NIPT - Single Blood Test For Baby’s Safety !!

Pregnancy whether natural(spontaneous)  or via IVF(ART- Assisted Reproductive Technology) comes with a great news in family and all await till nine months for a healthy baby to be born and fill happiness.Sad part when after nine months of efforts one may unfortunately have a baby born with some abnormalities or disabilities.

Science is making a continuous efforts to avoid such mishaps to happen and knock door of anyone.There are few old crude ways to rule out any such possibility before hand only but that puts baby in womb at risk with possibility of harm to carrying mom also.So definitely as patients one like to be aware of whats best and safe.

Via this write up we want to focus on latest in talk and most non invasive modality to know your baby’s risk to have abnormalities post birth.This latest single and simple blood test makes genetic screening more reliable 

Various random terms often heard via google or via your Doctor like-·       

Invasive and Non Invasive Methods·       

Preconceptional, Prenataland  Antenatal Methods·       

NIPT·       

PGD/PGS

What they all  upto, lets discuss that !!

DNA Of Baby and Parents-

Besides knowing DNA of parents by Karyotyping,you may be surprised to know that your blood carries baby’s DNA(cell free DNA or cfDNA) too so that actually forms the basis of all these novel tests.

Prenatal diagnostic testing- 

It involves testing the fetus before birth   to determine whether the fetus has certain abnormalities,more so especially if female falls into advanced age group .There are a variety of non-invasive and invasive techniques available for prenatal diagnosis. Each of them can be applied only during specific time periods during the pregnancy for greatest utility. The techniques employed for prenatal diagnosis include:-

1)  Ultrasonography

2)Amniocentesis

3)Chorionic villus sampling(CVS)

4) Fetal Blood Sampling

5) Genetic Sonogram  

Pre-implantationgenetic diagnosis (PGD)-

 Its done in cases of  IVF (in vitro fertilization)   who are at increased risk of having a baby with a genetic or chromosomal disorder. Before an embryo is transferred to a woman’s uterus, it is tested for certain genetic disorders and mutations. Only embryos that do not test positive for the disorders are transferred.

Screening During pregnancy- 

Women are customarily offered a variety of genetic screening tests during their first/second trimester of pregnancy to evaluate the risk for genetic disorders for their unborn baby.   Information from these screening tests are used to help determine even the slightest possibility that the fetus might be born with genetic disorders such as Down syndrome, cystic fibrosis, Tay-Sachs disease, sickle cell anaemia, etc.

NIPT(Non Invasive prenatal test)- 

It checks for DNA of your baby’s placenta in your blood sample.It can check for likelihood of having an abnormal baby with accuracy of 99% so that you and your doctor can decide for next steps.Purpose is to avoid risk of miscarriage associated with the invasive methods like-Chorionic villous sampling(CVS) and amniocentesis.

Safety –

This test is simple, quick  and safe Interpretation- Once the results come then your doctor will correlate with first trimester soft tissue markers via screening 

Diseases screened-·       

Various common chromosomal disorders are detected like- Downs syndrome,Edwards syndrome and Patau syndrome, even triploidies, microdeletions·      

 Blood group and Rh factor of  baby·       

Sex of the baby(Purpose is not gender determination as that’s Illegal and punishable in India to ask or to suggest both under PCPNDT act.

Aim- 

As certain genetic diseases run in certain families in particular gender only so that if same recurs timely call can be taken)

Time zone to do test-

Well NIPT though noninvasive but still its time duration to do can vary as per country as per law of land for termination of pregnancy.Also authentication of  that lab is a must.It means that particular IVF or High risk obstetrics /Genetic centre you seeking help should be authorized to do so from related authorities.There can be variation as per state to state even.

In India, NIPT can be done 9 weeks onwards

Who all should do NIPT ?(Indications)·     

 Maternal age > 35 years·       

Family history of anomalies·       

Previous baby born with anomalies·       

Recurrent miscarriages 

What does latest guidelines says  ?

Though there are a set of indications but still latest guidelines suggest it to be offered to all pregnant mothers irrespective of age.Rather if clinic can afford should empanel an independent genetic counsellor.Its a cafeteria choice for couples but definitely as doctor we should give them complete information so that an intelligent informed decision should be taken at end

 *Disclaimer- All information shared is as per clinical observation & knowledge over a period of time and evidence based facts and authors in good faith donot suggest to follow it blindly.Its for awareness of our  patients.Seek help of your doctor before taking any decision   

Acne in Adolescents -Prevention and Diet Instructions

      Acne in  Adolescents Lean PCOS-Prevention and Diet Instructions

There is little that can be more devastating to a young healthy woman than the stigma of acne which is there for everyone to see.

