Tuesday, 8 December 2015

Hazards of smoking on male and female fertility


                             “Love yourself enough to lead a healthy life "

We know that smoking can be a ground for cancer, heart problems, stroke and pulmonary diseases. Sadly, the list doesn’t end here, studies and analysis conducted worldwide indicates that smoking can cause infertility in both men and women. Smoking is not good for the health of  sperms and in turn has adverse affect on fertility. The fact is that smoking can actually cause infertility, miscarriages, preterm labours, growth retarded babies and the worst - childhood cancer.

Shocking fact is that more than one-third of the world’s population over the age of 15 years are smokers. 
Cigarette smoke contains more than 4000 harmful chemicals. It has around 60 carcinogens and mutogens including nicotine, carbon monoxide, heavy metals, benzopyrene, dimethylbenzanthracene, dimethylnitrosamine, naphthalene, and metanaphtalene. 

Negative consequences of smoking on  male fertility

The smokers semen samples showed reduced sperm count, motility  and viability. This low quality sperm is  less likely to fertilize eggs, which in turn inhibits the chance of conceiving.

Mechanism of action
Creatine kinase (CK) is an enzyme, expressed by various tissues and cell types that require high energy. This enzyme reversibly catalyzes conversion of creatine and adenosine triphosphate (ATP) to phosphocreatine and adenosine diphosphate (ADP). CK activity in seminal plasma, sperm cells and total semen considerably diminished with smoking. 

There is  permanent and severe DNA damage leading to prevention of oocyte fertilisation or the development of the embryo resulting in miscarriages. This damaged sperm loses its power to ward off destructive free radicals in semen. Toxic materials have also been detected in smokers semen. Nicotine  is also known to alter the hormonal balance through stimulation of cortisol, the growth hormone, which in turn will  curb the release of LH,FSH and PRL. Smoking can also lead to erectile dysfunction due to circulatory problems caused by the blocking of arteries.

The reactive oxygen species ( ROS) are atoms with unstable electron and are byproducts of metabolism of glucose in living cells. They grab electrons from surrounding atoms, making them unstable, which ultimately becomes like a chain reaction, making the cells damage, degenerate or mutate. The ROS is found to be high in smokers. In normal conditions anti oxidants  repair the negative effects by donating the extra electron that the ROS requires. The levels of antioxidants are found low in smokers, even their capacity to neutralise ROS is found to be less.

Leukocytes (WBC) are the major source of reactive oxygen species (ROS) in the ejaculate and elevated leukocytes impairs fertility by the formation of reactive oxygen species, which are in turn harmful to sperm DNA and membrane phospholipids because of oxidation, thus damaging sperms and causing mutation of genes leading to abnormalities. For more details on antioxidants read http://bangaloreivf.blogspot.ae/2015/10/what-are-antioxidants-and-their-benefits.html

Negative consequences of smoking on  female fertility


It is highly advisable for women to quit smoking before they plan their pregnancy. A pregnant smoker is risking her unborn baby’s life, as smoking aggravates the risk of spontaneous abortion, premature birth, very low birth weight, sudden infant death and ectopic pregnancies. I advice my patients to quit smoking at least 3 months prior doing the IVF procedure, as smoking unfavorably affects the procedure through premature aging of ovaries. Physiology of the men is such that they keep producing semen throughout their life. But women are born with a fixed number of eggs, if these eggs are damaged or depleted no amount of treatment can bring them back. Heavy Cigarette smoking has proven to cause tubal and  cervical problems  and DNA damages to the ovarian follicles. Even early menopause caused by premature aging of ovaries has been linked to smoking.


