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Nov24
Stress, Infertility and Stress Management
In today's world everyone is very concerned about performance, competition and perfection which lead to an insidious increase in stress. Stress causes damage that is often underestimated, and it is a social phenomenon that should be closely examined and evaluated. In today’s modern, fast paced society, it is easy for people to become stressed.
The trouble is that modern life is so full of frustrations, deadlines, and demands that many of us don’t even realize how stressed we are. By recognizing the symptoms and causes of stress, you can take the first steps to reducing its harmful effects and improving your quality of life.
It is not clear how exactly stress impacts fertility. It is not known whether high levels of stress can prevent pregnancy or affect a woman’s chance of conceiving. We do know that reducing stress provides a better quality of life during times of intense personal challenge. Doctors may not know the exact links between stress and fertility, a series of studies shows the impact is hard to ignore. It is reported that stress may play a role in the success of infertility treatments, including in vitro fertilization (IVF).
While stress does not cause infertility, infertility most definitely causes stress. Infertile women report higher levels of stress and anxiety than fertile women, and there is some indication that infertile women are more likely to become depressed. This is not surprising since the far-reaching effects of infertility can interfere with work, family, money and sex. Finding ways to reduce stress, tension and anxiety can make you feel better.

It is very difficult to say whether stress is causing infertility or infertility is causing stress. Both are interrelated.
Find out more in detail about fertility and infertility treatments at http://www.rupalhospital.com/infertilitytreatmentformaleandfemale.html
Result of stress on human body.
Stress can interfere with conception. Stress can affect the functioning of the hypothalamus — the gland in the brain that regulates your appetite and emotions, as well as the hormones that tell your ovaries to release eggs. If you're stressed out, you may ovulate later in your cycle or not at all. In an occasional woman, having too much stress can change her hormone levels and therefore cause the time when she releases an egg to become delayed or not take place at all. Other research indicates that stress may have an impact on other aspects of fertility beyond ovulation, including problems with fertilization and implantation in the uterus.
The American Society for Reproductive Medicine (ASRM), the gold standard in the infertility medical world, acknowledges that stress probably does not cause fertility problems (although men and women with fertility problems are often highly stressed by the disease). ASRM also report that stress can sometimes cause hormonal changes, ovulation disorders, and infertility, but this is very rare.
Stress is just one of many factors that can contribute towards infertility, but should always be taken into account for couples having trouble conceiving. This is especially the case if medical tests have shown no obvious explanations. The rates of unexplained infertility have been rising over the years, which is no surprise considering increasingly stressful lives.
Stress can also lead to alcoholism, smoking, drug use, or compulsive eating, as people use these as a temporary escape. These are all bad habits that can lead to infertility through developing related medical disorders.

Impact of stress on Fertility
Sometimes, infertility patients respond to the stress of being unable to conceive by aggressively pursuing treatment and procedures. Other patients withdraw and isolate from family, friends, and community. Neither of these extremes is ideal for patients who seek to treat their infertility and build a family.
Being unable to get pregnant when you want to, can be a huge source of stress, anxiety, and depression. Most people who cannot get pregnant have an actual physical explanation, but as month after month goes by, feelings of stress, anxiety, and depression often kick in. So even if the physical cause of infertility is treated medically say, surgery for endometriosis, problems with low sperm count and others, it's possible that high levels of stress can still make getting pregnant more difficult.
Infertility causes stress which is aggravated as time passes and the couple remains infertile. Among the causes of stress are the couple's isolation, life with unrealized potential and unborn child, disruption of day-to-day life during infertility evaluation and treatment, and the couple's feeling that they do not have control of their own lives. The IVF program is considered by many as the final step for the evaluation of the couple’s fertility potential; hence, couples participating in an IVF program are highly stressed, especially after a failed IVF cycle.

All women trying to get pregnant have a lot to deal with: taking time off from work for doctor appointments, having blood drawn, having pelvic exams, ultrasounds, injections, taking basal temperatures, timing intercourse and undergoing various diagnostic procedures. As if the cost and discomfort of solving the problems with fertility aren’t enough, one also has to deal with being on an emotional roller coaster, a husband who may not participate in medical treatments, friends and family who make insensitive comments and social situations that are almost unbearably painful (like a baby shower).
It is very difficult to say whether stress is causing infertility or infertility is causing stress. Both are interrelated.
Reduced stress is good for your health. While no one expects patients to approach fertility treatment stress-free, finding ways to minimize stress while pursuing treatment can help. It is helpful for patients to look for ways to reduce the burden of infertility treatments and medical protocols.
Following are some practical ways where women trying to get pregnant can reduce their stress.
Talk to your partner.
Remember you're not alone. Talk to people with infertility, through individual or couple counselling, or support groups.
Read books on infertility, which will help you to be normal and can help you deal with them
Learn stress reduction techniques such as meditation, yoga, progressive muscle relaxation or acupuncture
Avoid taking too much caffeine or other stimulants
Exercise regularly to release physical and emotional tension
Listen to music of your choice and relax
Plan medical treatment plan with your partner to which both of you are comfortable
Gather all information about causes of infertility and the treatment options available
Plan and arrange finances required for treatment and the possible insurance coverage
Walking/hiking

Connection between stress level and fertility outcome is very difficult to determine. Relaxing certainly won't do couples trying to conceive any harm, Reducing stress may be difficult, but meditation, yoga or other relaxation techniques might help to reduce stress and conceive at the earliest.
"Don't just try to relax because you think that it's going to help you get pregnant. But do relax just because it feels good, because it's comfortable, and because when you do feel good, you're healthier overall, and that can never be a bad thing for conception."
"Stress could disrupt fertility, but it very rarely--if ever--causes people never to conceive."
The emotions around trying to conceive can be more challenging than the treatments for Infertility. Telling patients to be less stressed can make them feel more responsible for causing their own infertility and feel blamed. Telling someone to relax can cause greater stress. However, asking how couples/friends are doing and suggesting concrete and pragmatic ways to reduce stress will enhance quality of life and give the patient back some sense of control. For many struggling with infertility, just having friends/loved ones available for listening is greatly appreciated.

