Dr. Gunasheela Gynaecologist & Obstetrician, Chairperson Of The Indian Branch Of Royal College Of Obstetricians And Gynaecologists Of U.K.

Q: I am a 26yr. old married woman. I was married two years back. I got pregnant this May {2002} but had a miscarriage in June. At that time I was in Zurich and all the reports of my tests came out normal. I have returned to India after that and had my periods in August. After that I have been trying for a baby but have not succeeded. Consulted a local doctor in Gurgaon. And after the tests I was diagnosed with HYPOTHYROIDISM {elevated TSH-6.07mIU/L} BUT FT3 and FT4 are normal. I also have high B.P {150/110} diagnosed for the first time. I want to know whether all this will create problems while conceiving. I am not able to get proper answers to my problem. PLEASE HELP

A: You have a case of secondary infertility having had a miscarriage in June 2002. It is not very easy to find out the cause of a single miscarriage. A single miscarriage can happen to anybody since 10 – 12% of pregnancies normally end up in abortion due to chromosomal abnormality in the embryo. Embryos with higher level of abnormality are frequently being discharged along with monthly menses without the patient’s knowledge. So the cause of a previous miscarriage does not have any relevance to the present state of inability to conceive.

Your hypothyroidism can easily be treated with Thyroxin tablet. This itself might help you conceive but what is worrying now is your blood pressure of 150/110. I suggest that you see a good cardiologist immediately. He has to find out the cause for this blood pressure and also treat you. Only after this gets sorted out, you should try for pregnancy. Since you are still 26 years old you have sufficient time to get your medical problems sorted out before trying your next pregnancy.

One of your articles cited childlessness as a contributor to being overweight. I'd never read that before... What's the basis for that statement? Looking forward to hearing from you!

My article mentioned overweight being a contributor to childlessness and not the reverse. Obesity is frequently associated with Polycystic Ovarian Syndrome. In this syndrome, there is a disorder of glucose metabolism caused by excessive secretion of insulin. High level of insulin results in release of free testosterone, which causes disruption of ovulatory follicles resulting in total an ovulation or release of poor quality ova.

Fatty tissue is also known to convert androgenic hormones to oestrogens. This is known as extra glandular production of estrogen hormone. Continuous production of estrogen from fatty tissue can disrupt pituitary production of gonadotropins. This again results in an ovulation. If cyclicity is not properly maintained in the body it is difficult to get pregnant either because the ova is not produced at all or if they are produced, they are of poor quality.

Q: I have a major problem that I have auxiliary breast at my underarms approximately of size 1x1n1/2 inch in size. It looks very ugly when I look in mirror and even when I wear tight dresses. I am unmarried, I consulted a gynaecologist she suggested to consult a plastic surgeon.....he suggested for gynaecologist a cosmetic surgery to remove it, I was ready for it but few days back I came to know that some important glands will be there near underarms. So, is it harmful to remove this auxiliary breast, will the doctor remove these glands also, will it affect my future life. Please help me.

A: The accessory breast tissue in the axilla is placed very close to the skin and it will be far away from the auxiliary glands, which are very deeply placed. So there is no danger of the gland being involved during operation.

Q: I want an address of a good doctor attached to an infertility clinic or hospital who will help to understand and cure the infertility.

A: Please let us know which city are you based in?

Anyway below given is the address of Dr. Gunasheela:
Gunasheela Surgical & Maternity Hospital
# 1, Dewan N Madhava Rao Road
Basavanagudi
Bangalore - 560 004
Ph: 080 - 6673585/6/90

Q: I have been having this white discharge; I am really scared, is it something serious to worry about. Please help me out.

A: Vaginal white discharge is of very common occurrence even in normal health. The discharge consists of cervical mucous, exfoliated superficial cells of the vagina and some water produced during cell metabolism. Vaginal discharge also harbours a few bacilli, which are good for health. Vaginal discharge does increase and decrease in quantity and its nature it is cyclical in response to hormones produced during normal menstrual cycle.

Vaginal discharge starts from about prepubertal age and continues till postmenopausal period. Some people are particularly conscious of this and they have a fear that it may be a symptom of cancer.

There are some discharges caused by certain protozoan infections known as trichomonous virginals and some caused by a fungal organism known as Candida Albicans. All these are easily curable. Sometimes one can have aversion of cervical canal (the lower end of the uterus due to minor injury to cervix during child birth). This kind of cervical canal frequently gets infected and produces a discharge. All these have to be seen by a gynaecologist and treated differently according to the situation.

Normally early cancer of the cervix does not produce any discharge. It is only highly advanced cancer, which gets secondarily infected, that causes vaginal white discharge.

Q: Dr. I am a 23 yr old girl with fit health. I get my periods late. When I do yoga they r regular but now when I have stopped they again have become irregular. I mean when I do physical exertion I get my periods otherwise they are late. This time also the date was 2nd but till now I haven’t got it. Because of this a lot of pimples have come out on my face. I want some home remedy for this plz help me out.

