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Papers by Rubina Merchant
Seminars in Reproductive Medicine, 2008
Polycystic ovary syndrome (PCOS) is a complex, multifaceted, heterogeneous disorder that affects ... more Polycystic ovary syndrome (PCOS) is a complex, multifaceted, heterogeneous disorder that affects $5 to 10% of women of reproductive age. It is characterized by hyperandrogenism, polycystic ovaries, and chronic anovulation along with insulin resistance, hyperinsulinemia, abdominal obesity, hypertension, and dyslipidemia as frequent metabolic traits (metabolic syndrome) that culminate in serious long-term consequences such as type 2 diabetes mellitus, endometrial hyperplasia, and coronary artery disease. It is one of the most common causes of anovulatory infertility. However, the heterogeneous clinical features of PCOS may change throughout the life span, starting from adolescence to postmenopausal age, largely influenced by obesity and metabolic alterations, and the phenotype of women with PCOS is variable, depending on the ethnic background. The etiology of PCOS is yet to be elucidated; however, it is believed that in utero fetal programming may have a significant role in the development of PCOS phenotype in adult life. Though a woman may be genetically predisposed to developing PCOS, it is only the interaction of environmental factors (obesity) with the genetic factors that results in the characteristic metabolic and menstrual disturbances and the final expression of the PCOS phenotype. Irrespective of geographic locations, a rapidly increasing prevalence of polycystic ovarian insulin resistance syndrome, excess body fat, adverse body fat patterning, hypertriglyceridemia, and obesity-related disease, such as diabetes and cardiovascular disease, have been reported in Asian Indians, suggesting that primary prevention strategies should be initiated early in this ethnic group. In lieu of the epidemic increase in the prevalence of obesity and diabetes mellitus in most industrialized countries including China and India owing to Westernization, urbanization, and mechanization, and evidence suggesting a pathogenetic role of obesity in the development of PCOS and related infertility, active intervention to combat the malice of these disorders is warranted. Pharmacologic therapy is a critical step in the management of patients with metabolic syndrome when lifestyle modifications fail to achieve the therapeutic goals, and studies in China and India have proved to be effective.
Springer eBooks, 2015
Single embryo transfer (SET) has been hailed as perhaps the only foolproof solution to avoid the ... more Single embryo transfer (SET) has been hailed as perhaps the only foolproof solution to avoid the incidence of multiple pregnancy, a significant complication of assisted reproductive technology (ART). While SET has remained successful in its motive of avoiding multiple pregnancy, the challenge of ensuring a positive clinical pregnancy and eventually a live birth following SET still looms. As the choice that determines that the ‘best amongst the rest’ of embryos implant in a multiple embryo transfer is eliminated in SET, the pressure to ensure that ‘only the best’ single embryo is transferred and yields a high probability of pregnancy mounts in SET. Several factors, such as patient selection, embryo quality, uterine receptivity and, most importantly, the embryo transfer (ET) technique itself, play a role in ensuring a high possibility of success following SET. While these factors are also common to the success of ET involving the transfer of multiple embryos, the significance of the SET technique would seem higher owing to the absence of embryo selection for implantation in the uterine cavity, the additional efforts to ensure the high quality of the single embryo transferred, and the emotional, psychological and financial involvement of the patient. A carefully planned, ultrasound-guided atraumatic ET technique that avoids difficult transfers and factors predictive of a poor outcome would go a long way to optimise clinical outcomes with SET.
Jaypee Brothers Medical Publishers (P) Ltd. eBooks, 2018
Cambridge University Press eBooks, Feb 9, 2015
Jaypee Brothers Medical Publishers (P) Ltd. eBooks, 2009
Fertility and Sterility, Apr 1, 2003
less past drug usage (9%) than the general American population (38.9%). Also, the rate of current... more less past drug usage (9%) than the general American population (38.9%). Also, the rate of current alcohol use in our patients (46.2%) is similar to the national rate (48.3%). ASRM guidelines do not include urine toxicology screening. It may be desirable to screen potential oocyte donors with urine toxicology testing, as donors may not fully disclose details of drug use.