The goal of stress reduction is to minimize, not eliminate stress, by finding the technique that serves the patient’s needs the best. Rupal hospital for women in Surat is a clinic where patient’s satisfaction and care is prime subject. The doctors are very friendly and always supportive to patients in dealing with all types of infertility issues and provide all moral and psychological support. The counselling facility for couples is also available. Each individual patient is taken care of personally by well experienced doctors and medical staff. We try to help patients acknowledge the stress they are carrying around and help them find ways that work for them to make the stress manageable. We offer patients a wide range of supportservices, including support groups, online communities, resourceful articles and stress relieving tips. We provoke them to participate in mind or body relaxation programs which have the skills to reduce stress at every stage of the cycle.
For any help relating to infertility and fertility treatments including male and female infertility, you can book an appointment with doctors and experts at Rupal Hospital for Women. We are also available at http://www.rupalhospital.com/


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Nov18
IUI (Intrauterine Insemination)- Treatment Option for Infertile Couples
Introduction
When couples get married, they often view parenthood as the next stage in their family life. They want to have a child, they want to be “mom” and “dad”, they cannot imagine that this may be hard to achieve or may not be a natural process. When several trials to conceive fail, they are shocked. Their basic expectation about family life gets shattered. Most of the couples are desperately looking for medical therapy that will end into a misery. Clearly this is not a struggle to survive; it is a struggle to fulfill a dream, to achieve what they view as a “full life”.
What is needed for pregnancy?
In the male partner, sperms are normally produced in the testes after puberty (after attainment of characters like growth of beard, moustache etc). From the testes, they are carried through the sperm conducting ducts (epididymis, vas, seminal vesicle and prostate gland). Then during sexual stimulation, after proper erection and ejaculation, they come out through penis. During sexual intercourse, these sperms, present in semen, are deposited inside the vagina.
In female partner, the deposited sperms must travel from vagina through the cervix (the mouth of the uterus). The cervix acts as gate-keeper, a it prevents entry of dead and abnormal sperms as well as bacteria present in semen, in the uterus. From uterus, sperms reach the Fallopian tubes (the tubes that are attached to the both sides of the uterus) where the sperms must meet the egg (ovum). The eggs are produced only before birth and so, there are fixed number of eggs inside the ovary. The ovum released from the ovary, into the abdomen at the time of ovulation (rupture of the surface of ovary to release the ovum). That ovum must be taken by the tube and thus inside the tube an embryo (earliest form of the baby) is formed, by meeting of the egg and the sperm.
It should be mentioned that out of nearly 200-300 million sperms, in average, deposited in vagina, hardly 500- 800 sperms can reach near the eggs and only one will succeed to form the embryo. The embryo then travels through the tube into the uterus and the uterus attaches the embryo firmly with it and thus the pregnancy starts. So, if there is defect in any one of them there will be difficulty in achieving pregnancy.
Thus, to summarise, pregnancy requires
1. Production of healthy (“Normal Morphology”) and movable (“Normal Motility”) sperms in adequate number (“Normal Count”) in the testes
2. Transport of these sperms through the sperm conducting ducts from testes to penis
3. Successful Erection and Ejaculation during Intercourse to deposit adequate number of these sperms in the vagina
4. Transport of these sperms from vagina through cervix to the uterus and the tubes
5. Presence of sufficient number of eggs inside the ovary and ability to release the eggs from the ovaries
6. Pick up of the eggs by the tubes
7. Approximation of eggs and the sperms to form the embryo
8. Transport of embryo from the tubes into the uterus
9. Acceptance of the embryo by the uterus and its growth
What is Infertility?

