Endometriosis is a common disorder of women of reproductive age. The most frequent clinical presentation of endometriosis is painful menstruation.
What are the common symptoms of endometriosis?
Endometriosis commonly present with painful menstruation, pelvic pain, pain during intercourse, infertility, and pelvic mass.
How to know the severity of endometriosis?
The correlation between the symptoms of endometriosis and the severity of disease is poor. Currently available laboratory markers are of limited value. At present, the best marker, serum CA-125, is usually elevated only in advanced stages and therefore not suitable for routine screening. Severity of endometriosis is difficult to determine from its symptoms. Usually symptoms are expressed according to area of involvement not depth of disease.
Who are affected by endometriosis?
Endometriosis usually starts in the ovary, it also can happen in the abdomen cavity affecting fallopian tubes, uterus and other pelvic organs like bladder and bowel. It affects women of reproductive age. Usually starts at around the age of 15 to 20 years and slowly spreads destroying nearby organs. It can subside spontaneously at menopause.
What is the correlation of CA 125 to endometriosis?
Plasma concentrations of CA-125 are increased in women with cystic ovarian and deep endometriosis and plasma concentrations are higher during menses than during the follicular and luteal phases of the cycle.
How ultrasonography and MRI are useful in Endometriosis?
Transvaginal ultrasound and magnetic resonance imaging are often helpful, particularly in detection of endometriotic cysts. Recently, trans rectal ultrasound and magnetic resonance imaging were shown to be valuable in detection of deep infiltrating lesions, especially affecting the rectum.
What is the role of Laparoscopy in endometriosis?
Direct assessment of endometriotic foci at laparoscopy may be viewed as a “gold standard” for identifying endometriosis. Laparoscopic removal of endometriosis significantly reduces pain and improves quality of life. Early diagnosis, surgical confirmation and therapy of endometriosis by laparoscopic techniques is recommended as soon as symptoms occur, even in adolescent girls.
Can a clinical test detect deep endometriosis?
A clinical examination during menstruation is proposed as a simple and reliable test to diagnose deep endometriosis. It also helps to decide which women may require bowel surgery. In >60% of cases deep lesions are “unexpected” findings at laparoscopy, these women are the candidates for bowel preparation before laparoscopy.
What is needed for definite diagnosis of endometriosis?
Diagnosis of endometriosis requires a careful clinical examination in combination with judicious use and critical interpretation of laboratory tests, imaging techniques, and, in most instances, surgical evaluation combined with biopsy results of excised lesions.
Which group of patients present with less severe symptoms?
Endometriosis, characterised by the ectopic localisation Of the endometrium, can be present as superficial implants, deep peritoneal lesions, and ovarian endometriomas, with or without associated pelvic adhesions. The frequency of dysmenorrhea and the frequency and severity of dyspareunia is less in patients with endometriosis located only on the ovaries than in patients with lesions at other sites.
What is Cystic Ovarian Endometriosis?
In some women, more severe forms present as either cystic ovarian or deep infiltrating endometriosis. Cystic ovarian endometriosis always has been recognised as a severe form because of its association with pelvic adhesions, infertility, and pelvic pain. Clinical examination during menstruation can diagnose reliably deep endometriosis, cystic ovarian endometriosis, or cul-de-sac adhesions. This test, preferentially combined with a follicular phase CA-125 assay, should be used to decide whether a preparation for bowel surgery should be given.
How CA 125 helps in pre-treatment of endometriosis?
The presence of pelvic nodularity during menstruation or a CA125 concentration higher than 35 U/mL can be used to decide in which women bowel pre-treatment should be given with a sensitivity of 87%, whereas <13%, will get an unnecessary bowel pre-treatment.
Deep pelvic endometriosis may lead to severe pain, the treatment of which may require complete surgical resection of lesions. Infiltration of bowel is a difficult therapeutic problem. Preoperative diagnosis is difficult and digestive infiltration may remain unknown before surgery. This may cause damage to the gut with incomplete resection during surgery and sometimes may require repeated surgery. Both magnetic resonance imaging (MRI) and endoscopic ultrasonography are able to detect rectal infiltration but their usefulness in the preoperative staging is still not evaluated.
Can Endometriosis affect fertility?
Endometriosis is a chronic, progressive disease and may lead to severe destructions of reproductive organs and infertility in advanced stages.
Approximately 30% to 50% of women that have the diagnosis of endometriosis also struggle with infertility. Twenty five percent to 50% of women diagnosed with infertility also have endometriosis, but the endometriosis may not be severe enough to be the primary cause of infertility. White women have been reported to be more likely than African American women to have endometriosis. In addition, risk factors for endometriosis include below average body mass index, smoking, and alcohol use.
How ovulation is affected by endometriosis?
After ovulation, peritoneal fluid contains concentrations of progesterone and of 17 beta-estradiol that are 5 to 20 times higher than plasma concentrations in women with ovulatory cycles but not in women with unruptured luteinized follicles. Since viable endometrial cells were found in the peritoneal fluid of over 50% of women, both with and without endometriosis, a new hypothesis is presented about the cause of pelvic endometriosis and the association of pelvic endometriosis and infertility: pelvic endometriosis could be the consequence of infertility caused by the unruptured luteinized follicle.
Many times, a woman who has difficulty conceiving will have a case of endometriosis that does not come with severe symptoms. This is known as silent endometriosis. These silent sufferers eagerly crowd into the waiting rooms of in vitro fertilisation (IVF) clinics and reproductive specialists with the hope of conceiving. However, these women may have endometriosis, and the in vitro attempts they take may fail.
How endometriosis can lead to infertility in a woman and how it is treated?
Infertility due to endometriosis could be due to several abnormalities like tubal dysfunction, impaired ovarian reserve, worsening egg quality, defect in implantation and decreased sperm motility inside the female reproductive system. Infertility due to endometriosis at the earlier stages can be treated by simpler treatment like ovulation induction and IUI. However, at advanced stages it requires IVF / ICSI as the disease spreads rapidly and destroys the ovaries. At later stages, usually the women are completely depleted of their eggs and have to go through egg donation programme.
What are the precautions for women trying to conceive with endometriosis?
If you are experiencing severe pain during cycles it may be due to endometriosis, you must consult local gynaecologist. Diagnosis of endometriosis is usually done with pelvic ultrasound which may show chocolate cysts in the ovaries. It is always better to undergo a laparoscopy to check patency of tubes at this stage . If you are trying to conceive then it is a better option. If you are diagnosed as mild to moderate case of endometriosis you should regularly follow up with AMH levels. This can indicate extent of destruction of ovaries. Severe endometriosis needs immediate attention for fertility preservation, you may need IVF at this stage for optimum results.
Which is the most common hormone disorder found in women?
PCOS is extremely prevalent and probably constitutes the most frequently encountered endocrine (hormone) disorder in women of reproductive age. Having the disorder may significantly impact the quality of life of women during the reproductive years, and it contributes to morbidity and mortality by the time of menopause.
What are the disorders associated with PCOS?
Polycystic ovary syndrome women are at increased risk for coronary heart disease and type 2 diabetes mellitus. Their risk factors include central obesity, hypertriglyceridemia, low levels of high-density lipoprotein (HDL) cholesterol, hypertension, and elevated fasting plasma glucose concentrations. Polycystic ovary syndrome women should undergo screening for hypertension, abnormal lipid profiles, insulin resistance, and reproductive disorders including cancer of endometrium.
What is PAO?
A subgroup of women (up to 30%) may have subtle abnormalities resembling Polycystic ovary syndrome called PAO. While PCOS occurs in at least 5% of the population, the isolated finding of polycystic-appearing ovaries (PAO), which meets the classic ultra-sonographic criteria, occurs in 16–25% of the normal population without evidence of the full-blown syndrome. These characteristics include androgenic ovarian responses to stimulation with gonadotropins, as well as metabolic changes such as lowered high density lipoprotein-C levels and evidence of insulin resistance. While these data generated by our group need further assessment, these findings suggest that important yet silent abnormalities may exist in otherwise normal women who have a trait of Polycystic ovary syndrome (namely PAO).
What is the most important reproductive concern in women with PCOS?
The most frustrating reproductive concern for women with PCOS is pregnancy loss. The spontaneous abortion rate in Polycystic ovary syndrome is approximately one third of all pregnancies. This is at least double the rate for recognized early abortions in normal women (12–15%). Reasons for this are unclear although hypotheses include elevated LH levels, deficient progesterone secretion, abnormal embryos from atretic oocytes, and an abnormal endometrium.
How PCOS negatively impact psychosocial development of young women?
Women with PCOS, particularly those with hirsutism, have an increased prevalence of reactive depression and minor psychological abnormalities. There is also evidence of increased psychological stress and an increased catecholamine response to provoked stress. The overall quality of life is decreased in hirsute women. The presence of hirsutism and menstrual irregularities, especially in younger patients, is extremely distressing and has a significant negative impact on their psychosocial development.
