Srushti Fertility Centre & Women's Hospital

Infertility is a condition that can be caused due to a variety of reasons, for both males as well as females. Yet, it also comes with plenty of emotional baggage because there is a great deal of social stigma attached to childless parents, especially in the developing countries like India, where we still hold on to traditional thinking which does not really justify modern day realities.

Understanding Infertility in the Developing World: As per medical science, infertility is defined as a problem that is faced by couples who do not manage to conceive even after a year of trying without any birth control measures. In countries like ours, there is a great social stigma that is attached to being childless. As per many studies by the World Health Organization (WHO), about 15% of couples the world over are affected by infertility. Also, such cases go undetected because there is a great social stigma attached to the same. Further, there may be underlying conditions like Tuberculosis which may have been undiagnosed because people do not like to talk to doctors about the symptoms. The main problem in countries like India, and others areas is that people do not open up about such problems and they consider doctors and other medical practitioners as strangers.

Still in the Dark Ages: Even though we have made the transition from an agricultural country where we would pray to the elements and wait for signs for all our everyday activities from harvesting to childbirth, to an industrial country we are still in the dark ages as far as our social setup goes. There are many educated and well-heeled families where being childless is considered as an issue. And many people tend to go to astrologers and temples to change their fate, where a simple visit to a doctor and procedures like IVF, or adoption as the last resort, can also work out.

Infertility Stigma for Males and Females: For an infertile couple, the problem may stem from the male, or the female or both partners. There are still many social stigmas that are attached to this and many people in countries like India tend to call the woman barren, if she is unable to bear a child. In many cases, the male partner does not even go in for a check up as it is not even considered as an option that the problem might lie with him. Male erectile dysfunction, ejaculation problems, and general infertility can cause a range of issues for the couple when it comes to conception. So it is imperative to have the same checked by the doctor so that a sperm test can also be conducted and the treatment can carry on accordingly with the help of IUI or IVF.

In case you have a concern or query you can always consult an expert & get answers to your questions!

Ovarian cysts are a common development in many women. Cysts are sacs filled with fluid which are formed in the female ovaries. Most cysts are harmless and do not even show any symptoms. However, some cysts do show outward symptoms like heavy bleeding, clotting, nausea, vomiting, stomach pain during the menstrual cycle, and pain during sex.

If you feel any of the above-mentioned discomforts, it will be in your best interest to consult a gynaecologist and get a check-up done. Most cysts are manageable unless they are very severe. In fact, it is best that cysts come to light at the right time and are efficiently managed, unless they develop into severe issues in the future.

Management of cysts

1. Oftentimes, medical practitioners resort to what is called ‘watchful waiting’.
2. At times, ovarian cysts disappear in a few months.
3. It is recommended to take a blood test and an ultrasound to see the progress of the cyst.
4. If you have already experienced menopause, then these tests are carried out every four months. This is because in such cases the risk of an ovarian cancer is at its highest and regular monitoring of the cyst is necessary.

Treatment of cysts
Ovarian cysts can be treated in their earlier stages. Here are some of the most popular treatments.

1. Laparoscopy is one of the most popular treatments. It is a surgery carried out under general anaesthesia. The tummy is cut to a radius of a key hole and a laparoscope is inserted. This helps the doctor to see the internal organs, which is then used to remove the cyst. This method is less painful and has a quick recovery time.
2. Laparotomy is the other method used for removing a cyst. In case the cyst is large, then one single large hole is made in the body to access the cyst. At times, the cyst and the ovaries are removed and sent for further laboratory inspection. This inspection is done to detect whether the samples are cancerous or not. This procedure is more complex than the previous one and might need the patient to stay in the hospital for a few days.
3. In case you have a cancerous cyst, then your reproductive part itself would have to be removed rendering you barren for your life.

Ovarian cyst is very much treatable and is best to be detected at an earlier stage for better and faster treatment. Thus, it is best to go for regular check-ups and report in case of any disturbing symptoms.

In case you have a concern or query you can always consult an expert & get answers to your questions!

In vitro fertilization (IVF) includes empowering the woman with medicines, taking various eggs from her ovaries, fertilizing them with her partner’s sperm, and inserting a portion of the subsequent embryos into her uterus with the trust that one will form into a fetus. 

