ISAR 2007 Chandigarh Congress report

Introduction

ISAR 2007 , The 12th National Congress on Assisted Reproduction Techniques and infertility management was held at Chandigarh from 8th-11th February 2007. The scientific programme of the conference was carefully charted out keeping the needs of experienced ART practitioners as well as the upcoming specialists. In the 4 days of conference i.e from 8-11th February, two live workshops were conducted. One on ART (assisted reproduction techniques) and other on role of ultrasound in infertility.

Main Conference

Main conference was held at Bhargava Auditorium, PGI, Chandigarh from 9th -11th February. Prof. N.K. Ganguly the Director General of Indian Council of Medical Research inaugurated the conference. Prof R.C. Sobti, Vice chancellor of Panjab University was the Guest of Honour. Nearly 450 faculty members and delegates registered for the conference. In addition to Indian 15 international delegates from countries like USA, Ukraine, Iran, Australia, Greece, Croatia, France and Israel were also present.

There were two Oration lectures. The conference oration was delivered by Dr. Adamson from USA on "Successes and challenges with IVF: global scenario" and second one the ISAR oration by Dr. Kamini Rao, President ISAR on "Treat tuberculosis prevents infertility". The main conference had a variety of sessions like guest lectures, panel discussions, stump the experts, debates etc. There was a special session" Meet the experts" where there were group discussions in groups of 10-15 delegates.

ART Workshop

The ART workshop was held at Jindal IVF and Sant Memorial Nursing home sector 20 D, Chandigarh on 8th February. Nearly 160 delegates attended the workshop. Basic ART and advanced micro manipulation techniques were shown live. The workshop was conducted by a team of experienced ART faculty which included Dr. B.S Mihnas (USA) Nalini Mahajan (N.Delhi), Prof. L. K. Dhaliwal (PGIMER Chandigarh), Dr. Vanita Suri (PGIMER, Chandigarh), Dr. Shreyas Padgaonker (Mumbai), Dr Jaideep Malhotra (Agra), Dr. Himanshu Patel (Ahemadabad), Dr. Kuldeep Jain (N.Delhi), Dr. Nimsh Shelat (Surat), Dr. Ashok Sharma (Chandigarh),Mrs. Manisha Mittal(Chandigarh), Umesh Jindal(Chandigarh).

The procedures shown included IVF lab setup and quality control, ovum pick-up, oocytes evaluation, sperm preparation, insemination, oocytes donation, embryo evaluation and embryo transfer. In addition sperm retrieval techniques such as PESA and TESA were also shown.

ICSI was performed with ejaculated as well as testicular sperm. Cryopreservation of embryos with slow cooling technique and vitrification was demonstrated. Advanced micromanipulation techniques with laser hatching, embryo biopsy and oosight spindle view were also shown.

The conference was accredited by the Punjab Medical Council and for Continuing Medical education (EACCME) for CME credits. We appreciate the contribution of" Serono symposia" for the help.

A trade exhibition was organized along with the conference. Almost 30-40 pharmaceutical and equipment companies displayed their products.

USG workshop

The ultra sound workshop was a live demonstration of diagnostic and intervention sonography, Color Doppler, 3D and 4 D. Ultrasound workshop was held in Lecture Theatre 1 at PGIMER Chandigarh on 11th February and nearly 250 delegates attended. International faculty included Prof. Asim Kurjak (Croatia), Dr David Adamson (USA), Dr Ariel Weissman (Israel), Dr Gordon Baker ( Australia).National Faculty included Dr S Suresh(Chennai), Dr Narender Malhotra (Agra), Prof Lakhbir Dhaliwal (PGIMER Chandigarh), Dr Kuldip Singh (Delhi), Dr Sonal Panchal (Ahmedabad), Dr Kamini Rao (President ISAR, Bangalore), Prof. Sunesh Jain (AIIMS, Delhi), Dr Mala Arora (New Delhi), Prof. Geeta Radhakrishnan (G.T.B. New Delhi), Prof. Manju Puri (LHMC Delhi), Dr Ladbans Kaur (Chandigarh), Dr Baljit Kaur (Chandigarh), Prof. Sarla Malhotra (Chandigarh), Dr Sushma Chawla (Jalandhar), Prof.Kala Vasishta (Chandigarh), Dr Umesh Jindal(Chandigarh), Dr Radhika (PGIMER,Chandigarh), Dr Anupam Lal (PGIMER,Chandigarh), Dr Neerja Chawla (Chandigarh) and Dr Mangla Dogra (Chandigarh).

