We have a team of devoted surgeons, who adopt a policy to provide high quality medical care with compassion, excellence, and integrity. There is a special interest in Laparoscopic interventional surgery.

Our surgical team has a lot of valued studies at different aspects of surgery and they continue to exploit the most up to date approach to surgical cases. Different major operative procedures can be readily accomplished at Sunrise Hospital especially with a good back up of intensive care unit. Most of our Laparoscopic operations are considered as a day care or one day stay, but we always take into consideration patients with special needs. Our surgery team believes that postoperative infection continues to be a major source of morbidity and discomfort to surgical patients, so proper preparation is always adopted and continuing monitoring of our hospital atmosphere is ratified.

Services:

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UTERINE FIBROID TREATMENT

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Uterine fibroids are lumps that grow on your uterus. You can have fibroids on the inside, on the outside, or in the wall of the uterus.

Your doctor may call them fibroid tumors, leiomyomas, or myomas. But fibroids are not cancer. You do not need to do anything about them unless they are causing problems.

Fibroids are very common in women in their 30s and 40s. But fibroids usually do not cause problems. Many women never even know they have them.

What are the symptoms?

Often fibroids do not cause symptoms. Or the symptoms may be mild, like periods that are a little heavier than normal. If the fibroids bleed or press on your organs, the symptoms may make it hard for you to enjoy life. Fibroids make some women have:

• Long, gushing periods and cramping.
• Fullness or pressure in their belly.
• Low back pain.
• Pain During Sex.
• An urge to urinate often.

Heavy bleeding during your periods can lead to anemia. Anemia can make you feel weak and tired. Sometimes fibroids can make it harder to get pregnant. Or they may cause problems during pregnancy, such as going into early labor or losing the baby (miscarriage)

How are uterine fibroids diagnosed?

To find out if you have fibroids, your doctor will ask you about your symptoms. He or she will do a pelvic exam to check the size of your uterus.

Your doctor may send you to have an ultrasound or another type of test that shows pictures of your uterus. These help your doctor see how large your fibroids are and where they are growing. Your doctor may also do blood tests to look for anemia or other problems.

TREATMENT OF FIBROIDS

• Small, asymptomatic Fibroids do not need treatment, a regular follow up with ultrasound is all that is needed in these patients.
• Treatments like Laparoscopy Myomectomy/hysteroscopy, Myomectomy, Gross wedgings of the uterus or laparoscopic Hysterectomy can all be offered to the patients and the correct treatment chosen according the reproductive needs of the patients. All the treatment “individually” or tailor made as each patient has her own individual needs.

SYMPTOMATIC FIBROIDS

• In women where fibroids lead to any of the above mentioned symptoms in the patient the fibroids must be removed. This is best done by the “LAPAROSCOPIC METHOD”.
• If the women is above 40 Years of age and her family is complete, She can opt for removing the whole uterus and not just the fibroid by a “LAPAROSCOPIC HYSTERECTOMY”
• If the patient is under 40 Years of age or is desirous of having a baby then a “LAPAROSCOPIC HYSTEROSCOPIC / MYOMECTOMY” would be performed for her.
• Both Laparoscopic Hysterectomy/Laparoscopic Myomectomy are performed at Sunrise Hospital as “SHORT STAY” procedures. Also at SUNRISE the patient is offered LUAL (Laparoscopic uterine artery ligation) along with her Laparoscopic Myomectomy to decrease the recurrence of Fibroids.

Comparison of Laparoscopic Surgery with Open Surgery:

LAP SURGERY	OPEN SURGERY
Only 1 Day Hospital Stay	Hospital Stay for 5-6 Days
Minimal blood loss (less than 100ml)	Patient loses at least 500ml of blood
No need for Blood Transfusion	Blood Transfusion often needed
No need for I.V Drip	I.V Drip needed for 24 Hours
Minimal pain (Most patients do not need even oral pain killers)	More Painful (Pain Score charts higher)
Early return to work (2-3 Days)	Usually return to work only after 1 month
Less Costly	More Expensive

Laparoscopic Hysterectomy

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Now a days as we all know a lot of unindicated Hysterectomies (Removal of uterus) are being performed in North India. There are specific indications (Medical Reasons) for performing a Hysterectomy like –

