Ovarian reserve is the pool of eggs present in the ovaries at any given time. Low ovarian reserve is when there is a physiological decrease in the number of eggs, resulting in an insufficient number to ensure a reasonable chance of pregnancy. Generally, it is caused by aging ovaries. Patients can have diminished ovarian reserve but intact ovarian function.
Females begin life at one of the earliest stages of development with millions of eggs. Unfortunately, a vast majority of them decay before they are ever needed for reproduction. In Utero, there is a rapid multiplication of germ cells starting at six to eight weeks. By the time the female fetus is 16-20 weeks, she has a peak of six to seven million eggs. This number declines to one to two million eggs at birth, falling even further to 2,50,000 to 5,00,000 eggs at puberty.
At 37 years of age, a woman will only have 25,000 eggs, and at menopause less than 1000.
There are three types of eggs in the ovary: a pool of immature eggs, eggs that are selected to mature and prepare for ovulation in a particular cycle, and a pool of atrophic or dead eggs. The eggs are encased in follicles that support and nourish them until they mature, though the vast majority never do so. Every month, a certain number or percentage of immature eggs are selected for maturation. One of these eggs will ovulate and the rest will regress, die, and be reabsorbed into the ovary through atresia. The number of eggs selected is dependent on the number of immature eggs in the pool.
Low ovarian reserve is a premature decrease in the number of eggs and can be caused by chromosomal anomalies such as Turner Syndrome, where there the woman does not have two X chromosomes, or gene abnormalities such as Fragile X.
Also, ovarian tissue can be destroyed through torsion, surgical removal of part of all of the ovary, ovarian cysts caused by endometriosis, benign or malignant ovarian tumors, radiation or chemotherapy, immunological conditions, pelvic adhesions, or a high body mass index.
Low ovarian reserve only becomes an issue when a woman has problems getting pregnant. Other women experience this condition in their 30s and 40s but may have had their children earlier in life, so it does not negatively affect them.
IVF success for all age groups is extremely dependent on how many eggs the doctor can obtain at the egg retrieval. A poor responder by definition is a woman from whom three or fewer mature follicles are formed after ovarian stimulation. There is three times less chance of pregnancy if we obtain less than four eggs from poor responders.
Fewer eggs mean fewer embryos to choose for the embryo transfer. Many times poor responders are older so the quality of their eggs is poorer, which decreases the chance of pregnancy and increases the chance of miscarriages. The patient’s response to ovarian stimulation is usually proportionate to their ovarian reserve.
There are several baseline tests used to determine if a woman is a poor responder:
The term infertility is defined as the inability to conceive despite regular and unprotected intercourse for 1 year. However, risk factors such as the woman’s age, abnormal menstrual periods, history of pelvic inflammatory disease whether there has been previous abdominal or pelvic surgery, and history of undescended testicles may warrant earlier investigations and treatment of infertility. It has been found that female factors are responsible for 40% of cases, male factors account for a further 40%, combined male and female factors account for 10% and the remaining 10% of cases are unexplained.
Infertility is classified into two types:
The treatment of male factor infertility is one of the true success stories in the field of reproductive medicine. Male fertility screening is done through semen analysis. Disorders of sperm quality range from a low count or motility to a complete absence of sperm production. Deformities of the sperm cell shape (morphology) are also important to its ability to fertilize the egg.
Mild abnormalities of semen parameters can be effectively treated using techniques that “wash” out the seminal plasma and improve the concentration of normally shaped motile sperm, which are then transferred to the uterus via intrauterine insemination.
However, for more severe conditions this treatment is inadequate. With a total motile cell concentration of less than 10 million cells per ml or a normal morphology of less than 4% by strict Kruger criteria, the chance of fertilization failure is very high, even with IVF. As a general principle, if the male factor cannot be reversed in the man’s body, by simple medical or surgical treatment, then IVF with ICSI represents the only rational approach, the results are excellent. Intrauterine insemination is not an effective way of treating mild to moderate male infertility.
The most common causes of low sperm count are temporary and treatable. Research has shown that emotional or physical stress, cigarette smoking, or heavy alcohol consumption can affect sperm production and male fertility. Sperm counts usually return to normal levels after such lifestyle issues are addressed. Certain drugs, radiation, and radiotherapy may have a detrimental effect on the production of sperm.
The presence of a varicocele may lead to a rise in the temperature around the testicles, which may adversely affect sperm production and motility. Testosterone deficiencies and certain autoimmune disorders cause the body’s defenses to attack developing sperm.
