Dr Vaishali Sharma Gynaec Clinic

Hello,

I am Dr. Vaishali Sharma, Practicing as Infertility Specialist and Laparoscopic Surgeon. Today our topic is Gynae Endoscopic surgeries, Laparoscopy, Hysteroscopy, and their benefits. Gynae Endoscopic surgery has completely changed the scenario of surgical management and gynaec cases. It allows us to remove quite big tumors or cysts with minimal scars on the abdomen. With laparoscopy we can completely deleniate the diseased tissue and we can remove it completely without causing any damage to the normal structure of that organ. For example, if we are doing laparoscopic surgery for a cyst, we can completely delineate that cyst from the ovary and we can remove it completely without causing any damage to the normal ovarian tissue. This way future infertily is not hampered and no harm is caused to the normal small folicles containing eggs in the normal ovarian tissue. Similarly, if we are doing any hysteroscopic procedure for removal of folic in the uterus, we can remove it completely from its base without causing any damage to the normal uterine walls. Earlier when the endoscopic procedures were not so many advanced doctors they had to do blind DNCs for removing such polyps etc. and that way small bits for the polyps, they used to remain inside and many times there was rigorous DNC for removing it completely causing damage to the normal walls of the uterus. In such cases, those patients used to come back with the complaint of decreased flow during the periods causing Asherman's syndrome which can cause a problem in conceiving later on. But nowadays, with hysteroscopic procedures, we can remove such polyps or small fibroids, present inside the uterus without any scar without any stitches and completely without causing any damage to the normal uterus walls.

So for example, there was a 45-year-old female who came from Bihar with a complaint of excessive bleeding during periods and she had been advised major surgery like removal of the uterus there, she came to us for the second opinion and on the investigation, it was found that there was a polyp inside the uterus. She underwent hysteroscopic removal of that polyps and for that, she got admitted in the morning, she was taken up further for the procedure and she was discharged in the evening without any scar or any stitch and her problem of having excessive bleeding was solved completely without any major procedure. So in such cases gynaec endoscopic surgeries, help us in preventing any unwanted major surgery. One more significant benefit of laparoscopic surgeries is that it can be performed during pregnancy also if it is needed. Laparoscopic surgeries are quite safe and secure for the fetus who is growing inside the uterus.

For example, there was this 37-year-old female who came from Chandigarh, she was diagnosed with the huge ovarian mask while undergoing checkup of pregnancy, she was 2 months pregnant at that time and was an ovarian cyst full diagnosed, she was advised to undergo medical abortion of the pregnancy, for that she came to us for the second opinion. We ruled out the risk of cancer by doing various blood tests, and we postponed the surgery we asked her to continue the pregnancy and during her 5th month of pregnancy we planned her for laparoscopic procedure, the ovarian cyst was removed completely through the laparoscopy while she was in her 5th month of pregnancy, and the fetus was completely safe and secure during the procedure and it was found out later on that the ovarian cyst was binained and she continued her pregnancy completely till 9 months of her duration and finally, she gave birth to a healthy and normal baby after 9 months. So, this way endoscopic surgery has helped us in avoiding unwanted medical abortion and also it insured growth and development of a healthy and normal baby, while side by side taking care of the ovarian shysht also. We managed ovarian cyst laparoscopically during the pregnancy itself because of laparoscopy only we could manage it. Gynaec endoscopic surgeries are very safe and secure. Laparoscopy and hysteroscopy they allow us the removal of very large fibroids and ovarian cyst through the small course without leaving any major scar on the abdomen.

If you want to know more about Infertility or Laparoscopic surgery or anything you can contact me through Lybrate. I want to thank all my patients for this support and the faith and the trust they have shown in us. And I am really humbled to receive two national awards from economic times in national fertility award function both in the fields of IVF and laparoscopic surgery.

Thank You!

