Small Breast || Female Hormone Deficiency || Unwanted Hair || Milk Secretion
Early Breast Development || Menstrual Irregularity || Infertility || PCOD
Excess Menstrual Bleeding || Premature Ovarian Failure || Premenstrual Syndrome
Menopause || Hormone Replacement Therapy


PCOD
Infertility in Female
Premenstrual Syndrome
Excess Menstrual Bleeding

 Poly-Cystic Ovarian Disease (PCOD)

What is Pcod Why This Occurs  Investigation& Diagnostic Tests: Treatment

Introduction: The full form of PCOD is polycystic ovarian disease. In this disease when ultrasound of ovary is done it is studded with multiple small cyst that is why this disease is called polycystic disease. 

Before discussing other detail about PCOD, I'll like to let you know about what is the normal physiology of menstruation. In normal female there are lacs of immature egg (ovarian) follicle lying in dormant state in the ovary. During the normal menstrual cycle on third day of cycle approximately 30 egg follicles starts maturing finally one of them will mature to full stage to form mature egg. When all the hormones are normal then one out of all maturing egg follicle is selected for further maturation & rest all shrink & atrophy. Finally this selected eg follicle passes through various stages of development & finally matures into a completely developed egg called ovum. Then egg is released out of the ovary (i.e. ovulation). Once the ovum is released ovary starts secreting progesterone for next 10 days. This progesterone hormone leads to strengthening of walls of blood vessel of endometrium. After 10 days of egg release i.e. ovulation, the production of progesterone hormone from ovary ceases. Thus the sudden deficiency of progesterone hormone leads to weakening of the linings of endometrial blood vessels which ultimately shrink & stop supplying blood to endometrium i.e. inner uterine lining. Thus in nut shell the production of estrogen from ovary lads to formation of inner lining of the uterus during menstrual cycle, where as production of progesterone from ovary after the ovulation leads to maintenance of this uterine lining. The menstrual bleeding occurs due to shedding of uterine inner lining i.e. endometrium due to disruption of its blood supply because of sudden deficiency of progesterone because of stoppage of its production from ovary. Thus if no ovulation occurs, there will not be any cyclical exposure of progesterone resulting in absence of regular menstrual bleeding. 

The full form of PCOD is polycystic ovarian disease. In this disease when ultrasound of ovary is done it is studded with multiple small cyst that is why this disease is called polycystic disease. These cysts are not real cyst but they are immature egg follicle. These multiple partially developed eggs looks like multiple cyst.

WHY THIS OCCURS 

In this disease there is formation of more than normal amount of male hormones as testosterone & Androstenidione from the ovary in that patients due to various causes mentioned below. For your information normally also ovary makes some amount of male hormone even in normal females. But in this disease the amount of secretion of male hormone increases due to various defects as absence of ovulation, appearances of hair growth over face.. The various causes of this excess male hormone formation from ovary is as follows.

1) PRIMARY PCOD: In this the ovary has inherent defect in structure & functions due to its defective development since birth so that it start making little more male hormone (testosterone & Androstenidione) than normal females. This little extra male hormone suppresses the maturation of egg in ovary. Thus multiple immature egg are present in ovary in every cycle (these immature look like cyst on ultrasound, but in real sense they are not cyst) but none of the immature follicle completes the maturity to fully developed eggs. Thus ovulation does not take place. Once there is no ovulation that leads to deficiency of progesterone hormone resulting into absent periods. 

2) Secondary PCOD: When all the classical features occurs due to obesity, congenital adrenal hyperplasia, Hypothyroidism, hyper-prolactinemia, etc.

Investigation& Diagnostic Tests:

Following tests will be required to diagnose the cause of pcod / Pcos, & to decide whether it is primary or secondary & what is its severity.
Complete hormone profile: LH, FSH, total testosterone, free testosterone, Androstenidione, SHBG, 17 HYDROXYPROGESTERONE, DHEAS, Estradiol, DH Suppression & Stimulation Tests, 
High Resolution Ultrasound
Color Flow Doppler
MRI
CT abdomen

TREATMENT

Treatment includes suppression of male hormone production & suppression of male hormone action at hair root levels.

2). Excess bleeding during period may also occur due to obesity, congenital adrenal hyperplasia, Hypothyroidism, hyperprolactinemia, hyperthyroidism & many other hormone diseases as DUB, Clotting disorder etc. For treatment all above causes are investigated then treated accordingly.

