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Get Pregnant

posted Dec 14, 2014, 10:36 PM by shailesh verma   [ updated Dec 15, 2014, 3:24 AM ]

Getting started, how to get pregnant.

Do I need to start taking any medicines so that I have a healthy pregnancy?

Yes, you need to start taking a vitamin called Folic acid (Folvite, Folinal etc.). This is a vitamin of the B group and is found in the non vegetarian sources of food. Studies hve found that Indian diets are always deficient in this vitamin

Are there any specific blood tests I need to get done before trying for pregnancy?

Yes, a couple of tests, to make sure all is well with your body, are a good idea before getting pregnant
Blood group of both the partnersespecially to ensure there is no Rh Incompatibility. This is when one partner has a positive and the other has a negative blood group. Difficulties (which are treatable) can happen if the lady has the negative blood group.

TSH (Thyroid Stimulating Hormone)The thyroid is an important hormone producing gland in the body. It is situated in the neck. Thyroid problems are very common, up to 3% of the population has some thyroid problems. Females who have thyroid abnormalities may have irregular periods, difficulties in conceiving, increased risk of losing the pregnancy if they become pregnant and higher chances of mental retardation in the baby. It is always good to know that thyroid levels are normal before trying for a pregnancy. This is a simple blood test, which has to be done on an empty stomach.

Blood Sugar needs to be checked if there is any past history of high blood sugars. High blood sugars, in early pregnancy lead to an increased risk of structural abnormalities in the baby.

Rubella status. Rubella is a viral disease that has few simple symptoms like fever, throat pain, and tiredness. It is easily treatable by simple medicines like Crocin. However, if Rubella happens to a lady who is pregnant, the virus travels into the uterus and infects the baby and can cause the baby to have severe eye, ear and heart problems. Fortunately, if a person has had Rubella in the past, she can never have it again.

This test is done to find out if the lady has had Rubella in the past. If she has had Rubella, then it is very good as she can never catch this infection again. If no, then it is a good idea to give the lady the Rubella Vaccine. This will immunize her and prevent her from contracting Rubella anytime in the future. The only caution is that she should not get pregnant for three months from the date of taking this vaccine as this is the time the vaccine takes to develop its effect in the body.

What are the other do’s and don’ts if I am planning to get pregnant during the next few months?

If you are planning to get pregnant in the next few months, you should
  • Stop drinking alcoholic drinks
  • Stop smoking
  • Ensure any anti wrinkle or anti aging cream you are using does not contain any Iso-tretinoic acid (this is an type of vitamin A which is very harmful for the baby, it is present in many such creams available in the market)

Can I continue to exercise/swim/ do yoga?

Yes, there is no problem in continuing to do mild exercises, swimming, cycling or yoga as is keeps the body fit and healthy. A fit and healthy body is able to get pregnant faster and is also more capable in having a healthy pregnancy.

What is infertility

posted Dec 5, 2014, 4:13 AM by shailesh verma   [ updated Dec 11, 2014, 11:32 PM ]

Infertility means not being able to get pregnant after one year of trying, or, six months, if a woman is 35 years of age or older.

How does pregnancy occur?
Pregnancy is the result of a process that has many steps. To get pregnant—
· A woman’s body must release an egg from one of her ovaries (ovulation).
· The egg must go through a fallopian tube toward the uterus (womb).
· A man's sperm must join with (fertilize) the egg along the way.
· The fertilized egg must attach to the inside of the uterus (implantation).
Infertility can happen if there are problems with any of these steps.

When Should I Get Help for Female Infertility?
It can take up to a year for a woman to get pregnant. This is considered normal. Most health care providers suggest a woman try for a year before seeking infertility testing. It is a good idea, though, to go to a health care provider to discuss pre-pregnancy health before starting to try to get pregnant.

Certain health problems can make getting pregnant more difficult. Don’t wait a whole year of trying to get pregnant before talking with your health care provider if you have a history of
· ectopic pregnancy
· irregular periods
· pelvic inflammatory disease
· repeated miscarriages
· thyroid problems

What is Secondary Infertility ?
Secondary infertility is defined as infertility affecting couples who have had at least one child previously. Unfortunately, couples suffering with secondary infertility don't often get the help and support they need from doctors, friends and family because they aren't perceived as truly infertile since they've already had children.

