Special Message:
Dr Sujoy Dasgupta is one of the leading doctors in Kolkata, who believes in patient's autonomy and patient-centred care, that means he strongly encourages patients to take their own decision, rather than imposing his own decision on his patients. He provides all the information related to the patient's particular diseases and provides all treatment options (like doing no treatment, medicine or surgery) and explains merits and demerits of all options, so that patients can take their own decision after judging all the aspects.
He is available at Garia, Narendrapur, Tollygunge, Behala, College Street, Salt Lake, Shakespeare Sarani and Sodpur.
Dr keeps himself updated regularly on the latest developments occurring in the field throughout the world and also keeps his patients updated by various means. He is possessing very bright academic career having number of Gold Medals, Honours, Awards and certifications. He has, to his credit two post graduate qualifications from India (MS, DNB) and number of certifications. He obtained MRCOG degree from the prestigious Royal College of Obstetricians and Gynaecologists, London, United Kingdom.
He has delivered invited lectures in various conferences at Regional, National and International Levels. He is actively involved in various organizations regarding social, academic and scientific acitivities- like Bengal Obstetric and Gynaecological Society (BOGS), Federation of Obstetric and Gynaecological Societies of India (FOGSI), Indian Association of Gynaecological Endoscopists (IAGE), Medical college Ex Students Association (MCESA) and Indian Medical Association (IMA) etc. He is managing the patients in line of "Evidence based Medicine"- that is according to the most recent scientific information obtained from Medical Literature.
Dr. is skilled to perform Infertility Work up, Infertility Counseling and Infertility Management in couples having all types of Infertility (Male, female and Unexplained). Many of his patients have experienced the joy of parenthood after long periods of Infertility. After his treatment, many couples with infertility problems like PCOS (Polycyctic Ovaries), Fibroids, Endometriosis conceived naturally after drug treatment, ovulation induction, surgery (laparoscopy, hysteroscopy in some cases) and in some advanced cases conception was possible by IUI (Intrauterine Insemination) and IVF (In vitro Fertilization- "test tube baby"). Many of his patients with low sperm counts are enjoying parethood after successful drug treatment, IUI and IVF. He continued his care to these couples throughout the pregnancy till delivery and afterwards. To give few examples- one patient with severe endometriosis, who refused surgery, conceived naturally after 3 months of injection therapy. Another patients with very low sperm counts was found to have hormonal imbalance, which was managed by medicines and sperm counts improved a lot to permit IUI and they conceived after 1st cycle.
Dr. has the expertise to treat successfully men and women with sexual problems. After his counseling, support and treatment, many patients with problems like ED (Erectile Dysfunction), PE (Premature Ejaculation), Painful Intercourse (Dysparaenia), Vaginal Dryness, Low libido etc are enjoying their conjugal life. To site an example, there was a couple where male partner had ejaculation problems. They were concerned about fertility problems. Doctor advised them to feel relaxed and performed IUI. The couple conceived and later on the ejaculatory problems subsided on its own. In another patient with severe premature ejaculation, he performed IUI and the couple had successful pregnancy.
Dr has made many couples with repeated miscarriage smile after successful treatment by giving them baby at or near term. He performs few investigations judiciously and finds out the cause to treat the cause. Even if no cause is found, he treats them with supportive care and many of them continued pregnancy with support and treatments. A Case report was published by him showing his successful management of a case of woman who conceived Triplet pregnancy after prolonged period of Secondary Infertility following Repeated Miscarriage (previous 3 loss) due to congenital abnormality in the uterus (Bicornuate Uterus) and delivered the babies in preterm condition. Another women with 3 previous miscarriage without any apparent cause conceived spontaneously and had successful live birth at term.
