Wednesday, 29 May 2013

Lifestyle problems that cause repeated abortion

Lifestyle problems that cause repeated abortion

It is the fact of the matter that probability plays a significant role in the infertility treatment and there are always chances of slippage. In spite of the utmost dedication by me or my team, there are cases where all assumptions fail and there is a painful termination of the pregnancy. I get a lot of patients where the female is suffering from the problem of habitual abortion and the chances of successful full-term pregnancy are limited. I always counsel the couple to make them mentally prepare.

There are a few prominent reasons like problems in the uterus, fibroids, surgical emergencies, intrauterine causes, specific medical problems or even unknown causes for repeated abortion. It is certainly a devastating situation for the couple when they face the unexpected termination. Especially for the female it is a trauma. Carrying the fetus for a few weeks and getting mentally ready for the pregnancy is a lifetime experience for her. Such abnormal termination will give a serious mental and emotional impact, apart from the physical one.

Although there are enormous reasons for repeated abortion, there are a few lifestyle related reasons that play a major role in this. I always try to understand the lifestyle of the couples so that potential risk can be mitigated.

Lifestyle that can cause repeated abortion

It is a hard core reality that today’s lifestyle has imposed many ill-effects on the overall health and pregnancy related problems is not an exception to that. While there are various uncontrollable factors like pollution, toxins, cacogenic colors and chemicals, etc. there are many self-imposed factors as well. When I discover the presence of such factors, the first suggestion to the couple is to avoid these factors in order to achieve successful pregnancy. Maximum couples follow the guidelines and immediately remove the lifestyle related causes and get the success in their mission.

a) Consumption of caffeine: It is true that caffeine brings a feeling of freshness and alertness in the body and acts as a natural painkiller, there are many adverse effects of excessive caffeine consumption. Statistics reveal that there is a very high risk of miscarriage for the patients that consume more than 200mg caffeine per day as compared to the patients that do not consume any form of the same. There is a hazard ratio of more than 2 for the females that is significantly high.

b) Obesity: While obesity is due to genetic or hormonal factors in a few females, there is a direct correlation of eating habits, obesity and repeated abortion. Overweight women have hormonal imbalance and it plays a critical role in developing the habit of repeated abortion. Abortion rate in obese women is as high as 38% as compared to 13% in normal-weight patients and 15% overall abortion rate.

c) Smoking and drug abuse: There is a direct link between smoking and drug abuse with repeated abortions. These two are extremely critical elements and I expect my patients to quit the habit before starting the treatment. Both these habits cause serious damage to the reproductive system and create absolute hormone imbalance.

d) Controlling these lifestyle problems would ensure that there is a successful pregnancy and the couple enjoys the parenthood!

What is PGD?

What is PGD?
Posted by Rita Bakshi on Thursday, 16 May 2013 in Infertility Articles
What is PGD?

There are many complicated cases where people have specific inherited problems that they do not want to transfer to the next generation. As an infertility expert I will be able to help them by conducting a special test known as Pre-implantation genetic diagnosis (PGD). This is a special technique of identifying genetic problems in the embryo that get created through IVF techniques.

I will recommend PGD when the female is facing multiple abortions or a family history of genetic disorders or you already have a baby with genetic disorder. There are more than 100 genetic conditions that will require PGD test.

Are there any risks?

Well in my opinion there are no particular risks in PGD. There are a few risks that are common in IVF treatment as well. For example there may be damage to the embryo while removing cells for testing or the test results may not be 100% reliable and conclusive.

Tuesday, 28 May 2013

The ABC of cryopreservation

The ABC of cryopreservation

Every case of infertility opens a new horizon of knowledge and expertise for me. As an infertility expert I need to take every problem carefully to understand the actual problem. Technology comes to rescue and there are many complex techniques that help a lot in making various steps simpler and quicker.

Normally, infertility treatment goes for multiple iterations and the couples need to undergo several rounds before the final success comes. There are a few steps that are complex and painful. It is very much cumbersome to repeat those steps every time. Techniques like cryopreservation help us in preserving the precious samples so that they can be used effectively in the subsequent iterations.

