Pregnancy and Birthing

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Introduction about Pregnancy

Pregnancy is a state of carrying a growing foetus for about 42 weeks, measured from the date of the pregnant mother’s last menstrual period (LMP). Pregnancy is indicated by an urine test and confirmed clinically through a blood test, ultrasound or detection of foetal heartbeat. Pregnancy period is divided into three trimesters of three months each.

Trimester 1

Fertilization of the female egg by the male sperm marks the beginning of pregnancy. On conception, the zygote travels down from the fallopian tube to attach itself to the inner wall of the uterus. A cluster of attached cells later forms the foetus and the placenta. By 12 weeks, the placenta starts to transmit nutrients from the mother to the foetus through the umbilical cord.

Trimester 2

Ultrasound scans to detect birth defects can be done by 18 weeks. Foetal movements can be felt by 20 weeks. Foetal hand and foot prints appear at 24 weeks. Foetus develops regular patterns of sleep and being active. Babies born at 28 weeks have a 92% survival rate though there may be complications.

Trimester 3

At 28 weeks, the foetus starts to open and close its eyes. A 29 weeks old foetus can kick, stretch and grasp. By 30 weeks, organs are all formed and foetus starts gaining weight rapidly. The foetus starts practise to breath from 32 weeks. By 34 weeks, the foetus has hardened bones, nails and smooth skin. At 36 weeks, the baby occupies most of the amniotic space. The baby starts to turn head down and in to the pelvis at 37 weeks. The chest becomes prominent and baby stores fat to keep itself warm after delivery. At 39 to 40 weeks, baby achieves its height and weight. Babies born at this time are considered full term.

Treatments to cure infertility

Infertility is defined as the inability to conceive after 12 months of unprotected sexual intercourse. 8 to 12 % of couples worldwide suffer infertility. The ratio of male to female infertility is 50:50. Couples experiencing infertility have to be screened for contributing factors from both the partners. Initial advise from doctors would be to increase the frequency of sexual intercourse few days before and during Ovulation. This increases the chances of natural conception. Beyond this, treatment for infertility aims at addressing the root cause.

In Men

  • Antibiotics to treat infections of reproductive organs
  • Supplements and Antioxidants to improve sperm count, sperm motility and sperm morphology
  • Medications, counselling and techniques to treat sexual dysfunctions such as
  • Erectile Dysfunction, Premature Ejaculation etc
  • Hormonal treatments for deficiency of male hormones such as Testosterone
  • Surgeries in Varicocele, Ejaculatory Duct Obstruction or blocks in Vas deference/Epididymis
  • Sperm retrieval for cryopreservation

In Women

  • Weight loss and medications such as Clomiphene and Metformin to regulate
  • menstruation in women with PCOS
  • Fertility drugs and Hormones to improve Ovulation and prevent miscarriages
  • Ovulation Induction using Gonadotrophins
  • Surgeries to correct blocks in Fallopian tubes or remove tissues in Endometriosis Oocyte retrieval and freezing, embryo transfer

Infertility treatments also include Assisted Reproductive Techniques (ARTs) such as IUI, IVF and ICSI.

Reasons for Infertility

There are reasons with either of the partners or a combination of factors that may lead to infertility in a couple. Problems in Ovulation, egg quality, sperm production, structural abnormalities, genetic factors, trauma, age, infections or too much exposure to certain toxins have been various reasons for causing infertility. Some of the more common reasons inclined to infertility are:

  • Inability to produce and release healthy eggs from Ovaries in women
  • Inability to produce and deliver viable male sperms capable of fertilizing the female egg
  • The fertilized egg may not be transported from the Fallopian tube to the Uterus
  • The Zygote, on reaching the uterus may not get itself successfully implanted to the Uterus.

Risk factors

Risk factors that may reason the possibilities of infertility in Men and Women alike in present day life style are:

  • Late marriage and delaying parenthood can have age as a restriction in achieving pregnancy
  • Tobacco is known to not only affect sexual health and fertility in men but also increase chances of miscarriages in women
  • Excess alcohol can have adverse effects on the quality of sperm as well as eggs
  • Being overweight or underweight can present health issues that can affect fertility
  • Stress, lack of sleep, unhealthy food are all contributing risk factors to infertility

In recent years, largest group of infertility is associated with “Idiopathic infertility” in other words, unexplained infertility. Female Idiopathic Infertility refers to conditions where clinical findings do not reveal any pathological mechanism to explain infertility. Male Idiopathic Infertility does not imply absolute infertility but the chances of achieving fatherhood naturally may be reduced or prolonged. Rational treatment for Idiopathic Infertility cannot be applied because there is no pathological findings behind the problem. However advanced research has enabled specialists to identify certain pathological existence that were earlier thought to be Idiopathic in reasoning. Evidence based medicine remains to be the need for treating Idiopathic Infertility.

