Dr.Sheriar on the best method of contraception and more

Dr. Nozer Sheriar is a consulting obstetrician, gynecologist and gynecological endoscopist at the Breach Candy, Hinduja Healthcare Surgical, Holy Family, Masina and Parsee general hospitals in Mumbai.

He is the secretary general of the Federation of Obstetric and Gynecological Societies of India (the national professional organisation of gynecologists with 222 societies and over 27000 members) and the ex president the Mumbai Obstetric and Gynecological Society.

He has a special interest in high risk obstetrics, hysteroscopic surgery, contraception and induced abortion.

Dr. Nozer Sheriar answered Sify readers’ queries related to the above in an exclusive chat. Read the transcript below.

hi doctor i m having pcod from last 3 yrs how it can be cure i m 5 inches and weight s 68 kgs

You have body mass index of almost 29. If you could lose about 10kgs you would find that most of your symptoms will improve. PCOD is a spectrum of effects with a direct co relation to weight in majority of women. The corner stone of treatment is weight loss through diet and exercise and a healthy lifestyle.

I am 45 years old can I become father at this age . I am unmarried and planned to marry with in few months . someone says after40 its very difficult to produce kid. my would be is 37 years old.please advice me ,

Unlike women men do not reach a clear menopause. The process is gradual and most men remain fertile in their 40s and 50s. However in the view of your age it would be wise to get a semen examination and if you are expecting a further delay after your relatively late marriage I would suggest that you freeze a few samples of your semen while normal for use at a later age.

wife is having irregular periods, some times twice in a month than we ckd tsh and found to be more than 10 . after mediction also the problem with thyroid. so we trid with accpressure but again no periods for last one and half month.

Firstly the hypothyroid had to be treated by thyroid hormone supplementation which will probably be life long. The irregular periods can very easily be treated by using cyclic hormones. If your family is complete the oral contraceptive pill will not only give you excellent protection but also give you regular periods. Suffice to say that irregularity of 2 weeks is not considered significant if your wife is not concerned.

hello sir. I am 27 and having pcod. trying to conceive.am going to have ovulation inductin and follicular tracking from next month.AMH 9.25.husband reports normal my hormones are normal.what are the sucess rates? how many times can i get induced?

PCOD is a very common condition. If you are overweight then the first line of treatment is to get to a normal BMI. Ovulation induction is a very successful treatment which may start with oral medicines and proceed to fertility injections if required. For any treatment to work you have to give it atleast 4 to 6 cycles before moving to the next level. Most importantly you need tyo relax, be positive and let the pregnancy happen.

doc do u think thay yoga is good for the uterus?

Yes. Yoga is an excellent exercise for women to improve health and help with both gynaec and obstetric problems

dr ihave fibroids which was detected 9 yrs ago but no prob so far shd i go for a scan or get treated for this no gynaec probs at all

You just continue with screening the fibroids periodically and treat them when they become symptomatic.

dear dr i suffer from incontinence which is becoming veryfrequent nowadays.can u suggest sum techniques which can relieveme of this prob thanx doc

The 2 main kind of incontinence are stress incontinence where the leak happens in response to coughing or straining and urge incontinence due to an irritable bladder. Both need treatment.

Why is it that IVF and IUI Treatments often result in multiple births?

Since ovulation with induction and medications results in super ovulation with multiple eggs being released there is a significant increase in the multiple births resulting in twins, triplets and even quadruplets. Today we have the technology to reduce high order multiple births to twin pregnancies by embryo reductions.

Recently it has been learnt that babies born with IVF treatment tend to get health disorders.True?

No. Hundreds and thousands of babies are born worldwide through IVF and there is no evidence any significant health disorders. There is one condition of male infertility which has come to the fore and since this may be propagative by IVF may affect the male child.

What is the success rate of pregnancy in IVF treatment?

The internationally accepted success rate IVF is 35 percent per menstrual cycle with a take home baby rate of about 20 percent.

Is it advisable to take painkillers in painful menstrual cycle?

If the menstrual cycle is associated with severe pain then judicious use of painkillers and anti spasmodics is advised.

Dear Dr. During my routine annual health check-up they did papsmear and said there is erosion in the cervix. they did cryo treatment as well, is this the correct treatment , also can i use CANSOFT for light itching , regards jaya

An erosion is a harmless condition which only needs treatment if it causes persistent complaints.

Do fibroids cause infertility in women?