Reasons- There are be multiple etiologies but in a young adolescent female PCOS should be ruled out first

Triggering factor- Can be some stress, diet changes, hormonal disturbances.

Acne vulgaris is a very common condition particularly in adolescents. It is basically caused by increased activity in sebaceous glands which is dependent on androgens. Acne in women may thus be considered as a manifestation of cutaneous androgenization. It often appears in the teenage years, induced by the burst of

pubertal androgenic activity, but if persistent, particularly severe or of late onset, acne is commonly associated with polycystic ovary syndrome (PCOS).

Role of Diet-

Acne causing food items-

Studies indicate that certain dietary factors, including dairy products and carbohydrate-rich foods — such as bread, bagels and chips — may trigger acne. Chocolate has long been suspected of making acne worse.

Acne clearing diet items-

1.    Oily fish like salmon or tuna.

2.    Chia seeds.

3.    Sweet potatoes

4.    Almonds.

5.    Sunflower seeds.

6.    Complex carbs.

7.    Orange juice.

But first rule out causative factor before following any of diet chart after consultation with your Doctor and preferably dietician

What we need to get rid of acne-

First we need patience- by doctor and patient both

Proper work up then as per etiology proceed

Good compliance as it make take long

Treatment may need to be maintained even once its cleared

Risks of relapses should be informed

Treatment modalities- Ideally Skin specialist and Gynecologist should work on same page to give patient best results

Treatment varies as per etiology- can be simple local measures or may need systematic approach with anti male hormone drugs and anti infection drugs

So follow advise as per situation

The presence of acne in women with PCOS is androgen dependent.

• Anti-androgens are the mainstay of treatment (e.g. combined oral contraceptive pill, CPA and

spironolactone).

Ovulation Kits

Ovulation kits help to detect the most fertile period of the month in a female to increase chances of pregnancy. Use an ovulation prediction kit so you can plan your time for trying to conceive appropriately. With this kit you will know 24-48 hours before you ovulate.  When the kit shows positive you and your partner should try conceiving on that day and the following day as well.

Principal- Its based on concept of LH surge followed by ovulation and successful fertilization during next 24 hours.

Ovulation –is the process of release of a mature egg from a mature follicle such that it has capacity to get fertilized

Advantage- Its cost effective and easy

Disadvantage- Difficult to use in cases of irregular periods and can be very stressful sometimes.So avoid using it without proper consultation with your Doctor

Prenatal Vitamins

Prenatal Vitamins

                           Author- Dr RichaSharma(IVF Consultant Mumbai) ·       

Prenatal vitamins are supplement which a prospective mother should start taking before and during pregnancy·       

Folic acid most important of them-it can be plain folvite or can be a combination of various other vitamis·

 Purpose- Its basically  for the safety of your baby.It helps not only to grow and develop cells of baby but also helps safeguard against brain and spine disorders(Neural Tube Defects)·       

When to start- At least one month prior to pregnancy·       

Advise- Follow anything after your doctor’s instruction only and don’t mix various therapies together.Follow one advise religiously to get best results.   

Cancer and Future Fertility-How to Preserve !!

Author-Dr Richa Sharma(IVF Consultant Mumbai)

Cancer is increasing in prevalence with improved detection and diagnostic techniques so prolonging the life and improving the quality of life.It has been observed to be affecting more of younger age groups so can have a lethal effect of the future fertility by destruction of their gametes (sperm or eggs). 

As doctor we feel need of spreading awareness at multidisciplinary level regarding preservation of future fertility which needs counseling and guidance at preliminary stages only before the damage happens.

Various Methods-

       1. Oocyte/Egg cryopreservation·       

       2. Sperm Cryopreservation·        

       3.Embryo freezing

Method will vary as per the clinical status.At the base level all needs to have a good IVF lab with strong freezing protocols and good clinical skills else all efforts go in vain !! So do proper home work before taking a call.

