Issuelessness: why blame woman alone?
Dr Meenal Kumar

Infertility means inability to bear a child or a failure of the process of procreation. The agony and distress of an infertile couple is to be seen to be believed. The plans of all adult couples include children, to be their descendants. When this "natural wish" fails to materialise - frustration, despair and helplessness are common. Infertility can isolate couples, put them through a great deal of mental trauma and strain their marriages. Unfortunately, it is the woman who is squarely and singularly blamed for the state of issuelessness, though it is the male who is at fault in at least half of the cases.

Besides sexual promiscuity, several other deviations in the behaviour and lifestyle of males as well as females can result in sterility. Late marriages, delayed plans for pregnancy, struggle and stress for employment and career advancement, ego clash of the partners — all can lead to infertility. If two years of consummation of marriage have elapsed and infertility is well established, consult a gynaecologist of your choice.

There are several causes of decreased fertility. One, the age of women who want to bear babies has gone up. Two, cases of sexually transmitted diseases, which damage the reproductive tract in both sexes, have soared. Three, men’s sperm count has decreased, probably due to pollution or stress or both.

For conception to take place, hundreds of individual hormonal, chemical and physical events take place in a precise order. For example, a sperm must form in the testicle, mature in the epididymis, be released into the female vagina, "swim" through the cervical opening, continue through the uterus and into a fallopian tube. In the tube, it must encounter a viable egg within 12 hours or so after its monthly release, attach it with the egg, penetrate its outer cover and fertilize the ovum within.

After staying in the fallopian tube for about two days, the fertilized egg must descend into the uterus, grow and divide for a few more days, and then implant itself on the uterine wall. A disruption in any of these events and conditions or underlying processes can cause infertility. The sperm may not be viable, it may contain the wrong number of chromosomes, and it may have been stored for too long, or sperm is immobile, (cannot "swim" correctly). It may be perfectly healthy but not accompanied by enough sperms (men whose semen contains less that 60 million sperms per millilitre frequently have infertility problems). The sperm ducts may be blocked, because of past infection or injury. The man may not be able to ejaculate, or his ejaculation may propel the sperm backward into his bladder rather than out through the male organ.

Once inside the cervix, the sperm may meet mechanical or chemical roadblocks. A muscle spasm may eject the sperm; the cervical mucus may be too thick to be penetrated, or chemically hostile to the sperm. The fallopian tube may be blocked by scar tissue. The sperm does manage to reach the egg; but it may not be able to penetrate the outer cover to fertilize it. A fertilized egg may be stuck in the fallopian tube, or it may not be able to implant successfully in the uterus.

The first attempt may succeed only in one out of five cases. Even the most fertile human couple does not necessarily conceive after the first intercourse. When an issueless woman reports to us, she is given physical and pelvic examinations, laboratory tests, and imaging procedures to locate the problem responsible for infertility. Laproscopy and ultrasound imaging may reveal structural or functional problems. Men are tested for the quantity and quality of their sperms. The most correctable problem (not the commonest) affecting male sperm levels is varicocele surrounding the testicles. Surgical corrections of large varicoceles restore fertility in about two-thirds of such cases. Other causes of male infertility include insufficient hormone levels, blockage of sperm carrying tubes, untreated diabetes or prostate disease, etc.

A couple is today less helpless than before. After testing is complete, doctors devise a strategy for each couple to increase fertility. Sometimes, small adjustments in sexual frequency and timing may result in pregnancy. Patients are taught to identify the woman’s fertile days. The practices that temporarily result in a lower sperm count — medications, alcohol, drugs, hot-tub bathing, etc — may be stopped. Gonadotrophin treatment to increase the number of female gametes is well accepted, as a part of IVF as well as ICSI.

In vitro fertilization (IVF) involves the mixing of sperms and eggs in the laboratory, outside the human body where fertilization takes place, and then the zygote (fertilized egg) is surgically placed in the woman’s fallopian tube or the uterus in an effort to establish pregnancy. One of the most recent developments in ART (assisted reproductive technology) is intracytoplasmic sperm injection (ICSI). This microsurgical procedure involves injecting a single sperm into an egg that may allow men with extremely low sperm counts to become fathers. Future lies in genetics, imaging and biotechnology to enhance fertility.

Today a child can be born from a donated egg, with donated sperm, from the uterus of a woman who is a "gestational carrier." In this way, a woman with no hereditary link to the offspring may deliver a child who is also not related genetically to her.

Unfortunately, ART has lost human touch. The victims are allured through glamorous advertisements and cheated with impunity. The success rate is low; the claims are tall. We know many couples in double-despair, who parted with lacks of rupees, but remained issueless. Caution and restraint are the watchwords for expectations for the couples.

London: Scottish scientists are in the process of inventing an artificial nose which can tell whether someone is ill from the smell of their breath.

The smell of a patient was used in medical diagnosis a century ago, but is now being rediscovered as a useful tool for doctors.

The "Spectral Nose", which is being built at Strathclyde University, would use advanced chemistry to detect different odours, and then a computer screen would give the patient an all-clear or indicate which disease they could have.

A desktop device for hospitals, laboratories, doctors’ surgeries and the workplace is being developed, along with a hand-held version which could be used in the home or in the field.

Professor Andrew Mills, of Strathclyde’s chemistry department, said they were still in the developmental stage and while a working device was some way off, progress had been good todate.

"The idea of detecting odours and using that as a means of medical diagnosis is not new. But although it is 100 years old, it is being rediscovered," he said.

