Recurrent Pregnancy Loss – Causes and Prevention

Recurrent pregnancy loss is repeated miscarriage a baby before 23 weeks of pregnancy and this can cause much distress for awaiting parents. 10-20% of pregnancies end in miscarriage out of which 1% to 2% of women experience repeated loss of pregnancy. Since such an event is least anticipated it can be emotionally difficult to handle.

What are the causes of recurrent pregnancy loss?

There are many possible causes for miscarriage, including: genetic and hormonal problems; infection and defects in blood-clotting; uterine problems and cervical weakness. The treatment recommendations for patients with recurrent pregnancy loss are based on the underlying cause of recurrent pregnancy loss.

Genetic causes – 2% to 4% of miscarriages are associated with a parental balanced structural chromosome rearrangement. These women experience repeated loss of pregnancy. In such a case your doctor may advise chromosomal analysis of both the partners to find the cause. Women older than age 35 have a higher risk of miscarriage than do younger women. This may be due to chromosomal defects in eggs of aging women.

Defects in the womb (uterus) – Some women may be born with defect in the size and shape of uterus. These are called congenital uterine anomalies and they include small uterus, T shaped uterus etc. Unicornuate, didelphic, and bicornuate uteri have been associated with smaller increases in the risk for loss of pregnancy.

You may have abortions if your uterus is divided by intrauterine adhesions, uterine fibroids or polyps. The uterine septum is the congenital uterine anomaly most closely linked to repeated abortions. Intramural fibroids larger than 5 cm, as well as submucosal fibroids of any size, can cause repeated loss of pregnancy.

Hormone imbalance – A condition called luteal phase defect can risk your pregnancy. Early pregnancy is secured by hormone like Progesterone. If this hormone is deficient then women may experience recurrent pregnancy loss. Often this condition is seen in women with PCOS. Polycystic ovarian syndrome (PCOS) can lead recurrent pregnancy loss due to luteal phase defect.

Infections – Infections speculated to play a role in RPL include mycoplasma, ureaplasma, Chlamydia trachomatis, L monocytogenes, and HSV. You must report to the doctor at the earliest if you are experiencing symptoms of urinary or vaginal infections. Apart from local infections any severe infections with fever are also dangerous in pregnancy.

What are the signs of early pregnancy loss?

Bleeding -Most commonly early miscarriages present with bleeding. You may experience mild spotting or it may be flow with clots.

Pain – Some women may experience pain as a symptom of recurrent pregnancy loss. This pain may be mild intermittent or excruciating. Any pain in the lower abdomen during pregnancy is abnormal and should be reported early. At times pain is associated with urination which suggests infections. Pain may be with or without bleeding at the onset. But if left untreated leads to bleeding or watery discharge followed by miscarriage.

Vaginal discharge – In pregnancy women experience more discharges from vagina. But watery discharge or curdy white discharge with itching should be reported early. This may be a symptom of abortion.

How to prevent early abortions?

Miscarriages can be prevented if couple are prepared well before pregnancy. You should consult your gynaecologist before preparing for parenthood. Few points to follow before preparing pregnancy-

You must have health checks to find medical illness like diabetes, high blood pressure, heart diseases, thyroid problem which may put you in risk during pregnancy. Blood clotting disorders can cause recurrent pregnancy loss and should be treated.

You should undergo infection screening for diseases like hepatitis, HIV, Rubella which may get transmitted to your baby. Other infections like urinary or vaginal infections should be treated well before pregnancy to prevent recurrent pregnancy loss.

You should screen for breast and cervical cancer before pregnancy and take necessary action accordingly.

You must be vaccinated for cervical cancer, rubella much before pregnancy.

Any family history of congenital diseases in the family of both partners should be discussed in detail and investigated.

If you are experiencing recurrent pregnancy loss then your consultant may advise for special evaluation of the uterus. Certain problems in the womb can be corrected before pregnancy. If you are having weakness in the birth canal like cervical incompetence then proper advise should be taken for cervical stitching during pregnancy.

Diet and nutrition play a major role in pregnancy. Proper advice should be taken before pregnancy for supplements like folic acid.

Embryo Freezing in IVF Treatment – Procedure & Advantages

IVF / FERTILITY CARE, WOMEN HEALTH

Embryo Freezing in IVF Treatment

EMBRYO FREEZING-Procedure & advantages

What is Embryo Freezing?

