Services

Reproductive Endocrinology

Obstetrics and gynecology (are typically abbreviated to OB/GYN, OBG, O&G or Obs & Gynae) are the two various surgical medical spheres dealing with the feminine reproductive organs in their pregnant and non-pregnant state, respectively, and in and of itself are typically combined to form one medical science and postgraduate training programme.

Reproductive Endocrinology

Reproductive endocrinology can be defined as a branch of medication that identifies and treats sterility in both men and ladies. Within United States Seventeen per cent of all pairs can face fertility problems, and plenty of are going to be diagnosed with a generative disorder. Several infertile couples value more highly to see a generative specialist once deciding upon fertility treatments. The reproductive endocrinologist can determine the factors concerned to infertility state and choose the suitable strategies to treat these factors.
Our team of enthusiastic and committed endocrinologists showcases a number of the foremost noted fertility consultants within the country. Systematically on the innovative of fertility treatments and technology, our physicians are committed to providing superior care to any or all patients facing these problems.

Sperm Cryobanking

We habitually have a back-up bodily fluid sample frozen for couples UN agency area unit undergoing treatment just in case of inability to present a sample on the day of the IUI, IVF or ICSI. Men experiencing cancer treatment before radiation and therapy can even benefit of our cryopreservation facilities. Those undergoing ICSI are inspired to freeze their sperm cell so we’ve adequate range of sperm cell at the time of ICSI. We have a tendency to habitually cryopreserve epididymal sperm cell and testicular, so recurrent makes an attempt at getting recent epididymal and gonad sperm cell is also avoided.

Donor insemination

In Donor insemination, the sperm is backed by a donor male whose uniqueness is withheld. Intra uterine insemination is same as that of donor insemination, where placing of sperms into the female uterus. Below are the following fascinating points The female is that the biological mother and genetic contributor, however the husband isn’t the biological father, except for all alternative considerations (legal and psychological), he’s the accepted father. He’s concerned within the physiological condition preparation right from the pre pregnancy counsel to insemination to the physiological condition, delivery and rearing of the kid thenceforth. The procedure is straightforward and no surgery is concerned in insemination The procedure could also be treated as adoption from conception with one partner being sharing the genes with the total support and agreement of the husband. Couples must be ready to settle for an anonymous gamete. Currently there’s a discussion whether or not the kid should learn of his biological father when he / she reaches adulthood. With the increase of HIV and alternative sexually transmitted diseases (STD, the importance of exploitation properly tested and segregated body fluid, for the treatment of sterility, has gained nice importance. In developed countries, the use of contemporary untested seed for donor insemination has been discontinued to forestall the unfold of those diseases through insemination procedures. These samples are selected for HIV, serum hepatitis and C so segregated in deep freeze (liquid nitrogen) to make sure safe donor insemination. Donor semen is employed solely when re-screening after 7 months for HIV. All the records of semen samples and donors are accurately preserved beneath strict confidentiality. Therapeutic donor insemination is indicated in couples where the male partner:
  • Could not produce sperm cells
  • Does not have quality sperms
  • Presence of genetic disorders

PICSI

In vitro fertilization, PICSI Sperm Selection Device offers important benefits in selecting sperm for the ICSI (Intra Cytoplasmic Sperm Injection) method. PICSI In the ICSI procedure, a seperate sperm cell is chosen and vaccinated into a gametocyte. The PICSI is a sterilised, plastic culture dish with 3 to 3.5 microdots of hyaluronan colloidal gel connected to all-time base interior of the dish. Hyaluronan may be a present as biopolymer found altogether in human cells, together with the gel layer close the gametocyte. Mature human sperm cell attaches by themselves to the hyaluronan over exact receptors found on the spermatozoa semipermeable membrane. Hyaluronan-bound sperm cell exhibits no progressive movement, though their tails beat and are capable of motility. Hyaluronan-bound sperm cell are simply hand-picked and off from the hyaluronan by micropipette to be used in intracytoplasmic sperm cell injection (ICSI). The PICSI spermatozoan Selection Device truly mimics a key phase within the natural fertilization method, the binding of mature spermatozoan to the gametocyte advanced. As a consequence, the chosen spermatozoan is basically a similar that will achieve success within the natural procreative method. Hyaluronan-bound PICSI-selected spermatozoan are, within the overwhelming majority of cases, a lot of mature, exhibit less polymer harm, and have fewer body aneuploidies.

ROS

In Human ejaculate, there is a dynamic interaction between anti-oxidant and pro oxidant. If ROS (Reactive Oxygen Species) is low, plays an vital physiological role by modulating gene and protein activities for proliferation, function and differentiation.

