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After struggling for more than a year to conceive, which is the definition of infertility, it can be disheartening to see other couples holding their babies or try to explain to others why you haven’t had a baby yet.  So in vitro fertilization (IVF) has become a ray of hope for couples struggling with infertility.   IVF is a series of procedures where the woman’s ovaries are stimulated to produce more than one egg and these eggs are retrieved, combined with sperm in a laboratory setting and the resulting embryo is transferred back to the woman’s uterus for implantation potentially leading to a successful pregnancy.  But before you begin your IVF journey, the doctor will recommend undergoing a few tests to try to find out possible reasons for the infertility and also to make sure all the parameters like hormonal levels are optimal for a successful IVF.  If some parameters are slightly off, the doctor could tweak or adjust the procedure and medications accordingly so that the best course of action is followed for your unique circumstances.

What are these pre-IVF tests?

Before the tests are carried out, the doctors at Xenith will meet with you for pre-pregnancy consulting to take an in depth look at your medical and family history like any chronic diseases like diabetes, your age, weight, a list of medications including any vitamins and supplements that you are taking, your diet and other such details in order to ascertain if you are a good candidate for IVF.  They will also look at your past history with infertility, details about any previous miscarriages, failed IVFs, results of any previous tests, or other such information.  They will also explain what is involved in the IVF procedure and a list of tests that will need to be done prior to IVF.  Following these discussions, they might begin these pre-IVF tests:

1. Semen analysis– A semen analysis accurately measures the number of sperm, their motility (ability to move), their morphology (size and shape), the total volume and consistency of the ejaculated sample. Sperm that have low mobility and cannot swim very well or move in a forward direction are thus not able to reach the egg. If the sperm quality is not great or if the counts are low, ICSI or Intracytoplasmic Sperm Injection, where a single sperm is carefully inserted into each egg to increase the chances of egg fertilization, might be carried out.  If there is no sperm found, then sperm might need to be collected directly from the testicles.  Digital high magnification is a technique where the sperm can be highly magnified to see very small defects in order to select better quality sperm.
2. Ovarian reserve testing-is done to assess how many eggs are there in a woman’s ovaries (ovarian reserve).  Since a female is born with all the eggs she will ever have, this amount and quality of the eggs will decrease with age and for other reasons.  Having a poor ovarian reserve means the likelihood of IVF success is low because the fertility drugs meant to stimulate your ovaries may not work as well.  So how is this determined?  Some blood tests will be done to determine levels of certain hormones.  FSH is a hormone that is produced to regulate the menstrual cycle and the egg production.  Abnormally high FSH levels might be a sign of poor ovarian reserve although it does get higher the older you get.  Antimullerian hormone (AMH) is a hormone produced by the follicles which can eventually mature to become an egg in the ovaries.  So, the AMH levels can predict the number of potential eggs a woman has.  Sometimes, the ovaries can respond too much leading to ovarian hyperstimulation syndrome (OHSS) where the ovaries can swell and cause pain and this has to be prevented.  Estradiol is another hormone that can predict the ovarian reserve.  Antral follicle count measures the number of follicles up to 10mm in size using transvaginal ultrasound.
3. Prolactin and thyroid stimulating hormones(TSH) -prolactin is associated with breast milk production and hinders ovulation.(1)   It could affect the progesterone levels which can promote the uterine lining for implantation by the fertilized egg.  TSH plays a role in controlling the body’s metabolism and affects the production of thyroid hormones.  Hypothyroidism (decrease in thyroid hormones) could lead to cyst growth in the ovaries and increased production of prolactin.  Hyperthyroidism (increase in thyroid hormones) could lead to increased risk of miscarriage and decreased sperm count in men.  The blood test could also test your blood sugar levels for diabetes.
4. Screening for infectious diseases- certain infectious diseases like Hepatitis B, HIV, Chlamydia, Syphilis, and some others could affect the fetus development or cause severe complications in pregnancy.  Screening of these diseases can ensure that both the mother and baby are safe
5. Ultrasound testing- The uterus could have some abnormalities that could prevent implantation or other issues.  Transvaginal ultrasound can be used to scan the uterine cavity and the lining for any discrepancies.  Newer technologies like 3D transvaginal ultrasound can make it even easier to find any anomalies in the uterus. (2) Saline infusion sonohysterogram could also be carried out where the uterus is filled with saline and the saline solution helps to outline the uterine walls making it easier to spot polyps, fibroids, scar tissue or any other abnormalities. 
6. Hysteroscopy-At times the uterine cavity is checked using an endoscopic procedure called Hysteroscopy. A scope with a camera attached to it is introduces inside the uterine cavity to check for inflammation, presence of polyps, infections and other issues. It also helps to assess any adhesions in the cavity. It can be used as a therapeutic procedure as the issues can be corrected in the same sitting. 
7. Genetic testing– might be done to see if there are any chromosomal or genetic abnormalities that could prevent a successful pregnancy or be passed on to the offspring.
8. Mock embryo transfer- is a trial run before the actual embryo transfer and helps the doctor see how your body would react under these circumstances, measure the distance from the ideal implantation location in the uterus to the cervix, and see if there are any restrictions in the path or scarring to avoid in the uterus as well as determine the best route for the implantation.

Upon looking at the results of these tests, some more additional tests might need to be performed like a laparoscopy which is a minimal surgical procedure done in cases of hydrosalpinx, where the tubes are filled with fluid and need to be removed before the IVF procedure.  The doctor might need to administer certain medications depending on the results and determine the type of procedures to carry out in order to boost IVF outcomes and give you a personalized treatment plan meant specifically for you.  Xenith Advanced Fertility Centre is one of the best IVF centers with an excellent success rate especially for couples who have had to deal with a few IVF failures already.  Come talk to us and let us help you fulfill your dreams of having a child.

