Fatherless Families

A unique alliance of senior politicians and churchmen will tomorrow make a historic stand against an attempt by the Government of UK to "drive the last nail in the coffin of the traditional family". MPs and peers from all parties, backed by both Anglican and Catholic church leaders, will ambush legislation intended to let lesbian couples become parents to test-tube babies without any involvement of a father beyond donating sperm. The new law would remove the existing requirement on test-tube clinics to ensure that a father is involved in the upbringing of any child they help create. The alliance of church leaders and Tories - augmented by some Labour rebels - will oppose the new law when it comes up before the House of Lords tomorrow. Their campaign is being backed by MPs from all parties, led by former Tory leader Iain Duncan Smith. They believe that the battle will become as symbolic of changes in social attitudes as the debates about the Abortion Law in the Sixties and Clause 28 of the 1986 Local Government Act outlawing the "promotion" of homosexuality in state schools. Writing in The Mail on Sunday day before, Mr Duncan Smith, who has undertaken pioneering research into the critical role that fathers play in keeping youngsters out of trouble, says the proposed new law is "another nail in the coffin of the traditional family and another blow against fatherhood". Mr Duncan Smith and his allies say the measure is in line with covert moves by the Government to undermine traditional families by removing terms such as "marriage, father, mother, husband, wife and spouse" from the statute book - and even from official forms.

The new row has been provoked by the Human Fertilisation and Embryology Bill which introduces new regulations governing the creation of embryos outside the human body. The most controversial provisions govern IVF treatment. The current duty on the part of clinics to take account of "the welfare of the child" when providing fertility treatment will be retained - but crucially, the reference to "the need for a father" will be removed. It means lesbian couples can be regarded as joint legal parents of children conceived through the use of donated sperm, eggs or embryos. In addition the new registration forms refer to "father or second parent". In the case of lesbian couples, this would allow one woman to be registered as the "mother" and the second woman as "second parent" instead of the sperm donor father.

The Archbishop of York, Dr John Sentamu, is expected to speak against the Bill in the Lords. He has regularly spoken out about the importance of fathers in avoiding a breakdown in family life and argued recently: "If we do not get a lot of role models from fathers, I don't think we're going to turn the tide." He has also spoken out in favour of the traditional two-parent family, arguing: "The Government needs to undertake a policy reorientation that incorporates the benefits of marriage to society as a whole, rather than relegating it to just another lifestyle choice." The Catholic Archbishop of Westminster, Cardinal Cormac Murphy-O'Connor, said yesterday: "The Bill proposes to remove the need for IVF providers to take into account the child's need for a father when considering an IVF application. "This is profoundly wrong as it radically undermines the place of the father in a child's life and makes the natural rights of the child subordinate to the couple's desires."

The campaigners say a new poll commissioned by the charity Christian Action Research and Education shows nearly four out of five people think it is vital to consider a child's need for a father when processing lesbian applicants for IVF treatment. The new law means that where sperm donor fathers are excluded by lesbian parents, children brought up by lesbian couples and who wish to contact their fathers will have to wait until they are 18 to exercise their legal right to establish their identity. Campaigners claim the new law is the latest evidence of a secret drive to remove traditional family roles from the statute book. An investigation established that in recent years, a number of measures have been pushed through quietly to achieve this. In 2000, tax credit forms were changed requiring applicants to refer to their spouses as "partners" not husbands and wives. Tax and benefits forms now routinely refer to "partners" instead of husbands, wives or spouses. And four years ago, Home Secretary Jacqui Smith, then Equality Minister, was responsible for a Government report which said: "It is envisaged that Government forms currently asking for details of a person's 'marital status' would be altered to read 'civil status'."

Ben Summerskill, chief executive of the gay and lesbian rights group Stonewall, said last night: "At a time when three million children in this country are growing up in singleparent households, it seems odd there should be this obsession with a few hundred who have the opportunity to have a second loving parent. "This is simply extending the protection that already exist in respect of heterosexuals." In 2000 Tony Blair pushed through legislation to repeal Section 28. But the move was opposed by religious groups and the Conservatives. The passage of the 1967 Abortion Bill also led to furious Parliamentary debate. It legalised abortion on demand and remains the basis of the current legislation.

The best I culled from the British press is this sentence: Men already believe they have become marginalised as sperm factories, walking wallets and occasional au pairs. By deepening their belief that a feminised Britain views them as surplus to requirements, this measure will therefore act as a further spur to male irresponsibility.

