Dr. Pooja Choudhary

Epithelial Ovarian Cancer is a condition in which malignant tumor emerges from the tissue lining in the outer surface of the ovary. Epithelial tumors are usually benign, but this form of malignancy has been found to be the most common type of ovarian cancer. Moreover, it cannot be diagnosed until in its advanced stage. Medical research shows that factors such as multiple pregnancies, delayed childbirth and early menarche seem to raise the risk of ovarian cancer, while dietary and environmental factors also play a significant role in it.

Symptoms
1. A majority of the patients have been observed to have extensive intra-abdominal growth.
2. They may experience discomfort or swelling of the abdominal region.
3. The feeling of being bloated, lack of appetite, unnatural weight alteration, dyspepsia, malaise, and urinary problems are frequently reported symptoms.
4. Patients also experience constipation and other gastrointestinal problems.

Treatment
The first step towards treatment of ovarian cancer is to diagnose the condition. A thorough pelvic examination (consisting of an examination of the vagina, uterus, ovaries, fallopian tubes, and cervix) will help to pin point any abnormality of the ovary. If the doctor notes nodularity, firmness or lack of tenderness during the examination, these can be taken as symptoms of malignancy of epithelial ovarian tumors. Ultrasound examination of the abdominal region will also help to locate abnormality in the tissues on the outer surface of the ovary. The next logical step towards treatment is getting a biopsy. During this procedure potentially malignant cells are removed and then diagnosed by a pathologist to conclude if the cells are cancerous or not. The process of removal is known as laparotomy.

Apart from a handful of stage one patients, most women with epithelial ovarian cancer receive chemotherapy. The standard treatment for this type of ovarian cancer is the surgical elimination of tumor. This includes total abdominal hysterectomy, a surgery in which the uterus and cervix is removed through an incision in the abdomen. Post surgical treatment consists of taxane-platinum chemotherapy. Patients with minimal residual cancer undergo external radiation therapy or intraperitoneal chemotherapy (radioactive liquid is channelled into the abdomen with the help of a catheter).

A lot of research has been done in this field and a variety of clinical trials are available for a patient, if he/she wishes to be a part of it. Leading methods are immunotherapy and targeted therapy are also available. Immunotherapy uses the immune system of the patient to battle cancer. Bodily substances or substances created in the lab are used to restore and boost the body’s natural defence mechanisms against cancer. Targeted therapy, on the other hand, uses substances to identify the cancer and attack the malignant cells without jeopardizing non-cancerous cells.

While some couples conceive with ease, conceiving a child can be extremely difficult for others. In cases where a woman is not able to get pregnant despite having regular intercourse in tune with her biological cycle, infertility tests may be suggested to investigate the reason behind this. In most cases, these tests are suggested if a year has gone by without intercourse resulting in a pregnancy. Women may also be said to be infertile, if they cannot carry a foetus to full term.

Infertility can affect both men and women and can be triggered by a number of different reasons. In some cases, it is treatable while in others, alternative ways of having a family may need to be discussed. Hence, it is very important to understand the different types and triggers for infertility and to undergo complete infertility investigations. Some of the common types of infertility investigations are as given below.

1. Blood tests: A blood test of both partners is used to assess the general health of the couple and to identify any health factors that may be impeding fertility.
2. Tests for women: 
   1. Hysterosalpingogram: This is an X ray that can identify if a blockage or any other issue in the fallopian tubes are the cause for infertility.
   2. Pelvic ultrasound: This is used to have a look at the anatomy of the female reproductive system and to check for fibroids.
   3. Laparoscopy / hysteroscopy: This is used to get a clearer picture of the ovaries, uterus and other parts of the reproductive system.
   4. Tracking cycle: Ovulation and the thickness of the uterus lining may also affect infertility, This can be diagnosed by tracking and assessing the menstrual cycle.
3. Tests for men
   1. Semen analysis:This test is used to get an idea of sperm concentration, motility and the appearance of sperm in a man’s semen. In some cases, the semen may not include any sperm cells. In such cases, a follow up investigation may be required to assess if sperm cells are being created in the testicles. This is known as testicular sperm aspiration or a testicular biopsy.
   2. Sperm DNA: The DNA in sperm also plays an important role in fertility. This test is used to assess the sperm DNA integrity and to see how it may affect embryo development and chances of an on-going pregnancy.

