Best Unbiased Evidence Based Health Information – themedideas Facts & Figures

  • Wednesday, February 20th, 2013

Updated on 31.10.2016.

To be viewed only by people above the age of 18 years

This section includes salient and important points regarding different health problems. Initially Obstetrics & Gynaecology would be the main area. People could have a quick look to learn the salient features of the health topics they are interested in. The information is factual, unbiased and evidence based. The topics are arranged alphabetically so that the readers could find them easily. Please try to go to the main health section (such as Infertility, Miscarriage etc) the topic is from. Otherwise you could use the search option at the right upper corner of the page. Type the topic and click the search sign to find related articles.

This service could be used by anybody from anywhere as long as he/she has a mobile with an internet connection.

 

slide12

 

[expand title=”A“]

AIDS

[/expand]

[expand title=”B“]

Nil

[/expand]

[expand title=”C“]

Consultation with the Doctor

Caesarean section (planned) is safest for the baby

[/expand]

[expand title=”D“]

Digoxin

[/expand]

[expand title=”E“]

Endometriosis

[/expand]

[expand title=”F“]

Nil

[/expand]

[expand title=”G“]

G-Y in Gynaecology – themedideas Facts & Figures

[/expand]

[expand title=”H“]

HIV transmision through mosquito bites

[/expand]

[expand title=”I“]

Infertility

[/expand]

[expand title=”J“]

Nil

[/expand]

[expand title=”K“]

Nil

[/expand]

[expand title=”L“]

Nil

[/expand]

[expand title=”M“]

Microsurgery

[/expand]

[expand title=”N“]

Nil

[/expand]

[expand title=”O“]

Ovarian Cysts & Tumours

[/expand]

[expand title=”P“]

Pregnancy

[/expand]

[expand title=”Q“]

Nil

[/expand]

[expand title=”R“]

Nil

[/expand]

[expand title=”S“]

Nil

[/expand]

[expand title=”T“]

Nil

[/expand]

[expand title=”U“]

Nil

[/expand]

[expand title=”V“]

Nil

[/expand]

[expand title=”W“]

Nil

[/expand]

[expand title=”X“]

Nil

[/expand]

[expand title=”Y“]

Nil

[/expand]

[expand title=”Z“]

Nil

[/expand]

 

 

[expand title=”AIDS“]

World AIDS Day

[/expand]

[expand title=”World AIDS Day“]

World AIDS Day, observed on 1 December every year, is dedicated to raising awareness of the AIDS pandemic caused by the spread of HIV infection.

World AIDS Day was first conceived in August 1987 by James W. Bunn and Thomas Netter, two public information officers for the Global Programme on AIDS at the World Health Organization in Geneva, Switzerland. Bunn and Netter took their idea to Dr Jonathan Mann, Director of the Global Programme on AIDS (now known as UNAIDS). Dr Mann liked the concept, approved it, and agreed with the recommendation that the first observance of World AIDS Day should be 1 December 1988.

Government and health officials observe the day, often with speeches or forums on the AIDS topics. Since 1995, the President of the United States has made an official proclamation on World AIDS Day. Governments of other nations have followed suit and issued similar announcements.

AIDS has killed more than 25 million people between 1981 and 2007, and an estimated 33.2 million people worldwide live with HIV as of 2007, making it one of the most destructive epidemics in recorded history. Despite recent, improved access to antiretroviral treatment and care in many regions of the world, the AIDS epidemic claimed an estimated 2 million lives in 2007, of which about 270,000 were children.

http://en.wikipedia.org/wiki/World_AIDS_Day

[/expand]

C

 

[expand title=”Consultation with the Doctor“]

What should you expect during consultation with the Doctor?

[/expand]

[expand title=”What should you expect during consultation with the Doctor?“]

During consultation with the Doctor you would expect the following:

i> Proper and detailed history taking

ii> Appropriate examination

iii> Arrangement of appropriate investigations

iv> Proper discussion about the possible diagnoses and treatment

v> Appropriate treatment after a diagnosis is made

Read more

http://themedideas.com/health/general-health/what-should-you-expect-during-consultation-with-the-doctor/

[/expand]

 

[expand title=”Caesarean section (planned) is safest for the baby “] (08.08.2015.)

I have been debating for years, on various occasions, that planned Caesarean section might actually be safer for the baby even in cephalic presentations, and what the trends in the rate of Caesarean sections have been showing, a planned Caesarean section would be the norm in the future and a vaginal delivery would be accidental unless it is too preterm. A similar fate awaits instrumental vaginal deliveries. I am glad to see that the Royal College of Obstetricians & Gynaecologists, London has published a statement on 29/07/2015 regarding a study published in BJOG on breech deliveries where the overall perinatal mortality in the planned vaginal delivery and planned Caesarean section group for a term breech baby were 253 (0.3%) and 79 (0.05%) respectively.

These results were lower than the perinatal mortality rates associated with a vaginal delivery where the baby was positioned head first in a WHO study which found the risk of fetal and neonatal deaths to be 0.39 and 0.38%, respectively. These were substantially higher (7.8 times) than 0.05% found in planned Caesarean section group for a term breech baby. It is unlikely that the overall perinatal mortality in planned Caesarean section group for a term cephalic baby would be higher than breech. Obviously randomised controlled trials on planned vaginal delivery vs Caesarean section for  term cephalic baby could confirm that. The other interesting finding in the study was that the overall perinatal mortality in the planned vaginal delivery group for a term breech baby was 0.3% that was about 23% lower than that for normal delivery in the WHO study.    

Commenting on the study, Professor Alan Cameron, Vice President of Clinical Quality for the Royal College of Obstetricians and Gynaecologists (RCOG) said:

This is a very interesting study which uses all of the existing data on breech delivery to determine the absolute risks of vaginal breech birth to the baby. The results show that the overall risks of babies dying or suffering complications during planned vaginal and planned Caesarean deliveries were about 1 in 300 and 1 in 2000.

Reference

[/expand]

 

[expand title=”Caesarean section (planned) is safest for the mother“] (08.08.2015.)

… a planned Caesarean section would be the norm in the future and a vaginal delivery would be accidental unless it is too preterm or the baby is already dead in utero

The maternal mortality in the pregnant women contemplating vaginal delivery is 0.39 per 10,000 and that for planned Caesarean section is 0.31 per 10,000

… planned Caesarean section is safer for both the mother and the baby. Not informing the pregnant women contemplating delivery regarding these ‘facts’ are morally and ethically wrong, and legally negligent act. Do we have to wait for evidence showing that planned Caesarean section is ‘safer’ for the Obstetricians, Neonatologists, Neonatal Nurses, Midwives, Healthcare Managers or Politicians?

I have been debating for years, on various occasions, that planned Caesarean section might actually be safer for the baby and mother even in cephalic presentations, and what the trends in the rate of Caesarean sections have been showing, a planned Caesarean section would be the norm in the future and a vaginal delivery would be accidental unless it is too preterm or the baby is already dead in utero. A similar fate awaits instrumental vaginal deliveries. We have evidence suggesting that compared with intended vaginal delivery, planned Caesarean section is safer for both the mother and the baby, despite the fact that the number of complicated cases would have been higher in women who had undergone planned Caesarean section. Not informing the pregnant women contemplating delivery regarding these ‘facts’ are morally and ethically wrong, and legally negligent act. Do we have to wait for evidence showing that planned Caesarean section is ‘safer’ for the Obstetricians, Neonatologists, Neonatal Nurses, Anaesthetists, Midwives, Healthcare Managers or Politicians? Shouldn’t we better invest time and money in making planned Caesarean section more safe and cost-effective rather than wasting enormous time and resources to impose ‘vaginal delivery’ on pregnant women without their ‘informed consent’?

