Monday, 12 December 2011
Monday, 7 November 2011
Aid for Women with AIDS
HIV infection has become an epidemic in the past few years with an estimated 61 million affected people worldwide, another 7 million are added every year as per UNAIDS, the United Nations watchdog for AIDS. With 27 million pregnancies every year in India, it is estimated that about 100,000 HIV infected women deliver every year. From infected pregnant women about 30,000 infants acquire HIV in India every year.
Human immunodeficiency Virus (HIV) belongs to a family of slow acting Lenti viruses that uses a special enzyme (a kind or protein) for replication. The virus binds to the immune cells (cells in the human body that protect it against infections) of the body and kills them. This leads to a progressive decline in the number and function of these immune cells, which in turn causes impairment of the immunity in the body. Low levels of immunity leads to an increased risk of infections and some type of cancers.
There is no evidence to suggest that pregnancy hastens the progression of HIV infection. However women who have HIV have a higher chance of abortion, small babies and an early delivery. The virus travels from the mother to the baby at three different times during pregnancy. Most commonly the baby gets infected while it is still in the womb, next commonly during delivery and least commonly after delivery by taking the infected mothers’ breast milk. More advanced is the mother’s disease, higher is the chance of the baby acquiring HIV from its mother.
Any pregnant women with HIV should be counseled about the nature of the disease, the need for long term treatment and general measures for HIV infection. She should be explained the risk to her and to the baby due to her infection. The option for termination of pregnancy should be discussed with her.
The primary mode of treatment of HIV positive women is administration of HAART (highly active antiretroviral therapy) started anytime after three and a half months of pregnancy. This consists taking oral medicines against HIV at home. It decreases the risk of the baby having HIV from 45% to around 8%. These medicines, which earlier had a very prohibitive cost are now available in generic versions at affordable prices, and can be taken at home.
The type of delivery is very important in decreasing the risk of HIV transmission from mother to child. It is recommended by the American College of Obstetricians and Gynecologists that Caesarean section should be done for all women to decrease the risk of infection to the baby further from 8% to 2%. Even women who have started having natural labor pains benefit from having a C section.
Centre for disease Control and Prevention, USA recommends avoidance of breastfeeding in HIV positive women. World Health Organization however recommends exclusive breastfeeding in women who do not have enough money to buy formula feed, but breastfeeding should be exclusive and should stop at four months of age of the baby. Giving a child a mixed diet of breast milk and formula feeds is worse for the baby as formula milk causes inflammation of the childs intestine from which the HIV virus can easily enter the body of the child.
All children born to HIV positive mothers should get Zidovudine (an antiHIV drug) and should be tested for HIV at birth and again at 6 weeks and 6 months and treated accordingly.
A good part of HIV transfer from mother to child is preventable through simple means. Women should be counseled for the same and helped in containing the virus.
How does AIDS spread?
Sexual mode is the major route of spread of HIV infection globally. Heterosexual intercourse accounts for 82% cases of HIV transmission in India. The risk of HIV infection with sexual intercourse is 1% per episode with an increased risk associated with female gender, presence of other sexually transmitted diseases and pattern of sexual behavior. There is a higher risk of male to female transmission compared to female to male transmission (8 times) due to the large surface area of the vagina, prolonged exposure to semen and trauma to the vagina during intercourse. Getting a blood transfusion with infected blood carries a 90- 100 % risk of contracting HIV infection. It is important to know that despite the strict control by the government on the screening of blood before transfusion and the crackdown of professional blood donors, there still exists a risk of 7 people accidentally getting AIDS through contaminated blood per every one million people getting a blood transfusion. This emphasizes the need for giving blood and its products only to those people who really need it. Infected needles are an important source of HIV infection for health care professionals like doctors and nurses and for intravenous drug addicts. Hollow bore needles are associated with 8 times increased risk of infection than a surgical needle. Needle prick with an infected hollow bore needle is associated with a 0.3% chance of HIV transmission.
Clinical course of HIV in the body
Exposure to HIV is followed by an incubation period, which lasts for about 3-6 weeks followed by a period of rapid multiplication of the virus in the body called Acute HIV syndrome in 60-70% cases. This syndrome is similar to other viral illnesses with mild fever, body ache etc. This is followed by a period of immune response of the body, which reduces the virus levels in the body to very low counts. The diagnosis of HIV infection by lab tests may be missed by antibody based detection methods (the most commonly done lab test for AIDS) for up to 2 months following the HIV infection. This period is also known as the window period. The disease then lies low in the body for up to 6-8 years following which the virus again becomes stronger than the body and there comes the final stage of full-blown AIDS
Human immunodeficiency Virus (HIV) belongs to a family of slow acting Lenti viruses that uses a special enzyme (a kind or protein) for replication. The virus binds to the immune cells (cells in the human body that protect it against infections) of the body and kills them. This leads to a progressive decline in the number and function of these immune cells, which in turn causes impairment of the immunity in the body. Low levels of immunity leads to an increased risk of infections and some type of cancers.
There is no evidence to suggest that pregnancy hastens the progression of HIV infection. However women who have HIV have a higher chance of abortion, small babies and an early delivery. The virus travels from the mother to the baby at three different times during pregnancy. Most commonly the baby gets infected while it is still in the womb, next commonly during delivery and least commonly after delivery by taking the infected mothers’ breast milk. More advanced is the mother’s disease, higher is the chance of the baby acquiring HIV from its mother.
Any pregnant women with HIV should be counseled about the nature of the disease, the need for long term treatment and general measures for HIV infection. She should be explained the risk to her and to the baby due to her infection. The option for termination of pregnancy should be discussed with her.
The primary mode of treatment of HIV positive women is administration of HAART (highly active antiretroviral therapy) started anytime after three and a half months of pregnancy. This consists taking oral medicines against HIV at home. It decreases the risk of the baby having HIV from 45% to around 8%. These medicines, which earlier had a very prohibitive cost are now available in generic versions at affordable prices, and can be taken at home.
The type of delivery is very important in decreasing the risk of HIV transmission from mother to child. It is recommended by the American College of Obstetricians and Gynecologists that Caesarean section should be done for all women to decrease the risk of infection to the baby further from 8% to 2%. Even women who have started having natural labor pains benefit from having a C section.
Centre for disease Control and Prevention, USA recommends avoidance of breastfeeding in HIV positive women. World Health Organization however recommends exclusive breastfeeding in women who do not have enough money to buy formula feed, but breastfeeding should be exclusive and should stop at four months of age of the baby. Giving a child a mixed diet of breast milk and formula feeds is worse for the baby as formula milk causes inflammation of the childs intestine from which the HIV virus can easily enter the body of the child.
All children born to HIV positive mothers should get Zidovudine (an antiHIV drug) and should be tested for HIV at birth and again at 6 weeks and 6 months and treated accordingly.
A good part of HIV transfer from mother to child is preventable through simple means. Women should be counseled for the same and helped in containing the virus.
How does AIDS spread?
Sexual mode is the major route of spread of HIV infection globally. Heterosexual intercourse accounts for 82% cases of HIV transmission in India. The risk of HIV infection with sexual intercourse is 1% per episode with an increased risk associated with female gender, presence of other sexually transmitted diseases and pattern of sexual behavior. There is a higher risk of male to female transmission compared to female to male transmission (8 times) due to the large surface area of the vagina, prolonged exposure to semen and trauma to the vagina during intercourse. Getting a blood transfusion with infected blood carries a 90- 100 % risk of contracting HIV infection. It is important to know that despite the strict control by the government on the screening of blood before transfusion and the crackdown of professional blood donors, there still exists a risk of 7 people accidentally getting AIDS through contaminated blood per every one million people getting a blood transfusion. This emphasizes the need for giving blood and its products only to those people who really need it. Infected needles are an important source of HIV infection for health care professionals like doctors and nurses and for intravenous drug addicts. Hollow bore needles are associated with 8 times increased risk of infection than a surgical needle. Needle prick with an infected hollow bore needle is associated with a 0.3% chance of HIV transmission.
Clinical course of HIV in the body
Exposure to HIV is followed by an incubation period, which lasts for about 3-6 weeks followed by a period of rapid multiplication of the virus in the body called Acute HIV syndrome in 60-70% cases. This syndrome is similar to other viral illnesses with mild fever, body ache etc. This is followed by a period of immune response of the body, which reduces the virus levels in the body to very low counts. The diagnosis of HIV infection by lab tests may be missed by antibody based detection methods (the most commonly done lab test for AIDS) for up to 2 months following the HIV infection. This period is also known as the window period. The disease then lies low in the body for up to 6-8 years following which the virus again becomes stronger than the body and there comes the final stage of full-blown AIDS
Age and Infertility
What is the relation between my age and my chances of getting pregnant?