Cryopreservation is the method of keeping the embryos, sperms, gametes, tissues from ovaries or testicles in an extremely low temperature with an intention of the use in future. Samples can be kept intact for the future use and there is a huge saving of cost and resources. There is increased efficiency and reduced discomfort and inconvenience to the couple.

We perform the task in two steps. Firstly, the sample is collected from the female or male partner and kept in special tubes that look like straws. These tubes are stored below zero degree Celsius temperature and there is a special solution used to prevent the specimens from getting frozen. This solution is called cryopreservant and the specimens are thawed before they are used.

There are multiple protocols for cryopreservation and they vary in terms of the storage temperature, type of cryopreservant, time required for freezing and thawing and the type of specimen.

What is ICSI?

What is ICSI?

Male infertility always puts bigger challenge in front of us and as infertility expert it is always learning. Male infertility is much complex than the female one and there are various parameters that need to be looked into. There have been multiple techniques developed to treat the issue and ICSI is one of them. It is so common that you might have heard that term frequently.

When we perform In Vitro Fertilization during the treatment of infertility, sperms are injected in the egg using a special needle. ICSI is the abbreviation of Intracytoplasmic sperm injection and it is one of the fundamental treatments of male infertility cases.

I use special tools and equipment to perform activities like picking up the best sperms and inserting them in the egg. Both activities are very critical, delicate and complicated. The sperms are injected to the core of the eggs and the process requires very high precision and perfection. The success ratio is more than 75 to 80 percent. I give special hormonal injection to the female partner because the uterus needs to be prepared for the pregnancy.

Who are the best candidates for ICSI?

Monday, 27 May 2013

Infertility – A Cause of Concern For Many

Infertility – A Cause of Concern For Many

According to a study, around 7.3 million people alone in US are affected by infertility. Out of which 1/3 of the cases are credited to the female partners while 1/3 to the male partner and rest 1/3 are known to cause by the blend of factors that are common and have no scientific explanation up till now.

According to a reputed magazine, a treatment called vitro fertilization is a standard treatment for infertility and it was used around 15 years ago. Earlier than that, traditional surrogacy was the sole duos who were not able to become parents.

Nowadays as science and technology has taken many shapes and turns, new and latest trends are coming into existence. One of the latest trends for infertility is Embryo adoption. It is the newest method of building a family. It combines assisted reproductive technology with adoption. So what infertile duos can do is adopt an embryo in place of a child.

Another trend in infertility is Egg donation. It is the most recent occurrence in the field of medical science. It is a more elaborated practice that is required to haul out eggs from a woman’s ovaries. This method is adopted when the male partner has no sperm production capability or has low sperm count due to which pregnancy is implausible. Also this method can be espoused by single woman and lesbian couples in order to conceive.

What causes repeated abortions and how to deal it?

What causes repeated abortions and how to deal it?
It was 4 o’clock in the morning and I could hardly manage to get up and pick up my cellophane that was continuously buzzing in the most irritating tone. Early morning phone calls rarely bring pleasant news for the gynecologists and infertility experts. This time also it wasn’t any good news; rather it was news of abortion of pregnancy. The patient was under IVF treatment and this was her fifth repeated abortion in a row. Repeated abortion is a very painful, but unfortunately very common problem in pregnancy cycle. The problem becomes worse when the couple is struggling hard against infertility and the doctor and the couple are putting their best to overcome the problem. In the first place, infertility treatment is itself very complicated and the success rate is quite low. If the female is facing the problem of repeated abortions, then the success rate drops further.

What is repeated abortion?
We diagnose the case of repeated abortion when the female faces an abnormal termination of pregnancy in the first trimester repeatedly two or three times. Statistics reveal that the percentage of abortion in the first trimester is as high as 15 to 20 percent, but one or two occurrences are not termed as case of repeated abortion. If I diagnose a confirmed case of repeated abortions, then the modus operandi for dealing the infertility case changes. Apart from making the conception successful, I concentrate on sustaining the pregnancy until the first trimester. If the pregnancy continues until the first 12 weeks, then there are very rare chances of abortion.