Which cancer has increased risk in women with PCOS?
Women with Polycystic ovary syndrome are at increased risk of endometrial cancer. Chronic unopposed estrogen exposure is probably the proximate risk factor. This may be confounded by obesity, hypertension, and diabetes, which are known correlates of endometrial cancer risk. It is imperative to screen all women with Polycystic ovary syndrome, even those who are considered too young to develop endometrial hyperplasia and carcinoma.
Can low grade inflammation be a risk factor of PCOS?
Women with Polycystic ovary syndrome have significantly increased CRP concentrations relative to those in healthy women with normal menstrual rhythm and normal androgens. Inflammatory marker like CRP concentrations is more with PCOS. It correlates with the degree of obesity and inversely with insulin sensitivity, although not with total testosterone concentrations.
PCOS
Which is a better predictor of metabolic syndrome in PCOS?
Obesity, a key determinant of insulin concentrations, appeared to have an independent effect on risk for the metabolic syndrome. In Anovulatory Polycystic ovary syndrome women a waist circumference of >83.5 cm along with biochemical evidence of hyperandrogenism is a powerful predictor of the presence of metabolic syndrome and insulin resistance. Age and central obesity (waist-hip ratio/waist circumference) are better predictors of metabolic syndrome in women with Polycystic ovary syndrome compared to other parameters including BMI.
How Metformin helps in PCOS?
Metformin is the most thoroughly investigated insulin-lowering agent used to treat PCOS; it enhances insulin sensitivity in the liver, where it inhibits hepatic glucose production, and in muscle, where it improves glucose uptake and use.
The persistence of regular ovulatory menstrual cycles in the 6 months after the end of treatment demonstrates that metformin treatment provides lasting benefits. All girls maintain a BMI <25 kg/m2, and this can play a role in normal ovulation menstrual cycles.
What is the role of AMH in diagnosis of Polycystic ovary syndrome ?
Serum anti-Mullerian hormone (AMH), produced in the ovaries by small follicles, is usually elevated in women with PCOS and correlates with the severity of this syndrome. AMH plays an important role in inhibiting follicular development by decreasing the sensitivity of the follicles to FSH and by inhibiting granulosa cell aromatase. Serum AMH appears as a sensitive and specific parameter that predict Polycystic ovary syndrome than antral follicle count and ovarian volume.
What is the source of DHEA in Polycystic ovary syndrome ?
Serum DHEAS has been found to be elevated in some women with polycystic ovary syndrome . In Polycystic ovary syndrome , it has been found that there are actually two different sources of androgens, the ovary and the adrenal. In women with PCOS, the theca cells are overactive and proliferate excessively, producing too much testosterone. Unfortunately, in 40-50% of women with PCOS, there is also another source of androgens, which is the adrenal glands. The adrenal glands produce all of the DHEA in the body.
What causes PCOS in non-obese women?
All women with PCOS are not obese. Between 20–50% of women with PCOS are normal weight or thin, and the pathophysiology of the disorder in these women may differ from that in obese women. It has been suggested that PCOS develops in non-obese women because of a hypothalamic-pituitary defect that results in increased release of LH, and that insulin plays no role in the disorder.
These women tend to have an increased waist to hip ratio and are insulin resistant and hyperinsulinemic compared to their normal counterparts.
How the lean PCOS are treated?
Even normal weight and thin women with PCOS respond to pharmacological measures to improve insulin sensitivity, such as administration of agents like metformin, with decreases in ovarian androgen production and serum androgens. Administration of myoinositol (3 g per day) reduce luteinizing hormone (LH), high-sensitivity C-reactive protein (hs-CRP) (inflammation), and androgens, as well as improve insulin tolerance test, in lean patients with PCOS.
How infertility in PCOS treated?
Lifestyle modification is very important in the treatment for PCOS, because weight loss and exercise have been shown to lead to improved fertility and the lowering of androgen levels. Ovarian stimulation along with insulin sensitizers help in many instances. IVF is an alternative option in Polycystic ovary syndrome . GnRH antagonist protocol appears to significantly reduce the rate of severe OHSS in these women. The average number of oocytes recovered is higher but rate of immature oocytes is more and fertilization rate is lower in the PCOS group.
Does IVM help in PCOS?
In-vitro maturation treatment can now be offered as a successful option to infertile women with polycystic ovaries or polycystic ovary syndrome. It is possible to combine natural cycle in-vitro fertilization with immature oocyte retrieval followed by in-vitro maturation, and thus offer women with various causes of infertility reasonable pregnancy and implantation rates without recourse to ovarian stimulation.
What is the effect of bariatric surgery in PCOS?
Bariatric surgery has been increasingly popular to treat morbid obesity associated with PCOS. In the larger population as the surgery has become safer with primarily a laparoscopic approach and selection of a healthier population for surgery, long-term survival is now superior with versus without the surgery.
Ischaemic heart disease and stroke are the world’s biggest killers. These diseases have remained the leading causes of death globally in the last 15 years.
Why we should be worried about heart disease?
Ischaemic heart disease and stroke are the world’s biggest killers, accounting for a combined 15.2 million deaths in 2016. These diseases have remained the leading causes of death globally in the last 15 years.
Leading cause of death
What are the traditional risk factors for Heart disease in women?
Diabetes mellitus
Hypertension
Dyslipidemia
Obesity
Physical inactivity
Smoking
What are the Non-traditional risk factors for Heart disease in women?
Pregnancy-Related Disorders and CVD Risk Association
Preterm Delivery
Hypertensive Pregnancy Disorders
Persistence of Weight Gain After Pregnancy
Autoimmune Diseases: Rheumatoid Arthritis and Systemic Lupus Erythematosus
Radiation and Chemotherapy for Breast Cancer
Depression
Symptoms of heart disease in women can also be confused with other conditions, such as depression, menopause, and anxiety.
What are the symptoms of heart disease in women?
Symptoms of heart disease in women can also be confused with other conditions, such as depression, menopause, and anxiety.
Common heart disease symptoms in women include:
indigestion or gaslike pain in the chest and stomach
cold sweats
dizziness
paleness
shortness of breath or shallow breathing
lightheadedness
fainting or passing out
anxiety
nausea
vomiting
Neck, jaw, back pain
What is Broken Heart Syndrome?
Stress-induced cardiomyopathy was first described in Japan in 1990 and was named after the octopus trapping pot with a round bottom and narrow neck, which resembles the left ventriculogram during systole in these patients.
It mainly affects postmenopausal women and is often preceded by extreme physical or emotional triggers. The clinical presentation, electrocardiographic findings, and biomarker profiles are often similar to those of ACS, but the coronary artery anatomy is found to be without significant obstructive disease at angiography.
The cause of Takotsubo cardiomyopathy remains unknown, but is thought to be related to a disproportionate distribution and activation of myocardial sympathetic receptors. The ventricular dysfunction, which usually involves the left, but may also involve the right ventricle, generally resolves within several weeks with supportive therapy, including β-blockade; however, especially in the presence of significant comorbidities, the outcome may not be benign.
Heart disease in women
What is the summary of healthy diet ?
A healthy diet is low in:
sodium (salt),
added sugars,
solid fats,
refined grains.
Solid fats are saturated fat and trans fatty acids. Refined grains come from processing whole grains, which results in a loss of nutrients (such as dietary fiber).
What is DASH diet or eating plan?
The DASH eating plan requires no special foods and instead provides daily and weekly nutritional goals. This plan recommends:
Eating vegetables, fruits, and whole grains
Including fat-free or low-fat dairy products, fish, poultry, beans, nuts, and vegetable oils
Limiting foods that are high in saturated fat, such as fatty meats, full-fat dairy products, and tropical oils such as coconut, palm kernel, and palm oils
Limiting sugar-sweetened beverages and sweets.
How to choose healthy foods ?
When following the DASH eating plan, it is important to choose foods that are:
Low in saturated and trans fats
Rich in potassium, calcium, magnesium, fiber, and protein
Lower in sodium
What are the symptoms should not be ignored in women as warning of heart disease?
Dramatic chest pain may not be there for a women.
1.Unusual fatigue:
You are suddenly worn out after your typical exercise routine.
You aren’t exerting yourself, but have fatigue or a “heavy” chest.
Simple activity like making the bed, walking to the bathroom or shopping makes you excessively tired.
Although you feel exceptionally tired, you also experience sleep disturbance.
2. Sweating and/or shortness of breath:
Sudden sweating or shortness of breath without exertion
Breathlessness that continues to worsen over time after exertion
Shortness of breath that worsens when lying down and improves when propping up.
What are the symptoms you should look out for heart disease?
Chest pain may not be there for a women. If it is there it may suggests heart disease. If chest pain is not there then it does not exclude heart disease.There may be only discomfort , heaviness, sense of pressure or heavy weight.
You should carefully look out for the following findings:
Women, in particular, can have pain in either arm — not just the left one like many men.
