Reproductive Medicine

Reproductive medicine is a special branch of medicine that deals with prevention, diagnosis and Center for Reproductive problems: goals include improving or maintaining reproductive health and allowing people to have children at a time of their choosing.

In women, reproductive medicine covers a range of issues that includes, but not limited to, MENSTRUATION, OVULATION, PREGNANCY as well as gynecologic disorders that affect fertility. The speciality cooperates with and overlaps mainly with Sexual Medicine (insert hyperlink) reproductive endocrinology and andrology. It also deals with gynecology, obstetrics, urology, genitourinary medicine, medical endocrinology, pediatric endocrinology, genetics, and psychiatry.

Infertility indicates the condition of not being able to get pregnant after one year of trying. Or, six months, if a female is 35 or older.Females who can get pregnant but are unable to stay pregnant may also be infertile. Pregnancy is the result of a biological process that happens through the following phases:

  • A female's body must release an egg from one of her ovaries (ovulation).
  • The egg must go through a fallopian tube toward the uterus (womb).
  • A man's sperm must join with (fertilize) the egg along the way.
  • The fertilized egg must attach to the inside of the uterus (implantation).Infertility can occur if there is an issue/problem/disorder in any of these phases.

No, Infertility is not always a female’s problem. Both females and males can have problems that cause Infertility. About one-third of Infertility cases are attributed to females’ problems. Another one-third of fertility problems are attributed to the males’ issues. The other cases are caused either out of a mixture of male and female problems or out of unknown problems.

Most cases of female Infertility are caused out of problems with ovulation. Without ovulation, there are no eggs to be fertilized. Some signs that a female is not ovulating normally include irregular or absent menstrual periods. Ovulation problems are often caused by PolyCystic Ovarian Syndrome (PCOS). PCOS is a hormone imbalance problem which can interfere with normal ovulation. PCOS is the most common cause of female Infertility. Primary Ovarian Insufficiency (POI) is another cause of ovulation problems. POI occurs when a female’s ovaries stop working normally before she is 40. POI is not the same as early menopause. Less common causes of fertility problems in women include:

  • Blocked fallopian tubes due to Pelvic Inflammatory Disease, Endometriosis, or Surgery for an ectopic pregnancy
  • Physical problems with the uterus
  • Uterine fibroids, which are non-cancerous clumps of tissue and muscle on the walls of the uterus

Many things can change a woman's ability to have a baby. These include:

  • Age
  • Smoking
  • Excessive use of alcohol
  • Stress
  • Poor diet
  • Athletic training
  • Being overweight or underweight
  • Sexually Transmitted Infections (STl's )
  • Health problems that cause hormonal changes, such as PCOS / POI

Many women are waiting until their 30s and 40s to have children. In fact, about 20 percent of women in the United States now have their first child after age 35. So age is a growing cause of fertility problems. About one-third of couples in which the woman is over 35 have fertility problems. Aging decreases a woman's chances of having a baby in the following ways:

  • Her ovaries become less able to release eggs.
  • She has a smaller number of eggs left.
  • Her eggs are not as healthy.
  • She is more likely to have health conditions that can cause fertility problems.
  • She is more likely to have a miscarriage.

Most experts suggest at least one year. Women at 35 years or older should see their doctors after six months of trying. A woman's chances of having a baby decrease rapidly every year after the age of 30. Some health problems also increase the risk of Infertility. So, women should talk to their doctors openly. Aging decreases a woman's chances of having a baby in the following ways:

  • Irregular periods or no menstrual periods
  • Very painful periods
  • Endometriosis
  • Pelvic inflammatory disease
  • More than one miscarriage

It is a good idea for any woman to talk to a doctor before trying to get pregnant. Doctors can help you get your body ready for a healthy baby. They can also answer questions on fertility and give tips on conceiving.