Yes fibroids present in the uterine cavity called as submucous fibroids and those who distort the cavity may be the primary cause of infertility.

Any medication required for small fibroids?

No while some medications may cause around 30 percent of shrinkage. This is temporary and they may re occur after the effect of the medication subsides.

I have heard that fibroids subside after menopause.Is it true?

It is true that being estrogen dependent fibroids do shrink after the woman is menopausal.

Are fibroids dangerous?

Very rarely. Fibroids may be associated with a sarcoma which is a cancerous condition. The incidents of this is less then 1 percent.

Hello Doctor.I want to know about fibroids.Why do they occur?

Fibroids are benign tumours of muscle and fibrous tissue. They are extremely common in women who have late pregnancies or few pregnancies. They are responsive to the hormone estrogen. Fibroids only require surgical treatments if they are large or symptomatic. Others can be observed periodically and left alone.

My wife has passed 40yrs. She is normal and healthy.We are trying for a child.Is there some kind of risk at a later stage of pregnancy?

There is an increase in the risk of down syndrome and also medical disorders such as hypertension and diabetes. Fortunately all these can be well managed.

Does an older woman after 35 yrs always fall in a high risk pregnancy category even if she is healthy and normal ?

Yes by virtue of a chronological age she does. However if she is healthy and comparable to younger women in what I call biological age, she is totally capable of a normal healthy pregnancy.

What is the best method of contraception today?

Contraception has to be selected by the user given a unique situation from a basket of choices called the cafeteria approach. The most effective temporary contraceptives are hormones such as oral contraception, injectables and the latest vaginal ring and intrauterine devices such as the copper IUD whose use may now be extended to 10 yrs and the hormone containing IUD which makes the bleeding significantly less and can be used for treating very heavy periods

What is induced abortion sir?

Induced abortion is the medical termination of the unwanted pregnancy. This could be done medically or surgically. Induced abortion by a qualified provider is one of the safest procedures while unsafe abortions by quacks are extremely dangerous and even life threatening. I consider the woman’s choice to access safe abortion as one of the most important rights that society can give a woman.

Why is it that some females have a heavy flow and some have scanty flow during menses? Is it genetic?

No. The reasons for both extremes could be certain hormonal disorders or then local pathologies. A delayed periods are often heavy because of endometrial overgrowth while a scanty periods may result from damage to the endometrial by infection or surgery.

I am 38 yrs now. I have always maintained a one and a half day mrnstrual cycle.Is it normal?

Yes it is. There is tremendous variation in the menstrual cycle from your one and a half days to even 6 days.

Is it normal to witness some pain on the ovulation day?

Yes. Some patients are able to pin point the day of ovulation by the experience of a sharp pain on the side the egg is released.

Which is the best side to sleep in doctor after 7 months of pregnancy?

The large size of the uterus tends to compromise the blood running from the lower part of the body to the heart potentially reducing the blood flow of the pregnancy. Sleeping on your left side is the recommended position though sleeping on the right side or even just tilted to the left side by 15 degrees is acceptable.

How many ultrasounds should one have during the 9 month pregnancy Sir?

It is generally accepted that one ultrasound per trimester is a reasonable minimum. The first being for diagnosis, the second to rule out birth defects and the third to evaluate growth and well being.

Is it true that vegans need to change their diet during pregnancy?

No …all diets can be balanced and so long as the calories proteins and other important elements are supplied to the body women can follow personal choice.

What about abdominal cramps during pregnancy? Is it normal?

No, while intestinal and abdominal wall cramps which are transient are not harmful. Any pain of cramping during pregnancy should be reported to your Obstetrician

Is it normal for one to be near pet dogs if she is pregnant? Any infection scare?

No, pet dogs which are well groomed and cared are not a problem to have around during pregnancy. Just a word of caution pets can sometimes be very possessive of their owners and have been known to exhibit envy to the new born.

What is your opinion on ultrasound? Is it harmful to the baby in the womb?

The ultrasound technology is over 50 yrs old and there has been no evidence of any detrimental effects on the foetus. However any technology however safe should be used only when required.

Is vaginal birth possible after caesarian section? This is for my elder sister who is 8 months pregnant with her 2nd child.

Yes. If the first caesarean was done for a non recurring indication vaginal birth is possible and would be successful in about 60 percent patients. Of course given the uterine scar which would be a weak point this is only permitted in well equipped settings with facilities for emergency caesarean in case, if it is required.

