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 husband's 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.

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 endometrial 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. I am married since three years and my husband is 39 years old. I suffer from polycystic ovary 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!

Q: Madam, I am Swati from Orissa. I read you in the Indian Express, Your solution towards the problem  are satisfying to me. So I am contacting you and  need your help. Mam , my problem is -- my breasts are too big.  Since there is no pain in the breast area. There  is no noticing spot or any mark. The problem is the size of the breast. I am  using sport bra but this is not satisfied. So please tell me how  to reduced the size and shape of the breast. any medicine or  any exercise may help me please consult. My weight is 60 and I am 25+.  I need your help.
Swati, Bhuvaneshwar.

Ans : I do not think you really have a serious problem just because you have big breasts. Good sized breasts have always been held as a sign of good health and good fertility of a woman in almost every culture and civilization in the world for thousands of years. All the great sculptures of Goddesses and courtesans of the gods are a testimony of this. So much so that even some world class beautiful woman are seeking to make the good sized breasts they have into even bigger ones! Unless you are very short, that is below 60-62 inches, your weight does not appear to be excessive. You do not complain of pain. So you have no physical or physiological problem. In fact you are blessed with something for which many others are dreaming, praying god and doing many things that are some times desperate! However this is not to say that the psychological and cultural discomfort you seem to be experiencing is to be brushed aside or slighted away. Unfortunately the level of culture and civilization in India regarding the respect and dignity women deserve from the men is very low, un worth and crude many a times. Due to such phenomenon, most mobs above the age of puberty tend to stare or oogle at women, more so if they have prominent breasts. They are unmindful of the discomfort and disconcert  that is caused to women like you. This  and a few other problems will continue to cause this kind of social and personal damage to innocent people like you, till the Indian Society changes for better, and sooner !

However, If you wish to avoid stares you can dress in sari, salwar kameez or zeens and Tshirts in a way that your breasts do not show out too well. When everything seems to be as nice as you have, contemplating breast reduction surgery appears totally un-warranted to me. Changes in diet and exercise can only affect their size, shape and lift to some extent along with your body in a overall sense. Consult any MBBS doctor or a physical education instruction and ask them for specific exercises for pectorals.

Q :I was married in March 99. I don't have children yet. We approached an IVF Clinic at Visakhapatnam. Both my husband and myself have undergone all tests. We were told that my husband's sperm count is less and all reports on my side are okay. His sperm count was 16 million per ml as per semen analysis about two years ago. My husband took treatment with the same doctor for five to six months. But there was no improvement. Later, I underwent artificial insemination at Vijayanagaram. But that did not work either. Six months ago, we heard some where that homoeopathy and Ayurveda can give better results. Hence we shifted to homoeopathy medicines. My husband has been taking this treatment for the last six months. Recently, he was asked to get his semen analysis and the count has fallen to 8 million. Is there any way to improve his sperm count? We cannot afford test tube baby centres. I am now 31 and my husband is 34. Kindly refer us to a doctor in Visakhapatnam. Roopa Devi, Visakhapatnam

Ans : Whenever there is low sperm count problem – Investigations have to be done to see if there is any treatable condition like hydrocele, hernia (or ) varicocele – that can be corrected surgically. Lack of sleep or rest, extremely hot work place (or) , lack of balanced diet (or) excessive fatigue or traveling etc do lead to low sperm count. Life style changes, proper diet, exercise, pleasant disposition etc can improve sperm count. Addictions like smoking, pan parag, alcoholism , severe depression etc can cause this problem. So one has to avoid such factors. . Some times alternative treatment may be helpful. As there is no definitive treatment for oligospermia, people do change treatment from one line of treatment to another line of treatment. There are no short cuts for this problem. Try medicines and life style changes. If there is no improvement IUI-[Intrauterine insemination] upto six cycles  is necessary. Still no improvement ART –Assisted Reproductive Technology is essential (IVF, GIFT, ICSI etc). Ultimately if money is a restraint, think of semen donation. It is an internationally accepted line of treatment. If necessary precautions are taken by the doctors, no problems do come from this treatment.

In Vishakapatnam we will offer free consultation for you at our branch. You can come in and discuss in person.

Q : Dear Doctor, I am 29 years old, married for the last 2 years, I attained menarche at 13 years and had regular cycles [with dysmenorrhoea ] until November, 2003.
During that November, I had delayed cycles (8 days) and prolonged bleeding – (almost 45 days) which was not controlled by cyacin. My next cycle on December, 25th  was normal (4/5 days).