What are the causes of Secondary Infertility?
There are many reasons that may explain why a couple is suffering with secondary infertility. A woman's fertility can change or be affected after having a child, even if she had no problem becoming pregnant the first or second time. Infection such as pelvic inflammatory disease (PID) can cause damage to the fallopian tubes, making it difficult for fertilization to occur, or increasing the risk of ectopic pregnancy.

Weight gain and an unhealthy diet can also affect your fertility. Gaining even a small amount of weight can throw your hormones off balance, affecting your menstrual cycles. If you are not ovulating, or ovulating irregularly, it may also be difficult to get pregnant. Endometriosis and fibroids are also contributing factors to secondary infertility.

Age can contribute to secondary infertility as well. With more women waiting to have their first child until well into their 30s, your fertility may have decreased significantly in the years between your first pregnancy, and attempting your second. Research shows that a woman's fertility begins a steady decline even in your late 20s and early 30s. (See age and Infertility) While this doesn't mean that you can't get pregnant, you may have a harder time conceiving and have an increased risk of miscarriage due to aging eggs. In addition to your fertility, your partner's fertility is also affected by age, thus contributing to secondary infertility.

When should I seek treatment?
If you are under 35, you aren't considered to have fertility problems until you've tried unsuccessfully for at least a year to get pregnant. This means that you've been having regular, unprotected sex for at least 12 months. If you're over 35, you should seek the treatment of a doctor after six months of trying. Repeated miscarriages, infection and irregular cycles are all reasons to speak to a doctor earlier. You will require an assessment of your current health, as well as tests to assess your reproductive status. (See Investigations for Infertility). Depending on the cause of the secondary infertility, you might be recommended a variety of fertility treatments.

If you feel that you are having trouble, or you may have trouble getting pregnant, don't hesitate to speak with your doctor at anytime.

What is the first step in seeking treatment?
The first step for many couples seeking medical treatment for infertility is to discuss their inability to conceive with an Infertility Specialist. The Infertility Specialist will review the couple's medical history and conduct a complete physical examination of the female. The evaluation of the male's medical history includes a discussion of previous pregnancies, developmental problems, surgeries, testicular trauma or infections and environmental exposure. The female medical history includes review of previous pregnancies, painful periods or pelvic pain, infections and previous surgeries.

CGH - A new hope !

posted Dec 5, 2014, 4:12 AM by shailesh verma   [ updated Dec 11, 2014, 11:25 PM ]

Microarray comparative genomic hybridisation, or CGH, is a new technique that allows doctors to screen the best embryos and make sure that only the healthiest are implanted.
It is not for everyone but for women who have had multiple miscarriages.

In a study, the success rate for IVF with CGH was found to be more than 90% in women under 38. For women over 38, it was 65%.

A news article here discusses such a case:

http://www.news.com.au/technology/new-ivf-fits-the-bill-breakthrough-del...

You may contact Dr Richa to get more information about CGH and find out if its right for you.

Please call 91-9810812189 or write to her at dr.richa.katiyar@gmail.com to get in touch.

Age and Infertility

posted Dec 5, 2014, 4:12 AM by shailesh verma   [ updated Dec 11, 2014, 11:22 PM ]

What is the relation between my age and my chances of getting pregnant?

Most fertility patients are aware of the term "biological clock". Women are born with all their eggs and with each month passing, some of these eggs are used up. A woman’s reproductive potential declines, especially as she approaches her fourth decade of life. The total eggs that are left in a woman’s body is called her “ovarian reserve”.

Because women in our society are marrying later, and consequently attempting pregnancy later in life, evaluation of ovarian reserve is critical to understanding a patient’s reproductive potential. Unfortunately, there is no perfect test and it is difficult to answer with certainty the question that is often asked by anxious patients. How much time do my ovaries have left? And; How long can I wait to have a baby?

Can I get pregnant even if I am in my forties?

A little assistance is needed if you are in your fourth decade of life but definitely, a pregnancy can happen. The assistance might be in the form of IUI or IVF/ ICSI.

How to get pregnant if I have gone through menopause?

If you are postmenopausal, it means that you have finished with your supply of eggs. However with egg (ova) donation, you can borrow an egg from a young donor, get it fertilized with the sperm of your husband and then the embryo transfer is done to your uterus. You then carry the pregnancy to term in your own uterus. This is what is called egg donation or Donor Egg IVF

What infertility tests will tell me how good are my chances of getting pregnant at my age?

