Sunday, August 16, 2009

The Fertility Time-Bomb is Ticking!

Many women are risking their chances of being able to have children by leaving it too late, according to Bill Ledger, Professor of Obstetrics and Gynaecology at the UK's University of Sheffield. He told the Daily Telegraph newspaper that women who chose to delay motherhood until their 30s and beyond in order to establish their careers were ignoring the implications this could have for their fertility.

Professor Ledger recommends that women planing to start a family later in life have a fertility test at the age of thirty to help gauge how quickly their fertility is declining. He helped to develop a test, launched in 2006, called the 'Plan Ahead Kit' which works out the number of eggs that a woman has left in her ovaries. From this, it predicts the woman's 'ovarian reserve' for the following two years. Professor Ledger believes the test, which costs INR 16,000 could help women make more informed reproductive choices and conceive naturally.

However, Dr Gillian Lockwood, medical director of Midland Fertility Services and vice president of the Royal College of Obstetricians and Gynaecologists' ethics committee, and Tony Rutherford, chair of the British Fertility Society, have both voiced concerns that tests could also create a false sense of security, as egg reserves are not the only factor involved in getting pregnant naturally.

Professor Ledger said that too many women were relying on the availability of IVF as a fallback, not realising that the treatment was not freely available on the National Health Service (NHS) in the majority of cases. Last week a report showed that eight out of ten primary care trusts were failing to provide the recommended three cycles of IVF to women under 40 on the NHS.

Speaking to the Observer newspaper, Dr Mark Hamilton, the leading consultant obstetrician and gynaecologist at Aberdeen Maternity Hospital and former chairman of the British Fertility Society, made further calls for a campaign to raise awareness of fertility issues in primary and secondary schools: 'Sexual health messages focus entirely on avoidance of sex, but this should be coupled with promotion of fertility awareness. We should be teaching everyone, from childhood up, about all the factors linked to fertility potential, and how the huge range of things from lifestyle choices to genetic inheritance can have harmful effects on that potential.'

The average age for women to start a family is now over thirty and has been steadily increasing for decades. Research shows that fertility halves by the age of 35 and declines steadily thereafter.

Friday, August 14, 2009

Why I Chose a Non-Exercise LifeStyle?

Interesting article from a friend on his blog! I am convinced.

Editor's Note; This is purely a personal viewpoint and lifestyle. No one should under any circumstances and under any conditions try to practice our style on their own. All medical and health matters should be thoroughly discussed with your physician and medical advisers.


A few days ago, while surfing the net, I came across a Time.com article titled "Why Exercise Won't Make You Thin". I read the article and agreed with much of what the author John Cloud wrote. Frankly, that article got me thinking about my own experience and how I benefited by giving up exercise.

The TV character Ray Barone (star of "Everybody Loves Raymond") once said "I love beef and I have always tried to get as much of it as I can". Ray says this to Debra, his TV wife, after he thoroughly embarrasses himself and Debra at a PTA event. I can understand Ray's behavior.

I love chocolate and I have always tried to get as much of it as I can. People, especially yuppie women, look at me and make snide comments when they are behind me in the line at the grocery store. Apparently, they are shocked by the amount of chocolate I buy. A few years ago, I was being driven to a concert in New Jersey by my dear friends, a wonderful couple. There is a Dunkin' Donuts store located right after the exit from the Holland Tunnel into New Jersey. I asked them to stop at the store and I went in with my friend's wife. She ordered something for them and I ordered two chocolate cream filled donuts. In my defense, chocolate cream filled donuts are not available in Manhattan - that is correct, no store in Manhattan serves this gorgeous donut, filled with chocolate cream on the inside and with powder sprinkled on the outside. It is impossible to eat this donut without making a mess of your lower face.

Before the server poured coffee and bagged my friend's order, I had eaten the two donuts while standing at the register. My lips and lower face had white powder stains mixed with a bit of the dark chocolate cream. Both the cashier and my friend's wife started laughing at me. That was not very nice of them but frankly I did not care. Finding that rare donut was reward enough. While donuts are great, a chocolate cake served at a fine Italian restaurant is pure heaven. After a dinner, I have been accused on inhaling a entire piece of chocolate cake before others can get a bite into their desserts. I would support the argument that chocolate was Europe's greatest gift to humanity.

So I can relate to Ray's binge of eating beef and spilling the au jus sauce all over his shirt while Debra was giving her campaign speech. But for a period of time, I was guilted out of eating chocolate by people who claimed they had my best heath interests at heart, literally at heart. At that time, during a routine physical, the doctor did a blood test and discovered that my cholesterol was 364. I was told this was a shocking figure and I must bring it down. I was also informed that among all the ethnic groups in the world, according to studies, the desi crowd (people of Indian origin) had the greatest statistical risk of getting heart disease.