The subsequent cycle was on January 31st, 2004 which lasted for 2 days   with scanty bleeding. Then since February 7th I have been having bleeding (though scanty) everyday. On February 20th I was put on Regesterone and my bleeding stopped. I have been advised Regesterone for 6 months to regularize my bleeding.
Since we have been using barrier method of contraception for the past 2 years and are planning a pregnancy now, should I wait for 6 months. Harmonal tests reports are done on 18/12/2003  - FSH-2.92 mIU/ml, LH – 50.43 mIU / ml . What is your advice ?
Thanking you, Jayanthi. 

Ans : Even though you are following barrier (condom) prevention, there is a possibility of pregnancy if some amount of semen leaked out of the condom when a couple relax after ejaculation without withdrawing penis or when erection is lost soon after ejaculation and semen spills out automatically. Sometimes a tear / tare could occur to the condom if the air in the tip was not expelled before putting it on or when a sharp nail of either partner comes in contact. Some couples have intercourse without a condom for some time and only then put on a condom before ejaculation.  When there was no condom, sometimes spermatozoa does pass out through the lubricating secretions of the male. There are a few other similar possibilities / situations where spermatozoa can enter the vaginal passage and lead to pregnancy. After delay of periods, if you have prolonged bleeding, pregnancy is one possibility. When such problem arises scanning will be helpful. Sometimes DDC will solve the problem. Registrone is useful only in cases where there is hormonal imbalance. If you wish to wait another 6 months for pregnancy, do follow proper family planning method. Along with barrier method, during ovulation period (12-18th day of cycle in regularly menstruating women), you can combine local spermicidal tablets (To-day), sothat conception does not occur when it is not planned. 

Q. We have been married for five years now and have no children yet. We had undergone medical examinations for both of us. My ovulation and other aspects were found normal (ultra sound scanning done).While my husband's count was 20-30 percent, his motility rate was found practically nil (active motile zero and sluggish motile 5 percent). He was having grade III varicocele and had undergone surgery and took profasi injections for eight weeks. Still the motility didn't improve much; only upto 3-5 percent. For the last one year, we are taking ayurvedic treatment since the other doctors told us that the only way for us is ICSI.

What are our chances for having a child? I am 28 years old and my husband is 37. Can't we go for intra uterine insemination? I have read that while opting for ICSI, the woman has to take hormone treatment for producing multiple ova. Does this hormone treatment have any side effects? Will this prove harmful to me in the future? Considering our age, how much chance do we have for a successful ICSI? I would also like to know whether we can avoid multiple pregnancy. I would be really grateful if you can provide us proper guidance. Preetha S. Menon, Kerala

Ans : Dear Preetha, you can safely rule out efforts for Intrauterine Insemination [IUI] with this kind of motility record. While it can not be ruled out that some herbal ingredients of Ayurvedic medicines may be fractionally helpful in improving some general parameters, there has been no scientific material that indicates dramatic improvements which are what would be needed in your case. Tens of thousands of woman undergo the procedure of Invitro Fertilization [IVF], Intracytoplasmic Sperm Injection [ICSI] every year all over the world. Long term side effects are not usual. Considering your age, you are among the very good result age group. Apart from age factors like baseline FSH, LH, ovarian reserve, oocyte quality, serum estradiol level, fertilization rate, cleavage rate, embryo quality and number, implantation factors etc are also to be reckoned with. In Indian situation most couples undergoing IVF procedures are happy about a twin pregnancy. In most cases you take recourse to the option of selective reduction if more than two embryos found to have implanted. This is a safe procedure. If you so wish, even in the case of a twin pregnancy, one embryo can be dealt with selective reduction procedure, though that is not what we normally advice unless the mother is bound to be having serious medical problems and a twin pregnancy can effect her health seriously.

You must however understand that there is no guarantee of a successful conception resulting from a solitary ICSI attempt. It is advisable that you are prepared for upto three attempts. The success rate for procedures of IVF-ICSI-ET are dependent on multiple factors. The more co-ordination and carefulness on part of the patient and the team of medical professionals involved, and emphasis on individual details, the better are the results. We wish you success in your endeavours.

