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Wednesday, March 28, 2012

Recurrent abortions

Dr. Uma Shrivastava, Infertility centre

Most of the recurrent abortions at early weeks are due to TORCH infections, high prolactin hormone levels, folate & other vitamin deficiencies.
Therefore correction of prolactin level before conception & supplement of Vitamin B6 during conception period will help normal fetal development at early weeks & further.
TORCH infection can be tested before conception by IgM & IgG.
In case of IgG positive cases also it is worthwhile using Spiromycin 3mIU for 3 weeks before conception, which will prevent very early attack from the virus in next conception. When conception occurs, supplementation of Spiromycin 3mIU till 20 weeks will prevent effect of the virus.
In both the above conditions supplement of Vitamin B complex & folate 1gm should be continued for at least 25 weeks of gestation. In addition, Iron & calcium supplements should be continued till term.
The above conditions should be well supported by progesterone till 12 weeks of gestation. It is always good not to let patient move around on her own. Rest can be allowed for 12 weeks till complete placentation.
The patient must be in well contact to the doctor for any emergency which can be managed in time.

Wednesday, March 14, 2012

Surrogacy issue has a legal hole

Article published on Kathmandu Post, April 30 by: DEV KUMAR SUNUWAR
Lack of legislation to recognise surrogacy has led to disputes, complications and insecurity for couples opting for it, say experts.
The Kathmandu District Court settled the first surrogacy related lawsuit last month but left a legal vacuum. In the lawsuit involving Shambhavi Shah and her husband Ujjwal Shumsher Rana, the court issued a verdict stating that a surrogate child is equally entitled to inheriting parental property. 
The verdict, however, does not resolve the problem. Surrogacy is common in infertile Nepali couples, at hospitals inside or outside the country. Since surrogacy is legal in India many couples and surrogate mothers flock to Indian hospitals. 
“Since the country lacks legal provisions on surrogacy, I had to take several references from other countries while issuing a verdict on this particular case,” said Judge Tek Narayan Kunwar. The judge said that though the case was not one of surrogacy as there seemed no consensus between husband and wife, lack of laws to govern such problems could give rise to disputes.
Surrogacy, as practiced in India, requires a couple’s agreement and the egg of the biological mother is fertilised with sperm of the father in a test tube and the embryo then transferred into the uterus of the surrogate mother. 

“Childless couples prefer surrogacy to adopting a child, because the baby is genetically theirs,” says Dr Uma Shrivastava, an Infertility and In Vitro Fertilisation (IVF) specialist. “I do not see any problem giving legal recognition to surrogacy.” 
According to doctors, mostly women who undergo several IVF cycles, multiple miscarriages, or have had their uterus removed fail to conceive. An estimate has it that around 15 percent of Nepali married couples are infertile.  
“The agony of infertile couples is more severe than that of those with HIV/AIDS, cancer or uterine prolapse,” said Dr Bhola Rijal, a senior gynaecologist and obstetrician. 
Since July 2004, Dr Rijal and his team have offered IVF services for over 350 test tube babies and treated over 1300 infertile couples at the IVF centre in the Chabahil-based Om Hospital and Research Centre.
“Many countries including India and Malaysia have given recognition to surrogacy. This has long been in practice in Nepal and many Nepali women go to India to act as surrogate mothers. Therefore, it is better to give legal recognition to surrogacy here,” added Dr Rijal. 
 Sapana Pradhan Malla, a Constituent Assembly member and women’s rights activist, says that surrogacy could be a boon for needy couples but she argued that when it comes to legal recognition, much has to be discussed. “Surrogacy should not be promoted haphazardly. If it is to be legalised, there should be a provision whereby needy couples could do it only after medical recommendation.”

Monday, March 12, 2012

Be conscious!

If you are having irregular menstrual cycle, you may have fertility problem but if you have a regular cycle even then you may have fertility problem. Therefore get your reproductive hormones profile done on D2/D3 of the cycle, you will know whether you have any problem or not.