Hello,

I am Dr. Vaishali Sharma, practicing as an Infertility Specialist and Laparoscopic Surgeon. Today our topic is infertility and its treatment. As we all know, infertility is a condition when a couple faces some problem in conceiving naturally even after staying together for one year. During the treatment for infertility, we provide strict privacy to the couple and we understand that considering the current social scenario it is very important for the couple to have complete privacy and complete understanding of the concept, and the treatment is kept completely private for the couple. Coming to the various options of treatments that are available for infertility, we have many laparoscopic procedures also and we have IVU and IVF treatments and other ART treatments. Sometimes the only laparoscopy is enough for treating any tubule blockage and sometimes when there is major tubule blockage, we have to refer to the patient to IVF. so, everything varies from couple to couple, it depends on what is the particular problem in that couple at that point of time and we need to treat that particular problem so that we can get a positive pregnancy result in another one or two months.

Approximately 10% of the couple face a problem of infertility when there is no cause actually found, it is called unexplained infertility. And in such cases, we have seen that the majority of them they conceive naturally if they try naturally for another one year or in such case we can go for IUI or ovulation induction using injections. Or really we may have to go for IVF in case their age is more than 35 or so. Recently there is a sharp increase in the number of cases having low AMH. AMH is basically used to major the ovarian resolve which gives us an idea about the quantity and quality of the eggs. And every day I feel I am seeing almost 4 to 5 cases having low AMH and most of them they been referred for doing the IVF and the majority of them have been referred for doing IVF with donor eggs. I would like to recommend that AMH is an important factor but there are other important major factors also which tell us about ovarian quality and the quantity like FSH, other hormones like LH and ultrasound picture and the number of inter follicles in the ultrasound. So we can not just to all the patients with low AMH to the donors cycles, it is always better to assess that patient personally and then we decide ki they can go for IVF with their own cycle,with their own egg and in case that is not an option then the option of donor cycle comes. The success rate of the treatment depends upon what is the major reason behind infertility, and in cases when egg quality is good, when sperm quality is good, we are able to get a good quality of embryo at the end of the day, then the success rate of such an IVF cycle can reach up to 80% almost 8 out of 10 of such couples, they conceive in one cycle or another one cycle.

So the success rate varies a lot with what is the basic behind infertility. Considering the current social scenario regarding infertility, we give complete privacy to couples who visit to us for the treatment, we completely respect their choices, and we know that it is very important for the couple to feel comfortable. And we follow all the guidelines which are related to infertility management regarding that. Sometimes only laparoscopic surgery is required which can treat the tubule blockage, sometimes we may have to take the patient for IVF, so each couple has his own specific problem, we need to tackle that problem at that point in time. So, accurate diagnosis for that particular couple and the targeted treatment of that problem, will definitely give us the quick result and positive pregnancy test within a very short period of time. I really want to thank our patients for the trust and faith that they have in us, and I am really humbled to receive 2 national awards last week only from Economic times, both in the field of IVF and laparoscopic surgery.

Thanks a lot.

Hi,

I am Dr Vaishali Sharma I am practicing as consultant gynaecologist and laparoscopic surgeon and infertility specialist in South Delhi. Fibroids are non cancerous growth these are actually in a overgrowth of the normal tissue of the uterus commonly known as rasoli in normal layman term and we should not worry about the fibroids, most of the time we can find the fibroids incidently on Ultrasound, if we will do the ultrasound in hundred women than 50% of them will be having small one or two fibroids. So there is nothing to worry about until unless there are symptoms which are caused by the fibroids.

Like if a female is having increase bleeding during periods or pain during periods or she is unable to conceive or there is history of multiple abortions then we may need to treat the fibroids and investigate further. We need to look at the size of the fibroid what is the sight of the fibroid and the surgery also depends on these factors. So, in cases where the fibroids are small and these are away from the cavity in such cases the patient can go ahead with the pregnancy, there is no problem.

But in case is the fibroids which is a bit bigger like 3-4cm or more than, or just close to the uterine cavity then we need to treat that fibroid by surgery. There are many methods which are available for treatment medicines are there, injections are there, and the surgeries are also available which are needed only in a small subset of the patients. The Laparoscopic surgery can be used to treat the fibroids, they can be many fibroid, they can be large fibroids. Nowadays we can remove them with the laparoscopy and there are hardly 2-3 small scars on the abdomen. The patient has to get admitted for one or two days in the hospital and if the fibroid is inside the uterine cavity than those can we remove hysteroscopically, it is absolutely scar less surgery there is no suture or any scar in the abdomen and patient can go home either the same day or the next day. So in case if you have any further query or you need to know something more about the Fibroid, you can contact me via Lybrate.

