Monday, 31 March 2014

Truths about low Sperm Count

More is better and less can always reduce the chance of positive! This is the normal belief of human beings. Same is with men, who are worried about low sperm count. Free advices to increase the sperm count could be seen splashing on the internet, few of those include, cold water shower, wearing boxers, and lots of almond. The truth is low sperm count does not mean infertility.  

Sooner the myths and misconceptions related to sperm counts are warded off, better the understanding of sperm count. Lots of men fear of the decline of sperm count based on groundless facts. For such men, it is important to understand that for a normal sperm count is around 15,000,000 sperms per ml (as defined by World Health Organization). Higher sperm count does not increase the chances of pregnancy, only men need to have normal sperm count for the same. 

The bitter reality is there are no medication or laboratory methods to increase the sperm count. Lower sperm count can/cannot be genetic. However, under the pressure of men, few doctors prescribe medicines to keep them satisfied only knowing that sometimes human psychology works better than medications.

Occasionally, the patients with low sperm counts are given HMG and HCG injections, proxeed, testosterone, Vitamin E, Vitamin C, anti-oxidants, high-protein diets, even homeopathic pills, in desperate cases ayurvedic churans and even varicocele surgery. Men should understand that there are no real ways to increase the sperm count and few doctors tend to reap benefits from men’s desperation. 

Patients think that the doctor has pill for every ill, while doctors think that there is no harm in prescribing few harmless medicines. In such confusion, men fail to explore the options like IVF and ICSI.

Men need to stop smoking and stop drinking alcohol. If men encounter the count persistently low, and the futile attempt to get pregnant, then you should consider going in for ICSI treatment. The test will not improve sperm count but it will be the best way to have a baby. 

Dr Neeraj Pahlajani

Sunday, 30 March 2014

IVF treatment cost

Cost chart of IVF treatment can be an instant pocket burner for patients, who long for parenthood but their financial condition handcuffs their longings. Knowing that IVF is the best option to have a child, patients flock the infertility clinics with seeded hopes. However, their spirits are dampened if they find to cost unaffordable. 

Sometimes, the concocted facts about the process and false allegations adds insult to the injury of doctors, who find themselves wedged in a situation when they want to treat the patients but cannot give financial assistance to them. The situation is equally tough for doctor, when he sees a patient walkout of the door, knowing her chances of conception. The exclusion of IVF treatment from health cover frustrates the patients, who are informed by the health insurance companies that assisted reproductive technologies (ART) are not covered by insurance and infertility is not counted under the types of illness. The tests, medication and checkups add up to thousands of dollars and doctors have no control over it. They offer best treatment without compromising the legitimacy of any process.

For a patient to understand IVF is a process of forming embryos outside the uterus and perform natural process inside a laboratory requires latest equipments with injections, monitoring and procedures. The process might cost dear but for the patients living abroad, coming to India is a much cheaper deal. India, the treatment costs less than half what doctors charge in countries like United States without compromise of treatment. Patients should not be disheartened as the treatment fulfills their wish of having a baby, 
which could not be fulfilled through normal process.

The IVF treatment in Pahlajani IVF Clinic might prove cost effective as the clinic charges legitimate for the process. IVF treatment involves complex steps and tests involving the use of expensive equipments. There can be nothing more painful for a doctor to refuse his patients, knowing that he could actually help them sail out of the tempest.

Fertility treatment includes cost of an IUI cycle, IVF cycle using fresh embryos, ICSI procedure, and additional cost of PGD procedure plus the medications.

So, patients seeking ART such as IVF should choose their physician carefully and weigh a number of factors. If cost is a factor in your decision making, ask the clinic for a detailed list of procedures and corresponding costs.

Dr Neeraj Pahlajani

Saturday, 29 March 2014

What are Grade A, B and C embryos?

IVF cycle can be an emotional rollercoaster journey for women, who hanker for motherhood in the world of technology. Embryo transfer is an important step of IVF cycle. The day of embryo transfer fills joy and anxiety in the IVF laboratories, where many women cry while many others nervous enough to evoke their tear gland. 

For doctors, it is an acid test to counsel women about grades of their embryos. Doctors and embryologists refer them as grade A, B or C embryos to determine the quality before transfer in a woman’s uterus during IVF cycle.

Observably, not all the embryos are Grade A, but women need to be upset if they find their embryos of Grade B or Grade C

They need to understand that Grade B or Grade C embryo does not mean that they would reproduce abnormal babies. Grades are just the medical reference and it does not determine the health of the baby.

An embryo is referred as Grade A when all the cells are equal and there are no fragments. A Grade B embryo is an embryo which has more than 10% fragments or has unequal cells and Grade C is the lowest quality embryo.

