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May29
The Importance of Progesterone: Symptoms and Solutions with Dr. Uday Thanawala, Gynecologist in Navi Mumbai
Progesterone is a crucial hormone in the female reproductive system, playing a significant role in regulating menstrual cycles and maintaining early stages of pregnancy. When progesterone levels are insufficient, various symptoms and health issues can arise. Understanding these symptoms and seeking appropriate treatment from a qualified gynecologist is essential. In Navi Mumbai, Dr. Uday Thanawala at Thanawala Maternity Home & IVF Center offers expert care and treatment options for women experiencing low progesterone levels.
Symptoms of Low Progesterone
If you don't have enough progesterone, you may experience:
1. Irregular Periods: Progesterone helps regulate the menstrual cycle. Low levels can lead to irregular, missed, or heavy periods.
2. Mood Swings: Hormonal imbalances can affect mood, causing irritability, anxiety, or depression.
3. Fatigue: Persistent tiredness and low energy levels are common symptoms of low progesterone.
4. Hot Flashes: Sudden feelings of warmth, often associated with menopause, can also result from low progesterone.
5. Infertility Issues: Progesterone prepares the uterus for pregnancy. Insufficient levels can lead to difficulties in conceiving and maintaining a pregnancy.
Seeking Treatment in Navi Mumbai
If you are experiencing these symptoms, consulting with a gynecologist is crucial. In Navi Mumbai, Dr. Uday Thanawala at Thanawala Maternity Home & IVF Center is renowned for his expertise in women's health, particularly in managing hormonal imbalances.
Treatment Options
Dr. Uday Thanawala offers various treatment options tailored to individual needs, including:
• Hormone Therapy: Supplementing progesterone through medications can help restore balance and alleviate symptoms.
• Lifestyle Changes: Recommendations on diet, exercise, and stress management can improve overall hormonal health.
• Fertility Treatments: For those facing infertility issues, Dr. Thanawala provides advanced treatments and support to enhance fertility chances.
Why Choose Thanawala Maternity Home & IVF Center?
Thanawala Maternity Home & IVF Center in Navi Mumbai is a leading facility for women's health and fertility treatments. Under the guidance of Dr. Uday Thanawala, the center offers comprehensive care, state-of-the-art technology, and a compassionate approach to patient care.
If you're experiencing symptoms of low progesterone, don't hesitate to seek help. Consult with Dr. Uday Thanawala, a trusted gynecologist in Navi Mumbai, to explore your treatment options and improve your health and well-being.
Contact Thanawala Maternity Home & IVF Center today to schedule your appointment and take the first step towards better health.

Website: https://thanawalamaternity.com/


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Apr18
Guardians of Well-Being: 6 Simple Ways to Prevent Urinary Tract Infections (UTIs)
Urinary Tract Infections (UTIs) can be discomforting and disruptive, particularly for women. Preventing UTIs is not only about addressing the symptoms but also understanding the root causes and adopting proactive measures. In this article, we'll delve into six simple yet effective ways to prevent UTIs. Additionally, we'll introduce the expertise of a trusted Gynecologist in Vashi, Navi Mumbai, available at Thanawala’s Maternity Home, offering a range of specialized services, including obstetrics, infertility treatment, and fibroids removal surgery.
1. Stay Hydrated:
Proper hydration is key to maintaining a healthy urinary system. Drinking an adequate amount of water helps flush out bacteria from the urinary tract, reducing the risk of infection. Aim for at least eight glasses of water a day to keep your system well-flushed and less susceptible to UTIs.
2. Practice Good Hygiene:
Maintaining good personal hygiene is crucial in preventing UTIs. Always wipe from front to back after using the toilet to prevent the spread of bacteria from the rectum to the urethra. Additionally, opt for unscented, gentle soaps for the genital area and avoid douching, as it can disrupt the natural balance of bacteria.
3. Urinate Regularly:
Don't hold in urine for extended periods. Regular and timely urination helps expel bacteria from the urinary tract, reducing the likelihood of infection. Make it a habit to empty your bladder as soon as you feel the urge.
4. Choose the Right Clothing:
Wearing breathable, cotton underwear allows air circulation, preventing moisture buildup. Avoid tight-fitting pants and synthetic fabrics that can trap moisture, creating an environment conducive to bacterial growth. Opt for loose, comfortable clothing to reduce the risk of UTIs.
5. Urinate After Intercourse:
After sexual activity, it's essential to urinate to flush out any bacteria that may have entered the urethra. This simple step can significantly reduce the risk of UTIs associated with sexual contact.
6. Cranberry Products:
Consuming cranberry juice or supplements may help prevent UTIs. Cranberries contain compounds that can inhibit the adherence of bacteria to the urinary tract walls, reducing the risk of infection. However, it's crucial to consult with a healthcare professional before making significant dietary changes.
Meet Your Trusted Gynecologist in Vashi, Navi Mumbai
For comprehensive women's health care, including prevention and treatment of UTIs, consider consulting the experts at Thanawala’s Maternity Home. Dr. Uday Thanawala, a highly regarded Gynecologist in Vashi, is an Obstetrician, Infertility Specialist, and renowned for his expertise in fibroids removal surgery. With a commitment to patient well-being, Thanawala’s Maternity Home is a beacon of excellence in women's healthcare.
Contact Information:
Location: Thanawala’s Maternity Home, 1st Floor, Mahavir Centre, Plot no 77, Sector 17, Vashi, Navi Mumbai 400703
Phone:
• 022- 27891237
• 022-27 891642
• 9920143277
Preventing UTIs is a proactive step towards maintaining women's health. By adopting these simple measures and seeking guidance from experienced healthcare professionals like Dr. Uday Thanawala, you can empower yourself with the knowledge and tools to safeguard your well-being.