Literally, the word “Infertility” means inability to conceive. But in reality, there are very few couples, who have no chance of natural conception and are called “Absolutely Infertile”. In fact, in many couples who present to infertility clinics, pregnancy may be the matter of time, thus the chance factor.
It should be kept in mind that, if there is factors to question fertility of either male or female or the female is of age less than 35 years; after one cycle (one month) of regular frequent intercourse, the chance of conception in human being is only 15%. That means, out of 100 couples trying for conception, only 15 will be able to succeed after one month of trying. The word “Regular” and “Frequent” are important; because to achieve pregnancy, couples are advised to keep intimate relationships for at least 2-3 times a week and this should be increased particularly around the time of ovulation (Middle of the menstrual cycle). Thus chance of pregnancy after 6 months, 12 months and 24 months of regular trying are respectively 60%, 80% and 100%.
The word, “Subfertility” seems better and more scientific than “Infertility”, to describe the couples who have reduced chance of conception, due to any cause. However, the word “Infertility”, seems more popular, although it puts pressure on the couples. In most cases, usually we advise to investigate after one year of regular and frequent intercourse, when the couples fail to conceive. However, if there are factors to question fertility; for example female with age more than 35 years, or with previous surgery in tubes/ ovaries/ uterus or known diseases like PCOS or endometriosis; or male partner having surgery in scrotum or groin or any hormonal problems or sexual dysfunctions- the wait period is usually reduced and couples can be investigated, even soon after marriage.
What causes Infertility?
Please look at the point “Thus, to summarise, pregnancy requires” where 9 points have been mentioned.
Thus the common causes may be
1. Problems in male- total absence of production of sperms, less than adequate number of sperms, problems in morphology and motility of sperms (most sperms not healthy or movable), blockage in transport of sperms and inability to deposit sperms in the vagina (sexual dysfunction- Erectile Dysfunction or less commonly, Ejaculatory Dysfunction). Examples include hormonal problems (Testosterone, thyroid, prolactin), diabetes, liver problems, causes present since birth, chromosomal abnormalities, surgery, infection, sexually transmitted diseases, smoking, exposure of scrotum to high temperature, some medicines or psychological causes.
2. Problems in female- total absence of less than adequate number of eggs in the ovaries, problems in ovulation, problems in picking of eggs by the tubes, blockage of tubes, problems in conduction of sperms or embryo by the uterus, problems in accepting the embryos by the uterus. Examles include causes present since birth, chromosomal abnormalities, polycystic ovarian syndrome (PCOS), old age, increased weight, fibroid, endometriosis, pelvic inflammatory diseases (PID), tuberculosis (TB), infections, smoking, surgery, some medicines, hormonal problems (thyroid, prolactin) or excessive stress.
3. Unknown causes- Despite thorough investigations, 25-30% causes of infertility remain unknown. This is called “Unexplained Infertility”. The reason may be mere chance factors or there may be some causes which, still medical science has yet to discover. But this should be kept in mind while treating infertility. That means, even with correction of the possible factors (like improving sperm counts or thyroid problems etc) or with proper treatment (IUI, IVF or ICSI), unfortunately the treatment can fail and the exact reason, why the treatment failed, is sometimes difficult to find out.
In general, what are the treatment options for infertility?
To start with, please remember there is no hard and fast rules for infertility treatment. Often medical science fails to understand why couples with very severe form of infertility conceive sooner than those who are having all tests normal. That means, whatever treatment is offered, it’s very important to continue regular sexual intercourse, as the chance of natural pregnancy is usually there in almost all couples. Your doctor will present the facts to you, without pressurizing you on a particular option. After coming to know all pros and cons of different treatment options, you can take decision. Do not hurry. It’s quite natural that you might be in stress.
In general, after the initial tests, a few periods of natural trying is allowed. After that, ovulation induction (giving medicines to release eggs from the ovaries) is offered, failing which IUI and finally IVF is offered. What will be the preferred treatment for you, will depend on your age, duration of marriage, male and female factors and of course, your age. For example, a woman with both tubes blocked or a male with very low sperm count, IVF would be the first line of treatment.
What is insemination?
Insemination literally means putting semen in a particular place. Various forms of insemination exist in fertility treatment. First one is “Intravaginal Insemination (IVI)”, where the raw semen, collected by the husband can be put inside the vagina, taking precautions (to prevent infection) by the husband himself or by the wife. Rarely, it needs medical assistance from a doctor. It’s usually advised to couples having sexual disorders where full penetrative intercourse is not possible (erectile dysfunction of the husband or very painful intercourse experienced by the wife) or where ejaculation cannot happen during intercourse (a very unusual problem). Thus, the success rate of IVI is no better than natural intercourse (success rate 15% per cycle), for those couples who can manage successful intercourse.
“Intrauterine Insemination (IUI)” is the treatment where “prepared” semen is put inside the cavity of the uterus, near the Fallopian tubes. Thus, IUI bypasses some hurdles that can cause problems during natural intercourse. The vagina, cervix and the whole length of the uterus are bypassed, putting the sperms near the eggs. Thus it increases the success rate compared to natural intercourse or IVI.
However, to achieve pregnancy after IUI, the female partner must have open tubes, adequate number of eggs produced by ovaries, eggs must be released by the ovaries and sperms must meet the eggs. And, thus nature plays important role, as in natural intercourse.
Please note, we used the word “prepared” semen. In natural intercourse, as mentioned earlier, the dead sperms and bacteria cannot enter the uterus, because cervix prevents their entry. If they are put artificially by IUI inside the uterus, severe reaction can happen. So, after collection, the husband’s semen is processed in the laboratory to remove all those impurities and to select only the best number of healthy and movable sperms and it definitely increases success rates of IUI
When IUI is generally advised?
As you can understand, to perform IUI, there must be minimum number of sperms in the semen, the tubes must be opened, the ovaries must be releasing eggs. If these are present, IUI is usually advised
• Less than adequate number of sperm counts, morphology or motility
• Couples who cannot perform full penetrative intercourse but refuse or unable to conceive by IVI
• Unexplained infertility- although IVF is better than IUI, but considering the cost, many couples in our country opt for 2-3 cycles of IUI before IVF
• PCOS and Mild Endometriosis- where natural intercourse or ovulation induction failed
• Couples in whom only one partner is positive for HIV or Hepatitis B or C- where transmission from one partner to another by unprotected sexual intercourse is not preferable.
What are the tests done before IUI?
The basic infertility evaluation is done before IUI include husband’s semen analysis, assessment of ovarian function (blood tests, ultrasound) and uterus (ultrasound). In some cases, laparoscopy (putting camera to see inside the abdomen by operation) or hysteroscopy (putting camera through vagina inside the uterus, by operation) may be required. Now, if the tubes are blocked, IUI is of no use. So, testing the tubes is advisable before IUI. But some women, who are at low risk of tubal disease (no history of pelvic pain, infection or surgery), one or two cycles of IUI can be done, failing which tubes must be checked by tests like HSG or SSG or in some cases by laparoscopy.
What IUI actually involves?
