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Do’s During Pregnancy

1) See your doctor regularly. Prenatal care can help keep you and your baby healthy and spot problems if they occur.
2) Continue taking folic acid (or any other medicine if prescribed) throughout your pregnancy. All women capable of pregnancy should get 400 to 800 microgram of folic acid every day. Getting enough folic acid lowers the risk of some birth defects. Taking vitamin with folic acid will help you to be sure you are getting enough.
3) Eat variety of healthy food. Include fruits, vegetables, whole grains and calcium-rich foods.
4) Get all essential nutrients, including iron, every day. Getting enough iron, every day. Getting enough iron prevents anaemia, which is linked to preterm birth and low weight births.
5) Drink extra fluids, especially water.
6) Get moving! Unless your doctor tells you there wise, physical activity is good for you and your baby.
7) Gain a healthy amount of weight. Check with your doctor to find out how must weight you should gain during pregnancy.
8) Wash your hands especially after handling raw meat or using bathroom.
9) Get enough sleep. Aim 7 to 9 hours every night. Resting on your left side helps blood flow to you and your baby and prevents swelling. Using pillows between your legs and under your belly will help you get comfortable.
10) Avoid any type of stress. Do meditation and breathing exercises regularly.
11) Make sure health problems are treated and kept under control. If you have diabetes, control your blood sugar levels. If you have high blood pressure, monitor it regularly.
12) Ask your doctor before stopping any medicines.
13) Wear comfortable clothes.
14) Join childbirth or parenting classes.

Don’ts During Pregnancy

1) Don’t smoke tobacco. Smoking during pregnancy passes nicotine and cancer causing drugs to your baby raises the risk of miscarriage, preterm birth and infant death.
2) Avoid alcohol intake during pregnancy.
3) Avoid exposure to toxic substances and chemicals, such as cleaning solvents, lead and mercury, some insecticides and nad paint. Pregnant women should avoid exposure to paint fumes.
4) Protect yourself and your baby for food-borne illness, which can cause serious health problems. Clean, cook, eat and store food properly. So avoid eating out.
5) Don’t clean or change a pet’s box. This can lead to infection, and can be harmful to the fetus.
6) Don’t take very hot baths or use hot tubs or saunas. High temperature can be harmful or cause you to faint.
7) Don’t use scented feminine products. Pregnant women should avoid scented spray, sanitary napkins, and bubble bath. These products might irritate your vaginal area and increase your risk of urinary tract infection.
8) Avoid X-Rays. If you must have dental work or diagnostic test, tell your dentist or physician that you are pregnant so that extra care can be taken.

1.What Is ICSI?

Severe male-factor infertility is treated very successfully by a relatively new laboratory technique called ICSI. ICSI involves injecting one sperm directly into the egg using a microscope with specialized micromanipulation equipment. ICSI is always used in conjunction with in vitro fertilization. For ICSI various sperm retrival techniques are used like PESA, MESA, TESA, and TESE.

2. If Sperm Count reports are Very Low what can be done?

Treatments for male factor infertility vary from intrauterine insemination (IUI) to in vitro fertilization with Intracytoplasmic Sperm Injection (ICSI). Individualized Medical treatment protocols are provided by the physician after the diagnostic evaluation is completed.

3. What is oligospermia?

The term “oligo” means few. Oligospermia is the presence of fewer than the normal number of sperm in the semen. Men with fewer than 20 million sperm/ml are usually defined as having oligospermia, or a low sperm count.

4. What is azoospermia?

Azoospermia is the complete lack of sperm in the ejaculate

5. What Are Treatment Azoospermia?

Yes. There are two different types of azoospermia. Obstructive azoospermia is the complete lack of sperm in the ejaculation due to a blockage in the male reproductive tract or the absence of the part of the reproductive tract that carries sperm from the testicle to outside the body. A blockage, or obstruction, may have been present at birth or may have occurred as a result of an infection or severe trauma to the testicles or the tubules surrounding the testicles that transport the sperm out of the body. Men with obstructive azoospermia almost always have some sperm in their testicles, but these sperm are not found in the semen because of the blockage or absence of part of the reproductive tract.

