Contents

FAQs - All you need to know!

IVF

If I Conceive, Will My Baby Be Normal?

At the time of writing, more than 50 000 babies have been born following IVF. These healthy babies show there is no increased risk of abnormality in IVF conceived babies compared to those conceived naturally.

Is There Any Physical Risk To Me?

With vaginal ultrasonic egg collection, you may be rest assured that this is certainly no more risky than a properly performed laparoscopy. We are proud that at Sir Ganga Ram Hospital till now more than 5000 vaginal ultrasonic egg collections have been performed and there have been no problems or accidents, so it is clear that the test-tube baby treatment is a relatively very safe procedure.

Will there be any hormonal imbalance due to the excessive hormones given?

No proven long-standing effects occur after the treatment cycle. However, during the course of treatment one may have symptoms related to ovarian hyper-stimulation.

Can I exercise as usual?

Yes, but water sports and exhaustive exercises are prohibited.

What if IVF fails the first time? How many times will I have to undergo it?

You can go through IVF as many times as you wish, but we advise upto four cycles at the most.

How much time does one successful treatment of IVF take?

Active treatment for IVF starts on day 2 of the menstrual Cycle. At present, the injections for down-regulation of hormones are started on day 21 of the previous menstrual cycle. In 10 to 14 days, menstruation starts. We then start stimulation of the ovaries with gonadotropins, which can take upto 14 days after which egg collection, fertilization and embryo transfer is carried out. After another 14 days, a pregnancy test is done to confirm the occurrence of pregnancy. In all, it takes about 40 days from the start of treatment to know whether treatment has been successful. Now with GnRh antagonists down regulation from previous cycle is not required as with agonists and can be started from day 6 of stimulation cycle.

ENDOMETRIOSIS

What is endometriosis?

Endometriosis is deposits of endometrial tissue (cells from inner lining of uterus) into the surfaces of abdomen. These deposits can occur over the ovaries, tubes, intestines and peritoneal surfaces.

If I have endometriosis what symptoms can I experience?

The following symptoms are common with endometriosis:

  •  Painful periods
  • Lower abdominal pain &lower back pain
  • Painful intercourse especially with deep penetration (dyspareunia)
  • Infertility (inability to conceive)
  • Nausea, vomiting, dizziness and fainting attacks during period.
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What happens in endometriosis?

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The female hormone estrogen causes the endometriotic implants to grow causing pain and swelling. These implants outside the uterus have no way to leave the body and become inflamed and swollen. If endometriosis occurs in ovaries it can cause cyst (blood filled sac) formation which is commonly known as chocolate cyst.

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What are the causes for endometriosis?

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No one knows for sure what causes endometriosis. One theory is based on the belief that menstrual fluid containing endometrial cells that normally flows out of the vagina, moves backward through the tubes and drips into the abdominal cavity and leads to implants on surrounding organs.

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How does endometriosis cause infertility?

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The deposits of endometrial tissue bleed during menstruation and thus enlarge to form cyst or adhere to organs around the pelvic area destroying the relationship between the tube and ovary. In these cases even if the tubes appear patent, there is difficulty in the egg being picked by the tube and transported to the uterus.

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Do the symptoms depend upon the severity of the disease?

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Symptoms can start very shortly after your first period or show up years later. Pain is common symptom of endometriosis. The severity of pain does not appear to be linked exclusively to how severe and extensive your endometriosis is.

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Where is endometriosis found?

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Endometriosis can affect the organs and structures of the pelvis. That is:

  • Ovaries, uterus, fallopian tubes.
  • Cul-de- sac (extension of the abdominal cavity, like a pouch, that lies between the rectum and back of the uterus)

Endometriosis can also be found in the lungs, diaphragm, brain, small and large bowel but this is very rare.

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How is endometriosis diagnosed?

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Endometriotic ovarian cysts can be diagnosed with help of ultrasound. A definite diagnosis of endometriosis requires looking through a laparoscope at the internal organs where it can be treated at the same step.

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How does one suspect endometriosis?

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Previously non painful menstruation becomes painful and there could also be pain during intercourse. Endometriosis may also be associated with difficulty in conceiving. Presence of cyst on ultrasound with thick material within, gives rise to suspicion of endometriosis.

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What is treatment of endometriosis?

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There are many different treatment modalities available for endometriosis. They range from medical treatment which includes the use of hormonal drugs to surgical treatment which is done by the help of laparoscopy or by open surgery.

  1. Pain Medication: Hormones in the form of pills (estrogen &amp; progesterone), Danazol (weak male hormone) &amp; GnRH agonist (Gonadotropin releasing hormone) can be given to suppress endometriosis.
  2. Surgery: Laparoscopic surgery is the best form of treatment for endometriotic cyst or to release adhesions. Sometimes open surgery may be required.
  3. Infertility treatment: Infertility management can be surgical ablation of endometriotic implants immediately followed by medical treatment for ovulation induction with either timed intercourse or IUI (intra uterine insemination). IVF (in-vitro- fertilisation) may be the only option in severe endometriosis or failure to conceive despite the above mentioned treatment.

