Hello, I am DR Vaishali Sharma. I am practising as a consultant Gynaecologist in South Delhi.
If you have any problem in conceiving naturally, then when to consult a gynaecologist. You should know that if your age is below 30-35 years then you can try naturally for one year. But if you are coming close to 35 years then I think that 6 months of natural conception is enough because you should not waste much time after the age of 35 years.
What are the options to increase the chance of pregnancy?
- The best thing is that you should go for Pre- conceptional counselling. But if you are not doing so then you should know that the best chance of conception is during the mid cycle, that is, if you have a cycle of 28-30 days then the best time for pregnancy is 10-16 days after your cycle. The number of days we are calculating here are from the 1st day of the cycle. So, this is the best time from which you can calculate naturally.
- The other thing is the kit that is available in the market to know what is the time of Ovulation, that is when the egg is released. So, these are the very commonly available in the market. YOu should use them from the 10th day of the cycle and then you have to use them daily, preferably in the afternoon period and you have to do the urine test yourself. If you find the two dark lines on it, that means you will be ovulating.
- Then if you find that you will not be able to conceive from these methods then you should go the nearby gynaecologist. She may advise you basic investigation from basic workup. For example a blood test, semen analysis and so on. And if the basic investigation area coming normal, then you are advised to have medicines. These medicines are roughly for 5 days. This is called Ovulation Induction. They basically increase the chances of ovulation and egg release. So, this thing you can try for 3-4 months but this has to be done under the guidance of Gynaecologist. We advise them to take 5 tablets during their periods. We call them from the 9th day of their cycle and perform an ultrasound to see whether the eggs are formed or not. Once the eggs are there and the appreciable size of 18mm is attained, then we give the injection to release the eggs. After this, we tell the patients that this is an appropriate time to try the conception. This way if the couple is not able to conceive within 6-8 months, then we advise them to go for either the injections, which will help in the formation of eggs.
- Or we advise them to go for IUI (Intrauterine Insemination). One most important point is that before suggesting IUI to the patient, the tubal testing is a must. That is usually advised HSG and SSG. In this way, we show that both the tubes are patent. In case there is a problem in semen or there is some problem with the male like the premature ejaculation or difficulty in performing. In such cases, we advise the patient to visit an endocrinologist. And the final option we give them is IUI. Through this, 50% of the patients are able to conceive in 6 months and another 50% of the patients are able to conceive in another 6 months. The cumulative success rate is come out to be around 75%.
- In case the patient is not able to conceive after injections and IUI then we usually advise them to go for Laparoscopy treatment. This is a diagnostic and therapeutic option because, in this, the woman has to get admitted to the hospital and we directly look through the Laparoscope, that is camera through which we are able to know if the tubes are blocked, any difference in the location, a relationship between the ovaries and the tubes. In this way, we are able to detect and correct it. It is a painless procedure and the woman has to admit in the hospital for 8 hours. THis is minor operation in which 2-3 stitches are there. BUt this is mandatory before proceeding further. After doing laparoscopy we are going to tell patients that the tubes are open and you can continue with the Ovulation induction and IUI. In that way, you will have the chances of pregnancy. And even after the Laparoscopic surgery, the tubes are blocked, then we suggest our patients for the IVF that is the test tube baby. If the tubes are blocked then IUI will not be helpful.
- IVF surgery is also advisable when the female partner is close to the age of 40 or so. After the age of 35 years, the quality of the eggs in the female ovary will decline sharply. So, sometimes the IVF is suggested directly to the patients in case ovarian reserves are poor.
- In case IVF test tube baby is advisable, then we have lot many options.
So, if you want to take an appointment, you can visit me at Asian clinic in GK-1 or you can consult me through Lybrate for the audio and the video call consultations.read more
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Caesarean Section Procedure
Treatment Of Female Sexual Problems
Termination Of Pregnancy Procedure
Treatment Of Pregnancy Problems
Well Woman Healthcheck
Treatment Of Female Sexual Problems
Treatment Of Medical Diseases In Pregnancy
Treatment Of Menstrual Problems
Intra-Uterine Insemination (IUI) Treatment
Medical Termination Of Pregnancy (Mtp) Procedure
Gynecology Laparoscopy Procedures
Pap Smear Procedure
Urinary Incontinence (Ui) Treatment
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Hello sir, I am 26 years and I have 1 year daughter and before marriage I am suffering from pcod. And now again I am suffering from irregular periods from last 1 month. My ovaries size are right 3.6, 2.6, 3.3 and left 3.4, 2.8, 2.7 and my weight is 88 kg. And tsh is 7.1.kindly help me out, what to do? And I did one abortion in month of may. After my pregnancy my period was regular but after my abortion. I am suffering from this.
I am 29 years old female, married and have two kids. I have a solid lump in breast from five years. I keep getting an ultrasound for the same every 6 months-1 year. It has not changed. Recently, a radiologist suggested to remove it surgically. Should I consult an oncologist?
