IVF Centre Delhi

COVID and ART

Arising in China in late 2019, the novel coronavirus (SARS-CoV-2) has swept the globe, confirmed cases of COVID-19 have grown rapidly. On the 23rd of March 2020, ‘lockdown’ was announced to limit the spread of the virus, subsequently private hospitals cancelled all elective work and ART procedures going on.Now as the COVID-19 pandemic is stabilising, with return to normal daily life activities, all ART treatments have been restarted in ART centers .We at our center have also reintroduced ART services and managing the patients following good clinical practice to minimise risk to patients and staff.

  • We manage our appointments, scans and procedures according to specific timetables to limit the number of patients at one point.
  • We try to Reduce face-to-face interactions:by reducing frequency and duration of visits without compromising safety and quality. We are encouraging telephone and video consultations in most situations.
  • We have put restriction on partners and accompanying persons ,unless its very important
  • Our waiting rooms and working spaces are redesigned to guarantee appropriate distancing.
  • We have Provision of protective screens for administrative staff.Personal protective equipment and sanitation devices for patients and staff has been installed.
  • All patients starting ovarian stimulation, IUI or embryo transfer cycles have to answer a Covid-19 risk questionnaire.
  • All patients are offered a choice to proceed with or postpone their ART treatment & patient preference is clearly documented. Patients are informed, clearly understand the risks related to COVID-19 disease
  • We are giving priority to treatments of Fertility preservation for patients facing cancer chemotherapy or other treatment that is likely to affect their fertility, special risk patients with low ovarian reserve, advanced age and those facing extirpative pelvic surgery (for instance due to severe endometriosis or bilateral ovarian cysts) are also given priority.
  • COVID test is done of all patients and partners having ovarian stimulation or IUI/DI on day 2/3,and again on Day 9/10 of cycle.
  • We advise patients and potential donors to self-isolate, if possible, from the start of ovarian stimulation treatment until egg collection in order to minimise the risk of infection, and risk of treatment cancellation.
  • We try Minimising clinical risk by following protocols to minimise the risk of OHSS : a GnRH-Antagonist protocol and GnRH-agonist trigger and careful ovarian stimulation to minimise the risk of hospital admission for patients and to reduce the burden of infection.
  • Cryopreservation of gametes and embryos during the pandemic is being performed only in separate cryocans. If a Patient become symptomatic after oocyte retrieval but prior to embryo transfer we advise to freeze all their embryos for future use

Dr. Prabhleen Kaur

  • M.B.B.S – 2009,Mahatma Gandhi Medical College, Jaipur Rajasthan University of Health Sciences.
  • M.S. (Obstetrics & Gynecology) – 2012, Mahatma Gandhi Medical College, Jaipur, Rajasthan University of Health Sciences.
  • Fellowship in Assisted Reproductive Technology and Infertility : Ridge IVF Center, New Delhi : August 2018 to August 2019

ACADEMIC ACHEIVEMENTS & GOLD MEDALS

  • Received Gold Medal and secured 2nd position in the University in First Prof M.B.B.S. University Examination and Honours in Biochemistry, August 2004.
  • Received Gold Medal and secured 1st position in the University in Second Prof M.B.B.S. University Examination and secured honours in Pharmacology, Pathology and Microbiology in May 2006.
  • Merit holder in University and secured honours in Obstetrics & Gynecology in Final Prof M.B.B.S.(Part-II),in March 2008.
  • Worked as Consultant in Infertility and Obstetrics/Gynaecology at Vinayak Hospital , Derawal Nagar from January 2018 to January 2020.
  • Worked as Associate consultant at Apollo Cradle, Moti Nagar from Jan 2017 to September 2019.
  • Senior Resident in Obstetrics & Gynaecology: Deen Dayal Upadhyay Hospital, New Delhi: 29/08/2013 to 28/08/2016.
  • Senior Resident in Obstetrics & Gynaecology: Shri Dada Dev Matri Avum Shishu Chikitsalaya, New Delhi :21/3/2013 to 27/8/2013.
  • Senior Resident in Obstetrics & Gynaecology: Action Balaji Hospital, New Delhi: 3/11/2012 to 31/3/2013.
  • Mahatma Gandhi Medical College & Hospital: Post graduate trainee (20th May 2009 – 31st May 2012).

