When we talk about infertility attention usually falls on treatment for women. However, infertility can affect men as well. The condition of infertility, can be described as the inability to become pregnant for a period of 1 year despite having unprotected, well-timed sexual intercourse. A low sperm count is one of the primary reasons for infertility in men.

Typically there should be fifteen million sperm per milliliter of semen. Low sperm count refers to the ejaculation of less than a normal amount of sperm in semen. This can also be termed as oligospermia. A complete absence of sperm in semen is known as azoospermia. Low sperm count does not mean that you cannot impregnate your partner but it reduces the chance of a successful conception. Thus, one of the most common ways to treat infertility caused by low sperm count is IVF.

IVF involves harvesting eggs from the woman s uterus and sperm from the male partner and combining them in a laboratory to form a zygote. When IVF is used to treat male infertility, a semen analysis is the first step. This helps determine the patient s sperm count, sperm motility, volume, pH levels, white blood cell levels etc.
The ejaculated semen is then processed so as to separate the sperm cells from the plasma. In this process sperm cells with higher motility are identified and segregated. These cells have a higher chance of fertilizing the egg.
Sperm cells are then injected into the harvested egg. Some techniques may require the injection of 50,000 or more sperm cells while others such as intracytoplasmic sperm injection (ICSI) can be effective with a single sperm cell. Once the egg is fertilized, it is allowed to develop for a few days in the laboratory. 
Two or three embryos are then selected to be reintroduced into the woman s uterus with the help of a catheter. The remaining fertilized embryos are preserved in an embryo bank in case the pregnancy is not successful. If these need to be used later, the woman does not have to go through the initial stages of IVF treatment to stimulate the follicles and harvest eggs from the ovaries.
When it comes to IVF, the success rates are very high. However, one of the most common side effects is the birth of twins or triplets. This is because multiple embryos are inserted into the uterus. The number of babies born then depends on the number of embryos that are implanted successfully.

Declining Sperm Count - How IVF Can Help Deal With It?

What is recurrent miscarriage?

If you have three or more miscarriages in a row, doctors call it recurrent miscarriage. If you have experienced recurrent miscarriage, your GP or midwife will refer you to a gynaecologist. Your gynaecologist will try to identify the reason for your losses.

Having miscarriage after miscarriage may leave you feeling utterly drained of hope. At times, it may be hard to keep trusting in the future. This experience affects every aspect of a woman s life from her mental and emotional health to her physical health and social well-being. 

If you can, try to draw comfort from the fact that most women who experience recurrent losses do go on to have a baby. This is especially the case if tests can find no reason for the losses. Six out of 10 women who have had three miscarriages will go on to have a baby in their next pregnancy.

Treatment of Recurrent Pregnancy Loss

Treatment for anatomic abnormalities of the uterus involves surgical restoration through removal of local lesions such as fibroids, scar tissue and endometrial polyps or timely insertion of a cervical cerclage (a stitch placed around the neck of the weakened cervix) or the excision of a uterine septum when indicated.

A thin endometrial lining has been shown to correlate with compromised pregnancy outcome. Often times this will be associated with reduced resistance to blood flow to the endometrium. Such decreased blood flow to the uterus can be improved through treatment with sildenafil (Viagra), Terbutaline and possibly aspirin.

Sildenafil (Viagra) Therapy Viagra has been used successfully to increase uterine blood flow. However, to be effective it must be administered starting as soon as the period stops up until the day of ovulation and it must be administered vaginally (not orally). Viagra in the form of vaginal suppositories given in the dosage of 25 mg four times a day has been shown to increase uterine blood flow as well as thickness of the uterine lining. To date, we have seen significant improvement of the thickness of the uterine lining in about 70% of women treated. Successful pregnancy resulted in 42% of women who responded to the Viagra. It should be remembered that most of these women had previously experienced repeated IVF failures.

Terbutaline this is a medication that relaxes the muscle in the uterine wall and so permits improved hormone delivery to the endometrium. The use of Terbutaline will often cause an increase in heart rate. It should not be prescribed to women who have irregular heart beats (arrhythmias), and women who have decreased cardiac reserve.

Aspirin this is an antiprostaglandin that improves blood flow to the endometrium. It is administered at a dosage of 81mg orally, daily from the beginning of the cycle until ovulation.

