Thyroid & Fertility Connection | Pregnancy & Fertility In Thyroid Disorders

ObGyn Reacts to Fit Tuber’s PCOD Diet Plan @Fit Tuber

https://youtu.be/pA4bpuSyDpc

Dear friends ,

I have started my YouTube channel Ladies Doctor on women health issues and the first post is on Pre Pregnancy visit. If you like the video do subscribe the channel as I hope to post videos of patient interest in future. Feedback’s, comments and suggestions are all welcome .

Muhurat IVF

This one came as a surprise to me.I am not for or against it but this particular request left me wondering or atlas gave me food for thought.Have encountered the request for muhurat for Embryo transfer but this one was unique.First of it's kind.
Somebody requested me to time the time when retrieved egg was mixed with the Sperm.As per that gentleman this was the correct time based on which the astrological findings were based in a human beings life and not on the time of birth.

Now if thats correct then all our Janam Patri's are incorrect and so the astrological readings.In that case Muhurat Caesarean is a thing of past.More over in  natural conception we don't know the time when actually fertilisation took place.And unless ICSI even in simple IVF we really don't know the exact moment of fertilisation.
Oh God....that's too complicated :) Anyways ,as long as it doesn't do any harm or too cumbersome,I think we can keep guessing the right Muhurat and try best for our Children as well as future children.What's the correct time in case of a FET ??
Interesting is all what I can say :)

Dr Kaushiki Dwivedee,a self feedback

Few years back I gave my own feedback for the patients to understand my working style and thus find it easier to choose or relate with me or not relate with me.It did help them as well as me.

Now I realise that I am a changed person than what I was till 2014 and thus it would be appropriate that I do my self assessment correctly.


Previously I used to go through each and every online report of each of my patients and advise them as well.Now I don't do it at all.As per supreme court of India it is a punishable offence if a doctor trees a patient without making a diagnosis.There are many cases where doctors tried to helped their patients and ended behind the bars as they had treated online without seeing the patient in person.

I was always bad in picking up phone calls as that I found really irritating while you are attending one patient,you ignore her and start talking to some one else but I used to be good in reverting back at text messages.Now I have delegated this duty to my colleagues dr Ankita Mittal and Dr Pooja Marwaha who keep you informed as well as I know what is going on with you.

For your treatment i am always there whether a cold case or an emergency as before.

One more differenceI travel abroad quite a bit.my commonest destination is Australia ,which i have to visit to maintain my FRANZCOG degree as well as to become an Australian citizen as well .So this December and march 2019 I would not be in India to complete my required number of Australia stay.After March 2019 I shall not be going out as frequently.In my absence Dr Ankita and Dr Pooja are in a situation to take care of you at Artemis hospital.

Though I am unable to make every person a happy person,we still try to be ethical and honest with our work.

Infertility Workup - What it involves ?

0. What is an infertility evaluation?
   An infertility evaluation includes exams and tests to try to find the reason why you and your partner have not become pregnant. If a cause is found, treatment may be possible. In many cases, infertility can be successfully treated even if no cause is found.
   When should I consider having an infertility evaluation?
   You should consider having an infertility evaluation if any of the following apply to you:
   
   • You have not become pregnant after 1 year of having regular sexual intercourse without the use of birth control.
     
   • You are older than age 35 years and have not become pregnant after trying for 6 months without using birth control.
     
   • You are older than age 40 years and have not become pregnant within 6 months of trying without using birth control.
     
   • Your menstrual cycle is not regular.
     
   • You or your partner have a known fertility problem.
     

