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INFERTILITY IN WOMEN

INFERTILITY IN WOMEN

SYNOPSIS 

In India, infertility affects one in six couples in urban areas; and about 27.5 million couples actively trying to conceive. Women contribute to about 50% of all infertility cases. In women, common causes of infertility  are ovulation-problems, damage to Fallopian tubes or uterus, or cervix-problems. Diagnosis is mainly by urine and blood tests, ultrasound, laparoscopy and hysteroscopy. Treatment is hormones, medication and minor surgery. Safe sex, hygiene and healthy life style and diet may reduce the probability of infertility. With assisted reproductive technology (ART), most of the women can achieve pregnancy. Infertility and its treatment have psycho-social impact which may need counselling and psychotherapy.

 

INFERTILITY IN WOMEN

Infertility is a loss. It’s the loss of a dream. It’s the loss of an assumed future. And, like every loss, it will be grieved.

INTRODUCTION

In India, infertility affects one in six couples in urban areas; and 10-14% of the population overall; about 27.5 million couples actively trying to conceive suffer from infertility.

If a couple is unable to conceive despite trying for one year, they are diagnosed as infertile. Cause of infertility can be either in male or in female partner. When it is in female partner, it is called female infertility. Female infertility factors contribute to about 50% of all infertility cases; and female infertility alone cause about one-third of all infertility cases.

In a few cases the infertility remains unexplained, or idiopathic, that is, its cause remains unknown.

CAUSES

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 women, common causes of infertility  are ovulation-problems, damage to Fallopian tubes or uterus, or cervix-problems. Also, as a woman ages, her fertility tends to decrease, and this can cause infertility.

Ovulation problems may be caused by one or more of the following:

Damage to the Fallopian tubes or uterus can be caused by one or more of the following:

DIAGNOSIS

One or more of the following tests/exams are used to evaluate fertility:

  • Urine and blood test to check for infections or a hormone problem, including thyroid function
  • Pelvic exam and breast exam
  • Test of cervical mucus and tissue to determine if ovulation is occurring
  • Laparoscopic examination to view the condition of organs and to look for blockage, adhesion or scar tissue.
  • HSG, which is an x-ray used in conjunction with a dye inserted into the fallopian tubes to check for blockage of the Fallopian tubes.
  • Hysteroscopy that uses a tiny telescope with a fibre light to look for uterine abnormalities.
  • Ultrasound to look at the uterus and ovaries. May be done vaginally or abdominally.
  • Sonohystogram combines an ultrasound and saline injected into the uterus to look for abnormalities or problems.
  • Tracking your ovulation through fertility awareness will also help your infertility specialist to assess your fertility status.

A scene of longing that gets at what infertility is like

TREATMENT

Female infertility is most often treated by one or more of the following methods:

  • Taking hormones to address a hormone imbalance, endometriosis, or a short menstrual cycle
  • Taking medications to stimulate ovulation
  • Using supplements to enhance fertility
  • Taking antibiotics to remove an infection
  • Having minor surgery to remove blockage or scar tissues from the fallopian tubes, uterus, or pelvic area.

PREVENTION

Usually nothing can be done to prevent female infertility caused by genetic problems or illness.

But several things can be done to reduce the possibility of infertility:

  • Take steps to prevent sexually transmitted diseases
  • Avoid illicit drugs
  • Avoid heavy or frequent alcohol use
  • Adopt good personal hygiene and health practices
  • Have annual check-ups with your GYN once you are sexually active

You must contact your doctor in case of any of the following symptoms:

  • Abnormal bleeding
  • Abdominal pain
  • Fever
  • Unusual discharge
  • Pain or discomfort during intercourse
  • Soreness or itching in the vaginal area

Some couples want to explore more traditional or over the counter efforts before exploring infertility procedures. However, do consult your fertility specialist about these.

ASSISTED REPRODUCTIVE TECHNOLOGY (ART)

In recent years, several medical procedures have become available to treat infertility. Collectively, these procedures are called assisted reproductive technology (ART). A few of these procedures are, in vitro fertilization (IVF),  intracytoplasmic sperm injection (ICSI), cryopreservation of gametes or embryos, and/or may involve the use of fertility medication. ART includes “all fertility treatments in which both eggs and sperm are handled. In general, ART procedures involve surgically removing eggs from a woman’s ovaries, combining them with sperm in the laboratory, and returning them to the woman’s body or donating them to another woman.”

With ART and other fertility treatments, it is now highly probable for almost all couples to have a baby.

