February 2023 - Imprimis IVF

PCOS – Causes, Symptoms and Treatment

What is Polycystic Ovarian Syndrome (PCOS)

Polycystic Ovarian Syndrome (PCOS) is a heterogeneous, multisystem endocrinopathy in women of reproductive age. PCOS symptoms may begin shortly after puberty but can also develop during teen years and early adulthood. It is defined and diagnosed by a combination of signs and symptoms of androgen excess, ovarian dysfunction and polycystic ovarian morphology or ultrasound. The symptoms involve chronic anovulation or ovulatory dysfunction resulting in infertility. In clinical practice, 75% of women with PCOS have anovulatory infertility and 50% experience recurrent pregnancy loss. A diagnosis of PCOS incurs a higher risk of infertility, cardiovascular disease, type 2 diabetes and gynaecological malignancies. There is a multitude of treatments for each sequel of Pcos, ranging from lifestyle modification to In-Vitro fertilization (IVF).

Pathogenesis involves environmental, dietary and hereditary factors. Efficient management of Pcos provides a window of opportunity towards the risk of associated complications. Treatment is broadly aimed at managing the effects of hypoandrogenism, irregular menstruation and infertility. In India, its prevalence is between 8.2% to 22.5%.

Causes of Polycystic Ovarian Syndrome PCOS:-

Family History:- Research suggests that certain genes might be linked to PCOS. Having a family history may play a role in developing this condition.
Excess androgen:- With PCOS, ovaries may produce high – levels of androgen. Having too much androgen interferes with ovulation. It means that eggs do not develop regularly and aren’t released from the follicles where they develop. Excess androgen also can result in hirsutism and acne.
Insulin Resistance:- An increase in Insulin levels causes ovaries to make and release male hormones (Androgen), which suppresses ovulation and contributes to other symptoms of PCOS.
Weight and lifestyle:- Pcos can occur in both slender and overweight women. However, women with PCOS are at a greater risk of being overweight or obese. Being above a healthy weight woman worsens insulin resistance, which is thought to be a key part of the development of PCOS. The good news is that a healthy lifestyle of nutritious food and physical activity can help to treat PCOS and improve symptoms.
Environmental:- Environmental factors, including stress, play an important role in the pathogenesis of PCOS.

Symptoms of Polycystic Ovarian Syndrome PCOS:-

Irregular Periods: Pcos results in irregular cycles as a result of ovulation. It may include Amenorrhea (abnormal absence of periods), oligomenorrhea (decreased flow of periods) or menorrhagia (excessive periods).
Excess Androgen: It causes symptoms like hair growth on the face, acne, weight gain, darkening of the skin, and thinning of hair on the head.
Infertility: Difficulty in conceiving due to ovulation. PCOS is a leading cause of female infertility. However, not every woman with PCOS is the same. Although some may need assistance with fertility treatment, others can conceive naturally.

Treatment for Polycystic Ovarian Syndrome PCOS:-

Most symptoms of PCOS are a result of hormonal imbalances. The treatment of PCOS includes a multidisciplinary approach:-

Health and Nutrition:-

It is the first line of treatment. We must meet a nutrition counsellor who will work with you to ensure that your diet and lifestyle are healthy and balanced. Weight loss can lower insulin and androgen levels, resolve ovulation, and reverse the symptoms of PCOS. The carbohydrates are to be limited. Choose complex carbohydrates, which raise your blood sugar levels slowly. Complex carbohydrates are found in fruits, vegetables, whole grains and cooked dry beans and peas.

Exercise plays an important role. Increasing daily activity and regular exercise may treat or even prevent insulin resistance.

Medications:-

To regulate your periods:

Oral Contraceptive Pills: Pills that contain estrogen and progesterone decrease (combined) androgen production and regulate estrogen. Regulating hormones can lower the risk of endometrial carcinoma.

To help ovulation so that you can become pregnant:

Clomiphene: This oral anti-estrogen medication is taken during 1st part of the menstrual cycle.
Letrozole: It helps to stimulate ovaries and help in ovulation induction.
Metformin: It helps to improve insulin resistance and lower insulin levels. It also plays an important role in ovulation.

IVF Treatment:-

If you have PCOS and medication does not help you to get pregnant, you may be offered In – Vitro fertilization (IVF). It involves eggs being collected from the ovaries and fertilized outside the womb. The fertilized eggs are then placed in the womb. IVF treatment increases the chances of having twins or triplets if you have PCOS.

Surgical:-

A minor surgical procedure called laparoscopic ovarian (LOD) may be a treatment option for fertility problems associated with PCOS who do not respond to medications.

The ovaries will be surgically treated using heat or laser to destroy the tissue-producing androgens. Laparoscopic ovarian drilling has been found to lower levels of testosterone and LH and increase FSH. It corrects the hormone imbalance and restores the normal function of the ovaries.

Options for infertility treatment in PCOS:-

Non – Pharmacological Intervention:-
Diet (low-calorie diet)
Exercise (150 min/week of moderate-intensity or 75 min/week of severe intensity)
Pharmacological Intervention:-

Oral ovulation induction agents like letrozole or clomiphene.
Injectable Gonadotrophin.

Assisted reproduction technologies:-

IUI (Intrauterine insemination)
IVF (IN Vitro-Fertilization)

Complications of PCOS:

Infertility: Epidemiologic evidence suggests that PCOS is the most common cause of ovulatory disorder, and oligo anovulation is related to increased risk for fertility.
Gestational Diabetes Mellitus:- If women with Pcos conceived, they are at a higher risk of developing diabetes during pregnancy (almost three folds) because of increased insulin resistance.
Miscarriage and premature birth.
Metabolic Syndrome:- This includes raised blood pressure, unhealthy cholesterol or triglycerides that significantly increases the risk of cardiovascular disease.
Type II Diabetes Mellitus.
Sleep apnea
Depression, anxiety and eating disorders.
Endometrial Carcinoma.

