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HUMAN REPRODUCTION WHERE ARE WE HEADED
 

HUMAN REPRODUCTION WHERE ARE WE HEADED

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THIS IS THE PRESENTATION OF OUR ORATION AT AMU ON 2ND OCT(GOLDEN JUBILEE OF JNMC ,ALIGARH AND AT SMS JAIPUR ON THE 3RD NOV(FAROOQ ABDULLA ORATION AWARD).......

THIS IS THE PRESENTATION OF OUR ORATION AT AMU ON 2ND OCT(GOLDEN JUBILEE OF JNMC ,ALIGARH AND AT SMS JAIPUR ON THE 3RD NOV(FAROOQ ABDULLA ORATION AWARD).......

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  • Wisot, Arthur L et. Al. Conceptions & Misconceptions : The Informed Consumer’s Guide through the Maze of In Vitro Fertilization and other Assisted Reproduction Techniques. First successful birth- July 25, 1978 in England- Louise Brown- In Vitro Fertilization 1984- first pregnancy as the result of Gamete Intra Fallopian Transfer was reported in Texas 1986- first successful pregnancy from zygote intrafallopian transfer.
  • The mother is to be cloned since her DNA was used
  • Each cell contains DNA. DNA is packaged into compact units called chromosomes. Basically a chromosome is one long chain of genetic material. It is the microscopic, rod-shaped, threadlike part of the cell that carries hereditary information in the form of genes.  Every cell has chromosomes and all individuals in the same species have the same number of chromosomes.  Within an individual, every cell has the same number of chromosomes and generally come in pairs (except in sex cells). People with Down Syndrome have 3 copies of chromosome 21. telomeres , these molecular chains have often been compared to the blank leaders on film and recording tape. Indeed, telomeres seem to perform a similar function in aligning the DNA molecule during the replication process. Protecting the vital DNA molecule from being copied out of synch, these telomeres provide a kind of buffer zone where asynchronous replication errors (that are inevitable) will not result in any of the vital DNA sequences being lost. As a cell gets older, it is under attack by oxides and other so-called free-radical chemicals in the body and environment. We survive as living beings because our cells have the ability to duplicate themselves before being killed by these natural causes. Each time our cells duplicate themselves, a small portion of the DNA molecule is lost and not copied. The loss is usually to the telomere and so the effect is usually insignificant. Scientists recently noted that the length of these telomere chains were shorter as we grew older. Eventually, the telomeres become so shortened that the losses in replication begin to effect the vital DNA molecule sequence and prevent the cell from being able to duplicate itself. This is why we age.
  • In cloning we are interested in the Nucleus (DNA)
  • “ Dolly’s birth was one of the biggest news stories of the nineties. Scientists made extravagant promises about medical and technological advances. Well, Dolly’s embarrassingly premature death received little attention, precisely because it exposes the horrors of cloning.” Dolly was diagnosed with arthritis, normally found in old sheep Telomeres are the ends of our chromosomes. Made of many repeats of the same DNA sequence, they act like shoelace caps: they protect the gene-containing body of the chromosome from being worn down. Breakdowns in telomere maintenance are implicated in ageing and cancer. Telomeres sit on the ends of chromosomes to protect them from damage. When chromosomes are replicated during cell division, a stretch of the telomere is left unreplicated—making the telomere a bit shorter with each division. After some 50 to 100 divisions, the telomeres become so short that the cell can no longer divide—a phenomenon scientists call senescence—that is, the state of being old.
  • A telomere is a repeating DNA sequence (TTAGGG) at the end of the body's chromosomes. The telomere can reach a length of 15,000 base pairs. Telomeres function by preventing chromosomes from losing base pair sequences at their ends. They also stop chromosomes from fusing to each other. However, each time a cell divides, some of the telomere is lost (usually 25-200 base pairs per division). When the telomere becomes too short, the chromosome reaches a "critical length" and can no longer replicate. This means that a cell becomes "old" and dies by a process called apoptosis . Telomere activity is controlled by two mechanisms: erosion and addition. Erosion, as mentioned, occurs each time a cell divides. Addition is determined by the activity of telomerase. apoptosis: The process by which a cell dies at a natural, "pre-programmed" time

HUMAN REPRODUCTION WHERE ARE WE HEADED HUMAN REPRODUCTION WHERE ARE WE HEADED Presentation Transcript