Hi Dr. I want to know when is a gynaecological examination done during menstrual cycle?

This would depend upon a patient’s complains when it has to be done when the problem manifests. Routine checks and screenings may be best if taken in the first half of the menstrual cycle.

How is it to consume fast food, soft drinks and artificial sweetners during pregnancy?

Its best to have a healthy diet and avoid the empty calories that go with fast food and aerated drinks. However an occasional indulgence is permitted since we appreciate the cravings the woman might experience. I recommend that the artificial sweetners be best avoided.

How much time can I walk everyday as a part of exerciseduring pregnancy? What hhousehold chores should I avoid?

The amount you walk depends upon how comfortable you are at the end of the exercise. I would recommend atleast half an hour 5 times a week. This need not be at one stretch. I also have a patient who continued training for the half marathon while pregnant.

Why is the consumption of folic acid considered very important before & during pregnancy?

Folic acid reduces defects of the neural tube that forms the brain and the spine by over 50 percent. This is why food fortified by folic acid or folic acid supplements are considered vital for well being before and during pregnancy.

How much weight gain is ideal in 3 months and 6 months of pregnancy?

A lot of it depends upon the weight you start with. If you have a normal BMI then it is usually a kilo a month in the first 6 months. And 2 kilos a month in the last 3 months( A total of 11-12 kilos). Ofcourse morning sickness may sometimes cause a failure to gain weight in the first trimester.

I am 8 weeks pregnant.I wanted to know if there is anything that I could add or avoid in my diet to get rid of morning sickness.

Morning sickness is to an extent physiological because of the hormones of pregnancy. It is generally triggered more by the intake of liquids. I suggest you start your day with a few biscuits or a toast and even brush your teeth may be an hour later. It is important that you eat something every 4 hours. Since this may also help. If however symptoms persist there are safe mendications that your Obstetrician may prescribe.

Which is more healthier Dr.Nozer.. Vaginal birth or Caesarian .. both for mother snd child? Thanks

The selection has to be individualised on medical grounds. Nature meant for babies to be born vaginal. It is only when vaginal birth becomes high risk due to a very large baby, breech presentation or a placenta pravia which blocks normal birth or if the foetus gets distressed is caesarean resorted to.

I am 3 weeks pregnant. Pls advise on prenatal care.

Its always good to start prenatal care early. You need a folic acid supplement through out the first trimester. Avoid exposure to risk in the form of X rays, contact with infections and self medications. The first 3 months may have difficult symptoms like nausea, lethargy, sensitive rests and frequency of urination. Most of the symptoms will disappear in the 2nd trimester. May I also suggest that you go see your Obstetrician as early as possible.

How can a female prepare for good health during and after menopause

Preparation would start before menopause with a healthy lifestyle, that ensures a normal weight and good bone health. Once menopause sets in the importance of a healthy diet with an adequate calcium intake and weight bearing exercise cannot be over emphasized.

What kind of tests do you prescribe for females on yearly basis to keep a check on their gynaecological health?

THE TESTS WOULD DEPEND ON YOUR AGE. Blood tests would be haemoglobin, blood sugar and TSH. A pap smear to screen for cervical cancer. An ultrasound to identify the problems of the ovaries and the uterine. A breast examination and a mammogram after the age of 40. The frequency and additional tests would depend upon your age, family history and specific complains.

Doctor what are the reasons that lead to pain during the menstrual cycle?

It may be primary which is what happens to young women. For this there is no specific cause. It may also be secondary to local conditions like fibroids and endometriosis.

Do scanty bleeding during menses also lead to infertility?

Yes if there is a uterine cause.

How many attempts of IUI are generally adviced if not succuessful in first attempt?

I would generally recommend 4-6 attempts after which other options could be considered.

Can my Tests indicate as to when I will get menopause? I am 42yrs now?

Yes. The FSH level gives us a good estimate while the AMH will tell us about your ovarian reserve. Knowledge of the age of menopause in your family particularly your mother and your siblings would also be a useful indicator.

Hello Dr. I am 42yrs female.All my & my husband’s tests are normal but I am unable to conceive.Till what age can one opt for IUI Or IVF ?

At 42 yrs IUI remains an option if your fertility parameters such as FSH and AMH are within reasonably normal limits. IVF can even be done later. Patients who are menopausal can opt for IVF with donor Oocytes. You are not alone, there are many women who plan pregnancy out of necessity or choice, after the age of 40.