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Don’t Let Infertility Get in the Way of Parenthood

Don't Let Infertility Get in the Way of Parenthood

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Every couple dreams of starting their own family – to be able to bear a child, nurture them and see them grow is one of those unique goals that every couple hopes to achieve someday. However, when this long-awaited dream stumbles upon a barrier in the form of infertility, it can be very frustrating. But hey, don’t lose hope yet, because there is a solution.

Want to know more? We reveal a very effective fertility treatment to make your parenthood dreams a reality.

In-Vitro Fertilisation

In-vitro fertilisation or IVF is a type of Assisted Reproductive Technology (ART). ARTs are clinical methods used to treat infertility, using procedures involving both egg and sperm. 

This week’s blog explores the ART method – ‘In-vitro Fertilisation’ (IVF). With its usual success rates ranging from 35%-55%, it has become a very popular fertility treatment method for couples worldwide and, increasingly, in Sri Lanka too. 

IVF uses a combination of medicines and surgical procedures to aid the fertilisation process between sperm and egg cells. Additionally, after fertilisation occurs, IVF helps the fertilised egg to implant in your uterus. Babies born using IVF (popularly known as test-tube babies) have been healthy and successfully delivered using this method. 

Is IVF the answer for you?

IVF treatment is designed for couples with infertility and genetic problems. Other medical conditions and issues for which IVF can be used are:

  • Fallopian tube damage/blockage
  • Ovulation disorders
  • Endometriosis – When tissue similar to the uterus lining grows outside the uterus
  • Uterine fibroids – Benign tumours in the uterus
  • Impaired sperm production/function – Low sperm mobility and functionality 
  • Low sperm count
  • Unexplained infertility
  • Fertility preservation for cancer treatment – IVF is suited for you if you are about to undergo cancer treatment (chemotherapy/radiation) that could affect your fertility. IVF can help you store your eggs and embryos for later use.

The IVF Process - How does it work?

In-vitro Fertilisation Process

Let’s break down the IVF process. There are  6 main stages.

Stage 1: Suppressing the menstrual cycle

This is the first step of IVF. As you begin your period, hormone tests and an ultrasound scan will be conducted. Afterwards, you will be prescribed birth control pills for 2-4 weeks to suppress ovarian hormones that prevent ovulation (the process of the female body releasing egg cells). This is done to synchronise the eggs to ensure that more eggs will become mature during the second stage. Finally, once birth control pills are stopped, most women get their periods again.

Stage 2: Ovarian stimulation

Synthetic hormones and medications will be used to stimulate your ovaries. This is crucial as IVF requires a woman to develop multiple eggs rather than a single egg (the typical amount a woman produces each month). Multiple eggs are needed to ensure the success of the treatment, as some eggs may not fertilise or develop normally after fertilisation.

Stage 3: Monitoring of eggs

This stage is when your doctor monitors the development of the eggs in your ovaries before collecting them for fertilisation. Vaginal ultrasound scans and blood tests will be done to assess this.

Stage 4: Collection of eggs

Once the doctor confirms that  your eggs are mature and ready for collection, you would have to undergo a clinical procedure to retrieve your eggs from your ovaries.  The mature eggs are removed using an ultrasound probe and a thin needle which is inserted into your vagina. This surgical procedure usually takes about 20 minutes. After this process, mature eggs are placed in a nutritive liquid and incubated.   

Stage 5: Fertilisation

Fertilisation is when the collected egg and sperm samples are mixed and incubated. After a few days, embryos (fertilised eggs) may develop. 

Stage 6: Embryo transfer

The final stage of IVF involves placing the fertilised eggs into the woman’s uterus. The doctor will place the embryos in your uterus using various tools such as catheters and a syringe. After 2 weeks, couples are advised to take a pregnancy test to check whether they are pregnant. If the embryo implants in your uterus lining, this will then indicate a successful pregnancy.

