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Obesity is increasingly becoming a worldwide health issue.  Obesity is defined as having excessive body fat and it can have a detrimental effect on our body.

How do you measure obesity?

Body mass index (BMI) is a simple way to check for obesity.  BMI is calculated as a person’s weight in Kg divided by the square of their height in meters (Kg/m²).  According to WHO guidelines, a person is considered overweight if their BMI is greater than or equal to 25 and are considered obese if their BMI is greater than or equal to 30.(1)  In Asians, the suggested cutoff limits are lower with overweight people greater than or equal to 23 and obese people greater than or equal to 25 due to the propensity of Indians to diabetes and higher waist circumference.(2)  However, BMI is only a rough guide and some people like muscular athletes may have high BMI values because of their increased weight in muscle than in fat.  Waist circumference is also sometimes used as a measure because carrying more body fat around your middle or abdomen is an indicator of the amount of fat around your internal organs.

What causes obesity?

Obesity could occur due to many reasons, some of which include genetics, increased food intake, unhealthy diet, lack of exercise or sedentary lifestyle, certain medications, pregnancy, lack of sleep, some chronic health conditions or amongst other things.

Symptoms of obesity

Symptoms of obesity include sleep apnea, fatigue, depression, erectile dysfunction, and lower back pain.  Obesity has also been linked to diabetes, high blood pressure, heart disease, stroke, osteoarthritis, certain cancers and infertility.

How is obesity linked to infertility?

Obesity could lead to hypogonadism which is a condition where the testicles don’t produce enough of the male hormone testosterone.  It was also found that increasing body weight correlated with decreasing testosterone levels in the blood.  The hypothalamus, pituitary gland and the testicles work in concert to produce various hormones like testosterone which in turn affect sperm production and obesity could disrupt this. Obesity can also cause testicular heat stress due to heavy fat deposits around the scrotum which carries the testicles and due to inflammation.(3)  The process of sperm production is temperature dependent and its best for the temperatures to be slightly lower than that of the body.  So, obesity could affect sperm production and lead to decreased sperm counts, sperm motility, changes in sperm morphology and breakages in the sperm DNA.  Disruption of endocrine function which is responsible for producing certain hormones could be due to obesity.  Insulin resistance has been associated with obesity. 

Obesity can also lead to increased insulin levels in the blood which could in turn decrease testosterone levels.  Sleep apnea or having disrupted sleep due to upper airway obstructions and lack of oxygen could also affect testosterone levels.

Obesity could also decrease the success rate of assisted reproductive technologies like Invitro fertilization (IVF).(4, 5)

How to treat obesity?

Obesity is mainly preventable although it is not a “quick fix.”  It can be dealt with by making some lifestyle changes like eating healthier foods like fruits, vegetables, legumes, whole grains, nuts and avoiding fast foods, processed foods, refined foods, fatty foods, sugary foods and alcohol.  Doing at least 30 minutes of moderate exercise daily like walking can help.  Also looking after your mental health, trying to eliminate stress and having a positive attitude can help.  Having a dietician who can help you keep track of what you can and cannot eat and help you make informed choices of your diet could help you tremendously.  It may help see a counsellor or try cognitive behavioural therapy which can teach you to understand when and why you eat or alter certain thought patterns.  Talk to your doctor if you find that these aren’t working and he might prescribe you weight loss medications which can make you less hungry or reduce the amount of fat you absorb from food.  It’s important to do this along with a healthy diet and regular exercise.  However, these medications might have side effects and so make sure you talk to your doctor to see if this is right for you.  Your doctor might also suggest bariatric weight loss surgery if you are morbidly obese and it has been found to restore fertility and normal hormonal levels.(6)

If you have any questions regarding this topic, please feel to contact the experts at Xenith Advanced Fertility Centre.

Women are born with a finite number of eggs and the egg quality and quantity decreases with age until it’s depleted.  Hence the woman’s ticking biological clocks is the pressure to have children once they hit a certain age. But men produce sperm throughout their lifetime unless due to disease or some damage.  One man has even fathered a child at the age of 96!  Do men have a biological clock?  Does age affect men’s fertility?  The answer is that aging does affect male fertility although its decline is slower than in women.  Increasing male age is associated with increased time to pregnancy and decreased pregnancy rates.

At what age does fertility decline in men?

A decline in fertility in a male is not as pronounced as in a female.  Male fertility generally decreases after the age of 40. (1)

How does aging affect male fertility?

