HEALTH TRIBUNE Wednesday, October 16, 2002, Chandigarh, India
 


Management of infertility
Of assisted reproductive technologies
Dr Sumita Sofat
A
ssisted reproductive techniques (ART) overcome the hurdles preventing spermatozoan and oocyte fusion. The rapid advances in the technique of oocyte and sperm handling and better understanding in reproductive biology have contributed to the better management of infertility.

Amla + honey = good health
S.R. Mittal
V
itamin C is an essential ingredient for human beings. It is required for the synthesis of inter-cellular cement "collagen", which is responsible for keeping various cells of the human body together. As an oxidant, it acts like a cop in the body, apprehending the rowdy molecules called free radicals that are naturally formed during various chemical reactions in the body and have the potential to damage.

Painful effect of statins
WASHINGTON:
AUS doctor has said that he had identified a rare but painful side effect of taking statins, cholesterol-lowering drugs that are the most widely prescribed medication in the world.

Natural blondes
London:
Natural blondes have joined the list of endangered species. The last of them will become extinct by 2202, says a study by experts in Germany.

INFO CAPSULE
Lethal prostate cancer
Washington:
Experiments with tissue samples taken from the men who died of prostate cancer that had spread to their other organs might point to ways to detect — and target — the malignancy early enough to save lives, scientists here said.

  • Internet & health

  • Blood pressure drugs

  • Alzheimer vaccine

  • Pollution & heart disease

  • Genes & breast cancerTop







 

Management of infertility
Of assisted reproductive technologies
Dr Sumita Sofat

Assisted reproductive techniques (ART) overcome the hurdles preventing spermatozoan and oocyte fusion. The rapid advances in the technique of oocyte and sperm handling and better understanding in reproductive biology have contributed to the better management of infertility.

Successful assisted reproduction involves the careful coordination of both a medical and a scientific approach to each couple who undertake a treatment cycle, with close collaboration among doctors, scientists, nurses and counsellors. Only meticulous attention to detail at every step of each patients treatment can optimise their chance of delivering a healthy baby as a result.

For many couples who have exhausted traditional clinical and surgical treatments for infertility, these new technologies may offer the best hope for pregnancy. Through these procedures women with otherwise untreatable infertility problems have given birth to healthy babies.

Some of the commonly performed techniques: IVF-ET — In vitro fertilisation and embryo transfer; Gift — Gamete intrafallopian transfer; Zift — Zygote intrafallopian transfer; Prost — Pronuclear stage intrafallopian transfer; IUI — Intra-uterine insemination: Sift — Sperm intrafallopian transfer; and Dipi — Direct intra-peritoneal insemination.

IVF-ET was first successfully introduced in humans by Edwards and Steptoe in 1978, resulting in the birth of Louise Brown, the world’s first baby to be born after using this technique. In India the first ever scientifically documented baby conceived by IVF was born in August, 1986. IVF is a method of assisted reproduction in which the man’s sperm and the woman’s egg are combined in a laboratory dish where fertilisation occurs and the resulting embryo is transferred to the woman’s uterus.

Appropriate patient selection, ovarian stimulation, monitoring and timing of oocyte retrieval should provide the invitro-fertilisation (IVF) laboratory with viable gametes capable of producing healthy embryos.

Who are the suitable candidates?

Initially, it was only used when the woman had blocked or damaged or absent fallopian tubes (tubal factor). It is now used in patients with long-standing infertility not responding to conventional treatment, endometrosis, immunological problems, unexplained infertility, male factor infertility, i.e. less sperm count.

Is there a role for EGG and sperm donation?

Eggs and sperm from a healthy donor or spare eggs from IVF cases can be donated to couples who lack the capacity to produce those gametes. Thus, it is possible to treat women without ovaries and make them pregnant following the transfer of embryo resulting from a donor occyte fertilised with the husband’s spermatozoon. Contrari-wise, it is also possible from a woman who has ovaries but no uterus to contribute to the birth of a baby by fertilising her occyte with her husband’s spermatozoon and transferring the resultant embryo to a surrogate mother.

IVF-ET can be offered to a couple in whom infertility is due to oligospermia or due to blockage after collecting the spermatozoa above the block by micro aspiration.

What tests are required before IVF?

What tests are required before IVF?

Both men and women need to be investigated thoroughly as regards the cause of infertility. These tests include abdominal and vaginal scan, colour doppler, harmonal assys and complete semen analysis.

