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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. Intracytoplasmic sperm injection (ICSI) is a procedure used along with IVF in cases of severe male infertility where a single sperm is injected directly into the egg. One of the factors leading to a successful IVF treatment, is to have a healthy embryo which is dependent on a  good quality egg and sperm.  In order to find out if the sperm quality is good, a semen analysis will need to be done.

What is meant by sperm quality?

Sperm quality refers to the overall health of the sperm and its ability to fertilize an egg. Many factors influence fertilization when undergoing IVF, such as sperm count, sperm motility, sperm morphology, and the amount of DNA fragmentation. 

1. Sperm count- As per WHO guidelines, fertility is more likely if a single ejaculate contains at least 15 million sperm per mL.(1)  Less sperm in the ejaculate could make it harder to get pregnant naturally.  In IVF, the semen is washed and only the healthy sperm are used to fertilize the egg, while it only takes one healthy sperm to fertilize an egg when using ICSI.
2. Sperm motility- refers to the ability of the sperm to move and different motility parameters are studied.  They look at what percent of all sperm are motile, what percent of sperm are motile in a mL of semen, how many total sperm in one ejaculate are motile and how fast they are moving as well as the type of movement of the sperm itself.  Progressive motility refers to the sperm swimming in a more or less straight line or in large circles rather than narrow circles or irregular movements.  It is considered normal if at least 32% of the sperm move progressively.(1)  However as mentioned earlier, with IVF, only the highly motile sperm are used or with ICSI only one healthy sperm is needed.
3. Sperm morphology- refers to the shape, size, and structure of the sperm and this can also contribute to IVF success. Typically, the sperm have oval heads and long tails.  The tail enables the sperm to swim towards the egg, and the sperm’s head contains the genetic material as well as the tip of the head has enzymes to help penetrate the egg’s surface.  Abnormalities in the morphology of the sperm can affect its ability to penetrate the outer layers of the egg for fertilization to occur.  Although with ICSI, the sperm is directly injected into the egg. 
4. DNA fragmentation-refers to the damaged or abnormal genetic material inside the sperm.  The sperm is made up of 23 chromosomes and the egg is made up of the other 23.  They join together to make up the genetic material or DNA of most cells through which proper growth and development occurs in the human body and also the information to form a healthy embryo.  DNA fragmentation can cause infertility leading to problems with having a baby. Studies have also found a correlation between abnormal sperm morphology and DNA fragmentation where the embryo may fail to develop or implant, resulting in miscarriage, or may cause genetic abnormalities within the offspring, even for those undergoing IVF.  Recent advances in the conventional microscopy methods as well as computer-assisted sperm analyzers (CASA), and other tests have made it easier to identify damaged sperm.

So, IVF can usually increase the chances of pregnancy even if the sperm count or motility is low and so are less of an issue.  However, for optimal IVF success, normal sperm count and motility are preferred. 

Is there anything you can do to improve fertility?

New sperm are produced continually in the testicles and take about 42 to 76 days to mature. Advanced paternal age and/or poor lifestyle can negatively impact sperm health producing less healthy embryos.  Some of the best ways to promote sperm health include eating a healthy diet, doing regular exercise, stopping smoking, limiting alcohol consumption, maintaining a healthy weight, preventing sexually transmitted infections, managing stress, avoiding exposure to toxins like lead and pesticides, avoiding certain medications, treating some medical conditions amongst various other things. If you haven’t been able to conceive after a year of unprotected sex, a fertility specialist could be able to find out the cause and provide proper treatments to put you on the journey to parenthood.  The experts at Xenith Advanced Fertility Centre would love to discuss any questions you might have about this topic.

Menopause occurs eventually as women age and it marks the end of her menstrual cycles. Even though menopause brings with it the freedom from the monthly periods, it also affects the body in several other ways.  Is depression something to be expected with menopause?

What is menopause

Women are born with all their eggs stored in their ovaries and this supply of eggs gets depleted over time.  Menopause happens when your ovaries have stopped releasing eggs and it’s been a year since you have had your last menstrual period. Perimenopause is the period of a few years before menopause with symptoms like irregular periods, vaginal dryness causing discomfort during sex, hot flashes which is a brief but sudden sensation of heat throughout your body, chills, night sweats meaning excessive sweating at night, problems with sleeping, mood changes or irritability, weight gain, having less energy, frequent urination, thinning hair and dry skin.  The severity of the symptoms varies between different women.  During this stage, the production of various hormones like estrogen is also affected.  Pregnancy is still possible during this time. The years after menopause are called post menopause and these symptoms usually ease off although there might be some added health risks like osteoporosis, cardiovascular disease, diabetes and dementia due to the decreasing levels of estrogen and other factors.   In India, the average age for menopause is around 46 (1) although if you have had a hysterectomy or damage to the ovaries due to chemotherapy, you might go into early or premature menopause.

