• Intrauterine insemination (IUI)
• In vitro fertilization (IVF) with standard insemination
• Intracytoplasmic sperm injection (ICSI)
• Blastocyst culture
• TESA, MESA, PESA and TESE  for male factor
• cryopreservation

IUI: Intrauterine insemination

Intrauterine insemination (IUI) has a long history and is much less “hi-tech” than some other methods of assisted conception. IUI can help couples where the man has a low sperm count or poor motility (the ability of the sperm to move), as long as there are sufficient levels of healthy, motile sperm to make the treatment worthwhile. If not, IVF or ICSI will be more suitable. Because sperm is placed directly inside the woman, IUI can also help couples who are unable to have intercourse because of disability, injury, or difficulties such as premature ejaculation. It is also recommended for women with mild endometriosis, and is often used as the first line of assisted conception treatment for couples with “unexplained infertility”.

The development of the ovarian follicles is monitored with ultrasound .When ovulation has occurred, the male partner is asked to produce a semen sample. This sample is prepared in the laboratory, and is then introduced into the woman’s uterus (womb) by means of a fine catheter, with the aim of getting the sperm nearer to the egg.

Examples of catheters used for IUI

Women usually remain lying down for 5-10 minutes following the procedure. Since the sperm is above the level of the vagina, it will not leak out when she stands up. There are no restrictions on activity following the IUI procedure.

How the IUI procedure is performed.

The amount of motile sperm available for IUI is very important. The chances of success with IUI are best if the total motile sperm count at the time of insemination is > 5 million. If the total motile sperm count is below one million, success rates are very low. Therefore, in vitro fertilization or donor sperm insemination is usually performed for these cases.

Donor insemination can be used in cases where the man is producing no sperm in the ejaculate, or for couples who do not wish to undergo the ICSI procedure.

In vitro fertilization (IVF)

In vitro fertilization (IVF)is the most effective treatment for women with absent, blocked or damaged fallopian tubes. IVF is a major treatment in infertility when other methods of assisted reproductive technology have failed. It is now used to treat a wide range of fertility problems.

Fertility drugs are used to stimulate the ovaries to produce multiple follicles. Each follicle should contain one egg. The chances of pregnancy are increased if more than one egg can be obtained and fertilized. The response to stimulation is monitored by ultrasound scan measuring the number and size of the developing follicles in the ovaries and by measuring the blood oestrogen level. The final preparation for egg collection involves a hormonal injection given to the woman 36-40 hours pre-operatively. This mimics the natural process which triggers the eggs to complete their maturation making them ready for fertilization.

The eggs are collected vaginally using ultrasound guidance, under general or local anaesthesia. After egg collection the eggs are fertilised by sperm outside the womb, in vitro.Embryo transfer is usually done two or three days after egg collection. Even on day five it can be done as desired by the embryologist.

ICSI: Intracytoplasmic sperm injection

Intracytoplasmic sperm injection (ICSI) is an in vitro fertilization procedure in which a single sperm is injected directly into an egg. This procedure is most commonly used to overcome male infertility problems, although it may also be used where eggs cannot easily be penetrated by sperm, and occasionally as a method of in vitro fertilization, especially that associated with sperm donation.

Couples go through the same preparatory processes as with IVF, namely ovulation induction and egg collection. Under high-power magnification, a glass tool (holding pipette) is used to hold an egg in place. A microscopic glass tube containing sperm (injection pipette) is used to penetrate and deposit one sperm into the egg. After culturing in the laboratory overnight, eggs are checked for evidence of fertilization. After incubation, the eggs that have been successfully fertilized (zygotes) or have had 3 to 5 days to further develop (zygotes or blastocysts) are selected. Two to three are placed in the uterus using a thin flexible tube (catheter) that is inserted through the cervix. The remaining embryos may be frozen (cryopreserved) for future attempts.

ICSI.

STAGES OF EMBRYO DEVELOPMENT

Day of egg retrieval. Motile sperms are selected by the swim-up procedure for IVF or ICSI.

An egg shortly after retrieval

A mature egg without its ‘cumulus’ cells.

ICSI

A fertilised egg displaying male and female ‘pronuclei’

A 4 Cell Embryo on day 2

A 8 Cell Embryo on day 3

Morula stage on day 4

Blastocyst on day 5

Blastocyst embryo starting to hatch from its shell on day 6

A healthy blastocyst will implant within about one to two days following IVF transfer, very soon after blastocyst hatching.

Testicular Biopsy:

Among one of the most common male infertility tests that examine the underlying causes of fertility problems is the testicular biopsy. This fertility test involves the removal of testicular tissue in order to analyze any abnormalities that may be causing infertility. Sperm is produced in the testicles, and any testicular abnormalities can seriously affect male fertility.

The following are some fertility complications that may be identified by a testicular biopsy:

• The absence of cells needed to produce sperm maturity
• Hypospermatogenesis (the production of abnormally low numbers of sperm)
• Germinal cell aplasia (lack of germ cells that enable sperm production)
• Evidence of previous testicular infection
• Abnormalities of Leydig cells

A testicular biopsy involves a small surgical procedure that takes place while a patient is under light sedation. This involves the insertion of a small needle into the testis in order to obtain a small sample of tissue. The procedure can take between fifteen minutes to a half an hour. The tissue that is extracted is then prepared for laboratory analysis to determine the presence of sperm. This sperm can then be used in infertility treatments usingassisted reproductive techniques (ART). More specifically, the sperm retrieved can be injected into an egg for fertilisation using intracytoplasmic sperm injection (ICSI) or in vitro fertilisation (IVF). The retrieved sperm can be stored and frozen for later use.

Cryopreservation:

Cryopreservation refers to the storage of a living organism at ultra- low-temperature such that it can be revived and restored to the same living state as before it was stored.

Embryo Cryopreservation (Freezing): Embryo cryopreservation (the process of freezing, storage and thawing embryos) can enhance pregnancy rates by allowing excess embryos not replaced in a fresh embryo transfer to be stored for future use.

Embryo freezing may also be performed when a fresh embryo transfer is not performed for any of the following reasons: (1) Risk of ovarian hyperstimulation syndrome (OHSS), (2) Poor quality endometrium (a thin uterine lining), (3) Intermenstrual bleeding, (4) Planned “banking” cycle in which the patient elects to store all embryos, (5) Extremely difficult embryo transfer.

