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Dr. Neelesh

Gynaecologist, Pune

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Dr. Neelesh Gynaecologist, Pune
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I pride myself in attending local and statewide seminars to stay current with the latest techniques, and treatment planning....more
I pride myself in attending local and statewide seminars to stay current with the latest techniques, and treatment planning.
More about Dr. Neelesh
Dr. Neelesh is a renowned Gynaecologist in Karve Nagar, Pune. You can visit him/her at Srujan Maternity Home in Karve Nagar, Pune. Don’t wait in a queue, book an instant appointment online with Dr. Neelesh on Lybrate.com.

Lybrate.com has top trusted Gynaecologists from across India. You will find Gynaecologists with more than 39 years of experience on Lybrate.com. You can find Gynaecologists online in Pune and from across India. View the profile of medical specialists and their reviews from other patients to make an informed decision.

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Srujan Maternity Home

Vibhawari Apartment, Manmohan Society, Karve Nagar. Landmark: Near Sahawas Society, PunePune Get Directions
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Im 25 years female I missed my periods for 6 days. Im quite confuse about my health. I have a baby of 19 months by cesarean. I feel like pain in my stitches. My stomach is quite bloated. And even im getting pain on my left chest its getting tight. I cannot do home pregnancy test due to some house issues or ill b in their eyes. Can you please suggest some other way to understand what a I going through.

BHMS, PGDCBM, MD(AM)
Homeopath, Gurgaon
Im 25 years female I missed my periods for 6 days. Im quite confuse about my health. I have a baby of 19 months by ce...
Pregnancy has to be ruled out first if you are not using any contraceptive method. If you cannot do a home pregnancy test, you can get it done in a lab. Bloating in abdomen and chest pain could be due to acidity and indigestion. Maintain regular eating schedule and try to get proper sleep.
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Symptoms And Treatment Of Chronic Obstructive Pulmonary Disease!

DNB (Respiratory disease), Fellowship Bronchoscopy, MBBS
Pulmonologist, Ahmedabad
Symptoms And Treatment Of Chronic Obstructive Pulmonary Disease!

The lungs are made of tubes through, which air passes in and out for exchange of gases, taking in alveoli. It is a disease of alveoli to which finer air conducting tubes are attached. Over a period of time, with age and exposure to various agents, these tubules get obstructed. The amount of air that can pass through these is reduced, leading to reduced oxygen supply to the lungs and thereby the various body organs.

Symptoms
The symptoms of COPD can be easily understood if we realize how COPD is caused. The progressive blockage of the air tubes causes less oxygen to reach the tissues, which is the most essential agent for all tissues and organs to function. Reduced supply produces a generalized limitation in physical activity. There are two main components to COPD - chronic bronchitis and emphysema. The symptoms indicative of COPD are as follows:

  1. Chronic cough: Also referred to as smoker's cough, the cough is relentless and does not subside with regular cough treatment. This is one of the first indications of COPD.
  2. Mucus buildup: There is constant buildup of mucus which gets expelled during coughing. The person never feels completely clear of mucus, and the regular cough expectorants do not help relieve the symptoms.
  3. Fatigue associated with limited activity: As noted earlier, the reduced capacity of the organs limits their activities. Therefore, regular activities like walking short distances or climbing stairs can induce fatigue.
  4. Shortness of breath: The above fatigue is associated with shortness of breath, even with small physical exertion. A person with COPD will see marked tiredness and reduced ability to perform routine chores and feel a tightness in the chest.
  5. Wheezing: Passage of air through the obstructed air tubes produces a whistling sound or wheezing. It is more pronounced when there is mucus accumulation in the airways.

Rarely, Frequent respiratory infections, more frequent flu attacks, swelling of the feet and ankles, cardiovascular disease, weight loss, and morning headaches.

