Elixir Fertility Centre

Hello and Good Afternoon,

My name is Dr. Pranay Ghosh and I am the director and infertility consultant and chief neurologist at Elixir Fertility Centre.

Today I will be talking about male factor infertility which is a relatively common but frequently neglected diagnosis. Usually when the couple comes in for the infertility assessment it is assumed that the problem lies with the female partner, but about 30% of cases the problem is solely due to the male factor and in about 50 to 20% cases the male partner is contributory. The problem of male infertility may be certain by a basic test as semen analysis and problem may be as severe as absence of sperm in the ejaculates, something that is known as azoospermia. And this is a potentially devastating diagnosis. However, in the majority of such cases it is now possible to have one’s own biological children with the availability of the new or assisted reproduction techniques. Foremost along with the detailed semen analysis, it is important to get a complete history and do a physical examination. A detail semen analysis implies that even in the presence of very few sperms in the ejaculate the diagnosis of a azoospermia should not be made because this is something that happens when the semen analysis is carried out by routine laboratories. A semen analysis is done to look into three variables. The count for the concentration, mobility of the sperm that is appearance of the sperm. This last perimeter that is the morphology of an overload and over reported. If the semen analysis comes out to be abnormal, the first thing that has to be done is repeat the semen analysis with a proper gap or absence of 2 to 7 days because there is a lot of fluctuation and variation in the semen parameters. If the repeat semen analysis comes out to be abnormal again, then advance sperm function test like sperm DNA fragmentation need to be carried out. In severe, in very severe cases of male infertility, just the semen analysis and sperm DNA fragmentation will not sufficient and by chromosome micro delusions studies need to be carried out to conform genetic normalcy. Once we have diagnosed that the male factor does exist and the male partner does suffer from deficient parameter, the good news is that now there are athlete treatment options available to rectify this and ones we are, we are usually able to pin point the cause of the male infertility which may be as uncommon fugnative abnormalities of hormonal imbalances, previous chemo radiations, previous surgery in pelvic area, substance abuse, certain medications or environmental toxins or maybe cannot be pinpointed due to idiopathic reasons. My male factor in infertility may be benefited by anti-oxidant supplementation and Intrauterine insemination/ IUI. However sever cases require intracytoplasmic sperm injection where cycle of IDF is carried out and after a pickup the fertilization is carried out by directly injecting one sperm inside the egg in a labotory. In cases of azoospermia, that is the absence of sperm in the ejaculate, the optional surgically obtaining the sperm from either the tester or the epidictic exists and this is usually done under anesthesia and the sperm that is obtained by surgical sperm retrieval is used to carried out exceed. For supportive treatment and tales, lifestyle modifications, quitting alcohol, giving up smoking, avoiding tight fitting under garments, hot baths and saunas. A very few, small fraction of the patients that knows the male factor infertility may be diagnosed with a condition called vericoseed, essentially dilation or distinction of the veins that trigger the testes, and this is a condition which may be benefitted by surgically correction. The options are many for the patients diagnosed with the male factor infertility and in the right hands; with the right expertise the results are excellent and gratifying.

Thank you.

Good afternoon, I am Dr. Puneet Kocchar. I am a consultant gynecologist and a fertility specialist at Elixir Fertility Center, New Delhi. Today I will be talking about Recurrent miscarriages and abortions.

A positive pregnancy test is a very exciting news not only for the couple but for the entire family. However, sometimes there is a miscarriage and the chances of miscarriage in the normal pregnancy are about 10-15%. If you have had only one miscarriage, then the chances that you will carry on till term without requiring any medical extensive treatment in your next pregnancy are nearly 80% or more. For women who have had only one miscarriage, we will not recommend going for extensive testing or treatment.

What is recurrent abortion or recurrent miscarriage? 

If a lady has had 3 or more repeated abortion, it is called recurrent abortions. Even these days we start doing test and treatment if a lady has had 2 abortions and we do not wait for third one to occur.

So, why does an abortion occur?

In simple terms, either it is a fetus, that is, an embryo is not normal or the womb which is going to carry the pregnancy has some problems in it. What happens to a fetus if you are carrying a genetically abnormal baby, that can lead to miscarriage. It is nature's way to take care of the pregnancy and not letting the abnormal baby come into life. So, we do tests called genetic tests to check the chromosomic make up of a baby. They can be done on the products of conception. We also recommend that we have complete parental care, that is the blood test of both mom and dad to check the both of the chromosomal content.

Sometimes, in2-5%of the cases, there is balanced chromosomal translocation. Now this translocation will not cause any problem to the person who is guiding translocation. But when you produce an egg or the sperm, the embryo can be abnormal and this will lead to a miscarriage.

What happens to a person carrying a translocation?

If you are carrying a translocation which is leading to repeated miscarriages, it is better to plan IVF cycle along with PGD or PGS rather than normal conception.

IVF is where we create an embryo using the eggs from the lady and sperm from the husband. When the embryo is ready, we take a small biopsy and we subject it to test and a complete chromosomal analysis. And once the results are back, the normal embryo is transferred back into the lady's womb resulting in healthy pregnancy. This is one factor that we just addressed.

