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Dec11
Causes For Recurrent Miscarriage
Recurrent Pregnancy Loss (RPL) is defined as the loss of two or more pregnancies. It excludes ectopic pregnancy and molar pregnancy. Around one percent of all women experience recurrent miscarriages. Doctors define this as- “Loss of consecutive two or more 1st trimester or early 2nd trimester pregnancies”.

Having one miscarriage can be very much disturbing for the couple, but having one after another is often a very traumatic experience. Women with repeated miscarriages can be reassured that their chance of having a healthy baby is the same as women who have never miscarried, says Eminent Gynaecologist and Fertility Expert from Blossom Fertility and IVF Centre Dr Rupal Nirav Shah.

Investigations to find out possible reason for recurrent miscarriage is advisable after the third recurrent miscarriage, but in women of more than 30 years, investigations are advised even after 2 abortions. In more than 50% cases, it’s impossible for doctors to identify the cause for recurrent miscarriage.

Causes For Recurrent Miscarriage:

1.Hormonal: Polycystic ovaries, Thyroid dysfunction
2.Blood clotting disorders
3.Genetic: any one partner with an abnormal chromosome
4.Uterine problems: abnormally shaped uterus, intra-uterine adhesions
5.Male Factor: abnormal DNA fragments in sperms
6.Poor quality eggs
7.Cervical weakness(Incompetence)
Causes 1 to 6 are usually responsible for 1st trimester and 7 is responsible for 2nd trimester repeated miscarriages.

Apart from these causes, there are Environmental influences too. Though these may not lead to repeated miscarriages, they may increase chances of abortions.

How to diagnose Chances for Recurrent Miscarriage?

1. Hormonal and immunology blood workup
2. Genetic study of male and female and in selected cases of abortus.
3. 3 D sonography, Hysterosalpinography or hysteroscopy to study shape of uterus

The over prescribed TORCH infection test is not important to diagnose cause for repeated miscarriage as this may be a cause for a single miscarriage.

What are your chances of having a healthy baby after recurrent miscarriage?

If your miscarriages are unexplained, then you have a good chance of having a successful pregnancy in the future. Only close tender loving care(TLC) by your obstetrician and closed relatives can increase your chances of a successful pregnancy. Many hormonal and immunological conditions conditions are treatable. Your gynaecologist is the best person, whom you can discuss about your chances of success. Women with a history of recurrent miscarriage are at risk of developing preeclampsia in later pregnancies.

When there is no reason found and you don’t want to take any chance Pre-implantation genetic screening is a good option in which, selected cytogenetically normal embryos are transferred in uterus to avoid bad news again with help of IVF treatment.

Sometimes repeated miscarriages are because of Chromosomal Abnormality in any of partners, then IVF with donor eggs or sperms is the best solution.

At Blossom Fertility and IVF Centre before suggesting any treatment for repeated pregnancy loss, couples are first evaluated to see if there is an underlying health condition that may be causing multiple miscarriages and for which treatment is available. These include uterine abnormalities, such as fibroids, blood-clotting disorders, hormonal problems, thyroid disease or diabetes. Obesity and age can also increase the risk of miscarriage. Before suggesting any treatment all this factors are evaluated.

Get in touch today to have a successful pregnancy despite recurrent pregnancy loss - Recurrent miscarriage - For Quick Response Call us on +91 99799 46222 Contact us at http://www.blossomivfindia.com


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Nov15
How can an Ectopic Pregnancy be treated?
Ectopic pregnancy is when a pregnancy grows outside of your uterus, usually in your fallopian tube. Ectopic pregnancies are rare but serious, and they need to be treated.

Whats an ectopic pregnancy? An ectopic pregnancy occurs when a fertilised egg implants and grows outside the main cavity of the uterus. Pregnancy begins with a fertilised egg. Normally, the fertilised egg attaches to the lining of the uterus.

Ectopic Pregnancy: Symptoms, Causes, and Treatments

Normal pregnancies develop inside your uterus, after a fertilised egg travels through your fallopian tube and attaches to your uterine lining. Ectopic pregnancy is when a fertilised egg attaches somewhere else in your body, usually in your fallopian tube thats why its sometimes called tubal pregnancy.

Ectopic pregnancies are rare it happens in about 2 out of every 100 pregnancies. But theyre very dangerous if not treated. Fallopian tubes can break if stretched too much by the growing pregnancy this is sometimes called a ruptured ectopic pregnancy. This can cause internal bleeding, infection, and in some cases lead to death.

Ectopic Pregnancy Symptoms

You may not notice anything at first. However, some women with an ectopic pregnancy have the usual early signs or symptoms of pregnancy a missed period, breast tenderness and nausea.

If you take a pregnancy test, the result will be positive. Still, an ectopic pregnancy cant continue as normal.

Signs and symptoms increase as the fertilised egg grows in the improper place.

Early warning of ectopic pregnancy

Often, the first warning sign of an ectopic pregnancy is pelvic pain. Light vaginal bleeding may also occur.

If blood leaks from the fallopian tube, you may feel increasing abdominal pain, an urge to have a bowel movement or pelvic discomfort. If heavy bleeding (hemorrhaging) occurs, you may feel shoulder pain as blood fills your pelvis and abdomen. Your specific symptoms depend on where the blood collects and which nerves are irritated.

Emergency symptoms during ectopic pregnancy

If the fertilised egg continues to grow in the fallopian tube, it can cause the tube to rupture. Heavy bleeding inside the abdomen is likely. Symptoms of this life-threatening event include extreme lightheadedness, fainting, severe abdominal pain and shock.

It is important to contact your doctor immediately if you are experiencing sharp pain that lasts more than a few minutes or if you have bleeding.

