What are the factors that make a woman fertile? + The most effective way to address infertility

Infertility is the inability to get pregnant after a year of unprotected intercourse. Both men and women can be infertile.

In about one-third of cases, the cause of infertility involves only the male.

In about one-third of cases, the cause of infertility involves only the female.

In the remaining cases, the cause of infertility involves both the male and female or no cause can be identified.

Women are born with a finite number of eggs. Thus, as the reproductive years progress, the number and quality of the eggs diminish. The chances of having a baby decrease by 3% to 5% per year after the age of 30 and this reduction is noted to a much greater extent after age 40.

Female infertility can also be caused by a number of factors including:

1. Damage to fallopian tubes

Damage to the fallopian tubes can prevent contact between the egg and sperm. Pelvic infections, endometriosis, and pelvic surgeries can lead to fallopian tube damage.

2. Hormonal causes

This can lead to ovulation disorders which prevent the ovaries from releasing eggs such as in polycystic ovary syndrome ,  hyperprolactinemia or disorders of the thyroid gland - hyperthyroidism / hypothyroidism, can interrupt the menstrual cycle and cause infertility.

3. Cervical causes

A small group of women may have a problem in which the sperm cannot pass through the cervical canal. Whatever the reason is , this problem may be treated with intrauterine inseminations.

4. Uterine causes

Abnormal anatomy and distortion of the uterine cavity due to the presence of polyps and fibroids or problem with the endometrial lining can lead to failed implantation of the embryo.

Endometriosis occurs when endometrial tissue grows outside the uterus - often affecting the function of the ovaries, uterus, and fallopian tubes.

5. Primary Ovarian Insufficiency:

Also called as Premature Menopause, when the ovaries stop working prematurely before the age of 40. Certain conditions are associated with early menopause like immune system diseases, radiation or chemotherapy and smoking.

Causes of male infertility may include:

1. Abnormal sperm production or function due to various problems, such as undescended testicles, genetic defects, health problems including diabetes, prior infections such as mumps, trauma or prior surgeries on the testicles or inguinal region.

2. Problems with the delivery of sperm, due to sexual problems, such as premature or retrograde ejaculation, certain genetic diseases, such as cystic fibrosis, structural problems, such as blockage of the epididymis, or damage to the reproductive organs.

3. Overexposure to certain chemicals and toxins, such as pesticides, radiation, tobacco smoke, alcohol, frequent exposure to heat can elevate the testicular temperature, impairing sperm production.

4. Damage related to cancer and its treatment, including radiation or chemotherapy for which timely cryopreservation can be done for future use.

5. Unexplained infertility, In approximately 20% of couples the cause cannot be determined using the currently available methods of investigation.

Why is IVF the best way to treat infertility in women?

Conception is a complicated process that depends on upon many factors:

On the production of healthy sperm by the man and healthy eggs by the woman

The sperm's ability to fertilize the egg when they meet.

The ability of the fertilized egg (embryo) to become implanted in the woman's uterus

IVF (or in-vitro fertilization) is a lab procedure where the sperm and the egg are combined in a dish (where fertilization takes place) and is followed by transferring the embryo (the fertilized egg) into the uterus. It is increasingly being used as a method to conceive as it has been established as a safe procedure that helps bypass a number of complications women may face while conceiving such as ovulation problems and issues with the fallopian tube.

Even women who face issues such as PCOS, endometriosis, and premature ovarian failure can conceive through this process. Moreover, IVF has been in practice since 1978 and has a safe track record. The success rates of IVF are high as well, making it a preferred procedure for couples who suffer from fertility problems. Unexplained infertility can also be treated with the help of this procedure.



What factors that  make a woman fertile? + The most effective way to address infertility

Reasons for spotting during pregnancy and what you can do about it

Seeing spots of blood during pregnancy is usually a cause for concern. However, it is not uncommon. The light bleeding, which is known as spotting may occur for a number of reasons.