3) Premenstrual syndrome occurs due to some hormone disorder & fluid retention in which patient get depressed, anxiety, body pain, fullness & bloating of body, Swelling over body. These symptoms are more pronounced before, during & after the periods. There are certain medicines which can cure it in few month time. The medicines are

a) Medroxyprogesterone
b) Desgestrol
c) Megestrol
d) Norethisterone
e) Hydroxyprogesterone
e) Oral E & P Combination Pills

2) Infertility In Female
Infertility is defined as inability to conceive in a couple having unprotected intercourse for over one year. Difficulty in conceiving & inability to have child in female can be due to many of below mentioned hormone diseases & other causes as discussed below. 

Causes of Infertility 
common causes for infertility are 
- Male Factor infertility
- Female Factor infertility
- infertility due to minor defects in both couple

Causes of Female Factor infertility:

Hormone Disorder: thyroid hormone disorder, high prolactin, Estradioal deficiency LH, FSH deficiency, Polycystic ovarian disease (PCOD), defective egg formation, decrease in progesterone hormone, Hypothalmic & pituitary disorder, excess of various male, Hyperprolactinemia, Anavulation/oligoanovulation, Chronic anovulation (polycystic ovary syndrome), Hypothalmic amenorrhea-anovulation, Pituitary disease (including hyperprolactinemia), Adrenal disease, Thyroid disease, Luteinized unruptured follicle syndrome, Ovarian failure, Gonadal dysgenesis
hormone in female. 
Vaginal Causes : Excessive acidity, chronic vaginitis
Cervical Causes : Hormonal, Inadequate estrogen, Infection : Chalmydia trachomatis, Ureaplasma urealyticum, Anatomic : Destruction by cone biopsy or cauterization, Immunologic.
Uterine causes : Leiomyomas, Polyps, Intracterine synechiaq (Asherman syndrome), Chronic endometritis, Ureaplasms urealyticum, tuberculosis.
Tubal Causes : Infectious, Chlamydia trachomatis, Neissaria gonorrhoeae, Mycobacterium tuberculosis, streptococcus, anaerobes, Inflammatory salpingitis isthmica nodosa.
Congenital Abnormalities : Diethylsitilbestrol exposure, idiopathic.
Endometriosis: Mild, Moderate, Severe
Ovulatory Disorders : Luteal phase deficiency, Hypoprogesteronemia, Pelvic Adhesions : After intrauterine device use, Associated with pelvic inflammatory disease, Associated with appendicitis, Associated with other bowel disease, Idiopathic 
Immunological disorders - eg. SLE.
Infections eg TORCH infections.
Metabolic Diseases : Diabetes

Investigations & Diagnosis : We need detailed history examination , blood tests as LH, FSH, Prolactin, Thyroid test, testosterone, free testosterone, androstenidione,17-hydroxyprogesterone, Dheas, SHBG, . 
Antisperm antibodyn sometimes also required to know the cause of infertility in females.
TORCH IgM for infection screening
USG for follicular/ Ovulation study, hysterosalpingography for uterus & tube status & Laproscopy
Transvaginal follicular monitoring with color Doppler for egg development

Hysteroscopy for diagnosos & treatment of uterine cavity diseases.

Treatment: . After a diagnosis of infertility, the best treatment plan based on the specific requirement is selected. Many times a combination of fertility treatments is necessary to achieve pregnancy. Commonly recommended treatments include ovulation induction, injectable ovulation induction, intrauterine insemination (IUI), in vitro fertilization (IVF) and reproductive surgery. By correction of these disorders good egg formation occurs & leads to conception in three to six months time. 

1) Drugs For Infertility 
a) Clomiphene
b) Gonadotropin Therapy
c) HCG Therapy
d) Hmg therapy
e) Metformin
f) Glitazones
g) Micronized progesterones
h) Laser Ovulation Induction
i) Tamoxifene
j) Letrozole
k) Diathermy of Ovaries

Ovulation Induction
Ovulation Induction is used for patients with ovulatory dysfunction. The first line of treatment may include oral medications, such as Metrformin or Clomiphene citrate. Other diagnoses may necessitate the need for injectable medication called gonadotropins. These may include Follicle Stimulating Hormone (FSH), Leutinising Hormone (LH), human Chorionic Gonadotropin (hCG) or combination of all of these. Both types of medications stimulated the ovaries to produce one or more eggs. Frequent monitoring is usually necessary to manage the effects of the medication. Monitoring includes ultrasound of the ovaries to measure follicle growth/egg development and the thickness of the uterine lining and Hormone Blood Tests.

