Apart from special features on health, our regular health column, Stethoscope will have experts from different medical  fields answering your queries. We are happy to announce that Dr. Priya Selvaraj, MD MNAMS MCE, Assistamnt Director, G.G. Hospital, Chennai will answer queries on obstetrics and gynecology and assisted reproductive technology. Send your questions by mail toe editorevestimes@gmail.com or editor@evestimesonline.com or to our office address.

When you have planned to start a family and have not conceived for a year or more, it is time to look into the matter. Our new feature on frequently asked questions in infertility will help dispel many myths and clarify doubts regarding conception among many couples aspiring for a baby.

FREQUENTLY ASKED QUESTIONS IN INFERTILITY

1. Does masturbation reduce chances of conception in the male?

Masturbation as such does not affect the fertility status of the man. In fact, we require a semen sample for examination preferably by masturbation rather than intercourse, with at least 3 days of abstinence.

2. How long are the eggs that are released from the ovaries fertile? How long does it take for fertilization to occur? How long does it take for implantation to occur?

The eggs are able to be fertilized for about 12 – 24 hours after ovulation in the female. The older the woman, the shorter this time becomes. Normally fertilization occurs within 24 hours after ovulation.  Implantation occurs about 5-10 days after ovulation.

3. How do you determine the first day of your cycle?

The first day of your cycle is the one when a continuous flow of menstrual blood occurs. Continuous spotting can also be included but not intermittent spotting.

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When I was pregnant about twenty years back in Delhi, I was prescribed two medicines by my gynec  who said that it would prevent miscarriage as I was commuting  by bus for an hour to work every day. I had very good health as I was a swimmer and cyclist and I had not anticipated any problems with my delivery. Despite arguing with her, she prescribed Gestanin and Duadilin which I took for nine months. Later on, the gynec insisted on performing a caesarean section though the other doctors who were present indicated that everything was normal but it would take time . I was asked to take some coffee in the morning at 5. 30 a. m. By about eleven my gynec came and wanted to do a caesarean section. She chided me for having coffee and decided to go for an epidural. During the surgery, I had unbearable headache and I also threw up. Anyway, the delivery went of well and I had a healthy daughter weighing 3.750 kg. Her milestones were fantastic . She started speech when she was just about eight months, was walking when she was one and by the time she was a year and a half she could narrate several nursery rhymes, count from one to hundred in three languages, front and back and also run around and play. However, after three she started developing a host of health problems including frequent colds and fevers for which she was treated with antibiotics and by the time she was ten she became a juvenile diabetic. On reading the literature for contraindications for the above two medicines, I found that juvenile diabetes is one of the complications that might arise.  I also suspect the epidural shot, as I too developed a lot of health complications. My question is , could the medicines have caused such problems in my child? I know there is no point discussing this now, but it will help relieve the anxiety and gnawing feeling I have harboured for two decades.

There are no known risks with these medications when it comes to association with juvenile diabetes. We have prescribed these for years in practice and its benefits outweigh the risks. These are used to protect one from threatened abortion or preterm labor. Drugs are prescribed with great prudence during pregnancy. Considering that she had a normal postnatal course, there is no implication of the epidural or medications in the causation of juvenile diabetes. However the most plausible explanation would be the recurrent infections which have a role in early destruction of pancreatic islet cells, commonly viral. This coupled with environmental factors and hereditary tendency is more likely. I am sure the diabetologist/endocrinologist would have discussed these issues with you. Please don’t feel guilty and extend your support to your daughter. She needs to be guided on maintaining a healthy lifestyle with a good dose of physical activity and stress management. Give her examples of famous personalities with this condition and encourage her to pursue her dreams. 

I have a teenaged daughter who feels very uncomfortable whenever I try to talk to her about menstruation , sex education etc. I want to teach her about personal hygiene and how to be careful with the opposite sex. However, the minute I broach the subject, she says she has some studying to do and disappears. How can I try to educate her? Is there any educative VCD/CD which I can give her so that she can watch it when she is alone and encourage her to ask questions? If there is, could you pl. give me the details?

I think teenagers these days have most of their information intact from their circle of friends. It is embarrassing for them to discuss it with parents all of a sudden when it should have been done earlier. As teenagers they tend to look for information outside as they have already started noticing changes which they were not taught to expect. This is why discussions should begin before they start menstruation. However there are books available about the body and feminine hygiene in well known book stores in the city. Please get in touch with these stores or browse the internet to know availability of VCD’s/DVD’s.

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I am a juvenile diabetic since the age of ten. Apart from the fact that my sugar levels go very high during the pre-menstrual period and dips suddenly the day my periods begin. I get severe stomach cramps and breast pain. Earlier, during my teenage years ( now I am 21) I used to have hypothyroidism for which I took eltroxin. Now my thyroid levels are normal but sugar control is not very good as I am stressed out due to the burden of my studies and now my job. More over, I have severe mood swings before my periods and this has cost me heavily in terms of my relationships with friends and relatives . I really don't know how to handle every menstrual cycle which is now causing panic in me. How to go through every cycle smoothly, with less pain and more specifically with no pre-menstrual mood swings?
 
