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Fayth Clinic conducts workshops in Mumbai to help teens combat obesity

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Dr. Paula Goel is a practicing adolescent pediatrician with special interest in adolescent obesity and its influence on lifestyle diseases in teenagers and young Indians. She is currently the adolescent pediatrician and director of Fayth Clinic, Mumbai – the only clinic specializing in adolescent health services in Mumbai. I got the opportunity to interview Dr. Goel through email about obesity among adolescents, the effects, preventive measures, and the workshops and treatment offered by Fayth Clinic.

 

For the last 6 years, you have worked extensively in the field of adolescent medicine dealing with problems of obesity and its effects in teenagers and young Indians. How would you rate the adolescent obesity ratio in India as compared to other countries? Is it growing at an alarming rate in India?

 

The incidence of obesity in Indian adolescents is about 1/3 of the developed countries, but it is growing at an alarming rate.

 

What do you attribute as the main causes for obesity in adolescents and children in India?

 

  • Overeating
  • Lack of Exercise
  • Increased sedentary activity with lack of exercise like TV viewing for more than 20 hrs per week with decreased physical activity
  • Children exposed to food advertisements and increase in caloric intake
  • Other screen time includes video games, internet use, telephone use, home viewing of movies
  • Heredity factors which reduce basal metabolic rate
  • Socio economic status: More obese in higher socio economic status in poorer countries and more obese in lower socioeconomic status in richer countries
  • Insulin resistance leading to sugar build up causing obesity and diabetes
  • Low leptin levels – does not allow brain to get signal that food intake is enough
  • Endocrine and chromosomal abnormalities

What are the major complications that an obese adolescent can face during adolescence and as an adult

 

Following are the complications faced as young adults:

 

  • Cardiovascular system: high blood pressure, heart attack, brain stroke
  • Respiratory system: breathlessness, asthma, frequent sleep apnoea, hypoventilation. High amount of fat in chest wall / abdomen limits the respiratory excursions which lead to frequent awakening and resultant sleep deprivation leading to daytime somnolence
  • Metabolic disorders: elevated cholesterol, diabetes, insulin resistance, menstrual irregularities
  • Gastro intestinal system: fatty liver, cirrhosis, hemorrhoids, hernia, colorectal cancer , gall stones
  • Malignancy: breast cancer, endometrial cancer, prostratic cancer , cervical cancer
  • Musculoakeletal problems : back pain , joint pains, frequent strains, sprains, limp, groin pain leg bowing
  • Poly cystic ovarian syndrome in young girls : dysmenorrhea, excess body hair ( hirsutism), acne, hair loss on scalp, central obesity, insulin resistance, infertility
  • Behavioural complications: disordered eating ,depression ,negative body image, decreased school performance, social isolation ,decreased self esteem ,bullying, being bullied
  • Metabolic syndrome in young adults characterized by central obesity, hypertension, DM, premature coronary artery disease

How much is the awareness for obesity in adolescents in India? What steps are being taken by you and your clinic to spread the awareness?

Awareness of obesity in India especially in the young population is increasing. Many adolescents suffer from BODY IMAGE PROBLEM and this also results in bulimia, anorexia nervosa and eating disorders which may lead to depression. We hold regular seminars, workshops, community camps and media awareness programs.

 

You have been conducting various workshops for rehabilitating adolescents. Are these workshops conducted only in Mumbai? Are the workshops also conducted in other parts of India? How successful have these workshops been?

 

We are holding these workshops only in Mumbai at present. The results have been rewarding with positive feedbacks from the participants. The take home message has been implemented.

 

Regarding treatment, what are the various plans that you provide to the patient? Who comprise the team (doctor, dietician, counsellor, etc.)? Could you tell us in brief what are the various steps in the treatment and rehabilitation process? In terms of percentage can you tell us how much of medication and counselling is involved?

