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14 Feb

Pregnancy Symptoms — Early Signs Of Pregnancy

Pregnancy symptoms differ from woman to woman and pregnancy to pregnancy; however, one of the most significant pregnancy symptoms is a delayed or missed period.

Understanding the signs of pregnancy is important because each symptom may have causes other than pregnancy. You may experience pregnancy signs within a week of conception.

Most Common First Signs Of Pregnancy

What are the most common first signs of pregnancy? The most commonly reported first symptoms of pregnancy include:

  • 29% of women surveyed reported a missed period as their first pregnancy symptom
  • 25% indicated that nausea was the first sign of pregnancy
  • 17% reported that a change in their breasts was the initial symptom of pregnancy

While implantation bleeding is often considered the first pregnancy symptom, the survey revealed that only 3% of women identified implantation bleeding as their first sign of pregnancy.

Symptoms Of Pregnancy Explained

Each of your symptoms of pregnancy below could be explained by other causes. What else could they be?

Spotting or light bleeding: If pregnant, this symptom is usually associated with implantation bleeding and is considered one of the earliest signs of pregnancy. The embryo usually implants to the uterine between 6 to 12 days after conception. Some women will experience spotting as well as cramping. Other women do not even notice implantation bleeding or cramping, so don’t worry if you are trying to get pregnant and don’t experience these symptoms; you could still be pregnant.

When this implantation occurs, light bleeding or spotting is perfectly normal. This symptom is sometimes accompanied by light cramping. Many women will conceive and not notice any implantation bleeding, so do not worry if you are trying to get pregnant and do not see this symptom, you could still be pregnant.

 Missed period: A delayed or missed period is the most common pregnancy symptom leading a woman to test for pregnancy. When you become pregnant, your next period should be missed.

Is it possible to be pregnant and still have a period? Some women can bleed while they are pregnant, but typically this bleeding will be shorter or lighter than a normal period. A missed period can be a symptom of pregnancy caused by something else.

Nausea or morning sickness: Nausea or morning sickness is the second most commonly reported first sign of pregnancy. Experienced to some degree by most expecting women, nausea typically shows up between 2 to 8 weeks after conception.

Nausea can be experienced with or without vomiting. It is important to know that nausea, frequently called morning sickness, can actually be experienced at any time of the day. Similarly, it usually occurs during the first trimester and subsides after that for most women, but some will experience nausea all throughout their pregnancies.

Swollen or tender breasts: The third most frequently cited symptom of pregnancy changes in the breasts.  These changes are usually indicated by swelling or tenderness. Changes to the breasts can start as early as 1 to 2 weeks after conception.

Fatigue or Tiredness: Following conception, as early as the first week after, many women cite feeling tired as a sign of pregnancy. This fatigue is commonly experienced by those who are expecting and is recognized as a typical symptom of pregnancy.

Frequent Pregnancy Symptoms

The previous symptoms are usually the first signs you experience when pregnant. There are other signs also commonly experienced by those who are expecting as well:

Backaches: Lower backaches are commonly reported by women who discover that they are pregnant. This symptom can occur with the onset of pregnancy, but it is often experienced later as the pregnancy progresses. This makes it an easy pregnancy symptom at week 27 to week 34.

Headaches: Experiencing headaches at the onset of pregnancy is another common early sign of pregnancy. Experts believe that the sudden rise of hormones in your body leads you to experience the headaches.

Headaches during pregnancy may also be caused by the increase of blood flow. There is an approximately 50% increase in the volume of blood flowing while you are expecting.

Frequent urination:  Don’t be surprised if you feel like you have to pee more often. Increase urination starts for most people between 6 to 8 weeks.

You will find that increased urination will pick back up or continue throughout your pregnancy as the expanding baby and uterus place pressure on your bladder.

Food cravings or food aversions:  The reason for certain food cravings or food aversions is not known. Don’t be surprised if you find yourself drawn to something you normally do not care for, or avoiding things that you normally like.

The food that expecting women crave or seek to avoid varies and are quite sporadic. It is alright to allow yourself the freedom to pursue those cravings and avoid the things you don’t want as long as you are getting the nutrition you need for a healthy pregnancy.

These cravings or aversions can occur early in pregnancy or anytime throughout your pregnancy.

Darkening of the Areolas: Some people lump darkening of the areolas into the symptom of pregnancy referred to as breast changes. That’s alright, it is important to note that if the areolas, area around your nipples, darkens, that is normal.  It is a common occurrence within those who are expecting.