Website: https://thanawalamaternity.com/


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Sep26
Navigating the First Trimester: Essential Gynecologist In Thane Advice for Pregnancy Care
The first trimester of pregnancy is a critical and exciting time for both expectant mothers and their growing babies. During these initial 12 weeks, numerous changes occur in a woman's body to support the development of the fetus. To ensure a healthy and successful pregnancy journey, it's crucial to follow the expert advice of a gynecologist in Currae Hospital in Thane. In this article, we will explore the essential guidance and care recommendations offered by gynecologists during the first trimester.
Understanding the First Trimester
The first trimester marks the period from conception to the 12th week of pregnancy. During this time, a woman's body undergoes significant transformations to accommodate the developing embryo. Common symptoms experienced during the first trimester include:
1. Morning Sickness: Many women experience nausea and vomiting, often referred to as "morning sickness." This can occur at any time of the day and may vary in severity.
2. Breast Changes: Hormonal changes lead to breast tenderness and swelling as the body prepares for breastfeeding.
3. Fatigue: Increased levels of the hormone progesterone can cause extreme fatigue, prompting the need for more rest.
4. Frequent Urination: The growing uterus can put pressure on the bladder, leading to more frequent trips to the bathroom.
5. Food Aversions and Sensitivities: Changes in taste and smell can result in aversions to certain foods or heightened sensitivity to odors.
Expert Thane Gynecologist Advice for the First Trimester
1. Prenatal Care: Schedule an appointment with a gynecologist in Thane as soon as you suspect you're pregnant. Early prenatal care is essential for monitoring the pregnancy's progress and addressing any potential complications.
2. Nutrition: A balanced diet rich in nutrients is vital during the first trimester. Gynecologists often recommend prenatal vitamins, folic acid, and a diet comprising fruits, vegetables, lean proteins, and whole grains.
3. Hydration: Drink plenty of water to stay hydrated and alleviate the effects of fatigue.
4. Morning Sickness Management: Discuss options for managing morning sickness with your gynecologist. They may recommend dietary changes, ginger supplements, or prescription medications if necessary.
5. Rest and Exercise: Maintain a balance between rest and light exercise. Gentle activities like walking or prenatal yoga can help alleviate fatigue and promote overall well-being.
6. Avoid Harmful Substances: Gynecologists emphasize the importance of avoiding alcohol, tobacco, and recreational drugs during pregnancy, as they can harm the developing fetus.
7. Stress Management: High stress levels can negatively impact pregnancy. Gynecologists may suggest relaxation techniques or stress-reduction strategies.
8. Regular Check-ups: Attend all scheduled prenatal appointments to monitor the baby's growth and address any concerns promptly.
9. Genetic Testing: Discuss the option of genetic testing with your gynecologist to assess the risk of certain genetic conditions.
10. Emotional Support: Gynecologists acknowledge the emotional aspects of pregnancy and may provide resources or referrals for emotional support and counseling.

