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The available eggs in the ovaries at a time are collectively called an ovarian reserve. Low reserve happens when the production of eggs reduces. This affects the chances of pregnancy. The general cause of low reserves can be aging ovaries. In such cases, the ovary may be healthy and functioning even if the reserve is low. Production of eggs lower as a woman ages. A woman starts with 250,00 to 500,000 eggs at puberty and ends up with 1000 eggs at menopause.

Causes:
Low reserves are caused by

1. Production of eggs decreases: Chromosomal abnormalities like Turner syndrome (lack of two X chromosomes) and genetic anomalies like Fragile X can decrease egg production.
2. Ovarian tissue damage: Rough torsion, endometriosis triggered ovarian cysts, malignant or benign tumours, surgical removal of ovary or any other part of it, chemotherapy or radiation, pelvic adhesions, immunological problems or high BMI (Body Mass Index) can destroy the ovarian tissues.

IVF Protocols:
If a woman has low ovarian reserves, then she will be put on the either of the following protocols:

1. Short GnRHa Flare: Gonadotrophin releasing-hormone-agonist (GnRHa) like Lupron, Nafarelin, Synarel or Buserelin is administered. This therapy is initiated at the onset of menstruation. The goal of the treatment is to stimulate the release of the follicular stimulating hormone (FSH) which augments the ovarian follicular growth.
2. Combined Clomiphene or Gonadotrophin/Letrozole Stimulation: Older women are mostly administered this protocol. But it is strongly advised not to, as this protocol can potentially harm the egg or the embryo.
3. Mid-follicular GnRH-antagonist protocol: Once the GnRHa-agonist protocol is commenced, the GnRH-antagonist is given several days later. Once the follicles reach the size of 12mm, GnRHa antagonists like Ganirelix, Orgalutran, Cetrotide and Cetrorelix are added. These drugs stop the pituitary from secreting the luteinizing hormone (FSH leads to secretion of this hormone).
4. Long GnRHa Pituitary Down Regulation Protocol: This is the usual approach to deal with low ovarian reserves.
5. Agonist/Antagonist Conversion Protocol: This protocol inhibits FSH production. This protocol generally yields good results.

Babies can enter this world in one of two ways: Pregnant women can have either a vaginal birth or a surgical delivery by Caesarean section, but the ultimate goal is to safely give birth to a healthy baby.

A C-section, or Caesarean section is a surgical procedure to remove baby through an incision in the mother’s abdomen and then a second incision in the uterus.

A C-section may be a necessity in certain situations, such as delivering a very large baby in a mother with a small pelvis, or if the baby is not in a heads-down position and efforts to turn the baby before a woman gives birth have been unsuccessful.

Sometimes the decision by an obstetrician to perform a C-section is unplanned, and it is done for emergency reasons because the health of the mother, the baby, or both of them is in jeopardy. This may occur because of a problem during pregnancy or after a woman has gone into labor, such as if labor is happening too slowly or if the baby is not getting enough oxygen.

Some C-sections are considered elective, meaning they are requested by the mother for non-medical reasons before she goes into labor. A woman may choose to have a C-section if she wants to plan when she delivers or if she previously had a complicated vaginal delivery.

Reasons for a C-section may include-

1. Health problems in the mother
2. The mother carrying more than one baby
3. The size or position of the baby
4. The baby’s health is in danger
5. Labor is not moving along as it should

The surgery is relatively safe for mother and baby. Still, it is major surgery and carries risks. It also takes longer to recover from a C-section than from vaginal birth. It can raise the risk of having difficulties with future pregnancies. Some women may have problems attempting a vaginal birth later. Still, many women are able to have a vaginal birth after cesarean (VBAC).

How You Might Feel-

You won’t feel any pain during the C-section, although you may feel sensations like pulling and pressure. Most women are awake and simply numbed from the waist down using regional anesthesia during a C-section.

That way, they are awake to see and hear their baby being born. A curtain will be over your abdomen during the surgery, but you may be able to take a peek as your baby is being delivered from your belly.

However, women who need to have an emergency C-section occasionally require general anesthesia, so they’re unconscious during the delivery and won’t remember anything or feel any pain.

Recovering from a C-section-

After a C-section, a woman may spend two to four days in the hospital, but it may take her up to six weeks to feel more like herself again.

Her abdomen will feel sore from the surgery and the skin and nerves in this area will need time to heal. Women will be given narcotic pain medications to take the edge off any post-surgery pain, and most women use them for about two weeks afterward.

A woman may also experience bleeding for about four to six weeks after a surgical birth. She is also advised to not have sex for a few weeks after her C-section and to also avoid strenuous activities, such as lifting heavy objects.

