Doctor in Indira IVF-Bhadup West
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The uterine cavity has a tissue base that is known as the endometrium. When this endometrium spills over or spreads to the other parts of the reproductive organ, it begins to punch through the uterine lining. Such a condition creates complications and even infertility, and is known as endometriosis.
Read on to know more about endometriosis and how it can cause infertility.
When the endometrium tissue spreads to areas like the ovaries, and the abdominal cavity, it can lead to numerous complications. Apart from pain, this may also cause infertility. 5 to 10% of the women worldwide suffer from this condition and have trouble conceiving. Additionally, about 30 to 40% of the infertility cases are due to endometriosis, not all cases. These figures are all confirmed by various medical studies.
How does it cause infertility?
Endometriosis can prevent ovulation, which is the process that occurs every month. During the ovulation process, the ovaries release eggs that may be fertilised in order for the woman to conceive. In this condition, the fimbria of the fallopian tubes also has trouble in capturing the egg, which prevents conception from taking place. This leads to infertility in the long run. Endometriosis also interferes with the proper production of the hormones that are required for normal ovulation and fertilisation of the egg.
Diagnosis: The diagnosis of the condition can be done with the help of lab tests and ultrasounds as well as imaging tests that can create the image of the womb and the endometrium lining. This will help in showing the severity and damage caused by the tissue. A surgical procedure called a laparoscopy may be carried out by the doctor to ascertain whether the patient is suffering from this condition. In this procedure, a small incision will be made and a camera will be inserted to view the insides on a screen, to learn more about the tissue’s spread and the kind of treatment that will be required. The doctor will also diagnose the condition on the basis of various symptoms like irregular and heavy bleeding.
Treatment for endometriosis associated with infertility needs to be individualized for each woman. There are no easy answers, and treatment decisions depend on factors such as the age of the woman, the severity of the disease and its location in the pelvis, the length of infertility, and the presence of pain or other symptoms. Some general issues regarding treatment are discussed below.
Treatment for Mild Endometriosis
Medical (drug) treatment can suppress endometriosis and relieve the associated pain in many women. Surgical removal of lesions by laparoscopy might also reduce the pain temporarily.
However, several well-controlled studies have shown that neither medical or surgical treatment for mild endometriosis improving the pregnancy rates for infertile women as compared to expectant management (no treatment).
For treatment of infertility associated with mild to moderate endometriosis, controlled ovarian hyperstimulation with intrauterine insemination - IUI is often attempted and has a reasonable chance to result in pregnancy if other infertility factors are not present.
Details about IUI success rates with endometriosis
IUI and endometriosis
Success rates with IUI for endometriosis have been variable in studies, showing:
- A pregnancy rate of 6.5% for women with endometriosis vs. 15.3% per cycle for unexplained infertility
- A pregnancy rate of 5.6% for women with advanced endometriosis vs. 22.7% per cycle for mild endometriosis vs. 25.7% for no endometriosis
- Pregnancy chances with insemination for natural cycle IUIs (no drugs) with endometriosis are about 2% per cycle vs. 11% with injectables plus IUI for endometriosis
Several studies have shown that medical treatment for severe endometriosis does not improve pregnancy rates for infertile women.
Unfortunately, infertility in women with severe endometriosis is usually resistant to treatment with ovarian stimulation plus intrauterine insemination. If the pelvic anatomy is very distorted, artificial insemination is unlikely to be successful. These women often require in vitro fertilization in order to conceive.
Although the studies of in vitro fertilization for women with severe endometriosis do not all show similar results, pregnancy success rates are usually good if the woman is relatively young (under 40) and if she produces enough eggs during the ovarian stimulation.
There are many reasons leading to infertility, but one of the main causes is the inability of the sperm to travel all the way up to the uterus to fertilize an egg. This is caused by defective sperms and could be due to poor sperm quality, poor motility, etc. There are multiple reasons for this, and even smoking, obesity, diabetes, hypertension, etc. could be reasons.
