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AWAITING SURGERY? HOW TO CHOOSE THE SURGEON

Surgery outcome is better if the surgeon is female.
– BMJ, number 2 in the list of top medical journals of the world

“Patients have a right to know how good a surgeon is,”
– Dr. Fiona Godlee, editor in chief of the BMJ

Surgeon Rating

The US has websites that rate the surgeons. A patient can use these to choose the surgeon. Also, in May 2015, three major hospital systems in the US implemented the “Take the Volume Pledge” that prevents surgeons and hospitals from doing surgeries in which they have “low volume.” Surgical “volume” is the number of times a surgeon/hospital has done a specific surgical procedure in a defined time period.

India will not have surgeon-rating websites for many, many years to come. And surgeons/hospitals do not have any guidelines to prevent them from doing surgeries that they have little experience or currency of doing. How may the patient in India choose the surgeon?

Surgeon’s Experience

For over two decades researchers have acknowledged that the outcome of a surgery is related to the surgeon’s experience. This was confirmed by a recent Harvard University study that analysed surgical performance in 14 countries with a total of more than 17,000 surgeons and 35 different procedure types. Analysis of data on more than one million surgeries has shown that the more procedures a surgeons has performed, the better her patients’ outcome, at least until she hits a learning plateau. The plateau is reached after 25 to 750 procedures depending on the complexity of the surgery.

“Low Volume” surgeons’ patients have higher mortality, morbidity, intraoperative and postoperative complications, readmissions to hospital, and mortality within 30 days of surgery, as compared to “high volume” surgeons: for example, in pancreatic cancer surgery, annual death rates were nearly four times higher; in certain other surgeries, death rates were three times higher; in endocrine surgery, complication rates and reoperation rate were about two times higher; in gastric bypass surgery, risk of serious complications fell by 10 percent for every additional 10 cases per year the surgeon performed.

Choosing the Surgeon in India

In India, search engines like Google, Bing and Yahoo may be used to find a better surgeon. But Google is the best and the most widely used search engine. Let us say you are looking for a Gynaecologic laparoscopy surgeon in Delhi. Search “Best Gynae laparoscopic surgeon in Delhi.” Take the first ten names on the list and look at their average ‘rating’ and the number of persons who have given it. The higher the average ‘rating’ and the greater the number of persons giving it, the better: a surgeon with a rating of 5/5 given by 100 persons is likely to be better than the one with 4.7/5 rating given by 40 persons.

Next, look at the Google search pages. Page 1 is usually full of ads and sites of big hospitals and agencies like Practo, Lybrate, Quora and so on. You will find surgeons at page two onwards. Visit their website and check:

a. Their performance in medical school and later. Academic brilliance is often indicative of good professional competence.
b. Whether they have done specialised training and whether they have done it at a reputed, highly selective, institute. Specialisation is even more important than “volume.”
c. Whether they are keeping current with the latest technology by visiting Centres of Excellence in developed countries like the US, UK, Germany etc.
d. Browse her Blogs

Next, schedule a consultation with the selected surgeon. At the consultation ask the surgeon:

i. How many years’ experience she has in doing the specific surgical-procedure. A minimum of five years’ is preferred.
ii. How many total specific surgical-procedure she has done. Depending on the complexity of the procedure, minimum of 25 to 750 is suggested.
iii. How many specific-procedure she has done in the previous two years. For complex surgery, a minimum of 30 per year is suggested.

A good surgeon will not mind such questions and will not give incorrect information.

And finally, surgeon’s communication skills and trust-building ability are of singular importance.

Now ask yourself: “Was I comfortable talking? Did she answer my questions well? Did she ask good questions of me? Was she caring? Is she someone I can trust my life with?”

If possible, ask the surgeon’s other patients about their experience; and other doctors about surgeon’s expertise.

Before taking a final decision, seek a second opinion. In complex cases, about 1 in 5 second opinions are different from the initial treatment recommendation.

Conclusion

Every surgery has the potential for life-threatening complications. “Even in the best of circumstances, bad things can happen.” Occasional bad outcome are inevitable; but many surgical injuries are avoidable.

Minimize the probability of bad outcomes by choosing the right surgeon and the right hospital.

