Sunday, 29 September 2013

Recurrent implantation failure, the devastating problem

Recurrent implantation failure, the devastating problem

The couple was not able to control their emotions of happiness and joy after looking at the report placed on the top of my neatly managed table. It was a positive report showing successful implantation of the embryo confirming the successful pregnancy. It was certainly a moment to celebrate and it becomes further special after a series of unsuccessful In Vitro Fertilization and discontinued pregnancy attempts. The time was surely tough for the couple and me as well.

We had been waiting so long for this good news and tried effortlessly to achieve success. The case was unique. The follicle development was normal, fertilization of the eggs was OK, development of the embryo was fantastic, endometrial thickness was just perfect; but still embryo implantation was failed! Not even once or twice, but for multiple times. However, the series of unsuccessful attempts was over and the couple got the biggest news of the life!

The unknown reasons of recurrent implantation attempts

It is certainly very disappointing to hear about the unsuccessful implantation after a series of painful procedures and emotional ups and downs. There are efforts of the couple, the infertility expert, the technicians and so many other people that go vein.

Why does it happen? Well, it is the fact of the matter that human endometrial (the inner lining of the uterus) is the biggest mystery in spite of extensive research and studies. It is the most crucial part in the human reproduction system.  It undergoes multiple changes and they are triggered by the hormonal secretions in the female body. The estrogen and the progesterone are the two most vital hormones that balance the entire activity. These hormones decide a unique characteristic of the endometrial lining and that it the receptiveness for fertilized egg. According to some experts there is a particular timeframe when the lining is maximum receptive, the so-called window of implantation!

There has been extensive research in the field of endometrial lining and their receptiveness. Studies indicate that there are hundreds of molecular signals known as biological markers that control the receptiveness. There is a certain period when the markers that support for implantation are at the peak and that is what window of implantation. The window is not fixed and it gets shifted to the earlier or later timeframe. Therefore, it is very difficult to determine the most feasible moment to attempt implantation.

The way out

Infertility experts work hard to achieve successful pregnancy and therefore, analyze the past attempts that were failed. It gives a fair idea about the peak window. Since it is based on the analysis pertaining to the specific case and not on the basis of some theoretical calculation, hence it is much accurate. Implanting the embryo after determining the best window, there are better chances of the success.

Recurrent implantation failures give too much stress and frustration to the entire team and therefore, it is better to spend some time in analyzing about the peak time and then trying for the embryo implantation.

Thursday, 26 September 2013

IVF, the role of the daddy

IVF, the role of the daddy

The process of infertility treatment requires a great degree of patience and mental strength. Not only for the couple that is undergoing the treatment, is it equally challenging for entire unit working for it in my team. Although I try to remain as neutral as possible during the treatment because it is necessary at my end, but still there are moments of distress and enjoyment that affect me up to some extent.

It is a fact that infertility treatment procedures and IVF primarily require physical and mental involvement of the female. However, participation of the father is equally necessary in relieving the stress of would be mother. It makes the relationship stronger and makes the bonding stronger. The couple feels more invested in the pregnancy.

There are various benefits of the involvement of husbands in the IVF process. I have detailed discussion with every couple during and after infertility treatment and try to understand their perception about the whole experience. We chat, discuss and analyze the phases we passed through together. There are a few feelings that come out prominently:

Feeling of pride: For husbands, it is certainly a matter of pride being the caretaker of the wife. They feel good reminding about the medication, accompanying her for the ultrasounds, making her comfortable for the procedure. The sense of responsibility and sharing shown by the husband makes IVF procedure a wonderful experience. The final outcome brings a wonderful feeling of involvement and accomplishment and it is beyond expression.

Feeling of involvement: IVF is a long running process and it is extremely important that the couple traverses through it jointly. A husband feels tremendously involved in the process by going through every phase along with the wife. The involvement brings closeness and he feels endowed in the complete experience with a better control over it. The fathers see every step of pregnancy and right from the stage of placing the embryo in the womb to the delivery of the baby, they witness every step. Husbands call the period of IVF treatment as period of highest attachment.

