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Sunday, March 18, 2012

Female foeticide - Why are we so obsessed about the foetus 'Right to Life' than our underprivileged womankind well-being?

My native is a village in south India. Our neighbourhood is occupied by people who belong to a particular caste. Their job (of those particular caste men) in olden times is thieving! Somehow ancient society came to term with the fact that theft is their means of survival and income (it is because theft with some kind acceptance from the society prevented those people from committing horrendous crime!). People belonging to that caste used to steal cattles from neighbouring village and the stolen cattles were retrieved back by giving money or grains to the people who stole them. They are very aggressive people (even now!). Women in their community are treated like cattles. The passion to have a boy child is extremely high among those people. The wish to have a particular sex baby is not wrong but they do this at the expense their girl child’s welfare. Girl children are taken for granted. They deprive them of proper nutrition and education.

In front of my house there lived a woman who had two girl children. She went on to have two more girl child but they were killed as soon as they were born. The fifth girl child survived few years because it is a belief that fifth child brings luck to the family! But when that fifth girl child became ill it was not given proper medical care and was allowed to die. A doctor started a private practise near my home. He came to know of all these happenings and he took the woman when she was pregnant again for a scan to know the sex of the baby (of course illegal!). But his stand is at least the baby can be aborted (if it is a girl) so that no cruel murder will take place. I really appreciate him. Fortunately the baby is a boy and the particular family were happy because their dream of having a boy child came true. To end the story the boy when he was around 15 years ran away from home and their dreams that the boy child will take care of them when they become old is shattered! The first two girl children are married at the tender age of 15 or so and the vicious cycle continues again. I am very young at that time to understand and think seriously about all these things. But I used to hear all these stories. That particular woman’s husband poured hot oil over her head when she is frying some snacks (because of a fight!). She used to sell those snacks to sustain her family. That is the plight of women living in such bad socio-economic conditions!

told my dad once ‘how horrible that woman is, she killed her babies as soon as they are born!’ My dad said, ‘You do not know about their social condition. Those women have no rights to take any decision. Even if she has decided to kill her babies, you must think about the situation which made a mother behave like that. The situation of female child in that particular community is not so good. They have to undergo all sorts of child abuse. When a mother feels that her child should not undergo the sufferings she has endured perhaps she decides to end the baby’s life at the very beginning. They do not have the money to afford many children and she cannot also avoid her in-law's or her husband’s pestering of having a boy child. If this has to change our society has to change. Our government has to implement programmes which will provide them job and education. Until the root cause of the problem like dowry, poverty and illiteracy is not cured these kind of female infanticide will continue to happen in our country’. He also said that ‘instead of curbing the root cause of the problem our government is trying to implement control measures which will lead ultimately to such happenings’. My dad was a judicial officer! I am angry with my dad for supporting that woman. I am angry at him for his inability to do anything. I thought ‘as a judge why can’t he put them behind bars'. Now I realize what he said is true.

When women from affluent socio-economic conditions sit in their comfort zone and talk about female foeticide I get angry. Actually what do they know? They should come out and move with those women to know what is actually happening (for sure they can’t even survive a single day in those conditions!). They should realise how horrifying the living condition of such women are! What kind of life those girl children are leading (filled with negligence, lack of education, lack of nutrition and sexual abuse)! People who fight against female foeticide talk about the foetus ‘right to life’. They never seem to care about what happens when the foetus really becomes a human with the ability to feel pain and emotions! As a woman struggling to have a baby I cannot support any form of killing (Baby, baby everywhere (even people abort or kill too!) but still I am unable to get one to shower my love :( ) But in case if I end up with multiple pregnancy and if I am advised to do selective abortion for the benefit of one foetus I will definitely go for it in order to give at least one of my offspring the best chance of survival. Am I a murderer then? So if parents do so in order to balance the family (having a boy and a girl) or to give their offspring the best economic condition by aborting an unwanted baby, is it wrong? Should we just be selfish to protect our species (we kill animals for recreation, for eating, we even kill chimpanzees and gorillas which are capable of learning languages and have emotions like us!, nobody cares about their pain or emotionsas much as we care for a human foetus which do not feel any pain or emotions.) and propagate our genes as much as possible and be careless once they come into the world and leave them with the attitude ‘let the best survive’, ‘let natural selection do its job!’. Until we are not able to change the living conditions of such women and girl children we have no rights to talk or comment about what they are doing with the foetus (or even the infant!) they create!

