Fortis Hospital - Noida

Hello,

I am Dr. Rutvij Dalal. IVF ki field mein mera takreeban 17-18 saal ka anubhav hai. Sir, aap humein bataiye purush banjhpan kya hai? Banjhpan ya infertility jisko kahte hai vo ek aisi condition hai jisme koi bhi couple agar 12 mahine se jyada try kar rahe hai conceive hone ke liye aur conceive nahi ho pa rahe hai uss condition ko hum infertility ya banjhpan ya nisantanta kahte hai. Nisantanta ki jo defination hai vo actually it varies depending on the female partner’s age. Toh halanki 12 mahine ke pahle hum koi jaanch wagaira nahi karwate hai ya koi treatment bhi nahi karwate lekin ye jo rule hai vo tabhi lagu hota hai agar couple young hai ya female partner ki jo age hai, wife ki jo age hai vo 35 se kam hai. Agar wife ki age 35 saal cross kar gayi hai jo aajkal ke jamane mein dekhne ko milta hai ki kaafi couples late marriage karte hai. Toh iss case mein unko 6 mahine se jyada rukna nahi chaiye. Toh aise mareejo mein jisme wife ki age 35 se jyada hai agar vo kewal 6 mahine ke liye try kare aur baahcha nahi ho raha hai toh unko kisi IVF specialist ya infertility clinic pe visit karna chaiye. Abhi sawal ye tha ki purush banjhpan kya hai toh banjhpan jo condition hai vo almost paya gaya hai ki almost one third cases mein stree jimmedar hoti hai, one third cases mein purush jimmedar hote hai aur baki one third mein dono mein thodi thodi pareshani hoti hai. Toh almost 50% matlab aadhe kisso mein purush ya males are responsible hai. Aur ye aajkal ke jamane mein bahut commonly milne lagta hai. Toh pahle ke jamane men hum dekhte the toh sperm count 100 million,150 million hua karta tha, aajkal ke jamane mein kewal 20 million is considered normal but vo bhi dekhne ko nahi milta. Toh uske peeche kaafi karan hai jiski wajah se ye jyada common hone laga hai toh purush banjhpan ek aisi condition hai isme hum semen analysis karte hai aur vo semen analysis mein WHO 5th manual ke hisab se jo criteria diya gaya hai vo match nahi hota agar count man lo 15 million se kam hota hai mortility 32% se kam ya fir morphology 4% se kam hoti hai, to unn cases hum bolenge ki purush banjhpan ki bemari hai unki.

Sir, aap hume bataiye purush banjhpan ke kya karan ho sakte hai? Most common reason ye ho sakta hai koi genetic fault hai purush mein jinke baare mein unko pata nahi ho, toh kai baar dekha gaya hai ki jo chromosomes hote hai 46 XY ek normal purush mein hota hai, agar yahi chromosomes ka number ek kam ya ek jyada ho gaya ho ya fir chromosome mein koi structural fault ho, maan lo koi chromosome mein breakage hai ya fir ek chromosome ki jagah pe dedh chromosome, ya fir kahi se extra chromosome ka piece aa gaya ho toh kya hota hai ki uss case mein genetic fault hone ki wajah se sperm ka production ruk jaata hai ya kaafi hadd tak kam ho jaata hai. Toh vo ek pramukh karan hai. Uske alawa tarah tarah ke kai karan hai,kai baar purusho ke sexually transmitted infection hua hota hai pahle jsiki wajah se unki jo naliya hoti hai jo sperms ka transport karti hai vo block ho jati hai toh uske wajah se obstructive absormia hota hai, balki aaj kal ke jamane mein late marriage hona ya pradushan you know pollution ka hona, food stuff mein adulteration hona, tarah tarah ke pollutants se aajkal hum long exposed hai, even lifestyle reason ek ho sakta hai buri aadte hai jaise smoking, tobbaco chewing hai, alchohal sharab ka sewan ye saari cheeje jimmedar hai purush banjhpan ke . increased number of cases ke hote huve.

Sir, purush banjhpan kitna commom hai aur ye kitne pratishat pursho mein paya jata hai? Almost 50% cases mein hum dekhte hai ki purush either alone ya fir in combination jimmedar hai kisi bhi couple mein bachche hone ke liye. Pahle ke jamane mein aisa mana jata tha ki kewal striya ya aurte jimmedar hoti thi balki infertility ko kai baar aurto ki hi beemari maani jati thi lekin aajkal ke jamane mein dekha jata ki kam se kam adhe cases mein purush directly ya indirectly jimmedar hai.

