Wednesday, 31 July 2013

Chocolate Cysts

Chocolate Cysts, treating the bitter problem at IFC

I do not know what is the rationale behind naming endometriosis as “chocolate cyst”? Perhaps it is because of the dark brown color of the old blood that appears exactly like chocolate during the ultrasound test.  It is quite disgusting that the word like chocolate that produces absolutely happy feeling to the females is used to describe the most annoying and problematic disease that becomes the major cause for female infertility.

The diagnosis

I recognize the presence of nasty cysts during the ultrasound examination, but they can be quite confusing and decisive. There is a detailed investigation if I suspect the minutest possibility of chocolate cyst in the ovaries.

Sunday, 28 July 2013

Celebrity and IVF

Celebrity and IVF, a welcome relationship

It isn’t a long time when the turmoil of discussions and controversies about surrogate pregnancy of Amir Khan or Farah Khan got settled, yet another Khan (Shahrukh)  triggered it recently with the news of the expected arrival of his third baby in the coming July. Well, why there is all of a sudden so much craze about IVF and Surrogacy in the celebrities? As a matter of fact it may be a modern trend in Bolywood, but it has been prevailing from a long time in Hollywood and the other countries.

As an infertility expert, I perceive it as a good sign. We all know that celebrities govern the mindset and when they endorse something, there is a wide acceptance.  It would surely spread a positive wave across the society about the surrogacy and IVF. In spite of increasing awareness towards various aspects of infertility and childbirth, there is still a taboo about the ways we treat it.

How celebrities help it?

We know that the glamour world is the most uncertain and deceptive world. There is an absolute darkness behind the bright spotlight. Still, there is a tremendous craze about it in the common people. There is a great fascination to adopt everything from them, right from the hair style to the lifestyle. When we see our role models taking the bold steps like going for surrogacy and egg donation, there is a wide acceptance of it in the society.  There is a change in the perception and I think it is great

Thursday, 25 July 2013

Are there any symptoms after embryo transfer?

Are there any symptoms after embryo transfer?

If someone asks me about the phase when there is the utmost anxiety and uncertainty during the infertility treatment, then I would promptly vouch for the phase when embryo plantation has been done and the couple is eagerly waiting for the pregnancy test. The touch time has been over, I have worked hard along with the infertile couple, the moments of agony and pain are now a history and there is an expectation of a new dawn! However, it is not as simple as it seems. The duration of 15 days between the embryo transfer and pregnancy test offers the most challenging time with a roller-coaster of emotions for the couple, especially for the mother. The father is busy in his daily routine and I am busy with the other patients waiting for their turn.

The lady goes in the state of utter confusion and dismay. She tries to seek help from the experienced ones, goes through the books and articles, Google the information and become part of the online support groups and forums. All these in vain due to the mutually contradictory information she gets.

The most commonly seen symptoms

When I implant the embryo after the fertilization and technically speaking it is no different from the normal pregnancy.  Therefore, the symptoms should also be the same. There is no doubt that the final confirmation will be done only when you go for the pregnancy test. However, there are a few signals that are very common after the embryo transfer.

Tuesday, 23 July 2013


Anejaculation, the ejaculation disability!

In my opinion male infertility has more complex and strange dimensions as compared to female infertility. Strangely, the male sexual anatomy is much simpler and easy to understand. There is no complex structure, no critical balance (or imbalance) of sexual hormones and no menstrual cycle. Still, the infertility aspect is certainly very complicated.

Couples visit infertility experts when they feel they are unable to conceive. We treat them according to the symptoms and suggest the best methods after analyzing the case completely. Sometimes, there is no option other than going for ART (Assisted Reproductive Techniques) where we collect the sperm from the male partner and the egg from the female partner. Fertilization process may happen in the laboratory or in the uterus itself, and there is successful conception!

Sounds great, isn’t it? But, the situation is not that simple and straightforward always! There are a few cases of infertility where the male partner is suffered from such a problem that he can’t ejaculate at all! You can imagine that in absence of ejaculation, he will not be able to contribute by giving sperms for fertilization process. Te problem is known as Anejaculation, typically called as the inability to ejaculate.

5 facts about Anejaculation!