• Heavy Menstrual bleeding (D.U.B) that does not respond to medicines.
• Fibroids in women, who are over 40yrs, have completed their family.
• Endometriosis & Adenomyosis
• Cancer of the Uterus or Cervix of the uterus ovaries or tubes.
• Pre Cancerous

In previous times Hysterectomy could only be performed after a large cut was given on the abdomen but now a day this method of removing the uterus is considered obsolete by most gynecologists. Even today 80% of Hysterectomies are performed by this outdated procedure in North India. In most 1st world countries , only about 30% of surgeries are performed by the open technique, as the patient takes a long time to recuperate after surgery , whereas Laparoscopic surgery offers several benefits to the patient like :

• Only 1 day hospitalization.
• Can return to work in 2-3 days.
• Minimal blood lost.
• No Blood Transfusion
• Minimal or No pain

Laparoscopic surgeries much superior to open surgery as the surgeon / Lap Gynecologist gets a 20 times magnified & well lit view (because of the Xenon light and other special equipment used in Laparoscopy) so the surgeon can perform a munch finer & better quality of surgery that what he/she can see at open surgery.

Certain Myths associated with laparoscopic Hysterectomy MYTH Busters

*Myth buster (a)
Today even very large uterus that were previously not operated by Laparoscopy can also be now operated at good Laparoscopic centers so “Any size of the uterus can be operated on Laparoscopic ally”(our hospital has the world record for a 5.4 Kg uterus removed by laparoscopy).

**Myth buster (b)
Previous Surgery: Women who have had previous open surgeries like Caesarean sections (any number of previous surgeries) can also be operated on laparoscopically now at good centers.

***Myth buster (c)
Cancer Surgery: Today at standard Laparoscopic centers even Cancer surgery (like – Cervix, uterus, etc) can easily be performed by the Laparoscopic route.

In Our country the additional Myths associated with Lap Hysterectomy are

• That it is more expensive. Again this completely wrong as Lap surgery is not only more cost effective but also lets the patient join back work earlier & helps the patient earning.
• Eyes / bones become weak after Hysterectomy / Hormonal disturbances occur after Hysterectomy – Now days as the ovaries are not usually removed at Hysterectomy (unless the patient suffers from Cancer) and since the female hormone come from the ovaries there are no Normal disturbances and neither do the eyes or bones become weak after Hysterectomy.
• Some part of the uterus may be left behind accidentally at Laparoscopy; this is completely untrue as the magnified view of the Laparoscope does not let even 1cm of any tissue or blood being left inside (Compared to open surgery where the surgeons’ naked eyes can always make mistakes.)

Carry home massage/Conclusion: As women play a key role in a functioning of an Indian family they usually do not have the luxury of falling sick and need to recover fast & Lap surgery helps them in just that.

Endometriosis

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What is endometriosis?

Endometriosis is the abnormal growth of cells (endometrial cells) similar to those that form the inside or lining the tissue of the uterus, but in a location outside of the uterus. Endometrial cells are cells that are shed each month during menstruation. The cells of endometriosis attach themselves to tissue outside the uterus and are called endometriosis implants. These implants are most commonly found on the ovaries, the Fallopian tubes, outer surfaces of the uterus or intestines, and on the surface lining of the pelvic cavity. They can also be found in the vagina, cervix, and bladder, although less commonly than other locations in the pelvis. Rarely, endometriosis implants can occur outside the pelvis, on the liver, in old surgery scars, and even in or around the lung or brain. Endometrial implants, while they can cause problems, are benign (not cancerous).

Who is affected by endometriosis?

Endometriosis affects women in their reproductive years. The exact prevalence of endometriosis is not known, since many women may have the condition and have no symptoms. It is one of the leading causes of pelvic pain and reasons for laparoscopic surgery and hysterectomy. Estimates suggest that between 20% to 50% of women being treated for infertility have endometriosis, and up to 80% of women with chronic pelvic pain may be affected.

While most cases of endometriosis are diagnosed in women aged around 25 to 35 years, endometriosis has been reported in girls as young as 11 years of age. Endometriosis is rare in postmenopausal women. Endometriosis is more commonly found in white women as compared with African American and Asian women. Studies further suggest that endometriosis is most common in taller, thin women with a low body mass index (BMI). Delaying pregnancy until an older age is also believed to increase the risk of developing endometriosis. It also is likely that there are genetic factors that predispose a woman to developing endometriosis, since having a first-degree relative with the condition increases the chance that a woman will develop the condition.

