Thursday, October 6, 2011

GETTING PREGNANT: EASY WAYS TO ENCOURAGE FERTILITY


GETTING PREGNANT: EASY WAYS TO ENCOURAGE FERTILITY
-          Dr. S.R. AMEERKHAN BABU., M.D.(Hom)Gen.med.

                If you’re having trouble getting pregnant but you're not quite ready for fertility treatments, there are things you can try on your own. For some couples, getting pregnant is quick and easy. For others, things may not go exactly as planned. Sometimes, problems are linked to specific physiological issues such as blocked fallopian tubes in the woman or low or no sperm count in the man -- problems that can be helped by fertility treatments such as in vitro fertilization (IVF) or insemination. For many others, however, reasons behind their infertility are much harder to define. And what if you aren't anticipating a problem but just want to give your fertility a boost? Some of these low-tech methods can work for you as well. Just keep in mind that the American Society for Reproductive Medicine says if you don't get pregnant after 12 months of regular unprotected intercourse -- or six months if you are a woman over 35 -- it's time to seek help from a fertility specialist.
                                                  
Fertility Booster No. 1: Eat Healthfully:
                Among the most common causes of unexplained infertility in women is "ovulatory dysfunction" -- an umbrella term encompassing problems with ovulation. Though a number of factors can be responsible, many doctors now believe diet is key. In a study of some 17,000 women conducted by the Harvard School of Public Health, researchers were able to define a group of "fertility foods" able to improve conception odds.
                            
                It is often said that you are what you eat. The food that we consume can make us fit and also assist us in overcoming lot of medical problems including infertility. So if you are planning to get pregnant and if you are unable to conceive, it is most probably your diet which is to be blamed. Rather than drowning your tears and sorrows into that ice cream tub or by digging into that rich chocolate dessert it would be better if you take care of your diet which can increase your fertility. The simplest reason why the right food selection can help you aid in fertility is that it can make you lose excess weight and regulate your hormonal levels which will help you in becoming pregnant quickly.
Below are Top best fertility foods that can help you become pregnant and make you hold the baby that you had been wanting badly:
·         Staying hydrated by consuming a lot of water will not only help in proper functioning of all your reproductive organs but will also provide natural fluid for the sperms to reach the cervix. So drink filtered or spring water and increase your fertility levels.
·         Green leafy vegetables especially spinach is loaded with antioxidants, iron and folic acid all needed to maintain the good health of your reproductive organs. Folic acid present in spinach not only assists you in getting pregnant by generating viable eggs but also prevents defects in newborns.
·         Include a healthy dose of orange and yellow vegetable in your daily diet as they are good sources of antioxidants and beta carotene. Beta carotene helps in correcting hormonal imbalance and also eliminates the chance of miscarriage.
·         Suffering from endometriosis or uterine fibroids then gorge on broccoli, cabbage and other cruciferous vegetables. These vegetables contain phyto-nutrients which help in regulating estrogens metabolism.
·         If your problem is irregular menstrual cycles then sweet potatoes, carrots and peas are must haves. These vegetables contain beta carotene which helps in regulating menstrual flow thereby increasing your fertility.
·         Enjoy a daily serving of fruits rich in Vitamin C such as blueberries, papaya, oranges, kiwi and strawberries which offer lot of nutritional benefits to women that are planning to conceive.
·         Dairy products and lean animal proteins such as fish are rich sources of amino acid that helps in generating fertility hormones FSH and LH. So include them in your diet and see your dream of getting pregnant realized soon.
·         Reach out for whole grain bread and tortillas instead of bakery products made of fine flour as they are rich sources of iron and vitamin B needed for enhancing fertility hormones.
·         You need to eat right fats if you wish to get pregnant. So a handful of nuts like almonds or walnuts which are great sources of omega 3 fatty acid should be included in your diet.
·         Lastly consume vegetable proteins in moderations especially tofu and other soy products which will help you in attaining ideal pre pregnancy weight and will therefore help you in getting pregnant.
The food that your gorge on have a big impact on how quickly you can conceive. So have a meal rich in fruits, vegetables, dairy products, vegetable proteins which are good sources of Vitamin C, Beta carotene, antioxidants, folic acid and iron that can help you in getting pregnant quickly.
Many researchers believes diet made a difference because the majority of women experiencing ovulatory dysfunction were also suffering from undiagnosed or subclinical PCOS (polycystic ovary syndrome), a condition related to insulin resistance that also affects ovulation. And finally, "You should not depend on it alone -- make it just one part of your overall efforts to conceive."