So, a Grade A embryo has a better chance of implanting and becoming a baby as compared to a Grade B embryo. In both cases, baby will be completely normal and the grades are given to determine the chances ofimplantation.

Technology comes with some limitation and it is impractical for the doctors to predict if the embryos would be implanted or not. Women with poor quality eggs should not lose hopes of conceiving as the embryos are living organisms and they have ability to self-correct.  It has been observed that embryos which were Grade B on Day 3 turn into blastocysts by Day 5.

Quality and complications related like miscarriage or abnormalities have no relation. Women, who are implanted Grade B embryos does not mean they increase the chances of miscarriage. Likewise, if a woman miscarries with Grade B embryo then it does not mean that the quality of embryo led to the miscarriage. 

A goof IVF doctor ensures the embryo transferred in woman’s womb is of good quality to grow and become a baby. Not all Grade A embryos become babies and many Grade B embryos become healthy babies.

It is important for a doctor to give pictorial description of embryos to the patient, even if it is Grade B embryo. Pictures can do a lot more than words. 

Embryos in pictures can be more assuring than the medical terminologies provided in reports. IVF patients are generally under the shadow of emotions, so, it is important for a good IVF doctor to provide pictures of embryos to patients to understand the practicality of process. 

It is the duty of both doctor and patient to establish a clear channel of communication.

Dr Neeraj Pahlajani

IVF Implantation Failure – Embryo or Uterus?

The fundamental cause of continual failed embryo implantation during In Vitro Fertilization (IVF) treatment might depend on varied of reasons. It is important for a patient to have unparallel understanding about the procedure including the success rates.

Understanding that no doctor is omnipotent and IVF does not have cent per cent success rate, the patient should establish a resistance free channel of communication with the doctors to be well-informed and not na├»ve about the process. 

Without downplay of concerns, the doctors should ensure counseling of patients before IVF process, as it might incur huge emotional, financial and faith loss. If a patient is well informed then she would know the possibilities during and after the cycle.

If patient or doctors skips the part of counseling, then none can avoid the blame game subsequent to the process. After the failed cycle, patient will suspect the abilities of a doctor and immediately start the hunt for another doctor. It is inevitable truth that no one wants to face their weaknesses and to escape the stigma of blaming self for the failed IVF, patients blame the doctors.

However, the doctor should be truly blamed when he/she forgets to counsel the patients. It is important for a doctor to educate its patients, knowing that the technology is not a miracle and it might fail.

Dejected patients, who become more susceptible to surrounding environment, start consulting a number of doctors simultaneously to ensure that this time they conceive. They leave no stone unturned to find a new IVF specialist without knowing the exact reason of IVF failure. Additional tests ordered by new IVF doctors prove a medicine of assurance for patients, who sometimes think, more tests means more chances of conceiving. However, the tests rarely give precise information.  

If the new doctor also fails to help patient conceive then the faith on IVF process is lost! Many doctors blame it on the patient while few suggest them new tests to heavy their pockets with currencies.

Few patients get stuck in the ruthless cycle, while others give up! So it is important to understand that the chances of IVF failure fairly increase if the embryos are of poor quality. This might be because of the poor quality eggs.

Sometimes, the IVF technology used by the doctors is poor which might result in repeated failure. Few other reasons include sub-optimal super ovulation IVF protocol.
If the problem is with the uterine lining, then doctors should diagnose it during the ultrasound scans, which show that the endometrium remains thin and does not become trilaminar. 

Sometimes, patients are suggested to opt for surrogacy if the embryos develop into Grade A blastocysts in the lab and she fails to conceive after the transfer of 6 Grade A blastocysts over 3 cycles. Before undergoing the process patients should be well-informed and have faith on doctors, not blind faith.

Dr Neeraj Pahlajani

Tuesday, 25 March 2014

IVF - Facts and Myths

Walking on the road of technology wearing a hat of naivety could sometimes be more dangerous than thought. Deriving meanings from underlined facts about In-vitro Fertilization (IVF) and abiding by the rule-chart of doctor is highly recommended. For infertile patients, who sometimes are susceptible fruits hanging loose in land of extortionists, it important to understand that not every sentence written on unreliable websites is a version coming from the mouth of a doctor. Few are fluky facts while the rest are misleading myths.

To clear a few most common myths about infertility, it is important to know that infertility NOT a woman thing, it can be a women thing, it cannot be or even it can be both man and woman thing. It depends on the organ response of individual couple to process of reproduction. While it is important for women to walk a measured distance from addiction of cigarettes, or liquor to be called as barren women, obesity, hot tubs and smoking can lessen the sperm count of men.   

In women, drinking may lead to irregular menstrual cycles and anovulatory menstruation (menstruation that occurs without ovulation). Alcohol can also increase the risk of birth defects once a woman becomes pregnant and can cause a severe collection of birth defects known as fetal alcohol syndrome (FAS).