In the cycle, in which IUI is planned, the woman is asked to take some medicines (or injections) in particular days of the periods as a part of “ovulation induction”. She is then advised to have ultrasound monitoring (TVS- transvaginal sonogram- where ultrasound probe is placed inside the vagina for better accuracy) to see if eggs are growing in response to the medicines or not. If eggs are growing, IUI is planned in a particular time when the egg(s) is more likely to rupture, so that the tie interval between sperm entry and egg release can be kept as minimum as possible.
Is ovulation Induction necessary for IUI?
Frankly speaking, IUI can be done without any medicines (as in case of natural intercourse or IVI), which is called “Natural Cycle IUI”, where only TVS monitoring is done to see how the eggs are growing. This may avoid some side effects of ovulation induction (see below) but is associated with low success rate than IUI done along with ovulation induction.
Is TVS necessary before IUI?
TVS is, undoubtedly, uncomfortable for the woman. But it gives better picture than ultrasound done conventionally. Now, the question is, whether ultrasound monitoring is at all needed or not. TVS directs the doctor how eggs are growing and at what number and size and when they are likely to rupture. Moreover, the rupture can also be confirmed by TVS. Again, the uncommon side effect of ovulation induction can be detected by TVS. That is called OHSS (“Ovarian Hyperstimulation Syndrome”) where excessive eggs can grow inside the ovaries and this can lead to collection of fluid inside abdomen and lungs and can turn very serious. Although very rare, it can be detected by TVS and early actions can be taken to prevent the progress of this condition.
In rare cases, where TVS cannot be done or patient declines, only option is to check urine by LH kit to predict the likely timing of ovulation and at that time IUI is planned. However, it is less accurate than TVS monitoring and is associated with less success.
What, if eggs are not growing in the ovaries?
In some women, particularly those who are overweight, aged or some cases of PCOS, eggs may not respond initially to one medicine. There are various forms of ovulation induction medicines (tablets, injection). If one is not working, your doctor can try increasing the dose of that medicine or add or replace it with other medicines. Please remember, it’s difficult to predict what medicine will be best suited for a particular patient. So, it’s basically a trial and error process.
What is done on the day of IUI?
As timing is important, the couples are requested to stick to the timing, advised by the doctor. The husband will be asked to collect the semen by masturbation, using clean technique (to avoid contamination by germs in the semen container). The semen is then prepared by the embryologist and will be checked to see the final number of sperms and their motility and morphology.
The wife is asked to lie down in the IUI table. After cleaning, a sterile speculum (instruments to separate walls of the vagina to see the cervix) is introduced inside the vagina and then 0.4-0.6 ml of the prepared semen is inserted inside the uterus with the help of a small catheter (fine tube). IUI done, under ultrasound guidance, gives better result than IUI done without it. The patient is asked to lie down few minutes after taking out the catheter and the speculum. The medicines are advised and then they can go home.
Is IUI painful?
Most women feel little discomfort during IUI but it should not be painful. If there is technical difficulty while putting catheter inside the uterus, your doctor will discuss it with you and in the next cycle, will plan management to solve this issue.
What happens if husband cannot collect semen?
Collection of semen in unfamiliar environment is understandably a matter of discomfort and seems awkward. Proper counseling and maintenance of privacy can help. Stress-free approach is needed. If it fails, do not hesitate to inform your doctor. Some medicines can help. But in those, who are unable to masturbate, there are some instruments, like ejaculator, can help to solve this problem.
What happens if sperm count is low?
IUI can be successful if sperm count is minimum more than 5 million per ml and there is reasonably good morphology and motility. If not, IVF or ICSI would be the better option. But IUI can serve as trial also. That means before putting the semen, the prepared sperms can be examined and it can be predicted what is the success rate of IUI in this particular case and whether IVF or ICSI would be needed. In rare occasions, where sperm count is extremely low but the couple do not wish for IVF or ICSI, pooled semen IUI can help- where the semen is collected in number of occasions and is preserved and the final pool is used for insemination, to give a reasonable success rate.
When donor sperm is used and how?
If a man does not have any sperms or too few sperms to do IUI, IVF or ICSI is not affordable, donor IUI is an alternative. But it is not done without consent from both husband and wife. The donor is not known to the couple or the doctor and no identity of the donor is revealed. No relative or friend can serve as donor. Donor semen is frozen semen, collected 6 months ago and the donor is tested for diseases like STD, HIV, Hepatitis B or C. Usual attempt is taken to chose donor having blood group and skin colour similar to those of the husband. But remember, it’s only given after discussion and written consent by the couple.
Can a couple have intercourse in the cycle where IUI is advised?
Intercourse around IUI increases the number of sperms available at the time of ovulation.
When should one check for pregnancy?
Usually if period does not come within 18 days after IUI, pregnancy test is advised. It can be done at home. If negative, then the cause of not having periods is sorted out.
What is the chance of success after IUI?
In one cycle, chance of success is around 20-25%. Most of the couples conceive after 3rd or 4th cycle of IUI. The chance of pregnancy after 6th cycle is low, so, usually IUI beyond 6 cycles is not advised.
The factors where IUI gives better results include unexplained infertility, sexual dysfunction of any of the partner, PCOS and male subfertility (low sperm count or motility)
What happens if IUI fails?
As said earlier, you should think about further treatment, if 3rd or 4th cycle of IUI fails. There is no use of doing IUI beyond 6 cycles, unless natural intercourse is not possible and the age is favourable. IVF gives better result.
Is there any harmful effect of IUI?
Very few harmful effects have been noted, for examples, hazards of ovulation induction (OHSS< twin pregnancy), pain, infection and discomfort. As mentined, if raw semen is given, unusual allergic reaction can happen.
How IUI is being done in your particular centre by Dr Sujoy Dasgupta?
We believe in patient’s autonomy. So we want to give time on discussion and presentation of facts and figures to the couples. We encourage questions from the couples and take utmost care so that no question remains unanswered.
We do not take decisions and impose it on the couples. We advise the couples to take time before taking decision on a particular treatment. If the couple decides, we respect and support their decision.
We try to take nominal charges and help couples to collect medicines (particularly injections) at lower prices than MRPs.
After thorough evaluation of both the partners, we plan for ovulation induction drugs, with consent from them and advise them to come for TVS. After each day TVS, we explain the progress and probable timing of IUI.
On the day of IUI, after requesting the couple to maintain punctuality, we advise the husband to collect semen, in comfortable atmosphere, maintaining the privacy. If there is problem in semen collection, we provide support to him and address his issues in sensitive way.
Our expert trained embryologist then prepares the semen. We always encourage the couples to see the condition of raw and prepared semen under microscope to maintain the transparency.
We advise the woman to fill up the bladder (to take water and not to urinate) to facilitate the passage of IUI catheter. Unlike other places, we perform IUI inside OT to prevent unwanted infection.
Again we maintain our uniqueness in the sense that we perform it under ultrasound guidance. The ultrasound guidance has been scientifically proved to increase the success rate of IUI. Moreover, we show the woman in the ultrasound (real time) how the catheter has been put inside the uterus (to make sure that we are not doing IVI or have placed it in wrong position). This also helps to reduce patient’s anxiety and uncertainty. After that, our nurse takes care of the patient and observes her when she takes rest.
Then we advise the post-IUI medicines and advise them what to expect and when they can go home. Again, this time we try to answer all questions the couples can ask.

