Q. I am married since three years and my husband is 39 years old. I suffer from polysistic overy disease. We consulted an infertility specialist. I was put on medication followed by IUI(Intra Uterine Insemination) but it failed two times. I was told that my male hormone level ( testosterone) is very high(4.2) and hence I was put on medication Glycomet Dexona and Rantac for six months. Earlier my menstrual periods were irregular and later on periods are not regular without medicine. Is it possible to solve this problem through allopathy? Which medication is more appropriate to cure this disease or hormonal imbalance. To regularise menstrual periods naturally what should I do ?
Sindu soman ,
Trissur.
Ans: Dear Sindhu,
When ever there are irregular periods there is possibility of hormonal imbalance. Almost all hormones present in our body are related to periods and ovulation, directly or indirectly. Thyroxin, prolactin, growth hormone, insulin are involved. Thyroxin, prolactin and insulin control is easy. Good medicines are available. Testosterone also can be brought down by a natural product (Prostacon) which binds with testosterone and reduces the active free testosterone .
You have not mentioned your age. You may be around 35. All the modern treatments work well till mid thirties. Internationally IUI is done for about six cycles in expert hands. If there is no result you have to proceed with next line of treatment, Assisted Reproductive Technique (ART). In ART within 1 to 3 attempts 80 to 90 percent success is possible. At this juncture I am afraid you may not get regular periods naturally. Many people say yoga, being happy and cool, meditation, discipline in eating habits, good exercise may help to regularize periods naturally.
Allopathy is evidence based medicine and a science. Things are explainable, have reasoning and are verifiable! Successful results are possible only through modern science. All other alternate methods are based on trail and error, belief and faith.
However, modern science cannot give you wonder pills for instantaneous cure of all problems ! Infertility is a difficult problem that could be caused by a combination of multiple variable factors. The possible reasons for a non-conception can be arrived at only after a thorough and systematic modular analysis and evaluation of the couple through a large number of tests and procedures. In our society very little importance is attached to having a good knowledge of our bodies ! So many people including some doctors think simplistically and feel that so many investigations and procedures are not necessary ! If all possible causes are found out and treatment commences, you need to be consistent abut it! That is atleast 6 cycles of IUI and 3 cycles of IVF/ICSI-ET etc , aided by laser etc techniques. Like everything in the world you get what you pay / work for ! Hope, enthusiasm, consistency and commitment with systematic scientific approach are necessary on the part of the couple and their team of doctors. If you follow that, you are most likely to succeed, sooner or later!
Q: I am a lady 40 years of age. I want to know what are the options for women over 40 years of age.
Ans: For women above forty years chances of getting pregnancy by their own egg increase if the base line FSH is less that 11 miu/ml. Second their embryos need Assisted Hatching too as it will increase the chances of implantation. 3rd and most important women above 40 should go for Pre Implantation Genetic Diagnosis (PGD) as at these age higher percentage of chromosomal abnormalities and mutation in gene observed.
The other simple and best option is “egg donation” by any younger lady.
Q : Dear Doctor, I am 44+ , a foreigner, now living in India, as my in-laws are here. My husband and I are having an adopted son of 7 years old. I had a late marriage. Back in my homeland I went for so many tests. I was told that one of my fallopian tubes is twisted and another is blocked by blood-clog of 2 inches. The doctors there told me to go for a test-tube baby. But being a catholic my people rejected the idea. My husband’s sperm test result is good and he loves children. As age caught up with me, we decided to drop the idea of getting pregnant and we decided for the adoption. My son doesn’t know the truth, for the past 2 years he is asking for a baby sister or a brother. So I told my son Mummy will get for him an adopted sister or a brother, but he insists on a baby out of my stomach ! Recently I read in the papers (Indian Express) that a lady in America gave birth to her first born in April at the age of 48 and going for second delivery (twins). This has motivated me and I felt I still have HOPE. My periods are very regular and normal 5 days flow. My womb is in very good condition, but I have never conceived not even once in my 16 years of married life. My questions are 1) Is there any possibility other than test tube baby for me to get pregnant ? 2) Even if I don’t get pregnant, will the blockage in my fallopian tube cause any kind of cancer or a threat to may life? (I am not afraid of the call of death but I have to go on living for the sake of my one and only beloved adopted son, who is very very young. As for him I am all his world. .
There is no history of infertility in any other members in both of our families. That too points that the fault lies with me !
Please help me as I am desperate and my hopes are all on you.