Most fertility patients are aware of the term "biological clock". Women are born with all their eggs and with each month passing, some of these eggs are used up. A woman’s reproductive potential declines, especially as she approaches her fourth decade of life. The total eggs that are left in a woman’s body is called her “ovarian reserve”.
Because women in our society are marrying later, and consequently attempting pregnancy later in life, evaluation of ovarian reserve is critical to understanding a patient’s reproductive potential. Unfortunately, there is no perfect test and it is difficult to answer with certainty the question that is often asked by anxious patients. How much time do my ovaries have left? And; How long can I wait to have a baby?
Can I get pregnant even if I am in my forties?
A little assistance is needed if you are in your fourth decade of life but definitely, a pregnancy can happen. The assistance might be in the form of IUI or IVF/ ICSI.
How to get pregnant if I have gone through menopause?
If you are postmenopausal, it means that you have finished with your supply of eggs. However with egg (ova) donation, you can borrow an egg from a young donor, get it fertilized with the sperm of your husband and then the embryo transfer is done to your uterus. You then carry the pregnancy to term in your own uterus. This is what is called egg donation or Donor Egg IVF
What infertility tests will tell me how good are my chances of getting pregnant at my age?
The infertility tests to determine your fertility potential are called tests of Ovarian reserve.
Follicle Stimulating Hormone (FSH). This is a blood test that measures the negative feedback from the ovary to the pituitary gland, which makes follicle stimulating hormone. It is done preferably on the third day of your periods (the first day being the day the periods began). FSH is the hormone that causes follicular recruitment and development in the ovary.
As ovarian function declines, and premenopause approaches, the negative feedback to the pituitary is decreased and the FSH level rises as the pituitary tries to drive the ovary harder. Commonly accepted values for a reassuring day 3 FSH value are less than 10 iu/ml. A slightly higher level may be compatible with development of an ongoing pregnancy with the use of appropriate therapy.
Unfortunately, this test is not a perfect predictor of reproductive potential because it is only one measurement in one cycle, and because ovarian function varies from cycle to cycle. Some cycles provide more fertility potential than others, especially in premenopausal patients. Sometimes it is possible to successfully treat a patient who has had a previously high FSH in a cycle that is more optimal by using hormonal medications to reduce the basal FSH level and then administering fertility medications.
These patients may become pregnant, especially if other markers of ovarian reserve are normal. In summary, one elevated FSH level on day 3 is not necessarily a steadfast indicator of an impossible case but should be interpreted in the light of further testing. Treatment should be started immediately if ovarian reserve is diminished as the ovarian function declines with age.
Inhibin B- Inhibin B is a specific hormone secreted by the ovarian follicle and is the most specific marker assessing ovarian reserve. The test appears to be more reliable than just a day 3 FSH blood test and is more consistent from cycle to cycle offering a more reliable evaluation of the true state of ovarian reserve. It is a marker of how the ovaries will respond to fertility drugs. The mean value at 95% confidence limits for day 3 inhibin evaluations is 33-45 pg/ml in normally fertile women. Since inhibin is a messenger hormone secreted by a healthy ovary to influence the pituitary gland, a low inhibin less than 30 pg/ml is a bad prognosticator of future reproductive potential. But a normal inhibin, even in the face of a slightly elevated day 3 FSH, can be encouraging and compatible with the initiation of a successful ongoing pregnancy.
Anti Mullerian hormone (AMH) is another new accurate marker of ovarian reserve. The advantage with AMH is that it can be done anytime during the women’s cycle.
The Clomiphene Challenge test provides an additional measurement of ovarian reserve. The principle of the test is to measure the basal FSH and estradiol levels on day three of the patient’s cycle. In order to evaluate the ovarian response to fertility drugs, 100 mg of Clomid is administered between days 5-9 of the cycle. The ovarian response on day 10 is further evaluated by checking the response to Clomid and measuring the FSH and estradiol. The test is abnormal if the day 3 or day 10 FSH is elevated above 10 iu/ml.
Stimulating the ovary with gonadotropins to see how they respond. An ovulation study is done and the number of eggs produced in response to the gonadotropins is evaluated. This is the ultimate test of ovarian reserve.
Most fertility patients are aware of the term "biological clock". Women are born with all their eggs and with each month passing, some of these eggs are used up. A woman’s reproductive potential declines, especially as she approaches her fourth decade of life. The total eggs that are left in a woman’s body is called her “ovarian reserve”.
Because women in our society are marrying later, and consequently attempting pregnancy later in life, evaluation of ovarian reserve is critical to understanding a patient’s reproductive potential. Unfortunately, there is no perfect test and it is difficult to answer with certainty the question that is often asked by anxious patients. How much time do my ovaries have left? And; How long can I wait to have a baby?
Can I get pregnant even if I am in my forties?
A little assistance is needed if you are in your fourth decade of life but definitely, a pregnancy can happen. The assistance might be in the form of IUI or IVF/ ICSI.
How to get pregnant if I have gone through menopause?
If you are postmenopausal, it means that you have finished with your supply of eggs. However with egg (ova) donation, you can borrow an egg from a young donor, get it fertilized with the sperm of your husband and then the embryo transfer is done to your uterus. You then carry the pregnancy to term in your own uterus. This is what is called egg donation or Donor Egg IVF
What infertility tests will tell me how good are my chances of getting pregnant at my age?
The infertility tests to determine your fertility potential are called tests of Ovarian reserve.
Follicle Stimulating Hormone (FSH). This is a blood test that measures the negative feedback from the ovary to the pituitary gland, which makes follicle stimulating hormone. It is done preferably on the third day of your periods (the first day being the day the periods began). FSH is the hormone that causes follicular recruitment and development in the ovary.
As ovarian function declines, and premenopause approaches, the negative feedback to the pituitary is decreased and the FSH level rises as the pituitary tries to drive the ovary harder. Commonly accepted values for a reassuring day 3 FSH value are less than 10 iu/ml. A slightly higher level may be compatible with development of an ongoing pregnancy with the use of appropriate therapy.
Unfortunately, this test is not a perfect predictor of reproductive potential because it is only one measurement in one cycle, and because ovarian function varies from cycle to cycle. Some cycles provide more fertility potential than others, especially in premenopausal patients. Sometimes it is possible to successfully treat a patient who has had a previously high FSH in a cycle that is more optimal by using hormonal medications to reduce the basal FSH level and then administering fertility medications.
These patients may become pregnant, especially if other markers of ovarian reserve are normal. In summary, one elevated FSH level on day 3 is not necessarily a steadfast indicator of an impossible case but should be interpreted in the light of further testing. Treatment should be started immediately if ovarian reserve is diminished as the ovarian function declines with age.
Inhibin B- Inhibin B is a specific hormone secreted by the ovarian follicle and is the most specific marker assessing ovarian reserve. The test appears to be more reliable than just a day 3 FSH blood test and is more consistent from cycle to cycle offering a more reliable evaluation of the true state of ovarian reserve. It is a marker of how the ovaries will respond to fertility drugs. The mean value at 95% confidence limits for day 3 inhibin evaluations is 33-45 pg/ml in normally fertile women. Since inhibin is a messenger hormone secreted by a healthy ovary to influence the pituitary gland, a low inhibin less than 30 pg/ml is a bad prognosticator of future reproductive potential. But a normal inhibin, even in the face of a slightly elevated day 3 FSH, can be encouraging and compatible with the initiation of a successful ongoing pregnancy.
Anti Mullerian hormone (AMH) is another new accurate marker of ovarian reserve. The advantage with AMH is that it can be done anytime during the women’s cycle.
The Clomiphene Challenge test provides an additional measurement of ovarian reserve. The principle of the test is to measure the basal FSH and estradiol levels on day three of the patient’s cycle. In order to evaluate the ovarian response to fertility drugs, 100 mg of Clomid is administered between days 5-9 of the cycle. The ovarian response on day 10 is further evaluated by checking the response to Clomid and measuring the FSH and estradiol. The test is abnormal if the day 3 or day 10 FSH is elevated above 10 iu/ml.
Stimulating the ovary with gonadotropins to see how they respond. An ovulation study is done and the number of eggs produced in response to the gonadotropins is evaluated. This is the ultimate test of ovarian reserve.
How Does Pregnancy Happen?
Pregnancy is the result of a process that has many steps. To get pregnant—
· A woman’s body must release an egg from one of her ovaries (ovulation).
· The egg must go through a fallopian tube toward the uterus (womb).
· A man’s sperm must join with (fertilize) the egg along the way.
· The fertilized egg must attach to the inside of the uterus (implantation).
Infertility can happen if there are problems with any of these steps.
What is a regular menstrual cycle?