Conclusion
Infertility is a peculiar thing. Very few men or women are absolutely infertile. That means they do not have ability to achieve pregnancy naturally. Majority of them are subfertile. That means most of them have lower than normal chance (compared to healthy couples) to achieve pregnancy in a normal menstrual cycle. Often we find that patients planning for treatment and in the mean time, they conceive naturally. That means even without treatment, there is some chance of pregnancy. Of course, it’s stressful situation for both the partners. Stress affects conjugal relationships and lead to many couples avoiding conjugal life. Indeed stress can affect the hormone levels in females and affects sexual performances in males. It’s easier for us to advise you to stay stress-free but is difficult to practice. Nevertheless, try relaxation as much as possible. Think that majority of the couples ultimately conceive by some form of treatment. Have faith in yourself and have faith in your doctor.


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Oct07
When to See a Fertility Specialist, Fertility Doctor for Infertility?
Infertility or reproductive problems are often treatable with infertility drugs and high-tech procedures. Assisted reproductive technology (ART) is a group of different methods used to help infertile couples. With the help of Assisted Reproductive Technology the chances of becoming pregnant for infertile couples has increased significantly. In Vitro Fertilization (IVF) is one such ART technique. IVF works by removing eggs from a woman’s body. The eggs are then mixed with sperm in petri dish in ivf laboratory to make embryos. The embryos are then transferred in the woman’s body. For nearly 40 years, in vitro fertilization (IVF) treatment has helped millions of couples worldwide to overcome a wide variety of infertility problems and has enabled them to realize their dreams of becoming parents. IVF helps infertile couples become pregnant by joining the egg and sperm together in an embryology laboratory where embryos are created that can later be transferred back into the woman's uterus.

In vitro fertilization (IVF) can be used to treat infertility with the following patients: blocked or damaged fallopian tubes; male factor infertility including decreased sperm count or sperm motility; women with ovulation disorders, premature ovarian failure, uterine fibroids; women who have had their fallopian tubes removed; individuals with a genetic disorder and unexplained infertility.

In Vitro Fertilization is assisted reproductive technology (ART) commonly referred to as IVF. IVF is the process of fertilization by manually combining an egg from ovaries and sperm in a laboratory dish, and then transferring the embryo to the uterus. Other forms of ART include gamete intrafallopian transfer (GIFT) and zygote intrafallopian transfer (ZIFT).

The treatment of IVF is helpful for couples diagnoised with problems including

Fallopian tube damage or blockage.
Ovulation disorders.
Premature ovarian failure.
Endometriosis.
Uterine fibroids.
Previous tubal sterilization or removal.
Impaired sperm production or function.
Unexplained infertility.
A genetic disorder.
Fertility preservation for cancer or other health conditions.

Learn in detail about ivf treatment, fertility and infertility in women and men at http://www.meandmummyindia.com/medical-services-index.htm

Advantages of IVF Treatments

The most obvious advantage of IVF treatment is the ability for the couple to have a biological child of their own. The IVF process uses only the best eggs and sperm from the couple, meaning the fertilization is more likely to be successful on the first try. A baby born through the IVF treatment will be no different from a baby conceived through natural means. IVF treatments are a great way to get around any infertility issues a couple might be having, without the need for major surgery or extensive infertility treatments. IVF can also be a great solution for patients who are unable to get pregnant through normal means, such as single mothers or same sex couples. Using donated eggs or sperm, they can use the IVF process to realize their dream of having a child. Even the infertile couple with male infertility or female infertility can opt for ivf with donor egg or donor sperm.

Side effects and Risks associated with IVF Treatment include multiple births, premature delivery and low birth weight, ovarian hyperstimulation syndrome, miscarriage, egg-retrieval procedure complications, ectopic pregnancy, birth defects, ovarian cancer and stress due to heavy ivf cost.

What To Expect After IVF Treatment

In vitro fertilization (IVF) related injections, monitoring, and procedures are emotionally and physically demanding on the female partner. Superovulation with hormones requires regular blood tests, daily injections, frequent monitoring by doctor and harvesting of eggs. These procedures are done on an outpatient basis and require only a short recovery time. Cramping during the procedure is common. According to the need and condition, patient may be advised to avoid strenuous activities for the remainder of the day or to be on bed rest for a few days after doctors advise.

Few considerations before opting for the IVF treatmentat at infertility clinic.

1. 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.

2. The number of IVF cycles needed will vary from patient to patient. Several factors play a role in the success of IVF treatment including age of the patient, degree of infertility among couple and the quality of the embryo and semen. Some women will only require one treatment before successfully conceiving, while other women may need to undergo as many as six IVF cycles. Unfortunately, some women are unable to conceive even after undergoing multiple IVF cycles.

3. If your fertility issues are less severe, you may opt for mini-IVF, which costs less because it involves lower doses of fertility drugs and less comprehensive oversight for your cycle. If your fertility issues do not result from ovulation issues, you may be eligible for natural cycle IVF, which involves no fertility medications.

4. The important point to be considered is the cost of money involved. It is good to have a clear idea of the costs involved before starting treatment, and to have finances in order before beginning. There is significant emotional drain on the couple and their relationship.

5. 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.

6. Have a detailed discussion with your partner. Both should stand on the same page. Decide the time frame for how long you would like to continue with the treatment. Till how long you will continue or when would you stop infertility treatment?

You should discuss your chances for success with IVF with your fertility specialist to determine which type of treatment may be right for your health and budget. Be sure to inquire about any additional costs that may arise during treatment, such as extra testing or psychological counseling, so that you can be prepared. Some fertility clinics offer financial planning assistance to help patients afford treatment.

Know about IVF treatment process, treatment options available, ivf cost and anything and anything about ivf at https://meandmummyindia.wordpress.com/2016/09/26/when-to-see-a-expert-fertility-specialist-or-ivf-doctor-for-infertility

How to Choose an IVF Specialist

The in vitro fertilization process is complicated and very personal, so finding a good doctor is important. Most likely, you will begin your journey toward IVF at your gynecologist's office. He or she will run basic fertility tests and conduct exams to diagnose your condition before making a recommendation. Your gynecologist may suggest your partner see an urologist. Once you and your partner have decided that IVF is the right treatment option, you'll need to choose a specialist. Finding a Clinic and narrowing down your choices is an important, potentially difficult process. Since IVF is such an involved procedure, you'll need to find a clinic where you feel comfortable with the staff and confident in your chances of conception. Finding a clinic and specialist who make you feel secure is an important step in your IVF process.