A woman usually produces a single follicle in the ovaries each month as a result of various hormonal changes. Once the egg which develops within the follicle is mature, it is released.
The fallopian tube subsequently picks the egg up and moves it towards the uterus. The quality of cervical mucus at the time of ovulation must be such that it allows free passage of the sperm into the uterus.
There are many different types of infertility experienced by women. Many of the fertility problems can be easily treated. Some of the most common causes of female infertility include tubal blockage, polycystic ovarian syndrome, fibroids, and endometriosis.
However, there are several other reasons why a woman may experience fertility problems, such as ovulatory disorders (like ovulation), premature ovarian failure, and uterine factors. Egg quality also plays a role in infertility in many women.
The female reproductive system is a very delicate structure that is easily affected by even the slightest change in your body. Because of this, it can be dangerous to alter the system too much. Menstrual suppression, for example, can potentially lead to infertility. Maintaining your health can also help you avoid some infertility risks, like luteal phase defects.
Women with eating disorders find it very difficult to conceive. Anorexics often stop menstruating, making pregnancy impossible until the eating disorder is corrected. Alternately, plus-sized women can also find themselves dealing with various fertility issues.
Delayed childbearing is becoming increasingly common in Western societies for several reasons: many couples prefer to rear their children only after establishing a stable relationship and financial security, also, there are increasing numbers of late and second marriages.
Although pregnancies in women approaching 50 and beyond are occasionally reported, there is a decrease in fertility (the ability to achieve a pregnancy) with advancing age. The decline is gradual over the reproductive life span of the woman; it is particularly noticeable over the age of 30 and accelerates between 35 and 40 so that fertility is almost zero by the age of 45.
A fertilized egg with abnormal chromosomes is the single most common cause of miscarriage: at least half of all miscarriages are due to abnormal chromosomes. The risk of miscarriage is also increased with ageing e.g. the risk of miscarriage at age 25-29 years is 10% while the risk at age 40-44 is 34%. Furthermore, advanced maternal age is associated with an increased risk of chromosomally abnormal offspring.
Unexplained Infertility is cases in which the standard infertility testing has not found a cause for the failure to conceive. Unexplained infertility affects 10% of infertile couples. In the majority of these cases, the failure to reach a diagnosis is not due to inadequate investigations but is probably due to other factors that cannot be assessed using conventional tests.
For example, it is not currently possible to determine if the eggs are released at the time of supposed ovulation; if the fallopian tubes are able to pick up the eggs; if the sperm are capable of reaching the site of fertilization; or if the eggs can be fertilized by the sperm.
Diagnosing unexplained infertility is by no means an easy process. It tends to be a diagnosis based on exclusion. Your reproductive endocrinologist will examine you and perform a variety of tests to try to determine exactly what is going on. You may be said to have unexplained fertility if:
Vaccines are injections or oral drops, given by doctors, in order to prevent diseases. You must understand that vaccines only prevent the occurrence of a disease; they have no role in treating a disease. Vaccines are disease-specific; vaccines meant for a disease prevent only that disease.
Vaccines are the wonders of the 20th century. Their impact on the health of society can never be overemphasized. Global eradication of dreaded diseases, like smallpox, is the most outstanding example of their success story. With their use, control, and eradication of diseases like polio, diphtheria, and tetanus is now within our reach. With ongoing research in this field, we hope to have vaccines for diseases like AIDS, malaria, and diarrhea [commonly caused by a virus called rotavirus] soon.
Vaccination is necessary for every child. Because prevention is always better than cure. It protects your child from many dreaded diseases, some of which have no cures like polio and hepatitis B. Apart from individual protection, they prevent the spread of the disease in the society.
Vaccines are the wonders of the 20th century. Their impact on the health of society can never be overemphasized. Global eradication of dreaded diseases, like smallpox, is the most outstanding example of their success story. With their use, control, and eradication of diseases like polio, diphtheria, and tetanus is now within our reach. With ongoing research in this field, we can hope to have vaccines for diseases like AIDS, malaria, and diarrhea [commonly caused by a virus called rotavirus] soon.
Vaccination is absolutely necessary for every child. Because prevention is always better than cure. It protects your child from many dreaded diseases, some of which have no cures like polio and hepatitis B. Apart from individual protection, they prevent the spread of the disease in society.
