Hope for the childless
By Esther Williams
The scanned image of the male reproductive structure showed the manner in which blood supply to these organs was functioning. It was found that the drainage of blood through the venous blood vessels was affected. "Such impairment of blood flow could affect the movement, count and even the normality of the structure of sperms," Prof. Harsha Seneviratne, Consultant Obstetrician and Gynaecologist says.

The couple in question was being investigated for infertility. Initial tests indicated that both husband and wife required further testing.

One of the tests that was required before a plan of treatment could be designed was an ultrasound scan of the abdomen/ reproductive system of the husband.

Since it was possible to quantify the extent to which the blood flow had been affected, a decision had to be made; whether or not the patient required a surgical option offering medical treatment.

This facility (ultra sound scan with colour Doppler) is now available at the Vindana Reproductive Health Centre, an added facility in their whole range of treatments.

It is at Vindana that the first local team performed In Vitro Fertilization (IVF) and successfully delivered two babies in the last two years. In addition there are several more ongoing pregnancies.

Higher levels of technologies have been added over the years in IVF and further introduction of newer techniques continues by collaborating with a reputed team from the UK.

Their infertility services include: basic investigations and treatments at Level 1, stimulating the ovaries with medication and placing the husband's sperm directly in the womb of the wife at Level II and test tube babies at Level III.

Evaluating male infertility clinically and by lab tests is done by their latest addition, the ultrasound scan assessment.

Treatment of such problems by way of more advanced technology such as the separation of sperms of best quality, storage of sperms for future use and intra-uterine insemination followed by the most advanced technologies in assisted reproduction such as IVF and Intracytoplasmic Sperm Injection (ICSI).

Vindana's facilities have thus been enhanced, providing for reproductive health from adolescence to the menopausal years, and in particular the management of infertility, high-risk pregnancies and a range of gynaecological disorders. "In the whole process," Dr. Harsha Seneviratne adds, "we are only promoting or giving a better chance for the sperm and ova to meet, thereby assisting nature.

The final fertilization takes place according to the natural phenomenon. All advances in fertility treatment, when you go beyond the basic level, involve fine tuned biological techniques.

Equipment and material have to be invariably imported. The cost of such techniques is an ever-present barrier to expanding the facility to all who need it.

An ultrasound scan is an indirect assessment of a structure living within the body. "Therefore however advanced the machine is it has its limitations whereby all abnormalities cannot be detected. It cannot be used to replace other forms of assessment, as it remains a tool for study," the doctor reiterates.

One in five couples have fertility problems. This could be attributed to social changes - People are driven to advancing their career prospects and status, causing stress that has affected lifestyles and the whole bio-system. Further, there is a marked change in the type and quality of food consumed.

Because of smoking, alcohol and ever-present pollution, life has deteriorated, especially in the urban society, causing all kinds of health complications, even in reproductive health.

However, it is heartening to note that men are coming forward voluntarily for investigations.

Explaining that this is due to better awareness and education, Dr. Seneviratne says that the blame that was previously shifted to women is very subtly changing. "Couples seem to support each other much better now."

Showing the way
Vindana conducted a workshop for medical staff (radiologists and gynaecologists) on January 8 and 9, providing an opportunity for them to gain knowledge and guidance in using the ultrasound scanning machine with colour doppler. Dr. S. Suresh, Director of Mediscan Systems: Diagnostic Ultrasound Research and Training Centre, Chennai was their resource person.

An applications expert from the Hitachi Ultrasound Company also fine-tuned the machine to the needs of the scanning practices of doctors and trained them in the use of this machine. The entire workshop had very active interaction between resource persons and participants.

Ultrasound Scans:
Ultrasound scans are images of the internal organs created from sound waves.

The images are produced when the sound waves are directed into the body then reflected back to a scanner that measures them.

Ultrasound scanning is used to help monitor and diagnose conditions in many parts of the body, including the kidneys, the liver and the heart. It is often used to examine conditions affecting the organs in a woman's pelvis - the uterus, fallopian tubes and ovaries.

It is not dangerous and has no side effects, so is considered safe to use during pregnancy.

The ultrasound scanner looks like a small paint roller.

As it moves back and forth over the body, it sends sound waves through the skin and muscles.

These waves are then turned into an image that appears on a TV screen. The scanner can be used externally on the skin, or through the natural openings of the body, such as the vagina.

It has revolutionized the care of women during pregnancy. The scan can be copied onto paper or an X-Ray film.

Battling anaemia in Sri Lanka
In Sri Lanka, hundreds of residents are taking an unusual taste test. They're sampling a variety of local breads and bread products to see whether they can detect anything unusual in any of the items. Do the testers notice a flavor of rusty nails in a sample of flat bread, for instance? Do they smell anything peculiar in a particular cookie?

Though the test may seem like a challenge for epicures, its ultimate goal is to conquer anaemia among Sri Lanka's 18 million residents.

Estimates indicate that half the women in Sri Lanka and throughout Southeast Asia have the disorder, the most common nutritional disorder in the world, says Rebecca Stoltzfus, assistant professor of nutrition at the School of Public Health. "Southeast Asia is probably the worst area in the world for iron deficiency," she says. Anaemia lowers a person's ability to think, decreases productivity, and increases the risk of infection.

Pregnant women with anaemia have a greater risk of dying in pregnancy or childbirth.

In children, anemia can retard growth and mental development. "As countries develop and get rid of other nutritional problems, anaemia hangs on," says Stoltzfus, particularly in places where people consume few animal products, which supply iron.

Parasites like hookworm also contribute to anaemia by eating blood, which stores most of the body's iron.

With the United States Agency for International Development and the Sri Lankan government, Stoltzfus is developing a program to reduce anaemia by fortifying all Sri Lanka's wheat flour with iron.

Step one are the taste tests, to see whether volunteers can taste or smell iron in various breads, pastas, crackers, and cookies prepared with iron-fortified flour.

"Food fortification is a good intervention," says Stoltzfus. "It's extremely inexpensive. The cost-benefit analysis becomes meaningless."

Furthermore, wheat is a prime food to fortify in Sri Lanka, she says, since it comprises about 40 percent of the nation's staple calories.

All the country's wheat is imported from the U.S. and processed at one mill.

Adding iron to the nation's wheat would be relatively simple.

So why hasn't it been done already?

One stumbling block is that scientists first need to find out how much iron and what type of iron should be used. "We'd like to pack in as much iron as we can without it tasting like rust," says Stoltzfus.

Bread with too much iron won't be palatable, and consumers won't buy it. So the products in the taste test contain varying amounts.

The bread products also contain five different forms of iron, ranging from ones that are highly bio-available (more likely to be absorbed by the blood supply) to those that are of low bio-availability (thus more likely to be excreted).

Ideally, says Stolzfus, "we'd like to pick the highest level of bio-avail- ability.
But when you use iron that is more bio-available it can react with the fats in the bread," she says.

"The bread ends up tasting like nails, or the color changes to green, or the bread doesn't rise as well."

For phase two of the project, Stoltzfus and her colleagues are designing a study to monitor the levels of haemoglobin (the iron-carrying molecule found in red blood cells) and rates of anaemia in people who are eating fortified flour.

The study seeks to make sure that fortification really does increase their blood iron levels.


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