Approach for infertility,what you should know

    Infertility is a common problem now a days with huge psychosocial impact in a couple’s life.In majority of cases the lack of awareness regarding normal physiology of reproductive organs, is the cause of infertility.This post is dedicated for the desirous couple who need some insights.There are few noteworthy points which they should understand to solve their problems..

    1.Three basic requisites for conception are A.adequate healthy sperm count in semen(semen is a fluid comes out from male Sex organ at the time of orgasm.The process of release of semen is called ejaculation.Semen contains millions of sperms per millilitre of semen.Sperm fuses with egg in females’ fallopian tube to form embryo which develops into baby in womb in approximately nine months.)

    B.Ovulation(release of egg from women’s ovary)

    C.opportunity of the sperm to meet with ovum in the fallopian tube.(after sexual intercourse the sperm from the semen released from male into female’s vagina goes into her uterus which has two tubes attached on each side.Both the tubes have finger like projections which are close to the respective side of the ovary.One egg comes per month from any one side of the ovary.That egg via finger like projection of fallopian tube are taken up, as soon as released from ovary and if sperms reaches that tube at that time,the egg gets fertilized.)

    2.To know the sperm count,you can simply go to your local clinical lab and ask for seminal analysis.You can see your sperm count against the normal range of the same in your seminal analysis report obtained from the lab.

    If this is normal,your second issue is ovulation in your female partners ovary.For this you should know that on the day of ovulation her temperature rises.If you do daily check the temperature of your wife just before getting up from the bed early morning and make a record of it from the day one of the menstrual cycle,you can find her body temperature increased on fourteenth day if she has 28day menstrual cycle.If her menstrual cycle is of more than 28 days,you simply subtract 14from that figure.For example,suppose her period comes every 35days.You subtract 14 from 35..It comes 21.So she would ovulate on 21st day(assuming first day of bleeding is day one of the menstrual cycle.So in such case woman is likely to conceive on 21st day.So desirous couple should make effort on 21st day in above example.Here one important thing to note is,sperm can survive for1-2days after ejaculation and egg upto 3-4days of ovulation So two days before to four days after ovulation a woman has better chance to conceive.So in above example the couple can make effort from 19th day to 25th day. One important tip is that,the male should keep abstinence during other period for better results.Further the female should take folic acid tablets from two to three weeks prior to their efforts and should continue it.Apart from this both partners should take vitamin E supplements 400mg  every alternate day or 15days every month.Apart from this,they should get treatment of any Sexually transmitted disease they have.

    If you have taken care of above things and still your wife did not become pregnant.There may be technical problem in intercourse.No chemical,lubricants or oil should be used.After intercourse and ejaculation the female should remain in lying position for at least three hours Preferably the foot side of bed should be raised.

    Best approach to summarize, Male should abstain from Sex from the first day of his wife’s menstrual cycle.(even he should not masturbate).He should know the duration of her menstrual cycle by reviewing her last three period onset dates.Whatever the average duration of menstrual cycle comes  by assesing last three period onset dates,just take a note of that.Subtract furteen from average duration.The number which comes after subtraction is the day on which her egg will come or ovulation date.On that very day have Sex with her if possible twice or thrice and keep her in lying position on the bed whose foot end is raised for three hours.

    Once more I need to elaborate the calculation of ovulation date(date on which a female’s egg released from ovary and taken up in the fallopian tube of her uterus.)Take following steps:

    Step-1.Mark in your calendar when your bleeding starts in a new cycle.The marked day is day1. Similarly in the next two cycles mark the bleeding start day in your calendar. Suppose in march month your bleeding had started on 25 March 2015.So day1 of the new cycle which had started in march was 25 March 2015.That bleeding persisted for 5 to 7 days and finished.Again in April,your bleeding had started on 27th,then the day1 of this second cycle would be marked in calendar on 27th April 2015.Again in May the bleeding started on 21 so it day1 of third cycle would be marked as 21st May.Again in June. Suppose it came on 20th June,so the day1 of the fourth cycle should be marked on 20th June.

    Now you have got day1 of the four consecutive cycles:

    1.        25 March 2015

    2.         27 April 2015

    3.          21 May 2015

    4.           20 June 2015

    Step-2.    You can count the days between day1 of the first and the day1 of the  second cycle, between 25 March and 27 April. ……….. 33 days(first menstrual cycle duration)

    Similarly between day1 of second and day1 of third cycle,

    between 27 April and 21 May………………..24 days(second menstrual cycle duration)

    Similarly,between 21 May and 20 June…………29 days(third menstrual cycle duration)

    Step 3-Add all the three consecutive cycle duration and divide the resulting number with three.

    In above case 33+24+29=86

    86/3=27 approx.

    So this is the average of your three consecutive cycle duration.