The Medical Management of Obesity consists of a detailed plan comprising of medical examination to determine the cause of obesity, diet and exercise protocol as per individual needs, detailed history will include onset, progression of obesity, growth and development, family history of obesity and complications. Exploring diet practices, family structure and habits. Over weight child with less than 50th percentile for height are screened for endocrine or genetic conditions. Screening for complications is important. certain conditions like high blood pressure, asthma and orthopaedic problems may require treatment before exercise regimen can be prescribed treatment .Laboratory screening is also required for base line investigations and associated complications .The team comprises of doctor(adolescent paediatrician),dietician and counsellor and exercise therapist. Review is done on a periodic basis .However, medications are not provided for to lose weight. Medication is required as per the medical requirement and counselling is done for all patients.

 

Talking with an adolescent is definitely different from talking to a child or an adult. So do you have to use a different approach in the treatment and rehabilitation of adolescents? (By approach I mean the method of treatment, the counselling done afterwards, even any symptoms and side effects during diagnosis).

 

Approach definitely has to be different. Understanding and gaining trust of the adolescent is very important to maintain compliance during the treatment. Vast majority suffer from problems of body image and also early depression. They are also very sceptical and have their own set of value system which is as per the peer group. So gaining the trust is most important. Once they are comfortable, they open up and counselling is then easier. Diet also has to be looked into carefully as this is a growing phase and severe restriction of diet is not possible as this will hamper growth and development. Moreover, adolescents if put on to a strict diet will always binge and will never comply with the diet plan. Certain weight training exercises are also not recommended as it damages the growth plate which is at the end of the bones and this will also affect the final height of the adolescent. Moreover, if there is any muscle injury, it is more dangerous than bone injury as bone injury is picked up by X-rays while muscle injury cannot be picked up and it takes a longer time to heal. Hence complete physical and medical examination is mandatory before starting exercise protocol.

 

Today we lead a fast pace lifestyle and stress accompanied with studies, competition among peers, peer pressure, etc. What are your suggestions to prevent adolescence obesity in India?

 

  • Lead a disciplined lifestyle
  • Breakfast provides food for the brain and should never be missed
  • A balanced diet with fruits and vegetables
  • Prevent obesity at an early stage of life
  • No child should be forced to complete the portion left behind on the plate in pre adolescent phase as it leads to obesity
  • Should not be given energy-dense foods: chocolates, ice-creams, chips, as rewards for good behavior
  • Fast foods/cold drinks be avoided
  • Life style modification -walking, cycling, playing outdoor games rather than video-games, outings- trekking/walking on the beaches instead of malls every week ends
  • Television viewing-a sedentary activity must be restricted. Snacking during TV viewing be condemned
  • May have medical reasons-evaluation required
  • Positive peer pressure through friends and peer educators may also be used to motivate to lose weight and to cope with body image problem, emotional taunts and emotional blackmail

How many workshops have you conducted on adolescence obesity? When is the next workshop scheduled to take place?

 

We have conducted about 4 to 5 workshops. The next workshop is due in January 2011.

How does one register for attending the workshop?

 

Either by phone (Mansi Kothari, Fayth Clinic admin 9869505556, tel: 02224311616/14) or by email services@faythclinic.com. For further details about Fayth Clinic visit www.faythclinic.com.

 

 

 

Patient with multiple flexion deformities walks again

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After a sabbatical of one year, I am back. This news would be of interest and a blessing to those who advised to go for hip and knee replacement surgery. Last month on August 11th 2010, Manipal Hospital performed hip replacement surgery along with bilateral knee replacement surgery and soft tissue release surgeries on a single patient – 10 surgeries in one single sitting

For the first time in India and the world, The Department of Orthopaedics at Bangalore based Manipal Hospital performed 10 surgeries on a patient in the same sitting with minimal blood loss with excellent results. The patient was stable throughout the intra-operative period and did not require post-operative ICU care. Patient recovered and took her first steps on the second post-operative day.

Mrs. Nagamma, 59 years old, complained of pain in both her hips and knees since 15 years and was unable to walk or sit for the past 6 months. The pains were gradual in onset and progressed with time. It was associated with gradually progressive Flexion Deformity; i.e. Bent hips and knees. She was able to move at home with the aid of a walker for the past 2 years and since the last 6 months, she was completely bedridden. She is a known case of Rheumatoid Arthritis but has no other illnesses. On examination, she was found to have Fixed Flexion Deformities of 50 degrees in both the hips and 60 degrees in the Right Knee and 50 degrees in the Left Knee. After thorough investigations and evaluation along with Medical and Rheumatology clearance she was

taken up for surgery on 11th August, 2010, wherein ten surgeries were performed on her viz. Bilateral Hip Replacement surgery along with Bilateral Knee Replacement surgery and 6 soft tissue release surgeries.