Treatment
While there is no cure for COPD, once it sets, the following are some ways to slow its progression and reduce severity of the symptoms:

  1. Bronchodilators: Dilate the air tubes and ease flow of air
  2. Corticosteroids: Help reduce inflammation and thereby improve airflow through the tubes
  3. Flu vaccination: Helps curb the frequent flu attacks
  4. Antibiotics: To contain infections
  5. Pulmonary rehabilitation: A combination of breathing exercise and patient education to improve lung function.
  6. Oxygen therapy: In very severe cases, oxygen may be required.
  7. Lifestyle changes: Eating healthy foods, preventing exposure to dust and smoke, quitting smoking, breathing exercises, bi-annual medical check-ups to monitor lung functions are essential. If you wish to discuss about any specific problem, you can consult a Pulmonologist.
3035 people found this helpful

I am suffering from vaginal infection after sex Please suggest some medicine I have taken metrogyl 400, pantosec,zocon-150, mefenamic acid, candid v6 But relief nahi hai. Please suggest something useful so that it get relief.

MD, Bachelor of Ayurveda, Medicine and Surgery (BAMS)
Ayurveda, Pune
Hello, I can understand your concern. Ayurveda medicines are great to cure this condition. You can take cap. Parvati and Cap. Parjanya twice a day and let me know your feedback. Get well SOON.
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HAVING S-E-X FOR THE FIRST TIME

PG Dip(psycosexual diseases), MBBS
Sexologist, Delhi
HAVING S-E-X FOR THE FIRST TIME



For both partners:


How do I have" good" sex?
What follows is not a set of rules. Rules about sex are impossible-- what should matter is that what you do makes you feel good. And" feeling good" should last past the sex itself-- you should not feel anxious afterwards about getting her pregnant or catching some horrible disease, so planning ahead about contraception and safe sex is part of the idea.

What time should we have sex?
When you have sex doesn't really matter. What should matter instead is that you and your partner have sex when you are both comfortable. Some people prefer to make love at the break of dawn, some in the afternoon sun, some in the darkness of night. More important than time of day is the time you have to spend. Give yourself a lot of time to have sex the first time. A weekend is ideal, but at least the whole day, including sleep time.

Should we eat or drink anything before sex?
Avoid eating a heavy meal, since that'll just make you sleepy. Eat light, don't drink too much alcohol, if any at all. It may help you shed inhibitions, but it may also make his erection much more difficult to achieve and you want to spend more time in the bedroom than the bathroom anyway, right?

Where should we have sex?
Where you have sex is probably a more important decision. Finding a place where you both can be private for up to forty-eight hours can be difficult at that age where most people are planning on losing their virginity. But it's worth it.
A bed is probably the best thing to make love in, still. Hopefully you'll have a room to yourself, with all the amenities that a bedroom affords, including heat, comfort, space, and the bathroom. Take a shower together! if you're about to have sex, you've probably had your hands all over each other before now. Get to know each other's bodies. Take your time. That's what lovemaking is about.


What do we need to bring?
Bring what you need to make you comfortable. Birth control pills, condoms.
Will we come at the same time?
Don't worry about making orgasm simultaneous. Some women do not orgasm during intercourse until they have gained experience, and even if you both are capable of climax, the odds are very much against the two of you coming together the first time. Enjoy yourselves, and rely on one another to tell the truth about what is pleasurable and what is satisfying.


For her:


What do I do first?
You can't expect him to know what makes you feel good. You'll have to tell him or show him, and that may mean taking some of the initiative, taking his hands and placing them where they make you feel good. Don't be afraid to ask him to" be gentler" or change positions. Go slow. If it's his first time, he may well be totally nervous about what you're about to do, and his penis may not respond at first. Patience, gentleness, and understanding are required to bring it back to life, and that may be hard for you to achieve, but that's why we told you to give yourselves lots of time.


Will it hurt?
You have probably heard horror stories about how much losing your virginity hurts. For a few women, it does, but with the right touch and the right partner, you should be able to take his penis into your body without pain. Have him take his time, use a lubricant, and press his fingers into you, opening you up slowly. Tell him when it feels good and when it hurts.

What position should I use?
Many women prefer to have sex the first time being on top, where they can control the first entry. Others want to be on the bottom and give their lovers that control. Choose what's best for you. Just remember to tell him to go slow, take your time, and if you feel the need, use a commercial lubricant.

For him:


What if I can't get it up?
It may sound funny, but your penis, which has worked great for years, may suddenly go on strike at your first chance at" real" sex. That's natural-- you're nervous. Take a deep breath. Do something else for a while with your hands, your lips and your tongue. Try to forget about your anxiety, and your penis will respond. It's only a temporary thing.


