Author: Kajal mangukiya

Asherman’s syndrome is an acquired condition where scar tissue (adhesions) form inside your uterus. The scar tissue can build up, decreasing the amount of open space inside your uterus. This condition can be a complication of medical procedures or cancer treatments. Women with Asherman’s syndrome may experience light or no periods, pelvic pain or infertility.

What is Asherman’s syndrome?

Asherman’s syndrome is a rare condition where scar tissue, also called adhesions or intrauterine adhesions, builds up inside your uterus. This extra tissue creates less space inside your uterus. Think of the walls of a room getting thicker and thicker, making the space in the middle of the room smaller and smaller.

This condition can cause pelvic pain and abnormal uterine bleeding and can lead to fertility issues. Asherman’s syndrome can be treated and treatment often helps relieve your symptoms.

How common is Asherman’s syndrome?

Asherman’s syndrome is considered a rare disease. It’s hard to know exactly how many people have Asherman’s syndrome because it can go undiagnosed. Some people may not experience any symptoms from this condition. If you don’t experience symptoms, you may never see a healthcare provider.

Who gets Asherman’s syndrome?

Asherman’s syndrome is an acquired condition, which means that something usually happens that causes you to develop scar tissue. You can acquire Asherman’s syndrome in several ways, including surgery, infections and cancer treatments.

Your risk of developing Asherman’s syndrome can increase if you’ve:

• Had surgery on your uterus in the past, including operative hysteroscopy, complicated dilation and curettage (D&C) or cesarean section (c-section).
• Had a history of pelvic infections.
• Been treated for cancer.

Is Asherman’s syndrome genetic?

Asherman’s syndrome is generally not a genetic condition. This means that you get this condition through something that happens (as a side effect of surgery, treatment or infection) and not passed down through your family.

What are the symptoms of Asherman’s syndrome?

If you have Asherman’s syndrome, you can experience a variety of symptoms. These symptoms can include:

• Having very light periods (hypomenorrhea).
• Not having a period (amenorrhea) or having abnormal uterine bleeding.
• Feeling severe cramping or pelvic pain.
• Having difficulty getting pregnant or staying pregnant.

In some cases, you may not experience any symptoms of Asherman’s syndrome. You may also still experience normal periods. If you feel any discomfort in your pelvis or have unusual periods, reach out to your healthcare provider.

What causes Asherman’s syndrome?

Asherman’s syndrome happens when scar tissue (adhesions) build up inside your uterus, limiting the space inside your uterus and sometimes blocking your cervix. This can happen for several reasons, but one of the main causes is often surgery of your uterus or cervix.

The causes of Asherman’s syndrome can include:

• Operative hysteroscopy: A surgery where your provider places a camera into your uterus and then cuts off and removes fibroids using an electric instrument.
• Dilation and curettage (D&C): A type of surgery, dilation and curettage (D&C) is used to open your cervix (dilate) and then remove tissue from your uterus. This tissue can be the lining of your uterus (endometrium) or tissue from a miscarriage or abortion. During the procedure, a tool is used to scrape away the extra tissue. This typically doesn’t cause scarring unless you have an underlying infection.
• Cesarean section (c-section): This surgery is used to deliver a baby. In some cases, a c-section can cause scar tissue to form. This can happen where the stitches (sutures) were used to stop bleeding (hemorrhages) during the c-section and you have an infection at the time of the procedure. Otherwise, it’s very rare for a c-section to cause Asherman’s syndrome.
• Infections: Infections alone don’t typically cause Asherman’s syndrome. But, when you have an infection while you undergo uterine surgery, like a D&C or a c-section, you can develop Asherman’s syndrome. Some infections that could lead to Asherman’s syndrome include cervicitis and pelvic inflammatory disease (PID).
• Radiation treatment: Sometimes, a treatment option can cause scar tissue to develop in your uterus. Radiation therapy can be used on conditions like cervical cancer, but this can cause adhesions (scar tissue) that lead to Asherman’s syndrome.

Can an IUD cause Asherman’s syndrome?

An intrauterine device (IUD) is a type of long-term birth control that’s placed inside your uterus and left there for a period of time (often several years). When this device is placed in your body, there’s always the risk of infection and the development of scar tissue. However, this isn’t a proven cause of Asherman’s syndrome and IUDs are not commonly linked to the condition.

How is Asherman’s syndrome diagnosed?

Asherman’s syndrome is typically diagnosed when you either experience symptoms of the condition like pelvic pain, amenorrhea (lack of menstruation), abnormal uterine bleeding or an inability to get and stay pregnant. Your medical history can also lead to a diagnosis of Asherman’s syndrome. If you have had a dilation and curettage (D&C) procedure, c-section, radiation therapy or pelvic infection, you may be tested for Asherman’s syndrome. All of these procedures and conditions can lead to Asherman’s syndrome.