ACADEMIC WORK/DISSERTATION

  • “A Comparative study between Cleavage stage embryo transfer at day 3 and Blastocyst stage transfer at day 5 in IVF/ICSI on Clinical pregnancy rates”. Dissertation under the guidance of Dr.M.L.Swarankar and Dr.Manju Maheshwari, Prof & Unit Head, Dept of Obstetrics & Gynaecology, Mahatma Gandhi Medical College & Hospital, Jaipur.
  • A Comparative study of Effects of Intrauterine Infusion of Autologous Platelet Rich Plasma with Intrauterine Infusion of Granulocyte Colony-Stimulating Factor on Endometrial thickness & Clinical Pregnancy Rates in Frozen Embryo Transfer. Dr.M.Gouri Devi, Dr.Nympheae Walecha, Dr.Prabhleen Kaur
  • “Attitudes and Practices of Gynecologists in Jaipur towards management of menopause” Indian Journal of Midlife health. Vol 1,Issue 2, Jul-Dec, 2010.
  • “Implantation Rates after Two and Five Days of Embryo Culture: A Comparative Study.” JK Science Journal. Vol. 15 No. 4, Oct- December 2013.
  • “A Comparative study between Cleavage stage embryo transfer at day 3 and Blastocyst stage transfer at day 5 in IVF/ICSI on Clinical pregnancy rates” Journal of Human Reproductive Sciences, Volume 7,Issue 3,Jul – Sep 2014.
  • “Serum Anti-Mullerian Hormone, Serum Follicle Stimulating Hormone and Serum Estradiol in the Prediction of Ovarian Reserve: A Comparative Study” International Journal of Science and Research, Volume 3[10], October 2014.
  • “Ectopic pregnancy rates with cleavage stage embryo transfer at day 3 versus blastocyst stage transfer at day 5: A prospective analysis”. Journal of Evolution of Medical and Dental Sciences. Vol. 3,Issue 55,October 2014.
  • “Cervical Pregnancy: A Case Report”, International Journal of Science and Research (IJSR) Volume 3 Issue 11, November 2014.
  • “Concurrent bilateral ectopic pregnancy: a rarity“ in International Journal of Reproduction, Contraception, Obstetrics and Gynecology. 2015 Aug; 4(4):
  • “A rare case of myiasis in a woman with genital prolapse“ in International Journal of Reproduction, Contraception, Obstetrics and Gynecology. 2016 Oct; 5(10): 3590-3592.

PARTICIPATION IN CONFERENCES AND PRESENTATION OF SCIENTIFIC PAPERS/POSTERS:

  • Participated in IMS Quiz of Indian Menopause Society held on December 8th, 2009 at Jaipur and secured 2nd position in quiz.
  • Presented Poster on “Attitudes and Practices of Gynecologists of Jaipur towards management of Menopause” in IMSCON 2010 held at Chennai from February 5-7,2010 & received the best poster award.
  • Participated in Quiz Competition in Contraception and Beyond World Congress @ Jaipur and secured 2nd position, on March 6-7,2010.
  • Presented a paper on “Place of VIA as a Screening Tool for Early Detection of Cervical Cancer in Low resource Setting” in 18th Indian Conference on Reproductive & Child Health (NARCHI) at Nagpur on 25th September 2010.
  • Presented a paper on “VIA” in the sixth National Conference on ISCCP and participated in the Live Workshop with Hands-on training on Colposcopy on 23-24th February,2011 at Jaipur, Rajasthan.
  • Presented paper on “ A comparative study between Cleavage stage embryo transfer at day 3 and Blatocyst stage transfer at day 5 in IVF/ICSI on Clinical pregnancy rates” at NARCHI-2012,held at New Delhi on 15th & 16th September,2012 & received 2nd prize for best scientific paper.

Poor Ovarian Reserve

Low Ovarian Reserve

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.

Where Did All the Eggs Go?

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 a 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.

Causes of Low Ovarian Reserve

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 indes.

Low Ovarian Reserve and IVF Success

Low ovarian reserve only becomes an issue when a woman has problems getting pregnant. Other women experience this condition in their 30’s and 40’s, 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:

  • Follicle stimulating hormone (FSH)
  • Estradiol (E2)
  • Inhibin B
  • Anti-Mullerian hormone (AMH)
  • Antral follicle count (AFC)

Azoospermia is defined as the complete lack of sperm in the ejaculate.

It occurs in 5% of infertile men. If this is the case, then one or both of two conditions may be present:
  •   There is a problem with sperm production.
  •   There is a blockage such that sperm production, although normal, cannot reach the ejaculate

Evaluation

A thorough review of medical problems, exposures, past surgery, medications, and family history is undertaken to help define causes of azoospermia. Then, a brief, well-performed physical examination is performed. Blood tests are taken that include testosterone and follicle stimulating hormone (FSH). Two semen samples are analysed and a standard semen analysis is performed. If no sperm are found, then the semen sample undergoes an additional evaluation in which the sample is “spun” down in a centrifuge to concentrate small numbers of sperm at the bottom of the tube. This “pellet” of the ejaculate is then examined thoroughly for sperm by an experienced lab technician. If 10 sperm or even 1 sperm is present in the pellet analysis, then conditions such as reproductive tract obstruction are disproved. Again, the value of finding even a small number of sperm in the pellet analysis is very significant because:
  1  It means that complete obstruction is unlikely
  2   And men may have the option of using ejaculated sperm for conception with assisted reproduction and may be able to avoid sperm retrieval procedures for this purpose.