Mood Swings: Expecting mothers frequently experience mood swings. This believed to be primarily caused by the hormonal changes that affect the neurotransmitters of the brain. The types of mood swings can vary from woman to woman.  Some may experience elevated highs and lows, whereas others alternate between states of happiness to states of depression or anxiety.

It is important to note that mood swings are normal; however, if you find yourself struggling with depression or extended periods of sadness, you should contact your healthcare provider. Some women prefer to go directly to a counsellor or mental health professional.

Pregnancy Symptom Alternatives

It is challenging already to determine if you are pregnant or not, but with symptoms of pregnancy varying from woman to woman and even pregnancy to pregnancy, it gets even more difficult. Additionally, most of the typical “pregnancy symptoms” can be explained by something else.

What else could it be?

A missed or delayed period, the most commonly reported first sign of pregnancy, could be caused by any of the following:

  • Pending menstruation
  • Excessive weight gain or loss
  • Fatigue or exhaustion
  • New workout regimen
  • Hormonal imbalance
  • Tension or stress
  • Change in birth control usage
  • Various illnesses
  • Breastfeeding

Nausea or morning sickness, the second most frequently cited symptom of pregnancy, might be explained by one of the below:

  • Food poisoning
  • Tension or stress
  • Anxiety
  • Change in hormonal birth control
  • Other stomach ailments

Tender or changing breasts, as the third most noted pregnancy symptom, might be triggered by any of the following:

  • Hormonal imbalance
  • Change in hormonal birth control
  • Impending menstruation

Fatigue or tiredness can be brought on by any of the following:

  • Tension or stress
  • Exhaustion from working too hard
  • Depression or other mental health struggles
  • Common cold or flu
  • New workout regimen
  • Allergies or other ailments
  • Lack of sleep
  • Improper nutrition

If you’re having the trouble, Dr.Ashish Kale will help you figure out why, and work with you to find a treatment that can help. He is one of the best Gynaec Endoscopy Surgeon, IVF Specialist in Pune & currently practising at Ashakiran hospital which is one of the best Infertility Center in Pune.

 

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14 Feb

Diabetes, Obesity & PCOS – Did You Know It Is The New Epidemic?

PCOS is a common hormonal abnormality seen mostly in reproductive Age groups Affects about 30% females.

Diagnosis is by Rotterdam criteria: 2/3 should be present.

  • Oligo/anovulation
  • Polycystic ovarian morphology
  • Hyperandrogenism

It also affects other metabolisms like insulin resistance causing diabetes, impaired glucose tolerance and this ultimately exacerbates obesity

  • It has a genetic predisposition.
  • PCOS can either be lean PCOS or obese PCOS.
  • This classification is important to categorize the causal effect and treatment also differs
  • Insulin-mediated glucose disposal reflects the action of insulin on muscle cells and this is decreased by 30-40% in women with PCOS.
  • This is further worsened with obesity.
  • The endogenous glucose production is also affected and this causes glucose intolerance.
  • They also have menstrual irregularities and infertility due to lack of mature egg (anovulation ) production.

 

Treatment

  1. Change in lifestyle and diet
  2. Exercise
  3. Weight reduction
  4. Drugs to regularise menses and antidiabetic drugs
  5. Ovulation-inducing agents with or without IUI for subfertility

In case you have a concern or query you can always consult Dr.Ashish Kale & get answers to your questions!

If you’re having the trouble, Dr.Ashish Kale will help you figure out why, and work with you to find a treatment that can help. He is one of the best Gynaec Endoscopy Surgeon, IVF Specialist in Pune & currently practising at Ashakiran hospital which is one of the best Infertility Center in Pune.

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17 Jan

What you need to know about Ovarian Hyperstimulation Syndrome (OHSS)

Complications from fertility treatments are rare; nevertheless, some people do experience side effects. Anyone undergoing ovarian stimulation is at risk of developing ovarian hyperstimulation syndrome (OHSS), one of the most serious side effects of fertility treatments. Because if this, It’s to your advantage to be informed and on the lookout for symptoms to bring to your doctor’s attention.

What is OHSS?

OHSS is irritation of the ovaries that can happen when they are stimulated to produce a lot of eggs at once. OHSS is caused by high levels of estrogen in the bloodstream, which causes the ovarian blood vessels to become leaky to fluids. This means fluids leave the bloodstream and collect in the abdominal cavity.

Even though a woman with OHSS drinks plenty of fluids, she can become severely dehydrated. As a result, the blood becomes thickened leaving her at risk for blood clots in the legs and lungs.

