Uterine fibroids are one of the most common causes of infertility and may cause pain and excessive bleeding during menstruation. They have also been linked to infertility in women.

Genetic changes, hormonal imbalance, extracellular matrix, and other growth factors are responsible for the presence of fibroids. The growth rate and size of the fibroids may vary from one woman to the other. There are times when fibroids may even shrink on their own.

Depending on the location of the fibroid in the uterus, they may be categorized into subserosal, mucosal, pedunculated, or fundal fibroids.

However, it is possible to get rid of troubling uterine fibroids with the help of a surgery. Fibroid removal surgery is of different types and is most commonly known as myomectomy.

Depending on the size, location, and shape of fibroid, fibroid removal surgery could be performed using any of the following two techniques:

• Laparoscopic fibroid removal surgery
• Open fibroid removal surgery
• Hysteroscopic fibroid removal surgery

If there is a single, small fibroid, the specialist may choose non-surgical fibroid removal (uterine fibroid embolization or radiofrequency ablation) to remove the growth. However, if the size of the fibroid is large or if there are multiple uterine fibroids, surgery is often considered to be the best solution.

Minimally invasive myomectomy or fibroid removal surgery is nowadays most common and can be performed with much ease and success.

Who needs to undergo Fibroid Removal Surgery?

Not all of the women need to undergo a surgery to get rid of the fibroids. It is only when there are certain issues that need to be taken care of when the surgery is recommended.

The following are the appropriate candidates for fibroid removal surgery:

• Women who experience painful periods and heavy bleeding
• Women who wish to get pregnant in the future
• Women suffering from infertility due to fibroids
• Women for which alternative treatments such as drugs and non-invasive treatment has not worked before
• Women suffering from other health issues due to fibroid such as low back pain and urinary tract or bowel issues

Hysterectomy is a surgical procedure conducted to remove the uterus, also known as the womb. It is an organ that holds and protects the fetus during pregnancy. The hysterectomy surgery also involves removal of the other parts of the reproductive system such as ovaries (where eggs are produced), fallopian tubes (which carry the eggs to the uterus), and the cervix (neck of the uterus).

The hysterectomy surgery can be performed through the vagina (vaginal hysterectomy) or through the abdomen (abdominal hysterectomy), with or without the use of laparoscopy. After having a hysterectomy, the woman is not able to conceive.

Vaginal hysterectomy is the surgical procedure to remove the uterus (womb) through the vagina. Depending on the patient’s condition, the doctor will choose which part is to be removed by hysterectomy surgery.

In which conditions would the doctor suggest hysterectomy procedure?

There are many reasons why a doctor recommends this type of surgery. The general condition where hysterectomy is recommended are:

• Cancer of ovaries
• Cancer of the uterus or cervix
• Uterine prolapse – when the uterus slips from its normal position into the vagina
• Abnormal tissue growth
• In some cases, irregular or heavy menstrual flow and discomfort may make hysterectomy an important treatment option.

You should know that removal of the uterus and other reproductive organs is a serious condition and there may be several hysterectomy side effects, and it can make significant changes in your life. A vaginal hysterectomy may be contraindicated in patients with uterine cancer, big size of the uterus, and narrow vagina.

The natural process of fertilization involves the conjugation of an egg and sperm inside the woman’s body. In-vitro-fertilization (IVF) is the procedure that involves the conception of an egg outside the body in a laboratory.  IVF comes under assisted reproductive technology (ART) that involves the use of advanced medical technology to help with pregnancy in the woman.

Which conditions may need IVF support?

• Blocked Fallopian tubes
• Endometriosis
• Advanced age of a woman
• Decreased sperm count
• Failure of the treatment with fertility drugs

Types of IVF treatment

The different types of treatments available for IVF are:

• Natural cycle IVF procedure: In this treatment, the fertility drugs are not administered. The egg released during the normal monthly cycle is collected and then fertilized.
• Mild stimulation IVF procedure: The lower dose fertility drugs are administered and then the eggs are collected and fertilized.
• In vitro maturation (IVM): The immature ovaries are collected and then allowed to mature in the laboratory.
• Embryo transfer: The fertilized embryos are taken and transferred to the mother’s womb.
• Blastocyst transfer: The embryos are cultured in the laboratory until blastocyst stage and then transferred to the mother’s womb.

IVF with Laser Assisted Hatching

Assisted hatching is a technique used in IVF where a gap or a hole is created on the outer shell of the embryo called zona pellucida before transferring the embryo into the mother’s womb. Before the implantation of the embryo, the developing embryo should “hatch” out of its outer shell (zona pellucida).