During an appointment, your healthcare provider will go over your medical history. If you have had any kind of pelvic surgery that isn’t included in your medical history, make sure to tell your provider. That information can be very important in diagnosing Asherman’s syndrome. Your provider will then do a physical exam, but to detect scar tissue inside your uterus, your provider will perform a sonohysterogram. For a sonohysterogram, your provider injects a little saline solution inside your uterine cavity through a small catheter. Then, they use transvaginal ultrasound to see if any tissue is blocking the cavity or cervix.

What imaging tests can be used to diagnose Asherman’s syndrome?

Imaging tests allow your healthcare provider to see your internal organs. Different tests provide various amounts of detail. These tests can be done on top of your skin and involve little to no preparation, or they can be more complicated procedures.

Imaging tests that can be used to diagnose Asherman’s syndrome include:

• Ultrasound: This type of imaging test uses sound waves to create a picture of your internal organs. An ultrasound can be done externally on your skin or internally with a transvaginal ultrasound. A thin wand is inserted into the vaginal during this version of the test.
• Hysteroscopy: During this procedure, your healthcare provider uses a thin tool with a camera on the end to look inside your uterus. This is inserted in your vagina and moved up through your cervix and into your uterus. Hysteroscopy allows your provider a very detailed look at the inside of your uterus. It can also be used to treat Asherman’s syndrome.
• Saline infusion sonography: This imaging test uses ultrasound along with a saline (a mixture of salt and water) solution to create a clear image of the inside of your uterus. The fluid expands your uterus so that your provider can see details of the shape and defects of your uterine cavity. This gives your provider a very detailed look at the inside and outside of your reproductive organs.

How is Asherman’s syndrome treated?

There are several ways to treat Asherman’s syndrome. During a conversation with your healthcare provider, it’s good to discuss how this condition makes you feel — including any pain you may experience — as well as your goals for future fertility. In some cases where a woman isn’t experiencing symptoms, a treatment option can actually be no treatment. However, if your plan includes future pregnancies, there are treatment options that can remove the scar tissue. Treatment can also help if you’re experiencing cramps or pelvic pain.

The main goal of treatment is to remove the scar tissue and restore your uterus to its original size and shape. Treatment for Asherman’s syndrome can help:

• Relieve pain.
• Restore your normal menstrual cycle (periods).
• Allow for the possibility of pregnancy if you’re pre-menopausal.

Your healthcare provider may use hysteroscopy to remove the adhesions in your uterus. During a hysteroscopy, your provider uses a thin tool called a hysteroscope to look inside your uterus. This tool can also be used to remove scar tissue. The hysteroscope is inserted into your vagina, through your cervix and into your uterus. Scar tissue is very carefully removed during this procedure. A possible risk of this procedure is damaging healthy tissue inside your uterus while removing the scar tissue.

Hormonal treatments (estrogen) may be paired with a small intrauterine catheter left inside your uterus for a few days after the hysteroscopy. This will reduce the risk of recurring scar tissue formation after the procedure. In fact, estrogen promotes healing of your endometrium (inner lining of the cavity) and the catheter provides a physical barrier between your anterior and posterior uterine walls, so that they don’t adhere to each other in the few days following the procedure for scar tissue removal. When an intrauterine catheter is inserted, you’ll be given antibiotics to prevent possible infections.

During pregnancy, exercise can help you stay in shape and prepare for labor and delivery. Here’s the lowdown on pregnancy and exercise, from getting started to staying motivated.

Pregnancy might seem like the perfect time to sit back and relax. You likely feel more tired than usual, and your back might ache from carrying extra weight.
But unless you’re experiencing complications, sitting around won’t help. In fact, pregnancy can be a great time to get active — even if you haven’t exercised in a while.

Why exercise during pregnancy?
During pregnancy, exercise can:
    •    Reduce backaches, constipation, bloating and swelling
    •    Boost your mood and energy levels
    •    Help you sleep better
    •    Prevent excess weight gain
    •    Promote muscle tone, strength and endurance

Other possible benefits of following a regular exercise program during pregnancy may include:
    •    A lower risk of gestational diabetes
    •    Shortened labor
    •    A reduced risk of having a C-section

Pregnancy and exercise: Getting the OK
Before you begin an exercise program, make sure you have your health care provider’s OK. Although exercise during pregnancy is generally good for both mother and baby, your doctor might advise you not to exercise if you have:
    •    Some forms of heart and lung disease
    •    Preeclampsia or high blood pressure that develops for the first time during pregnancy
    •    Cervical problems
    •    Persistent vaginal bleeding during the second or third trimester
    •    Placenta problems

It may also not be safe to exercise during pregnancy if you have any of these other complications:
    •    Preterm labor during your current pregnancy
    •    A multiple pregnancy at risk of preterm labor
    •    Premature rupture of the membranes
    •    Severe anemia

Pacing it for pregnancy
For most pregnant women, at least 30 minutes of moderate-intensity exercise is recommended on most, if not all, days of the week.
Walking is a great exercise for beginners. It provides moderate aerobic conditioning with minimal stress on your joints. Other good choices include swimming, low-impact aerobics and cycling on a stationary bike. Strength training is OK, too, as long as you stick to relatively low weights.