Basic steps of IVF

Super ovulation: During super ovulation drugs are used to induce the patient’s ovaries to grow several mature eggs rather than a single egg that normally develops each month. Depending on the programme and the patient, the drug type and the dosage vary. Most often the drugs are given over a period of seven to 10 days.

The growth of the follicle is monitored by ultra-sonographic screening of the ovaries, and blood samples may be drawn to measure the serum levels of estrogen and luteinizing hormone.

Oocyte aspiration: Ultra-sonographically guided approach to oocyte retrieval has become the procedure of choice.

Insemination, fertilisation and embryo culture:

On the day the eggs are HARVESTED, the husband provides a semen sample. Eggs are fertilised with the husband’s sperms in the laboratory. The union of these cells is termed as an embryo. A number of such embryos are formed. By careful monitoring of these reproductive cells, normal embryos are prepared for transfer.

Embryo transfer is done on an outpatient basis after 48 hours. No anaesthesia is needed.

Is admission required?

Woman may be admitted for ovum pick-up. Embryo transfer does not require admission.

Does women require to take extra rest?

No, normal activity may be undertaken after embryo transfer.

What is the success rate?

For any treatment cycle started, the expectation of a couple for pregnancy is about one is to four.

Newer procedures:

IVF technology is improving by leaps and bounds and many exciting advances have taken place recently. These are now available in India. They include Zona pellucida drilling by lasers or chemicals. By using "co-cultures" in which the embryo is cultured along with "feeder cells" in the culture dish, better pregnancy rate is claimed with co-cultured embryos as compared to embryos grown under traditional IVF conditions.

Embryo freezing:

Since most IVF programmes superovulate patients to grow many eggs, there are often many embryos. Since the risk of multiple pregnancies increases with the number of embryos transferred, many patients are left with spare embryos. It is now possible to freeze these embryos and store them in liquid nitrogen. These stored embryos can then be used later for the same patient so that she can have another embryo transfer cycle without having to go through superovulation.

Once stored, embryos can be used by the couple during a later treatment cycle, donated to another couple or removed from storage. Thus, embryo freezing provides an avenue for successful pregnancy in the patients with hypergonadotrophic hypogonadism or inheritable genetic disorder.

The writer is Director, Sofat Infertility & Women Care Centre, Ludhiana.
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Amla + honey = good health
S.R. Mittal

Vitamin C is an essential ingredient for human beings. It is required for the synthesis of inter-cellular cement "collagen", which is responsible for keeping various cells of the human body together. As an oxidant, it acts like a cop in the body, apprehending the rowdy molecules called free radicals that are naturally formed during various chemical reactions in the body and have the potential to damage. Vitamin C is also required for dentin formation in the teeth and it also aids in the absorption of iron from the body.

Rats have the capacity to synthesise vitamin C with their body whereas human beings are required to provide it through diet. The richest source of vitamin C is amla (Emblica Officinalis). The secondary source is lemon, lime, oranges, papaya, pineapple, cabbage, cauliflower, green peas and tomatoes. While cooking above 70 degree centigrade vitamin C gets destroyed.

Scurvy is the disease caused by the deficiency of this vitamin. In its shortfall, gums are swollen or bleeding, wounds are weak and readily fractured, haemorrhages, delayed wound healing and poor teeth formation in children. A balanced diet with vitamin C is the requirement to avoid scurvy. Pregnant or lactating mothers and in a stressed and traumatic patient, vitamin C is the remedy.

Each adult is required to consume 75 mg per day; an infant 30 mg per day; a pregnant woman 100 mg per day; a lactating mother 150 mg per day. Doctors use vitamin C for the treatment of infections, healing of ulcers, burns and trauma, quick healing of fractures, etc.

However, taking vitamin C tablets on a long-term basis is not without side-effects like the reformation of oxalates, kidney stones, diarrhoea, abnormal heart rhythm, damage to the outer layer of teeth and rebound scurvy if tablets are stopped abruptly.

Amla with honey is a super tonic, particularly when treated with solar rays since honey is an ingredient that provides instant energy without consuming insulin for its absorption in the body. A newly born child in India is first provided with honey to purify his/her internal system since it acts as antibiotic and also without side-effects.

