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Infertility Treatment in Chennai

 Infertility Treatment in Chennai

Fig 1: Infertility Treatment in Chennai

                The main aim of infertile couple is to conceive and have a healthy child. Infertility could be due to problems in men, women, both or in 20% of infertile couple all investigations may be normal and they may yet be infertile which is called as unexplained infertility.

Abnormalities in the women are not the only cause of infertility

  The important causes of infertility are:

   Evaluation of physical factors in couple

   Female oriented:

              1)      Problem in the development of egg in the ovary.

              2)      Obstruction in the Fallopian tubes preventing egg to and sperm to meet

              3)      Anomalies in the uterus 

   Male oriented problems:

       1) Problem in the production of sperms.

        2) Mental stress or anxiety and others reasons

 Test related to the women

Fig 2: Treatment for Women

Follicular study: 
     Follicular study is a vital component of egg assessment and timing of release of the egg. It basically employs a simple technique for assessing ovarian follicles at regular intervals (from 12^th day of periods 18^th to 20^th day) and documenting the pathway to ovulation (mature egg is released from the ovary).  

PCT (Post coital test): 
        PCT is also performed during follicular study to see if adequate sperm are entering cervix.

HSG: 
       A hysterosalpingogram (HSG) is an X-ray test that looks at the inside of the uterus and Fallopian tubes. This shows whether the Fallopian tubes are open or blocked and whether a blockage is at the junction of the tube and uterus (proximal) or at the other end of the tube (distal) It is done from 5^th -9^th day of period.

Hormone analysis:
    The level of hormones in blood plays an important role in conception. T4, TSH (thyroid stimulating hormone) and prolactin levels are tested routinely. FH and LH levels are also done wherever necessary.

Laparoscopy:
       Laparoscopic surgery, also called minimally invasive surgery (MIS), or keyhole surgery, is a modern surgical technique. It is used to visualise ovaries, uterus and Fallopian tube. Endometriosis can also be diagnosed. PCOD can be diagnosed. It is both diagnostic and therapeutic.

Diagnostic: By directly visualising, Uterus, Ovaries and tubes, checking tubal potency, couples can be reassured.

Therapeutic: 
         Therapeutic procedures like ovarian drilling, ovarian cyst removal, adhesion, myomectomy can be done through laparoscopy. Hysteroscopy will enable to visualise inner side of uterus and tubal opening.  

Test Related to Men

Fig 3: Treatment for men

       Semen analysis and hormone analysis are performed. In some cases urologist opinion is also taken. Treatment would be easier after the preliminary tests are done in the male along with his spouse Hormone tests like T4 TSH, prolactin, FSH, LH and testosterone are done wherever necessary.

Infertility Process:

       In this modern era conceiving a child naturally seems difficult, due to the changes in the social structure and function, where the priority of the woman has shifted from marriage to education and career, squeezing pregnancy between career ladder and home making, reducing treatment of infertility a rat race. As the age of marriage is raised conception window is narrowed, anxiety is built on attempts for early pregnancy.

Though reproductive medicine has stretched its wings far and wide and procreating children to many infertile couples, there are grey areas that don’t come under its per view. We are analyzing the other side of the coin- the functional aspect. Problem of infertility is like an iceberg- the visible part is the physical aspect. The tip of iceberg- It is amenable for tests and treatment. The submerged invisible part is the functional aspects-comprising of immune and hormone function not available for scrutiny of medical fraternity.

Why some people doesn’t conceive, in spite of best medical treatment and all physical factors corrected?

The problem of fertility (conception) has physical, functional, social and emotional aspects. The physical aspects (Egg, tube, Sperm, Hormone) are studied by tests and problems recognized and corrected by treatment. Medical treatment has advanced to a great extent in treating the physical aspects, medicines to improve the egg development, key hole surgery for tubal ,uterine and peritoneal factors, ART (assisted reproductive techniques, Test tube baby IVF, ICSI as the ultimate resort).