What are the Symptoms of OHSS?

The symptoms of OHSS may be mild, moderate, or severe and usually begin four to five days following egg collection. The accumulation of fluid in the abdominal cavity can be very uncomfortable and cause bloating, sometimes breathlessness. In severe cases, the fluid enters the lungs and causes respiratory distress.

Mild OHSS

  • Mild abdominal pain
  • Abdominal bloating and weight gain
  • Mild nausea
  • Vomiting
  • Diarrhea
  • Tenderness around the ovaries

Moderate to Severe OHSS

  • Rapid weight gain
  • Severe abdominal pain
  • Persistent nausea and vomiting
  • Decreased urinary frequency
  • Dark urine
  • Shortness of breath
  • Tight and enlarged abdomen
  • Dizziness

Who is at risk?

Some women are more at risk than others of developing this complication. Women with polycystic ovaries are most at risk because they have many tiny follicles present that Respond to the stimulation medicine. Other women at risk are those who have a high number of antral follicles, high anti-mullerian hormone (AMH) levels, high luteinizing hormone (LH) blood level and high LH to follicle-stimulating hormone (FSH)ratio.

An individual’s risk should be assessed by a doctor ahead of starting an IVF cycle to adjust the starting dose of stimulation medication accordingly. Additionally, the doctor will do regular ultrasound scans of the ovaries during the stimulation phase and monitor the circulating estrogen levels as they rise.

If the blood estrogen level is rising too high or too quickly, the doctor can reduce the dose of FSH medication or “coast” the treatment by stopping the FSH injections for a few days. This will give the ovaries a break from being over-stimulated and help to reduce the chance of OHSS.

How common is OHSS?

Mild OHSS occurs in around 30% of all treatment cycles and is considered a normal side effect of ovarian stimulation for IVF. The symptoms are easily managed with over-the-counter painkillers, dietary changes, and increased fluid intake.

Severe OHSS affects around 3 to 8% of cycles and is managed well with medical help.

Clinical Treatment of OHSS

For more severe cases, the following may be required:

  • Cancellation of embryo transfer until a later date
  • Prescription anti-nausea medication
  • Drain excess fluid from the abdomen with a needle puncture, similar to an egg retrieval
  • Administer intravenous fluids

How can OHSS be prevented?

Prevention is better than cure, and your doctor should monitor the stimulation phase of the IVF cycle carefully. Ultrasounds and blood tests measure the ovaries’ response to the stimulation drugs.

The dose will be lowered if the estrogen levels become too high or you may take a break from injections for a day or two. It is better to start with a lower dose and add extra FSH during ovarian stimulation than start too high and be at risk for complications. If the ovarian response is extremely high the doctor might choose to cancel the cycle altogether and start again with a lower dose next time.

If you’re having the trouble, Dr. Ashish Kale will help you figure out why, and work with you to find a treatment that can help. He is one of the best Gynaec Endoscopy Surgeon, IVF Specialist in Pune & currently practicing at Ashakiran hospital which is one of the best Infertility Center in Pune.

Dr. Ashish Kale should be able to choose the best treatment regimen for you that minimizes the chance of complications while maximizing the treatment outcome.

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04 Dec

HIV And Pregnancy

A diagnosis of HIV does not mean you can’t have children. But you can pass HIV to your baby during the pregnancy, while in labor, while giving birth, or by breastfeeding. The good news is that there are many ways to lower the risk of passing HIV to your unborn baby to almost zero. Here are some questions related to HIV and Pregnancy.

1. What can I do before getting pregnant to lower my risk of passing HIV to my baby?
If you plan to become pregnant, talk to your doctor right away. Your doctor can talk with you about how HIV can affect your health during pregnancy and your unborn baby’s health. Your doctor can work with you to prepare for a healthy pregnancy before you start trying to become pregnant.

Everyone living with HIV should take HIV medicines to stay healthy. If you are thinking about becoming pregnant and are not taking HIV treatment, it is important that you begin, because this will lower your chances of passing the virus to your baby when you become pregnant.

There are ways for you to get pregnant that will limit your partner’s risk of HIV infection. You can ask your doctor about ways to get pregnant and still protect your partner.

2. I do not have HIV, but my partner does. Can I get pregnant without getting HIV?
Women have a higher risk of HIV infection during vaginal sex than men. If you do not have HIV but your male partner does, the risk of getting HIV while trying to get pregnant can be reduced but not totally eliminated.

Talk to your doctor about HIV medicine you can take (called pre-exposure prophylaxis or PrEP) to help protect you and your baby from HIV.

