Sunday, 30 June 2013

The most challenging uterine problems that cause miscarriages!

The most challenging uterine problems that cause miscarriages!

Treating infertility and trying to achieve pregnancy is like balancing on a rope where the smallest jerk can cause the fall. There are sleepless nights for me and my team members as the infertility experts along with the couple that is striving hard to conceive. There are so many uncertainties during the journey and a few of them are absolutely unexpected.

When I start the infertility treatment to the couple and establish a rapport in the subsequent months there is an emotional bond gets developed unknowingly. Every unsuccessful attempt leaves a dent behind. A miscarriage is the gloomiest moment especially it comes in the second trimester when the things start getting settled.

Types of uterine problems

Among various causes of miscarriages, uterine problems are the biggest challenge because some of them are the biggest risk factor. There is a wide variety of uterine problems that come across during the journey of a successful pregnancy causing a standstill to the process. While all uterine problems cause miscarriages, a few bring the toughest challenge in front of me as an infertility expert!

a) Septate uterus: In a few females, there is a band of tissues in the uterus with no blood supply. This band practically divides the uterus in two parts and if the female gets a fertilized egg implanted on the septum, there is very likely miscarriage would happen. This is a problem by birth of the female and surgical procedure is required to correct it.

b) Unicorn shaped uterus: In a few females, the shape of uterus is like a horn. It is surely a by birth malformation in the mother where one side of the uterus does not get developed properly. This type of uterus has very high probability of preterm delivery, ectopic pregnancies and miscarriages.

c) Cervical insufficiency: Although it can’t be termed exactly a uterine problem, still we classify it in the same category due to the inter-relationship of the cervix and the uterus. In some women, the cervix gets dilated in the second trimester. It is more traumatic problem because it happens in the advanced stage of pregnancy when my patient and I both get little bit relieved about the pregnancy. Unfortunately it is a congenital problem and not much can be done to correct it. However, measures like complete rest and closure of the cervical opening with a surgical process can sustain the pregnancy.

d) Fibroids: Uterine fibroids are the toughest challenge for me and it requires great degree of patience and determination for both me and my patient to get rid of it completely. They get developed during childhood and there is no known cause behind it. I counsel the couple regarding the long-term treatment and persistent efforts. However, there are many successful pregnancies have been achieved so far with fibroid cases.

Undoubtedly it is a further complicated story of infertility when I discover uterine problems. I need to spend tremendous amount of energy in keeping the morale levels high for the patients and it is the biggest triumph to see a baby delivered after a successful pregnancy of a female with uterine problems.

Thursday, 27 June 2013

Ovulation Induction, the master process!

Out of the couples that come to me for a treatment of infertility, a large number of them are facing ovulation related problems. They come to me with a great hope and I also do not leave any chance to make the treatment successful. Needless to say it is a long journey with many ups and downs. There are smooth highways and rocky terrains and the couple has to completely cooperate and dedicate in the treatment. It will surely take a little bit time for my team and me to narrow down the exact cause of the problem, but the things become pretty under control when I know it. I can articulate the problem and the subsequent course of action to the patients.

When do I use Ovulation Induction (OI)?

Since ovulation is one of the most critical activities in the process of conception, very obviously we need to monitor it closely. Irregular ovulation can be a root cause for infertility problem and by using Ovulation Induction method, commonly known as OI we can regulate it or increase the number of eggs in one ovulation cycle.

Females have abnormal ovulation, irregular ovulation or absence of ovulation because of imbalance of the delicate hormones in the body of the female partner. Therefore, OI treatment has an integral part of balancing these hormones in the right proportion and in the right timing in order to achieve healthy and properly developed eggs.

Step by step process

My methodology of treating infertile couple is very different. First of all, I never let them feel any kind of negativity during the treatment period. It is actually very important because negative thinking and pessimistic viewpoint can actually affect the hormone secretion adversely. My team members and I keep the environment vibrant and pleasant and it certainly helps. The process of OI is a multi-step process and each step is extremely important.

A.I need to check the hormonal level before starting the treatment in order to arrive at the baseline data. Theoretically it is the starting point of the journey. After this point, these levels are monitored by checking blood samples after every milestone.

B.I prescribe special medicines that stimulate the hormonal secretion. The medicines can be in the form of oral medicines or injections. The frequency and power of the drug will depend on individual case. Typically clomiphone citrate and gonadotropins are used.

C.My team monitors the levels of hormones and the development of follicles during the whole process. When the size of follicles increases significantly, we prepare for the next major milestone, the actual conception. Typically estrogen is the hormone that is measured during the process.

The most critical part gets over with the ovulation induction process. However, it is not the end of the story, rather it is a beginning. After this, the couple can go for any method of conception right from the natural intercourse to surrogate baby. The option chosen by the couple will depend on the physical condition that is causing infertility. The process of OI demands tremendous concentration and hard work. Female ovulation process is extremely delicate and complicated and any slippage would not yield desired result!

Thursday, 20 June 2013

It is always better to be an early bird for infertility treatment!

It is always better to be an early bird for infertility treatment!

