New boost to family planning methods

Injectable contraceptives could become more popular among women in India in the days to come, as part of the Government’s national family planning programme. More women may have the option of taking injectable contraceptives following the Government’s proposal to include injectable contraceptive Depot MedroxyProgesterone Acetate, or DMPA, in the national family planning programme.

Most gynaecologists come across many women who, due to limited access to contraceptives, face unwanted pregnancy – and, thereby, morbidity related to pregnancy and abortion. According to the World Health Organisation, every eight minutes a woman in a developing nation will die of complications arising from an unsafe abortion. For every woman who dies of pregnancy-related causes, an estimated 20 women experience acute or chronic morbidity, often with tragic consequences. Introduction of new contraception methods in the public health system will, therefore, allow women to select methods based on their specific needs and preferences.

An injectable contraceptive is a shot that can offer pregnancy protection for up to three months. It is a simple, safe, and reversible family planning method than can be administered discreetly. The method is especially convenient for women who cannot remember to take a pill everyday or negotiate with their partner for using a condom. However, it is essential to visit a doctor for the first screening and counselling on eligibility and potential side effects.

DMPA is a progestogen shot, usually administered in the arm, hip or buttocks. It thickens the cervical mucus which stops the sperms from reaching the egg. It also makes the womb lining thinner and prevents the release of an egg. Progestogen is similar to the natural hormone progesterone, which is released by a woman’s ovaries during her menstrual cycle.

Injectables are 99.7 per cent effective in preventing pregnancy. As per current WHO recommendations on the use of injectable contraception, for women aged 18 to 45 years of age, there should be no restrictions on the use of DMPA, including no restrictions on the duration of its use (medical eligibility criteria Category 1). Among adolescents (menarche to less than 18 years) and women over 45 years, the advantages of using DMPA generally outweigh the theoretical safety concerns regarding fracture risk (MEC Category 2). There are no restrictions on the use of hormonal contraceptives, including DMPA for women at high risk of HIV (MEC Category 1). Women and couples at high risk of HIV acquisition should also be informed about and have access to HIV preventive measures, including male and female condoms irrespective of the family planning method they choose.

These hormonal contraceptives are safe and suitable for nearly all women, including women who are breastfeeding, who have or have not had children, and even those who may just have had an abortion or miscarriage. DMPA has a high acceptability as it is provided by an injection every three months, which can be given outside clinical facilities. Women who are HIV positive can also safely use injectables. However, it should be noted that injectables do not provide protection against any sexually transmitted diseases including HIV. Therefore, a condom must be used for protection against these diseases.

This injection must be taken within seven days of menstrual bleeding or within the first seven days after a miscarriage or abortion. In case of breastfeeding mothers, the injection can be taken after six weeks of childbirth, and within six weeks after childbirth in case of non-breastfeeding mothers. Till the woman does not wish to have babies, she can continue to take these injections after every three months. An important point to note, however, is that the injection has to be discontinued nine to 10 months prior to planning a baby, as the conception may take some time.

All contraceptives have side effects. Therefore, women should be counselled about DMPA’s side-effects and provided a leaflet or other material to inform them about DMPA’s mode of action. Some women may experience lighter or irregular bleeding while in some cases there may be no menstruation. Other possible side effects may include headache, dizziness, breast tenderness, and weight gain. Most side effects usually become less or stop within the first few months of using the injectable.

Source : The Pioneer (via Syndication)

Influence of diet on conception

When trying to conceive, often even the smallest thing, like the food that one eats, makes a difference. What one eats certainly affects the sex drive. But it can also impact the chances and the quality of conception. Lifestyle factors, like the diet and ways of life, can greatly influence overall health and well-being, including fertility. The good things is that these can be easily modified to suit one’s objectives.

The results of a 8 year study covering over 18,000 women published in The Fertility Diet (McGraw-Hill) by Jorge E. Chavarro, M.D., Walter C. Willett, M.D., and Patrick J. Skerrett “uncovered evidence based suggestions for improving fertility”. Instead of the many traditionally suggested fertility food items like oysters, ginseng, yam and garlic, ovulatory infertility, which is the underlying cause in almost a quarter of all cases of infertility, is now believed to be prevented much more through a complete and balanced diet.

