The Ramblings of a Middle Aged Fertility Physician whose life revolves around Eggs, Sperms & Embryos....
Saturday, August 16, 2008
The Lavabahn, Cloudscapes & Artichokes of LaVaSa
We write to taste life twice, in the moment, and in retrospection. We write, like Proust, to render all of it eternal, and to persuade ourselves that it is eternal. We write to be able to transcend our life, to reach beyond it.
-Anaïs Nin, entry for February 1954, in The Diary of Anaïs Nin
As little as five years from now, a sprawling township will spread across the Mose valley. Hindustan Construction Corporation (HCC) -- that has a 60 per cent stake holding in the Lavasa project with the LM Thapar group, Venkateshwara Hatcheries and private investors for company -- believes that by then there will be 100,000 primary inhabitants and a floating population of a million. Their vision is of a self-sufficient hill town. The likeness, if all goes to plan, will be to Davos. Nearly 12,500 acres of high valley land, contracted by Lavasa, circling most of the 20-km dammed Varasgaon lake, is in the throes of massive infrastructure building. The approach highway is the first sign, leading up to a network of arterial and trunk roads. For now, all roads lead to three hotels that are under construction, with a total room size of 560. To be managed by the Novotel, Starwood and ITC chains, they will be the first to see completion later this year. An 18-hole golf course is being laid out, a club house planned and, eventually, shopping centres.
The star attraction at Lavasa is the waterfront; all development springs around it. According to locals, however, Varasgaon lake actually all but dries up in the months leading up to the monsoon. That problem has been addressed. HCC, with their strength in infrastructure, has built a mini dam that has created a reservoir holding of 1.8 million cubic metres of water. Eighteen such dams and check dams will ensure year-round lake views. Dasve's architectural style is derived from the fashionable resort town of Portofino (Italy) and its pastel-coloured coastal residences, Damanhole in Phase 2 will sport a Western Ghat vernacular style.
A Hill Station encapsulated inside the mystic Sahyadri ranges provides a perfect setting for a getaway for many a travelers and tourists. The maddening pace of city life, the endless traffic jams, and the stifling work cubicle…is all conveniently forgotten at Lavasa wherein different kinds of leisure and recreation activities provide a refreshing escape from the metropolis. Lavasa offers exciting diversions such as star-gazing, boating, treks & relaxing. There are also cinemas, theatres, parks and meditation centers planned over the next decade. Setting new benchmarks in construction, planning and service delivery Lavasa offers its residents a level of town infrastructure hitherto, unknown in India. The high quality roads to Lavasa would provide total connectivity to its residents and visitors. Lavasa is approached by various routes. World-class road from the Chandni Chowk (Pune) to Lavasa makes traveling speedy and comfortable. I have christened the road from Pirangut to Lavasa as the Lavabahn (Autobahn - (German: IPA: [ˈaʊtoːbaːn], plural Autobahnen; English) is the German word for a major high-speed road restricted to motor vehicles capable of driving at least 60 km/h (37 mph) and having full control of access, similar to a motorway or freeway in English-speaking countries.).This road was laid out three years ago & has weathered 4 Western Ghat Monsoons with not a pot-hole along its length. this actually tells you the whole story about corruption and Mumbai Municipal Corporation Road Contractors!). Along the Autobahn, the drivers can stop at rest areas for fuel, food and beverages. In Germany, they are called Raststätte(n), while in Austria they are known as Raststation(en). These rest areas have restaurants serving breakfast, lunch and dinner. The restaurants may legally serve alcoholic beverages. Many of the rest stops also have motels. In Germany, the rest areas were operated by a government-owned company until 1998, when it was privatised. On our Lavabahn you get excellent Masala Chai with Jaggery (Instead of Sugar) at small village rest areas selling Chaha! Just before you leave urbanization, there are numerous small & medium sized hotels & restaurants selling Bata-Wada & Masala-Chai.