6. What is pesa?

For treating obstructive azoospermia, a procedure called Percutaneous Sperm Aspiration, or PESA, is used to aspirate sperm from the epididymis.

7. IVF Definition

In vitro fertilization (IVF) is a process by which egg cells are fertilized by sperm outside the womb, in vitro. IVF is a major treatment in infertility when other methods of assisted reproductive technology have failed. The process involves hormonally controlling the ovulatory process, removing ova (eggs) from the woman’s ovaries and letting sperm fertilise them in a fluid medium. The fertilised egg (zygote) is then transferred to the patient’s uterus with the intent to establish a successful pregnancy.
-The first “test tube baby”, Louise Brown, was born in 1978 and she herself is a mother of a healthy baby boy now.

8. Indications for IVF

There are a variety of indications for IVF.
- Male Factor Infertility : Male factor infertility includes low count and motility, high number of abnormal forms, ejaculatory dysfunctions, Failed reversal of Vasectomy/ Tubectomy , obstructive azoospermia etc.
- Age-Related Infertility : higher the age lesser the chances of conception. The fertility index keeps on decreasing after the age of 30 – 35.
- Reduced ovarian reserve, which means lower quantity (and sometimes quantity) of eggs. A day 3 FSH and estradiol test, antral follicle counts and AMH hormone levels are often done as screening tests for egg quantity. Reduced egg quantity and quality is usually treated with either IVF, or with IVF with egg donation.
- Absent or Damaged Fallopian Tubes : Rarely the fallopian tubes are found absent since birth. Many causes lead to blockage and damage of tube like severe adhesions, surgical procedures, infections etc.
- Endometriosis: The presence of tissue that normally grows inside the uterus (womb) in an abnormal anatomical location. Endometriosis is very common and may not produce symptoms, or it may lead to painful menstruation. It has also been associated with infertility.
- Unexplained Infertility: Sometimes inspite of being absolutely normal male and female with normal hormonal assays, regular sexual intercourse and with all normal reports the couple is unable to conceive, this condition can be termed as unexplained infertility.
- Recurrent Intrauterine Insemination Failure : repeated failure of IUI trials is also an indication for IVF. Inspite of good IUI trials with gonadotrophins and good post wash, if conception does not take place IVF is a better option.
- Tubal and Pelvic Adhesions : pelvic adhesions and tubal adhesion may make tube incapable of nurturing the eggs and conception fails. Blockage of tubes arises due to pelvic adhesions
- Preimplantation Genetic Diagnosis (PGD) – In cases of repeated abortions and neo natal death PGD becomes necessary. PGD can be done only after IVF. [ PGD also helps in diagnosing several genetic diseases.
- Premature Menopause: Also termed as premature ovarion failure, where the function of ovaries stops before the age of 30, Egg donation proves a better option which is possible only with IVF, menopause : Menopause is stage of life when a woman can no longer bear a child. With IVF, this is now a false saying.

9. How does IVF improve fertility?

- We force the body to produce multiple follicles and eggs (only one follicle with one egg inside develops in a natural menstrual cycle)
- We take the eggs out of the ovaries when they’re ready (release and tubal pickup of the egg can be inefficient naturally)
- We coerce fertilization in the lab (sperm or egg issues can cause fertilization problems in a natural situation)
- We culture the embryos for several days and then pick the best one (or more) for transfer to the female (selection of the best one(s) increases the chance of success)
- We transfer the embryo(s) to the best location in the middle of the uterine cavity (tubal transport of the embryo to the uterus is bypassed)
- Implantation rates are used by fertility doctors when talking with couples about their chances for IVF success rates and multiple births. Implantation rates are also used in IVF clinics as a measure of internal quality control.
- The first “test tube baby”, Louise Brown, was born in 1978 and she herself is a mother of a healthy baby boy now.

