Infertility Treatment – MOM Newsletter March 2017
MOM newsletter March 2017 publishes the latest news, story, innovations, successes, technology and happenings globally in areas of fertility / infertility treatment, maternity etc.
OAT: WHEN THE MALE FACTOR LEADS INFERTILITY CAUSES
By Dr. K K Gopinathan
O ligoasthenoteratozoospermia (OAT is the most common cause of male subfertility (when a man cannot get a woman pregnant after one year of regular sex without birth control). Among other reasons for OAT are ignoring symptoms and signs of infertility, ignorance about the condition itself and the general resistant to treatment that would compound the issue.
From our study among patients with long term infertility, we have identiﬁed two key factors: for those with longer periods of infertility, we must focus mainly on the male factor (unless there is an established female factor).
Besides, fibroid and endometriosis – identiﬁed for the ﬁrst time after a long period of infertility –may not be the primary factor for infertility though these could act as secondary cause to infertility.
So, make sure that there is no existing male factor before any invasive procedures can be adopted for endometriosis and fibroid.
CAUSES OF MALE FACTOR INFERTILITY
By Dr. Parasuram Gopinath
Male infertility can happen because of a wide variety of reasons ranging from environmental and behavioral problems, hormonal imbalances, physical problems, genetic disorders and psychological issues. Any of the problems that can affect the count, motility and morphology of the sperm can cause male infertility. The environmental and behavioral issues that can impact the male can be lifestyle choices or occupational issues. Few of them have been listed below.
Smoking. Regular use of recreational drugs or other drugs. Chronic alcohol abuse. Use of anabolic steroids. Overly intense exercise. Dietary deﬁciencies, Anemia, Malnutrition. Tight underwear and excessive use of hot water baths, tubs, and saunas. Exposure to environmental hazards and toxins such as pesticides, lead, paint, radiation, radioactive substances, mercury, heavy metals, etc. Excessive STRESS!
Modifying these issues can signiﬁcantly improve a man’s fertility potential as fertility reﬂects a man’s overall health. Men who live a healthy lifestyle are more likely to produce a healthy sperm. Another group of causes for male infertility is hormonal problems. Any thing that affects the hypothalamus-pituitary endocrine system which regulates the sperm production can be detrimental Either it can be excessive or reduced production of hormones from the hypothalamus and pituitary like FSH, LH, TSH, Prolactin etc. Diagnosing these problems and correct supplementation can help improve the fertility.
There are also a wide variety of physical problems like varicocele, hydrocele, hernia, issues to the tube/duct carrying the sperm from the testis to the penis etc can cause reduction in the sperm quality.
V aricocele is a very common problem that we come across and if diagnosed correctly, it can improve your sperm quality. Even issues with the duct] tube (vas deference) that carries the sperm from the testis to the penis like complete absence or blockage can be overcome with other treatment modalities. Even previous infections like Mumps, tuberculosis, typhoid or sexually transmitted diseases can cause either a blockage or complete damage to the testis.
Genetic issues like Klinefelter‘s syndrome, Y chromosome micro deletion can cause a signiﬁcant reduction in the sperm production. Severe sexual problems can also cause male infertility. These are both psychological or physical in nature like Erectile dysfunction, premature ejaculation, ejaculatory, loss of libido or sexual interest etc. These are issues which can be corrected with focused counselling and certain medications.
Unfortunately, in over 70% of the cases, male infertility cannot be diagnosed and that is when a lot of empirical treatment modalities are given like antioxidants. It is very difﬁcult to treat male infertility totally and we have to follow a step by step protocol in treating the couple, depending on the severity of the male factor. In many situations, mild to moderate forms of male infertility can be treated by lifestyle modiﬁcation as explained earlier. But most of the severe forms of male infertility are very difﬁcult to treat and it would be advised to proceed to a higher treatment modality after a reasonable trying time with basic medications.
SEMEN TEST AND ISSUES
By Dr. Parasuram Gopinath
Now, let’s look at the most important but common test; perhaps the only test that is universally accepted and used in such cases. It suffers from drawbacks like the parameters being varied from sample to sample, technician to technician and from lab to lab, even the sample with good parameters failing to give an accurate picture (if the male is fertile or not), pregnancies being possible even with very poor sample, and that one male being infertile to one woman and fertile to another, What are the probable causes for the variations? Even though the standard method of collection is by masturbation, many times the ejaculate produced after normal sexual act is far superior to the masturbated sample. The quality of the ejaculate produced by masturbation also differs depending upon many situations (even though masturbation is the accepted method of collection for semen analysis, it is also responsible for variations happening in the semen parameters). A drop of ejaculate taken for the analysis may not be representative of the whole sample. What should be considered as important criteria in semen analysis should be the count, motility and morphology. Motility and morphology are in fact far more important than the count hence it should be a routine to do morphological staining of all the samples.