I was disturbed myself and resolved to do everything I could to get my cholesterol down. I gave up chocolate and began exercising, the whole thing including treadmills etc. I went through EKGs, Stress tests, Thallium Stress Tests, the whole nine yards. I began taking statins in small dosage. I changed my diet and followed whatever I was told to do, including drinking 4 glasses of Metamucil daily (orange metamucil concentrate mixed with water). You try doing that at work in full view of about 20 colleagues and see what comments you get. But, in short, I became the near perfect disciple of the Behave Correctly school.

It helped a bit. My cholesterol numbers came down a little, especially the LDL, the bad cholesterol. But, there was no improvement in my HDL, the good cholesterol. So I was told to exercise more, because exercise supposedly helps to raise HDL.

I tried, I really did. But my personality does not seem to jive with exercise. The Treadmill was boring and so I tried to listen to music while I ran on the treadmill. Like most desis, I have to sing along when I listen to my favorite music. But apparently you cannot do so in a gym, however softly you choose to sing. So I began singing silently to myself and even that got really uncomfortable stares from others.

Apart from such social issues, exercise was frustrating. It meant I had to give up watching a favorite TV program or a movie. It was such a waste of time. Apart from exercising, I had to get dressed in exercise clothes and take the elevator to go down to another floor in our building to visit the gym. The whole thing was very intrusive on my time and felt highly unsatisfactory. I was getting irritable. So I gave up exercise.

At that time, a series of articles appeared in the New York Times, the Wall Street Journal, BusinessWeek arguing that chocolate, especially my favorite dark chocolate, was good for the human heart in moderate quantities. Whether humorous or otherwise, the articles confirmed my belief. So I began eating chocolate again, but in smaller quantities.

At that time, I rediscovered my love for Bollywood films and began buying DVDs of my favorite oldies. This was the spring of 2002 and due to the recession, the desi stores in Jackson Heights, Queens were selling these DVDs at about $5 each. Quickly, I became one of their valued customers.

On Saturday and Sunday, I would stay in bed the entire afternoon (after waking up late) and watch Bollywood oldies. Then I decided to experiment a bit and got some newer films. I still remember the weekend, when I watched 5 newer Bollywood films, one after another. Each movie was a discovery. By sheer luck or destiny, I had chosen the right sequence; each movie turned out to be more enjoyable than the earlier. After that weekend, there was no going back. Watching Bollywood movies became my primary weekend function.

When fall 2002 arrived, the weekend schedule had to be adjusted. Remember what the Marine told Tom Cruise in "A Few Good Men" - " We live by a code, Corps, God and Country". Well people like me have our own code for the fall. Mine is "Michigan, Big Ten and College Football". If a game is on TV, I have no choice. I have to watch it.

So that fall, Saturdays were done. I had to get up early to begin watching the two Bollywood music shows that came on at 9:00 am. Then at 11:30, one of Bollywood shows would end and I would switch to ESPN's College Game Day. The last 15 minutes of the dream team of the Coach, the Street Guy and the Anchor Fowler cannot be missed.

Then at noon, either a Michigan or Ohio State game would be on TV followed by a Big 12 game in the afternoon. The day would end around midnight after the evening game, an SEC or a Pac-10 game. So, from 9:00 am to midnight, every fall Saturday was pure heaven , with great games, eating in bed and becoming what God no doubt intended me to be. Sundays were reserved for watching Bollywood DVDs.

In that great scene near the end of Analyse This, Bill Crystal says "who am I? that is a question for the ages". The Indian Sages have pondered this question for ages. One of them, Sant Dnyaneshwar*, wrote of that divinely blissful feeling of liberation he felt when he discovered himself. Of course, he was describing his bliss when he received enlightenment.

My self-realization was very different from his. I found who I was, a guy who like to lie in bed and watch movies and TV. As Sant Dnyaneshwar wrote nearly 800 years ago, with this self-realization all my doubt was resolved and in its place came a sense of deep inner peace. My friends and close ones, the "educated Indian" sort - modern, liberal yuppies or ex-yuppies who strive to follow every trend that is in vogue, were both outraged and saddened.

But magically as it were, around that time, my HDL level began increasing. Within a couple of years of this disciplined movie-TV watching over the weekend, my HDL reached levels of my dreams. In addition, my Cholesterol/LDL ratio and the HDL/LDL ratio reached "ideal" levels. They remain so to this day.

