Articles on abortion

Choice Between Surgical and Medical Abortion

Dr. Niraj Mahajan, Gynecologist/Obstetrician
There are two methods by which abortion can be doneMedical Abortion -non-surgical abortion in which medicines are used to induce abortionSurgical Abortion - Use of trans-cervical procedures for terminating pregnancy, including vacuum aspiration, and dilatation and evacuation (D&E).Surgical or Medical Abortion for Unwanted PregnancyIf pregnancy is <= 7 weeks; medical Method with Mifepristone with misoprostol is favorable as success rate is as high as 97%.If pregnancy is between 7-12 weeks; surgical abortion is the only option.If pregnancy is beyond 12 weeks – 20 weeks, then woman needs to be hopsitalized and will be given either Mifepristone followed by Misoprostol tablet or only misoprostol tablets and woman will then abort like a miscarriage in the Hospital. If any products are remaining then it will be evacuated surgically.Surgical abortion is preferred if patient desires concurrent tubal ligation or IUCD (CuT) insertion.If a woman fulfills the criteria for selecting either method i.e. Before 7 weeks), final choice to be given to the woman.Summary of Choice between Surgical or Medical abortion in India<= 7 weeks – Medical method or Surgical method7-12 weeks – Surgical abortion 12 – 20 weeks – Medicines with or without surgical procedure in Hospital.Advantages of Medical AbortionAvoids surgery. Controlled by the woman and may take place at home. No need for admission to the Hospital. Usually well tolerated by women if properly counselled and motivated. No need to take leave from work, as bleeding can be manged with menstrual pads even while in office or at work.Disadvantages of Medical abortionTakes time (hours to days) to complete abortion, and the timing may not be predictable. Women experience bleeding and cramping, and potentially some other side-effects (nausea, vomiting, fever, and shivering). May require more clinic visits than surgical abortion.Advantages of Surgical AbortionQuick procedure. Complete abortion easily verified by evaluation of aspirated products of conception. Takes place in a Hospital so Sterilization or placement of an intrauterine device (IUD) may be performed at the same time as the procedure. It can be performed under local anaesthesia if woman is properly motivated and counselled.Disadvantages of Surgical abortionRequires instrumentation of the uterus. Small risk of uterine or cervical injury. Timing of abortion controlled by the Doctor and Hospital. Anaesthesia needs to be administered. Most doctors perform this procedure under short general anaesthesia. Woman needs to be in the Hospital for at least 6 hours. Effect of sedation will be there through out the day.

Abortion Is Not a Dirty Job if Combined With Family Welfare

Dr. Neelam Nath Bhatia, General Physician
I have been practicing for the past 40 years. I started in 1976, an year after the emergency ended in India. A time when sterilizations were supposedly done forcefully, thus associating a bad name with Family Planning and creating a fear of every doctor in aam junta of our country. Even during a routine check up, it had to be justified to women that no litigation would be forced on them.The name of Family Planning was changed to Family Welfare. Now it is Department of Gyne/Obs/Family Welfare.We were 100 crores in 1999 ( remember the movie 100 crore made by Dev Anand)2016 we are 130 crores despite abortions made legal in 1972.Every woman who comes to center should not be abused psychologically, monetarily or physically & procedure can be done with minimum trauma using MR syringe.If a doctor earns 5000/- plus in a fancy nursing home , same doctor can earn same amount by doing 10 minor procedures per day.The investment to start a clinic is not much compared to a dental clinic or for eyes or for ear-nose-throat clinics etc which require sophisticated equipment.Dry sterilization of instruments can be done using formaldehyde tabs.Woman who comes to doctor full of fear and doubt is made to relax and procudure takes just 5 minutes or a bit more but some sedation injection is given to make doctor and patient at ease.The woman is most motivated at this stage.If given counselling to get fitted with intra uterine device , she may agree provided charges are reasonable and she does not have to buy it on her own.Copper T is given by Govt. to Registered family welfare centers for Free.She can be sent for lap ligation also-a procedure that is permanent compared to IUCD and takes only 15 minutes ,the woman is discharged within 2 hours of observation.Now a days MTP pills are sold over the counter minus prescription and women are buying them because doctors are few and our women are scared.It is written on packs to get in touch with doctor in case of pain or heavy bleeding.2 reasons of maternal mortality in our country are infection and bleeding after delivery/abortion.Pain and bleeding after MTP tablets are a signal that some pieces might have been retained and pieces get infected leading to discharge of pus along with blood,.It is my request to my young colleagues that you do not have to go to rural areas to serve our women from 8-80 , half of our population.There is lots to do right here within our cities. Government allows doctors to do lots for family welfare .Investment is minimal , work is plenty and women are abused by untrained midwives as in rural areas within Delhi ,there are no regulations about who poses to be a doctor and there are more than 1000 rural illegal villages within Delhi where no doctor wants to set up a shop ,but good news is that there are authorized colonies near every village.A clinic can be set up in a 2 room set as a day care center to cater to a large population at the mercy of quacks.No leader will preach family planning ,it being a dirty word for vote bank politics.It is for us , the doctors to do counselling and treatment after guiding the woman along with her husband using a cafeteria approach.Not every device or operation or pills are for every woman.It has to be personal.It has to be individualistic.

