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A vaginal yeast infection is a common fungal infection in the vagina and vulva (tissue in the vaginal opening) and is also called vaginal candidiasis.  It is most often caused by a type of yeast called Candida albicans. 

What causes vaginal yeast infections

In the vagina, there is normally a balanced growth of bacteria and yeast.  Some bacteria like the Lactobacillus keep the growth of yeast in check.  But sometimes, this balance can be disrupted leading to an excessive multiplication and growth of the yeast cells causing a yeast infection.  This could be caused by various reasons like taking certain antibiotics which can kill some healthy bacteria, pregnancy which causes hormonal changes, uncontrolled diabetes which causes high blood sugar levels, birth control pills, weak immune system, menstruation, stress or wearing moist, tight clothing which could provide a breeding ground for yeast.  

Symptoms

Some of the symptoms of vaginal yeast infections could include an itching or burning sensation when urinating or having sex.  It could also cause redness and swelling in the vulva, thick white vaginal discharge, and a vaginal rash.  Some of these symptoms are similar to having a sexually transmitted disease and so you should get it checked by your doctor although it is not considered to be a sexually transmitted infection.   However, mild infections might have no symptoms at all.  If you often have yeast infections, it could be an indication of an  underlying health condition like diabetes. 

Treatment

Vaginal yeast infections could be treated by antifungal medications which could be oral medications or topical in the form of a cream or a vaginal suppository which is inserted into the vagina where it dissolves to deliver medications into the vagina.  Cotton underwear could be worn to absorb any moisture.  You could take some probiotics which are made up of good bacteria in the form of supplements or certain foods like yoghurt, buttermilk or some fermented foods.  Most medications will work quickly within a week’s time.  However, if it’s a severe case, it might take longer to resolve. 

Does it affect fertility

A vaginal yeast infection does not directly affect fertility.  However, it can indirectly affect it because sex might be painful and uncomfortable and the woman might be put off from having sex.  However, if you are often getting vaginal yeast infections, it could affect the consistency of the cervical mucus and also the pH of the vagina and prevent the sperm from getting past the vagina into the uterus and reaching the egg. If you have a severe case of vaginal yeast infection, it may take longer to treat up to a few months.  Just be aware that these same symptoms could also be due to more serious conditions like gonorrhoea and chlamydia which could cause scarring and blockage of the fallopian tubes causing infertility.  So, make sure to get it checked out by a doctor.  If a yeast infection remains untreated, it could cause additional health problems like infection in the blood.  Also repeat infections or if treatment doesn’t affect the infection, it could point to diabetes which is poorly controlled or rarely other diseases like HIV.

Prevention

Some things you can do to prevent infection include following a healthy diet like fruits, vegetables and yoghurt and getting regular exercise.  Try to avoid consuming excessive sugary foods.  Keep the vaginal area clean and dry and try to avoid using scented soaps and douching which can affect the natural pH balance of the vagina.  If you have to take antibiotics, you should also take probiotic supplements or other foods like yoghurt which have healthy bacteria.  Try not to wear tight clothes, wet swimsuits or sweaty clothes for long periods of time, wear cotton underwear and keep the vaginal area dry. During your time of menstruation, try to change pads and tampons often and use chemical free pads preventing any infection.  So, in conclusion, yeast infections are treatable and it cannot directly affect your fertility.  If you want to know more about vaginal yeast infections, feel free to talk to the experts at Xenith Advanced Fertility Centre.

Hepatitis is any disease that causes an inflammation/infection of the liver and it is mainly caused by hepatitis virus although some other viruses, parasites and bacteria could also cause inflammation of the liver.  Hepatitis could also be caused by certain health conditions, consuming excessive alcohol over long periods of time, certain toxins or medications or autoimmune diseases. 

Types of hepatitis

Hepatitis A is caused by Hepatitis A virus (HAV) and is spread through contaminated food and water.  It is a short term or acute disease. 

Hepatitis B is caused by Hepatitis B virus (HBV) through infected blood or sexual contact or passed from mother to baby during pregnancy.  It could be an acute (short term) or chronic (long term disease) and more severe. 

Hepatitis C is caused by Hepatitis C virus (HCV) through infected blood and some bodily fluids.  It could be transmitted through sharing of contaminated needles.  It is often a chronic infection and could lead to liver cirrhosis.  Many do not have any symptoms at all.

Hepatitis D is caused by Hepatitis D virus (HDV) and it occurs only in people who are already infected with Hepatitis B.  It can be acute or chronic (longer than 6 months).  It could be contracted through bodily fluids or through birth from the mom to her baby.

Hepatitis E is caused by Hepatitis E virus (HEV) and like HAV, it is spread through contaminated food and water especially in areas with poor sanitation.  It too is an acute disease although it could be more severe than Hepatitis A.  It could be dangerous for pregnant women, the elderly or the immunocompromised people.

Alcoholic Hepatitis is caused due to long term consumption of excess alcohol.  It could be reversed if caught early or if alcohol consumption is cut back.  Due to this the liver cells could get injured and could lead to scarring and permanent damage (cirrhosis) to the liver eventually leading to liver failure. 

Sometimes one’s own immune system can attack the liver thinking it is harmful.  This is more common in women.

Symptoms

Symptoms of hepatitis could include fatigue, nausea, flu like symptoms, abdominal pain, joint pain, loss of appetite, jaundice (yellow skin and eyes), dark urine and pale stool and sometimes even liver failure although sometimes there are no symptoms at all. 

