Artificial Wombs

Preliminary research, presented at the European Society for Human Reproduction and Embryology annual meeting held in Lyon, France, last month, suggests that a novel 'womb-on-a-chip' device may help to improve IVF success rates. The 2 millimetre wide chip, developed by Dr Teruo Fuji and colleagues at the University of Tokyo in Japan, acts like an artificial womb to nurture fertilised embryos - up to 20 at a time - to the stage at which they can be implanted into a real womb. According to the UK Human Fertilisation and Embryology Authority, over 30,000 women in the UK undergo IVF each year. However the success rates associated with conventional IVF methods are as low as 1 in 5, meaning that most of these expensive IVF cycles do not result in a successful pregnancy. Washing or moving the eggs during IVF treatment, a process which can cause harmful temperature or acidity changes, might be one possible reason for the low success rates seen in IVF says Dr Matt Wheeler from the University of Illinois in Urbana-Champaign, who is also working on automated IVF systems. Fuji's team believe that the new chip, which avoids these disruptive washing and moving processes, is closer to the real thing: 'We are providing the embryos with a much more comfortable environment, mimicking what happens in the body', he told New Scientist. Inside the chip, cells from the lining of the womb are cultured to provide nutrients to the growing embryos, helping them to develop to the stage at which they can be implanted into a real womb.

To test the device, the researchers carried out several experiments on mice, comparing the chip-grown embryos with those produced using conventional IVF. Their findings suggest that the chip-grown embryos outperformed conventional IVF embryos in several ways:
-More were successfully fertilised (43 out of 50, compared with 41 out 50).
-More developed to the stage at which they could be implanted into a real mother (35 out of 50 compared to 32 out of 50).
-Grew faster (containing around 77-119 cells compared to 58-94 cells, after 2 days).
-More continued to develop when implanted into female mice (44% compared to 40%).

Dr Wheeler commented: 'It's not just about more embryos surviving to be implanted...They also seem to be doing better once they are implanted'. Following these successful experiments in mice, Fuji's team have now been granted permission to begin trials on human embryos later this year. The next five years are going to see many path-breaking discoveries in the field of IVF. I personally believe that just a couple of years down the line all IVF culture systems will be automated based on principles such as the subject system.

The Ant & The Grasshopper

I just received an E-mail from an Indian friend working in the UK. I just had to reproduce her E-mail here. I think this is very relevant in today's context. I hope it disturbs you as much as it has disturbed me. Let me introduce the Traditional version of the Ant & the Grasshopper as we were taught in school:

The Ant works hard in the withering heat all summer building its house and laying up supplies for the winter.
The Grasshopper thinks the Ant is a fool and laughs & dances & plays the summer away.
Come winter,the Ant is warm and well fed. The Grasshopper has no food or shelter so he dies out in the cold.

The Kalyug Version:

The Ant works hard in the withering heat all summer building its house and laying up supplies for the winter.
The Grasshopper thinks the Ant's a fool and laughs & dances & plays the summer away.
Come winter, the shivering Grasshopper calls a press conference and demands to know why the Ant should be allowed to be warm and well fed while others are cold and starving.

NDTV, BBC, CNN show up to provide pictures of the shivering Grasshopper next to a video of the Ant in his comfortable home with a table filled with food. The World is stunned by the sharp contrast. How can this be that this poor Grasshopper is allowed to suffer so? Arundhati Roy stages a demonstration in front of the Ant's house. Medha Patkar goes on a fast along with other Grasshoppers demanding that Grasshoppers be relocated to warmer climates during winter. Amnesty International and Koffi Annan criticizes the Indian Government for not upholding the fundamental rights of the Grasshopper. The Internet is flooded with online petitions seeking support to the Grasshopper (many promising Heaven and Everlasting Peace for prompt support as against the wrath of God for non-compliance).

Opposition MPs stage a walkout. Left parties call for "Bharat Bandh" in West Bengal and Kerala demanding a Judicial Enquiry.
CPM in Kerala immediately passes a law preventing Ants from working hard in the heat so as to bring about equality of poverty among Ants and Grasshoppers. Lalu Prasad allocates one free coach to Grasshoppers on all Indian Railway
Trains, aptly named as the 'Grasshopper Rath'. Finally, the Judicial Committee drafts the 'Prevention of Terrorism Against
Grasshoppers Act' [POTAGA], with effect from the beginning of the winter. Arjun Singh makes 'Special Reservation ' for Grasshoppers in Educational Institutions & in Government Services.

The Ant is fined for failing to comply with POTAGA and having nothing left to pay his retroactive taxes,it's home is confiscated by the Government and handed over to the Grasshopper in a ceremony covered by NDTV. Arundhati Roy calls it ' A Triumph of Justice'. Lalu calls it 'Socialistic Justice '. CPM calls it the 'Revolutionary Resurgence of the Downtrodden ' . Koffi Annan invites the Grasshopper to address the UN General Assembly .


Many years later...

The Ant has since migrated to the US and set up a multi-billion dollar company in Silicon Valley. 100s of Grasshoppers still die of starvation despite reservation somewhere in India ...

As a result of loosing lot of hard working Ants and feeding the Grasshoppers, India is still a developing country.... Jai Hind..

Medical School

First-year students at Medical School were receiving their first anatomy class with a real dead human body.

All gathered around the surgery table with the body covered with a white sheet.

The professor started the class by telling them, "In medicine, it is necessary to have 2 important qualities as a doctor: The first is that you not be disgusted by anything involving the human body."

For an example, the Professor pulled back the sheet, stuck his finger in the butt of the corpse, withdrew it and stuck it in his mouth.

"Go ahead and do the same thing," he told his students.

The students freaked out, hesitated for several minutes, but eventually took turns sticking a finger in the butt of the dead body and sucking on it.

When everyone finished, the Professor looked at them calmly and told them, "The second most important quality is observation. I stuck in my middle finger and sucked on my index finger. Now learn to pay attention."

Anal Glaucoma

A woman calls her boss one morning and tells him that she is staying home because she is not feeling well.

"What's the matter?" he asks

"I have a case of anal glaucoma," she says in a weak voice.

What the hell is anal glaucoma?"

"I can't see my ass coming into work today"

MRKH Syndrome

Mr. and Mrs. XYZ first approached our clinic with their problem of Primary Infertility on 31st January 2005. The couple has been married for the past two and a half years and came to us asking for IVF with gestational surrogacy. Mrs XYZ, 30 years of age, was aware that she had a rare a congenital uterine abnormality called Mayer- Rokitansky Kustner Hauser Syndrome. Patients with MRKH syndrome have failed development of the embryonic Mullerian ducts. They have absolutely normal secondary sexual characteristics like breast development etc. Normal development of these ducts result in the formation of the uterus, cervix and the upper 2/3 of the vagina. However, failure of the same results in a variety of abnormalities, most common being vaginal atresia and agenesis of the uterus and cervix. There is however normal ovarian development and normal ovarian function.

A preliminary examination and a basic hormonal screening test were done to rule out other hormonal imbalances. The patient was then advised to keep a Basal Body Temperature chart for a month to confirm the dates of ovulation to help us plan a cycle. As soon as a we localized her cycle dates, her treatment cycle was begun and synchronized with the surrogate's cycle. She was given gonadotropin injections to stimulate her ovaries to produce multiple mature eggs. A laparoscopic Ovum pick-up was scheduled as her ovaries high in the pelvis making vaginal ovum pick-up difficult. We managed to obtain
just three mature eggs which were then fertilized with her husband's sperms and finally two embryos were transferred into the surrogate on day 2 but her pregnancy test came negative.

The patient, however, did not lose hope and decided to do another treatment cycle. We started the cycle again with a little more ovarian stimulation with fertility injections to get more eggs. The surrogate was also started on hormonal replacement therapy to prepare her uterine lining. This time we managed to obtain 10 eggs of which 9 fertilized and we transferred four embryos. The surrogate got pregnant and subsequently delivered full term twins . The treatment has fulfilled the hopes and dreams of this woman who was born without a womb. We are now in the midst of treating three other women with MRKH syndrome.

Maha - Mrityunjaya Mantra

(PRAYER FOR THE SICK)

Om Trayambakam Yajaamahe,

Sughandhim Pushtimvardanam,

Urvaarukamiva Bandhanaan,

Mrityor Mukshiya Maamritaat.

MEANING:

"We worship the Three - Eyed One (Lord Shiva), who is fragrant and nourishes well all beings. May He liberate us from death for the sake of Immortality, even as the cucumber is servered from its bondage to the creeper".

'NOTE'

This Maha - Mrityunjaya Mantra is a life-giving Mantra. In these days, when life is very complex and accidents are an everyday affair, this holy Mantra comes to your rescue. It wards off death by snake-bits, lightning, water accidents, motor accidents, air accidents, and accidents of all kinds. Besides, It has a great curative power. Diseases that are pronounced incurable by doctors arecured by this Mantra, when chanted with sincerity, faith and devotion. It is a Mantra too conquer death.

It is a Moksha Mantra as well, it is Lord Shiva's Mantra. It gives long life, health, prosperity, peace, satisfaction and immortality.

An E- mail sent by Dean IIT Madras, about our National Identity

"Dear Friends,

Here is a personal experience, as well as a moment of national pride, which I want to share with you. Hope you find it worth the time you put in reading it :

"In the middle of the 1965 India-Pakistan war, the US govt - then a close friend of Pakistan - threatened India with stopping food-aid (remember "PL-480"). For a food deficient India this threat was serious and humiliating. So much so that in the middle of war, Prime Minister (Late) Lal Bahadur Shastri went to Ram Leela Grounds in Delhi and appealed to each Indian to observe one-meal-fast every week to answer the American threat. As a school boy, I joined those millions who responded to Shastri ji's call. I continued the fast even when the war was over and India became self-sufficient in food. Hurt deep by the national humiliation suffered at the hands of the US govt, I had vowed to stop my weekly fast only when India starts giving aid to USA.

