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May19
Surgical Management of Infected Radicular Cyst Using Platelet Rich Fibrin (PRF), Synthetic Bone Graft and Periodontal Membrane for Guided Bone Regeneration: A Case report
Author: Dr. Brijesh Byrappa, Dr. Narahari Ranganatha, Dr. Mohammed Yunus, Dr. Ragesh Raman, Dr. Mamatha, N.S., Dr. Arun, K.P.

Radicular cysts are most common asymptomatic lesions of the jaw, it comprises up to 68% of cysts in the region. Large cyst of the jaw necessitate surgical management to obtain bone regeneration and healing of periapical tissues. Use of patients own blood components such as platelet rich fibrin (PRF) to enhance healing is unique concept in oral surgery. Through this case report we would like to illustrate the effectiveness of PRF mixed with synthetic bone substitute for guided bone regeneration in bone defect resulting from a periapical cyst enucleation. The treatment outcome of this case report shows that a combination of synthetic bone graft and PRF is successful in accelerating the physiological healing.

Click on the link below to access the article:
http://www.ijramr.com/sites/default/files/issues-pdf/2069.pdf


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May19
Clinical application of diode laser in gingival hyperpigmentation to enhance aesthetics
Author: Dr. Brijesh Byrappa, Dr. Zainab Abubaker, Dr. Swathi Mani, Dr. Narahari Ranganatha and Dr. Mohammed Yunus

Patients are highly inclined towards aesthetic outlook in the recent years. More number of patients visit dental offices with the complaint of greyish-black gums. The core reason for this pigmentation of the gingiva is due to the melanoblastic activity. There are wide range of treatment options for depigmentation of the gingiva. They include scalpel gingivectomy, free gingival graft, bur abrasion, use of chemicals, electrosurgery, cryosurgery and lasers. Among the various techniques, lasers provide promising therapeutic option as they are simple, painless, effective and a reliable tool. Here, we report gingival depigmentation of a patient using diode laser technique.

Click on the link below to access the article:
http://www.ijramr.com/issue/clinical-application-diode-laser-gingival-hyperpigmentation-enhance-aesthetics


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May05
Causes Of Hair Fall And Homeopathic Remedies For It!
Hair fall also known as alopecia is a problem encountered by millions of men and women worldwide. Hair fall can be a very distressing problem and can make you feel depressed. Hair fall may happen due to several reasons. Finding out the root cause of your hair fall will help you to deal with your problem more efficiently. Following are some causes that could be the reason for your hair fall:

For some people hair fall may be a hereditary problem.
Hormonal imbalance may at times lead to hair fall.
Stress can be a leading cause of hair loss.
Frequent use of hair styling tools may cause your hair to fall rapidly.
Consuming steroids like birth control pills very often may result in uncontrolled hair fall.
A diet with insufficient amount of protein can trigger hair fall.
But there is no reason for you to be disheartened, because there are many treatments available for controlling hair fall. Homeopathy offers promising remedies for reducing hair fall.

Some of the treatment methods are mentioned below:

If your hair fall is due to scalp diseases like dandruff or eczema then your homeopathic physician may recommend you medicines like Psorinum.
Your doctor may recommend you medicines like Pulsatilla or Sepia Officinalis, if hair loss happens due to childbirth or after menopause.
If hair fall is due to alopecia then your doctor may recommend you medicines like Calcrea Carbonica.
Homeopathic medicines like Fluoric acid are used for growing back your hair if bald spots appear on your scalp due to hair fall.
Medicines like Lycopodium are used for growing back your hair in case of complete baldness.
Silicea is a common homeopathic medicine prescribed for hair fall in case of young people.
Hair fall must not be ignored. You may consider consulting a homeopathic doctor if your hair is falling at an alarming rate.


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May05
Kidney Cyst - How Homeopathy Can Help?
A cyst that grows on the surface of the kidneys or inside the kidneys is known as a kidney cyst or a renal cyst. These cysts can be described as fluid-filled sacs that cause the kidneys to be enlarged and reduce their functioning capacity.

