K JayakrishnanDGO MD DNB
Cheif Consultant in Reproductive Medicine KJK Hospital, Fertility Research and Gynaecology Centre Nalanchira,
Trivandrum, Kerala, India
ForewordM Subhadra Nair
7CONTRIBUTORS
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Publisher: Jitendar P Vij
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Insights into Infertility Management
First Edition: 2012
9789350255186
Printed at:
5Dedicated to
Dr Thomas Chandy who inspired me to take this specialty
Dr M Subhadra Nair who motivated me to choose this subspecialty
Dr K Radhakumari who moulded me into a Reproductive Medicine Specialist
Radha K Pillai, my mother whose determination, strength and passion gave me the courage to pursue my dreams
and
Lekha, Niranjana and Ashwin for making this journey worthwhile.
- Aby K Koshy
- Department of Obstetrics and Gynecology
- Harrogate District Hospital
- United Kingdom
- Ameet Patki
- Medical Director ReGenesis
- Reliance Life Sciences
- Mumbai, Maharashtra, India
- Arati Gupte-Shah
- Consultant
- Pulse Women's Hospital, Ahmedabad and
- Gupte Hospital and Centre for Research in Reproduction
- Pune, Maharashtra, India
- Ava Desai
- Cancer Institute
- Ahmedabad, Gujarat, India
- Christian De Geyter
- Women's Hospital
- University of Basel, Switzerland
- Depalo Raffaella
- Unit of Pathophysiology of Human Reproduction and Gametes Cryopreservation
- Department of Gynecology, Obstetrics and Neonatology
- University of Bari “Aldo Moro” Italy
- Garruti G
- University of Bari, Italy
- Gideon Sartorius
- Women's Hospital
- University of Basel,
- Switzerland
- HJA Carp
- Department of Obstetrics and Gynecology
- Sheba Medical Center
- Tel Hashomer and University of Tel Aviv
- Israel
- Judith Menezes
- Fertilitetscentrum Stockholm
- Sweden
- K Jayakrishnan
- Cheif Consultant in Reproductive Medicine
- KJK Hospital, Nalanchira
- Trivandrum, Kerala, India
- Kavita Suri
- Laboratory Director
- Fertility Clinic and IVF Centre
- Mumbai, Maharashtra, India
- Madhupriya
- Associate Consultant
- Apollo Hospitals Chennai, Tamil Nadu, India
- Madhuri Patil
- Dr Patil's Fertility and Endoscopy Clinic
- Bengaluru, Karnataka, India
- Majumdar Abha
- Director
- Centre of IVF and Human Reproduction
- Department of Obstetrics and Gynecology
- Sir Ganga Ram Hospital
- New Delhi, India
- Mandakini Parihar
- Director Mandakini IVF Center
- Mumbai, Maharashtra, India
- Manish Banker
- Director Pulse Women's Hospital and Melbourne IVF
- Gujarat, Ahmedabad, India
- Maria De Geyter
- Women's Hospital
- University of Basel, Switzerland
- Mridhubashini G
- Director and Consultant
- Womens Clinic, Coimbatore, Tamil Nadu, India
- Oliver Sterthaus
- Women's Hospital
- University of Basel, Switzerland
- Padmini Raviraj
- Clinical Director
- Department of Obstetrics and Gynecology
- Liverpool Hospital
- Sydney South West Area Health Service, Australia
- Pankaj Desai
- Department of Obstetrics and Gynecology
- Medical College, Baroda, Gujarat, India
- Panzarino M Antonietta
- Unit of Pathophysiology of Human Reproduction and Gametes Cryopreservation
- Department of Gynecology, Obstetrics and Neonatology
- University of Bari “Aldo Moro” Italy
- Partha Guha Roy
- Senior Consultant
- Fertility Clinic and IVF Centre
- Mumbai, Maharashtra, India
- Peter Sjoblom
- Nurture Fertility
- University of Nottingham
- Nottingham, United Kingdom
- Pratap Kumar
- Professor and Head
- Department of Obstetrics and Gynecology
- Kasturba Medical College and Hospital
- Manipal, India
- Pravin Patel
- Director
- Pulse Women's Hospital and Melbourne IVF
- Gujarat, Ahmedabad, India
- Rajat Gyaneshwar
- Clinical Director
- Department of Obstetrics and Gynecology
- Liverpool Hospital
- Sydney South West Area
- Health Service, Australia
- Ranjana Mangoli
- Laboratory Director
- Fertility Clinic and IVF Centre
- Mumbai, Maharashtra, India
- Rebecca Moffat
- Women's Hospital
- University of Basel, Switzerland
- Rohit V Bhatt
- Chief Department of Obstetrics and Gynecology
- Bhailal Amin General Hospital
- Baroda, Gujarat, India
- Sadhana Desai
- Director Fertility Clinic and IVF Centre
- Mumbai, Maharashtra, India
- Emeritus Professor
- Department of Obstetrics and Gynecology
- Bombay Hospital Institute of Medical Sciences
- Mumbai, Maharashtra, India
- Sameer Dixit
- Hon. Sonologist
- Nowrosjee Wadia Maternity Hospital
- Mumbai, Maharashtra, India
- Sarat Battina
- Senior Consultant and HOD
- Department of obstetrics, Gynecology and Reproductive Medicine
- Apollo Hospitals Chennai,
- Tamil Nadu, India
- Savita Kurle
- Laboratory Director
- Fertility Clinic and IVF Centre
- Mumbai, Maharashtra, India
- Singh Tejshree A
- Consultant Infertility Unit
- Department of Obstetrics and Gynecology
- Kolmet Hospital and Research Centre
- New Delhi, India
- Smita Kokare (Bandgar)
- Associate Consultant
- Mandakini IVF Center
- Mumbai, Maharashtra, India
- Suresh Kattera
- IVF Scientific Consultant
- Singapore
- Totaro I
- University of Bari, Italy
- Totaro Ilaria
- Unit of Pathophysiology of Human Reproduction and Gametes Cryopreservation
- Department of Gynecology, Obstetrics and Neonatology
- University of Bari “Aldo Moro” Italy
- Vijay Mangoli
- Laboratory Director
- Fertility Clinic and IVF Centre
- Mumbai, Maharashtra, India
Newer concepts, innovations and technology have practically revolutionized the decision-making and management of various gynecological problems relating to infertility. With the explosion of information flooding the field, it became easier for an average clinician to keep pace with the advances and changes that are needed from time to time; since modern health care demands clinicians a practice of evidence-based medicine.