Reasons for Miscarriage

Dr. Yogesh Kumar, Ayurveda
Miscarriage or habitual abortion or recurrent pregnancy loss could be the toughest phase in a women’s life. A pain that no one can understand. The pain generally converts into depression. In this article, we will look closely to understand the causes of recurrent miscarriage.Recurrent Miscarriage or recurrent pregnancy loss is a term simply meaning occurrence of 3 consecutive pregnancy losses before 20 weeks or 24 weeks in some countries. The causes of recurrent miscarriage are complex and most often obscure. There may be many factors which are recurrent and non recurrent and sometimes there are unknown factors present responsible for early and late miscarriage.Causes of miscarriage or Recurrent pregnancy lossThe causes of miscarriage are very complex and obscure. The following are potential causes.Environmental factorsConclusions relating to environmental factors are difficult to prove.Smoking-Increases the risks of miscarriage due to decreased oxygen transfer to the fetus.Alcohol consumption should be avoided during pregnancy.X-rays and anti-cancerous drugs are known to cause miscarriage.Contraceptive Agents like IUD  increases the risk known to cause recurrent miscarriage.Drugs, chemicals, Anesthetic gases, arsenic, aniline, lead, formaldehyde cause miscarriage.Unexplained causesIncreasing maternal age can affect the function of ovaries.In spite of many causes mentioned it is difficult to pinpoint the exact cause of miscarriage.Endocrine and metabolic factorsLuteal phase defect (L.P.D): It results in early miscarriage as implantation and placentation are not supported properly.Deficient progesterone secretion: The cause is deficient progesterone secretion from corpus-luteum or poor endometrial response to the progesterone hormone.Thyroid abnormalities: Overt hypothyroidism or hyperthyroidism is associated with increased fetal loss.Thyroid and Diabetes mellitus when uncontrolled can cause miscarriages.Blood group incompatibilityIncompatible ABO group mating may be responsible for early pregnancy wastage and often recurrent but Rh incompatibility is a rare cause of death of the fetus before 28 weeks. Couple with group ‘A’ husband and group ‘O’ wife have higher incidence of abortion.Immunological disordersBoth Autoimmune and Alloimmune factors can cause miscarriage.Autoimmune disease: Can cause miscarriage usually in second trimester. These patients can form antibodies against their own tissues and placenta. These antibodies ultimately can cause rejection of early pregnancy.Alloimmune disease: Paternal antigens which are foreign to the mother invoke a protective blocking antibody response.These blocking antibodies can prevent maternal immune cells from recognizing the fetus as a foreign entity.Genetic factors Most of the early miscarriages are due to chromosomal abnormality.Polyploidy has been the cause in about 22% of miscarriage cases.Monosomy constitutes 20% of all miscarriage cases. In Monosomy the commonest is Monosomy x.Autosomal trisomy is commonest cytogenic abnormality.Structural chromosomal rearrangements are present in 2-4% of the miscarriages.These include translocation, deletion, inversion and ring formation.Other chromosomal abnormalities are also present like mosaic, double trisomy in about 4% of the cases.Anatomical abnormalitiesCervico-Uterine causes-These are related to mostly second trimester abortions.Cervical incompetence, either congenital or acquired is one of the most common causes of recurrent abortion.Congenital malfunction of the uterus  may be responsible.Reduce intra-uterine volume, increased expensile property of uterus. Reduced vascularity of placenta when implanted on septum.Increased uterine irritability and contraction.Uterine fibroid may also be responsible for infertility and abortion.Intra-uterine adhesion interfere with implantation, placenta and fetal growth.InfectionsInfections can cause late as well as early abortions. Miscarriage due to infection are quite rare in developed countries, but continues to grow in under developed countries. Trans-placental fetal infections occur with most micro organisms and fetal losses could be caused by any infection like:Viral-Rubella, Cytomegalo, Variola or HIV can cause infection.Parasitic: Toxoplasma, malaria.Bacterial: Bacterial infections like Chlamydia, Brucella can cause abortion before 20th week because of effective thickness of placental barrier.What to do when miscarriage happensThe process of expulsion of fetus is like that of mini labor. The fetus is expelled out first followed by expulsion of placenta after a varying interval. Follow these steps right away after 2nd recurrent pregnancy loss or miscarriage.Recurrent pregnancy loss testNew studies have shown that the couple should consider recurrent pregnancy loss test after two consecutive pregnancy loss. Women in their late 30's have more chances of recurrent pregnancy loss. There are many tests to rule out the cause of recurrent pregnancy loss, so consult your Doctor for detailed information.Support programs or support groupsOne can seek help from the various support programs or groups, developed for women suffering from recurrent pregnancy losses, available locally at the gynecology and obstetrics hospitals and clinics or on the internet.

