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IVF Treatment Center

In Vitro fertilisation, also known as IVF, is a fertility treatment where in fertilisation takes place in the lab instead of the female body.

The basic steps involved in IVF technology is taking many eggs from female retrieved through transvaginal ultrasound-guided needle and placing in a petri-dish with cleanly washed sperm cells retrieved via masturbation or else sperm donor. The retrieved eggs will become fertilized by the sperm cells and become embryos. One of the healthy embryo is then transferred to the same female uterus. After process completion, bed rest is advised for at least 24 hrs.

An estimated 6.5 million IVF conceived babies have been born in the world since IVF conception in 1980s. Also famously known as test tube babies, produced by IVF are as healthy and normal as naturally conceived children.

Success rate of IVF, according to a study of approximately 156,000 women, the average live-birth rate for the first cycle was 29.5 percent, which is a comparable success ratio as that to couples with the natural cycle of fertility. Researchers in the UK have developed a prediction model to estimate the success rate of a live birth over multiple cycles of IVF. This prediction model can be personalized based on a number of variables (reproductive history, maternal age, the cause of infertility, and lifestyle factors) as well as their response to treatment for a realistic understanding of the long-term probability of success of IVF.

In Vitro fertilisation

IVF is the preferred choice of treatment in the following health conditions:

  1. Fallopian tube damage or pathology: women with blocked or removed fallopian tubes
  2. Unexplained infertility (idiopathic): irregular ovulation cycles 
  3. Male factor: low sperm count may turn to an intracytoplasmic sperm injection (ICSI) which only required 1 healthy sperm to fertilize an egg.
  4. Endometriosis
  5. Cervical factor / immunological infertility: polycystic ovarian syndrome (PCOS) 
  6. Hormonal disturbances

Further, obesity can also complicate IVF, making it harder for overweight women to have successful IVF with their own eggs. Obesity is associated with increased dose and duration of gonadotropin stimulation, lower peak E2 levels, and increased oocyte retrieval time.

A large study published in 2013 reviewed over 9,500 egg donation IVF treatments. The egg donors were all of normal weight, and the recipients were divided into four groups: underweight, normal, overweight and obese. The rates of embryo implantation reduced to 23%, pregnancy rate decreased by 19% and live birth percentage reduced by 27% as body mass index (BMI), increased to obese.

A recent study indicated that obese women may need different doses and dosing regimen and fertility drugs than normal-weight women in order to ensure that their eggs ripen at the right time and can be extracted for IVF.

Therefore, it is recommended that patients with a high BMI reduce their weight before IVF treatment. Bariatric surgical procedures can be a durable option for weight reduction. This study highlights 5 patients who underwent Roux-en-Y gastric bypass bariatric surgery followed by in vitro fertilisation (IVF). Overall, these patients tolerated IVF well, and four of the five went on to have term deliveries. Rapid weight loss and increased risk of nutritional deficiencies in the first year after bariatric surgery have led to recommendations that gastric bypass surgery patients should wait at least a year before attempting pregnancy. IVF after bariatric surgery can be safe and successful.

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spine problems

The term “Orthopaedics” signifies a medical specialty that focuses on the body’s musculoskeletal system. This includes bones, joints, muscles, ligaments, tendons, and nerves.

Pain that originates in the spine anywhere between the upper and lower back is the “back pain” we refer to in our daily lives, obesity caused ones are:-

  1. A herniated disc
  2. Spine osteoarthritis

It affects approximately three out of four adults during their lifetime. Many back-pain patients complain about symptoms like numbness and tingling sensations, stiffness, achiness, and weakness.

It is known that obese people are more prone to spinal issues than those who’re not. Deleterious weight stresses almost every organ in the body, so it is no surprise that it also increases the risk of back pain, joint pain, and muscle strain. Every extra inch adds strain to the muscles and ligaments in the back since the spine tends to become tilted and stressed unevenly to an extent that the back may even lose proper support.

Extra weight around the stomach pulls the pelvis forward which in turn strains the lower back thereby causing pain. The vertebral disc as well, of an obese individual, may get weak or damaged sooner. Excess weight is also known to worsen pre-existing spinal issues.