Embryos are placed into straws or vials containing anti-freeze or cryoprotectant solutions. These are transferred to a programmable biological freezer which is used to achieve a controlled slow rate of cooling. During cooling, cells dehydrate and as the temperature is reduced, more ice forms and water is removed gradually from the cells. Slow cooling is continued to ~ -35°C at which point embryos are rapidly cooled by plunging into liquid nitrogen (-196°C). Embryos are kept in storage tanks of liquid nitrogen until thawing is performed.

Vitrification:

Vitrification in IVF can allow freezing of spare embryos with better post-thaw survival rates and higher pregnancy and live birth rates from the frozen embryo transfer cycles. We started vitrification of embryos in our IVF lab and have seen excellent post-thaw embryo survival and high pregnancy rates after frozen embryo transfer procedures.

Semen Cryopreservation

Semen freezing is useful for men who find it difficult to ejaculate on demand which may result in their inability to produce a sample on the day of egg collection.

Sperm from two sources can be frozen: from ejaculates or from fluid extracted in the operating room during surgical procedures (vasal, epididymal and testicular sperm specimens). The sperm is usually frozen for a period of one year; at that time, future arrangements are discussed. It is generally believed that sperm that have been through the freeze-thaw process are no more likely to result in birth defects than freshly ejaculated sperm.

The term infertility is defined as the inability to conceive despite regular and unprotected intercourse for 1 year. However, risk factors such as the woman’s age, abnormal menstrual periods, history of pelvic inflammatory disease and whether there has been previous abdominal or pelvic surgery, history of undescended testicles may warrant earlier investigations and treatment of infertility. It has been found that female factors are responsible in 40% of cases, male factors account for a further 40%, combined male and female factors account for 10% and the remaining 10% of cases are unexplained.

Infertility is classified into two types:

• Primary infertility if there was no previous pregnancy (approximately 40% of infertile couples).
• Secondary infertility if there was a previous pregnancy whatever the outcome (approximately 60% of infertile couples).

Male Factor Infertility

The treatment of male factor infertility is one of the true success stories in the field of reproductive medicine. Male fertility screening is done through semen analysis. Disorders of sperm quality range from a low count or motility to a complete absence of sperm production. Deformities of the sperm cell shape (morphology) are also important to its ability to fertilize the egg. Mild abnormalities of semen parameters can be effectively treated using techniques that “wash” out the seminal plasma and improve the concentration of normally shaped motile sperm, which are then transferred to the uterus via an intrauterine insemination. However, for more severe conditions this treatment is inadequate. With a total motile cell concentration of less than 10 million cells per ml or a normal morphology of less than 4% by strict Kruger criteria, the chance of fertilization failure is very high, even with IVF. As a general principle, if the male factor cannot be reversed in the man’s body, by simple medical or surgical treatment, then IVF with ICSI represents the only rational approach, the results are excellent. Intrauterine insemination is not an effective way of treating mild to moderate male infertility.

Factors affecting sperm production

The most common causes of low sperm count are temporary and treatable. Research has shown that emotional or physical stress, cigarette smoking or heavy alcohol consumption can affect sperm production and male fertility. Sperm counts usually return to normal levels after such lifestyle issues are addressed. Certain drugs, radiation and radiotherapy may have a detrimental effect on the production of sperm. The presence of a varicocele may lead to a rise in the temperature around the testicles, which may adversely affect sperm production and motility. Testosterone deficiencies and certain autoimmune disorders that cause the body’s defenses to attack developing sperm.

Female Factor Infertility

A woman usually produces a single follicle in the ovaries each month as a result of various hormonal changes. Once the egg which develops within the follicle is mature, it is released. The fallopian tube subsequently picks the egg up and moves it towards the uterus. The quality of cervical mucus at the time of ovulation must be such that it allows free passage of the sperm into the uterus.

There are many different types of infertility experienced by women. Many of the fertility problems can be easily treated. Some of the most common causes of female infertility include tubal blockage, polycystic ovarian syndrome, fibroids and endometriosis. However, there are several other reasons why a woman may experience fertility problems, such as ovulatory disorders (like an ovulation), premature ovarian failure and uterine factors. Egg quality also plays a role in infertility in many women.

The female reproductive system is a very delicate structure that is easily affected by even the slightest change in your body. Because of this, it can be dangerous to alter the system too much. Menstrual suppression, for example, can potentially lead to infertility. Maintaining your health can also help you avoid some infertility risks, like luteal phase defect.

Women with eating disorders find it very difficult to conceive. Anorexics often stop menstruating, making pregnancy impossible until the eating disorder is corrected. Alternately, plus-sized women can also find themselves dealing with various fertility issues.

Age and Fertility

Delayed child bearing is becoming increasingly common in western societies for several reasons: many couples prefer to rear their children only after establishing a stable relationship and financial security, also, there are increasing numbers of late and second marriages.

Although pregnancies in women approaching 50 and beyond are occasionally reported, there is a decrease in fertility (the ability to achieve a pregnancy) with advancing age. The decline is gradual over the reproductive life span of the woman; it is particularly noticeable over the age of 30 and accelerates between 35 and 40 so that fertility is almost zero by the age 45.

A fertilized egg with abnormal chromosomes is the single most common cause of miscarriage: at least half of all miscarriages are due to abnormal chromosomes. The risk of miscarriage is also increased with ageing e.g. the risk of miscarriage at age 25-29 years is 10% while the risk at age 40-44 is 34%. Furthermore, advanced maternal age is associated with an increased risk of chromosomally abnormal offspring.

Unexplained Infertility

Unexplained Infertility, cases in which the standard infertility testing has not found a cause for the failure to conceive. Unexplained infertility affects 10% of infertile couples. In the majority of these cases, the failure to reach a diagnosis is not due to inadequate investigations, but is probably due to other factors which cannot be assessed using conventional tests. For example, it is not currently possible to determine if the eggs are actually released at the time of supposed ovulation; if the fallopian tubes are able to pick up the eggs; if the sperm are capable of reaching the site of fertilization; or if the eggs can be fertilized by the sperm.

Diagnosing unexplained infertility is by no means an easy process. It tends to be a diagnosis based on exclusion. Your reproductive endocrinologist will examine you and perform a variety of tests to try to determine exactly what is going on. You may be said to have unexplained fertility if:

· you are ovulating normally

· your fallopian tubes are open and healthy

· you have no pelvic adhesions

· you do not have endometriosis

· your partner has a high sperm count and good sperm motility

· your postcoital test is positive

What are vaccines? How they protect my baby? Are they really necessary? Are they safe? Which are the vaccines available? With arrival of a newborn in the family every parent is faced with these questions.

What are vaccines?

How vaccines work?

Are vaccines really necessary?

Are vaccines safe?

What are the commonly advised vaccines?

