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Dr. Uttam Singh

Ayurveda, Delhi

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Dr. Uttam Singh Ayurveda, Delhi
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I pride myself in attending local and statewide seminars to stay current with the latest techniques, and treatment planning....more
I pride myself in attending local and statewide seminars to stay current with the latest techniques, and treatment planning.
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Dr. Uttam Singh is a renowned Ayurveda in Chandni Chowk, Delhi. He is currently practising at Mcd Ayurvedic Hospital in Chandni Chowk, Delhi. Book an appointment online with Dr. Uttam Singh and consult privately on Lybrate.com.

Lybrate.com has an excellent community of Ayurvedas in India. You will find Ayurvedas with more than 32 years of experience on Lybrate.com. You can find Ayurvedas online in Delhi and from across India. View the profile of medical specialists and their reviews from other patients to make an informed decision.

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Chandni Chowk. Landmark:-+91-11-23918515, DelhiDelhi Get Directions
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I have acute diarrhea developed recently and it is not subsiding. I am on electral but it is not effective the moment. I am a kidney transplant and difficult to be on anti-biotics. Kindly help.

DHMS (Diploma in Homeopathic Medicine and Surgery)
Homeopath, Ludhiana
Homoeopathic treatment arsenic album 30 Dr. Reckeweg) 5 drops every 2-3 hrly in 1 spoon fresh water nux vomika 30 (dr. Reckeweg) 5 drops in 1 spoon fresh water 3 times daily report after 5 dayss.
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I have gain weight very wast after did some exercise. Please give me some suggestions.

BAMS
Ayurveda, Ambala
First you should follow low calories food for weight loss. * in morning, take 1-2 chapattis with a bowl of cooked green vegetables. You can take a glass of lemon water with it *in lunch you can take a bowl of raw vegetables like carrot, radish, tomatoes, turnip or beetroot. *in evening, you can take a cup of green tea only with some pieces of friuts like apple, pineapple, pear. Avoid taking banana or mango. *in dinner, you can take vegetable soup or a bowl of cooked vegetables. But do not take potato, sweet potatoes. * you can take a cup skimmed milk 4 times a week only during day time. * work out for atleast 1 hour in morning, you can try skipping for 15minutes with a walk of 30 minutes and 5-10 minutes running. Follow these exercises in the morning - * lie down on flat surface, raise your legs without bending your knees, do it for 3-5 times daily * do not eat fastfoods and soft drinks, as they have high calories and the calories deposit in body in the form of weight if not utilised. * you can take medohar guggalu 1 tablet daily for quick weight loss but only under the guidance of ayurveda expert.
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I am suffering from hypothyroidism from last 2 years and taking 25 mg thyronorm tablet, and also I had pcod from last 8 years now I am 27 years old, and recently done with thyroid test and there is minor variation by 0.8mg, but again my doctor suggested me to increase dosage of thyronorm by 75 mg. Is it necessary to increase it as I am having minor variation. And cant it be cured completely. Please suggest is there any treatment for this.(and also previously I was taking glcoment 500mg for pcod and I used to get periods regularly, 2 years back I changed the doctor and they told me to leave glucoment and continue with thyronorm, initially when I undergone test for thyroid at that time also I have just minor variation, I don't remember lab values exactly.

MBBS, MD - Internal Medicine
Internal Medicine Specialist, Faridabad
where there is deficiency of thyroxine hormone leading to sluggishness, tired feeling, weight increase, slow heart beats, intolerance to cold, swelling of legs, feet and face, difficulty in concentrating and at times in speech. Treatment for hypothyroidism is giving thyroxine tablets. And dose are according to level of thyroid for life time. Avoid bad habits . Avoid stress. Some Relax during work. Go for walk, Take plenty of water, high-carbohydrate foods such as potatoes, rice, pasta and bread. Nutrient-rich foods that improve your health may also benefit your thyroid gland, antioxidant-rich fruits and vegetables more plenty of water: Blueberries, tomatoes, bell peppers, and other foods rich in antioxidants can improve overall health and benefit the thyroid gland. Eating foods high in B vitamins, like whole grains, may also help. flax oil, Selenium: Tiny amounts of selenium are needed for enzymes that make thyroid hormones to work properly. Eating selenium-rich foods, such as sunflower seeds or Brazil nuts, can be beneficial. Tyrosine: This amino acid is used by the thyroid gland to produce T3 and T4. Taking a supplement may help, avoid oily foods,junk foods, go for walk. Do Tests every 3 to 6 months. And consult doctor on time.
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Iam 22 years old. Am female. I have a long hair. It looks nly good wen I do my wash my hair but it couldnt be possible to wash daily. I want my hair to look silky and straight. Can you gve me any suggestions.