Evaluating Infertility

What type of doctor does an infertility evaluation?
Your obstetrician–gynecologist (ob-gyn) usually will do the first assessment. You also may choose to see a specialist. Infertility specialists are ob-gyns with special training in evaluating and treating infertility in women and men. These specialists are called reproductive endocrinologists. Men also may be evaluated and treated by a urologist. Some urologists have special training in male infertility.
What causes infertility?
The most common cause of female infertility is lack of or irregular ovulation. The most common causes of male infertility are problems in the testes that affect how sperm are made or how they function.
Other factors in women include problems with the reproductive organs or hormones. Scarring or blockages of the fallopian tubes may contribute to infertility. This may be the result of past sexually transmitted infections (STIs) or endometriosis. Problems with the thyroid gland or pituitary gland also may contribute to infertility. In men, blockage of the tubes that carry sperm from the testes may be a cause of infertility.
How does age affect fertility?
For healthy couples in their 20s or early 30s, the chance that a woman will become pregnant is about 25–30% in any single menstrual cycle. This percentage decreases rapidly after age 37 years. By age 40 years, a woman’s chance of getting pregnant drops to less than 10% per menstrual cycle. A man’s fertility also declines with age, but not as predictably.
Can lifestyle affect fertility?
In women, being underweight, being overweight, or exercising too much may be associated with infertility. In both men and women, drinking alcohol at moderate or heavy levels may be a factor in infertility. In men, smoking cigarettes and marijuana can reduce sperm count and movement.
What should I expect during my first visit for infertility?
The first visit with a fertility specialist usually involves a detailed medical history and a physical exam. You will be asked questions about your menstrual period, abnormal bleeding or discharge from the vagina, pelvic pain, and disorders that can affect reproduction such as thyroid disease. You and your partner will be asked about the following health issues:

• Medications (both prescription and over-the-counter) and herbal remedies
  
• Illnesses, including STIs and past surgery
  
• Birth defects in your family
  
• Past pregnancies and their outcomes
  
• Use of tobacco, alcohol, and illegal drugs
  
• Occupation
  You and your partner also will be asked questions about your sexual history:
  

• Methods of birth control
  
• How long you have been trying to become pregnant
  
• How often you have sex and whether you have difficulties
  
• If you use lubricants during sex
  
• Prior sexual relationships
  What tests are done for infertility?
  Tests for infertility include laboratory tests, imaging tests, and certain procedures. Imaging tests and procedures look at the reproductive organs and how they work. Laboratory tests often involve testing samples of blood or semen.
  What does the basic testing for a woman include?
  Laboratory tests may include a urine test, a progesterone test, thyroid function tests, a prolactin level test, and tests of ovarian reserve. Imaging tests and procedures may include an ultrasound exam, hysterosalpingography, sonohysterography, hysteroscopy, and laparoscopy. You may not have all of these tests and procedures. Some are done based on results of previous tests and procedures. You also may track your basal body temperature (BBT) at home.
  What is the purpose of tracking basal body temperature?
  A woman’s temperature increases around the time of ovulation and stays elevated for the rest of her menstrual cycle. To track ovulation, you will need to take your temperature by mouth every morning before you get out of bed. You record your temperature on a chart for two or three menstrual cycles.
  Charting monthly temperature changes can confirm ovulation but it cannot predict it. Some women also monitor their cervical mucus while charting BBT. Just before ovulation, a woman’s cervical mucus becomes thin, slippery, and stretchy. Cervical mucus monitoring is a natural way to help a woman identify her most fertile days.
  

What do results from a urine test determine?
A urine test determines when and if you ovulate by detecting an increase in the levels of luteinizing hormone (LH) in the urine. A surge in the level of LH triggers the release of an egg. If the test result is positive, it suggests that ovulation will occur in the next 24–48 hours. This gives you an idea of the best time to have sex to try to get pregnant.
How is a progesterone test done?
For a progesterone test, a sample of blood is taken about 1 week before you expect your menstrual period. The level of progesterone is measured. An increased level shows that you have ovulated.
Why would a thyroid function test be done?
Problems with the thyroid gland may cause infertility problems. If a thyroid problem is suspected, levels of hormones that control the thyroid gland are measured to see if it is working normally.
What is a prolactin level test?
This test measures the level of the hormone prolactin. A high prolactin level can disrupt ovulation.
What are tests of ovarian reserve?
The term ovarian reserve refers to a woman’s supply of eggs. Blood tests are used to check the remaining number of eggs.
Why are imaging tests and procedures done?
Different imaging tests and procedures are used to look at the uterus, ovaries, and fallopian tubes to find problems. Some procedures also are used to treat certain problems if they are found. The procedures that you may have depend on your symptoms as well as the results of other tests. Common imaging tests for female infertility include the following:

• Ultrasound exam—This test can predict when ovulation will occur by viewing changes in the follicles.
  