Many technical advancements in fertility treatments are being done, and they try to keep the natural process of fertilization intact, at the same time improving the chances of success. Intracytoplasmic sperm injection (ICSI, often used as a standalone term iksee) improves the rate of fertilization in that the sperm is directly injected into the egg. The environment of this artificial fertilization is completely controlled, and the fertilized egg is then placed into the womb for further growth. It is one of the recent methods of improving fertility, a part of ART (assisted reproductive technology).
- Poor sperm perms motility
- Semen where sperm concentration is low
- Male infertility with unidentifiable cause
- Poor sperm quality, with sluggish sperms
- Ejaculation issues, such as retrograde ejaculation (semen is ejected into the bladder)
- Useful in couples who have failed IVF.
The following outlines some of the steps for both male and female before and during the procedure.
Before the procedure - males:
- First step is the sperm collection; a screening is first done
- Sperms collection happens through either masturbation or directly from the testicles via a small incision
- Sperms could be collected fresh or collected and frozen for later use
Before the procedure – women:
- In the normal menstrual cycle, only a single egg is released. However, prior to ICSI, the woman is given ovulation drugs, which are high-dose hormone injections prior to ovulation. This ensures multiple eggs are released, which are then retrieved for fertilization in the external environment.
- Blood and urine are monitored regularly to identify the ovulation time, and eggs are collected within 24 to 36 hours of release
During the procedure - How ICSI happens:
- A healthy egg is chosen and placed in a glass tube, and a sperm is introduced to ensure fertilization
- This could be repeated in multiple tubes, and the most healthy one could be chosen to be implanted into the uterus
- Some of the fertilized ones could be frozen for later use, in case the implanted embryo fails to grow as expected
- The success rate for this procedure is quite high as the fertilization rate is almost 80 - 85 %
There is every possibility that even after going through more than three rounds of IVF, the treatment might not turn out to be successful, wherein it might not result in pregnancy. Naturally this kind of situation makes women frustrated and thus leads them to consider other alternative options.
One other option which is sometimes offered by IVF clinics present abroad after few unsuccessful attempts or miscarriages, which cannot be explained by the specialists, is using corticosteroids. Corticosteroids are steroid hormones that can either be made in the body or even in a lab.
Generally, corticosteroids are used to treat certain life threatening autoimmune diseases like lupus, severe kinds of allergies and for preventing the organ transplants from getting rejected. Certain serious side-effects are associated with corticosteroids, which include insomnia, infections, mood changes, heart problems, gain in weight and also headache.
At IVF Clinics, corticosteroids are given in order to meet the demands of people having fertility problems along with other doses to suppress immunity. All these are mainly driven by misunderstanding both on the part of a consumer as well as that of medical, on how the immune response actually works.
Immune system in case of pregnancy
- Most of the doctors carry a view, which is completely outdated. They believe that immunity gets naturally reduced, when a woman is pregnant. As a result of this belief, they feel that it is completely acceptable to get the immune system suppressed by way of medication.
- The argument which the doctors put forward in case of suppressing the immune system during pregnancy completely ignores clear proof of the fact that an immune response in a controlled manner is actually an essential part of normal embryo implantation. This is necessary for healthy growth of the fetal. Though the uterus might look to be unwilling to allow implantation of the embryo, if the immune system is suppressed through the use of drugs, then that will not solve the problem.
- The immune system plays an important role as it acts as a defence for the body against all kinds of infections and cancer. During pregnancy, cells of immune system assist the uterus to tolerate and properly nurture the embryo even when it carries the foreign genes from the father.
Use of corticosteroids is not so safe or effective
The records put forward by the IVF clinics through those women, who have been pregnant by way of IVF, have created the false perception about the fact that corticosteroid drugs are safe and effective. The patient group had low chance of adverse effects from the use of this drug has ensured wide-scale use of corticosteroids, as they come up with no kind of immune disorder.
Still, there always remains a high chance of problems in pregnancy and a higher rate of foetal malformations for women, who take these drugs. Data suggests that among 311 women, who had used corticosteroid drugs for more than the first 3 months of IVF cycle, had gone on to show 64% increase in miscarriage.
In certain case of autoimmunity, some women might benefit from these drugs but in majority of women, these steroids cause more than any good.