The best Cloudscapes on the Lavabahn are seen between 9am and 11am and then again 5pm and 7pm in the monsoons.The color of a cloud tells much about what is going on inside the cloud. Clouds form when relatively warm air containing water vapor is lighter than its surrounding air and this causes it to rise. As it rises it cools and the vapor condenses out of the air as micro-droplets. These tiny particles of water are relatively densely packed and sunlight cannot penetrate far into the cloud before it is reflected out, giving a cloud its characteristic white color. As a cloud matures, the droplets may combine to produce larger droplets, which may combine to form droplets large enough to fall as rain. In this process of accumulation, the space between droplets becomes larger and larger, permitting light to penetrate much farther into the cloud. If the cloud is sufficiently large and the droplets within are spaced far enough apart, it may be that a percentage of the light which enters the cloud is not reflected back out before it is absorbed (Think of how much farther one can see in a heavy rain as opposed to how far one can see in a heavy fog). This process of reflection/absorption is what leads to the range of cloud color from white through grey through black. For the same reason, the undersides of large clouds and heavy overcasts appear various degrees of grey; little light is being reflected or transmitted back to the observer. Other colours occur naturally in clouds. Bluish-grey is the result of light scattering within the cloud. A greenish tinge to a cloud is produced when sunlight is scattered by ice. A cumulonimbus cloud which shows green is an imminent sign of heavy rain, hail, strong winds and possible tornadoes. Red, orange and pink clouds occur almost entirely at sunrise/sunset and are the result of the scattering of sunlight by the atmosphere. The clouds are not that color; they are reflecting the long (and unscattered) rays of sunlight which are predominant at those hours. The effect is much the same as if one were to shine a red spotlight on a white sheet. In combination with large, mature thunderheads this can produce blood-red clouds.The sky is a veritable canvas at Lavasa. Ekaant is the place for cloud-gazing & the best cloudscapes from Ekaant are visible at Dawn/Dusk.
Saturday morning I was woken up with the whiff of fresh "Bhuttas" wafting into the clouds entering my bedroom at Ekaant. I was wondering at the odd sense of timing of roasting Bhuttas & then heard the pitter-patter of kid's feet. On looking out of the Balcony, saw over a dozen kids being chased by a Yogi Bear. This was my first introduction to children's voices & laughter at Ekaant. The kids were having a blast. Yogi Bear was a big hit & now was being chased by the tots into the Ekaant lobby. The parents were getting them to pose with Yogi Bear for their proud vacation snaps. Lavasa had something for all ages.
Had got up late & decided on an early Lunch. I was the first resident to come in for lunch into the multi-cuisine restaurant. I was greeted by the new F & B manager Mr Pant who requested for ten minutes before the buffet would be served. we got talking and incidentally he had set-up one my my favorite watering-holes at the Radisson, Jalandhar in 1999. Since I work 5 days a month at Jalandhar since 1999, someone talking about Jack-Daniel's got me hooked! Jack Daniel's is the finest pub one can find in North India at one of the most unlikeliest of towns-Jalandhar. I was amazed at the buffet layout- there was an artichoke salad, a tandoori-chicken salad, deicious prawn-curry at 2500 feet above sea level topped off with hot Kheer-Sevian. As I was finishing my Lunch, the gang of kids accompanied by a large tourist group descended on the Restaurant. I decided to leave behind the fun and frolic & laughter and take a walk around the Lake. The Dasve Lake which is designed to provide sporting and recreational facilities is enhanced by a 2.4 kms promenade which once completed, will form part of the retail and entertainment hub at Lavasa. With arbours, pedestrian bridges, shopping enclaves and dining areas, this will be the heart of Dasve. I was back to where I belonged - the time of the day not-withstanding. This was bliss.
Climb the mountains and get their good tidings. Nature's peace will flow into you as sunshine flows into trees. The winds will blow their own freshness into you, and the storms their energy, while cares will drop off like autumn leaves."
-John Muir (1838-1914)
Friday, August 15, 2008
Conceived in Japan, Orphaned in India
She's only 11 days old, and already her fate is tied in legal knots and international complications. Her biological parents are Japanese. When her mother, Yuki Yamada, could not conceive, she chose a surrogate mother in Ahmedabad to carry her child.
The child was born on July 25 in Anand, Gujarat. But a month before that, Yuki divorced her husband, Dr Ikufumi Yamada, and disowned the child. And that, it seems, is the root of all trouble for the infant who still does not have a name.
