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Jun24
Endometriosis, fertility & pregnancy
Endometriosis is a disease that affects women of reproductive age and that may be associated with both pelvic pain and infertility. Endometriosis is a condition that affects a woman's reproductive organs. It happens when the tissue that lines the uterus grows outside of it. It may be associated with both pelvic pain and infertility. In a simple language endometriosis happens when the tissue that lines the uterus grows outside of it. Scientific advances have improved the understanding of this benign (non-cancerous) but sometimes debilitating condition. Modern medicine now offers women with endometriosis many treatment options for relief of both pain and infertility.

Causes, symptoms, diagnosis and the options to manage and treat endometriosis including lifestyle, pain relief medications, hormone therapy and different types of surgery are all discussed here below.

What is endometriosis?

Endometriosis is a chronic condition that affects a woman’s reproductive organs. It happens when the lining cells (called the endometrium) of the uterus grow outside of it. Endometriosis most commonly involves ovaries, bowel or the tissue lining the pelvis. Rarely, endometrial tissues may spread beyond pelvic region and is found in other parts of the body. About 10% of women between the ages of 15-49 are affected by it and around 176 million women worldwide. This tissue can irritate structures that it touches, causing pain and adhesions (scar tissue) on these organs.

Symptoms of Endometriosis

The primary symptom of endometriosis is pelvic pain, often associated with the menstrual period. Though many woman experience cramping during their menstrual period, women with endometriosis typically describe their menstrual pain that's far worse than the usual. They also tend to report that the pain has increased over time. Common signs and symptoms of endometriosis may include:

1. Painful periods (dysmenorrhea). Pelvic pain and cramping may begin before and extend several days into your period and may include lower back and abdominal pain.
2. Pain with intercourse. Pain during sex or after sex is common in endometriosis.
3. Pain with bowel movements or urination. You're most likely to experience these symptoms during your period.
4. Excessive bleeding. You may experience occasional heavy periods (menorrhagia) or bleeding between periods (menometrorrhagia).
5. Infertility. Endometriosis is first diagnosed in some women who are seeking treatment for infertility.
6. Other symptoms. You may also experience fatigue, diarrhoea, constipation, bloating or nausea, especially during menstrual periods.

The cause of endometriosis is not known, although it often runs in families. Numerous biochemical and immunological changes have been identified in association with endometriosis, but it is unclear which may contribute to endometriosis and which simply result from it.

Learn about infertility and endometriosis in detail with infertility expert at https://www.youtube.com/watch?v=Xb9YvHZ4x70

Endometriosis and Infertility

If you have endometriosis, it may be more difficult for you to become pregnant. The main complication of endometriosis is impaired fertility. Approximately one-third to one-half of women with endometriosis has difficulty getting pregnant. For pregnancy to occur, an egg must be released from an ovary, travel through the neighbouring fallopian tube, become fertilized by a sperm cell and attach itself to the uterine wall to begin development. Endometriosis may obstruct the tube and keep the egg and sperm from uniting. But the condition also seems to affect fertility in less-direct ways, such as damage to the sperm or egg. Even so, many women with mild to moderate endometriosis can still conceive and carry a pregnancy to term. Doctors sometimes advise women with endometriosis not to delay having children because the condition may worsen with time.

Endometriosis can influence fertility in several ways: distorted anatomy of the pelvis, adhesions, scarred fallopian tubes, inflammation of the pelvic structures, altered immune system functioning, changes in the hormonal environment of the eggs, impaired implantation of a pregnancy and altered egg quality. At the time of surgery, your doctor may evaluate the amount, location, and depth of endometriosis and tell you whether it is minimal, mild, moderate or severe. Different stages relates with pregnancy success. A woman with severe endometriosis which causes considerable scarring, blocked fallopian tubes, and damaged ovaries, experience the most difficulty in becoming pregnant and often require advanced fertility treatment.

Test and Diagnosis

To diagnose endometriosis and other conditions that can cause pelvic pain, doctor will ask to describe the symptoms, including the location of pain and when it occurs. Tests to check for physical clues of endometriosis include Pelvic exam, Ultrasound and Laparoscopy. Laparoscopy can provide information about the location, extent and size of the endometrial implants to help determine the best treatment options.

Know in detail how endometriosis can be tested and diagnosed and the treatment options available at http://www.blossomivfindia.com/fertility-treatments

Treatment options when diagnosed with Endometriosis

There is no ‘best treatment’, since treatments will work differently for individual women with endometriosis. One should be aware of the different kinds of treatments, and their possible effects and side effects or complications. A combination of treatments can be used to assist relieve the symptoms associated with endometriosis. There are many options to manage and treat endometriosis including a healthy lifestyle, pain relief medications, hormone therapy such as the oral contraceptive pill and progestin. Different types of surgery including laparoscopy, laparotomy and hysterectomy are also possible.

In most cases, infertility specialists will recommend laparoscopy to remove or vaporize the growths as a way to also improve fertility in women who have mild or minimal endometriosis. Although studies show improved pregnancy rates following this type of surgery, the success rate is not clear. If pregnancy does not occur after laparoscopic treatment, in vitro fertilization (IVF) may be the best option to improve fertility.

IVF makes it possible to combine sperm and eggs in a laboratory to make an embryo. Then the resulting embryos are placed into the woman's uterus. IVF is one type of assisted reproductive technology that may be an option for women and families affected by infertility related to endometriosis. It is possible that all women with endometriosis are not able to become pregnant with IVF.

What can be done to maximise future fertility when diagnosed with Endometriosis?

The birth control pill is commonly prescribed to reduce menstrual cramping and help prevent endometriosis recurrence. Preventing endometriosis can help preserve fertility, so the pill is an excellent treatment option following endometriosis surgery if you are not yet ready to become pregnant. Women with endometriosis should consider consulting with fertility specialist, (a specialist in Reproductive Endocrinology/Infertility), even if she is not yet ready to try to conceive or become parent. Consulting fertility expert is extremely important if the age of the women is over 30 and is diagnosed decreased ovarian reserve. Fertility in women decreases with age. In addition to age, “ovarian reserve” also helps predict your ability to conceive. Surgery to remove or destroy endometriosis involving the ovaries may also reduce ovarian reserve and thus lower a woman’s chances for pregnancy even with fertility treatment such as IVF. Women with moderate to severe endometriosis may have scarring that can prevent the egg from entering the fallopian tube. Mild and minimal endometriosis are also associated with infertility, so all women with endometriosis need to consider the impact endometriosis may have on their fertility. A newer option for women is to freeze her eggs for possible future use in the event they experience infertility. Though egg freezing is costly, it is always a better option.

Many women believe endometriosis will prevent them from having children. This is a myth. Although some does experience infertility, about 70 percent of women with endometriosis do not. There are no preventive measures to avoid the condition. A woman can manage the symptoms only if she is diagnosed.

Choosing a qualified specialist, the one who is familiar with the latest developments in management of endometriosis is the best strategy. Finding a doctor with whom you feel comfortable is crucial in managing and treating endometriosis. You may also want to get a second opinion before starting any treatment to be sure you know all of your options and the possible outcomes. The Blossom Fertility and IVF Centre aims to reduce the stress and hassle associated with infertility investigations and treatment, by offering a one-stop diagnostic and treatment service for infertile couples. The specialists team at Blossom have years of experience in providing the comprehensive services in entire gamut of gynaecological and infertility treatment. We have handled a large number of cases related to IVF, ICSI, Blastocyst Transfer, Donor Eggs, Male infertility, Female infertility and various other complex processes and have achieved remarkable successes in them. Fertility experts here pay individual attention to the patients need and analyse the course of treatment and Reproductive endocrinologists, embryologists, anthologists and infertility specialists have helped hundreds of couples have babies through Assisted Reproduction.