DHMS (Diploma in Homeopathic Medicine and Surgery)
Homeopath, Ludhiana
Castor oil has been well known for its medicinal properties. It’s often used as a laxative, but has a wide variety of other health benefits, including many pertaining to hair and hair growth, as well as for facial oil cleansing method, stretch marks, dark spots and more. The oil has a unique chemical composition, which most likely contributes to its healing potential. It mostly consists of a triglyceride of fatty acids. It contains vitamin E, omega-6 fatty acids, minerals, and proteins, which are all important for the health of your hair and scalp. Castor oil: • helps with hair regrowth and hair loss, • makes the hair richer and darker, • prevents split ends, • treats dandruff and dry scalp, • moisturizes the hair and makes it shine, • works in an antifungal and antibacterial way and can prevent problems such as ringworm, and folliculitis. How to apply castor oil It’s best to use castor oil as a hair mask. This is particularly helpful if you’re trying to regrow hair or give it more moist and shine. 1. Castor oil has a thick consistency, so you can mix it with coconut oil, olive oil or jojoba oil in a half and half ratio. This will make the mask easier to distribute throughout your hair. 2. Use your fingers or a brush and start applying it onto your scalp with circular motions. This gentle massage increases the blood circulation, rejuvenates the hair, and stimulates hair growth. 3. Part hair into sections and apply the oil (mixture) to each section until all your hair is covered properly and evenly. 4. Wrap your hair in a warm towel (you can also use a shower cap) and leave it for two to eight hours. You can also leave it over night. This will give the oil enough time to penetrate the follicles and hydrate your scalp and hair thoroughly. 5. Wash your hair as usual using shampoo and conditioner. Make sure you rinse all the oil out of your hair. How often should you use castor oil? This depends on your objective and type of hair. If your aim is to treat hair loss, you will need to do it at least twice weekly, but even better if you can do it three or four times per week for several weeks.
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Hi I'm a male I have black spots on my face and Whitehead on my face skin please help me out wat should I do to reduce or control it please help me out with this wat should I apply or wat Should I do please help me.

DHMS (Diploma in Homeopathic Medicine and Surgery)
Homeopath, Ludhiana
Homoeopathic cream ANTIMARKS CREAM ( BIOVALLEY) Apply twice daily in circular fashion Dark spots are primarily caused by acne, blemishes and black heads. The percentage of dark spots increases as the exposure to the sun increases too. Since the rate of melanin would be decreases, it leads in turn to the darkening of the skin. So, apply sunscreen (Homoeopathic SUNCARE cream of BAKSON Company) , every time you go out and follow the recipes below in order to get relief from dark spots. Instead of using the chemical products for your skin, try using some natural home remedies. Using home remedies can work out to be much cheaper than chemical based products and they can help treat your condition without any side effects. Caring for your skin is highly important. Here are some home remedies that allow your skin to be free of dark spots, black spots or pimple marks or even acne scars on the face. 1.Take a medium sized tomato and squeeze the juice from it, add one tablespoon of lemon juice to the tomato juice and stir the mixture well. Apply on the face and let it dry for 20 minutes. Rinse the face with warm water. 2.Take pulp from Aloe Vera leaves and let it dry in the sun for 5 minutes and then add few drops of lemon juice to the dried pulp. Apply this mixture on the face and wash it off after 15 minutes. The results are quite good. 3.Onions have anti-microbial properties and they help remove the acne related scars and spots. Take an onion and cut it into several pieces, grind them and then, separate the juice from the beaten onions. Apply this mixture on the affected areas; allow the mixture to remain on the skin for a few minutes and rinse off with water. 4.Mix two tablespoons of sandalwood powder with a few drops of rose water and apply on the spots and on the entire face. Wash it off, after it dries. 5.Take a pinch of turmeric powder and add some lemon juice to it. Mix both the ingredients well together and dab the mixture on the black spots. Scars and spots will disappear and the results would show on the skin within a week’s time. 6.Take a small potato and grate it; mix it with some honey and dab
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My wife is 26 years old and suffering from pcos problem. We are trying for baby for last three years. After six months treatment she is getting regular period for last one year. She is suffering from vaginal infection. Her current period date is 19-9-2016. Her transvaginal sonography is done at 23-9-2016. Uterus is measuring 6.5*3.4*3.2 cm in size and appear bicornuate. Endometrial thickness is 3.8 mm. No intrauterine mass or fibroid is detected. Right ovary measuring, 3.4*3.1*1.9 cm (volume. 10. 8 ml ). Left ovary measuring 3.0*2.8*1.9 cm (vol. 8.73 ml ). There are multiple small follicles approx 3 - 5 mm size seen in both ovaries. No free fluid collection seen in cul-de-sac region. No pelvic mass or lymphadenopathy seen. Impression - bicornuate uterus. B/L polycystic ovarian disease. It is the report of my wife. Is something difficulties having bicornuate uterus to conceive. Please suggest us treatment.

BHMS
Homeopath, Surat
A bicornuate uterus has two horns and a heart shape which has a wall inside and a partial split outside. It is the most common CONGENITAL anomaly. Several studies show that women with a bicornuate uterus have about 60% success rate in delivering a living baby. In years case she has pcod so it will also affect her fertility n causing problems to have pregnancy. It is hormonal disturbance so it should be treated. According to studies total of 11 women approximately 90%successfuly carried a pregnancy to term. HOMEOPATHY definitely help years wife for treating pcod n to carry healthy pregnancy. Good luck.
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I have not slept for 2 days and nowmy head is aching, what to do? please help me.

