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Siladitya Bhattacharya

Publications and source records attributed to Siladitya Bhattacharya.

At least 19 recordsLinked to original sources
PubMed2007

An investigation of the effects of endometriosis on the proteome of human eutopic endometrium: a heterogeneous tissue with a complex disease.

The pathogenesis of endometriosis includes the proliferation of heterogeneous endometrial cells and their invasion into ectopic sites within the peritoneal cavity. This may be due to abnormalities of the eutopic endometrium itself, predisposing the cells to survive and implant ectopically. We investigated the applicability of 2-DE gels and peptide mass mapping to identify candidate endometrial proteins with a role in endometriosis. Despite the heterogeneous nature of endometrium, our results show that combining the analysis of 2-DE gels and peptide mass mapping yields consistent data. We identified dysregulated proteins in women with endometriosis which included: (i) molecular chaperones including heat shock protein 90 and annexin A2, (ii) proteins involved in cellular redox state, such as peroxiredoxin 2, (iii) proteins involved in protein and DNA formation/breakdown, including ribonucleoside-diphosphate reductase, prohibitin and prolyl 4-hydroxylase, and (iv) secreted proteins, such as apolipoprotein A1. These proteins have functions which suggest that they could play a role in the pathogenesis of endometriosis. This study demonstrated that 2-DE gel analysis and mass spectroscopic protein identification are suitable for the identification of proteins with candidate associations with endometriosis. These techniques should be used on a larger scale to identify endometriosis-related proteins, thus improving the understanding of this complex disease.

Adult↗
PubMed2006

Trends in semen parameters in the northeast of Scotland.

The data on trends in semen quality are conflicting and sensitive to geographical variations. Although previous British surveys on semen quality indicate a decline, the northeast of Scotland has never been included in these surveys. This is an area with low out migration rates where andrology services for a population of 500 000 are centralized within a single laboratory, thus providing a unique opportunity to study population-based trends in semen quality over time. We investigated trends in semen parameters between 1994-2005, in a cohort of 4832 men attending for routine semen analysis at the Aberdeen Fertility Centre who had a sperm density of greater than 20 million per mL. The main outcome measures were trends in sperm density, sperm motility and motile density in the first semen sample. Linear regression and time series analysis were used to examine trends over time in the semen parameters. The mean and standard deviation (SD) age of all men (n=5204) in the study was 34(6) years. The median (inter quartile range) for sperm density and motile density for the study population were 61 (40-91) million/mL and 99 (47-181) million. The mean (SD) sperm motility was 49 (19)%. Among 4832 men (with sperm count >20 million per mL), data adjusted for age and period of abstinence showed a decreasing trend for sperm density over time, R2=0.45 (P=.017). There was no such trend in sperm motility and motile density. However, this trend has to be interpreted with caution due to fluctuations in semen parameters, population bias and the retrospective nature of the analysis.

Adolescent↗
PubMed2006

Assessment of ovarian reserve--should we perform tests of ovarian reserve routinely?

Women undergoing IVF are routinely subjected to one or more tests of ovarian reserve. The results of these tests are also being extrapolated to women attending infertility clinics and those planning to delay childbearing. This debate examines the predictive power of currently available tests of ovarian reserve and questions the value of subjecting women to ovarian reserve tests. We propose that in the absence of an agreement on (i) a definition of poor ovarian reserve, (ii) the population to be tested and (iii) which interventions are effective in women with poor ovarian reserve, routine ovarian reserve testing is unhelpful.

Estradiol↗
PubMed2006

Research as a therapeutic experience? An investigation of women's participation in research on ending IVF treatment.

BACKGROUND: Women participate in research for many reasons, some of them therapeutic. This paper retrospectively analyses women's motivations for participating in a study on decision making at the end of in vitro fertilization (IVF) treatment. METHODS: A mixed methods study conducted by a practising midwife had focused on women's experiences of stopping IVF treatment after one or more unsuccessful attempts, and raised awareness of women's motivations for participating. Thematic analysis of interview transcripts permitted issues raised by the participants in the context of 'research as a therapeutic experience' to be explored. RESULTS: Reasons for participating in the study included: (1) altruism; (2) appreciation/gratitude for care received; (3) the need to debrief; and (4) gaining self-awareness and readjustment, which challenged the acceptance of childlessness. Reasons for using the research study as 'a therapeutic experience' in the context of failed IVF may be attributed to: (1) access to direct clinical care and advice; (2) opportunity for self-reflection and rationalization; (3) acceptance of reality; (4) resolution of conflict; and (5) opportunity to unburden themselves. CONCLUSION: Women appeared to use the interview process to reassure themselves about decisions made, and to seek direct clinical advice on whether to continue IVF using donor gametes.