Uterine fibroids are abnormal growths that develop in or on the wall of a woman’s uterus and are usually benign or non-cancerous.  Its size can vary anywhere from very small pea to larger than a melon.  The size of a fibroid is often described as a pregnancy like a 14 week sized or 4 month sized pregnancy.  Many women don’t even know they have fibroids because they don’t have any symptoms and often a pregnant woman first finds out about it when they do her routine ultrasound.  Most fibroids don’t need to be removed and just need to be monitored regularly especially if there are no symptoms.

Types of fibroids

There are 4 primary types of fibroids.

1. Subserosal fibroids develop on the outside wall of the uterus and they could cause bloating, abdominal pain and frequent urination as they apply pressure on nearby organs. 
2. Intramural fibroids are the most common and they grow within the uterine walls causing heavy periods and pelvic and lower back pain. 
3. Submucosal fibroids grow within the endometrial or uterine lining and grow into the uterine cavity causing very heavy periods and severe pain in lower back and pelvis. 
4. Pedunculated fibroids are attached to the uterine wall on small stalks or stems and can grow outside or inside the uterus.  If these fibroids twist on the stem, it can cause pain and pressure.

Symptoms

As mentioned earlier, quite often there are no symptoms with the presence of a fibroid.  Pain is the most common symptom when having fibroids.  But sometimes there are other symptoms like heavy or painful periods, spotting, becoming anemic from the excessive bleeding, feeling pressure in the lower abdomen, feeling bloated, pelvic pain, painful sex, infertility, miscarriage, and frequent urination.  As fibroids increase in size, they can squeeze out space meant for other organs and cause discomfort, pain, and swelling of the abdomen.

What causes them

It is not known exactly why they form.  Genetic factors might play a role.  Estrogen seems to stimulate the growth of fibroids in many instances. Hence, the size might increase due to rise in estrogen levels during pregnancy.  During the first trimester of pregnancy, some fibroids may grow larger but will then shrink after birth.  This is also why they often shrink after menopause.  It’s hard to predict how quickly or how big they will grow.

How does it affect fertility/pregnancy?

Only certain types of fibroids could affect fertility and this too only 1 to 2% of infertility cases are caused purely by fibroids.(1)  Most women who have fibroids still have the ability to become pregnant and it doesn’t cause any issues during their pregnancy.  Those affecting fertility could be –

Some fibroids that grow just under the uterine lining are more likely to affect fertility because they could prevent the embryo from attaching to the uterine wall.

 Fibroids that grow outside the uterus probably will not affect fertility.

 Fibroids which are more than 5 cm in size could have an impact on fertility and may need removal.

Also, fibroids which are situated close to the endometrium or the lining of the uterus, those indenting the endometrium, those situated very close to the tubal opening could be causing issues in fertility.

Some complications during pregnancy and delivery might include:

1. Restriction of fetal growth due to large fibroids taking up space in the uterus.
2. If the uterine wall is blocked by a fibroid, the placenta might break away from the wall reducing oxygen and nutrients to the fetus.
3. Could go into early labor due to the pain from the fibroids causing contractions.
4. Cesarean delivery might be needed if the fibroid is located in the lower part of the uterus because the baby’s head might not be able to enter the lower part of the pelvis during birth.
5. Baby may be in breech position due to the abnormal shape of the uterus.
6. Chances of miscarriage might increase due to the fibroid growing inside the uterine lining.

Treatment

Treatment depends on the size and location of the fibroids. Prior to pregnancy and especially prior to fertility treatments like IUI and IVF it is recommended to remove the  fibroids growing in the cavity. Also fibroids which are compressing the endometrium(uterine lining), large fibroids (>5 cm) are also usually removed prior to fertility treatments. Any fibroid causing a lot of symptoms such as pain and heavy bleeding may also be considered for removal. Treatment is done prior to pregnancy and if fibroids are diagnosed during pregnancy or increase in size during pregnancy, the expectant mothers might have to stay on bed rest, stay hydrated and be prescribed pain relievers to manage the fibroid symptoms.  Thus, it is always advisable to get the proper treatment for fibroids before conceiving. 

Some of the treatment methods are described below. However, some don’t help very much and complications can occur with treatments such as fibroid embolization and hence if there is an indication to treat the fibroid, surgery is the preferred option.

1. Hormonal therapy to shrink fibroids doesn’t cure fibroids but can help manage pain and other symptoms. 
2. Uterine fibroid embolization (UFE) uses small particles that block the flow of blood to the fibroid causing it to shrink and end any fibroid related symptoms.  The uterus is not damaged, there is less pain involved and a faster recovery time.  Fibroids that have been embolized also cannot regrow and these are the advantages to this procedure. However there are complications related to this procedure and not very frequently used.
3. Magnetic resonance imaging (MRI) guided ultrasound surgery where ultrasound waves are used to destroy fibroids with the help of MRI.
4. Myomectomy is a procedure to remove fibroids from the uterus surgically.  It can be done through laparoscopy (several small incisions), laparotomy( big abdominal incision) or hysteroscopy (through the vagina). 
5. Hysterectomy or the surgical removal of the uterus removes the uterus along with the fibroids.  This procedure is recommended only after completion of child bearing and in older women.

Speak to your doctor about the size and location of any fibroids you might have, to see if there are any issues with getting pregnant and carrying the baby to term.  Also ask your doctor if there are any treatment options for fibroids that might help you get pregnant.  Most infertility issues are not due to fibroids although if you suspect fibroids are preventing you from having children, you should get tested and treated.  Its best to take treatment before trying to conceive because once you are pregnant, you will most probably have to grin and bear the pain.  The start of an IVF journey usually involves preliminary evaluation of your overall health and this includes checking your uterus for any abnormalities like fibroids.  If you have any concerns about fibroids, feel free to come talk to the experts at Xenith Advanced Fertility Centre.

Fresh food is often thought to be better than frozen food, but is the same true for fresh IVF cycle versus frozen IVF cycle?  Let’s find out.