Contact Blossom Fertility and IVF Centre for any infertility related queries at http://www.blossomivfindia.com/ or call them on 91 261 2470444 to talk with the team of Infertility experts.


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Jun11
Artificial Insemination Benefits, Risks and Side Effects
Artificial insemination is a form of assisted reproductive technology technique. Artificial insemination is a technique that can help treat certain kinds of infertility in both men and women. In this procedure, sperm are inserted directly into a woman's cervix, fallopian tubes, or uterus. This makes the trip shorter for the sperm and bypasses any possible obstructions. Ideally, it makes pregnancy possible where it wasn't before. Intrauterine insemination (IUI), in which the sperm is placed in the uterus, is the most common form of artificial insemination.

Artificial insemination techniques available include intra cervical insemination and intrauterine insemination. Artificial insemination is a fertilization procedure in which sperm is artificially placed into a woman’s cervix (intra cervical insemination) or uterus (intrauterine insemination). During the treatment, the woman’s menstrual cycle is closely monitored using ovarian kits, ultrasounds, and blood tests. The semen to be implanted is “washed” in a laboratory, which increases the chances of fertilization while removing unnecessary, potentially harmful chemicals. The semen is inserted into the woman, and if the procedure is successful, she conceives. The chances of becoming pregnant using artificial insemination depends a lot on what type of fertility issue is preventing a natural conception. Generally there is a 5-25% rate of success per treatment for women who use AI to get pregnant, and these chances increase if the woman uses fertility drugs before the treatment.
Artificial insemination has been a popular form of fertility treatment for couples trying to conceive. The original technique used for artificial insemination was referred to as Intra cervical insemination or ICI. Today’s most common technique is called intrauterine insemination or IUI and is more effective procedure than the original. This process turns the dreams of having a child into a reality for many couples facing infertility issues and single women.

Though the pregnancy rates for women undergoing artificial insemination may not be as high as they are for some more advanced techniques, this technique has some key advantages: It's a simple procedure with few side effects and it is not expensive.
For these reasons, doctor may recommend it as an initial form of treatment for infertility.

Why is Artificial Insemination used?

Artificial insemination can be used for many kinds of fertility problems. Artificial insemination is beneficial to couples or individuals in many circumstances. For example a couple may be producing healthy sperm and eggs but not necessarily be able to have a child due to a medical condition. Some other scenarios where artificial insemination could be beneficial are listed below.

1. IUI is often performed as a first treatment for unexplained infertility along with ovulation-inducing medications.

2. It is often used to impregnate women whose partners have very low sperm counts or sperm that aren't strong enough to swim through the cervix and up into the fallopian tubes.

3. IA is used for infertility issues dues to cervical factor infertility. It means that cervix is unable to produce enough mucus and allows the sperm to travel to the womb. The mucus surrounding the cervix is hostile to sperm and prevents sperm from getting into the uterus and fallopian tubes. Artificial insemination allows the sperm to bypass the cervical mucus entirely.

4. Fertility issues caused by endometriosis.

5. When the male partner is impotent or suffers from infertility those results from medical issues.

6. In rare cases, some women suffer from a semen allergy that prohibits having direct contact with the sperm.

7. Women that want a child without a partner may consider artificial insemination.

8. Couple that is in a same-sex relationship may use artificial insemination to have a child.

Donor Sperm and Artificial Insemination

Women can use their husband’s sperm for insemination if it is viable, or they can choose to use donor sperm. In this case they will be using Artificial Insemination by Donor (AID) to get pregnant. This process may be needed if the husband’s sperm is not viable or if the female is single and wishes to have a baby on her own. This type of fertility treatment can also be utilized by couples where the male partner has a genetic disorder, or when more advanced treatments like intracytoplasmic sperm injection (ICSI) is too expensive.

The process of Artificial Insemination

An insemination procedure uses a thin, flexible tube (catheter) to put sperm into the woman's reproductive tract. For some couples with infertility problems, insemination can improve the chances of pregnancy. Donor sperm are used if the male partner is sterile, has an extremely low sperm count, or carries a risk of genetic disease. A woman planning to conceive without a male partner can also use donor sperm. Prior to insemination, the sperm usually are washed and concentrated (placing unwashed sperm directly into the uterus can cause severe cramps). Concentration is accomplished by selectively choosing highly active, healthy sperm that are more capable of fertilizing an egg.
Intrauterine insemination (IUI): Intrauterine insemination (IUI) is the placing of sperm into a woman's uterus when she is ovulating. This is achieved with a thin flexible tube (catheter) that is passed into the vagina, through the cervix, and into the uterus. IUI can use sperm from the male partner or a donor. It is often combined with super ovulation medicine to increase the number of available eggs.

Artificial insemination (AI): Artificial insemination (AI) is another name for intrauterine insemination but can also refer to placing sperm in a woman's vagina or cervix when she is ovulating. The sperm then travel into the fallopian tubes, where they can fertilize the woman's egg or eggs. AI can be done with sperm from the male partner or a donor, and can be combined with super ovulation.

Intrauterine insemination is a relatively simple and safe procedure, and the risk of serious complications is low. Risks include:

Infection: Studies indicate that less than 1 percent of women experience infection as a result of the procedure.

Spotting: Sometimes the process of placing the catheter in the uterus can cause a small amount of internal bleeding. This does not usually have an effect on the chance of pregnancy.

Multiple pregnancy: IUI itself is not associated with an increased risk of a multiple pregnancy — twins, triplets or more.
However, when coordinated with ovulation-inducing medications, the risk of multiple pregnancy increases significantly. A multiple pregnancy has higher risks than a single pregnancy does, including early labour and low birth weight.

What to Expect After Treatment?

These techniques are done on an outpatient basis and require only a short recovery time. You may experience cramping during the procedure, especially if sperm are inserted into your uterus. You may be advised to avoid strenuous activities for the remainder of the day. The treatment is pretty simple and painless with maybe a little cramping. It is performed in the fertility specialist clinic and the procedure can be done by a qualified nurse or a doctor.

IUI may also be used if a couple would like to avoid the higher cost of IVF treatment. Even though IUI is less effective per cycle than IVF, a couple may be able to afford more attempts with IUI. Artificial insemination should not be used in women with blocked fallopian tubes. The tubes are often checked out with an x-ray test called a hysterosalpingogram. Female age is a significant factor with IUI. Intrauterine insemination has very little chance of working in women over 40 years old. IUI has also been shown to have a reduced success rate in younger women with a significantly elevated day 3 FSH level, or other indications of significantly reduced ovarian reserve. If the sperm count, motility and morphology scores are quite low, intrauterine insemination is unlikely to work. Insemination is a reasonable initial treatment that should be utilized for a maximum of about 3 months in women who are ovulating (releasing eggs) on their own. It is reasonable to try IUI for longer in women with polycystic ovaries (PCOS) and lack of ovulation that have been given drugs to ovulate.

While artificial insemination does not guarantee pregnancy, it does have success rates of around 30 percent. The success rates do depend on a variety of factors that include the insemination method used, the age of the female, egg and sperm quality, male factor infertility and the endometriosis factor. Anyone interested in artificial insemination should seek a consultation with the fertility specialist.

