FSIVF & Research Center

Namashkar,

 Mai Dr Ruchi Malhotra aaj aap ko IVF failure ke bare mein kuch batana chahti hu. Ab IVF jaisa ki aap jante hai ek aisi cheez hai jisme hum log bachcha bana kar bachchedani mein implant karte hai. Ek anda hota hai aur ek sperm hota hai jisse ek beej taiyar karke vo bachcha bachchedani mein rakha jata hai. To kahi bhi koi bhi kaaran ho sakta hai jisse ye IVF successful na ho. Toh most important cheez rehti hai ki isme aap ke egg aur sperm ki quality; jaise egg ki quality agar achi hai aur sperm ki quality achi hai to IVF success hone ke chances bohot zada badh jate hai, ache centre mein 70-80% tak bhi success rate milta hai. Egg ki quality jaha kam ho jati hai aur sperm ki quality achi rehti hai us situation mein kayi bar kya hota hai ki ek mein jaise kam hai aur ek mein zada hai to bhi bachcha banke aage badh sakta hai. Jab sperm ki quality bhi bekar ho, egg ki bhi quality bekar ho to jo embryo ya jo beej banta hai vo itna healthy nahi hota hai to isme IVF failure ke chances bohot zada hote hai.

Second cause ho sakta hai ke uterus. Uterus ke andar bachchedani apki sahi nahi hai, bachchedani mein kahi parda hai ya uske lining mein problem ho rahi hai to us situation mein bhi bachcha aage implant nahi hota aur aage nahi badhta hai. To mainly aap ke jo egg, sperm aur uterus: ye main role play karte hai ki IVF failure kyu ho jate hai. Sath mein kayi hormonal problems hoti hai jaise thyroid ki problem hai jo properly control nahi ki gayi ho ya fir prolactin zada ho us situation mein bhi bacha aage grow nahi karta hai jis vajah se ye IVF failure ho sakte hai. Ya koi aur additional medical problem ho jaise mareez ko diabetes ho; us situation mein bhi baby kayi baar implant nahi karta. To ye reasons ho sakte hai IVF failure ke. Kayi aur reason bhi hote hai, remote reasons hote hain jaise lab conditions achi nahi ho ya doctor experience nahi ho vo bhi situations kayi bar ek failure mein lead kar sakti hai. Ye to maine aap ko kayi kaaran bataye jisme IVF failure hua hai aur kyu ho sakta hai but kayi bar ye hota hai ki koi bhi kaaran predict nahi kara ja sakta ki IVF failure sab cheez bilkul optimum ho, bilkul theek acha chala ho but fir bhi IVF mein 100% success milna mushkil rehta hai.

To ache centres mein 70-80% tak aap ko success rate mila ja sakta hai. Ab hamne bataya IVF failure kyu hota hai. Ab hum iske bare mein bhi discussion karte hai ki isko hum kis tarah se kam kar sakte hai. Jaise ab egg mein problem hai to egg ka kya kia ja sakta hai kayi bar third party assistance li ja sakti hai jisko hum donor egg lete hai. Donor egg leke sperm ke sath baby ready karke vo implant kiya ja sakta hai. Similarly, options available rehte hai donor sperm lene ke ya fir donor embryo lene ke. Ye sari cheeze tabhi ki jaa sakti hai jab couple iss cheez ko karvane ke liye agreeable ho. Agar couple iss cheez mein agreeable nahi hai to ye iss tarah se process nahi kiya ja sakta. Dusra hai agar hormone ki problem hai to hormone ko correct karne ke liye dawayi, injection us tarah se dii ja sakti hai ki jisme IVF aap ka next time successful ho. Third thing jo lining hai uterus ki lining banane ke liye hum aur bhi attempt ache dusri dawaiyon se karte hai jisse ki ye lining ban jaye aur IVF successful ho. Toh most mostly ye IVF is a very good process jiske andar agar pregnancy nahi ho rahi to chances aap ke pregnant hone ke bohot ache ho jate hai ache centre mein, ache doctor ke hath mein.

Thank you.