Ectopic pregnancies are diagnosed by your physician, who will probably first perform a pelvic exam to locate pain, tenderness, or a mass in the abdomen. Your physician will also use an ultrasound to determine whether the uterus contains a developing fetus.

Can I get pregnant again after an ectopic pregnancy?

Most people who have an ectopic pregnancy can have healthy pregnancies in the future, depending on the treatment you had and the condition of your fallopian tubes. The chances of having a successful pregnancy after an ectopic pregnancy may be reduced, but this will depend on why the pregnancy was ectopic and your medical history. If the fallopian tubes have been left in place, you have approximately a 60% chance of having a successful pregnancy in the future. Most women who have ectopic pregnancies go on to have other, healthy pregnancies. If one fallopian tube was injured or removed, an egg can be fertilized in the other tube before entering the uterus. If both fallopian tubes were injured or removed, in vitro fertilization might be an option. If you have an ectopic pregnancy, youre more likely to get another one in the future.

If you choose to conceive again, seek your doctor's advice. Early blood tests and ultrasound imaging can offer prompt detection of another ectopic pregnancy or reassurance that the pregnancy is developing normally.

Ectopic pregnancy cannot always be prevented, but a woman can reduce her risk by protecting herself against sexually transmitted infections through safer sex practices and ensuring prompt treatment of any infections that occur. Stopping smoking will also reduce the risk. If you are pregnant and having any of the symptoms mentioned earlier it is always better to consult your physician and seek advice. Blossom Fertility and IVF Centre health team includes physicians, psychologists, embryologists, lab technicians, nurses and allied health professionals who work together to help infertile couples achieve pregnancy. A patient with Vaginal bleeding or spotting, nausea and vomiting, Sharp abdominal cramps or severe lower abdominal pain on one side of the body or with any other complains is immediately treated and all efforts are taken to save pregnancy and no further damage is being done to fallopian tubes and fertility.

For more information on getting safe pregnancy after an ectopic pregnancy get in touch with our experts today for help or Call us on +91 99799 46222 or email at info@blossomivfindia.com or visit our website http://www.blossomivfindia.com


