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Helping Patients Have Healthy Babies
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Helping Patients Have Healthy Babies

This is the motto of Dr Ann Tan, obstetrician and gynaecologist, and Medical Director of Mount Elizabeth Fertility Centre. In this exclusive interview with THIS Quarterly, she talks about how she is driven by this work ethic, and shares her passion for social causes.

The first thing that strikes you upon meeting wellknown obstetrician and gynaecologist Dr Ann Tan is how petite this lady is. THIS Quarterly met this energetic specialist one afternoon in her stylish and cosy clinic, located in Mount Elizabeth Medical Centre.

What shone brightly that day was her passion for what she does and the lengths she would go for her patients. For example, she has no problems collaborating with other specialists - be they other gynaecologists or experts in other fields - to ensure that her patients have the best care.

Her care and concern comes through loudest and clearest when recounting difficult cases. She recalls a patient who developed secondary subfertility following heavy bleeding after her first delivery. As this patient was told she would not be able to conceive again, she sought a second opinion from Dr Tan, who discovered that there were multiple adhesions inside this woman’s uterus. They were preventing conception - the patient would require repeated procedures to enable the uterus to become receptive to pregnancies again. “Her lining was so thin that I advised her to consider alternatives, but she refused and persevered,” Dr Tan remembers. “She is now onto her third pregnancy!” Dr Tan admires this woman’s tenacity. “This patient’s trust, positivity and perseverance were key to her success. She would not let me give up trying for her!”

When talking about another case, the intensity in Dr Tan’s voice rises a notch. “I will always remember this patient because what happened to her could be said to be a miracle,” she insists. This patient lost her first baby mid-pregnancy when she delivered too prematurely. In her second pregnancy, she consulted Dr Tan when her water bag broke prematurely. “She was determined and wanted me to work with her to save the pregnancy. She laid in bed in hospital for two full months and delivered at 28 weeks, which was the minimal target I advised her to aim for,” Dr Tan recollects. “I believe it was a combination of prayer, good fortune and sheer determination on the mother’s part to make this happen.” Dr Tan adds that the baby is now a toddler and thriving - and she now has a younger sibling to play with!

And The Oscar Goes To

Did you know that Dr Ann Tan was the first specialist to offer the First Trimester Pregnancy Screen, or OSCAR, to test for Down syndrome 15 years ago? The desire to offer the test in Singapore was partially why she transitioned into private practice. “I feel that any woman would want the assurance of knowing whether her baby is normal as early as possible in the pregnancy,” she says.

OSCAR is still commonly used for antenatal screening in Singapore. While it has a detection rate of 90%, there are new DNA tests - of which Dr Tan is a strong supporter - that have rates of up to 99.5%.

HOLISTIC APPROACH

As a specialist who believes in taking a holistic approach, Dr Tan is open to her patients undergoing acupuncture and consulting traditional healers. “Some of my patients say they feel better after these therapies, and I generally feel that it’s alright aside from the first trimester,” she assures. “In fact, studies have shown that acupuncture improves the outcome for IVF.”

Over the past decades, Dr Tan has had many repeat patients, and she derives great pleasure from being a part of the family as it grows.

“Yesterday I delivered a baby for a patient,” she reveals a case in point. “I also delivered her two older kids over a span of 10 years.” She must be doing something right.

BUILDING HER REPUTATION

Dr Tan worked in the Singapore General Hospital (SGH) for 15 years before striking out on her own - coincidentally, also 15 years ago. The move was to gain more control of her time so that she could meet the needs of her three children.

She has since built up quite a reputation. “Many people know that I care for women with high-risk pregnancy issues; in particular, those with pre-term labour,” she shares. “And I’ve had to do cervical cerclages at times to reduce the risk of preterm deliveries.”

Currently, Dr Tan devotes more time helping couplesachieve their dream of being parents and having healthy babies using the latest available techniques for IVF and better options for management of high-risk pregnancies. “I am grateful that I have happy patients who were successful in conceiving despite the odds against them, either due to advanced age, low egg reserves, or when there are severely negative male factors,” she states. “My hope is that I can help them understand where they stand and point them in the correct direction to achieve their desired goals.”

However, she admits that, at times, she has the tough job of telling couples to stop trying and move on with their lives, which “can be particularly depressing”. At these times, they may have to consider unconventional methods, such as donor gametes.

Anti-Mullerian Hormone (AMH) Test

The level of AMH in a woman’s blood correlates with the number of active antral follicles, and is a reliable test of her ovarian reserve. The test can be done at any time in the menstrual cycle.