Sometimes the embryo is thick, which decreases its ability to hatch on its own. Making a hole or thinning the outer layer may help the embryos to hatch, which increases the chances of pregnancy. Pregnancy cannot occur unless the embryo hatches. Thus, assisted hatching IVF success rates are higher than simple IVF success rates.

Because of the use of additional technology, IVF with laser assisted hatching cost is higher than just IVF cost.

IVF with laser assisted hatching is recommended when:

• The embryos do not have sufficient energy and nutrients to complete the hatching process
• The woman is older than 37 years as they are more likely to have thick zona pellucida due to increased levels of follicle stimulating hormones
• The candidate has had repeated IVF failure
• The quality of the embryo is poor and demonstrated slow cell division and excessive fragmentation

It is performed by using infrared 1.48-μm diode laser. The technique does not cause any blastocyte damage. Laser assisted hatching has several advantages such as minimal handling of the embryo,  fast delivery, and exact control over the drilling of the hole.

It is performed before transferring the embryo into the mother’s womb on day 3, 5, or 6 after fertilization. An opening in the zona pellucida is created by drilling it with acidified tyrode’s solution.

The embryo is held firmly using holding pipette and a microneedle is applied on the area of zona pellucida. The microneedle is preloaded with Tyrode’s acid using mouth-controlled suction before each micromanipulation.

The acid is expelled over a small area of zona pellucida until it is breached. Suction is applied immediately after the breach of zona pellucida to prevent excess acid entering the embryo. The patients should be provided with antibiotics after implanting the embryo to reduce the risk of infections. 

IVF with Egg Donation

This procedure Is exactly the same as the usual IVF procedure with a difference that the egg used for fertilization comes from a different candidate than the one undergoing IVF. This procedure involves a process known as female egg donation in which a suitable candidate donates an egg for successful fertilization with the retrieved sperms.

The egg donation procedure is similar to how the eggs are retrieved from the womb of the future mother. The only difference is that during egg donation process, the ovaries of the donor are stimulated prior to the collection of suitable number of eggs from the ovaries. All the remaining stems in the donor egg IVF process are similar to the rest of the IVF procedure.

IVF with egg donation is mostly performed in the case of women who have insufficient number of eggs or whose eggs are compromised with respect to quality. The IVF specialist advices the woman to opt for donor eggs in case they believe that there are minimal chances of IVF success because of poor quality of her own eggs.

IVF with ICSI

Intracytoplasmatic sperm injection (ICSI) is an IVF variation in which the sperm is directly injected into the egg for fertilization. The resulting fertilized egg is placed in uterus of the woman. It is the most successful infertility treatment used to treat sperm-related conception problems in couples.

ICSI procedure does not require the sperm to penetrate the layers of the egg. It is highly useful to treat infertility problems in couples who suffer because the male partner’s sperms are either not able to get into the egg or are unable to fertilize the egg even when they are able to get through it.

During IVF with ICSI procedure, the eggs are extracted and held in one place with the help of a glass tool. A single sperm is injected into each egg using a small glass tube. The eggs are cultured and checked for fertilization overnight. The fully fertilized eggs are selected. A few fertilized eggs selected are placed in the uterus with the help of a catheter. The leftover embryos are preserved for future use.

While in simple IVF, the eggs and sperms are mixed together and allowed to fertilize naturally, in ICSI, a sperm is forced into the sperm for fertilization.

ICSI success rates largely depends on the quality of sperms used for fertilization. Overall, the success rate of ICSI is greater than any other technique used as a variation in the IVF procedure.

IVF with ICSI and Donor Sperms

IVF with ICSI is also performed when the sperms come from a suitable donor and not from the male partner of the female undergoing IVF procedure. ICSI IVF treatment is the same when conducted with donor sperms as it is with sperms that come from the male partner.

ICSI treatment involves the injection of a single sperm directly into the egg from the female partner or a donor. In the case of ICSI with donor sperms, a semen sample from a suitable donor is retrieved. The sperm sample is processed and viable and good quality sperms are extracted from for further procedure.

Next, the entire ICSI procedure is conducted in a similar manner. ICSI success rates are the same whether the sperm comes from a donor or the actual male partner. ICSI treatment cost is separate from the cost of IVF.

IVF with ICSI and Optical Spindle View

Optical spindle view is a specialized technique used at the time of IVF and ICSI. This technique helps the fertility specialists view the division of cells carefully to ensure that the entire process goes on smoothly.