Pain in the lower or upper back often starts in the chest and spreads to these areas.
The pain is sometimes sudden, not due to physical exertion, and can wake you up at night.
You may feel pain that is specific to the left, lower side of the jaw.
Pregnancy Risk increases with age . IVF Success rate decreases with age.
Success rate is less for women with IVF at age more than 40 years because the quality of the eggs harvested in assisted techniques such as IVF deteriorates with age.
After which age fertility of a woman starts to fall by IVF and natural process ?
The ability to conceive starts to fall around the age of 32 years. IVF Pregnancy risk increases with age.
What are the chances of getting pregnant without IVF with respect to age?
After the age 32, a woman’s chances of conceiving decrease gradually and significantly.
After age of 35, the fertility reduces fast
By age 40, fertility has fallen by 50%.
At the age of 30 years, the chance of conceiving is about 20%.
At the age of 40 the chance of conceiving is around 5% only.
What are the risks of Pregnancy for older mothers?
Evidence demonstrates that it is increasingly difficult for women to become pregnant after the age of 35. It also said that women over 35 have a higher risk of miscarriage.
As women get older the number and quality of egg cells that are produced by the ovaries declines.
How successful is IVF for older women?
While in vitro fertilisation (IVF) can potentially help many women conceive, much like unassisted conception it is far less successful as women get older. The live birth rate for women under 35 undergoing IVF is 31%, but the success rate is less than 5% for women over 42 years of age.
Why success rate is less for women with IVF at age more than 40 years?
Success rate is less for women with IVF at age more than 40 years because the quality of the eggs harvested in assisted techniques such as IVF deteriorates with age. These techniques stimulate the release of more egg cells but cannot compensate for the effects of reproductive ageing on egg quality.
Can I postpone my pregnancy for few years
Newer preservation techniques are designed to freeze eggs from younger women and allow postponed pregnancy at a later age. Human oocyte cryopreservation (egg freezing) is a procedure to preserve a woman’s eggs (oocytes). This technique was mainly developed to enable women who, due to studies or any other complication can´t deal with pregnancy during their most fertile years, to postpone their maternity until their personal situation is the right to form a family.
Femelife Fertility : Know about IVF
What are the health risks of late pregnancy?
Greater difficulty in initially conceiving a child.
Personal and psychological difficulties.
Increased risk of complications for both mother and infant during pregnancy and delivery .
Greater risk of general maternal health problems, such as high blood pressure, which can contribute to complications.
Higher risk of miscarriage in women above the age of 35.
Higher risk of having twins or triplets, which is itself associated with higher risk of complications.
More chance of having a baby with a congenital abnormality, such as Down’s syndrome.
Elevated risk of pre-eclampsia.
Higher risk of complications during delivery, such as prolonged labor.
Need for assisted delivery or Cesarean section is more.
Higher chances of stillbirth.
The risks of pregnancy and birth complications, caesarean section, increase with age.
Complications include-
gestational diabetes,
placenta praevia,
placenta abruption.
Older women are more likely to have a baby with birth defects or genetic abnormalities.
A woman over 35 is nearly 2.5 times more likely than a younger woman to have a stillbirth.
By age 40, she is more than five times more likely to have a stillbirth than a woman under 35.
For a woman aged 40 the risk of miscarriage is greater than the chance of a live birth.
Why risk of cesarean section is higher in elderly pregnant women?
Most older mothers experience normal labor and delivery. However, certain problems are more common in this age group, for example, placental abruption (premature separation of the placenta). Therefore, the rate of cesarean section is somewhat higher in older mothers.
What are the Genetic risks associated with pregnancy of elderly women?
Certain genetic risks present more often in pregnancy as women age. For example, the rate of having a baby with Down syndrome accelerates with maternal age.
While the rate of an embryo having Down syndrome at the 10-week mark of pregnancy is 1 in 1,064 at age 25, this rises to 1 in 686 at age 30 and 1 in 240 by the age of 35 years. At the age of 40, the Down syndrome rate increases still to 1 in 53, and down to 1 in 19 embryos at age 45.
What are the indications of egg freezing?
Oocyte cryopreservation can increase the chance of a future pregnancy for three key groups of women:
those diagnosed with cancer who have not yet begun chemotherapy or radiotherapy;
those undergoing treatment with assisted reproductive technologies who do not consider embryo freezing an option; and
those who would like to preserve their future ability to have children, either because they do not yet have a partner, or for other personal or medical reasons.
What is the success rate of egg freezing followed by IVF?
The percentage of transferred cycles is lower in frozen cycles compared with fresh cycles (approx. 30% and 50%). Such outcomes are considered comparable.
Is genetic defect affected with egg freezing and IVF ?
Two recent studies showed that the rate of birth defects and chromosomal defects when using cryopreserved oocytes is consistent with that of natural conception.
Excessive growth of facial or body hair on women may be symptom of an underlying disorder. Dark and coarse hair may appear on the face, chest, abdomen, back, upper arms, or upper legs due to excess androgens in blood. Most common medical disorder causing hirsutism is PCOS (Polycystic Ovary Syndrome) accounting up to 10% of all cases.
Excessive growth of facial or body hair on women
Excessive growth of facial or body hair on women may be symptom of an underlying disorder. Dark and coarse hair may appear on the face, chest, abdomen, back, upper arms, or upper legs due to excess androgens in blood. Most common medical disorder causing hirsutism is PCOS (Polycystic Ovary Syndrome) accounting up to 10% of all cases. Prompt medical attention often improves the condition whereas delaying medication makes the treatment more difficult and may have long-term health consequences.
The Human Hair
The human hair follicle is a complex structure and much has not been learnt about it. The hair follicle can be divided into 3parts: the lower segment (bulb and suprabulb), the middle segment (isthmus), and the upper segment (infundibulum). The lower segment around 4mm in length stays below the skin surface. The middle segment is a short section and the upper segment extends from the entrance to the skin to outside. Hair grows continuously in a cyclical fashion and rate of hair growth differs according to its position. Human body is covered by small vellus hair throughout except the palm and sole. In contrast the scalp is covered by lengthy terminal hair. The number of hair follicle at birth is fixed for life and it is around 100000 follicles in the scalp and 50 million on the body on an average.
Growth Cycle of Hair
Each hair grows from a follicle deep inside skin. Hair continues to grow even if it is plucked or removed as long as hair follicles are not completely destroyed. The number of hair follicles slowly begins to decrease at around age 40. Hair density varies by ethnic origin. Men and women of the same ethnic group have similar numbers of hair follicles and similar hair patterns. Asians and American Indians generally have less body hair than people of Mediterranean descent. Excessive hair that is due to genetic and ethnic variation is typically located on the arms, hands, legs, and feet, whereas hirsutism typically affects the face, abdomen, chest, inner thighs, and back.
Adults have two types of hair, vellus and terminal Vellus hair is soft, fine, generally colourless, and usually short. In most women, vellus hair covers the face, chest, and back and gives the impression of “hairless” skin. Terminal hair is long, coarse, dark, and sometimes curly and covers the face and body of men. Terminal hair grows on the scalp, pubic, and armpit areas in both men and women. A mixture of vellus and terminal hair covers the lower arms and legs in both men and women.
Hair growth occurs in cycles. While some hair follicles grow, others rest, and still others are shed. Hormonal changes, such as those associated with oral contraceptives (birth control pills) or pregnancy, may synchronize hair growth and make it appear to grow and shed more than usual. However, hair growth patterns usually return to normal within 6 to 12 months.
EFFECTS OF ANDROGENS ON HAIR GROWTH
Terminal hair that covers the face and body of men is usually the result of androgens. In men, androgens are produced primarily by the testes and the adrenal glands. In women, androgens are also produced but at a lower amount by the ovaries and the adrenal glands. Oestrogens, the female hormone reduces the effect of androgens in women. If vellus hair in women are sensitive to androgen then it may change to thick coarse terminal hair which grows faster. Once a vellus hair has changed to a terminal hair, usually it does not change back and is called hirsutism. Androgens increase sebum production, which results in oily skin and acne. Excess androgens in women can cause irregular or absent ovulation and menstruation. Extremely high androgen levels, such as when a tumor is present, may cause male-like balding, deepening of the voice, increased muscle mass, enlargement of the clitoris, and decreased breast size. These effects of excess androgens are called virilisation.
What causes hirsutism?
Excessive production of androgens by the ovaries (polycystic ovary syndrome, tumor)
Excessive sensitivity of hair follicles to androgens (genetic)
Excessive production of androgens by the adrenal glands (non-classical adrenal hyperplasia [NCAH])
Excessive production of cortisol by the adrenal glands (Cushing syndrome)
Menopause
Medications
Polycystic ovary syndrome is the most common cause of hirsutism and it is due to associated hormonal imbalances that cause the ovaries to overproduce androgens.