Symptoms of Polycystic Kidney Disease

Dull aching in loins.
Vague abdominal pain.
Frequent urination.
Haematuria.
Headache.
Drowsiness.
Anorexia.
Signs

Anaemia: moderate to severe.
Blood pressure: raised.
On palpation abdomen
Enlarged irregular kidneys.
Large knobby renal masses.
Enlarged polycystic liver (50% cases).
If not addressed in time, renal cysts can lead to kidney failure and hence be fatal. Thankfully, with homoeopathy, you can treat these cysts with negligible side effects. Some of the most well-known homoeopathic remedies for renal cysts are:

Apis mellifica: This homoeopathic remedy is often prescribed for acute forms of renal cysts. In such cases, the patient usually experiences swelling of the face, hands and feet, headaches and back pain. They may also experience a dull pain in the kidneys and have scanty urine. A study of the urine typically reveals high amounts of albumen along with blood corpuscles. The patient may also complain of a feeling of suffocation.
Arsenicum: Arsenicum is a common remedy for Kidney cysts. It is especially effective in cases where the cysts cause a waxen appearance, paleness, excessive thirst, diarrhoea and dropsy. Patients who benefit from arsenicum typically have dark urine with high amounts of albumen. They may also complain of dyspnoea attacks that are aggravated by lying down and relieved by expectorating mucus.
Phosphorus: Characteristic symptoms of kidney cysts that can be treated with phosphorus include tiredness and muscle pain all over the body, increased drowsiness and having very cold hands and feet. Unlike other ailments in this case the patient usually feels most tired on waking up. He may also complain of internal body heat without having an urge to drink water. Forgetfulness, giddiness and headaches are other symptoms that can be addressed by phosphorus. He may also find it difficult to lie on his side and complain of nausea and vomiting.
Digitalis: Kidney cysts that are accompanied by cardiovascular symptoms such as a feeble pulse can be treated with this homoeopathic remedy. It can also be sued to address dark and scanty urine, rheumatic pains, weak circulation and faintness of the stomach.
Other homoeopathic remedies for kidney cysts include belladonna, plumbum, glonoine, apocynum and cantharis. Homoeopathy addresses the body as a whole and not just the symptoms presented and hence is considered a holistic form of treatment. It is also favoured by many since it has negligible side effects. However, that should not imply that homoeopathy is safe to self-medicate with. With homoeopathy, what works for one person may not work for another, Hence. if you begin experiencing pain in your kidneys or any of the other symptoms associated with this condition, you must consult a homoeopathic doctor to get the right medication.


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May05
Sexual Problems And Homoeopathy
What Is Premature Ejaculation?

There is no set time when a man should ejaculate during sex. But it’s probably too soon if you have an orgasm before intercourse or less than a minute after you start. It’s a problem because when you ejaculate you lose your erection and can’t continue having sex. You and your partner may feel there’s not enough time to enjoy it.

It’s a common issue for men. Between 30%-40% have it at some time in their life. So, keep in mind -- it’s not something to worry about if it happens only occasionally.

What Causes It?

It’s not really known. But your brain chemistry could be at least partly to blame. Men who have low levels of the chemical serotonin in their brains tend to take a shorter time to ejaculate.

Emotional factors can play a role:

Stress
Depression
Performance anxiety
Guilt
Relationship problems
Sometimes PE can be a problem for men with erectile dysfunction (ED). That’s when the penis does not remain firm enough for sex. Men who are worried they could lose their erection may develop a pattern of rushing to ejaculate. It can be a hard habit to break.

When Should I See the Doctor?

Make an appointment if PE is bothering you or your partner. The doctor probably will ask if you’ve always had the problem or if it’s a new thing. He may ask about your sex life or your relationships. You’ll probably get a physical exam, too.

How Is It Treated?

Ninety-five percent of men are helped by behavioral techniques that help control ejaculation.

Stop and start: You or your partner stimulate your penis until your feel like you’re going to have an orgasm. Stop the arousal for about 30 seconds or until the feeling passes. Start the stimulation again and repeat three or four more times before you actually ejaculate.

The Squeeze: It works the same way as the start and stop method. But, when you feel like you’re reaching orgasm, you or your partner squeezes the head of your penis until you lose the erection. Repeat this a few times before ejaculating.

Some men find that if they think of something else during sex they can last longer.

What Medications Can Treat PE?