Session I was dedicated to infertility problem to evaluate the changes which occur in ovaries and uterus in response to hormonal changes due to ovulation inducing drugs. In addition to follicular studies, ultrasound can diagnose presence of other diseases which may be the cause for infertility like fibroids, endometriosis and inflammatory masses. Assessment of these pathologies, tubal patency and opening of blocked tubes were shown to the delegates.

Session II was dedicated to Sonoembryology. Early pregnancy complications are more common in patients who conceive after infertility treatment like ectopic pregnancy, multiple pregnancies, abortions and congenital malformations. The delegates were taught how to detect malformations in the fetus. In addition ultrasound guided procedures like amniocentesis and cordocentesis to evaluate amniotic fluid and fetal blood were demonstrated.

Session III Last session was to solve the diagnosis in difficult Gynae cases with the help of ultrasound and colour Doppler. The Gynae cases with pelvic masses were shown and differential diagnosis discussed. Ultrasound evaluation and blood flow to testes and prostate of men with infertility was also be demonstrated.

Free communications

Nearly 50 research papers were received for presentation in oral or poster sessions. These presentations were reviewed by senior faculty members and 3 best papers were selected for the prizes in to categories i.e. oral and poster.

Oral Presentation
Total Papers -25

Poster Presentation
Total papers - 24

Dr. Umesh Jindal
Organizing Secretary

8th February 2007

ART Workshop: Live Demonstration of Assisted Reproduction and advanced micro manipulation Techniques (ART)

International Faculty

1. 1. Dr. B.S.Minhas PhD from Global infertility solutions USA. Dr. Minhas has technical collaboration with Jindal IVF, Chandigarh. He is one of the leading embryologists in USA.
   
   
2. 2. Dr.Y. Menezo PhD from France. A pioneer and basic research worker . His main areas of research include development of culture media and cryopreservation of human embryos.

National Faculty includes
Leading IVF specialists from all over India

1. Dr. Nalini Mahajan, N.Delhi
   
   
2. Dr.Anoop Gupta, N.Delhi
   
   
3. Dr. Alka Gupta, N.Delhi
   
   
4. Dr. Sanjay Makwana, Jodhpur
   
   
5. Dr. Renu Makwana, Jodhpur
   
   
6. Dr. Lakhbir Dhaliwal, PGIMER, Chandigarh
   
   
7. Dr. Vanita Suri, PGIMER, Chandigarh
   
   
8. Dr. Shreyas Padgaonkar, Mumbai
   
   
9. Dr. Jaideep Malhotra, Agra
   
   
10. Dr.Narendra Malhotra, Agra
    
    
11. Dr. Himanshu Patel, Ahmedabad
    
    
12. Dr. Kuldeep Jain, N.Delhi
    
    
13. Dr. A.K.Mandal, Dept. of Urology, PGIMER, Chandigarh
    
    
14. Dr. Ashok Sharma, General Surgeon, Jindal IVF,Chandigarh
    
    
15. Dr. Nimish Shelat, Surat
    
    
16. Dr. Manisha Mittal, Chief Embryologist, Jindal IVF, Chandigarh
    
    
17. Dr. Umesh N.Jindal, Director,Jindal IVF, Chandigarh

The Organizers

Jindal IVF and Sant Memorial Nursing Home is the pioneer center in the field of Infertility in Northern India for the last 16 years. The first IVF baby was born in 1996 and since then the center has been providing comprehensive infertility and ART services of international standards. The laboratory is well equipped to provide all types of procedures including micromanipulation techniques.