Dr. Anita Mani
Infertility& Surrogacy Specialist at Gift IVF Centre
anitadane@gmail.com

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Dr. Anita Mani is a renowned infertility specialist in south India with 15 years experience in ART (Assisted Reproductive Technology). Dr. Anita has successfully set up ART hospitals in Cochin and Bangalore,  along with her spouse  Dr. S Mani, who specialises in surrogacy. She completed MRCOG, from Royal College of Obstetrician and Gynaecologist  London, DFFP from  ART Warwick university and  worked in UK for 5 years. Dr. Anitha believes in scientific and ethical practice and is currently the director of Gift Gyno IVF centre Cochin and  Bangalore.  Apart from advanced laparoscopic surgeries, she is also an expert in various ART techniques including IVF, IUI, ICSI , donor egg / sperm  and surrogacy. Her proficiency is in genetic abnormalities and high risk pregnancies.



Sunday, 6 December 2015

Myths and Facts About Infertility










Infertility is a women's problem
This is untrue. It is shocking that even some of the educated people are quite surprised to know that infertility is a female problem in 35% of the cases, a male problem in 35% of the cases, a combined problem of the couple in 20% of cases It is commonplace that most of the cases of failure to conceive are blamed on women

I don't have to worry about my eggs until I'm 40.
As a woman ages, the ovarian reserve declines. A woman's egg supply starts to decline in the late 20s, again in the 30s and then most notably after age 35.
Under the best of circumstances, even in the case of a healthy young fertile couple whose timing is perfect, on the average, there are just about 25% chances of conceiving per month.So as the age factor goes up, chances of conceiving comes down drastically.

Maybe you two are doing something wrong!
Infertility is a medical condition, not a sexual disorder in most of the cases.

Men with Azoospermia ( zero sperm ) Cannot have kids 
Obstructive azoospermia is a medical condition when the person produces sperm, but it does not come out in semen due to blockage in the male reproductive tract, Testicular aspiration can be done to aspirate sperms and  ICSI can be done to achieve pregnancy.

Women without womb ( uterus ) cannot have babies
A surrogate mother can carry the biological baby of the couple and thus even women who are born without a uterus can have their own baby through surrogacy.

Infertility does not affect marriage 
Researchers found that, over a span of 12 years, 27 percent ( one-third ) of women who did not have children after their fertility treatments were no longer living with their partner. The study  comprised of 47,515 Danish women.


IVF is only the last option 
IVF can be the first treatment option for women with bilateral blockage of tubes, severe male infertility, and advanced age. Unnecessary delay and risks of prolonged treatment can be avoided by timely IVF.

IVF is only for affluent people
The cost of IVF has not increased over the years. it is less than buying a vehicle / furniture these days and results in a lifetime of happiness.


Women cannot conceive after menopause 
Through egg donor IVF, women can easily have children at any age.


Adoption is difficult
Earlier, many couples found that adoption was costly and time-consuming. 
New guidelines for adoption of children has become operational and under the new system, parents in India need not approach adoption agencies for registration. Parents can register online and upload relevant documents to determine their eligibility.

Infertility is nature's way of controlling population.
Zero population growth is a goal pursued now in this time of world overpopulation, but logically speaking couple can still have two children.


It is not an easy situation when you are struggling with infertility. You know what loving parents you would be, and it is painful to have to explain to others that you have a medical problem.

Dr. Anita Mani
Infertility& Surrogacy Specialist at Gift IVF Centre
anitadane@gmail.com

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Dr. Anita Mani is a renowned infertility specialist in south India with 15 years experience in ART (Assisted Reproductive Technology). Dr. Anita has successfully set up ART hospitals in Cochin and Bangalore,  along with her spouse  Dr. S Mani, who specialises in surrogacy. She completed MRCOG, from Royal College of Obstetrician and Gynaecologist  London, DFFP from  ART Warwick university and  worked in UK for 5 years. Dr. Anitha believes in scientific and ethical practice and is currently the director of Gift Gyno IVF centre Cochin and  Bangalore.  Apart from advanced laparoscopic surgeries, she is also an expert in various ART techniques including IVF, IUI, ICSI , donor egg / sperm  and surrogacy. Her proficiency is in genetic abnormalities and high risk pregnancies.

Saturday, 28 November 2015

Fenugreek for PCOS, Diabetes and other medical conditions









“One quarter of what you eat keeps you alive. The other three quarters keeps your doctor  alive”.