There is a dynamic interplay between pro- and anti-oxidant substances in human ejaculate. Reactive oxygen species (ROS) in low, controlled levels in the extracellular space play an important physiological role, modulating gene and protein activities vital for sperm proliferation, differentiation, and function. Excessive reactive oxygen species (ROS) generation can overwhelm protective mechanism and initiate changes in lipid and/or protein layers of sperm plasma membranes. Additionally, changes in DNA can be induced.

Oxidative stress (OS) is outlined as a cellular condition related as disparity between the assembly of free radicals, mainly ROS, and their sifting capability by antioxidants. Once the assembly of ROS exceeds the antioxidant defence, important oxidative destruction happens to several cellular organelles by destructive proteins, lipids, carbohydrates and DNA, so ultimately resulting in death of the cell. The Oxidative Stress-induced sperm cell destructive has been urged to be a major causative attributes in 40-70% of all circumstances of male physiological condition. The cohort of ROS may be impaired by infectious, environmental and manner aetiologies.

DFI/SCSA

Sperm-DNA-Fragmentation If couples have trouble in conceiving, the factors affecting are due to
  • Sperm count
  • Motility (speed)
  • Morphology (shape) – is usual
  • It might me also due to sperm.
By talking to the fertility specialist regarding DNA fragmentation of sperm, provides an insight for not getting pregnant. The possibility of a successful pregnancy is due to the high level of DNA fragmentation. Our doctor says “Reproductive toxicants in the environment increase the level of DNA fragmentation.” Those people’s working with heavy metals like lead and nickel as well as pesticides, though, cities with high levels of documentation of miscarriages and infertility and air pollution, increases the level of sperm DNA fragmentation. According to the research, while there presently is not any tried role for routine DNA integrity testing within the analysis of sterility, sperm cell DNA Damage is an additional common in sterile men and will have an effect on reproductive outcomes in selected pairs, together with those with repeated spontaneous miscarriage or disorder (unexplained) sterility.

Sperm DNA Fragmentation

The hereditary material, DNA, present in both humans and various other organisms. The DNA consists of polymers, which are long, made up of simple units called phosphate and sugars. In DNA, information is stored as codes, which are made up of 4 types of molecules called bases. These bases are attached to strands of DNA. The order of the bases defines the information accessible for maintain and building organisms. If there is any change in the bases or physical break or both in the DNA strands then DNA fragmentation occurs. The physical breakings of DNA strands in sperm chromosomes are called Sperm DNA fragmentation. If Sperm DNA fragmentation occurs in a gene, for egg growth and cannot be repaired, then the consequence leads to the death of the embryo.

Sperm DNA Fragmentation Testing

Sperm DNA Fragmentation testing is same as that of regular semen analysis method at fertility clinic. A sample of semen is taken and sent for testing at sperm DNA fragmentation centre. Test includes Halosperm kit, which is based on technique called Sperm Chromatin Decondensation. This technique is more than 100 sperm are differentiated depending upon the expanded nuclei with expansion of five grades or without expansion. New Sperm DNA fragmentation tests are developed with the following test, which includes
  • Comet test
  • Tunel test and
  • Light microscope based SCD test
With the precision flow cytometer instrumentation, thousands of sperm per sample have much better numerical sturdiness than light microscope tests. Sperm DNA fragmentation testing can be done in the fertility centre along with semen analysis. A fresh sample of semen is positioned in a small vial, in an cold freezer or nitrogen container to diagnostic laboratory for testing. Currently, the SCSA is that the solely check of sperm cell DNA/chromatin that valid clinical interpretation criteria. With the SCSA check, 5,000 distinct sperm cell are rationed in a very high-precision flow cytometer. The check trials the presence of deoxyribonucleic acid strand breaks and also the proportion of sperm cell with abnormal proteins that constrain maternity success. The check regulates the proportion of sperm cell with fragmented deoxyribonucleic acid and also the degree of deoxyribonucleic acid injury and provides a deoxyribonucleic acid Fragmentation Index (DFI) score to point the probability of sperm cell tributary to sterility issues. The subsequent scores indicate fertility potential for natural conception and intrauterine insemination:
  • Greater than 24% DFI: Fair to Poor fertility potential
  • 14%to 24% DFI: Good to Fair fertility potential
  • Less than or equal to 14% DFI: Excellent to Good fertility potential

Causes for Sperm DNA Fragmentation

In regarding 30% of couples seeking clinical examination of infertility, the lads have spermatozoon DNA fragmentation at tier that places the person into the class of an extended time to natural or IUI physiological state (greater than 24% DFI). Oxidative stress – stress on the body that’s produced by the accumulative injury of free radicals that’s not sufficiently neutralised by antioxidants, which could be a main contributor to spermatozoan DNA fragmentation. Spermatozoon polymer fragmentation is related to infections, drug use, butt smoking, exposure to environmental and activity pollutants, advanced age, varicocele, diseases with high fevers, elevated male reproductive gland temperature (laptop computers, hot tubs), chronic diseases like polygenic disease, cancer treatment, cancer and poor diet. The major factor contributing to sperm damage is epidemic of obesity, which is very much common among obese man or overweight person.

