Jaideep Malhotra MD FICOG FICMCH
Editor-in-Chief SAFOMS Journal Treasurer Indian Menopause Society National Coordinater Club 35 Plus Vice President FOGSI 2010 Governing Council Member of ASPIRE, ISAR, ICOG and IFUMB
Agra, Uttar Pradesh, India jaideepmalhotraagra@gmail.com
Rohana Haththotuwa
Consultant Obstetrician and Gynecologist Chairman Ninewells CARE Mother and Baby Hospital 55/1, Kirimandala Mawatha
Colombo, Sri Lanka
Jaydeep D Tank MD DNB DGO FCPS MICOG
Consultant Jupiter Hospital Centre for IVF Joint Clinical Secretary Mumbai Obstetric and Gynecological Society (MOGS) Ashwini Maternity and Surgical Hospital Center for Advanced Endoscopy and IVF
Forewords PC Ho
Walfrido W Sumpaico
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Handbook on Managing Infertility (Meeting the Challenges in Low-Resource Settings)
First Edition : 2012
9789350255957
Printed at
4Contributors
- Asma Munir md
- Gynecologist and IVF Consultant
- Karachi, Pakistan
- Bharat Joshi msc
- Laboratory Director and Chief Embryologist
- Pulse Women's Hospital
- Ahmedabad, Gujarat, India
- Bhavna Sharma mbbs dgo
- Consultant Obstetrics and Gynecology
- KM and KDJ Hospital
- Gwalior, Madhya Pradesh, India
- Bhola Rijal mrtcog
- Chief Consultant and Chairman of Om Hospital and Research Center, and Nepal Medical College
- Founder of IVF unit in Om Hospital and Research
- Center, Kathmandu
- Derek F Lok mbchb phd (Adel) franzcog, crei
- Senior Clinical Lecturer, University of Sydney
- Consultant Gynecologist, RPAH, Westmead and Liverpool Hospital, Geneva
- Liverpool, NSW 2170, Australia
- Ernest Hung Yu NG
- Department of Obstetrics and Gynecology
- The University of Hong Kong
- Queen Mary Hospital, Hong Kong
- Hang Wun Raymond LI
- Department of Obstetrics and Gynecology
- The University of Hong Kong
- Queen Mary Hospital, Hong Kong
- Haroon Latif Khan mbbs fsc
- Embryologist/Chief Executive
- Lahore Institute of Fertility and Endocrinology (LIFE)
- Lahore, Pakistan
- Hrishikesh Pai md fcps ficog msc (usa)
- Treasurer of FOGSI; Vice President ISAR
- Past President
- Mumbai OBGYN Society
- Past Senior Vice President FOGSI
- Past President Indian Society of Gynecological
- Endoscopist
- Consultant (IVF Expert)
- Fortis Bloom IVF Centre and at Lilavati Hospital
- Mumbai
- Maharashtra, India
- Ian S Fraser ao md bsc (Hons) chb franzcog frcog crei dua
- Professor in Reproductive Medicine
- University of Sydney, NSW, Australia
- Visiting Medical Officer, Royal Prince Alfred
- Hospital, Sydney, NSW, Australia
- Honorary Secretary, FIGO
- Ivan Rizal Sini md franzcog gdrm spog
- Clinical Director of Morula IVF Jakarta and Chairman of Indonesian Reproductive Science
- Institute
- Morula IVF Jakarta
- The BIC, 1st Floor
- Jl. Teuku Cik Ditiro 12
- Menteng
- Jakarta 10310
- Jaideep Malhotra md ficog ficmch
- Editor in Chief SAFOMS Journal
- Treasurer Indian Menopause Society
- National Coordinater Club 35 Plus
- Vice President FOGSI 2010
- Governing Council Member of ASPIRE, ISAR, ICOG and IFUMB
- Agra
- Uttar Pradesh, India
- Jaydeep D Tank md dnb dgo fcps micog
- Consultant
- Jupeter Hospital Centre for IVF
- Joint Clinical Secretary
- Mumbai Obstetric and Gynecological Society
- (MOGS)
- Ashwini Maternity and Surgical Hospital
- Center for Advanced Endoscopy and IVF
- Mumbai, Maharashtra, India
- JP Rao md
- Consulting Sonologist
- Malhotra Nursing and Maternity Home
- Agra, Uttar Pradesh, India
- Kamini A Rao dgo dorcp frcog ficog fnams
- Obstetrics and Gynaecology (Infertility Specialist)