It took just 40 years. Last week THE day arrived. When the Indian ambassador in Washington DC handed over a cheque of US$ 50 million to the US govt, two plane loads of food, medical aid and other relief materials were waiting to fly to the USA. Time to break the fast? With no bad feeling about the USA, and good wishes for the Katrina victims, this humble Indian feels proud of the distance India has covered in 40 years. Let's celebrate a New India!"

We have miles to go, but let us feel proud of the direction our Nation is taking. Jai Hind.

Making Mothers Out of Grandmothers

After the Kargil war, we had the parents of the martyrs of the Punjab Battalion coming to us for Donor Egg IVF. The Punjab Battalion was the first to rush up the Kargil slopes when news of the Pakistani infiltration reached the Northern Command Army Headquarters. nearly 200 young men were killed & some of them were only sons of Jats & Jat-Sikhs in Punjab. There was a growing awreness about our work with Donor Egg IVF in the region. India Today, subsequently carried a color feature in their December 2003 issue called ; "Grand Old Parents". You can read this online at http://www.indiatodaygroup.com/itoday/20031222/ if you are a subscriber to India Today.

A 62-year old woman has become the UK's oldest woman to give birth to a child. Dr Patricia Rashbrook, who already has three children aged 18, 22 and 26, underwent IVF treatment using donor eggs in order to conceive her son, who was born by Caesarean section last month. Dr Rashbrook, who travelled to Eastern Europe for the fertility treatment with her second husband, 60-year old John Farrant, paid £7000 for the IVF with a donated egg. The treatment was carried out by Italian fertility doctor Severino Antinori, most famous for vowing to clone humans. Describing her new-born son, Dr Rashbrook, a child psychiatrist, said 'he is adorable', adding that 'having been through so much to have him we are overjoyed. His birth was absolutely wonderful and deeply moving for both of us'. Her husband, 61 year old John Farrant, said that he was 'awestruck' upon seeing his son. 'I felt transformed, as if fatherhood had fulfilled a need in me that I hadn't acknowledged before I met Patti', he added.

The oldest woman to have given birth following fertility treatment is Adriana Iliescu, a Romanian woman, who gave birth aged 66 in 2005. Clinics in India are not averse to treating women in their sixties - even though it is not recommended by the ICMR to do so. Most clinics have an upper age limit and few would treat women over the age of 50. One thing clinics in India have to take into account is the welfare of the prospective child - and many fertility physicians would not consider it to be in a child's best interests to be born to parents who are less likely to survive until it is an adult. Dr Rashbrook defends critics who say the couple have put their needs above those of the child: 'We would not have gone ahead if we felt we would not be good parents', she said, She added: 'I have always looked and felt very young, but nevertheless we have younger friends with children who have agreed to act as surrogate parents should anything happen to us'.

However, some fertility specialists have said they oppose the treatment of older women with IVF. Sam Abdalla, medical director of the infertility clinic at London's Lister hospital, said that although 'it is true we can easily get a 70 year old pregnant, or even someone older', he believes that 'it is much better to have the rules and framework that apply in Britain'. 'I hope this remains an individual case', he added. Patricia Hewitt, the Health Secretary, has however defended Dr Rashbrook, accusing critics of 'gender hypocrisy'. She said that the choice to undergo IVF should be a choice for individual couples and their doctors. But others have called this attitude 'irresponsible'. Ann Widdecombe MP said that it was not the right analogy, as men could conceive children naturally into old age and women could not. Josephine Quintavalle, from the pro-life campaign group Comment on Reproductive Ethics (Core), asked where Hewitt would draw the line: 'at 70, at 80, 100?'

Last month, the oldest woman to give birth to IVF twins did so in New York, aged 59, also following treatment using donated eggs. Mrs Cohen and her husband Frank Garcia, from Paramus, New Jersey, already have a daughter, Raquel, who was conceived in the same way.

Rotunda has a very successful Donor Egg IVF program and you can read more about this at
http://www.iwannagetpregnant.com/egg.asp

Posthumous Reproduction illegal in Japan

The supreme Court of Japan has overturned an earlier ruling that a child born after IVF using a dead man's sperm is legally the man's child. The child was conceived after the man's death from leukaemia in 1999, using his frozen sperm, and born in 2001. Originally, when the child's mother tried to register the birth, the local government refused to allow it, on the grounds that the father had died more than 300 days before the birth date and the normal length of human gestation is about 270 days. Under the Japanese Civil Code, a child is not recognised as having been born in wedlock if it is born more than 300 days after the end of a marital relationship. The mother filed a lawsuit to have her son legally recognised as the child of his father. In November 2003, the first court ruled against the mother on the grounds of 'common sense' saying it was impossible to recognise the father-child relationship in such a case, and that there was little social awareness for acknowledging a deceased man as a child's father, even if his sperm was used. However, in July 2004, the Takamatsu High Court overturned the lower court's ruling. Now, following an appeal, the Supreme Court has overturned the High Court decision, saying that this was not a parent-child relationship that the Civil Code had envisaged. 'No parent-child relationship in a legal sense can be recognised, given the father died before she got pregnant and there is no possibility of the baby being dependent or receiving inheritance', said Justice Ryoji Nakagawa, who heard the appeal. Some doctors believe that the ruling shows that regulation of this area of medicine in Japan lags behind progress in science and technologies available to help people have children. And they say it may present a challenge to doctors of reproductive medicine, as the field depends on voluntary self-regulation. Each institution is able to decide for itself what should happen to stored sperm when donors die. However, legislation on reproductive technologies, which had been planned for 2004, was shelved. A spokesman for the Health, Labour and Welfare Ministry said that 'though we believe some legislative steps are necessary, it is too early now because there is no national consensus'.
This is one area where the ICMR needs to come out with a consensus statement in our own country.

Wrong Answer

Have you been guilty of looking at others your own age and thinking... surely I cannot look that old? If so you may enjoy this short story.

While waiting for my first appointment in the reception room of a new dentist, I noticed his certificate, which bore his full name. Suddenly, I remembered that a tall, handsome boy with the same name had been in my high school class some 30 years ago. Upon seeing him, however, I quickly discarded any such thought. This balding, gray-haired man with the deeply lined face was way too old to have been my classmate. After he had examined my teeth, I asked him if he had attended the local high school. "Yes," he replied. "When did you graduate?" I asked. He answered, "In 1971. Why?" "You were in my class!" I exclaimed. He looked at me closely, and then the gentleman asked, "What did you teach?"

Why Men Are Just Happier People

What do you expect from such simple creatures? Your last name stays put. The garage is all yours. Wedding plans take care of themselves. Chocolate is just another snack. You can be president. You can never be pregnant. You can wear a white T-shirt to a water park. You can wear NO T-shirt to a water park. Car mechanics tell you the truth. The world is your urinal. You never have to drive to another public restroom because this one is just too icky. You don't have to stop and think of which way to turn a nut on a bolt.

Same work, more pay. Wrinkles add character. Wedding dress Rs 75,000 . Suit Rs. 15,000. People never stare at your chest when you're talking to them. The occasional well-rendered belch is practically expected. New shoes don't cut, blister, or mangle your feet. One mood - all the time. Phone conversations are over in 30 seconds flat. You know stuff about cars. A
five-day vacation requires only one suitcase. You can open all your own jars. You get extra credit for the slightest act of thoughtfulness. If someone forgets to invite you, he or she can still be your friend. Your underwear is Rs. 100 for three-pack. Three pairs of shoes are more than enough. You almost never have strap problems in public. You are unable
to see wrinkles in your clothes.

Everything on your face stays its original color. The same hairstyle lasts for years, maybe decades. You only have to shave your face and neck. You can play with toys all your life. Your belly usually hides your big hips. One wallet and one pair of shoes one color for all seasons. You can wear shorts no matter how your legs look. You can "do" your nails with a pocket knife. You have freedom of choice concerning growing a mustache. You can do Diwali shopping for 25 relatives in 25 minutes.

No wonder men are happier. Would love responses from intelligent & sporting women.

Transplantation of the Human Uterus

In the present-time, when the media talks only about Surrogacy & Gestational Carriers, there is a new & brave breed of scientists hard at work exploring new frontiers. We must doff our hats to the team from Saudi Arabia who have charted a completely new course in Reproductive Medicine. The work of Fageeh et al from the Multiorgan Transplant Unit, King Fahad Hospital and Research Center, Jeddah, Saudi Arabia was published in the Int J Gynaecol Obstet (2002 Mar;76(3):245-51).
Human uterine transplantation was performed on 6 April 2000 on a 26-year-old female who lost her uterus 6 years earlier due to post-partum hemorrhage. The donor, a 46-year-old patient with multiloculated ovarian cysts, underwent a hysterectomy modified to preserve tissue and vascular integrity. The donor uterus was connected in the orthotopic position to the recipient's vaginal vault and additional fixation was achieved by shortening the uterosacral ligament. The uterine arteries and veins were extended using reversed segments of the great saphenous vein, then connected to the external iliac arteries and veins, respectively. Immunosuppression was maintained by oral cyclosporine A (4 mg/kg/body wt.), azathioprine (1 mg/kg/body wt.) and prednisolone (0.2 mg/kg/body wt.). Allograft rejection was monitored by Echo--Doppler studies, magnetic resonance imaging (MRI), and measurement of the CD4/CD8 ratio in peripheral blood by fluorescence activated cell sorter (FACS scan). An episode of acute rejection was treated and controlled on the ninth day with anti-thymocytic globulin (ATG). The transplanted uterus responded well to combined estrogen--progesterone therapy, with endometrial proliferation up to 18 mm. The patient had two episodes of withdrawal bleeding upon cessation of the hormonal therapy. Unfortunately, she developed acute vascular thrombosis 99 days after transplantation, and hysterectomy was necessary. Macro- and microscopic histopathological examination revealed acute thrombosis in the vessels of the uterine body, with resulting infarction. Both fallopian tubes remained viable, however, with no evidence of rejection. The acute vascular occlusion appeared to be caused by inadequate uterine structure support, which led to probable tension, torsion, or kinking of the connected vascular uterine grafts.

