Erectile Dysfunction Shockwave Therapy: Don’t wince just get treated

Erectile dysfunction treatment might be a bit off-base topic for discussion but it is not an uncommon thing. The kind of unhealthy and polluted surrounding and habits one goes through in a daily is certainly one of the major causes of erectile dysfunction. The erectile dysfunction may be caused due to physical problems cognate to blood vessels, nerves, and hormones. The other type of reasons might be psychological. Normally, an erection occurs when someone’s imagination or senses are being stimulated and one gets kindled.

Erectile dysfunction shockwave therapy is an avant-garde modality that has been developed recently to treat erectile dysfunction. It is not a usual one and not intoxicating in nature, rather the erectile shockwave for erectile dysfunction aims at restoring the erectile mechanism so as to enable natural or spontaneous erection. It has been scientifically proven that the erectile dysfunction shock therapy induces cellular microtrauma that in turn stimulates the discharge of angiogenic aspects and the subsequent neovascularization of the treated tissue. The shock wave therapy was applied on the penile stem and crus for near about three minutes in each of the five anatomical sites. Unlike the medications for erectile issues that can hardly manage the symptoms, the erectile dysfunctionshockwave therapy addresses the root cause of many cases by equipping the penis with the ability to receive sufficient blood flow. The erectile dysfunction issue is one of the problems that most men suffers from but are unable to find a remedy for it that would fix it from the nub. India also suffers from the issue of impotence and the Andrologists in Bangalore are really capable of helping out men in this situation of crisis.

Andrologist is the medical practitioner who can assist you and treat the male related reproductive and sexual and urology organs also fertility issues. The Andrologist in Bangalore are trained to treat the disorders like infertility, erectile dysfunction, and genital trauma of the patients generally ranging from puberty to the elderly stage.

With the increasing rate of male infertility and other interrelated diseases the demand of erectile dysfunctional shockwave treatment is one such specialized therapy that can treat the issues from roots. Manipal Ankur provides complete and comprehensive erectile dysfunctional therapy that can help you understand the problem and to treat it properly without delaying the process. It is being recommended that people facing these issues shouldn’t shy away rather should come and get treated before it’s too late. 

Source: manipalankur.com/blog/worried-with-erectile-dysfunction-get-the-proper-treatment-today/

All You Need to Know About Erectile Dysfunction

Erectile dysfunction is a condition that is born out of factors that directly impact the overall health of a male. Erectile Dysfunction is not a disease but a fallout of health conditions. Long existing diseases like diabetes, poor life style choices like excessive smoking and drinking can lead to this condition.
Male impotency is triggered by erectile dysfunction and can be completely reversed with the help of erectile dysfunction treatment in India. Erectile Dysfunction can be treated at any age and the treatment process is kept in line with the overall health of the body along with the underlying cause of the problem.

Erectile Dysfunction Shockwave Therapy is the latest technology put on practice by Manipal Ankur for the treatment of erectile dysfunction. It is an effective procedure carried out to recalibrate the blood flow in the penis, so that the male reproductive organ is able to respond to a sexual stimulation from the opposite sex. Pulsed sound waves are directed on the male genital to create new blood vessels in vast quantities to sustain an erection. Shockwave therapy allows the patient to achieve normal erection and is aimed at permanently curing erectile dysfunction. It is an absolutely non-invasive procedure which is carried out by Androlgist in Bangalore at Manipal Ankur.

There has been a social stigma associated with the issue of Erectile Dysfunction which causes hesitation in the patient, effects his quality of life and curbs his confidence. Studies show that:

• Globally, 10 to 30% men suffer from the problem of Erectile Dysfunction on a reoccurring basis.
•  Most of the men experience the problem at a particular stage in life. Chances of Erectile Dysfunction increases significantly with age.

The only prerequisite to the treatment process is complete trust of the concerned patient as he has to thoroughly discuss his problem with the doctor and understand the nature of responsive treatment that is offered by Manipal Ankur. We aim to extend the best medical attention at your personal convenience.

All You Need to Know About IVF

IVF ( In vitro fertilization )has a major role in the world of fertility medicine. Though, that doesn’t mean that it isn’t complex and sometimes hard to comprehend. With more and more clinics opening globally, the data is flooding through and creating awareness like never before. This also means that there is room for error and misunderstandings about the whole IVFprocess, which can discourage women from considering it. So it’s vital to get the right information circulating about IVF treatment so it can help as many individuals as possible. Here are a few things you need to know about IVF treatment:

IVF is the fix for all infertility problems. This is not true. It could be used often, but there are other treatments as well, such as OI (ovulation induction) and IUI (intra-uterine insemination).

IVF is only used as a last resort. This is not true either. At times it’s the very first treatment, depending on the diagnosis.

IVF is only for the rich. This is certainly not true. With the introduction of IVF clinics in India, IVF costs have become cheaper and more flexible. Payment is often made in many phases which eliminatesthe need for a lump sum upfront.

Only young people can have IVF. This is often misunderstood by individuals. By means of donor eggs, treatment can be open to almost anyone of any age bracket.

IVF is successful in all cases. Despondently, this is also not true. Nevertheless at the Manipal Ankur we have a very high IVF success rates.

You will need to be admitted to an IVF Center overnight. This holds no truth either. Only infertility treatments such as evening egg collections might require an overnight stay.

IVF always means multiple pregnancies like twins or triplets. This is not the case. Controlling the number of embryos transferred means reducing the risk of a multiple pregnancy. However that said, multiple births are still more common after IVF treatment than anything else.

No one else understands what you’re going through. While IVF treatment is unavoidably a highly individual experience, you will be encircled by lots of individuals who have seen the process several times. Your emotions and feelings are likely to be very similar to those of the previous patients. What is important is thatat Manipal Hospital we are always on hand for advice and support whenever you need it.

IVF is quite challenging emotionally dueto the drugs. Severalfactors go into your IVF experience and though the drugs will form part of your reaction, they don’t complete it. You won’t certainly have an emotionally turbulent phase; there are lots of things to factor in. For example, stress of the treatment and how much you have already gone through.

If you are ever unclear or muddled about any element of your IVF treatment, you can contact us here: http://bit.ly/1NCczMG

Or call us on our Toll Free Number: 1800 208 4444

Increase Your IVF Success Rate

By preparing for your IVF you are able to support your hormonal and reproductive system, nourish your body, have nutrients available during the crucial early stages of fetal development and have the tools to handle any stress that may come your way during this journey.