Located in south Gujarat in Surat Me and Mummy hospital & IVF Centre has handled hundreds of infertility cases and has achieved remarkable success in them, a rare feat which few hospitals claim. 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.

Dr.Praful Doshi a consultant Gynaecologist and IVF Specialist has over 20 years of experience in fertility and assisted reproduction techniques and specialises in 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. The whole IVF section is provided with HEPA filtered, sterile, pressurised air for bacteria free and particle free atmosphere to improve the success of the treatment.

Contact us today for consultation with highly-skilled fertility specialist for the assisted reproductive technology treatments available and know more about ivf treatment, procedure, causes and ivf cost at http://www.meandmummyindia.com
Book an appointment with a fertility expert Dr Mitsu B Doshi & Dr Praful B Doshi today on 91-261-2471111 or email at info@meandmummyindia.com


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Aug26
Endometriosis and Infertility
When couples start their family, they have many dreams. Subsequently many of them, if not all, plan to extend their family to give a sense of accomplishment. That is a journey from being couples to being parents. But unfortunately, in some couples the journey is not smooth and some of them have to struggle a lot for it. Yes, you are right. We are talking about difficulty to conceive, popularly known as “Infertility”.

To achieve successful pregnancy, there must be production of sperms, transport of them and proper deposition of them into the vagina by the male partner. In female partner, the deposited perms must travel through vagina and uterus to reach the Fallopian tubes (the tubes that are attached to the both sides of the uterus) where the sperms must meet the egg (ovum). The ovum is produced by the ovary and released into the abdomen at the time of ovulation (rupture of the surface of ovary to release the ovum). That ovum must be taken by the tube and thus inside the tube an embryo (earliest form of the baby) is formed, which then travels through the tube into the uterus and the uterus attaches the embryo firmly with it and thus the pregnancy starts. So, if there is defect in any one of them there will be difficulty in achieving pregnancy.

Perhaps you have heard that infertility may be due to problems in male (defect in production, transport or deposition of sperms) or female (defect in ovaries or ovulation, bock in the tubes and defects in the uterus). But sometimes there may be more than one problems in either of the couples or apparently no reason is found (everything is normal, so pregnancy depends on chance factor). To clarify the latter, in normal healthy couples with regular unprotected timely intercourse, the chance of pregnancy in one menstrual cycle is only 15%, so it may be matter of time for some couples to conceive. But another important reason for infertility in female is endometriosis.

What is endometriosis?
Endometrium is the inner lining of the uterus. It responds to hormones secreted by the ovaries during normal menstrual cycle. It tends to thicken from the time of ovulation (as described above) and if pregnancy occurs, it continues to grow and supports the embryo to help in continuing pregnancy. If pregnancy does not occur, it is shed off outside the body and is seen as “menstrual Bleeding” or “Period”. Unfortunately in some women, the endometrium may be present outside the normal position. That condition is called endometriosis. It is commonly present around the ovaries, tubes, surrounding the uterus (outside normal lining) but may be present anywhere in the body (even in lungs, urinary system and rectum). As this endometrium (outside the uterus lining) also responds to the hormones in the same way as normal endometrium (that lines the uterus), there will be bleeding around this abnormal endometrium at the time of menstruation. But this bleeding, unlike normal menstrual bleeding cannot come outside the body and so the blood accumulates and forms a chocolate coloured material (old blood is chocolate coloured) and leads to adhesion between organs. Adhesion is a condition where different organs of our body attaches abnormally with each other leading to various problems. Sometimes this chocolate coloured blood may be surrounded by a membrane formed by body tissue and is then called “Chocolate Cyst” that is found around the ovaries.

What is the reason for endometriosis?
Unfortunately, despite extensive research throughout the world, the reason for endometriosis is not known. It is said to be due to some genetic factors or some environmental factors. Sometimes, delaying pregnancy is stated as the reason. In some women, however, it is caused by backward flow of menstrual blood (that enters into the tubes during menstruation). Usually these women have abnormal development of uterus (problems in uterus since birth), so that all the menstrual blood cannot come outside the body)

What is the problem with endometriosis?
Endometriosis usually causes pain. The pain may be long standing and usually occurs at the time of periods (dysmenorrhoea) or sometimes even between periods. The nature and site of pain depends on where it is located. If it is located very deep inside abdomen, it can cause pain during sexual intercourse (dysparaeunia). In some cases there may be pai duing passing urine or stool or bleeding during urination or with stool.
In around 50% cases, it can cause infertility. The cause of infertility is not always properly understood. But it has been seen that endometriosis can cause adhesion and thus can makes it difficult for the Fallopian tubes to pick up the ovum from the ovaries. Apart from this pain during intercourse often makes the woman avoid intercourse. In addition it can interfere with ovulation, sperm transport, meeting between sperms and eggs and also the process of attachment of uterus with the embryo.

However, endometriosis does not always cause pain or infertility. In some women, there may be both pain and infertility, some women only one symptom and in some women no symptom is found but endometriosis is discovered accidentally during treatment for other purpose (like during laparoscopy for appendicitis or during Caesarean Section).

How endometriosis is diagnosed?
Endometriosis is suspected by history of pain or infertility and examination findings. Like some women may have pain during examination of abdomen or vagina by doctors, even sometimes vaginal ultrasound causes pain. In ultrasonography (or sometimes CT scan is done) there may be presence of cysts or adhesion can be detected. But the “Gold standard” of diagnosis is laparoscopy. It is an operation where (“Microsurgery”), making a small opening in the abdomen under anaesthesia, a telescope is introduced and the area is seen through camera in a television monitor. At that time the chocolate cysts, adhesions and condition of the organs can be seen and diagnosed and if there is any doubt, biopsy can be taken. But in all cases, laparoscopy is not needed and treatment is started after the doctors presume the diagnosis by history from the patients, examination and the ultrasonography reports.