Tubal ligation reversal, on the other hand, requires a laparotomy, which needs a much bigger entry point on the abdomen, usually around four to six fingers long. Since the skin, each of the muscles, and different tissues of the stomach must be sliced through, there is extensively more uneasiness and a longer recovery time required after the surgery, when compared with a laparoscopic surgery, for example, with a tubal ligation. 

Here are a few common differences: 

1. Sperm quality: The male partner needs a sperm test before basic procedures of either of the two. In case that the sperm quality is great, then the couple could consider proceeding. In case that the sperm quality is poor, in vitro treatment is the better alternative. With IVF, poor sperm quality is effectively overcome. 
2. Tubal status: The length of the remaining tubal stumps after tubal ligation is an important aspect. The more extended the two remaining stumps are on each side, the better and more effective is the pregnancy. The shorter the stumps, the lower are the odds for pregnancy. 
3. Status of other pelvic conditions: Pelvic endometriosis or any scar tissue in the range of the tubes or ovaries would diminish the chance for accomplishment after tubal ligation reversal. Although, IVF pregnancy achievement rates are usually not influenced by these conditions. Along these lines, in vitro fertilization is most likely a superior alternative in women with noteworthy endometriosis or pelvic scar tissue. 
4. Female age: Chances for pregnancy with either tubal ligation or IVF decrease in the mid to late thirties and significantly reduce at the age of thirty-eight. By age forty-three or forty-four, not many women will have the capacity to have a baby using either approach. 
5. Egg amount and quality: A few women have a decrease in either egg amount or quality prior in life than anticipated. In this manner, the woman’s ovarian capacity needs to be tested before a choice is made in regards to whether to continue with either tubal ligation or in-vitro fertilization. AMH levels, ovarian antral follicle number, and day 3 FSH levels are generally done to evaluate ovarian capacity or hold. 
6. Doctor intervention: The greatest favorable position of tubal ligation reversal over IVF is that once the woman has experienced the surgery she ideally will not require any medication through the doctor, for example, medications or systems, keeping in mind the end goal to get pregnant.

In case you have a concern or query you can always consult an expert & get answers to your questions!

In today’s modern, fast paced society, it is easy for people to become stressed. In fact, one would almost think that being stressed is the “in” thing, and if you aren’t stressed it must mean there is something wrong with you! Realistically however, stress is not a good thing for our bodies in general, and has a very real impact on your fertility.

Can Stress Have an Effect on Your Fertility?

If your mind and body is under stress your body is signaled to release a hormone - Adrenalin. This is a stress relieving hormone and gives your body the rush to face the stress. This hormone inhibits the utilization of the hormone Progesterone, which is essential for fertility. Also during stress Prolactin, another hormone, is relapsed which also interferes with infertility. Hence to conceive its essential that your anxiety levels are under control.

How Stress Impacts Fertility?

Recent research tells us that stress boosts levels of stress hormones, such as adrenaline, catecholamines and cortisol, which can inhibit the release of the body’s main hormone, GnRH (gonadotropin releasing hormone), which is responsible for the release of sex hormones. Subsequently this may suppress ovulation in women, reduce sperm count in men and lower libido in both women and men.

Chronic Stress also decreases libido:

Chronic stress may cause lack of libido as well as a decrease in general fertility. This has become such a common issue that they have created a name for it Stress Induced Reproductive Dysfunction. These facts are very important to consider if you have been trying to conceive with no results. It also shows that stress relief should be a part of every couple's conception plan even if they are going through IVF.

Ways to reduce stress & improve fertility:

If you are having difficulty to conceive, it's imperative that you get fertility tests done and also evaluate your life. Look out for the stress points that may be hindering a relationship. Remember defeating the stress may be the solution to your worries.

1. Reduce stress in your life: The issues in your life may be work or result related. You need to learn to balance your personal and professional life. The sooner you do it the better; after all you are preparing yourself to welcome a new born in your life.
2. Change your reactions: Get a hang of the situation and react accordingly. Over reaction to a situation can harm your body and mind. Stop bothering so much about the future.
3. Let few things be the way they are: Stop getting bothered about people. Remember by nature everything will fall in place. Let few things be the way they are.
4. Make it your habit to reduce stress: Call it an obsession or a practice, train your mind to choose options where there is less stress.
5. Sleep well: A good rest is essential for a healthy mind and body. Meditate, do yoga or seek counseling. Go for facials if it sooths you.

