Dr Richa Sharma
In this write up, Dr Richa Sharma (IVF consultant and Physician, Bournhall Intenrational Ltd, answers to the queries of patients.
Q. I am a 31 years old woman weighing 85 kg. I was suffering from tuberculosis of the uterus and two months back, no tuberculosis showed in my PCR test. My left ovary has been damaged, so all hopes rest on the right ovary. Treatment of infertility has started. Earlier, I had 2 missed abortions and one case of dextrocardia in baby for which D and C was done. I am unable to conceive naturally, so the doctor has asked me to go for IUI. My right tube is not blocked and the semen analysis is also normal. Egg is forming well. Can I conceive?
Ans- First you should loose some weight(at least 5%) .As you have one healthy ovary , so its important to know the ovarian reserve by means of ultrasound and blood tests like AH,FSH and EstradiolYou have history of reccurrence of miscarriages so need to be evaluated- by certail panel of blood tests and checking your womb by a procedure called hysteroscopyYou have history of dextrocardia in baby so need to rule out any possibility of recurrence by genetic evaluationBest option in your case is IVF (provided all parameters mentioned above are with in range)
Q2. I am a 30 years old man who underwent semen analysis, which showed: quantity – 2.5 ml, colour -greyish white, viscosity – thick, liquefaction time – 30 min, reaction – alkaline, sperm count-occasional motile sperm seen, pus cells – 2-3/HPF, RBC – nil and epithelial cells – nil. What does this report mean? Can I father a child?
Ans- 2)yes definitely you can father a baby.This report indicates you have very less number of sperms(occasional) which can be used by way of test tube baby only(IVF) .In case sperms are not adequate then we retrieve the sperms surgically by procedures like TESA/MicroTESE.Male infertility is showing a rising trend and we have the solution for this in form of SSR(Surgical sperm retrieval)
Q3 -I am a 31 years old woman and 13 weeks and 2 days pregnant. My doctor said that there is no fetal cardiac activity and fetal movements are also absent so suggested abortion. This has happened for the second time with me (I was 13 weeks pregnant at that time too). I have gone through TORCH IgM test and it was negative. What could be the reasons for fetal cardiac arrest? What should I do?
Ans 3- Its more of a clinical scenario of recurrence as its happening second time. Recurrent miscarriage is a heterogeneous condition that has many possible causes; more than one contributory factormay underlie the recurrent pregnancy losses. 10-15% of all clinically recognised pregnancies end in a miscarriage.There are multiple reasons- like anatomical, genetic,endocrinological reasons, immunological factors and even environmental factors like smoking and drinking. In short ,it can be problem in egg/sperm/embryo or in the womb Or in some cases can be due to medical problems underlying so we have to investigate all aspects for a better treatment option.
Unfortunately in some(50%) segment of cases, its Idiopathic(means cause cant be detected).
First thing. TORCH is no more a recommended test in such cases. Rather there are a panel are tests which are advisable
Recommended Invstigations are-
1. Hysterosalpingography/ Hysteroscopy
2. APTT/ dRVVT/ Lupus anticoagulant
3. IgG & IgM anticardiolipin antibodies
4. TSH / Prolactin / Testosterone / HbA1C/ 2 hrs Post Prandial INSULIN
5. Karyotyping of both parents &
6. If possible abortus
And in selected cases-
1. ANDROGENS, LH, FSH IN PATIENTS WITH IRREGULAR MENSTRUATION
2. SERUM PROGESTERONE
3. EB FOR DATING & TB PCR, CULTURE
4. SERUM HOMOCYSTEINE LEVELS / THROMBOPHILIA SCREEN
5. HVS / WET PREP & pH / KOH Whiff test
6. SEMEN CULTURE / TB PCR
Besides that ur womb shuld be checked by a procedure called- Hysteroscopy with EB PCR test
This all to rule out pathology and accordingly take a call.
Q4- I am a 24 years old woman and married for 3 years. My weight is 62 kg and height is 5 feet. I have gained some weight since marriage. Now I am trying to conceive. I have started facing some problem with my periods. I had my periods in 45 days about 5 months back. After taking several tests, the doctor told me that my ovum walls are little thick and then suggested a course for conception. I took some medicines and injection for my ovum walls. My sonography showed that the eggs were released but we failed to have intercourse by that time. Now we have been trying to have relations between 10th & 22nd day of the cycle but till date I have not succeeded. I have reduced 2 – 2.5 kg weight. What should I do to conceive? Should I wait for some more weight loss or should we again go for tablets and injections.
Ans 4-It’s a case Of PCOS- which needs help in form of ART
PCOS is the most common metabolic abnormality in young women today, occurring in 10 – 30 percent of women of reproductive age. It can exist without clinical signs of the syndrome, which may then become expressed over time. Multifactorial disease with full clinical expression being the result of synergistic pathological interaction of genetic, epigenetic and environmental factorsAs ovulation doesn’t happen ontime due to the hormonal imbalance with more of the androgens and insulin levels making ovaries bit difficult to respond.
Key to Successful treatment depends on ability to reduce body weight by life- style modifications which include diet modification and exercise. Stress management also forms an important part of the treatment. Weight loss before infertility treatment improves ovulation rates in women with PCOS
The ideal amount of weight loss is unknown, but a 5% decrease of body weight might be clinically meaningful.
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