• Sonohysterography—This special ultrasound exam looks for scarring or other problems inside the uterus.
  
• Hysterosalpingography—This X-ray procedure shows the inside of the uterus and whether the fallopian tubes are blocked.
  
• Hysteroscopy—The procedure uses a camera with a thin light source that is inserted through the cervix and into the uterus. This can show problems inside the uterus and help guide minor surgery.
  
• Laparoscopy—This procedure uses a camera with a thin light source that is inserted through the abdomen. This can show the fallopian tubes, ovaries, and the outside of the uterus.
  What does the basic testing for a man include?
  Testing for a man often involves a semen analysis. This analysis is done to assess the amount of sperm, the shape of the sperm, and the way that the sperm move. Blood tests for men measure levels of male reproductive hormones. Too much or too little of these hormones can cause problems with making sperm or with having sex. In some cases, an ultrasound exam of the scrotum may be done to look for problems in the testes.
  How long does it take to complete an infertility evaluation?
  An infertility evaluation can be finished within a few menstrual cycles in most cases. Some insurance companies may cover the cost of an infertility evaluation. It is a good idea to call your insurance company to find out before you start your evaluation.
  

Why do IVF Cycles fail ?

A question which is often asked by my patients after a failed cycle despite my pre IVF cycle priming and counselling.It is frustrating for Patient and doctor alike when an IVF cycle fails.I don't make any claims of having a fantabulous IVF success rate.Till date any one quoting it anything more than 35 - 40 percent isn't telling you the complete truth.

Let us first understand the reason that why is IVF such a wasteful process.Every month around 300 follicles undergo degeneration as they are unhealthy.By giving gonadotrophin we are forcing them to grow and mature but that doesn't necessarily means a successful implantation or conception or live birth.

Let me discuss a case scenario.A 35 years old Lady with PCOD in whom I retrieved 12 embryos.7 became blastocysts.And can you imagine how many of them were actually healthy? It is shocking .We got Pre implantation genetic testing done .And there were just 2 which were not having any chromosomal anomaly.Which means 10 of these embryos would have either not got implanted or would have miscarried or we would have needed to terminate the pregnancy.

So it is unhealthy eggs and thus embryos which are the reason of the disappointing results that IVF provides.It is no one's fault.Not of your IVF specialist and not of you who can blame inadequate rest for failed cycle of hers. Relax.Plan early.Plan your pregnancy in time.And if you don't have a partner at right time ,Freeze your eggs,If you have a partner ,Freeze your embryos as we have got more experience of freezing embryos than freezing eggs.

How Much does IVF costs

How much will it cost me?This is the most common question asked by Couples who come for IVF.
I will try to be as clear as possible in answering this question.

First of all it is important to know what all an IVF cycle involves and then it will be easier for you to understand it.

Here I have not included the cost of investigations.

The first process is controlled ovarian Hyperstimulation which involves medicines which are costly.The cost of the medicine would depend on the need of your body.Some women need less medicine and some need more medicine to get similar degree of stimulation.But if you keep an estimate of INR 75,000 plus minus INR 10,000 it would be quite close to what you would eventually spend.

IVF involves Ovum pick up and embryo transfer.Both these procedures need IVF lab and OT.It also involves skills of embryologists apart for the infertility specialist.This amount varies from IVF centre to IVF centre.A good IVF lab needs good quality control and that has big role in determining the success of an IVF programme.A decent IVF lab would charge you around a Lakh.