The consumers are also better informed and demand the latest information on the diagnosis of their problem. Moreover, rapid progress in Assisted Reproduction Technology has identified treatable causes of infertility; thus, more people have been able to achieve a successful pregnancy. Pregnancy wastage is also reduced by preimplantation genetic diagnosis that enables the birth of a genetically normal baby.
For a busy clinician, the access to clinically relevant information should be useful and readily accessible. This is exactly where the book Insights into Infertility Management by Dr Jayakrishnan steps in. Dr Jayakrishnan, along with experts in India and abroad, tell us on various problems of infertility, which they have made a mark of their own.
Starting from the role of semen analysis in the investigation for infertility, it goes on to anovulation and induction of ovulation, to polycystic ovarian disease, to hyperprolactinemia in infertility, and to unexplained infertility. It goes on to setting up of an ART clinic, intrauterine insemination, methods of enhancing the IUI success rates. It explores the laboratory set-up for IVF and ICSI and embryo culture, discusses the current scenario of IVF and ICSI, selection of human oocytes, and finally, it ends up by telling us when to stop infertility treatment with a few facts about the ART bill and its implications, which all of us have to be aware of.
I congratulate Dr Jayakrishnan and all the contributors who have generously contributed to the book Insights into Infertility Management which will be of immense benefit to all gynecologists and postgraduate students of gynecology.
I thank Dr Jayakrishnan for the privilege he has given me by asking me to be the one to write the foreword for his marvellous work. I wish the book all success.
Dr M Subhadra Nair
Senior Consultant, Obstetrician and Gynecologist
Cosmopolitan Hospital, Thiruvananthapuram
Formerly Director and Professor
Obstetrics and Gynecology Medical College
Thiruvananthapuram, Kerala, India
11PREFACE
Reproductive medicine is an evolving specialty with new advances made everyday. When I set out to write this book, my aim was to give a comprehensive coverage of all aspects of infertility that was relevant in day-to-day practice. Most books I felt were either too concise or too elaborative; so, it was necessary to strike a balance between the two. Thus was born the idea of writing what I felt, was most relevant.
It is important that even as we practice, we follow evidence-based medicine, and I for one have been a firm believer in it. Most chapters in this book are based on the latest evidence and concepts. Each chapter has been written in a way that is lucid and at the same time tells all that we need to know while dealing with our patients. For every practitioner who wishes to practice reproductive medicine, this book serves as a primer. For the established practitioner, it acts as a refresher and a quick reference. For the postgraduate with interest in infertility, it simplifies things and answers all queries.
If after going through this book, concepts become clearer or interest is generated in Repro-ductive Medicine, I shall deem my work well done.
K Jayakrishnan
13ACKNOWLEDGMENTS
This book is a culmination of my desire to demystify reproductive medicine, making it simple and understandable for both the generalists and the specialists.
I would not have been able to achieve this dream, if not all my colleagues have contributed to various segments of this book. I am deeply indebted to them for their useful inputs and kind contributions.
I thank Dr M Subhadra Nair, my teacher, for having been kind enough to write the foreword to this book. Having been the one who initiated me into this specialty, this foreword holds a special place in my heart.
My gratitude to Mr PV Nair, Manager and Mr Sanal Kumar, Laboratory-in-Charge, KJK Hospital, Nalanchira, Thiruvananthapuram, Kerala, India for being patient and overseeing the smooth functioning of the hospital; so that I could devote my time towards this book.
What time I got to edit the book belonged to my family, Lekha, Niranjana and Ashwin. The three of you have been very supportive of my endeavor, not once complaining about my absence. I know I could not have done this without you.
To the most important people, I express my gratitude, especially, Mr Tarun Duneja (Director-Publishing) and Mr KK Raman (Production Manager) of M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India for the willingness shown in taking up this task at such short notice. Their promptness and enthusiasm is infectious.