  • PROF.NARENDRA MALHOTRAM.D., F.I.C.O.G., F.I.C.M.C.HProf. Dubrovnick International UniversityPresident FOGSI (2008-2009)Dean I.C.M.U. (2008)Senior V. P. of FOGSI (2003)Vice Dean Indian College of Medical Ultrasound (2006)Director Ian Donald School of UltrasoundNational Tech. Advisor for FOGSI-G.O.I.—Mc Arthur Foundation EOC CoursePracticing Obstetrician Gynecologist at Agra. Special Interest in High Risk Obs., Ultrasound, Laparoscopy andInfertility, ART & GeneticsMember and Fellow of many Indian and international organisationsFOGSI Imaging Science Chairman (1996-2000)Awarded best paper and best poster at FOGSI : 5 times, Ethicon fellowship, AOFOG young gyn. award, Corionaward, Man of the year award, Best Citizens of India awardOver 30 published and 100 presented papersOver 50 guest lectures given in India & AbroadOrganised many workshops, training programmes, travel seminars and conferencesEditor 8 books, many chapters, on editorial board of many journalsEditor of series of STEP by STEP booksRevising editor for Jeatcoate’s Textbook of Gynaecology (2007)Very active Sports man, Rotarian and Social worker MALHOTRA NURSING & MATERNITY HOME PVT. LTD. RAINBOW HOSPITALS 84, M.G. Road, Agra-282 010 Phone : (O) 0562-2260275/2260276/2260277, (R) 0562-2260279, (M) 98370-33335; Fax : 0562-2265194 www.malhotrahospitals.com,www.rainbow hospitals.org drnarendra@malhotrahospitals.com,jaideepmalhotraagra@gmail.com Visiting consultant:DHAKKA,KATHMANDU AND 12 OTHER IVF CENTRES in INDIA
  • PROF.JAIDEEP MALHOTRAM.D., F.I.C.O.G., F.I.C.M.C.H. Prof.Dubrovinck International University,Crotia President Elect ASPIRE(ASIA PACIFIC INITIATIVE) vice president FOGSI 2010 Chairperson International Academic Exchange Committee FOGSI 2002-2007 Governing council member of ICOG ,ISAR,IMS.ISPAT(VP) Indumati Zhaveri Award, Jagdeshwari Misra Award three times, Ethicon Fellowship, Outstanding Achievement Award 1999, Chorion Award Over 50 published and 100 presented papers Co-editor of step by step series of books Co-editor of manual of operative obs gyn Editor of “Fetus Our Other Patient” Credited with producing firsts of U.P. : IVF birth, ICSI birth, IVF Twins, ICSI Twins, IVF Triplets, TESA-ICSI Pregnancy etc. Credited for producing first hundred Test Tube Babies of Nepal Awarded Corion Prize for best original research in “Improving endometrial receptivity and blood flows.” Consultant IVF specialist Maulana azad medical college Delhi Consultant IVF specialist at Ludhiana, Jalandhar, Ambala, Gorakhpur,Delhi,Sirsa,Bhiwani, Bariely, Allahabad & Kathmandu , Dhakka MALHOTRA NURSING & MATERNITY HOME PVT. LTD.&RAINBOWHOSPITALS,AGRA 84, M.G. Road, Agra-282 010 Phone : (O) 0562-2260275/2260276/2260277, (R) 0562-2260279, (M) 98970-33335; Fax : 0562-2265194 www.malhotrahospitals.com,www.rainbowhospitals.org
  • jnmc,amu our life’s tarana the sunrise of our livesWhat ever we are today and what ever wehave achieved , both of us owe it to JNMC,AMUSalaam jnmc….yeh mera chaman hai hum apnechaman ke bul bul hain………………………….
  • we are indebted to our teachersProf mehdi hassan,prof.wasiurrehman,prof j n prasad,prof shaila razaProf sami hameed,prof tyagiji,prof kcsinghal,prof bal,prof badrul hassan,prof pnsaxena,prof kn ahamad,prof abida malikProf arif siddiqui,prof Prof ansari,profsadiq,prof abu kamar,prof lakhtakia,profsant kumar,prof mohd ahmad,Prof ashrafmalikProf shahista mohsin,prof kusumsaxena,prof kamlesh tiwari,prof rajyashreesharma,prof noor afshan,Prof imam banoAll the lecturers,registrars and colleagues
  • Thank you sms,jaipurMy father passed out from here(4 thbatch)My brother & bhabhi are profs hereI finished my tenure of president FOGSIin jaipur in 2009Deptt of ob gyn is a great friend of oursWe both provide technical support tothe IVF deptt of SMS,JaipurAnd today this ORATION has beenawarded to me….
  • HUMAN REPRODUCTIONwhere we are headed…………….. NARENDRA MALHOTRA drnarendra@malhotrahospitals.com 09837033335/0989703335 JAIDEEP MALHOTRA jaideepmalhotraagra@gmail.com 09897033335
  • origin of repr oduction So, God created man in His own image, in theimage of God created He him; male and femalecreated. And God blessed them and God saidunto them. Be fruitful and multiply andreplenish the earth and Subdue it. (Genesis 1:27-28)
  • BIBILICAL TIMES Rachel’s desperate plea to her husband Jacob“Give me children or else I will die” Anguish or Cry of female
  • nor mal need for r epr oduction One man ----One woman One sperm and one oocyte AND “THE STORK” AND THE SCIENTIFIC ROMANCE & THE MIRACLE OF LIFE
  • HUMAN REPRODUCTION
  • HUMAN REPRODUCTION has become a major health problem humans are the most infertile of all mammals 15% couples are infertile almost 50 % are due to male factorsreproduction has now shifted from thestory ofbird and the bees to inside labs.HAVE SEX FOR FUNFOR REPRODUCTION THERE IN A.R.T. hai na…..