What is their schedule?

General Precautions

What are vaccines?

• Vaccines are injections or oral drops, given by doctor, in order to prevent diseases.
• You must understand that vaccines only prevent occurrence of a disease; they have no role in treating a disease.
• Vaccines are disease specific; vaccine meant for a disease prevents only that disease.

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How vaccines work?

Vaccines contain organisms, which arealtered in such a wayso that they are not capable of producing disease but when administered in the body they are capable of producing substances, which fight against disease. After a variable period of time of vaccination these substances called antibodies are produced and protect our body from that disease.

Top

Are vaccines really necessary?

Vaccines are the wonders of 20th century. Their impact on the health of society can never be overemphasized. Global eradication of dreaded disease, like small pox is the most outstanding example of their success story. With their use, control and eradication of diseases like polio, diphtheria, tetanus is now within our reach. With ongoing research in this field, we can hope to have vaccines for diseases like AIDS, malaria, diarrhea [commonly caused by virus called rotavirus] in near future.

Vaccination is absolutely necessary for every child. Because, prevention is always better than cure. It protects your child from many dreaded diseases, some of which have no cures like polio and hepatitis B. Apart from individual protection, they prevent spread of the disease in the society.

Top

Are vaccines safe?

Yes. Most of the vaccines are safe. In some children D.P.T. can cause fever, pain and swelling at the site of injection which is easily controlled by paracetamol syrup prescribed by your doctor. But, even this can be avoided by using newer variety of D.P.T. vaccine.

Rarely, a vaccine can cause allergic reaction, so you should be careful about following things:

• Do remind your doctor about any allergic reaction during past vaccination.
• It is preferable to wait at doctor’s clinic for 15-20 minutes after vaccination so that any allergic reaction can be treated immediately.
• Qualified pediatrician’s clinic or hospital setup should be preferred for vaccination so that any allergic reaction could be properly managed.

Top

What are the commonly advised vaccines? What is their schedule?

Following are the commonly used vaccines

POLIO VACCINE

• Protects from poliomyelitis, disease causing paralysis.
• The only vaccine given in the form of oral drops.
• First dose is given at birth. Starting from 6 weeks onwards 4 doses are given at monthly interval. 2 booster doses are given at 1 ½ and 4 ½ years.

B.C.G.

• Protects from tuberculosis; commonly known as TB
• Single dose is given at birth at left shoulder.
• A small swelling appears at the site of injection 4-6 weeks later, which gradually disappears.

D.P.T.

• It is a combination vaccine which protects from three diseases namely diphtheria, tetanus and pertussis [ kali khansi ].
• Starting from 6 weeks 3 primary doses are given 4-6 weeks interval. Two booster doses are given at 1 ½ and 4-½ yr.

COMPONENT DPT VACCINE-[ Tripacel]

Newer and safer variety of DPT vaccine .This vaccine has very low incidence of fever, swelling, excessive cry or convulsion unlike conventional DPT vaccine. Preferred over conventional DPT [whole cell vaccine].

MEASLES

• Protects from measles; also called khasara or chhoti mata.
• Single dose is given around nine month of age.
• Mild fever or small rashes may develop 5-6 days later which usually disappear spontaneously.

M.M.R..

• It is combination vaccine protecting from three diseases namely measles, mumps [ kanphed] and rubella [viral disease
  causing rashes ].
• Single dose is given at 15 months of age. A second dose is advised at 5-½ yrs of age.

HEPATITIS-B

• Vaccine prevents from viral hepatitis caused by hepatitis B virus.
• First dose is given at birth followed by second and third doses at the age of 1month and 6 month respectively. A booster is recommended at 5 yrs of age.

* Hepatitis b is one of the fastest spreading & deadly disease. Spreads by transmission from infected mother to her baaby, transfusion of contaminated blood or blood product, or use of unsterilised needles and syringes etc.

* Starting features are usually fever, jaundice, loss of appetite and weakness. Virus remains in the body for long time and may lead to liver cancer or cirrhosis. No effective treatment is available. Only way to prevent is timely vaccination. Must vaccines even for adults.

Hib

• Prevents from diseases caused by bacteria called hemofilus influenza type-b.
• Three doses are given at 2, 4 and 6 months followed by a booster at 18 month of age. this vaccine is not needed for children above 5 yrs of age.
• Hib is an important cause of meningitis [brain fever] in small children. It may cause pneumonia, infection of ear, bones or joints.

TYPHOID

Presently available vaccine containing Vi antigen is given at 2 yrs of age. Repeat doses are given at 3 yrs interval.

Typhoid fever is fairly common in our country especially during summer and rainy season. It spreads through infected water, unclean vegetables etc. Vaccine does not provide absolute protection so food and water hygiene should always be maintained.

CHICKEN POX VACCINE

• Protects from chicken pox commonly known as chhoti mata.
• Single shot is given after one year of age. Very effective vaccine. Not needed in those who have already suffered from chicken pox.

Chicken poxis a viral disease characterized by fever, water filled rashes all over body and intense itching all over body. Usually disease is mild and self-limiting but may leave permanent scars over body. At times serious complication like involvement of brain and other organs by virus may occur, which are difficult to manage and may leave permanent damage.

HEPATITIS-A

• Protects from viral hepatitis caused by hepatitis A virus.
• First dose is given at 1 year of age followed by second dose 6 months later.

Hepatitis-A virus spreads through contaminated water, food, raw uncooked vegetables or unhygienic juices, ice creams, sugarcane juice, gol gappa etc from vendors. Faifly common disease during summers and rainy season. Presenting features area fever, jaundice, loss of appetite and weakness. No effective drug is available against virus. Mostly self limiting disease but complications may occur leading to liver failure.

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General Precautions

• All vaccines provide fairly good degree of protection still other routine preventive measures should be taken.
• Follow vaccination appointment strictly. If your child misses an appointment, get it done at the earliest. Delayed or missed doses may keep your child exposed to the disease and it may require rescheduling of further course.
• Vaccination can be given in presence of mild illnesses like cold and cough.
• In children vaccination is usually the part of general health checkup which involves child’s growth monitoring and timely supplementation of vitamins and iron. So it is advisable to get these done from a qualified pediatrician in your area.
• Some of the vaccines are relatively costly, but considering the cost of medical therapy for the disease and loss of school & working days by parents it is advisable to go for these vaccines.

Q1. Is there help for the couple with a Male Infertility Factor ?

Q2. What is ICSI ?

Q3. What are PESA, MESA & TESE?

Q1. Is there help for the couple with a Male Infertility Factor ?