Diagnosis

The doctor will first check your history to find out any reason for your illness and will do a physical exam to see if there is any tenderness or pain in the abdomen and liver and also check for any symptoms like yellowing of the eyes or skin.  Results of the blood tests can provide information on the type of virus, the viral load (the amount of virus present), the antibody levels that are fighting the virus in your body, liver enzyme levels which show how well the liver is working amongst other things.  A special liver ultrasound called transient elastography could be used to find out the amount of liver damage.  They may also take a sample of your liver, also called liver biopsy, by poking a thin needle through your skin and into the liver to check for damage.  An alternative to liver biopsy is magnetic resonance elastography (MRE) where the pattern of the sound waves can determine how much scarring is present in the liver.

Treatment

Treatment will depend on the type of hepatitis you have and its severity.  Treatment for Hepatitis A and E is just bed rest, proper nutrition, avoiding alcohol and hydration and it usually resolves on its own.  Pregnant women with Hepatitis E should be closely monitored.  Treatment for chronic Hepatitis B, C and D might require antiviral medications along with regular check-ups with the doctor to see if the medications are indeed working.  People infected with chronic Hepatitis B might need treatment for the rest of their lives.  Acute Hepatitis B infection might not need any treatment.  Corticosteroids could be used to treat autoimmune hepatitis and this suppresses the immune system.  Vaccines for Hepatitis A, B and D are available but not for Hepatitis C and E.  Also minimize the exposure to these viruses by staying away from alcohol and contaminated food and water, practice proper hygiene as well as contaminated needles and risky sexual contact.  If the liver is severely damaged, you might need a liver transplant.

Hepatitis and fertility

Some hepatitis infections can impair the quality of the sperm like its motility, its shape, its quantity and semen volume. (1)  They also might have an increased risk of damage inside the sperm which can cause infertility and miscarriage.  Hepatitis B and C affect fertility in males.  There is some evidence that it can affect female fertility also.  One study found that men with Hepatitis B are 1.59 times more likely to experience infertility than ones who haven’t been infected. (2) Hepatitis B virus has a specific protein which attacks the cell membrane of sperm and damages it decreasing its motility and fertilization rate. (3)  A HBV infection in women could cause scarring or blockages in the fallopian tube or lead to infertility in the uterus.  A HBV infection could lower the immunity in the women making them more vulnerable to sexually transmitted infections and pelvic infection. (4) So, it is important to see your doctor immediately if you feel you might have become infected with Hepatitis.  Also, if you are having trouble conceiving and have hepatitis, it might be beneficial to see your fertility specialist about how to improve your odds of having a baby and also how the baby would not have hepatitis transmitted through the mother.  Come feel free to talk to the experts at Xenith Advanced Fertility Centre if you have any questions about hepatitis and its effects on fertility.

Testicles are located in the scrotum which Is a loose bag of skin under the penis.  Sperm is produced in the testicles and male hormones like testosterone are also made here.   Cancer is a disease where some cells begin to grow and multiply uncontrollably eventually spreading to other areas of the body. Testicular cancer is cancer of the testicles.

How does it affect fertility

Often, testicular cancer will occur in one testicle and the unaffected testicle could make enough testosterone and sperm.  Almost all testicular cancers start in the germ cells in the testicles which make sperm and thus the cancer itself and its treatment could affect fertility.  Sometimes treatment might involve removing the testicle which is needed for reproduction and some treatment might affect some hormone levels and might damage the DNA in the sperm itself leading to issues with infertility or might even cause miscarriages or birth defects in the baby.  After chemo treatment, the production of sperm might slow down or might stop completely.  It might take a few years for sperm production to return and sometimes it might not be produced at all. 

So, make sure to discuss with your doctor how to preserve your fertility if you have plans to have children in the future before you begin treatment.  Fertility could also depend on your age, other health issues, the severity of the cancer, and the type of treatment.

What causes testicular cancer

It’s most common in young men. There is a higher risk of testicular cancer if there is a family history of it, if you have had testicular cancer before or if you are born with certain congenital malformations of the genitals. (1, 2)  Some environmental factors could also cause testicular cancer.  Most testicular cancers can be cured even if it’s found at an advanced stage.

Symptoms

Most testicular cancers can be detected early although in some cases there may be no symptoms until the advanced stage.  Often, a lump in your testicle could be the first sign of the testicle could be swollen.  Other symptoms could include pain in the testicle or scrotum, feeling of heaviness in the scrotum or lower abdomen, low back pain, or breast growth/soreness.  It’s often normal that one testicle is larger than the other or that one hangs lower than the other.  So, it is recommended that you should examine their testicles routinely. 

Diagnosis

Blood tests might be done to look for certain proteins called tumor markers or other enzymes which could indicate the presence of a tumor or cancer in the testicles.  An ultrasound could be done to verify the presence of a cancerous tumor or benign (noncancerous) tumor or if it’s some other condition like a varicocele (varicose veins in the scrotum) or something else.  Another diagnostic tool could be surgery although getting a biopsy (small piece of the tumor) is rarely done to prevent the cancer from spreading.  Surgery might be done to remove the entire testicle.  If testicular cancer has been diagnosed, more tests like CT, MRI and x-ray may be done to see if the cancer has spread to other areas of the body.

Treatment

Treatment may depend on the severity of the cancer.  The various treatment options are surgery, radiation therapy, chemotherapy, and other new treatment undergoing clinical trials.  Surgery is done to remove the affected testicle and some lymph nodes where the cancer might have spread as well as any tumors.  After the surgery, you might need to undergo chemotherapy and/or radiation therapy to make sure any remaining cancer cells are destroyed.  Radiation therapy uses X-ray or other types of radiation to kill cancer cells.  If radiation is directed at one testicle, the other testicle should be shielded with a lead shield if possible.  Chemotherapy uses drugs to kill the cancer cells or stop them from dividing.  Since sperm cells also divide quickly, they could also be damaged by chemotherapy.  After the treatment has ended, follow up tests might be done to make sure cancer is in remission and doesn’t come back.