The infertility tests to determine your fertility potential are called Tests of Ovarian reserve.

Follicle Stimulating Hormone (FSH). This is a blood test that measures the negative feedback from the ovary to the pituitary gland, which makes follicle stimulating hormone. It is done preferably on the third day of your periods (the first day being the day the periods began). FSH is the hormone that causes follicular recruitment and development in the ovary.

As ovarian function declines, and premenopause approaches, the negative feedback to the pituitary is decreased and the FSH level rises as the pituitary tries to drive the ovary harder. Commonly accepted values for a reassuring day 3 FSH value are less than 10 iu/ml. A slightly higher level may be compatible with development of an ongoing pregnancy with the use of appropriate therapy.

Unfortunately, this test is not a perfect predictor of reproductive potential because it is only one measurement in one cycle, and because ovarian function varies from cycle to cycle. Some cycles provide more fertility potential than others, especially in premenopausal patients. Sometimes it is possible to successfully treat a patient who has had a previously high FSH in a cycle that is more optimal by using hormonal medications to reduce the basal FSH level and then administering fertility medications.

These patients may become pregnant, especially if other markers of ovarian reserve are normal. In summary, one elevated FSH level on day 3 is not necessarily a steadfast indicator of an impossible case but should be interpreted in the light of further testing. Treatment should be started immediately if ovarian reserve is diminished as the ovarian function declines with age.

Inhibin B- Inhibin B is a specific hormone secreted by the ovarian follicle and is the most specific marker assessing ovarian reserve. The test appears to be more reliable than just a day 3 FSH blood test and is more consistent from cycle to cycle offering a more reliable evaluation of the true state of ovarian reserve. It is a marker of how the ovaries will respond to fertility drugs. The mean value at 95% confidence limits for day 3 inhibin evaluations is 33-45 pg/ml in normally fertile women. Since inhibin is a messenger hormone secreted by a healthy ovary to influence the pituitary gland, a low inhibin less than 30 pg/ml is a bad prognosticator of future reproductive potential. But a normal inhibin, even in the face of a slightly elevated day 3 FSH, can be encouraging and compatible with the initiation of a successful ongoing pregnancy.

Anti Mullerian hormone (AMH) is another new accurate marker of ovarian reserve. The advantage with AMH is that it can be done anytime during the women’s cycle.

The Clomiphene Challenge test provides an additional measurement of ovarian reserve. The principle of the test is to measure the basal FSH and estradiol levels on day three of the patient’s cycle. In order to evaluate the ovarian response to fertility drugs, 100 mg of Clomid is administered between days 5-9 of the cycle. The ovarian response on day 10 is further evaluated by checking the response to Clomid and measuring the FSH and estradiol. The test is abnormal if the day 3 or day 10 FSH is elevated above 10 iu/ml.

Stimulating the ovary with gonadotropins to see how they respond. An ovulation study is done and the number of eggs produced in response to the gonadotropins is evaluated. This is the ultimate test of ovarian reserve.


Letters to Dr. Richa Katiyar

Mam,

I am 40 year old can u suggest me that I can go fr ivf treatment as I hv nt concieved baby yet

Thanks, Ritu

Dear Ritu,

Yes you can go in for IVF treatment. All ages of women can go in for IVF treatments as thee are many methods of many types which can be used. Please email to me your AMH report and i will guide you from there.

Regards,
Dr. Richa



Dear Dr. Richa,

Yesterday I went to my doctor. I had a TVS test and my doctor told me that my egg counting is very poor that I should go for IVF.

Now, My question is I am 30 years old and should I try 3/6 months and then IVF or it is necessary for me to have immediate IVF.

I will be very greateful if u reply.

Thanks again.

Monica

Dear Monica,

If Doctor is saying that egg counting is poor, then it is better to go fo an early IVF and not waiting for long. You can reconfirm the no. of eggs by getting AMH (anti muellerian hormone) levels checked. Thias is a blood test whcih can be done anyday and anytime.

Feel free to contact me for further queries.