If our government implement laws to prevent female foeticide then people from poor socio-economic background try killing the infants after birth and if the law threatens them again they will just vanish leaving the girl child in dustbins. Why is our society so afraid of girl child? The answer is simple-dowry, poverty and illiteracy. Until these issues are addressed properly there is no point in creating laws to protect the female foetuses. Is PNDT successful in preventing female foeticide? Definitely not! It has only lead to gruesome murders (infanticide) and to the act of abandoning the girl child. What will happen if PNDT act is withdrawn? Women living in poor socio-economic conditions will benefit from it. They do not have to carry a baby all nine months only to kill or abandon them. The girl child who comes into this world unwelcomed need not have to face negligence, physical and emotional violence. If unwanted teenage pregnancies could be aborted for the benefit of the concerned female why can’t we provide that right to a couple (especially to a woman who is already facing a hell lot of socio-economic problems, in-law’s and husband’s torture) who want to complete their family with a girl or a boy?

Another main argument put forward by the social activists is, if female foeticide continues the ratio of female to male will dwindle. They insist that if it happens then violence against women will be more as males in our society will start fighting for the woman and try to own them. Females will be considered like a property. I do not think so, my view is a bit different. If the number of females available for marriage decreases, naturally the value of woman goes up in the marriage market which will ultimately lead to the eradication of dowry or the entire dowry system will be reversed (like a male has to offer dowry inorder to marry a woman).Why shouldn’t we let it happen? Let human's face the consequence of their deeds. Nature is so powerful and for sure it will bring back the balance in the human ecosystem.

Think it in this way-if you find a small baby and a young doctor getting drowned and if you have the chance to save only one of them who will you save? Saving a doctor is far more beneficial for the society isn’t it? Now think of a woman who is already tormented by our social system and her unborn foetus which cannot recognize pain and does not posses any emotions? Whose well-being will you consider first? If you still do not understand just consider the fact that the pitiful woman is once upon a time a foetus. Does it make sense now if you cannot take out the foetus inhibition from your brain? Let us first consider the happiness of our womankind who is in flesh and blood. Let us work towards their betterment and then we can think about the foetuses. Our society is simply not yet ready to consider the foetus ‘Right to Life’ when our fellow adult women are struggling for their ‘Right to Dignity’. My dad used to advise me when I use my emotions to judge a situation, ' Manju, be rational. In life there are only very few situations which demands you to decide with your heart (emotional thinking) and 99.9% of the time it is better to use your brain (rational thinking)'. I think this topic is also one such thing where your emotions should take a back seat.

Let me know what you think. All sorts of criticism are most welcome!

Saturday, March 3, 2012

What does scientific research say about improving oocyte/egg quality?

Oocyte quality is the most important determinant of IVF success. As a result of aging more chromosomal and spindle abnormalities accumulate in oocytes leading to increased incidence of infertility, foetal loss and birth defects like trisomy 21 or Down syndrome. Eggs obtained from younger women carry less genetic abnormalities and hence have higher chance of implanting and becoming a healthy baby. This is evident by the fact that women even after their menopause are able to get pregnant and carry the baby to term using donor eggs obtained from younger women.

When a woman undergoing IVF faces repeated failure, naturally the issue of egg quality crops up in the mind of infertility specialist and the patient. Unfortunately even after dramatic improvement in ART techniques, there is no sure way of saying whether an egg is competent enough (without genetic abnormalities) to produce an embryo which will subsequently implant and produce a baby. Although embryologists are able to select good embryos by observing their morphology under the microscope it doesn’t guarantee that the embryos are without abnormalities. A beautiful looking embryo of an older woman has more chance of being genetically defective than that of a younger woman. 

As a result older women as well as younger women who undergo repeated IVF failures are desperately searching for ways which would increase their egg quality and give them their most wanted wish-a baby! Infertility bulletin boards are filled with women who are determined to find a cure for their bad quality eggs. DHEA, metformin, melatonin, myo-inositol, wheat grass, anti-oxidants, fish oil, co-enzyme Q10, vitamins, especially vitamin D and other nutritional supplements are now-a-days extensively used by women to improve egg quality. Some of these substances used have scientific proof but some not. Selling supplements to improve egg quality is growing into a huge market as many businessmen are trying to make cash of our desperate situation. This led me to screen the scientific literature to find out what does science say really! Most of the experiments concerning oocyte quality are conducted in mice as it is difficult to do such experiments in humans for a number of reasons. 