A regular menstrual cycle is an important element of successful conception. The menstrual cycle refers to the maturation and release of an egg as well as the preparation of the uterus to receive and nurture the fertilized egg (embryo). The hormones released during the menstrual cycle control the sequence of events that lead to pregnancy. On the first day of the cycle, when menstruation (or your "period") begins, the uterus sheds its lining from the previous cycle. The typical menstrual cycle lasts for about 28 days and is divided into the following three distinct phases.
1) Follicular Phase - Days 1 to 13
During this phase, the hypothalamus and pituitary glands in the brain release a hormone known as follicle stimulating hormone (FSH). FSH stimulates the development of a follicle, which is a tiny fluid-filled sac in each ovary containing a maturing egg. The follicle also secretes estrogen, which produces mid-cycle changes in the cervical mucus. These changes help prepare the cervical mucus to receive and nourish sperm.
2) Ovulatory Phase - Approximately 14 Days Before Your Next Cycle Starts
The ovulatory phase begins when the level of luteinizing hormone (LH), also release by the pituitary gland, drastically increases or surges. LH causes the follicle to break open and release the mature egg into the fallopian tube. During her reproductive years, a woman usually releases a single mature egg each month. This process is known as ovulation. Cervical mucus is most receptive to sperm around this time and a woman has the best chances of conceiving right before and during ovulation.
3) Luteal Phase - Days 15 to 28
During this phase, the follicle that produces the egg becomes a functioning gland called the corpus luteum. The corpus luteum produces progesterone, which prepares the endometrium (lining of the uterus) for the implantation of the fertilized egg.
I want to know more about Fertilization
The ovulatory phase of the menstrual cycle is the optimal time for fertilization. When a couple has intercourse during this time, sperm swim through the cervical mucus, into the uterus and along the fallopian tube, where they meet the egg. Although millions of sperm are released, only one sperm can fertilize an egg. The egg has the capacity to be fertilized for about 24 hours after it is released from the follicle. (If fertilization does not occur, the egg passes through the uterus, and the corpus luteum ceases to function on about day 26. The uterine lining then breaks down and is shed several days later as the next menstrual cycle begins.)
What is Implantation?
After fertilization, the embryo travels through the fallopian tube toward the uterus. Inside the uterus, the embryo implants itself into the lining on about the 20th day of the cycle and continues to grow into an embryo and eventually a fetus. The corpus luteum continues to produce progesterone to preserve the uterine lining and help maintain pregnancy.
What and when is the ‘fertile period’?
Fertile period is the time period during a womans menstrual cycle when there are maximum chances of the woman getting pregnant. This is the time when the woman is ovulating. The ovulatory phase, in a woman with a regular 28 day cycle is around the 14th day of her cycle. In women with irregular periods however, predicting the fertile period is tricky.It is a common misconception that the ovulatory phase begins around day 14 of your cycle; in fact, it can more easily be determined by 14 days prior to the start of your cycle, which may not be an exact 28 days. Your cycle begins in the first day that you experience regular flow. Once you determine how long your personal cycle lasts, subtract 14 days from the predicted end of the cycle to determine time of ovulation.
· A woman’s body must release an egg from one of her ovaries (ovulation).
· The egg must go through a fallopian tube toward the uterus (womb).
· A man’s sperm must join with (fertilize) the egg along the way.
· The fertilized egg must attach to the inside of the uterus (implantation).
Infertility can happen if there are problems with any of these steps.
What is a regular menstrual cycle?
A regular menstrual cycle is an important element of successful conception. The menstrual cycle refers to the maturation and release of an egg as well as the preparation of the uterus to receive and nurture the fertilized egg (embryo). The hormones released during the menstrual cycle control the sequence of events that lead to pregnancy. On the first day of the cycle, when menstruation (or your "period") begins, the uterus sheds its lining from the previous cycle. The typical menstrual cycle lasts for about 28 days and is divided into the following three distinct phases.
1) Follicular Phase - Days 1 to 13
During this phase, the hypothalamus and pituitary glands in the brain release a hormone known as follicle stimulating hormone (FSH). FSH stimulates the development of a follicle, which is a tiny fluid-filled sac in each ovary containing a maturing egg. The follicle also secretes estrogen, which produces mid-cycle changes in the cervical mucus. These changes help prepare the cervical mucus to receive and nourish sperm.
2) Ovulatory Phase - Approximately 14 Days Before Your Next Cycle Starts
The ovulatory phase begins when the level of luteinizing hormone (LH), also release by the pituitary gland, drastically increases or surges. LH causes the follicle to break open and release the mature egg into the fallopian tube. During her reproductive years, a woman usually releases a single mature egg each month. This process is known as ovulation. Cervical mucus is most receptive to sperm around this time and a woman has the best chances of conceiving right before and during ovulation.
3) Luteal Phase - Days 15 to 28
During this phase, the follicle that produces the egg becomes a functioning gland called the corpus luteum. The corpus luteum produces progesterone, which prepares the endometrium (lining of the uterus) for the implantation of the fertilized egg.
I want to know more about Fertilization
The ovulatory phase of the menstrual cycle is the optimal time for fertilization. When a couple has intercourse during this time, sperm swim through the cervical mucus, into the uterus and along the fallopian tube, where they meet the egg. Although millions of sperm are released, only one sperm can fertilize an egg. The egg has the capacity to be fertilized for about 24 hours after it is released from the follicle. (If fertilization does not occur, the egg passes through the uterus, and the corpus luteum ceases to function on about day 26. The uterine lining then breaks down and is shed several days later as the next menstrual cycle begins.)
What is Implantation?
After fertilization, the embryo travels through the fallopian tube toward the uterus. Inside the uterus, the embryo implants itself into the lining on about the 20th day of the cycle and continues to grow into an embryo and eventually a fetus. The corpus luteum continues to produce progesterone to preserve the uterine lining and help maintain pregnancy.
What and when is the ‘fertile period’?
Fertile period is the time period during a womans menstrual cycle when there are maximum chances of the woman getting pregnant. This is the time when the woman is ovulating. The ovulatory phase, in a woman with a regular 28 day cycle is around the 14th day of her cycle. In women with irregular periods however, predicting the fertile period is tricky.It is a common misconception that the ovulatory phase begins around day 14 of your cycle; in fact, it can more easily be determined by 14 days prior to the start of your cycle, which may not be an exact 28 days. Your cycle begins in the first day that you experience regular flow. Once you determine how long your personal cycle lasts, subtract 14 days from the predicted end of the cycle to determine time of ovulation.
What is Infertility?
What is infertility?
Infertility means not being able to get pregnant after one year of trying, or, six months, if a woman is 35 years of age or older.
How does pregnancy occur?
Pregnancy is the result of a process that has many steps. To get pregnant—
· A woman’s body must release an egg from one of her ovaries (ovulation).
· The egg must go through a fallopian tube toward the uterus (womb).
· A man's sperm must join with (fertilize) the egg along the way.
· The fertilized egg must attach to the inside of the uterus (implantation).
Infertility can happen if there are problems with any of these steps.
When Should I Get Help for Female Infertility?
It can take up to a year for a woman to get pregnant. This is considered normal. Most health care providers suggest a woman try for a year before seeking infertility testing. It is a good idea, though, to go to a health care provider to discuss pre-pregnancy health before starting to try to get pregnant.
Certain health problems can make getting pregnant more difficult. Don’t wait a whole year of trying to get pregnant before talking with your health care provider if you have a history of
· ectopic pregnancy
· irregular periods
· pelvic inflammatory disease
· repeated miscarriages
· thyroid problems
What is Secondary Infertility?
Secondary infertility is defined as infertility affecting couples who have had at least one child previously. Unfortunately, couples suffering with secondary infertility don't often get the help and support they need from doctors, friends and family because they aren't perceived as truly infertile since they've already had children.
What are the causes of Secondary Infertility?
There are many reasons that may explain why a couple is suffering with secondary infertility. A woman's fertility can change or be affected after having a child, even if she had no problem becoming pregnant the first or second time. Infection such as pelvic inflammatory disease (PID) can cause damage to the fallopian tubes, making it difficult for fertilization to occur, or increasing the risk of ectopic pregnancy.
Weight gain and an unhealthy diet can also affect your fertility. Gaining even a small amount of weight can throw your hormones off balance, affecting your menstrual cycles. If you are not ovulating, or ovulating irregularly, it may also be difficult to get pregnant. Endometriosis and fibroids are also contributing factors to secondary infertility.