At least five servings of fruits and vegetables: Inclusion of fresh fruits and vegetables in the diet not only ensures overall health and fitness, but also fulfills the requirement of essential vitamins and minerals in the body, required for both male and female fertility. Some deficiencies, especially those of folic acid and certain minerals, can play havoc with the fertility of both sexes, reducing the quality of sperm in males and abilities to sustain a pregnancy in women.

Plenty of unrefined carbohydrates: Whole grain cereals in multi-grain breads, pasta or chapatti helps meet the requirement of carbohydrates while also providing the body with essential fiber. Sufficient carbohydrate is important not only to ensure adequate energy levels and overall fitness but also to maintain the appropriate biochemical balance in the body.

High quality proteins: While non-vegetarians can include fish, sea-foods and poultry, as sources of protein, in their diets, people with vegetarian diets also have a wide choice of pulses, soya products, milk and milk-products for sourcing their protein requirement. One should also include eggs in the diet if it is an option. It is advisable to include at least 2 servings of protein rich foods in the daily diet. Besides strengthening the muscles and improving stamina, some protein sources like certain pulses and meats also help in meeting the requirement of folic acid in the body.

Adequate water: The adequate intake of water per day depends on various factors like gender, activity level, health and of course the environmental conditions. Though there are various recommendations on the right quantity of water to be consumed per day, the Institute of Medicine recommendation, for temperate climates, is fluid intake per day of 3 liters for men and 2.2 liters for women. This is almost the same as the often mentioned thumb rule of “8 glasses” per day. Just remember that the intake covers all fluids.

But besides ensuring that one switches to a diet that is appropriate for supporting a healthy conception, one must also be aware of certain things that need to be avoided for the same.

AlcoholConsumption of alcohol, especially if not strictly regulated, affects not just the overall health and fitness but also both male and female fertility. Since it is not often easy to regulate, couples trying to conceive should attempt to completely stop alcohol consumption.

Smoking: Couples trying to conceive should abstain from smoking and generally any kind of tobacco use. Smoking inevitably affects both the sperm quantity and quality in males and thereby the chances of a conception. In women, smoking affects how receptive the uterus is to the egg.

Cessation of smoking and alcohol consumption are lifestyle modifications which apply to to both the partners if they are desirous of having a baby. For dads-to-be, limiting alcohol is even more important when compared to moms-to-be. According to a research study, ‘Effects of caffeine, alcohol and smoking on fertility’, published in the journal of The Fertility Society of Australia, the mechanisms by which alcohol impairs fertility are unclear, but in men it has been found to cause impotence, reduction of libido and poorer sperm quality.

Caffeine: Caffeine is present in tea, coffee and in some soft drinks. It is known to drastically reduce the chances of conception. Studies have shown that consumption of even 200 mg of caffeine per day almost doubles the average risk of miscarriage of 12.5%. This doesn’t mean that one has to altogether give up their coffee or tea if they want to conceive…just limit it to a reasonable level. While some experts suggest during pregnancy a limit of 100 mg of caffeine per day from all sources (1 cup of brewed coffee or 2 cups of tea), there is no specific basis for the same.

It is important to note here that alcohol consumption and smoking are undesirable not only during the phase of conception, but also throughout pregnancy. So when it comes to planning a baby, the first step should be a decision to abstain from both of them. According to National Health and Medical Research Council and National Institute of Clinical Studies, pregnancy is a time when smoking cessation advice has been found to be most effective.

Mercury: While it may sound a bit bizarre, we may unknowingly intake a lot of mercury by consuming certain soft water fishes, which are known to have high mercury content. High mercury levels can lead to Menamata disease, which interferes with fertility and can also cause miscarriage and preterm delivery.

To summarize… A healthy, complete and balanced diet, that includes lots of carbohydrates, good quality proteins, fruits and vegetables and less refined foods and fats, when combined with abstinence from alcohol and tobacco consumption and moderation with caffeine, can support a successful and healthy conception.

Female Infertility: Cause and Treatment

The worst news that a woman trying to conceive can receive is that she is infertile. In the United States, 10 per cent of the women face the nerve-racking problem of infertility, which is the inability to get pregnant naturally. This is not solely a curse for women as men can be infertile as well.

The Center for Disease Control (CDC) states that out of all instances when infertility causes distress to a couple; female and male infertility each account for one third of those instances. A combination of problems from both the man and the woman who are trying to conceive, account for the rest of the cases after accounting for 20 per cent of the cases, where the doctors are unable to identify any obvious cause of infertility.