Causes of repeated abortions
a) Chromosomal cause: More than 50% of the cases are contributed by chromosomal disorders. Number of chromosomes or structure of chromosomes can be faulty to cause repeated abortions. There are cases when specific genes responsible for abortion are passed in the fetus through the parents. Genetic analysis and corrective treatment is required in such cases.

b) Problems in the uterus: There are cases when the female has structural problems in the uterus or there are fibroids. The probabilities of repeated abortions greatly increase in such cases. We infertility experts need to concentrate on resolving these issues first, before dealing the infertility problems. With the help of advanced medical techniques and treatments, the problem can be cured completely and there are good chances of successful pregnancy.

c) Hormonal problems: Hormones like progesterone sustain pregnancy and in case of imbalance of this hormone there can be repeated abortions. Hormone supplements in the form of pills or injection can improve the situation dramatically.

Monday, 20 May 2013

Percutaneous Epididymal Sperm Aspiration

Percutaneous Epididymal Sperm Aspiration

Infertility is a complex problem and there are multiple facets of it. When patients come to me for infertility treatment, most of them do not know that there can be cases of male infertility. It is so common belief that infertility is a female problem and there is no male connection to it. The reality, however, is exactly reverse and statistically one third of the infertility cases are contributed by the male partner.

Treating male infertility is a complex problem in front of us and as an infertility expert I would say it is the most complex problem. Not only because of social issues, but because of physiological issues as well. Treating male infertility is much challenging than the female infertility. Complex testing methods are required to understand the root cause. Inappropriate sperm count; inferior sperm quality and less mobility can be some of the reasons for male infertility.
Percutaneous Epididymis Sperm Aspiration (PESA) is name of the technique used to determine the sperm count in a male. The procedure is very simple where the sperms are collected directly from the epididymis, the part of the testicle where these sperms are stored.

Why there is a need?

I would recommend PESA when:
The man is not able to ejaculate sperms due to the absence of a special tube known as deferens. This tube carries the sperms. The condition is known as azoospermia.
The man has undergone a vasectomy that failed.
There are dysfunctions in the ejaculation process.
The man is having the problem of retrograde ejaculation where the sperms go back to the bladder instead of going out through urethra.
What is the assurance of success?


OHSS: A big roadblock in the infertility treatment
Treatment of infertility is sometimes very challenging. While most of the cases are quite simple and we cure them on the basis of knowledge base collected by the previous cases. However, there are a few cases that place immense complication in front of me and I need to really work very hard to deal with the situation. Ovarian hyper stimulation syndrome (OHSS) is one of the same cases and I need to pay extra attention towards every minor and major symptom that is abnormal.

Ovarian stimulation is required during the treatment of infertility and in fact, it is one of the most integral parts of the entire process. Ovaries produce eggs that take part in the fertilization process. In the normal scenario, female body produces one egg at a time that gets released from the ovaries and reaches to the uterus through the fallopian tube. Extracting eggs is a complex and painful process and we as infertility experts don’t want to give trouble to the female participating in the process. We use special stimulant drugs to cause release of multiple eggs. The process is very safe and there are seldom any side-effects. However, there is a big challenge in a few patients when Ovarian Hyper Stimulation Syndrome occurs as a side-effect of these stimulant drugs.

What happens in OHSS?
Ovaries overreact to the stimulant drugs resulting in a severe swelling. Ovaries become multiple times bigger and there is a leakage of fluid in the abdomen. It is a fact that most of the women undergoing infertility treatment with ovarian stimulant drugs face OHSS symptoms, but many of them not even recognize it.

Who are in the risk zone?
There are a few females with very high risk of OHSS syndrome and we infertility expert estimate the risk before starting the ovarian stimulant drugs.

a) Females under the age of 35
b) Females with a history of OHSS in the earlier treatment cycles
c) Females suffering from ovarian cysts
These are the cases where there is a high probability of OHSS and therefore, we plan the treatment accordingly. Although there is no alternative other than giving stimulant drugs to release multiple eggs, but we try to keep the situation under control.
Types of OHSS

Wednesday, 15 May 2013

List of PGD conditions

There are more than 100 genetic conditions that will require PGD test.