INDICATIONS FOR ADVANCED TREATMENTS IN MALE INFERTILITY
Advanced treatments must be initiated if there is a consistently low count, consistently bad morphology, consistently poor motility (more than 50% of immotile sperms) and Follicle Stimulating Hormone of more than 8 (Sign of impending testicular failure). Given this scenario, we can conclude that we should give more importance to the male factor.
However, for most of the males with unexplained factors, the prognosis cannot be predicted. Also, results of the treatment – to a large extent – depends on the female factor and trying time, except in rare conditions. Fertility rate can never be zero though it can be very low. Our advice would be – to be on safer side – give reasonable trying time without compromising the success rate of advanced treatment.
INFERTILITY & MYTHS
By Dr. Parasuram Gopinath
Today if we look at the kind of cases we see, there is an equal contribution from both the husband and the wife that can lead to infertility.
Q WHEN SHOULD ANYBODY START TRYING FOR A PREGNANCY?
Biologically the best time to get pregnant is in the mid twenties with regard to the female age. Female’s age is one of the most important factor determining the chance of pregnancy in any couple and, as the female age increases the chance of getting pregnant decreases. There is rapid fall in pregnancy chances once the female crosses 34 yrs and is signiﬁcantly reduced by the time she is above 42 yrs.
Q WHAT IS THE IDEAL SEXUAL FREQUENCY FOR A COUPLE TO GET PREGNANT?
We advise our patients to have regular sexual intercourse, not necessarily daily but at least once every two or three days. Regular sex will improve the semen quality and also remove the unwanted anxiety associated with timing the intercourse during the fertile period. Fertile period sex can help only people who have very regular menstrual cycle, which is not the case in majority of the situations. Husband sperm has the capacity to survive inside the wife’s body or 2-3 days and the female egg once ovulated can survive up to 24hrs. So regular sexual life as we advise, will invariable improve the chances of getting pregnant.
Q HOW LONG SHOULD WE TRY BEFORE WE GET EVALUATED FOR INFERTILITY?
We should understand the fact that the chances of getting pregnant in a month of trying (unprotected sexual intercourse) is not more than 20% in normal couples and only 80% of them will get pregnant even if they try for 1 year. So it import that you start evaluating the couple if they are not pregnant in 1 year. But in certain situations like advanced female age (>35 yrs), we need to evaluate the patients much early as they tend to have additional negative factors / problem which they develop with advanced age.
Q WHAT IS A SEMEN ANALYSIS?
It is one of the ﬁrst and most important and simplest test done when a couple comes for infertility evaluation. It determines or helps us plan the mode of treatment that needs to be done for that particular couple.
Q IS SURGERY MANDATORY FOR ALL PATIENTS GETTING EVALUATED FOR INFERTILITY?
Not necessarily. We feel 80% of the couple just require a good counseling and only less that 20 percent of them require some kind of surgical treatment. Even in this 20%, its only 10 percent that require some forms of Assisted reproductive techniques (ART). Surgery or Hystero laparoscopy is done in situations when we ﬁnd an additional problem on ultrasound like ﬁbroid, endometriosis or tubal block etc. It is also done in certain cases wherein we are not able to identify any speciﬁc reason for infertility.
Q ARE THE CAUSES OF INFERTILITY MORE COMMON IN FEMALES, AS THEY ARE ALWAYS THE ONES WHO ARE BLAMED FOR?
Today if we look at the kind of cases we see, an equal contribution from both the husband or the wife for reasons that can lead to infertility.
Q WHAT ARE THE DIFFERENT PROCEDURES THAT COME UNDER ART?
We have procedures like IVF (In-Vitro Fertilization), ICSI, IMSIetc that are available. In these cases we take the eggs out of the female body and fertilize it with the husband’s sperm outside the female body and make an embryo and then transfer it into the uterus.
Q WHAT ARE THE SUCCESS RATES OF IVF PROCEDURES?