Yes, sometimes low sperm counts or poor sperm motility requires extra help to fertilise the oocyte (egg). A procedure called ICSI ( Intracytoplasmic Sperm – Injection) overcomes these severe Male Infertility factors.

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Q2. What is ICSI ?

In the lab, the embryologist performs the procedure by capturing an individual sperm cell & injecting it into the mature egg by means of a small pipette with the help of a sophisticated machine
called micromanipulator.

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Q3. What are PESA, MESA & TESE?

These are various sperm collecting techniques to collect sperm from men with azospermia but where sperm is being formed. These are collected from testes or tubes depending upon case to case. These can be successfully used with the technique of ICSI.

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DONOR-EGGS

Q1. Who needs to consider using an egg-donor?

Women who experience problems that lead to depletion of quality oocytes
(eggs) may need to consider an egg donor to assist in getting pregnant. Premature menopause, surgical removal of both ovaries or individuals over 40 who have failed to conceive despite appropriate fertility treatments are the most common individuals seeking an egg donor. Usually this is an anonymous process where the eggs are removed from the donor, fertilisation is allowed to occur & the resulting embryos are then transferred into the recepient’s uterus. Success rates are extremely high with this process.

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Q2. Who can donate the Ova?

Any young healthy woman less than 35yrs of age can donate eggs. She should be preferably from within the family of the patient & with preferably complete family. No matching is required. She can donate eggs even if a sterlisation operation has been performed on her.

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Q1. What is In Vitro Fertilisation (IVF)?

Q2. What is the success rate of IVF?

Q3. Any risks involved in IVF ?

Q4. How long does it take for one attempt of IVF & is hospitalisation essential during any stage of treatment?

Q5. How are eggs collected?

Q6. When is Semen sample required for Fertilisation?

Q7. When & how is embryo transfer (ET) done?

Q8. When & how is pregnancy confirmed?

Q9. What can be done with Spare embryos?

Q1. What is In Vitro Fertilisation (IVF)?

For patients with irreparably damaged fallopian tubes profound oligospermia (Low Sperm counts )or failure to conceive after adequate attempts of intrauterine insemmination, In Vitro Fertilasationhas become the treatment of choice. The technology involves incubating the oocytes(eggs) & sperm in the laboratory
& allowing the resulting embryo (s) to develop for a number of days prior to transferring them into the endometrial cavity (uterus).

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Q2. What is the success rate of IVF?

In the 1980’s pregnancy rates for IVF were relatively low, approx 15%. As the nutrition requirements for the embryo growth within the Laboratory became better understood, conception rates began to increase. As we head into the new millenium, anticipated pregnancy rates for many patients may exceed 50 percent.

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Q 3. Any risks involved in IVF ?

Increased emotional stress because of high cost & time consuming with success rate of 40%. Risks of multiple pregnancies & hyperstimulationsyndrome are all increased.

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Q4. How long does it take for one attempt of IVF & is hospitalisation essential during any stage of treatment?

Patient needs to be in constant touch with the IVF center for about one and a half month from starting medication upto the result of IVF. Out of this period active treatment takes ten to fifteen days during which patient has to visit the IVF Lab. No hospitalizations essential during the treatment cycle.

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Q5. How are eggs collected?

Prior to collection of eggs, patient is given medication in the form of daily injections starting from day 2 of menstrual cycle & response to these injections is monitored with frequent blood tests & Vaginal ultrasound. Eggs are retrieved from the ovaries by a needle with the help of transvaginal sonography guidance. It is done under mild anaesthesia & is a day care procedure. It is done 32-36 hours after
final hormone injection.

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Q6. When is Semen sample required for Fertilization?

Semen is required soon after collecting the eggs. A fresh semen sample is preferred. However if difficulty is anticipated in semen collection, the problem is sorted out in consultation with embryologist by cryofreezing the sample in advance.

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Q7. When & how is embryo transfer (ET)
done?

Embryo transfer is usually done two or three days after egg collection. Even on day five it can be done as desired by the embryologist. Normally no more than 3embryos are transferred into the uterine
cavity by a special catheter. Patient is advised to rest for a few hours.

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Q8. When & how is pregnancy confirmed?

Following ET patient is given Progesterone (hormone) Support & asked to get a blood test done 14 days after E.T. to confirm pregnancy.

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Q9. What can be done with Spare embryos?

The spare embryos can be frozen& these cryopreserved embryos can be used in subsequent cycles & patient need not take the injections for egg
formation.

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Q2. How can I tell if I am infertile & how can I determine the cause of infertility?

Q3. What other diagnostic tests can be carried out?

Q4. What is the role of Endoscopy in Infertility?

Q5. Any measures to be adopted to improve the chances of a successful pregnancy?

Q6. Are miscarriages common following Infertility Treatment?

Q1.How long should a couple attempt to conceive before seeking advice from an Infertility Specialist?

For couples who have recently discontinued contraception, the average monthly pregnancy rate approximates 20%. For a typical couple, this means that 50% conceive within 6months and another 30-40% conceivein the subsequent 6months. It becomes increasingly difficult to conceive spontaneously after 12 months of unsuccessful attempt. Therefore, infertility specialists recommend evaluation after 12 months of attempted conception. We also recommend evaluation after 6months inpatients over 35 due to concerns related to an age-related decline in fertility.

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Q2. How can I tell if I am infertile & how can I determine the cause of infertility?

By definition, infertility is the inability to conceive after 12 months of unprotected intercourse. Primarily there are three tests necessary to determine the cause. Initially, the husband has a semen analysis to make certain that there is adequate number of sperm.

The second test is to document ovulation is occurring in the woman by an Endometrial Biopsy or having a simple hormone test, progesterone done one week prior to the next anticipated menses.

Provided both of these are normal, the next test involves an X-Ray. A hysterosalpingogram (HSG) is performed to document that the fallopian tubes are open & to make sure the uterine lining is compatible for embryo attachment. Dye is injected through the cervix into the uterine cavity.

Eventually the dye goes into the fallopian tubes & should flow out through the end of the tubes. This documents that sperm are able to get to the fallopian tubes where fertilization normally occurs & that the egg can be captured by the fallopian tube. These three tests are the cornerstones to infertility evaluation.

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Q3. What other diagnostic tests can be carried out?

Besides the three basic tests – a Vaginal Sonographyis carried out to check the ovaries & the endometrial
lining & any fibroids in uterus or cysts in the ovary are seen. Hormonal Analysis (Day 2 FSH, LH, Prolactin, TSH, E2 ) are also done. Laparoscopy & hysteroscopy are also donewhere indicated.