Oocyte  cryopreservation/Egg Freezing-

Egg freezing means removing mature eggs and freezing them for later.This process may also be called egg banking . Its done in cancer patients preferably before exposure to chemo and radiotherapy. Its same like an IVF cycle except that embryos are not formed.Here  medications are given  to stimulate the development of multiple follicles in the ovaries. Type of cancer can also decide the protocols.Besides there are now more patient friendly mild stimulation protocol especially in estrogen sensitive(positive) cancers. The eggs are retrieved from the patient using a transvaginal technique under anesthesia and are kept frozen for future use by a method called vitrification. Frozen eggs can be kept frozen for years(5 years as per ICMR but not specified for cancer cases) till the woman decides to use them for conception  and once the patient is ready to get pregnant,the eggs are thawed and then fertilized using ICSI, an assisted reproductive technology that injects one sperm directly into the egg. The embryos(fertilized eggs) will then be transferred into the woman’s uterus (womb) inorder to achieve a pregnancy.  

Embryo Freezing -

  It has the highest success rate compared to any other treatment.  Its like normal IVF when eggs are retrieved and mixed with sperms. Once fertilized,the embryos (fertilized eggs) grow in the laboratory for 3-5 days until theyare suitable for freezing.   

Sperm Freezing-

Sperm Freezing is an effective and simplest way for men who have gone through puberty to store sperm for future use. Many men can store sperm either from natural ejaculate or from surgical retrieval of sperms(SSR).

Poor Amh and Egg Donation- When to Opt for ?

Recently we often come across young couples suffering from insufficient eggs with no evident reason.Such sudden surge can be due to multifactorial reasons ranging from genetics to environmental impact.Definitely we as humans and as science has certain limitations and cannot regrow whats lacking or deficient.We correlate with parameters like AFC,AMH,FSH as per female age to decide whether we can take chance for IVF with own eggs or have to directly go for egg donation.Its hard to advise but as doctor I feel its better to be clear and transparent to patient.Ultimately decision they can take based on facts with open eyes and mind

What’eggDonation?

Egg donation is a type of  Test Tube Baby  procedure where an egg is taken from a fertile young lady preferably under 30yrs and sperm is taken from intending husband and both are  united outside the body in laboratory and the resulting embryo (baby) is transferred into the uterus of the intending woman.

Egg donor- is woman who donates eggs(andey)

Recepient-woman who receives eggs in form of embryos(Bhrun)being transferred into her womb(Garbhasay)

Innovation- Trounson and colleagues from Australia first reported an egg donation cycle in 1983

This  concept has enabled millions of woman all round the globe to get pregnant who are not able to get pregnant  using their own eggs. Egg donation has brought a new hope to many couples who otherwise would have remained  childless.

Who all in need of Egg Donation ?

1)Premature ageing of ovary(Premature ovarian failure)-when there is early ageing or lack of eggs, reasons can be- Idiopathic (unknown), after ovarian surgery like removal of ovaries prematurely due to multiple reasons, In cancer patients after chemotherapy ,Radiotherapy

2)Genetic reasons like- Thalassemia, galactosemia 3)

Down syndrome or any other chromosomal disorders translocations (karyotyping)

4)Repeated  IVF failure due to poor egg quality

5)Menopausal, perimenopausal(females who are not getting monthly periods)

Oocyte donation is the most successful technique for achieving pregnancies in perimenopausal women. 

How female differs from male in fertility- Do you know that ???? 

 A women is born with a fixed no of eggs in her ovaries and these are depleted in the course of her  reproductive years(15-45yrs) unlike men whose sperms(shukranoo) are formed every 3 months so a man even of 80yrs can make a lady pregnant unlike a women after 45yrs has get almost nil chances to get pregnant as her own eggs are exhausted because her eggs are formed only once in her life time(at the time of birth) . New egg formation does not occur afterbirth and there are no medication or injection for new eggs to form( Concept of stem cells on research  and DHEA with variable evidence)

What’s the success rates and how it differs from normal pregnancy?Anything to worry ?

  The pregnancy after an egg donation cycle is like a normal pregnancy follow up. The success of egg donation cycle is approximately 45-50% per attempt . The success is not 100% because the implantation (Growth of the baby inside the womb) is under God’s  control and there are no medication at present which would  assure 100% implantation. The process of IVF can make babies outside the human body till 2-3days max 5 days and there after the babies (Embryos) are transfer back inside the womb and the further growth inside is dependent on God wish .Is it safe to go for donor and what all screened ?The egg donors are screened for infectious disease,genetic diseases along with baseline workup along with detailed psychological  evaluation .What are legal issues?The recepient couple should be aware that they would become the legal parents of any resulting children/child.Donor selection is based strictly as per ICMR guidelines and ART Bill(law of land)

Risksto baby born ?

