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Hi,

I am Dr. Bandita Sinha, Gynaecologist. Today I will talk about infertility and the reason why infertility is on rising. Infertility is defined as when the couple tries for pregnancy for 1 year without protection and still not successful in getting pregnancy. If the pregnancy has never happened then it is known as primary infertility. But if the couple has pregnancy even it is failed pregnancy and they are not getting the second pregnancy then it is known as secondary infertility. Today w will talk about why there is an increase in the infertility rate. I have been practicing in the last 2 decades. Women are struggling to get pregnant. What are the causes? First is faulty ovulation. More and more patients are having PCOS nowadays. It is a condition where there is irregular periods, acne, hirsutism and inability to conceive because ovulation does not happen along with it there could be obesity also.

There can be delayed ovulation, no ovulation. The patient may have to go for IVF also. Again the can be another factor which is called antimalarial factor or AMH which detects the basic fertility of a female. We have seen more females having low AMH in their early 30s even in 20s also. This AMH value indicates the basic fertility level of a female and tells how many good eggs are there is an ovary. After this report, she can plan for her pregnancy. For low AMH, exact causes cannot be known. There can be lifestyle factor, environmental pollution, smoking, alcohol which can indicate low AMH value. On low AMH value, research yet to be done. Apart from this, there are conditions where there is premature ovarian failure. Which means ovaries are aging more than the actual age. And thereby, causing the inability to produce eggs and leading to early menopause. It is also one of the important conditions where we are seeing girls are going ahead with early menopause and low fertility and need artificial technology to get pregnant.

Blocked tubes are one of the important causes of infertility. Tubes are important to get pregnancy but these tubes can get blocked due to some infections. TB is one of the important causes for the blockage of fallopian tubes. Cervical factors, uterine factors, uterine fibroids or polyps, cervical stenosis can create a problem with getting pregnant and sustaining the pregnancy. If there is a uterine fibroid, there can be a repeated miscarriage. We have seen a number of thyroid patients having difficulty in conceiving because of the obesity and irregular periods. There is also some autoimmune disorder which can also lead to sub-fertility or difficulty in conception. Diabetes is on rising. This is another factor which is having an impact on egg quality.

How to improve these conditions? We can look to the lifestyle what we are leading. We have to include more amount of fresh fruits, vegetables which are more anti-oxidants and folic acid in our diet. We have to have a proper exercise schedule. If there is a tendency of weight gain, we have to reduce the weight. Adequate BMI should be between 18-25. Anything above 25 has to be counseled and weight reduction should be done accordingly. Stress management is very important. It has a greater effect on fertility hormones. If the female is stressed out then the fertility hormones get disturbed, the prolactin level may increase. All these things can lead to ovulation and sub-fertility because egg quality will not be adequate. Similarly, if there is a habit of smoking, alcohol, that has to be stopped before planning the pregnancy. It can also lead to certain syndromes or miscarriages.

So, we need to take care of our lifestyle. We need to change our lifestyle. We have to do proper stress management. We need to do certain techniques which can calm us down. We should go for meditation, yoga and whatever which can bring harmony back to our life and maybe by this we can improve fertility to a certain extent. And yes, the medical field is always there and diagnostic told are there which can help a lady to get the pregnancy and move forward.

Thank You!

Hi!

I am Dr. Bandita Sinha, I am the director of World of Women Clinic. I am a consultant gynaecologist and fertility specialist. Today we will discuss high-risk pregnancies. What is high-risk pregnancy and what are the complications which can create a high-risk pregnancy and how to identify high-risk pregnancy and prevent it? High-risk pregnancy is a condition where the pregnancy is complicated with certain factors which can create maternal and foetal health problem. So, a normal pregnancy which is associated with certain other kinds of health disorder can be considered under high risk pregnancy. There are certain conditions which are detected when the lady is pregnant i.e they are pregnancy induced condition. Even the lady is healthy there goes so there are chances the pregnancy can lead to certain kind of complications which is considered as high-risk cases. The high-risk cases are usually treated as a team wherein the gynaecologist and the obstetrician, the paediatrician, neonatologist and the physician in other specialities can together work to treat that pregnancy.

What are the maternal conditions or the conditions related to the pregnancy which can lead to high-risk cases? Like preterm labor. Preterm labor is any labor pain which starts before 37 weeks. Here the health of the mother has no implication on the initiation of the labor pain. The labor can start on its own, there can be the infection, there can be short cervix or sometimes because of multi-foetal gestation there is a risk of preterm labor. Preterm labor is considered as a high-risk pregnancy. It should be dealt with a team of doctors and in a special multi-speciality hospital which has a neonatal unit where we can handle the preterm baby. Second factor is there are multi foetal gestations like twin pregnancy, triplet pregnancy or multi-foetal pregnancies so there the chances of preterm labor are very high. The other factors are also there which can complicate the pregnancy.