 

PSYCHO-SOCIAL IMPACT OF INFERTILITY 

Psycho-social impact of infertility is often overlooked because the focus is on physical causes of infertility. But this impact is important. And although it affects both the male and the female partner, the impact on women is greater.

Emotional Impact

Women are astonished, sad and angry when they first find out about their infertility.  As the treatments progresses, they are:

  • stressed
  • depressed
  • confused
  • worried
  • angry
  • upset
  • sad
  • pressured
  • grieved
  • suffer loss of:
    • self-esteem
    • self-confidence
    • sense of control over one’s destiny

Side effects of medication, money worries, and uncertain outcomes heighten the infertility-related stress.

Treatment failure, differences between partners on when to stop seeking treatment, decisions on adoption or living childless, cause further stress.

Coping with Stress

Counselling, Psychotherapy, Medications and Relaxation techniques such as mindfulness meditation, deep breathing, guided imagery, and yoga help cope with the psycho-social impact.

Other ways to cope with stress is to accept your feelings and to know that it happens to most women undergoing infertility treatment; to allow yourself to be angry, to cry to grieve; to stay connected to, and to communicate with, family and friends and your partner; to share with them your questions and fears.

Long invigorating walk, new hobby, listening to soothing music may also help. Also, cut down on intake of sugar, salt, saturated fats, and white flour; reduce or eliminate from diet chemical additives, alcohol, and caffeine, including colas, coffee, black tea, and hot cocoa.

If you feel stressed, angry and frustrated during infertility treatment, remember you are not alone. Everyone undergoing such treatment feels that way. The difference is only in the degree to which one is affected.

CONCLUSION

With ART and other fertility treatments, it is now highly probable for almost all couples to have a baby.

Still, 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.

Fertility treatment is often a long and arduous journey. It generates psycho-social pressures. But don’t lose hope. Don’t give up. Even miracles take a little time.

Art work made from think glass medication vials, Q-caps (used to administer fertility meds), and gauze, along with ceramic pieces and glue. Titled ‘Letting Go,’ made by Denise after infertility treatment failed and she decided to live childless.

ABNORMAL VAGINAL DISCHARGE (LEUCORRHOEA)

SYMPTOMS

Women often feel embarrassed to speak about vaginal discharge, leucorrhoea, though it usually is a harmless, natural, occurrence. Except when the discharge, which normally is clear and white and odorless, becomes yellow, green or grey, or white and curdy like cottage cheese, or frothy, or foul-smelling usually a fish-odor.

The other symptoms of Leucorrhoea are:

  • Rashes or sore spots on the genitals
  • Intense itching of the vagina
  • Pain during sex
  • Burning urination and frequent urge to urinate even with very little urine
  • Constipation and other Digestive disturbances
  • Backache, pain in the leg, pain in lower abdomen
  • Irritability and lack of concentration in work
  • Fatigue because of loss of fluids as discharge
  • Headaches

CAUSES

Leucorrhoea may be caused by:

  • Antibiotic or steroid use
  • Bacterial vaginosis (a bacterial infection)
  • STD
  • Pelvic infection
  • Pelvic inflammatory disease (PID)
  • Urinary tract infection
  • Injuries to the cervix or any of the tissues in the reproductive system during pregnancy
  • Diabetes
  • Anemia
  • Birth control pills
  • Douches, scented soaps or lotions, bubble bath
  • In young girls, hormonal imbalance caused by severe mental stress and trauma
  • Overindulgence in sexual activity
  • Improper diet and lifestyle during menstrual cycle
  • Lack of nutrients
  • Improper vaginal hygiene
  • Alcohol and smoking
  • Cervical or endometrial cancer

DIAGNOSIS

The doctor will take your health history, note the symptoms, and may test the discharge and may also do a Pap test to find the cause of the problem.

 

TREATMENT

Treatment will depend on the cause of the problem.

 

PREVENTION

To prevent Leucorrhoea:

  • Keep the vagina clean by washing regularly with a gentle, mild soap and warm water
  • Never use scented soaps and feminine products or douche. Also avoid feminine sprays and bubble baths
  • After going to the bathroom, always wipe from front to back to prevent bacteria from getting into the vagina and causing an infection
  • Wear 100% cotton underpants
  • Avoid too tight clothing

Whenever you feel that the vaginal discharge is abnormal, consult your gynecologist.

 

 

BREAST CANCER SELF SCREENING

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DEPRESSION IN PREGNANCY

Depression, suffering and anger are all part of being human. – Janet Fitch

Depression is the inability to construct a future. – Rollo May

SYNOPSIS

Depression is a mood disorder, a biological illness, which affects 14-23% of women during pregnancy. Depression makes a woman feel sad, bleak, helpless, anxious, irritable, fatigued and lacking in energy.