Fig: Mrs. Nagamma with the doctors of Department of Orthopaedics at Bangalore based Manipal Hospital

According to Dr. R.D Chakravarty, HOD, Orthopaedic Department, Manipal Hospital who spearheaded the surgical team, “First, she was placed flat on her back and Adductor Tenotomies were carried out on both her Hips, to correct the Hip Adductor deformities. Later, she was turned over to prone position and Hamstring Release procedure was done on both her Knees to correct the Knee Flexion deformities. Next, she was placed in a Right Lateral Position, i.e. on her right side with left side up and a Total Hip Replacement was done on her Left Hip. Similarly, she was shifted to a Left Lateral position, and a Total Hip Replacement was done on her Right Hip. After this, she was again placed Spine and Total Knee Replacement Surgeries were done on both her Knees. Total blood loss during the surgery was 800 ml. She was transfused two Units of Whole Blood to make up this loss. She tolerated the procedure well and post operatively was shifted to the ward as she was stable. She was put on Parenteral Antibiotics and Analgesics along with Anticoagulants and Anti DVT therapy.

She was made to get up from bed and walk on the second postoperative day and she responded well. With rigorous Physiotherapy and encouragement for Rehab, she is now moving with the help of a walker to meet her daily requirements and is also able to bend her knees comfortably till 90 degrees.”

Dr. S.C. Nagendra Swamy, COO, Bangalore Region, Director Shared Strategic Services noted, ” Keeping in mind that such an extensive surgery has never been attempted anywhere in the world before and also remembering the foreseeable risks associated with such an undertaking, we took care to perform a very thorough and meticulous preoperative planning. I applaud Manipal Hospital Orthopaedic team for competently performing such a delicate and rare surgery successfully and with such amazing results.”

Speaking to media persons Dr. H. Sudarshan Ballal, Medical Director, Manipal Hospital said, “In the West, surgeons rarely face these kinds of cases. Whereas in India, the patient tends to neglect due to financial and social reasons and finally comes at the last stage with such gross deformities. Correcting such deformed joints involves great technical skill and straightening a deformed joint can result in neurovascular damage if done without proper expertise and equipment. We are indeed blessed to have a professionally competent team and the best facilities to be able to perform a surgery of this magnitude without a hitch.”

Manipal Hospital, Bangalore is India’s first hospital to be ISO 9001:2000 certified for Clinical, Nursing, Diagnostics and Allied Areas. Manipal Hospital has been repeatedly ranked amongst the ten best hospitals in India.


Edentulous Support Society organizes seminar on prevention and treatment of Edentulism

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Seminar to highlight disability caused by Edentulism, educates over 1000 patients of the condition and possible treatment

The Edentulous Support Society, India’s first support group for people suffering from Edentulism (a condition of being toothless), is organizing a seminar to highlight the condition of Edentulism, as well as the means of prevention and treatment of the condition. The seminar will be held in the city on 4th July, Saturday, at 5.00pm at Ramkrishna More Sabhagruha in Pimpri-Chinchwad. This is the first in a series of seminars that are due to be organized across various cities in Maharashtra over a period to highlight to senior citizens the disabilities caused by Edentulism, and the methods that can be adopted to avoid contracting this condition.

The workshop, which is scheduled to take place at the Ramkrishna More Sabhagruha in Pimpri-Chinchwad
on Saturday, will address various issues ranging from the factors causing edentulism, who is susceptible to the condition and what measures can be taken to address the problems caused by it. Some notable guests who will be attending the event include Mrs. Aparna Tai Doke, the Mayor of Pimpri Chinchwad and Dr. Sriram Pandey, Founder and President of the Senior Citizen Club of Pimpri Chinchwad, who are also the partners for the event. The Edentulous Support Society, in addition to organizing this seminar, also aims to provide 100 free dentures to needy people who cannot afford them.