Q :0 Hi doc, I came to know about u in women's life and I believe you only can only help me. I am a 22 year old college going woman suffering from dysmenorria(abdominal cramp).I have consulted many gyneacologists but in vain. It started about six years ago? Its unbearably painful. Not only this, I also vomit frequently and have killer headache at day same time. This happens only on the first day and other days are normal. My monthly is very regular. I took m2 tone and ginette 35 on advice of my doc for 3 months. During this period of medication I don’t feel any pain and I thought Its fine. But after my dose is completed it started again. she advised me to continue for 3 more months and see. Right now I m taking this tab but I am afraid the same thing will happen after completing this dose. My USG result declare that everything is normal. I don’t understand what to do. This is creating a lot of problems especially during my exams. I am really helpless. please help. sujata.

Ans : There are various reasons for dysmenorrhea . The so called natural pain during periods for most of the young girls happens in three different ways. In spasmodic dysmenorrhea, the uterus contracts spasmodically to expel excessive menstrual blood, or to expel any blood clots or if the inner side of the uterine opening (internal os) is too small and tight or some other similar factor. That gives rise to pain. Congestive dysmenorrhea occurs due to excessive blood flow to reproductive organs during menstrual flow. This results in pain. In membranous dysmenorrhea, the cast off endometrium is shed out as a single entity through an undilated cervix and that leads to pain. Other than these, pain can occur due to some pathology like (1) Uterine fibroids, (2) Endometriosis – Some collection of menstrual blood in the lower abdomen - for example uterosacral ligaments, Pouch of Douglas, ovarian tubes, uterus etc (3) Pelvic infections. The symptoms you have are suggestive of endometriosis. The investigations through which we can come to conclusion are Color Doppler study of pelvic organs, diagnostic laparoscopy, if necessary inclusive of operative laparoscopy, MRI of pelvic region etc. Many patients and doctors hesitate about Diagnostic Laparoscopy on the ground of patient being still not married. If this is postponed too long, every month there is bleeding in the pelvis and that leads to adhesions between the organs. Ultimately it is called frozen pelvis and has to be dealt surgically. This can also lead to infertility. So you better get investigated rather than undergo only empirical treatment. Pain killers can be helpful temporarily.

Q. I am a regular reader of “HEALTH” I have found many of the health tips very useful. Many of them have really worked out well for me. I am a 25 years old young lady perusing my Masters degree in Agriculture. My problem is that I have very small breasts. I am underweight too. I am 5’1” feet and weigh 43 kgs. My friends make fun of me because of my small breasts. They make petty jokes. This embarrasses me a lot. It has made me mentally weak. I have lost confidence in myself. I wish I could have an attractive personality according to my age. I am really put down among my friends circle. Please help me in this regard. How I can improve my breast size, increase my height and weight. I have consulted many doctors for increasing my weight. But the medicines prescribed by them have done no good to me and is a mere waste of money. I hope you will really help me out . I always have a good diet which includes vegetables, curds, milk, fruits, ghee etc. But none of them have helped me so far. So please help me. Jyothsna Bhatt.

Ans : Hey young lady! You have no problem at all ! All breasts, big or small, are beautiful. They also perform their physiological functions well irrespective of the size or shape. Again at 5’1” you are not a pigmy by Indian standards. You are definitely of average height. There have been so many women of your height in the public domain – dance, music, stage, films, academics, socialites – who have won acclaim , applause and appreciation! The only place you may find your height a disadvantage are beauty / modeling contests! There are a million more wonderful things in this world that are better than those two !