- Director
- Bangalore Assisted Conception Center
- Bengaluru, Karnataka, India
- Lakhwinder Singh ms fais fmas fiages
- Laparoscopic Surgeon and Andrologist
- Genesis Fertility and Surgical Center
- Jalandhar, Punjab, India
- Malhotra Test Tube Baby Center
- Agra, Uttar Pradesh, India
- Manish Banker md
- Director and Infertility Specialist
- Pulse Women's Hospital, Ahmedabad
- President Elect, Indian Society for Assisted
- Reproduction [ISAR]
- Chairman, Infertility Committee
- Federation of Obstetrics and Gynecological
- Societies of India [FOGSI] [2007 – 2010]
- Nandan Roongta dnb, dgo, dfp
- Clinical Associate
- Lilavati Hospital IVF Centre
- Mumbai, Maharashtra, India
- Nandita Palshetkar md fcps ficog
- Present Senior Vice President of FOGSI
- Clinical secretary of Mumbai OBGYN Society
- Treasurer of Indian association of Gynecological
- Endoscopy
- Member of the Managing Committee of ISAR
- Consultant IVF Expert at Fortis Bloom IVF Centre
- New Delhi/mohali/vashi and At Lilavati Hospital
- Mumbai
- Maharashtra, India
- Narendra Malhotra mbbs md ficmch fiajago ficog ficmu frsh
- Consultant, Obstetrician, Gynecologist and IVF
- Specialist, Malhotra Hospital
- Agra, Uttar Pradesh, India
- Honorary Professor Indian College of Maternal and Child Health (ICMCH Kolkata)
- Consultant and Co-ordinator, Department of Obstetrics and Gynecology Apollo Pankaj Hospitals
- Agra, Uttar Pradesh, India
- President FOGSI, 2008
- Dean, Indian College of Ultrasound (ICMU) 2008
- Chairman, AOFOG YGAA and Publication Committee
- Neharika Malhotra md
- Consultant, Obstetrician
- Gynecologist and IVF Specialist
- Malhotra Hospital
- Agra, Uttar Pradesh, India
- Parikshit Tank md dnb fcps dgo dfp mnams micog mrcog
- Honorary Clinical Associate Obstetrics and Gynecology, Nowrosjee Wadia Maternity Hospital
- Mumbai, Maharashtra, India
- Consultant, Ashwini Maternity and Surgical Hospital
- Center for Endoscopy and ART
- Mumbai
- Maharashtra, India
- PC Ho
- President, Asia & Oceania Federation of Obstetrics and Gynaecology (AOFOG)
- Department of Obstetrics and Gynaecology, Queen
- Mary Hospital, 6th Floor
- Professorial Block, 102 Pokfulam Road
- Hong Kong
- Priya Sivadas
- Fellow, Sydney IVF
- Liverpool, NSW 2170
- Australia
- Ragweshwar Jyoti mbbs md
- Gynecologist
- Deen Dayal Upadhyay Zonal Hospital
- Shimla, Himachal Pradesh, India
- Rajat Gyaneshwar mbbs mhed franzcog
- Professor of Obstetrics and Gynecology
- College of Medicine Nursing and Health Sciences
- Fiji National University
- Fiji
- Rajesh Chaudhary md
- Lecturer in Department of Obstetrics and Gynecology, Nepal Medical College
- Research Officer
- Om Hospital and Research Center
- Kathmandu, Nepal
- Rishma Pai md dnb dgo fcps ficog
- Past Senior Vice President FOGSI; Treasurer of Indian Society of Assisted Reproduction
- Convenor DNB
- Jaslok Hospital, Member of Managing Committee
- Mumbai, Maharashtra, India
- OBGYN Societies and IAGE
- Consultant IVF Expert at Fortis Bloom IVF Centre and at Lilavati Hospital
- Mumbai
- Maharashtra, India
- RJ Norman BSc (Hons) mbchb (Hons) md franzcog frcpa frcpath frcog crei
- Director
- The Robinson Institute
- The University of Adelaide
- Ground floor, Norwich Centre
- 55 King William Road
- North Adelaide
- South Australia 5006
- Rohana Haththotuwa
- Chairman
- Ninewells CARE Mother and Baby Hospital
- Colombo 05
- Sri Lanka
- Rutvij Dalal
- Fellow in Reproductive Biology
- Lilavati Hospital Research Centre
- Mumbai
- Maharashtra, India
- Sabina Pradhan md
- Consultant