 

GOONEY BIRD

Weapons that most helped end World War II: “the bazooka, the Jeep, the atomic bomb and the Dakota.”
– General five star (later US President) Dwight D Eisenhower, Supreme Commander Allied Forces (SHAEF), World War 2

Vintage DC-3/Gooney Bird ‘Parshurama’

Yesterday, 04 May 2018, Rajeev Chandrasekhar, MP, gifted a flying DC 3 vintage aircraft to the Indian Air Force. The gift, accepted by Air Chief Marshal B S Dhanoa, Chief of the Air Staff, will join the Harvard and the Tiger Moth vintage aircraft in the Hindon-based Vintage Air Craft Flight of the IAF.

The gift-DC 3, tail number VP 905, now named ‘Parshurama,’ was produced in 1944 and retired from the IAF in 1974 after three decades of service. It was picked up from IAF museum in 2012 and restored to flying at a cost of £580,000 (₹ 5.26 cr) after six years’ of work in England. It flew from England to Hindon airbase in Ghaziabad – 7000 km, crossing five countries, in seven days – for the gift ceremony.

And thus, 30 years after the DC 3 retired (1988) from the IAF, it re-entered, still flying majestically.

Self on the Captain’s seat in Gooney Bird ‘Parshurama,’ 04 May 2018, Hindon Airbase – handing over ceremony of the flying vintage DC 3 to the Vintage Aircraft Flight of IAF

A few tit bits about the DC 3.

Gooney Bird as the American’s call it, or Dakota or Dak as we and the British call it, are but two of the over two dozen nicknames of this legendary aircraft.

Gooney Bird, like the albatross – a giant seagull-like bird noted for its powers of flight and unflattering but safe landings – a bird which aerodynamically should not be able to get off the ground but is so stupid it doesn’t know that and flies anyway. Similarly, the Dak is so stupid (a goon) that it doesn’t know it is not supposed to do the things that it does.

And what things they are, were!

In June 1943, a Dak was attacked by eight Junkers Ju 88 over Bay of Biscay. It still ditched safely on the sea and all aboard survived the ditching, but were killed by repeated attacks by the Junkers.

On 27 may 1952, the Dak became the first plane to land at North Pole. On 31 October 1956, it became the first plane to land at South Pole, putting the first person at the South Pole since Robert Scott’s party more than four decades ago.

First aircraft to land at the South Pole, 31 October 1956, DC-3 Dakota

A Dak ran out of gas over Missouri in 1957. Everyone bailed out. The Dak glided over the horizon and made a perfect unmanned landing in a cornfield! The Dak can fly by itself! It is forgiving and psychic – anticipates pilot-errors and compensates for these.

Landing on an airstrip in a jungle, one quarter of the right wing of a Dak was damaged and it became un-flyable. The enterprising crew cut off one quarter each of both the wings and lo and behold! The Dak flew back home.

Designed to carry about 30 people, in 1975 in Saigon, Vietnam, it carried 106!

Dakota Number “728” retired in 1975 having spent more than 9 1/2 years in the air covering over 12 million miles, the equivalent of 25 trips to the moon and back.

Air Chief Marshal B S Dhanoa, Chief of the Air Staff, and self at the Reception 04 may 2018, Hindon Airbase – handing over ceremony of the flying vintage DC 3 ‘Parshurama’ to the Vintage Aircraft Flight of IAF

Dak’s doings in the Indian Air force were no less startling. Inducted in September 1946 in No 12 squadron, it demonstrated its mettle almost immediately. Just one year after induction, on 27 October1947, it carried Army’s 1 Sikh Regiment to Srinagar to halt the tribal Lashkar launched and backed by Pakistan. It then bombed, day and night, the Pakistani/tribal positions in Poonch sector. Later, it began landing on a hastily prepared, short, 600-yards kuccha strip at Poonch to carry troops and supplies. “The Dakota is the reason why Poonch is still with us,” says Pushpindar Singh, military historian.

Dakota’s next stellar role was to supply the army in Ladakh and in North-East. In Laddakh, it landed at Kuchha air strips at Kargil, Leh, and Thoise, at altitude of 10,000 feet; and at Chusul (13,000 ft) and Fuk Che (13,500 ft). It would have certainly landed at Daulat Beg Oldi (DBO) airstrip, 16,614 ft, to set the record for ‘world’s highest aircraft landing at the time;’ but this record was set by Squadron Leader C.K.S Raje with the first landing at DBO in a Packet (C 119) aircraft on 23 July 1962.