If you decide to freeze the embryo,it would be another 30-40 thousand INR and you should find it out at the IVF lab .

If you decide to get a PGT done it comes quite costly as not many centres perform this procedure currently.The one I am associated with and provides this facility ,they charge 1.85 Lakhs ( over and above the 1.75 lakhs for the medicine and the procedural charges for IVF))

If it involves Ovum donors the ovum donating agency usually charge 80000 to 1.2 lakhs for a decent educated and pleasant donor.

Semen donors charge less.

This isn't a comprehensive list but just rough estimate of what you need to be ready with when planning an IVF cycle.The costs can be less or more depending upon the IVF centre you choose.

Surrogates can cost around 8- 10 Lakhs apart for the delivery expenses.

I have blocked Fallopian Tubes

Blockage of tubes.Does it sound familiar.Well you might have come across the term on one of the so many infertility help groups or blogs or Google in general where a female might have mentioned it as her cause of infertility.

What tubes do? They carry the egg released from the ovary in the tube where it gets fertilised by the sperm and moves into the uterus.If tubes are blocked this essential step won’t happen normally in the body.Why tubes get blocked.Most of the time we don’t find a reason but the common ones are previous pelvic infections.In India pelvic Tuberculosis is a common condition but still not as common as suspected by the IVF specialists.Other infections can be chlamydia or other sexually transmitted infections and the disease called endometriosis.

There are many such stories to talk about but I will choose one such case history randomly to make you understand more about tubal factor in Infertility.

A couple came to me for infertility investigations.What I found on Sonosalpingography i.e passing the saline through the tubes while observing it with an ultrasound machine that the tubes were bilaterally blocked.So now if there is a block ,what do you do?

Open the tubes or proceed for IVF where you bypass the need of tubes by fertilising the eggs outside the body.Of course I got her tested for genital tuberculosis as well as gave her azithromycin tablet just incase she had Chlamydia( After all a tablet of Azee comes cheaper than the test for Chlamydia).So there was no evidence of genital tuberculosis .

In modern day infertility treatment tubal surgery unless very minimal has got no role.Opening of tube doesn’t mean that the doctor has been able to restore the normal functioning as well as structure of the fallopian tube.Which would simply mean that you are not sure even if the doctor has opened the tube still you will get pregnant or not.There is also an increased chance of Tubal or ectopic pregnancy.So no doctor who follows evidence based medicine will give you an option of ‘opening the tube’.

The more realistic and cost effective treatment is IVF.Only 35 % but still it is a realistic option of conception per cycle.Even in IVF there is 4% increased chance of ectopic pregnancy that spontaneous conception but still it is better option than a tubal surgery any day.

Now this couple insisted upon tubal surgery and I did perform a hysteroscopic cannulation and laparoscopic fimbrioplasty.It opened one side of the tube.But was it the correct treatment.No it wasn’t. At least it isn’t the evidence based option.If I think in terms of my monitory benefit it is all good but probably that wasn’t the idea.the idea was to help them conceive.But who knows whats in store for her.miracles happen and if by chance the sperm sneaks in through that tube it was the wisest decision on part of the couple.If they failed or if she has an ectopic pregnancy,few more years would be wasted.Eggs would be little more old.More chance of having aneuploidy and chromosomal defect.Poor IVF response and if she conceives more chance of miscarriage.

Fingers crossed and let me hope she conceives.

Safe Age to get pregnant

It has been a long gap when I am trying once again to revive this blog.It was writers block or some fear or sudden maturity about the big bad world of social media or unwarranted trolling (trolling is always unwarranted) which prevented me from writing this blog.Previously I used to write what I used to feel,uninhibited and suddenly there was this apprehension.I was uncomfortable to bare my inner self to the whole world.I can't pretend and at the sometime I wasn't being able to be me.

I think I need one more chance and probably this time I shall be lucky.