What is fresh IVF

IVF or in vitro fertilization is a set of procedures meant for people who are dealing with infertility so that it can help them to have children.  In IVF, the woman’s ovaries are first stimulated with medication to produce more than one egg.  Once the eggs are mature, they are retrieved from her ovaries and fertilized with washed sperm in a laboratory setting.  Then the fertilized egg (embryo) is transferred back to the woman’s uterus after a few days hoping that it will implant in the uterine wall starting the journey to pregnancy. 

What is frozen IVF

If there are excess embryos left over or if the couple want to save the embryos till a later date, these viable embryos can be frozen or cryopreserved.  First some cryoprotective agents are added to prevent crystallization or cell damage.  Then they are frozen in liquid nitrogen at -196^oC and stored.  When the embryo is needed, it is thawed, the cryoprotective agents are removed, and then evaluated to see if it’s viable.  The viable embryo is then available for implantation. Meanwhile, the woman is given medications to create an ideal environment for the embryo to adhere to the uterine wall by making sure through bloodwork and ultrasound that the hormonal levels are balanced and the uterine lining has developed properly. 

Which process is better

Research shows that frozen embryo transfer results could be slightly higher compared to fresh transfers as the window of implantation in the uterus may shift under the influence of ovarian hyperstimulation. However, under well controlled cycles both fresh transfer and frozen embryo transfer have similar success rates. Each case should be individualized to offer the best possible success rates to the patient.  So, this doesn’t mean that frozen IVF or fresh IVF should be chosen all the time.(1)  There are various advantages and disadvantages for each procedure.  The appropriate procedure for each individual patient has to be determined by the specialist and is dependent on a number of unique circumstances for that specific patient.

1. High risk of OHSS- Ovarian hyperstimulation syndrome(OHSS) occurs sometimes on women undergoing IVF.  The IVF procedure begins with medications given to stimulate the ovaries to produce more than one egg for harvesting.  But in some rare cases, the ovaries could swell and cause pain, nausea, and vomiting among other symptoms.  In such cases, fresh embryo transfer might not be recommended and the embryo could be frozen to be used later when the ovaries are in better condition and the body is more receptive to becoming pregnant.
2.  Women having endometriosis or polycystic ovary syndrome (PCOS)- In women who are dealing with endometriosis, the uterine lining also grows outside the uterus and may cause scar tissue that blocks the fallopian tube or damage the ovaries.  The ovarian stimulation in IVF could cause a spike in estrogen levels, which in turn affects the uterine lining (endometrium) so that it’s harder for implantation to occur.  In this case, the doctor could delay the embryo transfer procedure and keep it frozen until a later date. Women suffering from PCOS, who have irregular or no periods, also stand a better chance of a live birth using frozen IVF transfer although they also stand a higher risk of preeclampsia using frozen IVF transfer.
3. If you want preimplantation genetic testing done to check for any genetic defects and the results are not yet available, you might need to delay fresh embryo transfer until the results are available.  So in this case, it might be best to resort to frozen embryo transfer.
4. Possibility of harming the embryos – Since embryos are delicate, they need to be handled with a lot of care in the freezing and thawing process and need to be carried out by an experienced IVF specialist.  Otherwise, there is a risk of harming the embryos, especially during their thawing.
5. Going through fresh embryo transfer takes less time initially because the embryo can be transferred a few days after the eggs are harvested whereas you might have to wait a month or more after egg harvest for frozen embryo transfer.  However, if you have harvested several eggs and several embryos have formed, you have the option to freeze these embryos and do the transfer several times later and not have to go through ovarian stimulation and the whole IVF process all over again.  You just need to have a receptive endometrium and proper hormonal levels for the embryo transfer and implantation to be successful.
6. Using frozen embryos can also be beneficial for your own mental and physical health. Going through the process of harvesting fresh eggs could take its toll both physically and mentally. Using frozen embryos needs to be planned carefully so that it coincides with optimal uterine receptivity for the woman.  But since the beginning part of IVF procedure like the ovarian stimulation and egg retrieval has already been carried out, it makes just the transfer of the thawed embryo easier.  Not all women’s bodies are immediately ready to receive an embryo after taking stimulation medications and some women need additional time to balance out their hormone levels and for their uterine environment to become more receptive to an embryo.  Frozen embryo transfers allow women the luxury of time to recover before embryo transfer.  However, if the IVF clinic is far away, you might need to travel back to the clinic again for a frozen embryo transfer and it might be easier to go through fresh embryo transfer in this case.
7. Age- It is common knowledge that age plays a big role in success rates for conception.  The older one gets, the odds of getting pregnant get lesser.  So, freezing your extra embryos when you are younger, can lead to a higher chance of success later on due to the better quality of embryos.

In the past, when the embryo freezing technique was not well established, fresh embryo transfer was preferred. Now due to extensive research and newer technology as well as access to better equipment, and extremely good freezing techniques with the use of vitrification, frozen embryo transfer cycles are opted for most of the times to reduce the effect of ovarian stimulation on implantation which happens in fresh cycles. Ultimately, what works best depends on each patient’s unique medical needs and the assessment from an experienced medical team. Understanding the differences between frozen and fresh IVF transfers as well as knowing it’s advantages and disadvantages could help you choose the treatment that’s best for you. Also each patient could react differently to the various medications that are administered during the IVF treatment and the IVF specialist needs to be closely monitoring the patient for any adverse signs and symptoms to decide between a frozen and fresh transfer.  The IVF specialists and staff at Xenith Advanced Fertility Centre have a long list of success stories and are very experienced in dealing with all sorts of infertility issues.  Please feel free to call them if you have any questions.

Endometriosis is a disorder where tissue similar to the tissue that lines the inside of the uterus (endometrium), grows outside the uterus in places like ovaries, fallopian tubes, bowel, and some other areas in the pelvic region.  Like the endometrium which thickens, then breaks down and bleeds monthly during the menstrual cycle, these other rogue tissues also have the same characteristics.  But unlike the endometrium where the menstrual blood has an outlet through the vagina, these other tissues have no way to exit the body and gets trapped, leading to possible cysts on ovaries, or irritation of surrounding tissues causing scarring or causing organs in the pelvis to stick to each other.  This could cause pain especially during the menstrual cycle and could lead to issues with fertility.  Endometriosis has no complete or permanent cure as long as menstruation is still going on, although its symptoms can be managed. The exact cause of endometriosis isn’t known.

