Saturday, 27 April 2013

interesting case yesterday!
the couple were married since the last 10 years and the female partner had to undergo a hysterectomy dues to Multiple big fibroids which were not regressing with medication or with Minimally invasive surgery.
the male partner is azoospermic with a low FSH reading so we put him on Injection HCG 5000 units/week for 12 weeks.
the Egg and sperm extraction for both partners was done yesterday.
the sperm extraction was done  by Testicular biopsy which is a minor surgery to remove a piece of tissue from the testicles for examination under a microscope.The skin over the testicle is cleaned with normal saline instead of antispetic as this may damage the sperm. The area around it is covered with a sterile towel. A local anesthetic is given to numb the area.
A small surgical cut is made through the skin, and a small piece of the testicle tissue is removed. A stitch is used to close the opening in the testicle. Another stitch closes the cut in the skin. If necessary, the procedure is repeated for the other testicle if sperm is not found from one side.
initially there was no motility found and all the sperms looked immotile.
after performing a density gradient wash there was still no motility,hence i added a litle bit of Media which provides nutrition to the sperm and kept it in the incubator for 3 hours.
after 3 hours motility was seen and ICSI was done.

Thursday, 25 April 2013

German Dominance in Europe!!
i am a big time soccer fan as would have been evident from my earlier post!
i have been up watching the Champions league SF's the last two nights,the games start a little past midnight so i havent been getting decent sleep the last couple of days.
what games they have been though! Bayern Munich and Borussia Dortmund have anhilated the Spanish teams FC Barcelona and Real Madrid by scores of 4-0 and 4-1 respectively.
i love Real madrid for the way they play.they are not the most talented team in the world like barca or bayern but they scrap and fight and get results and one man is responsible for that is jose Mourinho!! he taught the world how to counter Barcelona's Tiki Taka Brand of football during a phase when Barca were almost invinsible.
it was sad to see the two spanish giants suffer such humiliating defeats but good to see new talent like Robert Lewandowski,Mario Gotze and Marco Reus
above- Lewandowski scoring the 4th goal for Dortmund from the penalty spot.he had the game of his life scoring all 4 goals and will no doubt be playing for another team next year for a big fat fee!

this is my personal response to the scores of negative stories put forward by biased and paid media against surrogacy in INDIA.
From the developments in the last few days it is amply clear that a lot of news articles and stories have been biased and carried forward with an Agenda to discredit the Indian Doctors,Surrogate mothers and the entire surrogacy industry in INDIA.

certain tabloids such as the Daily mail and news channels like the CBS are deliberately carrying paid stories to discredit the good  work that has been done INDIAN medical fraternity and Indian women who have been surrogate mothers in the last few years and the INDIAN MEDIA has also picked up on these stories without verifying the truth behind them.

the ESHRE and FIGO report is based on the study of an INDIAN scientist which seems to be completely biased and was based out of only 1 or 2 cities whereas the fact is that surrogacy is carried out on a big scale in almost all major cities in INDIA.

the fact which cannot be ignored is that thousands of babies have been born for foreign nationals in INDIA in the last 4 to 5 years.has ESHRE or FIGO or HAGUE conducted a detailed study on this population and asked them how they feel about surrogacy in INDIA after having their babies?and who has given them the right the comment on services provided by the Indian Medical fraternity.
 have they interviewed the thousands of surrogate mothers and egg donors whose lives have been transformed,whose kids have finally been able to get a decent education and they could finally shift from a thatched hut into a concrete roof !!

poverty in various countries cannot be measured by just one yardstick!!

for example anyone who earns less than 20,000usdollars/year(10 lakh Indian rupees)in the USA is considered poor whereas in INDIA even well educated and prosperous middle class don’t earn so much/year.

there have been several hundreds of  couples who have tried surrogacy in USA,Canada and other countries and have spent upwards of two hundred thousand dollars and have been completely broke without a pregnancy and have successfully turned to INDIA and had babies for as much as 25,000usdollars.

there are stories of surrogate’s being exploited in the USA,UK,Canada etc as well then why does ESHRE,FIGO and the HAGUE turn a blind eye toward these stories.

why are these stories not being picked up by the international media.there have been stories of big surrogacy agencies being investigated for fraud and cheating in the USA and Canada by the FBI itself.a simple google search will reveal hundreds of such horror stories.

ESHRE and FIGO are apparently worried about the lack of quality care for surrogate mothers.all surrogacy cases are carried out by certified private clinics and hospitals in INDIA which are amongst the best in the world in their fields if not the best.

complications arise in women carrying natural pregnancies as well and this cannot be avoided but can be treated and diagnosed and the whole world is aware of the competence of INDIAN Doctors!

can the foreign press assure us that surrogate’s in the USA do not  suffer from complications and exploitation?the fact of that matter is if everything was hunky dory in the western countries with regards to surrogacy their clients would never have turned to INDIA.

why has the western world made having a baby through ART and surrogacy such an expensive this not exploitation of their own people??

if there were such huge issues facing  surrogacy in INDIA then it would not have been so would have been finished like it happened in PANAMA or GREECE or the UKRAINE!

the fact is that the American surrogacy industry is running scared because they are loosing out millions of dollars because almost all their clients are or were turning to india.

the fact is that surrogacy in the usa is feasible for a very small percentage of the population and the majority of the population is succesfully turning to INDIA.

 the statements put forward by ESHRE,FIGO and the HAGUE are biased,unjustified and totally contrary to the actual picture of surrogacy in INDIA.

the fact is that these organisations or their representatives have never been to INDIA and so are unaware of the ground realities.
 the need of the hour is to challenge these inaccurate statements and stories made henceforward portraying India and its citizens in poor light by various agencies and press in appropriate forums and may even sue if necessary.

