Oligospermia, PCOS, Tube Block, Sexual Dysfunction
•Couple with Multiple Factor Infertility.
•Husband- Low Sperm Count. Left sided varicocele with Atrophic small testis, mild sexual dysfunction
•Wife- PCOS-Anovulation. HSG showed both sided tubal block
•Was offered IVF or Laparoscopy-Hysteroscopy for tubal block.
•Conceived Naturally while awaiting Laparoscopy
Severe Endometriosis, Erectile Dysfunction
•3 years long Infertility
•Wife- Severe (Grade 4) Endometriosis
•Husband- Erectile Dysfunction
•Natural Conception after successful treatment for both
Success after 5 Miscarriage, Bicornuate Uterus
•35 years old lady with INFERTILITY and 5 REPEATED MISCARRIAGES (3 at 12 weeks, 2 at 18 weeks).
•Bicornuate uterus was seen in ultrasound and confirmed by hysteroscopy-laparoscopy.
•She was offered operative correction, which she refused.
•After explaining risks, she opted for ovulation induction.
•After 2nd cycle, she conceived but surprisingly it was TRIPLET (2 in left horn, 1 in right horn).
•At 26 weeks, she developed preterm labour and 2 babies were delivered vaginally.
•Surprisingly, the 3rd baby in Right horn continued till 35 weeks, when emergency C-section was done because of she had ruptured membranes (PROM).
•The 3rd baby was healthy and went home smoothly.
•Pic taken during C-section with her kind permission.
Male Infertility, Success after 2nd IVF and 10 failed IUI
•Married for 10 years with MALE INFERTILITY
•Tried IUI 10 times and IVF 2 times
•1st IVF ended in miscarriage
•Successful pregnancy after 2nd IVF
•Careful observation done throughout pregnancy with ultrasound monitoring.
•An episode of NO FETAL MOVEMENT (FM) at 32 weeks resolved spontaneously with CTG, Doppler scan and perception of FM subsequently.
•Delivery was planned at 37 weeks
•At 35 weeks, again felt NO FM. CTG was suspicious (as shown in the picture)
•We URGENTLY (Midnight) consulted Paediatrician and Anaesthetist and conducted Emergency C-section at 1 AM.
•The baby weighing 3.2 Kg was healthy and the mother went home in healthy condition.
•Timely decision and watchful observation can save life
Fibroid-Infertility, No Operation Done
•24 years old lady from Burdwan, 3 years infertility
•All fertility factors normal except MULTIPLE FIBROIDS in UTERUS.
•She was advised operation (to remove fibroids) which she refused
•Fortunately she conceived naturally within 2 months
•Fibroids increased in size in pregnancy but no other problems
•From 26 weeks, we suspected INADEQUATE GROWTH of the BABY (by putting hands over abdomen)
•Was advised ultrasound scan regularly (Growth scan with colour Doppler) which revealed growth restricted baby
•Decided to deliver the baby at 37 weeks after giving steroid injection to promote lung-maturity of the baby
•At CS, fibroids were seen and left undisturbed
•Baby’s weight 1.8 Kg, cried at birth, was sent to SCBU
•Baby had low blood sugar (Hypoglycaemia), well managed at NICU and went home safe
IUI, Ejaculation Problem, Hypospadias
•Infertility for 5 years due to Sexual Dysfunction
•Husband had severe PREMATURE EJACULATION with INABILITY to DEPOSIT SPERMS in the VAGINA, because of HYPOSPADIAS (ABNORMAL location of OPENING in PENIS), operated several times
•Semen analysis was absolutely normal
•Female factors (Tubes, Ovaries, Uterus) were all normal
•Offered SELF-INSEMINATION, with which they were not comfortable
•Opted for IUI
•Conceived successfully after 2nd IUI
•Pregnancy was uncomplicated and healthy baby was delivered at term
•Pictures were taken with their kind permission
Fallopian Tube Block, Successful Laparoscopy-Hysteroscopy
•5 years long Infertility
•HyCoSy showed BOTH THE FALLOPIAN TUBES were BLOCKED
•All other Fertility Factors normal
•Was offered 2 options
2.Laparoscopy and Hysteroscopic guided Proximal tubal Cannulation (Attempt to open the tube surgically), failing which IVF would be required
•Patient opted for option 2
•We managed to open one tube during the operation •Conceived naturally within 3 months of the operation
•Pregnancy was uncomplicated, except mild hypertension
•Delivered a healthy baby at 37 weeks
Success after all treatment FAILED
•FAILURE is NOT the LAST WORD
•This couple from Barasat, started Infertility Treatment at 2012, after having tried for 1 year
•All Fertility Factors of both were normal •They tried Ovulation Induction and IUI several times, which FAILED
•They consulted DIFFERENT PLACES, still NO LUCK
•They ended their treatment at 2014, feeling FRUSTRATED
•In a fine morning in 2016, the woman found herself PREGNANT
•It was HIGH RISK PREGNANCY because of OVERWEIGHT and HYPOTHYROIDISM. Proper care was provided, including serial ultrasound scans
•AT 32 weeks, she felt NO FETAL MOVEMENT (FM). We took it seriously and offered CTG and Doppler scan, both of which came normal and she felt FM and so was discharged
•At 35 weeks she again felt persistent no FM. This time CTG was SUSPICIOUS. Decision for URGENT DELIVERY was taken.
•Baby was delivered healthy, CRIED at birth, did NOT require NICU (though we kept it READY)
•Couple from Howrah with 7 years long Infertility
•It was because of PCOS leading to NO Ovulation. All other factors were normal
•Ovulation Induction 8 cycles FAILED and then they opted for IUI
•Conceived after 1st CYCLE of IUI SUCCESSFULLY
•Pregnancy was HIGH RISK, because of PLACENTA PRAEVIA (Placenta was lying in the lower part of the uterus)
•She had several episodes of bleeding throughout pregnancy and needed hospitalization several times, with advice of iron tablets, rest, observation, regular ultrasound and Haemoglobin check up
•At 34 weeks, she presented with severe bleeding. Her Haemoglobin was 6 g/dl
•To save the life of both, we decided for EMERGENCY C-Section and URGENT arrangement of BLOOD
•She needed 3 units of BLOOD TRANSFUSION during and after delivery
•Both mother and baby went home within 3 days despite the HIGH RISK FACTORS
•Picture of the HAPPY COUPLE at the 4th birthday of their PRECIOUS BABY, when they visited our clinic as a gesture of gratitude
•Pic taken with their kind permission
Severely Low Sperm Count, IUI, Twin
•Couple with MALE FACTOR INFERTILITY with SPERM COUNT only 5 million/ml, tested on several occasions
•Female factors were all normal
•Was advised IVF-ICSI, which they could not afford
•IUI with Donor sperms was NOT acceptable to them
•After repeated COUNSELING about the HIGH RISK of FAILURE, they opted for “TRIAL” of IUI using HUSBAND’s SPERMS
•To our UTTER SURPRISE, she conceived after 1st IUI and it was TWIN PREGNANCY!!!
•As Twin is HIGH RISK PREGNANCY, she was thoroughly MONIOTORED throughout
•She developed PREMATURE LABOUR at 35 weeks and delivered a MALE and a FEMALE baby, weighing 1.9 Kg and 1.7 Kg respectively
•As her haemoglobin was 8 g/dl before delivery and she was at HIGH RISK of BLEEDING, she was transfused one unit of BLOOD at delivery
Unexplained Infertility, Repeated Miscarriage
•REPEATED MISCARRIAGE at 1st Trimester, followed by SECONDARY INFERTILITY (Inability to conceive)
•Despite thorough Investigations, NO CAUSE was identified for INFERTILITY and REPEATED MISCARRIAGES
•Conceived naturally with their patience, faith and perseverance in DIFFICULT TIMES
•NO ADDITIONAL MEDICINE was used, except those used in normal pregnancy
•Only ‘treatment’ provided was TENDER LOVING CARE (Counselling, Support and Emotional Boosting when one feels FRUSTRATED)
•Pregnancy was complicated by off and on bleeding but everything was fine eventually
•Normal Vaginal Delivery of a healthy male baby at term
IVF, Unexplained Infertility, Twin
•38 years old with UNEXPLAINED INFERTILITY of 8 long years
•Conceived after 1st cycle of IVF with TWIN PREGNANCY
•SEVERELY ANAEMIC (Haemoglobin 7 g/dl before delivery) because of fibroid and piles. Could not tolerate iron tablets
•Developed SEVERE PRE-ECLAMPSIA with BP 180/110 mm Hg despite 3 MEDICINES and heavy PROTEIN LOSS in URINE. LIVER and KIDNEY function started to get deranged
•Steroid injection was given to promote lung maturity
•This HIGH RISK PREGNANCY was discussed with neonatologist and C-section was done at 31 weeks
•MALE and FEMALE babies weighing 1100 gram and 900 gram, respectively, were delivered and sent to NICU and finally went home
•After delivery mother’s BP was uncontrolled, so was sent to ICU to give MAGNESIUM SULPHATE injection to prevent convulsion and stroke (ECLAMPSIA)
•Mother was discharged within 4 days in HEALTHY CONDITION and her BP, liver and kidney became normal within 6 weeks
PCOS, Spontaneous Conception
•Patient of PCOS (polycystic ovary syndrome) Having INFERTILITY
•In pregnancy, she was diagnosed to have HYPOTHYROIDISM, which was managed with medicines and regular monitoring
•Initial blood sugar testing (with 75 gram OGTT- Oral glucose Tolerance Test) was normal but became abnormal at 28 weeks, was diagnosed with GESTATIONAL DIABETES MELLITUS (GDM), controlled with oral medicines and diet
•Regular ultrasound was done, which revealed LARGE BABY (excessive growth)
•Admitted at 32 weeks with ABDOMINAL PAIN and was diagnosed to have LIVER DISEASE
•At 36 weeks, she BROKE WATER and was admitted.