Bleeding during the first trimester

Spotting is most likely to happen during early pregnancy and the reasons could be many, such as:

- implantation bleeding occurs during the first month of pregnancy when the fertilised egg gets attached to the wall of the uterus.

- cervical polyps ( a tumour that form on the surface of the cervix) or yeast infection may also cause episodes of spotting.

- miscarriage may be another possible reason for spotting

- ectopic pregnancy is another cause. It is the condition in which the embryo plants itself in either of the fallopian tubes instead of the uterus.

- molar pregnancy is a rare condition associated with spotting during pregnancy. When this is the case, instead of your baby, an abnormal tissue grows inside the uterus. Sometimes it can be cancerous too.

Bleeding during the second or third trimesters

Spotting may also occur during late pregnancy and the possible reasons are listed below.

- problems related to placenta like placenta previa placental abruption can also result in spotting. These are serious conditions when the placenta either covers the cervix or it gets detached from the uterine wall respectively.

- uterine rupture is the rare and unfortunate event when a scar from a previous surgery (like the removal of fibroid or previous caesarean scar bursts open and the baby slips into the pregnant woman's abdomen.

- premature labour occurs when your body is too eager to deliver the baby, usually one month before the due date of delivery.

- vasa Previa is another rare condition when a baby who is still developing has his blood vessels entangled in the umbilical cord or placenta-crossing the cervix. It is extremely dangerous because the blood vessels may burst open thus causing the baby to bleed and lose oxygen.

Here's what you can do about spotting

It is strongly recommended that you should immediately see your doctor as soon as you detect any spotting during your pregnancy. Only a well-qualified medical expert can suggest the appropriate steps to be taken, depending on your individual reasons and symptoms related to spotting.

If you would like to consult with me privately, please click on 'consult'.
Related Tip: 6 Changes You Can Expect During the 2nd Trimester of Pregnancy

Reasons for Spotting During Pregnancy

Emergency is helpful in preventing pregnancies post unprotected sexual activity. It can be used in case of contraceptive failure, in case of sexual assault, incorrect use of contraceptives and unprotected sex.

Emergency contraception can be done by three methods. These are emergency contraceptive pills, combined oral contraceptive pills and copper intrauterine devices.



The copper IUD is considered to be one of the most effective forms of emergency contraception, when it is inserted within 5 days of unprotected sexual activity.

However, the emergency contraceptive pill regimen as per WHO is:

1 dose of levonorgestrel 1.5 mg, or 1 dose of ulipristal 30 mg, taken within 5 days (120 hours) of unprotected intercourse

The Yuzpe regimen which consists of 2 doses of combined oral contraceptive pills

What is Emergency Contraception?

Emergency contraception is usually referred to as the contraception which is used to prevent a pregnancy within the first 5 days after an unprotected sexual activity. It is used post failures of contraception, coerced unprotected sex, rape or misuse of contraception.

Emergency contraception is only effective in the first few days after an intercourse and before the egg has released from the ovary, and before there is fertilization between the egg and the sperm. The emergency contraception can do no harm to an interrupted pregnancy and a developing embryo.

Who needs emergency contraception?

Any girl or woman who is at her reproductive age might need an emergency contraception in case of an unprotected sexual intercourse.

Uses
1 Breakage , slippage or displacement of barrier methods 
2. Three or more missed OCPills for more than 12 hours 
3. Missed Mini pill for more than 3 hours 
4. Missed Desoestrel pills for more than 12 hours 
5. DMPA injections taken more than 2 weeks late 
6. Miscalculated dates of last period and present ovulation side effects 
These are meant only for emergency contraception and NOT AS A REGULAR CONTRACEPTIVE. It involves pumping of a hormone inside your body at levels which are 5 times higher than normal. hence excessive and unnecessary use may cause irregularity in the period cycles and an adverse effect on the menstrual health over a period of time. Ideally it should be taken under guided medical supervision.


In what situations should emergency contraception be used?

