The gynae talk | Dr Priyanka Singh Vasam | Swaasa Podcast
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Title: The gynae talk | Dr Priyanka Singh Vasam | Swaasa Podcast
Author Name: Swaasa
Description: Are regular periods a guarantee of fertility? Does IVF always lead to pregnancy? And is infertility only a woman's problem?
In the first episode of Her Health, Unfiltered by Swaasa, we speak with Dr. Priyanka Singh Vasan about fertility myths, PCOS, menstrual health and the women's health questions many people hesitate to ask.
Meet our guest
Dr. Priyanka Singh Vasan is an Obstetrician and Gynaecologist specialising in infertility and reproductive medicine. She is the Co-founder and Director of Radiance Specialty Clinics, Bachupally, Hyderabad.
She holds an MBBS and MD in Obstetrics and Gynaecology, along with fellowships in Reproductive Medicine and Gynaecological Endoscopy.
What we explore in this episode:
Menstrual health, regular periods and reproductive health
PCOS/PCOD and its relationship with fertility
Common myths about infertility and IVF
Male fertility and why reproductive health concerns both partners
Age, egg quality, lifestyle and fertility
When to consider professional fertility advice
Her journey as a gynaecologist, infertility specialist and clinic co-founder
This is an open, informative conversation about understanding your body, questioning common misconceptions and feeling more comfortable discussing women's health.
Watch, learn and join the conversation.
Subscribe to Swaasa for more healthcare conversations, expert insights and accessible health education. Share this episode with someone who may find it useful.
Disclaimer: This episode is for general educational purposes only. It is not a substitute for individual medical advice, diagnosis or treatment. Consult a qualified healthcare professional for advice about your personal health concerns.
Transcript:
(00:00) So, let's talk about most trending and interesting topic on internet, egg freezing. >> But freezing of egg doesn't will guarantee you with a live birth. [music] To be honest, now in India after surrogacy act, they have strictly mentioned in that act that >> Do you think unnecessary C-sections are increasing nowadays? >> Because they want to deliver their baby according to a auspicious [music] date and auspicious time.
(00:30) That is known as Muhurtham section. >> How do you decide when a couple needs IVF or IUI? >> And in cases [music] of unexplained infertility where every report seems fine, but they are they are difficult to conceive. >> Do sanitary [music] pad brands hide the potential risk? >> Definitely, because in sanitary pads also there are many >> Why is female sexual health is not discussed openly even on medical settings? >> Even though we [music] have a doctor friend also, but nobody think about discussing about the sexual health.
(01:07) Because [music] they have that misconception, to be honest, that >> Hi everyone, welcome to Swasa podcast, the fertility talk. Real questions, real answers, no awkwardness. Today we are joined by Dr. Priyanka Singh Vasam, the obs gain with 5 plus years of experience and 2 years of experience in infertility care.
(01:37) And she's also the founder of Radiant Specialty Clinic, Bachupally. Dr. Priyanka, welcome to Swasa podcast. >> Thank you. >> How are you doing? >> I'm doing great. >> You're not just an obs gain, you're managing a lot. How are you managing all at a time? >> Uh so, this is a very good question to be asked.
(01:57) Like I'm managing obstetrics and Gynaec plus fertility specialist. See both our branches are different. Obstetrician, as an obstetrician if I look, so I have to deliver baby. I have to optimize my time. And I have to give a lot of efforts because it's because we have emergency cases in Obstetrics and Gynaec. Now coming to a fertility thing, fertility usually takes it's not a one day program.
(02:26) It takes a lot of efforts. [snorts] It takes lot of time. And we have to study the patient day by day. Managing a fertility patient is a big challenging thing than managing a obstetric patient. Obs In Obstetrics, the patient comes us for delivery. They already have a baby. But here in fertility things, we have to start we have to uh make them ability to achieve pregnancy.
(02:59) So that holds more importance. So being both, definitely, but now I have chosen my path towards more of fertility because it's quite challenging. And now there are many reproductive advances which have come such as reproductive genetics, embryology, and assisted reproductive techniques which make it and every patient of fertility is different.
(03:25) And there are lot of challenges we have to face day by day. So I prefer more being called as a fertility specialist now. Yes, I'm obstetrician also, but now I have taken one step back for obs as an obstetrician, but now I'm more towards fertility. >> Okay. So how do you choose to be a Gynaec and the specialization in reproductive medicine.
(03:53) >> Okay. So, to be honest, this fertility and reproductive medicine is truly special for me because it deals with advanced medical science. With it helps couple to achieve pregnancy and to have a babies. So, during my post graduation day when I joined as an obstetrician, I really uh realized that it's delivering babies is wonderful job.
(04:27) But, to help a couple to achieve a pregnancy, it's quite meaningful. And every fertility patient is different. The treatment, the protocols, everything is different. And every patient is a challenging patient. To be honest, I really enjoy to be a fertility medicine specialist. >> So, when a couple walks into your clinic, what is the biggest or most common misconception they have? >> So, the whenever a patient comes to my Radiant Specialty Clinic, the biggest misconception they have is like, "Doctor, [clears throat] I am not able
(05:07) to conceive." And that is a question which is raised by a woman though both person walk to my clinic. Both male and female partners. But, the female is more curious to know why I'm not getting pregnant. Is there a problem in myself? But, I usually evaluate both at the same time. First, definitely, I start with a female.
(05:36) I take a detailed physical history. I evaluate her. Then, but I never miss a chance to evaluate a male partner, also. And to be honest, infertility, it is not always a female factor involved. Males factor is also equally responsible for seeking the fertile. So, there is a misconception that only female is required to have a fertility.
(06:03) No, both are equally responsible. >> So, what is the perfect age or a healthy age for a woman to conceive? >> To be honest, it starts after the age of 20. Where definitely in some rural areas, they get married early. So, definitely they want after marriage, many women want to conceive at early age.
(06:32) So, for them, obviously a fertility is never an issue. But, coming to the urban areas, where the career growth opportunity for them, this is first like they want to achieve more. So, for them, having a child takes a back step. First, they want to settle in life. So, my knowledge, a woman should conceive before the age of 34. If she has a lot of undergoing problems, first at least she should meet a fertility specialist and get herself evaluated.
(07:08) With because there is one test that is known as AMH, that is anti-mullerian hormone test. Which helps to know us the con It is a quantitative test which helps us to know the egg reserve. But, that doesn't mean that AMH is good that she can have a healthy pregnancy. No, it is just a quantitative test which helps us to know the quantity of eggs, but it doesn't predict us the the quality of eggs.
(07:35) So, that is a major role. Ideally after 35 years, the ovarian aging starts. There's more risk of aneuploidy and chromosomal abnormalities. So, to be honest, she should approach a fertility specialist before she turns 34. >> Mhm. Okay, so what about male? Like, what is the right age for a male? >> honest, in females and males have completely different to be assessed as per the age.
(08:10) In males, like, they it depends purely on the sperm concentration. If you have a normal semen parameters, it's good to conceive for a female. But, if the husband or the male partner, if he is more into habitual things such as alcohol, smoking, there's occupational stress, he's exposed to the anabolic steroids.
(08:38) So, for these male partners, it will be very difficult to get their partner in pregnancy. So, there's not a right age for the male factors, but yeah, above 50 years, to be honest, there can be certain changes in the semen parameters. So, it all depends upon first line of investigation, that is semen analysis test for males.
(09:09) >> So, let's talk about most trending and interesting topic on internet, egg freezing. So, nowadays we are hearing a lot about egg freezing. And what do you think is the right age for a woman to do egg freezing? >> Okay. So, for egg freezing, usually ideally the age is between 20 and 30 years. Since now the egg freezing has become a trending topic on social media.
(09:39) Usually, ideally, female actress and all were planning to get because they have some career to be followed, and then they will try to plan their pregnancy. But now, these days, since it has become a trending topic, most like unmarried females, because of their career and their opportunities on the way, they want to come to the clinic and get their eggs freeze as soon as possible.
(10:09) But egg freezing does not guarantee that you will have a healthy pregnancy later. >> [gasps] >> You can just because 20 and 30 is the It is the ideal reproductive age, where the quality of eggs are good. So, at that time, we can just retrieve the eggs, and these are usually unfertilized eggs, which are kept in the lab.
