Book Clinic Appointment with Dr. Sameer Pahlajani
Treatment Of Erectile Dysfunction
Treatment Of Male Sexual Problems
Treatment of Infertility
In Vitro Fertilization (Ivf) Treatment
Treatment Of Female Sexual Problems
Intra-Uterine Insemination (IUI) Treatment
Urinary Incontinence (Ui) Treatment
Sperm Donor Program
Natural Cycle Ivf Treatment
Management of High-Risk Pregnancy
Artificial Insemination Treatment
Preimplantation Genetic Diagnosis (Pgd)
Egg Donation Procedure
Treating Disorders of The Unborn Child
Fertilisation In Vitro - Embryo Transfer (Ivf - Et
Intracytoplasmic Sperm Injection (Icsi) Procedure
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Patient Review Highlights
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.
What to expect?
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 ultrasound 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 %
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.
Here are a few common differences:
- 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.
In case you have a concern or query you can always consult an expert & get answers to your questions!
Pelvic pain is most common in women, though sometimes it occurs in men as well. There is absolutely no reason why pelvic pain cannot be treated and therefore women need not panic if they are experiencing such pain. The treatment of any pain can be done methodically after discovering its cause. Thus, before jotting down the treatments for pelvic pain, it is important to explore the reasons that cause pelvic pain in women.
Reasons for pelvic pain
- Reproductive organs in women play an important part in causing pelvic pain. The reproductive organ is complex when it comes to women and many small or big problems there might end up leading to pelvic pain.
- Any urinary infection or bladder irritation might also lead to pelvic pain.
- The nerves and muscles of the abdomen may cause pain in the pelvis area as well. In fact, the nerves and muscles are very tender near the pelvis area and care should be taken so that one does not strain them or pull the ligaments. This can cause severe pain.
- Another interesting point to be noted is that sometimes even after going through a lot of examinations, no causes of pelvic pain are found. In such cases it is understood that the pelvic pain is a manifestation of the remains of a long forgotten injury or accident.
- It has been examined and found out that physical abuse can at times lead to chronic pelvic pain. Though this link has not yet been understood properly, but it is seen to be true.
Treatments for pelvic pain
- The most basic treatment is to apply heating pad on the affected area. Heat helps in relaxing the muscles and nerves thereby, lessening the pain. However, this would reduce the pain, but cannot make it disappear in a day. Thus, it is a continued process for a week or 10 days till the pain recedes.
- Relaxation techniques like meditation, breathing exercises, yoga and even muscle exercises like jogging help in reducing the pain. However, this should be done under guidance. One wrong move can actually aggravate the pain instead of lessening it.
- Then there are painkillers which are non-steroidal and help in lessening the pain. Painkillers have a correct dosage and must be taken only after consulting a doctor. Self-medication in such cases can prove disastrous.
- At times, when all medications fail, surgery is the last resort.
Thus, these are some of the treatments that can be undertaken if and when you are experiencing pelvic pain. All these are connected to the root cause and must be followed only under medical supervision.
In case the fertility odds are against your favour, you can undergo a procedure called IVF or in vitro fertilisation. It is a form of fertility treatment in which the sperms and eggs are combined in a laboratory. IVF is a very common fertility treatment procedure, involving modern technology. It is carried out by many women and couples worldwide. When you are facing ovulation problems and issues with the quality of eggs, have blocked fallopian tubes or if your male partner has a low sperm count, a sperm donor’s eggs are used via IVF to become pregnant.
The overall process of IVF involves several methods and steps:
- Ovarian stimulation: You will have to take a fertility drug called gonadotrophin eight to fourteen days before the beginning of your menstrual cycle. This will help to stimulate your ovaries for the development of multiple, mature eggs for fertilisation. You will also be given synthetic hormones like cetrorelix and leuprolide.
- Development of follicle: You should be visiting your doctor frequently while having the medicines for a check-up of your blood hormone levels. Your ovaries will also be measured using ultrasound. This will allow the doctor to monitor the follicle development.
- Trigger shot: You will be given a trigger shot injection when the follicles are prepared. This injection leads to full maturation of the eggs, making them ready for fertilisation. The eggs require a period of 36 hours for retrieval after receiving the trigger shot.
- Gathering of the eggs: An anesthetic will be given to you and an ultrasound probe will be inserted via your vagina for observation of the ovaries and follicles. A thin needle will be inserted through the vaginal wall with which the eggs are removed from the follicles.