Yes. Most of the child vaccines are safe. In some children, D.P.T. can cause fever, pain, and swelling at the site of injection which is easily controlled by paracetamol syrup prescribed by your doctor. But, even this can be avoided by using a newer variety of D.P.T. vaccines.
Rarely, a vaccine can cause an allergic reaction, so you should be careful about the following things:
The following are the commonly used vaccines and their schedule:-
Protects from poliomyelitis, disease causing paralysis.
The only vaccine is given in the form of oral drops.
Schedule: The first dose is given at birth. Starting from 6 weeks onwards 4 doses are given at monthly intervals. 2 booster doses are given at 1 ½ and 4 ½ years
Protects from tuberculosis; commonly known as TB.
A single dose is given at birth at the left shoulder.
Schedule: A small swelling appears at the site of injection 4-6 weeks later, which gradually disappears.
It is a combination vaccine that protects from three diseases namely diphtheria, tetanus, and pertussis (Kali khansi).
Schedule: Starting from 6 weeks 3 primary doses are given at 4-6 weeks intervals. Two booster doses are given at 1 ½ and 4-½ yr.
Newer and safer variety of DPT vaccine. This vaccine has a very low incidence of fever, swelling, excessive crying, or convulsion, unlike the conventional DPT vaccine. Preferred over conventional DPT (whole-cell vaccine).
Protects from measles; also called khasara or chhoti mata. Mild fever or small rashes may develop 5-6 days later which usually disappear spontaneously.
Schedule: A single dose is given around nine months of age.
It is a combination vaccine protecting from three diseases namely measles, mumps (knapped), and rubella (viral disease causing rashes).
Schedule: A single dose is given at 15 months of age. A second dose is advised at 5-½ years of age.
The vaccine prevents viral hepatitis caused by hepatitis B virus.
Hepatitis b is one of the fastest spreading & deadly diseases. Spreads by transmission from infected mother to her baby, transfusion of contaminated blood or blood product, or use of unsterilized needles and syringes, etc.
Starting features are usually fever, jaundice, loss of appetite, and weakness. The virus remains in the body for a long time and may lead to liver cancer or cirrhosis. No effective treatment is available. The only way to prevent this is timely vaccination. Must vaccines even for adults.
Schedule: The first dose is given at birth followed by second and third doses at the age of 1 month and 6 months respectively. A booster is recommended at 5 years of age.
Prevents diseases caused by bacteria called hemofilus influenza type-b. Hib is an important cause of meningitis (brain fever) in small children. It may cause pneumonia, and infection of the ear, bones, or joints.
Schedule: Three doses are given at 2, 4, and 6 months followed by a booster at 18 months of age. This vaccine is not needed for children above 5 years of age.
Typhoid fever is fairly common in our country, especially during summer and rainy seasons. It spreads through infected water, unclean vegetables, etc. Vaccines do not provide absolute protection so food and water hygiene should always be maintained.
Schedule: Presently available vaccine containing Vi antigen is given at 2 years of age. Repeat doses are given at 3-year intervals.
Protects from chicken pox commonly known as chhoti mata. Very effective vaccine. Not needed in those who have already suffered from chicken pox.
Chickenpox is a viral disease characterized by fever, water-filled rashes all over the body, and intense itching all over the body. Usually, the disease is mild and self-limiting but may leave permanent scars on the body. At times serious complications like involvement of the brain and other organs by virus may occur, which are difficult to manage and may leave permanent damage.
Schedule: A single shot is given after one year of age.
Protects from viral hepatitis caused by hepatitis A virus. Hepatitis-A virus spreads through contaminated water, food, raw uncooked vegetables or unhygienic juices, ice creams, sugarcane juice, gol gappa, etc from vendors. Fairly common disease during summers and rainy season. Presenting features are fever, jaundice, loss of appetite and weakness. No effective drug is available against the virus. Mostly self-limiting disease but complications may occur leading to liver failure.
Schedule: The first dose is given at 1 year of age followed by the second dose 6 months later.
All vaccines provide a fairly good degree of protection still other routine preventive measures should be taken.
Follow vaccination appointments strictly. If your child misses an appointment, get it done at the earliest. Delayed or missed doses may keep your child exposed to the disease and it may require rescheduling of further course.
Vaccination can be given in the presence of mild illnesses like colds and coughs. In children, vaccination is usually part of a general health checkup which involves the child’s growth monitoring and timely supplementation of vitamins and iron. So it is advisable to get these done from a qualified pediatrician in your area.