In NE, the Dak landed at Along, Daporijo, Inkiang, Tuting, Anini, Zero, Walong – all short, 7-800, yard strips nestled in hills, a few on miniature plateau with a sheer drop at one or both ends of the strip. All the airstrips with very difficult approaches. Only a Dak could land at these strips till the special STOL aircraft like Caribou, Otter, and C 130 J came along.

Chandrasekhar, the man behind the DC 3 ‘Parushrama’ restoration and handing over to the IAF, and self.

On a sunny but crisp and cool afternoon on 17 December 1935 in Santa Monica, California, the DC 3 (DST) sat at the edge of the runway for about five minutes, its engines running; then at full throttle, it ran down the runway and was airborne. The first time the DC 3 was in the air. Eighty-two years later, it is still in the air: six of them are in airline service with Buffalo Airways of Canada doing regular flights to NW Territories! One of these six is DC-3 C-GWZS which also flew in the D-day (6 June 1944) in the invasion of Normandy in WW 2.

At a total of 17,273 produced in various avatars, the DC 3 remains the most-produced airliner; the next is Boeing 737: 10,000 produced. As of September 2008, about 1,400 DC-3/Dakota airframes remained worldwide.

I am sure on 17 December 2035, its 100th birthday, the Gooney Bird will still be in the air. Because the only replacement for a DC 3 is a DC 3.

DAUGHTER OF UTTARAKHAND AWARD

DAUGHTER OF UTTARAKHAND AWARD

 

Dr Monika Pant (Vice President, BJP, Delhi) and Dr Rashmi Malhotra – my two nieces – accepted the Award for me since I was away; and Dr Monika read out my speech.

Extract from my acceptance speech at the Daughter of Uttarakhand Award;

“I’m an Uttarakhandi. But born in Lucknow, medical education and practice in Kanpur and in the US and in Delhi. My only connect to Uttarakhand was summer vacations in Nainital during my schooldays.

Then came the Uttarkashi earthquake, 1991. I spent a few weeks there to oversee the relief work undertaken by Swami Rama. That brought me face to face with the plight of the people in my home-state living in the villages perched on steep mountains.

I then founded Family Welfare Foundation of India to bring some medical care to the doorsteps of the villagers. The Foundation’s USP was that it neither sought nor accepted any donation from any one – individual, institution or govt.

In 1999, we became one of the few NGOs from India to be accredited by the United Nations (UN). Till date, we remain the only NGO in the UN system that does not accept donations from any one.

I also did bit of work for the setting-up of Swami Rama medical college, now HIHT University, at Rishikesh. I was a Professor in the college and trained the faculty in Minimally Invasive Surgery (MIS).

My work in Uttarakhand has been the best part of my life’s journey.”

26 April 2016

Laparoscopic & Robotic Gynec Surgeon

“I treat the patient, not the diagnosis”

Dr (Prof) Sadhana Kala
Laparoscopic & Robotic Gynec Surgeon
See:
www.drsadhanakala.com





FEMALE INFERTILITY TREATMENT

Fertility is God’s gift to women. And to men. But the gift is not equitable. A few have more of it, a few have less of it, and a few have none of it.

About 17% of couples have infertility. But with today’s technology, most of them can have a baby.

If a couple fails to conceive despite trying for 12 months, then it needs infertility treatment in Delhi. Since infertility can be in the man, or in the woman, both of them must be evaluated. In males, more than 90% of infertility is due to low sperm counts, poor sperm quality, or both. The remaining cases can be for several reasons: anatomical problems, hormonal imbalance, and genetic defects.

In females, infertility is mostly because of problems with ovulation or cervix, or damage to fallopian tubes or uterus, or abnormal cervical mucus. Also, as a woman ages, her fertility decreases.

DIAGNOSIS

Female infertility is a contributory factor in about half of all infertility cases; and the only factor in about one-third of all the cases. Most frequent causes of female infertility are:

• Ovulation problems • Damaged fallopian tubes or ovary • Cervix problem • Abnormal cervical mucus which prevents, or makes it difficult, for the sperm to reach the egg and to penetrate it • Age: as a woman ages, her fertility decreases.