Dr is competent in counseling, diagnosing and managing woman before conception (Preconceptional Care), during pregnancy (Antenatal Care), Delivery (Normal Delivery and Cesarean Section) and after delivery (Postnatal care). He is especially interested in managing Medical Disorders in Pregnancy (e.g., women with Diabetes, Thyroid disorders, Hypertension, Epilepsy, Renal disease, Bleeding disorders, Clotting disorders etc in pregnancy). He managed many of his patients with High Risk Pregnancy successfully. To exemplify, recently one patient aged 38 years, conceived after IVF with twin pregnancy developed uncontrolled hypertension (high blood pressure), and for this reason he performed Cesarean Section on her at 30 weeks of pregnancy (just after 7 months). Fortunately mother's condition improved after delivery and the babies are doing well. Thus all the three lives have been saved. Another mother with IVF pregnancy had no movement of the baby. A prompt CTG was advised, following which the baby's life was saved by emergency C-section at midnight.
Dr is trained to perform all types of Obstetric and Gynaecological Operations including Hysteroscopy and Laparosopy, Hysterectomy, Cystectomy etc. He performs all types of life saving surgeries, like Ectopic Pregnancy, management of abortion and miscarriage in pregnancy. He is specially trained to perform cancer Surgeries for women with Gynaecological Cancers. Not only for cancers, he is also expert in proving "Cancer Prevention Care" to women in form of Counseling, Screening, vaccination and also Colposcopy.
Dr has been actively involved in many Clinical Research projects like- projects on use of Magnesium Sulphate single dose in Hypertensive disorders, Managing women with Myasthania Gravis in pregnancy, IUI in various forms of Infertility, Pregnancy outcomes after Infertility Treatment, cervical cancer Screening based on HPV detection techniques etc.
Dr. Sujoy Dasgupta lends his expertise in the following areas of Gynecology, Infertility, Obstetrics, Sexual Dysfunction
Gynaecological Care- Menstrual disorders, PCOS, Fibroid, White discharge, Menopause, Hormone Therapy
Infertility- Drug treatment, Male and Female Infertility, Unexplained Infertility, Endometriosis, PCOS, Fibroid, Low Sperm Count, Ovulation Induction, TVS, HyCoSy, SIS, IUI, IVF, TESA, PESA, ICSI, Hysteroscopy, Laparoscopy
Ultrasonography
Laparoscopy, Hysteroscopy- Diagnostic, Adhesiolysis, PCOS Drilling, Cystectomy, Ectopic Pregnancy, Hysterectomy, Polypectomy, Biopsy, Tubal Recannulation, Salpingectomy, Myomectomy, Endometriosis
Sexual Disorders- Male and Female- Low libido, Erectile Dysfunction, Premature Ejaculation, Female Sexual Dysfunction, Painful Intercourse
Colposcopy, Cancer Screening, HPV Vaccination
Gynaecological operations- Hysterectomy, Cystectomy, Cancer Surgery
Pregnancy care- Pre-conceptional Care, Antenatal care, Postpartum Care
High Risk Pregnancy- Diabetes, Hypertension, Thalassaemia, Epilepsy, Thyroid Diseases, Babies with abnormalities
Delivery Service- Normal Delivery, Caesarean Delivery
Miscarriage- Repeated Miscarriage
Contraception Services- Family Planning, Abortion Services
Abortion Services- Medical, Surgical
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How fallopian tubes are tested
Posted by on Friday, 24th April 2020
How can one know that the Fallopian tubes are blocked?
Unfortunately, most women do not have signs or symptoms suggesting tubal block. However, if you had previous infections in pelvis, tuberculosis in any part of the body, previous ectopic pregnancy, appendicectomy or gynaecological surgery, or feel severe pain during periods or during intercourse, there is a chance of tubal blockage.
How the tubes are tested?
Whether tubes are open (“patent”) or not, is usually checked by a special X-ray, called Hystero-salpingogram (HSG), in which a contrast material will be given through the neck of the uterus (cervix). It is cheaper and easily available. However, some women can feel discomfort during HSG. Usually some pain-relief medications are given during the procedure.
Another method is Saline Infusion Sonography (SIS) or SSG, in which water is inserted inside the uterus with the ultrasound probe put inside the vagina (TVS). It is more accurate than HSG and causes less discomfort. Both HSG and SIS are done in out-door basis, without any need of anaesthesia.