In conclusion, the first trimester of pregnancy is a crucial period that sets the foundation for a healthy pregnancy and childbirth. Following the expert advice of a gynecologist is essential to ensure the well-being of both mother and baby during this transformative time. Remember that every pregnancy is unique, so open and honest communication with your gynecologist is key to addressing your specific needs and concerns.

Dr. Sujata Rathod, renowned as Thane's premier gynecologist, combines expertise with compassion. With years of experience, she's dedicated to women's health, providing top-notch care. Trusted by countless patients, Dr. Rathod is committed to nurturing new beginnings.

Take a look at : https://nurvinaari.com/about-dr-sujata-rathod/


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Apr24
Sperm Abnormality- Donor Sperm is NOT needed
Often we see men are coming to us with abnormal semen analysis report showing very low ("Oligospermia") or absent ("Azoospermia") sperm count or very poor "motility" (ability to move) of the sperms. They ask, if they require sperm donor. The answer is "NO".

Two things must be remembered-
1) Semen Report must be REPEATED from an AUTHENTIC LABORATORY after ABSTINENCE of 3-5 days. This is important, as the sperm count varies day to day. It takes almost 3 months to produce the sperms. therefore, if today you wear very tight underwear or you have high fever, your sperm count (checked after 3 months from today) will be low. As a result, a SINGLE ABNORMAL SEMEN ANALYSIS report does NOT HAVE ANY SIGNIFICANCE. You need to repeat it.

2) Both Male and Woman should be seen together. What treatment is required, actually depends on the reports of both the partners, their age and duration of infertility. Moreover, the pregnancy will ultimately happen on the woman. That's why, we need to see both together.

Unfortunately, in many of such cases, medicines cannot work. Still, you can become biological father using your own sperms. Initially you can take medicines. but even after taking medicines, sperm counts remain abnormal, you should consider IUI or IVF.

That means, we may not be able to improve your sperm count in most of the cases, but we can definitely help you to become the biological father of your baby.
What is IUI (Intrauterine Insemination) ?
Medicines (tablets, injection) are given to your wife to help her eggs grow. By ultrasound, we see whether eggs are growing. If the eggs about to rupture, husband’s sperm is collected, processed (“preparation”) and then inserted inside the uterus. The success rate is 10-15% per cycle. That means out of 100 couples trying IUI, 10-15 can conceive after the first cycle. You can try maximum 3-4 cycles of IUI.

When IUI can be done?
If the sperm count is mildly/ moderately low, IUI can be tried. However, for doing IUI, at least one fallopian tube of your wife MUST be open. Moreover, the success rate of IUI is higher if your wife's age is less than 35 years, she is having good number of eggs in the ovaries and you are not trying for pregnancy for long time.

What is IVF (in vitro fertilization)?
Your wife will be given some injection (gonadotrophin) to promote growth of the follicles (fluid filled sacs in the ovaries containing eggs). Injections are NOT painful and are needed to be taken under the skin. She has to come to TVS (ultrasound by putting probe in the vagina) follicular study regularly to see if the follicles are growing. Usually, injections are needed for 10-12 days. After that, under anaesthesia, eggs are collected from her body by inserting small needle. The eggs are then fertilized with the sperm to produce the embryos. The embryos are then transferred after 2-3 days (Fresh Transfer) or after 2-3 months (Frozen Transfer). The success rate of IVF is 40-50%. That means out of 100 couples undergoing IVF, 40-50 can conceive after the first cycle.

When IVF should be done?
If you have tried IUI for 3-4 cycles and failed, you should consider IVF. If your wife's fallopian tubes are blocked, her age is on the higher side, she is having less number of eggs in the ovaries and you have been trying for pregnancy for longer time, you should NOT delay IVF.

What to do if the sperm count is severely low?
In that case, you require a special type of IVF, called ICSI (Intracytoplasmic Sperm Injection). Here, the sperms collected from you, will directly be injected inside the eggs collected from your wife to form the embryo. It increases the success rate.

