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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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Jun22
THE GREATEST SERVICE: DR. SHRINIWAS KASHALIKAR
THE GREATEST SERVICE: DR. SHRINIWAS KASHALIKAR

"Your own self-realization is the greatest service you can render the world." ~ Sri Ramana Maharshi

There is no doubt about this; in terms of conviction.

But Self realization is merely "known" to most of us; by "missing" it! This is like "knowing water" by virtue of thirst! Hence; most of us have to go on rendering relatively “lesser” service in the form of; practice and promotion of NAMASMARAN (The universal and most democratic way of self realization) and its globally benevolent; powerful role in holistic renaissance (SWADHARMA); till we are ultimately able to render the greatest service in terms of our own self realization!

Our Sadguru Shri Brahmachaitanya Maharaj Gondavalekar said, “Trust that the practice of NAMASMARAN as prescribed by Guru would emancipate the universe! Lord Rama would bless!”
(ORIGINAL MARATHI :"गुरुकडून घेतलेले नाम, पावन करील जगास, हा ठेवावा विश्वास, राम कृपा करील खास." श्री. ब्रह्मचैतन्य गोंदावलेकर महाराज)


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Jun18
Tips on Choosing the Best Hair Transplant Surgeon
Losing your hair and going bald can be a very big blow to your self-esteem. Worse still is having a botched hair transplant procedure by a quack that ends up costing you a fortune and achieving very little if any hair growth. There are thousands of hair transplant experts that you can go to but not all are genuine or offer the best hair transplant service. If you are looking for a really quality service for your transplant, here are some important procedures that you can put into consideration in order to find the best service ever for your needs:-

Know the Credentials for the Hair Transparent Specialist

It really pays to know if the doctor that you are going to is really specialized in hair transplant and restoration treatments and whether they are certified to carry out the same. Hair restoration is a critical surgical operation and you really cannot risk entrusting this to a quack. Take time to do some homework in order to assess the credentials of your doctor. For the best hair transplant surgeon, always go for the reputation and ask other patients. Look for a doctor who is not only certified, but also a member of the major professional associations in the country.

Look at experience

Do the doctors have a long experience carrying out successful hair transplant operations? Is this verifiable? If they are experienced in this, then you should look forward to the best hair transplant procedure. The best hair transplant surgeons will establish their reputation through years of successful practice. If your doctor has been in the industry for a long duration of time without a track record of botched transplant procedures, chances are that they will offer you the best quality hair transplant service.

Choose a doctor that is readily available

Look for a surgeon who will be available for many post-operative care services. If you have chosen a doctor away from your home, make sure the doctor is readily available on phone, Skype or whatsapp for post-operative care services.

Look at the finer details

As they say, the smaller details are always very indicative of the bigger picture. When you are shopping for the best hair transplant clinic, it is therefore important to pay very close attention to what they call the fine details. For example, what is the condition of the hair transplant clinic? How are they responding to your inquiries? Are they responsive to your inquiries? How was the initial consultation at the clinic handled? Were they meticulous in explaining the procedure to you or did they rush you through without adequate information?

Ask for references and testimonials: Is the clinic able to provide you with testimonials of people who have used its hair transplant services? What were the personal experiences of the referrals who used the service like? It is also important to look at the before and after pictures of real people who used the clinic’s hair transplant services.

Hair transplant is not a procedure that you should take lightly. So it is important to take your time when looking for the best hair transplant service. For the best hair transplant in India, check out what Athena Hair Now Hair Transplant has to offer. The clinic is based in Chandigarh.


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Jun15
SATISFACTION AND NAMASMARAN: DR. SHRINIWAS KASHALIKAR
SATISFACTION AND NAMASMARAN: DR. SHRINIWAS KASHALIKAR

Student: Sir, in spite of years of practice of NAMASMARAN; I am still not able to experience what is described as satisfaction! What should I do?

Teacher: As far as I understand it, satisfaction is even more difficult than achievement of extraordinary feats.

Student: What do you mean?

