Find some of the most common neurological conditions.
Description: Migraine headache is most common headache, often accompanied by throbbing pain, nausea, and sensitivity to light and sound. They can last for hours to days and significantly impact daily activities.
Treatment: Treatment may include pain relievers, preventive medications, lifestyle modifications, and stress management techniques.
Description: A stroke occurs when blood flow to part of the brain is interrupted or reduced or due to rupture of the blood vessel, leading to brain cell damage and neurological deficits. Symptoms may include sudden weakness or numbness in the face, arm, or leg, confusion, trouble speaking or understanding speech, and severe headache.
Treatment: Treatment for stroke depends on whether it is ischemic (caused by a clot) or hemorrhagic (caused by bleeding). Ischemic strokes may be treated with clot-busting medications or procedures to remove the clot, while hemorrhagic strokes may require reducing BP and surgery if required.
Description: Epilepsy is a neurological disorder secondary to uncontrolled electrical disturbances in the brain, causing loss of consciousness, involuntary jerking of the limbs, tongue bite etc. Seizure types and severity can vary widely among individuals.
Treatment: Treatment may involve antiepileptic medications to prevent or reduce the frequency of seizures. In some cases, surgery or other interventions may be recommended.
Description: Parkinson's disease is a progressive neurological disorder that primarily affects movement. It is characterized by tremors, stiffness, bradykinesia (slowed movement), and problems with balance and coordination. Other symptoms may include speech and swallowing difficulties, cognitive changes, and mood disturbances.
Treatment: Treatment typically involves medications to manage symptoms, such as levodopa, dopamine agonists, and other medications to enhance dopamine levels in the brain. Physical therapy, occupational therapy, and lifestyle modifications may also be beneficial. In some cases, surgical interventions such as deep brain stimulation (DBS) may be considered.
Description: Dementia is a progressive neurodegenerative disorder characterized by a progressive decline in cognitive function, like memory loss(forgetfullness), impaired reasoning, and changes in behavior.
Treatment: Treatment for dementia primarily involves managing symptoms through medications to alleviate cognitive decline, therapy to support emotional well-being, and lifestyle adjustments to optimize daily functioning.
Understand infertility and treatments for it
When a couple fails to conceive after 1 year of unprotected regular intercourse, couple is said to be infertile or subfertile. Such couple needs thorough investigations to look for the cause
When a couple fails to conceive after 1 year of unprotected regular intercourse, couple is said to be infertile or subfertile. Such couple needs thorough investigations to look for the cause
The chances of conception in one menstrual cycle is called fecundity rate. For a normal couple, fecundity rates are 20%. This means the chances of conception in one cycle for a normal couple is 20%. At the end of 1 year, 80% of the couples conceive and the remaining who fail to conceive will need evaluation for subfertility.
But this fecundity rate varies largely in different age groups.
Couple who are trying to conceive are advised to have unprotected intercourse atleast 3 times a week.
Using lubricants, condoms or any type of artificial products is discouraged
Release of a mature egg from a follicle is called ovulation. Follicles are fluid filled sacs which have oocytes(eggs) inside. During each menstrual cycle, a cohort of 8-10 follicles start to grow. The most efficient one which gets selected by nature grows ahead of others, reaches maturity and releases the egg stored within. This process is called ovulation.
The process of ovulation occurs between Day 10 to Day 18 in a regularly menstruating woman. This period is called ovulation window. Sexual intercourse during this period increases chances of natural conception in a normal couple (Timed Intercourse or TI).
Its a 3 step process
Every month a follicle releases a mature egg and this process is called ovulation. The egg released is picked up by the fallopian tubes.
In a couple with two young healthy fertile partners, approximately 200 million sperms are ejaculated into the vagina. But there is an incredible attrition at each stage. This number reduces to a few thousands. Only 1 million can cross cervix, 10000 reach uterus and around one thousand can reach Fallopian tube that carries oocyte.
The egg and sperm interact and fuse in the fallopian tube. This process is called fertilisation. It leads to formation of an embryo
The embryo formed further travels through the tube into the uterine cavity. If the endometrium is favourable for implantation, the embryo gets implanted and conception occur.
1. Anovulation -abnormalities in egg formation or release.
2. Ovarian factors- other ovarian disorders such as endometriosis.
3. Tubal factors- blockage of fallopian tubes due to previous surgeries, any pelvic infection or endometriosis
4. Uterine factor- abnormalities such as fibroids, adenomyosis, small uterus, developmental abnormalities of uterus.
5. Endometrial factors- chronic infection, thin endometrium or endometrial polyps
Most cases are idiopathic where there is no obvious cause for male infertility. Few known causes are as below.