Sir, aap bataiye ki purush banjhpan ke kon kon se upchar hai? Purush banjhpan ke treatment ke liye sabse pahle hume uchit diagnosis karna jaruri hai. Toh sabse pahle complete thorough evaluation male partner ka ho vo jaruri hai, uske liye hum puri tarah ek toh clinical examination karenge, unka jo semen analysis hai vo detail mein dekhenge ki sperm count mein problem hai, mortility mein ya morphology mein ya teeno parameters kharab hai. Agar maan lo ki severe oligospermia hai jisme sperm count 5 million se bhi kam hai ya fir zero hai, jisko hum azoospermia bolte hai toh usi purush ke tarah tarah ke test hote hai jisme se kuch genetic tests ho sakate hai kuch hormones ke tests hote hai jaise ki testosaround hai, apheses wagaira, aur even ultrasound bhi karana jaruri padh sakta hai. So depending on the cause ye treatment vary karta hai alag alag cases mein alag alad treatment ki jarurat hoti hai depend karta hai ki kya wajah hai, agar koi wajah milti nahi hai jisko hum idiopathic male infertility bolte hai, toh hum kuch antioxidants ya vitamins, multi vitamins ki tablets 2-3 mahine try kar sakte hai. Balki agar maan lo sperm count zero hai jiska koi karan nahi hai toh hum directly testies mein se tukda nikal ke uska XE prakriya ke jariye unko ek bachcha de sakte hai vo aaj kal technology itni advanced hai ki zero sperm mein bhi treatment karna bahut asan hai. Agar maan lo varicoseal ek condition hai jiski wajah se sperm count kharab hai, varicoseal ek aisi condition hai jaha testies ke irdgird jo veins hoti vo engorsed ho jaati hai, vo bahut bhar jaati hai khoon se aur vo stagnation wajah se sperm count drop jata hai toh varicoseal ke liye surgery karwa sakte hai, usko ligate kar sakte hai hum. Agar maan lo blockage hai, kisi wajah se obstruction hua hai, kuch infection hua hai pahle uski wajah se obstruction hua hai toh vo obstruction ko reconstructive surgery ke jariye thik kar sakte hai toh uss marij mein dekha jayega ki sperm count normal ho jaata hai. Aur agar maan lo kisi kharab aadto ki wajah se sperm count drop hua hai toh unko vo aadate band karwa sakte hai agar hormonal imbalance hai toh latrozol clomifin citrate wagaira kafi dawaiya aati hai jis ki wajah se hormone thik ho sakte hai. Toh treatment basically iske upar nirdharit hota hai ki diagnosis kya hai, kis wajah se ye ho raha hai, agar koi diagnosis nahi mil raha hai toh uss cases mein bhi jaise meine bataya hum IVF ya XE kargar hai aur kaafi achche results mil sakte hai. Sperm function test kya hai? Sperm function test kuch aise tests hai jisme ye pata lagane ki koshi karte hai ki sperm ka jo function hai, eggs ko fertilise karna, vo kar pata hai ki nahi. Toh uske liye kaafi tests ka avishkar hua tha, kuch kuch fir accept huve the, kuch kuch tests accepted nahi huve the.

Toh uske baare mein vistar swaroop mein batane ke liye humare chief embryologist Dr. Akanksha Mishra humare sath shamil hai, vo apko jyada jankari denge ki sperm function tests kya hote hai. Sperm function tests, jaise humne baat ki, kai tarah ke hote hai jaise sperms hona, penetration hone se hota hai, sperm survival test hota hai aur DNA flagmentation bhi hota hai. Toh isme penetration se utna jyada aaj ke jamane mein jyada relevant nahi hai. Isme jyada jo kaam ka hai vo sperm survival test hai jisme hum ye check karte hai ki sperm kitne time ke liye survive karta hai. Lekin iski relevance bhi ek hadd ke baad khatam ho jaat hai, iss se jyada important hai DNA flagmentation test. Isme hum kya check karte hai ki jo sperm ka DNA hai,vo intact hai ya vo kisi tarike se tuta-futa hai. Toh agar sperm ka DNA tuta-futa hai toh iss se kya hota hai ki like previous miscarriages kisi ki hui ho, ya concieve karne mein dikkat ho rahi ho, toh jab aisi history hume milti hai toh hum DNA flagmentation test karwate hai ya toh kisi ka kuch previous medical record ho jaise ki diabetes ho ya kisi ko varicoseal ho ya kisi ki sperm reports, jisko hum sperm analysis karte hai, vo achchi na aayi ho, ya oligospermia ho ya sperm ki morphology humein achchi na dikhayi padh rahi ho, umar agar 40 saal se jyada hoti hai males ki, toh aise time mein hum DNA flagmentation test karke sekhte hai. Even agar kisi ke baar baar IVF fail hua toh usme bhi DNA fragmentation test hota hai. Previous IVF failure hota hai kisika ya uss se bhi jyada important, jaise ki logo ko repeated miscarriage hota hai, toh repeated miscarriage ka karan ho sakta hai ki embryo mein kuch chromosomal fault hona, aur iska contribution apke sperm ke taraf se bhi aa sakta hai. Toh aise patients ke liye bahut relevant hai ki hume DNA fragmentation test karke dekhe aur vo hum karte hai janini pe.

Sir, aage mein puchna chahungi ki azoospermia kya hai aur iske konse upchar hai? Azoospermia ek aisi medical condition hai jisme sperm count zero hota hai. Azoospermia ko sabse pahle ek diagnosis karna jaruri hai. Aisa ho sakta hai ki sperm count mil nahi ho lekin aapka diagnosis galat hua ho, kyuki kai baar aisa hota hai ki ek condition hai, criptozoospermia jisme sperms toh hote hai lekin agar usko sahi tarah se cntrifute karke semen analysis nahi kiya gaya toh ek galat diagnosis azoospemia ka ban sakta hai toh azoospermia ke diagnosis pe ek toh repeate semen analysis hona chaiye ye confirm karna chaiye ki wakai mein azoospermia condition hai aur agar azoospermia condition hai toh uske liye darne ki jarurat nahi hai. Azoospermia ke tarah tarah ke karan ho sakte hai, azoospermia ko teen hisso mein divide kare diagnosis ke hisab se toh iske teen pramukh karan hai ek hai pre testicular jisme brain se jo hormone nikalta hai uski kami ho ya fir thik se brain function nahi kar raha ho toh vo ek karan hai. Dusra karan hai intra testicular fault ya fir testies fail ho gaye ho, production mein hi kami ho. Aur teesra karan hai ki, agar testies bhi thik se function kar raha hai, brain bhi thik se hormones bana raha hai, par sperms banke bahar nahi nikal pa rahe hai usko hum obstructive azoospermia ya post testicular azzospermia bolte hai. Toh depending on the diagnosis agar sahi karan hume mile ki azoospermia kis wajah se hai toh uss hisab se hum treatment aage badate hai. Agar maan lo sperm production thik hai jo ki obstructive azoospermia mein paya jata hai uska upchar bahut aasan hai, simple hai. Ya toh hum reconstructive surgery karke obstruction ko hata sakte hai aur couple can go for a natural conception ya fir, agar maan lo blockage hai kahi pe toh epiderma se chhoti si sui daal ke hum sperm nikal sakte hai jiska upyog issi prakriya ke jariye hum bhroon bana sakte hai. Usko hum misa ya pisa per cutipiderma spermation bolte hai, bahut hi simple technique hai aur bina kisi aneasthesia ke ho jati hai. Lekin agar maan lo production mein hi kami hai, agar maan lo testies mein hi fault hai, toh jisko hum non obstructive azoospermia bolte hai usme sabse pahle ye dekhna jaruri hai ki sperm production wakai mein andar ho raha hai ki nahi, halaki iske liye koi proactive tests nahi hai lekin kuch tests jaise ki hormonal tetsts hai ya fir genetic tests hai, jisme hum microchromosome, micro deletion test kar sakte hai, vo dekhke hum pata laga sakte hai ki andar wakai mein sperm production ho sakte hai ki nahi. The best thing to do in case of non obstructive azoospermia is doing a micro tese.

