What Are The Advantages of Laparoscopy For Infertility?

Laparoscopy will allow the diagnosis of infertility problems that would otherwise be missed. For example, a woman who has severe endometriosis can be identified by using ultrasound. A woman with mild endometriosis can only be identified using surgery such as laparoscopy.

Another problem that can only be identified through surgery are pelvic adhesions. Also known as scar tissue, adhesions cannot be seen with ultrasound, x-rays or CT scans. Adhesions can interfere with the ability to conceive if they make it more difficult for the egg to get into the fallopian tube at the time of ovulation.

Many people view laparoscopy as less invasive surgery that traditional surgery. Traditional surgery requires making an incision in the abdomen which is several centimeters long. This in turn means that the patient has to spend two to three nights in the hospital. Laparoscopy utilizes one to three smaller incisions. Each incision may be one half a centimeter to a full centimeter in length. Most often, patients who have had a laparoscopy will be able to go home the same day as the surgery. In other words, a hospital stay is not usually required.

Some people believed that laparoscopy would result in less adhesions being formed after reproductive surgery. However, this does not appear to be true.

What are the disadvantages of laparoscopy for infertility?

Laparoscopy requires a different set of skills compared to traditional surgery. In many cases, it can be more challenging to complete a procedure. For example, removing one superficial medium sized fibroid can be accomplished equally well through laparoscopy or traditional surgery. However, a woman that has dozen of fibroids, large and small with some occupying the deep layers of the uterus is much better served with traditional surgery. A good fertility doctor will know when laparoscopy is an advantage and when it is a liability.

Laparoscopy versus IVF

Two commonly encountered problems during a laparoscopy, pelvic adhesions and endometriosis, can also be effectively treated using IVF. Since IVF is less invasive than laparoscopy and has a very high success rate, some couples will opt to skip laparoscopy and proceed directly to IVF. Even if a woman has severe adhesions that are not treated, this would not impact on her ability to conceive a pregnancy with IVF.

Where laparoscopy is having an upper hand, the IVF will be having a lower one as well.

1. Laparoscopy gives chance of natural conception to the lady. 
2. Laparoscopy provides information on state of uterus, tubes n pelvis, any preexisting condition leading to tubal blockage like PID, TB, endometriosis, post-surgical adhesions etc
3. Laparoscopy is cheaper
4. Unlike in-vitro fertilisation, medical help is not required for each pregnancy in case of laparoscopy.

Whereas laparoscopy holds these disadvantages:

We can’t treat tubal scarring, can’t confirm tubal functionality via laparoscopy. So tubes may be open but not functional. The risk of tubal pregnancy or ectopic remains if tube partially opened up post laparoscopy.

The success percentage of IVF and laparoscopy:-

There is a 38 percent chance of getting pregnant if you are between the ages of 34 and 40. If you are a female between the ages of 30 and 33, you have a 58 percent chance of getting pregnant after your first IVF cycle.

There are multiple factors which determine the success rate of pregnancy after an endometriosis laparoscopy:-

• Severity of endometriosis
• Type and number of surgeries performed.
• Age
• Ovarian reserve (following surgery, the reduction of ovarian reserve is observed as some primordial follicles may be inadvertently stripped off the ovarian cortex during cystectomy).
• Affected fallopian tubes – impairment of tubal motility/blockage
• Endometrium receptivity

Pregnancy rates after conservative laparoscopic surgery is observed to be about 60% in cases with moderate and 35% in cases with severe disease. High pregnancy rate is observed within the first 6 months of conservative surgery.

Original Source: http://zeevafertility.com/what-are-the-advantages-of-laparoscopy-for-infertility/

Fertility Treatment Options in PCOS

1. Lifestyle modifications

Keep up A Balanced Intake of Carbohydrates and Protein Everyday

Weight reduction in obese patients is the first line of treatment. Body mass index (BMI) < 25 improves menstrual disorders, infertility, impaired glucose intolerance (insulin resistance), hyperandrogenemia (hirsutism, acne) and obesity. Weight reduction (2–5%) improves the metabolic syndrome and reproductive function Hyperinsulinemia(increased levels of insulin in the body) contributes to increased levels of androgens in women with PCOS: Hyperinsulinemia increases the risk of dyslipidemia, cardiovascular disease, and diabetes mellitus. Insulin resistance is the principal abnormality to cause metabolic syndrome.

Accomplish Sugar Balance by Eating Low-GI and Low-GL Foods
One of the strategies that can help you accomplishing sugar balance is by eating low glycemic load and low glycemic index foods. Means the foods which are less in carbohydrates and more in proteins.

Eat food in small proportions in a day.

There are distinctive sorts of activities that can be incorporated, yet you can generally attempt the following.