Those who know me I was a general Obstetrician and Gynaecologist who extended my self to IVF and infertility treatment as well after a formal training in Australia.After more than 4 years I feel more attached to infertility management than delivering babies.Not that my skills are lost as I have been practising Obstetrics as heavily as before but it doesn't excite me as much as a professional as it used to before.

I shall start covering Infertility related topics one by one in a story line format to maintain the information quotient as well as to keep it interesting.

I live in a Metro called GURGAON or GURUGRAM. It is a modern Indian city,very polluted but still modern.The women of this city are smart ,fit and healthy.They take care of themselves,exercise,take vitamin supplements.Practice yoga and medication.Eat quinoa,Sushi and Chia ( All exotic and organic).All good ...isn't it.But something is going wrong terribly.In order to achieve this and more they are deferring there first pregnancy till late age.

It is true you have a toned body of a 25 years old at 35 years old.You look damn good and exotic.You are a Gurgaonmom and entrepreneur and successful.But have you been able to fool the time? No you haven't been.Your Ovaries are ageing.The best time to get pregnant is 20s.In 30 s your fertility starts to decrease and after 35 years the decline in fertility is fast.

The incidence of Aneuploidy meaning increase or decrease in the chromosome number in your egg increases.Leading to unhealthy eggs and embryos.You will face increased risk of miscarriage and will have decreased chance of pregnancy.

If you are in your early 30s ,try for conception for 12 months and if still unsuccessful meet an Infertility specialist.If you are between 30 years to 35 years ,are known to have irregular periods or scanty periods or endometriosis or any other health concern,meet the infertility specialist after 6 months of failed trail of conception.

if you are 35 years or  more , you might look 22 years old.But still don't fool yourself.Your ovaries look like that of a 35 years old.Devoid of follicles with decreasing egg quality.Meet the infertility specialist within 6 months of failed trial.

You might conceive spontaneously or with the help of IUI or might need IVF.Let your Infertility specialist decide.

For males also fertility decreases with increasing age but the decline isn't as fast as in women and males can father children even in their 60s and 70s while a women can ovulate after menopause.

https://www.reproductivefacts.org/globalassets/rf/news-and-publications/bookletsfact-sheets/english-fact-sheets-and-info-booklets/Age_and_Fertility.pdf

Swine flu vaccine in pregnancy

Laser for fibroid removal

LASER sound fascinating .A laser surgery sounds so exotic and as a MBBS students mention of LASER in the surgery mage it sound really impressive to my ears too.

Recently,my husband Dr Shalabh Mohan started LASER surgery for Piles and fissure and whole lot of general surgical conditions.And that made me curious as usual.Can I use it for my patients in any possible way to make the treatment better?I know vulval warts and skin tags can be removed -but I can it be for something more?

And then came A lady from Punjab.Rather her son got her to me.She had visited PGI Chandigarh and was advised removal of uterus.On examination I found a big cervical fibroid.Question was - Doctor can I avoid Hysterectomy?

I said probably yes with a cervical Myomectomy but with this big Fibroid the bleeding can be quite heavy and suddenly I remembered the friendly Diode Laser sitting next to the study table at home.Oh yes - we can.We surely can.Laser minimises the bleeding and the fibres can reach those nooks and crannies which isn't possible otherwise.So that what she wanted - a laser surgery.Getting an approval from her insurance company was a hassle.Insurance company wasn't willing to pay extra even if it meant less blood loss and early recovery.But still she wished to get the surgery done and I did perform.

With the ease of the LASER the 6cms fibroid was out and away in 1
5 to 20 minutes.The blood loss wasn't even 50 mls and the Lady had left for her home in 4 days.
How did I feel - surely ecstatic...it was a job well done.

IVF and the stimulation story

I was trying to explain a very old loyal patient of mine today.For an IUI I can't give you FSH in a dose which hyper stimulates you.And she said why?I said - see that can triplets or quadruplets which can complicate the pregnancy besides Ovarian hyper stimulation which can be dangerous for your life.And her response was -whats the harm in having triplets.In my current state I am willing to take all these possible risks.Well....her current state is a secondary sub fertility.Has a cute little child already.

