Doctor in Dynamic Fertility and IVF Centre
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Dr is professionally sound n goes into minute details of treatment process, unlike others she always try n explain the basis behind her decisions, always give nice,patient hearing n remembers details about the patient...
I found the answers provided by the Dr. Nalini Gupta to be very helpful and well-reasoned. Thanks for response and positivity
Hi Mam u r such a wonderful Dr and good nature .very thankful to u give me good life experience.
I found the answers provided by the Dr. Nalini Gupta to be knowledgeable. Thanks
Pregnancy can be easy and smooth, while on the other hand, it might be time consuming, marred with conception difficulties all along the way. Pregnancy may seem exciting to some, whereas it can be stressful for others. Regardless of whether it is the first child you are planning or have had a successful pregnancy previously; there are some tips you need to keep in mind in order to improve fertility and give birth to a healthy child.
These fantastic swimmers are at the very root of male fertility. Some important components which need to be taken into consideration are sperm count, sperm motility (the ability of the sperm to swim around the female reproductive tract) and morphology (shape and size of a sperm). In order to have all these parameters in check and working fine, one needs to abstain from smoking and limit alcohol consumption among many other lifestyle modifications.
Having unprotected vaginal intercourse during the woman’s fertile days in a month helps improve chances of conception.
Fertility becomes a challenge when you are either overweight or underweight. The weight of a woman affects ovulation (The release of eggs from the ovaries) and causes hormonal imbalance; factors which make it very difficult to conceive. Keep your weight levels in check and that could prove primarily essential in bettering your fertility.
Staying well nourished boosts your odds of conceiving! Make sure to include enough protein, iron, zinc, vitamin C, and vitamin D in your diet, because deficiencies in these nutrients have been linked to lengthened menstrual cycles (and therefore less frequent ovulation) and a higher risk of early miscarriage. Ask your gynaecologist if you should take a daily multivitamin supplement. And be sure to eat protein-rich foods, such as meat, fish, low-fat dairy products, eggs, and beans.
Beware of STDs or Sexually Transmitted Diseases. One is the most prone to STDs of any kind if he/she happens to engage in unprotected sexual intercourse; having a number of sexual partners just ups the chances of getting afflicted by STD. Protected vaginal intercourse helps prevent STDs, thus enhancing fertility and subsequently, chances of conception.
According to several studies, the lubricant one chooses surprisingly plays a significant role in determining fertility. Not all lubricants boost fertility and sperm motility (sperm count). Baby oil or egg whites are a few good examples of such lubricants.
While a limited amount of caffeine consumption is good, overdoing it might spoil and hamper fertility. Limit caffeine intake and keep it within a level of 200-250mg a day.
Smoking, besides playing havoc with every organ in the body, affects the reproductive organs and thus fertility. In men, it leads to reduced sperm count and in women, it causes DNA damage. Stub the bud right now and never get back to it.
Certain toxic chemicals can lead to female and male infertility. So it is advisable that you stay away from chemicals such as pesticides, organic solvents and lead, the primary toxins which pose a severe threat to fertility.
- Exercising regularly can never go wrong. It gives you the strength and stamina, boosting your overall health. However, vigorous exercises, especially when you are trying to conceive, will do you no good. It might adversely lead to the suppression of certain hormones such as progesterone (pregnancy stimulating hormone) and might affect ovulation, hence affecting fertility. Aim at a regular 20 minutes session of light exercises; mild cardiovascular exercises such as walking can work wonders, especially in such circumstances.
It is as important for the man as it is for the woman to undergo certain tests before the IVF cycle is started. Fertility is not only an issue for a woman, but it also might be for the man in question. There are certain tests that need to be conducted on men before they can gear up for IVF:
1. Semen Analysis: One of the most important tests for male infertility is semen analysis. Sometimes, a man may be completely healthy, but his sperm production could be of poor quality. Semen analysis is done to provide an accurate evaluation of sperm number, the ability to move (motility), size and shape (morphology), as well as the consistency and volume of the sample collected.
2. Binding Test: Sometimes agglutination occurs where the sperms might stick to each other by their heads or tails. Sperm antibodies might cause this problem. The IVF treatment's success might be compromised if this happens. A simple binding test is done to determine this.
3. Trial Wash: This is also known as sperm wash. It is mostly done to remove chemicals from the sperm. Not doing a sperm wash might end up affecting the later stages of the IVF treatment. In this process, the misshapen and immotile sperm is separated so a clean sample of motile and healthy sperm can be collected.
4. TUNEL Assay: Since sperms build up about half of a child's genetic makeup, a TUNEL Assay or 'sperm DNA test' is required. This test is done to measure the sperm population that have fragmented DNA. Negative impacts on genetics can hamper the success of the fertility treatment.
TUNEL Assay is usually recommended to men with:
- Leukocytes detected by the sperm analysis
- Age approaching 50
- A history of diabetes II type or prostatitis
- Exposure to chemicals or prolonged heat at workplaces
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.
The concept of egg quality of a woman is derived from the belief that the embryo implantation probability is powerfully related to the age and ovarian reserve of the woman. Thus, it is regarded that the quality of the egg is almost synonymous with the chances of embryo implantation. Its quality cannot be assessed merely by looking at the egg or measuring its ability to receive the fertilization by sperm or simply observing the initial embryo division.