Most women stay confused with the time of their ovulation or the duration of fertile period. A figure of 90% is often quoted as the proportion of couples, who are sexually healthy and are in their 20s and 30s and are not using any birth control measures, who will be expecting a child after staying together for a year. It is interesting to know that you have a high chance of getting pregnant at the time of ovulation. It is a small window period that comes each month. It is the time when your ovary produces ovum or egg and the egg is open for fertilisation. Even if you are having sex two or three days before ovulation, there is a high possibility of fertilisation. After ovulation is over, the window period gets shut for the next cycle. It is the safe period. Though doctors say that it cannot be considered 100% safe to have unprotected sex during this period, the chances of getting pregnant are considerably lower. 

When does ovulation actually start? 
It should be remembered that ovulation takes place at the middle of your menstrual cycle. It usually occurs halfway through the cycle. Commonly, the average time period of a cycle is 28 days. In such cases, ovulation will occur approx on 14th day (first day of bleeding is counted as day 1 of cycle). But, in some cases, women may have cycles as long as 23 to 35 days. In these women, ovulation day varies from 9th day to 21st day of cycle. 

How will you know that you are ovulating? 

1. Check your calendar: It is a healthy habit to keep a menstrual calendar. Now a days, a number of apps are available for maintaining menstrual calender. You must maintain the dates for a few months. This will give you an idea as to when you actually ovulate.It is difficult to know the actual time of ovulation if you are having irregular periods. 
2. Carefully listen to your body: It is a common thing that your body spontaneously sends a memo to you before ovulation starts. You get cramps or feel pain in the lower abdomen before ovulation starts. This pain is called mittelschmerz. It is a reminder of the coming periods. 
3. Chart your body temperature: Well, you will need to keep a record of your basal body temperature. You can measure it early morning before getting up from bed. Your basal body temperature changes throughout the monthly ovulation cycle. Progesterone hormone is responsible for the increase in body temperature. In the first half of the month, the progesterone levels are low and hence the temperature remains low as compared to the second half of ovulation. You can also use an ovulation detector kit to know the dates. 
4. Fertile Period: Three days prior to ovulation and two days after ovulation are considered the fertile period because a sperm can remain alive for 3 days inside female genital tract and an ovum once released, is available for 2 days for fertilisation.

The medical term bronchial asthma is also referred to as chronic respiratory illness that causes swelling of the air passageways. The main symptoms of the chronic respiratory illness includes shortness of breath, chest tightening, wheezing and coughing. More than 22 million people in the US suffer from this health condition. The main factor that causes asthma is air pollution and it occurs due to allergic reactions of airborne substances.

Important information on bronchial asthma

• About 5-10% of individuals suffer from this global health problem and it is mainly diagnosed based on a physical examination, clinical history and pulmonary functioning tests. 
• The treatment is provided by professional doctors mainly to control the symptoms of asthma.
• There are chances that acute shortness of breath occurs recurrently and it occurs either early in the morning or at night. 
• The four main conditions that are the cause of obstruction of the airway include edema of the airway walls, contraction of bronchial smooth muscle and irreversible changes in the lungs.
• About 5 % of adults and 10% of children are affected by bronchial asthma.

How to prevent bronchial asthma
It is very important that individuals who are affected by bronchial asthma stay away from the asthma triggers. The conditions that can trigger asthma include smoking of tobacco, air toxins and pollutions, food and airborne allergens, extreme weather conditions, dust mites, stress, food preservatives, anxiety and additives. To some extent it also happens due to singing, crying and laughing. Asthma attacks can also be triggered by respiratory infections such as cough and cold. It is very important to be healthy and have a strong immunity to be able to fight against infections.

How to diagnose bronchial asthma
The symptoms of bronchial asthma should be described properly to the doctor for treatment. The things that you do day to day and where you experienced unexpected flare-up must also be mentioned to the doctor. This way the doctor can identify the cause of inflammation of the bronchial passageways and shortness of breath. There are certain laboratory tests that can be performed to diagnose the health condition and these include chest X-ray, and spirometry.

Ayurvedic Bronchial Asthma Treatment
Ayurvedic treatment for Bronchial Asthma is initially focused on improving the digestive system. Herbal medicines are administered to clear the blockage from the channels by eliminating toxins (ama) from the body. They will then liquefy the Kapha present in the channels, allowing proper movement of Vata and fostering proper and easy respiration. Additionally, immune-booster herbal combinations are given to the patient in order to provide both physical and psychological strength, as the patient becomes weak due to repeated attacks of Asthma.

With the recent number of breast cancer cases on the rise, it is important that we should get the examination done on a regular basis as a preventive measure. Even if someone is suffering from it, it is important that we should make an effort and learn about.

If you have breast cancer then a surgery will be part of your treatment. Based on the condition, surgery will be carried out due to any of the following reasons:
1. To remove the cancerous tissues from the breast
2. To reconstruct the breast once the cancer is removed
3. To check whether the cancer has spread to the lymph nodes below the arm
4. To treat symptoms of cancer that has progressed to an advanced stage

Breast cancer surgery may be classified into two types-
1. Mastectomy: Mastectomy involves removing the entire breast; tissues in the adjoining region may also be removed. A double mastectomy is a procedure where both the breasts are removed.
2. Breast-conserving surgery: In this surgery, only parts of the breast affected by cancer are removed. The area of the breast that is to be removed will depend on the severity of the cancer. Some healthy tissues may also be removed in this surgery.