Doctors at Hammersmith Hospital, London, aim to carry out the first successful womb transplant within two years, reported the Evening Standard recently. Doctors say that the womb would be taken from a dead donor and will only remain in the recipient for two or three years, or until a baby is born. Richard Smith, a surgeon at Hammersmith Hospital, working with teams in Budapest and New York, announced that animal trials have been successful; 'We have had stunningly good results in the laboratory with good blood supply to the organ', he said. The team now wishes to move on to clinical trials in humans. This procedure may bring hope to women whose own wombs have been rendered useless by disease or surgery, or who were born without one, for whom IVF is not an option, and for women who have come to the end of the line of IVF with no success. There are currently 15,000 women in Britain who have no uterus, of which about 200 have turned to surrogacy. The procedure would provide an alternative to surrogacy, where problems include difficulties in finding someone to carry the baby and fears that the surrogate mother will refuse to hand over the child once born. There are also risks for the surrogate mother herself. In 2004, Natasha Caltabiano died after given birth for another couple. However, womb transplantation may carry associated risks as well. The mother would have to give birth by Caesarean and would have to undergo a course of immunosuppressant drugs. For this reason the transplanted womb would only be in for two or three years and would be removed once a child is born. Mr Smith highlighted that women have already given birth to healthy children after kidney transplants, which required them to take immunosuppressant courses to prevent rejection. Women who undergo a womb transplant would also be offered psychological counselling. Mr Smith said that the hospital, which is currently funded by charitable donations, would need £250,000 a year in funding to perform the transplants. It is estimated that each transplant would cost about £50,000. Womb transplantation has provoked a mixed response from the authorities and the public. Infertility organisations have welcomed the news but have warned women not to raise their hopes until the procedure has undergone successful human trials. Professor Lord Robert Winston, however, warned that 'this is not a road we should be going down. It is a dangerous procedure which could cost a woman her life'. Dr Patrick O'Brien, spokesman for the Royal College of Obstetricians and Gynaecologists, called the procedure 'fascinating' and said that women would chose to undergo the transplant but added that it was a 'separate question, for the Human Embryology Authority and the public to consider'. Public discussion boards have revealed concerns over 'Frankenstein' procedures and some have preferred the alternative of adoption. Whilst issues of safety may be overcome by Mr Smith and his team, the ethical objection to such a procedure may remain.

Work is in progress in at least 5 different countries presently on Human Uteri Transplantation. Would love to have new information or links to similar work anywhere in the world. Please go ahead and blog.

Long term consequences of in vitro fertilization and intracytoplasmic sperm injection

I recently came across this shocking article on the web posted by " THE SOCIETY FOR THE PROTECTION OF UNBORN CHILDREN". I was sure this would raise heated debates where-ever posted. Let us post this on our Blog & discuss the merits & demerits of the article through our Blog:

Many thousands of children have been born from assisted reproductive technology. In vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) are two techniques used. The oldest IVF baby, Louise Brown, is now 29 years old. Most early ICSI programmes began in 1994-5, so the eldest ICSI children are only 7-8 years old. How safe are these procedures? Doubts have been, and continue to be, raised about the outcomes for children who are born(1-5). There are few follow-up studies on outcomes after pregnancy is established, or on long-term health consequences for mothers and babies(6). What is currently known is that IVF exposes embryos to hazards not normally encountered in a normal pregnancy. We already know, thanks to many epidemiological studies, that events before birth can have disease outcomes in adulthood(7). But IVF is a relatively recent technology. It has been practiced widely without comprehensive assessment of its efficacy and safety. IVF has been used for many years in veterinary science. There have been unforeseen consequences in cattle, such as the 'large offspring' syndrome(8). IVF in animals has been associated with miscarriage, very high-order birthrate, physical abnormalities and peri-natal mortality(9). Slight hormone and nutrient imbalances within the first week of embryonic development may alter the course of development throughout the life of IVF animals, regardless of how they appear at birth(10). In humans, IVF results in more pregnancies of multiple gestation because usually more than one embryo is placed into the uterus. Twins and triplets tend to have a lower birthweight than singleton pregnancies. But babies from single IVF pregnancies also have below-normal birth-weight(110. There is also evidence that the in vitro environment of eggs and sperm can affect subsequent embryonic and fetal development(12).

Some examples of research suggesting the danger of IVF to children are: Male IVF babies had a five-fold increased risk of hypospadias(13,14). In Finland, IVF singletons and multiples had poorer health than other infants; 25% were preterm or weighed less than 2500g(15). In Sweden, 5680 IVF children were studied. The most common neurological diagnosis was cerebral palsy; IVF children had increased risk of 3.7 (singletons 2.8). Suspected developmental delay was increased four-fold(16).

ICSI is a particular IVF technique, used for severe male infertility. ICSI bypasses natural selection of sperm (eliminates competition) because only one sperm is used. There is no suitable animal model (an infertile primate) available, so the safety of ICSI could not be assessed on animal models before introduction(17). The following concerns have arisen(18): The risks of using sperm that potentially carry genetic abnormalities; it is thought that males eligible for ICSI carry a higher rate of genetic defects. The risks of using sperm with structural defects: although there is no absolute evidence that a physically abnormal sperm has abnormal genes, these sperm would not normally be able to fertilise an egg. The potential for damage (eg. from the needle or the chemicals used in the procedure), especially damage to the chromosomes is very much present.
The risk of introducing foreign material into the oocyte: some culture media may contain heavy metals known to be toxic to sperm. Some examples of research describing health problems for ICSI-conceived children: Increased prevalence of sex chromosome anomalies and a high prevalence of structural and numerical chromosomal aberrations have been reported(19). Infants born after ICSI were twice as likely as naturally conceived infants to have a major birth defect, and nearly 50% more likely to have a minor defect. Secondary analysis (interpret with caution) found an excess of major cardiovascular defects (odds ratio 3.99), genitourinary defects (1.33), and gastrointestinal defects (1.84) in particular cleft palate (1.33) and diaphragmatic hernia (7.73)(20). Infants conceived through ICSI or IVF have twice the risk of a major birth defect as naturally conceived infants(21). ICSI offspring are at risk of also being infertile(22).

Currently clinics deal with such knowledge by counselling and routinely offering pre-implantation genetic diagnosis(23). An abnormal result from prenatal testing is likely to culminate in abortion. Since prenatal testing is invasive, and abortion undesirable, a large amount of research has been conducted into preimplantation genetic diagnosis to detect affected embryos before they are implanted into the uterus. But development can be affected before any defect is apparent. So an
apparently normal embryo is no guarantee that foetal development and post-natal life will be normal(24). These concerns are a clear ethical challenge to clinics offering IVF. What are their ethical obligations to children born from such procedures, when doctors know there are risks involved? When IVF and ICSI children grow up, will we see lawsuits and claims for healthcare costs against doctors? What are the implications for informed consent? IVF and ICSI can be described as an experiment on a large scale, using children as subjects. While many parents may be released from the heartbreak of infertility, the means to this end are not ethically justified.

There are more untruths in the above article than truths. The article is poorly researched & not at all updated. I would like responses to these statements above. According to me, ICSI should be considered as a milestone in Assisted Reproduction after the biggest milestone called IVF. Would love responses from the specialists as well as the lay population.

You've got to find what you love

I just could not resist putting this up on the Rotunda Blog. I quote this speech to all my juniors & colleagues & consider this to be the most inspirational speech I ever read.

This is the text of the Commencement address by Steve Jobs, CEO of Apple Computer and of Pixar Animation Studios, delivered on June 12, 2005.

"I am honored to be with you today at your commencement from one of the finest universities in the world. I never graduated from college. Truth be told, this is the closest I've ever gotten to a college graduation. Today I want to tell you three stories from my life. That's it. No big deal. Just three stories.

The first story is about connecting the dots.
I dropped out of Reed College after the first 6 months, but then stayed around as a drop-in for another 18 months or so before I really quit. So why did I drop out?

It started before I was born. My biological mother was a young, unwed college graduate student, and she decided to put me up for adoption. She felt very strongly that I should be adopted by college graduates, so everything was all set for me to be adopted at birth by a lawyer and his wife. Except that when I popped out they decided at the last minute that they really wanted a girl. So my parents, who were on a waiting list, got a call in the middle of the night asking: "We have an unexpected baby boy; do you want him?" They said: "Of course." My biological mother later found out that my mother had never graduated from college and that my father had never graduated from high school. She refused to sign the final adoption papers. She only relented a few months later when my parents promised that I would someday go to college.

And 17 years later I did go to college. But I naively chose a college that was almost as expensive as Stanford, and all of my working-class parents' savings were being spent on my college tuition. After six months, I couldn't see the value in it. I had no idea what I wanted to do with my life and no idea how college was going to help me figure it out. And here I was spending all of the money my parents had saved their entire life. So I decided to drop out and trust that it would all work out OK. It was pretty scary at the time, but looking back it was one of the best decisions I ever made. The minute I dropped out I could stop taking the required classes that didn't interest me, and begin dropping in on the ones that looked interesting.

It wasn't all romantic. I didn't have a dorm room, so I slept on the floor in friends' rooms, I returned coke bottles for the 5?deposits to buy food with, and I would walk the 7 miles across town every Sunday night to get one good meal a week at the Hare Krishna temple. I loved it. And much of what I stumbled into by following my curiosity and intuition turned out to be priceless later on. Let me give you one example:

Reed College at that time offered perhaps the best calligraphy instruction in the country. Throughout the campus every poster, every label on every drawer, was beautifully hand calligraphed. Because I had dropped out and didn't have to take the normal classes, I decided to take a calligraphy class to learn how to do this. I learned about serif and san serif typefaces, about varying the amount of space between different letter combinations, about what makes great typography great. It was beautiful, historical, artistically subtle in a way that science can't capture, and I found it fascinating.