• Steroid injection was given to promote lung maturity of the baby
•She was in ADVANCED LABOUR. We discussed the plan with them and they opted for C-section (as large baby may get injured during vaginal delivery)
•C-section was difficult but the mother was fine and blood sugar became normal after delivery, without medicines
•Healthy Male Baby weighing 3.2 Kg was delivered, did not require NICU admission and his blood sugar was monitored
•Both mother and baby went home within 3 days in good health
Successful 1st IUI, Male Infertility, PCOS
•Patient of PCOS (polycystic ovary syndrome) Having INFERTILITY •SPERM PARAMETERS mildly abnormal (abnormal motility)
•Conceived after SUCCESSFUL OVULATION INDUCTION but landed up in MISCARRIAGE
(No heart beat seen in USG) due to Chromosomal abnormality of the baby (TRIPLOIDY)
•Next time, OPTED FOR IUI, after explaining the success rate •Did not want TUBAL PATENCY TEST (HSG/ HyCoSy) before IUI
•Conceived after 1st IUI
•Detected with Hypothyroidism, which was managed with medicines and regular monitoring
•Successful Pregnancy Outcome
Obesity, PCOS, Spontaneous Pregnancy
•Patient with PCOS (Polycystic Ovary Syndrome) with Obesity
•Before pregnancy, she was found to be Sub-clinically HYPOTHYROID, which was managed with medicines and regular monitoring
•Diagnosed by OGTT (75 gram Oral Glucose Tolerance test), in 1st visit, with to have GESTATIONAL DIABETES MELLITUS (GDM), which was NOT adequately controlled with diet and was offered Insulin
•She refused Insulin, so was advised oral medicines, which controlled blood sugar
•PLANNED DELIVERY was decided at 37 weeks with NICU Back up, after giving STEROID INJECTION for lung maturity
•Healthy Female Baby was delivered, cried at birth, did not require NICU
•Mother’s blood sugar become NORMAL after delivery, without need of medicines
•Both mother and baby went home within 3 days in good health
Fallopian Tube Block, Conceived Spontaneously, PCOS
•Everything is POSSIBLE in Fertility Treatment
•Couple with Infertility because of PCOS and problems in Ovulation
•Advised Tubal patency tests (HyCoSy) which showed both the Fallopian TUBES were BLOCKED
•We discussed with them 2 options 1)Directly IVF 2)Laparoscopy-Hysteroscopy- to confirm/ refute actual block and to make attempt to open it (“Proximal cannulation”). If that failed, she would require IVF
•They opted for IVF. We started preparing them for it. Before the actual stimulation, pregnancy test was done and surprisingly, it was POSITIVE.
•TVS and β-hCG blood test were done to make sure that it was NOT “ectopic pregnancy” (which is a possibility in actual tubal block)
•This spontaneous pregnancy was complicated by repeated urinary tract infections (UTI) for which she was put on antibiotics throughout (UTI can affect the growth of the baby)
•Healthy baby was delivered at term
•Message- Finding a “Bad” result” is NOT the end of the world
Pregnancy before IVF, PCOS, Hypothyroidism
•35 years old lady with INFERTILITY because of PCOS with Hirsutism (excessive body hair growth) and HYPOTHYROID (taking L-Thyroxine)
•Ovulation Induction failed, planning for IVF but conceived spontaneously
•From 28 weeks, we suspected INADEQUATE GROWTH of the baby (by putting hand over patients’ abdomen)
•Was advised serial ultrasound scans (Growth Scan with Colour Doppler) which revealed GROWTH RESTRICTED BABY
•Decided to deliver the baby at 37 weeks, in NICU set up after giving STEROIDS to promote lung maturity of the baby
•The baby was in BREECH (Upside Down, with buttock-first instead of usual head-first position)
•At 36+ weeks, she suddenly went into PRETERM LABOUR with RUPTURED MEMBRANES and so we decided for EMERGENCY C-Section
•Baby’s birth weight was 2.2 Kg, CRIED at birth, 2 loops of cord around neck, was in BREECH, did NOT require NICU admission
•Both mother and baby was discharged within 3 days after delivery
Ovulation Induction, Unexplained Infertility, B Negative Blood Group, Thalassaemia Carrier
•Primary UNEXPLAINED INFERTILITY for 2 years.
•All investigations NORMAL except subclinical HYPOTHYROIDISM (On L-Thyroxine before and throughout the Pregnancy)
•We diagnosed her having Thalassaemia Minor •Conceived at 1st cycle of Ovulation Induction (Clomiphene 100 + FSH 75x 2 doses)
•B NEGATIVE blood group. So, has been monitored throughout the pregnancy by Indirect Coomb’s Test (ICT) in blood and Anti-D given antenatally
•Haemoglobin was checked thoroughly and higher dose of iron given
•Developed itching in pregnancy, Liver Function Test (LFT) was abnormal and was diagnosed as “Obstetric Cholestasis”, for which medicines were given and LFT repeated regularly
•Growth Scan was advised from 28 weeks •36 weeks scan showed Inadequate Growth of the baby (Fetal Growth Restriction- FGR)
•Decision for delivery was taken, giving Steroid Injection for lung maturity of the baby
•At 37 weeks, C-section was done in NICU set up, keeping blood in hands for the mother
•The couple is now enjoying their parenthood after the struggle
IUI, Triplet, PCOS, Erectile Dysfunction
•It’s the perseverance, trust, Confidence and strong Positive Attitude that gave the results.
•Couple with 3 years of Infertility.
•Woman having PCOS and the man having some Sexual Dysfunction.
•After discussion of merits and demerits, opted for IUI.
•1st IUI cycle FAILED but the woman’s positive attitude persisted and so she camefor 2nd cycle in next month.
•This time urine test was POSITIVE for pregnancy and surprisingly it was TRIPLET baby (2 baby in one sac and another one in separate sac)
•It was VERY HIGH RISK PREGNANCY and so, we offered her SELECTIVE FETAL REDUCTION (converting Triplet to Twin by“killing” the mostly affected baby).
•But we had to respect her choices, as she said “High risk DOES NOT ALWAYS MEAN THAT I WILL HAVE ALL THESE PROBLEMS”.
•Pregnancy was complicated by moderate intermittent BLEEDING, Gestational DIABETES (GDM), Obstetric Cholestasis (Abnormal LIVER function), Severe ANAEMIA, LOW LYING Placenta and Inadequate GROWTH of 2 babies.
•She was thoroughly monitored by frequent check up, regular blood tests, 2 weekly ultrasound.
•We decided to deliver her at 32weeks after arranging a JOINT MEETING with neonatologist, fetal Medicine specialist and the patient and her husband.
•STEROID injection was given to promote LUNG MATURITY of the BABIES.
•This time also, they held strong positive response, even after explaining the risks and costs.
•Suddenly, at 27 weeks her WATER was BROKEN and was hospitalized and decision for delivery was taken after giving ANTIBIOTICS and ARRANGING BLOOD.
•All 3 babies cried at birth, weighing1 Kg(Male), 700 gram (Male) and 650 gram (FEMALE).
•Fortunately, the post-operative period was uneventful and she was discharged on 4th day after transfusing 1 unit BLOOD.
•All the babies were promptly shifted to NICU. With proper ventilator support, they gradually improved, started feeding and were discharged one after another.
•Now they all have gained proper weight, feeding well.
IVF Success in Difficult Case- Poor Egg Count, Sperm Defects, Endometriosis and Tubal Problem
couple was referred to us by our Colleague from Tamluk.
Husband’s semen test, done outside showed “No Sperms”. We repeated the test at our centre and found the result better, although it was abnormal. However, after doing tests, no cause for such abnormal result was obtained.
The woman had severe endometriosis. In laparoscopy, there was frozen pelvis (all organs like uterus, tubes, ovaries were attached to each other). Both the Fallopian Tubes were blocked.
We examined her and found her AMH was very low and there was insufficient number of eggs in the ovaries.
As her age was just 29 years, we advised her IVF-ICSI using her own eggs. We explained that the success rate would be very low because if multiple factors (less eggs in the ovaries, poor Sperm condition, Severe Endometriosis and Tubal Factor). They agreed.
IVF was done. However, the stimulation protocol was different from conventional one. After egg collection (“Ovum Pick Up”), we advised her GnRh Agonist injections for 3 months to suppress the hormones (this increases the chance of pregnancy in Endometriosis) and then replaced the hormones from outside and performed FET (Frozen Embryo Transfer).
Last week, she got Positive Beta hCG test. We repeated the test and there was satisfactory rise in the hormone.
Please pray for her.
So, what we see here
1) If a single Semen Report is abnormal, do not get disappointed. Please repeat the test from a good laboratory.
2) Low AMH or poor ovarian reserve does not always mean that you need Donor Eggs.
3) In severe endometriosis, IVF can give good success rate, if the age is younger.
Uploaded with kind permission from the woman
Less Number of Eggs, Spontaneous Conception
•This is another patient with “less number of eggs” who conceived NATURALLY without any treatment.
The couple had been trying for pregnancy for 6 months. The reports showed AMH 0.05. Her age is 32. All other reports were normal. We checked AFC (Antral Follicular Count) which was borderline. They were anxious about the AMH. We said, “We treat the patients, we do NOT treat a report”.
As her age is low, we gave her DHEA tablets and asked them to try for another 3 months. We wanted to avoid any UNNECESSARY treatment. We also explained that the role of DHEA is doubtful in improving the condition of the eggs but does not seem to have major side effects.
Today, she came to our clinic, Initially we thought she came for starting treatment (Ovulation Induction). But to our surprise, the pregnancy test was POSITIVE.
Low AMH does NOT ALWAYS mean, you need IVF. We have to see age, duration of trying, sperms, Fallopian tubes and Condition of the Ovaries. The MOST IMPORTANT factor is the AGE. If age is low and other factors are favourable you can try all other treatment options like natural trying, Ovulation Induction (OI- Trying after taking medicine for Ovulation) and IUI (Intrauterine Insemination) before jumping into IVF (in Vitro Fertilization). DHEA can be added after discussion with the couples.
However, if age is on the higher side, duration of infertility is long, sperm condition is poor, fallopian tubes are not OK, AFC or FSH are abnormal, then you have to think of IVF soon
PCOS, Follicular Study, Pregnancy
•PCOS related Infertility is EASIER to treat if you receive proper medicine, come for TVS Follicular Study and control your weight.