Her father is keen to take the girl back home to Tokyo, but a law enacted 120 years ago is in the way. First, as Dr Ikufumi is only the biological father of the child, the girl's legitimacy will have to be proved. Secondly, according to the Guardians and Wards Act, 1890, a single father cannot adopt a girl child.
With so much loaded against her, the girl is now spending time at a hospital in Jaipur. A friend of Ikufumi, Kamal Vijayvargiya—a jeweller from Jaipur settled in Tokyo—was instrumental in getting the girl shifted to Arya Hospital in Jaipur. He also got Ikufumi's mother to come down and take care of the child. She's here on a three-month tourist visa.
"She (the grandmother) is very disturbed as the child cannot be taken out of the country because of adoption laws. The child's mother, Yuki, who divorced her husband and disowned the child, turned down her ex-husband's request to visit India to complete the adoption process. The grandmother becomes very emotional when she is told that the child cannot be taken out of India. The lawmakers will have to find some solution to this," said Dr Sanjay Arya, who is looking after the girl.
Ikufumi (45)—an orthopaedic surgeon attached to a Tokyo hospital—and his former wife Yuki (41) signed an agreement of surrogacy with Dr Nayanaben Patel of Akansha IVF Centre, an Ahmedabad hospital, on November 22 last year. Pritiben Mehta, wife of Brijeshbhai Mehta, also from Ahmedabad, signed an agreement to serve as the surrogate mother. The fertilization process of Yuki's eggs with Ikufumi's sperm was completed in Tokyo and the embryo was brought to Ahmedabad.
The embryo transfer was done at Dr Nayanaben's hospital on November 22 in the presence of the Japanese couple. After that, they left for Tokyo. The baby was delivered on July 25.
But by then, the Japanese couple had divorced. And after the birth, surrogate mother Pritiben stuck to the terms of the contract and left the baby and went home. If the baby, whose nationality is Indian, doesn't get an Indian passport after the adoption process is completed, she may become the country's first surrogate-orphan.
Thursday, August 14, 2008
Early oocyte collection offers cancer victims fertility hope
Ovaries can be stimulated to produce oocytes for collection during the first phase of the menstrual cycle, German scientists have discovered in findings that offer the hope of restoring fertility to women following cancer treatment.
As conventional ovarian stimulation can leave cancer patients waiting up to 6 weeks before collecting oocytes and starting cancer therapy, Michael von Wolff, from the University of Heidelberg, and colleagues conducted a pilot study of stimulation in the first phase of the menstrual cycle.
Twenty-eight women underwent ovarian stimulation in the proliferative phase of the menstrual cycle using standard medication (group 1). A comparison group of 12 women started stimulation during the luteal phase, using GnRH antagonists and recombinant follicle stimulating hormone to reduce the luteal phase (group 2)
Average ovarian stimulation time was 10.3 days in group 1 and 11.4 days in group 2. The average number of oocytes collected was 13 and 10, respectively, of which 77 percent and 73 percent, respectively, were mature. Intracytoplasmic sperm injection led to fertilization in 70 percent and 75 percent of oocytes, respectively.
Dr von Wolff said: "This new protocol would enable patients with cancers such as breast cancer and Hodgkin lymphoma to have ovarian stimulation and oocyte collection. Waiting for 2 weeks before they start cancer treatment is acceptable for most patients while this process happens."
As conventional ovarian stimulation can leave cancer patients waiting up to 6 weeks before collecting oocytes and starting cancer therapy, Michael von Wolff, from the University of Heidelberg, and colleagues conducted a pilot study of stimulation in the first phase of the menstrual cycle.
Twenty-eight women underwent ovarian stimulation in the proliferative phase of the menstrual cycle using standard medication (group 1). A comparison group of 12 women started stimulation during the luteal phase, using GnRH antagonists and recombinant follicle stimulating hormone to reduce the luteal phase (group 2)
Average ovarian stimulation time was 10.3 days in group 1 and 11.4 days in group 2. The average number of oocytes collected was 13 and 10, respectively, of which 77 percent and 73 percent, respectively, were mature. Intracytoplasmic sperm injection led to fertilization in 70 percent and 75 percent of oocytes, respectively.