Infertility treatment depends on the cause identified by the above tests and hence it is important for both partners to undergo complete testing.

Nausea and vomiting can cause weight loss during the first trimester of pregnancy but there is nothing to worry about it.

Intra uterine insemination is a common fertility treatment which involves positioning a sperm within the woman’s uterus in order to help it fertilize. The primary objective of this treatment is to surge the number of sperms that are supposed to reach the fallopian tubes for multiplying the chance of fertilization. It offers an advantage to the sperms by minimizing its area of traversal, but the sperm must reach the eggs for fertilizing the ovum on its own. It is a minimally invasive method and much lesser expensive when compared to in vitro fertilization.

When do the doctors recommend intra uterine insemination?
The most common reason behind opting for intra uterine insemination is decreased sperm mobility and low sperm count. But there are various other reasons why gynecologists recommend this treatment and these include unexplained infertility, cervical scar tissues from past operations, cervical mucus problems, ejaculation dysfunction and several others.
On the other hand, intra uterine insemination is not recommended for women with conditions of pelvic infections, moderate to severe endometriosis and women with acute problems in the fallopian tubes.

How does the process of intra uterine insemination work?

• Before opting for the intra uterine insemination, doctors may recommend ovulation stimulating medicines which require careful monitoring of the eggs to determine when they are mature. The intra uterine insemination will be done between 24 and 36 hours after the rise in LH hormones which indicates high chances of ovulation.
• A semen sample is separated from the semen, and then the sperm is inserted directly into the uterus with the help of a catheter. This procedure improves the positioning of sperm cells into the uterus which, in turn, increases the chances of conception.
• The whole procedure takes about a couple of minutes and gives only minimal discomfort. Then the doctors closely monitor your signs and symptoms of pregnancy. In most cases, there is minimal risk of infection after the intra uterine insemination. Also, women who take fertility medications while having IUI also have chances to become pregnant with multiples.

What is the success rate of intra uterine insemination?
The success of intra uterine insemination depends on a host of factors. If a couple chooses to opt for this treatment every month, the chances of successful pregnancy are increased by 20 percent per cycle. But factors like age of the woman, use of fertility drugs, and the reason behind infertility play a critical role.

Since intra uterine insemination is a cheaper process compared to in vitro fertilization, the success rate of this procedure can sometimes be lower than the latter. It however in most cases gives good results. So, if you are interested in this treatment, you must consult with an expert gynaecologist for discussing your options. In case you have a concern or query you can always consult an expert & get answers to your questions!

Hello!

I am Dr. Pooja Chaudhary, MBBS MD-Obstetrics & Gynaecology . Today we are going to talk about 5 simple steps for a healthy pregnancy. The mother has to consult a doctor as soon as she gets to know that she is pregnant so that doctor can tell her about the prenatal care. The fact that she is pregnant that she should consult a gynecologist immediately because the pregnancy brings with it a new set of responsibilities the patient has to take care of a baby as well as her own health is also equally important. Now the five simple steps for a healthy pregnancy includes prenatal care, diet, exercise, sleeping habits and food habits. As we talk about the prenatal care the first and foremost thing is as she gets to know that she is pregnant she is put on Folic acid for the development of the baby and to prevent neural tube defects in the baby. It is essential that she takes healthy diet.

With the healthy diet of substantial amount of Carbohydrates, Proteins, Vitamins and Minerals as well as Fibre intake. Carbohydrates like rice, roti should be included. She should have five small portions for every meal. During pregnancy we tell the patients to have small frequent meals. This is done just to avoid constipation, gastric problems and because these problems increase during pregnancy mainly because of the hormonal imbalance. Her water intake should be very good. She should drink at least 10-12 glasses in hot and humid climate. This will take care of a urine infection. This will help her avoid constipation and this will also help her in digestion of the food. As far as proteins are concerned, if she is a vegetarian she can take pulses, soybean or paneer, dal and the non-vegetarian people can take egg, chicken or fish but it is advisable to avoid smoked seafood in the first three months of the pregnancy.