Emergency contraception can be used after a sexual intercourse. These include:

In case of no use of contraceptives

If it is a case of rape or coerced sex, where the woman was not protected

When there is a contraceptive failure, like

breakage

incorrect use or slippage

OCPILLS,

mini pills

DMPA

3 or more missed combined oral contraceptives, progestogen-only pill (minipill) taken more than 3 hours late, desogestrel-containing pill 12 hours or more, norethisterone enanthate (NET-EN) progestogen-only injection taken more than 2 weeks late

Delay in placing or dislodgement or early removal of the skin patch or the hormonal ring

Breaking, dislodgement, tearing or early removal of cervical cap or diaphragm

Failure of withdrawal that is ejaculation the external genitalia or vagina

The spermicide tablet failure

Miscalculating the periods, failure from using a barrier on the fertile days

Expulsion of an intrauterine contraceptive device (IUD)

Methods of Emergency Contraception:

There are three emergency contraception methods:

Copper-bearing intrauterine devices (IUDs)

Emergency contraception pills (ECPs)

Combined oral contraceptive pills or the Yuzpe method



Safety of Emergency Contraception

Lovemaking during pregnancy is less talked about because it is customary to distance pregnant ladies from intimacy. Many women even find it very uncomfortable to have sex during the pregnancy period as their body gets bigger.

However, there are other ways you and your partner can opt for to satisfy your needs like caressing, holding each other and kissing. There are some partners who feel sex during pregnancy is the best moment for sex, while there are others who are feared and have their own concerns.

Sex During Pregnancy - Pregnant Sex
Sex during pregnancy should be avoided. If at all done should be gentle, it should avoid pressing the abdomen. However, it is safe in the second trimester if the woman is comfortable. Yes, it is alright for partners to have sex from the second trimester onwards if the woman has had a healthy pregnancy.  This is because the thick mucus plug which seals the cervix in pregnant women safeguards the baby against any infection.

The strong muscles of the uterus as well as the amniotic sac, keep the little one safe in the womb. NO damage can be caused by the penis of your partner to the baby while having sex. Women can feel some movement of their baby after orgasm. Couples need not worry about the baby, as in no case it would provide discomfort to the baby. The chances of having a premature baby are reduced at times by having sex regularly.



Conditions to Avoid Sex During Pregnancy
The conditions in pregnancy when it is better to avoid sex mainly include times when any spotting or bleeding occurs during early pregnancy. In such a case, the Doctors advise not to have sex for at least 14 weeks.
Your doctor may even advise a pregnant woman not to have sex if she has a history of cervical illness, has had heavy bleeding, had a vaginal infection, and in case of the low lying placenta.
A pregnant woman experiencing frequent abdominal pain or cramps must also avoid sex during their pregnancy.
Sexual Behavior to Avoid During Pregnancy
There are 2 ways that are not safe and must be avoided while having sex during pregnancy. The first way is oral sex. Any pregnant woman must not allow their spouse to blow air into the vaginal region. Blowing air into the vagina can cause an air embolism, and this can be potentially serious for the mother as well as the baby.
Pregnant women should not have sex with partners who have an unknown sexual history as there are chances that he is infected with sexually transmitted diseases like HIV or Herpes. The diseases can be easily transmitted to the baby if you have sex with such a partner. It is better to avoid any complications and stay away from sex during the pregnancy period.
If you wish to discuss any specific problem, you can consult a doctor and ask a free question.

Conditions When to Stop Sex During Pregnancy

Do you know that the future health of your baby is decided  before you even conceive? Your preconception health is very important. Planning a baby is a demanding task, but if you plan it well you will have a healthier and easier pregnancy. 

These are a few tips which can do wonders

1. Relaxation at Work and Household Backup - Plan out your work schedule. You might need to change your work hours or may be change the job profile. You will also need someone to help you out with the household chores around this time.

2. Finances - Get your finances settled and insurance plan changed accordingly.

3. Lifestyle Modification - Eat healthy. Stop the intake of alcohol and stop smoking. Set aside a time for regular exercise if possible. Try to lose that extra flab and stay very active.