Infertility in men is most often caused by:

  • A problem called varicocele (VAIR-ih-koh-seel). This happens when the veins on a man's testicle(s) are too large. This heats the testicles, affecting the number or shape of the sperms the particular male is able to produce.
  • Other factors that cause a man to make too few sperm or none at all:
    • Movement of the sperm. This may be caused by the shape of the sperm.
    • Injuries or other damages to the reproductive system might block the sperm production process or its movement.
    • Congenital issues that affect a male's sperm producing ability.
    • Illness or injury-related issues that show up after a long time from their occurences. For example, cystic fibrosis often causes Infertility in males.

A male's sperm can be affected by his overall health and lifestyle. Some factors that may reduce the health or number of sperms include:

  • Heavy alcohol use
  • Drugs
  • Smoking cigarettes
  • Age
  • Environmental toxins, including pesticides and lead
  • Health problems such as mumps, serious conditions like kidney disease, or hormone problems
  • Medicines
  • Radiation treatment / chemotherapy for cancer

Doctors will do an Infertility checkup. This involves a physical exam. The doctor will also ask for both partners' health and sexual histories. Sometimes this can find the problem. However, most of the time, the doctor will need to do more tests.

In men, doctors usually begin by testing the semen. They look at the number, shape, and movement of the sperm. Sometimes doctors also suggest testing the level of a man's hormones.

  • Writing down changes in her morning body temperature for several months
  • Writing down how her cervical mucus looks for several months
  • Using a home ovulation test kit (available at drug or grocery stores)

Doctors can also check ovulation with blood tests. Or they can do an ultrasound of theovaries. If ovulation is normal, there are other fertility tests available.

Some common tests of fertility in women include:
Hysterosalpingography(HIS-turf-oh-Sal-ping-GOGH-ru-fee): This is an x-ray of the uterus and fallopian tubes. Doctors inject a special dye into the uterus through the vagina. This dye shows up in the x-ray. Doctors can then watch to see if the dye moves freely through the uterus and fallopian tubes. This can help them find physical blocks that may be causing Infertility. Blocks in the system can keep the egg from moving from the fallopian tube to the uterus. A block could also keep the sperm from reaching the egg.

Laparoscopy (Iap-uh-ROS-kuh-pee): A minor surgery to see inside the abdomen. The doctor does this with a small tool with a light called a laparoscope (LAP-uh-roh-skohp). She or he makes a small cut in the lower abdomen and inserts the laparoscope. With the laparoscope, the doctor can check the ovarie$, fallopian tubes, and uterus for disease and physical problems. Doctors can usually find scarring and endometriosis by laparoscopy.

Finding the cause of Infertility can be a long and emotional process. It may take time to complete all the needed tests. So don't worry if the problem is not found right away.

Infertility can be treated with medicine, surgery, artificial insemination, or assisted reproductive technology. Many times these treatments are combined. In most cases Infertility is treated with drugs or surgery.

Doctors recommend specific treatments for Infertility based on:

  • Test results
  • How long the couple has been trying to get pregnant
  • The age of both the man and woman
  • The overall health of the partners
  • Preference of the partners

Doctors often treat Infertility in men in the following ways:

  • Sexual problems: Doctors can help men deal with impotence or premature ejaculation. Behavioral therapy and/or medicines can be used in these cases.
  • Too few sperm: Sometimes surgery can correct the cause of the problem. In other cases, doctors surgically remove sperm directly from the male reproductive tract. Antibiotics can also be used to clear up infections affecting sperm count.
  • Sperm movement: Sometimes semen has no sperm because of a block in the man's system. In some cases, surgery can correct the problem. In women, some physical problems can also be corrected with surgery.

A number of fertility medicines are used to treat women with ovulation problems. It is important to talk with your doctor about the pros and cons of these medicines. You should understand the possible dangers, benefits, and side effects.