- Fertilisation: The eggs will be observed one final time before being combined with your partner’s sperm. Then they will be incubated overnight. Fertilisation occurs during this period and the abnormal eggs do not get fertilised. Three days after the egg retrieval, some of the successfully fertilised eggs transform into embryos composed of six to ten cells. Within five days, some of these embryos turn into blastocysts composed of fluid-filled cavities and tissue. This separates into the baby and the placenta. The most viable embryos are placed in your uterus. One to five embryos are placed in your uterus by the insertion of a catheter through the cervix. The embryo implants itself to the uterus walls. Gradually, it develops into the baby. The chances of pregnancy are higher when there are multiple embryos.
Before thinking of undergoing IVF, you must consult a doctor to know about the entire process. You also need to know whether you are fit to undergo IVF as there are several criteria you should satisfy for IVF. In case you have a concern or query you can always consult an expert & get answers to your questions!
Childbirth comes within an age bracket. Women feel this more so than men. Career demands or other personal choices can delay the time to get pregnant. Thus, freezing your eggs can prove to be beneficial, if you delay childbirth to focus on your career or education, or if you have certain medical conditions such as cancer.
- Egg Retrieval: Before the eggs are harvested, there is a lot you have to do. The first month is spent taking blood tests and ultrasounds. In the second month, you will have to take medicines before your procedure for egg retrieval. Ultrasounds and blood tests are also conducted at this stage to monitor the growth of the eggs. Around the time of your ovulation, the eggs will be harvested. You will be lightly sedated during the procedure. After the procedure, you might feel bloated and experience cramping. At least 15 eggs are retrieved for optimum chances. The medicines prescribed are all hormone injections which you can self-administer.
- Freezing and Storage: The largest human cell is the egg. It is comprised mainly of water. When the eggs are frozen, crystals can form which can destroy it. So an anti-freeze replaces the water after the eggs are dehydrated. This prevents crystal formation. Eggs are frozen using vitrification. In this process, the eggs are either slowly or flash frozen. Eggs can be frozen for as long as 10 years. This does not hamper the quality.
- Risks: There is no guarantee that freezing eggs will lead to having a baby. Sometimes, eggs do not survive the freezing or the thaw.
- Advantages: For women who are suffering from cancer, freezing their eggs might be the best option. They might want to preserve their fertility before their cancer treatment starts. This is useful since radiation and chemotherapy can harm your chances of getting pregnant.
The obvious advantage of freezing your eggs would be the fact that it gives you time. It lets you decide and keeps you one step ahead of your biological clock.
Donor egg IVF is used by more than 70 percent of infertile women above 45 years to conceive. More than 8,000 babies are born in the US to women of all age groups by this method of Assistive Reproductive Technologies (ART). This kind of fertility treatment will become even more popular, in the days to come, because of advances in the egg-freezing technology.
What are donor eggs
Donor eggs are eggs given by a healthy, fertile woman to an infertile woman for in-vitro fertilisation or IVF.
How does the Donor Egg IVF program work?
Before you start this course of treatment, you must consult your doctor regarding its feasibility and effect on your health. Typically, the process has the following steps;
- After a donor has been identified, the infertile woman (referred to as ‘you’) and the donor are given medication so that the menstrual cycles of both are synchronised. You are also given medication so that your endometrium lining is ready for womb transfer.
- After their donation, the eggs are fertilised using the In Vitro Fertilization technique.
- Since the donor is under 35, not more than three embryos are transferred from her to your womb.
- Embryos are formed after fertilising donor egg with partner sperm.
In some cases, the embryos may be transferred after they have been fertilised. This line of treatment is undertaken to reduce the stress of this treatment on you.
In cases of men, the following procedures are followed;
- Unless the sperm belongs to another man, your partner will be required to give a sample of his sperm to check sperm quality.
- The partner must give another sample on the day the eggs are collected.
- In the next stage, the eggs and sperm are mixed together and in vitro fertilised.
Chances of success in Donor Egg IVF program
The chances of you conceiving through this program are 60-70%. This strike rate is significantly higher than a conventional IVF line of treatment.
How to start with Donor Egg IVF program?
- Finding an egg donor is not that difficult these days. You can find a donor through a fertility clinic, an egg bank, an egg donation agency, a family member or a close family friend. Donors coming from a frozen egg bank are usually screened for health and other reasons. Most donors are in the age group of 21-35 years.
- Make it legal i.e while getting donors is easy, the tricky part is to comply with the various legal issues. Consult your spouse, doctor and your attorney before taking this step.
- Get counselling i.e. you need expert counselling before you conceive because, let us face it, your baby is not your biological offspring. You and your spouse need to be adequately psychologically prepared for this important development in the family.
In case you have a concern or query you can always consult an expert & get answers to your questions!