ESHRE or FIGO or for that matter the HAGUE or the UN should not have a say in how INDIA,its citizens and its Doctors function.they have no right to preach to us and are themselves not above the law!

the Hagues says that “In these circumstances(poverty), concerns have arisen that women may be coerced, or even forced, into becoming surrogate mothers”

coming from a body which promotes human rights and equality this is insulting and downright racist to the INDIAN woman and their independence and right to free thinking and choice!! ,no woman anywhere in the world will carry a pregnancy for 9 months unless she wants to,no one can coerce her or force her!

these agencies should realize that INDIAN women who become surrogate mothers are doing such out of their own free will and doing this to be able to afford a better lifestyle for themselves so more power to them!they have no right to pass judgement on them!!surrogacy gives them a choice to become financially independent which unfortunately is not being provided to them by their own elected representatives!

the indian Surrogacy industry is helping thousands of women and their families come out of poverty and giving them an opportunity to lead a prosperous life!besides this it is helping in promoting the tourism and hotel industry thereby contributing in a major way to INDIA economy.

it is entirely upto the INDIAN govt. alone to give directives regarding this matter and even the INDIAN it wrong by banning single and Gay individuals from having a baby through surrogacy in INDIA and at the same time allowing married heterosexual couples to come here and have a baby.

this discriminatory approach has played directly into the hands of the foreign press and associations such as ESHRE,FIGO and the HAGUE who have been waiting for such an opportunity to discredit the INDIAN Surrogacy industry and its Doctors.


Wednesday, 24 April 2013

Medical visas and not tourist visas are to be issued to foreign nationals who are expecting or have had a child through a surrogate mother in India. These will be issued only after furnishing the certificates from respective surrogacy clinics, the Union Health Ministry said in a press statement on Tuesday,Minister of State for Health and Family Welfare Abu Hasem Khan Choudhury was quoted in the statement, "There is no surrogacy law in the country."
"The Ministry of Home Affairs has issued two notifications... The Ministry of External Affairs has been requested to issue the medical visa instead of tourist visa to the foreign nationals visiting India for commissioning surrogacy...," the ministry statement said.

Playing ping-pong with the chinese!!

according to recent reports in the media and confirmed by the indian government a chinese border guards platoon of about 40 soldiers has pitched tents 10 kms(yes that is right 10 kms)inside the indian territory in ladakh in the western sector.

apparently the last time they did this was in 1986 in Arunachal pradesh and called it south tibet and they finally left on their own accord a full 9 years later in 1995.

according to the Indian side the disputed border with china runs a full 4056 kms but the chinese say it is merely 2000km long,herein lies the problem which Indian govt. fails to acknowledge!!

in a rather meek response to the chinese incursion the Indian Army has pitched its own platoon roughly 500 metres opposite the chinese tent!

well they should be doing more because this incursion is part of china's “string of pearl’s strategy” of encirclement around the indian peninsula,in the west they have Pakistan as their ally and have been making steady headway in the indian ocean and srilanka in the south!!

this is an act of aggression by china and India by underplaying this as a matter of varying perceptions about the border dispute are playing into the hands of the dragon and emboldening china further!!

Monday, 22 April 2013

weekend retreat with friends!
i wass off saturday night with my friends to a resort just outside Hyderabad with 3 other friends.we had a good time,it was damn hot so we spent a lot of time in the pool!
i would definetely recommend it to patients and friends!

3 babies were born on friday morning through the kiran infertility centre surrogacy program
twin boys and a girl.
below is a pic of the baby girl of Vijay Maddala from the USA!
below are pictures of the twin boys of Mrs and Mr.Loka from Hyderabad,India

all 3 newborns are doing great!!

Wednesday, 17 April 2013

why rahul Gandhi should not be PM!!
at a recent event while speaking to the Captain of the Indian Industries Rahul gandhi Referred to india as a beehive!! yes that is correct -A beehive!!
earlier when compared to the chineese Dragon,India was often referred to as the Elephant,which is still an Apt Anology,but a Beehive??is the Guy on weed or something?
everyone knows that the beehive has workers who slog,drones who do not work but have the capacity to fertilise and reproduce and the queen bee who rules the Roost!!now keeping in Mind that Sonia Gandhi the Congress chief is rahul's mother,it makes the anology even more bizarre!!
the question that begs to be answered is,do we want a good for nothing leader like Rahul gandhi to come to power and become our prime Minister?
he has not qualities of a leader,he sounds more like a Philosopher,i have listened to him several times in the past and never has he spoken on any important issues!
he says that there are several wrongs that India is facing and it will take time to control and correct these wrongs,well your family has been ruling the country for the last 60 years!! is 60 years not enough Mr.gandhi?
all of us know what the problems are Mr.Gandhi,we want a solution!! and you definetely are not the solution!! Narendra Modi is!!

here's a letter of Appreciation from Ivonette and Pedro from Brasil and their pics!their Daughter Estela was concieved and born at the Kiran infertility centre's Surrogacy program.

Alguns não sabem: Por causa de uma cardiopatia causada por febre reumática na minha infância, sou proibida pelos médicos de ficar gravida. Uma gestação seria de altíssimo risco. Apesar de saber desde os 19 anos que não poderia ficar grávida, a vontade de ser mae foi crescendo a cada dia...
Em maio do ano passado, assis...tindo ao programa do fantástico, que dizia que casais do mundo todo, inclusive do Brasil, estavam indo ä India para realizar o sonho da maternidade e paternidade através do programa de surrogate mother, decidimos naquele mesmo dia que iriamos a India realizar nosso sonho.
Em agosto de 2012, guiados por todas as forças divinas, chegamos ä hyderabad, India, na maravilhosa clínica que tao carinhosamente nos recebeu, Kiran Infertility Center. Dr. Samit, Sr. Anjani e toda a sua equipe, fizeram com que nossos dias alí fossem de paz, alegria, otimismo e sorte. Fizemos fertilização in vitro. Meus óvulos e espermatozoides do pai. Cinco embriões foram colocados na primeira tentativa...
Nove meses depois, nasce Estela, nossa estrela. Nome dado pela sua avó paterna, Estelita, que quando em vida, desejava uma neta com este nome.
Nada é por acaso...
Do impossível a

o possível. Deus fecha as portas e abre as janelas...