Selective Immunotherapy Using Intralipid, heparin, aspirin and corticosteroid

Many causes of pregnancy loss or failure can be treated with immunotherapy comprising combinations of aspirin and heparin and corticosteroids (dexamethasone or prednisone) and Intralipid (IL) to regulate increased NKa. Achievement of optimal success with Intralipid/corticosteroid therapy requires that the treatment be initiated well before ovulation takes place (about 7-14 days prior to anticipated implantation). Given the fact that only 10-15% of natural cycles (with or without the use of insemination and/or fertility drugs) will result in a pregnancy, it follows that repeated administration of Intralipid will be required in most cases before a pregnancy will occur. IVF achieves pregnancy rates that are often 2-3 times higher. This often makes IVF a treatment of choice in cases of immunologic recurrent pregnancy loss.

Role of IVF

Preimplantation genetic diagnosis (PGD) a procedure whereby the embryo can be tested for genetic or structural chromosomal abnormalities requires the use of IVF to select the best embryo(s) for transfer to the uterus. In cases of structural chromosomal (translocations) egg or sperm donation is often another option worth considering.

In those cases where due to intractable anatomical or alloimmune dysfunction IVF repeatedly is unsuccessful or is not an option, Gestational Surrogacy might represent the only recourse other than adoption.
If a couple with Recurrent Pregnancy Loss is open to all of the diagnostic and treatment options referred to above, a live birth rate of 70%   80% is ultimately achievable.

Recurrent Miscarriage - How to Deal With It?

Clotting of blood during or after a pregnancy is fairly common these days. While the reasons for these are numerous, the driving reason behind this being that the mother is weak after such an ordeal and it is, therefore, likely to affect her health. In pregnant women, blood clots tend to form in the deep veins present in the legs or near the pelvic area. The condition is known as Deep Vein Thrombosis (DVT). One of the main concerns for people suffering from Deep Vein Thrombosis (DVT) is the occurrence of Pulmonary Embolism (PE), which is a life threating diseases and is caused when a DVT breaks and travels to the blood vessels connected to the lungs.

The symptoms of Deep Vein Thrombosis (DVT)
According to the data published on  Centre for Disease Control and Prevention  website, from a recent survey conducted it has been estimated that almost 900,000 people suffer from Deep Vein Thrombosis (DVT) every year in the United States i.e. 2 in every 1000 people suffer from this life-threatening disease. 

This disease although life threatening can be taken into account by proper medical care at the early stages and therefore patients are advised to look out for any or all of the following symptoms-

The patient is experiencing pain, swelling or tenderness in one of their legs, although both might have been affected.
You have noticed a change in skin colour, and it has taken a reddish shade.
There is a warm sensation in and around the area of the clot.
The veins on your legs are appearing larger than they should.
Although all of these are proven symptoms for Deep Vein Thrombosis (DVT), it is common to have discomfort from swelling legs during pregnancy and does not always mean that the patient has symptoms of Deep Vein Thrombosis (DVT). If you are having the slightest thought that it may be a case of Deep Vein Thrombosis (DVT), you should immediately contact your GP, midwife, or call your maternity unit.

Treatment for Deep Vein Thrombosis (DVT)
When a patient is suffering from Deep Vein Thrombosis (DVT) and she is pregnant, anticoagulants, which is a medicine that prevents clotting of blood, is administered to them. While not all anticoagulants are safe to use during pregnancy, quite a few are. It is highly advisable that a doctor or medical practitioner is consulted before taking any further step.

How to prevent Deep Vein Thrombosis (DVT)
Like all diseases around the world, Deep Vein Thrombosis (DVT) is too a preventable one if the certain Do s and Don ts are kept in mind. Below is a list of certain things to keep in mind, in order to prevent Deep Vein Thrombosis (DVT)-

Being active and moving around regularly, will keep the blood circulation normal.
Beware of your family history and consult your doctor with the same.
Look out for symptoms and contact your doctor at once if you see one.
Every disease is preventable and curable. It is on us, what we choose to do with it, succumb to it, or stand up and fight it. Look out for the above-mentioned points and you will be at a safe distance from the clutches of Deep Vein Thrombosis (DVT).

Blood Clotting During & Post Pregnancy - How It Can Be Prevented?

What is endometriosis?