Ways to preserve your fertility

Fertility preservation might be needed to save the sperm for future use if you are diagnosed with testicular cancer and it should be done as soon as possible.  It may involve storing your sperm in a sperm bank for future use.  Here, the sperm in the semen sample is tested for quality, quantity, motility as well as other parameters and then cryopreserved (frozen) and stored.  The process of cryopreservation involves separating the sperm from the semen, placing it in a special freezing solution and frozen in liquid nitrogen at -196oC.  This prevents ice crystal formation which can damage the sperm.  However, some sperm banks will not accept semen samples that are positive for some infectious diseases like HIV or hepatitis.  The samples will be viable for a long time.  In the future, the frozen sperm can then be thawed and used for conception in the future via intrauterine insemination (IUI) or in vitro fertilization (IVF) together with intracytoplasmic sperm injection (ICSI).  IUI is a procedure where the sperm is transferred to the woman’s uterus when she is ovulating in order to conceive. IVF is a procedure where the woman’s eggs are retrieved from her ovaries, and placed with many sperm in a laboratory setting in order for fertilization to occur and form an embryo which is then transferred back to the woman’s uterus for conception to occur.  Sometimes in the case of severe male infertility, a single sperm is injected into an egg for fertilization to occur and this process is called ICSI.

Cancer can take a toll on your body physically but it could also affect you mentally and emotionally.  You might feel your life has been turned upside down and may feel overwhelmed with all the information and new terminology presented from your doctor.  You may feel angry, afraid, worried, guilty and ask yourself constantly why this would happen to you.  You may distance yourself from others to figure out what to do or you may feel very lonely.  You may also know others who have had cancer and survived and have some hope. It could also lead to stress, anxiety and depression.  After the treatment is finished you might also have to adjust to a “new normal” being careful of everything you do, being scared of the cancer recurring and for going back for a check up. (4) So how do you cope with all this?  It might help to have someone close to talk to and air out your feelings and concerns whether it be your close friend, your spouse, a support group or a counsellor.  It may help to not blame yourself and try to see the positive side of things.  Try to do things that relax you like listening to music, going for a walk, doing yoga and meditating, journaling, painting, going for a massage or trying out a new hobby.  If you are dealing with depression, you might need to see a professional.  You might also find peace in your faith.  Just know that testicular cancer has a high survival rate and it can be beaten.  So take a few deep breaths and stay positive.  If you wish to speak to some professional about how testicular cancer could affect your fertility, come talk to us at Xenith Advanced Fertility Centre.

Ovarian stimulation (OS) is a treatment that increases the number of eggs developing in a cycle with the aim of improving pregnancy rates because usually the ovaries release only one egg during ovulation each cycle.  It is recommended for people dealing with infertility which means that a couple has been unable to conceive even after 1 year of having unprotected sex. 

Assisted reproductive technologies like intrauterine insemination(IUI) or in vitro fertilization (IVF) have been used to improve conception rates with the help of ovarian stimulation. IUI is a procedure where the washed sperm is transferred to the woman’s uterus just when she is ovulating in order to conceive. IVF is a procedure where the woman’s eggs are retrieved from her ovaries, and placed with many sperm in a laboratory setting in order for fertilization to occur and the resulting embryo is then transferred back to the woman’s uterus for conception to occur.  Sometimes in the case of severe male infertility, a single sperm is injected into an egg for fertilization to occur and this process is called ICSI or intracytoplasmic sperm injection.  So, it’s beneficial to retrieve as many eggs by OS to improve the chances of conception via IVF.

Menstrual cycle explained

Day 1 of the menstrual cycle is the first day you get your period.  The menstrual cycle has 2 main phases: the follicular phase which makes up the first 10-16 days of the cycle until ovulation and the luteal phase which begins right after ovulation and goes until the start of menstruation again.  An average menstrual cycle goes for about 28 days.  The cycle is regulated by the levels of various hormones some of which include luteinizing hormone (LH), follicle stimulating hormone (FSH), estrogen and progesterone.  In the beginning of the follicular phase, the hypothalamus produces gonadotropin releasing hormone (GnRH) which will then cause the pituitary gland in the brain to release FSH which stimulates the growth and maturation of the follicles.  The maturing follicles produce estrogen which then peaks a day before ovulation and stimulates an increase of LH.  About 34-36 hours after the LH surge, ovulation occurs and the mature egg is released from the follicle around day 14.  The LH levels drop whereas progesterone levels begin increasing to prepare the uterine lining in the uterus for possible implantation of a fertilized egg. In the absence of a fertilized egg, the progesterone levels start decreasing and the uterine lining also called the endometrium is shed beginning the next menstrual cycle. 

How does ovarian stimulation work?

Prior to treatment, the fertility specialist will take a detailed medical history, conduct a physical exam, do an ultrasound of your ovaries and uterus, run various tests to predict how your ovaries will respond to various medications and also find out how many eggs are available.   Age can be a big factor since the quantity and quality of eggs decline over time especially after age of 35.  Anti Mullerian hormone (AMH) levels in the blood can predict the quantity (ovarian reserve) but not the quality of the eggs you have left in your ovaries.  An ultrasound can also be done to evaluate the number of viable eggs in the ovaries.  Since a female is born with all the eggs she will ever have and this number depletes over the lifetime and it is important to know how many eggs are left.  Sometimes hormonal imbalances could lead to infertility.  Levels of other hormones like LH, FSH, estrogen, progesterone and others are checked.  Depending on the results of these various tests, your age, your body mass index, your medical history and other conditions, the doctor will adjust the medication and the protocol they will follow for your unique circumstances. 