PCOS is NOT the disease of “Cysts”. It’s a hormonal problem and is NOT curable. However, it’s quite possible to keep this disease under control. The main treatment to keep it under control is Lifestyle changes, that is Weight Control.
In PCOS, infertility is a common problem. The reason is, there are enough eggs inside the ovaries but they cannot grow and rupture (“Ovulation”). So, when weight loss cannot help, the treatment is Ovulation Induction (OI). In most of the cases, OI is done with oral medicines like Clomiphene or Letrozole.
But it’s extremely important that you should NOT take these medicines WITHOUT TVS. In TVS, the ultrasound probe is inserted inside the vagina to see the number and size of the follicles (the sacs containing the eggs inside) within the ovaries. TVS follicular study is required for 2 reasons
1) Whether your ovaries are at all responding to the medicines. In some cases, the medicine may not help the eggs to grow. If medicines are not working, in the next month we have to change the medicines.
2) Whether you are over-responding to the medicine. If you respond nore than normal, there is chance of Multiple Pregnancy (Twin, Triplet etc) and Ovarian Hyperstimulation Syndrome (OHSS- Which is very serious complication) •If the medicine is working (medicine causing the follicles to grow and rupture), then the chance if pregnancy is 15% per month, that means out of 100 women, 15 can conceive in one month. If you do not conceive but your ovaries are responding to the medicine, you can take the medicines for next 3-4 cycles (depending on your age and duration of Infertility). You don’t need to come for TVS in those next months.
The pictures belong to a couple, came to us for Infertility of 4 years duration and PCOS. We gave them Letrozole and performed TVS Follicular Study to confirm Ovulation. She did not conceive after 1st month but she continued the same treatment in next month. She conceived after 2nd month of treatment.
Picture taken with kind permission from the patient.
Less Eggs does not always need IVF
•This couple was referred to us by our Gynaecologist colleague from Howrah. They were trying for pregnancy for 8-9 months and the lady had low AMH. Her age was only 32 years and AFC was good. The condition of the Fallopian tubes and Husband’s sperms were good.
We gave them oral medicine Clomiphene Citrate for Ovulation Induction but this medicine did not work (no eggs were growing after taking that tablet). They were desperately thinking for IVF.
After discussion, we gave them oral tablet Letrozole next month. The ovaries were responding well. We advised them to try it for 2 months further. But after 1 month, they came with good news.
Please pray for them.
PS- published with kind permission from the patient.
Infertility- we need to talk to the couple
•This couple had been trying for pregnancy for last 4 years. The husband’s age is 38 years and wife’s age is 36. They were advised IVF outside, only because of age.
When they came to us, we found all tests were normal. We asked them “WHAT YOU ARE THINKING?” They said, “We want to try for some more time”. On further enquiry, we discovered that they had very INFREQUENT INTERCOURSE (once in a month) because of ERECTILE DYSFUNCTION (ED) of the Husband. We treated the husband and his condition improved.
This couple wanted to start Ovulation Induction this month. They called us yesterday as she missed her period. Today, even before starting and Fertility Treatment, they got the GOOD NEWS.
Please pray for them.
PCOS conceived naturally with Letrozole
•PCOS women often conceive with simple weight reduction and Ovulation Induction (giving medicines to help the eggs grow and rupture). But while advising Ovulation Induction, it’s extremely important that the patient is monitored by TVS Follicular Study to see if the medicines are effective in causing Ovulation.
Often we find one tube is blocked in HSG and other tube is open. If one tube is open, that’s enough to result in pregnancy, if other factors are OK.
This lady has been trying for pregnancy for last one year. She is having PCOS and one tube blocked in HSG. Husband’s report is normal. We advised them Letrozole for Ovulation Induction and asked for TVS to confirm Ovulation. Today she came with smiling face. She conceived after 1st cycle of taking the medicine!!!!
Please pray for her.
PCOS and high Prolactin- conceived without IVF
•They came to us, last month, with inability to conceive, having tried for one and half year. The woman is having PCOS and elevated Prolactin. All other tests were normal.
Before coming to us, they had been advised to proceed for either Laparoscopy or IVF. They wanted neither of these two. They came to us for second opinion. We respected their decision and advised Ovulation Induction with oral tablets and injections.
Today they came with the good news.
IVF Success with Egg Donation in Premature Menopause
•She came to us last year, at 38 years of age, with inability to conceive despite trying for 3 years. She has a baby, 8 years old, conceived spontaneously. She did not have Periods for last 5 years.
We performed all necessary tests to find out the cause and found it as “Premature Menopause” or “Premature Ovarian Failure” (POF). However, no reason for POF was found despite all possible investigations.
We started Hormone therapy to protect the health of bone and heart. Regarding Fertility, they finally pored for IVF with Egg Donation.
But after Ovum Pick Up (OPU) from the donor and the Embryo Formation and Freezing all the Embryos, there was difficulty in preparing her Endometrium (The Inner Layer of Uterus) for FET (Frozen Embryo Transfer). She needed very high dose of Estrogen tablet and gel for this purpose. Finally FET has been done and the result is positive.
Please pray for her.
PS- Uploaded with Kind Permission from the Patient.
PCOS, Successful Ovulation Induction
•The young couple visited to us in July 2017 with Infertility. The lady had PCOS (Polycystic Ovary Syndrome). She tried Letrozole tablets for Ovulation Induction outside, before coming to us but did not respond to that medicine.
The man had mild problem in sperm motility. The rest of the tests were normal.
So, after discussion with us, they planned for 3 cycles of Ovulation Induction with oral medicine , Clomiphene Citrate (CC). TVS follicular scan was done in the 1st month, that diagnosed ovulation (thus she was responding to CC).
Finally, she conceived within 3 months of treatment with oral medicine. They kept their faith on us throughout the journey in pregnancy. Like other pregnant woman, all routine tests were done including Combined Test in 1st Trimester and Anomaly scan.
Indian women are at risk of GDM (Gestational Diabetes Mellitus), especially those with PCOS. Therefore, following International Recommendation, we perform OGTT (Oral Glucose Tolerance Test) using 75 gram glucose in early pregnancy for ALL women.
In this lady, the value of OGTT was higher and so we diagnosed GDM. The disease was controlled with diet and medicine. Blood test for HbA1c, Retinal check up, kidney function test, Echocardiography of the baby and Growth scan were all done along with regular monitoring of blood sugar.
Steroid Injection was given to the mother to promote lung maturity of the baby. Delivery was done at 38 weeks. Baby is healthy, weighing 2.78 kg. Mother is also doing well and blood sugar is now normal.
Thus PCOS needs proper care before and during pregnancy.
PCOS, Hypothyroid, Natural Conception
•They came to us with inability to conceive. They tried many medicines and even IUI. We found all tests normal except PCOS (Polycystic Ovary Syndrome).
We gave them time to decide. They returned after a year and requested Ovulation Induction (Medicines to help the eggs grow). We advised medicines and TVS Follicular Scan (to see if eggs were growing after taking the medicine). There was no result after 2 months. But in the 3rd month, they conceived.
Pregnancy was largely uneventful. All tests were normal. She was Hypothyroid, but it was well controlled with medicine.
Finally both the mother and baby are healthy.
Sperm Motility Problems, PCOS, Conceived with Ovulation Induction
•They came to us in December 2017 with Inability to conceive. The woman had PCOS. The man had mild problems in Sperm Motility. All other reports were normal.
The woman had Hypothyroidism, which was well controlled with Medicine.
They agreed to try Ovulation Induction (medicines to help the eggs grow) for 2-3 months. We performed TVS Follicular Scan to see if eggs were growing after taking the medicines. Fortunately they conceived after 1st month of taking the medicine.
Pregnancy was largely uncomplicated. All the reports were normal, like Combined Test, Anomaly scsn etc.
As she was at risk of FGR (Fetal Growth Restriction) or IUGR (Intrauterine Growth Restriction), we advised them Growth scan with Colour Doppler from 28 week. The result at 28 and 32 week were normal. However, the report at 36 week shower FGR with abnormal blood flow to the baby.
FGR carries the risk to the baby before birth (sudden death) and also after birth (low blood sugar, breathing problems, feeding troubles, infection, jaundice, NICU admission etc). So we decide to deliver the baby at NICU set up, after giving Steroids injection to the mother (for lung maturity of the baby).
Delivery was done. Mother has no problem. We advised her Low Molecular Weight to reduce her risk of Thrombosis (as she is overweight).
The baby was initially alright but subsequently his blood sugar fell down and he could not take milk properly. So he was admitted to NICU, but after everything was controlled, he had been sent to the mother.
Now mother and baby both are doing fine.
PCOS, Obesity, Hypothyroid, Conceived with Ovulation Induction
•They came to us in May 2017 for the first time with difficulty in conceiving. All the reports were normal except that the lady had irregular cycles for PCOS, because of which she did not have “OVULATION” (eggs were not growing and getting ruptured).
Additionally she was suffering from hypothyroidism, for which L Thyroxine supplementation was started.
She was also overweight. So we advised Weight Reduction.
Finally they agreed to have “OVULATION INDUCTION” (OI) with oral tablet Letrozole. In the first month, we monitored her with TVS Follicular scan to confirm if Letrozole was able to start Ovulation. When it was confirmed, we advised them to try this medicine at home for another 2 months. At the end of 2 months she felt frustrated as there was no pregnancy. But in next month she got the good news.
However, it was HIGH RISK PREGNANCY, because of PCOS, Hypothyroidism and Obesity. We performed screening for GDM (Gestational Diabetes Mellitus) using 75 gram glucose for OGTT (Oral Glucose Tolerance Test), because she was at risk of GDM. However, it was normal.
She was at risk of Preeclampsia (high Blood Pressure and loss of Protein in urine), so we advised low dose ASPIRIN tablet with regular blood pressure monitoring. It was also normal.
Thyroid was well controlled with medicine.