The second factor that we talked about is abnormalities in the womb. Now, simple test to analyze hormonal balance from the blood taken from the lady will tell us about thyroid status, diabetes, abnormal prolactin. These are all hormones which if are elevated or below the range can lead to abortions. THis can all be treated by giving oral tablets. So, these are important to be tested for any women having recurrent abortions.

• Then we look into other factors such as autoimmune problems which are very common, occurring in about 20% of the patients. During pregnancy, we advise you to take low dose aspirin tablets and low molecular weight hampering injections for the entire duration of pregnancy. And this results in more than 60% successful pregnancies.
• Another important factor that leads to abortion, which is Thrombophilias. THese are inherited problem which increases the tendency of blood to clot. Since the blood flow to the uterus is not occurring properly, you might again need blood gain agents such as aspirin.
• Some of the other common factors are an anatomical factor. So, if the uterus or a womb is carrying a fibroid can also lead to abortions. Now, these can be easily diagnosed by doing an ultrasound either 2-dimensional or 3- dimensional. If such a problem is present, we can treat it by doing a hysteroscopic procedure.
• Another important factor that leads to Abortion, especially in our part of the country, that is North India, is Tuberculosis. This is one of the commonest cause of miscarriages especially in our part of the country. It can be tested by doing Biopsy. Take a small amount of tissue from the uterus and check whether the lady is carrying Tuberculosis or not. It can be treated by giving oral medication of tuberculosis that has to be taken for the period of 6-9 months.
• Another common cause is the imbalance of Th1 or Th2 cytokines. These are the cytokines present in the uterus which may not let the embryo or the pregnancy to grow. And if these are found to be positive, we recommend Immunomodulation.

So, these are the various causes due to which a lady can have an abortion. An important thing here is do not loose hope and do not give up treatment. If you have had 2-3 abortions, you need to get complete panel of tests done and with the help of a treatment, you have 60% of the chance to deliver a baby normally.

If you wish to consult me, please contact me through Lybrate or you can visit my clinic directly.

Thank you.

Good morning , I am Dr Puneet K Kocchar. I am a consultant gynaecologist and fertility specialist.

Today I am explain about unexplained fertility. Now before going to unexplained fertility, I am going to tell you about what is infertility or sub-fertility.

If you have has unprotected regular intercourse for a period of one year or over one year and you have not been able to conceive, then you need to see a doctor. That is when you are suffering from sub fertility and you need to see a doctor. And for the women above the age of 35 years, if you have been trying reguarly to get pregnant over a period of 6 months and you are not pregnant. You might see a doctor and get some basic tests done.

Now coming to unexplained infertility. This is where when we are not able to find out the cause of infertility. Lets start from the basics. You need four basic things to get pregnant. I will show you here,

• First we need a sperm which should be normal and have good mortality present in the semen.
• When you have intercourse, the sperm is deposited in the vagina.
• Then you need eggs to be produced in the ovary and we need two fallopian tubes which should be patent and should be able to transfer the sperm to reach the egg.
• Then we have uterus which is normal and able to carry on the pregnancy.

Now unexpalined infertility is when all these factors are normal and still someone is not able to conceive. You will be suprised to know that unexplained infertility accounts for as much as  20-25% cases of infertility, that we see in our clinic daily.

The good news is that about 80% of the women are able to conceive. Most of them conceive on their own or some of them need help of a doctor. No extensive treatments are required in this case, mild treatment might help you conceive. Now the first kind of management is to provide oral medicines, such as follic acid, which help in the development of baby. If you are suffering from polycystic ovaries, we might give the medicines of ovugation induction to improve the quality of egg. These are the oral medications which help in the formation of the eggs. Sometimes we give injections to form highter number of eggs. There are some tablets which helps in improving the quality of few eggs.

On the other hand, there are extreme opposite case in which woman instead of having higher number of eggs, have low number of eggs. So these women might benefit from DHEA tablets, so we give them oral medications in order to improve the egg quality. After improving the egg quality and the serial ultrasounds we can see the egg is develpoing normally. And you have tried naturally, lets say about 3-6 months and you are still not pregnant, then the next step is for Intrauterine Insemination, also called IUI.

In IUI, once your egg is ready, we call the couple to the clinic. The husband has to give semen sample which is then processed. The good quality or the rapidly move sperm is put in the uterus. This might help in conception by increasing the chances of natural pregnancy by about 5%. In natural pregnancy, the chances of getting pregnant is about 15% and in IUI cycle, the chances increase to about 20%. If this fails for about 3-6 cycles, we have two more options;

We either perform the tests for the tubes again. So, we either do the laposcopy tests or we move towads IVF, which is called "In Vitro Fertilization". This is also called test tube baby treatment. It is not actually a painfull or extensive treatment, infact it is quite simple treatment which has a success rate of about 50-60% of conception for majority of couples, below the age of 35-36 years.

In the patients with unexplained infertility, the chances of conceiving without requiring IVF is very high. As I said, all you need is a good direction and not to give up hope and not to stop treatment for very long time. If you are suffering from any such problem, I would request you to call us and make an appointment and discuss the problems in personal.

You can contact me through lybrate or directly on my clinic.

Thank you.