It is fairly uncommon problem and infertility experts hardly encounter with it. Also, it is not very easy and straightforward to diagnose.
This problem is sometimes misunderstood with erectile dysfunction. Although in this case the male is able to arouse, get an orgasm. The only thing is he can’t discharge semen.  In case of erectile dysfunction, there will not be sexual arousal at all.
The problem needs to be explained by the patient explicitly, otherwise the doctors will not be able to diagnose it.
The symptoms of Anejaculation and Retrograde Ejaculation are similar, but in the later case semen does get discharged and goes backward to the urinary bladder. In case of Anejaculation it does not come out at all.
It is extremely impossible to collect the semen sample for diagnosis or sperm donation and we need to collect it directly from the testicles.
The treatment

Well, there is no treatment for this problem and we treat the patient on the basis of symptoms. There are a few patients with situational Anejaculation where they are unable to ejaculate because of surrounding environment. Providing them supporting condition may lead to successful ejaculation. For a few patients we use vibrator or electrical stimulator to achieve ejaculation.

There are some cases where no ejaculation happens at all even after prescribing strong stimulating pills. We collect the semen sample directly from the testicles or the epididymis and use for the fertilization process.

AMH test

AMH test, a method to pinpoint the chances of pregnancy

The paper flattered slightly due to the mild flow of air through the air-conditioner and the slight sound broke the silence in the room. It was the test report of one of my patients trying hard to get conceived. I suggested her getting AMH test as the last resort and the bitter truth was revealed by the report. She was very disappointed and disturbed to know the strange fact that she had actually “ruined” her ovarian reserve of eggs. The result was equally shocking for me because the female was running in early thirties and there were brighter chances of getting pregnant through ART methods!

What is ovarian reserve?

Every woman gets a fixed quota of eggs and the number is decided when she is in the womb of her mother. Sounds very strange, but it is absolutely true! Unfortunately there were no methods available earlier to find it out resulting in many attempts of natural and assisted efforts of pregnancy yielding nothing. The modern science has changed the scenario and there are tests like AMH available to determine the exact chances of a woman getting pregnant.

How does AMH help?

AMH or Anti-Mullerian HormoneTest is a special test performed on the blood sample collected from the patient. The test measures the level of AMH hormone in the blood that directly corresponds to the number of eggs available in the ovaries. It is typically called an “ovarian reserve” and has a definite correlation with the age. However, there can be large variations in the number of eggs left in the ovaries of different females irrespective of the other factors like age, physique and health condition being the same. It is absolutely individualistic factor. Factors like heredity, history of radio therapy and chemotherapy may drop the ovarian reserve drastically.

AMH certainly helps my patients to plan for pregnancy and most importantly it sets the expectation just right. A good ovarian reserve indicates brighter chances of pregnancy and we both start working enthusiastically towards achieving it.

AMH is really effective!

AMH has surely come as a great tool. There were methods available in the earlier times, but the validity and reliability of the result was always a big question mark. AMH gives a much clearer picture and we can decide the plan of action in a more precise manner. Experts appreciate the test because of the fact that it gives a definite idea about the probability of getting pregnant and women can be made well-aware about the fertility status much accurately. In a few cases, it is an eye opener for the patient and me because it gives us a clear indication to speed-up the efforts in case the patient is “about to finish” the quota of egg reserve.

AMH has become a true friend of infertility experts because it helps in setting the correct path of action. It is indeed a precious piece of information and there are certain benefits of it. Even if it shatters the dreams of a couple trying hard to conceive, it is better to know the bitter truth early and seek the other alternatives instead of wasting time in the fruitless efforts.

Thursday, 11 July 2013

Amenorrhea, the absence of menstrual

Amenorrhea, the absence of menstrual

There are various aspects of human reproduction system and some of them occur very rarely. As an infertility expert, I get a chance to encounter a wide variety of problems. It is essential to continuously study the vivid topics related to infertility and human reproduction, undoubtedly a practical scenario throws much light on the subject.
The recent example of a couple provided a brilliant chance for me to study an unusual problem that occurs in the females. The lady was complaining about absence of periods and suspecting pregnancy. I performed the pregnancy test and the result was negative. Further diagnosis revealed the presence of something else, Amenorrhea!

What is it?