Since ages, fenugreek has been  prescribed in Ayurveda and Chinese medicine for curing and preventing of many diseases.  This plant is widely cultivated across the world and its seeds are used in many international cuisines as taste enhancers. In India, along with the seeds, the leaves of the plant is  also widely consumed. It is known as   “ Methi” in Hindi and “Uluva” in Malayalam.

To name a few, fenugreek can resolve  digestive problems like heartburn, acid reflux,abdominal pain and constipation, skin problems like eczema, inflammation, cellulitis, hair loss  and dandruff. The mucilage present in these seeds aids in smoothing of intestinal inflammation. Cholesterol and triglyceride patients can also benefit from the use of fenugreek.

Fenugreek seeds  contains protein, vitamin C, vitamin B6, niacin, potassium, iron, magnesium, manganese, copper and phyto nutrients.

One of the most remarkable quality of fenugreek is that, it  stimulates milk production in nursing mothers. According to aurveda, fenugreek can augment the quantity and quality of milk produced by the breastfeeding women.

Research have proved that, daily intake of fenugreek in the prescribed form can control and prevent diabetes. It has great soluble fiber content and amino acids, which seems to have the property to induce more insulin production and reduce  the rate of absorption of sugar in the stomach and improve glucose resistance.

Polycystic Ovarian Syndrome (PCOS) is a very common condition affecting women population and is one of the main causes of infertility. One of the characteristic of this condition is glucose intolerance, which may eventually lead to diabetes, obesity and excess secretion of testosterone. Fenugreek is considered to be one of the natural foods which can aid to control this condition.

During pregnancy,  excess use of fenugreek is not advised, as  it is said  to induce labor.

Chinese medicine recommends fenugreek for treatment of various kidney ailments. It also poses anti carcinogenic properties and is effective in preventing colon cancer by protecting the colon’s mucus membrane.

Women suffering from menopausal symptoms and menstrual discomfort can benefit from this plant. Fenugreek has chemicals similar to estrogen, hence mood swings, hot flashes and depression associated with menopause can be taken care of by taking in fenugreek. This herb is also said to be helpful in increasing libido and preventing erectile dysfunction.



The seeds have a distinct aroma and flavor and can be used widely in many dishes. You can powder and store the fenugreek seeds and sprinkle them in most of the curries and  add them to Dosa batter (That’s the secret behind the delicious Dosas in hotels). The sprouts are  easy to make and quite nutritious. The brave ones can soak some seeds overnight and have it in the morning along with the soaked in water. Though little bitter, researches indicate that this can do wonders in controlling diabetes and improving the general health.  The leaves of the plant can be added to the wheat dough before making chappathis or rotis and believe me, it tastes awesome. The dried leaves called “Kasuri Methi” is incredibly flavorsome and  is easily available in stores. This is a must ingredient in Indian dishes like butter chicken,  chicken tikka, and malai paneer.

watch this video and learn how to easily grow fenugreek in your garden 


 Dr. Anita Mani
Infertility& Surrogacy Specialist at Gift IVF Centre
anitadane@gmail.com

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Dr. Anita Mani is a renowned infertility specialist in south India with 15 years experience in ART (Assisted Reproductive Technology). Dr. Anita has successfully set up ART hospitals in Cochin and Bangalore,  along with her spouse  Dr. S Mani, who specialises in surrogacy. She completed MRCOG, from Royal College of Obstetrician and Gynaecologist  London, DFFP from  ART Warwick university and  worked in UK for 5 years. Dr. Anitha believes in scientific and ethical practice and is currently the director of Gift Gyno IVF centre Cochin and  Bangalore.  Apart from advanced laparoscopic surgeries, she is also an expert in various ART techniques including IVF, IUI, ICSI , donor egg / sperm  and surrogacy. Her proficiency is in genetic abnormalities and high risk pregnancies.








Tuesday, 27 October 2015

What are antioxidants and their benefits ?






Quite often we hear about the benefits of antioxidants, their indispensability for maintaining a healthy body, their magical power to ward off cancer, Alzheimer etc. etc….  But most of the public do not have a clue as to what are these antioxidants. To know how the antioxidants work in our favor, we will also have to know about free radicals, which are being produced in our body.