The First Trimester Test (Combined Test) showed high risk for Down Syndrome (Chromosomal Abnormality and Mentally Challenged child). So we advised Amniocentesis (collecting fluid from mother’s uterus, around the baby, which is Amniotic Fluid) to confirm the suspicion, after explaining all risks and benefits. Amniocentesis was done and the result was NORMAL.
The Anomaly Scan was normal. Because of Obesity, she was at risk of IUGR (Intrauterine Growth Restriction), restricted growth of the baby. So we advised Regular Growth Scan , which revealed IUGR. However baby’s blood flow was normal.
So we gave her Steroid Injection to promote lung development of the baby and decided to deliver at 37 werk at NICU Set Up.
The delivery was done. Both mother and baby are healthy now. Because of weight, we advised her injection Low Molecular Weight Heparin (LMWH) to reduce the risk of blood clotting (Thrombosis).
We are grateful to them for keeping faith on us throughout their struggle.
“Infertility”- Always Treatment is not Needed
•This lady is 25 year-old and husband’s age is 27 years. They were trying for pregnancy for 9 months only. Within this time, they had number of investigations s d received number of medicines like DHEA, CLOMIPHENE, PROGESTERONE and LETROZOLE. Nothing worked. Actually nothing was required.
When they visited us at 2018 September, we asked them “ARE YOU IN A HURRY TO HAVE BABY VERY SOON?” They replied, “WE WANT TO TRY NATURALLY FOR SOME MORE MONTHS”. We respected their decision, stopped all medicines, advised only
1. Folic Acid
2. Regular Frequent Intercourse
3. Thalassemia test and Rubella test.
Today they came with smiling face with the GOOD NEWS.
Secondary Infertility- Successful Ovulation Induction
•Problem in conceiving second time
This problem is called “SECONDARY INFERTILITY”.
This lady 33-year-old, came from Singur, West Bengal. They have a baby boy born 8 years ago and he is doing well. That time, the lady conceived naturally without any treatment. They tried for pregnancy for last 4 years but in vain.
We performed investigations like Semen analysis of the husband, Tube check by SSG (Sonosalpingography) and hormonal tests and found all were normal, except that she has PCOS (Polycystic Ovary Syndrome). She is having irregular periods and is also overweight. We advised folic acid and weight reduction.
Next cycle, we gave Letrozole for Ovulation Induction and asked her to come for TVS Follicular Scan to see if there was ovulation (eggs growing properly inside the ovaries and are released from the ovaries). The report was satisfactory and we advised them to try by themselves.
As she had irregular periods, she could not understand whether she got pregnant or not. Today she came for consultation and while doing TVS we discovered there is pregnancy inside the uterus. The urine pregnancy test is also POSITIVE.
Sometimes proper tests, proper medicines and proper monitoring can give pregnancy by natural trying without any costly treatment.
Please pray for them. •
IUI Pregnancy, Male Infertility
•The best gift for this couple on this Festive day of Laxmi Puja.
They have been trying for pregnancy for last one and half years. They visited us, for the first time in May, 2018. Female factors were all OK. But husband has sperm problems. Proper evaluation was done and it revealed an Epididymal cyst, which was treated.
They decided for IUI and the result is positive after the 1st cycle of IUI.
PCOS, Problems in Masturbation, IVF, Pregnancy
•There are something, we do NOT understand.
This couple came to us in December 2017 with Infertility of 10 years with history of one miscarriage earlier. The lady is having PCOS (Polycystic Ovary Syndrome) with irregular periods. They tried several cycles of Ovulation Induction outside.
They went for one cycle of IUI but it could not be done due to “Semen Collection Problem” in husband. We talked to him, addressed his issue and offered him collection in homely environment with Sperm Freezing.
They initially planned for further IUI, with frozen sperms, because of financial constraints. But later they decided for IVF, being motivated by one of their relatives, ad she is already 35 years.
IVF was done, taking care of husband’s semen collection problem. As she is PCOS, she over responded to ovarian stimulations. This is called “Ovarian Hyperstimulation Syndrome” (OHSS), which was managed successfully with medicines, strict monitoring, protein rich diet etc. 40 eggs (!) were collected and ultimately 18 embryos were formed. Because of OHSS, we decided to freeze all embryos and going for FET (Frozen Embryo Transfer) later on.
While preparing her for FET, we found endometrium (the inner lining of the uterus) was not good. So we tried another medicine for it. However, she did not have bleeding. So, we gave her medicine for starting periods. Still she did not bleed.
Today she came to us for not having bleeding despite taking medicine. And to all our surprise, this is the result she got. Please pray for her.
This is why we say, there are many a things we do not understand properly. Some studies are saying, it may be related to stress. Probably, because of stress, her hormones were not functioning properly. And after release of stress after IVF, the hormones become active again. It’s a theory, but we do not know what’s happening actually. •
Severe Oligospermia, IVF-ICSI, Blastocyst, Frozen Embryo
•For this couple, nothing can be better than this Durga Puja Gift!
They came with Male Factor Problem. The man, 36 years, overweight, was on medicine Sulfasalazine (SSZ) for back pain (Ankylosing Spondylitis- AS). SSZ is known to reduce sperm count. However, after stoppage of the medicine SSZ and replacing with better medicine for AS could not improve sperm count. They tried different medicines to improve the sperm count but all failed.
When they came to us we found all female factors normal, except Polycystic Ovaries. We examined the man and advised some tests but all were normal.
We gave them options like- directly ICSI or trying for IUI in one cycle, all using husband’s sperms. They chose ICSI, after explanation of the success rates, merits and demerits.
Due to sperm problems, we got very few number of good quality embryos. All embryos were frozen and then transferred. Two embryos grew till blastocyst stage.
Today beta hCG result is 239.1 IU/ml. Please pray for them.
Bangladesh Patient, PCOS, Successful Pregnancy
•A great gift for us in this festive season.
They came to us with their desire to have a baby, after having struggle for long time. The woman has PCOS.
They came to us in Kolkata for the first time in December 2017 and we performed initial tests.
We advised them to take Tablet LETROZOLE from Bangladesh for 5 days and return to us to do TVS Follicular scan to see if eggs were growing after taking the medicine. They stayed in Kolkata for one werk for the scan and after knowing that the eggs were growing well they returned to Bangladesh.
They were advised to take medicine for another 3 months and if no result, they should return after 3 months.
Fortunately, they conceived after one month of taking the medicine. Pregnancy was uneventful. During pregnancy and delivery, the lady was under a good Obstetrician in Rajshahi. Today they become proud parents.
We thank them for giving us the good news on this Auspicious day if DURGA PANCHAMI. Please wish them
PCOS, Conceived with Letrozole
•Today morning, just before the festival starts, this patient came with smiling face.
She is having PCOS. Husband’s sperm had small problems in Motility. She did HSG outside which showed both tubes blocked. Then she underwent Laparoscopy which showed both the tubes normal.
They have been trying for pregnancy for ONLY 3 months and within this time she had 2 cycles of IUI outside using tablets and injections, probably because she was very much impatient.
When they came to us, we explained about their condition, counseled them. They wanted to try with taking medicines (OVULATION INDUCTION) for 3 months, before considering IUI. We gave them tablet Letrozole and performed TVS Follicular scan to see if eggs were growing with that medicine. The eggs were growing.
So we advised them to take the medicines for another 2 months. But fortunately they don’t require it. Only after 1st month if treatment, they got the GOOD NEWS.
Sometimes, you have to give time to yourself.
Diabetes, Sperm Motility Problem, Spontaneous Pregnancy
•This early morning message made our day.
The woman is diabetic, because of PCOS (Polycystic Ovary Syndrome). The man had increased DNA fragmentation in the sperms.
IUI, Triplet, Unexplained Infertility
•They came to us in May 2017 with inability to conceive for 2 years. They did some tests outside and these were normal. We carried out rest of the tests and all were normal. So it was “UNEXPLAINED INFERTILITY”.
After discussing the merits and demerits of different treatment options, they agreed to try medicines for 3 months. We gave Tablet Clomiphene Citrate (CC) for 3 months and performed TVS follicular scan in 1st month to confirm that CC was working (eggs were growing with CC).
Unfortunately they did not conceive within 3 months. They wanted to proceed for IUI (Intra-Uterine Insemination) for 3 to 4 times after discussion of the pros and cons. IUI was done using CC and Injection. In the 1st cycle, 3 follicles were growing.
We gave them 2 options- (1) proceeding for IUI , that carries the risk of multiple pregnancy (Twin, Triplet), or (2) cancelling the IUI that time. They were eager to conceive, so they opted for option (1).
IUI was done and they conceived after the 1st IUI. But as expected, it was TRIPLET pregnancy. Again we discussed 2 options- (1) to continue as Triplet that carries higher risk to mother and babies, or (2) to convert Triplet into Twin by “damaging” one baby, called “SELECTIVE FETAL REDUCTION”, that carries small risk of losing all the 3 babies. They decided for the 2nd option. Fetal Reduction was done around 14 weeks, after NT scan by an Expert Fetal Medicine Specialist. The procedure was uneventful.
The rest of the pregnancy was uncomplicated, except she continued Thyroid medicine for Hypothyroidism. However, she required extra visits and more frequent scans to see if all the babies were OK.
Finally, decision for delivery was taken after Steroid Injection for promoting Lung Maturity if the babies. Delivery was done by Caesarean Section as both babies were in Breech (Upside down, head up, bottom below) in NICU set up. As per their request, her husband was allowed to stay inside the Operation Theatre at the time of Delivery.
Both babies cried at birth, one male and one female weighing 2.3 and 2.1 Kg respectively. None of them required NICU Admission. Mother is also healthy.
We are grateful to this couple for keeping faith on us throughout their journey from the beginning till delivery.
PS- Picture taken with kind permission from the Mother.
•This couple came from Singur with Inability to conceive. The woman is having PCOS (Polycystic Ovary Syndrome). All other tests are normal. She received Letrozole tablet outside but without any monitoring.
We advised the same treatment with increased dose of the tablet but with regular TVS Follicular scan to check if she responded to the medicine (eggs are growing properly).
And she conceived after 1st cycle of treatment.
Please pray for her.
