not minimise your loss and marginalize your feelings. Let yourselves grieve for those children who will never be: for those loss embryos, for the loss of your hopes. By letting yourselves grive you are acknowledging how important those embryos were-in themselves as potential children-and to you as their potential parents. Their existence, however brief, was priceless-and what more appropriate response to their loss than to cry as though you will never stop?
Crying would not change what has happened; the scar will always be there. But grieving, however long it takes, will heal the wound and, in time , the pain will abate.
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