The procedure of Embryo freezing is done along with fertility treatment in an IVF laboratory. Embryo freezing allows people to store gametes, reproductive tissue and embryos for later use. The first successful pregnancy resulting from freezing a healthy embryo took place in the 1980s. Since then, many people have frozen embryos and used them later. If your doctor has given option for Embryo freezing and frozen embryo transfer you must know the risks and advantages.

Embryo freezing is a laboratory procedure which begins with injection of hormones and other medications to stimulate the production of potentially fertile eggs. The eggs are then extracted from the ovaries, either for fertilizing in a lab or for freezing. A person may wish to freeze their eggs. Or, they may wish to use them at once to become pregnant. Fertilisation of eggs with sperm can be achieved either with in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI). Often with in vitro fertilisation (IVF) or Intracytoplasmic sperm injection (ICSI) treatment, there may be good quality embryos left over after embryo transfer. Instead of discarding them, there is the option to freeze them to use in the future. A person can also freeze eggs and sperm, which are not fertilized. Embryos can be frozen to preserve fertility so it may be possible to have a baby at a later date.

When freezing is recommended?

Embryo cryopreservation and Embryo freezing is useful for surplus embryos during in vitro fertilisation. Patients who fail to conceive may become pregnant using frozen embryos in subsequent cycles. Successful patients in IVF treatment may come back later for frozen embryo transfer to achieve a sibling pregnancy.

Surplus oocytes or embryos resulting from fertility treatments may be stored for oocyte donation or embryo donation to another woman or couple by Embryo freezing. At times embryos may be created, frozen and stored specifically for transfer and donation by using donor eggs and sperm.

When the endometrium is not ready for implantation in the process of Embryo freezing embryos may be frozen for use at later date. This situation arises in patients with thin endometrium or oocyte donation and surrogacy programme.

There are certain situations like ovarian hyper stimulation when fresh embryo transfer becomes risky for the woman’s health. In this scenario embryos are frozen for later use.

Young patients undergoing cancer therapy can freeze their eggs, ovarian or testicular tissue for future use. Rare instances where mother is not fit to undergo a pregnancy may freeze embryos. They can come later for embryo transfer when the health issue is resolved.

How do people freeze embryos?

Cryo-preservation or cryo-conservation is a process where cells, tissues or organs are preserved by cooling to very low temperatures. Cryopreservation was applied to humans beginning in 1954 with the pregnancies resulting from the insemination of previously frozen sperm. There are two ways of Embryo freezing.

Slow freezing: This involves placing the embryos in sealed tubes, then slowly lowering their temperature. It prevents the embryo’s cells from ageing and reduces the risk of damage. However, slow freezing is time-consuming, and it requires expensive machinery.

Vitrification: In this process, the tissue is frozen after cryoprotection. The embryos are frozen so quickly that the water molecules do not have time to form ice crystals. This helps protect the embryos and increases their rate of survival during thawing. In the laboratory, large tanks filled with liquid nitrogen are available in which embryos are stored. The embryos remain in sealed containers at temperatures of -321ºF. At this temperature, almost no biological processes, such as ageing, can occur.

The tanks that contain frozen embryos are monitored 7 days a week. Each tank gets a physical inspection daily, looking for problems or signs of problems. The quantity of nitrogen in the tank is assessed as a means of monitoring for a possible slow leak or an impending tank failure. The nitrogen in the tank is topped up daily, since it continuously evaporates at a slow rate.

When to freeze embryos?

Not all embryos are suitable for freezing, so only good quality embryos will be chosen to freeze. Embryos can be frozen at different stages of their development – when they’re just a single cell, at the two to eight cell stage or later in their development (called the blastocyst stage). Eggs and sperm can also be frozen with out fertilising.

What is the success rates of thawing frozen embryos?

The process of thawing an embryo after cryopreservation has a relatively high success rate, and research suggests that women who use thawed embryos have good chances of delivering healthy babies.

How long can embryos stay frozen in Embryo freezing?

Procedures for human embryo freezing were developed in 1984 and only went into widespread use in the late 1980s. This means that the longest time a human embryo has been stored is 25-30 years and, typically, patients that have left embryos in storage for this long are not coming back for them.