Micro tse ek aise technique hai jisme testies ko poora open karke testis ko hi hum 40 -50 times magnification mein microscope ke neeche dekhke usme se tubles nikal ke embryologist ko de. Micro tse almost ek blessings ka roop hai jo kaafi azoospermia ke patients ko kaam mein aaye hai balki humare paas aise patients bhi aate hai jo dusri jagah pe testicular biopsy ya simple tesa karwake aaye hai aur jinko bola gaya hai ki aap ki testies mein koi sperm nahi hai, aise purusho mein nhi jo dusri jagah pe sperms nahi hai aise batake aaye hai, unke bhi sath humne micre tesa karke unhi ke sperms find karke unhi ke sperms use karke, bhroon banake humne bachche diye huve hai. Toh micro tese ek aisi taknik hai jisme kaafi skill ki jarurat hoti hai, kaafi mahanga equipment lagta hai toh poore delhi mein shayad 2 ya 3 jagaho pe hi hai aur poore bharat mein 10 se kam jagah pe micro tese uplabdha hai. Toh micro tese has been literally a blessing for such patients jo khud ki hi sperms ke sath jo apna khud ka bachcha banana chahte hai.

Mein Dr. Akanksha se poochna chahungi ki vo micro tse ke bare mein hme kuch vistar mein bataye. Jo micro tse ke prakriya hai uske liye ek bahut hi efficient team ki jarurat hai. Isme na sirf aisa clinician chaiye jo bahut achche se testies ko kholke usme se jo achche tubules hai unko identify karke uni tubules ko nikal ke lab mein de, jo humare clinician hai unhone brazil jaake khaas iss cheej ki training li hai par iske sah hi embryologist ka bhi lab mein bahut important role hota hai. Kyuki ye jo tubule hai vo clinicial nikal ke hume de dete hai lab ke andar lekin jaise ki isme tubule bahut hi kam hote hai, isme poori testies mein apko aisi bahut kam jagah milegi jaha pe sperme hai, aur jab ye tubule humare paas lab mein aate hai toh hume usme se hi sperm ko nikalna hai dhoodh ke aur ye jo sperms hote hai bahut hi microscopic hote hai ye bina microscope ke dikhai nahi padte. Toh micro tesa mein se humko sperm dhoondh ke unko xe karne ke liye choose karne ke liye kam se kam 3-4 ghante ka time lagta hai humein microscope mein iss sample ko microscope mein 3 se 4 ghante dekhna padta hai,taki hum usme se vo sperm choose kar payein jinse ek achcha embryo banega. Aur ek baar humare paas ye sperm aa jaate hai toh uske baad ye bahut hi jyada keemati hote hai toh inn sperms ko hum aise hi nahi jaane dete, hum inko kaafi technology ki sahayata se freez karke rakh lete hai, taki agar maan lijiye ek bar mein ye prakriya safal nahi hui ya IVF ka result nahi aaya toh agli baar jo ye purursh hai ye micro tesa ka poora procedure nahi karwana padega humare paas frozen sperm bhi rakhe hote hai jinka istemal hum baar baar XE karne ke liye kar sakte hai.

Thank You!

Hello,

My name is Dr. Nitin Jha and I am a senior laparoscopic surgeon. Today we will be talking about something called is SILS that is single incision laparoscopic surgery, as the name suggests, single incision laparoscopic surgery is a way of doing laparoscopic surgery by only one cut at the navel instead of the routine three or four cuts that normally we take for any laparoscopic surgery like for example for laparoscopic gallbladder surgery for gallbladder stones, previously we had to put around 3 or 4 small incisions, one in the navel, one in this area and one or two in this area. So this is the standard way of doing laparoscopic surgery and now we can do it by a very small cut inside the navel, very easily hidden and from outside you will not come to know from where the surgery has been done so this is what we call as a single incision. In the same way we do the surgery for a hernia. If you have incisional hernia anywhere in this area or umbilical hernia, we do it by a small cut here in the left lateral side or the side of the abdomen and that is almost like 1-1.5 cm long and that is only cut which is required for doing the laparoscopic hernia surgery also and similarly for appendix instead of the routine 3 cuts that is usually taken by all surgeons, normally we do it by single incision in which we just put a small cut again in the navel and that is sufficient to do the surgery, so this is what is called as single incision laparoscopic surgery.

The advantages compared to the single incision and the standard way of doing laparoscopic surgery is that in standard way you have around 3 to 4 cuts, so ultimately you have small wound scars but in single incision there is only one scar inside the navel so practically from outside you don't come to know about it that from where the surgery has been done. The 2nd advantages because the number of cuts are less, so the number of scar are less so the amount of pain is also supposed to be less in single incision surgery and obviously cosmetically it is better because the operative scar is almost like hidden, so don't come to know from where the surgery has been done. Another advantage is that the time of recovery is very less come in single incision as compared to the standard three-port, four-port surgery. Single-incision has its own drawbacks also in the form that we cannot in all patients we cannot provide this way or technique of doing surgery because suppose the gallbladder is very badly stuck or the appendix is very badly stuck then obviously we are not able to do it by single incision we have to convert it to normal four-port technique, so that is why before entering our scope inside it is very difficult to know whether in that typical case we will be able to do by the single incision or by the standard four-port, only once we put our scope inside, we have a look at the appendix or the gallbladder or the hernia and how good or bad of a condition it is that we will be able to do it by single incision or we will have to go with the conventional three or four-port technique.