Monday, 15 April 2013

Phew Manic Monday is upon us!!
it was a very relaxing weekend with a much needed break from work on saturday and sunday.
monday morning started off on a bit of a low with only 4 eggs retrieved.this can happen sometimes especially if the female partner has history of infertility and is on the wrong side of thirty or even in her forties as Estrogen levels come down as a woman approaches menopause.
well the quandry is whether to perform IVF or ICSI???
i would prefer to do IVF because the sperm count and motility both look good under the microscope however there is a small risk of fertilization failure because the outer wall of the egg is known to become hard with advancing age and make penetration of sperm difficult.
the risk with ICSI is that woman over 40 have a high rate of embryo loss with ICSI,anyhow i have performed ivf after much deliberation and fingers crossed.i will check for fertilisation tomorrow morning!!

Thursday, 11 April 2013

babies day out....of the Womb!!

today we had 2 births scheduled,both caesarian sections.
twin boys born to orran Allan and Dave Booher from NYC,USA and a baby girl for Ivonette and Pedro from Brasil.
orran and Dave are here in India Already and were present for the birth of their boys
Ivonette and Pedro will be arriving on saturday morning because the Indian Consulate gave them their medical visas a day later.
 above baby girl of Ivonette and Pedro from brasil.
below Boys of Orran and Dave from NYC,USA.

all 3 babies are healthy and expected to do well.
now over to Anjani kumar to process their paper work in quick time and send them home!!

Sir Robert Edwards, the British professor who has been called "the father of IVF," died yesterday at age 87. Edwards developed in vitro fertilization with another doctor Patrick Steptoe, and in 1978, the first "test tube baby" was born. When they first developed IVF, Edwards and his partner, the late Dr. Patrick Steptoe, were accused of playing God and this brought them into direct conflict with the catholic church and even own colleagues!the church even went to the extent of saying that the children born through ivf would be born without a soul,essentially meaning that they would be an incarnation of the devil itself!
try saying that to the Millions of children and their parents who had no hope until Edwards came up with "IVF"!
Edwards always said he was motivated by his belief that the most important thing in life is having a baby,nothing is more special than a child!! i entirely agree!!in a way all of us fertility specialists are carrying forward the legacy of Robert Edwards!!
the INDIAN connection to IVF
Dr. Subhas Mukherjee  was a physician from Kolkata, India, who created the world's second and India's first child using in-vitro fertilisation, Durga who was born 67 days after the first IVF baby in United Kingdom. Unfortunately, he was harassed by the communist West Bengal government, and not allowed to share his achievements with the international scientific community.
he Faced social ostracization, bureaucratic negligence, reprimand and insult instead of recognition from the West Bengal government, and refusal of the Government of India to allow him to attend international conferences,[he committed suicide in his Calcutta residence on 19 June 1981.
His feat has been given belated recognition as the Indian physician who in 1986 was officially regarded as being the first doctor to perform in-vitro fertilization in India
A film Ek Doctor Ki Maut directed by Tapan Sinha was made on his life.

Wednesday, 10 April 2013

Hey everyone,
it's midweek already and we are almost in the middle of April.time seems to be just whizzing past this year.well when one is busy this always seems to be the case.
today we had a total of 15 embryo transfers all for surrogacy cases in 3 hours,that is the maximum i have done in a day.seems a lot considering that most clinics do those many transfers in a month.
we are a very busy clinic and sometimes i feel that we maybe too busy for our own good but then we have a wonderul team of  Doctors,nurses,managers and House keeping that are always very reliable and share the same passion for delivering quality health care in all conditions.
let me introduce you to our staff
Below is a picture of Managing Director Dr.Naresh Sekhar with patients from spain and Egg donors from S.Africa.
in scrubs are Dr.Kiran Sekhar and Dr.Pratima Grover who are our top most fertility consultants,in this picture they are seen with patients Hema and Stephane from Mauritius and their parents.
below is a picture of a few of our nurses and para medical staff
Anjani kumar is the case manager and handles all correspondences with patients from india and Abroad.
our job does not finish until the intended parents are able to get the babies born through surrogacy their passports and exit visas until then they stay at the service apartments provided by the clinic and Paediatric nurse salamma takes care of the newborns until they go back home
sometimes life can get very boring,saw his humour filled post online,sharing it with you all...

Lesson 1: Naked Wife
A man is getting into the shower just as his wife is finishing up her shower when the doorbell rings. The wife quickly wraps herself in a towel and runs downstairs. When she opens the door, there stands Bob, the next door neighbor. Before she says a word, Bob says, “I’ll give y...ou $800 to drop that towel.” After thinking for a moment, the woman drops her towel and stands naked in front of Bob.

After a few seconds, Bob hands her $800 dollars and leaves. The woman wraps back up in the towel and goes back upstairs. When she gets to the bathroom, her husband asks,…

“Who was that?” “It was Bob the next door neighbor,” she replies. “Great!” the husband says, “Did he say anything about the $800 he owes me?”

Moral of the story:
If you share critical information pertaining to credit and risk with your shareholders in time, you may be in a position to prevent avoidable exposure.

Lesson 2:
A sales rep, an administration clerk, and the manager are walking to lunch when they find an antique oil lamp. They rub it and a Genie comes out. The Genie says, “I’ll give each of you just one wish” “Me first! Me first!” says the administration clerk. “I want to be in the Bahamas, driving a speedboat, without a care in the world.” Poof! She’s gone. “Me next! Me next!” says the sales rep. “I want to be in Hawaii,relaxing on the beach with my personal masseuse, an endless supply of Pina Coladas and the love of my life.” Poof! He’s gone. “OK, you’re up,” the Genie says to the manager. The manager says, “I want those two back in the office after lunch.”