  • Sar ah & Abr ahamSarah considered the problem and askedAbraham to go in unto my maid; it may be that Imay obtain children by her. Abraham honouredSarah’s request and Hagar conceived Irresistible Desire to have Child
  • CLONING HISTORY
  • INDIAN ANCIENT TIMESdhristrarastra 101 children out ofa mass with cells nutured in vitroby vyas into 100 karuva anddusheelasage gautam produced kripa andkripi only from his spermsthe 7th child of devki wastransfered to womb ofrohini(surrogate mother )
  • MAHABHARAT HAS MANY STORIESBIRTH OF KARNABIRTH OF DRONAAND BIRTH OFDRITDYUMN ANDDROUPADI FROMKING DROPADSPERMS BUT INARTIFICIAL WOMB
  • Human Repr oduction – changed 25th July, 1978 Louise Joy Brown World’s First Successful Test Tube BabyLandmark Event in Reproductive Revolution Science Proves Wonders
  • YESTERDAYin 1956 the first works on superovualtionin mice was done by ruth fowler and robertedwardshuman oocyte maturation in vitro was firstdescribed by edwards in 1962/1965world’s first embryo stem cell wasintroduced by edwards,john paul androbin colegardner then introduced preimplantationgenetics in mice and was successful ingetting the first fertilization in human eggsin vitro in 1960’s
  • YESTERDAYlandmark paper read andpublished by patrick steptoe onvisualisation of fallopian tubes(lancet)Edwards heard this and thepossibility of getting eggs out forIVF dawnedthese two joined hands andhistory was writtenbirth of ART
  • EARLY HUMAN STUDIESslices of ovaries from cases of steinleventhal syndrome studied by robertedwards provided by molly roseearly 60’s first embryo genetic testings forxx and xy were reported(lancet)(nature)first attempts to inject gonadotrophinsinto intact ovaries in vitro,using differentculture mediafirst meiosis was classified and timedpredicting of ovulation 37 hrs after the hcgwas done (edwards)
  • HUMAN STUDIES IN UKearly embryos were flushed out from uterus andoviduct after intercourse(beginning of earlyembryology studies)ethical questions started arisingin 1969 all stages of human fertilization in vitrowere visualised and documented and reported byedwardstrophectoderm biopsy and genetic diagnosisstudy was experimentedpatrick steptoe and robert edwards got togetherattempt to aspirate oocytes from ovaries thrulaparoscopythe oldham years began
  • EARLY CRITICISMpope and churchjames watson scientist testified in us senate that abnormal babieswill be bornthe first book on ethics came out written by a theologist gordondunstanoldham ethical committee approval and patient supportthe earliest indications were blocked tubes ,male factor andendometriosisthe need for luteal supportand the biggest mistake was made here for 2 years primolut wasused and no pregnanciescauses of failures were analysed(in three years it was found thatprimolut was the cause)the critisism was intense herehcg was used as luteal support and progesterone and the levels ofprimolut depot were reducedthey also started replacing two embryosthe first ivf pregnancy was established but turned out to be anectopic and was operated at 10 weeks gestation
  • EMBRYOS CULTURED BY EDWARDS THE FIRST PICTURES
  • EARLY EXPERIMENTS ANDTHE FIRST TEST TUBE BABY4 types of stimulation protocolsgift and orticryopreservation was triednatural cycle ivf was tried and 7 years after workbegan at oldham lesley and john brown wererecruited as second case for the natural cycle ivffour cases concieved and lousie brown continuedand delivered as the world’s first ivf baby,oneaborted as a triploidy and one was misscaraigewho went on a mountain climbing holiday andthen alistair was born as second ivf babycritics called us fakes(edwards)but science and medicine had entered humanreproduction and conception….reporduction wasmoving from berooms to labs
  • History1st human pregnancy andbirth by in-vitrofertilization (IVF). Louise Brown July 25th, 1978 Planned cesarean section. 2.61kgOldham GeneralHospital in Oldham, UK.Reported by Steptoeand Edwards
  • BOURN HALL CLINICWORK IN IVF CAME TO A STAND STILL FOR 2YEARS IN UK AFTER LOUISE BROWN WASBORN DUE TO THE ESTABLISHMENT OFBOURNHALL CENTRE(OPENED IN 1980)THE WORLD JOINED IVFIVF BABY WAS DELIVERED IN AUSTRALIA BYALEX LOPATAIN BOURNHALL NATURAL CYCLE IVF WASDONEWHILE IN AUSTRALIA ALAN TROUNSAN GROUPUSED CC HMG PROTOCOLS AND 2-3 EMBRYOS15% PREGNANCY RATE WAS ESTABLISHED