Repeated Miscarriage- a Painful Experience for Couples

Dr. Sujoy Dasgupta, Gynecologist/Obstetrician
Pregnancy gives a woman completeness by turning her into mother from a simple woman. It is the thing which makes the couple parents, the dream which they nurture right time from their marriage. Of course there are many couples who are not fortunate enough to achieve pregnancy and they are usually termed infertile and we have discussed it in separate post. But there are other couples who may or may not (as this is the usual case) find difficult to conceive but the pregnancy does not continue to the age of viability. Age of viability means the age, when a baby born can survive. Thanks to the improvement in neonatal care by leaps and bounds and availability of NICU which made it possible to survive even a baby born at 22 weeks. For example last month we delivered a baby at 28 weeks of pregnancy, who is fine now. But if the baby is 'born' before 20 weeks, it is called MISCARRIAGE. This is because these babies who weigh less than 500 gram cannot survive outside the uterus. It is seen that 10-15% couples who conceive successfully may not be able to carry pregnancy beyond 20 weeks. Thus the miscarriage rate for a single pregnancy is 10-15%. But in most of the time this mishap does not recur in future. We call it 'sporadic miscarriage' and often the cause is not known. But almost 1% of the couples who want to get pregnant may suffer from repeated miscarriage. That means the unfortunate events can repeat. These are called 'RECURRENT MISCARRIAGE' or 'REPEATED PREGNANCY LOSS *RPL).Causes of Recurrent MiscarriagesSo, what's the reason for RPL which is equally frustrating for the patients as well as the doctors? First of all let me honestly confess that in most of the cases the cause is not known (50-60%) and this is called 'UNEXPLAINED RPL'. Again we have to admit that despite tremendous advancement in science, the knowledge behind RPL is limited. Many theories and causes have ben proposed but most of them could not withstand the taste of time. That means if a problem is found in husband or wife, we are not certain whether the treatment of that problem will prevent future miscarriage. This should be explained properly to the couples to have realistic expectations and avoid unnecessary frustration s in future. Only factors which are definitely associated with RPL are only two- anti-phospholipid antibody syndrome (APS) and chromosomal problem of either of the couples. Detection and treatment of these problems are often rewarding as after treatment pregnancy continuation rate us very high. The other causes have been proposed but as mentioned above the link between RPL and these causes are not yet very clear and need further scientific research. Please remember according to the timing, RPL may be divided into two categories- the 1st trimester RPL (occurring before 12 weeks in each pregnancy) or second trimester RPL (12-20 weeks in each pregnancy).4-5% cases may be due to genetic or chromosomal problem of the couples. These problems can affect the egg (ovum) and/or the sperms. Even if the couples are normal, the baby may have abnormal chromosome.It is blessing that a genetically abnormal baby is miscarried by the nature, otherwise if it survives there is high chance that it may be mentally or physically handicapped. The reason may be increased age of the mother (above 35 years especially), exposure of mother to some environmental pollutants or sometimes increased age of the father (the latter is controversial). The diagnosis is done by chromosomal analysis of the couple by Karyotyping or FISH from blood samples. If the baby has been miscarried, it may be rational to send the tissue of the baby for chromosomal analysis to find out the cause. The treatment option in next pregnancy in such cases is genetic counseling by an expert and in most cases unfortunately only one option remains- that us IVF and PGD (pre implantation genetic diagnosis) where only genetically tested normal embryos are transferred by IVF ('test tube baby').Anatomical factors are responsible for 12-15% if RPL, in most cases the second trimester RPL. The most common cause is 'CERVICAL INCOMPETENCE'. The cervix is the mouth of the uterus which should remain closed in pregnancy to support pregnancy and should only open during delivery. But in some cases it can open prematurely leading to miscarriage. Usually this causes apparently painless miscarriage. In many women fibroid is found as a tumour of uterus. Whether fibroids cause RPL is again very controversial among the scientists and doctors. In some women who had repeated abortion or surgery to uterus and even tuberculosis (TB) there may be adhesion (binding together) between the walks of uterus. This is called Asherman Syndrome which causes scanty or absent periods and RPL. In few women there may be Congenital Anomaly of the uterus- that is where is some abnormalities inside uterus from birth. Thesr xan sometimes cause RPL, although controversial. These anatomical problems are diagnosed by proper examination, some tests like HSG (hystero salpingogram), SSG (sono salpingogram), 3D ultrasonography (USG), MRI, hysteroscopy and/or laparoscopy, depending on the women and test results. The treatment should be done cautiously as treatment may not always prevent RPL. For cervical incompetence usually we put stitch in the cervix in pregnancy or sometimes before pregnancy. Operation can be done, before pregnancy for fibroids, Asherman and congenital