What are antioxidants?

Antioxidants are chemical substances naturally found in Vitamin C, E, A, flavonoids, phenolic acids and beta-carotene in fruits, vegetables, nuts, pulses and cereals which inhibit oxidation and prevent cell damage. It is also found in synthetic form,  which is used as preservatives in processed food, but the effectiveness of synthetic antioxidants is not clear or established.  The antioxidant donates an electron to the free radical, thus neutralizing it into harmless. An antioxidant assist in countering oxidative stress, caused by free radicals.

What are free radicals?

Free radicals, also known as Reactive Oxygen Species (ROS) are chemical species that are naturally produced in our body during metabolism as a byproduct. However, some free radicals are produced in the body due to external factors like pollution, alcohol, smoking, medications, pesticides, infections, poor diet, toxins, radiation etc.  If free radicals are not controlled, it can attack the healthy cells of the body, resulting in oxidative stress posing danger to our health. Oxidation damages the cell membranes, cellular proteins and DNA. Preventing or fighting oxidative stress can go a long way in defending our body against tumors, cancer, heart problems, premature aging and scores of other body ailments. Deficiency of antioxidants will lead to piling up of free radicals in the body. A healthy dose of antioxidants will ensure that free radicals are deactivated before they start attacking the cells.

Sources of antioxidants

All the berry fruits, especially blueberry, blackberry,  cranberry and straw berry along with other fruits like apples, plums and grapes are loaded with the goodness of antioxidants. Phytochemicals, a form of antioxidant is found in tea and wine. Ascorbic acid, commonly known as Vitamin C is a very effective antioxidant present in most of the fruits and vegetables like capsicum, broccoli, and green leafy vegetables. Pulses like red kidney beans and black beans are also loaded with antioxidants. Vitamin E is fat soluble and found in abundance in nuts, fish, seeds, spinach, avocado, mango etc. Vitamin A is profoundly present in carrots, tomato, sweet potato, peaches and apples. Flavonoids have their presence in red wine, tea, soya and tomato and watermelon has lycopene content.

Role of antioxidants in pregnancy and infertility

Several studies conducted on pregnant women has indicated that a healthy dose of natural antioxidants do play a role in smooth pregnancy and in preventing miscarriages. Oxidative stress can be a reason for causing miscarriages, and some researches suggests that antioxidants may be helpful in preventing Pre-eclampsia (High blood pressure and protein in urine, during pregnancy can result in a fatal condition called Pre - eclampsia, which can cause preterm delivery.) Oxidative stress is also known to affect male fertility adversely by causing defective spermatogenesis. So infact, anioxidants can aid in improving the quality and quantity of the sperm.

Researchers have different opinions on whether, artificial supplements can give the same result as natural antioxidants.  So to be on the safer side, it is better to consume variety of  brightly colored fruits and vegetables, which will ensure a healthy dose of antioxidants. 



Dr. Anita Mani
Infertility& Surrogacy Specialist at Gift IVF Centre
anitadane@gmail.com
www.giftivf.com 
+91 484 2475031,  +91 484 2475034, 

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Dr. Anita Mani is a renowned infertility specialist in south India with 18 years experience in ART (Assisted Reproductive Technology). Dr. Anita has successfully set up ART hospitals in Cochin and Bangalore,  along with her spouse  Dr. S Mani, who specialises in surrogacy. She completed MRCOG, from Royal College of Obstetrician and Gynaecologist  London, DFFP from  ART Warwick university and  worked in UK for 5 years. Dr. Anitha believes in scientific and ethical practice and is currently the director of Gift Gyno IVF centre Cochin and  Bangalore.  Apart from advanced laparoscopic surgeries, she is also an expert in various ART techniques including IVF, IUI, ICSI , donor egg / sperm  and surrogacy. Her proficiency is in genetic abnormalities and high risk pregnancies.