"Where diseases are associated with characteristic odours, this could be used for rapid screening and mass screening.

Some of the odours associated with various diseases are: Rotten apples, pear drops or acetone (used in varnish remover) — forms of diabetes.

Sweaty sheep — smallpox.

Plucked feathers — measles.

A butcher’s shop — yellow fever.

Fish — uremia, which stems from kidney failure and can cause coma.

Musty fish/raw liver — liver failure.

Foul smell — a lung abscess or intestinal obstruction.

Freshly baked brown bread — typhoid.

Stale beer — tuberculosis — ANI

Happiness lies in biological functions!

Washington: Happiness may be related to the functioning of the body in key processes, such as those of the cardiovascular system and those controlling hormone levels, a new study reveals.

To unfold the mystery behind inverse relationship between happiness and health problem, Andrew Steptoe and his colleagues studied emotions and health of more than 200 middle-aged Londoners in their daily lives and found that those who reported more everyday happiness had healthier biological functions in a few key systems.

Happier individuals showed lower levels of cortisol, a stress hormone related to conditions such as type II diabetes and hypertension. They also had lower heart rates over the day and evening, which suggests good cardiovascular health.

According to the authors, these results were independent of psychological distress, which implies that positive well-being is directly related to the biological processes relevant to health. — ANI

Meditation helpful in psychotherapy

Washington: Meditation is now being incorporated into psychotherapeutic practice and combined with other healing traditions, reports the Harvard Mental Health Letter.

The focused attention of meditation may change attitudes and behaviour by decreasing preoccupation with one’s own suffering and fostering self-understanding.

"Professionals of both traditions are beginning to realize that the resemblance to the aims of psychotherapy is no accident," says Harvard Mental Health Letter editor Dr Michael Miller.

The psychotherapeutic tradition is now taking meditation more seriously in cognitive behavioral therapy. Behavioral therapy in its original form was concerned only with stimulus and response and tangible rewards and punishments. Eventually behaviour therapists recognized the need to take account of thoughts and feelings, and they incorporated cognitive techniques into therapy. Now some therapists have gone further, merging cognitive techniques and meditation in something they call the "third wave" of cognitive behavioral therapy.

Researchers also conclude that different types of psychotherapy are starting to borrow ideas and techniques from one another, and therapists may use several different approaches with a single patient.

"The introduction of meditation practice into cognitive behavioral therapy may represent a further stage in the historical evolution of psychotherapy," said Dr Miller. — ANI

EYESIGHT
Cataract surgery: the latest technique
Dr Mahipal S. Sachdev

Phacoemulsification is the latest technique of cataract surgery in practice. Cataract surgery has nowadays become a walk-in walk-out procedure with this technique.

In phacoemulsification, ultrasound energy is used to break the hard cataract into multiple pieces which are then sucked out through a small 3.2 mm incision. A foldable lens (IOL) of required power is then implanted in place of the natural lens thus removed.

• It allows for a stitchless, painless, no bandage surgery.

• Early visual rehabilitation for the patient.

• Minimum curvatural changes occur in the eye following surgery.

• Final glasses can be prescribed within three weeks.

• Post- surgery, the wound is very secure.

• Drops of local anaesthetic agent used instead of an injection in the eye, thus leading to a walk-in walk-out procedure.

There are several routinely asked queries that need to be answered before a cataract patient goes in for a phacoemulsification surgery.

Phacoemulsification takes about 10-15 minutes per eye.

Antibiotic drops are started before cataract surgery. Any specific systemic problem one should discuss with one’s surgeon before planning for surgery.

In some cases, the patient is able to see almost immediately following the surgery, although most patients experience clear vision after two or three days.

He or she may need to wear glasses only to fine-tune one’s vision. These spectacles have normal lenses unlike thick lenses used in the past. If unifocal IOL is used, near vision glasses are always required.

Normal activities — walking, reading, writing, watching television, etc — can be resumed soon after surgery. However, during the first week after surgery, it is better to avoid strenuous activities.

There is absolutely no diet restriction after phaco and one can continue one’s normal diet. However, diet regulation advised for other diseases like diabetes and high blood pressure must continue.

Yes, one may have microincision phaco surgery on one’s "second eye" provided there is no specific contraindication for phaco.

Routinely, one month’s gap is preferred, but it can be done at a gap of three to five days as per the patient’s comfort.

Phaco is usually possible in all routine cases. But in a new cases where cataract is hard to cut into pieces, phaco is difficult. Advanced machines like SOVEREIGN are able to manage this. SOVEREIGN is one of the latest generation phacomachines.

The latest multifocal/bifocal IOLs are designed to provide good distance vision, intermediate and near vision. They reduce the patient’s dependence on glasses for routine activities. Unlike conventional IOL, multifocal IOL has multiple zones of different focal lengths that bring everything from near to far in clear focus. These lenses provide almost complete freedom from glasses. These lenses are new and clinical trials regarding their efficacy are being undertaken the world over.

While the above answers take care of one’s basis information, another important aspect that needs to be taken into consideration is the choice of surgeon and the centre for the procedure. One should choose a surgeon who is proficient in phaco surgery as it is a reasonably difficult surgery to master, and a centre with the latest phaco technology.

Bimanual phaco or phaconit is the new technique of cataract surgery where two incisions of 1 mm are sufficient to remove the cataract. Instead of a foldable IOL, a rollable IOL that can be inserted through a 1 mm incision is used. It further hastens the post-operative recovery.