In vitro fertilization (IVF) includes empowering the woman with medicines, taking various eggs from her ovaries, fertilizing them with her partner’s sperm, and inserting a portion of the subsequent embryos into her uterus with the trust that one will form into a fetus.
Tubal ligation reversal, on the other hand, requires a laparotomy, which needs a much bigger entry point on the abdomen, usually around four to six fingers long. Since the skin, each of the muscles, and different tissues of the stomach must be sliced through, there is extensively more uneasiness and a longer recovery time required after the surgery, when compared with a laparoscopic surgery, for example, with a tubal ligation.
- Sperm quality: The male partner needs a sperm test before basic procedures of either of the two. In case that the sperm quality is great, then the couple could consider proceeding. In case that the sperm quality is poor, in vitro treatment is the better alternative. With IVF, poor sperm quality is effectively overcome.
- Tubal status: The length of the remaining tubal stumps after tubal ligation is an important aspect. The more extended the two remaining stumps are on each side, the better and more effective is the pregnancy. The shorter the stumps, the lower are the odds for pregnancy.
- Status of other pelvic conditions: Pelvic endometriosis or any scar tissue in the range of the tubes or ovaries would diminish the chance for accomplishment after tubal ligation reversal. Although, IVF pregnancy achievement rates are usually not influenced by these conditions. Along these lines, in vitro fertilization is most likely a superior alternative in women with noteworthy endometriosis or pelvic scar tissue.
- Female age: Chances for pregnancy with either tubal ligation or IVF decrease in the mid to late thirties and significantly reduce at the age of thirty-eight. By age forty-three or forty-four, not many women will have the capacity to have a baby using either approach.
- Egg amount and quality: A few women have a decrease in either egg amount or quality prior in life than anticipated. In this manner, the woman’s ovarian capacity needs to be tested before a choice is made in regards to whether to continue with either tubal ligation or in-vitro fertilization. AMH levels, ovarian antral follicle number, and day 3 FSH levels are generally done to evaluate ovarian capacity or hold.
- Doctor intervention: The greatest favorable position of tubal ligation reversal over IVF is that once the woman has experienced the surgery she ideally will not require any medication through the doctor, for example, medications or systems, keeping in mind the end goal to get pregnant.
One of the major milestones in a woman’s life is the entry into motherhood. For most women, when this does not happen in the natural logical sequence of things, there is anxiety and lot of pressure from family and friends.
However, with advancements now, there are options like intrauterine insemination and in vitro fertilisation (IUI and IVF) available, which can help increase the chances of conception and pregnancy. IVF is where the egg is retrieved from the woman’s womb, fertilised externally and then transplanted back into the uterus where it grows to full term. However, there are always unanswered questions like how long to wait before going for IVF, is it the right procedure for me, etc.
Read on to know to find answers to some of these.
- Maternal age: As a woman reaches 35 and a man reaches 40, the fertility rates drop significantly. The chances that a woman at 35 will conceive is about 20%, which goes down to 5% if the woman is 40. However, this rate can be significantly increased by using IVF. The quality of the egg would gradually deteriorate, and so if a woman is nearing 40, it is better to consider IVF as the ovarian reserve would be optimal with IVF.
- Failed intrauterine insemination: In couples who have problems with the sperm reaching the uterus, intrauterine insemination (IUI) is first attempted. However, if 3 or more attempts of fail, it is time to consider IVF.
- Duration of inability to conceive: While some couples conceive quite promptly in a month or two, most take about 6 to 8 months of unprotected sex to conceive. Therefore, IVF can be an option if you are failing to conceive even after a year. Less than a year, don’t fret. Take it easy and it might just do the trick.
- Medical health: Both the partner’s medical health should be taken into account. Lifestyle changes like smoking, alcohol abuse, drug abuse should be considered, which can account for poor sexual performance and therefore lead to an inability to conceive. Health conditions like diabetes and heart disease can also lead to infertility. Hypothyroidism in women is another thing that must be ruled out, as it often leads to an inability to conceive.
- Sexual problems with the partner: One of the first things to do before going for IVF is to check that the male does not have any issues. Be it erection issues or ejaculation issues or sperm issues, they need to be ruled out. Sperm quality, quantity, and motility have to be analysed, and if they are optimal, IVF can be considered.
