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Dr. Richa Jhavar

MBBS, DGO

Gynaecologist, Bhopal

17 Years Experience  ·  0 at clinic
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Dr. Richa Jhavar MBBS, DGO Gynaecologist, Bhopal
17 Years Experience  ·  0 at clinic
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Personal Statement

Hello and thank you for visiting my Lybrate profile! I want to let you know that here at my office my staff and I will do our best to make you comfortable. I strongly believe in ethics; a......more
Hello and thank you for visiting my Lybrate profile! I want to let you know that here at my office my staff and I will do our best to make you comfortable. I strongly believe in ethics; as a health provider being ethical is not just a remembered value, but a strongly observed one.
More about Dr. Richa Jhavar
Dr. Richa Jhavar is a trusted Gynaecologist in Trilanga Road, Bhopal. Doctor has helped numerous patients in his/her 17 years of experience as a Gynaecologist. Doctor is a qualified MBBS, DGO . You can consult Dr. Richa Jhavar at Kanha Maternity & Child Care Hospital in Trilanga Road, Bhopal. Book an appointment online with Dr. Richa Jhavar and consult privately on Lybrate.com.

Find numerous Gynaecologists in India from the comfort of your home on Lybrate.com. You will find Gynaecologists with more than 41 years of experience on Lybrate.com. Find the best Gynaecologists online in Bhopal. View the profile of medical specialists and their reviews from other patients to make an informed decision.

Info

Education
MBBS - GMC Bhopal - 2000
DGO - Maharaja Yeshwantrao Hospital - Indore - 2002
Professional Memberships
Federation of Obstetrics and Gynaecological Societies of India (FOGSI)

Location

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Kanha Maternity & Child Care Hospital

# TH-17, Akash Ganga Colony, E-8, Shahpura, Trilanga Road Landmark : Near Makhan Lal Chaturvedi UniversityBhopal Get Directions
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I have itching in my genital area and red rashes I have applied many ointment they worked only short period besides I took cetrizine tab bot problem persist what should I do.

MD - Homeopathy, PGDMLS, Diploma in Naturopathy & Yogic Science (DNYS), NDDY, Bachelor of Homoeopathic Medicine & Surgery
Homeopath, Ghaziabad
I have itching in my genital area and red rashes I have applied many ointment they worked only short period besides I...
Dear lybrate-user Having a rash is a symptom and not a disease. You should note that any external malady expressed by your body is a result of the underlying internal cause. Rash is a condition of the skin wherein it becomes red, inflamed and itchy. The common causes of a rash could be- Due to contact with clothing (tight clothing, hard detergents used to wash) Allergies: in cases of contact with the allergen (specific). Disease conditions: Psoriasis, impetigo, eczema, STDs (genital herpes), etc. The line of treatment should be specific to your cause and individual constitution. It should include internal medicine with external application to provide with a complete and permanent cure. You should: Wear loose clothing (100% cotton). Apply neem based products on the rash to clear the toxins and keep the region hygienic. Keep your body hydrated. Trust this serves your introductory purpose. Please feel free to contact me. Revert back with your specific signs and symptoms such as pain, itching, odor, perspiration, color, location and any other concomitants for a more specific guide.
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Thumb Walking

Diploma in Acupuncture, Pranic Healing, MD - Acupuncture
Acupuncturist, Bangalore
Thumb Walking

Starting from top of the thumb press all points downwards and move towards the base of index finger. Move upwards by pressing all points till top and come towards base of index finger. Similarly press other fingers also. Also press all points in the palm. You can press with blunted edge of a pen. Do the same with other hand daily twice. The benefits are many. All sorts of pains go away. 

I along with my girlfriend is planning a 3 day trip. We will be having casual sex during these days. We are preferring I pill as the contraceptive. When do we have to consume it? Her period is on 4th day.

DGO, MBBS
Gynaecologist, Faridabad
if her cycles are reg u need not to use any cotraceptives in last 5days but on safer side u can use it on 3rd day however barrier method is safe
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I am 4 months pregnant and I am diagnosed wiyh low lying placenta. Please guide me with the precautions.

