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Dilation And Curettage (D&C) - Know About The Procedure!

Dr.Purnima Jain 91% (16ratings)
MBBS, MD - Obstetrics & Gynaecology
Gynaecologist, Delhi
Dilation And Curettage (D&C) - Know About The Procedure!

Dilation and curettage procedure which is commonly referred to as D&C is a minor surgical procedure where the cervix is dilated while a special instrument is used for scraping out the lining of the uterus. It is important to know what you can expect before, after and during the process so that you can stay ahead of unnecessary worries and help the process to be smooth and fruitful.

When do doctors recommend dilation and curettage process?
You may be required to undergo the dilation and curettage procedure for one of many reasons. It can be used for removal of tissues in the uterus during or after an abortion or miscarriage or to remove little pieces of placenta after delivery. This process aids in preventing infection as well as heavy bleeding. On the other hand, it can help in diagnosing and treating abnormal uterine bleeding including polyps, fibroids, hormonal imbalances and even uterine cancer. A sample of the tissues in the uterus is tested under a microscope to check if there is any abnormal cell present.

What can you expect during the dilation and curettage process?
The D&C procedure is a minor one and takes about 15 minutes even though you will have to spend about 4 to 5 hours in the healthcare facility. Before the procedure, your doctor would check complete history, and at this point, you should tell your doctor if you suspect that you are pregnant, you are sensitive to latex or any medicines or if you have a history of bleeding disorders. You will then be given anesthesia so that you don’t feel any pain or discomfort during the procedure. Before this procedure, you will have to empty your bladder.

The D&C procedure comprises two main steps, dilation, and curettage.
Dilation involves opening of the lower part of the uterus or the cervix for allowing insertion of a slender rod. This is done to soften the cervix so that it opens and allows curettage to be performed. Curettage involves scraping of the lining and removal of the uterine contents with the help of a spoon-like instrument known as a curette. This may cause some amount of cramping, and a tissue sample would be taken out for examination in the laboratory.

After the completion of the procedure, you may experience slight bleeding and cramping. In some rare cases, adhesions or scar tissues may start forming inside the uterus, and this condition is termed as Asherman’s syndrome which can cause changes in the menstrual cycle along with infertility. This problem, if arises, can be solved with the help of surgery and therefore, you should report any abnormality in your menstrual cycle to your doctor. In case you have a concern or query you can always consult an expert & get answers to your questions!

3377 people found this helpful

IVF Cycle - Why It Is Canceled?

Dr.Deepti Nitin Gupta 87% (34ratings)
MBBS, Diploma in Obstetrics & Gynaecology, DNB (Obstetrics and Gynecology), Fellowship in Reproductive Medicine
IVF Specialist, Bhopal
IVF Cycle - Why It Is Canceled?

In vitro fertilisation (IVF) is a precarious treatment, which is filled with hope and despair in equal measures. While you cannot wait to have a baby through IVF and you are terribly excited when the IVF cycle starts with some success, you still need to be prepared to face disappointment at any stage in the cycle.

There are certain reasons why an IVF cycle can be cancelled. Some of the reasons include:

  1. Ovarian cysts: As an important part of pre-treatment in IVF, a screening is done to check for ovarian cysts. If you do have a cyst in your ovary, the date for the commencement of IVF will be pushed back. Medicines will be prescribed to reduce the cysts in such a case.
  2. Poor stimulation responses: Usually, more than three follicles in the ovaries are needed to produce eggs. Fertility drugs are given to stimulate the growth of the follicles. But sometimes, there is a poor response to the drugs and the needed number of follicles might not grow. In this case, either the IVF cycle is cancelled or a different medication is used.
  3. Hyperstimulation: On one hand, there is poor or under active response to fertility drugs and then there is hyperstimulation; which is an overactive response to the drugs. This leads to excessive growth of follicles, which causes ovarian hyperstimulation syndrome (OHS). The cycle is cancelled as OHS might cause serious problems in the womb.
  4. Decline in estradiol levels: The ovaries produce a type of estrogen called estradiol. When egg follicles grow, estradiol is secreted, which triggers the rest of the cycle. If the levels of estradiol drop, follicular development is hindered. In this case, the IVF cycle will be cancelled.
  5. Poor egg retrieval: Usually, an ultrasound is done to check the amount of mature eggs before the retrieval. Sometimes, fewer eggs are collected than what was expected. If egg retrieval is poor, the cycle will not move any further.
  6. Poor fertilization: Poor sperm or egg equality might hamper the process of fertilization, which will thus impact the development of the embryo. If the embryo does not form at all, the cycle will obviously be cancelled.
  7. Illness: If you or your partner has a high fever or fall ill anytime during the process, the IVF cycle may be abandoned.
3264 people found this helpful

Reasons Why IVF Cycle Is Cancelled

Dr.Rita Bakshi 91% (2903ratings)
MBBS, DGO, MD, Fellowship in Gynae Oncology
IVF Specialist, Delhi
Reasons Why IVF Cycle Is Cancelled

In vitro fertilisation (IVF) is a precarious treatment, which is filled with hope and despair in equal measures. While you cannot wait to have a baby through IVF and you are terribly excited when the IVF cycle starts with some success, you still need to be prepared to face disappointment at any stage in the cycle.