Fertility Booster No. 2: Weight Control

                Whether or not you eat the so-called "fertility foods," maintaining a healthy weight is another way to enhance your fertility. Studies show that having either a very low or very high BMI (body mass index) disrupts ovulation and may also affect production of key reproductive hormones. For many women -- particularly those who are overweight -- problems are traced to ovulatory dysfunction, often caused by PCOS. That said, a recent Dutch study of some 3,000 women found excess weight could also interfere with fertility even if a woman is ovulating normally. Reporting in the journal Human Reproduction, researchers documented a 4% decrease in conception odds for every point in BMI above 30. For women whose BMI was higher than 35, there was up to a 43% overall decrease in the ability to conceive. The good news: Losing those extra pounds may preclude the need for pricey fertility treatments. Another research says that, being too thin can also keep you from conceiving. "Women who are extremely lean often have a problem getting pregnant because they are not able to sustain a regular menstrual cycle -- for these women, it is more beneficial to gain weight.

 

Fertility Booster No. 3: Reduce Stress

                Although links between stress and infertility have been long debated, evidence continues to mount that the two are intertwined. In studies conducted at Harvard's Mind-Body Institute, women who underwent stress reduction therapy saw dramatic increases in their ability to get pregnant. In fact, even women who were already undergoing fertility treatments had more successful outcomes when stress was kept under control.
More recently, research linked stress to a condition known as functional hypothalamic amenorrhea (FHA). Affecting some 5% of women in their reproductive years, it causes irregular or absent menstrual cycles. What can you do to reduce fertility-related stresses? Experts say anything that makes you feel relaxed can help -- be it listening to music, doing yoga, getting regular massages, writing in a journal, reading, gardening -- even chatting on the phone with friends. You can also think outside the box for some unique ways to reduce stress. One recent study published in the journal Psychological Science found the simple act of holding hands with your spouse can drop stress levels dramatically. Or you might try renting a stack of romantic comedy videos. If you're tempted to handle your stress by smoking or drinking alcohol, experts say don't. Numerous studies have shown that smoking contributes to both male and female infertility and can even impair the outcome of fertility treatments. Excessive alcohol consumption can impair ovulation in women and sperm production in men.
Fertility Booster No. 4: Ovulation
                While being intimate during the "right time of the month" won't do anything to increase your fertility, it can increase your chances of getting pregnant -- simply by ensuring you and your partner connect during the time conception is possible.
Timing is key, because "an egg only lives for 24 to 36 hours." But sperm can live in the lower portion of a woman's reproductive tract a lot longer -- often up to five days. So to increase your chances of conceiving you should be intimate with your partner beginning three to four days prior to ovulation, and continuing up to 24 hours after ovulation.
But how do you know when you're about to ovulate? Experts say there are several methods you can use to approximate.
1.       Chart your basal body temperature (BBT): Your BBT, which is the lowest temperature your body reaches during the day, is affected by the hormones that influence ovulation. Just prior to egg release, your BBT drops about a half degree, then rises again after you ovulate. So by carefully monitoring and keeping track of your daily temperature for one or two months, Pollack says you will begin to see a pattern take shape. If you have intercourse during the days when your temperature drops, then there is a good chance you will be within your fertility window.
2.       Chart your cervical mucus: Corresponding to changes in body temperature are changes in cervical mucus. Just prior to ovulation, the mucus will seem more copious, thinner, and more clear than on other days. You might even be able to pull it apart so that it looks somewhat like rubber cement -- a phenomenon known as "spinbarket." By checking your cervical mucus daily and coordinating its consistency with your BBT, you can further nail down your most fertile time.
3.      Use an ovulation predictor kit (OPK): These over-the-counter kits, costing from $20 to $75 a month, check for the hormonal changes found in urine prior to ovulation. Some use a color-sensitive dipstick while newer OPKs have digital readouts that may be easier to interpret. OPKs can alert you to ovulation up to two days in advance. Once the OPK is positive, Pollack says, you would "have intercourse that day and every day for three days to help increase your chances of conception." Another device that may predict fertility is the "ferning" microscope, which can be used to detect changes in saliva that precede ovulation. However, experts say this approach may not be as reliable as an OPK.

