Infertility/Subfertility

For the various Obstetrics and Gynaecology Conditions for which women meet me,difficulty in conception is becoming a very common problem.Subfertility or Infertility has always been a problem but seems as if there is increase in the number of these cases.There are many social factors involved with it.Suddenly there are many cases of male factor infertility with a suboptimal sperm count.May be it is stress,may be it is due to increased consumptionof alcohol and smoking,may be it is radiation hazard in the  of too much mobile use(May be your latest gizmo blackberry or iphone or all these android phones flashing at your waist are not being kind on your sprems......so beware).
For females......In metros suddenly the age for first pregnancy has suddenly shifted to 30s.May be it is good for your career but not so ideal an age to start your family.About 10 yrs back by 28 or 29 I remember Ladies getting desparate to start their family.Now I find females who are horrified to find themselves pregnant at 28 or29 ,want a quick abortion and wait for few more years.By that time the now so common PCOD or a endometriosis or for that matter unexplained infertility has loomed in.
Many couples are so busy professionally that they don't find the time to have intercourse at the likely time of ovulation.Shifts are different,one of the partner is travelling et c etc.I am sure a lot of young couples reading this blogpost will relate to what i ahve just talked about.
My heart goes out for these couples who are trying to juggle between a hectic lifestyle,work,take time out for time consuming and costly subfertility treatment.
Ther are certain factors which obviously are unavoidable but atleast a timley planning of pregnancy can decreasequite a substantial number of infertility cases.Remember YOU CAN BEAT NATURE.IT IS SUPREME!!!!May be it is a good idea still to plan your first baby in your mid to late twenties. 

Hormonal imbalance

http://indiatoday.intoday.in/site/story/out-of-sync/1/134558.html


Read this article for information on hormonal imbalance

Facts about Miscarriage

A recent comment somewhere by a patient of mine (Don't know the real name as that person has used pseudonym) that my mistake led tomiscarriage has led me write this post.First of all I am sorry for the loss as Miscarriage is a traumatic event for a couple,but unfortunately 25% of pregnancies end up in miscarriage.Commonest cause is an unhealthy pregnancy.........Nature takes care by eliminating these pregnancies (theory of survival of the fittest).1% of the ladies might have a reason for recurrent miscarriage and need further investigations.
There are certain myths about miscarriages and not supported by any evidence.They are as follows.......

• One needs bed rest to prevent miscarriage.There is no role of bed rest in modern day Obstetrics apart from an incompetent OS(Mouth of the womb).
• Travelling causes miscarriage,unless it is a really bumpy road.
• One needs progesterone and HCG injections to 'support' the pregnancy.No evidence that they support pregnancy.
• Sex leads to miscarriage.It doesn't!!(Penetrative sex is contraindicated if placenta is low lying.)
• Flights cause miscarriage.Modern day aircrafts have a very good pressure control in the craft and is not at all a reason of miscarriage.
• TORCH group are responsible for recurrent miscarriage.
• Driving car causes miscarriage.It doesn't

Conditions which can increase the risk of miscarriage are

• Increasing age of mother (Ladies in their 30s)
• Uncontrolled Thyroid problem
• PCOD
• Any structural defect in uterus
• Small uterus
• Fibroids
• Severe UTI or any other severe infections
• High grade temperature
• Taking certain medicineswhich can have abortificient effect
• IVF or pregnancy after infertility treatment.

A negative feedback by a patient

Person with email id
smartladvicky@gmail.com ,this is a message for you.You have left a feedback for me in click India.com which can only be seen by me and no one else.I am posting your feedback on my blog and would welcome you for an open critisim.If you wish to leave a negative feedback, you are most welcome.

I think you say I am the worst Gynaecologist in Gurgaon and caused you to have miscarriage.
May be I am the worst Gynaecologist in Gurgaon ,I don't know really.But would surely like to know how my 'silly mistake' caused your miscarriage?It will be really very kind of you if you let me know what mistake I did which led to your miscarriage ,so that I can correct it in future.

