A report on the circumstances surrounding the 2003 death of Irish IVF patient Jacqueline Rushton has been published. The report was commissioned by the Republic of Ireland's Health Service Executive (HSE), and written by Alison Murdoch of the Newcastle Fertility Centre and independent healthcare consultant Stuart Emslie. Rushton, a 32-year-old nurse, was treated at the Human Assisted Reproduction Ireland unit of Dublin's Rotunda Hospital. She was admitted to this same hospital on 8 December 2002, after she was found to be overreacting to her IVF treatment, and was subsequently transferred to Dublin's Mater Private Hospital. Despite initially appearing to make a recovery, she collapsed and was placed on a ventilator, which was switched off on 14 January 2003. The cause of Rushton's death was found to be acute respiratory distress syndrome, a rare complication of ovarian hyperstimulation syndrome - itself a complication associated with IVF, where fluid from the bloodstream leaks into the abdominal cavity and causes it to swell.
The report concludes that there were problems with the management of Rushton's care, compounded by a lack of senior supervision and inconsistent compliance with official guidelines for treating her condition. The report recommends regular care audits, in which it is incumbent upon hospitals to prove standards rather than merely claiming to have them, together with and a review of in-house protocol in all general hospitals and IVF clinics.
Rushton's family have declared themselves satisfied with the outcome of the report, and they have instructed their solicitors to drop legal proceedings against the health authorities. They have also expressed their hope that the report's recommendations will prevent another family from going through the same ordeal. The Irish Patient Association has said that the episode raises significant questions about patient care. Irish health minister Mary Harney has announced that immediate steps are being taken to implement these recommendations across HSE hospitals.
The statement, issued by the Master of the Rotunda Hospital Dr Michael Geary acknowleged "lessons have been learned". "In all medical treatments, one cannot always be guaranteed that the outcome will be positive and every effort is made along the way to comply with best practice in patient care and treatment," Dr Geary said. "We sincerely hope, with the new insights and learnings available to us, that a similar incident can be prevented from occurring again in the future," he concluded. "There is always an onus on any healthcare provider to review their processes and systems and this report underlines again this requirement. It is very important for us to learn from this tragic event."
OHSS is the only medical emergency that a Fertility physician faces in his/her career. This report is important because it highlights the possibility of death in the event OHSS is not managed properly. For bloggers interested in the subject, Rotunda is hosting an International Congress on PCOS at Goa in August 2008. There will be an entire video session dedicated to the management of OHSS. The link to follow will be www.sisab.net/pcos2008
Thursday, August 2, 2007
Wednesday, August 1, 2007
The Laser Printer
Bad news, office drones: That laser printer sitting in your cubicle might be doing some serious damage to your health.
The humble office laser printer can damage lungs in much the same way as smoke particles from cigarettes, a team of Australian scientists has found. An investigation of a range of printer models showed that almost a third emit potentially dangerous levels of toner into the air. The Queensland University of Technology scientists have called on ministers to regulate these kinds of emissions. They say some printers should come with a health warning.
The researchers carried out tests on more than 60 machines. Almost one-third were found to emit ultra-tiny particles of toner-like material, so small that they can infiltrate the lungs and cause a range of health problems from respiratory irritation to more chronic illnesses. Conducted in an open-plan office, the test revealed that particle levels increased five-fold during working hours, a rise blamed on printer use. The problem was worse when new cartridges were used and when graphics and images required higher quantities of toner. The researchers have called on governments to regulate air quality in offices. They also want companies to ensure that printers are based in well-ventilated areas so that particles disperse.
That's such fun news, isn't it? And here you were eating salads, jogging and not smoking, and it's going to be your laser printer that does you in. Life sure is hilarious sometimes.
The humble office laser printer can damage lungs in much the same way as smoke particles from cigarettes, a team of Australian scientists has found. An investigation of a range of printer models showed that almost a third emit potentially dangerous levels of toner into the air. The Queensland University of Technology scientists have called on ministers to regulate these kinds of emissions. They say some printers should come with a health warning.
The researchers carried out tests on more than 60 machines. Almost one-third were found to emit ultra-tiny particles of toner-like material, so small that they can infiltrate the lungs and cause a range of health problems from respiratory irritation to more chronic illnesses. Conducted in an open-plan office, the test revealed that particle levels increased five-fold during working hours, a rise blamed on printer use. The problem was worse when new cartridges were used and when graphics and images required higher quantities of toner. The researchers have called on governments to regulate air quality in offices. They also want companies to ensure that printers are based in well-ventilated areas so that particles disperse.
That's such fun news, isn't it? And here you were eating salads, jogging and not smoking, and it's going to be your laser printer that does you in. Life sure is hilarious sometimes.
Tuesday, July 31, 2007
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.
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.
Monday, July 30, 2007
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..
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..
Sunday, July 29, 2007
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."
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."
Saturday, July 28, 2007
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"
"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"
Friday, July 27, 2007
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.
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.
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