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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, its 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. Its 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 babys 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. Its 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, its 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, its 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. Its 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. Its 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. Its 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, its 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 its 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 its 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. Thats 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, its 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 its 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 patients 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. Its 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
Fertility Treatment in Couples with Sexual Dysfunction
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, its 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. Its 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.
How Sexual Disorders are related to Infertility?
Sex and fertility are not the same thing. Couples with normal sex life may have difficulty in conception (for example couples with PCOS or low sperm count). On the contrary, couples with normal fertility may have sexual disorders. Sexual Disorders and infertility may be related in two ways.
Firstly, the stress of infertility starts to exert its adverse effects in conjugal relationships. Most of the couples, who had very satisfactory sex life, start to lose interest in sex. They feel sex as a mechanical tool whose sole aim is only to achieve pregnancy, in contrast to their life just after marriage, when sex was perceived as an expression of love-making process. The continuous advice from doctors, you should have regular intercourse makes the scenario worse. Some of them can feel other problems like erectile dysfunction, ejaculatory problems, painful sex, vaginal dryness etc. Remember, this group of couple never faced sexual dysfunction in earlier part of their life.
But, here we concentrate on second group of couples, who had sexual dysfunction from the very beginning. They did not have penetrative intercourse long time after marriage. Initially they ignore the problems because of pressure from professional field and some of them feel too shy to consult doctor for this problem. But when they themselves want to plan for a baby, or due to pressure from the family, they start to realize the importance of having a good sex life. At this point, most of them consult doctor to find the solution. But the problem seems more complicated than the couples in the first group (above paragraph). This is because, the doctors have to treat two problems together- sex and fertility. Apart from the problems in sex life, the stress factors also come into play.
Again, there are some couples, who come to our clinics earlier. They find problems in sexual intercourse but are not planning for pregnancy right now. In these cases, the treatment is relatively simpler, as we get ample time to correct the problems, to help them conceiving naturally.
What are the common types of sexual disorders that can prevent conception?
In simple words, absence of penetrative intercourse will prevent pregnancy. It may be problems due to lack of desire or problems in physical performance.
Few men and women do not feel any urge (libido) to have intercourse. Others may have the libido but find problems because of erectile dysfunction (lack of hardness) during intercourse. Uncommonly, some men may be able to insert the penis inside the vagina but cannot ejaculate (discharge) the sperms during intercourse. Some women may feel severe pain during attempted intercourse, that prevents them to participate in it.
What are the reasons behind sexual disorders?
Its a common misconception that all the sexual dysfunctions are due to psychological factors. Indeed, most of such problems may be related to some physical factors.
Life-style factorscontribute a lot. Stress due to various reasons (financial, professional, family related) affect sexual performance and libido. People working in stressful life, particularly marketing, banking and IT sectorsare badly affected. Previous bad experience with sex (like previous history of erectile problems, pain, bleeding) often come into play and this performance anxiety makes the situation worse. Relationship conflict also plays important role. Excessive use of alcohol can affect the orgasm and erection. Smoking, apart from its harmful effect on fertility, can affect libido, erection and orgasm. Excessive use of caffeine can also be responsible. Some medicines, particularly medicines used to control blood pressure and abusive drugs like cannabis can create such problems. Excessive weight can affect libido, erection, ejaculation, vaginal dryness and orgasm; in addition to delay in conception.
Sexual dysfunction can be the first sign of serious diseases like diabetes. Other hormonal problems like imbalance in sex hormones (low testosterone in male and female, low estrogen in female, high estrogen in male), high prolactin, thyroid diseases can be responsible for sexual problems and are easily treatable.
Diseases of heart (high blood pressure, heart failure), liver (cirrhosis), kidney (renal failure), nerves (diseases in brain, spinal cord) and blood (sickle cell disease, anaemia) can be responsible for sexual problems. This is another reason, why people with sexual disorders should not think that its a disease of reproductive system only.
Some operations (in spine, abdomen, pelvis, hernia, vagina, scrotum) and injuries (spine, pelvis) can have long-lasting serious side-effects on sexual function.
Infections, tumours, endometriosis can be responsible for pain and bleeding during intercourse.
Finally, lack of proper technique, improper knowledge and unrealistic expectations are also responsible.
In general, what are the treatment options for sexual disorders?
The first and foremost action is to find out the underlying cause responsible for sexual dysfunction. Thats why its important to have thorough check up by doctor to find out the cause. The check up includes asking question by the doctor (history taking), physical examination and then if needed, some tests (like blood, ultrasoundetc). Its important for you to be honest and to disclose all your problems and raise any concerns to the treating doctors.
If the cause is found, the treatment is simply, the correction of the cause, if possible (like correction of blood sugar in diabetic patient).
Even if no cause is found or when the cause cannot be corrected, the couple can have satisfactory sexual life. It involves proper counseling and sometimes sensate focusing (initial focusing on perception of the touch, rather than intercourse). Stress reduction and life-style modification (controlling weight, stopping smoking, reducing alcohol) cannot be overemphasized.
Pelvic floor exercise (Kegels exercise) can help both men and women to improve blood flow to pelvic organs and optimize the pelvic muscle functions, thus in turn, improving sexual function.
Next comes the role of medicines. There is a common misbelief that sexual dysfunction can ne corrected by steroids only. This is totally wrong, because steroids can rather worsen the sexual problems. Another misconception is that, once started, you need to take medicines throughout the life. The fact is that majority of the patients need medicines only for the time being. Majority of the couples respond well to these methods of treatment.
In very few cases, some additional measures can be needed like corrective surgery or vacuum device for erection problems.
What are the options for fertility treatment in presence of sexual disorders?
As mentioned before, if a couple with sexual problems want pregnancy, the doctors have to deal with two problems- sexuality and fertility. So, proper investigations are needed for both, to find out the cause. Then the treatment decision is taken, based on age and weight, underlying problems, how severe is the sexual problems, the treatment response, affordability and of course, the wish of the couples.
The first step treatment, is obviously to trying for natural conception, by regular penetrative penile-vaginal intercourse. So, the first line of treatment is to correct the sexual problems, as mentioned in the above section. Majority of the couples can have successful sex life after proper treatment and a large number of them conceive in the course of time, provided there is no major fertility problems (sperm, fallopian tubes, uterus, ovaries). If they fail to conceive, the treatment is just like other couples (those without sexual problems). That is, they can be offered ovulation induction, intrauterine insemination (IUI) and in vitro fertilization (IVF).