Hello, I am DR Vaishali Sharma. I am practising as a consultant Gynaecologist in South Delhi.

If you have any problem in conceiving naturally, then when to consult a gynaecologist. You should know that if your age is below 30-35 years then you can try naturally for one year. But if you are coming close to 35 years then I think that 6 months of natural conception is enough because you should not waste much time after the age of 35 years.

What are the options to increase the chance of pregnancy?

• The best thing is that you should go for Pre- conceptional counselling. But if you are not doing so then you should know that the best chance of conception is during the mid cycle, that is, if you have a cycle of 28-30 days then the best time for pregnancy is 10-16 days after your cycle. The number of days we are calculating here are from the 1st day of the cycle. So, this is the best time from which you can calculate naturally.
• The other thing is the kit that is available in the market to know what is the time of Ovulation, that is when the egg is released. So, these are the very commonly available in the market. YOu should use them from the 10th day of the cycle and then you have to use them daily, preferably in the afternoon period and you have to do the urine test yourself. If you find the two dark lines on it, that means you will be ovulating.
• Then if you find that you will not be able to conceive from these methods then you should go the nearby gynaecologist. She may advise you basic investigation from basic workup. For example a blood test, semen analysis and so on. And if the basic investigation area coming normal, then you are advised to have medicines. These medicines are roughly for 5 days. This is called Ovulation Induction. They basically increase the chances of ovulation and egg release. So, this thing you can try for 3-4 months but this has to be done under the guidance of Gynaecologist. We advise them to take 5 tablets during their periods. We call them from the 9th day of their cycle and perform an ultrasound to see whether the eggs are formed or not. Once the eggs are there and the appreciable size of 18mm is attained, then we give the injection to release the eggs. After this, we tell the patients that this is an appropriate time to try the conception. This way if the couple is not able to conceive within 6-8 months, then we advise them to go for either the injections, which will help in the formation of eggs.
• Or we advise them to go for IUI (Intrauterine Insemination). One most important point is that before suggesting IUI to the patient, the tubal testing is a must. That is usually advised HSG and SSG. In this way, we show that both the tubes are patent. In case there is a problem in semen or there is some problem with the male like the premature ejaculation or difficulty in performing. In such cases, we advise the patient to visit an endocrinologist. And the final option we give them is IUI. Through this, 50% of the patients are able to conceive in 6 months and another 50% of the patients are able to conceive in another 6 months. The cumulative success rate is come out to be around 75%.
• In case the patient is not able to conceive after injections and IUI then we usually advise them to go for Laparoscopy treatment. This is a diagnostic and therapeutic option because, in this, the woman has to get admitted to the hospital and we directly look through the Laparoscope, that is camera through which we are able to know if the tubes are blocked, any difference in the location, a relationship between the ovaries and the tubes. In this way, we are able to detect and correct it. It is a painless procedure and the woman has to admit in the hospital for 8 hours. THis is minor operation in which 2-3 stitches are there. BUt this is mandatory before proceeding further. After doing laparoscopy we are going to tell patients that the tubes are open and you can continue with the Ovulation induction and IUI. In that way, you will have the chances of pregnancy. And even after the Laparoscopic surgery, the tubes are blocked, then we suggest our patients for the IVF that is the test tube baby. If the tubes are blocked then IUI will not be helpful.
• IVF surgery is also advisable when the female partner is close to the age of 40 or so. After the age of 35 years, the quality of the eggs in the female ovary will decline sharply. So, sometimes the IVF is suggested directly to the patients in case ovarian reserves are poor.
• In case IVF test tube baby is advisable, then we have lot many options.

So, if you want to take an appointment, you can visit me at Asian clinic in GK-1 or you can consult me through Lybrate for the audio and the video call consultations.