Diagnostic criteria for PCOS:-

Two of the three features must be present for the diagnosis of PCOS:

Clinical: Acne, hirsutism or acanthosis nigricans.
Biochemical:

Total testosterone > 70ng/dl

Androestenedine > 248 ng/dl

DHEA – S > 248 ug/dl

Polycystic ovaries on ultrasound ( > 12 follicles (2-9mm diameter) in each ovary or ovarian volume > 10cc).

Role of IVF in PCOS:-

IVF is an excellent option when PCOS fertility medications fail. With IVF, there are higher chances of getting pregnant with lower risk. The main cause of infertility due to PCOS is that these women do not ovulate regularly, which can be regulated to conceive using IVF and have up to a 70% chance of becoming pregnant.

Ovarian Cyst – Symptoms, Causes & Treatment

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What is Ovarian Cyst

Ovarian cysts are fluid-filled sacs on the ovaries, a female reproductive system’s part. An ovarian cyst is a common issue in women, and it’s assumed that most women will get it once. Although most ovarian cysts are typically harmless and often resolve without any medical intervention, some can cause discomfort and pain, and in rare cases, they can become cancerous.

This blog post aims to provide a comprehensive overview of ovarian cysts, covering their symptoms, causes, types, diagnosis, and treatment options. It will also cover some potential complications of ovarian cysts and ways to prevent them. By reading this post, you will gain valuable information about ovarian cysts and how they can be effectively managed to improve your overall health and well-being.

Ovarian Cyst Symptoms

All ovarian cysts’ symptoms can differ depending on the size, type, and location. Some women may not experience symptoms, while others may have one or more of the following symptoms. It’s essential to note that these symptoms may also be related to other health issues, and only a healthcare provider can accurately diagnose an ovarian cyst. Women who face these symptoms need medical help to determine the leading cause.

Pain and discomfort: One of the most common symptoms of an ovarian cyst is pain, which can range from dull to sharp. The pain is typically felt in the pelvis. It’s important to note that while pain is a common symptom of an ovarian cyst, it can also be associated with various other conditions.
Changes in the menstrual cycle: Some women can experience changes in their periods.
Bloating and fullness: Ovarian cysts can cause pressure in the lower abdomen and bloating.
Other possible symptoms: Other symptoms that may be associated with ovarian cysts include:

Difficulty urinating or frequent urination
Pain during bowel movements
Breast tenderness
Nausea or vomiting
Weight gain
Fatigue

It’s essential to note that while the symptoms mentioned in this post are common indicators of ovarian cysts, they can also be caused by other health conditions. As a result, it’s essential to seek medical attention from an IVF expert if you’re experiencing any of these symptoms.

What are the Causes of Ovarian Cysts?

There are several potential causes of ovarian cysts, including:

Hormonal imbalances: Ovarian cysts can develop due to hormonal imbalances, such as excess estrogen or androgen hormones.
Polycystic ovary syndrome is a medical condition in which the ovaries produce high androgen hormones, which can lead to the formation of multiple small cysts on the ovaries.
Endometriosis is a medical condition where the lining tissue of the uterus grows outside, which can cause ovarian cysts when it grows on ovaries.
Pregnancy: Ovarian cysts can sometimes form during pregnancy, typically in the first trimester, due to changes in hormone levels.
Other possible causes: Ovarian cysts can also be caused by many medical conditions or fertility drugs.

Ovarian cysts can develop without any known cause. It’s important to note that having an ovarian cyst does not necessarily mean a person has cancer. Still, having any ovarian cysts evaluated by IVF experts to rule out any underlying severe conditions is essential.

What are the Types of Ovarian Cysts

There are different types of ovarian cysts, which are:

Functional cyst: Follicular and corpus luteum cysts are various functional cysts that perform like normal ovaries.
Dermoid cysts: These cysts are the form of cells that produce human eggs and contain various tissues.
Cystadenomas: These are formed from cells on the upper layer of the ovary and are filled with watery or mucous-like fluid.
Endometriomas: These are cysts that form due to endometriosis.

It’s important to know that some ovarian cysts may need treatment while others must resolve themselves. It is essential to look for a healthcare provider if you are facing these symptoms, as they need immediate treatment.

Diagnosis of Ovarian Cysts

The diagnosis of ovarian cysts typically involves a combination of different methods, including:

1: Physical examination: A healthcare provider may conduct a pelvic exam to check for any signs of tenderness or swelling in the ovaries.

2: Ultrasound: This technique uses sound waves to make images, which can help recognize a cyst and provide information about it.

3: Blood tests: Blood tests may be performed to measure hormone levels or detect tumour markers and substances produced by specific cancer cells.

4: Other diagnostic tests: Depending on the type and characteristics of the cyst, additional tests may be recommended, such as a CT scan, MRI, or biopsy. These tests can help provide more detailed information about the cyst and determine if it is cancerous or noncancerous.

It’s important to note that not all ovarian cysts require treatment. Still, a healthcare provider will typically recommend follow-up testing and monitoring to ensure that the cyst is not causing any complications or growing in size.

What can be the Preferred Ovarian Cysts Treatment?