(10:36) Once she has achieved her career opportunities, she has found her partner, then obviously, we match the semen with it, and then this unfertilized egg are fertilized, and then they are transferred to the back to the female as an embryo. But this egg freezing, it is also involves major injections, hormonal treatment, repetitive scans.
(11:09) And that is more concern for any young female. Ideally, egg freezing can be done to a patient who are undergoing some before chemo and radiotherapy. For them, because since after chemo and radiotherapy, it can hamper their egg quality. So, to prevent those, eggs freezing can be suitable for these cancer patients also.
(11:37) Young females and to those who have to undergo some pelvic surgeries later because of some pathology such as endometriosis, some fibroid conditions which can hamper their ovary ovary reserve and quality. >> That's so great, actually. I never knew about egg freezing. And most of the things that I'm seeing in internet that egg freezing might be not suitable for everyone.
(12:11) Is it true or >> Egg freezing, it depends upon the medical condition of the woman or the girl. First whenever she comes to me in my Radiance Specialty Clinic, any woman or any girl, first I have to assess her. Based on her on her history, her hormonal evaluation, her ultrasound scan, then only I can comment upon that she should undergo any egg freezing because every woman, every girl, they have a different body, different body, different changes are there, hormonal
(12:55) changes especially. So, there can be a drastic hormonal issues. In one female, the another female can be completely all right to undergo egg freezing. So, everything depends upon their hormonal assessment, their history, and evaluation. Depending upon that, only I can tell them to freeze their eggs.
(13:20) But freezing of egg doesn't as I said, it will guarantee you with you with a live birth. You are just freezing your eggs for the future use. But definitely if you are planning to get pregnant with using those eggs, it should be before the age of 34. As after 35, there can be hormonal drastic changes. Maybe your body would not be ideally taking up those eggs because we have to at uh transfer the embryo in your uterus.
(13:58) Your uterus also needs to be healthy at the same point of time. So, definitely the age 20 and 30 is suitable. But I prefer to be done before age of 34 as earliest as possible egg freezing. And this >> Uh so, is is it possible if a woman who freeze her eggs and use surrogacy after her that fell like she uses a girl or a woman who is in a healthy age like 20 to 30.
(14:32) Is it possible that way? >> To be honest, now in India after surrogacy act that is in 2021, they are strictly mentioned in that act act that of if there is any medical condition to a female, if she is not suit like if she has undergone previously hysterectomy hysterectomy means removal of the uterus or if there is some problem with underlying pathologies there, any big medical condition is there, then only she can opt for surrogacy.
(15:07) Now the surrogacy is not, you know, like you are doing your egg freezing and then you are opting for surrogacy. This is not done in India. In India now the rules have changed. It all depends upon your medical and surgical conditions. Then only you can plan for surrogacy in India. >> All right.
(15:34) That's a great to know because most of the young women they don't know anything about egg freezing. So, is there any specific medical tests a woman should do before freezing her eggs? >> See, whenever a patient or any girl or woman comes to me in my reading specialty clinic, firstly after the history, I usually tell them to do some hormonal test at the day of their day two of menses.
(16:03) Because that is the ideal time where I can concentrate on some hormones such as follicular stimulating hormone is there, luteinizing hormone is there, the estradiol levels, then her prolactin levels, her thyroid levels. So, to be honest and most important that anti-Müllerian hormone, that is AMH test.
(16:28) Because that it gives me a quantitative test about their fertility. Rest are hormonal evaluation, but based on those hormonal evaluation, I would get to know about these patient whether they are suffering from any hormonal changes in their body because now many girls and women are getting uh PMOS. PMOS is nothing but poly multifactorial ovarian uh disease.
(16:57) So, now it is a multifactorial disease. So, there are it makes a body to undergo some hormonal changes. There is rise in the luteinizing hormones. There is a shift of completely the hormonal transition is there. The woman can have thyroid issues, prolactin disorders, which is known as hyperprolactinemia. So, first we have to assess all the hormones.
(17:27) Based on their hormonal test, I can then do a ultrasound scan, in which I'll come to know about their uterine pathology, about their ovaries, about the fallopian tubes. And based on those all hormonal test and ultrasound evaluation, then can then only I can assure them about their future pregnancy. >> How do you decide when a couple needs IVF or IUI treatment? >> Okay, so this is a very good question.
(17:56) So, whenever a patient comes to my reading specialty clinics after detailed history and evaluation, firstly, for an IUI, that is intrauterine insemination, there are certain factors which is needed. First, there should be adequate ovarian reserve. Second, there should be at least one fallopian tube patent. And there there should be a good semen analysis report with good semen parameters.
(18:28) And if a male factor is there, if they have sperm concentration with that is around 10 million per ml. So, for them, ideally we can tell them to undergo intrauterine insemination. And in cases of unexplained infertility, where every report seems fine, but they're is a difficult to conceive. To those patient, intrauterine insemination can help.
(18:56) But in the case of IVF, that is in vitro fertilization, it works on those patients and couples where the female factors are involved, such as there's blocked fallopian tubes. They have undergone previous surgery history such as endometriosis or other pelvic pathologies. Any medical condition is there. So for them uh this all fact female factors play a role.
(19:31) For male, if they are having sperm concentration that is less than uh 5 million per ml or they are having severe oligoasthenoteratozoospermia, mean there is abnormal sperm concentration and abnormal forms of sperm. So for them, in vitro fertilization actually helps. >> So there are many options like IVF, IUI, egg freezing and all.
(20:01) So what are the difference between all these? >> So intrauterine insemination. So it is a very simple process where uh uh semen is collected. Then after collection of these semen the motile sperm is taken and it is directly injected in the uterus at the time of ovulation. So this is known as intrauterine insemination. Second, IVF.
(20:30) That is in vitro fertilization. It requires a controlled ovarian stimulation. Then there are hormonal injections given, repetitive ultrasound scans done. Then at the time of when the these uh follicles they mature, then we give a trigger injection. Then there is a ovum pickup date posted where we retrieve those eggs and we send it directly to the lab to the embryologist where they have a look on these eggs.
(21:04) So and these eggs are grown in the lab. This is known as in vitro fertilization. Now coming to ICSI, that is intracytoplasmic sperm insemination. Where usually the sperm, it is collected and then the a good motile sperms, they're directly injected to these eggs af- after the ovum pick up and then these eggs are then fertilized.
(21:36) Egg freezing means these unfertilized eggs are freeze, which can be used for future. And embryo freezing means where we are already we have fertilized these eggs and they form a embryo, but they are freeze and at the ideal time we insert these embryos back to the patient. So this is known as embryo freezing.
(22:01) >> And that's so good. And what is the biggest misconception of IVF? >> The biggest misconception of IVF, whenever a patient comes to me in my Radiant Specialty Clinic, >> [gasps] >> they tell what is the problem in me. I want to straight away go for in vitro fertilization because I have studied uh a lot about it on social media.
(22:28) I've done a lot of research and for me body IVF is a very suitable method. To be honest, we need to actually under- make couples understand there's certain factors which is involved in in vitro fertilization. Firstly, after your detailed history and examination, after your hormonal evaluation, then only I can comment whether you have to go in in vitro fertilization or not.
(22:57) Firstly, I need to see your hormonal test, your ultrasound, what are these reports predicting? Then only I can suggest you to go to IVF, because there are certain fertility treatments which are available. It is not all options are not towards IVF. With certain because some patients they have just hormonal imbalance, they have only ovulatory dysfunction.
(23:24) With like they have ovulatory dysfunction, then we can do some ovulation induction that where we only give a ovulation induction drugs, which is only for period of 5 days. Then after once after 14 days, we check for ovulation and we tell them to have a timely intercourse. That we can be done based on their like semen parameters.
(23:51) If it is the count, sperm concentration count is above 10 million per ml, we can tell them to go for intrauterine insemination also. So, to be honest, after if the ovulation induction protocols they don't work on the body, if intrauterine insemination is also not working, then the la- that also after five to six cycles, then to be honest, we can think about IVF.