Overview of Workshop

Live workshops entails showing procedures actually being performed to the audience. They provide a forum for young specialists to learn practical tips, clear their doubts and learn from each other's experience.

Today we have organized the workshop not only to include basic ART techniques but also many advanced techniques which are still considered research tools. This workshop highlights the complex and delicate nature of IVF laboratory work. The sequence has been decided keeping in view the time sequence required in IVF lab to perform these procedures. Most of the procedures have a very critical & limited time window and have to be performed within that period. However I will explain briefly all the procedures one by one.

1. Laboratory Set up
   
   
2. Indications and workshop
   
   
3. IVF --In-Vitro-Fertilization and Embryo- Transfer
   
   
4. ICSI--Intra-Cytoplasmic-Sperm-Injection
   
   
5. Cryopreservation 6. Special Procedures

Detailed List

1. Laboratory set up and quality control-IVF involves mixing up of male and female gametes (sperm and eggs) in the laboratory and providing these with an environment which mimicks that of the body for 2 to 5 days and replacing these in the uterus at the right time.
   It is of utmost importance that the life which begins in the laboratory is provided with conditions which are conducing not only for immediate success but also the long term health of the individual.
   
   To provide such conditions in laboratory is a herculean task. The growing embryos are very sensitive to changes in temperature, pressure and pH. They require less oxygen. The culture medium in which they float has to meet their nutritional requirements which changes with every developmental step. It has to maintain a biochemical and physical equilibrium between embryos and environment until the time these are replaced back in the body. In additions these have to be protected against contamination from pathogenic organisms.
   
   To achieve all this we need a very high standard of laboratory with a air particle count < 10,000 called class 10,000 air quality laboratories. This clean air is obtained by filtering the air through a series of multiple filters which absorb all chemicals, dust and bacteria, virus etc under positive pressure. Special incubators are required which maintain CO2 and temperature. Other equipment like microscopes, micromanipulators, embryo safe disposable etc. are required for viewing and performing procedures on the microscopic sized gametes.
   
   A very stringent quality control system to maintain equipment, class 10,000 conditions and electricity are required. This kind of set up involves an initial investment of nearly 50 lacs and also quite high recurring maintaining cost.
   