DGO, MBBS
Gynaecologist, Bhavnagar
I am 4 months pregnant and I am diagnosed wiyh low lying placenta. Please guide me with the precautions.
Whenever there is low lying placenta, it usually in most of the cases shifts upwards as time passes. But you have to check it by regular ultrasonography. Till then you have to take care. Don't do heavy work, avoid journey, if possible avoid climbing staircases. Low lying placenta can produce bleeding if not taken care of. It may vary in severity so best thing is to take care to avoid bleeding. If low lying placenta don't shift upwards till the 9th month of pregnancy, you have to undergo caeserian section because it may bleed very heavily in normal delivery to endenger ones life.
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Hi, I am 34 years old lady, last month my pregnancy test was positive and I took pregnancy termination medicines, my periods came in good flow for five days, After 10 days of periods I had unprotected sex with my partner but I took I Pill within 1 hour, now one month completed and my periods not come, Again I checked twice and test is positive, please advise shall I take medicines to terminate pregnancy again, or is this is issue with test strip due to some hormonal dis balance. Looking forward for your support.

Diploma in Family Medicine, M.Sc - Psychotherapy
Sexologist, Pune
Hi, I am 34 years old lady, last month my pregnancy test was positive and I took pregnancy termination medicines, my ...
Ms. Lybrate-user it seems to me you are really playing havoc with your hormones by taking random pills and using termination pills. Go to a sonography center and get your usg done to confirm whether or not you are pregnant. After confirmation consult your gynecologist for total evacuation. And after that, think of some regular contraceptive method instead of popping pills, cause those medicines will have lot of side effects.
1 person found this helpful
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Having mensuration problem. High bleeding and terrible stomach pain for 3 days from the date.

Bachelor of Ayurveda, Medicine and Surgery (BAMS)
Ayurveda, Noida
Having mensuration problem. High bleeding and terrible stomach pain for 3 days from the date.
It is due to harmonic changes and metabolic changes also. For this you may use the following ayurveda medicines. 1- laxamana loh. 1tab chandraprabha vati. 1tab maha yograj guggul. 4tabs twice daily with warm water after meals. 2- laxamanaristam 15ml twice daily with waterafter meals. For 3-6months regular. Follow regular routines of getting all dietary measures and daily behaviours as well as exercise and yoga every day. Use light diets and chapati with moong daal and green vegetables and dariya with green vegetables and moong daal soups fried with cumin seeds and ghee and garlic. Avoid avoid oily or junk food and dahi for your stresses and strain of menstruation.
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Bacterial Vaginosis - Understanding the Causes + Symptoms

MBBS, DGO, DNB (Obstetrics and Gynecology)
Gynaecologist, Chennai
Bacterial Vaginosis - Understanding the Causes + Symptoms

Bacterial vaginosis is an infection of the vagina that occurs due an imbalance of the vaginal bacteria. The naturally occurring bacteria in the vagina overgrow in number and this creates the imbalance. This disorder is very common among women, especially who are pregnant. This problem is usually not very serious and tends to go away in 4-5 days. However, in certain cases, they can cause serious complications:

The symptoms of bacterial vaginosis are:
1. You may experience vaginal discharge that is white or gray in color
2. You may have constant itching in your vagina
3. The vaginal discharge usually has a foul smelling odor
4. You may have a burning sensation while urinating.

Causes behind it:
Vaginal bacteria can be either good or bad. Any disruption in the delicate balance of the vaginal bacteria can lead to bacterial vaginosis. There is no exact known cause of this disorder, but it is believed that having multiple sex partners increases this risk. Other factors can be:

  • Douching: If you clean your vagina with water and other cleansing agents on a regular basis, then it may create bacterial imbalance, thus leading to this infection.
  • Multiple partners: Having multiple sex partners puts you at a higher risk of contracting bacterial vaginosis.

This disorder may also lead to various complications such as:

  • STIs: This infection may make you highly susceptible to various infections such as chlamydia, HIV and gonorrhea.
  • Disorders of the pelvic region: Bacterial vaginosis may lead to inflammation in the pelvic region, which in turn may lead to infertility.
  • Preterm birth: It increases the chance of premature birth.