Dr. Richa Katiyar

Dr. Richa on Focus TV

posted Dec 5, 2014, 4:11 AM by shailesh verma

YouTube Video


Aid for women with AIDS

posted Dec 5, 2014, 4:10 AM by shailesh verma   [ updated Dec 11, 2014, 11:23 PM ]

HIV infection has become an epidemic in the past few years with an estimated 61 million affected people worldwide, another 7 million are added every year as per UNAIDS, the United Nations watchdog for AIDS. With 27 million pregnancies every year in India, it is estimated that about 100,000 HIV infected women deliver every year. From infected pregnant women about 30,000 infants acquire HIV in India every year.

Human immunodeficiency Virus (HIV) belongs to a family of slow acting Lenti viruses that uses a special enzyme (a kind or protein) for replication. The virus binds to the immune cells (cells in the human body that protect it against infections) of the body and kills them. This leads to a progressive decline in the number and function of these immune cells, which in turn causes impairment of the immunity in the body. Low levels of immunity leads to an increased risk of infections and some type of cancers.

There is no evidence to suggest that pregnancy hastens the progression of HIV infection. However women who have HIV have a higher chance of abortion, small babies and an early delivery. The virus travels from the mother to the baby at three different times during pregnancy. Most commonly the baby gets infected while it is still in the womb, next commonly during delivery and least commonly after delivery by taking the infected mothers’ breast milk. More advanced is the mother’s disease, higher is the chance of the baby acquiring HIV from its mother.

Any pregnant women with HIV should be counseled about the nature of the disease, the need for long term treatment and general measures for HIV infection. She should be explained the risk to her and to the baby due to her infection. The option for termination of pregnancy should be discussed with her.

The primary mode of treatment of HIV positive women is administration of HAART (highly active antiretroviral therapy) started anytime after three and a half months of pregnancy. This consists taking oral medicines against HIV at home. It decreases the risk of the baby having HIV from 45% to around 8%. These medicines, which earlier had a very prohibitive cost are now available in generic versions at affordable prices, and can be taken at home.

The type of delivery is very important in decreasing the risk of HIV transmission from mother to child. It is recommended by the American College of Obstetricians and Gynecologists that Caesarean section should be done for all women to decrease the risk of infection to the baby further from 8% to 2%. Even women who have started having natural labor pains benefit from having a C section.

Centre for disease Control and Prevention, USA recommends avoidance of breastfeeding in HIV positive women. World Health Organization however recommends exclusive breastfeeding in women who do not have enough money to buy formula feed, but breastfeeding should be exclusive and should stop at four months of age of the baby. Giving a child a mixed diet of breast milk and formula feeds is worse for the baby as formula milk causes inflammation of the childs intestine from which the HIV virus can easily enter the body of the child.

All children born to HIV positive mothers should get Zidovudine (an antiHIV drug) and should be tested for HIV at birth and again at 6 weeks and 6 months and treated accordingly.

A good part of HIV transfer from mother to child is preventable through simple means. Women should be counseled for the same and helped in containing the virus.


How does AIDS spread? 

Sexual mode is the major route of spread of HIV infection globally. Heterosexual intercourse accounts for 82% cases of HIV transmission in India. The risk of HIV infection with sexual intercourse is 1% per episode with an increased risk associated with female gender, presence of other sexually transmitted diseases and pattern of sexual behavior. There is a higher risk of male to female transmission compared to female to male transmission (8 times) due to the large surface area of the vagina, prolonged exposure to semen and trauma to the vagina during intercourse. Getting a blood transfusion with infected blood carries a 90- 100 % risk of contracting HIV infection. It is important to know that despite the strict control by the government on the screening of blood before transfusion and the crackdown of professional blood donors, there still exists a risk of 7 people accidentally getting AIDS through contaminated blood per every one million people getting a blood transfusion. This emphasizes the need for giving blood and its products only to those people who really need it. Infected needles are an important source of HIV infection for health care professionals like doctors and nurses and for intravenous drug addicts. Hollow bore needles are associated with 8 times increased risk of infection than a surgical needle. Needle prick with an infected hollow bore needle is associated with a 0.3% chance of HIV transmission.


