IVF & Genetic Center Jabalpur Madhya Pradesh, India

Dear Colleagues,

Hello !!!

In this news letter we discuss PCO and beta thalassemia as the topic.

PCO is one of the commonest problem in today’s women. It is mostly found in urban population and especially who are under stress. There are lots of theories behind the etiology ,but recently insulin resistance is found to be the most suitable. Treatment with insulin of pregnant lady with diabetes results in a change in the society . These women are genetically prone for insulin resistance or insulin deficiency. When they deliver this genetic mutation is passed on to further generations and a population develops with insulin resistance or insulin deficiency. It might be the reason ,why we see there is a increasing number of individuals are suffering from diabetes and more females are coming with insulin resistance and PCOS ,who later on mostly develop frank diabetes. There is another theory that PCOS are the women who conserve the eggs in population and when the human population will be in danger, these women will help to fill the gap by producing eggs even at their later age.

Thalassemia is discussed, because it is one of common cause of anemia in pregnancy and usually not diagnosed well and treated as iron deficiency anemia

I wish you all the best ,

Sincerely Yours
Dr.D’Pankar Banerji


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1. Polycystic ovarian disease (PCOD) in adolescent

PCOD is one of the commonest problems in adolescent girls. Its increasing prevalence makes the young girl confused regarding her periods, her health status, and her appearance and future fertility. It can be very difficult to diagnose PCOD in teenage girls as they often experience irregular or absent periods.

Insulin resistance is one of the leading causes of PCOD; it may or may not be detectable in adolescents.
Teenagers may experience the full range of PCOD symptoms often seen in mature women including irregular or completely absent periods, heavier than normal bleeding and alopecia (male pattern baldness). Other symptoms range from acne, skin tags, and brown skin patches, exhaustion or lack of mental alertness, depression and anxiety.

Relation to weight gain: Insulin resistance is the root cause. As the body is not converting food to energy properly, it demands even more food. As these cravings increase, so does weight gain. As bodyweight increases, body further looses its ability to process food correctly, causing even more weight gain. Eating binges occur as a result of insulin resistance. More insulin enters the body stream, laying the foundation for excessive weight gain and obesity.

Relation to abnormal hair growth: As there is more free insulin, the insulin goes to ovary too. It acts on the theca interna of the graffian follicle. Here it makes more testosterone. More the testosterone is, more is the hair growth in male patter. Mostly it starts in face in the mustache and beard areas, then on the abdomen and chest or back. When the testosterone goes more then hair thinning starts and male pattern baldness may occur.Relation to menstrual abnormality: Increase testosterone at the graffian follicle hampers the release of eggs. When there is no release of eggs, it leads to amenorrhea or irregular menses.

PCOD in lean women: obesity in PCOD is not always the case. Half of the women diagnosed as PCOS are of normal weight, some are even underweight. Regarding insulin resistance in lean women, there is a controversy, whether it is same as an obese PCOD. Even in cases where the insulin level is normal, the sensitivity of the ovaries matters a lot, and thus production of testosterone. Raised testosterone may be the causative factor for anovulation, irregular periods and infertility. It is hypothesized that there is imbalance in insulin/glucose mechanism. Although there is lack of obesity, but the thin women with PCOD have higher insulin level in their blood than those without PCOS.

PCOS guidelines:

1. The root cause is with insulin resistance.

2. Obesity is important issue, hence weight control is must

3. Birth control pills are usually first choice for treatment, but in long run it may worsen the insulin resistance and may increase the body weight.

4. Exercise is necessary component of treating the PCOS. Exercise increased the number of insulin receptor sites on cell surface, boost metabolism, burn calories and helps to level out the production of insulin in the pancreas.

5. Balanced and healthy diet. Avoid high glycemic index foods, like bread, rice, refined sugars, potatoes,
Consensus in fertility treatment in PCOS;

Meeting held in Greece by ESHRE (European society of human reproduction and embryology) ASRM (American society of reproductive medicine) and Organon.

The overall conclusions were:

1. Evaluation of women with presumed PCOS desiring pregnancy should exclude any other health issues in the woman or infertility problems in the couple.

2. Preconceptional counseling emphasizing the importance of lifestyle,” especially weight reduction and exercise in overweight women, smoking and alcohol consumption,” should be provide before any intervention is initiated.

3. The recommended first line treatment for ovulation induction remains the anti-estrogen clomiphene citrate.

4. Recommended second line intervention should fail to result in pregnancy is either exogenous gonadotropins or Laparoscopic ovarian surgery (LOS) .It is pointed out that both have clear advantage and disadvantages, and that the choice must be made on an individual basis.