With today's advanced reproductive technology, you can always find a solution to all the fertility problems. You must meet an expert in the infertility field. Quality patient care and world class services are always the prime issues for Me and Mummy Clinic in Surat. Clinic gives meticulous attention to all the issues related to treatments, infrastructure, team composition and other related factors. We pride in our state of the art modern equipments for women's care, all under one roof. Our sophisticated infrastructure well aided by qualified staff has given us extra edge in gynaecological and infertility services. We are progressing rapidly with a vision of delivering finest care and service.

Dr.Praful Doshi a consultant Gynaecologist and IVF Specialist has over 15 years of experience in fertility and assisted reproduction techniques and specialises infertility, IVF and in Assisted Reproductive Techniques. Dr.Praful Doshi performs in vitro fertilization (IVF), Donor Egg IVF, ovulation induction, artificial insemination, intrauterine insemination (IUI) and intracytoplasmic sperm injection (ICSI). Dr.Praful doshi has been playing major role in providing specialised treatments to overcome infertility problems and making your dream of family complete. We provide affordable & high quality male & female infertility treatment with advanced reproductive technologies and world class IVF lab infrastructure.

Common causes of infertility problems in women - Ovulation problems - Endometriosis - Poor egg quality - Polycystic ovarian syndrome - Tubal factors - Unexplained fertility problems - Get expert guidance from the IVFspecialist - pregnancy and parenting experts today.

Know all about artificial insemination and IVF treatment, intrauterine insemination, donor sperm intrauterine insemination, in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI), Donor Egg IVF, ovulation induction, surrogacy, Reproductive Endocrinology and Gynecology including advanced Laparoscopic Surgery, Tubal reconstruction, and Minimally Invasive USG-guided therapeutic procedures at http://www.meandmummyindia.com and contact the top fertility expert in Surat to get satrted by calling at 91-261-2471111 or 2472222


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Jun03
Repeated Miscarriage- A Painful experience for the couples
Pregnancy gives a woman completeness by turning her into mother from a simple woman. It is the thing which makes the couple parents, the dream which they nurture right time from their marriage. Of course there are many couple s who are not fortunate enough to achieve pregnancy and they are usually termed infertile and we have discussed it in separate post. But there are other couple s who may or may not (as this is the usual case) find difficult to conceive but the pregnancy does not continue to the age of viability. Age of viability means the age, when a baby born can survive. Thanks to the improvement in neonatal care by leaps and bounds and availability of NICU which made it possible to survive even a baby born at 22 weeks. For example last month we delivered a baby at 28 weeks of pregnancy, who is fine now. But if the baby is 'born' before 20 weeks, it is called MISCARRIAGE. This is because these babies who weigh less than 500 gram cannot survive outside the uterus. It is seen that 10-15% couples who conceive successfully may not be able to carry pregnancy beyond 20 weeks. Thus the miscarriage rate for a single pregnancy is 10-15%. But in most of the time this mishap does not recur in future. We call it 'sporadic miscarriage' and often the cause is not known. But almost 1% of the couples who wamt to get pregnant may suffer from repeated miscarriage. That means the unfortunate events can repeat. These are called 'RECURRENT MISCARRIAGE' or 'REPEATED PREGNANCY LOSS *RPL).

CAUSES

So, what's the reason for RPL which is equally frustrating for the patients as well as the doctors? First of all let me honestly confess that in most of the cases the cause is not known (50-60%) and this is called 'UNEXPLAINED RPL'. Again we have to admit that despite tremendous advancement in science, the knowledge behind RPL is limited. Many theories and causes have ben proposed but most of them could not withstand the taste of time. That means if a problem is found in husband or wife, we are not certain whether the treatment of that problem will prevent future miscarriage. This should be explained properly to the couples to have realistic expectations and avoid unnecessary frustration s in future. Only factors which are definitely associated with RPL are only two- anti-phospholipid antibody syndrome (APS) and chromosomal problem of either of the couples. Detection and treatment of these problems are often rewarding as after treatment pregnancy continuation rate us very high. The other causes have been proposed but as mentioned above the link between RPL and these causes are not yet very clear and need further scientific research. Please remember according to the timing, RPL may be divided into two categories- the 1st trimester RPL (occurring before 12 weeks in each pregnancy) or second trimester RPL (12-20 weeks in each pregnancy).

4-5% cases may be due to genetic or chromosomal problem of the couples. These problems can affect the egg (ovum) and/or the sperms. Even if the couples are normal, the baby may have abnormal chromosome.It is blessing that a genetically abnormal baby is miscarried by the nature, otherwise if it survives there is high chance that it may be mentally or physically handicapped. The reason may be increased age of the mother (above 35 years especially), exposure of mother to some environmental pollutants or sometimes increased age of the father (the latter is controversial). The diagnosis is done by chromosomal analysis of the couple by Karyotyping or FISH from blood samples. If the baby has been miscarried, it may be rational to send the tissue of the baby for chromosomal analysis to find iut the cause. The treatment option in next pregnancy in such cases is genetic counseling by an expert and in most cases unfortunately ine option remains- that us IVF and PGD (pre implantation genetic diagnosis) where only genetically tested normal embryos are transferred by IVF ('test tube baby').

Anatomical factors are responsible for 12-15% if RPL, in most cases the second trimester RPL. The most common cause is 'CERVICAL INCOMPETENCE'. The cervix is the mouth of the uterus which should remain closed in pregnancy to support pregnancy and should only open during delivery. But in some cases it xan open prematurely leading to miscarriage. Usually this causes apparently painless miscarriage. In many women fibroid is found as a tumour of uterus. Whether fibroids cause RPL is again very controversial among the scientists and doctors. In some women who had repeated abortion or surgery to uterus and even tuberculosis (TB) there may be adhesion (binding together) between the walks of uterus. This is called Asherman Syndrome which causes scanty or absent periods and RPL. In few women there may be Congenital Anomaly of the uterus- that is yhere is some abnormalities inside uterus from birth. Thesr xan sometimes caus RPL, although controversial. These anatomical problems are diagnosed by proper examination, some tests like HSG (hystero salpingogram), SSG (sono salpingogram), 3D ultrasonography (USG), MRI, hysteroscopy and/or laparoscopy, depending on the women and test results. The treatment should be dobe cautiously as treatment may not always prevent RPL. For cervical incompetence usually we put stitch in the cervix in pregnancy or sometimes before pregnancy. Operation xan be done, before pregnancy for fibroids, Asherman and congenital anomalies.

In many cases (more than 70%) cases hormonal problems may be there and these may cause both 1st and 2nd trimester RPL. However whether treatment us beneficial or not, is again controversial. The commonest pattern is Luteal Phase Deficiency (LPD) due to deficiency of hormone progesterone. PCOS (Polycystic Ovaries) is also asdociated with RPL. The other causes are uncontrolled diabetes, thyroid problems, high prolactin and high testosterone, high insulin and low ovarian reserve. As mentioned earlier, it is not clear whether they all need testing and treatment but usually tests advised for these are blood for progesterone, TSH, Prolactin, FSH, LH, AMH, Insulin, Testosterone, sugar, HbA1C etc. Treatment is usually progesterone supplement along with correction of hormonal imbalance. It is to be mentioned that these patients need high dose of thyroid drugs (TSH normal for other people may be considered abnormal for RPL) and more tight control of blood sugar in diabetes.