None of this had even a hope of any practical application in my life. But ten years later, when we were designing the first Macintosh computer, it all came back to me. And we designed it all into the Mac. It was the first computer with beautiful typography. If I had never dropped in on that single course in college, the Mac would have never had multiple typefaces or proportionally spaced fonts. And since Windows just copied the Mac, its likely that no personal computer would have them. If I had never dropped out, I would have never dropped in on this calligraphy class, and personal computers might not have the wonderful typography that they do. Of course it was impossible to connect the dots looking forward when I was in college. But it was very, very clear looking backwards ten years later.

Again, you can't connect the dots looking forward; you can only connect them looking backwards. So you have to trust that the dots will somehow connect in your future. You have to trust in something - your gut, destiny, life, karma, whatever. This approach has never let me down, and it has made all the difference in my life.

My second story is about love and loss.
I was lucky - I found what I loved to do early in life. Woz and I started Apple in my parents garage when I was 20. We worked hard, and in 10 years Apple had grown from just the two of us in a garage into a $2 billion company with over 4000 employees. We had just released our finest creation - the Macintosh - a year earlier, and I had just turned 30. And then I got fired. How can you get fired from a company you started? Well, as Apple grew we hired someone who I thought was very talented to run the company with me, and for the first year or so things went well. But then our visions of the future began to diverge and eventually we had a falling out. When we did, our Board of Directors sided with him. So at 30 I was out. And very publicly out. What had been the focus of my entire adult life was gone, and it was devastating.

I really didn't know what to do for a few months. I felt that I had let the previous generation of entrepreneurs down - that I had dropped the baton as it was being passed to me. I met with David Packard and Bob Noyce and tried to apologize for screwing up so badly. I was a very public failure, and I even thought about running away from the valley. But something slowly began to dawn on me - I still loved what I did. The turn of events at Apple had not changed that one bit. I had been rejected, but I was still in love. And so I decided to start over.

I didn't see it then, but it turned out that getting fired from Apple was the best thing that could have ever happened to me. The heaviness of being successful was replaced by the lightness of being a beginner again, less sure about everything. It freed me to enter one of the most creative periods of my life.

During the next five years, I started a company named NeXT, another company named Pixar, and fell in love with an amazing woman who would become my wife. Pixar went on to create the worlds first computer animated feature film, Toy Story, and is now the most successful animation studio in the world. In a remarkable turn of events, Apple bought NeXT, I retuned to Apple, and the technology we developed at NeXT is at the heart of Apple's current renaissance. And Laurene and I have a wonderful family together.

I'm pretty sure none of this would have happened if I hadn't been fired from Apple. It was awful tasting medicine, but I guess the patient needed it. Sometimes life hits you in the head with a brick. Don't lose faith. I'm convinced that the only thing that kept me going was that I loved what I did. You've got to find what you love. And that is as true for your work as it is for your lovers. Your work is going to fill a large part of your life, and the only way to be truly satisfied is to do what you believe is great work. And the only way to do great work is to love what you do. If you haven't found it yet, keep looking. Don't settle. As with all matters of the heart, you'll know when you find it. And, like any great relationship, it just gets better and better as the years roll on. So keep looking until you find it. Don't settle.

My third story is about death.
When I was 17, I read a quote that went something like: "If you live each day as if it was your last, someday you'll most certainly be right." It made an impression on me, and since then, for the past 33 years, I have looked in the mirror every morning and asked myself: "If today were the last day of my life, would I want to do what I am about to do today?" And whenever the answer has been "No" for too many days in a row, I know I need to change something.

Remembering that I'll be dead soon is the most important tool I've ever encountered to help me make the big choices in life. Because almost everything - all external expectations, all pride, all fear of embarrassment or failure - these things just fall away in the face of death, leaving only what is truly important. Remembering that you are going to die is the best way I know to avoid the trap of thinking you have something to lose. You are already naked. There is no reason not to follow your heart.

About a year ago I was diagnosed with cancer. I had a scan at 7:30 in the morning, and it clearly showed a tumor on my pancreas. I didn't even know what a pancreas was. The doctors told me this was almost certainly a type of cancer that is incurable, and that I should expect to live no longer than three to six months. My doctor advised me to go home and get my affairs in order, which is doctor's code for prepare to die. It means to try to tell your kids everything you thought you'd have the next 10 years to tell them in just a few months. It means to make sure everything is buttoned up so that it will be as easy as possible for your family. It means to say your goodbyes.

I lived with that diagnosis all day. Later that evening I had a biopsy, where they stuck an endoscope down my throat, through my stomach and into my intestines, put a needle into my pancreas and got a few cells from the tumor. I was sedated, but my wife, who was there, told me that when they viewed the cells under a microscope the doctors started crying because it turned out to be a very rare form of pancreatic cancer that is curable with surgery. I had the surgery and I'm fine now.

This was the closest I've been to facing death, and I hope its the closest I get for a few more decades. Having lived through it, I can now say this to you with a bit more certainty than when death was a useful but purely intellectual concept:

No one wants to die. Even people who want to go to heaven don't want to die to get there. And yet death is the destination we all share. No one has ever escaped it. And that is as it should be, because Death is very likely the single best invention of Life. It is Life's change agent. It clears out the old to make way for the new. Right now the new is you, but someday not too long from now, you will gradually become the old and be cleared away. Sorry to be so dramatic, but it is quite true.

Your time is limited, so don't waste it living someone else's life. Don't be trapped by dogma - which is living with the results of other people's thinking. Don't let the noise of other's opinions drown out your own inner voice. And most important, have the courage to follow your heart and intuition. They somehow already know what you truly want to become. Everything else is secondary.

When I was young, there was an amazing publication called The Whole Earth Catalog, which was one of the bibles of my generation. It was created by a fellow named Stewart Brand not far from here in Menlo Park, and he brought it to life with his poetic touch. This was in the late 1960's, before personal computers and desktop publishing, so it was all made with typewriters, scissors, and polaroid cameras. It was sort of like Google in paperback form, 35 years before Google came along: it was idealistic, and overflowing with neat tools and great notions.

Stewart and his team put out several issues of The Whole Earth Catalog, and then when it had run its course, they put out a final issue. It was the mid-1970s, and I was your age. On the back cover of their final issue was a photograph of an early morning country road, the kind you might find yourself hitchhiking on if you were so adventurous. Beneath it were the words: "Stay Hungry. Stay Foolish." It was their farewell message as they signed off. Stay Hungry. Stay Foolish. And I have always wished that for myself. And now, as you graduate to begin anew, I wish that for you.

Stay Hungry. Stay Foolish.
Thank you all very much."

This Is How The Stock Market Works

It was autumn, and the Red Indians on the remote reservation asked their New Chief if the winter was going to be cold or mild. Since he was a Red Indian chief in a modern society, he couldn't tell what the weather was going to be. Nevertheless, to be on the safe side, he replied to his Tribe that the winter was indeed going to be cold and that the members of the village should collect wood to be prepared. But also being a practical leader, after several days he got an idea. He went to the phone booth, called the National Weather Service and asked "Is the coming winter going to be cold?" "It looks like this winter is Going to be quite cold indeed," the meteorologist at the weather service responded.

So the Chief went back to his people and told them to collect even more wood. A week later, he called the National Weather Service again. "Is it going to be a very cold winter?" "Yes," the man at National Weather Service again replied, "It's definitely going to be a very cold winter." The Chief again went back to his people and ordered them to collect every scrap of wood they could find. Two weeks later, he called the National Weather Service again. "Are you absolutely sure that the winter is going to be very cold?"

"Absolutely," The man replied. "It's going to be one of the coldest winters ever." "How can you be so sure?" the Chief asked. The weatherman replied, "The Red Indians are collecting wood like crazy."

This is the true Sensex story my friends.

Francois Marie Arouet

Those who can make you believe absurdities can make you commit atrocities.
-Voltaire

Lets talk about Voltaire today. Francois Marie Arouet (pen name Voltaire) was born on November 21, 1694 in Paris. Voltaire's intelligence, wit and style made him one of France's greatest writers and philosophers. Young Francois Marie received his education at "Louis-le-Grand," a Jesuit college in Paris. He left school at 16 and soon made friends among the Parisian aristocrats. His humorous verses made him a favorite in society circles. In 1717, his sharp wit got him into trouble with the authorities. He was imprisoned in the Bastille for eleven months for writing a scathing satire of the French government. During his time in prison Francois Marie wrote "Oedipe" which was to become his first theatrical success and adopted his pen name "Voltaire."

In 1726, Voltaire insulted the powerful young nobleman, "Chevalier De Rohan," and was given two options: imprisonment or exile. He chose exile and from 1726 to 1729 lived in England. While in England Voltaire was attracted to the philosophy of John Locke and ideas of mathematician and scientist, Sir Isaac Newton. He studied England's Constitutional Monarchy and its religious tolerance. Voltaire was particularly interested in the philosophical rationalism of the time, and in the study of the natural sciences. After returning to Paris he wrote a book praising English customs and institutions. It was interpreted as criticism of the French government and in 1734, Voltaire was forced to leave Paris again. At the invitation of his highly-intelligent woman friend, "Marquise du Chatelet," Voltaire moved into her "Chateau de Cirey" near Luneville in eastern France. They studied the natural sciences together for several years. In 1746, Voltaire was voted into the "Academie Francaise." In 1749, after the death of "Marquise du Chatelet" and at the invitation of the King of Prussia, "Frederick the Great," he moved to Potsdam (near Berlin in Germany). In 1753, Voltaire left Potsdam to return to France.

In 1759, Voltaire purchased an estate called "Ferney" near the French-Swiss border where he lived until just before of his death. Ferney soon became the intellectual capital of Europe. Voltaire worked continuously throughout the years, producing a constant flow of books, plays and other publications. He wrote hundreds of letters to his circle of friends. He was always a voice of reason. Voltaire was often an outspoken critic of religious intolerance and persecution. Voltaire returned to a hero's welcome in Paris at age 83. The excitement of the trip was too much for him and he died in Paris. Because of his criticism of the church Voltaire was denied burial in church ground. He was finally buried at an abbey in Champagne. In 1791 his remains were moved to a resting place at the Pantheon in Paris.