However, if the sexual problems cannot be corrected, this is not the end of the world. If the man can collect sperm by masturbation, he or the female partner can perform self-insemination. This can be done at home by the couples and can be coordinated with ovulation time and, even with ovulation drugs. This has success rate of 15% per cycle per couple (if 100 couples are trying it, in one month, 15 can conceive).
If self-insemination fails, or is not possible (for ejaculation problems), or is not acceptable to the couple, the option is IUI. For men with ejaculatory problems, sperms can be collected by Vibro-ejaculation (putting a simple instrument over penis, without pain) or by collecting sperms from the urine which is taken immediately after masturbation (post-masturbation urine- for retrograde ejaculation). IUI has the success rates of 20% per cycle, depending on the age, sperm count and other fertility factors. For women feeling severe pain during intercourse, IUI can be done under anaesthesia.
Self-insemination and IUI can only be successful in couples with normal fallopian tubes (at least one tube must be open), normal perm count or sperm counts mild to moderately abnormal, normal ovulation or ovulation done with medicines (as in PCOS). However, if these are not possible, because of fertility factors (very low sperm count, tubes blocked) or IUI fail, then the option is IVF. In one IVF cycle, 40% of the couples conceive in average. IVF can even be done, in men having no ejaculation but who can produce sperms inside the testes (by putting needle in the scrotum).
In very few cases, when these treatment options are not feasible, donor sperm, donor ovum or surrogacy treatment can be done.
What are the reasons behind low sex desire (Libido) in men or women?
The main reasons are life-style factors, hormonal imbalance and anxiety for poor performance.
How low libido is treated?
Treatment is simple, as stated above. It includes life style changes, sensate focusing and correction of the underlying disease.
How can a person with low libido become a parent?
Majority of the couples can conceive naturally after successful treatment of low libido. If the above-mentioned measures fail to correct the libido, then self-insemination, IUI or IVF can be done, depending on the cause.
What are the reasons behind Erectile Dysfunction (ED) in men?
The main reasons are life-style factors, hormonal problems, disorders in heart/ nerve/ blood, operations or injury; as mentioned earlier.
How ED is treated?
Majority of the men respond well to the correction of underlying cause, stress reduction, life style changes, Kegels exercises and medicines.
How can a man with ED become a father?
If the treatment of ED is successful, the couples can conceive naturally. However, if these fail, they can try self-insemination, failing which IUI, and occasionally IVF need to be done.
What are the reasons behind Ejaculatory Problems in men?
Ejaculatory dysfunctions are not common, apart from premature ejaculation (discussed below). It can be due to anxiety, diabetes, problems in nerves or prostate gland, after surgery or operation in spine or pelvic area and sometimes infection.
Majority of such men are able to ejaculate during masturbation or are feeling normal nocturnal emission (night fall) but fail to do so during intercourse. In these cases, usually no definite cause is found. This is called situational anejaculation. A portion of them can have ejaculation with some particular partner, but not with other(s).
Few men are suffering from absolute anejaculation. This means, they cannot have ejaculation during masturbation or intercourse. The cause is usually related to problems in nerve, diabetes, surgery or injury. A portion of them may have retrograde ejaculation, that is, during orgasm, the sperms are carried back towards urinary bladder (the sac that stores urine), rather than towards the penis. A post-masturbation urine sample can reveal sperm in such cases and diagnoses this condition.
How ejaculatory problem is treated?
Unfortunately, ejaculation problem is somehow difficult to cure. Some medicines can help few men. Vibroejaculatorcan be helpful in some men.
How can a man with ejaculatory problem father a baby?
Ejaculatory problems may not be cured, but such men can father their own baby. This is possible by collecting sperms by various means. If he can masturbate, self-insemination is possible. Alternatively, with vibroejaculation, sperms can be collected at home and self-insemination can be done. IUI and IVF are also possible in such cases.
However, if there is no ejaculation during masturbation, post-masturbation urine can be tested and if there is adequate number of sperms (Retrograde Ejaculation), IUI can be done. If the sperm counts are not enough, a special form of IVF (ICSI- Intra-cytoplasmic sperm injection) can be done.
Even if post-masturbation urine reveals no sperms, the sperms can be collected from the testes and ICSI can be done successfully.
Thus, although ejaculatory problems are uncommon and are difficult to treat itself, successful conception is quite possible.
Can Premature Ejaculation (PE) be related to Infertility?
Premature ejaculation is usually not a cause for infertility, though it can cause inadequate satisfaction during intercourse.
However, if the PE is severe degree, that means the sperm is discharged before vaginal penetration, it ca cause problems in conception. Sometimes, it can be due to some problems in the penis (opening not in proper place- hypospadias). In such cases, if conventional treatment of PE (exercise and medicines) are not helpful, self-insemination, IUI or IVF can be done successfully.
What are the reasons behind painful intercourse in women?
The reasons are mostly related to anxiety or fear. It can be due to some factors like vaginal dryness (when ovaries are not functioning properly, some medicines or local glands are not working) and infection (including sexually transmitted infections). If the pain occurs at deep penetration, it may be due to some tumours (occasionally cancers) in cervix, uterus or ovaries, infections, endometriosis and enlarged ovaries.
How painful intercourse is treated?
Again, the treatment depends on the cause. Counseling, sensate focusing, life-style changes play important role. Medicines and hormones are helpful in selective cases.
How can a woman with painful intercourse get pregnant?
Its important NOT to use any vaginal lubricants (including saliva) as any lubricants can potentially kill the sperms. However, some external moisturizers are there, which are sperm-friendly. If the simple measures fail, IUI can be done under anaesthesia. IVF can be done if IUI fails or is unacceptable.
Will my problem in conjugal life remain confidential?
Yes, except you and your partner and the treating doctors, nobody else (even your parents or friends) have any right to know about your personal life. Self-insemination can be done at home, without going to clinic, thus maintaining your privacy. If you have to go for IUI or IVF, you will be treated just like other couples (who fail to conceive despite normal sexual life)
How such problems are treated in the clinic of Dr Sujoy Dasgupta?
We believe in patients autonomy. So we want to give time on discussion and presentation of facts and figures to the couples. We encourage questions from the couples and take utmost care so that no question remains unanswered.
We do not take decisions and impose it on the couples. We advise the couples to take time before taking decision on a particular treatment. If the couple decides, we respect and support their decision.
We try to take nominal charges and help couples to collect medicines (particularly injections) at lower prices than MRPs.
We try to find out the root cause of the problems in the couples and try to solve them first. If that is possible we encourage them to try for pregnancy naturally. If these attempts fail, we discuss with the couple, the options, that include self-insemination, IUI, IVF and ICSI. We do not pose any of our decision on the couples, rather we discuss with them and help them to make their own decision.
Conclusion
Infertility is a peculiar thing. Very few men or women are absolutely infertile. That means they do not have ability to achieve pregnancy naturally. Majority of them are subfertile. That means most of them have lower than normal chance (compared to healthy couples) to achieve pregnancy in a normal menstrual cycle. Sexual problems are not uncommon but are easily treatable. Pregnancy is quite possible in couples who are not able to have penetrative intercourse.