It is very common for women to have heavy and painful periods or have a feeling of fullness in the lower abdomen. Although, it may not sound very alarming these could be the symptoms of uterine fibroids. These are the most common types of benign tumours found in women. The fibroids are basically some tissues and muscle cells that grow within the uterus, outside the uterus, or along the wall of the uterus. The fibroids are usually benign and asymptomatic and do not require any treatment unless they cause problems.
Know the causes
Though the exact cause of fibroid formation is not known, it is believed that the female hormones estrogen and progesterone have a role to play in their formation. Fibroids are formed only when a woman is producing these hormones and they are not seen in women in non-reproductive age i.e. before starting of menses or after stoppage of menses (menopause). If fibroids are persisting even after menopause or especially if increasing in size then it is an alarming sign. Such a fibroid needs to be taken care of immediately.
What are the symptoms?
Fibroids often remain quiet for long periods of time. They cause nonspecific symptoms in the pelvis and abdomen including:
- Fullness in the abdomen
- Low back pain
- Irregular menstruation
- Cramping with menstruation
- Painful sex
- Increased urgency to urinate
- Anemia, leading to tiredness and weakness
- Infertility Diagnosing the fibroids
When these symptoms are recurrent, it is good to confirm the diagnosis. This can happen with a pelvic exam followed by ultrasound scanning to confirm the size and location of the fibroids. A blood test also may be done to confirm anemia, which is common due to heavy periods.
Management of fibroids can range from doing nothing to periodic monitoring to surgical removal.
- If pain and heavy bleeding are the only symptoms, then pain killers like ibuprofen should suffice for symptomatic relief. Anemia, if severe, may require iron supplementation.
- Embolization is an option which shrinks the fibroid, at the same time preserving the uterus. The blood flow to the fibroid is cut off, thereby preventing its further growth. It takes about 1 to 3 hours and requires some bed rest after the procedure. There could be some pelvic pain and vaginal bleeding, which will gradually subside. The fibroids may grow back, but the benefits of keeping the uterus are definitely there. This is suitable in case of single fibroid with specific blood supply.
- The next surgical option is myomectomy, where the portion of the uterus which contains the fibroid alone is removed. This is done in women who still wish to get pregnant and in women who would like to retain the uterus. This can also be achieved laparoscopically( key hole surgery). In such cases, fibroids are cut into small pieces and then removed from the body. This procedure should be done by a doctor specialised in advanced gynecological endoscopy as all this cutting should be done in a bag to avoid any spillage of cells inside the abdominal cavity. This procedure is known as Laparoscopic Myomectomy with In-bag Moecellation.
- In women who have crossed their pregnancy phase, hysterectomy or complete removal of the uterus is advised. In these women, the bleeding and pain may not have subsided even after years of treatment with hormones. The growing fibroids could be pressing on the adjacent organs, causing pressure. This is the only definitive treatment and should be done in women have completed their family and don’t desire to be pregnant.
- Myomectomy and hysterectomy may be done laparoscopically or with an open method depending on the overall health, the size and location of the fibroids in the uterus.
In case you have a concern or query you can always consult an expert & get answers to your questions!
Hello. I am Tanaya 27 years female. I had PCOS. And I lost 10-12 kgs in last 4 months. Till last month I was in Birth control pills (Novelon) and had my periods twice in ten days interval. I had my last period on 25th of September. Last Saturday I did my pregnancy test and it came positive. Next day again I did again it came positive. However to make sure exact date of pregnancy I did Beta Hcg and Progesterone test. Today I got the results. Beta Hcg-22113 and Progesterone-25. As per result I am pregnant. Also I am having a belly pain specially upper belly. couple of lose motions I had earlier and Nausea tiredness. My question is that it is showing I am pregnant for 4-5 weeks which is same to the last date of my period how can an egg get fertilised when I was having period. My Doctor asked me to do usg afer 15th October.
I had sex on july. I checked my pregnancy by lab urine test or home pregnancy test after 15 weeks. Both give me negative pregnancy result. But after that when I take ultrasound or again urine pregnancy test in a hospital. They told me that I am pregnant. Because of I have regular menses, fetus is only of some days. Is it possible.
I am pregnant from 9 months my due date is nov 9 I have pain in abdominal and back pain mildly. Is this labour? I go to doctor for any injection increase the pain or wait? Pls tell me.
Ovarian cysts are fluid-filled sacs in the ovaries, often in multiples, which are very common in women. This is absolutely different condition from polycystic ovaries. Most of them are benign and not indicative of an underlying problem. They produce no specific symptoms and even if detected, can be watched over a period of time. Treatment may be required only if there are serious symptoms or there is higher possibility of cancerous nature of the cyst. Read on to know more.
- Functional: There are two types in this. The follicular variety is when the egg that is ready for fertilization does not completely shrink and stays for a few more days before it disappears. Another variety, the luteal ovarian cysts are formed when after the release of the egg, there is blood filling up in the corpus luteum.