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Q4. What is the role of Endoscopy in Infertility?

A Laparoscopy is particularly helpful in diagnosing & effectively treating endometriosis or pelvic adhesions(scar issue). The incisions for the procedures are small one fourth or half an inch & full recovery is often achievedin a day or two. Most importantly , in individuals with either of these conditions, a laparoscopy can dramatically improved the chances of conception.

Hysteroscopy is used to inspect the cavity of uterus via cervix using a fine telescope called a hysteroscope.
Hysteroscopy is an investigation to assess the conditionof the endometrium( Lining of the uterus) before IVF.

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Q5. Any measures to be adopted to improve the chances of a successful pregnancy?

Avoid extra stress from overwork mental or physical. Both Smoking and alcohol can be harmful to eggs & sperm. Even exposure to passive smoking results in more problems with Infertility. Men can also stay away from heat emitting areas, wear loose under garments& avoid chemical exposure.

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Q6. Are miscarriages common following Infertility Treatment?

No, Infertile women who conceive after fertility treatment have a similar risk of miscarriage when compared to fertile couples. The overall risk of miscarriage is approximately 20% among the general population.

Women who experience bleeding in the first three months of pregnancy however, may be at increased risk of miscarriage. Despite this ,at least two- thirds of patients with bleeding will deliver normally.

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Q7. Is it possible to get pregnant if I’ve had a tubal sterilization?

While this is considered a ‘permanent ‘ form of contraception, patients do have the option of surgically reuniting the fallopian tubes through a process called a microscopic tubalreanastomosis. An alternative to the procedure would be In Vitro Fertilisation (IVF), where the eggs are fertilised outsidethe body with the resulting conception placed into the uterus.

The choice for an individual would require a consultation to consider all other fertility factors.

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What are vaccines? How they protect my baby? Are they really necessary? Are they safe? Which are the vaccines available? With arrival of a newborn in the family every parent is faced with these questions.

What are vaccines?

How vaccines work?

Are vaccines really necessary?

Are vaccines safe?

What are the commonly advised vaccines?
What is their schedule?

General Precautions

What are vaccines?

• Vaccines are injections or oral drops, given by doctor, in order to prevent diseases.
• You must understand that vaccines only prevent occurrence of a disease; they have no role in treating a disease.
• Vaccines are disease specific; vaccine meant for a disease prevents only that disease.

Top

How vaccines work?

Vaccines contain organisms, which arealtered in such a wayso that they are not capable of producing disease but when administered in the body they are capable of producing substances, which fight against disease. After a variable period of time of vaccination these substances called antibodies are produced and protect our body from that disease.

Top

Are vaccines really necessary?

Vaccines are the wonders of 20th century. Their impact on the health of society can never be overemphasized. Global eradication of dreaded disease, like small pox is the most outstanding example of their success story. With their use, control and eradication of diseases like polio, diphtheria, tetanus is now within our reach. With ongoing research in this field, we can hope to have vaccines for diseases like AIDS, malaria, diarrhea [commonly caused by virus called rotavirus] in near future.

Vaccination is absolutely necessary for every child. Because, prevention is always better than cure. It protects your child from many dreaded diseases, some of which have no cures like polio and hepatitis B. Apart from individual protection, they prevent spread of the disease in the society.

Top

Are vaccines safe?

Yes. Most of the vaccines are safe. In some children D.P.T. can cause fever, pain and swelling at the site of injection which is easily controlled by paracetamol syrup prescribed by your doctor. But, even this can be avoided by using newer variety of D.P.T. vaccine.

Rarely, a vaccine can cause allergic reaction, so you should be careful about following things:

• Do remind your doctor about any allergic reaction during past vaccination.
• It is preferable to wait at doctor’s clinic for 15-20 minutes after vaccination so that any allergic reaction can be treated immediately.
• Qualified pediatrician’s clinic or hospital setup should be preferred for vaccination so that any allergic reaction could be properly managed.

Top

What are the commonly advised vaccines? What is their schedule?

Following are the commonly used vaccines

POLIO VACCINE

• Protects from poliomyelitis, disease causing paralysis.
• The only vaccine given in the form of oral drops.
• First dose is given at birth. Starting from 6 weeks onwards 4 doses are given at monthly interval. 2 booster doses are given at 1 ½ and 4 ½ years.

B.C.G.

• Protects from tuberculosis; commonly known as TB
• Single dose is given at birth at left shoulder.
• A small swelling appears at the site of injection 4-6 weeks later, which gradually disappears.

D.P.T.

• It is a combination vaccine which protects from three diseases namely diphtheria, tetanus and pertussis [ kali khansi ].
• Starting from 6 weeks 3 primary doses are given 4-6 weeks interval. Two booster doses are given at 1 ½ and 4-½ yr.

COMPONENT DPT VACCINE-[ Tripacel]

Newer and safer variety of DPT vaccine .This vaccine has very low incidence of fever, swelling, excessive cry or convulsion unlike conventional DPT vaccine. Preferred over conventional DPT [whole cell vaccine].

MEASLES

• Protects from measles; also called khasara or chhoti mata.
• Single dose is given around nine month of age.
• Mild fever or small rashes may develop 5-6 days later which usually disappear spontaneously.

M.M.R..

• It is combination vaccine protecting from three diseases namely measles, mumps [ kanphed] and rubella [viral disease
  causing rashes ].
• Single dose is given at 15 months of age. A second dose is advised at 5-½ yrs of age.

HEPATITIS-B

• Vaccine prevents from viral hepatitis caused by hepatitis B virus.
• First dose is given at birth followed by second and third doses at the age of 1month and 6 month respectively. A booster is recommended at 5 yrs of age.

* Hepatitis b is one of the fastest spreading & deadly disease. Spreads by transmission from infected mother to her baaby, transfusion of contaminated blood or blood product, or use of unsterilised needles and syringes etc.

* Starting features are usually fever, jaundice, loss of appetite and weakness. Virus remains in the body for long time and may lead to liver cancer or cirrhosis. No effective treatment is available. Only way to prevent is timely vaccination. Must vaccines even for adults.

Hib

• Prevents from diseases caused by bacteria called hemofilus influenza type-b.
• Three doses are given at 2, 4 and 6 months followed by a booster at 18 month of age. this vaccine is not needed for children above 5 yrs of age.
• Hib is an important cause of meningitis [brain fever] in small children. It may cause pneumonia, infection of ear, bones or joints.

TYPHOID

Presently available vaccine containing Vi antigen is given at 2 yrs of age. Repeat doses are given at 3 yrs interval.