New research finds lowest maternal mortality rate with elective cesarean delivery

 BMJ 2007; 335 doi: http://dx.doi.org/10.1136/bmj.39363.706956.55 (Published 15 November 2007)Cite this as: BMJ 2007;335:1025

Further to Consultant Obstetrician Mike Wyldes’ comments on his investigation into the CEMACH dataset [‘Elective Caesarean section safest form of childbirth’, above]:-

In April 2008, the UK’s Birth Trauma Association also analyzed data taken from the latest CEMACH report, and found that planned cesarean delivery had the lowest maternal mortality rate compared with all other births: “of the 2,113,831 women who delivered a baby after 24 weeks gestation between 2003 and 2005, one in 10 had a aesarean before labour had begun. Seven women died, giving a mortality rate of 0.31 per 10,000. This compared to 74 deaths amongst the remaining women who had a natural birth or an emergency caesarean section, giving a mortality rate of 0.39 per 10,000.”(1)

Certainly, planned cesarean delivery results in greater abdominal morbidity than PVD, but on the other hand, PVD results in greater pelvic floor trauma than planned cesarean delivery (see this week’s news report on the U.S. ‘Fourth International Consultation On Incontinence (ICI)’ for example(2) and my comment on the cesarean benefit of protection against fecal incontinence(3)).

Women should be honestly informed of each set of birth risks and benefits, supported during their decision-making process and have their final choice respected – whether it’s vaginal or cesarean delivery.

Finally on this issue, a 2003 HealthGrades Quality Study(4) in the U.S. “identified an association with higher vaginal complication rates in those hospitals that did fewer than expected preplanned cesarean sections” and likewise, lower vaginal complication rates in hospitals with more preplanned cesareans than expected. The report said that this finding was “suggestive of, but not definitive of, inappropriate under-utilization of preplanned first time C-sections in those hospitals”, and that further studies are needed.

References:

(1)http://www.telegraph.co.uk/news/uknews/1584671/Women-choosing-
caesarean-have-low-death-rate.html

(2)http://www.medicalnewstoday.com/articles/116063.php

(3)http://www.medicalnewstoday.com/youropinions.php?associatednewsid=116063

(4)http://www.healthgrades.com/media/english/pdf/Patient_Choice_Csection_St…

 

Reference

 

[/expand]

 

D

 

[expand title=”Digoxin“]

Digoxin use linked to increased risk of Death

[/expand]

[expand title=”Digoxin use linked to increased risk of Death“]

♥ Research results published in the European Heart Journal in 2012.

♥ Study population – 4,060 patients on digoxin treatment for atrial fibrillation (AF), an abnormal heart rhythm.

♥ For every six patients on digoxin for five years, one would die who may not have otherwise died.

♥ It does not necessarily mean that the drug itself is responsible.

♥ It does not necessarily mean that digoxin should no longer be used.

♥ This evidence should be used to guide clinical judgment while weighing the benefits and risks of using digoxin in a particular patient.

To read more

http://themedideas.com/career/examination/medical-exams/postgraduate/others-pg-med-exams/other-exams/cardiology-alert-digoxin-use-linked-to-increased-risk-of-death/

[/expand]

 

 

E

 

[expand title=”Endometriosis“]

* Endometriosis is a disease where the cells from the endometrium (lining of the womb/uterus) grow in the pelvis outside the womb (or in the womb muscle when it is called adenomyosis).

* Primarily, it is  not a disease of the womb/uterus. It affects the organs and tissues outside the womb.

* The commonest site or organ affected is the ovary.

* The incidence of endometriosis in the general female population is 1-2%.

* Its usual symptoms include pain just before and during periods (progressive dysmenorrhoea), painful sexual intercourse (dyspareunia) and pelvic pain, childlessness (infertility) etc (Triad of endometriosis). Other symptoms include heavy periods (10%), lower abdominal pain during passing urine, blood in urine, pain and/or bleeding during opening bowel, pain in and bleeding from surgical scar etc.

* The correlation between the severity of pain and extent of the disease is poor.

* It is found in 15-25% (1 in 4-7) of the infertile women.

* On the other hand, the incidence of infertility in women with endometriosis is 20-65% (2 in 3-10).

* The cause of endometriosis is unknown. There is a familial tendency (more maternal link) suggesting some genetic predisposition.

* Several theories, including implantation of cells from the lining of the womb following retrograde menstruation, have been put forward. In retrograde menstruation the menstrual blood flows backwards through the fallopian tubes into the pelvis.

* Given the fact that retrograde menstruation occurs in the majority (90%, 1 in 9) of women and endometriosis does not develop in all of them suggests strongly towards genetic/immunological predisposition in those who develop it.

* The risk of malignant (cancerous) change in endometriosis is small.

* The diagnosis is usually suspected from the history and examination but confirmed by laparoscopy (the Gold Standard). Ultrasonography cannot exclude endometriosis. Its only usefulness is to detect ovarian endometriotic cyst (endometrioma or chocolate cyst) and adenomyosis or adenomyoma (endometriosis in the womb muscle), but it cannot detect small endometriotic deposits in the pelvis. Blood test such as Serum Ca125 is not useful in making a diagnosis, as it could rise in several other conditions. Its only possible use would be to monitor for recurrence following treatment.

* Endometriosis is usually a progressive disease, and if not treated it would spread to other tissues and organs thereby damaging them. In advanced endometriosis adequate relief from symptoms would be very difficult to achieve due to the extensive damage to the tissues and organs.

* It usually regresses after menopause as it is estrogen (female hormone) dependent.

* The treatment of endometriosis depends on the stage of the disease, symptoms, whether the woman wishes to have more babies, her age, previous treatment etc.

* Its treatment includes Surgical (such as laparoscopic surgery or open surgery) and Medical (such as GnRh analogue, Danazol etc).

FAQs

Q. How endometriosis causes damage to tissues and organs?

* During periods the endometrotic tissues (anywhere) bleed as the lining of the womb does. The bleeding behaves like a foreign body in the areas affected and causes local inflammation which the body’s defence mechanism tries to control and heal (natural process). With the process repeating every periods scar tissue forms. Eventually the disease extends and greater number of organs (such as ovaries, tubes, bowel, bladder etc) and area of tissues get involved in the scar tissue (adhesions) that might cause persistent pain.

Q. Why endometriosis causes pain just before and during periods?

* It causes pain in the areas affected due to local inflammation. Therefore the pain is relieved by anti-inflammatory drugs (such as Ibuprofen, Mefenamic acid, Diclofenac etc).

Q. Why endometriosis causes pain during sexual intercourse?

* Due to the areas in the pelvis affected, mainly the area behind the womb.

Q. Why endometriosis causes pain outside the period as well?

* When the disease extends to a greater number of organs (such as ovaries, tubes, bowel, bladder etc) and area of tissues that get involved in the scar tissue (adhesions) it might cause persistent pain outside the period as well.

Q. Why endometriosis causes infertility?

* It might cause infertility due to the release of toxic chemicals that kill the sperm, egg or embryo, or change the motility of the hair-like structures (cilia) inside the Fallopian tubes; or damage to the ovaries (direct or due to adhesions) or tubes (due to adhesions); or painful sexual intercourse (dyspareunia).