While age is the defining factor of fertility, infertility is not an alien thing. It will be unjust to curse yourself if you fail to conceive, as infertility is not sterility. It is just inability to conceive through the natural process. With technologies of assisted reproduction such as, IUI, IVF and ICSI, there are no limitations in conceiving.

While no fertility fruits are prescribed in general, but nutritious intake can contribute a fraction in fertility.

While the optimal conception age of a woman is between 18 and 29 years of age, the women above 30 can also conceive but the chances of infertility multiplies with age. On an average, female fertility declines slightly starting at age 27, but drops off in a clinically around age 35 and then dramatically at age 40.
While cancer has no direct relation with freezing of eggs, but the option is recommended for women under 37 years of age who are concerned about their fertility options.

While IVF is the process of forming embryos outside the body, it is the most natural way in which genetic composition of the man and the women need to form a baby. Since this process is not possible inside a woman’s body either because of tubal blockage or poor sperm count, IVF helps in bringing the egg and the sperm together outside the body.

While IVF failure brings a stroke of sorrow for couples, there are technologies like IUI through which can help getting pregnancy even after IVF.

While it is true that there are chances of multiple pregnancies with IVF, the skilled IVF results in single healthy child. There is a direct correlation with the mother’s age.

While the clown therapy works, it is totally untrue that that emotional distress (whether related to IVF, infertility, or other life events) reduces the chances of pregnancy.

While it is important to take necessary precautions, there is no need of complete bed rest required after IVF. Most patients can carry on with normal activities including job till the final stage of pregnancy.  

Dr Neeraj Pahlajani

Monday, 24 March 2014

When do you actually need PGS/CCS test?

It is important for every patient to know that female uterus has natural selection process that prevents implantation of abnormal embryos and majority of chromosomally abnormal embryos have reduced survival period and are rejected in early stages of development. However, in older women the eggs are often chromosomally abnormal - and the percentage of eggs with a chromosomal abnormality increases with increasing female age. 

The idea of testing the chromosomes before transfer is to implant effective embryos with normal chromosomes and reject the abnormal ones. Women with failed IVF cycles are susceptible to understand the need of these tests. The unilateral thinking that the test would ascertain their chances of conceiving would further expose such patients to trauma.

There are certain facts that patients need to know before undergoing the tests. The obsolete FISH method, which was limited to the testing of only 10 or 12 out of 23 chromosomes, provided the room for PGS/CCS (Comprehensive Chromosomal Screening) to enter the technology-era. Without much paddle, these methods embraced with much acceptance without drilling into the risks surrounding the method. To diminish the risks of IVF failure, CCS was used to avoid a failed transfer, miscarriage or a pregnancy complicated by an abnormal fetus such as Down’s syndrome.

In simple definition, Preimplantation Genetic Screening (PGS) is the process of ensuring the right number of chromosomes and check structural abnormalities in the chromosomes by screening the embryos. The process is also called aneuploidy screening.

PGS is thought to increase success rates for IVF in women over 35, as well as those who have suffered repeated IVF  or recurrent miscarriage. Comprehensive Chromosomal Screening (CCS) is a term used to refer to a type of PGS/aneuploidy screening. The method allows for the evaluation of all 23 pairs of human chromosomes on a single cell.

With CCS, there are five to 10 cells retrieved from a Day 5 or 6 embryos (blastocyst). The embryo has to be frozen while waiting for the result, and then in a separate cycle, the normal embryo is thawed and transferred. Biopsying a Day 5 embryo increases the accuracy of this testing and minimizes the potential damage that a biopsy can cause on an embryo because it has several hundred cells by then.

Patients are uncertain whether tests of early embryos before transfer will increase the chance of a successful pregnancy. But, the chromosomal screening of the embryos prior to choosing the best ones might damage the embryos from the biopsy procedure, which increases risk of failure.

While these tests can help reduce risk for birth defects and miscarriage, certain lesser known risks surrounding the latest embryo testing methods should also be considered. The major concerns involve, the embryos could be traumatized by the biopsy procedure. So it is suggested for patients wedged in situations like, females above 38 years old, with repeated IVF failure (more than three attempts), screened with inherited genetic diseases, carriers of chromosomal translocations or have had recurrent miscarriages.

Dr Neeraj Pahlajani 

Things you need to know about Ovarian Reserve

Ovarian reserve

The proportionality of age and female fertility depends on the capacity of ovary to produce enough eggs capable of fertility and ovarian reserve is the term used to define the above. Biologically, women are born with a defined number of eggs that deplete with age. With every passing month, the number of eggs decreases (with best eggs ovulated first) and the incidence of eggs with abnormal chromosomes (aneuploidy) increases. As a result, the older women have lower fertility and greater risk for miscarriage than younger women. “Ovarian reserve” generally describes the size, quality, and developmental potential of the remaining eggs in the ovary.