Unexplained Hirsutism
For unknown reasons, some women have hair follicles that are abnormally sensitive to androgens. Androgen levels are normal and menstrual periods occur regularly in these patients. This tendency to develop hirsutism is clearly genetic, but the exact abnormality is not known.
Ovarian or Adrenal Tumors
On rare occasions, an androgen-producing tumor may develop in the ovaries or adrenal glands. This tumor may produce extremely high androgen levels. Symptoms, such as hirsutism, usually appear suddenly and progress quickly. Very high androgen levels may cause male-like balding, deepening of the voice, and increased muscle mass. Fortunately, most of these tumors are not cancerous.
Menopause
Around the time of menopause, the ovaries stop producing estrogen but continue to produce androgens. The decreased levels of estrogen may allow the androgens to have a greater impact, leading to an increase in 8 the number of dark terminal hairs, especially on the face. For this reason, many menopausal women complain of new facial hair (moustache and whiskers) and mild balding.
Which drugs may cause hirsutism?
Drugs with characteristics of androgens may cause hirsutism. Anabolic steroids used to increase muscle mass in chronically ill and debilitated people and by some bodybuilders, are chemically related to androgens. Natural supplements such as DHEA may cause hirsutism. Danazol, phenytoin, minoxidil, and diazoxide are other medications associated with increased hair growth.
How Hirsutism is diagnosed?
Physicians trained to treat hirsutism and related problems generally include reproductive and medical endocrinologists. Some gynecologists, dermatologists, and general practitioners also have acquired the necessary expertise. After identifying the causes of hirsutism, physician can recommend appropriate treatment. Any unwanted hair remaining after treatment may be removed by a variety of cosmetic treatments, including laser and electrolysis.
Doctors might recommend an ultrasound or a CT scan to check ovaries and adrenal glands for tumours or cysts. Tests that measure the amount of certain hormones in blood, including testosterone or other testosterone-like hormones, might help determine whether elevated androgen levels are causing hirsutism.
What laboratory tests should be ordered for a patient with hirsutism?
Laboratory testing depends on the symptoms expressed by patients. Cases of mild hirsutism may be left alone without any investigations. However, serum levels of total and free testosterone, DHEAS, and 17-OHP can be useful tests, depending on the individual patient. Patients with signs or symptoms of hypothyroidism,
hyperprolactinemia, acromegaly, or Cushing syndrome also should be evaluated with serum thyroid-stimulating hormone (TSH), prolactin, IGF-I, or 24-hour urine cortisol testing, respectively.
How is hirsutism treated?
Treatment of hirsutism is usually with a combination of oral contraceptive pills, spironolactone, other drugs like eflorinithine and cosmetic measures; however, other antiandrogens and gonadotropin-releasing hormone agonists can be used.
Patients with polycystic ovary syndrome may have improvement of symptoms if they are treated with insulin sensitizers.
Treatment of virilization is surgical removal of the tumor or steroid treatment for congenital adrenal hyperplasia.
How do you choose the appropriate therapy for hirsutism?
Most patients are given a trial of OCPs, with or without spironolactone, and are advised to use cosmetic measures while waiting for the medications to work. The topical cream eflornithine HCl may be used alone or in combination with other measures. Because of their more serious side effects and higher cost, the other medications are reserved for the most severe cases in which OCPs and spironolactone fail.
Whatever therapy may be chosen, the results do not last for more than 3 to 6 months. Although many medications and combinations have been used, only topical eflornithine HCl is currently approved by the Food and Drug Administration for treatment of hirsutism. Unfortunately, most patients have a relapse of hirsutism approximately 12 months after discontinuation of medical therapy.
What cosmetic measures can be used for the treatment of hirsutism?
Bleaching, shaving, plucking, waxing, depilating, and electrolysis are effective measures that can be used alone or in combination with medications. By these procedures terminal hair that is already present is removed. Simultaneous use of medications decrease new growth and rate of transformation to terminal hair. Laser-assisted hair removal is a commonly used method of treatment for hirsutism. It is done on outpatient basis using intense pulsed light therapy which cause thermal injury to the hair follicle. At least three to six treatments about 2 to 2.5 months apart are required. The techniques result in removal of hair, and a period of 2 to 6 months before the regrowth of hair, which is thinner and lighter. Patients with light skin and dark hair have the best results with the fewest side effects. The side effects include minimal discomfort, local swelling and redness lasting 24 to 48 hours.
IVF is used to overcome female infertility in the woman due to problems of the fallopian tube, making fertilisation in vivo difficult or due to problems in the partner like decreased sperm quality and quantity.
IVF is used to overcome female infertility in the woman due to problems of the fallopian tube, making fertilisation in vivo difficult or due to problems in the partner like decreased sperm quality and quantity. For IVF to be successful it typically requires healthy ova, sperm that can fertilise, and a uterus that can maintain a pregnancy. Due to the costs of the procedure, IVF is generally attempted only after less expensive options have failed. Pregnancy is a complex phenomenon and many things can change in due course of time. People who had a baby with IVF can get pregnant naturally later. Here are a few theories on what can impact natural success in pregnancies after IVF.
Endometriosis can subside after pregnancy
Sometimes, when a woman with endometriosis becomes pregnant through IVF, her body has time to recover from endometriosis, even if she doesn’t know she has it.
The disease is suppressed allowing the female environment to potentially be more favourable for subsequent pregnancies to occur during 9 months of childbearing.
Release of stress resolves the hormonal environment
For some women, after having their first child through IVF, the pressure of becoming pregnant significantly subsides and with decreased stress and lack of contraception, natural pregnancies may occur. Similarly, at many instances it is seen that women who have adopted a baby conceive naturally later.
Unexplained infertility may get better
About 20 percent of people who had a baby with IVF can get pregnant naturally later and this is more likely to happen if the cause of infertility was unexplained.
PCOS resolves with increasing age
PCOS patients often have regular cycles after a pregnancy, with increasing age the symptoms of PCOS reduce and the hormonal environment slowly returns to normal. This usually corrects defects in ovulation and improves quality of eggs and hence prepares the women for natural conception.
What should I Know before meeting a Fertility Specialist?
WOMEN – A woman’s fertility gradually declines with age, especially in her mid-30s, and it drops rapidly after age 37. Infertility in older women may be due to the number and quality of eggs, or to health problems that affect fertility.
When to see a doctor if you are a female patient?
You probably don’t need to see a doctor about infertility unless you have been trying regularly to conceive for at least one year. Talk with your doctor earlier, however, if you’re a woman and:
You’re age 35 to 40 and have been trying to conceive for six months or longer
You’re over age 40
You menstruate irregularly or not at all
Your periods are very painful
You’ve been diagnosed with endometriosis or pelvic inflammatory disease
You’ve had multiple miscarriages
You’ve undergone treatment for cancer
When to see a doctor if you are a male patient?
You have a low sperm count or other problems with sperm
You have a history of testicular, prostate or sexual problems
You’ve undergone treatment for cancer
You have testicles that are small in size or swelling in the scrotum known as a varicocele
You have others in your family with infertility problems
What are General factors responsible for infertility?
Diabetes mellitus,
thyroid disorders,
undiagnosed and untreated coeliac disease,
adrenal disease
What are environmental factors responsible for infertility?
Environmental factors
Glues,
Volatile organic solvents
Pesticides.
Tobacco smokers are 60% more likely to be infertile than non-smokers.
What is the effect of age on fertility?
Age.
WOMEN – A woman’s fertility gradually declines with age, especially in her mid-30s, and it drops rapidly after age 37. Infertility in older women may be due to the number and quality of eggs, or to health problems that affect fertility.
MEN -Men over age 40 may be less fertile than younger men .
What is the effect of tobacco on fertility?
Smoking tobacco –
reduces the chances of pregnancy.
reduces the possible benefit of fertility treatment.
Miscarriages are more frequent in women who smoke.
Smoking can increase the risk of erectile dysfunction
low sperm count in men is common in tobacco use.
What is the effect of tobacco on fertility?
WOMEN -Avoid alcohol if you’re planning to become pregnant. Alcohol use increases the risk of birth defects, and may contribute to infertility.
MEN – Heavy alcohol use can decrease sperm count and motility.
What is the effect of Weight on fertility?
Overweight- Inactive lifestyle and being overweight may increase the risk of infertility.
WOMEN -Ovulation Disorders .
MEN – A man’s sperm count may also be affected if he is overweight so a normal weight is always healthy for fertility.
Underweight. Women at risk of fertility who follow a very low calorie or restrictive diet.So eat healthy foods and develop healthy habits .
What is the effect of Exercise on fertility?
Exercise- Insufficient exercise contributes to obesity, which increases the risk of infertility.
Heavy Exercise – Ovulation problems are associated with frequent strenuous and intense exercise in women who are not overweight.Hence , it is important to avoid heavy exercise when you want to be pregnant.
What are infections associated with infertility?