anomalies.In many cases (more than 70%) cases hormonal problems may be there and these may cause both 1st and 2nd trimester RPL. However whether treatment us beneficial or not, is again controversial. The commonest pattern is Luteal Phase Deficiency (LPD) due to deficiency of hormone progesterone. PCOS (Polycystic Ovaries) is also asdociated with RPL. The other causes are uncontrolled diabetes, thyroid problems, high prolactin and high testosterone, high insulin and low ovarian reserve. As mentioned earlier, it is not clear whether they all need testing and treatment but usually tests advised for these are blood for progesterone, TSH, Prolactin, FSH, LH, AMH, Insulin, Testosterone, sugar, HbA1C etc. Treatment is usually progesterone supplement along with correction of hormonal imbalance. It is to be mentioned that these patients need high dose of thyroid drugs (TSH normal for other people may be considered abnormal for RPL) and more tight control of blood sugar in diabetes.In 60-70% cases the cause is Thrombolphilia, that is tendency to thrombosis or blood clotting. The most common is anti phospholipid antibofy syndrome (APS) which nay or may not be associated with thrombosis in other sites but can cause thrombosis if blood supply to the baby and thus causes stopage of its heart and miscarriage. Although more common in the Western World, some Hereditary Thrombolphilia may be found in other family members and commonly cause miscarriage and thrombosis. Deficiency of folic acid and vitamin B12 rarely xan cause thrombosis and RPL. The APS testing is often successful, so as the treatment with aspirin and heparin injection throughout pregnancy. With this 80% women can expect full term pregnancy. Folic acid and B12 vitamin supplement is commonly given to RPL patients. Whether testing for hereditary thrombophilia is needed in our country or not is controversial. But treatment is like APS- that is aspirin and heparin injection.Diseases of mother like diabetes, epilepsy, liver or kidney diseases, SLE etc can cause miscarriage. Exposure of mother to harmful substances like environmental pollution, radiation, chemotherapy and some toxic drugs, smoking, alcohol, cocaine, cannabis etc are also responsible but the latter usually cause sporadic miscarriage rather than RPL. So these drugs should be stopped and replaced by safer drugs and the diseases must be treated properly. Even exposure of father to some drugs can cause RPL. Again some abnormalities of sperms may cause RPL. So, semen analysis of the husband is usually done as a test for RPL.The most controversial topic for RPL is the infections. But itbis the fact proved by scientific studies that only infection in current pregnancy causes miscarriage. So infection is a cause of sporadic miscarriage, not RPL. In the past TORCH testing was very much popular but nowadays it is obsolete test and there is no scientific ground for tests or treatment of TORCH. Only test we recommend is rubella testing. If rubella IgG is negative that means you may get infection in pregnancy so we advice to take rubella vaccine and avoid pregnancy for one month. On the other hand, rubella IgG positive means you are already immune and thus you can never get rubella. So vaccine is not useful in those cases. If any genital infection is found in husband or wife, both if them should be tested and treated aggressively.TESTS REQUIREDFirst of all we need to know when we should advise tests. Assuming that most cases of miscarriages are SPORADIC, we usually do not advise investigation after single miscarriage unless the couple insists or there is some reason by the doctor to suspect some abnormalities that might cause future miscarriage. In the past testing was started after 3 miscarriages. But nowadays we do not want to give the couple, especially the woman a third trauma. So we usually advise tests after 2nd miscarriage. The tests usually start with checking for chromosome of the baby. It is followed by chromosome analysis of both the partners along with proper history taking and physical examination. Semen analysis is done for the husband. The wife is advised ultrasonography, routine blood, thyroid testing, testing for APS and blood group. These are tests usually dine everywhere. Further tests are done depending on the results if initial tests and especially if no cause is found after initial tests. It should be mentioned to the couples that the 2nd group if tests often do not have scientific grounds and are done only on benefit of doubt. They may not change the management plan. TORCH test is not done in modern era.TREATMENTThe basic treatment is support if the couples, reducing stress as stress can be responsible for RPL. When a cause is found this should be treated. While an optimistic approach should be taken with expectations for normal pregnancy in future but this should be based on scientific and realistic approach to avoid future frustration. The treatment may not be 100% effective and most treatment may not have scientific base but are usually not harmful. Treatment may not guarantee a successful future pregnancy but a positive attitude is necessary. This is called TENDER LOVING CARE (TLC) where proper support and discussion can help more than explanation if mere statistics. Treatment should be continued both before and after pregnancy confirmation, as mentioned above. This is to be mentioned that even after 6th miscarriage, the chance that future pregnancy will be normal is more than 50%. So, the message should be not to give up hope.