Endometriosis is a peculiar condition in the sense that women with severe endometriosis may not have any symptoms, while women with very mild disease may have severe pain or infertility.
How endometriosis is treated, in general?

As mentioned earlier, endometriosis does not always cause symptoms and so, it does not always need treatment. The common reason for treatment is presence of pain and infertility. Endometriosis-related pain is usually treated by medicines or sometimes by surgery. Before surgery, usually medicines are given to reduce the size and to reduce the blood loss during surgery. All these medicines can cause hormonal imbalance and thus deprives the endometriosis tissues of hormonal stimulation and thus reduces pain. As a result, during the treatment, patients usually cannot conceive because of this intentional hormonal deprivation. Unfortunately after stoppage of medicines, often the symptoms of pain come back.

Surgery for endometriosis is usually done under laparoscopy but it needs properly trained and skilled surgeons to do these operations. Operations can range from “minor” (like separating the adhesions, draining the chocolate colored fluid) and “major” (like removing the cyst or removing major organs). The surgery has the advantage over medicines is that it confirms the diagnosis and removes the diseased tissues. But there are problems with risks related to anaesthesia and surgery. In particular, there is risk of injury to intestine and urinary tracts, even with the best hands, that may increase patient’s sufferings. Apart from this, even after surgery, the disease can come back again after few months or years.

What is the cure for endometriosis?
Only cure for endometriosis is total deprivation of hormones. That is possible if the woman attains menopause (permanent cessation of menses). This is possible by natural way (around 45-50 years of age when menses cease permanently) or by operations to remove the ovaries and uterus. Another simpler way is achieving pregnancy, as usually after pregnancy most endometriosis patients feel better in relation to pain.

What happens if it is not treated?
Endometriosis is not like cancer. It is not life threatening usually. That means it will make you suffer in the worst way by causing severe pain and infertility but cannot endanger your life. So, you can have the options of not treating it, even if you have the symptoms. And of course, if you do not have symptoms, endometriosis may not require any treatment.

What is the treatment for endometriosis with infertility?
First of all, you have to make sure that you have difficulty in conception (that means you have given sufficient time to attempt but failed). Then we have to see whether there is any pain or other problems and what the condition of the disease by examination or ultrasonography is. We also have to look for any additional problems like problems in male partner, problems in uterus or ovaries or the hormones (like FSH, LH, prolactin, thyroid etc).

Then we have to plan the treatment. As there is no hard and fast rule, your doctor will explain you the options for you and you can decide what suits you the most, after judging merits and demerits of every option.
You may choose directly for surgery. In that case, you may be offered medicines for 2-3 months before surgery to make surgery safer for you and easier for the surgeon. The extent of surgery varies, depending on the disease status and your opinion. Remember, your opinion is important. You can choose for extensive operation (that may mean removal of both the tubes, that may be needed in advanced disease, leaving only option for IVF for pregnancy in future) or only diagnosis (just introducing the telescope and see) or minor operations (like separation of adhesions or removal of the cysts), after judging the merits and demerits of each options. But remember, you should not have any medicines for endometriosis after operation as most of the medicines (with some exceptions) interfere with pregnancy. This is, because, after operation is the best time to conceive and that time gives you the highest chance for pregnancy. If natural conception (or 1. ovulation induction- giving medicines to stimulate growth of your eggs, or 2. IUI- inserting your husband’s sperms by special process inside your uterus) does not occur within 12 months after operation, that’s probably the best time to consider IVF (“Test tube baby”). Of course, if you had extensive surgery or have advanced age (more than 35 usually), your doctor may advise you to go for IVF directly after operation without wasting the time.

You can opt for trial of treatment by medicines. You must know why I have used the word “Trial”. This is because, during medicine treatment, you cannot conceive. But you will be seen after 2-3 months to see if the disease has disappeared or decreased in size significantly. If this is the case, you can start infertility treatment (Ovulation Induction or IUI or IVF in some cases) directly. But if the disease did not respond to medicines by this time, you may need surgery, the extent of which has been described above.

You also have the options of not treating endometriosis at all. In that case, you can request your doctor to start infertility treatment directly. But remember, endometriosis (even treated endometriosis- after medicines or surgery) can interfere with any form of infertility treatment. It can lead to decreased response to medicines used for ovulation induction, thus reducing success rate(normal success rate is 20-25% in a menstrual cycle- that is without endometriosis). It can lead to low success rate after IUI (normal success rate is 25-30% in a menstrual cycle). Even with IVF (where normal success rate is 40-50% per cycle of IVF), the effectiveness of IVF may be reduced in presence of endometriosis.

What if I do not go for any treatment at all?
Infertility is a peculiar thing. Very few men or women are absolutely infertile. That means they do not have ability to achieve pregnancy naturally. Majority of them are subfertile. That means most of them have lower than normal chance (compared to healthy couples) to achieve pregnancy in a normal menstrual cycle. Often we find that patients planning for treatment and in the mean time, they conceive naturally. That means even without treatment, there is some chance of pregnancy. But that chance decreases in presence of any disease (like endometriosis) or increased age. And of course, nobody usually relies on chance. But the important message is that do not forget to have regular sexual intercourse eve if you are awaiting any test or endometriosis treatment. Of course, it’s stressful situation for both the partners. Stress affects conjugal relationships and lead to many couples avoiding conjugal life. Indeed stress can affect the hormone levels in females and affects sexual performances in males. It’s easier for us to advise you to stay stress-free but is difficult to practice. Nevertheless, try relaxation as much as possible. Think that majority of the couples ultimately conceive by some form of treatment. Have faith in yourself and have faith in your doctor.


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Aug22
Aging effects in Females for chances of Conceiving
Pregnancy later in life, after the age of 35, is becoming increasingly common. Women are delaying childbearing for a variety of personal and professional reasons. Many women today find themselves trying to conceive after the age of 35. This opportunity can be full of joy and riddled with questions. Despite some challenges, many women in their thirties and forties successfully conceive.