The children / child born through a egg donation cycle does not carry any increase in chance of abnormal child.    The ethical, moral , legal and medical issues hav ebeen addressed time and time again, yet the debate goes on. Strict guidelines and protocols are necessary. Within the complexity of these issues, continued efforts have to made to improve the outcome of egg donation program for both recepient and donors.

Sexual health In Males

    

Author- Dr Richa Sharma(IVF consultant Mumbai)

Men's sexual health is an important aspect of men's health, whether you're trying to prevent pregnancy and sexually transmitted infections or you're worried about erectile dysfunction or other men's sexual health problems.For some men, worries about penis size top the list of their sexual health concerns. However, you're probably more normal than you think  As you get older, understand common changes in men's sexual health — and how to maintain a healthy and enjoyable sex life at any age.  

Myths and Facts-

You often hear about the importance of physical health, mental health and spiritual health, but feeling confident about your sexual health also is very important. Achieving sexual health allows for:·        

Healthy relationships·        

Planned pregnancies·        

Disease prevention 

That's why it's essential to be well-informed about all aspects of sexual health and what it takes to have a fulfilling sex life. Similarly, it's important to be aware of factors that can complicate your sexual health. Don't let embarrassment keep you from bringing up concerns or asking questions of your doctor or other health care providers.We will discuss in a stepwise fashion various Myths and Facts at different stages in different age groups in  males

1. Myths-Masturbation is harmful ?

Ans- No its totally safe. It increases mental well-being not mental illness or instability like some myths suggest.

2.Masturbation can affect normal relationship of a husband wife ?

Ans –No rather it may help to improve the same.It has some advantages like- enhanced sex between partners understanding your own body increased ability for orgasms boosted self-esteem and body     image increased sexual satisfaction treatment for sexual     dysfunction 

3. Myth-Sexual health and fertility  go hand to hand.  Poor relationship will feeble your chances to have baby?

Ans-Good health definitely improves the chances of conception but its not a must as science is now advanced to overcome any difficulties happening naturally inform of Assisted Reproductive Techniques(ART)

4. Myth-Sex can increase cancer risk?

Ans- Rather it decreases risk. Men who are in a healthy relationship are less  to receive a prostate cancer diagnosis before the age of 70.  Even it has been observed that men who had frequent orgasms (defined as two or more a week) had a 50 percent lower mortality risk than those who had sex less often.

5.Oldage and sex life Physical changes, illness, disabilities and some medicines can make sex  difficult .Don't be afraid to bring up concerns with your doctor or other health care provider. And remember,whatever your age, take precautions to protect yourself from sexually transmitted infections. 

Patient Friendly IVF

                              

                                                   Patient Friendly IVF

                                                     Author- Dr Richa Sharma(IVF Consultant  Mumbai)

Infertility Is a very rampant and stressful condition affecting not only couples but the whole family.If we go by the statistics -60- 80 million couples suffering from infertility globally every year, between 15- 20 million are in India alone.Rising trend may be due to the multiple factors like-

·         Late marriages (career oriented females)

·         Changing Lifestyles(obesity,Junk Food,Irregular dietary habits,Drinling alcohol,smoking,Drugs)

·         Stressful jobs with no time for sex

·         Social pressure

·         And of course due to increasing awareness due to which more couples seeking help and more clear diagnosis

But the story doesn’t end here.Diagnosis of Infertility add stress to couples further depending upon cause.More so in females as they are scared of taking medicines with their mind googled by so many myths with less facts.Here comes the role of an IVF specialist.

Treatment can vary following the hierarchy as per clinical status.It can be IUI/IVF. Definitely First thing which comes in Mind of women on advising IVF is the fear of Daily puncturing of their body with needles(Hormonal Injections given to grow eggs) so that may make them delay the decision to take it further.But thanks to advanced science and technology that Now we have the option of What we call as-PATIENT FRIENLDY IVF- it involves minimum disturbance of the normal physiology by giving least dose of medicines.Besides there are better versions of Injectable medicines available which are self administrable and less painful and lighter and it may be combined with the oral combinations also.This we call as –Soft Protocols.It helps to keep quality of eggs and embryos on better side with more ability of the womb to accept the baby(Endometrial Receptivity).But definitely decision is individualized as per patient clinical scenario as one size doesn’t fit all.So seek Proper Infertility Guidance with our Fertility Expert at earliest to help you fulfil dream of being a Parent.

