Painful Menstrual Periods and Fertility Potential(In Hindi) on 21/7/202...

Painful Menstrual Periods and Fertility Potential(In Hindi) on 21/7/2020 at 11am (IST)





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​Dear Viewers In Our next Live video session we will speak about the painful menstrual periods- an agony which many women may suffer silently So Dear Ladies Dont Suffer alone, speak to Your Doctor

Age Not Only Number Game- But Game Changer Of Your Fertility !!

Age Not Only Number Game- But Game Changer Of Your Fertility !!
Author- Dr Richa Sharma

The average chance of becoming pregnant each cycle is only 20%.It takes 5 to 6 months for the average fertile couple to conceive. One out of every six couples has trouble conceiving and/or carrying a child to term. Over 1.2 million deliveries worldwide using assisted reproduction.

Women are born with all the eggs they will ever have. Some are ovulated, but several hundred are pre-programmed to die each month. Accelerated egg loss happens due to- smoking, ovarian surgery, pelvic radiation, chemo agents.Irrespective of whether the patient is undertaking any fertility related treatment or not, there will be a decline in the ovarian reserve with age and its rapid especially after 30 years of age.That’s why the success of an fertility treatment is dependent of the age of the female partner.To determine fertility potential, we as clinicians are dependent upon the clinical,biochemical and sonological parameters that’s called as Ovarian Reserve Assessment(quality and quantity of eggs in a particular age range )

        Trends-
  Many women today are attempting pregnancy at older ages, when they are biologically less fertile.
   Pregnancy rates sharply decline after age 35
   The exact age at which a women can no longer conceive varies widely.   

The trend in delaying fertility may be due to a greater emphasis on establishing a career, later marriages, and remarkable improvements in the area of contraception
Pregnancy rates related to age of female-

       Woman’s Age (y)       % Conceiving in 12 Months                                                                                               

             20-24                           86

             25-29                           78

             30-34                           63

             35-39                           52          

15 - 20% of all couples will experience difficulties with conception, but this increases up to 50% at age 35 – 40.
Reasons Of Decreased Pregnancy chances with age-

v Conception rate of normal fertile couples (~ 20% /month)

Probability of clinical pregnancy following intercourse on most fertile day of cycle:

        19-26 yrs old        50%

        27-34 yrs              40%

        35-39 yrs              30%

v Poor quality of aging oocytes

v Chromosomal abnl., morphologic abnl.

v Decreased ovarian reserve

v Altered hormonal environment– ovulatory dysfunction

v More conditions in older women– polyps,endometriosis, fibroids…

Sexual factors– decreased coital frequency

Treatment Options-

v Ovarian hyperstimulation with IUI

      -  generates more eggs and sperm to be present at                  the optimal time of conception.

v IVF (in-vitro fertilization)- vital to older when time        is critical , tubal pathology

          (live birth rate drop from 32% in women<35 to      10% in women 41-42 yrs)

v Oocyte donation- option for older women

   Pregnancy rates are determined by age of donor, but  pregnancy complications by age of mother.

v Delaying childbearing may increase infertility and the chance of developing chronic medical conditions.

v If no pregnancy after 6 months of trying, refer to specialist!! Time is vital for these patients.

Risks to the prospective pregnancy-

There are various ways to quantify the risks associated with advancing maternal age-

There are multiple tests today to quantify a women’s risk of chromosomal abnormality:

§ nuchal translucency

§ first trimester serum screening           

§ quad screen in 2nd trimester

§ invasive testing– CVS , amniocentesis

What patients need to know ?

As doctor, we are supposed to give clear picture to the patient about impending risks of adverse outcome of pregnancy in the form of

§ preterm birth

§ growth restriction

§ stillbirths

Besides that we should discuss the risks of Hypertension, Diabetes mellitus, low socioeconomic class….all influence outcome

Conclusion-

v Advanced maternal age is associated with reduced fertility and increased risk of adverse pregnancy outcomes.

v Associations are due to poor oocyte quality, age-related changes in uterine/hormonal function.

v Fortunately, the prospects for couples to conceive are better than ever with advancing age with advancement of science and introduction of ART and especially the Third Party Reproduction

Freezing Future- Lots In Magic Box

                            Author- Dr Richa Sharma(Senior IVF Consultant Mumbai)

Reproductive medicine as subspeciality is not only limited to IUI,IVF besides it has many other lateral and vertical extensions which gives wings to the humans to take planned decisions and control their lives and not just meeting the fate.One such miracle is –Freezing of future fertility at will and on need.

What is freezing of fertility ?

It means to preserve fertility for future in the form of freezing of gametes and reproductive tissue.It began with preservation in cancer patients but as per need can be extended in others too.For that IVF lab need to have upto date facilities and embryologist needs to be skilled enough in cryopreservation/vitrification

Who all can opt for ?