In 60-70% cases the cause is Thrombolphilia, that is tendency to thrombosis or blood clotting. The most common is anti phospholipid antibofy syndrome (APS) which nay or may not be associated with thrombosis in other sites but can cause thrombosis if blood supply to the baby and thus causes stopage of its heart and miscarriage. Although more common in the Western World, some Hereditary Thrombolphilia may be found in other family members and commonly cause miscarriage and thrombosis. Deficiency of folic acid and vitamin B12 rarely xan cause thrombosis and RPL. The APS testing is often successful, so as the treatment with aspirin and heparin injection throughout pregnancy. With this 80% women can expect full term pregnancy. Folic acid and B12 vitamin supplement is commonly given to RPL patients. Whether testing for hereditary thrombophilia is needed in our country ir not is controversial. But treatment is like APS- that is aspirin and heparin injection.

Diseases of mother like diabetes, epilepsy, liver or kidney diseases, SLE etc can cause miscarriage. Exposure of mother to harmful substances like environmental pollution, radiation, chemotherapy and some toxic drugs, smoking, alcohol, cocaine, cannabis etc are alse responsible but the latter usually cause sporadic miscarriage rather than RPL. So these drugs should be stopped and replaced by safer drugs anf the diseases mudt be treated properly. Even exposure of father to some drugs can cause RPL. Again some abnormalities of sperms may cause RPL. So, semen analysis of the husband is usually done as a test for RPL.

The most controversial topic for RPL is the infections. But itbis the fact proved by scientific studies that only infection in current pregnancy causes miscarriage. So infection is a cause of sporadic miscarriage, not RPL. In the past TORCH testing was very much popular but nowadays it is obsolete test and there is no scientific ground for tests or treatment of TORCH. Only test we recommend is rubella testing. If rubella IgG is negative that means you may get infection in pregnancy so we advice to take rubella vaccine and avoid pregnancy for one month. On the other hand, rubella IgG positive neans you are already imune and thus you can never get rubella. So vaccine is not useful in those cases. If any genital infection is found in husband or wife, both if them should be tested and treated aggressively.

TESTS REQUIRED

First of all we ned to know when we should advise tests. Assuming that most cases of miscarriages are SPORADIC, we usually di not advise investigation after single miscarriage unless the couple insists or there is some reason by the doctor to suspect some abnormalities that might cause future miscarriage. In the past testing was started after 3 miscarriages. But nowadays we do not want to give the couple, especially the woman a third trauma. So we usually advise tests after 2nd miscarriage. The tests usually start with checking for chromosome of the baby. It is followed by chromosome analysis of both the partners along with proper history taking and physical examination. Semen analysis us fone for the husband. The wife is advised ultrasonography, routine blood, thyroid testing, testing for APS and blood group. These are tests usually dine everywhere. Further tests are done depending on the results if initial tests ans0d especially if no cause us found after initial tests. It should be mentioned to the couples that the 2nd group if tests often do not have scientific grounds and are done only on benefit of doubt. They may not change the management plan. TORCH test is not done in modern era.

TREATMENT

The basic treatment is support if the couples, reducing stress as stress can be responsible for RPL. When a cause is found this should be treated. While an optimistic approach should be taken with expectations for normal pregnancy in future but this should be based on scientific and realistic approach to avoid future frustration. The treatment may not be 100% effective and most treatment may not have scientific base but are usually not harmful. Treatment may not guarantee a successful future pregnancy but a positive attitude is necessary. This is called TENDER LOVING CARE (TLC) where proper support and discussion can help more than explanation if mere statistics. Treatment should be continued both before and after pregnancy confirmation, as mentioned above. This isbto be mentioned thst even after 6th miscarriage, the chance that future pregnancy will be normal is more than 50%. So, the message should be not to give up hope.


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May25
Thyroid and Reproduction (Fertility, Sex and Pregnancy)
oday 25th May is the World Thyroid Day. Thyroid disorders are one of the most common disorders of hormones in our body. Thyroid is a small gland situated in front of the neck and secretes hormones like thyroxine (T4) and tri-iodo-thyronine (T3). These hormones control various functions of our body like heart, blood pressure, digestion, metabolism, growth, blood formation, brain function etc. But one of the most important function is its association with reproduction.


In both sexes, T3 and T4 are needed for sexual development during puberty so that full maturation from a child to adult occurs. That means development of hair (pubic and axillary hair), beard and moustache in boys, breast in girls, genital organ development in both sexes and menstrual function are dependent on thyroid gland. Finally production of eggs (rather maturation and release) and sperms are also related to it. In adults, thyroid function is needed to maintain the functions of sex glands particularly ovaries and testes. Desire for sex (libido) and performance of sex are also related to thyroid function.

The thyroid glands in turn is regulated by a hormone secreted from pituitary gland, located inside the brain. That hormone- TSH (thyroid stimulating hormone) controls secretion of T3 and T4., Thyroid gland may be affected by various diseases like autoimmune diseases (body itself destroys its organs), deficinecy of iodine, radiation, tumour, congenital causes (cause present from birth) and certain drugs. The result is that thyroid hormone seceretion may be reduced (hypothyroidism) or increased (hyperthyroidism). As a result, blood tests for TSH, T3 and T4 are commonly done to detect abnormalities of thyroid gland. If abnormalities are detected, further tests may be advised, e.g., ultrasound and scanning of thyroid gland.

So what can happen to reproduction if thyroid function is affected? Thyroid disorders are particularly common in females. Menstrual cycle may be irregular (comin every 2 or 3 months ) or may be scanty in amount or more commonly very excessive flow. These respond well to correction of thyroid hormone levels by drugs.

Thyroid diorder is a common cause of anovlation- that is women cannot release eggs in each month. The result is irregular menstruation and infertility- the inability to conceive a child. Often correction of thyroid hormone levels result in pregnancy. Please remember if you are trying for pregnancy, then your TSH value should not be the same like other people. We usually treat such women if TSH is more than 2.5 (this may be normal for labaoratory standrads for other people but not for those who plan for preganncy and who are pregnant).

It can cause low libido, vaginal dryness, reduced orgasm and painful intercourse.

In case of male, the thyroid disease is not very common but is not rare. It can affect sperm production leading to infertility. Apart from that it can afect sexual performance leading to low libido, easy fatigue and erectile dysfucntion (ED). All these resolve after proper treatment.

Never ignore checking thyroid status for adolescent boys and girls. It may be responsible for delayed puberty (delay in appearance of male like features in boys and female like features in girls) or precocious puberty (early onset of menstruation or breast development in girls; or early development of beard and moustache in boys). These may be associated with serious disorders and need proper attention.

Pregnancy is a condition where there is tremenous pressure on thyroid gland and it is needed to help in proper development of baby inside uterus. Women with thyroid disorders can have miscarriage, premature delivery, death of baby inside uterus or poor growth of the baby. She can experience bleeding in pregnancy, high blood pressure (preeclampsia) and even heart failure. In initial periods babies depend on mother's thyroid gland for its development. If baby does not get proper amount of thyroid hormones, its brain and body deveopment hampers. Particularly the brain development can be affected leading to mentally handicapped baby,as it may not be corrected even after treatment. So proper diagnosis and treatment of thyroid diseases in pregnancy are essential. After birth baby should be tested for thyroid disease and appropriate treatment should be started without any delay.

So, if you feel any of the above problems, please do not hesitate to consult your doctor and request testing of thyroid functions. If drug treatment is started, do not stop the drug without consulting doctor. Uncontroled thyroid disease can lead to heart attack, stroke and emergency situations like thyrotoxicosis or myxoedema- which can be potentially life threatening if not treated in time.