Today science has only developed to the extent of giving us the best success rate of 40-50% in the best of the cases, world over (below 35 yrs). If somebody is claiming higher results than this, you should be cautious. In addition, as the age advances or complexity of problem increases the chances will only decrease further. 50 it is mandatory that you understand the results that you should expect from your treating doctor before you start the treatment. It will help you prepare and reduce the anxiety and depression that is associated with a negative outcome.
Q IS DONOR TREATMENT ILLEGAL?
No, it is a very important and very legal treatment option in couples who do not produce sperm or egg of their own, for whom otherwise adoption is the only option. By doing donor treatment, we not only maintain the anonymity of the treatment but also provide the opportunity for the couple to have a child with at least one of their genetic material, unlike that in an adopted child who is completely different from the couple. But generally it is the couple who has to decide whether to accept it or not. Doctor has no role to decide the treatment options but it is his duty to counsel about the different options. The doctor should not straightaway deny the donor treatment if there is a real indication in the couple for the same.
IS MY BABY GROWING WELL ?
By Dr. Bijoy Balakrishnan
GROWTH DISORDERS IN PREGNANCY
Q rowth means different things to different people. For some, it is growth in wealth and for others – knowledge. But for a pregnant woman, it means the only one thing – ‘the growth of her baby’.
Every one including her neighbors and her milkman would want to know if her baby was okay. To make matters worse, she will be usually having an all-knowing aunt who will pass comments like ‘your tummy is looking small, is your baby small?. Eventually all these queries percolate down to the obstetrician’s consultation room where the anxious mother usually has only one question to ask “Is my baby small?”
Growth has two extremes, less growth called as intra-uterine growth restriction and excessive growth known as macrosomia – in medical jargon. I am going to conﬁne this article to less growth as excessive growth in any ﬁeld is never a cause of concern for a true-blue Malayali.
Mothers often argue that their periods are regular hence why they should scan to assess the age of the fetus. But unfortunately, the ovulation time can vary and it could be as long as a week thereby hindering accurate gestational age assessment.
Once the age is conﬁrmed, the next step is to measure the fetus and assess if fetal measurements are within the prescribed normal range for that gestational age. Parents usually ask for the weight of the fetus when they come in for a scan but an absolute weight measurement is meaningless if it is not matched with the gestational age.
For instance, if I say a fetus weighs 500 gm, it does not tell us whether the fetus in growing appropriately or not. But if I say the fetus weighs 500 gm at 20 weeks, I know the fetus is growing well and if the fetus is only 500 gm at 28 weeks, I can conﬁdently make a diagnosis of growth restriction. So, the weight in correlation with the gestational age is what helps us in making a diagnosis of growth restriction
If the baby is conﬁrmed to be small for the gestational age, there are two possibilities; one being the baby is small, but normal. These are babies that do not put on weight in spite of being well nourished, also called in medical parlance as constitutionally small and the other baby that is small because of some pathology. This pathology could be a genetic abnormality, structural malformation, maternal infection or poor nutritional supply from the mother to the fetus.
Growth of a fetus can only be assessed if the gestational age of the fetus is known. So, the ﬁrst step should be to make sure that the fetus has a dating scan or an early ﬁrst trimester scan which accurately dates the pregnancy.
In order to ﬁnd out the cause of fetal smallness, a detailed targeted USG needs to be done which focuses not only on structural malformation but also signs/marks that point towards genetic abnormalities. If the scan is normal, then a Doppler assessment of the blood supply to the fetus is done to ascertain if the growth restriction is primarily due to decreased nutritional supply from the mother to the fetus. The management of a small fetus depends on the cause of growth restriction.
However, if all the tests mentioned above are normal, then a serial assessment of growth is done at three weekly intervals to check the growth rate/ velocity of the fetus. If the growth rate is normal it would then be reasonable to assure that the fetus is constitutionally small The distinction is important as the latter has an excellent outcome.
So, the question that a mother should really ask is not “is my baby small?” but “is my baby growing well?” and therein lies the role of a fetomatemal specialist.
NIDCAP – FOR HEALTH AND WELLBEING OF INFANTS
By Dr. Riyas P K
Edappal Hospital is in the forefront of neonatal care, using NIDCAP. Neonatal care has rapidly progressed in the last few decades in India and Edappal Hospital was among the ﬁrst few to start Level-3 intensive care in Kerala. With state of the art facilities including ventilators, CPAP machines, ABG analyser,
Phototherapy units, C02 monitors and bilirubinometers along with other regular equipment besides a committed team, we are able to provide total care to our patients. We are also blessed with the opportunity to care those from the “birth of a solution” at CIMAR.
