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Understanding Female Sexual Response: An overview

10 May

About the Author:
Dr. Anand Shinde, M.D., Gyn

IVF Consultant & Director of Andrology At“IVF Pune”, 7th floor Deenanath Mangeshkar Hospital Pune-4
Phone : +91 20 26876396 / 40151777
Mobile : +91 9822012166
Email : shinde.ivfpune@gmail.com

Dr Anand Shinde is Trained in High Risk Pregnancy Management & also in A. R. T. at Birmingham. He currently practices with Nirmiti Clinic and IVF Pune.

Website: http://www.dranandshinde.com/ (Powered by Websites For Doctors)

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Do We Treat Male Infertility in the Era of ICSI ? – Dr. Anand K. Shinde

31 Mar

 

About the Author:
Dr. Anand Shinde, M.D., Gyn

IVF Consultant & Director of Andrology At“IVF Pune”, 7th floor Deenanath Mangeshkar Hospital Pune-4
Phone : +91 20 26876396 / 40151777
Mobile : +91 9822012166
Email : shinde.ivfpune@gmail.com

Dr Anand Shinde is Trained in High Risk Pregnancy Management & also in A. R. T. at Birmingham. He currently practices with Nirmiti Clinic and IVF Pune.

Website: http://www.dranandshinde.com/ (Powered by Websites For Doctors)

Gynecologists versus infertility specialists – who should be your first choice ?

3 Jun

Infertile couples are often confused whom they should visit when they need medical assistance. Even though infertility always affects a couple , it’s usually the woman who takes the initiative in seeking medical care . Most will bypass their family physician , but are unsure whether to go to a gynecologist or an infertility specialist. Both options have advantages and disadvantages , and it’s worth examining these.

The gynecologist is a logical first choice. Most women have a long-standing relationship with their gynecologist , and are comfortable with him. Since gynecologists are specialists in tackling women’s health problems , most can competently diagnose the cause of infertility ; and provide basic medical treatment. They are usually quite conservative; and would be the first choice for simple problems . However , they are often poorly equipped to deal with complex infertility problems.

Since a man with a hammer only sees nails, they will often subject the patient to unnecessary surgical procedures , such as a laparoscopy; or perform intrauterine inseminations for men with low sperm counts , simply because they do not have anything else to offer. They are often extremely poor at handling male infertility problems , and will usually refer these to their friendly urologist. This often means that care gets fragmented; and ends up of being poor quality.
Most gynecologists are also not aggressive enough when dealing with older women. Since most of their women are fertile, they often forget to remember the impact which aging has on the ovarian reserve of infertile women. Also since they rarely have a special interest in treating infertility , waiting rooms are often quite infertile-patient unfriendly. There are often full of expectant mothers , and this can cause unnecessary emotional distress. Also some of them are not compassionate or empathetic enough when dealing with the impact which infertility has on the woman’s psyche.

Infertility specialists would be the first choice, if you have a complex problem. Not only are they experts at dealing with infertility they have a lot of experience; and are armed with the advanced reproductive technology to solve most problems. However they are often quite expensive ; and some of them will often resort to unnecessary , complex costly treatment, even to tackle simple problems. This means the patient has to choose between the risk of wasted time with the gynecologist, versus overtreatment with the infertility specialist. Since the infertile couple doesn’t know how simple or complex their medical problem is , this often leaves them in a quandary.

What we do in our clinic ? If I am the first doctor the infertile couple is seeing, I will complete the workup for them , so we have an idea as to what the reason for the infertility is. This takes about 7 days and costs about US $ 200 only. If it’s a simple problem , we will suggest that they find a gynecologist for their treatment. This allows us to concentrate on infertile couples who have complex problems , so that we can provide them with a higher quality of service, without diluting our focus.

In the best of all possible worlds , gynecologists with take care of the simple problems ; and if they have failed to achieve a pregnancy within 6 months , they would refer these patients onto an infertility specialist. Unfortunately, since most doctors have a proprietary attitude towards their patients , they are often reluctant to refer these patients to infertility specialists , because they do not want to lose them. This often means that they waste the patient’s time , money and energy in pursuing ineffective treatments.

One useful tip is to create a clear plan of action with a well defined timeframe in partnership with your doctor , so you have a clear sense of what your treatment options are. This way, you retain control of your medical treatments as well as your life so you have peace of mind you did your best.