Long Live the Queen:) Incidentally, the ICMR guidelines have allowed Lesbians to legally take all the above mentioned treatments in India & we have been offering Lesbians the entire range of Infertility Services at Rotunda.

Fibroids & Fertility

What are the effects of fibroids on fertility, and on the outcomes of assisted reproduction technology, and when is intervention warranted?

According to published estimates, about 30 percent of all women up to the age of 30 years, and half of all women of reproductive age, will develop fibroids. About half of affected women will be asymptomatic. Fibroids are estimated to be associated with infertility in 5-10 percent of women, and are possibly the sole cause of infertility in 2-3 percent. Because most women with fibroids are fertile (and many are asymptomatic), having fibroids does not necessarily mean that reproduction will be compromised. However, it is clear that fibroids could impair fertility and/or cause pregnancy loss, through various possible mechanisms.

These potential mechanisms, include:
-Distortion of the endometrial cavity, preventing or otherwise impeding sperm migration and reducing implantation rates.
-Reduced vascularity and possible discordant growth of endometrial tissue overlying an intramural fibroid, impairing implantation.
-Dysfunctional uterine contractility caused by submucous or intramural fibroids, affecting sperm migration, tubal contractility and embryo nidation.
-Changes in the endometrial cavity milieu, as a result of glandular atrophy or distortion, adenomyosis, separation of muscle fibers from the basal layer of the endometrium, secretion of vasoactive amines, and local inflammatory changes.

Whether or not fibroids affect fertility or the outcomes of assisted reproduction technology (ART) will typically depend on their number, location, and size of fibroids.There is a general consensus that submucous fibroids impede fertility, as well as being associated with miscarriage, and that the obvious benefits of hysteroscopic myomectomy, coupled with its low risks, suggest that the resection of submucous fibroids is warranted to enhance fertility in women with no other obvious cause of infertility or with recurrent pregnancy loss. There is increasing evidence that intramural fibroids may impair the outcomes of ART. Laparoscopic or conventional myomectomy should be carefully considered prior to ART in women with intramural fibroids “of considerable size” in whom other causes of subfertility have been eliminated. Subserosal fibroids, appear from published data to be unlikely to compromise fertility or cause miscarriage, although the number, location and size of the fibroids should be considered in treatment decisions.

Factors to be considered in formulating a plan of management in a subfertile woman with fibroids are an accurate estimation of the size, number and location of the fibroids, and whether or not the uterine cavity/anatomy is distorted. TVS [transvaginal sonography] and hysteroscopy can achieve a sensitivity and specificity of 100 percent in the evaluation of uterine cavity distortion. It is reasonable to consider a hysteroscopic myomectomy for submucosal fibroids in a subfertile woman as this entails relatively little morbidity compared with an open myomectomy. Open myomectomy should be considered where there are large subserosal/intramural fibroids and they are multiple (>5). Patients should be carefully counseled about the intra-operative risks, risks of recurrence of leiomyoma (15 percent), uterine rupture (1 percent), and increased likelihood of caesarean section (50 percent) in future pregnancies.

Being a super-millionaire is a sure-fire recipe for unhappiness

I read this fascinating article on the web yesterday & thought it would be apt for our regular readers of Rotunda Ramblings. Non-medical article for a change, but opens up new vistas of thought. Enjoy the read & reflect!

