Infertility Management Sushma Deshmukh
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1INFERTILITY MANAGEMENT: Made Easy®
3INFERTILITY MANAGEMENT: Made Easy®
Second Edition
Sushma DeshmukhMD DGO Medical Director Central India Test Tube Baby Center Deshmukh Hospital Nagpur, Maharashtra, India Head and Incharge Department of Obstetrics and Gynecology Get-Well Superspeciality Institute and Research Center Nagpur, Maharashtra, India ForewordsGautam N Allahbadia Narendra Malhotra
4
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Infertility Management Made Easy®
First Edition : 2007
Second Edition : 2014
9789350905319
Printed at
System requirements:
Accompanying CD/DVD ROM is playable only in computer and not in DVD player.
CD/DVD has autorun function—it may take few seconds to load on your computer. If it does not work for you, then follow the steps below to access the contents manually:
2CD Contents
  1. Courtesy
  2. Introduction
  3. Diagnostic Hysteroscopy
  4. Removal of Polyps by Scissors
  5. Removal of Polyp through Grasping Forceps
  6. Hysteroscopic Excision of Adhesive Fibrotic Band
All the video with Courtesy by Professor Dr Osama Shawki
5Dedicated to
My mother, Dr Sarojini Deshmukh who is a constant source of inspiration, and a thorough supporter
6
7Contributors
10
11Foreword
The culmination of a kaleidoscope of disorders with endocrinological, genetic, biochemical, physiological and psychological origins, infertility is recognized as perhaps one of the most debilitating and frustrating conditions that couples experience today. Its myriad causes and consequences not only pose a serious challenge to the psyche and patience of the couple afflicted, but also to the ability and knowledge of the treating physician. Devastated by what could be considered as a traumatic nightmare, patients, usually uninformed and entrapped in a vicious circle of circumstances dominated by stress, shuttle from practitioner to practitioner in search of the most eluding ‘promise for a child’. Ultimately, at their lowest ebb in emotions, finances, self-esteem and faith, and psychologically exhausted in the event of failure, they either give up, consider adoption, or are at the brink of a strained marital relationship. However, the undaunted and remarkable boons of technology have sowed the grain of optimism to attempt to change this dismal plight of patients, making their goal a not so distant dream!
Advances in ultrasound diagnostic methods, such as 3D and 4D color Doppler ultrasonography, contrast sonography, falloposcopic, hysteroscopic and laparoscopic diagnostic techniques, have now equipped the clinician with the tool to evaluate and treat female pelvic pathology on an outpatient basis and also perform assisted reproductive technology (ART) procedures like embryo transfer with maximum ease and efficiency with an added cost-benefit ratio. Advances in 12genetic and molecular diagnostic techniques like polymerase chain reaction (PCR), PCR-based comprehensive chromosome screening (CCS), fluorescent in situ hybridization, preimplantation genetic diagnosis (PGD), array comparative genomic hybridization technique (aCGH), and blastomere biopsy, aided with computer-assisted scoring system (CASS) have now made the selection of morphologically and developmentally viable embryos a reality. Advances in ART such as motile sperm organelle morphology evaluation (MSOME), PICSI, intracytoplasmic morphologically-selected sperm injection (IMSI), embryoscopy, time-lapse videography to determine embryo cleavage, cryopreservation of oocytes and embryos, vitrification, in vitro oocyte maturation, and the identification of various early pregnancy molecular markers in the hands of experienced operators, have lead to more promising success rates, made infertility management more flexible and less time-constrained and alleviated the suffering of a majority of infertile patients. Carrying out the right investigations, making the right diagnosis, and using judgment and skill in the administration of new and apparently attractive therapy and technology, is an absolute necessity.
Infertility Management Made Easy®, a dedicated effort to platform the various causes of infertility, the investigations warranted, and the therapeutic approaches to management in the most efficacious method, after a successful first edition, now gives the reader a deeper and updated insight into the easy and skillful management of infertility. The significance of making the right therapeutic choice on the right patient at the right time on the basis of a sound diagnosis, in lieu of the hurdles that obstruct success and the complications that beset the practice of ART, reads loud and clear, much to the advantage of postgraduate medical students embarking on a career in infertility practice, treating physicians, nurses, and patients alike. I would like to congratulate Dr Sushma Deshmukh for her persistent efforts 13in airing the intended message through a panel of luminaries in the field of infertility, in well-designed chapters, that should go a long way in simplifying the management of infertility.