When Laparoscopy is advised?
If HSG or SIS show both the tubes are blocked, then the only way to confirm the blockage is by laparoscopy. This is, because, sometimes, the spasm of the muscles of the tube during HSG or SIS can lead to “false positive” result; that means if tubes are found to be blocked by those tests, the tubes may actually be found open actually during laparoscopy.
Laparoscopy is also advised to check the tubal patency, if there are other reasons (like removal of cyst or severe pain) or when HSG or SIS could not be done for technical difficulties.
Laparoscopy is done under general anaesthesia with two or three small opening (key-hole surgery) in the abdomen and a coloured material (“dye”) is introduced through the uterus.
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Semen Collection Problems and Embarrassments
Posted by on Friday, 24th April 2020
How semen collection and analysis is done?
The easiest and the most commonly used method is masturbation. You should collect it in the laboratory in a room with adequate privacy and comfort. Of course, for most of the men, it seems awkward to collect semen in unfamiliar environment, away from home. Usually most laboratories provide a separate room where you can bring your partner with you.
Is any preparation required?
Please maintain abstinence for 3 to 5 days (not more than 5, not less than 3). That means you should avoid intercourse and masturbation for 3-5 days prior to the test. This is because, both long term (more than a week) and short (less than 2 days) period of abstinence can lead to false results regarding quality and quantity of the sperms.
Get relaxed. Wash your hands properly before the collection. It's important to collect all the semen in the collection pot and not to spill a portion outside.
Do not hesitate to tell your doctor if you feel any problem.
If a person feels ashamed to collect sperms in the laboratory, what should he do?
This is particularly embarrassing for many men, if you are doing the test for the first time. But remember, this is a commonly performed test in the laboratory.
Try to get relaxed. Some men cannot collect semen, just because of mental stress. Avoidance of stress and counselling help many men to overcome this problem.
If your problem during collection is because of problems in erection, some medicine is given to improve your erection.
If you have erection but are unable to ejaculate, Vibro-ejaculator (see below) can help you.
A man tried but could not collect sperms in the laboratory. What should he do?
It's preferable to collect semen in the laboratory. But if it’s not possible, you can collect it at home. In that case, you must 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.
If a man is not habituated to the masturbation, what should he do?
Do not worry. Some men may have this problem.
The options include
Vibro-ejaculator- a small device applied on the front part of the penis ("Glans Penis") to stimulate the organ to discharge the semen.
Non-Toxic Condom-rubbing the penis against special condom (not ordinary condom).
Intercourse- Some men feel comfortable to practise coitus interruptus (withdrawing the penis just before ejaculation) using non-toxic condom.
If a man cannot ejaculate even during intercourse, what are the options?
Please inform your doctor. The problem may be due to some previous surgery, neurological problems, spinal cord injury, diseases of prostate or problems since birth. The following methods are useful, not only for testing sperms, but can also freeze the sperms for future treatment, if required.
Non-toxic condom- If you have nocturnal emission (“Night fall”) you can use this condom over penis while sleeping and collect the semen and carry it to the laboratory. However, all the parameters cannot be tested because of delay in transport.
Vibro-ejaculator- can help in many cases
Testing urine-In few men, 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.
Prostatic message- If urine test shows no sperms, your doctor can insert lubricated gloved fingers inside your anus to massage your prostate gland, that can help some men to ejaculate.
Electroejaculation- If prostatic message also fails, your prostate gland can be stimulated using a small probe inserted through the anus under general anaesthesia.
Testicular biopsy- If all of the above method fails, needle can be inserted inside the testes to check whether sperms are produced inside. If that fails, small cut is given in an attempt to collect the sperms from the testes.
Finally, problem during semen collection is common and many men face it. Fortunately, most of them can overcome this embarrassment by themselves. If you feel any problem, do not hesitate to tell your doctor.
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Semen Analysis- How, Where, Why?
Posted by on Friday, 24th April 2020
Why Sperm analysis is done?