Fertility Booster No. 5: Conception Kits and Other Tests
                A kit that helps predict ovulation may tell you when it's the best time to have intercourse, but most did little else to foster fertility -- until now.
A new kit developed by Conceivex not only offers ovulation prediction, but it also contains a small latex-free cervical cap to actually help you conceive. The idea here is to concentrate an ejaculate into the cap and insert it into a woman's body directly at the opening of the cervix. In a kind of do-it-yourself mini-insemination, it does away with the need for sperm to swim through a sometimes chemically "hostile" vaginal canal, placing them instead right at the palace gates. Experts recommended the kit, says it's most useful for women with previous cervical issues or for men with low sperm volume or performance anxiety. Though Conceivex won't repair any defects, it is a way around them. It's also an important aid for men with sperm concentration problems. Although Conceivex requires a prescription, it can be purchased online after completing a questionnaire reviewed by their medical doctors.
A second new kit is called Fertell. While the female version is simply an ovulation predictor kit, the male version is an at-home test able to measure sperm motility --the ability of sperm to reach a woman's fallopian tubes. It does not require a prescription. Other do-it-yourself sperm motility tests are available. "There is no harm in trying these kits, or any of the other methods to encourage fertility. But if you don't get pregnant within the suggested time frame, then don't wait -- see a fertility specialist".



Combined therapy along with Homoeopathic treatment helps in combating Menopause

 Introduction
Menopause is a universal and irreversible part of the overall aging process involving a woman's reproductive system, after which she no longer menstruates. Awareness about these changes is less in our country compared to developed nations. Patients seeking treatment for menopause is less, but we find such patients visiting for their menopause related symptoms like irregular bleeding, fatigue, night sweats, etc. Though we have many rubrics in the repertory for menopause and its symptoms, many a times we fail to provide desirable results. Many physicians find in such cases along with the indicated drug, other managing measures like food modifications, exercise, home remedies and herbs, supplements, micronutrients and vitamins are helpful. This article discusses about such combined therapies along with definition, symptoms, pathophysiology, investigations, rubrics and drugs for menopause.

Definition
The word "menopause" literally means the "end of monthly cycles" from the Greek word pausis (cessation) and the root men- (month), because the word "menopause" was created to describe this change in human females, where the end of fertility is traditionally indicated by the permanent stopping of monthly menstruation or menses. Menopause is a term used to describe the permanent cessation of the primary functions of the human ovaries: the ripening and release of ova and the release of hormones that cause both the creation of the uterine lining and the subsequent shedding of the uterine lining. Menopause typically (but not always) occurs in women in midlife, during their late 40s or early 50s, and signals the end of the fertile phase of a woman's life. It is not uncommon however to see a women menstruate well beyond the age of 50.

Perimenopause refers to the time before menopause when vasomotor symptoms and irregular menses often commence. Perimenopause can start 5-10 years or more before menopause.
Menopause is characterized by a continuation of vasomotor symptoms and by urogenital symptoms such as vaginal dryness and dyspareunia.

The cause of menopause is “burning out” of the ovaries. Throughout a woman’s reproductive life, about 400 of the primordial follicles grow into mature follicles and ovulate, and hundreds of thousands of ova degenerate. At about age 45 years, only a few primordial follicles remain to be stimulated by FSH and LH, and, the production of estrogens by the ovaries decreases as the number of primordial follicles approaches zero. When estrogen production falls below a critical value, the estrogens can no longer inhibit the production of the gonadotropins FSH and LH. Instead, the gonadotropins FSH and LH (mainly FSH) are produced after menopause in large and continuous quantities, but as the remaining primordial follicles become atretic, the production of estrogens by the ovaries falls virtually to zero.