What is depression

Depression is considered to be a mental health condition which affects a person’s feelings, thoughts, and behaviours.  Its symptoms can include feelings of sadness or emptiness, being tired all the time, having no interest in activities that you used to enjoy, trouble remembering or concentrating, changes in appetite and also changes in weight, and having trouble sleeping. Depression can affect how you feel, think, and handle daily activities.

There’s been a lot of debate about whether transitioning into menopause is associated with depression.  Many studies show an increased risk of depression during perimenopause.(2, 3).  These depressive symptoms also decreased in postmenopause.(5) The studies also found that those who have had a previous episode of depression are at an increased risk for depression although women with no previous episode of depression are also at higher risk of depression during the transition into menopause.  However, there’ s no evidence that menopause itself causes depression.

It could also be brought on by various other factors surrounding menopause. 

1. Physical– symptoms like hot flashes can cause anxiety and disruptions in your sleep and it could affect your mood, thereby leading to depression.  Changes in your physical appearance like gaining weight and thinning hair could also affect your perception of yourself.
2. Mental– The idea that you can no longer bear kids and the thought that you have lost your youth could take a toll on you mentally.  At this age, you might also be dealing with aging parents, career changes and your own kids might be leaving home making you feel vulnerable and alone.  Other issues like lack of social support, unemployment, and personal health issues could all add up, making you feel helpless which in turn increases the risk for depression.  Problems with memory and decreased cognitive function have also been reported in perimenopausal women.
3. Hormonal– Normally, the levels of the reproductive hormones like estrogen, progesterone, luteinizing hormone (LH) and follicle stimulating hormone (FSH) among others, go up and down depending on the time of the monthly period.  However during the transition period to menopause, the levels of estrogen and progesterone are more variable.  Estrogen levels tend to decrease as you near menopause. All these fluctuations could possibly trigger the risk of depression. (3, 6)  However, it was found that a certain subset of women seem to be predisposed to have mood disturbances triggered by hormonal fluctuations. This subset includes women with a history of mood disorders. The risk of depression appears to be higher during perimenopause, when hormone levels are changing, than during postmenopause, when estrogen and progesterone levels are low but stable. So hormonal levels itself are not correlated with depression.
4. Genetics- A personal or family history of major depression, postpartum depression, or premenstrual dysphoric disorder seem to be a major risk factor for depression in the perimenopausal period.

Treatment

There are many different treatments available depending on the severity of depression.

1. Lifestyle- Smoking can increase the severity and frequency of hot flashes and smokers are at risk of entering menopause earlier. (4) Eat a healthy diet with lots of fruits and vegetables, lean protein and healthy fats, avoid alcohol and caffeine and stay hydrated.  Do at least 30 minutes of regular exercise daily.  Try relaxation techniques like meditation and yoga and be positive and not self-critical.  Get enough sleep and try acupuncture or massage.  Enjoy time with family and friends. 
2. Hormone replacement therapy (HRT)- is an option for relieving severe symptoms and the doctor might prescribe it depending on your personal and family medical history.  Doctors usually prescribe the lowest dose and for a short period of time because even though it can relieve some menopausal symptoms, it can also make you more prone to other health conditions like heart disease, stroke and breast cancer. These drugs usually involve estrogen, progesterone, or a combination of the two. There are also a variety of dosage forms, including pills, patches, and creams.
3. Antidepressants- could help people who are not good candidates for hormonal therapy and is used for patients going through serious depression. Depression is a recurrent illness in that it can come back out of the blue.
4. Psychotherapy- Cognitive behavioural therapy can teach you to be more aware of your thoughts that make you feel bad, and replace them with positive ones.  It also helps to talk to close friends and family about what you are going through.  Your faith could also help you during this time.

The transition to menopause can affect each woman uniquely in different ways.  It might feel very overwhelming at times.  If you are dealing with depression or if it’s affecting your daily activities and relationships, talk to your doctor about how to alleviate these symptoms so that you can adjust better to this new phase of life.  The professionals at Xenith Advanced Fertility Centre have all the expertise in dealing with such situations and you can feel free to avail upon their advice.

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.