I could feel the disturbing silence in my consulting room after declaring the diagnosis of infertility for a couple sitting right in front of me. Both were representing the classic DINK (Double Income No Kids) community of the modern world where kids are the last priority over promotions and career growth. Remind you, I am not a typical oldie who is unhappy with everything that happens in the modern world, but there are certain things that certainly upset me!

The most common face of infertility that I witness almost daily in my consulting room is almost the same. A couple with reasonably fit body, excellent personality and still unable to conceive! While there are many cases where reasons of infertility are known, a major chuck was contributed by the cases of unexplained infertility. Delay in detecting infertility makes the life measurable for my patients and it is equally tiresome for me too!

Importance of detecting infertility early

Detection and diagnosis of infertility in the early age, therefore, becomes extremely important. It gives immense relief to infertility experts like me because I get sufficient time to treat the root cause. Let’s understand it by an example. A couple that got married when the female was 27 and the male was approaching or just crossed 30. They delay the pregnancy for at least two to three years because of career pressures. By the time they decide to go the family way and start trying for that the age of female has crossed the crucial figure of 30.

The situation becomes worse when they sit in the consulting chair of my room after trying two years desperately for conception. I diagnose the case thoroughly and after a few tests give them the shocking news of infertility!
It is a fact that there is never “too late” in the treatment of infertility and I have seen the cases of conception in the late forties as well. However, exceptions can’t be a rule and therefore I always recommend that it is very vital to detect infertility early.

What are the benefits?

It is a fact that the vitality and rigor of our body gets decreased with the increasing age. Also, there are physiological changes with the higher age that lowers the chances of success in a few procedures of infertility treatment.

Ovulation abnormalities: Secretion of Progesterone and Estrogen decreases with old age and therefore it is difficult to deal with ovulation abnormalities that cause infertility.

Inadequate quantity and inferior quality of sperm: Healthy and strong sperms are vital for pregnancy. Male sperm count gets decreased with age and thereby reduces the chances of conception.

Chase against time: Getting diagnosed infertility earlier gives a sigh of relief because you have much longer time to struggle. Getting diagnosed with it in the thirties put tremendous pressure on the coupe and instead of going with an enthusiastic manner; they go under pressure of getting the success as early as possible.
Age plays a vital role in the whole process and therefore couples should come to infertility expert as early as possible to get sure success!

Wednesday, 19 June 2013

Bollywood: Khans for surrogacy

Surrogacy is the new buzzword thanks to Bollywood’s biggest Khans opting for it. Back in 2011, actor Aamir Khan and wife Kiran Rao had a child through a surrogate mother, and now Shah Rukh Khan is reportedly set to follow in their shoes, albeit there’s no confirmation from him. This, say experts,
marks the coming of age of the phenomenon in India, with both the screen idols boosting the trend among the public, too.

Dr Rita Bakshi, infertility specialist, International Fertility Centre, has got 15 In-vitro fertilisation surrogacy queries since reports of Shah Rukh and wife Gauri planning their third child went public. “Several couples who were confused about if they should opt for the procedure, have decided to go in for it. Celebs are role models and it immensely helps in shedding a lot of inhibitions. The actors have done a great service to childless couples by helping bring the procedure in limelight,” says Bakshi.

“I am already receiving a large number of IVF surrogacy related queries, and I expect a further spurt,” says Dr Anubha Singh, infertility expert, Artemis Health Institute. Bakshi, however, says SRK and Gauri have no reason to keep mum about the procedure. “They would be doing a greater service if they talk about it openly. Aamir Khan kept talking about surrogacy openly and had thus emboldened many to opt for the procedure,” she says.  While Shah Rukh remained unavailable for comment, a source said, “They are not talking about it since there are false rumours that the couple got the baby’s sex determined, which is not true.”

Experts say...
There are a lot of stigmas related to surrogacy in India. When a celeb couple opts for a surrogate child, it helps a lot to shed myths
Dr Anubha Singh, infertility expert

I wish Shah Rukh Khan chooses to speak openly about it. He will help surrogate mothers gain respect in the society and light up the lives of childless couples
Dr Shobha Gupta, IVF expert

Monday, 17 June 2013

Is “high-risk obstetrician“just another fad?

There are so many occasions where I am invited by my patients when they celebrate the arrival of the long awaited baby after a hard time of treatment. They feel proud to become parents and want me to share their joy. I was desperately waiting for the party to conclude because there was nobody known to me except the host. I overheard a conversation where one lady was proudly announcing about the high-risk obstetrician she would be visiting in the subsequent months. I was little bit amazed with the way she was uttering the words like “high-risk obstetrician” as if she is an expert of the subject. This was not the first time I heard this jargon and it seems there is a craze to visit high-risk obstetrician after getting pregnant!
What is it exactly?
Well, it is in fact a specialized branch of gynecologists also known as perinatologists or MFM Maternal Fetal Medicine) expert. They are highly expert and able to deep dive in the problems of pregnancy and childbirth. They are typically more proficient in:

 Sophisticated ultrasound techniques and special procedures like the tests of amniotic fluid, etc.
Understanding the probable problems that can be caused at the time of childbirth
They have great exposure of high-risk nurseries and have a phenomenal capability of handling premature and extremely sick babies
They are equipped to handle cases with complex medical history and complications
When a “high-risk obstetrician” is really required?