Homoeopathy has great results in treating sexual illnesses. Only an indicated medicine can treat the patient so one must not take any homoeopathic medicines without consulting a doctor. Some common homeopathic remedies for better sex include:

1. Agnus Castus: Low Sexual desire, patient is depressed and melancholy.Yellowish urethral discharge in males with no erection and sexual desire.

2. Lycopodium: Patient complaint of low sexual desire over a period of time, he is very sensitive and feels sad, depressed, melancholic with loss of memory. Frequently complaints of gastric origin including, gastritis, flatulency, acidity,dyspepsia,etc. Suffer from ED-Erectile dysfunction or PE-Premature ejaculation, with no sexual desire. Impotency without erection.

3. Graphites: It specially suited to female patient with low or no sexual desire. Low libido with aversion to sex, menses are delayed and scanty along with hard stools and constipation. Males with low sexual drive, aversion to sex with ED-Erectile dysfunction or PE-Premature ejaculation. Its one of the best homeopathy medicine for low sexual desire specially in old male and females.

4. Phosphoricum acidum: Low libido in males with pain and soreness of testicles due to inflammation. Extreme weakness both mentally and physically. Body ache with soreness of muscles. Extreme hair fall along with pimples and rashes. Eczema of testicles

5. Sepia: Women who indifferent to love ones, due to constant stress. Low sexual drive during late 40’s specially during menopause. Low libido after birth of child, miscarriage or after pregnancy.

6. Baryta Carb: Males who suffer from ED-Erectile dysfunction or PE-Premature ejaculation, with low libido. Enlarge prostate gland. Dementia, loss of memory, loss of confidence, with history of induration of glands.

7. Onosmodium: No sexual desire in both male and female, patient feels very tired and week. Low sexual desire n females due to pain in uterus, with early and prolonged periods. Deficient erection in males with low or no desire to sex.


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Feb16
Infertility Treatment- what to expect
Last week I got a call from one of my patients, who conceived after long period of infertility. She called me to remind me that, that very days was the birthday of her son, that is the wealth that she gained after long battle. And even the son tried to talk to me over phone with his soft voice. And this success is really rewarding for any Infertility Specialists.
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.
Treatment of Infertility
To start with, please remember there are 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.
So, infertility treatment is actually based on stepwise manner. We initially advise some tests and then advise a treatment. If that treatment fails, we move to next treatment.

So, all the time, you have to keep patience. Eventually, majority of the couples will conceive. Don't give up hope. You have to win the race ultimately