Low Ovarian Reserve

Ovulation cycle of a woman starts in early, with development of millions of eggs. Majority of these eggs before a woman decides to enter reproduction cycle. At birth, a female has around one to two million eggs at birth, which falls to 250,000 to 500,000 eggs at puberty. At 37 years of age, a woman will only have estimated 25,000 eggs and at menopause less than 1000.

Causes of Low Ovarian Reserve

Basic two reasons that leads to the decrease in number of eggs can be, chromosomal anomalies such as Turner Syndrome, where there the woman does not have two X chromosomes, or gene abnormalities such as Fragile X. Second, if the ovarian tissue is destroyed through torsion, surgical removal of part or the entire ovary, ovarian cysts caused by endometriosis, benign or malignant ovarian tumors, radiation or chemotherapy, immunological conditions, pelvic adhesions, or a high body mass index.

Problems in IVF due to low ovarian reserve

Low ovarian reserve can result in problems in conceiving and even miscarriage. The rate of IVF success depends on number of eggs the doctor can obtain at the egg retrieval. Women, who respond poorly to the stimulation, produce fewer mature follicles resulting in three times less chance of pregnancy. Old women produce less number of eggs and most of them are of poor quality. And, embryos formed from such eggs either decreases the chances pregnancy or increases the chances of miscarriages.

Tests to determine Ovarian Reserve

There are certain tests to determine the remaining egg supply in a women, Basal AntralFollicle Count test is one such test, in which, a transvaginal ultrasound test is performed to determine woman’s ovarian reserve. The female ovarian reserve determines the fertility potential. Females are born with a lifetime limited number of eggs in their ovaries in the time of birth. Puberty is the inception of egg release and by the time a woman reaches menopause, her egg supply (and potential fertility) is exhausted.

An antral follicle is a small, fluid-filled sac that contains an immature egg. The follicles can be seen, measured and counted on Cycle Days 2, 3, and 5 by using ultrasound. The number of eggs retrieved correlates directly with IVF success rates. When an average to high number of antral follicles (eight or more) are visible on the ultrasound, the good number of eggs are retrieved for IVF. If few antral follicles appear, a poor response is expected and the IVF cycle might be delayed or withheld.

Another test for testing ovarian reserve is Anti Mullerian Hormone (AMH) test. The test can be performed on any day of a woman’s cycle. AMH is a hormone produced by granulosa cells in ovarian follicles. Women with higher AMH values will tend to have better response to ovarian stimulation for IVF.  Women with lower AMH have lower antral follicular counts and produce a lower number of oocytes (eggs).

AMH test level do not determine the quality of egg. Having more eggs at the IVF egg retrieval provides an opportunity for a greater number of eggs to fertilize and develop into embryos.  More eggs do not always mean more embryos.  Egg quality is an important aspect of fertilization and development of embryos.  So, both the above tests are performed before IVF to determine the ovarian reserve.

Dr Neeraj Pahlajani

Friday, 21 March 2014

Must read books for Infertile Couples

The Baby Solution: Your Essential Resource for Overcoming Infertility
by Daniel Kenigsberg, Lauren Hartman

It is a book that would instill hope in lives of infertile couple with frank, practical and compassionate advice from an infertility specialist. The Baby Solution is a step-by-step, practical guide to overcoming infertility. Reassuring and friendly, this book will give readers an insider's view on getting expert care, providing information about intrauterine insemination (IUI), in vitro fertilization (IVF), and other standard infertility treatments, as well as the latest state-of-the-art care. It also includes such alternative means of improving fertility as acupuncture and traditional Chinese medicine. This essential resource gives readers tips to help them financially negotiate a field where the cost of treatment is high and the business concerns of clinics and doctors can sometimes override a patient's best interests. This guide will tell readers how to choose a doctor or a clinic that will give them the best chance of success, how to get the most out of their insurance coverage, and how to keep their relationship intact during treatment. Third-party reproduction options, including sperm and egg donation, surrogacy, and embryo donation, are also discussed.

Navigating the Land of If: Understanding Infertility and Exploring Your Options
By Melissa Ford

Understanding the complex world of infertility, author of the extremely successful blog Stirrup Queens and Sperm Palace Jesters, Melissa Ford helps the readers to navigate through the difficulties. The Land of If got its name not only because “IF” is the abbreviation for “infertility” in the online world, but also because there are so many “ifs” inherent in being here. No stranger to the Land of If herself, Ford shares her hard-earned knowledge and insights, helping couples struggling with infertility understand the lingo, learn the details doctors tend to leave out, and keep their emotional sanity despite seemingly insurmountable obstacles. Navigating the Land of If gives the nitty-gritty on injections, rejections, biting your tongue during happy parent-to-be conversations, and trying not to cry over baby shower invitations.