What causes endometriosis?

The cause of endometriosis is unknown. One theory is that the endometrial tissue is deposited in unusual locations by the backing up of menstrual flow into the Fallopian tubes and the pelvic and abdominal cavity during menstruation (termed retrograde menstruation). The cause of retrograde menstruation is not clearly understood. But retrograde menstruation cannot be the sole cause of endometriosis. Many women have retrograde menstruation in varying degrees, yet not all of them develop endometriosis.

Another possibility is that areas lining the pelvic organs possess primitive cells that are able to grow into other forms of tissue, such as endometrial cells. (This process is termed coelomic metaplasia.) It is also likely that direct transfer of endometrial tissues during surgery may be responsible for the endometriosis implants sometimes seen in surgical scars (for example, episiotomy orCesarean section scars). Transfer of endometrial cells via the bloodstream or lymphatic system is the most likely explanation for the rare cases of endometriosis that develop in the brain and other organs distant from the pelvis.

Finally, there is evidence that shows alternations in the immune response in women with endometriosis, which may affect the body’s natural ability to recognize and destroy any misdirected growth of endometrial tissue.

What are the symptoms of Endometriosis?

Most women who have endometriosis, in fact, do not have symptoms. Of those who do experience symptoms, the common symptoms are pain (usually pelvic) and infertility. Pelvic pain usually occurs during or just before menstruation and lessens after menstruation. Some women experience painful sexual intercourse (dyspareunia) or cramping during intercourse, and or/pain during bowel movements and/or urination. Even pelvic examination by a doctor can be painful. The pain intensity can change from month to month, and vary greatly among women. Some women experience progressive worsening of symptoms, while others can have resolution of pain without treatment.

Pelvic pain in women with endometriosis depends partly on where the implants of endometriosis are located.

• Deeper implants and implants in areas with many pain-sensing nerves may be more likely
• to produce pain.
• he implants may also produce substances that circulate in the bloodstream and cause
• pain.
• Lastly, pain can result when endometriosis implants form scars. There is no relationship between severity of pain and how widespread the endometriosis is (the “stage” of endometriosis).

Endometriosis can be one of the reasons for infertility for otherwise healthy couples. When laparoscopic examinations are performed for infertility evaluations, endometrial implants can be found in some of these patients, many of whom may not have painful symptoms of endometriosis. The reasons for a decrease in fertility are not completely understood, but might be due to both anatomic and hormonal factors. The presence of endometriosis may involve masses of tissue or scarring (adhesions) within the pelvis that may distort normal anatomical structures, such as Fallopian tubes, which transport the eggs from the ovaries. Alternatively, endometriosis may affect fertility through the production of hormones and other substances that have a negative effect on ovulation, fertilization of the egg, and/or implantation of the embryo.

Other symptoms that can be related to endometriosis include:

• lower abdominal pain,
• diarrhea and/or constipation,
• low back pain,
• chronic fatigue
• irregular or heavy menstrual bleeding, or
• blood in the urine.

Rare symptoms of endometriosis include chest pain or coughing blood due to endometriosis in the lungs and headache and/or seizures due to endometriosis in the brain.

Endometriosis and cancer risk

Women with endometriosis have an increased risk for development of certain types of cancer of the ovary, known as epithelial ovarian cancer (EOC), according to some research studies. This risk is highest in women with endometriosis and primary infertility (those who have never borne a child), but the use of oral contraceptive pills (OCPs), which are sometimes used in the treatment of endometriosis, appears to significantly reduce this risk.

The reasons for the association between endometriosis and ovarian epithelial cancer are not clearly understood. One theory is that the endometriosis implants themselves undergo transformation to cancer. Another possibility is that the presence of endometriosis may be related to other genetic or environmental factors that also increase a women’s risk of developing ovarian cancer.

How is endometriosis diagnosed?

