Dr. Sujoy Dasgupta Obstetrician and Gynecologist in Kolkata

Dr. Sujoy Dasgupta
Obstetrician and Gynecologist, Kolkata

MBBS (Gold Medalist, Hons), MS (Gold Medalist- OBGY), DNB (New Delhi), FIAOG, Fellow- Reproductive Endocrinology & Infertility- American College of Obstetricians & Gynecologists (USA), MRCOG (London)

Dr. Sujoy Dasgupta is one of the leading doctors in Kolkata, who believes in patient's autonomy and patient-centred care, that means he strongly encourages patients to take their own decision, rather than imposing his own decision on his patients. He provides all the information related to the patient's particular diseases and provides all treatment options (like doing no treatment, medicine or surgery) and explains merits and demerits of all options, so that patients can take their own decision after judging all the aspects.

Dr. Sujoy Dasgupta keeps himself updated regularly on the latest developments occurring in the field throughout the world and also keeps his patients updated by various means. He is possessing very bright academic career having number of Gold Medals, Honours, Awards and certifications. He has, to his credit two post graduate qualifications from India (MS, DNB) and number of certifications. He obtained MRCOG degree from the prestigious Royal College of Obstetricians and Gynaecologists, London, United Kingdom. He has delivered invited lectures in various conferences at Regional, National and International Levels. He is actively involved in various organizations regarding social, academic and scientific acitivities- like Bengal Obstetric and Gynaecological Society (BOGS), Federation of Obstetric and Gynaecological Societies of India (FOGSI), Indian Association of Gynaecological Endoscopists (IAGE), Medical college Ex Students Association (MCESA) and Indian Medical Association (IMA) etc. He is managing the patients in line of "Evidence based Medicine"- that is according to the most recent scientific information obtained from Medical Literature.

Dr. Sujoy Dasgupta is skilled to perform Infertility Work up, Infertility Counseling and Infertility Management in couples having all types of Infertility (Male, female and Unexplained). Many of his patients have experienced the joy of parenthood after long periods of Infertility. After his treatment, many couples with infertility problems like PCOS (Polycyctic Ovaries), Fibroids, Endometriosis conceived naturally after drug treatment, ovulation induction, surgery (laparoscopy, hysteroscopy in some cases) and in some advanced cases conception was possible by IUI (Intrauterine Insemination) and IVF (In vitro Fertilization- "test tube baby"). Many of his patients with low sperm counts are enjoying parethood after successful drug treatment, IUI and IVF. He continued his care to these couples throughout the pregnancy till delivery and afterwards. To give few examples- one patient with severe endometriosis, who refused surgery, conceived naturally after 3 months of injection therapy. Another patients with very low sperm counts was found to have hormonal imbalance, which was managed by medicines and sperm counts improved a lot to permit IUI and they conceived after 1st cycle.

Dr. Sujoy Dasgupta has the expertise to treat successfully men and women with sexual problems. After his counseling, support and treatment, many patients with problems like ED (Erectile Dysfunction), PE (Premature Ejaculation), Painful Intercourse (Dysparaenia), Vaginal Dryness, Low libido etc are enjoying their conjugal life. To site an example, there was a couple where male partner had ejaculation problems. They were concerned about fertility problems. Doctor advised them to feel relaxed and performed IUI. The couple conceived and later on the ejaculatory problems subsided on its own. In another patient with severe premature ejaculation, he performed IUI and the couple had successful pregnancy.

Dr. Sujoy Dasgupta has made many couples with repeated miscarriage smile after successful treatment by giving them baby at or near term. He performs few investigations judiciously and finds out the cause to treat the cause. Even if no cause is found, he treats them with supportive care and many of them continued pregnancy with support and treatments. A Case report was published by him showing his successful management of a case of woman who conceived Triplet pregnancy after prolonged period of Secondary Infertility following Repeated Miscarriage (previous 3 loss) due to congenital abnormality in the uterus (Bicornuate Uterus) and delivered the babies in preterm condition. Another women with 3 previous miscarriage without any apparent cause conceived spontaneously and had successful live birth at term.

Dr. Sujoy Dasgupta is competent in counseling, diagnosing and managing woman before conception (Preconceptional Care), during pregnancy (Antenatal Care), Delivery (Normal Delivery and Cesarean Section) and after delivery (Postnatal care). He is especially interested in managing Medical Disorders in Pregnancy (e.g., women with Diabetes, Thyroid disorders, Hypertension, Epilepsy, Renal disease, Bleeding disorders, Clotting disorders etc in pregnancy). He managed many of his patients with High Risk Pregnancy successfully. To exemplify, recently one patient aged 38 years, conceived after IVF with twin pregnancy developed uncontrolled hypertension (high blood pressure), and for this reason he performed Cesarean Section on her at 30 weeks of pregnancy (just after 7 months). Fortunately mother's condition improved after delivery and the babies are doing well. Thus all the three lives have been saved. Another mother with IVF pregnancy had no movement of the baby. A prompt CTG was advised, following which the baby's life was saved by emergency C-section at midnight. 

Dr. Sujoy Dasgupta is trained to perform all types of Obstetric and Gynaecological Operations including Hysteroscopy and Laparosopy, Hysterectomy, Cystectomy etc. He performs all types of life saving surgeries, like Ectopic Pregnancy, management of abortion and miscarriage in pregnancy. He is specially trained to perform cancer Surgeries for women with Gynaecological Cancers. Not only for cancers, he is also expert in proving "Cancer Prevention Care" to women in form of Counseling, Screening, vaccination and also Colposcopy.

Dr. Dasgupta has been actively involved in many Clinical Research projects like- projects on use of Magnesium Sulphate single dose in Hypertensive disorders, Managing women with Myasthania Gravis in pregnancy, IUI in various forms of Infertility, Pregnancy outcomes after Infertility Treatment, cervical cancer Screening based on HPV detection techniques etc.

Dr. Sujoy Dasgupta lends his expertise in the following areas of Gynecology, Infertility, Obstetrics, Sexual Dysfunction:

Gynaecological Care- Menstrual disorders, PCOS, Fibroid, White discharge, Menopause, Hormone Therapy

Infertility- Drug treatment, Male and Female Infertility, Unexplained Infertility, Endometriosis, PCOS, Fibroid, Low Sperm Count, Ovulation Induction, TVS, HyCoSy, SIS, IUI, IVF, TESA, PESA, ICSI, Hysteroscopy, Laparoscopy

Ultrasonography

Laparoscopy, Hysteroscopy- Diagnostic, Adhesiolysis, PCOS Drilling, Cystectomy, Ectopic Pregnancy, Hysterectomy, Polypectomy, Biopsy, Tubal Recannulation, Salpingectomy, Myomectomy, Endometriosis

Sexual Disorders- Male and Female- Low libido, Erectile Dysfunction, Premature Ejaculation, Female Sexual Dysfunction, Painful Intercourse

Colposcopy, Cancer Screening, HPV Vaccination

Gynaecological operations- Hysterectomy, Cystectomy, Cancer Surgery

Pregnancy care- Pre-conceptional Care, Antenatal care, Postpartum Care

High Risk Pregnancy- Diabetes, Hypertension, Thalassaemia, Epilepsy, Thyroid Diseases, Babies with abnormalities

Delivery Service- Normal Delivery, Caesarean Delivery

Miscarriage- Repeated Miscarriage

Contraception Services- Family Planning, Abortion Services

Abortion Services- Medical, Surgical

Experience

Ex- Clinical Tutor- Obstetrics, Gynaecology, Laparoscopy, KPC Medical College, Kolkata July, 2015 -  January, 2016

Obstetrics and Gynaecology, Infertility, laparoscopy, Sexual Dysfunction, Upkar Nursing Home, College Street, Kolkata November, 2014 -  Present

Visiting Consultant, Infertility, Sexual Dysfunction, Care IVF Central Avenue, Kokata May, 2013 -  December, 2015

Consultant- Obstetrics, Gynaecology, Infertility, laparoscopy, Sexual Dysfunction, Hindusthan Health Point Garia, Kolkata December, 2013 -  Present

Visiting Consultant- Obstetrics and Gynaecology, Infertility, laparoscopy, RSV Hospital Tollygunj, Kolkata November, 2013 -  Present

Visiting Consultant- Obstetrics and Gynaecology, Infertility, laparoscopy, Iris Hospital Baghajatin, Kolkata June, 2014 -  Present

Gynaecologist- Gynaecological Onco-Surgery, Colposcopy, Hysteroscopy, Chittaranjan National Cancer Institute (CNCI), Kolkata July, 2013 -  July, 2015

Incharge, Infertility and IUI, Infertility and IUI Clinic, Medical College Kolkata October, 2010 -  June, 2013

Visiting Consultant , Indian Air Force, West Bengal September, 2015 -  March, 2017

Consultant Obstetrics, Gynaecology, Infertility, Laparoscopy, Sexual Dysfunction, Behala Balananda Brahmachary Hospital and Research Centre, Kolkata November, 2015 -  Present

Visiting Obstetrics, Gynaecology, Infertility, Laparoscopy, Zenith Superspecialist Hospital Belgharia, Kolkata June, 2015 -  Present

Visiting Consultant, Infertility, Calcutta Cure Line IVF And Infertility Clinic, Kolkata November, 2015 -  Present

Consultant- Infertility and IVF, Bavishi Pratiksha Fertility Institute Tollygunge, Kolkata September, 2017 -  Present

Visiting Consultant- Obstetrics and Gynaecology, Infertility, laparoscopy, AMRI Hospital Mukundapur, Kolkata December, 2017 -  Present

Visiting Consultant- Obstetrics and Gynaecology, Infertility, laparoscopy, Medica Superspeciality Hospital Kolkata, Kolkata December, 2017 -  Present

Specialities

  • Obstetrics and Gynecology

  • Embryology

  • Sexual Medicine

  • Gynecology

  • Andrology

  • Sexology

  • Reproductive Medicine

  • IVF & Infertility

  • Gynaecological Endoscopy

  • Venereology

Procedures

  • Abdominal Hysterectomy

  • Ablation

  • Abortion

  • Advanced Laparoscopic Surgery

  • Advanced Laparoscopy

Conditions

  • Abnormal Female Sexual Function

  • Abnormal Menstruation

  • Abnormal Uterine Bleeding

  • Adrenogenital Disorders

  • Allergic Seminal Vulvovaginitis

Expertise

Dr. Sujoy Gupta lends his expertise in the following areas of Gynecology, Infertility, Obstetrics, Sexual Dysfunction: 

  • Gynaecological Care- Menstrual disorders, PCOS, Fibroid, White discharge, Menopause, Hormone Therapy
  • Infertility- Drug treatment, Male and Female Infertility, Unexplained Infertility, Endometriosis, PCOS, Fibroid, Low Sperm Count, Ovulation Induction, TVS, HyCoSy, SIS, IUI, IVF, TESA, PESA, ICSI, Hysteroscopy, Laparoscopy
  • Ultrasonography
  • Laparoscopy, Hysteroscopy- Diagnostic, Adhesiolysis, PCOS Drilling, Cystectomy, Ectopic Pregnancy, Hysterectomy, Polypectomy, Biopsy, Tubal Recannulation, Salpingectomy, Myomectomy, Endometriosis
  • Sexual Disorders- Male and Female- Low libido, Erectile Dysfunction, Premature Ejaculation, Female Sexual Dysfunction, Painful Intercourse
  • Colposcopy, Cancer Screening, HPV Vaccination
  • Gynaecological operations- Hysterectomy, Cystectomy, Cancer Surgery
  • Pregnancy care- Pre-conceptional Care, Antenatal care, Postpartum Care
  • High Risk Pregnancy- Diabetes, Hypertension, Thalassaemia, Epilepsy, Thyroid Diseases, Babies with abnormalities
  • Delivery Service- Normal Delivery, Caesarean Delivery
  • Miscarriage- Repeated Miscarriage
  • Contraception Services- Family Planning, Abortion Services
  • Abortion Services- Medical, Surgical

Education

MBBS (Gold Medalist, Hons), 2004, Medical College, Kolkata, Kolkata, India

MS (Obstetrics and Gynaecology- Gold Medalist), 2010, Medical College Kolkata, Kolkata, India

DNB (Obstetrics and Gynaecology), 2014, National Board of Examinations, New Delhi, New Delhi, India

Fellow- Reproductive Endocrinology and Infertility, 2015, American College of Obstetricians and Gynecologists (ACOG, USA), USA

FIAOG, 2016, Indian Academy of Obstetrics and Gynaecology

MRCOG (London), 2017, Royal College of Obstetricians and Gynaecologists (UK), London, United Kingdom

Practice Information

Upkar Nursing Home, Kolkata

Upkar Nursing Home, Kolkata

Gate No.3, Opp. Medical College, 30D, College Street, Kolkata, West Bengal - 700073

FRI

04:30 PM - 07:30 PM

Behala Balananda Hospital and Research Centre, Kolkata

Behala Balananda Hospital and Research Centre, Kolkata

Plot No. 151 & 153, Diamond Harbour Road, Behala, Kolkata, West Bengal - 700034

THU

09:30 AM - 11:30 AM

Hindusthan Health Point, Kolkata

Hindusthan Health Point, Kolkata

Hindusthan More, Near WBSEB, 2406, Garia Main Road, Kolkata, West Bengal - 700084

MON

07:00 PM - 09:00 PM

RSV Hospital, Kolkata

RSV Hospital, Kolkata

40, Deshpran Sasmal Road, Tollygunge Phari, Kolkata, West Bengal - 700033

IRIS Hospital, Kolkata

IRIS Hospital, Kolkata

82/1, Raja Subodh Chandra Mullick Road, Next to Big Bazaar, Ganguly Bagan, Kolkata, West Bengal - 700086

Zenith Super Specialist Hospital, Kolkata

Zenith Super Specialist Hospital, Kolkata

9/3, Feeder Road, Rathtala, Belgharia, Kolkata, West Bengal - 700056

Medica Superspecialty Hospital (MSH), Kolkata

Medica Superspecialty Hospital (MSH), Kolkata

127 Mukundapur, E.M Bypass, Kolkata, West Bengal - 700099

Vision Care Hospital, Kolkata

Vision Care Hospital, Kolkata

E.M. Bypass, Behind Metro Cash & Carry, Mukundapur, Kolkata, West Bengal - 700099

Genome The Fertility Centre, Shakespeare Sarani

Genome The Fertility Centre, Shakespeare Sarani

Formerly Theatre Road, Beside Andhra Bank, Near Park Circus Crossing, 67, Shakespeare Sarani, Kolkata, West Bengal - 700017

SUN, MON, SAT

09:30 AM - 02:30 PM

TUE, WED, FRI

09:30 AM - 04:30 PM

Woodlands Multispeciality Hospital,  Kolkata

Woodlands Multispeciality Hospital, Kolkata

8/5, Alipore Road, Kolkata , Kolkata, West Bengal - 700027

Private Practice Information

Doctors' Point, Tolygunj, Phone 91630405537

Doctors' Point, Tolygunj, Phone 91630405537

71/1E Netaji Subhash Chandra Bose Road, Near Malancha Cinema Hall Tollygunj, Kolkata, West Bengal - 700040, Tollygunj, Kolkata - 700153

TUE

06:30 PM - 09:00 PM

  • (+91) 91630405537, 9831483585
Friends Diagnostic Private Limited Garia Phone 9088482135, 03324309035

Friends Diagnostic Private Limited Garia Phone 9088482135, 03324309035

128 Baroda Avenue, Garia, Near 45 Bus Stand, Beside Palki Restaurant, Kolkata, Kolkata, West Bengal - 700084

THU

06:30 PM - 09:30 PM

SAT

06:30 PM - 09:30 PM

  • 9088482135, 9831483585
Saha Polyclinic Sodepur, Phone 9432316865

Saha Polyclinic Sodepur, Phone 9432316865

Barasat Road, Kachkol More, End of Sodepur Flyover East, Near Sodepur Rail Station Platform Number 4, Sodepur , Kolkata, West Bengal - 700110

SAT

03:00 PM - 05:00 PM

  • 9432316865, 9831483585
Upkar Nursing Home College Street, Phone 03322570166, 03322570165

Upkar Nursing Home College Street, Phone 03322570166, 03322570165

30D College Street, Opposit to gate Number 3 of Medical College Kolkata, Kolkata, West Bengal

FRI

04:30 PM - 07:00 PM

  • 03322570166, 03322570165, 9831483585
Behala Balananda Bramhachary Hospital and Research Centre

Behala Balananda Bramhachary Hospital and Research Centre

Plot No. 151 & 153, Diamond Harbour Road, Behala, Behala, Kolkata, West Bengal - 700034

THU

09:30 AM - 11:00 AM

  • (033) 23961687, (+91) 9433716111
Hindusthan Health Point Pvt Ltd, Garia, Phone 9831483585

Hindusthan Health Point Pvt Ltd, Garia, Phone 9831483585

2406 Garia Main Road, Hindusthan More, Garia, Kolkata 700084 , Kolkata, West Bengal - 700084

MON

07:00 PM - 09:00 PM

  • 9831483585, 9831483585
Techno India Hospital (DAMA) Salt Lake, Phone 03323576163, 03323350237

Techno India Hospital (DAMA) Salt Lake, Phone 03323576163, 03323350237

Jal Vayu Vihar, LB Block, Sector III, Kolkata, West Bengal 700098, Salt Lake, Kolkata, West Bengal - 700098

TUE

04:00 PM - 06:00 PM

  • 03323576163, 03323350237, 9831483585
Apollo Clinic Narendrapur, Phone 033-24770553, 033-24770554

Apollo Clinic Narendrapur, Phone 033-24770553, 033-24770554

Adyashakti Complex, 507 NSC Bose Road, Narendrapur , Opposite Mandir Gate , Kolkata , West Bengal , Kolkata, West Bengal - 700103

WED

07:00 PM - 09:00 PM

  • 033-24770553, 033-24770554 , 9831483585
Genome, The Fertility Centre

Genome, The Fertility Centre

67 Shakespeare Sarani, Beside Andhra Bank, Kolkata 700017, Park Circus, Kolkata, West Bengal - 700017

SUN

09:30 AM - 02:30 PM

MON

09:30 AM - 04:30 PM

TUE

09:30 AM - 04:30 PM

WED

09:30 AM - 04:30 PM

FRI

09:30 AM - 04:30 PM

SAT

09:30 AM - 02:30 PM

  • 03330855000, 9831483585

Patient Experience

Your participation in the survey will help other patients make informed decisions. You will also be helping Dr. Sujoy Dasgupta and his staff know how they are doing and how they can improve their services.