On Day 1 of the cycle, they might do some baseline bloodwork and ultrasound.  After this, the treatment will begin and the length of the stimulation will depend on how the follicles respond as per the bloodwork and ultrasound results.  They will begin treatment with gonadotropins to stimulate development of multiple follicles.  Usually, many follicles will die in the beginning of the menstrual cycle and the aim is to enable these follicles to continue growing by stimulating them.  With multiple follicles developing at the same time, there is a risk of premature ovulation.  So other medications will be used to make sure that ovulation occurs at the right time.  An injection of another hormone will be needed to trigger ovulation 36-38 hours before egg retrieval in order for the doctor to precisely time the retrieval.  They will aim to retrieve between 8 to 15 eggs because it’s a fine balance between the risk of ovarian hyperstimulation syndrome (OHSS), having multiple pregnancies which could risk health of both mother and babies, and risking the chance of having a high quality embryo.  OHSS is an adverse response from having excess hormones and too many follicles developing, leading to swelling and pain in the ovaries along with other symptoms.  If less than 4 eggs are to be retrieved, it might be considered a poor response to stimulation. 

The ovarian stimulation could last between 8 to 13 days and you will need to take daily injections and go often for blood tests and ultrasound so that the follicles could be closely monitored.

What medications are used?

Fertility drugs are medications that can stimulate or control ovulation.  Here are some that are used:

1. Clomiphene citrate- increase the FSH levels secreted by the pituitary gland.
2. Synthetic Human Chorionic Gonadotropin (hCG)- induce ovulation
3. FSH- stimulate follicle growth in the ovaries
4. Gonadotropin-Releasing Hormone (GnRH)-used to stimulate the pituitary gland to secrete LH and FSH.
5. GnRH agonist-suppresses ovulation
6. GnRH antagonist-binds GnRH receptors and prevents premature ovulation.
7. Progesterone- given after egg retrieval to make implantation more successful.

Lifestyle and self care

There are some things you can do to improve the outcome of ovarian stimulation.  Some of these include getting moderate exercise, maintaining a healthy weight, eating a healthy diet, stop smoking, taking proper medications for any health issues, getting enough sleep, and reducing stress.  You can also read up on ovarian stimulation and ask your doctor any unanswered questions.  You can get emotional support from your partner, close friends or family, a counsellor or join a support group. Ovarian stimulation can improve the odds of conception by maturing many eggs at one time.  The experts at Xenith Advanced Fertility Centre are very well qualified to help you along on the journey to parenthood.  Feel free to contact them if you have any questions about ovarian stimulation or any other topics about fertility.

Hyperspermia is a condition in which a man produces a larger than normal volume of semen during ejaculation. Semen is the fluid that contains sperm, along with some alkaline fluid from the prostate as well as some other fluids to help the sperm travel and survive its journey to fertilize the woman’s egg and it is ejaculated by a man during orgasm.  Hyperspermia is very rare and it doesn’t cause any issues with his health although it could sometimes reduce his fertility.

The normal volume of ejaculate after 2-7 days of sexual abstinence is about 2-6 mL and more than 6 ml is thought to be hyperspermia according to one study (1).  However, frequent ejaculation may lower the semen volumes and prolonged abstinence could increase the semen volume. 

What causes hyperspermia

It is not known exactly what causes hyperspermia.  Long periods of abstinence could increase semen volume.  Also use of steroids, certain medications used for surgery and drugs to increase sexual drive could cause hyperspermia.  Certain diets rich in protein and fibres may also cause hyperspermia.  An infection in the prostate could also lead to hyperspermia. 

Does hyperspermia affect fertility

The quantity of sperm or the sperm concentration in the ejaculate could affect fertility although in most cases, hyperspermia doesn’t affect fertility too much.  If the ratio of number of sperm to volume of semen is within the normal limits or there is more sperm, then this could even increase fertility due to the higher semen volume.  However, if the semen is thinner and results in dilution of the sperm, then there is a decrease in fertility and it may take longer than usual to conceive.   If there is a longer period of sexual abstinence, there may be a higher proportion of sperm that is dead or damaged which could also lead to infertility.   Taking steroids or certain drugs could cause hyperspermia.

Symptoms of hyperspermia

Of course, the main symptom of hyperspermia is producing a higher volume of semen during ejaculation and this might increase risk of infertility like taking longer to conceive or having a slightly higher risk of miscarriage.  Some men with hyperspermia might have a higher sex drive and some others also report slight discomfort or pain during ejaculation. 

How is it diagnosed

The doctor will give you a physical exam and you will have semen analysis done to check your sperm count, semen volume as well as other parameters in your semen.  The semen volume cannot be tested in a single ejaculation.  A blood test might be done to check your hormone levels.  An ultrasound might also be done to check for any issues related to infertility.

Treatment

Talk to a fertility specialist to increase sperm count if you are facing issues with infertility.  Speak to a urologist to reduce the semen volumes.  Infertility issues could be addressed through in vitro fertilization (IVF), intrauterine insemination (IUI), Intracytoplasmic sperm injection (ICSI) or other assisted reproductive technologies.  IUI involves washing, and concentrating the sperm and injecting this into the woman’s uterus when she is ovulating in order to aid in conception.  IVF involves stimulating the woman’s ovaries to produce more than one mature egg and retrieving these eggs and fertilizing them with either many sperm (IVF) or injecting one sperm into the egg (ICSI) for fertilization in a laboratory setting.  The fertilized egg is then transferred back to the woman’s uterus for implantation. You don’t necessarily need to treat hyperspermia if it is not causing any issues.  However, if it’s affecting your fertility and you are having trouble conceiving, it might be important to see a fertility specialist or a medical expert to have this reviewed and rectified.  The experts at Xenith Advanced Fertility Centre could help you to overcome this issue if you are having trouble conceiving.  Come talk to us if you have any questions.