Clinical course of HIV in the body

Exposure to HIV is followed by an incubation period, which lasts for about 3-6 weeks followed by a period of rapid multiplication of the virus in the body called Acute HIV syndrome in 60-70% cases. This syndrome is similar to other viral illnesses with mild fever, body ache etc. This is followed by a period of immune response of the body, which reduces the virus levels in the body to very low counts. The diagnosis of HIV infection by lab tests may be missed by antibody based detection methods (the most commonly done lab test for AIDS) for up to 2 months following the HIV infection. This period is also known as the window period. The disease then lies low in the body for up to 6-8 years following which the virus again becomes stronger than the body and there comes the final stage of full-blown AIDS

Acupuncture and IVF

posted Dec 5, 2014, 4:10 AM by shailesh verma   [ updated Dec 11, 2014, 11:20 PM ]

An increasing number of fertility specialists and centers offer acupuncture as a part of their IVF protocol. Limited but supportive evidence from clinical trials and case series suggests that acupuncture may improve the success rate of IVF and the quality of life of patients undergoing IVF and that it is a safe adjunct therapy. A systematic review and meta-analysis published in the British Medical Journal found that complementing the embryo transfer process with acupuncture was associated with significant and clinically relevant improvements in clinical pregnancy

Acupuncture mechanisms:
Four mechanisms by which it has been suggested that acupuncture may improve IVF outcomes are:
· Neuroendocrinological modulations
· Increased blood flow to uterus and ovaries
· Modulation in cytokines
· Reduction of stress, anxiety, and depression.

Electro-acupuncture in oocyte retrieval for IVF

Electro-acupuncture has been found to be a good alternative to conventional medical analgesia, it results in shorter hospitalisation times and lower costs.

Vaccination during Pregnancy

posted Dec 5, 2014, 4:09 AM by shailesh verma   [ updated Dec 11, 2014, 11:31 PM ]

Risk to a developing fetus from vaccination of the mother during pregnancy is primarily theoretical. No evidence exists of risk from vaccinating pregnant women with inactivated virus or bacterial vaccines or toxoids. Live vaccines pose a theoretical risk to the fetus. Benefits of vaccinating pregnant women usually outweigh potential risks when the likelihood of disease exposure is high, when infection would pose a risk to the mother or fetus, and when the vaccine is unlikely to cause harm. The guidelines for vaccinations during pregnancy say that generally, live-virus vaccines are contraindicated for pregnant women because of the theoretical risk of transmission of the vaccine virus to the fetus. If a live-virus vaccine is inadvertently given to a pregnant woman, or if a woman becomes pregnant within 4 weeks after vaccination, she should be counseled about the potential effects on the fetus. But vaccination is not ordinarily an indication to terminate the pregnancy. Whether live or inactivated vaccines are used, vaccination of pregnant women should be considered on the basis of risks versus benefits – i.e., the risk of the vaccination versus the benefits of protection in a particular circumstance.

Aamir Khan Surrrogate baby

posted Dec 5, 2014, 4:08 AM by shailesh verma   [ updated Dec 11, 2014, 11:19 PM ]


Celebrities and Surrogate Babies 
Kiran Rao and Aamir Khan are now the proud parents of a baby boy. This miracle was accomplished using the services of a generous and kind lady who wanted to give the gift of motherhood to Kiran.

Kiran was unfortunately sufferring from a bad obstetric history, and had had a couple of miscarriages in the past. She had been advised IVF with the help of a surrogate. And now the miracle was accomplished, with the birth of a bonny baby boy on first December.Hopefully, this will take away the stigma attached to IVF in general and Surrogacy in particular, and more and more couples aspiring for parenthood will use surrogates to help them acheive their dreams.

Baby "Miracle", born after 25 years

posted Dec 5, 2014, 4:07 AM by shailesh verma   [ updated Dec 11, 2014, 11:23 PM ]

Mr and Mrs A had been married for more than 25 years, but were still in their mid forties on account of their early marriage. After not conceiving naturally, they started going to Doctors, and they tried everything and everyone. They want to Allopaths, Homeopaths, Avurved Vaids, Unani and Siddhi Doctors. They also tried Naturopathy, Magnetic therapy, Acupressure, Acupuncture, Reiki healers, Tarot card readers. Wherever they saw a ray of hope, they went but to no avail.

After 10 years of this, they resigned to their fate of being childless, until they came to know about IVF, and approached me very hesitantly.

Unfortunately, conventional IVF was not for them as Mrs. A's age was quite advanced and her eggs were of poor quality, so i introduced to them the concept of egg donation, which they embraced gradually.

Mrs A conceived a single child in her first try and baby "Miracle"was born a bonny baby after nine months. The pleasure and disbelief of the parents and grandparents was unbelievable. Both mother and baby are doing well.

All the best to baby"Miracle" and her proud parents.

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