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Feb16
Diet in Pregnancy- What to avoid?
Pregnancy is a journey of a woman from womanhood to motherhood. Each and every pregnancy is precious and so women usually remain anxious about their lifestyle and food habits. Most of the pregnant mothers do not hesitate to sacrifice their comfort and habit, only to keep their baby safe. Here are the few tips which describes what are the common food items that must be avoided in pregnancy.
1) Some fishes
Fishes are integral part of most of the non-vegetarian Indian dishes. Majority of the fishes are not harmful, rather most of them (particularly fresh water fishes) are rich in protein and omega-3 fatty acid, that helps in brain development of the baby.You must take those. But remember, always take well cooked fishes. Avoid raw fishes like “Sushi” as they are likely to contain bacteria and parasites, causing stomach upset, that can lead to early labour and even damage the baby by causing premature delivery.
Avoid refrigerated and smoked sea fish and other seafood as they are likely to be infected with a harmful bacteria, called listeria. Listeria infection is notorious for causing fever and infection in mother. More importantly, it can pass into the baby causing miscarriage, serious infection and even death, either before delivery or immediately after delivery.
Avoid fishes containing mercury and other pollutants,particularly, big fish like shark, shellfish, salmon, tilefish, king mackerel etc because they contain higher levels of mercury which can harm an baby’s immature nervous system.
2) Some dairy products
While intake of properly pasteurized and boiled milk is highly recommended, if you can tolerate it, because of high energy, carbohydrate, protein, fat and mineral content; raw milk, unpasteurized milk should be totally avoided, as they may contain harmful bacteria, particularly listeria, as mentioned earlier. Similarly, soft cheeses should not be taken in pregnancy.
3) Alcohol and smoking
Excessive alcohol in pregnancy can cause ‘fetal alcohol syndrome’, characterized by abnormalities in face, heart, brain etc and evenmental retardation. These babies are likely to have growth disturbances. .
Smoking can cause miscarriage and low birth weight of the baby that may even cause still birth. Passive smoking is also equally important. So, both mother and father should avoid smoking.
4) Caffeine
Excessive caffeinated food can be a cause of miscarriage. Do not take more than 2 cups (or 200 mg) of coffee per day.
5) Under-cooked meat and eggs
These can cause food poisoning, as well as listeriosis. Also, there is chance of transmission of a parasite, toxoplasma, which can cause miscarriage, still birth and abnormalities in the baby (problems in heart, brain, eye, intelligence etc). Cook eggs until the yellow and white parts are firm. It’s better to avoid restaurant foods.
6) Unwashed fruits and vegetables
These items may carry certain bacteria that can lead to stomach upset. They are also known cause of causing listeriosis, as explained above. Avoid long refrigerated vegetables and salads made in restaurant. Raw vegetable sprouts, often taken for high minerals and protein, should be avoided as they may also harbor harmful bacteria.
7. Some juices
Avoid fresh and raw juices as they may contain harmful bacteria like listeria and even toxoplasma. Choose packaged juices as they are pasteurized and are kept under refrigeration.
8. Fatty Foods
While some fat is needed for brain growth and energy of the baby, excess fat may cause excessive weight gain that may increase the risk of high blood pressure and even diabetes, both can affect mother and baby. Mothers with excess weight are more likely to have premature delivery, problems during delivery and infection. Again repeated cooking of fatty food should be avoided, as it is more harmful to both.
9. Herbal supplements
Because their safety during pregnancy is not known, it’s best to avoid herbal supplements during pregnancy. This also includes herbal tea. .
10. Drugs
Do not take any drugs without consulting your doctors, whatever problem you are having.Even avoid excessive vitamin use as excess dose of vitamin A can damage the heart, face and brain of your baby and make it mentally handicapped. Some painkillers can cause heart defects in the baby. Some antibiotics may also be unsafe.


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Feb16
Fallopian Tube Block in Infertility- How to Proceed
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. Examples 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 Fallopian Tube(s)?
Fallopian tubes (commonly called “the tubes”) are the structures that are connected to the both sides of the uterus, as mentioned above. Each tube is of 10 cm length. The part attached to the uterus is called the “cornu” and the part remaining free is called the “fimbria”. It’s the fimbria, that is present near the ovary and picks up the ovum and transports it inside the tube. The cornu received the sperms from the uterus and passes it inside. Inside the tube, the sperms and the egg meet to form the embryo, which then travels down the tubes into the uterus and then the pregnancy starts.