Written by sreelakshmi

2 July, 2009 at 9:44 pm

Lupin Announces Acquisition of Worldwide Rights for its first NDA – AllerNaze™

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Pharmaceutical Major, Lupin Ltd. announced recently the acquisition of worldwide rights for the intra-nasal steroid (INS) product, AllerNaze™ (triamcinolone acetonide, USP) Nasal Spray, 50mcg from Collegium Pharmaceutical, Inc.

The United States will be the first market in which Lupin will launch the product. Lupin expects to expand its US sales force as it launches AllerNaze™, building on its presence in pediatrics and expanding into other key specialties such as allergy/immunology and otolaryngology.

The U.S. Food and Drug Administration (FDA) has already approved AllerNaze™ (triamcinolone acetonide, USP) Nasal Spray, 50 mcg, an aqueous based intranasal steroid indicated for the once daily treatment of nasal symptoms associated with both seasonal allergic rhinitis (SAR) and perennial allergic rhinitis (PAR) in adults and children twelve (12) years of age and older. The safety and efficacy of AllerNaze™ in both SAR and PAR have been well established in 14 controlled clinical trials involving almost 1,200 subjects. The studies assessed the safety and effectiveness of AllerNaze™ in treating the symptoms (runny nose, nasal itching, sneezing, and nasal congestion) in patients with allergic rhinitis.

The United States alone reports up to 40 million cases every year that severely affect quality of life of such patients. The INS market generated $ 2.5 Billion in annual sales in United States alone (IMS data).

Commenting on the development, Dr. Kamal Sharma, Managing Director, said: “Our investment in AllerNaze™ reflects our commitment to expand our brand business in the US and also in some select markets. Having built a significant base in the US by leveraging our internal research & development initiatives we remain focused on growing our brand presence with strategic investments in exclusive brand products which we will nurture and grow. With this we reaffirm our commitment to bringing new and effective therapies to patients around the world in areas where we feel there still remains a significant unmet medical need”

“We are excited about Lupin’s first NDA acquisition and this opportunity to expand our US brand business into another specialist segment. The AllerNaze™ acquisition demonstrates

Lupin’s commitment to its brand franchise in US. It will allow Lupin to draw on its existing strengths within Pediatrics and grow into other specialties to carve a share out of the multi-billion dollar allergic rhinitis market. AllerNaze™ offers a quality intra-nasal steroid option to physicians as they deal with adherence and compliance issues when treating allergic rhinitis,” said Vinita Gupta, President and CEO, Lupin Pharmaceuticals, Inc.

Written by sreelakshmi

2 July, 2009 at 9:29 pm

METROPOLIS HEALTHS SERVICES AND NOVARTIS LAUNCHES NATION WIDE HEPATITIS AWARENESS PROGRAM

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Metropolis Health Services, India’s only multinational chain of diagnostic centers will be joining hands with pharma major Novartis to organize a yearlong Hepatitis Awareness Program. The awareness campaign will focus on a variety of programs from Hepatitis screenings for general public pan India across Metropolis centers, Complete Medical Education (CME’s) for doctors & public awareness launched from 19th May 2009 to commemorate World Hepatitis Day.

Hepatitis is inflammation of the liver, which in turn causes damage to individual liver cells. It is most often caused by viral infection. Hepatitis B is a contagious liver disease caused by the Hepatitis B virus (HBV), present in the body and bodily fluids of infected individual. This deadly virus infects liver cells, resulting in cirrhosis (liver scarring), liver cancer, failure and untimely death. It is usually spread through an HBV infected individual’s blood, semen, or any other body fluids. This can happen through direct contact with the blood or open sores of an infected person, having sexual contact with an infected person, an infected mother passing it to her baby at birth or sharing needles, syringes, or other drug injection equipment.

According to World Health Organization (WHO), even though India is considered to have moderate percentage level of HBV infections in the population, there are estimations that approximately 40 million Indian are Hepatitis B virus (HBV) carriers. Over 100,000 Indian succumb each year from complications caused by HBV infections (i.e. cirrhosis, liver cancer etc). In an effort to keep this rising toll in check nationwide plans have already been implemented in 2003, to arrange for availability of vaccination to all infants in the poor sections of 33 districts. Also another 1.49 million non-slum infants were added to the program in 2005.