Fertility Cleansing

Fertility cleansing supports liver health for proper hormone balance, healthy liver function and aids in cleansing the body of environmental toxins and pollutants. Fertility cleansing also helps to support uterine health by increasing circulation, aiding the uterus in its natural ability to clear out old menstrual blood. Fertility cleansing is based on your monthly cycle and generally lasts from 25-30 days.

Eating a Fertility Diet

Nutrition is the foundation of healthy fertility and a healthy pregnancy. Nutrition can have a direct impact on the future development and health of your child. This is a big deal and such a great opportunity for you to prepare ahead of time.

De-stress: Stress Decreases IVF Success

This may seem surprising but it does make some sense since IVF cycles use very controlled hormonal levels for their success. The strong hormonal medications used for IVF may render stress hormones less potent on fertility since the entire hormonal cycle is being controlled. While this is reassuring you should still consider creating a stress support system for yourself so your experience is a supported one.

IVF is a profound procedure that is a blessing to have available as an option. Move forward feeling encouraged, empowered and nourished on your journey.

How infertility treatment can be diagnosed ?

Reproductive Health Clinic

There is an enormous difference between choosing not to have kids and physically being unable to conceive one. Manipal Ankur, Reproductive Health Clinic  understands this emotion quite deeply and has established its core roots around this fact. With its extensive research and experience in the field of Andrology, Reproductive Medicine & Men's Health, Manipal Ankur, Reproductive Health Clinic  has succeeded to become leaders in the field of Female Infertility, Male Infertility and Mens Health in the state of Karnataka.

Many couples end up needing advanced treatments such as IVF, in vitro fertilization to overcome this age related decline. Women’s liberation brings many advantages to women. However, as women delay childbearing, society has not educated us about this fertility decline. The age of the male

partner does not appear to matter much when it comes to fertility. In approximately 40 percent of infertile couples, the male partner is the sole cause and in 20 percent a contributing cause, of infertility.

Manipal Ankur is the most trusted and leading Reproductive Health Clinic in . It focuses on Andrology, Reproductive Medicine & Men's Health in order to deliver high quality services that ensure maximum chances of success for patients. Transforming your despair into a reassuring and hopeful experience, we at Manipal Ankur have accomplished an environment of security for our patients. We have introduced into India, optimum infertility treatment procedures.

Bad Habits Result in Bad Sperms

Infertility amid men is at upsurge these days. Unwholesome lifestyle, stress and improper diet are some of the major origins of low sperm count. A couple might enjoy love making, but becoming pregnant is difficult if the sperm count of the male is low. When it comes to pregnancy, many health conditions like low sperm count, sperm allergy, erectile dysfunction etc. can affect the couple. Lack of sex and loads of stress also plays a chief role in decreasing sperm count. Low sperm count is due to various things.

Here are some bad habits that affect the quality of sperms in male:

Using Laptop:  Using a laptop on the lap for a long duration of time increases the temperature in the scrotum and reduces sperm production.

Hot Bath: A hot shower is relaxing to the body, but it reduces sperm count as the temperature of the testicles are raised. This damages the sperm quality and reduces the count.

Tight Briefs: Wearing tight briefs can increase the heat in the testicles. This in turn lower the sperm counts. Prefer boxers over tight underwear.

Mobile Phone: The radiation that comes from the mobile phones have a great impact on the sperm count of men. According to studies, a mobile can reduce sperm count.

Stress: Stress is one of the major causes of many healthproblem. Taking stress not only affects your emotional health, but also leads to infertility problems in men.

Lack of sex: Making love is one of the best solutions to several sexual problems. Abstaining from sex decreases the sperm count. The sperm changes its shape and becomes stale.

Alcohol Drinking: alcohol decreases the testosterone levels which reduces the sperm count. It is one of the common causes of infertility in men.

Smoking: Tobacco can lead to impotence. So it not only reduces sperm count, but also makes a man infertile! Even smoking pot can lead to infertility.

Watching TV:  Becoming a couch potato leads to obesity and reduce sperm count. A study from the British Journal of Sports Medicine confirmed that men who do not watch a lot of TV and workout regularly have better sperm count and quality.

What Every Man Should Know About Prostate Cancer?

Prostate cancer is cancer that occurs in a man’s prostate. It is a small gland that produces the seminal fluid which nourishes and transports the sperm. Prostate cancer is one of the most common types of cancer in men. Prostate cancer usually grows slowly and primarily remains limited to the prostate gland, where it may not cause serious harm. While some types of prostate cancer grow gradually and may need minimal or no treatment, other types are aggressive and can spread quickly. Here are a few things all men should know about prostate cancer:

What is prostate cancer and what are the symptoms?

The prostate is a walnut-sized gland situated below the bladder and in front of the rectum in men. Almost all forms of prostate cancer start with small deviations in the size and shape of the prostate gland cells. These cells can grow uncontrollably, creating tumors. In most cases, these tumors grow very slowly; however, in a small percentage of cases, they can be more aggressive. Regrettably, prostate cancer in the early, slow-growing stages is almost always symptom-free. Bone pain or blood in the urine may direct an advanced stage of prostate cancer. But the majority of men have no signs or symptoms. That’s why it is vital to be screened regularly.

What do prostate screenings entail?

There are two mechanisms. One is the PSA blood test, which measures the level of Prostate Specific Antigen in the blood. Elevated levels may indicate the presence of cancer. The second component is the digital rectal exam performed by a urologist. While this is the test that many men are anxious about, for the majority it is a fast and painless procedure, lasting just a few seconds. During this exam, the urologist checks for irregularities, asymmetry and hard areas in the prostate. It is important to do both exams because it is possible for a person to have low PSA levels yet still have prostate cancer. Combined, the screenings are highly effective in early detection — important because when caught early, prostate cancer is highly treatable.

Who should get screened?

Men should speak with their physician to determine if screening is appropriate for them. However, it is difficult for a patient to make an informed decision about his prostate health unless he knows his PSA level.

What are the risk factors for prostate cancer?

The risk factors include:

Race: African Americans have higher rates than the rest of the population.

Age Risk increases with age.

Family history: If your father, brother or grandfather had prostate cancer, your risk may be higher.

Diet: The high-fat, high-calorie western diet is a factor.

Agent Orange exposure: Past exposure to this chemical brings elevated risk.

Viruses and infections: Researchers believe there may be a link between certain illnesses and prostate cancer.

What are the treatment options?

Perhaps the most important thing a man can do upon diagnosis is to find a urologist who he trusts. A good urologist is not only up-to-date on the available options, but also can help a patient choose the most appropriate course for his individual situation, taking into account his age, general health and the stage of the cancer.