Endometriosis can be suspected based on symptoms of pelvic pain and findings during physical examinations in the doctor’s office. Occasionally, during a rectovaginal exam (one finger in the vagina and one finger in the rectum), the doctor can feel nodules (endometrial implants) behind the uterus and along the ligaments that attach to the pelvic wall. At other times, no nodules are felt, but the examination itself causes unusual pain or discomfort.

Unfortunately, neither the symptoms nor the physical examinations can be relied upon to conclusively establish the diagnosis of endometriosis. Imaging studies, such as ultrasound, can be helpful in ruling out other pelvic diseases and may suggest the presence of endometriosis in the vaginal and bladder areas, but still cannot definitively diagnose endometriosis. For an accurate diagnosis, a direct visual inspection inside of the pelvis and abdomen, as well as tissue biopsy of the implants are necessary As a result, the only accurate way of diagnosing endometriosis is at the time of surgery with laparoscopy.

Laparoscopy is the most common surgical procedure for the diagnosis of endometriosis. Laparoscopy is a minor surgical procedure done under general anesthesia.During laparoscopy, biopsies (removal of tiny tissue samples for examination under a microscope) can also be performed for a diagnosis. Sometimes biopsies obtained during laparoscopy show endometriosis even though no endometrial implants are seen at laparoscopy.

How is endometriosis treated?

Endometriosis can be treated with medications and/or surgery. The goals of endometriosis treatment may include pain relief and/or enhancement of fertility.

Medical treatment of endometriosis

Nonsteroidal anti-inflammatory drugs or NSAIDs (such as ibuprofen or naproxen sodium) are commonly prescribed to help relieve pelvic pain and menstrual cramping. These pain- relieving medications have no effect on the endometrial implants. However, they do decrease prostaglandin production, and prostaglandins are well-known to have a role in production of pain sensation. Because the diagnosis of endometriosis is only definite after a woman undergoes surgery, there will of course be many women who are suspected of having endometriosis based on the nature of their pelvic pain symptoms. In such a situation, NSAIDs are commonly used, such as naproxen or ibuprofen, are commonly used. If they work to control pain, no other procedures or medical treatments are needed. If they do not relieve the pain, additional evaluation and treatment generally occur.

Since endometriosis occurs during the reproductive years, many of the available medical treatments for endometriosis rely on interruption of the normal cyclical hormone production by the ovaries. These medications include GnRH analogs, oral contraceptive pills, and progestins.

Gonadotropin-releasing hormone analogs (GnRH analogs)

Gonadotropin-releasing hormone analogs (GnRH analogs) have been effectively used to relieve pain and reduce the size of endometriosis implants. These drugs suppress estrogen production by the ovaries by inhibiting the secretion of regulatory hormones from the pituitary gland. As a result, menstrual periods stop, mimicking menopause. Nasal and injection forms of GnRH agonists are available (Zoladex, Leuprolide).

The side effects are a result of the lack of estrogen, and include:

• Hot flashes,
• Vaginal dryness,
• Irregular vaginal bleeding,
• Mood changes,
• Fatigue, and
• Loss of bone density (osteoporosis).

Fortunately, by adding back small amounts of estrogen and progesterone in pill form (similar to treatments sometimes used for symptom relief in menopause) many of the annoying side effects due to estrogen deficiency can be avoided. “Add back therapy” is the term that refers to this modern way of administering GnRH agonists along with estrogen and progesterone in a way to keep the treatment successful, but avoid most of the unwanted side effects.

Oral contraceptive pills

Oral contraceptive pills (estrogen and progesterone in combination) are also sometimes used to treat endometriosis. The most common combination used is in the form of the oral contraceptive pill (OCP). Sometimes women who have severe menstrual pain are asked to take the OCP continuously. Continuous use in this manner will free a woman of having any menstrual periods at all. Occasionally, weight gain, breast tenderness, nausea, and irregular bleeding are mild side effects. Oral contraceptive pills are usually well-tolerated in women with endometriosis.

Progestins

Progestins [for example, medroxyprogesterone acetate, norethindrone acetate, norgestrel acetate ] are more potent than birth control pills and are recommended for women who do not obtain pain relief from or cannot take a birth control pill.

Side effects are more common and include:

• Breast tenderness,
• Bloating,
• Weight gain,
• Irregular uterine bleeding, and
• Depression

Since the absence of menstruation (amenorrhea) induced by high doses of progestins can last many months after cessation of therapy, these drugs are not recommended for women planning pregnancy.