1. Infection of testes (Orchitis)
2. Radiotherpy/ chemotherapyUndescended testes
3. Ejaculatory dysfunction
4. Excessive oxidative damage to sperms due to stress, prolonged abstinence or unknown factors
5. Chromosomal or genetic disorders
A couple is said to have unexplained infertility when they are unable to conceive without any obvious cause on preliminary investigations i.e. regularly ovulating, normal uterus, normal semen analysis, and patent fallopian tubes.
Evaluation of infertile couple is usually a lengthy investigation in which all possible etiologic factors in both partners have to be considered. After History and examination of the coupke, optimal and cost effective investigations are preferred to start with.
1. Baseline Transvaginal scan on day 2 of menstrual cycle:
This is the most important scan for a woman trying for conception and is considered mandatory for assessment of female partner. This helps in assessment of ovaries, gives a fair idea about possible number of eggs in ovaries, any abnormalities of uterus or any tumours in uterus and ovaries.
2. Hormonal evaluation:
A range of hormones can affect fertility of woman. Evaluation of hormonal levels by blood tests can give a clue on possible cause of infertility.
3. SSG:
Saline salpingogram is an ultrasound guided tubal patency test. it is generally done between D6-8 of menstrual cycle.
Fallopian tubes are pathways for transport of egg and sperm. It is in the tubes, where fertlilisation or fusion of egg and sperm takes place. So, it is important to confirm that fallopian tubes are open.
Premedications are given to reduce the pain during the procedure.Under aseptic precautions, a small catheter is introduced into the uterine cavity and normal saline is injected into the catheter. During injection, Transvaginal ultrasound is performed.
Normal filling of uterine cavity is observedSpillage of fluid into the abdominal cavity is recorded
Spillage of fluid on both sides of uterus mostly confirms that fallopian tubes do not have any block.Picture
4. Follicular study:
Tracking of follicular growth and endometrial lining by Transvaginal ultrasound is vital in fertility treatment. This can be done in a natural or a treated cycleFollicles are assessed on D2 of menstrual cycle to start with. After staring medications, after D8, Transvaginal scan is performed at 2-4 days interval until the follicle reaches 18-20 mm. endometrial lining is assessed at each visit. A trigger shot is given and ovulation is confirmed after 36-48 hrs.
5. 3- Dimensional Ultrasound:
3-D ultrasound is considered Gold-Standard for assessment of uterine cavity abnormalities. Developmental abnormalities of uterine cavity called Mullerian anomalies need to be diagnosed as they can have impact on fertility, pregnancy and delivery.Diagnostic hystero-Laparoscopy may be needed in a few cases for evaluation
1. Semen Analysis
This is the single most important investigation in evaluation of male partner.
Collection of semen sample:
>Do not have any sexual activity(ejaculation) for atleast 2 days but not more than 5 days before obtaining semen sample i.e. 2-5 days of abstinence
>Wash your hands and penis with soap and dry before collecting specimen
>Semen should be collected in a sterile nontoxic jar provided by the laboratory only.
>Sample should be collected by masturbation.
>Lubricants or any body fluid should not be used
>Semen assessment should be done within 1 hr of collection of sample
>Any difficulty in collection should be discussed with your fertility consultant. Other methods of semen collection can be offered.
Various parameters are assessed starting from volume. The 3 most important parameters being sperm concentration, motility and morphology.
Sperm concentration:indicates the number of sperms per volume unit. It is expressed in million/ml. Normal sperm concentration is >/= 15million/ml or >/= 39million per ejaculate. Men with this sperm concentration have been found to have normal fertility potential.
Sperm Motility:This parameter indicates the ability of sperms in the ejaculate to move. It is an important quality of sperms because they have to reach from the introitus to the fallopian tube for successful fertilisation. Normally, atleast 42% of total sperms should be motile and atleast 35% should exhibit progressive motility.
Sperm morphology:It indicates appearance of sperms in given semen sample. Normal looking head, midpiece neck and tail of sperm after staining. Strict criteria should be followed for assessment of sperm morphology.
Reports should be discussed in detail with fertility specialist if any of the parameters are found to be abnormal.
2. Hormonal Evaluation
These tests are generally done when semen parameters are found to be abnormal. These give a clue towards possible cause of reduced sperm count and also the prospect of success by treatment with medications.