Achievements & Contributions

  • Dasgupta S, Chaudhury K, Mukherjee K. Usefulness of chorionic villus sampling for prenatal diagnosis of thalassaemia: a clinical study in eastern India. Int J Reprod Contracept Obstet Gynecol 2015 Jun; 4(3):790-794.
  • Dam P, Chakravorty PS, Mukherjee P, Dasgupta S. An Atypical Successful Outcome of Multifetal Pregnancy in Bicornuate Uterus: A Case Report. J Int Med Sci Academ Oct-Dec 2014; 27 (4) : 211-212.
  • Ghosh I, Mittal S, Banerjee D, Singh P, Dasgupta S, Chatterjee S, Biswas J, Panda C, Basu P. Study of accuracy of colposcopy in VIA and HPV detection-based cervical cancer screening program. Aus N Z J Obstet Gynaecol 2014; 54: 570–575  DOI: 10.1111/ajo.12282 PMID: 25476810.
  • Dasgupta S, Mukherjee K, Chaudhury K. Risk of miscarriage following chorionic villus sampling on 315 cases for prenatal diagnosis of Thalassemia. BJOG. EP3.07. DOI: 10.1111/1471-0528.12778: 29-30.
  • Dam P, Dasgupta S, Das N, Chakravorty PS.  Evaluation of Role of Intrauterine Insemination in Infertility in a Tertiary Care Hospital. J of Evolution of Med and Dent Sci 2014 Apr 21; 3 (16):  4337-4348. 
  • Dasgupta S. Incisional Hernia in Pregnancy: A Review. Int Med J of Students' Research 2012 Jan; 2 (1): 18-23.
  • Dasgupta S. An Unusual Association of Lung and Ovarian Malignancy in a Young Nonsmoker Female. Int J of User-Driven Healthcare 2012 Oct-Dec; 2(4): 20-28.
  • Biswas T, Sen P, Dasgupta S, Guha Niyogi S, Ghosh GC, Bera K, Biswas R. Creating Secondary Learning Resources from BMJ Case Reports through Medical Student Conversational Learning in a Web Based Forum: A Young Man with Fever and Lymph Node Enlargement. Int J of User-Driven Healthcare 2011 Jul-Sept; 1(3): 7-19.
  • Dasgupta S. Unexplained Infertility- An Enigma of reproductive Medicine. Asian Students' Med J 2011 May; 6(6).
  • Basu P, Dasgupta S, Singh P. "Screening of Cervical Cancer" in Screening in Obstetrics and Gynaecology: Management of Abnormality. Pandey A, Magon N Eds. FOGSI Publication: Jaypee 2015 p135-146.
  • Dasgupta S, Banerjee Ray P. Association between ophthalmoscopic changes and obstetric outcomes in preeclampsia and eclampsia. Int J Reprod Contracept Obstet Gynecol 2015 Dec; 4(6): 1944-1949.
  • Dasgupta S, Sarkhel A, Jain A.   Single Loading Dose of Magnesium Sulphate in Severe Preeclampsia and Eclampsia-Is it Effective? A Randomized Prospective Study. Obstet Gynecol Int J 2015 Sept, 2(6)
  • Dasgupta S. Salpingectomy should be done routinely during hysterectomy. BOGS Times 2015 July: 7 (1); 6-7. 
  • Banerjee, D, Singh, P, Dasgupta, S, Mandal, R, Basu, P, Biswas, A phase II randomised trial evaluating concomitant immunotherapy and radiation therapy for stage-III cervical cancer. BJOG 2014 Mar; 121 (S2): 197
  • Gold Medal in Biochemistry, 1st Professional MBBS
  • Gold Medal in Pharmacology, 2nd Professional MBBS
  • Gold Medal in Otorhinolaryngology (ENT), 3rd Professional MBBS Part I
  • Gold Medal in Obstetrics and Gynaecology, 3rd Professional MBBS Part II
  • Gold Medal in Obstetrics and Gynaecology for being selected as "Best PG Student" in MS, Obstetrics and Gynaecology
  • Mcnamar Silver Medal in Biochemistry in 1st Professional MBBS
  • Sutherland Silver Medal in Forensic Medicine and Toxicology in 2nd Professional MBBS
  • Senior Class Assistant (The "Best Student")  in Biochemistry
  • Senior Class Assistant (The "Best Student") in Pharmacology
  • Senior Class Assistant (The "Best Student") in ENT
  • Senior Class Assistant (The "Best Student") in Paediatric Medicine
  • 1st Certificate of Honours in Physiology in 1st Professional MBBS
  • Honours (80.1% marks) in Biochemistry
  • Honours (80% marks) in Pharmacology
  • Honours (77% marks) in ENT
  • Kunj-Kusum Scholarship for securing the FIRST position in 2nd Professional MBBS Examination among the students of the college
  • Highest Marks in the University in Biochemistry
  • Highest Marks in the College in Pharmacology
  • Highest Marks in the College in ENT
  • Dr Saroj Bhattacharya Memorial Award in Obstetrics and Gynaecology in 3rd Professional MBBS Part II
  • 1st Prize in Case Presentation in BOGSCON - "An Atypical Outcome of Multifetal Pregnancy in Bicornuate Uterus"
  • 2nd Prize in AICC-RCOG Quiz in Pune, on "Medical Disorders in pregnancy"
  • Champion, Late Smt Birangana Devi Oration Competetion, Conference on Recent Trends in Cancer Research, Early Diagnosis, Prevention & Therapy "The Accuracy of Diagnostic Colposcopy using IFCPC 2011 Classification in Women Screened by VIA and HPV DNA Test"
  • 1st Prize, Oral Paper Presentation, 9th Annual Conference of ISCCP "The Accuracy of IFCPC 2011 Classification to Detect Cervical Neoplasia"
  • Work Published in Bengali Daily Aajkaal on 27th October, 2016 Thursday, Page Number 14, Last Column - 2016http://aajkaal.in/epaper/epaper
  • Work Published in Bengali Daily Pratidin on 16 January, 2018 Tuesday, Page Number 9 - 2018http://epaper.sangbadpratidin.in/epaper/edition/1504/sangbad-pratidin-16-01-18/page/9
  • Invited Panelist at Panel Discussion, Plexus, Annual Fest of KPC Medical College, 2011 "Occupational Hazard among Health Care Providers"
  • Invited Faculty at Scientific Programme of MCESA, 2014 "Obstetric Critical Care"
  • Quiz Master of Scientific Programme, MCESA, 2014
  • Workshop Coordinator, ISCCP ANnual Conference, 2014
  • Invited Faculty at Live Workshop on Colposcopy and Manegement of Cervical Precancers, CNCI, April 2014; August 2014; December 2014; July 2015
  • Invited Faculty at Scientific Programme in BOGSCON, 2015 "Thromboprophylaxis in Obstetrics"
  • Invited Faculty at Scientific Programme in MCESA, 2015 "Thromboprophylaxis in Pregnancy"
  • Quiz Master in Scientific Programme of MCESA, 2015
  • Examiner, Vivavoce Table, FORCE 2015
  • Quiz Master, Retrocon, 2015
  • CME of Medical Education and research Committee, BOGS, 2015
  • Chairperson in a session, Endogyn, 2015
  • Chairperson in a session, Annual Conference of South Kolkata Medical Association, IMA, 2015
  • An Atypical Outcome Of Multifoetal Gestation In Bicornuate Uterus 1st prize in BOGSCON, 2012  January, 2012 ECOHUB Conclave, Kolkata
  • Prevalence And Significance Of Anti-Phospholipid Antibodies In Selected At-Risk Obstetric Cases: A Comparative Prospective Study East Zone Yuva FOGSI May, 2012 Hotel Hindusthan International, Kolkata
  • Management Of Overt Diabetes Before, During And After Pregnancy   June, 2012 Eden Hospital Seminar Room
  • Perineal Injury In Obstetrics- Prevention And Management.   August, 2012 Eden Hospital Seminar Room
  • Operative Vaginal Delivery- Is It A Lost Art?   October, 2012 Eden Hospital Seminar Room.
  • Evaluation of Role of Intrauterine Insemination (IUI) in Infertility ART-AIM Update October, 2013 Hyatt Regency, HKolkata
  • The Accuracy of Diagnostic Colposcopy using IFCPC 2011 Terminology   BOGSCON, 2014. January, 2014 ITC Sonar, Kolkata
  • The Accuracy of Diagnostic Colposcopy using IFCPC 2011 Classification in Women Screened by VIA and HPV DNA Test Champion in Late Smt Birangana Devi Oration Competition February, 2014 CNCI., Kolkata
  • The Accuracy of IFCPC 2011 Classification to Detect Cervical. Neoplasias   1st prize in 9th Annual Conference of ISCCP, 2014  February, 2014 Hotel Hindusthan International, Kolkata
  • Growing Teratoma Syndrome- More Questions Than Answers BOGS Clinical Meeting June, 2014 Medical College, Kolkata
  • Rate of Miscarriage Following Chorionic Villus Sampling on 315 for Prenatal Diagnosis of Thalassaemia http://epostersonline.com/rcog2014/?q=node/3040   RCOG World Congress, 2014 HICC, Hyderabad March, 2014
  • Invited Panelist in a Panel Discussion on "Saving Mothers" in a CME by BOGS Committee of Safe Motherhood, at Medical College Kolkata, 2015
  • Invited Faculty at East Zone Yuva FOGSI 2015 held at Puri- "Prophylactic Salpingectomy"
  • Invited Speaker, "Prophylactic Salpingectomy"- East Zone Yuva FOGSI, Puri, 2015
  • Invited Expert Panelist, "High Risk Pregnancy", "Why Mothers Die" International Conference, Kolkata 2015
  • Invited Speaker- "Management of Sexually Transmitted Diseases", BOGSCON 2016
  • Invited Quiz Master, Mediquiz, Scientific Programme of 82nd Reunion of Medical College Kolkata- 2016
  • Peer Reviwer of BMJ Case Reports
  • Active member of BOGS (The Bengal Obstetric & Gynaecological Society)
  • Live member of FOGSI (Federation of Obstetric & Gynaecological Societies of India)
  • Member of IAGE (Indian Association of Gynaecological Endoscopists)
  • Live Member of IMA (Indian Medical Association)
  • Active Member of MCESA (Medical College Ex-Students’ Association)
  • Active Member of JVAA (Jadavpur Vidyapith Alumni Association)
  • Secretary, Publication, Website and Buletin Committee, BOGS, 2015-16
  • Secretary, Medical Education and Research Committee, BOGS, 2014-15
  • Coordinator, Website Committee, MCESA, 2014-15
  • Cultural Secretary, JVAA, 2013-2014, 2014-2015
  • Member, Registration Committee, Endogyn, 2015
  • Member, Scientific Committee, 81st Scientific Annual Conference of MCESA
  • Member, Publication Committee, Retrocon 2015 (Annual Reunion and Scientific programme of CSS)
  • Member, Scientific Committee, FORCE (FOGSI Revision Course for Examinations), 2015
  • Member, Workshop Committee, BOGSCON 40, 2015
  • Member, Publication Committee, 9th Annual Conference of ISCCP (Indian Scioety of Colposcopy and Cervical Pathology, 2014
  • Executive Committee Member, Medical College Ex-Students' Association (MCESA) 2016-17, 2017-18
  • Member, Scientific Committee, "Why Mothers Die" International Conference, 2015
  • Member, Workshop Committee, BOGSCON 2016
  • Member, Workshop Committee, International Conference on High Risk Pregnancy and Labour, 2016
  • Member, Scientific Committee, BOGSCON 2017
  • Member, Scientific Committee, Endogyn 2017
  • Member, managing Committee, BOGS, 2016-17, 2017-18
  • Member, Scientific Committee, FORCE 2016
  • Secretary, Perinatology Committee, BOGS, 2016-17
  • Secretary, Website Committee, BOGS 2017-18
  • Member, Scientific Committee, BEST, 2017
  • Assistant Secretary, Publication Committee, BOGSCON 2018
  • Assistant Secretary, Scientific Committee, MCESA Reunion, 2018
  • Member, Royal College of Obstetricians and Gynaecologists

Blog

Fallopian Tube Block in Infertility- What You Can Do?

When couples get married, they often view parenthood as the next stage in their family life. They want to have child, they want to be “mom” and “dad”, they cannot imagine that this may beard to achieve or may not be a natural process. When several trials to conceive fail, they are shocked. Their basic expectation about family life gets shattered. Most of the couples are desperately looking for medical therapy that will end into a misery. Clearly this is not a struggle to survive; it is a struggle to fulfill a dream, to achieve what they view as a “full life”.


What is needed for pregnancy?

In the male partner, sperms are normally produced in the testes after puberty(after attainment of characters like growth of beard, moustache etc). From the testes, they are carried through the sperm conducting ducts (epididymis, vas,seminal vesicle and prostate gland). Then during sexual stimulation, after proper erection and ejaculation, they come out through penis. During sexual intercourse, these sperms, present in semen, are deposited inside the vagina.  


In female partner, the deposited sperms must travel from vagina through the cervix (the mouth of the uterus). The cervix acts as gate-keeper, a it prevents entry of dead and abnormal sperms as well as bacteria present in semen, in the uterus. From uterus, sperms reach the Fallopian tubes (the tubes that are attached to the both sides of the uterus)where the sperms must meet the egg (ovum). The eggs are produced only before birth and so, there are fixed number of eggs inside the ovary. The ovum released from the ovary, into the abdomen at the time of ovulation (rupture of the surface of ovary to release the ovum). That ovum must be taken by the tube and thus inside the tube an embryo (earliest form of the baby) is formed, by meeting of the egg and the sperm. It should be mentioned that out of nearly 200-300 million sperms, in average,deposited in vagina, hardly 500- 800 sperms can reach near the eggs and only one will succeed to form the embryo. The embryo then travels through the tube into the uterus and the uterus attaches the embryo firmly with it and thus the pregnancy starts. So, if there is defect in any one of them there will be difficulty in achieving pregnancy.


Thus,to summarise, pregnancy requires

1.       Production of healthy (“Normal Morphology”) and movable (“Normal Motility”) sperms inadequate number (“Normal Count”) in the testes

2.       Transport of these sperms through the sperm conducting ducts from testes to penis

3.       Successful Erection and Ejaculation during Intercourse to deposit adequate number of these sperms in the vagina

4.       Transport of these sperms from vagina through cervix to the uterus and the tubes

5.       Presence of sufficient number of eggs inside the ovary and ability to release the eggs from the ovaries

6.       Pickup of the eggs by the tubes 

7.       Approximation of eggs and the sperms to form the embryo

8.       Transport of embryo from the tubes into the uterus

9.       Acceptance of the embryo by the uterus and its growth

What is Infertility?

Literally,the word “Infertility” means inability to conceive. But in reality, there are very few couples, who have no chance of natural conception and are called“Absolutely Infertile”. In fact, in many couples who present to infertility clinics, pregnancy may be the matter of time, thus the chance factor. It should be kept in mind that, if there is factors to question fertility of either male or female or the female is of age less than 35 years; after one cycle (one month) of regular frequent intercourse, the chance of conception inhuman being is only 15%. That means, out of 100 couples trying for conception, only 15 will be able to succeed after one month of trying. The word “Regular” and “Frequent” are important; because to achieve pregnancy,couples are advised to keep intimate relationships for at least 2-3 times  a week and this should be increased particularly around the time of ovulation(Middle of the menstrual cycle). Thus chance of pregnancy after 6 months, months and 24 months of regular trying are respectively 60%, 80% and 100%. 

The word, “Subfertility” seems better and more scientific than “Infertility”, to describe the couples who have reduced chance of conception, due to any cause.However, the word “Infertility”, seems more popular, although it puts pressure on the couples. In most cases, usually we advise to investigate after one year of regular and frequent intercourse, when the couples fail to conceive.However, if there are factors to question fertility; for example female with age more than 35 years, or with previous surgery in tubes/ ovaries/ uterus or known diseases like PCOS or endometriosis; or male partner having surgery in scrotum or groin or any hormonal problems or sexual dysfunctions- the wait period is usually reduced and couples can be investigated, even soon after marriage. 


What causes Infertility?

Please look at the point “Thus, to summarise, pregnancy requires” where 9 points have been mentioned. Thus the common causes may be

1.       Problems in male- total absence of production of sperms, less than adequate number of sperms, problems in morphology and motility of sperms (most sperms not healthy or movable), blockage in transport of sperms and inability to deposit sperms in the vagina (sexual dysfunction- Erectile Dysfunction or less commonly,Ejaculatory Dysfunction). Examples include hormonal problems (Testosterone,thyroid, prolactin), diabetes, liver problems, causes present since birth,chromosomal abnormalities, surgery, infection, sexually transmitted diseases,smoking, exposure of scrotum to high temperature, some medicines or psychological causes.

2.       Problems in female- total absence of less than adequate number of eggs in the ovaries,problems in ovulation, problems in picking of eggs by the tubes, blockage of tubes, problems in conduction of sperms or embryo by the uterus, problems in accepting the embryos by the uterus. Examples include causes present since birth, chromosomal abnormalities, polycystic ovarian syndrome (PCOS), old age,increased weight, fibroid, endometriosis, pelvic inflammatory diseases (PID),tuberculosis (TB), infections, smoking, surgery, some medicines, hormonal problems (thyroid, prolactin) or excessive stress.

3.       Unknown causes- Despite thorough investigations, 25-30% causes of infertility remain unknown. This is called “Unexplained Infertility”. The reason may be mere chance factors or there may be some causes which, still medical science has yet to discover. 

But this should be kept in mind while treating infertility. That means, even with correction of the possible factors (like improving sperm counts or thyroid problems etc) or with proper treatment (IUI, IVF or ICSI), unfortunately the treatment can fail and the exact reason, why the treatment failed, is sometimes difficult to find out.  


What are the treatments for infertility, in general?

To start with, please remember there is no hard and fast rules for infertility treatment. Often medical science fails to understand why couples with very severe form of infertility conceive sooner than those who are having all tests normal. That means, whatever treatment is offered, it’s very important to continue regular sexual intercourse, as the chance of natural pregnancy is usually there in almost all couples. Your doctor will present the facts to you, without pressurizing you on a particular option. After coming to know all pros and cons of different treatment options, you can take decision. Do not hurry. It’s quite natural that you might be in stress. In general, after the initial tests, a few periods of natural trying is allowed. After that, ovulation induction (giving medicines to release eggs from the ovaries)is offered, failing which IUI and finally IVF is offered. What will be the preferred treatment for you, will depend on your age, duration of marriage,male and female factors and of course, your age. For example, a woman with both tubes blocked or a male with very low sperm count, IVF would be the first line of treatment.