   Since you have been diagnosed quite early at age 10, I am sure your family has been supportive and so have your friends, both at school and workplace, so you owe it to them to keep yourself healthy and not buckle under pressure. Please understand that just as work is worship so is your body. These days there is hardly any distinction between adult onset and juvenile diabetics because stress levels and the inability to cope with it are pushing more and more youngsters to developing it at an earlier age. The first step is to get in touch with a good diabetologist who can bring your sugar under control with the right doses of insulin. Please recheck your thyroid status if it has been over 6 months to a year since the last blood test. The fluctuating blood sugar levels may be related to the premenstrual syndrome itself in the form of dietary preferences rather than to insulin levels. Please follow a prescribed dietary and fitness regime. Considering your inadequate blood sugar control, hormonal pills may not be the option at present; however you may take multivitamins everyday and a combination of vitamin E with evening primrose oil for 2 weeks prior to menses. Severe cramps can be overcome with antispasmodics but it would be worthwhile to follow up with a gynecologist. Stress management is essential and please make sure you take help even if it means meditation or a visit to the psychiatrist/psychologist.
 
 I am a working woman, 23 years. I am about to get married. I don't want to get pregnant immediately after marriage because I would like to settle down in my career first. I would like to know which method of contraception will suit me the best. My best friend who got married recently is having problems with IUD . She says that her bleeding is heavy and she gets severe cramps during her periods. I am very sensitive to pain and I don't want to undertake this. As for oral contraceptives, two of my aunts had breast cancer, one of whom passed away. I have read somewhere that if there is an incidence of breast cancer, it is best to avoid oral contraceptives. I have never been to a gynec before and I feel shy to talk about this to anyone, including my mother. I cannot discuss this with my fiancé because it is an arranged marriage and only now I am getting to know him. I am confused. Is there any help at hand?

There is help at hand. First of all having 2 second degree relatives with breast cancer does pose a slightly increased risk compared to general population. If you are unaware of anymore cases in the family please make it a point to find out and if there are more, it is possible to assess your risks by appropriate genetic counseling and testing. In general it is better for you to be aware about risk factors related to the disease such as conditions that allow our normal natural hormones (estrogen) to act for a long time in our body on female target organs like breasts, uterus and ovaries without a break namely, early menarche and late menopause, postponing childbirth or not having children at all. Visit a gynecologist as awareness is more important and you must learn the techniques of self breast examination which can be easily performed even during a shower. Intrauterine device for women who have not completed at least one childbirth should be preferably avoided. I would recommend the use of condoms or low dose oral contraceptive pills such as novelon or femilon but would still advice you to have a personal consultation first to assess risk status and advice on future fertility.

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I am a twenty eight year old married woman. My first delivery was by a Caesarean section. The reason given to me was that foetal heart beats were feeble. Otherwise I was doing exercises and keeping my health in great condition. I was all along led to believe that I would have a normal delivery, which I preferred because I am a working woman and wanted to get back to shape immediately. Now I am pregnant again and I am worried I may have to go for a caesarean section gain. Some people tell me that if the first delivery has been through caesarean, then the following delivery will also be only through c-section. I am going for regular walks and all my parameters are normal. What are the chances of normal delivery this time? Also, my first delivery was by a vertical section on my stomach which looks ugly. I want to get rid of the scar. After the second delivery is through, is this possible?

First of all pregnancies are always categorized as low risk and high risk, never as “no risk”. All obstetricians treat their patients hoping for a normal outcome for mother and child and decisions cannot always be foretold when things look apparently normal. Even a normal labor can be converted to an emergency c-section due to a sudden abnormality in fetal heart rate pattern. Since you had it as an emergency section for a non recurrent indication, it is best to discuss with your obstetrician about your chances this time for a normal labor. The decision would depend on the indication, scar integrity and the health condition of mother and fetus in the current pregnancy. If you have a tendency to form keloids (pigmentation and elevation of scar due to an excessive healing process) then it is likely to occur on any scar that you may incur so get in touch with a dermatologist who can advise you on laser treatment for scars. The incisions for caesarean these days are mainly “bikini cut” and rarely visible.

I lead a life of great tension and it is affecting my health, especially now that I am forty seven years old. The ambience at home is not at all conducive to even tolerate any pre-menopausal outbursts or irritability as I have my parents-in-law at home. I am seriously considering hormone replacement therapy. But my GP tells me that it is better that I take up meditation, modify my diet to a high protein one and take up painting which was once a hobby; and forget about taking HRT because he says that it may not be good for everybody, especially because it has now been proved to cause cancer or may result in osteoporosis. What is your call on HRT?

Hormone replacement therapy is advised only after personal consultation with a gynecologist. Any usage of hormones is done with discretion. It is wrong to assume that there are no beneficial effects and in fact its usage helps in keeping osteoporosis at bay. Please include the meditation, high protein diet and painting as hobby in your agenda, but at the same time consider visiting a gynecologist to get the right prescription of HRT suitable for you which can be decided only after a a comprehensive health and family history and check up.

 

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STETHOSCOPE

Stethoscope, our regular health column will bring you a lot of information on health care issues, counseling and advice from doctors in different fields. You can send in your queries to doctor@evestimesonline.com So make the most of it!

Can you stomach these facts?

*Most gastro-intestinal disorders arise due to infections caused by poor hygiene, both personal and environmental.

* Infectious diseases like diarrhea, caused by the rota virus and cholera, due to a water-borne bacteria named vibreao cholera, are the commonest gastro-intestinal diseases in children.

*Add a pinch of purified common salt and a tablespoon of sugar to a glass of pre-boiled and cooled water. Stir the mixture and give the solution to the patient with diarrhea in minute doses of one to five spoons every five to ten minutes. Dilute fruit juices can also be given.

*Contrary to earlier belief that ulcers occur due to increased secretion of acid and stress and alcohol, it is now know that Helicobacter Pylori in the human stomach is the chief cause.

• Symptoms of ulcer are upper abdominal pain and vomiting. Characteristic features of the ulcer pain are localization to the epigastrium, relation to food and periodicity.

Gastric and duodenal ulcers are the two most common kinds of peptic ulcers.