In theory, a correctly frozen embryo can remain viable for any length of time. But different laws regulate length of freezing in different countries. Most countries allow freezing up to 10 years.

The embryos remain in sealed containers at temperatures of -321ºF. At this temperature, almost no biological processes, such as aging, can occur.

Frozen or fresh embryos – which is better?

Many studies has been done recently for embryofreezing. A study published in the International Journal of Reproductive Biomedicine looked at the results of over 1,000 instances of embryo transfer involving either fresh or frozen embryos.

The researchers found no statistical difference between the types of embryos, in terms of pregnancy rates or fetal health.

Freezing of human sperm, eggs and embryos @ Femelife

Within the laboratory at Femelife we have a tissue bank where we freeze and store oocytes (eggs), sperm and embryos for our patients. The bank has personnel and computerised system for full time monitoring. The procedure is done under supervision of the lab director, and is licensed by the ICMR, Govt of India. All tissue in the bank is stored frozen in liquid nitrogen at a temperature of -196C in vacuum lined tanks that are computer controlled and monitored 7 days a week with a dedicated alarm system. The embryologists are responsible for maintaining the bank and no other employee has access to it.

The process of freezing eggs vs. freezing embryos

The egg freezing procedure and the embryo freezing procedure both start the same basic way with hormone medication, injected over for 8–12 days, that stimulates the ovaries to produce multiple eggs. Freezing multiple eggs increases the chances of finding healthy eggs later. Study have shown that embryos survive the freeze thaw process better than eggs. The freezing of eggs is a recent procedure and may need further development for wide usage.

What are the risks associated with Embryo freezing, cryopreservation of embryos and human gamete?

Risk of contamination

Since viruses and bacteria can also survive at cryogenic temperatures it needs special attention. The risk of cross-contamination, i.e., transfer of bacteria or other microorganisms from liquid nitrogen to stored samples, is should be taken care. Some investigators have suggested that liquid nitrogen should be sterilised in order to prevent such contamination when so-called open cryodevices, which bring the sample in direct contact with the liquid, are utilised.

Risk of reduced or lost viability

In Embryo freezing Long-term storage does not impact viability/developmental potential of slow-frozen embryos. Cryostorage appears to be safe for slow-frozen oocytes as well.

Risk of specimen loss

In contrast to the risk of infection or time-related decrease in viability, under current practices the risk of loss of cryopreserved gametes and embryos due to human error or equipment failure is relatively high. It is the responsibility of the IVF laboratory to take proper care of the procedure in vital procedures like Embryo freezing.

Risks inherent in shipment and handling

At times, frozen eggs or embryos need transportation for further use according to patient convenience. The shipping procedure carries risk of vessels being exposed to elevated ambient temperature and air pressure, vibration/other physical shock, and horizontal storage.

A two-step removal of vitrified samples, during which the sample is held in the neck of a dewar in nitrogen vapour for 15 seconds, leads to reduced viability due to thermodynamic instability and devitrification at relatively low temperatures. Cross country transportation of cryopreserved eggs and embryos are guarded by certain laws.

Embryo freezing is a type of fertility preservation. Embryo freezing may be useful for women with cancer who want to have children after having radiation therapy, chemotherapy, or certain types of surgery, which can cause infertility. Also, called embryo banking and embryo cryopreservation it is widely used in IVF treatment.

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Eating during Pregnancy, Food & Diet Plans

Health, WOMEN HEALTH

food in pregnancy

Eating during Pregnancy

A balanced diet provides all of necessary nutrients in proper proportions for adequate nutrition, function and development of body. In pregnancy, balanced diet is essential for growth of the baby and wellbeing of mother. Without good nutrition mother is more prone to disease, infection and restriction of growth of foetus.

Extra calories / eating for two

During the first three months’ calorie needs of pregnant mothers are basically the same as they were before pregnancy. However, pregnant women should add 200 calories to their usual dietary intake during the second trimester, and 300 calories during their third trimester when the baby is growing quickly.

Brain growth of baby

Baby’s brain starts forming just three weeks after conception and it undergoes rapid changes during pregnancy. Majority of brain growth is completed when the baby is born and later it undergoes few fine changes only. Food containing docosahexaenoic acid (DHA) is important in pregnancy for helping the brain and central nervous system mature. Iodine deficiency during pregnancy is the leading cause of preventable mental health.