What to do if there is no sperm (Azoospermia)?
There is also no need to use donor sperms. You can father your own baby using your own sperms, collected from your testicles, by small needle (TESA- Testicular Sperm Aspiration). Those sperms can be used for ICSI.

Donor sperms are used for IUI ONLY when your sperm count is very low, you require IVF-ICSI but unfortunately you cannot afford. Donor sperms can ONLY be used after taking consent from BOTH the husband and the wife.
Conclusion-
In most of the case, you can become biological father of your own baby using your own sperms by IUI or IVF. If the problem is mild, IUI can be tried. In case of severe problem, you should not delay IVF. Donor sperm is not usually needed.


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Apr24
Sperm Problems- IUI or IVF- What to do?
Often we see men are coming to us with abnormal semen analysis report showing very low ("Oligospermia") or absent ("Azoospermia") sperm count or very poor "motility" (ability to move) of the sperms. Naturally, they are very much worried and want to know whether medicines can be helpful.

Two things must be remembered

1) Semen Report must be REPEATED from an AUTHENTIC LABORATORY after ABSTINENCE of 3-5 days. This is important, as the sperm count varies day to day. It takes almost 3 months to produce the sperms. therefore, if today you wear very tight underwear or you have high fever, your sperm count (checked after 3 months from today) will be low. As a result, a SINGLE ABNORMAL SEMEN ANALYSIS report does NOT HAVE ANY SIGNIFICANCE. You need to repeat it.

2) Both Male and Woman should be seen together. What treatment is required, actually depends on the reports of both the partners, their age and duration of infertility. Moreover, the pregnancy will ultimately happen on the woman. That's why, we need to see both together.

Unfortunately, in many of such cases, medicines cannot work. Still, you can become biological father using your own sperms. Initially you can take medicines. but even after taking medicines, sperm counts remain abnormal, you should consider IUI or IVF.

What is IUI (Intrauterine Insemination)?
Medicines (tablets, injection) are given to your wife to help her eggs grow. By ultrasound, we see whether eggs are growing. If the eggs about to rupture, husband’s sperm is collected, processed (“preparation”) and then inserted inside the uterus. The success rate is 10-15% per cycle. That means out of 100 couples trying IUI, 10-15 can conceive after the first cycle. You can try maximum 3-4 cycles of IUI.

When IUI can be done?
If the sperm count is mildly/ moderately low, IUI can be tried. However, for doing IUI, at least one fallopian tube of your wife MUST be open. Moreover, the success rate of IUI is hiogher if your wife's age is less than 35 years, she is having good number of eggs in the ovaries and you are not trying for pregnancy for long time.

What is IVF (in vitro fertilization)?
Your wife will be given some injection (gonadotrophin) to promote growth of the follicles (fluid filled sacs in the ovaries containing eggs). Injections are NOT painful and are needed to be taken under the skin. She has to come to TVS (ultrasound by putting probe in the vagina) follicular study regularly to see if the follicles are growing. Usualy, injections are needed for 10-12 days. After that, under anaesthesia, eggs are collected from her body by inserting small needle. The eggs are then fertilized with the sperm to produce the embryos. The embryos are then transferred after 2-3 days (Fresh Transfer) or after 2-3 months (Frozen Transfer). The success rate of IVF is 40-50%. That means out of 100 couples undergoing IVF, 40-50 can conceive after the first cycle.

When IVF should be done?
If you have tried IUI for 3-4 cycles and failed, you should consider IVF. If your wife's fallopian tubes are blocked, her age is on the higher side, she is having less number of eggs in the ovaries and you have been trying for pregnancy for longer time, you should NOT delay IVF.

What to do if the sperm count is severely low?
In that case, you require a special type of IVF, called ICSI (Intracytoplasmic Sperm Injection). Here, the sperms collected from you, will directly be injected inside the eggs collected from your wife to form the embryo. It increases the success rate.

Whether IUI or IVF/ ICSI will be done using your sperms or donor sperms?
We always encourage the couples to become biological parents. Therefore, we always prefer using your own sperms. Donor sperms are used for IUI ONLY when your sperm count is very low, you require IVF-ICSI but unfortunately you cannot afford. Donor sperms can ONLY be used after taking consent from BOTH the husband and the wife.