How can I get rid of endometriosis?

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Endometriosis is a progressive disease and it lasts till you get your menses (menopause). The process of endometriosis can be halted by surgery or medicines mentioned above but it can recur after sometime (1-2 years after surgery and approx 3 months of stopping medical treatment).

Does endometriosis lead to complications if I get pregnant?

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Endometriosis generally remains subsided and symptoms disappear during pregnancy and lactation as there are no regular menses during this time.

Laparoscopy and Hysteroscopy

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What is Laparoscopy?

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  • It is an Intra abdominal ‘Keyhole’ Surgery
  • Laparoscopy is an operative procedure done under general anaesthesia that allows intra abdominal surgery to be performed with the help of a special optical device called laparoscope.

This is inserted through a tiny incision

  1. Made in the abdominal wall near the navel for viewing the abdominal cavity. By introducing special instruments though additional incisions or cut over abdomen.
  2. It is possible to perform minimally invasive surgical procedures without the need of creating a large opening in the abdominal wall.

Why

Why does one require laparoscopy?

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Laparoscopy is an important diagnostic tool in the evaluation of an infertile patient. An inspection through the laparoscope gives us a general impression of the state of the pelvis and enables us to find the cause of infertility. Also, the tubal patency can be checked by injecting a blue dye into the uterus, through a thin tube inserted through the cervix (mouth of the uterus), and seeing it spill out though the tubes. In addition the laparoscope can also be used to safely carry out operative procedures, which enhance fertility.

What

What are the commonly done procedures by laparoscopy?

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  • Assessment of tubal patency by chromopertubation
  • Adhesiolysis to clear tubes, ovaries and uterus and restore normal anatomy of pelvis
  • Ovarian drilling in PCOS
  • Cyst removal from ovaries
  • Endometriotic cyst drainage and fulgurating all endometriotic deposits in the cyst
  • Clearance of endometriosis including fulguration of all possible deposits in pelvis
  • Obtaining biopsies to confirm diagnosis if in doubt from ovaries, tube or deposits in the pelvis
  • Opening of the distal end of tubes
  • Removal of ectopic pregnancy
  • Removal of fibroids protruding on the surface of the uterus
  • Clipping or removal of tubes before IVF in case of gross hydrosalpinx
  • Controlling hysteroscopic septum resection or hysteroscopic adhesiolysis by direct visualization by laparoscope simultaneously, to prevent injury to uterus or any other surrounding structures
  • Confirming successful cornual cauterization to achieve tubal patency by seeing spillage of dye from the outer end of the tube.

Are

Are there any advantages of laparoscopy over open surgery?

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Smaller and cosmetically better scars

  • Reduced pain after surgery
  • Shorter stay in the hospital
  • Less chances of wound infection
  • Formation of lesser post-operative adhesions
  • Faster recovery and resumption of normal activity

Does

Does laparoscopy have any complications?

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Inability to perform the procedure due to technical problems or extreme obesity Intended laparotomy (open surgery) in the best interest of the patient whenever required Injury to internal organs and blood vessels Injury to internal organs and blood vessels.

What

What is the approximate time taken for surgery?

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Usually between 30 – 60 minutes but may extend to 3 hours depending upon nature of the surgery.

Will

Will I need to take complete bed rest?

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No, you can get up from bed and start moving about as early as 2 hours after surgery unless advised otherwise by your consultant. You can start walking, climbing stairs and can resume all basic activities on the very same day, 4-6 hours after surgery.

How

How soon can I start eating after the surgery?

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Approximately 3 hours after surgery (initially liquids followed by soft diet), normal diet is allowed next day onwards.

When

When can I bathe after Laparoscopy?

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You can bathe the day after the surgery. In case the dressing becomes wet, you can even take it off and then apply some aftershave lotion or spirit and put a band-aid on it.

Will

Will I have any pain after surgery?

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Slight pain and distension of abdomen along with shoulder pain are common after surgery. This is because; gas is filled into the abdomen to visualize the inside during surgery. However, this settles within 24 hours. You can take a pain killer whenever required. A slight pain at the stitch line may continue even up to 7 days, which is normal.

Can

Can I have vaginal bleeding after surgery?

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There may be some bleeding for a few days after hysteroscopy, which subsides on its own.

Will

Will I require overnight stay in the hospital for these procedures?

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Procedures using laparoscopy are routinely performed under general anesthesia as day care cases, without the need for an overnight stay in hospital. However, prolonged laparoscopic procedures may require one or more days as an in-patient, depending on the exact nature of the procedure.

When

When can I get back to work?

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Usually one to two days of low activity after surgery should suffice. However, follow the concerned doctor’s advice.

What d

What do you do in hysteroscopy?

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Hysteroscopy is an operative procedure performed under general anaesthesia where a telescope is introduced into the uterus through the vagina to visualize the inside of the uterus.

Why do

Why does one require hysteroscopy?