Should I tell her if i'm a virgin?
Many men think that because they're men, they should be in charge of the sex, regardless of who has the more experience. If you're a virgin and she's not, tell her, and let her lead if she wishes. This is as much a learning experience as a loving one. Don't be afraid to confess the truth. A lot of women would rather know that your fumbling is inexperience, rather than just sheer ineptitude, and will gratefully show you the ways of the world.


What if I orgasm too soon?
If you actually climax much too soon before you wanted to, take your time, take a nap, and try again. The second time you should be much more relaxed and ready to take your time-- so will your penis.


Am I big enough? too big? the right shape?
Size of the penis is a common concern. The average penis is slightly more than five and a half inches in length when erect, and that's more than enough to hit every major nerve center of the clitoris and the vagina, the legendary g-spot included. The vagina is capable of stretching to take a large penis, or shape itself to pleasure a small one. Size has very little to do with your ability as a lover.
Another common issue is shape. Some men become concerned because their penis bends downwards, or to the left, and assume that because they never see men like them in erotic movies that they're not normal. Others worry that a downward bend will make sex difficult or painful because the vagina isn't shaped with that bend in mind.
Keep in mind that sex can be performed in any number of positions. The penis and vagina can be matched in many different ways, and each new position can bring new pleasures to you and your partner. Some people believe that a downward-bending penis is much easier to perform oral sex upon.


Will I be a good lover?
Being a good lover doesn't happen automatically. With the right partner, time, care, and practice, you have everything you need to become a great lover. Your first times, for both you, will be fumbling and awkward, but hopefully they'll be the start of great times for the rest of your lives

9 people found this helpful

Is there a complete cure for dermoid in homeopathy. My mother in law is having bilabial dermoid it is almost 4.5*4 size is it better to do operation or take homeopathy treatment.

MBBS, DGO, MD, Fellowship in Gynae Oncology
Gynaecologist, Delhi
Is there a complete cure for dermoid in homeopathy. My mother in law is having bilabial dermoid it is almost 4.5*4 si...
Dermoid cyst needs to be operated before rupture, as it may cause infection and/ or serious problem once rupture.
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My periods are delayed for 10 days. May I know the reason. I am 22 years old. What is the reason for the above? Initially my periods was for 15 days. But now it is delayed. Y?

M.B.S.(HOMEO), MD - Homeopathy
Homeopath, Visakhapatnam
My periods are delayed for 10 days. May I know the reason.
I am 22 years old. What is the reason for the above? Initi...
Missed or late periods happen for many reasons other than pregnancy. Common causes can range from hormonal imbalances to serious medical conditions. There are also two times in a woman's life when it's totally normal for her period to be irregular: when it first begins, and when menopause. Stress Stress can throw off your hormones, change your daily routine, and even affect the part of your brain responsible for regulating your period — your hypothalamus. Over time, stress can lead to illness or sudden weight gain or loss, all of which can impact your cycle. If you think stress might be throwing off your period, try practicing relaxation techniques and making lifestyle changes. Adding more exercise to your regimen may help get you back on track. Low Body Weight Women with eating disorders, such as anorexia or bulimia, may experience missed periods. Weighing 10 percent below what’s considered a normal range for your height can change the way your body functions and stop ovulation. Getting treatment for your eating disorder and putting on weight in a healthy way can return your cycle to normal. Obesity Just as low body weight can cause hormonal changes, so can being overweight. Your doctor will recommend a diet and exercise plan if they determine that obesity is a factor in your late or missed periods. Polycystic Ovary Symptom (PCOS) PCOS is a condition that causes the body to produce more of the male hormone, androgen. Cysts form on the ovaries as a result of this hormone imbalance. This can make ovulation irregular or stop it altogether. Other hormones, such as insulin, can also get out of balance, due to insulin resistance, which is associated with PCOS. Treatment of PCOS focuses on relieving symptoms. Your doctor may prescribe birth control or other medication to help regulate your cycle. Thyroid Issues An overactive or underactive thyroid gland could also be the cause of late or missed periods. The thyroid regulates your body’s metabolism, so hormone levels can be affected as well. Thyroid issues can usually be treated with medication. After treatment, your period will likely return to normal. Your doctor can properly diagnose the reason for your late or missed period and discuss your treatment options. Keep a record of changes in your cycle as well as other health changes to show your doctor. This will help them make a diagnosis. Contact a doctor right away if you have unusually heavy bleeding, a fever, severe pain, nausea and vomiting, or bleeding that lasts longer than seven days.
1 person found this helpful
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I am prescribed DUB 5 for twice a day for five days. I just wanted to know after how many days shall I expect my periods?

