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Dead sperms   

What is Dead sperms  
Causes of Dead sperms  
Investigations & Diagnosis 
Treatments 
Response of treatment

 

 

 

 

What is Dead Sperms: When semen has less of mature normal sperms & more of dead sperms this condition is abnormal. When ever there is less of normal sperm then chances of spontaneous pregnancy decreases (i.e. difficulty in conceiving i.e. wife does not becomes pregnant). This is one of the common causes of male factor infertility. This is also one of the most common semen abnormalities in men. 

How sperms develop: When boy becomes of 14 years of age then L.H. & F.S.H. hormone secretion from pituitary increases. The rise in these hormones leads to proliferation of sperm forming cells (Germ Cells) in the testis. These germ cells start multiplying under the effect of above-mentioned pituitary  hormones along with assistance of other hormones as testosterones, Growth hormones, Androstenidione, insulin like growth factor-I, Thyroids hormone, paracrine hormone & growth factors. Under the control of above-mentioned hormones germs cells divide & transformed into primary spermatocytes. Then further maturation of primary spermatocytes to spermatids & then finally into mature spermatozoa (i.e. normal sperms) occurs under the control of above-mentioned hormones. After few weeks of progressive maturation inside the testis these sperms become normally motile & develop the capacity to fertilize the ovum. This total sperm cycle from first stage to final stage of normal mature sperms is of three months. Any hindrance in the development of these spermatozoa will lead to dead sperms, less count of sperm & decreased motility, immotile or even dead sperms

Causes of dead sperm: The various causes of dead sperms are as follows:

1) Deficiency of central sperm producing hormones:  
Hypothalamic pituitary deficiency: Idiopathic GnRH deficiency, Kallman syndrome, Prader-Willi syndrome, Laurence-Moon-Biedl syndrome, Hypothalamic deficiency, pituitary hypoplasia, Trauma, post surgical, postiradiation, Tumour (Adenoma, craniopharyngioma, other), Vascular (pituitary infraction, carotid aneurysm), Infiltrative (Sarcoidosis, histiocytosis, hemochromatosis) Autoimmune hypophysitis, Drugs (drug-induced hyperprolactinemia,  steroids use)  
Untreated endocrinopathies, Glucocorticoid excess, Hypopituitarism, Isolated gonadotropin deficiency (non acquired): Pituitary, Hypothalamic, Associated with multiple pituitary hormone deficiencies: Idiopathic pan hypo pituitarism (hypothalamic defects), Pituitary dysgenesis, Space-occupying lesions(craniopharyngioma, Rathke pouch cysts, hypothalamic tumors, pituitary adenomas), , Laurence-Moon-Beidl syndrome Prader-Willi syndrome , Frohlich syndrome, Hypergonadotropic hypogonadism : Klinefelter syndrome,  Noonan syndrome,  Viral orchitis, Cytotxic drugs, Testicular irradiation. 

2) Testicular disorders (primary leydig cell dysfunction i.e. Hypoganadism), Chromosomal (Klinefelter syndrome and variants, XX male gonadal dysgenesis), Defects in androgen biosynthesis, Orchitis (mumps, HIV, other viral, ),Myotonia dystrophica, Toxins (alcohol, opiates, fungicides, insecticides, heavy metals, cotton seed oil), Drugs (cytotoxic drugs, ketoconazole, cimetidine, spironolactone)

3) Varicocele:  varicocele is dilatation of scrotal vein in the scrotum that leads to rise in temperature of testis and raise testicular temperature, resulting in less sperm production & death of whatever sperms are produced. 

4) Drugs (e.g. spironolactone, ketoconazole, cyclophosphamide, estrogen administration, sulfasalazine)  
5) Autoimmunity i.e. presence of Antisperm antibody. These Antisperm antibodies bind with sperms & either make them less motile, totally immotile or even dead which is called necrospermia.  