Sperm analysis is an essential part of evaluation of an infertile couple. In most cases, this is the only test, a male partner requires. However, a single abnormal semen analysis does not always mean that there is any abnormality in the man.
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), the man's health was abnormal 3 months ago, the semen analysis may become abnormal. Again, the results can vary from one laboratory to another.
Is there any difference between semen and the sperms?
Semen consists of 2 parts- the sperms and the fluid ("seminal plasma"). The sperms cannot be seen by the naked eye. The fluid that you can see, is the semen. So, semen and the sperms are not the semen.
How semen is tested?
In the laboratory semen is tested for certain parameters like- volume (amount of semen), liquefaction (time needed for semen to become liquid), colour, appearance etc. The sperms are checked for total count, motility (ability of the sperms to move), morphology (the appearance of the sperms), vitality (whether sperms are living or not) etc. It is important for the laboratory to follow 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.
How semen collection and analysis is done?
The easiest and the most commonly used method is masturbation. You should collect it in the laboratory in a room with adequate privacy and comfort. Of course, for most of the men, it seems awkward to collect semen in unfamiliar environment, away from home. Usually most laboratories provide a separate room where you can bring your partner with you.
Is any preparation required?
Please maintain abstinence for 3 to 5 days (not more than 5, not less than 3). That means you should avoid intercourse and masturbation for 3-5 days prior to the test. This is because, both long term (more than a week) and short (less than 2 days) period of abstinence can lead to false results regarding quality and quantity of the sperms. Get relaxed. Wash your hands properly before the collection. It's important to collect all the semen in the collection pot and not to spill a portion outside.Do not hesitate to tell your doctor if you feel any problem.
In the next video, we will discuss what to do if you feel problem during semen collection in the laboratory.
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How PCOS and Infertility can be treated
Posted by on Friday, 24th April 2020
How PCOS is treated?
Unfortunately, there is no cure for PCOS. However, it can be kept under control. Majority of the women can keep the disease under control with lifestyle changes (diet and exercise), rather than medicines. These can also help to prevent the long-term consequences. You should aim to keep your weight to a level that is normal. Losing only a small portion of weight will improve regularity of your periods, ovulation and also the chance of pregnancy. Some women are prescribed “Insulin sensitizers” like inositol and metformin. Treatment of fertility depends on your age, duration of infertility and other fertility factors.
Usually the first line of treatment is OI (Ovulation Induction). The next lines are IUI (Intrauterine Insemination) and IVF (In Vitro fertilization) respectively.
What is Ovulation Induction?
Medicines (tablets and/ or injection) are given to help your eggs grow and rupture. In the first cycle, it is important to see (by ultrasound) whether eggs are growing or not. If the eggs rupture, the chance of pregnancy per cycle is 15% and after 4-6 cycles of OI, it is nearly 50-60%. That means, out of 100 women who had ovulation, 15 can conceive after one month.
How IUI is done?
IUI is one step ahead of OI. Here along with medicines given for OI, husband’s sperm is collected, processed (“preparation”) and then inserted inside the uterus. The success rate is 15-20% per cycle.
When IVF is advised?
If a woman fails to conceive after 4-6 cycles of IUI, if the age is on higher side, there is long duration of infertility or additional problems like sperm defects or tubal blocks, IVF is advised. The success rate is 40-50% per cycle. But caution should be taken as these women are at risk of developing OHSS (Ovarian hyperstimulation syndrome- excessive response by ovaries) and twin pregnancy. Frozen embryo transfer reduces the risk.
Is there any role of laparoscopy?
Only very few women who fail to ovulate with any medicines, sometimes laparoscopy is done where some cysts are punctured using electric current (laparoscopic ovarian drilling- LOD). Additionally, LOD can be done for women requiring laparoscopy for other purposes (like pain, testing the tubes). However, LOD carries risk of ovarian damage and therefore, should be done in selective patients.
Is any special precaution required in pregnancy?
Women with PCOS are at higher risk of developing miscarriage, diabetes (gestational diabetes mellitus- GDM), high blood pressure (preeclampsia), growth problems, premature delivery during pregnancy. Therefore, screening for GDM should be done along with regular scan under specialist supervision throughout pregnancy.