   
2. Indications and workup
   

   2.1 IVF: Indications and Patient Selection IVF was initially developed as a method to bypass the fallopian tubes and treat intractable infertility. Over the time the indications have widened. An indication for IVF exists whenever the treatment related success rate is clearly superior to any other modality of treatment or waiting. 1. Tubal occlusion failed Tuboplasty. Badly damaged tubes Surgery not preferred by patient Tubercular etiology 2.Impaired tubal function without occlusion Previous ectopic pregnancy Previous tuboplasty Tubercular etiology Recurrent PID 3.Unexplained infertility Duration more than 3 years Older than 33 years. 4.Male infertility Total motile sperm count < 10 million 5.Endometriosis 6.Cervical/ Immunological Factor Failed 5-6 IUI cycles 7.Hormonal disturbances 12 failed ovulatory cycles. Based On Prognosis Any infertility of more than 5 years duration Wife's age more than 32 years Previous treatment failures Contraindications for IVF There are very few absolute contraindications for IVF 1.Any medical illness likely to compromise maternal health during pregnancy e.g. severe heart disease etc. 2. Very poor prognosis for IVF e.g. badly damaged uterus , poor ovarian reserve etc. In these cases surrogacy or ovum donation case be suggested 3.Previous 6 failed IVF cycles 4.Financial constraints 5.Religious and emotional reasons 2.2 ICSI: INDICATIONS AND PATIENT SELECTION ICSI intra cytoplasmic sperm injection has revolutionized the way male infertility is treated. Almost all problems can be successfully treated by ICSI. Indications 1. Oligoasthenospermia 2. Unexplained infertility 3. Immunological infertility 4. Varicocele 5. Recurrent pyospermia 6. Obstructive Azoospermia. 7. Non obstructive azoospermia 8. Ejaculatory dysfunction Contraindications Severe testicular atrophy Only immature sperms in testicular samples Contraindications for IVF/ISCI in wife. Genetic disorder in the male partner. Very short infertility Financial, religious or psychological reasons. 2.3 PRETREATMENT EVALUATION After selection of a case for IVF/ICSI following workup needs to be done for both husband and wife. Any abnormality detected should be treated adequately before undergoing the procedure for optimal outcome. General - both husband and wife should undergo general health tests such as haemogram, complete urine examination, blood sugars, blood group etc. Infection screen - HIV, hepatitis antigen and VDRL should be done in both partners. Genital tuberculosis also needs to be ruled out by appropriate tests. Cause of infertility - By the time most of the couples are selected for IVF/ICSI they have already undergone a diagnostic work up. However, the investigations must be reviewed again and performed or repeated if required. Endoscopy - laparoscopy is not a must to undergo IVF/ICSI. It should only be done if it will add to the information available or improve prognosis by surgical intervention. For example removal of a large emdometrioma. There is a controversy regarding hysteroscopy. Views differ between universal hysteroscopy to individualized approach in indicated cases only. Assessment of ovarian reserve. The female partner should be assessed for ovarian reserve to decide the dose of gonadotrophins and prognosticated. Basal antral count on ultrasound, D2 FSH and age, these three factors combined together give a fair assessment of ovarian reserve. Hormonal evaluation - Any thyroid dysfunction or hyper prolactinaemia detected needs to be treated adequately before hand. No other detailed hormonal evaluation is required. For male partner, or recent semen examination, swim up sperm survival tests and culture are recommended to decide about choice of laboratory procedure i.e. IVF or ICSI. A trial or mock embryo transfer should be done to anticipate the problems in cervix such as stenosis, angulated or un cooperative patient. The most important evaluation is psychological and social case study. Many sessions of counseling with all the concerned members helps to reduce anxiety and prepares the couple better for a very stressful procedure.

   
   
3. In-Vitro-Fertilization and Embryo transfer
   This procedure involves hyperstimulating the ovaries, taking out eggs from these developed follicles with the help of a needle under ultrasound guidance. The patient is given light general anaesthesia to make the procedure painless. The follicular fluid containing the eggs is transferred immediately to the laboratory. Eggs are identified under microscope and mixed with sperms from husband. Sperm and egg are cultured together in special culture media in CO2 incubators. The embryos are transferred back to the womb after 48-72 hours.
   
   
4. Intracytoplasmic Sperm Injections:
   In cases where the sperms in the male partner are very low or week this technique is used. A single sperm is injected inside the egg with the help of a special equipment called micro-manipulator. Under very high magnification it is possible to operate on this very- very tiny objects. ICSI is a very successful procedure. Men even with an occasional sperm in the semen or sperm taken out from the testes can be used to achieve very good success rates.
   
   
5. Cryopreservation: Usually there are surplus embryos. These can be stored in liquid Nitrogen for quite a long time. The procedure of freezing and thawing these embryos is quite complex and delicate. Irreversible damage can occur during these procedures. The main procedure involves additions of cryoprotectants and slow cooling to avoid damage.
   
   
6. Special Procedures: Lasers are being used to operate on the outer covering of the egg and embryos, the zona pellucida for various purposes like helping the embryo to come out of it i.e. latching or to take out a cell from the embryo for genetic testing i.e. embryo biopsy and many other such procedures.
   