Q. Could Hormone Replacement Therapy (HRT) be used in women with endometriosis?

* It is a debatable issue as endometriosis is estrogen (female hormone) dependent. There are HRTs that do not contain estrogen such as Tibolone. The issue should be discussed with a Gynaecologist before deciding to take HRT.

[/expand]

 

 

H

 

[expand title=”HIV“]

HIV transmision through mosquito bites

[/expand]

[expand title=”HIV transmision through mosquito bites“]

*Human immunodeficiency virus, or HIV, is a human retrovirus that infects lymphocytes and other cells bearing the CD4 surface marker.1

*The virus is transmitted primarily by sexual and parental routes.1

*Could HIV be transmitted through mosquito bites?

*Surveys to determine knowledge regarding HIV have shown in many countries, including Papua New Guinea, that a large proportion of the literate population still believe that mosquitoes can transmit the HIV virus from one person to another. Since AIDS was first recognized, many have reported on the possibility of mosquito involvement in the transmission of the virus. In 1988, almost half of 6625 men and women interviewed in Zaire and nearly half of 4189 teacher-trainees interviewed in Zimbabwe believed in the transmission of HIV by mosquitoes. A survey involving 1500 high school students from 14 schools in 4 different provinces in Papua New Guinea revealed that 34% of them considered mosquitoes to be carriers of HIV.2

*There are two ways blood feeding arthropods can spread disease, mechanically, by simple transfer of virus between hosts by contaminated mouth parts, or, biologically that would require virus replication in arthropod tissues (especially salivary glands).1

* Studies with HIV have shown clearly that the virus disappears in the mosquito after about 1-2 days, the time required for the mosquito to digest the blood-meal. Since the virus does not survive to reproduce and invade the salivary glands, biological transmission of HIV is not possible.2 The evidence that indicates that HIV is not transmitted by mosquito bite include: i> HIV virus can not replicate inside the mosquito, bed bug, flea, or other blood sucking insect and the lack of replication of HIV in arthropod cells due to lack of T4 antigen on cell surface, and ii> it is unlikely that HIV is transmitted by insects, given the low infectivity of HIV and the short survival of the virus in the mosquito. HIV appears to be much less easily transmitted probably due to lower titers of virus in body fluids. So, on the basis of experimental evidence and probability estimates, it has been concluded that the likelihood of mechanical or biological transmission of HIV by insects is virtually nonexistent.1

* It has been calculated that, for mechanical transmission, an HIV-free individual would have to be bitten by 10 million mosquitoes that had been feeding on an HIV carrier to receive a single unit of HIV from contaminated mosquito mouthparts. In short, there is still no evidence of arthropod transmission of the HIV virus.2

* Although mosquitoes are carriers of malaria, filaria, yellow fever, dengue, chikungunya and Japanese encephalitis, there is no evidence that mosquitoes can transmit HIV.

1. Iqbal MM. Can we get AIDS from mosquito bites? J La State Med Soc. 1999 Aug;151(8):429-33.

2. Bockarie MJ, Paru R. Can mosquitoes transmit AIDS? P N G Med J. 1996 Sep;39(3):205-7.

[/expand]

 

 

I

 

[expand title=”Infertility“]

Concerns about IVF (Test tube baby) and ICSI

Endometriosis and Infertility

Female Fertility and Ageing

Infertility Counselling

Infertility gene

Infertility is a growing problem

Introduction to Infertility

I-Y in InfertilitY (more than 80 Key points you must know)

 

Pelvic Infection and Infertility

Pregnancy and its Mechanism

The Natural Conception

The scale of fertility problems

Tubal factor Infertility

[/expand]

[expand title=”Concerns about IVF (Test tube baby) and ICSI“]

IVF pregnancies at an increased risk of perinatal mortality and other adverse perinatal outcomes.

*Since the advent of IVF over 30 years’ ago, its use is widespread in the management of infertility. While its place as the last resort is well accepted, concerns about the higher adverse outcome of pregnancies resulting from IVF have been expressed since as early as 1985.

*IVF is expensive and more invasive with higher risks compared to other treatment of infertility. It is associated with higher risks of ovarian hyperstimulation syndrome (could be serious leading to ITU admission/death), multiple pregnancy (with all of its serious complications for the babies and mothers), pelvic infection, bleeding from pelvic blood vessels due to injury during egg collection (death from this problem has occurred) etc.

*The first indication that IVF singleton pregnancies may also have a poorer outcome appeared in 1985

*IVF pregnancies in general have higher rates of adverse maternal outcomes compared with spontaneously conceived pregnancies

Caesarean section delivery

Pregnancy-induced hypertension (high blood pressure in pregnancy)

Pre-eclampsia (high blood pressure and protein in the urine in pregnancy)

Gestational diabetes (diabetes in pregnancy)

*IVF pregnancies in general have higher rates of adverse perinatal (around the time of delivery) outcomes compared with spontaneously conceived pregnancies

Preterm delivery (delivery before 37 weeks)

Low birth weight (<2500 g) babies

Admission to neonatal intensive care unit

[Some of the excess risk of adverse perinatal outcomes in IVF pregnancies is due to multiple pregnancies, but the singleton babies are at higher risk as well]

*Yq deletions (problems in the long arm of the Y chromosome) cause male infertility. This defective gene could be passed to the male offspring through ICSI. As a result the male offspring will be infertile and would require ICSI to have a child. Similarly, cystic fibrosis (a serious autosomal recessive genetic disease) mutations could be passed to the offspring from the affected infertile father through ICSI.

Excerpts from the book “Infertility – A Growing Problem  The Facts and Solutions”, Dr Sudipta Paul, Dey Publications, Kolkata, India.

[/expand]

[expand title=”Endometriosis and Infertility“]

* Endometriosis is found in 15-25% (1 in 4-7) of the infertile women.

* On the other hand, the incidence of infertility in women with endometriosis is 20-65% (2 in 3-10).

* Its usual symptoms include pain just before and during periods (progressive dysmenorrhoea), painful sexual intercourse (dyspareunia) and pelvic pain, infertility etc (Triad of endometriosis).

*  Endometriosis might cause infertility due to the release of toxic chemicals that kill the sperm, egg or embryo, or change the motility of the hair-like structures (cilia) inside the Fallopian tubes; or damage to the ovaries (direct or due to adhesions) or tubes (due to adhesions); or painful sexual intercourse (dyspareunia).

* The diagnosis is usually suspected from the history and examination but confirmed by laparoscopy (the Gold Standard). Ultrasonography cannot exclude endometriosis. Its only usefulness is to detect ovarian endometriotic cyst (endometrioma or chocolate cyst) and adenomyosis or adenomyoma (endometriosis in the womb muscle), but it cannot detect small endometriotic deposits in the pelvis. Blood test such as Serum Ca125 is not useful in making a diagnosis, as it could rise in several other conditions. Its only possible use would be to monitor for recurrence following treatment.

* The treatment of infertility associated with endometriosis includes:

1. Laparoscopic surgery

+++ This is the best option. The cumulative success rate is 23-81% depending on the severity of endometriosis, female partner’s age and presence of other factors. It requires a Gynaecologist skilled in doing laparoscopic surgery for endometriosis (needs operative skills far greater than doing a diagnostic laparoscopy that is commonly performed to have a look) and proper operation theatre facilities, and is relatively expensive.

2. Medical treatment

xxx Medical treatment does not have any significant role in improving fertility as it causes anovulation during the treatment period. It is useful for treating pelvic pain that is associated with endometriosis, but not for treating infertility.