What to do if there is no sperm (Azoospermia)?
There is also no need to use donor sperms. You can father your own baby using your own sperms, collected from your testicles, by small needle (TESA- Testicular Sperm Aspiration). Those sperms can be used for ICSI.

Conclusion-
In most of the case, you can become biological father of your own baby using your own sperms by IUI or IVF. If the problem is mild, IUI can be tried. In case of severe problem, you should not delay IVF. Donor sperm is not usually needed.


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Apr24
Sperm Abnormal- Can Medicines Help?
Often we see men are coming to us with abnormal semen analysis report showing very low ("Oligospermia") or absent ("Azoospermia") sperm count or very poor "motility" (ability to move) of the sperms. Naturally, they are very much worried and want to know whether medicines can be helpful.

Two things must be remembered
1) Semen Report must be REPEATED from an AUTHENTIC LABORATORY after ABSTINENCE of 3-5 days. This is important, as the sperm count varies day to day. It takes almost 3 months to produce the sperms. therefore, if today you wear very tight underwear or you have high fever, your sperm count (checked after 3 months from today) will be low. As a result, a SINGLE ABNORMAL SEMEN ANALYSIS report does NOT HAVE ANY SIGNIFICANCE. You need to repeat it.

2) Both Male and Woman should be seen together. What treatment is required, actually depends on the reports of both the partners, their age and duration of infertility. Moreover, the pregnancy will ultimately happen on the woman. That's why, we need to see both together.

What medicines should I take if the second semen analysis report is also abnormal?
It all depends on how abnormal the report is. In case of mild abnormalities, we give medicines called "Antioxidants" (special types of minerals and vitamins that act on the sperms) for 2-3 months and ask to repeat the test again to see if there is any improvement. At the same time, some life-style changes are advised. These include avoidance of smoking and alcohol, reducing weight, avoidance of using tight underwear, prolonged sitting and driving.

However, if the problem is severe, you can take antioxidants. But it is more IMPORTANT to do some tests to FIND OUT THE CAUSE. Sometimes, we can find the cause like diabetes, which if controlled, can improve your sperm count without any other treatment.

What tests are required?
You may need physical examination of your genital organs by the doctor. You may be advised some blood tests for hormones (Testosterone, FSH, LH, Sugar etc). Some ultrasound examination of your testicles or prostate gland may be advised. In severe cases, some genetic testing (blood test to see if there is any chromosomal problem) may be needed.

Can any medicines help if there is severe problem?
In most of the cases, medicines cannot help. You can take antioxidants but SHOULD NOT RELY solely on it. In most cases, you will require IUI or IVF. However, there is ONLY ONE CASE where medicines can ACT DRAMATICALLY. That is if there is problem in the pituitary gland (situated in the brain). In that case, taking gonadotrophin injections for 3-6 months will significantly improve your sperm count.

What's the problem if medicines are taken for long time?
As such, medicines will not harm. But if you take medicines despite the fact that your sperm count is not improving, you can land up in azoospermia. This is because, in male having severe oligospermia, there is a tendency that sperm count may further decrease over time. Therefore, relying on medicine will INDIRECTLY HARM you. Rather, you should think of IUI or IVF.

Can Testosterone be taken?
Even if your testosterone is low, if you start taking tablet/ injection of testosterone from outside, your SPERM COUNT WILL DECLINE FURTHER. Therefore, under any circumstances, if you want to become father, you SHOULD NOT TAKE TESTOSTERONE. Sometimes, after hormonal tests, we can advise tablets like Letrozole, which can help to improve the testosterone level, indirectly.

IUI or IVF- What to do?
If the sperm count is mildly/ moderately low, IUI (Intrauterine Insemination) can be tried. however, if its severely low, you should go for special type of IVF (in vitro fertilization), called ICSI (Intracytoplasmic Sperm Injection). All of these will be done using your sperms only.

What to do if there is no sperm (Azoospermia)?
You need some investigations to find out the cause. If there is pituitary gland problems, injections can be helpful. In most of the other cases, no medicines can help. But you can become the biological father of your baby using your own sperms, collected from your testicles, by small needle (TESA- Testicular Spwerm Aspiration). those sperms can be used for ICSI.