Female Fertility Tips

Female Fertility Guide

Women who have already been pregnant don’t expect to have problems conceiving again, but in fact as many as a third of all the patients at fertility clinics will have had a child, or a pregnancy, in the past. This is known as secondary infertility. Some conditions which affect fertility can develop after a first pregnancy, and an untreated infection after a delivery can sometimes cause problems. In other cases, secondary infertility is just down to age. If a couple have relatively minor fertility problems and start trying for a first child when they are fairly young, they may still manage to conceive, but if the minor problems are combined with age, it can make all the difference. In some cases, secondary infertility will remain unexplained. It is important not to assume you cannot possibly have a fertility problem just because you’ve already conceived before. If you’ve been trying unsuccessfully for another baby for more than a year, it is worth having some basic tests carried out.

Boosting your fertility naturally

We may be able to influence our fertility, and improve the chances of success of any fertility treatment, by making some quite simple changes to our lives. How much attention we pay to what we eat and drink, and what we do at work and in our spare time can all make a difference.

Smoking

If you are a smoker, giving up is one of the most important things you can do to help increase your chances of getting pregnant and improve your fertility. Women who smoke often take longer to conceive, and smoking can affect your ovarian reserve, reducing egg quality and quantity. Women smokers are twice as likely to have fertility problems as non-smokers. On average, women who smoke reach the menopause two years earlier than non-smokers, and they are more likely to have an early menopause. One study has suggested smoking can shorten a woman’s reproductive life by ten years. What’s more, it’s not just your own smoking that can affect your fertility – if your partner smokes, that can cause problems too. Women who live with a smoker have been shown to take longer to get pregnant.

Drinking

Moderation here, as in all things, is the key. You should certainly be drinking less than the recommended upper limit of 14 units a week for women, and it is often advised that women who are trying to conceive should give up alcohol altogether. Research suggests that women who drink more than five units of alcohol a week take longer to get pregnant, and the general advice if you’re trying to conceive is to limit yourself to one or two units once or twice a week.

Caffeine

It has been claimed that just one cup of coffee a day can reduce your fertility by half, but the evidence is not consistent when it comes to the link between caffeine consumption and infertility. Consuming very large quantities of caffeine is not a good idea anyway, and the crucial level seems to be around 300mg a day, which means your caffeine intake could possibly cause problems if you drink more than three or four cups of coffee, six cups of tea or eight cans of cola in a day. One study found that women who drink more than five cups of coffee a day were at greater risk of miscarriage. Despite the conflicting evidence, it makes sense not to drink too many caffeinated drinks if you are trying to lead a healthy lifestyle.

Prescription drugs

You should check whether any prescription or over-the-counter drugs that you use on a regular basis might have an effect on your fertility. Some non-steroidal anti-inflammatory drugs, such as Ibuprofen, can affect ovulation. Thyroid replacement hormones, antidepressants, tranquilisers and asthma medication have all been linked to fertility problems. For men, some antibiotics, anti-histamines, antimalarial drugs, blood-pressure tablets and arthritis drugs may cause problems. If you, or your partner, are taking any medication on a regular basis, it is worth checking that it isn’t going to affect your chances of getting pregnant.

Weight

Female fertility is affected by extremes of weight, but there is a wide scale in the middle where both slim and curvy women fall within perfectly healthy weight ranges. However, when a woman has too little body fat, it can cause her periods to stop and you can’t get pregnant if you aren’t ovulating. It will also be much harder to conceive if your body is deprived of vital minerals, vitamins and nutrients.

At the other end of the scale, obesity also has an impact on ovulation. Fat cells produce oestrogen, and excess weight can lead to raised oestrogen levels, which may prevent ovulation. Women who are overweight are also more likely to have polycystic ovary syndrome, which can affect fertility. If your partner is very overweight, this could reduce his fertility by affecting his sperm quality.

Exercise

Apparently, most of us don’t get enough exercise. It helps maintain our bodies in good working order, as well as increasing fitness and strength. It has just as important a role in keeping us emotionally balanced, reducing stress and making us feel relaxed. It is often beneficial for those who suffer from depression, anxiety or insomnia. There are long-term benefits too, as it can help prevent high blood pressure and heart problems.

As always, you can have too much of a good thing, and women who do huge amounts of exercise can have problems with ovulation. We are talking about extremely vigorous exercise here, and it isn’t an excuse to avoid a brisk walk around the park, as this problem mainly affects female athletes who are in regular training.

Diet

With diet, as with everything, a balance is essential, You will come across lots of advice about food and fertility, which may involve cutting out all kinds of things entirely, from dairy produce and red meat to sugar and wheat, but for most of us this would not be a particularly enjoyable experience. What’s more important, we probably wouldn’t stick with it for very long. It is far better to make less dramatic changes to your diet that you know you will be able to live with.

The food many of us eat is full of additives, and you may want to try to cut down the amount of processed convenience foods you consume and consider using organic produce. If you’re not sure about something, read the label. Sometimes surprisingly few of the ingredients listed on ready-meals are actually recognisable as food.

Eating properly means your body gets the fuel it needs to function at its best. We’re all pretty well versed in the rules of healthy eating now – a balanced diet with lots of fruit and vegetables, making sure you have sufficient protein, carbohydrate and unsaturated fat (that’s the sort you get in olive oil, seeds and fish rather than in meat and dairy products).

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Environmental hazards

Every day we are exposed to chemicals and toxins, but there is little clear evidence as to how they may affect our reproductive systems. Part of the problem is that there are just so many potentially damaging substances in everyday products like household cleaners and pesticides, solvent-based paints, additives and preservatives. Although individual chemicals or toxins may have been tested and declared safe, we don’t know the cumulative effects of being exposed to so many all at once. It is clearly impossible in the twenty-first century to lead a life free from pollutants and chemicals, but you can try to limit your exposure by cutting back on your use of these products in your home.

There may be more specific hazards in the workplace. We know that exposure to radiation and pesticides can have a harmful effect on the human reproductive system and there are suggestions that other substances could inhibit fertility, although there is not always clear scientific evidence. If you have concerns that chemicals you use at work may be affecting your fertility, you should talk to your doctor.

What is IVF (in vitro fertilization)? Is it right for you?

What is IVF?

In-vitro Fertilization is an advanced assisted reproductive technology. The egg and the sperm are fertilized outside of the body. After a period of allowing the embryo to mature inside a safe incubator, like that provided by an Embryoscope, the fertilized embryo is then transferred to the uterus. The IVF procedure was first done in 1978 and since then has made it possible for more than four million children to be born.

When will you be prescribed to undergo IVF?

1) If you have been unable to conceive after trying actively for over a year

2) If you are over 35 years old and have been able to conceive after trying for 6 months

3) If you have an unexplained infertility

4) If you have been diagnosed with uterine fibroids, polycystic ovarian syndrome (PCOS), shrinking ovarian reserve, or endometriosis.

