Dr. Kuldeep R Wagh

Surrogacy is the method that is used for reproduction in which a woman other than the woman, who wants to have the baby, agrees to undertake pregnancy and give birth to a child for the couple that appoints her. A couple can opt for surrogacy in the following conditions.

- Infertility
In the case of females who cannot reproduce due to infertility or some other medical conditions that make the process risky for both the mother and the childlike heart diseases, liver infirmities and high blood pressure, surrogacy can opt for so that the couple can experience the bliss of becoming parents.

- If you are a single parent
A single parent can opt for surrogacy in order to fulfil his/her dream of having a child to live for.

- Other factors
There are several other factors when a couple might want to opt for surrogacy. For instance, in couples, where the female is too busy building a stable career for herself and she cannot take the risk of opting for pregnancy, surrogacy can come to their rescue. Also, repeated miscarriages, pelvic disorder, hysterectomy, an impaired uterus or the absence of uterus can act as reasons to opt for surrogacy.

There are a few factors that need to be considered before opting for surrogacy. They are listed below.

Type of surrogacy
Traditional surrogacy and gestational surrogacy are the two options available. In traditional surrogacy, the surrogate mother not only carries the embryo in her womb until childbirth but also donates the egg. However in gestational surrogacy, the egg is taken from the biological mother and impregnated in the womb of the surrogate mother through in vitro fertilization techniques. The intended parents need to take a decision regarding the type of surrogacy that they wish to opt for.

Surrogacy laws
The intended parents must be aware of the surrogacy laws prevalent in their country so as to make sure that they can go through the entire process smoothly. For instance, in India, it is mandatory that the surrogate child should be biologically related to one of the two parents.

Cost of surrogacy
Another important factor that needs to be considered while opting for surrogacy is the cost of the undertaking. It can involve high costs due to the unpredictability of the situations surrounding the process, so the financial stability of the intended parents should be kept in mind. Also, choose the right agency or even if you choose an independent candidate to become the surrogate mother for your child, make a wise choice. If you wish to discuss about any specific problem, you can consult a gynaecologist.

'Congratulations! You're pregnant!' Almost all women long to hear these words and nothing should come in the way, even diabetes. So, if you are a Type 1 or Type 2 diabetic, here are a few things you should keep in mind to have a healthy baby.

Your blood sugar must be monitored regularly
The most important thing you can do to have a healthy baby is to keep your blood sugar as close to normal before and during your pregnancy. Testing is recommended a minimum of four times a day. Glucose passes through the mother's blood to the fetus and hence if your blood sugar fluctuates, so will your baby's. High blood sugar levels are especially harmful during the first 8 weeks of pregnancy when the baby's brain, heart, kidneys and lungs are formed.

Your pregnancy is considered high risk
High blood sugar levels can increase the risk of a miscarriage as well as the risks of your baby being born with birth defects. Diabetes can also increase the risk of developing preeclampsia during the second half of your pregnancy. This could result in a C section or premature birth. Thus, maintain regular checkups and keep your doctor in the loop of all your activities.

You should watch out for signs of Ketosis
When you have low blood sugar, the body produces ketones that can be passed on from you to your baby. This production of ketones is a result of the body's burning of fat instead of glucose to provide energy and can develop a condition called ketosis. Symptoms you should watch out for are stomach aches, nausea, fatigue, muscle stiffness, frequent urination and fruity breath.

You need vitamins and supplements
Most women require vitamin and mineral supplements at the time of pregnancy. Of these, folic acid, iron, calcium and Vitamin D are the most important. These supplements help in the healthy growth of the baby.

You should exercise regularly
Maintaining a regular physical activity routine is very important for diabetics who are expecting a baby. This will help you regularize your blood sugar, relieve stress and strengthen your heart. Avoid activities that increase your risk of falling and aim for at least thirty minutes of daily exercise such as walking, swimming or yoga.

Check your medication
Some medication can be detrimental during pregnancy such as cholesterol and blood pressure medication. Consult your doctor to find a suitable alternative, if needed. You may also need to change the kind of insulin you take and its frequency and amount. As you get closer to the delivery date, your insulin requirement may even double or triple.

The key to preventing complications during pregnancy is controlling your diabetes. So take your insulin regularly, maintain regular checkups and eat healthy. You need to be seen by your obstetrician more frequently. Your pregnancy will be monitored closely by more frequent ultrasounds and NST. If your sugar level remains under control and pregnancy is advancing well, a natural onset of pains is aimed for and a normal delivery is expected.

One of the silent diseases in the female population, endometriosis can be symptomless for years and sometimes even decades, but can sometimes manifest itself quickly. The uterus is lined on the inner side by a tissue known as endometrium. When this tissue is found in other parts (fallopian tubes, abdomen, near the ovaries, etc., it is known as endometriosis.

Causes: The exact cause for endometriosis is not clear. There is a possibility that during the regular period, there could be spilling of the tissue back into the fallopian tube, from where it reaches the ovaries or other organs and gets implanted.

There are certain predisposing factors for a woman to develop this condition, including genetic correlation and non-menopausal women. The female hormone estrogen is essential for the development of endometriosis. There are also immunological reasons attributed to the development. It can range from minimal to mild to moderate to severe.

