Tuesday, 27 August 2013

Overtreating patients

Overtreating patients

Overtreating patients with low AMH level is the common mistake

Infertility treatment is like a jigsaw puzzle where one incorrect placement could result in many pieces getting place incorrectly, and the reverse is equally true. That’s the reason we infertility experts appear very busy all the time. It is not easy to arrange jigsaw puzzles, really!

 Jokes apart, but it is a fact that multiple complexity and surfeit of parameters may lead to incorrect conclusion and improper diagnosis. Overdependence on the diagnostic tools and laboratory tests has also become one of the common factors in the modern medical science. Availability of multiple tests and affordability of the patients makes it very convenient for the doctors to go for unwanted or avoidable tests. Furthermore, the situation worsens when there is treatment planned on the basis of one-sided diagnosis.

Over treating patients with low AMH level, the classic example

It is not very long time when we heard about AMH or Anti-Mullerian Hormone test, the blood test to determine ovarian reserves.  Doctors advise the test to examine the number of eggs and their quality so that better treatment can be planned. Sounds very logical, isn’t it? However, it is actually the one side of the coin. The test is indeed useful in determining the level of ovarian reserves, reading results is the tricky part of it.

Friday, 23 August 2013

Why sperm count is as unreliable as the weather?

Why sperm count is as unreliable as the weather?

It is a well-known fact that predicting weather 100% accurately is not possible because of the multiple parameters associated with it. I would say the same thing with one of the major milestones of the infertility treatment, the sperm count test!

I open the sealed envelope from the bundle waiting for my attention. The first one is the semen test report of one of my patients. The couple is undergoing IVF cycle and this was required to determine the quality and quantity of the sperms. To my dismay, the count was incredibly low this time. This was the third test consecutively and the results were absolutely devastating.

It is one of the commonest experiences of us as infertility experts. Semen testing reports always leave us extremely puzzled. The degree of variation that is demonstrated by sperm count reports can be compared only with the share market index that goes up and down drastically with no apparent logic or rationale!

The variation is unbelievable

Tuesday, 20 August 2013

Why Estradiol test is required in a few cases?

Why Estradiol test is required in a few cases?

I read a lot of material on infertility treatment that is my core area and also on various other subjects. Very recently I read an article about the high dependency on various tests and diagnostic methods in the modern medical science. I suddenly realized that there is certainly a great reliance on these tools and we just can’t move forward a centimeter without it.

Undoubtedly most of the tests are required and patients sometimes get puzzled with the number of tests undertaken, especially in treatments that last longer like the infertility treatment.  Patients come to me fully prepared about the treatment by collecting information from all the possible sources.  A detailed interrogation is expected when some unusual or rare test is prescribed to them. I need to spend considerable time to explain the severity and the necessity of these tests!

Human reproductive system is like a game of trapeze in a circus where there is a need of absolute timing and perfection. There are many hormones that play important role in it and they come and phase out as and when required. We infertility experts are forced to keep a close surveillance on their entry and exit and the diagnostic tests are the only way out.

Estradiol test, the process with lesser occurrence

Sunday, 18 August 2013


Vaginismus, the strange face of infertility

It is quite incredible to be an infertility expert sometimes. As you go deeper and deeper there are new discoveries about the unknown facets of the infertility problem. Although many of these facets are very rare and sometimes never encountered in a long career as well, but they are quite strange and horrifying if they appear in front of us!

There are a few problems that we study in the books and journals and even experienced doctors also never get a chance to encounter that problem. Recently I handled a case that gave me an opportunity to handle a rare problem that causes infertility in females. The couple had got married two years back and there was a huge pressure from the parents and close relatives to expand the family. The real problem was known to the couple only and now they were sitting in my cabin seeking help for a very unusual problem, “Vaginismus”!

What is it?

This is a typical condition in women when there is  reflex action in the vaginal muscles while intercourse. The reflex action closes the vaginal opening so tightly that the penetration becomes impossible. In some cases, the penetration is possible, but it is extremely painful for the woman. You can understand the gravity of the problem now. It might sound ridiculous and strange, but unfortunately it is true.  Without penetration it is impossible to conceive and there is the actual problem!

Thursday, 15 August 2013

Sperm testing

Sperm testing

Sperm testing, the toughest challenge of infertility treatment

Do not get mistaken by the heading! I am not talking from the technical point of view. There are many other difficult things in the process of infertility treatment.  Sperm testing is one of the easier processes in the treatment of infertility and sperm testing, on the contrary is much easier. The challenging part of the sperm testing process is the male ego and as an infertility expert I need to put a lot of energy in it.

Why there is reluctance?

Well, actually there are multiple reasons behind it and we need to understand the male psychology behind it.

(a) It is humiliating: Most men consider it absolutely humiliating. They feel that sperm testing is a direct suspicion about their masculinity. They feel that if their sexual life is normal, then there is not at all a question on their ability.
(b) It is scary: It is very strange, but most of the males are not aware about the procedure of sperm testing. They feel it is a surgical process and could harm their masculinity. That is the reason they try to avoid it.
(c) It is unnecessary: In our country, still there is very less awareness about sex education and majority of people consider childbirth as a responsibility of a woman exclusively. Therefore, they never feel a need to get the sperm tested.  They feel that there is no need to get involved into it.
(d) It reveals the truth: For some men, it is a matter of utter disappointment and frustration to know about the low sperm count or weak mobility of the sperms. They try to hide the things under the carpet and therefore never agree to perform sperm testing. The poor quality of sperm is a direct hit on their masculinity and social image.
(e) It is stressful: Males have a natural tendency to avoid medical professionals and they feel extremely stressful and distressful to visit a doctor especially for the problems like semen testing.
How to deal with the situation?

