Dr. Anju Ahuja

In simple terms, infertility is the inability of a couple to bear children when using no contraception. This could be due to the male not being able to contribute to conception or the female not able to carry a pregnancy to term. Though the female is attributed to be the reason very often, almost 50% of infertility cases are due to issues with both the male and female.

Causes: Some of the main male and female causes of infertility are listed below.

1. Women: Poor egg quality, thyroid abnormalities, polycystic ovarian syndrome, endometriosis, pelvic surgery, chemotherapy, radiotherapy, and uterine prolapse.
2. Men: Erectile dysfunction, hypogonadism, low sperm count, poor sperm quality, testicular infections, ejaculation disorders.

Risk factors: Infertility is on the rise and some of the risk factors are identified to be:

1. Advanced maternal age: With females choosing to have children later in life, even as late as 40 years, infertility is on the rise. As per studies, female fertility is believed to reduce after 32 years.
2. Smoking: This is the biggest contributor of infertility in recent times, the effect is more severe when the woman is also a smoker
3. Obesity: With changing lifestyles, obesity has become an epidemic in both women and men, leading to infertility.
4. Increased stress levels: This leads to strained relationships. Impotence in men, poor egg quality, and erectile dysfunction are all caused by increased stress levels, leading to infertility.
5. Eating disorders: Leads to obesity and poor health overall, leading to infertility.
6. Alcohol consumption: This again causes erectile dysfunction, leading to infertility.
7. Excessive or lack of exercise: Lack of exercise leads to obesity and overall lethargy. Over-exercising, on the other hand, leads to erectile dysfunction.
8. Environmental pollution: Exposure to toxins and chemicals has increased, reducing overall sperm and egg quality.

Infertility is often caused by a combination of these factors. Changing lifestyles with smoking among women on the rise is a major cause of infertility.

Diagnosing infertility: The reason for infertility should be identified so that treatment can be directed appropriately. Most often, women are cited as the reason for a couple’s infertility. That is not necessarily the case, and in about 30% of the cases, the male also could be contributing to infertility. The following methods are useful:

1. Physical exam
2. Semen analysis
3. Blood tests
4. Ultrasound
5. STD testing
6. Laparoscopy
7. Thyroid function tests

Treatment: Once the cause is identified, then targeted treatment can be done, including:

1. Sexual counseling for the couple
2. Treatment for erectile dysfunction and hypogonadism
3. Hormonal treatments for women
4. Fallopian tube surgery
5. Laparoscopic surgery.
6. Intrauterine insemination
7. In-vitro fertilization
8. Sperm donation

An early detection of cancer increases the chance of cure and survival; the same is true in the case of breast cancer as well. However, globally, an estimated 80% of women that undergo breast biopsy for diagnosis do not have breast cancer. So, when should a woman undergo breast biopsy? Read on to get an in-depth understanding.

What is a breast biopsy?
A breast biopsy is a clinical test that detects unhealthy tissues and suspicious fluids in the human breast. The sick cells are removed and examined under a microscope in a bid to detect breast cancer. A biopsy is the only means of determining whether the suspect area in the breast is affected by cancer.

What are the types of breast biopsy?
Various types of breast biopsy procedures are practised. These include fine-needle aspiration biopsy, core needle biopsy, stereotactic biopsy, ultrasound-guided core needle biopsy, MRI-guided core needle biopsy, and surgical biopsy.

The fine-needle aspiration biopsy is the most uncomplicated process that can evaluate a lump which can be felt during a clinical exam. Core needle biopsy may be used for evaluating lumps that are visible on a mammogram or ultrasound scanning. Stereotactic biopsy utilizes mammograms to pinpoint a location of suspicion within the breast.

Ultrasound-guided and MRI-guided core needle biopsy methods are used to guide core needle biopsy processes.

When is it recommended?
A gynaecologist may recommend undergoing a breast biopsy if he or she suspects a lump or thickening of the flesh in the breast. Mammograms and ultrasound or MRI techniques may detect a suspicious finding. Subsequently, patients have to undergo a breast biopsy to confirm the presence (or absence) of cancerous growth in the breast. Doctors and health professionals also recommend the test if conditions such as unusual areolar or nipple changes (such as scaling, crusting, bloody discharge or dimpled skin) are detected.

