In this article, Dr Lim Min Yu, an IVF clinician and OB/GYN from the Astra Women’s & Fertility Centre shares more about egg freezing as a way of preserving fertility.   Not only are fertility rates on the decline in Singapore, but couples are also choosing to get married and have children later in life. Age is an important factor affecting fertility and while you cannot stop the ageing process, there are ways to preserve fertility. What is Egg Freezing? Egg freezing, also known as oocyte cryopreservation, is a process in which a lady’s eggs (oocytes) are retrieved, frozen and stored as a way to preserve the fertility of a lady who wants to conceive later on in her life. Egg freezing enables ladies to avoid the issue of declining egg quality which is a common problem faced by women as they grow older. Reasons Why Ladies Freeze Their Eggs Ladies are born with all the eggs they will ever produce. Hence, as women grow older, the quality and quantity of eggs decline. Egg freezing is a way of preserving the healthy eggs of women when they are younger and not necessarily ready to conceive just yet. There are two main reasons why ladies often opt to freeze their eggs: 1. Medical A very common reason for ladies who want to freeze their eggs is to protect themselves from medical treatments that might affect their fertility and/or reproductive organs. A lady who is undergoing treatment for cancer might opt for egg freezing in case treatments such as chemotherapy and/or radiotherapy negatively affect fertility. Ladies who are at higher risk of getting cancer as a result of certain genetic conditions might also choose to freeze their eggs. This is because doctors may recommend removing the ovaries in order to reduce the risk of cancer developing. If ladies freeze their eggs before the ovaries are removed, they will still have the option of trying for pregnancy even after surgery. 2. Elective Some ladies are not ready to have a baby and start a family when they are in their peak reproductive years. As a result, some may prefer to have their eggs frozen so they can try for pregnancy even after their fertility has declined. This is also known as elective egg freezing. Egg Freezing in Singapore Egg freezing for medical reasons is allowed in Singapore and as of 2023, elective egg freezing will be allowed too. Each patient is different and therefore ladies should always consult their doctor to find out if egg freezing is a viable option. While there is no age limit for medical egg freezing, elective egg freezing is only available for ladies aged 21-35. To ensure ladies are able to make an informed choice, they will have to undergo counselling before their elective egg freezing procedure. The counselling session will highlight the invasive nature of the procedure, some of the limitations (no guarantee of a successful pregnancy, risks of a late pregnancy etc.) as well as the costs involved. What is the Egg Freezing Process Like? The initial stages of the egg freezing process are similar to the initial stages in an In-vitro Fertilisation (IVF) cycle. The lady is administered a series of hormone injections for about 2 weeks. She is observed with regular ultrasound scans and blood tests to determine if she is responding to the treatment well. When the eggs are mature, the lady will be administered a final injection. Then, the eggs are extracted from the lady while under sedation or a general anaesthetic. After the eggs have been extracted, they are examined by an embryologist and the mature eggs are then frozen. Most clinics use a flash-freezing method known as vitrification that will freeze the eggs at -196 degrees Celsius in under one minute. Vitrification is the preferred method of freezing as it has a much higher “post-thaw” survival rate for eggs of over 90% compared to the old method of freezing where the eggs only had a survival rate of about 60%. Are Eggs Harder to Freeze Than Sperms or Embryos Eggs are the largest cells in the human body, and largely made of water. When being frozen with the old slow freezing method, water forms ice crystals which can damage the egg. The vitrification process starts off with dehydrating the egg, to remove as much water as possible before ultra rapid freezing. Sperm are about 10,000 times smaller than eggs, with much less water in each cell. Therefore they are less susceptible to damage from ice crystal formation. Embryos are usually frozen when there are a few hundred cells. Therefore the chances of surviving the freezing process are better, as even if a few cells are damaged during the process, the other cells will survive, and resume cell division and multiplication once warmed up. What Happens After Egg Freezing? When the lady is ready to conceive, the eggs will be thawed and injected with sperm to achieve fertilisation. Upon successful fertilisation, the eggs are transferred to the uterus as embryos. Common FAQs Regarding Egg Freezing 1. When is the best age for me to freeze my eggs? Ladies should freeze their eggs before the age of 35. Fertility starts to decline after the age of 35 and this affects both the quality and quantity of the eggs. 2. How long can the eggs be kept frozen? In Singapore, there is no time limit on how long eggs frozen for medical reasons can be kept frozen. As freezing effectively hits the “pause” button, these eggs will be just as young and healthy as they were at the time of freezing. 