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Feb16
Low Sperm Count- The Solution
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 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, its 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. Its 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.
Semen Analysis
Semen analysis is an indispensable part of evaluation of an infertile couple. It is accepted that if semen analysis report is normal, male factor is usually said to be normal. However, a single abnormal semen analysis does not always mean that there is any abnormality in the man. This is, because, semen consists of 2 parts- the sperms and the fluid ("seminal plasma"). In a man, sperm production requires 3 months and it needs cool temperature than rest of the body. This is why, men have their testes hanging outside the body in the scrotum.Thus, today's semen analysis reflects a man's health 3 months before. If, for any reason (for example, high fever, tight underwear, hot tub bath etc), man's health was abnormal 3 months ago, the semen analysis may become abnormal. Again, the results can vary from one laboratory to another.
How semen collection and analysis is done?
The easiest and the most commonly used method is masturbation. But remember, you have to do it in awkward environment, where privacy will be maintained, but the mental pressure, that you have to give semen, may be harmful. So, stay relaxed. It's preferable to collect semen in the laboratory. But if its not possible, you can collect it at home, carry it in the pocket of your trousers and must reach the laboratory within 30 minutes of collection. Please inform the laboratory about the timing of collection.
Please maintain abstinence for 3 to 5 days (not more than 5, not less than 5). That means you should avoid intercourse and masturbation for 3-5 days prior to the test. It's important to collect all the semen in the collection pot and not to spill a portion outside.
Then it's tested in the laboratory for certain parameters like- volume (amount of semen), liquefaction (time needed for semen to become liquid), total sperm count, motility (ability of the sperms to move), morphology (the appearance of the sperms), vitality (whether sperms are living or not) etc. Please make sure that your laboratory is following WHO 2010 criteria for semen analysis (not the older criteria like 1992). Sometimes, some special tests may be done on the semen depending on your scenario.
What happens if a man cannot collect semen?
Collection of semen in unfamiliar environment is understandably a matter of discomfort and seems awkward. Proper counseling and maintenance of privacy can help. Stress-free approach is needed. If it fails, do not hesitate to inform your doctor, especially if you are not accustomed to masturbation or had difficulty earlier.. Some medicines can help. But in those, who are unable to masturbate, there are some instruments, like vibro-ejaculator, can help to solve this problem. This is a small device applied on the front part of the penis ("Glans Penis") to stimulate the organ to discharge the semen. The other options include rubbing the penis against a special Non-Toxic Condom (Not ordinary condom) or intercourse with that condom. Some men feel comfortable to practise coitus interruptus.
In few men, when no semen comes out, the problem may be retrograde ejaculation (Semen going into bladder instead of moving forward). In that case, sperms can be collected from the urine immediately after masturbation. If it fails, options include some medicines, electroejaculation (Putting current in prostate gland by a small probe inserted through the anus under general anaesthesia), prostatic message and sometimes collecting sperms from testes with a small fine needle.