(24:21) But IVF will be a very last approach. First, we can uh based on the hormone and some patient can easily get get pregnant with some hormonal evaluation also. Just they need to have some supplements which can help them to conceive. >> Okay. So, when is the when will you decide when a patient or a couple needs this treatment? So, >> To be honest, a patient uh which who requires IVF, if they have failed three four cycles of ovulation induction, Three, four cycles of intrauterine insemination. They are having blocked
(25:03) fallopian tubes. There are some pelvic surgeries which are done previously. There is a condition known as endometriosis which affects the adjacent reproductive organs. It usually affects pelvis also. So, these conditions and some medical conditions where it is very difficult for the patient to conceive. And some uterine anomaly.
(25:30) These all factors usually decide whether the patient should undergo IVF treatment. And in male factor, definitely the semen parameters still hold the first line of investigation. If their semen parameters are not in the within the normal range, then obviously we have to suggest them to undergo IVF. >> Okay. So, when is a surgery is needed in a fertility treatment? >> A surgery if it has affected the all the adjacent organs which are near the uterus, such as ovary, bowel, bladder, and it's
(26:15) it's diminishing the ovarian reserve. So, only that the age age plays a major role to decide whether the patient has to undergo first the surgery and then the treatment. If there is a advanced age, her ovaries are diminishing. And her all the pelvic adjacent organs are are getting deteriorated which can hamper the egg quality.
(26:43) Then definitely she should undergo surgery first and then take the IVF treatment. But in other situation, if uh it does is not happen hampering the quality of the egg. Not affecting the ovarian reserve. So we can offer IVF first and then undergo surgery later also. >> So what is the weirdest case you have ever treated? >> The weirdest case I've ever treated is a patient came to me in my leading specialty clinics.
(27:23) Her all It was a case of unexplained infertility. Her I did a whole hormonal evaluation. It seems out to turn normal. I did her ultrasound sonography. All adjacent organs seems normal. Her fallopian tubes were normal. Her uterus was normal. There was no any pathologies detected. Then I evaluated her based on her hormonal assessment.
(27:55) Everything turned out to be good. Coming to the male factor, male also all semen parameters were normal. And to be honest, only the problem was her with was AMH. Ideally AMH is a quantitative test which tells about the maturity of the eggs. Okay, so her AMH was quite low. Quite low and it was around zero. To be honest.
(28:24) Then also, to be honest, as a fertility specialist, I would tell you go for a first line of treatment to go is for IVF. But couple were not happy with the word in vitro fertilization. They don't wanted to unless they wanted to seek first some medical treatment. So okay, I approached them for a medical fertility treatment.
(28:52) Two times it failed. The third time she became pregnant. But the her a beta hCG value was also quite high. But the pregnancy was outside the uterus. That was inside the fallopian tube. That is known as ectopic pregnancy. She got operated for the ectopic pregnancy. Now, I don't have a chance also to get her tell her to have a basic medi- fertility treatment that is ovulation induction drugs. I can't tell her to have that.
(29:27) Because now one side tube is removed. The right side tube is already gone. If I tell her to go to intrauterine insemination, ideally it can be happen only through left side of the tube. Ideally, I have to inject the sperm into her uterus. But the sperm will decide from which side it has to go. So, I can't take that risk also.
(29:54) But it will be night 80% can show failure also. Then also, ideally I told patient to wait for 3 months. After 3 months, we'll see what's to be done. To be honest, in these 3 months but I told her to have a normal uh nutritional supplements to be continued. Whatever I have given you previously. And be stress free. Since the patient knew her condition, so now she stopped thinking and worrying about being pregnant.
(30:27) And after 3 months, I got a call on a specific date in morning hours and she told I did missed my periods. I did my urine pregnancy test and came out to be positive. So, on that day for me, first I did her beta hCG levels. I checked, so it was high. Then I told her recommended her to go for a ultrasound scan.
(30:54) The scan showed a positive intrauterine pregnancy. So, it was big achievement for us. A patient having AMH of zero, where the pregnancy is very impossible. It was just a miracle, to be honest. And now she is 6 months pregnant. >> Wow. >> So, it's a big achievement because a patient where she had to go IVF, but the couple was not ready for IVF.
(31:27) Then also they opted for a natural pregnancy and she got pregnant having only one tube and AMH zero. So, this is the most weirdest case where I was going to plan for a in vitro fertilization for her, but naturally she conceived. And she's doing well. And her baby. >> That's really a miracle. Do you think unnecessary C-sections are increasing nowadays? >> Oh.
(31:55) Yes, definitely. Now C-sections are emerging as a very trending topic on social media also. Like people are more opting towards C-sections because they want to deliver their baby according to a auspicious date and auspicious time. That is known as Muhurtham sections. So, since nowadays in no female wants to undergo a natural labor, which because there's a myth going around because you'll get a lot of pain.
(32:29) Unnecessarily a doctor makes you wait in a labor room for more than 12 or 14 hours. Once because to be honest, it is a very stressful condition for an obstetrician, also. If a patient is going into labor for 12 to 14 hours, a doctor also has to be there. They forget that. They only think that my my wife is there in the labor room for next 12 to 14 the doctor is still monitoring the baby is not out yet.
(32:59) So, they think why not we should opt for a C-section and deliver the baby on auspicious date and time. It will save the efforts which is made by a female. It will save their day because more males are in occupation. If they think like I'll deliver on this date and time, I can arrange my work. I can have more relatives called because if we land over a normal labor, definitely it is time-consuming.
(33:34) The efforts are more because at the end of the day, she has to push and bear down and deliver a baby. The obstetrician are just a helpful source which would help her to deliver a baby. But the efforts is made by the pregnant woman only. So, they think why to have make so much effort and why to bear so much pain in delivering a baby.
(34:05) So, better we opt for a more of C-section. The baby will be uh delivered at this time and it is uh just a 45 minutes to 1 hour >> [snorts] >> procedure. Then, definitely I don't have to go all through that labor pain. My time and my efforts are saved. But ideally this practice should stop because if we are delivering all the babies in Muhurtam, >> [snorts] >> it doesn't guarantee in future that your baby is very auspicious that he or she will be a big personality.
(34:47) Because we are not born on a auspicious date or time. Then also we have achieved in our fields. So, there's a myth that bonding our babies in a specific date and time will definitely bring uh some prosperity, wealth, happiness, but we have to remove this taboo from the population. >> Uh this is very new to me because nobody knows about this Muhurtam sections and all.
(35:22) >> To be honest, I would encourage all the pregnant women if they should try delivering naturally. A normal vaginal birth should be put on more emphasis because now options of labor analgesics also available. They can offer labor analgesia, which can helps them to have a painless delivery and they need need not put more efforts.
(35:54) And this will help to increase natural vaginal birth rates also. >> Do sanitary pad brands hide the potential risk? >> Definitely because in sanitary pads also there are many chemically chemicals exposed. Which as a a doctor or as a labor men, for them it is very difficult to know what is to be used. Still now also in a village, they are using clothes.
(36:31) They are not moving towards the sanitary pad because every sanitary pad is costing a higher amount. And to be honest, in urban areas now we have opted for sanitary pads because definitely nobody is using clothes. But we forget that there are some chemicals which are mixed in those sanitary pads. And definitely people don't Some people don't even change.
(37:01) They keep one use one sanitary pad for whole day also. So to me, it should be ideally if you're having heavy menstrual bleeding that is for first 2 days of your menses, you need to change the sanitary pad every 4 4 hours. >> What are the other safest forms rather than sanitary pads? >> These days the menstrual cups and tampons are also available in the market.
(37:31) These menstrual cups, they are usually it made up of plastic where these menstrual cups are inserted inside the vagina. But the most beneficial part of this is like you can remove it when it is the you seem to like it's full. And you can reuse those menstrual cups. You don't need to dispose them. You can just remove it, properly wash it or sterilize it, and then you can back use back.
(38:06) In the case of tampons, now people are using it, but the major disadvantage of tampons is like if you keep it if you place it inside your vagina and you forget to remove it, it can lead to some toxic shock syndromes, also. Which can, you know, usually affect the health. And it can result in risk. And or in some cases, it can result in mortality, also.