Adult↗
PubMed2006

Conscious sedation and analgesia for oocyte retrieval during IVF procedures: a Cochrane review.

BACKGROUND: Various methods of sedation and analgesia have been used for pain relief during oocyte recovery during IVF. OBJECTIVE: To compare conscious sedation and analgesia with alternative methods for pain relief and pregnancy outcomes. METHODS: We searched the Specialised Register of the Menstrual Disorders and Subfertility Group, the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, the National Research Register and Current Controlled Trials up to February 2004. RESULTS: Twelve trials were included. Owing to considerable heterogeneity, regarding types and dosages of sedation or analgesia used, and tools used to assess pain, a meta-analysis was attempted only in trials where appropriate data were available. Clinical pregnancy rates per woman in individual trials were comparable. Data on pain showed conflicting results. CONCLUSION: No single method or delivery system appeared superior for pregnancy rates and pain relief. Future studies need to be consistent in the choice of tools used to measure pain and the timing of such evaluations.

Analgesia↗
PubMed2006

Obstetric outcome in women with threatened miscarriage in the first trimester.

OBJECTIVE: To assess pregnancy outcomes in women with threatened miscarriage in the first trimester. METHODS: This was a retrospective cohort study based on data extracted from the Aberdeen Maternity and Neonatal Databank. Cases included all primigravid women with first-trimester vaginal bleeding who delivered after 24 weeks of gestation between 1976 and 2004. The control group comprised all other women who had first pregnancies during the same period. Data were analyzed by univariate and multivariate statistical methods. RESULTS: Compared with the control group (n = 31,633), women with threatened miscarriage (n = 7,627) were more likely to have antepartum hemorrhage of unknown origin (odds ratio [OR] 1.83, 95% confidence interval [CI] 1.73-2.01). Elective cesarean (OR 1.30, 95% CI 1.14-1.48) and manual removal of placenta (OR 1.40, 95% CI 1.21-1.62) were performed more frequently in these women, who also had a higher risk of preterm delivery (OR 1.56, 95% CI 1.43-1.71) and malpresentation (OR 1.26, 95% CI 1.13-1.40). Threatened miscarriage in the first trimester is required in 112, 112, 17, 85, 32 patients, respectively, for each additional case of manual removal of placenta, elective cesarean, antepartum hemorrhage of unknown origin, malpresentation, and preterm delivery. CONCLUSION: Pregnancies complicated by threatened miscarriage are at a slightly higher risk of obstetric complications and interventions. LEVEL OF EVIDENCE: II-2.

Abortion, Threatened↗
PubMed2005

Unfulfilled expectations: how circumstances impinge on women's reproductive choices.

Throughout Europe women are having fewer babies, but more of them are being delivered by caesarean section. There is some evidence that this major surgical procedure discourages women and/or their partners from having further children. This study is aimed at ascertaining the extent to which mode of delivery in first confinement affected women's decision-making about having another child. This paper reports results from (1) a questionnaire sent to 5300 women who delivered their first baby in Aberdeen in northeast Scotland between 1980 and 1995, but who did not have another viable pregnancy within 5 years, and (2) in-depth interviews with a stratified random sample of 82 of these respondents which covered experiences of birth, decision-making about subsequent pregnancies and infertility. Verbatim transcripts were analysed thematically. Questionnaires were returned by 3204 women (60%). Among those who had no further pregnancies, 1182 (71%) had deliberately limited their fertility. Of those who had a second child, 696 (66%) deliberately left a gap of 5 or more years between them. The factors which apparently influenced the decision to limit fertility included early intention, experience of the first, or index birth, health, lifestyle, influence of partner, age, first child and fertility problems. In interviews, women presented these factors as constraints on their behaviour, which restrained them from freely choosing to have more children and in some cases to have the number they had planned. As the decision to have only one child or to leave a large gap between children is unusual, women may have been presenting their choices in this way to make their actions appear more socially acceptable and their motivations as blameless.

Adult↗
PubMed2005

Which surgical decisions should patients participate in and how? Reflections on women's recollections of discussions about variants of hysterectomy.