MBBS, cc USG
General Physician, Gurgaon
You can take(If No drug allergy) : 1. Tablet Crocin (Paracetamol 500 mg) one tablet after food when required for headache after food for 2-3 days (maximum 2 tablets with gap of 12 hour can be taken in a day) I am giving you some tips for sound sleep and early awaking in morning follow advises given below: 1. Strict to sleep time schedule 2. Do regular physical activity 3. Regular meditation/ yoga, i can give you address of rajyoga meditation center near your house (this is free of cost) One thing i want to tell you that if you can relax your mind by Rajyoga meditation than you can reduce your sleep upto 5-6 hour and you will feel fresh and active 4. Avoid tea coffee after 7 pm 5. You can wash your face and feet at bedtime 6. Avoid daytime sleep 7. You can use alarm and gradually reduce your waking time by 15 minutes Consult me/ Physician if symptom persist
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Hello sir, I am thin and long, I eat too much still I am not becoming healthy/fat? What should i do to gain weight?

BHMS
Homeopath, Faridabad
Hello,Homoeopathic medicines are less invasive and have more herbal approach towards gaining the weight. There are a number of homoeopathic medicines, which treat the root cause behind the body’s inability to gain weight or bulk up. 1. Take alfalfa tonic(wsi), 2 – 2 tsp. Thrice a day, half an hour before meals. 2. Calcarea phos 200, 5 drops , once in aweek , morning empty stomach for 2 weeks. 3. Take eggs, milk, butter, bananas, potatoes, mangoes, figs, oats, soyabean and dry fruits. 4. do light exercises regularly to keep your body active. These homoeopathic medicines and dietary addition will increase your appetite and give your metabolism a healthy boost. ***If you do not get results with this treatment then please revert me i will suggest you to go through some tests.*** thanks.
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How to improve digestion? And removing waste to toilet? Please help. I have also disturbance of gas.

MBBS
General Physician, Cuttack
1.Take bland diet, Avoid spicy, oily, fried and Junk food 2 Eat and drink slowly. 3.Avoid fatty food,carbonated Drink like soda/ soft drink/Beer, chewing gum, sucking hard candy etc, 5.Avoid gas forming food like onion, bean , peas, potato, lentil,lettuce, cabbage, cauliflower, broccoli,mushroom,whole wheat bread.Fruits like apple/peach/pear 6. .Avoid stress, anxiety 7.stop alcohol/ smoking 8. Go for regular exercise and avoid sedentary life style 9.Take one tablet of pan40 in the morning 10.Take unienzyme 1 tablet thrice daily after food for few days. 11.consult me for further advice
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I feel some sort of mild pain in both the knees. I am not interested for allopathy treatment. Can you suggest for ayurvedic treatment. It will be nice of you if you can suggest hospitals in Kolkata and Bangalore.

Commonwealth Fellow Joint Replacement, DNB - Orthopedics, MS - Orthopaedics, MBBS
Orthopedist, Delhi
Do not ignore your knee pain for long time it may damage your knee joints so you can consult any good orthopaedic surgeon for the better treatment. They may help you with better options.
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I am 19 year old. I am 49 kg. My height is 5'7" I want to increase my weight and height.

Vaidya Visharad
Ayurveda, Narnaul
Peanut butter is a yummy spread for toast and bread. If you’re trying to gain weight, feel free to go for this high-calorie and nutritious food. Apply it on your whole wheat bread for breakfast and see how your weight increases within a short period of time.  Besides, you can spread a spoonful of peanut butter on fruits or vegetables like banana, apple slices, fresh berries, wheat germ or applesauce.  Alternatively, a peanut butter sandwich is also a good choice.
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I am very lean and skinny boy I want to gain mass perfectly. What precautions must I take and what kind of food Can I eat?