Yoga is an ancient practice from India that focuses on various body poses (asanas), mind (meditation) and breathing(pranayama) joined together.  It is well known that some exercises like yoga during pregnancy can keep you in good shape and also prepare you for labor and delivery.  But can yoga increase your chances of conception?

The number of couples struggling with infertility is steadily increasing all over the world due to stress, health issues, age and various other factors and it is taking a toll on one’s body both physically and mentally.  The chances of conception can increase with a healthy body and calm mind.  This is where yoga could help.

Fertility yoga is a special type of yoga to help women who are struggling with infertility.  Basically, fertility yoga involves doing yoga poses, and following breathing and meditation techniques that are thought to be beneficial for your reproductive health and helps you to relax and decrease stress and anxiety, increasing your chances of conception. A study at Harvard has found that women who took fertility focused yoga courses were almost three times more likely to conceive than those who did not.(1)

It has been shown that yoga can indirectly boost your fertility.  How?

1. Yoga relieves stress– stress is common in couples struggling with infertility and it could take a physical toll on both the man and the woman’s body leading to depression and anxiety.  Stress could lead to hormonal imbalances which in turn could affect ovulation and cause irregular periods in women. (2)  When the body is under stress, it tries to compensate by shutting down processes in the body which it thinks is not necessary to survive.  Stress could also affect sperm count as well as sperm quality in men.  People under stress could also resort to drinking too much alcohol, smoking, eating unhealthy foods and other things which in turn could affect fertility.  Yoga has positive effects on reducing stress. (3)  It can lower the heart rate as well as blood pressure.  It can also keep hormonal imbalances due to conditions like polycystic ovarian syndrome (PCOS) at bay.
2. Yoga can help in attaining and maintaining a healthy weight. (4)  It can decrease obesity which can play an important role in improving chances of conception.  It can also improve your flexibility and strengthen your body which could help throughout your pregnancy and during labor and delivery. 
3. It can improve your breathing- Diaphragmatic breathing could reduce stress (5) and it’s important to breathe with your nose rather than through your mouth.  People who are under a lot of stress tend to breathe fast shallow breaths with their mouths and yoga helps you to be aware of how you breathe and slow it down, which, in turn, is a stress reducer.
4. It can improve blood flow to various parts of the body(6) and is also good for your heart.
5. It can create mindfulness of your own self and help you to accept whatever is going on in your body, and in your circumstances.(6)  It can help you realize how the mind and body are connected together and can affect each other to bring about your better health. 
6. It can lower pain levels (6)
7. It can improve sleep quality.(7) sleep deprivation in women has been found to alter certain hormonal levels which in turn could affect fertility.

Improvements in these above parameters could in turn boost fertility.

What yoga poses could you try?

1. Surya Namaskar- also called sun salutation is a series of poses that helps improve blood circulation and could help with irregular menstrual cycles. 
2. Paschimottanasana- or the seated forward fold stretches the muscles in your lower back, hips and hamstrings.
3. Baddha Konasana- or the butterfly pose improves flexibility of muscles in inner thighs, hips, knees and genitals.  It is done by sitting with soles of your feet together and slowly moving the knees up and down like a butterfly.
4. Viparita Karani- also improves blood circulation to your pelvic region and is called the legs up the wall pose.
5. Marjaryasana- is called the cat stretch by starting on all fours and rounding out the spine and drawing in the navel.
6. Balasana- helps relieve stress and increase blood flow as well as stretches the back muscles,

knees, hips and thighs. It is called a child’s pose because it resembles a foetal position. Do it on an empty stomach.

• Kapalbhati Pranayama- helps reduce stress levels by sitting in lotus position, inhaling deeply and exhaling forcefully to push the stomach in.
• Bhramari Pranayama- also called the humming bee breath asana is done by placing your thumb over your ears, closing your eyes with the rest of your fingers and making a humming bee sound in a high pitch tone while exhaling for as long as you can. It helps to calm the body.
• Anulom Vilom – or alternate nostril breathing, improves lung function and has a calming effect.
• Shavasana- is very simple and also known as the corpse posture and is done at the end of each yoga posture to normalize the heartbeat and also relax strained muscles. It is basically lying flat on your back and breathing normally for 3 to 4 minutes. It can give you a peaceful rest.

Practice these moves regularly to help you relax and de-stress. However, make sure you have mastered the correct posture and breathing techniques by learning from a certified yoga instructor in order to avoid any injury.  Also try to avoid over exercising as this too could be detrimental to fertility and avoid doing hot yoga.  Couples are recommended to do yoga together as it can help them overcome stress related to the strenuous IVF procedure and they can spur each other on and support each other.  Also speak to your physician or your fertility specialist before trying anything new especially if you have a medical condition.  The experts at Xenith Advanced Fertility Centre would love to answer any questions you might have about how to boost your fertility.

Egg freezing is a procedure where a woman’s eggs are retrieved, frozen and stored for use at a later date.  Many young women feel the need to pursue higher studies and a career before having kids.  Others might not have met their partner yet and feel the clock is ticking away.  Still others might have some health issues like cancer and might want to preserve their eggs before undergoing chemotherapy or surgery.  Whatever the reason, egg freezing could help preserve good quality, healthier eggs when you are younger for use at a later date because as women age, the egg quality and quantity decreases. Since women are born with all the eggs they will ever have and this quantity and egg quality decreases over time, it might be advantageous to preserve good quality eggs when they are younger.  It is thus important to talk to a fertility specialist about your unique circumstances and get advice about your chances of going through a successful pregnancy.  Egg freezing needs to be contemplated by women who wish to have a child at a later date when they might not have many good quality eggs at that time.

What questions do you ask your doctor?