NIDCAP: INTEGRATING NURSERY WITH FAMILY TO NURTURE INFANTS
New-born Individualized Developmental Care and Assessment Program (NIDCAP) is a Nursery Certiﬁcation Program (NNCP) under the auspices of the NIDCAP Federation International (NFI). It recognizes the excellence of a hospital nursery’s commitment to and the integration of principles of NIDCAP for infants, families, and the staff. Nurseries provide a dynamic environment for the full integration of expert medical and nursing care, securely embedded within the active pursuit of mutual respect, caring, nurturance of infants in collaboration with families.
Advances in perinatal and intensive care have greatly decreased the mortality rates for preterm, and survival of babies at high risk for developmental compromise. The challenge confronting healthcare professionals, who care for these infants and their families, is not only to assure the infants’ survival, but to optimize their developmental course and outcome. The scenario has shifted from survival to intact survival. The concept of NIDCAP pioneered a way to read infant behavior so that we may hear their voice and understand them.This practice has taught us what the infant expects for comfort, well-being and a sense of security – so vital for their healthy development.
NIDCAP Improves Infant’s health and quality of life
Exchanging the womb for the NICU environment at a time of rapid brain growth compromises preterm infants’ early development, leading to long-term physical and mental health problems and developmental disabilities. NIDCAP aims to prevent the iatrogenic sequelae of intensive care and to maintain the intimate connection between a parent and an infant, one expression of which is
Kangaroo Mother Care. NIDCAP embeds the infant in the natural parent niche, avoids over – stimulation, stress, pain, and isolation while it supports self-regulation, competence, and goal orientation. Research demonstrates that NIDCAP improves brain development, functional competence, health, and life quality. It is cost effective, humane and ethical, and promises to become the standard for all NICU care.
The biological expectation of the fetal infants is for continual sensory and kinaesthetic input from the amniotic ﬂuid and the reactive amniotic sac. Such input influences not only motor system development, but also the development of all other systems engaged in feedback loops with the continually differentiating motor system. Fetal infants, moreover, expect maternal diurnal nutritional sleep-wake-activity and hormonal rhythms, which among other things regulate states of consciousness and their differentiation. They expect muted inputs to senses, all inevitably changed by the disruption of preterm delivery.
The truncation of the parents’ emotional and physical preparation of a full-term pregnancy further adds to the challenge for preterm infants and their parents. Even in medically low-risk preterm infants, these challenges lead to an increase in later developmental difﬁculties, which include speciﬁc learning disabilities, lowered intelligence quotients, disorders of executive function and attention, lowered thresholds to fatigue, as well as a high incidence of visual motor impairments, spatial processing disturbances, language comprehension and speech problems, emotional vulnerabilities, and difﬁculties with self-regulation and self-esteem.
CORE MEASURES IN IMPLEMENTING NIDCAP
1. Protected sleep
2. Pain and stress assessment, and management
3. Activities of daily living (positioning, feeding and skin care)
4. Family-centred care
5. A healing environment
The goal is to provide a structured care environment which supports, encourages and guides the developmental organization of the premature and/or critically ill infant. Developmental care recognizes the physical, psychological and emotional vulnerabilities of premature and/or critically ill infants and their families, and is focused on minimizing potential short and long-term complications associated with the hospital experience.
Based on the premise that infant behaviors are a means of communication, healthcare professionals are encouraged to examine infant responses to the environment systematically and adjust their care giving activities when signs of stress were observed.
Core measure 1
Protected sleep is the most important core measure because it highlights the importance of behavioral state; which is the foundation for all human activities. Only when an individual is physically, behaviorally and emotionally prepared for interaction, can care giving activities occur without deleterious effects. The corresponding criteria includes speciﬁc interventions that promote sleep as well as educate families about the importance of sleep in the hospital and at home post the discharge.
Core measure 2
PAIN AND STRESS ASSESSMENT, AND MANAGEMENT
Attributes and corresponding criteria speciﬁc to pain and/or stress assessment and management of these:
(a) Routine assessment and documentation of pain and stress with an established pain/stress tool
(b) Management of pain and stress before, during, and following all painful procedures with subsequent documentation of interventions and a return of the infant’s pain scores to pre-procedural baseline. Involvement in and sharing of a pain and stress management care plan with parents.