BHMS
Homeopath, Faridabad
Hello, Gaining weight is a slow process which requires patience and dedication! The food what and how you eat, makes the difference! For increasing your weight, concentrate on the below points ( if you don’t have any medical condition) which helps in gaining weight in a right way without harming your body. - Consume more healthy fats. Foods containing healthy fats are full of nutrients and also high in calories, making them a great option for weight gain. Foods containing plant fats should be your first option - this includes items such as nuts, seeds, peanut butter, avocados and olive oil. Foods containing healthy animals fats include lean meats and full fat dairy products - although if you have high cholesterol, you should probably stick to low-fat options. -Eat more protein. Good sources of protein include lean meat, fish and poultry, in addition to eggs, whole grains, dairy products and legumes. -Drink more calories. Try drinking a large glass of orange juice in the mornings (along with your normal breakfast). Drink a glass or two of full-cream milk throughout the day.Protein shakes will help you to gain muscle mass, particularly if you're working out. -Have 6 small and frequent meals in a day. -Gain muscle mass. It's a good idea to continue to exercise while you attempt to gain weight the healthy way. Strength training includes working with weights and performing exercises such as squats, deadlifts, bench presses, bicep curls, crunches, chin-ups and leg curls. Just keep in mind that the more you exercise, the more calories you will need to consume to replace those you lost while working out. This is where protein shakes and bars really come in handy. -Quit smoking. As it suppresses the appetite. -Stay healthy. The most important thing through the entire weight gain process is to stay healthy - eating a balanced diet and continuing to exercise throughout. -Take enough of rest and sleep for rejuvenation of the cells and tissues. -Think Positive which will help you in achieving your target of gaining weight. -Avoid taking unnecessary stress/ tension. Medication: Take Schwabe’s Alfaalfa Tonic and Five Phos., both thrice daily ½ an hour before meals for 1month.
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I got less marks in exam. I am very much depressed. My friends got more marks than me. Please help. I will wait for your reply. Please reply as soon as possible.

Reparenting Technique, BA, BEd
Psychologist, Bangalore
You may have to examine both your study habits and how you answer at exams. I will give you some guidelines for the former but you need to check out the latter with a colleague, teacher, or tuition guide so that they may know your habits and give you more specific instructions. Daily exercise of at least half an hour is a must. Even if you go to a gym, ask for aerobic and/or callisthenic exercises with whatever else you are doing. A healthy body harbors a healthy mind. With regard to memory, it is very important that your brain and body is ideally rested to be able to recall whatever is required, rather comfortably. Puzzles pose problems to the brain that help it to use new pathways and neurons, which give the brain considerable exercise. It taxes the left brain to use logic to solve the myriad possibilities which other activities do not stimulate. Crosswords are excellent for vocabulary learning and use. Jigsaws and Rubik cube stimulate different permutations to finally settle on the most likely one. Picture completion and anagrams help approach problem-solving from several angles. Do Sudoku, and memory co-relation activities and skills. Have a good night’s sleep, have a good breakfast of more proteins, meditate often, remain free of stress, eat a lot of fiber (whole grains, fruits and vegetables), nuts, avocado, eat dark chocolate, consume less of fat and use olive oil instead, do Yoga meditation exercises, etc. You need to check out if you are stronger visual or auditory. The visual is a better mode than the auditory. However, if you combine the two modes, you will get the best concentration. Have a special place of learning, which should be well lit, with soft painted walls, well-ventilated, with no distractions. When you get bored, study by writing. If you repeat learning, at least, five to seven times, you will apparently remember for a longer time. Sit comfortably but do not slouch. The reading material should be of a fairly large print. Study at small intervals of about 40 minutes and then take a break or change the subject. Short-term memory is a faculty of the left brain, and long-term memory is a feature of the right brain. When people are stressed, they tend to favor the right brain and abandon the left brain, where short-term memory resides. So, it is really very simple: deal with the stress and activate left brain functions. Here are a few suggestions to activate left brain function: shut your left nostril and breathe, move your eyes from right to left and vice versa for at least half a minute at a time, and do callisthenic exercises with some form of counting, regularly. There is a new exercise called Super Brain Yoga, which is done by holding the right earlobe with your left thumb and index finger, and the left earlobe with your right hand’s thumb and index finger. In this position, you must squat down and rise up and do this for five minutes every day. There is some memory enhancing techniques and study methods that your teacher will be able to guide you with. If your home life is full of distractions and stress, it is likely to affect your memory, adversely. In that case, I suggest that the family goes for counseling too. The following foods do help too: Blueberries, walnuts, turmeric, Spinach, tomatoes, broccoli, acorn squash, green tea, oily fish, boiled egg, turkey, apples, oatmeal, leafy greens, lentils, pumpkin seeds, avocado, cinnamon, thyme, sunflower seeds, and red wine. Avoid sugar and junk food.
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Hi sir am a student. My name is rohit and I am a 21 years old. My problem is that im too thin. And my class friends pull my leg about this. Now I wan to gain a shaped full weight. So I need suggestions to what to do. Please kindly help me. Thank you.

PGDD, RD, Bachelor of Home Science
Dietitian/Nutritionist, Mumbai
Hye, thanks for the query. Being underweight can be a concern if it's the result of poor nutrition. Here are some healthy ways to gain weight when you're underweight: eat more frequently. When you're underweight, you may feel full faster. Eat five to six smaller meals during the day rather than two or three large meals. Choose nutrient-rich foods. As part of an overall healthy diet, choose whole-grain breads, rice and cereals; fruits and vegetables; dairy products; lean protein sources; and nuts. Don't fill up on diet soda, coffee and other drinks with few calories and little nutritional value. Instead, drink smoothies or healthy shakes. Snack on nuts, dried fruits and fresh fruits. Even when you're underweight, be mindful of excess sugar and fat. An occasional slice of cake or ice cream is fine. But most sweets should be healthy and provide nutrients in addition to calories. Sheera, lassi and chikki are good choices. Exercise, especially strength training, can help you gain weight by building up your muscles. Exercise may also stimulate your appetite.
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I am sandeep. I am studying Burch first year. I have a problem on my hair fall. How to stop it any best medicine pls.

