Editor
Sunita R
Tandulwadkar
MD FICS FICOG
Chief Ruby Hall IVF and Endoscopy Center Head Department of Obstetrics and Gynecology Ruby Hall Clinic
Pune, Maharashtra, India
Forewords
Bomi Bhote
Togas Tulandi
Prakash Trivedi
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The Art and Science of Assisted Reproductive Technology
First Edition: 2015
9789351524755
Printed at
5Dedicated to
My Guru
Param Pujya Swami Shree Gagangiri Maharaj
Guru Brahma Guru Vishnu Guru Devo Maheshwaraha |
7Contributors
- Abha Majumdar
- Director
- Centre of IVF and Human Reproduction
- Department of Obstetrics and Gynecology
- Sir Ganga Ram Hospital
- New Delhi, India
- Alain Chanson
- Center of Reproductive Medicine
- Lausanne, Switzerland
- Alfred Senn
- Center of Reproductive Medicine
- Lausanne, Switzerland
- Anupama Singh
- Fellow in Reproductive Medicine
- Ruby Hall IVF and Endoscopy Center
- Ruby Hall Clinic
- Pune, Maharashtra, India
- Arveen Vohra
- Cosultant Reproductive Medicine
- Bengaluru, Karnataka, India
- Ashok Agarwal
- Director
- Andrology Center and
- Center for Reproductive Medicine
- Cleveland Clinic
- Ohio, USA
- Ashwini S
- Fellow in Reproductive Medicine
- Gunasheela Fertility Center
- Bengaluru, Karnataka, India
- Bhavana Mittal
- Infertility and IVF Specialist
- Pushpanjali Institute of IVF and Infertility
- Shivam Surgical and Maternity Center
- New Delhi, India
- Bina Vasan
- Manipal Hospital
- Bengaluru, Karnataka, India
- Bindu Chimote
- Vaunshdhara Clinic
- Nagpur, Maharashtra, India
- Capalbo A
- Center for Reproductive Medicine
- Clinica Valle Giulia
- Rome, Italy
- Chaitanya Nagori
- Director
- Dr Nagori’s Institute for infertility and IVF
- Ahmedabad, Gujarat, India
- Chaithra SK
- Fellow in Reproductive Medicine
- Ruby Hall IVF and Endoscopy Centre
- Ruby Hall Clinic
- Pune, Maharashtra, India
- Chauhan Kumudini
- Associate Consultant Infertility Unit
- Department of Obstetrics and Gynecology
- Sir Ganga Ram Kolmet Hospital
- New Delhi, India
- Christophe Blockeel
- Center for Reproductive Medicine
- Universitair Ziekenhuis Brussel
- Vrije Universiteit Brussel (VUB)
- Laarbeeklaan, Brussels, Belgium
- Cimadomo D
- GENERA Center for Reproductive Medicine
- Clinica Valle Giulia
- Rome, Italy
- Daniel R Franken
- Department of Obstetrics and Gynecology
- Faculty of Health Science
- University of Stellenbosch and Tyberberg Hospital
- Cape Town, South Africa
- Devika Chopra
- Fellow in Reproductive Medicine
- Ruby Hall IVF and Endoscopy Centre
- Ruby Hall Clinic
- Pune, Maharashtra, India
- Devika Gunasheela
- Managing Director
- Gunasheela Fertility Center
- Bengaluru, Karnataka, India
- Center for Reproductive Medicine
- Dutch Speaking Free University of Brussels
- Brussels, Belgium
- Engie Al Salman
- Department of Obstetrics and Gynecology
- Faculty of Medicine
- University of Alexandria
- Egypt
- Fabien Murisier
- Center of Reproductive Medicine
- Lausanne, Switzerland
- Fessy Louis T
- CIMAR Fertility center
- Cochin, Kerala, India
- Françoise Urner
- Center of Reproductive Medicine
- Lausanne, Switzerland
- Giulia Brigante
- Department of Biomedical
- Metabolic and Neural Sciences
- University of Modena and
- Reggio Emilia and Azienda USL of Modena
- Via Giardini, Modena, Italy
- Hrishikesh Pai
- Consultant
- Gynaecologist and IVF Specialist
- Bloom IVF Center