BASM, MD, MS (Counseling & Psychotherapy), MSc - Psychology, Certificate in Clinical psychology of children and Young People, Certificate in Psychological First Aid, Certificate in Positive Psychology, Positive Psychiatry and Mental Health
Psychologist, Palakkad
I am prescribed DUB 5 for twice a day for five days. I just wanted to know after how many days shall I expect my peri...
Dub 5 Tablet is used in heavy menstrual bleeding, pain during menstruation, endometriosis and breast cancer. Dub Tablet side effects Common Edema (swelling), Abdominal bloating, Anxiety, Irritability, Depression, Muscle pain. Take this medicine in the dose and duration as advised by your doctor. Swallow it as a whole. Do not chew, crush or break it. Dub 5 Tablet may be taken with or without food, but it is better to take it at a fixed time.
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Long term use of painkillers can cause kidney cancer

C.S.C, D.C.H, M.B.B.S
General Physician, Alappuzha
Long term use of painkillers can cause kidney cancer
A study published in the journal Archives of Internal Medicine has shown that people who regularly take painkiller drugs like ibuprofen or naproxen are 51 percent more likely to develop kidney cancer. There is no increased risk from taking aspirin or paracetamol. The mechanism through which painkillers could cause kidney disease is the inhibition of prostaglandin synthesis with resulting papillary and tubular injury, and ultimately damage to DNA.

The study analyzed data from 77,525 women in the Nurses’ Health Study and from 49,403 men in the Health Professionals Follow–up Study. The risk was related to the duration of use of the painkillers. There was a decrease in the risk by 19% if the painkiller was used for less than four years. There was a 36 per cent increase in risk of kidney cancer for people who used them regularly for 4 to 10 years. The risk increased almost three times for those who used these drugs regularly for 10 years or more.

The good news is that kidney cancer is uncommon so the risk is small for average users.

Two other important causes of kidney cancer are obesity and smoking. So people on painkillers should not smoke and should also keep their weight under control to prevent kidney cancer.

IUI (Intrauterine Insemination)- Treatment Option for Infertile Couples

MBBS (Gold Medalist, Hons), MS (Obst and Gynae- Gold Medalist), DNB (Obst and Gynae), Fellow- Reproductive Endocrinology and Infertility (ACOG, USA), FIAOG, MRCOG (London, UK)
Gynaecologist, Kolkata
IUI (Intrauterine Insemination)- Treatment Option for Infertile Couples

Introduction

When couples get married, they often view parenthood as the next stage in their family life. They want to have a child, they want to be “mom” and “dad”, they cannot imagine that this may be hard to achieve or may not be a natural process. When several trials to conceive fail, they are shocked. Their basic expectation about family life gets shattered. Most of the couples are desperately looking for medical therapy that will end into a misery. Clearly this is not a struggle to survive; it is a struggle to fulfill a dream, to achieve what they view as a “full life”.

What is needed for pregnancy?

In the male partner, sperms are normally produced in the testes after puberty (after attainment of characters like growth of beard, moustache etc). From the testes, they are carried through the sperm conducting ducts (epididymis, vas, seminal vesicle and prostate gland). Then during sexual stimulation, after proper erection and ejaculation, they come out through penis. During sexual intercourse, these sperms, present in semen, are deposited inside the vagina. 

 In female partner, the deposited sperms must travel from vagina through the cervix (the mouth of the uterus). The cervix acts as gate-keeper, a it prevents entry of dead and abnormal sperms as well as bacteria present in semen, in the uterus. From uterus, sperms reach the Fallopian tubes (the tubes that are attached to the both sides of the uterus) where the sperms must meet the egg (ovum). The eggs are produced only before birth and so, there are fixed number of eggs inside the ovary. The ovum released from the ovary, into the abdomen at the time of ovulation (rupture of the surface of ovary to release the ovum). That ovum must be taken by the tube and thus inside the tube an embryo (earliest form of the baby) is formed, by meeting of the egg and the sperm. 