Unsung Lullabies: Understanding and Coping with Infertility
by Martha Diamond, David Diamond, Martha Diamond

The three specialists in the field of Reproductive Psychology have penned down their own struggles with infertility with an understanding that experiencing infertility could not be matched with any other emotional stigma. With insight and compassion, Drs. Janet Jaffe, Martha Diamond, and David Diamond give couples the tools to

*Reduce their sense of helplessness and isolation
*Identify their mates' coping styles to erase unfair expectations
*Listen to their "unsung lullabies"--their conscious and unconscious dreams about having a family--to mourn the losses of infertility and move on.

Ground-breaking, wise, and compassionate, Unsung Lullabies is a necessary companion for anyone coping with infertility.

Inconceivable: A Woman's Triumph over Despair and Statistics
by Julia Indichova, Christiane Northrup

A book that would push an infertile woman out of the stigma.

Misconception: One Couple's Journey from Embryo Mix-up to Miracle Baby
by Paul Morell, Shannon Morell, Angela Elwell Hunt 

It is a story of a couple eager to bring the new life into the world. After years of infertility and miscarriages, Paul Morell and Shannon Morell, finally had in vitro fertilization. In 2009, they are blessed with daughters had been born, and six precious embryos had been frozen.

They counted the days until they could transfer the six remaining embryos. Until the fateful day of February 17, 2009, when the clinic called. “The doctor would like you to come in today,” Shannon writes. “Face to face with the doctor, I noticed that his face was gravely serious. 'There's been a terrible incident in our lab,' he said. 'Your embryos have been thawed.' A pause, as we both exchanged disbelieving looks, and he went on...'Your embryos have been transferred into another woman.'" 

The Morells have a story to tell. It is a cautionary tale of medical errors, unexpected miracles, sincere mourning, and grateful bonding with their son. Amazingly, theirs is also a story of joy-filled thanksgiving...a story of life that is precious, sacred, and treasured.

Conquering Infertility: Dr. Alice Domar's Mind/Body Guide to Enhancing Fertility and Coping with Infertility
by Alice D. Domar, Alice Lesch Kelly

Infertility is a heartbreaking condition that affects nine million American couples each year. It causes tremendous stress, can trigger debilitating sadness and depression, and can tear a marriage to shreds. In Conquering Infertility, Harvard psychologist Alice Domar—whom Vogue calls the “Fertility Goddess”—provides infertile couples with what they need most: stress relief, support, and hope. Using the innovative mind/body techniques she has perfected at her clinic, Domar helps infertile women not only regain control over their lives but also boost their chances of becoming pregnant. With Conquering Infertility, women learn how to cope with infertility in a much more positive way and to carve a path toward a rich, full, happy life.

Do You Love Someone Who Is Infertile? What You Can Do to Help Her, What to Say to Support Her, and What You Should Never Do or Say.
By Shari DeGraff Stewart and Julia Fichtner Krahm

It is a book for everyone who has a woman around going through infertility. For people, who are confused to channel their emotions in form of love and support towards an infertile wife, daughter, sister, or friend, it a true guide in form of stories and advices. In a heartfelt collection, authors Shari DeGraff Stewart and Julia Fichtner Krahm help anyone who cares about one of the seven million infertile women translate love into supportive words and actions. Drawing from their own experiences and those of others, the authors offer compassionate guidance on how to address many common challenges that readers might face when helping a loved one through this difficult time.

Precious Babies: Pregnancy, Birth and Parenting after Infertility
by Kate Brian

A look at the common difficulties faced by women who had trouble conceiving, once they have that long-awaited positive pregnancy test When women who are attempting to conceive through IVF or other fertility treatments do become pregnant, they often expect that they will now be the same as any other pregnant woman—but the reality is that the experience of infertility continues to resonate during pregnancy, birth, and often long afterwards. Packed with case histories and informed by expert advice, this guide is the first to address the specific practical and emotional issues experienced by women who have struggled to become pregnant, and provide much-needed reassurance and support. It discusses and offers help for the increased risk of miscarriage, multiple pregnancies, premature birth, postnatal depression, and donor family issues. It also covers family life, early days, trying again, only children or more than one child, the teenage years, and beyond. (Courtesy: goodreads)

Dr Neeraj Pahlajani

Tuesday, 18 March 2014

Are you losing eggs after 30?

It is true that the biological clock of a woman ticks faster and louder with each passing year. But another parallel truth is that women are born with about 100,000 eggs, so the length of a woman's cycle, whether longer or shorter, does not predict a woman's fertility. Women lose eggs while they are busy racking up life experiences in their 20s. But, what matters more is not the quantity of eggs a woman loses but the quality of eggs she is left with. It depends on variety of factors including the genetics, and the habits.