Namashkar,

 Mai Dr. Ruchi Malhotra aaj aap ke liye ek naya video lekar aayi hoon jisme mai aap se discussion karungi ki infertility ki kya testing ki ja sakti hai aur kya testing karni chahiye. Jaisa ki aap sab ko ab tak pata lag gaya hai ki infertility ek aisi condition hoti hai jisme ek couple jo sath mein reh raha ho bina contraception ke ek saal tak agar pregnancy nahi ho pati hai to usko hum infertility kehte hai. To jab ek infertility ki samsya ek dampati ke samne aati hai to hamare ko kya karna chahiye. Sabse pehle cheez to hai ki hame ek infertility specialist ya infertility visheshagya ke paas jakar apni baat batani chahiye ki ek saal se hum log bina contraception ke hai aur hamare ko pregnancy nahi ho pa rahi hai.

Uske bad mein 3 basic test mai aaj aap ko bataungi jo bohot jaruri hai jo ye batate hai ki infertility testing hame kaise lekar aage badhna chahiye. To 3 basic testing mein most important test is ultrasound. Theek hai. Ultrasound jo hota hai uske andar hum puri andar bachchedani ki condition, tube ki condition, andedani ki condition ye sari cheeze hum log ko bohot detail mein pata lag jati hai aur mukhya kaaran infertility ke ek acche ultrasound se hi diagnose ho jaate hain. To jab hum ultrasound karte hain hum uske andar bachchedani yani ki uterus ke aakar ko dekhte hain, uterus ke size ko dekhte hain, uterus ke bachchedani ki lining ko dekhte hain ki jaha par hum log bachcha implant karte hai vo bachcha vaha accept ho payega ke nahi, bachchedani ke andar koi gaanth hai to ye bade aasaan roop se ultrasound ke andar pata lag jati hai. Dusri cheez hai jo andedani hai, andedani ka bohot mahatvapurand yog kisi bhi infertile couple ke life mein kyunki andedani mein kis akar ki hai, kitne size ki hai, uske andar koi cyst to nahi hai vo sari cheeze hame andedani se pata lagti hai.

To ek hum log count karte hai jisme hame pata lag jata hai ke is andedani mein is tarah itne ande hame shayad mil paenge jab hum uska ilaaj shuru karenge jisko hum bolte hai AFC ya antral folicular count. To andedani mein hum AFC dekhte hai. Bachchedani mein hum bachchedani ka size dekhte hai aur fir aati hai tubes. Tubes ke andar kahi bhi koi bhi agar jaise paani bhara ho, jaise hydrosalpinx ho ye sari condition ya fir vo ek gunjal bani huyi ho, infection ho ye sari cheeze hame ultrasound se hi sirf pata lag jati hai. Dusri important cheez hai ki hame tubes ka pata karna bohot zaruri rehta hai ki tubes khuli huyi hai ki tubes band hai. To iska ek basic test hota hai jisko bola jata hai HSG ya fir hysterosalpingogram. Is basic test se hum log aap ko ye bata sakte hain ki aap ki tube khuli hai ya tube kahi se aakar mein, banavat mein theek nahi hai ya uske andar paani bhara hua hai. To kahi bhi tube blockage hoga to bhi pregnancy hone ke chances bohot kam ho jate hai.

Aur teesra test hai bohot simple sa test hai jo male partner ka kiya jata hai jisko semen analysis bola jata hai. To uske andar hum semen mein number dekhte hai shukraduyon ka number dekhte hai, uski motility dekhte hai, uski morphology dekhte hain ki woh kaise chal rahe hain, uska aakar kaisa hai, uske andar koi infection to nahi hai; to ye sari ek hame normal semen test ke andar detailed review karne se hame ye sari cheeze pata lag jati hai. To basic 3 tests, keval 3 test ek ultrasound jisko trans-vaginal ultrasound karna padta hai jo hum internal ultrasound bolte hain, second is hysterosalpingogram jo HSG hai and third test semen analysis. Ye 3 test are main basic test jinse hum puri aapki infertility ki problem ko diagnose karke uska treatment plan kar sakte hai. To jab aap kahi bhi jate hai to ek dheer sare testing karane ki zarurt nahi hoti hai, infertility clinic mein jayenge to ye main test ke adhaar pe hi baki testing ko decide kiya ja sakta hai.

Thank you very much.

Polycystic ovarian disease (PCOD) or syndrome (PCOS) is a condition where there are multiple cysts in the ovaries and as a result there are several symptoms in various body parts. One of the significant things to note is that there is a strong correlation between diet and PCOD/PCOS.