6) Undescended testicle (cryptorchidism). Undescended testis is a condition when one or both testicles fail to descend from the abdomen into the lower part of scrotum during fetal development. Undescended testicles can lead to less sperm production. Because the testicles temperature increase due to the higher internal body temperature compared to the temperature in the scrotum, sperm production may be affected.
7) Mosaic Klinefelter's syndrome. In this disorder of the  chromosomes, of the man is abnormal. This causes abnormal development of the testicles, resulting in low sperm production. Testosterone production may be low or normal.
8) Viral Orchits as mumps or other viral infections.  
9) Infections as tuberculosis, sarcoidosis involving testis or surrounding structures as epididymis. 
10) Chronic systemic diseases as Liver diseases, Renal failure, Sickle cell disease, Celiac disease  

11) Neurological disease as myotonic dystrophy  
12) Development and structural defects as mild degree of Germinal cell hypo-plasia
13) Partial Androgen resistance  
14) Mycoplasmal infection  
15) Partial Immotile cilia syndrome 

16) Partial Spermatogenic arrest due to interruption of the complex process of germ cell  differentiation from spermatid level to the formation of mature spermatozoa results in decreased sperm count i.e. oligospermia. Its diagnosis is made by testicular biopsy. This is found in upto 30% of all cases of dead sperm patients.

17) Heat Exposure to testis: as febrile illness or exposure to hot ambience induces a abnormality in spermatogenesis.
19) Infection as bacterial epididimo-orchitis, even in prostatis spermatogenic defect have been noted.
20) Hyper-thermia due to cryptorchidism

21) Chromosomal abnormality: has been found in many cases of low sperm count
22) Alcohol use, Cocaine or heavy marijuana use or Tobacco smoking may lower sperm count

23) Anti-sperm antibodies.  In some people there occurs development of some abnormal blood proteins called anti-sperm antibodies, which binds with sperm and make them either immotile or dead or decrease their count.
24) Infections. Infection of uro-genital tract may affect sperm production. Repeated bouts of infections are one of the common causes associated with male infertility.
25) Klinefelter's syndrome. In this disorder of the  chromosomes, a man has two X chromosomes and one Y chromosome instead of one X and one Y. This causes abnormal development of the testicles, resulting in low or absent sperm production. Testosterone production also may be lower.
26) Trauma to testis
27) Environmental toxins: as Pesticides and other chemicals in food  or as ayurvedic medicines.
 28) Genetic Factors: as idiopathic partial hypo-gonadotropic hypogonadism

Diagnosis of Cause of Dead Sperms


For correct diagnosis of cause of more of Dead sperm, we need detail history & physical examinations then certain relevant investigations are required.

History & Physical Examinations: First step in proper treatment is accurate diagnosis of cause of dead sperms. So we first try to find out cause. We take detailed history, thorough drug history and general physical examination, examination of testis, epididymis, testicular veins & sperm carrying duct examinations. These examinations give idea about whether testis is normally developed or not & how is its function. After that depending on likelihood of particular, cause relevant tests are done. All testing facilities are available at our centre. Thus you may consult us at our centre & at same time you may get all tests done. The time taken in getting all the reports ready is 36 hours. So if you are from out of Delhi, you may come here for two days.

Investigation & Diagnosis: For completes diagnosis of causes of dead sperms one or more of the following tests may be required as

Complete male hormone profile: This profile includes all the male hormone tests which control testicular development, functions including normal sperm Productions. The tests include L.H., F.S.H., Testosterones, prolactins, thyroids test, & other relevant hormone tests depending on history & examinations. 
2)
Antisperm antibody   
3) USG or Doppler study of scrotum & testis 
4) Semen culture sensitivity 
5) Semen fructose 

6) Immunobead test 
7) Sperm Function Tests 
8) Human Sperm-Zona Pellucida Binding Ratio 
9) Human Sperm-Zona Pellucida Pentration test 
10) Genetic Studies 
11) FNAC Testis 
12) Egg penetration test 
13) Molecular genetic studies done in some special cases 
14) Chromosome analysis i.e. Karyotype 
15) Assessment of androgen receptor 
16) Combined Pituitary hormone tests is performed when needed  
17) MRI head if pituitary hormone defect suspected
18) Hemogram test for systemic diseases.
19) Sperm Function Tests
The hamster egg penetration assay (HEPA) and the hemizona assay (HZA) are sperm function tests which can help assess the ability of sperm to penetrate the egg. These tests will not definitively tell whether a pregnancy will occur, but an abnormal test result helps predict reduced fertilizing capability. These tests are performed only rarely today.
20) Semen Fructose
21) Sperm Coiling Test to find out whether the particular sperm is live or dead

 

At our center facility for all the above tests are available. 

Treatment: Once the cause of low sperm count are found then with in three months of treatment sperm count & motility becomes normal in more than 90% cases.

