Hepatitis- Overview and Prevention !!

Hepatitis is an inflammation of the liver. The condition can be self-limiting or can progress to fibrosis (scarring), cirrhosis or liver cancer. Hepatitis viruses are the most common cause of hepatitis in the world but other infections, toxic substances (e.g. alcohol, certain drugs), and autoimmune diseases can also cause hepatitis.
Types of Hepatitis Viruses-
There are 5 main hepatitis viruses, referred to as types A, B, C, D and E. These 5 types are of greatest concern because of the burden of illness and death they cause and the potential for outbreaks and epidemic spread. In particular, types B and C lead to chronic disease in hundreds of millions of people and, together, are the most common cause of liver cirrhosis and cancer.
Hepatitis A and E are typically caused by ingestion of contaminated food or water. Hepatitis B, C and D usually occur as a result of parenteral contact with infected body fluids. Common modes of transmission for these viruses include receipt of contaminated blood or blood products, invasive medical procedures using contaminated equipment and for hepatitis B transmission from mother to baby at birth, from family member to child, and also by sexual contact.
Acute infection may occur with limited or no symptoms, or may include symptoms such as jaundice (yellowing of the skin and eyes), dark urine, extreme fatigue, nausea, vomiting and abdominal pain.
Hepatitis A virus (HAV) –
• Faecooral contamination
• Infections are in many cases mild- with most people making a full recovery and remaining immune from further HAV infections.
• Predisposing factors- Most people in areas of the world with poor sanitation have been infected with this virus.
• Preventive measures-Hgyeine a must. Safe and effective vaccines are available to prevent HAV.
Hepatitis B virus (HBV) –
Mode of transmission-
• Spread is by exposure to infective blood, semen, and other body fluids.
• From infected mothers to infants at the time of birth or from family member to infant in early childhood.
• Through transfusions of HBV-contaminated blood and blood products, contaminated injections during medical procedures, and through injection drug use.
• HBV also poses a risk to healthcare workers who sustain accidental needle stick injuries while caring for infected-HBV patients.
Prevention-Safe and effective vaccines are available to prevent HBV.
Hepatitis C virus (HCV) –
Transmission- is through exposure to infective blood. This may happen through transfusions of HCV-contaminated blood and blood products, contaminated injections during medical procedures, and through injection drug use. Sexual transmission is also possible, but is much less common. There is no vaccine for HCV.
Hepatitis D virus (HDV) -infections occur only in those who are infected with HBV. The dual infection of HDV and HBV can result in a more serious disease and worse outcome. Hepatitis B vaccines provide protection from HDV infection.
Hepatitis E virus (HEV) – Fecooral contamination
HEV is a common cause of hepatitis outbreaks in developing parts of the world and is increasingly recognized as an important cause of disease in developed countries.
aSafe and effective vaccines to prevent HEV infection have been developed but are not widely available.

Kind Regards
Dr Richa sharma
Senior IVF consultant DELHI NCR
Post Doctoral Fellow National Board(FNBE) 
Reproductive Medicine(New Delhi), Bangalore
Fellow Reproductive Medicine, Madras Medical Mission (Chennai) MRCOG(London)

Failure Of Sustainability Of Precious Pregnancy- Causes and Interventions !!

    

To have health baby is the dying need of any woman in the world.This is the ultimate Gift any Mom wants.But what happens when one gets pregnant but cannot sustain it-Definitely it is something which is even more painful than absolute infertility.Reaction of couples may vary especially more so of female partner -any abortion is no less than mourning of a death- a life which was to smile is no more !!Something really disheartening .Womb of a lady cries every month in lack of baby-what we call as Menstrual periods.

Impact on Woman- There is significant, and often unrecognized, psychological and psychiatric trauma for the mother – for many, miscarriage represents the loss of a future child, of motherhood, and engenders doubts regarding her ability to procreate.Studies have shown that a significant percentage of women experience grief, depression, and anxiety, and that there is an increased risk of major depressive disorder following a miscarriage. The psychological effects can persist for 6 months to 3 years and tend to deepen with additional miscarriages

Today we will review what could be the possible causes and what could be the possible steps which can help thriving of a prospective baby.

