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Know All About Intracytoplasmic Sperm Injection

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This Article is written Dr Gautam Allahbadia, Medical Director of Rotunda -The Center for Human Reproduction, the world-renowned infertility clinic at Bandra. He is also the Medical Director at the Deccan Fertility Clinic & Keyhole Surgery Center, Shivaji Park, Mumbai

According to the World Health Organization, the incidence of infertility is about 10% worldwide. The WHO data has further concluded that in most developing countries, one out of four ever-married couples of reproductive age are infertile because of primary or secondary infertility. Misconceptions are very common in the world of infertility. One popular myth is that infertility is the “woman’s problem” and once that problem is fixed, the couple will be able to conceive. This is far from the truth. Data collected over the last twenty years reveal that infertility is due to a male factor in almost 30% of cases. In another 30% of cases there is a combined male and female factor. Therefore, the male factor is at least partly responsible in about 60% of infertile couples.

Growing infertility among urban couples

Stress and environmental pollution are two of the main causes of growing infertility among urban couples. Stress plays a very important role, and often couples conceive when the stress factor is removed from their lives. Late marriages, choosing career over babies, changing food habits, environmental pollution are just some of the subtle factors silently contributing to the growing incidence of infertility. The final nail in the coffin is stress that stems from work, from peers, from relatives and ultimately from the infertility itself, forming a vicious cycle.

A recent Danish study has concluded that average sperm counts in the general population have dropped to half of what they used to be fifty years back, from 113 million/ml in 1940 to 66 million/ml in 1990. The Internet Journal of Urology published an article that says this change is recent and appears to occur internationally, suggesting adverse effects of lifestyle or environmental factors on the male. If the decrease in sperm counts continue at this rate, we will witness widespread male infertility in the next few years. To date there is no conclusive evidence as to the precise cause, and available preventive measures which can be taken to avoid this trend are not common knowledge. Not only are sperm counts decreasing, but also are the average sperm volumes which contain a greater proportion of deformed spermatozoa with reduced motility.

Treatment for male infertility by ICSI

Less than a decade ago, treatment for a severe male factor limited to inseminations or IVF using donor sperms. Today, newer advances in male infertility have introduced innovative therapeutic options that offer men, including ones with no sperms in their ejaculate, a greatly improved chance to conceive their own biological child.

Intracytoplasmic sperm injection
(ICSI) is a procedure that can be used as a part of IVF (in vitro fertilization) or test tube baby treatment. It was introduced in 1992 and was welcomed as a breakthrough in fertility treatment where the problem is on the man’s side. Since then, it has become the most successful technique in male infertility treatment, replacing older techniques. In ICSI only one sperm is needed, which is directly injected into each egg to make it fertilize.

Who might benefit?

ICSI can offer real hope to couples where the man has a very low sperm count, produces few good quality sperms, or has a problem with anti-sperm antibodies in his semen. In fact it can also help in cases where there are absolutely no sperms in the semen (azoospermia). Sometimes in such cases sperms are actually produced in the testes but do not come out. The man may have had an irreversible vasectomy, or has no sperm in his semen due to missing tubes or blockages in his reproductive organs. These sperms can be retrieved from the testes directly and used to fertilize the eggs by ICSI. This procedure thus offers an alternative to the use of donor sperms; an option that is preferred by many as it gives them a chance to have their own biological child. Couples who have tried IVF can move on to ICSI if not enough eggs could be retrieved from the female partner; or if fertilization has failed with standard IVF.

How does it help?

With ICSI, the sperm do not have to travel to the egg or penetrate the outer layers of the egg. Therefore it can help men whose sperm are too few, or cannot move properly, or where the sperm can get to the egg, but are unable to fertilize it for some reason. In ICSI each sperm is picked up by a micromanipulator and physically injected into each egg thereby making it fertilize. Two days later the fertilized eggs become balls of cells called embryos. These embryos are then transferred into the lady’s uterus by a fine catheter.

What is the success rate?

The success rate of ICSI is increasing as more and more clinics become experienced in this technique. The overall average success rate for women under 35 years is around 30%.

What are the advantages?

ICSI opens doors to parenthood that were previously closed for couples with a male factor problem. It gives men with absent, few or immotile sperms the chance to have their own biological child, which might not have been possible without this technique. Sperms can also be retrieved from the testes of men who have in the past undergone a vasectomy that now cannot be reversed.

What are the disadvantages?

Nature follows the principle ‘Survival of the fittest’. During normal conception, only the hardiest sperm manage to travel great distances and break through the membrane of an egg to fertilize it. Weaker sperm never make it. Because ICSI bypasses this process of natural selection, critics worry about higher rates of miscarriage, and long-term health & developmental problems for children conceived using whatever sperm are available. Research so far has been reassuring about most potential risks. No impact has been seen on the cognitive and motor skills of children conceived using ICSI.

Gautam Allahbadia appointed as Youngest President of Mumbai Obstetric & Gynecological Society (MOGS)

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Recently Dr Gautam Allahbadia took over as President of the Mumbai Obstetric and Gynecological Society (MOGS) – the youngest president in its 75 year history.

