Chikitsa Hospital

Hello friends,

I am Dr. Rupali, work as a senior consultant in the department of IVF and reproductive biology. So, today I am going to talk about IVF failures and how to tackle it? IVF failure is such a very very important topic, a very frustrating topic for the treating physician as well as the patients. IVF failure ke kya causes ho sakte hai? Agar hum IVF failure ke baare mein soche toh yes, successful implantation yani ki ek successfully jo embryo uterus mein jaake chipakata hai, ek bahut hi complex procedure hota hai, aur bahut saare factors isme play karte hai. And as all of you know, in spite of all good factors, in spite of such perfect air-conditioned sperm conditions, embryo conditions, lab conditions we have seen that overall successful pregnancy rate with an IVF, nowhere crosses 48 to 50%. So, aaj mein apke samne isike baare mein kuch discussion karungi. Commonest factors which we can say, which are responsible for implantation failure are one is the uterine factor, agar mother ke uterus mein koi problem hai.

What is the common problem which can actually leads to implantation failure? The commonest problem is the thinning of the endometrium, which is the endometrium, which is there, jo andar ki lining hoti hai uterus ki, vo receptive nahi hai, vo embryo ko chipkane ke liye favorable nahi hai. Aur iss case mein kya kiya ja sakta hai? Aise scenario mein bahut kam options rah jaate hai, one is you try to increase the thinness of the endometrium yani ki andar ki jo lining hai uski thickness, uska motapa thoda sa badhane ki koshish karo, by giving drugs, injections etc. apart from that there is something called as endometrial receptivity assay, endometrial receptivity assay ek aisa test hai, jis se ye test karte hai ki kis samay mein, during the menstrual cycle, menstrual cycle ke kis phase mein, endometrium sabse jyada receptive hai. Embryo ko chipakne ke liye sabse jyada receptive hai. Usually, hum first IVF case mein, first IVF cycle mein hum ye nahi karte hai, hum ye tabhi karte hai jab humare ko doubt hota hai ya fir failure cases hote ha.jinme hum bilkul accuretely koshish karte hai ki embryo chipakne ka jo time hai vo accurate pata chal sake. Indeed agra bahut jyada IVF failures hai patients mein toh mu unko hysteroscopy ke liye bhi suggest karte hai. Hysteroscopy ek tarah ka examination hota hai jisme hum camera leke uterus ke andar wali lining aur uterine cavity ko ek baar dekhte hai ki sab thik thak hai ke nahi, kahi kisi taraf se lining kharab toh nahi ho rahi, jhilli jo andar ki jhilli hoti hai jaha pe chipkta hai bachcha vo kahi se moti toh nahi ho rahi hai, this is the other thing. Apart from that aur kya kar sakte hai, egg factor is very very very important when we talk in terms of IVF success. And here one of the most important factors jo egg ko influence karta hai vo hai patient ki age, mother ki age. Studies have shown that if the mother's age, if the female partner’s age is more than 35 years, toh usme fragmentation, genetic abnormalities, chromosomal defect bachche mein hone ke chance badh jaate hai. Apart from that egg vaise bhi bahut sensitive hota hai, free radical damage wagaira se. So that is why if the age is much higher say if the age is around 40 years then the chances of a successful IVF decrease. Aur iska kya tod hai? As such number one, jab bhi patient ho IVF ka if it is indicated do it at a younger age. Kam age pe, at a younger age less than 35 years of age, the chances of success are much better if we compare it to a patient who is 40 years of age. Dusra tarika ye hota hai, if the age is much higher then we might opt for donor IVF, where we can take donor eggs, that is another option. More so if there are multiple failures in the patient, bahut jyada baar cycles fail ho chuke hai uss patient mein. Coming to the next thing, talking about sperm factors.

