Fetus Day

FetusCon2016
Fetus day(31oct) Celebration, Jabalpur MP
Organized by:
Banerji Research Foundation
In Association with JOGS and IRIA(Jabalpur)
Endorsed by :Society of Fetal Medicine
Venue: Hotel Gulzar, Madan mahal road, Jabalpur
Date : 6.11.2016
Time: 9 am to 4pm
Session 1 : Genetics: 9 am to 11 am
1. Basic Genetics for non geneticists, How to apply Genetics in clinical practice: Dr.D’Pankar Banerji , 20 min
2. Advances in Genetic testing in care of the unborn fetus : Dr.Ratna Dua Puri, New Delhi, 20 min
3. Non Invasive Prenatal test-Current scenario ,What to know and what not to know:  Dr.Ratna Dua Puri, New Delhi, 20 Min

  1. Case presentation with panel Discussion, cases form participating Obgy and Paediatricians are taken: 60 minutes, Dr.Ratna Dua Puri, Dr. Preeti Parekh Tomar, Dr.D’Pankar Banerji

Session 2: Obstetric sonography and Fetal Monitoring : 11.15am to 1.30 noon

1. What you should know when managing a Twin pregnancy: Dr. Mayank Choudhry, Ahmedabad
2. Optimizing outcome in Fetal Growth Restriction: Dr.Chanchal Singh, New Delhi
3. Placental sonography standarization : Accreta, increta and percreta., Dr. Mayank Choudhry, Ahmedabad
Lunch: 1.30 to 2.00pm
Session 3 : Live demonstration/ Lecture: 2pm to 4 pm
1. Fetal Neurosonography: Dr.Mayank Choudhry.
 

  1. Screening for congenital heart disease in routine scan: Dr. Chanchal Singh
    3. Basics of color doppler imaging of uterine artery in Pre-eclampsia:Dr. Sneh Choubey, Jabalpur
    4. Evaluation of Umbilical artery, Middle cerebral artery , ductus venosus : Dr. Preeti Parekh Tomar, Indore

FetusCon2016

FetusCon2016
Fetus day(31oct) Celebration, Jabalpur MP
Organized by:
Banerji Research Foundation
In Association with JOGS and IRIA(Jabalpur)
Endorsed by :Society of Fetal Medicine
Venue: Hotel Gulzar, Madan mahal road, Jabalpur
Date : 6.11.2016
Time: 9 am to 4pm
Session 1 : Genetics: 9 am to 11 am
1. Prenatal detection and interpretation of Copy number variation: Dr.Ratna DuaPuri,New Delhi
2. Current update on Molecular Karyotyping in prenatal diagnosis :Dr.D’Pankar Banerji, Jabalpur
3. Non Invasive Prenatal test-Current scenario ,What to know and what not to know:  Dr.Ratna Dua Puri, New Delhi
Session 2: Obstetric sonography and Fetal Monitoring : 11.15am to 1.30 noon

1. What you should know when managing a Twin pregnancy: Dr. Mayank Choudhry, Ahmedabad
2. Optimizing outcome in Fetal Growth Restriction: Dr.Chanchal Singh, New Delhi
3. Placental sonography standarization : Accreta, increta and percreta., Dr. Mayank Choudhry, Ahmedabad
Lunch: 1.30 to 2.00pm

Session 3 : Live demonstration/ Lecture: 2pm to 4 pm
1. Fetal Neurosonography: Dr.Mayank Choudhry.
2. Screening for congenital heart disease in routine scan: Dr. Chanchal Singh
3. Basics of color doppler imaging of uterine artery in Pre-eclampsia:Dr. Sneh Choubey, Jabalpur
4. Evaluation of Umbilical artery, Middle cerebral artery , ductus venosus : Dr. Preeti Parekh Tomar, Indore

Genetics and Reproduction: IVF and ICSI with PGD

Based on Reproductive genetics understanding, therapies are developed and used to maximize outcomes.

Specifically, increased pregnancy rates,decreased incidence of obstetric complications and miscarriage, and the avoidance of fetuses affected by birth defects or other deficiencies are the stated goal of much of the current research in reproductive medicine. The role of genetic testing to guide medical decision making in this regard is sizable and will likely continue to grow in the future.

Genetic evaluations within reproductive medicine may be subdivided into 4 main categories:

1. Preconception genetic testing: The genetic evaluation of prospective parents before pregnancy.

2. Antenatal genetic testing: The genetic evaluation of women who are currently pregnant to determine  the genetic makeup of the developing fetus.

3. Preimplantation genetic testing ( PGD and PGS): The genetic evaluation of an embryo, before uterine transfer, via an embryo biopsy during an in-vitro fertilization (IVF) procedure.

4. Genetic analysis following fetal demise: The genetic evaluation  of the product of conception following a failed pregnancy.

 

IVF and Endometriosis

Endometriosis is a common gynecological condition that affect approximately 10-15% of the female population.

Endometriostic ovarian cysts may be present in up to 20-40% of women with endometriosis scheduled for IVF and on both sides in 19-28% of the cases.

The best medical approach to treat endometriotic ovarian cysts is controversial, as it may delay the fertility, the lady desires.

Should we remove the endometriosis by surgery is matter of debate.

With surgery , there are great chances that it may affect the ovarian reserve and impairs the responsiveness to treatment, and also does not offer any additional benefit in terms of fertility outcomes.

In addition, surgery is great risk to women, as it is mostly a complicated surgery.