The four common disorders found out by researchers are:-

  1. Lower back pain
  2. Spondylosis (spine degeneration)
  3. Internal disc disruption (IDD)
  4. Neck problems unrelated to IDD or spondylosis

Due to Obesity, adipose tissue causes extra pressure on the lumbar spine and knee which exacerbates pain. Bariatric surgeries help weight loss thereby reducing pain intensity to as much as 75% to 80.8%  as cited by an article of Bariatric times. The pain score carried out in the study when compared to preoperative baseline, indicated significant symptomatic pain resolution of the pain of head, neck, shoulder and lower back. Pain relief was observed in day to day physical activities during sports as well as work. Use of Analgesic significantly reduced. An increase in Quality of life within 6 months to 1 year post operation was observed.  

As per UCLA Health article, Retrospective studies showed that after performing Bariatric surgeries, the frequency of back pain decreased in up to 83% of the patients, and lumbar back pain symptoms were reduced in 82–90% patients in a period of 6 months to one year.

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Joint Replacement Surgery

Our bones attach to each other at a joint, where strong tissues called tendons and ligaments help connect the bones. It is common for such joints to experience stress as we age. But it is pertinent to note that weight too plays a role along with age. Every pound of excess weight exerts about 4 pounds of extra pressure on knees. This means that if a person is 100 pounds overweight then the knees undergo 400 pounds of excess pressure. “Fat” itself is such an active tissue that releases such chemicals which promote inflammation. Researchers have also found that hand osteoarthritis (OA) is more common amongst obese people.

According to the Arthritis Foundation, the average onset of Rheumatoid arthritis (RA) is between the ages of 30 and 60, and children can also get it. RA is a chronic condition that progresses over time with periods of increased disease activity, called flares and periods of remission.

In 1971, the number of cases of arthritis primarily caused by obesity was at 3 %. By 2002, that number had increased six-fold to 18 %. An obese has a 60 % greater risk of getting arthritis than people who maintain healthy body weight. A study examined the factors contributing to total knee and hip replacements in people between the ages of 18 – 50. A remarkable 72 % of those who underwent joint replacement surgery were obese.

Bariatric or Metabolic surgery can prove to be very beneficial for joints too. For 0.5 kgs lost, 2.5 kgs of pressure on joints are reduced. Other benefits are pain reduction, increased mobility, better outcome after a joint replacement surgery etc. Bariatric surgery can be considered the best way for a joint replacement.

  1. Sleeve Gastrectomy- Reduces the stomach to approximately 15 % of its original size.
  2. Gastric Bypass-The surgery changes the absorption rate of food, as well as decreasing the amount that can be ingested.
  3. Robotic Surgery

Orthopaedic surgeons themselves are referring more patients for consideration of bariatric surgery in anticipation of future elective procedures.

Many patients pursue bariatric surgery for improvement in their physical image and somatic health improvement. Health-related quality of life improves after bariatric surgery & long-term improvements are positively associated with the long-term amount of weight reduction leading to less joint problems.

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PCO with obesity

Infertility has become a bane of modern living and PCOS is one of the major causes of infertility.

Polycystic Ovarian Syndrome commonly called PCOS condition is a very common endocrine condition in reproductive-aged women often leading to difficulty in conceiving. Women diagnosed with PCOS can experience irregular periods, abnormal hair growth, acne, and can have ovaries containing multiple small cysts.

PCOS has a negative effect on fertility since such women are not able to ovulate or release an egg, each month due to an overproduction of estrogen. This subsequently leads to irregular periods and increased levels of hormones such as testosterone that can affect oocyte quality, inhibit ovulation, lead to insulin resistance, and increase the risk disorders such as gestational diabetes.

The relation between PCOS and obesity can be termed as complicated. Signs and symptoms of PCOS begin for some females soon after they start having periods. Women with PCOS produce too much insulin, or the insulin they produce does not function normally which leads to weight gain. Women diagnosed with PCOS may also find it difficult to lose weight. For some others substantial weight gain is followed by PCOS. However, it is certain that women suffering from obesity have a greater risk for PCOS and women with PCOS have a greater risk for obesity.

Many PCOS women with obesity may also develop coronary artery disease and glucose abnormalities at a very young age. Bariatric surgery can be a significant procedure to fight against all these abnormalities and a solution for all such irregularities. According to a study, in the state of Gujarat itself 18% females and 14 % of Males are over-weight.