10. Female Partner Examination

- Clinical Examination
- Sonography
- Lab Investigation Then We Plan Treatment Protocol
- After a detailed history & physical examination, few basic laboratory investigations & a sonological evaluation is very significant to choose the modality of treatment for infertility as it affects the success rate of the treatment.
- We, here at SFWH follow a basic protocol before commencing any treatment of infertility. History taking can be converted into a counseling session which works to break the ice between the couple & doctor. The initial shyness & awkwardness to talk on intimate issue is also lost. Trust & confidence develops which helps the couple to understand & participate in the treatment.
- Points to be highlighted in history are duration of infertility, menstrual history, coital frequency, past medical & surgical history, occupational history & history of allergy.
- We start the clinical examination of female by measuring her weight & height & then calculating her BMI. Our experience has shown that ladies who have normal BMI not only respond well to the treatment of infertility but also have a better outcome of pregnancy as compared to their obese or underweight counterparts.
- After recording the weight, the lady should be escorted into a comfortable examination room by a trained nursing staff where detailed general & systemic examination is done. Verbal consent should be obtained & procedure explained in detail. We need not stress that male doctors should do the examination in presence of a female nursing staff. During the examination findings of relevance are development of secondary sexual characters, presence or absence of galactorrhoea, signs of androgen excess like hirsuitism & thyroid enlargement. Sterile speculum examination is important to rule out vaginismus from other causes of dysparunia. This examination can also reveal any abnormality or discharge from the cervix. Bimanual examination gives idea about the size & mobility of uterus. Any abnormal finding in physical examination should be supported by laboratory & radiological evidences & should be treated before the treatment of infertility commences.

11. Ultrasonography

- Trans vaginal sonography has become the most important tool in the armamentarium of the physician to diagnose & treat infertilit. TVS has a high sensitivity & specificity for follicular monitoring, prediction & conformation of ovulation.
- While evaluating the female genital system by TVS, the examiner should scan every part in detail.
- Cervix is evaluated for the length of the cervix, nabothian cyst & cervical mucous.
- Endometrial cavity is scanned for endometrial thickness, endometrial pattern, endometrial polyps & presence of any foreign bodies or synechia.

12. Uterus

- Trans vaginal ultrasound examination of the body of uterus is done to observe a detailed view of the myometrium & to diagnose any mullerian anomalies like septate uterus & bicornuate uterus , fibroid & adenomyosis.

13. Ovaries

- Apart from the location, mobility & size of the ovary, assessment of its volume & pre-antral follicles is also important to predict the outcome of any fertility therapy. Ovarian pathologies like functional cysts, PCO & endometriomas can be diagnosed by TVS.

14. Fallopian tubes

- Healthy fallopian tubes are not visualized in a routine transvaginal scan (except if there is a massive fluid collection in the pelvis). Hence diagnosis of healthy tubes is a diagnosis of exclusion.

15. Pelvis

- Excluding the periovulatory period, any free fluid in pelvis should be tried to diagnosed & treated before commencement of any treatment.

16. Male Partner Examination

- Detail History
- Clinical Examination
- Lab Investigation
- Semen Analysis

17. IUI

- IUI is defined as direct placement of the processed sperm into the uterine cavity at any point above the internal os.Intrauterine insemination is also called artificial insemination, or IUI. Human artificial insemination with the male partner’s sperm for infertility began being used in the 1940’s.