Female fertility is diagnosed by physical, pelvic and breast examination, medical history and one or more tests such as:
• Urine or blood tests to check for infection, hormone problem and thyroid function • Ovarian reserve tests to determine the quality and quantity of eggs available for ovulation. • Cervical mucus and tissue test to check for ovulation. • Ultrasound to look at the uterus and ovaries’ abnormalities or problems. • Hysteroscopy to look for uterine abnormalities and growth inside the uterus. • Laparoscopy to see endometriosis, scarring, blockages or irregularities of the fallopian tubes, and problems with the ovaries and uterus and surrounding area. • Genetic tests to find if a genetic defect is causing infertility.

Depending on the cause, your age, and how long you have been infertile, one or more therapies may be needed to restore fertility.

TREATMENT

In India, 10-15 out of 100 couples (22-33 million couples) need Infertility treatment. And the number is increasing. Female infertility treatment may be medication or surgery or Assisted Reproductive Technologies (ART).

Medication:

• Antibiotics for infections.
• Hormones for hormone imbalance, endometriosis, or a short menstrual cycle.
• Medicine to stimulate ovulation.
• Supplements to enhance fertility.

Laparoscopic surgery to:

• Correct an abnormal uterine shape.
• Remove:
 Endometrial polyps and fibroids that misshape the uterine cavity.
 Pelvic or uterine adhesions.
 Blockage or scar tissues from the fallopian tubes, uterus, or pelvic area.

ART

• Intra Uterine Insemination (IUI). In IUI, ovulation is monitored and millions of healthy sperms are placed inside the uterus at the time of ovulation.

• In Vitro Fertilization (IVF). In IVF, mature eggs are retrieved from the woman, fertilized with a man’s sperm in a dish in a lab, and the embryo is then transferred to womb. IVF cycle takes several weeks and requires frequent blood tests and hormone injections.

IUI is less physically demanding and a much shorter, and much cheaper (for three cycles, IUI, ₹ 10-15,000; IVF, ₹ 3-5 lakh) process than IVF; but IUI has a higher risk of multiple pregnancy.

Also, IUI success rate after three cycles is about 55%; for ART, it is 75-94%. For IUI, the rate dips sharply with woman’s age: dips to 3-14% for a woman of 45. For IVF the dip is hardly any.

For women in their late 30s and above, going directly for IVF may be a more cost-effective option.

But remember, ART is an art, not just science. Just as art depends on artist, so ART depends on the ARTist – the infertility specialist in Delhi. Just as the artist becomes more skilled with practice and experience, so does the ARTist, the doctor. So the right question to ask is not what the success rate of ART is; the right question to ask is what the success rate of the ARTist, the infertility doctor in Delhi, is.

Infertility is a complex disorder. Treatment demands significant financial, physical, psychological and time commitments. Be prepared for that.

Blog 01

Best Gynecologist in East of Kailash Serves Superior Gynecological Care for Women

Dr. (Prof.) Sadhana Kala Obstetrics & Gynecologist in East of Kailash, Delhi, is a highly renowned, integrated and the leading Woman Care doctor in Delhi. Our Centre is well equipped with all the facilities that make you feel warm and at home. We strive to maintain the highest standard of consultancy and cater Advise with the most concurrent and innovative knowledge regarding all subjects within the era of Dr. (Prof.) Sadhana Kala Care. Best Gynecologist in East of Kailash delivers a number of services, each woman requires through her life; ranging from her puberty till her midlife. The specialty of Gynecology, Obstetrics, Infertility, and Sexual Health has been our main area of specialization over many years.

Gynecological issues

Dr. (Prof.) Sadhana Kala is a leading provider of comprehensive Obstetrics & Gynecology Services. Our whole cadre collaborates to cater women and expectant mothers the highest standard of multidisciplinary and high-quality care. Our cadre works closely with other specialty areas and solutions should the want arise. We use the updated information and innovative technology to diagnosis and cure patients and are proud to be a part of over many labor and deliveries every year.

Dr. (Prof.) Sadhana Kala caters the full standard of obstetrical services, and also serves superior gynecological care for women, from adolescence through the post-menopausal years. Our years of going through in the multi-cultural community of Best Gynecologist in East of Kailash Delhi give us the knowledge to cater solutions according to a broad range of cultural values and personal preferences. We endeavor to realize your requirements and will provide you the specialized care you expect.