You may also want to consider donor sperm or assisted reproductive technology, such as semen washing or in vitro fertilization, to get pregnant. These options can be expensive and may not be covered by your health insurance.

3.I’m pregnant. Will my baby have HIV?
If you just found out you are pregnant, see your doctor right away. Find out what you can do to take care of yourself and to give your baby a healthy start to life.

With your doctor’s help, you can decide on the best treatment for you and your baby before, during, and after the pregnancy. You should also take these steps before and during your pregnancy to help you and your baby stay healthy.

Just because you have HIV doesn’t mean your child will get HIV. In the United States, before effective treatment was available, about 25% of pregnant mothers with HIV passed the virus to their babies. Today, if you take HIV treatment and have an undetectable viral load, your risk of passing HIV to your baby is less than 1%.

4. What can I do to lower my risk of passing HIV to my baby?
Thanks to more HIV testing and new medicines, the number of children infected with HIV during pregnancy, labor and childbirth, and breastfeeding has decreased by 90% since the mid-1990s.

5. Can I take HIV medicine during pregnancy?
HIV-infected pregnant women should take HIV medicines. These medicines can lower the risk of passing HIV to a baby and improve the mother’s health.

If you haven’t used any HIV drugs before pregnancy and are in your first trimester, your doctor will help you decide if you should start treatment. Here are some things to consider:

Nausea and vomiting may make it hard to take the HIV medicine early during pregnancy.
It is possible the medicine may affect your baby. Your doctor will prescribe medicine that is safe to use during pregnancy.
HIV is more commonly passed to a baby late in pregnancy or during delivery. HIV can be passed early in pregnancy if your viral load is detectable.
Studies show treatment works best at preventing HIV in a baby if it is started before pregnancy or as early as possible during pregnancy.
If you are taking HIV drugs and find out you’re pregnant in the first trimester, talk to your doctor about sticking with your current treatment plan. Some things you can talk about with your doctor include:

Whether to continue or stop HIV treatment in the first trimester. Stopping HIV medicine could cause your viral load to go up. If your viral load goes up, the risk of infection also goes up. Your disease also could get worse and cause problems for your baby. So this is a serious decision to make with your doctor.
What effects your HIV medicines may have on the baby
Whether you are at risk for drug resistance. This means the HIV medicine you take no longer works against HIV. Never stop taking your HIV medicine without first talking to your doctor.

6. Can I get help paying for care during pregnancy?
If you are pregnant, Medicaid may pay for your prenatal care. If you are pregnant and living with HIV, Medicaid might pay for counseling, medicine to lower the risk of passing HIV to your baby, and treatment for HIV. Each state makes its own rules regarding Medicaid. Contact your local or county medical assistance, welfare, or social services office to learn more. If you are unable to find that number, search your state’s department of health.

If you don’t think you qualify for assistance, check again. Sometimes states change their Medicaid rules. Under the Affordable Care Act, Medicaid eligibility expanded to cover many more people. Also, you may be newly eligible for Medicaid because of increased income limits for prenatal care and HIV treatment for pregnant women.

You may also access care through the Ryan White HIV/AIDS Program. Find a Ryan White HIV/AIDS Program medical care provider near you.

If you’re having the trouble, Dr.Ashish Kale will help you figure out why, and work with you to find a treatment that can help. He is one of the best Gynaec Endoscopy Surgeon, IVF Specialist in Pune & currently practicing at Ashakiran hospital which is one of the Best Infertility Center in Pune.

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28 Nov

Dr Ashish kale awarded the “IMA Dr. D.S. Munagekar Award”

Dear Dr. Kale,

Greetings from Indian Medical Association!

We are pleased to inform you that Indian Medical Association Awards committee has selected your good self for the “IMA Dr. D.S. Munagekar Award” under AWARDS GIVEN FOR RESEARCH Award for the year 2017-2018 in recognition of the services rendered by you.

The Award shall be conferred upon you during the ensuing IMA NATCON – 2018,  79th Annual Meeting of IMA Central Council to be held at Bengaluru,

Karnataka on 27th– 28th December 2018.

The Venue for Award Ceremony is Eagleton The Golf Resort, Bengaluru at 5 p.m. on 27th December 2018.

You are requested to kindly receive this award in person. A line of Confirmation in this regard will be highly appreciated with a copy marked to Dr. G.N. Prabhakara, Organizing Secretary, 93rd  Annual National Conference of IMA at Email: imanatcon2018@gmail.com & prabhakaragn@yahoo.com

Please note that TA/DA is not permissible to receive this Award as per the rules of IMA. Kindly arrange your travel for attending the Award Function.

