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Miscarriage Due To Genetic Abnormality
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Dr. Aniruddha Malpani
Renowned infertility specialist. He runs an infertility clinic in Mumbai and has written many books.
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Hydrocele
 Pitchaiah asks,
My marital life is 4 years old but we cannot get a baby because my sperm count is nil (azoospermia) and I have one testis (left). It is also affected by hydrocele? What is the solution?
 Dear Pitchaiah,
A hydrocele is a collection of water around the testis and does not affect sperm production. Can you send me the detailed semen analysis report? Volume? Fructose? PH? Please repeat it again. Do 2 samples, after an interval of 1 hour (sequential ejaculate), and ask them to centrifuge the sample and check the pellet for sperm precursors. Send me this report once you get it. If it's still zero, then the next step is to find out what is the reason for your azoospermia. There are 2 possibilities - obstructive azoospermia; or non-obstructive azoospermia. You need a testis biopsy to determine if sperm are being produced in the testes or not. A good urologist will do this for you. Ask him to do multiple micro biopsies and send them to the pathology laboratory in Bouin's fluid. Let me know what the report is once you get this.
Treatment For Healthy Egg
Zubia asks,
I'm 30 years old. My fallopian tubes are blocked. I have tried ICSI two times. But my egg quality was not good which did not make healthy embryos. Is there any treatment for healthy eggs, which I can try before my next treatment? Or any treatment in the world to open tubes?
Dear Zubia,
I agree you have tubal factor infertility. I am sorry there is no way of repairing damaged fallopian tubes, as they cannot function normally even after surgery, since their inner lining (the cilia) has been damaged. I agree that IVF would be your best treatment option, as it would maximise your chances of conceiving quickly. This can be very frustrating.
Can you send me more details about your prior IVF cycles? What medicines were used for superovulation? How many eggs were grown? What was the E2 (estradiol) level in the blood? How many embryos were transferred? What was the embryo quality? What was the endometrial thickness?
You should have at least this much basic information. If not, please ask your doctor for your detailed medical records. This will help immensely in improving your chances of success for your next IVF treatment cycle, as we can use this information and learn what to do differently, to maximise the chances of a pregnancy.
Repeating the ICSI cycle in our clinic with better superovulation and careful monitoring and transferring more embryos would be your best treatment option, as it would maximise your chances of conceiving.
Myomectomy
Ruby asks,
I had a large fibroid and had a myomectomy done 6 months ago. Recently, I got pregnant and had a miscarriage at 5 weeks. The ultra sound reports said that they saw a scar and the next day I bleed and I had miscarriage. I am just wandering if the miscarriage could be due to scar tissue in my uterus due to myomectomy.
Dear Ruby,
This is very unlikely! The commonest reason for a miscarriage is a genetic abnormality in the foetus, and this is Nature's defence mechanism, to prevent the birth of an abnormal baby. While these defects are often random, they are commoner in older women. This is because the eggs of older women have more genetically abnormalities, because they have "aged" and have genetic defects, which cannot be screened for. Intramural fibroids (in the wall of the uterus) usually do not need to be removed, as they do not affect embryo implantation. These can be best removed with an operative hysteroscopy.
Premature ejaculation
Sun asks,
I'm married for 3 years now and suffer from a problem of early ejaculation. Can it be cured? If yes, please tell me how?
Dear Sun,
Premature ejaculation is a psychological problem. You can learn to control it by learning the "squeeze technique". Using local anaesthetic jelly (such as lignocaine jelly) can also help to numb the penis, and delay ejaculation. You can also ask your doctor to treat you with antidepressants, which can help some men with this common and distressing problem.
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