(38:34) So, you have to be very careful with the use of tampons and menstrual cups. Because if you have kept it and you forget to remove it, they can cause some foreign body reactions, also. So, every whether you're using a menstrual pads, menstrual cups, or tampons, everything needs to be changed in at frequent intervals.
(39:00) Definitely, uh your menstrual cycle and menstrual hygiene also plays a very important role. So, you have to take care of your own menstrual hygiene. So, that you can provide a good environment and you will also feel good at the time of your menses. >> So, what about period panties? >> Period These days, period panties are also used, but it is another form of sanitary pads, only.
(39:31) Usually, these period panties people opt for using at night. Because at night, we usually take 8 hours of sleep. Nobody wants to get up and change these uh menstrual night panties. So, usually, ideally, they uh like before going to sleep, they put the these panties. And in the morning, [clears throat] as they change.
(39:57) To be honest, at every packet, it's written that it gives a good absorption. It will work for more than 12 13 hours. But ideally, we should not go by that timing. Because nobody can decide a time. And nobody can know how what a female is facing during that menstrual. Every uh person's menstrual cycle and menstrual flow is different.
(40:24) Some can have normal flow, some can have average flow, and some can have heavy flow. So, based on heavy flow, it's better to keep on changing at frequent intervals. And not keeping it like the pack is saying me to keep for 13 hours. No, please don't do that. It should be changed at frequent intervals, and it should be properly disposed.
(40:48) It should not be disposed like in dustbin. You should properly cover those sanitary pads and then dispose it. Because you have to create cleanliness, sanitation is equally important in menstrual hygiene. >> That's very interesting and important information. Why is female sexual health is not discussed openly even on medical settings? >> Ideally, every female thinks like I am a good with health.
(41:21) I have a peace set of mind. And I'm not suffering from any disease. So, they don't think our sexual health is an important talk to be discussed through their family, relatives, or to a doctor. Even though a doctor they have a doctor friend also, but nobody think about discussing about their sexual health. Because they have that conception misconception, to be honest, that they'll judge me if I talk about my sexual health.
(41:53) Nobody wants to discuss about what ideally they are facing. After marriage, and nobody wants to discuss with their colleagues, with their family, or relatives regarding their sexual intercourse problems, also. Everybody thinks like she or he will judge me if I discuss. And to be honest, mostly family and relatives, they only judge the females.
(42:28) That she will have some she will only have the problem. The male never have a problem. So, because of that, a female is not openly discussing about her sexual health. They are getting discouraged with their own set of people. And if at all they are facing any problem with their sexuality also, nobody wants to openly discuss because of the taboos and judgment made by their social media, relatives, and family members.
(43:02) So, ideally, I want everyone to create an awareness about sexuality. And it's okay. Like if you discuss about your sexual health to your family first, and every family should be supportive. If they are unable to provide a better guidance, [clears throat] they can seek guidance from a doctor. Who is a maybe a male doctor or female, the gender doesn't matter.
(43:32) But a professional advice is always helpful for a future growth and future betterment. >> Thank you for the advice, doctor. How does a lifestyle influences on PMOS cure and diet of a woman? >> Definitely, uh lifestyle imbalances, your lack of sleep, lack of exercises, lack of your physical body and mind, they all affect PMOS.
(44:08) Because PMOS is nothing but a multifactorial disease. It now since now the name has changed from PCOS to PMOS. PCOS means polycystic ovarian syndrome. Where first they usually only emphasized on ovaries. But now the term they have changed from PCOS to PMOS. Why? Because it is not only a role of ovary. It is a multifactorial.
(44:38) This multifactorial it it is not only the over because of ovaries you are getting the syndrome. It is because of your inadequate diet, inadequate health, the lifestyle, inadequate sleep and exercise. All together it's uh hampering the over ovary dysfunction. So definitely we have to improve ways on lifestyle.
(45:09) We have to maintain our lifestyle like getting up uh early morning hours, getting down to bed at early hours. Adequate 6 to 8 hours of sleep is required. Good nutritious diet is required. Avoid junk food as much as possible. You can minimize the intake. Have a control on your diet. Count your calories. Count your steps of walking. Ideally more than 10,000 steps we should uh do everyday.
(45:44) So all these if you bring changes in these lifestyle factors, definitely you can fight from these PMOS. Because it is just a syndrome. If you work on your body, definitely you will uh achieve of not having a PMOS. If you're not working on your body, definitely hormonal imbalance will be there.
(46:09) And drastic changes in hormonal imbalance only leads to this PMOS. >> That's very interesting. And most of the women nowadays face this PCOD and PMOS problem. So, they have to change their lifestyle for sure. So, let's start the rapid fire round. So, this is a myth versus fact round. I'll be asking a question.
(46:29) You have to say is it a myth or fact? You can judge someone's fertility based on how healthy they look. >> It's a myth because any healthy person, we don't know whether what is going inside their body. There can be hormonal shifts. So, definitely it's a myth. >> Uh stress can actually affect your menstrual cycle. >> It's a fact.
(46:54) Definitely a stress can affect your fertility. >> Women should avoid exercising during their periods. >> It's a myth. A brisk walking and small time for exercise will not hamper anything in menstrual cycles. >> You can have PCOS even if you're not overweight. >> It's a myth. There is a term known as lean PMOS also. >> [snorts] >> So, it's not like a healthy individual or underweight cannot have a PMOS.
(47:30) They can have PMOS. >> Okay. Women need to get a gynecological checkup only when something is wrong. >> This is a myth. Uh annual gynec checkup is always required. If they are suffering, please don't suffer. Visit your gynecologist as soon as possible. >> Okay. Thank you, doctor. So, we'll be continuing with the next round.
(47:53) I'll be giving you two options. You have to select anyone. Okay. Age or lifestyle, which has a bigger impact on fertility? >> Definitely age has more bigger factor than lifestyle because as our age advances, there can be decline in your ovarian reserve. >> Okay. Fertility awareness or fertility preservation? >> Fertility awareness because if you are more aware about fertility, then only you can use bigger terms like fertility preservation.
(48:27) >> Okay. The bigger challenge, misinformation or stigma around infertility? >> Misinformation because if you are not leading your body properly and you are misguided with people, so definitely misinformation will hamper more on fertility than stigma. >> Egg freezing or embryo freezing, which gives you more options later? >> To be honest, these both have different scenarios.
(48:57) Egg freezing means we are freezing the unfertilized eggs. Embryo freezing means we are fertilized the eggs and we have injected a sperm. Now we are forming an embryo. So these both are different terms. So I can't choose one. >> Okay. Egg or sperm, which is more affected by age? >> Definitely, to be honest, uh egg is more affected than sperm because as the age increases, the ovarian reserve starts diminishing.
(49:29) >> Okay, thank you. And there is There is another round, which is short answer. You have to give only one-line answers to these questions. One fertility myth you wish would disappear. >> That uh healthy person cannot have infertility problems. >> Next one. One fertility factor people underestimate. >> Uh age. >> One thing couples should never blame themselves for.
(50:02) >> Why I'm not able to conceive. >> One fertility test or checkup people more often misunderstand. >> AMH, anti-mullerian hormone. >> Why? >> Because A AMH is a quantitative test. If because it tells about the quantity of eggs you are having. But it is AMH is a not a predictor that you will get pregnant. So, it is just a test which helps us to know the quantity of eggs, but it is not a qualitative.
(50:39) Egg quality is not decided by AMH test. >> Okay. One question you wish every couple asked before starting fertility treatment. >> That uh I have we have tried conceiving uh for more than 1 year with unprotected sexual intercourse, but still we are not conceiving. Nobody mentions the optimizing time of intercourse.
(51:05) >> Mhm. Okay. One piece of advice you would give your younger self about fertility and reproductive health. >> Don't panic because every be it male or female, we will face issues at a point of time. So, seek help of medical professional as soon as possible. Don't be late because of some family issues or some financial issue.
(51:38) Please first seek the professional advisers. Once the you take a proper evaluation and treat evaluation about from detailed history, then you can seek the medical treatment. >> Thank you so much, doctor, for giving your valuable time. We know that you are very busy, but even though very thank you so much. >> Thank you.