If the prevailing PCOS condition is due to obesity, the chances of cure are almost close to 100% particularly young females with such condition. There are few types of surgeries and procedures for such condition, but your surgeon will likely have a recommendation as to which will be most effective for PCOS. The proven methods are Laparoscopic Sleeve Gastrectomy (LSG) and Endoscopic Sleeve Gastroplasty (ESG).

The Laparoscopic Sleeve Gastrectomy (LSG) generates weight loss solely through gastric restriction (reduced stomach volume). In LSG approximately 2/3rd of the stomach is stapled off roughly the size and shape of a Banana or Sleeve. This operation does not involve any ‘rerouting’ or reconnecting of the intestines. Hence it is technically as simpler operation than the gastric bypass.

Endoscopic Sleeve Gastroplasty (ESG) is one of the latest advancements in Medical Science. Endoscopic Bariatric Procedure does not require any hole or incision to put on any part of the body but a special Endoscopic instrument is inserted through an oral route to reach the stomach. Then the size of the stomach is reduced using stitches. On the same day after 4-6 hours of the procedure, a patient can go home. Moreover, as the procedure involves zero blood-loss, there is no need for blood transfusion and chances of infections are also almost nil.


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bariatric surgery for diabetes type 2

Diabetes is one of the most common medical conditions which affect more than 150 million people worldwide. Owing to the dynamic lifestyles of people nowadays, at least 90% of the people have Diabetes type 2 which is related to Obesity, overweight, family history, insufficient physical activity or old age.

Obesity is a medical condition that is related to diabetes and occurs when a person carries excess weight or body fat, so as affecting the person’s health. A medical expert would say a person with high Body Mass Index is Obese.

Types of Diabetes:

  1. Diabetes Type 1- it is believed to be an autoimmune condition.
  2. Diabetes Type 2- your body can’t use insulin efficiently.
  3. Gestational- occurs only during pregnancy

Generally, metformin is the medication prescribed for type 2 diabetes. It works by improving the sensitivity of your body tissues to insulin so that your body uses insulin more effectively.

The most common amongst all is diabetes type 2. Risk factors for type 2 diabetes include:

  • having a sedentary lifestyle
  • being overweight
  • having had gestational diabetes or prediabetes

Although diabetes is traditionally viewed as a chronic, relentless disease in which delay of end-organ complications is the major treatment goal, bariatric surgery offers a novel endpoint: major improvement or even complete disease remission. For obesity, it is one of the most popular and safe methods. Evidence suggests that bariatric or metabolic surgery for obesity may lower death rates for severely obese patients, especially when coupled with healthy eating and lifestyle changes after surgery.

Though bariatric surgery for obesity or weight loss surgery includes a variety of procedures performed on people who are obese, the basic principle of weight loss is achieved by the following methods:

  1. Sleeve Gastrectomy: Reducing the size of the stomach through removal of a portion of the stomach. This approach resulted in reduced surgical morbidity and mortality compared with the traditional one-stage approach highly obese patients. Unexpectedly, patients achieved remarkable weight loss after the first stage and SG.
  2. RYGBP: This is the most common amongst all. By resecting and re-routing the small intestines to a small stomach pouch. After RYGBP, ingested food bypasses most of the stomach and the first part of the small intestine. (gastric bypass surgery)
  3. Restricting food intake and decreasing the absorption of food in the stomach and intestines.

Results:

  • Average 77 % of excess body weight is lost in one year after surgery
  • A study shows that after 10 to 14 years, patients have maintained 60 % of excess body weight loss. A study of 500 patients showed that 96 % of physical problems were improved and resolved in some cases which mainly includes back pain, sleep apnea, high blood pressure, type 2 diabetes and depression.
  • In most cases, patients report an early sense of fullness even by taking little food so that there will be no desire to take more food

Bariatric surgery can help in prevention of diabetes and helps weight loss through gastric bypass in obese patients. Also, non-diabetic patients can decrease their likelihood of developing diabetes by 60 percent.

One long-term study tracked 400 people with type 2 diabetes. Six years after bariatric surgery, 62% showed no signs of diabetes. They also had better blood pressure, cholesterol, and triglyceride levels.

In a recent study, over 20,000 patients were examined. It revealed that 84% who underwent obesity surgery for diabetes experienced complete reversal of their type 2 diabetes.

Rapid improvement in blood sugars and reduction or elimination of diabetic medications is often seen within the immediate period following bariatric surgery for diabetes type 2.

 

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