This is one of the more reason why we should not allow any disease to become that bad, suppose you start having pain of appendix you should be done as soon as possible, suppose you start having pain of gallbladder surgery, gallbladder stones, you should do it as early as possible because the earlier we diagnose, the earlier we treat the disease, it is more simple, the more time that we waste in diagnosing or more time we will waste in deciding, becomes more and more complex and in that case we have to basically resort to the four-port technique or sometimes even open surgery if there are a lot of other complications of the disease. So that is why the sooner we tackle the disease, the easier it is to operate and the more chances of single incision surgery as compared to any other standard way of doing surgery.

Thank you

Hi,

I am Dr. Nitin Jha. Main Senior Consultant Surgeon hoon laproscopic. Aaj hum log baat karenge gallbladder stone disease ke bare mein bahut common disease hai normally logo ko initially simple acidic gas ke sath present karta hai so sabse jyada jo ilaaj log yahi karte hain ki pahle rantac ya zantac type of kuch antiacid treatment lete hain kuch din unse kaam chal jata hai par aur uske baad ek situation aisi aati hai jab pain jyada hota hai, discomfort jyada hota hai. Finally ultrasound karte hain to usme pata lagta hai ki gallbladder mein stone hai. So in short yeh hai ki kabhi bhi agar aapko acidity ya gas ki jyada takleef lage to definitely pet ka ek baar ultrasound jarur karen usse hamein pata lagega ki kahin gallbladder ko koi stone to cause nahi hai ye sabh problems ka.

Anyway jab ye ek bar detect ho jata hai uske baad hame kya karna chahie, jabhi bhi gallbladder me stone hoga uska ilaj hamesha ek hi hai uska surgery hai. Aapko bahut saare information milenge koi stone ko galane ki dawai batayen ge koi aur aisi koi dawai duniya mein exist nahin hoti hai ise sirf hamara time waste hota hai, aapka money waste hota hai aur obviously jo sada simple disease tha starting mein simple ek uncomplicated gallbladder disease jo bolte hain bina koi khaas complications ke wahi cheez baad mein bigadh ke aur badi ho jati hai usme phir hamein aur 2-3 cheez karna padta hai kyunki simple agar initially hum karte to ek hi simple cheez se kam chal jata. Isko samajhne ki koshish karte haiin iske liye main ek chhota sa diagram banaya hai ye apna liver hai, yeh bile duct bolte hain isko yeh jo bile yahan se banta hai wo is duct ke dwara neeche aata hai aur ye ek theli type ki cheez jisko hum pit ki theli bolte hain, ye pit ki theli mein pit thodi der jama hota hain aur uske baad fir wahan se wo neeche release hoke small intestine mein aa jata hai.

Ab kisi karan se ye pit ki theli ki jo peeckne wali property hoti hai wo khatam ho jaati hai jiske karan pith iske ander phas jata hai aur kyunki wo nikal nahi pa raha hai to pit ke ander kuch aisi cheez hoti hai jisko hum bile salt, cholesterol, bile pigment bolte hain ye sabhi initially liquid form mein thi but kyunki yahan per pit fass gaya to ye bahar nahi nikal pati to isliye wo solidify hoke stone ban jaate hain aur wo chahe stone ek ho, do ho, hazaar ho koi fark nahi padta chahe wo stone to 2mm ka ho ya 20mm ka ho koi fark nahi padta, chhota stone alag pareshaan karta hai, bada stone alag pareshaan karta hai par Itni surety hain ki dono hi stone aapko pareshan karenge. Ab initially kya hota hai yeh sirf pit initially to infact kahi baar asymptomatic rehta hai agar aap koi dusre karan se janch karna chahte ho to aapko pata chalta hai ki gallbladder mein stone bhi pada hua hai ya kahi baar aap health checkup mein jate ho ultrasound ke liye tab tab aapko dikhta hai ki stone pada hai tab tak wo aapko koi pareshan nahin kiya hota usne lekin koi bhi initially choti hoti hai dheere-dheere apna wo kharab roop dharan karna shuru karti hai waise hi ismain jab second asymptomatic phase raha uske baad jo next phase aata hai usko hum bolte hain dyspepsia matlab thoda sa gas jyada ban na, khatte dkaar aana, kadwa pani ka muh mein aana ye sabhi initial symptoms hote hain jisko log confused karte hain ki simple acid hai ya gas hoga jiske karan hum log digene or rantac type tablet se kaam chalane ki koshish karte hain kuch salon ke baad fir wahi pain jo hai wo pain shuru hota hai ye usually pain is area mein jo pet ke upar ka hissa hota hai aur kabhi-kabhi isike piche jo back hota hai usme jata hai.

Initially pain chota aur kam hota hai dheere-dheere obviously or badhna shuru ho jata hai isko hum bolte hain cholecystitis matlab pit ki theli ka infection karna shuru karta hai wo ab kuch saal ke baal kabhi-kabhi aapne suna hoga appendix main pus ban jata hai, appendix fat jata hai waise hi iske ander bhi pus ban jata hai that is called as empyema gallbladder usi mein kabhi-kabhi stone jo hai iske neck par, mouth par fassh jata hai to aapka pain or dugna ho jata hai us situation main aapko aur takleef jehlani padhti hai par anyway yahan tak bhi agar hum usko timely correct kar lete hain to is problem se hum hamesha ke liye chutkara paa lete hain lekin suppose kisi karan se ye stone jo hai slip karke yahan bile duct mein ya pit ki nali jo bolte hain usme fass jata hai tab aapki pareshani or double ho jati hai us situation mein aapko aur simple pit ki theli ke operation se kaam nahi chalega aapko fir hamein endoscopy karke ERCP ek process bolte hain wo pehle muh se ek durbeen jayegi, durbeen pet mein aake yahan small intestine mein aake pahle is nali ko saaf Karega aur uske baad phir hamein surgery karni padegi matlab jahan pahle simple kaam tha wo aapka 2 kam ho jayega.

