Fertility NEWS LETTER

Ideal fertility : ICSI / IVF & Genetic Center India

Vol II, issue 7, July 2005

In This issue

  1. Ovarian Aging
  2. Genetics of Hytidiform mole
  3. Group discussion on ovulation induction and sperm preparation

Dear Colleges
Hello

I had been to Annual meeting ESHRE ( Europian society for Human Reproduction and Embryology ) at Copenhagen ,Denmark.The research papers are mind boggling from routine IVF and ICSI to ovarian transplant.
There was a paper from Marco Filicori regarding the use of microdose of human chorionic gonadotropin in ovulation induction in later part of preovulatory phase along with FSH. He showed in his paper that addition of LH activity in laterpart of the oocyte growth give better eggs and better endometrium and more pregnancies.
I will try to present with the good papers in future issues
Thanks and good wishes to you all

Dr. D’Pankar Banerji

1. Ovarian Aging

Ovarian function/reserve testing is an important part of infertility evaluation. The peak follicle count is achieved by 20 weeks in uteri. From that point on, there is continuous decline in the number of follicles that can be recruited. The rate of follicle loss varies. During ovarian stimulation, the growth of some of those follicles that are initially recruited but otherwise would undergo atresia is maintained. It is important to assess ovarian function before stimulation in order to choose the optimal stimulation protocol and type and dose of gonadotropin. It is equally important to counsel patients about possible outcome. They need to be able to make an informed decision before committing themselves to the treatment process and the financial burden

Recently it has been proposed that subfertility may be the earliest sign of ovarian ageing .It has also been suggested that the interval between menopause and the onset of subfertility is fixed. From data from assisted reproduction, it has been established that women who respond poorly to controlled ovarian hyperstimulation (COH) with gonadortrophins become menopausal earlier and in this respect IVF could be viewed as a dynamic test of ovarian reserve. However, as yet there is no generally accepted definition of low or poor response to COH for IVF.It has been proposed that number of follicles less than five on the day of hCG administration could be regarded as low response.although others suggest that the gonadortrophins dosage should be taken into account and that the definition of poor response in IVF can only be met when the daily dosage of FSH >300 IU per day.

The central issue in ovarian ageing is the decline in the number of follicles. It is assumed that the ovarian follicle cohort available for recruitment by gonadotrophin stimulation for IVF is essentially constant until a certain age. A recent paper reported on the fate of young infertile females (idiopathic infertility), They all had regular cycles with majority of then having FSH level in normal range at the beginning of the cycle. These unexpected poor responders differed form normal controls in number of aspects: Although their basal FSH levels were with in normal range, they had higher median basal FSH concentrations, and significantly lower antral follicle counts. The antral follicle count has been proposed as a reliable predictor for low ovarian response.

2. 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

3. Group discussion

Date : 7.8.2005,Sunday
Time 4pm to 6pm
Venue : class room of Ideal Fertility : IVF/ICSI and Genetic center, Naudra Bridge,Opp Jyoti cinema,Jabalpur

Topics :
1.Controlled ovarian Hyperstimulation in assisted reproduction
2. Sperm preparation methods in assisted reproduction

Registraion : Free
Tour of embryology lab is available to interested participant

Ready made culture media for IUI, freshly prepared on demand, is available, Contact for details at, Ideal Fertility : IVF and Genetic center

We are now started working as Satellite center for IVF and ICSI for few nearby centers in Mahakaushal region of MP (you stimulate the patients we will carryout fertilization and embryo transfer and patient is referred back): for details contact, Ideal Fertility: IVF and Genetic center

Facilities Available at Ideal Fertility : IVF and Genetic Center

1. IVF and ICSI
2. Chromosomal Analysis and Karyotyping
3. Prenatal diagnosis of Beta thalassemia and other genetic disease ( by Chorion biopsy and Amniocentesis)
4. Endoscopic Surgery .Laparoscopic and Hysteroscopic
5. Nonsurgical clearing of fallopian tube
6. Interventional and conventional sonography
7. Embryo and sperm cryofreezing
8. DNA PCR for Tuberculosis

Team At Ideal Fertility : IVF and Genetic Centre

1.Dr.D’Pankar Banerji ,MBBS,MS Gynecologist and Infertility specialist
2.Dr.Mrs.Rinku Banerji, MBBS,DCP ,Pathologist and Embryologist
3.Ms.Usha and Shushma : Nurses

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