Sexually transmitted infections
chlamydia,
gonorrhea
Adeno-associated virus might have a role in male infertility so it is important to have a screening for these infections.
WOMEN – A woman’s fertility gradually declines with age, especially in her mid-30s, and it drops rapidly after age 37.
MEN -Men over age 40 may be less fertile than younger men .
Screening mammography can be done every year for women starting from age 40 to reduce risk of breast cancer
What is the relation of breast cancer with alcohol drink?
The more alcohol you drink, the greater your risk of developing breast cancer. Hence , stop or reduce your alcohol quantity that reduces your risk of breast cancer.
What is the relation of smoking and breast cancer risk ?
Smoking increases breast cancer risk. Hence , Stop smoking that keeps you healthy.
Is there a relation between weight of a person and breast cancer risk ?
Overweight is a risk factor for breast cancer. Overweight women has increased risk of breast cancer.
How physical activity helps to reduce breast cancer risk ?
Physically active people maintain a healthy weight, which helps to reduce the risk of breast cancer.
What is the type of physical exercise helps to maintain a healthy weight and decrease the breast cancer risk ?
For a healthy life healthy weight is essential . Hence , You can observe the following for a healthy weight :
At least 150 minutes a week of moderate aerobic activity or
75 minutes of vigorous aerobic activity weekly
One of the above with strength training at least twice a week keeps you healthy.
Is there a role of breast feeding in prevention of breast cancer?
Breast-feeding play a role in breast cancer prevention. The longer you breast-feed, the greater the protective effect. So breast feeding to the baby reduces the risk of breast cancer too.
What is the effect of hormone therapy on risk of breast cancer?
Combination hormone therapy for more than three to five years increases the risk of breast cancer. Hence be careful while on long term hormone therapy. Is it really necessary ?
You should screen yourself for breast cancer by consulting the doctor.
What is the role of radiation exposure/CT Scan in Breast cancer?
Some studies showed relation between between breast cancer and radiation exposure so it is better to reduce your exposure to radiation.
Which diet reduces risk for breast cancer?
Mediterranean diet with extra-virgin olive oil and mixed nuts may reduce the risk of breast cancer in women.
Fruits ,vegetables, whole grains, legumes and nuts are healthy for your body and also reduces the risk of breast cancer.
Hence , healthy diet including vegetables, fruits and nuts with loads of antioxidants reduces the risk of breast cancer.
Is there a relation between birth control pills and breast cancer?
Birth control pills and intrauterine devices (IUDs) increases the risk of breast cancer due to the hormone in it. Risk is estimated to be very small . The risk decreases after the medicine is stopped . As there is a small risk of breast cancer for people taking hormone therapy, you should be vigilant about breast cancer screening. If you find any mass oin breast then immediately consult the doctor.
What is the role of family history in Breast cancer ?
Genetics is the primary cause of 5–10% of all cases. So women with family history of breast cancer to the mother should be vigilant about breast cancer detection.
When you should suspect breast cancer ?
Appearance of new lump or mass in the breast needs a screen and consultation of doctor. If you develop some skin changes over breast always consult the doctor.
Mass or lump in the breast , is it always indicates cancer?
No.
There are a number of benign conditions which can cause mass or lump in the breast and these issues can be solved by medicines or may need a small surgery. Hence , never get scares if you find a mass or lump in a breast, consult the doctor.
SCREENING FOR BREAST CANCER
What is the common screening for breast cancer?
Mammograms are the commonly used for screening for breast cancer and early diagnosis too.
What is mammography ?
Mammography is a specific type of breast imaging that uses low-dose x-rays to detect cancer in early stages .This can detect the breast cancer before women experience any symptoms . At this point the disease is mostly treatable so the patient can have a healthy life further .
When I should have a screening mammogram ?
Mammography helps in early detection of breast cancers .
Mammography can show changes in the breast up to two years before it can be detected clinically.
Current guidelines from the U.S. Department of Health and Human Services (HHS) and the American College of Radiology (ACR) recommend screening mammography every year for women, beginning at age 40.
Research has shown that annual mammograms lead to early detection of breast cancers, when they are most curable and breast-conservation therapies are available.
Current guidelines from the U.S. Department of Health and Human Services (HHS) and the American College of Radiology (ACR) recommend screening mammography every year for women, beginning at age 40.
Healthy Habits Prevents Breast Cancer.
Screening mammography: every year for women starting from age 40 reduce risk of breast cancer . Healthy habits including breast feeding reduces the risk of breast cancer .
Biggest Assignment as a Parent- Raising a child with Genital Ambiguity
The decision to have a baby is the first step in a lifelong commitment of love, time, and financial resources and dealing with a baby with sexual ambiguity is devastating and painful .
Sexual ambiguity is a complex issue. An accurate diagnosis is essential and may take some time. Sex of assignment must be based not only on the underlying diagnosis and karyotype but also on the potential for adult sexual function, fertility, and psychological health. For these reasons, input from several specialties, including endocrinology, genetics, neonatology, psychology, urology, and an ethicist, is important. All members of the team must communicate adequately with each other. Parents must fully understand the medical recommendation for sex assignment and required therapy. They must wholeheartedly agree and support the assigned sex to avoid ambivalence, which can lead to gender confusion and psychological trauma for the child.
Parents may be dealing with two major categories of children presenting with this problem:
Virilized 46, XX females –females look like male
Under virilized 46, XY males- males look like female
The most common cause of sexual ambiguity in newborns is congenital adrenal hyperplasia secondary to 21-hydroxylase deficiency. Adrenal gland is situated above the kidneys and secretes several hormones.
As a general rule, gonadal tissue containing Y chromosomal material is at higher risk for development of malignancy.
When infant is born with ambiguous genitalia, and the sex of the infant is uncertain, what next ?
Accept the truth, cooperate with medical professionals as further testing is necessary to determine the infant’s sex. Explain all the relevant history during pregnancy that may help in a diagnosis.
Reference to more commonly understood birth defects may be useful. Several days may be necessary to complete the testing and a team will participate to make an accurate diagnosis and a considered recommendation.
Completion of the birth certificate should not be postponed, and sex assignment should not be delayed. Accept the sex assigned by Medical team.
What can cause genital ambiguity in newborn? Is it preventable?
Drug ingestion, alcohol intake, and ingestion of hormones during pregnancy can lead to such a situation. Hence Maternal history is particularly important. Progestational (androgenic) therapy used for threatened abortion or androgens for endometriosis during pregnancy should be avoided as far as possible. If the mother has signs of excessive androgen or parental family history for occurrence of ambiguity, neonatal deaths, consanguinity, or infertility it can lead to sex disorders.
What is the extent of problem?
The most common cause of a virilised female is congenital adrenal hyperplasia (CAH). Virilisation may also be caused by maternal ingestion of androgens or synthetic progesterone during the first trimester of pregnancy. The measurement increased ACTH in blood is useful for making a diagnosis. These babies have female chromosomes with male outlook, however they do have ovaries and uterus like any other female child.
An undervirilized male (previously called male pseudo hermaphroditism) refers to a male with female external genitalia. The abnormality may range from various grades of feminisation to a completely female phenotype. Such disorders result from deficient androgen stimulation of genital development and most often are secondary to testosterone biosynthetic defects. These boys have male chromosomes with female outward looks.
How the condition is diagnosed? What are the tests done?
The diagnosis of the origin of sexual ambiguity can rarely be made by examination alone, it is always combined with a series of tests. Tests are directed to determining the presence or absence of palpable gonads (presumably testes), the presence or absence of a uterus, and the karyotype to allows classification of the infant as a virilized female, an under virilized male, having a disorder of gonadal differentiation, or having one of the
unclassified forms. Certain forms of CAH may cause dehydration, hypertension, or areolar or genital hyperpigmentation. Turner’s stigmata may be present, including webbed neck, low hairline, and edema of hands and feet.
Radiographic studies are necessary to find out structural abnormalities like the presence of gonads and other reproductive structures. Pelvic ultrasound examination by qualified and experienced personnel should be performed as soon as
possible to look for a uterus. The presence of gonads, fallopian tubes, and a vaginal vault may also be determined. If necessary, a genitogram may be performed to see the lower reproductive organs like presence of vagina and its extent.
Because 21-hydroxylase deficiency is a common cause of sexual ambiguity, the level of 17-hydroxyprogesterone (17-OHP) should be assessed in all such infants who do not have palpable gonads. Screening of newborns for CAH with measurement of a 17-OHP level is now mandated in all 50 of the United States and in many countries throughout the world. A karyotype is essential and must be obtained expeditiously. Buccal smears are absolutely contraindicated because they are inaccurate. In many laboratories, a karyotype can be completed within 48 to 72 hours.
Defects in testosterone synthesis can be diagnosed by low testosterone levels with defect in its synthesis pathway (from the level of enzymes block either in the adrenal or in testicular pathways).
What is the role of parents in upbringing?