Moral of the story: Always let your boss have the first say.

Lesson 3:
A priest offered a lift to a Nun. She got in and crossed her legs, forcing her gown to reveal a leg. The priest nearly had an accident. After controlling the car, he stealthily slid his hand up her leg. The nun said,”Father, remember Psalm 129?” The priest removed his hand. But,changing gears, he let his hand slide up her leg again. The nun once again said, “Father, remember Psalm 129?” The priest apologized “Sorry sister but the flesh is weak.” Arriving at the convent, the nun went on her way. On his arrival at the church, the priest rushed to look up Psalm 129. It said, “Go forth and seek, further up, you will find glory.”

Moral of the story: If you are not well informed in your job, you might miss a great opportunity.

Lesson 4:
A crow was sitting on a tree, doing nothing all day. A rabbit asked him,”Can I also sit like you and do nothing all day long?” The crow answered: “Sure, why not.” So, the rabbit sat on the ground below the crow, and rested.

...A fox jumped on the rabbit and ate it.

Moral of the story: To be sitting and doing nothing, you must be sitting very high up.

Lesson 5: Power of Charisma
A turkey was chatting with a bull “I would love to be able to get to the top of that tree,” sighed the turkey, but I haven’t got the energy.” “Well, why don’t you nibble on my droppings?” replied the bull. “They’re packed with nutrients.” The turkey pecked at a lump of dung and found that it gave him enough strength to reach the lowest branch of the tree. The next day, after eating some more dung, he reached the second branch. Finally after a fourth night, there he was proudly perched at the top of the tree. Soon he was spotted by a farmer, who shot the turkey out of the tree.

Moral of the story: Bullshit might get you to the top, but it wont keep you there.

Lesson 6:
A little bird was flying south for the winter. It was so cold the bird froze and fell to the ground into a large field. While he was lying there, a cow came by and dropped some dung on him. As the frozen bird lay there in the pile of cow dung, he began to realize how warm he was. The dung was actually thawing him out! He lay there all warm and happy, and soon began to sing for joy. A passing cat heard the bird singing and came to investigate. Following the sound, the cat discovered the bird under the pile of cow dung, and promptly dug him out and ate him.

Moral of the story:
1. Not everyone who shits on you is your enemy
2. Not everyone who gets you out of shit is your friend
3. And when you’re in deep shit, it’s best to keep your mouth shut !

Monday, 8 April 2013

Monday morning has started off great!
4 oocyte retrievals and a couple of embryo transfers and a very pleasant surprise which i shall come to later!!
the embryos were transferred into two surrogate mothers,one was for an INDIAN NRI couple and the other was for a candian couple.

a lot of folks still dont believe that it is possible to make an embryo which consequently results in the birth of a baby outside the womb in a petri dish,so i shall explain here how this is possible!

what are all the instruments in the ivf lab?
very important-a good Lab must have a good embryologist(:

Laminar flow is a clean air filtration unit which is like a box in which the handling of the the Gametes is done,this is how it looks like in my lab!
 inside the laminar flow,the following equipment are arranged
The stereo zoom is an optical microscope variant designed for low magnification observation of a sample using incident light illumination rather than transillumination,we use it for collection of oocytes from the follicular fluid and for adding washed sperm to the oocytes and for embryo transfer.
Unlike a compound light microscope, illumination in a stereo microscope most often uses reflected illumination rather than transmitted illumination, that is, light reflected from the surface of an object rather than light transmitted through an object and has a megnification of 100X.
the stereozoom has a heating stage so that the gametes are always at 37 degree celcius.
below is a picture of the German made C16 Gas boy which is used for short time storage of gametes at 37 degree centigrade and 5% co2 to mimic the environment in utero
another very important instrument in the lab is the Micromanipulator
it is a device which is used to physically interact with a sample under a microscope, where a level of precision of movement is necessary that cannot be achieved by the unaided human hand. It may typically consist of an input joystick, a mechanism for reducing the range of movement and an output section with the means of holding a microtool to hold, inject, cut or otherwise manipulate the object as required(sperm)Micromanipulation first saw clinical use(1992) in IVF for purposes of assisted fertilization in the treatment of male factor infertility, where fertilization potential was low in cases of poor sperm quality. The ultimate evolution of this approach has been the development of the single sperm injection procedure referred to as Intracytoplasmic Sperm Injection, or ICSI. Sperm of virtually any quality and from any level of the male reproductive tract may be used with the only criterion for use being that the sperm is alive even if it is not moving (motile). Dead sperm may be able to achieve fertilization; however, the DNA or genetic material from such sperm is too degenerate to form a viable embryo. Immature sperm from the testicle or the epididymis can be retrieved for use with ICSI for men who possess no sperm in their ejaculated semen (azoospermia).

finally after ivf or ICSI the Fertilised embryo is placed in large incubators in petri dishes for anywhere between 2 to 5 days before being transferred inside the uterus.
above pic of a petridish inside the Incubator
above pic is of the bigger incubator which is used for culture of embryos.
now for the surprise,i was pleasantly surprised to see one of my patients Oksana from ukraine seated in the lounge,i was surprised because she did not have an appointment and she currently lives with her Husband in Dubai and her treatment was not due yet.
apparently she had to come all the way from Dubai to pick up her shots and Oral medication because no medical store/Doctor was willing to give her the drugs even when she had a proper prescription,unless she took the treatment with them locally in Dubai which seems unfair and like an arm twisting tactic to me.
so we gave her the medication and she flies back to Dubai later in the evening.she always has lots of questions and is very keen to have a baby,unfortunately she cannot carry a pregnancy because of a hysterectomy she had to undergo because of cervical cancer.
but she has intact ovaries and we are going to be transferring their gametes into a surrogate mother.surrogacy as a recognised method of treatment is essential for such women to be able to have their own genetically related children.
she will return in about 2 weeks for her OPU.
we wish her the Best in her endeavour to start her family.