Then comes the exercise where we simply tell the patient not to go for a brisk walk. Just simple walking is enough. 15 to 20 minutes post meal walking is good for the patients. Patient can also opt for Ketal exercises which helps in vaginal musculation. Exercise is really important in pregnancy because it improves your back pain, it improves constipation, it also improves your muscular endurance, it helps in normal vaginal delivery. As far as the weight is concerned, for a normal patient with normal height, the weight during the entire pregnancy can range between 12 to 15 kgs. But in case it is a twin or the pre-pregnancy weight is already on a higher side your doctor can explain you better about the how much weight you can gain during pregnancy. Lifestyle changes is also very important part of pregnancy. Those who do smoking or drink alcohol are requesting not to do so because it causes many complications like preterm birth, abortions, stillbirths, miscarriages.

Avoid travelling on an uneven jerky surface. And one must remember that during pregnancy whatever testing is done it is very time limited. If you do the test before the limited time period or after that time period, then it carries little value. At the time they are monitoring the pregnancy they would also do genetic screening of the babies and the genetic screening is very time limited. If it is done in around three months it has to be done around three months.

If you miss that deadline then the scanning is not valid and you will miss the opportunity of getting a screening done for the baby. So whenever your doctor prescribes that this test has to be done during this time then it carries importance. So you make sure that you do your testing on a regular basis. You stay in touch with your doctor on a regular basis so your baby can be screened and ultrasound scan be done at a time when it is required to be done. In case of any queries you can contact me at my clinic in Safdarjung Enclave or you can contact me through lybrate itself.

Chlamydia is one of the more common STDs among both the genders. It spreads through physical intimate contact; it can develop irrespective of one’s age, however, is most commonly observed among young women. In women, the symptoms include yellow or green colored odorous vaginal discharge, painful urination and a burning sensation or itching around the vagina, lower abdominal ache, painful menstruation or bleeding during sexual intercourse. Now if the infection reaches up to the fallopian tubes, it causes a disease known as Pelvic Inflammatory Disease (PID). In case of unprotected oral sex, the bacteria causing this disorder, ‘Chlamydia Trachomatis’ might infect the throat as well.

Reasons Behind Chlamydia in Women:

1. Being a sexually transmitted disease, Chlamydia gets passed on from one person to another through unprotected sex or through the contact with the genitals of an infected person.

2. In some cases, infants are likely to inherit the disease from their mothers during birth, if she is already affected with it. Hence pre-natal checkups are essential for detection.

3. Although very rare, this infection can affect the eyes as well via oral or genital contact.

How To Treat Chlamydia?

1. The infection can be resolved within a couple of weeks with the use of antibiotics. Once it is diagnosed, the treatment course should start immediately. The widely used antibiotics for curing chlamydia are azithromycin and doxycycline. If you are breastfeeding or pregnant or suffering from any allergy, your doctor might prescribe erythromycin or amoxicillin. For severe complications, a longer course is administered. The treatment may induce mild side-effects in the form of vaginal thrush, sickness, diarrhea and tummy pain.

2. Try and avoid any sort of sexual activity (intercourse or other activities) till the treatment is completely done and none of you show any other sign of the infection.

One of the major milestones in a woman’s life is the entry into motherhood. For most women, when this does not happen in the natural logical sequence of things, there is anxiety and lot of pressure from family and friends. However, with advancements now, there are options like intrauterine insemination and in vitro fertilisation (IUI and IVF) available, which can help increase the chance of conception and pregnancy.

IVF is where the egg is retrieved from the woman’s womb, fertilised externally and then transplanted back into the uterus where it grows to full term. However, there are always unanswered questions like how long to wait before going for IVF, is it the right procedure for me, etc.