Oxidative stress contributes to somatic aging and it is also implicated in reproductive aging. So experiments were done to see whether using anti-oxidants improve egg quality and reproductive parameters. The researchers supplemented mice with pharmacological doses of vitamin C and E (both are well-known antioxidants) during their early or late life. They found that administration of oral anti-oxidants counteracted the negative effects of female aging on oocyte number and quality (PMID: 11835584). Good news right! Please do not rush to the pharmacy. Their research finding is not yet complete! Even though they found a positive effect of these supplements on the oocyte level they also found that oral administration of pharmacological doses of vitamin C and E reduced reproductive fitness and impaired ovarian and uterine function of female mice. They also said that the antioxidant diet decreased the frequency of litters, litter size, total number of offspring born and survival of male pups to weaning (PMID:12054212). Shocking or? A very recent publication suggested that, when mice are given low concentration of N-acetyl-L-cysteine the quality of fertilized oocytes and early embryo development improved. It also improved the quality of oocytes in older mice (PMID: 22357770). 

Now the question is how seriously we should take these experiments? First we should keep in mind that these experiments are performed in mice. The next thing to remember is ‘nothing equals a good diet’. Do you feel that you are not able to eat enough vegetables and fruits a day? Is your medical condition preventing you from getting appropriate amounts of nutrition from your diet? Supplementing with a good vitamin pill is a nice thing to do. Otherwise the best way is to add colour to your life by eating different coloured vegetables and fruits. Remember darker their colour more is the anti-oxidant content in them. 


I am sure most of you will be aware of DHEA. If you google you will find lots of information about DHEA. Please visit CHR (Center for Human Reproduction) website for further details. DHEA was found to increase oocyte production (PMID: 16169414). The mechanism behind it is not so clear. DHEA is used in mice to induce PCOS phenotype in previously normal ovaries (PMID: 16514202). DHEA supplementation was also shown to decrease embryo aneuploidy (genetic defects) (PMID: 21067609). 

I have seen women who swear on DHEA for their IVF success. Many women even achieved natural pregnancies after taking DHEA. Will DHEA work for me? It might work. It worked for many but we should not also forget that it didn’t work for so many others. I am not trying to be negative, just trying to be cautiously optimistic. Try to monitor your thyroid levels and insulin levels when on DHEA (as it is found to affect both either in a positive or negative manner). Please remember that it is a steroid hormone and it is wise to be safe than sorry! 

Melatonin and Myo-inositol

Melatonin is a hormone produced in our body and it regulates circadiac rhythm. It has very powerful anti-oxidant properties and is found to protect nuclear and mitochondrial DNA (hence less genetic abnormalities) (PMID: 16217125). A recent publication concluded that melatonin is likely to improve oocyte and embryo quality in women undergoing IVF or ICSI but they found no statistical significance between the treated and non-treated group (PMID: 21770829). Melatonin was found to significantly improve thyroid function, reduce gonodotrophin levels, and in some women it helped in the re-acquisition of normal menstrual cycle. Furthermore, an abrogation of menopause-related depression, amelioration of hot-flashes and improvement of quality and duration of sleep has been reported. Myo-inositol is involved in several aspects of human reproduction. Elevated concentrations of myo-inositol in human follicular fluids appear to play a positive role in follicular maturity and also act as a marker for good quality oocytes. (I got this information from clinical identifier: NCT01115127)

Should I try it?

Why not? Both melatonin and myo-inositol are naturally synthesized in our body and supplementing them won’t be a bad idea (but please read about the side-effects of melatonin supplementation). But better way is to optimize your health and get sound sleep.

Vitamin D

A search for vitamin D and oocyte quality did not give any appropriate pubmed result. I am sure many publications will come in the future on this topic. But searching for vitamin D and fertility gave some interesting information. Human sperms express vitamin D. Serum concentration of vitamin D is positively associated with sperm motility (PMID: 21427118). It is also found to regulate a large number of genes in reproductive tissue (PMID: 22047005). Animal data show that low vitamin D status is connected with impaired fertility, endometriosis and polycystic ovary syndrome (PMID: 10232622). 

