Tuesday, June 28, 2016

Tushar Kapoor-single parent Surrogacy (What do you say) ?

#Tushar Kapoor becomes a dad , came as a surprise to many.First of all congratulations to him and his whole family.And as I clicked on the net to find some juicy gossip about a possible clandestine affair,it turned out to be interesting,informative,bold,unconventional and thought provoking piece of news.Single parent surrogacy!!

Not long back some one wanted to know the rights of single males to opt as an option for surrogacy#.The Indian Law allows an Indian female or male to opt for surrogacy legally.If you are a foreign national ,then you can't get it done in India legally.

The legalities associated with surrogacy is complex world over with no uniform law.India is one such country which allows the intended parents the legal rights by virtue of the contract signed by the surrogate mother.

Those who are curious about how can a male be a single parent..A male can have a Ovum donor,a surrogate mother and his sperm and take help of an # ICMR certified centre to go ahead with a surrogacy.

Single parent surrogacy has many ethical issues.There can't be a right or a wrong answer to them.Here we are taking care of an individuals right  and instinct to have child but at the same time it is also pertinent question.....what about the child?Is it in the larger interest of that child.I am no one to judge and would invite the readers to pour in their comments.

Same sex couples can't have children through surrogacy but if single parents can then obviously there can be loop holes which same sex couples can use to satisfy their parental instincts.And moreover it doesn't make sense either to deprive them of that instinct(but then in India same sex couples will have to wait to get it done legally till it is approved by our judiciary.

Thursday, June 23, 2016

Doctor : Please give me a twin.( Can I...May Be I can)

I am an attractive looking female in early 40s.Look younger than my age :)
Still I keep on asking my husband to perform a weight loss surgery on me when he shows me the pictures of people who were Obese and lost many kgs following a Bariatric surgery.I get annoyed and depressed at times or mostly.Being skinny was never my lives aim but to have toned body,6 packs ab and sun kissed skin was.And for a while I think he is giving unfair advantage to his patients. They are more uncontrolled and thus they can have surgery while I am thinner...I have to work hard to get my dream body.

And then comes a lady to me or rather two.Both have one prior baby and they ask me to perform an IVF on them to give them twins.They have got pots of money at home and they wish to have children who can enjoy.Fair enough.Demand is valid.Isn't it?Both these women are my ex patients and I am myself amazed how i managed to conduct so many vaginal deliveries in past.I am impressed by myself.

And I sit down thinking but fertility isn't an issue,how can I perform an IVF with desire to  have twin Pregnancy as an indication?And she cajoles me.Doctor it will be a great help and you know money is no issue for me.Ask whatever you want to.I trust you.And here I am ...she trusts me and how can I perform an un indicated IVF and how do I promise her a twin.The embryos might get implanted or they might not.I can't be so unethical as to put 4 or 5 embryos anyways and then performing the guillotine of reaming 2 or 3 with KCL.Even the Lady got horrified with this thought.Well she was justified in asking.I even got swayed for a while with her authentic demand and then the guidelines and ethics.So a NO.

And I know...no bariatric surgery.I need a personal trainer and not a Bariatric surgeon myself :) :) 

Wednesday, June 22, 2016

Freeze the future !! ( All about IVF)

Though there are many moments of my past which I want to vitrify and keep it frozen for ever,take it out once in a while thaw it,feel it and keep it back safely frozen.We all know freezing prevents early decaying or rotting.But this whole paragraph was just a weird imagination of freezing the moments.

Another scenario.A young woman visited for consult and told how young men aren't willing for commitment these days.And being human one ends up having sex with people who don't even commit long term.I could relate what she said with a similar condition in Sydney,where wealthy qualified Ladies in 30s couldn't find a partner to have child with as these 40 plus boys were interested in skate boards,cycling,maintain a physique and a half age trophy wife.

So what?So a very big social dilemma.What happens of women who want children and can't have as they don't have a committed partner or husband?or still further she has either but wants to defer pregnancy for a career she always dreamt of?

There comes the role of oocyte freezing.There are techniques by which the stimulate ovary is used as a site of oocyte retrieval and then the eggs are frozen for ages.Suppose a lady decides to get it frozen at the age of 30 years her egg
will remain 30 year old when she turns 40 years.And thus her  chances of conception by using that stored egg is same as that for a 30 year old lady and not 40 year old lady .Amazing...isn't it.

So if career is important or till you find a proper partner,you can cryopreserve your eggs and make baby when you really want.

And most important is the age of egg for conception.Implantation failures are really a rare cause,otherwise 72 years old won't be getting pregnant with IVF with menopausal uterus
then(of course by donor egg).

This whole process is a reality.I would advise all the young women stuck in a dilemma like this to come and meet me at my clinic and I can enlighten you further.I can even come to your companies to talk about this rather sensitive and important issue.

Sunday, June 19, 2016

How Much Time Have I got Doctor?

It is not an uncommon question encountered by a routine Gynaecologist by Women in her 30s who wants to balance between a career and a family.Do we have an answer?Up to an extent yes but not certainly with a hundred percent certainty.