  • OBJECTIONSlife/society for the unbornchild/gynaecologists etcregular pregnancies were reported from alloversimon fischel/jacques cohen/howardjones/jean cohen/peter in vienna/matts insweden/paul devroylegal action by life group against robertedwardsedwards gave a lecture on cryo freezingand all news papers /bbc and other carrieddamaging stories, he fought a legal battleagaint all 7 of them and wonall papers , notes and lecture recordingwere legally reviewed in courts
  • History1st successful IVF in US 1981 Reported by Jones and Seager-Jones Norfolk, Virginia
  • FIRST KEPT ON HAPPENINGFIRST FROZEN BABY FROMHOLLAND(KNOWN AS THE ICEBABY)SCANDINAVIANS USED TVS FORFOLLICLE ASPIRATION FIRSTICSI WAS DISCOVERED INBELGIUMA LIBERAL IVF LAW WAS PASSEDBY UK GOVT 10 YEARS AFTERLOUISE BROWNJEAN PURDY DIED IN 1986PATRICK STEPTOE DIED IN 1988
  • IVF BABIES louise brown and ivf has turned 34 this year(her mother died aug 2012) louise brown has produced a normal healthy naturally conceived baby( the last fear of ivf is gone) alistar the first male test tube baby still has to reproduce tesa babies will be infertile due to y -deletion ??BBC News - Five millionth test tube babywww.bbc.co.uk/.../health-1864958... - इस पृष्ठ का अनुवाद कर े1 Jul 2012 – Five million "test tube babies" have now been born aroundthe world, according to ... put the total number of test tube babiesborn at five million
  • History of ART 1978- first successful birth using In Vitro Fertilization 1984- first successful birth using Gamete Intra Fallopian Transfer 1986-first successful birth using Zygote Intra Fallopian Transfer 1993 ICSI Accidently discovered
  • INDIAN SCENARIOCLAIMS FROM KOLKATA BUT NOTDOCUMENTEDTHE FIRST DOCUMENTED IVF BABYIS FROM MUMBAI KEM BY INIDRAHINDUJA AND HER TEAMNARI REGISTERY SHOWS THATTHERE ARE 250CENTRES(UNOFFICIALLY OVER 500)
  • Dr Subash Mukerjee 16-1-31 to 19-7-81 1. Medical Graduate, Calcutta 2. PhD in Biochemistry, Calcutta. 3. Second PhD in bioassay of urinary reproductive hormones, Edinburgh. 4. Varied research interests ranging from Contra- ception to Conception Technologies.
  • The Agarwals 2001 KANUPRIYA
  • WORLD’S FIRSTS BY MUKERJEE HMG to induce follicular growth in an IVF cycle. Credited to Howard Jones (Human Reproduction. 11 SUPPL. 1 1996). Used TV route for OPU. Credited to Gleicher et al., (LANCET. 2:508-9. 1983) Successfully froze and thawed human embryos. Credited to Trounson & Mohr (NATURE.305: 707-9. 1983).
  • Recognition of Mukerjee’s contribution to IVF 1. S.M. Mukerjee ‘Architect of IVF in India’. TCAK in Current Science 2. West Bengal Govt. establishes a Chair named after Mukerjee in NRS Medical College. 3. Placed a memorial plaque at NRS Medical College 4. WB Govt. proposes to established an Institute in Reproductive Medicine named after Mukerjee 5. Work Cited in Encyclopedia of World Medicine 6. Rotunda’s Subash Mukerjee’s Orations
  • IVF initiated in 1983 at ICMR Institute forResearch in Reproduction, Bombay•Collaboration between Institute forResearch in Reproduction and KEMHospital, Bombay.•Project Approved by Scientific AdvisoryCommittee of IRR and KEM EthicsCommittee for Human Experimentation.•Progress reported to ICMR ScientificAdvisory Committee periodically.•Transparency of work at all stages.
  • The IVF Team in Bombay IRR KEM HOSPITAL• Chander Puri• Harbans Juneja • Indira Hinduja• J.V. Iyer • Several rotating• Geetha Ranga Housemen.• T.C. Anand Kumar
  • HARSHA BORN 8th AUGUST 1986IRR AND KEM the first centers from India to be included in the INTERNATIONAL REGISTRY OF IVF CLINICS published in the J. OF IN VITRO FERTILISATION AND EMBRYO TRANSFER IN 1988.
  • PUBLICATIONS FROM IRRANNOUNCEMENT OF DETAILS IN ICMR BULLETIN.I.N. HINDUJA AND T C ANAND KUMAR: THE IN VITRO FERTILIZATION AND EMBRYO TRANSFER AND GAMETE INTRAFALLOPIAN TRANSFER PROGRAM AT THE IRR AND KEM HOSPITAL BOMBAY. J. in vitro Fertilization & ET 5 -376-7 1988.I.N. HINDUJA AND T C ANAND KUMAR: IVF-ET IN INFERTILE WOMEN. the Natl. Med. J. India 1:10. 1988.
  • On the 7th November 2007 Dr. RogerAbdelmassih (Brazil) offered a dinnerparty to his friends in order to celebrate 30years of sucess of the first IVF.Louise Brown and her family was presentas well the Indian and the Britishconsulates, among 300 people.