Symptoms of endometriosis

Some women suffer from silent endometriosis or they don’t have any symptoms at all and thus it can go undetected for a long time.  Others however have pain ranging anywhere from mild to severe.  The severity of the pain is not necessarily a good indicator of the severity of the condition.  So, a woman having mild endometriosis could have severe pain or someone with advanced endometriosis could have little or no pain.  The similarity in symptoms of endometriosis with other conditions like pelvic inflammatory disease, which is an infection of the reproductive organs, or other conditions like irritable bowel syndrome (IBS), which is a chronic gastrointestinal disorder, can prolong diagnosis. 

Some of the symptoms of endometriosis could include:

1. Painful menstrual cramps or abdominal/pelvic/lower back pain- may begin before the period begins.  Pelvic pain is one of the most common symptoms of endometriosis.  Pain may increase over time and so its important to have regular gynecological exams to monitor its progression.
2. Heavy menstrual bleeding, irregular periods or spotting between periods
3. Diarrhea or constipation during periods
4. Having low energy or fatigue
5. Pain during or after sexual intercourse
6. Pain with urination or bowel movements during periods.  You could also have blood in your stool or urine.
7. Bloating
8. Infertility-is sometimes only first diagnosed when looking into reasons for infertility.  Endometrial tissue could attach onto ovaries forming cysts or it could block the eggs from releasing.  It could also cause scarring in the fallopian tubes blocking sperm from travelling up the tube or stopping the fertilized egg from going back into the uterus.  It could also cause a hormonal imbalance, affect the body’s immune system, or impair implantation of the fertilized egg on the uterus wall.   It is important to note that if the patient has a severe form of endometriosis so that they may no longer be able to conceive naturally, they could still become pregnant with IVF treatment.

Diagnosis

When going to visit a doctor about this, they will note down your medical history as well as family history of endometriosis.  They might do a pelvic exam to feel for any cysts or scars and use a speculum to see inside the vagina and cervix.  They might also run some imaging tests like ultrasound, CT scan or MRI to better see your organs.  They might do a laparoscopy where they make a small incision in the belly and see if there are any lesions using a laparoscope which is a thin tube with a camera on the end.  They might also take a biopsy or a sample tissue to confirm diagnosis of endometriosis.  This is the only certain test to ascertain if you have endometriosis.

Treatment

The doctor may first try pain medications and hormone therapy to see if it’s effective in helping you.  If this doesn’t work, they might try a more conservative surgery laparoscopically where they try to remove the rogue endometrial tissue without damaging the reproductive organs so that you can still become pregnant. Many a times women with Endometriosis need IUI or IVF to conceive. The last resort would be a hysterectomy where the uterus and ovaries are removed which is usually not done in the reproductive age group.  It is also important to make sure that you are okay mentally while dealing with these issues.  Having a support group or a therapist or a close friend or family member to talk to, might help.

Is there anything else you can do?

Even though using hot water bottles could give temporary relief from pain, some lifestyle changes could also help.  Some of these include eating healthy with lots of fruits and vegetables, nuts, fish and no red meat along with no alcohol, caffeine, or soda.  Exercise regularly to improve circulation, reduce stress and it may decrease your estrogen levels to help with endometriosis symptoms as well as boost your fertility.  Try out yoga to stretch out muscles and tissues in the pelvis especially.  Many women with endometriosis can still get pregnant and deliver a healthy baby.  Some treatment options include removing the endometrial tissue surgically, freezing your eggs or embryo, and opting for in vitro fertilization (IVF).  The experts at Xenith Advanced Fertility Centre with clinics in Wakad and Koregaon Park have dealt with many such cases and would love to explain any of this in detail so that you can succeed in your goal of having a baby. Discuss with the experts about when is the best time to try to conceive if you have been diagnosed with endometriosis and what are your alternative plans.  Your symptoms may worsen over time with endometriosis making it more difficult to conceive naturally and so it’s important to discuss all this with your doctor up front so that you might understand your options.

In vitro fertilization is a form of assisted reproductive technology carried out to aid in conception of a child.  People undergo stress due to some change that causes a physical or emotional strain in their body and anxiety is the body’s physical or emotional reaction to stress.  Most people usually have some degree of stress, but too much stress or chronic stress over a long period of time can feel too overwhelming having a toll on your physical as well as mental health and it’s important during these times to learn how to alleviate it.

Signs of stress/anxiety

Some signs of stress might include worrying excessively, being fearful, having trouble concentrating, irritability, increased heart rate, having difficulty breathing or having panic attacks, having difficulty sleeping, change in eating patterns, often feeling tired, or feeling depressed.

IVF and how it could affect you

People struggling with infertility may already be experiencing a lot of stress and anxiety by failing to conceive for more than a year and there is a social stigma associated with being infertile and seeking treatment for infertility.  IVF involves going through various consecutive steps and each has to be completed successfully in order to move onto the next step.  This could lead to increased anxiety with each subsequent stage with the highest anxiety experienced in the final two week waiting period to find out if you are indeed pregnant.  This could be especially difficult for men who sometimes find it hard to discuss their feelings openly and keep it all balled up inside.  They might feel helpless as they see their female partner go through the various aspects of IVF like the daily hormone injections, blood tests, and ultrasound scans and it could also lead to a roller coaster of emotions like guilt, anxiety and sadness while they feel the need to outwardly project themselves as the strong, stoic type.  This could put a strain on marital relationships.

So how do you deal with the feelings of stress and anxiety?