The decision about sex assignment must be carefully made, taking into consideration each “level” of sex determination. Sex assignment also depends on fetal sex hormone exposure, the potential for adult sexual function, and psychological and cultural considerations. It is vital that parents completely understand and support the decision because ambivalence about sex of rearing may result in gender confusion and psychological trauma.
Virilized females are usually assigned a female sex. They have normal ovaries as well as uterus and vaginal structures and, with surgical correction and steroid replacement, can have normal sexual function and achieve fertility. However, severely virilized females should be assigned a male sex.
Undervirilized males are often infertile, and sex assignment has usually been based on
phallic size. Adult social and fulfilling sexual function should be the primary goals of gender assignment. If male sex assignment is contemplated, a trial of depot testosterone (25 mg every 3-4 weeks) for 1 to 3 months indicates whether phallic growth is possible.
In patients with gonadal dysgenesis and Y chromosomal material, gonadectomy is necessary, and fertility is not possible. Internal duct structure is also frequently deranged. Small phallic size usually leads to a female sex assignment.
True hermaphrodites who have a unilateral ovary and uterine structures may have spontaneous puberty and normal fertility and may be raised as females. External genital size and structure may allow male assignment, but more commonly, external genitalia are poorly virilized, and affected infants are assigned a female sex.
What are the future prospective regarding marriage, child bearing etc.?
Parents must understand that having normal sexual performance does not correlate with reproductive ability. However, physicians always give preference to sexual ability than childbearing probability. Our aim in parenting is to give the child a sexual identity which may contradict the genetic makeup and at places may force us to sacrifice the gonads for future life.
We have much to learn about gender identity and must consider which decisions may be made later than previously thought (e.g., surgery). Some surgical interventions are cosmetic, and some affected patients have expressed the wish to make the decisions in adolescence or adulthood. This field challenges many of our perceptions of sex and gender and our role as physicians. Although the infant with genital ambiguity presents a medical and social emergency, decisions should be made carefully, cautiously, and with all necessary biochemical and anatomic information available. Most important, the multidisciplinary team approach must involve the parents in an open and honest
discussion of the options. In the end, it is the parents who come first in decision making on sex assignment.
A male child be with complete androgen insensitivity should be raised female. Complete androgen insensitivity usually does not have suspicion of ambiguity in the new born period or early childhood. Affected children grow as normal females until puberty. They feminize with normal breast development at puberty because high levels of testosterone are aromatized to oestrogen, but they have no pubic or axillary hair and no menses because they lack uterus and ovaries. Gender identity is usually female. Patients come to medical attention because of lack of menses in adolescent period.
The diagnosis is therefore frequently made when patients are in their middle to late teens. If diagnosed early the testes should be removed to prevent cancer and oestrogen therapy should start early. This therapy helps in developing the vagina and performance as a female is not compromised.
Undervirilized males traditionally, infants with 5-alpha-reductase deficiency were raised as females until puberty, then continued life as males, and, in some cases, achieved fertility. More recently, however, the condition has been recognized early in life, and affected males are now raised from infancy as boys.
Virilized females are usually assigned a female sex. They have normal ovaries as well as
Uterus and ovaries and, with surgical correction and steroid replacement, can have normal sexual function and achieve fertility.
However, severely virilised females should be assigned a male sex. They can perform sexual function as a male but cannot reproduce as they don’t have male gonads.
Patients with Y-related chromosomal or genetic disorders that cause mal development of one or both testes are said to have gonadal dysgenesis. They present with ambiguous genitalia and may have inadequate virilisation, uterus and vagina may be present in such children. The Y-containing dysgenetic testes are at risk for developing cancer and must be removed better reared as females.
How to deal with infertility in such cases?
Fertility potentiality is decided by karyotyping, presence of gonads and presence of uterus and vagina. Accordingly, they can go for gamete donation programme or surrogacy. The decision has to be taken after discussion with the couple.
Noise is unwanted unpleasant sound which is loud or disruptive to hearing. From definition of physics, noise is same as any form of sound but it is perceived in the brain in a different way.
What is noise pollution?
Noise pollution is environmental noise and the propagation of noise which cause harmful impact on the activity of human or animal life.
What are the health issues associated with noise pollution?
Exposure to noise is associated with adverse health outcomes.
Examples:
Hearing loss
High blood pressure
Ischemic heart disease
Sleep disturbances
Injuries
Peptic ulcer
Decreased work performance
What are the Psychological effects of noise pollution?
Noise has following psychological effects –
Annoyance
Psychiatric disorders
Adverse psychosocial well-being
What is the noise levels allowed for residential areas?
WHO recommends value of 50 dB allowed for residential areas.
How noise pollution affects cardiovascular health?
High noise levels can result in cardiovascular effects. Exposure to moderately high levels during a single eight-hour period causes a statistical rise in blood pressure of five to ten points and an increase in stress, and vasoconstriction leading to the increased blood pressure as well as increased incidence of coronary artery disease.
Can we reverse noise induced hearing loss?
Noise-induced hearing loss is permanent. But this is very much preventable.
What is the acceptable noise levels in India?
The Central Pollution Control Board of India has set the safe limit for ambient noise at 55 dB for residential areas and 65 dB for commercial areas.
What is the average city noise ?
Average city traffic noise corresponds to 70 dB.
What is the heavy city noise ?
Average city traffic noise corresponds to 90 dB.
What are examples of very loud noise and its measure?
Very loud noise spans 90 to 110 dB. Examples of 100 and 110 dB respectively are a farm tractor and a jet plane flying 310 meter overhead.
Which is the most nosiest city in India?
A study by the National Physical Laboratory indicated that Mumbai is ‘the noisiest city in India’, the biggest source of noise for a person there being vehicular traffic .
What is the noise level that can drive the person insane?
A noise of 140 decibels is sufficient to drive a person insane.
Which noise can make a permanent hearing loss?
Prolonged exposure to noise levels greater than 85 decibels can impair hearing permanently.
How to avoid noise pollution?
Ear plugs and ear muffs can be used for this purpose. The workers in noisy environment should be rotated to avoid prolonged exposure. Education about noise pollution and its health hazards are important steps.
Cholesterol is a lipid or fat-like substance that’s found in all the cells in your body. Your body needs some cholesterol to work properly. But having too much cholesterol in your blood raises your risk of coronary artery disease.
What is the function of cholesterol?
Cholesterol is an essential structural component of all animal cell membranes and is essential to maintain both membrane structural integrity and fluidity. It is helpful in synthesis of vitamin D and all steroid hormones.
What are the types of lipoproteins?
Types of lipoproteins in the blood. In order of increasing density, they are –
Chylomicrons,
Very-low-density lipoprotein (VLDL),
Intermediate-density lipoprotein (IDL),
Low-density lipoprotein (LDL),
High-density lipoprotein (HDL).
Whatis good Cholesterol?
HDL particles are thought to transport cholesterol back to the liver, either for excretion or for other tissues that synthesize hormones, in a process known as reverse cholesterol transport (RCT ) . So HDL is called good cholesterol. HDL is called the “good” cholesterol because it carries cholesterol from other parts of your body back to your liver.Liver then removes the cholesterol from body.
How do I know what my HDL level is?
A blood test called LIPID PROFILE can measure your cholesterol levels, including HDL.
How frequently we should check blood lipid profile?
For people who are age 19 or younger:
The first test should be between ages 9 to 11
Children should have the test again every 5 years
Some children may have this test starting at age 2 if there is a family history of high blood cholesterol, heart attack, or stroke
For people who are age 20 or older:
Younger adults should have the test every 5 years
Men ages 45 to 65 and women ages 55 to 65 should have it every 1 to 2 years
What is normal level of HDL ?
HDL cholesterol, higher values are better for health. High HDL level can lower your risk for coronary artery disease and stroke. How high your HDL should be depends on your age and sex:
Age 19 or younger – More than 45mg/dl
Men age 20 or older – More than 40mg/dl
Women age 20 or older – More than 50mg/dl
How to increase blood HDL level?
Lifestyle changes help to increase HDL levels and gives protection against cardiovascular diseases.
Eat a healthy diet. To raise your HDL level, you need to eat good fats instead of bad fats .
Stay at a healthy weight. You can boost your HDL level by losing weight, especially if you have lots of fat around your waist.
Getting regular exercise can raise your HDL level, as well as lower your LDL. You should try to do 30 minutes of moderate to vigorous aerobic exercise on most, if not all, days.
Avoid Smoking and exposure to smoke can lower your HDL level.
Why HDL is called good cholesterol?
Large numbers of HDL particles correlates with better health outcomes,whereas low numbers of HDL particles is associated with atheromatous disease progression in the arteries. High HDL levels gives protection against cardiovascular diseases. So HDL is called good Cholesterol.
What are the drugs that can affect HDL level?
Certain medicines can lower HDL levels .
Beta blockers
Anabolic steroids
Progestins
Benzodiazepines
Which food is advised to avoid for a favourable lipid profile?
