Shivesh Nursing Home & Maternity Centre

Hello,

 I am Dr. Saloni Chopra, Gynaecologist. I have worked in govt. sector for 3 years and in the private sector for a few years. I have done my ultrasound laparoscopy as well as infertility courses. Today we will talk about a very highlighted topic i.e. infertility. Infertility is seen in every 3rd couple who enters to our OPD and the reason is because of late marriages of the couple. They are giving more importance to their career as compared to family life. It is seen in the woman of reproductive age group. When we call a couple infertile when they are not able to conceive after 1 year of unprotected sexual intercourse. If the woman age is more than 35 years then we call them infertile even after 6 months of unprotected intercourse. Infertility can be of 2 types: Primarily and secondary. Primary means when they are not able to have one child after marriage and secondary means they had a previous child but after trying for 2nd child, they are not able to conceive.

So, the most common factors for infertility are female infertility as well as combining both of them. The female factors account for 40-50% and malefactors 25-40% of the cases and the rest of them are the combine factors. So, the most common cause in the female infertility is the ovulation problem i.e. menstrual irregularity and because of hormonal imbalance happening in the body. The second common cause is the uterine or the cervical factor. Uterine factor means that there is some fibroid, some swelling, some polyp inside the uterus which is causing infertility. And the cervical factors means is the problem when the cervix which is the mouth of the uterus which is causing some abnormality. 3rd is the tube. The tubal factor is also very important because our pregnancy is formed inside the tubes and then it comes in the uterus. If the tubes are blocked or damaged because of any reason then there will be difficulty in conceiving.

 The third can be because of unexplained infertility. We don't know the exact cause of it. And sometimes there is some pelvic adhesion. There can be some endometriosis and sometimes if the female is having any cancer then the treatment of that also cause infertility. The medical condition like thyroid, hypertension, diabetes is also one of the factors which can cause infertility in the female. If we talk about male, so the most common cause is semen analysis. Sperm can be low and the mortality also can be low, there can be abnormal morphology in the semen. There can be some pus cells and the infection in the semen analysis. All of these factors can cause infertility. Along with this, there can be some other medical factors that they are taking drugs, smoking, alcohol or they are in a very heated environment. All these can also have some abnormality in the semen analysis. If they are also going for some cancer treatment can also give this problem. Along with this if they have PE then also they can have male infertility. And there can be a combined factor. So, there can be some male problems or female problems. So, in this condition, we have to treat both of them. What is basically the risk factor for infertility? It can because of the increasing age of the mother and father, smoking, tobacco chewing, alcohol, stress, being overweight, all these can take you towards infertility.

How do we diagnose infertility? We have to diagnose male as well as female. For male, we have to go for semen analysis which is the first and foremost investigation to be done. If required, we can go for hormonal analysis. We can take the treatment with a urologist to figure out what can be the treatment for any of the factor which has gone wrong out of all these 3. For female infertility, we have to do the basic ultrasound, pelvic ultrasound in which we see how is the uterus, how is the endometrial line. How are the tubes and the ovaries? If there is an ovary problem which we can see in the uterus along with this, how are the follicles are forming in the ovaries because of this help in the formation of pregnancy as well as the menstrual problem? 2nd is we need to go for the hormonal tests to see the ovulation problem.

If there is any hormonal abnormality, the problem with the thyroid, this means they will be having ovulatory dysfunction. Next, we have to go for the blood test. 3rd is we have to look for the tubes. We can o the laparoscopy as well as hysteroscopy in which we see the whole uterus from outside and inside whether any of them has any problem. And sometimes, if anything is wrong then we have to go for genetic testing of the couple. How do we treat them? So, the treatment part first includes counselling. Because of the infertility treatment impacts on physical and mental health also.

So, this should be very well prepared. 2nd we have to start the medications for the patient. Like for the females, we can give drugs for ovulation induction and we can see how their ovaries are reacting, how the eggs are forming, we can go for follicular monitoring along with this. 2nd is we can go for surgeries. In the investigation, if we see any of the fibroid, blocked tube or polyp or endometriosis or any pelvic adhesion, we can go for the surgery to remove. So that the chances for them to conceive gets improved. 3rd is if the female is not able to conceive then there are other modalities like intra-uterine insemination, IVF, surrogacy, adoption, they can go for the donor. For males also, we can give the medications to improve the fertility and if required, we can go for the surgery of varicocele. So, I think this brief will help you.

Thank You.

Hello,

 I am Dr. Saloni Chopra, Gynaecologist. Today I will talk about a very highlighted topic which is very common amongst the adolescent age group as well as the women of the reproductive age group which is called PCOS. Previously it was considered as a disease thinking that it will affect only the ovaries. But over the period of time we have realized that it is not only the ovaries, it is the whole body which will be affected and it is a hormonal imbalanced condition. It almost affects 10 million females in the whole world. The cause of the PCOS is unknown. But there are 3 factors which we can consider. One is genetic which runs in the family. There is a possibility that you also can have the same problem. 2nd is there are 2 hormones which are responsible for it and which increases the level of this condition.

One is the insulin level. Insulin hormone is the one which controls the sugar level of the body. So, what happens in this condition, insulin level increases but this does not act upon the body so that is called insulin resistance. 2nd is the high level of androgen which are the male hormones which cause inflammation in the ovaries and affect the menstrual cycle. So, if we think what are the symptoms of PCOS, the most common is an infrequent cycle or frequent cycle, absence of periods. Infrequent means it will come after 40-60 days. Too frequent means it can come within 15-20 days. Absence means they can have an absence for 2-3 months. This basically not takes on there, mental and physical health also gets disturbed.

The other symptoms will be weight gain, acne, hair loss, and male pattern baldness, unwanted hair on the chin, breast, thigh, abdomen. And there will be a time when a woman will have the difficulty in conceiving also. They can have blackness over the armpits, neck region and groin region. It can also cause depression and stress for the woman. How do we diagnose PCOS? There are 3 things which have to be considered. First is the history of the patient. 2nd is hormonal imbalance which we can check by the blood test. In ultrasound, we will see the enlarged ovaries and multiple cysts in the ovaries. If any of the 2 factors are present, we can categorize the patient into PCOS. It is not necessary that all the 3 factors should be there.

So, now what are the risk factors? If the patient continues with PCOS and does not take any treatment, they can have other complications like infertility, diabetes, hypertension, stroke, heart disease. How do we treat PCOS? The 2 most important thing lifestyle in which you need to have a balanced diet and regular exercises. Even a 5% reduction in weight can regularise your cycle and reduce the symptoms of PCOS. And the 2nd thing which we can go to is the drug. So, if the women are not trying to conceive, we can give them medications, hormonal pills to regularize the cycle. We give the medicines to control the symptoms. We can go for laser treatment and there are creams available for that. If the patient is trying to conceive, we can give insulin drugs as well as for ovulation. Last is surgery which is not done at the initial stage of PCOS and if it is required, we can go for ovarian drilling in which we do multiple holes in the ovaries. I hope you have liked the video.

Thank You.