- Lilavati Hospital
- Mumbai, Maharashtra, India
- Ian Cooke
- Academic Unit of Reproductive and
- Developmental Medicine
- Sheffield, UK
- Israel Ortega
- IVI-Madrid
- Rey Juan Carlos University
- Madrid, Spain
- Jaideep Malhotra
- Director
- Rainbow Hospitals
- Agra, Uttar Pradesh, India
- Jana AlShalati
- Department of Obstetrics and Gynecology
- McGill University
- Montreal, Quebec, Canada
- Juan A García-Velasco
- IVI-Madrid
- Rey Juan Carlos University
- Madrid, Spain
- Jure Knez
- Department of Reproductive Medicine
- University Medical Centre
- Maribor, Slovenia
- Jyothi Patil
- Fellow in Reproductive Medicine
- Gunasheela Fertility Centre
- Bengaluru, Karnataka, India
- Kamala Selvaraj
- GG Hospital
- Chennai, Tamil Nadu, India
- Kamini A Rao
- Chief Consultant Department of Reproductive Medicine
- Bengaluru, Karnataka, India
- Madhuri Patil
- Dr Patil’s Endoscopy and Fertility Center
- Bengaluru, Karnataka, India
- Manuela Simoni
- Department of Biomedical, Metabolic and Neural Sciences
- University of Modena and Reggio Emilia and
- Azienda USL of Modena
- Via Giardini 1355-Modena, Italy
- Marc Germond
- Center of Reproductive Medicine
- Lausanne, Switzerland
- Meenakshi Dua
- Southend Fertility and
- IVF Centres
- Delhi NCR, India
- Nalini Mahajan
- Clinical Director
- NOVA IVI Fertility
- New Delhi, India
- Nandan Roongta
- Consultant
- Gynaecologist and IVF Specialist
- Bloom IVF Center
- Lilavati Hospital
- Mumbai, Maharashtra, India
- Nandita Palshetkar
- Consultant
- Gynaecologist and IVF Specialist
- Bloom IVF Center
- Lilavati Hospital
- Mumbai, Maharashtra, India
- Narendra Malhotra
- Director
- Rainbow Hospitals
- Agra, Uttar Pradesh, India
- Director
- Vaunshdhara Clinic
- Nagpur, Maharashtra, India
- Nayana Patel
- Akanksha IVF Clinic
- Anand, Gujarat, India
- Neena Malhotra
- Professor
- ART Center
- Department of Obstetrics and Gynecology
- All India Institute of Medical Sciences
- New Delhi, India
- Nirzari Mangeshikar
- DNB OBGY Student (Final Year)
- Ruby Hall IVF and Endoscopy Center
- Ruby Hall Clinic
- Pune, Maharashtra, India
- Nishad Chimote
- Vaunshdhara Clinic
- Nagpur, Maharashtra, India
- Padma Rekha Jirge
- IVF Specialist
- Shreyas Hospital
- Kolhapur, Maharashtra, India
- Pankaj Kaingade
- Akanksha IVF Clinic
- Anand, Gujarat, India
- Parinaaz Parhar
- Fellow in Reproductive Medicine
- Ruby Hall IVF and Endoscopy Centre
- Ruby Hall Clinic
- Pune, Maharashtra, India
- Partha Guha Roy
- Senior Clinical Consultant
- Fertility Clinic and IVF Center
- Mumbai, Maharashtra, India
- Parul Arora
- Rainbow Hospitals
- Agra, Uttar Pradesh, India
- Pooja Lodha
- Lead Consultant
- Department of Fetal Medicine
- Ruby Hall Clinic
- Pune, Maharashtra, India
- Pratap Kumar
- Department of Obstetrics and Gynecology
- Kasturba Medical College
- Manipal University
- Manipal, Karnataka, India
- Prathiba G
- Department of Obstetrics and Gynecology
- Gunasheela Fertility Center
- Bengaluru, Karnataka, India
- Priya Bhave Chittawar
- Reproductive Endocrinologist
- Fertility Specialist
- Gynecological Endoscopic Surgeon
- Bhopal, Madhya Pradesh, India
- Rajvi H Mehta
- Director
- Trivector Embryology Support Academy
- Bengaluru, Karnataka, India
- Ranjana Mangoli
- Fertility Clinic and IVF Center
- Mumbai, Maharashtra, India
- Rienzi L
- Genera Center for Reproductive Medicine