So what it means is that sub fertility a 'disease' which leaves a couple so vulnerable and desperate that one is willing to take all the risks.

I have another lady under my care.Pregnant with an IVF conception.The dose at which she was stimulated was unheard of.And I had asked -so didn't you get OHSS? She said-yes I did.Was even admitted in ICU for few days,but she still had a sense of satisfaction on her face,as if to say,'' doesn't matter ,it was a small price to have baby'.

It becomes a dilemma as an infertility specialist.What is justified?Infertility treatment is nerve wrecking and costly-an emotional roller coaster too.Low dose stimulation means less eggs but then how can one be oblivious to the mothers health and life.But at the same time a low harvesting of egg means a possibility of repetition .

The evidence based and safe answer is still mild stimulation but I just wonder to a couple badly desirous of conception does this makes any sense?

Probably not for most Indian couples.

I am scared Doc!!

Not uncommonly ,couples visit me with a particular complaint after many years of suffering in silence.Health is a state of physical,mental and emotional well being.And unfortunately these co uples though physically healthy have severe emotional issues.

A typical history is where the male is a considerate person and the woman has a fear of painful sex and they are unable to consummate the marriage despite being in relationship for many years.
Most of the time the Lady doesn't have any problem locally but it is the 'fear' .

If you have tried every possible conservative method in the world and still are unable to overcome the fear,visit a Gynaecologist who has some knowledge of urogynaecology. After examination it can be ruled out if there is a local problem and that can be fixed.If there isn't any anatomical problem,then a vaginal dilatation can be performed under anaesthesia.It works as the lady knows that now the dilation has been performed and that helps them overcome the fear.

Lot many time if there is a local scarring an operation called fentons operation which widens the vagina is useful.It is a kind of vaginal reconstructive surgery .

Those who have never faced this issue might find this post surprising but for those it is a real concern,their life is muddled with a problem which they find difficult to share with anyone easily and keep on suffering.

Chronic Vaginitis

Nothing can be more frustrating that a constantly itchy vagina with a fungal or bacterial infection.What increases the frustration further is one has already visited the best of gynaecologist in the town,has had many courses of anti fungals,antibiotics,many pessaries,potassium permegnate solution and all sort of ph maintaining washes.

By now many sufferers start thinking that their martial life has gone for a toss or they themselves are mentally ill.

Is there anything which still remains to be tried?As a hope of relief comes Boric acid capsules which can be used vaginally for 14 days to get rid to resistant fungal of bacterial infection.Next time you have a similar condition under your Gynaecologist's supervision do try .It should be used as 600 mgs pessary.In India it isn't easily available ,so you can try this product from Amazon which I recently searched online for one of my patients.

Book to read while Pregnant

Many a times Pregnant women ask we the book or books they should read while pregnant.Those who have been my patients know that I give an elaborate handbook ( What to expect when expecting)to all the moms under my care which answers most of the FAQs.Still if you wish to read further you can read this book available on Amazon.This book is good.Also covers lots of Pregnancy complications which many a pregnant women tend to imagine themselves with all possible complication while reading this book.Avoid that and then it is a nice book to read and understand pregnancy.

Stressed ???

Stress - It isn't uncommon word or rather it is an extremely common word.
Atleast 50 % of my patients are stressed.It leads to whole load of health problems.It has contribution in infertility,metabolic syndromes like PCOD,irregularity of periods,discordance in sexual and marital life and so on and so forth.

But why are we stressed? Who is responsible?Is it us?Is it our surrounding?Is it multifactorial?
Who can help us?How can one help oneself?

I am writing this post for two reasons.One -this is a very commonly asked question.Second-I think ,I am qualified to write it now.A stage in life where I can say I have learnt to handle situations in life in a way which has reduced the stress levels to a minimum.