Tuesday, 13 October 2015

Medical terms and definitions associated with IVF and ART procedures


Following are the medical terms and their definitions associated with IVF and other ART procedures, according to the assisted reproductive technology regulation bill issued by the Ministry of Health and family welfare

  1. “artificial insemination” means the procedure of artificially transferring semen into the reproductive system of a woman and includes insemination with the husband’s semen or with the donor’s semen
  2. “assisted reproductive technology”, means all techniques that attempt to obtain a pregnancy by handling or manipulating the sperm or the oocyte outside the human body and transferring the gamete or the embryo into the reproductive tract of a woman
  3. “assisted reproductive technology bank” means an organisation that is set up to supply sperm or semen, oocytes or oocyte donors and surrogate mothers to the assisted reproductive technology clinics or their patients
  4. “assisted reproductive technology clinic” means any premises, equipped with the requisite facilities for carrying out the procedures related to the assisted reproductive technology
  5. “biological parent” means the genetic parent
  6. “commissioning couple” means an infertile married couple, who approach an assisted reproductive technology clinic or assisted reproductive technology bank for obtaining service’s that the assisted reproductive technology clinic or the assisted reproductive technology bank is authorised to provide
  7. “couple” means a relationship between a male person and female person who live together in a shared household through a relationship in the nature of marriage which is legal in India
  8. “cryo-preservation” means the freezing and storing of gametes, zygotes and embryos
  9. “donor” means the donor of a gamete or gametes but does not include the husband who provides the sperm or the wife who provides the oocyte to be used in the process of assisted reproduction for their own use
  10. “egg”, means the female gamete namely the oocyte
  11. “sperm” means the male gametes produced in the testicles and contained in semen
  12. “embryo”, means the fertilised ovum that has begun cellular division and continued development up to eight weeks
  13. “fertilisation”, means the penetration of the ovum by the spermatozoon and fusion of genetic materials resulting in the development of a zygote
  14. “foetal reduction”, means reduction in the number of foetuses in the case of multiple pregnancies
  15. “foetus”, means the product of conception, starting from completion of embryonic development until birth or abortion
  16. “oocyte” and “ovum”, means, the female gamete present in the ovary, and an ovulated oocyte in which the first polar body has been released
  17. “patients” means an infertile married couple who comes to any registered assisted reproductive technology clinic and is under treatment for infertility
  18. “gamete”, means sperm and oocyte namely the egg
  19. “gamete donor”, means a person who provides sperm or oocyte with the objective of enabling an infertile couple to have a child
  20. “implantation”, means the attachment and subsequent penetration by the zona-free blastocyst, which starts five to seven days following fertilization
  21. “infertility”, means the inability to conceive after at least one year of unprotected coitus or an anatomical or physiological condition that would prevent a couple from having a child
  22. “Insurance” means an arrangement in which a company undertakes to provide guarantee of compensation to the family/ nominee/ beneficiary of surrogate mother/ oocytes donor in case of death and the compensation of medical expenses incurred in case of medical emergency to the surrogate and oocytes donor themselves and in case of any complications that have arisen during pregnancy which are likely to continue for the rest of life of surrogate and oocytes donor
  23. “Legitimate” means in accordance or in compliance with the existing/ established law or accepted patterns and standards
  24. “Medical Visa” means an official authorization/endorsement in a passport or similar documents issued by Indian High Commission or Indian Embassy permitting entry into and travel within India for treatment of infertility at an Assisted Reproductive Technology (ART) Clinic registered under National Registry of ART Clinics
  25. “Foreigners Regional Registration Officer/ Foreigners Registration Officer” means an officer having jurisdiction over the area for implementation of the Acts/Rules pertaining to foreigners where the assisted reproductive technology clinic is located
  26. “Non Resident Indian (NRI)” means an Indian citizen who is ordinarily residing outside India and holds an Indian Passport
  27. “Overseas Citizen of India (OCI)” means a person registered as Overseas Citizen of India (OCI) under section 7A of the Citizenship Act, 1955
  28. “People of Indian Origin (PIO)” means a person who or whose any of ancestors was an Indian national and who is presently holding another country’s citizenship/ nationality i.e. he/she is holding foreign passport
  29. “Pre-implantation Genetic Diagnosis” includes the technique in which an embryo formed through in-vitro fertilisation is tested for specific disorders prior to the transfer
  30. “Record” means documents pertaining to infertile couple, gamete donor and surrogate mother’s medical history, diagnosis/screening, types and steps of treatments/ procedures and their complications, if any and final outcome, written consent’s, agreement’s, No Objection Certificate’s (NOCs), other related documents etc.
  31. “surrogacy” means an arrangement in which a woman agrees to a pregnancy, achieved through assisted reproductive technology, in which neither of the gametes belong to her or her husband, with the intention to carry it and hand over the child to the commissioning couple for whom she is acting as a surrogate
  32. “surrogate mother” means a woman who is a citizen of India and is resident of India, who agrees to have an embryo generated from the sperm of a man who is not her husband and the oocyte of another woman, implanted in her to carry the pregnancy to viability and deliver the child to the commissioning couple that had asked for surrogacy
  33. “surrogacy agreement” means an agreement between the commissioning couple availing of assisted reproductive technology and the surrogate mother; (zt) “zygote” means the fertilized oocyte prior to the first cell division.