What are the preparations involved?
Before undergoing the breast biopsy, patients should inform their doctors about any allergies or any consumption of prescribed medication such as aspirin or other blood-thinning tablets. Similarly, doctors must be notified in advance if patients are unable to lie on their stomach for a long stretch of time. When biopsy procedures involve magnetic resonance imaging, doctors must be told if the patient has a cardiac pacemaker or any other electronic device implanted in their body. Also, health professionals must be advised when biopsy candidates are pregnant. These precautions are necessary because an MRI biopsy may not be suitable in these circumstances.

Women that are scheduled to undergo biopsy must wear an excellent supporting brassiere since they may have to hold a cold pack in the biopsy site. The correct undergarment can hold the pack in place and offers the necessary support.

It is worthy to note that multiple breast biopsy procedures may be required to obtain a tissue sample from the patient’s breast. The attending gynaecologist may recommend a particular method based on the size, location, and other individual characteristics of a lump in the breast.

So, you might have to undergo the procedure if recommended by your doctor. Patients can seek a second opinion if skeptical in this regard.

Childbirth is one of the most beautiful and exciting times in a woman’s life. However, carrying a baby for nine months and giving birth can be a strenuous process, particularly when the woman opts for a C-section delivery. After the birth of the child, the mother needs more time to heal than women that opt for a vaginal delivery.

We have listed four easy and simple ways to help a new mother cope with the strain of childbirth.

1. Adequate rest: In contrast to other forms of surgery, a C-section is a major surgical procedure that requires the body to undergo major healing processes. Women that have delivered a child may have to stay in the hospital for an estimated 3 to 4 days after delivery. This duration may be extended in case of any complications during childbirth. Even though it sounds easy to rest, new mothers may find it difficult to lie in bed for long hours when their tiny bundle of joy demands a lot of caring and attention. So, the best way to deal with this situation is for the new mother to rest when the baby is sleeping. Relatives and caregivers can be enlisted to help with diaper changes while the new mother undergoes a full resting schedule.
2. Relaxation: Women that opt for a C-section childbirth should avoid movement immediately after delivery to the extent possible. They must avoid climbing stairs and keep everything within arm’s reach. The placement of all essential items should be designed to minimize any movements for the new mother. Also, new mothers should hold their abdomen in a bid to protect the incision site whenever they sneeze or eject a cough. Under normal conditions, it may take up to 2 months for the new mother to resume a regular life routine. They are advised to avoid strenuous work but can be encouraged to undertake short walks.
3. Relieve discomfort: In the days following childbirth, women should consult with their doctors regarding the most suitable pain relievers. The choice of medication is important because these women are breastfeeding their babies. The gynecologist may prescribe a pain reliever or over the counter NSAID. Besides medicines, a heating pad can help alleviate the pain and discomfort in the site of surgical incision.
4. Nutrition: Good nutrition is essential after childbirth. As long as the new mother breastfeeds her baby, she remains the child’s only source of nutrition. Thus, they are advised to consume a variety of healthy foods so that the baby grows strong and healthy. Research indicates that consuming vegetables adds flavor to breast milk; this feeling can boost the newborn child’s appetite. New mothers should ensure they consume plenty of fluids, mainly water, to increase the supply of milk and to keep constipation at bay.

These words of advice can help women to cope with the aftermath of a successful delivery. Doctors and medical professionals must be consulted to imbibe best practices for the mother and her newborn. In case you have a concern or query you can always consult an expert & get answers to your questions!

Andrology is the male equivalent of gynecology, which refers to the study of the female reproductive system and sexual health. Unlike its female counterpart, andrology is not very widely used. Urology is a more popular known specialty for male urinary and reproductive issues.

Read on to understand some of the common issues and procedures that come under the purview of andrology.