Feeling of togetherness: I have seen immense improvement in the relationship between the husband and wife during the infertility treatment and IVF procedure. There are very obvious reasons behind it. The process brings extreme closeness and togetherness between both of them. Most importantly this is not my perception, but I hear it straight from the horse's mouth!

Feeling of responsibility: The couple has to take too much pain and labor in achieving successful pregnancy. The involvement makes the husband aware about the difficulty and discomfort faced by the woman during the process. It makes the fathers more responsible towards the baby.

It is a good trend that nowadays husbands are eager to participate in the process of creation of a new life. They want to feel the difficulty and take their share of responsibility. Undoubtedly the physical discomfort would be suffered by the wife, they can share the mental distress at least!

Tuesday, 24 September 2013

Turn the “two week tension” into “two week bliss”

Turn the “two week tension” into “two week bliss”

I treat infertility for so many couples and experience so many moments of emotional sway along with them. We feel the grief, the misery and the glee together. However, there are some moments that are supposed to be faced by the woman and nobody including the husband is able to share the load. These are the toughest moments. It is required that one should face them with courage and patience. Keeping positive attitude helps a lot.

When we undergo the process of infertility treatment, there is a waiting period of two weeks after the ovulation. The process of fertilization is over and we have to just wait for another two weeks to confirm the pregnancy. After completing the procedure, I move forward to some other case because there is nothing to do for a couple of weeks. However, the female has to keep waiting for two long weeks, without any further procedure related to the treatment. It is perhaps the most difficult time for her.

There are a few tips that can ease the waiting time.

A. Go with a positive drift: I keep on telling this to my patients and many have admired the effectiveness of this technique. It is a fact that the more you want to suppress an emotion, it retaliates like anything. Telling someone to be positive and avoid negative notions is easier said than done. I tell my patients to go with a drift of positive emotions by thinking everything related to pregnancy for at least one hour daily. It may be reading about pregnancy symptoms, going through the blogs related to prenatal care, talking to pregnant ladies, imagining the pregnancy symptoms and many more. It really makes a miracle and women feel recharged and rejuvenated after doing it daily.

B. Stay occupied: This is the other tip. Although working women never face a problem in doing that, but the things are harder for home makers. There is immense frustration when you have nothing to do. Whatever they try to be occupied, there are moments when free time gives them immense tension and frustration. Scheduling meeting with friends, going to the favorite movie, joining hobby classes, enjoying a vacation or visiting the relatives could be the better options.

C. Follow the dos and don'ts: I always tell certain dos and don:ts to my patients and it really helps. Regarding things that are not to be done, I tell them to avoid people who do not understand the gravity and sensitivity of the problem. They will bring nothing but immense negativity and pessimism in the environment. There should not be discussions, movies, articles and gossip pertaining to pregnancy, abortion, infertility and related things. All such things drain the energy and increase the feeling of anxiety and fear. Regarding the things to be followed are, watching positive movies and reading good books, meditation and breathing techniques are the most preferred.

 I feel really good to know that my patients get tremendous benefit by these techniques and it becomes quite easy for them to spend the toughest time of the infertility treatment.

Sunday, 22 September 2013

Time-lapse imaging, the ground-breaking technique

Time-lapse imaging, the ground-breaking technique

The field of medical science is ever growing and there are multiple research and developments going on across the globe to expand the knowledge levels. The treatment of infertility is also not an exception to it.
Embryo analysis, the current method

Today, we use a different process to determine the growth of embryo. The technicians in my laboratory are very particular about it and never miss a single instance, irrespective the number of IVF simultaneously going on. They remove the embryo carefully from the incubator and observe the development under the microscope. I personally intervene in case of any abnormality. Although we also take some static images of the embryos, but one thing is sure, chromosomal abnormalities can't be identified precisely in this method. Moreover, there are chances of developing embryo getting disturbed, no matter how carefully we handle them. We use techniques like biopsy to distinguish the genetic disorders. The new method is non-invasive, but still more precise and that is the biggest distinguishing factor.