 

About: Dr. Aniruddha Malpani

Dr. Aniruddha Malpani is a leading consultant infertility specialist and practices with his wife, Dr. Anjali Malpani, in Mumbai, India. Their clinic, Malpani Infertility Clinic (www.drmalpani.com) has been rated as one of India’s best (Outlook magazine survey); and attracts patients from all over the world. Over 1500 babies have been born as a result of their treatment all over the world. Dr. Malpani also founded HELP, the Health Education Library for People (www.healthlibrary.com), which is India’s first Consumer Health Education Resource Center and the world’s largest patient education library.
Contact: www.drmalpani.com, info@drmalpani.com

 

PGD – CGH – is it of any use?

25 Apr

The newest IVF technology uses a fancy new technique which marries IVF and genetics. This is called PGD (preimplantation genetic diagnosis)with CGH ( comparative genomic hybridisation) and there are lots of press releases and articles touting this as the newest breakthrough !

Doctors , like all big boys, love to play with new toys – and the newer the better ! This is especially true when they have expensive new technological tools, which no other competitor has. Doctors can be very competitive – and are always trying to be one-up on each other. An easy way of being different is to use the newest technology – but the trouble is that never is not always better ( though newer is always more expensive !)

Because these new tools are so expensive , doctors need to use them extensively, to justify the expense – after all, they need to show the bean counters who pay their salaries and bonuses that the new tool is cost effective !

The key question thoughtful patients need to be asking is – Is it really better? Or is it a solution looking for a problem?

I think the truth is we really don’t know right now! It’s very likely to be useful for some patients – but to expect it to be useful for everyone across the board is hoping for too much ! While it may seem logical to use PGD, unfortunately, biological systems are not always logical! What seems to make sense in theory often does not

As a doctor in clinical practise, whose major focus is simply to get as many of my patients pregnant as quickly as possible, I am quite conservative and prefer to wait and watch.

I follow Alexander Pope’s dictum,
Be not the first by whom the new are tried,
Nor yet the last to lay the old aside.

Only time will tell how useful PGD-CGH is – but the enormous commercial pressures under which IVF clinics operate – and the constant demand by patients that their doctor use the newest and the latest breakthrough technology they read about in the newspaper means that most IVF clinic will likely end up overusing it!

About: Dr. Aniruddha Malpani

Dr. Aniruddha Malpani is a leading consultant infertility specialist and practices with his wife, Dr. Anjali Malpani, in Mumbai, India. Their clinic, Malpani Infertility Clinic (www.drmalpani.com) has been rated as one of India’s best (Outlook magazine survey); and attracts patients from all over the world. Over 1500 babies have been born as a result of their treatment all over the world. Dr. Malpani also founded HELP, the Health Education Library for People (www.healthlibrary.com), which is India’s first Consumer Health Education Resource Center and the world’s largest patient education library.
Contact: http://www.drmalpani.com, info@drmalpani.com
Blog: http://blog.drmalpani.com/
Disclaimer: All the contents of this Article is provided “As Is”. That means there is no warranty of any kind. Indianhealthjournal makes no claim that the Article’s information is appropriate in any jurisdiction or that the products described in the Article will be available for purchase in all jurisdiction.

Treatment by halves

25 Aug

Date: 23rd August 2010

Author: Dr. Swati Allahbadia

About: Dr. Swati Allahbadia is a Consultant Gynaecologist practicing in Mumbai since the last 19 years. She has wide ranging experience in every aspect of Gynaecology having worked in the Family planning area for two years, as Lecturer and then Associate Professor at the Sion Hospital-a teaching Hospital in Mumbai. She currently practices at: Rotuna Hospital, Brach Candy Hospital and Wadia Hospital.

” Sonny, send your worst cases to your enemy”-An old Gynaecology Professor to his assistant.

At the Wadia Maternity and Gynaecological Hospital in Mumbai that is exactly what we get. Women who have undergone multiple surgeries that have failed, multiple cycles for infertility treatment and have exhausted their resources but not hope, have lost a number of babies and are taking that one final chance, mothers carrying babies with severe growth restriction or anomalies where the gynaecologist doesn’t want to break the bad news, ART practitioners who want their patients to undergo laparoscopy cheaply and save money for IVF and so on.
I speak from hind sight and a review of cases that I have managed and here are some of my observations-
ART practitioners, seem to jump too soon into IUI and then IVF cycles and further ICSI if all fails.
Several patients have a simple problem like lack of knowledge of fertile period, insufficient frequency of coitus, use of lubricants or douches, washing off the ejaculate, pain during intercourse from infection or inadequate relaxation and just advising couples on these basic techniques works for them.