  • 1960’S TO THE 2000
  • TODAY SCENARIOART WIDELYACCEPTEDWORLD OVERMANY CENTRESPGDSTEM CELLCLONINGHYBRID EMBRYOS
  • THE ALL POTENT MALE DETORIATING SPERM COUNTS AND QUALITY
  • DETORIATING SPERM QUALITYBANE OF MODERN SOCIETYPOLLUTIONWIDE SPREAD PESTICIDE USECHEMICALSSTRESSSMOKING AND EXCESS ALCOHOLSTDINCREASED INFLUENCE OF ESTROGENS (DIETARY FADS,FASHIONS,DAIRYPRODUCTS,SOYA,ADDITIVES)INDIAN MALE SPERM COUNT HAS FALLEN FROM 60-110 TO 20 MILLION/ML
  • NEW FRONTIERS IN ARTevaluationdrugsmanagementassisted reproductionpreimplantation diagnosisgenetic manipulationsstem cell culturecloning
  • EVALUATIONdedicated infertility specialiststvs,color doppler and 3 d & 4 d usghormone analysislaparoscopyhysteroscopycasa and other auto spermanalysistrial fertilizationgenetic tests ,enzyme testssurvival tests etc etc
  • AUTOMATIC SPERM ANALYZERS
  • NEWFRONTIERS INULTRASOUNDEVALUATION COLOR DOPPLER 4 D USG 3 D USG
  • NEW FRONTIERS IN DRUGS FOR THE MALE MICRONUTRIENTS & HOLISTIC
  • NEW FRONTIERSIN DRUGS ANDDRUG DELIVERYSYSTEMS FORART DERMAL DELIVERY SYSTEMS
  • IMPROVED DRUG DELIVERYSUB CUTANEOUS INJECTIONSNASAL SPRAYSGONADOTROPHIN SOLUTIONSPRELOADED SYRINGESGONADOTROPHIN PENSSOFTER STIMULATION PROTOCOLS
  • NEWER METHODS OF DRUGDELIVERY OF F.S.H.LONG ACTING FSH/LHTRANSDERMALORAL FSH PILLFUTURE OF STIMULATION
  • RECOMBINANTTECHNOLOGY *purity *response *quality oocytes *batch to batch variabilty
  • GnRH ANTAGONISTS ‘Drug of the Millennium’ Ganorelix Cetrorelix OVERCOME THE SHORTCOMINGS OF LONG PROTOCOL NOW BEING MADE IN INDIA (EFFECTIVE AND CHEAPER)
  • The ideal Indian protocol 10000 hCG 0.25 mg Cetrorelix/day 225 hMG / 225 IU rec FSH 100 mg CC / dayTamoxifen/letrazole 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
  • Long acting r ec- FSH• The first baby after stimulation with long acting rec-FSH has been delivered by the Belgium group(Beckers, Macklon,Devroy fertil steril 2003)
  • Long acting r ec-FSHRelatively short half life of FSHpreparations(32+/-12 hrs)requiresdaily injections.Attempt to create long acting FSHagonist,chimeric genes containingCTP of beta-hCG fused with beta-FSH were constructedHalf life of 95 hrs
  • Long acting FSHOvarian hyperstimulation was initiatedwith single subcut injection of 180mcg ofrecFSH-CTPNormal follicles developed & estradiollevels rising normallyOn 9th day largest follicle exceeded 14mmcotreatment with antagonistCycle day 10, 150 units of FSH given tillfollicle size >18mm obtainedhCG 10,000 units given ,36 hrs lateroocytes retrieved)
  • Or all y Long acting LH a gonistsextensive research is on, on thismolecule also,make life easier for ivfpts by reducing number of injections
  • ORAL FSH…. THEFUTURE
  • NEW FRONTIERS IN MANAGEMENT TODAYoperative endoscopic proceduresdrugs for endometriosis,pid,etciuiivf-eticsi-etassisted hatchingblastocyst culturetesa,tese,mesa-icsiblastomere biopsy and pgdgenetic manipulationscloning
  • Operative Endoscopy in InfertilityENHANCE ARTRESULTS
  • LAPAROSCOPIC ULTRASOUND
  • 25TH JULY 1978 11.25PM
  • INVITRO FERTILIZATIONABSENCE OF FUNCTIONAL FALLOPIANTUBESREFRACTORY ANOVULATIONUNEXPLAINED INFERTILITYENDOMETRIOSISPCOPOOR SPERM QUALITY ANTISPERM ANTIBODIESFAILED IUI
  • IVF
  • HAS TRANSFORMED THE TT OFSEVERE MALE INFERTILITYNOW OFFERS HOPE TO MENWITH VIRTUALLY NO SPERMSNO MOTILE SPERMSMALFORMED SPERMSIVF WITH POOR FERTILIZATIONSEVERE OBSTRUCTIVE ICSIOLIGOZOSPERMIANON OBSTRUCTIVEOLIGOZOSPERMIAROUND CELLS AND SPERMATIDSINJECTEDRESCUES ONE DAY OLD UNFERTEGGS
  • IMSI -2005choose the right sperm
  • SPERM RETRIEVAL TECHNIQUES
  • STATE OF THE ART LABS
  • Modular automatic hand free labs
  • state of the art labs
  • MICROMANIPULATION1.ENHANCING FERTILIZATION ZONA DRILLING OR CUTTING INJECTING SPERM IN PERIVITTILINE SPACE INJECTING SPERM IN OOPLASM2.EXPERIMENTAL EMBRYOLOGY DESTROYING BLASTOMERES ISOLATING BLASTOMERES3.GENETIC DIAGNOSIS IN EMBRYO(pgd)AND OOCYTE4.ASSISTED HATCHING
  • Cultur e Systems Conventional culture media Human tubal fluid Co-cultures Sequentional complex supercomplex media (IVF – S0-S2, G1.2 &G2.2) (Medicult-IVF/M3Scandinavian/Quins)G1.2 TM And G2.2 TMG 3 SERIES & EMBRYO GLUE
