Released on: May 22, 2008, 1:55 am

Press Release Author: SOUMYA

Industry: Healthcare

Press Release Summary: W

hy does one want to have a child ? Is it true that all women have a maternal
instinct, which demands that she should become a mother, so that she showers all her
love to her offspring? This may not be the only reason. As a matter of fact, a
mother is only responsible for carrying the baby for 9 months and delivering it to
the outside world

Press Release Body: FRCS ( Edin), FRCOG (Lond)

hy does one want to have a child ? Is it true that all women have a maternal
instinct, which demands that she should become a mother, so that she showers all her
love to her offspring? This may not be the only reason. As a matter of fact, a
mother is only responsible for carrying the baby for 9 months and delivering it to
the outside world. Once that has happened, the father is as much involved with the
safe keeping, nurture, health needs, physical, emotional and educational needs of
the child. Most fathers share the care of children equally with the mothers. So
the problem of infertility is one of the couple not any one of them; it is common
knowledge that a woman alone is responsible for the infertility problem may be in
about 40% of the cases and the man is responsible in an equal number of cases. It
is very likely that they are both responsible in the remaining 20% of the cases.
The man and woman get married for fulfillment of physical and emotional love. The
nature of self-esteem an individual acquires when he or she is admired and sought
after by a person of the opposite sex itself is a boon in life. Marriage results
in culmination of their expectations from one another until they gradually settle
down to the humdrum of daily life in due course.

The baby is only an offshoot of marriage and every couple takes it for granted that
it can be created at will. In today's world, the babies should be created when you
want them, and not at any time.

The start with, the desire to have a child is born out of the common belief that
every couple after marriage should have a child to show that they are truly married,
to show that their marriage has been consummated, and to show their masculinity and
the femininity to each other and the rest of the world. But, when the pregnancy
does not occur, after a few months of trail at conception, the couple suddenly gets
a new sense of disappointment, which leads in course of time to frustration and
fear. This finally causes a big dent in their self-esteem.

A wish for a child in the family further gets exaggerated because of socio-cultural
processes, family pressure caused by the disappointed grandparents, disputes in
dividing - the family legacy, business, profession etc. Thus childlessness causes a
breach in the family dynamics.

The individual partners of the marriage express feeling of guilt. Men may attribute
this to some of their innocent habits of masturbation during their post pubertal
era. Some cannot forgive themselves if they have procured abortion in their
previous pregnancies voluntarily because of unsuitable socio-economic factors. Some
partners blame themselves and others blame each other. In either case, marital
harmony is the casualty.

Roughly about 80 to 85% of couples produce a pregnancy before the end of the first
year of marriage or before the first year of trying for pregnancy. Normally, we
expect the couple to get investigated for the infertility problems after such a
period of failed trial. The couple who has been married late in life should start
getting investigated much earlier. The treating physician who is normally a
gynaecologist well versed in taking care of infertile folks, should tailor the level
of investigations according to the age of the woman. A woman in early twenties
needs to have a very conservative approach for evaluation of the cause of
infertility. But a woman of thirty years who is married only 6 - 8 months requires
more aggressive approach in both investigation and treatment.

History taking is the first line of approach. When one asks them how long they
have been "trying for pregnancy", it is frequently observed that a woman who has
been married for 5 years, says that she has been trying only since 2 - 3 months. By
this she means that she has been taking medical help since only so many months. In
actual fact, what we have asked them to mention is how long has the woman been
exposed to unprotected sex. Probably, in this couple it may be all the 5 years.
This would really give a very serious dimension to the status of infertility. A
general history of the female should take note of the following; genitourinary tract
problems in the family, regularity or irregularity of periods, quantity of bleeding
and abdominal pain in relation to menses. One must also think on the frequency of
sexual activity and if it is free from pain. When one is interrogating a woman on
her sexual problems, not infrequently she complains that all the semen that is
ejaculated leaks out of the vagina. This is not at all an unusual phenomenon.
Some men produce about only 0.5 - 1 ml of semen and some others might produce 5 ml
of semen. Viscous semen that does not flow out of the vagina may not be very
helpful for fertility. High viscosity of semen itself can be a barrier for sperm
motility. But on the other hand, if one thinks that the vagina is not deep enough
to hold a required quantity of semen at its depth, one may advise her to have a
pillow beneath her buttocks after sexual intercourse so that the vagina takes a deep
downward direction thus preventing the leak.

General examination of the female consists of noting the height and weight,
examination of breast whether there is any secretion of milk by pressing the areolar
region. One must look for male distribution of hair, which is often associated with
obesity and irregular periods. Some women complain that the periods appear once in
2 - 3 months, another may state that she has to take 5 - 7 tablets every month to
get a period; otherwise she may not get periods for years together. Many women
think that if only their periods become regular, they would automatically become
pregnant. So they insist that no investigations should be done on them with regard
to their infertile status and all they want is regularization of periods. This is
also a wrong impression. Irregularity of periods is caused by so many conditions
like the disturbance of ovarian function, increased production of prolactin hormone
by the pituitary gland and thyroid disturbances. Extreme obesity and
disproportionately low body mass index can also cause loss of menses.