Not long back I was a typical type A personality who was driven on adrenaline.Even today I am a type a Personality but I have learnt to tame that type A person in me.I let it be awake when I need it but at other times I make it have good rest.Yes....thats correct you need to take good rest,detach yourself from the mad rush around you to perform more effectively and more productively .

After so many years in my profession and also my life,I realize,events are predestined.Though one should give one's best in whatever one does,nothing is in one's hand.Once I could feel this and make myself believe in this theory 70 % of my stress was relieved.Secondly ,the definition of success has changed for me.It no longer means the biggest player in the market ( number wise).I enjoy what I do.But excess of anything is bad,including enjoyment.The moment one increases one's work load beyond a certain limit the performance and productivity falls down.Recently there was a Lady admitted under surgeons for some general surgery related problem.She had an incidental ovarian cyst as well which she wished to get removed in the same sitting.Now due to whatever reason,it was convenient for the surgeon to operate the Lady late in night around 10 pm.In my opinion elective surgeries are best done in elective hours for best outcome.So what I did was I refused to operate .That lady had not come for me.For her it didn't matter who the treating gynaecologist was and thus I requested the surgeons to call some one else,which they did.

I saved myself from a stressful situation.Previously I would have operated her even at 10 pm in the night against my own wishes and belief and a tired body and mind.It would have given me 12 - 13 k but I would have lost my health and sleep and of course would have been an unsafe tired surgeon.

It is just an example .The situations are varied and you will have to find your ways to minimize your stress levels.

Another change - now when in theatre I am not worried of the waiting list in OPD.Things need to be prioritized.An emergency or on going active surgery takes priority over an OPD patient.If unhappy to wait,there are other consultants available around and am sure they can be taken care of.There is no point trying to be omnipresent. 1300 OPD fees ,isn't worth a complication in OT or a law suit in court.

INR

Now my own health is my priority.I insure to take 2 to 3 hours out for me in my 24 hours for my health and exercise.All the joys and pleasures in the world can be felt only till we have a healthy body and mind for which it should be treated as a temple and should be worshipped.

Lastly ,now i don't think any loss is irreparable accept the loss of life .So ,I don't fear the future.There is no question as what next?

These are few of the changes ,which I think has helped me immensely.Try to incorporate in your life and see if that helps an irregular period or a failing marriage or dry sex or endometriosis or makes you conceive .

I have got thyroid dddd !!!!!

Are you also worried ,you have got thyroid'? If the answer is yes then we need to know a bit more about thyroid.And what do you mean when you reach the doctor to tell'you have got a thyroid"
Thyroid is intact a gland in neck region of all of us unless surgically removed.It is present since birth.Due to various reasons it can under function when Pituitary gland ,a gland in brain starts producing more TSH and you suffer from Hypothyroidism.

On the contrary if Thyroid is overactive and produces more thyroxine,less of TSH is needed and produced by the pituitary.That is called Hyperthyroidism which is less common but more serious issue then Hypothyroidism.

In Pregnancy the cut off for TSH is 2.5 If the concerned Lady has anti thyroid antibody and TSH level is between 2.5 to 10 mu,even then thyroxine supplement is needed to prevent potential complications like mental retardation ,miscarriage ,if Anti thyroid antibody is negative,no supplement is needed between TSH values 2.5 to 10.Any value measuring 10 and above needs thyroxine supplement.

( Based on American Thyroid society guidelines 2017)

Normal Delivery or caesarean ??

You are Pregnant.Are you ?Most likely you are if you are reading my post or are planning it real soon.Or may be you are not.Pregnancy and delivery are facts of life which most of the women go through with great apprehension,enjoyment ,doubts and at times confusion.

It is a quite frequent question - Doctor ,which one is better -normal or Caesarean section ?Well well,may be few years back my answer would have been 'of course vaginal delivery if you can manage it safely'.Still my answer is more or less the same but my attitude to it has changed slightly.I don't know whether it is right or wrong but it is changed for sure.I will share my thoughts and the reason behind it.