Depression can be treated. Left untreated, it can lead the woman to poor nutrition, drinking and smoking causing the babies to be born premature, less active, and have developmental problems. Antenatal depression is a strong precursor to Postpartum Depression.

Depression treatment is psychotherapy, medication, and self-care. Cognitive behavioural therapy (CBT) is the often used psychotherapy. A woman can do it herself after suitable instructions. Medication is antidepressants. These pose a very small risk to fetus. A few supplements are also claimed to help. But these should not be taken without doctor’s advice. Self-care involves proper diet, adequate sleep, exercise, and pregnancy-yoga.

Several women have depression during pregnancy. So you are not alone. Do not therefore hesitate to speak to your doctor at the first appearance of the symptoms of depression.

INTRODUCTION

Pregnancy is a joyous period for women. But for a few the joy is clouded by mood swings. We all have transitory mood swings. But if these last a few weeks or a few months, then these signal depression.

DEPRESSION

Depressions are biological illnesses caused by changes in brain chemistry. Such changes may be triggered by the hormonal changes during pregnancy. This is called antenatal depression. But except in name, it is similar to clinical depression.

SYMPTONS

Symptoms of depression vary from person to person. But if you have one or more (usually five) of the following symptoms for most of the day, nearly every day, for two weeks or more, it signals depression:

  • feelings of sadness, bleakness, hopelessness, and anxiety;
  • lack of interest or pleasure in doing anything;
  • feeling tired or having little energy;
  • difficulty concentrating;
  • difficulty remembering.
  • feeling emotionally numb.
  • extreme irritability.
  • sense of dread about everything, including the pregnancy.
  • feelings of failure, or guilt.
  • trouble getting to sleep, waking up in the night or sleeping too much;
  • overeating or decreased appetite.
  • weight loss/gain unrelated to pregnancy
  • low self-esteem, or feelings of guilt or failure
  • fidgeting a lot, or moving and speaking very slowly
  • loss of interest in sex.
  • thoughts of suicide or self-harm may occur.
  • inability to get excited about the pregnancy, and/or baby
  • feeling of disconnection with the baby, and an inability to form/feel a bond with the developing baby.

RISK

Anyone can have depression. But the following factors, or a combination of these, increases the risk of getting depression:

• Family history of depression. Risk of suicide also goes up.
• Personal history of depression or anxiety in the past – like during an earlier pregnancy or after the birth of a previous child. Also the risk of postpartum psychosis, a rare but very serious condition that involves hallucinations, increases.
• Life stress events, such as financial problems, the end of a relationship, the death of a close friend or family member, or a job loss.
• Lack of support like having relationship problems or an unsupportive partner or having your baby on your own, or if you feel isolated from friends or family
• Unplanned pregnancy finding out you’re pregnant when you didn’t plan to be.
• Domestic violence and emotional abuse that tend to get worse when you’re pregnant.
• Infertility treatments
• Complications in pregnancy

TREATMENT

Antenatal depression is treatable with psychotherapy, medication, and self-care.

Psychotherapy:

Cognitive behavioral therapy (CBT) is the often used psychotherapy. It helps the mother recognize her emotions and counter her negative thoughts. She is encouraged to do CBT herself after step by step instructions in CBT through books and talks, or she may be advised do it in sessions with a therapist.

Medication

She may also need antidepressants. Not enough evidence is available that these are completely safe to take in pregnancy. A few of these pose a very small risk of birth defects that include fetal heart and skull abnormalities. Doctor weighs the risks and benefits to the mother and to the baby to decide on antidepressants. If the mother was on mental health medication before pregnancy, she should not stop these without asking the doctor. Also, she should not start any medication, including herbal medication, without asking the doctor.

Supplements

Several supplements such as St. John’s wort, SAMe, Saffron extract, 5-HTP and DHEA are being marketed as being helpful in depression. These seem to help some people but sufficient evidence is not available for their efficacy. A few of these can interfere with prescription medications or cause dangerous interactions and may be unsafe. Consult your doctor before taking any supplements or herbal medication.

Acupuncture 

Acupuncture is claimed to help relieve depression. But the evidence for its effectiveness is ambiguous or outright contradictory. The World Health Organization has recognized acupuncture as effective in treating mild to moderate depression. – Dr. Andrew Weil in ‘Depression, Health, World, Organization.’

Self-care

Diet, sleep, and physical activity are just as important as medication and therapy — sometimes more so.

Diet and nutrition.

Diet is so important to mental health that a new field of medicine called nutritional psychiatry has grown around it. Many foods have been linked to mood changes, the ability to handle stress and mental clarity.