Non-Consummation of Marriage, Conceived Naturally
•PS- Published with kind permission from the patient. •For any couples coming with Infertility it’s important to ask for Sexual Dysfunction, frequency of Intercourse and duration of trying for the baby.
This couple visited some other place, after having tried for 6 months for pregnancy. They were advised all the tests like Semen, Hormones, Ultrasound etc. However, when they went for HSG of the woman (to look for tubal patency), the radiologist could not perform HSG and found the hymen was intact. He suspected NON CONSUMMATION of MARRIAGE.
Then the couple came to us and we felt their problem was not “INFERTILITY”, rather “SEXUAL DYSFUNCTION”. After talking to them in details, we discovered that they did not have proper knowledge about the body anatomy and therefore they did not know the actual technique.
We discussed with them the importance of proper technique and proper penetration. After counselling they agreed to wait for another 6 months before starting any “INFERTILITY TREATMENT”.
The lady got pregnant within 3 months. Pregnancy was uncomplicated and yesterday she delivered a healthy baby.
Therefore, it’s important for the couples to disclose their personal issues to doctor before any test or treatment. •
PCOS not responding to oral medicines, Conceived with Injections Naturally
•The basic problem in PCOS (Polycystic Ovary Syndrome) is that there are numerous eggs in the ovaries but they do not grow and Ovulate (release of eggs).
The first line of treatment in PCOS, therefore, is Ovulation Induction (giving medicine to grow and release the eggs). This has to be done VERY CAREFULLY. If medicines are ineffective, eggs won’t grow. On the other hand, slight increase in dose can cause many follicles to grow, leading to serious complications like OHSS (Ovarian Hyperstimulation Syndrome- ovaries enlarge, water can accumulate in various body parts) and Multiple Pregnancy (Twin, Triplet etc). That’s why we must do TVS Follicular Scan to see if eggs are growing and whether there is chance of OHSS or not.
The first line of agents in Ovulation Induction are usually oral tablets like CC (Clomiphene Citrate) and Letrozole. Sometimes we add Metformin tablet to improve the response to the oral medicines. If these do not work we have 2 options- injection Gonadotropin (that carries small risk of OHSS and Multiple pregnancy, therefore, needs intense Monitoring by TVS) or a surgery called LOD (Laparoscopic Ovarian Drilling- the electric current is used to burn few follicles in PCO). However, LOD carries surgical, anesthetic risks and also the risk of ovarian damage.
This couple came to us with PCOS with 3 tears long Infertility and Irregular Periods in March 2018, referred by another Doctor to us. They tried Ovulation Induction with CC and Letrozole with the highest possible dose. But she did not ovulate. She underwent LOD outside (in Chennai). But even after surgery she did not ovulate. So we used the last option which is expensive- daily dose of small amount of FSH (Gonadotropin) injection and intense monitoring. They conceived with 2nd cycle of our therapy.
Please pray for them.
Erectile Dysfunction, Ejaculation Problem, Conceived with Self Insemination
•Problems in Sex Life is not as uncommon, as it seema. This couple presented to us in April 2017 with ERECTILE DYSFUNCTION of the man and they never had successful penetration. After initial work up no apparent cause was found and the man was advised some medicines, some special exercise etc.
Erection improved within a month and he was able to penetrate but there was NO EJACULATION during intercourse. However, there was ejaculation during Masturbation and he also felt “night fall”.
Ejaculation problem is difficult to treat. So they tried Self Vaginal Insemination. However, they felt frustrated and planned for IUI. All fertility investigations of both husband and wife (Semen, Ultrasound, Hormones, Tubes) were normal.
While planning for IUI, they conceived “naturally” with self-vaginal Insemination.
Unexplained Infertility, Conceived with Clomiphene
•1. You have to give time.
2. If you take medicines for Ovulation Induction, it’s important to do Follicular scan to see if eggs are growing with the medicines, at least in the 1st cycle.
When all reports (Semen, Tubes, Hormones) are OK , still you struggle to conceive.
This couple came to us in April 2018. All reports were normal except Tubal Patency test, which we performed by SSG and found normal.
They received Letrozole for Ovulation Induction 6 cycles outside, but without any Follicular Scan.
After discussion, they agreed to have 3 cycles of Clomiphene Citrate (CC). In the first cycle we found she was ovulating with CC. We advised them to try it for another 2 cycles and then return.
They returned today , after 2 months only, taking CC for 2 cycles only, but with Good News.
Please pray for them.
Success after 2nd IUI, PCOS-Infertility
•You have to have faith on yourselves.
This couple came to us in early 2017. The woman was having PCOS (Polycystic Ovary Syndrome).
After reviewing all reports we advised Ovulation Induction (OI) with different medicines and injections. However all failed to give pregnancy.
We are thankful to this couple as they bore with us when we had problems with TVS monitoring (machine disturbance, change of place and emergency problem from our part).
Finally they decided for 2 cycles of IUI, failing which they would go for IVF.
IUI 1st cycle done at December 2017 but it failed. They did not give up. They opted for 2bd cycle IUI in January 2018 and it becomes positive.
Like before, they kept trust on us throughout the pregnancy. The woman developed Gestational Diabetes Mellitus (GDM) which was controlled with medicine and dietary restrictions. GDM was diagnosed according to DIPSI Guidelines using 75 gram glucose tolerance test. Retinal check up, kidney function test, HbA1c testing, Regular monitoring of blood sugar, Echocardiography of the baby and Growth scan were all done, apart from routinely advised first trimester screening and Anomaly Scan.
After discussion with them, decision for delivery was taken. Steroid injection was given for lung maturity of the baby. Delivery was done at 38 weeks at NICU Set up. Healthy baby cried at birth, weighing 2.74 Kg and did not require NICU Admission.
The family is ready to welcome their new member with great pride.
Natural Pregnancy after 4 times IUI Failure, PCOS, Ejaculatory Disorder
•Sometimes your strong WILL power, TRUST and the ability to FIGHT matter.
The couple came to us first time in June 2016 with inability to have a baby. The woman is having PCOS and hypothyroidism. The man had mild problems in Ejaculation. All other investigations were normal.
The man’s problem did not respond to standard medicine and Pelvic Floor Exercise etc. They finally agreed to have self-vaginal Insemination at home. But the woman’s PCOS also did not respond to Clomiphene. (At that time Letrozole was Banned in India).
So they decided for IUI. After so much trial and error, we found she was responding to the combination of Clomiphene tablets and Injections. So first cycle IUI was done in January 2017.
The result of the first cycle IUI was POSITIVE! Unfortunately it was BIOCHEMICAL PREGNANCY. The test report came negative within one week. However, they kept faith on themselves and on us.
The lady repeatedly asked “Doctor I am feeling better with your medicines. My periods are more regular now. I know you can fulfill my dream of Motherhood”.
2nd IUI was done in July 2017. It was straightforward NEGATIVE.
Then they took a break and tried self-vaginal Insemination and concentrated on man’s problem. His problem improved a little.
They again came for 3rd cycle IUI in February 2018. Again it was NEGATIVE. They felt frustrated but never LOST HOPE.
Then 4th cycle IUI was done with Letrozole and Injection in June 2018. It was also NEGATIVE.
They decided to go for IVF after few months after they can arrange for money, time and all. In last consultation, they asked for details of IVF.
However, they NEVER STOPPED TRYING. Finally the self-vaginal Insemination is SUCCESSFUL.
This it took MORE THAN 2 YEARS to see their smiling face. However, the jounery is yet to be completed.
PLEASE PRAY FOR THEM.
PCOS Conceived without any treatment
•”Give Yourself Time”.
The husband is a Doctor and therefore, was very much concerned about wife’s condition (PCOS). They were just planning for pregnancy.
We asked them to give more time. No Fertility Investigation or No Active Treatment was given. We only checked for hormonal profile in PCOS and advised L Thyroxine for Thyroid Problem and Metformin for PCOS.
Additionally, as a part of Routine Pre Pregnancy Care, only few tests were advised- blood group, Thalassemia screening and Rubella Testing. Folic Acid Supplement was started.
The plan was to allow them at least 6 months time for Spontaneous Conception, failing which Active Investigation and Treatment of Fertility problems will be advised.
Now they got the good news.
So, give yourself time. Many a times, you do NOT need any investigation or Treatment at all.
PCOS, Conceived Naturally while planning for IUI
•PCOS trying for pregnancy for one year. Mild defects in Sperms.
Taken 4 cycles of Clomiphene and conceived in the month when they lost all hopes and were planning for IUI.
PCOS- always does NOT need treatment
•Woman with PCOS. Came today with Good News. No active treatment was done. Was advised only Folic Acid and Metformin.
IVF Success after Failure, Poor Egg Count, Sperm Morphology Problem
•Couple with poor ovarian reserve and abnormal Sperm Morphology.
Had IUI once. It failed.
Went for 1st cycle IVF. No Embryo was formed, unfortunately.
Kept trust and tried 2nd cycle IVF after 1 month.
This time 2 embryos formed. Frozen Transfer was done. And it came positive.
Pray and hope everything will be fine.
Natural Pregnancy is Possible even when you plan for IVF
•When you are planning for IVF, that does NOT mean that you can never conceive NATURALLY. The same applies when IVF fails.
What matters is, whether you conceive, NOT how you conceive.
This lady had previous ectopic pregnancy. When she came to us at 37 years in April 2018, we found severe endometriosis with both tubes blocked and low AMH. We gave them two options
They were planning for IVF, but after Puja 2018.
Last week they came with positive PREGNANCY TEST but with anxious look (concerned about Ectopic again).
We did serial beta hCG in blood and today ultrasound scan revealed totally normal pregnancy INSIDE the uterus (so it’s NOT Ectopic). Moreover, the heart beat has been seen.
Please pray for her.
Erectile Dysfunction, Conceived by Self Insemination while planning for Pregnancy
•The couple had difficulty in consummation of marriage because of severe ERECTILE DYSFUNCTION of the husband and severe LOW DESIRE of the wife.
They came to us in June 2017, saying that they did not have a single episode if SUCCESSFUL INTERCOURSE even 6 months after marriage. All initial examination and reports of the both the partners were normal.