Looking forward to your acceptance of Award and confirmation of Participation in the above function.

Yours Sincerely,

Dr. Ravi S. Wankhedkar                    Dr. R.N. Tandon

NATIONAL PRESIDENT, IMA        HONORARY SECRETARY GENERAL, IMA

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Male Infertility Treatment in Pune
19 Nov

6 Ways To Ensure High Success Rates For IVF

IVF Specialist in Pune Baner

For the average couple, the chances of getting pregnant are approximately 20% in any given month but couples who face fertility issues may have less than a 5% chance of conceiving without fertility treatment. Fertility treatments such as IVF (in vitro fertilisation) have become very popular as they can increase the chances of conceiving to as much as 40% of people who cannot conceive.IVF involves the extraction of eggs which are then fertilised with sperm in a specialised lab and the resultant embryos are then transferred to the woman’s uterus. There are several ways to increase the success rate of IVF treatments so that you get it right on the first go.

Natural Methods To Ensure High IVF Success Rates

Repeated IVF cycles are very stressful and can become quite a financial burden which is why fertility experts often recommend that couples take steps to increase their chances of a successful IVF cycle. Here are 6 simple ways to increase your chances of conceiving through IVF.

1. Reduce Stress Levels

IVF is an effective infertility treatment but the procedure involves blood tests, daily hormone injections, egg retrievals, and multiple cycles which can be a source of emotional upheaval and stress, especially for the woman. However, high levels of stress can reduce fertility levels as studies show that women with high stress levels have a 2-fold increased risk of infertility and would, therefore, have lower IVF success rates as compared to other women. It is not possible to completely eliminate the stress of infertility and IVF cycles but reducing stress levels will go a long way in increasing the chances of a successful IVF cycle. Meditation or simply relaxing while listening to soothing music for 30 minutes at the end of the day will help to lower stress levels and can improve IVF success rates.

2.Reach Your Ideal Weight

Obesity and weight gain have been linked to several health problems including lower fertility levels. Studies show that the probability of pregnancy is reduced by 5% per unit of BMI exceeding 29 kg/m2 while animal tests show that obesity could cause a decrease in pregnancy rates of up to 60%. Excessive body weight disrupts a woman’s hormonal balance which increases her chances of irregular periods and reduces her fertility levels. Fertility experts also point out that obesity raises a woman’s risk of premature delivery, miscarriage, and stillbirth which is why it is best to have a healthy body weight before starting IVF treatments. A woman should follow a healthy diet and exercise routine and aim for herideal weight for IVF success – which is between 19 and 25.

3. Avoid Heavy Exercise

Light exercise on a regular basis can help to improve fertility levels but strenuous or heavy exercise can reduce fertility levels. This is why fertility experts warn women to avoid high-intensity workouts while they are undergoing IVF treatments. Studies show that women who indulged in 4 hours or more of high-intensity exercise over a prolonged period are 40% less likely to have a live birth. Furthermore, women who exercise that much are also twice as likely to have an implantation failure and so doctors advise women undergoing IVF treatments to switch to low-intensity exercises such as walking or yoga.

4. Give Up Alcohol 

Ideally, both partners should give up alcohol completely. Even moderate amounts of alcohol can affect fertility while excessive amounts have been proven to negatively affect sperm quality. Consumption of just 4 alcoholic drinks a week has been associated with a decrease in IVF live birth rates. The odds of a live birth are reduced even further if both partners consume alcohol regularly. This also applies for people who smoke or consume tobacco products.

5.Practice Yoga

Yoga for IVF success has gained recognition only within the last decade. Studies show that yoga increases the success rates of ART (Assisted Reproductive Technology) treatments such as IVF by improving the physiological and psychological states of both partners. Practising yoga on a regular basis reduces depression, anxiety, and stress and can also help to increase blood flow to the reproductive organs, thus improving the chances of a successful IVF cycle.

6.Moderate Ejaculation Frequency

Men are advised to refrain from sexual intercourse and masturbation for approximately 3 days before their semen sample is required. This can help to increase sperm count and increase the chance of a successful IVF procedure. Men are not advised to abstain from ejaculation for prolonged periods as studies show that this can impact sperm health and reduce the mobility of sperm.

Fertility rates and IVF outcomes are also affected by unhealthy lifestyle choices such as smoking and drinking. It is important for both partners to abstain from such habits in order to optimise their chances of a successful IVF cycle.