It is tough to determine the pivotal age of a woman when her child bearing years actually end, but the there is a steady decline in production of ovarian eggs with biological clock ticking fast at 30. For women, who value their professional mobility tend to forget bitter truth about natural fertility, which declines through a woman's 30s and 40s. Quality ovarian eggs deteriorate with age and women find it difficult to conceive in during late 30s. 

By the time a woman turns 40, she is left with only 3 per cent quality eggs. 90 per cent eggs are lost throughout the biological cycle, which starts the day she hits puberty. Women, who tend to shelve the idea of getting pregnant before their escalating career increase the risk of having complications in conceiving. But women above 35 do not need to abandon the hope of having children as there are chances of conceiving through IVF.

Potential decline in ovarian reserve is directly proportional to age. While most of the women continue to produce eggs throughout their 30s and 40s, the reservoir of potential eggs shrinks to produce eggs that might give them problems while conceiving. With the approach of menopause, sometimes at mid-40s, women experience rapid decline of store and production of eggs. Healthy 30-year-old woman has about a 20 percent chance per month of becoming pregnant, while a 40-year-old woman has about a 5 percent chance per month.  

Ways to slow the ticking of biological clock

Women are you nervous listening to the tick-tick-tick of biological clock but there are no scientific ways or pills to retain the fertility but certain controlling obesity, stress and smoking can control the harmful effects on fertility. Women who have more pregnancies are fertile for longer, and some women are born with more eggs than others, she said. The more eggs with which a woman is born, the longer she will be fertile and more time she will have until the onset of menopause. 

Women’s egg count

Other than some indirect methods like ultrasound to measure size and volume in ovaries or blood tests that checks the hormone levels, there are no methods to calculate exact number of eggs in a women.

It is important to know that women in the 19-26 age groups have double the chance of conceiving each menstrual cycle compared to women between 35 and 39 years old. Age is the most powerful predictor of fertility and women need to be more “fertility aware”, especially about the factors that reduce the ovarian reserve.

Dr Neeraj Pahlajani


Monday, 17 March 2014

Legal issues and Ethical considerations surrounding Egg Donation

Egg donation, embryo donation, semen donation and surrogacy was legalized in the country after the Government of India appointed Indian Council of Medical Research (ICMR) to form the decree to sketch legal issues and ethical considerations surrounding the infertility treatments. The practice of donation, creating of embryos outside the body and storage that was derived more than a decade ago revolves around some Ethical Considerations and Legal Issues and Chapter 3 of ICMR defines the Code of Practice for infertility treatment. Pahlajani IVF Clinic strictly follows the norms defined by ICMR and preserves the rights of donors under the law.

Throughout the egg donation process, Pahlajani IVF Clinic ensures confidentiality of both donor and recipient. Under the legal agreement of the hospital, the identities are veiled, unless unusual circumstances of medical emergency or orders of court. Secondly, the donors are kept abreast of the legal, ethnic and risks involved in the procedure. The donors are informed beforehand that the offspring (if any) will not know her identity. Also, the recipients are au fait on the limitations tagged with the proposed treatment, techniques and possible side-effects.  

Pahlajani IVF Clinic encourages no treatment without the consent of infertile couple throughout the stages of treatment via a standard consent form to be filed before the process. Before initiation of any kind of process, the donors are serviced with thorough counseling sessions to ensure psychological involvement, balanced decision and push the degree of positivity to higher levels. In case, the donated eggs are used for research purpose, the projects are first approved by the Institutional Ethics Committee.

Criterion to be an egg donor with Pahlajani IVF Clinic

There are few requirements that an egg donor should meet, including, the age criteria that should be between 21 and 35 years. The girl/woman should be free from HIV, Hepatitis B and C, Hypertension, Diabetes, sexually transmitted diseases, and common genetic disorders such as thalassemia. Secondly, the hospital records and determines the blood group and the Rh status, and other relevant information in respect of the donor, such as height, weight, age, educational qualifications, profession, colour of the skin and the eyes, and the family background in respect of history of any familial disorder.

Pahlajani IVF Clinic protects the anonymity of the donor except the child demands the information after becoming an adult. Also, the donor shall have no parental right or duties in relation to the child.Ethical ramifications gyrating around gamete donation sometimes creates a vacuum in fertility treatment. While donors are concerned about autonomy, justice, beneficence, and non-maleficence, the recipients need assurance of the clinical reproduction service. However, Pahlajani IVF Clinic believes in informed decision making and conserves the interests of the donors. 