In today’s modern, fast paced society, it is easy for people to become stressed. In fact, one would almost think that being stressed is the “in” thing, and if you aren’t stressed it must mean there is something wrong with you! Realistically however, stress is not a good thing for our bodies in general, and has a very real impact on your fertility.
Can Stress Have an Effect on Your Fertility?
If your mind and body is under stress your body is signaled to release a hormone - Adrenalin. This is a stress relieving hormone and gives your body the rush to face the stress. This hormone inhibits the utilization of the hormone Progesterone, which is essential for fertility. Also during stress Prolactin, another hormone, is relapsed which also interferes with infertility. Hence to conceive its essential that your anxiety levels are under control.
How Stress Impacts Fertility?
Recent research tells us that stress boosts levels of stress hormones, such as adrenaline, catecholamines and cortisol, which can inhibit the release of the body’s main hormone, GnRH (gonadotropin releasing hormone), which is responsible for the release of sex hormones. Subsequently this may suppress ovulation in women, reduce sperm count in men and lower libido in both women and men.
Chronic Stress also decreases libido:
Chronic stress may cause lack of libido as well as a decrease in general fertility. This has become such a common issue that they have created a name for it Stress Induced Reproductive Dysfunction. These facts are very important to consider if you have been trying to conceive with no results. It also shows that stress relief should be a part of every couple's conception plan even if they are going through IVF.
Ways to reduce stress & improve fertility:
If you are having difficulty to conceive, it's imperative that you get fertility tests done and also evaluate your life. Look out for the stress points that may be hindering a relationship. Remember defeating the stress may be the solution to your worries.
- Reduce stress in your life: The issues in your life may be work or result related. You need to learn to balance your personal and professional life. The sooner you do it the better; after all you are preparing yourself to welcome a new born in your life.
- Change your reactions: Get a hang of the situation and react accordingly. Over reaction to a situation can harm your body and mind. Stop bothering so much about the future.
- Let few things be the way they are: Stop getting bothered about people. Remember by nature everything will fall in place. Let few things be the way they are.
- Make it your habit to reduce stress: Call it an obsession or a practice, train your mind to choose options where there is less stress.
- Sleep well: A good rest is essential for a healthy mind and body. Meditate, do yoga or seek counseling. Go for facials if it sooths you.
Please note that if your fertility reports are normal, then it's just a matter of time. Give you, your partner and your body time. There are certain medical complications or disorders that can also be responsible for infertility. Be calm and composed so that you are able to face the rough waters clearly with your partner.
In case you have a concern or query you can always consult an expert & get answers to your questions!
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!
There are women who feel their looks are spoilt because of the presence of excessive body hair. While hair on women's body is common, excessive body hair isn't a normal condition and must be taken seriously. Women are generally unaware that the condition is known as Hirsutism.
What is Hirsutism?
Hirsutism can be defined as growth of excessive facial and body hair in women. With the world obsessed with flawless skin, such changes from feminine hair pattern (soft, fine, vellus hair) to masculine hair pattern (hard, dark, terminal hair) in a woman is generally unwelcoming and, hence, very distressing for the woman.
Why do some women develop Hirsutism?
In order to understand the reasons for such excessive growth in some women, it is important to understand the differences in the physiology of men and women. The male or female appearance of one's body is dependent on a delicate balance between male and female sex hormones. There is a predominance of the hormone estrogen in a woman's body, whereas androgens (testosterone) are the predominant sex hormones among men. However, some amount of androgens is secreted by the ovaries and adrenal glands (located next to kidneys) in women also. But, an excessive production of these hormones results in Hirsutism. Hormonal imbalance is by far the most common cause of Hirsutism.
Causes of Hirsutism
The common causes of hirsutism include:
1. Endocrine causes
- Polycystic Ovarian Syndrome (PCOS) - PCOS is a condition of hormonal imbalance in the body, which can result in an irregular menstrual cycle, enlarged ovaries with a cystic appearance on USG, infertility, obesity and hirsutism. For more information on the causes and management of PCOS.
- Cushing's syndrome - Excessive production of hormone Cortisol by the adrenal glands can lead to symptoms such as high blood pressure, abdominal obesity, skin discoloration, muscle weakness, irregular menstruation, and hirsutism etc. This syndrome is known as Cushing's syndrome.
- Congenital Adrenal Hyperplasia (CAH) - CAH is a condition of excessive production of hormones Androgens and Cortisol by the adrenal glands and generally manifests in childhood in the form of virilization. In such cases, CAH can present with symptoms such as ambiguous genitals, obesity, hypertension etc. However, sometimes the manifestation of CAH is deferred to early adulthood and results in milder symptoms, hirsutism being one of them.
