ÿþ<html> <head> <meta http-equiv="Content-Language" content="en-gb"> <meta name="GENERATOR" content="Microsoft FrontPage 5.0"> <meta name="ProgId" content="FrontPage.Editor.Document"> <META NAME="DESCRIPTION" CONTENT="PULSE International: Fortnightly Medical Newspaper from Pakistan"> <META NAME="KEYWORDS" CONTENT="Pulse, Medical, Pakistan, News, Professional Medical Publications"> <META NAME="OWNER" CONTENT="masood@masoodjawaid.com"> <META NAME="AUTHOR" CONTENT="Masood Jawaid"> <meta http-equiv="Content-Type" content="text/html; charset=unicode"> <title>Pulse International - Main News</title> </head> <body topmargin="0" leftmargin="0" link="#000000"> <SCRIPT LANGUAGE="JavaScript"><!-- imgsrc=new Array(); imgsrc[1]="a_current_button1.gif"; imgsrc[2]="p_current_button1.gif"; img =new Array(); for (i=0; i< imgsrc.length; i++) { img[i]=new Image(); img[i].src=imgsrc[i]; } function change(number, picture) { { document[picture].src=img[number].src; } } // --> </SCRIPT> <table border="0" cellpadding="0" cellspacing="0" style="border-collapse: collapse" bordercolor="#111111" width="100%" id="AutoNumber1" background="../images/index_topstrip.gif" height="36"> <tr> <td width="33%" height="130" align="center"> <p><b> <font color="#008000" face="Arial" size="2">Fortnightly Medical Newspaper <br> published from Pakistan</font></b></td> <td width="33%" height="130" valign="bottom"> <p align="center"> <img border="0" src="../../images/pulselogo.gif" width="282" height="120"></td> <td width="34%" height="130" align="center"> <p align="center"><font face="Arial" color="#008000" size="2"><b>Published by <br> Professional Medical Publications</b></font></p> </td> </tr> <tr> <td width="33%" height="26" align="center"> <p align="center" dir="ltr"><span lang="en-us"><b> <font face="Arial" size="2">January</font></b></span><font face="Arial" size="2"><b><span lang="en-us"> </span>1<span lang="en-us">5</span>-<span lang="en-us">31</span>, 20</b></font><span lang="en-us"><b><font face="Arial" size="2">12</font></b></span></td> <td width="33%" height="26" align="center"> <p align="center">&nbsp;</td> <td width="34%" height="26" align="center"> <p align="center"><b><font size="2" face="Arial">ISSN: 1026-6828</font></b></td> </tr> </table> <table border="0" cellpadding="0" cellspacing="0" style="border-collapse: collapse" bordercolor="#111111" width="100%" id="AutoNumber2" height="36"> <tr> <td width="100%" valign="top" align="center" height="36"><font size="2">&nbsp;</font><div align="center"> <!--webbot CLIENTSIDE bot="XmmFpEx" MODULEID="'mj (project)\top_menu1_off.xws'" PREVIEW="&lt;img src='../../top_menu1.gif?02A9627E' editor='menumaker' border='0'&gt;" startspan --><script src="xaramenu.js"></script><script menumaker src="../../top_menu1.js"></script><noscript><img src="../../top_menu1.gif?02A9627E" editor="menumaker"></noscript><!--webbot bot="XmmFpEx" endspan i-checksum="64999" --></div> </td> </tr> </table> <table border="0" cellpadding="0" cellspacing="0" style="border-collapse: collapse" bordercolor="#111111" width="100%" id="AutoNumber3"> <tr> <td width="100%" colspan="3"><hr></td> </tr> <tr> <td width="18%" align="left" valign="top"> <p align="center">&nbsp;<!--webbot CLIENTSIDE bot="XmmFpEx" MODULEID="'mj (project)\menu_r_off.xws'" PREVIEW="&lt;img src='menu_r.gif?02BBEDF2' editor='menumaker' border='0'&gt;" startspan --><script menumaker src="menu_r.js"></script><noscript><img src="menu_r.gif?02BBEDF2" editor="menumaker"></noscript><!--webbot bot="XmmFpEx" endspan i-checksum="5033" --> &nbsp;</p> <p>&nbsp;</td> <td width="76%" align="left" valign="top"> <table border="0" cellpadding="0" cellspacing="0" style="border-collapse: collapse" bordercolor="#111111" width="100%" id="AutoNumber5" height="178"> <tr> <td width="100%" height="18"></td> </tr> <tr> <td width="100%" height="106" dir="ltr"> <p class="MsoNormal" align="center"><b><font face="Arial"><u>Management of Infertility<br> </u><font size="5" color="#0000FF">Registration and Reporting by all IVF Centers is essential<br> &nbsp;to ensure patient safety- Prof. Peter Baillie<br> </font><span style="font-size: 16pt">After complete investigations, have detailed session with the couple, explain results, <br> prospects, be truthful and realistic<span lang="en-us"> </span>- Prof. Tayyab</span></font></b></td> </tr> <tr> <td width="100%" height="19" dir="ltr">&nbsp;</td> </tr> <tr> <td width="100%" height="16"> <p align="justify"><font size="2" face="Arial">KARACHI: A special symposium on IVF was one of the salient features of the scientific programme of Baqai Medial University s Silver Jubilee Celebrations during December 2011.