Editors Alka Kriplani MBBS MD (Obst and Gynae) MAMS FICOG FICMCH FIMSA
Professor (Head Unit-II) Department of Obstetrics and Gynaecology All India Institute of Medical Sciences Ansari Nagar, New Delhi-110029
Roya Rozati Professor, Owaisi Hospital and Research Centre, Deccan College of Medical Sciences Infertility Specialist Mahavir Hospital and Research Centre Hyderabad MHRI-Centre for Fertility Management, Hyderabad
Jitendar P Vij
Jaypee Brothers Medical Publishers (P) Ltd
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Controversies in Obstetrics, Gynaecology and Infertility
© 2006, Alka Kriplani, Roya Rozati
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the editors and the publisher.
First Edition: 2006
9788180617041
Typeset at JPBMP typesetting unit
Printed at Paras
5Dedicated to the patients, teachers, and colleagues from whom we have gained our experience and knowledge and to the medical students and research scholars in the field of reproduction and molecular biology who have always been the source of inspiration.
Dedicated to my parents for their faithful support, generous love, and inherent gift of character and courage, and also to my loving husband and children for their great support6
7Contributors
- Monica Abbi md
- Chief Resident
- Department of Obstetrics and
- Gynaecology, Hutzel Hospital,
- Wayne State University, Detroit
- Nutan Agarwal md
- Associate Professor
- Department of Obstetrics and
- Gynaecology, AIIMS
- New Delhi-110029
- Gautam N Allahbadia md
- Scientific Director
- Rotunda-The Center for Human
- Reproduction, Bandra, Mumbai,
- India
- Hon. Consultant, The Prince Aly
- Khan Center for Human
- Reproduction, Mumbai
- Swati G Allahbadia md
- Scientific Director
- Rotunda-The Center for Human
- Reproduction, Bandra
- Mumbai
- C Ambuja md dgo
- Professor of Obstetrics and
- Gynaecology, Gandhi Medical
- College, Musheerabad, Hyderabad
- Balamba
- md dgo
- Kaberi Banerjee
- Senior Research Associate
- Department of Obstetrics and
- Gynaecology, All India Institute of
- Medical Sciences, Ansari Nagar
- New Delhi-110029
- Veena Bangera
- Inkus IVF Centre, 311, Mehta
- Bhavan Near Hinduja College
- Charni Road, Mumbai-400004
- Neerja Bhatla md
- Additional Professor
- Department of Obstetrics and
- Gynaecology
- All India Institute of Medical
- Sciences
- New Delhi-110029
- Suman C
- Senior Resident
- Department of Obstetrics and
- Gynaecology
- AIIMS, New Delhi-110029
- S Chhabra
- Professor and Head
- Obstetrics and Gynaecology
- Mahatma Gandhi Institute of
- Medical Sciences
- Sevagram 442102
- Wardha, Maharashtra
- Deepika Deka md
- Additional Professor
- Department of Obstetrics and
- Gynaecology, AIIMS
- New Delhi-110029
- Sejal Desai
- Shyam V Desai
- (md dgo fcps mnams)
- Goral N Gandhi msc
- Scientific Director, Rotunda-The