Gautam N Allahbadia
md dnb fnams fcps dgo dfp ficmu ficog
Medical Director
Rotunda: The Center for Human Reproduction
Bandra (West)
Rotunda IVF and Keyhole Surgery Center
Vashi, Navi Mumbai
Rotunda Blue Fertility Clinic and Keyhole Surgery Center
Shivaji Park, Dadar (West)
Rotunda Fertility Clinic and Keyhole Surgery Center
Mumbai, Maharashtra, India
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15Foreword
It is indeed my great pleasure to write a foreword for Infertility Management Made Easy® by Sushma Deshmukh. Infertility is a major problem and this affects the younger generation and carries a lot of social stigma.
All sections of the book are self-explanatory. It ushers the basics of infertility, evaluation and management as well as the advanced up comings. I really appreciate the efforts taken by Dr Sushma Deshmukh to present the vast and complicated topic of infertility in simplified way. In a true sense, it is really Infertility Management Made Easy.
Narendra Malhotra
mbbs md (Obs and Gyn) ficmch
fiajago ficog ficmu frsh
Malhotra Nursing and Maternity Home (P) Ltd
Agra, Uttar Pradesh, India
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17Preface to the Second Edition
It was immense pleasure to work on the second edition of Infertility Management Made Easy®. The world is growing fast. So also the science and technology are also advancing. Every year, the concepts and guidelines are changing, new drugs are added and the old drugs packing up from the pharmaceutical industry. But, the basic concepts are remaining near about same. Especially, the infertility management has taken advanced leap. It is necessary for the gynecologists to add this knowledge in basic concepts and to keep pace with current infertility management.
I have tried to make all the chapters easy along with addition of funny poems and rhymes. The chapters start from basic infertility evaluations, moves around important assets and ushers advantages of specific investigations, exploring the infertility problems and their solutions, advancing towards skills of assisted reproduction techniques.
Hence, infertility should be studied focusing couple evaluations, endocrinal problem exploration, ovulation induction, laparoscopy, hysteroscopy suggestions and assisted reproduction.
Sushma Deshmukh
18Preface to the First Edition
I am very much happy
To release
Infertility Management Made Easy
Infertility what should we call it?
Is it a disease or social Taboo?
It is a complex problem
Involving body sometimes
But psyche always!
The childless couple
Many times unmanageable
Difficult to treat!
Sometimes curable
With resultant sweet fruit
In some patients disease is curable
But without fruitful outcome.
… Advanced science and technology
has become boon to our society
also in the field of infertility
trying to go beyond horizon …
so a ray of hope always remain
if all efforts are in vain
i.e. Assisted reproduction!
Basically, assisted reproductive technology (ART) is an art
And beginning of new life with effort and support
We are trying to work with this concept
And provide assisting hand for it.
Sushma Deshmukh
19Acknowledgments
Infertility Management Made Easy® is a self-inspirating as well as challenging task for me. It was a surprise for me that within 15 days of its release, the book has been recognized at international levels and occupied space in Amazon series. The whole credit goes to the contributors, the hard working Jaypee Brothers team and the man of vision Shri Jitendar P Vij (Group Chairman), Mr Ankit Vij (Managing Director), Mr Tarun Duneja (Director-Publishing) and Mr KK Raman (Production Manager) of M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India. I have special feeling for all of them.
Working with the second edition was again a different task. But the support of the team has encouraged me a lot. My soul supporters are my husband Dr Sudhir Deshmukh, my kids Sushant and Suyash, my brothers Dr Satish Deshmukh and Dr Sanjay Deshmukh. My parents are a constant source of inspiration for me.
My computer assistant Vandana and Pritam deserves a special note, working tirelessly for the second edition. I cannot forget to mention the readers of this book worldwide. I received many phone calls from Afghanistan, UK, for the appraisal for the book. Even whenever, I go for the conferences across the world, I get compliments from many doctors who are unknown to me. I am really honored with this love of readers and confidence by the publisher on me.
Special thanks to world famous Hysteroscopist Professor Dr Osama Shawki who has provided his excellent videos for the book.