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By Dr. Sulbha Arora, Clinical Director, Nova IVF Fertility, Mumbai

We recently had a couple come in seeking fertility treatment. The wife is 39 years of age, and the husband is 44. They had been married for 6 years, but had not conceived yet, inspite of undergoing a laparo-hysteroscopy and some planned relation cycles. After evaluating them, we found that her ovarian reserve was good inspite of her age, and his sperm parameters were normal. They underwent a self IVF cycle with us in the month of March. As advanced maternal age is associated with lower chances of success due to higher percentage of abnormal embryos, they opted for PGT. PGT or pre-implantation genetic testing involves checking the embryo’s chromosomes before transferring them. She had five embryos that were biopsied at blastocyst stage and frozen. The PGT result indicated that one embryo had normal chromosomes, whereas the remaining four were abnormal. The one normal embryo was thawed and transferred into the woman’s uterus in the month of August. Ten days later her Beta hCG test was positive, indicating a pregnancy, and her 6 week scan now has shown a single health.

Infertility is a silent struggle in India, and is most prevalent amongst 30-40 years of age group of couples in India. IVF is commonly opted by couples who want to become parents, but are not able to conceive naturally due to various fertility factors. In Vitro Fertilization (IVF) is one of the types of assisted reproductive technology (ART) that involves retrieving the eggs from the woman’s ovaries, fertilizing them with the man’s sperms and replacing the resulting embryo(s) back into the uterine cavity. First, the woman is prescribed a course of daily injections that starts from the first or second day of her cycle. These injections help to produce multiple mature eggs in both her ovaries. Next, the doctor performs a procedure called egg retrieval. This is a short procedure done under general anesthesia. The eggs are retrieved through the vagina, and there are no cuts or stitches involved.Post this, the sperms and the eggs are fertilized in the IVF lab. After that one or two embryos of good quality are transferred into the woman’s uterus and the woman may become pregnant if the embryo implants itself in the lining of the uterus. Some IVF clinics also transfer more than two embryos, but it is not advisable.

Infertility can take a toll on the couple’s relationship. Yes, you have heard it right! If any couple is identified with infertility then it could be stressful for the couple. Infertility mainly can be disturbing for the woman as there is still a stigma attached to it. Moreover, the treatment for infertility can be physically and even mentally challenging. The success rate of any ART-related treatment may depend on certain factors such as the age of the couple, the underlying cause of infertility, and the type of treatment they undergo. But, you need not worry as you will surely be able to turn your dream of becoming parents into reality and enjoy parenthood by inculcating habits that will benefit both your physical as well as mental well-being while undergoing an IVF treatment.

There is a common misconception among many couples that an IVF treatment requires an anonymous donor’s sperms/eggs to help them conceive. Understanding the time-sensitive aspect of IVF, if timely intervention is made, then the couple can opt for an IVF treatment with their own egg/sperms.

Understanding Self-Cycle:

·         Did you know? Treatment for infertility has evolved with time and has also helped to enhance the success rates. Physicians now have a variety of options to personalize the infertility treatment for individual couples owing to the advancements in technology and the better understanding of the physiological processes. In vitro fertilization (IVF) is one of the most advanced treatment options that are available currently.

·         IVF may be offered as a ‘self-cycle IVF’ or a ‘donor cycle IVF’, depending on the requirements of the couple, after a thorough evaluation by a fertility expert.  

·         In self-cycle IVF, the couple’s own gametes (sperms and egg) are used, whereas we use either eggs or sperms from a donor in a donor cycle IVF. Donor cycle IVF may have a higher success rate as compared to self-cycle IVF in cases where the couple’s own gametes are low in quantity or quality.However, some couples may prefer to first try with their own gametes, opting for donor gametes only as a last resort. This usually comes from the desire for having a child who is biologically linked to them. At Nova, we understand and respect the couple’s choice. We understand that this is a deeply personal decision to make. Once we evaluate you, we discuss with you in detail the expected success rate and finances involved with both the options, and encourage you to make an informed decision based on what option you are more comfortable with.

·         Consult an infertility expert to understand what method is best suited for you.

When are donor gametes indicated?

·         Women with a good ovarian reserve as determined by the antral follicle count and Serum AMH levels, would have similar chances of conceiving with both her own as well as donor eggs. In such cases, donor eggs are not recommended. As the woman’s age advances, the quantity and quality of her eggs both starts to decline. This results in lower success rates with a self-cycle. When this ovarian reserve is completely depleted, donor eggs may become the only option. Usually a significant decline in the ovarian reserve starts after 30 years of age. However, as the aging process affects every woman differently, some women may have a very low reserve in the 20s itself, and some may have a good reserve well into their 30s. Overall, the success rate for self-cycle IVF is good among younger women and may decline beyond 35 years of age.

·         Zero sperm count in the male partner, among men in whomeven the surgical means of extracting sperms (ex- testicular biopsy) have failed to yield healthy sperms.

Takeaway message:  Couples must educate themselves and consult a fertility expert in order to make the best treatment decision when it comes to choosing between self or donor IVF cycles. Always be aware and choose what is right for you with the help of an expert and you will surely be able to conceive and fulfil your dreams of parenthood. 

By Dr Suneet Khanna
Obesity is a very complex disorder.There are many genetic, biological & environmental factors that have a major effect on body weight. It is not about will power.

EAT LESS MOVE MORE is a good advice
Telling people with weight problems to just “eat less move more”is ineffective advice.It rarely work’s in the long term. Its like telling someone with depression to cheer up.