There are certain preventive measures that you can adopt to prevent this condition:
1. Using soaps which contain no or very little chemicals
2. Use latex condoms during sexual intercourse to prevent sexually transmitted infections.
3. Don’t clean your vagina on a regular basis

If you wish to discuss any specific problem, you can consult a gynaecologist.

2555 people found this helpful

Hi last mnth I had my missed abortion on 21st march now this mnth I should hv my periods but till date I am not down. Wat should I do should I consult doc or wait for some more time? please suggest.

MBBS (Gold Medalist, Hons), MS (Obst and Gynae- Gold Medalist), DNB (Obst and Gynae), Fellow- Reproductive Endocrinology and Infertility (ACOG, USA), FIAOG
Gynaecologist, Kolkata
Hi last mnth I had my missed abortion on 21st march now this mnth I should hv my periods but till date I am not down....
After abortion oeriods may be delayed. First get urine pregnancy test done. If negative nothing to worry- if positive get usg donr.
1 person found this helpful
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Hello mam I am 4 weeks pregnant and my hcg is 555 in my blood test report as my doctor give me dhupston and car 3 iron tablet. As im gaining my weight till the time I take tablet and im suffering from constipation also. Please suggest me what to do. As my gyine told me your hcg report is not normal.

MBBS, MS - Obstetrics and Gynaecology
Gynaecologist, Delhi
Hello mam I am 4 weeks pregnant and my hcg is 555 in my blood test report as my doctor give me dhupston and car 3 iro...
Your hcg level is normal for 4 weeks pregnancy. Hcg level doubles in 48 hrs in early pregnancy Repeat your beta hcg test if level has doubled in 48 hrs pregnancy is normal.
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I had a sex with my bf on last month. While we were having a sex his condom get tear while having sex and the sperms came in me. But I immediately went to washroom and out the sperms from urine. While we were having sex it was my 4th day of my period. And after having sex I have taken I pill. So I want to ask you that am I pregnant or not. After 21 days I have done a test pregnancy test. It was negative. So I want to know that am I pregnant or not.

Fellowship in Minimal Access Surgery, MS - Obstetrics and Gynaecology, MBBS
Gynaecologist, Bangalore
I had a sex with my bf on last month. While we were having a sex his condom get tear while having sex and the sperms ...
Dear Lybrate user, If you have had sex on 4th da of period, chances of pregnancy are negligible. Moreover, you had taken I pill. So, the possibility of pregnancy is almost Nil.
2 people found this helpful
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Homeopathy for Osteoarthritis: Why is it a Good Option?

MD - Homeopathy, Masters Degree of Homoeopathy
Homeopath, Mumbai
Homeopathy for Osteoarthritis: Why is it a Good Option?

Osteoarthritis (OA) is a degenerative disease that affects the various bone and joints health, leading to painful movement and thereby limiting the patient's mobility.  Knees, hips, joints of hands and legs are affected.

Symptoms of OA

The symptoms revolve around the bones and joints including:

  1. Pain and stiffness of the joints
  2. Swelling of the joints
  3. Inability to form a clench
  4. Difficulty holding things 
  5. Stooped posture 
  6. Weakness of legs and hands
  7. Reduced height over time

Treatment options in allopathy are limited to nonsteroidal analgesics to control pain and in severe cases, surgical correction, in case of OA.  However, homeopathy takes into account the triggering symptoms, the associated symptoms, and the status of the immune system before deciding on a treatment regimen.

With this holistic approach, homeopathy achieve the following:

  1. Reduce the pain, swelling and stiffness
  2. Slows the pace of further degeneration
  3. Improves mobility of the affected joint(s)
  4. Improves the body's overall immune system, thereby allow the body to promote healing on its own
  5. Homeopathic intervention in the early phases is particularly helpful, as it will arrest disease progression
  6. It also enable better absorption of minerals and nutrients essential for bone health. This allows healing of existing bone fractures and avoids further bone damage by strengthening the bones
  7. Homeopathic treatment also enables the body's chemical state to withstand stress and illnesses better
  8. It vitalizes the body's natural healing and ability to repair itself, to create a better state of health and well-being

Some of the popular homeopathic medications based on areas and associated symptoms are listed below:

Knee joints:

  1. Bryonia Alba: Pain worsened with movement, relieved with rest; associated with swelling and stiffness of the joints; difficulty in climbing stairs.
  2. Calcarea Carbonica:  Swelling and pain that is worsened when getting up from a seated position. The joints feel cold and painful.
  3. Sulphur: Worse with climbing stairs, prolonged standing, feeling of warmth in the knees. 