   Hatching can be done with the help of needles and also with mild acids. All these procedures are done with the help of the micromanipulator.
   Spindle view is a research tool by which one can see the internal micro organelles present in the cells without disturbing or damaging the physiological processes. With its help one can learn the effect of various physical and chemical conditions on the egg and embryos. Also the procedures of nuclear transfer, cytoplasmic transfer etc for cloning purposes can be performed with its help.
   
   Blastocyst culture is a technique where embryos are grown for extended period of 5 days in the laboratory. It involves special culture media which have to be changed sequentially.

Conference oration and Inauguration

Date: 9th February,
Venue: Bhargava Auditorium
Time: 11.45A.M to 1.00P.M

Introduction to Guests
Dr. David Adamson, from USA. Vice President of American Society of Assisted Reproduction will deliver the conference oration.
Chief Guest: Prof. N.K. Ganguly
Director General ICMR (Indian Council of Medical Research)New Delhi
He was instrumental in the development of ICMR guidelines for regulation of ART practices and accreditation of IVF centers in India.
Guest of Honour : Prof. R.C.Sobti, Vice Chancellor , Panjab University, Chandigarh. He is a pioneer biotechnologis be involved in basic research related to genetic and ART.
Dr. Kamini Rao, President Indian Society of Assisted Reproduction (ISAR)
Dr. Hrishikesh Pai, Honorary Secratory General ISAR
Dr. L.K.Dhaliwal, Organzing Chair person
Dr. Umesh Jindal ,Organzing secratory

Conference Oration will be delivered by Prof. D. Adamson from U.S.A .He will be speak on the "successes and challenges in IVF around the world. "Nearly 1%of all births are as a result of ART techniques in developed countries. Many countries have established registries which monitor the births and long term health of children born with these techniques. ART techniques have been highly successful in alleviating intractable infertility. Still the challenges which remain to be tackled are risk of multiple pregnancy slight risk of increase in congenital anomalies in ICSI babies and reducing the costs .He will also throw light on other related issues like cloning, nuclear transfer stem cells etc.

Inauguration
Indian Society of Assisted Reproduction (ISAR) was established considering the rapid advances and remarkable development in the field of Assisted Reproduction Techniques (ART) nationally and internationally. Dr. Mahendra Parekh felt the need of forming an Indian Society for promoting Assisted Reproduction. It was founded on 16th Feb.1991 in Mumbai. Prominent ART specialists from India joined hands. The main aim of the society was to bring together all the ART specialists, disseminate information to the members and infertile couples and to constitute a forum for regulation and promotion of scientific activities in the field of ART. Currently the society has more than six hundred members. It holds annual national conferences. It has started compilation of national data of ART procedures in India. With increasing demands and strength, the society is looking towards moving forward. ISAR Excutive Committee

Morning Session
9th February, 2007 , Bhargava Auditorium Hall A

Session 1 is related to the pharmacology. The medicines used for ART techniques. Polycystic ovarian disease is a common disorder which is increasing day by day. It presents with infertility, menstrual disturbance, hair growth and obesity. Prof. Anil Bhansali from the department of Endocrinology PGI will discuss the new medicines available and under research for this condition. Dr. Sudarshan Ghosh Dastidar from Kolkata will discuss the ideal composition of hormone injections used for ovulation induction for ART. Dr. Ariel Wiessman form Israel will deliberate on the current status of aromatose inhibitors. Letrozole, a hormonal medicine used for breast cancer has found to be effective for ovulation induction also. There was a lost of controversy regarding the off label use of this drug.

Session 2 Relates to general, ethical and legal issues related to ART. Prof. L.K.Dhaliwal fromPGI will discuss controversial issues involved in third party reproduction e.g sperm and egg donation and surrogacy. Dr. Nimish Shelat from Surat will critically analyse the ICMR guidelines which have come recently.

Many young males and females suffer form cancers, leukaemias etc which have become curable with modern anticancer treatment. These drugs have potential of affecting fertility. Prof. Korula George from Vellore will highlight the modalities to preserve fertility during and after chemotherapy.
Infertility treatment is very lengthy, cumbersome and prolonged besides being very costly. Dr. Amit Patki from Mumbai will focus on how to get results with minimal treatment.