The various treatments are as follows:

Correction of the Cause: First of all we try to find out the primary cause of infertility by above mentioned investigations. Then we correct the basic defect i.e. correction of hormone disorder & other defects. We also give following treatment for permanent cure of low sperm count & motility disorder.

1) Correction of Hormone deficiencies: Once the hormone disorder is found then it is corrected by any of the below medicines. Usually dead sperms problem is cured in three month time with proper hormone treatment. 

2) Gonadotropin Therapy: Gonadotropins are most potent natural stimulators of sperm production in the testis. Once we start gonadotropin therapy, these gonadotropins stimulates the sperm producing cells in testis. Under the stimulating influence of gonadotropins dormant sperm forming cells which were not producing normal sperms, they start dividing & producing normal sperms. Thus in more than 90% cases sperm production can be normalized in three to four months time if it is started in properlyselected cases of low sperm count. Gonadotropin therapy is most successful of all the available treatment for dead sperms till now. In many cases of dead sperms, when all other treatment has failed even in those cases gonadotropin therapy is effective. Thus treatment of dead sperms with gonadotropin therapy results in pregnancy soon.

3) Repronex.

4) Bravelle

5) Ovidrel

6) Gonadotropin-releasing hormone (Gn-RH) analogs

7) Growth hormone therapy in many cases where somatotropin deficiency is found.

8) Growth Factor, Mineral & Micronutrient Therapy 

9) Free Radial Scavangers: These are drug to reduce the free damaging oxidative radical in the testis. For your information every minute lot of oxidant radicals are generated inside the testis which damages sperm forming cells. These special antioxidant drugs scavange these damaging oxidative free radicals thus leading to production of normal sperms by the testis. In many study these free radical scavengers have been found to be very-very effective in curing dead sperms.

10) Coenzyme ubique: These drugs improve the nutritional status of the testis. Thus testis as well as sperm forming cells get enough nutrient which helps in fast generation of normal sperms in good number with good motility & fertilizing capacity.

11)  Carnititine supplementation increases the production of sperm, with normalization of normal sperms in semen in three months.

12) Fertyl: This drug is taken orally and it causes the pituitary gland to release more FSH and LH, which then stimulates the testis to produce more normal sperms.

 13) Bromocriptine. This medication is for men who have elevated levels of prolactin.

14) Correction of thyroid hormone

15) Correction of congenital adrenal hyperplasia

16)    Vitamins

17)     Zinc

18)     Methy-Predinisolone

19)    Antibiotics

20)    Antiestrogens

21)    Tamoxifen

22)    Clomiphene

23)     Hgh

24)    Antimicrobials

25)    Anti-inflammatory

26)    AIH

27)    ART

28)    Certain Newer Drugs has been found very effective

30) Surgery:  Surgery is also the treatment of choice for significant varicocele. Similarly surgery may be one of the treatment options for many endocrine tumours.

32)  Test tube baby is also delivered with our efforts by use of intra-cytoplasmic sperm injection (ICSI) after separating out live sperms out of dead ones then transfer of embryo to uterus of mother.

33) Semen Bank: Facility for good quality sperm is semen bank in also available. At our center we have facility for all the testing & treatment facility required for low sperm count to achieve pregnancy. 

34) Assisted reproductive technology (ART)
ART has revolutionized the treatment of infertility. Each year thousands of babies are born in India as a result of ART. Medical advances have enabled many couples to have their own biological child.

The most common forms of ART include:

a)       In vitro fertilization (IVF). This is the very effective ART technique. IVF involves retrieving mature eggs from a woman, fertilizing them with a man's sperm in a dish in a laboratory and implanting the embryos in the uterus three to five days after fertilization. IVF often is recommended as a first-line therapy. It's also widely used for unexplained infertility, male factor infertility.

b)       Electroejaculation. Electric stimulus brings about ejaculation to obtain semen.

c)       Surgical sperm aspiration. This technique involves removing sperm from part of the male reproductive tract such as the epididymis, vas deferens or testicle. This allows retrieval of sperm if blockage is present.

d)       Intracytoplasmic sperm injection (ICSI). This technique consists of a microscopic technique (micromanipulation) in which a single sperm is injected directly into an egg to achieve fertilization in conjunction with the standard IVF procedure. ICSI has been especially helpful in couples who have previously failed to achieve conception with standard techniques. For men with low sperm concentrations, ICSI dramatically improves the likelihood of fertilization.