The optical spindle view technique is used after the fusion of the eggs and the sperms is complete using ICSI as a part of the IVF procedure. The use of this technique helps ensure that the ICSI procedure is successful and that no DNA damage taken place around the site of injection of the sperm.

IVF with ICSI and Testicular Biopsy

Sometimes during IVF and ICSI, the fertility specialist may order a testicular biopsy to assess testicular function in the male partner before using his sperms. During testicular biopsy procedure, a small sample of tissue from just one or both the testicles is removed and examined under a microscope. The specialist confirms whether the male partner is fertile or not and accordingly donor sperms are arranged for IVF and ICSI.

Hysterectomy is the surgical procedure to remove your uterus, also called as womb. It is the organ that holds and protects the fetus during pregnancy. The surgical hysterectomy procedure also involves removal of the other parts of the reproductive system such as ovaries (where eggs are produced), fallopian tubes (which carry the eggs to the uterus), and the cervix (neck of the uterus). The hysterectomy procedure can be performed through the vagina (vaginal hysterectomy) or through the abdomen (abdominal hysterectomy), or by laparoscopy. After having a hysterectomy, you will not be able to conceive.

In which conditions would the doctor suggest hysterectomy procedure?

There are many reasons why a doctor recommends this type of surgery. The general condition where hysterectomy is recommended are:

• Cancer of ovaries
• Cancer of the uterus or cervix
• Uterine prolapse –when uterus slips from its normal position into the vagina
• Abnormal tissue growth
• In some cases, irregular or heavy menstrual flow, and discomfort may make hysterectomy an important treatment option.

You should know that removal of the uterus and other reproductive organs is a serious condition and there may be several hysterectomy side effects, and it can make significant changes in your life.  

Women suffering from polycystic ovarian syndrome may show different symptoms. Therefore, polycystic ovarian syndrome treatment for them may differ depending on their concerns.

For example, some women suffering from PCOS could be overweight, therefore, weight loss and diet monitoring may be advised to them initially. Some women with PCOS may have a normal body mass index (BMI), however, they could be suffering from other symptoms such as cystic acne or excessive facial hair. Therefore, she may be put on birth control pills for a while to negate the symptoms.

The following are some of the most common forms of polycystic ovarian syndrome treatment available worldwide:

For women not planning a pregnancy

• Self-care: Weight loss, lifestyle modifications, and physical exercising
• Medications: Anti-diabetic medications (metformin), statins, and hormone and hair inhibitors
• Hormonal: Birth control pills

For women planning a pregnancy

• Self-care: Weight loss, lifestyle modifications, and physical exercising
• Medications: Anti-diabetic medications (metformin), statins, and hormone and hair inhibitors
• Ovarian stimulation: Gonadotropins, letrozole, and Clomid
• Surgery: Laparoscopic ovarian drilling (ovarian diathermy)

In laparoscopic ovarian drilling, two to three minor incisions are made in the lower abdomen to pass the laparoscope and instruments through which the laser is passed. The ovarian cysts producing high amounts of androgens are ruptures with the help of heat generated by the laser. This lowers the LH and testosterone levels and therefore, the hormone imbalance is temporarily restored.

Symptoms of Polycystic Ovarian Syndrome

The following are some of the symptoms of polycystic ovarian syndrome:

• Irregular periods
• Absence of periods
• Difficulty getting pregnant
• Excessive hair growth (hirsutism) mainly on the neck, face, back, and chest
• Weight gain
• Male-type baldness
• Hair thinning
• Cystic acne
• Oily skin
• Depression and mood swings
• Severe premenstrual syndrome (PMS)

Diagnosis for PCOS

Irregular periods or absence of periods is one common sign that may indicate that the woman may have a polycystic ovarian syndrome. However, it can only be confirmed with the help of ultrasound during a regular visit to the gynecologist.

The following tests are performed to confirm PCOS:

• Ultrasound (abdominal or transvaginal)
• Blood work-up: LH, FSH, blood sugar, TSH, free testosterone, and Prolactin

Who all can get PCOS Treatment?

Not all women suffering from the polycystic ovarian syndrome are a candidate for treatment. The following women are advised to seek treatment for the polycystic ovarian syndrome:

• Those with irregular or missing periods
• Women with severe symptoms such as cystic acne, hair loss or thinning, and considerable weight gain
• Women trying to conceive but are unable to due to irregular ovulation