9th February, 2007 Afternoon Session

Bhargava Auditorium Hall A
The first session will be oration by Dr.Kamini Rao president ISAR. TB is endamic in India, Genital TB is more prevalent than recognized. It may silently affect internal reproductive organs even without producing any symptoms. Effective treatment of TB especially in early stages can prevent infertility.
The second session is regarding new research in the field. Until now once the testes were destroyed there is no hope for the infertile men. ICSI could help many of these desperate cases . Prof. Sofikitis whose original work on germ cell transplantation is a landmark will talk about his research in this field. In future this research may pave the way for germ cell grafting and regeneration.

Prof. Y.Menezo is a pioneer in IVF culture media. The culture media he developed with his extensive basic research are bench marks in IVF laboratories worldwide. He will discuss the composition of media and its effect on embryo quality.

Prof. B.N.Chakravarty is a father figure in India as far as ART is concerned. He will talk about the Indian senario.

A panel discussion on diagnosis of genital TB will concentrate on modalities to diagnose and the controversies surrounding the newer tests. They will also discuss the implications of such diagnosis on the treatment outcome. The panelists include Dr. Sonia Malik, Dr.Shishta N Basu, Prof. L.K. Dhaliwal, Dr. Jyoti Pillai, Dr. Dhiraj Gupta and Sanjay Patel.

In "Meet the experts" session there will be different tables. On each table different topics will be discussed by experts. This session provides an excellent opportunity for the youngsters to interact directly with the experienced faculty. These topics include

• Ovum donation & surrogacy
  
  
• Role of ultrasound in infertility
  
  
• Induction of ovulation with gonadotrophins and Gn-RH analogues
  
  
• Cryoperesrvation and vitrfication
  
  
• Poor responders
  
  
• Workup of infertile couple
  
  
• endometiosis
  
  
• Genital Tuberculosis
  
  
• Case selection for IVF ICSI
  
  
• Repeated inplantation failure
  
  
• Sperm Banking
  
  
• Male infertility
  
  
• Endocsopy in infertility
  
  
• Intra uterine insemination
  
  
• IVF lab set up and quality control
  
  
• Poor oocytes/embryo
  
  
• IVF stimulation protocols
  
  
• PGD
  
  
• Blastocyst culture

Saturday 10th February (HALL A)

The morning starts with presentation of original research papers in the free communications session . Sessions II Prof. Yves Menezo will discuss the repair mechanisum in oocytes. The oocytes which is the basic unit required for human development andergoes lot of stress and damage during ART. The natural defense mechanisms by oocytes will be discussed.

A pregnancy loss after successful ART procedure is very traumatic . Common reasons are ectopic pregnancy, early abortions and multiple preganancy. Prof Vanita Jain from PGI will discuss the modalities to prevent this loss.

Ovum pick up the procedure done to collect oocytes is one of the most crucial steps involved in ART. Without good oocytes quality no IVF lab can produce good embryos . Dr Bavishi from Ahemadabad will elaborate on problems and remedies related to oocyte pick up.

Session III is an interesting session where the cases will be presented by the delegates and the opinion of the experts will be saught regarding diagnosis and management.

Session IV: Dr Duru Shah from Mumbai will discuss about the cost reduction strategies in IVF. IVF although effective is still a very costly procedure and out of the reach for most people. Reduction in costs will increase the acceptability and benefit millions of infertile women who can't afford this treatment. Dr Weissman will discuss the different types of ovarian stimulation regimens required for ART. Dr Hrishikesh Pai will discuss the pros and cons of extended culture of embryos in laboratory for 5 days, the blastocyst culture.

The morning session will conclude with the evaluation of Posters by judges. There are 23 research papers presented in the form of posters which will be evaluated and best 3 papers will receive award.