5) If your male partner has been tested at Semen Analysis Centers and his results show low motility or sperm count.

6) If you have already tried other forms of treatment to no avail

7) If you have not been identified with a diagnosis that can be treated

The process:

Every IVF procedure is unique and tailored to suit the needs of a particular couple. However, it typically comprises five major steps that are performed over the extent of one menstrual cycle.

1) Ovarian stimulation (8-12 days): In addition to a course of medication that would stimulate your ovaries to develop multiple eggs, you will be subject to regular ultrasounds to gauge the extent of maturation of your ovarian follicles. The consistent surveillance is important for avoiding ovarian hyperstimulation syndrome. When the follicles mature, you will be injected with chorionic gonadotropin (hCG) to make the eggs ready for fertilization.

2) Egg retrieval (30 minutes): About one and half days after your hCG injection, your eggs will be retrieved from your ovarian follicles while you are under anesthesia and your partners sperm will be collected to fertilize the eggs.

3)IVF (4-9 days): The fertilization occurs in-vitro or outside the body, in your infertility clinic, in this step. An embryologist requires 18 hours to determine the fertilization. The embryos will incubate for 2 to 5 days, usually.

4) Embryo transfer: This can happen at any time between the third day after the IVF (fresh embryos) and two months after it (in which case your embryo will be frozen). Your embryos will be transferred to your uterus with a narrow catheter.

5) Embryo implantation (6-10 days): This is a crucial time after embryo transfer when you will have to continue with fertility medications. At the end of this period your doctor will conduct a blood test to determine if the embryo has been planted in the lining of your uterus. If that is indeed the case then it means that your in-vitro fertilization was a success.

What IVF does to your body:

1) It reworks you natural physical order. IVF overwrites the natural instinct of our bodies to avoid having many babies at once, to increase chances of conceiving for the infertile.

2) It medically stimulates your ovaries and induces it to produce multiple eggs. This process is known as controlled ovarian stimulation.

3) It postponed natural ovulation and stems its spontaneity because then the eggs will be lost, negating the in-vitro fertilization cycle.

4) It prepares your uterus for receiving the fertilized embryo and its implantation.

Cancer is not equal to Infertility

     Cancer and certain cancer treatments, can disturb your reproductive health. It could be worth it to consider ways of preserving your fertility before you begin your treatment. When you are told that you have cancer, your ability to have children may be the outermost thing of your mind. Whether you already have children or haven’t yet thought about becoming a parent, it is worth thinking about your fertility before starting some forms of cancer treatment.

Cancer treatments that can affect your fertility include chemotherapy, radiotherapy, and surgery on your reproductive organs, including the ovaries or testicles. Hormone therapies and other treatments may also have an impact on fertility, but less is known about the effects of these treatments. It can be difficult to know what the effects of the cancer treatment will be until much later. Many people who are treated for cancer, especially those treated for cancer as children, remain fertile and go on to have a family of their own in later life. Some find that their fertility is affected for a short time and then recovers when treatment has finished, but others find that their fertility is affected for longer. It often depends on your individual circumstances, such as your age, the treatment you receive, where in your body the cancer is and whether you are male or female.

Women and fertility

If you’re a woman of childbearing age, cancer treatments can affect your fertility by:
•             stopping you from producing certain hormones
•             stopping your ovaries from working and therefore causing an early menopause
•             damaging the lining of your womb
•             involving surgery to remove your womb

Men and fertility

Cancer treatments can affect your fertility by:
•             stopping, or interfering with, the production of sperm
•             affecting the production of testosterone or other hormones involved with sexual function
•             damaging nerves and blood vessels in your pelvic area, which can make it difficult to get an erection or ejaculate

Fertility treatment

If either your fertility or your ability to have sex has been affected by your cancer or a cancer treatment, you may want to try a fertility treatment to help you conceive.

If you are considering having fertility treatment, speak to your GP first. If you have private fertility treatment, the cost will vary from clinic to clinic.

Your GP will be able to arrange some tests and refer you to a specialist fertility doctor. The specialist will be able to give you information and advice about the most appropriate fertility treatments for you.

Types of fertility treatment include the use of:
•             In vitro fertilisation (IVF)
•             Your frozen sperm, embryos, eggs or ovarian tissue
•             donated sperm, eggs or embryos

Getting support

Trying for a family and finding out whether or not you’re fertile can be stressful. If you’re finding any of these issues difficult, you may find that it helps to talk to someone. Consider discussing your feelings with your family, your partner, a friend or your cancer specialist. Some people find that fertility treatments do not suit them or don’t work. If this is the case, there are other options for having a family, such as adoption or surrogacy.

There is a lot to think about if you’re considering any of these options, so talk them through with someone close to you or your doctor, or contact one of the organisations below for specific information and advice.

CASA - Computer Assisted Semen

CASA- COMPUTER ASSISTED SEMEN ANALYSIS- a state of the art facility available at Ankur

High end Microoptics machine with florescence microscopy “Computer Assisted Semen Analysis”. A Microscope images of moving sperms is translated into a series of measurements and quantified numbers. Compared to conventional methods, it provides:

A revolution in precision and accuracy – especially for sperm morphology, a critical factor of fertilization. A Video Images are depicted live on the computer monitor. Images are shown in negative contrast ie. sperm is seen in white against a black background.

Eliminates operator bias and provides additional parameters of fertilizing ability (see 3 below) and also images to recheck the validity.

Mostly used for assessment of sperm concentration and specific patterns of sperm motility (velocity, linearity etc). Imaging systems in CASA are high end since the sperm movements are upto 80 beats per second and ordinary video systems capture images at 25 to 30 frames per second. The latter will give a hazy image of the tail as well as low reliability of sperm motility. CASA has facility to reconstruct input video images at higher frame rates and is therefore a reliable instrument to analyse fast moving sperms.

It generates kinematic values based on velocity of movement, width of the sperm head trajectory and frequency of the change in the direction of sperm head. Hence it is able to analyse variations in sperm motility patterns in a quantifiable way.

The available clinical data show that the measurement obtained by CASA are correlated with conception in vivo and fertilization in vitro, but comprehensive quality control and quality assurance programs are necessary to ensure accuracy. CASA can be a guide to predict if the sperm can penetrate through the cervical mucous in the female, that the spermatozoa prepared for an in vitro fertilization attempt will succeed / fail to penetrate the coverings of the oocyte.