Tuberculosis & Fertility-Facts and Myths vs Pitfalls

Tuberculosis (TB) is still rampant in India; and TB of the genital tract used to be the commonest cause of tubal infertility in the past. Comparatively today, the occurrence of TB has been reduced, because of improved socioeconomic conditions. However, it is often misdiagnosed in infertile women, leading to a lot of heartbreak and distress.

Effect on Fertility-

It is now understood that subclinical (latent) genital tuberculosis (TB) without clinical evidence of TB has a negative impact on fertility by affecting the endometrium. However, it is not known whether latent infection has detrimental effect on ovarian reserve.

Factors to assess Fertility potential:- 

There are various factors that help the prognosis of TB, like:-

Biological age

Chronological age

Biochemical parameters- AMH, FSH,LH,E2

Sonological parameters- AFC

To add to it previous and present treatment history is also taken into consideration, besides sometimes the extraneous matters and factors may have impact, which is why in-depth information makes it easier to diagnose the condition.

Tuberculosis has been found to be one of the factors leading to infertility – which may be in form of tubal/ovarian factor. But in order to diagnose and treat it at the right time and in the right manner, the question that arises is whether a diagnosis is actually needed or not.

Sometimes false positive tests and obsolete tests may land into diverting the focus so not bearing results, besides wastage of time adding to financial and psychological burden on the society. 

Through this article, we have shared a few tips that our readers must know and will help couples in getting many answers, especially the affected couples.

Facts and Myths-

Let’s start with some basics:-   Tuberculosis is an infectious disease which is caused by the tubercle bacillus.There is a difference between an infection with the tubercle bacillus and the TB disease. In India, most of us have been exposed to the tubercle bacillus.

Causative factor is either because of exposure to patients who have TB; or because of vaccination with the BCG vaccine (which is often given routinely to babies in India) so-it can be acquired or induced. This exposure helps us to become immune to TB and to fight the infection, because it allows us to produce protective anti-TB antibodies which help us to fight off the bacillus in the body.How does TB cause infertility?It does so only when it infects the genital tract. This is called genital TB. While the initial exposure to the tubercle bacillus is through the lungs ( because the bacillus is inhaled), most of us can fight off the infection, as a result of which it remains silent in the body, causing no harm. However, sometimes these latent bacilli can get reactivated, and then spread throughout the body through the blood stream. They can then get deposited in any part of the body, causing a TB infection of that part. It is only when it lodges and infects the genital tract, that TB can cause infertility. When a man is infected by genital TB, it causes tuberculous epididymo-orchitis, blocking the passage, as a result of which the man becomes azoospermic (no sperm enter the semen tract because the tract is blocked). Similarly, when a woman is infected by genital TB, it may cause tuberculous endometriosis (infection of the uterus) and salpingitis (infection of the tubes). This infection can often be silent, and may not cause any symptoms or signs at all!! But it may manifest as Infertility.

Science is a continuous evolving tool with the aim to conquer and defeat diseases but some diseases continue to be fatal in general. Tuberculosis is one of those. 

Various tests can aid to detect and diagnose besides the clinical picture (when it gets too advanced).

Here are few pitfalls:- 

1. Culture of bacteria by minor techniques- Tuberculosis is endemic in India, and it’s a disease which can affect practically any organ system, including the lungs, bones, brain and the reproductive tract. While it’s easy to “suspect” TB, it’s also extremely hard to confirm the diagnosis of tuberculosis in the lab, because it’s very difficult to grow the TB bacillus in vitro.While curettage is an easy procedure to perform, actually growing the bacillus in the lab, even in women with frank genital TB can be very hard, because this is a very temperamental bacillus which grows very slowly in the microbiology lab. So many clinicians may not opt for this.

2. Mantoux test- The Mantoux (tuberculin) skin test is equally unreliable. It tests merely for the presence of immunity against TB – and can be similarly misinterpreted.