Treatment of ovarian cysts can vary depending on many factors, like type and the size of the cyst, the presence of any symptoms, and the patient’s health and age. Treatment options may include:

Watchful waiting: Small, noncancerous ovarian cysts may not require treatment and may resolve independently over time. In these cases, a healthcare provider may recommend watchful waiting and regular monitoring to ensure the cyst does not grow or cause complications.
Medications: Hormonal birth control pills or other hormone therapies may be used to regulate hormonal imbalances that can contribute to developing ovarian cysts. Pain relievers can also be recommended in pain.
Surgery: Surgery may be necessary if a cyst is significant and causing pain. The type of surgery will depend on the characteristics of the cyst, but options may include laparoscopy or laparotomy to remove the cyst or the affected ovary.
Ovarian cystectomy is a surgical process that includes removing the cyst while preserving the ovary. It is typically performed in cases where the cyst is small and noncancerous, and the individual wishes to maintain their fertility.
Oophorectomy: This surgical procedure involves removing the affected ovary and may be recommended in cases where the cyst is large, cancerous, or causing significant pain or discomfort.

What are Preventions for Ovarian Cysts?

It is not always possible to prevent the development of ovarian cysts, as they can occur naturally and for various reasons. However, some steps can reduce developing ovarian cysts, including:

Hormonal birth control: Taking hormonal birth control, such as the pill or the patch, may help regulate the menstrual cycle and reduce the risk of developing functional cysts.
Regular gynaecological check-ups: Regular visits to a gynaecologist help detect the presence of ovarian cysts early on before they become problematic.
Keeping a healthy weight: Being obese can grow the risk of developing ovarian cysts. Having a healthy weight through a healthy diet and exercise can help decrease the risk.
Managing underlying medical conditions: Certain medical conditions, such as endometriosis and PCOS, can increase the risk of developing ovarian cysts.
Avoiding exposure to toxins: Certain toxins, such as cigarette smoke and certain chemicals, may increase the risk of developing ovarian cysts. Avoiding these toxins can help decrease the risk.

These steps can help reduce developing ovarian cysts, but they do not guarantee that cysts will not grow. It is essential to be aware of the signs and symptoms of ovarian cysts and seek medical attention if any symptoms arise.

What Size of Ovarian Cyst is Dangerous?

Any ovarian cyst that causes symptoms such as pain, bloating, or changes in the menstrual cycle, regardless of its size, should be evaluated. Additionally, ovarian cysts that are larger than 5 centimetres in length or that continue to grow should be closely monitored and may require further evaluation or treatment.

Conclusion

Ovarian cysts are an ordinary condition that affects every woman. While many cysts are minor and do not cause symptoms, some can grow larger and cause pain or discomfort. It’s essential to seek medical attention if you experience any symptoms of ovarian cysts, as early detection and treatment can help prevent complications and improve outcomes.

At Imprimis IVF, we understand ovarian cysts’ impact on a woman’s fertility and overall health. Our experienced team works closely with every patient and develops a personalized treatment plan accordingly.

What are the Five Stages of IVF?

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Five Stages of IVF – Life becomes even more blissful and fulfilling with the appearance of two pink lines on the pregnancy testing kit. These two lines bring a wave of emotions you have never experienced. But due to numerous physical, physiological, and environmental reasons, some couples can not conceive naturally. Medical advancements over the years have helped overcome this hurdle with Assisted Reproductive Technology (ART).

In-vitro fertilization, or IVF treatment, is the most trusted medical procedure that helps infertile couples trying hard for a baby but cannot do so.

However, before going for IVF treatment in Srinagar, it’s essential to prepare yourself by becoming familiar with the five stages of IVF Treatment.

Five Stages of IVF

IVF is a highly complex medical procedure that involves the following five stages of IVF-:

Pre-cycle Testing:

Before IVF treatment, the male and the female must undergo various tests like pelvic examination and transvaginal ultrasounds.

The fallopian tubes and uterus are carefully examined for any issues requiring a diagnosis. It is also known as ovarian reserve testing or fertility testing, which includes detecting sexually transmitted diseases, blood tests for hormonal imbalance, semen analysis, thyroid function, and ovarian reserve.

Stage 1: Ovarian Stimulation and Ovulation Triggering

A woman’s ovaries are home to thousands of ovarian follicles. Each follicle contains an oocyte which is an immature egg cell. Stimulation of the ovaries is the process that prepares the ovaries to produce these eggs. The more eggs, the more favourable the outcome and success rate!

To increase the shares of success, the woman is on hormone medication for 8-14 days. These medications are given as pills, patches, and injections that act on the ovaries to produce or overproduce eggs for fertilization. Also, these medications prepare the uterine lining for pregnancy. On average, 15-30 hormonal medicines in the form of injections are administered to the female.

These IVF injections happen to be quite expensive. The cost of IVF injections and medications for ovarian stimulation is around 60,000-80,000 INR.

Stage 2: Egg Pick Up (EPU) or Egg retrieval

The egg retrieval process consists of using a needle, which is performed under general anaesthesia. As is clear from the name, this stage involves the collection of eggs from both ovaries. It is performed 34-36 hours after the last medication dose or trigger shot. The vagina is adequately cleaned, and the fertility expert correctly examines the ovaries through ultrasound before this stage.

EPU is achieved with the help of transvaginal ultrasounds in which a needle is connected to a suction device. Through the vagina, this needle makes its way into each ovary. The egg (oocyte) is collected from each follicle as the needle enters the ovaries. It takes about 15-30 minutes to retrieve an egg. These retrieved eggs are stored to fuse with sperm harvested from the male.

Stage 3: Sperm Retrieval

The sperm from the male are harvested two-three days before fertilization or on the day of retrieval of eggs.

The various methods available to retrieve sperm from the male are stated below:

Testicular Sperm Aspiration (TESA)
Testicular Sperm Extraction (TESE)
Microdissection TESE (microTESE)
Percutaneous Epididymal Sperm Aspiration (PESA)
Micro Epididymal Sperm Aspiration (MESA)

Stage 4: Fertilization

IVF treatment typically involves the manual fertilization of eggs with sperm ejaculated by the male partner. The necessary condition for fertilization is that the eggs must be mature. The retrieved eggs are examined for mature eggs.