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Mar22
Infertility due to Diminished Ovarian Reserve
Ovarian reserve is a term that is used to determine the capacity of the ovary to provide egg cells that are capable of fertilization resulting in a healthy and successful pregnancy.The ability of a woman's ovaries to produce high-quality eggs is known as ovarian reserve (OR). As women get older, their OR naturally declines, the number and quality of eggs go down, and it becomes harder to get pregnant. Women attempting pregnancy after age 40 often have difficulty getting pregnant for this reason.

Premature Ovarian Aging and Infertility & Diminished Ovarian Reserve

DOR or POA negatively affects female fertility primarily through sub-optimal number of eggs and poor quality of eggs. Smaller number of lower-quality eggs reduce women’s fertility in two ways: they make it more difficult to get pregnant, and once pregnant, miscarriage are more likely to happen.

The standard goal of all fertility treatments is the improvement in pregnancy rates in patients with infertility problems. Within the past years, ovulation induction has contributed to the success of assisted reproduction techniques, in vitro fertilization (IVF) and embryo-transfer (ET). The efficacy of these techniques depends on a personalized protocol of controlled ovarian hyperstimulation (COH) and an adequate oocyte recruitment.

A woman is born with her entire life supply of eggs, approximately 1-2 million. At the time of her first menstrual period, the number of eggs has diminished to 300,000-400,000. Each cycle, hundreds of eggs undergo stimulation and usually only one is released during ovulation; the others are reabsorbed and are not functional. Peak fertility in women occurs before age 30, with a monthly pregnancy rate of 20-25 percent. This monthly rate starts to decrease around age 32, but rapidly declines beginning in the late 30’s and into the 40’s. Approximately one in three women experience infertility by age 40, mainly due to poor egg quality. Egg quality decreases as a woman ages, resulting in impaired fertilization, reduced implantation, and increased miscarriage along with the increased potential for chromosomal abnormalities of the fetus.

As more women are delaying childbirth and more baby boomers are reaching midlife, the problem of diminished ovarian reserve (DOR) is increasing. This has several major medical consequences including infertility, decreased bone mass with risk of fracture, abnormal uterine bleeding from lack of regular ovulation, and hot flashes. This article will address ovarian reserve testing and its impact on treating infertility.

As a woman, your fertility potential is largely determined by your ovarian reserve. Ovarian reserve refers to the number of eggs you carry in your ovaries, as well as the health and quality of those eggs. Assuming no other reproductive problems exist, ovarian reserve plays a large role in determining whether you will get pregnant or not. Your ovarian reserve depends not only on the quantity and quality of the eggs in your ovaries, but also on the quality of the response of ovarian follicles to hormone signals from the brain.

Ovarian reserve is a biological variable, and egg quantity and quality in an individual woman can be average for her age, better than average, or worse than average. Women with poor egg quality are said to have poor ovarian reserve , poor ovarian function, or occult ovarian failure.

Know in detail about Infertility in male and female and their treatment at http://www.blossombestivfindia.com/InfertilityServices

Diminished Ovarian Reserve

Diminished ovarian reserve (DOR) is a condition where the ovary loses normal reproductive potential, which will compromise fertility. DOR can occur from injury or disease, but it is most often the result of normal aging. Around 20% of women diagnosed with infertility have DOR. Diminished Ovarian Reserve (DOR) is a condition meaning a woman's natural reserve of eggs has significantly reduced. This is a process that does normally occur for a woman as she is nearing menopause, but it can occur in a woman of any age. When this occurs, conceiving becomes difficult for a woman as her ability to produce eggs begins to diminish. Diminished ovarian reserve does not eliminate the possibility of pregnancy. However, this problem should encourage a woman to be more aggressive in her quest to become pregnant as time is clearly of the essence.

When a woman is diagnosed with DOR (high baseline FSH, low antral follicle counts and/or low AMH), most often she is told her chances of conceiving a biological child are very slim and that common infertility treatment, such as IVF, may also not be successful. Most of these women are told their only option is to seek out an egg donor to help her successfully achieve a pregnancy.

What are common causes of diminished ovarian reserve?

By the age of 45, few women remain fertile. However, success rates for fertility improve using in vitro fertilization (IVF) and egg donation. Certain things contribute to the diminished ovarian reserve. The common causes include:

Age of 35 years and older
Smoking
Cancer treatments using chemotherapy and radiation
Genetic abnormalities, such as X chromosome abnormalities
Surgical removal of a portion or all of an ovary

What signs and symptoms are associated with DOR?

There are no outright symptoms and signs associated with diminished ovarian reserve, other than shortening of the menstrual cycle (going from 30 days to 24 days). Once menopause occurs, women show symptoms and signs of low estrogen, which include vaginal dryness, hot flashes, missed or absent menstrual periods, and trouble sleeping.

How is the ovarian reserve assessed?

To diagnose diminished ovarian reserve, the fertility specialist will perform a thorough physical examination and take blood samples. Testing is done on the second or third day of the menstrual cycle to measure estradiol and follicle-stimulating hormone(FSH) levels. Fluctuations in normal baseline values of these two hormones indicates a decline in the ovarian reserve. Another blood test that checks fertility is the anti-Mullerian hormone (AMH), which reflects the actual number of eggs in the woman’s body. In addition, the doctor will conduct ultrasounds to visualize the number of follicles on the ovaries.

Learn in detail about egg donation, egg quality, sperm donation, sperm management and cryopreservation of egg and sperm at http://www.blossomivfindia.com/archives/1071


How is DOR treated?

At present, there are no treatments for slowing down or preventing ovary aging. After DOR is diagnosed, a woman can cryopreserve (freeze) eggs or embryos for later use. With ovarian failure, or when ovaries do not respond to ovarian stimulating drugs, donor eggs are recommended by the fertility specialist. Women with DOR can use eggs donated from younger women to conceive long after menopause occurs. Part of the treatment for infertility is injectable gonadotropin (FSH). The response of the ovaries following FSH for stimulation is predictive of egg quantity. In vitro fertilization is a treatment option for women who have poor egg quality, as well as few viable eggs. A natural IVF cycle is used for women who produce 2-3 follicles, and it does not require ovarian stimulation. With natural IVF, the success rate is only 5%. However, with regular IVF, the success rate is 10%.

The option which offers the highest pregnancy rate for women with a poor ovarian response is to use donor eggs. While this is medically straight forward, it can be very hard for a young woman with regular cycles to accept this option. Often, it's worth doing one cycle with your own eggs even if the chances are poor, so that you have peace of mind that you did your best. This also may make it easier to explore the option of donor eggs for the future. When making the choice to move on to donor eggs or adoption be sure that you have explored all available treatment options to your satisfaction.

Many treatment strategies have been developed in order to treat women with poor ovarian reserve. Because time is at a premium for these women, treatment needs to be aggressive, in order to help them conceive before their eggs run out completely. IVF is usually their best option, as it offers the highest success rates. Superovulating these women can be quite tricky, and this is where the experience and the expertise of the doctor makes a critical difference ! Blossom Fertility and IVF Centre and its team of experts take individual interest in each and every patient because the problem of ovarian reserve differs from patient to patient. It is true that a skilled doctor will be able to design an optimal superovulation for women with poor ovarian reserve, it is also true that the results are still likely to be poor. We the doctors at Blossom, provide all the help to patients from blood test, counselling, ultra sonography and all other support till the success of the treatment and the ultimate goal of having a baby.