- Pathological: There are many types here – dermoid, cystadenomas, endometriomas, cancerous cystadenocarcinomas etc. These are worrisome and need to be treated. Both varieties, once identified, should be monitored. The functional variety, though may not cause a problem, can cause infertility and so necessitate treatment.
Any ovarian follicle larger than 2 cm can be called as an ovarian cyst. They are usually benign and do not produce any symptoms. However, if they turn pathologic or grow in size, they can cause various symptoms such as:
- Irregular menstruation
- Heavy bleeding
- Intermittent spotting
- Painful and/or frequent urination
- Severe, recurrent abdominal pain
- Abdominal bloating
- Constipation or loose motions
- Nausea, sudden vomiting
- Fever, dizziness, and weakness
While cysts are often quiet and do not produce any symptoms, they can cause intermittent, nonspecific symptoms like above. If there is a family history of ovarian cancers in mothers, maternal aunt, Sisters, Grandmothers etc then women should have regular Gynaecological checkups to have a check done for ovarian cysts.
Why go for laparoscopic surgery?
- Laparoscopic surgery is considered to be one of the most effective ways of treating the condition of ovarian cysts. During the surgery, problem causing non-cancerous cyst can be removed without harming the ovaries. In the case of cancer, both ovaries along with uterus etc may have to be removed. This decision is taken by the operating surgeon depending upon age of the patient, characteristics and nature of the cyst and future fertility desires of the patient.
- The patient is given general anesthesia during the surgery. After the surgery, one is suggested to rest for a day and may be permitted to return to normal activities within a day’s time. However, one needs to avoid any strenuous activity for almost a week.
- While some cysts can be watched for years, others need treatment. This would be specifically true in cases where the couple is facing infertility issues or if there is a higher possibility of cancerous cysts. Such cysts need urgent intervention and should be monitored by a gynecologist with an experience in oncology. There are few blood tests that are needed to be done to know the nature of the cyst if it is benign or cancerous.
Hi. I am 20 years old. It's been 3 years of my marriage. I have pcos. I am trying to conceive. I don't want to take birth control pills or 21 days tablets as they have many side effects like weight gain and hair loss. So my doctor prescribed me ova care tablets for 3 months. I have been taking ova care tablets since 1 month. Is there any chances of getting pregnant by taking these tablets. How many months does it take to get pregnant?
Laparoscopy is one of the most common procedures for diagnosing and removing endometriosis. Instead of giving a big incision, this procedure of surgery uses lightweight instrument through a small hole or incision. There could be one or more incisions based on the number of instruments that require access inside the body. This procedure involves the use of a camera to ascertain endometriosis as well as treat it in the same sitting. This brings drastic improvement in infertility as well as pain associated with the endometriosis. If a cyst is found in the ovary, laparoscopic surgeon removes it very delicately without causing any harm to the normal ovary, as a part of the Laparoscopic Surgery for Endometriosis.
How does the procedure go?
Eating and drinking should be suspended before 8 hours of the laparoscopic surgery. The doctor takes a call on whether to give a general or local anesthesia. Mostly, General anaesthesia is given during such procedures. A person specialised in Gynecological Endoscopy ( Gynaec Laparoscopic Surgeon) is the best to perform such a procedure.
How is the procedure performed?
The abdomen is first inflated with gas with the help of a needle. It pushes the abdominal wall from the organs to give a clear visibility to a surgeon. The laparoscopic Camera is then pushed through an incision or a set of incisions to examine the internal organ. If the scar tissue or endometriosis needs to be removed, a doctor can use one of the several laparoscopic techniques such as electrocautery, excision etc. Post the surgery, the incision is closed with stitches. The whole procedure usually takes 30-60 minutes depending upon the severity of endometriosis.
Why is laparoscopy done?
- If the endometriosis pain has returned after a hormone therapy
- If there is a growing endometriotic cyst
- If the scar tissue found on the pelvic wall poses a threat on fertility
- If the endometriosis interferes with other organs such as the bladder etc.
- If the pain during menses ( dysmenorrhoea) refuses to subside
Duration of hospital stay:
Operations such as these are usually conducted at the outpatient facility owing to their less risky nature. A patient need not spent more than a day in the hospital. Rarely in severe cases of endometriosis overnight hospitalisation may also be required. One can successfully return to normal work within 1 week of the surgery.
Post-surgical recovery: Once the laparoscopy is done, the next steps of treatment are decided based on the patient's age and severity of endometriosis. Few hormonal medicines are advised according to the desire for fertility etc. If a patient is over and above 35 years of age, the risk of miscarriages double. Since the quality of egg declines by the year, it makes sense to undergo infertility treatment such as the in vitro fertilization (IVF), intake of fertility drugs, insemination etc. If, however, the patient is below 35 years of age, makes sense to conceive naturally first and consult a doctor simultaneously. A routine check-up post-laparoscopic surgery on alternate six months for a year will keep any risks at bay. Consult an expert & get answers to your questions!