It should be mentioned that out of nearly 200-300 million sperms, in average, deposited in vagina, hardly 500- 800 sperms can reach near the eggs and only one will succeed to form the embryo. The embryo then travels through the tube into the uterus and the uterus attaches the embryo firmly with it and thus the pregnancy starts. So, if there is defect in any one of them there will be difficulty in achieving pregnancy.

Thus, to summarise, pregnancy requires

  1. Production of healthy (“Normal Morphology”) and movable (“Normal Motility”) sperms in adequate number (“Normal Count”) in the testes
  2. Transport of these sperms through the sperm conducting ducts from testes to penis
  3. Successful Erection and Ejaculation during Intercourse to deposit adequate number of these sperms in the vagina
  4. Transport of these sperms from vagina through cervix to the uterus and the tubes
  5. Presence of sufficient number of eggs inside the ovary and ability to release the eggs from the ovaries
  6. Pick up of the eggs by the tubes 
  7. Approximation of eggs and the sperms to form the embryo
  8. Transport of embryo from the tubes into the uterus
  9. Acceptance of the embryo by the uterus and its growth

What is Infertility?

 

Literally, the word “Infertility” means inability to conceive. But in reality, there are very few couples, who have no chance of natural conception and are called “Absolutely Infertile”. In fact, in many couples who present to infertility clinics, pregnancy may be the matter of time, thus the chance factor. 

It should be kept in mind that, if there is factors to question fertility of either male or female or the female is of age less than 35 years; after one cycle (one month) of regular frequent intercourse, the chance of conception in human being is only 15%. That means, out of 100 couples trying for conception, only 15 will be able to succeed after one month of trying. The word “Regular” and “Frequent” are important; because to achieve pregnancy, couples are advised to keep intimate relationships for at least 2-3 times a week and this should be increased particularly around the time of ovulation (Middle of the menstrual cycle). Thus chance of pregnancy after 6 months, 12 months and 24 months of regular trying are respectively 60%, 80% and 100%. 

The word, “Subfertility” seems better and more scientific than “Infertility”, to describe the couples who have reduced chance of conception, due to any cause. However, the word “Infertility”, seems more popular, although it puts pressure on the couples. In most cases, usually we advise to investigate after one year of regular and frequent intercourse, when the couples fail to conceive. However, if there are factors to question fertility; for example female with age more than 35 years, or with previous surgery in tubes/ ovaries/ uterus or known diseases like PCOS or endometriosis; or male partner having surgery in scrotum or groin or any hormonal problems or sexual dysfunctions- the wait period is usually reduced and couples can be investigated, even soon after marriage. 

What causes Infertility?

Please look at the point “Thus, to summarise, pregnancy requires” where 9 points have been mentioned. 

Thus the common causes may be

  1. Problems in male- total absence of production of sperms, less than adequate number of sperms, problems in morphology and motility of sperms (most sperms not healthy or movable), blockage in transport of sperms and inability to deposit sperms in the vagina (sexual dysfunction- Erectile Dysfunction or less commonly, Ejaculatory Dysfunction). Examples include hormonal problems (Testosterone, thyroid, prolactin), diabetes, liver problems, causes present since birth, chromosomal abnormalities, surgery, infection, sexually transmitted diseases, smoking, exposure of scrotum to high temperature, some medicines or psychological causes.
  2. Problems in female- total absence of less than adequate number of eggs in the ovaries, problems in ovulation, problems in picking of eggs by the tubes, blockage of tubes, problems in conduction of sperms or embryo by the uterus, problems in accepting the embryos by the uterus. Examles include causes present since birth, chromosomal abnormalities, polycystic ovarian syndrome (PCOS), old age, increased weight, fibroid, endometriosis, pelvic inflammatory diseases (PID), tuberculosis (TB), infections, smoking, surgery, some medicines, hormonal problems (thyroid, prolactin) or excessive stress.
  3. Unknown causes- Despite thorough investigations, 25-30% causes of infertility remain unknown. This is called “Unexplained Infertility”. The reason may be mere chance factors or there may be some causes which, still medical science has yet to discover. But this should be kept in mind while treating infertility. That means, even with correction of the possible factors (like improving sperm counts or thyroid problems etc) or with proper treatment (IUI, IVF or ICSI), unfortunately the treatment can fail and the exact reason, why the treatment failed, is sometimes difficult to find out.  