 Dr. Anita Mani
Infertility& Surrogacy Specialist at Gift IVF Centre
anitadane@gmail.com

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Dr. Anita Mani is a renowned infertility specialist in south India with 15 years experience in ART (Assisted Reproductive Technology). Dr. Anita has successfully set up ART hospitals in Cochin and Bangalore,  along with her spouse  Dr. S Mani, who specialises in surrogacy. She completed MRCOG, from Royal College of Obstetrician and Gynaecologist  London, DFFP from  ART Warwick university and  worked in UK for 5 years. Dr. Anitha believes in scientific and ethical practice and is currently the director of Gift Gyno IVF centre Cochin and  Bangalore.  Apart from advanced laparoscopic surgeries, she is also an expert in various ART techniques including IVF, IUI, ICSI, donor egg / sperm  and surrogacy. Her proficiency is in genetic abnormalities and high risk pregnancies.

courtesy :  assisted reproductive technology regulation bill issued by the Ministry of Health and family welfare

Sunday, 11 October 2015

Moringa (Drumstick) - key to your infertility woes and answer to a multitude of ailments



It won’t be an exaggeration to call Moringa Tree (Drumstick)  a “ MIRACLE TREE”. All the parts of the tree like, the leaves, bark, fruits, flowers,  sap, seeds, oil and even the root has medicinal or commercial utilities. Since ages, this has been utilized in Ayurveda to prevent and cure more than a hundred diseases and for enhancing general health and boosting immunity. I can go on and on and write pages about this precious tree, which is a powerhouse of goodness. But I will just give a brief account of the medicinal and nutritional properties of this plant

It is near to impossible to find a plant with as much Protein, Vitamin C,A, Pottassium, Calcium content as in Muringa leaves. It also has significant traces of Thiamine, Riboflavin, Niacin and Pyridoxine.

Muringa leaves  is known to stabilize blood pressure and sugar. It also seems to have diuretic and antiseptic properties, is  effective in curing headaches, fevers, infections, arthritis, anemia, parasite infection, ulcers and constipation.

The high protein content in muringa leaves make it an ideal food for vegetarians, as this is one vegetable, which can almost match the protein content in animal meat. Studies prove that the protein in muringa is better and higher than in soya. The amino acids essential for our body is present in these leaves. Even after drying, the leaves retain lot of its nutritional value, this along with the cheap and easy availability makes it ideal as a supplement for the malnourished  people in the third world countries.

In India, especially in the southern states, drumsticks and the leaves are revered as an aphrodisiac and is eaten to increase the sex libido, correct erectile dysfunction and improving the semen quality.  Male and female infertility is now a global challenge and  the tonic made out of flowers and leaves of  muringa is said to be a remedy for this crisis. It is also prescribed to the breastfeeding moms to enhance milk production.