Teacher: Practice of NAMASMARAN is actually a training of doing an activity where you do not get any tangible, predictable and measurable “benefit”! Being such a practice; NAMASMARAN actually transforms us to our original omnipotent, omnipresent and omniscient state, which is totally devoid of any desires! This is an immortal state. But this may require not years and decades but even more.

Student: I don’t understand!

Teacher: When we are told that we should not expect anything; we think that we should not expect money, name, fame, power etc. So we stop expecting those things and start expecting satisfaction; because we think it is assured by Guru! But this concept of “getting” itself traps us! We mistakenly take the satisfaction referred to by our Guru, to be some kind of gratification and keep waiting for it; and are eventually disappointed!

Student: So what to do?

Teacher: Just as we breathe oxygen; we ought to practice NAMASMARAN. As per our stage of transformation our physical, emotional and intellectual needs, desires and aspirations have to be unhesitatingly and legitimately fulfilled through our own efforts; in the light of guidance and empowerment of inner voice i.e. our Guru! Actually our needs and desires go on changing or disappearing in the process of our transformation, without any coercion or suppression!

Student: In short, we should not expect anything, even happiness, peace, satisfaction from NAMASMARAN?

Teacher: It may appear strange. But it is true! For example, when we feel cold, we "want" or we "desire" warm clothes. But how can we want warm clothes or warmth from NAMASMARAN, which transforms us to our original state of being “fire”? Moreover once we become fire, how can we experience the warmth of warm clothes?
Hence NAMASMARAN is said to be for the sake of NAMASMARAN only!

Student: Sir, this is quite different from the emotional exuberance of millions of devotees!

Teacher: Actually, most of us are in need of some solace, some peace; some escapism and so on. Hence we try to cling to some tradition, some cult and feel secure in it. Often we infatuate piety, devotion, surrender, blessings, bounty, freedom from instincts; etc as these are our emotional crutches. We seek some social acceptability, social recognition and some social cohesiveness. There is nothing objectionable in it.

But for me; NAMASMARAN is a straight forward and transcientific process of individual and universal blossoming, i.e. “holistic evolution” over and above “organic evolution”. Hence my Guru Shri Brahmachaitanya Maharaj Gondavalekar says that practice of NAMASMARAN is for the sake of NAMASMARAN only!


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Jun14
GLOBAL GURU KRUPA: DR. SHRINIWAS KASHALIKAR
GLOBAL GURU KRUPA: DR. SHRINIWAS KASHALIKAR

My guru Shri Gondavalekar Maharaj taught throughout his life; that NAMASMARAN is the way of individual and universal emancipation.

But we don't see expected results in our personal life and global life as an effect of NAMASMARAN. This creates doubt!

Gradually we learn to appreciate that our comprehension is limited and fallible whereas the GRUKRUPA; in personal as well as global terms is accurate and beyond our imagination and often different from our predictions! We realize that it is our inevitable privilege to be immersed in NAMASMARAN and NAMASMARAN is an incoming and blissfully unstoppable global spring!

Blessed and privileged are those of us, who realize this; and rejoice in welcoming this spring, by practicing NAMASMARAN and globalizing it; by sharing its grandeur with others in one way or another!


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Jun12
BENEVOLENT GLOBAL SPRING: DR. SHRINIWAS KASHALIKAR
BENEVOLENT GLOBAL SPRING: DR. SHRINIWAS KASHALIKAR

NAMASMARAN is an act of connecting with or uniting with one's true self (which is the same as the SELF of universe). It is practiced in different ways in different traditions and is the fountainhead of universally benevolent perspectives, thoughts, policies, plans, motivations, urge and actions!

Indeed it is an incoming benevolent global spring; as predicted by Sadguru Brahmachaitanya Shri Gondavalekar Maharaj over hundred years ago and keeps inspiring billions for last one and half century!

Blessed, are those of us, who are enabled to recognize and rejoice this and devote their lives in and for NAMASMARAN!

SHRIRAM SAMARTH!


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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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