Author Name:Swaasa
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Youtube Video URL:https://www.youtube.com/watch?v=r52-8WHOpQg
Title: The gynae talk | Dr Priyanka Singh Vasam | Swaasa Podcast
Author Name: Swaasa
Description: Are regular periods a guarantee of fertility? Does IVF always lead to pregnancy? And is infertility only a woman's problem?
In the first episode of Her Health, Unfiltered by Swaasa, we speak with Dr. Priyanka Singh Vasan about fertility myths, PCOS, menstrual health and the women's health questions many people hesitate to ask.
Meet our guest
Dr. Priyanka Singh Vasan is an Obstetrician and Gynaecologist specialising in infertility and reproductive medicine. She is the Co-founder and Director of Radiance Specialty Clinics, Bachupally, Hyderabad.
She holds an MBBS and MD in Obstetrics and Gynaecology, along with fellowships in Reproductive Medicine and Gynaecological Endoscopy.
What we explore in this episode:
Menstrual health, regular periods and reproductive health
PCOS/PCOD and its relationship with fertility
Common myths about infertility and IVF
Male fertility and why reproductive health concerns both partners
Age, egg quality, lifestyle and fertility
When to consider professional fertility advice
Her journey as a gynaecologist, infertility specialist and clinic co-founder
This is an open, informative conversation about understanding your body, questioning common misconceptions and feeling more comfortable discussing women's health.
Watch, learn and join the conversation.
Subscribe to Swaasa for more healthcare conversations, expert insights and accessible health education. Share this episode with someone who may find it useful.
Disclaimer: This episode is for general educational purposes only. It is not a substitute for individual medical advice, diagnosis or treatment. Consult a qualified healthcare professional for advice about your personal health concerns.
Transcript:
(00:00) So, let's talk about most trending and interesting topic on internet, egg freezing. >> But freezing of egg doesn't will guarantee you with a live birth. [music] To be honest, now in India after surrogacy act, they have strictly mentioned in that act that >> Do you think unnecessary C-sections are increasing nowadays? >> Because they want to deliver their baby according to a auspicious [music] date and auspicious time.
(00:30) That is known as Muhurtham section. >> How do you decide when a couple needs IVF or IUI? >> And in cases [music] of unexplained infertility where every report seems fine, but they are they are difficult to conceive. >> Do sanitary [music] pad brands hide the potential risk? >> Definitely, because in sanitary pads also there are many >> Why is female sexual health is not discussed openly even on medical settings? >> Even though we [music] have a doctor friend also, but nobody think about discussing about the sexual health.
(01:07) Because [music] they have that misconception, to be honest, that >> Hi everyone, welcome to Swasa podcast, the fertility talk. Real questions, real answers, no awkwardness. Today we are joined by Dr. Priyanka Singh Vasam, the obs gain with 5 plus years of experience and 2 years of experience in infertility care.
(01:37) And she's also the founder of Radiant Specialty Clinic, Bachupally. Dr. Priyanka, welcome to Swasa podcast. >> Thank you. >> How are you doing? >> I'm doing great. >> You're not just an obs gain, you're managing a lot. How are you managing all at a time? >> Uh so, this is a very good question to be asked.
(01:57) Like I'm managing obstetrics and Gynaec plus fertility specialist. See both our branches are different. Obstetrician, as an obstetrician if I look, so I have to deliver baby. I have to optimize my time. And I have to give a lot of efforts because it's because we have emergency cases in Obstetrics and Gynaec. Now coming to a fertility thing, fertility usually takes it's not a one day program.
(02:26) It takes a lot of efforts. [snorts] It takes lot of time. And we have to study the patient day by day. Managing a fertility patient is a big challenging thing than managing a obstetric patient. Obs In Obstetrics, the patient comes us for delivery. They already have a baby. But here in fertility things, we have to start we have to uh make them ability to achieve pregnancy.
(02:59) So that holds more importance. So being both, definitely, but now I have chosen my path towards more of fertility because it's quite challenging. And now there are many reproductive advances which have come such as reproductive genetics, embryology, and assisted reproductive techniques which make it and every patient of fertility is different.
(03:25) And there are lot of challenges we have to face day by day. So I prefer more being called as a fertility specialist now. Yes, I'm obstetrician also, but now I have taken one step back for obs as an obstetrician, but now I'm more towards fertility. >> Okay. So how do you choose to be a Gynaec and the specialization in reproductive medicine.
(03:53) >> Okay. So, to be honest, this fertility and reproductive medicine is truly special for me because it deals with advanced medical science. With it helps couple to achieve pregnancy and to have a babies. So, during my post graduation day when I joined as an obstetrician, I really uh realized that it's delivering babies is wonderful job.
(04:27) But, to help a couple to achieve a pregnancy, it's quite meaningful. And every fertility patient is different. The treatment, the protocols, everything is different. And every patient is a challenging patient. To be honest, I really enjoy to be a fertility medicine specialist. >> So, when a couple walks into your clinic, what is the biggest or most common misconception they have? >> So, the whenever a patient comes to my Radiant Specialty Clinic, the biggest misconception they have is like, "Doctor, [clears throat] I am not able
(05:07) to conceive." And that is a question which is raised by a woman though both person walk to my clinic. Both male and female partners. But, the female is more curious to know why I'm not getting pregnant. Is there a problem in myself? But, I usually evaluate both at the same time. First, definitely, I start with a female.
(05:36) I take a detailed physical history. I evaluate her. Then, but I never miss a chance to evaluate a male partner, also. And to be honest, infertility, it is not always a female factor involved. Males factor is also equally responsible for seeking the fertile. So, there is a misconception that only female is required to have a fertility.
(06:03) No, both are equally responsible. >> So, what is the perfect age or a healthy age for a woman to conceive? >> To be honest, it starts after the age of 20. Where definitely in some rural areas, they get married early. So, definitely they want after marriage, many women want to conceive at early age.
(06:32) So, for them, obviously a fertility is never an issue. But, coming to the urban areas, where the career growth opportunity for them, this is first like they want to achieve more. So, for them, having a child takes a back step. First, they want to settle in life. So, my knowledge, a woman should conceive before the age of 34. If she has a lot of undergoing problems, first at least she should meet a fertility specialist and get herself evaluated.
(07:08) With because there is one test that is known as AMH, that is anti-mullerian hormone test. Which helps to know us the con It is a quantitative test which helps us to know the egg reserve. But, that doesn't mean that AMH is good that she can have a healthy pregnancy. No, it is just a quantitative test which helps us to know the quantity of eggs, but it doesn't predict us the the quality of eggs.
(07:35) So, that is a major role. Ideally after 35 years, the ovarian aging starts. There's more risk of aneuploidy and chromosomal abnormalities. So, to be honest, she should approach a fertility specialist before she turns 34. >> Mhm. Okay, so what about male? Like, what is the right age for a male? >> honest, in females and males have completely different to be assessed as per the age.
(08:10) In males, like, they it depends purely on the sperm concentration. If you have a normal semen parameters, it's good to conceive for a female. But, if the husband or the male partner, if he is more into habitual things such as alcohol, smoking, there's occupational stress, he's exposed to the anabolic steroids.
(08:38) So, for these male partners, it will be very difficult to get their partner in pregnancy. So, there's not a right age for the male factors, but yeah, above 50 years, to be honest, there can be certain changes in the semen parameters. So, it all depends upon first line of investigation, that is semen analysis test for males.
(09:09) >> So, let's talk about most trending and interesting topic on internet, egg freezing. So, nowadays we are hearing a lot about egg freezing. And what do you think is the right age for a woman to do egg freezing? >> Okay. So, for egg freezing, usually ideally the age is between 20 and 30 years. Since now the egg freezing has become a trending topic on social media.
(09:39) Usually, ideally, female actress and all were planning to get because they have some career to be followed, and then they will try to plan their pregnancy. But now, these days, since it has become a trending topic, most like unmarried females, because of their career and their opportunities on the way, they want to come to the clinic and get their eggs freeze as soon as possible.
(10:09) But egg freezing does not guarantee that you will have a healthy pregnancy later. >> [gasps] >> You can just because 20 and 30 is the It is the ideal reproductive age, where the quality of eggs are good. So, at that time, we can just retrieve the eggs, and these are usually unfertilized eggs, which are kept in the lab.