·      Improve the efficiency of IVF

·      Alternative to embryo freezing

·      Oocyte preservation for patients with ovarian hyper

·      stimulation syndrome

·      Oocyte donation programme( for quarantine purpose)

·      The treatment of congenital infertility disorders

·      Prevent fertility loss through surgery

·      Treatment of premature ovarian failure (POF)

·      Also in cancer patients prior to exposure to chemotherapy or radiotherapy(fertility Cryopreservation)

·      In career oriented females who want to plan family later due to other commitments

·      In case male partner not available or not able to give semen sample (ED/refuses)

·      In cases of failure to form embryos esp when repeated risk is there- half of the oocytes can be cryopreserved to find out the reason  (as to whether egg or sperm)

Is it limited to any particular gender ?

It can be beneficial in males and females both

How long we can freeze ?

As per ICMR it can be stored upto 5 years and depending upon situation term can be extended

What are pros and cons being in freezing temperature ?

Benefits are clear from indications mentioned above and disadvantage is due to the attrition affect of freezing media and post recovery survival especially when the samples frozen are not that great in quality and quantity

Fluid Collection in Ivf-Myths and Facts

IVF is a finer treatment option for childless couples but it needs a better understanding before opting for it.It has lots of Myths and Facts associated with it.

Patients often have fear of side effects of medicines used to stimulate their ovaries to grow  their eggs.One such side effect is Accumulation of fluid in the body what we call medically as OHSS(Ovarian Hyperstimulation Syndrome) but its not a uniform feature in all IVF patients.OHSS has a tendency to happen in selective group of patients with high risk factors which can be predicted and prevented.So via this write up our focus is on to single out such predisposing factors so that appropriate measures can be taken on time.Its not only duty of a treating doctor but a patient also needs to be aware than landing up with sudden surprises and bitter experiences.

Why is it a concern?

•       Marked increase in patient population in infertility clinics

•       Changing lifestyle

•       Advances in the field of ART – act as a Double edged sword with pros and cons

•       ART technology – is morepatient friendly,with less complication with cost still a limiting factor with no 100% gaurantee

What is OHSS ?

It is a Life Threatening medical(Iatrogenic,drug induced) Complication

and unique to the treatment of infertility with an an acute onset but reversible in nature with enlarged ovaries with cysts and fluid accumulation in body cavities to variable extent depending on gravity and grade

What are types of OHSS ?

Mild,Moderate,Severe and Critical

Who all have risk to develop OHSS ?

•       Young age, Low body mass index

•       Polycystic ovary syndrome (PCOS)

•       Higher doses of exogenous gonadotropins

•        High Estradiol levels with rapid rise

•       Previous episodes of OHSS

•       Multiple developing follicles(20-25)

•       Exogenous hCG for superovulation/ luteal support

•       Multiple Pregnancy

•       Serum factors increasing permeability of blood vessels

How it can be prevented ?

Primary  or Secondary prevention

1. Cycle cancellation
2. Coasting or controlled drift
3. Drugs – GnRH analogs

•       GnRH antagonists

•       Recombinant LH

•       Insulin sensitizers - Metformin

•       IV albumin 20%

•       ACE inhibitors + Angiotensin II receptor blocker

•       Glucocorticoids

4. USG Guided Follicular Aspiration
5. Elective Embryo Cryo Preservation and Transfer in subsequent cycle
6. In vitro maturation of oocytes (IVM)

How will my body behave when I Have OHSS ?

Most frequent symptoms and signs are –

•       Distention of lower abdomen

•       Nausea and vomiting

•       Dyspnea and respiratory distress

•       Diarrhea

•       Quick weight gain

•       Ovaries enlarged up to >12 cm

What to do If I have pregnancy and OHSS Both ?

Course generally unpredictable.That depends on how many pregnancies and response of body and period of onset of OHSS

Can It be 100% Prevented /Eliminated?

No but deterioration can be prevented.There is definitely aim to have OHSS free treatment

How to manage OHSS ?

Principles

•       Monitoring

•       Supportive therapy

•       Maintenance of intravascular volume

•       Prevention/treatment of complication

•       Counselling - Signs and symptoms of OHSS

•       Evaluate the baseline status with

 - complete history

 - complete general and systemic examination

(pelvic examination contraindicated as ovaries are fragile,can rupture or undergo torsion)

Outpatient measures-

•       Limit activity

•       Weigh daily

•       Monitor intake(1liter/day) and output

•       Daily follow up

•       Report if symptoms worsen or

            weight gain > 2lb/day

Admission needed in hospital as per clinical status of the patient