In this stage, the sperm is injected into the eggs collected during stage 2 with the help of Intracytoplasmic Sperm Injection (ICSI) or through conventional fertilization, where the sperm and eggs are placed on a small dish where the sperm is allowed to fuse with the egg on its own. Fertilization is carried out 3-5 days after the retrieval of eggs at a clinic or doctor’s office. The ICSI IVF cost may vary from one fertility centre to another.

Stage 5: Transferring the Embryo into the Uterus

3-5 days after the successful completion of EPU, embryo transfer is carried out. During this stage, a long, thin, and flexible tube is allowed into the vagina, which enters the uterus. The tube is coined as a catheter. The catheter carries a syringe consisting of one or more embryos. One of the embryos is finally placed in the uterus. If the embryo gets successfully implanted in the uterine lining, it will result in a pregnancy.

Embryo transfer takes up to 5 minutes and is performed without anaesthesia as it’s a painless procedure.

After this stage, a pregnancy test is undertaken by the woman after ten days. The pregnancy test is repeated after 7-8 days. The IVF treatment is successful if two pink lines appear on the pregnancy test kit.

Conclusively, IVF treatment takes about 6-8 weeks (45-60 days).

Should you return home and continue your daily activities after IVF treatment?

A common question may strike a couple’s mind after IVF treatment is completed. The answer is plain and simple, yes. There’s no need for strict bed rest after IVF.

It’s for the best that you carry on with your daily activities to keep your mind occupied. Staying positive is the key to turning your IVF cycle successful.

The Success Rate and Cost of IVF Treatment in 2023

The success rate of IVF treatment depends on an array of factors. The success rate of IVF treatment lies between 30-40% for women below 35. For women above 35, the success rate decreases and is witnessed to be around 20-30%.

The average IVF treatment cost, including medical tests, drugs, and the entire process, lies between 1,50,000 to 2,50,000 INR.

The cost of IVF treatment will vary according to the type of IVF treatment, number of cycles, medical tests during IVF, geographical location, and success rate of the fertility centre.

Potential Risks and Complications of IVF Treatment

Even though IVF treatment has one of the highest success rates among all other reproductive treatments, it also has potential risks and complications that a couple must be aware of.

Some of the most common risks and complications of IVF treatment are stated as follows:

Multiple Pregnancies-: Sometimes, the IVF cycle can result in multiple pregnancies, which can lead to low birth weight and early labour and, in some cases, pose a threat to the life of both the mother and the babies.
Ovarian Hyperstimulation Syndrome (OHSS)-: The medications given during the first stage of IVF to stimulate the ovaries to produce more eggs can sometimes result in overstimulation. This overstimulation of ovaries due to medications like human chorionic gonadotropins (HCG) may result in bloating, vomiting, diarrhoea, swelling of the abdominal region, and nausea. This condition is known as Ovarian Hyperstimulation Syndrome (OHSS).
Premature Births-: The IVF procedure can also increase the risk of early labour and premature births.
Ectopic Pregnancy or Extrauterine Pregnancy-: In an ectopic pregnancy, the fertilized egg, instead of getting implanted along the uterine lining, will get implanted somewhere else, like the fallopian tube. Data shows that around 2-5% of women are seen to have ectopic pregnancy after undergoing IVF treatment. If ectopic pregnancy occurs, the couple can not carry the pregnancy to term.
Emotional fatigue-: IVF treatment is more of an emotional ride for a couple, especially a woman. Since the success rate of IVF is around 30-40% only, fear of failure always lingers in a woman’s mind.

A plethora of times, a couple has to undergo more than one IVF cycle. As mentioned, each IVF cycle can take up to 45-60 days. It can build up negative thoughts about conceiving and take a toll on a couple’s mental health.

Bottom line

Five Stages of IVF – IVF treatment is advised for infertile couples who have tried other ART techniques or have had multiple failures. Couples considering IVF treatment must consult the best fertility centre, like Imprimis IVF, Srinagar, for the best consultation. Since IVF is a complicated process, fertility centres like Imprimis IVF also help ensure a maximum success rate.

Female Infertility: Symptoms, Cause, Diagnosis & Treatment

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Female Infertility: Infertility is a medical condition in which a couple cannot get pregnant after having regular sexual intercourse without contraception for 12 months or more. For women above 35, infertility means being unable to conceive after having traditional intercourse for six months.

It can also be defined as the condition where a woman can conceive but either has repeated miscarriages or stillbirths. If infertility is due to the female partner, it is termed female infertility.

Scientifically, during unprotected intercourse, the sperm ejaculated by the fertile male partner swims through the uterus and reaches the egg for fertilization. But the sperm cannot do so because of some ovulatory dysfunction in the female. Or even if the sperm can fertilize the egg, the embryo so formed cannot get implanted in the uterus, which leads to a miscarriage.

Types of Infertility in Females

Female infertility has become a household term affecting 1 in every six women. Infertility in females, or infertility, in general, can be classified into two types:

Primary infertility-: If a couple has never been able to conceive, or even if they have, they could not carry the pregnancy to term.
Secondary infertility-: If a couple has at least one child but cannot conceive for a second time.

Female Infertility Causes

The female reproductive system is quite delicate. Even the slightest dysfunction in any part, namely the uterus, ovaries, or fallopian tube, can lead to issues in conceiving.

The root cause behind female infertility may or may not be detected accurately. The reports may appear normal, but you may still be unable to conceive. However, numerous factors have been witnessed to be the primary causes of female infertility causes which are stated below:

PCOS

PCOS is found to be one of the most common causes of female infertility as it disrupts menstruation and can lead to the formation of cysts which are around 8mm in size. These cysts produce eggs but cannot release them, so ovulation can not occur.

