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 and whether there has been previous abdominal or pelvic surgery, history of undescended testicles may warrant earlier investigations and treatment of infertility. It has been found that female factors are responsible in 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 an 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 that 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 an 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 defect.
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 child bearing 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 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, 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 which cannot be assessed using conventional tests. For example, it is not currently possible to determine if the eggs are actually 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 doctor, in order to prevent diseases. You must understand that vaccines only prevent occurrence of a disease; they have no role in treating a disease. Vaccines are disease specific; vaccine meant for a disease prevents only that disease.
Vaccines are the wonders of 20th century. Their impact on the health of society can never be overemphasized. Global eradication of dreaded disease, like small pox is the most outstanding example of their success story. With their use, control and eradication of diseases like polio, diphtheria, tetanus is now within our reach. With ongoing research in this field, we can hope to have vaccines for diseases like AIDS, malaria, diarrhea [commonly caused by virus called rotavirus] in near future.
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 spread of the disease in the society.
Vaccines are the wonders of 20th century. Their impact on the health of society can never be overemphasized. Global eradication of dreaded disease, like small pox is the most outstanding example of their success story. With their use, control and eradication of diseases like polio, diphtheria, tetanus is now within our reach. With ongoing research in this field, we can hope to have vaccines for diseases like AIDS, malaria, diarrhea [commonly caused by virus called rotavirus] in near future.
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 spread of the disease in the society.
Yes. Most of the 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 newer variety of D.P.T. vaccine.
Rarely, a vaccine can cause allergic reaction, so you should be careful about following things:
Following are the commonly used vaccines
Protects from poliomyelitis, disease causing paralysis.
The only vaccine given in the form of oral drops.
First dose is given at birth. Starting from 6 weeks onwards 4 doses are given at monthly interval. 2 booster doses are given at 1 ½ and 4 ½ years
Protects from tuberculosis; commonly known as TB.
Single dose is given at birth at left shoulder.
A small swelling appears at the site of injection 4-6 weeks later, which gradually disappears.
It is a combination vaccine which protects from three diseases namely diphtheria, tetanus and pertussis (kali khansi).
Starting from 6 weeks 3 primary doses are given 4-6 weeks interval. Two booster doses are given at 1 ½ and 4-½ yr.
COMPONENT DPT VACCINE-(Tripacel)
Newer and safer variety of DPT vaccine. This vaccine has very low incidence of fever, swelling, excessive cry or convulsion unlike conventional DPT vaccine. Preferred over conventional DPT (whole cell vaccine).
Protects from measles; also called khasara or chhoti mata.
Single dose is given around nine month of age.
Mild fever or small rashes may develop 5-6 days later which usually disappear spontaneously.
It is combination vaccine protecting from three diseases namely measles, mumps (kanphed) and rubella (viral disease causing rashes).
Single dose is given at 15 months of age. A second dose is advised at 5-½ yrs of age.
Vaccine prevents from viral hepatitis caused by hepatitis B virus. First dose is given at birth followed by second and third doses at the age of 1month and 6 month respectively. A booster is recommended at 5 yrs of age.
Hepatitis b is one of the fastest spreading & deadly disease. Spreads by transmission from infected mother to her baaby, transfusion of contaminated blood or blood product, or use of unsterilised needles and syringes etc.
Starting features are usually fever, jaundice, loss of appetite and weakness. Virus remains in the body for long time and may lead to liver cancer or cirrhosis. No effective treatment is available. Only way to prevent is timely vaccination. Must vaccines even for adults.
Prevents from diseases caused by bacteria called hemofilus influenza type-b.
Three doses are given at 2, 4 and 6 months followed by a booster at 18 month of age. this vaccine is not needed for children above 5 yrs of age.
Hib is an important cause of meningitis (brain fever) in small children. It may cause pneumonia, infection of ear, bones or joints.
Presently available vaccine containing Vi antigen is given at 2 yrs of age. Repeat doses are given at 3 yrs interval.
Typhoid fever is fairly common in our country especially during summer and rainy season. It spreads through infected water, unclean vegetables etc. Vaccine does not provide absolute protection so food and water hygiene should always be maintained.
Protects from chicken pox commonly known as chhoti mata.
Single shot is given after one year of age. Very effective vaccine. Not needed in those who have already suffered from chicken pox.