Saturday, 6 April 2013

5 a side football non stop for three hours,3 times a week is great!! i play tuesday,thursday and saturday from 8 pm till 11 pm but it does leave your lower body all sore the next day!! so i got up in the morning and finished half a can of relispray and headed to work!!
egg retrievals have to be done at a precise time(36 hours after HCG) otherwise you risk premature rupture of the follicles in vivo and no eggs can be retrieved hence being late for work is not an option no matter how late one plays soccer or parties late in the night,speaking of which my Pal Happy singh urf Satvinder Singh is back from his Goa vacation with family and we plan to hit the party scene later tonight!!
Happy Singh&Mrs!
anyways today there was one single egg retrieval posted and 3 embryo transfers everything went of well!!
the donor from thailand produced 24 ooctes must be some kind of a record cos Thai Donors usually produce between 8 to 10 oocytes and not more! just a personal opinion_Thai women are very petite and slight in built and very very softspoken and manager Anjani Kumar seems to fall in love with them quite often(:
so now have to perform IVF for all the 24 oocytes and then come back in the evening to denude the Oocytes.this is one slight modification i have made to that of my colleagues from across the world.i perform Denudation(the process of stripping the fertilised oocyte of the excessive cumulus mass) the same evening after Adding the sperm to the oocyte and not the next day as is done by the others.this i feel reduces the seminal ROS(reactive oxygen species) which can lead to poor fertilisation rates and subsequently poor pregnancy rates.
next week is Going to be super busy as there are about 6 babies expected to be born to surrogate mothers.
see you monday!

why i think Sanjay Dutt Should not be pardoned?

"winning takes care of everything"-this is the tagline that Nike is using now for Ads featuring Golf Legend Tiger woods after he won the Arnold Palmer Invitational and regained #1 spot in Golf!
well i think Not!!! winning does not take care of everything,or Does it??maybe in todays Society it does??
why am i talking about Tiger woods when i meant to Talk about Sanjay Dutt?one can compare their lives,well maybe not completely but their lives have had similar paths in one respect that both were down in the dumps and then rose like the proverbial phoenix,both for totally different reasons though!
in November  2009,a tabloid published a story claiming that Woods had an extramarital affair with New York City nightclub manager, a claim he denied initially but later admitted to his transgressions
In the days and months following Woods' admission of infidelity, several companies re-evaluated their relationships with him. Accenture, AT&T, Gatorade and General Motors completely ended their sponsorship deals, while Gillette suspended advertising featuring Woods.TAG Heuer dropped Woods from advertising in December 2009 and The magazine Golf Digest suspended Woods' monthly column.A December 2009 study estimated the shareholder loss caused by Woods' affairs to be between $5 billion and $12 billion.
soon woods became one of the most disliked men on the planet and also ended up getting divorced from his wife.however now with the Success he is getting on the Greens,and his apology he seems to be getting back on track.
Sanjay Dutt has not only apologised hundreds of times but has also served 18 months in Prison for Illegal possession of a 9mm pistol and an AK-56 assault rifle on 19 April 1993, Dutt was arrested under the dreaded Terrorist and Disruptive Activities Act (TADA).he claimed in court that he was scared in the aftermath of the 1992 Communal riots in Mumbai and had kept the weapons for self protection!! an Ak -56 assault rifle for self protection??anyways he was granted Bail in 1995 due to the intervention of late Shiv sena Supremo Bala saheb thackeray and with great difficulty he managed a comeback and enjoyed huge success in films,partly made easy because of the good will his Actor father and then member of Parliament ,the Late Sunil Dutt enjoyed in the film industry and in political circles.
he later endeared himself to the masses with his acting prowess in films like "Vastav" and "Munnabhai MBBS".in 2007 the local court convicted him for possession of illegal arms and he had to undergo 6 years of jail time but later that year Dutt was granted bail again by the supreme court because several crores of rupees were riding on him because of the movies he had to make and also because he assured that he would never leave the country without permission from the highest court!
in 2009 Dutt like several others before him thought that the best way to escape the law would be to become a politician and he tried his best to become a member of parliament by contesting on a samajwadi party ticket!!however he later withdrew his nomination because the Supreme court refused to suspend his sentence and a convicted person cannot contest elections in INDIA(what a farce,since almost 50% of our politicians have criminal cases pending against them,not convictions though)
finally 20 years later On 21 March 2013, The Supreme Court has upheld the conviction of actor to serve jail for 5 years, 18 months of which he already spent in jail during the trial.  The court said that the circumstances and nature of the offence was so serious that Dutt cannot be released on probation.
predictably theBollywood community rallied behind  Dutt after the Supreme Court conviction. Actor Jaya Bachchan who is also a MP, said she would meet the governor of Maharashtra state to plead for Dutt's cause. 
  pseudo secularist and the ever pruritic Film director Mahesh Bhatt tweeted: "Heart broken. Just heard that Sanjay Dutt has to go to jail for 5 years. I expected mercy! Alas it did not happen."
now the biggest blooper- Press Council of India and former chief Justice Markandey Katju has appealed to Maharashtra Governor to pardon the actor. Katju sought pardon for Dutt under Article 161 of the Constitution saying that he had not been found guilty of having played a role in the 1993 blasts and had suffered a lot for 20 years and now had a wife and two kids,actually 3,1 more from his previous marriage!!
really Mr.Katju?i believe the courts have been very lenient with Dutt.everyone knows that he has had links with the Underworld including India's enemy #1 Dawood ibrahim.there are call records and even pictures of Dutt posing with Dawwod and His Henchmen like Abu Salem and Dawood's brother Anees!infact Dutt himself admitted in court that he met Dawood once in Dubai,now why the hell does a film actor have to meet the most wanted terrorist and smuggler?
infact Abu Salem and Two other Underworld Dons themselves met Dutt and gave him the Fire arms for keeping them safely at his Home just before the Mumbai bomb blasts in 1993 in which more than 450 innocent men,women and children lost their lives.infact Dutt was in possession of several more assault rifles such as Ak-47 and Ak-56 which at that time even the Mumbai police did not have such assault weapons,which he then asked his friend to if he was truly scared why did he not seek police protection or apply for an arms licence?so if one is scared for their family,should one just approach the underworld and purchase assault weapons?should everyone start doing that Mr.Katju??
i believe Dutt aided and abetted the Mumbai underworld and terrorists including the Pakistani ISI by stockpiling their weapons and was part or atleast had knowledge about the Mumbai blasts.even if he did not had he informed the Govt. and the police about his being approached by the underworld there was a very good chance that hundreds of innocent lives would have been saved! Mr.Dutt has blood on his hands and he has escaped with a minimum sentence of just 5 years and even that he should not serve?If he was an ordinary citizen,he would have at the minimum gotten a life sentence!!
then why this farce of the law and the judiciary?ok i accept that he is a changed man and he has kids and a wife,does not every other criminal repent?so should all of them be pardoned?
Batman Begins is one of my favourtie movieand it is prudent and i completely agree when"RA'S Al Gul the characted played by Lam Neeson says "Criminals thrive on the indulgence of society's understanding" explaining to Bruce wayne about the relationship between society and criminals.