Cost and Price of IVF Treatments

Although IVF has considerable success rates, it is the most expensive assisted reproductive treatment. However, it has been the most sought-out infertility treatment method by most couples due to its success rates, despite its high prices.

Benefits of IVF

Treatment for infertility with In-vitro Fertilisation

So, now that you know what IVF is and what happens in its process, is it worth it? Let’s find out.

  1. Improved chances of having a healthy baby

Did you know IVF procedures involve conducting tests like preimplantation genetic testing (PGT) on a fertilised embryo before transferring it to the uterus? These tests assess any abnormal number of chromosomes and risks of inherited genetic conditions like cystic fibrosis or Tay-Sachs Disease in embryos. So if you use IVF, the chances of your baby being healthy is higher.

  1. Better chances of conception

If natural reproductive methods haven’t helped you and your partner conceive, it’s maybe the right time to look into IVF treatments. With success rates ranging between 35%-55%, it increases a woman’s chances of conception due to it being conducted in a highly controlled process. Furthermore, IVF enhances the chances of a woman being pregnant beyond her 20s too.

  1. Lower risk of miscarriage

Since tests like PGT are conducted during IVF, they can identify the most genetically viable embryos. Miscarriages mainly occur due to chromosome abnormalities, so IVF’s capability to ensure that the best embryos are placed in a woman’s uterus reduces the possible risk of miscarriages caused by genetic and chromosomal abnormabilities. 

  1. More control over family planning

Advancements in modern science, such as IVF, are unquestionably great innovations. If you are a busy couple or feel that you aren’t ready for parenthood yet, IVF lets you decide when you want to conceive by cryopreserving your eggs or embryos  until you are ready for parenthood.

Risks of IVF Treatments

  1. Multiple births 

If more than one embryo is placed in your uterus, the risk of having multiple births increases. This could cause complications with early labour and the baby’s weight.

  1. Premature births and low birth weight 

Previous research proves that IVF slightly increases the chances of a baby being born early or with a low birth weight, which could be unhealthy for the baby.

       3. Ovarian hyperstimulation syndrome 

This occurs when certain hormones and medications are used to induce ovulation during IVF, and the ovaries become swollen and painful. Symptoms like abdominal pain, nausea, vomiting and bloating would occur.

       4. Miscarriage  

Miscarriage can be a very unpleasant experience. However, despite the advanced tests conducted in IVF, due to various issues in fertilisation, such as the possibility of chromosomal variation and more, even IVF has a similar risk of miscarriage – a percentage similar to women conceiving naturally. Therefore, a successful conception cannot be guaranteed entirely, even with this procedure.

Other risks include possible bleeding and damage to the bowel, bladder and blood vessels during the collection of eggs and an increased risk of cancer and ectopic pregnancy (when the embryo implants outside the uterus). It is vital to be educated about the benefits and risks of IVF to decide whether IVF is the right option for you.

From where can I get IVF treatment?

If you are interested in seeking IVF treatments, you must consult a gynaecologist who will provide you with the necessary advice and information. In addition, they will diagnose any medical conditions or issues that have prevented you from successfully conceiving before recommending this treatment option. 

You can consult a gynaecologist via oDoc to discuss comprehensively with them whether IVF is right for you. They will help you achieve your dream of becoming a parent and educate you on the best option for conception.

In-vitro Fertilisation treatments with oDoc

References

  1. In vitro fertilisation, Mayo Clinic
  2. In vitro fertilisation process, Midwest Reproductive (PA)
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Migraines 101: Symptoms, Causes and Treatments

Migraines 101: Symptoms, Causes and Treatments

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If you are one of the 1 billion people with migraines, you may know how uncomfortable a migraine attack can be. If you are not, how does it feel to be one of God’s favourites?! 

Keep reading to find out the answer to that 😉

Here's what a migraine feels like:

Most people describe it as a pulsating, pounding, dull ache that spreads across their forehead. You can feel the pain on one side of your head or both sides. Sometimes you can even feel it shift. 