The ovaries regulate the production of estrogen and progesterone. However, sometimes the ovaries produce an excess of male hormone androgens. Polycystic Ovarian Syndrome or PCOS refers to a medical condition that leads to disruption of the menstrual cycle and shedding of the endometrium as a result of hormonal imbalance due to the production of the male hormone androgens.

Uterine Fibroids

Uterine fibroids are found in the form of growths or lumps and are caused due to the imbalance of reproductive hormones, namely estrogen and progesterone. The uterine fibroids can block or damage the fallopian tube, which may further lead to complications in conceiving. Around 20% of childbearing women have uterine fibroids.

Endometriosis

Endometriosis is a medical condition when the uterine lining starts to grow outside the uterine cavity, like the abdomen, pelvis, behind the uterus, or in the ovaries.

This condition can lead to infertility as it doesn’t allow the smooth transfer of eggs from the ovaries to the fallopian tube because of the growth of scars between the ovaries, fallopian tubes, and uterus.

Endometriosis may also lead to endometrial cysts and may prevent the fertilized egg from getting implanted in the uterine wall.

Blocked or Damaged Fallopian Tubes-:

Fallopian tubes are home to eggs. The sperm swims through the uterus and enters the fallopian tube. A blocked or damaged fallopian tube prevents the sperm from reaching the eggs and makes natural conception almost impossible.

Sexually transmitted infections, pelvic inflammatory disorders, pelvic surgery, and pelvic tuberculosis are some of the reasons that block or damage the fallopian tubes.

Around 20% of infertility issues stem from damaged or blocked fallopian tubes.

Hyperprolactinemia

Production of Prolactin hormone in large amounts is referred to as hyperprolactinemia which can result in infertility issues.

Ovarian Cysts

If ovarian cysts (a fluid-filled sac in or on the ovaries) are formed due to medical conditions like PCOS or endometriosis, it may pose problems in conceiving.

Premature Ovarian Failure

Premature ovarian failure refers to the early onset of menopause around or before the age of 40 or 45. It is bound to cause problems in conceiving naturally.

Hypothalamic Dysfunction

Hypothalamic dysfunction occurs when the hypothalamus cannot function optimally. When this happens, the hypothalamus cannot coordinate with the pituitary gland that regulates the timely release of healthy eggs for fertilization. The process of ovulation comes to a stop due to hypothalamic dysfunction.

Ectopic Pregnancy

During a normal pregnancy, the egg, after fertilization, is implanted in the endometrial lining. Ectopic pregnancy, also known as extra-uterine pregnancy, occurs when the embryo gets implanted somewhere else in the uterus. This medical condition may lead to miscarriages. Bleeding is often witnessed during an ectopic pregnancy.

Sexually Transmitted Infections-:

Sexually transmitted diseases can potentially prevent natural conception.

These infections can cause pelvic inflammatory disease (PID) and can also cause damage to the fallopian tubes. Both these conditions are directly linked to infertility in females.

Uterine Abnormalities-: Uterine abnormalities can be the reason behind female infertility. Uterine abnormalities may result from the growth of scar tissues, fibroids, polyps, miscarriage, multiple abortions, infections, and the growth of benign tissues.
Cancer-: Uterus cancer is the primary reason behind the development of tumours of varying sizes. These tumours are found to be one of the causes of female infertility.
Other Hormonal Imbalances-: LH, FSH, and estrogen are the hormones responsible for the timely release of healthy eggs. However, the ovulation process gets disrupted if the eggs are released in the wrong amount and at the wrong time due to hormonal fluctuations.
Unexplained infertility-: When the cause behind infertility can’t be ruled out during the infertility tests in females, this type of infertility is categorized under unexplained infertility.

Data shows that in as many as 10-30% of cases, the root cause behind female infertility can not be identified.

Risk Factors of Infertility in Females

Gynaecologists have drawn up a list of risk factors associated with infertility in females. The risk factors of female infertility include:

Age (above 35)
Drugs and steroids
Excessive alcohol consumption
Smoking
Poor diet
Heavy exercises
Medications
Chemotherapy and radiation treatment
Eating disorders like anorexia, binge eating, bulimia
Unhealthy lifestyle
Stressful regime
Poor Body Mass Index (being underweight or overweight)

Female Infertility Symptoms

Numerous symptoms back infertility in females you can keep an eye on before arriving at any conclusion. Female infertility symptoms include:

Irregular and Abnormal Menstrual Cycle-: If you have irregular periods or your menstrual cycle lasts for more than seven days, it can be a symptom of infertility. A healthy menstrual cycle is of around 21 to 35 days. Reproductive issues may arise If it is less than 21 days or more than 35 days. The irregular menstruation cycle accounts for around 30-40% of cases of female infertility.
Prolonged and Heavy Bleeding during Periods-: If you have heavy bleeding during periods that last for more than the normal range of 2-7 days, it can lead to fertility issues.
Excruciating Pain during Periods-: Bearable pain for a day or two is common, but if your periods are accompanied by severe pain and cramps, it can be due to a reproductive health problem like endometriosis.
Unexplained Weight Gain or Loss-: If you have lost or put on weight unexpectedly, you should get a medical checkup.
Pain during Sexual Intercourse-: If you feel Intolerable pain constantly during sexual intercourse with your partner, it can point towards infertility.
Hair Growth on Unwanted Areas-: If you witness hair growth on unwanted areas like the chest, jawline, and at your back, it may indicate PCOS or other medical problems linked to infertility.
Hormonal Imbalances-: If the hormonal balance in the body is disrupted, it may affect fertility in females and can cause acne, reduced sex drive, and thinning of hair.
No Periods-: Complete absence during childbearing age indicates something is wrong with your reproductive system.

If you observe such symptoms, you should visit a gynaecologist or IVF expert.