1. Identify in detail what is causing you stress.  You might be worried about if you will ever have kids, or about what your partner is going through or maybe blaming yourself for having to go through IVF due to your lifestyle, genetics, or various other reasons.
2. After you have identified your worries, try to examine it realistically and see if its valid or if there’s anything you can do about it.  Have a chat with your doctor, your partner or a close friend.  Get support from your family if you are close to them.  Try not to blame yourself for your past and look positively towards the future.  Try not to take out your anxiety on your partner.  Educate yourself about IVF, what it involves and how it could affect you.  Try to anticipate decisions you might need to make during IVF and discuss this with your partner.
3. Think of ways to overcome these feelings of anxiety by understanding your triggers and what to do when these thoughts come up.  Temporarily avoid situations that make you anxious like maybe going to a baby shower, or a playground.  Try to put a positive twist on things.  Maybe write down your worries as well as possible solutions or if you can’t find any solutions, learn to let it go.  Give yourself a time limit to ruminate on them.  Once the time is up, don’t think of these things until the next scheduled time you have given towards it.
4. Look after yourself by exercising regularly, eating healthy, learning to meditate, journal, listen to music, read a good book, go on a date night with your partner or anything else that you enjoy doing.  Don’t isolate yourself and instead meet regularly with your close friends and family.  You could try volunteering as a way to remove the focus from yourself and give back to the community.  Also learn how to reduce your stress by not taking on too much of a workload and learning to say no during this period.
5. If you feel it’s too overwhelming, get support professionally through a therapist/counsellor, or join an IVF support group.  Know that it’s normal to have anxiety about what you are dealing with and you are not alone in this situation.  Learn to take it one day at a time.  Know that your thoughts can affect your behavior and eventually your own health.

Going through IVF can affect each individual differently and the emotions may run amuck or may be hidden silently.  No matter what the outcome is, know that you have done everything in your power to have a child so that you have no regrets looking back.  If you would like to discuss any of these things, feel free to contact the experts at Xenith Advanced Fertility Centre who are very experienced in helping you go through the IVF experience positively and aid you in your dreams of parenthood.

The idea of having diabetes might send a sense of alarm about the long term consequences of having a lifelong condition and how to cope with it.  Diabetes is a chronic disorder when the blood sugar levels are too high in the body.  The carbohydrates in the food that we eat is broken down into glucose by the body and this is released into the bloodstream.  An increase in blood sugar levels signals the pancreas to release insulin which then allows the blood sugar to pass into the body’s cells for use as energy.  In diabetics, the body doesn’t make enough insulin or the body doesn’t use insulin properly causing the blood sugar levels to remain high which in turn over long term can lead to health problems like heart disease, vision loss and kidney disease. 

What is gestational diabetes

In gestational diabetes, pregnant women become diabetic usually around week 24 and 28 although it could happen earlier too.  This is usually resolved after the baby is born.  Changes in hormone levels during pregnancy as well as other changes such as weight gain causes insulin to be used less effectively.  This condition which is called insulin resistance increases the body’s need for insulin leading to gestational diabetes. 

Symptoms

Many pregnant women have little or no signs of gestational diabetes.  This is why the doctors routinely check for it between the 24^th and 28^th week of pregnancy.  Some women might have some symptoms like excessive thirst, sweating, fatigue, being overweight and frequent urination.  But often these symptoms are similar to pregnancy symptoms and thus might get missed.

Who’s at risk?

Pregnant women more likely to develop gestational diabetes are ones who have a family history of diabetes, who have had previous pregnancy with gestational diabetes, are of older reproductive age, have polycystic ovary syndrome (PCOS) which is a hormonal issue in women of reproductive age or who are obese.

Diagnosis

When testing for pregnancy is done, they usually also screen for diabetes initially.  The oral glucose tolerance test (OGTT) is also done between 24 to 28 weeks during pregnancy to test for gestational diabetes.  Fasting needs to be done for 10 hours usually overnight followed by a blood test.  Then a  glucose drink is given followed by more blood tests after 1 and 2 hours.  Results of high blood glucose levels could mean you have insulin resistance and your body might not be able to deal with the extra demand for insulin.

Treatments

Gestational diabetes cannot be prevented but can be managed well with following a healthy, balanced diet and regular exercise.  However, medication might be needed if the sugar level is still not under control after following a healthy diet and exercise.  If possible, try to lose the excess weight before becoming pregnant.  Eat some protein in every meal and eat lots of fresh fruits and vegetables.  Try to eat spread out and manage your carbohydrate intake of foods like potato, bread, and rice throughout the day so that there is no sudden spike in sugar levels.  Also avoid processed, sugary, and baked foods.   Make sure you eat at scheduled times and eat smaller quantities of food more often.  Stop smoking as well as drinking alcohol.  Check your blood sugar routinely to make sure they are within the normal range.  Include foods high in calcium, folic acid, iron and fiber.  Doing regular moderate exercise of 30 minutes daily like a brisk walk can help to lower the blood sugar.  Check with your doctor about how much exercise you can do and how to follow a healthy diet. 

If you’re at higher risk for gestational diabetes, your doctor may test you earlier. Also, check your blood sugar levels after 6 to 12 weeks after delivery and then every 1 to 3 years to make sure the levels have returned to normal.  The baby will have to be tested for blood glucose levels immediately after birth and monitored regularly because it might be too low.  So the baby needs to be fed soon after birth to keep the blood sugars at normal levels.

Complications

If gestational diabetes isn’t properly managed, it could lead to premature delivery, excessive birth weight in baby, low blood sugar in baby, breathing difficulties in baby, high blood pressure due to mother having preeclampsia, and higher risk of future diabetes in both baby and mother.  The increased insulin produced in response to high glucose levels converts excess sugar to fat leading to a child with excessive weight and the mother might have to deliver via cesarean section. Also, the high blood sugar levels in the mother especially just before delivery could cause over consumption of the baby’s insulin in turn leading to low blood sugar levels in the baby’s blood.  High blood sugar in the mother could lead to early labour which could lead to respiratory distress of the baby.