1. What is involved in egg freezing- The doctor will assess you and run various tests like blood tests and do a pelvic ultrasound to determine how many potential eggs you have in your ovaries.  You will then be given various hormone injections and medications to stimulate your ovaries so that several eggs will mature at the same time.  Once the eggs have matured, they will be retrieved under an ultrasound guided surgery under anesthesia.  This short procedure will take only 15 to 30 minutes.   The retrieved eggs are then flash frozen in a matter of milliseconds in a process called vitrification. In vitrification, the formation of ice crystals is avoided due to the flash freezing, the water is replaced with a preserving solution and frozen in liquid nitrogen at -196oC in special cryogenic freezers in an embryology lab so that the biological process in the egg is halted.  In the future, when the egg is needed for fertilization, it is thawed quickly, the preserving fluid is removed and the eggs are washed in culture medium and warmed, awaiting fertilization.  The fertilized egg or embryo is then transferred back into the woman’s uterus for possible implantation and conception.  The whole procedure of retrieving the eggs will take about 3 weeks and is the same as the initial stages of invitro fertilization(IVF).
2. At what age do I consider freezing my eggs – basically, the answer is, the younger you are, the better your chances.  In general, its best to carry out egg freezing before the age of 35 because female fertility begins to decline rapidly around age 35 although this could vary for different people depending on various factors like overall health, lifestyle, chronic diseases, genetics or other things.  If you’re past this age, speak to your fertility specialist about your chances of conception.
3. How many eggs do I freeze- depends on your ovarian reserve or how many eggs you have left in your ovaries.  The number of eggs you want to freeze could depend on your age as the egg quality declines over time, your overall health, your genetics and various other factors.  So an older woman might want to freeze more eggs than a younger woman in order to have better chances of getting pregnant.  It would also depend on how many kids you want to have in the future.  Remember that not every egg will survive the freezing and thawing process or successfully fertilize with the sperm. So, its good to discuss with your doctor about your chances of having a child and what to do to improve your chances of conception. 
4. Is there any risks and side effects- Most women go back to work and normal activities the day after the procedure since it is done on an outpatient basis, and the risk of complications is very low.  Some women might have some minor side effects from the medications like headaches, nausea, breast tenderness and bloating which will dissipate soon.  You might also have some slight cramping after the egg retrieval procedure.  Your periods will soon return back to normal after this procedure and this doesn’t affect your future fertility in any way.  In very rare cases, ovarian hyperstimulation syndrome (OHSS) could occur due to the excessive stimulation of the ovaries and the ovaries get enlarged causing nausea, vomiting, bloating and severe abdominal pain, however most clinics nowadays are OHSS free cliics. This is a safe procedure for the mother and there is no increased risk of birth defects in the baby or complications for the mother.  
5. What is the success rating of this clinic – Often, you can find this information online.  You could also ask the doctor if this number is based on the conception rate or number of successful live births.  Some clinics will not take on high risk patients or patients that have low chances of conception just to keep their success rates high.  Also look into the qualifications and the amount of experience of the fertility specialist.  See if you are able to have good rapport with the specialist and if the clinic has all the amenities and equipment needed to do everything and tackle most scenarios right on site.
6. What will be the cost and financial considerations for this procedure – the cost of freezing your eggs could vary from one facility to another.  Find out if the quote that is given will include hormone injections, the various appointments for ultrasound, blood tests, anesthesia costs, as well as the egg retrieval process.  Will it be covered by your insurance?  Sometimes, you might have to go through multiple rounds of egg freezing to get more eggs.  Will you get a discount for doing more than one round?  Also, you will also have to look at the yearly cost of storing those eggs until you decide to use them. The more eggs you freeze, the higher the cost of storing them. 

When you meet with the fertility specialist, make sure you have a frank discussion with them and ask all your questions.  Read up about the whole process and go prepared with questions like details about the procedure itself, does the clinic have all the proper equipment under one roof, and the total cost.  Egg freezing is not a guarantee for pregnancy and find out what are your chances and how many eggs will need to be harvested for your specific age and circumstances.So egg freezing could buy you some time and help you to secure your parenthood dreams for the future.  If you are contemplating egg freezing, and have any questions about it, please feel free to contact the experts at Xenith Advanced Fertility Centre who can explain everything in more detail.

Testicular atrophy occurs when the testicles have shrunk or reduced in size.  Testicles are the 2 oval shaped reproductive organs enclosed within the scrotum located behind the penis.  The scrotum itself can control the temperature around the testicles by shrinking during cold temperatures and getting bigger during warmer temperatures.  However, the shrinking of the testicles themselves is called testicular atrophy.  The testicles produce and store sperm and also produce a hormone called testosterone which is important for fertility, and they are also important for bone and muscle mass. 

What causes testicular atrophy

The testicles mainly consist of two types of cells which are the germ cells responsible for sperm production and the Leydig cells responsible for production of the male hormone mainly testosterone.  A reduction in either of these cells could cause testicular atrophy. 

Testicular atrophy could occur due to many reasons some of which could include testicular torsion, orchitis, varicocele, injury, aging, hormone imbalances, chronic and excessive consumption of alcohol or exposure to certain chemicals.  Testicular torsion occurs when a testicle spins and twists the spermatic cord which in turn, reduces the blood flow to the scrotum causing pain and eventually causing testicular atrophy if it’s not treated quickly.  Viral orchitis due to the mumps or HIV virus or bacterial orchitis due to sexually transmitted infections like Chlamydia or Gonorrhea, or infections in the urinary tract could lead to inflammation of the testicles causing pain, swelling, nausea and fever eventually lead to testicular atrophy.  A varicocele is like having varicose veins in the testicles, where the blood pools in the veins of the scrotum and this in turn could affect the sperm producing tubes in the testicles and lead to testicular atrophy.  The testes could also shrink naturally due to aging as the body produces less testosterone or sperm.  Hormone imbalances could occur due to taking steroids or some medications, or having certain diseases or infections. (1)

Some men who are on testosterone replacement therapy (TRT) for various reasons might also experience testicular atrophy.