Before I write what I feel,let me tell my interpretation of high Caesarean section rate in corporate hospitals.It isn't certainly not for money making.No doctor is paid more for doing Caesarean vs normal delivery.Hospital probably gains marginally from caesarean section but atlas I haven't been told my anyone and I mean no one in either of the the two hospitals I have worked to perform a single un indicated surgery.The most common reason is a scared doctor,scared of things going wrong during the long process of labour and at times not to wait the long hours of labour and get tied leaving rest of the chores and social life and responsibilities and at times a busy OPD.

Now coming back on track,Vaginal delivery is good.Caesarean is good too.Vaginal birth after caesarean section is no less good.But what is bad then ?Bad is when a procedure is done against the wishes of the Lady and if it is unindicated. Now a caesarean on demand of a lady without any Obstetric indication isn't unindicated. The Lady needs to know pros and cons of all the three methods and after that whatever she decides is a correct decision.

Not many of us give a unbiased we including me.Vaginal delivery is the normal process which nature wanted.But has caesarean got certain advantages over it ? Probably yes.With vaginal delivery there is for sure more chances of weakness of the pelvic floor in long run with an increased chances of urinary leakage,pelvic organ prolapse.It is not to be mistaken with me saying ,women who delivered by caesarean won't or can't have these problems.If the baby size is too big and if it is a traumatic delivery it can have long lasting impact on your pelvic wall as well as the baby.Again i am not saying ,it is rule of thumb but it can happen.

Now caesarean - well it has many disadvantages too.Recovery is longer than vaginal delivery for sure but it isn't a long long process but there is increased risk of adhesions,injury to bowel and bladder,infection,ectopic pregnancy,placenta praaevia and increased possibility of caesarean section in future pregnancy.

Vaginal birth after caesarean section can be achieved in 60 to 80 % of women who had previous caesarean section.But if any female decides an elective caesarean after a previous caesarean is also not an insane decision.VBAC has a risk (1%) of previous scar giving way during labour and that risk increases if we need to use any drip -syntocinon or Prostaglandin gel either for induction or augmentation.The lady needs to take an informed decision whether is wishes to take the risk of repeat major surgery or the scar giving way.

Now you know,when I see dispassionately which I wasn't able to do before due to my NHS training which  then recommended -Normal delivery rate of 80%,I don't think either of the mode of delivery is bad.It is all about choices.But what I do disapprove is ,if the woman wants a vaginal delivery and can achieve one safely to convert it into a caesarean.


If any one of you wish me to write any further posts on this issue or any other please do write back .

Genital Warts

Genital warts aren't uncommon.I am frequented by Ladies who have developed warts and aren't sure what it is or they have done so much internet surfing that the are too stressed by the time they visit a specialist.
Genital warts are caused by Human Papilloma Virus,the same virus type which causes cervical cancer but having said that Vulvar warts aren't equal to cervical cancer and thus detection of a wart shouldn't be a cause of panic.It is one of the sexually transmitted disease but it doesn't mean that your partner is cheating on you.Actually most of the women develop these warts many months or years after acquiring the HPV infection.HPV can be transmitted by skin to skin contact and need not be through penetrative sex.Condoms are the most effective way of preventing HPV transmission but condoms don't give 100% protection.Even for oral sex it is advisable to put condom over the penis and sharing of sex toys should be avoided.
Warts in general don't cause massive symptoms or cause major damage.They can look unsightly and if not removed can be a source of spreading the infection to your partner.For very small warts some chemicals can be used but it takes a lot of time for them to get cleared with the chemicals .
Surgically it can be removed using electrocautery or laser.It is important to seek specialist help.HPV infection and warts can get cleared off the body completely or it can be recurrent.There is no medicine to prevent the recurrence and depends on the immunity of the lady.If smoker,stopping smoking can be helpful in making the treatment more effective.