Current guidance about informed consent suggests patients ought to know about the procedures involved in any treatments they agree to undergo, and have a right to be involved in decisions about their care. However, it is not clear how this guidance is and should be applied to decisions between variant surgical procedures such as abdominal or vaginal hysterectomy. We sent structured questionnaires about information provision and decision-making to 157 women who were scheduled for hysterectomy in north-east Scotland. A purposive sub-sample of 20 women was interviewed in depth post-operatively. 104 women (66%) responded to the questionnaires. 75% reported being told at outpatient clinics what kind of hysterectomy they would have, but fewer than half had been told about the advantages and disadvantages of different kinds. Between 26% and 65% of women thought they had been given too little information about various issues pertaining to different types of hysterectomy. The interview accounts suggested that gynaecologists offered women little opportunity to influence the selection of a surgical procedure. Women did not express a desire for a greater say in this selection, but appreciated being told, or would have liked to know, why particular procedures were recommended for them. There may be circumstances in which it is important for surgeons to tell patients about options they have ruled out in their particular cases. Decisions between alternative surgical procedures are often highly contingent on the dispositions and skills of individual surgeons. They raise practical and ethical issues that have been neglected in recent discussions about patient involvement in decision-making. As policy makers continue to emphasise the importance of choice and patients become increasingly aware of the existence of variant procedures, these issues need careful consideration.

Adult↗
PubMed2005

Investigation of staff and patients' opinions of a proposed trial of elective single embryo transfer.

BACKGROUND: In the context of mounting concern about the risks of twin pregnancies resulting from IVF, this study aimed to assess staff and patients' attitudes towards a proposed randomized controlled trial (RCT) of elective single embryo transfer (SET) in a Scottish fertility centre. METHODS: The views of 10 members of IVF clinic staff were assessed by means of a focus group and those of 12 couples by semi-structured interviews. RESULTS: Staff were aware of the risks of twin pregnancies to mothers and babies and the need for evidence of success in SET, but had reservations about the proposed RCT. The need to subject patients to unpopular scientific procedures such as randomization and blinding conflicted with their perceived caring role. They felt it would be hard to recruit and onerous to patients but nevertheless discussed how it could be successfully mounted if necessary. They debated how to ensure that consent was fully informed, and when, and how, to randomize. Patients accepted the possibility of twins but were largely unaware of risks inherent in twin pregnancies. They saw no need for a trial and found the idea of randomization unacceptable except in younger women. They would accept SET if it became unit policy and appeared unaffected by financial considerations. CONCLUSIONS: Involving affected staff at the design stage may make it easier to conduct a SET trial in their clinics. IVF patients whose ultimate goal is pregnancy are less likely to support a trial which aims to minimize twin pregnancies.

Adult↗
PubMed2005

Number of embryos for transfer after IVF and ICSI: a Cochrane review.

BACKGROUND: The most common complication of IVF is multiple pregnancy, which occurs in 25% of pregnancies following the transfer of two embryos. Single embryo transfer can minimize twin pregnancies but could also lower live birth rates. Our aim was to perform a systematic review of randomized trials to determine the effectiveness of single versus double embryo transfer. METHODS: Cochrane Collaboration review methods were followed. Randomized controlled trials comparing single and double embryo transfers were identified by searching Medline, EMBASE and the Cochrane register of controlled trials. Contents of specialist journals and proceedings from meetings of relevant societies were hand searched. Data were pooled with Rev Man software using the Peto-modified Mantel-Hanzel method. RESULTS: Pooled results from four trials indicate that although double embryo transfer leads to a higher live birth rate per woman [odds ratio (OR) 1.94, 95% confidence interval (CI) 1.47-2.55] in a fresh IVF cycle, comparable results are obtained by subsequent transfer of a frozen embryo (OR 1.19, 95% CI 0.87-1.62). The multiple pregnancy rate is significantly higher (OR 62.83, 95% CI 8.52-463.57) after double embryo transfer. CONCLUSIONS: Single embryo transfer significantly reduces the risk of multiple pregnancy, but also decreases the chance of live birth in a fresh IVF cycle. Subsequent replacement of a single frozen embryo achieves a live birth rate comparable with double embryo transfer.

Adult↗
PubMed2005

Obstetric outcome in women with subfertility.

BACKGROUND: It has been suggested that a history of subfertility is associated with increased obstetric and perinatal risks. It is unclear if the cause is inherent characteristics in the women or the fertility treatment. OBJECTIVES: To compare the obstetric and perinatal risks of singleton pregnancies in women with a history of subfertility in comparison with the general population. DESIGN: Population cohort. SETTING: Aberdeen, Scotland. POPULATION: Cases were women attending the Fertility Clinic between 1989 and 1999 who subsequently went on to have singleton pregnancies. Controls included the general population of women who delivered singletons over the same period. METHODS: We performed a retrospective cohort study to investigate the obstetric outcome of singleton pregnancies in women with subfertility. The general population of women who delivered singletons over the same period served as controls. MAIN OUTCOME MEASURES: Obstetric and perinatal complications in singleton pregnancies. RESULTS: Maternity records were available for a total of 1437 subfertile women and 21,688 controls. Subfertile women were older [mean (SD) age: 31 (4.7) years vs 27 (5.4) years, P < 0.01] and more likely to be primiparous (70% vs 65%, P < 0.001). After adjusting for age and parity, subfertile women were at increased risk of pre-eclampsia (OR 1.9, 95% CI 1.5-2.5), placenta praevia (OR 3.9, 95% CI 2.2-7.0) and placental abruption (OR 1.8, 95% CI 1.1-3.0), and more likely to undergo induction of labour (OR 1.5, 95% CI 1.3-1.6), caesarean section (OR 2.1, 95% CI 1.8-2.4) and instrumental delivery (OR 2.2, 95% CI 1.8-2.6), and deliver low birthweight (OR 1.4, 95% CI 1.3-1.7) and preterm (OR 1.7, 95% CI 1.2-2.2) infants. There were no differences between treatment-related and treatment-independent pregnancies. CONCLUSION: Subfertile women are at higher risk of obstetric complications, which persist after adjusting for age and parity.