So, multi-foetal pregnancy is also considered to be a high-risk case. There are certain patients who develop pregnancy induced hypertension. The patient was not hypertensive before she is pregnant but now due to the pregnancy condition, there is a occur increase in the blood pressure. So, increase in blood pressure along with the urine protein and swelling together we call it a syndrome which is known as preeclampsia. If these patients are diagnosed in proper time and treated in proper time so we can manage the patients very well and they can have a healthy delivery and the baby. But sometimes they are not identified and if it is not treated properly, they can be life-threatening to the mother as well as the growing baby. Then there is a gestational diabetes which is known as diabetes during pregnancy. The lady was nondiabetic beforehand and then now after the pregnancy maybe after 24 weeks or 28 weeks the sugar level goes high and they are diagnosed as a gestational diabetic patients. They are the high-risk patients which can have lot many complications if they are not treated properly, they should be under proper diet plan, we give certain medications to reduce the sugar level and at the time of delivery the sugar levels are very high then maybe insulin is required for these patients.

Babies also have certain complications of gestational diabetic patients, so it is very important to identify these mothers during the certain test in the early pregnancy and treat them adequately so at the end of the pregnancy the mother delivers a healthy child and also the mother's health is under control. Gestational diabetes patients usually come back to normal conditions after pregnancy but there are few patients who have a tendency to cut have developed type 2 diabetes after the delivery. So, if there is a strong family history of diabetes, gestational diabetic patients may become type 2 diabetics. Then the maternal age. Nowadays, there is more pregnancy happening in the 30s and sometimes we have seen patients above 35 years. So, the age of 35 years plus or the teenage pregnancy both comes under high risk pregnancy because there are a lot of medical conditions which starts happening after 35 years. These are the patients who are prone to develop hypertension, gestational diabetes and other genetic disorders related to foetal malformation or repeated miscarriages.

These patients require special attention and they are considered under high-risk pregnancies. There are a certain group of patients who have autoimmune disorders, history of previous miscarriages, history of previous birth defects so and STDs, HIV infections; all are considered under the high-risk group. There are certain diseases like lung disorder, previously detected cardiac problem, there are other health issues which are prevailing in the mother before the pregnancy and when these pregnant patients enter into pregnancy, they all come under a high-risk group, so as to treat them special and get a healthy baby. To what is the implication of high-risk pregnancy on the mother and the baby? These patients require additional attention, specialized treatment, they need to go for certain investigations which are more than the normal pregnancy, they have to go ahead with many sonographies to find out the health of the baby and if there is a risk like diabetes and hypertension, we keep the patients on certain diet which has also a very important role to control the conditions.

These patients should be managed very early right from the beginning we should counsel the patients that her medical conditions can cause the problem in the growing foetus and her health can also be involved; so, they should take proper care and should be under proper medication and routine follow up. So the once these cases are identified, we do the proper investigations, we do all the tests related to the mother and the baby and if taken care as a team I think they will have a healthy outcome and the mode of delivery does not means that C-section has to be done but then yes if the high-risk pregnancy is there, there are chances of more C-section than normal delivery is but yes if it is taken care of well and the patient is managed properly, the mother and baby both are healthy to chances of normal delivery is also there.

Thanks

Hello, 

I am Dr. Bandita Sinha. I am an obstetrician and infertility specialist. I have been practicing from last 20 years.  Today I would like to discuss about PCOS/PCOD. It is very common. 1 in every 5 females having PCOS. In India around 1 million cases are diagnosed per year. It is becoming an epidemic in our country. We should know what is it. It is caused due to hormonal imbalances.

Certain things which happen and we need to know the symptoms of PCOS. It is a metabolic disorder wherein irregularity in the menses, scanty menses, irregular or prolonged menses or the menses can stop altogether. Apart from it there is obesity or weight gain or difficulty in losing weight, facial hair, thinning of hair, mood swings and irritability as well.

How does it happen? It is a lifestyle disorder. There can also be the possibility of genetically implication. In lifestyle, intake of junk food has increased the development of PCOS. Lack of physical activities, sleep. Stress is very important factor. This usually happens when we are taking stress or irregularity of food or junk food to much, then there is liberation of the male hormones or androgen in our body. Male and female hormones give rise to small cyst in the ovaries.

How is this disease diagnosed? Normally patient comes with irregular or scanty periods, facial hair, weight gain and acne. This condition can be diagnosed with certain blood test which detects the hormonal level. Apart from that we also do a sugar test to rule out the insulin level. And sonography is done to check the cyst.

How do we treat this condition? Patient thinks that it can never be cured. Yes, there is no cure but as like the diabetes, things should be in under control. Lifestyle changes are required. We need to change our dietary pattern. Patient should go for a low carbohydrate diet. Absolute no for the junk food. We should go for a weight loss session. 45 minutes exercises are important. Along with that stress management is also recommended. A good night sleep for at least 7-8 hours. Relaxation techniques like yoga or meditation. PCOS is a condition where there is the male and female hormone imbalance. With all these and the medication, things will become normal for you. The fertility also improves. They are able to conceive as well. In very rare cases where the medicines are not working and patient require for fertility than we opt for a surgery which is laparoscopic ovarian drilling which helps ovaries to ovulate.

In a nutshell I would recommend that the healthy lifestyle, exercise, along with the stress management will help to control this disorder. And let's live a healthy life following a healthy lifestyle. If you want to know more about PCOS or related condition and the condition which are affecting the fertility of a female you can contact me through Lybrate.

Thank You.