Fertility NEWS LETTER

Ideal fertility : ICSI / IVF & Genetic Center India

Dear Colleges
Hello

Nice to interact with you once again.

I had been to the conference of Indian Society of assisted Reproduction 2007 at Chandigarh. The place and the venue was excellent. The presentations were very good. It is a national conference of reproductive medicine and held once in a year. It is my strong wish that we all ISAR members make it more successful and academic by reducing the number of other conference which takes place through out the year by ISAR members themselves.

In all conferences we have lectures and presentations, but the interactive time is very short or not at all when lectures go long. If the interaction time is given more then participants will be more benefited and they will be more involved in the gatherings.

It is my own view and if you have something different in mind then please write me .

I want to make this news letter more doctor friendly and interactive.

With best wishes for Holi

Sincerely yours
Dr. D’Pankar Banerji

Analogy between the Testis and the Ovary

If we as a gynecologist wish to treat male infertility ,then it will be very easy if we correlate the testicular function with ovary (which we better understand).here are few facts which I feel will be relevant.

1. Both are developed from the the gonadal ridge that is mesoderm and covered by mesothelium .
2. Germ cells migrate from the yolk sac and they rest in the gonads .
3. There are three types of cells in both: Surface epithelium,Stromal tissue and The Germ cells ( we classify their tumors according to this cell lineage…!)
4. Fate of surface epithelium : they surround the germ cells.In ovary they form granules cells and in Testis they form sertoli cells.
5. Stromal cells in the ovary are called theca cells and in testis they are Leydig cells.
6. We can apply two cell two gonadotropin theory in both.
7. LH acts on theca in Ovary and on Leydig cells in Testis.
8. FSH acts on granules cells in Ovary and on Sertoli cells in Testis.
9. LH converts cholesterol to androgens in both. In ovary it cholesterol is converted to androstenedione ( less potent male hormone ) and in Testes it converts to testosterone.
10. In both ,the male hormones are directed towards Germ cells.
11. In ovaries the male hormone is aromatized by FSH by granulose cells to female hormone that is estradiol. Good eggs ( germ cells) can only grow in presence of good amount of estrogen.
12. In testes the testosterone is trapped by Sertoli cells by a protein called Androgen Binding protein hence the amount of male hormone is high around spermatogonia ( germ cells ).Good spermatogenesis can only takes place in high amount of testosterone ,may be 50-100 times than systemic levels. Some of them also covert in more potent male hormone that is dihydro testostosterone.

HSG : Can it be little less painful ?

Hystero-salpingo-graphy is procedure which is still one of he first investigation to find out the cause of infertility in a couple, and still remains the most effective non invasive way to see the tubes and the uterus. But most of my patients who has undergone this test had an harrowing experience and they are averse to any other fertility investigations.

Can you imagine the pain the lady feels who is without any anesthesia ,when we hold her cervix and try to screw the HSG cannula in her cervix and apply a counter traction while injecting the dye and taking films. And if fluoroscopy is not available then physician waits for the first film and if it is ok ,proceeds for the next.!!!!!! While putting counter traction and pulling the uterus down ,we disturb the natural anatomy of the uterus and the tubes too.

Can we make it more simple and less pain full. Injection diclofenac 3 cc i/m given by the staff atleast two hours before. Inj.buscopan i/m or i/v can be given along with diclofenac. Patient in lithotomy position. Parts are painted and draped. Sims speculum exposes the cervix and it is held by minimum grip with tinaculum .

A 10 no. Foley catheter is guided into the cervix and bulb is inflated by 1.5 –2.0 ml saline .As both the os are competent in nulligravida ,it fits in to the cervical canal. Remove the tinaculum. Put a clamp on the Foley catheter and inject the dye with a 10 ml syringe .As there is no traction on the cervix patient remains comfortable and as many films can be taken. If tubes are not open and we put little more pressure while injecting the bulb slips out, indicates some filling defects in the tubes. Uterus is well visualized in its natural position and any deviation from the midline (may be due to adhesions ) can be shown in the films.

Only problem is : some times the catheter slips out because of cervical mucus and we have to reinsert it. In gravid patients or where the external os is not tight to hold the bulb ,the catheter can be pushed into the uterine cavity and bulb filled with least amount of saline to get a hold .More inflation will hamper the view of uterus and over distention of the uterine cavity causes pain.

Two triplet conception by conventional IVF – Case Report

Two triplet conception by conventional IVF –Case report Both the patients ,S. V. and S. S. aged 26 and 31yrs respectively were on long protocol and stimulated with urinary FSH and HMG. Oocyte retrieval was done under propophol and conventional IVF was done at our center .Six and 8 embryos were formed respectively. Three good quality embryos were transferred on day 3 .Rest of the embryos were frozen. Urine pregnancy test was done after 15 days of embryo transfer and found positive .USG done after one week to confirm the pregnancy and their numbers . In both the case all three embryos implanted . Fetal heart was identified in all the three sacs in both patients.

But in S. V. two embryos died spontaneously even after showing heart beats (natural reduction ) other embryos is doing well at the time of reporting.

S. S. is taken for embryo reduction and procedure is same as described in our earlier issues (Vol III,issue 9 )

There is still a dilemma over the single embryo transfer and better pregnancy rate by putting more embryos at the cost of multiple pregnancy. We know that with more confidence in lab work and selecting best embryos after long culture of embryos till day 5 ,we will be putting single embryos in the womb and freeze the rest. We already started the strategy to select best blastocyst where embryos are more in numbers and do the single blastocyst transfer

Training in IVF and Embryology

Module I : Ovulation induction and Intra Uterine Insemination ( One day ),Rs.2000
Module II : Conventional IVF and fundamentals of Embryology( Two days ), Rs.20,000
Module III : Intra cytoplasmic sperm injection, Micro manipulation ( Two days ) Rs.50,000
For details contact ,two participants per batch

For sale
Needle guide of GE logiq alfa vaginal probe, available at reasonable cost .
Culture media for sperm preparation ( tested for sperm survival ) available
Call for IUI lab setup at low cost

Dates :
Throughout the year

Accommodation :
Drafts : should be in favor of Dr. D’Pankar Banerji, payable at Jabalpur.

Stay can be arranged in nearby hotels at an extra cost Rs.250-1000 per day
Lunch will be served during the training session.

Faculty :
Dr. D’Pankar Banerji ,Consulting Gynecologist and Infertility specialist
Dr.Mrs.Rinku Banerji,Embryologist

Certificate will be issued after the course to participants

Sale and purchase of the used equipments

This column is created for the friends who wish to purchase and sale their medical equipments and provide an interactive space

Letters to the editor:
I welcome your views and comments in this column and will be published in the forthcoming publications

Dr.Shyamalla ( left ) and Dr.Biswas (right ) with our embryologist Dr.Mrs.Rinku Banerji

Training in IVF and Embryology

Module I : Ovulation induction and Intra Uterine Insemination ( One day ),Rs.2000
Module II : Conventional IVF and fundamentals of Embryology( Two days )Rs.20,000
Module III : Intra cytoplasmic sperm injection, Micro manipulation (Two days )Rs.50,000 For details contact. Two participants per batch