3. Where are the eggs kept? Frozen eggs are kept in storage tanks filled with liquid nitrogen called Dewars. These tanks are stored in assisted reproduction centres. Some centres have sophisticated temperature monitoring systems that will send messages to the staff mobile phones if a rise in temperature is detected, enabling them to assess the situation and move the eggs to another tank if there is a problem. 4. Is egg freezing safe? Research to date has not shown an increased risk of babies having birth defects as a result of egg freezing. 5. If I freeze my eggs, will it increase my chances of falling pregnant? If you freeze your eggs when you are younger, you can use these healthier eggs when you are trying for a baby once you are much older. It is important to keep in mind that using the eggs that you have frozen to try for a baby does not mean you will definitely have a baby. There are many other factors that can affect your chances of falling pregnant. 6. Is egg freezing legal in Singapore? From 2023, the Singapore government has announced that ladies can now freeze their eggs for non-medical reasons.. You can find out more here. 7. How much will it cost if I need to freeze my eggs for medical reasons here in Singapore? The estimated cost of one cycle of egg freezing is $10,000.   Consult SMG Women’s Health for professional advice if you have any enquiries. *Content is republished with permission from SMG Women's Health.  

Pregnancy and delivery changes a woman forever – beyond physical changes, it also changes one mentally and emotionally. At a time when the new arrival takes priority over everything else, many women find themselves sacrificing their own practical and self-care needs in favour of the baby’s nutrition and safety. It is important to remember that postpartum care for yourself is critical so that you can be your best self as you bond with and care for your infant. Understanding the postpartum periodThe postpartum period encompasses the first 6 weeks after giving birth. This period, often dubbed as the fourth trimester, is a time when your body begins to heal and adjust to not being pregnant. It is described as a period of significant transition characterised by changes in self-identity, the redefinition of relationships, opportunities for personal growth and alterations to sexual behaviour as women adjust to the ‘new normal’. In short, there is definitely a lot going on!  There are many factors that come into play in your postpartum recovery journey. These include whether you’ve just had your first child or your third, vaginal or C-section delivery, if you had gestational diabetes or if your baby was born preterm. Nevertheless, there are some general changes in your body and mind that you can expect.  Changes to your bodyExpect some soreness in your vagina if you had a vaginal delivery. This would be accompanied by some bleeding over the first week. Bleeding is likely to gradually change to light-coloured discharge that may continue for about 6 weeks. You would also feel contraction-like sensations as your uterus is contracting back to its pre-pregnancy size.If you had delivered via C-section, you will experience pain at the site of incision. Movement is likely to be difficult. For example, you may have trouble getting in and out of bed. However, you are advised to move around to avoid blood clots from developing. Mood changesIt is common to feel sad during the first few days after delivery. You may also feel irritable, moody, anxious, may have difficulty concentrating or even experience sleep problems. As your hormone levels are changing during this period, with oestrogen and progesterone levels dropping off and prolactin and oxytocin levels rising and falling as your baby nurses, it is normal to experience a case of baby blues. These feelings typically peak on the third or fourth day and subside within 2 weeks. Do seek help if you find yourself experiencing severe mood swings, loss of appetite and overwhelming fatigue as these may be symptoms of postpartum depression. How can you care for yourself?Your body has done a lot of work throughout your pregnancy and continues to as you care for your newborn. It’s important that you also care for yourself and get the support that you need to cope during the intense postpartum period. Ask for and accept help from your partner, family and friends. There are many remedies you can try to ease discomfort and pain, including pain medications. Talk to your doctor to know what is safe to take, especially if you are breastfeeding. It’s okay to feel uncomfortable about your postpartum body but remember to be gentle on yourself and set realistic weight loss expectations. Plan small trips to get out of the house from time to time for a change in environment It’s normal to feel like you have no idea what you are doing in the early days. As you spend more time with your baby, you’ll be able to figure out what your baby needs and wants. The postpartum period is overwhelming. You may experience a range of conflicting and contrasting emotions, including intense feelings of joy and love as well as guilt and lack of control. Be gentle on yourself. Accept that your life has changed and while the transitioning phase may be hard, it will get better.   References Healthline. Your Guide to Postpartum Recovery. Available at: https://www.healthline.com/health/postpartum-recovery-timeline Accessed 10 November 2021. Finlayson K, et al. PLoSOne 2020;15(4):e0231415. MSD Manual Consumer Version. Overview of the Postdelivery (Postpartum) Period. Available at: https://www.msdmanuals.com/home/women-s-health-issues/postdelivery-period/overview-of-the-postdelivery-postpartum-period Accessed 10 November 2021. 