Typhoid fever is fairly common in our country especially during summer and rainy season. It spreads through infected water, unclean vegetables etc. Vaccine does not provide absolute protection so food and water hygiene should always be maintained.

CHICKEN POX VACCINE

• Protects from chicken pox commonly known as chhoti mata.
• Single shot is given after one year of age. Very effective vaccine. Not needed in those who have already suffered from chicken pox.

Chicken poxis a viral disease characterized by fever, water filled rashes all over body and intense itching all over body. Usually disease is mild and self-limiting but may leave permanent scars over body. At times serious complication like involvement of brain and other organs by virus may occur, which are difficult to manage and may leave permanent damage.

HEPATITIS-A

• Protects from viral hepatitis caused by hepatitis A virus.
• First dose is given at 1 year of age followed by second dose 6 months later.

Hepatitis-A virus spreads through contaminated water, food, raw uncooked vegetables or unhygienic juices, ice creams, sugarcane juice, gol gappa etc from vendors. Faifly common disease during summers and rainy season. Presenting features area fever, jaundice, loss of appetite and weakness. No effective drug is available against virus. Mostly self limiting disease but complications may occur leading to liver failure.

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General Precautions

• All vaccines provide fairly good degree of protection still other routine preventive measures should be taken.
• Follow vaccination appointment strictly. If your child misses an appointment, get it done at the earliest. Delayed or missed doses may keep your child exposed to the disease and it may require rescheduling of further course.
• Vaccination can be given in presence of mild illnesses like cold and cough.
• In children vaccination is usually the part of general health checkup which involves child’s growth monitoring and timely supplementation of vitamins and iron. So it is advisable to get these done from a qualified pediatrician in your area.
• Some of the vaccines are relatively costly, but considering the cost of medical therapy for the disease and loss of school & working days by parents it is advisable to go for these vaccines.

Things to be watched at doctor’s clinic

Precautions to be taken at the chemist shop

How to make Doctor your friend & get maximum out of him

Things to be watched at doctor’s clinic

Make sure that prescription is written clearly

You should be able to read names of the drugs as well as other instructions. Clarify if any doubt. Dispensing of wrong medicine by chemist due to misinterpretation is very common and could lead to dangerous consequences. Similarly dosages should be understood clearly. Ingesting 5 ml drug instead of 0.5 mls or 1 spoon full [5.0mls] for 1 ml is very frequent.

Ask how to prepare the medicine

Drugs are usually in form of tablets, capsules, syrups or drops. Tablets are of two varieties, one has to be swallowed directly, and others called dispersible tablets have to be prepared by adding water to it. Syrups may be ready diluted or be in dry form, which is to be prepared by adding water. Regarding preparing liquids instructions are written on bottle. Read them carefully. Mostly there is a mark on the bottle upto which water is to be added. Some bottles do not have mark but are supplied with measuring cup to add water.

Quantity of the drug to be given

Measurement of quantity is easy for tablets and capsules. Syrups and drops are supplied with measuring cup or dropper. Cups are marked at different levels like 2.5ml, 5.0ml and 10.0ml. Likewise droppers are also marked like 0.2ml, 0.4ml, 0.6ml, 0.8ml and 1.0ml. Always use these cups and dropper for accurate measurement. Alternatively one can use a disposable syringe, which are available without needle. Measurement is very accurate and it is very convenient to give medicines using disposable syringe.

Some doctors write medicines in spoons rather than mls. Do remember mostly TSF is meant by a teaspoon full and is equal to 5.0ml. But commonly available spoons at home vary in size any thing from 2.5ml to 7.0ml so quantity of drug given may not be the desired one. Always use measuring cup, dropper or disposable syringe for accurate dosages.

Frequency of the dosage

Frequency of the dosage is usually determined by the type of drug and the severity of the disease. For different frequencies doctor use different abbreviations or symbols. Some of the commonly used abbreviations are OD –once a day, Bid – twice a day [12 hrly], TDS-three times a day [8 hrly], QID- four times a day [6 hrly], SOS- whenever required, HS- at the bed time. Make yourself familiar with these abbreviations and whenever in doubt clarify from your doctor.
Timing of the dosages should be chosen in such a way that as far as possible proper interval between two dosages is maintained and it doesn’t disturb child’s routine. E.g.- BD dosage could be given at 8 am and 8 pm while TDS dosage could be given at 7 am, 3 pm and 11pm.

Relation to meal

Always ask whether drug should be given empty stomach or full stomach. Some drugs work better with empty stomach on the other hand there are drugs that can cause gastric irritation when given with empty stomach.

Signs of deterioration

Ask about the signs and symptoms to be watched during the course of the medicine. Presence of certain signs like adequate frequency of urination during loose motion, or return of appetite during the course of jaundice are reassuring signs showing improvement. On the other hand
presence of certain signs during the course may indicate worsening condition like failure to passing urine or drowsiness during loose motions and fast breathing and bluish discoloration of lips during the course of pneumonia. Be watchful about these signs because they require immediate medical attention.

Side effects of the drugs

No drug is free from side effect but mostly they are innocuous [harmless] and require no treatment. Like red colored urine by some anti T.B. drugs and black colored stool on oral iron therapy. But some times severe allergic and other problems may occur, so ask your doctor about side effects to be observed and reported.

When to report back for recheck

In most of the mild illnesses patient is called back at the end of the course but timing and the frequency of revisits is determined by the severity and the type of the disease. In some long-term treatments where drugs are to be given for long duration [e.g. treatment of T.B. or treatment of epilepsy] periodic checkups at monthly or bimonthly interval is needed . It is to see the progress of the disease as well as watch for the complications of the disease and side effects of the medicines.

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Precautions to be taken at the chemist shop

Cross check the medicine given and medicine written on the prescription.

Never accept a substitute

Happens very frequently. Chemist will give you all possible reasons like—it is the same medicine with different name, company has closed, not available any where etc. check 2 or 3 chemist and if still not available call back your doctor and ask for substitute or alternate medicine.

Always insist on bills

Never accept medicine without proper bill. A proper bill with batch number will at least work as deterrent to chemist for giving wrong medicine.

Check the expiry date

Do not accept medicines whose expiry date is very close.

Take full course

Very often it is seen that medicines are not given for full duration prescribed. This habit should be discouraged because insufficient dosage is not able to cure the disease, which may resurface later. Apart from this insufficient dosage is the main reason for development of resistance in which drugs become ineffective. Estimation of full course is easy with tablets and capsules. But in case of syrups and drops single bottle may not be sufficient, so calculate the total dosage required and buy full course.

