Friday, September 3, 2010

FAQ of Patients (infertility questions which is published in Indian express)

1) Dr. We are married 10 years, husbands carry problems of no sperm is there any chance of  Pregnancy?

Your husband can have detailed check-up, if it is due to blockage, then you can have ICSI treatment after sperm collection by aspiration (TESA/PESA)
In this treatment eggs and sperms are collected and fertilized in lab and the embryo is repeat back into uterus. If there is no sperm production at all, then the only option is by donor sperm IUI.

2) My wife is suffering from endometriosis and her tube test was done, which said both tube blocked. What treatment should we have for achieving pregnancy?

She can have laparoscopic surgery to evaluate and correct tubal block if it is corrected she can conceive naturally. If the tubes are very badly damaged it is better to opt for IVF, in which Eggs are collected through scan guided aspiration and fertilized in lab. It is better to do earlier rather than late as age is the most important determining factor for success.

3) We are married for 4 years, husband is diabetic, he is having low count of sperm all other tests are normal according to doctors. Why we are not conceiving after treatment?

Hopefully your tubes have been checked and confirmed patent (open).

Husband needs to control diabetes by diet, exercise, any infection should be treated. (Semen Culture). After medical treatment and improvement of semen, IUI can be performed, in which washed sperms are deposited inside uterus during the time of ovulation to achieve pregnancy. Sometime it can take 4-6 attempts of IUI. If count is very low you may require ICSI.

4) I have undergone ICSI 6 times and everything failed. Is there any other treatment option, as I am suffering from severe endometriosis and had 2 laparoscopic mayomectomies? We tried for adaptation and failed because of age problem.

You can consider surrogacy, where you will have your egg and husband’s sperm fertilized by IVF being kept in a third persons (healthy) uterus to achieve a child. Volunteering persons can be your friend or relative or a healthy person arranged by hospital. Some people opt for a donor egg with husband’s sperm during surrogacy when they don’t have healthy egg.

5) Doctor will you please inform me, if there is any way I can have a child. As I was getting periods only with medicines, we did genetic testing and they told me, I have turner syndrome.

Unfortunately in this problem your ovaries will not produce eggs. There is a method called donor egg programme. There for you can have someone to donate eggs to help you achieve pregnancy by fertilizing that egg with husband’s sperm by IVF method.

Wednesday, August 25, 2010

IVF Proceedure In Gyno IVF Centre Kerala, India

Introduction.IVF is the procedure in which fertilization of egg and sperm is done in laboratory to form embryo and it is then transferred into the uterus. (Womb)It is done for infertile couples who cannot
conceive naturally or by IUI.
Indication for IVF.
Female infertility due to tubal block, endometriosis,
pelvic infection, fibroid, Adenomyosis, anovulatory, PCOS, are some indications.
Low sperm count or reduced motility of sperm due to various reasons are also an indication. Unexplained infertility in both.
Success depends on the quality of egg, sperm and the embryo which in term is depended on the patient. Younger the age, higher the success rate. It is also depended on pelvic health. Damage to ovaries due to endometriosis or adhesion can reduce success.
At the time of periods start injection in 2nd or 3rd day. Daily injections for 10 to 14 days. After that ultra sound scan. Certain blood test to check hormone level will also be done by hospital. The development of eggs is monitored on ultra sound scan and dose of injection, will be altered accordingly. Once eggs are ready, patient will be given a different injection called HCG before egg collection (OR), which may be during night, so patient get admitted for 1 or 2 days till OR. Egg collection will be done by ultra sound scan guided aspiration, under anesthesia, patient will be discharged home after recovery, by evening Mild discomfort in lower abdomen or spotting is normal after that. Some patients have distended abdomen and gas formation also; there is no need to worry, as there are body’s changes to egg collection and ovarian stimulation. Very rarely patient requires admission and medicine for hyper stimulation.

If husband has TESA/PESA, it will be done under GA on the date informed by doctor as needed, as doctors are making embryos and scanning and planning treatment. Moreover, the detail of eggs, embryos and quality becomes clear only after few days by embryo transfer.

Patient will be given medicines to take orally and keep vaginally. Next is embryo transfer. In this time patient will be in mild sedation during embryo transfer (E.T.) The procedure of putting embryo in uterus is very simple, but has to be done with lot of care and concentration in dark atmosphere.

After ET rest as advised. do urine pregnancy test/blood test according to advice from hospital If test is negative, it needs repeated after 2-3 days. Do not stop medicine at all. Once Result is confirmed positive Dr Will advice further medicine or may include injections also, which needs to be taken up to 3 months of pregnancy.

Story Of Women Just Among The Thousands, Who Visit Us.

This is the story of women just among the thousands, who visit us.

Profile: (when she came to us)

Name: ABC
Married: 23 years.
Children: none
Job: hopping infertility centres
Husband: Business
Moments of happiness: None
Moments of desperation and tears : everyday.
Attitude from society: no need to explain.