 5 Alpha Reductase Deficiency (5ARD) insofar as that condition affects males, with simultaneous sex determination
Acute Intermittent Porphyria
Acute Recurrent Autosomal Recessive Rhabdomyolysis (ARARRM)
Adrenoleukodystrophy (Adrenomyeloneuropathy)
Aicardi Goutieres Syndrome 1 (AGS1)
Alpers Syndrome
alpha thalassaemia/mental retardation syndrome*
Alpha-1-antitrypsin deficiency
Alports Syndrome
Alzheimers Disease - early onset
Amyotrophic Lateral Sclerosis 1 (ALS1)
Anderson Fabry Disease
Androgen Insensitivity Syndrome
Angelman Syndrome (UBE3A gene only)
Aplastic anaemia - severe*
Argininosuccinic Aciduria
Arrhythmogenic Right Ventricular Cardiomyopathy/ Dysplasia (ARVC/D), Autosomal Dominant
Ataxia Telangiectasia
Autosomal Dominant Polycystic Kidney Disease (ADPKD)
Autosomal Dominant Retinitis Pigmentosa
Autosomal Recessive Dopa Responsive Dystonia
Autosomal Recessive Severe Combined Immunodeficiency with Bilateral Sensorineural Deafness
Bardet-Biedl syndrome (BBS)
Barth Syndrome
Battens Disease (infantile)
Beta Hydroxyisobutyryl CoA Hydrolase Deficiency (Methacrylic Aciduria)
Beta Thalassaemia*
Bethlem Myopathy
Bilateral Frontoparietal Polymicrogyria
Birt-Hogg-Dubé Syndrome
Branchio-Oto-Renal Syndrome (BOR)
BRCA 1 (increased susceptibility to breast cancer)
Breast Ovarian Cancer Familial Susceptibility (BRCA2)
Bruton Agammaglobulinemia Tyrosine Kinase (BTK)
Canavan Disease
Cardiac Valvular Dysplasia
Carney Complex
Catecholaminergic Polymorphic Ventricular Tachychardia 2 (CPVT2)
Central Core Disease of Muscle
Cerebral Autosomal Dominant Arteriopathy with Sub cortical infarcts and Leukoencephalopathy (CADASIL)
Cerebral Cavernous Malformations (CCM)
Charcot Marie Tooth Disease
Charcot Marie Tooth Disease Type 2
Charcot Marie Tooth Disease, demyelinating, type 1A (CMT1A)
Chondrodysplasia Punctata
Chromosomal rearrangements (various)
Chronic Granulomatous Disease
Citrullinaemia type 1
Classical Ehlers Danlos Syndrome
Coffin-Lowry Syndrome
Congenital Adrenal Hyperplasia (21 hydroxylase deficiency)
Congenital Fibrosis of the Extraocular Muscles
Congenital Stationary Night Blindness
Conradi-Hunermann-Happle Syndrome
Cowden syndrome (CS)/PTEN hamartoma tumour syndrome (PHTS)
Crouzon Syndrome
Cystic Fibrosis
Czech dysplasia, metatarsal type also known as Progressive pseudorheumatoid dysplasia with hypoplastic toes
Dentatorubral-Pallidoluysian Atrophy (DRPLA)
Diamond Blackfan Anaemia*
Dominant Dystrophic Epidermolysis Bullosa
Donohue Syndrome
Downs syndrome
Dravet Syndrome
Dyskeratosis congenita (Male embryos only)
Dystonia 1 Torsion Autosomal Dominant (DYT1)
Early-onset Alzheimer disease Type 3 & 4
Ectodermal dysplasia (Hypohidrotic)
Ectrodactyly, Ectodermal Dysplasia, Clefting Syndrome (EEC)
Ehlers-Danlos Type IV
Elastin (ELN)-related Supravalvular Aortic Stenosis
Ellis-Van Crevald Syndrome
Epilepsy, female restricted, with mental retardation (EFMR)
Facioscapulohumeral Dystrophy
Factor XIII deficiency
Familial Adenomatous polyposis coli (FAP)
Familial Hemophagocytic Lymphohistiocytosis (FHL)
Familial Paranganglioma Syndrome (PGL1)
Fanconis Anaemia A*
Fanconis Anaemia C*
Fragile X Syndrome
Fraser Syndrome
Frontotemporal Dementia
Gangliosidosis (GM1)
Gaucher Disease Type III
Gaucher's Disease (Type II)
Glutaric Acidemia (aciduria)
Glycogen Storage Disease Type 1A
Gonadal mosaicism
Greig's Cephalopolysyndactyly
Haemophilia A
Haemophilia B
Harlequin Ichthyosis
Hereditary diffuse gastric cancer
Hereditary Haemorrhagic Telangiectasia or Rendu-Osler-Weber Syndrome
Hereditary motor and sensory neuropathies
Hereditary Nonpolyposis Colorectal Cancer: Lynch Syndrome (for all subtypes)
Holt Oram Syndrome
Homozygous familial hypercholesterolaemia
Hunters Syndrome
Huntingtons Disease (Huntingtons Chorea)
Hydroxyisobuyryl CoA Hydrolase Deficiency
Hyper IgM Syndrome - Hypogammaglobulinaemia*
Hyper-IgE Recurrent Infection Syndrome, Autosomal Dominant
Hypophosphatasia (Infantile/ Perinatal lethal)
Hypophosphatemic Rickets: X-linked dominant (Xlh)
Hypospadias (severe)
Idiopathic Arterial Calcification of Infancy
Incontinentia Pigmenti
Juvenile Retinoschisis
Kearns Sayre Syndrome (KSS)/ Pearsons Marrow-Pancreas Syndrome (PMPS)
Krabbe Disease
L–2-Hydroxyglutaric aciduria
Leber Congenital Amaurosis
Leber's hereditary optic neuropathy / Lebers Optic atrophy
Leigh Syndrome (Infantile Subacute Necrotising Encephalopathy)
Leigh's (subacute necrotising encephalopathy of childhood)
Lenz syndrome
Lesch Nyan Syndrome
Leukocyte Adhesion Deficiency (Type I)*
Li-Fraumeni Syndrome
Long Chain 3-hydroxyacyl-CoA Dehydrogenase Deficiency (LCHAD)
Long QT Syndrome Types 1, 2, 3, 5 & 6

