Samyak Hospital

Hello friends, myself Dr Purnima Jain, I am practising obstetrics and gynaecology for last 15 years. Today in this video we are going to discuss about infertility its causes and the basic investigation which are required to investigate an infertile couple. First of all, what is infertility? In India whenever two person decides to continue as a life partner then the whole family starts expecting that after some time the new family member will be added to our family. But in about 15% of patients, this dream is never fulfilled, this is called infertility and technically if we want to define infertility, infertility is when a couple is unable to conceive even after one year of regular and unprotected intercourse. Infertility can be of 2 types primary infertility and secondary infertility, primary infertility is when a couple has never complete irrespective of the duration of their pregnancy and secondary infertility is when a couple has a prior history of conception, whatever the outcome may be but after that there they are unable to conceive this is called secondary infertility. So what can be the causes of infertility in a couple, infertility is not a problem of only female or male it can be a problem of both so causes of infertility can be due to a female cause or male cause due to both. In about 30 to 35% cases it can be due to female factors in about 35% it can be due to male factors and in another 10 to 15% it can be due to problem in both male and female and in 10 to 15% there can be no reason, that is a and explaining infertility. Among causes of infertility in females it can be due to broadly they can be divided into three categories one there is a failure of ovulation or tubal blockage or failure of implantation. Failure of ovulation can be due to some hormonal imbalance or improper development of gonads and tubal blockage, the tubal blockage can be due to some infection like a pelvic inflammatory disease, genital tuberculosis and sexually transmitted diseases. Thirdly, the failure of implantation, failure of implantation can be due to the thin endometrium and some blockage in the endometrium cavity due to a fibroid, polyp, asherman syndrome due to which the zygote is not able to implant in the endometrium. So these are the main three categories of female infertility, about male infertility again male infertility can be due to hypogonadism which leads to failure of production of sperm and it can be due to some genetic factors or due to maldevelopment of gonads or it can be due to hormonal imbalance or decrease hormones. Secondly, it can be due to obstruction in the outflow of sperm that is epididymis, vas deferens etc. If you want to investigate a couple about what can be the cause of infertility in this couple, then there are some basic investigation and some invasive investigation. Basic investigations can be some blood test like haemoglobin, blood group hormonal profile, serum TSH, serum follicular stimulating hormones, serum utilising hormone, serum prolactin and serum AMH and some viral markers like HIV, hepatitis B, anti-HCV and investigation for syphilis and then there are some tests for whether there is ovulation occurring or not, for it we are doing an ultrasound for follicular monitoring first or second day and then for eight and ninth day of cycle on alternate day to see whether the follicle is being developed or not. Then there can be investigations to see whether there is any tubal blockage or not for which there are three investigations available, first is HSG or Hysterosalpingography, in which a dye injected by a cervix into the uterus and fallopian tubes and then an X-ray is done to see that whether the tubes are patent or not and second is saline sonography in which a saline is injected by a cervix into the uterus and fallopian tubes and then ultrasound is done to see whether the tubes are patent or not. But if it is not clear by that, we can do laparoscopy which is an operative procedure and sometimes hysteroscopy is also done. For male infertility, we have to do a basic investigation which is Semen analysis, in which we see counts, morphology and motility of the sperms and if it is normal then it is ok but if it is abnormal then we have to further investigate. So these are the basic investigations which are required to investigate the infertile couple. Thank You.

Hello viewers, I am Dr Purnima Jain. I am practising Obstetrics and Gynaecology from last 17 years. In this video, I am going to talk about Pregnancy Care and the different investigations required during pregnancy.

Pregnancy is the most happiest period of a women's life but at the same time, women goes through various emotional conflicts during this epriod. So, she is happy about her pregnancy but at the same time, she is worried about the various ailments which affect during pregnancy. Also, she is scared about various investigations and scans which are being done repeatedly. So, she should be explained and informed and explained about various things which are required during pregnancy.

I am tyelling you the things which are commonly practised by all the gynaecologist. There may be different view of different doctors but the goal of all is same, that is, to have a healthy abby and a healthy mother at the end of pregnancy. And to achieve this, I think that the patient should be well informed because a well informed patient will enjoy her pregnancy and after the period is over, she will have a better outcome.

How to calculate the expected date of delivery?

The first question which patient asks is when will be the delivery date. So, we should know that how to calculate the expected date of delivery. Usually the duration of pregnancy is about 40 weeks or 280 days and it is calculated from the last day of periods. It is a simple method of calculation is, from last menstrual period + 9 months + 1 week gives the expected date of delivery. Suppose your Last month od periods was 10th.oct, 2016 then the expected date of delivery will be 17th.july, 2017.

Secondly, we divide pregnancy into 3 trimesters.

1st Trimester is from 1- 12 weeks.

2nd Trimester is from 12-28 weeks.

3rd Trimester is from 29-40 weeks.

The division of these three trimesters is necessary because problems during different period are different and care during different period are different.

In 1st Trimester, as soon as you diagnose your pregnancy, one should visit a gynaecologist and get registered with the gynaecologist because at this time, we need to get certain investigations done and patients usually have some problems like vomiting and most frequent problem during 1st trimester is problem of abortion. The routine investigation which are done during 1st trimester are Haemoglobin, serum TSH level, blood group, HIV, Hepatitis B surface antigens, BDRL, blood sugar levels, routine urine test, microscopic examination, IGM levels and if required HPMC level.

Ultrasound scan is usually done on 6th week for the confirmation of pregnancy, viability and in the later time for dating of pregnancy.

2nd trimester is usually healthier period. Patient usually suffer least problems. But during the 2nd trimester, at 16th week, we give first tetanus toxoid injections. And on 18th week, we do anomaly scan and triple or quad test. On 20th week, 2nd dose of tetanus toxoid is given. On 24th week, we do blood sugar test fastinga nd after meals. On 22nd week, if required a Fetal echo is done. If required means, if there is a malformation history of previous child or if the mother is suffering from hypertension, heart failure etc. Duering 2ns trimester, irona nd calcium supplementations are usually started and diet counselling is done.

During 3rd trimester, on 28th week, a color doppler test is done to see fetal growth and well being. On 32nd week, routine check up is done. And on 36th week, a repeat ultrasound for fetal representation is done.

After 36th week, a patient should visit gynaecologist every week to avoid complications.

For further information, please contact me through Lybrate.