There is a misconception that a snoring baby is one who is in deep, restful slumber. While often times snoring is due to mucus in the nostrils, in rare cases, it can be a sign of a more serious problem such as sleep apnoea. What does normal sleep look like?Sleep patterns of infants vary with age. In their first month of life, a newborn sleeps up to 20 hours a day. This gradually reduces to about 11 hours by the time they are 2 years old. It is normal for an infant to have short pauses in breathing followed by rapid breathing during sleep, however, this should not be seen with colour changes or loud, noisy breathing. When snoring is harmlessIn most cases, babies who snore simply have blocked noses. This is because the nasal passages of infants are very small, so even a tiny bit of dryness or extra mucus in their noses can make them snore or have noisy breathing. A stuffy nose can usually be cleared up using a simple home remedy of saline drops or may not need any treatment at all. If the loud breathing or snoring does not resolve over a short period of time, it may be an indication of other underlying issues, requiring the attention of a paediatrician. Infant sleep apnoeaPersistent snoring in babies may indicate the presence of a sleep-related breathing disorder called infant sleep apnoea. This is a condition where there is a pause or reduction in breathing when an infant sleeps. Infant sleep apnoea may be central, obstructive or mixed. Snoring is more commonly associated with obstructive sleep apnoea. SymptomsThe following are some signs of the presence of infant sleep apnoea: Prolonged pauses in breathing lasting 20 seconds or longer A breathing pattern of repeated pauses, gasping for breath or choking Persistent snoring Difficulty breathing while taking naps during the day Risk factorsPremature babies are more likely to have infant sleep apnoea than those born full-term. The risk is more pronounced during the first months after birth in infants with lower birth weight. Apart from that, a variety of medical conditions can cause infant sleep apnoea or make it worse, including acid reflux, anaemia, infection and lung disease. Infants with underdeveloped facial features, such as a small chin or jaw, having a large tongue, tonsils or adenoids or those with a floppy airway due to a softening of the voice box (larynx) are also at risk. Seeking interventionUnresolved sleep apnoea is of concern as it may affect growth and development and lead to long term physical and behavioural issues. So, if you are concerned about your baby’s consistent snoring, it’s best consult a paediatrician to get it checked. Taking a quick recording of the snoring and playing it for the paediatrician would be helpful to determine if there’s anything of concern going on. A sleep study may be recommended to monitor breathing during sleep, which can detect and identify any problems. In most cases, infant sleep apnoea resolves as the child grows and matures. Studies have also found breastfeeding to be protective against snoring. In other cases where there are other underlying medical conditions, treatment with medications or surgery may be necessary depending on the nature of the problem.   References Hong H, et al. Am J Respir Crit Care Med 2018;198:15-16. American Academy of Sleep Medicine. Sleep Education. Infant Sleep Apnea. Available at: https://sleepeducation.org/sleep-disorders/infant-sleep-apnea. Accessed 13 August 2021. Healthline. Why Is My Newborn Snoring? Available at: https://www.healthline.com/health/parenting/newborn-snoring. Accessed 13 August 2021. Bonuck K, et al. Pediatrics 2012;129(4):e857-e865. Katila M, et al. Acta Paediatr 2019;108(9):1686-1694.