3. Stimulated Intrauterine Insemination (IUI with ovulation induction)

+ The success rate is about 12-23% depending on the female partner’s age, presence of other factors etc. How IUI improves pregnancy rate in women with endometriosis is not clear.

4. IVF (Test Tube Baby)

++ The success rate is lower in the presence of endometrioma (ovarian cyst). The success rate improves if the endometrioma is removed (preferably laparoscopically) before IVF.

[/expand]

[expand title=” Female Fertility and Ageing“]

* Natural conception rate in the female declines substantially from the age of 30 years and the decline is more marked after 34. Similar declining trends are seen in the success rates of all the treatment for infertility including In-vitro Fertilisation (IVF / Test tube baby) and donor insemination (DI) treatment in relation to advanced female age.

*The possible reasons for the decline in female fertility with advanced age include primarily an ageing egg (oocyte) that might be associated with mitochondrial dysfunction and an older womb (uterus).

 

Decline in fem fer 

* With advanced age the women are also more likely to suffer from the effects of other diseases such as endometriosis, pelvic infection etc that are associated with infertility. The risks of chromosomal abnormalities (such as Down’s syndrome and others) in the baby and miscarriage also increase with advanced female age.

* Women over 35 years of age have increased risks of early and late pregnancy and neonatal (newborn related) complications. The risks include miscarriage, ectopic pregnancy (pregnancy outside the womb cavity), stillbirths, multiple pregnancy (with its higher risks), diabetes in pregnancy, placenta praevia and placental abruption (causes of serious bleeding in pregnancy), high blood pressure in pregnancy, Caesarean section etc that lead to higher risks to the mother and baby.

* In the general population, the risk of miscarriage in women <35 years is about 15% (1 in 7) that increases to about 24% (1 in 4, 60% increase) at 35-39 years of age and then doubles to 51% (1 in 2) at 40-44 years of age (240% increase compared with <35 years).

* The optimal age for childbearing, for the health of the mother and baby, is between 20-35 years (preferably 20-30 years). The women who feel that having a child is important for their lifetime fulfilment should plan to complete childbearing by the age of 35. This is the best biological advice. In fact, biologically, the only aim of life of all living beings is to pass the genes to the next generation.

* The life-time chances of remaining childless increases with advanced female age. The later in life the woman starts to try for pregnancy the chances of remaining childless increases proportionately.

 

Lifetime Childlessness

The risk of being childless doubles if the woman

starts to try for pregnancy after the age of 34

(30% after 34 compared with 15% between 30-34)

 * It doubles again if the woman starts to try for pregnancy after the age of 39 (60% after 39 compared with 30% between 35-39).

* The rates of increase in remaining childless remain similar up to 30-34 years, but increase sharply after 34 years. Women should consider this fact if they plan to delay childbearing.

* These rates of remaining childless reflect the rates of natural conception without any treatment. The rates would be lower if appropriate treatment for infertility is undertaken earlier.

* In practice, it is unfortunate that the majority of infertile couples delay consulting an Infertility Specialist because of variety of reasons such as lack of awareness regarding infertility and its treatment, and that female fertility declines with advanced age; denial that they might have some problems, reluctance, fear of repercussions amongst the family, friends and in the society; religious beliefs, sometimes due to inappropriate advice and false reassurance received from variety of people including some health professionals etc.

* It would be wise, useful and cost-effective to consult an Infertility Specialist at the appropriate time to have a proper assessment of the couple’s condition.

* With advanced female age and consequent reduction in the success rates of treatment, proportionately greater number of treatment cycles would be required to achieve a pregnancy with proportionately higher costs.

Delaying treatment for few years beyond 35 years of age

almost halves the chance of success

 * Therefore it would be prudent to commence investigations and treatment of women with infertility close to 30 years or earlier, if possible, rather than 35 years and beyond as the natural conception rates and success rates of any treatment including ovulation induction, tubal surgery, IUI/DI, IVF would be substantially lower as they approach 35 years and beyond.

* If the couples are seen by an Infertility Specialist around 30 years or earlier, investigated and/or receive initial treatment for another year or so, majority of them could still have IVF etc, if required, before they cross 35 years when the success rates of those treatment would still be very good. As the success rates of treatment would be greater compared with women around 40 years, it would be relatively cheaper (higher success rate per cycle of treatment means less expenditure per live baby born).

* To achieve this objective it is important to try to increase the awareness in the general population (particularly young generation) regarding the problem of infertility and its direct correlation with advanced female age.

* There is no treatment, including IVF, with 100% success.

 

 “The Doctor is neither God

nor a Magician

                                                                                                                                                                                                   Dr Sudipta Paul

[/expand]

[expand title=” Infertility Counselling“]

☺Counselling should be offered to every couple

The Warnock Report (1984, UK) recognised the need for counselling

The requirement for infertility counselling has been clearly stated in the Human Fertilization and Embryology Act Code of Practice (1991), UK.

Counselling should consist of three distinct types e.g.

●Implications counselling (about possible diagnoses and outcome)

●Support counselling (about support in relation to the management)

●Therapeutic counselling (about treatment options, their success rates, side effects, complications and costs)

☺Any unit offering treatment for infertility should have the appropriate personnel for these types of counselling

☺The Third Voluntary Authority Annual Report (1986, UK) stated that: “Proper counselling is possible only if space and time are available to the couple in a neutral atmosphere with a fully trained counsellor, possibly a member of the team who is not the prescribing doctor.”

☺The responses of the couple suffering from fertility problems are similar to reactions to bereavement and loss, described by Kubler-Ross as to follow five stages (DABDA). These include

Denial and isolation (withdrawal from family, friends and husband/partner; request for second opinion)

Anger (‘why me?’ hostility to husband/partner and/or doctor)

Bargaining (to enquire whether she could conceive)

Depression (realisation of the fact)

Acceptance (opts for treatment or not to try)

[/expand]

[expand title=”Infertility gene“]

A new gene whose absence/defect might cause Infertility has been identified by researchers from the University of Edinburgh, UK. The results have been published in the Journal of Cell Science. The gene SRPK linked to chromosome clustering that is important for the eggs (oocytes) to remain fertile was identified. This research was undertaken on hundreds of infertile Drosophila (fruit flies) oocytes. The process of chromosome clustering is shared by Drosophila and humans. Therefore this finding might be important for Infertility in Humans.

[/expand]

[expand title=”Infertility is a growing problem“]

* The prevalence of infertility is likely to increase due the increase in the number of women i> delaying childbearing, ii> with obesity and iii> getting pelvic infection

* Greater number of women is delaying childbearing due to social reasons. With increasing female education and career opportunities, and change in the mind-set of the society, more and more women are delaying childbearing.

* The other contributory factor that might increase the prevalence of infertility would be increasing obesity due to improvement in the socio-economic conditions. In developed countries obesity has already become a serious health issue. With the fast economic growth, it has been increasing rapidly in the developing countries as well (the clock of the time-bomb is ticking).

* Increase in the prevalence of pelvic infection due to change in the sexual behaviour of the population might also contribute to the increased prevalence of infertility.

[/expand]

[expand title=”Introduction to Infertility“]

* Infertility is not merely a problem of inability to have a baby.

* It has significant psychological, marital, social and financial implications to the couple.

* In societies, where people (both men and women) crave to have a son, the impact of not being able to have a baby at all is disastrous, particularly to the woman.

* The negative impact on the male partner, however, should not be ignored.