Other drugs used to treat endometriosis

Danazol
Because of the side effect profile Danazol is not usually used now days.

Aromatase inhibitors
A newer approach to the treatment of endometriosis has involved the administration of drugs known as aromatase inhibitors. These drugs act by interrupting local estrogen formation within the endometriosis implants themselves. They also inhibit estrogen production in the ovary, brain, and other sources, such as adipose tissue. Aromatase inhibitors cause significant bone loss with prolonged use and cannot be used alone without other medications such as GnRH diagonists or combination of oral contraceptives in premenopausal women because they stimulate development of multiple follicles at ovulation

Laparoscopic Treatment of Endometriosis
Laparoscopy is the gold standard for the diagnosis of endometriosis i.e. the diagnosis of endometriosis is confirmed by laparoscopy.

Laparoscopy in infertility related to Endometriosis
The adhesions (bands of tissue that make organs stick together) are seprated at laparoscopy and Endometriomas (Blood filled endometriotic ovarian cysts) are treated, and normal uterine, tubal and ovarian relationship established, any endometriotic deposits found in the pelvis are also removed. In case of SEVERE ENDOMETRIOSIS at “SUNRISE” a novel approach called “SANDWITCH THERAPY” is practiced wherein after a primary laparoscopy, the patient is given 6 cycles of GNRH agonists (Zoladex, Leuprolide) to quiten any endometriosis that may have been left behind after the primary laparoscopy. A relook laparoscopy is then performed after this. We have found a marked increase in the fertility (almost reaching 70-80%) after sandwitch therapy in such patients compared to single laparoscopy (fertility rate 25-30% only in such cases)

Laparoscopy in chronic pelvic pain
All the endometriotic deposits are removed to release the pain in endometriosis by laparoscopy. Also DIE (Deeply Infiltrating Endometriosis) like recto vaginal Endometriosis is completely removed for pain relief at laparoscopy.

DYSFUNCTIONAL UTERINE BLEEDING

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What is dysfunctional uterine bleeding?

Dysfunctional uterine bleeding is irregular bleeding from the uterus. For example, you may get your period more often than every 21 days or farther apart than 35 days. Your period may last longer than 7 days. It is not serious, but it can be annoying and disrupt your life. In most cases, this problem is related to changes in hormone levels. It is not caused by other medical conditions, such as miscarriage, fibroids, cancer, or blood clotting problems. Your doctor will rule out these and other causes of vaginal bleeding to confirm that you have dysfunctional uterine bleeding.

What causes dysfunctional uterine bleeding?

Dysfunctional uterine bleeding is usually caused by changes in hormone levels. In some cases the cause of the bleeding isn’t known.

Normally one of your ovaries releases an egg during your menstrual cycle. This is called ovulation. Dysfunctional uterine bleeding is often triggered when women don’t ovulate. This causes changes in hormone levels and in some cases can lead to unexpected vaginal bleeding.

Women can also get this condition even though they ovulate, although this is less common. Experts don’t fully understand this type of vaginal bleeding. It may be caused by changes in certain body chemicals.

What are the symptoms?

You may have dysfunctional uterine bleeding if you have one or more of the following symptoms:

• You get your period more often than every 21 days or farther apart than 35 days. A normal adult menstrual cycle is 21 to 35 days long. A normal teen cycle is 21 to 45 days.
• Your period lasts longer than 7 days (normally 4 to 6 days).
• Your bleeding is heavier than normal. If you are passing blood clots and soaking through your usual pads or tampons each hour for 2 or more hours, your bleeding is considered severe and you should call your doctor.

Talk to your doctor if you have had irregular vaginal bleeding for three or more menstrual cycles or if your symptoms are affecting your daily life.

How is dysfunctional uterine bleeding diagnosed?

Your doctor must first rule out all other causes of vaginal bleeding before diagnosing dysfunctional uterine bleeding. These causes include miscarriage and problems with pregnancy. Vaginal bleeding may also be caused by common conditions, such as uterine fibroids.