A happy begining despite Endometriosis

About 2 months back a young lady came to me.She had been diagnosed with fibroid uterus in Singapore and she wished to get a laparoscopic myomectomy done.In India we realised she had  severe endometriosis and big endometrioma in both ovaries.She was all of 26years........quite a young age to start a family for ambitious young generation.
On putting the laparoscope in I realized that things were pretty bad.Her fallopian tubes were distorted very badly.Buried in adhesions and ofcourse two big endometrioma.Rectum was also stuck under endometrial adhesions.I performed an extensive ( Level 5 Laparoscopy on her)At the end of surgery the cysts were out,and tubes out of adhesions and rectum was free.Small out of methylene blue trickled out from one tube.I advised her to start planning her family in the next cycle,try for 3 cycles and then to meet my friend Dr Hemashree rajesh at SGH for an IVF(To be honest I thought she won't conceive without IVF).
Few days back i got an excited call from her to tellme that she had conceived spontaneously but wasn't getting an appointment for Ultrasound or a consultant appointment.
Congrats to her and her husband( Both of them trusted my judgments and didn't go doctor shopping the current trend in Gurgaon).I wish them all the best.
here would like to say,those ladies who defer pregnancy for a career might end up with problemslike her and believe me,a successful carrer is nothing without someone to share with ,importantly your own kids!!
This time it was an happy ending,but it might not be so always.IF you have endometriosis react and take treatment in time.Don't wait for a hysterectomy!!!

'Organic Delivery'

Last month I conducted a delivery.I love to call it an 'Organic delivery'!!Why ORGANIC? Cause everything about it was 'natural'.While describing the incident ,I will try to be non judgemental.And will leave the interpretation of  story for you.............
I came across this lady in one of my OPDs.I remember the first encounter.. Quite early in her pregnancy she was switching over from another consultant to me.I remembered her through out her antenatal visits as the lady who loved to speak and ask loads of questions.My average time spent with her in each visit used to be about 45 minutes(instead of allocated 20 minutes as per the hospital rules) .This used to annoy rest of the waiting patients to no end,as it used to delay their schedule accordingly.In her next visit I used to find that despite talking for several minutes to me she had treated her particular condition in her own way.After a while I realized it was no point getting annoyed by her own way of her antenatal care.It was 'her' and she wanted me to realize this fact.Once without mincing her words she told me,I know I can take care of my pregnancy and my body but I just want your presence.......just in case things go wrong.Fair enough,I thought!!Then she told me a long list of do's and don't during labour.It was an exhaustive list and here I had to put my foot down at the risk of annoying her.Some of her demands were too risky for herself and the baby.Once in her last trimester she had some problem due to which I had to examine internally and realized she was already halfway  dilated.Though this was her second delivery which was likely to be much quicker than her 1st one she wished to go home and let nature take charge.She did tell me quite proudly that her last delivery was also in a triage.(Not an ideal situation to be honest as at times things can go wrong and triage is not the best place to deliver the baby).10 days later when she came back she was getting uterine contractions which she dismissed as some 'grinding'.After a lot of persuation she agreed for an internal and she was almost completely dilated.But she and husband were still not convinced.They want 'labour' to set in.They were convinced that she would go in labour only after a week and she knew her body best(remember she told me so quite early)I didn't know how they would realise that labour has set in if till then she hadn't.I was anticipating a total natural 'bathroom delivery' at home with a push.But thankfully well past midnight she felt some pushing sensation,reported it and myself and my whole team acted like a flying squad.Now what happened during delivery wasn't what I or my neonatologist friend would have liked to do in the best interest of  the mother and the child but we did as ultimately it was her body and her baby.It was just during the 15 minutes of labour I could see both of them little worked up and out of control.But once the baby delivered,they knew best.Proudly they exclaimed....... this time we made it and it was not in triage.
Post delivery I was ordered by her husband 4 days later to take few stitches for her 1st degree perineal tear,which I declined politely till I had seen her in my OPD.It was getting enough for me,It was getting enough for them too,because the all so important world cup cricket needed them to be at home to give the desperately needed moral support to the India team.A follow up visit to a doctor who wasn't listing to them wasn't as important.I know they visited one of my colleague with a request to take the stitches on the condition that she won't be prescribed any antibiotics.The doctor wasn't comfortable to take stitch without antibiotic cover and she advised them to meet me.Till date which is almost more than 3 weeks since the delivery they haven't returned back to me and I know for sure tomorrow they have booked appointment with some other gynaecologist.
What makes me write this post? It is good to know one's body and situation but maybe not so good to be a control freak.I just hope things are fine with her but as there is no follow up visit,I really don't know.

PS : I must appreciate the enthusiasm of the couple.They wished to be so much in control that the lady wished me to teach her husband how to check dilatation so that he can decide the time to bring her to the hospital.