Contact Blossom Fertility and IVF Centre if you are facing the infertility issue due to diminishing ovarian reserve and our team of experts will be happy to assist you in all the ways. Visit our website at http://www.blossombestivfindia.com/


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Feb25
HEALTHY PREGNANCY: DR. SHRINIWAS KASHALIKAR
HEALTHY PREGNANCY: DR. SHRINIWAS KASHALIKAR
The ultimate definition of health is realization of the immortal self experienced usually as unshakable and complete fulfillment or satisfaction. Hence, obviously; the best time to start promotion of such health is right from the time of conception.

How?

Through the practice of NAMASMARAN. Even as the conceived embryo cannot do it, the pregnant mother is blessed to enable the conceived embryo to participate in it! Every pregnant mother has this golden opportunity and privilege!


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Jan28
Facts to know about effects of Smoking on Fertility, Infertility & IVF
Smoking is the largest cause of preventable death in the world. Smoking causes 90% of all deaths from lung cancer and chronic obstructive pulmonary disease (COPD). It increases the risk of coronary heart disease, stroke, several types of cancer, infertility, stillbirth, sudden infant death syndrome (SIDS), osteoporosis, and premature skin ageing (wrinkles). Even second-hand smoke is dangerous for health.

Cigarette smoking can cause infertility.

If you are a smoker and are trying to get pregnant, stop smoking now. Quitting may be one of the best things you can do for your health, for family and for your fertility.

Smokers are more likely to have fertility problems than non smokers. If you smoke for many years, or smoke many cigarettes per day, your risk for fertility problems is increased. When you smoke, more than 7000 chemicals spread throughout your entire body and all of your organs.

In females smoking can lead to fertility problems, including the following:

Ovulation problems
Genetic issues
Damage to your reproductive organs
Damage to eggs or premature menopause
Increased risk of cancer and increased risk of miscarriage

Detailed information about male and female infertility treatments, causes and symptoms is available at http://www.rupalhospital.com/infertilitytreatmentformaleandfemale.html

In males Men that smoke are at an increased risk for the following male fertility problems:

Lower sperm count and sperm motility problems
Hormonal issues
Erectile dysfunction - trouble getting or maintaining an erection

In addition, smokers that try fertility treatments tend to take long time to conceive. If you are trying to get pregnant without success and your partner smokes, encourage him to quit. The sooner he quits, the sooner you may be able to conceive.
Here are the few important questions and answers that need to be considered and understood by the persons smoking.

"The best way to protect your fertility is to give up smoking."

Can smoking affect my ability to have a child?

Most people understand that smoking increases the risk for heart, vascular, and lung disease. Many do not realise that smoking can also lead to problems with fertility in both men and women. Sperm count, Erectile dysfunction and pregnancy complication rates increases with smoking.

Will smoking affect my eggs or sperm?

Chemicals (such as nicotine, cyanide, and carbon monoxide) in cigarette smoke speed up the loss rate of eggs. Unfortunately, once eggs die off, they cannot be regenerated or replaced. This means that menopause occurs 1 to 4 years earlier in women who smoke (compared with non-smokers). Male smokers can suffer decreased sperm quality with lower counts (numbers of sperm) and motility (spermÕs ability to move) and increased numbers of abnormally shaped sperm. Smoking might also decrease the spermÕs ability to fertilize eggs.

How can smoking impact my ability to conceive?

Women who smoke do not conceive as efficiently as non smokers. Infertility rates in both male and female smokers are about twice the rate of infertility found in non smokers. The risk for fertility problems increases with the number of cigarettes smoked daily. Even fertility treatments such as IVF may not be able to fully overcome smoking effects on fertility. Female smokers need more ovary-stimulating medications during IVF and still have fewer eggs at retrieval time and have 30% lower pregnancy rates compared with IVF patients who do not smoke.

Does second hand smoke of partner have effect on fertility?

Second-hand smoke can affect your fertility. If you live with a smoker, encourage your loved one to stop. Second-hand smoke exposes you to poisonous chemicals, affecting your fertility. In fact, fertility experts say that second hand smoke is almost as damaging to your fertility as if you were smoking yourself! Exposure to cigarette smoke for even just a few days can affect your health and your fertility. Second-hand smoke is also a known cause of Sudden Infant Death Syndrome (SIDS). If you do become pregnant, you and your partner must stop smoking to protect the health of your baby.

If I stop smoking, will my chances for conceiving and having a healthy pregnancy improve?

Yes. Quitting smoking can improve fertility though the decrease of the egg supply cannot be reversed. The rate of pregnancy complications due to smoking decreases, the longer a person has not smoked.

Can smoking affect my children?

Men whose mothers smoked half a pack of cigarettes (or more) a day had lower sperm counts. Smoking during pregnancy also can lead to growth restriction of the baby before birth. Children born with lower-than expected birth weights are at higher risk for medical problems later in life (such as diabetes, obesity, and cardiovascular disease). Children whose parents smoke are at increased risk for sudden infant death syndrome (SIDS) and for developing asthma.

Read about the factors affecting fertility and infertility in men and women of fertile age at https://rupalhospital.wordpress.com/

Quitting smoking can be very, very difficult but studies show that the chance for success is much higher if you work with your health-care provider and/or a support group. Sometimes, temporary use of a nicotine replacement (such as nicotine gum or patch) and/or prescription medication can improve quitting smoking rates, and you can use these while trying to conceive, if needed. Though it generally isnÕt advised to use these during pregnancy, you and your health-care provider might consider their use during pregnancy after weighing the risks and benefits.

The facts about smoking and fertility

Smokers take longer to conceive than non-smokers and are more likely to have fertility problems. While smoking can lead to some long-term fertility damage, studies have also shown that fertility rates can improve after one year of quitting.

Some women may be tempted to keep smoking until they get pregnant. However, it's best for you and your future baby if you quit before you achieve pregnancy. It'll improve your chances of conceiving, be easier on your body, healthier for your baby, and lower the risk of miscarrying the pregnancy before you've even had a chance to give up smoking. The take-home message for young women is that smoking irreversibly damages an irreplaceable population of ovarian cells. Numerous studies had identified specific effects of maternal smoking during pregnancy, including foetal growth retardation, neonatal deaths, pregnancy complications, premature delivery and possible effects on lactation and long-term effects on surviving children.
Further, there have been indications that smoking decreases fertility in women increases the frequency of menstrual abnormalities and decreases the age of spontaneous menopause. In males, it has been suggested that cigarette smoking negatively affects every system involved in the reproductive process. Spermatozoa from smokers have reduced fertilising capacity, and embryos display lower implantation rates.

If your partner is also a smoker, it's best to quit together, and there are many good reasons to do so. Dropping the habit together will increase your chances of successfully quitting, too.

Fertility often improves for women after they stop smoking. Studies show that female smokers can increase their chances of conceiving by quitting at least two months before trying to get pregnant. Quit smoking and you may just find it easier to get pregnant. In conclusion, although smokers as a group may not experience reduced fertility, males with marginal semen quality may benefit from quitting smoking. Also, smokers should quit smoking for the sense of responsibility for their future generation as tobacco smoke contains numerous mutagenic substances.

The best way to protect your fertility is to give up smoking. Despite these warnings, millions of women of childbearing age still continue to smoke. By doing so, they risk their own health and the health of their babies and put the family building at stake.

