Thursday, August 23, 2007

Uterine Washing for Increased Success In IVF?

The results of a new study have suggested that broad-spectrum antibiotic therapy, in the form of intravenous administration plus intra-uterine lavage, could help increase the chances of a successful IVF pregnancy in couples who have had one or more failed IVF cycles. Researchers from the Feinstein Institute for Medical Research and the New York Presbyterian Medical Center’s MacLeod Laboratory, in New York, USA, conducted the small retrospective study to investigate whether giving broad-spectrum antibiotic therapy to couples after a failed IVF cycle would help improve the chances of achieving a successful pregnancy in the next IVF cycle.

The study was conducted after “two decades of favorable experience with antibiotic therapy, initially given orally, later administered intravenously with uterine lavages, both in terms of reversing infertility and improving pregnancy outcome.”
In their paper published in the Internet Journal of Gynecology and Obstetrics, the researchers report the analysis of 52 consecutive couples (mean age of the women 38.5 years) treated between January 2002 and April 2004. All of the couples had a history of primary or multiple failed IVF cycles. Before initiating the antibiotic therapy both partners in each couple underwent antibody testing, bacterial testing (including for Chlamydia) and culturing. The result of the culture studies did not affect the recommendation of antibiotic therapy.

The women in each couple received the following: 10 days of intravenous clindamycin at the full therapeutic dose, plus five intra-uterine lavages (with a combination of ampicillin, gentamicin, fluconazole and metronidazole for one hour, followed by filling the uterine cavity and cervical canal with a metronidazole-containing gel) performed on consecutive days in the first five days of intravenous therapy. The antibiotic treatment was completed with a three-week course of oral doxycycline. The men received intravenous clindamycin (although half declined and were given oral co-amoxiclav as a substitute) and a three-week course of oral doxycycline. Overall there were two cases of mild diarrhea, which responded to treatment, and no other complications were seen.

The outcomes in the antibiotic-treated patients were compared with those of three historical control groups, derived from previously published studies of couples in conventional repeat IVF cycles. In each comparison, the antibiotic-treated group was found to have a significantly higher standardized delivery rate – these rates were from 33.8-46.1 percent in the antibiotic-treated group, compared with 6.4-22.8 percent in the three control groups. The researchers discuss the outcomes in detail in the full paper. For example, the only pregnancy-related complication in the antibiotic-treated group was one cases of pre-eclampsia. They emphasize that further research is required, and conclude: “These findings suggest that a certain number of failures during IVF cycles are due to an intra-uterine infection that could affect the course of the pregnancy, the mode of delivery, and cause maternal and fetal complications.”

I shudder to think what could be lapped up by the "failed IVF" patients if anecdotal reports based on a single clinic's experience finds its way into the front pages of daily newspapers. This was a retrospective "experience-based" study with no scientific value, but has found itself in all the leading dailies globally because the editors want a catchy byeline!

Wednesday, August 22, 2007

Lights In IVF Clinics May Damage Embryos


A study has found that exposure to the 'harsh' cool-white fluorescent lighting commonly used in fertility clinics, research labs and most office environments could be particularly damaging to an embryo's healthy development. A joint team of researchers in Hawaii and Japan conducted the study on mouse embryos and found that certain types of light exposure are more damaging to embryo development than others.
The study also indicates that mammalian embryos, which develop in dark wombs, lack a protective mechanism that other animals, such as amphibious frogs or fish which lay external eggs, possess in order to cope with exposure to light. These results were published last week in the Proceedings of the National Academy of Sciences of the United States of America.
Sunlight and cool-white fluorescent office light, which is blue-white in appearance, were the most detrimental to the mice embryo development while warm-white light, which is typically used to illuminate homes and residential environments and has a yellow-white colour, was significantly less damaging, according to Dr. Ryuzo Yanagimachi, a retired reproductive biology specialist involved with the University of Hawaii study in collaboration with Manami Takenaka and Toshitaka Horiuchi of the Prefectural University of Hiroshima. They found that even reducing light-exposure to ten seconds for direct sunlight and to a few minutes for blue-white light, still caused damage to the embryos in the study.
It appears that the light stimulus triggers a stress response in the embryos that hampers their healthy development. When exposed to light, the embryos produced increased levels of radical oxygen which is toxic to cellular development, explained Dr. Yanagimachi. He added that the study has lent support to his belief that light is a neglected environmental factor in embryo development.
The researchers suggest that labs which deal with human and animal embryos would improve their success in embryo development if they (1) replace 'harsh' office lighting with 'softer' warm-white light bulbs for illumination, thereby reducing damage to reproductive materials when they are unavoidably exposed to light in the lab, and (2) generally attempt to minimise light exposure as much as possible during each stage of embryo development that is manipulated outside of the uterus including during egg extraction, sperm insemination and fertilisation.
These are lessons to learn. I had heard this from a senior Professor at Vancouver in 1992 & when I set up my laboratory in Mumbai, we had the warm yellow lights put all across the clinic in opposition to the architect & the turn-key IVF specialists!