The wife’s condition improved dramatically after 1st month of treatment and counseling. However, husband’s condition improved a little, even after several steps of all possible therapy. So, finally he was advised to have PENILE DOPPLER which suggested impaired blood flow to the penis. Urological consultation was done but nothing worked.
In May 2018, they said, they are more interested in pregnancy than satisfying conjugal life, at least for the time being. So, they were advised pre conceptional care. They agreed to have 3-4 months of self-vaginal insemination with LH kit, failing which they would opt for IUI.
Fortunately they did not require IUI, rather conceived by the technique they were advised to follow.
So, SEXUAL DYSFUNCTION is not uncommon. Do not suffer silently.
PCOS- often you conceive with proper medicines
•Ovulation Induction 3 cycles with medicine can often be helpful for many couples with PCOS to get pregnant.
But it’s important to check if the lady is having Ovulation with that medicine, by TVS
This is an example.
Success in Sperm Morphology Problem
•Patient presented from Jamshedpur with one year duration of Infertility. Apparently it looked “Unexplained Subfertility” with all reports normal. Subsequent Semen Analysis from 2nd Lab revealed “Teeatozoospermia” (Abnormal shape of Sperms). Was advised antioxidants to the husband and Wife underwent Ovulation Induction with Letrozole 5 mg followed by TVS Follicular Study.
This is the report today.
Please wish them luck.
Successful IUI with Donor Sperms
•Referred from Bahrampur for IUI.
Husband Azoospermic, could not afford testicular Sperm Aspiration (TESA) and IVF-ICSI. So opted for Donor IUI.
Female factors normal.
Conceived at first IUI with Donor Sperm.
Please pray for her.
Success after Non-Consummation of Marriage for Erectile Dysfunction
•Couple presented with non consummation of marriage because of problem in husband. However, no medicines worked. They finally attempted pregnancy by self insemination as per our advice (husband used to collect semen and used to insert it with dropper inside the vagina). Today they came with the good result (Shown in the picture below). Please pray for her.
PCOS, Hyperstimulation (OHSS), Hypothyroid, Thalassaemia carrier
•Published with kind written consent from the patient.
Infertility and High Risk Pregnancy gi hand in hand.
She is having PCOS, in 1st cycle with 100 mg Clomiphene Citrate (CC), she had OHSS (Ovarian Hyperstimulation Syndrome- where ovaries respond in unusual excessive manner to the medicines given for increasing the chance of rupture of the eggs). That cycle was cancelled and they were asked to abstain from sexual intercourse.
Next cycle she was given 50 mg CC. This time again she had OHSS. We offered her conversion to IVF but she could not afford.
Surprisingly she conceived and it was single tone pregnancy (we were apprehensive that there may be twin or triplet).
She is beta thalassaemia carrier (but husband normal), so she had severe Anaemia in pregnancy.
She is hypothyroid and was on replacement with L Thyroxine throughout the pregnancy.
First trimester screening (combined test) showed High Risk for Down Syndrome, so Amniocentesis was done and fortunately the report came as normal.
By 28 weeks she developed intense itching all over the body, and after blood test, was diagnosed to have Obstetric Cholestasis.
Serial Growth Scan revealed FGR (Fetal Growth Restriction).
Steroid was given to promote lung maturity of the baby and delivery was done at 36 weeks with NICU backup , keeping one unit of blood in hand.
Baby boy weighing 2 kg was delivered and cried at birth, did not require NICU.
One unit blood was transfused.
Finally we see her smiling face. •
Fibroid-Infertility, Conceived WITHOUT Operation, PCOS, Hypothyroid
•Fibroid always DOES NOT NEED REMOVAL.
Patient presented with Infertility because of PCOS in 2016. We advised weight reduction and offered investigation.
All tests were normal except polycystic ovaries and multiple FIBROIDS in uterus.
We advised her try for natural conception first.
She could not come for follow up because of personal and career commitment..
However, all of a sudden she visited to us in 2017 with positive pregnancy test.
Her Fibroids increased in size tremendously causing severe pain (relieved by frequent use of injection and advice for hospitalization).
Additionally, her vaby did not grow well (FETAL GROWTH RESTRICTION- FGR) for which serial ultrasound monitoring was done.
Baby was also in BREECH (upside down, buttock first and head higher).
After testing for OGTT with 75 gram glucose, she was found to have GDM (Gestational Diabetes Mellitus) which was controlled with oral medicines and diet.
She was also hypothyroid taking medicine.
Considering all high risk we planned for C section at 36 weeks with consent that she might need MYOMECTOMY (Fibroid Removal) during C Section and blood in hand. Steroid was given to promote lung maturity of the baby.
However, we managed to deliver the baby without disturbing the Fibroids. Blood was NOT transfused.
A very cute female baby weighing 2 Kg was delivered and sent to SCBU for initial breathing troubles. However she was alright within 24 hours and was sent to ward with mother.
Both are healthy with mother’s blood sugar being normal after delivery.
PS- Taken with kind permission from the patient.
Unexplained Infertility, Obesity, Repeated Miscarriage,
•Infertility with Recurrent Miscarriage
Patient presented to us with previous 2 early miscarriage (no heart beat seen) followed by secondary Infertility.
All investigations were normal (hormones, ultrasound, tubes, semen). Regarding Miscarriage- karyotype, Anti Phospho lipid antibody, 3D ultrasound all were normal.
She was obese with hypothyroid.
As a treatment of “UNEXPLAINED INFERTILITY” she received several cycles.
The Recurrent Miscarriage was also UNEXPLAINED.
We discussed with her next treatment plan. She tried to wait and fortunately conceived within 3 months SPONTANEOUSLY.
Regarding UNEXPLAINED REPEATED MISCARRIAGE, we discussed with her treatment options and their limitations and lack of GUARUNTEE that these treatment are 100% effective. She opted for these treatment as a last resort. We repeatedly explained that all these treatment may fail and without medicine successful outcome can happen.
1. Hydroxyprogesterone caproate inj (500) twice weekly till 20 weeks
2. Natural micronized progesterone gel once daily till 30 weeks
3. Inj hCG (5000) twice weekly till 12 weeks
4. Inj Enoxaparin (40) daily till delivery
5. Inj IgG once in 3 weeks till 18 weeks
6. Tab dydrogesterone 20 mg/day till 20 weeks
7. Aspirin 75 mg/day till one week before delivery.
We planned for delivery at 37 weeks. But suddenly she went into labour and the liquor was MECONIUM STAINED (baby passed stool and was distressed before delivery). So decision for Emergency C Section was taken.
She delivered a healthy Male Baby last night.
A mother’s smile with her baby in her lap is just DIVINE.
Unexplained Infertility, Natural Conception
•Patient with Unexplained Subfertility, spontaneous conception, thalassemia minor delivered successfully.
Male infertility, Spontaneous Pregnancy
• A couple with mild male factor Infertility (slightly low Sperm motility) was advised HyCoSy to check for tubal patency. She was reluctant to do the test. The cycle in which she finally agreed to do the test, ended up in missed period. Urine pregnancy test was positive. But she could not believe in her eyes. So they checked blood from the laboratory and it turned out to be positive.
PCOS, Natural Conception, Obesity, Hypothyroidism
•They were trying for pregnancy for two years. They tried ovulation induction with oral medicines for several cycles •We found all investigations normal, except PCOS •We gave them ovulation induction with injectables. These failed. She was planning for IUI. In the meantime she conceived naturally. •Her blood group was negative, so serial blood test for ICT (Indirect Coombs Test) was done to see if baby was affected or not. ICT was normal •Thyroid problem was well controlled with medicines •Delivery was done successfully. Baby is doing well •Mother was advised heparin injection after delivery to prevent thrombosis (as she was overweight)
Dermoid Cyst Removal, Laparoscopy, Natural Pregnancy
•Dermoid Cyst Removal and Preserving the healthy Ovary by Laparoscopy in a lady with Infertility.
It was 5 cm dermoid cyst in left ovary. After taking consent and explaining the risk, we proceeded for Laparoscopy and removed the cyst with all hair (!!!) and secretion. The right ovary was intact and not disturbed. The left ovary was preserved as much as possible so as not to compromise her Fertility much.
We also performed hysteroscopy to look inside the uterus in the same sitting (with her consent) to avoid the need of second operation.
We also checked whether the tubes are patent or not by inserting blue dye (Methylene blue- shown in the picture).
Dermoid cyst is a benign tumour of the ovary that may contain hair (seen in this picture), oil (like skin secretion), skin, teeth, bones, cartilages etc.
The chance of malignancy is very rare.
But if left untreated, it can undergo TORSION (twisting of the ovary, causing severe pain and may cause gangrene of the ovary if untreated, an ACUTE EMERGENCY) and also hemorrhage inside the cyst.
It was a CHALLENGE to remove the cyst (5 cm size) keeping the ovary (we took consent from the woman that she may require removal of the ovary, fortunately it did not happen).
The operation took long time but finally it was done. •She got pregnant naturally within 3 months of surgery
Fibroid-Infertility, Lapaparoscopic Myomectomy, Low AMH, Advanced Age, Spontaneous Pregnancy
•40 year-old woman presented with Infertility of 5 years •AMH was very low and she was advised IVF with Egg-Donation •She had large fibroid (6 cm) with heavy menstrual bleeding, not relieved by any medicines •We removed the fibroid by laparoscopy (Myomectomy) and she was discharged from the hospital next day •Within 3 months after the operation, she conceived spontaneously (Without IVF) and delivered a healthy baby
Secondary Unexplained Infertility, Spontaneous Conception
•Their first pregnancy ended in miscarriage after a trauma •Then they could not conceive but all reports were normal •She conceived spontaneously with twin •At 28 weeks, she went into preterm labour and delivered the babies •Unfortunately one baby dies because of infection •The other baby was taken care in NICU •Now both the mother and baby are doing well •
Sometimes, a very strong determination can make you win the game
The lady is 36 years-old. The man’s age us 38 years. They were trying for pregnancy for last 5 years. However, all reports were fine. So, it was “Unexplained Infertility”.
They tried Ovulation Induction several times, before coming to us. We offered them IUI. They wanted to take time.