Age can contribute to secondary infertility as well. With more women waiting to have their first child until well into their 30s, your fertility may have decreased significantly in the years between your first pregnancy, and attempting your second. Research shows that a woman's fertility begins a steady decline even in your late 20s and early 30s. (See age and Infertility) While this doesn't mean that you can't get pregnant, you may have a harder time conceiving and have an increased risk of miscarriage due to aging eggs. In addition to your fertility, your partner's fertility is also affected by age, thus contributing to secondary infertility.
When should I seek treatment?
If you are under 35, you aren't considered to have fertility problems until you've tried unsuccessfully for at least a year to get pregnant. This means that you've been having regular, unprotected sex for at least 12 months. If you're over 35, you should seek the treatment of a doctor after six months of trying. Repeated miscarriages, infection and irregular cycles are all reasons to speak to a doctor earlier. You will require an assessment of your current health, as well as tests to assess your reproductive status. (See Investigations for Infertility). Depending on the cause of the secondary infertility, you might be recommended a variety of fertility treatments.
If you feel that you are having trouble, or you may have trouble getting pregnant, don't hesitate to speak with your doctor at anytime.
What is the first step in seeking treatment?
The first step for many couples seeking medical treatment for infertility is to discuss their inability to conceive with an Infertility Specialist. The Infertility Specialist will review the couple's medical history and conduct a complete physical examination of the female. The evaluation of the male's medical history includes a discussion of previous pregnancies, developmental problems, surgeries, testicular trauma or infections and environmental exposure. The female medical history includes review of previous pregnancies, painful periods or pelvic pain, infections and previous surgeries.
Infertility means not being able to get pregnant after one year of trying, or, six months, if a woman is 35 years of age or older.
How does pregnancy occur?
Pregnancy is the result of a process that has many steps. To get pregnant—
· A woman’s body must release an egg from one of her ovaries (ovulation).
· The egg must go through a fallopian tube toward the uterus (womb).
· A man's sperm must join with (fertilize) the egg along the way.
· The fertilized egg must attach to the inside of the uterus (implantation).
Infertility can happen if there are problems with any of these steps.
When Should I Get Help for Female Infertility?
It can take up to a year for a woman to get pregnant. This is considered normal. Most health care providers suggest a woman try for a year before seeking infertility testing. It is a good idea, though, to go to a health care provider to discuss pre-pregnancy health before starting to try to get pregnant.
Certain health problems can make getting pregnant more difficult. Don’t wait a whole year of trying to get pregnant before talking with your health care provider if you have a history of
· ectopic pregnancy
· irregular periods
· pelvic inflammatory disease
· repeated miscarriages
· thyroid problems
What is Secondary Infertility?
Secondary infertility is defined as infertility affecting couples who have had at least one child previously. Unfortunately, couples suffering with secondary infertility don't often get the help and support they need from doctors, friends and family because they aren't perceived as truly infertile since they've already had children.
What are the causes of Secondary Infertility?
There are many reasons that may explain why a couple is suffering with secondary infertility. A woman's fertility can change or be affected after having a child, even if she had no problem becoming pregnant the first or second time. Infection such as pelvic inflammatory disease (PID) can cause damage to the fallopian tubes, making it difficult for fertilization to occur, or increasing the risk of ectopic pregnancy.
Weight gain and an unhealthy diet can also affect your fertility. Gaining even a small amount of weight can throw your hormones off balance, affecting your menstrual cycles. If you are not ovulating, or ovulating irregularly, it may also be difficult to get pregnant. Endometriosis and fibroids are also contributing factors to secondary infertility.
Age can contribute to secondary infertility as well. With more women waiting to have their first child until well into their 30s, your fertility may have decreased significantly in the years between your first pregnancy, and attempting your second. Research shows that a woman's fertility begins a steady decline even in your late 20s and early 30s. (See age and Infertility) While this doesn't mean that you can't get pregnant, you may have a harder time conceiving and have an increased risk of miscarriage due to aging eggs. In addition to your fertility, your partner's fertility is also affected by age, thus contributing to secondary infertility.
When should I seek treatment?
If you are under 35, you aren't considered to have fertility problems until you've tried unsuccessfully for at least a year to get pregnant. This means that you've been having regular, unprotected sex for at least 12 months. If you're over 35, you should seek the treatment of a doctor after six months of trying. Repeated miscarriages, infection and irregular cycles are all reasons to speak to a doctor earlier. You will require an assessment of your current health, as well as tests to assess your reproductive status. (See Investigations for Infertility). Depending on the cause of the secondary infertility, you might be recommended a variety of fertility treatments.
If you feel that you are having trouble, or you may have trouble getting pregnant, don't hesitate to speak with your doctor at anytime.
What is the first step in seeking treatment?
The first step for many couples seeking medical treatment for infertility is to discuss their inability to conceive with an Infertility Specialist. The Infertility Specialist will review the couple's medical history and conduct a complete physical examination of the female. The evaluation of the male's medical history includes a discussion of previous pregnancies, developmental problems, surgeries, testicular trauma or infections and environmental exposure. The female medical history includes review of previous pregnancies, painful periods or pelvic pain, infections and previous surgeries.
Cigarette Smoking and Infertility
Despite the mandatory statutory warning of ‘Cigarette smoking is injurious to health’, more and more young women are now picking up smoking, throwing all caution to the winds. The reasons for the increase in this fad are many, including peer pressure, desire to appear ‘cool’ and the like. Most women, since their childhood have known that smoking leads to lung cancer. This is very true but there is more news to follow for women who are planning to start a family, for it is very well known that smoking causes infertility, that is difficulty in conceiving and having children, in a high percentage of women.
After the age of the woman, the second most important factor in determining a woman’s reproductive potential is whether she smokes or not.
Smoking affects fertility in many ways. Cigarette smoke contains more than 2500 chemicals. Most of these components have not been evaluated for their effects on health. Two of the major components that are responsible for adverse effects of cigarette smoke are nicotine and carbon monoxide. In a well-designed study published in Archives of Environmental Health, out of 24,000 women, the frequency of abnormal ovulation and abnormal bleeding was found to be 67% higher in women who were smokers than in non-smokers. A woman ovulates once a month, and normally produces one egg only. If eggs do not form, pregnancy automatically does not happen.
Nicotine also alters tubal motility. Each egg, once produced by the ovary has to be conveyed by the fallopian tubes from the ovary to the uterus. If the tubes do not function properly, the egg gets delayed in its journey towards the uterus, does not meet the sperm at the right time and pregnancy does not happen. If the fallopian tubes are working at suboptimal levels, sometimes fertilization does happen but the embryo does not reach the uterus in time for implantation but gets implanted in the tube itself, what is called an ectopic pregnancy. This situation is a virtual time bomb because as the pregnancy grows, it might rupture the tube leading to excessive bleeding and even death. Women who have been smoking at the time they conceived the child have twice the risk of having an ectopic pregnancy versus non-smoking women.
Even if a woman who smokes does get pregnant, the risk of having a miscarriage is four times higher than in normal women. Smoking is the most important preventable cause of abortion. Not so many women were smoking in the yesteryears, it was mainly very high society women, or very low class laborers who indulged in smoking ‘bidis’. Now the trend of smoking has become very common in young girls. What is worse, most women do not come out in the open about their smoking habits leading to risks in pregnancy like low birth weight of the baby and even sudden death of the baby in the womb of the mother due to a condition called ‘abruptio placentae’. ’
Babies, after birth are at higher risk of ‘Cot Death” or ‘Sudden Infant Death Syndrome’ in which a baby, apparently healthy goes off to sleep one night and does not wake up again. After a lot of research in leading hospitals all over the world, it was determined that babies at risk for cot death were male and whose mothers had smoked during pregnancy.
After the age of the woman, the second most important factor in determining a woman’s reproductive potential is whether she smokes or not.
Smoking affects fertility in many ways. Cigarette smoke contains more than 2500 chemicals. Most of these components have not been evaluated for their effects on health. Two of the major components that are responsible for adverse effects of cigarette smoke are nicotine and carbon monoxide. In a well-designed study published in Archives of Environmental Health, out of 24,000 women, the frequency of abnormal ovulation and abnormal bleeding was found to be 67% higher in women who were smokers than in non-smokers. A woman ovulates once a month, and normally produces one egg only. If eggs do not form, pregnancy automatically does not happen.
Nicotine also alters tubal motility. Each egg, once produced by the ovary has to be conveyed by the fallopian tubes from the ovary to the uterus. If the tubes do not function properly, the egg gets delayed in its journey towards the uterus, does not meet the sperm at the right time and pregnancy does not happen. If the fallopian tubes are working at suboptimal levels, sometimes fertilization does happen but the embryo does not reach the uterus in time for implantation but gets implanted in the tube itself, what is called an ectopic pregnancy. This situation is a virtual time bomb because as the pregnancy grows, it might rupture the tube leading to excessive bleeding and even death. Women who have been smoking at the time they conceived the child have twice the risk of having an ectopic pregnancy versus non-smoking women.