The oil extracted from the seeds and roots also have scores of benefits. The unique property of this oil is that  it doesn’t turn stale even after years, hence is used  in perfumes, cosmetics and as lubricant  in machinery and watches.

Muringa is an easy to grow tree which requires minimum maintenance. In olden days, it was an asset to the South Indian kitchen backyards. The pesticide free fruits, leaves and flowers can augment the nutritional value of your food and keep you far away from illnesses.

   "All that man needs for health and healing has been provided by God in nature, the
                                 Challenge of science is to find it."

Dr. Anita Mani
Infertility& Surrogacy Specialist at Gift IVF Centre
anitadane@gmail.com

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Dr. Anita Mani is a renowned infertility specialist in south India with 15 years experience in ART (Assisted Reproductive Technology). Dr. Anita has successfully set up ART hospitals in Cochin and Bangalore,  along with her spouse  Dr. S Mani, who specialises in surrogacy. She completed MRCOG, from Royal College of Obstetrician and Gynaecologist  London, DFFP from  ART Warwick university and  worked in UK for 5 years. Dr. Anitha believes in scientific and ethical practice and is currently the director of Gift Gyno IVF centre Cochin and  Bangalore.  Apart from advanced laparoscopic surgeries, she is also an expert in various ART techniques including IVF, IUI, ICSI, donor egg / sperm  and surrogacy. Her proficiency is in genetic abnormalities and high risk pregnancies.


Monday, 5 October 2015

Is the future of Intra- Cytoplasmic Sperm Injection (ICSI) - PIEZO ICSI ?



When I attended the ACE 2015  conference, I was privileged to listen to an  interesting lecture by a Japanese embryologist. It was concerning a new technology called PIEZO  ICSI, wherein  vibration was used to puncture the egg instead of a needle, as employed in conventional  ICSI procedure. 

First let us understand the conventional ICSI procedure. ICSI is a process in which a sperm is directly injected into an egg. In current micromanipulators, sharp needle is used to forcibly penetrate the egg  through the zona pellucida (protecting cover of egg ) which causes considerable deformation of the zona or in simple terms creates a hole. This deformation may increase the internal pressure of the oocyte, (egg) induce the emission of ooplasm (cytoplasm inside the egg) from the oocyte after removal of the needle and may cause oocyte death.

Since the cytoplasm inside cell (egg)  has high extendibility, the inserted needle may not penetrate the cytoplasm. So the sperm should be injected after aspiration of the matter into the pippette, which is done by the embryologists. They aspirate little cytoplasm  and then only inject the sperm into the egg cell.

The first report on piezo-ICSI was published by Kimura and Yanagimachi (1995), who used mice as subjects. By means of this method, egg penetration can be achieved by voltage of piezoelectric elements. Similarly, after the cytoplasm is reached it can be punctured by applying one piezo pulse. 

So basically vibration is used to puncture the egg, there is no sharp needle, but only a smaller blunt needle. Therefore, chances of injuring the egg is less. Moreover, there is no need to aspirate the matter from egg contents to confirm entry, which again reduces the chances of harming the egg.

Currently, this method is being used in Japanese fertility centers, with higher success rate than conventional ICSI.  It is quiet expensive to maintain an ART lab, so upgrading with new equipment can be a challenge in the current Indian scenario, as ultimately the patients will have to  bear the brunt.




Reference

Dr. Anita Mani
Infertility& Surrogacy Specialist at Gift IVF Centre

-------------------------------------------------------------------------------------------------
Dr. Anita Mani is a renowned infertility specialist in south India with 15 years experience in ART (Assisted Reproductive Technology). Dr. Anita has successfully set up ART hospitals in Cochin and Bangalore,  along with her spouse  Dr. S Mani, who specialises in surrogacy. She completed MRCOG, from Royal College of Obstetrician and Gynaecologist  London, DFFP from  ART Warwick university and  worked in UK for 5 years. Dr. Anitha believes in scientific and ethical practice and is currently the director of Gift Gyno IVF centre Cochin and  Bangalore.  Apart from advanced laparoscopic surgeries, she is also an expert in various ART techniques including IVF, IUI, ICSI , donor egg / sperm  and surrogacy . Her proficiency is in genetic abnormalities and high risk pregnancies.