Chemist is not a doctor

Never take professional advises from chemist. They are always very keen to use there superficial knowledge and try ‘ hit & trial ‘ method. This could prove extremely dangerous. Similarly do not discuss the usefulness and effects of the drugs with the chemist. At the best they will confuse you.

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How to make Doctor your friend & get maximum out of him

• Always take the appointment. It saves your time and also confirms the availability of the doctor.
• Note down all your queries on a paper. It ensures that you do not forget any important question and do not face embarrassing situation of “something else was to be asked, I can’t recall it”.
• Do not forget to take previous prescriptions and related health documents along. Keep them in a file in proper sequence. It helps your doctor in quickly referring to previous health status.
• You may have your beliefs and customs regarding health and disease. Do not hesitate in clarifying from your doctor. It is better to ask a ‘foolish’ question now then make a mistake later.
• Do not compare health and development of your child with other children. Age of attainment of physical milestones [weight, height etc] or developmental milestones are not fixed. There is always a range of age during which they can be attained. As long
  as they are to the satisfaction of your doctor there is nothing to worry.
• As for as possible call doctor only during clinic hours. Avoid calling at residence especially during odd hours, unless really needed. Remember your doctor also needs rest. Use mobile no. only for real emergency.
• While calling your doctor keep old prescriptions ready for immediate reference. Always keep a “working” pen and a paper ready. Holding on the telephone line and calling ‘ Chhotu’ to search for a pen could be embarrassing for you and irritating for your doctor.
• While calling doctor do not hold crying baby and keep the volume of T.V. or Music system low.
• As far as possible do not seek telephonic consultation, because improper advice due to misinterpretation of facts could prove dangerous.
• Do not ignore the problems and delay consultation especially at the weekends, because on Sundays and holidays your doctor
  may not be available, and may cause lot of inconvenience to you.

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M.D. New born & Child specialist

Ph-27495603, 27477030, 9811106056

Arrival of the baby

Keeping baby comfortable

Breast feeding the baby

Baby massage

Care of the naval

How baby grows

Vaccination

Arrival of the Baby

After a long wait of nine months, when finally your baby arrives, you have some questions in mind, such as how your babies are born and what happens immediately after their birth? Actually when babies are born:

• They are wet and naked. They have come from a warm and comfortable environment of their maternal womb, so .
• They are immediately dried up, cleaned and kept under a warmer, so that a temperature can be maintained for them.
• They are examined, to check if they are breathing normally, and all other things such as weight, height, heart sound, visual reaction, hearing
  screening, reflexes, and umbilical stump are normal.
• They are given the Injection of vitamin K, to prevent any kind of bleeding.
• If everything is alright, baby is shifted to the mother’s room.

Baby with mother-“rooming in”

All normal babies are “Roomed In” or kept with mother. It helps in initiating breast- feeding and also keeping baby warm and
comfortable.

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Keeping Baby Comfortable

As a parent of a newborn, you try your best to keep your baby comfortable in this new world. Following are the answers of some common questions:

What should be the optimum room temperature?

• Unlike adults, newborn babies do not have adequate
  mechanism to generate or shed heat, so they are required to be kept
  under optimum temperature.
• By enlarge the room temperature which is slightly warm
  or uncomfortable to an adult is usually comfortable for the baby.
• During winter baby should be fully covered with woolen.
  Socks, hand gloves and cap should be used to prevent heat loss. Room
  should be kept warm with room heaters.
• During summer baby should wear loose and soft cotton
  clothes. Room should be properly ventilated and kept cool by using cooler
  or air conditioners.

How to asses whether baby is comfortable or not?

• When comfortable, baby’s hands and feet
  should be reasonably warm to touch and sole and palm should be pink
  in color.
• If baby is too cold, sole and palms tend to get bluish.
• If baby is sweating overhead and neck it means he is
  over clothed or room temperature is too high.

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Breast
Feeding The Baby

Breast-feed is the ideal food for your child because of
its nutritional composition. Following are the facts associated with the
breast-feeding:

How to go about it ?

• Baby should be put to mother’s breast as soon
  as possible, preferably within half to one hour.
• Do not give anything else like honey, water or
  top milk.
• Initial watery yellow milk called colorstrum is good
  for babies health and should never be discarded.
• Adopt a “Semi-demand” approach. If baby
  demands feed him otherwise offer every 2-3 hrly.
• Babies have a tendency to fall asleep after few sucks,
  don’t worry. Try to tickle him gently to keep awake.
• Babies should be fed exclusively by breast for first
  4-6 months. During this period they do not require any supplements including
  water.

Is my baby getting enough milk?

• A cranky baby, a baby who puts hands inside
  his mouth or who makes sucking movements doesn’t always mean
  a hungry baby.
• Mother’s milk is always adequate for nutritional
  requirements of a baby.
• Be sure your baby is getting enough milk if he….

1. Remains contented and happy
for 2-3 hours after feed.

2. Passes
urine at least six times a day.

3.Shows
satisfactory weight gains i.e. App. 30 grams per day during first 4 months.

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Baby Massage

Benefits

• Improves blood circulation .
• Improves muscle tone.
• Improves texture of the skin and reduces dryness.
• Enhances neuromotor development by sending sensory
  signals to brain.

How to go about it?

• Baby should be at least 15 days old and 3 kg
  before massage is started.
• Any mild oil can be used.
• Prefer non-scented and non-irritating oil. Avoid mustard
  oil.
• Room should be warm enough and draught free.
• Before applying rub hands between palms to maintain
  temperature.
• Use gentle pressure, do not apply undue force.
• Use rhythmic movements first from trunk towards
  periphery of limbs and than in reverse direction.
• During massage make passive movements of joints.

Watch out

• Do not rely on housemaids for baby massage. Vigorous
  and over zealous massage and exercise by maids have known to cause soft
  tissue injuries and fractures.
• Do not instill oil in ears or nostrils of the baby.
• Do not try to ‘raise the ghunti’ by putting
  finger inside mouth.

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Care of the Naval

• At birth blue colored G V paint is applied over the
  cord.
• Cord dries and falls off in 5-10 days after
  birth.
• Clean stump with surgical spirit twice a day.
• Do not apply any ghee, oil or powder over the stump.
• If discharge continues or stump becomes red- consult
  immediately.

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How Baby Grows ?

• Normal birth weight for a full term baby is
  2.5 kg to 3.9 kg.
• They loose 5-8% of weight during first 3-4 days.
• Regain birth weight by 7-10 days.
• Normal weight gain is 25-35 grams/ day for first 4
  months.