Breaking 7 Fertility Myths

While infertility is getting increasingly common today, we still tend to take issues around it for granted. A common misconception is that infertility gets cured on its own. This is generally why we refrain from breaking inertia and opting for enhanced life-style choices. Listed below are 7 such myths that need to be over-ridden in order to better combat the problem of infertility.

1. Male fertility is independent of age
Fueled by the fact that couples tend to give lesser importance to male infertility, it often goes unnoticed when an age-related issue arises. In addition to deterioration in semen volume itself, post 40 there is progressive decrease in both sperm quality and its ability pass on healthy genes.

2. You are fertile as long as you are getting pregnant.
Secondary infertility is often experienced by couples seeking to have a second child or ppl having infertility after one conception. A history of good fertility rates in one’s family or previous records of one’s own fertility need not necessarily mean that infertility is alien. Progressive degeneration of both eggs and sperm need to be checked for.

3. Weight and fertility are not linked
Women who are over-weight do conceive and therefore couples battling infertility under-mine the implication of those extra-pounds. However, lesser known is the fact that being overweight causes hormonal imbalances in both men and women. Every 5-10% weight gained leads to a recorded drop in fertility. For women battling ovarian cysts, weight reduction is often all it takes to conceive that bundle of joy!

4. A woman’s egg reserve does not diminish till 40
Women only have as many as 400-500 ovulating eggs in a lifetime despite having a reserve of thousands at puberty. The ovarian reserve decreases with age. While the reserve undergoes a loss of about 10% in late 20’s, in 30’s women often have about 15% chances of a healthy pregnancy. By the age of 35, a woman’s chances of having a baby is a meek 10% which is further reduced to 5% at 40.

5. Smoking does not affect fertility
Both active and passive smoking are risk factors for infertility. Researchers have proven that smokers experience infertility issues twice as often as non-smokers do. Besides a drop in sperm count, men who smoke tend to pass on mutated genes more often than men who do not smoke. In women, smoking causes a steep drop in egg reserve and leads to pre-mature menopause.

6. Infertility Runs In Family.
Infertility is not hereditary. However, there are medical conditions that are hereditary which may interfere with your ability to get pregnant. Some types of fertility problems can be hereditary. Endometriosis is one female fertility problem that can be hereditary. Generally speaking, fertility problems tend to have more to do with lifestyle factors than with heredity or genetics. The most severe fertility problems cannot, by definition, be passed on, because there are usually no children to which the problem could be passed.

7. How position affects conception
Whilst semen inevitably comes out of the vagina following an ejaculation, sufficient sperm is deposited in the neck of the womb which then heads towards the egg, regardless of the sexual position.

The silver lining is the fact that it is never too late to make wellness a way of life. The key is to accept the facts about one’s body and embracing realistic solutions for the same. Small changes in your day-to-day lifestyle can go a long way in preventing fertility problems.

Microsurgical Epididymal Sperm Aspiration

What is it?
Under direct observation, a special needle is used to aspirate viable sperms from the epididymis instead of the testis. Like TESE this is a useful adjunct to IVF and in particular to ICSE. Alternatively it can be done to extract sperms which can be kept refrigerated and used later. Cryopreservation offers the benefit of repeat procedure, should the IVF fail.

Who requires it?
Men with obstruction of the male reproductive tube – congenital or acquired. congenital absence of the Vaz deferens on both sides is a good indication. Acquired causes may be due to infection, injury, previous failed spermatic duct recanalization or failed duct – epididymis recanalization (called vasoepididymostory). Iatrogenic causes may be traceable bladder neck, pelvic, abdominal or inguino-scrotal surgery.

What is the rationale of using TESE?
It was a general conclusion that in a normal male the sperms undergo a certain amount of maturity, mobility and fertilizing capacity before proceeding to the Vaz deferens. However, recent research has shown that in reproductive tract obstruction, good quality sperms are available in the upper part of the epididymis. Microscopically and functionally y they are as good as the sperms of the testis and can be aspirated and used for IVF. However the same cannot be said for the distal epididymis. Here the sperms undergo destruction and plenty of macrophages can be found in histology. These observations become important while selecting the site of sperms aspiration during MESE.

Why it is preferred to donated sperm? Compared to a donor sperm, it is always preferable to have the husband’s sperm if the morphology is ok.

Are there any problems with this procedure?
This is a minimally invasive procedure done using an operating microscope. Only a tiny segment of the epididymis is sliced (called micropuncture) to extract sperms. In comparison a bit of testis tissue is removed in TESE. In MESE, amount of blood contamination of the epididymal fluid is minimised due to the micropuncture. This improves the fertilizing quality of the sperms.

MESE procedure: A tiny surgical incision is made in the scrotum and the testis is first identified. The epididymis is then identified – this is located above and behind the testis. Using an operating microscope , a micropuncture is made on the tubule in the upper part of the epididymis. Epididymal fluid is gently aspirated. The aspirate is immediately handed over to the embryologist who immediately examines the same under the microscope and confirms adequacy and good quality of sperms (sperm count and motility). It optimal amounts of sperms of the right quality is not found, the efferent ductules can similarly be approached through micropuncture. This is one advantage on the procedure. Similarly only a few microliters of fluid is required to harvest the sperms. Hence the procedure can be considered minimally invasive.

Sexually Transmitted Diseases

Sexually Transmitted Diseases (STD) have an influence on your fertility levels on many levels. While the ability to conceive itself is disturbed, the health of the child is also affected. Here are pointers on how you could reduce risk factors as a pregnant STD patient-

• Seeking the right treatment while pregnant could as much as bring down the chances of your infant developing STD from 25%-2%.

• Pelvic Inflammatory Disease (PID ), a consequence of other sexually transmitted diseases can be avoided when you treat the initial intense discomfort caused.

• Chlamydia, has long term side effects, if left untreated. It not only affects your health, but also that of your baby.

• Neonatal Herpes Infection, a serious illness can be life threatening. While most women with herpes do not transmit neonatal herpes to their children, if you or your partner has genital herpes, it is important to inform your doctor about your risk.

• Symptoms of Gonorrhea include bleeding after sex and yellow or bloody vaginal discharge which can inflame the pelvic area, causing epididymitis. This is known to hamper your conception.
Women tend to be at the risk when it comes to STD. Therefore, most doctors agree that a pre-conception STD test is essential to check for undiagnosed STD from the past and to see if any unknown damage could impede the woman’s chance of getting pregnant.

Menstrual & Uterine Cycles

The menstrual cycle is entirely hormone driven and controlled by the ovaries and it is superior to the pituitary gland. It is not advisable to attempt any procedure for stabilization of uterine cycle unless the cause of the problem is known. The end result of hormonal imbalance is always anovulatory cycles. The patient however will present with history of menstrual irregularities and inability to conceive. A brief approach to such a case in terms of diagnosis and treatment is presented here. Specific strategy will depend on the nature of the problem.

