I saw lot of patients with secondary infertility who had ectopic pregnancy after their marriage.
It shows that :
1. They are fertile .
2. The sperms and eggs are usually of good quality.
3. The fertilization site , that is fallopian tube is at fault. The tube is patent, ,it allows sperm to go to the egg ,that is waiting at the outer portion of the fallopian tube. The sperm fertilizes the egg, but when the tube pushes the fertilized egg to the uterus , it gets trapped in the tube. It happens because the internal surface of the tube is not smooth. The uterus grows with the growing embryo , but tube can not, so it cracks and the patients land into the severe internal bleeding ( if not seen earlier part of pregnancy). Usually she gets operated and the tube with the pregnancy is removed. Now the lady is with only one tube left.
4. Now she tries for another pregnancy, but couldn’t achieve it. Why? ,as she is fertile, her periods are regular, ,she produces eggs in every month, and staying with her husband, but without pregnancy. This happens because : She had a pregnancy ( ectopic) with the better tube she had ( and it is removed, as she had ectopic). The tube left is usually inferior compared to the tube that is removed, Otherwise she could have a normal pregnancy with this remaining tube.
5. Now the treatment starts , and a Hysteros Salpingo graphy ( HSG) / laparoscopy is done to see the remaining tube , and report comes : patent tubes. Now she is confused . If the remaining tube is patent, then she should have a natural pregnancy. On that quest : She undergoes lots of useless treatments, like multiple Intra-uterine inseminations (IUI). If her remaining tube is not good , then what ever you do ( with putting sperm in her uterus,IUI) fertilization does not happen.
6. This is because : Tube has to do three functions: a. give passage to sperms and eggs, b. Give nutrition to the fertilized eggs, c. Propel the fertilized egg( embryo) to the uterine cavity. Fault in any of the three function will hamper pregnancy in uterine cavity.
7. So the treatment is not putting sperms in uerine cavity (IUI) , as IUI has not created her earlier ectopic, The treatment is Fertilization. If it is not happening in tube ( in-vivo) , then she should have fertilization,In-vitro ,that is IVF
8. I see many patients with previous ectopic , who waste their time and money in these useless treatments. You can earn money but you can not recover the age. Age makes the eggs poor, and when they come late , the chances of IVF gets poorer. They are increasing their problems and reducing the chances of getting pregnancy because of their own ( ? treating physician’s) ignorance.
9. If they come early for IVF , the chances of success will be more as compared to primary infertility patients ( who never has pregnancy).
10. In India , the tubes are damaged due to Tuberculosis infection(?). some times this inffection damages the uterine lining also ( endometrium).
11. So more delay in getting IVF; May create problem in both ” Seed and the Soil”
Activity in Embryology Lab
3-D Uterine cavity
3-D rendering of Fetal Face
Blastocyst Transfer : Embryos developed in ASTEC incubator
We have MIRI multichambered bench top incubator for embryo incubation for blastocyst culture.
We find that MIRI is very convinient ,one chamber for one/two patient but very sensitive to mild disturbances in CO2 and O2. It is very difficult to measure pH of media in MIRI, so the blastocysts formed in them are not very well turgid and hatching on day 5 is very rare.
Compared to that , my ASTEC 30 liter trigas incubator is sturdy and gives very good blastocysts on day 5 and many of them are hatching on day5, even we are opening it more frequently than the MIRI chambers. We can measure pH of the media more easily and can keep it more towards pHi.
We tried to shift completely to MIRI number of times ,but every time we come back to our trusted friend ASTEC ( two incubators we have),,It ( ASTEC) gives very good quality day 5 embryos . Feeling that, conduction will give better results than convection is questioned.
We always measure the pH of fresh batch of culture media to put it more towards pHi. It is really easy with ASTEC. You can’t trust the fixed gas mixture concentration in blastocyst culture for all culture media, That might be the difficulty with Benchtop incubators.
Biotechnology training :Ishani banerji under the guidance of Dr.Dharmendra (Phd. embryology) is undergoing training and her dissertation in mammalian oocyte in-vitro maturation and In-vitro fertilization at our embryology training laboratory section. We have started training biotech students in our DNA laboratory and embryology lab. They will do their dissertation and further training in Human IVF and embryology under guidance of Dr.Rinku and Dr.D’Pankar Banerji. We invite students to do their dissertation . We are formulating the curriculum for fellowship program for IVF, Embryology and Molecular Genetics and Molecular Pathology training.
Sonographic features of fetal aneuploidy ( Chromosomal anomalies)
All pregnancies are theoretically at risk of aneuploidy. We do genetic sonography with our latest 5-D sonography machine : Samsung UGEO WS80A
In aneuploid fetus sonography may reveal :
- Structural anomalies
- Aneuploidy markers
- Other findings : Intrauterine growth retardation, polyhydramnios,
1.Structural anomalies may be :
- central nervous system anomalies
- Facial abnormalities
- Cystic hygroma
- Diaphragmatic hernia
- Cardiac Defects
- Gastrointestinal Abnormalities
- Genitourinary anomalies.
- Non immune hydrops.
- Extremity anomalies.
- Aneuploidy markers:( ” Soft Markers”) : variation in normal anatomy that, except for their relationship to aneuploidy( esp. Trisomy 21) are unlikely to be clinically significant. Compared to the structural anomalies , markers are often transient and non specific findings which can also occur frequently in euploid fetuses
- Nuchal fold thickening
- Echogenic intracardiac focus
- Shortened long bones
- Hyperechoic bowel
- Renal pyelectasis
- Choroid plexus cysts.
- Hypoplastic or absent nasal bone.
- Single umbilical artery