Our judicial system is perhaps the weakest amongst succesful Democracies.there are lakhs of undertrials who have been rotting in our overburdenede jails for years for crimes as petty as pick pocketing because they cannot afford the standard bail of 5000 indian rupees or a hundred US$!!how come Mr.Katju has never pleaded leniencey for them?No Govt. has taken the initiative in reforming the judicial system.Law Ministers have no knowledge of the law.Law Commissions are hogwash and their recommendations just gather dust. are we a Banana republic?on an estimation there are 5 crore cases  pending in our Courts and nearly 1 lakh  cases are pending in the Supreme Court, millions of cases are pending  in High Courts and crores of cases in the lower courts. is justice delayed not justice denied?? our Courts are specialising in the denial of justice when they claim the opposite!
the lawyers,judges and Police are running a nexus.The lawyers tell lies and twisted truths, They Bribe the judges to get favourable orders.The rich and powerful generally escape the long arm of the law  and the small man keeps getting the wrong end of the stick!!

Friday, 5 April 2013

TGIF-thank god Its Friday.

friday morning started with 3 embryo transfers,one was a routine IVF and the other into two Gestational carriers/Surrogate mothers.
the lady who underwent the ivf was 42 years and had undergone several ivf cycles in the USA(4 previous ivf cycles).
she has blocked bi lateral fallopian tubes so the only way she can get pregnant is through ivf,however she has a peculiar problem in the fact that her External cervical os/opening is always blocked.
before embryo transfer for each patient a trial transfer is done where in the outer sheath of the embryo transfer catheter is place through the cervix into the uterus to make sure that the embryo transfer is simple and easy.
achieving a pregnancy through ivf is not just about creating embryos but transferring them in a  simple and easy manner into the uterus under ultra sound guidance.the time taken from loading the embryos and transferring them should be minimal,i try to keep it to under 10 seconds,now if the cervix is blocked the Gynaecologist has to struggle with placing the outer sheath inside the uterine cavity thereby wasting precious seconds and exposing embryos to the Ambient environment.
also a difficult transfer can cause bleding and the embryos will get damaged if they come in contact with blood.
hence it is vital to perform a easy embryo transfer,we took a swab of the cervix and sent it for culture and sensitivity,it showed bacterial infection which was the cause for the cervical block.
the patient was put on Intra venous antibiotic for 7 days which cured the infection,however the cervix continued to be blocked, the Gynaecologist  Evaluated this as being due to the patient being tensed and not relaxing enough for the cervix to dilate,hence an embryo transfer was planned under General Anaesthesia and needless to say it went of very well.
below is an image for an USG guided Embryo transfer

Thursday, 4 April 2013

how i became and Embryologist!!
i always wanted to be a general surgeon since i got into medical school but i was not the most hardworking student.i always scored average in my exams but i got a decent 60% in my final year and i was content with the marks i scored but not My father! My old Man is like an old fashioned military dictator always demanding perfection,myself on the other hand was content being an average joe!!
after i passed my final year MBBS i was completing my 1 year compulsory internship at the OSMANIA general hospital which is the biggest Govt. hospital in all of Andhra Pradesh.
during my surgical stint there i assisted quite a lot in various kinds of surgeries and had made up my mind that i wanted to be a surgeon.however certain events happened during the course of my internship and i found myself working at My parents fertility clinic every evening from 4 pm to 10 pm.
i was handling administration and counselling patients,taking their consent etc before procedure,mostly non clinical used to be tiring as hell because i had to report for internship at osmania everyday at 9 sharp and finish work at 3 pm and get to work at my parents clinic by 4 pm.
twice a week i used to be on call at osmania general so i used to go without sleep for 36 to 40 hours at a Folks would tell me not to attend the fertility clinic and concentrate on my entrance exam for post graduation but i knew in My heart that i had to step in and handle Administration because my father would not be able to do so for atleast another year and My mother had zero experience for it! my folks had put in a  lot of effort to get where they were in life and i could not just sit by the side and watch their Dream go sour!!
now any Doctor who has worked in a Government run hospital in INDIA will tell you that it is not the easiest place to work,the facilities for patients are not the best and infra structure at times can be appalling! lots of times Doctors and interns find themselves at their innovative best trying to overcome these shortcomings!!
Osmania General Hospital is one of the oldest hospitals in India located at Afzal Gunj, Hyderabad.. It was built during the time of the Last Nizam, Osman Ali Khan, and is named after him.
It is run by the Government of Andhra Pradesh
however working in a government hospital in India gives Doctors the best experience to handle diffficult situations because of the sheer volume of patients that come in there on a daily basis,this is one reason i believe Indian Doctors are the best in the world for practical skill and experience because
so i was working at osmania and at my clinic handling administration.
working at my parents clinic i slowly got drawn towards embryology,i started of by simply observing the resident embryologist and it truly amazed me that a single cell which is less than 120 microns in size develops into 100 cells right in front of your eyes in a matter of 5 days and 9 months later a baby results from the work that an embryologist does in the lab.
a surgeon saves lives but an embryologist creates lives!! anyhow i was studying in whatever remaining remaining time i got because i had not given up on being a surgeon yet but after a while the resident embryologist quit and we had to hire free lance embryologists from other cities/countries even because India at that time had a real dearth of good quality embryologists.
however the pregnancy rates with these professionals was hardly upto the mark and at that time i decided that i will myself train to be an embryologist.
i trained at various centres in INDIA and Abroad for more than a year because India does not have a recognised course for Embryology still which is really stupid because india has perhaps the maximum # of ivf clinics in the world!!
anyhow after my training was complete i started working full time as a Embryologist since 2008 and i am proud to say that i have helped more than 2000 infertile couples to have children through various procedure like IUI/IVF/ICSI and Surrogacy.
 i recently completed my Masters in Andrology and Men's health from Edith Cowan university Australia

