Dr Somas on FB Live

dr somas penang

I was invited by Krista of Redbox Studio to be on FB Live with her to talk about women’s reproductive health as well as answer questions from the people who were watching us live on Facebook. Here is a replay of our video interview session today.

In this interview, I talk about what I do as a gynaecologist, the babies I’ve delivered, the biggest baby I’ve delivered and I also answered questions on fibroids, POI and menopause from the people who were watching.

Causes of Male Infertility

The definition of infertility in a couple is defined as the inability to achieve pregnancy despite one year of frequent and unprotected intercourse.

The distribution of male and female causes of infertility has not been well defined.

However, some studies have quoted, 20 percent of cases were attributed to male factors, 38 percent were attributed to female factors, 27 percent had causal factors identified in both partners, and 15 percent could not be satisfactorily attributed to either partner.

Recent reports have shown increasing incidence of declining sperm counts as well as increasing incidence of urogenital abnormalities and testicular cancer in some regions of the world. Epidemiology studies suggest that fertility rates are lower in men over age 40.

While many men with male infertility have a decrease in number of sperm cells in the ejaculate, or no sperm cells in the ejaculate, some infertile men have normal sperm counts.

Over 80 percent of men with infertility have low sperm concentrations associated with a decrease in sperm motility. Others may have a decrease in sperm motility and abnormal sperm morphology.

What if the seminal analysis is abnormal?

A semen analysis, which is a non-invasive test that evaluates semen and sperm health, should be done before any treatments (even clomid) are tried.
One abnormal results doesn’t mean male infertility.

The semen analysis can be affected by recent illness/flu, anxiety/stress at work. The Seminal Analysis has to be repeated to confirm the results, to see if the abnormal results repeat.

Tips to help increase sperm counts
  • Avoiding toxic chemicals at workplace/home. (Pesticides, paint, varnish etc.)
  • Avoid hot showers , hot long baths, steam/sauna. (Don’t sit with laptops on your thighs!)
  • Stop smoking
  • Increase anti-oxidants in your diet. (Increase intake of zinc, Vitamin C, Vitamin E, folic acid, selenium)
  • Maintain healthy weight (obese men have low sperm count)
  • Reduce alcohol intake (excessive drinking reduces sperm count and movement)
  • Reduce soy intake (The study found men who ate high amounts of soy had lower sperm counts than men who did not)
  • Have frequent intercourse (Have intercourse every other day during the fertile period)

What Should You Eat When You’re Pregnant?

To maintain a healthy weight when you are having a baby depends on both the amount and the type of food you eat before you become pregnant and during your pregnancy.

Being overweight carries risks for you and your baby.

The more overweight you are, the greater the risks. Being underweight increases the risk of your baby not growing as well as he or she should.

Simply being at a correct weight for your height does not necessarily mean that you are eating healthily.

Some foods are best avoided if you are planning to become pregnant or if you are already pregnant, as they may contain substances that could affect your unborn baby’s development.

What’s a healthy diet for pregnant women?
  • Your meals should contain starchy foods such as potatoes, bread, rice and pasta, choosing wholemeal (These foods are filling without containing too many calories)
  • Eat at least five portions of different fruits and vegetables every day rather than foods that are higher in fat and calories
  • Eat a low-fat diet. Eat as little fried food as possible and avoid drinks that are high in added sugars, and other foods such as sweets, cakes and biscuits that have a high fat or sugar content
  • Eat fibre-rich foods such as oats, beans, lentils, grains and seeds, as well as wholegrain bread, brown rice and wholemeal pasta.
  • Eat some protein every day; choose lean meat, and try to eat two portions of fish a week. Lentils, beans and tofu are also a good source of protein
  • Eat dairy foods for calcium but choose low-fat varieties such as skimmed milk or low-fat yogurt
  • Watch the amount of food that you eat. (Do not ‘eat for two’!)
  • Always eat breakfast
  • If you must have coffee, limit yourself to 1-2 cups of coffee per day.
What vitamins do pregnant women need?

You need extra vitamins during pregnancy as they’re needed for growth and development of the fetus/baby. There are 13 important vitamins: vitamins A, C, D, E and K and the vitamin B series.

Apart from vitamin D, which we get from sunlight, most vitamins come from our diet. It is quite common for people to be low in vitamin D and folic acid (vitamin B9). These vitamins are important in pregnancy and you can boost your levels by taking vitamin supplements.

Folic acid
Folic acid is one of the B vitamins and helps to reduce the risk of your baby having spina bifida or Neural Tube Defects. Taking extra folic acid may also reduce the risk of heart or limb defects and some childhood brain tumours. The recommended daily dose is 400 micrograms (μg). Ideally, you should start taking extra folic acid before you conceive and continue to take it until you reach your 13th week of pregnancy.

Vitamin D
All pregnant women are advised to take vitamin D when pregnant and breastfeeding. This is because it is common for people to have low levels of vitamin D.

How To Conceive a “Horse” Baby

The year of the Horse starts in February 2014 and it takes seven days and nine months to produce a baby. So NOW is the time to conceive if you a thinking of having a “Horse” baby.

“Horses are trustworthy, friendly and open-minded. They are good friends to have and will always be honest with you.”

“Horse people are extemporaneous and quick-witted. They are quite intelligent and use their practicality to their advantage in their business and personal lives. Their sharpness makes them quick to pick up new skills and are able to handle many tasks at one time.”

So the time has come to try and get that “hard working, intelligent Horse!”