In general, what are the treatment options for infertility?

To start with, please remember there is no hard and fast rules for infertility treatment. Often medical science fails to understand why couples with very severe form of infertility conceive sooner than those who are having all tests normal. That means, whatever treatment is offered, it’s very important to continue regular sexual intercourse, as the chance of natural pregnancy is usually there in almost all couples. Your doctor will present the facts to you, without pressurizing you on a particular option. After coming to know all pros and cons of different treatment options, you can take decision. Do not hurry. It’s quite natural that you might be in stress. 

In general, after the initial tests, a few periods of natural trying is allowed. After that, ovulation induction (giving medicines to release eggs from the ovaries) is offered, failing which IUI and finally IVF is offered. What will be the preferred treatment for you, will depend on your age, duration of marriage, male and female factors and of course, your age. For example, a woman with both tubes blocked or a male with very low sperm count, IVF would be the first line of treatment.

What is insemination?

Insemination literally means putting semen in a particular place. Various forms of insemination exist in fertility treatment. First one is “Intravaginal Insemination (IVI)”, where the raw semen, collected by the husband can be put inside the vagina, taking precautions (to prevent infection) by the husband himself or by the wife. Rarely, it needs medical assistance from a doctor. It’s usually advised to couples having sexual disorders where full penetrative intercourse is not possible (erectile dysfunction of the husband or very painful intercourse experienced by the wife) or where ejaculation cannot happen during intercourse (a very unusual problem). Thus, the success rate of IVI is no better than natural intercourse (success rate 15% per cycle), for those couples who can manage successful intercourse. 

“Intrauterine Insemination (IUI)” is the treatment where “prepared” semen is put inside the cavity of the uterus, near the Fallopian tubes. Thus, IUI bypasses some hurdles that can cause problems during natural intercourse. The vagina, cervix and the whole length of the uterus are bypassed, putting the sperms near the eggs. Thus it increases the success rate compared to natural intercourse or IVI.

However, to achieve pregnancy after IUI, the female partner must have open tubes, adequate number of eggs produced by ovaries, eggs must be released by the ovaries and sperms must meet the eggs. And, thus nature plays important role, as in natural intercourse.

Please note, we used the word “prepared” semen. In natural intercourse, as mentioned earlier, the dead sperms and bacteria cannot enter the uterus, because cervix prevents their entry. If they are put artificially by IUI inside the uterus, severe reaction can happen. So, after collection, the husband’s semen is processed in the laboratory to remove all those impurities and to select only the best number of healthy and movable sperms and it definitely increases success rates of IUI

When IUI is generally advised?

As you can understand, to perform IUI, there must be minimum number of sperms in the semen, the tubes must be opened, the ovaries must be releasing eggs. If these are present, IUI is usually advised 

  • Less than adequate number of sperm counts, morphology or motility
  • Couples who cannot perform full penetrative intercourse but refuse or unable to conceive by IVI
  • Unexplained infertility- although IVF is better than IUI, but considering the cost, many couples in our country opt for 2-3 cycles of IUI before IVF
  • PCOS and Mild Endometriosis- where natural intercourse or ovulation induction failed
  • Couples in whom only one partner is positive for HIV or Hepatitis B or C- where transmission from one partner to another by unprotected sexual intercourse is not preferable.

What are the tests done before IUI?

The basic infertility evaluation is done before IUI include husband’s semen analysis, assessment of ovarian function (blood tests, ultrasound) and uterus (ultrasound). In some cases, laparoscopy (putting camera to see inside the abdomen by operation) or hysteroscopy (putting camera through vagina inside the uterus, by operation) may be required. Now, if the tubes are blocked, IUI is of no use. So, testing the tubes is advisable before IUI. But some women, who are at low risk of tubal disease (no history of pelvic pain, infection or surgery), one or two cycles of IUI can be done, failing which tubes must be checked by tests like HSG or SSG or in some cases by laparoscopy. 