Miserable? Bored? You must be rich
Helen Kirwan-Taylor
13 November 2007


For some people, flying first class represents the height of luxury. But not Prince Alwaleed bin Talal of Saudi Arabia, who has become the first person to buy an Airbus A380 superjumbo to use as a private jet. Given that the passenger version costs £145 million, the VIP edition – dubbed "The Flying Palace" – will surely cost a hefty chunk of change. Another, anonymous, billionaire spent £83 million on a flat in the Richard Rogers Partnership's new Hyde Park development – which was double the going rate.
Such excessive spending might not be a sign of conspicuous consumption but of addiction. "For the super-rich, houses, yachts, cars and planes are like new toys that they play with for five minutes and then lose interest in," says psychoanalyst Manfred Kets de Vries, one of the new breed of therapists treating the angst of the very rich. "Pretty soon, to attain the same buzz they have to spend more money. All the spending is a mad attempt to cover up boredom and depression."
According to de Vries, the super-rich are increasingly succumbing to what has been labelled Wealth Fatigue Syndrome (WFS). When money is available in near-limitless quantities, the victim sinks into a kind of inertia. Feeling any sort of excitement means taking more and more risks, financially and physically. Luxury holidays are replaced by abseiling in Australia and swimming with sharks. The first-class ticket of old becomes a private jet such as Prince Alwaleed's: Boeing has 11 standing orders for such wide-bodied "mobile mansions".
Frank James, the author of Richistan, a study of this new class, saw WFS up close. "The rich are never happy, no matter what they have," he told CNN. "There was this man who owned a 100ft yacht. I said: 'This is a terrific boat.' He said: 'Look down the harbour.' We looked down the marina, and there were boats two and three times as large. He said: 'My 100ft yacht today is like a dinghy compared to these other boats.' When else in history has someone been able to call a 100ft yacht a dinghy?"
The rich are no longer a tiny elite who hide behind electronic gates in Mayfair. There are half a million American households with assets of more than $10 million, and a study of 71 countries by Merrill Lynch and the consultancy firm Capgemini found that the fortunes of "high net worth individuals" increased by 11.4 per cent last year.
In Britain, the wealthiest self-made billionaires have trebled their fortunes over the past five years. But, as you draw up battle plans for surviving the credit crunch, spare a thought for the sufferers of WFS and how monumentally dull and isolating it is to live in a world where estates are traded like Pokémon cards. "A lot of my clients made money in commodities, and consequently everything – including houses and boats – is treated like shares," says Peter Grabham, a project manager for the rich and famous. "When the houses have outlived their purpose, they are sold." Gardens arrive on the back of trucks; art collections fill entire wings overnight, though the owners often can't recall the artists' actual names. I have seen 20-year-old cypress trees craned into gardens – and out again when the owner got bored with that year's fashionable look. One neighbour in Holland Park tore up her house, employing the most expensive interior designer in England. But after spending the better part of £2 million on refurbishment, she decided she was more a traditionalist than a minimalist, and tossed the contents into the skip outside.
A famous hedge fund manager spent the better part of £20 million building the most exquisite estate in Gloucestershire. As soon as he had thrown a few big parties to show it off, he sold it. "I need a new project," he muttered. Some of our friends have jumped from nice five-bedroom houses in South Kensington to gated mansions in St John's Wood, complete with hot and cold running staff. But many who join the super-rich find it hard to keep their old circles of support. Happiness studies have repeatedly shown that being marginally better off than your neighbours makes you feel good, but being a hundred times richer makes you feel worse. So either you change your friends or live with the envy of others. "When a relationship becomes unequal, it becomes difficult," explains Dr Brendan Burchell, a professor of economics and psychology at Cambridge University. "If you're out in a three-star restaurant, how do you split the bill when he is a super-millionaire? And if he has a driver and you consider a taxi a luxury, you stop having shared experiences."In the end, the super-rich become isolated – and the only way to find empathy is to surround themselves with people as rich as themselves."The poorer everyone else gets, relative to the rich, the more isolated the rich become," says Dr Burchell. "Soon you end up like the Russian oligarchs, needing bodyguards and electric gates outside your house."
The happiest nations, he says, are those where people feel most equal, even if that means being less wealthy. Pentecost, a tiny island in the South Pacific, has recently been voted the happiest place on earth. They don't have WFS – in fact, they don't have money; they use pigs' horns instead.In places such as Pentecost, people actually talk to each other – indeed, belonging to a community is one of the single most important prerequisites for happiness. But when you jet between the Scottish estate, the London mansion and the chalet in Aspen, there isn't much time to get to know the neighbours.
"One of the most common complaints among the super-rich is loneliness," says de Vries. "People stop calling them. They assume they're too busy, or they are simply too intimidated." Or they simply can't cut through the barricade of staff.
Families, too, can fall victim to WFS. As the men get richer, the wives are either tossed out in favour of a new model or become engaged in inane, busy-making activities. The post-nup is the new must-have among hedge funders.
"This world is full of gold-diggers, and rich men are highly suspicious," says de Vries. "Often, they develop a form of paranoia."Meanwhile, for the wives, shopping trips to Paris and Milan get tedious. "Super-rich wives are effectively unemployed, and have all the same mental issues as the real unemployed," says Jon Stokes, an organisational psychologist and executive coach with Stokes and Jolly.
Children are just as vulnerable. In America, upmarket brat camps offering psychological support for rich kids are now common. Suniya Luthar, a professor of psychology and education at the Teachers College of Columbia University, found that such children are just as prone to antisocial behaviour as those from inner cities.
One in five affluent American children also suffers from clinical depression. One of the reasons given was absent parents: "These kids just get sent from house to house on private jets with nannies and tutors on board," says a teacher who works for the very rich during the holidays. "No one engages with them who isn't staff."
According to de Vries, the only cure for the boredom and anxiety is to give something back. "These people need to return to small pleasures and to stop worrying about having bigger and better toys," he says. "It's not what you have but what you do that makes you ultimately happy."The problem, though, is that your day job becomes about staying rich. "All those people you employ, funds you have to manage and wealth advisers you have to meet must be exhausting," says Stokes.
And boring. And then there are the five new construction projects to visit. Choosing one set of curtains is a challenge: choosing them for 20 bedrooms would finish most of us off.
Bo Derek didn't suffer from Wealth Fatigue Syndrome. Her advice was simple: "Whoever said money can't buy happiness simply didn't know where to go shopping." Exactly. I find it hard to sympathise with those suffering from an excess of cash; in fact, I find it all too easy to picture myself in their designer shoes... I'd be chauffeur-driven in a Bentley Continental GT and tackle longer journeys in a private jet, launched from my own private runway. Then I'd buy a super-yacht, complete with gym, bars, cinemas, air-defence systems and submarine (for a quick getaway). I'd model mine on Roman Abramovich's £200 million Eclipse; currently under construction, it will be three times as long as Nelson's Column. If my iPod ran out of tunes once on board, I'd order a command performance from Rod Stewart for £500,000 or, for another £2.2 million, get in the Rolling Stones. I'd spread my wealth with some fractional shopping, the successor to timeshare, which involves a percentage share of ownership: £200,000 would buy me a one-sixteenth share of a Gulfstream jet (or 23 days' usage a year). Around £11,000 would get me a year's fractional ownership - 50 weekdays in winter or four three-day weekends in summer - in an Aston Martin Vantage Roadster. I'd spend the rest on fractional ownership of fine art, a racehorse, and two or three foreign properties - a villa in Tuscany, a serviced apartment in Milan and a little place in the Seychelles. For us non-billionaires, it's probably the closest to experiencing the terrible problems of being obnoxiously wealthy that we can get.