If, based on the above evaluation, it is not entirely clear as to whether there is a problem with sperm production or one of a blockage in the ducts of the reproductive tract, then the next step is to examine the testis itself and assess sperm production. Classic approach is to perform a testis biopsy under local anesthesia.
Treatment
If sperm are not found in the ejaculate, then there is either obstruction or blockage in the reproductive tract or sperm is not being made at levels sufficient to get into the ejaculate. A blockage can be due to prior infection, surgery, prostatic cysts, injury or congenital absence of the vas deferens (CAVD). Except for cases of congenital absence, most cases are of obstruction are repairable with microsurgical or endoscopic reconstruction.
In cases of azoospermia that is not due to blockage, termed nonobstructive azoospermia, medical treatment can help some men develop ejaculated sperm (i.e. those with reversible conditions such as Kallman syndrome, hyperprolactinemia; varicocele); in most instances however, the only hope for building a biological family is to use sperm retrieved from the testis with assisted reproduction. One of the most difficult aspects of nonobstructive azoospermia is that only 50%-60% of men will have usable testicular sperm.

Ideally azoospermic men should undergo a thorough evaluation and be clear on their methods and chances of having their own genetic child.

Shivshankaran

Dr. Anjali Gupta

Educational Qualifications

  • M.B.B.S. in July 2003 from Pt. Jawahar Lal Nehru Memorial Medical College And Hospital, Raipur
  • D.G.O. in May 2007 from Netaji Subh ash Chandra Bose Medical College And Hospital, Jabalpur
  • ICOG certified training in gynaecological endoscopic surgery

Academic Achievements

  • Certificate of merit in first professional M.B.B.S.
  • Certificate of merit in Ophthalmology
  • Passed all M.B.B.S. professionals in first class in first attempt

Professional Experience

  • Internship –Pt J.L.N. Memorial Medical College and Hospital, Raipur
  • D.G.O. from N.S.B. Medical College And Hospital, Jabalpur
  • Worked as senior resident in Gynae and Obs department at E.S.I. Hospital, Noida
  • Worked as senior resident in Gynae and Obs department at Lal Bahadur Shastri Hospital, Delhi
  • ICOG certified training in gynaecological endoscopic surgery
  • Observership in Infertility for 6 months
  • Worked as Clinical Assistant with Dr. Sadhna Desai at Fertility Centre Mumbai

Reasons For Infertility

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:

  • Primary infertility if there was no previous pregnancy (approximately 40% of infertile couples).
  • Secondary infertility if there was a previous pregnancy whatever the outcome (approximately 60% of infertile couples).

Male Factor Infertility

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.

Female Factor Infertility

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.

Age and Fertility

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

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:

  • you are ovulating normally
  • your fallopian tubes are open and healthy
  • you have no pelvic adhesions
  • you do not have endometriosis
  • your partner has a high sperm count and good sperm motility
  • your postcoital test is positive

Vaccination Birth Right Of Every Child

Q.1 What are vaccines?

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.

Q.2 How vaccines work?

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.

Q.3 Are vaccines really necessary?

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.

Q.4 Are vaccines safe?

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:

  • Do remind your doctor about any allergic reaction during past vaccination.
  • It is preferable to wait at doctor’s clinic for 15-20 minutes after vaccination so that any allergic reaction can be treated immediately.
  • Qualified pediatrician’s clinic or hospital setup should be preferred for vaccination so that any allergic reaction could be properly managed

Q.5 What are the commonly advised vaccines? What is their schedule?

Following are the commonly used vaccines

POLIO VACCINE

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

B.C.G.

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.

D.P.T.

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).

MEASLES

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.

M.M.R.

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.

HEPATITIS-B

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.

Hib

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.

TYPHOID

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.

CHICKEN POX VACCINE

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.

HEPATITIS-A

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.

Q.6 General Precautions

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.

Author: Dr. Arun Gupta
M.D. New born & Child specialist
Ph-27495603, 27477030, 9811106056

How Babies Look And Behave During Early Days Period

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:

Head

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.

Eyes

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.

Skin

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.

Breasts

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.

Genitals

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.

Stool

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.

Urination

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.

Sneezing

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.

But watch out

Vomiting could be indication of serious underlying problem if; Vomiting is forceful Is associated with abdominal distention Vomitus is of green color

Jaundice

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.

What is to be done:

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:

  • Appears within 24 hours or after 72 hours of birth.
  • Persists beyond 2 weeks of age.
  • There is intense yellow staining of abdomen, thighs or sole.
  • Urine is dark colored or, stool is pale or white in color.
  • Baby is lethargic and not taking feeds.

In Vitro Fertilization (IVF)

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.

ICSI: Intracytoplasmic sperm injection

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.