Dr von Wolff said: "This new protocol would enable patients with cancers such as breast cancer and Hodgkin lymphoma to have ovarian stimulation and oocyte collection. Waiting for 2 weeks before they start cancer treatment is acceptable for most patients while this process happens."
Wednesday, August 13, 2008
Endometrial leukaemia inhibitory factor expression predicts IVF success
The success of IVF can be predicted by measuring the endometrial expression of leukaemia inhibitory factor (LIF) during the luteal phase of the menstrual cycle, Brazilian study findings indicate.
Paulo Serafini, from the University of São Paulo, and colleagues immunostained luteal phase endometrial biopsy specimens of 52 women due to undergo IVF. Standard protocols were used to perform embryo culture and transfer.
The median age of the women was 35 years. Immunostaining for LIF was weak in 5.8 percent, mild in 61.5 percent, and strong in 32.7 percent of samples. The average number of embryos transferred was three, and their cumulative quality score was 20.
In all, 39 percent of the women achieved clinical pregnancy following IVF. Strong endometrial LIF expression was significantly associated with pregnancy, such that women with strong expression were 6.4 times more likely to become pregnant than those with weaker expression.
Age was also associated with clinical pregnancy, with each 1-year increase in maternal age associated with a 30 percent decrease in the likelihood of becoming pregnant.
"Midluteal endometrial LIF expression can be assessed immunohistochemically and used both as a biomarker of adequate endometrial development and a predictor of IVF success," the team says.
Paulo Serafini, from the University of São Paulo, and colleagues immunostained luteal phase endometrial biopsy specimens of 52 women due to undergo IVF. Standard protocols were used to perform embryo culture and transfer.
The median age of the women was 35 years. Immunostaining for LIF was weak in 5.8 percent, mild in 61.5 percent, and strong in 32.7 percent of samples. The average number of embryos transferred was three, and their cumulative quality score was 20.
In all, 39 percent of the women achieved clinical pregnancy following IVF. Strong endometrial LIF expression was significantly associated with pregnancy, such that women with strong expression were 6.4 times more likely to become pregnant than those with weaker expression.
Age was also associated with clinical pregnancy, with each 1-year increase in maternal age associated with a 30 percent decrease in the likelihood of becoming pregnant.
"Midluteal endometrial LIF expression can be assessed immunohistochemically and used both as a biomarker of adequate endometrial development and a predictor of IVF success," the team says.
Tuesday, August 12, 2008
First 'fast-freeze' IVF baby born
A couple have become the first in the UK to have a baby using a pioneering IVF technique which fast-freezes embryos, doctors in Cardiff say. Evie, who was conceived through "vitrification", was born to Ian and Rebecca Bloomer on 23 July. The method uses liquid nitrogen to freeze embryos quickly, reducing the risk of damage when they are thawed.
The couple, of Cwmbran, had tried for a baby for seven years and say their success should offer hope to others.
The couple had been trying for a baby since they married in 2001 but tests revealed Mrs Bloomer, 28, had endometriosis, a condition which was making it difficult for her to conceive.
They attended the IVF clinic at the University Hospital of Wales, in Cardiff, and after a failed attempt, the hospital offered the Bloomers a new way of freezing their unused embryos.
The technique - vitrification - gives embryos a better chance of surviving until couples are ready to try IVF again because the fast-freeze method prevents the formation of crystals that can damage embryos when they are thawed.
It's overwhelming. I'm still staring at her now thinking 'wow, she's ours - it's actually happened for us'
Mrs Bloomer became pregnant almost immediately using one of the fast-frozen embryos and gave birth to Evie at the Royal Gwent Hospital, in Newport, on 23 July.
"We were willing to try anything really, we'd both always wanted children. It's overwhelming. I'm still staring at her now thinking 'wow, she's ours - it's actually happened for us'," said Mrs Bloomer.
"I hope that if anybody going through treatment sees us and sees Evie it gives them one last little bit of hope to go for it.
"It's been a real emotional rollercoaster. There's been ups and downs, but you get through it and to have Evie now, you forget what you went through. It makes it all worthwhile."