    Step-4. Date of ovulation=Average menstrual cycle duration Minus 14

    So in above case it is 27-14=13

    So in this case ovulation day is 13 th day.

    So this female would be most likely to be pregnant,if sexual inter course would be done on 13th day from 20th June.

    If the dates are regular in a female then you are not required to do such calculation.Ask what is her expected date of coming period and do Sex 14 days before that expected date.

    If you have addressed the above points and still not being pregnant,then go for ultrasonography for pelvic organs and tubal patency test.If they are also normal.Get Yourself tested for VDRL, HIV,TORCH TEST,MICROFILARIA TEST,HORMONAL ASSESSMENT.

    But that part would better in consultation with your gynaecologist.






Menstrual Cycle problems selfcare and insights

Females are the creator of civilization.Their contributions to the humanity is immense.History tells us that the discovery of agriculture in 10000 BC ,is most probably done by the females.In their entire life cycle there are challenges for them and they stand the test of time.From the initiation of their menstrual cycle(menarche) to the cessation (menopause),they have to deal with their hormonal fluctuation and its physiological and psychological impact on their body.
Age of menarche is decreasing by three month per decade due to global warming.At lower age when they are not very mature psychologically,they have to deal with considerable stress and anxiety with respect to their menstrual cycle.So my effort is to provide some insights about the menstrual cycle to general community.
1.Menstrual cycle is ideally of 28 days in which bleeding occurs in first five days.The day on which bleeding starts is called day-1.and the days counted onward from this day.Females should mark that date every month on calendar to assess their menstrual health.And the number of days the bleeding persisted in that month should be noted.You can assess your menstrual cycle duration by counting number of days between to consecutive months.Suppose your bleeding has started on 18th April 2015 and you marked the date in calendar as day-1 and bleeding stopped on 22 April 2015(5 days) and in next cycle your bleeding had started on 14th May 2015 again it is day-1 of your next menstrual cycle.Now counting the days from 18th April upto 13th May 2015(14th may is the day-1 of new cycle) is 26 days so the menstrual cycle was of 26 days.
Now the question is….Is this a menstrual cycle of normal duration?
Answer is ‘yes’.
Standard 28 days cycle is ideal but you can consider normal range from 21 days to 35 days.
So the cycle of less than 21 days and more than 35 days are abnormal.
Duration of bleeding is 5 days normally but a normal range may be 2 to 8 days.
So in brief, quick to remember
Normal menstrual cycle 28 days(4 weeks) Normal range 3 to 5 weeks
Normal bleeding days in a mentrual cycle 5 days Normal range 2 to 8 days.
2.If you have menstrual cycle longer than normal.First you should have idea about your menstrual cycle duration by checking your previous menstrual cycle duration on the basis of which you expect your next period to come.
Now, many of you have complains that your period is not coming for more than one and half months from the last cycle.What should you do if you can not consult a doctor.
-Go to any clinical Laboratory near you and get your blood tested for hemoglobin.If it is less than 11gm/dl.You have anaemia.What you can do for your anaemia.Your doctor prescribes you Iron and folic acid tablets(called hematinics).Here many of you might be feeling that many times despite of your taking hematinics tablet your hemoglobin level has not been improved.
Why it is so?
Our blood contains two things
i)Liquid portion called Plasma(which has many dissolved chemicals,you don’t need to remember)
ii)Suspended Cells in the plasma.Three types of cell
-RBC(most abundant cell of our body,red in color due to color material in their wall called hemoglobin)Red Blood Cells-they are helpful in oxygen transport because of hemoglobin which attaches oxygen.
-WBC-white blood cells are security cells of our body.It fights with germs.(you might have seen pus which is composed of dead WBC and microbes)
-Platelets which protects us from excessive bleeding.When there is any damage in blood pilpelines and starts bleeding,these platelets seal the the bleeding point of the pipeline.
You need to know about hemoglobin.It is a color which is painted on RBC,that is why RBC is red.Apart from giving red color to RBC, the hemoglobin helps oxygen transport by holding the oxygen when blood flows to the lungs,we inhale air rich in oxygen in lungs,the oxygen crosses the thin wall of blood pipelines in the lungs and enters into flowing blood.The oxygen gets attached to the RBC where the hemoglobin is painted.So blood gets recharged in our lungs with oxygen.This blood moves to the different parts of the body and the oxygen is distributed and discharged there.And again when the blood returns lung it is recharged back.
So the hemoglobin is crucial for us.Without hemoglobin oxygen delivery to all body parts get compromised. No oxygen no burning of glucose.No burning of glucose no energy.Without energy survival is difficult.Even if you do nothing,you require some energy to survive.
Now let us see the components of hemoglobin
Heme is made up of Iron
Globin is made up of protein
So for correction of anaemia you need at least two stuffs
One -iron for which you  can take Iron tablets.what if you don’t know which tablet you should take,or you have no medical shops nearby.? 