Even if a woman who smokes does get pregnant, the risk of having a miscarriage is four times higher than in normal women. Smoking is the most important preventable cause of abortion. Not so many women were smoking in the yesteryears, it was mainly very high society women, or very low class laborers who indulged in smoking ‘bidis’. Now the trend of smoking has become very common in young girls. What is worse, most women do not come out in the open about their smoking habits leading to risks in pregnancy like low birth weight of the baby and even sudden death of the baby in the womb of the mother due to a condition called ‘abruptio placentae’. ’
Babies, after birth are at higher risk of ‘Cot Death” or ‘Sudden Infant Death Syndrome’ in which a baby, apparently healthy goes off to sleep one night and does not wake up again. After a lot of research in leading hospitals all over the world, it was determined that babies at risk for cot death were male and whose mothers had smoked during pregnancy.
Exercise during pregnancy
It’s a common myth in Indian women that they should avoid exercise during pregnancy. The belief is that since they are nurturing a life inside their bodies, they should try to conserve energy so that more of it is available to pass on to the baby. This no longer holds true, as exercise is a big plus for both you and your baby (if complications don't limit your ability to exercise throughout your pregnancy). It can help you to have
* Easier labor
* Quicker Labor
* More energy during labor
* Less chance of a Caesarean section
* Optimal Weight gain during pregnancy
* Less chance of constipation and heartburn
* Decrease chance of swelling and varicose veins
* Less back pain.
* Improvement in sleep
* More energy
* Less chance of miscarriage
* Better psychological state of mind. Improves mood and body image.
* Lose weight quicker after delivery
A safe exercise plan during pregnancy depends on when you start and whether your pregnancy is complicated. If you exercised regularly before becoming pregnant, continue your program, with modifications, as you need them. If you weren't fit before you became pregnant, don't give up! Begin slowly and build gradually as you become stronger. Whatever your fitness level, you should talk to your doctor about exercising while you're pregnant.
Discuss any concerns you have with your doctor. You may need to limit your exercise if you have:
· pregnancy-induced high blood pressure
· early contractions
· vaginal bleeding
· premature rupture of your membranes, also known as your water (the fluid in the amniotic sac around the fetus) breaking early
Always talk to your doctor before beginning any exercise program. Once you're ready to get going:
· Start gradually. Even 5 minutes a day is a good start if you've been inactive. Add 5 minutes each week until you reach 30 minutes.
· Dress comfortably in loose-fitting clothes and wear a supportive bra to protect your breasts.
· Drink plenty of water to avoid overheating and dehydration.
· Skip your exercises if you're sick.
· Opt for a walk in an air-conditioned mall on hot, humid days.
The kind of exercises that you can do depends on what interests you and what your doctor advises. Many women enjoy dancing, swimming, yoga, biking, or walking. Swimming is especially appealing, as it gives you welcome buoyancy (floatability or the feeling of weightlessness). Many experts recommend walking. If you're just starting, begin with a moderately brisk pace for a kilometer, 3 days a week. Add a couple of minutes every week and gradually pick up the pace. It is important to go slowly for the first 5 minutes to warm up and to slow down for the last 5 minutes to cool down.
Whatever type of exercise you and your doctor decide on, the key is to listen to your body's warnings. Many women, for example, become dizzy early in their pregnancy, and as the baby grows, their center of gravity changes. So it may be easy for you to lose your balance, especially in the last trimester.
Your energy level may also vary greatly from day to day. And as your baby grows and pushes up on your lungs, you'll notice a decreased ability to breathe in more air (and the oxygen it contains) when you exercise. Your body is signaling that it's had enough if you feel fatigue, dizziness, heart palpitations (your heart pounding in your chest), shortness of breath or pain in your back or pelvis. And if you can't talk while you're exercising, you're doing it too strenuously. You should also keep your heart rate below 160 beats per minute.
It also isn't good for your baby if you become overheated because temperatures greater than 102.6 degrees Fahrenheit (39 degrees Celsius) could cause problems with the developing fetus - especially in the first trimester - which can potentially lead to birth defects. So don't overdo exercise on hot days.
When the weather is hot, try to avoid exercising outside during the hottest part of the day (from about 10 AM to 3 PM) or exercise in an air-conditioned place. Also remember that swimming makes it more difficult for you to notice your body heating up because the water makes you feel cooler.
Most doctors recommend that pregnant women avoid weight training and sit-ups after the first trimester, especially women who are at risk for preterm labor. Lifting reduces the blood flow to the kidneys and uterus, and exercises done on your back (including sit-ups and leg lifts) cause your heart rate to drop, also decreasing the flow of oxygenated blood to your body and the baby. It's better to tone your abdominal muscles while on all fours, by relaxing and then tightening your muscles as you exhale.
Unless your doctor tells you otherwise, it's also a good idea to avoid any activities that include:
· bouncing
· jarring (anything that would cause a lot of up and down movement)
· leaping
· a sudden change of direction
· a risk of abdominal injury
Typical limitations include contact sports, downhill skiing, scuba diving, and horseback riding because of the risk of injury they pose. Although some doctors say step aerobics is acceptable if you can lower the height of your step as your pregnancy progresses, others caution that a changing center of gravity makes falls much more likely. If you do choose to do aerobics, just make sure to avoid becoming extremely winded or exercising to the point of exhaustion.
And check with your doctor if you experience any of these warning signs during any type of exercise:
· vaginal bleeding
· unusual pain
· dizziness or lightheadedness
· unusual shortness of breath
· racing heartbeat or chest pain
· fluid leaking from your vagina
· uterine contractions
What Are Kegel Exercises?
Kegel exercises are equally important during and after pregnancy to help restore the tone and strength of your birth canal. Kegel exercises help strengthen your pelvic muscles, which weaken during childbirth. If these muscles are weak, you can have bladder control problems. You may also find that intercourse is more fulfilling when you have control of your kegel muscles.
It is very easy to do Kegels exercises. Pretend that you are trying to stop the flow of urine the next time you are sitting on the toilet (or anywhere for that matter). Those are the very muscles you need to contract in order to do your Kegels. Be sure when you are doing your Kegel’s that you concentrate on the pelvic floor muscles specifically; try not to do any other exercises. You should squeeze for about 15 seconds several times per day.
It is important that you don’t overdo your Kegel’s particularly in the early weeks after birth, or you may become very sore. Consider working up to doing three sets of ten repetitions over the course of the day.
Remember, a regular exercise routine can help you stay you stay healthy and feeling your best throughout pregnancy
* Easier labor
* Quicker Labor
* More energy during labor
* Less chance of a Caesarean section
* Optimal Weight gain during pregnancy
* Less chance of constipation and heartburn
* Decrease chance of swelling and varicose veins
* Less back pain.
* Improvement in sleep
* More energy
* Less chance of miscarriage
* Better psychological state of mind. Improves mood and body image.
* Lose weight quicker after delivery
A safe exercise plan during pregnancy depends on when you start and whether your pregnancy is complicated. If you exercised regularly before becoming pregnant, continue your program, with modifications, as you need them. If you weren't fit before you became pregnant, don't give up! Begin slowly and build gradually as you become stronger. Whatever your fitness level, you should talk to your doctor about exercising while you're pregnant.
Discuss any concerns you have with your doctor. You may need to limit your exercise if you have:
· pregnancy-induced high blood pressure
· early contractions
· vaginal bleeding
· premature rupture of your membranes, also known as your water (the fluid in the amniotic sac around the fetus) breaking early
Always talk to your doctor before beginning any exercise program. Once you're ready to get going:
· Start gradually. Even 5 minutes a day is a good start if you've been inactive. Add 5 minutes each week until you reach 30 minutes.
· Dress comfortably in loose-fitting clothes and wear a supportive bra to protect your breasts.
· Drink plenty of water to avoid overheating and dehydration.
· Skip your exercises if you're sick.
· Opt for a walk in an air-conditioned mall on hot, humid days.
The kind of exercises that you can do depends on what interests you and what your doctor advises. Many women enjoy dancing, swimming, yoga, biking, or walking. Swimming is especially appealing, as it gives you welcome buoyancy (floatability or the feeling of weightlessness). Many experts recommend walking. If you're just starting, begin with a moderately brisk pace for a kilometer, 3 days a week. Add a couple of minutes every week and gradually pick up the pace. It is important to go slowly for the first 5 minutes to warm up and to slow down for the last 5 minutes to cool down.
Whatever type of exercise you and your doctor decide on, the key is to listen to your body's warnings. Many women, for example, become dizzy early in their pregnancy, and as the baby grows, their center of gravity changes. So it may be easy for you to lose your balance, especially in the last trimester.