Remember to warm up, stretch and cool down. Drink plenty of fluids to stay hydrated, and be careful to avoid overheating.
Intense exercise increases oxygen and blood flow to the muscles and away from your uterus. In general, you should be able to carry on a conversation while you’re exercising. If you can’t speak normally while you’re working out, you’re probably pushing yourself too hard.
Depending on your fitness level, consider these guidelines:
    •    You haven’t exercised for a while. Begin with as little as 10 minutes of physical activity a day. Build up to 15 minutes, 20 minutes, and so on, until you reach at least 30 minutes a day.
    •    You exercised before pregnancy. You can probably continue to work out at the same level while you’re pregnant — as long as you’re feeling comfortable and your health care provider says it’s OK.

Activities to approach with care
If you’re not sure whether a particular activity is safe during pregnancy, check with your health care provider. Consider avoiding:
    •    Any exercises that force you to lie flat on your back after your first trimester
    •    Scuba diving, which could put your baby at risk of decompression sickness
    •    Contact sports, such as ice hockey, soccer, basketball and volleyball
    •    Activities that pose a high risk of falling — such as downhill skiing, in-line skating, gymnastics, and horseback riding
    •    Activities that could cause you to hit water with great force, such as water skiing, surfing and diving

Other activities to avoid include:
    •    Exercise at high altitude
    •    Activities that could cause you to experience direct trauma to the abdomen, such as kickboxing
    •    Hot yoga or hot Pilates
If you do exercise at a high altitude, make sure you know the signs and symptoms of altitude sickness, such as headache, fatigue and nausea. If you experience symptoms of altitude sickness, return to a lower altitude as soon as possible and seek medical care.

Staying motivated
You’re more likely to stick with an exercise plan if it involves activities you enjoy and fits into your daily schedule. Consider these simple tips:
    •    Start small. You don’t need to join a gym or wear expensive workout clothes to get in shape. Just get moving. Try a daily walk through your neighborhood or walk the perimeter of the grocery store a few times. Take the stairs instead of the elevator.
    •    Find a partner. Exercise can be more interesting if you use the time to chat with a friend. Better yet, involve the whole family.
    •    Try a class. Many fitness centers and hospitals offer classes, such as prenatal yoga, designed for pregnant women. Choose one that fits your interests and schedule.

Listen to your body
As important as it is to exercise, it’s also important to watch for signs of a problem. Stop exercising and contact your health care provider if you have:
    •    Vaginal bleeding
    •    Dizziness
    •    Headache
    •    Increased shortness of breath before you start exercising
    •    Chest pain

Other warning signs to watch for include:
    •    Painful uterine contractions that continue after rest
    •    Fluid leaking or gushing from your vagina
    •    Calf pain or swelling
    •    Muscle weakness affecting balance

A healthy choice
Regular exercise can help you cope with the physical changes of pregnancy and build stamina for the challenges ahead. If you haven’t been exercising regularly, use pregnancy as your motivation to begin.

Hypothyroidism is a condition marked by an underactive thyroid gland and may be present during pregnancy. Many symptoms of hypothyroidism are similar to pregnancy symptoms. For example, fatigue, weight gain, and abnormal menstruation are common to both. Having low thyroid hormone levels may even interfere with becoming pregnant or be a cause of miscarriage. 

What are the symptoms of hypothyroidism?

Hypothyroidism is a common condition. It can go undetected if symptoms are mild. Hypothyroidism means the thyroid is underactive and making insufficient amounts of thyroid hormones. Symptoms of hypothyroidism may be mild and may start slowly. The following are the most common symptoms of hypothyroidism:

• Feeling tired
• Unable to stand cold temperatures
• Hoarse voice
• Swelling of the face
• Weight gain
• Constipation
• Skin and hair changes, including dry skin and loss of eyebrows
• Carpal tunnel syndrome (hand tingling or pain)
• Slow heart rate
• Muscle cramps
• Trouble concentrating
• Irregular menstrual periods

The symptoms of hypothyroidism may resemble other conditions or medical problems. Always talk with your healthcare provider for a diagnosis.

How does hypothyroidism affect the foetus?

During the first few months of pregnancy, the foetus relies on the mother for thyroid hormones. Thyroid hormones are important in normal brain development and growth of the foetus. Hypothyroidism in the mother can have long-lasting effects on the foetus. 

How is thyroid function tested?

You will have blood test that measures thyroid hormone (thyroxine, or T4) and serum TSH (thyroid-stimulating hormone) levels to check for hypothyroidism. Hypothyroidism is often suspected when TSH levels are above normal and T4 levels are below normal.

Who should undergo thyroid function screening?

Routine screening for hypothyroidism during pregnancy is recommended. A pregnant woman with symptoms of hypothyroidism, a history of hypothyroidism, or with other endocrine system conditions should be treated according to the TSH level.

How is hypothyroidism treated during pregnancy?

