Institute of Reproductive Medicine - MadrasMedical Mission Hospital

There are many reasons leading to infertility, but one of the main causes is the inability of the sperm to travel all the way up to the uterus to fertilize an egg. This is caused by defective sperms and could be due to poor sperm quality, poor motility, etc. There are multiple reasons for this, and even smoking, obesity, diabetes, hypertension, etc. could be reasons.

Many technical advancements in fertility treatments are being done, and they try to keep the natural process of fertilization intact, at the same time improving the chances of success. Intracytoplasmic sperm injection (ICSI, often used as a standalone term iksee) improves the rate of fertilization in that the sperm is directly injected into the egg. The environment of this artificial fertilization is completely controlled, and the fertilized egg is then placed into the womb for further growth. It is one of the recent methods of improving fertility, a part of ART (assisted reproductive technology).

Indications:

1. Poor sperm perms motility
2. Semen where sperm concentration is low
3. Male infertility with unidentifiable cause
4. Poor sperm quality, with sluggish sperms
5. Ejaculation issues, such as retrograde ejaculation (semen is ejected into the bladder)
6. Useful in couples who have failed IVF
7. Low AMP reserve
8. Low egg quality
9. Tubal blockage

What to expect? 

The following outlines some of the steps for both male and female before and during the procedure.

Before the procedure - males:

1. The first step is the sperm collection; a screening is first done
2. Sperms collection happens through either masturbation or directly from the testicles via a small incision
3. Sperms could be collected fresh or collected and frozen for later use

Before the procedure – women:

1. In the normal menstrual cycle, only a single egg is released. However, prior to ICSI, the woman is given ovulation drugs, which are high-dose hormone injections prior to ovulation. This ensures multiple eggs are released, which are then retrieved for fertilization in the external environment.
2. Blood and urine are monitored regularly to identify the ovulation time, and eggs are collected within 24 to 36 hours of release

In Vitro Fertilization (IVF) Treatment 
The process of IVF (In Vitro Fertilization) is a laboratory procedure where the egg is fertilized with the sperm in a laboratory dish and is implanted into the woman’s uterus. Intra Cytoplasmic Sperm Injection (ICSI) Intra Cytoplasmic Sperm Injection (ICSI) is an assisted reproductive technique wherein a single sperm is injected into the cytoplasm of the oocyte with the help of special micro-manipulators.

While alcohol and drug addiction are commonplace, sexual addiction is also a real problem. This addiction can affect men and women. In many cases, this type of addiction lasts for months before it is diagnosed. A sex addict is a person who uses casual sex to relieve anxiety, tension, feelings of loneliness etc. In some cases, people can get so obsessed with sexual activities and thoughts that it affects their day to day life. This addiction can involve activities that are considered normal and healthy or be focused on activities that are socially frowned upon. It can manifest itself in the form of one night stands, engaging with prostitutes, watching porn excessively etc. Thankfully, as with any other kind of addiction, sexual addiction can be treated.

It is not easy to diagnose a sex addict as this form of addiction has many stages. Some of the symptoms a sex addict professional looks out for are:

1. Intense sexual urges.

2. Abnormal sexual activities.

3. Difficulty connecting with people emotionally.

4. The use of sex as an escape from uncomfortable situations etc.

5. Irresponsible sexual behaviour.

Hence, the first step to coping with sexual addiction is for the patient to visit a doctor and accept that he or she has a problem. Many addicts do not realise they have a problem and lie to both themselves and their partners about the addiction. For example, most sexual addicts tell themselves that they watch porn only occasionally and that is simply harmless fun.

Once diagnosed, an addict needs positive motivation. Humiliation or looking down on the person because of his or her habits may worsen the situation instead of helping the person. Overcoming an addiction to pornography, voyeurism, phone sex, compulsive masturbation etc require intense effort and for this the person needs to feel that the people around him support him.

The patient and his loved ones also need to recognise the symptoms of the addiction. For example, if a person tends to watch pornography at night, he needs to ensure that he is occupied with something else until the urge to watch it goes away. In achieving this he may need the help of the people he lives with.

In some cases, psychotherapy may also be required to treat sexual addicts. This can be in the form of both inpatient and outpatient treatment programs. Psychotherapy takes the form of both one on one counselling sessions and group exercises.

Intracytoplasmic Sperm Injection i.e. ICSI is different from conventional IVF i.e. In Vitro Fertilization because a single sperm is selected by the embryologist to be injected by a needle into the egg rather than a dish with many sperms placed near the egg so that the fastest swimming sperm enters it. Once the sperm is injected directly into the egg, it fertilizes, after which the embryo is transferred into the womb or uterus. 