Contraception - Common Myths and Misconceptions

Dr. Sujoy Dasgupta, Gynecologist/Obstetrician
Sex is a basic human right. But to have sex safely and without fear of unwanted pregnancy - should be the priority. Many women across the world die every day as a result of unwanted pregnancy, mostly due to unsafe abortion. So, couples can avoid pregnancy and enjoy sex life fully, only if they can follow safe and effective contraceptive advice. Let me clarify some popular myths and misconceptions abut contraception. 1. Contraception is useful for allWhile the ideal contraceptive is necessary but it does not exist. So, what may seem suitable for a couple may not be useful for another couple. We need to assess various points like a number of children they have, wish to have further children and plan to have children, general health of wife and husband (and any diseases they suffer from), the frequency of intercourse, the chance of infection, the age of the partners etc. 2. Regarding barrier methodsMost popular barrier method is a male condom. But the myths are that" condoms reduce sexual pleasure" and" condoms get easily damaged leading to failure.Condoms are especially useful for those who are at risk of infections, who do not have very frequent intercourse and who are not suitable for other methods. Condoms do not decrease sexual pleasure, some of the condoms have medicated products which can increase the duration of intercourse and also act as a lubricant to facilitate intimacy. But men should know how to use it properly. It should be worn on erect penis expelling all the air and projecting the tip beyond the tip of the penis. While withdrawing penis after intercourse, the condom should be held at the base of the penis. Actually, failure/ rupture of condoms occur because of mishandling of condom or not knowing the proper use of it. So, before use, please make sure that you know its correct use. Definitely, some men can feel latex allergy and they have to use a non-latex condom, which is widely available.There are barrier methods for females also- like female condom, diaphragm, and cervical cap etc. But they are not very easy to use and are not so popular.3. Oral Contraceptive Pills (OCP)Myths OCP causes an increase in weight.OCP cause cancers.Facts CP seldom causes gain in weight. The gain in weight is coincidental, that means you have some other reason of gaining weight- like not having exercise, ignoring diet control and some other diseases. OCP rather reduces risk of cancer- especially ovarian cancer (which is very difficult to diagnose and very lethal), cancer of colon, cancer of endometrium (inner lining of uterus). Of course, there is little risk of breast cancer, but the risk is not very high, it can be easily detected by examination by doctor. So, if you take ocp, get rid of all the fears. Just try to have self- breast examination every month. 