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Fulltext Impact and Adaptation of Reproductive Training During COVID-19 Pandemic in Malaysia

Abdul Karim AK, Azrai Abu M, Ahmad MF, Mat Jin N, Suharjono HN

Malays J Med Sci, 2021 Oct;28(5):34-41.
PMID: 35115885 DOI: 10.21315/mjms2021.28.5.3

The novel coronavirus (COVID-19) pandemic has affected the community at large. It has affected almost everyone and every aspect of social, economic and educational activities. Training in reproductive medicine has not been spared, as training in this field requires a combination of clinical interaction with patients, procedural experience, constant discussions and the element of research. The changes to numbers of new infections or active cases dictate the restrictions placed on the community and health care services alike. At the beginning of the pandemic, both the patients' fear of going to a health care facility and movement restrictions had caused a significant reduction in the number of COVID-19 cases. Furthermore, the Ministry of Health (MOH) Malaysia's recommendation to withhold all non-essential medical services, including those related to reproductive medicine, falls under this category. Therefore, it could negatively impact the quality of training and lead to an extension of training duration in reproductive medicine. Thus, the procedural experience could be supplemented with simulator training, teleconsultation could replace standard clinic sessions and online meeting platforms could replace routine academic meetings. Any modifications must be adaptable or flexible, as similar infectious pandemics and restrictions could recur from time to time.
Letter to the Editor: The Coronavirus Disease 2019 Impact on Oncofertility Services in Malaysia

Ahmad MF, Abu MA, Abdul Karim AK

J Adolesc Young Adult Oncol, 2020 12;9(6):693-694.
PMID: 33090942 DOI: 10.1089/jayao.2020.0105
Comparative analysis of IVF-ICSI outcomes between advanced and early stage of endometriosis stimulated with HMG

Arshad AH, Azrai Abu M, Ahmad MF, Abdul Karim AK

Med J Malaysia, 2022 Jan;77(1):1-5.
PMID: 35086987

INTRODUCTION: Endometriosis is a challenging disease to treat, and patients may eventually need in vitro fertilisation with Intracytoplasmic sperm injection (IVF/ICSI) to conceive after other modalities failed. There are inconsistent outcomes of IVF performance in patients with endometriosis especially with highly purified human menotropin gonadotrophin (hMG). This study was commenced to determine whether the use of hMG affects the IVF outcome in different stage of endometriosis.
MATERIALS AND METHODS: This is an observational study. Eighty-seven women who had endometriosis confirmed surgically and underwent IVF/ICSI treatment, stimulated with hMG alone were included. Based on the revised American Society for Reproductive Medicine (rASRM), the participants were classified as early endometriosis (I/II) (n=39) or advanced endometriosis (III/IV) (n=35). The main outcome measures used were clinical pregnancy rate.
RESULTS: Women with advanced endometriosis had a lower oocyte yield, less good quality day-3 embryos and lower clinical pregnancy rate compared with the mild endometriosis. However, higher fertilisation rate were recorded in advanced stage endometriosis compared to milder disease.
CONCLUSIONS: The rASRM classification of endometriosis is valuable in predicting IVF outcome as advanced endometriosis performs poorly compared to a milder disease. Highly purified hMG could be an alternative as an ovarian stimulation in endometriosis.
Knowledge, attitudes and practice regarding copper intrauterine contraceptive devices among doctors in Malaysia

Chew KT, Salim N, Abu MA, Abdul Karim AK

BMJ Sex Reprod Health, 2018 Jun 01.
PMID: 29972367 DOI: 10.1136/bmjsrh-2017-101869

BACKGROUND AND OBJECTIVE: Intrauterine contraceptive devices (IUDs) are an important method to reduce unmet need for family planning and for prevention of unintended pregnancy. However, IUD use in Malaysia is still low. Doctors play a major role in influencing IUD uptake among women. This study was designed to evaluate doctors' knowledge, attitudes and perceptions towards IUDs and factors associated with their current practice.
METHODS: A questionnaire was mailed to public and private contraceptive providers who practise in Kuala Lumpur, Malaysia.
RESULTS: A total of 400 doctors were invited and 240 (60%) of them responded to the survey. Of the respondents, 161 (65.9%) were from the public or government sector and 89 (34.1%) were from the private sector. The knowledge score of doctors was classed as 'average', and correlated well with their previous training level, working position, number of patients seen in a week and number of contraceptive methods available in their facilities. The age, gender, working duration, availability of IUDs in the premises and number of IUD insertions in a month were not statistically associated with the providers' knowledge. The use of IUDs was low, especially among private doctors, and was significantly related to their knowledge of the method. Knowledge scores, perception and practice were significantly lower in the private sector.
Fertility preservation opportunities for cancer patients in Malaysia

Abdul Karim AK, Ahmad MF, Abdul Hamid H

Med J Malaysia, 2021 05;76(3):417-418.
PMID: 34031343

Fertility preservation is significant for oncology patients to maintain their ability to start a family when they are ready. Onco-fertility, as a discipline, exists at the intersection of oncology and reproductive medicine that safeguards and expands the fertility options for cancer survivors, by facilitating early intervention and suitable treatment with favourable outcomes. Successful fertility preservation requires a comprehensive networking among the gynaecologists, oncologists, pathologists, imaging and other specialists, involved in diagnosing and treating cancer in the reproductive age group. There are several ways in which fertility can be preserved, like role of gonadotrophin releasing hormone analogues, in vitro maturation, and cryopreservation.
Fulltext Anti N-Methyl-D-Aspartate receptor encephalitis with ovarian teratoma: a dilemma in diagnosis

Lee, CL, Zainuddin AA, Abdul Karim AK, Yulianty A, Law, ZK, Md.Isa N, et al.

Journal of Surgical Academia, 2016;6(1):66-69.
MyJurnal

We report a rare case of altered mental status in a young patient with immature ovarian teratoma. A 22-year-old woman presented with seizures, hallucination, amnesia and orofacial dyskinesia. Examination and investigation revealed an ovarian massand asalphing-oophorectomy was performed. The histopathological examination result showed an immature teratoma grade 2 with thepresence of immature primitive glial tissue. Her CSF N-Methyl-D-Aspartic acid receptor (Anti-NMDAR) antibodytest was positive. N-Methyl-D-Aspartic acid receptor antibody associated limbic encephalitis is an autoimmune antibody-mediated neuropsychiatric disorder. Resection of the tumour and immunotherapy resulted in full recovery.