Most of us are not aware that during World War II a lot of food material was sent to the British army fighting for and on behalf of the British Government in different parts of the world. In this food material amla was one of the main ingredients to save fighting forces from scurvy disease since during day-time they had to live in bunkers and during night-time they had to fight. Therefore, they were generally deprived of sunlight which is a major source of vitamins and enzymes for human body.

Therefore, vitamin C in the form of amla is best for human health.

The writer is a Trustee, Nature Cure Education Trust, Ludhiana.
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Painful effect of statins

WASHINGTON: AUS doctor has said that he had identified a rare but painful side effect of taking statins, cholesterol-lowering drugs that are the most widely prescribed medication in the world.

A few patients who complain of muscle-aches when taking the drugs could actually be suffering from a toxic side-effect — and standard tests used to detect the problem may not always work.

A similar problem forced the recall last year of Bayer AG's statin Baycol. Some patients suffered severe muscle damage and an estimated 100 died.

The usual way to look for the problem is by measuring levels of an enzyme called creatine kinase, produced when muscle is broken down. Reuters
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Natural blondes

London: Natural blondes have joined the list of endangered species. The last of them will become extinct by 2202, says a study by experts in Germany.

Researchers predict the last truly natural blonde will be born in Finland — the country with the highest proportion of blondes. But they add that too few people now carry the gene for blondes to last beyond the next two centuries. The problem is that blonde hair is caused by a recessive gene. ANI
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INFO CAPSULE
Lethal prostate cancer

Washington: Experiments with tissue samples taken from the men who died of prostate cancer that had spread to their other organs might point to ways to detect — and target — the malignancy early enough to save lives, scientists here said.

The research unfurled a potential red flag for metastatic, or spreading, prostate cancer. Using state-of-the-art technologies, tissue analyses revealed levels of a protein called EZH2 appear to rise as the disease heads into the final, fatal stage.

"We found the greatest EZH2 overexpression in metastatic prostate cancer tissue," said Dr Arul Chinnaiyan, assistant professor of pathology and urology at the University of Michigan Medical School in Ann Arbor and lead author of the study published in the October 10 issue of the British journal Nature. UNI

 

Internet & health

Hanoi: Internet use in Vietnam is negatively affecting the health and education of young people and encourages truancy, state-run media says.

Many pupils and students skip school in favour of using the Internet for hours, which costs them money and their health.

A report by the Ministry for Culture and Information said that there are around 4,000 Internet cafes in Vietnam, used mainly by 13 to 25-year-olds. DPA

 

Blood pressure drugs

CHICAGO: Drugs that combat high blood pressure can fight off dementia and other advanced-age mental problems among blacks - a finding already known to apply to whites, a study has said.

The finding is significant because hypertension, for genetic and other reasons, is a disproportionate problem among blacks compared to Caucasians, the report from the Indiana University School of Medicine says. Reuters

 

Alzheimer vaccine

WASHINGTON: Modifications to an experimental vaccine for Alzheimer’s disease that was discontinued because of side-effects might make it safe, a study suggests.

Researchers in Canada and Germany found that a more refined form of the vaccine worked in mice, which raised the chance that it might not produce in humans the inflammation that ended clinical trials.

That remains only a possibility and requires more research, said JoAnne McLaurin of the Centre for Research in Neurodegenerative Diseases at the University of Toronto. She is the first author of the study being published in the online edition of the journal Nature Medicine. AP

 

Pollution & heart disease

NEW DELHI: High levels of pollution in the country’s cities may be adding to the risk of heart diseases, experts warn calling for more research in the area.

Atmospheric pollution has been observed to be associated with the progression of atherosclerosis deposition of fatty material in blood vessels that leads to heart diseases — in experimental animals and increased cardiovascular morbidity and mortality in humans as observed in developed countries, Prof Anoop Misra and Dr Naval K. Vikram of the AIIMS Department of Medicine said. PTI

 

Genes & breast cancer

SYDNEY: In a significant breakthrough, researchers from Australia and Canada claim to have found that high breast density, the strongest known risk factor for breast cancer, is genetically linked.

"The hunt is now on to find the genes. Once found, the genes may help define new sub-type of breast cancer, and enable targeted prevention strategies and treatment. It might also explain a greater amount of the genetic effect on breast cancer than do the recently discovered genes BRCA1 and BRCA2," says Prof John Hopper, Director of the University of Melbourne's Centre for Genetic Epidemiology.

Women with breast density in the top 20 per cent have a five-fold increased risk of breast cancer than women in the bottom 20 per cent for their age. ANI
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