Growth of height stops latest around 18-20 years of age. Some fools or rogue medics may tell you of stupid methods to enlarge / elongate your leg bones! Beware of them and shun them. The single universal beauty quotient (measure) for men and women, which has a scientific and aesthetic basis, and knowingly or unknowingly appeals to human perception all over the world for centuries, has been waist hip ratio! Divide your waist (taken at the narrowst part – just below the lowest rib above your novel) size in inches / cms with your hip size ( taken at the broadest). Even if you eat well, you may not gain weight if you have worries and are under stress and strain . Some people may have a high basal metabolic rate and expend more calories for day to day activities. Some may have chronic tonsillitis / urinary tract infection / respiratory infections. Get investigated for Thyroid hormone profile and rule out any problem there. Undergo mountoux test and rule out sub-clinical tuberculosis . Eat food that contains lot of protein, calcium, vitamins and minerals- take atleast 200gms of soya food everyday. In spite of all this if you still do not gain weight, you can request your doctor to consider prescription of anabolic steroids. Buy a good book on body massage, learn and practice massaging your breasts for about 15 to 20 minutes everyday. Any ratio that is 0.70 to 0.90 is in the range of extremely beautiful to averagely beautiful. In all probability your ratio will be a good one! You need to know that beauty and sex appeal are not things that are only medical issues. Most of the time they are not medical issues at all ! They are mostly about accentuation, disposition, presentation, inclination etc! Take good care of your hair and the way you style them, keep your skin clean and moisturized, bleach body hair, do eyebrows, do some yoga postures for about 10 minutes daily, do body shaping exercises, since you are under weight get hungry through play/ exercise and hog food with abandon, just push more of it down even if you don’t like it, practice well with shoes and sandals with 4 to 6 inches platform and wear them when it matters to you to look tall, wear your sari, salwar kameez or western outfits in a manner that accentuate whatever figure you have, padded bra is not a bad idea, be cheerful and smiling, let your eyes sparkle, develop pleasant manners and disposition, be out going, do not consider going out with men for coffee/lunch/movie/picnic etc a taboo.

While you are thus transforming slowly but steadily, make excuses and keep away from friends that have so far been nasty , petty and mean to you about your looks, find and cultivate new friends and new social, study and cultural groups for interaction!

And lo! You will be the cynosure of all your old friends, however big breasts they may have or tall they may look ! But all this cannot come with a mere wish! You need to get hold of books with there different subjects, read and understand them, practice them by trial and error, learn tips from those who are od at any of these things, and use your imagination !

Not in the least, you should develop your grasp and acumen over the subject you are studying now by going out much beyond what is in text books, acquire some insight about it through practice and observation and from latest research material available around, develop good awareness about things in general around us through newspapers, magazines, TV. And if necessary, use internet to find new friends and groups ! No Pain __ No Gain ! After all this intensive work, you will be a new person ! If still you perceive that your breasts are not large enough, you must know that it is not your business!

Your Business would be to find a nice man for spouse that will find you wonderful, the way you are ! If you/your spouse are still not happy after all this, you can consider breast implants at a later date. Good luck to you in all your endeavours !

Q ) I am a 36-years-old lady. I have lost desire for sex. I just do not feel like having sex with my husband. My vagina is very dry. Please advice what to do in this matter. I have become dis-interested in sex. Please advice. Sravana P.S.Mangalore

Ans : A normal sexual drive in a male or female of us depends primarily on the hormones and health condition of a person. Hormone Analysis is necessary for serum estradiol, testosterone, DHEA, Free thyroxin, Prolactin etc. Kidney failure, any chronic illness such as diabetes, blood pressure, prolonged sub clinical viral infections, certain medications are the possible medical conditions for loss of interest/ desire about sex. If there is nothing wrong about these you are basically a sound material ! Next comes the social conditioning since childhood, the kind of marital life your parents lived, the marital life of any elder brother and sisters, your own exposure in real life and through friends, books, Tv and movies to matters related to love and sex, various types and scope of interaction you have had with males of different ages in the society, their attitude and behavior towards you etc , before and after your marriage . The kind of physical and emotional bond that has evolved or not evolved between you and your husband, the kind of mutual respect, affection, caring and consideration you two have shown to each other in different aspects of day to day life including matters related to the sexual arousal, timing of ejaculation, orgasm etc in you two is of great importance. The type of response system that has evolved in you as a result of all the above is what determines your sexuality at this stage in your life. You say you ‘have lost desire for sex ‘ ! If your expression is accurate , you did have it before you lost it ! It is a much better situation than having never had it at all. We Indian families, even wife and husband, do not discuss sex openly and transparently. We just do it. Any relationship problems you may have with his career advancement, remuneration, problematic or unsuccessful business, his not giving time to you and / or your children, his- dis-interest in taking you out to your satisfaction, any fear or suspicion you may have about any real or perceived activity of your spouse concerning his interest in other women or being very differential to them etc, could also be the cause of such ‘loss’. Execive obesity, disinterest in being fit , presentable , clean and hygienic in any of you two also can cause this ‘loss’. In essence, any kind of breakdown in communication and understanding in a long term sexual relationship in a marriage, its underlying grief, hostility, anger, depression or sense of mis-understanding can often be the cause for such a loss.