SIGNS AND SYMPTOMS
The menopausal transition can cause
Vascular instability
Urogenital atrophy
Skeletal
Skin, soft tissue
  • Breast atrophy
  • breast tenderness +/- swelling
  • Decreased elasticity of the skin
  • Formication (itching, tingling, burning, pins and needles, or sensation of ants crawling on or under the skin)
  • Skin thinning and becoming drier
Psychological
Sexual

PATHOPHYSIOLOGY
During climacteric, ovarian activity declines. Initially, the ovulation fails, no corpus luteum  is formed and no progesterone is secreted by the ovary. Thus the menstrual cycles tend to become anovulatory and irregular (Metropathia haemorraghica).Later oestrogenic activity also diminishes and atrophic endometrium ensues, leading to menopause. As a result of cessation of ovarian activity, and fall in estrogen level, there is a rebound increase in secretion of FSH by the anterior pituitary gland. FSH level may rise as much as 50 fold, thus making menopausal urine a commercial source of Gonadotrophin(HMG). With further advancing years, gonadotrophin activity of the anterior pitiuitary also ceases and a fall in the level of FSH is eventually noticed .

CHANGES IN THE GENITAL TRACT
These changes are of atrophic type and affect the external genitalia as well as the internal organs. They take time to occur – over a number of years. Not only the main pelvic structures reduced  in size but, more  importantly, the fascial framework and the intra pelvic ligaments supporting the bladder and the genitalia are weakened;this may lead to complications.
Vulva:  This shows the flattening of the labia majora, the minor labia becoming more evident. Sexual hair become grey and sparse. The clitoris shrinks.
Uterus:  The uterus becomes small with a relatively large cervix- return to infantile proportions.
Tubes and ovaries:  These show great shrinkage, the tubes becoming thin, while the ovaries are reduced to small white wrinkled bodies 2-3 cm in length. In addition to the shrinkage of the vaginal introitus, the vagina diminishes in length and its secretions are limited, leading to sexual problems. Changes in the vaginal epithelium increase these problems.

PRINCIPAL CHANGES IN THE SERUM HORMONE LEVELS
Once menopause is well established , the plasma estrogen level may remain low at 10 to 20 pg/ml. Oestrone level varies between 30 and 70 Pg/ml. the ovary also secretes a small amount of testosterone which may be responsible for mild hirsutism noticed after the menopause. The gonadotrophin hormone (FSH) appears in high concentration at menopause, because it is not inhibited by the prevailing low levels of estrogen.

Mensturation may gradually decrease, suddenly cease or become irregular. Oestrogen levels fall over the 5 years preceding ovarian failure which occurs usually between 45 and 50 years of age, with an average around 50 years. The fall in oestrodiol has a positive feedback on the pitiuitary, increasing production of FSH and LH.

The ovaries eventually produce androstenidione, which is also produced by the adrenals, and is converted in peripheral fat into weak oestrogen oestrone

INVESTIGATIONS
Assessment and evaluation prior to initiating treatment:
The following plan is recommended, it helps in finding the actual pathology and progress of symptoms, which helps in finding the constitutional or antimiasmatic remedies and further way of treatment.
    1. Detailed family and personal history, physical examination - height , weight and BP.
    2. Examination of breast.
    3. Pelvic examination.
    4. Evaluation of menopausal symptoms and need for medication.
    5. Evaluation of the individual risks versus benefits from treatment.
    6. Routine screening tests like blood routine, urine routine, Fasting and post prandial blood sugars.
    7. Lipid profile and cardiovascular risk assessment. (Plasma lipids have been known to be altered by the with in month variations in the female hormonal system. The early menopausal subjects shows a significant increase in the total cholesterol level and slightly higher in late menopausal subjects.)
    8. Transvaginal sonography and assessment of endometrial thickness.
    9. Routine mammography.
    10. Endometrial histology – in cases of post menopausal bleeding or family history of uterine cancer. Or past history of late menopause, infertility, and PCOD.

