Fertility NEWS LETTER

Ideal fertility : ICSI / IVF & Genetic Center India

Vol IV Issue 10, October 2007

In This issue

  1. Fetal condition in relation to uterine contraction at labor
  2. Genetics of Hydatidiform mole
  3. Training in IVF and Embryology

In Previous Issue

  1. Chromosomes : The basic knowledge
  2. Gene and Diseases

Dear Colleges
Hello

This month I had been to a conference at Montreal on In-vitro maturation of oocyte and annual conference of International Society of IVF( Sep.16-19 2007). But somehow I found that conference little bit more commercial and I do not feel that it is a good trend. I apologize if I am hurting anybody’s sentiments and it is my personal experience.

  1. An injection of hCG is given 36 hrs prior to retrieval of immature oocytes during the workshop on IVM, and in few patients few shots of gonadotrophins are given. Should we call it a IVM or minimal stimulation IVF.We feel only oocytes before hCG and GV oocytes are grown and matured in lab and fertilized should be called a IVM.
  2. An advocacy/commercial stall were put by the organizers with the exhibitors at the conference site. Patients with malignancy who preserved their eggs and healthy females who cryo preserved their oocytes were brought and advocating the process of organizers’ institution. We feel it is better to put your results in research papers than advocating the process by putting patients in presence of fertility expert delegates. We should keep our dignity slightly higher than the exhibitors.
  3. Lunch was missing , even though mentioned in program schedule, It was surprising. As coffee breaks, written in schedule are followed ,then lunch should have been written “excluded”.
    Getting response from information secretariat was one of the most difficult task we have ever faced.

With Best wishes

Sincerely yours

Dr. D’Pankar Banerji

(Click Archives for Earlier issues)

Fetal condition in relation to uterine contraction at labour

Fetus is person or a passenger who has to pass through a treacherous path ( passage ) at the time of labor. There is force to expel it. Hence we can say that labor is machine and it has three component ,passage ,passenger and force and its output ( a healthy baby with a healthy mother ) can only be assessed when it is put to the test and we can comment on that machine retrospectively(most of the time ).

Fetus is the prime person and we always need that its circulation should be intact all the time. Every uterine contraction with a pressure above 6 kPa ( kilopascals, unit of force ) ,that is usually felt as pain by the delivering woman, produces cessation of blood flow in intervillous placental blood flow .It leads to relative hypoxia to the fetus.

Fetal arterial oxygen(pO2) falls by 0.5 to 0.75 kPa with each contraction and the lowest reaches at the end of contraction.

Fetal oxygen recovery takes 60 to 90 seconds ,to reach normal pO2.

Total duration of fetal hypoxia will be contraction phase ( 60 –70seconds ) plus recovery phase ( 60-90 seconds ), hence it is two to 2.5 minutes .

Any uterine contraction with less than 2.5 to 3.0 minutes interval will cause fetal hypoxia, hence be it normal uterine contraction or induced by oxytocin infusion ,should not exceed three contraction every 10 minutes.

Fetal oxygenation requires oxygen transport across the placenta, oxygen association with fetal hemoglobin and fetal consumption after delivery at the cellular level. All these steps are essential for fetal growth and metabolism. Hypoxemia is defined as a decrease in oxygen content in fetal blood . Hypoxia is a decrease in oxygenation at the cellular level.

Reduction in perfusion for short duration creates respiratory acidosis ( collection of CO2 in circulation) and is not very dangerous .But prolonged reduction in circulation metabolic acidosis and is dangerous.

Asphyxia is defined as hypoxia with metabolic acidosis.

But there is discrepancy: Around 20 % of all newborns exhibit abnormal arterial oxygen pressure (pO2),partial pressure of carbon dioxide (pCO2) and pH value at birth. However majority of these hypoxic and acidotic newborns are vigorous and do not develop abnormalities during the neonatal period.

“Asphyxia needs to be severe or affect a previously compromised fetus before it translates into end-organ damage.” In a common Indian setup, during labor ,the fetus is assessed by intermittent auscultation of the fetal heart ,either by normal stethoscope or fetal Doptone.( It is at par with continuous electronic monitoring with expensive fetal monitors, related to fetal hypoxia and outcome ).

The best way to count the fetal heart rate is , in between the contractions and soon after the contraction. Fetal heart sounds every 6 seconds are multiplied by 10 ,to get the FHR per minute during that 6 seconds. So we can get FHR/min at 6 seconds intervals after the contraction. Dip in the FHR after contraction should recover immediately after contraction and late deceleration can be identified easily with this approach .