Tuesday, 13 August 2013

Premature ejaculation

Premature ejaculation, the hidden cause of male infertility!

It was already 10PM in the night and it was nearly two hours I was waiting for the semen report of a couple undergoing treatment for infertility. I was suspecting male infertility in this case and therefore, told the male partner to undergo semen testing. I was almost sure about a report of less sperm count or mobility issues with the sperms. Finally, the report came and to my surprise, it was absolutely normal. I was in a state of utter confusion and dismay.

However, I called up the couple once again and had detailed counseling sessions and then revealed something that is perhaps the most hidden aspect of an infertility problem. It is premature ejaculation, one of the common causes of male infertility. The male partner in the above-mentioned couple was suffering from the problem of premature ejaculation. I analyzed the root cause and started the appropriate treatment. Very soon the couple departed from my room with a positive report of pregnancy!

What is premature ejaculation?

The process of ejaculation happens after a certain time of vaginal penetration or manual stimulation. It causes the release of sperms along with semen fluid in the form of a powerful jet spray so that the sperms go deeper in the vagina and start the journey of fertilization. Normally it takes one to two minutes for a man to ejaculate.

Sunday, 11 August 2013

Pelvic pain

Pelvic pain, the loyal companion of infertility

We can never generalize the symptoms of various problems that females face because every problem has a separate set of symptoms. It is not possible for an infertility expert like me to diagnose only on the basis of a few symptoms. It is compulsory to go for detailed examination to derive a conclusion. Infertility is a complex area and we need to look at every aspect of it before starting the treatment. People come with so many different problems, but one thing is always common among all, the pelvic pain!

Only those women who have experienced the immense sting and discomfort of the pelvic pain can tell about the severity. It is an unbearable pinch in the lower abdomen that just ruins the life completely if it remains untreated.

The faces of the monster

Pelvic pain shows its irritating presence in a wide variety of ways and the severity and intensity varies with the particular problem.

Thursday, 8 August 2013


Laparoscopy, the pathway to painless surgery through a hole

Being an infertility expert, the surgeries have become part of my life, but I still remember the childhood days when surgery was perhaps the biggest fear in the world for me. I had never imagined that one day I will be performing multiple surgeries almost daily.  Surgical process (or operation in the more familiar term is a fearful matter. The thought of getting incision makes us uncomfortable and in a few cases it becomes a phobia when the patient is not ready to undergo any type of surgery. Thankfully the medical science has advanced so much and there are options like laparoscopy available where patients can undergo surgery with minimum discomfort and pain!

When do I go for Laparoscopy?

Laparoscopy or Laparoscopic Surgery, also called as a keyhole surgery; is an operation performed by us to inspect the organs around the pelvic area, such as ovaries, fallopian tubes and uterus, etc. Sometimes I am not able to find the exact cause of the problem by regular inspection then, I go for laparoscopy. The process becomes greatly useful for us and we are able to diagnose many problems with the help of it.

Cists (Ovarian Cists) or Tumors
Ectopic Pregnancy
Pelvic Pains
Laparoscopic surgery is also used to do biopsy, to treat hernia or to take out or partial removal of some organs; such as ovaries, uterus, appendix and gallbladder, etc.

Tuesday, 6 August 2013

IVF: a journey of pleasurable ending through Painful injections

IVF:  a journey of pleasurable ending through Painful injections

What is the biggest cause of distress and anxiety while going through any of the medical procedures? If I ask this question in an open forum, then the most common is the fear of needles! Human beings have natural reluctance towards injection. Not because it hurts, but because you KNOW when it hurts! Nowadays technology and innovation in the field of medicines and medical sciences has come up with moderately painful. Still the fear associated with injections lingers in the mindset of almost all of us.

Being an infertility expert, I just can’t avoid this painful procedure. The process of IVF involves multiple occasions when I must insert painful injections in the body of my patient. I tell them to focus on the outcome rather than pain. It will give a sigh of relief because ultimately there is no gain without pain!

The painful experience of injections

As an IVF (In Vitro Fertilization) specialist pain is one of the most common worries I handle during the treatment.Almost every other patient has the same concern. While some would express it boldly, some would never let the fear come out. Every IVF patient knows that it is inevitable to have long course of injections during the IVF treatment. Though as a doctor I cannot avoid the injections, butsurely can try to make it the least painful.

Sunday, 4 August 2013

Is it something like “follicles but not eggs”?

Is it something like “follicles but not eggs”?

Treating infertility is certainly very interesting. When I treat people for different types of infertility problems some questions are the most probable to be asked by my patients. These questions are normally overheard during discussions with the peer group, friends and family members. Sometimes the questions are very much logical and relevant whereas sometimes they are absolutely vague and ridiculous. They are based on half-cooked information received from the others and usually baseless and irrelevant.  However, I try to answer the questions with complete explanation so that there are no confusion and doubts in the mind of the patients.

“Follicles but not eggs”, the most common asked doubt!

Couples always ask this question to me and now I have been accustomed to the question so much that it is really something unusual for me if the infertile couple does not ask about it. It is a common misconception that there are few cases where females suffer from a peculiar problem when they have follicles inside the body, but there are no eggs! The follicles are absolutely empty and that is the reason the IVF egg retrieval done by their infertility expert has yielded fewer eggs than expected. In my opinion, there is nothing more generalization of a problem than this and doctors should actually refrain from doing this. The patients can’t perceive the things from the doctor’s perspective and they look at it from a layman’s angle. Taking the words by their direct meaning can lead to serious misinterpretations.

The myth and the reality