Dr. Kazi Trupti

Infertility refers to being able to get pregnant after one year of trying. Women who can get pregnant but are unable to stay pregnant are also termed as infertile. Ovulatory disorders are one of the most common reasons why women are unable to conceive and is presen in 30% of women suffering from infertility.

1. Hormonal problems: Ovulation is linked with a complex balance of hormones and any disruption in the process can hinder ovulation. The disruption includes the fact that the ovaries are not producing normal follicles in which the eggs can mature. Ovulation is rare if the eggs are immature and there are no chances of fertilization. Polycystic ovary syndrome is the most common disorder responsible for infertility. Malfunction of the hypothalamus leading to failure in triggering hormonal stimulus to ovaries for egg maturation leading to immature eggs and ovarian failure. Malfunction of the pituitary gland leading to imbalance in hormonal secretion thus causing disturbance in ovulation. This can occur due to physical injury, a tumour or a chemical imbalance in the pituitary.
2. Scarred ovaries: Ovulation failure can also be due to a physical damage to the ovaries. Invasive surgeries involving ovarian cysts leads to damaging or scarring of capsule of the ovary to become due to which follicles cannot mature leading to disruption of ovulation.
3. Premature menopause: Early menopause or premature menopause before the normal age means that the natural supply of eggs has been depleted. This is most common in extremely athletic women with a history of low body weight and extensive exercise.
4. Follicle problems: Infertility is also caused due to non-ruptured follicle syndrome in which women who produce a normal follicle, with an egg inside of it, every month but the follicle fails to rupture. This leads to disruption of ovulation as the egg remains inside the ovary.
5. Others: Treating female infertility by chemotherapy is next to premature ovarian failure by loss of primordial follicles. Sexually transmitted infections are a leading cause of infertility. Tobacco smoking is detrimental to the ovaries and the amount of damage is dependent upon the amount and length of time of exposure of smoke in the environment. Nicotine in cigarettes interfere with the body’s ability to create oestrogen, a hormone that regulates ovulation. In addition, blocked fallopian tubes due to pelvic inflammatory disease or surgery for an ectopic pregnancy also causes infertility. Infertility can also be due to physical problems with the uterus or fibroids of uterus where non-cancerous clumps of tissue and muscle on the walls of the uterus.

Pregnancy can be a tricky time for most women, although it is not a pathological condition. One must be prepared for pregnancy with the best of health in the pre pregnancy period. This also includes women who are suffering from diabetes. The complications during pregnancy and delivery increase manifold if one has not controlled the glucose and blood sugar levels before getting pregnant. So read on to know more about coping with pregnancy if you happen to have diabetes.

Complications: Pregnancy with diabetes can cause severe complications if the blood sugar levels are not controlled properly before pregnancy. This can cause the diabetes to become even worse in the long run, with the onset of various other related ailments like kidney disease, heart disease, eye problems and more. It can also increase the risk of premature delivery, and too much birth weight of the baby as well as low glucose levels right after the baby’s birth. Further, one can also lose the baby to a miscarriage due to excessively high blood sugar levels. This can also affect the glucose and blood sugar level of the baby as the glucose passes through the body.

Related conditions: If you happen to have high blood sugar levels, then you and your baby can get affected in an adverse way. To begin with, you may come down with severe depression regarding how you will be able to manage your diabetes and pregnancy together, and also due to the implications of the condition after the birth of the baby. It can also cause a condition called Preeclampsia in which the pregnant woman’s blood pressure becomes high and too much protein starts to pass from the urine, which can also result in frequent urination and life threatening defects and problems for you and the baby. In such cases, you will have to be hospitalised and the baby will need to be delivered via a C section or a Caesarean Section.

Planning ahead: If you know that you are trying to conceive, the best way is to be fully prepared well in advance. This includes planning ahead for managing the blood sugar levels and keeping the risk of other ailments at bay. You can start by losing excessive weight and seek treatment to bring down the blood sugar levels. Exercising and watching your diet are also some good ways to ensure that your Type 1 or Type 2 diabetes is in control.

Medical Team: It is pertinent to be in touch with your medical team on a constant basis. This team should include the obstetrician and gynaecologist as well as your regular doctor to whom you can report any changes.
Keep health close to your heart when you are pregnant by taking care of all existing ailments.

Cervical cancer (a malignant tumor of the cervix, the lowermost part of the uterus) is one of the most preventable types of cancer. Because of the Pap smear test, the number of cervical cancer cases has actually dropped over the past 20 years. However, many women still develop cervical cancer.