Your doctor will ask how often, how long, and how much you have been bleeding. You may also have a pelvic exam, urine test, blood tests, and possibly an ultrasound. These tests will help your doctor check for other causes of your symptoms. He or she may also take a tiny sample (biopsy) of tissue from your uterus for testing. Preferably after a hysteroscopy wherein a pen size scope is inserted with the uterine cavity to look for the cause of bleeding.

RECURRENT MISCARRIAGES

Recurrent Pregnancy Loss is a profound personnel tragedy to couples seeking parenthood. Miscarriage occurs in approximately 22 to 25% of pregnancies.

Miscarriages can be caused by several disorders like Infections, Hormonal problems or certain problems in the blood like Thrombophilias or by Genetic defects etc.

As Laparoscopic Gynaecologists the “ANATOMIC” problems that come to us are the most completely reversible cause of Recurrent pregnancy loss

Amongst these “Anatomic” problems the miscarriage can be caused by:

• A fibroid present in the uterus.
• A “SEPTUM” (wall) present in the cavity of the uterus.
• A “POLYP” or any other growth present within the uterus.
• Cervical Incompetence: In this condition the mouth of the uterus (CERVIX)which is supposed to open only during childbirth (labour)opens before time(before the child is full term) and leads to either a miscarriage or the birth of a very premature baby .

TREATMENT OPTIONS FOR THESE WOMEN

Previously these women were treated by applying a stitch on the mouth of the uterus from below during pregnancy(called as vaginal encerclage). But sadly many of these women still continue to have miscarriages.

Hence at SUNRISE we have a new procedure designed for these unfortunate women wherein the mouth of the uterus is tied from above by Laparoscopy, this procedure is called as “LAPAROSCOPIC ENCERCLAGE” and it is highly successful in women who have had repeated miscarriages or preterm babies.

Other causes of Miscarriages like fibroid, Polyp , Septum or any other anatomic problem in the uterus can also be treated by Laparoscopy or Hysteroscopy.The problems of hormonal imbalances or infections or genetic defects also can all be diagnosed and treated simultaneously.

All these investigations and treatments done can not only save the parents of the psychological trauma of having a miscarriage for the parents but also helps them get the most beautiful gift of a healthy baby delivered on time.

POSTMENOPAUSAL BLEEDING

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If you have completed menopause — gone without a period for more than one year — you should not experience any menstrual bleeding. Even a little spotting is not normal after menopause. If you have postmenopausal bleeding, make an appointment to see your doctor as soon as possible. It could be caused by a number of health problems, some of which are serious.

Here is an overview of the most common causes of postmenopausal bleeding.

Causes of Postmenopausal Bleeding

Several health conditions can cause postmenopausal bleeding, including:

Polyps: These are growths, usually noncancerous, that can develop in the uterus, on the cervix, or inside the cervical canal, and may cause bleeding.

Endometrial atrophy (thinning of the endometrium): The endometrium, the tissue that lines the uterus, can become very thin after menopause because of diminished estrogen levels, and may cause unexpected bleeding.

Endometrial hyperplasia: In this condition, the lining of the uterus becomes thick, usually as a result of too much estrogen and too little progesterone, and bleeding may occur as a result. Obesity may be the cause of the problem. Some patients with endometrial hyperplasia may have abnormal cells that can lead to endometrial cancer (cancer of the uterine lining).

Endometrial cancer (uterine cancer): Bleeding after menopause can be a sign of endometrial cancer. Other causes: Hormone therapy, infection of the uterus or cervix, use of certain medications such blood thinners, and other types of cancer can cause postmenopausal bleeding.

Determining the Cause of Postmenopausal Bleeding

Your doctor can determine the cause of your bleeding by taking your medical history, performing a physical exam, and conducting a few tests. Tests may include:

Transvaginal ultrasound: During this test, a special imaging device is inserted inside the vagina so that your doctor can view the pelvic organs and look for abnormalities. Endometrial biopsy: A thin tube is inserted into your uterus and a tiny sample of the uterine lining is removed so that it can be sent to a lab to look for abnormalities.

Hysteroscopy: During this test, your doctor uses an instrument with a light and small camera to examine the inside of the uterus and look for problems.

D&C (dilation and curettage): This test allows your doctor to remove tissue from the uterus lining so that it can be sent to a lab for analysis. Ultrasound and biopsy can be performed in your doctor’s office; hysteroscopy and D&C are usually performed in a hospital or outpatient surgical center.