What causes a migraine attack?

The direct causes of migraines have still not been identified. However, researchers believe that ‘abnormal’ brain activity affecting nerve signalling, blood vessels and chemicals are the root cause of migraines. Researchers have identified the following as significant triggers for migraines:

  • Severe heat
  • Dehydration
  • Bright lights
  • Unusual smells
  • Hormonal changes in women (oestrogen and progesterone fluctuations) during menstruation, pregnancy or menopause
  • Changes in sleep pattern

Hereditary history of migraines and being a female are some risk factors for developing migraine conditions.

causes of migraine attacks

How does a migraine attack arise?

Stages of migraine

Let’s learn about the process of how a migraine attack occurs and its respective symptoms.

  1. Prodrome Phase

This is the initial stage of a migraine. Usually occurring around 1-2 days before the migraine attack or any other headaches related to it, here are some prodrome symptoms:

  • Food cravings
  • Neck stiffness
  • මානසික පීඩනය
  • Fatigue
  1. Attack Phase

It is during this phase that people have reported extremely uncomfortable sensations. The pain typically begins above your eyes and might spread over to one side of your head, your entire head or shift from side to side. Throbbing in the head may worsen if you exert yourself or move.

Other notable symptoms to look out for during the migraine attack phase include:

  • Increased sensitivity to light and sound
  • Nausea
  • Feeling faint

The symptoms of a migraine attack could last between several hours to two days, depending on the patient.

  1. Postdrome Phase

The migraine attack is followed by the postdrome phase. You may feel sick for up to a day. You may also experience:

  • Extreme tiredness
  • Pain in the head  that increases when you move too quickly or lean over
  • Confusion

You must gain sufficient rest after experiencing a migraine attack to recover effectively.

Now that we have broken down each stage of a migraine, did you also know there are different types of migraines, each with varied symptoms? Keep scrolling to find out more

Different types of migraines that exist

There are two common types of migraines: 

  • Migraine with aura
  • Migraine without aura

Along with the previously mentioned symptoms of a migraine, a person might experience either a migraine with an aura or a migraine without an aura.

Aura? What’s that?

It may sound like a pretty word but, it’s not a comfortable sensation. Aura is a condition that involves minor impairments to your vision, senses and speech for a period of time. Common signs involve blurry vision, coloured spots, neck stiffness, inability to hold your balance, difficulty speaking or forming words.

1. Migraine with aura (Brainstem Aura)

A person who experiences a migraine with brainstem aura would experience pain at the back of the head on both sides. They would face the following symptoms before the main migraine attack happens.

                                        Aura symptoms

  • An aura with visual problems
  • Numbness of body, face and tongue
  • Speech problems
  • Problems with moving

                                     Brainstem symptoms

  • Difficulty talking (unclear speech)
  • Vertigo (a spinning feeling)
  • Ringing in the ears
  • Eye problems in one eye (blind spots, flashes of light, temporary blindness, etc.)

2. Migraine without aura

Although, others may not experience an aura before their migraine attack or headaches. The following are some symptoms of a migraine without aura.

  • Migraine occurs only on one side of the head 
  • Throbbing/pulsating pain in the head
  • Pain gets more intense as you move (Eg: Walking)
  • Becoming sensitive to light
  • Becoming sensitive to sound
  • Nausea with or without vomiting

Treatment and tips for managing migraines

But wait! There’s some good news. Although migraine is not something that can be cured, you can still manage and control migraines from occurring through the following methods. As a result, it may lead to fewer attacks.

  • Adjustments to your lifestyle

You must ensure that you minimise or avoid any migraine triggers mentioned above. Along with this, managing your stress would also help you reduce the intensity of migraines.

  • Keep a journal

Maintaining a journal to list the instances you face migraine symptoms and attacks will help identify your triggers. This will allow you to avoid events and circumstances that trigger these symptoms.