Read on to find answers to some of these questions.

1. Maternal age: As a woman reaches 35 and a man reaches 40, the fertility rates drop significantly. The chances that a woman at 35 will conceive is about 20%, which goes down to 5% if the woman is 40. However, this rate can be significantly increased by using IVF, moving it up to about 80%. The quality of the egg would gradually deteriorate, and so if a woman is nearing 40, it is better to consider IVF as the ovarian reserve would be optimal with IVF.
2. Failed intrauterine insemination: In couples who have problems with the sperm reaching the uterus, intrauterine insemination (IUI) is first attempted. However, if 3 or more attempts of fail, it is time to consider IVF.
3. Duration of inability to conceive: While some couples conceive quite promptly in a month or two, most take about 6 to 8 months of unprotected sex to conceive. Therefore, IVF can be an option if you are failing to conceive even after a year. Less than a year, don’t fret. Take it easy and it might just do the trick.
4. Medical health: Both the partner’s medical health should be taken into account. Lifestyle changes like smoking, alcohol abuse, drug abuse should be considered, which can account for poor sexual performance and therefore lead to an inability to conceive. Health conditions like diabetes and heart disease can also lead to infertility. Hypothyroidism in women is another thing that must be ruled out, as it often leads to an inability to conceive.
5. Sexual problems with the partner: One of the first things to do before going for IVF is to check that the male does not have any issues. Be it erection issues or ejaculation issues or sperm issues, they need to be ruled out. Sperm quality, quantity, and motility have to be analysed, and if they are optimal, IVF can be considered.

In case you have a concern or query you can always consult an expert & get answers to your questions!

Celiac disease is a condition in which the small intestine becomes sensitive and reactive to gluten, leading to difficulty in digesting food. Gluten is a kind of a protein found in wheat or barley. In reality, if either of the partners is suffering from celiac disease then you are prone to fertility related issues.

Impact of Celiac disease

As compared to men, this disease is more common among women in general. Women suffering from the disease are generally more prone to infertility and other genealogical problems like preterm births and miscarriages. In the case of men, the disease causes the infertility problems including sperm abnormalities such as low count, abnormal shape, reduced function and such others. Additionally, men with the untreated celiac disease might also have reduced levels to testosterone.

Infertility and Celiac disease

Infertility is one of the lesser known effects of the celiac disease, which is relatively uncommon amongst people. The disease causes infertility by affecting the menstrual cycle among women either in a direct or indirect manner. Some of the infertility related problems caused due the disease are listed below.

• Delayed occurrence of menstruation
• Early menopause
• Secondary amenorrhea (a medical condition associated with sudden cessation of menstruation for 6 months or more)
• Hormonal disruptions and abnormal changes

Diagnosis

Celiac disease is usually diagnosed by its own set of underlying symptoms such as chronic fatigue syndrome, irritable bowel syndrome (IBS), iron-deficiency anemia, and such others. Additionally, the condition can be diagnosed if a person is having repeated miscarriages or inability to conceive for unidentified causes.

What can you do about it?

If you experience symptoms of Celiac disease, consult your doctor at the earliest and follow the treatments and preventative measures suggested. Additionally, you can also consult a dietician who will help you to move on to a low grain or no grain diet that would help you further to avoid the disease. In case you have a concern or query you can always consult an expert & get answers to your questions!

The vagina is a muscular, tubular structure of the female genital tract extending from the vulva to the cervix (the opening of the urethra). Sexual activity affects vaginal health in a number of different ways during intercourse and in the long term.