Yes, so agar female mein problem hai yes, male mein bhi problem ho sakti hai. Like humara jo light microscope hota hai, humare paas jo magnifications hoti hai kai baar usme sperm defects ache se nahi pata chalte. So that is why there is something called as sperm function tests which have come up. Which are again not indicated in normal IVFs but haan agar kuch suspicion ho ki male factor mein kuch problem hai with some history, microscope mein dekhne ke baad agar lagta hai ki isme problem hai ya fir recurrent IVF failures hai, then we can do sperm function tests. Isse not only the morphology yani ki external look of the sperm but we can also assess the DNA of the sperm. The integrity of DNA can also be assessed by these tests and then we can choose good sperms, which is really really good for the formation of an embryo. Yes, eggs mein problem ho sakti hai sperms mein problem ho sakti hai, finally jo embryo bankar aata hai, usme bhi problem ho sakti hai. So jo banke aata hai, sometimes it is not up to the mark, upto the quality, jo mujhe microscope ke neeche dikh raha hai, uske hisab se jo corresponding day hai, uss level tak vo develop nahi hua hota hai, toh there could be a problem in the embryos. Apart from that IVF requires very very very strict lab conditions. Laboratory jaha pe culture ho raha hai embryos ka, they have to have the right temperature maintenance, humidity maintenance, no growth of microorganisms, in a very very sterile environment the carbon dioxide percentages are to be monitored and the growth of the embryo has to be monitored. So the culture conditions have to be maintained very very strictly very very stringently when we talk of an IVF lab, taki humare results ache aa sake. Apart from that patient, yani ki mother mein koi general condition ho jaise ki thrombophilia ho ya fir antibody syndromes ho these are two common practice which can lead to recurrent failure of IVFs and inn cases mein hum kya karte hai, we give them lower molecular weight happener, blood thinner diye jaate hai, taki unka blood thin rahe, taki unki endometrial receptivity better rahe. Endometrium tak blood flow normal rahe. But yes, let me make this very clear at the end of the day inspite of all these conditons still there can be IVF failures and every patient needs to be persistent, if they have good conditions, if they have some favorable conditions apko lage rahna padta hai, and in my experience somehow patients do conceive. I will definitely not commit to all patients but yes kaafi saare patients conceive kar lete hai jo persistent rahte hai, jo patience rakhte hai and lage rahte hai treatment ke liye.

Thank you.

Hi,

I am Dr. Rupali, IVF Specialist, Chikitsa Hospital, Indraprastha Apollo Hospital & Apollo Cradle Royale, Delhi. Today I will talk about the management of PCOS. This management depends on the patient. The first line of management for every patient at every stage of this problem whether it is a minor problem or major problem is lifestyle modification. Now, what does this mean? It means that the patient should be doing certain modification in her own lifestyle that is the way she eats, the way she lives and what are they?

1. The patient should inculcate some practice of exercise. Agar ek patient 1-week mein 150 minutes exercise kar sakta hai, which is of 150 min exercise in the entire week moderate-intensity, then also the condition improves. Agar patient ka weight improve hota hai only 10-15%, most of the symptom will decrease. I have had patients who were 100+ kgs, they became 85 kgs and they conceived self. Agar aap apne khane mein modifications karte hain means aap ko ek hypocaloric diet lena hai jismein carbohydrate content kam ho. And you should have something called smart objective. Really targeted objectives for a lifestyle modification so tha iske results easily achievable hon.

Apart from this, when we talk in terms of infertility, yes, the patient might just need the simple timings of the intercourse along with the ultrasound if required or some drugs. So, these drugs might be some oral drugs or it could be injections. Further, the chances of infertility can be improved by doing IUI or IVF, Laparoscopy perse is not usually required in patients just for PCOS. But yes if something else has been suspected along with PCOS, we tend to do laparoscopy in these patients. More or less if the patient is very keen on getting herself treated with these measures, specifically with the lifestyle modifications, some amount of drugs and there is insulin resistance, we need to give them some amount of metformin. In the end, most of the patients are relieved from the problem and are much happier.

Thank you.