* Infertility is defined as failure to conceive after regular unprotected sexual intercourse for 2 years in the absence of known reproductive pathology (National Institute of Clinical Excellence, UK, 2004).

* As infertility denotes no fertility, some people prefer the term sub-fertility that means reduced fertility. Sterility means absolute absence of fertility.

*In the female, primary infertility means that the woman has never been pregnant and secondary infertility means that the woman has had pregnancy before but been unable to conceive since then.

*In the male, primary infertility means that the man has never made any woman pregnant and secondary infertility means that the man has had made a woman pregnant before but been unable to do that since then.

[/expand]

[expand title=”I-Y in InfertilitY (more than 80 Key points you must know)“]

I-Y in InfertilitY (more than 80 Key points you must know)

 

[/expand]

[expand title=”Pelvic Infection and Infertility“]

* The incidence of pelvic infection in the general female population is about 10-15%.

* It most commonly occurs in the younger age groups (15-24 years).

* The risk factors for pelvic infection include young age at first sexual intercourse, a high frequency of sexual intercourse, multiple sexual partners, not using condom or spermicide, abortion (termination of pregnancy, both medical and surgical), miscarriage, insertion of coil (IUCD), intra-uterine instrumentation (e.g. D&C), appendicitis, tubal/pelvic surgery etc.

* The likelihood of tubal factor infertility depends on the severity and number of episodes of pelvic infection.

* The possibility of tubal factor infertility after one episode of mild pelvic infection is about 0.6% (1 in 167) but following an episode of severe disease that rises to about 21.4% (1 in 4.67, 3467% increase).

* The overall possibility of tubal factor infertility after one episode of pelvic infection is about 8%, that rises to about 19.5% after two episodes (144% increase) and to as high as about 40% after three episodes (105% increase compared with two episodes and 400% increase compared with one episode).

FAQs

Q. What are the symptoms of pelvic infection?

* The usual symptoms of acute pelvic infection include vaginal discharge, pelvic or lower abdominal pain, fever etc. In chronic pelvic infection persistent pelvic or lower abdominal pain, persistent or recurrent vaginal discharge, painful sex, heavy periods, painful periods etc might be present. Vaginal spotting in between periods (intermenstrual bleeding) is a feature of pelvic infection due to Chlamydia trachomatis.

Q. How is the diagnosis of pelvic infection made?

* It is usually suspected from the symptoms and examination findings. Genital swabs could confirm the nature of infection (such as bacterial, protozoal or fungal). Laparoscopy is diagnostic. Ultrasonography is helpful in excluding other problems, but cannot diagnose pelvic infection.

Q. How the incidence of tubal factor infertility due to pelvic infection could be reduced?

* The incidence of tubal factor infertility could be reduced by changes in behaviour, taking appropriate precautionary measures and use of appropriate antibiotics when indicated.

* Simple measures like using condom and prompt treatment of pelvic infection would have a significant impact in reducing the incidence of tubal damage and pelvic adhesions, and consequent infertility and pelvic pain. Women should be particularly careful while having abortion, and should ensure that it is done in an appropriate environment.

Q. Are there any other risks associated with pelvic infection?

* The risk of pregnancy in the Fallopian tube (ectopic pregnancy, a potentially life-threatening condition due to rupture of the tube and bleeding inside abdomen) also increases to 9.1% following pelvic infection (a 6.5-fold increase).

* Pelvic infection may result in chronic pelvic pain due to adhesions that increases the risk of having a hysterectomy (removal of the womb) by 10-fold.

[/expand]

[expand title=”Pregnancy and its Mechanism“]

To become pregnant naturally the following must happen

(The Five Pillars of Natural Conception, Paul S 2009)

1. The woman must ovulate (release an egg)

The egg (ovum) develops in the ovary and is subsequently released at ovulation. This function is controlled by several hormones released by the brain including GnRh (Gonadotrophin Releasing Hormone) from the hypothalamus, and FSH (Follicle Stimulating Hormone) and LH (Luteinising Hormone) from the pituitary gland, and ovary (estrogen and progesterone). Ovulation (release of the egg) is also controlled by other local factors including chemicals in the ovary. There are two ovaries, and in a healthy female of reproductive age*, ovulation usually occurs from one of them in each menstrual cycle. The notion that ovulation occurs alternately from each ovary in consecutive months may not be correct.

*Reproductive age – It starts around the time of first menstrual period (Menarche) and finishes with the complete stoppage of menstrual periods (Menopause). The usual range of reproductive age is 12-50 years (variable). The first few years after the menarche and last few years preceding the menopause (peri-menopause) are not that useful in relation to reproduction because of lack of regular ovulation. Therefore, for practical purposes, 15-45 years of age is generally considered as reproductive age in the female.

2. The Fallopian tube(s) (reproductive channels) must be functional

The egg, once released from the ovary, enters the Fallopian tube and meets the sperm there. Following fertilisation in the Fallopian tube the fertilised egg enters the uterus (womb) after 3-4 days where it implants and grows in to the baby. The Fallopian tubes are not mere channels for the passage of the sperm and egg, these have important functional roles in collecting the egg from the ovary, and transport of the egg and fertilised egg. Hair-like structures (cilia) in the endosalpinx (lining of the Fallopian tubes) play important role in the transport of the egg and fertilised egg. Damage to the Fallopian tube(s) is associated with infertility and would increase the risk of ectopic pregnancy in the tube. For natural conception to occur at least one Fallopian tube must be open and functional. One cannot drive a car along the road unless the road is open and drive-worthy!

3. The uterus and endometrium (lining of the womb) must be receptive and capable of carrying a pregnancy

Abnormalities of the uterus and its lining may affect implantation of the fertilised egg leading to failure of implantation or miscarriage at a later stage. Ageing of the female and some diseases might affect normal functioningof the uterus and its lining.

4. The man must produce good quality sperm in adequate numbers

Only one healthy (normal with good progressive motility) sperm is required to fertilise an egg, however, millions of healthy sperm are initially required to complete the process of fertilisation. The process of the sperm reaching the egg in the Fallopian tube, from the front passage through the neck of the womb and womb is an enormously difficult task for the sperm. Majority of the sperm die/fail to reach the egg during the process. Only few healthy sperm reach the egg and one of them fertilises it. Thereby, Nature ensures that only the best quality sperm (vigorous enough to reach the egg) would fertilise the egg.

5. Regular unprotected sexual intercourse without any sexual dysfunction

Unprotected sexual intercourse should take place regularly without any sexual dysfunction (at least 2-3 times/week, preferably without a gap of more than 1 day in between) to deposit sperm high in the front passage around the time of ovulation (usually occurs between 12-16 days of a 28 days menstrual cycle). The egg lives for about 24 hours while the sperm survives for about 3 days (up to 7 days has been reported) inside the female genital tract. Therefore, sexual intercourse, at least 2-3 times/week, usually provides some living sperm inside the female genital tract for most of the time. This significantly improves the chance of a pregnancy happening. With regular intercourse, 94% and 77% of fertile women aged 35 years and 38 years respectively conceive within three years of trying.

[/expand]

[expand title=”The Natural Conception“]

*Of 100 couples trying to conceive naturally

► 20 would conceive within 1 month

► 70 would conceive within 6 months

► 85 would conceive within 12 months

► 90 would conceive within 18 months

► 95 would conceive within two years

*Five couples out of 100 would fail to conceive naturally after trying for 2 years

*Therefore, 2 years has been considered as the cut-off period for infertility as the majority (95%) of couples would have conceived naturally by then. The rest 5% of couples might have some problems conceiving naturally and it would be reasonable to investigate whether there is any reproductive pathology and start treatment if necessary.