HORMONE REPLACEMENT AND ALLIED THERAPY
The basic objective of oestrogen replacement therapy is to increase the circulating levels of oestrogen to physiological levels of 45- 200 pg / ml to alleviate the climacteric symptoms resulting from oestrogen deficiency. Semi- synthetic hormones are used for hormone replacement therapy (HRT) because they are more physiologic in their actions. HRT can be administered in the form of oral medications, dermal patches or gels for local application, depending on the patients needs.
There are many contraindications to HRT as follows:
Conventional therapy majorly depends on the Hormone replacement therapy (HRT). But many studies suggest that HRT has got many unwanted side effects. For example, the results of a major study, called women’s health initiative (established by the Government of United States of America), had explored many health risks. In fact this important study was stopped early because the health risks outweighed the health benefits. Women taking the hormones greatly increased their risk for breast cancer, heart attacks, strokes and blood clots. However all hormone replacement therapies probably do carry some health risks, including high blood pressure, blood clots, and increased risks of breast and uterine cancers.
  1. Presence of active endometrial cancer and  hormone dependent tumours.
  2. Active breast cancer and oestrogen progesterone receptor  positive cancers.
  3. Presence of or suspicion of pregnancy.
  4. Undiagnosed vaginal bleeding.
  5. Severe liver disease or abnormal liver function tests.
  6. Acute vascular thrombosis.
  7. History of thrombo embolism.
  8. Estrogen dependent vascular thrombosis.
Other relative symptoms are - Strong family history of breast cancer, History of migraine and severe headaches. Thrombo phlebitis,  uterine fibroids, Endometriosis, Gall bladder disease, Glucose intolerance.

HOLISTIC APPROACH TO MENOPAUSE
A holistic approach considering the lifestyle, personal habits, food habits, inclusion of nutrients and herbal diet, etc. along with homoeopathic treatment helps in overcoming menopausal symptoms. Information on each such intervention has been given under respective titles.

I. Life style changes and personal habits:  
  1. Exercises- Brisk walking fro 40 – 60 minutes atleast 5 times/week.
  2. Physical workouts-Weight bearing exercises for limbs and back strengthening.
  3. Yoga and meditation- Breathing exercises (Pranayama) beneficial in reducing stress.
  4. Simple diet- Containing liberal amounts of vegetables and fruits (fibres and vitamins) lower contents of saturated fats and restricted sugar content.
  5. Fluid intake- Consume fluids liberally to maintain tissue hydration.
  6. Control or abstain- Smoking , alcohol intake, unrestricted consumption of tea / coffee.

II. Herbs and plant products:
Plants are a source of phyto oestrogens which have mild oestrogenic and some anti estrogenic effects. Soya has been the most extensively investigated plant. Phytooestrogens are a source of aglycones and isoflavones, coumestones and lignans.common Indian foods rich in phytooestrogens- isoflavons are found in Bengal grams, cereals fruits like apples and berries,and red  clover. Lignans in whole grain, pulses, legumes and beans, sunflower seeds and saponins in herbs like turmeric fenugreek or methi ginger and also in root vegetables yam and grains.

An intake of 50 mg of isoflavones per day has been beneficial in reducing hot flushes, preventing osteoporosis, reducing ldl cholesterol. Also there is an evidence that soya exerts a protective action against breast cancer. The hot flushes can be managed with Wearing cool clothing, Drinking cold water or juice at the onset of flush, shower with tepid water.

III. Micronutrients and antioxidants:
These are essential to the body and required in very small amounts. These include vitamins minerals, essential amino acids, essential fatty acids. Many of these are antoxidants also. Antoxidants protects against the tissue damage. Menopausal women are vulnerable because of the loss of the protective effects of oestrogens and the age related effects.

IV. Calcium and vitamin D3:
In ageing women, the need for calcium supplementation increases to about 1000- 1500 mg / day Provided the calcium should be properly absorbed and utilized. Thus it slows down the process of age related osteoporosis.