• Foods to avoid are:

o Alcohol: it depletes serotonin, which makes people prone to anxiety, depression and panic attack.
o Caffeine: It lowers serotonin and increases the risk for anxiety, depression, and poor sleep. Reduce intake of coffee, tea, and hot cocoa.

• Foods to take are those rich in:

o B12 and folate. These prevent mood disorders and dementias. Sources: beetroot, lentils, almonds, spinach, liver (folate); liver, chicken, fish (B12)
o Vitamin D. Its deficiency is associated with different mood disorders. Sources: sun exposure; breakfast cereals, breads, juices, milk; high-quality supplements.
o Selenium. It decreases depression. Sources: cod, Brazil nuts, walnuts, poultry.
o Omega-3 fatty acids. These improve cognitive and behavioral function. Low levels of omega-3 fats leads to mood swings and depression. Sources: cod, haddock, salmon, halibut, nut oils, seeds, walnuts, and algae; high-quality supplements
o Endorphins. These enhance mood and promote a sense of well-being. Source: dark chocolate

Sleep

Lack of sleep (insomnia), or disturbed/obstructive sleep (apnea) are linked to depression. People with insomnia are 10 times more likely to have clinical depression and 17 times more likely to have clinical anxiety, and people with apnea are five times more likely to have clinical depression, than people who sleep normally. To help get sleep, lower room temperature, follow a schedule, avoid naps during the day, listen to relaxing music, try a low carb/high fat diet and eat 3-4 hours before sleep time, exercise, and practice yoga and meditation.

Exercise

Exercise releases endorphins, natural cannabis-like brain chemicals, and other natural brain chemicals, that enhance your sense of well-being. Depression causes tiredness and lack of energy. It may therefore be difficult to begin exercising. So begin with a walk for five or ten minutes and gradually increase to 30-45 minutes a day for three to five days a week. Results will appear after a few weeks because exercise is a long term treatment. Therefore pick up an exercise – walking, cycling, swimming – that you enjoy.so you will continue to do it

YOGA

Yoga focuses on the balance between your mind, body and breath. This balance is created through:

• physical exercises and postures (asanas)
• breathing exercises (pranayama)
• relaxation
• meditation

Yoga improves your physical, mental and emotional wellbeing. It helps you to:

• Improve your circulation, muscle tone and flexibility; to keep the body supple and relieve tension around the cervix by opening up the pelvic region. This prepares to-be-mothers for labor and delivery.
• Alleviate the effect of common symptoms such as morning sickness, painful leg cramps, swollen ankles, lower-back pain and constipation.
• Stay mentally agile through relaxation, breathing and meditation.
• Train you to breathe deeply and relax consciously, helping you to face the demands of labor and childbirth.
• Feel calm, and ease muscle tension.
• Recover faster post-delivery.

If you are already doing Yoga, you may continue to do pregnancy yoga during pregnancy. Since most miscarriages happen during the first trimester, you may, as a precaution, decide not to do Yoga during that period. Although there is no evidence that doing yoga, or any other exercise, during the first trimester will harm your pregnancy.

If you have never before done Yoga, then do not begin it in the first trimester. Begin in the second trimester, after 14 weeks of pregnancy. Join a pregnancy Yoga class. Your instructor will start you gently and slowly and modify the posture to suit the stage of your pregnancy.

Avoid these:

• Lying on your back after 16 weeks.
• Breathing exercises that involve holding your breath or taking short, forceful breaths.
• Strong stretches or difficult positions that put you under strain.
• Lying on your tummy (prone).
• Upside-down postures (inversions).
• Back bends.
• Strong twists.

A study published in Obstetrics & Gynecology in December 2015 found no evidence of fetal distress in any of the 26 postures attempted. These included downward facing dog and savasana. But avoid any poses that feel uncomfortable.

The Art of Living recommends only nine asanas (postures) for pregnancy Yoga. These include Shavasana (Corpse Pose) and Yoga Nidra (Yogic sleep).

You may restart postpartum yoga six weeks after a vaginal delivery; and a longer period after a Caesarean section as advised by your doctor. The postpartum asanas help combat back and neck aches and also help breastfeeding mothers.

ADDITIONAL

To help yourself handle depression:

• Talk about your concerns with your partner, family and friends. They may offer you a proper perspective or practical help. And simply talking about your problems makes these seem more manageable.
• Take time to relax. Give yourself some “me time.” Read, take a calming bath, lunch out with friends, watch an entertaining movie or play. In short do anything that takes your mind away from your concerns and gives you physical and mental relaxation.