*The rate of natural conception is about 20% in the first month since the couple commenced to try for pregnancy. The chance of becoming pregnant is about 62.5% over the next 5 months (between 2nd-6th months) and remains around 50% over the next 6 months (between 7th-12th months), and around 67% over the next 12 months (between 13th-24th months).

*The highest rate of natural conception (20%, 1 in 5) is found in the first month since the couple commenced to try for pregnancy.

*The rate falls to about 12% (1 in 8, approximately) per month between 2nd-6th months, about 8% (1 in 12, approximately) per month between 7th-12th months and about 6% (1 in 17, approximately) per month between 13th-24th months.

*The monthly rate of natural conception is useful for the individual woman to find out about her chances of becoming pregnant each month depending on how long she has tried before.

*Empirical treatment, in the absence of a diagnosis of reproductive pathology, would not be appropriate or beneficial unless its monthly/per cycle success rate is higher than the woman’s monthly natural conception rate.

*This rate is an average and should be interpreted against the age-related chance of conceiving. Although the changes in the rates for different duration since the couple commenced to try for pregnancy remain similar for different age groups, the actual number of couples achieving pregnancy would be proportionately smaller with advanced female age. Therefore, a 39 year-old woman would have a significantly lower monthly rate of natural conception compared to a 23 year-old.

[/expand]

[expand title=”The scale of fertility problems“]

* One in seven couples (15%) has fertility problems.

* Approximately 40 million or 4 crore people in India could be affected by infertility.

*Male factors are responsible in 30%, female factors in 40%, and the rest 30% are associated with combined male and female factors and unexplained infertility

* An improved public awareness and understanding of the issues in relation to infertility could possibly help dealing with the problem better.

* It would be useful if preventive steps to reduce the incidence of infertility could be adopted.

* A timely consultation with an Infertility Specialist would reduce the delay in receiving appropriate treatment, provide the right treatment and make the process of treatment better.

[/expand]

[expand title=”Tubal factor Infertility“] 

* Tubal factor is present in about 14% (1 in 7) of infertility.

* One or both Fallopian tube(s) is(are) blocked or damaged (due to pelvic infection) or distorted (due to adhesions) or absent.

* The commonest cause of tubal block or adhesions is pelvic infection, which is associated with multiple sexual partners, not using condom, termination of pregnancy (abortion), miscarriage, appendicitis etc. The commonest cause of pelvic infection is Chlamydia trachomatis (was Gonococcus in the past).

*In practice, there are generally two tests to check tubal patency (whether the tubes are open), laparoscopy & dye test and hysterosalpingogram or HSG (X-ray of the womb and the tubes).

* Laparoscopy & dye test is performed when the risk of tubal/pelvic diseases is high such as positive Chlamydia trachomatis IgG antibody; history of pelvic infection, pelvic adhesions, abdominal/pelvic surgery, endometriosis, painful sexual intercourse, significantly painful periods, tubal (ectopic) pregnancy etc.

* Laparoscopy & dye test is superior to HSG as a test for tubal patency and detection of pelvic diseases.

* Other procedures to check tubal patency include Hysterosalpingo-Contrast-Sonography(HyCoSy), Fertiloscopy, Falloposcopy etc.

*The treatment of tubal factor infertility includes:

1. Tubal surgery

Cumulative success rate is about 40% (12-67%) in 3 years depending on the severity of the tubal damage, female partner’s age, duration of infertility and presence of other factors.

2. IVF

Success rate is about 24% (10-27%) per cycle depending on the female partner’s age and presence of other factors.

Tub Surg vs IVF

[/expand]

 

 

M

 

[expand title=”Microsurgery“]

Advantages of Microsurgery

[/expand]

[expand title=”Advantages of Microsurgery“]

* Cosmetic (no big scars).

* Minimal operative bleeding.

* Less chance of blood transfusion and its associated complications.

* Minimal trauma to the tissues during surgery.

* Lower risk of adhesions and pain abdomen after surgery.

* Shorter hospital stay saving bed-charges and reducing serious hospital acquired resistant infections.

* Less chance of thrombo-embolism (clots in the leg veins and lungs that might kill the patient).

* Shorter post-operative recovery period and the need to take time-off from work.

* Early return to normal life.

* Less chance of wound problems and hernia.

[/expand]

 

 

O

 

[expand title=”Ovarian Cysts & Tumours“]

Dermoid Cyst

[/expand]

[expand title=” Dermoid Cyst“] 

Dermoid Cyst (Benign germ cell ovarian cyst)

* Occurs due to differentiation (change) of totipotent (that could form any tissue) germ cells into embryonic tissues.

* Most common in young women with a median age at presentation of 30 years.

* Commonest neoplastic ovarian cyst during pregnancy (90% of cysts in pregnancy is corpus luteal cyst that is not neoplastic).

* Bilateral in about 11%.

* Contents – Yellowish or brownish-grey greasy sebaceous material, hair, teeth and nervous tissue (ectodermal); thyroid (5-20%), intestinal and bronchial tissues (endodermal); osseus tissue and smooth muscle (mesodermal).

* Symptoms – Asymptomatic (60%, majority), abdominal swelling, pain, dyspareunia (painful sex), backache, urinary symptoms etc.

* Diagnosis is usually suggested by ultrasound.

* Complications – Torsion (3.5-10%), rupture (1-4%; hair coming with urine if rupture occurs into the bladder), chemical peritonitis and chronic granulomatous peritonitis (in case of rupture – spontaneous or during surgery), infection, impaction in the pelvis causing obstructed labour in pregnancy, malignant (cancerous) change etc. Rupture is more common during pregnancy due to pressure from the enlarging uterus or trauma during delivery.

* Malignant (cancerous) change in 1-2%.

* Treatment – Removal of the cyst by open surgery. The place of laparoscopy is debatable as it would be difficult to remove the cyst intact, but it is not absolutely contraindicated. There is no medicine to treat it.

[/expand]

 

 

 

[expand title=”Pregnancy“]

General Pre-pregnancy Advice

[/expand]

 

[expand title=”General Pre-pregnancy Advice“]

Body weight

Caffeinated beverages

Cervical cancer screening

Complementary therapy

Diet

Drinking alcohol

Exercise

Folic acid supplementation

Natural conception

Occupation

Optimum frequency and timing of sexual intercourse

Prescribed, over-the-counter and recreational drug use

Smoking

Stress and counselling

Susceptibility to Chicken pox

Susceptibility to Rubella (German measles)

Tight underwear for men

[/expand]

[expand title=”Body weight“]

Women with a body mass index (BMI) of more than 29 are likely to take longer to become pregnant. Women with a BMI of more than 29 and not ovulating are likely to increase their chances of becoming pregnant if they lose weight. If they participate in a group programme involving exercise and dietary advice that would lead to more pregnancies than weight loss advice alone. High BMI/obesity has been increasing substantially as a contributor to infertility and it is also associated with increased risk of miscarriage. Women, in defence of their own obesity, often give examples of other obese women having babies. The fact is that obese women could have babies but the chance of that is significantly reduced compared to women with normal BMI. The chance of a pregnancy happening, naturally or following treatment for infertility, does significantly increase if they lose weight. The risks of miscarriage and complications of obesity in pregnancy, on the other hand, are significantly reduced as well. Men with a BMI of more than 29 are likely to have reduced fertility. Women with a BMI of less than 19 and irregular or absent menstrual periods are likely to improve their chances of becoming pregnant if they increase their weight. (NICE 2004)

[/expand]

[expand title=”Caffeinated beverages“]

There is not enough evidence of an association between drinking of caffeinated beverages (tea, coffee and colas) and fertility problems.(NICE 2004)

[/expand]

[expand title=”Cervical cancer screening“]

To avoid delay in getting pregnant/fertility treatment the woman should be up-to-date with cervical (Pap) smears. Cervical smears are done to screen for abnormal cells in the cervix (neck of the womb) that could be found several years before the development of cervical cancer. Cervical cancer is the commonest female genital cancer in India and is a major cause of death as 80% (8 in 10) present late when it is incurable. India contributes to 20% (1 in 5) cases of cervical cancer worldwide. Of all cancers in the Indian female, breast cancer has recently superseded cervical cancer and become number one.