Which Food in pregnancy is to be avoided?

Avoiding certain foods in pregnancy is recommended for maternal and fetal well-being. Pregnancy is a state of lower immunity and pregnant women catch infections easily. Moreover, not all medications can be used to treat diseases in pregnancy. Hence it is safer to avoid certain foods in pregnancy which can give rise to food poisoning or infections. Fish such as shark, swordfish, king mackerel, and tilefish have high mercury levels and must be avoided. Smaller fish have less mercury content can be chosen instead as their longevity in water is short such as fresh water fish.

Similarly, smoked meat or fish should be avoided as they can cause infections. Raw uncooked eggs or poultry, unpasteurised milk and milk products, raw sprouts, unwashed fruits or vegetables are not advisable as well. Pregnant women should carefully avoid excess caffeine, alcohol or tobacco as these could harm the baby. Artificial sweetners, sugar rich foods, canned foods and foods containing nitrates as in frozen meat are better avoided in pregnancy.

Vegetarian food in pregnancy

Vegetarians can meet their protein needs by eating select milk and egg foods, protein-rich vegan foods like nuts, hummus, and beans, soy milk, soy cheese, soy yogurt, and tofu. Pregnant women require an additional 45 grams of carbohydrates per day which can be obtained from fruits, vegetables, grains, and several dairy products. Nuts and vegetable oils can provide the dietary fat requirement for pregnant women. Carbohydrates enriched with folic acid reduce the rate of birth defects. Milk, yogurt, dark green leafy vegetables such as spinach, dried beans and peas and cheese are good sources of calcium.

Role of dietary fibres in pregnancy

Dietary fibre is a nutrient that cannot get digested by human gastrointestinal tract. It absorbs water and helps bowel movements. Insoluble fibre like vegetables (especially dark green leafy ones), root vegetable skins, fruit skins, whole wheat products are essential during pregnancy to prevent constipation. Soluble fibres absorb water, bind to fatty acids and slow down sugar absorption. Some types of soluble fibres are: kidney beans, sprouts, broccoli, spinach, apple, orange, grapefruit, grapes, prunes, grains, oatmeal etc.

Choosing fruits and vegetables

Pregnant women need at least 70 mg of Vitamin C daily, which is contained in fruits such as oranges, grapefruits and honeydew, and vegetables such as broccoli, tomatoes, and sprouts. At least 2-4 servings of fruit and 4 or more servings of vegetables daily is recommended during pregnancy. Fresh fruit contains lots of essential vitamins and nutrients and eating plenty of fresh fruit during pregnancy can help wellbeing of mother and baby. Broccoli and dark, green vegetables, such as kale and spinach, contain vitamin C, vitamin K, vitamin A, calcium, iron, folate and potassium which are essential in pregnancy.

Planning meals in pregnancy

Pregnant women should plan for small frequent meals. Lighter meals help prevent gastrointestinal upsets like abdominal distension and vomiting. Fatty foods like fried, baked snacks can be replaced by servings of fruits and nuts. Drinking 3-4 litres of water daily is essential during pregnancy.

Foods to avoid vomiting of pregnancy

Foods with high content of sugar, fat or salt lead to vomiting in pregnancy. A large evening meal can give rise to morning sickness. Having small and frequent meals and drinking a lot of cold water suppresses vomiting sickness of pregnancy. At times, fast foods and street foods can cause food poisoning and better be avoided in pregnancy.

Vitamins and minerals in pregnancy

The lack of calcium, iron, iodine and other vitamins lead to baby’s learning disabilities, delay in language development, behavioural problems, delayed motor skill development, and a lower I.Q. Deficiency of Folic acid in pregnancy leads to severe malformations of the brain and spinal cord. Folic acid is found in green leafy vegetables, broccoli, beans, citrus fruits and liver.

Eating well during pregnancy is essential and the guidelines for eating well for a healthy pregnancy are simple and easy to follow. Healthy eating keeps the mother safe throughout pregnancy and provides baby the essential nutrients they need inside the uterus.

HSG test for infertility – Advantages and Side effects

IVF / FERTILITY CARE, WOMEN HEALTH

Why HSG (Hysterosalpingogram) is done?