Your doctor might recommend ICSI treatment for you if you have an extremely low sperm count resulting in infertility or other medical sperm conditions such as poor motility or poor morphology. It may also be suggested if prior attempts at IVF procedures have failed in fertilizing the egg or the fertilization rate is extremely low. You must also consider ICSI treatment if you resort to embryo testing or if the sperm needs to be collected from the epididymis or testicles surgically. 

However, you must keep in mind that if your partner has a genetic problem resulting in low sperm count, it could be passed on to your child, if you decide to use your husband's sperm for this process.

Success Rates of ICSI:

The success rate of ICSI treatment depends on your age and your fertility problem. Your eggs are healthier when you are young and as you age, chances are that they will become less healthy.

1. 35 per cent if you are under 35 years of age
2. 29 per cent if you are between 35 to 37 years of age
3. 21 per cent if you are between 38 to 39 years of age
4. 14 per cent if you are between 40 to 42 years of age
5. 6 per cent if you are between 43 to 44 years of age
6. 5 per cent if you are above 44 years of age

Advantages of ICSI Treatment:

Intracytoplasmic Sperm Injection gives you a chance to conceive a child genetically when most other options are exhausted. Males may be unable to ejaculate on the day the eggs are collected due to anxiety. ICSI proves to be advantageous because sperm may also be surgically extracted for this process. It is extremely helpful for those couples who suffer from unexplained infertility. However, one of the most important factors is that ICSI treatment does not affect your child's physical or mental health.

Facial aging is an issue which shows its first signs around the late twenties and early thirties. It is manifested in the form of fine lines, dark circles, wrinkles and rough skin, especially near the eyes and lips. This process cannot be reversed. It is a part of human body and the way the skin matures with age. But, it can be treated through surgical and non-surgical or natural means to make sure that the process of aging is slowed down.

Factors Affecting Facial Aging:

There are several factors which affect the facial aging and aggravate the process faster. Some of these factors are:

1. If you smoke excessively, your face would sooner or later start showing signs of aging prematurely.
2. At times, this process gains speed due to genetic issues.
3. Stress and anxiety are the most important reasons for a person to start showing signs of aging at an early stage of life.
4. If you lead a hectic lifestyle which involves excessive travelling throughout different climates, the exhaustion may be manifested through facial aging.

What are Dermal Fillers?

Dermal fillers help to diminish facial lines and restore volume and fullness in the face.

As we age, our faces naturally lose subcutaneous fat. The facial muscles are then working closer to the skin surface, so smile lines and crow's feet become more apparent.

The facial skin also stretches a bit, adding to this loss of facial volume. Other factors that affect the facial skin include sun exposure, heredity, and lifestyle.

Dermal fillers can be used to:

• Plump thin lips
• Enhance shallow contours
• Soften facial creases and wrinkles
• Improve the appearance of recessed scars

Dermal fillers can be very helpful in those with early signs of aging, or as a value-added part of facial rejuvenation surgery.

Administration:

You must make a note of the fact that dermal filling is not considered to be a type of surgical treatment. However, it does use anaesthesia while being administered. In fact, the patient is first given a dose of anaesthesia and left to rest for about half an hour. Some fillers have anesthesia in the syringe itself otherwise, we apply numbing cream or topical anesthesia. Thereafter, dermal fillings are applied with the help of fine needles. You need to realise that the use of fine needles with precision can be done only by those who have been specially trained for it. Thus, if your dermatologist recommends you for a treatment of dermal filling, then he/she ought to be a trained expert in carrying out the procedure. If you, on your own prefer to get this treatment done, then you should also find an expert who is well trained in administering this procedure.

Thus, dermal fillers are quite famous in the world of facial dermatology to reverse the aging process. It helps in reducing fine lines, wrinkles and adds volume and smoothness to the skin.

No Blood, No needle, No visit to hospital, you can do yourself at home with water. A thin layer of transparent screen like structure hangs in front of the abdominal muscles known as peritoneum. This peritoneum protects the abdominal structures and the muscle. This can also be used for performing dialysis which is carried out when the functioning of kidney gets affected. In peritoneal dialysis a thin and soft catheter is placed in the person’s belly one week before performing the procedure.

The catheter has numerous holes in order to facilitate the transformation of fluids. Dialysis solution is prepared in a bag and the tubing is connected to the catheter placed in the abdomen thereby, the fluids absorb the waste materials from the body. The fluid is allowed to stay in your body for a particular period of time which is commonly referred as dwell time and later the fluid is drained out.

There are two types of peritoneal dialysis, continuous ambulatory peritoneal dialysis and automated peritoneal dialysis. This is the simple form of dialysis which anybody can perform after a short training period and this can be done anywhere in clean private place like hotels, home and even in office.

