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“Babies for all” – Your fertility options

 If you are one of those who has not yet seen the joy of parenthood, this article is for you. With advances in medical science, even for extreme cases, there are multiple options available.

Initial treatment consists of history, examination, blood tests & specific workup of a couple. If simple
drugs, intrauterine insemination (IUI), etc. do not work, then a more advanced therapy is needed.

Let us begin with a man whose sperm count is zero; the world seems to be coming to an end. But wait, few hormone tests & a biopsy may reveal if the body is making sperms and if there is just an obstruction on the way. If this is the case, then with the help of surgery to remove the block or with in vitro fertilization (IVF) with needle aspiration of testicular tissue (TESA), you may have your own genetic child. For those whose body is not producing any sperms, one of the options is donor sperm IUI.
A large number of drugs & injections can help women, produce eggs. If not, there are always donor eggs. Donor eggs are also used when due to advanced age, a woman has stopped producing her own eggs.

If a woman is born without a normal uterus or has lost it to disease, then surrogacy is the answer. Surrogacy is often called “hiring a womb”, where another woman provides her uterus just as a room to grow the baby for nine months. Also various medical disorders, which do not allow a woman to carry a pregnancy surrogacy, may be used.

You just went for a routine ultrasound & there came the news of you carrying fibroids in your uterus. Don’t panic, fibroids are not an end to life. They are non cancerous growths arising from the muscle of uterus & most of them lie silently, without causing any ill effects.

Depending on their size & location, they may give rise to heavy menstrual flow, irregular menses, painful periods, difficulty in conceiving, repeated miscarriages, pregnancy complications, anaemia, heaviness in lower abdomen, etc. Fibroids are easily diagnosed on ultrasound.

This fibroid may not require urgent treatment

Various treatments options include simple reassurance to the patient, if symptoms are not many & patient is nearing menopause, as most fibroids tend to shrink after menopause.

Most large fibroids & those distorting the inner lining of the uterus will need treatment. Injections & several medicines can temporarily shrink the fibroids.

Hysteroscopy involves insertion of a narrow telescope through the vagina & removal of submucous variety of fibroids. Laparoscopy through very fine cuts, may be surgery of choice in a selected group of patients. Hysteroscopy & Laparoscopy are forms of minimally invasive procedures, which allow quick, pain free recovery, 1-2 days hospital stay & minimal blood loss. Other treatment options are embolization of uterine artery, Mrgfus.

Remember, you are not the only one living with fibroids. Leave the management to the doctor, there is more to life then worrying about fibroids.

Endometriosis – an enigma….often compared to cancer, can debilitate a woman with severe pain during menses or infertility. Different modalities of treatment include medicines, surgery & alternative medicines. Surgical removal is indicated when there are large ovarian endometriomas (chocolate cysts). To prevent recurrence, disease needs to be completely excised & this depends on the expertise of the surgeon. This video shows laparoscopic surgery for endometriosis.

Pain is an unpleasent sensation that none of us would want to expetience. Yet, many young girls have to tragically go through this month after month. This takes a toll on them not only  physically & emotionally , but also reduces their efficiency in the most productive & demanding years resulting in an overall poor quality of life.

As the age old saying goes, all women must go through some pain, let us understand what is normal & when should you start getting alarmed.

Slight pain on first or second day of menses is considered to be natural. It can be easily managed with rest, hot water bags locally & occasionally some pain killers.

You need to see a doctor when pain is of severe intensity, lasts longer or appears later in life after many years of painless menses. You may be asked to do an ultrasound & blood test, which most of the time will be normal. This will reassure you.

Sometimes there could be pelvic infections, endometriosis or ovarian cysts. A short therapy with antibiotics or hormones will help most patients, except a few who may need surgery. Minimal Access surgery (also called Keyhole or Laparoscopic Surgery) benefits such patients with very fine, small scars, minimal pain, very short hospital stay & fast recovery, with complete cure of the disease within.

Are you in your mid thirtees, busy with job commitments, working overtime for the next promotion? Or are you still looking for Mr. Right, somebody who will be commited to you & your child.

Ladies, please pause for a moment!  Your biological clock is ticking fast. The number & quality of female eggs starts dropping after the age of 35. You may be having regular monthly bleeding  with normal flow, but still the fertilizing capacity of your eggs keeps going down. The chances of getting pregnant also keep reducing  from the age of 35, drastically after 40 & there is a very remote possibility of becoming a mother naturally after 45 years of age.

There are few tests to assess the fertilizing capability of eggs, namely AFC & AMH. AFC (Antral Follicle Count) is an ultrasound study to count the number of resting follicles, which will eventually become eggs.

AMH (Anti Mullerian Hormone) is a blood test to again assess your chances of getting pregnant.  The test results have to be interpreted carefully, considering multiple factors. The treatment options, even if it is IVF, become less with increasing age & you may have to take the help of donor eggs, if the time has run out.