Its in the interest of the family that couple makes healthy choices for themselves, their partners, and their future children. Rupal Hospital is dedicated to provide the highest quality of services in womenÕs health. It is the result of years of experience, knowledge, understanding and constant updating and effort that has made the Rupal Hospital the best amongst all. Doctors at Rupal Hospital take keen interest in public health education. We believe that preventive interventions are equally important as curative medicine, and prevention always requires awareness and educations. We conduct several workshops and seminars that will improve the health being of couples and in turn will help them to attain pregnancy.

Get Awesome Facts on pregnancy and and benefit of our expertise on Infertility Treatment, male and Female infertility symptoms and solutions at http://www.rupalhospital.com or you can contact us on 91-261-2599128-9


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Dec14
Things You Really Need to Know About IVF Before Using It
In vitro fertilization is a popular option for women who are looking for help conceiving, but there's a lot that comes along with the fertility treatment. That’s why it’s important to have all the IVF treatment facts ahead of time. You must speak with your obstetrics and gynecology or reproductive endocrinologist or our IVF experts at our reproductive Center to share
information to help prepare for your future.

Start with a fertility test first.

Whether you want to get pregnant now or wait a little longer, it’s a good idea to know where your fertility levels stand. Fertility doctors suggest a simple test called Anti-Mullerian Hormone Blood Test (AMH), which is a good indicator of egg reserve and grades your fertility levels between high, medium, and low.

IVF isn’t always a first option.

Many women think IVF is their first option if they want it, but the truth is most fertility doctors will tell you to try natural pregnancy first. If you’re 30 to 35, you should try for at least six months and if it’s not working, then you need to do a work-up to see what procedure to target. Even after that, our Infertility doctor will try oral or injectable fertility medication before IVF. Of course, there’s always exceptions and those include a low score on your AMH or if you’re 40-years-old or older. If there’s a small sperm count you have to go straight for IVF or if a woman has tubal blockage, recurrent miscarriage (like three or more) or if there’s potential for certain genetic disorders, then you can start off with IVF.

IVF works best when you’re younger.

Fertility experts says though we might think IVF is a treatment option when we’re older, the truth is, it actually works better if we’re younger. IVF doesn’t really fix the age of your eggs so you have to think about that early. Unfortunately, along with fertility, IVF success rates or successful pregnancies decline as women get's older.

IVF Treatment - It comes at a cost.

You’ve likely heard that IVF can be expensive. It’s true. There are affordable and economical fertility clinic to make treatment more accessible, like ours.

Be patient - During IVF Treatment

One of the biggest misconceptions about IVF is that it works right away. It’s very common you’ll need to do it more than once. In younger patients it may be a little less (if you’re not pregnant in the first cycle, you’ll likely get pregnant in the next), but if you’re in your forties the average is like three cycles. This is only an indicative figure and will vary from person to person and case to case basis. Please consult our experts for more on this.

You can have IVF using donated eggs and/or sperm

For some, the hope of having children is diminished by unforeseeable circumstances, such as developing cancer or finding out that you or your partner have low ovarian reserve or low sperm count. In such situations, fertility clinics offer donor conception, which uses sperm, eggs or embryos donated by someone else for your fertility treatment. The use of donor eggs and sperm is becoming more common today.

You are more likely to fall pregnant with a multiple pregnancy through IVF than natural pregnancy

It's true with assisted reproduction treatments, such as IVF or egg donation. This is because fertility clinics will often use a process called double embryo transfer when carrying out IVF, as traditionally, it was deemed to increase the chances of pregnancy.

It’s not 100 percent successful.

The most important fact to know about IVF is that it’s not 100 percent successful. The process can take time, money, and even an emotional toll on your life, and in the end, it might not work. Thats where choosing the correct IVF clinic will help you a lot in evry single step of the fertility treatment process.

Despite the fact that IVF success rates are on the incline because of constant advancement in Assisted Reproductive Technology, it is still important for women and couples who are seeking IVF treatment to take age into consideration. This is because the success of an IVF cycle is very much determined by the age of the embryo and sperm that is being implanted, for example the younger the embryo or oocyte, the greater the chance of conception.

There’s a significant emotional drain on the couple and the relationship. We encourage couples to find alternative outlets like exercise, counseling therapy to find balance throughout the treatment process. There are so many errors built into conception and things we can’t control due to genetics. Most IVF failures are not something that a couple can fix, even if a woman has a good, healthy diet and exercises—those are important, but it’s very age dependent.

Support during the fertility treatment is absolutely vital...infertility treatment can be such a solitary experience otherwise. Counselling can provide emotional support before, during or after fertility treatment. If dealing with infertility leaves you struggling to cope with everyday life or causes you to revisit past problems, counselling can be very therapeutic.

You can contact the team of IVF experts at Blossom Fertility & IVF Center in India - Surat Gujarat at http://www.blossomivfindia.com or you can fix up an appointment with us by calling on +91 261 2470333. Get started today by contacting us today for all further info on infertility treatments like IVF, ICSI, IUI, IMSI, Surrogacy or at http://www.blossombestivfindia.com and gather all information to attain happy parenthood.


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Nov14
Diabetes and Reproduction & Sex
Today 14th December is World Diabetes Day. India is nowadays considered the “Diabetic Capital” of India. The rate at which diabetes is increasing in modern societies is, indeed, a matter of concern. Diabetes does not merely mean increased and sometimes uncontrolled blood sugar. It affects various organs and systems of our body , particularly affecting heart (coronary artery disease), brain (stroke), eye (retinopathy), kidney (nephropathy), blood pressure (hypertension), liver (fatty liver), nerves (neuropathy), increased risk of infection and even some cancers. Obesity and diabetes go hand-in-hand. So, the main control measures are life style changes (controlling weight, diet, exercise, avoidance of alcohol and smoking); drugs (oral drugs and insulin) and monitoring by physician.
1. Sexual Dysfunction-
Diabetes is a major cause of sexual dysfunction in both male and female. It can reduce the libido (sexual desire) by altering the sex hormone levels. In case of male, Erectile Dysfunction (ED) is sometimes the first symptom of diabetes. So, if a male suffers from ED, rather than taking drugs directly from medicine shops, the cause of ED must be evaluated, particularly diabetes. Often patients do not know that they are diabetic but when the cause of ED is investigated, diabetes is discovered incidentally. It can also affect the nerves and thus can worsen the sexual problems. In female, it can lead to decreased arousal leading to avoidance of sexual activity. In some cases, it is responsible for premature ejaculation (PE) in males. Thus any person with sexual problems, should be evaluated for diabetes. Control of diabetes often resolves the problem.

2. Menstrual problems-
Obesity and diabetes together can affect hormone balance leading to irregular menstruations ranging from periods occurring at every 2-3 months, sometimes too frequently (every 10-15 days), scanty flow and sometimes heavy flow. This is particularly true in case of polycystic ovarian syndrome (PCOS) which can affect various organs and systems of the body. In PCOS, insulin is there in the body but it cannot function properly and ultimately it leads to diabetes. In some cases, this high blood sugar may be responsible for appearance of excessive hair growth (male-like hairs) in females. Even in some cases, diabetes may be associated with increased thickening of the endometrium (the inner lining of the uterus). In thw worst cases, these women may have cancers in endometrium. So, women with menstrual problem need proper evaluation. Reduction in weight and control of blood sugar help to control menstrual problems.

3. Infertility-
As mentioned above, PCOS is a common cause of infertility. Similarly, diabetes and obesity can lead to problems in ovulation and thus creates problems in having pregnancy. Control of weight and blood sugar lead to successful conception in most cases. Similarly in male, high blood sugar can affect sperm production and thus impairs male fertility. Sexual dysfunction can aggravate the problem. Infection also plays a important role.