Treatment for Sperm DNA Fragmentation

With the growth of ICSI (Intracytoplasmic Sperm Injection), few fertility surgeons will not focus on the quality of the sperm as the sole sperm can be vaccinated into the egg for insemination. Few other fertility doctors will evade ICSI and try to reduce sperm DNA fragmentation to certain level, which is well-matched with natural fertility. Other recommendations for treatment
  • Discontinue smoking
  • Keep the testes cool – no hot tubs or long hot baths, and wear boxer shorts
  • Avoiding medications such as SSRIs
  • Having healthy diet
  • Examinations for urogenital infections
  • Enquiring doctor about supplementary vitamins and antioxidants

CASA (Computer Assisted Semen Analysis)

The use of CASA (Computer Assisted Semen Analysis) has radical the flexibility to review and perceive spermatozoon function because it relates to humanoid infertility. The foremost advances are within the ability to a lot of accurately verify spermatozoon concentration (counts) and motility (movement). Generally, spermatozoon is “looked” at by a processed digitizing pill through a magnifier. The computer has been “taught” by the laboratory personnel what spermatozoon appear, and the way they move. Once the computer “sees” a spermatozoon underneath the magnifier, it’s ready to draw a digitized image of every individual spermatozoon, together with the speed and path this spermatozoon takes whereas moving underneath the magnifier.
CASA-Computer-Assisted-Semen-Analysis
An excellent deal has been learned concerning the traditional and abnormal “micro” characteristics of spermatozoon using this technique. The strategy is, however, not fool proof. The computer is as intelligent as its programmer. Little changes within the program will alter the spermatozoon calculations considerably. The computers should perpetually be monitored and rationalized. In most research laboratory, all grossly abnormal CASA are perpetually verified by repeat analysis yet like a “hands on” human review opinion. We tend to feel that any abnormal spermatozoon count should be verified by a manual count and assessment technique.

Total Laparoscopic Hysterectomy

A Total Laparoscopic Hysterectomy (TLH) is associate operation to get rid of the womb with the help of associate operative telescope referred to as an laparoscope. This small instrument is inserted through a little cut within the abdominal wall and permits the specialist to visualize into the abdomen. The key factor about this type of hysterectomy is that you just won’t have to be compelled to have an oversized cut in the abdomen and recovery is typically a lot of quicker. Cervix or the neck of the female internal reproductive organ is additionally removed throughout this operation. Ovaries could or might not be distant reckoning on desires and persons condition. Not each patient is suited to the current operation. If it’s appropriate, your woman’s doctor can advise you.

Following are the things, which happen during surgery

  • Person will be under anaesthetic, which is general.
  • Carbon dioxide gas is going to inflate the abdomen and to form area for the sawbones to figure. The specialist can insert the endoscope through the umbilicus (belly button) in order that the team will see what they’re doing.
  • The sugeons also will create 3 little cuts within the abdomen to insert alternative instruments that are required for the surgery.
  • The specialists can have an awfully clear read of the within of your abdomen and might use the image on the screen to free female internal reproductive organ from the tubes, ligaments and blood vessels on either side. A cut also will be created round the cervix and into the duct to modify the female internal reproductive organ to be removed through the duct. The cut are going to be closed with absorbed stitches.
  • If the ovaries and tubes are to be removed at constant time they’re going to even be freed and removed through the duct.
  • The cavum are going to be washed out with a sterile answer. The gas are going to be removed (as very much like possible) and also the wounds closed with sutures.
Sometimes, a little drain tube is introduced through one among the injuries to empty some blood stained fluid and gas once the operation. this can be removed the subsequent day.

Complications

All operations have a low risk of problems. For a few individuals the risks are very high. For instance, risks of suffering complications can increase if you smoke, have cardiovascular disease, polygenic disease otherwise you are overweight. Before the operation write down any queries or issues that you just could have. Embrace something that you just suppose could increase your risk of complications. This may be useful after talking with the medical team, who will advise and reassure you. Overall, if you’re offered associate operation it’s as a result of we have a tendency to believe the advantages way outweigh the possible for damage.