3. DNA Fragmentation Index (DFI)
This semen test measures the quantity of fragmented or damaged DNA material carried by sperm head i. e. the quality of genetic material carried by sperm. This is a special investigation, reserved for recurrent pregnancy losses, or poor quality embryos formed during IVF treatment, recurrent implantation failure.
A couple is said to have unexplained infertility when they are unable to conceive without any obvious cause on preliminary investigations i.e. regularly ovulating, normal uterus, normal semen analysis, and patent fallopian tubes.
In todays era, age-related infertility has become more common because, for a variety of reasons, women are choosing to start families in their thirties. This decision has its advantages like, mental preparedness, financial stability and career growth. But a good proportion of those women face infertility due to advanced age.
It has been proved time and again that maternal age is the single most important determining factor for natural conception as well as success of fertility treatments. Also, pregnancy complications and medical complications in pregnancy also increase steadily with advanced maternal age. Why and hows are explained in brief.
Ovarian reserve refers to the number of eggs remaining in her ovary at a given point of time.
Women are born with finite number of eggs in their ovaries. And this number declines steadily with age. The rate of decline increases with age.
Not just the number of eggs, but there is steep decline in quality of eggs after the age of 35. Quality may refer to fertilisation ability of eggs, repair mechanisms of eggs, and also the chromosomal number in the oocytes. With age, the percentage of eggs having abnormal chromosomal numbers (aneuploidies) increases. This contributes to higher miscarriage rates in older women.
Success of fertility treatments largely depend on the quality of gametes. i.e. quality of egg and sperm. So, success of IVF also is largely affected by woman’s age.
Pregnancy complications such as miscarriage, chromosomal abnormalities in offspring, hypertension, diabetes, labour complications also are higher in older women.
So based on these facts, it is advisable to start families for women when their age is between 23-30 years.
To have one’s own offspring is an instinctive desire. Having to go through fertility treatment is not anyone’s wish. But, we cant thank science enough for giving every couple an opportunity to have their offspring. It is only due to advancements in the field of Assisted Reproductive Technologies that miilions of couples across the world who hardly had a chance of natural conception now are enjoying parenthood. Different fertility treatments are like different roads to be travelled to achieve parenthood.
Treatment plans are tailored to each patient based on their history, examination, investigations, diagnosis and most importantly, previous treatments which the couple have undergone.
Few of the treatment modalities are elaborated below.
Intrauterine insemination or artificial insemination is a procedure in which semen is washed and sperms with good motility are separated and injected into the uterine cavity with a catheter. The procedure is painless.
The odds of pregnancy with IUI is about 10-15% in one cycle. In a few groups of patients, after 3-6 cycles of IUI pregnancy rates are about 30-40%. Pregnancy rates are largely dependant on cause of infertility.
The aim of IUI is to put millions of sperm at the top of the uterus. More sperms in the uterus will lead to more sperms in the tube and higher chances of conception in comparison to timed intercourse.
Semen collection is done at the laboratory on the day of IUI. Sperm preparation is done at the laboratory to achieve best possible semen sample for insemination.
Types of IUI
1. Natural cycle IUI
No medications are given for development of eggs. On follicular monitoring, once ovulation is confirmed, IUI can be performed. This is generally done when woman is regularly menstruating and there is mild male factor infertility.
2. OS and IUI
Medications are use for growth of follicles and once follicle reaches about 20-22mm size, ovulation is triggered. 24-36 hrs after the trigger shot IUI is performed.
3.AID
Artificial Insemination with Donor sample is done when husband has no viable sperms for treatment (Azoospermia). This is done only after taking written informed consent from the couple. The donor sample is obtained from donor agency recognised by ART authorities.
In-Vitro Fertilisation is a type of fertility treatment where embryos are formed outside the body. It is the most advanced fertility treatment available with highest odds of pregnancy i.e. 70-80%
IVF is done in 4 steps
1. Ovarian stimulation
2. Collection of gametes- oocytes and sperms
3. Preparation of embryos
4. Transfer of embryos
The first step of IVF treatment is ovarian stimulation. This involves taking daily injections for 8-12 days, starting from day2 of cycle to develop multiple follicular development. Each follicle contains an egg. Multiple follicles can give more number of eggs in one cycle of IVF stimulation. More eggs are then utilised to make more embryos. More number of embryos can be frozen and utilised for future use.