Pre-implantation Genetic Diagnose

Pre-implantation Genetic Diagnose: A technique to ensure healthy babies

Among the cases of infertility problems, I would say the most difficult cases are those where there are some genetic problems. Every case puts a different challenge in front of us as infertility experts because the root cause of infertility is different in every case. Genetic disorders place a separate challenge because they may cause serious problems in the babies that take birth after the treatment cycle. My team and I struggle hard and the couple also put their best efforts to let a conception happen. Everything go vein if there are genetic disorders in the baby. There are cases when couples face recurrent miscarriages, continuous failure of IVF retries or cases where earlier babies born with genetic disorders like ‘down syndrome’.

What is PGD?
Pre-implantation Genetic Diagnosis or PGD is a special technique used by us to do genetic profiling of the embryo or Oocyte. They are used when couples don’t want to carry forward to the next generation.

We use various Assisted Reproductive Techniques that help in making the fertilization successful. All these techniques ultimately result in a successful pregnancy. PGD helps in identifying and curing the genetic disorders in the baby before the birth. It is an appendage process to ensure birth of healthy babies.

Who are the best candidates of PGD?
I recommend PGD only in the cases where it is really required. It is neither an essential part of the entire process nor it is a generic process. The couples that get benefited by it the most are:
a) Couples with a history of multiple miscarriages or habitual miscarriages.
b) Couples with a family history of genetic cases like Thalassemia, hemophilia, single gene disorder and chromosome translocations, etc.
c) Couples where the female has to undergo multiple abnormal terminations, either forcible or automatic.
d) Couples where the male partner is facing male infertility issues.

Tuesday, 14 May 2013

Is ZIFT common across the globe?

Is ZIFT common across the globe?

In my opinion ZIFT is not as popular across the globe as the other methods of ART, but it is certainly very effective in some cases where there is no alternative. It is more invasive process as compared to the other processes. However, in some situations it is the only option to get success in pregnancy and I recommend it for the same reason. Statistically, only one percent of the total ART cases are contributed by ZIFT.

When ZIFT is ideal?

In case of severe problems related to the ovaries
The couple has undergone more than five cycles of IUI, i.e. Intrauterine Insemination.
The fallopian tubes of the female are unblocked
The couple is unable to conceive after continuous efforts of one year
The male partner has very low count of sperms

When ZIFT is not suitable?