  • Blastocyst Cultur e Day 4 ↓ Priority to highest 2 PN score Prepare one ET dish, one freeze dish & day 6 growth dish (Overnight incubate) ↓ Day 5 Blastocyst assess & scoringTransfer good Freeze spare Slow growing2 blastocysts blastocysts ↓(Zona intact) Fresh G2.2 media ↓ ↓Zona free transfer Day 6 ↓ ↓100 µl droplet of IOIU pronase Freezefor 1-1½ hrs ↓Wash 4 times ↓Transfer zona free blastocyst
  • Embryo quality assessmentsProteiometic tests/spectrophotometry/bioanalysis
  • Assisted Hatching W her e & W hy ? Women age > 35 Yrs. Thick Zona Before P.G.D. Previously failed implantation Basal FSH high
  • Success Package Producing quality Recoveringquality oocytessperms Quality Lab Set Up State of the art equipments, Consumables Timed oocyte retrieval ↓ Insemination/ICSI ↓ Culture Systems
  • CRYOPRESERVATION1. GAMETES SPERMS OOCYTES2. OVARIAN TISSUE3. TESTICULAR TISSUE4. EMBRYOS
  • CRYOPRESERVATION OF EMBRYOSWIDELY USED WITHGOOD RESULTSTHAWED EMBRYOSENABLES COUPLE TOHAVE TWO OR MORESUCCESSIVEREPLACEMENT CYCLESAFTER SINGLE OPUREDUCES THE COST OFCYCLE
  • BIO FREEZER SYSTEMS
  • CRYOPRESERVATION OF OOCYTES
  • IVMIMMATURE OOCYTE PICKUPSMATURING OOCYTES IN VITROOOCYTE BANKSGIVES HOPE TO PTS WITH POF ANDPCOS
  • PREIMPLANTATION GENETIC DIAGNOSISBLASTOMEREBIOPSYFISH AND PCR(PENTA PROBE)ET OF ONLY DISEASEFREE EMBRYOSHOPE FOR HEALTHYBABIES
  • PGDFISH FOR CHROMOSOMAL RELATED ANEUPLOIDY PCR IS FOR SINGLE GENE DEFECTS
  • POLAR BODY BIOPSYFIRST AND SECOND POLAR BODY BIOPSY
  • PRECONCEPTIONAL SEX SELECTION ANDPREIMPLANTATION SEX SELECTIONPOSSIBLE NOWETHICAL ASPECTSSOCIAL ASPECTS
  • DESIGNER BABIESBLUE EYESGOLDEN HAIRFAIR SKINTALLINTELLIGENTWELL BUILTLIKES OF PRIYANKAAND HRITHIKSPOSSIBLE FOR APRICE
  • party reproduction & parenting how ? Oocyte donation Sperm Donation Embryo Donation IVF with gestational carrier Traditional surrogacy Adoption Ovarian Transplantation
  • donor sper m SPERMBANKSIN CHINAFOR DONORS
  • embr yo donations
  • IVF with gestational carrier surrogacy
  • SURROGACYWHERE UTERUS IS ATFAULTNO UTERUS BUT OVARIESWOMB FOR HIREGOOD RESULTSETHICAL ASPECTSCOSTS
  • HUMAN RIGHTS
  • The laws that currently exist area poorly constructed patchwork quilt,that can be confusing even to legalpractitioners
  • Ethics - Definition Code of moral principles derived from a system of values and beliefs that helps define the correctness of our actions.
  • Ethics in Repr oductive MedicineWho is the actual patient Many participants involvedSpectrum of Patients From couple to single to homosexualsImpact of our decision on unborn child –CrucialCommercialisation of the ProfessionPregnancy at any cost – Pregnancy at whose cost ?
  • Ethical Dilemmas in Reproductive MedicineFertility preservation & reproduction in cancer patientsFertility treatment when the prognosis is very poor or futileChild rearing ability & the provision of fertility servicesInforming offspring of their conception by gamete donationFamily members/friends as gamete donors & surrogatesDonating spare embryos for embryonic stem cell researchHIV & Infertility TreatmentPreconception gonadal selection for non-medical reasonsFinancial incentives in recruitment of oocyte donors/surrogatesReproduction in single partner, lesbians & gays
  • IVF TOURISM IN INDIAAccording to a study in 2004,India could earnas much as two billion dollars annually by2012,through medical tourism including fertilityservices.India spends just 1.2% of GDP on health, buttakes care of foreign patientsIt ranks second in medical tourism in2007,only next to ThailandIndian hospitals treated 4.5 lakh patients ascompared to 12 lakhs by Thailand
  • Acr oss the bor der lawsLaws all over the world aredifferent, even different states inUS have different laws,.Difficult to keep trackTill the demand is there,providers are availableLets not forget the safe watersfor abortions and cloning
  • IVF Tourism inIndiaA Boon or a threat ? Why is India such a favourite destination for ART ?