Endometriosis is a common condition where cells of the lining of the womb (the endometrium) are found elsewhere, usually in the pelvis and around the womb, ovaries and fallopian tubes. It mainly affects women during their reproductive years. Endometriosis is not an infection and it is not contagious.

What are the symptoms?

The main symptoms of endometriosis are pelvic pain, pain during or after sex and painful, sometimes heavy periods. It may cause problems with getting pregnant. It can affect many areas of a woman s life including her general physical health, emotional wellbeing and daily routine. Many women may have no symptoms. It is a long-term condition. Some women with endometriosis become pregnant easily while others have difficulty getting pregnant.

What causes endometriosis?

Endometriosis occurs when the cells of the lining of the womb are found in other parts of the body, usually the pelvis. Each month this tissue outside the womb thickens and breaks down and bleeds in the same way as the lining of the womb. This internal bleeding into the pelvis, unlike a period, has no way of leaving the body. This causes inflammation, pain and damage to the reproductive organs. Less commonly, endometriosis may occur on the bowel and bladder, or deep within the muscle wall of the uterus (adenomyosis). It can also rarely be found in other parts of the body.

The symptoms of endometriosis are common and could be caused by a number of other conditions such as irritable bowel syndrome (IBS) and pelvic inflammatory disease (PID).

There is no simple test for endometriosis.
Your gynaecologist may examine your pelvic area, this will include an internal examination.
You may be offered a scan. This can identify whether there is an endometriosis cyst in the ovaries. A normal scan does not rule out endometriosis.
For most women, having a laparoscopy is the only way to confirm endometriosis; because of this, it is often referred to as the  gold standard  test. This allows the gynaecologist to see the pelvic organs clearly and look for any endometriosis.
Several factors may influence your decision about treatment. These include:

How you feel about your situation
Your age
Whether your main symptom is pain or problems getting pregnant
What treatment can I get?

The options for treatment may be:

Pain relief

Hormone treatments: There is a range of hormone treatments to stop or reduce ovulation (the release of an egg) to allow the endometriosis to shrink or disappear. The hormonal methods below are contraceptives and will prevent you from becoming pregnant:

The combined oral contraceptive (COC) pill or patch. These contain the hormones estrogen and progestogen and work by preventing ovulation and can make your periods lighter, shorter and less painful.
The intrauterine system (IUS): this is a small T-shaped device which releases the hormone progestogen. This helps to reduce the pain and makes periods lighter. Some women get no periods at all.
The hormonal methods below are non-contraceptive, so contraception will be needed if you do not want to become pregnant:
Use of hormonal progestogens or testosterone derivatives
GnRH agonists are drugs that prevent estrogen being produced by the ovaries and cause a temporary and reversible menopause.
Some women find that recreational exercise improves their wellbeing, which may help to improve some symptoms of endometriosis.

Surgery: Surgery can be used to remove areas of endometriosis. There are different types of surgery, depending on where the endometriosis is and how extensive it is. How successful the surgery is can vary and you may need further surgery.

Laparoscopic surgery: The gynaecologist removes patches of endometriosis by destroying them or cutting them out.
Laparotomy: If the endometriosis is severe and extensive, you may be offered a laparotomy. This is major surgery which involves a cut in the abdomen, usually in the bikini line.
Hysterectomy: Some women have surgery to remove their womb (a hysterectomy) with or without the ovaries. Depending upon your own situation, your doctor should discuss hormone replacement therapy (HRT) with you if you have your ovaries removed.
What if I am having difficulty getting pregnant?

Getting pregnant can be a problem for some women with endometriosis. Your doctor should provide you with full information about your options such as assisted conception. If you become pregnant, endometriosis is unlikely to put your pregnancy at risk.

Endometriosis - Signs & Symptoms That Indicate It!

Pregnancy brings with it a new set of additional responsibilities. The mother has to be extra vigilant about monitoring and caring for her health. This ensures that sufficient nutrition is being provided to the growing infant, at the same time, ensuring no harm comes to you. Listed below are some simple ways to do the same.

1. Prenatal care: As soon as you realize you are pregnant, it is advisable to talk to a doctor or a midwife about proper prenatal care. This could include anything and everything from prenatal vitamins to food habits to exercise to sleeping habits to periodic scanning and a number of other things that your doctor will prescribe.