What is Fallopian Tube(s)?

Fallopian tubes (commonly called “the tubes”) are the structures that are connected to the both sides of the uterus, as mentioned above. Each tube is of 10 cm length.The part attached to the uterus is called the “cornu” and the part remaining free is called the “fimbria”. It’s the fimbria, that is present near the ovary and picks up the ovum and transports it inside the tube. The cornu received the sperms from the uterus and passes it inside. Inside the tube, the sperms and the egg meet to form the embryo, which then travels down the tubes into the uterus and then the pregnancy starts.

What happens if tubes are blocked?

If both the tubes are blocked completely, anywhere along the length (cornu,fimbria or the middle), pregnancy is not possible. This is quite obvious, because either the sperm cannot enter other egg is not picked up or they cannot meet.However,if any of the tubes are partially blocked, then the sperms and egg can pass and meet but the embryo cannot come down into the uterus. As a result, the pregnancy continues inside the tube, which is called “Ectopic pregnancy” that is life-threatening for the mother. It's important to remember that ectopic pregnancy can happen even if both the tubes are open.

What are the reasons for tubal blockage?

Often,the exact cause is not known. Infections the commonest cause. The infections may be due to sexually transmitted infection (STI), particularly Chlamydia infection or infection from bowel or appendix. Tuberculosis is very common incur country and can affect the tubes, silently, without affecting any other parts (not even the lungs) of the body. Endometriosisis also a common reason for tubal blockage. Any pelvic surgery (surgery in ovaries, tubes, uterus, even appendix)can block the tubes by “adhesion”.This means the tube may be open but attached to the bowel or rotated on itself,so that the tube cannot pick up the eggs from the ovaries. Sometimes fibroid of uterus can compress the tube and cause blockage. Women, with previous history of ectopic pregnancy, are at risk. Uncommonly, some abnormalities,present since birth can block the tubes.

What are the types of tubal blockage?

Tubal block may be one sided or both sided. It may involve only a particular part of a tube or multiple parts of a tube. The site of the block may be the cornu, the fimbria or the middle portion. 

Hydrosalpinx,is a thing that you must know. In this condition, the tube is blocked but the mid-portion is dilated and contains some fluid (often infected). This tube is not functional. And the problem is even if there is pregnancy by IVF inside the uterus, this fluid from the tube may trickle down, coming in contact with the embryo and can potentially kill the embryo!

How can I understand that the tubes are blocked?

Unfortunately,very few women have signs or symptoms indicating tubal block. However, if you had previous infections in pelvis, tuberculosis in any part of the body, appendicectomy or other gynaecological surgery, there is chance of tubal block.Patients with fibroid and endometriosis are also at risk of tubal block. If you feel severe pain during periods or during intercourse, there is a chance that the tubes may be blocked.

When the tubes should be tested?

As mentioned earlier, the routine investigation of infertility includes testing for the ‘open-ness’ of the tubes- “Tubal Patency tests”. That means if pregnancy does not come within 12 months of regular intercourse, thence usually advise the tests. Sometimes, tests are needed, after 6 months of trying (see above). However,in some women, with low risk of tubal block (no risk factors as mentioned above),it may be appropriate to start treatment and continue it for few cycles and if no response, then tubes should retested. 

How the tubes are tested?

The method of tubal patency test depends on your risk of having blocked tubes and also your wishes, availability of resources, other fertility factors and of course the affordability.Routine ultrasound (like TVS) cannot detect tubal patency. However, it can detect hydrotherapy in most of the cases. 

If you do not have any risk factors (like pain during periods, endometriosis,previous infections or surgery), you can choose either HSG or SIS. These redone in out-door basis, without any need of anesthesia. 

HSG (Hystero-salingogram)is a method by which, your tubes will be seen under Xray. After visualizing your cervix (mouth of the uterus) by a speculum (instrument inserted in the vagina) a small screw will be inserted inside the cervix and a contrast material (which can be seen by the X ray) will be given through it. If tubes are open, the Xray will show that the contrast material will be going through the tubes into the abdomen. 

The advantage of HSG is that, a test showing open tube has good correlation with tubal patency (if HSG shows the tubes are open, it’s likely that tubes reopen). It is widely available and also cheaper.

However,the problem is that most of the women feel it painful, although they are given pain-killers for it. In addition, there is small risk of infection, for which antibiotics are prescribed. The contrast material can rarely give rise to allergy in some sensitive women and it may be life-threatening in very rare cases. Another problem is the false positive result. That means if tubes are found to be blocked in HSG, in 50%cases, they will be found to be open subsequently in laparoscopy. This is mainly because of some spasm of the muscles of the tube during the test. 

SIS (Saline infusion sonography)or HyCoSy (Hystero-Contrast-Sonography) is the method by which tubal patency is checked by ultrasound (TVS) along with water like material inserted inside the uterus through a small tube. If tubes are open, the passage of water can be seen going into the abdomen through the tubes, in the ultrasound. 

The advantage of HyCoSy is that it’s much less painful than HSG, although mild discomfort may be there. Pain-killers and antibiotics are prescribed usually.Additionally, problems inside the uterus can be better visualized, even better than normal TVS. In addition, the false positive result is much lower, only 7%.That means if HyCoSy suggests that the tubes are blocked, in most cases, the tubes will be found to be blocked at laparoscopy. 

The problem with HyCoSy is mainly the cost and it’s not available everywhere. 

An important merit of doing the tubal test is that, sometimes the water or the contrast material used in these tests can open the “mild” block. That’s why we often find patients who conceive spontaneously with pregnancy inside the uterus, after apparently “blocked”tubes in HSG or HyCoSy. 

Now, laparoscopy is reserved for those,who are at high risk of tubal block. This includes women with risk factors(pain, surgery, infection etc) o women having “blocked” tube in HSG or HyCoSy.Clearly, it’s done after hospitalization under general anaesthesia inside the OT. Two or three small opening (key-hole surgery) will be put inside the abdomen and through vagina a coloured material (“dye”) will be given inside the uterus. If the tubes are open, the laparoscopic camera will show that dyes coming out of the tubes inside the abdomen. 

The advantage is that it’s a definitive test, can help you to make final decision.It also provides the options of treatment. If there is corneal block in HSG, we can make attempt to open the tubes using laparoscopy (see below). In addition,if there is hydrosalpinx, where the tube serves no function, the tubes can be removed (salpingectomy) or clipped (we put clips to block the tubes) to improve the chance of pregnancy if IVF is the only option left for you. In addition,laparoscopy helps us to see whether there is any other diseases that have been missed by routine tests and that may account for infertility. We can treat the cysts of PCOS (by applying current to destroy some cysts), remove any large cysts, remove any adhesion, treat endometriosis etc. 

The disadvantage of laparoscopy is of course, the need of anaesthesia and associated surgical and anaesthetic risks, although in modern era, the serious complications are uncommon.


What are my options if tubes are found to be blocked in HSG? 

There are simply two options. It depends on your age, fertility factors and affordability. Number one is directly, you can go for IVF. In that case, you can save time and cost. It may be a preferred option, if you are aged or have some other fertility factors (low sperm count, endometriosis etc). The chance of pregnancy per cycle of IVF is usually 40%. 

Another option is that you can confirm the block by other tests, keeping in mind that you may need IVF if the tubes are found blocked ultimately. We usually advise to have laparoscopy. However, some women want to give a trial with HyCoSy,because if HyCoSy shows the tubes are open, then you can avoid laparoscopy and you can try different fertility treatment options. 

In laparoscopy, first we see if tubes are open or not. If open, there is no need of further treatment in laparoscopy. However, if tubes are found blocked,especially if the block is in cornu, we can try “hysteroscopic tubal cannulation”, where we put a small catheter through hysteroscope (a telescope, like endoscope, put inside the uterus through vagina so that we can see inside the uterus using a camera) to open the tubes. If tubes can be opened, you have all options for fertility treatment open.  However, if we fail to open the tubes, the only option left is IVF. In addition, if there is fimbrial block, it can be released and new opening in the fimbria can be made. The treatment of hydrosalpinx by laparoscopy has already been discussed (see above). 

Having said that, there are some group of women, who conceive while waiting for IVF or laparoscopy after a blocked tube found in HSG.


What can I do if tubes are blocked in HyCoSy?

In this case also, there is choice between the two- laparoscopy first and IVF directly. 

What can I do if laparoscopy suggests tubal block?

Unfortunately,in that case, the only option left is IVF. As mentioned before, if hydrosalpinxis found it must be treated before IVF. However, sometimes we find hydrosalpinx in laparoscopy but cannot cut the tube of clip it, simply because you did not give consent to us for doing so. In that case, we can suck out (“aspirate”) the fluid from the hydrosalpinx under ultrasound guidance (no need of further laparoscopy) using the needle. 


How tubal block is dealt in your particular centre by Dr Sujoy Dasgupta?

We believe in patient's autonomy. So we want to give time on discussion and presentation of facts and figures to the couples. We encourage questions from the couples and take utmost care so that no question remains unanswered.We do not take decision sand impose it on the couples. We advise the couples to take time before taking decision on a particular treatment. If the couple decides, we respect and support their decision.We prefer to have SIS or HyCoSy, rather than HSG, to reduce the pain to the women. We discuss all the options if tubes are found blocked.


Conclusion

Tubal factor can account for 20-25% cases of female infertility. It’s more common in secondary infertility (women who conceived earlier-whatever be the fate of the pregnancy). Tubal test is a part of infertility investigation. The choice between HSG and HyCoCy is open to you. If tubes are found blocked, the options are IVF directly or confirming the block by laparoscopy. 








Iui (Intra Uterine Insemination) - Treatment Option for Infertile Couples

Diagramatic- How IUI is done
Diagramatic- How IUI is done

Introduction

When couples get married, they often view parenthood as the next stage in their family life. They want to have a child, they want to be “mom” and “dad”, they cannot imagine that this may be hard to achieve or may not be a natural process. When several trials to conceive fail, they are shocked. Their basic expectation about family life gets shattered. Most of the couples are desperately looking for medical therapy that will end into a misery. Clearly this is not a struggle to survive; it is a struggle to fulfill a dream, to achieve what they view as a “full life”.


What is needed for pregnancy?

In the male partner, sperms are normally produced in the testes after puberty (after attainment of characters like growth of beard, moustache etc). From the testes, they are carried through the sperm conducting ducts (epididymis, vas, seminal vesicle and prostate gland). Then during sexual stimulation, after proper erection and ejaculation, they come out through penis. During sexual intercourse, these sperms, present in semen, are deposited inside the vagina.


In female partner, the deposited sperms must travel from vagina through the cervix (the mouth of the uterus). The cervix acts as gate-keeper, a it prevents entry of dead and abnormal sperms as well as bacteria present in semen, in the uterus. From uterus, sperms reach the Fallopian tubes (the tubes that are attached to the both sides of the uterus) where the sperms must meet the egg (ovum). The eggs are produced only before birth and so, there are fixed number of eggs inside the ovary. The ovum released from the ovary, into the abdomen at the time of ovulation (rupture of the surface of ovary to release the ovum). That ovum must be taken by the tube and thus inside the tube an embryo (earliest form of the baby) is formed, by meeting of the egg and the sperm.


It should be mentioned that out of nearly 200-300 million sperms, in average, deposited in vagina, hardly 500- 800 sperms can reach near the eggs and only one will succeed to form the embryo. The embryo then travels through the tube into the uterus and the uterus attaches the embryo firmly with it and thus the pregnancy starts. So, if there is defect in any one of them there will be difficulty in achieving pregnancy.

Thus, to summarise, pregnancy requires

  • Production of healthy (“Normal Morphology”) and movable (“Normal Motility”) sperms in adequate number (“Normal Count”) in the testes
  • Transport of these sperms through the sperm conducting ducts from testes to penis
  • Successful Erection and Ejaculation during Intercourse to deposit adequate number of these sperms in the vagina
  • Transport of these sperms from vagina through cervix to the uterus and the tubes
  • Presence of sufficient number of eggs inside the ovary and ability to release the eggs from the ovaries
  • Pick up of the eggs by the tubes
  • Approximation of eggs and the sperms to form the embryo
  • Transport of embryo from the tubes into the uterus
  • Acceptance of the embryo by the uterus and its growth



What is Infertility?

Literally, the word “Infertility” means inability to conceive. But in reality, there are very few couples, who have no chance of natural conception and are called “Absolutely Infertile”. In fact, in many couples who present to infertility clinics, pregnancy may be the matter of time, thus the chance factor.

It should be kept in mind that, if there is factors to question fertility of either male or female or the female is of age less than 35 years; after one cycle (one month) of regular frequent intercourse, the chance of conception in human being is only 15%. That means, out of 100 couples trying for conception, only 15 will be able to succeed after one month of trying. The word “Regular” and “Frequent” are important; because to achieve pregnancy, couples are advised to keep intimate relationships for at least 2-3 times a week and this should be increased particularly around the time of ovulation (Middle of the menstrual cycle). Thus chance of pregnancy after 6 months, 12 months and 24 months of regular trying are respectively 60%, 80% and 100%.

The word, “Subfertility” seems better and more scientific than “Infertility”, to describe the couples who have reduced chance of conception, due to any cause. However, the word “Infertility”, seems more popular, although it puts pressure on the couples. In most cases, usually we advise to investigate after one year of regular and frequent intercourse, when the couples fail to conceive. However, if there are factors to question fertility; for example female with age more than 35 years, or with previous surgery in tubes/ ovaries/ uterus or known diseases like PCOS or endometriosis; or male partner having surgery in scrotum or groin or any hormonal problems or sexual dysfunctions- the wait period is usually reduced and couples can be investigated, even soon after marriage.

What causes Infertility?

Please look at the point “Thus, to summarise, pregnancy requires” where 9 points have been mentioned.

Thus the common causes may be

  • Problems in male- total absence of production of sperms, less than adequate number of sperms, problems in morphology and motility of sperms (most sperms not healthy or movable), blockage in transport of sperms and inability to deposit sperms in the vagina (sexual dysfunction- Erectile Dysfunction or less commonly, Ejaculatory Dysfunction). Examples include hormonal problems (Testosterone, thyroid, prolactin), diabetes, liver problems, causes present since birth, chromosomal abnormalities, surgery, infection, sexually transmitted diseases, smoking, exposure of scrotum to high temperature, some medicines or psychological causes.
  • Problems in female- total absence of less than adequate number of eggs in the ovaries, problems in ovulation, problems in picking of eggs by the tubes, blockage of tubes, problems in conduction of sperms or embryo by the uterus, problems in accepting the embryos by the uterus. Examles include causes present since birth, chromosomal abnormalities, polycystic ovarian syndrome (PCOS), old age, increased weight, fibroid, endometriosis, pelvic inflammatory diseases (PID), tuberculosis (TB), infections, smoking, surgery, some medicines, hormonal problems (thyroid, prolactin) or excessive stress.
  • Unknown causes- Despite thorough investigations, 25-30% causes of infertility remain unknown. This is called “Unexplained Infertility”. The reason may be mere chance factors or there may be some causes which, still medical science has yet to discover. But this should be kept in mind while treating infertility. That means, even with correction of the possible factors (like improving sperm counts or thyroid problems etc) or with proper treatment (IUI, IVF or ICSI), unfortunately the treatment can fail and the exact reason, why the treatment failed, is sometimes difficult to find out.  



In general, what are the treatment options for infertility?

To start with, please remember there is no hard and fast rules for infertility treatment. Often medical science fails to understand why couples with very severe form of infertility conceive sooner than those who are having all tests normal. That means, whatever treatment is offered, it’s very important to continue regular sexual intercourse, as the chance of natural pregnancy is usually there in almost all couples. Your doctor will present the facts to you, without pressurizing you on a particular option. After coming to know all pros and cons of different treatment options, you can take decision. Do not hurry. It’s quite natural that you might be in stress.

In general, after the initial tests, a few periods of natural trying is allowed. After that, ovulation induction (giving medicines to release eggs from the ovaries) is offered, failing which IUI and finally IVF is offered. What will be the preferred treatment for you, will depend on your age, duration of marriage, male and female factors and of course, your age. For example, a woman with both tubes blocked or a male with very low sperm count, IVF would be the first line of treatment.


What is insemination?

Insemination literally means putting semen in a particular place. Various forms of insemination exist in fertility treatment. First one is “Intravaginal Insemination (IVI)”, where the raw semen, collected by the husband can be put inside the vagina, taking precautions (to prevent infection) by the husband himself or by the wife. Rarely, it needs medical assistance from a doctor. It’s usually advised to couples having sexual disorders where full penetrative intercourse is not possible (erectile dysfunction of the husband or very painful intercourse experienced by the wife) or where ejaculation cannot happen during intercourse (a very unusual problem). Thus, the success rate of IVI is no better than natural intercourse (success rate 15% per cycle), for those couples who can manage successful intercourse.

“Intrauterine Insemination (IUI)” is the treatment where “prepared” semen is put inside the cavity of the uterus, near the Fallopian tubes. Thus, IUI bypasses some hurdles that can cause problems during natural intercourse. The vagina, cervix and the whole length of the uterus are bypassed, putting the sperms near the eggs. Thus it increases the success rate compared to natural intercourse or IVI.

However, to achieve pregnancy after IUI, the female partner must have open tubes, adequate number of eggs produced by ovaries, eggs must be released by the ovaries and sperms must meet the eggs. And, thus nature plays important role, as in natural intercourse.

Please note, we used the word “prepared” semen. In natural intercourse, as mentioned earlier, the dead sperms and bacteria cannot enter the uterus, because cervix prevents their entry. If they are put artificially by IUI inside the uterus, severe reaction can happen. So, after collection, the husband’s semen is processed in the laboratory to remove all those impurities and to select only the best number of healthy and movable sperms and it definitely increases success rates of IUI

When IUI is generally advised?

As you can understand, to perform IUI, there must be minimum number of sperms in the semen, the tubes must be opened, the ovaries must be releasing eggs. If these are present, IUI is usually advised

  • Less than adequate number of sperm counts, morphology or motility
  • Couples who cannot perform full penetrative intercourse but refuse or unable to conceive by IVI
  • Unexplained infertility- although IVF is better than IUI, but considering the cost, many couples in our country opt for 2-3 cycles of IUI before IVF
  • PCOS and Mild Endometriosis- where natural intercourse or ovulation induction failed
  • Couples in whom only one partner is positive for HIV or Hepatitis B or C- where transmission from one partner to another by unprotected sexual intercourse is not preferable.

What are the tests done before IUI?