It has been observed that generally the embryos with chromosomal abnormality take six to eight hours more as compared to the healthy ones. This is alarming and there are very high chances of IVF failure in this case. The phenomenon is called Aneuploidy, i.e. extra chromosome. Statistically it is the biggest culprit behind the failure of IVF in couples.

What is time-lapse imaging?

Time-lapse imaging itself is not a new technique. In fact, it is one of the oldest techniques where a camera takes photographs of a particular event at regular intervals. These multiple photographs show the development or change in the object correctly and precisely. The number of images and the interval can be adjusted and more pictures we take, more detailed growth can be observed.

Time-lapse imaging can be used to determine the growth of the embryo before it is implanted in the uterus. In this method, thousands of pictures are taken at the regular intervals during the first few days of embryo development. Experts try to estimate the time between the first glance of the embryo when it looks like a cavity filled with some liquid to the full-grown blastocyst. This process takes around four to five days.

There was a research done to assess the effectiveness of time-lapse imaging method and the results are quite encouraging. The study was not done to determine the quality of embryos for implantation, but it just recorded the readings and determined the high risk, low risk and medium risk embryos. The results of implantation were compared post facto. Results confirmed that embryos identified as problematic on the basis of image analysis were failed to survive while the embryos identified as healthy ones were able to reach up to live birth.

Experts say that it indicates the effectiveness of the new method for selecting the best embryos with the lowest risk of chromosomal abnormality. That increases the likelihood of successful pregnancy automatically. Although it appears to be very promising prima-facie, but it needs to prove itself on the touchstone of statistical methods. Once the reliability is established, Time Lapse Imaging will open new horizons of success to the IVF. It is certainly a buoying up news for the childless couples.

Thursday, 19 September 2013

Atelier diva' May' 2013

Take it is easy, its Menopause Dr.Rita Bakshi,

Senior Gynecologist & IVF Specialist-International Fertility Centre, GreenPark, New Delhi.
The end of your monthly cycles is the time that requires a healthy change in your life cycle¦

I know it's too early to ask, but I am scared of Menopause. Is it hard to handle? and she paused for a moment, forcing herself to smile.

I was inspired to write this column when I met this patient of mine. She was just 27 and was really scared of this word Menopause, probably she heard someone in her family talking as the difficult time in a womans life.

She further asked me Is this a stage of forgetfulness, hot flashes.

And I told her what I am telling you Its a new beginning.  True a woman becomes forgetful, she suffers with mood swings, vaginal dryness and night sweats that affect her sleep, but then these changes can also be due to normal aging which will subside after a while.

You don't need to be afraid, instead you need to be educated. Menopause is a natural biological event when ovulation ceases, menstruation gets less frequent and ultimately stops. In other words, it is a time when a woman passes from a reproductive to a non-reproductive stage.

What can never change about Menopause is the fact that you are not alone; remind yourself again and again that millions of women are dealing with the end of fertility. You don't know but many of them are muddling along in discomfort, irritation and they all claim that they are scared of this phase in their lives. The truth is every woman feels the same, and all you need to do is to take full charge of your health during this period.

The only problem that I see today is we are not educated about this. According to me, Knowledge is Power. The first thing to do is to identify the symptoms, then consult your doctor and always keep yourself abreast with information on Menopause. Keep telling yourself that I will deal with it wisely because there is no other way. All women are blessed with great will power and can deal with anything and everything. All you need to do is to educate yourself and things will follow.

I have had many patients who talk to me of Menopause as if it is a disease. It is not at all a medical condition, but a natural one, which could be easily taken care of by your right mental approach. Support it with a healthy change in your eating regime by incorporating a lot of fresh fruits, fiber rich foods etc.

Please follow these simple guidelines:-

Get enough sleep because if you are sleep deprived, even a simplest thing will also affect you badly. So get enough amount of night sleep by avoiding large meals, alcohol, caffeine or any sort of physical activity before going to bed.Â
Do not just sit in a corner, engage yourself in any kind of physical activity that you like 5 - 6 times a week. Spend time with your loved ones.
Read books, develop some hobby and try to stay as positive as you can in order to overcome daily stress. You can also try some relaxation techniques.
Do not keep your problems only to yourself but discuss them with your partner or friends so that you can feel relaxed & relieved. Move out, visit new places with your friends and family don’t you forget there is life after menopause.
You can ask your doctor for medicines or therapies that can reduce problems associated with menopause to certain extent.
The secret to a Happier Menopause is a Happier YOU. The truth remains the same for thousands of women You and I can live the healthiest and happiest lifestyle during this period” only if we want to. Your unparalleled energy, hope and power will see you through this with absolute ease.