The Cardiff hospital was the first in the UK to begin offering embryo vitrification, in August 2007.
Lyndon Miles, head of embryology and andrology for IVF Wales, said 17 out of the 39 women offered the treatment so far had fallen pregnant and four of those were expecting twins.
He said the process would also be helpful to women diagnosed with cancer who wanted to freeze a number of eggs in case chemotherapy left them infertile.
"Though this is a new technique for the UK, early results and publications in Japan and the USA have been extremely encouraging," Mr Miles said.
Lyndon Miles said he was delighted to have helped the Bloomers. "The first published study on babies born from vitrification shows no adverse effects of the technique and there are no implications to Evie's health as a result of the vitrification process.
"I'm delighted we have been able to help Ian and Rebecca."
Vitrification involves rapidly cooling and storing embryos at very low temperatures for future use.
"An IVF cycle produces a number of embryos. Those that aren't immediately transferred back to the patient and that are of good enough quality are cooled slowly to the temperature of liquid nitrogen (-196C) and stored until needed.
"Conventional, slow freezing creates ice crystals which can damage the embryo as it is thawed," Mr Miles said.
"Vitrification differs from traditional cooling and storing techniques in that it allows instantaneous 'glass-like' solidification of eggs and embryos without the formation of ice crystals.
"Since no ice crystals form, a much greater percentage of embryos survive thawing following vitrification."
He said with conventional freezing methods, post-thaw survival rates varied from 50% to 80% whereas with vitrification they had achieved 98%.
"In addition, since the introduction of the technique, our pregnancy rate has more than doubled compared to conventional freezing methods," Mr Miles added.
Monday, August 11, 2008
Serum anti-Müllerian hormone levels predict ICSI outcomes
The number of oocytes retrieved for intracytoplasmic sperm injection (ICSI) is strongly associated with midluteal, early follicular, and ovulatory anti-Müllerian hormone (AMH) levels, Egyptian researchers have discovered.
Dahlia El-Haieg and colleagues from the University of Zagazig, measured AMH, follicle-stimulating hormone (FSH), and leuteinizing hormone levels, and conducted ultrasound evaluation, during the menstrual cycle of 33 patients undergoing their first ICSI treatment cycle.
Nine women had a poor response to ICSI. The number of oocytes retrieved from normal and poor responders was 9.4 and 3.0, respectively.
AMH levels were significantly lower in poor than normal responders in both the ovulatory and midluteal phases. The number of oocytes retrieved positively correlated with midluteal AMH, day 3 AMH, and ovulatory AMH levels, as well as antral follicle counts and average ovarian volume. Day 3 FSH levels negatively correlated with the number of oocytes retrieved.
Poor response was predicted by midluteal, day 3, and ovulatory AMH levels, with areas under the receiver operating characteristics curves of 0.977, 0.900, and 0.980, respectively. Midluteal and early AMH also significantly predicted clinical pregnancy.
"Midluteal and early follicular AMH may offer a better prognostic value for clinical pregnancy than other currently available markers of assisted reproductive technology outcomes," the team concludes.
Dahlia El-Haieg and colleagues from the University of Zagazig, measured AMH, follicle-stimulating hormone (FSH), and leuteinizing hormone levels, and conducted ultrasound evaluation, during the menstrual cycle of 33 patients undergoing their first ICSI treatment cycle.
Nine women had a poor response to ICSI. The number of oocytes retrieved from normal and poor responders was 9.4 and 3.0, respectively.
AMH levels were significantly lower in poor than normal responders in both the ovulatory and midluteal phases. The number of oocytes retrieved positively correlated with midluteal AMH, day 3 AMH, and ovulatory AMH levels, as well as antral follicle counts and average ovarian volume. Day 3 FSH levels negatively correlated with the number of oocytes retrieved.
Poor response was predicted by midluteal, day 3, and ovulatory AMH levels, with areas under the receiver operating characteristics curves of 0.977, 0.900, and 0.980, respectively. Midluteal and early AMH also significantly predicted clinical pregnancy.
"Midluteal and early follicular AMH may offer a better prognostic value for clinical pregnancy than other currently available markers of assisted reproductive technology outcomes," the team concludes.
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