Thyroid hormone replacement is used to treat the mother. The dosage of thyroid hormone replacement therapy is based on the individual’s levels of thyroid hormones. Thyroid hormone levels may change during pregnancy. And, the thyroid replacement dosing may also change. Thyroid hormone levels need to be checked every 4 weeks during the first half of pregnancy. The treatment is safe and essential to both mother and fetus. Routine screening for all newborns includes a test of thyroid hormone levels.

1. Myth? Breastfeeding is easy.

Babies are born with the reflex to look for their mother’s breast. However, many mothers need practical support with positioning their baby for breastfeeding and making sure their baby is correctly attached to the breast. Breastfeeding takes time and practice for both mothers and babies. Breastfeeding is also time intensive, so mothers need space and support at home and work.

2. Myth? It’s usual for breastfeeding to hurt – sore nipples are inevitable.

Many mothers experience discomfort in the first few days after birth when they are learning to breastfeed. But with the right support with positioning their baby for breastfeeding and making sure their baby is correctly attached to the breast, sore nipples can be avoided. If a mother faces breastfeeding challenges like sore nipples, support from a lactation consultant or other skilled professional can help them overcome the issue.

3. Myth? You should wash your nipples before breastfeeding.

Washing your nipples before breastfeeding isn’t necessary. When babies are born, they are already very familiar with their own mother’s smells and sounds. The nipples produce a substance that the baby smells and has ‘good bacteria’ that helps to build babies’ own healthy immune system for life.

4.    Myth? You should separate a newborn and mother to let the mother rest. 

Doctors, nurses and midwives often encourage the practice of ‘skin-to-skin’ – also known as kangaroo mother care – immediately after birth. Bringing your baby in direct contact, so their skin is against yours, is a very important practice that helps them to find and attach to the breast. If you can practice this within one hour after birth and then frequently after, it helps to establish breastfeeding. If the mother cannot do this, then the partner or another family member can step in. 

5.    Myth? You should only eat plain food while breastfeeding.

Like everybody else, breastfeeding mothers need to eat a balanced diet. In general, there is no need to change food habits. Babies are exposed to their mothers’ food preferences from the time they are in the womb. If a mother perceives that her baby reacts to a specific food she eats, it is best to consult a specialist. 

6.    Myth? Exercise will affect the taste of your milk.

Exercise is healthy, also for breastfeeding mothers. There is no evidence that it affects the taste of your milk. 

7.   Myth? You won’t be able to breastfeed unless you do it straight away.

It is easier to get breastfeeding started if you begin in the first hour after birth because a baby’s reflexes are very strong at that time. They are ready to learn to feed at the breast. If you do not latch your baby on right after birth, do it as soon as possible in your situation. If you need help putting your baby to the breast, ask for support from a qualified lactation consultant or other skilled professional. Frequent skin-to-skin contact and putting your baby to the breast will help to get breastfeeding going. 

8.    Myth? You can never use formula if you want to breastfeed. 

Mothers may decide they need to use formula on some occasions, while continuing to breastfeed. It is important to seek unbiased information on formula and other products that replace breastmilk. To keep breastmilk production going, continue offering the breast to your baby as often as possible. It can be useful for mothers to consult a lactation specialist or skilled professional to help with a plan that works best for them to continue breastfeeding.  

9.    Myth? Many mothers can’t produce enough milk. 

Almost all mothers produce the right amount of milk for their babies. Breastmilk production is determined by how well the baby is latched on to the breast, the frequency of breastfeeding and how well the baby is removing milk with each feeding. Breastfeeding isn’t a ‘one woman’ job and mothers need support. Support like ongoing breastfeeding guidance from health care providers, help at home, and staying healthy by eating and drinking well. 

10.    Myth? You shouldn’t breastfeed if you’re sick.

Depending on the kind of illness, mothers can usually continue breastfeeding when they’re sick. You need to make sure you get the right treatment, and to rest, eat and drink well. In many cases, the antibodies your body makes to treat your disease or illness will pass on to your baby, building his or her own defences. 

11.    Myth? You can’t take any medication if you’re breastfeeding.

It’s important to inform your doctor that you are breastfeeding and to read the instructions with any medications you buy over the counter. It might be necessary to take medications at a specific time or in a specific dosage, or to take an alternative formulation. You should also tell the baby’s doctor about any medications that you’re taking.

12.    Myth? Babies who have been breastfed are clingy.

All babies are different. Some are clingy and some are not, no matter how they are fed. Breastfeeding provides not only the best nutrition for infants, but is also important for their developing brain. Breastfed babies are held a lot and because of this, breastfeeding has been shown to enhance bonding with their mother.  

13.    Myth? It’s hard to wean a baby if you breastfeed for more than a year.

There’s no evidence that it is more difficult to stop breastfeeding after one year, but there is evidence that breastfeeding up to two years is beneficial for both mothers and children. All mothers and babies are different and need to determine together how long they want to breastfeed. 

14.    Myth? If you go back to work, you’ll have to wean your baby.

Many mothers continue breastfeeding after going back to work. First, check the policies in your country and your own workplace. If you have the right to time and a place to breastfeed during working hours, you may be able to go home and breastfeed, ask a family member or friend to bring your baby to you, or to express your milk and take it home. If you don’t have the option to breastfeed during working hours, look for moments during the day to express your milk and then feed your baby directly when you are at home. If you decide to give your baby a breastmilk substitute for some feeds, it still very good to continue breastfeeding whenever you are with your baby.