Functional aspects: Functional aspects comprise of immunity and organ function. Diet (antioxidants-vitamins) improves the structure where as exercise improves the function by increasing the blood flow. Diet and exercise improve the quality of egg and sperm.

Immune function: 
         These days’ nutritive values of food are comparatively low due to the low soil fertility. Protein content of the soil has gone down by 30-50% and levels of the minerals like Iron, Calcium, magnesium and Zinc are also low. Anti nutrients like GM       (genetically modified) foods, pesticides, herbicides refined sugars, hydrogenated fats, water from plastic bottles, color preservatives and junk foods depletes conception nutrients being absorbed. They damage egg and sperm health causing improper development of egg and sperm leading to infertility, abortion, congenital anomalies etc.

Exercise is good way of improving BMR and reducing weight. It is good way of detoxing by way of sweating, breathing and relieving constipation. It decreases insulin resistance and LDL cholesterol, improves immune function and anti oxidant levels. It also decreases stress hormones and food craving. University of ADELAIDE conducted 6 months study on diet and exercise in 18 overweight women. There was 71% increase in insulin sensitivity, 39% decrease in LH levels and 11% decrease in central fat.

Hormone function: 
       Hormone balance is directly dependent on our emotions. Fertilisation and implantation is dictated by hormonal interplay. They are so designed that when physical factors are OK, when we don’t think about pregnancy, conception occurs naturally. The normal conception rate would be 10%-15% per month. When we are anxious about pregnancy and expect every month stress hormones are released and upset normal hormonal balance and conception is delayed. When we are happy, relaxed and confident happy hormones are released which enhance natural function.

Emotional aspects of the infertility:

How emotions are involved in conception?

        It has many dimensions. Self esteem is directly affected in conception. Emotional trauma is more than physical suffering. This is due to the conflict between self, society and family.

Society: Infertility is pet subject of sarcasm to the society, making infertile couple social outcasts.

Family: In the past joint family system was there, which gave lot of moral support to the couple. Now with nuclear family, for a word of reassurance we need to seek the help of counselors or psychologists. Inter personal relationship between husband and wife also can suffer due to infertility. Both of them need to express their feelings, understand and offer mutual support.

Sexual relationship is also affected. We need to understand it’s not only the frequency but also the quality of sexual contact that helps in conception.

Counselling:

Among the top issues that contribute to the stress, are physical tests and procedures, relationship challenges, financial issues, emotional issues, decision making, hormone treatments, and exhaustion. Researchers have shown that infertility and stress are related to each other.

A sense of isolation, male pragmatic ambivalence, and financial pressures of treatment and uncertainty about what the future holds, can exert extreme stress on the couple relationship.  This normally manifests in a distance between them. The result of this distance is at best a lack of communication and at worst a breakdown of communication, which for many couples can result in separation.

“Only by including the psychosocial dimension into infertility consultation, we will be able to make biological reproduction” (Johannes Bitzer) In addition to the professional counsellor, every medical and paramedical staff in an infertility clinic must be trained and equipped with basic counselling skills to be able to provide a patient-centered care is believed to improve health outcomes, increase patient and team satisfaction, reduce negative psychological reactions and help patients better to come to terms with their experiences.

Sex Counselling:

Sexual counselling is a part of infertility procedures. The sexual health counselling provided by the Clinical Counsellor in entirely patient-centered and confidential. They will meet with individuals or couples to explore sexual health issues, answer questions, provide information about services and provide referrals to clinicians or other agencies in the community.

Our Conception Formula:

Conception =   Physical    +       Functional

                                

                        Egg                    (Immune + Hormone)

                        Tube                   Diet + exercise

                        Uterus

                        Hormones

                        Sperm

When couple feels they are lagging behind others, they feel guilty. Guilt increases anxiety and depression increases. If they feel that this is an opportunity to prepare them physically and naturally to beget a healthy, intelligent child with good qualities and delay is not a failure. Their self esteem will increase and they will wholeheartedly pursue the treatment and become successful.

Finally we need to remember that conception is a natural function and if we handle physical and functional factors with positive mindset, treatment will surely be successful.