Super ovulation
Super ovulation is frequently used for patients with unexplained infertility; for those who had unsuccessful surgical treatment for mild endometriosis or for patients with a mild male infertility factor. In fact, super ovulation is recommended following the patient's infertility workup but before in initial laparoscopy to avoid the surgery completely. The objective of super ovulation is to stimulate the production of 2-5 oocytes (eggs), giving the sperm more 'targets' to fertile. Treatment includes Clomiphene citrate tablets or the synthetic FSH. This egg stimulation process is monitored with frequent vaginal ultrasounds and Hormone Blood testing. When the follicles (which house the eggs) are large enough, hCG is injected to trigger ovulation. Super ovulation is combined with IUI for better results.

2) Intrauterine Insemination: it is done for any defect in female vagino-cervical canal, or for a defect in male sperm count or motility. For this semen wash done & healthy motile sperms are taken & then they are injected directly in uterus leading to good pregnancy rate. IUI allows the placement of millions of sperm directly into the uterine cavity at the time of ovulation. The sperm are 'washed' with special solutions to remove the semen and to concentrate the sperm. There is a greater chance of pregnancy when the sperm are closer to the eggs with the IUI.

Therapeutic Donor Insemination (TDI) 
TDI involves timed insemination from an anonymous or a known donor. It is recommended to use frozen semen to prevent genitally transmitted disease by the Food Drug Administration (FDA), USA and the Centers for 

3) In Vitro Fertilization: Test tube baby procedure is adopted for various male & female causes of infertility.

4) ICSI - (Inracytoplasmic Sperm Injection): In this procedure single sperm is injected into a single eggs with the help of microinjector so that one achieves good fertilized egg & later normal baby even with single egg. The single sperm are picked and injected into the eggs using specially designed microscopes, micro needles and micromanipulation equipment. The eggs are checked then for evidence of normal fertilization. Fertilization rates for ICSI are very good. In various IVF programs the success rate foe for pregnancy are about 60-85%.

5) Gamete/Zygote Intra-fallopian Transfer
Gamete intra-fallopian transfer (GIFT) and zygote intra-fallopian transfer (ZIFT) are adaptations of IVF. GIFT and ZIFT are used in unexplained female infertility and in mild male infertility.
6) Blastocyst Transfer
7) Assisted Hatching (AH)

8) Artificial Insemination of Sperm from semen bank .This facility is not very costly with good success rate.
9) Reproductive Surgery
Surgery for fertility problems includes operative laparoscopy and/or hysteroscopy. Laparpscopy is performed to diagnose and treat endometriosis, adhesions and tubal problems. Hysteroscopic procedures are used to diagnose and treat intrauterine problems such as polyps, fibroids, adhesions and uterine septums. At times, both these surgeries may be required. 