Your energy level may also vary greatly from day to day. And as your baby grows and pushes up on your lungs, you'll notice a decreased ability to breathe in more air (and the oxygen it contains) when you exercise. Your body is signaling that it's had enough if you feel fatigue, dizziness, heart palpitations (your heart pounding in your chest), shortness of breath or pain in your back or pelvis. And if you can't talk while you're exercising, you're doing it too strenuously. You should also keep your heart rate below 160 beats per minute.
It also isn't good for your baby if you become overheated because temperatures greater than 102.6 degrees Fahrenheit (39 degrees Celsius) could cause problems with the developing fetus - especially in the first trimester - which can potentially lead to birth defects. So don't overdo exercise on hot days.
When the weather is hot, try to avoid exercising outside during the hottest part of the day (from about 10 AM to 3 PM) or exercise in an air-conditioned place. Also remember that swimming makes it more difficult for you to notice your body heating up because the water makes you feel cooler.
Most doctors recommend that pregnant women avoid weight training and sit-ups after the first trimester, especially women who are at risk for preterm labor. Lifting reduces the blood flow to the kidneys and uterus, and exercises done on your back (including sit-ups and leg lifts) cause your heart rate to drop, also decreasing the flow of oxygenated blood to your body and the baby. It's better to tone your abdominal muscles while on all fours, by relaxing and then tightening your muscles as you exhale.
Unless your doctor tells you otherwise, it's also a good idea to avoid any activities that include:
· bouncing
· jarring (anything that would cause a lot of up and down movement)
· leaping
· a sudden change of direction
· a risk of abdominal injury
Typical limitations include contact sports, downhill skiing, scuba diving, and horseback riding because of the risk of injury they pose. Although some doctors say step aerobics is acceptable if you can lower the height of your step as your pregnancy progresses, others caution that a changing center of gravity makes falls much more likely. If you do choose to do aerobics, just make sure to avoid becoming extremely winded or exercising to the point of exhaustion.
And check with your doctor if you experience any of these warning signs during any type of exercise:
· vaginal bleeding
· unusual pain
· dizziness or lightheadedness
· unusual shortness of breath
· racing heartbeat or chest pain
· fluid leaking from your vagina
· uterine contractions
What Are Kegel Exercises?
Kegel exercises are equally important during and after pregnancy to help restore the tone and strength of your birth canal. Kegel exercises help strengthen your pelvic muscles, which weaken during childbirth. If these muscles are weak, you can have bladder control problems. You may also find that intercourse is more fulfilling when you have control of your kegel muscles.
It is very easy to do Kegels exercises. Pretend that you are trying to stop the flow of urine the next time you are sitting on the toilet (or anywhere for that matter). Those are the very muscles you need to contract in order to do your Kegels. Be sure when you are doing your Kegel’s that you concentrate on the pelvic floor muscles specifically; try not to do any other exercises. You should squeeze for about 15 seconds several times per day.
It is important that you don’t overdo your Kegel’s particularly in the early weeks after birth, or you may become very sore. Consider working up to doing three sets of ten repetitions over the course of the day.
Remember, a regular exercise routine can help you stay you stay healthy and feeling your best throughout pregnancy
How Men and Women react differently to Infertility and its Treatment
Studies have shown (not surprisingly) that men and women react differently to infertility. Women are more open with their emotions and have been on record as perceiving infertility as the most upsetting event of their lives and show their vulnerability more openly than men. These feelings are more pronounced in women belonging to cultures where motherhood is perceived as the main role of women in the family.
Men are more reserved with their feelings, although this does not mean to that they do not feel the loss of the status of fatherhood as keenly. Although some studies suggest that women get more distressed at loss of motherhood, others indicate that both men and women find infertility equally distressing. Men however are more reserved about displaying emotions and less affected by treatment. However as the brunt of infertility and its treatment is largely borne by women, most of the strategies today for coping with the stress and trauma of infertility is targeted towards women, men are left bereft of the benefits of counseling groups and
other standardized measures of tackling stress.
However, when the male partner is the main reason for infertility in the couple, men show significantly higher levels of stress, as virility (and procreation) is valued very strongly by men and infertility is viewed as a challenge to manhood. As regards approach to treatment, men prefer a pragmatic and a problem solving approach whereas women like more to share their emotional reactions.
Life without offspring has different implications for men and women. The role of women is very strongly intertwined with motherhood. Also, as a woman ages and goes through the gamut of marriage, pregnancy, delivery and motherhood, her social life alters. As all other women among her friends in her age group go through these same roles in near about the same timeframes, their focus in life changes together. The quality of friendship is impacted as common topics and interests become scarcer. Many infertile women end up losing contact or isolating themselves from women who have children. Men, being the breadwinners of he family changes little, whether they have children or not.
Men are more reserved with their feelings, although this does not mean to that they do not feel the loss of the status of fatherhood as keenly. Although some studies suggest that women get more distressed at loss of motherhood, others indicate that both men and women find infertility equally distressing. Men however are more reserved about displaying emotions and less affected by treatment. However as the brunt of infertility and its treatment is largely borne by women, most of the strategies today for coping with the stress and trauma of infertility is targeted towards women, men are left bereft of the benefits of counseling groups and
other standardized measures of tackling stress.
However, when the male partner is the main reason for infertility in the couple, men show significantly higher levels of stress, as virility (and procreation) is valued very strongly by men and infertility is viewed as a challenge to manhood. As regards approach to treatment, men prefer a pragmatic and a problem solving approach whereas women like more to share their emotional reactions.
Life without offspring has different implications for men and women. The role of women is very strongly intertwined with motherhood. Also, as a woman ages and goes through the gamut of marriage, pregnancy, delivery and motherhood, her social life alters. As all other women among her friends in her age group go through these same roles in near about the same timeframes, their focus in life changes together. The quality of friendship is impacted as common topics and interests become scarcer. Many infertile women end up losing contact or isolating themselves from women who have children. Men, being the breadwinners of he family changes little, whether they have children or not.
Friday, 4 November 2011
IVF in Delhi
New Delhi is the capital of India, a country which is one of the largest emerging economies of the world.India is characterized by the fact that although the official language is Hindi, vast majority of the population speaks English and almost all official work gets done in English too. Delhi is a city that bridges two different worlds. Old Delhi, once the capital of Islamic India, is a labyrinth of narrow lanes lined with crumbling havelis and formidable mosques. In contrast, the imperial city of New Delhi created by the British Raj is composed of spacious, tree-lined avenues and imposing government buildings.
Delhi has an area of 1,483 sq km and is situated at Latitudinal parallel: 28.3oN and Longitudinal meridian: 77.13oE. It is 293 m above sea level and has a population of 13.85million (Census 2001). The temperatures vary from 45oC (Max) - usually in May – Jun to 5oC (Min) -usually in Dec – Jan. People of Delhi embrace a modern lifestyle. Delhi has always been a Cosmopolitan city where one would find people from all parts of India. Overall, Delhi is a very multi-linguist and multi-cultured society which has now opened itself to embracing every new custom and tradition.
With more and more tourists coming to Delhi, the government has a special ministry to look into the well being of visitors. Tours and travel agencies in the city provide tourism services ranging from accommodation to guide and sight-seeing. Delhi tourism department has set up help desk services for foreign tourists who can find all necessary information about the city.
With the opening up of the economy and advancements in Medical Infrastructure, more and more patients from countries all over the world are flocking to India for all types of treatments including IVF (invitro fertilization). They have many advantages coming here for their treatments vis a vis other countries. The Doctors in India are among the best all over the world as the entire medical profession; from teaching in Medical Colleges to professionally practicing Doctors come under the gambit of the Medical Council of India which ensures quality in education and practice. Second is the cost of treatment, which is much less compared to treatments anywhere else in the world. Third is the cutting edge technology available in the hospitals here. Fourth is the ease of communication as English is the chief means of communication in New Delhi. Other languages spoken are Hindi , Urdu, Punjabi and Bangla. Translators of all main languages of the world are easily available. Lastly, patients who want to exercise the option of egg donation IVF cycle or surrogacy in IVF during their treatment in Delhi can find healthy donors and surrogates too.
It is no surprise that we have patients coming in from USA, Europe, Australia, South East Asia and the middle East coming here to get IVF (invitro fertilization) done, with good success rates and ease of cost.
Delhi has an area of 1,483 sq km and is situated at Latitudinal parallel: 28.3oN and Longitudinal meridian: 77.13oE. It is 293 m above sea level and has a population of 13.85million (Census 2001). The temperatures vary from 45oC (Max) - usually in May – Jun to 5oC (Min) -usually in Dec – Jan. People of Delhi embrace a modern lifestyle. Delhi has always been a Cosmopolitan city where one would find people from all parts of India. Overall, Delhi is a very multi-linguist and multi-cultured society which has now opened itself to embracing every new custom and tradition.
