World Record in Surgical Skill

In December 2023, Dr Cyriac performed a landmark laparoscopic surgery removing a 4.420-kg uterus with multiple fibroids. This achievement was recognised by the Asia Book of Records (January 2024).

The patient had lived with the condition for 17 years. Her uterus had reached the size of a full-term pregnancy, pressing on nearby organs. Through keyhole surgery, the uterus was removed, and she was discharged the next day.

Understanding Common Gynaecological Concerns Fibroids

Nearly half of all women may develop fibroids. Symptoms include heavy bleeding, pelvic pain, fullness, and pressure on the bladder or bowel.
Treatment depends on size and location. Laparoscopy and hysteroscopy offer faster recovery with minimal invasion.

Fibroids: What Women Should Know

Nearly half of all women may develop fibroids, although many may never be aware of them. When symptoms do occur, they commonly include heavy menstrual bleeding, pelvic pain, a feeling of fullness, or pressure on the bladder or bowel.

Fibroids develop in different layers of the uterus, and their effects vary accordingly:

• Inner-layer fibroids can interfere with fertility and often cause heavy bleeding.

• Middle-layer fibroids may distort the uterine lining and affect conception.

• Outer-layer fibroids usually do not affect periods but may lead to bloating and discomfort.

Treatment depends on the size, location, and severity of symptoms. Medications may help in certain cases, especially when surgery needs to be postponed. When surgical treatment is required, laparoscopic surgery offers a quicker and less invasive recovery. Fibroids located inside the uterine cavity can be removed through hysteroscopy, without any abdominal incisions.

Endometriosis: A Growing Challenge

Endometriosis is becoming increasingly common. In this condition, tissue similar to the uterine lining grows outside the womb—on the ovaries, pelvis, or within the uterine muscle itself.

Pain typically begins during menstruation and gradually extends to the days before and after periods. In some women, the pain becomes constant and severe. While medications may provide temporary relief, complete laparoscopic clearance offers the best long-term results and significantly improves fertility outcomes.

Changing Trends in Fertility

As more women prioritise education and careers, the average age of childbearing has increased. However, the biology of reproduction remains unchanged.
“Egg quality in Indian women begins to decline around the age of twenty-four,” explains Dr Cyriac. “After thirty-five, the decline becomes more pronounced.”

Men are also experiencing rising fertility challenges, often linked to lifestyle factors such as smoking, pollution, pesticide exposure, alcohol consumption, tight clothing, and sedentary habits.

When couples struggle to conceive naturally, doctors follow a systematic approach. Natural conception is encouraged when ovulation is regular, fallopian tubes are open, and sperm parameters are normal.

• IUI (Intrauterine Insemination) is used when minor interventions may enhance fertilisation. Washed, active sperm are placed directly into the uterus.

• IVF and ICSI are recommended when fertilisation requires medical assistance. IVF allows the egg and sperm to meet in a controlled environment, while ICSI involves injecting a single healthy sperm directly into the egg. Egg quality remains one of the most important factors in treatment success.

Early childbearing reduces the risk of several reproductive disorders. Modern lifestyle factors contribute to PCOD in young women. While PCOD is often assumed to indicate a high egg reserve, many unmarried women diagnosed with PCOD may actually have low egg reserves.

High-Risk Pregnancies

Conditions such as repeated miscarriages, diabetes, hypertension, autoimmune disorders, advanced age, or previous surgeries require close monitoring. With proper care, most high-risk pregnancies progress safely.

One exceptional case involved a 71-year-old woman who conceived after extensive evaluation and delivered a healthy baby at 32 weeks—prior to the ART Act 2021, which now sets age limits for assisted reproduction.

Life After IVF

IVF pregnancies are not different from natural ones after 12–16 weeks. Caesareans are only recommended when medically required. Extended bed rest is unnecessary, and common food myths (pineapple, papaya) are unfounded.

Are IVF Babies Any Different?

IVF babies are no different from naturally conceived babies, explains Dr Cyriac.
“Once an embryo implants,” he says, “the pregnancy progresses according to nature.”

A child’s growth and development are shaped by genetics and epigenetics—factors such as environment, care, love, and values—rather than the method of conception.

Hormone Therapy and Women’s Health

Perimenopause and menopause often bring symptoms such as hot flushes, mood changes, vaginal dryness, and sleep disturbances. For women without risk factors such as breast cancer, stroke, or heart disease, low-dose oestrogen therapy can significantly improve comfort and quality of life.

Understanding Vaginismus

Vaginismus may have physical or psychological causes.
“We never blame the woman or the man,” says Dr Cyriac. “We evaluate both partners.”

If the hymen is rigid, a minor procedure can resolve the issue. If the male partner has a tight foreskin, circumcision may be recommended. When fear, anxiety, or past trauma is involved, counselling and gradual therapy help couples regain a healthy intimate life.

Some couples seek help even after ten years of marriage without intercourse, highlighting how deeply this condition can affect relationships.

Fertility Challenges Over Time

Many couples conceive easily the first time but face difficulty later. In earlier generations, closely spaced pregnancies kept reproductive organs active. Today, longer gaps between pregnancies may contribute to conditions such as adenomyosis, fibroids, blocked fallopian tubes, and hormonal imbalances.

Nature prioritises reproduction, and prolonged gaps can reduce the efficiency of the reproductive system over time.

Advanced Surgical Expertise

Laparoscopy has transformed gynaecology and fertility care. Beyond record-breaking surgeries, Dr Cyriac has managed rare and complex cases, including retrieval of oocytes from undescended ovaries located near the kidneys.

His expertise includes:

• Complete clearance of severe endometriosis

• Precise fibroid removal

• Complex fertility-related surgeries

• Tubal recanalisation to support natural conception

• Correction of uterine prolapse using laparoscopic hysteropexy

• Treatment of vault and vaginal prolapse through sacrocolpopexy

Dr Cyriac also offers Implanon, a subdermal contraceptive implant for women seeking an alternative to Copper-T or sterilisation. This quick, two-minute OPD procedure, performed under local anaesthesia, involves discreet placement of the implant in the arm.

Freezing Fertility for the Future

Egg, sperm, and embryo freezing allow individuals and couples to preserve fertility. Women may choose to freeze eggs for personal reasons or prior to cancer treatment.

India’s ART laws ensure strict safety, ethical practices, and anonymity. Donor eggs and sperm are sourced only from licensed ART banks, and surrogacy in India is entirely altruistic and limited to Indian citizens.

Dr Cyriac encourages patients to educate themselves using reliable sources.
“The internet can be frightening,” he notes. “Accurate information helps couples understand their options clearly.” He remains approachable and encourages patients to clarify all doubts whenever needed.

Role of AI in Modern Fertility Care

Artificial intelligence is becoming an important tool in embryology laboratories. It helps monitor embryos and supports specific lab processes. While AI cannot improve egg or sperm quality, it enhances precision and may reduce human error. Embryo transfer, however, will always require the expertise of a skilled doctor.