- Clinica Valle Giulia
- Rome, Italy
- Rishma Pai
- Consultant
- Gynaecologist and IVF Expert
- Lilavati and Jaslok Hospitals
- Mumbai, Maharashtra, India
- Sadhana K Desai
- Founder Director
- Fertility Clinic and IVF Center
- Mumbai, Maharashtra, India
- Sanjay Patel
- Gynec-Endoscopic Surgeon
- Infertility and IVF Specialist
- Director,
- Mayflower Women’s Hospital
- Ahmedabad, Gujarat, India
- Sejal Naik
- Rahul Hospital and Well Woman Clinic
- Surat, Gujarat, India
- Sejal Doshi
- MD Candidate (2015)Northeast Ohio Medical University
- Ohio, USA
- Sesh Kamal Sunkara
- King’s College, London
- Division of Women’s Health
- United Kingdom
- Sonal Panchal
- Dr Nagori’s Institute for Infertility and IVF
- Ahmedabad, Gujarat, India
- Chief Embryologist
- Ruby Hall IVF and Endoscopy Center
- Ruby Hall Clinic
- Pune, Maharashtra, India
- Sonia Malik
- Southend Fertility and IVF Centers
- Delhi NCR, India
- Sunita R Tandulwadkar
- Chief
- Ruby Hall IVF and Endoscopy Center
- Head
- Department of Obstetrics and Gynecology
- Ruby Hall Clinic
- Pune, Maharashtra, India
- Susmitha Dulipalla
- Fellow in Reproductive Medicine
- Ruby Hall IVF and Endoscopy Center
- Ruby Hall Clinic
- Pune, Maharashtra, India
- Togas Tulandi
- Professor
- Department of Obstetrics and Gynecology, and
- Milton Leong Chair in Reproductive Medicine
- McGill University, Montreal, QC, Canada
- Ubaldi F
- Clinical Director
- Genera Centre for Reproductive Medicine
- Clinica Valle Giulia
- Rome, Italy
- Vandana Bhatia
- Southend Fertility and IVF Centers
- Delhi NCR, India
- Vijay Mangoli
- Fertility Clinic and IVF Center
- Mumbai, Maharashtra, India
- Yasser Orief
- Department of Obstetrics and Gynecology
- Faculty of Medicine
- University of Alexandria, Egypt
The past few decades have witnessed momentous advances in the field of assisted human reproduction and assisted reproductive technology, which has given hope to millions of women who cannot conceive after undergoing basic treatment. Thus, ART process has given hope to millions of childless couples and is an added new dimension to gynecology and obstetrics.
Assisting in creation is not only an art but also a science, because there are many procedures to be followed meticulously to achieve success. Procedures such as IVF, ICSI, IMSI, freezing of eggs and embryos and surrogacy are all a part of ART.
Dr Sunita Tandulwadkar is a successful gynecologist, and I have known her for the last twenty years. Her rapport and bond with the patients is something which I have always appreciated over the years. Her other quality of always striving for excellence is what has brought her to the pinnacle in her field.
She is a master in ART and the book will reduce the learning curve of embryologists and clinicians, as it offers practical information which one can easily translate into clinical practice.
I am very pleased to write the foreword for The Art and Science of Assisted Reproductive Technology which aims to highlight the ongoing future of ART.
Her knowledge and expertise along with contributions from other experts makes this a beacon and a reference book for all the people in this field.
Bomi Bhote
Chief Executive Officer
Ruby Hall Clinic
Pune, Maharashtra
13Foreword
The most beautiful thing we can experience is the mysterious.
It is the source of all true art and science.