Hi,

I am Dr. Ruchi Malhotra, IVF Specialist. Today I will talk about PCOS. Ladies of 15 to 30 years of age are suffering from it. What are the symptoms and treatment for it? In this, a lady has multiple cysts in the ovaries. It can be diagnosed with ultrasound. Generally, we have seen that the patient is obese in PCOS. The patient has androgenic symptoms. There are male hormones in the female body. It promotes hair growth on the face and other parts of the body. Also, acne and pimples which are generally seen in teenagers are increased. There could be loss of hair. Periods will be irregular. The patient may have insulin resistance. The cause is unknown but still, we have found that lifestyle problems like sedentary lifestyle, junk food are some of the reasons for PCOS. If an unmarried girl is coming to us with such symptoms like periods issue then treatment is totally different.

We have to control their hair loss, acne and we have to regularize their periods. So, we have to give the hormones as per the requirement. For the lady who wants to get pregnant, there are different modalities for such kinds of patients. The first and foremost is weight reduction. Even 10% reduction in the body weight can make improvement in the lady. She can improve her cycle and make the ovulation regular which can help her in conceiving. They have to avoid all bad habits. They have to improve their living style. Such kind of improvements are actually going to help patients. At the time of the treatment, we give some pills to the patient and that is how we monitor the size of the egg. As the cycle progresses, we are more hopeful for the positive results. If something good is not happening then we have to give hormone injection to the patient so that egg formation can happen. Then there is another treatment which we call laparoscopic drilling.

In this, we make 4 holes in each ovary which is going to help the patient to ovulate. If all these will not work then we have to go for artificial reproductive technique which is called IVF. In this, we give special hormonal injections, in which the eggs are formed and eggs are taken out from the ovary outside of the human body and then fertilized with the sperm. Then we make the uterus ready to transfer the embryo. So, this is the last procedure which we have to do for PCOS patient. For any information, you can contact me through Lybrate.

Thank You!

Namaskar!

Me Dr. Ruchi Malhotra, IVF Specialist. Aaj apko IUI ke bare sari chizen btaungi. Intra mtlb andar, Uterine mtlb bacha dani, Insemination mtlb dalna. Easy language me iska mtlb hai ki bache dani ke andar semen dalna. Ab IUI krne ke bhut sare indications hote hain and bhut sare contra-indications hote hain. Hum kis condition me patient ko IUI suggest krte hain. IUI unke lia hota hai jinke semen me problem hai ya to semen absent ho. Semen me sperm hi nhi hai. Un cases me donor semen leke IUI kia jata hai. Or agar semen me sperm kam hai to aise cases me bhi IUI kia jata hai. PCOS me IUI kia jata hai. Ya fir cervical problem ho means bache dani me koi problem ho jo sperm ko andar nhi jane deti. Next condition hai vaginismus, isme intercourse nhi ho skta, islia IUI kia jata hai.

Ab me apko contra-indications btaungi. Kis cases me IUI recommend nhi kia jata. Tubal block TB, endometriosis or ectopic pregnancy ki vjha se ho skta hai. In cases me IUI nhi kia jata hai. Bachedani me ande na bane jise hum kehte hai premature ovarian failure ya fir low AMH level ya menopause, in cases me bhi IUI contra-indicated rehta hai. Ab me apko btaungi ki IUI me actually kya kia jata hai. Patient ko hum second day of periods me bulate hain. Medicines and dawaiyon ke through ye treatment proceed kia jata hai. Injections islia dia jate hai so that eggs follicles ban saken. Isko transvaginal scan (TVS) bolte hain. Ye 4-5 times kia ja skta hai. Jab egg ka size normal ho jata hai to usse trigger dia jata hai. Ye ek inejection hota hai so that egg ande dani me se nikal jaye. Ise rupture bola jata hai. Fir iske 36 hours baad IUI kia jata hai. Isme semen sample collect kia jata hai. Semen ko wash kia jata hai. Or best sperm leke bache dani ke andar rkha jata hai. Ye kam bina anesthesia ke kia ja skta hai. Or ache center me iska success rate 15-20% rehta hai.

