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18/Feb/2016

Imagine this scenario. A young couple in their late 20’s early 30’s enters the consulting room of a gynaecologist. The women is having some vaginal infection and needs a gynaecological opinion. The gynaecologist examines and gives appropriate treatment. The couple thank the doctor and before leaving the room the women asks “doctor May I ask you one more question” “sure” says the doctor. “We are both 29 yrs old and have just married a few months back, how much time can we wait more before having a baby. You see we are still financially not settled and would like to wait couple of more years but the family is insisting on having a baby. What is your opinion? ” Well this is the story of modern India. Better education opportunities, women empowerment, rising costs and high standard of living are leading to late age at marriage and prolonged career goals. Couples now want to be independent, well settled financially before they have a baby. All this perfectly make sense and therefore we find more and more women having their first child in their late 20’s and early 30’s. But unfortunately God had planned it some other way. A women’s maximum fertility potential (Ability to conceive) as per Gods planning is between 18-28 years of age. Thereafter it starts falling and beyond 35 years there is a drastic reduction in fertility potential. It has to be remembered here that this is a general rule. Some women may easily conceive even at 40 and some women have difficulty even at 22. One has to understand that before planning or postponing planning there are few factors which may be taken into account- some scientific and some practical. So this is the checklist for all those couples planning to postpone the pregnancy by a few years:

  • Age of the women: As already mentioned a women’s fertility potential is at its peak between 18-28 years and it’s always better to have a baby before the age of 30. So yes if you are 30 and planning to postpone your pregnancy, give it another thought. Career and life goals can wait. Please prioritize your ambitions.
  • Menstrual pattern: If you have any irregularity in your menstrual pattern, consult your gynaecologist and rule out PCOS (polycystic ovarian disease). 30% of women with subfertility have PCOS. Alternatively irregular menses could be due to POF (premature ovarian failure). In both cases women have a tendency to form cysts in their ovaries. Both these together are the leading cause of infertility. So beware of irregular menses.
  • Infections: If the women has a prior history of tuberculosis whether it be of lung or intestines, there is a fair chance that the bacteria may have spread to the uterus or fallopian tubes. Genital tuberculosis may lead to infertility by either causing blockage of tubes or damaging the uterine lining or the endometrium. Even repeated pelvic pain and recurrent vaginal infections may point to something we call as PID(pelvic inflammatory disease) and lead to fallopian tubal block and infertility. 10-15% of women with subfertility have tubal factors as a cause.
  • Uterine fibroid or polyps: These are benign tumors of the uterus that may lead to difficulty in conceiving. They may be completely incidental findings or may be associated with symptoms like heavy bleeding. If one is planning to postpone a pregnancy it is prudent to do a usg pelvis to rule out these. One has to remember that even if an usg is normal there are still chances of developing these tumors later. Also these tumors once removed have a tendency to recur. The treatment will however differ depending upon their size and location. Its best to sit across your gynaecologist and discuss the options.
  • Surgical history: If a women has undergone any gastrointestinal (Appendix, bowel etc) surgeries in the past there are chances of adhesions in pelvis which may lead to subfertility.

Also surgeries in male partner – like inguinal (groin) hernias, hydrocele or varicocoele surgery, any testicular trauma (while playing football,cricket) may lead to fault with the sperm count and motility. Therefore if either of the partner has a significant surgical history, think twice before delaying pregnancy.

  • Medical History: If either of the partner is suffering from medical disorders like high BP, thyroid disorders, diabetes or epilepsy, then it’s better to get the particular disease well controlled with medications before you conceive. It has to be remembered that some diseases may get flared up or may require higher dosage of medications during pregnancy so continuous monitoring is essential.

Also medications that are not safe during pregnancy could be converted to pregnancy safe medications way before planning the pregnancy. These are some essential points that should be considered before planning.

