Dr. Keshav Malhotra MBBS. MCE holds a Masters’s degree in Clinical Embryology from Monash university Australia and is one of the few ESHRE-certified Clinical Embryologists from INDIA. He is the Lab Director of Rainbow IVF and now the Director of Malhotra Embryology Training Academy. Dr. Malhotra is the Co-chair of SIG Embryology for ASPIRE (Asia Pacific Initiative on Reproduction), and he is also on the executive board of ISAR(Indian Society of Assisted Reproduction) and ISPAT(Indian Society for Prenatal Diagnosis and Therapy). He has worked on Key projects pertaining to Embryology in India like the Occupational Standard for Embryologists (Healthcare Sector Skill Council India-2018) and the ISAR – Embryology Consensus 2019. He was recognized as Budding Embryologist of the Year by Economic Times INDIA -2019.
SpOvum® got an opportunity to present its product portfolio to Dr. Keshav Malhotra, who visited SpOvum on 16th Dec 2022. He was fascinated by the RoboICSI workbench especially the one-click sperm immobilization feature of the RoboICSI workbench. Dr. Keshav was really excited when he tried out using the button-based controller and the one-click immobilization feature by himself.
Dr. Keshav Malhotra with Founder Directors of SpOvum
Dr. Keshav appreciated the stiffness estimation experiments on mouse embryos and the vision of applying the observations and their insights in the embryo monitoring system using the AI and ML of SpOvum.
He had some wonderful questions and a few good suggestions and was appreciative of SpOvum’s initiative in bringing innovations to the A.R.T. space through Robotics, Automation, and AI.
From left to right: Kishor, Santosh, Dr. Keshav Malhotra, Ramnath, and Kunal
One-click immobilization feature of the RoboICSI workbench displayed on the screen
World Health Organization (WHO) defines Infertility as Failure to achieve pregnancy after 12 months or more of regular unprotected sexual intercourse.
Here are some of the misconceptions about Infertility.
Myth 1: Treatment for Infertility is complex and expensive It depends upon the condition of the patient. Depending upon the degree of the complexity of the situation different procedures like Ovulation Induction (OI), Intra Uterine Insemination (IUI), and Invitro fertilization (IVF) are available. The procedures need not be complex and expensive. Except for the case of IVF, others are out-patient treatments
Myth 2: Infertility is due to a female’s inability On the contrary, males contribute significantly to infertility[1].
Myth 3: Infertility treatment assures success Depending upon several aspects the success rate is estimated to be about 40% or more[2]
Myth 4: Infertility treatment is affordable only to the Rich Indian medical eco-system is making conscious efforts in ensuring that the treatment is accessible and affordable without compromising on quality.
Myth 5: Infertility treatment can be taken at any age While it seems to be true age plays a significant role in achieving success. The odds of success improve if one takes it at an earlier age.[3]
Let’s collaborate…
If you have questions or if you want to be a part of this myth-busting venture about infertility and conception using ART, you can reach out to contact@spovum.com or send a message on 9513646022
“If you or anyone you know need help in and around Bagalkote reach out to Mane Hospital’s LifeNu IVF Center. It is quite accessible and affordable. It is situated very close to both the Railway station as well the Bus Stand of Bagalkote. LifeNu in collaboration with SpOvum intends to bring the best in class ART technology to its patients!”
– LifeNu IVF Center, Mane Hospital
References:
Kumar N, Singh AK. Trends of male factor infertility, an important cause of infertility: A review of literature. J Hum Reprod Sci. 2015 Oct-Dec;8(4):191-6. doi: 10.4103/0974-1208.170370. PMID: 26752853; PMCID: PMC4691969.https://pubmed.ncbi.nlm.nih.gov/26752853/
Malhotra N, Shah D, Pai R, Pai HD, Bankar M. Assisted reproductive technology in India: A 3 year retrospective data analysis. J Hum Reprod Sci. 2013 Oct;6(4):235-40. doi: 10.4103/0974-1208.126286. PMID: 24672161; PMCID: PMC3963305.https://academic.oup.com/hropen/article/2017/2/hox011/4062213
Megan L. Sneed, Meike L. Uhler, H. Edward Grotjan, John J. Rapisarda, Kevin J. Lederer, Angeline N. Beltsos, Body mass index: impact on IVF success appears age-related , Human Reproduction, Volume 23, Issue 8, 1 August 2008, Pages 1835–1839, https://doi.org/10.1093/humrep/den188
SpOvum has been operating successfully at Mane hospital’s LifeNU. While SpOvum is taking care of their operations including Technology-enablement, Embryologists, Dashboard, Maintenance, Calibration ad a bit of counseling. Recently SpOvum has also installed its flagship product- RoboICSI® holder, and smART Alerts system. SpOvum is making a conscious effort to see that LifeNU meets its KPIs along the Vienna consensus.
Largely, it has been successful in achieving so. For example, we have got an ICSI Damage rate of 0% (Benchmark from Vienna consensus is ≤ 5%), a Day3 Embryo Development rate of 84% (Benchmark from Vienna consensus is ≥ 70%), Blastocyst cryo survival rate of 100% (Benchmark from Vienna consensus is ≥ 99%)
SpOvum is making strides in ensuring IVF hospitals excel in providing quality IVF treatment to patients.