What IUI actually involves?

In the cycle, in which IUI is planned, the woman is asked to take some medicines (or injections) in particular days of the periods as a part of “ovulation induction”. She is then advised to have ultrasound monitoring (TVS- transvaginal sonogram- where ultrasound probe is placed inside the vagina for better accuracy) to see if eggs are growing in response to the medicines or not. If eggs are growing, IUI is planned in a particular time when the egg(s) is more likely to rupture, so that the tie interval between sperm entry and egg release can be kept as minimum as possible. 

Is ovulation Induction necessary for IUI?

Frankly speaking, IUI can be done without any medicines (as in case of natural intercourse or IVI), which is called “Natural Cycle IUI”, where only TVS monitoring is done to see how the eggs are growing. This may avoid some side effects of ovulation induction (see below) but is associated with low success rate than IUI done along with ovulation induction.

Is TVS necessary before IUI?

TVS is, undoubtedly, uncomfortable for the woman. But it gives better picture than ultrasound done conventionally. Now, the question is, whether ultrasound monitoring is at all needed or not. TVS directs the doctor how eggs are growing and at what number and size and when they are likely to rupture. Moreover, the rupture can also be confirmed by TVS. Again, the uncommon side effect of ovulation induction can be detected by TVS. That is called OHSS (“Ovarian Hyperstimulation Syndrome”) where excessive eggs can grow inside the ovaries and this can lead to collection of fluid inside abdomen and lungs and can turn very serious. Although very rare, it can be detected by TVS and early actions can be taken to prevent the progress of this condition. 

In rare cases, where TVS cannot be done or patient declines, only option is to check urine by LH kit to predict the likely timing of ovulation and at that time IUI is planned. However, it is less accurate than TVS monitoring and is associated with less success.

What, if eggs are not growing in the ovaries?

In some women, particularly those who are overweight, aged or some cases of PCOS, eggs may not respond initially to one medicine. There are various forms of ovulation induction medicines (tablets, injection). If one is not working, your doctor can try increasing the dose of that medicine or add or replace it with other medicines. Please remember, it’s difficult to predict what medicine will be best suited for a particular patient. So, it’s basically a trial and error process.

What is done on the day of IUI?

As timing is important, the couples are requested to stick to the timing, advised by the doctor. The husband will be asked to collect the semen by masturbation, using clean technique (to avoid contamination by germs in the semen container). The semen is then prepared by the embryologist and will be checked to see the final number of sperms and their motility and morphology.

The wife is asked to lie down in the IUI table. After cleaning, a sterile speculum (instruments to separate walls of the vagina to see the cervix) is introduced inside the vagina and then 0.4-0.6 ml of the prepared semen is inserted inside the uterus with the help of a small catheter (fine tube). IUI done, under ultrasound guidance, gives better result than IUI done without it. The patient is asked to lie down few minutes after taking out the catheter and the speculum. The medicines are advised and then they can go home.  

Is IUI painful?

Most women feel little discomfort during IUI but it should not be painful. If there is technical difficulty while putting catheter inside the uterus, your doctor will discuss it with you and in the next cycle, will plan management to solve this issue.

What happens if husband cannot collect semen?

Collection of semen in unfamiliar environment is understandably a matter of discomfort and seems awkward. Proper counseling and maintenance of privacy can help. Stress-free approach is needed. If it fails, do not hesitate to inform your doctor. Some medicines can help. But in those, who are unable to masturbate, there are some instruments, like ejaculator, can help to solve this problem.

What happens if sperm count is low?

IUI can be successful if sperm count is minimum more than 5 million per ml and there is reasonably good morphology and motility. If not, IVF or ICSI would be the better option. But IUI can serve as trial also. That means before putting the semen, the prepared sperms can be examined and it can be predicted what is the success rate of IUI in this particular case and whether IVF or ICSI would be needed. In rare occasions, where sperm count is extremely low but the couple do not wish for IVF or ICSI, pooled semen IUI can help- where the semen is collected in number of occasions and is preserved and the final pool is used for insemination, to give a reasonable success rate.

When donor sperm is used and how?