- IVF Unit
- Om Hospital and Research Center
- Kathmandu, Nepal
- Sakshi Tomar mbbs md
- Consulting Radiologist
- Lakimpur, India
- Sanjay Gupte md dgo ficog frcog llb
- Director
- Gupte Hospital
- Pune, Maharashtra, India
- President of FOGSI (2009–2010)
- Seung-Yup Ku md
- Department of Obstetrics and Gynecology
- Seoul National University Hospital
- Seoul, Korea
- Shee-Uan Chen md
- Gynecologist (Infertility specialist)
- Department of Obstetrics and Gynecology
- National Taiwan University Hospital
- Taipei, Taiwan
- Sheila Loh
- Clinical Director
- Raffles Fertility Centre
- Raffles Hospital
- Singapore
- Shin Yong Moon md phd
- Professor
- Department of Obstetrics and Gynecology
- Seoul National University College of Medicine
- Director, Institute of Reproductive Medicine and Population, Seoul National University
- Seoul, Korea
- Director, Laboratory of In Vitro Fertilization
- Seoul National University Hospital
- Seoul, Korea
- Shivanand Sakhare ms dnb fcps
- National Board Fellow in Reproductive Medicine
- Clinical Assistant Bloom IVF Centre
- Mumbai, Maharashtra, India
- Shyam V Desai md dgo dfp fcps mnams ficog
- Honorary Professor Obstetrics and Gynecology
- Mumbai University
- Postgraduate Teacher
- Port Trust Hospital, Mumbai
- Consultant Obstetrics
- Gynecology and Endoscopic Surgeon
- Dr Balabhai Nanavati Hospital
- Hinduja Healthcare Surgical
- Seven Hills Hospital and Dr LH Hiranandani
- Hospital, Mumbai, Maharashtra, India
- Sonal Karia mbbs md franzcog
- Obstetrician, Gynaecologist and Fertility Specialist
- Sydney, NSW, Australia
- CREI fellow, Sydney IVF and Royal Prince Alfred
- Hospital
- Sydney, NSW
- Australia
- Tomoko Inoue md phd
- Director
- IVF Namba Clinic
- Okaka
- Upul Senarath mbbs md
- Senior Lecturer in Community Medicine
- Faculty of Medicine
- University of Colombo
- Colombo, Sri Lanka
- Vijay Kulkarni ms
- Consultant Andrologist and Microsurgeon
- Mumbai, Maharashtra, India
- Walfrido W Sumpaico md
- Dean
- College of Medicine
- Manila Central University
- Secretary General, AOFOG
- President/CEO of the United Doctors Medical Center
- Yin Yin Yong
- Senior Embryologist (resp)
- Raffles Fertility Centre
- Raffles Hospital
- Singapore
- Yoshiharu Morimoto md phd
- IVF Namba Clinic
- 1-17-28, Minamihorie, Nishi-ku
- Osaka, Japan
- Yu-Shih Yang md phd
- Department of Obstetrics and Gynecology
- National Taiwan University Hospital
- No. 7 Chung-Shan South Road, Taipei, Taiwan
Infertility is a common gynecological condition. Although it is not a life-threatening condition, but infertility is a stigma in many countries in this region, leading to a lot of distress in the infertile couples. In the recent few decades, many significant advances have been made especially in the area of assisted reproduction and more infertile couples can now achieve a successful pregnancy. However, many of the new methods of infertility treatment are expensive and may not be affordable to patients in low-resource settings. Despite the rapid economic advances of many countries in the Asia-Oceania region, many patients in this region still cannot afford the expenses involved in infertility treatment. I would like to congratulate Dr Jaideep Malhotra, Dr Rohana Haththotuwa and Dr Jaydeep D Tank for organizing the Handbook on Managing Infertility which concentrates on the infertility management in low-resource settings. This book will be useful to many gynecologists in this region as a practical guide in their management of infertile couples.