Wednesday, 3 April 2013

Midweek blues!!
no cases today apart from a day 5 transfer or what we embryologists call a Blastocyst transfer
The blastocyst consists of two primary cell types:
  • the inner cell mass which is th source of embryonic stem cells.
  • the trophoblast a layer of cells surrounding the inner cell mass and the blastocyst cavity known as the blastocele which later combines with the maternal endometrium to form the placenta.
The blastocyst develops from the Morula, a solid ball of about 16 undifferentiated, spherical cell. As cell division continues, the blastomeres change their shape and tightly align themselves against each other, forming the fluid-filled cavity called the blastocoele.
The cells now forming differentiate into two types, an inner-cell mass growing on the interior of the blastocele and cells growing on the exterior of it. In 24 to 48 hours, the zona pellucida breaches, referred to as hatching.
The cells on the exterior of the blastocyst begin excreting an enzyme which erodes epithelial uterine lining and creates a site for implantation. The cells surrounding the blastocyst now destroy cells in the uterine lining, forming small pools of blood, which in turn stimulate the production of capillaries. This is the first stage in the growth of the placenta. The inner cell mass of the blastocyst divides rapidly, forming two layers. The top layer becomes the embryo, and cells from there occupy the amniotic cavity. At the same time, the bottom layer forms a small sac.
below is a pic of the blastocyst that was transferred today morning.for comparison i have placed a 6 -8(day 5)celled embryo besides the Blastocyst.the embryo stopped growing at 6-8 cells and did not progress further the main reason being it might have been of inferior quality.

usually at our clinic we do a day 3 transfer for 70% of our surrogacy cases,a day 2 trasnfer in 20% of the cases and a day 5/6 transfer in 10% of the cases.
if it is a day 5/6 transfer then we do not transfer more than 2 Blastocyst.
most infertile couples who come in for ivf or surrogacy are happy having twins but some folks request only a single pregnancy and in these cases we transfer only 1 Blastocyst.

Advantages and disadvantages of a Blastocysts transfer
Blastocyst transfer can be highly successful for some groups of women, but it isn’t right for everyone and does have some drawbacks:
blastocyst transfer can result in a higher likelihood of becoming pregnant when compared with cleavage stage embryo in certain groups of women(higher age group using self eggs) on the contrary if you opt for blastocyst transfer, you may not get any embryos that develop to the blastocyst stage.
  • there may also be fewer embryos to freeze.
  • now a lot of folks advocate a Blastocyst transfer to prevent multiple pregnacies but Even if you have only one blastocyst transferred there is still a small risk of twin pregnancy. This is because at the very early stages of development blastocysts can split to give monozygotic or identical twins. 
so transfer done,pregnancy test will be done on the Gestational carrier in ten days.
good luck to the Couple from Australia!!

today is the 99th Birth Anniversary of My childhhod Hero!!since childhood i have always been fascinated by a carrier in the Armed forces,i always wanted to be an airline pilot but could not make it because i have Myopia/short sightedness and one personality the stories of whom i grew up on was Sam Hormusji Framji Jamshedji Manekshaw  (3 April 1914 – 27 June 2008), also known as Sam Bahadu ("Sam the Brave"), was an Indian military leader who was the first Indian Army officer to be promoted to the rank of Field Marshal. His distinguished military career spanned four decades and five wars, beginning with service in the British Indian Army in World War II. Manekshaw rose to be the 8th chief of staff of the Indian Army in 1969 and under his command, Indian forces conducted victorious campaigns against Pakistan in 1971 and the liberation of Bangladesh in December 1971.
Towards the end of April 1971, Indira Gandhi, Prime Minister of India at that time, asked Gen. Manekshaw if he was ready to go to war with Pakistan. Manekshaw refused saying his armoured division and two infantry divisions were deployed elsewhere, of whose 189 tanks, only 11 were fit to fight, and that they would be vying for rail carriage with grain harvest at that point of time. Besides, the Himalayan passes would soon open up, with the forthcoming monsoon in East Pakistan turning rivers into oceans. When she asked the cabinet to leave the room and the chief to stay, he offered to resign. She declined to accept it, but sought his advice. He then said he could guarantee victory if she would allow him to prepare for the conflict on his terms, and set a date for it. These were acceded to by the Prime Minister.
Manekshaw masterminded the rout of the Pakistan Army in one of the easiest and quickest surrenders in recent military history. The war, lasting under a fortnight, saw more than 45,000 Pakistani soldiers and 45,000 civilian personnel being taken as POWs(prisioners of war). It ended with Pakistan's unconditional surrender of its eastern half, resulting in the birth of Bangladesh, as a new nation.
  indira gandhi was the indian PM at that time and was somewhat of a paranoid personality,she got whiff of a rumour that Sam Was planning a military coup,when confronted Sam had this to say
·         "Don't you think I would be a worthy replacement for you, Madam Prime Minister? You have a long nose. So have I. But I don't poke my nose into other people's affairs."