  • Human Reproduction – Future Reproductive Bazar Designer Babies Your Comments… ?
  • Homosexual Man Lesbians Single Partner Right to have babies ??? Bearing or Rearing ??? Legal & Moral Status ??? Production or Reproduction ???Changing Society – Changing Concept
  • First Gay couple to have a baby thru surrogate in India
  • INDIAN REGISTRY OF CENTRES
  • STEM CELL CULTUREEMBRYONIC STEM CELLSADULT STEM CELLSUMBILICAL CORD CELL
  • STEM CELLSEMBRYONIC STEM CELLS AREPLURIPOTENTCAN DERIVE ALL TISSUES OF BODYDERIVED FROM EMBRYOS NOLONGER REQUIRED FOR IVFCAN BE CONTINUOUSLY RENEWEDMAY BE USED TO PRODUCEDIFFERENT CELL LINEAGE
  • CLINICAL ASPECTS OF STEM CELLS
  • STEM CELLSINTEREST STILL REMAINS INES FROM SOMATIC CELLS OFPTS TO HAVE COMPATIBLETRANSPLANTATIONRESEARCH ON HUMAN ESWILL INCREASE THERAPEUTICOPTIONS FOR REGENERATIVEMEDICINE AND TREATINGCOMMON AND CURRENTLYINCURABLE DISEASES INFUTURE
  • GENE THERAPY ANDGENE MANIPULATION
  • where are we headed from here………..
  • TOMMORROW IS HEREALARMING?SCIENTIFICADVANCES INHUMANREPRODUCTION
  • DESIGNER BABIES
  • Chromosome—6 SHORT ARM HASHISTOCOMPABILITY GENESIf we could translocate shortarm of Chromosome-6 andlocate it on a animal’s embryowe could produce animals forspare parts (Liver, Heart,kidneys)(Monkeys, Apes, Pigs,Baboons)
  • This is what has happened on 27/9/12 ………………
  • THE FUTURE IS BORN FROM PLASTIC WOMB 1997A sheep is rearedin vitro from 17weeks onwardsby Japanese
  • HUMAN SPERMS IN MICEJAPANESE SCIENTISTS HAVE MANAGEDTO IMPLANT TESTICULAR TISSUE OFHUMANS INTO MICE TESTIS AND THESEMICE ARE NOW PRODUCING HUMANSPERMSSCIENTISTS HAVE APPLIED FORPERMISSION TO USE THESE SPERMSFOR FERTILIZATION CAPABILITYTREATMENT OF MALE INFERTILITY ??
  • Perfect Husband Gene Discovered (Hindustan Times 25 Aug. 99)Steve Connor London : Scientists have discovered a genetic basis for monogamy and believe the findings could shed light on the brain chemistry of love and attachment. By transferring a single gene, the researchers have been able to convert naturally polygamous males with anti-social tendencies into paragons of fidelity and sociability.
  • Age of cloningA line has been crossed, andreproductive biology will now neverbe the same for people or for sheep (Time, March 97)
  • T he Making of Doll y DNA Cloning depends onStep 1: Take the Nuclei out of a sheep eggStep 2: Transfer nuclei from the Mother Empty DNA DNASheep Egg Mother’s Egg
  • Cloning Depends on DNA NucleusChromosome
  • Cell NucleusIts all about DNA
  • Other Cloned Animals Cloned mouse July 1998cloned calves Cloned mule
  • Other Cloned Animals December 2001 Five cloned December 2001female piglets, named Noel, The worlds firstAngel, Star, Joy cloned kitten, and Mary named Cece
  • WHAT IS CLONING?means duplicationembryonic cloning has beenknown and practised since along timeadult cloning from differentiatedcellsstem cell culture and cloningmay be accepted
  • HUMAN CLONINGREPRODUCTIVE CLONING : MAY NOTBECOME SOCIALLY POPULARCELLULAR CLONING : MOREPROMISING:UNDERSTAND MECH.OFGENETIC DISEASESBETTER PRODUCTION OF TRANSGENICANIMALSPROVISION OF STEM CELL OR TISSUEAS THERAPEUTIC MODALITY OF CLONEDPERSON
  • WHAT ARE WE AIMING AT WITH CLONING…… DUPLICATES ? SPARE PARTS ? JUST FOR FUN ? SCIENCE FICTION ? PROVING SCIENCE ? RESURRECTING THE DEAD? BRINGING ALIVE THE PAST? LIVING FOREVER? DEFYING DEATH?We still are not sure
  • No sperms neededNo males neededNo sex to reproduceChildren without intercourseLiterally single parent
  • My cellYour empty follicleMy embryoHer wombOr Even an animal womb
  • FIRST HUMAN CLONE IS BORN ?