BAMS
Ayurveda, Ambala
Follow these best tips for treatment of hair fall • Add protein containing items in your foods for healthy hair growth such as take a bowl of cereal daily and a glass of milk or 100 gm cheese or 1-2 eggs. . • To reduce hairfall , Practice Yogasana like SHIRSHASANA and SARWANGASANA only under the guidance of Expert. • you can use MAHABHRINGRAJ TEL of BAIDYANATH COMPANY and apply it 3 times in a week massage your scalp for 10 to 15 minutes daily .It increases blood circulation in your scalp and enhances hair growth. • Avoid the excess use of products such as hair colours or shampoo . * Take Vitamin-E rich foods like dry fruits ( Almonds,Pista etc) daily. * Apply the egg yolk to the scalp atleast once a week.It gives nourishment to hair root and enhances hair growth.
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Im 24 year female. My scalp is leaving purple marks on pillow after applying coconut oil. And scalp is little bit itchy too. May I know the reason.

M.D. (Ayurveda )
Ayurveda, Patiala
it may be because of the oil you are applying, it may be adulterated. Change the oil your are using. .Kindly add camphor to the oil, only a pinch. If your have dandruff then you apply durdurpatradi oil over your scalp. Good luck.
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Fallopian Tube Block In Infertility - What Can You Do?

MBBS (Gold Medalist, Hons), MS (Obst and Gynae- Gold Medalist), DNB (Obst and Gynae), Fellow- Reproductive Endocrinology and Infertility (ACOG, USA), FIAOG
Gynaecologist, Kolkata
Fallopian Tube Block In Infertility - What Can You Do?

When couples get married, they often view parenthood as the next stage in their family life. They want to have a child, they want to be “mom” and “dad”, they cannot imagine that this may be hard to achieve or may not be a natural process. When several trials to conceive fail, they are shocked. Their basic expectation about family life gets shattered. Most of the couples are desperately looking for medical therapy that will end into a misery. Clearly this is not a struggle to survive; it is a struggle to fulfill a dream, to achieve what they view as a “full life”.

What is needed for pregnancy?

In the male partner, sperms are normally produced in the testes after puberty (after attainment of characters like growth of beard, moustache etc). From the testes, they are carried through the sperm conducting ducts (epididymis, vas, seminal vesicle and prostate gland). Then during sexual stimulation, after proper erection and ejaculation, they come out through penis. During sexual intercourse, these sperms, present in semen, are deposited inside the vagina.

In female partner, the deposited sperms must travel from vagina through the cervix (the mouth of the uterus). The cervix acts as gate-keeper, a it prevents entry of dead and abnormal sperms as well as bacteria present in semen, in the uterus. From uterus, sperms reach the Fallopian tubes (the tubes that are attached to the both sides of the uterus) where the sperms must meet the egg (ovum). The eggs are produced only before birth and so, there are fixed number of eggs inside the ovary. The ovum released from the ovary, into the abdomen at the time of ovulation (rupture of the surface of ovary to release the ovum). That ovum must be taken by the tube and thus inside the tube an embryo (earliest form of the baby) is formed, by meeting of the egg and the sperm.

It should be mentioned that out of nearly 200-300 million sperms, in average, deposited in vagina, hardly 500- 800 sperms can reach near the eggs and only one will succeed to form the embryo. The embryo then travels through the tube into the uterus and the uterus attaches the embryo firmly with it and thus the pregnancy starts. So, if there is defect in any one of them there will be difficulty in achieving pregnancy.

Thus, to summarise, pregnancy requires:

1.Production of healthy (“Normal Morphology”) and movable (“Normal Motility”) sperms in adequate number (“Normal Count”) in the testes

2.Transport of these sperms through the sperm conducting ducts from testes to penis

3.Successful Erection and Ejaculation during Intercourse to deposit adequate number of these sperms in the vagina

4.Transport of these sperms from vagina through cervix to the uterus and the tubes

5.Presence of sufficient number of eggs inside the ovary and ability to release the eggs from the ovaries

6.Pick up of the eggs by the tubes

7.Approximation of eggs and the sperms to form the embryo

8.Transport of embryo from the tubes into the uterus

9.Acceptance of the embryo by the uterus and its growth

What is Infertility?

Literally, the word “Infertility” means inability to conceive. But in reality, there are very few couples, who have no chance of natural conception and are called “Absolutely Infertile”. In fact, in many couples who present to infertility clinics, pregnancy may be the matter of time, thus the chance factor.

It should be kept in mind that, if there is factors to question fertility of either male or female or the female is of age less than 35 years; after one cycle (one month) of regular frequent intercourse, the chance of conception in human being is only 15%. That means, out of 100 couples trying for conception, only 15 will be able to succeed after one month of trying. The word “Regular” and “Frequent” are important; because to achieve pregnancy, couples are advised to keep intimate relationships for at least 2-3 times a week and this should be increased particularly around the time of ovulation (Middle of the menstrual cycle). Thus chance of pregnancy after 6 months, 12 months and 24 months of regular trying are respectively 60%, 80% and 100%.