PATIENT TRENDS

When asked what trends she has seen in her female patients, she gives a look of concern.

“More women are prepared to think about pregnancy but usually later on, when their careers are more settled,” she reports. “This is fuelled by news of women celebrating pregnancies and birth beyond 45 years of age.”

While there are such cases, Dr Tan warns that these stories may not be fully revealed, and urges women to understand where their personal fertility potential is at the age of 30 or so. “Get your personal anti-mullerian hormone level tested to understand where you stand,” she advises.

In Singapore, IVF is currently allowed until the woman reaches her 45th birthday, but her chance of a successful conception actually falls rapidly after 40 years of age, as the quantum and percentage of normal eggs would have declined by this time. Older men are also responsible for the declining fertility of the couple. “In my investigation of fertility, both men’s and women’s health and fertility status are screened.”

WHAT IS HER STRATEGY THEN?

“Gamete freezing is something I hope would be allowed in Singapore so that people will not view infertility as only a woman’s issue, but as a couple’s issues,” she explains. “Male factor infertility is a common indication for IVF.” This is arguably a form of biological insurance for those who are not in a position to have a child for various reasons. Still, there is no guarantee as saving one’s gametes only ensures one half of a potential pregnancy and child. “So it has to be a deliberate and considered decision,” she stresses. “While men produce sperms throughout their lives, their quality will decline as well,” she adds, explaining that drinking, smoking, ageing, and medical problems will reduce the quality of the sperms over time. “If you freeze your eggs and your sperms when you are younger, then you will have a lower risk of having abnormal babies and reduce the risk of miscarriages.”

Creating Cancer Awareness

In 2006, while she was President of The Association of Women Doctors of Singapore, she and her team championed HPV vaccination for women as this reduced their risk of developing cervical cancer.

Improvements in the vaccine since means it now offers greater protection, even for men. “The improved vaccine is now offered to boys and men to reduce the risk of male oral and anogenital cancers,” she enthuses.

OF MOTTO AND FRIENDSHIPS

Dr Tan reveals that everything she does for her patients is according to her motto.

In order to do so, she insists that she needs to understand what they do. “How you exercise” and “what you eat” are among the questions she would have on her long list. Dr Tan says that many couples are willing to share and be open because they have been trying to get pregnant and not succeeding. “Therefore, they will talk to you because they want to put the jigsaw puzzle together.” And because she goes on such intensely personal journeys with her patients, many of them have gone on to be her friends.

What drew her to gynaecology in the first place? “In this specialty, I get to be both physician and surgeon,” she explains the attraction. “I have the privilege of helping couples through a significant milestone: becoming parents.” She then reveals that she was inspired by an aunt, a prominent gynaecologist who is now delivering the grandchildren of women she had delivered. “I am still in awe at how she does it - so energetic and yet so calm.”

Speaking of family members, Dr Tan is mother to three beautiful daughters, aged 17 to 24 years. Always practising what she preaches, she insists that they take good care of their health. As it turns out, the oldest daughter graduated as a veterinarian, the middle one is in studying fine art and the youngest one is boarding school. “So my brain has to think in different time zones!” Dr Tan laughs. “I look forward to Christmas when all of us are home together in Singapore.”

PARTING WORDS

What final message about female health and fertility would Dr Tan like to pass on to all women out there, especially the next generation? “Save fertility in different ways,” she affirms.

By this, she means to take steps such as having good nutrition from their adolescent years, getting the appropriate vaccines, and perhaps saving their eggs for the future if they are not in a position to be mothers when they are at the peak of their fertility. Use of certain supplements such as vitamin D maybe needed to optimise their well-being, and staying fit through exercise is a must.

PASSION FOR HELPING OTHERS

Dr Tan’s drive to help people extends beyond her patients, and has led her to assume positions in various professional societies, one of which is the Halogen Foundation. She was awarded the Public Service Medal PBM in 2012 for her efforts in social service.

The 15-year-old not-for-profit institution of public character (IPC) aims to be the recognised charity dedicated to transforming the lives of young people through leadership and entrepreneurship development. “I find this particularly relevant as I see the needs of the financially disadvantaged youths, and hope that our programmes at Halogen will make a positive impact on their lives,” she shares.

She encourages everyone to be aware of local kids who fall between the cracks; they often have low self-esteem and lack confidence. “Our programmes give them the platform to uncover their own talents, transforming these street-smart but less academically inclined youths to have an entrepreneurial mindset.”

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