Tuesday, 29 September 2015

Donor- recipient synchronization for the success of donor egg IVF


Dr. Anita presented a paper on Donor- recipient synchronization for the success of donor egg IVF at the 2015 International congress of the “Academy of Clinical Embryology” held at KochiThe success of donor egg program depends greatly on the synchronization of both the donor and the recipient, to get simultaneous periods and to start the luteal support on time. 


Successful Synchronization :-


  • S  -  Simultaneous Periods
  • U  -  Ultrasound Scan
  • C  -  Coordination
  • C  -  Communication
  • E  -  Email Synchronisation 
  • S  -  Screening donor
  • S  -  Success
  • F  -  Freezing semen sample
  • U  - Unforeseen Risks
  • L  -  Luteal support



Simultaneous periods is a must, so change the period date of the recipient by giving combined pills or progesterone, as needed.  It is better not to change the period of the donor as it may be associated with longer stimulation and higher gonadotropin consumption and lesser pregnancy rate.
Ultrasound scan is the magic tool to success. Keep checking the follicular growth and endometrial thickness. In case thickness is not sufficient you can increase the dose or consider adding Sildenafil.
Coordination between the team members team comprising   infertility specialist, IVF coordinators, international client manager and embryologist is very important and they should meet regularly  to keep update of the list of patients, donors and their timing. Train efficient staff to be the coordinators who can communicate well and arrange for the timely screening. If patients are abroad, let them collect the medicines in advance, as it may not be available in some countries.
Communication with the patient and donor before starting the ART cycle should be constant, so that the program goes well. Provide guidance for recipients in the form of leaflets  and online information, to get proper understanding about the timing and procedure.Counsellor should meet both the donor and the recipient , to make them understand the implications fully and properly.
Email Synchronisation will be helpful for the NRI patients, this will help to reduce their frequency and number of visits. The female partner can be given priming tablets to start on the second day, so that she can cut short her visit for embryo transfer. The scans can be done locally and results mailed to the doctor, so that date of luteal support can be advised.
Screen the  donor at least 1 month before, or earlier to pickup potential problems like ovarian cysts, pelvic infections and other medical problems.screening should include AFC and AMH as  needed , so that the recipient does not end up with poor responder, after all the synchronization.Deficient endometrial lining  can be avoided by screening in advance. Difficult embryo transfer is not an issue, if there is MET
Success of the treatment depends on synchronisation, health of the donor, condition of endometrium of the recepient, ART lab facilities and the expertise of the medical team.

Freezing of semen sample can be done, when the male partner visits the clinic for the first time, so that a repeat visit can be avoided, when his wife comes for the donor egg program.

Unforeseen risks like Illness of the donor or her family member, can cause chaos, so the recipient should be counseled about the possibility. Some clinics have standby donors, who are on pill. 

Luteal support should be started for the recipient either the night before egg pick up or at least on the day of retrieval , as the window of implantation is small







Dr. Anita Mani
Infertility& Surrogacy Specialist at Gift IVF Centre
anitadane@gmail.com

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Dr. Anita Mani is a renowned infertility specialist in south India with 15 years experience in ART (Assisted Reproductive Technology). Dr. Anita has successfully set up ART hospitals in Cochin and Bangalore,  along with her spouse  Dr. S Mani, who specialises in surrogacy. She completed MRCOG, from Royal College of Obstetrician and Gynaecologist  London, DFFP from  ART Warwick university and  worked in UK for 5 years. Dr. Anitha believes in scientific and ethical practice and is currently the director of Gift Gyno IVF centre Cochin and  Bangalore.  Apart from advanced laparoscopic surgeries, she is also an expert in various ART techniques including IVF, IUI, ICSI , donor egg / sperm  and surrogacy. Her proficiency is in genetic abnormalities and high risk pregnancies.