While some cases of cervical cancer cannot be prevented, there are many things a woman can do to reduce her risk of developing cervical cancer.

Reduce Your Risk of Cervical Cancer:

1. Get a regular Pap smear. A Pap smear can be the greatest defense against cervical cancer. It can detect cervical changes early on, before they have a chance to turn into cancer.
2. Limit the number of sexual partners you have. Studies have shown that women who have many sexual partners increase their risk for cervical cancer. You also increase your risk of developing HPV, which has been shown to lead to cervical cancer.
3. Quit smoking or avoid secondhand smoke. Smoking cigarettes increases your risk of developing many cancers, including cervical cancer.
4. If you are sexually active, use a condom. Having unprotected sex puts you at risk for HIV and other sexually transmitted infections (STIs), which can increase your risk factor for developing cervical cancer.
5. Follow up on abnormal Pap smears. If you have had an abnormal Pap smear, it is important to follow up with regular Pap smears or colposcopies, and whatever else your doctor has recommended for you. If you have been treated for cervical dysplasia, you still need to follow up with Pap smears or colposcopies.
6. Get the HPV vaccine. If you are under 27, you may be eligible to receive the HPV vaccine, which prevents high risk strains of HPV in women. The vaccine is most effective when given to young women before they become sexually active.

Again, cervical cancer prevention should be a top priority for all women. Small lifestyle adjustments, combined with regular medical care, can go a long way in preventing cervical cancer.

What is puberty?
Puberty is the phase in life when the body of the child matures to become an adult. This change is mainly influenced by the developing reproductive system and it makes them capable of sexual reproduction. It a progressive change and happens over a span of few years. Girls start to develop breasts and might start menstruating whereas boys notice changes in body hair growth pattern with their voices beginning to crack.
The average age for a girl to attain puberty is found to be 11, whereas in boys, it is longer and the average age is somewhere around 12. Puberty also marks the onset of emotional maturity in kids as well.
Sometimes puberty can be seen at a very young age such as 7 or 8; this is called precocious puberty. This can make it physically and mentally taxing for a child and can be a sign of health issues.

What causes puberty?
The stimulation of the hypothalamus in the brain leads to the production of a hormone called Human Gonadotropin-releasing hormones (GnRH) which signal the Pituitary Gland to produce luteinizing hormone (LH) and follicle-stimulating hormone (FSH). This is responsible for sexual development.
Signs that may indicate the onset of puberty in girls:

The telltale signs of puberty in girls are:

1. Development of breasts
2. Growth of hair in areas such as armpits and genitals
3. A growth spurt, i.e., rapid growth in height
4. Start of menstruation or her periods
5. Increase in body fat in certain areas of the body
6. Development of acne
7. “Mature” body odour

Signs that may indicate the onset of puberty in boys:
The usual signs of puberty in boys are:

1. Enlargement of the testicles or penis
2. Pubic, underarm, or facial hair development
3. Rapid height growth — a growth "spurt"
4. Deepening of voice
5. Acne
6. "Mature" body odor
7. Increase in hair growth in other parts of the body such as the arms and legs

Along with these signs and symptoms, other signs can be changes in mood. Boys and girls may develop sexual urges wherein you will notice an unexplained attraction to the opposite sex.

What is Labour?
Labour and delivery are demarcated by the end of the pregnancy when a woman delivers the child or more than one child and it leaves the uterus. Normally, the gestation period for humans is somewhere around 37 weeks to 42 weeks. In most developed countries, the deliveries happen in hospitals, where as in developing as well as under developed countries, births happen at home under the supervision of traditional birth attendant, called the midwife.

Stages of Labour:
Vaginal delivery is the most common form of childbirth. Labour consists of three stages

• The opening and shortening of the cervix: Lasts from 12 to 19 hours
• Coming down of the baby and its birth: 20 minutes to 2 hours
• Expulsion of the placenta: Varies from 5 to 30 minutes

In the first stage, your abdominal muscles will begin to cramp associated with back pain. These cramps can be of durations of half a minute, about 10 minutes apart. These contractions start coming closer and become more intense as the second stage starts closing in. During the second stage, you may have to push along with the contractions to help give birth to your baby. Most babies are born head-first, although there are cases, when the baby is born buttocks first or legs first. This is commonly called “breeching”. In the third stage, it recommended to cut the umbilical cord and ensure that the placenta is entirely removed from the uterus or it may cause complications later.