S.A
Ans. Dear Friend, Begin feeling good about yourself ! You are bold and adventurous, married a foreigner and emigrated ! There is absolutely no fault of yours and You are in no way responsible for the condition of your fallopian tubes. Your decision to adopt a child was very wise given the limitations you have stated. Yet, the aspirations of your adopted child for a sister or brother born to you, and your own patent or latent craving for a child of your own is only natural, unexceptional and even laudable! However at 44, age is not on your side. While conception through IVF (Invitro Fertilization) or ICSI (Intracytoplasmic Sperm Injection) is the only solution and is absolutely possible at this age, the degree of certainty progressively decreases after 35 years of age ! Rate of occurrence of congenital abnormalities (Birth defects) gets higher with age after 35. This is more a problem of the Oocyte quality than that of the uterus and endometrium. However , obtaining oocytes from a fitter and younger donor, fertilizing them with the sperm of your husband and then transferring the resultant embryos into your womb, can offer certainty of a much higher degree. This can also be done along with a few embryos derived from your own oocytes. Later we allow nature to choose what to retain and develop into a continuing conception ! Religion and religious practices will always come and go, change, transform , evolve and so on. Mankind is much more evolved and matured now than it was ever before. Religion now plays lesser and lesser negative role in enabling fine people like you make their choices.
It is time that you and your spouse choose and assert your own choice and decision. Let your in-laws, and the custodians of religion make their own choices about their own lives and not that of others. The danger you fear and presume because of the blockage in your fallopian tubes is absolutely unfounded and baseless. Relax and rest assured that such blockages are absolutely normal and natural, happen to millions all over the world and have absolutely no effect whatsoever on your health. Do not ever think of death because of this or something else ! Eat well, work well, love well everyone around you, be considerate, be cheerful and happy with all the wonderful things and people you have ! You are always welcome to aspire for more , and do not forget to exercise and play regularly till your last day. And when it is time, the whistle blows for all of us! we all have to go. But there is no need to rush for it or fear it !.
Q: Can fibroids interfere with IVF?
Ans: Fibroids are benign tumors consisting of fibrous tissue and muscle which grow in the uterus. The significance of fibroids relates to not only their size but also their location. Even small fibroids located inside the cavity of the uterus where embryos need to implant, may interface with success and need to be removed. Fibroids that do not encroach on the cavity of the uterus are generally not significant unless they are larger than 5 cm in diameter and also if there are many fibroids causing significant uterine enlargement.
Q: I have endometriosis, does this affect my fertility & also success with IVF?
Ans: Endometriosis is a condition where cells that usually remain confined to the cavity of the uterus, grow outside of the uterus usually on or in the ovaries and also on the surface of the pelvic pain and may also decrease the chances of natural conception by about one-third Patients who require IVF who have endometriosis still have the same chances of a successful outcome as patients of the same age without endometriosis as long as immunological factors that may accompany endometriosis are identified and treated appropriately.
Q . I am married for past 9 years, but I am still childless. The problem is with me. My husband is perfect. I would like to know how to find a lady who can become a surrogate mother for our child. That is can she bear a child for us with my husbands sperms. Please reply to me . Awaiting your reply. We are ready to bear the costs and remunerate her well for this.
Regards
Uma
Ans : It is necessary to have a complete fertility profile of you and your husband, before coming to the conclusion for a surrogate mother. If you have no normal production of eggs of your own, you need egg donation, either from a lady of your choice that you can organize or from the proposed surrogate herself. Once your husbands sperm and the donor eggs develop into embryos in the IVF lab, the same can be transferred for implantation into the womb of the surrogate. We do have a regular surrogate / egg donation programme at our Hyderabad and Visakhapatnam centers. In case of any difficulty for you in finding access to such a programme in your own city, you may get in touch with us.
Q : Me and my husband are 33 years old and married since three years. But we are still issueless. I am suffering from frigidity and also libido. When I consulted a gynec, I was put on medication. Ebexid, Ferty 50 mg for one month and was later started taking 100 mg and also Corion 5000. I did a follicular scan test (Report: Uterus measured 9.0 x 4.2 x 3.3cms, right ovary measured 4.8 x 2.8 cm and left ovary measured 6.8 x 3.8cms and sonography of the pelvis done on day 19 revealed that R+ ovary appears enlarged and irregular follicle of size 20 x 19 mms and L+ovary appears enlarged. There is evidence of a complex mass of size 41 x 32 mms seen in the L+ ovary and features of an endometriotic ovary) and doctor advised me for DTC but anesthesiologist suspected me of hypothyroidism. (Thyroid test results : T3 88.70 mg, T4 5.20mg, TSH third generation 3.27. My husband’s semen analysis- total count 50 mill with 60 percent active motile. What is the reason for not conceiving. Is it endometriosis and enlarged ovaries. Please advice.