There is a hormone called AMH -Anti mystery hormone :) .Well this anti mystery hormone is actually called anti Mullerian Hormone.This AMH gives an idea of your ovarian reserve.It would not give any idea of the quality of hormone remaining but will comment on the quantity of ovarian follicles remaining at that particular time.Higher the AMH more is your ovarian reserve and probably you can wait few more years and vice verse.

AMH has other uses too.It is measured by Infertility specialist world over as the baseline which helps us in deciding the starting dose for Gonadotrophins for stimulating an IVF cycle or for that matter even IUI cycle.

Some interesting facts about AMH
AMH can be tested on any day of the cycle unlike FSH
It is higher in women who have PCOS simply because women with PCOS have at least 6 times more antral follicle than non PCOS women(even PCOS has something to cheer up about :) That is why in PCOS the risk of OHSS is more and your infertility professional is super careful about the dose of medication if needed for your ovulation induction.

But remember it the only mystery it clears is the amount of follicles not the QUALITY OF FOLLICLES,which deteriorates with increasing age. 

Friday, June 17, 2016

Love,stress and Dhoka (LSD)

Somebody asked me the other day.Doctor,why this sudden rise in abnormal children,Complicated pregnancies and increased conception with IVF?

Well the answer isn't too complex or complicated.Very straight forward.Even you can answer even if you are not a Medico.

The lifestyle has changed a lot in last 10-15 years.People fall in love and then get out of love and then again fall in love and get out of it , till  a women has reached in her 30s.Suddenly you realise the body clock is ticking away and you need to be in long term love and marriage too.(Indian community still is quite conservative.Partners aren't still so much in vogue as are the husbands).What ticks away are your ovarian follicles meant to be the eggs for ovulation and conception and baby.

You can exercise hard,you can get plastic surgery done,you can get office time shots of Botox and look half your age.But remember,you can't fool your ovaries which is loosing hundreds of follicle every month since your birth.And comes a point the quality of eggs remaining isn't of best possible quality,which increases
INFERTILITY,difficulty in conception,structurally and genetically malformed babies and increased rate of IVF Pregnancy or even failed IVF cycles.And that leads to stress,which anyways is no less already with all the approaching deadlines,pending assessments and probable promotions.A dream of moving to foreign land,decreased frequency of sex as it is anyways hampered by the hectic life of deadlines which both partners are living

And suddenly you feel cheated ( Dhoka) by the nature.While you were busy building your career ,Nature was busy stealing your oocytes or deteriorating it's quality.

Isn't the answer very simple and logical?

So do we stop building carriers?Absolutely not !! Do we have answers to deteriorating oocytes or depleting oocytes,a late age possible conception and still get good outcomes?Yes there is .Promise ....will try to give the answers in next post.But goes without saying....Natural way is the best without intervention of an IVF doctor like me.

Sunday, June 12, 2016

Women Health: Patience is a Virtue -Ovulation Induction for IUI

Women Health: Patience is a Virtue -Ovulation Induction for IUI

Patience is a Virtue -Ovulation Induction for IUI

There is a friend of mine,who insists patience is a virtue,has compelled me to be patient and leave my quick fix ways.And I am inculcating the habit.Patience is a virtue in personal life,professional life and life of even the patients we treat.

As always my posts are all motivated by real life posts.In last one month I came across 4 prescriptions showed to me by patients who had come to me for a second opinion regarding their subfertility treatment.Except for one,all three had 8-9 follicles > 16 mms ,were already given 10.000 IU of HCG and were ready for a spontaneous conception or IUI.It can be dangerous.Really dangerous.Multiple pregnancies are no fun neither is OHSS.

In this post I wish to talk of how much is too much for stimulation in cycle meant to be an IUI(Intrauterine Insemination)?I won't site specific cases as I realise that way the patients reading the posts can identify themselves and might not feel too comfortable.

IUI is known treatment for
Mild Male factor infertility
Unexplained infertility

For Mild factor Infertility(I will disscuss what is mild factor in next post) with no female factors even an unstimulated cycle is good enough and there is no advantage of using clomiphene citrate or Gonadotrophins

For Unexplained Infertility stimulation with Gonadotrophin + IUI gives maximal percentage of success.(more than Gonadotrophin alone or CC + IUI).If treating unexplained infertility my first line of treatment would Gonadotrophin + IUI but one needs to be cautious about the dose.
AMH levels give a fair idea about the initiating dose for IUI as well as IVF stimulation cycle.
THE AIM SHOULD BE TO DEVELOP NO MORE THAN ONE BUT MAXIMUM TWO LARGE FOLLICLES.Any thing more than that increases the level of multiple pregnancy and it's complication significantly.One way of acheiving it is by giving low dose FSH for 14 days straight(Now you know why I remembered my friend?He has made me understand the virtue of patience) and if need be increase the dose another 37.5 for a week and give trigger when we have a nice follicle ready for it and plan IUI.

If bychance you have give gonadotrophin in a dose higher than needed....well recognise the problem.Either ask the patient to abondon the cycle.Or talk with the couple if they are willing to get it converted to an IVF cycle.with 6-7 > 15 mm follicles and a trigger of 10000IU HCG,she would be definitely safter with an IVF than an IUI.One can control the number of embryo transfer as well as prevent OHSS by sucking out the follicle and follicle fluid.