The basic infertility evaluation is done before IUI include husband’s semen analysis, assessment of ovarian function (blood tests, ultrasound) and uterus (ultrasound). In some cases, laparoscopy (putting camera to see inside the abdomen by operation) or hysteroscopy (putting camera through vagina inside the uterus, by operation) may be required. Now, if the tubes are blocked, IUI is of no use. So, testing the tubes is advisable before IUI. But some women, who are at low risk of tubal disease (no history of pelvic pain, infection or surgery), one or two cycles of IUI can be done, failing which tubes must be checked by tests like HSG or SSG or in some cases by laparoscopy.

What IUI actually involves?

In the cycle, in which IUI is planned, the woman is asked to take some medicines (or injections) in particular days of the periods as a part of “ovulation induction”. She is then advised to have ultrasound monitoring (TVS- transvaginal sonogram- where ultrasound probe is placed inside the vagina for better accuracy) to see if eggs are growing in response to the medicines or not. If eggs are growing, IUI is planned in a particular time when the egg(s) is more likely to rupture, so that the tie interval between sperm entry and egg release can be kept as minimum as possible.

Is ovulation Induction necessary for IUI?

Frankly speaking, IUI can be done without any medicines (as in case of natural intercourse or IVI), which is called “Natural Cycle IUI”, where only TVS monitoring is done to see how the eggs are growing. This may avoid some side effects of ovulation induction (see below) but is associated with low success rate than IUI done along with ovulation induction.

Is TVS necessary before IUI?

TVS is, undoubtedly, uncomfortable for the woman. But it gives better picture than ultrasound done conventionally. Now, the question is, whether ultrasound monitoring is at all needed or not. TVS directs the doctor how eggs are growing and at what number and size and when they are likely to rupture. Moreover, the rupture can also be confirmed by TVS. Again, the uncommon side effect of ovulation induction can be detected by TVS. That is called OHSS (“Ovarian Hyperstimulation Syndrome”) where excessive eggs can grow inside the ovaries and this can lead to collection of fluid inside abdomen and lungs and can turn very serious. Although very rare, it can be detected by TVS and early actions can be taken to prevent the progress of this condition.

In rare cases, where TVS cannot be done or patient declines, only option is to check urine by LH kit to predict the likely timing of ovulation and at that time IUI is planned. However, it is less accurate than TVS monitoring and is associated with less success.

What, if eggs are not growing in the ovaries?

In some women, particularly those who are overweight, aged or some cases of PCOS, eggs may not respond initially to one medicine. There are various forms of ovulation induction medicines (tablets, injection). If one is not working, your doctor can try increasing the dose of that medicine or add or replace it with other medicines. Please remember, it’s difficult to predict what medicine will be best suited for a particular patient. So, it’s basically a trial and error process.

What is done on the day of IUI?

As timing is important, the couples are requested to stick to the timing, advised by the doctor. The husband will be asked to collect the semen by masturbation, using clean technique (to avoid contamination by germs in the semen container). The semen is then prepared by the embryologist and will be checked to see the final number of sperms and their motility and morphology.

The wife is asked to lie down in the IUI table. After cleaning, a sterile speculum (instruments to separate walls of the vagina to see the cervix) is introduced inside the vagina and then 0.4-0.6 ml of the prepared semen is inserted inside the uterus with the help of a small catheter (fine tube). IUI done, under ultrasound guidance, gives better result than IUI done without it. The patient is asked to lie down few minutes after taking out the catheter and the speculum. The medicines are advised and then they can go home. 

Is IUI painful?

Most women feel little discomfort during IUI but it should not be painful. If there is technical difficulty while putting catheter inside the uterus, your doctor will discuss it with you and in the next cycle, will plan management to solve this issue.

What happens if husband cannot collect semen?

Collection of semen in unfamiliar environment is understandably a matter of discomfort and seems awkward. Proper counseling and maintenance of privacy can help. Stress-free approach is needed. If it fails, do not hesitate to inform your doctor. Some medicines can help. But in those, who are unable to masturbate, there are some instruments, like ejaculator, can help to solve this problem.


What happens if sperm count is low?

IUI can be successful if sperm count is minimum more than 5 million per ml and there is reasonably good morphology and motility. If not, IVF or ICSI would be the better option. But IUI can serve as trial also. That means before putting the semen, the prepared sperms can be examined and it can be predicted what is the success rate of IUI in this particular case and whether IVF or ICSI would be needed. In rare occasions, where sperm count is extremely low but the couple do not wish for IVF or ICSI, pooled semen IUI can help- where the semen is collected in number of occasions and is preserved and the final pool is used for insemination, to give a reasonable success rate.



When donor sperm is used and how?

If a man does not have any sperms or too few sperms to do IUI, IVF or ICSI is not affordable, donor IUI is an alternative. But it is not done without consent from both husband and wife. The donor is not known to the couple or the doctor and no identity of the donor is revealed. No relative or friend can serve as donor. Donor semen is frozen semen, collected 6 months ago and the donor is tested for diseases like STD, HIV, Hepatitis B or C. Usual attempt is taken to chose donor having blood group and skin colour similar to those of the husband. But remember, it’s only given after discussion and written consent by the couple.

Can a couple have intercourse in the cycle where IUI is advised?

Intercourse around IUI increases the number of sperms available at the time of ovulation.


When should one check for pregnancy?

Usually if period does not come within 18 days after IUI, pregnancy test is advised. It can be done at home. If negative, then the cause of not having periods is sorted out.

What is the chance of success after IUI?

In one cycle, chance of success is around 20-25%. Most of the couples conceive after 3rd or 4th cycle of IUI. The chance of pregnancy after 6th cycle is low, so, usually IUI beyond 6 cycles is not advised.

The factors where IUI gives better results include unexplained infertility, sexual dysfunction of any of the partner, PCOS and male subfertility (low sperm count or motility)


What happens if IUI fails?

As said earlier, you should think about further treatment, if 3rd or 4th cycle of IUI fails. There is no use of doing IUI beyond 6 cycles, unless natural intercourse is not possible and the age is favourable. IVF gives better result.

Is there any harmful effect of IUI?

Very few harmful effects have been noted, for examples, hazards of ovulation induction (OHSS< twin pregnancy), pain, infection and discomfort. As mentined, if raw semen is given, unusual allergic reaction can happen.



How IUI is being done in your particular centre by Dr Sujoy Dasgupta?

  • We believe in patient’s autonomy. So we want to give time on discussion and presentation of facts and figures to the couples. We encourage questions from the couples and take utmost care so that no question remains unanswered.
  • We do not take decisions and impose it on the couples. We advise the couples to take time before taking decision on a particular treatment. If the couple decides, we respect and support their decision.
  • We try to take nominal charges and help couples to collect medicines (particularly injections) at lower prices than MRPs.
  • After thorough evaluation of both the partners, we plan for ovulation induction drugs, with consent from them and advise them to come for TVS. After each day TVS, we explain the progress and probable timing of IUI.
  • On the day of IUI, after requesting the couple to maintain punctuality, we advise the husband to collect semen, in comfortable atmosphere, maintaining the privacy. If there is problem in semen collection, we provide support to him and address his issues in sensitive way.
  • Our expert trained embryologist then prepares the semen. We always encourage the couples to see the condition of raw and prepared semen under microscope to maintain the transparency. 
  • We advise the woman to fill up the bladder (to take water and not to urinate) to facilitate the passage of IUI catheter. Unlike other places, we perform IUI inside OT to prevent unwanted infection. 
  • Again we maintain our uniqueness in the sense that we perform it under ultrasound guidance. The ultrasound guidance has been scientifically proved to increase the success rate of IUI. Moreover, we show the woman in the ultrasound (real time) how the catheter has been put inside the uterus (to make sure that we are not doing IVI or have placed it in wrong position). This also helps to reduce patient’s anxiety and uncertainty. After that, our nurse takes care of the patient and observes her when she takes rest. 
  • Then we advise the post-IUI medicines and advise them what to expect and when they can go home. Again, this time we try to answer all questions the couples can ask.

Conclusion

Infertility is a peculiar thing. Very few men or women are absolutely infertile. That means they do not have ability to achieve pregnancy naturally. Majority of them are subfertile. That means most of them have lower than normal chance (compared to healthy couples) to achieve pregnancy in a normal menstrual cycle. Often we find that patients planning for treatment and in the mean time, they conceive naturally. That means even without treatment, there is some chance of pregnancy. Of course, it’s stressful situation for both the partners. Stress affects conjugal relationships and lead to many couples avoiding conjugal life. Indeed stress can affect the hormone levels in females and affects sexual performances in males. It’s easier for us to advise you to stay stress-free but is difficult to practice. Nevertheless, try relaxation as much as possible. Think that majority of the couples ultimately conceive by some form of treatment. Have faith in yourself and have faith in your doctor.

The simplistic picture describing IUI Process
The simplistic picture describing IUI Process



Endometriosis and Infertility


When couples start their family, they have many dreams. Subsequently many of them, if not all, plan to extend their family to give a sense of accomplishment. That is a journey from being couples to being parents. But unfortunately, in some couples the journey is not smooth and some of them have to struggle a lot for it. Yes, you are right. We are talking about difficulty to conceive, popularly known as “Infertility”.

To achieve successful pregnancy, there must be production of sperms, transport of them and proper deposition of them into the vagina by the male partner. In female partner, the deposited perms must travel through vagina and uterus to reach the Fallopian tubes (the tubes that are attached to the both sides of the uterus) where the sperms must meet the egg (ovum). The ovum is produced by the ovary and released into the abdomen at the time of ovulation (rupture of the surface of ovary to release the ovum). That ovum must be taken by the tube and thus inside the tube an embryo (earliest form of the baby) is formed, which then travels through the tube into the uterus and the uterus attaches the embryo firmly with it and thus the pregnancy starts. So, if there is defect in any one of them there will be difficulty in achieving pregnancy.



Perhaps you have heard that infertility may be due to problems in male (defect in production, transport or deposition of sperms) or female (defect in ovaries or ovulation, bock in the tubes and defects in the uterus). But sometimes there may be more than one problems in either of the couples or apparently no reason is found (everything is normal, so pregnancy depends on chance factor). To clarify the latter, in normal healthy couples with regular unprotected timely intercourse, the chance of pregnancy in one menstrual cycle is only 15%, so it may be matter of time for some couples to conceive. But another important reason for infertility in female is endometriosis.

What is endometriosis?

Endometrium is the inner lining of the uterus. It responds to hormones secreted by the ovaries during normal menstrual cycle. It tends to thicken from the time of ovulation (as described above) and if pregnancy occurs, it continues to grow and supports the embryo to help in continuing pregnancy. If pregnancy does not occur, it is shed off outside the body and is seen as “menstrual Bleeding” or “Period”. Unfortunately in some women, the endometrium may be present outside the normal position. That condition is called endometriosis. It is commonly present around the ovaries, tubes, surrounding the uterus (outside normal lining) but may be present anywhere in the body (even in lungs, urinary system and rectum). As this endometrium (outside the uterus lining) also responds to the hormones in the same way as normal endometrium (that lines the uterus), there will be bleeding around this abnormal endometrium at the time of menstruation. But this bleeding, unlike normal menstrual bleeding cannot come outside the body and so the blood accumulates and forms a chocolate coloured material (old blood is chocolate coloured) and leads to adhesion between organs. Adhesion is a condition where different organs of our body attaches abnormally with each other leading to various problems. Sometimes this chocolate coloured blood may be surrounded by a membrane formed by body tissue and is then called “Chocolate Cyst” that is found around the ovaries.

What is the reason for endometriosis?

Unfortunately, despite extensive research throughout the world, the reason for endometriosis is not known. It is said to be due to some genetic factors or some environmental factors. Sometimes, delaying pregnancy is stated as the reason. In some women, however, it is caused by backward flow of menstrual blood (that enters into the tubes during menstruation). Usually these women have abnormal development of uterus (problems in uterus since birth), so that all the menstrual blood cannot come outside the body)

What is the problem with endometriosis?

Endometriosis usually causes pain. The pain may be long standing and usually occurs at the time of periods (dysmenorrhoea) or sometimes even between periods. The nature and site of pain depends on where it is located. If it is located very deep inside abdomen, it can cause pain during sexual intercourse (dysparaeunia). In some cases there may be pai duing passing urine or stool or bleeding during urination or with stool.

In around 50% cases, it can cause infertility. The cause of infertility is not always properly understood. But it has been seen that endometriosis can cause adhesion and thus can makes it difficult for the Fallopian tubes to pick up the ovum from the ovaries. Apart from this pain during intercourse often makes the woman avoid intercourse. In addition it can interfere with ovulation, sperm transport, meeting between sperms and eggs and also the process of attachment of uterus with the embryo.

However, endometriosis does not always cause pain or infertility. In some women, there may be both pain and infertility, some women only one symptom and in some women no symptom is found but endometriosis is discovered accidentally during treatment for other purpose (like during laparoscopy for appendicitis or during Caesarean Section).

How endometriosis is diagnosed?

Endometriosis is suspected by history of pain or infertility and examination findings. Like some women may have pain during examination of abdomen or vagina by doctors, even sometimes vaginal ultrasound causes pain. In ultrasonography (or sometimes CT scan is done) there may be presence of cysts or adhesion can be detected. But the “Gold standard” of diagnosis is laparoscopy. It is an operation where (“Microsurgery”), making a small opening in the abdomen under anaesthesia, a telescope is introduced and the area is seen through camera in a television monitor. At that time the chocolate cysts, adhesions and condition of the organs can be seen and diagnosed and if there is any doubt, biopsy can be taken. But in all cases, laparoscopy is not needed and treatment is started after the doctors presume the diagnosis by history from the patients, examination and the ultrasonography reports.

Endometriosis is a peculiar condition in the sense that women with severe endometriosis may not have any symptoms, while women with very mild disease may have severe pain or infertility.

How endometriosis is treated, in general?

As mentioned earlier, endometriosis does not always cause symptoms and so, it does not always need treatment. The common reason for treatment is presence of pain and infertility. Endometriosis-related pain is usually treated by medicines or sometimes by surgery. Before surgery, usually medicines are given to reduce the size and to reduce the blood loss during surgery. All these medicines can cause hormonal imbalance and thus deprives the endometriosis tissues of hormonal stimulation and thus reduces pain. As a result, during the treatment, patients usually cannot conceive because of this intentional hormonal deprivation. Unfortunately after stoppage of medicines, often the symptoms of pain come back.

Surgery for endometriosis is usually done under laparoscopy but it needs properly trained and skilled surgeons to do these operations. Operations can range from “minor” (like separating the adhesions, draining the chocolate colored fluid) and “major” (like removing the cyst or removing major organs). The surgery has the advantage over medicines is that it confirms the diagnosis and removes the diseased tissues. But there are problems with risks related to anaesthesia and surgery. In particular, there is risk of injury to intestine and urinary tracts, even with the best hands, that may increase patient’s sufferings. Apart from this, even after surgery, the disease can come back again after few months or years.


What is the cure for endometriosis?

Only cure for endometriosis is total deprivation of hormones. That is possible if the woman attains menopause (permanent cessation of menses). This is possible by natural way (around 45-50 years of age when menses cease permanently) or by operations to remove the ovaries and uterus. Another simpler way is achieving pregnancy, as usually after pregnancy most endometriosis patients feel better in relation to pain.

What happens if it is not treated?

Endometriosis is not like cancer. It is not life threatening usually. That means it will make you suffer in the worst way by causing severe pain and infertility but cannot endanger your life. So, you can have the options of not treating it, even if you have the symptoms. And of course, if you do not have symptoms, endometriosis may not require any treatment.

What is the treatment for endometriosis with infertility?

First of all, you have to make sure that you have difficulty in conception (that means you have given sufficient time to attempt but failed). Then we have to see whether there is any pain or other problems and what the condition of the disease by examination or ultrasonography is. We also have to look for any additional problems like problems in male partner, problems in uterus or ovaries or the hormones (like FSH, LH, prolactin, thyroid etc).

Then we have to plan the treatment. As there is no hard and fast rule, your doctor will explain you the options for you and you can decide what suits you the most, after judging merits and demerits of every option.

You may choose directly for surgery. In that case, you may be offered medicines for 2-3 months before surgery to make surgery safer for you and easier for the surgeon. The extent of surgery varies, depending on the disease status and your opinion. Remember, your opinion is important. You can choose for extensive operation (that may mean removal of both the tubes, that may be needed in advanced disease, leaving only option for IVF for pregnancy in future) or only diagnosis (just introducing the telescope and see) or minor operations (like separation of adhesions or removal of the cysts), after judging the merits and demerits of each options. But remember, you should not have any medicines for endometriosis after operation as most of the medicines (with some exceptions) interfere with pregnancy. This is, because, after operation is the best time to conceive and that time gives you the highest chance for pregnancy. If natural conception (or 1. ovulation induction- giving medicines to stimulate growth of your eggs, or 2. IUI- inserting your husband’s sperms by special process inside your uterus) does not occur within 12 months after operation, that’s probably the best time to consider IVF (“Test tube baby”). Of course, if you had extensive surgery or have advanced age (more than 35 usually), your doctor may advise you to go for IVF directly after operation without wasting the time.

You can opt for trial of treatment by medicines. You must know why I have used the word “Trial”. This is because, during medicine treatment, you cannot conceive. But you will be seen after 2-3 months to see if the disease has disappeared or decreased in size significantly. If this is the case, you can start infertility treatment (Ovulation Induction or IUI or IVF in some cases) directly. But if the disease did not respond to medicines by this time, you may need surgery, the extent of which has been described above.

You also have the options of not treating endometriosis at all. In that case, you can request your doctor to start infertility treatment directly. But remember, endometriosis (even treated endometriosis- after medicines or surgery) can interfere with any form of infertility treatment. It can lead to decreased response to medicines used for ovulation induction, thus reducing success rate(normal success rate is 20-25% in a menstrual cycle- that is without endometriosis). It can lead to low success rate after IUI (normal success rate is 15-20% in a menstrual cycle). Even with IVF (where normal success rate is 40-50% per cycle of IVF), the effectiveness of IVF may be reduced in presence of endometriosis.


What if I do not go for any treatment at all?