What is Recurrent Pregnancy losses(RPL) ?

Recurrent miscarriage, habitual abortion, or recurrent pregnancy loss (RPL) -is three or more consecutive pregnancy losses. Infertility differs because it is the inability to conceive. In many cases the cause of RPL is unknown.  About 1% of couples trying to have children are affected by recurrent miscarriage

Causes-

It can be explained or unexplained(Idiopathic)-Definitely skills and upto date knowledge of the treating physician matters .To add to it needs TLC(Tender Love Care) besides the role of science.

There are various causes for recurrent miscarriage, and some are treatable. Some couples never have a cause identified, often after extensive investigations.About 50-75% of cases of Recurrent Miscarriage are unexplained

1)      Anatomical causes-Uterine,cervical

2)      Chromosomal-Translocations, aneuploidies

3)      Endocrine-PCOS,Thyroid disorders, Diabetes mellitus,Progestrone deficiency

4)      Thrombohilia

5)      Immune factors

6)      Lifestyle factors

7)      Infections

8)      Male-specific minor histocompatibility

9)      Unexplained

10)   Combined male and female factors

11)   Foetal defects

Diagnosis-

·         Ultrasound assessment-esp in early pregnancy and pre pregnancy evaluation

·         Parental chromosome testing  

·         Thrombophila profile

·         Ovarian reserve assessment

·         Thyroid profile

·         Diabetic profile

Treatment-

·         If the likely cause of recurrent pregnancy loss can be determined treatment is to be directed accordingly.

·         Role of blood thinners in thrombophilia cases  

·         Role of antibiotics in cases of infection  

·         There are currently no treatments for women with unexplained recurrent pregnancy loss. The majority of patients are counseled to try to conceive again, and chances are about 60% that the next pregnancy is successful without treatment.However, each additional loss worsens the prognostic for a successful pregnancy and increases the psychological and physical risks to the mother.

·         Aspirin has no effect in preventing recurrent miscarriage in women with unexplained recurrent pregnancy loss.

^·          No role of immunotherapy

·         In certain chromosomal situations, while treatment may not be available -IVF with PGD

·         Option of donor egg/donor sperm/donor embryo/surrogacy as per the clinical situation in worst situations

·         Close surveillance during pregnancy is generally recommended for pregnant patients with a history of recurrent pregnancy loss.  

                                                                                                                 Kind Regards

                                                                                                           Dr Richa Sharma
                                                                                            Senior IVF consultant  DELHI NCR
                                                                                        Post Doctoral Fellow National Board(FNBE)
                                                                                  Reproductive Medicine(New Delhi), Bangalore
                                                             Fellow Reproductive Medicine, Madras Medical Mission                                                                                                                           (Chennai)
                                                                                                            MRCOG(London)

Role Of Blocked Fallopian Tubes -Myths and Facts !!

Any preganancy revolves around four major factors-Sperms(Male factor),Egg(ovarian),Fallopian tubes(Tubal) and a healthy womb(Uterine) and to add to it comined, unexplained and the grey zone of implantation and sustainability.
This proves each step is so important and contributing to be worked upon
Today we will discuss about the tubal factor as what role fallopian tubes have exactly !!
Role of fallopian tubes-Fallopian tubes are actually the only connecting link to form the baby when its by natural or minimaly invasive means
So if tubes are damaged by any means its going to effect the final outcome
Effect on body- As if tubes are damaged they wont show any symptoms but may have signs in form of pain lower abdomen or associated sign sof PID especially when they are blocked and distended with infected fluid(Hydrosalpinx,pyosalpinx)
Effect on IVF outcome-The debate on hydrosalpinx and impaired IVF outcome has mainly focused on the best treatment before IVF and on functional surgery as an alternative treatment. We would like to initiate a debate on the possible reasons why the outcome is impaired. We know that salpingectomy is effective in terms of improved birth rates after IVF, but we do not know exactly why. The main focus is on embryotoxic properties of the hydrosalpinx fluid, which include micro-organisms, endotoxins, cytokines, oxidative stress and lack of nutrients. The endometrial receptivity may be reduced as an effect of disturbed expression of the cytokine cascade, which is essential for implantation. The presence of excessive fluid in the uterine cavity may also be a mechanical hindrance to implantation. We believe that the hydrosalpinx fluid is of crucial importance, but the actual mechanism of action needs to be clarified
Latest Updates-omen with hydrosalpinges are indeed a heterogeneous group: when hydrosalpinges are clearly visualized by ultrasound, the implantation rate (IR) and pregnancy rate (PR) are markedly reduced compared with other women with hydrosalpinges that were identified by hysterosalpingography or laparoscopy, but not seen on ultrasound
Reference link for interested readers-http://www.wikihow.com/Treat-Blocked-Fallopian-Tubes