S Ella, Pondicherry
Ans : Infertility is a complex problem. Before pronouncing the reason for infertility we need to investigate both partners. It may be single factor (or) multiple factor problem. Free Thyroxin levels are the main indicator about thyroid function. It may vary from lab to lab. The normal values for free thyroxin are 9-20 miu/ml. Instead of Just total T4 get Free T4 levels. According to that, supplementation of thyroxin is necessary or not can be decided.
If there is a chocolate cyst in the ovary (menstrual blood collected in an encysted cyst) ovulation will be affected. Cyst can be removed by Ultrasound guided aspiration and methotrexate instillation in to the cyst to prevent recurrence of the cyst. Laparoscopy is also helpful if there is associated pelvic endometriosis. If there is such problem, they can be fulgurated with underwater current cauterization.
Other tests like PCT, antisperm antibody either in serum (or) cervical mucus, serum prolactin levels, base line FSH, LH have to be completed for you. For husband –semen analysis shows only physical characters. There are tests to know the sperm functions. There is one final critical test to know the DNA integrity. But this is not available yet in India. One should not take ovulation induction drugs too long. There are studies , (over use may lead to ovarian cancers in the future. So it is best to consult a competent fertility specialist 3 months ovulation induction and timing of intercourse can be tried. If no pregnancy 6 months ovulation induction and intrauterine insemination is advised. Still no pregnancy IVF maximum 3-4 attempts.
Frigidity is a psychological problem to certain extent libido also depends on psychology. Please go through good books on erotica and try to overcome frigidity. To improve libido – imagination, reading, watching, talking about erotica will be helpful . Try to shed the inhibitions and make you sex life a pleasurable one.
Q : Dear Doctor, I am 32 years. I got married in Feb 1997. Exactly six months after my marriage, i got pregnant. My husband didn't want the baby. So I had to go for an abortion. Then I started taking oral pills for one year. I stopped pills as I wanted to conceive. But till today, I have not conceived. I took infertility treatment for one year. Everything was normal except for raised prolactin hormone . I was treated for it for one year . I have undergone artificial insemination more than 8 times. Then my doctor told me that I have fibroids and have fluid in my uterus and I can never become pregnant ! what is the mode of treatment for me? I am ready to undergo any treatment. Now my prolactin is normal. My scan report shows that everything is normal and my husband's sperm analysis too is normal.
ArshiaTazeen,Mysore
Dear Arshia ,
Many educated people are also doing this mistake of under going MTP for unwanted pregnancy. Prevention is always better than cure. All those getting married, should consult their family doctor well before the marriage and discuss various options. There are many safe methods to postpone pregnancy . Of all the methods, oral pills are safest for newly wed couples. Once they know each other and their sexuality, they can switch to safe period, condom, vaginal pessaries etc., But never IUCD (copper T ) or MTP are advisable to nulliparous women (who never had a child before).
Secondary infertility is a very common complication after MTP or Copper T. Because of liberal use of antibiotics infections that are visible to naked eye are not found these days. There will be microscopic damage to the tubes which naked eye cannot even notice. That is why all the reports appear normal , and yet you are not conceiving . You had seen proven potential of conceiving , within six months of marriage . The simple logic is, if you are not conceiving, definitely there is some reason. But it could not be identified with the investigations done in your case.
You have put in all the preliminary efforts. Now the best line of treatment in your case is IVF-ET (Invitro Fertilisation and Embryo Transfer ) . This gives better results in patients with tubal damage. Before proceeding with IVF, we must decide about fibroid. If the fibroid is away from endometrium ( inner lining of uterus ), no need of myomectomy ( Fibroid removal) . All the reproductive tract infections must be thoroughly treated before IVF-ET. Myomectomy can be done through laparoscopy also .
Q : Dear Doctor, I am 29 and my husband is 32. We are married for the past 18 months but are issueless. I have regular periods, once every 28 days lasting 3-4 days. I have taken Clomiphene Citrate for a period of three months. This month, I have undergone laparoscopy. Initially, my husband's sperm count was low and he had taken HCG injection once a week for three months. But now, for the past eight months, his count is normal. (latest being 40 million with 80% motility). Now he is on a herbal capsule for the past one month . Kindly suggest what should we do next.