Anyway kabhi-kabhi yahi stone jo hai ye yahan par pancreatic duct bolte hain usme fass jata hai us situation mein wo pancreatitis karne ka bhi power rakhta hai. So in short ye hai ki bimari Ko itna badhne kyon dena jo sada simple bimari hai usko sada simple hi rehna chahiye aur pahle isi ko hamein operation itna bada cheera marke karna padta tha jise hum open surgery bolte the to abh jo ye hai laparoscopy se hota hai isme 3-4 chhote-chhote ched hote hain usi mein pura operation ho jata hai, usi ko agar ander bahut bad condition nahi hai to usko hum ek cut se hi kar lete hain usko bolte hain single incision laparoscopic surgery us situation mein aap bina, matlab koi aur cheera faadi karte hue nabhi ke ek chhota sa ched hota hai usi mein jo pura operation hai wo ho jata hai so that is called single incision.

So jo kaam aaj shayad ek cut se hojaye ya ho sakta hai ya do ya teen cut Lage uske liye pura pet kyon kholne ki jarurat padni chahiye. So that is why it's all depend on us ki hum koi bimari ko kitna bura karke fir hum wohi ilaaj karate hain ye jab starting mein jab sada simple hota hai usi samay ilaaj karate hain. Starting mein hamein takleef bhi kam hoti hai, jhanjat kam hota hai, pain kaam hota hai, operation bhi simple rehta hai, Jaise-Jaise kahani aur bigadti hai to utna hi pain ya takleef jo hai patient ko jyada jhelna padta hai aur obviously surgeon ke liye bhi pareshani badhti hai because wo operation utna hi difficult hota jata hai. Isliye mera simple sujhav rahega ki kabhi bhi agar aapko gallbladder mein stone rahe to isko turant dikhayen surgeon ko jaake iske bare mein aur jankari le aur iske bare mein jo uchit ilaaj hota hai wahi karen unnecessary bina koi logic ke treatment ke chakkar mein na fasse aur kuch janna chahte hain to aap mujhe mere clinic mein aakar mil sakte hai.

Thank you!

Hi,

I am Dr. Akansha Mishra, IVF Specialist. Today we will discuss egg or oocyte freezing. Mai iske baare mein isliya baat karna chahti hun kyuki ye technical hai and this is our expertise. And this topic is very relevant in today's scenario. Ismein hum lady ke eggs ko sperm ke sath nahi milate. Ye ek fertility preservation ka tarika hai. Jismein lady ke eggs aise freeze ho jaate hain ki hum unki chice ka sperm leke, unke embryo banake baby bana sakte hain. Kin logon ke liia egg freezing relevant hai? Iske 2 reasons hain medical and social. Social ye ho sakte hain ki lady shaadi ke liya taiyaar nahi hai ya fir divorce hone se vo dusri shaadi ke baare mein soch rahi hai.

Another reason jo lady bahut hi career oriented hoti hain. Jo career mein kuch karna chahti hain and then baby plan karna chahti hain. But after 35 humari fertility reduce hone lag jaati hai. Eggs ki quality reduce hoti hai. Isliya jaruri hai ki time rehte fertility ko vahin hi preserve kar liya jaaye. Un eggs ko preserve kar liya jaaye jis se aage conceive karne mein koi dikkat na ho. Medical reasons mein jo ladies cancer therapies ke liya jana chahti hain. Like cancer therapies se aap ki ovaries mein bahut hi farak padta hai and fir vo eggs banane ke capable nahi ho paati hain. Aise patients ke liya bahut jaruri hai ki unki fertility baad ke liya preserve kar li jaaye. Dusra reason premature ovarian failure ho sakta hai. Ye unke liya hain jinhein pata hai ki genetically unmein problem hai, toh unke liya important hai ki 22-23 saal ki age mein hi eggs freeze kar ke rakh liya jaayein.

Ismein step 1 evaluation hota hai. Hum aap ki medical history lete hain. Hum janna chahte hain ki aap eggs freeze kyun karana chahte hain. Jab ye ho jaate hai toh hum periods ke 2nd day se ovary ko stimulate karna shuru kar dete hain. Naturally, humari body mein 1-2 eggs bante hain. Yhana hum ovary ko apne control mein laake jo stimulation hormones hain unki dose thodi badha ke aap ko injections dete hain hormones ke. Is se jitne jyada eggs ek baari mein bana paayein, vo bana lete hain. Stimulation 10-11 days ke aas pass chalta hai. Jab eggs mature ho jaate hain toh hum halke sibation mein unhein extract kar lete hain. Ye ek normal ultrasound jaisa hi hota hai. Uske baad hum eggs ko vitrification ke through freeze kar lete hain. Hum eggs ki saari biological activities ko stop kar dete hain. Inko hum kitne bhi saalon tak rakh sakte hain. Ye procedure hum 2007 se kar rahein hain. Ye bahut hi technical and delicate procedure hota hai. Eggs body ke sabse bade cells hote hain. Inmein bahut paani hota hai and inhein freeze karna bahut mushkil hota hai. Lekin isi area mein humari expertize hai.

So, agar aap humare paas apne eggs freeze karta hain toh unki guarantee 98-99% hai. Eggs freeze karne ka matlab ye nahi hai ki unhein freeze kar ke rakh lena. Jaruri ye hai ki vo usi form mein aane chahiyai and unki fertility preserve rehni chahiyai. Ismein hum dekhte hain ki ek live birth ke liya kitne eggs freeze kar ke rakhne chahiyai. So, 4-5 frozen eggs se bhi ek liver birth mili hai. So, fir bhi hum kahenge ki 8 eggs freeze hain toh ek live birth ka promise hum aap ko de sakte hain. So, the last question, is egg fertility is safe for the a newborn baby? Numerous studies mein dikhaya gaya hai ki egg freezing is completely safe. So, we empower women to take charge of their fertility and decide when is the best time to have their baby. In absence of this technique, logon ke liya mushkil ho jata tha ki konsa sperm use karna hai. Unhein kabhi kabhi donor sperm ke liya bhi jana padta tha. So, now a woman can decide when does she want to become a mother. Ab unhein apna career hold pe rakhne ki jarurat nahi hai.And agar unhein cancer treatment ke liya jana hai toh unhein worried hone ki jarurat nahi hai ki futture mein unke bache ho payenge ya nahi. So, we give freedom to a woman and this is the message that we want to give that you have the power to decide when you want to be a mother.