When Mrs ABC Name to see me, she did not cry, she did not smile, she just had a ghostly expression on her face. Well, you would not really expect anything more from here after visiting around 30 centres for infertility treatments in the last 23 years. There is not a single month in the calendar, which she had spared trying to achieve motherhood. After the first year of marriage, their plight began, initially it was only medicines and scans and tests. Later it progressed to intra uterine inseminations (IUI) where she waited with all her dignity forgotten. Still hoping to see the innocent toothless smile. When the 12th month of IUI also marked with painful periods, her husband felt pity for her and both started years and years of diet and bottles and bottles of distasteful concoction followed, After 3 years of sacrifice, one of their friends suggested a magical healing from a specialist homeo. They did not leave any stone unturned. And homeo followed Ayurveda and so did many others.

Modern medicine had new things coming up, and they both packed bags for Bombay. She dreamed about her baby in a test tube, all the way in the train while her husband tried to calculate to meet ends after the huge investment in IVF. The second and third IVF were done after he worked harder and harder to see a smile on her face. They did think about adoption but the nightmares of the child being called names by the naive people of there village hurt them.

She tried to look happy, when she came back from every function that she attended. She cried in the toilet, because she loved her husband and did not want him to see her tears.

He worked day and night to expand his business, he sold all the disposable property they had and they managed to make the finance for ICSI treatment. Fortunately they did not have to go far, medicine had advanced in Kerala.

The age had diseased her uterus. As if crying for mercy the womb developed tumours called fibroids which caused her pain and heavy bleeding. Ultimately doctors of the highest specialist order managed to dig out some of the fibroids from her uterus through laparoscopic surgery. They were sure that the second ICSI will be successful, as the uterus was lighter now.

Alas! The surgery had left all the organs in her pelvis sticking like a gum, and as if in a vengeance, more and more fibroids appeared in her next scan and then went the second by surgery, now the doctors opened her up for thorough cleaning of the internal organs followed by a third attempt of ICSI. Year passed by at this attempt of fight with the fate, it had taken toll on both of them. So much of hope a human can have, one wonders after hearing their story.

When I told them that, I can help them, they did not believe at first. They still could not believe their eyes, when I first showed them the scan picture of 2 tiny pregnancies in the surrogate mother. All the doubts melted away when they saw the movements of their 2 tiny babies on screen on their third month.

The eggs that we retrieved from her and fertilized with husband sperm in the IVF lab had now become a full grown babies, in the surrogate mothers womb, by 8th month.

The one moment I cannot forget, is the one when I saw the face of the couple when I handed over the twin babies to them. We did not even bother to clean or dress them before we gave them to their mama and papa, they had waited, way too long for that moment. More than a doctor, I felt myself as a human being at that moment. Then I saw tears rolling down and I was happy to see, the warm tears washing of the blood from the boy and the girl.

Tuesday, August 24, 2010

The Story Of Surrogate Women

Name: XYZ
Age: 30 years
Married: 12 years
Children: 4
Job: asking loan from everyone known.
Husband job: Drinking, when time permits beating wife.
Moments of happiness: none
Moments of desperation and tears: daily
Attitude from society: no need to explain

The most marked thing about her, was her beauty, but after hearing her story, it was clear that it was a curse on her. Although she was good in studies, her looks led to guys following her all the time.

At last she ran off with this young handsome man, who was adoring her all the time. The expectation of life was nothing less than a fairy tale. Life had a different toll waiting for her. After the first childish birth her husband started having doubts on her. He started drinking heavily and lost his job. Then he did odd jobs on off, and by the birth of their third child, they lost almost everything, in the way of booze.

As her family was not supporting her, she did not have any place to get away. Fourth time she missed her periods, she went to a centre for termination, but could not afford the amount that they claimed. The beatings that she endured almost every night were not as painful as the look on her children’s hungry face. Several times she contemplated suicide, but the nun friend in the nearby convent kept giving her hopes from the stories of the bible.

It was the nun who actually supported her in her discussion in going for surrogacy, after she saw that in a magazine she felt a ray of hope for the future of her children. She wanted all the 3 girls and her boy to get some education, so that they do not end up like her. Surprisingly her husband agreed to that idea, when he understood that, it will bring financial help; As the baby is inserted in a very early stage into the womb and because it is belonging to biological parents, he did not have any reluctance in his wife becoming surrogate. Luckily she conceived in the first attempt of embryo transfer after ivf and had a smooth pregnancy till the end. She opted to stay in the hospital for the 9 months, as she knew her husband’s character. Good nourishment and rest restored her physical and mental health tremendously. She started to laugh and tell jokes and talking to her kids on the mobile phone, who were now being taken care by the nun. Surprisingly the moment she started sending money, her husband changed his attitude. He stopped threatening her, which further boosted her confidence; with the help of the nun, she booked a small house in a 3 cent plot, which she bought later. She was more than happy to give the baby to their parents, and for first time in her life, felt that she did something worthy.

The cash that was left was put in fixed deposit in the names of children for their education and she also found a job as care taker in the convent nursery school.