Infertility Tests for Females

Before treatment comes the identification of the root cause behind the reproductive ailment. We’ve already learned that female infertility can be caused by many factors that need to be identified. The fertility specialist carries out an array of infertility tests for females to determine the cause, which includes:

Physical examination
Urine test
Pap smear
Blood test
Genetic testing
Ultrasound scan
Laparoscopy
X-ray Hysterosalpingography (HSG)
Hysteroscopy
Saline sonohysterogram

Female Infertility Treatment

After the root cause behind infertility is identified, fertility specialists take other parameters like the woman’s age, personal preferences, and overall health status into account for choosing the right fertility treatment.

Fertility drugs and medications-: Fertility drugs are prescribed to women to stimulate ovulation and regulate irregular ovulation cycle.
Tubal surgeries-: Tubal abnormalities are corrected with tubal surgeries like laparoscopy. Laparoscopy helps treat blocked or damaged fallopian tubes by creating a new opening for the sperm to enter. This surgery also helps treat fibroids and abnormal uterine shapes and remove endometrial cysts.
Assisted Reproductive Technology-: Assisted reproductive Technology like IVF, IUI, and ICSI have helped infertile women conceive and welcome a healthy baby.

Conclusion

Pregnancy is an age and time-dependent process. In today’s world, couples do not prefer having children at an early age which is why infertility is a common problem. So, planning a pregnancy can help you enormously if you want to increase your stakes of natural conception. If you notice any symptom that you think can be problematic, visit a gynaecologist. Also, ensure you maintain a healthy lifestyle to welcome a healthy baby.

And if you want to know more about ART treatment in Srinagar, we welcome you to the best fertility centre, Imprimis IVF.

Male Infertility: Symptoms, Cause, Diagnosis & Treatment

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Male infertility is more prevalent than one might think. We are used to seeing women as the ones with issues, but the contribution of men toward infertility is almost equal.

Fertility in men revolves around three primary parameters, namely sperm count, sperm motility, and sperm morphology. When for some reason, any of the parameters mentioned above is altered, it results in male infertility.

What is Male Infertility?

Male infertility is when a man cannot help his female partner conceive after having sexual intercourse without contraception for 12 months or more.

Statistical Data for Male Infertility

Scientists have stated that infertility in men has witnessed a drastic increase during the past few decades owing to numerous factors.

According to the data put forward by the Indian Society of Assisted Reproduction (ISAR), around 10-14% of Indian couples are affected by infertility issues.

Data shows that one-third of cases of infertility are due to females, one-third to males, and one-third to both males and females.

Infertility is more prevalent in metropolitan cities where people are more exposed to risk factors that pace the way to problems in conceiving.

Understanding the causes and risk factors of infertility in men is essential.

Causes of Male Infertility

Infertility in men is caused due to altered semen parameters, including sperm count, sperm motility, and sperm morphology.

Sperm Count-:

A normal or healthy sperm count means the sperm concentration is more than 15 million sperm/ml of the semen sample. If your sperm count is less than 15 million/ml, it may cause problems in conceiving.

Sperm Motility-:

In simple terms, we can say sperm motility is the ability of the sperm to swim toward the egg for fertilization. Normal sperm motility is considered to be around 40%.

The number 40% signifies that out of the total sperms produced, 40% are efficient enough to swim through the uterus and reach the egg.

Sperm Morphology-:

Sperm morphology is defined as the shape and size of a sperm cell. If there is a problem with the shape or size of the head, midpiece, or tail of the sperm, it may lead to infertility.

Male infertility is associated with many hormonal, physical, psychological, and behavioural problems and risk factors. The causes of male infertility are stated below:

Hormonal imbalance-:

Hormonal balance is vital for the healthy upkeep of the body. However, if the balance is disturbed, this may affect the normal functioning of the thyroid, hypothalamus, adrenal, and pituitary glands. This imbalance can lead to complications in conceiving.

Genetic dysfunction-

Kallmann’s disorder, Kartegener’s disorder, Klinefelter disorder, and cystic fibrosis are commonly witnessed genetic conditions that can lead to infertility in men. Genetic dysfunction accounts for 10-15% of cases of low sperm count.

Varicocele-:

The production of sperm by the testicles is a temperature-dependent process. If the temperature becomes high, sperm production reduces.

The scrotum is that part of the male reproductive system responsible for maintaining the ideal temperature in the testicles. But when the vein in the scrotum gets enlarged, blood flow to the testicles increases, and sperm production decreases. This medical condition is termed scrotum varicose veins or varicocele.

Infections-:

Sexually transmitted diseases and inflammatory bacterial infections can lead to scars that may negatively impact sperm production.

Previous Surgeries-:

Surgeries of the male reproductive system, like the bladder, testicles, scrotum, or the organs surrounding it like the stomach, hernia, abdominal region, prostate, and rectum, can hamper sperm production and fertility.

Excessive Drinking and Smoking-:

Alcohol and tobacco affect sperm motility. Excessive consumption of alcohol and smoking results in defective sperm, poor sexual performance, and deteriorated testosterone levels. However, controlled intake of alcohol and tobacco doesn’t contribute to infertility in men.

Spinal Cord Injury-:

Any injury in or around the spinal cord can lead to infertility issues in men.

Retrograde Ejaculation-:

Normal ejaculation occurs when the semen darts through the penis. But in some cases, the semen enters the bladder instead of flowing out through the penis. This medical abnormality is known as retrograde ejaculation and significantly affects fertility in men.

Testicular Cancer-:

Testicular cancers and even non-malignant tumours adversely affect male fertility.

Trauma-:

An injury, surgery, or bacterial infection can cause testicular trauma. An immune response is triggered in the testes that results in sperm damage.

Hemochromatosis-:

Haemochromatosis is a medical abnormality in which iron gets deposited in the testes.