18. However, it is not effective for couples with:

- Tubal blockage or severe tubal damage
- Ovarian failure (menopause)
- Severe male factor infertility
- Advanced stages of endometriosis

19. Insemination for male factor infertility

- Studies have shown that intrauterine insemination can be effective for some cases associated with poor sperm quality. However, if the total motile sperm count at the time of insemination (after the processing) is less than 5 million, the chances for pregnancy are substantially lower. If the total motile sperm count is below 1 to 5 million, success rates are very low. Therefore, in vitro fertilization with ICSI (injecting sperm into the eggs) is usually done for these cases.
- IUI is most commonly used for unexplained infertility. It is also used for couples affected by mild endometriosis, problems with ovulation, mild male factor infertility and cervical factor infertility.
- Insemination is a reasonable initial treatment that should be utilized for a maximum of about 3-4 months in women who are ovulating (releasing eggs) on their own. It is reasonable to try IUI for longer than this in women with polycystic ovaries (PCOS) and lack of ovulation that have been given drugs to ovulate.

20. What are the types of surrogacy?

- Surrogates can be divided into natural surrogates and IVF surrogates.

21. IVF Surrogacy (Gestational Carrier) – Full Surrogate

- This is where a woman carries a pregnancy created by the egg and sperm of genetic couple. The carrier is not genetically related to the child.

22. Natural Surrogacy (Traditional/Straight Surrogate)

- Here, the surrogate is inseminated with sperm from the male partner’s of an infertile couple. The child that results is genetically related to the surrogate and to the male partner but not to the commissioning female partner.

23. To whom surrogacy is advised?

- There are several groups of patients that natural and IVF surrogacy may be advised to.

24. IVF Surrogacy

- Women whose ovaries are producing eggs but they do not have uterus this could be because they have had a hysterectomy (removal of uterus) performed due to cancer, severe hemorrhage or ruptured womb, or they were born without a uterus. This is by far the most common indication for IVF surrogacy.
- Women who suffer from medical problems such as diabetes, heart and kidney diseases and in whom a pregnancy would be life threatening. However, their long term prospect for health is good.
- Repeated miscarriages where the causes of miscarriage have been fully investigated, may also suggest IVF surrogacy treatment.

25. Traditional Surrogacy

- Women who have no functioning ovaries due to premature menopause ( some may argue that the best option for these patients is egg donation).
- A woman who is at risk of passing on a genetic disease to her offspring, may opt for traditional surrogacy.
- As with IVF surrogacy, women who suffer from medical problems such as diabetes, heart and kidney diseases and in whom a pregnancy would be life threatening may select traditional surrogacy if their long term prospect for health is good.

26. To become a surrogate the woman should fulfill the following criteria:

- Age between 21 & 35 years old.
- A non smoker, on drug user who maintained a healthy life style.
- Must have successfully carried at least one pregnancy till full term.
- In a stable living situation.
- If married, have a spouse who is supportive of her decision to become a surrogate mother.
- Have a healthy, weight/height ratio.
- Should have a healthy life style and no addictions and no genetic diseases. Steps for Surrogacy Programme :

27. Sonography

Steps for Surrogacy Programme:
- First a consultation of intended genetic parents (IGPs) with doctor.
- Detailed examination and counseling.
- Giving various options of surrogate and IGPs should select a surrogate of their choice.
- Consultation with legal adviser. Form J : Agreement of surrogacy Form U : Contract between patient and surrogate. Surrogacy agreements are the first stage in a two step process .The purpose of the surrogacy agreement is to allow each party to state their intentions,& their responsibilities to one another
-The agreement will clearly state that the surrogate does not intend on parenting any resulting children & does not wish to have physical or legal custody of any children. The surrogacy agreement will also define the right & responsibilities of the assisted parents.
- Synchronization of donor recipient cycle : One cycle before actual IVF procedure we bring the menstrual period as close as possible to both donor and recipient. Preferably recipient gets period, a couple of days earlier than donor. The recipient will require estradiol & progesterone to help prepare her uterine lining for implantation of the transferred embryos. management. Our goal is to see your complete family through surrogacy. We shall be with you and guide you till your dream turns into reality.
- Actual treatment
- We at motherhood womans and child care hospital doing surrogacy for needy couple after complete screening of surrogate mother and genetic parents. It has been done after doing all legal contract between them trough lawyer, several babies have been born through this procedure at our hospital.