  • Genetic predisposition: If one has a family history of genetically abnormal child (commonly downs or mongoloid child) or a history of infertility or multiple abortions in family its better to start planning early as there may be an abnormal gene running in one’s family. Even if detected there is seldom a cure available for genetic abnormalities. And as age of a women progresses the risk of genetic abnormal child is more.
  • Smoking and tobacco consumption: All of us are aware that smoking and tobacco increase the risk of cancer. But what most of us are unaware is that these have detrimental effect on the gametes (ovum and sperm). Tobacco not only is responsible for the death of gametes but also causes defective gene formation. Also it leads to miscarriage, low birth weight babies, preterm or early delivery.

Now a days in addition to young men we find lots of young women who are smokers. Smoking may cause irreversible damage to the gametes. Stopping tobacco may not reverse the effect but stop the damage immediately.

  • Obesity: This is a major problem in cities. Easy availability of junk food in addition to hectic work schedules has led to irregular and faulty eating habits. On top of that no one has the time and motivation to exercise. 10 years back this was a problem in young adults and now we find obese teenagers and kids.

It is well known that obesity leads to suppression of reproductive function in both men and women. Also the rate of miscarriage and preterm delivery are also more if the pregnant women is obese. Obesity may also predispose you to high BP, diabetes and heart disease at a very young age. So if you are planning a pregnancy, please start a good diet and exercise regimen. This applies not only to the women but also to the men. A healthy couple will not only produce a healthy fetus but will be able to give birth to a healthy baby and raise a healthy child. If none of the above points are relevant in your case and you want to plan a pregnancy at the later date, we would advise you to visit a gynaecologist and get some tests done. A routine examination and tests like basic hormonal profile (TSH/prolactin/CBC), an ultrasonography (USG) pelvis and Semen analysis need to be performed before taking any decision. Abnormality in any of these may need immediate attention and treatment so that it does nor worsen by the time you start planning. We advise all young couple who are planning to get married and who are just married to go through all the above points carefully and take appropriate action towards them. For some it may just be minor changes, few may require expert help from a dietician or gynaecologist or a physician. Young adults of our country are now capable of taking their own decisions, but it may occasionally be needed that one pays attention to what adults and experts advice. Taking a calculated decision will help to avoid any dejections and failure in future. Infertility clinics now a days are full of young adults wanting to have a child just because the right time was missed. Some repent there was no one to guide them while some did not pay heed to early signs and symptoms. Science has advanced so much that today we can make a 60 year old lady also pregnant, but if one takes out few years of their hectic schedules to give birth to a child, it will save you from all the mental, financial and physical stress involved in the infertility treatment. Our job as a doctor is to inform and educate you. Finally which path to choose will be the couple’s decision. Thinking wisely before making any decisions will avoid a lot of complications in your life.


24/Aug/2015

Myth 1: I should tilt my lower body upward or keep a pillow below my buttock  to help the sperm get to my egg
Fact: False! There’s absolutely no evidence that shows shifting gravity in your favor will increase your chances of getting pregnant. So after sex, just relax!

Myth 2: You should eat for two when you are pregnant
Fact:  Yes, you’re eating for two — but that doesn’t mean two adult-sized servings are necessary. The average woman with a normal weight pre-pregnancy needs only about 300 extra calories per day to promote her baby’s growth, according to the American Congress of Obstetricians and Gynecologists (ACOG). That’s roughly the number of calories in a glass of skim milk and half a sandwich. A woman of normal weight should gain 10 – 11 kgs  during pregnancy — less if she’s overweight Also, women who gain more than 15- 20 kgs  when they’re carrying just one child have a higher risk of a cesarean section or a difficult vaginal birth.

Myth 3: One must eat three healthy meals a day
 Fact :False! You should be eating six or seven small meals (every two to three hours). “Eating frequently and from various food groups will keep your blood sugar in a constant range, which is healthy for you and your baby

Myth 4 : One must avoid Hair Dyes when pregnant
Fact : Chemicals from hair dye, permanents, and relaxers are absorbed through the skin only in minimal amounts that aren’t harmful. We don’t believe there’s any fetal risk from hair dyes and such. But strong odors from hair treatment products make some pregnant women feel nauseous. So use them in a well-ventilated space with a fan. You can hold off on hair treatments until you’ve passed your first trimester if you’re really worried. You can also avoid dyes with ammonia, which has strong fumes. “Hair changes a lot during pregnancy. Products that worked well before pregnancy might not give the same results.”