IUI 5-6 times ki ja skti hai quki iska success rate IVF se kam hai. IVF ka success rate 60% tak jata hai ache center me. Agar aap is treatment ke bare me kuch bhi janna chahte hain to mujhe mere center me aa ke mil skte hain. Aap mujhe Lybrate ke through bhi call kr skte hain.

Thank You. 

Hello Everyone!

I am Dr. Ruchi Malhotra . And today I am going to discuss about IUI. What is it, what are its indications and what are its goals, what are its contraindications, what are its success rate and how does it differ from IVF. I will cover all these questions.

Now let's know what is IUI and why is it done? It is planned in that way, best sperms are placed inside the uterine cavity of the woman. It is an advantage that it gives a head start to the sperm to reach the eggs very quickly to give the results of pregnancy. On the basis of certain indications IUI is done. First when the sperm count is less or the absence of sperm and that is why donor sperm is used. Then there could be a problem of PCOS in which eggs are there but they are not released. In such situations also, IUI helps or there could be some cervical factors. In which sperms are not able to reach. There could be other factor like vaginismum in which proper intercourse cannot happen. So, these are the basic indications in which IUI is used.

There are certain contraindications where IUI is absolutely contraindicated. The indication when the tubes are blocked and if it is blocked, even if we placed the sperms inside the uterine cavity, it will never be able to fertilise the egg. Then there is absence of egg like premature ovarian failure or periods stops very early. In such cases IUI is not going to help. In menopausal women, IUI is not going to help. Or there could be severe tuberculosis of uterine cavity in which linings are not there, in such cases also, IUI is not going to help. So, these are contraindications where we should not do IUI. Now let's talk about the procedure. Treatment starts from the 2nd day of the periods in which injections or the tablets are given to the patient to let the eggs formed. Now this is done by follicular monitoring which is done by transvaginal ultrasound scan. In this growth of the follicle is seen.

Sometimes injections could be use to increase the size of the egg. We need to give a trigger to release the egg in paritonial cavity. And approximately at 36 hours, IUI is done. After that we collect the semen sample after the sterile condition. Semen preparation is done in the lab. We wash the semen and remove all the unhealthy components to take out the best sperm. This we place in uterine cavity. This increases the chances of pregnancy pretty much. Now the success of IUI depends on lots of factors. Success rate of IUI is 15-20%. IUI can be done may be for 5-6 times. And if it does not succed than one can go for IVF. So, if you have any question you can contact me at FSIVF & Research Center through Lybrate.

Hi!

I am Dr. Ruchi Malhotra from FS IVF Centre, Delhi. I am a senior consultant. I’ve been working with Lady Hardinge medical college for many years as a senior consultant. Thereafter I worked at All India Institute of Medical Sciences, after which I came into this infertility practice. Today I am going to discuss about Artificial Reproductive Techniques or ART. Now ART is a technique which is used for patients who are suffering from infertility. What is infertility? We define infertility when a couple is living together without any precautions and is unable to conceive after one year without any precautions. When such couple comes to us we need to find what is the cause? why they are not conceiving? and furthermore how do we need to treat them? So there are certain basic tests when the patient comes to us for such a complaint. Most important is the history, whether the couple is living together or not. Sometimes it happens when couple comes to us but the husband is travelling, husband is not living so they are not having a normal sexual activity because of which may be they are missing the ovulation period and may be they are not conceiving.

May be there is some kind of sexual problem with in the couple which also comes out in the history or there could be a problem with the hormones in the female. She might be having delayed periods or early period or prolonged cycle or maybe she is having no cycles at all. So these are the main causes which we find out in the history from the couple and then further we need to decide how we need to treat these patients. So ART includes many methods, most important of which are IUI (Intrauterine Insemination) and IVF (In-Vitro Fertilization ). So first we will discuss about IUI. In IUI, the method is, first we stimulates the ovary of the patient by giving them tablets or by giving them some injections. We make the eggs ready which is called as the follicle which finally give us the baby. These follicles are then followed by a transvaginal ultrasound. In this once we reach the particular follicle size then we give them a trigger injection so that the follicle can rupture and comes out of ovary.

Following which we take the husband’s sperm and we segregate the best sperm and we inject them into the uterus of the female. So this is the process of IUI. Now if we discuss about IVF, it is totally different process and in which basic treatment is we give injections and we will make the eggs ready. Now IVF is all about the number of eggs which we get from the ovaries. We give them gonadotropins and we increase the number of eggs and when these eggs reach a particular size, we under anesthesia need to take out these eggs. These eggs are taken out in a test tube in specific conditions of temperature, air and lab. Then we take the husband’s sperm and we inject the sperm into the eggs.