Infertility is a peculiar thing. Very few men or women are absolutely infertile. That means they do not have ability to achieve pregnancy naturally. Majority of them are subfertile. That means most of them have lower than normal chance (compared to healthy couples) to achieve pregnancy in a normal menstrual cycle. Often we find that patients planning for treatment and in the mean time, they conceive naturally. That means even without treatment, there is some chance of pregnancy. But that chance decreases in presence of any disease (like endometriosis) or increased age. And of course, nobody usually relies on chance. But the important message is that do not forget to have regular sexual intercourse eve if you are awaiting any test or endometriosis treatment. Of course, it’s stressful situation for both the partners. Stress affects conjugal relationships and lead to many couples avoiding conjugal life. Indeed stress can affect the hormone levels in females and affects sexual performances in males. It’s easier for us to advise you to stay stress-free but is difficult to practice. Nevertheless, try relaxation as much as possible. Think that majority of the couples ultimately conceive by some form of treatment. Have faith in yourself and have faith in your doctor.





The Relation Between Thyroid and Reproduction (Fertility, Pregnancy)


25th May is the World Thyroid Day. Thyroid disorders are one of the most common disorders of hormones in our body. Thyroid is a small gland situated in front of the neck and secretes hormones like thyroxine (T4) and tri-iodo-thyronine (T3). These hormones control various functions of our body like heart, blood pressure, digestion, metabolism, growth, blood formation, brain function etc. But one of the most important function is its association with reproduction.




In both sexes, T3 and T4 are needed for sexual development during puberty so that full maturation from a child to adult occurs. That means development of hair (pubic and axillary hair), beard and moustache in boys, breast in girls, genital organ development in both sexes and menstrual function are dependent on thyroid gland. Finally production of eggs (rather maturation and release) and sperms are also related to it. In adults, thyroid function is needed to maintain the functions of sex glands particularly ovaries and testes. Desire for sex (libido) and performance of sex are also related to thyroid function. 




The thyroid glands in turn is regulated by a hormone secreted from pituitary gland, located inside the brain. That hormone- TSH (thyroid stimulating hormone) controls secretion of T3 and T4., Thyroid gland may be affected by various diseases like autoimmune diseases (body itself destroys its organs), deficiency of iodine, radiation, tumour, congenital causes (cause present from birth) and certain drugs. The result is that thyroid hormone secretion may be reduced (hypothyroidism) or increased (hyperthyroidism). As a result, blood tests for TSH, T3 and T4 are commonly done to detect abnormalities of thyroid gland. If abnormalities are detected, further tests may be advised, e.g., ultrasound and scanning of thyroid gland. 






So what can happen to reproduction if thyroid function is affected? 

Thyroid disorders are particularly common in females. Menstrual cycle may be irregular (coming every 2 or 3 months) or may be scanty in amount or more commonly very excessive flow. These respond well to correction of thyroid hormone levels by drugs. 

Thyroid disorder is a common cause of anovlation- That is women cannot release eggs in each month. The result is irregular menstruation and infertility- the inability to conceive a child. Often correction of thyroid hormone levels result in pregnancy. 

Please remember if you are trying for pregnancy, then your TSH value should not be the same like other people. We usually treat such women, if TSH is more than 2.5 (this may be normal for labaoratory standards for other people but not for those who plan for preganancy and who are pregnant). 

It can cause low libido, vaginal dryness, reduced orgasm and painful intercourse.

In case of male, the thyroid disease is not very common but is not rare. It can affect sperm production leading to infertility. Apart from that it can affect sexual performance leading to low libido, easy fatigue and erectile dysfunction (ED). All these resolve after proper treatment.


Never ignore checking thyroid status for adolescent boys and girls. It may be responsible for delayed puberty (delay in appearance of male like features in boys and female like features in girls) or precocious puberty (early onset of menstruation or breast development in girls; or early development of beard and moustache in boys). These may be associated with serious disorders and need proper attention.\


Pregnancy is a condition where there is tremendous pressure on thyroid gland and it is needed to help in proper development of baby inside uterus. Women with thyroid disorders can have miscarriage, premature delivery, death of baby inside uterus or poor growth of the baby. She can experience bleeding in pregnancy, high blood pressure (preeclampsia) and even heart failure. In initial periods babies depend on mother's thyroid gland for its development. If baby does not get proper amount of thyroid hormones, its brain and body development can be hampered. The brain development can be affected leading to birth of a disabled baby, as it may not be corrected even after treatment. So proper diagnosis and treatment of thyroid diseases in pregnancy are essential. After birth, baby should be tested for thyroid disease and appropriate treatment should be started without any delay.




So, if you feel any of the above problems, please do not hesitate to consult your doctor and request testing of thyroid functions. If drug treatment is started, do not stop the drug without consulting doctor. Uncontrolled thyroid disease can lead to heart attack, stroke and emergency situations like thyrotoxicosis or myxoedema- which can be potentially life threatening if not treated in time.





Pregnancy gives a woman completeness by turning her into mother from a simple woman. It is the thing which makes the couple parents, the dream which they nurture right time from their marriage. Of course there are many couples who are not fortunate enough to achieve pregnancy and they are usually termed infertile and we have discussed it in separate post. 

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But there are other couples who may or may not (as this is the usual case) find difficult to conceive but the pregnancy does not continue to the age of viability. Age of viability means the age, when a baby born can survive. Thanks to the improvement in neonatal care by leaps and bounds and availability of NICU which made it possible to survive even a baby born at 22 weeks. For example last month we delivered a baby at 28 weeks of pregnancy, who is fine now. But if the baby is 'born' before 20 weeks, it is called MISCARRIAGE

This is because these babies who weigh less than 500 gram cannot survive outside the uterus. It is seen that 10-15% couples who conceive successfully may not be able to carry pregnancy beyond 20 weeks. Thus the miscarriage rate for a single pregnancy is 10-15%. 

But in most of the time this mishap does not recur in future. We call it 'sporadic miscarriage' and often the cause is not known. But almost 1% of the couples who want to get pregnant may suffer from repeated miscarriage. That means the unfortunate events can repeat. 

These are called 'RECURRENT MISCARRIAGE' or 'REPEATED PREGNANCY LOSS *RPL).

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Causes of Recurrent Miscarriages

So, what's the reason for RPL which is equally frustrating for the patients as well as the doctors? 

First of all let me honestly confess that in most of the cases the cause is not known (50-60%) and this is called 'UNEXPLAINED RPL'. Again we have to admit that despite tremendous advancement in science, the knowledge behind RPL is limited. Many theories and causes have ben proposed but most of them could not withstand the taste of time. That means if a problem is found in husband or wife, we are not certain whether the treatment of that problem will prevent future miscarriage. 

This should be explained properly to the couples to have realistic expectations and avoid unnecessary frustration s in future. Only factors which are definitely associated with RPL are only two- anti-phospholipid antibody syndrome (APS) and chromosomal problem of either of the couples. Detection and treatment of these problems are often rewarding as after treatment pregnancy continuation rate us very high. 

The other causes have been proposed but as mentioned above the link between RPL and these causes are not yet very clear and need further scientific research. Please remember according to the timing, RPL may be divided into two categories- the 1st trimester RPL (occurring before 12 weeks in each pregnancy) or second trimester RPL (12-20 weeks in each pregnancy).

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4-5% cases may be due to genetic or chromosomal problem of the couples. These problems can affect the egg (ovum) and/or the sperms. Even if the couples are normal, the baby may have abnormal chromosome.

It is blessing that a genetically abnormal baby is miscarried by the nature, otherwise if it survives there is high chance that it may be mentally or physically handicapped. The reason may be increased age of the mother (above 35 years especially), exposure of mother to some environmental pollutants or sometimes increased age of the father (the latter is controversial).

 The diagnosis is done by chromosomal analysis of the couple by Karyotyping or FISH from blood samples. If the baby has been miscarried, it may be rational to send the tissue of the baby for chromosomal analysis to find out the cause. The treatment option in next pregnancy in such cases is genetic counseling by an expert and in most cases unfortunately only one option remains- that us IVF and PGD (pre implantation genetic diagnosis) where only genetically tested normal embryos are transferred by IVF ('test tube baby').

Anatomical factors are responsible for 12-15% if RPL, in most cases the second trimester RPL. The most common cause is 'CERVICAL INCOMPETENCE'. The cervix is the mouth of the uterus which should remain closed in pregnancy to support pregnancy and should only open during delivery. But in some cases it can open prematurely leading to miscarriage. Usually this causes apparently painless miscarriage. 

In many women fibroid is found as a tumour of uterus. Whether fibroids cause RPL is again very controversial among the scientists and doctors. In some women who had repeated abortion or surgery to uterus and even tuberculosis (TB) there may be adhesion (binding together) between the walks of uterus. This is called Asherman Syndrome which causes scanty or absent periods and RPL. 

In few women there may be Congenital Anomaly of the uterus- that is where is some abnormalities inside uterus from birth. Thesr xan sometimes cause RPL, although controversial. These anatomical problems are diagnosed by proper examination, some tests like HSG (hystero salpingogram), SSG (sono salpingogram), 3D ultrasonography (USG), MRI, hysteroscopy and/or laparoscopy, depending on the women and test results. The treatment should be done cautiously as treatment may not always prevent RPL. For cervical incompetence usually we put stitch in the cervix in pregnancy or sometimes before pregnancy. 

Operation can be done, before pregnancy for fibroids, Asherman and congenital anomalies.

In many cases (more than 70%) cases hormonal problems may be there and these may cause both 1st and 2nd trimester RPL. However whether treatment us beneficial or not, is again controversial. The commonest pattern is Luteal Phase Deficiency (LPD) due to deficiency of hormone progesterone. PCOS (Polycystic Ovaries) is also asdociated with RPL. The other causes are uncontrolled diabetes, thyroid problems, high prolactin and high testosterone, high insulin and low ovarian reserve. 

As mentioned earlier, it is not clear whether they all need testing and treatment but usually tests advised for these are blood for progesterone, TSH, Prolactin, FSH, LH, AMH, Insulin, Testosterone, sugar, HbA1C etc. Treatment is usually progesterone supplement along with correction of hormonal imbalance. It is to be mentioned that these patients need high dose of thyroid drugs (TSH normal for other people may be considered abnormal for RPL) and more tight control of blood sugar in diabetes.

In 60-70% cases the cause is Thrombolphilia, that is tendency to thrombosis or blood clotting. The most common is anti phospholipid antibofy syndrome (APS) which nay or may not be associated with thrombosis in other sites but can cause thrombosis if blood supply to the baby and thus causes stopage of its heart and miscarriage. 

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Although more common in the Western World, some Hereditary Thrombolphilia may be found in other family members and commonly cause miscarriage and thrombosis. Deficiency of folic acid and vitamin B12 rarely xan cause thrombosis and RPL. The APS testing is often successful, so as the treatment with aspirin and heparin injection throughout pregnancy. With this 80% women can expect full term pregnancy. Folic acid and B12 vitamin supplement is commonly given to RPL patients. Whether testing for hereditary thrombophilia is needed in our country or not is controversial. But treatment is like APS- that is aspirin and heparin injection.

Diseases of mother like diabetes, epilepsy, liver or kidney diseases, SLE etc can cause miscarriage. Exposure of mother to harmful substances like environmental pollution, radiation, chemotherapy and some toxic drugs, smoking, alcohol, cocaine, cannabis etc are also responsible but the latter usually cause sporadic miscarriage rather than RPL. So these drugs should be stopped and replaced by safer drugs and the diseases must be treated properly. Even exposure of father to some drugs can cause RPL. Again some abnormalities of sperms may cause RPL. So, semen analysis of the husband is usually done as a test for RPL.

The most controversial topic for RPL is the infections. But itbis the fact proved by scientific studies that only infection in current pregnancy causes miscarriage. So infection is a cause of sporadic miscarriage, not RPL. In the past TORCH testing was very much popular but nowadays it is obsolete test and there is no scientific ground for tests or treatment of TORCH. 

Only test we recommend is rubella testing. If rubella IgG is negative that means you may get infection in pregnancy so we advice to take rubella vaccine and avoid pregnancy for one month. On the other hand, rubella IgG positive means you are already immune and thus you can never get rubella. So vaccine is not useful in those cases. If any genital infection is found in husband or wife, both if them should be tested and treated aggressively.

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TESTS REQUIRED

First of all we need to know when we should advise tests. Assuming that most cases of miscarriages are SPORADIC, we usually do not advise investigation after single miscarriage unless the couple insists or there is some reason by the doctor to suspect some abnormalities that might cause future miscarriage. In the past testing was started after 3 miscarriages. But nowadays we do not want to give the couple, especially the woman a third trauma. So we usually advise tests after 2nd miscarriage. The tests usually start with checking for chromosome of the baby. It is followed by chromosome analysis of both the partners along with proper history taking and physical examination. Semen analysis is done for the husband. The wife is advised ultrasonography, routine blood, thyroid testing, testing for APS and blood group. These are tests usually dine everywhere. Further tests are done depending on the results if initial tests and especially if no cause is found after initial tests. It should be mentioned to the couples that the 2nd group if tests often do not have scientific grounds and are done only on benefit of doubt. They may not change the management plan. TORCH test is not done in modern era.

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TREATMENT

The basic treatment is support if the couples, reducing stress as stress can be responsible for RPL. When a cause is found this should be treated. While an optimistic approach should be taken with expectations for normal pregnancy in future but this should be based on scientific and realistic approach to avoid future frustration. The treatment may not be 100% effective and most treatment may not have scientific base but are usually not harmful. Treatment may not guarantee a successful future pregnancy but a positive attitude is necessary. This is called TENDER LOVING CARE (TLC) where proper support and discussion can help more than explanation if mere statistics. Treatment should be continued both before and after pregnancy confirmation, as mentioned above. This is to be mentioned that even after 6th miscarriage, the chance that future pregnancy will be normal is more than 50%. So, the message should be not to give up hope.









Defect of Low Sperm Count: The Way Forward

Introduction

When couples get married, they often view parenthood as the next stage in their family life. They want to have a child, they want to be “mom” and “dad”, they cannot imagine that this may be hard to achieve or may not be a natural process. When several trials to conceive fail, they are shocked. Their basic expectation about family life gets shattered. Most of the couples are desperately looking for medical therapy that will end into a misery. Clearly this is not a struggle to survive; it is a struggle to fulfill a dream, to achieve what they view as a “full life”.


What is needed for pregnancy?

In the male partner, sperms are normally produced in the testes after puberty (after attainment of characters like growth of beard, moustache etc). From the testes, they are carried through the sperm conducting ducts (epididymis, vas, seminal vesicle and prostate gland). Then during sexual stimulation, after proper erection and ejaculation, they come out through penis. During sexual intercourse, these sperms, present in semen, are deposited inside the vagina.


In female partner, the deposited sperms must travel from vagina through the cervix (the mouth of the uterus). The cervix acts as gate-keeper, a it prevents entry of dead and abnormal sperms as well as bacteria present in semen, in the uterus. From uterus, sperms reach the Fallopian tubes (the tubes that are attached to the both sides of the uterus) where the sperms must meet the egg (ovum). The eggs are produced only before birth and so, there are fixed number of eggs inside the ovary. The ovum released from the ovary, into the abdomen at the time of ovulation (rupture of the surface of ovary to release the ovum). That ovum must be taken by the tube and thus inside the tube an embryo (earliest form of the baby) is formed, by meeting of the egg and the sperm.


It should be mentioned that out of nearly 200-300 million sperms, in average, deposited in vagina, hardly 500- 800 sperms can reach near the eggs and only one will succeed to form the embryo. The embryo then travels through the tube into the uterus and the uterus attaches the embryo firmly with it and thus the pregnancy starts. So, if there is defect in any one of them there will be difficulty in achieving pregnancy.


Thus, to summarise, pregnancy requires

1.Production of healthy (“Normal Morphology”) and movable (“Normal Motility”) sperms in adequate number (“Normal Count”) in the testes

2.Transport of these sperms through the sperm conducting ducts from testes to penis

3.Successful Erection and Ejaculation during Intercourse to deposit adequate number of these sperms in the vagina

4.Transport of these sperms from vagina through cervix to the uterus and the tubes

5.Presence of sufficient number of eggs inside the ovary and ability to release the eggs from the ovaries

6.Pick up of the eggs by the tubes

7.Approximation of eggs and the sperms to form the embryo

8.Transport of embryo from the tubes into the uterus

9.Acceptance of the embryo by the uterus and its growth


What is Infertility?

Literally, the word “Infertility” means inability to conceive. But in reality, there are very few couples, who have no chance of natural conception and are called “Absolutely Infertile”. In fact, in many couples who present to infertility clinics, pregnancy may be the matter of time, thus the chance factor.

It should be kept in mind that, if there is factors to question fertility of either male or female or the female is of age less than 35 years; after one cycle (one month) of regular frequent intercourse, the chance of conception in human being is only 15%. That means, out of 100 couples trying for conception, only 15 will be able to succeed after one month of trying. The word “Regular” and “Frequent” are important; because to achieve pregnancy, couples are advised to keep intimate relationships for at least 2-3 times a week and this should be increased particularly around the time of ovulation (Middle of the menstrual cycle). Thus chance of pregnancy after 6 months, 12 months and 24 months of regular trying are respectively 60%, 80% and 100%.

The word, “Subfertility” seems better and more scientific than “Infertility”, to describe the couples who have reduced chance of conception, due to any cause. However, the word “Infertility”, seems more popular, although it puts pressure on the couples. In most cases, usually we advise to investigate after one year of regular and frequent intercourse, when the couples fail to conceive. However, if there are factors to question fertility; for example female with age more than 35 years, or with previous surgery in tubes/ ovaries/ uterus or known diseases like PCOS or endometriosis; or male partner having surgery in scrotum or groin or any hormonal problems or sexual dysfunctions- the wait period is usually reduced and couples can be investigated, even soon after marriage.

What causes Infertility?

Please look at the point “Thus, to summarise, pregnancy requires” where 9 points have been mentioned.Thus the common causes may be

1.Problems in male- total absence of production of sperms, less than adequate number of sperms, problems in morphology and motility of sperms (most sperms not healthy or movable), blockage in transport of sperms and inability to deposit sperms in the vagina (sexual dysfunction- Erectile Dysfunction or less commonly, Ejaculatory Dysfunction). Examples include hormonal problems (Testosterone, thyroid, prolactin), diabetes, liver problems, causes present since birth, chromosomal abnormalities, surgery, infection, sexually transmitted diseases, smoking, exposure of scrotum to high temperature, some medicines or psychological causes.


2.Problems in female- total absence of less than adequate number of eggs in the ovaries, problems in ovulation, problems in picking of eggs by the tubes, blockage of tubes, problems in conduction of sperms or embryo by the uterus, problems in accepting the embryos by the uterus. Examles include causes present since birth, chromosomal abnormalities, polycystic ovarian syndrome (PCOS), old age, increased weight, fibroid, endometriosis, pelvic inflammatory diseases (PID), tuberculosis (TB), infections, smoking, surgery, some medicines, hormonal problems (thyroid, prolactin) or excessive stress.