In 1814 a group of "ultras" (right-wing religious) stole Voltaire's remains and dumped them in a garbage heap. No one was the wiser for some 50 years. His enormous sarcophagus (opposite Rousseau's) was checked and the remains were gone. (see Orieux, Voltaire, vol. 2 pp. 382-4.) His heart, however, had been removed from his body, and now lays in the Bibliotheque nationale in Paris. His brain was also removed, but after a series of passings-on over 100 years, disappeared after an auction.

If you are aware of books, movies, databases, web sites or other information sources about Voltaire, or if you would like to comment please write your comments here.

President Abdul Kalam From The Heart

I decided not to blog today & instead let you guys read something that every Indian should. The following is our President Abdul Kalam's speech to the IT Industry yuppies at Bangalore.

"I have three visions for India.

In 3000 years of our history people from all over the world have come and invaded us, captured our lands, conquered our minds. From Alexander onwards.The Greeks, the Turks, the Moguls, the Portuguese, the British, the French, the Dutch, all of them came and looted us, took over what was ours.

Yet we have not done this to any other nation. We have not conquered anyone. We have not grabbed their land, their culture, their history and tried to enforce our way of life on them. Why? because we respect the freedom of others.

That is why my first vision is that of FREEDOM. I believe that India got its first vision of this in 1857, when we started the war of independence. It is this freedom that we must protect and nurture and build on. If we are not free, no one will respect us.

My second vision for India is DEVELOPMENT. For fifty years we have been a developing nation. It is time we see ourselves as a developed nation. We are among top 5 nations of the world in terms of GDP. We have 10 percent growth rate in most areas. Our poverty levels are falling. Our achievements are being globally recognized today. Yet we lack the self-confidence to see ourselves as a developed nation, self- reliant and self-assured. Isn't this incorrect?

I have a THIRD vision. India must stand up with our own STRENGTH to the world. Because I believe that unless India stands up to the world, no one will respect us. Only strength respects strength. We must be strong not only as a military power but also as an economic power. Both must go hand-in-hand. My good fortune was to have worked with three great minds. Dr. Vikram Sarabhai of the Dept. of space, Professor Satish Dhawan, who succeeded him and Dr.Brahm Prakash, father of nuclear material. I was lucky to have worked with all three of them closely and consider this the great opportunity of my life.

I see four milestones in my career:

ONE: Twenty years I spent in ISRO. I was given the opportunity to be the project director for India's first satellite launch vehicle, SLV3. The one that launched Rohini. These years played a very important role in my life of Scientist.

TWO: After my ISRO years, I joined DRDO and got a chance to be the part of India's guided missile program. It was my second bliss when Agni met its mission requirements in 1994.

THREE: The Dept. of Atomic Energy and DRDO had this tremendous partnership in the recent nuclear tests, on May 11 and 13. This was the third bliss. The joy of participating with my team in these nuclear tests and proving to the world that India can make it, that we are no longer a developing nation but one of them. It made me feel very proud as an Indian.The fact that we have now developed for Agni a re-entry structure,for which we have developed this new material. A very light material called carbon-carbon.

FOUR: One day an orthopaedic surgeon from Nizam Institute of Medical Sciences visited my laboratory. He lifted the material and found it so light that he took me to his hospital and showed me his patients. There were these little girls and boys with heavy metallic callipers weighing over three Kg each, dragging their feet around. He said to me: Please remove the pain of my patients. In three weeks, we made these Floor reaction Orthosis 300 gram callipers and took them to the orthopaedic centre. The children didn't believe their eyes. From dragging around a three kg. load on their legs, they could now move around! Their parents had tears in their eyes. That was my fourth bliss!

Why is the media here so negative? Why are we in India so embarrassed to recognize our own strengths, our achievements? We are such a great nation. We have so many amazing success stories but we refuse to acknowledge them. Why?

We are number one in the world in milk production. We are number one in Remote Sensing satellites. We are the second largest producer of wheat. We are the second largest producer of rice. Look at Dr. Sudarshan, he has transformed the tribal village into a self-sustaining, self-driving unit. There are millions of such achievements but our media is only obsessed in the bad news and failures and disasters.

I was in Tel Aviv once and I was reading the Israeli newspaper. It was the day after a lot of attacks and bombardments and deaths had taken place. The Hamas had struck. But the front page of the newspaper had the picture of a Jewish gentleman who in five years had transformed his desert land into an orchard and a granary. It was this inspiring picture that everyone woke up to. The gory details of killings, bombardments, deaths, were inside in the newspaper, buried among other news. In India we only read about death, sickness, terrorism, crime. Why are we so NEGATIVE?

Another question:

Why are we, as a nation, so obsessed with foreign things? We want foreign TVs, we want foreign shirts. We want foreign technology. Why this obsession with everything imported?. Do we not realize that self-respect comes with self-reliance? I was in Hyderabad giving this lecture, when a 14 year old girl asked me for my autograph. I asked her what her goal in life is:
She replied: I want to live in a developed India. For her, you and I will have to build this developed India. You must proclaim. India is not an under-developed nation; it is a highly developed nation.

YOU say that our government is inefficient. YOU say that our laws are too old. YOU say that the municipality does not pick up the garbage. YOU say that the phones don't work, the railways are a joke, the airline is the worst in the world, mails never reach their destination. YOU say that our country has been fed to the dogs and is the absolute pits. YOU say, say and say. What do YOU do about it? Take a person on his way to Singapore. Give him a name - YOURS. Give him a face - YOURS. YOU walk out of the airport and you are at your International best. In Singapore you don't throw cigarette butts on the roads or eat in the stores. YOU are as proud of their Underground Links as they are. You pay $5 approx. Rs.60) to drive through Orchard Road (equivalent of Mahim Causeway or Pedder Road) between 5 PM and 8 PM. YOU comeback to the parking lot to punch your parking ticket if you have over stayed in a restaurant or a shopping mall irrespective of your status identity. In Singapore you don't say anything, DO YOU?

YOU wouldn't dare to eat in public during Ramadan, in Dubai. YOU would not dare to go out without your head covered in Jeddah. YOU would not dare to buy an employee of the telephone exchange in London at 10 pounds (Rs.850) a month to, "see to it that my STD and ISD calls are billed to someone else." YOU would not dare to speed beyond 55 mph (88 kmph) in Washington and then tell the traffic cop, "Jaanta hai sala main kaun hoon (Do you know who I am?). I am so and so's son. Take your two bucks and get lost." YOU wouldn't chuck an empty coconut shell anywhere other than the garbage pail on the beaches in Australia and New Zealand. Why don't YOU spit Paan on the streets of Tokyo? Why don't YOU use examination jockeys or buy fake certificates in Boston? We are still talking of the same YOU. YOU who can respect and conform to a foreign system in other countries But cannot in your own. You who will throw papers and cigarettes on the road the moment you touch Indian ground. If you can be an involved and appreciative citizen in an alien country why cannot you be the same here, in India.

Once in an interview, the famous Ex-municipal commissioner of Bombay Mr.Tinaikar had a point to make. "Rich people's dogs are walked on the streets to leave their affluent droppings all over the place," he said. "And then the same people turn around to criticize and blame the authorities for inefficiency and dirty pavements. What do they expect the officers to do?
Go down with a broom everytime their dog feels the pressure in his bowels? In America every dog owner has to clean up after his pet has done the job. Same in Japan. Will the Indian citizen do that here?" He's right.We go to the polls to choose a government and after that forfeit all responsibility. We sit back wanting to be pampered and expect the Government to do everything for us whilst our contribution is totally negative. We expect the government to clean up but we are not going to stop chucking garbage all over the place nor are we going to stop to pick up a stray piece of paper and throw it in the bin. We expect the railways to provide clean bathrooms but we are not going to learn the proper use of bathrooms. We want Indian Airlines and Air India to provide the best of food and toiletries but we are not going to stop pilfering at the least opportunity. This applies even to the staff who is known not to pass on the service to the public.

When it comes to burning social issues like those related to women, dowry, girl child and others, we make loud drawing room protestations and continue to do the reverse at home. Our excuse? "It's the whole system which has to change, how will it matter if I alone forego my sons' rights to a dowry." So who's going to change the system? What does a system consist of? Very conveniently for us it consists of our neighbors, other households, other cities, other communities and the government. But definitely not me and YOU. When it comes to us actually making a positive contribution to the system we lock ourselves along with our families into a safe cocoon and look into the distance at countries far away and wait for a Mr. Clean to come along & work miracles for us with a majestic sweep of his hand. Or we leave the country and run away. Like lazy cowards hounded by our fears we run to America to bask in their glory and praise their system.

When New York becomes insecure we run to England. When England experiences unemployment, we take the next flight out to the Gulf.When the Gulf is war struck, we demand to be rescued and brought home by the Indian Government. Everybody is out to abuse and rape the country. Nobody thinks of feeding the system. Our conscience is mortgaged to money."

I thought this speech is highly thought provoking, calls for a great deal of introspection and pricks one's conscience too....I am echoing John F. Kennedy's words to his fellow Americans to relate to Indians....."ASK WHAT WE CAN DO FOR INDIA AND DO WHAT HAS TO BE DONE TO MAKE INDIA WHAT AMERICA AND OTHER WESTERN COUNTRIES ARE TODAY"

Let us all get our friends to read this speech. Maybe it will make a difference & we do a RDB to the system.

Little Zach

Little Zachary, a Jewish kid, was doing very badly in maths. His parents had tried everything: tutors, mentors, flash cards, special learning centres, in short, everything they could think of to help his maths.

Finally, in a last ditch effort, they took Zachary down and enrolled him in the local Catholic school. After the first day, little Zachary came home with a very serious look on his face. He didn't even kiss his mother hello. Instead, he went straight to his room and started studying. Books and papers were spread all over the room and little Zachary was hard at work. His mother was amazed. She called him down to dinner, to her shock, the minute he was done, he marched back to his room without a word, and in no time, he was back hitting the books as hard as before.