If you’re having the trouble, Dr.Ashish Kale will help you figure out why, and work with you to find a treatment that can help. He is one of the best Gynaec Endoscopy Surgeon, IVF Specialist in Pune & currently practising at Ashakiran hospital which is one of the Best Infertility Center in Pune.

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01 Nov

Polycystic Ovarian Syndrome: Understanding The Causes, Symptoms & Treatment

IVF Specialist in Pune

What is Polycystic Ovary Syndrome (PCOS)?

Polycystic ovary syndrome (PCOS) is a health problem that can affect a woman’s hormones, menstrual pattern, ability to have children and appearance. Women with PCOS, typically have high levels of androgens (male hormones), which lead to many small fluid-filled sacs in their ovaries. About 20% of women of childbearing age suffer from PCOS.

What causes PCOS?

The cause of PCOS is unknown. But most experts think that several factors, including genetics, could play a role. Women with PCOS are more likely to have a mother or sister with PCOS.

A main underlying problem with PCOS is a hormonal imbalance. In women with PCOS, the ovaries make more androgens than normal. Androgens are male hormones that females also make. High levels of these hormones affect the development and release of eggs during ovulation.

It is also thought that insulin may be linked to PCOS. Insulin is a hormone that controls the conversion of glucose and other food into energy. Many women with PCOS have too much insulin in their bodies because they have problems using it. Excess insulin appears to increase production of androgen. High androgen levels also lead to acne, excessive hair growth, weight gain and problems with ovulation.

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What are the symptoms of PCOS?

The symptoms of PCOS can vary from woman to woman. PCOS is the most common cause of female infertility. This is because of problems in ovulation. Infrequent, absent, or irregular menstrual periods are also common Hirsutism which is increased hair growth on the face, chest, stomach or back occurs because of increase in male hormones. This is usually treated with Laser hair removal and creams. Acne and oily skin also occur due to the same reason. Women with PCOS generally tend to put on extra weight.

How is PCOS related infertility treated?

  • Lifestyle Modification: Many women with PCOS are overweight or obese, which can cause health problems. You can help manage your PCOS by eating healthy and exercising to keep your weight at a healthy level.
  • Supportive Medications: The medicine metformin is used to treat type 2 diabetes. It has also been found to help with PCOS symptoms, though it isn’t approved by the U.S Food and Drug Administration (FDA) for this use. Metformin affects the way insulin controls blood glucose and lowers testosterone production. It slows the growth of abnormal hair and, after a few months of use, may help ovulation to return. Recent research has shown metformin to have other positive effects, such as decreased body mass and improved cholesterol levels.
  • Fertility Medications: Lack of ovulation is usually the reason for fertility problems in women with PCOS. Several medications that stimulate ovulation can help women with PCOS become pregnant. Treatment options include :
  •  Clomiphene – The first choice therapy to stimulate ovulation for most patients.
  • Metformin is taken with clomiphene – Maybe tried if clomiphene alone fails. The combination may help women with PCOS ovulate on lower doses of medication.
  • Gonadotropins – Given as injections if the ovaries do not respond to tablets.
  • Laparoscopic Ovarian Drilling: This is a procedure that may increase the chance of ovulation. It’s sometimes used when a woman does not respond to fertility medicines. This surgery can lower male hormone levels and help with ovulation. These effects last a few months.
  • In-Vitro Fertilization (IVF): IVF offers the best chance of becoming pregnant in any given cycle. It also gives better control over the chance of multiple births.

If you’re having the trouble, Dr.Ashish Kale will help you figure out why, and work with you to find a treatment that can help. He is one of the best Gynaec Endoscopy Surgeon, IVF Specialist in Pune & currently practising at Ashakiran hospital which is one of the Best Infertility Center in Pune.

By Asha IVF Center, Gynaec Endoscopy Surgeon in Pune, Infertility Center in Pune, IVF Specialist in Pune, Women's Clinic , , , , , , 0 Comments
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14 Sep

UPA after IVF failure

Ulipristal acetate (UPA) for fibroids–IVF outcomes following treatment with UPA after IVF failure:
series of 2 case reports

Asha Kiran Hospital, Nursing home, and IVF Centre, Pune, Maharashtra, India

INTRODUCTION

The failure to become pregnant after assisted reproductive techniques depends upon but is not limited
to the ability of the embryo to implant and attach itself to the healthy endometrium. One of the commonest reasons why this can be hampered is the presence of uterine fibroids, particularly sub-mucous and intra-mural ones. The distance between the fibroid and the endometrial cavity is the main
factor which decides the impact on implantation and successful pregnancy outcome. Along with the
distance from cavity, the size and number are also important. Even after conception, a pregnancy with
a uterine fibroid is considered as a high-risk pregnancy.