MYTHS ABOUT DIET FOR BREASTFEEDING MOTHERS

Myth #1: You can’t drink caffeine while breastfeeding. A small amount of caffeine does enter breast milk, but in moderation caffeine is okay. When in doubt, look at your baby for signs of fussiness and choose drinks like tea that typically contain less caffeine than coffee.

Myth #2: Drinking more water will help you make more milk. Forcing yourself to drink more water than you want won’t increase your milk supply. Just drink to thirst and make sure to have water within arm’s reach before you settle in to a nursing session.

Myth #3: You should avoid foods that make you gassy — they’ll make your baby gassy too! The gas you pass is made in your gut by your friendly gut flora reacting to the undigested food. That undigested food can’t find its way into your breast milk to make gas in your baby’s gut.

Myth #4: You need to drink milk to make milk. If that were true, cows would be in trouble.

Myth #5: Drinking dark beer will help increase your milk supply. There’s just no evidence to back this up. In fact, drinking too much alcohol can reduce your prolactin level. This is the hormone that helps you make the amount of milk you make. According to the CDC, not drinking alcohol is safest for breastfeeding moms.

Although irregular cycles or painful monthly cramps can be common issues affecting women, they are by no means something that women must adjust to as their norm. Many intervention methods, both surgical and medical, exist to relieve and in many cases cure symptoms of conditions ranging from menstrual disorders to urinary incontinence. Speak with your clinician if you are experiencing especially painful cramps, severe abdominal pain, or heavy and/or prolonged bleeding between periods or during intercourse, as they could be signs of a more serious women’s health issue.

Common gynecological problems include:
    •    Cervical Dysplasia
    •    Menstrual Disorders
    •    Pelvic Floor Prolapse
    •    Pelvic Pain
    •    Polycystic Ovarian Syndrome
    •    Uterine Fibroids
    •    Urinary Incontinence

Cervical Dysplasia
Cervical dysplasia is a precancerous condition of the cervix, caused by the human papillomavirus (HPV). Cervical dysplasia usually appears without symptoms, therefore it is important to see your OB-GYN for an annual exam, as well as regular pap smears after the age of 21, to screen for any abnormal cells. 

Patients ages nine to 26 can receive an HPV vaccine to protect against the four most common strains of the virus. The recommended age is between nine and 11 before your child becomes sexually active, and both boys and girls can receive the vaccine.

Menstrual Disorders
Heavy or prolonged  menstrual bleeding, bleeding with intercourse, bleeding between periods and especially painful cramps can be signs of a menstrual disorder in women of menstruation age. Depending on the menstrual cycle problem or condition and the severity, medical and/or surgical intervention methods are available.

Pelvic Prolapse
The pelvic organs (the vagina, bladder, rectum and uterus) are held in place by connective tissue and ligaments within the pelvis. The physical stress of pregnancy and childbirth and weakening of tissue due to factors such as menopause and chronic constipation can lead to the walls of the vagina falling down. When this occurs, the pelvic organs behind the vagina (the bladder, rectum and uterus) fall down as well.

Chronic Pelvic Pain
The complexity of chronic pelvic pain can be baffling. A variety of health issues such as endometriosis, bladder pain syndrome, irritable bowel syndrome (IBS) , pelvic floor muscle dysfunction, or uterine leiomyoma can account for the severe pain some 20 percent of women experience because of this condition. Defined as persistent pain between the belly button and pubic bone, that lasts for longer than six months, chronic pelvic pain most commonly strikes women. 

Uterine Fibroids
One of the most common benign tumors in women, uterine fibroids (also known as leiomyomas or myomas) develop in the uterus most typically during the childbearing years. Several different types of fibroids can develop in various places in and around the uterus:
    •    Submucosal fibroids develop under the inner lining of the uterus, distorting the normal contour of the cavity.
    •    Intramural fibroids grow within the uterine wall and can also eventually distort the shape of the uterus.
    •    Subserosal fibroids grow on the outside of the uterus, and can press on surrounding organs.
Linked to hormone levels, the growth of fibroids usually diminishes with the onset of menopause.

Urinary Incontinence
Urinary incontinence, which is an inability to control release of urine, can be both a costly and embarrassing problem. Sometimes it can be caused by a temporary condition, such as a urinary tract infection, and other times urinary incontinence in women can be an ongoing issue caused by changes in muscles and nerves around the bladder.
Urinary incontinence is a common condition among women over the age of 35, and many patients feel it is an expected part of normal aging. This is not the case, and fortunately many treatment options are available for both types of urinary incontinence.
    •    Stress incontinence, causes loss of urine during physical activity, coughing, sneezing or laughing.
    •    Urge incontinence, which also causes an uncontrolled release of urine, is characterized by a strong, sudden need to urinate.