This went on for some time, day after day while the mother tried to understand what made all the difference. Finally, little Zachary brought home his report card. He quietly laid it on the table, went up to his room, and hit the books. With great trepidation his mum looked at it and to her great surprise, little Zachary got an "A" in maths. She could no longer hold her curiosity. She went to his room and said: "Son, what was it?" Was it the nuns?" Little Zachary looked at her and shook his head, no. "Well then," she replied, "was it the books, the discipline, the structure, the uniforms? WHAT was it?" Little Zachary looked at her and said, "Well, on the first day of school, what did it for me was when I looked up and saw that guy nailed to the plus sign, I knew they weren't messing around."

Have a nice weekend:)

Meet The Ancestors

An American boy has found out the identity of his anonymous sperm donor using an online genealogy DNA testing firm, New Scientist magazine reports. His story means that donor anonymity can no longer be assured, according to an accompanying editorial. The boy, aged 15 at the time, sent off a cheek swab to a genealogy website, which lead to the discovery of two men with Y-chromosome DNA very similar to his own. But unlike most people who contact the service, he was not interested in sketching the far reaches of his family tree. His mother had conceived using donor sperm and he wanted to track down his genetic father.
The teenager tracked down his father from his Y chromosome. The Y is passed from father to son virtually unchanged, like a surname. So the pattern of gene variants it carries can help identify which paternal line an individual has descended from and can also be linked to a man's surname.
The boy paid www.FamilyTreeDNA.com $289 for the service. His genetic father had never supplied his DNA to the site, but all that was needed was for someone in the same paternal line to be on file. After nine months of waiting and having agreed to have his contact details available to other clients, the boy was contacted by two men with Y chromosomes closely matching his own. The two did not know each other, but the similarity between their Y chromosomes suggested there was a 50 per cent chance that all three had the same father, grandfather or great-grandfather. Importantly, the men both had the same last name, albeit with different spellings. This was the vital clue the boy needed to start his search in earnest. Though his donor had been anonymous, his mother had been told the man's date and place of birth and his college degree. Using another online service, Omnitrace.com, he purchased the names of everyone that had been born in the same place on the same day. Only one man had the surname he was looking for, and within 10 days he had made contact. According to Oxford geneticist Bryan Sykes, the case raises serious questions about whether past promises of anonymity can be honored. He also said that it was particularly interesting, because confidential information had been obtained without any unethical practice being undertaken. 'Fifteen years ago, when the father donated his sperm, nobody in the world could have known this would be possible', he said.

In the Indian context, the ICMR proposed guidelines assure anonymity to semen donors, but there is nothing to stop individuals from using other methods to identify these people.. That the boy succeeded using only the DNA test, genealogical records and some internet searches has huge implications for the hundreds of thousands of people who were conceived using donor sperm. With the explosion of information about genetic inheritance, any man who has donated sperm could potentially be found by his biological offspring. Absent and unknown fathers will also become easier to trace.
"This is the first time that I know of it being done," says Bryan Sykes, a geneticist at the University of Oxford and chairman of OxfordAncestors.com, a genetic genealogy service. The case raises serious questions about whether past promises of anonymity can be honoured, he says.

As more genetic information becomes available online, finding a donor father can only get easier. FamilyTreeDNA.com is running 2400 projects to trace particular surnames and has a database of over 45,000 Y chromosome signatures. The Sorenson Molecular Genealogy Foundation, based in Salt Lake City, Utah, promises to go even further. It is recruiting people from around the world and hopes to compile a database of about 500,000 representative individuals, with confirmed pedigrees going back at least four generations. The foundation will keep a database of information on Y chromosome markers, mitochondrial DNA (passed down through the maternal line) and 170 other genetic markers.

The news will be especially unsettling for men who donated anonymously before the power of genetics was fully appreciated. Donors were often college students who traded their sperm for beer money. Many have not told their wives or children and have never considered the implications of having a dozen offspring suddenly wanting to meet them. "The case shows that there are ethical and social concerns about assisted reproduction that we did not think about," says Trudo Lemmens, a bioethicist at the University of Toronto, Canada. So, welcome to the new world.

Sperm Banks - An Antiquarian

When Rotunda – The Center For Human Reproduction and its Human Sperm Banking Division opened its doors in 1996, the technology for preserving or "banking" human sperm by cryogenic methods, while nearly a quarter century old, was still in its infancy in India.

The prefix "cryo" comes from the Greek work "kryos," meaning cold or frost. The science of cryogenics deals with the effects of extremely cold temperatures on matter. Applying this technology to preservation of sperm was a natural outgrowth of the development of artificial insemination.

Although we tend to think of artificial insemination as a modern technology, it has a history dating back to 1779. That was the year an Italian priest and physiologist named Lazaro Spallanzani performed a laboratory experiment that revolutionized scientific thinking. Until that time, our understanding of reproduction was based on our understanding of how plants grow. It was believed that the embryo was the "product of male seed, nurtured in the soil of the female." Spallanzani's experiment established for the first time, that for an embryo to develop, there must be actual physical contact between the egg and the sperm. Armed with this new understanding, Spallanzani successfully inseminated frogs, fish and dogs. But while the artificial insemination of animals was quickly propelled into an industry, the application of this technology to "growing" of human babies proceeded cautiously.

The first successful artificial insemination of a woman was recorded just eleven years after Spallanzani's experiment. In 1790, the renowned Scottish anatomist and surgeon, Dr. John Hunter, reported that he had successfully inseminated the wife of a linen draper, using her husband's sperm. For over a century nothing more was heard on the subject. Then, in 1909, a letter appeared in the American journal, Medical World, spotlighting another aspect of the little known procedure. In the letter, the author, Addison Davis Hard, claimed that the first human donor insemination had been performed at the Jefferson Medical College in Philadelphia in 1884 -- twenty-five years earlier. According to Hard's letter, the mother, a patient of Dr. William Pancoast, was the Quaker wife of a local merchant, fifteen years her senior. The couple had come to the doctor seeking advise about her inability to have children. Extensive examinations of the woman revealed no abnormality. Finally, the husband was examined. It was discovered that he was azoospermic, or sterile. According to Hard's letter, when Dr. Pancoast discussed the case with his medical students, including Hard, someone in the group suggested that semen should be collected from the "best looking" member of the class, and used to inseminate the woman. Dr. Pancoast agreed to the experiment. Without informing either the woman or her husband of his intentions, he called the merchants wife back under the pretense of doing another examination. The woman was anesthetized, and the procedure was carried out. It wasn't until it became evident that the woman had actually conceived that her husband was informed. Fortunately, he was pleased. At his request, his wife was never told how she became pregnant. Hard's letter went on to say that, as a result of this medical school experiment, the merchant's wife gave birth to a son, who became the first known child by donor insemination (DI).

The idea of applying artificial insemination to human propagation was difficult enough for turn-of-the-century society to accept: to use the sperm of a man other than the woman's husband was scandalous. Hard's letter triggered heated debate among lawyers, moralists, theologians and medical practitioners. However, after a year of debates, the controversy, as the practice itself, appears to have faded into oblivion. If any doctors were treating infertility through DI, they were doing it
with the utmost discretion. DI remained virtually unknown to the public until 1954. That was the year the first comprehensive account of the process was published in The British Medical Journal. As it had before, donor insemination provoked heated public debate. The Archbishop of Canterbury established the first in a long procession of commissions that, over the years,
inquired into the development of the practice. The first commission produced a report strongly critical of DI, and recommended that the practice be made a criminal offense. A Parliamentary Commission agreed. In Italy, the Pope
declared DI a sin, and proposed that anyone using the procedure be sent to prison.

In that same year (1954), on this side of the ocean, the Supreme Court of Cook County ruled that regardless of a husband's consent, DI was "contrary to public policy and good morals, and considered adultery on the mother's part." The ruling went on to say that, "A child so conceived, was born out of wedlock and therefore illegitimate. As such, it is the child of the mother, and the father has no rights or interest in said child." This perspective was maintained as late as 1963, when a court in the United States held that a DI child was illegitimate because the sperm donor was not married to the child's mother. Regardless of her husband's consent, the court stated, the woman's insemination constituted adultery. But a year later, there were signs that attitudes were changing. In 1964 Georgia became the first state to pass a statute legitimizing children conceived by DI, on the condition that both the husband and wife consented in writing. In 1973 the Commissioners on Uniform State Laws, and a year later, the American Bar Association, approved the Uniform Parentage Act. This act provides that if a wife is artificially inseminated with donor semen under a physician's supervision, and with her husband's consent, the law treats the husband as if he were the natural father of the DI child. The laws most states have enacted pertaining to DI have been based on this act. In every case, the statute makes it clear that the donor who provides the doctor or sperm
bank with sperm is not the legal father of any child conceived by that sperm.

One court ruling in particular is relevant: the 1968 People V. Sorensen. While an earlier (1945) oral opinion in an Illinois case held that donor insemination was neither adultery nor grounds for divorce; it was not until the Sorensen case that a court ruled the DI child was legitimate. In the Sorensen case, the California Supreme Court upheld the criminal conviction of a man
for not supporting a DI child conceived with his consent during marriage. Sorensen claimed the child was not his, therefore he had no obligation to support it. The court ruled that the sperm donor had no more responsibility for the use of his sperm than a blood donor had for his blood. The court noted, "since there is no 'natural father', we can only look for a lawful father." And that was Sorensen.

The father of artificial insemination marked up another first in reproductive biology. It is believed that Spallanzani was the first to report the effects of cooling on human sperm when he noted, in 1776, that sperm cooled by snow became motionless. But efforts to actually freeze sperm did not begin until the mid 1800s. In 1866 a man by the name of Montegazza was the first to envision banks for frozen human sperm. He suggested that "a man dying on a battlefield may beget a legal heir with his semen frozen and stored at home." While it took some 150 years, during the Gulf war crises
in 1992, Montegazza's vision became a reality. Service men were able, and indeed some opted to freeze and store specimens of their sperm before leaving for battle.