In developed countries, population based cytology (Pap smear) screening that started in the 1940s has been shown to be effective in reducing the incidence and death from cervical cancer. It is regrettable that the screening programme is not yet developed in India after 70 years since its availability.

All sexually active women should have Pap smear at regular intervals. A useful guide is to get Pap smear done routinely between 25-64 years, at least at 3 yearly intervals between 25-49 years and at least at 5 yearly intervals between 50-64 years. Women above 64 years should have Pap smear if they have never had any or if they have had abnormal smear before.

[/expand]

[expand title=”Complementary therapy“]

The effectiveness of complementary (non-Allopathic) therapies for fertility problems has not been properly evaluated. Therefore, further research is required before such interventions can be recommended. (NICE 2004)

[/expand]

[expand title=” Diet“]

The general advice for healthy eating includes: i> eating a well balanced diet, ii> low in salt, sugar and saturated fats, iii> high in fibres, fresh vegetables and fruits, iv> with more white meat (chicken), fish and pulses than red meat (goat, lamb) and v> dairy products (egg) in moderation. If a woman has been eating a well balanced diet, there is no need for vitamin and mineral supplements, unless she is a vegan.

Women should avoid taking vitamin A and D when they are trying for pregnancy and in the first three months of pregnancy as these might have adverse effects on the baby in early pregnancy. If any woman wants to take multivitamins (or “Health” drinks) she should make sure that these do not contain vitamin A and D. In cases of confirmed vitamin A and/or D deficiency consult a Specialist. (NICE 2004)

[/expand]

[expand title=”Drinking alcohol“]

Drinking more than 1-2 units of alcohol once or twice per week (1-4 units per week) and episodes of intoxication (binge drinking) increases the risk of causing harm to a developing baby.Alcohol consumption of 3-4 units per day (21-28 units per week) for men is unlikely to affect their fertility, although excessive alcohol intake is detrimental to semen quality. (NICE 2004)

[/expand]

[expand title=”Exercise“]

Regular exercise is an integral part of healthy living. Swimming and walking (for at least 30 minutes per day) are excellent, but if the woman is not used to exercise, she should start off slowly.(NICE 2004)

[/expand]

[expand title=”Folic acid supplementation“]

☺Marginal to severe folate deficiency is present in 5% of the general population and in early pregnancy.

☺Folic acid supplementation around the time of conception and up to 12 weeks’ pregnancy reduces the risk of having a baby with neural tube defects (NTDs, which affect the spinal cord and brain) by 3/4th (RR* 0.28, 95% CI** 0.13- 0.58). Neural tube defects include spina bifida (commonest, about 2/3rd of all), anencephaly (the second most common, about 1/3rd of all) and encephalocele (<1/10th of all). The prevalence varies from 1 in 100-2000 pregnancies depending on the geographical location (highest in certain northern provinces in China and lowest in the Scandinavian countries). The risk of recurrence is 3-5% after one affected baby and 8-10% after two affected babies. The risk is 3-4% if one of the parents is affected by multifactorial NTD.

The recommended dose of folic acid is 0.4 mg per day. For women who have previously had a baby with a neural tube defect or who are receiving anti-epileptic medication, a higher dose of 5 mg per day is recommended. This higher dose has also been suggested for women with a BMI of >35, although the benefit is yet to be proven.

☺To achieve maximum benefit, the folic acid should be started at least before becoming pregnant and continued up to 12 weeks’ pregnancy as the neural tube in the baby is formed around 3-4 weeks of its embryonic age (5-6 weeks of pregnancy).

☺Maternal folic acid supplementation is associated with decreased risk of other congenital anomalies, including cardiovascular defects (OR*** 0.61, 95% CI 0.40- 0.92) and limb defects (OR 0.57, 95% CI 0.38- 0.85), and some paediatric cancers including leukaemia, paediatric brain tumours and neuroblastoma.

☺Whether periconceptional folic acid supplementation increases the incidence of twin births is yet to be proven. (NICE 2004 & RCOG SACOP 16, 2009)

*RR = Relative Risk (is the ratio of the number of a group in which the event of interest occurs to the number in which it does not)

**95% CI = 95% Confidence Interval (a range that includes the true value with a probability of 0.95)

***OR = Odds Ratio (is the ratio of the number of a group who develop the outcome of interest to the number who do not)

[/expand]

[expand title=”Natural conception“]

The chance of becoming pregnant is about 85% by 12 months and about 95% by 24 months.(NICE 2004)

[/expand]

[expand title=”Occupation“]

*Some occupations involve exposure to hazards/agents that could reduce female or male fertility

*Female fertility, occupations and occupational agents

Anaesthetists, operation theatre nurses, dental assistants – Nitrous oxide

Nurses, pharmacists – Chemotherapeutic drugs, antibiotics, mercury, cadmium

Office workers – Visual display units (e.g. computer monitor)

Hospital and other workers – Shift work / intense physical work load / long working hours

Metal workers, smelters, battery factory workers – Lead, cadmium, manganese

Wood workers – Formaldehyde

Agricultural workers – Pesticides

Smelters – Lead

Lamp factory workers – Mercury vapour

*Male fertility, occupations and occupational agents

Agricultural workers – Ethylene dibromide, dibromochloropropane (pesticides), polychlorinated biphenyls

Chemists, laboratory workers, painters – Acetone, carbon disulphide, glycol ethers (solvents)

Radiotherapists – X-ray

Engine drivers, diggers – Vibrations

Welders, bakers, drivers – Heat (increase in scrotal temperature) (NICE 2004)

[/expand]

[expand title=”Optimum frequency and timing of sexual intercourse“]

Sexual intercourse at least every 2 to 3 days (without a gap of more than 1-2 days in between) optimises the chance of pregnancy. Timing intercourse to coincide with ovulation (by using basal body temperature chart, ovulation kit, the fertile period etc) causes stress and is not recommended.(NICE 2004)

[/expand]

[expand title=”Prescribed, over-the-counter and recreational drug use“]

A number of prescriptions, over-the-counter and recreational drugs interfere with male and female fertility

*Female infertility – Chemotherapy, nonsteroidal anti-inflammatory drugs (e.g. Ibuprofen, Mefenamic acid, Diclofenac etc), tranquilisers, immunosuppressives, drugs for asthma, antidepressants, use of marijuana, cocaine etc.