Monitoring of cycle involves follicular monitoring by transvaginal ultrasound. Hormonal monitoring by blood tests is optional and is done in selected cases. Once follicles reach appropriate size, decision for trigger shot is taken. Trigger causes final maturation of oocytes. At 34-36hrs of trigger shot patient is posted for oocyte retrieval.
This step consists of collection of male gametes i.e. sperms and female gametes i.e. oocytes.
It is a surgical procedure done to remove eggs from ovaries. It is a minimally invasive procedure which lasts for about 10-15 minutes. Patient is not allowed any food or liquids atleast 6hrs prior to the procedure. After a few premedications, procedure is done in IVF Operation Theatre.
Transvaginal retrieval of oocytes is done by Ultrasound guidance under anaesthesia by fertility cosultant. Follicular fluid is aspirated and handed over to IVF lab. Patient is generally allowed to take liquids after 3-4 hrs, assessed at 8 hours and discharged the same day.
In most cases when sperm is provided by the male partner, this only involves semen collection by masturbation on the day of oocyte retrieval. But in a few men where sperm counts are extremely low or absent, TESA ( Testicular Sperm Aspiration, MTESE (Microsurgical Testicular Sperm Extraction) is done. In these sperms, Testicular sperms are obtained.
Alternatively, a sample of semen can be frozen prior, to be used in case of failed semen collection on the day of oocyte retrieval or when the partner is not available on the day of oocyte retrieval.
Semen collected is prepared in the andrology lab by sperm wash. Cocentrated motile sperms are then transferred to embryology lab where fertilisation takes place.
The most important key step of IVF, making of embryos takes place in embryology Lab. Once oocytes and sperms are ready, the process of fertilisation can be done in two ways
Oocyte and sperms are suspended in a petridish with culture media. Self-employed penetration of oocyte has to take place
In this method, Intra-Cytoplasmic Sperm Injection, where one sperm is injected into one oocyte with the help of micromanipulator under microscopic observation
After fertilisation, the embryos are grown in nourishing media that mimics internal environment of fallopian tubes for 3-5days
3rd day embryos are called Cleavage stage embryos or 8 Cell embryos. Embryos can be frozen at this stage or can be grown till Day5.
5th day embryos are called Blastastocyst.
If embryo is grown to blastocyst stage, it can then be genetically tested. While it may be beneficial to some, it is not recommended for everyone.
Both Day3 and Day5 embryos are routinely transferred. Generally blastocysts have higher odds of success per transfer and aim is to bring embryos to this stage of development. However, if there are’nt many embryos developing and the ability of embryos to reach Day5 is a concern, then Day 3 embryos are transferred. However good embryology labs may be, there is no better place than the womb for embryos to grow.
This is the final step of IVF treatment. After the early development of embryos in lab, the embryos are ready to be transferred to the womb. To make a receptive environment, the inner lining of the uterus, the endometrium is strategically prepared. The medications used depend on the strategy planned for individual case. For example, HRT, Natural cycle, modified natural cycle, mild stimulation cycle, down regulation ovulation induction cycle and many more. Once the endometrium reaches 8-10mm in thickness, decision for embryo transfer and the dates are finalised.
The procedure of embryo transfer is done in IVF-OT. It is a simple procedure, does not require anaesthesia or analgesia. The procedure takes less than 5-10minutes. Once urinary bladder is full, under ultrasound guidance, the embryos are loaded into transfer catheter and transferred into the womb.
Post transfer precautions and medications should be followed as advised by the fertility consultant. Pregnancy testing is generally performed after 12-14 days of transfer.
Find answers to commonly asked questions about Renew Health Care, our services, and what to expect during your visit. Have a question? Check here first for quick and helpful information
Common causes of female infertility include ovulation disorders, fallopian tube blockages, uterine abnormalities, and age-related factors
> If you have tried to conceive for the past one year and have been unable to
> Earlier if you are older than 30 years of age
> Have irregular periods
> Known gynaecological disorders
Symptoms of neurological disorders can vary widely depending on the specific condition but may include headaches, seizures, numbness or tingling, difficulty with coordination, and changes in vision or speech.
Treatment options for infertility may include medication to stimulate ovulation, intrauterine insemination (IUI), in vitro fertilization (IVF), surgery to correct anatomical issues, or assisted reproductive technologies.
Effective methods of contraception include birth control pills, contraceptive patches, intrauterine devices (IUDs), contraceptive injections, and barrier methods such as condoms or diaphragms. The best method depends on individual health needs and preferences.
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