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Recurrent Pregnancy Loss Clinic
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Wednesday, 12 November 2008 |
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Recurrent Pregnancy Loss Clinic
Almost anyone who has suffered a miscarriage or stillbirth worries about the risk of having subsequent losses. Recent information indicates that women should look into testing after two losses when it used to be common to wait until three. This is especially important for women in their 30s and 40s. Newer studies indicate a miscarriage rate of 26-40% after a woman has suffered two losses, so earlier testing makes sense both emotionally, physically, and in many cases financially as well.
The two major clinically important categories of causes for spontaneous abortion (miscarriage) are fetal and maternal.
Fetal causes include the genetic composition of the fetus.
Human live borns have a very low percentage of chromosomal abnormalities (about 0.6% or 1 in 170). This low percentage indicates that almost all chromosomal abnormalities are lethal and aborted early in pregnancy.
The only chromosomal abnormalities (other than those involving the X and Y sex chromosomes) that might result in a human live born are trisomy 21 (three of the 21 chromosome, known as "Down's syndrome"), trisomy 18 (three of the 18 chromosome, known as "Edward's syndrome" and all die during infancy) and trisomy 13 (three of the 13 chromosome, known as "Patau syndrome" and all die during infancy).
Maternal causes include abnormalities in the "environment" in which the embryo and fetus develops. Known maternal causes related to an action of the mother are uncommon, but can include
Heavy smoking (uncommon for this to result in a loss)
Alcohol abuse (uncommon for this to result in a loss)
Irradiation or exposure to chemical toxins
Medications known to be teratogenic (cause fetal malformation)
Other maternal causes which are not related to any conscious activity of the mother or couple include
Anatomic abnormalities (typically uterine)
Hormonal imbalances (typically in progesterone)
Immunologic system errors (autoimmune and alloimmune)
Serious or life threatening maternal disease
By far the most common causes for spontaneous pregnancy loss are fetal not maternal. It is difficult for a woman with an undesired pregnancy to consciously create an unfavorable environment for the pregnancy to successfully force a miscarriage.
Often couples blame themselves for "doing something" that must have resulted in the pregnancy loss. Focusing on themselves (often harshly) for doing something wrong is unfortunate since
It adds guilt on top of an existing emotionally charged situation, which is counterproductive and may delay or arrest recovery from the event.
It is misdirected since very few losses are related to conscious maternal actions.
It often assumes that such losses are rare events when in fact they are common (but not commonly discussed)
An evaluation for known causes of recurrent pregnancy loss is usually initiated after 2 or 3 consecutive pregnancy losses. The tremendous emotional impact of each loss may encourage an evaluation sooner than later. A full evaluation includes
Demonstration of a normally shaped uterine cavity (by either hysterosalpingogram or hysteroscopy)
Tests to rule out infectious diseases
Evaluation for a hormonal deficiency in progesterone production (by either endometrial biopsy or bloodwork)
Analysis of both the maternal and paternal chromosomes (by bloodwork)
Laboratory testing for immunologic causes of pregnancy loss (by bloodwork)
Taking a history for maternal disease states, environmental or other toxin exposure
If a full evaluation is completed on couples with either 2 or 3 consecutive losses there will still be about 50% (1 of 2) of couples with "unexplained" recurrent pregnancy loss. That is, roughly half of couples seem to have a reason for recurrent loss that is beyond modern medicine's ability to diagnose this cause. This can be frustrating for both the couple and the physician. In this situation, the couple will at least know that potentially repairable pathology has been ruled out. |
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Phone: 91 22 2446 6633 / 2444 9992 |
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Evaluation of Male Patient
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Wednesday, 12 November 2008 |
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Evaluation of Male Patient
Deccan Fertility Clinic administers the following tests to determine problems of the male partner concerning inadequate or abnormal sperm production and delivery, anatomical problems, previous testicular injuries or hormonal imbalances. These tests are based on the physician's examination and analysis.
The male partner provides a semen sample that is analyzed with a battery of advanced andrology tests in our fully-equipped laboratory. In addition to the standard semen analysis using World Health Organization (WHO) criteria, we also analyze sperm to assess the number of motile sperm that can be extracted from the ejaculate.
Normal Semen Analysis
We encourage male partners to have their semen analyzed at our laboratory so the samples can be tested against rigorous standards. In addition to the routine analysis of our morphology, motility and concentration, some of the additional testing we perform on the semen includes:
Routine semen cultures to detect infections
Pre and Post processing to determine what to expect for our IUI or IVF procedures
Testing for antisperm antibodies
Long Term Survival Studies
Detection of biochemical markers in the semen
for example: fructose testing
Additional diagnostic testing for patients with severe male problems
for example: HOS Test
In cases where the semen analysis is normal, treatment will focus on the work-up of the female partner only.