Some of the vaccines are relatively costly, but considering the cost of medical therapy for the disease and the loss of school & working days by parents it is advisable to go for these vaccines.
Babies at birth may not look as you might have imagined. Their head shape may look odd. Their skin may have some sticky substance. Eyes may be puffy. It may have some red marks as well. Don’t be dismayed. These are normal for the baby. And with time, these will change to the expected features.
As your baby grows during the initial weeks, you will find many events, which may seem alarming and cause a lot of anxiety. But, most of these are normal and with the passage of time disappear and require no treatment. Some of the events are:
It may look a little elongated. This is due to birth pressure and should look normal in two weeks. There could be soft boggy swelling, over the head, which pits on pressure. It is due to compression around the presenting part of the head, during the delivery. Called ‘ Caput’ it usually disappears in 2- 3 days.
At times, swelling over the head may be due to leaking of blood, under the outer covering of the skull bone. It is well-defined, soft, and mostly on one side of the head, over one of the skull bones. Called ‘Cephalhematoma’ it usually disappears in 6-8 weeks.
There is a soft spot, on the top of the head called ‘fontanel’, the bones of the head have not joined yet. Its size is variable and it pulsates with a heartbeat. It takes about 12 to 18 months to fill this spot. One must consult a doctor if it closes before six months or remains open after 2 years of life.
Eyelids are puffy [swollen] at birth due to pressure of birth. This swelling will disappear in a couple of days.
Watery discharge from one or both eyes is normal during the initial months. This is due to blockage of the duct responsible for drainage of secretions from the eye. Consult your doctor if secretion turns yellowish, which could be due to infection.
The red spot in the eyes, over the white portion is due to the leaking of a small amount of blood. It may look alarming, but is harmless and will disappear in 4 to 6 weeks.
Red-colored spots and rashes appearing on the second or third day are very common. Starting from the face they may spread and involve the whole of the body. No treatment is required and they disappear in the next couple of days. Scaling and peeling of skin, especially on the hand and feet is common and clears in a few days.
Blue-colored spots over the lower back and extremities are virtually seen in all babies. Termed ‘ Mongolian spots’ are of no significance they usually disappear between 12- 18 months.
Red-colored birthmarks called stork bites are seen over the eyelids, forehead, and back of the neck; take about one year to go.
Strawberry-like birthmarks, tend to increase initially but eventually disappear by the child is five.
Milia are white or yellow pinhead spots seen on the nose due to the retention of secretions; that disappear spontaneously.
One or both breasts may become swollen around 4th day. Little milk may also come out. Perfectly normal condition. The swelling disappears in about 2 weeks. Never try to squeeze or massage.
In baby girls, bleeding from the vagina may occur third day onwards; usually disappears by 7th day.
In baby boys, the skin around the tip of the penis is adherent and non-retractable, which may persist for 2 to 3 years. Do not try to retract it forcibly.
A newborn baby should pass stool within the first 24 hrs.
After that stools for the first two days are dark green and sticky called meconium. 3rd day onward color becomes yellowish, semisolid to watery in consistency and there is a tendency to pass stool after every feed. They may pass stools up to 15-20 times a day. This is quite normal and termed a transitional stool. No treatment is required.
On the other hand, some babies do not pass daily, some may even pass at the interval of 5 or 6 days. As long as the baby is active, accepting feeds regularly, passing urine frequently, and his abdomen is not unduly distended there is nothing to worry about.
Most babies pass urine within 48 hours of birth.
After about a week, urine frequency increases, it may go up to 20 times a day, but it should not be less than 6 times in 24 hours.
Babies usually look uncomfortable or cry just before passing urine. This is a normal reaction to the feeling of a distended bladder.
Watch out – if the baby dribbles, has a thin stream of urine, or has excessive crying during urination. It could be due to some obstruction. Consult your pediatrician.
Most newborn babies sneeze, they do it in all kinds of weather. Sneezing is not a sign of cold. They do it to clear respiratory passage of mucus and secretions. It’s a sign of good health so one should not worry.
Most newborns tend to throw out small amounts of fresh or curdled milk, especially after the feeds. This occurs due to a condition called aerophagia where babies swallow air while taking feeds. When this air comes out it brings some milk with it. Condition is aggravated, when baby is on bottle feeds and the size of bottle teat is too small or too large.
As long as the baby is active, accepting feeds well, passing urine adequately, and gaining weight properly there is nothing to worry about.