What happens if tubes are blocked?
If both the tubes are blocked completely, anywhere along the length (cornu, fimbria or the middle), pregnancy is not possible. This is quite obvious, because either the sperm cannot enter or the egg is not picked up or they cannot meet.
However, if any of the tubes are partially blocked, then the sperms and egg can pass and meet but the embryo cannot come down into the uterus. As a result, the pregnancy continues inside the tube, which is called “Ectopic pregnancy” that is life-threatening for the mother. It’s important to remember that ectopic pregnancy can happen even if both the tubes are open.
What are the reasons for tubal blockage?
Often, the exact cause is not known. Infection is the commonest cause. The infections may be due to sexually transmitted infection (STI), particularly Chlamydia infection or infection from bowel or appendix. Tuberculosis is very common in our country and can affect the tubes, silently, without affecting any other parts (not even the lungs) of the body. Endometriosis is also a common reason for tubal blockage. Any pelvic surgery (surgery in ovaries, tubes, uterus, even appendix) can block the tubes by “adhesion”. This means the tube may be open but attached to the bowel or rotated on itself, so that the tube cannot pick up the eggs from the ovaries. Sometimes fibroid of uterus can compress the tube and cause blockage. Women, with previous history of ectopic pregnancy, are at risk. Uncommonly, some abnormalities, present since birth can block the tubes.
What are the types of tubal blockage?
Tubal block may be one sided or both sided. It may involve only a particular part of a tube or multiple parts of a tube. The site of the block may be the cornu, the fimbria or the middle portion.
Hydrosalpinx, is a thing that you must know. In this condition, the tube is blocked but the mid-portion is dilated and contains some fluid (often infected). This tube is not functional. And the problem is even if there is pregnancy by IVF inside the uterus, this fluid from the tube may trickle down, coming in contact with the embryo and can potentially kill the embryo!
How can I understand that the tubes are blocked?
Unfortunately, very few women have signs or symptoms indicating tubal block. However, if you had previous infections in pelvis, tuberculosis in any part of the body, appendicectomy or other gynaecological surgery, there is chance of tubal block. Patients with fibroid and endometriosis are also at risk of tubal block. If you feel severe pain during periods or during intercourse, there is a chance that the tubes may be blocked.
When the tubes should be tested?
As mentioned earlier, the routine investigation of infertility includes testing for the ‘open-ness’ of the tubes- “Tubal patency tests”. That means if pregnancy does not come within 12 months of regular intercourse, then we usually advise the tests. Sometimes, tests are needed, after 6 months of trying (see above). However, in some women, with low risk of tubal block (no risk factors as mentioned above), it may be appropriate to start treatment and continue it for few cycles and if no response, then tubes should be tested.
How the tubes are tested?
The method of tubal patency test depends on your risk of having blocked tubes and also your wishes, availability of resources, other fertility factors and of course the affordability.
Routine ultrasound (like TVS) cannot detect tubal patency. However, it can detect the hydrosalpinx in most of the cases.
If you do not have any risk factors (like pain during periods, endometriosis, previous infections or surgery), you can choose either HSG or SIS. These are done in out-door basis, without any need of anesthesia.
HSG (Hystero-salingogram) is a method by which, your tubes will be seen under Xray. After visualizing your cervix (mouth of the uterus) by a speculum (instrument inserted in the vagina) a small screw will be inserted inside the cervix and a contrast material (which can be seen by the X ray) will be given through it. If tubes are open, the Xray will show that the contrast material will be going through the tubes into the abdomen.
The advantage of HSG is that, a test showing open tube has good correlation with tubal patency (if HSG shows the tubes are open, it’s likely that tubes are open). It is widely available and also cheaper.
However, the problem is that most of the women feel it painful, although they are given pain-killers for it. In addition, there is small risk of infection, for which antibiotics are prescribed. The contrast material can rarely give rise to allergy in some sensitive women and it may be life-threatening in very rare cases. Another problem is the false positive result. That means if tubes are found to be blocked in HSG, in 50% cases, they will be found to be open subsequently in laparoscopy. This is mainly because of some spasm of the muscles of the tube during the test.
SIS (Saline infusion sonography) or HyCoSy (Hystero-Contrast-Sonography) is the method by which tubal patency is checked by ultrasound (TVS) along with water like material inserted inside the uterus through a small tube. If tubes are open, the passage of water can be seen going into the abdomen through the tubes, in the ultrasound.
The advantage of HyCoSy is that it’s much less painful than HSG, although mild discomfort may be there. Pain-killers and antibiotics are prescribed usually. Additionally, problems inside the uterus can be better visualized, even better than normal TVS. In addition, the false positive result is much lower, only 7%. That means if HyCoSy suggests that the tubes are blocked, in most cases, the tubes will be found to be blocked at laparoscopy.
The problem with HyCoSy is mainly the cost and it’s not available everywhere.
An important merit of doing the tubal test is that, sometimes the water or the contrast material used in these tests can open the “mild” block. That’s why we often find patients who conceive spontaneously with pregnancy inside the uterus, after apparently “blocked” tubes in HSG or HyCoSy.
Now, laparoscopy is reserved for those, who are at high risk of tubal block. This includes women with risk factors (pain, surgery, infection etc) o women having “blocked” tube in HSG or HyCoSy. Clearly, it’s done after hospitalization under general anaesthesia inside the OT. Two or three small opening (key-hole surgery) will be put inside the abdomen and through vagina a coloured material (“dye”) will be given inside the uterus. If the tubes are open, the laparoscopic camera will show that dyes coming out of the tubes inside the abdomen.
The advantage is that it’s a definitive test, can help you to make final decision. It also provides the options of treatment. If there is corneal block in HSG, we can make attempt to open the tubes using laparoscopy (see below). In addition, if there is hydrosalpinx, where the tube serves no function, the tubes can be removed (salpingectomy) or clipped (we put clips to block the tubes) to improve the chance of pregnancy if IVF is the only option left for you. In addition, laparoscopy helps us to see whether there is any other diseases that have been missed by routine tests and that may account for infertility. We can treat the cysts of PCOS (by applying current to destroy some cysts), remove any large cysts, remove any adhesion, treat endometriosis etc.
The disadvantage of laparoscopy is of course, the need of anaesthesia and associated surgical and anaesthetic risks, although in modern era, the serious complications are uncommon.
What are my options if tubes are found to be blocked in HSG?
There are simply two options. It depends on your age, fertility factors and affordability. Number one is directly, you can go for IVF. In that case, you can save time and cost. It may be a preferred option, if you are aged or have some other fertility factors (low sperm count, endometriosis etc). The chance of pregnancy per cycle of IVF is usually 40%.
Another option is that you can confirm the block by other tests, keeping in mind that you may need IVF if the tubes are found blocked ultimately. We usually advise to have laparoscopy. However, some women want to give a trial with HyCoSy, because if HyCoSy shows the tubes are open, then you can avoid laparoscopy and you can try different fertility treatment options.
In laparoscopy, first we see if tubes are open or not. If open, there is no need of further treatment in laparoscopy. However, if tubes are found blocked, especially if the block is in cornu, we can try “hysteroscopic tubal cannulation”, where we put a small catheter through hysteroscope (a telescope, like endoscope, put inside the uterus through vagina so that we can see inside the uterus using a camera) to open the tubes. If tubes can be opened, you have all options for fertility treatment open. However, if we fail to open the tubes, the only option left is IVF. In addition, if there is fimbrial block, it can be released and new opening in the fimbria can be made. The treatment of hydrosalpinx by laparoscopy has already been discussed (see above).
Having said that, there are some group of women, who conceive while waiting for IVF or laparoscopy after a blocked tube found in HSG.
What can I do if tubes are blocked in HyCoSy?
In this case also, there is choice between the two- laparoscopy first and IVF directly.
What can I do if laparoscopy suggests tubal block?
Unfortunately, in that case, the only option left is IVF. As mentioned before, if hydrosalpinx is found it must be treated before IVF. However, sometimes we find hydrosalpinx in laparoscopy but cannot cut the tube of clip it, simply because you did not give consent to us for doing so. In that case, we can suck out (“aspirate”) the fluid from the hydrosalpinx under ultrasound guidance (no need of further laparoscopy) using the needle.
How tubal block is dealt 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 prefer to have SIS or HyCoSy, rather than HSG, to reduce the pain to the women. We discuss all the options if tubes are found blocked.
Conclusion
Tubal factor can account for 20-25% cases of female infertility. It’s more common in secondary infertility (women who conceived earlier- whatever be the fate of the pregnancy). Tubal test is a part of infertility investigation. The choice between HSG and HyCoCy is open to you. If tubes are found blocked, the options are IVF directly or confirming the block by laparoscopy.