Drugs and Steroids-:

Drug intake and supplementation have been linked directly to decreased sperm count.

Obesity-:

Being overweight also contributes to male infertility.

Excessive Exercise-:

Exercise helps boost your reproductive health, but excessive exercise is seen to decrease testosterone levels.

Stressful Regime-:

A stressful regime increases your body’s production of stress hormones. This overproduction of stress hormones adversely affects the production of testosterone and other hormones responsible for sperm production.

Symptoms of Male Infertility

Well, a majority of times, male infertility may go asymptomatic. However, there are cases where men witness evident male infertility symptoms that may warrant a medical checkup, including:

Inability to ejaculate
Decrease in volume of seminal fluid
Infected semen (coloured semen)
Pain or swelling around the genital area
Poor sex drive or reduced sexual desire
Erectile dysfunction
Abnormal increase in breast size
Evident reduction in facial and body hair

Diagnosis of Male Infertility

The diagnosis begins with male fertility tests from an advanced laboratory. The second step is to repeat the test from a different laboratory. If both the times the results highlight a problem, seek medical guidance.

Infertility Tests for Males

Conducted to identify the root cause of infertility are:

Semen analysis
Hormone testing
Ultrasound – TRUS
Scrotal Doppler
Genetic testing
Testicular biopsy

You can successfully treat male infertility based on the cause and duration of infertility. There’s no need to worry endlessly about infertility test reports. You can use various surgical procedures to help you welcome a healthy baby.

Surgical Treatment for Male Infertility

Depending on the test reports and cause, male infertility treatment takes into account various reconstructive procedures to restore fertility in men-:

Varicocele surgery
Vasovasostomy
Vasoepididymostomy
Trans-urethral resection of ejaculatory duct

In some infertility cases, surgeries are not required. Medications and lifestyle changes can help bring positive results that boost male fertility.

Surgical Procedure to Help Conceive-:

● IVF-: In vitro fertilization treatment may help conception as fertilization occurs in a laboratory under controlled conditions. Good quality sperm are detected and stored and then fused with the egg. This fertilized egg gets impacted into the uterus or your female partner.

● ICSI-: Another ART is ICSI treatment which stands for intracytoplasmic sperm injection. The best part about ICSI is that only one sperm is required to carry out the treatment. This single sperm is injected directly into the uterus, fusing with the egg and leading to pregnancy.

● Donor Sperm Insemination-: If nothing improves sperm health, you may opt for donor sperm insemination. During donor sperm insemination, a male with good sperm count, motility, and morphology is reached. His sperm is collected and stored. Then this sperm is fused with the egg using ART, resulting in pregnancy.

Sperm Harvesting Procedures

For IVF and ICSI, sperm for fertilization with the eggs are harvested side by side from the male using the below-mentioned sperm harvesting procedures:

Testicular Sperm Aspiration (TESA)
Percutaneous Epididymal Sperm Aspiration (PESA)
Testicular Sperm Extraction (TESE)
Micro Epididymal Sperm Aspiration (MESA)
Microdissection TESE (microTESE)

Conclusion

Male infertility has become as common as female infertility. Data cement that fertility issues due to men are equal to those due to women. But the good news is like female infertility issues; male infertility is also treatable. You need to consult an experienced urologist who can diagnose and guide you. Also, ensure you undergo treatment from a highly trusted fertility centre like Imprimis IVF, Srinagar.

Sperm Morphology

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Your semen analysis reports indicate sperm morphology normal range– of 2%. Chances are you have no clue about what this 2% stands for. And sperm morphology treatment might be a ghost term for you. You are eager to know if this means you are infertile or if there are other concerning issues. Is it possible to figure out what the term ‘sperm morphology’ implies so that you don’t have to go and see a doctor?

Imprimis IVF, Srinagar, will help you navigate sperm morphology treatment and the associated problems, if any.

What is Sperm Morphology

Morphology is a biological term that studies the form and structure of a living organism or any of its body parts. So, when we are using this term with sperm in simple words, we can say that sperm morphology is the study of the form and structure of sperm, i.e. its shape and size.

Every part of your body has a specific shape to perform particular functions. For instance, your blood vessels are designed to have a tube-like shape. And their primary function is to carry or supply oxygen and nutrients to various organs of your body. For some reason, if the condition of your blood vessels gets deformed or there is a blockage in any of the blood vessels, it will lead to severe problems. It will disrupt the whole process of blood circulation.

The same is true for your sperm. Your sperm must be of a specific shape and size. If there is any deformity, it is bound to create difficulties in getting pregnant.

Sperm Morphology Normal Range

The sperm cell is produced in your testes. A sperm has three parts: head, midpiece, and tail.

If all the parts of a sperm cell are of standard shape and size, then it is known as normal sperm morphology. A typically shaped sperm cell has the following dimensions and functions:

Head-: The head of the sperm cell has a smooth oval shape with a pointed front end. The nucleus that carries the DNA of the sperm cell is present in the head.

A normal-shaped sperm is 5-6 micrometres long and 2.5-3.5 micrometres wide.

Acrosome cap-: Acrosome cap makes up nearly 40-70% of the sperm’s head.

A protective membrane surrounds the egg produced by the ovaries. The sperm cell has to penetrate through this membrane to reach the egg for fertilization. The well-pointed acrosome cap is used for this purpose.

Midpiece-: The midpiece of the sperm cell is thinner than its head and provides it with energy to swim.
Tail-: Ideally, the tail is around 45-50 micrometres long. It’s thinner than the other two parts of the sperm cell.

The sperm has to swim through the uterus to fuse with the egg to fertilize it. The tail of the sperm helps it to swim through the uterus.

Apart from this, the head of a customarily shaped sperm should not contain large fluid-filled drops or vacuoles.