There are certain reasons why an IVF cycle can be cancelled. Some of the reasons include:

  1. Ovarian cysts: As an important part of pre-treatment in IVF, a screening is done to check for ovarian cysts. If you do have a cyst in your ovary, the date for the commencement of IVF will be pushed back. Medicines will be prescribed to reduce the cysts in such a case.
  2. Poor stimulation responses: Usually, more than three follicles in the ovaries are needed to produce eggs. Fertility drugs are given to stimulate the growth of the follicles. But sometimes, there is poor response to the drugs and the needed number of follicles might not grow. In this case, either the IVF cycle is cancelled or different medication is used.
  3. Hyperstimulation: On one hand, there is poor or under active response to fertility drugs and then there is hyperstimulation; which is an overactive response to the drugs. This leads to excessive growth of follicles, which causes ovarian hyperstimulation syndrome (OHS). The cycle is cancelled as OHS might cause serious problems in the womb.
  4. Decline in estradiol levels: The ovaries produce a type of estrogen called estradiol. When egg follicles grow, estradiol is secreted, which triggers the rest of the cycle. If the levels of estradiol drop, follicular development is hindered. In this case, the IVF cycle will be cancelled.
  5. Poor egg retrieval: Usually, an ultrasound is done to check the amount of mature eggs before the retrieval. Sometimes, fewer eggs are collected than what were expected. If egg retrieval is poor, the cycle will not move any further.
  6. Poor fertilization: Poor sperm or egg equality might hamper the process of fertilization, which will thus impact the development of the embryo. If the embryo does not form at all, the cycle will obviously be cancelled.
  7. Illness: If you or your partner has high fever or fall ill anytime during the process, the IVF cycle may be abandoned.

Consult an Expert & get answers to your questions!

3838 people found this helpful

Menopause - Spot the Early Signs!

Dr.Meenu Goyal 90% (638ratings)
DGO, MBBS
Gynaecologist, Delhi
Menopause - Spot the Early Signs!

Menopause is the time in a woman’s life at which she cannot procreate anymore. Side effects of pre-menopause, menopause and post menopause, shift incredibly from woman to woman. Nonetheless, normal side effects of menopause incorporate:

  1. Hot flashes
  2. Changes in eating habits
  3. Weakness
  4. Stress
  5. Tiredness
  6. Vaginal dryness and itching

The majority of the side effects connected with menopause really occur during the pre-menopause stage. A few women experience menopause with no complications or disagreeable symptoms. However, others find menopausal side effects crippling and they usually happen during pre-menopause and go on for quite a long time. The symptoms that women experience are basically identified with decreased levels of the female sex hormones estrogen and progesterone. Side effects change generally due to the many impacts that these hormones have on the female body.

Your period may not be as regularly as it used to be. You may bleed heavier or lighter than usual, and at times experience spotting. Additionally, your period might be shorter or longer in time length. In case that you do miss your period, try to rule out pregnancy. In case you are not pregnant, a missed period could show the beginning of menopause. In case you start spotting after not having your period for twelve continuous months, try to converse with your specialist to discount any genuine conditions, for example, cancer.

Symptoms of untimely menopause are frequently the same as those seen by women experiencing common menopause and may include:

  1. Unpredictable or missed periods
  2. Periods that are heavier or lighter than normal
  3. Hot flashes (a sudden warmth that spreads over the abdominal area)
  4. These symptoms are an indication that the ovaries are delivering less estrogen.
  5. Vaginal dryness (the vagina may likewise get to be distinctly more dry and less adaptable)
  6. Bladder fractiousness and increased of loss of bladder control (incontinence)
  7. Emotional changes (crabbiness, mood swings, mellow stress)
  8. Dry skin, eyes, or mouth
  9. Restlessness
  10. Diminished sex drive

Keeping in mind the symptoms recorded above, in case that you are less than forty years old and experience any of the accompanying conditions, you need to see your specialist to figure out if you are experiencing untimely menopause:

  1. You have experienced chemotherapy or radiation
  2. You or a relative has an immune system issue, for example, hypothyroidism, Graves' infection, or lupus
  3. You have unsuccessfully attempted to wind up distinctly pregnant for over a year
  4. Your mom or sister experienced untimely menopause

To analyze untimely menopause, your specialist will in all likelihood carry out a physical exam and extract blood to diagnose different conditions, for example, pregnancy and thyroid illness. He or she may likewise arrange a test to quantify your estradiol levels. Low levels of estradiol, a type of estrogen, can demonstrate that your ovaries are beginning to fall flat. At the point when estradiol levels are beneath thirty, it might show that you have early menopause. If you wish to discuss any specific problem, you can consult a gynaecologist.