There are a few scenarios when ZIFT is not effective at all

ICSI: The modus operandi

ICSI: The modus operandi

We hold the matured eggs using a special pipette. It is designed to hold the eggs in a better and organized manner.
A sharp and delicate hollow needle is used to pick up a single sperm in immobilized state.
The needle with sperm is injected to the shell of the female egg called as Zona. The sperm is injected in the inner part of the eggs called as cytoplasm. This is centre of the egg.
The eggs are monitored next day to ensure normal fertilization.

ICSI: The success story

We need to understand that there are two aspects of success when we think about IVF programs. The first one is known as fertilization rate and the other one is known as pregnancy success rate. In case of fertilization rate, we consider the process of fertilization. There are around 70 to 80 percent cases where fertilization happens after the ICSI process. The rate is significantly high on any parameter.

Pregnancy success rate is the rate of a successful pregnancy until the childbirth. IVF using ICSI method is more successful as compared to IVF using the other methods. The reason is simple, in case of ICSI, the woman is more fertile, the age is relatively less, the overall health and fitness is better and the average quality and quantity of eggs is better. Success rate is obviously higher because of these reasons. However, there are some cases of unexplained infertility that lowers the chances of successful pregnancy using ICSI.

There are some other aspects as well. IVF using ICSI is a complex procedure and I need to apply the skill and expertise to achieve success. The quality of the treatment, laboratory, equipment, and skill of my team are the other aspects that denote the success.

Thursday, 9 May 2013

Gamete Intra-fallopian Tube Transfer (GIFT)

Gamete Intra-fallopian Tube Transfer

The biggest challenge for me as an infertility expert is to identify the type of infertility. There are various aspects of it and normally we go through elimination mode. An assisted reproductive procedure is used while treating the infertility so that the process of fertilization takes place easily. This procedure is the external aid to the normal natural process. GIFT is a special technique of ART where eggs and sperms are kept in the fallopian tube as soon as the egg matures.

I need to talk to the female partner and explain her about the procedure in detail because she is going to play a major role in that. Although the procedure is not very complicated, still she has to be convinced with it. GIFT is similar to an IVF (In Vitro Fertilization). The ovaries of a female are stimulated with external methods to release more than one egg so that the chances of success are increased. The male partner or donor gives the sperm for the process. The eggs and the sperms are mixed in the dish. Up to this point, GIFT and IVF are similar.

We have counseling session with the couple to explain the procedure. In case of GIFT, the eggs and sperms are transferred in the fallopian tubes and the fertilization happens there. In case of IVF, the fertilization takes place in the laboratory, outside the female body. The embryo gets the most natural environment immediately after the fertilization.

ZIFT is also same as GIFT, the only difference is, and doctors transfer the zygote or the newly fertilized eggs that are returned to the fallopian tubes instead of eggs and sperms. This process involves more complexity because there are two separate procedures to retrieve the eggs and again to insert the embryo.

   Cryopreservation of Gametes

• Spermatozoa
It is a fact that cryopreservation of the male gametes is relatively easy and simple as compared to the female counterpart. The reason might be because of the huge quantity of sperms found in the semen. Even if the cryopreservation techniques are not that effective, you will still be left with good number of sperms.

There are some factors plays a major role in the effectiveness and success of cryopreservation technique of sperms.
• Semen quality If you preserve the semen sample taken through normozoospermic method, then the survival is much higher, typically 25% as compared to a sample taken by oligoozoospermic method where the survival is 12%.

• Preparation of the semen – It is important to prepare the semen properly if the survival rate is required to be high. The method of semen washing also determines the survival rates. Typically normozoospermic semen samples survive 25% if they are taken just by normal preparation method. If the semen is taken by swim-up technique, then the survival rate is 36%. There is another method known as density gradient configuration that improves the survival rates significantly. Research indicates that there is an increase from 12% to 27% with swim-up technique and 23% with centrifugal technique.


It is certainly very difficult to cryopreserve Oocyte as compared to sperm. The eggs are usually very delicate and there is damage to the outer shell very easily irrespective of the techniques we use to preserve them. The latest cryopreservation protocols, however, have become very helpful in preserving the Oocyte in a better way. Although the survival rate for Oocyte is as high as 60%, but the rate of live births using the survived Oocyte is still much lower as compared to the fresh ones....