35) Varicocele ligation: A varicocele is an abnormal tortuosity and dilation of veins of within the scrotum. It can be surgically treated - which might help fertility in some cases.

Response of treatment: When we start treatment, maturation of spermatocyte to mature spermatozoa start occurring in three to 4 weeks time and achievement of normal sperm count with normal sperms is achieved in three months. Thus cure rate is achieved in more than 95% of patients in three months time.

Side effects: This treatment is harmless because we prescribe well proven drugs which are prescribed in scientific literature. These medicines have to be purchased from medical store by patient himself. 

 

We get patients from these colonies of Delhi & NCR.

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DELHI CLOTH MILLS DAREEBA CHAWRI BAZAR CHANDNI CHOWK FARASHKHANA IDGAH ROAD I S B T BARA TOOTI TIMARPUR RANA PRATAP BAGH RLY C A O ROOP NAGAR ROSHAN AREA ROAD WAZIR NAGAR SAFDARJANG AIR PORT SEWA SANGH SUBZI MANDI PRAGATI VIHAR KAMLA NAGAR SHAKTI NAGAR PATRACHAR ROAD PARTAP NAGAR MALKA GANJ MARKET MALKA GANJ LANCER ROAD MARKET JAWAHAR NAGAR DELHI UNIVERSITY C C INSTITUTE BIRLA LINES PATRACHAR VIDYALA LOK NAYAK BHAWAN DADA GHOSH BHAWAN PATEL NAGAR WEST PATEL NAGAR SOUTH PATEL NAGAR EAST PATEL NAGAR A F PALAM WORK SHOP KIRBY PLACE DHAULA KHUAN DEPOT DELHI CANTT CENTRAL ORDINANCE ARMY BASE A P S COLONY BAZAR ROAD CENTRAL VEHICLE NIRMAN BHAWAN UDYOG BHAWAN U P S C SOUTH AVENUE SECTT SOUTH GYMKHANA CLUB DEFENCE HEAD QRS SHAHJAHAN ROAD ORGANISATION CENTRAL TRACTOR RESEARCH INSTITUTE INDERPURI N P LABORATORIES DARGAH SHAREEF HAZRAT NIZAMUDDIN HARI NAGAR ASHRAM JANGPURA MOTI NAGAR KARAMPURA ZAKHIRA VISHNU GARDEN SUDERSHAN PARK RAMESH NAGAR H O NORTH INDUSTRIAL AREA KIRTI NAGAR CENTRAL KIRTI NAGAR INDUSTRIAL AREA E S I HOSPITAL D I AREA MANSAROVER GARDEN I I T HAUZ KHAS YUSAF SARAI N I E COMPUS HAUZ KHAS MARKET HAUZ KHAS GREEN PARK GREEN PARK MARKET ASHRAM SHRI AUROBINDO MALVIYA NAGAR PANCHSEEL ENCLAVE PUSHPA VIHAR SECTOR I SOUTH MALVIYA NAGAR TIHAR ASHOK NAGAR VIKASPURI VISHNU GARDEN TILAK NAGAR EAST TILAK NAGAR MAHABIR NAGAR KHYALLA PHASE II KHYALLA PHASE I CHAND NAGAR MAJOR BHUPINDER SINGH NAG FATEH NAGAR GOVINDPURI KALKAJI NEHRU PLACE FLATTED FACTORIES COMPLEX OKHLA INDUSTRIAL ESTATE C R R I ASHOKA HOTEL CHANKYAPURI MALCHA MARG MOTI BAGH NANAKPURA ANAND NIKETAN R K PURAM SECTOR III R K PURAM SECTOR VIII R K PURAM SECTOR IV R K PURAM SECTOR II R K PURAM SECTOR XII R K PURAM SECTOR I R K PURAM V POSTAL SAVING BUREAU R K PURAM SECTOR VII R K PURAM SECTOR IX KIDWAI NAGAR WEST KIDWAI NAGAR LAXMI BAI NAGAR NETAJI NAGAR SAROJINI NAGAR H O AMAR COLONY LAJPAT NAGAR DEFENCE COLONY KRISHNA MARKET JAMIA NAGAR ZAKHIR NAGAR PUNJABI BAGH SECTOR III PUNJABI BAGH RAJOURI GARDEN J 6BLOCK RAJOURI GARDEN J J COLONY NAJAFGARH ROAD RAJOURI MARKET SUBHASH