4. Intrauterine Contraceptive Devices (IUCD)Most popular is copper T. Medicated iucds are also available, that contains hormonal drugs. Copper T does not increase risk of infection, a common misconception lies among woman.5. Emergency contraceptive pills (i pill etc)Often couple uses these pills regularly after intercourse. Remember these pills contain very high content of hormonal drugs, which can lead to serious side effects like hormonal imbalance, irregularities in periods (and thus can prevent you from getting pregnant in future, even when you want pregnancy), ectopic pregnancy (pregnancy outside tubes that are life-threatening) etc. So, use regular contraception if you want to prevent pregnancy. I pill is not meant to be taken for every time.  6. LigationLigation of male (vasectomy) and female (tubectomy) is done as permanent contraception for couples having more than 2 children. Ligation in male does not disturb sexual activity. It is easier than female ligation. Again, female ligation is also a very safe technique. So, please remove all misconceptions and myths about contraception. Have safe sex, enjoy life.

3 Simple Ways to to Avoid Unwanted Pregnancy

Dr. Himani Gupta, Gynecologist/Obstetrician
1. Use protection - Prevention is always better than cureIndian social scenario is changing - Pre- marital, extramarital and living in relationships are on a riseAt times these relationships are casual and will lead to unwanted pregnancyAt the end of it, it is the female's body which will bear the brunt of physical discomfort of abortionThere are many myths in people's minds regarding use of regular contraceptive methods like oral contraceptive pills, condoms or Copper - TWhether a couple is married or unmarried when these regular contraceptive methods are used, unwanted pregnancy can be avoidedA consultation with the Gynaecologist for check up and to understand their correct use is a must and will allay your anxieties and concernsA word of caution here about Emergency Contraceptive Pill It is clear that these pills are for emergency situationsCouples in steady relationship should adopt regular contraceptive methodThese emergency pills have very high content of hormonesUsing them can make your next menses irregular, delayed and heavyThey should be taken ONLY on advice of a Gynaecologist2. Be alert - For early diagnosis of unwanted pregnancyAs soon as you have missed your periods, check yourself for pregnancyEasiest method is to do a urine pregnancy test done at home in a kit easily available at ChemistThe instructions to do the tests are also clearly written on packet Advanced tests for diagnosis of pregnancy can be done on your Gynaecologist 's advice like a test in blood known as Serum Beta HCG and sonography3. Timely treatment - See a Gynaecologist at earliestWhen we talk about unwanted pregnancy, it is clear that couple wants terminationGovernment of India has made guidelines to offer safe abortion to all who seek it, regardless of marital statusThere are two ways of undergoing abortion:A. Surgical D&C - This is traditional way and will require a day's time hospitalization.- If done in Govt approved MTP (Medical Termination of Pregnancy) center, it is safe B. Abortion by pills- If clinical situation is of early pregnancy and within the limit set by Govt of India, oral abortion pills  can be taken on advice of a Gynaecologist- There are no risks of anesthesia and surgical instrumentation in this method and no hospitalization is required