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Hydantoins Ethylene dibromide, toxic effects , Ethylene glycol ethers, toxic effects , Ethylene oxide, toxic effects , Ethylene thiourea, effects thyroid gland, N-Ethyl-maleimide-sensitive fusion protein (NSF), Ethyl norepinephrine. Sympathomimetics Ethynodiol diacetate, dosage administration , hirsutism, virilization, Etidronate disodium (Didronel) action adverse effects side effects , with corticosteroid therapy, dosage administration , effects endocrine function values, glucocorticoid-induced osteoporosis, with glucocorticoid therapy, hypercalcemia malignancy, dosage administration , hyperphosphatemia with, indications , osteomalacia caused by, osteoporosis, Paget disease bone pharmacology , preparation , Etiocholanolone, testosterone metabolism , Etodolac. Nonsteroidal anti-inflammatory drugs Etomidate (Amidate) ACTH hypersecretion, action adverse effect side effects , Cushing syndrome patients who are criticalally ill, dosage administration , indications , preparation , Etoposide. Podophyllotoxin derivatives testicular tumors, Euglobulin lysis hyperthyroidism, hypothyroidism, Euglycemic clamp, Eulexin. Flutamide Eumelanin, Eumenorrhea, with hyperprolactinemia, Eunuchoid body proportions, respiratory problems due , Eunuchoidism causes , classic hypogonadotropic. Kallmann syndrome Euphoria, corticosteroid-induced, Eutherians, X chromosome inactivation , Euthyroid hyperthyroxinemia, elderly, Euthyroidism elderly, free thyroxine (T4) index , nonthyroidal illness, determination , serum free thyroxine , measurement , Euthyroid sick syndrome, children, , laboratory findings , serum total free triiodothyronine (T3) , Euvolemia, SIAD, Evening primrose oil, premenstrual syndrome, Everone. Testosterone enanthate oil Evista. Raloxifene HCI Exemestane, breast cancer treatment, Exercise, adaptations , aerobic, amenorrhea, anorexia nervosa, body weight, cardiovascular disease prevention, catecholamine levels, delayed puberty, diabetes treatment, pediatric adolescent patients, elderly, fuel metabolism during, gestational diabetes, glucagon, glucocorticoids, glucose homeostasis , gowth hormone, hypertriglyceridemia management, insulin sensitivity, isometric, sympathoneural response , lipid-lowering effects , luteal phase dysfunction, metabolic control diabetes, plasma metalonin levels, postmenopausal osteoporosis, premenstrual syndrome, prolactin, protein, pyruvate dehydrogenase, scale exertion , genitalhormones, sympathetic nervous system, terminology , thyroid hormones, ventilatory response , diabetes, weight-bearing, hypercalcemia, weight loss, Exercise intolerance, diabetes, Exocrine secretion endocrine secretion, overlap , form , Exocytosis, insulin secretion, misplaced, lactotropes, Exon(s), Exophthalmos, causes , differential diagnosis , endocrine / metabolic causes , endocrine / metabolic causes , Graves disease, measurement , physical examination , with thyroid acropachy, unilateral, investigative studies , Exorphins, structure , Exotoxin, increased serum calcitonin percursors inflammation, infection, sepsis, Exotropia, causes , Expected date delivery, calculation , Expert Panel the Identification, Evaluation, Treatment Overweight Obesity, Exportins, Expressed sequence tags (ESTs), Expression secreeing, Expressivity, External beam radiotherapy. Radiation therapy External genitalia. Genitalia. External otitis, malignant, diabetes, Extracellular fluid (ECF), depletion, sympathoneural response , extravascular (interstitial) compartment , intravascular (plasma) compartment , solutes , loss , unmeasured, volume decreased, hypoosmolality, increased, hypoosmolality, normal, hypoosmolality, Extracular muscles abnormal movement , causes , disorders , endocrine / metabolic causes , endocrinopathy , enlargement , endocrine / metabolic causes , Graves disease, innervation , movements , Graves ophthalmopathy, T cells , thyroid-associated ophthalmopathy, Eye(s). Ophthalmopathy albinism, Alport syndrome, anterior chamber pathologic changes , endocrine / metabolic causes , peripheral synechiae , anti-Mongoloid slant , causes , catecholamines , chondrodysplasias, corticosteroid therapy , deep-set, endocrine / metabolic causes , diabetes , endocrine disorders , Ophthalmopathy, endocrine; Vision, changes endocrinology, Fabry disease, hypophosphatemia, immunologic disorders , corticosteroids , infantile GM1 gangliosidosis, inflammation corticosteroids , pregnancy , inherited disorders amino-acid metabolism, lysosomal storage diseases, menstrual cycle , metabolic diseases affecting, movement , abnormalities , diabetes , normal hormonal fluctuation , oral contraceptives , pregnancy , response autonomic nerve implses, Stickler syndrome, thyroid disorders , Eyebrow(s) coarse, causes , loss causes , hypothyroidism, loss outer third , causes , Eyelash(es) long, cause , loss , causes , whitening , Eyelid(s) disorders , endocrine / metabolic causes , edema endocrine causes , Graves disease, oral contraceptives , eruptive xanthomas , causes , hyperpigmentation , causes , hyperpigmentation , endocrine causes , hypopigmentation , endocrine causes , lag, endocrine causes , lower, edema , margins, hyperpigmentation , causes , Mongoloid obliquity , endocrine causes , pregnancy, puffy, causes , redundant folds , causes , retraction, endocrine causes , upper, retraction , Graves ophthalmopathy, Eye movement disorders(s), Nystagmus with chiasmal field defects, diabetes , Fabry disease, clinical course , clinical feature , cutaneous manifestations , genetics , metabolic defect , ocular manifestations , treatement , Facial flushing. Flushing Facial hair growth, onset, males, Facial palsy diabetes, malignant (necrotizing) external otitis, pregnancy, Facteur thymique serique. Thymulin Factitious hypoglycemia, Factor V Leiden mutation, oral contraceptive use, Factor VII, activation , Factor VIII estrogens , hyperthyroidism, hypothyroidism, serum level , thyroid function , Factor IX, production , cloned sheep, Factor XI activation , as kallikrein activator, Factor XII. Hageman factor inflammatory response, Factor S. Neural sleep factor central nervous system effects , Factrel. Gonadorelin HCL Facultative thermogenesis, Fad diets, hazards , Fadrozole, breast cancer treatment, FAF. Fibroblast activating factor fa gene, Fahrenkrug, Jan, Falchuk, Kenneth R., Fallopian agents , true hermaphroditism, Fallopian tubes. Oviduct evaluation , infertility , menopause , transport , Falls, elderly, Famciclovir, effects endocrine function values, Familial adenomatous polyposis, thyroid cancer , Familial amaurotic idiocy. Tay-Sachs disease Familial delayed pubert, clinical presentation , confirmation diagnosis, prognosis , short stature, treatment , Familial dysalbuminemic hyperthyroxinemia, serum free thyroxine , measurement , Familial dysautonomia, Riley-Day syndrome osteoporosis , Familial dysbetalipoproteinemia, Familial dyslipidemia, Familial expansile osteolysis, Familial glomus tumors, Familial hyperaldosteronism glucocorticoid-suppressible, type II, Familial hypercholesterolemia, heterozygous, homozygous, ocular manifestations , polygenic, without xanthomas, treatment , with xanthomas, Familial hyperglucagonemia, Familial hyperkalemia hypertension, Familial hyperthyroidism genetics , nonautoimmune, Familial hypoalphalipoproteinemia, Familial hypocalciuric hypercalcemia (FHH), clinical manifestations , diagnosis , differential diagnosis , genetics , hypermagnesemia , laboratory findings , neonatal primary hyperparathyroidism, pathogenesis , pathophysiology , treatment , Familial hypokalemic periodic paralysis, Familial hypothyroidism, Familial iminooglycinuria, Familial isolated hypoparathyroidism, PTH gene mutations , Familial lipidosis, ocular manifestations , Familial lipoprotein disorders(s), Familial lipoprotein(a) excess, Familial male precocious puberty, Familial medullary thyroid cancer, diagnosis , non-MEN, pathology , prognosis , Familial papillary thyroid cancer, Familial pheochromocytoma, children, incidence, , Familial X-linked hypoparathyroidism, Familial 46, XX dysgenesis, Famotidine. Histamine antagonist(s), H2 effects endocrine function values, gastric acid hypersecretion, MEN1, Fanconi (pancytopenia) syndrome, acquired, causes , clinical features , eyelids , hypophosphatemia , idiopathic, inherited disorders amino-acid metabolism, ocular manifestations , primary, renal, short stature , Farber lipogranulomatosis, ocular manifestations , Farber syndrome, ocular manifestations , Fareston. Toremifene citrate Far Western protein blots, Fas. Fas ligand autoimmune diabetes, autoimmune thyroiditis, cell death mediated by, opioids , Fasciculations hyperthyroidism, thyrotoxic myopathy, Fasciitis, ectopic bone formation , FasL. Fas ligand Fas ligand (FasL.), autoimmune diabetes, biologic response , deletion , effects growth development, T-cell deletion, Fas receptor(s) adrenal function critical illness, delection , effects growth development, Fasting. Caloric deprivation; Starvation fuel metabolism after, glucose homeostasis , liver , infants children, hypoglycemic effects , ketoaciduria , maximal duration , metabolic responses , leptin , neuroendocrine adaptation , leptin , physiology , testosterone levels , transient intolerance , infancy childhood, TSH secretion, Fasting hypoglycemia, evaluation , management , Fat(s). Fatty acid(s); Lipid(s); Lipid(s); Triglyceride(s) dietary decrease , elderly, diabetic diet, hydrogenated, intake , breast cancer, unhydrogenated, energy intake from, malabsorption abetalipoproteinemia, chylomicron retention disease, Wolman disease, metabolism , critical illness, chronic phase, as stored energy, Fat, body. Adipose tissue; Adiposity Fat cell(s). Adipocyte(s) Fatigue, endocrinopathy, Fat redistribution syndrome(s), , Fat stai, parathyroid pathology, intraoperative use , Fatty acid(s) derivatives , hormonal functions , essential, esterified, free, fatty liver, insulin resistance, long-chain, metabolism , acetyl-coenzyme A , liver, muscle, oxidation , mobilization from adipose tissue, oxidation , plasma / serum level cirrhosis, critical illness, renal failure, pregnancy, production , chorionic somatomammotropin , protein metabolism, reference values , starvation, transport plasma, turnover, hepatic, hydroxy, synthesis , intake , plasma lipoprotein levels,