(10:36) Once she has achieved her career opportunities, she has found her partner, then obviously, we match the semen with it, and then this unfertilized egg are fertilized, and then they are transferred to the back to the female as an embryo. But this egg freezing, it is also involves major injections, hormonal treatment, repetitive scans.
(11:09) And that is more concern for any young female. Ideally, egg freezing can be done to a patient who are undergoing some before chemo and radiotherapy. For them, because since after chemo and radiotherapy, it can hamper their egg quality. So, to prevent those, eggs freezing can be suitable for these cancer patients also.
(11:37) Young females and to those who have to undergo some pelvic surgeries later because of some pathology such as endometriosis, some fibroid conditions which can hamper their ovary ovary reserve and quality. >> That's so great, actually. I never knew about egg freezing. And most of the things that I'm seeing in internet that egg freezing might be not suitable for everyone.
(12:11) Is it true or >> Egg freezing, it depends upon the medical condition of the woman or the girl. First whenever she comes to me in my Radiance Specialty Clinic, any woman or any girl, first I have to assess her. Based on her on her history, her hormonal evaluation, her ultrasound scan, then only I can comment upon that she should undergo any egg freezing because every woman, every girl, they have a different body, different body, different changes are there, hormonal
(12:55) changes especially. So, there can be a drastic hormonal issues. In one female, the another female can be completely all right to undergo egg freezing. So, everything depends upon their hormonal assessment, their history, and evaluation. Depending upon that, only I can tell them to freeze their eggs.
(13:20) But freezing of egg doesn't as I said, it will guarantee you with you with a live birth. You are just freezing your eggs for the future use. But definitely if you are planning to get pregnant with using those eggs, it should be before the age of 34. As after 35, there can be hormonal drastic changes. Maybe your body would not be ideally taking up those eggs because we have to at uh transfer the embryo in your uterus.
(13:58) Your uterus also needs to be healthy at the same point of time. So, definitely the age 20 and 30 is suitable. But I prefer to be done before age of 34 as earliest as possible egg freezing. And this >> Uh so, is is it possible if a woman who freeze her eggs and use surrogacy after her that fell like she uses a girl or a woman who is in a healthy age like 20 to 30.
(14:32) Is it possible that way? >> To be honest, now in India after surrogacy act that is in 2021, they are strictly mentioned in that act act that of if there is any medical condition to a female, if she is not suit like if she has undergone previously hysterectomy hysterectomy means removal of the uterus or if there is some problem with underlying pathologies there, any big medical condition is there, then only she can opt for surrogacy.
(15:07) Now the surrogacy is not, you know, like you are doing your egg freezing and then you are opting for surrogacy. This is not done in India. In India now the rules have changed. It all depends upon your medical and surgical conditions. Then only you can plan for surrogacy in India. >> All right.
(15:34) That's a great to know because most of the young women they don't know anything about egg freezing. So, is there any specific medical tests a woman should do before freezing her eggs? >> See, whenever a patient or any girl or woman comes to me in my reading specialty clinic, firstly after the history, I usually tell them to do some hormonal test at the day of their day two of menses.
(16:03) Because that is the ideal time where I can concentrate on some hormones such as follicular stimulating hormone is there, luteinizing hormone is there, the estradiol levels, then her prolactin levels, her thyroid levels. So, to be honest and most important that anti-Müllerian hormone, that is AMH test.
(16:28) Because that it gives me a quantitative test about their fertility. Rest are hormonal evaluation, but based on those hormonal evaluation, I would get to know about these patient whether they are suffering from any hormonal changes in their body because now many girls and women are getting uh PMOS. PMOS is nothing but poly multifactorial ovarian uh disease.
(16:57) So, now it is a multifactorial disease. So, there are it makes a body to undergo some hormonal changes. There is rise in the luteinizing hormones. There is a shift of completely the hormonal transition is there. The woman can have thyroid issues, prolactin disorders, which is known as hyperprolactinemia. So, first we have to assess all the hormones.
(17:27) Based on their hormonal test, I can then do a ultrasound scan, in which I'll come to know about their uterine pathology, about their ovaries, about the fallopian tubes. And based on those all hormonal test and ultrasound evaluation, then can then only I can assure them about their future pregnancy. >> How do you decide when a couple needs IVF or IUI treatment? >> Okay, so this is a very good question.
(17:56) So, whenever a patient comes to my reading specialty clinics after detailed history and evaluation, firstly, for an IUI, that is intrauterine insemination, there are certain factors which is needed. First, there should be adequate ovarian reserve. Second, there should be at least one fallopian tube patent. And there there should be a good semen analysis report with good semen parameters.
(18:28) And if a male factor is there, if they have sperm concentration with that is around 10 million per ml. So, for them, ideally we can tell them to undergo intrauterine insemination. And in cases of unexplained infertility, where every report seems fine, but they're is a difficult to conceive. To those patient, intrauterine insemination can help.
(18:56) But in the case of IVF, that is in vitro fertilization, it works on those patients and couples where the female factors are involved, such as there's blocked fallopian tubes. They have undergone previous surgery history such as endometriosis or other pelvic pathologies. Any medical condition is there. So for them uh this all fact female factors play a role.
(19:31) For male, if they are having sperm concentration that is less than uh 5 million per ml or they are having severe oligoasthenoteratozoospermia, mean there is abnormal sperm concentration and abnormal forms of sperm. So for them, in vitro fertilization actually helps. >> So there are many options like IVF, IUI, egg freezing and all.
(20:01) So what are the difference between all these? >> So intrauterine insemination. So it is a very simple process where uh uh semen is collected. Then after collection of these semen the motile sperm is taken and it is directly injected in the uterus at the time of ovulation. So this is known as intrauterine insemination. Second, IVF.
(20:30) That is in vitro fertilization. It requires a controlled ovarian stimulation. Then there are hormonal injections given, repetitive ultrasound scans done. Then at the time of when the these uh follicles they mature, then we give a trigger injection. Then there is a ovum pickup date posted where we retrieve those eggs and we send it directly to the lab to the embryologist where they have a look on these eggs.
(21:04) So and these eggs are grown in the lab. This is known as in vitro fertilization. Now coming to ICSI, that is intracytoplasmic sperm insemination. Where usually the sperm, it is collected and then the a good motile sperms, they're directly injected to these eggs af- after the ovum pick up and then these eggs are then fertilized.
(21:36) Egg freezing means these unfertilized eggs are freeze, which can be used for future. And embryo freezing means where we are already we have fertilized these eggs and they form a embryo, but they are freeze and at the ideal time we insert these embryos back to the patient. So this is known as embryo freezing.
(22:01) >> And that's so good. And what is the biggest misconception of IVF? >> The biggest misconception of IVF, whenever a patient comes to me in my Radiant Specialty Clinic, >> [gasps] >> they tell what is the problem in me. I want to straight away go for in vitro fertilization because I have studied uh a lot about it on social media.
(22:28) I've done a lot of research and for me body IVF is a very suitable method. To be honest, we need to actually under- make couples understand there's certain factors which is involved in in vitro fertilization. Firstly, after your detailed history and examination, after your hormonal evaluation, then only I can comment whether you have to go in in vitro fertilization or not.
(22:57) Firstly, I need to see your hormonal test, your ultrasound, what are these reports predicting? Then only I can suggest you to go to IVF, because there are certain fertility treatments which are available. It is not all options are not towards IVF. With certain because some patients they have just hormonal imbalance, they have only ovulatory dysfunction.
(23:24) With like they have ovulatory dysfunction, then we can do some ovulation induction that where we only give a ovulation induction drugs, which is only for period of 5 days. Then after once after 14 days, we check for ovulation and we tell them to have a timely intercourse. That we can be done based on their like semen parameters.
(23:51) If it is the count, sperm concentration count is above 10 million per ml, we can tell them to go for intrauterine insemination also. So, to be honest, after if the ovulation induction protocols they don't work on the body, if intrauterine insemination is also not working, then the la- that also after five to six cycles, then to be honest, we can think about IVF.