All of us in India spend most of our earnings on a home, assets, jewellery, clothes, investments, business expansion and some time on medical expenses. We spend a lot less than we ought to, on books, CD’s etc , on any workshops about lifestyle and life management, library memberships, using club or gym facilities for game, sport or exercise, family picnics, non hectic non – hasslesome cool holiday travel etc. Begin exploring your own personalities, do everything possible to enhance it, become as pleasant and charming person as possible, take to regular physical exercise of some kind, do buy and read good books on love and sexuality, some erotic literature, CD’s , movies etc., meet friends and attend parties where people with culture and polish interact in a more open, less inhibited and humorous manner, and so on! Discuss and interact with your husband more openly, show more consideration and understanding than you normally do, be kind about his drawbacks and weaknesses if any, do your best to help him over come them. Do not hesitate to think erotic or fantasize whatever appeals to you ! Be more social, be a more open person, do not hesitate to pay and receive compliments from your spouse and other interesting people around ! Be confident and charming . Your sexuality will again sprout and develop and could even grow stronger and more mature and expert than it ever was ! You will surely get what you work for ! But work, you must !

Q1.Dear Doctor, I am an 18 year old girl of height 4.11 ft and weight 38 kg. I am very thin. My periods are irregular. I was advised to take Fefol and calcium tablets. Please suggest some exercise or diet to enhance my growth. Gouri.

Ans : Dear Gouri, There are hundreds and millions of girls in India and rest of the world who are shorter or of about your height ! It means that there is nothing wrong with your height. Growth in height comes to a stop in a couple of years or a little later, once the girls attain puberty. Better and balanced nutrition and sustained physical activity (sport & game) is resulting in increased heights in most populations around the world. You are past that stage. So it is time to make the best of other things possible for you to enhance physical appeal and other aspects of your personality for a healthier, happier and a more youthful life, over a long period of life. It is highly advisable that you begin playing some sport or game, two or three times a week, and some strengthening and endurance exercises for another two or three days. Spend an hour at the minimum in this. Since you are lean, you need nutritious diet that has vegetarian or animal protein, fat etc apart form lots of fresh green salads, fresh fruits, egg, milk, curds, sprouts. All this will give a shapely body, nice skin and hair ! Try using sun glasses and an umbrella / cap /helmet etc whenever you go out in sun during any season. Use a moisturizer every time you shower or have a wash. Study a few books and magazines that give you lot of tips about grooming and being presentable. Improve your general knowledge, awareness, communication skills, be cheerful always, be nice to everyone around you and be firm when needed. All these things will make you a wonderful person and give you nice and pleasant life, body and mind as well.

Q.Dear Doctor, My name is Raji, a 20 years old young lady. I am doing my final UG. My problem is with my menstrual cycle. My menarche has started when I was 13 years. I had regular periods for only a few months. Then it became irregular. Earlier I had periods once in a month, then once in two months, then once in three months. At first I thought it would become normal soon. When I consulted a doctor she also said so. But it was not so. Nowadays I do not know when I will get my periods. I got my previous periods after 4 months (that also after I had a tablet) before 3 months. I heard that cod liver oil will regularize periods. So I am taking Cod liver oil capsules. But no use. I am now having symptoms for menstruation but it (menstruation) is not occurring. What can I do for this problem? I am also having extra growth of (unwanted) hair all over my body (except lips, palms and feet). I am un-comfortable socially. Because of this so much stress and tension is brewing in me. I have developed inferiority complex. Is there any remedy for this ? Is there any relation between hirsuitism and irregular periods. Please help me.

Ans : Irregular periods and hirsuitism are clearly related. The problem starts with irregular periods, slowly progresses with hirsuitsm. Hirsutism is frequently associated with PCOD (Polycystic Ovarian Disease). Here male hormone is secreted more. The causative factors for Hirsuitism are (1) Ideopathic (or) Familial – runs in families. Such people may have elevated levels of androstanediol glucoronate. (2) PCOD – Here irregular periods , reversal of hormones FSH:LH ratio, obesity, anovulation (lack of  egg production) are the features. (3) Adrenal enzyme defect  (4) Ovarian or adrenal tumor.
Diagnosis can be made through certain investigations

Coming to the treatment part – If it is familial origin- general cosmetic measures electrolysis, waxing etc. and even bleaching  sometimes could be useful over the parts wherever you think it is needed. Many men in Indian culture do not find it really offensive if a woman has a hairy body, other than the face.  In fact in many cultures in India it is believed that women who have more body hair have a high sexual drive and this factor by itself causes a stirring in many men ! It is only hair over upper lip and on the chin that  could create a feeling of discomfort and disquiet among some men that need to feel good about you and thus affect your marriage prospects. But once this is taken care  as above, you may be able to find yourself acceptable.    If PCOD is there – oral contraceptive pills are useful. Anti androgens like spirinolactone 50-100mg daily along with pills can be taken in consultation with your Gynaecologist.  