Regards
Dr Richa Sharma
Senior IVF consultant DELHI NCR
Post Doctoral Fellow National Board(FNBE)
Reproductive Medicine(New Delhi), Bangalore
Fellow Reproductive Medicine, Madras Medical Mission (Chennai)
MRCOG(London)

Book Availability Update

Dear All it gives us immense pleasure to announce that our book is all set to be launched on amazon and other major book stores in Delhi.Besides that all who need can send their requests at richa.sharma47@gmail.com for north zone and in west ,East and South zones (mumbai) can email on pratul1974@gmail.com
Thanks To Almighty,Teachers and Friends with special thanks to parents and Dr Amit Basnotra,Prof Sanjay G. Rad-Tutor,Mr vicky Vicky Bhargava and For all time support by My Husband Mr Pratul Kekatpure

Explanations for Unexplained Infertility- unreached and unmet zones !!

Scientifically speaking-Unexplained infertility refers to the absence of a definable cause for a couple's failure to achieve pregnancy after 12 months of attempting conception despite a thorough evaluation, or after six months in women 35 and older
To simply it means when underlying cause for as to why the couple cannot have baby can be detected and it is considered as most frustrating for both the couple and the treating Physician
It is relatively simple to identify the cause of infertility in women with ovulatory disorders or tubal disease, and in men with semen abnormalities. These categories account for the source of infertility in approximately 75 percent of couples. Infertility in the remaining 25 percent of couples is due to endometriosis (8 percent) or miscellaneous factors (eg, cervical factor, immunological factor, uterine synechiae) (2 percent) or is unexplained (15 percent)

What actually can be done in a simplified manner-
When it takes longer than it should to get pregnant, the first thing you want to know is why. So you go through the full diagnostic process, from researching family medical history to physical examinations to hormone tests.
The diagnostic testing we have available will only identify the major reasons why a couple may have a difficult time getting pregnant but it certainly can not identify all the reasons.

Before jumping into invasive treatment options, start off with minimal intervention treatments There's a good number of patients who can get pregnant with more minimal interventions. The only way to know for sure is to try
Lifestyle modifications,dietarty interventions etc also can add to fertility.Many couples we see where multiple high tech procedures may fail to help but ultimately may get preganant naturally or with minimal invasions..So besides science our positive thought process and approach to our problem may help.
Well the last option is -IVF/ICSI-to help detect minor defects at microscopic level.

Hierarchy Of Treatment In Infertlity

Hierarchy Of Treatment In Infertlity

15% Of the couples are infertile with equal involvement of male and female factors besides the combined and unexplained category.
Like in any streamline here also we have to follow the hierarchy of treatment starting of course from simplest to most refined but definitely there is no hard fast rule-it depends on the basic work, clinical scenario and skills to add to it,but as patient its must you should be aware as what all could be the possibilities with cafetaria choice for you.Wise and Correct decision at right time at end matters !!

Various modalities stepwise ideally -
1.Ovulation inducion with monitoring with timed intercourse
2.Intrauterine insemination
3,IVF
4.ICSI
5.Donor egg/donor sperm
6.Donor embryo
7.Surrogacy(situational and indicated as per work up)

My First Book Launch At Hotel Taj Mann Singh New Delhi

My Book Pertaining to various issues on infertility and public awareness launched at Hotel Taj Maan Singh New Delhi !!

Male Age and Effects on Offsprings !!

Male Age and Effects on Offsprings !!