4. Infection-
Diabetes is notorious for increasing susceptibility to infection and often interferes with eradication of infection. In female, the infections may lead to vaginal white discharge and even in severe cases can block the fallopian tubes leading to infertility permanently. In male, it can cause phimosis (tight foreskin) and sometimes infection of sperm conducting-passage leading to infertility. So, male and female with genital infection must be evaluated for diabetes. Proper control of blood sugar and antibiotics are needed to control these.

5. Pregnancy problems-
Women with diagnosed diabetes are encouraged to control blood sugar before pregnancy. Otherwise there will be problems for mother as well the baby. Diabetes can cause miscarriage, preterm labour and worsens maternal problems like hypertension, nephropathy and retinopathy in pregnancy. It can lead to sudden unexplained death of the baby inside the uterus. The baby can have excessive weight (that leads to its diabetes in later life) and other problems like low blood sugar at birth, problems in breathing, problems in brain and problems in heart etc. So, proper control of blood sugar is needed before pregnancy and should be continued throughout pregnancy.

6. GDM-
Some women may have normal blood sugar before pregnancy but may develop diabetes in pregnancy. This is called gestational diabetes (GDM). It is also associated with increased risk of complications to mother and baby. 50% women with GDM can develop diabetes in later life. So, women with repeated miscarriage, still birth and very large baby should be evaluated for diabetes. Treatment must be continued throughout pregnancy.

To summarize, diabetes is not only responsible for diseases of heart and brain but it can affect your reproductive life, particularly sexual function, conception and pregnancy. So, if you suffer from these problems, do not hesitate to check blood sugar. If diabetes is detected, there is no need to worry as proper control will solve all these problems.


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Sep18
Stress and Family Life
In our modern life, stress is an indispensable part. Career, jobs, studies, incomes, business, money, property- all are associated with some sorts of stress. The problem gets exaggerated when it affects the family life. Because, at the end of the day, we all want to enjoy a happy family life. And a family life has its sense when the husband and the wife are in harmony. Needless to say, that a family is incomplete without a kid.

How stress affects family life? Effect of stress is not limited to mind. It has serious effects in the body. It affects blood circulation and the heart. It puts pressure on nerves. It also alters the blood sugar level. And he end result is diabetes, hypertension (high blood pressure) and heart diseases. Ultimately these diseases affect all the organs of our body. Some people try to get rid of stress by smoking and alcohol. These will simply put burden on already affected heart and blood.

Stress also alters important hormone levels in our body. The hormones needed for basic reproductive function (sex, conception and pregnancy) are either increased or decreased. Prolactin hormone is increased. Normally prolactin is needed to secrete milk from breast to fed the baby. But abnormally increased prolactin leads to milk secretion from breast (even without pregnancy) and irregularities in periods. Very high prolactin may even lead to problems with ovulation (at middle of each period, the egg gets released from ovary) and as a result, the woman cannot conceive a baby. Even in male, high prolactin leads to difficulty in erection of penis. In some male, it can lead to gynaecomastia (growth of male breast). Excessive high dose of prolatin leads to loss of sex desire in male and interferes with spermatogenesis (sperm production).

Apart from increasing prolactin, stress can directly affect the hormones secreted from the pituitary gland of both male and female, the testes in male and the ovaries in female. As a result, all the reproductive functions get disturbed leading to problems in sex (loss of desire in both male and female, problems in erection and ejaculation in male), irregular periods in female and ultimately pregnancy cannot occur.

The diseases occurring as a result of stress (diabetes, hypertension etc) also affect the normal functions of ovaries causing irregular periods, even no periods at all. There may be problems in ovulation and thus difficulties in achieving pregnancy. Even if pregnancy occurs, it may be aborted because of these diseases. Similarly in male, diabetes and hypertension will cause sexual dysfunction and will affect sperm production.

The lifestyles accompanying stress are also responsible for harmful effects on family life. Smoking and alcohol have been mentioned earlier. Stress may be associated with abnormal weight gain and that will affect the woman’s life in badly manner. There will be disturbances in periods, ovulation problems, infertility and even pregnancy loss. Sitting for long time while driving or keeping laptops on laps, will increase the temperature of scrotum in male and thus will decrease the sperm production.

Again there is a vicious cycle- stress leads to family problems like problems in sex and in having pregnancy. That will in turn increase pressures from family (especially in-laws) and the society. This will simple aggravate the stress.
So, what can be done to avoid these problems? The answer seems to be simple- that is avoiding stress. But it’s very easy to say and difficult to commit. First thing is try to bring stress at home just keep it at your workplace. Avoid smoking and cut down alcohol consumption. Avoid sitting long time in front of computers and take periodical rests when you are working continuously. The rest does not mean that you have to lie down in bed; just have a short walk. Start exercise that will keep you healthy and reduce your stress. Yoga is an Indian culture that taught the Western world how to reduce stress. Take plenty of water and green vegetables and fruits. Avoid fast food. Always put on comfortable dresses. And if all of these do not work, try if you can do something to avoid the stress- like changing the workplace, talking directly to your co-employees or the employer. If still all these cannot help, consult psychological counselor. A timely counseling will reduce stress significantly. In very few cases, drugs may be needed to reduce stress. But remember, drugs can only be useful if you are trying all the other measures. Simple dependence on drugs won’t help much.

Now regarding family problems associated with stress follow simple measures. Often we feel embarrassed to discuss these issues. Try to enjoy time of personal intimacy to the fullest. Don’t think of any problems during that time. If still there are problems, don’t hesitate to take medical help. And please remember, the drugs used to solve sexual problems may have side effects. So, these should be taken only after medical consultation.
In case of female, maintain optimum weight. Avoid fast food, alcohol and smoking. If periods are irregular, maintain a menstrual diary. Consult a doctor to find out if there are some serious issues associated with these problems (like hormonal problems, thyroid diseases, even some tumours). You doctor will then decide the best treatment for you. If there are low desire for sex, don’t hesitate to take help of doctor. It may be a symptom of hormone deficiency that can affect your different systems (like bone, heart, blood etc). Now a days, there are lots of treatment options available for this.

For male, if there is low desire, consult your doctor to find out the cause of this problem. At the same time, avoid any anxiety, alcohol and smoking. Sometimes there are problems with erection. Instead of trying drugs shown in media or newspaper, feel free to talk to your doctor; because erection problem may be caused by some serious issues like heart disease, diabetes etc. So, if you have erection problems, consult doctor. He/ she will counsel you and give you the best treatment. Now if the problem is with ejaculation (like early loss of semen or very low semen), that issue can also be solved in the same way.

What’s about infertility problems? Stress and infertility are inter-related, as described before. Now, if there is problem with fertility, please remember few facts. Even in totally healthy couples, the chance of pregnancy after regular intercourse in fertile period (in the middle of menstrual cycle, usually) is only 20%. Though it appears disappointing, majority of couples conceive in course of time. So, couples are requested to report to doctor only if they tried regularly for one year without any protection. Then your doctor will assess you and try to find out the problem. And again, treatment of infertility is also depending on chance. Hat means we have to increase the chance above the natural chance (which is 20%). So, even one treatment fails, there is enough scope, so no need to lose hope. In other words, there is no need to increase the stress.

So, stay healthy, keep your mind healthy by avoiding stress and keep your family relationship totally stress-free.


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