<span lang="en-us"> </span>This session was jointly chaired by Prof. Saad Rana an eminent obstetrician and gynaecologist from Islamabad with Prof. Mrs. Zahida Baqai, Lt. Gen. S. Azhar Ahmad and Prof<span lang="en-us"> </span>.Maj. Gen.<span lang="en-us"> </span>Mohammad Aslam. Apart from Prof. Peter Baillie from BMU, other guest speakers included Prof.<span lang="en-us"> </span>Mohammad Tayyab and Prof. Arshad Chohan from Lahore and Prof.<span lang="en-us"> </span>Sirajudullah from Karachi. Dr.Shaheen Zafar moderated the session.</font></p> <p align="center" dir="ltr"> <img border="0" src="images/Peter-Baillie.jpg" width="222" height="285"></p> <p align="center" dir="ltr"> <span style="font-size: 11.0pt; line-height: 115%; font-family: Arial; font-style: italic"> Prof.<span lang="en-us"> </span>Peter Baillie</span></p> <p align="justify"><font size="2" face="Arial">In his introductory remarks Lt.Gen. S.Azhar Ahmad Vice Chancellor of Baqai Medical University said that God Almighty has given special respect to women. The first IVF baby was delivered at Baqai Institute of Reproduction and Developmental Sciences (BIRDS) BMU IVF Center in 1995 and since then many senior gynaecologists are referring infertile couples for treatment to this center. About three hundred procedures are performed here every year. So far more than two hundred live babies have been gifted to the infertile couples from this center.</font></p> <p align="center" dir="ltr"><b><font face="Arial" color="#0000FF">Low Cost IVF, ART in Developing Countries</font></b></p> <p align="justify"><font size="2" face="Arial">Prof. Peter Baillie from BMU was the first speaker who talked about low cost IVF, ART in developing countries. Worldwide infertility figures, he said, are about 9-16% and the prevalence of infertility is higher in developing countries. It also leads to more social pressure on families. With the ART the cost of management has become much higher. The first ART pregnancy, he said, was reported in 1978, while first ICSI pregnancy occurred in 1992. The outcome has now improved from 15% in the early days to 35-40% but the take home baby rate is low because of imperfect procedures. In well established IVF centers the take home baby rate is about 53.4%. He laid emphasis on registration and reporting from all IVF centers to ensure professional ethics, limit the cost and make sure that this facility is not abused.<br> <br> Continuing Prof. Peter Baillie said that in view of the new developments, now major gynaecological diseases are no more a contra indication for IVF and other ART procedures. About ten years ago the cost was about rupees two lac sixteen thousand rupees which has now increased to between three to five lacs. In some developed countries Free ART facilities are available for infertile couples with certain limitations. In India in Vellore IVF costs just one lac eighty seven thousand rupees even today. He was of the view that a take home baby rate of less than 20% is not at all acceptable from any center. He also gave comparative cost in Australia and Nigeria where it is just one thousand US dollars. Longer the reproduction cells are outside, worst is the outcome, he remarked. Day 3-5 are considered the best days for replacement of embryos. Frozen sperms lose up to 20% of outcome on rewarming or replacement. Some time ago Europe decided to formulate guidelines on low cost ART but these have not yet been finalized. Prof. Peter Baillie reiterated that registration of all IVF Centers and ensuring transparency in their functioning was extremely important for patient safety. Cost can be reduced considerably if cost of drugs, laboratory procedures is reduced. Australia, South Africa and Nigeria have managed that and their take home baby rate is between 18-20%.