Core measure 3
DEVELOPMENTAL ACTIVITIES OF DAILY LIVING: POSITIONING. FEEDING AND SKIN CARE
The attributes and criteria for positioning includes a commitment to ensure proper postural support throughout the infant’s hospital stay, documentation and role modelling of appropriate positioning practices to parents and colleagues. Distinct attributes and criteria for feeding focus on the appropriate use of non-nutritive sucking, employing infant feeding cues as a measure of infant feeding readiness and parental education and support of breastfeeding and the use of breast milk.
Finally, attributes and corresponding criteria speciﬁc to skin care highlight the importance of accurate assessment and documentation of skin integrity and practices which protect the vulnerable skin.
Core measure 4
The family-centered care’s core measure incorporates the tenets of the Institute for Family-Centered Care and recognizes that families must have:
(a) Unrestricted access to their infant
(b) Assessment of their emotional and physical well-being and their evolving competence and conﬁdence in parenting their infant. Access to resources and supports that assist them in their short and long term parenting needs.
Core measure 5
THE HEALING ENVIRONMENT
The attributes speciﬁc to the healing environment encompass the physical, human and organizational elements requisite for a safe and healing hospital experience.
The criteria include the measurement and maintenance of recommended light and sound levels and assurance of physical and auditory privacy for families, promotion of effective communication, collaboration, and caring behaviors among the healthcare team and documentation of evidence-based policies, procedures and resources to sustain the healing environment overtime.
Care interventions to reduce noise
Education of staff and parents about the effects of sound and need for calmness (within limits of medical needs) and use the following information posters.
- Regular audit of unit noise levels — different times of day, ward rounds and handovers, feedback to Staff/ Parents.
- Close incubator doors softly
- Avoid placing objects on top of incubator
- Silence alarms as soon as practicable
- Set alarms and phones at lowest safe level
- No radios in unit (age appropriate musical toys may be individually appropriate for post term infants)
- Consider ear muffs during excessively noisy procedures such as MRIs
- Recommended sound levels support early Parent/ infant interaction
- Babies have opportunities for exposure to their parent’s voices
- Noise disrupts sleep which is essential for growth and development
- High noise levels can be stressful for infants, parents and staff
- Threshold for cochlear damage in adults is 80 db; immature cochlear is more sensitive
- Hearing well developed by around 27weeks gestation
LIGHT AND VISION – CARE INTERVENTIONS
- Protect infants from light with levels below 25 lux until 32/34 weeks Corrected GestationalAge (CGA) (use incubator cover or canopy with open cot). Also, provide shading for older unstable infants
- From 32 weeks CGA, start introducing moderate light exposure – 2 hrs per day – canopy or incubator cover reduced, while still shielding baby from bright overhead lights or sunlight
- Gradually build up to ‘cycled lighting’ which reflects day/night lighting when infant is approaching term (35 — 37 weeks CGA)
- Protect infants from focused lighting during medical procedures/examinations; could use eye mask or carer’s hand
- Remember to consider the effect of increased lighting levels on infants in nearby cots
- Vision – avoid placing strongly contrasting images in infants view before term
- Vision – Demonstrate to parents how infants may begin to follow the outline of their face from around 33/34 weeks
SMELL AND TASTE – CARE INTERVENTIONS
- Encourage the parent (mothers in particular) to leave a muslin cloth, or small piece of clothing with their odour next to their baby. Mother can place cloth near her breasts whilst expressing to obtain her odour. The mother will also be able to experience her babies odour which will support her when expressing milk.
- Babies will experience their parents’ odour through regular skin to skin contact where possible, use expressed breast milk for mouth care.
- Educate staff and parents about the need to avoid introducing noxious smell when handling infants; strong perfumes, cigarette smoke, etc.
- Allow alcohol gel to ‘dry’ before handling babies.
CUE BASED HANDLING – CARE INTERVENTIONS
- Before any intervention, consider and prepare environmental needs; lighting/noise etc.
- Parent participation – encourage and involve parents form early on and with guidance, they will begin to recognise their baby’s behavioural patterns, and may then help provide consistency and knowledge of what their baby responds to dislikes.
- Observe the infant sleep state, physiological stability and cues.
- Positive Touch – gently let infant know whenever an intervention is about to happen, and then, when you have ﬁnished.
- Infant massage is not recommended while babies are premature, but can be used post term.
- Support and teach parents ‘Positive Touch’ and ‘Comfort holding’ from the beginning; learn from observing staff until they feel conﬁdent themselves.