Hysterosalpingogram ( HSG) is a type of X-Ray of abdomen to know the condition of the fallopian tubes. If the fallopian tubes are blocked then couple may have difficult in conceiving, it is required to check whether tubes are open or not in cases of infertility. It’s also used to investigate miscarriages resulting from abnormalities within the uterus such as tumour masses, adhesions and uterine fibroids.

What is HSG

What is a Hysterosalpingogram (HSG)?

HSG is a diagnostic X-Ray procedure that usually takes around 15 minutes to perform. It is usually done before ovulation around 10 -12 days after menstruation. This is done on an outpatient basis.

How the patient is prepared for HSG test?

The doctor usually obtains history regarding pregnancy and any allergies as HSG should not be done on a pregnant woman. Any kind of allergies should be noted as the dye used in this procedure may cause severe reactions in such people. This procedure should not be performed in inflammatory condition like chronic pelvic infection or an untreated sexually transmitted disease. Since the dye used may damage a developing foetus doctors advise to take contraceptive pills in the cycle when HSG is done in order to prevent pregnancy. The patient is also given antibiotics to prevent infection and also at times a pain killer to reduce the discomfort during the procedure.

How is a Hysterosalpingogram done?

Hysterosalpingography uses a real-time form of x-ray called fluoroscopy to examine the uterus and fallopian tubes

A woman is positioned under a fluoroscope (an x-ray imager that can take pictures during the study) on a table. The doctor then examines the patient’s uterus and places a speculum in her vagina. Her cervix is cleaned, and a cannula is placed into the opening of the cervix. A liquid containing iodine (a fluid that can be seen by x-ray) is slowly pushed through the cannula. The contrast is seen as white on the image and can show the contour of the uterus as the liquid travels from the cannula, into the uterus, and through the fallopian tubes. If the tubes are blocked the dye doesn’t pass through and may cause swelling of the tubes called hydrosalpinx.

After the HSG, a woman can immediately return to normal activities but refrain from intercourse for a few days.

Does HSG cause pain?

An HSG usually causes mild or moderate cramping pain for about an hour. However, some women may experience cramps for several hours. These symptoms can be greatly reduced by taking medications used for menstrual cramps like pain killers before the procedure or when they occur.

What are the risks of HSG?

HSG is considered a relatively safe procedure. However, some complications mild or serious can happen in less than 1% of the time. There is always a slight chance of cancer from excessive exposure to radiation. However, the benefit of an accurate diagnosis far outweighs the risk. The effective radiation dose for this procedure varies. Special care is taken during x-ray examinations to use the lowest radiation dose possible while producing the best images for evaluation.

In the event of a chronic inflammatory condition, pelvic infection or untreated sexually transmitted disease, be certain to notify the physician or technologist before the procedure to avoid worsening of infection.

Women should always inform their physician or x-ray technologist if there is any possibility that they are pregnant.

The most common serious problem with HSG is pelvic infection. This usually occurs when a woman has had previous tubal disease (such as a past infection of chlamydia). In rare cases, infection can damage the fallopian tubes or make it necessary to remove them. A woman should call her doctor if she experiences increasing pain or a fever within 1-2 days of the HSG.

Fainting – Rarely, some woman may get light-headed during or shortly after the procedure and faint due to a vasovagal attack.

Iodine Allergy – Rarely, a woman may have an allergy to the iodine contrast used in HSG. A woman should inform her doctor if she is allergic to iodine, intravenous contrast dyes, or seafood. Women who are allergic to iodine should have the HSG procedure performed without an iodine-containing contrast solution. If a woman experiences a rash, itching, or swelling after the procedure, she should contact her doctor.

Spotting – Spotting sometimes occurs for 1-2 days after HSG. Unless instructed otherwise, a woman should notify her doctor if she experiences heavy bleeding after HSG.

What are the limitations of HSG test?

Hysterosalpingography only sees the inside of the uterus and fallopian tubes. Abnormalities of the ovaries, wall of the uterus, and other pelvic structures may be evaluated with MRI or ultrasound. Alternatively, a surgical procedure to directly view the tubes (laparoscopy) can be done which is more accurate than HSG.

What is the next step if tubes are found to be blocked on Hysterosalpingography?

Patients may undergo revaluation of tubes with laparoscopy or may be suggested to go for IVF. In vitro fertilization (IVF) is a procedure which can bypass the function of the tubes and can achieve pregnancy in cases with the blocked fallopian tubes.