You can eat Jaggery, spinach, amaranth,whatever vegetables or fruits which are naturally colored.You say you don’t have access to these things or what a poor person from developing countries can do?Golden advice is that,prepare your food in a pan made up of Iron,you can get sufficient iron.One important thing you should know that iron is absorbed in duodenum which is the starting segment of our small intestine,just beyond our stomach.One more thing is important to know that vitamin-C is important for iron absorption from intestine.So the person taking general iron tablets should take vitamin-c before taking iron.Now the question is,what to do if vitamin -C tablets are not available.You can take Amla,Indian gooseberry, Lemon juice,orange juice,guava,and all the citrus fruits and what else…off course green chillies after eating you yourself say C…C……. Just joking!
Two-protein, no need to purchase costly supplements.Eat plenty of pulses of all types,soyabean is the richest source of protein,but for non vegetarians I would like to stress that,they should take white portion of the boiled egg(not the shell obviously). 
So you might have had some idea till now that your hematinics might not be correcting your hemoglobin level because of inadequate protein and vitamin-c intake.
Let us come back again to the menstrual cycle.So your period is delayed for more than one and half months and you get yourself checked for blood Hb(hemoglobin level),if it is less than 11gm/dl twke iron,vitamin-c and protein rich diet to improve your hemoglobin for at least one or two months,your problem of delayed period would be relieved in most of the cases.If you are little more aware of medicine and worried about iron toxicity.Go for anemia profile test and check for your values in the report.If your parameters are normal then you might have vitamin B12,folic acid requirements,in that condition you can go for vitamin B complex.But iron deficiency is most common cause of anemia in the females of reproductive age. 
What to do if your hemoglobin level is normal and your period is delayed.
Go to chemist shop and get Hcg kit for pregnancy test.All the testing procedures and result interpretations are written on the kit pack.You can do the test yourself.
This test has some limitation.If it is positive,it doesn’t always confirm pregnancy,it may be positive in any disease in which the chemical is released in urine.
If Hb is normal and pregnancy test is also negative then what else?
If the female is nursing or breastfeeding her child then also the period may be delayed.
if the female is taking some contraceptive pills,the period may be delayed.
If none of the above causes are the reason of delayed period. The female should go for complete blood test and ultrasonography and consult the gynaecologist. 
Many females feel lower abdominal pain during or before their menses,such pains are generally well relieved by mefenamic acid+dicyclomine tablets.
Some females have excessive periods after very delayed menses,in many of such cases there is a chance that they are conceived and for poor hormonal support,the conception underwent abortion.
In Such cases bleeding occurs profusely and for many days.During heavy bleeding and afterwards the female should maintain their body water by taking plenty of fluids,juices,pulses,and iron rich diet.Further for excessive bleeding they may need blood transfusions.
Heavy bleeding may be due to deficiency of chemicals in your blood,those are called clotting factors.Vitamin K helps in formation of clotting factors II,VII,IX,X by liver.So in heavy bleeding vitamin k injection one amp daily for three days may be taken along with some hemostatic injection used to control bleeding.Some hormonal pill can also be used to control bleeding.But again I warn!you should not take those medicine without the advice of a qualified medical practitioner of your area.
Menstrual bleeding also occurs excessively,if they take aspirin during the periods.Apart from this   hot and spicy things may exaggerate the menstrual bleeding.So try to avoid those things during periods.
Blood is a good culture media on which many disease causing organisms can grow.So during menses their is greater chance of female genital infection.So personal hygiene is extremely important.In some developing country there is a myth prevalent that the females should not take bath during periods,this is not true.They should take bath daily and  should wear fresh clothes apart from this they should use sanitary napkins fresh and non contaminated.Those who can not afford to purchase costly sanitary napkins can use sterilised cotton cloth by boiling in water for 15 minutes.
Many females have complain of excessive white dicharge from their genitals with foul smell.Majority of such cases can be treated by following three points:
1.Levofloxacin 500mg one tab daily orally for five days to the female(Her male partner should have a single dose of it.)(warning!qualified doctor should be consulted for proper dose adjustment and advice)
2.Metronidazole tablets 400 mg twice daily for five days orally(warning you should not have had alcohol 48 hour before the treatment,nor you should take alcohol during the treatment and upto three days after the last dose of metronidazole.)
3.Clotrimazole vaginal tablets to be inserted in vagina in posterior fornix for the six consecutive nights.
This tablet should be inserted carefully,otherwise it may cause injury in internal structure.
Posterior fornix of vagina is needed to be clarified.When you insert your middle finger deeper,you can feel the cervix which is the lower part of uterus.If you can slide your finger posteriorly you may find a space which extends far upward from the cervix you touched.That posterior and upward space in relation to the cervix is posterior fornix.Your Clotrimazole vaginal tablets should reach there to be effective.