Age is a natural biological phenomenon which definitely effects females but doesnt spare males too.To have an update about ourselves is a must.
Advanced age of male especially once they cross 40s rise risks of impaired quality of the sperms due to the DNA damages though various lifestyle modifications and latest techniques like ICSI can help overcome but not 100%

Aging is a natural process comprising of irreversible changes due to a myriad of endogenous and environmental factors at the level of all organs and systems. In modern life, as more couples choose to postpone having a child due to various socioeconomic reasons, research for understanding the effects of aging on the reproductive system has gained an increased importance. Paternal aging also causes genetic and epigenetic changes in spermatozoa, which impair male reproductive functions through their adverse effects on sperm quality and count as, well as, on sexual organs and the hypothalamic-pituitary-gonadal axis. Hormone production, spermatogenesis, and testes undergo changes as a man ages. These small changes lead to decrease in both the quality and quantity of spermatozoa. The offspring of older fathers show high prevalence of genetic abnormalities, childhood cancers, and several neuropsychiatric disorders. In addition, the latest advances in assisted reproductive techniques give older men a chance to have a child even with poor semen parameters.

Endometriosis-Basics !!

Endometriosis is one of the most common medical conditions affecting the lower abdomen (lower belly) in women. In endometriosis, the kind of tissue that normally lines the inside of the womb (endometrial tissue) also grows outside of it. This can happen without the woman being aware of it. But in other women endometriosis is a chronic disease, associated with severe pain and fertility problems.

It often takes years for endometriosis to be diagnosed as the cause of these problems. Until the diagnosis is made, many women try to cope with their pain somehow. They believe that the pain — even really bad pain — is a normal part of their menstrual period.

There is currently no cure for endometriosis. But there are many things that can be done to relieve the symptoms. And if treatment is adapted to suit women's personal circumstances and the severity of their endometriosis, many can cope quite well with the disease.
Symptoms-

The main symptom of endometriosis is pain in the lower abdomen. This often arises when women have their menstrual period, or during or after sex. The severity of pain may vary, sometimes radiating through the lower belly, back and legs. It is often described as “cramp-like” pain, and might be accompanied by nausea, vomiting and diarrhea.

Prevalence-

Data concerning symptom-free women varies a lot: Between 2% and 50% of women are thought to have “silent” endometriosis which they are unaware of.
It is estimated that 40% to 60% of women who have very painful periods also have endometriosis.
20% to 30% of women who are unable to get pregnant are believed to have endometriosis.

Effects-

More severe forms of endometriosis can affect nearly every area of a woman’s life. Many feel less womanly as a result of the recurring pain. Particularly young women with severe symptoms may not be able to develop a positive relationship to their own body. Painful sex can make it difficult to have an enjoyable sex life. Women who have more serious forms of endometriosis might not be able to become pregnant and have their own children. Chronic pain may lead to tiredness, irritability and depressed moods. Together, all of these factors can put strain on relationships too.

In many women, the recurring pain makes it difficult to carry out their usual everyday activities, work properly or pursue their hobbies. Women who cannot go to work because of bad pain and cramps often face problems at work, as well as having feelings of guilt and shame.

Diagnosis-

In women who do not have any symptoms, endometriosis is often discovered by chance. Women often first go to see a doctor because they are unable to get pregnant.

There are several things doctors can do to see if you have endometrial implants or endometriosis-related scar tissue or adhesions, and to rule out other causes of your symptoms. At first you will have an in-depth talk with your doctor about the type of symptoms (anamnesis), as well as a general physical and gynecological check-up. Depending on the symptoms, other examinations may be done too, such as an examination of the inside of your abdomen (laparoscopy).

Once finally diagnosed, the available treatment options can often reduce the pain or even make it go away completely. This, as well as knowing it is a benign illness, is a great relief for most women.

Treatment-

There is currently no “cure” for endometriosis – in other words, there are no treatments that can fight what is causing it. But various treatments can help relieve the symptoms, temporarily or permanently. The medication options include painkillers, hormonal contraception and stronger hormone therapy. Painkillers only relieve the symptoms, whereas hormone-based treatments slow down the growth of endometrial implants.

Surgery is also an option. The aim of surgery for endometriosis is usually to remove as many endometrial implants as possible. Sometimes surgery is even necessary – for instance, if endometrial implants are affecting bowel or bladder function.

Eat Healthy and Think Healthy !!