➡️Treatment to help a person conceive naturally will depend on many factors, including the age of the person who wishes to conceive, how long infertility has lasted, personal preferences, and their general state of health.

Frequency of intercourse
    •    The first strategy a couple trying to conceive may wish to try is having sexual intercourse more often around the time of ovulation.
    •    Typically the menstrual cycle lasts for about28–32 days. Counting from the first day of the last period, a female will usually ovulate anywhere between day 11 and day 21.
    •    Any person whose cycle is shorter than 21 days or longer than 35 days should see their doctor for an evaluation.

Treatments will depend on the underlying cause of infertility.
    ⁃    In males, this can include medications for erectile dysfunction. Surgery may include a procedure to remove a varicose vein in the scrotum or repair a blocked epididymis.
    ⁃    In females, doctors can prescribe fertility drugs to regulate or induce ovulation. These can include clomiphene (Clomid, Serophene), letrozole (Femara), dopamine agonist medications, and a variety of hormonal drugs.
    ⁃    If the fallopian tubes are blocked or scarred, surgical repair may make it easier for eggs to pass through. A person may also be advised to undergo IVF. We may also treat endometriosis with laparoscopic surgery. They make a small incision in the abdomen and insert a thin, flexible microscope with a light at the end, called a laparoscope. The surgeon can then remove implants and scar tissue, which may reduce pain and aid fertility.

The following methods are currently available for assisted or artificial conception:
    •     Intrauterine insemination (IUI): At the time of ovulation, a doctor inserts a fine catheter through the cervix into the uterus to place a sperm sample directly into the uterus.
    •     In vitro fertilization (IVF): Doctors place the sperm with unfertilized eggs in a petri dish, where fertilization can take place. They then place the embryo in the uterus to begin a pregnancy. IVF techniques can include intracytoplasmic sperm injection (ICSI) and assisted hatching.
    •     Sperm or egg donation: If necessary, a person can use egg or sperm donation. Fertility treatment with donor eggs can be done using IVF.
    •     Electric or vibratory stimulation to achieve ejaculation: It may be possible to help a person achieve ejaculation with electric or vibratory stimulation. This can help a male who cannot ejaculate normally, for example because of a spinal cord injury.
    •     Surgical sperm aspiration: The sperm is removedTrusted Source from a part of the male reproductive tract such as the vas deferens, testicle, or epididymis. Doctors will use IVF to fertilize the egg or freeze the sperm for later use.

➡️The doctor will ask about medical history, medications, and sexual habits and perform a physical examination.
➡️If a test shows an abnormality, the doctor may recommend an examination of the testicles for lumps or deformities and an exam of the shape and structure of the penis.
In addition, the doctor may order following tests:
    ⁃    • Semen analysis: A sample may be taken to test for sperm concentration, motility, color, and quality, as well as the presence of blood or infection. Sperm counts can fluctuate, so several samples may be necessary.
    ⁃    • Blood test: The lab will test for levels of testosterone and other hormones.
    ⁃    • Ultrasound: This may reveal issues such as ejaculatory duct obstruction or retrograde ejaculation.
    ⁃    • Chlamydia test: Chlamydia can affect fertility, but antibiotics can treat it. However, antibiotics cannot cureTrusted Source any existing damage to fertility.

Infertility tests for females
A female will undergo a general physical examination, and the doctor will ask about medical history, medications, menstruation cycle, and sexual habits.

➡️They will also undergo a gynecologic examination and a number of tests:
    •    Blood test: This can assess hormone levels and whether a female is ovulating.
    •    Hysterosalpingography: A technician injects fluid into the uterus and takes X-rays to determine whether the fluid travels properly out of the uterus and into the fallopian tubes. If a blockage is present, surgery may be necessary.
    •    Laparoscopy: A thin, flexible tube with a camera at the end is inserted into the abdomen and pelvis, allowing a doctor to look at the fallopian tubes, uterus, and ovaries. This can reveal signs of endometriosis, scarring, blockages, and some irregularities in the uterus and fallopian tubes.
Other tests can include:
    •    ovarian reserve testing to count the eggs after ovulation
    •    pelvic ultrasound to produce an image of the uterus and ovaries
    •    thyroid function test, as this may affect the hormonal balance

It can be caused by a number of different factors, in either the male or female reproductive systems. However, it is sometimes not possible to explain the causes of infertility.

Causes of male infertility
    •    Abnormal sperm production or function: due to undescended testicles, genetic defects, health problems such as diabetes, or infections such as chlamydia, gonorrhea, mumps or HIV. Enlarged veins in the testes (varicocele) also can affect the quality of sperm.
    •    Problems with the delivery of sperm: due to sexual problems, such as premature ejaculation; certain genetic diseases, such as cystic fibrosis; structural problems, such as a blockage in the testicle; or damage or injury to the reproductive organs.
    •    Overexposure to certain environmental factors: such as pesticides and other chemicals, and radiation. Cigarette smoking, alcohol, marijuana, anabolic steroids, and taking medications to treat bacterial infections, high blood pressure and depression also can affect fertility. Frequent exposure to heat, such as in saunas or hot tubs, can raise body temperature and may affect sperm production.
    •    Damage related to cancer and its treatment: including radiation or chemotherapy. Treatment for cancer can impair sperm production, sometimes severely.