What if you already have diabetes and have become pregnant

If you already are diabetic and want to plan to have a baby, you should try to get your blood glucose levels close to your normal limits before you get pregnant because it is considered to be a high risk pregnancy.

Having high blood glucose during the first weeks of pregnancy could harm your baby, even before you know you are pregnant. So, you should see your doctor as soon as possible so that you can have a healthy pregnancy.  During the first 8 weeks of pregnancy, a baby’s organs like the brain, heart, kidneys and lungs begin forming and high blood glucose levels during this time could be harmful because there is a higher chance of birth defects and miscarriage.  You may need to scrutinize how and what you eat as well as do regular exercise and make sure you take any medications or insulin on time.  Discuss with your doctor about any possible effects of the medications you are taking on your pregnancy.  Issues due to chronic diabetes like eye or kidney problems could worsen due to pregnancy if your blood sugar levels are too high.  Serious issues may occur if you develop preeclampsia when you have high blood pressure and there’s too much protein in your urine during your pregnancy.  If you have preeclampsia after 37 weeks of pregnancy, the doctor may recommend you deliver your baby early.  If it’s before 37 weeks, your doctor may look at various options and keep a close eye on you, to keep you and your baby healthy as long as they can before delivery. Make sure you get routine checkups done also.  Make sure you take any vitamins as per your doctor’s instructions which also can help you and your baby stay healthy.Getting checkups before and during pregnancy, following your diabetes friendly diet, being physically active, and taking the proper diabetes medications, will help you manage and keep your gestational diabetes in check.  If you have any questions about gestational diabetes, feel free to contact the experts at Xenith Advanced Fertility Centre.

The wedding day is a day that many people dream about and imagine how it’s all going to happen.  It’s all very exciting and there’s a lot of things to plan for like what you are going to wear, the type of cake and flowers you will have, finding the venue, who’s on the guest list and on and on the list continues.  It might all feel very overwhelming and can keep you very busy planning everything down to the tiniest details.  However, the reality of married life after the wedding and the honeymoon phase could be a lot more different than you imagined.   Pre-marital counselling could help couples discuss various topics so that you don’t step into marriage blindly. It helps couples build a strong foundation for their marriage.  It involves having discussions with a qualified counsellor about many topics relevant to marriage so that you can improve your relationship with your partner.

What do you need to know before you plan your wedding?

1. How to improve your communication/conflict resolution skills- Everyone has varying skills of communicating with others.  Good communication and conflict resolution skills are important for every relationship which involves a lot of listening carefully to what your partner is trying to convey both verbally and non-verbally as well as effectively saying what’s on your mind without placing blame.  It’s very important to learn how to resolve conflicts tactfully without resorting to shouting or totally avoiding which will eventually cause even more bigger problems down the road.  Couples can learn about how each other deals with stress, how to recognize the signs during such situations as well as how to work through it.
2. Financial planning- its very important for couples to be on the same page about money and expenses.  Money can bring about a lot of stress for couples and it’s helpful to decide or discuss how to manage your finances in advance.  Try to have a set budget for your wedding day which will in turn help you be organized about expenses down the road.
3. Family planning- many couples have no idea about if and when they want to have kids.  It helps to talk about these topics beforehand so that you know each other’s views.  Most couples assume that when they want to have kids, it will happen smoothly and quickly.  But, it helps to deal with the what ifs that might happen in the future.  What if you have to deal with the diagnosis of infertility?  Would you opt for in vitro fertilization (IVF) or other assisted reproductive technologies?  Dealing with infertility can wreak havoc on relationships both physically and mentally.  Differing coping strategies between the couples could cause conflict and counselling could help couples be there for each other without placing blame, feeling guilty and being more compassionate.  If you want to hold off on having children until later, would you want to freeze your eggs/sperm?  Pregnancy could be wonderful news but what happens after?  Would your parents or in-laws look after them or would you have to stay at home and give up your career?  Would you opt for adoption if having your own kids is not possible?  Do you have different parenting styles like are you a more laid back or more strict type?  These might be difficult or divisive topics to discuss but it’s good to know up front about your partner’s views on such things so that you can think seriously about what the future holds.
4. Religion/faith- Being of different faiths or even in situations of same faith but differing levels of adherence can bring on conflicts.  So it’s important to discuss where each person stands and learn the art of compromise.
5. Extended family relationships/dynamics- it helps to know if you are going to live together with your extended family or if you are going to be living alone as a couple.  What are your partner’s views about cohabitating with other family members?  How do you get along with your in-laws or even members of your own family?  How far are you going to go to help them out?
6. Career and other responsibilities- do you want to continue working after marriage or after having children.  What would be the responsibilities of each person around the home?  It helps to know if your partner is willing to pick up the slack and work together to run the home smoothly.

There are many more things to discuss with your future spouse before you begin planning for your wedding.  Sometimes even the smallest things like how you squeeze out the toothpaste or which side of the bed you sleep in could bring on conflict.  Learn to let it go and don’t sweat the small stuff. Each couple will have different issues and learning to communicate well and work together as a couple can be a key to a successful marriage and these discussions prior to marriage could help prevent conflicts later on.

To my dear daughter Sahana,

Some day when you read this letter, I want it to remind you of how much you are loved.  First of all, I named you Sahana because you have taught me and your dad patience. I have waited patiently and long to hold you in my arms and never let go of you.  I will protect you fiercely, guide you gently, love you unconditionally, and teach you everything I know.  Your dad is a very smart and loving man who works as an engineer and loves taking things apart and fixing anything and everything.  So I am sure he will teach you to be a strong, independent girl who will take on the world by storm.  Your dad can find humor in the littlest of things and this is what I love about him. I pray that you will inherit some of his wit and humor.  I myself am a school teacher and am honored to mould the minds of little children, to teach them how amazing this world is and help them become mature, responsible adults.  I have many other interests including love for travel, music, and reading.  I hope to introduce you to so many different places all over the world and help you fall in love with people and their cultures and also learn to adapt.  I hope to instill in you the love of reading which can transport you faraway imaginary worlds from the comfort of your own room.  Music can be so therapeutic and bring healing in times of stress and the love of music can also bring people together. My faith has kept me solidly grounded and prevented me from stumbling.  I have also made many mistakes in life and have learned to get back up again and go forward.  I pray that through my experiences, I can teach you to avoid the same mistakes I made and yet feel free to be independent and venture out on your own.