Treatment procedure

Determination of infertility treatment involves individualised evaluation, clinical implications and possible applications. Time, commitment and cost are the limiting factors a couple may undergo during the course of the treatment procedure. Infertility treatment procedure generally includes the following steps:

Diagnosis

  • The couple will discuss with the specialist, their health history, medications, sexual history and sex habits.
  • Men may undergo a physical exam and a semen analysis
  • Women may need a pelvic exam along with a physical exam. Other tests usually suggested are blood hormone tests and ultrasound scan of the Uterus and the
  • Fallopian tubes

Lifestyle modifications that aid weight loss, counselling on sexual habits, usage of Ovulation calculator and other remedies to increase chances of natural conception are the first line management goals

Therapeutic options

Medications to control the pathological cause of the problem in either male/ female forms the baseline treatment for infertility. Predisposing health conditions such as Diabetes, heart problems, vascular diseases and metabolic disorders are to be brought under control before starting infertility treatment. Some of the common therapeutic options include:

  • Fertility drugs to restore fertility in women with PCOS and men with Hypothalamic Hypogonadism
  • Hormone replacement for hormonal deficiencies
  • Drugs to restore sexual function in men Erectile Dysfunction/premature Ejaculation
  • Antibiotics to overcome infections
  • Antioxidant support to improve Sperm parameters in men
  • Surgeries to correct Varicocele, Ejaculatory duct obstruction or sperm retrieval in men
  • Surgeries to widen Fallopian tubes, remove Fibroids and Oocyte retrieval in women

Couples who do not achieve pregnancy through medications or surgeries may need Assisted Reproductive Techniques(ARTs) such as Intra Uterine Insemination, In Vitro Fertilisation or Intra Cytoplasmic Sperm Injections (ICSI). These procedures may also involve cryopreservation of gametes or embryo, embryo transfer and surrogacy.

Tests during treatment

Infertility evaluation is a tool not just for diagnosis but also to monitor treatment progress. There are several tests that either or both of the partners may have to take up in order to record clinical findings from time to time. Tests are necessary to ensure that the male is producing enough active sperms that get ejaculated effectively in to the vagina and successfully travel to reach and penetrate the egg. In women, tests evaluate the efficacy of the ovaries to release the egg, ability of the reproductive tract to allow fertilisation and the capability of the reproductive system to facilitate implantation.

Hysterectomy

A hysterectomy is the partial or total removal of the womb. This is considered for treating extremely large fibroids or excessive bleeding.A total hysterectomy can prevent the return of fibroids but also causes side effects like reduced libido and early menopause. Total hysterectomy also means no child bearing.

Tests in Men

  • Semen analysis is done by collecting masturbated semen and studied in a lab mainly for sperm parameters.
  • Hormone testing is done determine the levels of male hormones, mainly the Testosterone
  • Genetic defects causing infertility can be detected by genetic testing
  • Testicular Biopsy is performed to detect abnormalities in spermatogenesis or to retrieve sperms for ARTs
  • Transrectal/scrotal ultrasound scans and Vas Deference imaging may be performed

Tests in Women

  • Ovulation testing includes blood tests to know hormone levels that indicate Ovulation.
  • Hormone testing to assess the reproductive process
  • Hysterosalpingography is a procedure that images the Uterus and the Fallopian tubes for structural blocks and abnormalities
  • Ovarian Reserve testing involves hormone tests to know the quantity of eggs available for ovulation
  • Ovarian or Uterine diseases can be detected using Pelvic Ultrasound or Sonogram

Causes & symptoms of Infertility

Infertility, classified as male and female are attributed to specific disorders or abnormalities as underlying causative factors with respective symptoms.

In Men

Low sperm count, low sperm motility and abnormal sperm morphology contribute to major cause of male infertility. Symptoms that are indicative of insufficient sperm parameters are:

  • Diabetes
  • Family history of genetic defects
  • Undescended testicles
  • Bacterial or Viral infections
  • Trauma or surgeries of the testicles
  • Varicocele
  • Exposure to toxins/excess heat/chemotherapy
  • Lifestyle habits – Tobacco, Alcohol or drug abuse
  • Medications and steroid use
  • Cancer

Male sexual disorders that may interfere with delivery of sperms in to the Vagina for successful fertilization are:

  • Erectile Dysfunction
  • Premature Ejaculation
  • Retrograde Ejaculation
  • Cystic Fibrosis
  • Micro penis

In Women

Unlike in men, women experience infertility mostly due to endocrine disorders or structural deformities.

  • Age – Quality and Quantity of eggs decrease with age
  • Menstrual disorders
  • Ovulation Disorders – PCOS and Hypothalamic Amenorrhea
  • Tubular Occlusions – Blocks in Fallopian Tubes
  • Endometriosis
  • Endometrial Polyps
  • Uterine Fibroids
  • Infections (STIs)

Why Chennai Gynecologist?

At Chennai Gynecologist we aim to provide you with safest, quality and best medical services for treating whole range of women’s health starting from Puberty to Menopause Management. We are 100 Percent sure that the price and quality of services we provide will be standard and safe. We are also sure that you will experience high quality services that makes your life more valuable for the money and Quality Time spent.

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