A: A 23-year-old girl with irregular periods which gets automatically corrected while doing exercise is very typical of Polycystic Ovarian Syndrome. This condition is identified by several features:

1. Occurs in pubertal age.
2. Accompanied by obesity.
3. Irregular infrequent periods is the rule.
4. Ultrasound scan of the pelvis shows a typical ovarian gland with thickened fibrous tissue like structure inside the ovary surrounded by multiple small follicles.

These patients also have features caused by excessive amount of male hormones such as acne, some have male distribution of hair and some have purplish discolouration of skin along the folds of the armpit. This condition is not serious but it has to be confirmed by a gynaecologist and treated accordingly.

The only home remedy available is to go on reducing your diet and continue to do physical exercise to keep fit.

Q: I am nearing the age of 40, and my periods come once in a month. I have bleeding only for the first day and after that nothing. I do not have any other symptoms as mentioned in your column. Could it be menopause or should I consult a doctor.

A: It is very unlikely that you are reaching menopause at 40. The average Indian woman usually attains menopause at about 50 yrs of age. One does not go by the quantum of menstrual bleeding to diagnose menopause. If you are worried that you have got into the state of menopause, you may get your Serum FSH done in any laboratory. If Serum FSH is more than 15 on the 2nd or 3rd day of your cycle, it is likely that you have attained menopause.

The only reason why a woman wants to find out if she is in menopause is to start treatment for prevention of osteoporosis. Women lose a lot of bony structure matrix during the state of impending menopause. It is at this time they should start taking bone building therapy. I am interested in doing IUI/IVF and want suggestions of a good doctor who could help me.

Q: What are the symptoms and changes in a woman's body during & after menopause?

A: Menopause is the period during which the hormones in a woman's body undergo changes. This is associated with cessation of menses with large number of symptoms like:

1. Emotional disturbances
2. Mood swings, depression etc
3. Dry Skin
4. Cessation of menses.
5. Low self esteem
6. Hot flushes
7. Sweating
8. Bone and muscular pains
9. Dryness in vagina, hence giving rise to painful intercourse etc.
10. There is a gradual decrease in the bone density leading to osteoporosis, i.e. thinning of bones. Thereby making the patient vulnerable to fractures like spiral, forearm, and thigh.
11. There is also slightly higher chance of getting a heart attack
Hence life style changes are very important. This includes exercises, weight reduction, calcium supplement etc. This could be given to you by your doctor.

Q: Dear doctor, I am Devi, presently residing in the US. After coming to US my periods was not regular, I was consulting the doctor for this problem that they told it may be due to the climate change. I came to US on 2001, at the time I did not think of getting pregnant. Soon after some months I had to undergo some blood tests and was told that my hormone level was not good. As I don't have the idea of getting pregnant they prescribed me the drug provera. I was taking that drug for one year. At last they told that I may have PCO. They didn't do any test but they told that it should be. Now the doctor is saying that I have to go to the fertility treatment with ovulation induction with the drug clomid, (clomophene). I have some doubts in this what will happen if I take this drug, for how many cycles I should take. When is the best time for doing intercourse while taking this drug? As I want to conceive I am going to the fertility treatment next month. Please say what are the procedures before giving this drug, like whether they will check my ovaries. My doctor told that I am not ovulating well and I am not releasing the eggs. That is the problem. Please answer me I am really much worried I have no parents or friends here and I am all alone here and I can not share my feelings also, if you answer me I’ll be happy. Thanks for reading my mail and spending your precious time for me. Thanks.

A: PCOS is a very common condition affecting young women from the time of puberty till the time of menopause. These people are usually obese; frequently have excessive hair growth and irregular periods. About 30-40% have disturbed ovulation causing infertility. Clomiphene Citrate (CC) is a popular drug used to induce ovulation. But before you start using them your specialist must make sure about your husband’s seminal quality and if your tubes are patent. The CC tablets are given for a period for 5 days starting from Day 3 or Day 5 of your menses.

If the ovulation occurs, it may happen about 5-6 days after you finish the course. So, one must be sexually active from the 10-17th day of the CC induced cycle. The doctors may want to monitor the success of ovulation by ultrasound scanning. You may interrogate your doctor in this direction and find out further information from him/her.

Q: Hello Doc. My name is Mrs. Anjali Gawand. I am 24 years old, have been married for past 3 years. I got pregnant in the first year of my marriage. But unfortunately had undergone a miscarriage. After that I started putting on weight. And started getting period problems, like not getting periods for 3-4-5 months together. And due to this I never got pregnant again, even after trying for 2 years. Then I came to know about a disease called P. C. O. D. -through a T. V. chat show. And the doctor spoke about the symptom which shows that the person is suffering from P. C. O. D. and I found all those symptoms in me. It seems that the female who is suffering from this disease get a period problem, he said that in this Disease the ovaries are covered with fat's not allowing the eggs to come out due to which the woman get's period problem, she starts putting on weight - and then her neck starts becoming black because some black velvety type skin starts growing on the neck and so on - I found all these symptoms in me doctor. And that is how I came to know that I am also suffering from this P. C. O. D. But now Doctor I want to know some more information about this disease - and would also like to know what should one do if she gets it. Doctor please help me to solve my problem. I am waiting very eagerly to become a mother - please help me. Thanking you, Anjali.