Risks with Laparoscopic Hysterectomy

  • Medications should be taken for urine infections by intake of antibiotics
  • Damage to the ureters or bladder
  • Surgeons decides whether to use laparoscope to convert to a abdominal hysterectomy
  • If ovaries are removed then may experience hot flushes
  • After this operation, hysterectomy is irreparable so there is no likelihood of pregnancy again

Recovery

  • Bloating/PainSome pain is common. You will additionally expertise a period-like, pain in the shoulders and cramping sensation. This may be due to Co2 gas, which is used to inflate the abdomen. This might last for 2 days, in some cases it might last for weeks. Strive forthright analgesics like paracetamol (Panadeine or Naprogesic). According to doctors, severe pain is unusual in this case.
  • ShoweringWound might dry after the operation; hence avoid bathing, swimming or using spas until the sutures are out.
  • DressingKeep dressings intact for 24hrs without they’re sordid or wet. Leave the wounds open, or (preferably) cowl with a Band-Aid (it has been shown that keeping wounds slightly damp and heat enhances healing). Don’t apply any antiseptic creams, Betadine, Dettol, denatured alcohol etc. to the injuries. These are pointless and in most cases injurious to healing tissue. Sutures can get to be removed around 5 days from the date of operation. Subsequently massage the injuries with a moisturizer containing fat-soluble vitamin.Some redness or ‘flare’ is common, particularly round the injuries. If the redness is scattering or the wound is liquidating, you feel unwell or feverish, get recommendation.
  • Sore throat and nauseaIt is quite traditional to possess an inflammatory disease and a few nausea once the operation. The inflammatory disease is owing to the endotracheal (breathing) tube used while you’re anaesthetized. Analgesics (pain killers) and little quantities of fluids can facilitate. Nausea and temporary state is owing to the anaesthetic itself.
  • Dizziness/loss of concentration
    • This might happen due to the anaesthesia (especially morphine or panadeine).
    • A person should take more than a week off from work as it involves energetic work
    • Avoid exercised for more than a week
  • Vaginal bleedingThis might last for more than five days. Avoid strenuous exercise, tampons and sex if you are still bleeding. Some female might notice stich material, which is used to close the vagina inside the abdomen. This will fall within a couple of months. Don not pulls any thread as it is attached to vagina inside. This will look like a black thread, hence do not panic.

Tubal Recanalization

The fallopian tubes are absolutely necessary for feminine fertility. They’re however the eggs get from the ovaries to the female internal reproductive organ. Below traditional circumstances, spermatozoan can travel into the fallopian tubes to fertilize an egg discharged from the ovary, and also the ensuing embryo is nourished and elated to the female internal reproductive organ, wherever the maternity can still continue. A typical explanation for feminine sterility is blockage of the fallopian tubes, sometimes because the results of trash that has engineered up. Sometimes, scarring from surgery or serious infection will result in occlusion. Interventional radiologist’s are able to analyse and treat obstructions within the fallopian tubes with a medical procedure referred to as uterine tube Recanalization. Recanalization is that the methodological term for reopening. Throughout the procedure, that doesn’t need any needles or notches, a speculum is placed into the channel and tiny plastic tube (catheter) is undergone the cervix the into the female internal reproductive organ. A liquid distinction agent (sometimes known as “dye”, though nothing is being stained), is injected through the tube. Associate X-ray camera shows the cavity on a tv screen and what’s known as a “hystero-salpingogram” or “HSG” is obtained. Factually, meaning a “uterus-and-fallopian-tube-image”. If a blockage of two or one of the fallopian tubes is known, a smaller tube is then ribed through the primary tube right then into the uterine tube to open the blockage. Over 91% of the time, a minimum of one blocked uterine tube is reopened and traditional operate rebuilt.

Who can undergo fallopian tube recanalization?

Sometimes, ladies have X-ray photograph during a doctor’s workplace, clinic, or x-ray department that shows a blockage. Typically they’re found to own a haul with the tubes throughout laparotomy, once the doctors inject blue dye into the female internal reproductive organ examine the tubes employing a “scope”, and zip passes through. Sometimes, a blockage is discovered through sonogram within which sterile saline (water) is injected into the female internal reproductive organ. At now, specialist will assess the tubes and can attempt to unblock them at a similar time if attainable.

Side Effects

Most women can have small recognizing for daily or 2 subsequently. We are going to provide you with a pad in recovery and you will want to own some pads reception just in case of recognizing. There ought to be no lingering pain or different unpleasant sensation. If you feel pain, cramps, fever, or discharge, please contact your woman’s doctor right away.