Proper burping after each feed is the best remedy to prevent excessive vomiting. To burp one should hold the baby in a lap or against the shoulder and tap her back gently for about 5 minutes. If he doesn’t burp don’t try too hard, baby may not require it. After burping, place baby in right lateral posture with head slightly above the body.
Vomiting could be an indication of a serious underlying problem if; Vomiting is forceful and is associated with abdominal distention Vomitus is of green color
Yellowish discoloration of eyes and body. Starts on the 2nd or 3rd day of life. Increases till the 5th to 7th day and then gradually subside by the 11th to 14th day of life. Mostly It’s a harmless condition called “physiological jaundice”. Occurs due to elevation of a substance in blood called bilirubin.
Usually, no treatment is required but consult your pediatrician. No role for sun exposure. It’s not caused by eating yellow-colored foodstuffs like papaya or mango. It has no relation to wearing yellow clothes. No need to keep the household tube lights on. But jaundice could be dangerous if:
Cryopreservation refers to the storage of a living organism at ultra- low-temperature such that it can be revived and restored to the same living state as before it was stored.
Embryo cryopreservation (the process of freezing, storage and thawing embryos) can enhance pregnancy rates by allowing excess embryos not replaced in a fresh embryo transfer to be stored for future use.
Embryo freezing may also be performed when a fresh embryo transfer is not performed for any of the following reasons:
Embryos are placed into straws or vials containing anti-freeze or cryoprotectant solutions. These are transferred to a programmable biological freezer which is used to achieve a controlled slow rate of cooling. During cooling, cells dehydrate and as the temperature is reduced, more ice forms and water is removed gradually from the cells. Slow cooling is continued to ~ -35°C at which point embryos are rapidly cooled by plunging into liquid nitrogen (-196°C). Embryos are kept in storage tanks of liquid nitrogen until thawing is performed.
Vitrification in IVF can allow freezing of spare embryos with better post-thaw survival rates and higher pregnancy and live birth rates from the frozen embryo transfer cycles. We started vitrification of embryos in our IVF lab and have seen excellent post-thaw embryo survival and high pregnancy rates after frozen embryo transfer procedures.
Semen freezing is useful for men who find it difficult to ejaculate on demand which may result in their inability to produce a sample on the day of egg collection.
Sperm from two sources can be frozen: from ejaculates or from fluid extracted in the operating room during surgical procedures (vasal, epididymal and testicular sperm specimens). The sperm is usually frozen for a period of one year; at that time, future arrangements are discussed. It is generally believed that sperm that have been through the freeze-thaw process are no more likely to result in birth defects than freshly ejaculated sperm.
Do not rely on housemaids for baby massage. Vigorous and overzealous massage and exercise by maids have been known to cause soft tissue injuries and fractures. Do not instill oil in the ears or nostrils of the baby. Do not try to ‘raise the unit’ by putting your finger inside your mouth.
Vaccines are oral drops or injections given to protect babies from various communicable diseases. Vaccines have no role in the prevention of disease. Initial vaccines like Oral Polio, BCG, and Hepatitis B are usually given before the baby is discharged. Baby’s Growth parameters and Vaccination data are recorded on a health card. It also shows dates for future checkups and vaccinations.
After a long wait of nine months, when finally your baby arrives, you have some questions in mind, such as how your babies are born and what happens immediately after their birth. Actually when babies are born:
All normal babies are “Roomed In” or kept with their mothers. It helps in initiating breastfeeding and also keeping the baby warm and comfortable.
As a parent of a newborn, you try your best to keep your baby comfortable in this new world. Following are the answers to some common questions:
Unlike adults, newborn babies do not have adequate mechanisms to generate or shed heat, so they are required to be kept under optimum temperature.
Enlarging the room temperature which is slightly warm or uncomfortable to an adult is usually comfortable for the baby.
During winter baby should be fully covered with woolen. Socks, hand gloves, and caps should be used to prevent heat loss. The room should be kept warm with room heaters.
During summer baby should wear loose and soft cotton clothes. The room should be properly ventilated and kept cool by using cooler or air conditioners.
When comfortable, the baby’s hands and feet should be reasonably warm to the touch, and the sole and palm should be pink in color.
If the baby is too cold, soles and palms tend to get bluish. If the baby is sweating overhead and neck it means he is overclothed or the room temperature is too high.
Breastfeeding is the ideal food for your child because of its nutritional composition. Following are the facts associated with the breast-feeding:
Baby should be put on the mother’s breast as soon as possible, preferably within half to one hour. Do not give anything else like honey, water, or top milk.