The laparoscopic removal of bilateral endometriomas prior to IVF should be limited to those cases with normal ovarian reserve, presence of pain symptoms, rapid growth or sonographic features of malignancy.

Conversely., in the absence of the above-mentioned features, patients with bilateral endometriomas should be encouraged to proceed directly to IVF to reduce time to pregnancy, to avoid potential surgical complications and to limit costs.

The retreival of oocytes may be less in endometriotic cases, compared to normal, but the quality of oocytes may be same and pregnancy rates may be comparable, if lady goes for IVF as early as possible, when all conservative approaches are exhausted

Blastocyst transfer may help in repeated IVF failure cases

Recurrent implantation failure may identified after three failed IVF cycles or after transfer of 10 high grade embryos. There are many different factors which may contribute for this recurrent IVF failure, such as parental chromosomal translocations, abnormal uterine anatomy , hydrosalpinx, or inadequate  culture conditions or embryo transfer techniques.

Failure may be due to factors with the “Seed,Soil or the Cultivator”

Some studies have suggested that local injury of the endometrium by means of a catheter or hysteroscopy can induce an inflammatory response that may facilitate the preparation for implantation.

Artificial rupture of the covering of the embryo ( Zona pellucida) may improve implantation: Assisted Hatching, but is still not proved.

Pre-implantation genetic screening of the embryos is now a day used to get and select best embryos. But this strategy did not show any improvement in patient outcome  and did not show any significant difference on clinical pregnancy rates.

A few studies have reported that congenital and acquired prothromotic conditions are more prevalent in women with recurrent implantation failure. Therefore use of low molecular weight heparin (LMWH) and mini dosage of aspirin on patients with thrombophilia and recurrent implantation failure has been discussed, but large studies are required to prove them .

Finally, another possible strategy is to extend embryo culture to blastocyst stage, aiming to improve embryo selection and uterine receptivity

Bed rest after Embryo transfer in In-vitro fertilization

Bed rest after Embryo transfer in In-vitro Fertilization treatment

Few common questions and concerns after Embryo Transfer.

* What will happen when I stand up?

* For How long I should be in bed ?

* Can I go for a pee , my embryos may come out .?

* That center asked my “friend” to be in bed after embryo transfer for 15 days, and she got the child.

Is there any evidence that : Bed rest after embryo transfer increases implantation or live birth rate?

In Fact : there is no evidence that it does.

There should not be any guilt that, ” If I could have taken an absolute bed rest , may I become pregnant”

It has been shown that: Women, a few minutes after embryo transfer, can stand , empty bladder and return home with no apparant risk to the process of implantation. No restriction of the routine activity or the patients need be advised after the transfer.

The UK National institute of clinical excellence (NICE) in 2004 issued the NICE Clinical Guidelines 001 for Fertility (2), which included the following recommendation:

1.11.9.4 Women should be informed that bed rest of more than 20 minutes duration following embryo transfer does not improve the outcome of in vitro fertilization treatment.

Better take your embryo for a walk. moderate exercise and intercourse around embryo transfer has shown to improve implantation and pregnancy rates.

Cost cutting in IVF ICSI treatment.

Cost cutting can be done by multiple ways in IVF treatment.

One of the most important aspect is Drugs used in IVF treatment.

Low cost IVF can be done if we use Urinary derived gonadotropins.

Now a days, may be because of market pressure or because of misinformation, many IVF centers started using Recombinant Gonadotropins in place of age old urinary gonadotropins.

Do you know that Urinary products, esp Human Menopausal Gonadotropin(HMG) gives better results that Recombinant(Rec FSH) ones ( Ref: Cinics Review Articles in ObGy clinic of north america March 2015).

HMG is one third of the cost of Rec FSH. Hence we made our cost structure IVF may be one fifth to one sixth of many IVF Centers in world.

We use mostly HMG  and it gives very good Blastocysts. Very good IVF success rates, some times the implantation rate goes up to 80-85%. But over all implantation rate is 60-65%

 

Child born from Frozen, Vitrified embryo, after 2 and half years of storage

This lady undergone IVF treatment, she conceived with twin pregnancy,. The pregnancy went well till 6th month. But she started bleeding and aborted both the baby one after another. The second baby was alive for one month ,but died due to prematurity in nursery. We vitrified her extra embryos and transferred two of them after she recovered completely from that episode. One embryo implanted and she had a full term live baby. Now baby is grown so beautiful and intelligent.

Luteal Phase support in IVF treatment, can we make it little comfortable for female partner

When  IVF  is performed, in many centers, after egg retrieval, they start injection Progesterone daily for at least 15-20 days till the day of pregnancy confirmation. It is really a painful phase of fertility treatment. Injections of progesterone are usually  oil based and they dissolve slowly. When you inject it , it makes a small lump in the muscle, either in buttock or arm. It is very painful experience for the female partner.

Can we make this luteal phase little pain free, or can we make Fertility treatment little bit more comfortable.

Female partner suffers the most in IVF treatment, even if the fault may be in male partner, She has to receive injections for the growth of the eggs , undergo egg retrieval, and then injections for luteal phase support. And if she achieves pregnancy, then she might have to receive this injection may be for three months.

Here at Ideal Fertility center , we use vaginal progesterone and we usually or mostly do not use injections of progesterone for luteal support, and our pregnancy rate is at par with the best centers in world performing infertility treatment.

We try to make the IVF treatment comfortable as far as possible for the female partner. We try to make it more user friendly. Minimum visits, minimum blood tests, minimum injections, without compromising the outcome