Myth 5 : Caffeine Is a No-No
Fact : Do you love your morning cup of coffee? Many pregnant women do, but often they’re warned to give up caffeine because it might cause miscarriage, preterm birth, or low birth weight.
But the case against caffeine isn’t strong. “There does not appear to be any relationship between caffeine consumption and preterm birth. Also, if a pregnant woman drinks less than 200 milligrams of caffeine per day — the amount in about one 12-ounce cup of coffee — there’s no clear evidence she faces any increased risk of miscarriage or low birth weight.

Myth 6 : Flying Can Increase Your Risk of Complications
Fact: Don’t worry about the small amounts of radiation that pregnant women might encounter while passing by or through an airport X-ray machine or flying at high altitudes .We get exposed to radiation all the time from being on the ground, and certainly flying increases that a bit. But the kind of radiation you’re exposed to [during air travel] doesn’t have much penetration into the body, so it’s unlikely to ever cause fetal exposure at all.”
Nor are body scanners dangerous. It’s a very minute amount of radiation, and it’s extremely unlikely to cause any sort of fetal effects. If you’re planning to fly in your last trimester, check with your airline about any restrictions. Most airlines get a little anxious if you look like you might deliver en route.
Some pregnant women should never fly without a medical clearance first. Women who have coexisting lung or cardiac problems when they’re pregnant might find they don’t do well flying at 30,000 feet, They should ask their doctor before they get on a plane, but an otherwise normal, healthy woman should be able to fly very safely.

Myth 7: It’s a complete no no to have a drink
Fact : One glass of wine isn’t going to hurt the baby. But one glass here and there doesn’t mean nine — in fact, two or more alcoholic drinks daily can lead to fetal alcohol syndrome. So while it’s best to cut out alcohol completely, an occasional small glass of wine is harmless.

Myth 8: Skip the gym
Fact: False! Actually, low-impact workouts can be a great way to control your weight and prep for baby. Just avoid contact sports or exercises that involve lying on your back (which reduces blood flow to you brain and uterus).

MYTH 9: . All pregnant women have morning sickness
FACT: Not every woman will experience morning sickness, because every woman and their pregnancy hormone levels are individual.  The feeling of morning sickness is often caused by a rise in the female hormone estrogen during pregnancy. If the pregnant woman’s body already produced a high level of estrogen prior to her pregnancy, additional estrogen may cause morning sickness in the first trimester, or not. It all depends on the individual

MYTH 10: Eating spicy food can cause preterm labour
Fact: It is a myth that eating spicy food during pregnancy to induce labor actually works. There is no known food that can bring on labor. The exact cause of labor is unknown, but it’s believed that the fetus sends a signal which may make the uterus contract and go into labor.  Yes, some women say that as soon as they ate a spicy dish, within several hours they went into labor. Unfortunately, there are no statistics on this theory. To date there has not been any research that concludes that eating any spicy foods will start contractions.  One reason some women stand by their chili pepper theory is that spicy food is known to irritate the digestive system in most people, and might be followed by diarrhea.  Diarrhea dehydrates your body and one of the known side effects of dehydration in pregnant women is contractions.  Therefore it may seem like your SPICE did the trick, but really it was your dehydrated body that brought those contractions, and possibly labor

MYTH 11: Pregnant women who carry low have a boy, OR Increased acne during pregnancy carry a girl.
FACT: How a woman carries depends on her body type and whether she has been pregnant before, but does not reflect gender.  Women tend to carry lower or higher depending on their body type. Taller, thinner women appear to carry higher. Shorter and fuller women appear to carry lower. Neither has any correlation to gender. Also, in a second pregnancy, since abdominal muscles may be looser, the pregnancy may appear to be lower.
Pregnancy acne has nothing to do with gender; it is a result of natural hormonal changes