Any alternative to HSG Test?

Many women are scared of the HSG test as it causes pain and also exposes to radiation. Often they search for any alternative test to evaluate the fallopian tubes. Laparoscopy is the best test to check the fallopian tubes. It can evaluate the condition of the ovaries, uterus and pelvis along with the tubes. It gives a real time view of all the pelvic organs. Although it is a costly test and requires anaesthesia it is considered the gold standard test for tubal function.

What is HSG

Premature Ovarian Failure – Causes & Treatment

IVF / FERTILITY CARE, WOMEN HEALTH

What is premature ovarian failure?

When a woman’s ovaries stop working before age 40, she is said to have premature ovarian insufficiency (POI) or premature ovarian failure (POF) also, known as premature menopause. It is a common condition, affecting 1–2% of women younger than 40 years of age. It found among 0.1% of women, younger than 30 years of age. When this happens, a woman’s menstrual cycles become irregular and stop. Her ovaries stop making hormones such as oestrogen and progesterone. Moreover, she stops releasing eggs (ovulating) regularly or at all.

Some women develop POF when they are teenagers, even before they start to have menstrual periods. If that happens, the teen will never experience normal function of her ovaries. For other women experiencing POF, their ovaries may continue to intermittently release (ovulate) eggs. These women may continue to have menstrual cycles for months or years before their ovaries completely shut down. For this reason, the currently used term POI is preferred to the older terminology “premature ovarian failure (POF).

Causes of Premature Menopause

In human females, the process of ovarian follicular maturation, or maturation of eggs, is a highly organised and complex process. Maturation of Eggs is the progressive maturation of small primordial follicles that progress to become large ovulatory follicles. When follicles eventually mature, the oocytes (eggs) are released from the surface of the ovary. They are collected by the uterine tube, and proceed to become fertilised.

The causes of POF remains unknown in most cases. A genetic cause of POF is identified in few patients, i.e. in 5-7% of the total cases, whereas causes remains most often undiscovered. Fragile X syndrome is one of the genetic causes of POF which can be transmitted in the family.

Predisposing Factors of Premature ovarian failure

Women receiving cyclophosphamide for either kidney diseases or rheumatoid arthritis are at risk of developing POF.

Malnutrition and cigarette smoking are perhaps the only consistent environmental features associated with an earlier menopause.

The first known significant cause is damage to the ovaries, such as that caused by iatrogenic agents like chemotherapy or radiotherapy or pelvic surgery may be associated with ovarian failure. Surgical menopause may be induced by removal of ovaries, but interestingly hysterectomy to remove the uterus is also associated with an earlier menopause.

Premature ovarian failure (POF) may be considered as an autoimmune endocrine disease. Autoantibodies and lymphocyte subset changes are associated with premature ovarian failure. This problem can run in family as well.

What POF women experience?

Women with POF experience menopausal symptoms, such as hot flushes, night sweats and vaginal dryness, In addition, there is increased risk of developing osteoporosis because of the lengthened time of exposure to reduced oestrogen similar to those going through a natural menopause.

For most women, it can be an unexpected and distressing diagnosis, with unpleasant symptoms, but made worse by the fact that it coincides with infertility.

Infertility In POF

Premature ovarian failure (POF) is a disorder associated with female infertility, and it affects approximately 1% of women under the age of 40 yr. It can be attributed to two major mechanisms: follicle dysfunction and follicle depletion .

Despite having amenorrhea and markedly elevated serum gonadotropin levels, some women with karyotypically normal can go to spontaneous premature ovarian failure. Nevertheless, they have ovarian follicles that function intermittently. Graafian follicles capable of responding to these high FSH levels are faced with high serum LH levels as well, which might prevent normal follicle function.

Premenopausal women may be at risk for the development of osteoporosis. However, bone loss in women with amenorrhea from other causes has not been assessed. Women with POF have diminished general and sexual well-being and are less satisfied with their sexual lives than other women

Treatment of premature menopause

Many women with premature ovarian failure (POF)would benefit from symptom relief by the use of exogenous steroids, to compensate for the loss of ovarian hormone estrogen and possibly progesterone and androgens. Menopausal symptoms, such as hot flushes, night sweats and vaginal dryness can be relieved by oestrogen replacement, such as sequential HRT or oral contraceptive pill.

