Dr. Laxmi Goel

Hello!

I am Dr. Laxmi Goel, infertility and IVF specialist, and consultant gynaecologist at Fortis Bloom Fertility Centre. Today I am going to speak about infertility, its causes, and treatment. Infertility is a very common problem in today's world. When do we say that the couple is infertile when they are having unprotective intercourse for 1 year and they are not able to conceive. It is called infertility. But if the female's age is more than 30 years then we wait for 6 months i.e. if they had in protective intercourse for 6 months and they are not able to conceive then it is termed as infertility. Then they should seek a doctor and start the treatment. Now we come to the causes of infertility.

Overall the causes of infertility, the female accounts for 30-40% and male accounts for the 30% of the cases of infertility. So, we should not only treat the females, males also should be treated. And malefactors should also be assessed. Now we come to the female factors. Among the females, the common causes of infertility include the ovulatory dysfunction. That means the female is not able to produce the eggs or if she is producing the eggs, the ovulation is not happening. The 2nd cause is the tubal factor that means the fallopian tubes are blocked. The 3rd cause is the uterine factor. There can be some infection in the uterus, tuberculosis which is very common in India. It can also hamper the uterine cavity which can lead to infertility and there can be cervical factors. So, whenever the couple is coming, we should always assess these factors and we always treat according to the cause.

Among the malefactors, the oligospermia that means the sperm count is low and when the sperm motility is very low. Now when we come to the treatment part. Sometimes there is no cause that is called unexplained infertility. It means we have evaluated everything. We have done follicle monitoring that means the patient is producing the egg, she is ovulating but her tubal factor, we have done HSG for that. Whenever we are going with treatment, first of all, we go with the simple treatment. In which we give 2-3 cycle. Follicular monitoring is done on the 2nd day then on 9th days, 11th days and 13th days till the mature follicle is 18-20 mm and then we give the trigger shot and when the follicle rupture, we tell the couple to have the natural intercourse and try these steps for 2-3 cycles. If the pregnancy does not happen in 2-3 months then we go for the next step that is IUI. In this process, when the female has produced the eggs i.e. of 18-20 mm, we give the trigger shot and we take the semen sample to process it and wash it and then transfer the semen sample inside the uterine cavity of the female.

It increases the chances of pregnancy by 5-10%. We go for IUI for 2-3 cycles. If the pregnancy is not happening then we go for laparohysteroscopy. With the help of laparoscope and hysteroscope we assess the uterus from inside, outside and we assess the tubes and the ovaries. After that, if everything is normal that we go for 2-3 cycles of IUI. But if we see anything abnormal like if we have locked tubes or we have endometriosis or we have decreased ovarian reserves we counsel the couple for IVF. We give 10 days of injections to the female and have her follicles are mature enough that means 18-20mm than we take the eggs out and we also take the sperm of the male to form the embryo outside with the help of IVF or ICSI.

And when the embryo is formed, on day 3 or day 5, we transfer back to the uterine cavity. So, this is the procedure of IVF. We have multiple advances in this field. So, a couple should not hesitate to go to the doctor because so many new things are coming up. You should always consult a doctor. Should always consult an infertility specialist if you are not able to conceive.

Thank You!

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. 

Type of fibroids depending upon the location- 

1. Submucosal 
2. Intramural 
3. Subserosal 

What are the symptoms? 

Fibroids often remain quiet for long periods of time. They cause nonspecific symptoms in the pelvis and abdomen including: 

1. Fullness in the abdomen 
2. Low back pain 
3. Irregular menstruation 
4. Cramping with menstruation 
5. Painful sex 
6. Increased urgency to urinate 
7. Anemia, leading to tiredness and weakness 
8. 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.

Treatment Options 

Management of fibroids can range from doing nothing to periodic monitoring to surgical removal. 

1. If the patient complains of pain and bleeding then mefenamic acid and tranexamic acid are given for symptomatic relief. For control of bleeding various hormonal medicines are prescribed such as OCPs, GnRH analogs injections, ulipristal but if hormonal treatment does not work then resort to surgical treatment as already mentioned in content. Also if the patient has come with infertility with fibroid uterus the en location of fibroid is very important as submucosal fibroids must be removed hysteroscopically and intramural fibroids with submucosal indentation must be removed under laproscopy guidance.
2. 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. 
3. 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. 
4. 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. 
5. 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!