Cyproterone acetate, another potent antiandrogen, 2mg/day can also be given. Flutamide 250-375mg/day too can be given. All these drugs need to be given for longer periods like 6-12 months.

Proper diagnosis has to be made by either by an endocrinologist (or ) a Gynaecologist. To come to a conclusion, investigations are necessary. Other than familial hirsutism, supervision of specialist for medication is necessary.

Q: I am 30 and my husband is 35. We got married 2½ years back and trying for a kid since 1½ years without any result. My periods are very regular i.e once in a 28 days lasting for 3 to 4 days. As per the semen analysis of my husband six months before, the sperm count was 58 million / mL, mortility 50%. My Gynaecologist prescribed me Barkeit, Naturogest, Fortomid and Hey-Fote, Foluix to my husband. Still I did not conceive. Then we decided to try 6 months for a natural conception but failed. After trying these six months, again my husband got his semen tested on 3rd Feb-04. Just before that day i.e on 2nd Feb-04 we had sex. The harassing report came out like this - count 7 million / ml, mortility 80%. Our Gynaecologist suggested to test again with two days abstinence and the newly done semen analysis says count is 80 million / ml with 80% mortility. Is this fluctuation normal ? please answer.

Under this situation one gynaecologist suggests me to go for ultrasound and biopsy of the uterus and another suggests laparoscopy. Please advise me what should I go for ? Will I be able to conceive ? What should be the plan for intercourse. Should we do intercourse every day from 12th -16th day of menstruation ? Kindly advise me in detail ? Kabita Mahapatra, Balasore, Orissa.

Ans : Infertility is defined as the inability to conceive even after one year of unprotected intercourse. As already 2½years are over since you got married, it is good to investigate the cause of infertility. Both man and woman put together, there are about 10-12 factors for this problem. All those factors should be normal. When any one or more of the factors are not satisfactory, this problem arises. Many people do not understand this and advise few tests on each occasion. That is why treatment gets prolonged. It is better to investigate thoroughly at one go and then come to a conclusion and start necessary treatment. In case of female partner, routine blood tests, hormone analysis, histosalpingography , endometrial biopsy, post coital test, antisperm antibody and, sometimes laparoscopy should be done. In case of male – routine blood tests, hormone analysis, semen analysis, sperm function tests, scrotal scanning etc should be done. The major line of treatment could be (1) Just medicines, Follicular study and timing of intercourse (2) Follicular study + intrauterine insemination (3) Assisted Reproductive Technology (GIFT, IVF, ICSI). Get all the tests done so that no stone is left unturned. If we know the reason, treatment becomes easy and fast. Do not get confused with different opinions. Though the diagnosis and treatment of infertility is in itself a highly specialized field requiring constant study, first hand practice, observation and evaluation of different approaches , in most places it is a Gynaecologist with a busy Gyanaecological and obstetric practice that is approached for advise and treatment. And most Gynaecologists are averse to consulting a fertility expert for their patient as all such experts too have only the qualification of an MD/MS in Gynaecology and Obstetrics. There is yet no structural super speciality courses like D.M /M.Ch etc available for infertility. This does complicate things in this age of transition. You can have intercourse with 24-36 hrs gap during ovulation period. Good luck

Q: I am a Government Employee who has undergone tubectomy five years back. I have a daughter of 6 years, for which I am getting special pay. Now my wife is insisting for the second child. Is it possible for me to go for an operation. George Kurian, Tripunithura

Q:My marriage is fixed on eighth of next month. I would like to have a child after one year. So I want to know about the safe period. Is it true that we can have sex during the safe period without any preventive measures. I am eagerly waiting for your reply. Megha, Pallakkad

Ans :If intercourse is done at the time of ovulation , pregnancy can occur. Ovulation(egg release) time changes with the length of periods. If the menstrual cycle length is 28 days, ovulation occurs around 14th day of periods. 2-3 days before and after ovulation period is called danger period as spermatozoa can be alive and kicking even upto 72 hours. During danger period either condom or today vaginal pessaries are useful. If the periods are irregular – ovulation period is approximately 14 days minus expected date of period. If calculation of ovulation is difficult, such people should follow either condom, oral pills (or) Today vaginal pessaries. It is good that you are asking before marriage. Many educated people are also neglecting to find out well in advance and come for abortion later . Before conception people are not serious. They only realize after pregnancy confirmation. However you must understand that safe period is not 100% safe ! 15-20% of the time ovulation can occur very early or very late. So the best method is contraceptive pills or condom. My personal advise is condom. Try to go to a library and read the answers given in this column on how to use a condom properly and correctly.

