Fertility NEWS LETTER
Fetus day celebrated on 31st OctoberFetus day celebrated on 31st October
Vol VIII Issue 11, Nov 2010
Jabalpur obstetrics and gynecological society dedicates 31st October as Fetus day
With an objective
- To prevent and diagnose genetic disorders by prenatal diagnosis
- Delivery of a healthy child
- Enhancement research and treatment options in fetal medicine
With a motto |
1. HEALTHY FETUS HEALTHY NATION
Genetic diseases, Its diagnosis and prevention may reduce the burden of lots of preventable genetic disorders, like thalassemias and sickle cell disorders. Down syndrome screening is now a routine. Prenatal diagnosis ,a term once considered synonymous with invasive fetal testing and karyotype evaluation, now encompasses pedigree analysis, fetal risk assessment, genetic counseling and fetal diagnostic testing.
Defining fetal status clarifies many perinatal decisions. If fetal conditions is reassuring and the situation is stable, management is confidently conservative, seeking further intrauterine time for maturation. If fetal status is uncertain, management will depend on gestational age : near term ,delivery may be the best option; before then, enhanced surveillance and preparation for delivery is indicated; remote from term, intrauterine therapy might be in order. When fetal compromise is certain, our primary responses are delivery and neonatal management – down to the frontiers of viability. So what we do is determined by what we think of the fetal status.
The availability of high-resolution ultrasound imaging and screening programs has made the : Unborn child a true patient. In some cases , intervention before birth may be desirable, which oftern does not require direct access to fetus-for example ,transplacental administration of pharmacological agents for cardiac arrhythmias or antibiotics in case of fetal infection. Other conditions can be treated only by invasive access to fetus. In utero transfusion of hydropic fetus to treat the anemia of Rh isoimmunisation, first described in1961, was probably the first successful invasive therapeutic procedure. Today blood transfusion through umbilical cord, intrahepatic vein, or (exceptionally) directly into the fetal heart is widely offered, with good fetal and long term outcome when procedures are done by experienced operators. Some conditions are amenable t surgical correction, and in majority of cases this is best done after birth.
To summarize , fetus should be taken as an separate individual ,not an transient appendage to the “would be mother”. A healthy fetus becomes a healthy child and a healthy offspring is a great asset to the society, and a healthy pool of strong child makes the nation strong. In other way we can even go the extent that “ Fetus should be assumed as father of an adult”.
2 . IVM ( invitro maturation ) of oocytes from women with PCOS
PCOS is very hertogenous syndrome, often first diagnosed when the patient presents complaining of infertility; approximately 75 % of these patients suffer infertility due to anovulation. The majority of women with anovulation or oligo ovulation due to PCOS have menstrual irregularities, usually oligo or amenorrhea, associated with clinical and / or biochemical evidence of hyper androgenism. In almost all these patients, ultrasonic scan of the ovaries typically reveals numerous antral follicles. Fertility tre atments for women with PCOS include lifestyle management, administration of insuli sensitizing agents, laparoscopic ovarian drilling, ovulation induction, and IVF. This group of patients has an icreased risk of severe ovarian hyperstimulation syndrome ( OHSS) from gonadotropin stimulation compared with women who have normal ovaries. The risk of multiple follicle ovulation and subsequent multiple pregnancies is also of crucial importance. However , the high number of antral follicles in patients with PCO makes them prime candidates for IVM treatment,even if the appearance of PCO in the scan is mnot associated with an vularion disorder. Indeed , the main determinant cinically of success rates of IVM treatment is antral follicle count.when hCG priming is used before oocytes tretival, it has bben found that immature oocytes retrieved form normal ovaries , PCO , or women with OCOS have a similarly high maturation , fertilization, and cleavage potential. However , although the implantation rate was lower, the live birth rate was singnificanatly lower in IVM group. These results suggested that IVM is a promising alternative to conventional IVF treatment for women with PCO or a high antral follicle count who require assisted conception.
3. Coventional IVF in natural cycle
A women aged 34 yrs undergone ovarian stimulation for IVF with flare protocol. She developed only 3 good follicle and only 3 eggs retrieved. They were put in conventional IVF and only one embryo formed and day 3 transfer of a fragmented embryo done, resulted in no pregnancy.
As there were only 3 follicle, we did the AMH and it was 1.2 ( lesser than normal lower limit).
We discussed about egg donation but the couple refused and accepted another attempt with higher amount of gonadotropins after 2 -3 months.
In between, she had her periods and came to us on day 8 of cycle for further discussion. I did an ultrasound to see the ovaries and the endometrial lining.
There were two follicle on of 12 mm and other was 11 mm. and endometrial thickness was 6 mm.
I convinced her for natural cycle IVF with a very lesser cost (US $ 300). I tracked the follicle and put one HMG150 on day 9 and Gn Rh antagonist on day 10. On day 11 there was only one follicle and it was 16 mm. Inj hCG 10,000 IU given in midnight. Egg collection was done after 36 hours.
We retrieved one single egg with good quality. After 3 hours of maturation, it was inseminated with conventional IVF.
It fertilized and on day 1 there was a good quality PN.
On day 3 single good quality 8 cell embryo with confluent margins transferred atramatically.
Luteal support was given as usual with vaginal progesterone.
After 14 days of embryo transfer, a urine pregnancy test was done and it came positive.
There is literature that when ovarian stimulation fails then a natural cycle some time gives better egg and embryo
Archives |
- Vol VIII, Issue 11, Nov 2010
- Vol VIII, issue 6, June,2010
- Vol VIII,issue 5, May 2010
- Vol VIII,issue 4, April 2010
- Vol VIII Issue 3, March 2010
- Vol VIII, Issue 1,Jan 2010
- Vol VII, Issue 12,Dec.2009
- Vol VII, Issue 11,Nov.2009
- Vol VII, Issue 10,Oct.2009
- Vol VII, Issue 9, Sep.2009
- Vol VII, Issue 8, Aug 2009
- Vol VII, Issue 7,July 2009
- Vol VII, Issue 6,June 2009
- Vol VII Issue 4 april 2009
- Vol VI, Issue 9, Sep 2008
- Vol Vi Issue 8, aug 2008
- Vol Vi Issue 7, july 2008
- Vol VI, Issue 6, June 2008
- Vol V, Issue 17, may 2008
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- Vol IV, Issue 16, April 2008
- Vol III, Issue 15, March 2008
- Vol I & II, Issue 13-14, Jan Feb 2008
- Vol IV, Issue 12, December 2007
- Vol IV, Issue 11, November 2007
- Vol IV, Issue 10, October 2007
- Vol IV, Issue 9, September 2007
- Vol IV, Issue 8, August 2007
- Vol IV, Issue 7, July 2007
- Vol IV, Issue 6, June 2007
- Vol IV, Issue 5, May 2007
- Vol IV, Issue 4, April 2007
- Vol IV, Issue 3, March 2007
- Vol IV, Issue 2, FEB_2007
- Vol IV, Issue1, Jan 2007
- Vol III, Issue 9, Nov Dec 2006
- Vol II, issue7, July 2005
- Vol II, Issue4 April 2005
- Vol II, Issue3, March 2005
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