  • Apply a cold compress on your forehead

This method slows down the nerve signals involved with migraine pain and generates a soothing, cool feeling that can help reduce the severe headache.

  • OTC pain or migraine medications

These medications include Nonsteroidal anti-inflammatory drugs (NSAIDs), Paracetamol, etc. These would reduce the intensity of migraine headaches and attacks. It is advisable to consult a doctor and receive a prescription before taking these medications.

  • Stay hydrated

Often when we are out in an environment with severe heat, we may forget to keep ourselves hydrated. Dehydration is a main trigger of migraine attacks. Therefore, ensuring an adequate intake of fluids will rule out the possibility of dizziness and headaches associated with dehydration.

Did any of the above symptoms and triggers sound familiar to you?  Feel like you’ve experienced them? If you have, it is possible that the ‘really bad headache’  you experienced was actually a migraine attack. Consulting a doctor about these symptoms may help diagnosis and treatment of your ailment. .

Consult a GP via the oDoc app to receive expert medical advice on reducing the highly uncomfortable symptoms of migraines and improving your well-being.

Sources

  1. Everything You Want To Know About Migraine, Healthline (2021)
  2. Migraine with brainstem aura, Genetic and Rare Diseases Information Center (2022)
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What Goes Wrong in Sleep? An Overview of Sleep Disorders

What Goes Wrong in Sleep? An Overview of Sleep Disorders

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Written by Dr. Ruwanthi Jayasekara

Consultant Respiratory Physician (MBBS, MD Medicine, MRCP UK, ESRS/ Expert Somnologist)

Good sleep is essential for a good life, and we spend about one-third of our lives sleeping. Therefore, it is essential to be aware of disorders that can occur during sleep, how to identify them, and treatments are available for them.

What types of sleep disorders are there?

There are many types of sleep disorders but here are some of the most common ones: 

  • Insomnia (difficulty in falling asleep and/or staying asleep)
  • Sleep related breathing disorders (eg. Sleep apnoea)
  • Central disorders of hypersomnolence (conditions with excessive sleep)
  • Parasomnias (involves unusual and undesirable physical events or experiences that disrupt your sleep)
  • Sleep-related movement disorders 

Let’s take a deeper look into each of the above-mentioned sleep disorders including how each affects the patient and what they can do to prevent them.

types of sleep disorders

Insomnia

People with insomnia find it very difficult to fall asleep and/or sleep well at night despite having a suitable environment and time to sleep. This will result in an impairment in their daytime functioning. In some people, this can be short-term, such as in anticipation of a stressful event like facing an exam or starting a new job. In others, this goes on for many months and years, causing distress to the patient.

Patients with insomnia will be evaluated using 

  • Sleep diaries – These let you measure and record when the patient went to bed, when they woke up during the night and woke up in the morning
  • Actigraphy – It is a wearable sleep test that tracks the patient’s movements while they are sleeping to analyse when they’re asleep and awake
  • Polysomnography (sleep study) – It is a comprehensive test that records brain waves, oxygen level in blood, heart rate, breathing, leg movements, etc during the sleep study.

This condition’s management includes sleep hygiene measures, medication revision and cognitive behavioural therapy.

Sleep-related Breathing Disorders

These conditions are involved with abnormal and difficult respiration during sleep. While some of these sleep-related breathing disorders have low health impacts, others may have serious consequences due to their effects on the patient’s sleep and balance of oxygen and carbon dioxide in their blood.