2. Diet: You need to ensure two things that is you are eating enough for two people and everything is healthy and not harmful for the little one that gets all its nutrition through you. The diet should be healthy, nutritious, wholesome and of course free of junk. Some pointers to a healthy diet include:

a. Include a good amount of fruits and vegetables every day; break it into five small portions.
b. Sufficient amount of carbohydrates should be the basis of each meal.
c. Whole grains are preferred to white grains, which also give good amount of fiber.
d. A good amount of proteins including fish, eggs, meat, nuts, pulses, milk, and other dairy products.
e. Ensure adequate amount of iron, calcium, and other minerals are included in the diet.
f. Avoid eating unpasteurized dairy products, uncooked or undercooked food and smoked seafood.
g. While most vitamin requirements should be met through the diet, in some people, prenatal vitamins which provide the increased demands for folic acid.

3. Weight gain: If your weight was normal for your age and height before pregnancy, expect to add about 12 to 15 kg during your pregnancy. Consult with your doctor on weight changes and nutritional aspects to monitor weight throughout pregnancy. This could change based on if it is twins, your weight before pregnancy, and body type.

4. Exercise: Exercising during pregnancy is being increasingly encouraged for the following reasons:

a. Improved energy levels
b. Controls back pain
c. Improved sleep pattern
d. Improves constipation
e. Improves muscles strength and endurance
There are specific exercises designed to benefit the pregnant women. Whether it is walking or swimming aimed at improving overall health or Kegel exercises aimed at improving vaginal and perineal muscles, your doctor should be able to draw up a routine.

5. Lifestyle changes: With pregnancy setting in, it is time to bid goodbye to smoking and drinking alcohol. Continued smoking after onset of pregnancy has many serious complications, including growth retardation, low birth weight. Alcohol can lead to miscarriage, stillbirth and premature delivery.

These are simple ways to monitor and care for your and of course, the baby's health throughout pregnancy.

5 Ways to Monitor and Care for Your Health During Pregnancy

When endometrial tissue that usually grows inside the uterus, starts growing outside uterus, it is called Endometriosis. Pain during or before periods, pain during intercourse, pain while urinating or bowel movements, heavy bleeding, infertility are some of the symptoms of endometriosis.

Treatment of endometriosis usually depends on the following factors:

Age of female
Severity of symptoms
Duration of the symptoms
Future plans for children/ fertility
Associated pathologies
Accordingly the doctor might choose any of the treatment options like:

Medication for Pain: If the symptoms are mild, then the doctor will prescribe some pain  relieving medications like Nonsteroidal anti-inflammatory drugs (e.g. Diclofenac) or anti-spasmodics(e.g.drotaverine)
Hormone Therapy: Hormone therapy is effective, but once you stop them, your symptoms may recur. Some of the hormone therapies include: 
Hormonal Contraceptive pills: Useful in controlling the hormones that are responsible for endometrial tissue growing outside the uterine cavity.
Medroxyprogesterone: This helps to counter effect estrogen hormone which is responsible for endometrial tissue growth.
Gonadotropin-releasing hormone (GnRH) agonists: Gonadotropin hormones that stimulate ovaries are blocked by these. They bring down oestrogen levels and hence symptoms. It can cause absence of menstruation in some females which is reversible.
Danazol: It is synthetic androgen, suppresses growth of endometrial tissue temporarily.  However, Danazol may not be a favourable option because of its side effects. Females should avoid pregnancy while on this drug.
Dienogest: This newer progesterone molecule, which does not have major side effects and is apporved for use in endometriosis.
Other medications like selective progesterone receptor modulators, immunomodulators, anti angiogenic factors are being evaluated.
Conservative surgery: If you are trying to conceive, then surgical excision or ablation of endometrial tissue is one treatment option.Suboptimal surgery with conservation of maximum ovarian tissue is considered suitable in such cases.
Hysterectomy: In severe endometriosis cases where female has completed her family, hysterectomy is offered wherein the uterus, cervix & if required ovaries can be removed.

Endometriosis - Ways To Manage It Well!

Don't wait any longer, manage your Perinatologist online with a Lybrate doctor today

Consult for Perinatologist - Online and Easy!

FilterClear All

COMMON SPECIALITIES

COMMON ISSUES