Please note that if your fertility reports are normal, then it's just a matter of time. Give you, your partner and your body time. There are certain medical complications or disorders that can also be responsible for infertility. Be calm and composed so that you are able to face the rough waters clearly with your partner.

In case you have a concern or query you can always consult an expert & get answers to your questions!

Pelvic pain is most common in women, though sometimes it occurs in men as well. There is absolutely no reason why pelvic pain cannot be treated and therefore women need not panic if they are experiencing such pain. The treatment of any pain can be done methodically after discovering its cause. Thus, before jotting down the treatments for pelvic pain, it is important to explore the reasons that cause pelvic pain in women.

Reasons for pelvic pain

1. Reproductive organs in women play an important part in causing pelvic pain. The reproductive organ is complex when it comes to women and many small or big problems there might end up leading to pelvic pain.
2. Any urinary infection or bladder irritation might also lead to pelvic pain.
3. The nerves and muscles of the abdomen may cause pain in the pelvis area as well. In fact, the nerves and muscles are very tender near the pelvis area and care should be taken so that one does not strain them or pull the ligaments. This can cause severe pain.
4. Another interesting point to be noted is that sometimes even after going through a lot of examinations, no causes of pelvic pain are found. In such cases it is understood that the pelvic pain is a manifestation of the remains of a long forgotten injury or accident.
5. It has been examined and found out that physical abuse can at times lead to chronic pelvic pain. Though this link has not yet been understood properly, but it is seen to be true.

Treatments for pelvic pain

1. The most basic treatment is to apply heating pad on the affected area. Heat helps in relaxing the muscles and nerves thereby, lessening the pain. However, this would reduce the pain, but cannot make it disappear in a day. Thus, it is a continued process for a week or 10 days till the pain recedes.
2. Relaxation techniques like meditation, breathing exercises, yoga and even muscle exercises like jogging help in reducing the pain. However, this should be done under guidance. One wrong move can actually aggravate the pain instead of lessening it.
3. Then there are painkillers which are non-steroidal and help in lessening the pain. Painkillers have a correct dosage and must be taken only after consulting a doctor. Self-medication in such cases can prove disastrous.
4. At times, when all medications fail, surgery is the last resort.

Thus, these are some of the treatments that can be undertaken if and when you are experiencing pelvic pain. All these are connected to the root cause and must be followed only under medical supervision.

In case you have a concern or query you can always consult an expert & get answers to your questions!

One of the major milestones in a woman’s life is the entry into motherhood. For most women, when this does not happen in the natural logical sequence of things, there is anxiety and lot of pressure from family and friends.

However, with advancements now, there are options like intrauterine insemination and in vitro fertilisation (IUI and IVF) available, which can help increase the chances of conception and pregnancy. IVF is where the egg is retrieved from the woman’s womb, fertilised externally and then transplanted back into the uterus where it grows to full term. However, there are always unanswered questions like how long to wait before going for IVF, is it the right procedure for me, etc.

Read on to know to find answers to some of these.

1. Maternal age: As a woman reaches 35 and a man reaches 40, the fertility rates drop significantly. The chances that a woman at 35 will conceive is about 20%, which goes down to 5% if the woman is 40. However, this rate can be significantly increased by using IVF. The quality of the egg would gradually deteriorate, and so if a woman is nearing 40, it is better to consider IVF as the ovarian reserve would be optimal with IVF.
2. Failed intrauterine insemination: In couples who have problems with the sperm reaching the uterus, intrauterine insemination (IUI) is first attempted. However, if 3 or more attempts of fail, it is time to consider IVF.
3. Duration of inability to conceive: While some couples conceive quite promptly in a month or two, most take about 6 to 8 months of unprotected sex to conceive. Therefore, IVF can be an option if you are failing to conceive even after a year. Less than a year, don’t fret. Take it easy and it might just do the trick.
4. Medical health: Both the partner’s medical health should be taken into account. Lifestyle changes like smoking, alcohol abuse, drug abuse should be considered, which can account for poor sexual performance and therefore lead to an inability to conceive. Health conditions like diabetes and heart disease can also lead to infertility. Hypothyroidism in women is another thing that must be ruled out, as it often leads to an inability to conceive.
5. Sexual problems with the partner: One of the first things to do before going for IVF is to check that the male does not have any issues. Be it erection issues or ejaculation issues or sperm issues, they need to be ruled out. Sperm quality, quantity, and motility have to be analysed, and if they are optimal, IVF can be considered.