Which factors determine Normal Sperm Morphology?

The male hormone, testosterone, is responsible for regulating the production of sperm. It might surprise you, but the male reproductive system also produces the hormone estrogen.

For sperm to have a normal sperm morphology, there must be a proper balance between the production of these two hormones. If this balance is disturbed for any reason, it will hinder the process of sperm formation.

This process of sperm formation occurs at its own natural pace. It takes about 65-90 days for a sperm to be formed. It starts with a single round-shaped cell that slowly grows into the sperm we see in the diagram.

Optimum testosterone levels ensure that as the sperm cell grows, each part, i.e. the head, midsection, and tail, have the proper shape and size. It is due to poor levels of testosterone that result in abnormal shape and size of the sperm cell. Abnormal sperm morphology or teratozoospermia refers to abnormalities or defects in the form and dimensions of the head, midsection, or tail.

Abnormal sperm morphology is characterized either by head defects, midsection defects, tail defects, or in some cases; the sperm is acrosomeless.

It has the following defective characteristics:

Two heads or two tails
An elongated and deformed head
A rough head
The bent, asymmetrical, or irregular midpiece
Bent, short or coiled tail
Vacuolated head

These are some of the abnormalities that occur in a sperm cell.

You must be wondering, is abnormal sperm morphology a matter of concern? Data shows that typically 30-40% of a man’s sperm have abnormal morphology. The problem in conceiving starts when most sperm are abnormally shaped.

You have a normal sperm morphology if your semen sample has 4-14% usually shaped sperm. This range is defined under Kruger’s criteria. However, if it falls to less than 4%, you have a low sperm morphology.

You must note that abnormal sperm morphology is not a parameter that indicates infertility. It simply represents the concentration of typically shaped sperm in your semen sample.

Factors leading to Abnormal Sperm Morphology

Age-:. Sperm morphology deteriorates with your age. The testosterone levels decrease, leading to a decrease in sperm morphology.
Obesity-: As we know, testosterone is responsible for the production of sperm. For sperm to have a normal sperm morphology, the testes must produce an optimum testosterone level.

If you are obese, then your body produces estrogen in high amounts. It leads to the underproduction of testosterone. And it further affects your sperm morphology.

Stressful regime-: If you have a stressful regime, then the amount of stress hormones in your body increases and adversely affects testosterone production. It further reduces your sperm morphology.
Smoking and drinking alcohol-: Excessive consumption of alcohol and tobacco can negatively impact the shape and size of your sperm.
Drugs and steroids-: Drugs like cocaine, marijuana, etc., affect your sperm morphology adversely.
Diabetes-: If you have diabetes, you are at a higher risk of abnormal sperm morphology.

Sperm abnormalities like double heads and round and elongated spermatids are more prevalent.

Genetics-: Heredity plays a role in deciding sperm morphology in a male. The family history of teratozoospermia is likely to be inherited genetically.
Exposure to chemicals-: If you come in close contact with herbicides, pesticides, paints, organic compounds like benzene, and heavy metals like lead, you may have a large number of abnormal sperms.

Abnormal Sperm Morphology Treatment

Sperm morphology treatment starts with a semen analysis. Before concluding anything, it’s advised to go for multiple semen analysis tests from top-notch laboratories to ensure maximum accuracy.

Lifestyle changes that can help boost morphology sperm count

Surgery is not the only option to improve sperm morphology. You can enhance sperm morphology treatment by making small and simple changes in your day-to-day life.

Lose the extra weight-: If you are obese, you must manage your weight to improve your sperm morphology. Maintaining a healthy Body Mass Index will ensure good levels of testosterone.
Bid goodbye to recreational drugs-: Any drugs should be avoided to improve sperm morphology.
Go for loose clothing-: Testes function at a proper temperature. A tight dress can hamper sperm production by increasing the temperature of the testes. I prefer wearing comfortable and breathable cotton underwear for healthy and normal sperm production.
Keep your alcohol and tobacco intake under control-: Yes, you need to limit your alcohol and tobacco consumption if you desire to improve sperm morphology.
Consult a trusted fertility specialist-: People often skip consulting a specialist and start taking medicines blindly without knowing the root cause that needs diagnosis. Reaching out to a good clinic like Imprimis IVF, the best Infertility treatment centre in Srinagar proves beneficial.

As already stated, sperm production takes around 65-90 days. Maintaining a healthy lifestyle for 3-6 months is essential to gather positive results.

Data shows that 90% of the time, You can improve sperm morphology with these simple lifestyle changes. The remaining 10% of cases can rely on treatment options to improve sperm morphology.

Treatments for Poor Sperm Morphology

Certain Assisted Reproductive Technology methods have helped men with abnormal sperm morphology. The most promising and trusted ART treatment methods include:

IUI-: IUI, which stands for Intrauterine Insemination, has helped tackle abnormal sperm count in men with high sperm count and sperm motility.

IUI treatment is cost-effective because a washed or processed sperm is injected directly into the uterus.

ICSI-IVF-: If the sperm count, as well as motility, is low, then in-vitro fertilization with ICSI can help you conceive if you have abnormal sperm morphology.

In ICSI treatment, the egg is fertilized with the help of a single sperm cell. After getting fertilized, this egg is then implanted in the uterine lining.

This method has summoned encouraging results when sperm morphology is as low as 2%.

Final Words

The test results of semen analysis can spark many questions about abnormal sperm morphology treatment. There’s no need to stress about this unknown term sperm morphology. Remember that stress plays a crucial role in the process of sperm production. So it would be best if you keep stress at bay. Consult a reproductive specialist if you cannot stop worrying about the complications of abnormal sperm morphology. Follow a healthy and stress-free lifestyle. It will not only help improve sperm morphology but also help you stay fit in the long run.