A: If you have all the symptoms that you mentioned, excessive weight, irregular periods and blackish discoloration of the skin over the neck etc., you probably have PCOD. PCOD is not a big problem; nearly 65% of patients who come to my Infertility clinic have this condition. First of all you must make sure that you haven’t got any problem with your thyroid gland. If you pass those tests, there are few tests relevant to confirm the diagnosis of PCOD. The most important test is an ultra sound examination of the pelvis for appearance of ovaries. You require some basic pituitary hormone assays. You will also need some evaluation of serum insulin. I would advise you to see an Infertility Specialist for treatment.

Q: Hello Doctor, I'm Nanditha & 26yrs old & my husband is 31yrs old. We are married since 2 1/2 yrs.We are planning for a baby now. But my periods had become irregular after stopping anti-baby pills which I had used for 6 months. Now my periods have become regular since 6 months but duration between my periods has become more than 35 days. Because of this I’m unable to know when the eggs are released. What would be your suggestion regarding this? How do we get our timings right? Thank you in advance, Regards Nanditha.

A: Having periods once in 35 days is not abnormal. If you are getting your periods once in 20 days the ovulation would occur on 14th day of cycle. If you get once in 35 days of cycle, you will get on 21st day. Ovulation is always related to next period and it has to happen on 14th day of your next period. So you may concentrate on sexual activity around that period.

Q: Dear Doc, I shall be getting married soon, kindly advice on the best option for contraception.

A: The best contraceptive for you would be the Oral Contraceptive Pills. There are a number of pills that are in the market now and you could go in for a low dose pill like Femilon or Novel on, which have very few side effects and associated with almost no weight gain. Please do not use the intra uterine contraceptive device (IUCD) (e.g.; Copper T etc) as you still not have any children? It can be started on the 5th day of your period and it’s to be continued for 21 days. You could consult your local gynaecologist for further information regarding the Oral Contraceptive Pills. It is the most effective contraceptive option available to you right now.

Please Note: It does not cause any impalement in your future fertility. The obesity to conceive returns as soon as you stop the tablets.

Q: Dear Doctor, I use contraceptive pills for 3 months (From August-Nov of 2002) later because of side effects I stopped them. The weight that I gained in those 3 - 4 months is 17 kgs. Now even after stopping Iam unable to loose that weight. Can u help me out Please Yours, Rajeswari

A: Oral contraceptives do cause weight gain, but only in the order of 3 – 4 kgs. 17 Kgs is just too much of weight to put on and one cannot entirely blame the oral contraceptives for this. I would advise you to enroll yourself in a gym and a regime of diet and exercises will help you to reduce your weight. It is important to loose weight as obesity can have any impact on Future fertility, Cardio Vascular problems, Arthritis, diabetes, etc.

Q: I usually have regular periods, but sometimes, it doesn't come for 2 or 3 months. We are not planning for kids right now and I am not using any medications also. Why is it so. I get tensed, when they are delayed... Any home remedies (like diet etc) to get regular periods... when my periods come after 2 or 3 months, it bleeds horribly. I become very weak. Any suggestions would be greatly appreciated. Thanks

A: Your irregular periods are a very common problem caused by obesity, hormonal imbalances or by a very common condition called Poly Cystic Ovaries (PCO). This is a condition where one may not be producing an egg at the right time of the cycle. I don’t know what your weight and height is. If you are over weight, I would advise you to join a gym and go on a reducing diet. This will help to regularize your periods to a large extent. Regarding the excessive bleeding, people with irregular periods do bleed heavily. There are medications to reduce the bleeding like oral contraceptives, mefanamic acid, tranexamic acid, etc. Oral Contraceptives will help to regularize your periods and this will be a suitable option, as you are not planning to have children. Please contact your local gynaecologist for further details regarding the Oral Contraceptive Pills.

Q: Dr. Gunasheela, I'm from Sri Lanka and 29 years old. My wife is also of the same age. We've been married for 3 years but still we have no kids. We have taken medical treatment from the start but have not met with any success. Following problems are there. 1. My sperm count is low (5-10 millions) 2. My wife has undergone a myomectomy (to remove fibroids) 5 years back. We have tried IUI several times. Is it possible for us to get an IVF done at your institution? If yes, what would be the cost (a rough estimate)? Please reply. Yours Truly, Sandaruwan Sooriyahetti

A: You are an ideal couple for In Vitro Fertilization (IVF). Sperm count of 5-10 million is more than adequate for this kind of procedure. Regarding your wife, she is said to have had myomectomy 5 yrs back. Myomas are notorious for recurrence. I do not know if she has recurrence already, in any case even if there are myomata in the musculature of the uterus it doesn’t matter, if the uterine cavity is satisfactory. Myomectomy operation is also said to produce adhesions, which can cause problem for natural conception. Later it may even come in the way of conception by Intra Uterine Insemination (IUI).

If you want to come for IVF to my institution you are welcome. The overall charges inclusive of biochemistry investigations, drugs required for ovulation induction and laboratory procedures will cost you approximately Rs.100,000/-.