Some common medicines used to treat Infertility in women include:

  • Clomiphene citrate (Clomid): This medicine causes ovulation by acting on the pituitary gland. It is often used in women who have polycystic ovarian syndrome (PCOS) or other problems with ovulation. This medicine is taken by mouth.
  • Human menopausal gonadotropin or hMG(Repronex, Personal): This medicine is often used for women who don't ovulate due to problems with theirpituitary gland. Mg acts directly on the ovaries to stimulate ovulation. It is an injected medicine.
  • Follicle-stimulating hormone or FSH (Gonal-F, Follistim): FSH works muchlike hMG. It causes the ovaries to begin the process of ovulation. Thesemedicines are usually injected.
  • Gonadotropin-releasing hormone (Gn -RH) analog: These medicines are often used for women who don't ovulate regularly each month. Women who ovulate before the egg is ready can also use these medicines. Gnu-RH analogs act on the pituitary gland to change when the body ovulates. These medicines are usually injected or given with a nasal spray.
  • Metformin (Glucophage): Doctors use this medicine for women who have insulin resistance and/or PCOS. This drug helps lower the high levels of male hormones in women with these conditions. This helps the body to ovulate. Sometimes clomiphene citrate or FSH is combined with metformin. This medicine is usually taken by mouth.
  • Bromocriptine (Par/ode/): This medicine is used for women with ovulation problems due to high levels of prolactin. Prolactin is a hormone that causes milk production.

Many fertility drugs increase a woman's chance of having twins, triplets, or other multiples. Wornen who are pregnant with multiple fetuses have more problems during pregnancy. Multiple fetuses have a high risk of being born too early (prematurely). Premature babies are at a higher risk of health and developmental problems.

Intrauterine insemination ( lUI ) is an Infertility treatment that is often called artificial insemination. In this procedure, the woman is injected with specially prepared sperm. Sometimes the woman is also treated with medicines that stimulate ovulation before lUI.

IUI is often used to treat:

  • Mild male factor Infertility
  • Women who have problems with their cervical mucus
  • Couples with unexplained Infertility

Assisted reproductive technology (ART) is a group of different methods used to help infertile couples. ART works by removing eggs from a woman's body. The eggs are then mixed with sperm to make embryos. The embryos are then put back in the woman's body. ART can be expensive and time-consuming. But it has allowed many couples to have Children that otherwise would not have been conceived. The most common complication of ART is multiple fetuses. But this is a problem that can be prevented or minimized in several different ways.

Common methods of ART include:

In vitro fertilization (IVF) means fertilization outside of the body. IVF is the most effective ART. It is often used when a woman's fallopian tubes are blocked or when a man produces too few sperm. Doctors treat the woman with a drug that causes the ovaries to produce multiple eggs. Once mature, the eggs are removed from the woman. They are put in a dish in the lab along with the man's sperm for fertilisation. After 3 to 5 days, healthy embryos are implanted in the woman's uterus.

Zygote intrafallopian transfer (ZIFT) or Tubal Embryo Transfer is similar to IVF. Fertilization occurs in the laboratory. Then the very young embryo is transferred to the fallopian tube instead of the uterus.

Gamete intrafallopian transfer (GIFT) involves transferring eggs and sperm into the woman's fallopian tube. So fertilization occurs in the woman's body. Few practices offer GIFT as an option.

Intracytoplasmic sperm injection (ICSI) is often used for couples in which there are serious problems with the sperm. Sometimes it is also used for older couples or for those with failed IVF attempts. In ICSI, a single sperm is injected into a mature egg. Then the embryo is transferred to the uterus or fallopian tube. ART procedures sometimes involve the use of donor eggs (eggs from another woman), donor sperm, or previously frozen embryos. Donor eggs are sometimes used for women who cannot produce eggs. Also, donor eggs or donor sperm is sometimes used when the woman or man has a genetic disease that can be passed on to the baby. An infertile woman or couple may also use donor embryos. These are embryos that were either created by couples in Infertility treatment or were created from donor sperm and donor eggs. The donated embryo is transferred to the uterus. The child will not be genetically related to either parent.