NAGAR SUBHASH NAGAR WEST TATARPUR JANTA MARKET NARAINA VIHAR NARAINA NARAINA INDUSTRIAL ESTATE SAFDARJANG ENCLAVE HIMAYUNPUR EXTN NAUROJI NAGAR MEHRAULI T B HOSPITAL KAILASH NAGAR SAHSTRI NAGAR RAGHUBARPURA GEETA COLONY GANDHI NAGAR GANDHI NAGAR BAZAR ROHTASH NAGAR SEEMAPURI OLD VIVEK VIHAR VISHWAN NAGAR VISHWA KARMA NAGAR TELIWARA SHAHDARA BHOLA NATH NAGAR BALBIR NAGAR MANSAROVER PARK LONI ROAD KABOOL NAGAR DILSHAD GARDEN NEW SEEMAPURI SHAHDARA MANDI MODEL TOWN A BLOCK MODEL TOWN II MUKERJEE NAGAR NEW SABZI MANDI NIRANKARI COLONY SURAJ NAGAR JAHANGIRPURI BLOCK A VIJAY NAGAR SHALIMAR BAGH JARODA MAJRA JAHANGIRPURI BLOCK H HARIJAN SEWAK SANGH GUJRANWALA NAGAR PART II G T S NAGAR BHAIPARMA NAND NAGAR ADARSH NAGAR A T MILLS JAHANGIRPURI BLOCK D SHAKURPUR BLOCK I ANANDVAS SHAKURPUR PITAMPURA SRINAGAR COLONY SARASWATI VIHAR MULTANI MOHALLA SHAKURBASTI R S RANI BAGH GANESHPURI INDERLOK ONKAR NAGAR LAWRENCE ROAD LEKHU NAGAR POWER HOUSE SARAI ROHILA ALIPUR NANGLI POONA Gurgaon Gurugram ROAD A F RAJOKARI BAWANA NARELA NARELA TOWN SANOTH BUDH NAGAR JAWALPURI NAGLOI NANGLOI PHASE III SULTANPURI BLOCK F SULTANPURI BLOCK C SUTTANPURI BLOCK B SAMEYPUR BADLI BADLI HAIDERPUR NAJAFGARH BADARPUR BADARPUR T P STATION TUGHLAKABAD TUGHLAKABAD A F STATION AMBROHI BAKROLA PALAM PALAM ENCLAVE NANGAL RAVA ARJAN GARH GREATER KAILASH KAILASH KAILASH COLONY MASJIDMOTH PHASE II N BLOCK GREATER GREATER KAILASH II SADIQ NAGAR SOUTH EXTN PART I ANDREWS GANJ SOUTH EXTN PART II GULMOHAR PARK ASIAN GAMES VILLAGE GUATAM NAGAR MASJID MOTH EXTN ANARKALI AZAD NAGAR GOBINDPURA KRISHAN NAGAR H O KRISHAN NAGAR BAZAR LAJPAT RAI CHOWK RADHEYPURI RAM NAGAR BHARAT NAGAR WAZIRPUR PHASE III SHASTRI NAGAR NIMRI ASHOK VIHAR H O SATYAWATI NAGAR BHAJANPURI BRAHAMPURI JAGJIT NAGAR MAUJPUR SEELAMPUR YAMUNA VIHAR ZAFRABAD CIVIL LINES C R P F CAMP DISTT COURTS MAIDENS HOTEL AMRIT KAUR MARKET MULTANI DHANDA P S B PAHARGANJ PAHARGANJ SWAMI RAM TIRATH NAGAR SHAKURBASTI MUNIRKA VASANT VIHAR I VASANT VIHAR II JANAKPURI BLOCK C 4 POSSANGIPUR JANAKPURI JANAKPURI BLOCK D 1 JANAKPURI BLOCKC 2 JEEWAN PARK UTTAM NAGAR NEW RAJINDER NAGAR RAJINDER NAGAR RAVINDER RANGSALA BIJWASAN AMBEDKAR NAGAR PUSHPA BHAWAN KHANPUR MADANGIR DAKSHINPURI PHASE III B S F CAMP TIGRI HAMDARD NAGAR DAKSHIMPURI PHASE I QR MADIPUR MADIPUR PASCHIM VIHAR PASCHIM VIHAR BLOCK B HARI NAGAR BE BLOCK HARI NAGAR DA & DB LOCK MAYAPURI MAYAPURI SHOPPING CENTRE EAST OF KAILASH NEHRU NAGAR SRINIWASPURI R K PURAM R K PURAM WEST D D A MUNIRKA JAWAHAR LAL NEHRU UNIVERS CHHAWLA D D A SALAM JHARODA KALAN P T S JHARODA KALAN UJWA KANJHAWALA KHERA KALAN MANGOLPURI BLOCK A MANGOLPURI BLOCK S MANGOLPURI MANGOLPURI BLOCK 1 KUTUBGARH HIMMATPURI KALYANPURI KHICHRIPUR TRILOKPURI KALYAN VAS SHAKARPUR LAXMI NAGAR MARKET PATPER GANJ NAND NAGRI NAND NAGRI A BLOCK NATHU COLONY CHILLA VILLEGE GOKULPURI KARAWAL NAGAR BHAJAN PURA