1. Semen volume– There have been many studies about the relationship between men’s age and semen volume and most of the studies have found that there is a decrease in semen volume as men grow older.  One such study found that semen volumes peaked between ages of 30 to 35 years and were significantly less in men who were more than 55 years old. (2)
2. Sperm motility– which is how well the sperm can swim is also affected with age.  Many studies found a decrease in motility with increasing age. (3)
3. Sperm morphology- which is the size and shape of the sperm is more subjective and its interpretive results can vary from lab to lab.  Normal sperm has an oval head with a long tail whereas abnormal sperm have defects in the head or tail. Again most of the evidence found a decline in normal sperm morphology with age. (3)
4. There are also higher levels of DNA damage in the sperm with increasing age in turn leading to genetic defects in the offspring like Down Syndrome, autism, and schizophrenia.  This could also cause decreased fertility, increased stillbirth or chances of miscarriage. (4) 
5. Hormonal factors- Declining testosterone may cause decline in libido, erectile dysfunction, and difficulty achieving ejaculation. The level of testosterone does appear to influence sexual function.  High levels of testosterone in the testicles are needed for sperm production.  As men age, testosterone levels decrease.
6. Medical issues and medications- Medical illnesses like blood pressure, diabetes and issues with the prostate could develop later on in life for which you might need to take medications.  These illnesses or medications could in turn affect fertility.

So, the ability of sperm to fertilize an egg decreases with paternal age.  Even by going through certain assisted reproductive technologies like IVF, pregnancy rates decreased as the age of the men increased. (5)  There could also be a rise in complications in the mother like placenta previa, hypertension, preterm labor, miscarriage, decreased birth weight amongst other things if the father is older.  Invitro fertilization (IVF) is a procedure where a woman’s egg is retrieved, and placed together with many sperm in a laboratory setting in the hopes that one of the sperm will fertilize the egg.  The resulting embryo is then transferred back into the woman’s uterus for implantation hopefully leading to a pregnancy.  Intracytoplasmic sperm injection (ICSI) is an additional procedure done with IVF where an individual sperm is selected by the embryologist and it is injected directly into the egg.  It is usually used to treat those with severe male infertility or for other medical reasons.  A study has found that when using ICSI together with IVF, the obstacles due to a man’s age could be overcome if the woman’s oocyte or egg is young and healthy. (6)

What can you do?

You cannot grow younger but there are some things you can do to improve sperm health and improve the odds of having a baby.  You can lead a healthy lifestyle like eating a well balanced diet rich in fruits and vegetables, stop smoking, stop drinking excessively, maintain a healthy weight, do regular exercise, avoid hot tubs, and minimize stress.  Increasing sexual frequency could also improve sperm health. There are still a lot of unknown factors about the effect of male aging on fertility and further research needs to be done to better understand the impact of a man’s age on fertility.  If you are struggling with infertility or have questions or concerns about this topic, feel free to contact the experts at Xenith Advanced Fertility Centre.

The process of motherhood right from conception to delivery can be an exciting albeit nervous journey.  When you finally get to hold the baby in your arms, you might be so relieved and thinking that taking care of the baby will come naturally.  However, the first few weeks after delivery could be a huge adjustment period for the mom because babies need constant attention and the moms needs often go by the wayside.  So how does a new mother cope and prepare for the post-partum journey?

New moms need extra care because their bodies have gone through and will continue going through many physical changes.  Here are some things she might need:

1. Education-They might be dealing with vaginal pain due to vaginal tears during delivery or pain after having a caesarean section due to the surgical incisions made in the abdomen and uterus.  They might be given pain medication but if they are still in severe pain or have a fever, they need to consult their doctor immediately.  They will also have heavy vaginal bleeding for the first few days which will taper off after 10- 12 days and change to a yellowish colour.  If the heavy bleeding persists, they will need to get it checked by a doctor. (1)  Breastfeeding support is needed especially for first time moms.  They need to be educated about how the baby latches to the breast, how to make sure the baby is getting enough nutrition, the pain that might be involved with this and how to alleviate it, what to do if you have plugged ducts or mastitis or how to use nipple cream amongst other things.  WHO recommends that the baby be breastfed at least for the first 6 months for optimal growth. (2) They might also need education on how to look after a newborn in other ways like bathing a baby, how to soothe a baby etc and all this might come with experience or with advice from the health care provider, family or friends.  Sometimes they might need to deal with effects of pregnancy induced hypertension (high blood pressure) or gestational diabetes. 
2. Sleep or rest- is a necessity for a mom who is exhausted after just giving birth.  However, with the baby’s feeding schedule and various other reasons, it might be difficult to get enough sleep.  Try to sleep when the baby is sleeping even if it’s for short periods.  Try to pump your breast milk using a breast pump and enlist the help of your partner or someone close to you to feed the baby while you get some rest. 
3. Various aids- like nursing pads, nursing bras, breast pump, nursing pillow, bottle warmers and sterilizers could come in handy during this time.  Nursing pads placed in your bra helps absorb leaking breast milk.  Nursing bras provide good support for the breasts and make it easier to quickly feed the baby.  A bottle warmer can quickly warm up breast milk or formula and a bottle sterilizer can disinfect the bottle, nipple and its various parts.  A breast pump can pump out extra milk from your breast to prevent breast engorgement and also makes it convenient for someone else to feed the baby.   A nursing pillow can help hold the baby in the right position to breastfeed when the mom is too tired.
4. “Me” time- allows the mother to do what she likes to do to give her a break from the baby.  They could schedule some time for their partner or close family/friend to look after the baby while the mom gets some down time or do things that she enjoys like listening to music, painting, going out for a walk, shopping or innumerable other things. 
5. Eat healthy food and stay hydrated- in order for your body to recover from childbirth and also because you are breastfeeding.  Try to eat nutritious foods high in protein and healthy fats, fruits, vegetables, whole grains, dairy, and nuts to give you energy and could improve your mental health.  You could also look into taking postnatal vitamins as per your doctor’s recommendations.
6. Emotional support– is important for women dealing with stress or depression.  New moms might feel anxious, overwhelmed, have mood swings, crying spells, feel irritable, or have difficulty sleeping.  It might help to talk with a therapist/counsellor or close friend or family to talk over what you are struggling with and how it makes you feel. 
7. Help- with doing things around the house like cleaning, laundry, cooking, or looking after siblings. You could also ask someone to pick up your groceries or cook your meals. 