- Move and turn infants slowly, keeping part of their trunk in contact with the mattress or base of support. Avoid ‘ﬂip turning’ as this will stimulate a startle reﬂex and extensor postures.
- Pace care giving according to an infant’s cues – pausing helping infants to settle when they show signs of stress/avoidance.
POSITIONING – CARE INTERVENTIONS
- Promote ﬂexed symmetrical postures by encouraging:
- Shoulders forward with hands to their face, avoiding the shoulders ‘back’, retracted position.
- Hips to the midline with their feet tucked well into the nest or other support; avoiding the ‘valgus‘, everted (turned out) posture widely abducted hips. Feet together.
- Head and neck should be in line, avoiding hyperextension and excessive rotation; neck rolls are not recommended unless indicated medically for an individual infant.
- Trunk should be in mid ﬂexion – avoiding extended postures.
- Gel cushions should be used for all infants until they have developed enough head control to maintain their head in the midline in supine without support.
- Time in KC position – Parents should be encouraged and supported to have their baby in KC ideally for a minimum of 60 minutes each time, to achieve the maximum beneﬁts. This will need to be reduced when an infant shows signs of instability, distress or the parent wishes to discontinue KC.
- Parents will be provided with information explaining the beneﬁts, preparation for and delivery of KC – they also need to consider their own comfort as will be in KC position for over an hour; therefore, be advised to wear comfortable clothes and have a drink to hand.
- KC also needs to be a positive bonding experience for parents.
- All staff will be given training and information regarding KC delivery.
- Recommended for – all medically stable infants, including those receiving respiratory support; staff availability will need to be considered to ensure safe transfer for ventilated infants.
- KC – Should be recorded, time and frequency
- Feeding during KC – continuous and bolus feeds can still be given during KC; the feed may need to be given by a nurse or second Parent depending on individual unit policy.
Developmentally supportive measures during stressful/painful care interventions
- Discuss with parents. Ask what they have observed helps their baby most eg. supportive holding, grasping ﬁnger, gently talking to. This is more relevant with long term babies, as over time they learn to read their babies cues and responses.
- Timing – when is best time for the infant? – Always considering medical need. Try to ﬁt in with infant‘s sleep pattern.
- Environmental – minimise infant’s exposure to bright light, reduce noise levels. If high light is needed, protect infant from this.
- Comfort – provide nesting and support in ﬂexed posture
- Offer and facilitate infant sucking (N NS) – prior to during and following intervention. This can also be combined with Sucrose or EBM.
- Use Positive Touch – preparation and support of infants during procedures – teach Parents from earliest possible opportunity and then involve their help whenever possible and/or appropriate.
- Facilitate baby to self-comfort-hands to face/grasping/able to brace feet.
- Assess infant’s behaviour/stability/ posture prior and on completion of procedure or care.
- Pace intervention in response to infants responses and stability.
To conclude, this practice has taught us what the infant expects for comfort, wellbeing and a sense of security so vital to healthy development and should become standard of care in all new-born care centres.
ONLINE CALCULATORS TO PREDICT YOUR CHANCE OF HAVING A BABY USING IVF
Source: Huffington Post
If you’re wondering – and hoping – your future might include babies and you’ve been thinking it might be time to talk about in vitro fertilization (IVF), at least two online tools can help assess your individual chances of getting pregnant with treatment. The reasons for infertility vary widely and it can sometimes be difficult to estimate chances of pregnancy, especially before the ﬁrst cycle which provides information about the quality of eggs, sperm, and embryos.
Both patient predictor tools – one released in the US and one just launched in the UK are designed to provide additional information to couples considering IVF treatment, along with consulting a fertility specialist Each uses your unique information on factors known to affect fertility, sophisticated algorithms and extensive databases on the experiences of women who became pregnant using IVF. The resulting estimate can help you understand whether IVF might be an option by predicting a rate of success after each cycle. While both patient calculators are designed to do the same thing, there are differences. The UK tool is the ﬁrst to give estimates for success for up to six cycles – important as multiple cycles are often required to get pregnant The current SART model – used by many doctors – makes estimates for up to three cycles. The UK version also factors in the use of frozen embryos while the current SART model is based on sequential transfer of fresh embryos. The SART predictor does factor in multiple transfer of embryos and the probability of twins and the UK model does not And, the SART version leverages their extensive database of patient infertility treatment and outcomes more than twice the size of the UK version – nearly 500,000 cycles for 320,000 women vs. 189,269 cycles for 115,000 women.