1. Vasectomy: One of the most effective methods of birth control, vasectomy is ligating the tubes so that the sperm does not enter the urethra. It is a definitive surgical contraceptive technique and is very simple, as compared to the other contraceptive measures.
2. Circumcision: Surgical method of removing the foreskin, which may be done for medical or elective reasons, at birth or later in life. This is one of the most widely performed surgical procedures across the world.
3. Prostatitis: The prostate gland is a walnut-sized gland located between the bladder and the penis. It can get inflamed as a result of infection, often bacterial. This can be acute or chronic and presents with painful urination and change in color of urine. The patient never has the feeling of having emptied the bladder fully, and there is a constant fullness. Urge to urinate is increased, especially at night. A course of antibiotics often helps in treatment.
4. Impotence: The most common reproductive problem in males, impotence or erectile dysfunction is now known to have strong psychological and physiological components. In addition to male organ problems, there can be unhealthy relationships and performance anxiety which also could lead to impotence. In most cases, counseling will help in managing impotence.
5. Epididymitis: In sexually active males, the epididymis which is located behind the testicles can get inflamed as a complication of gonorrhea or chlamydia. There can also be swelling of the testicles, frequent urination, and a burning sensation when urinating. Treatment includes pain killers and antibiotics.
6. Phimosis: In a patient with phimosis, the foreskin cannot be pulled back beyond the glans. There could be a balloon-like swelling with urination under the foreskin. It is often painless, but with the erection, may be slightly painful. Seen in young children, usually resolves by the age of 7 years.
7. Peyronie's disease: This is a connective tissue disorder, where fibrous plaques form in the soft areas of the penis. The penis develops a curvature which does not easily go away. It becomes common with age and interferes with urination and sexual intercourse. Though it resolves with time, there is no definitive treatment for this condition.

These are the major conditions encountered by andrologists. This specialty has gained popularity over the last few decades and is only set to get more popular in the coming years.

Sexology, by definition, refers to a scientific study of human sexuality to include sexual functions, interests, and behaviors. A clinical sexologist deals with the treatment of sexual and relationship issues. It covers all aspects to include biological, psychological, sociological, and historical information. A sexologist is more commonly known as a sex therapist. With sex life slowing down with pregnancy, there are many questions that people have. Read on to know some of these and their brief answers.

Is it safe to have sex during pregnancy?
– A healthy sex life through pregnancy is encouraged, to keep the relationship healthy and happy. In many cases, not having an active sex life can be a cause of rifts.

We were not aware about the pregnancy, so we continued with normal sex life, is that okay?
– It is perfectly okay, as sex is considered safe throughout pregnancy until the water breaks. Of course, the physical comfort of the woman should be taken into account, else there is no harm to an active sex life. With increased levels of estrogens and progesterone in the blood, the woman wants to have more sex but is often scared.

What positions are better during pregnancy?
- Any position which does not add pressure on the belly. Spooning, woman on top, and other positions which the couple finds comfortable can be used without any harm.

Till what stage of pregnancy can we have sex?
- From a medical point of view, sex is allowed until the water breaks. However, the physical comfort of the woman should be taken into account. Not adding pressure on the belly is advisable.

Do uterine or gynecologic problems would mean a complete no-no to sex?
- If you have a normal pregnancy, then there are no medical limitations to an active sex life. However, if the pregnancy has complications, then you should be extra-cautious. For instance, a placenta previa where the placenta has slid down. Secondly, cervical insufficiency, expected premature labor, abdominal pains, dilated cervix, unexplained vaginal bleeding, and ruptured waters are conditions where sex is absolutely not allowed. There could also be where the male is having urinary infections.

What are some things to keep in mind when it comes to sex during pregnancy?
- It is completely normal to feel a strong urge to have sex during pregnancy. The increased hormone levels are responsible for this. In addition, some vaginal bleeding is also normal with sex. There is no harm to the baby with sex, which is fully protected in the womb. Be frank to discuss any concerns with your doctor and get your doubts clarified.
 

Pregnancy and high blood pressure isn’t as deadly a combination as feared by many. A blood pressure that is equal to or more than 140/90 mm of Hg is considered to be high and abnormal. While hypertension requires close monitoring, here is what every pregnant woman must know about this condition.

What are the different types of high blood pressure that can occur during pregnancy?