With more and more tourists coming to Delhi, the government has a special ministry to look into the well being of visitors. Tours and travel agencies in the city provide tourism services ranging from accommodation to guide and sight-seeing. Delhi tourism department has set up help desk services for foreign tourists who can find all necessary information about the city.
With the opening up of the economy and advancements in Medical Infrastructure, more and more patients from countries all over the world are flocking to India for all types of treatments including IVF (invitro fertilization). They have many advantages coming here for their treatments vis a vis other countries. The Doctors in India are among the best all over the world as the entire medical profession; from teaching in Medical Colleges to professionally practicing Doctors come under the gambit of the Medical Council of India which ensures quality in education and practice. Second is the cost of treatment, which is much less compared to treatments anywhere else in the world. Third is the cutting edge technology available in the hospitals here. Fourth is the ease of communication as English is the chief means of communication in New Delhi. Other languages spoken are Hindi , Urdu, Punjabi and Bangla. Translators of all main languages of the world are easily available. Lastly, patients who want to exercise the option of egg donation IVF cycle or surrogacy in IVF during their treatment in Delhi can find healthy donors and surrogates too.
It is no surprise that we have patients coming in from USA, Europe, Australia, South East Asia and the middle East coming here to get IVF (invitro fertilization) done, with good success rates and ease of cost.
Can a wrong diet lead to Infertility?
Women with a high intake of trans fatty acids instead of carbohydrates or unsaturated fats have an increased risk for ovulatory infertility, according to the results of a study reported in the January issue of The American Journal of Clinical Nutrition.
Most people do know about the existence of saturated and unsaturated fats but are unaware of the dangers posted by transfats. Transunsaturated fatty acids, (full form of Transfats), which were previously implicated and known to be notorious for increasing the risk for causing heart diseases and Type 2 diabetes mellitus and even a few cancers have now been found to cause infertility in women. During research, it was found that women who were unable to conceive had excess intake of transfats in their diets. Transfats when assimilated in the body caused ovulation defects, which were making these women infertile apart from many other causes.
Trans fat is found in numerous foods - commercially packaged goods, commercially fried food such as pizzas, french fries and chicken nuggets, margarine, commercial baked goods like donuts, cookies and crackers. Even simple foods like Popcorn do contain some amount of these Transfats. Any packaged goods that contain "partially-hydrogenated vegetable oils", "hydrogenated vegetable oils" or "shortening" most likely contain Trans fat. A lot of food products do list the content of transfat in the composition of the food. For those labels not listing the amount of trans fatty acids in countries where trans-fat labeling law does not exist, here is how you can figure it out on your own: add up the values for saturated, polyunsaturated and monounsaturated fats. If the number is less than the "Total fats" shown on the label, the unaccounted is transfat.
Trans fatty acids are manufactured fats created during a process called hydrogenation, which is aimed at stabilizing polyunsaturated oils to prevent them from becoming rancid and to keep them solid at room temperature. Jorge E. Chavarro, MD, of the Harvard School of Public Health in Boston, Massachusetts, and colleagues decided to test the hypotheses that trans unsaturated fatty acids (TFAs) increase the risk of ovulatory infertility whereas polyunsaturated fatty acids (PUFAs) reduce this risk. Infertility, defined as the inability to conceive after 12 months of unprotected intercourse, affects 10% to 15% of couples
The investigators prospectively followed up a cohort of 18,555 married women without a history of infertility who attempted to conceive or who became pregnant between 1991 and 1999. During follow-up, diet was evaluated twice with a food-frequency questionnaire.
There were 438 incidents of ovulatory infertility reported during follow-up. Trans unsaturated fats may increase the risk of ovulatory infertility when consumed instead of carbohydrates or unsaturated fats commonly found in nonhydrogenated vegetable oils.
It is advisable that during infertility treatment patients apart from taking Medicine and other precautions they should avoid as far as possible foods containing these Transfats
Women with high risk of Type -2 Diabetes and heart disease should also cut down on these Transfats .
Most people do know about the existence of saturated and unsaturated fats but are unaware of the dangers posted by transfats. Transunsaturated fatty acids, (full form of Transfats), which were previously implicated and known to be notorious for increasing the risk for causing heart diseases and Type 2 diabetes mellitus and even a few cancers have now been found to cause infertility in women. During research, it was found that women who were unable to conceive had excess intake of transfats in their diets. Transfats when assimilated in the body caused ovulation defects, which were making these women infertile apart from many other causes.
Trans fat is found in numerous foods - commercially packaged goods, commercially fried food such as pizzas, french fries and chicken nuggets, margarine, commercial baked goods like donuts, cookies and crackers. Even simple foods like Popcorn do contain some amount of these Transfats. Any packaged goods that contain "partially-hydrogenated vegetable oils", "hydrogenated vegetable oils" or "shortening" most likely contain Trans fat. A lot of food products do list the content of transfat in the composition of the food. For those labels not listing the amount of trans fatty acids in countries where trans-fat labeling law does not exist, here is how you can figure it out on your own: add up the values for saturated, polyunsaturated and monounsaturated fats. If the number is less than the "Total fats" shown on the label, the unaccounted is transfat.
Trans fatty acids are manufactured fats created during a process called hydrogenation, which is aimed at stabilizing polyunsaturated oils to prevent them from becoming rancid and to keep them solid at room temperature. Jorge E. Chavarro, MD, of the Harvard School of Public Health in Boston, Massachusetts, and colleagues decided to test the hypotheses that trans unsaturated fatty acids (TFAs) increase the risk of ovulatory infertility whereas polyunsaturated fatty acids (PUFAs) reduce this risk. Infertility, defined as the inability to conceive after 12 months of unprotected intercourse, affects 10% to 15% of couples
The investigators prospectively followed up a cohort of 18,555 married women without a history of infertility who attempted to conceive or who became pregnant between 1991 and 1999. During follow-up, diet was evaluated twice with a food-frequency questionnaire.
There were 438 incidents of ovulatory infertility reported during follow-up. Trans unsaturated fats may increase the risk of ovulatory infertility when consumed instead of carbohydrates or unsaturated fats commonly found in nonhydrogenated vegetable oils.
It is advisable that during infertility treatment patients apart from taking Medicine and other precautions they should avoid as far as possible foods containing these Transfats
Women with high risk of Type -2 Diabetes and heart disease should also cut down on these Transfats .
Age and IVF(Invitro fertilisation)
What is the relation between my age and my chances of getting pregnant using IVF (Invitro fertilisation)?
Most fertility patients are aware of the term "biological clock". Women are born with all their eggs and with each month passing, some of these eggs are used up. A woman’s reproductive potential declines, especially as she approaches her fourth decade of life. The total eggs that are left in a woman’s body is called her “ovarian reserve”.Because women in our society are marrying later, and consequently attempting pregnancy later in life, evaluation of ovarian reserve is critical to understanding a patient’s reproductive potential. Unfortunately, there is no perfect test and it is difficult to answer with certainty the question that is often asked by anxious patients. How much time do my ovaries have left? And; How long can I wait to have a baby?
Can I get pregnant using IVF(Invitro fertilisation) even if I am in my forties?
A little assistance is needed if you are in your fourth decade of life but definitely, a pregnancy can happen. The assistance might be in the form of IUI(Intrauterine Insemination) or IVF (Invitro fertilisation)/ICSI (Intracytoplasmic Sperm Injection).How to get pregnant using IVF (IN vitro fertilisation)if I have gone through menopause?
If you are postmenopausal, it means that you have finished with your supply of eggs. However with an IVF cycle with egg (ova) donation, you can borrow an egg from a young donor, get it fertilized with the sperm of your husband and then the embryo transfer is done to your uterus. You then carry the pregnancy to term in your own uterus. This is what is called egg donation or Donor Egg IVF (Invitro fertilisation)What infertility tests will tell me how good are my chances of getting pregnant with IVF (Invitro fertilisation)at my age?
The infertility tests to determine your fertility potential are called tests of Ovarian reserve.Follicle Stimulating Hormone (FSH). This is a blood test that measures the negative feedback from the ovary to the pituitary gland, which makes follicle stimulating hormone. It is done preferably on the third day of your periods (the first day being the day the periods began). FSH is the hormone that causes follicular recruitment and development in the ovary.
As ovarian function declines, and premenopause approaches, the negative feedback to the pituitary is decreased and the FSH level rises as the pituitary tries to drive the ovary harder. Commonly accepted values for a reassuring day 3 FSH value are less than 10 iu/ml. A slightly higher level may be compatible with development of an ongoing pregnancy with the use of appropriate therapy.