(24:21) But IVF will be a very last approach. First, we can uh based on the hormone and some patient can easily get get pregnant with some hormonal evaluation also. Just they need to have some supplements which can help them to conceive. >> Okay. So, when is the when will you decide when a patient or a couple needs this treatment? So, >> To be honest, a patient uh which who requires IVF, if they have failed three four cycles of ovulation induction, Three, four cycles of intrauterine insemination. They are having blocked
(25:03) fallopian tubes. There are some pelvic surgeries which are done previously. There is a condition known as endometriosis which affects the adjacent reproductive organs. It usually affects pelvis also. So, these conditions and some medical conditions where it is very difficult for the patient to conceive. And some uterine anomaly.
(25:30) These all factors usually decide whether the patient should undergo IVF treatment. And in male factor, definitely the semen parameters still hold the first line of investigation. If their semen parameters are not in the within the normal range, then obviously we have to suggest them to undergo IVF. >> Okay. So, when is a surgery is needed in a fertility treatment? >> A surgery if it has affected the all the adjacent organs which are near the uterus, such as ovary, bowel, bladder, and it's
(26:15) it's diminishing the ovarian reserve. So, only that the age age plays a major role to decide whether the patient has to undergo first the surgery and then the treatment. If there is a advanced age, her ovaries are diminishing. And her all the pelvic adjacent organs are are getting deteriorated which can hamper the egg quality.
(26:43) Then definitely she should undergo surgery first and then take the IVF treatment. But in other situation, if uh it does is not happen hampering the quality of the egg. Not affecting the ovarian reserve. So we can offer IVF first and then undergo surgery later also. >> So what is the weirdest case you have ever treated? >> The weirdest case I've ever treated is a patient came to me in my leading specialty clinics.
(27:23) Her all It was a case of unexplained infertility. Her I did a whole hormonal evaluation. It seems out to turn normal. I did her ultrasound sonography. All adjacent organs seems normal. Her fallopian tubes were normal. Her uterus was normal. There was no any pathologies detected. Then I evaluated her based on her hormonal assessment.
(27:55) Everything turned out to be good. Coming to the male factor, male also all semen parameters were normal. And to be honest, only the problem was her with was AMH. Ideally AMH is a quantitative test which tells about the maturity of the eggs. Okay, so her AMH was quite low. Quite low and it was around zero. To be honest.
(28:24) Then also, to be honest, as a fertility specialist, I would tell you go for a first line of treatment to go is for IVF. But couple were not happy with the word in vitro fertilization. They don't wanted to unless they wanted to seek first some medical treatment. So okay, I approached them for a medical fertility treatment.
(28:52) Two times it failed. The third time she became pregnant. But the her a beta hCG value was also quite high. But the pregnancy was outside the uterus. That was inside the fallopian tube. That is known as ectopic pregnancy. She got operated for the ectopic pregnancy. Now, I don't have a chance also to get her tell her to have a basic medi- fertility treatment that is ovulation induction drugs. I can't tell her to have that.
(29:27) Because now one side tube is removed. The right side tube is already gone. If I tell her to go to intrauterine insemination, ideally it can be happen only through left side of the tube. Ideally, I have to inject the sperm into her uterus. But the sperm will decide from which side it has to go. So, I can't take that risk also.
(29:54) But it will be night 80% can show failure also. Then also, ideally I told patient to wait for 3 months. After 3 months, we'll see what's to be done. To be honest, in these 3 months but I told her to have a normal uh nutritional supplements to be continued. Whatever I have given you previously. And be stress free. Since the patient knew her condition, so now she stopped thinking and worrying about being pregnant.
(30:27) And after 3 months, I got a call on a specific date in morning hours and she told I did missed my periods. I did my urine pregnancy test and came out to be positive. So, on that day for me, first I did her beta hCG levels. I checked, so it was high. Then I told her recommended her to go for a ultrasound scan.
(30:54) The scan showed a positive intrauterine pregnancy. So, it was big achievement for us. A patient having AMH of zero, where the pregnancy is very impossible. It was just a miracle, to be honest. And now she is 6 months pregnant. >> Wow. >> So, it's a big achievement because a patient where she had to go IVF, but the couple was not ready for IVF.
(31:27) Then also they opted for a natural pregnancy and she got pregnant having only one tube and AMH zero. So, this is the most weirdest case where I was going to plan for a in vitro fertilization for her, but naturally she conceived. And she's doing well. And her baby. >> That's really a miracle. Do you think unnecessary C-sections are increasing nowadays? >> Oh.
(31:55) Yes, definitely. Now C-sections are emerging as a very trending topic on social media also. Like people are more opting towards C-sections because they want to deliver their baby according to a auspicious date and auspicious time. That is known as Muhurtham sections. So, since nowadays in no female wants to undergo a natural labor, which because there's a myth going around because you'll get a lot of pain.
(32:29) Unnecessarily a doctor makes you wait in a labor room for more than 12 or 14 hours. Once because to be honest, it is a very stressful condition for an obstetrician, also. If a patient is going into labor for 12 to 14 hours, a doctor also has to be there. They forget that. They only think that my my wife is there in the labor room for next 12 to 14 the doctor is still monitoring the baby is not out yet.
(32:59) So, they think why not we should opt for a C-section and deliver the baby on auspicious date and time. It will save the efforts which is made by a female. It will save their day because more males are in occupation. If they think like I'll deliver on this date and time, I can arrange my work. I can have more relatives called because if we land over a normal labor, definitely it is time-consuming.
(33:34) The efforts are more because at the end of the day, she has to push and bear down and deliver a baby. The obstetrician are just a helpful source which would help her to deliver a baby. But the efforts is made by the pregnant woman only. So, they think why to have make so much effort and why to bear so much pain in delivering a baby.
(34:05) So, better we opt for a more of C-section. The baby will be uh delivered at this time and it is uh just a 45 minutes to 1 hour >> [snorts] >> procedure. Then, definitely I don't have to go all through that labor pain. My time and my efforts are saved. But ideally this practice should stop because if we are delivering all the babies in Muhurtam, >> [snorts] >> it doesn't guarantee in future that your baby is very auspicious that he or she will be a big personality.
(34:47) Because we are not born on a auspicious date or time. Then also we have achieved in our fields. So, there's a myth that bonding our babies in a specific date and time will definitely bring uh some prosperity, wealth, happiness, but we have to remove this taboo from the population. >> Uh this is very new to me because nobody knows about this Muhurtam sections and all.
(35:22) >> To be honest, I would encourage all the pregnant women if they should try delivering naturally. A normal vaginal birth should be put on more emphasis because now options of labor analgesics also available. They can offer labor analgesia, which can helps them to have a painless delivery and they need need not put more efforts.
(35:54) And this will help to increase natural vaginal birth rates also. >> Do sanitary pad brands hide the potential risk? >> Definitely because in sanitary pads also there are many chemically chemicals exposed. Which as a a doctor or as a labor men, for them it is very difficult to know what is to be used. Still now also in a village, they are using clothes.
(36:31) They are not moving towards the sanitary pad because every sanitary pad is costing a higher amount. And to be honest, in urban areas now we have opted for sanitary pads because definitely nobody is using clothes. But we forget that there are some chemicals which are mixed in those sanitary pads. And definitely people don't Some people don't even change.
(37:01) They keep one use one sanitary pad for whole day also. So to me, it should be ideally if you're having heavy menstrual bleeding that is for first 2 days of your menses, you need to change the sanitary pad every 4 4 hours. >> What are the other safest forms rather than sanitary pads? >> These days the menstrual cups and tampons are also available in the market.
(37:31) These menstrual cups, they are usually it made up of plastic where these menstrual cups are inserted inside the vagina. But the most beneficial part of this is like you can remove it when it is the you seem to like it's full. And you can reuse those menstrual cups. You don't need to dispose them. You can just remove it, properly wash it or sterilize it, and then you can back use back.
(38:06) In the case of tampons, now people are using it, but the major disadvantage of tampons is like if you keep it if you place it inside your vagina and you forget to remove it, it can lead to some toxic shock syndromes, also. Which can, you know, usually affect the health. And it can result in risk. And or in some cases, it can result in mortality, also.