There is an increased rate of complications such as miscarriage, preterm birth, degeneration of
fibroid, etc.

The factors predisposing to uterine fibroids include age, African ancestry, obesity and nulliparity
. Although studies performed to date have extended our knowledge of fibroid pathology, their Etiology has not been fully elucidated. With an increasing population of sub-fertile and infertile
women, the incidence of fibroid is increasing manifold. They are often even seen as an incidental diagnosis in these group of women, who are routinely subjected to an ultrasound screening
before deciding the modality of treatment. Here, we report a case series of 2 women, with fibroids,
who were put on UPA prior to IVF. These women had at least one previous IVF failure.

Uterine fibroids are present in approximately 70% and 80% of 50-year-old white and black women,
respectively.

4 Common symptoms include heavy menstrual bleeding and subsequent anemia, pelvic pain, dysmenorrhea, decreased quality of life, and reproductive dysfunction.

The optimal treatment for patients with symptomatic uterine fibroids and pregnancy desire remains
unknown. It has been reported that myomectomy may improve fertility outcomes in women with
submucosal and intramural fibroids. Nevertheless, there is still insufficient evidence from randomized
controlled trials to establish the effect of myomectomy to improve fertility.

4 On the other hand, current evidence is still insufficient to establish whether radiologic procedures represent a valid treatment option for women with symptomatic fibroids who want to preserve their fertility

Alternative medical therapies have limitations and are not considered a valid fertility-preserving
treatment option. Uterine fibroid growth depends on the ovarian steroids estrogen and progesterone. Accordingly, oral progestin may promote fibroid growth and induce abnormal bleeding. Although the progestin-releasing intrauterine device would control heavy menstrual bleeding, it is hardly ever used in women with a deformed endometrial cavity by submucosal fibroids and also prevents pregnancy if used.

Therefore, the mode of management of fibroids in women who desire pregnancy depends on the size,
number and location of uterine fibroids. The mainstay of management remains the surgical approach
when indicated.

5 Further on, the results of studies conducted by Lai et al, Noor et al and Eze et al support the
need for treating uterine fibroids before planned pregnancy to minimize the risk of complications described
above.

6-8 There are convincing data that progesterone and its receptors increase the proliferation activity of
the cells in uterine leiomyomata, hence treatment with anti-progestins and progesterone receptor modulators seems to be reasonable 3,5.

Results of a successfully completed phase III clinical trials with the application of ulipristal acetate
(UPA) (first-in-class selective progesterone receptor modulator–SPRM) have been published recently.

UPA is a selective P receptor modulator (SPRM) that potently modulates P-receptor
activity with proapoptotic/antiproliferative effects on fibroid cells and with pharmacokinetic
properties supporting once-daily dosing. Two short-term (3 months) randomized clinical trials
showed that UPA effectively controls HMB and shrinks fibroids.9,10 After treatment cessation,
menstruation usually returns within 4-5 weeks, but fibroid volume reduction can be sustained for up
to 6 months.

Administration of 5 mg or 10 mg UPA daily has been shown to rapidly stop (within a week) excessive
uterine bleeding, reduce the volume of the three largest fibroids by -44.8% and -54.8% for UPA 5 mg and 10 mg, respectively. The effect on fibroid volume has been observed for up to 6 months after treatment cessation.

It is also important that UPA restores patient Quality of Life scores to the level of healthy women and in the majority of patients resume menstruation and ovulation within one month after treatment cessation.

When compared with the Gn-RH agonist (leuprolide acetate), UPA has controlled uterine bleeding faster and more consistently (7 days vs. 30 days), fibroid reduction  for up to 6 months has been smaller for Gn-RH a (-16.5%) and UPA has shown a superior safety profile as estradiol levels are maintained in the mid-follicular range.

The presented results on the application of UPA in the medical treatment of symptomatic uterine
fibroids are very promising and gynecologists are given a new treatment option.

Ulipristal treatment has not shown any adverse effect on the quality of embryos in the morphological assessment during the ICSI procedure. Pregnancy does not induce changes in fibroid size following earlier treatment with ulipristal acetate.

However, since UPA exerts mainly antiprogestogen effects on the endometrium, whether the ART
protocols have to be modified, need further studies.