PC Ho
President
Asia & Oceania Federation of Obstetrics and Gynaecology (AOFOG)
9Foreword
From the earliest days, man has always sought companionship with woman. They profess undying love for each other and promise to look after each other's welfare till death do they part. But, in addition, they also promise to take care of the children, they will be blessed with. And we have all been witness to the joy and contentment in the births of beloved descendants.
This is the central core of the problem of infertility—it fulfills the goal of companionship between man and woman but frustrates their goal of continuity. One must, therefore, look not only on the medical aspects of the problem for much greater might be the personal and social aspects of infertility.
Handbook on Managing Infertility is unique because it is written from an “eastern” perspective, a bit different from what has been written in current literature. Moreover, it is authored by persons with great personal experience and expertise on the topic. Finally, it fulfills AOFOGs main thrust of education for it is members and the population they serve. I am grateful for the privilege of writing this foreword. Daunting as the task may have been, I congratulate the editors and contributors for their effort, time and talent in producing this handbook. I wish the reader satisfaction in reading the handbook.
Walfrido W Sumpaico
Dean, College of Medicine
Manila Central University
Secretary General, AOFOG
President/CEO of the United Doctors Medical Center
10Preface
What do we gift a person who cannot hear…, a hearing aid, may be?, or a wheelchair to someone who cannot walk.., but what do we give to the infertile couples of developing world, struggling with their nutritional and infrastructural needs, have humungous maternal and neonatal mortality and morbidity, are high on dependency and definitely low on faith…
Yes. It is a ‘child’ the most precious gift to mankind for its continuity, perpetuation and prosperity! The birth of Louise Brown in 1978, a remarkable beginning, one of its kinds, rarest of all…but the most celebrated one so far, gave hope and happiness to millions in this world. This was regarded as the beginning of a new era of assisted reproductive technology (ART). Since then, the field of ART has seen innumerable new discoveries and technological advances which has led to increasing indications, which otherwise were unthinkable and beyond the reach of common man.
Today, the world boasts of 4 million IVF babies, but still 80 million couples are childless and either have no access to the fertility services or cannot afford them.
Even though ART today is an accepted treatment modality, the simplification of setting up labs and technology has led to mushrooming of ART centers even in developing countries, but the lack of expertise, adequately trained clinicians and technical personnel has made it a bit compromised. Also, sheer amiss of laws (only guidelines) has made 3rd party reproduction more lucrative business and the West is looking towards this region for oocyte donors and surrogates.
In our more than two decades of obstetric and gynecological practice in this region, we have been frustrated enough for not being able to offer, fertility services to our infertile couples because of sheer lack of accessibility or affordability.
This endeavor of ours is to equip ourselves with the least possible resources most effectively and enduringly! This small effort of ours is, indeed an attempt to highlight the special problems and hurdles these low-resourced countries face on their way to successive implementation of high end technological implications and their increasingly unmet need for an intensive and expensive infrastructure for it to support, this package of technological advancement.
Our main aim is to throw light on those specific areas, which can be and should be tackled with a little foresight and care, so as to maximize all available resources with time and cost effectiveness, ensuring higher results in lower input areas as well. We are sure that this book will be a great help to all practitioners looking for viable and workable solutions.
We would like to express our deep sense of gratitude to Professor Walfrido W Sumpaico, for his motivation for this first ever AOFOG publication. Sincere thanks to Prof PC Ho for his constant support and guidance, deep sense of appreciation to all our esteemed contributors for burning the midnight oils to get this manuscript ready on time, and have no words for Shri Jitendar P Vij (Chairman and Managing Director) and his team, for the untiring help and effort to get this publication ready, lastly to all our spouses and children for bearing with us in our endeavor.
Jaideep Malhotra
Rohana Haththotuwa
Jaydeep D Tank