IVF NEWS FROM AROUND THE WORLD
COUPLE’S PREGNANCY ANNOUNCEMENT WITH 452 IVF NEEDLES GOES VIRAL
A Texas couple’s pregnancy announcement after a long struggle with fertility issues featured their 452 IVF needles and two onesies for their coming twins. Lauren Walker, 28, announced in a Facebook post, which has since gone viral. that she and her high school sweetheart Garyt, are expecting twins after years of trying and hundreds of in-vitro fertilization treatments. Walker’s pregnancy announcement photo features her 452 IVF needles arranged in a circle around two onesies that together read “Worth the wait… and wait and wait and wait.
“We prayed for 953 days…452 Needles, 1000’s of tears, 1 corrective surgery, 4 clomid/letrozole attempts, 2 IVF rounds, 3 failed transfers and &1 Amazing GOD,II Walker wrote. “When we started, we knew off the bat that I was having issues, II Walker told ABC News, “which I guess is a blessing.” The couple said supporting each other during the process of trying to get pregnant was of the utmost importance.
COUPLE IN 50s CONCEIVES THROUGH IVF
Jagraon residents Rajveer Singh , 50 and Gurpreet Kaur, 49 were ﬁnally able to conceive after 28 years of their marriage. This was an uphill struggle for the couple who did not have a child for years because of medical reasons. After two unsuccessful attempts of IVF, the couple ﬁnally conceived after treatment from a private hospital in Ludhiana and delivered a healthy baby boy. “IVF proved to be a boon for us as after 28 long years of infertility and many unsuccessful IVF attempts we were blessed with a child,‘I said Rajveer Singh and Gurpreet Kaur. They said they had lost hope after many failed attempts of conceiving a child. Dr Vijaydeep Kaur, gynaecologist and infertility specialist at a private hospital said, “After meticulous investigation, the couple was taken for IVF. The very ﬁrst attempt proved to be successful. The pregnancy was closely monitored because of the increased risk of complications owing to the complainant’s age.
3-PERSON IVF – WHAT DOES IT MEAN?
The Human Fertilization and Embryology Authority (H FEA) approved the use of a new medical technique, known as mitochondrial donation, at UK fertility clinics. This means people at high risk of conceiving a baby with certain life threatening genetic conditions can have the chance to conceive a healthy, genetically related child.
This technique is encompassed in a range of techniques often referred to as 3-Person IVF. UK licensed fertility clinics can now apply to the HFEA for permission to offer this on a case-by-case basis to fertility patients.
This new technique works by transferring the nucleus of an affected woman’s egg (or nucleus of a fertilized embryo) into the shell of another woman’s egg or embryo (having ﬁrst removed the nucleus). This technique creates an embryo from the genetic material of three people.
HFEA’S decision to approve use of mitochondrial donation came after an independent scientiﬁc panel published its fourth set of ﬁndings on the technique’s safety and efficacy.
These ﬁndings recommended this new 3-Person IVF technique could be used cautiously in certain cases.
IS JANET JACKSON’S IVF SUCCESS STORY TYPICAL?
Source: Huffington Post
Janet Jackson just had her ﬁrst baby. At the age of 50. She used donor eggs, and had an “easy pregnancy and delivery.” While it may be an encouraging message to some couples facing the challenges of infertility, it may be equally frustrating to hear about yet another successful IVF process if their own attempts have been unsuccessful Open up almost any magazine, website or video, and you’re likely to hear a story about the struggles couples have with infertility and the measures they take to have a baby of their own. As a mother of four, I was lucky enough to be able to conceive easily and naturally, and it is only through speaking with friends and colleagues that I understand the challenges many couples face in trying to have a family.
CIMAR HOSTS SEMESTER AT SEA
Primary agenda was to understand the medical ethics involved in medical tourism, abortion and surrogacy.
K erala’s leading infertility centre, CIMAR hosted students from Semester at Sea (SAS) – a study abroad program founded in 1963, now managed by the Institute for Shipboard Education in Fort Collins, CO, USA.
During the visit, CIMAR hosted a group of over 30 undergraduate students, learning Medical Ethics at its Kochi facility along with their professor Dr Mary Ann Cutter.
Dr Parasuram, Consultant and Scientiﬁc Director of CIMAR had an in-depth discussion over how India has become one of the most sought after countries for Medical Tourism in the world and the reasons have grown beyond Ayurveda. “The biggest advantage is our ability to have world class doctors with all the latest equipment at signiﬁcantly lower costs. Statistics show that there is a saving ofabout 60-90% in the treatment cost including travel and accommodation while comparing to the cost in countries like the US. Another major advantage is to have access to specialist/super specialist, without too much of waiting time, said Dr Parasuram.