Also, in the studies so far, it has been observed that the effect of UPA is best-seen up to 6 months
of cessation of the drug. Therefore, for women who require ART, it should be planned within this
time frame.

Although larger and randomized control studies are required to further reinforce the fact,
treatment of uterine fibroids is a promising treatment modality before planned pregnancy to improve
fertility, enhance ART results, and to minimize the risk of obstetric complications.
Below we report 2 cases of pre-IVF Ulipristal, where uterine fibroid shrinkage was seen enabling
ART without prior surgery for fibroids.

CASE REPORT

Case 1

A 31-year-old woman with primary infertility presented to us following one failed IVF cycle done
outside 1 year ago for unexplained causes. With us, the couple infertility work-up revealed normal
the study, except multiple uterine fibroids, which probably grew during the past 1 year when she did
not seek any treatment.

The couple was counseled regarding the impact of cavity distorting, as well as the peripheral
intra-mural fibroids. Both options were offered-laparohysteroscopic myomectomy and Ulipristal
Acetate for 3 months. Not wanting to undergo surgery, the couple chose to take the medical
management.
The woman was put on 5 mg daily dose of Ulipristal acetate for 12 weeks. A fibroid mapping was
repeated after 12 weeks of UPA therapy. The comparison of fibroids pre and post UPA are tabulated
in Table 2.
To enable a better comparison of the pre and post UPA effects on fibroids, a fibroid mapping, and a
sketch was done. The sagittal uterine sketch of the fibroids, pre, and post-UPA is shown in Figure
1. After the UPA therapy cessation, she was taken for an IVF in the immediate cycle. 8 oocytes were
retrieved, and 6 fertilized – 3 Grade A, 2 Grade B and 1 Grade C. A fresh embryo transfer was done
of the 2 Grade A embryos.
The beta hCG value on Day 16 was 1600 mIU/mL. A single viable intra-uterine gestational pregnancy
was documented at 6 weeks, which was followed upto 9 weeks, and is ongoing till submission of this
paper.

Case 2 :

A 26-year-old lady with primary infertility. She had 2 failed IVF cycles-one done outside, and one
with us. There was no obvious cause of infertility except multiple fibroid uterus, of which 2
fibroids were indenting the endometrial cavity. The woman was firmly against surgery – we had tried
to convince her prior to our 1st IVF cycle too.

The fibroid mapping, case 2, has been tabulated in
Table 3. Having refused surgery strongly, before going ahead with the 2nd IVF cycle, we offered her
UPA with an aim to shrink the fibroids, and improve the distorted cavity. She was also counseled
that the isthmic fibroid, which abutted against the endometrial cavity, may cause difficulty while
performing the embryo transfer.

Not wanting to undergo surgery, the couple chose to take 5 mg daily dose of Ulipristal acetate for
12 weeks. A fibroid mapping was repeated after 12 weeks of UPA therapy. The comparison of fibroids
pre and post UPA are tabulated in Table 4.

The sagittal uterine sketch of the fibroids, pre and post UPA, for case 2, is shown in Figure 2. We
had frozen embryos from her previous IVF cycle, and a FET was performed after a good lining was
formed. Her beta hCG was positive on day 16, and a TVS at 6 weeks showed a single viable intra–
uterine gestation, which has been carried till 14 weeks, when this article

In infertile women, appropriate evaluation and classification of fibroids, particularly those
involving or suspected to be involving the endometrial cavity is essential. Our findings support
UPA as an efficient and safe treatment to reduce the size of uterine fibroids. However, its
shrinkage effect involves also the small myometrial myomas that distort uterine morphology, and the
proven restoration of uterine anatomy maximizes the chances of a successful IVF.

Further studies are needed to clarify

• The role of UPA in IVF candidates
• Whether such a medical management could avoid surgical procedures
• Whether there are specific cases of uterine leiomyomatosis (localization, dimension, number of
fibroids) that would be eligible to the sole medical treatment with UPA
• Any detrimental effect of UPA on endometrial phase hampering IVF response.

was submitted. The pregnancy is ongoing and uneventful so far.

CONCLUSION

Although there is currently insufficient evidence to recommend medical treatment in the management of fibroids, UPA seems to be a novel and promising option, especially for infertile women who refuse to undergo surgery inspite of the fibroids distorting the cavity, and for those with fibroids who shall undergo IVF.
It has shown future promise in our small case series, however further, well designed RCTs are needed. Although no pregnancy-related complications or teratogenic effects have been reported to date, further series are required in order to establish the safety of ulipristal acetate as a treatment of symptomatic fibroids prior to IVF and pregnancy.

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