Outcomes

Usually, each fallopian tube can be unclogged. Most couples can conceive at intervals a cycle or 2. The FTR procedure was regular so there was no risk of being fertile at the time of your procedure. You’ll begin attempting to induce pregnant once more once the recognizing has stopped, and do not ought to wait an additional cycle in between. Douching isn’t wise normally, however significantly once the FTR as a result of the cervix could also be slightly open for daily roughly. Successful FTR and gestation are lesser once severe scarring is gift from previous surgery or dangerous infections, like pelvic inflammatory disease (Pelvic Inflammatory Disease). FTR unclogs the tubes, however doesn’t reverse the method at work that caused them to become blocked within the 1st place. For that reason, concerning 1/3 of patients can reocclude their tubes by concerning six months. You’ll want to consult your doctor if you’ve got not gotten pregnant once six months and he or she is brooding about enhancing your fertility, like supplying you with injections to stimulate your ovaries. It’s wise in this case to create positive that your tubes are still open. Interventional radiotherapist will perform HSG and securely repeat the FTR if obstruction is once more found.

Ovarian Cystectomy

The normal ovary naturally could be a partly cystic structure. Most sex gland cysts develop as significance of disordered organic process within which the cyst fails to unharness the gametocyte. The vesicle cells still secrete fluid and expand the cyst, which in future will become cystic. Ovarian Cysts pretty conjoint and involve all age teams, occurring in each indicative and non-indicative females. Seven percent of 6000 healthy ladies in a very study rumored had detectable adnexal plenty on transabdominal ultrasound. Of these, ninety one percent were cystic with most identified as straightforward cysts.
Ovarian-cystectomy
The ovaries are the feminine girdle reproductive organs that house the ova and also are liable for the formation of sex hormones. They’re balancing organs placed on either aspect of the female internal reproductive organ inside the broad ligament below the female internal reproductive organ (fallopian) tubes. The ovary is inside the female internal reproductive organ fossa, an area that’s sure by the external bone vessels, destroyed point artery, and therefore the epithelial duct. The ovaries are liable for releasing and covering ova, or eggs, necessary for copy. Indeed, sex gland cysts were the fourth commonest medicine reason for hospital admissions at late 1980′s. Most cysts ad lib resolve whereas some can persist. The persistent sex gland cysts are presumably to be surgically managed. The quality surgical approach to presumably benign sex gland cysts is that the laparoscopic sex gland cystectomy. Indeed, it’s one in all the foremost common procedures performed by the active specialist medical specialist.

Myomectomy

Myomectomy is that the surgical elimination of fibroids from the female internal reproductive organ. It permits the female internal reproductive organ to be left in the same place and, for a few females, makes gestation a lot of probably than before. Myomectomy is that the most popular fibroid treatment for ladies Myomectomy Before myomectomy, decreases the fibroids with gonadotropin-releasing secretion analogue (GnRH-a) medical aid might scale back blood loss from the surgery. GnRH-a medical aid lowers the number of oestrogen your body makes. If you are bleeding from a fibroid, GnRH-a medical aid can even improve anaemia before surgery by stopping female internal reproductive organ harm for many months. Below are the surgical methods:
  • Hysteroscopy- this surgical method involves injecting a instrument to the vagina and to the uterus
  • Laparoscopy- this surgical method involves using an instrument with one or more small cuts in the abdomen
  • Laparotomy- this method uses a bigger incision in the abdomen
These surgical method uses depends on the location, size and number of fibroids.
  • Hysteroscopy is used for removing fibroids, which is present on the inner wall of the uterus. These fibroids can be removed if it is not deep routed into the uterine wall
  • Laparoscopy usually used for removing two or three fibroids, up to about 2.1 in. (5.2 cm), which are grown outside the uterus
  • Laparotomy used to remove la fibroids that have grown deep routed into the uterine wall or large fibroids and many fibroids
The time in hospital after surgery depends on each surgery
  • Hysteroscopy is a casualty procedure
  • Laparoscopy is a casualty procedure or may need a stay of 1 day
  • Laparotomy has to stay for an average of 1 day to 5 days
Retrieval time depends on the technique used for the myomectomy:
  • Hysteroscopy requires from a 3 days to 3 weeks to recover.
  • Laparoscopy needs 2 to 3weeks.
  • Laparotomy needs 3 to 6 weeks.

Why Myomectomy is done?

Myomectomy reserves the uterus while treating fibroids. It may be a sensible treatment option if:
  • Anaemia cannot be treated with medicine
  • Pressure or pain cannot be relieved through any medicine
  • Fibroid which changes the wall of the uterus
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