How is that possible? Even I wondered. Then I saw an article in the New York Times that seemed to suggest that the real benefit of exercise seems to be that it makes people feel good. In other words, the physical exercise may not the main benefit. The main benefit may come from the happy feeling it creates in the people who enjoy exercise. My doubts were resolved. If I get the same good feeling by lying in bed and watching Bollywood films, it should have the same benefits that exercise provides others. To many this might sound ludicrous and utterly self-serving, but to me it makes perfect sense.

A point of posture if I may. TV anchors often speak disparagingly of "couch potatoes". They are so clueless. Serious TV watchers do not use the couch. It is bad for the back and the spine. The anchors should read what Jerry, the western cowhand, said to an English visitor in a Louis L'Amour novel. As Jerry explained "In England, they ride for about an hour or so. That is why they use the English saddle. But the western cowhand spends 15-16 hours in the saddle, he eats in the saddle and sleeps in the saddle. You need a comfortable western saddle to do that".

This is the perfect analogy for TV watching. A couch is fine if you watch TV for an hour or two. But if you want to watch 14-15 hours of TV in a day, you need a king-size bed, a firm mattress, good pillows and end tables where you can put your drink and food. Only then, can you lie down all day, eat in bed and do your TV watching regimen in bodily comfort. This is good for your spine, your inner peace and your heart, as has been the case for me.

Why write this article now? The first trigger was the Time.com article about exercise. The second was the result of my heart scan that I received a couple of days ago. For those who do not know, this is great technology. It is called an Electronic Beam Tomography scan. They use it to scan the arteries of your heart to find levels of plaque in your arteries. This is only direct visual measure of plaque in your blood vessels that I know. Others like HDL, LDL, Cholesterol etc. are indirect measures that enable you to infer the condition of your arteries but do not provide a direct measurement.

I was thrilled to see that my plaque level after seven years of my weekend regimen is zero, yes Zero. Further, according to the cardiological radiologist, the probability of me getting a heart attack is less than 0.2%.

Clearly I do not know whether my weekend life style is responsible for my cholesterol and plaque levels. But just as clearly, it does not do any harm. And it provides me pleasure and a sense of inner peace. Why can't my "educated" friends understand this?


* Editor's Postscript: I have enormous respect and devotion towards Sant Dnyaneshwar. He was the founder of the Bhagwat-Dharma in Maharashtra, the dharma of deep devotion that pervades the State of Maharashtra and all of India. Sant Namdeo carried this movement into North India and Sant Tukaram was its pinnacle some 300 odd years later.

Dnyaneshwar translated the Bhagwat-Geeta from Sanskrut into Marathi and transformed Marathi from a language of farmers and rural labor into a language embraced by the intellectual elite of Maharashtra. His poetry is simply out of the world. Today, 800 years after him passing, his poems are sung in every Marathi speaking household worldwide. How rare is this? Just ask yourself, how many English speaking families recite Chaucer in their homes?

In our article, we have used our interpretation of the words of Dnyaneshwar to provide a humorous but heart-felt analogy for our viewpoints. That is not only our right but our tradition. Just look at how many ways the Bhagwat-Geeta has been interpreted over the past 4000 odd years? So we do not intend to give offense to any body by quoting the great Sant in our article.

Thursday, August 13, 2009

World's Biggest Airplane!!!





















32 wheels! -- Cost's more than my house to rotate the tires! The World's Biggest Airplane, the Russian Antonov 225. These pics are of the Russian behemoth when it came into Medford,OR,USA to pick up two Sikorsky fire fighting helicopters to take overseas. The cost - Only $1,000,000 to transport them!

While they were loading the helicopters, the Russian pilots (two crews), went into town to buy cigarettes by the case and Levis jeans. It is amazing something this huge can stay in the air. The Wright brothers would never have dreamed about this!

Wednesday, August 12, 2009

Give up alcohol, coffee - it's better than IVF

Women wanting to become pregnant are as likely to succeed by giving up alcohol and caffeine as by attending a fertility clinic, a UK nutrition specialist claims.

Dr Emma Derbyshire, of Manchester Metropolitan University, said 32 per cent of those having trouble conceiving became pregnant by giving up stimulants, compared to 33 per cent after IVF treatment.

And she revealed quitting smoking was as important as a healthy diet in improving a woman's fertility.

Dr Derbyshire said couples should tackle their unhealthy lifestyles first before choosing expensive fertility treatment.

"Women wanting to get pregnant stand nearly the same chance of conceiving if they cut out alcohol and caffeine as if they attend an IVF clinic for fertility treatment," she said.

Australian Medical Association state president Andrew Lavender said while a healthy diet was vital for women trying to get pregnant, in some cases it "just isn't that simple".

"The vast majority of people seeking IVF are doing so because there are other underlying health issues and they are eating healthy and doing all of those sorts of things, it's gone beyond that," he said.