– Brisk Walks – Gentle Weightlifting – Yoga – Pilates Make a point to practice for 30 minutes every day and 5 days seven days.
Oversee Trans-fat Levels – 
The foods rich in trans fats , makes the estrogen inactive or it can convert the estrogen into testosterone, the male sex hormone. Hence decreasing the levels of trans fats in the diet will help in reducing the levels of testosterone and maintaining the levels of female sex hormone- estrogen.

Avoid these foods – Chips – Pizza – Confectionery – Baked Foods – Biscuits 
Search for food rich in omega 3 unsaturated fats to adjust your hormones. 
Moderate Down with Your Coffee Intake
Something else you can do is to relax on your espresso admission. A Fertility and Sterility ponder demonstrates that while drinking some coffee day by day can enhance estradiol levels, drinking 4 to 5 glasses can deliver 70% more. This will impact the menstrual cycle of ladies and influence hormonal lopsided characteristics.

Eat organic food.

2. Treatment options

Anti-conception medication – Taking estrogen and progestin day by day can re-establish an ordinary hormone balance, control ovulation, mitigate manifestations like abundance hair development, and ensure against endometrial malignant growth. These hormones arrive in a pill, fix, or vaginal ring. These are the treatment options only for those, who are not trying to conceive, but have irregular cycles, problems of acne, increased facial hair.

Metformin

Metformin (Glucophage, Fortamet) is a medication used to treat type 2 diabetes. It additionally treats PCOS by enhancing insulin levels.

– Patients with polycystic ovarian disease with BMI > 25 (see p. 459) are often found insulin resistant. Obese women with PCOS often suffer from impaired glucose tolerance (33%) or type 2 diabetes (10%). Correction of their metabolic abnormality (see p. 470) along with weight reduction gives satisfactory result.

Treatment with metformin (insulin sensitizer) is found to reduce increased insulin levels. Combination treatment with metformin and clomiphene increases ovulation rate significantly.

Clomiphene

Clomiphene (Clomid) is a medicine that can assist ladies with PCOS to get pregnant. Be that as it may, it builds the hazard for twins and other different births. Clomiphene therapy is simple, safe and at the same time cost-effective. Most centres use an initial dose of 50 mg daily. Dose is increased in 50 mg steps to a maximum 150 mg daily, if ovulation is not induced by the lower dose. Successful induction rate is as high as 80 percent but cumulative pregnancy rate is about 70 percent over 6–9 cycles.

Letrozole

Letrozole 2.5 mg given from D3 to D7 increases the release of gonadotropins hormones from the pituitary gland and stimulates development of ovarian follicles and help in PCOS. Letrozole is used either as a first line therapy (alternative to clomiphene) or in clomiphene resistant women with anovulatory infertility. Pregnancy rates are comparable or better than that of clomiphene. Multiple pregnancy rates are low. No increased risk of foetal congenital malformations has been observed with letrozole.

Medical procedure

Medical procedure can be a choice to enhance richness if different medications don’t work. Ovarian drilling is a technique that makes minor openings in the ovary with a laser or slight warmed needle to re- establish typical ovulation.

In vitro fertilization:-

STEP 1: OVULATION INDUCTION

Before and during the in vitro fertilization process, the fertility specialist will monitor the ovaries and the timing of the egg release. The doctor will make sure that the ovaries are producing eggs, and that your hormone levels are normal, among other procedures.

Most women take fertility medicines or hormones at this time to stimulate the ovaries to produce one or more eggs. Having several eggs available for IVF will increase the chances that a lady will get pregnant.
If the lady cannot produce any eggs, and the donor eggs are available, the lady desirous of pregnancy can ask for the same with mutual consent.

STEP 2: EGG RETRIEVAL

During this step in the IVF process, pain medication is given to reduce any discomfort. Then a very thin needle is passed through the upper vaginal wall. With the use of vaginal ultrasound, fluid is removed from the follicles under gentle suction.

Immediately after aspiration of the follicle, the oocyte (egg) is isolated from the follicular fluid. The egg is placed in a culture dish containing nutrient media and then transferred to the incubator.

STEP 3: FERTILIZATION

The next step of the IVF process is the fertilization of the egg. A sperm sample is secured, either from the male partner or a donor, and the most active sperm is mixed with the egg in a special chamber. Sometimes the sperm is directly injected into the egg. Then, the sperm and egg are placed in an incubator and monitored to make sure that a healthy embryo develops.

STEP 4: EMBRYO TRANSFER AND IMPLANTATION

The final step of the IVF process is the embryo transfer. First, the embryos are examined to select the healthiest ones for transfer. To transfer the embryo(s), a speculum is placed in the vagina and the embryo(s) are transferred via a small plastic tube placed through the cervix into the uterine cavity. After the IVF process is complete, bed rest is often advised for around 24 hours.

Original Source: http://zeevafertility.com/fertility-treatment-options-in-pcos/

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