Adenosine deaminase (ADA), Adenovirus, IgM antibody, ADH-Anti diuretic hormone (Vassopressin), Adrenaline (Epinephrine), B- Acid Fast Bacilli,susceptibility-Amikacin, AFB- Acid Fast Bacilli.susceptibility-Augmentin,  Acid Fast Bacilli, susceptibility-Capreomycin, AFB- Acid Fast Bacilli, susceptibility-Cycloserine, AFB- Acid Fast Bacilli,susceptibility-Ethambutol, AFB- Acid Fast Bacilli.susceptibility-Ethionamide, AFB- Acid Fast Bacilli,susceptibility-lsoniazid, AFB- Acid Fast Bacilli,susceptibility-Kanamycin, AFB- Acid Fast Bacilli, susceptibility-Ofloxacin, AFB- Acid Fast Bacilli.susceptibility-Pyrazinamide, AFB- Acid Fast Bacilli,susceptibility-Rifampicin, AFB- Acid Fast Bacilli,susceptibility-Roxithromycin, AFB- Acid Fast Bacilli, susceptibility-Streptomycin, AFB-Acid fast bacilli by Flourescent Microscopy, AFB-Acid fast bacilli by ZN stain, AFB-Acid fast bacilli, Culture (Rapid) by US FDA approved non-radiometric, continuous monitoring VERSATREK System. (Improved version of commonly used manual and automated/radiometric rapid culture systems) AFB-Acid fast bacilli, Susceptibility-1 st line [SIRE] (Includes Streptomycin, Isoniazid, Rifampicin and Ethambutol)  