What happens if the report is abnormal?
If a single report is abnormal, as mentioned above, it may not be conclusive. So, we usually advise repeating the test after few days, preferably from a second laboratory. At the same time, its important to diagnose the cause of this abnormality. To find out the cause, you may need physical examination of your genital organs. Your doctor may ask you some questions and with your permission, may check your body areas (hair growth, breast development), penis, scrotum, testicular size etc. Doctor can advise you some tests like ultrasound of your testes, or sometimes of your prostate gland. I severe cases, doctor can advise you some hormonal tests (blood tests- LH, FSH, Testosterone etc) and in some occasions, karyotyping (chromosomal analysis)
So, whenever we find abnormality, we have to detect the cause. Treatment without detecting thee cause is more likely to fail. So, first thing is- whether sperms are produced or not.
One important thing is to remember, sperm production has nothing to do with manliness. You may feel absolutely normal with normal sex life but sperm production may be defective. So, first thing is not to feel depressed when the report comes abnormal.

What treatment can be done?
Every attempt is made to find out the cause and treat the cause so that you can father your baby using your own sperm by natural means. Treatment includes some life-style advice, some medicines (antioxidants etc). But if the problem is severe, medicines may not act. The only conditions, where medicines act very well, is when the sperms are not produced because of hormonal problems in the pituitary gland.
What lifestyle changes are advised?
Remember, life style changes can improve your sperm count to some extent. You should avoid smoking, alcohol, taking drugs like anabolic steroids etc. You should try avoiding heat exposure to your scrotum. This can be done by avoiding tight underwear, avoiding prolonged sitting, avoiding prolonged driving, avoiding hot bath tub etc. Try keeping laptop and mobile phone away from your lap or thighs.
What is the next action?
If the sperm count improves, then natural conception is possible. In other cases, we may not be able to improve the sperm count, but pregnancy is possible. If the problem is mild, intrauterine insemination (IUI) can be done, with the success rate 20-25% per cycle. This means, every 100 women undergoing IUI, 25 can conceive in the 1st cycle. In other cases, up to 3-4 cycles of IUI can be done. If IUI fails, then the option remains IVF with success rate 40%. Remember, in all these cases, your sperms will be used.
IUI can be successful if sperm count is minimum more than 5 million per ml and there is reasonably good morphology and motility. If not, IVF or ICSI would be the better option. But IUI can serve as trial also. That means before putting the semen, the prepared sperms can be examined and it can be predicted what is the success rate of IUI in this particular case and whether IVF or ICSI would be needed. In rare occasions, where sperm count is extremely low but the couple do not wish for IVF or ICSI, pooled semen IUI can help- where the semen is collected in number of occasions and is preserved and the final pool is used for insemination, to give a reasonable success rate.
What is insemination?
Insemination literally means putting semen in a particular place. Various forms of insemination exist in fertility treatment. First one is Intravaginal Insemination (IVI), where the raw semen, collected by the husband can be put inside the vagina, taking precautions (to prevent infection) by the husband himself or by the wife. Rarely, it needs medical assistance from a doctor. Its usually advised to couples having sexual disorders where full penetrative intercourse is not possible (erectile dysfunction of the husband or very painful intercourse experienced by the wife) or where ejaculation cannot happen during intercourse (a very unusual problem). Thus, the success rate of IVI is no better than natural intercourse (success rate 15% per cycle), for those couples who can manage successful intercourse.
Intrauterine Insemination (IUI) is the treatment where prepared semen is put inside the cavity of the uterus, near the Fallopian tubes. Thus, IUI bypasses some hurdles that can cause problems during natural intercourse. The vagina, cervix and the whole length of the uterus are bypassed, putting the sperms near the eggs. Thus it increases the success rate compared to natural intercourse or IVI.
However, to achieve pregnancy after IUI, the female partner must have open tubes, adequate number of eggs produced by ovaries, eggs must be released by the ovaries and sperms must meet the eggs. And, thus nature plays important role, as in natural intercourse.
Please note, we used the word prepared semen. In natural intercourse, as mentioned earlier, the dead sperms and bacteria cannot enter the uterus, because cervix prevents their entry. If they are put artificially by IUI inside the uterus, severe reaction can happen. So, after collection, the husbands semen is processed in the laboratory to remove all those impurities and to select only the best number of healthy and movable sperms and it definitely increases success rates of IUI
What can be done if there is no or very few sperms?
In such cases, we have to find out the exact problem. If the problem is due to adequate sperm production but blockage in the sperm conducting duct, some surgery can be done. However, such surgery is not widely available and may fail. So, most of the men usually opt for special type of IVF (In Vitro Fertilization) using the technique called ICSI (Intracytoplasmic sperm injection). Here sperms are collected from semen (is some sperms are there), or urine (in retrograde ejaculation) or by putting needle inside your scrotum (usually under anaesthesia). In case of block, the chance that we can collect your sperm from your body is 80-100%. That means, out of 100 such men, in more than 80 cases, sperms can be obtained from his testes. The procedures include TESA (Testicular Sperm Aspiration), TESE (Testicular Sperm Extraction), MESE (Microsyurgical Epididymal Sperm Extraction) and PESA (Percutaneous Epididymal Sperm Aspiration).
If it appears that the sperms are not produced well, still sometimes some sperms can be seen inside the testis. However, the chance of getting your sperms is 50%. So, if you agree, we can try collecting the sperms from your testes using TESA or TESE. Before that, we need to be sure that there is adequate chance of getting sperms from your body and so, you may need further investigations.
What is ICSI?
ICSI is a type of IVF. In standard IVF, your wife will be given some injections to mature her eggs, which will be collected under anaesthesia through the vagina using ultrasound. These eggs are then mixed with the sperms in the laboratory and the embryos, thus produced, are either directly put inside your wife's uterus or some may be frozen and kept for future use, if the 1st cycle fails.
In ICSI, the best single sperm is chosen and is inserted directly inside the egg to produce the embryo.
When donor sperm is used and how?
If a man does not have any sperms or too few sperms to do IUI, IVF or ICSI is not affordable, donor IUI is an alternative. But it is not done without consent from both husband and wife. The donor is not known to the couple or the doctor and no identity of the donor is revealed. No relative or friend can serve as donor. Donor semen is frozen semen, collected 6 months ago and the donor is tested for diseases like STD, HIV, Hepatitis B or C. Usual attempt is taken to chose donor having blood group and skin colour similar to those of the husband. But remember, its only given after discussion and written consent by the couple.
How Abnormal Sperm Count is Treated at clinics of Dr Sujoy Dasgupta?
We believe in patients autonomy. So we want to give time on discussion and presentation of facts and figures to the couples. We encourage questions from the couples and take utmost care so that no question remains unanswered.
We do not take decisions and impose it on the couples. We advise the couples to take time before taking decision on a particular treatment. If the couple decides, we respect and support their decision.
We try to take nominal charges and help couples to collect medicines (particularly injections) at lower prices than MRPs.
We advise only those investigations that are needed and then find out the cause, if possible. We give the ouples all the options like medicines, IUI, ICSI, surgery, donor sperms etc and given them adequate time to consider their decision, Once, they decide, we respect their decision and proceed according to their wishes. The privacy and confidentiality are maintained strictly throughout
Conclusion
Infertility is a peculiar thing. Very few men or women are absolutely infertile. That means they do not have ability to achieve pregnancy naturally. Majority of them are subfertile. That means most of them have lower than normal chance (compared to healthy couples) to achieve pregnancy in a normal menstrual cycle. Often we find that patients planning for treatment and in the mean time, they conceive naturally. That means even without treatment, there is some chance of pregnancy. Of course, its stressful situation for both the partners. Stress affects conjugal relationships and lead to many couples avoiding conjugal life. Indeed stress can affect the hormone levels in females and affects sexual performances in males. Its easier for us to advise you to stay stress-free but is difficult to practice. Nevertheless, try relaxation as much as possible. Think that majority of the couples ultimately conceive by some form of treatment. Have faith in yourself and have faith in your doctor.


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Aug21
Pregnancy with Blocked Fallopian Tubes
Fallopian tube damage is a common cause of infertility and tubal ectopic pregnancy. The fallopian tubes are the pathways in which the ova travel from the ovaries down into the uterus, and if there is a blockage in these tubes it can prevent this from occurring. A fallopian tube blockage typically prevents successful passage of the egg to the sperm, or the fertilized egg to the uterus. The fallopian tubes are two thin tubes, one on each side of the uterus, which help lead the mature egg from the ovaries to the uterus. When an obstruction prevents the egg from traveling down the tube, a woman has a blocked fallopian tube, also known as tubal factor infertility. This can occur on one or both sides and is the cause of infertility in 40 percent of infertile women.

Causes of Blocked Fallopian Tubes

Blockage can happen in one or both fallopian tubes. Some of the causes of the blockage are:
Pelvic inflammatory disease (PID): PID is one of the major cause of blocked fallopian tubes. PID refers to the collective inflammatory issues that affect the female reproductive system by creating blockage and damage to the fallopian tube. PID is the result of a sexually transmitted disease(STD), but not all pelvic infections are related to STDs.

Side effect of surgeries: Complications due to surgeries that involve the uterus and fallopian tubes like a C-section, abortion etc. can cause a blockage

Fibroids: A fibroid may bring about pressure on the fallopian tubes thus causing a blockage in the path of sperm or eggs

Endometriosis: Instead of shedding during menstruation, if you are experiencing endometriosis i.e. the endometrial cells are found outside the womb, it can cause a blockage. This is because the scars and adhesion that are created because of endometrial tissue can place physical pressure, creating anobstruction in fallopian tubes. This can prevent the tubes from taking in the eggs released from the ovary or making way for them to the uterus.

Infections: Infections, including sexually transmitted infection (STI) like chlamydia and gonorrhea or any infection caused by an abortion or miscarriage, can cause a blockage in the tubes.

Ectopic pregnancy: Sometimes, instead of continuing to travel toward the uterus, the fertilized egg is implanted in fallopian tubes, resulting in tubal pregnancy. If the woman has already experienced an ectopic pregnancy, she develops an increased risk of scar formation leading to the blockage of fallopian tubes

Ruptured appendix: If the woman has a history of a ruptured appendix, there is a chance that the infection can affect the fallopian tubes leading to blockage.