Symptoms of testicular atrophy

Other than reduced testicle size, symptoms could include pain in the testicles, infertility, decreased sexual drive, less facial or pubic hair, low muscle mass and softer testicle.  Testicular atrophy could affect sperm morphology and production in turn affecting fertility.

Diagnosis

The doctor will check your history of steroid use or certain medications you are taking as well as find out about your lifestyle and if you have any sexually transmitted diseases.  The doctor will also do a physical exam to check for size, firmness and other conditions.  An ultrasound exam of the testicles might be done to look for any abnormalities and how the blood is flowing.  A blood test might also be done to see if there is any infection or hormonal imbalance.  This condition could be reversed with proper treatment but sometimes it cannot be treated if it’s caught very late or if it’s very severe.

Treatment

The course of treatment for testicular atrophy could depend on the reason for the testicular atrophy.  Hormonal therapy could be used to increase testosterone and sperm production.  Medication could be used to treat an infection or a disease.  Surgery might be needed for testicular torsion or for varicocele.  Lifestyle changes like not consuming alcohol or steroids, changing medications, exercising, and eating healthier could also improve this condition.  If infertility continues after treatment, assisted reproductive technologies like in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI) and other procedures could be used to improve chances of conceiving.  The ICSI procedure involves a single sperm carefully injected into the center of an egg using a micro needle. With ICSI, only one sperm per egg is needed.

However, sometimes testicular atrophy might not be reversible.  For instance, if testicular torsion isn’t treated immediately, it might not be reversed and so its better to treat it earlier.  Dealing with testicular atrophy could also have an impact on you emotionally also when you are dealing with infertility, decreased sexual libido, less facial or pubic hair amongst other reasons.  It might cause stress, anxiety, anger, depression and low self esteem.  Low testosterone levels could also lead to depression, having trouble concentrating or affect your memory. Speak to your doctor on how to deal with these feelings if it’s affecting your life.  You could also improve your lifestyle, cut out alcohol, get regular exercise, try meditation and eat healthy to improve your mood.  It’s important to get it treated early in order to reverse testicular atrophy.  So don’t delay if you feel you might be dealing with testicular atrophy and get it checked from your doctor right away.  If you have any questions regarding testicular atrophy, come speak to our experts at Xenith Advanced Fertility Centre.

Infertility, which is the inability to conceive after 12 months of unprotected sex, is becoming very common around the world.  Infertility is not talked about very much and many people are often unaware of it.  The number of couples seeking treatment for infertility has increased drastically because women are postponing pregnancy due to various reasons like getting higher education and furthering their career, because people are more aware of fertility treatments like IVF and ICSI, and because the success rates for such procedures have improved.  However, did you know that fertility could also be affected by your mental health and it could also be the other way around where people dealing with infertility could become more prone to mental health issues like stress, anxiety and depression?

Society sometimes places a social stigma on childless couples and women might thus feel incompetent or defective and thus feel isolated.  When women are diagnosed with infertility, it could trigger certain intense emotions like grief, shame, anger, denial, self blame, frustration, stress, anxiety or even depression.  Stress is the response to a perceived threat or a situation whereas anxiety is the response to the stress.  Anxiety might cause panic attacks for example for no apparent reason.  Some of the symptoms of depression include feeling disinterested in most things, feeling hopeless or overwhelmed, having almost no energy, having insomnia, having no appetite or feeling angry amongst other things and these feelings could last more than two weeks.   Most people encounter stress and anxiety in their lives but if it’s long term or if it’s unmanaged, it could affect one’s health including fertility.  In order to find out the cause for the infertility, the person might need to go through various tests like blood tests, ultrasound scans, and other procedures and these might feel very invasive.  Going through in vitro fertilization (IVF) or other fertility treatments in order to increase the chances of conception could increase the levels of anxiety and stress even more.  By failing every month to conceive, the anxiety levels increase and then going through various treatments for it could add to the mental stress.  Having recurrent miscarriages could also increase anxiety and lead to depression.  Some of the medications used during IVF could also affect one’s mental health and some antidepressants taken to improve mental health could increase the risk of pregnancy loss.  So, it’s important to talk to your physician about what to do.

What can affect mental health and fertility

Infertile women are more prone to mental health issues.  Infertility in women could be due to many reasons such as a damaged or blocked fallopian tube which could make it difficult for the egg or the fertilized egg to travel to the uterus, endometriosis where tissue similar to the uterus lining grows outside the uterus and cause a lot of pain, polycystic ovary syndrome (PCOS) which is a hormonal condition sometimes causing eggs to form cysts, and various other diseases, infections, environment, medications and age.  But sometimes, the cause for infertility could be unexplained. 

Stress could affect hormone levels which could in turn affect egg quality, prevent embryo implantation in the uterus or other things.  Stress could also delay ovulation or affect your sex drive,

Fertility and mental health could also be affected by lifestyle factors like diet, exercise, obesity, insomnia, smoking and drinking excessive alcohol or caffeine.

How to cope

-Talk to someone whether it’s your partner, a close friend or family, a support group or a counsellor about how you are feeling.  It might help to air out your fears and feelings that you are struggling with and get advice or a different point of view.  It might help to just have someone listen to your thoughts and for them to keep silent.  It might also help to cry or release your pent up feelings and not keep it all bottled up inside.  A psychiatrist or counsellor might teach you various coping skills on what to do when you feel anxious and to know what the warning signs would be.  You could also get more educated about what you are dealing with and how to cope with it.  Try not to compare how you deal with stress with others reactions because everyone deals with stress differently. 