Thank You.

Hi,

I am Dr. Rutvij Dalal, IVF Specialist. Today we will discuss recurrent implantation failure or the solution we have for IVF failure. We see a lot of patients who are referred from other Drs. Who has a repeated history of IVF failure, repeated ICSI. Humare pass aise patients aate hain jinhone 2-3 places pe IVF kara rakha hai. Aisa dekha gaya hai ki patients bahut jyada naraz hote hain. Unhein aisa lagta hai ki aur koi hul nahi hai. So, today we will discuss what we do here and why we excel in this field. We have a special campaign running here called faith reborn campaign which specifically raises the concern, gives extra care and attention. We enhance the quality of the eggs and make sure that eggs are of the highest grade. Along with this, we have a special sperm selection method like IMSI, PICSI, etc, We choose the best sperm possible for embryo generation. It is clear that if we select the best egg and sperm, we will generate the best embryo. Humein agar samajhna ho ki IVF kyun fail hota hai. IVF fail hone ke 2 reasons hain. 80% reasons embryo related hote hain jahan pe genetically complications hote hain and 20% reasons uterus ko leke hote hain. So, we make sure karte hain ki har patient ko individualize approach mile which the patient deserves.

We also have seen a lot of success with this campaign and a lot of patients who come to us are those that have tried IVF elsewhere but failed. And we have numerous instances that we have treated them successfully. We have tailor-made solutions to failed IVF patients ensuring that our state of the art embryology laboratory that we have. jo laboratory mein bharun ban rahe hote hain unhein ehsaas hota hai ki mata ke sharir mein hai which is the best environment for their growth. It is like the best thing which gives you the best results. Apart from that let's see what we do differently than other centers do not have. It is like a secret that why we have success rates than others. So, we have additional technologies with us. Our lab is armed with a lot of innovative technology that probably other IVF centers do not have. Many of these technologies include laser resistant hatching of the embryos. Ismein hum bhrun ke bahar ki diwar chin lete hain taki bhrun ko asani se bacha dani mein chipakane ka mauka mile. We try to do only blastocyst transfer in these challenges cases. We have the hysteroscopy evaluation of the uterus. Agar aap ka 3-4 times fail ho chhuka hai toh hum hysteroscopy karte hain. Agar andar parde ya aur koi problem hai toh use nikal sakte hain. Apart from that we do immune testing. Yahan pe ye dekha jata hai ki immunology ek reason toh nahi hai. Other than this we also check a few more problems ki vo nahi honi chaiye. Agar tube mein paani bhar jata hai toh IVF ke fail hone ke chances badh jaate hain.

So, we have to remove it before going for the IVF. Apart from that we have another technology which is called IMCI. Ye ek aisi technique hai jahan sperm ko 7000 times zoom kar ke chaeck kia jata hai. Is vajaha se hum best sperm choose kar paate hain. So, era technology humein endometrium batata hai ke aap ka sabse acha receptive day konsa hai. So, 80% ke lia humare pass best sperm selection ke ways hain. And ye tarika humein highest quality ke sperm select karne mein help karta hai. Apart from this, we can also do PGTA. Yahan hum blastocyst ke kuch cells nikal ke unhein genetic testing ke lia bhejate hain. Aur ye humein help karta hai btane mein ki kitne embryo normal hain. Agar hum normal embryos diagnose karte hain toh usmein success rate bahut acha hai. Toh ye hum un patients ko suggest karte hain jinhone pehle IVF kara rakha hai and unka fail ho rakha hai. Apart from this we have DNA fragmentation testing. Hum embryo transfer karte time use karte hain. It is something that you do in a better way and to get good results for such patients. Lastly, our clinic is the leading destination for such couples who have gone through repeated implantation or repeated IVF cycle.

Thank You.

"Hi,

I am Dr. Atul Mishra, Orthopedist. Today I will talk about total knee replacement. Moreover, the emphasis is on partial knee replacement. We all know that total knee replacement is a very gratifying procedure if done in the right patient and at the right place. This surgery is in practice for the last 30 years with a success rate as high as 97%. In this surgery, we put a surface bone above the knee. And there is high-density polyethylene in between. But it has been found that not all the patients are actually a candidate for knee replacement surgery. Particularly in the younger age group that is the age group between 45-65 years, in these patients, many times it has been found that the complete knee is not damaged. Only one compartment of the knee like middle compartment or the which is outside i.e. lateral compartment is gone.

That means the patient which has one compartment of the knee joint damaged does not have to undergo a total knee replacement. The solution for such patients is a partial knee replacement. In this, we do not change or resurface the whole knee. It is only the damaged component which is addressed to. There are some surgeries which are known as joint preserving surgeries where we change the access of the knee joint. and we do not touch the knee joint from inside. That is how we delay the surgery and this is known as joint preserving surgery. Many times, the patient does not agree to this because this has a success rate of around 70-80%. So, if patients want immediate results then the partial knee replacement is the solution. Here, we just open and we make a very small incision and we change the surface of only the compartment which is damaged. We do not touch the other compartment which is normal.

It can be done on the medial compartment, lateral compartment and in the patella femoral portion. The advantages of partial knee replacement are, it is a minimally invasive surgery, cutting of the normal bone is very less and the patient is immediately able to walk and back to the normal routine in 15-20 days. Moreover, there is no limitation of motion. The patient is able to do routine activities. Nowadays, it has also become a computer and robotic navigated. So, this surgery is being in practice for the last 30 years. And such patient who undergoes a partial knee replacement surgery can lead a good and active lifestyle for at least 10-15 years. Thereafter, if they have a problem then this can be converted into total knee replacement.

Thank You!