1. Gestational hypertension: Women suffering from this condition typically suffer from high blood pressure after the 20th week of pregnancy. While in most of the cases, no protein or signs of organ damage are detected, many women might develop a condition known as the preeclampsia.
2. Chronic hypertension: This is a condition that occurs at least 20 weeks before the pregnancy. This is a little hard to detect since there are no symptoms attached to this condition.
3. Chronic hypertension and superimposed preeclampsia: This is a condition that is often seen in women with chronic hypertension. It typically befalls before the pregnancy and is characterized by high protein in the urine. Typically, a pregnancy of this type has delivery-related complications.
4. Preeclampsia: This condition occurs 20 weeks after the pregnancy. It is often associated with complications involving other organs such as liver, kidneys, brain, and blood. If this goes untreated, it can prove fatal for the mother and the unborn baby.

Why is high blood pressure an unwanted problem?

1. Reduced blood flow to the placenta: If the placenta doesn’t receive adequate blood, the baby receives less food and oxygen. It can lead to premature birth, slow growth, and low birth weight. Premature birth can lead to infection of the baby and breathing problems.
2. Placental abruption: This is a condition where the placenta gets separated from the inner lining of the uterus before the delivery happens. Abruption can cause heavy bleeding leading to life-threatening condition both for the mother and the baby.
3. Injury to other organs: If the hypertension is not tackled well, it may lead to injury of the lungs, heart, liver, kidney and many other organs. In many cases, it could prove to be life-threatening as well.
4. Premature delivery: In case of high blood pressure, a doctor might take a call for an early delivery to avoid the risk of unnecessary complications.

What are the signs and symptoms to develop this condition?

1. Pain in the kidney or excessive protein in the urine.
2. Vomiting and nausea.
3. Problems in vision including but not related to blurred vision, temporary loss of vision and light sensitivity.
4. Limited liver function.
5. Fluid accumulation in the lungs resulting in shortness of breath.
6. Frequent and long stretches of headaches.
7. Pain in the upper abdomen especially on the right side, under the rib.

Though pregnancy is one of the most cherished phases in a woman’s life, there are times when it is not desired. This can be due to various reasons ranging from premarital sex to the couple not being ready yet. Whatever the reason, emergency contraceptive measures are available, and I-Pill has become synonymous with that.

Since its introduction, it is widely used to prevent unwanted pregnancies. The easy availability (no prescription required) and low cost have added to its popularity. However, not many realize it has some side-effects and the need to be aware of certain facts when using the I-pill.

1. It is an emergency contraceptive pill, should be used between 24 to 72 hours after unprotected sex
2. It is effective in 95% of the women when taking during this time frame
3. It prevents pregnancy by stopping fertilisation or preventing implantation of the fertilising egg
4. It stops pregnancy; however, if you conceive before the pill it was taken, it will not have any effect. It is therefore not an abortion pill
5. So, if you miss the period the next month, test for pregnancy
6. It does not offer protection against sexually transmitted disease including HIV/AIDS
7. It is not to be used on a regular basis
8. If you are on long-term medication, please consult with the doctor before taking the I-pill
9. It has no long-term consequence. However, there could be some minor symptoms including breast tenderness, nausea, vomiting, headache, and lower abdominal pain (pelvic area),
10. The next menstrual cycle could be delayed by a couple of days
11. There could also be spotting before the actual period starts
12. Women who are allergic to levonorgestrel should not take I-pill.
13. It can cause skin allergies and reduce libido.
14. When used repeatedly, it can cause delayed and irregular menstruation
15. It is ideal for use between the age of 25 and 45. Teenagers should not use it regularly. This needs to be made aware through sex education, as the prevalence of teenage sex and pregnancy is on the rise in India
16. Repeated usage can cause ovarian damage and severe menstrual issues, so occasional use is the only recommended usage
17. It is safe to take the pill during lactation. There is no effect on the quality of milk or any other adverse effect on the baby

I-Pill was introduced as an emergency contraceptive method, and not for regular contraceptive purpose. Its correct usage and avoiding complications is largely dependent on sex education which needs to start early and talk about other safe sex measures and avoid using it on a regular basis. In case you have a concern or query you can always consult an expert & get answers to your questions!