Conclusion-
In most of the case, we may not be able to improve your sperm count by medicines. Taking medicines years after years, can rather be harmful. In most cases, you can become biological father of your own baby using your own sperms.


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Apr24
Polycystic Ovary in USG does NOT always mean PCOS
Sometimes women are coming to us with ultrasonography (USG) report showing "PolyCystic Ovaries" and they are thinking that they have PCOS.
What is PCO (Polycystic Ovary)?
Polycystic ovaries have more number of follicles (fluid-filled spaces containing the eggs), which appear like cysts. However, the “cysts” in PCOS are not tumours.

What is polycystic ovary syndrome (PCOS)?
PCOS is hormonal disorder where there are irregular periods, excessive hair growth on face or body (“hirsutism”), loss of hair on head, oily skin, acne and weight gain along with polycystic ovaries found in ultrasound. The main problem in PCOS is not the “cysts”, rather cysts are arising because of hormonal problems.

The symptoms vary from woman to woman. Some women have very few mild symptoms, while others are affected more severely by a wider range of symptoms.

When a woman is said to have PCOS?
A diagnosis is made when you have any two of the following:

1.irregular, infrequent periods or no periods at all

2.an increase in facial or body hair and/or blood tests that show higher testosterone levels

3.an ultrasound scan that shows polycystic ovaries.

Therefore, if you have PCO in USG but you do NOT have irregular periods and you don't have excessive hair growth etc, then you DO NOT have PCOS. You just have polycystic Ovaries.

It is a quite common condition, affecting 2 to 26 in every 100 women. Unfortunately, there is no cure for PCOS. However, it can be kept under control.


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Apr24
IVF in PCOS- When it is needed
Women with PCOS have good number of eggs inside the follicles but they cannot be released (Ovulation). As a result, sperms cannot meet the eggs, leading to infertility. Unfortunately, there is no cure for PCOS. However, it can be kept under control. You should aim to keep your weight to a level that is normal.

Is IVF ONLY treatment for PCOS?
Treatment of PCOS-Infertility depends on your age, duration of infertility and other fertility factors. Usually the first line of treatment is OI (Ovulation Induction). If patient fails to conceive with OI, then IUI is offered. If IUI also fails, then ONLY IVF is usually advised. Therefore, majority of the women with PCOS conceive without IVF; especially if they are young (age less than 35 years), infertility duration is short, husband;s sperm condition is OK and Fallopian tubes are alright.

When IVF is suggested for PCOS?
If your age is on the higher side (age more than 35), infertility duration is of longer time, husband's sperm reports are not good or your fallopian tubes are blocked then you should consider IVF. Moreover, if you tried OI several cycles (4-6 cycles) with oral tablets and injections and also tried IUI 3-4 cycles, the chance of pregnancy is low, without IVF. Therefore in that case, you should seriously consider IVF.

What should you do before IVF?
First of all please remember, the success rate of IVF is only 40-50%. That means out of 100 couples undergoing IVF, 40-50 can conceive after the first cycle. Some may need additional cycles. Keep your weight normal. reducing weight helps to improve success rate of IVF.

How IVF is done?
You will be given some injection (gonadotrophin) to promote growth of the follicles (fluid filled sacs in the ovaries containing eggs). Injections are NOT painful and are needed to be taken under the skin. You have to come to TVS (ultrasound by putting probe in the vagina) follicular study regularly to see if the follicles are growing. Usually, injections are needed for 10-12 days. After that, under anaesthesia, eggs are collected from your body by inserting small needle. The eggs are then fertilized with the sperm to produce the embryos. The embryos are then frozen and are transferred after 2-3 months.

Why embryos are not transferred in the same cycle and are frozen?
In PCOS, there is a risk called, OHSS (Ovarian Hyperstimulation Syndrome), where excessive number of focllicles can develop, leading to fluid accumulation in tummy and chest. It may turn serious, sometimes. Therefore, if we freeze the embryo, the OHSS severity decreases. At the same time, during IVF, we give some medicines to reduce the risk of OHSS, ask to come for regular monitoring and request the women to take protein rich diet and plenty of water.

Overall, the success rate is higher in PCOS, after IVF, compared to other causes of infertility.


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Apr24
PCOS-Infertility- When to do Laparposcopy
The basic problem in PCOS (Polycystic Ovary Syndrome) is that there are numerous eggs in the ovaries but they do not grow and Ovulate (release of eggs).