MYTH 12. Pregnant women shouldn’t  take warm baths.
Fact: Women are told not to take baths because HOT water — over 98 degrees — is unfavorable to the pregnancy. Taking a warm (NOT HOT!) bath with someone to help you get in and out of the bath safely can help:
•    Decrease uncomfortable swelling in arms and legs.
•    Increase the amniotic fluid.
•    Prevent premature contractions.
Help the mother relax and alleviate anxiety about the health of her baby.
This is also why swimming is such a great pregnancy exercise

MYTH 13: Pregnant women shouldn’t eat fish.
FACT:Mercury and food poisoning are significant concerns. Women are individuals and every pregnancy is unique. Small white fish have lower mercury levels because they have been living in the ocean for a shorter period of time. Get fresh fish and smell it. A woman’s sense of smell is heightened during pregnancy for a reason — the pregnant woman’s body is helping her determine what is healthy for her baby.
Moreover, fish oil contains helpful Omega 3 fats, which actually enhance the development of the baby’s brain, improve the baby’s IQ, make the baby a better sleeper after birth, prevent premature contractions and premature labor, prevent high blood pressure during pregnancy, and act as an anti-inflammatory that prevent infection. If a pregnant woman is uncomfortable eating fish, she can visit her local health food store for fish oil supplements

MYTH 14: If you watch a lunar eclipse during your pregnancy, your baby will have a cleft lip
FACT: This ancient myth has been traced back to the Aztecs. They believed that an eclipse was a bite on the face of the moon. If a mother watched it, the same thing would happen to her baby. For protection, the mom must carry something metallic, such as a safety pin, on her underwear. Although it’s a beautiful myth, the truth is that a cleft palate is caused by a blend of genetic and environmental factors that in no way include the planets.
MYTH 15: Men cannot REALLY be a part of the pregnancy.
FACT: Making your life partner into your pregnancy partner can make a big difference in how much you enjoy your pregnancy. Pregnancy can be the most wonderful opportunity to bring a couple together as a solid team. When men are given the means to assist, pregnancy can make the relationship between that man and his pregnant partner exceptionally strong — strength a couple will need when baby arrives

MYTHS ABOUT INFERTILITY AND IN VITRO FERTILISATION (IVF) PREGNANCY

Myth : Infertility is the same thing as sterility, and it’s rather rare.
Fact : Sterility is the complete inability to reproduce where as infertility is “sub-fertility,” or impaired fertility. A sterile person cannot reproduce but about 70 percent of those who seek treatment for infertility are eventually able to have a baby.

Myth : Infertility is a women’s problem
Fact : 1/3rd of cause is attributed to women, 1/3rd to men and 1/3rd to either both or unexplained. Therefore infertility is not only a woman’s problem.

Myth : Women are having babies well into their forties, so it’s probably safe to delay childbearing.
Fact : Fertility is definitely age related. Studies have suggested that on an average, female fertility declines slightly starting at age 27, but drops off in a clinically meaningful amount around age 35 and then dramatically at age 40. The ideal age for conceiving for a woman is in her twenties.

Myth : Infertility is caused by the stress. (“Just relax”)
Fact : In most cases, about 80 to 85 percent of the time, doctors diagnose a medical cause as a factor leading to infertility for which no amount of relaxation will help. In cases of unexplained infertility, often infertility is caused by rare problems that are impossible to discover through a routine checkup. Chronic stress and fatigue may alter hormones, but most cases fertility drugs are helpful in cases where hormones fall outside of normal ranges.

Myth : Doctors take huge risks with embryos in high-tech programs, making these options unethical
Fact : With the help of pro active measures taken by the patients in managing their treatment risk to the embryo can be minimized. For example, a couple can limit the number of potential embryos (i.e., the number of eggs exposed to sperm) to a number they are willing to carry to term in that cycle, and hence avoid the ethical minefield of pregnancy reduction.