Beja Sanskar an Ayurved Remedy for Abortions and Infertility

Dr. Yogesh Joshi, Ayurveda
Every person has a unique Constitution. The constitution is created when a sperm unites with the female ovum. The status of 5 basic elements and 3 Doshas in the nature, in the uterus, in the sperm and ovum and the body of mother, plays an important role in defining the constitution of a person. That is why the constitution is never changed and it reflects in ones mind and body. This reflects in formation of body elements and psychological structure of the person.Constitutional Analysis gives you the clear picture of you Body ConstitutionDosa prakruti-% of Vatta, Pitta & Kapha in the body.Dhatusarata - % of dominancy of elements in the body-( Lymph, Blood, Muscle,Fat, Bone marrow and shukra dhatu)Manas Prakruti- It gives perfect analysis of the psychological analysis of the person.Our body is a complicated machine. It is completely dependent on the nature for its nourishment. As we work daily and do our daily routine , our body elements have to face wear and tear. This wear and tear is to be replaced by good quality and quantity of the body elements. If these body elements replaced by good quality and quantity the our body becomes healthy and no week loops are left in our body. But if these body elements are not replaced by good quality and quantity week loops are left in our body and that part starts creating stress in our body. This is the start of stress.Our body consists of 7basic body elements:-Rasa(Lymph)Rakta(Blood)Mausa(Muscle)Meda(Fat)Asthi(Bone)Majja(Bone marrow)Shukra.We have different factories in our body to create these elements. Each factory has to be provided with good raw material to produce the good product. All the process in the factory should run in proper manner. Proper energy should be provided to each part of the factory to run the mechanism in proper way and all the waste products should be thrown out after the formation of the good product. If this process of formation of all elements is in proper way then only the healthy product is formed and when it is supplied to the proper place by proper way then only the body gets nourished in proper manner. If there is any problem in the process coordination between 5 basic elements, 3 doshas, 7 body elements& Agni is disturbed and our body starts generating stress in the body. As body and mind are related to each other stress effects on both mind and body and along with this soul is also affected. It is also seen that if mind is disturbed then it affects body and souls and if soul is disturbed if affects mind and body.By finding a correct cause and a place where the mechanism is disturbed , stress can be controlled and this is the basic principle of Ayurveda treatment and analysis to control the stress.Factors affecting infertility and recurrent abortions taking:-Hormonal ImbalanceStressFamily history.Diet .Past illness .Physical relation ship.History of celibacy.Addictions.Work history.Education.Life styleA structured program for Bejasanskar for expecting couples – Duration – 3 months to correct the body elements.It includes-2 sessions every week of 75 to 90 minsThe sessions are based on Yoga, Meditation and Live music therapy. These sessions helps the couple for mind detoxification and body mind coordination, mind & body strengthening and regulation of hormones.Body detoxification program – shodhan bypanchakarma- It is to be decided by the Associated Ayurved Doctor  which type of procedure should the couple should under go for shodhana.Rasayan Chikitsa – 21 daysVajikaran chikitsa – 21 days.