5429 people found this helpful

Bleeding In IVF - Risks And Management!

MD - Obstetrtics & Gynaecology, MBBS, FNB Reproductive Medicine, MRCOG
IVF Specialist, Mumbai
Bleeding In IVF - Risks And Management!

Bleeding in IVF

IVF in layman term means test tube baby with the highest results of all assisted reproductive treatments so far.
Bleeding can happen in 30 to 40% of patients during IVF at different stages - after egg pick up, during the luteal phase and during pregnancy

Definitely bleeding generally taken with dread but it can be a good sign also and can be harmless

1. Bleeding after OPU is due to the needle prick
2. During luteal support can be due to vaginal progesterone increasing sensitivity of cervix
3. Due to blood thinners
4. Can be a sign of a vaginal infection
5. Trauma due to sex
6. Local factors like polyps formed new due to elevated estradiol levels
7. Implantation sign especially when around day 10

So don't panic. Reach your doctor to get appropriate management solutions.

Know About Delayed Puberty

Dr.Arun Kumar Singh 92% (453ratings)
MD - General Medicine, DM - Endocrinology, MBBS
Endocrinologist, Delhi
Know About Delayed Puberty

Puberty results from activation of gonads (testes in boys/ ovaries in girls) by pituitary hormones LH and FSH. Activated gonads produce sexual hormones (testosterone in boys and estrogen in girls ) which are responsible for gender specific physical changes at puberty along with behaviour changes. Testosterone in boys is responsible for hair growth over pubic area and face with maturation of genital organs, breaking of voice, development of muscular and skeletal system. Similarly, estrogen in girls is responsible for breast development, maturation of genital organs with feminisation of body. Bone maturation with rapid height gain is seen at puberty both in boys and girls. Various systemic and hormonal disorders can result in either late or early puberty. 

LATE PUBERTY - 

Most of the boys show signs of puberty latest by age of 14 years and most girls start showing signs of puberty latest by age of 13 years. The earliest sign of puberty in boys is enlargement of testes and in girls is height spurt/breast development. When boys older than 14 years and girls older than 13 years don't have any signs of puberty it is called delayed puberty. 

CAUSES OF DELAYED PUBERTY - 

  1. Constitutional delay is most common cause of delayed puberty. The constitutional delay means child is not having any illness and he is going to develop puberty spontaneously at later age. But diagnosis of this condition can be made only after physical examination and investigations so that other causes of delayed puberty are ruled out. 
  2. Functional hypogonadotropic Hypopogonadism - Delayed but spontaneous puberty develops. This condition can be seen in systemic illnesses like chronic infections, poor nutritional status etc. 
  3. Hypogonadotropic Hypogonadism - Disorders of pituitary gland result in low LH and FSH so that testes/ovaries are not stimulated and sex hormone is not produced. This can be caused by various genetic disorders, brain tumours, head injury, brain radiation etc. 
  4. Hypergonadotropic Hypogonadism - In this scenario, LH and FSH levels are normal but gonadal are not able to produce sex hormones resulting in delayed puberty. 

CONSEQUENCES OF DELAYED PUBERTY - 
The absence of age specific pubertal changes cause anxiety and distress in children and their parents. These children may develop low self-esteem and are teased by their peers. Along with the poor development of physical signs of puberty, fertility is also affected in hypogonadism. And most importantly, delayed puberty can be the symptom of serious underlying illness like intracranial tumours etc. These children deserve medical attention to get best results. 

INVESTIGATIONS - 
Serum testosterone/estradiol with LH and FSH is done to find out where is defect i.e. whether at the level of pituitary gland or at the level of testes/ovaries. Further investigations depend on levels LH, FSH, estradiol/testosterone. Other useful investigations include prolactin, T4, TSH, ray hand for bone age, ultrasound pelvis, MRI pituitary gland etc. 