Ameliorating the clinical effectiveness and efficiency is the key to achieve our target of absolute patient satisfaction. Dr. (Prof.) Sadhana Kala makes a positive contribution by regularly organizing training and educational activities relating to health and medicine. The future is unsealed and everyone fears that the work of a lifetime could be in jeopardy. The possibility of losing what took a lifetime to form can only break one’s confidence. During these times, thoughts inevitably turn to what is more valuable in one’s life.

Gynecologist in Hauz Khas Provides You Best Parental Care

A woman’s life is specified by unique changes that happen with time: from accomplishing menarche, conception, pregnancy, childbirth, and menopause. These changes do bring about troubles, directly or indirectly linked to the reproductive system and hence needs a particular branch of medication that focuses on these areas.

Gynelogical issues in women

Gynecology consists medical and surgical procedures, for the complete spectrum of diseases including the female reproductive system, whereas Obstetrics is the surgical specialty that deals with the care of mother and child, before, during and after the child takes birth.

Infertility is the special branch of medical study that deals with the infertility problems in both men and women and includes diagnosis of infertility, therapeutic techniques are to improve fertility and embryology services such as in vitro fertilization (IVF).

An annual visit to the gynecologist is an important part of keeping up with your body’s life changes. Our exams and treatment options are tailored to fit your healthcare needs. We provide annual exams for women from adolescence to menopause and beyond in addition to services and counseling related to birth control, menopause and sexually transmitted diseases. The doctor also has training and experience in both major and minor gynecological surgeries.

Gynecologist in Hauz Khas, Delhi offers women’s health services across South Delhi. We are committed to catering women with the best quality of healthcare through each and every stage of life, from adolescence to post-menopause. Dr. (Prof.) Sadhana Kala, the best Gynecologist in Delhi lead assistants and medical support all dedicated to maintaining the best level of care for our women patients.

Women having a desire for a baby and expectant mothers depend and believe on Dr. (Prof.) Sadhana Kala for the best physician lead prenatal care and delivery approach in South Delhi.

Dr. (Prof.) Sadhana Kala, Best Gynecologist in Hauz Khas, is specially trained to perform minimally invasive surgeries when appropriate for our patients. She is trained in the utilization of the robotic system. These less intrusive surgical techniques cater significant benefits over traditional methods. Minimally invasive surgery enables our patients to benefit from less pain, fewer complications and shorter recovery time.

Blog 02

Gynecologist in New Friends Colony for Treating Women Health Issues

Gynecology can be a very in-depth field and all women are advised to get routine and typical regular checkups to assure that their health is 100% and they are free of charge from disorders. A specialist of Gynecology really should often be professional and be sure ladies patients are always treated with respect, full esteem and kept comfortable. When a woman is fishy of issues with female organs she needs to right away look, aid and care from a Gynecologist in New Friends Colony.

Gynecological issues in women

When a lady is worried about finding herself pregnant, the most efficacious physician to talk with would be the Best Gynecologist in New Friends Colony. There isn’t anything worse for a woman than the fear of a disorder with her private organs; a Gynecologist in New Friends Colony can help diagnose if anything is present and the best way to proceed forward.

With the changing lifestyle practices, the numerous medical complications that can affect a woman keep increasing. Everywhere on the earth, the Governments are striving to provide the best healthcare facilities for women. Some of the common diseases and complications that women face in their lifetime include,

  • Hormonal imbalance
  • Infertility
  • Ovarian and Cervical cancer
  • Breast cancer

FEMALE GYNECOLOGIST IN DELHI

Gynecology was a field that was preponderantly filled with male doctors. As years went by, it was recognized that plenty of the patients did not feel much comfort with being treated by them. But in the recent times, there has been a substantial rise in the number of female gynecologists in the field. This condition does not connote that the male doctors are not pretty competent, but its roots from the fact that women feel a bit embarrassed, humiliated or held back when they want to ask a question related to their condition. This, in turn, forecloses them from telling the Gynecologist what problems they are suffering from, leading to a misdiagnosis on the part of the gynecologists. Dr. (Prof.) Sadhana Kala is a female Gynecologist in Delhi New Friends Colony for women who are in need of a female doctor to assist them for their condition.