Avoid trans fats – they can increase LDL cholesterol and lower HDL cholesterol levels. Foods such as cakes and cookies , fried foods , some margarines.
Surrogacy is a method of assisted reproduction that helps biological parents start families when they cannot conceive naturally or by artificial methods. Couples pursue surrogacy for several reasons and come from different backgrounds.
There are two types of surrogacy arrangements: gestational surrogacy and traditional surrogacy. In gestational surrogacy, an egg is removed from the biological mother or an anonymous donor and fertilized with the sperm of the biological father or anonymous donor. The fertilized egg, or embryo, is then transferred to a surrogate who carries the baby to term. The child is thereby genetically related to the woman who donated the egg and the father or sperm donor, but not the surrogate. In a traditional surrogacy arrangement, a surrogate becomes pregnant with the use of her own eggs. Indian government legalised surrogacy in 2002 and from then gestational surrogacy is practiced in India.
GUIDELINES FOR SURROGACY –
The ART clinic or Fertility Hospital must not be a party to any commercial element in donor programmes or in gestational surrogacy.
A surrogate mother carrying a child biologically unrelated to her must register as a patient in her own name. While registering she must mention that she is a surrogate mother and provide all the necessary information about the genetic parents such as names, addresses, etc.
She must not use/register in the name of the person for whom she is carrying the child, as this would pose legal issues, particularly in the untoward event of maternal death (in whose names will the hospital certify this death?).
The birth certificate shall be in the name of the genetic parents. The clinic, however, must also provide a certificate to the genetic parents giving the name and address of the surrogate mother.
Surrogacy by assisted conception should normally be considered only for patients for whom it would be physically or medically impossible/ undesirable to carry a baby to term.
Payments to surrogate mothers should cover all genuine expenses associated with the pregnancy. Documentary evidence of the financial arrangement for surrogacy must be available. The ART centre should not be involved in this monetary aspect.
A third-party donor and a surrogate mother must relinquish in writing all parental rights concerning the offspring and vice versa.
A child born through surrogacy must be adopted by the genetic (biological) parents unless they can establish through genetic (DNA) fingerprinting (of which the records will be maintained in the clinic) that the child is theirs.
A prospective surrogate mother must be tested for HIV and shown to be seronegative for this virus just before embryo transfer. She must also provide a written certificate that (a) she has not had a drug intravenously administered into her through a shared syringe, (b) she has not undergone blood transfusion; and (c) she and her husband (to the best of her/his knowledge) has had no extramarital relationship in the last six months.
No woman may act as a surrogate more than thrice in her lifetime
A relative, a known person, as well as a person unknown to the couple may act as a surrogate mother for the couple. In the case of a relative acting as a surrogate, the relative should belong to the same generation as the women desiring the surrogate.
A surrogate mother should not be over 45 years of age. Before accepting a woman as a possible surrogate for a particular couple’s child, the ART clinic must ensure (and put on record) that the woman satisfies all the testable criteria to go through a successful full-term pregnancy.
Surrogacy Rules and Regulations in India
2002 – gestational surrogacy allowed in India
2008- Commercial surrogacy allowed
2012- India bars foreign gay couples, singles from surrogacy
2016-Bill to Ban Commercial Surrogacy Introduced In
Lok Sabha, Bill is still under discussion.
No Visas to Foreigners Wanting to Visit India For Surrogacy
Surrogacy Should Be Allowed Only for Indian Couples, Government Says
2018- Central government’s women employees, whose children are born through surrogacy, will now be entitled to maternity leave, according to an official order of the personnel ministry.
Discussion on surrogacy bill
In August 2017, the Parliamentary Standing Committee submitted its 102nd report on the Surrogacy Regulation Bill, 2016.
The report gives a clause by clause analysis of the Bill. In it, the Committee has pointed out certain pertinent observations which clearly indicate the draconian nature of the Bill, which is based on impractical and paternalistic presumptions.
Traditional surrogacy or gestational surrogacy?
One of the biggest and most prominent drawbacks is the contradiction in the Bill with respect to whether traditional surrogacy is allowed or gestational surrogacy. Traditional surrogacy is one where the egg of the surrogate mother and the intended father’s sperm is used to conceive the child with the help of IVF technology. It is the most widely practised forms of surrogacy.
However, it has been widely criticised due to the genetic link with the surrogate mother, which can lead to several emotional complications for the parents. On the other hand, gestational surrogacy – also referred to as “full surrogacy” – is the case where the egg and sperm are of the commissioning parents and the surrogate mother carries the fertilised egg of the intended parents. Thus, all of the genetic material involved originates either from the intended parents or donors.
The Surrogacy Regulation Bill, 2016, under Section 4 (iii) (b) (III) lays down: “No women shall act as a surrogate mother or help in surrogacy in any way, by providing gametes or by carrying the pregnancy, more than once in her lifetime.”
The effect of this provision under the bill is that the surrogate mother can provide her gametes and be a surrogate as well. On this, the Standing Committee opined that, “… on the one hand the Department asserts that only Gestational surrogacy is permitted under the Bill, whereas clause 4(iii)(b)(III) advocates the concept of Traditional Surrogacy. Thus, there is an apparent contradiction between the Department assertions and provisions of clause 4(iii)(b)(III). The Committee, therefore, recommends that the infirmity in clause 4(iii)(b)(III) be rectified and the clause be amended suitably so as to spell out in unambiguous terms that the surrogate mother will not donate her eggs for the surrogacy.”
The object of the Bill is to prevent exploitation, PREVENT COMMERCIAL SURROGACY-
However, this very basic provision if not rectified can lead to the opening of a Pandora’s box, especially since the current Bill provides that surrogacy can only be performed by a “close relative”. The emotional stress and complications of having a close relative as a surrogate, on the life of the surrogate child, surrogate mother and the commissioning parents, is immeasurable.
Close relative as a surrogate
The Committee has very beautifully dealt with the issue of “close relative” being a surrogate. The object of this provision was to curtail exploitation of the surrogate; however, it would be unrealistic and very complex. The provision can be analysed from two perspectives. First and foremost, infertility is a taboo in India and for couples to come forward and undergo Artificial Reproductive Technique (‘ART’) procedures and surrogacy procedures is frowned upon. In such a situation, to force couples to only be able to have close relatives as surrogates is arbitrary and violative of their basic reproductive rights.
Second, in the context of the surrogate mother, it would be unfair for her to have to see the child repeatedly, and the effect the same would have on the child is a different matter of concern altogether. The Committee has recognised these factors and suggested that “limiting the practice of surrogacy to close relatives is not only non-pragmatic and unworkable but also has no connection with the object to stop the exploitation of surrogates envisaged in the proposed legislation.
“The Committee, therefore, recommends that this clause of “close relative” should be removed to widen the scope of getting surrogate mothers from outside the close confines of the family of the intending couple. In fact, both related and unrelated women should be permitted to become a surrogate.”
Waiting period 5 years before commissioning surrogate-
ART and surrogacy procedures have emerged essentially due to increasing infertility in the society. The current Bill defines infertility as the inability to conceive after five years whereas the previous draft Bills, of 2008 and 2014, defined it as the inability to conceive after one year.
The Committee has compared this definition of infertility with that given by the WHO and suggested that “since conception has many interplay functions, a five-year time bar would add to the misery of already distressed intending couples. The five-year waiting period is therefore arbitrary, discriminatory and without any definable logic. The Committee, therefore, recommends that the definition of infertility should be made commensurate with the definition given by WHO. The words ‘five years’ in clause 2(p) and 4 (iii) (c) II, be therefore, replaced with ‘one year’ and consequential changes be made in other relevant clauses of the Bill.”
This suggestion by the Committee is based on the basic fundamental Right to Reproduction and the Right to Privacy. How and when individuals wish to reproduce is their own personal discretion. The government can impose limitations and set criteria, however, the same should be rational and not arbitrary.
Other suggestions
The Committee makes several other laudable suggestions, some of which take root from the previous ART Bills and some which are based on reasonable analysis of the current social-medical scenario. It suggested that ‘compensated surrogacy’ should be allowed and that single parents and live-in partners should be allowed to commission surrogacy.
Provision of breast milk banks
The Committee also recommended that there should be a provision of breast milk banks for the surrogate child, and a tripartite surrogacy agreement should be entered into between the parties instead of separate agreements, to make the process easier.
The Committee has analysed the bill in a very comprehensive manner and put forward suggestions which if not incorporated would have a domino effect and push the entire surrogacy industry underground, which in turn could lead to the exploitation of the all the members of the surrogacy arrangement. Surrogacy is undertaken by individuals to procreate and to found a family; the essence of that needs to be understood and retained.
COMMERCIAL SURROGACY
The parliamentary standing committee on health after examining the Surrogacy (Regulation) Bill 2016 has made a case to allow surrogacy on payment of money on the grounds that “economic opportunities available to surrogates through surrogacy services should not be dismissed in a paternalistic manner”.