Tuesday, August 21, 2007

Rabin's killer given go ahead to father a child

Israel's High Court of Justice has ruled that Yigal Amir, the assassin who killed Prime Minister Yitzhak Rabin in 1995, will be allowed to father a child using artificial insemination (AI). Amir was jailed for life without parole following the murder and married Larissa Trimbobler by proxy in 2004. The prison does not allow conjugal visits. The case was brought as former Knesset Members Neta Dobrin and Ronen Tzur petitioned against the ruling by the Israeli Prison Service that would allow Mr Amir to father a child. Their petition was rejected, allowing Mr Amir and Ms Trimbobler to proceed with AI treatment. Amir, an ultra-nationalist Jew, has shown no regret for shooting Rabin in an effort to stop the handover of Israeli land in any peace deals with Palestine. Trimbobler, a divorced mother of four, emigrated to Israel from the former Soviet Union and has visited Amir in prison every two weeks for several years.
In their unanimous ruling Justice Ayala Procaccia wrote, 'Amir was and is one of the most widely condemned criminals in the Israeli national consciousness, if not the most widely condemned...Nonetheless, he, like all prisoners, has basic human rights that were not appropriated from him when he went to prison'. The ruling found that restrictions placed on Amir were related to his loss of freedom after being sentenced to life, other restrictions on his human rights may also be inherent in this loss of freedom. Any further restrictions that may be applicable were to be based on the interests of state security or other considerations of vital public interest. 'Beyond these, however, Amir is entitled, as is every prisoner, [to all the other] basic rights.' wrote Justice Procaccia.
As the Israeli Basic Law on Human Dignity and Freedom, which includes the right to a family, was not restricted by Amir's sentence then the court found that he has as much right as any other Israeli to start a family. A right provided by the basic law can only be withheld on the basis of a law or specific authorization, if the act is in accordance with the values of Israel as a Jewish and democratic state, only for a worthy cause and only if the action taken is balanced. It was judged that to deny Amir a family would not meet these conditions.
The decision was greeted with dismay by Yossi Lahmani, the director-general of the Rabin center. He commented, 'The court should have understood, as the last bulwark of democracy, that this was not a technical-medical decision about inseminating a lady who, by all accounts, is eccentric and decided to become pregnant from the detestable killer, but a fundamental and special decision that distinguishes this 'shooter in the back of the nation' from other killers.'
The case mirrors the recent British case of Kirk Dickson, also serving a life sentence for murder, who has been denied the right to use AI to impregnate his, much older, wife. Mr Dickson, whose wife will be 51 when he is first eligible for release in 2009, took his case to the European Court of Human Rights claiming that the Home Office refusal to allow him access to fertility treatment breached his right to found a family and his right to family life provided in the European Convention on Human Rights. His appeal was rejected by a bare majority. As part of the ruling the court found that the nature of the crime committed and the welfare of any child that may be conceived under the circumstances must be taken into account.
Any Comments?

Monday, August 20, 2007

The Power of Prayers

Prayers offered by strangers had no effect on the recovery of people who were undergoing heart surgery, a large and long-awaited study has found. And patients who knew they were being prayed for had a higher rate of post-operative complications like abnormal heart rhythms, perhaps because of the expectations the prayers created, the researchers suggested.

Because it is the most scientifically rigorous investigation of whether prayer can heal illness, the study, begun almost a decade ago and involving more than 1,800 patients, has for years been the subject of speculation. The question has been a contentious one among researchers. Proponents have argued that prayer is perhaps the most deep human response to disease, and that it may relieve suffering by some mechanism that is not yet understood. Skeptics have contended that studying prayer is a waste of money and that it presupposes supernatural intervention, putting it by definition beyond the reach of science. At least 10 studies of the effects of prayer have been carried out in the last six years, with mixed results. The new study was intended to overcome flaws in the earlier investigations.

In a hurriedly convened news conference few months ago, the study's authors, led by Dr. Herbert Benson, a cardiologist and director of the Mind/Body Medical Institute near Boston, said that the findings were not the last word on the effects of so-called intercessory prayer. But the results, they said, raised questions about how and whether patients should be told that prayers were being offered for them. "One conclusion from this is that the role of awareness of prayer should be studied further," said Dr. Charles Bethea, a cardiologist at Integris Baptist Medical Center in Oklahoma City and a co-author of the study. Other experts said the study underscored the question of whether prayer was an appropriate subject for scientific study. "The problem with studying religion scientifically is that you do violence to the phenomenon by reducing it to basic elements that can be quantified, and that makes for bad science and bad religion," said Dr. Richard Sloan, a professor of behavioral medicine at Columbia and author of a forthcoming book, "Blind Faith: The Unholy Alliance of Religion and Medicine." The study cost $2.4 million, and most of the money came from the John Templeton Foundation, which supports research into spirituality. The government has spent more than $2.3 million on prayer research since 2000.