Pahlajani IVF Clinic walks on few defined principles of ensure health benefit and preventing harm to donors. Donors are well-versed about the longitudinal effects of the ovulation drugs and recoil of the process. 

Dr Neeraj Pahlajani

Saturday, 15 March 2014

Egg Donation Programmes at Pahlajani Test Tube Baby Center

Egg donation is a marvel of creating lives through modern technology. Considering the need of few women, who are unable to produce their own eggs or do not want their genetic conditions to pass on to their children, Pahlajani Test Tube Baby Center has been organizing several egg donation camps in Raipur.

It is important to donate eggs as some women, who are unable to produce their own eggs require donations for healthy pregnancy. Multiplicities of reasons are attached to infertility and requirement of donated eggs. Some women might have gone through the menopause early – as young as 20, few women are left infertile after chemotherapy or radiotherapy for cancer, while other women have genetic conditions that resist to be transferred to their offspring.

During the egg donation camp organized at Pahlajani Pregnancy Care, the donors are provided the medical care throughout the process to diminish the risk involved in the process. Eggs of women usually between 21 to 35 years of age are accepted. In the standard egg donation process, the donors might be prescribed a medication for one or more weeks to temporarily halt ovaries' normal functioning to ensure controlled response to fertility drugs.

The egg donation procedure aims to obtain several mature eggs through egg stimulation procedure. The process of stimulating the ovary to produce more eggs than normal is called ‘hyperstimulation’. Donors are suggested to abstain from intercourse or use contraception during the donation cycle to avoid pregnancy with sometimes twins, triplets or quadruplets. The donors need to undergo frequent blood tests and ultrasounds to monitor the periodical development of eggs in response to the hormones. The eggs are removed from the ovaries through minor surgical procedure called transvaginal ovarian aspiration. Hence, the donated eggs are transferred into recipient for in vitro fertilization (IVF). The extracted eggs are first incubated then used in IVF or frozen to be used later.

It is important to for a donor to know that the eggs may go to more than one recipient. Also, one or more women may conceive or no pregnancies may occur. Sometimes, the donated embryos are used by another couple, or used for research, or are left frozen indefinitely. It depends on the need of the situation. At Pahlajani Pregnancy Care, the donors are given medical assistance since the inception of donation cycle. Along with the medical assurances, the donors are helped to ease their inhibitions related to the process. Till date, several donors have donated the gift of parenthood to childless couples through their eggs. 

Dr Neeraj Pahlajani     

Thursday, 13 March 2014

Are you too old to get pregnant?

Gradient in the age and fertility graph of a woman takes steep rise during mid-20s and steady decline with approaching late-30s. Before a woman actually starts considering idea of getting pregnant, it sometimes is too late. A woman’s fertility clock starts ticking at its strongest pace, when she hits puberty and it gradually declines much earlier than thought. Although, the male fertility declines leisurely, but for couples with huge age difference face trouble when a partner five years older or more as sperm quality declines with age.

The most fertile time of a woman is between the ages of 19 to 26-years, as the chances of conceiving two days before ovulation are 50 per cent higher. With time, women become 10 per cent less fertile at 27 and the fertility rate starts sharply declining in the mid-30s. Sometimes, a late decision leaves a vast barren ground of infertility before the couples. However, most of the women were seen giving birth to a healthy baby at 35 without real complications in conceiving but after 35 the proportion of women experiencing infertility or miscarriage increases as the rate of fertility drops by nearly 40 per cent between the age of 27 and 34.

After 35, the fertility rate starts depending on the ages of both the partners. If the age difference is less, then two out of five women conceive with 30 per cent chances but couples with larger age difference experience infertility issues as the chances of conceiving remains less than 20 per cent. It is not that women stop conceiving, it just takes longer time and more complications. By the age of 40 only two in five of those who wish to have a baby will be able to do so.

On the other hand, male fertility starts declining at the age of 35. Many men remain fertile into their 50s and beyond, the proportion of men with sperm disorders increases with age. The decline in male fertility is more gradual for men than women. The decline in male fertility can affect the health of the children they may go on to have. Men can remain fertile for much longer than women. Even though male fertility also declines with age, it tends to happen gradually for men.

The reason behind decline of fertility in women is considered as ovulation problem and blockages to the fallopian tubes. When a woman hits 30s, she is left with less number of quality eggs that makes her ovarian reserve decline. And with the approach of menopause that comes usually around 40s, women are left with meager number of eggs. In fact, the chances of conceiving non-identical twins are seen mostly in older women. This is because the struggles to produce more Follicle Stimulating Hormone (FSH) to make women ovulate at the older age. The hormone is called follicle. Body produces FSH to fight the fewer viable eggs left in your ovaries. But the over-production of FSH can result in more than one follicle ripening and releasing an egg and multiply pregnancies.