Sunday, March 4, 2012

Sonosalpingography vs. Hysterosalpingography

This study was conducted to bring into focus the value of pelvic sonograms in assessing tubal patency in order to overcome the radiation hazard associated with hysterosalpingogram (HSG), reduce the cost of examination and encourage it as first – line office based procedure for the diagnosis of female infertility. Hence the present study was undertaken to evaluate uterine outline and tubal patency in infertile patients by transvaginal sonosalpingography (SSG) and to compare it with HSG.
50 infertile patients undergoing routine infertility investigations were selected randomly who agreed to participate in the study.  Within three – four months before or after hysterosalpingography, sonosalpingography was performed. The uterus and tubes were identified using a 6.5 MHz vaginal ultrasound probe and around 10 – 20 ml of normal saline was injected into the uterine cavity through an endocervical catheter. In addition, the procedure was performed with prophylactic antibiotics
Main outcome measures:
The shape of the uterus and its cavity, the flow of saline through the tubes, the presence of hydrosalpinges before or after the injection of saline and the presence of free fluid in the pouch of Douglas.
Most of the cases studied were between the age group of 25-30yrs (51 percent), and the mean duration of infertility was around 6-10 yrs (39 percent).  Sonosalpingography revealed bilateral patent tubes in 60 percent cases, and the remaining 40 percent cases showed either bilateral or unilateral block of the tubes. The sonographic and hysterosalpingographic findings were similar in 94% of the women with respect to uterine assessment and in 81% with respect of tubal findings. The sensitivity of sonosalpingography in diagnosing tubal patency was 85% and the specificity 84%. Adverse events of sonosalpingography included mild to moderate pelvic pain was noted in 6 patients. Infectitious complications was not revealed.
The results confirm that sonosalpingography utilizing saline as a contrast medium is a reliable, inexpensive, simple and well-tolerated method to assess tubal patency in an outpatient setting.
Sonographic hysterosalpingography is a simple office procedure which should be used in the preliminary assessment of the uterine cavity and the fallopian tubes. Its use will reduce the need for hysterosalpingography. 
However, in case where surgical interventions had taken place HSG may still prove useful.
Following, is an article regarding the first test tube (IVF) baby of India, extracted from the website of Deccan Herald:

Saturday, October 04, 2003

I feel like Edison’s bulb, says India’s first ‘test tube baby’
 D H News Service BANGALORE, Oct 3
She sat in the corner of the auditorium quietly listening to the presentations. Suddenly her name was announced and all eyes turned to her. The audience applauded and the lensmen clicked on Kanupriya, India’s first and world’s second test tube baby, now a 25-year-old marketing executive in Delhi.

“I often feel like Edison’s bulb. Everybody talks about the bulb, very few know about the man who founded it. I wish this applause could go to Dr Subhash Mukherjee, the architect of In-Vitro Fertilisation (IVF) in India. Unfortunately he is now no more,” said Durga alias Kanupriya while addressing a gathering of doctors and specialists at the 25th anniversary celebration of IVF in the world, here today. It was organised by Indian Council of Medical Research (ICMR), Hope Infertility Clinic and Inter Academy Biomedical Science Forum, Bangalore.

“I feel no different from others, thanks to my parents, especially my father, who kept me away from media glare. I was told in phases about my birth but I understood more as I grew up. My first question to my parents was regarding Dr Subhash because his name was often mentioned. They told me he was the man who helped in my birth. Unfortunately I could not spend much time with the doctor as he died when I was very young,” said Kanupriya.

Her father P K Agarwal, a businessman from Kolkata came all the way to celebrate his daughter’s birthday in Bangalore, which was commemorated as IVF’s 25th anniversary. He said he was averse to media because, “Media was skeptical about the technology employed by Dr Subhash. The irony is that it was the time when the rest of the world was celebrating the birth of Mary Louise Brown, who preceded my daughter by 67 days and became the world’s first test tube baby,” said Mr Agarwal. India’s first recorded test tube birth was in 1984 in Mumbai.

He narrated his first visit to Dr Subhash who was a noted endrocronologist, physiologist and gynecologist at Nilratan Sarkar Medical College, Kolkata. “I told him we were a childless couple and my wife’s fallopian tubes were blocked.

He said he could help but he warned that the child could be deformed or disabled. He explained to me the IVF procedure. I agreed ,” said Mr Agarwal. Born on October 3, 1978, Kanupriya’s birth remained unrecognised in the medical history because Dr Mukherjee could neither document his research in IVF nor make it public because of the controversy it would have raised.