Conclusion
PCOS is common but majority of the women can do well with lifestyle changes. The chance of pregnancy after treatment is higher for women with PCOS than for other women. Proper care should be taken before and during pregnancy.
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Treatment of low AMH
Posted by on Friday, 24th April 2020
What are the treatment options for low AMH?
Only a low AMH cannot decide what treatment you should have. Age is the most important factor to decide the mode of treatment. We also have to check your duration of infertility, previous pregnancy (if any), condition of your tubes and also partner’s sperms.
If all other factors are favourable and you have only low AMH, a short period of Ovulation Induction (OI- Giving medicines to stimulate the ovaries to release the eggs) and IUI (Intra-uterine insemination- partner’s sperms are inserted inside your womb through a small catheter) can be tried. If these fail, you may need to consider IVF.
Is IVF done as the last resort?
A low AMH does not always mean that you need IVF. However, if your age is on the higher side or duration of infertility of long, IVF may be the better option for you, rather than OI or IUI. IVF should also be considered if your tubes are blocked or partner’s sperm count is very low.
In IVF, your eggs are stimulated with hormones and are then collected in the laboratory. The eggs are then “fertilized” with the sperms to produce the embryos, which are then transferred inside your uterus. However, in small number of women with low AMH, the chance of obtaining eggs is reduced and even if, eggs are obtained, these may not be of good quality. If pregnancy does not result and embryos are not of good quality, then you may be offered “Egg Donation-IVF”.
“Egg Donation”- What is it actually?
In women with low AMH, egg donation is usually done as a last resort. Here, the eggs are collected from another woman (donor), who has been checked to ensure that she is healthy and does not contain any diseases like HIV, hepatitis or thalassaemia. These eggs are then fertilized with your husband’s sperms and the embryo is inserted inside your uterus. The process will remain confidential, that means except you and your husband, nobody will know that donor-egg has been used.However, before using donor eggs, we usually advise the couples to try IVF (if required) with self-eggs.
What to do if previous IVF failed?
In case of low AMH, if you had good number of healthy embryos produced from your own eggs, the excess embryos can be frozen. So, if the first embryo-transfer fails, you still have your own embryos for transfer in future.
But if you had small number of embryos and all have been transferred (none remained for freezing), we have to review whether the quality of the embryos was good or not. As only one healthy embryo can give rise to pregnancy, if embryos were of good quality (Grade A), then you can try second IVF with your own eggs. However, if embryo quality was not good (Grade B or poorer), it’s better to think about egg-donation.
What is the chance of success?
The chance of success depends on your age, duration of infertility and your response. In general, the chance of pregnancy after each cycle of IUI is 15-20% (out of 100 women having IUI, 15-20 can conceive after 1st cycle) and after IVF, it is 30-40%. However, the chance is slightly lower in women with POR.
Is there any risk in pregnancy?
Every pregnancy carries some risk of miscarriage, abnormalities in the baby, premature delivery and growth problems. The mother can suffer from diabetes, high blood pressure (Preeclampsia) and bleeding. All these risks are slightly increased in women who conceive with POR. However, majority of these women will have uncomplicated pregnancy.
Is there no chance of natural conception?
In women who attain menopause before 40 years, 10% can conceive spontaneously, without any treatment. In women with low AMH but having menstruation, this chance of natural conception is even higher. So, low AMH does not always mean that you have to go for OI, IUI or IVF. But it again depends on your age and other factors.
What medicines can be tried? Or anything else?
Some medicines may be tried to improve ovarian response. DHEA (dehydroepiandrosterone) showed some positive results. In some women, testosterone gel or antioxidants, vitamin D3 etc can be helpful. However, whether the medicines are actually helpful, is a matter of debate and it needs further research.
Conclusion
Al low AMH does not always mean that you cannot become mother. Most of the women conceive either spontaneously or by medicines or by IUI. Few of them require IVF. Donor-IVF is usually used as a last resort.
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