Hi, I am Dr. Deepak. Rathi, Ayurveda Specialist. Aaj mein aap ko piles ke bare mein bataunga. Is problem mein patient ko bohot pain hota hai. Ismein patient ko bleeding, pain or kabhi-kabhi masse bhi bahar aane lagte hain. Ismein swelling aa jati hai. Ismein wound ho jata hai and bleeding bhi hoti hai. Ye external and internal problem hoti hai. Ismein aap medicines le sakte hain ya fir surgery kra sakte hain ya fir ayurvedic sharsutra therapy le sakte hain. Is therapy se is disease ko manage and control kia ja skta hai. Ismein bleeding and pain ki problem 7-10 days mein hi control ho jati hai. Ismein internal masse shrink bhi ho jate hain. Surgery major hoti hai jismein aap ko anesthesia diya jata hai.

Logon ke liya ye ayurvedic therapy boon hai. 3-4 days mein ye thread shed off ho jata hai. Ayurvedic medicines se roots bhi khatam ho jati hain is disease ki. Is disease ko control karne ke liya aap constipation ko control rakhen. Iske alwa pani jayada piyein. Fibre rich diet len. Fruits and vegetables jayada len. Fast food and maida kam khayein. Fried chizen na khayein. Agar aap ko koi information chaiye to aap mujhse Lybrate ke through contact kar sakte hain. Thank You.

Hi,

I am Dr. Atul Mishra, director and head of the department orthopedics. Now we are talking about osteoarthritis of the knee. Osteoarthritis of the knee joint is the most common cause of pain in the knee, ghutne mein sujan, dard aur iss tarah ki pratikriya jo hai at the age of around 55 to 60 years hoti hai patients ko, isi ko osteoarthritis bolte hain. Osteoarthritis mein jo basic abnormality hai wo ye hai ki ghutne ke andar jo surface pe jo cartilage hai vo cartilage ke andar chote chote ghaav ban jate hai, vo ghaav andar bleed karte hai or pain karte hai jisse patient ko dikkat hoti hai chalne mein, roz marra ka apna kaam karne mein, sidhi chadne utarne mein. In fact, kuch mareez hamare paas is condition mein bhi aate hai jisme vo apne bed se uthke toilet tak bhi jane mein asamarth hote hai.

To hume ye dekhna hai ki awareness badhe, patients jo hai vo sahi samay pe doctori salah le paye or osteoarthritis se ek jo crippling vise jo stage hoti hai jisme insaan itna majboor apne aap ko feel karta hai ki vo thoda bohot bhi na chal paye vaise paristithi na aye. Kul mila ke 10 lakh se zada log hamare desh mein is bimari se peedit hai. Shuruvati lakshano ke andar ghutne mein sojan hona, jaha tahan ghutne ke aajo bajo aas pas dard hona, rozmarra ki activity jisme sidhi chadna utarna, niche baith ke prarthana karna, puja karna ye sab cheeze patient karne mein asamarth hojata hai. Ye bimari jo hai isme dard ek waxing and waning type phenomena hota hai, patient do mahine theek rehega or teesre mahine patient ko ye problem ayegi, phir wo kuch pain killers, kuch balm, iodex laga ke apna kaam chalata hai, problem kam ho jati hai lekin andar hi andar joint ka degeneration jo hai vo hota rehta hai. Ultimately the best possible way is to consult a doctor as early as possible or doctori salah ke andar kuch minimum amount of pain killers taki soojan aur dard kam ho vo shuru karna chahye aur ek X-ray jo hota hai jisme ghutne ki paristhiti pata lagti hai vo kara lena chahiye. X-ray se ye clear-cut define ho jata hai ki haddi ya haddi ke andar ka cartilage vo damage hua hai ya nahi hua hai.

Ek MRI scan usse bhi kafi kuch pata lagta hai. MRI cartigram naam ki ek nayi jaanch hai jo ki aaj kal hamare desh mein uplabdh hai, usme cartilage ka volumetric analysis bhi ho jata hai jisse ye maloom chalta hai ki kitna healthy articular cartilage ghutne ke andar bacha hai aur is tareeke se hum bimari ka prognosis jo hai woh determine kar sakte hai. Activity modification upchar ke liye bohot jaroori hai. 3 activities aisi hai jo ki hum patient ko bolte hain ki three activities like climbing of stairs woh kam se kam kare agar disease active hai to, niche ukdu baithna Indian style toilet mein woh kam se kam kare aur padmasan laga ke baithna yani ki ghutne ko 120 degree se zada mod ke rakhna ye aisi 3 cheeze hai jo aap apni activities daily activities mein thoda kam karein to ghutne ke andar articular cartilage mein pressure kam padega or pressure kam padega to uska wear and tear jo hai vo slow hojaega. Iske saath saath physiotherapy, regular exercises, cycling, swimming or walking iska ek apna mehtva aur apna role hai. Ye activities hamesha patient ko hum salah dete hai ki vo karte rahe taki disease badhe na.

Disease ka ghutne ke andar jo progression hai vo slow rahe. Pain killers kam se kam lene chahiye kyunki pain killers se kidney ke upar or pet ke andar gastritis, ye 2 cheeze aisi hai jispe iska dushprabhav jo hai pain killers se padta hai. Disease modifying agents kafi sare available hai aur kuch injections bhi available hai jo ki ghutne ke andar lagaye ja sakte hai, jo ghutne ko andar se lubricate karte hai or cartilage ki healing process jo hai use enhance karte hai. Activity modification aur injections in sab cheezo ke saath saath mein ek nayi padhti jisko sarkar se manyata abhi mili hai wo hai autologous chondrocyte transplant. Autologous chondrocyte transplant jo hai vo ek jo young patients hai hamare jinko bohot jaldi jo hai ghutne ke andar cartilage ka wear and tear ho jata hai khaskar chot lagne se, jab cartilage ke andar chot lagti hai, ghutne ke andar chot lagti hai or cartilage jo hai woh scruff off hoke, rub off hoke us ek chip ki tarah vo nikal jati hai, aisi paristhiti mein vo samay ke sath bohot hi kharab tareeke se ghutne ko kharab kar sakti hai.

