Fertility NEWS LETTER

Ideal fertility : ICSI / IVF & Genetic Center India

Vol IV, Issue 1, Jan 2007

In This issue

  1. Ovulation induction and ovarian stimulation
  2. Prenatal diagnosis of thalassemia .. a case report
  3. Training in IVF and Embryology

Dear Colleges
Hello

I wish you all a very happy and prosperous New Year.

Hope this letter finds you in good spirit and health and I wish all a very happy and prosperous new year. As we decided we are putting our next write-up on ovulation. I am very thankful to our fellow doctors who have given a good feedback to our news letter and opted to contribute their experiences and cases with us. We did a prenatal diagnosis of a thalassemia case and put it as a case report. We as a obstetrician should think about the correct diagnosis of anemia in females of reproductive age .There are lots of females who are carriers of thalassemia and sickle cell anemia who are not helped by any treatment and there are great chances of delivering thalassemia major or sickle cell disease child.

With best wishes

I remain ,sincerely yours
Dr. D’Pankar Banerji

1. Ovulation Induction and ovarian stimulation

There is a slight difference between the words, ovulation induction and ovarian stimulation. The earlier one is used when the women dose not ovulate normally and she needs drugs for releasing her eggs, and the later one is, when the lady ovulates regularly and we want that she should release more than one eggs in a given cycle.

Who needs ovulation induction?

In our OPD mostly, we get two types of women. One is menstruating regularly ( between 21 to 35 days) and the other is menstruating away from this time interval.( we are not discussing amennorrhea)

If a women is having painful regular menses it means she releases her eggs regularly. She does not need follicular study to prove ovulation. But if we treat her to make her release more than one eggs then there are ample chances that we might iatrogenically disturb her menstrual clock. ( we will discuss it later )

Now if the lady in OPD is not menstruating regularly then there might be few varieties . One, who menstruates but the interval is 2 months or three months. Second ,might bleed only when she takes medicines ( hormones ) and the third may be one who was menstruating regularly and now missing her periods.

Here we should find out why she is not releasing her eggs regularly? Because, if she does not release her eggs then pregnancy will be difficult.

Most commonly, there are three reasons ,either raised male hormone or raised prolactin or egg reserve is diminishing (approaching menopause, mature or premature) Increased body weight and signs of androgen dominance (hair growth in those areas where male has) will be evident by the look of the patient.

Problem appears when patient’s weight is normal and she does not look hirsute. A transvaginal sonography of the ovaries gives a fare assessment. Multiple follicles in periphery of the ovary ,and with large ovaries predicts increased androgen (Poly cystic Ovary,PCO), but small follicles in normal sized ovaries and spread through out the ovary, patient may be hyper prolactinimic and a ovary with small volume and reduced visible follicles shows reduced reserve. Higher level of hypothyroidism may act through raising prolactin.

Here a hormonal profile like FSH, LH, TSH and Prolactin may help us to reach the diagnosis of anovulation.

Raised LH and normal FSH with PCO like ovaries on ultrasound shows increased androgen. Raised prolactin and raised TSH makes appropriate diagnosis and treatment with prolactin reducing drugs (bromocriptine or cabergoline) helps in earlier one and Tab Eltroxin in later. Raised FSH and/or LH denotes reduced reserve Induction of ovulation in PCOS consists different approaches from clomiphene to gonadotrophins and/or ovarian drilling with weight reduction. They will be discussed in further issues.

2. Prenatal diagnosis of thalassemia .. a case report

Mrs. N. Wife of Mr. J. aged 28yrs,muslim, came to us with amennorrhea of 20 weeks . Obstetric history shows, she had two full term pregnancies. The first one was a girl child with beta thalassemia major and died at the age of 7 yrs after bone marrow transplantation, two yrs.back. Second child is alive male with thalassemia minor and healthy at present, six yrs old.

She was referred to us by a pediatrician who treats their children, for prenatal diagnosis of the present pregnancy for thalassemia diagnosis. Both the parents are obviously thalassemia minor and are carriers of the disease. They were ready for termination of the pregnancy if the present one comes out to be a thal. Major.

On history of their marriage they were found to be cousins. And there was consanguinity. The pedigree is given below.

We did the ultrasound and found that the fetus is of 19 weeks and healthy. After explaining all the consequences we did ultrasound guided amniocentesis and 20 ml of amniotic fluid was recovered .Post procedure ultrasound shows that fetus was unharmed. Amniotic cells were recovered after centrifugation.

DNA analysis of the parents shows that they are carrying a mutation of beta globin gene and both the parents are carrying same type of mutation.

On analysis of the amniotic cells ,beta chain of the fetus shows that the baby is also carrying the mutation in one chain. The other chain shows to be normal. (Heterozygous, a carrier) The result is : Fetus is a carrier and have a good chance of survival. The mutation identified was : COD-16-C, a rare variety

Conclusion : Present case report shows that prenatal diagnosis of beta thalassemia, a deadly disease, can be done in early pregnancy, and early termination of the diseased fetus helps the couple. Proper implication of the prenatal diagnosis and carrier identification can help us to eradicate this dangerous disease, like what have been achieved in Cyprus.

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

Dates :
Throughout the year

Charges :
Module I : Rs.2000.00
Module II : Rs.20,000.00
Module III : Rs. 50,000.00

For Module I and II Rs.20,000
For all the three modules/Module II and III : Rs.55,000.00

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

Maximum candidates will be five for Module II and Module III
Certificate will be issued after the course to participants

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