In case you have a concern or query you can always consult an expert & get answers to your questions!
It is as important for the man as it is for the woman to undergo certain tests before the IVF cycle is started. Fertility is not only an issue for a woman, but it also might be for the man in question. There are certain tests that need to be conducted on men before they can gear up for IVF:
1. Semen Analysis: One of the most important tests for male infertility is semen analysis. Sometimes, a man may be completely healthy, but his sperm production could be of poor quality. Semen analysis is done to provide an accurate evaluation of sperm number, the ability to move (motility), size and shape (morphology), as well as the consistency and volume of the sample collected.
2. Binding Test: Sometimes agglutination occurs where the sperms might stick to each other by their heads or tails. Sperm antibodies might cause this problem. The IVF treatment's success might be compromised if this happens. A simple binding test is done to determine this.
3. Trial Wash: This is also known as sperm wash. It is mostly done to remove chemicals from the sperm. Not doing a sperm wash might end up affecting the later stages of the IVF treatment. In this process, the misshapen and immotile sperm is separated so a clean sample of motile and healthy sperm can be collected.
4. TUNEL Assay: Since sperms build up about half of a child's genetic makeup, a TUNEL Assay or 'sperm DNA test' is required. This test is done to measure the sperm population that have fragmented DNA. Negative impacts on genetics can hamper the success of the fertility treatment.
TUNEL Assay is usually recommended to men with:
- Leukocytes detected by the sperm analysis
- Age approaching 50
- A history of diabetes II type or prostatitis
- Exposure to chemicals or prolonged heat at workplaces
5. Screening for Infectious Diseases: This test is done for both the partners to check for diseases like AIDS, Hepatitis C, and so on. In case you have a concern or query you can always consult an expert & get answers to your questions!
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
- Oftentimes, medical practitioners resort to what is called ‘watchful waiting’.
- At times, ovarian cysts disappear in a few months.
- It is recommended to take a blood test and an ultrasound to see the progress of the cyst.
- 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.
- 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.
- 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.
- 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. In case you have a concern or query you can always consult an expert & get answers to your questions!
PGS or Pre-implantation Genetic Screening is a test conducted to decipher the chromosome count of the embryo. Today, if you are planning to get pregnant or using alternative technologies for pregnancy; there are several tests that need to be conducted so that the child is born healthy and stable. One such test is the PGS, it determines whether or not the count of chromosomes is normal, which is forty six, is present in the embryo. If there are abnormal numbers of chromosomes present in the embryo then it might lead to additional problems in the future. In such cases, special treatments and procedures are conducted.
There are several advantages of PGS. Some of them are highlighted in details below.
- Healthy pregnancy: Interestingly, a man can produce sperms throughout his lifetime. But a woman is born with the eggs already created. The chances of producing a healthy baby with those eggs decrease as the age of the woman increases. It is seen that those women who think of delivering a child in their older ages are often found with chromosome deficiencies in the embryo. Thus, to avoid such a situation, it is best to perform PGS.
- Reduces the chance of miscarriage: Pregnancies which occur without having performed any prior tests like the PGS have high chances of resulting into a miscarriage at the slightest of carelessness. But research has found that those pregnancies which take place after considering the chromosomal health of the embryo have reduced the risk of being abnormally terminated.
- Time reduction between two IVF Circles: For those who do not know IVF stands for In-Vitro Fertilisation. It is a process which aids a woman in becoming pregnant. It is often opted by those who are having issues in naturally conceiving a child. PGS here plays an important role. If the test detects abnormal embryo, then the next IVF circle can be started right away without wasting any time. But if the PGS detects a normal embryo then the IVF circle is deemed to be successful and the woman can continue with the pregnancy.
Thus, these are some of the main advantages of Pre-Implantation Genetic Screening. This helps to determine whether the embryo is of the desired choice or not and whether the baby born out of it would be healthy and normal. It is one of the tests which need to be conducted preceding implantation to provide better results after the implantation process is carried out. In case you have a concern or query you can always consult an expert & get answers to your questions!