There are a few types of sleep-related breathing disorders. They are 

  • Obstructive sleep apnoea 
  • Central sleep apnoea
  • Sleep-related hypoventilation disorders
  • Sleep-related hypoxemia

Some risk factors of obstructive sleep apnoea are 

  • Male sex
  • Ageing
  • ස්ථූලතාව
  • Smoking
  • Alcohol use 
  • Certain craniofacial features such as receding jaw or small chin
  • Patients or their bed partners complain of loud snoring
  • Fragmented sleep
  • Getting up frequently to go to the toilet
  • Feeling excessively sleepy in the daytime
  • Feeling irritable and moody in the daytime

Apnoeic Spells and its Treatments

Sometimes a spouse may notice that the patient stops breathing at night for prolonged periods. This phenomenon is known as an apnoeic spell. Patients are evaluated with sleep studies called ‘polysomnography’, tests that evaluate sleep in detail and diagnose the underlying sleep disorder. The first line treatment is CPAP therapy (a device that provides continuous positive airway pressure). Additionally, weight loss with exercise and a healthy diet are also substantial.

Central Disorders of Hypersomnolence

These are a rare group of sleep disorders where patients complain that they are always sleepy during the day and the night. Patients tend to fall asleep in the daytime even after adequate sleep. E.g. Narcolepsy. Some patients with excessive sleepiness may have an underlying undetected medical or psychiatric condition. 

Excessive sleep has a significant detrimental impact on the patient’s life. These patients must be evaluated with sleep studies and blood investigations before starting their treatment.

Circadian Rhythm Sleep-Wake Disorders

Circadian rhythm sleep-wake disorders are a group of disorders where the patient’s body’s clock, which helps to maintain a regular day and night pattern, is affected. 

There are several types of circadian rhythm sleep-wake disorders.

  • Delayed sleep-wake phase disorder

This is where the patient does not fall asleep until the morning and tends to wake up in the afternoon – the patient’s circadian clock is delayed compared to the average population. These patients may struggle to wake up on time for school and work. 

  • Advance sleep-wake phase disorder

On the other hand, this disorder tends to have an early sleep pattern and early rise pattern. There are various types of disorders. Shift workers also suffer from the detrimental effects of not sleeping on time and staying awake when they should be sleeping. 

  • Jet lag disorder 

This is another condition in which people suffer due to crossing time zones. Understanding these conditions is vital as many treatment modalities help reduce these problems.

Parasomnias

Parasomnias are another set of sleep disorders involving a lot of sleep movement. In certain sleep stages, some people have confusional arousals, sleepwalking, sleep terrors, sleep-related eating, violent movements in sleep, acting out dreams, nightmares etc. Patients are evaluated with a sleep diary and polysomnography. These conditions must be identified and treated as many patients suffer from poor sleep and daytime dysfunction due to these issues.

Sleep-related Movement Disorders

Sleep-related movement disorders include restless leg syndrome and periodic limb movement disorder, where the patient has a lot of leg movement at night, leading to disturbed sleep.

How do you prevent sleep disorders from occurring in the first instance?

The baseline management of any sleep disorder is the maintenance of good sleep hygiene practices.

  • Maintain a regular sleeping and waking up time
  • Have regular meals
  • Avoid caffeinated drinks close to bedtime
  • Avoid smoking and alcohol
  • Keep your devices away at least one hour before bedtime

Despite these measures, if a patient feels that they have an issue with their sleep, it is best not to delay diagnosis, as sleep is essential for a healthy life. They can consult experienced sleep specialists via the oDoc app to have a comfortable and convenient consultation in just three taps within the comfort of their own home.

Dr Ruwanthi Jayasekara

SLMC 25147

Chest Physician

Sources

  1. How Is Actigraphy Used to Evaluate Sleep, Sleep Foundation (2022)
  2. Sleep-Related Breathing Disorders, Sleep Foundation (2022)
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Pedal Power: Health Benefits of Cycling

Pedal Power: Health Benefits of Cycling

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Fuel shortage in Sri Lanka leads to more cycling

In a state where public transport has also been limited, and bus ticket prices have risen exponentially, the lack of transport options has made daily commuting and travelling during emergency situations increasingly difficult. As a result, walking and cycling have become almost the only choice for many Sri Lankans.

Cycling is a low-impact aerobic exercise that offers a wealth of benefits. It is a great exercise that keeps you moving and helps establish a physically and mentally healthy lifestyle.