Toxic shock syndrome (TSS) is a potentially life-threatening condition that causes a steep drop in blood pressure, resulting in deprivation of oxygen to the organs, which in severe cases leads to death. This disease has been associated with menstruating women who use superabsorbent tampons. It was first recognized in the 1970s and 80s when women using tampons of certain brands were affected by this syndrome and those brands were immediately taken off the market. This disease primarily affects tampon wearers and harmful effects of cervical caps, diaphragms, and menstrual sponges have surfaced.

New mothers are susceptible to TSS as well as those who are recovering from a surgery, are wounded or are using prosthetics. It is important to know about its symptoms so that you can identify the disease and seek professional help at the earliest.

Symptoms

Warning signs of TSS include:
-Seizure
-Headaches
-Muscle aches
-Diarrhea
-High fever
-Nausea

Causes
An overgrowth of bacteria called staphylococcus aureus (staph) causes this disease. It can be found primarily in female bodies. This is one of the many staph bacteria that lead to skin infections in burn victims and patients recovering from surgical wounds. Group a streptococcus (strep) bacteria is another cause of this syndrome.

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

Oligospermia, also known as low sperm count, is a condition in which the fluid men ejaculate during orgasm contains less than 15 million sperm per milliliter. Consequently, low sperm count reduces your ability to father a child although there are certain treatments which can help alleviate the condition. Environmental factors, as well as your lifestyle, can affect your sperm count. It can also be a side effect of other medical conditions and diseases. Following are the causes and treatments for Oligospermia:

Causes

1. Medical causes - Medical conditions like varicoceles result in reduced sperm count along with complications like allergies and ejaculation problems. Antibodies in the form of immune system cells can also contribute to Oligospermia. Alterations in the hormones and defects of tubules that carry the sperm can cause significant damage to the sperm quality. Certain medications, celiac disease, tumors are also among other medical causes which can result in low sperm count.

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

Abnormal uterine bleeding, also known as AUB, is one of the most common causes requiring gynecologic evaluation. Hysteroscopy is a procedure wherein a thin camera called hysteroscope is introduced into the uterus via the vagina and this light helps in a thorough examination of the uterus. In cases where there are cysts or fibroids or even cancerous growths, this is used to get more details on the lesions. However, hysteroscopy also has a therapeutic use in that it is used to treat conditions like abnormal uterine bleeding. Read on to know more about AUB and how hysteroscopy helps in treatment. 

Causes of Abnormal Uterine Bleeding: Vaginal bleeding that occurs more often than 21 days and farther apart than 35 days is known as abnormal uterine bleeding. The bleeding is also abnormal if it lasts longer than 7 days and more than 80 mL of blood is lost during each cycle. 

Some causes include: 

1. Hormonal imbalance 
2. Cancer 
3. Uterine polyps 
4. Uterine fibroids 
5. Cervical infections 

Diagnosis/Treatment: 

When a woman has abnormal bleeding, further diagnosis is required to confirm the exact cause of the bleeding. This is where the hysteroscopy comes into the picture. Hysteroscopy, literally translates to viewing the uterus from inside directly through a camera. 

How it is done: 

Hysteroscopy is done as an outpatient procedure and normally takes about 3 to 4 hours. General or spinal anesthesia may be used depending on complexity and overall patient health. The uterus is filled with a fluid like saline or glycerin and a thin lighted instrument called the hysteroscope is inserted through the vagina, up the cervix, and into the uterus. This tube is flexible and so can be moved across the uterus to identify any areas of abnormality. It also has a camera and so can be used to take pictures of suspicious areas. 

Causes for infertility may also be detected using hysteroscopy. Small knives can also be used to remove the lesion like fibroid or polyp. These are often the cause of abnormal bleeding. Samples can also be taken for biopsy to confirm if any cancerous growth is detected.

Hysteroscopy is a safe and effective way to examine the cervical canal and uterine cavity. It is better to accompany D&C with hysteroscopy instead of going for blind dilatation and curettage, especially in women who are peri or premenopausal. Hysteroscopy is a safe procedure if done by a doctor, specialised in gynecological endoscopy and helps in both diagnosis and treatment of abnormal uterine bleeding.

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