Dr Gautam Allahbadia is a leading fertility physician of international recognition based in Mumbai’s suburb of Bandra, with several of his ‘Rotunda Centers’ spread in cities across the country. With several international fertility congresses organized under the aegis of the Rotunda banner, the doctor is no stranger to holding academic programs and hosting renowned doctors from all over the world – the US, UK, France, Germany, Iran, Turkey, Greece, Finland, Singapore and of course Israel. Being trained at several centres in various continents he emphasized the importance of interaction between the advanced and developing countries. Besides several academic programs for the year, the young doctor also asked his colleagues to join in for two pleasure cum business trips – one to Israel & Turkey and the other to free India’s largest hill city, Lavasa.

A keen scientist with over a hundred and fifty scientific papers and several new procedures & surgeries to his name, Dr Allahbadia lamented the lack of research papers by Indian doctors in spite of a wealth of clinical material. He encouraged all gynecologists in academics or in private practice to come forward with their rare cases and to carry out research in simple day to day practice.

In keeping with the present politico-cultural scenario, the Mumbai gynaecologist’s patriotism was on display with a presentation on India’s contribution to science and business – from ancient times to today. He spoke of eminent Indian contributions to the world, such as the discovery of ‘zero’, the use of calculus & trigonometry; Ayurveda, the world’s most ancient school of medicine and Sanskrit, considered the most scientific language for computers. He enlightened his audience on the percentage of US doctors, NASA scientists and heads of multinationals who are Indians.

The audience was reminded that sonography, operative endoscopy and culturing of cells for test tube babies were all started by gynecologists – stem cell research owes its origin to the foundation laid by gynaecologists. Thus he encouraged his colleagues to build on their predecessors’ legacy by going ahead and give the world some more original research.

Like President Obama he promised change by organizing a joint Indo-Israeli Year where leading doctors from Israel would come to Mumbai every quarter to demonstrate their specialized skills and share information in endoscopy, sonography and infertility. Dr Allahbadia highlighted the similarities between the two countries and the technological advances of Israel to show how Mumbai doctors would benefit from the interaction.

Being a leader in third party reproduction with several landmark cases on record including the first Indian surrogate for a Chinese Singaporean couple and the first for a gay couple from Israel, the President of the MOGS touched on the difficult times for the medical tourism industry but showed the way out by suggesting development of newer techniques and research.

Among several of the city’s leading gynecologists who attended the meet, the occasion was also graced by the presence of the Consul General of Israel Mrs Orna Sagiv, as well as leaders from the pharmaceutical and surgical equipment industry who felicitated the young new President to usher in a year filled with both learning and entertainment for the country’s doctors.

The MOGS President announced a new fellowship grant, valued at Rs 10 lakhs, for young Mumbai doctors to train abroad – created by Mr Ajit Gulabchand in memory of his gynecologist mother the late Dr Shantabai Gulabchand.

As the gynecologists applauded Mr Gulabchand’s generosity, Dr Allahbadia, the proprietor of India’s first budget IVF center – the Deccan Fertility Clinic and Keyhole Surgery Center at Dadar, in keeping with the low cost philosophy of its namesake Deccan Airlines, extolled the virtue of philanthropy and entreated doctors & corporates to come forward and share social responsibility.

Written by sreelakshmi

1 April, 2009 at 3:07 pm

Deccan – India’s First Budget IVF and Keyhole Surgery Centre

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India’s first state-of-the-art Budget IVF Clinic and Keyhole Surgery Centre ” Deccan” is an initiative of renowned IVF Specialist Dr Gautam Allahbadia, who has developed the centre in the memory of his late mother in order to offer subsidized IVF services to the poor and the needy. Conveniently located at Shivaji Park, in the heart of Mumbai, the clinic has been developed at par with any other centre with due commitment to technology, techniques and quality and provides all the facilities required to deliver a full range of services to couples requiring assistance conceiving.

The centre offers a comprehensive range of infertility services under one roof, so patients don’t need to shuttle from clinic to lab to the scan center. The practice is restricted to treating infertile patients exclusively, and the clinic offers patients the very best medical care – at affordable prices. Some of the services offered by the clinic are basic work up of the infertile couple, one stop fertility diagnostic services, semen processing, ovulation induction and monitoring, in vitro fertilization, donor egg IVF, embryo freezing, treatment of recurrent pregnancy loss, Diagnostic and operative laparoscopy and hysteroscopy and minimally invasive ultrasound guided procedures.

The Deccan team is led by the Medical Director, Dr Gautam N Allahbadia who coordinates the Infertility & Assisted Conception services along with Dr Prajakta Pawar, the Clinical Associate. The Laboratory Director, Mrs Anjali Awasthi looks after the ART laboratory along with the Biologist, Ms Anuja Tamhane. The Keyhole Surgery Center clinical faculty includes Dr Swati Allahbadia, Dr Pritesh Naik, Dr Rajendra Sankpaland Dr Vivek Salunkhe, who perform Minimally Invasive Fertility Alleviation Surgery for our patients.

Says Dr Gautam Allahbadia,”The opening of Deccan IVF Clinic is special to me. Apart from being India’s first budget IVF Clinic, it is one of our first steps in taking the miracle of life to the masses. We know that facing infertility can be one of the most stressful situations a person can encounter emotionally, physically and financially. We are working towards making the dream of Assisted Reproduction a reality for the common man”.

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