Adult↗
PubMed2004

What is the most relevant standard of success in assisted reproduction? Redefining success in the context of elective single embryo transfer: evidence, intuition and financial reality.

Treatment-related multiple pregnancy poses the biggest threat to the safety of IVF. Despite a double embryo transfer (DET) policy in most European centres, twin rates continue to be unacceptably high, at 20-35%. Elective single embryo transfer (SET) is an effective way to minimize twin pregnancies, but the debate surrounding its routine clinical use continues. A review of the literature was undertaken in order to seek evidence about the effectiveness of SET, and identify barriers to its acceptance in clinical practice. Data from randomized controlled trials (RCTs) indicate that SET results in lower live birth rates per fresh IVF cycle (odds ratio 0.53; 95% confidence interval 0.31-0.89; P = 0.02) in comparison with DET. Data on cumulative live birth rates are unavailable from RCTs, although the expectation is that these are comparable in the two groups. SET is unlikely to be suitable for all women undergoing IVF and outcomes may be sensitive to different laboratory protocols. The perceived effectiveness of SET is influenced by the way existing evidence is interpreted. Other factors affecting the routine use of SET include laboratory techniques, individual preferences and funding issues.

Embryo Transfer↗
PubMed2004

Role of utero-ovarian vascular impedance: predictor of ongoing pregnancy in an IVF-embryo transfer programme.

The objective of this study was to evaluate the role of uterine, endometrial and follicular blood flow in prediction of ongoing pregnancy after assisted conception. A prospective observational study was conducted on 53 women undergoing IVF treatment. Transvaginal colour and pulsed Doppler measurements were performed on the day that pituitary suppression was confirmed, on day 10 of ovarian stimulation and on the day prior to human chorionic gonadotrophin injection. On the last day of ovarian stimulation, blood flow in the ascending uterine artery of the women who would conceive was characterized by significantly lower pulsatility index values. Sub-endometrial vascular impedance was comparable in the pregnant and non-pregnant groups. There were no differences in the perifollicular vascularity between pregnant and non-pregnant women. The chance of achieving pregnancy predicted by uterine artery Doppler and perifollicular blood flow in women whose PI values were higher than 3.26 and 1.08 was very low, with a sensitivity of 1.00 and specificity of 0.59 and 0.82 respectively. The data provide evidence for an association between utero-ovarian perfusion and reproductive outcome following IVF treatment. Uterine and ovarian vascular impedance values identify those women whose pregnancy chances are significantly limited. Measures to decrease vascular impedance in such women might enhance pregnancy rates by improving embryo quality and uterine receptivity for implantation.

Embryo Transfer↗
PubMed2004

Ending in-vitro fertilization: women's perception's of decision making.

This study was undertaken to assess patient satisfaction with the decision making process as well as with the decision made at the end of in-vitro fertilization (IVF) treatment. Couples who had decided to end treatment after unsuccessful IVF at a single hospital within the last 24 months were invited to complete a questionnaire. Valid questionnaires were returned by 71 (51%) out of a total of 139 couples. Sixty-nine (97%) questionnaires were completed by the female partner. Most women (73%) felt that they were adequately informed about the issues important to the decision. Fifty-eight women (81%) were involved with the decision making process; 38 (58%) felt supported by the clinic doctor and 41 (62%) were satisfied with the decision made. In response to a number of questions about information provision, few women (18 - 24%, depending on the individual question) felt that they had received enough information from the IVF clinician about advantages and disadvantages of stopping treatment and options such as adoption and fostering. Women contemplating the end of IVF treatment appear to be satisfied with the clinician's attitude, the decision making process and the decision made. While information provided during the final consultation is felt to be adequate for decision making, discussion about certain important options such as adoption and fostering could be more detailed.

Adult↗