In case you have a concern or query you can always consult an expert & get answers to your questions!

Childbirth comes within an age bracket. Women feel this more so than men. Career demands or other personal choices can delay the time to get pregnant. Thus, freezing your eggs can prove to be beneficial, if you delay childbirth to focus on your career or education, or if you have certain medical conditions such as cancer.

1. Egg Retrieval: Before the eggs are harvested, there is a lot you have to do. The first month is spent taking blood tests and ultrasounds. In the second month, you will have to take medicines before your procedure for egg retrieval. Ultrasounds and blood tests are also conducted at this stage to monitor the growth of the eggs. Around the time of your ovulation, the eggs will be harvested. You will be lightly sedated during the procedure. After the procedure, you might feel bloated and experience cramping. At least 15 eggs are retrieved for optimum chances. The medicines prescribed are all hormone injections which you can self-administer.
2. Freezing and Storage: The largest human cell is the egg. It is comprised mainly of water. When the eggs are frozen, crystals can form which can destroy it. So an anti-freeze replaces the water after the eggs are dehydrated. This prevents crystal formation. Eggs are frozen using vitrification. In this process, the eggs are either slowly or flash frozen. Eggs can be frozen for as long as 10 years. This does not hamper the quality.
3. Risks: There is no guarantee that freezing eggs will lead to having a baby. Sometimes, eggs do not survive the freezing or the thaw.
4. Advantages: For women who are suffering from cancer, freezing their eggs might be the best option. They might want to preserve their fertility before their cancer treatment starts. This is useful since radiation and chemotherapy can harm your chances of getting pregnant.

The obvious advantage of freezing your eggs would be the fact that it gives you time. It lets you decide and keeps you one step ahead of your biological clock.

In case you have a concern or query you can always consult an expert & get answers to your questions!

Intrauterine insemination (IUI) and in vitro fertilization (IVF) are two commonly used methods of fertility treatment, which increase a couple’s chance of becoming pregnant.

The Procedure

IUI- IUI is a procedure during which processed and concentrated motile sperm are inserted directly into a woman’s uterus. This procedure is timed according to a woman’s ovulation, and may be performed one to two times in the days immediately following the detection of ovulation. After ovulation a woman’s egg is picked up by the fallopian tube and waits there for the sperm. Since the IUI procedure deposits higher concentrations of good quality sperm close to where the egg is waiting, the chances that the egg and sperm will find one another are increased.

IVF- IVF is the most successful method of fertility treatment utilized today to help couples to conceive. The basic components of the IVF process include stimulation of the ovaries to produce multiple eggs at a time, removal of the eggs from the ovary (egg retrieval), fertilization of the eggs in the laboratory, and subsequent placement of the resulting embryos into the uterus (embryo transfer). The chance of pregnancy from IVF depends primarily on the age of the woman, the cause of infertility, and factors related to the quality of the IVF laboratory.

Success Rates

IUI Treatment: There is a marked difference between IVF and IUI pregnancy rates. IUI has a success rate between 5% and 20%, but it can even be as low as 1-2 %, depending on the woman’s age and fertility levels. The chances of conceiving through IUI is higher if fertility drugs are administered along with the treatment.

IVF Treatment: IVF has a high success rate – between 20% and 35% and it can even go as high as 40%. This may not seem like a lot, but it is very high, considering that an average young and fertile couple has only a 15-20% chance to conceive in a month. It is important to understand what IVF and IUI success rates mean and the factors that affect it before deciding on a fertility treatment. You can also use any reliable online IUI vs IVF comparison tool to determine your approximate success rates with each of these treatments, depending on your age, lifestyle, and medical history.

You should use online sources of information to understand more about fertility problems, how age affects fertility levels, and whether freezing your eggs is a good option for you. However, discuss all these issues with your doctor to ensure that you have the right information and that you have understood it correctly. Fertility specialists provide you with personalized fertility plans based on your health which is why you should always talk to them before you make any decision.