Are you living in a country where winter is harsh and there is very less sunlight? It is advisable to take vitamin D supplements. There is lot of contradictions regarding safe vitamin D dosage. According to the new guidelines the tolerable upper limit is 4000 IU for ages 9 and above. Vitamin D at very high doses is found to cause calcification of soft tissues including brain tissue and several other complications. Published cases of toxicity, for which serum levels and dose are known, all involve intake of ≥ 40000 IU (1000 mcg) per day (search in google for Vitamin D Council for further information).

In summary are you living in a country where you get ample sunlight? Then just roam around with no sunscreen and expose your skin to sun’s rays. Exposure to sun rays for 10 minutes will help your body synthesize 10,000 IU of vitamin D. You can do this without the fear of vitamin D toxicity because your skin has a built in mechanism to prevent vitamin D toxicity. Take vitamin D supplements if you live in a country where there are very less sunny days and monitor your serum vitamin D levels at appropriate intervals. 

Diet or calorie restriction

This section is the most interesting part of this article. I found a very high quality publication on this topic and this is means it is more reliable. Calorie restriction in the absence of malnutrition is found to slow down the aging process and extend lifespan. If calorie restriction can slow down the aging process of somatic cells does it has the ability to slow down oocyte aging too? The research says YES. Recently a publication in PNAS, which is a reputed, high-ranked journal, showed that calorie restriction showed striking beneficial effects on chromosomal, spindle and mitochondrial dynamics in mature oocytes of adult female mice at ages normally associated with poor reproductive parameters. The study said that calorie restriction vastly improved fertility in aged animals. When initiated during adulthood calorie restriction significantly extended reproductive lifespan and increased the survival rate of offsprings conceived by aging females. This study clearly states that old age induced oocyte aneuploidy and spindle defects can be safely circumvented using calorie restriction (PMID:21730149). The study is well-designed and very promising. Rhesus monkey maintained on calorie restriction diet into advanced age showed the same health benefits as in mice.

Should I start a calorie restricted diet?

Why not? But you should also remember that this study is done in mice. Sometimes animal studies cannot be translated to humans. Please remember to take a good nutritional supplement (especially folic acid) when you are on a calorie restricted diet. Our ancestors are wise enough to starve themselves (do a fast) atleast once a week. Calorie restriction comes with an added benefit, who wouldn’t love to look younger than their real age!!!


Metformin is a calorie restriction mimetic. It induces a dietary restriction like state (PMID: 20090912). It extends life span and is considered to be an anti-aging drug. It possesses anti-tumour properties. It activates genes which are induced during calorie restriction. So if calorie restriction preserves oocyte quality metformin can also do it! Hyperinsulinemic conditions are detrimental for oocyte quality. Metformin reduces insulin levels by decreasing insulin resistance and hence increases the egg quality of women suffering with PCOD.

Should I start metformin?

Are you diagnosed with PCOD? Do you have insulin resistance? Are you having poor egg quality because of PCOD? Metformin is for you. Do you have diminished ovarian reserve? Are you struggling to produce enough eggs? Then metformin is not for you. Metformin is known to reduce antral follicle count and when you are undergoing IVF number of eggs collected matters too!

Does lowering FSH and increasing AMH help me if I have poor egg quality?

FSH and AMH help to determine our ovarian reserve (egg quantity) and not egg quality (
 21133869), (
2073613). But as you age both egg quantity and egg quality starts to decrease simultaneously. This does not mean that egg quantity and quality are related. I think egg quantity and quality are two different events which has no connection to each other. This can be substantiated by the fact that younger women with diminished ovarian reserve are more likely to get pregnant and carry the baby to term even though they produce less amount of eggs during IVF stimulation (
21602123). On the other hand older women with low ovarian reserve are less likely to conceive. So both FSH and AMH should be just looked as markers for poor ovarian reserve and nothing more. This can be understood if the actual modes of action of these two hormones are studied in detail. Egg quality is something to do with our genetic machinery which has no connection to these two hormones. Decreasing FSH or increasing AMH is also less likely to increase follicle numbers. Actually increasing AMH artificially can bring down your antral follicle count. 

These are some of the important scientific information which every woman undergoing multiple IVFs should understand. I wish this will reduce their tension about what supplements to take and what not to take, what is realistic and what is not. But at the end if you think taking certain supplements (because your friend took a supplement and fell pregnant miraculously!) increases your confidence level go ahead and take it, provided it should be from a reliable pharmaceutical company. You should also know for sure that the particular supplement does not have any negative side-effects that will compromise your health. Good luck for every woman who is searching frantically for that single good egg which will make their dream come true!
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