We leave the eggs and sperm together outside in a lab environment and let the embryos grown. Embryos can grow to stage 3 or stage 5, day 3 or day 5. So the transfer is then prepared, the uterus is prepared and these embryos are then transferred into the uterine cavity. This is the entire process of IVF. After 14 days of transfer we can look for a positive result. Aap bhi is infertility ki samasya se pareshan hain aur apko iska koi ilaj samaj mein nahi aa rha toh aap mere pass visit sakte hain. Mera centre Azadpur Sabzi Mandi ke samne hi hai. Ye adarsh nagar metro station ke paas padta hai. Aap directly bhi yahan aa sakte hain aur via Lybrate bhi aakar mere se mil sakte hain. Online consultation bhi ho sakte hai aur Video Conference bhi ho sakte hai.

Namaskar!

Mai Dr. Ruchi Malhotra FS IVF Centre mei infertility specialist consultant hoon. Mere paas bahut mariz jinke har jagah treatment fail ho chuki hai voh ate hain or unko yahin success mila hai. Aaj main aapko bataongi ki infertility kya cheez hoti hai aur uska treatment ke liye hamare paas kya kya option hai. Aajkal ke time mein jab mahila aur uska husband saath mein rehte hain or ek saal tak pregnancy nahi ho pati hai toh hum usko infertility kehte hain. Infertility jab patient hamare paas aata hai to hame kuch testing karni hoti hai jis se hame ye pata lagta hai ki usme kya problem hai jis wajah se us couple ko pregnancy nahi ho pa rahi hai. Iske baare mein kuch aap ko samjhana chahungi.

Infertility mein bachha na hone mein 50% contribution husband ka hota hai aur 50% contribution wife ka hota hai. Husband ki testing main toh bahut simple cheez hai. Semen check kiya jata hai jis mein hum sperm ka number dekhte hain, uski motility dekhte hain ki woh kitne chalte hai, woh dekhte hain. But female mei, cheezein thodi si complicated hoti hai. Yahan pe main aapko samjha paongi. Yeh ek female reproductive system hai. Yeh do andedani hoti hain yani andkosh. Yeh do nalee hoti hain tubes jinko bola jata hai aur yeh bachedani hote hai. Normal course mein anda yahan se nikal kar tube k andar jata hai or yahan husband ke semen se mil k bachedani main tyar hoke bachha badta hai. In main se kuch bhi, kahin bhi agar problem ho to pregnancy age thahertei nahi hai ya badti nahi hai. Jaise ki ande. Ande main kahin khrabi hai. Jaise ajkal Polycystic ovary kafi logon ko hai.

Ya phir hormone ki koi aur kami ho, ya thyroid ho. In sab vajaha se anda nahi banta hai. Doosra agar anda ban raha hai aur tube main kahin bhi blockage hai, jaise TB k vajha se blockage hai, ya pehle kabi pregnancy hue uske vajha se blockage ho sakti hai. Tab yeh anda tube main se hoke is bachedani mein nahi jata. Jab anda yahan nahi paonchega toh pregnancy hone ke chances bilkul zero ho jate hain. Teesri cheez bachedani ke ander koi problem ho sakti hai. Jaise bachedani ke ander koi fibroid ho sakta hai, ya septum ho sakta hai, ya tuberculosis ho sakta hai ya endometerosis ho sakta hai. In sab situations mein bhi pregnancy aage nahi badd sakti.

Toh jab aap ek doctor ke paas jate hain, ek specialist ke paas jate hain toh vo apko identify kr ke btate hain ki apki problem kya hai or uss problem ka kya samadhan hai. Aaj ki date mein hamare paas most problems ka samadhan hota hai. Jaise ande nahi ban rahe hain to hamere paas injections hote hain jin se hum ande bana sakte hain. Tube blockage hoti hai to hame IVF karna padta hai. Bachedani mein koi problem ho to Histeroscopy kr ke hum bachedani thik kar sakte hain. Yeh sare cheezein specialist hi aapko guide kar sakte hain ki kaise aapko aage badhna hai apne treatment ke liye.