(38:34) So, you have to be very careful with the use of tampons and menstrual cups. Because if you have kept it and you forget to remove it, they can cause some foreign body reactions, also. So, every whether you're using a menstrual pads, menstrual cups, or tampons, everything needs to be changed in at frequent intervals.
(39:00) Definitely, uh your menstrual cycle and menstrual hygiene also plays a very important role. So, you have to take care of your own menstrual hygiene. So, that you can provide a good environment and you will also feel good at the time of your menses. >> So, what about period panties? >> Period These days, period panties are also used, but it is another form of sanitary pads, only.
(39:31) Usually, these period panties people opt for using at night. Because at night, we usually take 8 hours of sleep. Nobody wants to get up and change these uh menstrual night panties. So, usually, ideally, they uh like before going to sleep, they put the these panties. And in the morning, [clears throat] as they change.
(39:57) To be honest, at every packet, it's written that it gives a good absorption. It will work for more than 12 13 hours. But ideally, we should not go by that timing. Because nobody can decide a time. And nobody can know how what a female is facing during that menstrual. Every uh person's menstrual cycle and menstrual flow is different.
(40:24) Some can have normal flow, some can have average flow, and some can have heavy flow. So, based on heavy flow, it's better to keep on changing at frequent intervals. And not keeping it like the pack is saying me to keep for 13 hours. No, please don't do that. It should be changed at frequent intervals, and it should be properly disposed.
(40:48) It should not be disposed like in dustbin. You should properly cover those sanitary pads and then dispose it. Because you have to create cleanliness, sanitation is equally important in menstrual hygiene. >> That's very interesting and important information. Why is female sexual health is not discussed openly even on medical settings? >> Ideally, every female thinks like I am a good with health.
(41:21) I have a peace set of mind. And I'm not suffering from any disease. So, they don't think our sexual health is an important talk to be discussed through their family, relatives, or to a doctor. Even though a doctor they have a doctor friend also, but nobody think about discussing about their sexual health. Because they have that conception misconception, to be honest, that they'll judge me if I talk about my sexual health.
(41:53) Nobody wants to discuss about what ideally they are facing. After marriage, and nobody wants to discuss with their colleagues, with their family, or relatives regarding their sexual intercourse problems, also. Everybody thinks like she or he will judge me if I discuss. And to be honest, mostly family and relatives, they only judge the females.
(42:28) That she will have some she will only have the problem. The male never have a problem. So, because of that, a female is not openly discussing about her sexual health. They are getting discouraged with their own set of people. And if at all they are facing any problem with their sexuality also, nobody wants to openly discuss because of the taboos and judgment made by their social media, relatives, and family members.
(43:02) So, ideally, I want everyone to create an awareness about sexuality. And it's okay. Like if you discuss about your sexual health to your family first, and every family should be supportive. If they are unable to provide a better guidance, [clears throat] they can seek guidance from a doctor. Who is a maybe a male doctor or female, the gender doesn't matter.
(43:32) But a professional advice is always helpful for a future growth and future betterment. >> Thank you for the advice, doctor. How does a lifestyle influences on PMOS cure and diet of a woman? >> Definitely, uh lifestyle imbalances, your lack of sleep, lack of exercises, lack of your physical body and mind, they all affect PMOS.
(44:08) Because PMOS is nothing but a multifactorial disease. It now since now the name has changed from PCOS to PMOS. PCOS means polycystic ovarian syndrome. Where first they usually only emphasized on ovaries. But now the term they have changed from PCOS to PMOS. Why? Because it is not only a role of ovary. It is a multifactorial.
(44:38) This multifactorial it it is not only the over because of ovaries you are getting the syndrome. It is because of your inadequate diet, inadequate health, the lifestyle, inadequate sleep and exercise. All together it's uh hampering the over ovary dysfunction. So definitely we have to improve ways on lifestyle.
(45:09) We have to maintain our lifestyle like getting up uh early morning hours, getting down to bed at early hours. Adequate 6 to 8 hours of sleep is required. Good nutritious diet is required. Avoid junk food as much as possible. You can minimize the intake. Have a control on your diet. Count your calories. Count your steps of walking. Ideally more than 10,000 steps we should uh do everyday.
(45:44) So all these if you bring changes in these lifestyle factors, definitely you can fight from these PMOS. Because it is just a syndrome. If you work on your body, definitely you will uh achieve of not having a PMOS. If you're not working on your body, definitely hormonal imbalance will be there.
(46:09) And drastic changes in hormonal imbalance only leads to this PMOS. >> That's very interesting. And most of the women nowadays face this PCOD and PMOS problem. So, they have to change their lifestyle for sure. So, let's start the rapid fire round. So, this is a myth versus fact round. I'll be asking a question.
(46:29) You have to say is it a myth or fact? You can judge someone's fertility based on how healthy they look. >> It's a myth because any healthy person, we don't know whether what is going inside their body. There can be hormonal shifts. So, definitely it's a myth. >> Uh stress can actually affect your menstrual cycle. >> It's a fact.
(46:54) Definitely a stress can affect your fertility. >> Women should avoid exercising during their periods. >> It's a myth. A brisk walking and small time for exercise will not hamper anything in menstrual cycles. >> You can have PCOS even if you're not overweight. >> It's a myth. There is a term known as lean PMOS also. >> [snorts] >> So, it's not like a healthy individual or underweight cannot have a PMOS.
(47:30) They can have PMOS. >> Okay. Women need to get a gynecological checkup only when something is wrong. >> This is a myth. Uh annual gynec checkup is always required. If they are suffering, please don't suffer. Visit your gynecologist as soon as possible. >> Okay. Thank you, doctor. So, we'll be continuing with the next round.
(47:53) I'll be giving you two options. You have to select anyone. Okay. Age or lifestyle, which has a bigger impact on fertility? >> Definitely age has more bigger factor than lifestyle because as our age advances, there can be decline in your ovarian reserve. >> Okay. Fertility awareness or fertility preservation? >> Fertility awareness because if you are more aware about fertility, then only you can use bigger terms like fertility preservation.
(48:27) >> Okay. The bigger challenge, misinformation or stigma around infertility? >> Misinformation because if you are not leading your body properly and you are misguided with people, so definitely misinformation will hamper more on fertility than stigma. >> Egg freezing or embryo freezing, which gives you more options later? >> To be honest, these both have different scenarios.
(48:57) Egg freezing means we are freezing the unfertilized eggs. Embryo freezing means we are fertilized the eggs and we have injected a sperm. Now we are forming an embryo. So these both are different terms. So I can't choose one. >> Okay. Egg or sperm, which is more affected by age? >> Definitely, to be honest, uh egg is more affected than sperm because as the age increases, the ovarian reserve starts diminishing.
(49:29) >> Okay, thank you. And there is There is another round, which is short answer. You have to give only one-line answers to these questions. One fertility myth you wish would disappear. >> That uh healthy person cannot have infertility problems. >> Next one. One fertility factor people underestimate. >> Uh age. >> One thing couples should never blame themselves for.
(50:02) >> Why I'm not able to conceive. >> One fertility test or checkup people more often misunderstand. >> AMH, anti-mullerian hormone. >> Why? >> Because A AMH is a quantitative test. If because it tells about the quantity of eggs you are having. But it is AMH is a not a predictor that you will get pregnant. So, it is just a test which helps us to know the quantity of eggs, but it is not a qualitative.
(50:39) Egg quality is not decided by AMH test. >> Okay. One question you wish every couple asked before starting fertility treatment. >> That uh I have we have tried conceiving uh for more than 1 year with unprotected sexual intercourse, but still we are not conceiving. Nobody mentions the optimizing time of intercourse.
(51:05) >> Mhm. Okay. One piece of advice you would give your younger self about fertility and reproductive health. >> Don't panic because every be it male or female, we will face issues at a point of time. So, seek help of medical professional as soon as possible. Don't be late because of some family issues or some financial issue.
(51:38) Please first seek the professional advisers. Once the you take a proper evaluation and treat evaluation about from detailed history, then you can seek the medical treatment. >> Thank you so much, doctor, for giving your valuable time. We know that you are very busy, but even though very thank you so much. >> Thank you.
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