Saturday 10th February (Hall A)

Afternoon session:

After noon session starts with a panel discussion on improving results in IVF. The success rates have steadily improved in IVF laboratory because of better understanding of the needs of growing embryos, creation of appropriate environment, the culture media and equipment. The penal discussion will focus on these issues.

Second session will start with a presentation by Dr. Dhiraj Gada. He would discuss the problems in semen banking, the ethical, legal and procedure related to issues involved. Dr Vijay Mangoli from Mumbai will discuss about how to judge an IVF laboratory. The quality indices which serve as a benchmark for both IVF lab personal as well as patients and regulatory authorities. Success of and ovum donation procedure constant demand for ova banks. Moreover ovarian presentation as a method of preserving fertility for future is also needed in certain situations. Dr. Manish Banker will discuss the current status of oocytes & ovarian cryopreservation.

Third session will focus on endometrium, the soil in which the growing embryo implants and get its nourishment. Presence of fluid in endometrium is an ominous sign seen at ultrasound. The causes and treatment will be discussed by Dr. nalini Mahajan from Delhi. Dr Sadhna Desai will discuss the causes and treatment of thin endometrium which means inadequately prepared uterus. Dr. R. G patel will discuss the tests by which one can assess whether endometrium is prepared to accept the embryo.

Medical science is full of controversies. There are many right ways of handling a medical condition. Debate bring out different opinions about a controversial problem. Presence of endometriosis a condition where cysts form in the ovary can be handled by both surgery as well as ART. Dr. Handa from Chandigarh and Dr. Dilip Datta from Kolkatta will put their views on this issue.

Blocks at the proximal ends of fallopian tubes can be handled well by cannulation or dilation by a stent and also by ART. Which gives better results will be discussed by Dr. Kuldeep Jain from Delhi and Dr. Sujata Kar from Bhubneshwar. The most controversial issue is womb on hire. Dr Kamla Selvaraj and Dr. Mala Arora will discuss this burning issue of great ethical legal, and social importance.

The session will end with the general body meeting of the society.

Saturday 10th February 07 Hall B

The morning session starts with presentation of original research papers.

Session II is regarding endocrinological aspect. First talk is on the hormonal tests required for evaluation of the infertile couple by Dr. Jayam Kannan from Chennai. Dr Mandakini Parihar will deliberate on the effect of age of fertility. More and more women are delaying child birth for career options without realizing the slow and study decline in ovarian function which occurs wth age. Dr Nandita Palshetkar from Mumbai will discuss the hormonal support required after the ART procedures for sustaining the support of corpus luteum.

Stump the experts session is an interesting session designed to break the monotony of lectures. The opinions regarding management of various interesting and rare cases will discussed.

In 4th session issues related to USG will be discussed. With ultrasound techniques internal female organs have become almost transparent. Do we still need to do operative procedure i.e. diagnostic laparoscopy is a question being asked. Prof. Asim Kurjak from Croatia will answer this question.

For ART cycles stimulation of ovarian is done by ultrasound and hormones. Dr Narendra Malhotra from Agra will discuss if we can safely reduce ultrasound visits and hormone tests.

Multiple pregnancy is an unwanted side effect of ART procedures. Reduction of supernumery embryos during first trimester of pregnancy can improve neonatal outcome. Dr Sonal Panchal will discuss various issues related to these procedures.

Saturday Afternoon Hall B

Endoscopic surgery is part of infertility management. However, careful selection of cased, delicate handling and taking every case to preserve fertility is important to minimize the side effects of surgery.

Next session is also related to endoscopy. Blockade of tubes is an absolute and primary indication for IVF . However where the tubes are filled with inflammatory fluid a condition called hydrosalpinx, the results of ART go down. Dr. Sanjeev Khurd from Surat will elaborate on the management of hydrosalpinx.

Endometriosis can be a debilitating disease. Extensive endometriosis can affect fertility as well as quality of life by causing debilitating pain. Conservative endoscopic surgery in such situation is a challenge. Dr. Nutan jain will share her experience.

