Medication and herbal supplements

Confusion about adjuvant medication, natural herbal supplements. What should I take when I'm trying to fall pregnant? The prenatal vitamins is a supermarket aisles and chemist aisles full of different combination of vitamins and minerals can cause confusion . Some have vitamin D, some are filled with the iron, some have more coenzyme Q10, some have more vitamin E, some have more folic acid than others. What is really the ideal supplement that you need for when you're trying to fall pregnant?

A majority of the time when you're on a healthy lifestyle and a healthy diet, people are not deficient of nutrients. It's recommended that 500 micrograms of folic acid be taken three months prior to conception and three months into conception. Anything above folic acid, it's usually best to discuss with your doctor. If you're anemic, you might need some iron supplements. If your vitamin D levels are low, you might need vitamin D supplements. A good multivitamin that has all possible prenatal vitamins and minerals is not a bad idea if you're a poor eater or if your being deficient due to some chronic diseases or gut malabsorption syndromes. They're not necessarily essential.

One of the misconception some of my patients have is the role of folic acid in conception "But doctor, we've been taking folic acid for almost a year and we're not pregnant." Folic acid is not a fertility medication. It's recommended because folic acid helps in growth and development of new cells, especially of neural tubal region, and therefore reduces the incidence of baby's brain development issues or deformity. And so, it's required essentially for the growth and development of new tissue, not necessarily help you fall pregnant.

There are some conditions in which a high dose of folic acid is desirable and it might be patients who are diabetic or patients who have had a previous child affected by neural tube defect like spinal bifida or other neural tube abnormalities. There are some patients who don't absorb folic acid very well, as they have an enzyme defect that prevents adequate metabolism of folic acid ( MTHFR) and we sometimes prescribe a high dose folic acid for those patients or an active form of folic acid called folinic acid.

I suggest any supplements over and above the usual recommendations of preconception formula should be taken with caution. You should discuss it with your doctor.

Please my office on 03 9473 4730 and make an appointment if you would like to discuss it further.

(c) Chandrika Parmar

Patience and focus on yourself in your journey to fall pregnant

Fertility treatments, often test your patience. For people who are trying to fall pregnant every month that passes that they're not pregnant or they have a menstrual cycle, it's quite difficult sometimes to keep going. Sometimes we advise counseling. Sometimes we advise taking a break, going out and enjoying your life. Take a short holiday, forget about trying. Get involved in fun filled activities around you that you love doing.

I'd say it's not uncommon for people trying to fall pregnant to actually forget to live, and it's really, really hard to find a balance where on the one side, you're really devastated by not being able to fall pregnant. The other side life must go on.

Let's say on an average each month, the chance of falling pregnant if you're under 35 is about 15% per month. That's not a lot, but that's what the chances are. It can take three to six months and sometimes nine to 12. Fertility treatments are there to help, but they certainly don't carry 100% success rate. Sometimes they can increase your baseline pregnancy rate to 15% to 20%, and occasionally up to 30%. It still could take with assisted fertility, a few months to get pregnant.

Sometimes seeing a counselor on the side helps. Counselors, especially fertility counselors, are really important in giving you an unbiased opinion of what's happening, helping you establish some coping mechanism. And the most important thing is to remember that the two of you exist together because you want to be together. You want to have fun together. You want to live your life together.

And the process of creating this child started with the two of you enjoying yourself so much that you wanted to extend it into a family. It's important not to forget that and focus on yourself sometimes. Hopefully that family will happen soon. While it's not happening, don't forget yourself. Enjoy life.

lease feel free to call my office on 03 9473 4730 and make an appointment.

(c) Chandrika Parmar

Egg freezing: why women are buying time

Please find the link to my article that appeared on BUPA website on July 18, 2016

Every story and every journey is different!

Saw A. and M. today, this gorgeous couple who's been seeing me for about almost three years. They're young. They're only 31, 32. When they first came, they had a desire to have a big family. Neither of them knew that they had issues. They started trying. Things didn't happen for six months. They decided to see their GP. Baseline investigations from the GP was all fine. The GP gave them a referral, saying, and I remember reading this note from GP, saying, "They're not really keen on doing anything exciting or IVF. They just want some general advice about fertility."

I remember seeing them after reading the GP's note and reading between the lines, and knew that this is a young couple who was not keen on IVF treatment, which is absolutely fine, because IVF is usually used as a last resort, but sometimes IVF is essential. You can't move forward without it.

With that in mind, I remember doing some investigations for both of them. A. just was perfect. Everything was fine, fit, healthy, beautiful, just had a very low AMH, or anti-Müllerian hormone, in other words. It's a test for ovarian reserve, or how many eggs that there are in a ovary for any given age, which was the first indication of something being not quite right. M. just had some issues with the semen analysis, other than that, was a perfect bill of health.

They walked out of the office today very happy because they are pregnant and they are ever so grateful. It's taken them three long years to get here, and during the three long years' journey, they have tried everything that was not IVF. It didn't work. They eventually resorted to IVF treatment and it worked.

For a lot of people, when it's absolutely unexplained or some minimal issues with their fertility, it's just really hard to know what's going on. The the eggs are released in the body. The sperm finds the egg in the body. There's no way of putting a real time camera in the uterus. I sometimes wish I could invent that, put a camera inside the uterus and see what's going on with those two. What's the egg doing? Is it accepting the sperm? Are they fertilizing? Are they lodging back into the uterus for implantation?

There is so much that we do not know. We're all learning as we go. If you are having difficulty falling pregnant, and you spend a lot of time wondering about what to do next, it's best to make an appointment.

Please feel free to call my office on 1800 PARMAR and make an appointment.

(c) Chandrika Parmar

Polycystic ovarian syndrome may not be as complex as you think!

Polycystic ovarian syndrome is a condition where you have a hormonal imbalance where you don't have the right balance of estrogen and progesterone. Sometimes you're not ovulating, and other times you have excess male hormones in your system, which gives rise to some of the side effects of symptoms of polycystic ovarian syndrome like facial hair, hair on your breast, hair around your belly button. Your visits to the beauty salon increases probably waxing and laser treatment increase. Sometimes it gives rise to insulin resistance and altered carbohydrate metabolism, and you're just not able to lose weight. In fact, the body is so sensitive to rises of insulin that you could very easily put on weight if you're not careful. You could sweat it out in the gym, but not lose weight as quickly as you girlfriend does who doesn't have polycystic ovarian syndrome.

There are times when polycystic ovarian syndrome does not have any symptoms. The only symptom you have is lack of ovulation. It can present in any form from a spectrum of absolutely normal cyclical rhythm menstruation and no male hormone symptoms, normal looking pelvic ultrasound scans and having no issues with falling pregnant, to the other end of the spectrum where you can have everything possible.

Whilst polycystic ovarian syndrome is in some ways a misnomer and the ovaries are not always polycystic .Its not a disease but rather a condition where things are out of balance and sometimes you would need assistance to get it back to normal. A lot of the management and treatment on polycystic ovarian syndrome is based on lifestyle, healthy diet exercise, trying to normalize your BMI, possibly cutting out processed carbohydrate from diet and just being sensible. There is a genetic basis for polycystic ovarian syndrome, so you can't totally clear it off the system, however you can control it. When it comes to fertility sometimes you may need some simple treatments like ovulation inducing medication. Very commonly prescribed by fertility specialists and best taken under supervision and cycle monitoring to get a better outcome .

If you're having issues with polycystic ovarian syndrome, just want some advice and lifestyle management or wanting to fall pregnant, make an appointment.

Please feel free to call my office on 1800 PARMAR and make an appointment.

(c) Chandrika Parmar