We spoke with Dr. Yeong Cheng Toh, fertility specialist and medical director of IVF(SG), to discuss the fertility challenges and how environmental factors affect fertility.
Regarding patients with PCOS, how would you approach treatment for them, and how does PCOS typically impact fertility?
Polycystic ovary syndrome (PCOS) is quite common, and its prevalence can be influenced by ethnicity, with certain groups being more prone to the condition. PCOS is characterized by multiple follicles, hormonal imbalances, and sometimes elevated androgen levels. These patients typically respond well to IVF treatment.
Our approach is holistic. For overweight patients with polycystic ovaries, we focus on helping them reach a healthy BMI through lifestyle changes, including referrals to nutritionists, exercise, and dietary adjustments. Achieving the right BMI is crucial before starting IVF, as it ensures the body is in the optimal condition to carry a pregnancy.
PCOS can be managed before IVF. Many patients experience ovulation problems, and we emphasize the importance of lifestyle changes and ovarian induction. For younger patients without sperm issues, ovulation induction may be enough to achieve pregnancy naturally.
However, many PCOS patients come to us later, around ages 37 or 38, after trying for several years. At this stage, IVF becomes a more viable option, offering higher success rates per cycle compared to other treatments.
What about the complexities of endometriosis? How does it affect fertility, and what is your approach to diagnosing and treating it?
Endometriosis can be both debilitating and progressive. It occurs when the uterine lining grows outside the uterus, causing pain, heavy periods, and difficulty conceiving. Diagnosing it can be challenging, but it’s often based on clinical symptoms. The gold standard for diagnosis is laparoscopy, where a camera is inserted to view the lesions.
Endometriosis primarily causes infertility by distorting the anatomy—blocked fallopian tubes, endometriotic cysts in the ovaries, and other obstructions that impair ovulation. Whether we treat it before IVF depends on the patient’s condition. In cases of mild endometriosis, we often prioritize egg retrieval and embryo freezing before addressing the endometriosis itself.
Surgery to remove cysts can reduce ovarian reserve, particularly in older patients, so we carefully weigh the risks and benefits before proceeding with surgery.
We hear that toxins in personal care and hair care products can impact our endocrine health. Should we aim to reduce our exposure to toxins?
This is a common concern, and there is much discussion about the potential effects of toxins like microplastics, environmental factors, and what we consume. The saying, “We are what we eat,” holds true to some extent. We advise pregnant women to be mindful of what they consume, as it directly impacts their health. While it’s important to recognize that certain products may affect fertility, the extent of their impact is still not fully understood.
The amount of hair products absorbed through the scalp is likely minimal. Manufacturers typically report that the vast majority of users are unaffected, so my advice is to approach these concerns sensibly—everything in moderation.
