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
Tuesday, July 24, 2007
Monday, July 23, 2007
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.
This is one area where the ICMR needs to come out with a consensus statement in our own country.
Sunday, July 22, 2007
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?"
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?"
Saturday, July 21, 2007
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.
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.
Friday, July 20, 2007
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.
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.
Thursday, July 19, 2007
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.
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.
Wednesday, July 18, 2007
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 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."
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