Blog 04

Preventive Care Tips by Gynecologist in Kalkaji Delhi

Gynecologist in Kalkaji Delhi has a dedicated unit for Gynecology and to treat disorders of the reproductive system. She will guide you right from the commencing when you have decided to be a mother through the whole period of pregnancy till the birth of the child and afterward. With highly experienced specialists as part of the gynecology, you can totally rely on her and be assured you’re in safe hands.

gynaecological issues in women

Because a woman’s health needs change with each stage of life, Best Gynecologist in Kalkaji, Delhi caters quality, feel for care from adolescence through climacteric.

From well-woman exams to treatment for self-gratification, overactive bladder, pelvic prolapse and many other disorders, you can count on the Dr. (Prof.) Sadhana Kala, Best Gynecologist in Delhi.

And when you are in a situation that’s troubling you, causing you discomfort, concern or embarrassment, you should not have to wait and bear. That’s why Dr. (Prof.) Sadhana Kala, Gynecologist in Kalkaji, makes appointments available quickly.

With Dr. (Prof.) Sadhana Kala, Gynecologist in Delhi, much of her attention is dedicated to the increasing medical needs of today’s women to cater the care possible at its best. She caters several Gynecological services through latest techniques and minimally invasive procedures.

With Dr. (Prof.) Sadhana Kala, Gynecologist in Kalkaji, she focuses on care of all women, from the cradle to climacteric, and she is one of the potent and powerful advocates for women’s health. As a highly qualified Gynecologist, she has an energy that is incomparable. She has a compassionate and deep esteem for variant morals, principals, and faiths, yet she works in a seamless way. She realizes that all women have different desires, and we customize the care accordingly.

Dr. (Prof.) Sadhana Kala, Gynecologist in South Delhi, specializes in preventive care and cure. She thinks beyond the patient’s immediate medical requirements by offering holistic and seamless unified care.  She caters comprehensive services under one roof.  As a Specialist, she covers multiple areas, including check-ups, Laparoscopy, Dysfunctional Uterine Bleeding, and Fibroids.

The services range from diagnosis to curing, aiding and even emotional and psychological support. You will feel the Warmth and Care of Dr. (Prof.) Sadhana Kala, Best Gynecologist in South Delhi, Exceptional Care for You and your Baby by her backed by modern, up to the minute equipment.

Best Gynecology treatment

Gynecologist in Defence Colony Helping Women for Their Health Issues

Dr. Sadhana Kala is a well-known Gynecologist in Defence Colony holding the degree of MS, FIAMS, FACS from USA, FICOG, MAAGL. She has a clinical, teaching, and research experience of 41 years and she has expertized in the medical fields of Laparoscopic surgery in Delhi, Infertility treatment in Delhi, Hysteroscopic surgery, high risk pregnancy treatment in Delhi, gynecology surgery, and Obstetrics. She was a university topper at her time of academics and achieved several Gold and Silver medals and Certificates of Honor, and Distinction in Medicine.

Currently, she is professionally appointed as senior consultant Gynecologist and Laparoscopic Surgeon at Apollo Hospitals, Cradle Royale – R-2, Nehru Enclave, New Delhi 19 and Moolchand Medcity & Hospitals, Lajpat Nagar, New Delhi – 24. Previously, she has been working as a consultant to:

  • Apollo Hospitals, New Delhi
  • Batra Hospital, New Delhi
  • Modi Hospital, New Delhi
  • Max Hospital, New Delhi
  • Fortis La Femme, New Delhi
  • AI, ONGC, AAI, SAIL etc.
  • Army, Navy, Air Force

Therefore, no matter what sort of gynecological problem you are facing, you can consult the most trusted best Gynecologist in Defence Colony without any hesitation. Dr. Sadhana Kala is known as the best Gynecologist in Delhi as she comforts the patient to freely discuss the problems they are facing and recommends completely safe and guaranteed treatment for diagnosing the problems. She takes her professional responsibilities with keen dedication and always stay focused on what her patients actually want to discuss.

Holding 41 years of experience, she has resolved many cases of infertility among the couples and here she discusses the infertility causes in the female.

  • Damage to fallopian tubes – Fallopian tubes transmit the fertile eggs from the ovaries to the uterus, and thus, the blocked or damaged fallopian tubes can actually prevent the sperms getting to the egg.
  • Improper hormonal changes – As an experienced Gynecologist in Defence Colony, Dr. Kala explains that most women suffer from several problems during their time of ovulation and the most common are observed while releasing the egg from the ovary and stiffening of the endometrium.