Hip Joints:

  1. Colcynthis: Cramping pain improved by pressure.
  2. Rhus Toxicodendron: Pain when getting up from a seated position.
  3. Pulsatilla Nigricans: Associated with muscle stiffness and cramping.

Finger joints:

  1. Antimonium Crudum: The pain pain gets worse in cold weather, improved by applying something warm) 
  2. Benzoic Acid: There is an associated crackling sound when the fingers are moved or if there are nodes in the area of joints. . The urine is highly offensive in these people. 
  3. Calcara Fluorica:  There are stony hard nodes formed in the joint area, greatly reducing the mobility.

These medications are safe, completely natural, do not induce habit formation, and are approved by FDA.  They don't just treat the symptoms but help manage the patient as a whole.  This justifies why homeopathy is definitely a good option in treating osteoarthritis.

7216 people found this helpful

Hello. Mene suna hai ki agar ap recently pregnant hue hai to b periods aa jate hai. Kya ye aise hota hai ki pregnant ho to b periods ate hai?

CCEBDM, PG Diploma In Clinical cardiology, MBBS
General Physician, Ghaziabad
Hello. Mene suna hai ki agar ap recently pregnant hue hai to b periods aa jate hai. Kya ye aise hota hai ki pregnant ...
No. You can't have your menstrual period while you're pregnant. There may be vaginal bleeding ,/ spotting during first three months but this is not regular periods . periods will come only when u r not pregnant .
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I am 26 years married and pregnant. Its my 4 th month started today. I had sex with my husband is it fine or will it have some adverse effects. Kindly suggest. wait Ng for answer. Thanks in advance.

MBBS, DGO, FGO
Gynaecologist, Jalandhar
I am 26 years married and pregnant. Its my 4 th month started today. I had sex with my husband is it fine or will it ...
No, it is not having any adverse effect . In a normal ongoing pregnancy sex is not prohibited but it should not be too frequent and position should be such that penetration is not too deep
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I'm 29/years old. My last period was on March 30 th and till date I on may 9th I haven't received my periods. I have made pregnant test after 4 days of missed period it was negative. When can I take the test again.

MD - Alternate Medicine, PGDIP.IN GERIATRIC CARE, Post Graduate Diploma in Holistic Healthcare
Ayurveda, Balasore
I'm 29/years old. My last period was on March 30 th and till date I on may 9th I haven't received my periods. I have ...
Hi lybrate-user, hope you are worries about your pregnancy. Wait for minimum 15 days then have your hcg preg test by urine. You will be confirmed. As a slow progress of progestorone seen some cases which causes negative in test. Ok.
1 person found this helpful
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I delivered my baby on Thursday 7th April, my nipples got sore feeding the baby. Can you please suggest any remedy.

MBBS, MD
Pediatrician, Gurgaon
Nipcare cream to be applied on nipple few times a day. Even if child takes cream, it is not harmful.
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I recently under gone ectopic pregnancy removal and my left fallopian tube was removed since it's was ruptured. Is there any way to prevent in future. Please suggest some tips on how to take care going forward and what is the gap you suggest before I start planning to conceive. Also I would like to know if there will be less amount of eggs produced or will there be irregular cycle since only tube produces egg Thanks in advance.

BHMS
Homeopath, Mumbai
I recently under gone ectopic pregnancy removal and my left fallopian tube was removed since it's was ruptured. Is th...
Dear Lybrate user, eggs are produced by ovaries and transferred by fallopian tubes. keep a gap of 3months to recover your health. have healthy food and walk you will conceive soon as your other fallopian tube is healthy . although it reduces the chance.
2 people found this helpful
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Unbearable pain due to periods. Abdomen and thighs paining like hell. Any remedy?