Begin each day by telling yourself take it easy, its just Menopause

Tuesday, 17 September 2013

Do men face emotional mayhem during infertility treatment ?

Do men face emotional mayhem during infertility treatment ?

When they say “men are from the Mars and women are from the Venus” it means men are always strong, happy-go-lucky and flamboyant! Well, as an infertility expert with so many years of experience I would say the reality is drastically different. I have come across hundreds of couples so far with varying infertility problem and found the men most deeply affected, but the least bothered about!

The “masculine” aspect of infertility

The world talks so much about the problem of infertility. There are discussions in blogs, forums, talk shows, magazines, but from the feminine perspective only. Females find it quite easy and comfortable talking about the pain, the agony and frustration. It is, however, not that easy for their counterparts.
Men never talk about it openly, barring a few discussions about it with a mug of beer. However, it doesn’t mean they are not bothered about it. On the other hand, they look at it with very different perspective and ironically that is not even gets noticed.Â

Feeling of guilt: The detection of infertility is a big blow for him, especially if he is contributing to the problem. Men have been considered responsible for producing an heir. The incompetence makes him timid and shy. He feels that he will not be able to face his wife.

Feeling of insecurity: The infertility problem immense sense of insecurity to him. The insecurity about relationship, love and married life. In most of the cases, the insecurity doesn’t come on the surface and even if it comes, it is the tip of the iceberg.

Feeling of disguise: Men feel tremendously disguised when the problem is revealed. They feel it a threat to their social status and pride. The feeling of getting humiliated gets converted in the feeling of disguise, self-rejection and isolation from the society.

In our society infertility is always considered a feminine issue. The first suspect is always the female partner. It is a fact that more than half of the cases of infertility are due to the problem in the male partner. While the new generation is well aware of the fact, social force and false ego of masculine power makes him thinking the other way. It creates tremendous pressure and conflict in the mind. It results in bottling up the feeling making the condition worse.

The role of infertility experts

I am not just an expert of reproductive procedures while treating the infertility problem. On the other hand, I need to play the role of a psychiatrist, a counselor and a friend. Sometimes I need to call the experts, if the case is beyond my limits. I talk to the men, explain the root cause of problem, discuss the possible remedies and try to release the tension in the air. I tell to the man that he is not only sufferer in the world. There are so many sailing in the same boat. It gives immense relief. Open dialogue is the only way to cope-up with emotional turmoil in the men. If it can’t be done by the family, friends and support groups, then the infertility expert wears that cap!

Sunday, 15 September 2013

Repect for the Surrogate Mothers

Repect for the Surrogate Mothers

Every coin has two sides similarly every profession or a deed is considered in a positive as well as in a negative way. Whether surrogacy is a boon or a bane is a big question in today’s world. It is a little difficult to maintain a balance in the world towards positive contributions. Surrogacy is a scientific boon, in other words a great sacrifice by many women who have come forward to help parents who are unable to produce their own baby. The procedure involves In Vitro Fertilization where the embryo is fertilized outside the body and implanted in a non-related surrogate mother’s uterus. Various fertility centers offer various financing programs to the surrogate mother to help her make her parenthood easier and more feasible.

Many a times it is thought, that following this pattern of surrogacy on humanitarian grounds is a misuse of the same for commercialization. But it is a living for many women who are willing to take care of all the aspects of carrying a child according to what the intended parents require. The surrogate mothers are paid very heavily these days and hence they utilize this money for their own livelihood or for educating their children or for some other good reasons. They get to become independent and earn their own money to make their lives better.