5. Recommended third line treatment is IVF because this treatment is effective in women with PCOS.

Patient tailored approach is needed. Metformin in PCOS should be confined to women with glucose intolerance and that routine use of metformin in ovulation induction is not recommended. There is insufficient evidence regarding aromatase inhibitors use in routine ovulation induction

2. Diagnosis of Thalassemia
The hemoglobinopathies are genetic disorders of hemoglobin and can be classified broadly into two types . The first includes those that result from an inherited structural alteration in one of the globin chains. The second, the thalassemias, is constituted by inherited defects in the rate of synthesis of one or more of the globin chains. For instance, beta thalassemia, caused by defective synthesis of beta chain of the hemoglobin, is the most serious clinically.

The human adult hemoglobin is synthesized in the red blood cells and its major function is oxygen transport from the lungs to the tissues. It consists of a major component ,Hemoglobin A ( HbA) and a minor component ,HbA2, which constitutes about 2.5 % of the total. During intrauterine life ,several embryonic hemoglobins are present. The structure of these hemoglobin's is similar. Each consists of two separate pairs of identical globin chains, the alfa like and the beta like chains.

Beta like chains are controlled by a gene cluster on chromosome 11 in which the different genes are arranged in order. Beta ,gamma and delta globin gene are situated in chr.11.

The alfa like gene cluster is on chromosome 16.

There are one beta gene in each chromosome, means two beta in an individual. There are two alfa gene in each chromosome ,means there are four alfa gene in each individual.

Hb A is alfa2-beta2, Hb A2 is alfa2-delta2 and the HbF is alfa2-gamma2.

According to the chain which is defective, several types of thalassemias have been described. The common and clinically important types are the beta, delta-beta, and alfa thalassemias. For beta-thalassemia there are two types of mutations, the beta0 (betazero)in which no beta chains are produced and beta+( betaplus),in which some beta chains are produced but at a reduced rate. Some types of beta thalassemia are designated beta++ to indicate that the defect in beta chain production is particularly mild.
Investigation of suspected thalassemia:

Thalassemia trait( Thal-minor) is generally not thought to cause health problems, although women with the trait may be more likely to develop anemia of pregnancy than women without the trait. Obstetricians sometimes treat this with folate supplementation. Most types of thalassemia trait cause the red blood cells to be smaller in size than usual, a condition called microcytosis. Sometimes this is inaccurately referred to as ‘Low Blood’. Since iron deficiency is the most common cause of microcytosis, doctors sometimes mistakenly prescribe iron supplementation to individuals with thalassemia trait. Therefore ,before prescribing iron supplements, doctor should rule out thalassemia trait and/or perform lab test to evaluate iron levels. A person with thalassemia trait can also be iron deficient, but if she is not ,iron supplements may result in excess body iron. Excess iron can deposit in many areas of the body, causing organ damage in the long term.

Testing for thalassemia trait involves having a single blood sample drawn. Following screening tests identify most types of thalassemia trait, as well as sickle cell trait, E-trait and most other known hemoglobin trait:

1. Hemoglobin electrophoresis with quantitative estimation of Hb A2 and Hb F

2. Complete blood count

3. Iron studies ( free erythrocyte protoporphyrin, ferritin, and/or other iron studies.)

Individuals with beta thalassemia trait usually have evidence of microcytosis and increased kevels of HbA2 . HbF is sometimes elevated as well. Individuals with alpha thalassemia trait usually have evidence of microcytosis and normal levels of HbA2 and F. If iron deficiency is detected ,individual must be retested after completing iron supplement therapy.

It is important for individuals to be aware of their thalassemia trait status, particularly individuals of reproductive age. Depending on the Hb type of current or future partner, future children nay be at risk for thalassemia disease or other related Hb diseases. Prenatal tests are available for the babies found to at risk . Tests are done by either chorion villus sampling or amniocentesis.

3. Training in IVF and Embryology

Module I : Ovulation induction and Intra Uterine Insemination ( One day )
Module II : Conventional IVF and fundamentals of Embryology( Two days )
Module III : Intra cytoplasmic sperm injection, Micromanipulation ( Two days)

Course fees

Module I : Rs.2000.00 ( US$ 50 )
Module II : Rs.20,000.00 ( US$ 500 )
Module III : Rs. 50,000.00 ( US$ 1250 )