Tubal ligation removal: Tubal ligation, a popular birth control method, is removed when the couple desires for a baby. The chances for the fallopian tube blockage are high in this case because of the scar tissue that is formed after the procedure

Know in detail about symptoms, causes and treatment options for blocked fallopian tubes at https://rupalhospital.wordpress.com/category/blocked-fallopian-tubes/

What are the symptoms?

Unlike anovulation, where irregular menstrual cycles may hint to a problem, blocked fallopian tubes rarely cause symptoms. Women may experience certain symptoms or nothing at all. Strong to mild abdominal pain, fever, painful periods, strange looking or smelling vaginal discharge, or feeling pain while having sex or passing urine are some possible symptoms, but because many women still ovulate, blocked fallopian tubes can go unnoticed until a woman is trying to get pregnant.

Treatments for blocked fallopian tubes

When it comes to treating blocked fallopian tubes, the traditional solution is tubal surgery. However, surgery is invasive and has several possible side-effects, one of the most common one being the risk of developing ectopic pregnancies. A less invasive and more affordable solution in cases of fallopian tube obstruction is in vitro fertilization or IVF. Nowadays, most women who suffer from blocked fallopian tubes choose IVF instead of surgery. IVF is safe and effective and offers women with infertility problems a very easy solution to conceive. However, in case the obstruction of the fallopian tubes is associated with hydrosalpinx formation (fluid filling a blocked fallopian tube), the success rate of IVF is smaller, so doctors recommend treating hydrosalpinx before having IVF.

Blocked Fallopian Tubes Cause Infertility?

Each month, when ovulation occurs, an egg is released from one of the ovaries. The egg travels from the ovary, through the tubes, and into the uterus. The sperm also needs to swim their way from the cervix, through the uterus, and through the fallopian tubes to get the egg. Fertilization usually takes place while the egg is traveling through the tube. If one or both fallopian tubes are blocked, the egg cannot reach the uterus, and the sperm cannot reach the egg, preventing fertilization and pregnancy. Its also possible for the tube not to be blocked totally, but only partially. This can increase the risk of a tubal pregnancy, or ectopic pregnancy.

Can You Get Pregnant With a Blocked Fallopian Tube?

If only one fallopian tube is blocked, but the other is clear, it may still be possible to achieve pregnancy. It depends on how well the ovaries are functioning, and also what caused the blocked tube in the first place.

The fallopian tubes can sometimes become blocked or even damaged due to certain conditions that a woman may suffer from. In rare cases, the blockage to the fallopian tubes may have been present since birth as a birth defect, but has gone undetected until the woman reached adulthood and tried to conceive.

So dont lose heart if you are diagnosed with blocked fallopian tubes. Consult with your doctor and look for a treatment plan most suitable for you and enjoy healthy pregnancy and motherhood.
Dont wait too long to start a family thats a message from Consultant Obstetrician, Gynaecologist, and Fertility Specialist today.
Start creating your family by contacting today Rupal Hospital for Women and Know about your options for having a baby with blocked fallopian tubes using IVF & assisted reproductive technology. You can contact fertility and IVF specialist at http://www.rupalhospital.comor simply call on +91-2612599128


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Jun27
Obesity and Pregnancy
When couples strive to increase their chances of fertility, a multitude of factors may be considered. They may be more conscious of the foods they eat, alcohol or caffeine consumed, or exercise regimen maintained. Although these day-to-day habits are certainly good to keep in mind, it is also important to remember that ones weight plays a part in his or her overall health, and when it comes to fertility, weight is yet another factor that may influence success rates.

To become pregnant, a healthy weight matters. Being overweight or obese can impact your fertility. Obesity is a rising epidemic affecting millions worldwide. Obesity also significantly affects a womans capacity to carry on a pregnancy to term. Obesity is defined by an extraordinarily high Body Mass Index (BMI) in which the index is a reflection of body fat content. Around 1 in 4 women are at least overweight as per surveys and studies. The rates are higher among women facing problems of conception. Obese women are three times more likely to suffer infertility than women with a normal body mass index. Overweight or obese women experience longer times to pregnancy and reduced probabilities of conception relative to their normal-weight counterparts. Moreover, they are at an increased risk of early and recurrent miscarriage. These women generally have reduced oocyte quality, lower developmental potential, and poor clinical outcomes when they undergo assisted reproduction treatment.

Healthy women have healthy eggs and are more likely to have healthy children,

Obesity has a number of different effects on fertility of men and women as follows:

1. Obesity affects hormones
When body mass index goes past the overweight category (BMI of 2529.9) into the obese category (BMI of 30 and above), hormonal changes may occur in the female body. When the levels of natural hormones change, the chances of conception decrease.

2. Obesity leads to insulin resistance
The hormonal imbalance that comes with obesity often leads to insulin resistance. That is a major risk factor on the road to diabetes but it also affects fertility and can create abnormal menstrual cycles. Insulin resistance can lead to anovulation, in which body does not produce eggs properly.

3. Obesity affects natural and assisted pregnancies
Obesity makes it more challenging to become pregnant, no matter whether a couple is using natural means or reproductive technologies such as in-vitro fertilization (IVF). It also increases the risk for a miscarriage. This issue may be caused by the hormonal issues or because of poor quality eggs.

4. Obesity decreases Men's fertility, too
Although much of the focus on obesity and infertility is on women, it absolutely affects men, too. For men, obesity leads to a drop in testosterone, which can lead to infertility. On top of that, erectile dysfunction occurs at a higher rate among obese men.

