In vitro fertilization (IVF) is a process of fertilization in which eggs (ova) from a woman's ovary are removed. They are combined with sperm outside the body in a laboratory procedure, and then the fertilized egg (zygote) is transferred to the same or another woman s uterus for a successful pregnancy.

IVF is one of the several assisted reproductive techniques (ART) used to help infertile couples to conceive a child.

Causes of Infertility

Blocked fallopian tubes
Hormonal imbalance
Endometriosis
Women with ovulation disorder
Uterine fibroids
In the man, low sperm count or poor quality sperm
Genetic disorder
Procedures
Two procedures are done to gain access to ovaries

It involves inserting the needle through the vagina (transvaginally). With the help of an ultrasound machine, the physician guides the needle to the location of the ovaries
In the other procedure, called laparoscopy, a small thin tube with a viewing lens is inserted through an incision in the navel. This lets physician to see inside the patient, and locate the ovaries.
Method
Without additional techniques, the chances of pregnancy would be extremely small. The additional techniques used in IVF include-

Ovarian hyperstimulation- Stimulation to induce development of multiple follicles of the ovaries.
Final maturation induction- Induction of final oocyte maturation is performed, generally by an injection of human chorionic gonadotropin (HCG), when the ovarian follicles have reached a certain degree of development. This is known as the "trigger shot  
Egg and sperm preparation- Semen is prepared for fertilization by removing inactive cells and seminal fluid in a process called sperm washing. An oocyte selection may be performed prior to fertilization to select eggs with optimal chances of successful pregnancy. 
Co-incubation- Eggs are removed from the woman and placed in one of the fallopian tubes, along with the man's sperm. This allows fertilization to take place inside the woman's body. Therefore, this variation is actually an in vivo fertilization, not in vitro.
Embryo culture- The main durations of embryo culture are until cleavage stage (day two to four after co-incubation) or the blastocyst stage (day five or six after co-incubation)
Embryo transfer- The number to be transferred depends on the number available, the age of the woman and other health and diagnostic factors. Embryos are transferred to the patient's uterus through a thin, plastic catheter, which goes through her vagina and cervix.
Aftercare
After the IVF procedure is performed the woman can resume normal activities. A pregnancy test can be done approximately 12-14 days later to determine if the procedure was successful.

Risks

Multiple pregnancies
Ectopic pregnancy
Ovarian rupture, bleeding
Infections
Complications of anesthesia

In Vitro Fertilization - Quick Facts!

The presence of red blood cells in the urine is called hematuria. If there are sufficient red cells, the urine turns to a bright red, pink or cola shade. Frequently, the urine looks totally ordinary because there is insufficient blood to change the colour. In this situation, the condition is called 'microscopic' hematuria.

The most common causes of hematuria are given below:

    Urinary tract infection (UTI)
    Kidney stones
    Tumours in the kidney or bladder
    Exercise: In this case, the blood is produced in the urine after strenuous activity. It is more commonly experienced by male patients.
    Injury: Traumatic damage to any part of the urinary tract, from the kidneys to the urethral opening, can cause hematuria.

The symptoms of hematuria vary depending upon the condition. These are as follows:

    Glomerulonephritis: If the glomerulonephritis is not serious, it may not show any signs. If the symptoms do show up, they can cause swelling, particularly in the lower furthest points(the thighs, legs, feet, and toes), decreased urine, and hypertension.
    Kidney or bladder infection: Symptoms rely on the site of the diseaseand can even cause extreme pain on one side of the lower back, fever, chills, nausea with vomiting, and pain in the bladder.
    Prostate infection: There can be pain in the lower back or in the region between the scrotum and rearend. Pain with discharge, blood in the semen, andfever and chills can also occuronce in a while.
    Tumour in the kidney or bladder: Most kidney and bladder problems develop without bringing about any pain or uneasiness. At the point when side effects build up, abdomen pain may be persistent.
    Kidney stones: When a kidney stone gets attached to the ureters, it can bring about extreme pain in the back, side or crotch, with nausea and difficulties in urination.