You might get confused when you hear about it for the first time from the infertility expert. We know that females start menstrual periods as they achieve puberty. The cycle is continued for many years until she achieves another milestone in the life, the menopause! If a female experiences absence of three or more consecutive menstrual cycles at any phase other than pregnancy during this period, then technically it is termed as Amenorrhea. I would say it is certainly a rare phenomenon and that’s why you will not even hear about it in the normal scenario.
There are two types of Amenorrhea exist:

Primary Amenorrhea: Usually girls experience the first menstrual cycle between 13 to 16 years of age. If menstrual cycle does not start in a girl even if she reaches to the age of 16, we call it a Primary Amenorrhea.

Secondary Amenorrhea: If the menstrual cycle starts in the appropriate age, continues for a few years and then stops intermittently without a pregnancy, then we term the problem as Secondary Amenorrhea. It is required that there is a gap of three or more months in a row.

What is the root cause?

Well, the reasons are different in case of primary and secondary Amenorrhea.
The primary Amenorrhea causes due to failure of female reproductive organs like the ovaries, problem on the nervous system or problem in the pituitary gland that is responsible for secretion of hormones that help in triggering menstruation.
The secondary Amenorrhea can be triggered due to malnutrition, stress, problems in thyroid gland, depression, etc. Typically breast feeding mothers also experience it after starting the menstrual cycle. This happens because of hormonal imbalance. In a few cases family history, eating disorders and rigorous physical training has also been observed as the root cause behind this problem.

The symptoms and treatment

The primary symptom of Amenorrhea is obviously the absence of menstrual cycle, there can be many other symptoms like severe headache, loss of hair, heaviness in the voice and secretion from the breasts can be observed. Some of these symptoms are often misunderstood as the symptoms of pregnancy and the absence of periods adds to the confusion.
Treatment of Amenorrhea lasts for some time and apart from the hormonal treatment, I advice lifestyle changes to the couple and lowering the calorie intake, stopping rigorous exercise, reducing stress level and stopping the medicines that contain steroids. This will certainly help in bringing back the hormonal imbalance and triggering the menstrual cycle!

Tuesday, 9 July 2013

Excess Weight during Pregnancy

Excess Weight during Pregnancy

When you are expecting, you get to eat as many inflatable donuts and Chips as you want, right? Wrong! You only need about 300 extra calorie consumption a day during maternity to support your child's growth. So you do not need to be chowing down everything in sight!

Be cautious about the quantity of pounds you obtain during your maternity. Getting too much or too little pounds can be dangerous to you and your child.

Is gaining the right quantity of pounds essential during pregnancy?You bet. It's essential to obtain the right quantity of pounds for your system. Doing so can help secure the wellness of your child. In comparison to females who obtain a proper and balanced quantity of pounds during pregnancy:Ladies who obtain too little are more likely to have a child with low birthweight (less than 5 pounds, 8 ounces), Ladies who obtain too much are more likely to have a large child or an early child. An early child is created too early, before 37 finished several weeks of maternity. These mothers also may also have wellness issues, like diabetic issues and hypertension. These circumstances can cause problems during maternity.

How much pounds should you obtain during pregnancy?

Monday, 8 July 2013

Fragmented DNA, yet another fragment of male infertility

Fragmented DNA, yet another fragment of male infertility

It is certainly very sad, but true that females are considered responsible for the infertility problem and surprisingly the misconception is not limited to our country only. When I get couples across the globe in my infertility clinic, almost 90% of the people are unknown about something like “male infertility”. Thanks to the awareness in the generation next, at least 10% of the couples know that there could be problem in the male partner too!

What is the reason for this pathetic situation? Undoubtedly it is directly associated with the age old concepts of so-called “male superiority” that says a male can reproduce at any age and there are no limitations of health and psychological factors. Although the research and finding of the modern science has debunked the theory, but there are still the majority of people believe on it.

The fact and figures
When I take a new case of infertility, the first thing that I do is counseling and convincing session with the couple to make them believe that there could be a problem in the male partner. They get stunned when I present the statistical findings in front of them that say 30% of the infertility problems are caused by male infertility and interestingly this is exactly same as their counterparts. The information comes out as a blow!

It is a fact that we infertility experts are much comfortable and relaxed while treating the female infertility because there are clear indications of problems and symptoms. The diagnostics can be absolutely pinpointed and the couple can expect a successful pregnancy.  On the other hand, a male infertilityis very complex and difficult to treat.