4. Reduce Stress - Create a support system for yourself. Engage in activities that uplift your mood.

5. Take Folic Acid -Take 400 mcg of folic acid tablet daily. It helps prevent birth defects of brain and spine in the baby.

6. Avoid Exposure to - Harmful chemicals, metals and toxic substances at workplace and home. Protect yourself from infections. Stay away from cats.

7. Up-to-Date Vaccination - Make sure your vaccination is complete. Vaccination against rubella and flu are very important. It is also important to maintain a gap of at least one month between your rubella shot and pregnancy planning.

8. Optimize your Medical Condition - If you have Hypertension, Diabetes, Asthma, Epilepsy or any other medical condition you must take complete advice from the physician. Blood pressure and sugar levels have to be under full control. The type and dose of the drug may need modifications.

9. Check Family History - Ask your parents, grandparents, brothers, sisters, aunts and cousins about any health problems in the family like genetic problems, mental retardation or malformations in babies. This can help your Gynaecologist to determine which problems to look for and how to prevent it. 

10. Visit your Doctor - Carry a record of your medical conditions, family history and a checklist of your queries. Get tested for Li Blood Group, Thalassemia, HIV, Thyroid Levels, and Blood Sugars.



Why Your Baby's Health is Decided Much Before You Even Conceive

Recurrent pregnancy loss refers to the situation when three consecutive pregnancy loss takes place. A pregnancy loss is a clinically defined pregnancy which ends before twenty weeks.

Causes of recurrent pregnancy loss

Major cases of pregnancy loss occur due to genetic abnormalities and chromosomal abnormalities. The abnormality may occur from the sperm, egg or the early developed embryo.
Recurrent pregnancy loss may occur in a woman due to ascending maternal age. This happens because of poor quality of the egg, which further leads to chromosomal abnormalities. In some cases, the pregnant mother or the father can have some gene irregularities. In such cases, the would-be-born infant is affected, and this causes pregnancy loss or miscarriage.
Uterus abnormalities also lead to recurrent pregnancy loss. This may happen because of poor supply of blood to the uterus. Abnormalities in the uterus are in-born in some women and in others these may develop over time.
Women having a poor immune system are likely to suffer pregnancy loss. Abnormalities in hormone secretion like thyroid or diabetes may also cause pregnancy loss in women.
If a woman suffers from abnormalities in blood clotting, the chances of miscarriage are enhanced.
Testing for recurrent pregnancy loss
Several tests and examinations should be carried out for detection of pregnancy loss. 

Karyotype analysis of the woman and her male partner has to be conducted. Karyotype refers to the genetic or chromosomal constituents of an individual and this test is carried out to detect abnormalities in genes and chromosomes of the parents, which cause miscarriage when passed on to the developing infant.
Another test includes the evaluation of the uterus and the uterine cavity. This is done by ultrasound, saline ultrasound, MRI, hysterosalpingogram X  ray or by hysteroscopy. These tests help to get information on the uterus shape, about fibroid presence, detect abnormalities within the uterus and observe the opening and closing of the tubes. Tests to detect the functioning of hormones are also carried out.
Treatment
The treatment for women with recurrent pregnancy loss depends upon the underlying causes of the pregnancy loss.

In case of patients with karyotypic abnormalities, genetic counselling is recommended, where a specialist is consulted to know about chromosomal abnormalities.
Prenatal genetic studies are carried out by some couples to know about the offspring s genetic make-up. This is done with chorionic villus sampling or with amniocentesis. A process known as in vitro fertilization can be carried out.
In case of uterine abnormalities, a surgery may be performed and medications for reducing blood clot are used if antiphospolipid syndrome is detected.
Recurrent pregnancy loss may happen due to various reasons and proper tests, and treatment procedures should be carried out for curing pregnancy loss. This phenomenon affects a woman and her partner deeply.

Recurrent Pregnancy Loss - Know the Reasons Behind it!

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