Is it safe to try and conceive in the same month of laparoscopy? Though my husband has normal count, should he take hormone analysis .
Anita Mary, Tuticorin
Dear Anita ,
90% of regularly menstruating women have regular ovulation. Inspite of regular periods , 10% of women may not have ovulation . Sometimes super ovulation ( producing more number of eggs ) helps to conceive, as more number of eggs are available for fertilization . Clomiphene citrate is a widely used drug for ovulation induction. Whatever medicines you take, we have to monitory whether it is serving the purpose or not. Ovulation study (or) follicular study through ultrasound is a must. According to the present definition of WHO , 40 million count is normal. But count is not the final parameter to conclude fertility DNA integrity is the acid test for sperm performance .
At least sperm function tests give better idea of sperm performance . Many times and at many places, investigations are done in installments . The best way is to perform all the battery of investigations at a time. We can identify the culprit of sub fertility in one go . For example a vessel is holding water but there are leaks, if you close one or two holes, still water leaks. What you should do is close all the holes at a time if you can . Many times patients conceive immediately after laparoscopy, as thin membranous blocks in the tube get cleared due to the procedural functions carried out in laparoscopy. There is no harm if you conceive after laparoscopy. Hormonal analysis in men are helpful to correct hyper prolactenemia , hypo or hyper thyroidism etc . When sperm count is 70-80 million, hormonal analysis is not necessary Where count is fluctuating , hormonal analysis is helpful
Q : We are married for 4 years with no issues. We have been getting treatment for both of us from a Gynaecologist for more than 2 years now. First I would explain about my case.
I had checked up with a leading Andrologist who is the certifying person on the National Board for the male factor. Actively Motile (AM) : 17% With other motile factors coming to 55%. Our Gynaecologist told that (AM) should be 25% according to WHO standard but the Andrologist has told it is only 15%. Based on the wordings of our Gynaec that my Semen is best suited for IUI (report being given by another Andrology center), we had done IUI twice without success (one IUI was done in 2003 with another Doctor.
My wife's case - Our Gynaec prepares from the period date 3rd day to 7th day with Letoval/Siphene and with that 4th and 6th day with Gonal F / Ovugraf for getting the right size of follicle, and used injection Profasi / etc. for rupturing. On the rupture date she had tried IUI which did not lead to a conception. The Sperm Wash for IUI was given at a centre away from where the IUI was done. It was brought prepared which counted 25 Million in 0.5 ml. For my Wife tube testing was also done and now the Doctor says she has no clue for the failure and next thing to be done is only Laparoscopy.
Other than the preparation my wife normally gets the follicle which is sized around 1.9 to 2.2 cm with endometrical thickness of 9 to 10 mm and it ruptures around 14th day. The issue less factor is creating a lot of misunderstanding between us.
We have not changed our Doctor for the past 2 1/2 years as we felt this can affect chances of a conception. Can you suggest us how we can overcome this problem. Is there any advanced/latest method of Laparoscopy that is available. Upon hearing from you I can even send our reports scanned to you. Hoping to get your reply soon. Murali
Ans :Dear Murali, whenever there is a problem of Oligospermia [Low sperm count ] we have to look into the cause of Oligospermia. Some times we may be able to improve the sperm parameters. Basic factors that affect are (1) Lack of physical or mental rest and / or presence of stress (2) Improper nutritional intake (3) Wearing very tight under cloths (4) Having excessive hot water baths or working in close proximity to very hot areas like furnaces, underground mines, chemical inhalation or other pollutant inhalation etc.
Coming to pathophysiological factors – presence of any post operative status of hernia or hydrocele, varicocele affects spermatogenesis. High levels of prolactin or imbalance of thyroxin can affect spermatogenesis. If you have any of the above it has to be corrected. Change your life style. Take good balanced diet. Do some regular physical exercise, especially some form of aerobic exercises. Relax mentally. Some times medicines like Clomiphine Citrate, Tomoxifen, Vitamin E, some Ayurvedic perpetrations etc also help. The total course may be for around 6 months.
In practice we are experiencing good result with IUI treatment in cases with good motility (30-40%) and count 20-30 million. In Biological sciences there is no fixed rule. Exceptions are there. Rarely I have come across people that conceived with less than 5 million count at home. So ultimately systematic way of approach to a case like yours is (1) Do investigations to find the reason for Oligospermia. (2) Start medications to improve count (3) can proceed with IUI for six continuous cycles. Either before or in between the course of IUI – Diagnostic + operative laparoscopy can be done. If there is no success even after 6 cycles of IUI treatment , then we could proceed with IVF – ICSI (Invitro Fertilisation – Intracytoplasmic Sperm Injection). It is advisable to be prepared for three attempts of this procedure.