However, with advancement of technologies, the couple need not worry. The upward trend of IVF has preserved the excitement of couples wanting have babies at any age. It is suggested to see a doctor after the age after regular failed attempts of getting pregnant.

Dr Neeraj Pahlajani

Saturday, 8 March 2014

Medical Tourism – No more a Taboo in Raipur

Even as the institutions like IIM and AIIMS has anointed Raipur among one of the rapidly developing cities in country, the burgeoning idea of medical tourism parallelly has caught the imagination fertility tourists living in geographically dispersed cities towards the state.

Away from the cacophony of fast moving metropolitans, Raipur is situated in the heart of Chhattisgarh, a tribal heartland in Central India. With rare combination of state-of-the-art medical infrastructure and potential IVF and surrogacy options in Raipur, it has gradually fueled the international demand. Raipur can be termed as a bastion for couples wanting to ply their gametes at cheaper rates. With low traffic frequency rates, uber medicinal and infrastructural at hospitals, Raipur has become one of the favorite destinations for foreigners wanting to undergo fertility treatment.

It was observed that medical tourists were more liberal than ever for undergoing treatment in Raipur, after several infertile couples from USA, Europe, Africa and even neighboring countries like Bangladesh and Afghanistan came here it to find the cure. Success stories of the IVF and surrogacy in Raipur has put the doubts of couples to rest, who are otherwise skeptical about the treatment because of the obvious complications associated to it. Also, the cheap IVF treatment offered in Raipur has warded off the discomfort of pocket burning fees demanded in the first world countries. Visit counts of tourists tripping Raipur has multiplied in past one decade, with most of them returning with assured pregnancy results. The city has won an international recognition after high ratio of infertile couples was blessed with children.

The day commercial surrogacy was declared legal in India it also opened the flood gates of all the inhibitions related to surrogacy and IVF in the country. After facing a tough rebound from less liberal countries, medical tourism has emerged as a successful intersection of inexpensive and medical infrastructure in Raipur. In years, the city has witnessed high influx of tourists seeking medical care willing to travel the tribal land. Skewed population distribution in metros, and commercialized health care has locomoted the infertile tourists towards Raipur. The infertility hospitals have been able to preserve their appeals for assuring best treatment to patients. A taboo associated with IVF and surrogacy is dying a fast death after Raipur was appended to the list of best known IVF and surrogacy destinations.

Dr Neeraj Pahlajani

Wednesday, 5 March 2014

Medical Tourism In India

With India becoming a mecca for infertile couples, medical tourism has clearly laid an offshore pipeline for the global fertility tourists to fish for cut-price generic material from country’s pool. Though, medical tourism stumbles onto few legal and ethical obstacles in many countries like Canada, France and UK, where laws and statutes cover the legal issues of fertility treatment. 

In India, without real ethnic or legal implications, medical tourism has opened new avenues for couples seeking IVF treatment in pocket friendly rates. Couples wanting to undergo IVF treatment tend to churn out leads from internet to get best, assured and cheap fertility help. India, with its fascinating culture, also has impressive IVF with less than lesser implications and more chances of fertility. Beyond border quest for babies has globalised the surgical procedures, giving multiplicity of options to infertile couples before actually undergoing the life changing procedure.

While some countries have shortage of women donors, some actually restrict the doctors with legal implications. However, the scenario is rather more flexible in India. With higher rate of IVF successes, India has ace on its sleeves to have magnified its presence on world map. Easing the paramount concerns of infertile couples, hassle-free treatment and more chances of getting pregnant has anointed the country as one of the favorite destinations for medical tourism. Also to add, commercial surrogacy is completely legal in India, increasing international confidence on the country for treatment. It is one of those countries where legal issues around fertility treatment are left to official guidelines. For example, many countries have strict single embryo transfer policies, while in India will leave the number of embryos implanted up to the discretion of the fertility specialist. Where implantation of single embryos dims the chances of conceiving, it also reduces faith on the entire procedure. 

Apart from legal regulations, the fragile cord of ethnic inference has rarely affected the surrogacy procedure as anonymity of the donor is maintained. Boasting its large pool of skilled doctors and low treatment prices, healthcare balances the global brain drain of IT and medicine. Medical tourism has clearly shrunk the borders and brought countries closer to resolve medical issues over a wider spectrum.

With population of humongous proportion, need of availability, accessibility and affordability to reduce exacerbating health insecurity would be the pressing concern in few decades. However, the IVF successes have seeded the hope of infertile couples to experience the bliss of parenthood, with such procedures becoming bold predictions of reckoning.

Dr Neeraj Pahlajani

Dr.Malpani's Blog: How do I interpret my ovarian reserve test results ?

Dr.Malpani's Blog: How do I interpret my ovarian reserve test results ?