—Albert Einstein
(1879-1955)
Creating life in the test tube is not a mystery anymore, it has become a reality. Indeed, advances in assisted reproductive technology have revolutionized the science and the treatment of infertility. It has increased our understanding about oocyte development, fertilization, gamete development and gamete cryopreservation. The contents of The Art and Science of Assisted Reproductive Technology are comprehensive. As the title indicates, Dr Sunita Tandulwadkar has combined art and science in producing the book. It covers different aspects of reproduction including laboratory aspect of infertility, medical and surgical treatments, gamete manipulation, the use of gamete donation and the obstetrical outcome. This is a complete text for infertility and reproduction that serves the clinicians, scientists and the trainees. It is a good addition to the medical literature.
Togas Tulandi MD MHCM
Professor
Department of Obstetrics and Gynecology, and Milton Leong Chair in Reproductive Medicine
McGill University
15Foreword
During the last 2-3 decades, the field of assisted reproductive technologies have surged with many peaks. Many pioneers and successful ART consultants reached a point of saturation; their growth though high came to a plateau.
Being in the field of endoscopy and ART for more than two decades, I have seen a few specialists to have maintained enthusiasm, passion to learn and excel.
Their spirits have never died in spite of scientific and professional success. One such person is Dr Sunita Tandulwadkar, a woman with a broad and long-term vision. It is my privilege to write the foreword of such an exceptional talent from India, having this aptly titled book The Art and Science of Assisted Reproductive Technology.
The book with national and international experts covers all aspects; whether from the laboratory, research clinical and technologies of the future.
I, as both President of the Federation of Obstetric and Gynaecological Societies of India (FOGSI) and Indian Association of Gynaecological Endoscopists (IAGE) and actively involved with ART-ISAR, appreciate her great work. The contributing experts are handpicked.
The book is a wealth for both experts and amateurs in the field of ART.
Long live the fire, passion, interest and expertise of Sunita to learn and share.
Prakash Trivedi
President FOGSI 2015
17Preface
It is remarkable to see how ART as a specialty has matured and established itself over the years since the birth of the world’s first IVF baby Louise Brown in the UK in 1978.
Infertility affects 10 to 15% of couples in the current scenario owing to various causes. Whatever be the reason, it is clear that more and more couples are seeking help about their fertility issues. With this backdrop, there is an increased needs for all of us to be more thorough with our knowledge of infertility and come up with sound economical and effective solutions.
This book has been motivated by the desire, we had to further the evolution of understanding of human reproduction and ART. The book presents research-based best practices related to ART aiming to specifically provide a sound basis for evaluation and treatment of infertile couples. It has brought together experts from the field of ART across the globe to provide their valuable inputs on the subject.
I have made sincere efforts to focus on issues starting from basics in infertility to the emerging issues, such as third party reproduction, especially in the Indian scenario, outcomes of children conceived through the ART as well as laboratory aspects of ART.
I am dedicating the book to the readers and hoping that they find it immensely useful and imparts extra confidence in handling the many demands in the field. We also look forward to feedbacks and inputs from all which will help us improve further.
Sincerely thanking to all my team members and the esteemed contributors without whose efforts the book would have not been the same. My special thanks to Dr Nirzari Mangeshikar who has worked with me tirelessly for more than 12 months to complete the book. I really appreciate her efforts. Thanks to Dr Pooja Lodha, Dr Parinaaz Parhar, Dr Anupama Singh and Dr Chaithra SK who have helped for proofreading apart from contributing to chapters. My heartfelt thanks to my husband Dr Rajesh Tandulwadkar and my son Rishi for their constant, unwavering support and encouragement as well as criticism which as given the book its current shape.
I am heartily thankful to Shri Jitendar P Vij (Group Chairman), Mr Ankit Vij (Group President), Mr Tarun Duneja (Director-Publishing), Mr KK Raman (Production Manager), Mr Sunil Kumar Dogra (Production Executive), Mr Neelambar Pant (Production Coordinator), Mr Sabarish Menon (Commissioning Editor—Mumbai Branch), Mr Quaisher Hossain (Medical Editor), Mr Girish Pandey (Typesetter), Mr Rohan (Graphic Designer), and Mr Himanshu Sharma (Proofreader) of M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, and their highly professional publishing team to work in such a professional manner. Thanks to their editorial efforts to improve the book overall.
Furthermore, the outlook for the future looks stunning including novel technologies that may facilitate quantum advances in the clinic and laboratory and we hope to be a part of this movement.
Sunita R Tandulwadkar