Between the years 1938 and 1945, a number of scientists observed that sperm could survive freezing and storage temperatures as low as minus 321 degrees Fahrenheit. But surviving is one thing; being able to successfully function in the conception process is another. The first major breakthrough in that area came in 1949 when A.S. Parkes and two British
scientists developed a method of using a syrupy substance known as glycerol to protect semen from injury during freezing. The process was further refined in 1953 by Dr. Jerome K. Sherman, an American pioneer in sperm freezing. Sherman introduced a simple method of preserving human sperm using glycerol, but he combined this with a slow cooling of sperm, and storage with solid carbon dioxide as a refrigerant. Sherman also demonstrated for the first time that frozen sperm, when thawed, were able to fertilize an egg and induce its normal development. As a result of this research, the first successful human pregnancy with frozen spermatozoa was reported in 1953. (Shortly before the Cook County Supreme Court ruled DI was "contrary to public policy and good morals.") Considering the hostile climate for DI at the time, it is not surprising that nearly a decade passes before the first public announcement of a successful birth from frozen sperm. The announcement, made the 11th International Congress of Genetics in 1963, triggered interest in the possibility of sperm banks. Approximately a decade later, in the early 70s, the first commercial sperm bank opened.

When we (Gautam Allahbadia and Swati Allahbadia) established Rotunda – The Center For Human Reproduction in 1996, we had a specific vision for their new undertaking. I was a consultant at the Bombay Hospital, and Swati, a lecturer at Sion Hospital and we saw this new reproductive potential as a practical, viable solution to a painful dilemma we had witnessed in the practice of our professions: the often traumatic effect of sterility on men. Our observations concurred with the findings of Dr. Patricia Schreiner-Engle of the Mt. Sinai School of Medicine. According to Dr. Schreiner-Engle, the loss of a man's ability to father children often has a shattering impact on his self-esteem. It doesn't matter whether the sterilization is the result of a voluntary vasectomy, or of cancer or some other disease which requires surgery, chemotherapy or radiation. Whatever the reason, a man's loss of his ability to perpetuate his family name often triggers a crises in identity -- a sense of diminished masculinity. Infertility is still perceived by many to be a female problem. However, for nearly half of the
20 million infertile couples in the India, the problem stems from the infertility of the male. A University of Wisconsin survey, which was sent out to doctors throughout the United States who were treating problems of infertility, revealed that a surprising number of those doctors were quietly treating infertility with donor insemination. The physicians performing the procedure were using fresh semen, and usually selected the donors themselves, most often medical students, residents of other hospital personnel. Most of these doctors reported an effort to select donors who matched the husband in such things
as height, hair, skin and eye color, blood type, religious or ethnic background and educational level. Donor screening for genetic disease was usually limited to a medical history. Few of the doctors performed any biochemical tests on the donors.
The publishing of the University of Wisconsin survey generated an increased demand for anonymous donor insemination. Sperm banks across the USA responded. By the beginning of the eighties, meeting this need had become their main focus. In India, even in the early 1990s, there was only one recognised banking service in Mumbai.

At first some doctors resisted the use of frozen sperm for donor insemination. The job of a fertility specialist is to help a woman get pregnant. Research the time suggested the chances were slightly better with fresh sperm than with frozen sperm.
Over the years, expanded demand for DI, convenience, and the number and variety of donor prospects offered by sperm banks slowly eroded this resistance. Then in 1985, something happened that dramatically hastened the transition to the predominate use of frozen sperm for DI: the identification of a devastating newly recognized sexually transmitted disease --
HIV. A year later, in response to this new threat, the American Association of Tissue Banks began discouraging the use of fresh semen among its member sperm banks. In February 1988, the American Fertility Society (now, the American Society for Reproductive Medicine), the Food and Drug Administration, and the Center for Disease Control all recommended that
only frozen semen be used for DI, in conjunction with a minimum 6 month quarantine period. It became clear to the scientific community that the best way to ensure semen was not infected with HIV, hepatitis or other sexually transmitted disease is to freeze and quarantine the specimen for 6 months, at which time the donor is retested. This reduces the possibility that the donor had the virus at the time the specimen was collected and frozen. Today, the majority of sperm used for DI is frozen, clearly giving sperm banks a critical role in reproductive biology.

We have come a long way since the days when the only viable alternative an infertile couple had to become parents was adoption. The ability to freeze and store sperm has contributed greatly to this process. It has played an integral part in the development of today's more effective reproductive technologies. Fortunately, male factor infertility no longer means a couple must forgo the experience of pregnancy and childbirth. Thanks to modern reproductive technology and sperm banks, many of these couples have the option of becoming parents by using artificial insemination. While couples and individuals requiring sperm for artificial insemination make up most of the people who use today's sperm banks, these institutions also provide help for other individuals with reproductive problems. Among them, men facing voluntary sterilization, or
sterilization resulting from medical conditions or treatments. There is a medical and legal consensus today that men facing the possibility of sterilization, reduction in fertility potential or exposure to reproductive hazards should be fully informed of the option of semen storage. This practice is frequently followed by physicians treating men who are facing vasectomy, orchiectomy, chemotherapy, radiation therapy, or high risk occupational exposure to radiation or toxic substances. Our current environmental crisis has also generated a need for sperm bank services. Men who work in industries where there is the danger of exposure to radiation, toxins or other genetically threatening environmental pollutants are using sperm banks to preserve their sperm as insurance against possible accidents that could leave them infertile, impotent, or genetically damaged. In addition to these typical uses for sperm bank services, Rotunda –The Center For Human Reproduction has responded to some unique requests; of fathers donating sperm for infertile sons and brothers donating sperm for infertile brothers.

If you are a couple with a male factor reproductive problem, or a single woman who has chosen to become a mother, you may be considering using the services of a sperm bank. Your first step should be to discuss the possibility with your doctor. His or her knowledge of your physical condition, and your doctor's experience in reproductive medicine can provide
you with insight into whether a sperm bank can help you meet your specific reproductive goals or needs. Ultimately, however, only you can make that decision. It will depend as much on who you are and your feelings and beliefs about what you are doing, as it will on what you are seeking to accomplish. But before you can make that decision, you need to understand precisely what a sperm bank can and cannot do for you.

* A sperm bank can freeze and store sperm for a man facing voluntary or medically induced sterilization. Sperm that can be thawed at a later date and used for artificial insemination.
* A sperm bank can freeze and store the sperm of a man whose vocation places him at risk for an environmental accident that could leave him infertile, impotent, or genetically damaged.
* A sperm bank can store a husband's sperm for AIH or other modern reproductive technologies that require sperm for use during ovulation.
* A sperm bank can provide safe, disease-tested sperm for artificial insemination from a wide selection of carefully screened and tested anonymous donors.
* A sperm bank can provide recipients seeking sperm from an anonymous donor with accurate and comprehensive information about their prospective donors, so that the recipients can select the donor best suited to meet their specific requirements.

In other words, a sperm bank can test, freeze, store and provide safe, disease-screened sperm for use in various reproductive technologies.

* A sperm bank cannot guarantee successful conception.
* A sperm bank cannot guarantee a healthy pregnancy or child.
* A sperm bank cannot genetically determine or in any way manipulate the intelligence, talents or physical characteristics of any child conceived from the sperm it supplies.

Legend has it that the world renowned dancer, Isadora Duncan once wrote to George Bernard Shaw, "You have the greatest brain in the world, and I have the most beautiful body, so we ought to produce the most perfect child." To which Shaw is alleged to have answered, "My dear woman, what if the child inherits my body and your brains?"

Shaw fully understood the element of chance involved in procreation; the innumerable possibilities that come into play with the union of sperm and egg. The laws of nature that dictate those possibilities remain intact whether the conception is the result of normal sexual intercourse or reproductive intervention.


1. How Safe Is The Donor Sperm Provided By Sperm Banks?
While in India, only the state of Delhi has laws at present governing the operation of sperm banks, the American Society for Reproductive Medicine and the American Association of Tissue Banks have established guidelines which most professional sperm banks the world over follow. Rotunda Sperm Bank adheres to these principles. These guidelines require the rigorous screening of donors.

So thorough is this screening process that a user of donor sperm from an accredited sperm bank probably knows more about her anonymous donor than any bride knows about the man she is about to marry. Or for that matter, more than many women know about their husbands even after ten years of marriage. Accredited sperm banks not only screen all donors for an array of genetic and sexually transmitted diseases, but freeze and quarantine all anonymous donor sperm for six months
so they can retest the donor to make sure he tests negative for HIV, hepatitis and other sexually transmitted diseases (STD). Only when this testing reveals that the donor is free of these diseases is his frozen sperm released for use. Safety is the primary advantage of using a sperm bank.

2. Are There Any Risks Involved In Being Artificially Inseminated With Frozen Sperm?
Nothing in life is without risk. In this case, however, the potential risk is not in the use of thawed frozen sperm, but in the insemination process itself. Artificial insemination is an invasive procedure, therefore there is always the possibility of infection. There is also the normal risk of defects and complications associated with any pregnancy, particularly when the woman is over forty, as is the case with many of the women who choose artificial insemination.

3. How Can I Be Sure I Am Getting The Correct Sperm?
There have been reports in the newspaper in recent years of lawsuits alleging mix-ups in sperm specimens supplied by sperm banks. Since one man's sperm cannot be distinguished from another, even under the most powerful microscope, such a mix-up is not beyond possibility, either during processing or in the doctor's office during the administration of the
insemination. Rotunda – The Center For Human Reproduction, Bandra, Mumbai In Collaboration with Andrology Laboratory Services, Incorporated, Chicago, USA has introduced the DNA-ID check which confirms your infant's identity using saliva.

What Is THE DNA-IDCHECK?