Cambridge University Press eBooks, Feb 9, 2015
Comprehensive Textbook of Sexual Medicine, 2014
The Art and Science of Assisted Reproductive Techniques (ART), 2018
The Art and Science of Assisted Reproductive Techniques (ART), 2018
Manual of Ovulation Induction and Ovarian Stimulation Protocols, 2016
Manual of Ovulation Induction and Ovarian Stimulation Protocols, 2016
Seminars in Reproductive Medicine, 2008
Polycystic ovary syndrome (PCOS) is a complex, multifaceted, heterogeneous disorder that affects ... more Polycystic ovary syndrome (PCOS) is a complex, multifaceted, heterogeneous disorder that affects $5 to 10% of women of reproductive age. It is characterized by hyperandrogenism, polycystic ovaries, and chronic anovulation along with insulin resistance, hyperinsulinemia, abdominal obesity, hypertension, and dyslipidemia as frequent metabolic traits (metabolic syndrome) that culminate in serious long-term consequences such as type 2 diabetes mellitus, endometrial hyperplasia, and coronary artery disease. It is one of the most common causes of anovulatory infertility. However, the heterogeneous clinical features of PCOS may change throughout the life span, starting from adolescence to postmenopausal age, largely influenced by obesity and metabolic alterations, and the phenotype of women with PCOS is variable, depending on the ethnic background. The etiology of PCOS is yet to be elucidated; however, it is believed that in utero fetal programming may have a significant role in the development of PCOS phenotype in adult life. Though a woman may be genetically predisposed to developing PCOS, it is only the interaction of environmental factors (obesity) with the genetic factors that results in the characteristic metabolic and menstrual disturbances and the final expression of the PCOS phenotype. Irrespective of geographic locations, a rapidly increasing prevalence of polycystic ovarian insulin resistance syndrome, excess body fat, adverse body fat patterning, hypertriglyceridemia, and obesity-related disease, such as diabetes and cardiovascular disease, have been reported in Asian Indians, suggesting that primary prevention strategies should be initiated early in this ethnic group. In lieu of the epidemic increase in the prevalence of obesity and diabetes mellitus in most industrialized countries including China and India owing to Westernization, urbanization, and mechanization, and evidence suggesting a pathogenetic role of obesity in the development of PCOS and related infertility, active intervention to combat the malice of these disorders is warranted. Pharmacologic therapy is a critical step in the management of patients with metabolic syndrome when lifestyle modifications fail to achieve the therapeutic goals, and studies in China and India have proved to be effective.
Springer eBooks, 2015
Single embryo transfer (SET) has been hailed as perhaps the only foolproof solution to avoid the ... more Single embryo transfer (SET) has been hailed as perhaps the only foolproof solution to avoid the incidence of multiple pregnancy, a significant complication of assisted reproductive technology (ART). While SET has remained successful in its motive of avoiding multiple pregnancy, the challenge of ensuring a positive clinical pregnancy and eventually a live birth following SET still looms. As the choice that determines that the ‘best amongst the rest’ of embryos implant in a multiple embryo transfer is eliminated in SET, the pressure to ensure that ‘only the best’ single embryo is transferred and yields a high probability of pregnancy mounts in SET. Several factors, such as patient selection, embryo quality, uterine receptivity and, most importantly, the embryo transfer (ET) technique itself, play a role in ensuring a high possibility of success following SET. While these factors are also common to the success of ET involving the transfer of multiple embryos, the significance of the SET technique would seem higher owing to the absence of embryo selection for implantation in the uterine cavity, the additional efforts to ensure the high quality of the single embryo transferred, and the emotional, psychological and financial involvement of the patient. A carefully planned, ultrasound-guided atraumatic ET technique that avoids difficult transfers and factors predictive of a poor outcome would go a long way to optimise clinical outcomes with SET.
Jaypee Brothers Medical Publishers (P) Ltd. eBooks, 2018
Cambridge University Press eBooks, Feb 9, 2015
Jaypee Brothers Medical Publishers (P) Ltd. eBooks, 2009
Fertility and Sterility, Apr 1, 2003
less past drug usage (9%) than the general American population (38.9%). Also, the rate of current... more less past drug usage (9%) than the general American population (38.9%). Also, the rate of current alcohol use in our patients (46.2%) is similar to the national rate (48.3%). ASRM guidelines do not include urine toxicology screening. It may be desirable to screen potential oocyte donors with urine toxicology testing, as donors may not fully disclose details of drug use.
Cambridge University Press eBooks, Feb 9, 2015
Comprehensive Textbook of Sexual Medicine, 2014
The Art and Science of Assisted Reproductive Techniques (ART), 2018
The Art and Science of Assisted Reproductive Techniques (ART), 2018
Manual of Ovulation Induction and Ovarian Stimulation Protocols, 2016
Manual of Ovulation Induction and Ovarian Stimulation Protocols, 2016