Physical examination of the female may give away the diagnosis in some cases.
Absence of breast development associated with scanty hair in the armpits and pubic
region may be a fairly serious problem. It may denote a condition known as ovarian
dysgenesis. This is frequently due to chromosomal abnormalities like for eg.,
having one sex chromosome less or one sex chromosome more than what is required.
Any woman who has not started menstruating by the age of 15 should be considered as
a case of primary amenorrhoea. These girls should be investigated.

Some girls may get what is known as hidden menses or cryptomenorrhoea. This is
frequently due to the presence of hymen, which has no natural opening at all. When
the first menses appears in a little girl, the bleeding flows out of the uterine
cavity and through the cervix. But it gets retained in the vagina as the hymenal
membrane has closed the introitus. (See Figure)

A normal woman bleeds roughly about 80 ml during the whole menses. The vagina
itself can hold up to 500 ml without causing any discomfort. So a little girl may
not know that she has already attained menarche about six months ago and that the
menstrual fluid is collecting inside the vagina without her knowledge. After a
couple of months, the vagina cannot distend anymore; the menstrual fluid starts
escaping in a retrograde fashion through the fallopian tube and starts trickling
into the pelvis. The distension of the vagina may cause obstruction of the urethra
and the little girl is frequently brought for inability to pass urine. This
condition is known as hematocolpos. One when examines the introitus, one can see a
purplish discolored bulging hymenal membrane.

This condition is easily treated by making an incision over the bulging, bluish
discoloured hymenal membrane. This will result in a gush of dark coloured tarry,
viscous old blood amounting to 500 - 600 ml of fluid. The membrane will again close
up if one does not follow up with a second operation after 2 - 3 days so as to exise
the hymen (Picture B) all along the margin of introitus and entering the raw margin
(Picture C) so as to keep the opening patent.

When a young girl of 15 - 16 years of age has been brought to the clinic for non -
occurrence of menstrual bleeding, it may be much more serious than cryptomenorrhoea.
If she has developed all the secondary sexual characters, it is possible that she
may not have the uterus or she may not even have a vagina. This becomes obviously
on examining the vulval region carefully.

Congenital absence of vagina - also called, as Rokitonsky Syndrome, is a condition
where the patient's chromosomal components are all normal. Examination of the vulval
area shows that there is no vaginal opening. These women usually do not have a
uterus. If one examines the inside of pelvis by a laparoscope, one only sees well
developed tubes and ovaries on either side with the uterus represented by a band of
fibrotic structure in mid line. Such women have normally functioning ovaries, which
are capable of producing ova (eggs) cyclically. They also produce female hormones,
which will help in formation of secondary sexual characters like development of
breasts, female distribution of fat on shoulder, waist and hips and growth of
axillary and pubic hair. For these women an artificial vagina can be constructed.

The operation consists of dissecting out a space between the rectum and urinary
passage from the level of hymenal membrane to the level of pelvic peritoneum, which
is the lower, most portion of the membranous sac containing abdominal and pelvic
organs. While this is being created by the Gynaecologist, a Plastic Surgeon will
shave off a thin layer of patient's skin from the inner aspect of the thigh. The
skin is wrapped over a sterile spongy mould measuring about 4" in length and 1 " in
diameter. This is placed inside the space that has been artificially created, and
the hymenal orifice is temporarily closed (see picture).

The mould can be removed after 6 days gently freeing it from the skin graft, which
has already got adhered to the wall of the space created. Post - operatively, care
is taken to keep the space open by advising the patient to insert a condom covered
teakwood mould in the space created, so that the space does not collapse. The
patient is taught to take it out, in the morning - wash it - and replace it in a
fresh condom into the vagina. In course of time, the space will get stabilized.
The mould can only be inserted for a few hours in the night when the patient goes to
sleep. It is very important to counsel the patient and parents before hand that she
will never be able to menstruate or bear a child. The operation is entirely meant
for sexual activity. Such a person should be encouraged to marry a widower or
divorcee who has already produced a few children through his first marriage.

Congenital absence of vagina is not a case of total infertility. The woman's
ovaries can produce eggs. The eggs can be collected for the purpose of
fertilization outside the body by her husband's sperm. The embryos formed thereof
can be grown in another woman's uterus who will act as a surrogate or a gestational
carrier for the genetic mother.

(The above article has been written by Dr. Sulochana Gunasheela, India's leading
infertility expert and to more details one can visit the website or call on 080 - 26673585)

Web Site:

Contact Details: kurisupally road, ravipuram, kochi.

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