Dean Marek, a chaplain at the Mayo Clinic in Rochester, Minn., and a co-author of the report, said the study said nothing about the power of personal prayer or about prayers for family members and friends. Working in a large medical center like Mayo, Mr. Marek said, "You hear tons of stories about the power of prayer, and I don't doubt them." In the study, the researchers monitored 1,802 patients at six hospitals who received coronary bypass surgery, in which doctors reroute circulation around a clogged vein or artery. The patients were broken into three groups. Two were prayed for; the third was not. Half the patients who received the prayers were told that they were being prayed for; half were told that they might or might not receive prayers. The researchers asked the members of three congregations — St. Paul's Monastery in St. Paul; the Community of Teresian Carmelites in Worcester, Mass.; and Silent Unity, a Missouri prayer ministry near Kansas City — to deliver the prayers, using the patients' first names and the first initials of their last names. The congregations were told that they could pray in their own ways, but they were instructed to include the phrase, "for a successful surgery with a quick, healthy recovery and no complications."

Analyzing complications in the 30 days after the operations, the researchers found no differences between those patients who were prayed for and those who were not. In another of the study's findings, a significantly higher number of the patients who knew that they were being prayed for — 59 percent — suffered complications, compared with 51 percent of those who were uncertain. The authors left open the possibility that this was a chance finding. But they said that being aware of the strangers' prayers also may have caused some of the patients a kind of performance anxiety. "It may have made them uncertain, wondering am I so sick they had to call in their prayer team?" Dr. Bethea said. The study also found that more patients in the uninformed prayer group — 18 percent — suffered major complications, like heart attack or stroke, compared with 13 percent in the group that did not receive prayers. In their report, the researchers suggested that this finding might also be a result of chance. One reason the study was so widely anticipated was that it was led by Dr. Benson, who in his work has emphasized the soothing power of personal prayer and meditation. At least one earlier study found lower complication rates in patients who received intercessory prayers; others found no difference. A 1997 study at the University of New Mexico, involving 40 alcoholics in rehabilitation, found that the men and women who knew they were being prayed for actually fared worse.

The new study was rigorously designed to avoid problems like the ones that came up in the earlier studies. But experts said the study could not overcome perhaps the largest obstacle to prayer study: the unknown amount of prayer each person received from friends, families, and congregations around the world who pray daily for the sick and dying. Bob Barth, the spiritual director of Silent Unity, the Missouri prayer ministry, said the findings would not affect the ministry's mission. "A person of faith would say that this study is interesting," Mr. Barth said, "but we've been praying a long time and we've seen prayer work, we know it works, and the research on prayer and spirituality is just getting started."

I believe in the power of prayers & I know that prayer works - I wish we would scientifically set up a similar study in India!

Sunday, August 19, 2007

Dead Duck

A woman brings a very limp duck into a veterinary surgery. As she lays the duck on the examination table the vet pulls out his stethoscope and listens to the duck's chest for signs of life. After a few moments the vet shakes his head and turns to the woman and says sadly, "I'm sorry but the duck has passed away." The distressed owner wails, "Are you sure?"

"Yes of course I'm sure. The duck is dead," he replies.

"How can you be so sure?" she protests. "I mean you haven't done any testing - he might be in a coma or something." The vet rolls his eyes and leaves the room. He returns with a black Labrador. As the duck's owner looks in amazement, the dog stands on his hind legs, puts his front paws on the examination table and sniffs the duck from top to bottom. He then looks at the vet and with sad eyes shakes his head. The vet pats the dog on the head and takes him out and returns a few moments later with a cat. The cat jumps up on the table and also sniffs the duck from its beak to its tail at the back end and back again. The cat sits and shakes its head and meows softly, jumps down from the examination table and strolls out of the examination room.

The vet looks at the woman and says, "I am sorry, but as I said, this Is most definitely, 100% certifiably, a dead duck."

The vet turns to his computer terminal and after hitting a few keys a bill is printed off, which he hands to the woman. The duck's owner, still in shock, takes the bill. "£450!" she cries. "£450 just to tell me my duck is dead?" The vet shrugs. "If you had accepted my word for it, the bill would have been only £30. But with the LAB report and the CAT scan - it all adds up."

Saturday, August 18, 2007

The Rooster to beat all Roosters

A farmer wanted to have his hens serviced, so he went to the market looking for a rooster. He was hoping he could get a special rooster—one that would service all of his many hens. When he told this to the market vendor, the vendor replied: “I have just the rooster for you. Henry here is the horniest rooster you will ever see!”