2. Tumors - Tumors in ovary or adrenal glands can again cause hirsutism due to excessive production of androgens
- Long term steroid consumption (commonly used for immunosuppression, rheumatoid arthritis, and multiple sclerosis)
- Performance enhancing drugs (often used by athletes)
4. Idiopathic - the woman may be having hirsutism despite normal hormone levels
There are essentially two lines of treatment for hirsutism - one is medical management and the other is a cosmetic treatment.
Medical treatments for hirsutism -
A. Birth control pills - It's possible to reduce the severity and intensity of hair growth using birth control pills- the most commonly prescribed medical intervention! The birth control pills help by decreasing the production of androgens by ovaries. Besides this, estrogen present in the pills also helps the liver to produce more of sex hormone binding protein- these proteins bind to circulating androgens, thereby reducing their action on the body. Both these actions help in reducing the growth of hair on the body.
B. Anti-androgen medications - There are three categories of anti-androgen medications, which are commonly used for the treatment of hirsutism.
- I. Spironolactone - Spironolactone is a diuretic medicine, which blocks the effects of androgens on the hair follicles, thus controlling hair growth.
- II. Finasteride - Finasteride works by blocking the conversion of body testosterone into its more potent chemical entity, thereby limiting the effect of testosterone on hair growth.
- III. Flutamide - Flutamide is a potent anti-androgen, which blocks the actions of androgens and helps in controlling the hair growth.
However, we have to ensure that the woman is not pregnant when taking any of these three medications. These medicines are often combined with oral contraceptives, which also have a synergistic effect in reducing the severity of hirsutism. One should also seek an expert opinion before starting these medications as there can be serious side effects, especially on liver.
C. Steroids - Low dose dexamethasone can be used to control the overactive adrenal glands when used carefully. However, long-term steroid therapy has got its own side effects and this therapy should only be considered under expert care and guidance.
D. Insulin sensitizing medicines - Medicines such as Metformin and Pioglitazone (Basically these are anti-diabetic medications) help in reducing insulin resistance in the body, which, in turn, helps in controlling the effects of excessive circulating androgens.
Cosmetic treatment for hirsutism -
One very important aspect of cosmetic management of hirsutism is self-care. This can include shaving, waxing, use of depilators and bleaching creams. All these measures help to reduce the amount of visible hair in undesired parts of the body. But, this needs to be done very frequently for a sustained visible effect.
Permanent hair removal is also possible using electrolysis or LASER treatment. In electrolysis treatment, electric current is passed into the hair follicle using a needle, which damages the root of the hair permanently. Similarly, LASER treatment uses LASER to destroy the hair follicle. Both these are effective methods to get rid of the undesired hair. However, we do not yet know if there are any long-term complications or side effects of these methods and these methods are not yet approved by the US FDA.
Related Tip: How Safe is Laser Surgery for Facial Hair Removal??
Infertility is a condition where a couple, trying to conceive in a natural way is not able to do so even after one year of trying. It is also a matter of worry for patients who are over the age of 35 years and those who are not able to conceive naturally even after 12 months of trying constantly.
Causes: There are many causes of infertility. It may be down to a condition present in one or both partners. Ovulation and fertilisation are the main elements of the conception process and any condition in the female or male can upset either function, which can make it difficult to conceive.
While abnormal sperm production and transport may be a common condition that leads to infertility in males, other factors like side effects of cancer treatments and too much exposure to toxins and chemicals can also play an important role in this regard. For females, the causes of infertility may range from ovulation disorders, uterine and fibroid tumours, uterine and cervical anomalies, damage to or blockage of the fallopian tubes, endometriosis, primary ovarian insufficiency and pelvic adhesions.
Infertility Symptoms in Women
In women, changes in the menstrual cycle and ovulation may be a symptom of a disease related to infertility. Symptoms include:
- Abnormal periods. Bleeding is heavier or lighter than usual.
- Irregular periods. The number of days in between each period varies each month.
- No periods. You have never had a period, or periods suddenly stop.
- Painful periods. Back pain, pelvic pain, and cramping may happen.
Treatment: Female patients can turn to medication that will stimulate ovulation, intrauterine insemination, and surgical processes to correct a uterine septum and remove endometrial polyps, or even a hysteroscopy surgery. Male patients can go through a treatment for any existing infections, hormonal injections and medication, surgical options like vasectomy reversal and art or assistive reproductive technology.
If these methods fail, the patient or the couple can always turn to methods like in vitro fertilisation. For other mild reasons, lifestyle changes along with a stress free environment can help in increasing the chances of conception.