There has been a discussion on the similarities of laws for Abortion in the US and India, only in its time frame. In the US, the decision to have an abortion sole fully lies with freedom of choice of the mother where as in India, it needs to be certiﬁed by the doctor and has to have a deﬁnite indication as per the guidelines to seek an abortion. Because of this, there has been an increase innumber of illegal abortion centers, leading to septic complications from these centers.
With regards to surrogacy, there was an in- depth discussion on the pros and cons of commercial surrogacy and discussion on the recent change in legislation on surrogacy. Statistics showed that 80% of surrogacy treatment in India was done for foreigners and of that, 60% was gay couples which amounted to a large number of unnecessary surrogacy. The government of India has, in a recent notiﬁcation, banned all types of surrogacy for foreigners, NRIs and FIGS. This has itself brought down the number of unnecessary surrogacy to a large extent.
With the introduction of the Surrogacy Bill which has been cleared by the Cabinet and due to be presented in the Parliament, the government has banned all types of commercial surrogacy while allowing altruistic surrogacy (where you cannot pay the surrogate except for the medical expenses). This has brought about a mixed reaction among the fraternity where in some people believe that it will abolish unnecessary surrogacy.
But the contrary group does feel that it will take away the chance of several couples to have their own child, whose only option was to have surrogacy treatment. The main motivation for mothers to act as surrogates was ﬁnancial gains and major group of the surrogates were from lower strata of the society. So by introducing only altruistic surrogacy the possibility of several deserving couples to opt for that treatment is lost.
In the US, there are mixed types of laws where in certain states permit only altruistic and others permit both commercial and altruistic surrogacy. In case of commercial, the cost would be signiﬁcantly high (over 70,000 USD where the same option was available earlier in India for less than 25,000 USD).
There was also a concern raised by the students about the possibility of a parallel illegal market for surrogacy, once the new Surrogacy Act has been passed, which will have a potentially negative impact on the society.
WORLD’S LEADING MIDWIFE VISITS CIMAR
”Heather Bower was quite impressed with our facility and did have a very informative discussion with our team from gynecologists to birth nurses. Indeed, she stressed on the requirement of such centers to promote natural births in India”
Bower with Dr. Parasuram Gopinath
Heather Bower is the Lead Midwife for Education in the Department of Family Care & Mental Health at the University of Greenwich. She has been a midwifery lecturer for 15 years, and lead midwife for education for another university 10 years before joining the university of Greenwich in 2014, in her current role.
Bower visited CIMAR – Kerala’s leading birthing centre – to understand the way India handles birthing.
“It was indeed a great moment when Bower contacted us and expressed her interest to visit our center and the joy only seemed to have increased knowing her credentials. We did talk about the various scenarios affecting maternal and child health in India and the UK. It was interesting to know that still 70 – 80% of the deliveries that happen in the UK are still conducted by midwifes and do not see the doctors at all, said Dr. Parasuram Gopinath.
It is only the patients with some element of risk or the possibility of risk that are referred to a Gynecologist.
To improve the success and safety aspect of natural birth currently the natural births are conducted in community centers which are in very close proximity to the hospital. This will enable them to shift the patient to the hospital in case of an emergency. Another factor contributing to the success of the natural birth centers are the availability of highly trained and quick Emergency services that can transfer the patient to the hospital in no time. Even the incidence of home births in the UK has come down to below 5%.
Where as in India with the limitations of a similar emergency services and qualiﬁed midwives there is still a lot of stigma and risk associated with a natural birth center. In a state like Kerala where the literacy levels are very high there has been an increase in demand for such centers. But unfortunate instances like the one that happened in natural birth at Kottakkal do bring in a lot apprehension and fear in the people who seek these facilities.
In an instance during the recent past where a junior superstar‘s wife had to be shifted to a multispecialty hospital and ultimately having to undergo a caesarean section after hours of pain and perineal injury trying to go for a natural birth in such a center.
It is very important for people who desire these methods to actually understand the availability of a hospital and the emergency services near that center. It is with great caution that we should try and replicate what we learn from the west without understanding our limitations. There are very few hospitals like us who try and incorporate these facilities together where in the birth center is associated next to the hospital where there is a 24 hour emergency backup in case of emergency.