International Fetus Day
We dedicate 31st October as Fetus day, the most important person on this earth ( the unborn patient), with a slogan
” Healthy Fetus Healthy Nation”
Every year, we do a scientific conference on the subsequent sunday of 31st October ( if 31st october is not a sunday).
This year also, we are planning a conference on 1st November/ 8th November, depending on the convenience of the guest speakers.
I invite all like minded people for this scientific feast
Time lapse technology / morphokinetics in Embryology
Reading all the literature and references I come to a conclusion that , the end point of any Time lapse technology in embryo culture is getting a blastocyst, or blastocyst is the end point if any Time lapse technology , may be it Embryoscope or something else.
As we are doing 100 % blastocyst transfer since 8/9 years , if we get a day 5/6 blastocyst for particular couple, then it is obvious that this embryo is competent enough to reach that stage. It is survival of the fittest.
The problem occurs when the centre transfer day 2/3 embryos. There may be multiple embryos on day 2/3, but which is going to survive ,very difficult to assess. All may look similar, but when they are put to the challenge to make their own food and survive onwards without maternal support ( called embryonic genome activation), then many of them wither. As they look similar, the clinician “may” transfer the withering one. Here, the Time Lapse technology helps to select the best one ,which “may” survive. But looking at the high cost of Time lapse, I feel blastocyst culture is easy and quite cheaper, and top of that, we are transferring the end point .
” The Mother Nature also selects best quality day 5 embryo.”
If we don’t get the blastocyst, then this cohort of embryo are genetically poor or aneuploid, and even though they are good at day2/3 ( in Time Lapse/ or regular incubator, ) they are not going to survive. The patient may see the embryo transfer occurred , but it fails. So when we don’t get any blastocyst on day 5, we defer it and tell the couple about the event ( Not a very easy task for any IVF clinic)
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”