In case you have a diseased uterus, which makes you infertile, you can undergo a procedure known as uterus transplant or uterine transplant to get pregnant. In the process of sexual reproduction, a diseased uterus does not allow embryonic implantation. This factor is referred to as uterine factor infertility or UFI. As a result, you will not be able to get pregnant.
Who requires a uterus transplant?
This procedure involves women who have UFI and women who had their uterus removed by hysterectomy. Women who have a damaged uterus on account of an injury or infection, which does not function anymore, can also undergo a uterus transplant procedure. Women from the age of 21 to 45 are eligible for this procedure. Many women are born without having a uterus. This condition is called Mayer-Rokitansky-Küster-Hauser syndrome.
Uterus transplantation begins with undertaking a uterus retrieval surgery on the uterus donor. The uterus, which is recovered has to be stored and transported to the location of the patient undergoing the transplant. An ischemic tolerance may last over 24 hours. Three major surgeries have to be carried out with the recipient. Firstly, a transplantation surgery is required in which the donor’s uterus gets transplanted. In case pregnancy develops, a caesarean section surgery has to be performed. The patient is given immune suppressive therapy. After childbirth, a hysterectomy is done in order to terminate the immune suppressive therapy.
Will the women be able to get pregnant after having sex?
Women receiving a uterus transplant will not be capable of becoming pregnant without undergoing fertility treatments. The transplanted uterus is not connected with the fallopian tubes, which is the location of the normal fertilisation process. The women will require to carry out IVF or in vitro fertilisation to become pregnant after a uterus transplant. IVF is a process in which the eggs are removed from the ovaries and get fertilised in a laboratory. Then, they are implanted in the uterus. After undergoing the uterus transplant procedure, a woman has to wait for a period of one year. The uterus requires time for healing and after recovery, the embryo may be implanted for pregnancy. After giving birth successfully, a woman will be able to keep the transplanted uterus.
She has the option to get pregnant again. However, after giving birth twice, a hysterectomy must be carried out for the removal of the uterus. This is done so that the woman can stop using the immune suppressant drugs, which are associated with major risks. Uterus transplant is a relatively new technology. In October 2014, the first healthy baby was born to a woman who had undergone a uterus transplant. This surgery is kind of experimental in nature and is usually the last option for getting pregnant.
Pregnancy is a stage which needs to be cautiously enjoyed by all expectant mothers. The word ‘cautiously’ is used and stressed upon by medical practitioners because it is a period where two lives are at stake i.e the mother’s and the baby’s. Both their health and nutrition are of the utmost importance during this stage. In the third trimester, which includes the seventh, eighth and ninth month, when the delivery date is knocking on your doorstep, you should be more cautious than ever.
Some of the precautions to be taken during these months are listed below.
- By this time, the essential features of the baby, such as hands and legs are fully developed. In fact, the baby might just start moving and should be given some space. Thus, expectant women must be watchful of the weight they carry. At no cost must their spine be injured or hurt. This can be disastrous for both the mother and the baby.
- It is best to avoid stairs, if possible and certainly use the elevator for higher floors. In case you have to take the stairs, then holding the railings would give you the support you need. For physical exercises, you can go for a walk or just practice simple breathing exercises to keep you active.
- Extra sleep is required during this month; and that too on the left side. Sleeping on the right side should be avoided. This helps in smooth blood circulation.
- This month is crucial for the baby as it is nearing delivery. As an expectant mother you should be able to understand the signs your body gives you. It is best to avoid heavy weight lifting and too much of work. You should drink lots of water and keep yourself hydrated all the time.
- Avoid dust, animal excretes and stale food is important as it might hinder the brain development of the unborn child.
- Overeating should be avoided.
- You must take a break from household chores.
- Exercises must be continued under supervision.
- Fish must be avoided as at times they contain mercury which is not good for the unborn baby.
- Travelling is a strict no-no during this month.
- You must decide on the process of the delivery—natural or C-section beforehand.
- Going for regular check-ups is mandatory.
These are some of the precautions which must be taken during the last three months of your pregnancy. It would ensure the good health and well-being of your baby as well as your own. In case you have a concern or query you can always consult an expert & get answers to your questions!