Based upon the suspected cause of hematuria, some of the treatments may include the following:

    Urine culture: In this test, a urine sample is extracted and examined to check whether bacteria has developed. This test is used to find a case of a kidney or bladder disease.
    Computed tomography (CT) of the kidneys, ureters and bladder: For most cases,a CT scan is conducted. This helps in viewing the internal organs and finding the areas that may have been affected by the condition. It also shows the extent of the damage and the spread of the disease so that a proper treatment plan may be laid out.
    Ultrasound: This test uses sound waves to create images that can show whether or not a kidney mass is a non cancerous. This method can also be used to find out whether or not there are any kidney stones, which may be causing hematuria.
    Cystoscopy: In this test, the specialist embeds an adaptable telescope into the urethra and passes it into the bladder to investigate the bladder lining for tumours or different issues.

Can Hematuria Be Treated?

There are two methods by which abortion can be done:

Medical Abortion - Non-surgical abortion in which medicines are used to induce abortion

Surgical Abortion - Use of transcervical procedures for terminating a pregnancy, including vacuum aspiration, and dilatation and evacuation (D and E).

Surgical or Medical Abortion for Unwanted Pregnancy

If pregnancy is lesser than = 7 weeks; medical method with Mifepristone with Misoprostol is favorable as the success rate is as high as 97%.

If pregnancy is between 7-12 weeks; surgical abortion is the only option.

If pregnancy is beyond 12 weeks - 20 weeks, then the woman needs to be hospitalized and will be given either Mifepristone followed by Misoprostol tablet or only Misoprostol tablets and woman will then abort like a miscarriage in the hospital. If any products are remaining, then it will be evacuated surgically.

Surgical abortion is preferred if patient desires concurrent tubal ligation or IUCD (CuT) insertion.

If a woman fulfills the criteria for selecting either method i.e. before 7 weeks, final choice has to be given to the woman.

Summary of choice between Surgical or Medical abortion in India

lesser than = 7 weeks - Medical method or surgical method

7-12 weeks - Surgical abortion

12 - 20 weeks - Medicines with or without surgical procedure in hospital

Advantages of Medical Abortion

Avoid surgery

Controlled by the woman and may take place at home

No need for admission to the hospital

Usually, well tolerated by women, if properly counselled and motivated

No need to take leave from work, as bleeding can be managed with menstrual pads even while in the office or at work.

Disadvantages of medical abortion

Takes time (hours to days) to complete abortion, and the timing may not be predictable. Women experience bleeding and cramping, and potentially some other side-effects (nausea, vomiting, fever, and shivering). May require more clinic visits than surgical abortion.

Advantages of Surgical Abortion

Quick procedure

Complete abortion easily verified by evaluation of aspirated products of conception

Takes place in a hospital so Sterilization or placement of an intrauterine device (IUD) may be performed at the same time as the procedure. It can be performed under local anaesthesia if woman is properly motivated and counselled

Disadvantages of surgical abortion

Requires instrumentation of the uterus

Small risk of uterine or cervical injury

Timing of abortion controlled by the doctor and hospital

Anaesthesia needs to be administered. Most doctors perform this procedure under short general anaesthesia. A woman needs to be in the hospital for at least 6 hours. Effect of sedation will be there throughout the day.

Methods of Abortion for Unwanted Pregnancy

The tissue that lines the uterus is known as the endometrium. In some cases, it can grow outside the uterus. This is known as endometriosis. Endometriosis usually involves organs in the pelvic cavity such as the ovaries, fallopian tubes, bowel and lining of the pelvic cavity. In rare cases, it may involve the vagina, cervix and bladder as well.

Depending on the location and extent of endometrial tissue, it can be classified into four stages ranging from minimal to severe. Most cases of endometriosis fall into the minimal or mild category which involves mild scarring and superficial tissue implants. Moderate or severe endometriosis can cause cysts and severe scarring. Infertility is also commonly associated with severe endometriosis.