<br> Giving details of patients managed a Baqai Medical University IVF Centre BIRDS, Prof. Peter Baillie said that in one group of thirty seven infertile couples who visited BIRDS, eighteen took babies home and seven of them without any IVF procedure just by taking care of other causes of infertility. Stress, weight changes, inflammation, Para inflammation, endocrine disorders, insulin resistance, exogenous causes especially in male could be one of the causes of infertility. Even treating insulin resistance in male restores pregnancy. He opined that efforts should be made to diagnose insulin resistance early. In another study of one hundred sixty patients suffering from PCOS, half of them became pregnant prior to ART when their PCOS was managed successfully. One must treat the cause of infertility and not the syndrome. Metformin not only reduces breast cancer but also increases life. It is important to start metformin three months before pregnancy. He concluded his presentation by stating that human reproductive medicine is extremely important for optimal outcome in Pakistan and now low cost alternatives are available.</font></p> <p align="center"> <img border="0" src="images/Pict-08=BMU.jpg" width="807" height="237"></p> <blockquote> <blockquote> <blockquote> <p align="justify" dir="ltr"><i><font size="2" face="Arial">During the IVF symposium which was a part of the Baqai Medical University Silver Jubilee Celebrations photograph on left shows Lt.Gen. S.Azhar Ahmad presenting a mementoe to Prof.Zahida Baqai. Picture also shows Prof.Zahida Baqai presenting mementoes to other guest speakers Prof. Saad Rana from Islamabad (Chairman) Prof. Sirajudullah Syed and Dr. Shaheen Zafar the moderator of the session.</font></i></p> </blockquote> </blockquote> </blockquote> <p align="center"> <img border="0" src="images/Tayyab.jpg" width="222" height="286"></p> <p align="center" dir="ltr"> <span style="font-size: 11.0pt; line-height: 115%; font-family: Arial; font-style: italic"> Prof. M. Tayyab</span></p> <p align="center" dir="ltr"><b><font face="Arial" color="#0000FF"> Work-up on Infertility</font></b></p> <p align="justify"><font size="2" face="Arial">This was followed by an excellent presentation by Prof.<span lang="en-us"> </span>M. Tayyab from Allama Iqbal Medical College Lahore who spoke on work-up on infertility. This simple but straightforward approach to manage infertile patients had many important messages for the practicing gynecologists and other healthcare professionals. Prof. Tayyab said that one must look for a cause to treat a cause. It is estimated that only 10-15% of infertile couples will eventually seek treatment, it has social disability and severe psychological impact. Consultants must spend some time with the patient, look at the reasons carefully and make sure to see husband and wife together. Ask the patients their age, how long they have been married and make sure that they have been living together. Age of patient is important because after thirty five years of age, fertility rate is reduced. Take history of contraceptive use; ask for previous marriage or pregnancy, personal social history. Find out whether it is primary or secondary infertility. Take menstrual, medical history, gynaecological history; look for PCO, Sexually Transmitted Infections. Do not forget to take surgical history particularly involving abdomen, pelvis. Take the history in chronological order. Ask for authentic semen analysis report as many labs were not giving correct reports and even people with normal semen analysis are given abnormal, semen reports and they are then treated for that. Take care while asking for coital history. Patients with psychological problems should be seen by a psychologist.