If the bleeding is chronic, the patient may show evidence of anemia. This must be treated.
A urine based pregnancy test is done to rule out possible pregnancy as a routine precaution. This is to ensure that in the event of a pregrancy already in progress, the patient is not subject to any further investigation.

Tests to check the number and quality of platelet is done to confirm if the patient is suffering from any coagulopathies. If confirmed, this can be confirmed.

A PAP smear is a simple test to rule out cervical cancer.

Liver function tests and tests for thyroid hormone status can help eliminate these problems and if necessary correct them.

Progesterone, esterogen and prolactin levels may need to be checked. Prolactin level may be
high in a pituitary adenoma. Similarly DHEAS may be high in polycystic ovarian disease.
An endometrial biopsy may be necessary through a D & C procedure, direct hysteroscopy enabled biopsy to understand the histo-pathological status of the uterus. A transvaginal ultrasound may be needed to understand the state of the uterus and ovaries.

Generally, most cases of menstrual irregularities will have a high estrogen level in the cycle and a low progesterone level. Besides estrogen, optimal levels of progesterone at the right time is needed for ovulation. Hence using prepared hormones, the patient is placed on a regime that almost mimicks the normal menstrual cycle. If all other factors are normal, this itself will be sufficient to induce ovulation during the fertility window period. This in essence is the method of stabilization of uterine cycle. Oral contraceptive pills are prescribed with caution and only when the female does not want pregnancy. For couples desirous of a child , the female is given a series of progestin therapy. Cycles should stabilize in three months failing which hysteroscopy and if necessary, clomiphine induced release of eggs may be considered.

Non steroidal anti-inflammatory agents (naproxen, mefanemic acid) may be used to reduce bleeds and also pain if any.

Stages of Menstruation

Menstruation is a monthly occurrence for almost all sexually mature females. Menstruation occurs when the uterus sheds the endometrium (inner nutrition rich mucous membrane of the uterus) in the absence of pregnancy. It happens in women from puberty (between age 11to 15) to menopause (between age 45-50.)
Here is a brief description of the four stages that the endometrium undergoes during Menstruation. The animation graphically represents this process. (The myometrium is a layer of the uterus that consists of uterine myocytes).
Stage of Menses (Days 1-4)
Also known as the bleeding phase, menses is caused due the withdrawal of the ovarian hormones – oestrogen and progesterone at the end of the ovarian cycle. Normal bleeding consists of dead endometrial cells, blood, vaginal cells, mucous from the cervix and other necrotic tissues. Most women bleed for 3 to 5 days.
Stage of Repair (Days 4-6)
Post the menstrual bleeding, for a short duration of about 48 hours the endometrium rests and repairs itself. The endometrium is disorganized and about 1mm thick during this stage.
Stage of Proliferation (Days 6-16)
As estrogen gets produced in the ovary, the endometrium proliferates. It increases in size and thickness. New blood vessels grow from the stumps of the old vessels. Endometrial glands grow bigger although their number remains the same. At the end of the proliferative stage, the endometrium is about 2-3 mm thick.
Women who are being treated to cure infertility undergo ultrasonography to measure the endometrial thickness.
Stage of Secretion (Days 16-28)
Once ovulation occurs, progesterone produced in the ovary increases and the endometrium continues to grow to reach a thickness of around 5-7 mm. Women undergoing ultrasound treatment for Infertility tend to have thickness up to 10 -15mm.
The endometrial glands begin to secrete in this stage, due to which it’s called the stage of secretion. Initially, the secretions get collected in the cells of the glands but towards the last few days of this stage, the secretions are pushed out of the cells and get collected in the endometrial cavity.
Endometrial growth stops from the 22nd day of the cycle as the corpus luteum (the essential lining that grows waiting to nourish a healthy pregnancy) degenerates. Eventually it begins to shrink, after which shedding of the endometrial lining occurs. Thus starts the next menstrual cycle.

Environmental Pollution and Fertility

Decline in semen quality and reproduction has been attributed to changing lifestyle and pollution. However, there have been contradictory reports during the past 50 years.
Studies have shown that constant genetic and evolutionary pressure has led to a decline in spermatogenesis. Semen quality decline in Paris, Italy, Denmark, Norway, Scotland, Belgium, Finland, India and USA has been related to increasing pollutants and industrialization.
Possible causes for semen quality decline are pollution due to physical (heat, radiation) and chemical (halogens, glycols/glycol ethers, disinfectants, organophosphates, pesticides, insecticides, organic solvents, carbon disulphide, dibromochloropropane; heavy metals like lead, cadmium, chromium, mercury, beryllium, manganese, zinc; phytoestrogens/ estrogenic/ androgenic/ hormonal compounds; smoke, automobile/ industrial emissions, nuclear dust, contraceptive residues) factors present in general environment and occupational areas.
Smoking, obesity, excessive heat to testicles, drinking excess alcohol and caffeinated beverages, eating estrogenic/androgenic foods have been reported to affect male fertility adversely.
Prolonged cell phone usage affects sperm motility. Increased sperm abnormalities and reduced sperm motility have been seen in metal welders.
Semen quality (motility, count, normal sperms) and fecundity decrements were also related to stress, working duration and occupational posture.
All above factors induce oxidative and DNA damage, teratogenecity, congenital defects, endocrine disruption, abortion, still birth, anatomic, genetic, immunological disturbances etc affecting semen quality and reproduction.
However, due to contradictions and non replications in various epidemiological findings (due to methodological problems), a wide integrated study with various parameters should be undertaken to address the issue.
According to National Health Survey reports the level of infertility in India is 2.5 % at national level and varies from 1.4 to 4.4 % among different states of India and Karnataka as per our statistics is 3.1%. In India alone, 18 million couples suffer from infertility which accounts for 14 % of all infertile couples in the world. The global magnitude of infertility is 60 to 80 million couples suffer infertility each year.

Semen quality

The meta-analysis report of Carlsen et al. (1992) that semen quality in men worldwide has undergone a decline. Decrease in semen quality has also been reported from different geographical regions like Paris (Auger et al., 1995), Italy (Bilotta et al., 1999), Denmark (Bostofte et al., 1983; Jorgensen et al., 2006), Norway (Bendvold, 1989), Scotland (Irvine et al., 1998), Belgium (Van Waeleghem et al., 1996), Finland (Horte et al., 2001) and USA (Leto and Frensilli, 1981; Swan et al., 2003).Published information in Asia is limited. Zhang et al. (1999) analysed the change in sperm quality and male infertility among men in China from 1983 to 1996. The results of the analysis showed a definite negative correlation and statistical significant decrease in sperm concentration, motility and morphology.
Sperm quality in men attending our clinic shows a 15 % decline in sperm motility and 2 % decline in morphology over the last 5 years.