Different Hospitals in india are: Moolchand Health Care, St. Stephen’s Hospital, Dr. Ram Manohar Lohia Hospital, G.B Pant Hospital, Lok Nayak Hospital, RG Stone Urological Reasarch Institue, Sir Ganga Ram Hospital, Jeevan Hospital, Deen Dayal Upadhyaya Hospital, Orthonova Hospital, Batra Hospital, Sahi Hospital, Indraprastha Apollo Hospitals, Holy Faimly Hospital, Jeevan Mala Hospital, Jaipur Golden Hospital, Lady Harding Hospital, Smt. Sucheta Kriplani Hospital, Mata Chanan Devi Hospital, Safdarjung Hospital, Mohindra Hospital, M.P Heart centre Hospital, Bara Hospital, Hindu Rao Hospital, Holy Angels Hospital, Shankar Hospital, Holy Family Hospital, Chopra Hospital, Escorts Hospital St. Stephen's Hospital, Vardaan Hospital, Visitech Eye Hospital, Vardhman Mahavir Medical College, Safdarjung Hospital, Lok Nayak Jai Prakash (LNJP) Hospital, Private Hospital, Guru Teg Bahadur Hospital, Kalra Hospital,  Bangalore Baptist Hospital, Bowring Hospital, B W Lions Eye Hospital, Bangalore Hospital, Bangalore Children's Hospital, Genesis Hospital, Lakeside Hospital, M G A Hospital, Mallya Hospital, Manipal Hospital, Sindhi Charitable Hospital, Yellamma Dasappa Hospital,  Sir Harkisandas Narottamdas Hospital, Prince Alikhan Hospital, Saifee Hospital, Breach Candy Hospital, Jaslok Hospital, Habib Ismail Hosptal, Kalajyot Hospital, Motiben Dalvi Hospital, Bombay Hospital, Corwest Jain Clinic Group of Hospitals, D.S. Kothari Hospital, Lotus Hospital, Elizabeth Hospital, Bhatia Hospital, The Bomanji Dinshaw Petit Parsee Hospital, Cumbala Hill Hospital, Noor Hospital, K.B. Haji Bachoali Charitable Ophthalmic & ENT Hospital, Bai Jerbai Wadia Hspital, Nawroji Wadia Maternity Hospital, Wadia Hospital, Yerla Medical Trust Hospital, Tarachand Bappa Hospital, Dhanwantari Hospital, Shri Samasta Parajiya Suvarna Hospital, Smt.B.C.J. General Hospital, Smt.B.C.J. General Hospital, Holi Spirit Hospital, Lilavati Hospital, The Bandra Holy Family Hospital, Raheja Hospital, Gurunanak Memorial Hospital, Ramakrishna Mission Hospital, Radhibai Watumull Global Hospital, BSES Hospital, Sushrut Hospital, LH Hiranandani Hospital, Maganlal Popatlal & Sarvoday Hospital, Rajawadi Municipal General Hospital, Shatabdi Hospital, KBB Hospital, V.N. Hospital, Dr.K.B. Babha Hospital, Cooper Hospital, Bhagwati Hospital, Sion Hospital, K.E.M. Hospital Nayar Hospital, Kama Hospital, G.T. Hospital, J.J. Hospital, Sr.George Hospital, Aliganj Hospital, Blue Cross Hospital, Getwell Hospital, Krishna Lok Hospital, Lucknow Hospital, Medwin Hospital and Health Centre, Vivekanand Hospital, G.M.Associate Hospital, Dufferin Hospital, Civil Hospital, Communicable/Infectious Diseases Hospital Lifeline Hospital and Heart Centre, Lucknow Hospital, Shalimar Hospital, Rajendranagar Hospital Tuberculosis Hospital, Lucknow Rajpoot Hospital, Nishat Hospital, Z A Chartable Hospital, Indira Gandhi Eye Hospital, Sitapur Eye Hospital, Awadh Hospital and Heart Centre, Balrampur Hospital, Cantonment General Hospital, Civil Hospital, Dr.Shyama Prasad Mukherjie Hospital, Fatima Hospital, G.M.Associate Hospital, K.K.Hospital, Veerangana Jhalkari Bai Female Hospital, Shekhar Hospital, Queen Mary Hospital, Osmania General Hospital, Gandhi Hospital, Government Maternity Hospital, Nilofar Hospital, Cancer Hospital, T.B. Hospital, Hospital for Mental Diseases, Sarojini Devi Hospital, Sundram Medical Foundation, Chennai. MIOT Hospital, Chennai. Apollo Hospital, Madras. Malar Hospital Limited, Gandhi Nagar Adyar, Chenni. Calcutta Medical College Hospital. N.R.S. Medical College & Hospital, Calcutta. R.G. Kar Medical College & Hospital, Calcutta. Calcutta National Medical College & Hospital, Instt. of Postgraduate Med. Education & Research, Calcutta Seth S.K.M. Hospital, Calcutta. Sambhu Nath Pandit Hospital, Calcutta. Lady Dufferinvictoria Hospital, Calcutta. Howrah General Hospital, Howrah, Hoogly Sadar Hospital, Hoogly, Chittaranjan Seva Sadan & Chittaranjan Cancer Hospital,  Ramakrishna Mission Seva Pratishthan General Hospital, Calcutta.

Moolchand Health Care, St. Stephen’s Hospital, Dr. Ram Manohar Lohia Hospital, G.B Pant Hospital, Lok Nayak Hospital, RG Stone Urological Reasarch Institue, Sir Ganga Ram Hospital, Jeevan Hospital, Deen Dayal Upadhyaya Hospital, Orthonova Hospital, Batra Hospital, Sahi Hospital, Indraprastha Apollo Hospitals, Holy Faimly Hospital, Jeevan Mala Hospital, Jaipur Golden Hospital, Lady Harding Hospital, Smt. Sucheta Kriplani Hospital, Mata Chanan Devi Hospital, Safdarjung Hospital, Mohindra Hospital, M.P Heart centre Hospital, Bara Hospital, Hindu Rao Hospital, Holy Angels Hospital, Shankar Hospital, Holy Family Hospital, Chopra Hospital, Escorts Hospital St. Stephen's Hospital, Vardaan Hospital, Visitech Eye Hospital, Vardhman Mahavir Medical College, Safdarjung Hospital, Lok Nayak Jai Prakash (LNJP) Hospital, Private Hospital, Guru Teg Bahadur Hospital, Kalra Hospital

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