3.Unknown causes- Despite thorough investigations, 25-30% causes of infertility remain unknown. This is called “Unexplained Infertility”. The reason may be mere chance factors or there may be some causes which, still medical science has yet to discover. But this should be kept in mind while treating infertility. That means, even with correction of the possible factors (like improving sperm counts or thyroid problems etc) or with proper treatment (IUI, IVF or ICSI), unfortunately the treatment can fail and the exact reason, why the treatment failed, is sometimes difficult to find out.


Treatment of Infertility

To start with, please remember there is no hard and fast rules for infertility treatment. Often medical science fails to understand why couples with very severe form of infertility conceive sooner than those who are having all tests normal. That means, whatever treatment is offered, it’s very important to continue regular sexual intercourse, as the chance of natural pregnancy is usually there in almost all couples. Your doctor will present the facts to you, without pressurizing you on a particular option. After coming to know all pros and cons of different treatment options, you can take decision. Do not hurry. It’s quite natural that you might be in stress.In general, after the initial tests, a few periods of natural trying is allowed. After that, ovulation induction (giving medicines to release eggs from the ovaries) is offered, failing which IUI and finally IVF is offered. 

What will be the preferred treatment for you, will depend on your age, duration of marriage, male and female factors and of course, your age. For example, a woman with both tubes blocked or a male with very low sperm count, IVF would be the first line of treatment.


Semen Analysis

Semen analysis is an indispensable part of evaluation of an infertile couple. It is accepted that if semen analysis report is normal, male factor is usually said to be normal. However, a single abnormal semen analysis does not always mean that there is any abnormality in the man. This is, because, semen consists of 2 parts- the sperms and the fluid ("seminal plasma"). In a man, sperm production requires 3 months and it needs cool temperature than rest of the body. This is why, men have their testes hanging outside the body in the scrotum.Thus, today's semen analysis reflects a man's health 3 months before. If, for any reason (for example, high fever, tight underwear, hot tub bath etc), man's health was abnormal 3 months ago, the semen analysis may become abnormal. Again, the results can vary from one laboratory to another.


How semen collection and analysis is done?

The easiest and the most commonly used method is masturbation. But remember, you have to do it in awkward environment, where privacy will be maintained, but the mental pressure, that you have to give semen, may be harmful. So, stay relaxed. It's preferable to collect semen in the laboratory. But if its not possible, you can collect it at home, carry it in the pocket of your trousers and must reach the laboratory within 30 minutes of collection. Please inform the laboratory about the timing of collection.

Please maintain abstinence for 3 to 5 days (not more than 5, not less than 5). That means you should avoid intercourse and masturbation for 3-5 days prior to the test. It's important to collect all the semen in the collection pot and not to spill a portion outside.Then it's tested in the laboratory for certain parameters like- volume (amount of semen), liquefaction (time needed for semen to become liquid), total sperm count, motility (ability of the sperms to move), morphology (the appearance of the sperms), vitality (whether sperms are living or not) etc. Please make sure that your laboratory is following WHO 2010 criteria for semen analysis (not the older criteria like 1992). Sometimes, some special tests may be done on the semen depending on your scenario.


What happens if a man cannot collect semen?

Collection of semen in unfamiliar environment is understandably a matter of discomfort and seems awkward. Proper counseling and maintenance of privacy can help. Stress-free approach is needed. If it fails, do not hesitate to inform your doctor, especially if you are not accustomed to masturbation or had difficulty earlier.. Some medicines can help. But in those, who are unable to masturbate, there are some instruments, like vibro-ejaculator, can help to solve this problem. This is a small device applied on the front part of the penis ("Glans Penis") to stimulate the organ to discharge the semen. The other options include rubbing the penis against a special Non-Toxic Condom (Not ordinary condom) or intercourse with that condom. Some men feel comfortable to practise coitus interruptus.In few men, when no semen comes out, the problem may be retrograde ejaculation (Semen going into bladder instead of moving forward). In that case, sperms can be collected from the urine immediately after masturbation. If it fails, options include some medicines, electroejaculation (Putting current in prostate gland by a small probe inserted through the anus under general anaesthesia), prostatic message and sometimes collecting sperms from testes with a small fine needle.


What happens if the report is abnormal?

If a single report is abnormal, as mentioned above, it may not be conclusive. So, we usually advise repeating the test after few days, preferably from a second laboratory. At the same time, its important to diagnose the cause of this abnormality. To find out the cause, you may need physical examination of your genital organs. Your doctor may ask you some questions and with your permission, may check your body areas (hair growth, breast development), penis, scrotum, testicular size etc. Doctor can advise you some tests like ultrasound of your testes, or sometimes of your prostate gland. In severe cases, doctor can advise you some hormonal tests (blood tests- LH, FSH, Testosterone etc) and in some occasions, karyotyping (chromosomal analysis)So, whenever we find abnormality, we have to detect the cause. Treatment without detecting thee cause is more likely to fail. So, first thing is- whether sperms are produced or not.

One important thing is to remember, sperm production has nothing to do with manliness. You may feel absolutely normal with normal sex life but sperm production may be defective. So, first thing is not to feel depressed when the report comes abnormal.


What treatment can be done?

Every attempt is made to find out the cause and treat the cause so that you can father your baby using your own sperm by natural means. Treatment includes some life-style advice, some medicines (antioxidants etc). But if the problem is severe, medicines may not act. The only conditions, where medicines act very well, is when the sperms are not produced because of hormonal problems in the pituitary gland.What lifestyle changes are advised?Remember, life style changes can improve your sperm count to some extent. You should avoid smoking, alcohol, taking drugs like anabolic steroids etc. You should try avoiding heat exposure to your scrotum. This can be done by avoiding tight underwear, avoiding prolonged sitting, avoiding prolonged driving, avoiding hot bath tub etc. Try keeping laptop and mobile phone away from your lap or thighs.


What is the next action?

If the sperm count improves, then natural conception is possible. In other cases, we may not be able to improve the sperm count, but pregnancy is possible. If the problem is mild, intrauterine insemination (IUI) can be done, with the success rate 20-25% per cycle. This means, every 100 women undergoing IUI, 25 can conceive in the 1st cycle. In other cases, up to 3-4 cycles of IUI can be done. If IUI fails, then the option remains IVF with success rate 40%. Remember, in all these cases, your sperms will be used.IUI can be successful if sperm count is minimum more than 5 million per ml and there is reasonably good morphology and motility. If not, IVF or ICSI would be the better option. But IUI can serve as trial also. That means before putting the semen, the prepared sperms can be examined and it can be predicted what is the success rate of IUI in this particular case and whether IVF or ICSI would be needed. 

In rare occasions, where sperm count is extremely low but the couple do not wish for IVF or ICSI, pooled semen IUI can help- where the semen is collected in number of occasions and is preserved and the final pool is used for insemination, to give a reasonable success rate.


What is insemination?

Insemination literally means putting semen in a particular place. Various forms of insemination exist in fertility treatment. First one is “Intravaginal Insemination (IVI)”, where the raw semen, collected by the husband can be put inside the vagina, taking precautions (to prevent infection) by the husband himself or by the wife. Rarely, it needs medical assistance from a doctor. It’s usually advised to couples having sexual disorders where full penetrative intercourse is not possible (erectile dysfunction of the husband or very painful intercourse experienced by the wife) or where ejaculation cannot happen during intercourse (a very unusual problem). Thus, the success rate of IVI is no better than natural intercourse (success rate 15% per cycle), for those couples who can manage successful intercourse.

“Intrauterine Insemination (IUI)” is the treatment where “prepared” semen is put inside the cavity of the uterus, near the Fallopian tubes. Thus, IUI bypasses some hurdles that can cause problems during natural intercourse. The vagina, cervix and the whole length of the uterus are bypassed, putting the sperms near the eggs. Thus it increases the success rate compared to natural intercourse or IVI.

However, to achieve pregnancy after IUI, the female partner must have open tubes, adequate number of eggs produced by ovaries, eggs must be released by the ovaries and sperms must meet the eggs. And, thus nature plays important role, as in natural intercourse.Please note, we used the word “prepared” semen. In natural intercourse, as mentioned earlier, the dead sperms and bacteria cannot enter the uterus, because cervix prevents their entry. If they are put artificially by IUI inside the uterus, severe reaction can happen. So, after collection, the husband’s semen is processed in the laboratory to remove all those impurities and to select only the best number of healthy and movable sperms and it definitely increases success rates of IUI


What can be done if there is no or very few sperms?

In such cases, we have to find out the exact problem. If the problem is due to adequate sperm production but blockage in the sperm conducting duct, some surgery can be done. However, such surgery is not widely available and may fail. So, most of the men usually opt for special type of IVF (In Vitro Fertilization) using the technique called ICSI (Intracytoplasmic sperm injection). Here sperms are collected from semen (is some sperms are there), or urine (in retrograde ejaculation) or by putting needle inside your scrotum (usually under anaesthesia). In case of block, the cahn=ance that we can collect your sperm from your body is 80-100%. That means, out of 100 such men, in more than 80 cases, sperms can be obtained from his testes. The procedures include TESA (Testicular Sperm Aspiration), TESE (Testicular Sperm Extraction), MESE (Microsyurgical Epididymal Sperm Extraction) and PESA (Percutaneous Epididymal Sperm Aspiration).If it appears that the sperms are not produced well, still sometimes some sperms can be seen inside the testis. However, the chance of getting your sperms is 50%. So, if you agree, we can try collecting the sperms from your testes using TESA or TESE. Before that, we need to be sure that there is adequate chance of getting sperms from your body and so, you may need further investigations.

What is ICSI?

ICSI is a type of IVF. In standard IVF, your wife will be given some injections to mature her eggs, which will be collected under anaesthesia through the vagina using ultrasound. These eggs are then mixed with the sperms in the laboratory and the embryos, thus produced, are either directly put inside your wife's uterus or some may be frozen and kept for future use, if the 1st cycle fails.In ICSI, the best single sperm is chosen and is inserted directly inside the egg to produce the embryo.

When donor sperm is used and how?

If a man does not have any sperms or too few sperms to do IUI, IVF or ICSI is not affordable, donor IUI is an alternative. But it is not done without consent from both husband and wife. The donor is not known to the couple or the doctor and no identity of the donor is revealed. No relative or friend can serve as donor. Donor semen is frozen semen, collected 6 months ago and the donor is tested for diseases like STD, HIV, Hepatitis B or C. Usual attempt is taken to chose donor having blood group and skin colour similar to those of the husband. But remember, it’s only given after discussion and written consent by the couple.

How Abnormal Sperm Count is Treated at clinics of Dr Sujoy Dasgupta?

We believe in patient’s autonomy. So we want to give time on discussion and presentation of facts and figures to the couples. We encourage questions from the couples and take utmost care so that no question remains unanswered.We do not take decisions and impose it on the couples. We advise the couples to take time before taking decision on a particular treatment. If the couple decides, we respect and support their decision.We try to take nominal charges and help couples to collect medicines (particularly injections) at lower prices than MRPs.We advise only those investigations that are needed and then find out the cause, if possible. We give the ouples all the options like medicines, IUI, ICSI, surgery, donor sperms etc and given them adequate time to consider their decision, Once, they decide, we respect their decision and proceed according to their wishes. The privacy and confidentiality are maintained strictly throughout

Conclusion

Infertility is a peculiar thing. Very few men or women are absolutely infertile. That means they do not have ability to achieve pregnancy naturally. Majority of them are subfertile. That means most of them have lower than normal chance (compared to healthy couples) to achieve pregnancy in a normal menstrual cycle. Often we find that patients planning for treatment and in the mean time, they conceive naturally. That means even without treatment, there is some chance of pregnancy. Of course, it’s stressful situation for both the partners. Stress affects conjugal relationships and lead to many couples avoiding conjugal life. Indeed stress can affect the hormone levels in females and affects sexual performances in males. It’s easier for us to advise you to stay stress-free but is difficult to practice. Nevertheless, try relaxation as much as possible. Think that majority of the couples ultimately conceive by some form of treatment. Have faith in yourself and have faith in your doctor.







8 Ways to Avoid Irregular Periods

How to make your menstrual cycles regular?

In our clinics everyday some patients at different ages will come with complaint of irregular menstrual cycles. But there are other patients who feel embarrassed to seek doctor's help for this problem. While it seems to be a simple problem related to reproduction only, often it is associated with diseases that are matter s of concern.First, you should know what is meant by the word "irregular"? In most women period occurs at interval of 28 to 30 days. But it is said to be normal if it happens every 21-35 days. That means you should have periods not more frequently than every 3 weeks or not less frequently than every 5 weeks. But if you had previous cycles at interval of every 4 weeks but now you are having periods every 5 weeks, that is ABNORMAL, although it is occurring every 35 days. In other words change in interval up to 7 days is normal, not beyond that. For example, if you had periods every 30 days previously and for last 2 months it is happening every 33 days or every 25 days, then it's normal. But if it happens at interval of more than 37 days (30 + 7) or less than 23 days (30- 7) then it's of course abnormal.So what are the things you can do for regular periods?

1. Normal weight

Ideal weight varies according to the height. We express it in terms of BMI (Body Mass Index) that is the weight in Kg divided by square of the height in centimeters. Ideal BMI should be between 19 to 25. If it's more than 25, reduce weight by diet and exercise. IT can resume normal menstruation without any drugs. IF despite your sincere efforts, you are unable to lose weight or even after normalization of weight menstruation remains irregular, you must consult your gynaecologist for treatment.On the other hand very low BMI can also cause irregular menses. Treatment is weight gain. This is often seen in athletes and they are even at risk of losing bone calcium because if excessive exercise and strict diet control. If gaining weight does not help, you must consult your doctor for having regular periods.

2. Stress, Anxiety, Tension, Depression

These are inevitable part of modern lifestyle. These may not only cause mental problems but will also cause physical problems by altering the hormone levels. The result is abnormal menstrual cycle. Try to avoid them by relaxation, counseling and if necessary by taking help of doctors.

3. Thyroid disorders

Problem of thyroid gland is common in females and causes abnormal weight and changes action of many hormone s. The result is irregular menstruation. So if you feel lethargy, extreme cold, weakness increased weight, do not forget to check thyroid status after consulting doctor.



4. Pituitary disorders

Pituitary gland is a gland situated inside the brain that controls hormone of other gland s of the body. If there is some tumour or some abnormalities in its function, there will be high level of prolactin hormone secretion or there will be deficiency of hormones like FSH and LH. As a result ovaries cannot produce enough hormones and you will have irregular menstruation. So in case of abnormal menstruation, pkease Check your prolactin level.

5. PCOS

Polycystic Ovarian Syndrome is common nowadays. Apart from causing abnormal menstruation, it increases risk of infertility, high blood pressure, diabetes, heart disease and even cancer. It is diagnosed by clinical feature s, hormone tests and ultrasonography. It may also cause weight gain, male like growth of hairs in body and oily skin. The treatment is weight control and drugs to regularize menses. This is particularly important in young women an teenagers, in whom timely treatment can prevent many serious consequences.

6. Premature Ovarian Failure

In some women menopause can come earlier and irregular menstruation may be the early indication of this. This may be followed by permanent cessation if periods. So if you are planning for family expansion but have irregular menses, do not delay pregnancy.

7. Problems in uterus

Excessive trauma to uterus by repeated surgical abortion or infections like STD r tuberculosis can damage the lining of uterus. The result is irregular menses followed by total cessation of menses. But this problem can be easily treated if you consult your gynecologist in time.

8. Systemic diseases and drugs

Irregular menses should never be ignored. Sometimes it may be because if some undiagnosed diseases like diabetes, diseases if heart, liver, kidney, chest etc. Often it may be the side effect if the drugs you are taking- like antacids containing domperidone, psychiatric drugs, Steroid s or chemotherapy.In conclusion, irregular menstruation may sometimes warn you about serious disease s and may be associated with infertility and early menopause. Stay health y, have healthy diet and lifestyle, maintain normal weight, get rid of tension and attend your doctor's clinics in time.






Erectile Dysfunction: Causes and Treatment

Erectile dysfunction also known as ED occurs when the man is not able to maintain or achieve erection of penis to meet his or his partner's sexual satisfaction. The problem is often faced by newly married men. Fortunately most of them are able to overcome this problem with experience. It is also very common with increased age. 


So, what are the causes. In some male, it is psychological, caused by anxiety, depression, stress, marital disharmony etc. Use of alcohol and smoking will aggravate the problem. Psychological causes can happen at any age but more common at younger age. But in some cases, it is associated with serious diseases, especially at old age. It has been seen that in apparently healthy male ed is the first sign of heart disease. So, if you have ed, make sure that i's not caused by your heart problem. Again diabetes is another important cause. Excessive weight gain will also cause hormonal imbalance and thus problems in erection. Some hormone may also cause ed like thyroid, prolactin and even testosterone (male sex hormone). If you have chronic diseases like liver or kidney disease, it may also lead to ed. Diseases of nerves and spines should also be kept in mind. Sometimes, infections or tumour in private parts (prostate, testis etc) will also add to ed. Other diseases of penis like abnormalities in blood vessels can also be responsible, especially in young guys. Apart from these, some surgeries in abdomen and some drugs (like drugs to lower blood pressure, antidepressants, hormonal drugs etc) will also cause ed.


Now, what you can do? if you want to suffer silently, you will land up in other problems like problem in sexual life, problem in family relationships, depression and even inability to make your partner pregnant. But do all men with ed have to go to doctor? initially, the men should try life style modifications like avoiding smoking and alcohol; avoiding stress and anxiety; making good understanding with partner and also reducing weight. The partner should also have sympathetic attitude to the husband who is having ed.


But if still the issue is not resolved you have to consult doctor. It's not a mater of hesitation or embarrassment, as you may think. Rather it is needed to ensure that you are healthy. So, your doctor will talk to you, will check you and try to find out if any cause is there or not (like heart disease, diabetes, hormones etc). He may order some basic tests to ensure that everything is alright. After that he will advise you the treatment. If the cause is found, treatment of the cause (like diabetes) may cure ed. Even if no cause is found, ed can be treated by various ways.


But should you try the drugs shown in television or newspaper? 

remember, drugs used in ed have important side effects and we advise drugs only when it is absolutely necessary. In most cases simple measures like stress reduction, exercise help. Sex counselling of both the partners helps a lot. And if still ed persists, we advise drugs. There are variety of drugs, all are having own advantages and disadvantages. Particularly sildenafil group of drugs can affect heart and retina. So, we always practice caution before prescribing such drugs. And when patients are advised such drugs we advise to inform us when he feels eye problems, chest pain, fainting or even painful persistent erection of penis (" priapism").