Early stage ke andar khaskar young patients mein jinko chot lagne ke bad cartilage ki problem shuru ho, vaha par autologous chondrocyte transplant jaisi padhti jo hai vo bohot upyogi hai. Is padhti ke andar hum patient ke cartilage ke kuch cells jo hai vo lab mein regenerate karte hai aur fir 1.5-2 mahine me jab vo cells kafi regenerate ho jate hai lab mein, to fir ghutne ko chota sa incision laga ke, ghutne ko khol ke unko hum re-implant kar dete hain ghutne ke andar. Lekin ye padhti young patients ke andar kafi successful hai aur iske iski jabse abhi manyata jabse sarkar se mili hai to isse kafi mareez jo hai laabhanvit hue hai. Autologous chondrocyte transplant ke alava jab mareez ki condition aisi ho jati hai jiske andar vo cripple hona shuru hojata hai yani ghutne ki bimari ke sath mein pair ke andar alag alag tareeke ki deformity woh sab develop ho jaye aur pair tede ho jate hain, to aisi condition ke andar knee replacement naam ki jo padhti hai woh bohot kargar hai. Knee replacement surgery koi nayi ya koi vishesh tareeke se kari jane vali nahi hai, pichle 10 ya 12 saal mein is surgery ke andar bohot sare technical advancements hue hain.

Mai ye kehna chahunga ke actual mein knee replacement aisa surgery hai jo ki jisme hum ghutne ke andar pura ghutna nikal ke koi kambje vala jod nahi dalte. Basically ye surgery ki philosophy ye hai ki hum iske andar ghutne ke upar ke surface jo hai vo change karte hai. To sahi mayne mein isko surface replacement kaha jata hai. Ye ek model hai jiske andar ye ek artificial knee hai aur is artificial knee mein knee replacement kaise kaam karta hai ye dikhaya gaya hai. Jo upar ki haddi hai jise femur bolte hai usme ye is tareeke se cap ki tarah se ye upar ka component lag jata hai aur niche ki haddi yani tibia uske andar ye tibial tray ki form mein lag jati hai aur upar aur niche ke components ke beech mein ek ye high density polythene hota hai. To upar ka component is high density polythene pe glide karta hai is tareeke se aur yahi kritrim joint ya knee replacement ya surface replacement ya pratyaropad hai. Ab aaj kal jo technical advancements hai usme biomaterials ke upar nayi cheez samne jo ayi hai vo pichle 2-3 saal se naye biomaterials jaise ki gold knee naam se available hai.

Inn biomaterials ka jo sabse bada advantage hai vo ye hai ke inke implantation ke baad patient ko kisi bhi tarike ka koi allergic phenomena nahi hota hai kyunki usme ek alloy ka upar se coating hota hai. Dusri yeh hai ki woh zada uski surface property jo hai woh zada acchi hai, vo zada chikna hota hai to isse patient ko artificial jo hum surface lagate hai uski jo longivity hai vo mil jati hai. Normally ek knee replacement ka life jo kritrim joint hai uska life 10-15 saal hota hai lekin nayi technological advancement se, naye biomaterial se ab iski life 20-25 saal tak badh gyi hai. Dusra inke banavat mein, kafi revolutionary design mein, kafi technical advancements hue hai, pehle jo designs hote the wo kafi crude the lekin ab jo designs hai unki surface geometry ek is tareeke se hai joki ek insaan ke ghutne ko bohot closely match karti hai. Isilye ye knee implantation ke baad mein patient ko kafi kuch original joint jaisa hi feel hota hai, natural feel hota hai aur usme patient ko ek jo pehle ek abnormal sensation ati thi vo nahi ati hai.

Dusri cheez hai kyunki ye itna disabling disease hai aur pehle logon ke mann mein dar tha lekin ab patients ka acceptability is surgery ke liye bohot badh gya hai aur ye bohot hi safe operation hai aur agar ye ek ache centre par, ek experienced surgeon se aap karvayenge to patient ko hamesha laabh milega aur kisi tareeke ki pareshani nahi ayegi.

Thank you very much!

Hi!

I am Dr. Nitin Jha, Fortis Hospital, Noida me a senior consultant, laparoscopic surgeon hun. Stomach ke major problems ko hum laparoscopic surgery se treatment krte hain. Aaj me sabse common symptoms acidity and gas ke bare me discuss krenge. Kuch logon ko khana khane ke baad peat fulna or gas formation, khatte dakar aana or kbhi kbhi adha pacha hua khana vapsa muh me aana. Ye sab upper GI ke symptoms hote hain. Iska sabse common cause hai gallbladder stones. Iske or bhi symptoms hai jaise muh me kadva pani aana, khatte dakkar aana, indigestion hona. Isko noral condition maanke hum normal tablets lete rehte hain.

Or fir kuch time baad jab pain jhela nhi jata to hum hospital jate hain. Uske baad diagnosis hota hai jisme kbhi gallbladder stone paya jata hai or hiatal hernia milta hai. GERD me khana upar se niche jane ke baad niche se upar bhi aa skta hai. Is bimari me itna major ho jata hai ki stomach bhi chest tak aane lgta hai. Hiatal hernia ko medicines se control krne ki koshish krte hain. Ise prevent krne ke ek baar me heavy khana nhi khana, thoda khana khana or bar bar khana, khana khane ke baad turant nhi letna and thoda walk krna, in sabse isko control kia ja skta hai. Bina surgery ke hi ise thik kia ja skta hai. Lekin in sab ke bad bhi agar ye overcome na ho to surgery di jati hai.

Iska operation laparoscopy se kia jata hai. Laparoscopic nissen fundoplication surgery ka name hai. Isme hum stomach ko niche late hain. Chest and stomach k bich ke gap ko thik kia jata hai. Is se stomach abdominal cavity me rhega and chest me nhi jayega. Isme khana niche ko hi puch krega. Islia simple advice hai ki acidity and gastric problem ko avoid na kren. Iska proper diagnosis bhut important hai taki surgery tak jane ki requirement na pade. Medicines lene se bhi apko problem ho skta hai. Islia kbhi bhi aisa problem ho to consult your surgeon. Agar aap mujhse koi information lena chahen to Lybrate ke through contact kar skate hain.

Thank You!

Causes and treatment of Ear discharge