5. Losing weight can improve all of the above
In recent years, the connection between lifestyle, weight, nutrition and fertility is gaining more public exposure. A multidisciplinary approach to weight management is more likely to be a successful treatment option. The emphasis should be on lifestyle change, education about proper diet, exercise, and behavior modification. A more holistic approach to obesity and reproductive health can help increase the chances of conception in obese women. In doing so, it would also have a positive impact on the general health.

As a result of weight loss, the hormonal imbalances and other effects of obesity begin to decrease.

Know in detail about fertility treatment in male and female at http://www.blossomivfindia.com/fertility-treatments

More specifically, the greater a womans body-mass index (BMI) is, the less likely she is to have a successful IVF experience. A Recent study has shown that to a large extent, todays generation is what their moms and dads ate prior to and around their conception. "This is a huge issue that really does carry through to certainly the next -- and probably the next two -- generations."

Obesity has negative effects on reproductive health. It has been established that obesity is associated with decreased natural fecundity, a decreased ovulation rate, increased time until conception, and increased rates of miscarriage. Additionally, an increased rate of pregnancy complications, including gestational hypertension, preeclampsia, gestational diabetes, postpartum hemorrhage, and fetal macrosomia, are all associated with obesity. Since the incidence of obesity is continually rising, an increasing number of overweight and obese women are seeking fertility treatments through assisted reproduction technology (ART).

There is nothing in medical science that says that IVF can't be done on fat or obese women. IVF remains more complicated for Obese Women and they require different medication doses than normal weight women. Consequently, there is a need to understand the full impact of obesity on in vitro fertilization (IVF) treatments. In vitro fertilization is used to help women become pregnant by mixing the sperm and egg outside the body, then implanting the embryo into the womans uterus.

Following are the effects of obesity on in vitro fertilization (IVF) success rates.

1. Obese women need higher doses of drugs: Obesity is associated with higher doses of medications to stimulate the ovaries. Obese women also take longer to respond, have increased cycle cancellation rates, and fewer eggs retrieved.

2. Obese Women are less likely to get Pregnant: IVF pregnancy rates are lower in obese women. The age-adjusted odds of live birth are reduced due to high BMI. In other words, the chances of having a baby decrease as the womans weight increases.

3. Obesity Affects Eggs and Embryos: Egg quality, fertilization rate and embryo quality all decrease in obese women. This means that eggs retrieved may result in a failed IVF cycle. Obese women are less likely to have successful IVF from their own eggs (and not donor eggs), due to poorer egg quality. When it comes to IVF with donor eggs, obese women apparently have normal success rates. It is apparent that women with a BMI of >25 and especially those with a BMI of >30 exhibit a poorer ovarian response to fertility drugs (impaired follicle and embryo development with fewer blastocysts becoming available for transfer). These women also tend to have a reduced ability to implant transferred embryos into their uterine linings because of its thickness, perhaps due to reduced endometrial receptivity.

4. Obesity Affects the Uterine Lining: An obese woman is at a greater risk of developing abnormal thickening of the uterus lining. This is because estrogen is secreted in excess in an obese woman. The uterine lining becomes thick and is less receptive in obese women. It is apparent that women with a BMI of >25 and especially those with a BMI of >30 exhibit a poorer ovarian response to fertility drugs (impaired follicle and embryo development with fewer blastocysts becoming available for transfer). These women also tend to have a reduced ability to implant transferred embryos into their uterine linings because of its thickness, perhaps due to reduced endometrial receptivity.

All fertility options and treatments available for infertile couples can be learned at http://www.blossombestivfindia.com/Program/OurFertilityPrograms

Women who are planning to get pregnant or to enter IVF programs should be advised to lose weight before starting so, as very strict diets are not allowed during pregnancy or while on IVF. The clinical significance of a growing population of overweight women is enormous because not only can this compromise their overall reproductive performance, but it also compounds the risk of chronic medical conditions such as diabetes, and coronary/cerebral/peripheral vascular disease, and thus compromises life expectancy as well as the quality of life. As such, being overweight represents an overall life hazard that should be addressed by the medical profession as well as by society as a whole. The answer is surely not a simple one, but the solution does not lie in dieting alone. Instead, it requires an overall modification in lifestyle.

It is important to note that reducing BMI through weight loss has been demonstrated to significantly improve fertility treatment outcomes and to lower both treatment and pregnancy complications. In other words, not only does obesity make it much more difficult to conceive, but it also exposes both the mother and the infant to all manner of risks before and after birth.

Blossom Fertility & IVF Center in India is for IVF, IUI, ICSI, Surrogacy, Egg & Sperm Donation. The clinic offers IVF (In Vitro Fertilization) treatment to infertile couples from all over the world. Clinics expertise in fertility treatment and cutting edge technology has helped majority of the patients achieve pregnancy. Obese women coming for fertility and infertility treatment are advised to reduce weight and to get BMI corrected. All options related to pregnancy for obese women are explained in detail. Finally, it is important to emphasize that overweight women are at far greater risk during pregnancy than are women of normal body weight. Women who are planning to get pregnant or to enter IVF programs are advised to lose weight before starting, as weight loss "improves ovulatory function" as well as pregnancy outcomes. It is important to note that reducing BMI through weight loss has been demonstrated to significantly improve fertility treatment outcomes and to lower both treatment and pregnancy complications. In other words, not only does obesity make it much more difficult to conceive, but it also exposes both the mother and the infant to all manner of risks before and after birth. "Because of the complex nature of obesity and of reproduction, when an obese woman with sub fertility presents for fertility treatment, an individualized yet systematic approach is needed.

Contact the Fertility experts of Blossom Fertility Centre regarding any fertility problems including male infertility, female infertility, IVF, ICSI, Blastocyst Transfer, Donor Eggs and various other complex processes at http://www.blossombestivfindia.com


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