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Feb16
Diabetes and Reproduction
Today 14th December is World Diabetes Day. India is nowadays considered the “Diabetic Capital” of India. The rate at which diabetes is increasing in modern societies is, indeed, a matter of concern. Diabetes does not merely mean increased and sometimes uncontrolled blood sugar. It affects various organs and systems of our body , particularly affecting heart (coronary artery disease), brain (stroke), eye (retinopathy), kidney (nephropathy), blood pressure (hypertension), liver (fatty liver), nerves (neuropathy), increased risk of infection and even some cancers. Obesity and diabetes go hand-in-hand. So, the main control measures are life style changes (controlling weight, diet, exercise, avoidance of alcohol and smoking); drugs (oral drugs and insulin) and monitoring by physician.
1. Sexual Dysfunction-
Diabetes is a major cause of sexual dysfunction in both male and female. It can reduce the libido (sexual desire) by altering the sex hormone levels. In case of male, Erectile Dysfunction (ED) is sometimes the first symptom of diabetes. So, if a male suffers from ED, rather than taking drugs directly from medicine shops, the cause of ED must be evaluated, particularly diabetes. Often patients do not know that they are diabetic but when the cause of ED is investigated, diabetes is discovered incidentally. It can also affect the nerves and thus can worsen the sexual problems. In female, it can lead to decreased arousal leading to avoidance of sexual activity. In some cases, it is responsible for premature ejaculation (PE) in males. Thus any person with sexual problems, should be evaluated for diabetes. Control of diabetes often resolves the problem.

