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 !!