So the farmer took Henry back to the farm. Before setting him loose in the hen house, though, he gave Henry a little pep talk: “Henry,” he said, “I’m counting on you to do your stuff.” And without a word, Henry strutted into the henhouse. Henry was as fast as he was furious, mounting each hen like a thunderbolt. There was much squawking and many feathers flying, until Henry had finished having his way with each hen. But Henry didn’t stop there. Henry went into the barn and mounted all of the horses, one by one, and still at the same frantic pace. Then he went to the pig house, where he did the same. The farmer, watching all of this with disbelief cried out, “Stop, Henry!! You’ll kill yourself!!”

But Henry continued, seeking out each farm animal in the same manner Well, the next morning, the farmer looked out and saw Henry lying there on his lawn. His legs were up in the air, his eyes rolled back, and his long tongue hanging out. A buzzard was already circling above Henry. The farmer walked up to Henry saying, “Oh you poor thing, look what you did, you’ve gone and killed yourself. I warned you little buddy.”

“Shhhhhhh,” Henry whispered, “The buzzard’s getting closer.”

Friday, August 17, 2007

Letter From A Sikh Friend

I was standing at Jalandhar station when my attention went towards a Sikh youth standing near me wearing a black turban having a long beard and wearing a kirpan over his shirt looking similar to the classic terrorist pictures made popular by Bollywood movies & the Bhindranwale era.

After a while, one local train arrived, which was totally packed. The Sikh youth tried to get onto the train but failed to do so. Just then a voice was heard from the back coach 'Sardarji Barah Baj gaye' (Sir it's 12 o'clock!). The Sikh youth looked over at that voice maker who was a young mischievous type of person and instead of showing any anger smiled at him. The smile made was so enigmatic that it seemed as if some type of truth lies behind it. Not able to resist my temptation, I walked towards him and asked him why did he smile at that person who teased him. The Sikh youth replied, 'He was not teasing me but was asking for my help'. I was surprised with these words and he told me that there was a big history behind that which one should know. I was eager to know the history and the Sikh youth narrated:

During 17th Century, when Hindustan was ruled by Mughals, all the Hindu people were humiliated and were treated like animals. Mughals treated the Hindu women as their own property and were forcing all Hindus to convert to Islam and even used to behead people if they were refused to convert. That time, our ninth Guru, Sri Guru Teg Bahadurji came forward, in
response to a request by some Kashmiri Pandits to fight against all these cruel activities.

Guruji told the Mughal emperor that if he could succeed in converting him to Islam, all the Hindus would accept the same. But, if he failed, he should stop all those activities. The Mughal emperor happily agreed to that but even after lots of torture to Guruji and his fellow members, he failed to convert him to Islam and Guruji along with his other four fellow members, were tortured and sacrificed their lives in Chandni Chowk (Old Delhi )...That's why the Gurudwara there is named "Sheesh
Ganj"(Sheesh means head). Since the Mughals were unable to convert them to Islam they were beheaded. Thus Guruji sacrificed his life for the protection of Hindu religion. Can anybody lay down his life and that too for the protection of another religion? This is the reason he is still remembered as "Hind Ki Chaddar" (Shield of India). For the sake of whom he had sacrificed his life, none of the Hindus came forward to lift his body, fearing that they would also be assassinated. Seeing this incident our 10th Guruji, Sri Guru Gobind Singhji (Son of Guru Teg Bahadarji) founder of Khalsa made a resolution that he would convert his followers to such human beings who would not be able to hide themselves and could be easily located
in thousands.

At the start, the Sikhs were very few in numbers as they were fighting against the Mughal emperors. At that time, Nadir Shah raided Delhi in the year 1739 and looted Hindustan and was carrying lot of Hindustan treasures and nearly 2200 Hindu women along with him. The news spread like wild-fire and was heard by Sardar Jassa Singh who was the Commander of the
Sikh army at that time. He decided to attack Nadir Shah's Kafila on the same midnight. He did so and rescued all the Hindu women and they were safely sent to their homes. It didn't happen only once but thereafter whenever any Abdaalis or Iranis had attacked and looted Hindustan and were trying to carry the treasures and Hindu women along with them for selling them in Abdal markets, the Sikh army although fewer in numbers but brave hearted, always attacked them at midnight, 12 O'clock and rescued the Hindu women.

After that time whenever there occurred any similar incidents, people started to contact the Sikh army for their help and Sikhs used to attack the raiders at Midnight, 12 O'clock. Nowadays, these "smart people" and some Sikh enemies who are afraid of Sikhs, have spread these words that at 12 O'clock, the Sikhs go out of their senses. This historic fact was the reason which made me smile over that person's ignorance as I thought that his Mother or Sister would be in trouble and wants my
help and was reminding me by shouting aloud, 'Sardarji Barah Baj Gaye'

I just thought these little known facts about India should be brought out to our readers. Would love your feedback.