Q :First of all, my hearty congratulations to you and New Indian Express for invaluable service to the infertile couples. About me : a M.B.B.S doctor, aged 42 now , physically, mentally and sexually normal. About my wife : aged 44 now, PCOD with secondary infertility, not a diabetic or HT. Hormonal profile –normal, Tubes patent. We are married since 15 years, have only a daughter aged 8 years now, born by repeated stimulation with clomiphene citrate 100 mg and natural intercourse, delivered by emergency LSCS ecause of severe preeclampsia. My daughter is suffering from cerebral palsy. For the past three years, trying for the next baby, we are undergoing repeated stimulation with clomiphene 100mg, with FSH, (Gonal-F) and IUI (done 6 times) but without success. My question is: considering our age, and low success rate of IVF, Is it worth trying IVF ? Kindly help us, please.

Ans :I have carefully gone through your medical history. The treatment you are undergoing now holds good for people of younger age say below 35-37 years. Specially in women, as the age advances, genetic changes take place in the oogonium. This reproductive cell is exposed to external environment (chemical radiation, temperature etc) from birth to menopause. Because of that the oocyte quality is affected. Your first child is suffering with cerebral palsy. It could be due to intrapartum complications. With advanced maternal age, fecundity rate falls down and rate of congenital abnormalities raises higher. At this juncture, If you want a healthy child, I suggest you to go through IVF. You could either opt for a surrogate mother from the embryo made out of your sperm and the oocyte of your wife. But this would only take care of enhancing IVF embryo implantation rate. The female age related abnormality rate is un-affected. A better option, if acceptable to you both, is to go in for a donor oocyte for fertilizing with your sperm. Such embryo could have a much better rate of implantation. You can also opt for a young surrogate for such an embryo, if you can organize one for your selves. This will result in a much better rate of implantation. The health and intelligence quotient of a child is mainly dependent on nutrition, prevention of maternal diseases like PET, Diabetes etc during antenatal period, and proper oxygenation during delivery. Do not give too much of importance to chromosomes.

Q. I am 19-year-old girl who attained puberty at the age of 11. My periods were irregular for two years, but after that it was normal. Now it has stopped abruptly. For the last three months, it has not occurred. Please tell me what the reason could be. What should I do to make this normal? For the last three years, I have had severe menstrual pain. I was taking the ayurveda tonics Ashokarishtam, Kumarasava and Saraswatarishtam, and the pain stopped. Also, I am a pure, dutiful daughter. I used to masturbate sometimes, but I am pure in my character. SSP, Coorg

Ans :If you do not get periods regularly at this age – it can be due to stress or over weight. Take balanced diet, do good exercise, keep yourself stress free. You can have a checkup with your doctor. You may need ultrasound scan of pelvis, hormone analysis (T3, T4, TSH, Prolactin, FSH, LH) etc. 5mg Progesteron (Primolut N) daily two for 5 days from 25th day of menstrual cycle every month is sufficient to make your periods regular – provided all the reports are normal. Masturbation is something natural for most people in the world – men and women. Because of the social customs, cultures, the way of life, people do not and cannot mate whenever and with whoever they feel like. Yet it is not possible to suppress the natural and universal urge to mate that gets precipitated once too often in different people at different times. By masturbating you are able to meet the challenge of such an universal and natural urge and surge in a peaceful and harmonious manner. You are able to neutralize such a powerful overpower, without in any way affecting the society around you, without seeking any personal or family trouble!. So have no guilt feeling of any kind at all about masturbation. And do not be bothered about being pure and all. Being pure is having a pure heart and soul. It is left to each individual to make their own considered and conscious decisions about when and with who to have sex. Having or not having sex at a particular time period or with a particular person is not test for the purity or the lack of it of any person !. Take good care of yourself and lead a good life happily, the way you feel like !