Chicken poxis a viral disease characterized by fever, water filled rashes all over body and intense itching all over body. Usually disease is mild and self-limiting but may leave permanent scars over body. At times serious complication like involvement of brain and other organs by virus may occur, which are difficult to manage and may leave permanent damage.
Protects from viral hepatitis caused by hepatitis A virus. First dose is given at 1 year of age followed by second dose 6 months later.
Hepatitis-A virus spreads through contaminated water, food, raw uncooked vegetables or unhygienic juices, ice creams, sugarcane juice, gol gappa etc from vendors. Faifly common disease during summers and rainy season. Presenting features area fever, jaundice, loss of appetite and weakness. No effective drug is available against virus. Mostly self limiting disease but complications may occur leading to liver failure.
All vaccines provide fairly good degree of protection still other routine preventive measures should be taken.
Follow vaccination appointment 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 presence of mild illnesses like cold and cough. In children vaccination is usually the part of general health checkup which involves 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 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. There 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 lot of anxiety. But, most of these are normal and with passage of time disappear and require no treatment. Some of the events are:
May look little elongated. This 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. Its well defined ,soft and mostly on one side of the head, over one of the skull bone. Called ‘Cephalhematoma’ usually disappears in 6-8 weeks.
There is a soft spot, on the top of the head called ‘fontanel’, here bones of the head have not joined yet. Its size is variable and it pulsates with heart beat. It takes about 12 to 18 months to fill this spot. One must consult 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 couple of days.
Watery discharge from one or both eyes is normal during initial months. This is due to blockage of duct responsible for drainage of secretions from the eye. Consult your doctor if secretion turns yellowish, which could be due to infection.
Red spot in the eyes, over white portion is due to leaking of small amount of blood. It may look alarming, but is totally harmless and will disappear in 4 to 6 weeks.
Red colored spots and rashes appearing on second or third day are very common. Starting from face they may spread and involve whole of the body. No treatment is required and they disappear in next couple of days. Scaling and peeling of skin especially on the hand and feet is common and clears in few days.
Blue colored spots over lower back and extremities are virtually seen an all babies. Termed as ‘ Mongolian spots’ are of no significance they usually disappear between 12- 18 months.
Red colored birthmarks called stork bites seen over 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 are due to retention of secretions; disappear spontaneously.
One or both breasts may become swollen around 4th day. Little milk may also come out. Perfectly normal condition. Swelling disappears in about 2 weeks. Never try to squeeze or massage.
In baby girl, bleeding from vagina, may occur third day onwards; usually disappears by 7th day.
In baby boys, 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 first 24 hrs.
After that stools for 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 upto 15-20 times a day. This is quite normal and termed as 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 baby is active , accepting feeds regularly, passing urine frequently and his abdomen is not unduly distended there is nothing to worry.
Most babies pass urine within 48 hours of birth.
After about a week, urine frequency increases, it may go upto 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 from feeling of distended bladder.
Watch out – if baby dribbles, has thin stream of urine or has excessive cry during urination. It could be due to some obstruction. Consult your pediatrician.
Most newborn babies sneeze , they do it in all kind of weathers. 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.
Regurgitation of milk (vomiting)
Most newborns have a tendency to throw out small amount 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 size of bottle teat is too small or too large.
As long as baby is active, accepting feeds well, passing urine adequately and gaining weight properly there nothing to worry.
Proper burping after each feed is the best remedy to prevent excessive vomiting. To burp one should hold baby in 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 indication of serious underlying problem if; Vomiting is forceful Is associated with abdominal distention Vomitus is of green color
Yellowish discoloration of eyes and body. Starts on 2nd or 3rd day of the life. Increases till 5th to 7th day and than gradually subside by 11th to 14th day of the 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 of sun exposure. Its 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:
In vitro fertilization (IVF)is the most effective treatment for women with absent, blocked or damaged fallopian tubes. IVF is a major treatment in infertility when other methods of assisted reproductive technology have failed. It is now used to treat a wide range of fertility problems.
Fertility drugs are used to stimulate the ovaries to produce multiple follicles. Each follicle should contain one egg. The chances of pregnancy are increased if more than one egg can be obtained and fertilized. The response to stimulation is monitored by ultrasound scan measuring the number and size of the developing follicles in the ovaries and by measuring the blood oestrogen level. The final preparation for egg collection involves a hormonal injection given to the woman 36-40 hours pre-operatively. This mimics the natural process which triggers the eggs to complete their maturation making them ready for fertilization.