Unfortunately, this test is not a perfect predictor of reproductive potential because it is only one measurement in one cycle, and because ovarian function varies from cycle to cycle. Some cycles provide more fertility potential than others, especially in premenopausal patients. Sometimes it is possible to successfully treat a patient who has had a previously high FSH in a cycle that is more optimal by using hormonal medications to reduce the basal FSH level and then administering fertility medications.
These patients may become pregnant, especially if other markers of ovarian reserve are normal. In summary, one elevated FSH level on day 3 is not necessarily a steadfast indicator of an impossible case but should be interpreted in the light of further testing. IVF (In vitro fertilisation)treatment should be started immediately if ovarian reserve is diminished as the ovarian function declines with age.
Inhibin B- Inhibin B is a specific hormone secreted by the ovarian follicle and is the most specific marker assessing ovarian reserve. The test appears to be more reliable than just a day 3 FSH blood test and is more consistent from cycle to cycle offering a more reliable evaluation of the true state of ovarian reserve. It is a marker of how the ovaries will respond to fertility drugs. The mean value at 95% confidence limits for day 3 inhibin evaluations is 33-45 pg/ml in normally fertile women. Since inhibin is a messenger hormone secreted by a healthy ovary to influence the pituitary gland, a low inhibin less than 30 pg/ml is a bad prognosticator of future reproductive potential. But a normal inhibin, even in the face of a slightly elevated day 3 FSH, can be encouraging and compatible with the initiation of a successful ongoing pregnancy.
Anti Mullerian hormone(AMH) is another new accurate marker of ovarian reserve. The advantage with AMH is that it can be done anytime during the women’s cycle and gives very good prediction of the number of eggs we can expect to harvest during the IVF (invitro fertilisation) procedure.
The Clomiphene Challenge test provides an additional measurement of ovarian reserve. The principle of the test is to measure the basal FSH and estradiol levels on day three of the patient’s cycle. In order to evaluate the ovarian response to fertility drugs, 100 mg of Clomid is administered between days 5-9 of the cycle. The ovarian response on day 10 is further evaluated by checking the response to Clomid and measuring the FSH and estradiol. The test is abnormal if the day 3 or day 10 FSH is elevated above 10 iu/ml.
Stimulating the ovary with gonadotropins to see how they respond. An ovulation study is done and the number of eggs produced in response to the gonadotropins is evaluated. This is the ultimate test of ovarian reserve.
Patients with good ovarian reserves can expect a good response during their IVF (invitro fertilisation) procedure. Patients with poor ovarian reserves due to advanced age or premature ovarian failure should not become despondent but should go in for Egg Donation IVF cycles .
Can a wrong diet lead to Infertility?
Women with a high intake of trans fatty acids instead of carbohydrates or unsaturated fats have an increased risk for ovulatory infertility, according to the results of a study reported in the January issue of The American Journal of Clinical Nutrition.
Most people do know about the existence of saturated and unsaturated fats but are unaware of the dangers posted by transfats. Transunsaturated fatty acids, (full form of Transfats), which were previously implicated and known to be notorious for increasing the risk for causing heart diseases and Type 2 diabetes mellitus and even a few cancers have now been found to cause infertility in women. During research, it was found that women who were unable to conceive had excess intake of transfats in their diets. Transfats when assimilated in the body caused ovulation defects, which were making these women infertile apart from many other causes.
Trans fat is found in numerous foods - commercially packaged goods, commercially fried food such as pizzas, french fries and chicken nuggets, margarine, commercial baked goods like donuts, cookies and crackers. Even simple foods like Popcorn do contain some amount of these Transfats. Any packaged goods that contain "partially-hydrogenated vegetable oils", "hydrogenated vegetable oils" or "shortening" most likely contain Trans fat. A lot of food products do list the content of transfat in the composition of the food. For those labels not listing the amount of trans fatty acids in countries where trans-fat labeling law does not exist, here is how you can figure it out on your own: add up the values for saturated, polyunsaturated and monounsaturated fats. If the number is less than the "Total fats" shown on the label, the unaccounted is transfat.
Trans fatty acids are manufactured fats created during a process called hydrogenation, which is aimed at stabilizing polyunsaturated oils to prevent them from becoming rancid and to keep them solid at room temperature. Jorge E. Chavarro, MD, of the Harvard School of Public Health in Boston, Massachusetts, and colleagues decided to test the hypotheses that trans unsaturated fatty acids (TFAs) increase the risk of ovulatory infertility whereas polyunsaturated fatty acids (PUFAs) reduce this risk. Infertility, defined as the inability to conceive after 12 months of unprotected intercourse, affects 10% to 15% of couples
The investigators prospectively followed up a cohort of 18,555 married women without a history of infertility who attempted to conceive or who became pregnant between 1991 and 1999. During follow-up, diet was evaluated twice with a food-frequency questionnaire.
There were 438 incidents of ovulatory infertility reported during follow-up. Trans unsaturated fats may increase the risk of ovulatory infertility when consumed instead of carbohydrates or unsaturated fats commonly found in nonhydrogenated vegetable oils.
It is advisable that during infertility treatment patients apart from taking Medicine and other precautions they should avoid as far as possible foods containing these Transfats
Women with high risk of Type -2 Diabetes and heart disease should also cut down on these Transfats .
Most people do know about the existence of saturated and unsaturated fats but are unaware of the dangers posted by transfats. Transunsaturated fatty acids, (full form of Transfats), which were previously implicated and known to be notorious for increasing the risk for causing heart diseases and Type 2 diabetes mellitus and even a few cancers have now been found to cause infertility in women. During research, it was found that women who were unable to conceive had excess intake of transfats in their diets. Transfats when assimilated in the body caused ovulation defects, which were making these women infertile apart from many other causes.
Trans fat is found in numerous foods - commercially packaged goods, commercially fried food such as pizzas, french fries and chicken nuggets, margarine, commercial baked goods like donuts, cookies and crackers. Even simple foods like Popcorn do contain some amount of these Transfats. Any packaged goods that contain "partially-hydrogenated vegetable oils", "hydrogenated vegetable oils" or "shortening" most likely contain Trans fat. A lot of food products do list the content of transfat in the composition of the food. For those labels not listing the amount of trans fatty acids in countries where trans-fat labeling law does not exist, here is how you can figure it out on your own: add up the values for saturated, polyunsaturated and monounsaturated fats. If the number is less than the "Total fats" shown on the label, the unaccounted is transfat.
Trans fatty acids are manufactured fats created during a process called hydrogenation, which is aimed at stabilizing polyunsaturated oils to prevent them from becoming rancid and to keep them solid at room temperature. Jorge E. Chavarro, MD, of the Harvard School of Public Health in Boston, Massachusetts, and colleagues decided to test the hypotheses that trans unsaturated fatty acids (TFAs) increase the risk of ovulatory infertility whereas polyunsaturated fatty acids (PUFAs) reduce this risk. Infertility, defined as the inability to conceive after 12 months of unprotected intercourse, affects 10% to 15% of couples
The investigators prospectively followed up a cohort of 18,555 married women without a history of infertility who attempted to conceive or who became pregnant between 1991 and 1999. During follow-up, diet was evaluated twice with a food-frequency questionnaire.
There were 438 incidents of ovulatory infertility reported during follow-up. Trans unsaturated fats may increase the risk of ovulatory infertility when consumed instead of carbohydrates or unsaturated fats commonly found in nonhydrogenated vegetable oils.
It is advisable that during infertility treatment patients apart from taking Medicine and other precautions they should avoid as far as possible foods containing these Transfats
Women with high risk of Type -2 Diabetes and heart disease should also cut down on these Transfats .
Thursday, 11 August 2011
Thursday, 14 July 2011
Polycystic Ovaries and Infertility
Dr. Richa has been my doctor for about 5-6 years now and I was a regular patient at her clinic. I had been suffering from Polycystic ovaries since puberty and i have never had a respite from the effects of this disorder. My periods have always been erratic, irregular accompanied by heavy bleeding . I Came to Dr. Richa for my regular treatment as I wanted to conceive. She has always been very confident about the way she carried herself at her job and also the knowledge she has about infertility treatments. Something in me made me feel she is gonna cure me and I am going to get pregnant. Inspite of never having had my periods on time, I conceived using Dr.Richa's Treatment of Hormonal injections and medicines and Now i am a proud mother of a 2 year old baby. Thanks a ton to dr. Richa for making my impossible dream come true. I can still visualise the sight of holding my baby in my arms for the first time in the operation theatre. I will always be grateful to her. Believe me, PCOD is no longer a thing of fear or panic as I know its possible to become pregnant and have a normal life even after one has this disorder.
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