The procedure is very costly as it includes a lot of expenses like medical expense, living expense and compensation but worth the price for a gift so precious for the intended parents. There are lots of clinics with the best surrogacy arrangements and they make sure that the surrogate mothers are paid their due for the sacrifice they are making to earn a living. This is a very personal and an intimate relationship and the surrogate mother must be taken great care of as she is not only giving you a baby for a lifetime but prepared to offer her womb.

But despite the growth in these services the surrogacy is not yet officially regulated in India. Corrupt middlemen definitely attract and push uneducated and poor women into surrogate motherhood to fulfill the international needs. But this practice must be stopped and the women must be given her rights and respected in society as she is renting a womb which by itself is a big sacrifice. The child may be conceived naturally or impregnated by fertility methods performed by doctors inan infertility clinic. It is the duty of the intended parents to take care of the surrogate mother throughout the nine months and make sure that they have empathy for each other.

Monday, 9 September 2013

Surrogacy and Mythology

Surrogacy and Mythology

Surrogacy has been shown as a medical intervention that has helped millions of childless parents. It is supposed to be one of the modern miracles of science. But surrogacy is not anew age invention. It has been a part of every society since times immemorial.It had been practiced since ages in one form or the other.

To understand surrogacy, we must first understand a woman. Initially such a question seems absurd but there is more to it than meets the eye. The broader question is to understand woman so as to establish her in her right position. In Indian mythology there is the tale of the goddess being empowered by the gods. They gave her ten weapons to adorn her ten arms. These gods represented the various forces of Nature like the Sun, the Moon and the Ocean among others. Then astride the mighty lion she fought and vanquished Evil. In ancient folklores the Earth is said to be the woman and the Sun and Rain empowers her to bring forth the fruits from within her. Her powers are latent – deep inside her. A woman denied can be quiet and deadly in her anger. The fertile earth can change into the barren desert.

What is surrogacy? It is the deputing of one woman by another. The surrogate agrees to bear the child of another who cannot go through the process of child birth. Sperm (frozen or fresh) is implanted surgically inside the womb of the surrogate. For couples denied parenthood for medical reasons this method has been a godsend blessing. The sperm may come from the intended father or from a donor if the former is lacking in it. Monetary incentives may or may not be the compelling factor in such an arrangement.

 Surrogacy and its complications is nothing new. In the Bible is the story of Sarah and Abraham who were childless. Their Egyptian slave Hagar agreed to become the surrogate. But her intimacy with Abraham made Hagar arrogant. This caused Sarah to banish her but later they were reunited. The child Ishmael later became one of the leaders of the tribe.

Today the complication of intimacy is reduced because the implantation is done in a surgical clinic. But the woman bearing the child becomes a biological mother and this could form to strong maternal urges; she might not be willing to surrender the child despite previous agreement. Does the surrogate mother then have no rights? In Indian mythology there is the story of the fetus being taken out of imprisoned princess Devaki and being implanted in the womb of Rohini, another wife of her husband Vosudev. Even without surgery one can be a surrogate mother like Yashoda who unknowingly reared the boy Krishna as her own. But what rights did she have when Krishna returned to his biological mother Devaki? The scriptures are silent.

Thus we came to see that surrogacy has been an eternal part of all our societies.Â

Sunday, 8 September 2013

TORCH test

TORCH test: A diagnosis that throws light on infections

I have seen plenty of diagnostic tests in my career as an infertility expert. Most of the tests are targeted to a specific problem and help me in understanding and treating a specific problem. However, there are tests like the TORCH test that is capable of telling about multiple infections in a single test. It is a fact that nowadays we seldom use it because there are various other tests available that can give much accurate and fast result.  However, the contribution of TORCH test in the medical diagnostic history can never be overlooked. There was a time when it was used extensively and people used to get benefited by the results.

What is TORCH test?

The TORCH test is a combined test that is used for screening pregnant women and even the infants to determine the presence of antibodies in the blood. If antibodies of specific disease are found in the blood, then it indicates the recent or past infection in the body. The test can find presence of following infections:

Toxoplasma gondii
Rubella (German Measles)-
Cytomegalovirus (CMV)-
Herpes simplex virus (HSV)-
Syphilis (Treponemapallidum)
When is it recommended?