TREATMENT - 
After diagnosis is established, Testosterone/estrogen replacement should be started to boys older than 14 year and girls older than 13 years respectively. Hormone replacement is very effective and usually safe. In adulthood those with hypogonadotropic hypogonadism can be treated with LH and FSH to produce sperms/ eggs so that they can achieve fertility. If you wish to discuss about any specific problem, you can ask a free question.

2953 people found this helpful

Ovarian Function, Age, and Fertility!

Dr.Seema Jain 89% (60ratings)
MBBS, MD - Obstetrtics & Gynaecology, DNB (Obstetrics and Gynecology), Royal College of Obstetricians and Gynaecologists (MRCOG)
IVF Specialist, Pune
Ovarian Function, Age, and Fertility!

The ovaries are an important part of the female reproductive system. In a normal scenario, a woman has two ovaries that lie on either side of the uterus. Their main function is to produce eggs and release them into the fallopian tubes. These eggs then travel to the uterus where they may be fertilized. The ovaries are also responsible for the release of estrogen and progesterone. These hormones help regulate the menstrual cycle.

The functioning of the ovaries is directly related to a woman’s age. When a girl is born her ovaries have approximately 2 million eggs. These are in the form of follicles. By the time she reaches puberty, this number would have reduced to around 400,000. It is believed that a woman releases only around 450 eggs during her entire reproductive period. This is less than 1% of the eggs she was born with. During each menstrual cycle, one of the follicles will mature into an egg and be released. At the same time, some follicles may die. Thus, as a woman ages, the number of eggs available reduces. By her 30th birthday, the rate at which eggs are lost increases. By her 40th birthday, a woman’s eggs will die rapidly. Without a healthy egg being released sperm cells will have nothing to fertilize. Thus, ovarian functioning decreases as a woman grows older. This implies that the risk of infertility also increases as a woman grows older.

Along with a decrease in the number of eggs available the quality of eggs also reduces with age. Thus, though the ovaries may release an egg even when a woman is in her 40s, the chance of these eggs being fertilized is very low. Even if the egg is fertilized, women who conceive a child after the age of 40 have a high risk of miscarriage. There is no direct way to assess the quality of a woman’s eggs but some tests may help indicate the chances of getting pregnant. This includes a Basal FSH to indicate the level of follicle stimulating hormones, tests to determine the amount of Estradiol and tests to determine ovarian reserve. Ultrasounds can also help assess the number of follicles in the ovaries. This test is known as an Antral Follicle Count.

Infertility caused by decreased functioning of the ovaries is usually termed as unexplained infertility. In such cases, IVF is often the most preferred form of treatment.

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

5140 people found this helpful

Understanding The Role Of Hormones In Infertility!

Dr.Abhay Ahluwalia 87% (100ratings)
MBBS, MD - General Medicine, DNB, DM - Endocrinology
Endocrinologist, Gurgaon
Understanding The Role Of Hormones In Infertility!

Ever wondered how your body releases an egg each month or how the uterus wall thins and thickens at different times of the month? It is the job of your body’s chemical messengers – hormones, which manage the various processes involved in preparing your body for fertilization.

Hormones and Fertility
A subtle balance of different hormones, involved in managing the reproductive organs, enables and maintains fertility. These hormones regulation changes like the discharge of an egg from the ovary and thickening of the uterine wall lining (endometrium). Infertility results if this balance is disrupted.

Roles of hormones in making a woman infertile

Knowing the role of a hormone in making a woman infertile will be easier if you know its role in making the same woman fertile. Here is the role of the five most important hormones that encourage fertility in women-

  1. FSH or Follicle-stimulating hormone - The pituitary gland in the brain releases the Follicle-stimulating hormone. The major role of this hormone is to allow a woman to have better control over her menstrual cycle and production of an egg in her ovary. The levels of this hormone designate the proper functioning of the ovary as well as the quality of the produced egg. When there is an imbalance in this hormone, the ovary of the woman will not function properly to produce eggs, thus creating infertility in women.
  2. LH or Luteinizing hormone - The pituitary gland releases this hormone. It plays a vital role in stimulating the ovary of a woman to discharge eggs. It instigates the manufacturing of progesterone to prepare the uterus of a woman to accept a fertilized egg. When the level of this hormone is disturbed, it will not stimulate the ovary to release eggs.
  3. Estradiol Hormone - This is a vital form of the oestrogen hormone. When the levels of this hormone become irregular, it will reduce the chances of making a woman conceive.
  4. Thyroid hormones - This hormone assists greatly in making the ovulation as well as the ovary of a woman to function normally by interacting with the progesterone and oestrogen hormones.
  5. Progesterone hormone - This hormone plays an important role in making a fertilized egg to continue as well as to develop in the uterus of a woman. Any imbalance in the level of this hormone will not allow the egg in the uterus to grow.

