Dr.sathya balasubramanyam

MD DNB MRCOG (UK) FNB(Reprod med)

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  • Do all fibroids affect fertility? How can they be managed?

The effect of fibroids on fertility is quite a controversial topic. However, all fibroids are not found to cause infertility. Submucous fibroids that project into the uterine cavity are found to hinder implantation rates and thus affect fertility. Intramural fibroids above 5 mm in size are found to affect implantation as well.

GnRH analogs help in shrinking the size of fibroids but this alone cannot provide a complete solution for fibroids. Hysteroscopic resection helps in the management of submucous fibroids while open surgery is preferred in case of intramural fibroids.

  • How does obesity affect fertility?

Many cases of infertility reported are mainly due to obesity. Obesity in women is often associated with implantation failure, miscarriage and anovulation. Hence obese women are often advised to lose weight before initiating a fertility treatment. It has been found that reducing the weight even by a mere 5% can show significant improvement in the pregnancy outcome.

Obesity in men is known to affect sperm count and testosterone levels. Maintaining a healthy weight is essential not just for reproductive health but also for a healthy life.

  • Do procedures like ICSI increase the risk of anomalies in new born?

According to studies and researches conducted on the topic, the technique of ICSI as such do not cause any anomalies in the children born from these procedures. However, defects can be caused due to the low quality of gametes used in the procedure rather than the technique. Cardiovascular, neurological and genitourinary some anomalies, that are caused due to poor quality of gametes.

  • Can endometriosis be medically managed?

Endometriosis treatment oriented at treating infertility does not benefit much from medical management. Surgical management offers better results than medicines. However, ultra long protocol with GnRH is known to bring about better results in stage 3 or 4 IVF and ICSI procedures.

  • What is the cycle limit for IUI?

According to evidence based guidelines, if IUI do not result in a successful pregnancy even after six ovulation cycles, IUI is stopped and IVF is carried out. However waiting for about six cycles has its own cost implications.

IUI treatment that is administered along with gonadotrophins cost about the same as that of an IVF cycle. Since IVF has a better success rate, it would be logical to try it sooner. That said, the treatment technique is decided based on a number of factors such as the age of the woman undergoing the treatment, the duration or period of infertility and so on.

  • How can the ovarian reserve of a poor responder improved?

There are various protocols that are available to increase the ovarian reserve in poor responders. However, the effectiveness of these procedures is still under scrutiny. The treatment measures are started after providing thorough counselling to the patient regarding the prognosis.

The GnRH antagonist protocol where a high dose of gonadotrophin is administered is one of the important protocols preferred for this. Ultra short and flare protocols are other options though they have an increased risk of premature LH surge, when compared to the GnRH protocol.





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Dr. Sathya Balasubramanyam

FNB(Reprod med)

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