- Diminished ovarian reserve: A woman with an increased FSH level on the third day of the menses is regarded as having diminished reserve of ovary. This implies that her ovary is not competent in sending feedback signals to the pituitary gland and the body responds by producing an increased amount of FSH for stimulating the ovary. For more than 10 years, it has been found that in over thousands of fertility treatment cycles, women with an increased FSH level have a lower egg quality.
- Advanced age of maternity: Even though the FSH level is normal, the age of the mother who provides the eggs plays an important role to determine the quality of the egg. Quite like women with increased FSH levels, eggs obtained from women aged more than 40 years can have some problems at a later stage of fertilization. Normal FSH levels are not considered a reassuring factor, owing to the lower implantation rate in females aged over 45 years.
- Diminished quality of egg: With an increase in age, the capacity of the mitochondria in producing energy slowly decreases. The egg is linked to the circulation before ovulation, and it is linked again after the embryo implantation. But during the one week time ranging from ovulation to implantation, the egg and the resulting embryo are contained in the zona pellucida and function on the basis of mitochondrial energy supply. The older age of the woman doesn’t cause any problem at the initial stage of ovulation. Its fertilization and embryonic development are also normal. But soon, it runs out of energy and stops dividing before reaching the stage of implantation.
Therefore, it is important to have the eggs tested to find out any sort of chromosomal abnormality. In case the mother is deficient of producing high quality eggs, the best option is to have donor eggs.
The fallopian tubes are a part of a woman’s reproductive system. This is the passage through which the egg travels to meet the sperm and attach the end result to the lining of the womb or the uterine lining. In many cases, the fallopian tubes may get blocked, which can cause a series of complications, including infertility and other issues.
Read on to know more about the complications as well as the diagnosis.
Fallopian tubes: These are two thin tubes that flank either side of the uterus. It helps the matured egg from travelling from the ovaries to the uterus.
Blockage of fallopian tubes: Sexually transmitted diseases or STDs, as well as endometriosis, can cause a blockage in the fallopian tubes. The tubes can get blocked from one or both sides.
Complications: Blocked fallopian tubes can lead to major complications like early pregnancy loss as well as infertility. Every month, the ovaries release eggs during a cycle known as the ovulation cycle. During this period, the eggs leave the ovaries and travel through the fallopian tubes in order to reach the uterus, where they can possibly get inseminated with sperm, after which they will get fertilised and attach themselves to the uterine lining or the womb. In case the fallopian tubes are blocked, the eggs gets blocked and do not get a passageway to travel from the ovaries and into the uterus. This can lead to infertility as it will prevent fertilisation of the released egg. Furthermore, blocked fallopian tubes can also lead to tubal pregnancies, which will have to be terminated as it can lead to severe health risks.
Symptoms: So how can you find out whether your fallopian tubes are blocked? There are a number of symptoms that may be caused in the course of this condition. It is important to be even more careful about the symptoms because they may not be as obvious as other conditions, where irregular periods and heavy bleeding may point to the problem at the very onset. Pain in the lower abdomen and unusual discharge usually point to the problem. Also, loss of pregnancy due to the blockage is also a clear cut diagnosis.
Diagnosis: The diagnosis of the condition is done with the help numerous tests and imaging examinations conducted by a gynaecologist. A specialised X-ray called hysterosalpingogram or HSG is used in order to diagnose the issue. In this kind of examination, a dye is inserted through the uterus. This dye has a lens at the end, which shows the blockage and its extent. The doctor then conducts tests to find out the causes of this condition so that proper treatment may be followed.
INVO (intravaginal culture of oocytes), also called IVC (Intravaginal culture) is an abetted procedure of reproduction where early embryo development and oocyte fertilization are carried out inside a gas penetrable, air-free plastic tool or device that is placed into the maternal vaginal chamber for incubation. It is a device that helps the future mothers to participate in the evolution and growth of their own embryos present inside their body. The device is composed of an inner cavity with a protective outer rigid shell and a rotating valve.
It can be used for IVF (In Vitro Fertilization) cycles; whether with the mother's own eggs or any donor's eggs. It provides the same successful results as conventional treatments. It works in a very simple way:- when the requisite samples to produce embryos have been acquired or when the eggs have been impregnated in the laboratory, they together with culture medium are placed into the INVOcell device and then the device is inserted into the vagina of the mother and there it is kept for two to three days (for 72 hours culture period). Throughout this time, the mother can lead a practically normal life but she needs to elude taking bath, having intercourse or flying during those days on which she is wearing it.
When fertilisation takes place, it will be the mother's own heat which will supply the best conditions for the proper development of the embryos. Once they are set and ready, the doctor will remove the INVO from the mother's vagina to recover the embryos. The embryos are then evaluated under the microscope to choose the healthiest-looking ones to transfer them into the uterus. Within the uterus they will be embedded in order to begin developing.
- It is one of the most cost-effective assisted conception treatments.
- In this method, the embryo incubation is more natural.
- Since in this whole process embryo incubation in the laboratory isn’t required, the possibility of stumbling at the laboratory is diminished.
- In this method, the couple experiencing the treatment is involved more.
- This method has similar efficacy as the IVF treatments.
Disadvantages of INVO are:
- Since the device has to remain for three days in the mother's vagina, it causes some discomfort.
- The patient has to spend much time in the assisted reproduction clinic and visit it more often.
The studies suggest that it could be a usable alternative choice for assisted reproduction.
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.
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.