The onset of labour is marked by the expulsion of the amniotic fluid and  then the contractions begin to set in. Most women can walk around and eat food during labour, but when the contractions start to get too painful, it is suggested to get help and have someone around during that time. It is not recommended to push during the first phase, but then it becomes essential to push from the second stage onwards. Your gynaecologist will be able to tell you which stage of labour you are in by looking at the dilation of your cervix. As soon as you start to feel your contractions kicking in, you must contact your gynaecologist or your birthing attendant.

Maintaining proper vaginal hygiene is imperative to ward off any sort of STD or STI, even before any sort of irritation, infection or disease occurs. The normal vaginal pH balance helps cater to the growth of useful bacteria. Some useful tips to maintain proper vaginal hygiene can be:

1. Douching (spraying a mixture of water, baking soda, vinegar or iodine on the vaginal area) is strictly discouraged. It can interfere with the normal pH levels of the vagina and can make the area extremely acidic, which sets the stage for the growth of bacterial infections.

2. A balanced, healthy, nutritious diet is recommended for a healthy vagina as well as for good reproductive health. Certain fluids such as cranberry juice can help prevent the onset of any yeast infection.

3. Safe sex should be practised in order to keep harmful bacteria away. Using a condom during a sexual intercourse helps prevent the occurrence of any sort of STI or STD.

4. Gynaecological check-ups should be done every four months or so to be on the safe side regarding any doubts about unhealthy vagina. Prevention is always better than cure in the long run.

5. Petroleum jelly should not be used for lubrication during sexual intercourse as such fluids tend to damage the latex in the condom and may even lead to a possible infection.

6. Clothes should be chosen carefully to keep the vaginal area clean and dry. Cotton underwear is generally the best option in this regard as it can help prevent any bacterial infection by keeping the area clean and dry.

7. Certain simple sanitary habits such as changing of tampons or sanitary pads every four hour during one’s periods, proper washing of the genital area after relieving the bowels, can go a long way in nurturing the health of the vagina.

8. Opt for gentle skin care products to wash the vaginal area as that area is extremely sensitive. Avoid scrubbing the vaginal area as well.

Menopause is characterized by the absence of menstrual periods for 12 months. It is the time in a woman’s life when the ovaries stop functioning. The periods then stop forever. The normal period of menopause is 51 years of age, however, menopause may happen as ahead of schedule as the 30s or as late as the 60s. There is no solid lab test to determine when a lady will encounter menopause. Early menopause usually starts between the ages of 40 and 45. Untimely menopause begins significantly earlier, before the age of 40. Nevertheless, premature or early menopause is not that common with only about one percent of the women going through early menopause before the age of 40.

The signs and symptoms of early menopause are like the usual menopause. Some basic side effects include:

1. Irregular periods (amenorrhea)
2. Hot flashes
3. Night sweats
4. Vaginal dryness
5. Mood shifts
6. Mental fogginess
7. Diminished sex drive

Your specialist will suggest a treatment depending on your individual circumstances. Some common ways to deal with premature or early menopause are as follows:

1. Hormone Replacement Therapy
Supplements containing estrogen and progestin can help and replace some of your reproductive hormones in the body that can no longer make it all alone. They are frequently taken until the normal period of menopause (around 50) to help avoid bone loss. This treatment is not suggested for all ladies since it expands the danger of:

• Heart issues
• Stroke
• Blood clots
• Breast cancer

2. Supplemental Calcium and Vitamin D
Supplementary calcium and vitamin D can help in preventing osteoporosis in case you are not getting enough of these supplements from your normal diet. Women between ages 19 to 50 need to consume 1,000 milligrams of calcium for each day through food or supplements. Ladies over age 51 need to consume 1,200 milligrams for each day. A prescribed day-to-day measure of vitamin D has not yet been built up. For grown-up females, most specialists prescribe 600 to 800 global units through food or supplements. One should get a prescription from a doctor before ingesting the medication.

Other strategies to deal with Infertility
A few ladies with untimely menopause can at present get pregnant with no treatment. Ladies who want to have children, however, tend to become infertile after early or untimely menopause, need to consider in-vitro treatment, fertilization or even adoption.

Talk Therapy
Numerous ladies discover that having a conversation with a therapist can be supportive to adapt to their anxiety. It helps them release their pent up emotions and gives the clarity and satisfaction about their problems. Talk therapies like cognitive behavioral therapy are always beneficial since they help in addressing the symptoms and side effects that a woman may be going through emotionally when it comes to early menopause.