A few of the varying effects and the factors responsible for these effects are listed below:

1. Changing size of the vagina: The vagina is designed to be elastic and adjustable. So, no permanent change in size is possible but it does undergo temporary changes in sizes as effects of sex. The inner walls of the vagina enlarge during sexual intercourse and during childbirth. Tissues in the clitoris puff out and harden, this also causes an expansion in size. It takes a while to get back to its normal size.
2. Vaginal secretion: When you are aroused during sex, the blood vessels supplying the vagina expand immediately. The blood flow increases to lubricate the vaginal walls (rugae). The rugae unfold and the space increases. These secretions are important because, women who are sexually inactive for a long time at a stretch, experience dryness that leads to urinating difficulties and rashes.
3. Unusual discharge: Apart from natural lubricants, vagina secretes some fluids, the process being termed as 'female ejaculation'. A tiny amount of white fluid made of prostate plasma cells, is produced just before you climax and discharged with some quantity of urine. Sometimes, prostatic specific antigen (PSA) and prostatic acid phosphatase (usually found in semen) are also found in the secretion.
4. Infections in the urinary tract: The friction caused by sexual intercourse may cause small cuts which enable bacteria to pass from the vagina to the urinary bladder through the urethra. This causes infection in the bladder, the urinary tract and the vagina. These can be avoided by using a condom or by urinating before and after having sex.
5. Vaginal pain: A lot of women report the experience of pain and discomfort inside or around the vagina during and immediately after sex. The pain can result from repeated sex within a short period of time or reduced secretion of natural lubricants. If the pain is too severe, you should see a doctor because yeast infections or chronic vulvodynia can also be responsible for the pain sensation.

In case you have a concern or query you can always consult an expert & get answers to your questions!

Urine incontinence is a condition that can be caused by one's everyday habits, side effects to medication, or any other long-term physical ailments. A thorough check-up by your doctor can help in getting to the root cause of this condition.

Certain beverages, medicines and foods can act as diuretics. This leads to bloating in your bladder and an increase in the volume of your urine. They include the following:

1. Liquor
2. Caffeine
3. Decaffeinated tea or coffee
4. Aerated drinks
5. Artificial sweeteners
6. Corn syrup
7. Drinks that contain high doses of artificial flavours, sugar or acid, particularly citrus based beverages
8. Heart medicines, narcotics, and muscle relaxants
9. Extensive intake of vitamins B or C
10. Urinary tract infection (UIT)
11. Constipation

Other causes:

Urinary incontinence can also be caused by the following:

1. Pregnancy: Hormonal changes and increasedweight of the uterus can cause stress incontinence.
2. Childbirth: Delivery can weaken the muscles required for bladder control. It damages the bladder nerves and steady tissue. With prolapse, the uterus, bladder, or the intestine can be pushed down from their usual position and might even protrude into the vagina.
3. Changes developed with age: Maturing of the bladder muscle can weaken the bladder's ability to store urine.
4. Menopause: After menopause,women deliver less estrogen. Disintegration of these tissues can cause incontinence.
5. Hysterectomy: In women, the same muscles and tendons support the bladder and uterus. Any surgery that removes the uterus may harm the supporting muscles, which can prompt incontinence.
6. Expanded prostate: Particularly in older men, incontinence usually occurs from growth of the prostate organ, a condition known as considerate prostatic hyperplasia.
7. Prostate cancer: In men, stress incontinence or urge incontinence can be connected with an untreated prostate disease. Incontinence is a reaction to medicines prescribed for prostate growth.
8. Obstruction: A tumour in your urinary tract can disrupt the typical stream of urine, prompting flood incontinence. Urinary stones at times cause leakage of urine.
9. Neurological disorders: Various sclerosis, Parkinson's illness, stroke, a mind tumour or a spinal damage can meddle with the nerve signals. These are important in keeping control of the bladder.

Your specialist may suggest the following:

1. Bladder control: You may begin by attempting to hold off for 10 minutes each time you feel a desire to urinate. The objective is to extend the time between visits to the toilet until you start urinating in two to three hour intervals.
2. Two-fold voiding: Twofold voiding implies urinating, then holding it for a couple of minutes and attempting once more. This exercise can help in leveraging better control in the long run.
3. Fixed toilet time: You may attempt to urinate every two to four hours instead of sitting tight when the need arises.
4. Liquid intake and diet: You may need to stay away from liquor, caffeine or acidic foods. Also, the fluid intake may have to be reduced in such cases.

In case you have a concern or query you can always consult an expert & get answers to your questions!