Management Of Infertility In POF

Infertility is a significant issue for most women undergoing POF. A number of treatment regimens have been evaluated with the aim of restoring fertility. However, treatments with clomiphene, Gonadotrophins, GNRH agonists or immunosuppressants do not significantly improve the chance of conception and are not used.

The only reliable fertility treatment is the use of donor eggs. It is an assisted reproductive procedure that is widely practised in most countries. At present, in vitro maturation of immature follicles is possible. But in vitro growth and maturation from stored ovarian tissue is not reliably achievable in humans. For women with impending POF, there may not be any alternatives. Young women about to begin cancer treatment are encouraged to attempt a cycle of IVF if time permits. They can go for storing embryo or eggs for later use.

Ovarian Transplantation In POF

Young women suffering from impending POF may store ovarian tissue. This gives the hope that at a later stage their tissue can be implanted. Storing the use of ovarian tissue can help restore fertility. In vitro growth and maturation of immature follicles of frozen ovarian tissue may restore fertility.

Lifestyle Changes In POF

Women suffering from oestrogen deficiency will need counselling. They should be recommended a number of measures to protect against osteoporosis. It includes increased physical exercise, eating a diet rich in calcium and vitamin D and avoiding risk factors such as smoking and high alcohol intake.

Women with POF are advised to undergo HRT until the normal age of menopause. They require addition of testosterone to HRT to improve sexual function and wellbeing.

Premature ovarian failure (POF), a major life-changing condition that affects a significant proportion of young women. It remains an enigma and the researcher’s minefield. Among women surviving childhood cancers POF is commonly seen. This is due to improved iatrogenic interventions POF sufferers inevitably increase.

Patient Counselling

When primary ovarian failure is diagnosed in the adolescent female, the patient and her family are often unprepared for such news. Its implications for compromised fertility and the need for long-term hormonal therapy is frustrating. Adolescents may demonstrate myriad emotions ranging from apathy or denial to depression. These emotions may be different from those of their parents or guardians. Parents can provide valuable insights about their daughters’ future. Ability to appreciate the significance of the diagnosis and help in managing the situation is of utmost importance.

Ovarian Drilling – How It Helps PCOS?

IVF / FERTILITY CARE, WOMEN HEALTH

ovarian drilling

What is ovarian drilling and how does it work?

ovarian drilling – In women with PCOS ovulation doesn’t occur regularly and usually they have ovaries with a thick outer layer. The ovaries make more testosterone, the male type of hormone. High testosterone levels lead to irregular menstrual periods, acne, and extra body hair.

Ovarian drilling is done to break the thick outer surface and destroy some of the testosterone producing tissue made by the ovaries. This can help the ovaries release an egg each month and start regular monthly menstrual cycles. This may reduce symptoms of excess testosterone

How drilling of ovary is done?

A minimally invasive surgery called laparoscopy is used for ovarian drilling. A thin, lighted telescope (laparoscope) is put through a small surgical cut (incision) near the umbilicus. A tiny camera is used to see the ovaries. The surgeon inserts tools through other tiny incisions in the lower belly and makes very small holes in the ovaries. This helps to lower the amount of testosterone made by the ovaries.

What are the benefits of drilling ovary?

About 50% of women get pregnant in the first year after surgery. Some women still may not have regular cycles after the surgery. Others may have other fertility problems (such as blocked tubes or a low sperm count) that can prevent pregnancy. Some women after a short period of regular ovulation may go back to previous irregular cycles.
For some women with PCOS, ovarian drilling will not fix the problems with irregular periods and ovulation, even temporarily. However, ovarian drilling can help a woman respond better to fertility medicines.

What are the risks of drilling ovary ?

There are certain risks of the surgery done for ovarian drilling .
Some of the risks are related to surgery. As with all surgical procedures, there are risks of bleeding, anaesthesia, and infection. Also, laparoscopy can cause injury to the bowel, bladder, and blood vessels. Very rarely, there is a risk of death.
There are also risks to fertility. If there is too much damage to the ovary during the ovarian drilling procedure, a woman may enter menopause at a younger age than expected. After the procedure, adhesions (scarring) can form between the ovaries and the fallopian tubes, making it hard to get pregnant. Most important in many women the beneficial effects are for too short period and they immediately go back to the previous status.

ovarian drilling

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