DNA-IDCHECK is an infant identification and parentage confirmation system. Using state-of-the-art DNA technology, the test is inexpensive, efficient and non-intrusive, requiring no more than a small saliva sample from the parent(s)
and infant. When a DNA mismatch occurs, the DNA-IDCHECK System can establish if you are NOT the father. Our DNA-IDCHECK System is an inexpensive screening test to decide you might require more extensive, legally certifiable
testing. The DNA-IDCHECK System, using a special analysis for matching parent-to-infant genetic code, can only identify an individual or prove if an adult is not the genetic parent of a particular infant. In other words, they convey no relevant genetic information during the testing procedure: The test reveals nothing else about the tested individual. Confidentiality and privacy issues are never violated. For more details log on to www.iwannagetpregnant.com or contact Rotunda-The Center For Human Reproduction, Bandra, Mumbai at 26553000/2000 or goralgandhi@gmail.com

However, well-run, professional cryobanks follow rigid labeling, processing and storage procedures that make such confusion unlikely. The best way to avoid this problem is to choose an experienced, efficiently operated professional sperm bank that adheres to the guidelines set up by the American Society for Reproductive Medicine. Sperm banks will, of course, never supplant the natural process for conceiving a child. But in combination with artificial insemination and other modern reproductive technologies, and by working along side reproductive care physicians, today they offer many couples and
individuals who are unable to conceive naturally the possibility of experiencing pregnancy and the birth of their desired child.

Age, Infertility & Donor Eggs

While most healthy older women who become pregnant have uneventful pregnancies and healthy babies, thousands more are unable to achieve pregnancy because of declining ovarian function. A decline in ovarian function is normal with increasing age. A woman's number of eggs steadily decreases from a peak at mid-gestation of 7 million to approximately 400,000 at puberty. Certain tests can reflect gradations in ovarian reserve status and predict a woman's potential fertility. The most important lab test is the day 2/3 follicle-stimulating hormone level.

Women with declining ovarian responsiveness and clinical outcomes consistent with declining ovarian reserve have decreased day 3 serum inhibin B levels despite having non-elevated day 3 serum FSH concentrations. Declining ovarian reserve may be demonstrated by a decrease in day 3 inhibin B levels before a rise in day 3 FSH levels. A constant source of frustration in fertility centers is that patients are referred to the specialty clinic too late, when diminished ovarian reserve is so marked that treatment success is severely limited. Earlier assessment of ovarian function would alter this unfortunate trend.

Reproductive failure in women of older age appears to be directly related to ovarian age. It seems that the age-related decline in fertility may be due more to degenerative oocytes than to aneuploidy. The decline in female fertility occurs primarily as a result of a decline in oocyte quality as well as quantity A decline in the number of oocytes retrieved with age may be of less importance than the decline in oocyte quality. Embryo implanting ability and survival decline gradually after 30 years of age, but by more than two thirds after 40 years and in younger women with reduced ovarian capacity. The frequency of chromosomal anomalies in recognized abortuses increases in parallel with the age-specific rise in the incidence of spontaneous abortions. Recent techniques such as cytoplasmic or germinal vesicle transfer are designed to replace the senescent cellular machinery believed to be responsible for genetic errors that occur during early cell division. PGD can accurately identify embryos with genetic deficiencies prior to implantation.

Research indicates that much of the decline in fecundity can be attributed to an increasing risk of fetal loss with maternal age. Much of this fetal loss is due to chromosomal abnormalities--a result of ageing oocytes. Fecundability, on the other hand, does not begin to decline until the early 40s. This is also a result of ageing at the ovarian level, namely follicular atresia, in the years just prior to menopause. The irregularity of menstrual cycles--longer cycles and increasingly variable hormonal patterns--at these ages may be a direct result of the small and rapidly dwindling remaining pool of follicles. The number of small antral follicles in both ovaries as measured by vaginal ultrasonography is clearly related to reproductive age and could well reflect the size of the remaining primordial follicle pool.

There is a significant decline in human fecundity with advancing age. A significant decrement in success rates is also seen in older women undergoing assisted reproduction, including in-vitro fertilization. We have observed a drop in the ongoing pregnancy rate per patient, from about 32 % in women aged less 30 years to lesss than 28 % in women aged more than 35 years. Embryo implantation rates also decline in a linear fashion, from 5 % in women less than 30 years to approximately 2 % at age over 40 years. We observed that the impaired implantation efficiency seen in older women is apparently independent of the magnitude of their stimulation response. Although no statistically significant relationships were found between serum FSH concentrations as obtained in the early follicular phase and the number of oocytes collected, or the total dose, there was a trend to poorer response as the FSH approached closer to 10 mIU/mL. The decline in number of oocytes retrieved with increasing age can be at times overcome by augmenting the daily dose of gonadotropins to as much as 1050 mIU/mL. Oocyte factors are felt to be primarily responsible; however, some available data suggest that uterine factors, e.g. diminished endometrial receptivity, may also play a role.

Natural fertility rates decline in most animals with age, becoming dramatically apparent in women as they enter the fifth decade of life. By the time of the perimenopause, pregnancy rarely occurs, whether or not assisted reproductive techniques are initiated. However, if oocytes are donated by young women to older women, both embryo implantation and pregnancy rates are restored to normal levels in recipients. These results strongly suggest the pregnancy wastage experienced by older women is largely a result of degenerative changes within the aging oocyte(egg), rather than senescent changes in the uterus. The poor prognosis for fertility in older women can be reversed through oocyte donation from younger individuals.

There are presently no treatment strategies apart from oocyte donation, which have been shown to significantly improve implantation efficiency in older women. Women in the older age group have a higher chance of achieving pregnancy from ovum-donation programs than by persisting in using their own aged eggs, which have a very poor prognosis for success.
However, recent efforts have focused on the continued development of improved stimulation protocols in higher doses, facilitation of embryo implantation by zona pellucida micromanipulation, and the possibility of screening preimplantation embryos for aneuploidy. Elderly women with partners who have suboptimal sperm parameters reflected by low fertilization capacity scores may benefit from micro-manipulation procedures. Egg Donation is the only answer presently until maybe Cytoplasmic Transfer becomes routine- maybe a decade from now.

Necrozoospermia

Necrozoospermia is a condition in which all of the sperm in a man's ejaculate are dead. In point of fact, there are a number of reasons for a man to be afflicted with necrozoospermia. Indeed, necrozoospermia can be the result of everything from diet, disease, injury, medications, alcohol or illicit drug use and other factors. In many instances, if the underlying cause of necrozoospermia is resolved, the condition of necrozoospermia likewise will be rectified.

If you have been told by your doctor that you suffer from necrozoospermia, it is important that you do seek further medical attention. In some instances, necrozoospermia can be a symptom of a serious problem that can have very serious additional consequences beyond necrozoospermia. For example, in some instances, necrozoospermia is the sign of another condition or disease that could even end up resulting in erectile dysfunction. Although allopathy has no answers for this condition, some Indian Ayurvedic formulations seem to have shown improvement with this condition in isolated case reports.

For the doctor, he must distinguish between live –immotile sperms and dead-immotile sperms. Assisted Reproductive Techniques can help patients whose sperms are alive but immotile. We had a patient; the individual simply didn't follow proper collection technique and had been using a lubricant gel. As soon as he collected without the lubricant, his motility was in the normal range. One should also test the semen for autoantisperm antibodies that might have been caused by a different habit of sex, eg. Anal sex. Usually, with such severe motility problems, the patient has to undergo Intracytoplasmic Sperm Injection (ICSI). Let me start a thread here for the medical bloggers.

For a man with 100% immotile sperm in the ejaculate, of which 10% are live, are pregnancy rates better with ICSI (after selecting live sperm with a hypo-osmotic swelling test); or is it better to offer TESE-ICSI (ICSI with testicular sperm extraction)?

10% viable sperms should be good enough for ICSI. Why TESE-ICSI, if one can get 10% viable sperms in the ejaculate? Moreover, TESE is associated with complications - like fibrosis. TESE because you cannot pick out which of the 10% are viable sperm to inject with good reliability. HOS test may help but data on it's use for ICSI involves small numbers. You are much more likely to have higher viability from the testis (assuming no motile sperm are found in the vas or epididymis) than from the ejaculate. Surgical retrieval of sperm is an option that should not be ignored in such cases, as we all are driven to achieve the best possible outcomes for our patients. Do a testicular retrieval fresh at the time of IVF/ICSI. You will probably find motile (twitching) sperm. This is much more reliable than trying to identify viable sperm in a 0% immotile ejaculate.

The task of selecting a single sperm for injection, from the stated 10% viable population from the sample of zero motility, on the basis of the HOS test, is no way nearly as easy as some colleagues would like you to believe. It is technically difficult to pick up curled sperm which have been exposed to HOS solution. But you can pick the sperm up from culture media, transfer your needle into a drop of HOS solution, hold the sperm near the opening of the needle and allow the HOS solution to diffuse into the needle and you can watch the sperm start to curl inside the ICSI needle. As soon as you see the sperm tail curl, you can move to a PVP drop, break the tail and perform the ICSI.

Our experience with such situation is that (1) the outcome (in terms of fertilization and pregnancy rates) is the same between viable (non-motile) testicular sperm and viable (non-motile) ejaculated sperm; (2) motile spermatozoa can be found in some (about 40%) of the patients with 100% immotile sperm in ejaculated semen. This is the only reason that testicular biopsy is carried out in patients with 100% non-motile ejaculated sperm in our Center.

First, a viability test is essential. Alternatives to HOS are Eosin Y or Trypan blue staining, or use of a fluorescent DNA-binding probe such as Hoechst 33258. If all the sperm in semen are 'dead', we would not suggest ICSI using them. In our practice, we determine whether there is an immediate possible cause of cell death such as high reactive oxygen species generation by leukocytes, which might be addressed. If not, a vas or testicular aspiration is considered. We have seen normal (for the site)
motility from either vas or testis when semen sperm motility is poor. Second, if some of the sperm are apparently live, we would attempt to stimulate motility using pentoxifylline. Surprisingly, this has worked in some cases of 0% motility. The induced motility may or may not be of sufficient quality and quantity to consider IUI or IVF. But, even if there is only twitching motility, this may be sufficient to choose sperm for ICSI. The pentoxifylline is washed out of the sperm preparation before any of the insemination procedures. This also avoids having to use HOS to choose non-motile sperm. Third, if no sperm respond to pentoxifylline, medical, genetic, or electron microscopic evidence could be gathered to rule out an immotile cilia syndrome, followed by genetic counseling.