The biggest obstacle for women age 35 or older may be getting pregnant in the first place. Fertility rates begin to decline gradually at age 30, more so at 35, and markedly at age 40. Even with fertility treatments such as in vitro fertilization, women have more difficulty getting pregnant as they age. As women age, it can become more of a challenge to conceive and maintain a healthy pregnancy. Fertility begins to decrease during the ages of 32 and 37, with a more rapid decline after 37. Women are born with a certain amount of eggs. As they age, the quantity and quality of eggs begin to decline, particularly during the third decade of life.

Infertility evaluation is generally recommended for women who have been trying for 12 months or longer. But if you're 35 or older, don't wait a whole year. Get an evaluation after six months or sooner if your periods aren't regular, or if you've had previous abdominal surgery.

The health related risks of late pregnancy in life

Becoming pregnant over the age of 35 can increase the risk of pregnancy complications for both mother and baby. These are due to changes in the reproductive system and the increased likelihood of general health problems that comes with age. Older women are at an increased risk of the following complications during pregnancy:

Infection or surgery that caused scar tissue around the fallopian tubes or cervix
Endometriosis
Fibroids or uterine disorders
Decrease in cervical fluid
Chronic health problems such as high blood pressure or diabetes

Recent studies, however, have shown that women who postpone childbearing do face some special risks including: infertility and miscarriage, premature delivery and stillbirth, gestational diabetes, bleeding complications, hypertensive disorders of pregnancy, prolonged labour, C-section, chromosomal abnormalities in babies, growth retardation in babies and delivering multiples.

Babies that are born prematurely or with a low birth weight are at an increased risk of both short- and long-term health problems, including respiratory distress syndrome, infection and developmental delays. Some research suggests that the age of the father at conception may also affect the health of the child, although more research is required in this area.

Learn everything about infertility in men and women and about its treatment at http://www.rupalhospital.com/infertilitytreatmentformaleandfemale.html

How can I increase my chances of having a healthy baby while trying to conceive after 35?

Trying to conceive after 35 may seem overwhelming, but there are many things you can do to make getting pregnant easier. Plan your pregnancy. Few of the things to remember include

1. Schedule a pre-conception appointment – You and your health care provider can review your medical history, current medications and overall lifestyle.

2. Women over age 35 take longer to conceive – The average time it takes a couple over 35 to conceive is 1-2 years, so try to remain positive if you do not become pregnant immediately.

3. A woman who is physically, mentally and emotionally healthy is more likely to conceive. Avoid alcohol, smoking and caffeine as it negatively affects fertility. Maintain balanced weight as overweight or underweight can also affect fertility by interfering with hormone function.

4. Observe fertility signs of yourself as it tells a lot about your body. Record basal body temperature and cervical fluid, which tells the best time to have intercourse while trying to conceive. These help in identifying whether you are ovulating properly.

5. Take at home fertility screening test. This often gives couples peace of mind as they move through the journey to conceive.

6. Visit your health care provider if you haven’t conceived after 6 months of trying, to discuss the possibility of fertility testing. You may decide to consult a fertility specialist at this time.

7. Consider taking a supplement to help improve egg quality after consultation.

As with all pregnant women, it may be recommended that women over the age of 35 undergo genetic screening for birth defects. This is particularly important due to the increased risk of certain disorders for children being born to older mothers.
Age is not something we can control. But if you want a baby or another baby, and you’re in a relationship, you can have a conversation with your partner sooner rather than later.

Know in detail about all types of treatment available for infertile couples at http://www.rupalhospital.com/about.html

The treatment options for infertility in mature women

Assisted Reproductive Technologies play a major role in achieving parenthood for elderly women’s. For the treatment of infertility in adult women in the premenopausal or menopausal age there are very limited options. Advanced age mother react poorly to ovarian stimulation. Even with the ivf treatment the chances of giving live birth is less as compared to younger women’s. Females over 35 face additional risk of gestational diabetes, placenta previa, peeling, caesarean section, premature birth, blood clotting, etc. The treatment option for individual women differs. It includes ovarian hyper stimulation, In vitro fertilization (IVF), Intra cytoplasmic sperm injection (ICSI) and Egg/Ooctye donation.

To improve the performance of IVF among older women, some clinics recommend assisted hatching, embryo transplant in the embryonic bladder, pre-implantation genetic diagnosis and transplant of high quality embryos. The best option for elderly women is to use donor eggs from a young donor. The option of Embryo donation and the help of surrogate mothers using sperm of the biological father and donor eggs can also be considered.

Even after you get pregnant, age continues to have an effect. The older you are when you get pregnant, the more likely you are to have a chronic disease, such as high blood pressure or diabetes that may be undiagnosed and can affect your pregnancy. As per the saying: Age is nothing but a number. But when it comes to getting pregnant and having a healthy pregnancy, it can matter. Rest assured, most healthy women who get pregnant after age 35 and even into their 40s have healthy Babies. That doesn't mean, though, that you shouldn't think about smart steps you can take to maximize your health and your baby's health during pregnancy.

If you are planning on becoming pregnant or are pregnant at the age 35 or plus, speak with your health care provider for evaluation. In today’s lifestyle, where many couples are career oriented and could barely manage spare time, the cases of infertility are on the rise due to excessive work related stress, irregular eating habits and various other reasons. There are host of factors responsible for infertility. There are millions of couples who’re facing the prickly issue called infertility. For more than 4 decades, Rupal Hospital for Women’s Specialists have helped infertile couples navigate smoothly through the often complicated process of infertility to the journey of parenthood. Rupal Hospital and fertility Clinic offers Comprehensive facilities for full Infertility Tests and diagnosis for male & female infertility - Successful In vitro treatment for infertility. Rupal Hospital has been a one stop place for all gynaec problems and our expertise lies in providing affordable services and handling difficult cases of infertility. The service provided under one roof includes infertility workup, ICSI, IUI, IVF, Laser Assisted Hatching, Cryopreservation, Donor Program, Blastocyst Culture and Transfer, Pre Genetic Diagnosis and Screening (PGD and PGS), Sonography, Laproscopy & Hysteroscopy.

For age related infertility information in men and women you can consult Specialists at Rupal Hospital for Women at http://www.rupalhospital.com or seek an appointment at 91-261-2599128


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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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