3. Non-specific tests-  TB QuantiFERON Gold test is unreliable and has been discarded by good doctors.

4. PCR test- It is comparatively authenticated with 50% error still there

5. Chest X ray- It’s a non specific test which can only give an idea of underlying pathology but cannot pin point diagnosis

6. Keyhole surgery (Laparoscopy)-  Your doctor may come across certain findings via this surgery and recommend you medicines but it may also be empirical.Tuberculosis is a very difficult and misleading disease and definitely when there has to be treated but question is more hard to solve in infertile population. Definitely it cannot be recommended like a candy or Over the counter medicine as drugs involved have lots of side effects.

Summary- 

The diagnosis of TB of the genital tract remains notoriously difficult to make. Most patients are misdiagnosed as having TB when in fact they don’t, and many are treated for no good rhyme or reason !If your gynaecologist diagnoses you as having genital TB based on these unreliable tests, then please do NOT start anti-TB medicines. Please better seek a second opinion from a physician, preferably once who is a TB specialist!If genital tuberculosis has been diagnosed to a stage beyond the possibility of treatment, couples may have to opt for Surrogacy or Adoption. So it’s a must to know the basics and seek an expert opinion at an early stage.

*Disclaimer-Authors don’t suggest you follow this write up as medical advice. This is just sharing of information and awareness based on facts and clinical expertise!!

Cancer Awareness-Signs of Cervical cancer !!

Signs of Cervical cancer !!

In recent years, unfortunately, cancer of the cervix is considered one of the leading causes of death among women.Besides breast cancer, this disease is the second in line when it comes to how dangerous it is. 

Cancer of the cervix does not always show symptoms in the early stage of the disease, but regular testing (Papanicolaou test) can help you discover abnormal cells in the cervix that causes cancer. 

Also, doctors warned early signs and symptoms of this fatal disease in women should never be ignored.As we mentioned already, the early stages of the disease often do not show any kind of symptoms.

 But the first symptoms that indicate that cancer has spread are the following:-

Pain in the legs -During the early stage of the cancer development, a number of women suffer from swelling and leg pain. After the first stage, the cervix is swollen and can obstruct normal blood flow, leading to swelling and pain in the legs.

Urinary problems-A urine test can help you find if you have cancer of the cervix. If the cancer is diagnosed in this way, it means that the tumor is already at stage 4 and also that the abnormal tissue has spread to the bladder and affects its function.A very common symptom in women suffering from cervical cancer is tingling when urinating. It is important to know that urinary problems are not always a sign of urinary infection, so it is best to visit a specialist.

Bleeding-Bleeding that occurs between regular menstrual cycles should be examined in time in order to take appropriate measures.At the beginning of the first stage, cancer cells can be on the surface of the cervix, or deeper into the tissue.

During the tumor development, menstrual cycles become more difficult, irregular and often followed by pain in the pelvis, waist or legs.

 Swelling of the lower extremities sometimes occurs in some patients. This is a sign that the tumor has evolved in the last stage.Then normal blood flow is interrupted because blood vessels are under pressure. Also, cancer cells can spread to the bladder causing tingling or blood in the urine.

Once the tumor expands you may often notice various symptoms, including anal pain and blood in the stool.

Also, if the tumor extends onto the urethra or upper urinary tract, it can lead to hydronephrosis — swelling of the kidneys.

Smoking Thrills But Kills Future Fertility -Quit Now !!

Smokers take longer to conceive than non-smokers and are more likely to have fertility problems. Women who smoke (Primary/Secondary smoking) have an increased risk of infertility and are more likely to take longer to get pregnant

In Men-

Smoking can decrease Motility Of sperms leading to asthenozoospermia

Smoking can Increase DFI(DNA Fragmentation Index)-DNA damaged sperm may lead to problems with fertilization, embryo development, embryo implantation, and increased miscarriage rates.Male smokers may also have abnormal hormone levels, which can affect fertility.

Smoking can alter epigenetic profile of sperms

Male smoking is also associated with decreased IVF success rates and possibly increased miscarriage rates. Also, secondhand smoke can harm her fertility as well.When he smokes, it not only decreases his sperm health. It also decreases female's fertility.

In Women-

Premature aging

Damage of eggs

Increased Risk of miscarriage

Impaired function of fallopian Tubes

Growth discorders in the future child

Deterioration in health with increased tendency to have cancer

Time Duration To Quit Smoking- allowing at least three months for improvement after quiting the habit helps.