Does the gynaecologist have a good reputation?

How to choose your gynaecologist?
Visiting a gynaecologist should be a part of every woman's medical routine. Finding the right gynaecologist may take some time, but it's worth doing your research and choosing someone you feel comfortable with. After all, your gynaecologist will be the one helping you through your pregnancy and delivery so it is important to feel that you can speak to him or her freely. Here are a few tips to help you make your choice:

Does the gynaecologist have a good reputation?
There is nothing wrong in being particular about your standards when it comes to your gynaecologist. After all, your gynaecologist is privy to some of the most intimate facets of your sexuality, body and overall health. Start with the website of the hospital he or she is affiliated to. This should tell you about the doctor's medical credentials and for how long they have been practising. It may highlight their particular areas of interest or experience as well. See if the gynaecologist is also an obstetrician. If she isn't you will need to see a different doctor at the time of your delivery because only obstetricians are qualified to deliver babies.

You can also ask around among your friends, family, colleagues or your own general physician. You are bound to find someone who goes to that particular gynaecologist and if not, you will probably hear of a good gynaecologist you might want to consider.

What should I ask the gynaecologist?
When you go for your first "introductory" appointment, you may want to ask yourself the following questions:

• Does the gynaecologist answer your questions willingly and accurately?
• Is she friendly and responsive?
• Do you feel comfortable asking her personal medical questions?
• Does she seem up to date?
• Is she listening to your concerns and answering accordingly?
• Is she gentle during her check-up?
• Does she seem to care about your comfort?

If you don't feel a rapport building with this doctor, try another one.

How easy is it to meet the gynaecologist?
Good doctors are always busy, but you don't want a doctor who always seems too busy to take her time with you or to speak to you. Most doctors are willing to give you their cell phone number or email addresses. Find out how this gynaecologist deals with emergency calls. Ask how quickly she aims to get back to people with non emergency queries. Check out how long you would usually have to wait for routine appointments, and how quickly you could be seen if you were unwell.

How far is the gynaecologist from your home?
Think about the distance you need to travel for your appointments with your gynaecologist. Do you want one close to home or would it be easier to visit someone close to your work? Think about how you will get there. If you need to use public transport check out how easy it will be. If you are pregnant or thinking of starting a family, you might find it easier to have a doctor closer to home since you will be going for more frequent check-ups.

Do you prefer a female gynaecologist?
Many women prefer female gynaecologists. But keep an open mind: you may also find a male gynaecologist who is understanding and helpful. Make your decision after you have had a chance to speak with several doctors.

How do you feel about the gynaecologist?
There is a reason that a women's intuition is so revered, it is often right! So do your researches, check background information, schedule an appointment and meet the gynaecologist, but in the end trust your gut.

Often family members have a common gynaecologist because it is easier to see someone known, tried and tested than to look for a new doctor. Do not feel bad about wanting someone else if for some reason you are not comfortable with the gynaecologists that your other family members have been happy with. It is about your health and your body so you have to be satisfied.

Friday, 5 July 2013

Never let the hopes of baby get ruined because of PCOS

Never let the hopes of baby get ruined because of PCOS

The couple sat in front of me with a saddened face after spending a few years of traumatic waiting time for a successful pregnancy. Initial diagnosis indicated some other problem and I was suspecting the nasty disease that is the root cause of infertility problem in a large number of cases. Polycystic Ovarian Syndrome or PCOS contributes more than 10% cases of infertility across the globe and it is perhaps the most challenging problem in front of us as infertility experts.

My initial suspicion got confirmed subsequently and there was a series of investigations and treatment continued for a long time. The efforts of the patient and our team got a big success with a full-term pregnancy and cute baby to fulfill dreams of the deprived couple!