MD - Homeopathy, BHMS
Homeopath, Vadodara
Unbearable pain due to periods. Abdomen and thighs paining like hell. Any remedy?
Yes homoeopathic medicines can be very effective in dysmenorrhea. But better consukt with more details... as that way the resukts are more sure... You may take homoeopathic medicine Abroma augusta q tds...
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IUI (Intrauterine Insemination)- Treatment Option for Infertile Couples

MBBS (Gold Medalist, Hons), MS (Obst and Gynae- Gold Medalist), DNB (Obst and Gynae), Fellow- Reproductive Endocrinology and Infertility (ACOG, USA), FIAOG
Gynaecologist, Kolkata
IUI (Intrauterine Insemination)- Treatment Option for Infertile Couples

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.  

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, it’s 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. It’s 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 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. It’s 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 husband’s 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

When IUI is generally advised?

As you can understand, to perform IUI, there must be minimum number of sperms in the semen, the tubes must be opened, the ovaries must be releasing eggs. If these are present, IUI is usually advised 

  • Less than adequate number of sperm counts, morphology or motility
  • Couples who cannot perform full penetrative intercourse but refuse or unable to conceive by IVI
  • Unexplained infertility- although IVF is better than IUI, but considering the cost, many couples in our country opt for 2-3 cycles of IUI before IVF
  • PCOS and Mild Endometriosis- where natural intercourse or ovulation induction failed
  • Couples in whom only one partner is positive for HIV or Hepatitis B or C- where transmission from one partner to another by unprotected sexual intercourse is not preferable.

What are the tests done before IUI?

The basic infertility evaluation is done before IUI include husband’s semen analysis, assessment of ovarian function (blood tests, ultrasound) and uterus (ultrasound). In some cases, laparoscopy (putting camera to see inside the abdomen by operation) or hysteroscopy (putting camera through vagina inside the uterus, by operation) may be required. Now, if the tubes are blocked, IUI is of no use. So, testing the tubes is advisable before IUI. But some women, who are at low risk of tubal disease (no history of pelvic pain, infection or surgery), one or two cycles of IUI can be done, failing which tubes must be checked by tests like HSG or SSG or in some cases by laparoscopy. 

What IUI actually involves?

In the cycle, in which IUI is planned, the woman is asked to take some medicines (or injections) in particular days of the periods as a part of “ovulation induction”. She is then advised to have ultrasound monitoring (TVS- transvaginal sonogram- where ultrasound probe is placed inside the vagina for better accuracy) to see if eggs are growing in response to the medicines or not. If eggs are growing, IUI is planned in a particular time when the egg(s) is more likely to rupture, so that the tie interval between sperm entry and egg release can be kept as minimum as possible. 

Is ovulation Induction necessary for IUI?

Frankly speaking, IUI can be done without any medicines (as in case of natural intercourse or IVI), which is called “Natural Cycle IUI”, where only TVS monitoring is done to see how the eggs are growing. This may avoid some side effects of ovulation induction (see below) but is associated with low success rate than IUI done along with ovulation induction.

Is TVS necessary before IUI?

TVS is, undoubtedly, uncomfortable for the woman. But it gives better picture than ultrasound done conventionally. Now, the question is, whether ultrasound monitoring is at all needed or not. TVS directs the doctor how eggs are growing and at what number and size and when they are likely to rupture. Moreover, the rupture can also be confirmed by TVS. Again, the uncommon side effect of ovulation induction can be detected by TVS. That is called OHSS (“Ovarian Hyperstimulation Syndrome”) where excessive eggs can grow inside the ovaries and this can lead to collection of fluid inside abdomen and lungs and can turn very serious. Although very rare, it can be detected by TVS and early actions can be taken to prevent the progress of this condition. 

In rare cases, where TVS cannot be done or patient declines, only option is to check urine by LH kit to predict the likely timing of ovulation and at that time IUI is planned. However, it is less accurate than TVS monitoring and is associated with less success.

What, if eggs are not growing in the ovaries?