Causes of Female Infertility

Cervical Issues – In some cases, an abnormal mucus production or a previous surgical procedure performed on that area can cause a blockade that prevents the sperm from passing through the cervical canal. There is a workaround for this problem – intrauterine inseminations. In this process, the sperm is placed inside the uterus artificially to help with fertilization. This procedure increases the number of sperms that reach the egg.

Damage to Fallopian Tubes – A damaged fallopian tube can prevent the egg from reaching the uterus where it can met by the sperms. The fallopian tubes are responsible for carrying the eggs from the ovaries to the uterus. A damage to the tube can be caused by pelvic surgeries, pelvic infections and endometriosis.

Uterine Problems – In this case, the structure of the uterus is not hospitable for the foetus. This is caused by the presence of polyps and fibroids. Polyps are the abnormal growths of tissue that are most commonly present in the uterus, nose or colon. They can be present in any organ that has blood vessels. Fibroids are specific to the uterus. They are also abnormal growths that affect 70 to 80 per cent of the women of African-American descent who are above the age of 50. The incidence among Indian women is about 25% as per a study conducted by the National Institute of Health.

Hormonal Causes – The hormonal causes involve problems with ovulation (when a matured egg is released from the ovaries). Because of some hormonal changes, this transfer of the mature egg does not take place. Blood tests to detect the hormone levels beside ovulation predictor kits and basal body temperature charts can be used to detect this ovulation problem.

Unexplained Reasons – As the name suggests, an unexplained infertility is when the causes are not clearly identifiable. This happens in 20 per cent of infertility cases. More advanced methods of investigation are required to analyse such other causes.

Diagnosing Infertility

Blood Tests – Can be used to detect a number of potential causes including improper hormonal levels.  The level of testosterone in men is also analysed through a blood test.

Laparoscopy – This procedure involves looking at the outside of the uterus, ovaries, and fallopian tubes by inserting a fiberoptic camera attached to a thin tube through an incision near the belly button. Laparoscopy helps doctors look for abnormal growths in the area. This happens in the case of endometriosis which is due to the formation of endometriotic tissues in other parts of the body apart from being present in the uterus.

Hysterosalpingography (HSG) – An HSG involves inserting a dye or saline into the cervix. Thereafter through X-ray or ultrasound, doctors can find out whether the fallopian tubes are open or blocked.

Semen Analysis – Is performed in the case of male infertility to determine the strength and number of the sperms.

Treating Female Infertility

In vitro fertilization (IVF) – IVF is a method of artificial insemination. In this case, the egg and sperm are combined outside the body and then placed in the uterus after the embryo forms. Since 1981, when the procedure was first introduced, it has been successfully used to give birth to over 200,000 babies.

Medical therapy – Special drugs can be given to women facing problems with ovulation. These drugs are also known to improve fertility. Gonadotropins can also be used in case of an unexplained infertility. Women with insulin resistance may receive additional drugs.

ICSI – Intracytoplasmic Sperm Injection or ICSI is done in case of male infertility. The sperm is injected directly into the egg in a dish and then placed in the uterus.

Egg donation – Egg donation involves the removal of oocytes from the ovary of a woman who has taken fertility drugs for ovarian stimulation. After the eggs have been extracted, in vitro fertilization is performed, using the sperm from the recipient’s partner.

Intrauterine insemination – This procedure involves placing the sperm in the uterus when the female is ovulating. The sperm is first rinsed with a special solution and then, using a thin plastic catheter, placed in the uterus through the cervix.

Hysteroscopy – Similar to laparoscopy, a hysteroscope is placed in the uterus through the cervix. Doctors can then use it to locate and remove scar tissue, treat endometriosis, open blocked fallopian tubes and remove ovarian cysts.

GIFT and ZIFT  In Zygote Intrafallopian Transfer or ZIFT, the fertilized eggs are placed in the uterus of the mother after IVF within 24 hours while in Gamete Intrafallopian Tube Transfer or GIFT, the sperm and eggs are mixed before insertion.

Women facing infertility need not panic as it can be treated in several ways. As a last resort, if none of the above mentioned treatments work, a couple can always go in for adoption or surrogacy. In surrogacy, the surrogate mother is inseminated with the sperm from the recipient’s partner. The surrogate mother then carries the baby and delivers it on behalf of the recipient.