CARBS MAKE YOU FAT
Low carb diets are very effective for weight loss. However carbs are not what causes obesity in the first place.The truth is whole foods that are high in carbs are very healthy.

FAT MAKES YOU FAT
Fat has often been blamed for the obesity epidemic,but there is nothing inherently fattening about dietary fat.Yet eating a lot of fat along with a high carb, high calorie junk food based diet, will definitely make you fat.

EATING BREAKFAST IS NECESSARY TO LOSE WEIGHT
It is true that breakfast skippers tend to weigh more than breakfast eaters.
Eat when you are hungry, stop when you are full.

FAST FOOD IS ALWAYS FATTENING
Fast food does not have to be unhealthy or fattening.Most fast food chains offer some healthier alternatives to their main offerings.Such as chicken skewers/ steak with baked potato or chicken salads with avocado dip

WEIGHTLOSS DIETS ACTUALLY WORK
Dieting usually doesn’t work in long term. Most people gain the weight back. If you manage to increase your activity levels, eat healthier ( take professional
help ) & sleep better, then weight loss will be easier.

“Diet” FOOD CAN HELP YOU LOSE WEIGHT
A lot of junk food is marketed as healthy. Examples include low fat food, fat free foods, processed gluten free foods & disguised high sugar beverages. A good thumb rule – if the packaging of a food tells you its healthy then probably its bad for you

Dr Suneet Khanna
Diet Doctor
The Westside Clinic

By Dr Narendra Saini

SARS-CoV-2,Covid 19,Update

Cases : 36,753,904 deaths : 1,066,856 US Cases 7,833,763 death 217,738
India : Cases 6,906,151
death :106521
Brazil : cases 5,029,539 deaths 149034 (worldometer)

Vitamin D may reduce complications related to Covid-19, study finds
A study has concluded that hospitalized patients with COVID-19 are less likely to have life-threatening complications if they have sufficient vitamin D levels. The sunshine vitamin, as it is often referred to, is synthesised within the body with as little as 15 to 30 minutes of early morning sun exposure.A low vitamin D status, measured as the plasma level of the transport form of vitamin D, 25(OH)D,is widespread worldwide.The researchers found that having a vitamin D level of above 30 ng/ml was significantly associated with having less severe COVID-19.The researchers also found that the patients with sufficient vitamin D had higher blood lymphocyte counts and lower levels of C-reactive protein in their blood, both of which indicate a positive immune response and may reduce the likelihood of developing cytokine storm, which can cause acute respiratory distress syndrome in COVID-19 patients, sometimes resulting in death. Scientist believes that being vitamin D sufficient helps to fight consequences from being infected not only with the coronavirus but also other viruses causing upper respiratory tract illnesses including influenza.
Vitamin D supplement requirements vary with age “For those under the age of one, 400 IU per day is standard, whereas in children and adults, the dosage can range from 600-800 IU per day. There are only a few dietary sources of vitamin D eg.cod liver oil, fat fish, and mushrooms. Vitamin D status can be significantly improved by fortified foods. Over 60 years of age, a reduction in the synthesis of vitamin D in the skin becomes apparent

face coverings (nose &mouth) should be part of new normal.
Smoking in any form at this time should be banned in public places as it may increase the spread of virus
Teamwork and feeling of openness is important for winning this Corona war.

Dr Narendra Saini
Chairman Scientific
committee DMC
Chairman AMR committee IMA Hq
Past Sec Gen IMA
Director SAINI DIAGNOSTICS ICMR approved lab for RTPCR testing

According to Union Health Ministry India’s COVID-19 crosses 69-lakh mark in a single with a spike of 70,496 new cases.The total reported death in last 24 hours . Total case tally stands at 69,06,152 including 8,93,592 active cases, 59,06,070 cured/discharged/migrated cases & 1,06,490 deaths

In solidarity, the All India Institute of Medical Sciences (AIIMS) Resident Doctors Association has done candlelight march at AIIMS for demanding justice in Hathras case.

According to the Resident Doctors Association Statement “Today, when the world unites to fight grappling situation of the pandemic, COVID-19, here do we stand as Indians, who seek more interested in offending their own fellow countrymen. It is not just the woman who is raped that dies inside, the entire family instead. This is a horrifying event that can ever happen to your daughter, mother, sister, or friend who belongs to the female gender.”

“In the present scenario of struggle to fight for life, we ought to help each other more, stand with each other, and be a support to anyone and everyone. I urge each and every person of my country to stand together in this fight for justice. In this regard, we, at AIIMS, New Delhi, had marched to Gate No. 1 as we stand in solidarity with the rape victims seeking justice for them.” Statement further adds

In some countries ‘credible’ cases have been reported of reinfection. Recently in India also a study done by CSIR-IGIB reported reinfection cases of Asymptomatic patients. According to Dr.Randeep Guleria who is Director of All India Institute of Medical Sciences(AIIMS) reveals in a brief Interview with Medically Speaking team about the facts and reason behind the reinfection cases so far.

Can a person get COVID-19 twice ?

If a person recovers from COVID-19, it doesn’t mean he/she wouldn’t get re-infection or it gives immunity passport. We were initially saying previously people felt that if a person gets COVID-19 infected and recovers then he/she may have an immunity passport and now protected from getting the infection again. But now there are some doubts that if a person may not have protection after some months especially if a person had a mild infection in the past.

What precautions people should take to protect themselves from Reinfection?

Even if you get recovered from COVID-19 infection then also you must continue to practice all the precautions in terms of physical distancing , wearing a mask and handwashing.