If a man does not have any sperms or too few sperms to do IUI, IVF or ICSI is not affordable, donor IUI is an alternative. But it is not done without consent from both husband and wife. The donor is not known to the couple or the doctor and no identity of the donor is revealed. No relative or friend can serve as donor. Donor semen is frozen semen, collected 6 months ago and the donor is tested for diseases like STD, HIV, Hepatitis B or C. Usual attempt is taken to chose donor having blood group and skin colour similar to those of the husband. But remember, it’s only given after discussion and written consent by the couple. 

Can a couple have intercourse in the cycle where IUI is advised?

Intercourse around IUI increases the number of sperms available at the time of ovulation.

When should one check for pregnancy?

Usually if period does not come within 18 days after IUI, pregnancy test is advised. It can be done at home. If negative, then the cause of not having periods is sorted out.

What is the chance of success after IUI?

In one cycle, chance of success is around 20-25%. Most of the couples conceive after 3rd or 4th cycle of IUI. The chance of pregnancy after 6th cycle is low, so, usually IUI beyond 6 cycles is not advised.

The factors where IUI gives better results include unexplained infertility, sexual dysfunction of any of the partner, PCOS and male subfertility (low sperm count or motility)

What happens if IUI fails?

As said earlier, you should think about further treatment, if 3rd or 4th cycle of IUI fails. There is no use of doing IUI beyond 6 cycles, unless natural intercourse is not possible and the age is favourable. IVF gives better result. 

Is there any harmful effect of IUI?

Very few harmful effects have been noted, for examples, hazards of ovulation induction (OHSS< twin pregnancy), pain, infection and discomfort. As mentined, if raw semen is given, unusual allergic reaction can happen.

How IUI is being done in your particular centre by Dr Sujoy Dasgupta?

We believe in patient’s autonomy. So we want to give time on discussion and presentation of facts and figures to the couples. We encourage questions from the couples and take utmost care so that no question remains unanswered.

We do not take decisions and impose it on the couples. We advise the couples to take time before taking decision on a particular treatment. If the couple decides, we respect and support their decision.

We try to take nominal charges and help couples to collect medicines (particularly injections) at lower prices than MRPs.

After thorough evaluation of both the partners, we plan for ovulation induction drugs, with consent from them and advise them to come for TVS. After each day TVS, we explain the progress and probable timing of IUI.

On the day of IUI, after requesting the couple to maintain punctuality, we advise the husband to collect semen, in comfortable atmosphere, maintaining the privacy. If there is problem in semen collection, we provide support to him and address his issues in sensitive way.

Our expert trained embryologist then prepares the semen. We always encourage the couples to see the condition of raw and prepared semen under microscope to maintain the transparency. 

We advise the woman to fill up the bladder (to take water and not to urinate) to facilitate the passage of IUI catheter. Unlike other places, we perform IUI inside OT to prevent unwanted infection. 

Again we maintain our uniqueness in the sense that we perform it under ultrasound guidance. The ultrasound guidance has been scientifically proved to increase the success rate of IUI. Moreover, we show the woman in the ultrasound (real time) how the catheter has been put inside the uterus (to make sure that we are not doing IVI or have placed it in wrong position). This also helps to reduce patient’s anxiety and uncertainty. After that, our nurse takes care of the patient and observes her when she takes rest. 

Then we advise the post-IUI medicines and advise them what to expect and when they can go home. Again, this time we try to answer all questions the couples can ask.

 

Conclusion

Infertility is a peculiar thing. Very few men or women are absolutely infertile. That means they do not have ability to achieve pregnancy naturally. Majority of them are subfertile. That means most of them have lower than normal chance (compared to healthy couples) to achieve pregnancy in a normal menstrual cycle. Often we find that patients planning for treatment and in the mean time, they conceive naturally. That means even without treatment, there is some chance of pregnancy. Of course, it’s stressful situation for both the partners. Stress affects conjugal relationships and lead to many couples avoiding conjugal life. Indeed stress can affect the hormone levels in females and affects sexual performances in males. It’s easier for us to advise you to stay stress-free but is difficult to practice. Nevertheless, try relaxation as much as possible. Think that majority of the couples ultimately conceive by some form of treatment. Have faith in yourself and have faith in your doctor.

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