There are very interesting videos in this session. These include hysteroscopic adhesiolysis by Dr. Kuldeep Jain from Delhi, Genital tuberculosis by Sanjay Patel from Ahemadabad, uterine transplant by Edwin Remirez from USA, ultrasound guided ET by Dr. Mangla Telang from Delhi and end to end anastomosis of fallopian tubes by Sanjay Patel.

Last session is debates on reigning controversies. With improved antiretroviral therapy the demand is increasing from the seropositive HIV couples for fertility. Dr Rashmi Bagga from PGI and Dr Rajat Kumar Ray from Rouerkela will discuss whether Art is justified in those couples.

With donor ova women can conceive well past the age of reproduction even in 6th and 7th decades. Are such pregnancies in the interests of women , society and the children borne out of such procedure will be discussed by Dr. Mina Chimote from Nagpur and Dr. Mangla Telang from Delhi. Polycystic ovarian disease in a very common condition. Medical management is very successful . However there is a risk of hyperstimulation & multiple pregnancy besides it being very costly. Surgery offers a cheaper and effective alternates. However surgery is also brought with dangers of anesthesia, surgical complications and permanent damage to the ovaries.

Sunday 11th February

The morning session starts with presentation of research papers in both halls.

1st session in Hall A is an interactive session by Prof. Gordon Baker from Australia. He will discuss with the audience on investigations and management once report of semen is obtained shows abnormality.

The next session is managing errectile dysfunction in men, a very common problem by Dr. Chaitanya Nagori from Ahemadabad. Dr Sanjay Makwana from Jodhpur will discuss the role of ICSI when sperm count is zero.

Dr. K. R Sharma from Jaipur will discuss the androgen disorders in the infertile couple.

The session will end with a panel discussion on management of oligoastheno spermia a very common and frustrating problem.

In Hall B. Dr Adamson from USA will outline strategies to reduce multiple pregnancy rate by transferring only one embryo. Dr M.S. Srinivas from Bangalore will discuss the assisted hatching a technique by which zona pellucida the egg shell is broken so as to help the embryo implant better.

Genetics plays an important part. Many conditions have now been recognized to of genetic origin. Male infertily, recurrent abortions and endometriosis are such conditions. Dr Rajeev Kumar from AIIMS, Neeraj Khare from Indore and Roya Rozati from Chennai will deliberate on role of genetics in male infertility, recurrent abortion and endometriosis respectively.

International Faculty

	David Adamson, MD 540, University Avenue, Suite 250, Palo, Alto, California, USA Special Interest: Endometriosis, ART
	H. W. Gorden Baker, MD, PhD, FRACP Prof., Dept of OBGYN, Univ. of Melbourne, The Royal Women's Hospital, Carlton, Victoria, Australia Special Interest: Management of male infertility
	Jean Cohen, MD Clinique Marignan, 8 rue de Marignan France Special Interest: History and regulations of ART
	Asim Kurjak, MD PhD Prof. and Chairman Dept. of OBGYN Medical School University of Zagreb, Sveti Dub Hospital, Zagreb, Croatia Special Interest: Ultrasound
	Brijinder S. Minhas, PhD HCLD ELD MBA President Gobal Infertility Solutions 542, Wayland Avenue, Kenilworth, IL 60043, USA Special Interest: Embryology
	Yves Menezo, Egr. Bio.chem DEA PhD Head of the ART Dept. 33, Chemin des Villas, 69300 Caluire France Special Interest: IVF Media
	Ariel Weissman, MD IVF Unit, Dept. of Obstetrics and Gynaecology Edith Wolfson Medical Centre Holon 58100 Israel Special Interest: Endocrinology and ART
	Nikolaos Sofikitis, MD, PhD, DMSci Professor and Chairman Department of Urology Ioannina University School of medicine Ioannina Greece Special Interest: Sperm Xenograph