DOWNSIDE

Untreated depression can lead to poor nutrition, drinking and smoking. These can cause premature birth, low birth weight, and developmental problems. Babies of ‘depressed’ mothers may be less active, have lower attention span, be more agitated, have behavioral problems and delayed cognitive and language development as compared to babies born to normal mothers.

Antenatal depression is a strong precursor to Postpartum Depression: a major depression in the weeks and months after childbirth. It affects mother’s health and quality of life and also the well-being of the baby. It can cause bonding issues with the baby and can contribute to sleeping and feeding problems for the baby.

CONCLUSION

If you have symptoms of depression, remember, you are not alone. Between 14-23% of women struggle with some symptoms of depression during pregnancy. Antenatal depression can be treated and managed. Most women recover with a few weeks, or a few months, of treatment.

So do not feel shy. Speak to your pregnancy doctor in south Delhi at the first appearance of the symptoms of depression.

REFERENCES

1. Depression During pregnancy
https://www.babycenter.com/0_depression-during-pregnancy_9179.bc#articlesection1
2. Depression In pregnancy

3. Facing Depression During Pregnancy
https://www.webmd.com/baby/features/facing-depression-during-pregnancy#1
4. Depression during pregnancy: You’re not alone
https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by- Antenatal depression
5. Antenatal depression
https://en.wikipedia.org/wiki/Antenatal_depression
6. Prenatal Yoga for women to do during pregnancy | The Art of Living …https://www.artofliving.org/in-en/yoga/yoga-for-women/yoga-and-pregnancy
7. Introduction to Pregnancy Yoga – Verywell Fit
https://www.verywellfit.com › Fitness › Yoga › Yoga and Your Health
8. Pregnancy yoga for beginners – BabyCentre UK
https://www.babycentre.co.uk/a1033238/pregnancy-yoga-for-beginners
9. The Complex Relationship Between Sleep, Depression & Anxiety …
https://sleepfoundation.org/excessivesleepiness/…/the-complex-relationship-between-sl…
10. Depression & Sleep – National Sleep Foundation
https://sleepfoundation.org/sleep-disorders-problems/depression-and-sleep
11. Can Acupuncture Treat Depression? – Scientific American
https://www.scientificamerican.com/article/can-acupuncture-treat-depression/
12. Natural remedies for depression: Are they effective? – Mayo Clinic
https://www.mayoclinic.org/…/depression/…/natural-remedies-for-depression/faq-200.
13. Depression and anxiety: Exercise ease symptoms – Mayo Clinic
https://www.mayoclinic.org/diseases…/depression/in…/depression…exercise/art-20046.
14. Exercise is an all-natural treatment to fight depression – Harvard Health
https://www.health.harvard.edu/…/exercise-is-an-all-natural-treatment-to-fight-depress..
15. 20 Simple Ways to Fall Asleep as Fast as Possible – Healthline
https://www.healthline.com/nutrition/ways-to-fall-asleep

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Visit to a Gynecologist in Delhi for Ensuring Complete Women Health

Every woman at some point of life needs to visit a gynecologist. This not only helps in maintaining the general health but also provides quality care and treatment at the most important phase of a woman’s life i.e. pregnancy. Routine checkup ensures that everything is going perfectly fine and if any medical problem occurs it can be cured at an early stage.

There are numerous issues that women have to deal such as anatomy issues, genetic issues etc. Gynecologist in Delhi is an expert in these areas and prescribes the right treatment and medications to help a woman get back on the right track. Some women are afraid of visiting a doctor. It is extremely essential, to be honest with the doctor. Early recognition can make it possible for several types of cancer to be treated as well as sexually transmitted diseases and problems such as infections and endometriosis.

Seeing a gynecologist in Delhi assists you in understanding your body better and suggests you the ways to take good care of your health. To make sure your reproductive organs are in healthy condition a yearly examination by a specialist is the must. If you want to have a baby, have a pain in the reproductive area, need birth control medications, have an infection or getting a positive pregnancy test visiting a gynecologist is a wise decision in all these cases. However, finding a reputable doctor requires some research work. Here are some ways to help you choose the appropriate one for you –

  • Ask family members and friends
  • Ask your general physician
  • Search online
  • Insurance companies as they have the list of the reputable doctors

The questions your gynecologist asks you are to help you to stay well and therefore not being honest is not recommended. As your body changes during puberty and into adulthood, your female provider can help you with every step. Building a strong relationship with your gynecologist over the years will help you to better understand your body and your health. Feeling comfortable enough to have exams will let you know that you have selected the right expert for your reproductive requirements.