Park Holme mother-of-three Karen Cameron, 33, who gave birth to daughter Lilly three weeks ago and has two other children, Jordan, 6, and Hudson, 4, with husband Michael, was not surprised by Dr Emma Derbyshire's comments.

"I drink very little alcohol and stopped when we were trying to fall pregnant. I don't drink tea or coffee and I fell pregnant with each of my children very easily," she said.

"I think that healthy diet definitely played a role in that."

Tuesday, August 11, 2009

The Use Of Immunofluorescence In Microdissection Testicular Sperm Extraction

Microdissection testicular sperm extraction is a procedure used to extract sperm from patients with irreversible non-obstructive azoospermia. Sperm extracted are then used for in vitro fertilization (IVF). While this technique has improved the sperm retrieval rate compared to other biopsy techniques, sperm are still often not retrieved. The purpose of our research was to develop a technique for identifying small foci of sperm for retrieval for use in IVF.

After injecting the seminiferous tubules of fertile mice testes with a mouse antibody specific for the human acrosome, we could identify sperm in the majority of animals using confocal microscopy on excised testes. Performance of the same procedure on sterile mice did not reveal any fluorescent signal.

Though pleased with the results of our research, there are several limiting factors that must be addressed prior to practical clinical use. First, injection of human seminiferous tubules and achieving adequate antibody distribution might prove more difficult as the seminiferous tubules are longer, and it will likely require increased hydrostatic pressure to disperse the antibody. This pressure may prove problematic and lead to rupture of the tubules.

Second, while the antibody did bind to the sperm, it was not as selective as anticipated. There was binding of the antibody to both the head and tail of spermatozoa, not just the acrosome. This could have been due to the fact that a mouse-derived antibody was used in a mouse model, which could possibly be associated with the occurrence of a significant amount of non-specific binding of the sperm. There was also background staining within the tubules, making identification of the sperm more difficult. Also, it is still unknown the extent to which the antibody will prove to be detrimental to the sperm, rendering it unusable for IVF.

Lastly, in our animal model the testes were excised from the mice prior to microscopic analysis since the specimen being observed under the confocal microscope required water submersion. Obviously, a different method of analyzing human testicular tissue in situ is required. Intraoperative performance of the confocal microscopy could address this problem, but providing the necessary equipment for this procedure in the operating room may prove challenging.

Despite the obstacles facing practical use of immunofluorescence in microdissection testicular sperm extraction, we are encouraged by the results of our study. More research is certainly needed to evaluate the feasibility of this technique in humans.

Written by Jason R. Greenhalgh, MD, Thomas S. Griffith, PhD, and Moshe Wald, MD as part of Beyond the Abstract on UroToday.com.

Monday, August 10, 2009

Human egg-trafficking business exposed in Romania

Two Israeli doctors and one Romanian are being detained by a special Romanian investigative police unit after raids on a Romanian IVF clinic suspected to be involved in international human egg and stem-cell trafficking. The Romanian department for fighting organized crime (DIICOT) announced in a statement that 'the group was focusing on identifying foreign couples eager to resort to assisted reproduction techniques and on grabbing Romanian (women) aged 18-30 to donate ova for 800 to 1,000 lei' (around £165 to £205).

The Sabyc Clinic in Bucharest, run by Israeli gynaecologist Harry Mironescu, has performed more than 1,200 IVF cycles over the last ten years. However at no point has it been licensed to provide such procedures and DIICOT stated that all were thus carried out illegally. The recipients of the majority of these cycles were Israeli, British and Italian women.

At the time of the raid around thirty people were arrested at the clinic (with the majority of them reported to have been Israelis). Of these, two Israelis – Professor Nathan Levitt and Dr. Genya Ziskind – and three Romanians have been put under house arrest on charges of human egg-trafficking, involvement in a criminal group, and practicing medicine without a permit. The two Israelis have been warned not to attempt to leave the country. The owners of the fertility and cosmetic surgery clinic, father-son pair Harry and Yair Miron, are also being held by the Romanian authorities.

In Israel legislation that would have relaxed rules on egg donation to allow those not undergoing IVF to donate eggs, though not in exchange for payment, has been put on hold. Israel has strict rules on egg donation and though IVF cycles are provided without additional charge as part of the national health benefits (helping Israel have the highest availability of IVF in the world), the eggs used in these procedures must be purchased individually.

Last month a study into cross-border fertility treatment in Europe showed that every year, thousands of women from Britain are travelling abroad to access treatment which is unavailable to them at home. The study, presented at the annual conference of the European Society for Human Reproduction and Embryology (ESHRE), estimated that 20,000 to 25,000 cross-border treatment cycles take place per year.