Air pollution

Air, water and soil pollutants are commonly known as environmental endocrine disruptors or xenoestrogens or environmental hormones. Disrupting chemicals like alkylmercury, carbon disulphide, vinclozolin, procymidone, pesticides, insecticides, plastics, gums, paints, glycols, glycolethers and glycolesters.
Air pollution is mainly caused by smoke resulting from automobiles, industrial gases and domestic cooking using wood, cow-dung cake which increases the levels of lead, carbon monoxide, sulphur, nitrogen oxide, fluorides etc. and thus influence the male reproductive health.
Comparison of semen quality revealed decrease in sperm motility, normal sperm numbers, decreased normal head shape but increased abnormal chromatin sperms in higher air pollution period. Air pollution also increases DNA damage in human especially in susceptible groups. Intermittent exposure to environmental pollution results in sperm DNA damage causing male infertility and miscarriage.
In a study in Italy people who were exposed to traffic fumes had poorer sperm quality and in particular, had lower sperm motility.
Ozone exposure is known to cause oxidative stress, which is documented to disrupt testicular and sperm function.
As with smoking, exposure to ozone may induce either an inflammatory reaction in the male genital tract or the formation of circulating toxic species and, thus can cause a decline in sperm concentration.
Besides ozone, nitrogen oxide, carbon monoxide and fine particulate matter, each of these air pollutants was believed to be capable of impacting sperm production.
Heavy metals
Heavy metals affect male reproduction causing various lesions in reproductive organs leading to infertility. Cadmium is a ubiquitous heavy trace metal toxicant and is well known as an industrial pollutant. Exposures to cadmium have been reported to reduce male fertility.
Chromium is an important heavy metal which possesses several industrial applications Occupational exposure to chromium leads to alteration of semen status and may adversely affect the reproductive success of exposed workers.
Lead is the most significant toxin of the heavy metals. Industrial decisions, such as the addition of lead to paints, dyes, and gasoline, have created an epidemic of lead poisonings. Lead is a naturally occurring substance and can be found in organic and inorganic forms.
Lead is a reproductive toxicant detrimental to human semen quality. Decreased sperm count, motility, acid phosphatase, succinic dehydrogenase, fructose, surface reaction of sperm head DNA besides increasing abnormal sperms was reported in occupational exposure of lead in printing press workers in India. Higher lead level lowers sperm’s ability to bind and fertilize the egg.
Mercury, widely used in modern technology and industrial revolution, has become an important pollutant for animals and humans. Mercury intoxication has been associated with male reproductive toxicity in experimental animals and mercury may have the potential to produce adverse effects on fertility of men. In a small population in India, it was found that occupational exposure to metals, solvents, pesticides, extreme heat or vapours increases incidence of poor motility (oligo-asthenospermia) and even zero sperms (azoospermia).

Changing lifestyle

There is a good evidence that diet and lifestyle can impair a man’s fertility. Several studies have clearly shown that cigarette smoking lowers both sperm counts and sperm motility. Excessive alcohol consumption has also been shown to impair normal. It is well known that the testicles should be cooler than the rest of the body for sperm production to be at its best. The harmful effect of a varicocele on sperm production is believed to result from the extra warming of the area caused by the dilated veins.
Hormone-like substances such as DHEA or “androgens” intended to build muscle mass can actually stop sperm production completely. Excessive consumption of coffee or other caffeine-containing beverages have been reported to be deleterious for sperm production. It is probably best to avoid high intake of soy products, since they can contain weak plant estrogens. Moderate exercise may be beneficial. However, prolonged, excessive and no exercise may be bad.
Oxidative stress is a common factor in some male and female infertility. This is due to certain molecules known as “reactive oxygen species” or oxidants in the semen which can damage the sperm cell membrane, DNA and fertility.
Prolonged cell phone usage may negatively affected sperm motility characteristics, though still needs to be validated.
It is still not clear whether the psychological strain in normal jobs affects male reproductive function or sperm counts. However, stress has some effect on ability to conceive in men with already low sperm concentration.

Occupational hazards

However men working in hot environment like welders had reduced progressive motility, increased sperm defects like coiled tails. Job stress also affects sperm motility and morphology causing abnormal heads and coiled tail. Prolonged occupational heat, radiation, chemical exposures were found to affect spermatogenesis.

General environmental pollution

There is an unexplained three fold increase in US male infertility (sperm density, semen volume) between 1965-82 was due to environmental /occupational pollution (with increasing toxic substances, halogenic compounds, glycols and glycol ethers, metals, hormones), abnormal lifestyle, heat, smoking, consumption of alcohol and drugs etc. affecting sperm production.

Radiation

Radiation causes degenerative changes in germ cell affecting steroid synthesis. It also causes genetic damages in germ cell like gene mutations, chromosomal aberrations, spermatogonial apoptosis and sterility.

Fluoride

Fluorine and fluoridesoccur only in the form of compounds with other elements. It is used in small amounts to purify water and to decrease tooth decay. Fluoride toxicity may cause adverse effects on the reproductive system of males living in fluorosis endemic areas.

Female Aging & Infertility

Female age is important when considering probability for getting pregnant. Increased infertility rates with aging are well documented and apparent in our society. The real issue is egg quantity and quality -which translates into embryo quality after fertilization. As women wait longer to have children, more couples have fertility problems due to declining egg quality and other issues that are more common in older women.

Many couples end up needing advanced treatments such as IVF, in vitro fertilization to overcome this age related decline. Women’s liberation brings many advantages to women. However, as women delay childbearing, society has not educated us about this fertility decline. The age of the male partner does not appear to matter much when it comes to fertility. Reasons for this include:

• All of a woman’s eggs are present at birth. They cannot divide or be “resupplied”, whereas sperm are produced constantly after puberty in men.
• Eggs age over time, while new sperm are constantly coming off the production line.
• Sperm from older men can have a reduced fertilizing potential compared to younger men. However, this tends to be “all or none”. If the sperm can fertilize eggs – we usually don’t see poor embryo quality due to reduced sperm quality.
• Sometimes older men have less interest in frequent intercourse, which can be a factor.

In the developed world, deferment of marriage and postponement of child-bearing in marriage are resulting in unprecedented numbers of couples who desire pregnancy relatively late in life. These factors combine with a decline in fertility and an increase in pregnancy wastage with advancing age to present new challenges for the clinician treating infertility.