In some women, particularly those who are overweight, aged or some cases of PCOS, eggs may not respond initially to one medicine. There are various forms of ovulation induction medicines (tablets, injection). If one is not working, your doctor can try increasing the dose of that medicine or add or replace it with other medicines. Please remember, it’s difficult to predict what medicine will be best suited for a particular patient. So, it’s basically a trial and error process.

What is done on the day of IUI?

As timing is important, the couples are requested to stick to the timing, advised by the doctor. The husband will be asked to collect the semen by masturbation, using clean technique (to avoid contamination by germs in the semen container). The semen is then prepared by the embryologist and will be checked to see the final number of sperms and their motility and morphology.

The wife is asked to lie down in the IUI table. After cleaning, a sterile speculum (instruments to separate walls of the vagina to see the cervix) is introduced inside the vagina and then 0.4-0.6 ml of the prepared semen is inserted inside the uterus with the help of a small catheter (fine tube). IUI done, under ultrasound guidance, gives better result than IUI done without it. The patient is asked to lie down few minutes after taking out the catheter and the speculum. The medicines are advised and then they can go home.  

Is IUI painful?

Most women feel little discomfort during IUI but it should not be painful. If there is technical difficulty while putting catheter inside the uterus, your doctor will discuss it with you and in the next cycle, will plan management to solve this issue.

What happens if husband 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. Some medicines can help. But in those, who are unable to masturbate, there are some instruments, like ejaculator, can help to solve this problem.

What happens if sperm count is low?

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.

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, it’s only given after discussion and written consent by the couple. 

Can a couple have intercourse in the cycle where IUI is advised?

Intercourse around IUI increases the number of sperms available at the time of ovulation.

When should one check for pregnancy?

Usually if period does not come within 18 days after IUI, pregnancy test is advised. It can be done at home. If negative, then the cause of not having periods is sorted out.

What is the chance of success after IUI?

In one cycle, chance of success is around 20-25%. Most of the couples conceive after 3rd or 4th cycle of IUI. The chance of pregnancy after 6th cycle is low, so, usually IUI beyond 6 cycles is not advised.

The factors where IUI gives better results include unexplained infertility, sexual dysfunction of any of the partner, PCOS and male subfertility (low sperm count or motility)

What happens if IUI fails?

As said earlier, you should think about further treatment, if 3rd or 4th cycle of IUI fails. There is no use of doing IUI beyond 6 cycles, unless natural intercourse is not possible and the age is favourable. IVF gives better result. 

Is there any harmful effect of IUI?

Very few harmful effects have been noted, for examples, hazards of ovulation induction (OHSS< twin pregnancy), pain, infection and discomfort. As mentined, if raw semen is given, unusual allergic reaction can happen.

How IUI is being done in your particular centre by Dr Sujoy Dasgupta?

We believe in patient’s 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.

After thorough evaluation of both the partners, we plan for ovulation induction drugs, with consent from them and advise them to come for TVS. After each day TVS, we explain the progress and probable timing of IUI.

On the day of IUI, after requesting the couple to maintain punctuality, we advise the husband to collect semen, in comfortable atmosphere, maintaining the privacy. If there is problem in semen collection, we provide support to him and address his issues in sensitive way.

Our expert trained embryologist then prepares the semen. We always encourage the couples to see the condition of raw and prepared semen under microscope to maintain the transparency. 

We advise the woman to fill up the bladder (to take water and not to urinate) to facilitate the passage of IUI catheter. Unlike other places, we perform IUI inside OT to prevent unwanted infection. 

Again we maintain our uniqueness in the sense that we perform it under ultrasound guidance. The ultrasound guidance has been scientifically proved to increase the success rate of IUI. Moreover, we show the woman in the ultrasound (real time) how the catheter has been put inside the uterus (to make sure that we are not doing IVI or have placed it in wrong position). This also helps to reduce patient’s anxiety and uncertainty. After that, our nurse takes care of the patient and observes her when she takes rest. 

Then we advise the post-IUI medicines and advise them what to expect and when they can go home. Again, this time we try to answer all questions the couples can ask.

 

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, it’s 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. It’s 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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