NewZNew (Chandigarh) : Over 110 doctors of National Integrated Medical Association (NIMA) attended a CME (continued Medical Education) conducted in association with Max Super Speciality Hospital Mohali on ‘Fertility Enhancing Procedures’ at Hotel Park Grand, Chandigarh last night. Dr Seema Wadhwa, Senior Consultant, Gynaecology and Advanced Laparoscopy Specialist, Max Super Speciality Hospital Mohali spoke on the latest advancements to treat infertility. Dr Deepak Gupta, Senior Consultant, Neurology spoke on ‘Management of Hyperacute Stroke’. Present on the occasion were Dr R P Gaba, President NIMA and Sandeep Dogra, Vice President-Operations, Max Hospital.

Talking about Laparoscopic Treatment  Options, Dr Wadhwa said that many procedures that were traditionally only done through large open incisions are now  done laparoscopically through a keyhole. These include options such as Laparoscopic Myomectomy for the removal of large Fibroids or multiple fibroids and Laparoscopic treatment of advanced stage Endometriosis  which causes adhesions, Ovarian cysts and blockage of Fallopian tubes and is a major cause of infertility.

Hysteroscopic Treatment Options such as removal of removal of scar tissue from the inside of the uterus, or removal of a uterine septum can be done as day care procedures informed Dr Seema. “In patients with failed medical management, diagnostic Laparoscopy and Hysteroscopy becomes mandatory to improve reproductive outcome and Operative procedures are done at the same sitting. Hence Endoscopy is a powerful tool for the diagnosis and treatment of intrauterine benign pathologies to enhance fertility. It is a simple, safe, reproducible, effective, well-tolerated, and low-cost surgical procedure  without any analgesic pre-treatment, for assessing, diagnosis as well as treatment in the same sitting. This is also called see-and-treat approach, she added.

“Technological improvements, such as miniaturized hysteroscopes, highly advanced HD Cameras, mechanical, and electrical 5F instruments, innovations in Latest Energy Sources  and the use of correct techniques, enable us to perform many operative procedures in a Day Care setting, added Sandeep Dogra, Vice President-Operations. Important advantages of these Fertility Enhancing  minimally invasive Procedures  are decreased recovery time, better cosmetic results Ultra short stay in the hospital and most of all these are totally painless Procedures, he added.

Infertility (or a state of sub–fertility) in women can manifest itself as either:

• the inability to become pregnant
• an inability to maintain a pregnancy
• an inability to carry a pregnancy to a live birth.

Laparoscopic Treatment Options:

• Laparoscopic Myomectomy for the removal of large Fibroids or multiple fibroids which distort the shape of uterus and prevent pregnancy through a 5 to 10mm insicion
• Laparoscopic treatment of advanced stage Endometriosis  which causes Adhesions, Ovarian cysts and Blockage of Fallopian tubes and is a major cause of infertility.
• Laparoscopic removal of large Ovarian masses or Cysts which prevent egg formation in a woman.
• Laparoscopic procedures in patients with a history of multiple prior surgeries.

 Hysteroscopic Treatment Options/procedures which can be done by day care include:

• removal of scar tissue from the inside of the uterusor
• removal of a uterine septum,
• removal of Polyps in Uterus as well as cervix,
• Fibroid removal through Hysteroscope
• Opening of  Proximal Tubal Blockages,
• Biopsies & workup in Planning line of medication

 Female factors that affect fertility include the following categories:

• Uterine: Congenital or acquired defects; may be associated with primary infertility or with pregnancy wastage and premature delivery.

Many Uterine abnormalities can contribute to infertility, including Uterine or Cervical  Polyps, Fibroids, Endometriosis, Pelvic adhesions (scar tissue in the pelvis) and Uterine Anomalies such as a Uterine Septum and Adhesions as in Asherman’s syndrome . These abnormalities have been reported in 21 to 47% of patients undergoing IVF cycles.

• Ovarian: Alteration in the frequency and duration of the menstrual cycle—Failure to ovulate or form an egg is the most common infertility problem as seen in PCOS patients.
• Tubal: Abnormalities or damage to the fallopian tube; may be congenital ( by birth) or acquired
• Peritoneal:Anatomic defects or physiologic dysfunctions (eg, infection, adhesions, adnexal masses as Large Ovarian Cysts)
• Cervical: Stenosis or abnormalities of the mucus-sperm interaction