In case you have a concern or query you can always consult an expert & get answers to your questions!

The available eggs in the ovaries at a time are collectively called an ovarian reserve. Low reserve happens when the production of eggs reduces. This affects the chances of pregnancy. The general cause of low reserves can be aging ovaries. In such cases, the ovary may be healthy and functioning even if the reserve is low. Production of eggs lower as a woman ages. A woman starts with 250,00 to 500,000 eggs at puberty and ends up with 1000 eggs at menopause.

Causes:
Low reserves are caused by

1. Production of eggs decreases: Chromosomal abnormalities like Turner syndrome (lack of two X chromosomes) and genetic anomalies like Fragile X can decrease egg production.
2. Ovarian tissue damage: Rough torsion, endometriosis triggered ovarian cysts, malignant or benign tumours, surgical removal of ovary or any other part of it, chemotherapy or radiation, pelvic adhesions, immunological problems or high BMI (Body Mass Index) can destroy the ovarian tissues.

IVF Protocols:
If a woman has low ovarian reserves, then she will be put on the either of the following protocols:

1. Short GnRHa Flare: Gonadotrophin releasing-hormone-agonist (GnRHa) like Lupron, Nafarelin, Synarel or Buserelin is administered. This therapy is initiated at the onset of menstruation. The goal of the treatment is to stimulate the release of the follicular stimulating hormone (FSH) which augments the ovarian follicular growth.
2. Combined Clomiphene or Gonadotrophin/Letrozole Stimulation: Older women are mostly administered this protocol. But it is strongly advised not to, as this protocol can potentially harm the egg or the embryo.
3. Mid-follicular GnRH-antagonist protocol: Once the GnRHa-agonist protocol is commenced, the GnRH-antagonist is given several days later. Once the follicles reach the size of 12mm, GnRHa antagonists like Ganirelix, Orgalutran, Cetrotide and Cetrorelix are added. These drugs stop the pituitary from secreting the luteinizing hormone (FSH leads to secretion of this hormone).
4. Long GnRHa Pituitary Down Regulation Protocol: This is the usual approach to deal with low ovarian reserves.
5. Agonist/Antagonist Conversion Protocol: This protocol inhibits FSH production. This protocol generally yields good results. Consult an Expert & get answers to your questions!

Doctors believe that all women are born with a certain quantity of eggs as well as chances of conception. Also, all bodies are unique with individual strengths and weaknesses. Fertility tests can help in unravelling a number of issues as well as the health of your reproductive system as a whole. It is important to address various lifestyle issues in order to retain your fertility and ensure that you have a hassle free conception. Read on to know more about the ways in which you can preserve your fertility.

1. Oral health: There are a number of medical studies that go as far as suggesting that the state of the woman’s oral health is a significant factor when it comes to the proper functioning of her reproductive system. Many women who have required treatment for infertility are said to have suffered from oral health problems like inflammation and gum disease. One needs to avoid these issues so as to have more reproductive success. So, it is important to brush and floss on a regular basis in order to have better oral and reproductive health.
2. Food: When we are talking about oral health, how can food intake be too far behind? In order to maintain good oral health, it is important to take care of your eating habits. One should steer clear of excessive sugary food intake as well as junk food intake which end up harming the gums as well as the overall system of the patient. Also, you must avoid eating processed carbohydrates like white bread and white rice. It is also a good idea to get your proteins from plant sources rather than animal sources. Furthermore, it is also a good option to strike trans fat off the list and to pick unsaturated fats instead. This kind of a diet is known as low glycemic diet which keeps the sugar levels stable. This helps in boosting all body functions in general, including one’s fertility.
3. Smoking: As per a number of medical studies, about 13 per cent of the infertility cases are linked with excessive smoking. Tobacco has an adverse effect on the state of your fertility, and it usually makes the eggs deteriorate at a much faster rate. It can also cause early miscarriage and ectopic pregnancy, which is a dangerous condition where the egg gets lodged in the fallopian tube. Smoking can also bring about early menopause.
4. Vitamin supplements: Many doctors suggest that once a woman has entered her child bearing years, it is important to start taking multivitamins as these contain folic acid. Folic acid is an important nutrient that helps in foetal growth and stimulates ovulation. If you wish to discuss about any specific problem, you can consult an IVF Specialist.