Cinnamon Helps you Fight with PCOS

Poly Cystic Ovarian Syndrome (PCOS) is a common cause for infertility among women. Women with PCOS suffer from hormonal imbalance and develop cysts in their ovaries. The condition causes irregular menstrual cycles, excessive hair growth, sudden weight gain and problems in conceiving. When the condition remains unsolved, it might lead to diabetes and heart problems.

Women with PCOS typically have very high levels of insulin resistance that prevents stability in blood sugar levels. While weight reduction, medicines that treat diabetes and ovulation inducing medicines are common ways to treat PCOS, cinnamon is increasingly gaining popularity as a natural medicine for women plagued by PCOS.

Some of the adverse effects that insulin resistance has on normal menstrual cycle include:

• Deterioration of egg quality that prevents it from reaching optimum maturity.
• Miscarriages as the imbalance in hormones hinder the embryo from attaching to the uterus.
• Higher levels of insulin resistance are often an indication of Type 2 diabetes as well.

Cinnamon has properties that reduce insulin resistance and help glucose enter cells. Research findings have shown a steep shift toward regularity in menstrual periods of patients who consume cinnamon on a daily basis when compared to other PCOS patients. Besides, as an organic solution, it does not have the side effects that many other medicines tend to have.

Cinnamon supplements that maybe obtained as a concentrate of the aromatic spice is a great way to boost fertility. Water soluble compounds made from cinnamon have a great way of enhancing insulin activity. This property of cinnamon is found to be highly effective to treat Type 2 diabetes as well.
For those of you battling PCOS, having a teaspoon full of cinnamon powder with two tablespoons of honey is very beneficial. Another great idea is to add cinnamon in beverages like lemon juice or green tea. In fact, they are available as Ayurvedic juices as well.

PCOS can be treated effectively as long as you are willing to make wellness a priority. Exercise regularly and set small-term weight-loss goals. Avoid junk food and incorporate a wholesome diet. Maintain an ideal sleep-cycle.

Take care of yourself today, to be able to give your best to the little one tomorrow.

Hysteroscopy

What is Hysteroscopy:  A  procedure where an endoscope is used to visualize the uterus and the uterine tubes.  Several pathologies of these organs can be identified and treated. Indeed some of these disorders may be the cause of infertility in the female. Hence this is a good diagnostic and therapeutic  (operative) tool for female infertility. It is normally done immediately after the menstrual periods during which time the uterine lining is thin and access to uterine cavity is better.

What is a hysteroscope?

This is a flexible fibreoptic device that can be passed into the vagina and guided through the cervix into the uterus. This is less traumatic to the patient as otherwise we have to inspect the uterus by approaching through the anterior abdominal wall (open abdominal access) which involves a surgical incision. It is also less expensive and the hospital stay is for one day only. The diameter  of the tube is chosen such that it can pass through the narrow cervix.  The cervix may need to be dilated a little bit in some cases. The instrument has a illumination device at the tip and a set of lenses help to bring the image to the television screen on which the doctor can clearly see the interior of the uterus. Facilities exist for insufflation of gas or fluids through the instrument for distending the uterus. For therapeutic purposes, hysteroscopes also have provision to introduce tiny scissors, graspers, resecting instruments, electrical loops and  lasers.

Common indications for hysteroscopy:

• Heavy or abnormal uterine (like bleeding in between normal cyclical bleeds)  and severe abdominal cramps.
• Unusual vaginal discharge
• To check the size and shape of the uterus during investigation of infertility. Congenital uterine malformations can also be diagnosed
• Diagnosis and evaluation of polyps and fibroids in the uterus. Polyps can be removed through the procedure. Biopsied can be taken through appropriate instruments inserted through the hysteroscope. Thus malignancies can be diagnosed and appropriate treatment strategies planned in due course.
• Intrauterine adhesions (Asherman’s syndrome). They can also the cleared using laser or heat.
• Sometimes there may be retained products of conception that is causing bleeding. These can be removed.
• Similarly intrauterine devices may be found which may be removed.  Alternatively it can also be used to place intrauterine devices in the uterus.
• Can be extended to visualise the tubo uterine junction and the tubes. Prodecures as necessary can be undertaken for e.g tubal blockages can be cleared and luminal continuity restored.
• Repeated miscarriage
• For routine investigation of infertility
• As a part of a therapeutic procedure like dilatation and curettage, laparoscopy

How is the procedure performed:

A date is fixed depending on the menstrual cycle. It is preferable to undergo the procedure in the pre-ovulatory phase as possibility of an established pregnancy is zero and hence there is no question of disturbing it, especially if investigating for infertility.  A date is taken immediately after the monthly menstrual bleed is over.  The doctor will ask details of any medicines being taken, any allergies to specific drugs and if any anticoagulants like aspirin is being taken.  Recent pelvic infection and the details of the treatment must be brought to the attention of the doctor.  The patient will be advised not to use any tampons in the vagina for 24 hrs before the procedure.
A local, regional or general anesthesia can be used for this procedure, besides a sedative and a painkiller. The doctor will decide which is best for the case.
The patient will change to the OT gown provided in the operation theatre.  The bladder must be emptied before the procedure.  The patient is made to lie on her back with the legs wide apart and raised and supported by table footrests. This is called the lithotomy position and offers the doctor the best view and access to the external and internal genital organs. The external genitals will be thoroughly cleaned with an antiseptic solution that will remove all microbes and reduce any local infection. . A speculum will be inserted into the vagina to provide a clear view of the cervix.  The tip of the hysteroscope is gently inserted into the cervical opening and guided upwards until it reaches the uterine cavity.  The illuminator ensures that the interior of the uterus is clearly visible and the camera transmits real time images to the TV screen which is viewed by the doctor and team.  The tip of the hysteroscope can be moved in different directions so that no part of the wall is missed and also the tubal openings are visualized. The tubes can also be examined.
The procedure take about half an hour following which the patient is rested for some three to four hours  in the recovery room  and then asked to go home. The exception is when general anesthesia is used where a post operative stay for a longer duration is done.  Patient is advised to abstain from sex and the use of vaginal tampons for some days.  There may be mild abdominal cramps and light bleed from the vagina, but this will stop in a few days.

Risks of the procedure:

Occasional perforation of the uterus, uterine tube  and neighboring viscera like intestines may occur resulting in peritonitis. Sometimes gas or fluid used during the insufflation may result in embolization as they may be absorbed into the blood stream. Patient is asked to keep in touch with the hospital and come immediately if the doctor feels that further attention is required.  In particular the patient is advised to report fever, severe lower abdominal pain and severe vaginal bleeding.