*Male infertility – Chemotherapy, long-term daily use of some antibiotics, Sulfasalazine, Cimetidine, and androgen injections; cocaine, anabolic steroids etc. Use of beta-blockers and psychotropic drugs might lead to impotence. (NICE 2004)

[/expand]

[expand title=”Smoking“]

Smoking (including passive smoking) is likely to reduce fertility in the female. There is an association between smoking and reduced semen quality (although the impact of this on male fertility is uncertain), and obviously stopping smoking improves general health.(NICE 2004)

[/expand]

[expand title=”Stress and counselling“]

Inability to get pregnant, its investigations and treatment are extremely stressful for the couple. They should be counselled appropriately in relation to the causes, investigations, and the nature, success rates, side effects and costs of potential treatment options.

[/expand]

[expand title=” Susceptibility to Chicken pox“]

☺If a woman is susceptible to Chicken pox and contracts the infection in pregnancy that could cause serious illness of the woman including death (75% of deaths from Chicken pox occur in adults) and serious damage to the baby (especially in the first twenty weeks of pregnancy). Fifty percent of the susceptible pregnant women would develop either modified or usual chickenpox and a further 5% would have sub-clinical infection following significant exposure to chickenpox.

☺ Vaccinating women who are susceptible to Chicken pox is cost-effective. They should be advised not to become pregnant for at least 3 months following vaccination. Prevention is the best treatment. Chicken pox vaccination produces long-term immunity in about 90% of vaccinees and might be protective up to 20 years. It reduces mortality from Chicken pox by 2/3rd. Women who are trying for baby should be offered vaccination if they did not have Chicken pox or Chicken pox susceptibility screening (Varicella Zoster IgG, a blood test) if they are not sure whether they had Chicken pox.

Effects of Chicken pox infection in pregnancy

*Chicken pox occurs in 3 out of 1000 pregnancies (more in India). Pneumonia (10%), hepatitis and encephalitis are more common. The severity of pneumonia increases in later pregnancy. Mortality rates were 20-45% in the pre-antiviral era but have fallen to 3-14% with antiviral therapy and improved intensive care. In the UK the case fatality rate is less than 1% but that is five times higher in pregnancy than in the non-pregnant adult. In developing countries like India, with serious lack of healthcare facilities for the general population, the mortality rates would probably be very high around 20-45%, and cost of treatment would be relatively high and unaffordable. This makes a strong case in favour of vaccinating women who are susceptible to Chicken pox.  Spontaneous miscarriage does not increase if chickenpox occurs in the first 12 weeks of pregnancy. There is a small risk of fetal varicella syndrome (FVS) in the first 28 weeks of pregnancy (0.55% <12 weeks, 0.91% <20 weeks and extremely rare 20-28 weeks). Fetal varicella syndrome includes skin scarring in a dermatomal distribution; hypoplasia of the limbs; neurological abnormalities (microcephaly, cortical atrophy, mental retardation, and dysfunction of bowel and bladder sphincters) and eye defects (microphthalmia, chorioretinitis, cataracts). Varicella infection of the newborn might occur if maternal infection occurs 1-4 weeks before delivery (about 50% of babies are infected and about 23% of these develop clinical varicella). (RCOG 2007)

[/expand]

[expand title=” Susceptibility to Rubella (German measles)“]

☺If a woman is susceptible to Rubella and contracts the infection in pregnancy, that could cause serious damage to the baby, especially in the first twelve weeks of pregnancy.

☺Women with infertility should be offered Rubella susceptibility screening (Rubella IgG, a blood test) so that those who are susceptible to Rubella can be offered Rubella vaccination and advised not to become pregnant for at least 1 month following vaccination. Prevention is the best treatment. (NICE 2004)

☺Rubella vaccination produces long-term immunity in about 95% of vaccinees. Rubella IgG might be detectable up to 16 years.

Effects of Rubella infection in pregnancy

* The risk of fetal infection and congenital anomalies is about 80%  (8 in 10) in the first twelve weeks of pregnancy and is about 25% (1 in 4) after twelve weeks of pregnancy. The risk of severe fetal abnormalities due to infection probably declines after sixteen weeks of pregnancy.

* Rubella infection could affect almost all organs/systems of the fetus (baby) such as the Eye (cataract, retinopathy, microphthalmia, glaucoma), Heart (patent ductus arteriosus, pulmonary valvular stenosis, pulmonary artery stenosis, coarctation of the aorta, ventricular septal defect, atrial  septal defect), Ear (bilateral and progressive sensorineural deafness) , Central nervous system (meningoencephalitis, microcephaly, chronic parencephalitis, mental retardation, behavioural disorders), Blood (thrombocytopenic purpura, anaemia), Liver (hepatosplenomegaly, hepatitis), Lung (interstitial pneumonitis),  Endocrine (diabetes mellitus, thyroid disease, growth hormone deficiency, precocious puberty),   Bone  (radiographic lucencies),  Skin (chronic rubeliiform rash, ‘Blueberry muffin’ spots), Immune system (thymic aplasia, hypogammaglobulinaemia, lymphadenopathy) etc.

[/expand]

[expand title=”Tight underwear for men“]

There is an association between raised scrotal temperature and reduced semen quality (that might be associated with male infertility), but it is uncertain whether wearing loose-fitting underwear improves fertility. It has also been suggested that use of laptop (on the lap) for prolonged periods might affect semen quality. (NICE 2004)

[/expand]

 

G-Y in Gynaecology – themedideas Facts & Figures

 

Author

 

Best Examination Questions: Obstetrics & Gynaecology – The MCQ Bank

Best Examination Questions: Obstetrics & Gynaecology – The MCQ Bank No 1

Best Examination Questions: Obstetrics & Gynaecology – The MCQ Bank No 2

Best Examination Questions: Obstetrics & Gynaecology – The MCQ Bank No 3

Best Examination Questions: Obstetrics & Gynaecology – The MCQ Bank No 4

Is age-related decline in female fertility a mitochondrial dysfunction?

Uterine fibroids: Alternative treatment to hysterectomy or myomectomy – themedideas Facts & Figures

Best Examination Tips: Informed consent in O&G – themedideas Facts & Figures

Best Examination Tips: Cardiology Alert!!! Digoxin use linked to increased risk of Death

Best Examination Tips: Inherited Thrombophilia in O&G – themedideas Facts & Figures

Best Examination Tips: Introduction to Infertility

Best Health Tips: What are the reasons for patients’ dissatisfaction and how you could improve your level of satisfaction?

Best Health Tips: What is the most appropriate treatment option for you?

Best Health Tips: What appears the easiest treatment option may not be the best for you

Best Health Tips: What treatment appears cheap is not necessarily cost-effective

Best Health Tips: Who is a good Doctor?

Best Health Tips: What should you expect during consultation with the Doctor?

I-Y in InfertilitY (more than 80 Key points you must know) – themedideas Facts & Figures

Best Examination Tips: “Good Medical Practice” & Medical Ethics – themedideas Facts & Figures

Best Examination Tips: Clinical Risk Management – themedideas Facts & Figures

Best Examination Tips: How to Critically Appraise a Research Publication (Paper) – themedideas Facts & Figures

Best Examination Tips: How to evaluate a Test – themedideas Facts & Figures

Best Examination Tips: Evidence Based Medicine – themedideas Facts & Figures

Best Examination Tips: Audit – themedideas Facts & Figures

Best Career Tips: Medical Interview Questions & Topics

 

© Dr Sudipta Paul, themedideas.com, 2013

Best Unbiased Evidence Based Health Information – themedideas Facts & Figures
5 (100%) 1 vote

Tags: , , , , , , , , , ,

 



Comments are closed.