The first line of treatment in PCOS is weight control. Medicines like Metformin or Inositol can be added, if needed.

The second step is OVULATION INDUCTION (OI)- giving MEDICINES, ORALLY (Clomiphene or Letrozole) so that the eggs grow and get released ("Ovulation"). But while taking medicines, its important to see if the medicines are able to induce ovulation, by TVS Follicular Study.

What to do if the oral medicines are not working (you are not ovulating with oral medicines?)
In that case, we have 2 options-

1) Injection Gonadotrophin

2) Laparoscopy

Laparoscopic Ovarian Drilling (LOD)-
By Laparoscopy ("Microsurgery", putting camera inside the abdomen by key-hole), some of the follicles ("Cysts") are burned using electric current.

The Advantages of Laparoscopy are-
a) Any other possible diseases and causes of infertility can be detected (diseases of the tubes, endometriosis etc).

b) If the woman is having pain/ endometriosis/ cyst etc, these can be treated at the same time.

c) After laparoscopy, the chance of spontaneous conception increases (without need of frequent visits to the doctors).

The Disadvantages of Laparoscopy are-
a) If LOD is done in over-enthusiastic manner (many cysts are burned), it will damage the ovaries and the woman can land up in PREMATURE MENOPAUSE.

b) There is risk of anaesthesia and surgery.

c) The "Adhesion" (abnormal attachment between the organs) caused by Laparoscopy may further increase the risk of INFERTILITY.

So, LOD is done ONLY IF-
i) If the weight of the woman is normal;

ii) LH and AMH both are very high; and

iii) There was no response (Ovulation) with oral medicines.

All these 3 factors MUST be present before LOD.
Otherwise, LOD will do more harm than benefits.


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Apr24
PCOS-Infertility- If oral tablets fail
The basic problem in PCOS (Polycystic Ovary Syndrome) is that there are numerous eggs in the ovaries but they do not grow and Ovulate (release of eggs).

The first line of treatment in PCOS, therefore, is Ovulation Induction (giving medicine to grow and release the eggs). This has to be done VERY CAREFULLY. If medicines are ineffective, eggs won't grow. On the other hand, slight increase in dose can cause many follicles to grow, leading to serious complications like OHSS (Ovarian Hyperstimulation Syndrome- ovaries enlarge, water can accumulate in various body parts) and Multiple Pregnancy (Twin, Triplet etc). That's why we must do TVS Follicular Scan to see if eggs are growing and whether there is chance of OHSS or not.

The first line of agents in Ovulation Induction (OI) are usually oral tablets like CC (Clomiphene Citrate) and Letrozole. Sometimes we add Metformin tablet to improve the response to the oral medicines.

What to do if the oral medicines are not working (you are not ovulating with oral medicines)?
If these do not work we have 2 options-

1) Injection Gonadotropin (that carries small risk of OHSS and Multiple pregnancy, therefore, needs intense Monitoring by TVS)

2) surgery called LOD (Laparoscopic Ovarian Drilling- the electric current is used to burn few follicles in PCO). However, LOD carries surgical, anesthetic risks and also the risk of ovarian damage, if not done in proper way.

What to do if you had ovulation with oral medicines but failed to conceive?
If OI is done with oral medicine, the success rate is 15% per cycle. That means, out of 100 women taking the tablet, having regular intercourse and undergoing TVS Follicular Study, 15 will conceive at the end of one month.

It is useless to take the medicines for OI years after years. Pregnancy should happen within 6-9 cycles of OI.

If oral tablets has been tried for 4-6 months, it's better to add injections for next 3-4 months.

How to take the injections?
Injections are usually started from day 2/ 3/ 4 of the period. The number of injection depends on your response. The injections are NOT painful and need to be taken under the skin. TVS Follicular Study is done from day 8/9, once in every 2-3 days (until day 14-16) to confirm that the injection is working. You should have regular physical relationship as well.

How long injections can be taken?
How long you can take injections, depends on your age and the duration of infertility.

It is useless to take the injections for OI years after years. Pregnancy should happen within 3-4 cycles of OI.

If still pregnancy cannot happen, it's better to consider IUI or IVF.


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