"When the engine is running smoothly, it affects how you view the world,”

Most people know that one of the keys to a healthy body is making the right food choices. A diet of colorful vegetables and fruits, whole grains, lean meats and fish, and low-fat dairy foods can go a long way to prevent physical problems. A lesser-known fact is that nutritious foods can also protect our mental health-there is a relationship between overall good nutrition and mental wellbeing.

Think Tank and A happier Brain -Needs a balanced Diet

The brain, like other organs such as your heart and liver, responds to what you eat and drink. It needs essential fatty acids, amino acids, complex carbohydrates, vitamins, minerals, and water in order to stay healthy. If you deprive your brain of these nutrients, it cannot function properly.

Fatty Acids-
One of the most important food components your brain needs is fatty acid. When you consider that a large part of the brain is made up of fat, you can understand why. Two of the types of fatty acid found in the brain are omega-3 and omega-6. These are known as essential fatty acids, and the body cannot make them but must take them in through food.

It's best to get an equal balance of these fatty acids, but unfortunately, the typical Western diet contains excessive amounts of omega-6 fatty acids and not enough omega-3 fatty acids, with a ratio of about 15:1. This ratio may contribute to health problems such as cardiovascular disease and some types of cancers. It may affect mood and mental well-being, too.

Amino Acids-
Amino acids are another important brain nutrient. This is because the messengers within the brain, called neurotransmitters, are made from amino acids. And some of the neurotransmitters that amino acids build are related to mental health.

Serotonin, which is responsible for feelings of contentment, is made from the amino acid tryptophan. And dopamine, which helps you to feel motivated, is derived from phenylalanine. Like omega-3 and omega-6 fatty acids, tryptophan and phenylalanine are taken in through foods, such as meats, dairy products, eggs, and soy products.

Complex Carbohydrates-
Carbohydrates serve a few purposes in brain nourishment. Some research suggests that carbohydrates actually help to stimulate the production of feel-good serotonin. Carbohydrates also help the body to absorb the amino acid tryptophan more effectively. And, the brain runs on glucose, which is derived from carbohydrates.

The best kind of carbohydrate to eat is complex carbohydrates (found in whole-grain foods, fruits, vegetables, and legumes). They release glucose more slowly than simple carbohydrates (found in simple sugars and white breads or pasta), giving the brain a stable and consistent flow of fuel.

Vitamins and Minerals-
Vitamins and minerals play a part in brain health, too.  Important vitamins for the brain include vitamins C and D, and the B vitamins. Minerals, such as magnesium, selenium, and zinc are also essential to good brain function.

Water -
A final important nutrient for your brain is water, which makes up about 80 percent of the brain. If you're dehydrated, even mildly, you can experience mental health symptoms such as irritability and loss of concentration.

Be Cautious-

Try to avoid or limit these foods and beverages:

caffeinated drinks (tea, coffee, and soft drinks)
alcoholic drinks
sugary foods
refined and processed foods
deep-fried foods

Stress of infertility, challenges and Interventions-Unmet Needs Of Infertility Remedies !!

Medical interventions may exacerbate anxiety, depression, and stress.
While the causes of infertility are overwhelmingly physiological, the resulting heartache — often exacerbated by the physical and emotional rigors of infertility treatment — may exact a huge psychological toll.

Gender Impact and Human Psyche-

Less research has been done on men's reactions to infertility, but they tend to report experiencing less distress than women. However, one study found that men's reactions may depend on whether they or their partners are diagnosed with infertility. When the problem is diagnosed in their wives or partners, men do not report being as distressed as the women do. But when men learn that they are the ones who are infertile, they experience the same levels of low self esteem, stigma, and depression as infertile women do

Stress of infertility and interventions-

Individuals who learn they are infertile often experience the normal but nevertheless distressing emotions common to those who are grieving any significant loss — in this case the ability to procreate. Typical reactions include shock, grief, depression, anger, and frustration, as well as loss of self-esteem, self-confidence, and a sense of control over one's destiny.

Relationships may suffer — not only the primary relationship with a spouse or partner, but also those with friends and family members who may inadvertently cause pain by offering well-meaning but misguided opinions and advice. Couples dealing with infertility may avoid social interaction with friends who are pregnant and families who have children. They may struggle with anxiety-related sexual dysfunction and other marital conflicts.