Gurgaon Gurugram H O Gurgaon Gurugram KUTCHERY NEW COLONY Gurgaon Gurugram RAILWAY ROAD Gurgaon Gurugram SOHNA ADDA Gurgaon Gurugram URBAN ESTATE Gurgaon Gurugram AIR FORCE Gurgaon Gurugram Gurgaon Gurugram PALAMPUR ROAD DUNDAHERA MANESAR BADSHAHPUR BHUDSI SOHNA(Gurgaon Gurugram) FEROZEPUR JHIRKA TAURA DHARUHERA NUH NAGINA DAULATABAD (Gurgaon Gurugram) PALMAR

GHAZIABAD H O KAVINAGAR MEERUT ROAD (GHAZIABAD) HINDON AIR FIELD MALAKNAGAR CHIKAMBERPUR MOHAN NAGAR BHARAT NAGAR GHAZIABAD CITY RAMNAGAR MODEL TOWN DASNA GATE BHOOR BHARAT NAGAR MUKUNDNAGAR CHANDRA NAGAR GHAZIABAD AMRIT NAGAR KHAEKRA LONI GOVINDPUR HARMUKHPUR MODINAGAR KARWI R S MOHIUDDINPUR KARWL MURADNAGAR TOWN MURADNAGAR NOIDA COMPLEX HINDON NAGAR JAIN INDSTIRAL ESTATE MAHARISHI NAGAR

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We get patients from all major cities in India & Abroad . In the following cities all the facilities for investigation & treatments including medicines are available as Delhi (North, South, East, Central, West, New Delhi). To Different Communities like Hindustani, Hindustan, Hindu, Christian, Muslim, Sikh, Parsee. The other cities are NCR, National Capital Reagion in India, Indian, Hindustan, Ghaziabad, Faridabad, Noida, Gurgaon Gurugram, Meerut, Bombay, Chandigarh, Calcutta,  Simla, Jammu, Srinagar, Aligarh, Lucknow, Kanpur, Allahabad, Varanasi, Dehradun, Madras, Kolkatta, Nainital, Agra,  Jaipur, Bikaner, Jodhpur, Porbandar, Dwarka, Ahmedabad, Gandhi Nagar, Vadodara, Surat, Mumbai, Pune, Thane, Panaji, Nasik, Nagpur, Indore, Ujjain, Bhopal, Gwalior, Jabalpur,  Raipur, Hyderabad, Goa, Visakhapatnam, Bangalore, Banglore, Bangalooru, Mysore, Mangalore, Manipal, Chennai, Pondicherry, Madurai, Kanchipuram, Coimbatore, Kanyakumari, Ernakulam, Trivandrum, Darjeeling, Gangtok, Bhubaneswar, Puri, Guwahati, Shillong, Imphal, Kohima, Agartala, Patna, Ranchi.

 

 

 

 

 

We provide treatment for :  Infertility Treatment Delhi Infertility Treatment Centre India Fertility Doctor Treatment Specialist Expert Senior Best Therapy Hormone Experienced Difficulty Conceiving Becoming Pregnant Pregnancy Getting Gurgaon Gurugram Ghaziabad Noida Fatridabad North west East Central Famous Clinic Centre Hospital  hormone therapy  is one of the very remarkable advancement in the last 5 years.

 

 

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