According to WHO a normal semen analysis includes:
A Sperm Concentration of greater than 20 million sperm
Motility or movement of sperm of greater than 40%
Volume greater than 2cc
Additionally, our laboratory uses the Kruger classification of more than 14% normal morphology
Abnormal Semen Analysis
An Abnormal Sperm Analysis is repeated first for verification. Typically, the male partner is referred to a urologist for evaluation. If the urologic evaluation is normal, results of the sperm count determine further treatment. For example, a total motile sperm in excess of 5 - 10 million would make intrauterine insemination an option. If the number is less than a 1 million, ICSI would be a better course of treatment.
Azoospermia
Azoospermia is a condition, where there is no sperm in the initial fluid. In most cases, it is caused by either primary testicular failure or hormonal, chromosomal or obstructive abnormalities. Patient need hormonal, urologic, genetic or ultrasonographic examinations to further evaluate the problem.
Sperm Antibodies
Antisperm antibodies are substances that attach to the surface of the sperm and may interfere with the ability of the sperm to move & penetrate the cervical mucus, or to fertilize an egg. They must be ruled out when infertility is either unexplained, following an abnormal postcoital test, or when significant sperm coagulation is noted in the initial semen analysis. Our laboratory uses the immunobead technique to detect sperm antibodies. If they are detected, sperm washing in conjunction with IUI or IVF is considered.
Deccan Fertility Clinic & Keyhole Surgery Center
1, Shankar Niwas, Plot No 117,Dadasaheb Rege Marg,Opp Shiv Sena Bhavan,
Shivaji Park,Mumbai 400 028
India
Tel: +91 22 2446 6633 / 2444 9992
Fax: +91 22 2444 4443
testtubebabyclinic[<@>]gmail.com
http://www.testtubebabyclinic.com |
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Phone: 91 22 2446 6633 / 2444 9992 |
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Oocyte Donor Program
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Wednesday, 12 November 2008 |
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Oocyte Donor Program
Egg quality has remained one of the major determinants of successful IVF. Egg quality diminishes over age 35 and significantly declines over the age of 39, yielding a low chance of successful pregnancy in an otherwise healthy woman capable of carrying a pregnancy. Egg donation allows a couple to experience a significant increase in their rate of pregnancy with ability to experience a pregnancy and delivery.
Indications
Repeated IVF failures with own eggs
Age greater than 38 years
Premature ovarian failure
Menopausal patients
Patients with genetic defects
In egg donation IVF, the donor of eggs may be anonymous or she may be a sister, close friend, or relative of the infertile woman. The egg donor is given fertility medications to stimulate her ovaries to produce multiple eggs. Hormone replacement is used to synchronize the recipient to the egg donor cycle. Just prior to ovulation, using standard IVF techniques, the eggs are retrieved from the donor's ovaries and fertilized with sperm of the recipient couple.
There ends the brief but important role of the donor. In the IVF lab, the donor's eggs are mixed with the sperm of the father to be. Up to four embryos are transferred to the infertile woman's uterus, two to three days later. Hormone support is administered for the first couple of months to maintain the pregnancy. A pregnant recipient of donor egg IVF has a reduced rate of miscarriage or Down's Syndrome.
Donor Egg IVF was initially developed to treat women with premature ovarian failure, women who didn't have any eggs and couldn't become pregnant. The applications of this new technology have greatly expanded. Donor Egg IVF is now used for women who are carriers of genetic diseases, women who have had multiple failed cycles of IVF, women with impaired ovarian function, or for older healthy women. This treatment also heightens the chance of pregnancy for women whose attempts at IVF have revealed a poor response to fertility medications, or eggs that did not fertilize well or form viable embryos.
Deccan Fertility Clinic is proud to announce its comprehensive egg donation program utilizing the team approach. Donors are thoroughly screened both medically and psychologically in the effort to assess whether they meet the stringent guidelines established by the professional staff.
Recipients are interviewed and counseled regarding the medical and psychosocial implications of the process.
The old tradition of donation is based on anonymity, secrecy and non-disclosure. We have developed a program that offers only anonymous donors.
Deccan Fertility Clinic & Keyhole Surgery Center
1, Shankar Niwas, Plot No 117,Dadasaheb Rege Marg,Opp Shiv Sena Bhavan,
Shivaji Park,Mumbai 400 028
India
Tel: +91 22 2446 6633 / 2444 9992
Fax: +91 22 2444 4443
testtubebabyclinic[<@>]gmail.com
http://www.testtubebabyclinic.com
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Phone: 91 22 2446 6633 / 2444 9992 |
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