Surrogacy
Women with no eggs or unhealthy eggs might also want to consider surrogacy. A surrogate is a woman who agrees to become pregnant using the man's sperm and her own egg. The child will be genetically related to the surrogate and the male partner. After birth, the surrogate will give up the baby for adoption by the parents.

Gestational Carrier
Women with ovaries but no uterus may be able to use a gestational carrier. This may also be an option for women who shouldn't become pregnant because of a serious health problem. In this case, a woman uses her own egg. It is fertilized by the man's sperm and the embryo is placed inside the carrier's uterus. The carrier will not be related to the baby and gives him or her to the parents at birth. Recent research by the Centers for Disease Control showed that ART babies are two to four times more likely to have certain kinds of birth defects. These may include heart and digestive system problems, and cleft (divided into two pieces) lips or palate. Researchers don't know why this happens. The birth defects may not be due to the technology. Other factors, like the age of the parents, may be involved. More research is needed. The risk is relatively low, but parents should consider this when making the decision to use ART.

Success rates vary and depend on many factors. Some things that affect the success rate of ART include:

  • Age of the partners
  • Reason for Infertility
  • Clinic
  • Type of ART
  • If the egg is fresh or frozen
  • If the embryo is fresh or frozen

The U.S. Centers for Disease Prevention (CDC) collects success rates on ART for some fertility clinics. According to the 2006 CDC report on ART, the average percentage of ART cycles that led to a live birth were:

  • 39 percent in women under the age of 35
  • 30 percent in women aged 35-37
  • 21 percent in women aged 37-40
  • 11 percent in women aged 41-42

ART can be expensive and time-consuming. But it has allowed many couples to have children that otherwise would not have been conceived. The most common complication of ART is multiple fetuses. But this is a problem that can be prevented or minimized in several different ways.

Fertility Management Counseling involves a meaningful interaction between a trained Counselor and infertile couples and their families. Couples seek medical treatment to overcome Infertility. The psychological impacts of Infertility are anxiety, sadness, fear and some element of shame and guilt. They are also constantly questioned by the family and friends about the delay in pregnancy which adds stress to the couple. The Fertility management Counselor offers an elaborate guidance and customized coping skills to manage the psychological issues related to Infertility. They also educate and prepare the infertile couples for medical aspect of fertility treatment.

Infertility may have profound psychological effects. The man and/or woman may become more anxious to conceive, ironically increasing sexual dysfunction. Marital discord often develops in infertile couples, especially when they are under pressure to make medical decisions. Women trying to conceive often have clinical depression rates similar to women who have heart disease or cancer. In many cultures and subcultures the inability to conceive bears a stigma. In closed social groups, a degree of rejection (or a sense of being rejected by the couple) may cause considerable anxiety and disappointment. The psychological aspects of Infertility can be dealt with in individual and couples counseling with a mental health professional such as a psychologist, psychiatrist, or clinical social worker who are trained as Fertility Management Counselor. The more you understand about Infertility and your options, the better you can cope with its effects.

A trained Counselor is a professional who has the following academic and technical skills and knowledge:

  • A Master's or Doctoral degree from an accredited program in the field of counseling, psychology, psychiatry and social work.
  • Knowledge of medical procedure in Infertility.
  • Teach coping skills and strategies to alleviate anxiety due to Infertility
  • Promote and maintain healthy marital relations during the treatment
  • Guide couple to manage external family pressure
  • If sadness is prolonged and how it may impact the Infertility treatment process
  • Your reproductive endocrinologist recommends or requires you to see a Counselor before certain treatments to prepare you, like when deciding to use an egg or sperm donor.
  • Counselor specialized in Infertility counseling assist with stress management, providing patients with coping strategies to deal with the psychological stress of Infertility and the physical and mental stress of undergoing AHR (Assisted Human Reproduction) treatments.
  • Counselor encourage patients to be assertive in defining and meeting their needs within a system that can sometimes be intimidating.
  • Counselor promote self-care during AHR treatments and work at maximizing treatment efficacy.
  • Counselor enhance informed consent by helping couples to understand and comprehend what they are consenting to and the implications of their consent, including the psychosocial impact of undertaking treatment that contribute to informed consent.