Causes of female infertility
    •    Ovulation disorders: which affect the release of eggs from the ovaries. These include hormonal disorders such as polycystic ovary syndrome. Hyperprolactinemia, a condition in which you have too much prolactin — the hormone that stimulates breast milk production — also may interfere with ovulation. Either too much thyroid hormone (hyperthyroidism) or too little (hypothyroidism) can affect the menstrual cycle or cause infertility. Other underlying causes may include too much exercise, eating disorders or tumors.
    •    Uterine or cervical abnormalities: including abnormalities with the cervix, polyps in the uterus or the shape of the uterus. Noncancerous (benign) tumors in the uterine wall (uterine fibroids) may cause infertility by blocking the fallopian tubes or stopping a fertilized egg from implanting in the uterus.
    •    Fallopian tube damage or blockage: often caused by inflammation of the fallopian tube (salpingitis). This can result from pelvic inflammatory disease, which is usually caused by a sexually transmitted infection, endometriosis or adhesions.
    •    Endometriosis: which occurs when endometrial tissue grows outside of the uterus, may affect the function of the ovaries, uterus and fallopian tubes.
    •    Primary ovarian insufficiency (early menopause): when the ovaries stop working and menstruation ends before age 40. Although the cause is often unknown, certain factors are associated with early menopause, including immune system diseases, certain genetic conditions such as Turner syndrome or carriers of Fragile X syndrome, and radiation or chemotherapy treatment.
    •    Pelvic adhesions:- bands of scar tissue that bind organs that can form after pelvic infection, appendicitis, endometriosis or abdominal or pelvic surgery.
    •    Cancer and its treatment: Certain cancers — particularly reproductive cancers — often impair female fertility. Both radiation and chemotherapy may affect fertility.
 
Risk factors
Many of the risk factors for both male and female infertility are the same. They include:
    1.    Age
Women’s fertility gradually declines with age, especially in the mid-30s, and it drops rapidly after age 37. Infertility in older women is likely due to the lower number and quality of eggs, and can also be due to health problems that affect fertility. Men over age 40 may be less fertile than younger men.

    2.    Tobacco use. 
Smoking tobacco or marijuana by either partner may reduce the likelihood of pregnancy. Smoking also reduces the possible effectiveness of fertility treatment. Miscarriages are more frequent in women who smoke. Smoking can increase the risk of erectile dysfunction and a low sperm count in men.

    3.    Alcohol use. 
For women, there’s no safe level of alcohol use during conception or pregnancy. Alcohol use may contribute to infertility. For men, heavy alcohol use can decrease sperm count and motility.

    4.    Being overweight. 
Among American women, an inactive lifestyle and being overweight may increase the risk of infertility. For men, sperm count also may be affected by being overweight.

    5.    Being underweight. 
Women at risk of fertility problems include those with eating disorders, such as anorexia or bulimia, and those who follow a very low-calorie or restrictive diet.

    6.    Exercise issues. 
A lack of exercise contributes to obesity, which increases the risk of infertility. Less often, ovulation problems may be associated with frequent strenuous, intense exercise in women who are not overweight.

Prevention
Some types of infertility aren’t preventable. But several strategies may increase your chances of pregnancy.
➡️For Couples:
    ⁃    Have regular intercourse several times around the time of ovulation for the highest pregnancy rate. Intercourse beginning at least five days before and until a day after ovulation improves your chances of getting pregnant. Ovulation usually occurs in the middle of the cycle — halfway between menstrual periods — for most women with menstrual cycles about 28 days apart.
➡️Men
Although most types of infertility aren’t preventable in men, these strategies may help:
    ⁃    Avoid drug and tobacco use and drinking too much alcohol, which may contribute to male infertility.
    ⁃    Avoid high temperatures found in hot tubs and hot baths, as they can temporarily affect sperm production and motility.
    ⁃    Avoid exposure to industrial or environmental toxins, which can affect sperm production.
    ⁃    Limit medications that may impact fertility, both prescription and nonprescription drugs. Talk with your doctor about any medications you take regularly, but don’t stop taking prescription medications without medical advice.
    ⁃    Exercise moderately. Regular exercise may improve sperm quality and increase the chances for achieving a pregnancy.

➡️Women
For women, a number of strategies may increase the chances of becoming pregnant:
    ⁃    Quit smoking: Tobacco has many negative effects on fertility, not to mention your general health and the health of a fetus. If you smoke and are considering pregnancy, quit now.
    ⁃    Avoid alcohol and street drugs: These substances may impair your ability to conceive and have a healthy pregnancy. Don’t drink alcohol or use recreational drugs, such as marijuana, if you’re trying to get pregnant.
    ⁃    Limit caffeine: Women trying to get pregnant may want to limit caffeine intake. Ask your doctor for guidance on the safe use of caffeine.
    ⁃    Exercise moderately: Regular exercise is important, but exercising so intensely that your periods are infrequent or absent can affect fertility.
    ⁃    Avoid weight extremes: Being overweight or underweight can affect your hormone production and cause infertility.
Treatment to help a person conceive naturally will depend on many factors, including the age of the person who wishes to conceive, how long infertility has lasted, personal preferences, and their general state of health.