- Center for Human Reproduction
- Pradeep Garg md
- Assistant Professor, Department of
- Obstetrics and Gynaecology
- All India Institute of Medical
- Sciences
- Ansari Nagar, New Delhi-110029
- Deepti Goswami
- Associate Professor
- Department of Obstetrics and
- Gynaecology, Maulana Azad
- Medical College, New Delhi
- Indira Hinduja
- Inkus IVF Centre, 311, Mehta
- Bhavan Near Hinduja College
- Charni Road, Mumbai-400004
- Deepa Janga
- Senior Resident
- Department of Obstetrics and
- Gynaecology, AIIMS
- New Delhi-110029
- Nikhil S Jani md dgo dnbe
- Kaushal S Kadam md
- Scientific Director, Rotunda-The
- Center for Human Reproduction,
- Bandra, Mumbai
- Alka Kriplani
- mbbs md (obs and gynae)
- mams ficog ficmch fimsa
- Professor (Head Unit-II)
- Department of Obstetrics and
- Gynaecology
- All India Institute of Medical
- Sciences, Ansari Nagar
- New Delhi-110029
- Atul Kumar ms
- Anil Hospital, Hysteroscopic
- Surgery Division
- Deepak Marg, MD Road
- Jaipur-302004
- Alka Kumar ms
- Anil Hospital, Hysteroscopic
- Surgery Division, Deepak Marg
- MD Road, Jaipur-302004
- TC Anand Kumar msc phd
- Hope Infertility Clinic
- 12 Aga Abbas Ali Road,
- Bangalore 560042
- Danny Laliwala
- Inkus IVF Centre, 311, Mehta
- Bhavan Near Hinduja College
- Charni Road, Mumbai-400004
- Bhawna Malhotra
- Senior Research Associate
- Department of Obstetrics and
- Gynaecology, AIIMS
- New Delhi 110029
- Narendra Malhotra md
- Malhotra Test Tube Baby Centre
- 84, MG Road, Agra-280010
- Jaideep Malhotra md
- Malhotra Test Tube Baby Centre
- 84, MG Road, Agra-280010
- Trishala Meghal
- Clinical Assistant
- NILES and Aakar IVF-ICSI Centre
- Mumbai
- Asima Mukhopadhyay
- Research Associate
- Department of Obstetrics and
- Gynaecology, AIIMS
- New Delhi 110029
- Hrishikesh Pai md fcps ficog
- Consultant Gynecologist and ART
- Specialist, Babies and Us Fertility,
- IVF and ICSI Centre
- Rishma Dhillon Pai
- md fcps dgo dnb ficog
- Consultant: Jaslok Hospital and
- Research Centre, Mumbai
- Director: The Everywoman Centre
- (I) Pvt. Ltd., Kemps Corner
- Mumbai. Director: Pearl Centre,
- Senapati Bapat Road, Dadar (W)
- Mumbai 400028
- Nandita Palshetkar md
- Consultant Gynecologist and ART
- Specialist
- Babies and Us Fertility, IVF and ICSI
- Centre, Lilavati Hospital
- Bandra, Mumbai
- Consultant Gynecologist
- Harkisandas Hospital
- Mumbai
- Sukhpreet Patel
- md dnb fcps dgo pgdmls
- Ameet Patki
- md dnb fcps mrcog
- Consultant and Head Reliance Life
- Sciences, Sir HN Hospital and
- Research Center, Mumbai
- Honorary Associate Professor
- KJ Somaiya Medical College
- Mumbai
- Rajavardhani msc
- Embryologist, MHRI-Centre for
- Fertility Management, Hyderabad
- Kamini A Rao md frcog
- Medical Director
- Department of Molecular Medicine
- Bangalore Assisted Conception
- Centre Pvt. Ltd.