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Vaccination

• Vaccines are oral drops or injections given to protect
  baby from various communicable diseases.
• Vaccines have no role in prevention of a disease.
• Initial vaccines like Oral Polio, BCG and Hepatitis
  B are usually given before baby is discharged.
• Baby’s Growth parameters and Vaccination data
  are recorded in a heath card. It also shows dates for future check ups
  and vaccinations.

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Babies at birth may not look as you might have imagined. Their head shape may
look odd. There skin may have some sticky substance. Eyes may be puffy. It may
have some red marks as well. Don’t be dismayed. These are normal for the baby.
And with time, these will change to the expected features.

As your baby grows during the initial weeks, you will find many events, which
may seem alarming and cause lot of anxiety. But, most of these are normal and
with passage of time disappear and require no treatment. Some of the events
are:

Head

Eyes

Skin

Breasts

Genitals

Stools

Urination

Sneezing

Regurgitation of milk
[vomiting]

Jaundice

Head

• May look little elongated. This due to birth pressure
  and should look normal in two weeks.
• There could be soft boggy swelling ,over the head, which
  pits on pressure. It is due to compression around the presenting part
  of the head, during the delivery. Called ‘ Caput’ it usually disappears
  in 2- 3 days.
• At
  times, swelling over the head may be due to leaking of blood, under the
  outer covering of the skull bone. Its  well defined ,soft and mostly
  on one side of the head, over one of the skull bone. Called ‘Cephalhematoma’
  usually disappears in 6-8 weeks.
• There
  is a soft spot, on the top of the head called ‘fontanel’, here bones of
  the head have not joined yet. Its size is variable and it pulsates with
  heart beat. It  takes about 12 to 18 months to fill this spot. One
  must consult doctor, if it closes before six months or remains open after
  2 years of life.

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Eyes

• Eyelids are puffy [swollen] at birth due to pressure of birth. This swelling
  will disappear in couple of days.
• Watery
  discharge from one or both eyes is normal during initial months. This is
  due to blockage of duct responsible for drainage of secretions from the
  eye. Consult your doctor if secretion turns yellowish, which could be due
  to infection.
• Red
  spot in the eyes, over white portion is due to leaking of small amount of
  blood.   It may look alarming, but is totally harmless and
  will disappear in 4 to 6 weeks.

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Skin

• Red
  colored spots and rashes appearing on second or third day are very
  common. Starting from face they may spread and involve whole of the
  body. No treatment is required and they disappear in next couple of days.
• Scaling
  and peeling of skin especially on the hand and feet is common and
  clears in few days.
• Blue
  colored spots over lower back and extremities are virtually seen an all
  babies.  Termed as ‘ Mongolian spots’ are of no significance they usually disappear
  between 12- 18 months.
• Red
  colored birthmarks called stork bites seen over eyelids, forehead and back
  of the neck; take about one year to go.
• Strawberry
  like birthmarks, tend to increase initially but eventually disappear by
  the child is five.
• Milia
  are white or yellow pinhead spots seen on the nose are due to retention
  of secretions; disappear spontaneously.

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Breasts

One or both breasts may become
swollen around 4^th day. Little milk may also come out. Perfectly
normal condition. Swelling disappears in about 2 weeks. Never try to squeeze
or massage.

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Genitals

In baby girl, bleeding from vagina,
may occur third day onwards; usually disappears by 7^th day.

In baby boys, skin around the
tip of the penis is adherent and non-retractable, which may persist for 2 to
3 years. Do not try to retract it forcibly.

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Stool

• A
  newborn baby should pass stool within first 24 hrs.
• After
  that stools for first two days are dark green and sticky called meconium.
• 3^rd day onward color becomes yellowish, semisolid to watery in consistency and
  there is a tendency to pass stool after every feed. They may pass stools
  upto 15-20 times a day. This is quite normal and termed as transitional
  stool. No treatment is required.
• On
  the other hand, some babies do not pass daily, some may even pass at the
  interval of 5 or 6 days. As long as baby is active , accepting feeds regularly,
  passing urine frequently and his abdomen is not unduly distended there is
  nothing to worry.

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Urination

• Most babies pass urine within 48 hours of birth.
• After
  about a week,  urine frequency increases, it may go
  upto 20 times a day, but it should not be less than 6 times
  in 24 hours.
• Babies
  usually look uncomfortable or cry just before passing urine. This is a normal
  reaction from feeling of distended bladder.
• Watch
  out – if baby dribbles, has thin stream of urine or has excessive cry during
  urination. It could be due to some obstruction. Consult your pediatrician.

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Sneezing

Most newborn babies sneeze ,
they do it in all  kind of weathers. Sneezing is not a sign of cold. They
do it to clear respiratory passage of mucus and secretions. It’s a sign of good
health so one should not worry.

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Regurgitation of  milk [vomiting]

• Most
  newborns have a tendency to throw out small amount of fresh or curdled milk
  especially after the feeds. This occurs due to a condition called aerophagia
  where babies swallow air while taking feeds. When this air comes out it
  brings some milk with it. Condition is aggravated, when baby is on bottle
  feeds and size of bottle teat is too small or too large.
• As
  long as baby is active, accepting feeds well, passing urine adequately and
  gaining weight properly there nothing to worry.
• Proper
  burping after each feed is the best remedy to prevent excessive vomiting.
  To burp one should hold baby in lap or against the shoulder and tap her
  back gently for about 5 minutes. If he doesn’t burp don’t try too hard ,
  baby may not require it. After burping, place baby in right lateral posture
  with head slightly above the body.

But watch out

• Vomiting could be indication
  of serious underlying problem if;
• Vomiting is forceful
• Is associated with abdominal
  distention
• Vomitus is of green color

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Jaundice

• Yellowish discoloration of eyes and body.
• Starts on 2^nd or 3^rd day of the life.
• Increases till 5^th to 7^th day  and than gradually
  subside by 11^th to 14^th day of the life.
• Mostly It’s a harmless condition called “physiological jaundice”.
• Occurs due to elevation of a substance in blood called bilirubin.

What is to be done:

• Usually no treatment is required, but consult your pediatrician.
• No role of sun exposure.
• Its not caused by eating yellow colored foodstuffs like papaya or mango.
• It has no relation to
  wearing yellow clothes.
• No need to keep the
  household tube lights on.

But jaundice could be dangerous
if:

• Appears within 24 hours or after 72 hours of birth.
• Persists beyond 2 weeks of age.
• There is intense yellow staining of abdomen, thighs or sole.
• Urine is dark colored or, stool is pale or white in color.
• Baby is lethargic and not taking feeds.

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