One day, the lady came to us, demanding IVF. We explained the drawbacks of IVF. But she was ready to accept all the complications of IVF and was mentally prepared to accept the fact that the success rate of IVF is only 40-50% throughout the world.
She responded well to the Ovarian Stimulation, good quality of eggs were obtained. Frozen Embryo Transfer was done.
The result is POSITIVE.
Please pray for them
Self Insemination is a process of “Natural Conception” that can help to achieve pregnancy in Ejaculation Problem.
This couple came to us with the Ejaculation problem. They were married for 3 months. The man could not ejaculate during intercourse. However, he was able to ejaculate during masturbation and he also experienced “night fall”.
We tried to find out the cause by taking detailed history, physical examination and tests (blood, urine, Ultrasound). However, all reports were normal. We tried few medicines (their efficacy in Ejaculation Problem is doubtful) but these did not work.
Finally, we asked them “what do you think”. They were eager to have pregnancy. They wanted to go for IUI (Intrauterine Insemination) directly. But as they were young and had just started planning for pregnancy, we advised them to try for “Self Insemination” for 3 months.
They followed “Self Insemination” at home. The wife detected the time of “Ovulation” (release of eggs from the ovaries) using urine test by LH kit. When the test was positive, they used to practise insemination into the vagina. No medical assistance was needed for this purpose.
They finally returned to us last week with good news.
Please pray for them.
PS- uploaded with kind permission
Successful Treatment with Medicine for Male Infertility
If there is abnormal Semen Report, it’s important to see the whole report, NOT merely the count. It’s also important to ensure that the test has been done from an authentic laboratory and that laboratory should follow the WHO 2010 guidelines for semen analysis (Not the older version of WHO 1999 or WHO 1992).
Again, we must see what’s the Total Motile Count (TMC) of the sperms. If TMC is normal or mildly low, oral tablets can be advised (although their efficacy is doubtful) and the couple can try naturally. Lifestyle changes are also advised (avoiding smoking, excess alcohol, prolonged sitting, tight underwear and long driving). However, the female factors must be normal and the duration of trying must not be long. The repeat semen test should be done after at least 3 months, because it takes 3 months of time for the sperms to complete their formation. Again, the sperm count varies from day to day. So the next step of treatment (IUI/ IVF) should be decided after 3 months only.
If TMC is moderately low, the treatment is IUI (Intra Uterine Insemination) using Husband’s sperms, provided female factors are normal and infertility is of short duration. Medicines and life style changes are advised along with IUI. If 3 to 4 cycles of IUI fail, then only consider IVF (In Vitro Fertilization), if the semen reports remain the same.
But if TMC is very low, its important to do some tests in an attempt to find out the cause. If no cause is found, better to consider ICSI (Intra Cytoplasmic Sperm Injection) soon. In this case, waiting to see whether medicines are acting, may be the waste of time. However, as ICSI is costly, medicines can be taken until the decision is taken. However, delaying ICSI in this case can further reduce the count.
Therefore, the treatment depends on the count, motility a d morphology of the sperms.
This couple came to us 5 months ago with Infertility. Husband’s sperm report was abnormal. We repeated the test and found that the TMC was mildly low. We advised him medicines and lifestyle changes and repeating the semen test after 3 months. All the reports of the wife were normal. But, as the wife’s age was 35 years, we started Ovulation Induction (OI) for her (giving medicines to grow the eggs to improve the chance of pregnancy). We planned for 3 months of OI.
But after 2 months of taking medicines by the man and 2 months of OI, they returned with the good news.
Please pray for them.
Uploaded with kind permission.
Successful Ovulation Induction in PCOS
In women with PCOS, there are sufficient number of eggs inside the ovaries. The only problem is that the eggs cannot grow and are released (“Ovulation”). Therefore, if the Fallopian Tubes and the Sperms are normal, the treatment of PCOS Infertility is “Ovulation Induction (OI)”- the treatment to stimulate the eggs to grow and ovulate.
Before ovulation induction, the main advice is weight control. If weight is optimum, the response of the ovaries by the medicines increases. Sometimes, some medicines (Metformin, Inositol) can be added.
The first line of medicines used for OI are orally taken medicines like Clomiphene Citrate (CC) and Letrozole. Whether you need to try CC or Letrozole first depends on your condition. But if you take medicine for OI, Do NOT take it without TVS Follicular Study. This is important to see whether your ovaries are responding to the medicine in the first month. If you are responding by the medicines (eggs are growing and are ovulating), in one month the chance of pregnancy is 15%, that means out of 100 women having adequate response to the medicines, only 15 can conceive within one month, provided they have regular unprotected intercourse.
So, if your ovaries are responding to the medicines but you cannot get pregnant, you can take the same medicines for next 3-4 months without further TVS. If you cannot get pregnant by these months, you need to move to the next step.
Again, if you do not respond to the medicines by the first month, taking the medicines months after months, is simply the waste of time and money.
The picture (uploaded with kind permission) is from a woman with PCOS with eight years of Infertility. She took CC and low dose Letrozole, before coming to us, but without TVS. We advised her weight loss and prescribed Metformin and Inositol. Then we started ovulation induction with higher dose of Letrozole and performed TVS Follicular Study and found that she was responding to the medicines. We advised them to try the same medicines for next 3-4 months without any need to visit us. But, they visited us just after missed period with the good news.
Please pray for them.
Thus, the correct medicine in correct dose and proper treatment can give you pregnancy by simple ovulation induction.
Spontaneous Pregnancy when you are thinking for Egg Donation IVF
The couple had been trying for pregnancy for EIGHT long years. The woman was diagnosed with Poor Ovarian Reserve (POR), that is low Egg Count as seen by low AMH and Low AFC. She was advised to try for IVF with Self-eggs and also IVF with Donor-eggs. She could not afford IVF.
She came to us last week. She is already 38 years old and is not having periods for last nine months. Blood results showed high FSH, meaning that she was having Premature Menopause. We thought she would probably require egg donation and IVF.
Before prescribing medicines to induce the periods, we always want to make sure that it’s not because of pregnancy. We asked her if she tested urine for pregnancy test. She said, “No, Because I know it would be NEGATIVE. Whenever I had delayed periods, I tested urine but always it came negative”. But we insisted on it repeatedly. Reluctantly, she tested the urine after buying the kit from the nearby shop.
And it became POSITIVE.
(Picture taken with kind permission).
Please pray for her.
Pregnancy is POSSIBLE after Menopause.
Pregnancy is POSSIBLE after Premature Menopause.
Natural Conception is POSSIBLE after Menopause.
Natural Pregnancy is POSSIBLE even when you lose all hope and plan for Egg-Donation-IVF.
NEVER LOSE HOPE.
Pregnancy is possible with Simple medicine if you have TVS Follicular Study
In simple language, “Ovulation Induction” (OI) means taking medicines to improve the chance of pregnancy. These medicines (Tablets, Injections) are advised to increase the chance of Ovulation (the process of growing of the eggs in the ovaries and then release of the eggs).
But do NOT take these medicines without TVS Follicular Study. Why? If there is ovulation and the couple practise regular intercourse, in one month the chance of pregnancy is only 15%. That means, out of 100 women having ovulation, only 15 can conceive after one month. But how do you know that you had ovulation? The answer is TVS Follicular Study. If in 1st month, you had ovulation, you can take the medicines for next 3/4 months without further TVS. But TVS in 1st month is necessary.
This lady (picture taken with permission) came to us with 5 years of Infertility. She took tablet Letrozole several times. After 2 to 3 months of treatment when she did not get pregnant, she used to change the doctor. Repeatedly she was receiving Letrozole in different doses. When they came to us, “What do you want?” They told, “We want to try naturally gor another 2/3 months before considering IUI / IVF”. We respected their decision and started OI with another effective medicine Clomiphene Citrate. We performed regular TVS Follicular Study and found that there was ovulation. We asked them to try it for next one month, after which we would consider IUI. Fortunately, she conceived after 1st month. Please pray for her.
Azoospermia- Successful TESA-ICSI
This couple had been trying for pregnancy for ten long years. Wife’s age is 29 years and all of her reports were normal.
Husband’s age is 35 years. Repeated Semen Analysis showed absent Sperms in the Semen. After physical examination (of Testicular Size) and investigations (blood for FSH, Testosterone), it was confirmed as a case of NOA (Non Obstructive Azoospermia)- no obstruction in Sperm Conducting Duct but there was problem in Sperm Production inside the testicles.
We discussed 2 options –
1) Intrauterine Insemination (IUI) using Donor Sperms. This is cheaper but success rate is low. They did not accept donor sperms.
2) ICSI (Intracytoplasmic Sperm Injection), which is a special form of IVF (In Vitro Fertilization), after attempting to collect his own sperms from his testicles by TESA (Testicular Sperm Aspiration). They initially hesitated to accept it because of the cost but finally agreed.
The process of IVF started. The woman responded well to the ovarian stimulation. Good number of eggs were collected from her. TESA was done on the same day. ICSI was done.
But the woman’s uterus was not looking good to accept the embryos. So all the embryos were frozen. She was given 3 injections at monthly basis to decrease the size of her uterus and then embryo transfer was done.
They got the positive results.
We are keeping our fingers crossed.
Please pray for them.
Pregnancy at Higher Age with Simple Medicine
Higher age does NOT always mean Donor-Egg-IVF.
This couple came to us from Asansol. The husband’s age is 44 years, wife’s age 40 years. The lady became pregnant 3 times. First pregnancy was 21 years ago, resulting in a male baby. The second pregnancy was terminated as they were not ready for that. In the third pregnancy, she delivered a female baby, 7 years ago. All of them were spontaneous pregnancies without any problems or complications.
Unfortunately, the boy died at 18 years of age after an accident. After becoming little “stabilized”, they were desperately looking for another baby, because the baby girl was looking for a sibling. They visited different places and she was advised to have IVF with egg donation, because of her age.
When they presented to us with broken heart, we explained them the risks to the mother and the baby as a result of pregnancy at advanced age. They agreed to take the risks. We evaluated her cardiac, renal condition and blood sugar. All routine tests like Thalassemia Screening and Rubella Testing were done.