Symptoms of PCOS

Strangely, PCOS has multiple symptoms and a few of them are really very confusing. It is not possible for me to conclude the disease as PCOS on the basis of symptoms, unless I go through a series of detailed investigation. Patients come with a wide variety of symptoms including

• Irregular or infrequent menstrual cycle with an interval of more than 35 days
• Irregular bleeding
• Highly increased weight or obesity
• Increased levels of male hormones in the body
• Acne, dandruff and oily skin
• Patching of skin

We use precise diagnostic methods to conclude the problem of PCOS before starting the treatment. Irregular menses give a clear indication of PCOS and I check precisely for the interval of 35 days and the count starts from the first day of the bleeding to the day just before the bleeding of next month. The other method of calculating number of cycles in one year is also equally effective. It is little bit alarming if the number of cycles is less than eight in a year.
The treatment

Once I narrow down to the problem of PCOS, the next challenging part starts to treat it. PCOS is a multi-faceted problem and the treatment also needs to be quite comprehensive.

While I prefer oral contraceptive to regulate the menses because they are safe, easy and very effective, many experts go for the other tests like TSH to measure the Thyroid hormone level and also prolactin level first. There are cases where drugs are given to induce menstrual cycle as well, if they are missing at all.

It is further important for me to conclude that the problem is due to PCOS and not because of any other thing line ovarian failure. There are clear symptoms of these problems like very low level of estrogen and no bleeding. PCOS would typically raise the estrogen level.

Thursday, 4 July 2013

Gain Bodyweight Securely During Your Pregnancy

Gain Bodyweight Securely During Your Pregnancy

Eating a proper and a healthy eating plan will help your child get the nutritional value he or she needs and grow at a proper rate. But how much additional calorie consumption do you really need?

Though you do need some additional calorie consumption, it's not necessary to ''eat for two.'' The common expectant mother needs only about 300 healthy calorie consumption more a day than she did before she was anticipating. This will help her obtain the right quantity of bodyweight during maternity.

Ask your physician how much bodyweight you should obtain. A woman who was regular bodyweight before getting anticipating should gain 25 to 35 pounds after becoming pregnant. Healthy females should gain 28 to 40 pounds. And obese females may need to gain only 15 to 25 pounds during maternity.

In general, you should obtain about 2 to 4 pounds during the first three weeks you're pregnant and 1 lb per weeks time during the rest of your maternity. If you are anticipating twin infants you should obtain 35 to 45 pounds during your maternity. This would be a typical of 1 ½ lb weekly after the regular excess bodyweight in the first three weeks.

Wednesday, 3 July 2013

Celiac illness may be connected to infertility

Celiac illness may be connected to infertility

For partners who are struggling to get pregnant, discovering the underlying cause of infertility can be a long and annoying process. Previously, infertilityissues were considered a female problem, but today's analysis has shown the causes are pretty equally split with one third being female reproduction issues, one third male reproduction issues and the rest are issues related to both the partners.

Celiac disease

Celiac illness is a condition where the coating of the little bowel becomes broken due to wheat understanding. The fine coating or villi in the little bowel is accountable for taking in vital nutrients from the food you eat, and when they become broken it can cause a wide range of medical conditions including rashes, IBS, lack of nutrition and much more. It may be difficult to imagine that celiac illness could have any regards to infertility, but some analysis is beginning to point in that direction.

Over the last ten years, scientists from around the globe have been looking at the possibilities of a celiac link to mysterious infertility issues. What scientists have discovered may provide viable solutions for many partners being affected by infertility. In Chicago physicians discovered the number of repeated natural abortion was four times greater among celiac sufferers. Thanks to these outcomes, physicians now regularly screen for celiac illness in sufferers struggling mysterious infertility.

Tuesday, 2 July 2013

Chromosomal abnormalities, the miscarriage menace

Chromosomal abnormalities, the miscarriage menace

There is no doubt that my work as an infertility expert is extremely tiring and exhausting. The question is why I am doing it then? The answer is very simple; it gives an immense sense of gratitude and satisfaction as I reach to a happy ending by handing over a cute baby to my patient. However, not all stories are so unfortunate to have such a fine conclusion. There are many slips between the cup and the lips where miscarriage or abortion or abnormal termination of pregnancy what we call it in the technical jargon halts the journey of pregnancy in between. The process of pregnancy is extremely complicated and there are multiple permutations and combinations for miscarriages. Chromosomal abnormalities are the nasty cause where exact reason and treatment is very difficult.