Procedure followed during Peritoneal Dialysis

All you need to perform a peritoneal dialysis is catheter and transfer set, cycler, dialysis solution and safety precautions materials to stay away from getting infections.
Step 1 - Perform a sterile aseptic technique. Wear a glove and surgical mask before connecting the catheters and transfer set. Clamp the tubing and remove the catheter once the dialysis solution enters your abdomen
Step 2 - Allow the solution to remain in your abdomen for a particular period of dwell time
Step 3 - Drain the fluid from the abdominal cavity into the drain bag. You may feel a mild tugging sensation when adequate amount of fluid is drained.
Step 4 - After drain close or clamp the transfer set and later flush a fresh solution directly to drain bag so as to remove the air from the tubing.
Step 5 - Close your drain bag and open your transfer set and refill your belly with fresh solution.

Make sure you perform without giving way for infection and excess fluid and dextrose absorption.

Uterine fibroids are benign growths, which originate in the walls of the uterus. They are also known as 'myomas' or 'fibromyomas' and their sizes tend to vary. You may not realize that you have a fibroid as they do not cause many problems.

The causes of uterine fibroids are: 

1. Hormones: Hormones that stimulate the uterine lining to prepare it for the menstrual cycle are known to aid in the development of uterine fibroids.
2. Genetic changes: Genetic changes in the cells of the uterus may lead to this disorder.

Ayurveda is a natural method of treatment that focuses on using various herbal remedies to cure a disorder. The Ayurvedic remedies for uterine fibroids aim to boost the immune system and balance the hormones in the body. This allows the ovaries to function properly and thus allows the uterus to remain healthy.

The various ayurvedic remedies for uterine fibroids are:

1. Curcumin: This remedy helps the body get rid of the free radicals due to its high antioxidant content. It helps in reducing the inflammation in the uterus and thus treat uterine fibroids.
2. Ashwagandha: Ashwagandha has medicinal properties that boost your overall wellbeing in addition to boosting your immune system. It is also known to improve the functioning of the brain and treat impotency.
3. Diet: The diet should consist mostly of fiber and whole grains. Alcohol and saturated fats should be limited. You should eat foods, which are pungent, bitter and astringent so that the metabolism is smooth; this prevents formation of uterine fibroids.
4. Lifestyle changes: You should restrict smoking and alcohol consumption as they tend to aggravate free radical damage in the body. You should also follow a regimen that incorporates regular exercise and a balanced diet. This will enhance your wellbeing and allow you to remain healthy.
5. Panchakarma: Panchakarma is an Ayurvedic remedy that helps in correcting hormonal imbalances in the body. Correction of hormonal imbalances helps in preventing uterine fibroids. If you wish to discuss about any specific problem, you can consult an ayurveda.

A traumatic injury refers to a serious brain injury that affects all the aspects of a person including his or her personality. This may be the result of a severe fall, a car accident, firearms etc. Unlike an injury to the arm or leg, no two traumatic injuries have the same effect. These injuries also do not heal like other injuries.

There are many different kinds of treatment options available for traumatic injuries. Initially, treatment aims at stabilizing the individual and assessing the scope of the injury. Acute treatment is used to minimize secondary injuries. In many cases, surgery is also required to prevent secondary injuries and to help maintain a steady flow of oxygenated blood to the brain. This relieves the internal swelling and pressure. It also minimized additional damage to brain tissue. Most patients also need rehabilitative care to get back to their normal life.

Surgical treatment is usually advised in the case of a traumatic head injury. However, in the case of internal brain injuries, this may not be the first preference. In such cases, an intracranial pressure monitoring device or a bolt is implanted to monitor pressure levels in the brain. Only then surgery may be required to drain bleeding in the skull cavity and to repair the torn tissues. Blood clots or hematomas will also need to be removed surgically. Sometimes, surgery may also be required to create a window in the skull so as to relieve internal pressure.

In severe cases, if there is extensive tissue damage, the damaged portion of the brain may be surgically removed. This creates space for the healthy brain tissue to heal. In the case of an open brain injury, surgery is the first course of treatment. In such cases, the doctor’s first sim is usually to repair the fractured skull and remove damaged tissue. This minimizes pressure on the brain and also helps prevent secondary infections and injuries.

These surgeries are generally performed while the patient is under general anaesthesia. Recovering from a traumatic brain injury takes time and hospitalization is usually required for a few weeks. Once the injury has healed considerably, rehabilitation is then required to relearn basic skills. This may begin as an inpatient procedure and later be transferred to an outpatient exercise. The duration and type of rehabilitation required vary from case to case and depends on the type and severity of the injury.