This has been justified by Ried et al in 1993 in their research with supplementation  of calcium carbonate and lactate- gluconate to post menopausal women in doses of 1 gm / 24 hours for 5 years and demonstrated  significantly slowed axial and appendicular bone loss.
Chapuy et al in 1992 has demonstrated  both suppression of bone loss and reduction of fracture.

IV. Calcitonin:
Many clinical  studies have produced evidence to suggest that calcitonin  is able to prevent  bone loss in the spine in post menopausal women. Calcitonin injection has been known to cause side effects like nausea and vomiting , flushing and intertrigo, intranasal administration remains another alternative.

V. Biphosphonates:
These  are stable active analogues of pyrophosphate, which act by inhibiting bone resorption. These  compounds are worth considering in women in whom oestrogens are contraindicated, or for those averse to Hormone  Replacement Therapy.

Aroma therapy, Herbalism, Accupressure, Accupuncture, Nutrition and supplements can be suggested as the supportive line of treatments for menopausal complaints.

HOMOEOPATHIC APPROACH
The advantage of homoeopathy is that it considers the patient as whole. Since the symptoms of menopause are not limited to one system or location, a drug selected on the totality is of more helpful than the “single complaint specific drugs”. Our repertory has covered the menopausal symptoms directory or indirectly. Below is a reportorial analysis on the common symptoms of menopause. Therapeutics of menopause follows the analysis.

THERAPEUTICS
Many authors have discussed about the drugs that are commonly indicated during the time of menopause or the climaxis, as referred to in many of the writings. The commonly indicated remedies for General Menopausal symptoms are Amyl Nitrosum, Belladona, Bellis perennis, Cactus grandiflorus, Calcarea carbonicum., Caulophyllum,  Cimicifuga racemosa, Castoreum, Conium ,Crotalus Horridus,  Erigeron, Gelsemium,  Glonine, Graphitis., Kali-carbonicum, Kreosotum,  LACHESIS, Manganum, Mag.phos , Murex., Nux-vomica, Nux moschata, Oophorinum, Psorinum, Pulsatilla , Sabina, Sangunaria, Sepia, Sulphur, Sulphuric acid, Thlasi bursa , Tuberculinum, Ustiligo, Vibrunum opulus and Zincum Valerianum.

Aliments from menopause
Lachesis. (It’s a Well Specific Remedy for Menopause)

Ailments during menopause
For hot flashes and night sweats: Amyl nitrosum, Belladonna, Ferrum metallicum, Lachesis, Pulsatilla, Pilocarpus microphyllus, Sepia and Valeriana.
For sleeplessness (insomnia):  Aconitum napellusArsenicum album, Belladonna, Chamomilla, Coffea crude, Lycopodium clavatum ,Passiflora incarnataSulphur and Viburnum opulus.
For constipation: Hydrastis, Iris versicolorMagnesia muriaticaMagnesia phosphorica and Sepia
For incontinence of urinePulsatilla and Zincum metallicum.
For vaginal dryness: Aconitum napellusApis mellificaBelladonnaBryonia, Ferrum phosphoricum  Hydrophobinum, LycopodiumNatrum muriaticum and Spiranthes.
For depression, fear, nervous or irritability: Aconitum napellus, Amyl nitrosum,  Arum Metallicum, Borax, Chamomilla, Ignatia amara, Lachesis, Nux vomicaPassiflora incarnataSepiaStramonium and Viburnum opulus.
For bone related problems like Osteophorosis: Bellis perennis and Calcarea carbonica
For menorrhagia: Lachesis, Sepia, Argentum mettalicum and Cimicifuga racemosa
For painful and enlarged breast: Sangunaria
For painful breast: Cimicifuga racemosa
For burning, palm, sole and vertex: Sulphur, Sangunaria and Lachesis
For excessive perspiration: Sepia
For earache: Gelsimium
For rheumatic pain: Caulophyllum
For headache: Glonine, Sangunaria, Sepia and Cimicifuga racemosa