The cervical factor is another neglected area. Most IVF clinics do a transvaginal scan and a simple per speculum or per vaginal check is skipped. Cervical erosions, ulcers, small polyps chronic cervicitis contributing to her infertility are missed. The first time the cervix is looked at is during an IUI by which time its too late to treat and the doctor proceeds with the procedure-which is likely to fail if the infection has tracked into the uterus or results in an abortion should a pregnancy occur. A simple procedure like a cryo or thermo cauterisation cure the erosion and several patients conceive spontaneously after.

Sometimes the cervical canal is tortuous or stenosed or there are large cysts [Nabothian]-obstructing passage of sperms and causing infertility. A generous dilatation, rupturing the cysts, removing the polyps and lysing the adhesions cures the infertility or makes the IUI or Embryo transfer much smoother and bloodless and hence more likely to be successful.

Uterine polyps are treated by most gynaecologists by simply pulling it or curetting it out-increasing chances of recurrence. If done at hysteroscopy taking care to cut the base, the polyp is unlikely to recurr and the patient has better chances of pregnancy -spontaneously or assisted.

Fibroids not only distend the uterine cavity, make the endometrium inflamed and hostile to implantation, they may mechanically obstruct passage of sperm if they are close to the cervix or the fallopian tubes. They also make an IUI / ET a bit more difficult. With modern laparoscopic techniques, it is possible to have few or no adhesions after myomectomy and often patients conceive after the myomectomy.

Poly cystic ovaries or indeed any ovarian cyst needs to be diagnosed and ovarian drilling removes large unruptured follicles that mechanically obstruct newer ones, changes the hormonal environment, and these patients come back pregnant much to their surprise. If they are on treatment, ovarian drilling makes them sensitive to drugs like clomiphene to which they were hitherto resistant, reduces their requirement of gonadotropins and chances of Ovarian Hyperstimulation. However one needs to do just 4-5 punctures, with a minimum current for just a few seconds and copiously irrigate the ovary to avoid thermal damage to other eggs.

Endometriotic cysts are often punctured and left to nature by gynos not sufficiently confident of endoscopy-removing the cyst wall is essential to prevent recurrence of these cysts.

Tiny patches of endometriosis are also left untouched-these release several factors that inhibit ovulation, alter tubal and uterine peristalsis and interfere with conception. Removal of all endometriosis, makes a patient better responsive to ovulation induction and increases her chances of pregnancy.

If there is a problem in sperm count or motility, the male partner is sent to an andrologist who may rule out hernias, hydrocoeles, varicocoeles and undescended testes but rarely bothers to do his sugars, thyroid function tests and take a history of exposure to high temperature or stress, do a semen culture and treat the infection. An exhorbitant nutritional supplement is prescribed that most men stop after a month because of the cost. It is so easy and cost effective to test and take a history to get at the real problem before jumping to do an IUI where the few poorly motile sperms will also be lost and then to ICSI. The chances of successful ART  are also increased by taking care of these other common problems.

Finally, many women have multiple cervical dilatations for various procedures and often have an incompetent os on top of a multiple gestation. Good idea to look out for this prior to infertility treatment and continue to look for it from 3 months onwards with a sonography[ most sonologists never comment on the cervix] and take a stitch if required, preventing a precious pregnancy aborting.

Male gynaecologists avoid proper exam of the patients breasts which is left to nurses. they often miss galactorrhoea and though the prolactin levels are normal, correction of the galactorrhoea does often restore normal cycles and fertility.

Thyroid disorders are missed if the tests are not done at a good laboratory-so looking for signs of thyroid disturbance and sending these patients blood to a good [although expensive] lab may be worth it.

So lets ‘Look at the patient not just the disease’. Lets not be in a hurry to start an ART cycle. Lets take care of everything we possibly can-this would help our infertile patients get pregnant at minimum cost and carry their babies to term which is the final aim of both the patient and the doctor.

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