Any of the following is dangerous and requires expedited delivery ,preferably by caesarian section.
average rate between contraction os less than 100 beats/min
The rate is less than 100 beats/min .30 seconds after the contraction .
There is an unexplained average rate of more than 160 beats/min between contractions, especially in at risk patients in whom the tachycardia persists through three or more contractions ( 10-15 minutes) despite corrective measures.

Genetics of Hydatidiform mole

Complete hydatidiform mole:

A complete hydatidiform mole is diploid, i.e. the presence of 46 chromosomes, but all chromosomes is of paternal origin. As always in the case of the uniparental origin of one or more chromosomes, this requires at least two sequential errors. The most frequent mechanism of origin is the fertilization of an oocyte without nucleus (or with inactivated nucleus) by a single sperm, followed by duplication of the haploid genome. In the remainder (~20-25 %), an enucleated oocyte is fertilized by two sperms cells. A third possible cause, the fertilization of an empty oocyte by a diploid sperm cell, is extremely rare. How an enucleated oocyte is generated is not clear, but on possible error is a non-disjunction of all chromosomes during meiosis, with all chromosomes ending up in one of the polar bodies. Since 46 YY has never been observed (and thus probably non-viable), cytogenetic investigation usually reveals a 46,XX Karyotype and in a minority a 46 XY Karyotype is found.

This embryo is called androgenotic embryos (both pronuclei are of paternal origin) and they fail to develop an embryoblast whereas the trophoblast proliferates excessively, resulting in a hydatidiform mole. If both the pronuclei are of maternal origin (gynogenotes, equivalent of parthenogenesis), no extra embryonic components are formed and the embryoblast develops into a teratoma

Partial hydatidiform mole:

Partial mole is caused by triploidy, the presence of three copies of each chromosome .The extra haploid set of chromosomes can have either a maternal origin (and then it is called digynic triploidy) or paternal (diandric triploidy).

Diandric triploidy is associated with placental features of partial mole and normal growing fetus where as digynic triploidy is associated with small placenta but the fetus with IUGR and macro cephalic.

These features indicate that both maternal and paternal genes are essential for normal embryonic development. Certain maternal genes are required for development of the embryo proper; where as extra embryonic components depend on the presence of active paternal genes. This is regulated by a process called genomic imprinting, where by certain genes are differently expressed, solely depending on whether they are on the maternal or paternal chromosome.

Extra dose of paternal chromosome creates defect of placenta and extra dose of maternal chromosomes creates fetal anomaly.

Training in IVF and Embryology

Module I : Ovulation induction and Intra Uterine Insemination ( One day )
Module II : Conventional IVF and fundamentals of Embryology( Two days )
Module III : Intra cytoplasmic sperm injection, Micro manipulation ( Two days )

Course Objectives:

The purpose of the course will be to provide an avenue for participants to enter into the field of reproductive biology and an opportunity to gain greater appreciation of the biological processes of mammalian reproduction .At the end of the course, the participants should able to do In-vitro Fertilization of mammalian oocyte.

Course Details :

  1. Basic reproductive endocrinology of male and female
  2. Ovulation induction and controlled ovarian Hyperstimulation .
  3. Sperm preparation methods
  4. Fundamentals of embryology
  5. Meiosis and its genetic aspect
  6. Gametogenesis
  7. The development of Assisted reproduction technology
  8. IVF culture media and techniques
  9. Quality control of embryology lab
  10. Handling and culture of Oocytes
  11. Stereo zoom and inverted microscopy and photomicrography
  12. Setting of the micro manipulators.
  13. Intra cytoplasmic Sperm Injection
  14. Students will have practical hands on experience in this field and supposed to complete their task and submit a project report at the end.
  15. Library and internet facilities will be provided as required.

Course fees :

Module I : Rs.2000.00 ( US$ 50 )
Module II : Rs.20,000.00 ( US$ 500 )
Module III : Rs. 50,000.00 ( US$ 1250 )

For Module I and II Rs.20,000 ( US$ 500 )
For all the three modules/Module II and III : Rs.55,000.00 ( US$ 1375 )

Payments :
Draft : in the name of Dr. D’Pankar Banerji,payable at Jabalpur

Accommodation :
Participants can be provided accommodation in nearby hotels at an extra cost ,Range is Rs.700-3000 per day

Lunch will be served without an extra cost

Timing :
10.00 am to 5.00 pm

ONLY TWO PARTICIPANTS PER BATCH FOR MODULE II AND III

Dates :
Throughout the year.

Course Directors :
Dr. D’Pankar Banerji,IVF specialist and Dr.Mrs.Rinku Banerji,Embryologist and molecular pathologist.

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