World Hepatitis day, an initiative by World Hepatitis Alliance, a nongovernmental organization represents almost 200 hepatitis B and hepatitis C patient groups from around the world and is governed by a representative board of patient groups from seven world regions.

Ameera Shah, Executive Director, Metropolis Health Services stating the need for this nationwide awareness program, says “It is crucial for the country to realize the magnitude of this disease. There is no obvious cure for it and the only option is awareness and prevention. Our singular aim is to generate know how of Hepatitis B so that people (both Doctors and General Public) are wiser and more responsible. Metropolis Health Services has always been in the fore front of disease prevention and focuses on a healthier and wiser India”

Dr. Suresh Menon, Chief Scientific Officer, Novartis states that, “In spite of Hepatitis B being around 10 times more prevalent and 50 to 100 times more infectious than HIV, hardly anything is known about it to general population. This adds to our social responsibility to spread the necessary awareness about Hepatitis B, so as to keep people informed about and also protected from; this deadly disease.”

Written by sreelakshmi

24 May, 2009 at 8:24 pm

METROPOLIS HEALTH SERVICES LAUNCHES “MOM’S SPECIAL HEALTH CHECK UP”

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Exclusive health check up packages for up to 40% discount

 

I know I am late in giving this news. In fact I was busy with my exams and boy did I miss wordpress. By the end of this week I would complete my course. In one’s life there is no one as important as your mother. Every year Metropolis Health Services organise special health camps for women to celebrate Mother’s Day. This is a really good initiative on their part. After all, who wouldn’t wish for their mother’s wellbeing.

Metropolis Health Services, India’s leading multinational chain of diagnostic centres has started special health check up camp pan India for women to commemorate this Mother’s Day. This special health check up camp includes health check up packages for women at a special discount of up to 40% and is available from the 10th of May 2009 up to 31st of May 2009.

Metropolis is providing these checkups for over 20 days at their centres in Mumbai, Pune, Ahmedabad, Surat, Bengaluru, Chennai, Coimbatore, Kerala, Delhi and Kolkata. The rates of these packages will vary according to the city. In Mumbai, this service can be found in 14 Metropolis Health Services centres.

Metropolis has exclusively designed the following three packages keeping in mind the need for an overall check up for today’s women. Besides the essential tests, Metropolis also offers stress tests (TMT) and Electrocardiogram (ECG) at a discount up to 20%.

 

PACKAGE 1 

PACKAGE 2 

PACKAGE 3 

  • Complete Blood Test (CBC)
  • FBS
  • Lipid Mini
  • Creatinine
  • Thyroid-Stimulating Hormone (TSH)
  • Urine Routine
  • Serum Glutamic Pyruvic Transaminase (SGPT)
  • Iron, Calcium
  • Complete Blood Test (CBC)
  • FBS
  • Lipid Mini
  • Creatinine
  • Thyroid Stimulating Hormone (TSH)
  • Urine Routine
  • Serum Glutamic Pyurvic Transaminase (SGPT)
  • Iron, Calcium
  • PAP Smear
  • Complete Blood Test (CBC)
  • Haemoglobin A1c (HbA1c)
  • Cholesterol
  • Creatinine
  • Thyroid Stimulating Hormone (TSH)
  • Urine Routine
  • Serum Glutamic Pyurvic Transaminase (SGPT)
  • Iron, Calcium

Ameera Patel, Executive Director, Metropolis Health Services, commenting on the rationale behind “Mom’s Special Health Check Up”, said, “Metropolis identifies the need of the hour for today’s mothers who are constantly juggling with time and the many roles they play in life. Every family must celebrate the women in it, the one who holds it together and realize the importance of her holistic wellbeing. We have always actively supported the Indian women’s health and it is important for women to be aware and alert when it comes to their health and that is the inspiration behind this Mother’s Health Check Up initiative.”

. To find out about the closest centre to you, contact Metropolis Health Services on +91 9987858328.


Written by sreelakshmi

22 May, 2009 at 12:09 am

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.