In nature, the fertility (or) fecundity rate of every person is not same. So even normal people at home take different periods, say, anywhere one month to three years to conceive . So when we are doing some artificial methods, do not expect miracles. We must be patience and show perseverance to succeed in any thing in life. Effort with Patience pays !
Q : What is ovarian reserve? or a biological clock ?
Ans : A female fetus starts out with more than one million immature eggs and this number decreases steadily so that at the time of puberty, there are approximately 200,000 eggs remaining in the ovaries for future ovulation. Many eggs are recruited each month but in a natural cycle only one egg matures. Menopause refers to the time when all viable eggs have been sued up & this generally occurs in the mid to late 40’S, The biological clock therefore refers to the time starting with puberty & ending with the menopause during which the number of eggs decreases steadily. As a women. Approaches menopoause, the ovaries become more resistant to stimulation producing fewer eggs that they did in the years before. For some women this ovarian resistance can start in the 30’s & even occasionally in the teens and early 20’s. There are number of ways of estimating ovarian reserve: the most common is to measure the FSH & LH on the second or third day of the menstrual cycle. An FSH level over 10 suggest the onset of ovarian resistance.
Q. I am married since three years and my husband is 39 years old. I suffer from polysistic overy disease. We consulted an infertility specialist. I was put on medication followed by IUI(Intra Uterine Insemination) but it failed two times. I was told that my male hormone level ( testosterone) is very high(4.2) and hence I was put on medication Glycomet Dexona and Rantac for six months. Earlier my menstrual periods were irregular and later on periods are not regular without medicine. Is it possible to solve this problem through allopathy? Which medication is more appropriate to cure this disease or hormonal imbalance. To regularise menstrual periods naturally what should I do ?
Sindu soman ,
Trissur.
Ans: Dear Sindhu,
When ever there are irregular periods there is possibility of hormonal imbalance. Almost all hormones present in our body are related to periods and ovulation, directly or indirectly. Thyroxin, prolactin, growth hormone, insulin are involved. Thyroxin, prolactin and insulin control is easy. Good medicines are available. Testosterone also can be brought down by a natural product (Prostacon) which binds with testosterone and reduces the active free testosterone .
You have not mentioned your age. You may be around 35. All the modern treatments work well till mid thirties. Internationally IUI is done for about six cycles in expert hands. If there is no result you have to proceed with next line of treatment, Assisted Reproductive Technique (ART). In ART within 1 to 3 attempts 80 to 90 percent success is possible. At this juncture I am afraid you may not get regular periods naturally. Many people say yoga, being happy and cool, meditation, discipline in eating habits, good exercise may help to regularize periods naturally.
Allopathy is evidence based medicine and a science. Things are explainable, have reasoning and are verifiable! Successful results are possible only through modern science. All other alternate methods are based on trail and error, belief and faith.
However, eatments work well till mid thirties. Internationally IUI is done for about six cycles in expert hands. If there is no result you have to proceed with next line of treatment, Assisted Reproductive Technique (ART). In ART within 1 to 3 attempts 80 to 90 percent success is possible. At this juncture I am afraid you may not get regular periods naturally. Many people say yoga, being happy and cool, meditation, discipline in eating habits, good exercise may help to regularize periods naturally.
Allopathy is evidence based medicine and a science. Things are explainable, have reasoning and are verifiable! Successful results are possible only through modern science. All other alternate methods are based on trail and error, belief and faith.
However, modern science cannot give you wonder pills for instantaneous cure of all problems ! Infertility is a difficult problem that could be caused by a combination of multiple variable factors. The possible reasons for a non-conception can be arrived at only after a thorough and systematic modular analysis and evaluation of the couple through a large number of tests and procedures. In our society very little importance is attached to having a good knowledge of our bodies ! So many people including some doctors think simplistically and feel that so many investigations and procedures are not necessary ! If all possible causes are found out and treatment commences, you need to be consistent abut it! That is atleast 6 cycles of IUI and 3 cycles of IVF/ICSI-ET etc , aided by laser etc techniques. Like everything in the world you get what you pay / work for ! Hope, enthusiasm, consistency and commitment with systematic scientific approach are necessary on the part of the couple and their team of doctors. If you follow that, you are most likely to succeed, sooner or later!