Newborns come with a lot of responsibility which can be tiring on the parents, especially the mom.  When the mom is looked after both physically and mentally, she is able to, in turn, look after the baby well.  If you have questions about any of these things, feel free to contact the experts at Xenith Advanced Fertility Centre.

Male infertility is becoming a growing problem worldwide. Infertility is defined as not being able to conceive after 12 months of having unprotected sex. So, are there emotional and psychological consequences associated with infertility? 

What causes male infertility?

Male infertility can be caused by many factors including issues with the sperm quality, quantity or morphology.  This could be due to blockage which prevents delivery of sperm, illness, injury, genetic factors, hormonal conditions, obesity, being exposed to environmental toxins, stress, lifestyle factors and many others.  Sometimes however, one might be told that they are dealing with unexplained fertility where the reason for their infertility is unknown.

Does it affect mental health?

The impact of male fertility is often underestimated because of the failure to communicate.  Sometimes men stay silent or hide their emotions in order to support their partner or due to the stigma attached to infertility.  They feel that they need to remain strong and stoic partly because of childhood conditioning and due to societal stereotypes of men in general.  Sayings like “shooting blanks” or “not being a man” or feeling defective could all culminate in loss of self worth.  This could lead to issues like hostility, and mental health issues like anxiety, and depression. 

Many couples are also delaying having a baby due to career goals and other plans which could also lead to issues with infertility.  Undergoing IVF treatment to overcome this could bring on additional anxiety and stress due to feelings of vulnerability and helplessness by watching their partner having to deal with the bulk of the procedure.  If there have been previous treatment failures, it can cause even more anxiety and stress.  Feelings of jealousy may also arise by observing your peers having kids and this could also cause irritability, anger or guilt, frustration, shame, loss, or mourning making you feel alone and isolated.  So, men are more disinclined to open up or share their feelings to others about infertility. 

In general, there is more support available for women when dealing with infertility than for men.  Men are often told to just deal with it by themselves and they often lack the resources or information on how to go forward from there.  Sometimes men are not willing to look for support through group therapy, chat boards, psychological counselling or other ways.  They just keep it under wraps and this can in turn, take a toll on their mental health.

It’s normal to feel sad when dealing with infertility.  However, if these feelings linger on for weeks or months, you could be dealing with depression.  Symptoms of depression could include anger, withdrawal from friends and family, working long hours, issues with eating and sleeping, erectile dysfunction, inability to concentrate or having suicidal thoughts.  By seeking treatment and talking about it, you can overcome these feelings and thoughts. Studies have found that infertile males had more mental issues than fertile males especially depression, anxiety, hostility, and being extra sensitive to people around them. (1).  Feeling shameful can lead to isolation which could lead to depression especially if you or your family have had a previous history with depression or mental illness.

What to do?