Initial watery yellow milk called colostrum is good for babies’ health and should never be discarded. Adopt a “Semi-demand” approach. If baby demands feed him otherwise offer every 2-3 hours. Babies have a tendency to fall asleep after a few sucks, don’t worry. Try to tickle him gently to keep him awake. Babies should be fed exclusively by breast for the first 4-6 months. During this period they do not require any supplements including water.
A cranky baby, a baby who puts hands inside his mouth or who makes sucking movements doesn’t always mean a hungry baby.
Mother’s milk is always adequate for the nutritional requirements of a baby.
Be sure your baby is getting enough milk if he.
People have different attitudes and beliefs towards health and disease, which are mostly based on their traditions & customs. They also differ in their faith and understanding of medical science.
As doctors we always try to educate them the concept and working of modern medical science. There are so many steps between taking a prescription and stopping of medicine. A proper understanding of these steps, is absolutely essential. More often than not, success or failure of the treatment depends on these small things.
You should be able to read names of the drugs as well as other instructions. Clarify if any doubt. Dispensing of wrong medicine by chemist due to misinterpretation is very common and could lead to dangerous consequences. Similarly dosages should be understood clearly. Ingesting 5 ml drug instead of 0.5 mls or 1 spoon full [5.0mls] for 1 ml is very frequent.
Drugs are usually in form of tablets, capsules, syrups or drops. Tablets are of two varieties, one has to be swallowed directly, and others called dispersible tablets have to be prepared by adding water to it. Syrups may be ready diluted or be in dry form, which is to be prepared by adding water. Regarding preparing liquids instructions are written on bottle. Read them carefully. Mostly there is a mark on the bottle upto which water is to be added. Some bottles do not have mark but are supplied with measuring cup to add water.
Measurement of quantity is easy for tablets and capsules. Syrups and drops are supplied with measuring cup or dropper. Cups are marked at different levels like 2.5ml, 5.0ml and 10.0ml. Likewise droppers are also marked like 0.2ml, 0.4ml, 0.6ml, 0.8ml and 1.0ml. Always use these cups and dropper for accurate measurement. Alternatively one can use a disposable syringe, which are available without needle. Measurement is very accurate and it is very convenient to give medicines using disposable syringe.
Some doctors write medicines in spoons rather than mls. Do remember mostly TSF is meant by a teaspoon full and is equal to 5.0ml. But commonly available spoons at home vary in size any thing from 2.5ml to 7.0ml so quantity of drug given may not be the desired one. Always use measuring cup, dropper or disposable syringe for accurate dosages.
Frequency of the dosage is usually determined by the type of drug and the severity of the disease. For different frequencies doctor use different abbreviations or symbols. Some of the commonly used abbreviations are OD -once a day, Bid – twice a day [12 hrly], TDS-three times a day [8 hrly], QID- four times a day [6 hrly], SOS- whenever required, HS- at the bed time. Make yourself familiar with these abbreviations and whenever in doubt clarify from your doctor.
Timing of the dosages should be chosen in such a way that as far as possible proper interval between two dosages is maintained and it doesn’t disturb child’s routine. E.g.- BD dosage could be given at 8 am and 8 pm while TDS dosage could be given at 7 am, 3 pm and 11pm.
Always ask whether drug should be given empty stomach or full stomach. Some drugs work better with empty stomach on the other hand there are drugs that can cause gastric irritation when given with empty stomach.
Ask about the signs and symptoms to be watched during the course of the medicine. Presence of certain signs like adequate frequency of urination during loose motion, or return of appetite during the course of jaundice are reassuring signs showing improvement. On the other hand presence of certain signs during the course may indicate worsening condition like failure to passing urine or drowsiness during loose motions and fast breathing and bluish discoloration of lips during the course of pneumonia. Be watchful about these signs because they require immediate medical attention.
No drug is free from side effect but mostly they are innocuous [harmless] and require no treatment. Like red colored urine by some anti T.B. drugs and black colored stool on oral iron therapy. But some times severe allergic and other problems may occur, so ask your doctor about side effects to be observed and reported.
In most of the mild illnesses patient is called back at the end of the course but timing and the frequency of revisits is determined by the severity and the type of the disease. In some long-term treatments where drugs are to be given for long duration [e.g. treatment of T.B. or treatment of epilepsy] periodic checkups at monthly or bimonthly interval is needed . It is to see the progress of the disease as well as watch for the complications of the disease and side effects of the medicines.