Myth : The “hips up theory” is the best position for conception
Fact : Position makes no difference sperm has to reach cervical mucus within five minutes, or they are inactivated by the active PH of the vagina. Hips resting on a pillow or staying in the position at the time of ejaculation will not increase the chances of fertilization.

Myth : Egg freezing is only useful for women with medical conditions like cancer
Fact : Egg freezing is an evolving option for women under 37 years of age who are concerned about their fertility options. Egg freezing is currently still considered experimental, and should only be done as part of a research protocol.

Myth : Methods like acupuncture don’t help with infertility
Fact : Studies comparing women who have acupuncture and women who don’t, indicate it may enhance fertility. Many acupuncturists now specialize in fertility, and “our patients who have utilized acupuncture and other complementary methods may have benefited

Myth : Adoption cures infertility. (“Just adopt and you’ll get pregnant.”)
Fact : Researches have shown that out of those adoptive families who have experienced infertility, mostly approximately half have been under medical treatment for infertility on an average of three years prior to adopting. It has been estimated that between five and fourteen percent of couples who quit treatment to pursue adoption eventually conceive. This percentage is same as for couples who quit treatment and choose not to adopt & subsequently conceive. The flawed idea behind this myth is that if couples do not think about getting pregnant, it will happen for them.

Myth : IVF is considered unnatural.
Fact : IVF is the most natural way in which genetic composition of the man and the women need to form a baby. Since this process is not possible inside a woman’s body either because of tubal blockage or poor sperm count, IVF helps in bringing the egg and the sperm together outside the body.

Myth : IVF is very expensive
Fact : Most people avoid IVF expecting this to be an exorbitant process costing lakhs. However most IVF cycles including drugs costs between Rs.1 lakhs – Rs. 1.5 Lakhs.

Myth : IVF is an end of the road process
Fact : Many people shun away from IVF thinking that if this process is unsuccessful they will never be able to become pregnant. However, there are many couples who conceive naturally or with IUI even after IVF

Myth : IVF babies have malformations
Fact : The background risk for congenital malformation after natural conception is 2-3 %. With IVF it increases by 0.5 – 1 %. Majority of IVF pregnancies give rise to normal babies.

Myth : IVF is a very painful process
Fact : IVF is not as painful as many people think it to be. Apart from the inconvenience and discomfort of multiple injections (between 1-2 per day for 10-14 days). There is no other painful procedure involved. Egg collection which can be a painful process is done under Anesthesia so that the patient feels no pain. Embryo Transfer is again a painless process.

Myth : There is need of complete bed rest in IVF pregnancies
Fact : Though extra precaution is recommended in first three months of  any pregnancy, most patients can carry on with normal activities including there job till the final stage of pregnancy

Myth : Certain dietary changes improve pregnancy rates.
Fact : There is no particular diet that has shown to improve IVF pregnancy rates. People living in different parts of the world with varying dietary habits get pregnant with IVF. However, a healthy food habit is recommended. A good mixture of protein, carbohydrates, vitamins and plenty of water is advised. It is best to avoid spicy and oily food.

Myth : “Everyone else seems to get pregnant so easily , why not us!”
Fact : It is estimated that 1 in 8 people experience infertility at some point in their lives. Infertility is a common health problem in men and women. Fortunately, 90% of all cases have a specific cause for the infertility that can be uncovered with proper diagnosis & then can be treated.

Myth : “If you have sex every day it will increase your chances of getting pregnant”
Fact : Because normal, healthy sperm remain active in the woman’s reproductive system from 48-72 hours, having intercourse at 36-48 hour intervals around the time of ovulation is usually adequate. In fact, if the man has a low sperm count that replenishes slowly, having sex every day may be counterproductive.

Myth : “Infertility only happens to couples who have never had a child before.”
Fact : Unfortunately for many couples who have a child and wish to conceive again, a variety of factors can contribute to what is known as “secondary infertility.” A number of problems could have occured since the last conception, such as endometrioses anovulation, tubal disease or decline in the concentration of sperms in male.