The committee observed that if many impoverished women are able to provide their children with education, construct home, start a small business, etc. by resorting to surrogacy, there is no reason to take this away from them. While it is mandated that organ, donation should be altruistic, the committee has held that altruistic surrogacy was “extreme and entails high expectation from a woman willing to become a surrogate without any compensation or reward”.
The Union Cabinet, chaired by Prime Minister Narendra Modi, on 21 st March 18 gave approval for amending the Surrogacy (Regulation) Bill, 2016 to provide for rights of child born through surrogacy to that of a natural child or biological child and mandate for surrogacy clinics to be registered with the appropriate authorities in the states.
The amendments also seek 16 months of extended insurance coverage for the surrogate mother to cover all complications besides a strict clause to safeguard the surrogate mother from exploitation, the Union Health Ministry said.
The proposed legislation ensures effective regulation of surrogacy, prohibit commercial surrogacy and allow altruistic surrogacy to the needy Indian infertile couples, as per an official statement.
Once it becomes the Act, it will regulate the surrogacy services in the country, control the unethical practices in surrogacy and prevent its commercialization of surrogacy. It will also prohibit potential exploitation of surrogate mothers and children born through surrogacy.
HOW EVER THE FERTILITY CONSULTANTS AND PROSPECTIVE CUSTOMERS ALL OVER INDIA ARE EAGERLY WAITING FOR THE LEGALISATION OF SURROGACY BILL ,AS FOR THE TIME BEING THE TECHNOLOGY IS AT STANDSTILL.
Cardio is a type of aerobic exercise. This is physical exercise of low to high intensity that involves or requires utilisation of free oxygen to meet energy demands during exercise through aerobic metabolism.
What are the different types of exercises?
Isotonic Exercise – increase your breathing and heart rate. They keep your heart, lungs, and circulatory system healthy and improve your overall fitness. Examples : brisk walking, jogging, swimming, and biking.
Isometric exercises make your muscles stronger. Some examples are lifting weights and using a resistance band.
Balance exercises – help prevent falls. To improve your balance, try tai chi or exercises like standing on one leg.
Flexibility exercises stretch your muscles and can help your body stay limber. Yoga and doing various stretches can make you more flexible.
Continuous moderate exercise should be performed for at least 30 minutes five times a week. This will reduce obesity by 19% versus no activity at all.
What are the health benefits of doing cardio or aerobic exercise ?
Benefits of regular aerobic exercise are:
Strengthening the muscles involved in respiration, to facilitate the flow of air in and out of the lungs
Strengthening and enlarging the heart muscle, to improve its pumping efficiency and reduce the resting heart rate, known as aerobic conditioning
Improving circulation efficiency and reducing blood pressure
Increasing the total number of red blood cells in the body, facilitating transport of oxygen
Improved mental health, including reducing stress and lowering the incidence of depression, as well as increased cognitive capacity.
Reducing the risk for diabetes. One meta-analysis has shown, from multiple conducted studies, that aerobic exercise does help lower Hb A1Clevels for type 2 diabetics.
Intrauterine insemination (IUI) is a simple and cost effective fertility treatment.In this procedure healthy sperm is placed into a woman’s uterus when she is ovulating. This procedure is used for couples with unexplained infertility, minimal male factor infertility, and women with cervical mucus problems. IUI success is improved when it is done in conjunction with ovulation-stimulating drugs. It can be performed using the husband’s sperm or donor sperm. Before the procedure, the woman should be evaluated for any hormonal imbalance, infection or any structural problems.
Factors for a successful IUI programme :
Healthy sperm (Sperm count, motility and morphology should be good)
Timing of IUI – for a healthy pregnancy the sperm and egg should meet within 24 hrs. of ovulation. An aged or degenerated egg cannot yield a healthy pregnancy.
Fallopian tubes should not have any blockage or obstruction.
Similarly, the quality of egg should be good, an egg with thick covering(zona) does not allow sperm to enter inside the egg.
The uterus should be prepared well to receive the embryo otherwise implantation does not happen.
When is IUI used?
The most common conditions where IUI is recommended :
Low sperm count or decreased sperm mobility.
Unexplained infertility
A hostile cervical condition, including cervical mucus problems
Cervical scar tissue from past procedures which may hinder the sperms’ ability to enter the uterus
Ejaculation dysfunction
Success rate in IUI :
The success of IUI depends on several factors. If a couple has the IUI procedure performed each month, success rates may reach as high as 20% per cycle depending on variables such as female age, the reason for infertility, and whether fertility drugs were used, among other variables.
Pregnancy rate :
Approximate pregnancy rate as a function of total sperm count (may be twice as large as total motile sperm count). Values are for intrauterine insemination. (Old data, rates are likely higher today)
Main article: Pregnancy rate
The pregnancy or success rates for artificial insemination are 10 to 15% per menstrual cycle using ICI, and 15–20% per cycle for IUI. In IUI, about 60 to 70% have achieved pregnancy after 6 cycles.
However, these pregnancy rates may be very misleading, since many factors, including the age and health of the recipient, have to be included to give a meaningful answer, e.g. definition of success and calculation of the total population.For couples with unexplained infertility, unstimulated IUI is no more effective than natural means of conception
Cost of IVF treatment is the single most deciding factor to have a baby
Why IVF treatment is costly?
IVF cost
IVF treatment is a programmed procedure extending from 4 to 6 weeks of time. It includes treatment for both the couples simultaneously. Initial investigations for both the couple may vary from 5000 -50 000 INR depending on the extent of problem. Pre-IVF treatment includes corrections of any underlying disorder which may hamper success of IVF. These include any chronic medical disorders like hypertension, diabetes, autoimmune diseases, heart disorders, skin diseases, infections and inflammatory diseases.
IVF programme starts with daily hormone injections to the female partner which are costly. These fertility medications may cost around one lakh rupees. Along with these injections continuous monitoring of follicular growth is required. Duration of the injections depends on the protocol decided by the IVF specialist. The protocol may be of long or short duration depending on the patient profile. Once the follicular growth is satisfactory the patient is take for collection of eggs. Oocyte retrieval or egg collection is usually done in an operation room under sedation. This procedure cost will be around 30,000 -50,000 INR.
IVF or ICSI procedure is carried out inside a laboratory with advanced microscopes and hi-tech equipment. It usually takes 3 to 5 days to grow the embryos in the laboratory. There are various optional procedures carried in the laboratory apart from IVF/ICSI depending on the need of patient. Some of them are sperm freezing, freezing of oocytes and embryos, IMSI, PGD/PGS, Assisted hatching. Total IVF laboratory cost may vary from 50,000 to 1,50,000 depending on the various steps taken for the couple.
IVF/ICSI is not a sure success treatment. It depends on the patient profile, the expertise of IVF specialist and Embryologist. It also depends on the quality of drugs used, culture conditions which varies among Fertility clinics and IVF laboratories. Due to the repeated failures IVF packages become very costly for the trying couple.
Cost of IVF in India
The decision to have a baby is the first step in a lifelong commitment of love, time, and financial resources. At Femelife Fertility we understand the long-term implications of the couple’s decision and wish to lessen the financial burden from the beginning. Our attention to quality, coupled with innovations in the treatment of infertility, has led to our excellent success rate.
What are the alternative to IVF Treatment?
Like many aspects of our health, fertility is improved by adopting a healthy lifestyle. Maintaining an ideal weight, a diet rich in antioxidants (found in fruits and vegetables), as well as multi-vitamins may improve the quality of egg and sperm. Avoiding pollution, smoking, junk food, reducing stress and controlling chronic medical conditions such as high blood pressure and diabetes may also improve a couple’s chances of fertility. Couples with underlying medical or genetic conditions should see a doctor so that they can increase their overall health before conceiving. Dr Nabaneeta Padhy at Femelife Fertility evaluates all aspects of the couple and gives suggestions for improving natural fertility.
Is low cost IVF Successful?
The costs of fertility treatment depend on individual needs. Treatment options range from intrauterine insemination (IUI), which is the least expensive, to in vitro fertilization (IVF) with donor egg, which is the most expensive. Often there are less expensive options than IVF that may work for the couple. The only way to find out how much treatment will cost is to set up an initial consultation. Cost of IVF treatment in India is expensive but at Femelife Fertility infertility treatment is cheaper with high IVF success. Hence Femelife Fertility is the best IVF centre in INDIA.
Wide network of IVF clinics of Femelife makes IVF treatment easily accessible for patients from all regions of the world.
What are IVF packages?
Is it wise to go for IVF packages?
Femelife Fertility has designed several discounted packages to meet the varying needs of patients. Many centres charge for each service individually, and these pays can significantly increase the total IVF cycle costs paid by the patient. Femelife Fertility prefers discounted fees, which are designed as a single price that is paid prior to starting of IVF cycle.