How is Postmenopausal Bleeding Treated?

Treatment depends on what is causing the bleeding. If polyps are to blame, surgery may be needed to remove them. Endometrial atrophy can be treated with medication alone; endometrial hyperplasia may be treated with medication, such as progestin or progesterone therapy, and/or surgery to remove thickened areas of the endometrium. If you have endometrial hyperplasia, you will need to see your doctor on a regular basis for monitoring.

• Risk factors for women’s infertility include ovulation problems, blocked Fallopian tubes(especially dye to TB in our country), uterine problems, uterine fibroids, age, stress, poor diet, athletic training, and those risk factors listed for men.
• Aging decreases a woman’s fertility; after age 35 about 33% of couples have fertility problems; older women’s eggs are reduced in number, not as healthy and less likely to be released by the ovary – the woman is also more likely to have a miscarriage and other health problems.
• Women under 35 should try for a year or 6 months if 35 or older to become pregnant before contacting their doctor if they have no health problems.
• Doctors use the histories of both partners and may run tests such as sperm studies, ovulation tests,ultrasound, hysterosalpingography, or laparoscopy.
• Infertility may be treated with medicine, surgery, artificial insemination, or assisted reproductive technology, based on the couples test results and other factors.
• There are multiple medicines that may be used to treat infertility in women.
• Intrauterine insemination is artificial insemination where a woman is injected with sperm into the uterus.
• ART (assisted reproductive technology) is when a woman’s eggs are removed, mixed with sperm to make embryos that are placed back in the woman’s body; it’s successful about 11% to 39%, depending on the woman’s age.
• There are several types of ART; in vitro fertilization and intracytoplasmic sperm injection.
• Surrogacy (the woman’s male partner sperm is used to fertilize another woman egg and that other woman carries the fetus to term and the infant is then adopted ) is a way for some couples to obtain a baby.
• A gestational carrier is a woman who has an embryo placed in her uterus, carries the fetus to term and gives the baby to the couple (or responsible persons) that produced the embryo.

What is infertility?

Infertility means not being able to get pregnant after one year of trying. Or, six months, if a woman is 35 or older. Women who can get pregnant but are unable to stay pregnant may also be infertile. Pregnancy is the result of a process that has many steps. To get pregnant:

• A woman must release an egg from one of her ovaries (ovulation).
• The egg must go through a Fallopian tube toward the uterus (womb).
• A man’s sperm must join with (fertilize) the egg along the way.
• The fertilized egg must attach to the inside of the uterus (implantation).

Infertility can happen if there are problems with any of these steps.

What causes infertility in men?

Infertility in men is most often caused by:

• A problem called varicocele. This happens when the veins on a man’s testicle(s) are too large. This heats the testicles. The heat can affect the number or shape of the sperm.
• Other factors that cause a man to make too few sperm or none at all.
• Movement of the sperm. This may be caused by the shape of the sperm. Sometimes injuries or other damage to the reproductive system block the sperm.

Sometimes a man is born with the problems that affect his sperm. Other times problems start later in life due to illness or injury. For example, cystic fibrosis often causes infertility in men.

What increases a man’s risk of infertility?

A man’s sperm can be changed by his overall health and lifestyle. Some things that may reduce the health or number of sperm include:

• Heavy alcohol use
• Drugs
• Environmental toxins, including pesticides and lead
• Smoking cigarettes
• Age
• Health problems such as mumps, serious conditions like kidney disease, or hormone problems
• Medicines

What causes infertility in women ?

Most cases of female infertility are caused by problems with ovulation (Egg release), . Without ovulation there are no eggs to be fertilized. Some signs that a woman is not ovulating normally include irregular or absent menstrual periods.

Ovulation problems are frequently caused by polycystic ovarian syndrome (PCOS). PCOS is a hormone imbalance problem which can interfere with normal ovulation. PCOS is the most common cause of female infertility. Primary ovarian insufficiency (POI) is another cause of ovulation problems. POI occurs when a woman’s ovaries stop functioning (working properly) before she is 40 years old.

Other causes of female infertility.