Symptoms: From being completely benign to causing severe pain, endometriosis can present itself in varying ways. The implanted tissue can be minimal like a small lump to large clumps. The symptoms are not dependent on the size of the implanted tissue, however, 

1. Painful menstruation: One of the most common causes of non-menstrual cramps, the pain is different from usual menstrual pain, starts a few days before the period and can last up to after the period.
2. Pelvic pain: One of the most common causes of pelvic pain, this can happen wherever the implanted tissue is. In severe cases, this tissue can also bind different organs, forming what are called adhesions. The bladder or the bowels may adhere to the uterus. These are more painful than individual lumps of tissue outside the uterus.
3. Intermenstrual bleeding: There could be spotting to severe bleeding between the regular cycles.
4. Painful sex: There is a deep pain within the pelvis and it can lead to losing interest in sex.
5. Infertility: The most severe symptom and complication is not being able to become pregnant.

Diagnosis: A detailed patient history, discussion on symptoms followed by ultrasound and laparoscopy can help in diagnosing endometriosis.

Treatment: If there is no symptom and fertility is not an issue, then it is possible that no treatment is required. However, depending on symptoms and complications, the following are done.

• If pain is the only main problem, painkillers are administered
• Surgical treatment may be required if there is severe bleeding and adhesions complicating the situation. 

This will also relieve other symptoms:

1. Hormone therapy is also an option for treating endometriosis.
2. If you are having pelvic pain and irregular bleeding, bring it up with your doctor. Even if it is not endometriosis, a thorough check up will put your mind at rest. If you wish to discuss about any specific problem, you can consult a gynaecologist.

The term infertility in females explains a wide range of disorders but in order to simplify things, lets’ just say, infertility in women is a condition in which women are unable to conceive. There are numerous reasons that can be responsible for this situation and although some are preventable or curable, most others have no specific cure or treatment.

Ovulatory Disorders

One of the most common reasons for infertility is an ovulatory disorder. Almost 30 percent of female infertility is caused due to this reason. 70 percent of such infertility is treatable with drugs such as Reprones/Menogan and Clomiphene. Here is a list of causes of failed ovulation-

1. Disruption in the complex hormonal balance.

2. Ovaries fail to produce mature eggs. Polycystic ovarian syndrome is the most common disorder causing this problem. This syndrome has reduced FSH production and increased production of LH, Oestrogen and Testosterone. Suppressed FSH production may cause the partial development of ovarian follicles.

3. Hypothalamus may malfunction thereby causing the pituitary to malfunction, thus losing control over the process or FSH and LH production.

4. Physical damage to the ovaries by multiple surgeries or due to the formation of cysts.

5. A rare case of premature menopause.

6. Problems of the follicle.

7. Poor functioning of fallopian tubes

Diseases or disorders in the tube have been another major reason of infertility in women. Almost 25 percent of women infertility occurs due to this reason. Although treatments exist, success rates of the treatments are as high as 30 percent. The causes of tube damage may be as follows-

1. Infection caused by bacteria or viruses

2. Abdominal diseases like colitis and appendicitis

3. Previous pelvic or abdominal surgeries.

4. A condition called ectopic pregnancy which occurs in the tube, and even if very carefully but successfully overcome, may leave permanent damage.

5. Rare congenital defects in which women may be born with tube anomalies.

Endometriosis

This is the condition where the endometrium expands excessively thereby preventing individuals from getting pregnant. This affects almost 10 percent of the population of infertile women. Almost 40 percent of women with endometriosis are infertile.

Other Factors

Other additional factors may include:

1. Abnormal uterus

2. Congenital diseases

3. Behavioural factors like personal habits, lifestyle and health factors.

4. Exercise and diet- extremely overweight or underweight women may have problems in conceiving.

5. Cigarette smoking reduces the chances of conceiving by one-third.

6. Alcohol increases the chances of birth defects.

Hence, pregnancy is tougher than it might really seem. If you wish to discuss about any specific problem, you can consult a gynaecologist.

Ovaries are a part of a woman’s reproductive system. The primary function of ovaries include producing ‘ova’ or eggs and secreting hormones such as progesterone and estrogen. Cysts are fluid filled sacs that form the ovaries; they usually do not cause any symptom and are not painful.

There are primarily two types of ovarian cysts:

1. Follicle cysts: During a woman’s menstrual cycle, the egg develops in a sac known as the follicle. Under normal circumstances, the sac breaks open and releases the egg. When this doesn’t happen, fluids start accumulating in the follicle to form a cyst.

2. Corpus luteum cysts: Follicle sacs dissolve after releasing the egg, but in some cases, these sacs remain and the opening of the sacs gets sealed. It again results in fluid accumulation, leading to the formation of corpus luteum cysts.

Symptoms

Usually, cysts do not cause any symptom. If the size of the cysts increases, they may cause symptoms such as stomach pain, pain during bowel movements and sex as well as pelvic floor pain. The breasts may become tender and one may experience rapid breathing. Other symptoms of ovarian cysts are fever, nausea and dizziness. Usually, rupturing of a cyst leads to these symptoms surfacing; hence you would know when exactly to call the doctor.

Treatment

The treatment options for ovarian cysts are:

1. Laparoscopy: Laparoscopy is carried out if the cysts are small in size. An incision is made close to the navel, through which an instrument is inserted to get rid of the cyst.
2. Birth control pills: For chronic ovarian cysts, oral contraceptives are prescribed to stop the ovulation process in order to arrest the formation of cysts.
3. Laparotomy: In case of large cysts, this procedure is recommended. A relatively bigger incision is made in the abdomen, through which the cyst is removed.

Ovarian cysts, if left untreated, can certainly cause infertility. Pre-menopausal women and who suffer from frequent hormonal imbalances in the body are the most vulnerable to this condition.