Our journey of infertility has been a long, arduous path and yet I will keep trying with every ounce of strength that I possess until I hold you in my arms.  This has taught me perseverance and never losing sight of my ultimate goal of having you and your siblings.  We have embarked on the journey of IVF to have you as our IVF baby.  We hope to have you in our arms soon because of the high IVF success rates.  I look forward to the adventure of motherhood.  I hope that you too will learn to stand strong in what you believe in and learn the art of perseverance and being joyful at all times.

Your grandparents lived in northern India and moved here to Pune for job opportunities.  Thus your 2 uncles and I were born here in this beautiful city of Pune.  They have taught us to always be optimistic and to look on the bright side of things.  So, I know that even when I go through dark days, there’s always a silver lining beneath it all.  I want to instill that in you and be joyful at all times even when life throws you some curveballs.  I want you to follow your passions and never lose that childlike faith in people around you.  Give freely and never expect anything in return.  Love the people around you.  Learn to see things through their eyes and never give up on them.  Many people are lonely and sometimes they just need a listening ear.  More than giving them money, give them your time.  When your grandparents first moved to Pune, everything was foreign to them including the language.  However, the Bharshankar family helped them tremendously by opening up their homes to them and helping them adjust to life in Pune.  Sadly, my uncle and aunty have passed away.  We are forever indebted to them and still are very close to their kids Pinky and Lata who now have kids of their own.  They too, along with your uncles, are eagerly awaiting your arrival.  Always have a heart of gratitude and be thankful for everything you have.  Learn to appreciate the simple things in life.  Learn to forgive and learn to grow from your past failures, always looking ahead to greener pastures.   Learn to laugh at your own mistakes and use your imagination to propel you to a brighter future.   But most importantly, learn to love unconditionally.  I have so much to teach you and can’t wait to meet you soon.   I pray that you will always shine like a sparkling jewel attracting the people around you and spreading joy.  I want you to know that I will always be there for you no matter what and will continue to love you forever.

Love, Your mom.

In vitro fertilization or IVF is a series of procedures to help achieve a successful pregnancy.  The IVF treatment itself starts with ovarian stimulation where you will be prescribed medication so that more than one egg matures at the same time. These mature eggs will then be retrieved and placed together with healthy sperm in a petri dish for fertilization to occur. The resulting viable embryo is then transferred back into the uterus for implantation hopefully leading to pregnancy.  Many couples opt for IVF due to issues with fertility because they haven’t been successful in trying to conceive naturally for more than a year.  Male infertility could be due to abnormal sperm in terms of shape or motility, decreased quantity or no sperm, issues with the male reproductive system or other factors.  Female infertility could be due to decreased egg quality, issues in the fallopian tubes or uterus, hormonal issues or other factors.  By going through an IVF treatment, you could bypass some of these hurdles to help you conceive.  When you are going through your first IVF, you might be very excited about what the future could bring especially if you have been dealing with infertility for a while and yet you might also be anxious about doing everything correctly like the timings of various medications/injections, or what you should and shouldn’t do.  However, if after you have gone through the whole procedure ending with the two week nail biting wait to see if you are pregnant and that first IVF treatment fails, you may be left dejected with many questions about what could have gone wrong and what you should do now.  Sometimes an IVF procedure also gets cancelled if the eggs are of poor quality or if they are not getting fertilized or for some other reason.  You could also have undergone a successful first IVF treatment and you now want to follow up with a second IVF treatment to get a sibling for the first child.  Either way, there are some things you could do to be better prepared for the second IVF treatment.

Talk to your doctor

Have a frank conversation with your doctor about the possible reasons for failure of first IVF treatment.  Some questions that might come up could include: could it be the quality of the egg or sperm, could it be the receptivity of the uterus, was there any genetic issues with the embryo, is it due to any previous health condition, is it due to some medications, or is it due to your lifestyle.  Air out all your concerns to see if anything could be improved for the second IVF cycle. Talk to your doctor about what are the chances of success for the second IVF cycle in your special circumstances.  The doctor might need to tweak the medications or change the medications for the next round of IVF.  The doctor might suggest intracytoplasmic sperm injection (ICSI) procedure along with IVF where one sperm is injected directly into the egg for aiding in fertilization. You could find out if there are any new advances in IVF treatment that might increase the chances of a successful conception. Preimplantation Genetic Screening (PGS) involves screening the embryo for any genetic anomalies before implantation into the uterus.  This could reduce the chances of miscarriage.  If the egg or sperm quality is not good, it might also mean looking at egg or sperm donor or looking at surrogacy if you aren’t physically able to carry a baby to term.   Take your time to make the decision that’s best for you and your partner.  It might mean taking a vacation to relax before trying a second IVF cycle.  Do lots of research and ask all your questions you might have.  You could also check to see if the doctor has lots of experience in this field and offers the newest technology and equipment for you to have the best chance for success. If the first IVF treatment was successful, you might want to follow the same protocol to be successful in the second.

Do you have frozen eggs or embryos

Sometimes, if there are many eggs retrieved during the first IVF procedure, you can choose to have the eggs or the resulting embryos cryopreserved or frozen for future use.  This makes it much easier to prepare for a second IVF treatment because you don’t have to go through the whole process of stimulating your ovaries and the egg retrieval process all over again.  Couples should consider this option during the first cycle in preparation for the second.

Do not blame yourself

 Do not blame yourself for what happened or dwell on the “what ifs”. Sometimes there is no rhyme or reason for why the treatment didn’t work and it could be left unexplained.  Try to accept it for what it is and look ahead positively to the second IVF cycle. 