Getting Pregnant

Obesity & Infertility

The British Fertility Society has issued new guidelines for the treatment of women with fertility problems that help doctors address the impact of obesity.

"Obesity reduces the chances that a woman will conceive naturally and decreases the possibility that fertility treatment will be successful," said Tony Rutherford, Chair of the BFS's Policy and Practice Committee.

The new guidelines recommend that clinicians inform their patients about the negative effects of extra weight on the chances of conceiving naturally. They also suggest that clinicians defer the provision of fertility treatment to women whose body mass index (BMI) is greater than 35 kg/m2.

Women younger than 37 years should be encouraged to reduce their BMI to less than 30 kg/m2 to maximize the effectiveness of fertility treatment and to reduce the associated risks associated with fertility treatment, the guidelines state.

They add that women should be assisted in this, with the provision of psychologic support, dietary advice, exercise classes and, where appropriate, weight-reducing agents or bariatric surgery.

"The BFS has produced these new guidelines to help doctors provide safer and more effective fertility treatment for women," said Rutherford.

"We want to work with our patients to improve their chances of becoming pregnant with minimum risk to their health and that of their child."

Human chorionic gonadotropin

Human chorionic gonadotropin (hCG) is a peptide hormone produced in pregnancy, that is made by the embryo soon after conception and later by the syncytiotrophoblast (part of the placenta). Its role is to prevent the disintegration of the corpus luteum of the ovary and thereby maintain progesterone production that is critical for a pregnancy in humans. hCG may have additional functions, for instance it is thought that it affects the immune tolerance of the pregnancy. Early pregnancy testing generally is based on the detection or measurement of hCG. Because hCG is produced also by some kinds of tumor, hCG is an important tumor marker, but it is not known whether this production is a contributing cause or an effect of tumorigenesis.
Its primary role is to support the corpus luteum which secretes estrogen and progesterone. These hormones are necessary to support a pregnancy during the first trimester. hCG levels rise when pregnancy is established and it is the hormone measured by pregnancy urine test kits.

hCG products such as Profasi and Pregnyl are derived from human tissue. Ovidrel is a new pure product that is derived from mammalian cell DNA technology. It is injected subcutaneously facilitating patient administration. hCG is extensively used as a parenteral fertility medication in lieu of luteinizing hormone. In the presence of one or more mature ovarian follicles, ovulation can be triggered by the administration of hCG. As ovulation will happen about 40-45 hours after the injection of hCG, procedures can be scheduled to take advantage of this time sequence. Thus, patients who undergo IVF, typically receive hCG to trigger the ovulation process, but have their eggs retrieved at about 36 hours after injection, a few hours before the eggs actually would be released from the ovary. In a normal menstrual cycle, the release of LH is triggered when hormones (such as estrogen) reach the appropriate levels. This is governed by hormonal relationships mediated though the hypothalamic-adrenal-pituitary axis. As hCG supports the corpus luteum, administration of hCG is used in certain circumstances to enhance the production of progesterone.