The word, “Subfertility” seems better and more scientific than “Infertility”, to describe the couples who have reduced chance of conception, due to any cause. However, the word “Infertility”, seems more popular, although it puts pressure on the couples. In most cases, usually we advise to investigate after one year of regular and frequent intercourse, when the couples fail to conceive. However, if there are factors to question fertility; for example female with age more than 35 years, or with previous surgery in tubes/ ovaries/ uterus or known diseases like PCOS or endometriosis; or male partner having surgery in scrotum or groin or any hormonal problems or sexual dysfunctions- the wait period is usually reduced and couples can be investigated, even soon after marriage.

What causes Infertility?

Please look at the point “Thus, to summarise, pregnancy requires” where 9 points have been mentioned.

Thus the common causes may be

1.Problems in male- total absence of production of sperms, less than adequate number of sperms, problems in morphology and motility of sperms (most sperms not healthy or movable), blockage in transport of sperms and inability to deposit sperms in the vagina (sexual dysfunction- Erectile Dysfunction or less commonly, Ejaculatory Dysfunction). Examples include hormonal problems (Testosterone, thyroid, prolactin), diabetes, liver problems, causes present since birth, chromosomal abnormalities, surgery, infection, sexually transmitted diseases, smoking, exposure of scrotum to high temperature, some medicines or psychological causes.

2.Problems in female- total absence of less than adequate number of eggs in the ovaries, problems in ovulation, problems in picking of eggs by the tubes, blockage of tubes, problems in conduction of sperms or embryo by the uterus, problems in accepting the embryos by the uterus. Examples include causes present since birth, chromosomal abnormalities, polycystic ovarian syndrome (PCOS), old age, increased weight, fibroid, endometriosis, pelvic inflammatory diseases (PID), tuberculosis (TB), infections, smoking, surgery, some medicines, hormonal problems (thyroid, prolactin) or excessive stress.

3.Unknown causes- Despite thorough investigations, 25-30% causes of infertility remain unknown. This is called “Unexplained Infertility”. The reason may be mere chance factors or there may be some causes which, still medical science has yet to discover. But this should be kept in mind while treating infertility. That means, even with correction of the possible factors (like improving sperm counts or thyroid problems etc) or with proper treatment (IUI, IVF or ICSI), unfortunately the treatment can fail and the exact reason, why the treatment failed, is sometimes difficult to find out.

In general, what are the treatment options for infertility?

To start with, please remember there is no hard and fast rules for infertility treatment. Often medical science fails to understand why couples with very severe form of infertility conceive sooner than those who are having all tests normal. That means, whatever treatment is offered, it’s very important to continue regular sexual intercourse, as the chance of natural pregnancy is usually there in almost all couples. Your doctor will present the facts to you, without pressurizing you on a particular option. After coming to know all pros and cons of different treatment options, you can take decision. Do not hurry. It’s quite natural that you might be in stress.

In general, after the initial tests, a few periods of natural trying is allowed. After that, ovulation induction (giving medicines to release eggs from the ovaries) is offered, failing which IUI and finally IVF is offered. What will be the preferred treatment for you, will depend on your age, duration of marriage, male and female factors and of course, your age. For example, a woman with both tubes blocked or a male with very low sperm count, IVF would be the first line of treatment.

What is Fallopian Tube(s)?

Fallopian tubes (commonly called “the tubes”) are the structures that are connected to the both sides of the uterus, as mentioned above. Each tube is of 10 cm length. The part attached to the uterus is called the “cornu” and the part remaining free is called the “fimbria”. It’s the fimbria, that is present near the ovary and picks up the ovum and transports it inside the tube. The cornu received the sperms from the uterus and passes it inside. Inside the tube, the sperms and the egg meet to form the embryo, which then travels down the tubes into the uterus and then the pregnancy starts.

What happens if tubes are blocked?

If both the tubes are blocked completely, anywhere along the length (cornu, fimbria or the middle), pregnancy is not possible. This is quite obvious, because either the sperm cannot enter or the egg is not picked up or they cannot meet.

However, if any of the tubes are partially blocked, then the sperms and egg can pass and meet but the embryo cannot come down into the uterus. As a result, the pregnancy continues inside the tube, which is called “Ectopic pregnancy” that is life-threatening for the mother. It’s important to remember that ectopic pregnancy can happen even if both the tubes are open.

What are the reasons for tubal blockage?