Usually, if a woman is in the initial stages of cancer then she may opt for the latter as it entails removing parts of the breast. They may also undergo radiation therapy along with these surgeries.
For checking if the cancer has spread to the lymph nodes below the arm, the lymph nodes are removed from the body. Once they are removed, they are studied under a microscope to check if it has spread, if yes then the extent of their damage. This procedure is carried out along with the surgery to remove the cancer.

Once the mastectomy procedure is completed, you can opt for a breast reconstruction surgery to rebuild the area. You may opt for this procedure at the time of breast cancer removal or at a later stage. If you are considering breast reconstruction surgery then you should discuss it with your surgeon.

Surgery is sometimes not used to treat cancer, but in slowing the progression of cancer or even reducing its symptoms.It is important you talk to your surgeon before the procedure to understand the goal of the surgery.

Ovarian cysts are a common development in many women. Cysts are sacs filled with fluid which are formed in the female ovaries. Most cysts are harmless and do not even show any symptoms. However, some cysts do show outward symptoms like heavy bleeding, clotting, nausea, vomiting, stomach pain during the menstrual cycle, and pain during sex.

If you feel any of the above-mentioned discomforts, it will be in your best interest to book an appointment with your gynaecologist and get a check-up done. Most cysts are manageable unless they are very severe. In fact, it is best that cysts come to light at the right time and are efficiently managed, unless they develop into severe issues in the future.

Management of cysts

1. Oftentimes, medical practitioners resort to what is called ‘watchful waiting’.
2. At times, ovarian cysts disappear in a few months.
3. It is recommended to take a blood test and an ultrasound to see the progress of the cyst.
4. If you have already experienced menopause, then these tests are carried out every four months. This is because in such cases the risk of an ovarian cancer is at its highest and regular monitoring of the cyst is necessary.

Treatment of cysts

Ovarian cysts can be treated in their earlier stages. Here are some of the most popular treatments.

1. Laparoscopy is one of the most popular treatments. It is a surgery carried out under general anaesthesia. The tummy is cut to a radius of a key hole and a laparoscope is inserted. This helps the doctor to see the internal organs, which is then used to remove the cyst. This method is less painful and has a quick recovery time.
2. Laparotomy is the other method used for removing a cyst. In case the cyst is large, then one single large hole is made in the body to access the cyst. At times, the cyst and the ovaries are removed and sent for further laboratory inspection. This inspection is done to detect whether the samples are cancerous or not. This procedure is more complex than the previous one and might need the patient to stay in the hospital for a few days.
3. In case you have a cancerous cyst, then your reproductive part itself would have to be removed rendering you barren for your life.

Ovarian cyst is very much treatable and is best to be detected at an earlier stage for better and faster treatment. Thus, it is best to go for regular check-ups and report in case of any disturbing symptoms.
 

Also known as tubal sterilization, tubectomy is a permanent method of contraception in women. It is a surgical procedure in which a portion of the fallopian tubes are blocked to prevent an egg that is released from the ovaries, from reaching the uterus. In case an egg is present in the uterus, it carries with it the risk of fertilization, thus, can lead to pregnancy. Sometimes the patient may change her decision and ask for a reversal of the process. However, it should also be kept in mind that the surgery is a complex one. The results are often not guaranteed.

The Procedure

• Tubectomy refers to cutting or blocking a small portion of the fallopian tubes that prevent the released eggs from reaching the uterus.
• The surgeon reaches to the fallopian tubes by cutting open a portion of the abdomen in case of an open surgery.
• Laparoscopic techniques are also available to conduct the surgery.
• The fallopian tubes are blocked by an artificial clip to prevent the passage of eggs.

Are there any risk factors involved?

1. Tubectomy may create a number of health complications in the long run.
2. Tubectomy is not advised for patients who have previously undergone abdominal surgeries.
3. Major risks of injury such as perforation surrounding blood vessels, internal haemorrhage or a severely life-threatening situation such as ectopic pregnancy may occur later on. Ectopic pregnancy is when fertilization and implantation occur within the fallopian tube instead of the uterus.
4. Tubectomy is even more challenging than vasectomy and has higher chance of giving rise to health complications.

Although the procedure is complex, it has a few advantages as well. Minimally-invasive surgeries help in quicker recoveries. It is almost 99% effective as a measure of birth control and thus provides a permanent solution. This surgery can even be done immediately after delivery. Sometimes, in rural areas, family welfare departments, government hospitals and primary health care centres offer free surgery and care to aid and educate about family planning.