There are other drugs that can be applied directly over penis. Testosterone group of drugs are prescribed only in selective cases as they have serious side effects and even they can reduce the size of your testes. In some cases where drugs cannot be given or drugs fail, we advise penile implants or artificial pump to maintain erection. Finally in very few cases, where blood vessels of penis is blocked, we can cure it by some operations. 

So, if you feel ed, don't get depressed. At the same time don't feel embarrassed to take medical help. Today's embarrassment may harm you in future. So, get cured and enjoy your personal life.





Is Stress Affecting Your Sex Life?

In our contemporary lifestyle, stress is an indispensable factor. Career, business, jobs, studies, incomes, money matters, property issues- all are associated with some kind of stress. The problem gets bigger when it affects the family life. This id because, at the end of the day, all of us want to enjoy a happy family life. And a family life has its sense when the husband and the wife are in harmony. Needless to say, that a family is incomplete without a kid. 


How stress affects family life? 

Effect of stress is not limited to mind. It has serious effects in the body. It affects blood circulation and the heart. It puts pressure on nerves. It also alters the blood sugar level. And he end result is diabetes, hypertension (high blood pressure) and heart diseases. Ultimately these diseases affect all the organs of our body. Some people try to get rid of stress by smoking and alcohol. These will simply put burden on already affected heart and blood. 

Stress also alters important hormone levels in our body. The hormones needed for basic reproductive function (sex, conception and pregnancy) are either increased or decreased. Prolactin hormone is increased. Normally prolactin is needed to secrete milk from breast to fed the baby. But abnormally increased prolactin leads to milk secretion from breast (even without pregnancy) and irregularities in periods. Very high prolactin may even lead to problems with ovulation (at middle of each period, the egg gets released from ovary) and as a result, the woman cannot conceive a baby. Even in male, high prolactin leads to difficulty in erection of penis. In some male, it can lead to gynaecomastia (growth of male breast). Excessive high dose of prolatin leads to loss of sex desire in male and interferes with spermatogenesis (sperm production).

Apart from increasing prolactin, stress can directly affect the hormones secreted from the pituitary gland of both male and female, the testes in male and the ovaries in female. As a result, all the reproductive functions get disturbed leading to  sexual problems including problems in erection and ejaculation in male, irregular periods in female, loss of desire in both male and female, and ultimately pregnancy cannot occur. 

The diseases occurring as a result of stress (diabetes, hypertension etc) also affect the normal functions of ovaries causing irregular periods, even no periods at all. There may be problems in ovulation and thus difficulties in achieving pregnancy. Even if pregnancy occurs, it may be aborted because of these diseases. Similarly in male, diabetes and hypertension will lead to sexual dysfunction which affects the production of sperm. 

The lifestyles accompanying stress are also responsible for harmful effects on family life. Smoking and alcohol have been mentioned earlier. Stress may be associated with abnormal weight gain and that will affect the woman’s life in badly manner. There will be disturbances in periods, ovulation problems, infertility and even pregnancy loss. Sitting for long time while driving or keeping laptops on laps, will increase the temperature of scrotum in male and thus will decrease the sperm production. 

Again there is a vicious cycle- stress leads to family problems like problems in sex and in having pregnancy. That will in turn increase pressures from family (especially in-laws) and the society. This will simple aggravate the stress. 


So, what can be done to avoid these problems? 

The answer seems to be simple- that is avoiding stress. But it’s very easy to say and difficult to commit. First thing is try to bring stress at home just keep it at your workplace. Avoid smoking and cut down alcohol consumption. Avoid sitting long time in front of computers and take periodical rests when you are working continuously. The rest does not mean that you have to lie down in bed; just have a short walk. Start exercise that will keep you healthy and reduce your stress. Yoga is an Indian culture that taught the Western world how to reduce stress. Take plenty of water and green vegetables and fruits. Avoid fast food. Always put on comfortable dresses. And if all of these do not work, try if you can do something to avoid the stress- like changing the workplace, talking directly to your co-employees or the employer. If still all these cannot help, consult psychological counsellor. A timely counselling will reduce stress significantly. In very few cases, drugs may be needed to reduce stress. But remember, drugs can only be useful if you are trying all the other measures. Simple dependence on drugs won’t help much.


Now regarding family problems associated with stress follow simple measures. Often we feel embarrassed to discuss these issues. Try to enjoy time of personal intimacy to the fullest. Don’t think of any problems during that time. If still there are problems, don’t hesitate to take medical help. And please remember, the drugs used to solve sexual problems may have side effects. So, these should be taken only after medical consultation. 

In case of female, maintain optimum weight. Avoid fast food, alcohol and smoking. If periods are irregular, maintain a menstrual diary. Consult a doctor to find out if there are some serious issues associated with these problems (like hormonal problems, thyroid diseases, even some tumours). You doctor will then decide the best treatment for you. If there are low desire for sex, don’t hesitate to take help of doctor. It may be a symptom of hormone deficiency that can affect your different systems (like bone, heart, blood etc). Now a days, there are lots of treatment options available for this.

For male, if there is low desire, consult your doctor to find out the cause of this problem. At the same time, avoid any anxiety, alcohol and smoking. Sometimes there are problems with erection. Instead of trying drugs shown in media or newspaper, feel free to talk to your doctor; because erection problem may be caused by some serious issues like heart disease, diabetes etc. So, if you have erection problems, consult doctor. He/ she will counsel you and give you the best treatment. Now if the problem is with ejaculation (like early loss of semen or very low semen), that issue can also be solved in the same way.


What’s about infertility problems? 

Stress and infertility are inter-related, as described before. Now, if there is problem with fertility, please remember few facts. Even in totally healthy couples, the chance of pregnancy after regular intercourse in fertile period (in the middle of menstrual cycle, usually) is only 20%. Though it appears disappointing, majority of couples conceive in course of time. So, couples are requested to report to doctor only if they tried regularly for one year without any protection. Then your doctor will assess you and try to find out the problem. And again, treatment of infertility is also depending on chance. Hat means we have to increase the chance above the natural chance (which is 20%). So, even one treatment fails, there is enough scope, so no need to lose hope. In other words, there is no need to increase the stress.

So, stay healthy, keep your mind healthy by avoiding stress and keep your family relationship totally stress-free.






5 'Common' Sex Problems

In our modern hectic schedule, sexual problems are very common but often people ignore them and try to take help of drugs directly shown in television or newspaper advertisements. These may give temporary solutions but in the long run, they can be harmful. Because, most of the sexual problems have definite causes and the cause should be properly diagnosed and treated by a trained doctor.


1. Low libido - 


libido means desire for sex. Both men and women can have low libido. However, it is more common in female, although they often do not consult doctor for this problem. The causes of low libido include- hormonal problems (like deficiency of thyroid hormones, testosterone in men and estrogen in female, high prolactin), blood sugar, liver diseases, anaemia, heart diseases etc. Sometimes it may be due to psychological factors like depression or anxiety. Again in some cases, poor performance during sex or past experience of pain or injury during sex may often lead to avoidance of sex by an individual. So, what can be done- simple thing, do not feel shy, consult your doctor so that the proper cause is diagnosed and treated and thus you would be able to enjoy your family life. Remember, especially for men, viagra will never lead to increased libido.


2. Pain during intercourse - while the first intercourse is sometimes painful, but persistence o pain is abnormal and it can disrupt the conjugal relationship between a couple. Women are often the worst sufferer of the pain. The pain may occur during insertion, when the penis has just entered or when it is deep inside the vagina. This timing is important to diagnose the cause so that treatment can be done without delay. Common causes are dryness of vagina (especially after menopause), endometriosis, infections or some tumours. But sometimes, the vaginal muscle can have involuntary spasm that prevents any form of vaginal intercourse. If you feel so, do not hesitate o consult your doctor. He or she will talk to you in sensitive manner and then check you to come to diagnosis and then give you the treatment.However, sometimes men may feel pain during intercourse. The cause is often due to incorrect position or due to phimosis (very tight foreskin). Some men have the idea that tight foreskin will'break" with repeated intercourse but this is a wrong idea. Phimosis, if ignored can lead to infections, urinary and sexual problems and even cancer. So, do not ignore it.


3. Bleeding during intercourse - while the first intercourse may lead to some vaginal bleeding in women, repeated bleeding needs medical attention. It is often due to some polyp, tumour or infection but even sometimes due to some cancers. Sometimes faulty position or faulty technique may also be responsible, and it may be associated with injury of vagina. So, never ignore such conditions and go to your doctor's chamber immediately. If a male sees bleeding from penis after intercourse, it may be due to phimosis (as mentioned above) or some tumour or more commonly due to some injury in penis. It needs medical attention immediately, as delay will make the problem worse. 


4. Erectile dysfunction (ED) - some men may feel problems in achieving adequate hardness in penis during intercourse. Remember, almost all men can sometimes face this problems, especially with increase in age. But if it occurs repeatedly, then it reduces your self-confidence. Some causes may be due to psychological factors like anxiety or depression, but majority of ed is due to some diseases that may be missed if you do not take proper action. Such diseases include diabetes, heart disease, diseases of nerves, blood, hormones (thyroid, testosterone, prolactin) or even some chronic diseases. Sometimes abnormalities in blood flow in penis may cause ed. But do not get scared, at the same time do not feel shy. Just have a visit to your doctor's chamber and check the exact cause. It almost always responds well to medicines.


5. Ejaculation problems - 


some men may feel difficult to ejaculate semen. Most of them actually have retrograde ejaculation (re)- that may be due to some diseases of the nerves surrounding the prostate gland. In this condition, the semen does not flow forward, rather it moves back towards urinary bladder, so that semen is mixed with urine. But more common problem faced by many men is premature ejaculation (pe) - that often leads to very short duration of sex. It is easily treatable with the help of some drugs and sex exercises. Some special sex tips also help a lot. You just need to have better control over ejaculation of semen and reduce sensitivity of the penis - simple thing.











Today is the world cancer day and the theme of this year is "we can, I can." Yes we all can battle the cancer. But the irony is that majority of women ignore early signs and symptoms of cancer and do not consult doctors in time. Some of these cancers are actually preventable if proper action is taken.

Ovarian cancer 

What will you do if you feel gaseous distension (gas, bloating), acidity, constipation, change in bowel habit, decreased appetite, feeling of full stomach, weight loss and abdominal swelling? majority of the women ignore these symptoms and take antacids before it is too late. But these are often symptoms of early ovarian cancer and thus if you ignore these symptoms, you are harming yourself. Ovarian cancer is difficult to treat if detected at a late stage. But at an early stage, it is curable. So, don't ignore these symptoms.Who are the women at risk of ovarian cancer - women who are not having a baby, who themselves or have close relatives (sister/ mother/ daughter) with a history of cancer in breast/ ovary/ bowel/ uterus etc. But some women are at a lower risk like those using oral contraceptive pills- ocp (the birth control pills can reduce the risk by 50%) and those who have had tubal ligation (permanent family planning methods).If you have such risk factors, you must not avoid any such above mentioned symptoms. Rather you should consult gynecologist early. Ovarian cancer can be detected by ultrasound, ct scan, some blood tests (ca 125) and in some cases biopsy may be needed. And remember, majority of the ovarian diseases are not cancer but you must be sure that it's not cancer causing your problem.If ovarian cancer is diagnosed, the treatment is surgery (to be done by expert personnels) and most of the women need chemotherapy. Ovarian cancer is common in elderly women but it can affect younger women also. So, all the women should take care of the above mentioned symptoms.

Cancer of cervix

Cervix is the mouth of the uterus. In our country, this is the commonest cancer affecting women whereas it is uncommon in the western countries too. The irony is that women die of this disease whereas it is totally preventable.It is caused by a virus (human papilloma virus- hpv) that is sexually transmitted (so it affects sexually active women). But it has a peculiar feature that actually occurs, before cancer, called precancerous stage - when the cells of cervix show some changes that we can detect and treat. So, if women regularly consult a doctor (when they do not have problems), we can check if she is at risk of cervical cancer or not, by some simple tests (pap smear, hpv testing etc). If such changes are found (that is not cancer) we can treat her so that she does not develop cancer. These methods of detection, before disease occurs or before an individual feels that she is having disease, is called 'screening'.Another method of preventing, is vaccination of hpv, that should be given to the adolescent girls before they become sexually active. It can be given too older women (who are sexually active), although the response is somehow lower than if given at an early age. But vaccination is not alternative to screening. So, both screening and vaccination should be done to prevent this cancer.Even if detected at an early stage, it is totally curable. So, women should not ignore symptoms of excessive vaginal discharge (remember, all excessive discharges are not due to cancer), abnormal or heavy menstrual bleeding, bleeding occuring unpredictably in between menstruation, bleeding after intercourse etc.It is treated by surgery and some cases may need radiation also.

Cancer of uterus

Cancer of uterus is common after 50 years of age (although can occur in early years also). It is the commonest gynecological cancer in the western world. It mainly occurs in women who are obese (excessive weight), having diabetes or hypertension (high blood pressure), not having any baby, who are having personal or family history of cancer in uterus/ breast/ ovary/ bowel.It can be prevented by taking ocp (birth control pils) and controlling weight. In many cases, it is also preceeded by some precancerous changes (hyperplasia) that can be detected by ultrasonography and if needed small biopsy procedure.The common symptoms are abnormal heavy bleeding and bleeding after attaining menopause (after totall stoppage of menses). So, any abnormal menstrual bleeding must be properly investigated.It is usually well curable if treated early - by surgery and in few cases, may need radiation, chemo or hormone therapy.

Cancer of vulva

The external genitalia of female is known as vulva. Cancer in vulva is relatively uncommon but still it can happen, especially those who are having diabetes, are HIV positive or have poor hygiene.Never ignore any symptoms of excessive itching in your private parts. It may be the early symptom of vulval cancer. Some cases, patient may have ulcer or tumour or bleeding.It can be detected easily on examination by a doctor and then biopsy. It is treated well with surgery and some cases, radiation may be needed.

Summary: Majority of the gynaecological cancers are preventable. They can be diagnosed early if women consult doctor at an early stage. Majority of them respond to treatment.




6 Tips for Improving Men's Health

So, some tips for men's health- as well as an attempt to eliminate some myths and misconceptions.

Men’s health



1. Stay healthy

Check regularly whether foreskin of penis (the skin covering the red portion of the penis, called “glans penis”) can be retracted backwards or not. This is for male who are not circumcised. And clean the materials (“white materials”- called smegma) collected beneath the skin regularly. If it cannot be retracted normally or during urination or intercourse, it is likely to be abnormal. And it may be a condition called “Phimosis”. If you feel you have phimosis or tight foreskin, do not force to retract it, because in doing so you will land up in more difficult and emergency situation, called “Paraphimosis”. So, only solution is to get it checked by doctor. Phimosis is common in males with diabetes and those having repeated infections. It can lead to further infections, problems during urination (that may even damage kidneys) and even cancer of penis in the long run.

Do not ignore any abnormal swelling or ulcer or pain or tumour or any white or reddish patch in penis or scrotum. But some conditions are very normal like pearly penile papules (PPP) that look like small reddish or pinkish granules at the broader end of the glans penis. Similarly it is very common to have very dark pigmentation of penis and scrotum, even in very fairly skinned persons, especially in our country.

Testicles should be checked regularly, at least once a week. Please remember, both testes are not of exactly same size and they do not lie exactly at the same level (one little above and one little low). And scrotum reacts with change of temperature. So, in cold days, scrotum contracts and you have scrotum lifted up so that testes lie at higher position. Conversely at warm days, they hang down more.

But never ignore any injury, swelling or pain in scrotum or testes. Some peculiar sensation (“pain in lower abdomen”) is common during accidental pressing of testes and this indicates testes are normal. Absence of such sensation is usually abnormal. But if testicular pain persists you should not ignore it. The pain may be due to stone in kidney or infection in urine or testes or even tumour. And sharp stabbing pain indicates that there may be torsion which is a medical emergency (twisting of testis, if not treated early, can damage testes). The causes of testicular swelling are usually hydrocele (collection of water outside testes). Infection or tumour. Remember, testicular tumour or cancer is a very common malignancy in young male but it responds well to treatment. Any swelling in scrotum above testes should also be noted. Sometimes it may be varicocele (swelling of veins above testes), hernia or some cysts.

2. Urinary problems

Do not ignore if you have difficulty in urination like pain, requiring more pressure, increased frequency, difficult to start, not feeling any desire or very strong urge that is difficult to control. In younger age it is due to stone or infection or some narrowing of passage (urethral stricture). In older age, it is likely to be due to prostatic enlargement. Remember, prostate enlargement is common after 40 years but in very few cases, it may be cancer. Men with family history of prostatic cancer needs ‘cancer screening” like regular check up for detection of cancer in early stage.

Blood in urine is another problem that indicates some injury or stone, tumour or infection. Even cancer in urinary tract can cause passage of blood in urine.






3. Sexual Problems

Most of the sexually active men are often obsessed about size of the penis. But it actually maters little for satisfaction unless it is abnormally low (“Micropenis”). Do not feel that the pictures shown in internet or film are real. So all the methods of ‘’enlargement techniques” are actually bogus. If it is micropenis, it needs proper evaluation to diagnose the cause of the cause and then the cause needs to be treated to achieve actual normal size.

Masturbation is not harmful for sexual health except that it may interfere with concentration in other activities (like study and work) and sometimes can lead to premature ejaculation.

Sometimes people complain about ‘’low sex stamina”. It is a vague term. It should be either of the three like low desire, erectile dysfunction (ED) or ejaculatory problems. Low desire for sex is a condition that needs proper evaluation to diagnose the cause. Remember, ”Viagra” is not the solution for each and every sexual problem. Low desire can be successfully treated if we can address the actual cause of such ‘’low desire”.

ED is a common problem faced by many men, with increased incidence at older age. While some ED has psychological causes, majority of this can be due to some serious conditions like heart diseases, diabetes, nerve problems, hormonal problems, drugs and even some problems in penis itself etc. S, if you directly take “Viagra” without proper evaluation, you are actually damaging your health by delaying the diagnosis of heart disease or diabetes. Sometimes, it may be the earliest symptom of heart disease or diabetes. So, never ignore it.

Painful erection, especially without sexual stimulation is called ‘Priapism” and thi is a quite serious problem. Not only it is caused by diseases like blood diseases, even cancers etc; it may damage the penis seriously.