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

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

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

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

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

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


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Feb16
Common Sexual Problems in Day to day life
In our modern hectic schedule, sexual problems are very common but often people ignore them and try to take help of drugs directly shown in television or newspaper advertisements. These may give temporary solutions but in the long run, they can be harmful. Because, most of the sexual problems have definite causes and the cause should be properly diagnosed and treated by a trained doctor.

1. Low libido- libido means desire for sex. Both men and women can have low libido. However, it is more common in female, although they often do not consult doctor for this problem. The causes of low libido include- hormonal problems (like deficiency of thyroid hormones, testosterone in men and estrogen in female, high prolactin), blood sugar, liver diseases, anaemia, heart diseases etc. Sometimes it may be due to psychological factors like depression or anxiety. Again in some cases, poor performance during sex or past experience of pain or injury during sex may often lead to avoidance of sex by an individual. So, what can be done- simple thing, do not feel shy, consult your doctor so that the proper cause is diagnosed and treated and thus you would be able to enjoy your family life. Remember, especially for men, viagra will never lead to increased libido.

2. Pain during intercourse- while the first intercourse is sometimes painful, but persistence o pain is abnormal and it can disrupt the conjugal relationship between a couple. Women are often the worst sufferer of the pain. The pain may occur during insertion, when the penis has just entered or when it is deep inside the vagina. This timing is important to diagnose the cause so that treatment can be done without delay. Common causes are dryness of vagina (especially after menopause), endometriosis, infections or some tumours. But sometimes, the vaginal muscle can have involuntary spasm that prevents any form of vaginal intercourse. If you feel so, do not hesitate o consult your doctor. He or she will talk to you in sensitive manner and then check you to come to diagnosis and then give you the treatment.
However, sometimes men may feel pain during intercourse. The cause is often due to incorrect position or due to phimosis (very tight foreskin). Some men have the idea that tight foreskin will'break" with repeated intercourse but this is a wrong idea. Phimosis, if ignored can lead to infections, urinary and sexual problems and even cancer. So, do not ignore it.

3. Bleeding during intercourse- while the first intercourse may lead to some vaginal bleeding in women, repeated bleeding needs medical attention. It is often due to some polyp, tumour or infection but even sometimes due to some cancers. Sometimes faulty position or faulty technique may also be responsible, and it may be associated with injury of vagina. So, never ignore such conditions and go to your doctor's chamber immediately.
If a male sees bleeding from penis after intercourse, it may be due to phimosis (as mentioned above) or some tumour or more commonly due to some injury in penis. It needs medical attention immediately, as delay will make the problem worse.

4. Erectile dysfunction (ed)- some men may feel problems in achieving adequate hardness in penis during intercourse. Remember, almost all men can sometimes face this problems, especially with increase in age. But if it occurs repeatedly, then it reduces your self-confidence. Some causes may be due to psychological factors like anxiety or depression, but majority of ed is due to some diseases that may be missed if you do not take proper action. Such diseases include diabetes, heart disease, diseases of nerves, blood, hormones (thyroid, testosterone, prolactin) or even some chronic diseases. Sometimes abnormalities in blood flow in penis may cause ed. But do not get scared, at the same time do not feel shy. Just have a visit to your doctor's chamber and check the exact cause. It almost always responds well to medicines.

5. Ejaculation problems- some men may feel difficult to ejaculate semen. Most of them actually have retrograde ejaculation (re)- that may be due to some diseases of the nerves surrounding the prostate gland. In this condition, the semen does not flow forward, rather it moves back towards urinary bladder, so that semen is mixed with urine.
But more common problem faced by many men is premature ejaculation (pe)- that often leads to very short duration of sex. It is easily treatable with the help of some drugs and sex exercises. Some special sex tips also help a lot. You just need to have better control over ejaculation of semen and reduce sensitivity of the penis- simple thing.


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