MYTH : It’s all psychological: Stress is the leading cause of infertility. People just need to relax and they’ll get pregnant.
Fact : Infertility is a medical problem; it is a disease or condition of the reproductive system. While relaxation may help with overall quality of life, stress and deep emotions may result from struggles with infertility, not cause it. A recent survey conducted for RESOLVE, The National Infertility Association, revealed that 22% of women mistakenly believe that stress is the number one cause of difficulty conceiving, rather than a medical condition. At least 50 percent of those who complete an infertility evaluation respond to treatment with a successful pregnancy. Those who do not seek help have a “spontaneous cure rate” of about 5 percent after a year of infertility.

MYTH : Infertility is a personal failing.
FACT : Infertility is a crisis and it is normal for people to feel a sense of inadequacy that affects their self-esteem and self-image. It is highly recommended that all those who face infertility issues become more informed about the wide range of options and connect with others facing similar challenges, as well as considering professional counseling.

MYTH : Infertility is not problematic for people until they hit their late 30s.
FACT : Most people are not aware that for women, infertility decline begins at 27 or even sooner, although the most significant decline occurs in the mid 30s. According to the American Society for Reproductive Medicine, approximately 10 percent of women under 35 experience infertility and that number more than doubles to 22 percent for women ages 35-39. For women over 40 years old, the number nearly triples to 29 percent. Infertility is defined for patients under the age of 35 as the failure to conceive after one year of intercourse without using contraceptives. For patients older than 35, this time frame is shortened to six months. In addition, recent research indicates that men, too, may experience a decline in fertility with age. “The drop in natural pregnancy rates is directly correlated to the effects of normal ovarian aging – as women age, their eggs become less fertile and chromosomal abnormalities may begin to appear,” But the good news is that with the appropriate treatment, the majority of conceive.”.

MYTH : IVF is still pretty risky.
FACT : The average live delivery rate for IVF in 2000 was 29.9 percent per retrieval — slightly better than the 20 percent chance that a reproductively healthy couple has of achieving a pregnancy and carrying it to term.

MYTH : Diet is important for pregnancy, not conception.
FACT : Removing sugars from the diet, (e.g., caffeine, white flour, white sugar, white corn, white rice, etc.), will improve ovulation and regularity. Foods that are broken down quickly raise insulin levels too quickly and disrupt delicate hormonal values in the ovaries causing more testosterone to be produced, impairing egg quality and thus possibly lowering the chance of conception. In some women, high insulin levels may cause irregular ovulation, irregular periods, or polycentric ovarian syndrome (PCOS).

MYTH : Semen spills out of vagina is this the cause of infertility
FACT : Normally 3-5 ml of semen is ejected & a few ml then spills out of vagina What is important few conception to the initial spill & the sperms that reach up to cervix which acts as a reservoir & keep.

MYTH : Success rate is very low & expenses are very high.
FACT : Success rate depends on many factors. Most important is age, younger the age, Higher the chances. Other factor are cause of infertility, duration & quality of egg & sperm. Expenses are not too high in India. Rates very from clinic to clinic. It is equivalent to expenses in any major surgery related to heart or kidney.

MYTH : Once there is genital tubercuculasis, chances of pregnancy even with IVF are very low.
FACT : Genital tuberculosis is very common causative factor for infertility in India. It affects the tube ovaries as well as uterine cavity. The success of IVF in these cases in similar as in other causes of infertility. Provided the uterine cavity is normal & free of synchiae. If uterine cavity is oblitiraled more than half by tubercular synchiae, surrogacy is alternate option.

MYTH : When there is very low sperm count or nil count in husband’s semen, donor semen is used.
FACT : In cases of oligo spermia or azoosperm ICSI is done using husband semen only. Donor semen is used only if both partners consent to do so. Egg donation sperm donation or embryo donation is done only with proper informed consent.




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WE CARE, WE CAN