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

2006 people found this helpful

Hormones & Infertility - Is There A Link?

Dr.Rajesh Jain 91% (220ratings)
MBBS Bachelor of Medicine and Bachelor of Surgery, MD Preventive Medicine, PG Diploma Diabetes
Endocrinologist, Kanpur
Hormones & Infertility - Is There A Link?

Ever wondered how your body releases an egg each month or how the uterus wall thins and thickens at different times of the month? It is the job of your body’s chemical messengers – hormones, which manage the various processes involved in preparing your body for fertilization.

Hormones and Fertility
A subtle balance of different hormones, involved in managing the reproductive organs, enables and maintains fertility. These hormones regulation changes like the discharge of an egg from the ovary and thickening of the uterine wall lining (endometrium). Infertility results if this balance is disrupted.

Roles of hormones in making a woman infertile

Knowing the role of a hormone in making a woman infertile will be easier if you know its role in making the same woman fertile. Here is the role of the five most important hormones that encourage fertility in women-

  1. FSH or Follicle-stimulating hormone - The pituitary gland in the brain releases the Follicle-stimulating hormone. The major role of this hormone is to allow a woman to have better control over her menstrual cycle and production of an egg in her ovary. The levels of this hormone designate the proper functioning of the ovary as well as the quality of the produced egg. When there is an imbalance in this hormone, the ovary of the woman will not function properly to produce eggs, thus creating infertility in women.
  2. LH or Luteinizing hormone - The pituitary gland releases this hormone. It plays a vital role in stimulating the ovary of a woman to discharge eggs. It instigates the manufacturing of progesterone to prepare the uterus of a woman to accept a fertilized egg. When the level of this hormone is disturbed, it will not stimulate the ovary to release eggs.
  3. Estradiol Hormone - This is a vital form of the oestrogen hormone. When the levels of this hormone become irregular, it will reduce the chances of making a woman conceive.
  4. Thyroid hormones - This hormone assists greatly in making the ovulation as well as the ovary of a woman to function normally by interacting with the progesterone and oestrogen hormones.
  5. Progesterone hormone - This hormone plays an important role in making a fertilized egg to continue as well as to develop in the uterus of a woman. Any imbalance in the level of this hormone will not allow the egg in the uterus to grow.
1485 people found this helpful

Oocyte Freezing - All You Should Know About It!

Dr.Aditi Dani 90% (56ratings)
MS - Obstetrics and Gynaecology, DNB OBGYN, ART Diploma
IVF Specialist, Mumbai
Oocyte Freezing - All You Should Know About It!

Oocyte freezing is a path-breaking technology that was first done successfully in the 1980s. Over the past three decades, with a high success rate, oocyte or egg cell freezing is a boon to women who want to preserve their fertility. It also helps women with cancer undergoing chemotherapy or whose ovaries must be surgically removed to experience the joy of motherhood.

What is Oocyte Freezing?

In this process, a woman’s egg cells or oocytes are extracted and preserved in sub-zero temperatures. The egg cells can be thawed at a later stage and combined with sperms in the lab. It can then be introduced into the uterus to induce pregnancy.

How is the procedure performed?

First, the doctor will examine the quality and quantity of your oocytes. The amount of Follicle Stimulating Hormone and Estradiol in the menstrual blood of the third day of your cycle is also examined. After a complete assessment of the health of your egg cells and screening for infectious diseases like HIV, you can begin the procedure. You can resume your regular activities after a week of the procedure.

After the tests and screening, hormones are injected to stop ovulation for 2 to 4 weeks. More hormones, to ripen multiple eggs in the ovary, are injected after that. After the eggs mature, they are extracted through the vagina with the help of an ultrasound-guided needle. The eggs are immediately frozen using a slow controlled rate process or a faster vitrification process. When you are ready for a baby, the cryopreserved eggs are placed in a warming solution, injected with a sperm and allowed to grow into the embryo. Introducing the embryo into the uterus is usually done after 3 to 5 days.

Who should do it?

• Women undergoing chemotherapy or pelvic radiation therapy that can potentially affect fertility
• Women with a family history of early menopause
• Ovarian diseases that damage the ovaries
• Women with conditions like Turner Syndrome, Fragile X Syndrome, BRCA Mutation, which causes failure of ovaries or genetic mutation
• Women with personal reasons to delay pregnancy

Oocyte freezing is an empowering decision for many women, who otherwise could not have conceived. With a success rate of 75%, women suffering from cancer or gynaecological problems can experience the joy of motherhood. The younger you are at the time of freezing, the higher are your chances of motherhood.

2861 people found this helpful