They did all Fertility Investigations outside, so we did NOT have to do any tests. The reports showed she had low AMH. The first day, they visited us, was the day-4 of her period, so, we checked her AFC (Antral Follicular Count- the number if eggs in the ovaries) by TVS (Trans Vaginal Scan) and found it was low. We asked them “What to you think?” The reply was, “We want to try for baby from self-eggs, if necessary by IVF. If this fails, only then, we will consider Donor-Egg-IVF”. We respected their decision and asked, “When you are planning for IVF with self eggs?” They said, “Probably after March, because if financial year ending”. They asked, “Could you give any medicine to increase the chance of pregnancy, in the meantime?” We explained that the chance of pregnancy after taking medicines for Ovulation Induction (OI) at this age is extremely low. Still they insisted.
Following their requests, we started OI with Clomiphene Citrate and advised her to come for Follicular Study (by TVS) for 3 days. We found that there was ovulation (rupture of the eggs) after taking the medicine. They said, they will try it in February and March and then will return for IVF in April.
But fortunately, they got the good news after the first month. Thus, this lady, at 40 years if age, needed to visit us only for 4 days in total.
We are keeping our fingers crossed.
Uploaded with their kind permission.
HSG increases the chance of Pregnancy
What is HSG (Hysterosalpingogram)?
HSG is a test done as a part of Female Infertility Evaluation, to check whether the Fallopian Tubes are open. Fallopian tubes (commonly called “the tubes”) are the structures that are connected to both sides of the uterus. Inside the tube, the sperms and the egg meet (“fertilization”) to form the embryo.
It is a type of X Ray, done by inserting a special liquid (“Contrast”) into the Uterus through the Vagina.
When HSG is done?
If you have been trying for pregnancy for one year, but could not conceive, HSG should be done.
But in some cases, it should be done earlier (if you fail to conceive within 6 months). This includes advanced age (more than 35 years), previous operation in tubes/ ovaries, previous history of Ectopic Pregnancy (Pregnancy outside the uterus), Endometriosis (the lining of the uterus lying outside the uterus), Previous PID (Pelvic Inflammatory Disease- a form of sexually transmitted infection of the tubes/ ovaries) or severe pain during menstruation or pain during intercourse.
What to do if both the tubes are found to be blocked in HSG?
You still can consider SSG (Sono Salpingo Graphy- doing ultrasound by putting saline inside the uterus) as a second test to check tubal patency. If SSG shows tubes are open, you do not need any special treatment. However, if SSG also shows the “block”, then there are simply two options. You can consider laparoscopy or go for IVF straightforward.
When Laparoscopy is advised?
If you are at a younger age, other fertility factors (Sperms and the ovaries) are normal and the infertility is of shorter duration, laparoscopy may be a suitable approach for you. If laparoscopy confirms the patency of the tube(s), you can try for pregnancy naturally. Sometimes, an attempt can be made to remove the block by laparoscopy. However, if laparoscopy shows the tubal block and the tubes cannot be opened, you need IVF after Laparoscopy.
When to go for IVF?
If the conditions of the ovaries or the sperms are not satisfactory, your age is on the higher side, or infertility is of long duration, directly going for IVF would be the better option for you. Again, if you fail to conceive within 6-12 months’ time after laparoscopy, even when the tubes were found open, you may need to consider IVF.
What to do if one tube is blocked in HSG and the other tube is open?
In that case, you DO NOT need any special treatment like IVF or Laparoscopy, provided there is no Hydrosalpinx (Tubes are swollen) and the sperms and the ovaries are healthy.
How HSG improves the chance of pregnancy?
During HSG the liquid is pushed forcefully into the tubes through the uterus. Thus, HSG can overcome “mild block” present in the tubes, if any. This, it can increase the chance if pregnancy.
This couple had been trying for pregnancy for last one and half year. The reports of sperms and the ovaries were normal. The woman tried medicines for few months. We advised HSG. The next month she conceived without need of any medicine.
PCOS Conceived with simple medicine
PCOS (Polycystic Ovary Syndrome) is not the disease of the “Cysts”. What appear as “cysts”, are actually the follicles (the sacs containing the eggs inside) which have not grown larger.
In a woman, there are follicles in the ovaries. In one month only one can enlarge and rupture, releasing the eggs (“Ovulation”). However, in PCOS, thus ovulation cannot happen properly.
Therefore, there is no actual “Cysts”. Ovarian Cyst is a different disease, which is actually a type of tumour, that can be treated by surgery. In PCOS, there is no such tumour. So, we cannot take out the “Cysts” and cure it.
In fact, PCOS is NOT CURABLE. It’s a hormonal problem but can be kept under control. It’s a chronic disease like Diabetes, Hypertension, Thyroid disease etc, which are not curable but can be controlled. If you find “less” or “no” cysts, that does not mean that your PCOS is cured. So, there is nothing called “mild PCOS” or “severe PCOS”.
Please remember, PCOS and “Polycystic Ovaries” are not synonymous. Many women can have “Polycystic Ovaries” in ultrasound scan without PCOS. To stamp them as “PCOS”, they must have irregular periods or features of excess testosterone (male hormone) like excessive hair growth. So, if a lady is having regular periods, no features of excess testosterone but is having “Polycystic Ovaries” in ultrasound, she is NOT having PCOS.
In PCOS infertility, “Ovulation Induction” (OI) works well. It means giving medicines to help the eggs grow and ovulate. But if you are taking these medicines, it’s extremely important to check if your ovaries are responding to the medicine. This can be done by TVS Follicular scan. Otherwise, taking medicines for months after months, is simply the waste of time, money and energy.
This couple came to us with Infertility of 2 years. The man’s report was normal. The lady had PCOS. She tried medicines for OI for long time, but without TVS. We advised weight reduction and started OI with high dose Letrozole. We performed TVS Follicular scan and found that she was ovulating. The next month, she missed her period and the result is positive.
Please pray for them.
PS- Uploaded with kind permission.
Successful Pregnancy with Self Insemination, Sexual Dysfunction, High Age
Self Insemination can give successful pregnancy in Sexual Dysfunction.
PS- Uploaded with kind permission.
The couple came to us in June 2017 with Non-Consummation of Marriage. The husband’s age was 43, wife’s age was 38. The man had Erectile Dysfunction (ED).
After initial examinations and investigations, no apparent cause for the ED was found. We tried all possible medicines at the highest possible doses but unfortunately, nothing worked for him. Finally, we advised Penile Doppler (to see blood flow in the Penis by ultrasound, after Papaverine Injection into the Penis). It showed abnormal blood flow to the penis. So, only options remaining were vascular surgery or Vacuum Erection Device (VED).
The couple decided to think for pregnancy first, as the lady was already 38 years old. We performed initial investigations like Semen Analysis, AMH, Rubella and Thalassemia screening. All were normal
We explained the possible complications of Pregnancy for the mother and baby because of the age. They agreed to take the risks.
They wanted to proceed for IUI (Intrauterine Insemination). We explained, IUI is a medical procedure, so if they wish a d feel comfortable, they can try Self Vaginal Insemination for 2 to 3 months. If this failed, IUI could be considered.
We explained them how to do Self Insemination. The lady was asked to detect the timing of Ovulation (Release of eggs) by Urine test, done at home, using LH kit. The husband was asked to collect his semen in a sterile container and put it inside the vagina by dropper. All these were done at home by themselves. No medicines, apart from Folic Acid was advised. This is, because, we believe in the least possible number of investigations, the least possible use of medicines and the least possible medical interventions.
They returned after 2 months with POSITIVE Pregnancy Test. Because of the age, it was High Risk Pregnancy. We performed all the routine tests like Combined Test, Anomaly Scan etc.
South Asian Women are at risk of GDM (Gestational Diabetes Mellitus). GDM carries high risk of DEATH of the baby, before birth. It should be detected by a test called OGTT (using 75 gram Glucose), NOT by Ordinary Fasting Sugar or PP Sugar. Here the initial OGTT was normal. But OGTT at 28 weeks was abnormal. So, she developed GDM, which was well controlled with diet and oral medicine only (Without Insulin).
Because if her age, first pregnancy and being overweight; the baby was at risk of developing IUGR (Intrauterine Growth Restriction)- the inadequate growth of the baby. It should be detected by Serial Growth Scan and Colour Doppler. We performed this and detected IUGR at 34 weeks, along with decreased Liquor (water around the baby). IUGR babies are at risk of serious complications before and after birth. So, we gave her Steroid Injection (to promote lung maturity of the baby) and decided for delivery at 37 weeks at NICU set up.
Delivery was done by Caesarean Section. Both mother and baby are healthy now.
1. Sexual Dysfunction is common but Pregnancy is Possible.
2. Self Insemination can give pregnancy without any Medical Intervention.
3. Higher age does not always need any treatment to achieve pregnancy.
4. Pregnancy at high age is High Risk Pregnancy and needs proper care.
5. Screening for GDM should be done by OGTT twice in pregnancy.
6. IUGR should be diagnosed by growth scan.
7. Delivery should be done in NICU Set Up.
Pregnancy in PCOS without Laparoscopy or IVF
This couple came to us with infertility of four years. The woman is having PCOS. She tried oral medicines for 12-14 cycles but no pregnancy happened. They were advised to have Laparoscopy. they came to us to seek second opinion. We asked them, “what you are planning?”. The reply was “We are frustrated. We will go for IVF in April (after financial year ending). We do not want Laparoscopy. Can we try any other treatment while preparing (mentally and financially) for IVF?” After explanation of benefits and risks, they wanted to try injections for 2-3 months.
We gave them injections with oral medicines and performed TVS Follicular Study and found good response. They agreed to try it for another 2 cycles before IVF. They tested urine for pregnancy but could not believe what they were seeing. (Uploaded with their kind permission).
We are keeping our fingers crossed.
Successful Ovulation Induction in PCOS.
The couple came to us with PCOS. They wanted OI. We started Letrozole. In the first cycle TVS confirmed Ovulation. They conceived after 3rd month. She was hypothyroid, which was controlled with medicine. Age delivered the baby at 37 weeks .