Often, the exact cause is not known. Infection is the commonest cause. The infections may be due to sexually transmitted infection (STI), particularly Chlamydia infection or infection from bowel or appendix. Tuberculosis is very common in our country and can affect the tubes, silently, without affecting any other parts (not even the lungs) of the body. Endometriosis is also a common reason for tubal blockage. Any pelvic surgery (surgery in ovaries, tubes, uterus, even appendix) can block the tubes by “adhesion”. This means the tube may be open but attached to the bowel or rotated on itself, so that the tube cannot pick up the eggs from the ovaries. Sometimes fibroid of uterus can compress the tube and cause blockage. Women, with previous history of ectopic pregnancy, are at risk. Uncommonly, some abnormalities, present since birth can block the tubes.

What are the types of tubal blockage?

Tubal block may be one sided or both sided. It may involve only a particular part of a tube or multiple parts of a tube. The site of the block may be the cornu, the fimbria or the middle portion.

Hydrosalpinx, is a thing that you must know. In this condition, the tube is blocked but the mid-portion is dilated and contains some fluid (often infected). This tube is not functional. And the problem is even if there is pregnancy by IVF inside the uterus, this fluid from the tube may trickle down, coming in contact with the embryo and can potentially kill the embryo!

How can I understand that the tubes are blocked?

Unfortunately, very few women have signs or symptoms indicating tubal block. However, if you had previous infections in pelvis, tuberculosis in any part of the body, appendicectomy or other gynaecological surgery, there is chance of tubal block. Patients with fibroid and endometriosis are also at risk of tubal block. If you feel severe pain during periods or during intercourse, there is a chance that the tubes may be blocked.

When the tubes should be tested?

As mentioned earlier, the routine investigation of infertility includes testing for the ‘open-ness’ of the tubes- “Tubal patency tests”. That means if pregnancy does not come within 12 months of regular intercourse, then we usually advise the tests. Sometimes, tests are needed, after 6 months of trying (see above). However, in some women, with low risk of tubal block (no risk factors as mentioned above), it may be appropriate to start treatment and continue it for few cycles and if no response, then tubes should be tested.

How the tubes are tested?

The method of tubal patency test depends on your risk of having blocked tubes and also your wishes, availability of resources, other fertility factors and of course the affordability.

Routine ultrasound (like TVS) cannot detect tubal patency. However, it can detect the hydrosalpinx in most of the cases.

If you do not have any risk factors (like pain during periods, endometriosis, previous infections or surgery), you can choose either HSG or SIS. These are done in out-door basis, without any need of anesthesia.

HSG (Hystero-salingogram) is a method by which, your tubes will be seen under Xray. After visualizing your cervix (mouth of the uterus) by a speculum (instrument inserted in the vagina) a small screw will be inserted inside the cervix and a contrast material (which can be seen by the X ray) will be given through it. If tubes are open, the Xray will show that the contrast material will be going through the tubes into the abdomen.

The advantage of HSG is that, a test showing open tube has good correlation with tubal patency (if HSG shows the tubes are open, it’s likely that tubes are open). It is widely available and also cheaper.

However, the problem is that most of the women feel it painful, although they are given pain-killers for it. In addition, there is small risk of infection, for which antibiotics are prescribed. The contrast material can rarely give rise to allergy in some sensitive women and it may be life-threatening in very rare cases. Another problem is the false positive result. That means if tubes are found to be blocked in HSG, in 50% cases, they will be found to be open subsequently in laparoscopy. This is mainly because of some spasm of the muscles of the tube during the test.

SIS (Saline infusion sonography) or HyCoSy (Hystero-Contrast-Sonography) is the method by which tubal patency is checked by ultrasound (TVS) along with water like material inserted inside the uterus through a small tube. If tubes are open, the passage of water can be seen going into the abdomen through the tubes, in the ultrasound.

The advantage of HyCoSy is that it’s much less painful than HSG, although mild discomfort may be there. Pain-killers and antibiotics are prescribed usually. Additionally, problems inside the uterus can be better visualized, even better than normal TVS. In addition, the false positive result is much lower, only 7%. That means if HyCoSy suggests that the tubes are blocked, in most cases, the tubes will be found to be blocked at laparoscopy.

The problem with HyCoSy is mainly the cost and it’s not available everywhere.

An important merit of doing the tubal test is that, sometimes the water or the contrast material used in these tests can open the “mild” block. That’s why we often find patients who conceive spontaneously with pregnancy inside the uterus, after apparently “blocked” tubes in HSG or HyCoSy.

Now, laparoscopy is reserved for those, who are at high risk of tubal block. This includes women with risk factors (pain, surgery, infection etc) o women having “blocked” tube in HSG or HyCoSy. Clearly, it’s done after hospitalization under general anaesthesia inside the OT. Two or three small opening (key-hole surgery) will be put inside the abdomen and through vagina a coloured material (“dye”) will be given inside the uterus. If the tubes are open, the laparoscopic camera will show that dyes coming out of the tubes inside the abdomen.

The advantage is that it’s a definitive test, can help you to make final decision. It also provides the options of treatment. If there is corneal block in HSG, we can make attempt to open the tubes using laparoscopy (see below). In addition, if there is hydrosalpinx, where the tube serves no function, the tubes can be removed (salpingectomy) or clipped (we put clips to block the tubes) to improve the chance of pregnancy if IVF is the only option left for you. In addition, laparoscopy helps us to see whether there is any other diseases that have been missed by routine tests and that may account for infertility. We can treat the cysts of PCOS (by applying current to destroy some cysts), remove any large cysts, remove any adhesion, treat endometriosis etc.