Any swelling of penis after intercourse should not be ignored, especially if it affects whole of the penis. This is called “Fracture of Penis” that is a medical emergency.

Some people are facing problems with early ejaculation that leads to very low sex timing. This premature ejaculation (PE) is easily treatable by some drugs and few tips and exercises but it needs long term treatment. Please do not think that duration of ‘’normal” intercourse would be more than one hour. Anything around 5 minutes are sufficient for satisfaction.


Similarly absence of ejaculation or presence of blood in semen or bleeding during intercourse are abnormal and needs medical attention, although these problems are relatively uncommon.



4. Infection

Infection in sex organs may have long term consequences like urinary problems, infertility, sexual problems etc and so must not be ignored. All these have been discussed in point number one “”Stay Healthy”)



5. Male Infertility

Due to changes in environment, food habits, addiction and pollution- male infertility is increasing. Semen test is integral part of male fertility testing. But remember, one abnormal semen analysis is not m=necessarily meaning that that person cannot father a baby. With advent of various treatment options, we need to know the cause of male infertility. The next plan is to treat the cause. Even if the cause cannot be treated, there is no loss of hope. Some male have normal sperm production in testes but sperms cannot come out in semen due to obstruction in the passage. In that case, collection of semen from testes can make that male father. On the other hand, if sperm is not produced inside the testes, we need to know the cause and then that cause should be corrected


6. Contraception

Condom is a very good method of contraceptive that also provides protection against infection. It prevents transmission of infection and STD (even HIV) from one partner to another. But correct use is very much important to know as often it breaks or slips due to incorrect use.

Medical methods of male contraceptives (like pills) are not very much popular, unlike females, due to very few studies and serious side effects (like permanent sterility).

Vasectomy is a very effective method of permanent family planning. It does not decrease sexual pleasure and needs very little operative time. It is very easy to do, even without need of hospitalization. But after vasectomy, the couple should use alternative contraceptive for at least 3 months, because immediately after vasectomy, the contraceptive benefits are not obtained.






Sexual Problems and Infertility- Make Sure That It's Not Diabetes
  • Scenario one: Mr PS, 35 years old, married for 5 years, now planning to have a child, suddenly felt that his erection of penis is not as good as it was earlier. initially he tried medicines shown in TV and newspaper and then many treatments through internet. But his problems persisted. Finally when he came to doctor, he was diagnosed to have ERECTILE DYSFUNCTION. When the doctor asked him to take a blood test, the results revealed he has high blood sugar and then he was prescribed anti-diabetic drugs. After taking this medication, his sexual performance improved much better.


So, what went wrong? Erectile dysfunction may be an early indication of diabetes. So, if you experience such problems, never ignore it and never feel ashamed to talk to a doctor. If you try medicines shown in TV/ newspaper, your problem will persist and the diabetes may go to such point that your life will be threatened. So, never ignore such problem, however embarrassing it might be.

  • Scenario two: Mrs AM, a 42 years old lady having two children, gradually feeling of low sexual urge. Her husband tried many things but nothing worked. She also had repeated attacks of vaginal infections. After trying many things by themselves, they consulted doctor. And the cause of her LOW SEX DRIVE and VAGINAL INFECTION was found to be uncontrolled diabetes. And the story was same. She was put on insulin therapy and her conditions improved. But if she came earlier, she could have avoided insulin therapy.

So, if any male or female is experiencing low sex desire, he or she should not try various types of treatments by themselves. Proper diagnosis is necessary, so that life threatening diseases are not missed. And as you all know, diabetes can sometimes be life-threatening. So, just imagine, a situation for which you feel embarrassed to talk to doctor, can endanger your life.

  • Scenario three: Mr MQ, a 30 years old male, is feeling pain and discomfort during intercourse and also sometimes during urination. He thought it may solve automatically after marriage. But it did not. And then he also had bleeding sometimes during intercourse and the pain increased. When he presented to doctor, doctor diagnosed it as a case of tight foreskin or PHIMOSIS. And the next day blood sugar was found to be very high. He was cured by circumcision after controlling blood sugar level with insulin. But after that he was found to have problems in retina and kidney. These are all because of diabetes. had he not ignored Phimosis, he could have avoided these complications of diabetes (retinopathy and nephropathy).

So, if you feel any problems, particularly infections in private parts, do not ignore them Consult doctor and try to find out the cause.

  • Scenario four:. Mrs AR, 32 years female, having REPEATED MISCARRIAGE in previous three pregnancies. No apparent cause was found. Then blood sugar test was done properly and she was found to have very high blood sugar. Then she was advised to avoid pregnancy until sugar was controlled. She followed the advice and then conceived fourth time when blood sugar was normal. Then she delivered a baby who was totally normal.

So, if any couple is experiencing repeated miscarriage, they should test for diabetes first.

So, never feel that diabetes is merely a disease of sugar. It can affect every organ and system. So, if you feel any problems in personal or conjugal life, however embarrassing to you it might be, never feel ashamed, rather consult doctor and have proper diagnosis done. A stitch in time saves nine.




6 Essential Nutrients for Women

A woman's body needs a lot of nourishment. There are many vitamins and minerals that ensure a healthy body. However, as you reach puberty and age more, a few nutrients become vital for healthy functionality, reproduction as well as vitality. On this International Day Of Action For Women's Health, 28th May, learn more about the women's health so that you or women around you stay healthy.

Here are top 6 nutrients that are a must for women of all ages:1) Vitamin B12 - Women suffer from extreme fatigue as soon as they reach late 20s or mid-30s. Vitamin B12 has proven to be very helpful in not only curbing the feeling of fatigue, but also in promoting swiftness and alertness in the body.2) Vitamin D3 - Lack of vitamin D3 is detrimental for breast and ovarian cancers which plague a large number of women. Vitamin D3 also builds immunity against some autoimmune diseases and gives adequate strength to muscles, bones and teeth.3) Iron - Adequate levels of iron in the body ensures that you never run out of energy and are always active. In addition, iron plays an important role in maintaining efficient functioning of the brain.4) Vitamin B6 - Vitamin B6 mainly promotes the maintenance of a healthy and regular sleep pattern and protects against sleep-related disorders such as insomnia. It also helps in regulating your appetite while maintaining hormonal balance, and hence protecting you from mood disorders.5) Folate - Women who are expecting or have recently given birth certainly benefit a great deal from adequate consumption of folate. These women are highly vulnerable to a number of brain and spinal defects which can be effectively prevented by the intake of folate. Folate also helps to make the body highly resistant to colon and breast cancers.6) Calcium - Calcium is like a wonder drug for all women as it solves a majority of problems which hinder their daily life. It plays a key role in keeping their blood pressure stable and is very efficient in controlling certain noxious symptoms of Premenstrual Syndrome(PMS). It is also important to maintain their bone density as they grow older.

4 Natural Ways to Cure Polycystic Ovarian Syndrome

Polycystic Ovarian Syndrome (PCOS) is a very common syndrome among many young girls and women. Problems like irregular periods, weight gain, acne, hair loss and other hormonal imbalances are the common symptoms. It is a common cause of infertility and pregnancy problems. If left untreated it may lead to diabetes, heart disease and even cancer.


Here are the most natural ways to handle PCOS problem:

1) Mind your Diet: Easiest way is to work on your diet. Avoid junk food. Eat more of fruits, vegetables and whole grains.

2) Physical Exercise Works: Exercise is a must. It will help you manage body weight and can also help in conceiving. Exercise also balances testosterone and insulin levels.

3) Vitamin Supplements: Add more Vitamins A, E and C and Minerals like Zinc and calcium to your diet, in consultation with your doctor.

4) Drugs depending on menstrual problems or infertility. But main treatment is always weight control.





10 Things to Avoid in Pregnancy


Pregnancy is a journey of a woman from womanhood to motherhood. Each and every pregnancy is precious and so women usually remain anxious about their lifestyle and food habits. Most of the pregnant mothers do not hesitate to sacrifice their comfort and habit, only to keep their baby safe. Here are the few tips which describes what are the common food items that must be avoided in pregnancy.  

1) Some fishes

Fishes are integral part of most of the non-vegetarian Indian dishes. Majority of the fishes are not harmful, rather most of them (particularly fresh water fishes) are rich in protein and omega-3 fatty acid, that helps in brain development of the baby.You must take those. But remember, always take well cooked fishes. Avoid raw fishes like “Sushi” as they are likely to contain bacteria and parasites, causing stomach upset, that can lead to early labour and even damage the baby by causing premature delivery.

Avoid refrigerated and smoked sea fish and other seafood as they are likely to be infected with a harmful bacteria, called listeria. Listeria infection is notorious for causing fever and infection in mother. More importantly, it can pass into the baby causing miscarriage, serious infection and even death, either before delivery or immediately after delivery.

Avoid fishes containing mercury and other pollutants,particularly, big fish like shark, shellfish,  salmon, tilefish, king mackerel etc because they contain higher levels of mercury which can harm an baby’s immature nervous system.

2) Some dairy products

While intake of properly pasteurized and boiled milk is highly recommended, if you can tolerate it, because of high energy, carbohydrate, protein, fat and mineral content; raw milk, unpasteurized milk should be completely avoided, as they may contain harmful bacteria, particularly listeria. Similarly, soft cheeses should not be taken in pregnancy.  

3) Alcohol and smoking

Excessive alcohol in pregnancy can cause ‘fetal alcohol syndrome’, characterized by abnormalities in face, heart, brain etc and evenmental retardation. These babies are likely to have growth disturbances. .

Smoking can cause miscarriage and low birth weight of the baby that may even cause still birth. Passive smoking is also equally important. So, both mother and father should avoid smoking.

4) Caffeine

Excessive caffeinated food can be a cause of miscarriage. Do not take more than 2 cups (or 200 mg) of coffee per day. 

5) Under-cooked meat and eggs

These can cause food poisoning, as well as listeriosis. Also, there is chance of transmission of a parasite, toxoplasma, which can cause miscarriage, still birth and abnormalities in the baby (problems in heart, brain, eye, intelligence etc). Cook eggs until the yellow and white parts are firm. It’s better to avoid restaurant foods.

6) Unwashed fruits and vegetables

These items may carry certain bacteria that can lead to stomach upset. They are also known cause of causing listeriosis, as explained above. Avoid long refrigerated vegetables and salads made in restaurant. Raw vegetable sprouts, often taken for high minerals and protein, should be avoided as they may also harbor harmful bacteria.   

7. Some juices

Avoid fresh and raw juices as they may contain harmful bacteria like listeria and even toxoplasma. Choose packaged juices as they are pasteurized and are kept under refrigeration.

8. Fatty Foods

While some fat is needed for brain growth and energy of the baby, excess fat may cause excessive weight gain that may increase the risk of high blood pressure and even diabetes, both can affect mother and baby. Mothers with excess weight are more likely to have premature delivery, problems during delivery and infection. Again repeated cooking of fatty food should be avoided, as it is more harmful to both.

9. Herbal supplements

Because their safety during pregnancy is not known, it’s best to avoid herbal supplements during pregnancy. This also includes herbal tea. .

10. Drugs

Do not take any drugs without consulting your doctors, whatever problem you are having.Even avoid excessive vitamin use as excess dose of vitamin A can damage the heart, face and brain of your baby and make it mentally handicapped. Some painkillers can cause heart defects in the baby. Some antibiotics may also be unsafe.






Contraception - Common Myths and Misconceptions

Sex is a basic human right. Having safe sex without fear of unwanted pregnancy should be the priority. Many women across the world die every day as a result of unwanted pregnancy, mostly due to unsafe abortion. So, couples can avoid pregnancy and enjoy sex life fully, only if they can follow safe and effective contraceptive advice. Let me clarify some popular myths and misconceptions abut contraception. 

1. Contraception is useful for all

While the ideal contraceptive is necessary but it does not exist. So, what may seem suitable for a couple may not be useful for another couple. We need to assess various points like a number of children they have, wish to have further children and plan to have children, general health of wife and husband (and any diseases they suffer from), the frequency of intercourse, the chance of infection, the age of the partners etc. 

2. Regarding barrier methods

Most popular barrier method is a male condom. But the myths are that" condoms reduce sexual pleasure" and" condoms get easily damaged leading to failure.Condoms are especially useful for those who are at risk of infections, who do not have very frequent intercourse and who are not suitable for other methods. Condoms do not decrease sexual pleasure, some of the condoms have medicated products which can increase the duration of intercourse and also act as a lubricant to facilitate intimacy. But men should know how to use it properly. It should be worn on erect penis expelling all the air and projecting the tip beyond the tip of the penis. While withdrawing penis after intercourse, the condom should be held at the base of the penis. Actually, failure/ rupture of condoms occur because of mishandling of condom or not knowing the proper use of it. So, before use, please make sure that you know its correct use. Definitely, some men can feel latex allergy and they have to use a non-latex condom, which is widely available.There are barrier methods for females also- like female condom, diaphragm, and cervical cap etc. But they are not very easy to use and are not so popular.

3. Oral Contraceptive Pills (OCP)

Myths 

  • OCP causes an increase in weight.
  • OCP cause cancers.

Facts 

CP seldom causes gain in weight. The gain in weight is coincidental, that means you have some other reason of gaining weight- like not having exercise, ignoring diet control and some other diseases. OCP rather reduces risk of cancer- especially ovarian cancer (which is very difficult to diagnose and very lethal), cancer of colon, cancer of endometrium (inner lining of uterus). Of course, there is little risk of breast cancer, but the risk is not very high, it can be easily detected by examination by doctor. So, if you take ocp, get rid of all the fears. Just try to have self- breast examination every month. 

4. Intrauterine Contraceptive Devices (IUCD)

Copper T. Medicated IUCDs are very popular, that contains hormonal drugs. Copper T does not increase the risk of infection which is a common misconception in women.

5. Emergency contraceptive pills (i pill etc)

Often couple uses these pills regularly after intercourse. Remember these pills contain very high content of hormonal drugs, which can lead to serious side effects like hormonal imbalance, irregularities in periods (and thus can prevent you from getting pregnant in future, even when you want pregnancy), ectopic pregnancy (pregnancy outside tubes that are life-threatening) etc. So, use regular contraception if you want to prevent pregnancy. I pill is not meant to be taken for every time. 

 6. Ligation

Ligation of male (vasectomy) and female (tubectomy) is done as permanent contraception for couples having more than 2 children. Ligation in male does not disturb sexual activity. It is easier than female ligation. Again, female ligation is also a very safe technique. 

So, please remove all misconceptions and myths about contraception. Have safe sex, enjoy life.




Nowadays, India is considered the “Diabetes Capital” of the world with more than 50 million people suffering with Type-2 Diabetes. In modern societies diabetes is increasing at a very fast rate which is indeed a matter of concern. It affects various organs and systems of our body , particularly affecting heart (coronary artery disease), brain (stroke), eye (retinopathy), kidney (nephropathy), blood pressure (hypertension), liver (fatty liver), nerves (neuropathy), increased risk of infection and even some cancers. Obesity and diabetes go hand-in-hand. So, the main control measures are life style changes (controlling weight, diet, exercise, avoidance of alcohol and smoking); drugs (oral drugs and insulin) and monitoring by physician.






  1. Sexual Dysfunction: Diabetes is a major cause of sexual dysfunction in both male and female. It can reduce the libido (sexual desire) by altering the sex hormone levels. In case of male, Erectile Dysfunction (ED) is sometimes the first symptom of diabetes. So, if a male suffers from ED, rather than taking drugs directly from medicine shops, the cause of ED must be evaluated, particularly diabetes. Often patients do not know that they are diabetic but when the cause of ED is investigated, diabetes is discovered incidentally. It can also affect the nerves and thus can worsen the sexual problems. In female, it can lead to decreased arousal leading to avoidance of sexual activity. In some cases, it is responsible for premature ejaculation (PE) in males. Thus any person with sexual problems, should be evaluated for diabetes. Control of diabetes often resolves the problem. 
  2. Menstrual problems: Obesity and diabetes together can affect hormone balance leading to irregular menstruations ranging from periods occurring at every 2-3 months, sometimes too frequently (every 10-15 days), scanty flow and sometimes heavy flow. This is particularly true in case of polycystic ovarian syndrome (PCOS) which can affect various organs and systems of the body. In PCOS, insulin is there in the body but it cannot function properly and ultimately it leads to diabetes. In some cases, this high blood sugar may be responsible for appearance of excessive hair growth (male-like hairs) in females. Even in some cases, diabetes may be associated with increased thickening of the endometrium (the inner lining of the uterus). In the worst cases, these women may have cancers in endometrium. So, women with menstrual problem need proper evaluation. Reduction in weight and control of blood sugar help to control menstrual problems. 
  3. Infertility: As mentioned above, PCOS is a common cause of infertility. Similarly, diabetes and obesity can lead to problems in ovulation and thus creates problems in having pregnancy. Control of weight and blood sugar lead to successful conception in most cases. Similarly in male, high blood sugar can affect sperm production and thus impairs male fertility. Sexual dysfunction can aggravate the problem. Infection also plays a important role.
  4. Infection: Diabetes is notorious for increasing susceptibility to infection and often interferes with eradication of infection. In female, the infections may lead to vaginal white discharge and even in severe cases can block the fallopian tubes leading to infertility permanently. In male, it can cause phimosis (tight foreskin) and sometimes infection of sperm conducting-passage leading to infertility. So, male and female with genital infection must be evaluated for diabetes. Proper control of blood sugar and antibiotics are needed to control these. 
  5. Pregnancy problems: Women diagnosed with diabetes are encouraged to control blood sugar before pregnancy. Otherwise there will be problems for mother as well the baby. Diabetes can cause miscarriage, preterm labour and worsens maternal problems like hypertension, nephropathy and retinopathy in pregnancy. It can lead to sudden unexplained death of the baby inside the uterus. The baby can have excessive weight (that leads to its diabetes in later life) and other problems like low blood sugar at birth, problems in breathing, problems in brain and problems in heart etc. So, proper control of blood sugar is needed before pregnancy and should be continued throughout pregnancy. 
  6. GDM: Some women may have normal blood sugar before pregnancy but may develop diabetes in pregnancy. This is called gestational diabetes (GDM). It is also associated with increased risk of complications to mother and baby. 50% women with GDM can develop diabetes in later life. So, women with repeated miscarriage, still birth and very large baby should be evaluated for diabetes. Treatment must be continued throughout pregnancy.




To summarize, diabetes is not only responsible for diseases of heart and brain but it can affect your reproductive life, particularly sexual function, conception and pregnancy. So, if you suffer from these problems, do not hesitate to check blood sugar. If diabetes is detected, there is no need to worry as proper control will solve all these problems.