In the male, hCG injections are used to stimulate the leydig cells to synthesize testosterone. The intratesticular testosterone is necessary for spermatogenesis from the sertoli cells. Typical uses for hCG in men include hypogonadism and fertility treatment. In the world of performance enhancing drugs, hCG is increasingly used in combination with various anabolic androgenic steroid (AAS) cycles. When AAS are put into a male body, the body's natural negative feedback loops cause the body to shut down its own production of testosterone via shutdown of the HPTA (hypothalamic-pituitary-testicular axis). High levels of AASs that mimic the body's natural testosterone trigger the hypothalamus to shut down its production of gonadotropin-releasing hormone (GnRH) from the hypothalamus. Without GnRH the pituitary gland stops releasing luteinizing hormone (LH). LH normally travels from the pituitary via the blood stream to the testes where it triggers the production and release of testosterone. Without LH, the testes shut down their production of testosterone, causing testicular atrophy. In males, hCG mimics LH and helps restore / maintain testosterone production in the testes. As such, hCG is commonly used during and after steroid cycles to maintain and restore testicular size as well as endogenous testosterone production. However, if hCG is used for too long and in too high a dose, the resulting rise in natural testosterone will eventually inhibit its own production via negative feedback on the hypothalamus and pituitary.

During first few months of pregnancy, the transmission of HIV-1 from woman to fetus is extremely rare. It has been suggested this is due to the high concentration of hCG, and that the beta-subunit of this protein is active against HIV-1.

Follicle Stimulating Hormone (FSH)

Follicle stimulating hormone (FSH) is naturally produced by the pituitary gland and stimulates the recruitment and development of the ovarian follicles located on the ovaries, each of which contains an egg. FSH is also referred to as a pituitary gonadotropin. The production of FSH and other reproductive hormones is controlled by the complex interaction of several hormones in a biologic feedback system known as the "hypothalamic-pituitary-adrenal" axis. The hypothalamus is the "master gland" in control of regulating these processes.

The first FSH containing commercial gonadotropin in India, Pergonal, was released by Serono Laboratories. Pergonal is derived from the urine of post-menopausal women and purified for injection. FSH levels are higher in women who are menopausal making their urine a good source for extraction. Pergonal also contains leutinizing hormone (LH) which produces many effects including higher estrogen levels.Newer FSH products include Gonal-F and Recagon which are obtained from mammalian cell cultures through recombinant DNA technology. These products are pure and do not contain the "contaminants" seen in Pergonal. Pergonal has to be administered by intramuscular injection while the newer medications are given subcutaneously with much less discomfort Both human and genetically derived products are difficult to obtain and manufacture and are therefore expensive.

Opinions differ as to the need for additional LH in FSH stimulated cycles. Some physicians prefer protocols that combine products containing LH with Gonal-F (pure FSH). When a patient is "down regulated" with Lupride, or especially Ovurelix, natural levels of LH are reduced to very low levels and some externally administered LH is believed by many to be beneficial.
Egg quality is difficult (at best) to judge but some embryologists believe pure FSH cycles produce "better quality" eggs.

In procedures such as in vitro fertilization, FSH is administered by injection to cause the development of numerous eggs which can be retrieved and fertilized. When FSH is used in stimulated intrauterine insemination cycles, there is less control over how many eggs are ovulated thus increasing the chances of multiple births. Most cases of quadruplets, or more, result from stimulated IUI cycles. Patients must be closely monitored by a Fertility Physician to minimize the risk of multiple births.

FSH should only be administered by a Fertility Physician thoroughly trained in its use. Serious side effects can occur and patients must be closely monitored with estradiol hormone level measurements and ultrasound. Hyperstimulation is a very serious, but rare, complication that can result in stroke and other like threatening events. Side effects are minimized when these products are monitored by specialists with extensive clinical training in their use.