1. Cycling can help you lose weight

Cycling is a great aerobic workout that burns calories and helps people lose weight and belly fat. To lose weight, you must burn more calories than you take in. Depending on your intensity and weight, cycling can burn between 400 and 1000 calories each hour.

Body parts that are exercised, targeted, toned, and used while cycling

  • Foot: Ankle dorsiflexion and plantar flexors
  • Arms: Triceps and biceps 
  • Shoulders: Deltoids
  • Calf: Gastrocnemius and soleus
  • Buttocks or Gluts: Gluteus minimus, gluteus maximus, and gluteus medius
  • Thigh: Quadriceps and hamstrings

2. Cycling boosts mental health and brain power

Cycling can ease feelings of stress, depression, or anxiety as it may help take your focus away from the mental chatter of your day.  When cycling, concentrating on the road or your cadence might help you improve your attention span and awareness of the present moment. Here are a few ways cycling could boost your positive mental health.

  • It improves your mood. Cycling increases blood flow throughout your body, allowing endorphins and other feel-good chemicals like dopamine, norepinephrine, and serotonin to spread quickly.
  • It promotes positive mental health. Exercise is known to have significant effects on self-esteem, sadness, anxiety, and stress. Still, cycling has been identified as one of the most beneficial exercises for the head and heart.
  • It helps you sleep better. Regular riding helps synchronise your circadian rhythm and can help to reduce levels of stress hormones that can make proper regenerative, deep sleep difficult.
  • Improves your memory. Riding a bike helps build new brain cells responsible for memory. 
  • Improves creative thinking. The regular, uniform movement of cycling relaxes the brain, stabilising both physical and mental functions.
  • Cycling promotes new thought patterns that promote feelings of calm and well-being. You can use it as a type of meditation and a great way to “zone out.”
benefits of cycling

3. Cycling improves balance, posture, and coordination

As you stabilise your body and keep your bike upright, you’ll improve your overall balance, coordination, and gait.

Maintaining balance is important because it tends to deteriorate with age and inactivity. Therefore, enhancing your balance can help lower your risk of injury and keep you off the sidelines by preventing falls and fractures.

correct posture of cycling

4. Cycling can reduce the risk of heart diseases

Regular cycling stimulates and improves your heart, lungs and circulation, reducing your risk of cardiovascular diseases such as strokes, high blood pressure and heart attacks.

Cycling also helps your cardiac muscles become more robust and lowers your resting pulse and blood fat levels.Additionally, research shows that people who cycle to work have a lung function that is two to three times better than those who commute by car.

Drawbacks of cycling and safety

Cycling has a few disadvantages to consider, and these primarily relate to cycling outside, which involves factors beyond your control.

There could always be a risk of an accident, whether in an urban or rural area. Hence, 

  • Obey the law at all times. Even if you have the right of way, exercise caution when passing through crossroads and crowded locations. Invest in a good helmet and any other necessary safety equipment.
  • Avoid wearing any loose clothing that could get caught in your bike chains.
  • Unfavourable weather might also be a barrier. So, invest in rain and cold weather gear and have a backup transportation plan for when conditions are unsafe for riding.
  • For extended daytime rides, use sunscreen on all exposed skin.
  • Take a break if you experience pain, fatigue, or muscle soreness.
  • If you have any cycling-related injuries, staying off the bike is best until you fully recover.
tips for cycling safely

The bottom line

Given the current situation in Sri Lanka, cycling to your destination may seem like the only option. However, just play it safe and use caution when necessary, especially on busy roads or during unfavourable weather.

If you have any injuries or need clarification regarding conditions that cycling may affect, speak to a general practitioner or a physician via the oDoc app.

Sources

  1. 15 benefits of cycling: why cycling is great for fitness, legs and mind, Cycling Weekly (2022).
  2. 12 Benefits of Cycling, Plus Safety Tips, Healthline (2021).
  3. Cycling – health benefits, Better Health (2021).
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