The eggs are collected vaginally using ultrasound guidance, under general or local anesthesia. After egg collection the eggs are fertilized by sperm outside the womb, in vitro.Embryo transfer is usually done two or three days after egg collection. Even on day five it can be done as desired by the embryologist.
Intracytoplasmic sperm injection (ICSI) is an in vitro fertilization procedure in which a single sperm is injected directly into an egg. This procedure is most commonly used to overcome male infertility problems, although it may also be used where eggs cannot easily be penetrated by sperm, and occasionally as a method of in vitro fertilization, especially that associated with sperm donation.
Couples go through the same preparatory processes as with IVF, namely ovulation induction and egg collection. Under high-power magnification, a glass tool (holding pipette) is used to hold an egg in place. A microscopic glass tube containing sperm (injection pipette) is used to penetrate and deposit one sperm into the egg. After culturing in the laboratory overnight, eggs are checked for evidence of fertilization. After incubation, the eggs that have been successfully fertilized (zygotes) or have had 3 to 5 days to further develop (zygotes or blastocysts) are selected. Two to three are placed in the uterus using a thin flexible tube (catheter) that is inserted through the cervix. The remaining embryos may be frozen (cryopreserved) for future attempts.
For patients with irreparably damaged fallopian tubes profound oligospermia (Low Sperm counts )or failure to conceive after adequate attempts of intrauterine insemmination, In Vitro Fertilasationhas become the treatment of choice.
The technology involves incubating the oocytes(eggs) & sperm in the laboratory & allowing the resulting embryo (s) to develop for a number of days prior to transferring them into the endometrial cavity (uterus).
In the 1980′s pregnancy rates for IVF were relatively low, approx 15%. As the nutrition requirements for the embryo growth within the Laboratory became better understood, conception rates began to increase. As we head into the new millenium, anticipated pregnancy rates for many patients may exceed 50 percent.
Increased emotional stress because of high cost & time consuming with success rate of 40%. Risks of multiple pregnancies & hyperstimulationsyndrome are all increased.
Patient needs to be in constant touch with the IVF center for about one and a half month from starting medication upto the result of IVF. Out of this period active treatment takes ten to fifteen days during which patient has to visit the IVF Lab. No hospitalizations essential during the treatment cycle.
Prior to collection of eggs, patient is given medication in the form of daily injections starting fromday 2 of menstrual cycle & response to these injections is monitored with frequent blood tests & Vaginal ultrasound. Eggs are retrieved from the ovaries by a needle with the help of transvaginal sonography guidance. It is done under mild anaesthesia & is a day care procedure. It is done 32-36 hours after final hormone injection.
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 over zealous massage and exercise by maids have known to cause soft tissue injuries and fractures. Do not instill oil in ears or nostrils of the baby. Do not try to ‘raise the ghunti’ by putting finger inside mouth.
Vaccines are oral drops or injections given to protect baby from various communicable diseases. Vaccines have no role in prevention of a disease. Initial vaccines like Oral Polio, BCG and Hepatitis B are usually given before baby is discharged. Baby’s Growth parameters and Vaccination data are recorded in a heath card. It also shows dates for future check ups 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 mother. It helps in initiating breast- feeding and also keeping 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 of some common questions:
Unlike adults, newborn babies do not have adequate mechanism to generate or shed heat, so they are required to be kept under optimum temperature.
By enlarge 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 cap should be used to prevent heat loss. Room should be kept warm with room heaters.
During summer baby should wear loose and soft cotton clothes. Room should be properly ventilated and kept cool by using cooler or air conditioners.
When comfortable, baby’s hands and feet should be reasonably warm to touch and sole and palm should be pink in color.
If baby is too cold, sole and palms tend to get bluish. If baby is sweating overhead and neck it means he is over clothed or room temperature is too high.
Breast-feed 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 to 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 colorstrum 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 hrly. Babies have a tendency to fall asleep after few sucks, don’t worry. Try to tickle him gently to keep awake. Babies should be fed exclusively by breast for 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 nutritional requirements of a baby.
Be sure your baby is getting enough milk if he..