Sunday 15 December 2013

Fertility and Female Age

Social trends have led to deferring the age of child bearing not only in the developed countries but also in developing countries.

It is well understood that the number of oocytes in the ovaries decline naturally and spontaneously through process of programmed cell death.Hence chances of achieving pregnancy not only decline through natural conception but also through assisted reproductive technologies (IUI/IVF/ICSI)

This has been re-enforced by research led by Prof Siladitya Bhattacharya, of the Reproductive Medicine team at the University of Aberdeen (UK) who found that the chances of a woman having a baby following IVF go "very rapidly downhill" from the age of 37.Data was obtained from 121,744 women from across the UK.

They found the chances of having a baby following IVF start to decline by the time the woman reaches her mid-30s, but especially from 37.The team used data from women who underwent their very first cycle of IVF using their own eggs.The research also found that even after a pregnancy has been confirmed, women aged 38-39 were 43% more likely to have a miscarriage than women aged 18-34, while women aged 40-42 were almost twice as likely to lose the baby as the younger age group.

To conclude, age is amongst one of the most important factors which determines the success to achieving conception. Hence awareness of effect of age on fertility is important when counselling couples with infertility.

Monday 18 November 2013

Fertility Preservation in Children with Cancer in India - A New Initiative to Address a Neglected Issue

The use of chemotherapy, radiotherapy and surgery in the treatment of children with cancer has implications for their future fertility. Guidelines exist in Europe and North America in regards to offering counselling and fertility preservation options to these patients when risk of loss of fertility is high. The scenario (prevalence, guidance, practice and utilisation) is unknown in India.

On 8th November 2013, a closed educational and brain-storming forum was held at Cankids India, New Delhi, with the presence of all stakeholders – patient survivors and their parents, parent support groups and representation from the largest childhood cancer NGO in India, and of health professionals (reproductive medicine specialist and pediatric oncologist). The aim was to educate, increase awareness and formulate an action plan to address the issue of fertility preservation in children with cancer in India.




An action plan was formulated which included
  • Development of a risk-based algorithm for fertility preservation at diagnosis of a child with cancer
  • Endorsement of algorithm by relevant organisations like Paediatric Haematology Oncology Chapter of Indian Academy of Paediatrics and by Indian Fertility Society
  • Dissemination and advocacy for adoption of algorithm by centres treating childhood cancer across India 
  • Commencement of monthly fertility clinic for childhood cancer survivors who have hitherto not been offered any counselling or service
  • Development of pan India programs for fertility counselling and services for children with cancer
  • Prospective collection of data from these patients so as to understand the current epidemiology