-Learn relaxation techniques like meditation, yoga or breathing exercises to decrease anxiety.  Try to remove activities or things that cause you stress.

-Practice journaling and keep a diary so that you can write down or articulate your thoughts and feelings.

-Eat healthy foods filled with fruits, vegetables, nuts, whole grains and avoid processed foods, and bakery/sugary items.

-Try to get 7 hours of sleep, try to relax before going to sleep, go to sleep at set time every day, keep the room dark and don’t watch tv or mobile before going to bed.  Disturbances in one’s sleep due to certain diseases or other factors could affect fertility as well as mental health.  Sleep disorders could affect reproductive hormone levels in turn affecting fertility.

-Stop smoking, and limit alcohol and caffeine consumption.

-Get regular exercise like walking for at least 30 minutes daily.

-Before beginning IVF or any other treatment for fertility, it is recommended that people be counselled on what they could expect and feel emotionally during the various phases of the treatment and also be taught how to cope with such feelings. They should be educated on how to deal with their fears and help them to be better prepared and educated for the ups and downs of going through the treatment.  So your mental health could affect your fertility and it’s very important to address this by talking to a mental health professional or your doctor.  If you are struggling with infertility and or dealing with issues in your mental health and you don’t know what to do or where to start, try talking to your doctor and ask for advice.  The experts at Xenith Advanced Fertility Centre are very well versed in such circumstances and could help you alleviate your fears and concerns so that you could go on to have a successful conception and pregnancy.

A varicocelectomy is a surgical procedure done to manage enlarged veins around the testes, also called varicoceles, in the scrotum. Varicoceles are quite common, might not be noticed at all throughout your life and are rarely dangerous.

What is a varicocele

The scrotum is a sac of skin that hangs just below the penis and it contains the testicles which produce and store sperm and also produce certain hormones like testosterone.  The scrotum hangs outside the body so that a lower temperature could be maintained for the sperm production.  The scrotum also contains arteries and veins that deliver blood to the reproductive glands.  A varicocele is similar to varicose veins in the leg.  The veins have one-way valves that move blood from the testicles to the scrotum and then back to the heart.  However, sometimes the one-way valve in the vein, which is supposed to ensure that the blood only flows to the heart, doesn’t work very well and the blood begins collecting in the vein, enlarging the vein and producing varicocele.  Why varicoceles form is not certain and so there are no known preventive measures.  Varicoceles most often occur in the left testicle and it could shrink your testicle.

Symptoms

Varicoceles could cause three issues which are decreased fertility, decreased production of testosterone in the testes, or slight discomfort or pain. (1) Varicoceles often have no symptoms or complications.  Sometimes there may be a dull, recurrent pain and or swelling or a lump in the scrotum.  The pain might be reported when they are standing for longer periods of time and might subside when they are lying down on their backs.  Sometimes, the enlarged veins might be visible and look like a bag of worms.  Sperm production and sperm quality might be decreased, and testosterone levels might be decreased leading to decreased fertility.  In rare instances, the presence of a varicocele could cause there to be no sperm at all in the ejaculate.   Rarely, varicoceles could also decrease testosterone levels so low that it could cause other complications like decreased libido etc. A varicocele will not get better on its own and it can happen at any age.

Diagnosis

The doctor may diagnose a varicocele by various methods.  The doctor could do a physical exam to feel for the presence of varicoceles, could ask for a semen analysis and a blood test to test your fertility levels and could also do a scrotal ultrasound to measure how big the veins have become.  There are 4 different sizes or grades of varicoceles.  Grade 0 can only be seen by ultrasound, Grade I can only be felt when you are doing a Valsalva maneuver, Grade II can be felt but not seen and Grade III can be felt and seen.   A Valsalva maneuver is done with the person closing their mouth and nose and trying to push the air out or bearing down.  If the varicocele is not bothering you or affecting your fertility, you might not need any treatment. 

If the varicocele is causing minor pain or discomfort, it could be treated with painkillers or wearing supportive underwear.  If the varicoceles are causing too much pain, causing infertility or shrinking your testicles, you might have to undergo a varicocelectomy.  Also, if the varicocele is damaging your testicle, it might need to be treated. 

What is varicocelectomy

In this surgical procedure, the affected vein is cut and sealed so that the blood will not flow into this vein and diverted through to other healthy veins. The procedure can be done as an open surgical procedure, Laparoscopic procedure with the use of a scope and a Microsurgical procedure by performing the procedure under an operative microscope. The best way is to do a microsurgical procedure as the magnification helps in identifying the enlarged veins in a much precise manner and ligating them properly. At Xenith the method used is the Microsurgical Varicocelectomy done under a high end operating microscope thus giving the best outcomes for this procedure.   .  You can usually go home a few hours after the surgery or when the doctors deem you are well enough to go home.  You might have some swelling and some pain in the scrotal area and might need to take pain killers and apply an ice pack.  You also will have to avoid strenuous exercise, lift heavy objects, or sex for the first one or two weeks after surgery.  Contact your doctor right away if you have heavy bleeding at the site, increased pain or fever.  A varicocelectomy is a relatively safe procedure, it can improve your fertility and decrease any testicular pain.  The testosterone levels could also increase after a varicocelectomy. 

In a very few people, the varicocele could reoccur after treatment or one might still have some pain or discomfort.

Not all varicoceles need to be or should be operated. It is important to identify and decide when to operate and when not to intervene.  So speak to your doctor about what is best for you if you are suffering from varicoceles.  If you are having any of the symptoms of a varicocele and are concerned about how it might affect your fertility, please feel free to contact the experts at Xenith Advanced Fertility Centre.