  • EXPERIMENTAL EMBRYOS HAVE BEEN MADETHREE PARENTSNUCLEUS,CYTOPLASMAND FOLLICLESHYBRID EMBRYOSPERMISSION FORIMPLANTATION
  • Hybrid embryosHUMAN AND COWIS THIS WHAT YOUWANT(HALF COWAND HALF HUMAN)(LIKEMYTHOLOGICALFIGURESTHESE EMBRYOSHAVE BEENCREATED ANDNOW ONLY THEIMPLANTATION ISTO BE TRIED
  • OBJECTIONS AGAIN CRITICISM AGAINmay be validobjectionstodaybut tomorrowwe don’t know
  • Chr omosomes16 6 24 78 40 46
  • Good-Bye Doll y At age 3 Dolly showed signs of premature aging. Dolly died at 6 years old from progressive lung disease (symptom of old age) Dolly’s DNA was already 6 years old when she was born - WHY? It’s all about DNA
  • Doll y and CloningDolly’s experimenters used 277 clonedembryos to produce one sheep, meaning276 failed. QuestionHow many failures will it take to produce a human
  • Chromosome—6 SHORT ARM HASHISTOCOMPABILITY GENES If we could translocate short arm of Chromosome-6 and locate it on a animal’s embryo we could produce animals for spare parts (Liver, Heart, kidneys) (Monkeys, Apes, Pigs, Baboons)`
  • Futur e ExperimentsHybrid Animal cr eating new life Catrilla
  • Future ExperimentsButterCat CatCow SparrowBoxer TigerOwl
  • Ovarian tissue transplantImagine ovarian tissue transplanted onyour fore armOocyte retrieval from just under skin
  • Stem cells to produce gametes -2007Sperms and occytes from sameperson(THEORETICALLY YOU WILLBE THE GENETIC FATHER ANDMOTHER OF YOUR CHILD)Sperm from one palmOocyte from the palm of other handA shake hand will produce a baby
  • Stem Cell Researchers’ Discovery Will Allow Gay Couples To Create Their Own Eggs My two dads may soon be a genetic reality.Scientists have discovered how to create a baby with the DNA of two fathers without the need for a donated egg.
  • Doctors claim first mom-daughter uterus transplantSTOCKHOLM — Two Swedish womenare carrying the wombs of their mothersafter what doctors called the worlds firstmother-to-daughter uterus transplants.
  • Lab-Made Eggs Raise New Fertility Options Early-Stage Cells Used to Produce Healthy Mice; Could the Dead Become Parents?Japanese scientists have made viablemouse eggs in a laboratory dish, anadvance that may offer a new route fortreating infertility in people.The experiment completes a long-soughtquest in reproductive biology: to makesperm and eggs in a lab dish. A year ago,the same core group of scientists at KyotoUniversity created healthy mouse sperm inthe lab.In the latest experiment, the dish-createdeggs were fertilized with natural mousesperm to create healthy, fertile mice. Theresearch appears in the journal Science
  • It will be even tougher torepeat the trick in people. Butif it can ever be done, it hasthe potential to transformreproductive medicine byenabling both infertile menand women to conceive theirown genetic offspring.Any such advance wouldalso raise thorny ethicalquestions. In theory, at least,it would allow a man orwoman of any age—or evensomeone who is dead butwhose tissues are preserved—to become a parent.
  • Japanese stem cellresear ch inspir es USscientists to cr eate a lab human sper m A team of Japanese scientists at Kyoto University has successfully created fertile eggs through the use of stem cells. Their experiment resulted in mice having healthy babies. Taking the research forward is Dr Renee Pera, of Stanford University in California, who hopes to soon create human sperm using stem cells.
  • NORMAL SEX &FERTILIZATION MAY BE FORGOTTEN SOON
  • Future of ARTImmature oocyte pick ups & injections. Ovary banks & injections to ovaries.Oocyte cryopreservations.Spermatic injections for ICSI. (Germ cellI.C.S.I.)Gene manipulation.PGD with blastomere biopsy & fish & PCR.Embryonic cloning & PGD.Designer babies.Blastocyst cultures.Advances in stimulation :— GNRHantagonists &analogue uses.Plastic wombs?Cloning of adult humans?
  • ART GUIDELINES AND ART LAWS 2008TO BE TABLED IN THEPARLIAMENT WHEN ??REGULATIONSOME POINTS NOTFAVOURABLEBY ICMR AND GIVT OF INDIAISAR HAS STARTED WITHACCREDITAION OF INDIANCLINICS AND CENTRES
  • Have sex to enjoy… for pregnancy ART hai na How do you want Your ChildNaturallyTimedIUIIVFICSIGenetically EngineeredDesignerCloned
  • HORACE WROTEOF VARIOUS THREATS,---THOU…..ART ANXIOUSLY INQUISITIVE TOKNOW:BUT GOD HAS,WISELY,HID FROM HUMAN SIGHTTHE DARK DECREES OF FUTURE FATE;AND SOWN THEIR SEEDS IN DEPTH OF NIGHT;HE LAUGHS AT ALL THE GIDDY TURNS OF STATE;WHEN MORTALS SEARCH TOO SOON,AND FEAR TOO LATE.
  • thanks for hearing me out on this issue of Advances in humanreproduction ,I hope in a few year s this does not lead to this……………
  • SALUTE TO THE 34 YEARS OF ART AND TO THE PIONEERS
  • Greeting FromART TEAM MTTBC