The disadvantage of laparoscopy is of course, the need of anaesthesia and associated surgical and anaesthetic risks, although in modern era, the serious complications are uncommon.

What are my options if tubes are found to be blocked in HSG?

There are simply two options. It depends on your age, fertility factors and affordability. Number one is directly, you can go for IVF. In that case, you can save time and cost. It may be a preferred option, if you are aged or have some other fertility factors (low sperm count, endometriosis etc). The chance of pregnancy per cycle of IVF is usually 40%.

Another option is that you can confirm the block by other tests, keeping in mind that you may need IVF if the tubes are found blocked ultimately. We usually advise to have laparoscopy. However, some women want to give a trial with HyCoSy, because if HyCoSy shows the tubes are open, then you can avoid laparoscopy and you can try different fertility treatment options.

In laparoscopy, first we see if tubes are open or not. If open, there is no need of further treatment in laparoscopy. However, if tubes are found blocked, especially if the block is in cornu, we can try “hysteroscopic tubal cannulation”, where we put a small catheter through hysteroscope (a telescope, like endoscope, put inside the uterus through vagina so that we can see inside the uterus using a camera) to open the tubes. If tubes can be opened, you have all options for fertility treatment open. However, if we fail to open the tubes, the only option left is IVF. In addition, if there is fimbrial block, it can be released and new opening in the fimbria can be made. The treatment of hydrosalpinx by laparoscopy has already been discussed (see above).

Having said that, there are some group of women, who conceive while waiting for IVF or laparoscopy after a blocked tube found in HSG.

What can I do if tubes are blocked in Hycosy?

In this case also, there is choice between the two- laparoscopy first and IVF directly.

What can I do if laparoscopy suggests tubal block?

Unfortunately, in that case, the only option left is IVF. As mentioned before, if hydrosalpinx is found it must be treated before IVF. However, sometimes we find hydrosalpinx in laparoscopy but cannot cut the tube of clip it, simply because you did not give consent to us for doing so. In that case, we can suck out (“aspirate”) the fluid from the hydrosalpinx under ultrasound guidance (no need of further laparoscopy) using the needle.

How tubal block is dealt in your particular centre?

We believe in patient’s autonomy. So we want to give time on discussion and presentation of facts and figures to the couples. We encourage questions from the couples and take utmost care so that no question remains unanswered.

We do not take decisions and impose it on the couples. We advise the couples to take time before taking decision on a particular treatment. If the couple decides, we respect and support their decision.

We prefer to have SIS or Hycosy, rather than HSG, to reduce the pain to the women. We discuss all the options if tubes are found blocked.

Conclusion:

Tubal factor can account for 20-25% cases of female infertility. It’s more common in secondary infertility (women who conceived earlier- whatever be the fate of the pregnancy). Tubal test is a part of infertility investigation. The choice between HSG and HyCoCy is open to you. If tubes are found blocked, the options are IVF directly or confirming the block by laparoscopy.​

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Do isotretinoin cause hair loss? I'm 18 years old and going to take it 20mg for acne? Any more side effects?

B.Sc. - Dietitics / Nutrition, Nutrition Certification,Registered Dietitian
Dietitian/Nutritionist, Delhi
It should not have any side effect as such. But if you experience any side effect please stop immediately.
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I am 21 years old student learning engg. I am suffering from anti sleepiness from 14 months, everyday I sleep at 2 to 3 pm and wake up at 12 pm. I smoke every day. And causes low BP. So what to do?

Ph.D - Ayurveda, FFAM-Post Graduate Fellowship, MD - Ayurveda
Ayurveda, Delhi
Stop smoking, it is bad for health, if worrying stop, be positive. Take bath two times, reasonable exercise, yoga and meditation and selected herbal remedies

I want put some weight. So mass gainers are safe nd which brand is best nd cheep.

Diploma in Diet and Nutrition
Dietitian/Nutritionist, Hyderabad
It is better to take natural foods. Avoid supplements, as their effect is not guaranteed plus you will lose a lot of money over them. To gain some weight, you need to eat healthy. Take small meals but eat something solid every 2 hours. 1. Take at least two fruits per day and one glass fruit juice. 2. Take one peanut butter/cheese sandwich daily. 3. Eat 20 almonds & 5 khajoor daily 4. Drink full cream milk, curd, lassi, chikoo shakes etc. 5. If your are non veg you can have more eggs, chicken, fish. 6. Dals have good protien. Have more dals, rajma, kabuli chana, soya beans etc. 7. Avoid junk food and colas. Avoid chips and other namkeen. 8. No need for any extra supplements. Natural diet is best. 9. Go for regular walks / exercise / do yoga. Sleep well. 10. Take deworming tablets every six month. Feel confident about yourself and be positive.
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