• Blocked Fallopian tubes due to pelvic inflammatory disease,endometriosis, or surgery for an ectopic pregnancy
• Physical problems with the uterus like fibroids, polyp, adenomyosis etc.
• Endometriosis
• TB
• Harmonal disturbance in the thyroid or adrenal gland, diabetes etc.

Laparoscopic treatment for infertility :

Today laparoscopy has come as a boon for Infertility patients as it requires only 1 day hospital stay, early resumption of day to day activities, minimal blood loss and minimal adhesions make this procedure highly beneficial for the patients and also lead to higher pregnancy rate.

During Laparoscopy for Infertility :

Procedures that are easily done are-

• Lap Myomectomy- Removal of fibroidsResection of Endometriosis.
• Tubal Reconstruction is case of previous Laparoscopic Ligation also Known as Tubal Recanalisation.
• PCOD Drilling- for polycystic ovarian syndrome for patients who do not respond to medical management alone.
• Lap Adhesiolysis especially in cases of tuberculosis.
• Tubal Cannulation for Mucosal blocks in the tube.

Hysteroscopy

Wherein the inner cavity of the uterus is examined by a per size scope and any abnormalities corrected.

• Hysteroscopic Myomectomy : Wherein fibroids present inside the cavity of the uterus are removed at the same setting with special instruments like Resectoscope or Hysteroscopic Morcellators.
• Hysteroscopic Polypectomy: Polyps are benign growths present in side the uterus which lead to infertility and irregular bleeding per vaginum. These growths are removed at the Hysteroscopy.
• Septal Resection: Uterine septum is the presence of an abnormal wall within the cavity of the uterus which is reserted(removed) at the time of Hysteroscopy so that infertility or miscarriage is prevented.
• Hysteroscopic Adhesiolysis is for ashermans syndrome: Sometimes small bands of tissue (Synechiae) present inside the cavity of the uterus are separated with special Hysteroscopic scissors.
• Hysteroscopic Tubal Cannulation.

Pre and Post Laparoscopic Advice

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Your doctor may have advised you a Laparoscopic Surgery for your problems, in preparation for your surgery please follow the below mentioned advice: NIGHT BEFORE SURGERY:
Please eat your meals by 9PM and do not eat anything after that.
Please remain calm and sleep early knowing that you are in safe hands.

MORNING OF SURGERY: Take your Anti Hypertensives (B.P Medication) and/or your Thyroid Medication at 7am with a sip of water. Do not eat or drink anything after that.
[Unless your Surgery is in the afternoon and the doctor has permitted you to eat or drink ]
PLEASE TAKE A SCRUB BATH, AND HAIRWASH in the morning of your Surgery
Please get admitted to the Hospital in the Time Slot given to you to avoid any ADMINISTRATIVE PROBLEMS.
Upon your admission you will be guided to your patient room where you will be changed into the hospital clothes and will then be shifted to the Recovery Room before your surgery.


AFTER YOUR SURGERY ON DISCHARGE: Please take your medications on time as per your advice on discharge.
You can climb steps, Use Indian Toilet etc after Laparoscopic Surgery.
Please be mobile and start your Daily Work immediately. Please Join Work Soon.
You can take off your water proof dressing at home and take a bath and please Scrub the wound areas thoroughly with soap and water. Since you do not have any External Stitches that need to be removed, Please do not worry about your PORT SITES.
Eat a healthy and well Balanced Diet and Exercise Regularly.
You can join the Gym/ Do Aerobics 1 week after your Surgery.

AFTER HYSTERECTOMY: DO NOT HAVE INTERCOURSE / GO SWIMMING for 2 months after your surgery.
Collect your Reports and follow up with your Doctor 1 week after Surgery with Prior Appointment.

Infrastructure & Technology

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Bedi hospital is well equipped with 3 state-of-the-art Modular Operation Theater. We have the latest HIGH DEFINITION MONITORS with IMAGE ONE CAMERAS and XENON LIGHT SOURCE and the most updated energy sources like HARMONIC SCALPEL (Johnson & Johnson).

LAB :

We have fully flashed SRL lab services with the latest equipment including Architect Roche machine to offer all Hormone studies as well.

Hospital Management System (HMS):

We have unique Hospital Management software that ensures complete transparency of patient bills and records. Also as HMS is internet connected, and controlled it aids us in the central administration of all administrative activity.