Pain in the pelvic area just before and during menstruation is one of the most characteristic symptoms of this disorder. This is because the overgrown endometrial tissue acts like normal endometrial tissue and is shed during menstruation. The only difference is that since there is no exit for this overgrown tissue, it is trapped in the pelvic cavity. The location of the implantation of endometrial tissue also plays a role in the amount of pain experienced. The deeper the implant, more the pain. Implants near areas with high nerve density are also more likely to be painful than implants in areas with low nerve density.  These implants may also release substances into the blood stream that can cause pain.

Other symptoms associated with this disorder are:
  Painful intercourse
  Painful urination
  Pain during bowel movements
  Infertility

These symptoms especially the pelvic pain can vary from month to month in terms of duration and intensity.

A few simple changes in your diet can help manage the symptoms associated with this disorder and in some cases, prevent it as well. Avoid processed food and foods that are high in sodium content. You should also avoid high-fat dairy and food that is rich in arachidonic acid. Instead, increase your consumption of carbs and green leafy vegetables. You could also add two tablespoons of walnut oil a day to your diet to help combat inflammation and the other effects of arachidonic acid.

Early stages of this disease can be treated with hormone therapy, but if it has progressed to the later stages, surgery may be needed. This surgery is performed laparoscopically and aims at removing all the implanted tissue from outside the uterus. However, in cases where the anatomy of the pelvic organs has been distorted by the implants, a hysterectomy may be required. This option, however, it usually considered only in cases where a woman does not have any plans of conceiving more children. 

Endometriosis - How It Is Affecting Your Life?

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 book an appointment with your 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

Oftentimes, medical practitioners resort to what is called  watchful waiting .
At times, ovarian cysts disappear in a few months.
It is recommended to take a blood test and an ultrasound to see the progress of the cyst.
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.

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.
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.
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.

Ovarian Cysts - 3 Ways They Can Be Treated!

PMS or premenstrual syndrome affects women exactly prior to their menstrual cycle. This syndrome may have affects manifold, impacting a woman s physical health, behavior and emotions. The condition is very common and affects more than 80% of the women before their monthly cycles begin.

Causes-

The exact cause of PMS is not yet ascertained. It is believed that changes in hormones in the body can lead to PMS. Before the menses start, progesterone and estrogen levels tend to dip in the body. This hormonal dip results in anxiety, anger and irritability issues. Levels of serotonin, a chemical in the brain which affects your moods and thoughts, in the body also decrease at this time. Here are certain factors which make you prone to PMS  

Family history of PMS
Being subject to domestic violence
Emotional and physical trauma
Substance abuse
Past history of mood disorders
Symptoms-

The menstrual cycle lasts for 28 days. On the 14th day, egg is released from the ovaries; this is known as ovulation. The bleeding or menstruation occurs on the 28th day of the cycle. Symptoms of PMS start to show up from around the 14th day of the cycle.

PMS includes signs such as abdominal cramps, bloating, acne and sudden craving for sweet foods. Stomach disorders such as constipation and diarrhea are also common. Mental disorders such as anxiety and mild depression have also been observed.

Managing PMS Symptoms-

With PMS, one can take these steps to deal with the various signs of discomfort. Here are some remedies to deal with PMS symptoms:

Eat a balanced diet consisting of fruits and vegetables to get Vitamins and minerals in the required amounts.
Keep yourself hydrated to ease symptoms of bloating.
Consuming supplements of folic acid, Vitamin D and calcium can help easing the symptoms.
Sleep for 6-8 hours on a regular basis.
Exercise regularly to beat stress and avoid bloating.
Try relaxation techniques to get rid of stress or at least limit stress levels.
Some pain killers can help combat the pain resulting from muscle aches.

Dealing With Premenstrual Syndrome (PMS)

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