- #6/7Kumara Krupa Road, High
- Grounds, Bangalore 560001
- Satyanarayana Reddy msc
- Research Scholar, Mahavir Hospital
- and Research Center, Hyderabad
- Suguna Reddy msc
- Research Scholar
- Mahavir Hospital and Research
- Center, Hyderabad
- Roya Rozati md frcog
- Professor and Infertility Specialist
- Owaisi Hospital and Research
- Centre, Deccan College of Medical
- Sciences
- Mahavir Hospital and Research
- Centre, MHRI-Centre for Fertility
- Management, Hyderabad
- Usha Sariya md
- Consultant Obstetrician and
- Gynaecologist
- Sir HN Hospital, Mumbai
- Consultant Oncologist: Cama and
- Albless Hospital, Mumbai
- NC Saxena msc phd
- Division of RHN
- Indian Council of Medical Research
- New Delhi-110029
- Shailaja Gada Saxena
- mbbs msc (uk)
- Research Associate, Reliance Life
- Sciences, Sir HN Hospital and
- Research Center, Mumbai
- Duru Shah
- md fcps fics ficog dgo dfp
- Hon. Professor of Obstetrics and
- Gynaecology, Grant Medical College
- Hon. Obstetrician & Gynaecologist:
- -Breach Candy Hospital
- -Sir Hurkisandas Nurrotamdas
- Hospital
- -Jaslok Hospital and Research
- Centre
- RS Sharma msc phd
- Division of RHN
- Indian Council of Medical Research
- New Delhi – 110029
- Ruchi Singh
- Inkus IVF Centre, 311, Mehta
- Bhavan Near Hinduja College
- Charni Road,
- Mumbai-400004
- D Swaminathan
- Molecular and Reproductive
- Biologist, Department of Molecular
- Medicine
- Bangalore Assisted Conception
- Centre Pvt. Ltd., 6/7 Kumara Krupa
- Road, High Grounds
- Bangalore 560001
- Prakash Trivedi
- Chief Gynaecological Endoscopist,
- Urogynaec. and Laser Surgeon
- National Institute of Laser and
- Endoscopic Surgery (NILES)
- Mumbai
- Jaslok Hospital and Research
- Centre, Mumbai
- Scientific Director: Aakar IVF-ICSI
- Centre, Mumbai
- Hon. Asst. Prof. Pd. D. Y. Patil Medical
- College and V.C.Gandhi-Rajawadi
- Municipal Hospital
- Reena Wani msc
- md dgo fcps dfp dnbe mrcog
- Assoc. Professor, Obstetrics and
- Gynecology
- TN Medical College and BYL Nair
- Children Hospital, B5 and 7,
- Wayward, Sitladevi Temple Road,
- Mahim Mumbai-400016
- Kusum Zaveri md
- Inkus IVF Centre, 311, Mehta
- Bhavan Near Hinduja College
- Charni Road, Mumbai-400004
Over the years, field of Obstetrics and Gynaecology has witnessed enormous expansion in clinical and basic data as well as tremendous growth in field-related technology. This growth also created a greater need to many controversies issues that have been subsequently arising. The goal of the book “Controversies in Obstetrics, Gynaecology and Infertility” is to reach the actual and agreed upon answers to some of the controversies, through evidence-based medicine.
Our purpose in writing this book has been to produce a comprehensive account of what the specialist in training in obstetrics, gynaecology and infertility must know. Accordingly we have tried to offer the students not only an advanced textbook in obstetrics, gynaecology and infertility but one which integrates the relevant aspects of other subjects which nowa- days impinge more and more on the clinical filed.
In general the matters are considered very briefly or perhaps not at all; this is not a book on how things are done, but on how correct treatment is chosen, what advantages one choice has over another, what complications are to be expected, etc. Our contributors have provided practical information and solid science in a format that can be appreciated and understood by a broad range of readers. As a result of these efforts it is designed to appeal to the medical student as well as to the resident, the fellow, and the seasoned practitioner that helps to survey the recent developments or address new questions and controversies. It is also belief and our hope that this text can serve as a solid foundation for the future.
The authors represent a wide range of expertise in the medical and scientific fields. They include nobel laureates and pioneers, both medical and scientific, in assisted reproductive technology as well as specialists in other areas of obstetrics and gynaecology. The objective of this edition has been to review and integrate the basic scientific informations on which the clinical practice of obstetrics and gynaecology depends.
We hope that our efforts will provide a coherent, integrated account of the field we have attempted to cover, which will be to the satisfaction of the readers.
Alka Kriplani
13Acknowledgements
I would like to acknowledge the tremendous effort put forth by my Ph.D student Mr Satyanarayana Reddy and Mrs Rajavardhani (Embryologist) in the preparation and organization of this book, as well as the authors who have contributed their time and expertise in preparing the chapters and staff of M/s Jaypee Brothers Medical Publishers (P) Ltd., New Delhi and Mr Vijayendra M, for their support during the gestation period for this book. Without the work of all of these individuals, this very important addition to our medical literature would not be available today.