 Look at your lifestyle

Take a close look at your own and your partner’s lifestyle.  Stop smoking, drinking alcohol, and drinking too much caffeine.  Eat healthy food with lots of fruits and vegetables, cut out foods with refined sugars like baked goods and sugary drinks as well as avoid processed and fried foods.  Do moderate exercise and try to lose weight if you are overweight.  Take prenatal supplements like folic acid and various other vitamins as per your doctor’s instructions.  Get enough sleep and try to get rid of stress.  Take care of yourself and learn to relax.  Try yoga or meditation.  Take up a hobby to keep your mind occupied.

Make sure you are emotionally and physically prepared

You might have been a bundle of nerves when going through your first IVF treatment.  But now that you have already gone through one IVF cycle, you might already know what to expect and be more confident about it.  Try to stay calm and be optimistic.  It helps emotionally and mentally if you have someone to confide in, like your partner, a close friend or family member or you could join a therapy group or talk to a professional therapist or counsellor to alleviate your fears and concerns. If you feel your body is still not back to its usual self, take some time off before your next treatment because only you know your own body.  However, if you are older, try to do it sooner rather than later because egg quality decreases with age.

Try not to compare your second IVF treatment with your first

Each treatment is unique and your body might react differently.  So try not to fret over why its not feeling the same as before.  Try not to research too much on the internet about every twinge you feel in your body and why you feel the way you do because some of the online forums might lead you to panic and do more harm than good.  Sometimes you might feel more emotionally vulnerable and cry at the drop of a hat which could be due to the effect of some hormonal changes in your body.  Feel free to cry and vent it out.  Speak to your doctor to answer any queries. In general, its important to take care of yourself if you are going to be carrying a baby.  Make sure you are healthy physically and emotionally and this can improve your success rate for your second IVF treatment.  Stay positive and be optimistic by keeping yourself occupied.  Talk to your doctor about what could be done to improve your chances of success.  The professionals at Zenith Advanced Fertility Centre have a lot of experience in dealing with this and would love to help you achieve your dreams of having a child.  Feel free to ask them any questions you might have.

The best time to conceive is around the time you are ovulating.  But what does this actually mean and how do you find out when you are ovulating.  First let’s find out what’s happening exactly during the menstruation cycle.

The follicles in your ovaries are a fluid filled sac containing an immature egg.  At the beginning of the menstrual cycle, a few of these follicles begin maturing.  But by the middle of the cycle, only one dominant follicle will be mature enough to release an egg and ovulation is the time when the egg is released from the follicle into the fallopian tubes. In the meantime, the sperm enter the uterus through the cervix and go through the fallopian tube to fertilize the egg.  Then the fertilized egg travels to the uterus for implantation, leading to pregnancy if the implantation is successful.  If the egg is not fertilized by sperm, it will disintegrate and the uterine lining will be shed as menstruation.

Ovulation cycle and calendar

The menstrual cycle is dependent upon a delicate balance between the levels of various hormones that are released.  The first day of your last period or the day you begin bleeding is considered day 1 of your menstrual cycle. The length of a menstrual cycle is the number of days between the first day of menstrual bleeding of one cycle to the first day of the next cycle. The menstrual cycle may be divided into two phases which are the follicular phase and the luteal phase. The follicular phase begins from the first day of menses until ovulation around day 14.  During this phase a few ovarian follicles begin developing and maturing.  The rest of the cycle is considered to be the luteal phase and is 14 days long in most women.  The average duration of menstrual flow is between four and six days. 

It is important to keep track of your own cycle because it can vary for each individual.  Ovulation occurs roughly halfway through your menstrual cycle which is between 13 and 15 days after your last period began, if you have your period every 28 days which is considered the average.  So the best time to conceive can be anywhere from a few days before ovulation (because sperm can live for three to six days) until about a day after the release of the egg, which is only viable for about 12 to 24 hours.  Thus, it’s good to keep track of your cycle length for a few months and be aware of the signs in your body.  It might help to write it down to help you remember how it felt in the previous month around the same time.

What are some symptoms of ovulation

Basal body temperature- During ovulation, the body releases the hormone progesterone, which brings on a slightly raised temperature of about 0.5 degrees a day or two later.  So you would need an accurate thermometer that measures every 10^th of a degree and the temperature should be measured when you are at rest preferably before you get out of bed in the morning.  Try to see a monthly pattern of the temperatures to predict when you will ovulate.

Cervical mucus becomes clearer and thinner with a more slippery consistency similar to that of egg whites when you are ovulating to protect sperm in their journey to the egg.  However, when you are not ovulating, the mucus is sticky and thick to prevent sperm from getting into your uterus

Other symptoms of ovulation may include softening of cervix, mild cramps, increased sex drive, light spotting, breast tenderness, and backache.

How to track for ovulation

You can use an app to help track your menstrual cycle.  You could also use a home ovulation predictor kit which checks for a surge in luteinizing hormone (LH) levels which means that you are about to ovulate. 

More accurate results could be gotten through ultrasound where the size of the developing follicle is monitored closely till it is ready to release the egg.  It will also monitor the thickness of the uterine lining.  This process which is called follicular study or monitoring, makes it easier to find out when you are most fertile accurately.  It could also diagnose any problems related to ovulation.

Once you have determined when you will ovulate, you can have sex 2 days before and a day after ovulation.  During this fertile window, you can have sex every day to increase your chances to become pregnant because it only needs one sperm to fertilize the egg.  It is also suggested to lay in bed for 10 to 15 minutes after intercourse.  You should see a fertility specialist if you have certain medical conditions, irregular menstrual cycles, endometriosis, PCOS, hormonal imbalances, pelvic inflammatory disease due to sexually transmitted diseases, previous pelvic or abdominal surgeries, or use anabolic steroids or certain medications which might prevent you from getting pregnant. Speak to the experts at Xenith Advanced Fertility Centre if you need advice about any of this.