1. Be encouraging-to help them to talk honestly about their feelings and what they are dealing with.  Don’t place blame on your partner but make it a team effort and have a frank discussion on how to move forward.  Don’t put pressure on yourself or your partner but give yourselves time to heal and to think clearly.  Don’t make any rash decisions but deal with it together with your partner.  Stress could also decrease fertility. In the right headspace, you could look at assisted reproductive technologies like IVF, or sperm donor or decide to adopt or not have kids at all. 
2. Get professional support- If you are not comfortable talking with close family or friends, and it seems very overwhelming, it might help to talk to a professional counsellor or psychologist especially if they are experts on the area of infertility. Counselling could provide an environment free from expectations and opinion.
3. Join a support group for men dealing with infertility so that you can relate to others dealing with the same issue and you can feel comfortable talking about how you are feeling.
4. Lifestyle- See if a change in lifestyle can affect your fertility.  Eat healthy foods and avoid unhealthy foods.  Exercise regularly, get enough sleep, stop smoking and drinking alcohol.
5. Some medications, chronic illnesses or hormonal imbalances could also affect fertility.  Speak to your doctor if there is something you can do to improve your fertility. 

Having a positive outlook and being true to yourself can help you recover mentally from diagnosis of infertility.  Feel free to come talk to the experts at Xenith Advanced Fertility Center if you are needing advice on what to do.

Polycystic ovary syndrome (PCOS) is a common disorder of the endocrine system in women causing a hormonal imbalance which could lead to metabolic, reproductive and psychological issues.  The endocrine system regulates certain processes in the body using hormones which are chemical messengers that move throughout the bloodstream.  The hormonal imbalance causes the ovaries to produce higher levels of androgens which are male hormones like testosterone which in turn interferes with the development of the egg and its release.  Some of these unreleased eggs develop into cysts which are basically fluid filled sacs and they build up in the ovaries causing the ovaries to get enlarged and it could cause irregularities in ovulation.  Women with PCOS have at least two of the 3 following conditions:

1. Irregular or no menstrual periods
2. Excess of male hormones(androgens)
3. Polycystic (multiple cysts) ovaries

Some of the symptoms of PCOS could include irregular menstrual cycles, too much hair on face, chin, chest or other parts of the body where men usually have hair(hirsutism), acne, male pattern baldness, weight gain, darkening of skin along neck creases, in the groin and underneath breasts and presence of skin tags.  If your symptoms aren’t managed, you are at a higher risk for serious health problems like: heart disease, high blood pressure, high cholesterol, diabetes, gestational diabetes, sleep apnea, stroke, endometrial cancer, and depression. A pelvic exam, blood test for hormone levels, and an ultrasound can help diagnose PCOS.  PCOS affects each person differently and sometimes one may find out they have PCOS only after they have been unable to become pregnant. 

Here are 5 myths about PCOS

1. People with PCOS have multiple cysts in their ovaries -This is not always true even though the name polycystic ovary means many cysts in the ovary and this name can be misleading.  As mentioned above, only 2 of 3 conditions need to be true to be diagnosed with PCOS.
2. You can’t get pregnant if you have PCOS-Due to the hormonal imbalance, the ovary doesn’t release the egg during ovulation regularly.  This can cause irregular or no periods.   Even though PCOS is a leading cause of infertility, many women with PCOS can get pregnant naturally or through fertility treatments although they are at a higher risk for some issues like miscarriage.  Infertility drugs can help women with PCOS get pregnant.  Get help from a fertility specialist as to what’s the best treatment for you, if you would like to have a child.
3. You are overweight if you have PCOS-is not always true.  PCOS affects different people in different ways.  It’s more common for women with PCOS to be overweight although there are women with PCOS who are thin. Experts don’t know what causes weight gain in women with PCOS.  It could be due to insulin resistance where higher levels of sugar in the bloodstream don’t get absorbed by the cells for energy but are rather converted to body fat.  So a combination of a healthy diet and regular exercise could help you lose weight.  Shedding even a small amount of weight could make your periods regular and help relieve some fot he symptoms of PCOS.  Speak to your doctor for advice on losing weight
4. PCOS can be cured- Unfortunately, there is no cure for PCOS, but overweight and obese women can help balance their hormone levels by losing weight. Otherwise, treatment is aimed at managing symptoms. A wide range of treatment options can help prevent any potential problems.
5. Lifestyle changes, such as healthy eating and regular exercise, improve the way your body uses insulin and, therefore, regulates your hormone levels better.
6. Birth control pills can also be a good treatment option if you aren’t interested in getting pregnant any time soon, because they can regulate your menstrual cycle and reduce androgen levels.
7. Fertility medications also can help stimulate ovulation if you want to get pregnant
8. Lifestyle changes, such as losing weight or managing stress levels
9. Medications which help regulate hormones
10. You have PCOS because of something you did- the exact cause of PCOS is unknown and you are not to blame.  However, several factors like genetics could play a role.  Women with PCOS often have higher levels of androgens or male hormones which could affect ovulation and regular menstrual cycles.

So, don’t get discouraged if you have PCOS because you can still live a healthy life with PCOS.  The experts at Xenith Advanced Fertility Center can help you get on the right track and keep PCOS under control.

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.