<br> Continuing Prof. Tayyab said that look for obstetric problems, vaginal discharge, retro verted uterus and one must have the moral courage to say that some of these infertile couple will not conceive. Ask for all the baseline investigations of wife during the first visit do it once but do it complete and then have a careful look at it. It is no use of asking so many investigations if the treating physician does not have time to look at these reports. It is ethical and mandatory to do all these investigations. There is no role for post coital test but pelvic sonogram is quite good. Women should be put on bromocriptine mesylate (Parlodel) only if it is indicated. Hysteroscopy is not required in all patients. Be careful not to introduce infections during hysteroscopy. After all the results are available, have a detailed session with the couple and talk to them on realistic aspects. Tell the truth to the patient. Explain results and the prospects. Be truthful and realistic.<br> Stress is an important cause of infertility. Once their stress is off, many patients will conceive. Consultant s time, Prof.Tayyab pointed out is more important than the sophisticated tests. There is no short cut to good history. Review the previous records thoroughly. Be careful with semen analysis reports and ensure weight reduction in patients with BMI more than thirty. Take care of the tubal status, do proper counseling and always tell the truth to the patient, he concluded.</font></p> <p align="center" dir="ltr"> <img border="0" src="images/Arshad-Chohan.jpg" width="222" height="286"></p> <p align="center" dir="ltr"> <span style="font-size: 11.0pt; line-height: 115%; font-family: Arial; font-style: italic"> Prof.<span lang="en-us"> </span>Arshad Chohan</span></p> <p align="center" dir="ltr"><b><font face="Arial" color="#0000FF">Role of Endometrium in Ovulation Induction</font></b></p> <p align="justify"><font size="2" face="Arial">Prof.<span lang="en-us"> </span>Arshad Chohan from KEMU made a presentation on role of endometrium in ovulation induction. He discussed in detail the low cost IVF, unexplained infertility and what we can do for the patient. He laid emphasis on qualitative tests and opined that normal reports do not mean that the patient will conceive and abnormal reports do not mean that she will never conceive. The patient should be fully competent to host pregnancy; at times endometrium is not receptive. He also discussed the window of implantation throughout the cycle and the best time to transfer the embryo. Average transplantation rate in IVF is 25% Clomiphene Citrate and Gonada Trophin Injection are the two drugs for ovulation. FSH treatment, Prof. Arshad Chohan remarked is very expensive. It requires intensive monitoring. He also talked about the undesirable side effects of letrozole a new drug for treatment of infertility and ovulation. It is highly potent and selective. Single egg transfer gives results and there is no chance of twins. This new drug, he further stated, gives promising results and has increased the success rate in treatment of infertility in IVF.<br> Prof.<span lang="en-us"> </span>Siraj discussed the sperm ocyte interaction and how to prevent the entry of multiple sperms. He also talked about improving morphology, adverse effects of tobacco smoking which has over fifty carcinogens. Stopping smoking will help improve the morphology, he added.</font></td> </tr> <tr> <td width="100%" height="19" dir="ltr">&nbsp;</td> </tr> </table> </td> <td width="6%" valign="top"> <p align="left"> <br> <br> &nbsp;</td> </tr> <tr> <td width="18%">&nbsp;</td> <td width="76%">&nbsp;</td> <td width="6%">&nbsp;</td> </tr> <tr> <td width="16%" bgcolor="#3366FF" height="1"><font size="1" color="#3366FF"> 1</font></td> <td width="62%" bgcolor="#3366FF" height="1"><font size="1" color="#3366FF"> -</font></td> <td width="22%" bgcolor="#3366FF" height="1"><font size="1" color="#3366FF"> -</font></td> </tr> <tr> <td width="16%" bgcolor="#008000" height="19">&nbsp;</td> <td width="62%" bgcolor="#008000" height="19"> <p align="center"><FONT color=#ffffff size="2" face="Arial">© Professional Medical Publications. 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