Although the female was boasting a lot about the “high-risk obstetrician” she was planning to consult, actually there are very typical scenarios when you actually need it. Normal gynecologists are capable enough to handle the normal and complex problems of pregnancy. Infertility experts like us are even more capable of doing it since we treat the infertility problem that has more complex facets.

In case of normal pregnancies, there are a few situations when you really need an expert that can help you in case of an unforeseen event.

Multiple complexities during the pregnancy: There are cases when females are suffering from multiple complex situations like fibroids, thyroid problems and history of repetitive miscarriages and so on.
Triplet pregnancies: They are extremely critical to handle and therefore require very special care. There may be cases with further complexities like obesity or diabetes where utmost care and absolute close surveillance is required. Sometimes there is a need of selective reduction in order to deliver healthy babies, and then it is the situation that can be handled by a “high-risk obstetrician” only.
Late age pregnancies: There are cases of late age pregnancies, typically in case of infertility issues where the prolonged treatment increases the age drastically. There are many problems associated with the late age pregnancies and therefore, always need an extra effort to look after the situation.
“High-risk obstetrician” is a specialized person that should be called only when it is really required. People consider it as a status symbol and unnecessarily go for it when it is not needed.

Sunday, 16 June 2013

Motor disorders: The latest discovery would change the scenario

Motor disorders: The latest discovery would change the scenario

When infertility experts like me treat patients with infertility problems, the complete focus is towards achieving a successful pregnancy. The couple is also obviously eager to enjoy the parenthood. Naturally the facets of genetic disorders get ignored in the whole process and they get surfaced only when the parents see abnormality in the development of the baby. Although we work hard to diagnose them at the time of treatment, but there are still many unknown factors about genetic disease.

Genetic issues are responsible for multiple problems and the motor disorders top the list. They appear like an insurmountable obstacle and ill-fated baby and parents both become the victims of it. The first signs of motor disorders come out with the exceptionally delayed motor milestones like sitting, crawling and walking. Poor response to the motor stimulants and symptoms like dropping the things and clumsiness become a cause of worry for the parents. These defects not only make the normal life miserable, but it is equally painful for the baby as well. The problem does not remain restricted to the motor activities, but affects the overall underdevelopment of the child. It worsens if there is mental retardation also discovered.

I always keep on searching for the latest developments and research in the field of genetic diseases. The recent breakthrough would certainly floor way in the methods of treatment of children deprived of the basic development due to motor disorders. A team of doctors has successfully identified the root cause of motor disorders. According to them, there has been a mutation in a particular gene known as DARS that causes serious motor disorders like Spasticity and Spinal cord disorders that restrict the movement and development. The recent discovery is surely a great milestone because there have been great efforts to conquer this gigantic challenge.

The technique used to analyze the fundamental cause is known as genome sequencing and it helped a lot in discovering the real problem. The team added that the gene was never suspected earlier and the real cause would have been remained hidden without this study. The genetic disorders are transferred from the parents and therefore, genomes of the parents and babies are required to be checked for the research of genetic problems.

I see the recent finding as a light at the end of the tunnel and it would surely able to distinguish and diagnose the motor problems so that there are no more disabled babies!

Tuesday, 4 June 2013

Zygote Intrafallopian Transfer (ZIFT)

  Zygote Intrafallopian Transfer (ZIFT): An effective solution for infertility
As an infertility expert I always feel that the couple face a really tough time when they struggle with the infertility problems. There are multiple reasons of it, and identifying the exact one is like searching a needle from the pile of husk. Thankfully, there are latest techniques available that help us determine the most likely cause and suggest the best treatment methodology. It enhances the chances of success. ART or Assisted reproductive technology is a very effective method to treat infertility problems. This method involves external assistance to the natural fertilization process and thus it increases the chances of pregnancy. The success rate is much higher and couples are blessed with the most important gift of the life.

ART is a broad term and there are two very effective methods come under this category. The first is known as GIFT (Gamete Intrafallopian Transfer) or GIFT and the full form of ZIFT is Zygote Intrafallopian Transfer or ZIFT. ZIFT is very effective in treating various types of male and female infertility issues and it has been recognized as one of the most successful methods. I use both techniques to cure infertility problems and it depends on the individual case.

ZIFT is a technique when the eggs are fertilized with the male partner’s sperms in the laboratory. We insert these fertilized eggs 0directly in the fallopian tube by a laparoscopic surgical process. Fertilized eggs traverse through the fallopian tube as their normal journey and reach to the uterus. Meanwhile the uterus is prepared by us to welcome the pregnancy. There are special hormones given to the mother so that environment gets ready before the conception happened. As soon as the fertilized egg reaches to the uterus and gets implanted, the pregnancy becomes successful.

ZIFT: The procedure in detail