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How our gynaecologists saved a patient from a dangerous complication?

This is the story of a young married woman who was saved by our team of expert gynaecologists from a dangerous complication of ovarian hyperstimulation due to over-enthusiastic ovulation induction (excess dosage of medication given for enhancing egg release from the ovary) by another doctor. A 23-year-old woman married for 8 months was planning a pregnancy and had approached an unqualified doctor in the outskirts of Hyderabad. She came to us in a critical condition and was suffering from severe abdominal pain.

What went wrong?

Alarmingly high doses of medication given to the woman inadvertently resulted in the above mishap. The same medication, when used in correct doses, yields good favourable results like egg release at the right time. In a normal fertile woman who is ovulating normally and regularly, the egg is released on the 14th day (in case of a regular cycle of 28 days). This is documented in a scan called follicular tracking. Hence, the couple is made aware of the probable fertile days to plan conception.

The group of women who have irregular or delayed cycles with non-documented egg release require the ovulation induction drugs. These drugs enable ovulation to happen which is again documented by the follicular scan and accordingly the couple is advised for conception. This prescription of drugs at Zoi is done in a very meticulously, in low doses tailored according to each woman's need. We start with the lowest dose and slowly escalate according to the need while doing the follicular scan each month. When prescribed in the right way, there are no side effects.

The Zoi Approach:

On evaluating her, we knew that she was given very high doses of medication used normally to induce ovulation earlier in the menstrual cycle.
We ran her through various examinations and investigations, found that her ovaries were hyperstimulated with ovulation of multiple follicles i.e., multiple eggs released from the ovary at a time causing ovarian rupture and blood collection in the abdomen. We did a laparoscopic surgery and to our astonishment saw the blood collection of about 300cc to 500cc in the pelvis and ovaries grossly enlarged floating in the blood. We cleared the ovaries of the huge follicles and dealt with whatever was needed at that time and saved both her ovaries. She was relieved from severe pain such that she did not feel even a little pain after surgery. We discharged her with a smile and a sigh of relief the very next day.

We have achieved successful pregnancies and deliveries. This involves detailed counselling, investigation of the couple by the gynaecologists. We also have diagnostic/ therapeutic hysteroscopy and laparoscopy to perform fertility enhancing surgeries for women who require intervention.

We at Zoi, are assertive in making decisions as a team which give fruitful results to anxious couples waiting for a newborn.

Causes Of Infertility:

Infertility is defined as the inability to conceive a pregnancy after 12 months of unprotected sexual intercourse. According to a 2018 report, around 27.5 million couples in India suffer from infertility. Causes of infertility are many and varied and involve male, female or a combination of factors. This includes problems with the production of sperm or eggs, the structure or function of male or female reproductive systems; and/or hormonal and immune conditions.
In 40% of couples, the cause of infertility is attributed to a sperm factor, in another 40% the cause is found within the female reproductive system, and a third will have a combination of male and female factors.

Pre-Conception Counselling:

The Centers for Disease Control and Prevention defines preconception care as a set of interventions aimed at identifying and modifying biomedical, behavioural, and social risks to a woman's health or pregnancy outcome through prevention and management. The goal is to ensure that the woman is as healthy as possible before conception to promote her health and the health of her future children. Preconception care is integral to primary care for women in their reproductive years.

Ovulation Tracking:

A simple process of ovulation cycle tracking can help you identify which days you're most fertile. We do this by tracking your hormone cycle to predict when ovulation is going to take place. Ovulation is triggered by a surge of hormones from the pituitary gland (Luteinising Hormone). This usually takes place 24 hours before ovulation.
By carrying out simple blood and ultrasound tests to detect this hormone surge, we can advise you of the ideal days to have sexual intercourse that gives you the best chance of conception. It doesn't require a consultation with a fertility specialist or any invasive fertility treatments or medicines and is more accurate than the home ovulation prediction kits.
Also, only the female partner needs to come into the clinic for tracking the cycle.

The Ovulation Induction Process:

Ovarian hyperstimulation is a serious complication of overenthusiastic infertility treatment

Assessment:
Your fertility specialist will assess your ovulation cycle with blood tests to measure hormone levels at specific stages of your cycle, and an ultrasound to see the development of follicles in the ovaries and thickness and appearance of the uterus lining.

Timed Intercourse Or Artificial Insemination:

Around the time of ovulation, your specialist will advise the most appropriate days to have sexual
intercourse to maximise your chance of pregnancy or perform intrauterine insemination where prepared sperm is inserted into the uterus.

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