SINCE Independence, Malaysia’s total fertility rate has been on the decline. Dr K.K. Iswaran, consultant obstetrician and gynaecologist, also sub-specialist in reproductive medicine and in vitro fertilisation, says that Malaysian women’s capability of bearing more children has decreased over the years. “The fertility rate is the average number of children that would be born to a woman over her lifetime. It has dropped from 5.8 to 3.2 in the year 2000 and further dropped to 2.6 this year. In women, the problem of infertility stems from an increasing trend of postponing the child bearing years beyond their most fertile years of between 19 to 24 years old,” said Dr Iswaran.
“On top of this, the stress from work that the women are facing these days as well as the multitude of fertility problems such as polycystic ovarian syndrome, which has the genetic predisposition, results in the rise of male hormones, poor egg quality, insulin resistance resulting in obesity further contributes to the reduction of the fertility rate.”
He said the incidence of vaginal infections is increasing and it should be assessed by a gynaecologist so that appropriate treatment and screening for sexually transmitted disease are carried out.
DR K.K. ISWARAN: Consultant obstetrician and gynaecologist
Dr Iswaran is the outgoing head of reproductive medicine (fertility unit) at Hospital Kuala Lumpur (HKL).
He has been the head of the unit since 2008.
“IVF pregnancy rate among the patients who came to us was just under five per cent in 2008. The rate has doubled each year and the current pregnancy rate has risen to 40 per cent. This is contributed by the various initiatives that have been put in place to screen and pre-treat patients to ensure that they are optimised for fertility treatment,” he said.
In doing so, Dr Iswaran developed the gynae-endocrine clinic in HKL where gynaecologists and endocrinologists provide treatment for patients with severe endocrine abnormalities such as hyperprolactinemia, hyper/hypothyroidism and hosts of other endocrine abnormalities which result in infertility.
The andrology clinic is also one of Dr Iswaran’s initiatives due to the rising male infertility rate, whereby a gynaecologist and an urologist jointly manage patients with azoospermia (no sperm) or poor sperm parameters to ensure that the quality and quantity of sperm are suitable for intracytoplasmic sperm injection (ICSI).
The unit has a dedicated reproductive surgery session to handle patients who require surgery prior to IVF treatment. Patients with endometriosis, one of the causes of infertility may require laproscopic (minimal invasive) surgery to remove ovarian cysts or release of adhesions so as to improve the pregnancy rate.
The reproductive medicine unit of HKL has taken the advantage of the DaVinci robotic system to provide robotic surgery for the removal of uterine fibroids and severe endometriosis. As for patients with blocked tubes or previous tubal ligation, reanastomosis of the tubes can also be carried out via robotic surgery.
Cyropreservation (freezing of gametes, sperms, oocytes, ovarian tissues) is being carried out for young cancer patients prior to the commencement of chemo/radiotherapy to preserve the fertility for future use. This is the only unit under the Ministry of Health that provides such services.
Dr Iswaran is also the chairman of the Fertility and Sterility sub-committee of the O&G Society of Malaysia.
Together with the Ministry of Health, the reproductive medicine unit of the O&G department at HKL initiated the first Malaysian Reproductive Medicine Congress in 2009.
The congress featured renowned reproductive medicine consultants and embryologists to share their knowledge. Dr Iswaran was the organising chairman of the congress in 2011 as well and presently advises the upcoming congress in 2013.
The reproductive medicine unit of HKL provided the necessary information to support the Ministry of Health’s initiative towards subsidised fertility treatment.
All the developments at the HKL reproductive medicine unit and also towards subsidised care would not have been possible without the support of the ministry’s director-general of health past and present.
And the present subsidy is for 100 cycles and the cost to the public is RM4,000 per fertility treatment.
Dr Iswaran continues to seek new sources of funds for fertility treatments to improve and further develop reproductive medicine and fertility treatment in Malaysia.
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