Hi,

I am Dr. Rupali, IVF Specialist, Chikitsa Hospital, Indraprastha Apollo Hospital, & Apollo Cradle Royale, Delhi. Today I will talk about PCOS. Aaj kal ke time mein ye bahut hi common diagnosis ban gaya hai. Ye middle class and upper-middle class mein jyada dekha jata hai. Ismein kya hota hai? Ismein periods time pe nahi aate hain ya fir prolong hote hain ya fir kam ho jaate hain ya fir 3-6 months tak nahi aate. Patients ko hyperandrogenemia ho jata hai. Iska matalb hai masculine features aa jaate hain. Like body pe hair jyada hona, pimples hona. Ultrasound mein polycystic ovaries dikhti hain. In conditions mein se agar koi 2 conditions bhi hain toh hum patient ko PCOS bolte hain. Young girls mein jab tak periods regular nahi ho jaate, hum 2 saal ke baad hi unhein PCOS ka label dete hain. Shuru mein hum ultrasound ek diagnostic criteria nahi lete hain. Although we have a lot to tell in this topic I would be very brief. The most important complaint the patient is present to me is weight gain. Agar patient ka weight badhta hai to PCOS ke features bhi badh jaate hain. Aise mein weight lose karna mushkil ho jaata hai.

Aise mein aap ko weight gain control karna hota hai. So, please remember, jitni marzi medicines le lein, sabse pehla control and prevention hai weight loss. You have to have good lifestyle management and regimen. Jo aap kar rahein hai, is problem ko stop kar sakte hain. Apart from this, yes, mere pass aise patients bhi aate hain jinko pigmentation hota hai, neck ki skin dark ho rahi hoti hai. Ye manifestation hain insulin resistance ke. Kafi sare patients aate hain infertility le ke. Aisa jaruri nahi hai ki har ek patient ko ek lamba choda treatment mile. Jo treatment humara hota hai infertility ke lia, basic step ladder pattern mein jata hai. Kuch patients jo PCOS ke hote hain, unhein simple medicines se hi pregnancy ruk jaati hai. But han kuch logon ko dusra spectrum yanike IVF ki bhi jarurat padti hai. So, these are the main symptoms of PCOS jiske sath patient humare paas aata hai. Iske alwa, I would also want to tell you, later on in life, patient ko jab time ho jata hai, in patients mein metabolic syndrome hota hai. Ismein patient ka BP high hota hai, again motappa hota hai, diabetes ke high chances hote hain. So, jo bhi management aap ko samjhayein jaate hain vo aap k life long lene hain. Iske alwa jo aage ka management hai, I will be speaking about it in the next video.

Thank You.

Hello everyone,

I am doctor Rupali and I work as an infertility specialist. Now today, I am going to be talking about the causes, symptoms and basic treatment of infertility in general. When should we start suspecting that yes this could be a patient of infertility or when should you people start expecting that yes you could be a patient of infertility? Now in general as a thumb rule, it requires usually one year of regular unprotected intercourse for us to label a patient as being infertile for us to label yes the couple is infertile.

Now what are the chances that this patient can conceive, now what are the chances usually a couple would conceive within a span of one year, say approximately around 72% of patients would conceive in 6 months time, by the time it is one year it goes after 80% and by the time it's 2 years it goes as high as over 90%. Apart from that we usually do start getting more actively investigational in patients who are say aging more so in the current scenario where we do get couples who do not want to have babies in the initial years of marriage, who are more work prone, concentrating on their work and time the age limit is around 35 years after which we are more actively into investigations. The third criteria are if we have some history which helps us to find out that yes this patient could have a problem, like a patient who gives us the history of :

1) Irregular cycles where the periods are irregular.
2) Heavy flow during periods could also mean problem.
3) Delayed periods in such patients or even no periods, no period for 3 months, no periods for 6 months.

These are the patient likely to be infertile apart from that yes history of pain lower abdomen, history of fever, history of tuberculosis, history of excessive vaginal discharge which is associated with some amount of foul smell or itching, etc. These are kind of patients where we would start suspecting that yes they could have a problem in the female partner.

Now apart from that, the male partner’s history is to be also taken in detail. We would start thinking of problems of fertility in the male partner, if the amount of ejaculate is less or if they are unable to ejaculate at the right time or there is a deformity, any form of coital problems during coitus also is a reason why would we investigating them for infertility.

Now treatment in these patients would not mean an IVF, treatment in these patients would vary according to the conditions and most of the conditions we might end up doing are minor interventions like giving them drugs, like regularising their cycles, helping them to lose weight, which is one of the most important criteria and then finally guiding them into pregnancy with the help of certain medications, small ultrasounds and they might conceive.
Yes down the line procedures like intrauterine insemination or IVF also do come towards the end, but yes initially they can be managed by simpler things.

I hope this is informative enough for you people we will continue in the next video.

Thank you