There are about 40 ways to treat infertility. About 85% to 90% of patients are treated with conventional methods, including advice about timing of intercourse, drug therapy to promote ovulation or prevent miscarriages, and surgery to repair reproductive organs. Only about 3% of patients make use of more advanced assisted reproductive technology such as in vitro fertilization (IVF). While medical interventions offer much-needed help and hope, studies suggest that they may also add to the stress, anxiety, and grief that patients are already experiencing from infertility itself.

Medication side effects- Drugs and hormones used to treat infertility may cause a variety of psychological side effects. For example, the synthetic estrogen clomiphene citrate, frequently prescribed because it improves ovulation and increases sperm production, may cause anxiety, sleep interruptions, mood swings, and irritability in women. (These side effects have not been documented in men.) Other infertility medications may cause depression, mania, irritability, and thinking problems. Patients and clinicians may find it hard to figure out which reactions are psychological and which are caused by medications — yet identifying causes is essential for determining next steps.

Money worries- In India we dont have insurance coverage for infertility treatment so all burden on pocket of couple so those not being able to obtain treatment may contribute to feeling helpless and hopeless.

Choices and outcomes-Over all, infertility interventions help about half of patients become parents, with the likelihood of success decreasing with age. Patients who learn they are to become parents may be overjoyed, but also must learn to adjust to new roles and pressures — both during pregnancy and after childbirth. Women who have suffered multiple miscarriages, for example, are likely to feel anxious about whether they will be able to carry to term. Older couples may debate whether to undergo prenatal testing such as amniocentesis.

Treatment failure- may trigger a renewed cycle of grieving and distress.

Treatment End Point !!-
It's also difficult to know when to stop seeking treatment. Frequently one partner wants to end treatment before another, which can strain the relationship. Most patients need to gradually, and with great difficulty, make the transition from wanting biological children to accepting that they will have to pursue adoption or come to terms with being childless.

Additional mental health challenges

Case reports and studies using self-report measures indicate that infertile patients feel more distressed than other people. More rigorous research, however, has concluded that — for the most part — rates of anxiety, depression, and other mental health disorders are not greater than in the general population. Patients may experience serious mental health problems on a transient basis, as they deal with the emotional and physical roller coaster typical of infertility treatment.

Infertility treatment can also exacerbate existing psychiatric conditions. Infertile women with a history of depression, for example, are more likely than other infertile women to become depressed during treatment.

Therapies that may help-

Many patients find a way to cope on their own, or they seek support from friends, family, or one of the many infertility support groups now available in person and online. But others need additional help.

Counseling-Referrals for short-term counseling are common — especially to increase coping strategies, or to provide help with making decisions (as patients face many choices during treatment). Patients who experience prolonged changes in mood or sleep patterns or who have relationship problems should seek a more comprehensive evaluation, as these may be signs of anxiety or depression.

Ideally, counseling should begin before patients start infertility treatment, as some studies — though not all — suggest that addressing psychological factors such as depression, anxiety, and stress may help increase the chances of giving birth to a child. Clinicians working with infertile patients can provide information on how to manage fatigue, reduce stress and anxiety, and improve communication with others.

Psychotherapy- Specific types of therapy may also be useful. For example, studies have concluded that interpersonal therapy (which focuses on improving relationships or resolving conflicts with others) and cognitive behavioral therapy (which identifies and tries to change unhealthy patterns of thought or behavior) can give relief to infertile patients suffering from mild to moderate depression. Researchers have shown that psychotherapy can be helpful for anxiety or depression whether delivered individually, to couples, or in a group.

Relaxation techniques-Given that infertility and its treatment often cause considerable stress, experts recommend various relaxation techniques. For example, mindfulness meditation, deep breathing, guided imagery, and yoga promote stress management.

Medications-. Antidepressants and anti-anxiety medications are useful when symptoms are moderate to severe. However, it's wise for women taking psychiatric medication to consider the risks to the developing fetus. Further complicating treatment, some infertility medications can interact with psychiatric drugs It is important for patients and clinicians to weigh all these factors when making medication decisions.