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Hysteroscopy is done to visualize the inside of the uterus to make sure that there are no pathologies, which could cause infertility and which if present, can be corrected simultaneously by operative hysteroscope to improve fertility.

What a

What all problems can be treated by hysteroscopy?

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  • Visualization of cavity of uterus and site specific targetted biopsies whenever necessary
  • Removal of endometrial polyps
  • Removal of sub- mucous fibroids
  • Clearance of adhesions in the cavity of the uterus
  • Excision or cutting away of uterine septum
  • Removal of foreign bodies or old products of conception or embedded intra uterine contraceptive devices
  • Cornual catherization to open up the tubes
  • Insertion of ESSURE for proximal tubal occlusion

Are th

Are there any complications of hysteroscopy?

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  • Inability to perform the procedure due to technical problems
  • Poor visualization due to thickened endometrium/ poor distension
  •  Difficult cervical dilation due to fibrosis/ cervical ridge
  • Perforation of the uterus

Polycystic Ovarian Syndrome (PCOS)

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What is

What is PCOS?

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Polycystic ovarian syndrome or PCOS is a medical condition in women where the primary problem is lack of regular ovulation (egg formation) and excessive male hormone in blood. It presents as irregular periods, inability to conceive and with symptoms related to excessive male hormone like acne, facial hair, baldness etc.

How com

How common is PCOS?

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About one in seven to ten women are likely to have this condition.

Why doe

Why does PCOS occur?

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A large part of the reason for PCOS stems from before birth. These influences could be certain genes inherited from either parent or influences (stress, drugs, hormones) that your mother may have had, when she was carrying you. These causes cannot be modified. However, a small but significant influence is exerted by environmental factors after birth. These are lifestyle related. What you eat, how much you weigh, what is your body fat percentage, how much exercise you get, all consolidate to increase its severity. Obesity is a major risk factor that aggravates all manifestations of the disease.

What ca

What can I do to limit the condition?

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While PCOS does not go away, controlling life-style related factors, especially when obese, can help the condition. Even in women who are not obese, it is the weight around their waists that upsets hormonal balance. Hence, weight loss remains the mainstay of treatment. Dietary modifications include a diet rich in natural fibre and protein and low in carbohydrates and added sugar. Physical activity in any form helps immensely (walking/ jogging/ running/ skipping/ swimming etc.)

Will I

Will I be able to get pregnant?

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Yes. In the absence of other causes for infertility, most women will conceive with medicines/injections given for ovulation. Some may need an IUI in addition. Very few would need IVF.

Will I

Will I ever have normal periods?

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Weight loss by 10% or more of body weight, in some women might normalize periods. In others, periods become regular later in life. In many others, medicines are needed to normalize periods.

Can I f

Can I fully be rid of my problem of excessive body hair?

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No. PCOS is a condition of excessive male hormone secretion and the ovaries continue to do that till they are active (about age 48 to 50). Body hair can be gotten rid of temporarily by waxing or threading and permanently by laser hair removal techniques. Medicines help in preventing new coarse hair from developing.

What me

What medicines help in treating PCOS?

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No medicine can fully treat PCOS. Life-style modification remains the main stay. However, specific medicines are given to target specific problems associated with PCOS. For infertility there are a set of ovulation inducing medicines and injections. For regularizing periods, oral contraceptive pills or oral progesterone is prescribed. For acne or excessive body hair, medicines are given to lower androgen levels or to block its action.
Sometimes, metformin, a diabetes medicine is given to those women who show high sugar in blood in response to a glucose load. Metformin may also be given to women undergoing IVF in order to avoid the complication of OHSS.

What is

What is Ovarian drilling?

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This is a surgical procedure done laparoscopically in women with PCOS who do not ovulate with clomiphene citrate. It is a day-care procedure involving general anaesthesia. Three 1-cm cuts are made on the abdomen. The ovaries are drilled using electrical energy in an attempt to reduce the androgen producing areas within it. This is expected to normalize the hormonal events leading to ovulation. About 50% of PCOS women that were rightly selected for this procedure, will begin to ovulate regularly after this.

When is

When is IVF needed in women with PCOS?

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When many cycles of successful ovulation induction coupled with timed intercourse initially and with intra-uterine insemination later, have failed, one needs to consider IVF. If the male partner has semen issues or if the woman has tubal block, IVF would be undertaken as a first line measure.

What ar

What are the chances that my child will have a similar condition?

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PCOS has a complex inheritance pattern and whether or not a woman will manifest all its associated features will depend on a complex interaction between genes, intra-uterine influences and extra uterine influences. Yes, girls born to mothers with PCOS may be at a higher risk but not at a hundred percent risk.

Are the

Are there any long term health risks associated with PCOS?

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Long-term health risks associated with PCOS are usually seen in over-weight individuals and can be mitigated if you can stay within the ideal weight range. The long-term health risks include Type II diabetes mellitus, lipid abnormalities, fatty liver, hypertension, ischaemic heart disease and endometrial cancer.