Most doctors would recommend seeking help for fertility if…

  • you’re 35 years old or younger and you’ve been unable to get pregnant after unprotected intercourse for at least one year.
  • you’re over 35 years of age, and you have not been able to get pregnant after six months (because as we know, the chances for successful treatment rapidly decline after 35).

Before you start thinking about getting pregnant, you should do what you can to get healthier.

Not only will a healthier person increase the chances of getting pregnant, it’ll also increase the possibility of you having a healthy baby.

Things you can do to get healthier include (this implies to both the partners):

  • Losing extra weight
  • Choosing a healthier diet
  • Cutting back on caffeine
  • Starting a fertility-friendly exercise routine
  • Quitting smoking
  • Cutting back on excess alcohol.

The first step in the management of a couple trying to conceive naturally is to investigate if there are any factors that are preventing natural conception.

Some of the common reasons, why couples do not conceive naturally after trying for a year or so:

  • Male factor – inability for the male to produce sufficient number of sperms of suitable quality.
  • Female factor – inability to ovulate monthly
  • Tubal factor – tubal blockage/adhesions that prevents the sperm from meeting the eggs.

Do not forget to take Folic Acid, as it has proven to be beneficial in reducing the incidence of neural defects in babies. Folic acid should be taken about 2 weeks before getting pregnant!

Do not hesitate to seek help early!

Bahasa Indonesia version of this page available here.


Vagina Infections & Douching: Myths & Facts

Vaginal infections or Vaginitis is an inflammation of the vagina that creates discharge, odour, irritation, or itching. It is difficult to diagnose because vaginitis has many causes.

Women use a variety of over the counter medications to treat the itching, discharge, and discomfort of these conditions.

The vagina creates its own environment and maintains a balance among the normal bacteria found there and the hormonal changes in a woman’s body.

Some vaginal discharge is quite common and normal for women of child bearing age. Normally, cervical glands produce a clear mucous secretion that drains downward, mixing with bacteria, discarded vaginal cells, and Bartholin gland secretions at the opening of the vagina.

These substances may (depending on how much mucous there is) turn the mucous a whitish colour, and the discharge turns yellowish when exposed to air. There are times throughout the menstrual cycle that the cervical glands produce more mucous than others, depending on the amount of oestrogen produced.

This is normal.

Vaginitis occurs when the vaginal ecosystem has been changed by certain medications such as antibiotics, hormones, contraceptive preparations (oral and topical), douches, vaginal medication, sexual intercourse, sexually transmitted diseases, stress and change in sexual partners.

• Some vaginal infections are transmitted through sexual contact, but others such as yeast infections probably are not. Vaginitis means inflammation and is often caused by infections, but may be due to hormonal changes (especially when a woman is going through menopause).

What women should know about vaginal douches

A vaginal douche is a process of rinsing or cleaning the vagina by forcing water or another solution into the vaginal cavity to flush away vaginal discharge or other contents.

Vaginal douches are available over the counter and are made in a variety of fragrances by several manufacturers; they are also available by prescription to treat certain conditions or prepare for certain procedures.

Why do some women use vaginal douches? 

Women choose to use douches for a variety of reasons. Many of these are related to myths or misinformation about what vaginal douches can do.

A woman may use a douche to:

• Rinse away any remaining menstrual blood at the end of the monthly period. This is not necessary since the body will clean itself.

• Avoid pregnancy or sexually transmitted diseases following sexual intercourse. However, douching is neither a contraceptive nor a preventative measure against STDs or other infections. It can, in fact, increase the risk of developing an infection.

• Reduce vaginal odours. Women who have an unusual vaginal odour need to see their clinician for proper diagnosis since extreme odour may be sign of an infection or other serious problem, and using a douche may only complicate the condition.

• Feel “cleaner”.  The vagina actually cleans itself so vaginal douches are not necessary.

So, is douching a healthy practice? 

The answer is no.

According to a study published by the American Journal of Public Health, douching may reduce a woman’s chance of becoming pregnant during a particular month by approximately 30%.

Regular vaginal douching changes the delicate chemical balance of the vagina and can make a woman more susceptible to infections.

Douching can introduce new bacteria into the vagina which can spread up through the cervix, uterus, and fallopian tubes.

Researchers have found that women who douche regularly experience more vaginal irritations and infections such as bacterial vaginosis, and an increased number of sexually transmitted diseases.

Furthermore, regular users of vaginal douches face a significantly higher risk of developing PELVIC INFLAMMATORY DISEASE (PID) — a chronic condition that can lead to infertility, or even death, if left untreated.

Bacterial vaginosis and PID can have serious adverse affects on pregnancy including infections in the baby, labour problems, and preterm delivery. For these reasons, douching is no longer recommended as a safe or healthy way to routinely clean the vagina.

The only safe and healthy way to clean the vagina is to let the vagina clean itself. The delicate chemical balance of the vagina is very sensitive and easily disrupted by routine vaginal douching.

How does the vagina clean itself? 

The vagina cleans itself naturally with its own mucous secretions.

When bathing or showering use warm water and gentle unscented soap to cleanse the outer areas of the vagina. Feminine hygiene products such as soaps, powders, and sprays are not necessary and may lead to irritation of sensitive tissues.

When is time to see your gynaecologist?

It’s time to visit your gynaecologist when you suffer from:

• Vaginal pain
• Vaginal itching
• Vaginal burning
• A foul odour from your vagina
• Painful urination
• Any vaginal discharge that is different from your normal discharges such as thick and white, cottage cheese-like, or yellowish-green

If you suspect you have a vaginal infection contact your doctor for diagnosis and treatment — do not try to wash it away with a douche!

Finally, if you’re visiting your gynaecologist, remember never to douche before your visit!