Premenstrual syndrome includes several symptoms affecting both physical and mental health, which are:

(A.) Emotional and behavioral signs and symptoms
• Tension or anxiety
• Depressed mood
• Crying spells
• Mood swings and irritability or anger
• Appetite changes and food cravings
• Trouble falling asleep (insomnia)
• Social withdrawal
• Poor concentration
• Change in libido

(B.) Physical signs and symptoms
• Joint or muscle pain
• Headache
• Fatigue
• Weight gain related to fluid retention
• Abdominal bloating
• Breast tenderness
• Acne flare-ups
• Constipation or diarrhea
• Alcohol intolerance

There are several cause that could have lead her to develop this condition and it includes: 
    •    Cyclic changes in hormones: -Signs and symptoms of premenstrual syndrome change with hormonal fluctuations and disappear with pregnancy and menopause
    •    Chemical changes in the brain: Fluctuations of serotonin, a brain chemical (neurotransmitter) that’s thought to play a crucial role in mood states, could trigger PMS symptoms. Insufficient amounts of serotonin may contribute to premenstrual depression, as well as to fatigue, food cravings and sleep problems.
    •    Depression: – Some women with severe premenstrual syndrome have undiagnosed depression, though depression alone does not cause all of the symptoms
 
There are several methods that can help you manage or prevent them, they are:
    1.    Exercise – Engaging in about 30 minutes of cardio exercises such as brisk walking, jogging, running, or swimming, at least 5 days every week can help in managing symptoms such as fatigue and prevent mood swings by generally elevating your mood. Apart from handling PMS, regular exercise will also help in improving your overall health.
    2.    Making dietary changes – Several dietary changes are known to provide PMS relief such as eating smaller meals frequently and a reduction in salt intake can ease bloating and fluid retention. Eating a balanced diet that includes healthy foods such as whole grains, green leafy vegetables, fresh fruits, and bowls of salad can benefit you by not only relieving the symptoms of PMS but also helping you maintain a healthy weight. Incorporate calcium rich foods such as dairy, plenty of nuts and green leafy vegetables to your diet. If you are lactose intolerant or are allergic to nuts, try adding a calcium supplement to your routine.
    3.    Managing stress – Getting adequate sleep by regularizing your sleep schedule can help in managing stress. Practicing deep relaxation techniques such as yoga, deep breathing etc., can also help in alleviating insomnia and stress. It is especially useful for women who experience severe migraine headaches.
    4.    Avoid smoking – Several studies have shown that women who smoke cigarettes reported that they experienced worse, more severe PMS symptoms than women who avoid smoking altogether.
    5.    Incorporating health supplements – Supplements such as such as iron, folic acid, vitamin B-6, vitamin D and magnesium can help in managing cramps and reducing mood swings.
    6.    Avoid alcohol and caffeine – Reducing your alcohol and caffeine intake can also help in managing your PMS symptoms effectively.

Most girls start their periods when they’re about 12, but they can start as early as 8, so it’s important to talk to girls from an early age to make sure they’re prepared.
Respond to questions or opportunities as they arise and do not be embarrassed. Periods are natural.
Though Mothers might have some questions about it, so here we brought the answers to few of the most commonest questions asked in our OPD. 

How shall we know when the periods are going to start?
Signs that your period is on its way are if you’ve grown underarm and pubic hair. Typically, you’ll start your periods about 2 years after your breasts start growing and about a year after getting a white vaginal discharge. The average girl will get her first period around 12 years old, but it varies from person to person.

Why haven’t the periods started yet?
Your periods will start when your body is ready. This is usually between age 10 and 16, or 2 years after your first signs of puberty.

How to get ready for the first period?
Talk to your parent or another adult you trust about what you can expect before it actually happens.
It’s a good idea to start carrying sanitary pads or tampons around with you in advance.

How long does the first period last?
Your first period might not last very long, as it can take your body some months to get into a regular pattern. As a general rule, once they’re settled, you’ll have a period every 28 to 30 days and it will last 3 to 7 days.

How much blood lose can she have?
It might seem a lot, but it’s only about 3 to 5 tablespoons. It’s not a sudden gush – you’ll just see a reddish-brown stain on your pants or on your sheets when you wake up in the morning.

What if period blood leaks through through their clothes?
There are ways of covering up stains until you’re able to change your clothes, such as tying a sweatshirt around your waist. Keep a spare pair of pants and tights at school or in your bag.

Should she use pads, tampons or menstrual cups?
This is up to you. Tampons, menstrual cups and pads (towels) are safe and suitable if you’ve just started your period. You might want to use pads for your very first period as tampons and cups can take some getting used to. It might be worth experimenting until you find the product that suits you best.