The “why”

Well, it is a speechless moment for me when a disappointed couple asks the same question after a devastating abortion. They have really worked hard and tried their level best to sustain the pregnancy. However, all the dreams shatter one fine morning when miscarriage leaves them in a state of utter disappointment. Frankly speaking chromosomal abnormalities are caused by unknown reasons where the immune system of the mother considers the fetus as a foreign element and “cleans it up” as a normal procedure. There is a theory that says the fetus reaches up to a certain level and then there are particular genetic abnormalities that stop the growth. Sometimes there are a few missing genes or a few unwanted extra genes get developed causing interruption in the growth of the placenta. It ultimately results in miscarriages happens.

The “what”

Interruption in the cell division is the fundamental thing that happens in the miscarriage caused by chromosomal issues. Chromosomal abnormalities share a large percentage in the overall number of miscarriages and statistically around 40 to 47 percent cases are contributed by this factor. Division of cells is extremely complicated process and there are numerous factors that can go incorrect. The numbers of chromosomes go imbalanced and there is no further growth of the fetus.

The “How”

Undoubtedly there is no specific treatment for Chromosomal Abnormalities that cause abortion, but there are surely precaution measures that can help in analyzing and reducing the probability of miscarriage caused by chromosomal abnormalities. Whenever I suspect the slightest chance of such abnormality, there are a few techniques that can help in testing it effectively. Tracing of the genetic makeup is traced with advanced techniques. It is a really frustrating thing for me to do these tests after the miscarriage already happens.

a) Chromosomal testing of the fetal tissues: Although it is a post-facto test, but I prefer it to prevent reoccurrence of miscarriage. I check the genetic pattern of the fetus and try to analyze what exactly caused the termination.

b) Karotyping test: It is a special test for the analysis of chromosomal pattern in the blood. The genetic pattern of the parents is matched with the genetic pattern of the fetus to understand the genetic makeup.

Monday, 1 July 2013

The latest miracle in infertility treatment!

Select CCS, the latest miracle in infertility treatment!

It has been a long time I am handling various aspects of infertility and still I feel there are hundreds of things that are still mystery. We have been successful in helping thousands of childless couples to enjoy the sweetest moment of life that is parenthood and there have been magnificent breakthroughs in this field. However, there are so many things that come as great obstacles in front of us.

The “broken” egg that breaks the expectation!

There are various aspects of female infertility and certainly one of the most complex one is the quality of the egg in a female. Remember that it plays a phenomenal role in the pregnancy and any sort of abnormality can either make the conception impossible, or there may be problems in the normal growth of the fetus.

The quality of the female egg determines the quality of the embryo. Unfortunately until very recent times, there was no guaranteed method available to distinguish and determine a healthy egg. Although we use many other methods to reach to the highest accuracy level, there are still possibilities of errors. The embryos are judged from the external appearance and although the assumption is correct usually, but we were not sure absolutely!

It is certainly incredible that it is possible to even select the best sperm from a lot of millions to ensure successful pregnancy, but it is not possible to select the “really” healthy egg. There are tools like genetic tests or checking the ovarian reserves are available to do the health check, but with limited accuracy!

The latest breakthrough

It was really the great day for me when I heard recently about the latest breakthrough in the field of female infertility treatment. It will surely help us in determining the health of the female embryo with the highest level of accuracy.

According to the authentic information there has been a new technique developed named as SelectCCS or Select Comprehensive Chromosome Screening. The method is based on the screening of chromosomes in an egg.

Chromosomes play the fundamental role in the quality of embryo and most interestingly, screening of these chromosomes would significantly determine about the embryo health. Typically a Euploid embryo is made up of 46 chromosomes in the group of two and the Aneuploid embryo will have abnormal number of chromosomes.

How SelectCCS is performed?

It is a special technique used by us to screen the embryo at the molecular level. This technique gives the exact information to us so that we can analyze and decide the health status. The method is very accurate and helps especially those females who experience multiple miscarriages. Maximum times these miscarriages are contributed by the improper quality of embryo.
The advantage

SelectCCS procedure not only tells the exact health of embryo, we infertility experts can decide to go for single embryo plantation. It avoids the unwanted complication of twin or triplet pregnancies. Single Embryo Transfer or SET can be used to ensure healthy and successful pregnancy. There is tremendous improvement in the success ratio and safety level of the IVF cycle.

It has surely come as the biggest relief to my female patients who have crossed 35 years of age or who have undergone multiple IVF cycles. IT is certainly going to answer all questions and queries of such couples!