Tuesday, 2 April 2013

Yesterday was a major victory for Indian Drug Manufacturers like CIPLA and NATCO!! the supreme court of INDIA in a landmark judgement rejected Swiss pharma giant NOVARTIS AG's plea to preserve its patent over cancer drug GLIVEC which is a life saving drug for CML(chronic Myeloid Leukemia).before GLIVEC there was no cure for CML but with the advent of Glivec the survival rate is 95%.
India has an estimated 3 lakh CML patients,Glivec which is sold by Novartis for about 1.2 lakh INR/month (2200us$ APPROX) whereas Indian manufacturers sell the same drug(generic/non patented) with the same efficacy for a monthly cost of 8000 INR(150 Rupees).you can imagine the cost burden on the poor and middle class citizens!
India is a country where the the patent law is given a twist under a section 3(d) which prevents patenting of new forms of the same drugs unless they exhibit enhanced efficacy,the non existence of this section is a loop hole which Pharma giants can bypass in other countries but not in INDIA!!now why am i writing about this?for two reasons.
1.Glivec like several other life saving drugs such as Sutent(kidney and gastic cancer),Pegasys(hepatitis C),Iressa(lung cancer),Nexavar(renal cancer) are sold by Multi national pharma giants at ten times the cost of what indian pharma companies are selling these life saving drugs for!!
so not only is this beneficial for Indian Patients but also the Indian version of these drugs are exported to most third world countries  resulting in INDIA emerging as the "Pharmacy of the world" selling over 26 Billion$ worth of low cost generic(non patent) drugs to almost all poor and developing countris.
it is estimated that 80% of HIV/AIDS patients in the developing world are surviving because of low cost Anti Retro viral Indian Drugs.
2.the same applies to Gonadotropin injections for IVF/Surrogacy cases
ivf(In vitro fertilisation) is a very expensive treatment which costs roughly 12,000 to 15,000 US$ in countries such as USA,UK,Canada,Australia and several European countries whereas the same  procedure in India Costs 3500 to 5000us$ /cycle)
surrogacy costs 100 thousand us$ above in the USA but in INDIA between 28,000 to 32,000us$.
Big Pharma giants make huge profits but it is also vital for them to give something back to the society also and one way they can do this is by reducing profit margins!!
update on the twin boys born last week to the Couple from the USA.
one of the boys is doing great and feeding well and gaining weight,the second twin's Creatinine levels were rising hence he will be taken for a  transurethral incision of the PUV (posterior urethral valve)tomorrow morning and he should do fine!! fingers crossed!

Monday, 1 April 2013

Back after a nice weekend,hope all of you had a fun Easter!!
i was in Bangalore over the weekend for a the SASSM(south asian society for sexual medicine) was held at the Indian Institute of Science,it has a lovely campus i must say.i was very impressed by the infrastructure over there.

the conference in itself was highly informative and was a good platform to meet several experts from all over the world in a field that is very up and coming and i believe a somewhat neglected area in the field of modern medicine
since the explosion of feminism in the last twenty five years men have been the neglected species and whilst i am all for women power,this i believe is unfair and Generally the impact has been on men's sexual health especially the age group of 40 to 70 years.the lectures focussed on several important issues like Erectile dysfunction,premature ejaculation and sexual health in men suffering from cancer
it is important for men suffering from cancer to realise that they have the option of preserving their fertility by getting their semen or testicular tissue frozen as radio and chemotherpay has the potential to destroy the testicular tissue.
the supra sperm semen bank located at the Kiran infertility centre of which i am the Director has helped several such men preserve their fertility and also helped in creating awareness about this not only amongst the general population but also amongst the medical community.
so i took the early morning flight today from bangalore and reached the centre directly and
awaiting me in the lab were oocytes from two patients,one was a young oocyte donor and the other was a 40 year old lady with Endometriosis.
Endometriosis is a very common cause of infertility amongst females resulting in poor egg quality
In endometriosis, cells that normally line the uterus leave the organ and become deposited in other sites within the body, such as on the ovaries, rectum, bladder or pelvic area. These deposits respond the same way as normal uterine cells do to the hormone changes that occur over a woman's monthly cycle meaning they thicken, and then shrink  which can cause pain in the pelvic region due to adhesions and bleeding.
Endometriosis is thought to affect 5 to 10 percent of women.

now here is an interesting fact about Endometriosis-according to a study done in Italy,The more attractive the woman the more she may be predisposed to developing a severe form of endometriosis!!Several researchers believe that a general phenotype exists which is associated with the disease!
Female attractiveness is linked with higher estrogen levels, and it's possible that the hormone "might favor the development of aggressive and infiltrating endometriotic lesions, particularly in the most feminine subjects," The women also completed a questionnaire about their sexual history, and the results showed that women with severe endometriosis were more likely to have had sexual intercourse before age 18. This could be a result of these women being more attractive, even during adolescence, the researchers said.
 Hilary Clinton who was diagnosed with endometriosis and had a difficult time conceiving her first child Chelsea Clinton. Other famous women who have been diagnosed and faced endometriosis include Marilyn Monroe, Dolly Parton , Mary Jo Fernandez, Queen Victoria of the British Empire, Deirdre Hall and super model Padma Laxmi.
women having Pelvic Endomteriosis find it very difficult to concieve naturally and even if they concieve they find it difficult to continue the pregnancy to term resulting frequently in miscarriage and pre term labour,in these women IVF and Surrogacy is a god option to have their own genetic child.