Fertility Management Counseling can be provided in hospital and clinical settings.

  • One to two hour on-site counseling sessions are provided for couples and individuals.
  • Also, one hour health focus sessions are offered by nurses, embryologists and Counselor for in-vitro fertilization (IVF) treatments. For donor insemination (Dl) patients using known donors, Infertility counseling can be initially offered to the known donor (and partner if applicable), followed up by a session with both the patient/partner and the donor/donor’s partner.
  • Where timing for the provision of counseling services is concerned, a patient is counseled before entering into a treatment process. However, counseling can also be provided during or after a cycle as well as enough post-treatment counseling is being done.
Fertility care/services provided
  • Fertility evaluation & management – male & female
  • Sexual health assessment & care – male & female
  • Andrological & gynaecological care
  • Cancer screening
  • Pre-conception care
  • Endocrinological evaluation
  • Lifestyle modification & health coaching
Fertility Procedures
  • Nature cycle follow-up & cycle regulation
  • Ovulation induction with follicular studies
  • Intrauterine insemination (IUI)
  • IVF & natural cycle IVF
  • ICSI
  • Donor programmers – Oocyte, sperm
  • Surrogacy
Fertility related surgeries:
  • Diagnostic Laparoscopy with hysteroscopy with chromotubation& D&C
  • Operative Laparoscopy / Hysteroscopy
  • Correction of endocervical canal
Gynaecological Procedures
  • Colposcopic biopsy
  • Cervical biopsies
    • Cryo therapy
    • Cone biopsy
  • Hysteroscopic endometrial resection
  • Hysteroscopic polypectomy
  • Hysteroscopic myomectomy (fibroid removal)
  • Transabdominal hysterectomy
  • Laparoscopic tubal sterilization
  • Laparoscopic myomectomy (fibroid removal)
  • Laparoscopic cyst removal
Maternity
  • Cervical Encirclage
  • Normal vaginal deliveries
  • Vacuum assisted vaginal deliveries
  • Caesarean delivery
  • Lactation care
  • Pre- and postnatal exercise classes
  • Postnatal psychological counseling.

Reproductive Medicine Team

Dr K.S. Kavitha Gautham MS (OG), DRM (Ger.)
- Consultant Gynaecologist & Reproductive Medicine

Dr.Jaletha Helan DGO, DNB (OG), D.Diab, DRM (Germany)
- Consultant Gynaecologist & Reproductive Medicine

Dr Vijayasarathi Ramanathan, MMed-SexHlth, PhD, FECSM
- Consultant Sexual Medicine

Dr P. Periyasamy MS(Gen), MCh(Uro), DNB (Uro)
- Consultant Urologist/Andrologist

Dr Ravikiran Muthusamy, MD, DM (PGIMER)
- Consultant Endocrinologist

IVF TEAM

Dr Priya Kannan MM (Aus.), MCE (Aus.)
- Consultant Embryologist and Human Genetics

Ms Tharanya. K B.Sc, M.Sc, M.Phil (Biotech)
- Jr.Embryologist

Mr.Murugavel B.Tech, Mr Hemaraj B.Tech
- Trainee Embryologist

Fertility Counseling
Mrs S.A. Jayamary BSc, MA (PA), MSW

IVF Co-ordinator
Mrs.R.KavithaLakshmi MBA


Fertility

If you are concerned about your fertility, the first thing you should understand that you are not alone. Up to one in 6 couples worldwide have difficulty in conceiving in the 1st 12 months of trying. Many couple believe that once they plan for pregnancy or after marriage immediately they have to conceive stop!!! Don’t panic!!!. Scientific evidence over the past decades have helped millions overcome problems with fertility.

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