SpOvum® got an opportunity to present its product portfolio to the team of Oasis fertility headed by Dr Krishna Chaitanya in the early morning of 29th November 2022. Though it was originally expected to be brief (about fifteen minutes) it got extended! Thanks to the intriguing interaction. Dr Krishna and Dr Gaurav had some wonderful questions and were appreciative of SpOvum’s initiative in bringing innovations to the A.R.T. space through Robotics, Automation, and AI.
SpOvum presented its flagship product – RoboICSI® and its ICSI workbench – RIWB™. The scope of automation and some of the key aspects that the innovation can address were discussed. The meeting happened virtually over the Zoom video communication platform. Further, SpOvum presented a live demo of the RoboICSI® gripper-holder, the workbench comprising the programmable manipulators, the Electronic aspiration system controlled by a click-based controller, and an indigenously designed button controller.
SpOvum wishes to engage with the Oasis fertility team to bring a synergetic approach to addressing some of the needs of the IVF ecosystem. As the vision statement of Oasis indicates “To be the trusted experts and leaders in providing evidence-based fertility treatments with compassion” SpOvum has found a common ground for a strong collaboration. Looking forward to a brighter future!
The connection of beauty to the eyes of the beholder is much deeper than what it looks. Different people have different perception of reality or on things. Some might find somethings good while other may find it bad. In this study let us concentrate on Morphological inspection.It is the best tool and it has wide range of observations for a given sample…Let’s find out how?. The image below was asked for assessment to the embryologists in a conference and was told to grade the oocyte accordingly.
Oocyte image given for the quiz [courtesy : ESHRE Atlas of human embryology]
Around 20 of them took up the quick quiz. The image that was given during the quiz was taken from ESHRE Atlas of human embryology. Below the image were a list of buttons which were related to the grading of the oocytes like: Maturity, Size, Zona, SER etc. They had to select the appropriate options referring to the image.
The result of the quiz was made into a pie charts for better representation and understanding. We were surprised to see the answers obtained.
Zona appearance, for example appeared to be Uniform for 63.2% of them and Non-uniform for 36.8%.
Likewise, maturity of oocyte for a M2 oocyte was 83.3%, M1- 11.1% and GV 5.6%.
Maturity graph [M2;GV;M1]
Grading the oocyte based on quality, 50% has told it is good, 25% abnormal, 15% approximately mature and 10% said almost normal.
Grade quality of the oocyte
The polar body had sections like – Shape, texture, size and fragments. Shape: 2 of them found it to be irregular, 10 of them opted oval and 5 of them found the oocyte to be round. Based on the texture of PB- 10 of them found it smooth and 7 of them rough. The PB size was selected normal by 15 of them, smaller and enlarged by 5 of them. 7 of them found the PB to be fragmented whereas 9 of them found the PB to be normal without any fragments.
Polar body grading
Zona pellucida grading of the oocyte
Vacuoles and SER have got the same percentage of answers. Absent is 62.5% and Present is 37.5%.
A morphologically normal sperm cell is about 40-50 µm in length and consists of a head and tail. [2]
Head: It mainly consists of nucleus and acrosome. Sperm head performs two functions- genetic and activation. The genetic function is embodied in the sperm nucleus which consists of DNA and nuclear proteins and thus is responsible for the transmission of hereditary characters from the male. The major part of the sperm head is occupied by the nucleus about 65%, which determines the sperm head shape. The sperm head anterior end is covered by a cap-like structure called acrosome. The acrosome is represented by Golgi complex and it contains a number of hydrolytic enzymes, such as hyaluronidase and acrosin, which are required for fertilization. During fertilization, the acrosomal membrane fuses with the oocyte cytoplasmic membrane and followed by acrosomal reaction, an event where the acrosomal enzyme is released from the head tip. Sperm head measures between 4.0-5.5 µm in length and 2.5-3.5 µm in width. [1 and 2]
Structure of a Sperm
Neck: It is a short, slightly constricted segment made up of projections located between the head and the tail portion. Neck differs clearly from the head and also from the rest part of the tail. [1 and 2]
Tail: The tail measures 40-50 µm in length and provides motility for the cell. Sperm cell’s entire motility apparatus is contained in the tail. The tail can be divided into the mid-piece (anterior portion), principle piece, and end-piece (posterior portion). Mid-piece supports the head at exactly the center position. The mid-piece consists of tightly packed mitochondria surrounded by a sheath. The mitochondria in the mid-piece supply energy in the form of ATP for tail movement. The principle piece is the longest part of the tail and comprises most of the propellant machinery. Motility plays the main role in sperm transport through the cervix. [2]
Abnormal Sperm Morphology
Teratospermia is a condition characterized by the presence of sperm with an abnormal morphology that affects fertility in males. Normal sperm exhibits an oval-shaped head with a regular outline and a cap (acrosome) covering more than one-third of the head surface. The mid-piece is slender, less than one-third of the width of the head, straight and regular in outline. The tail is slender, uncoiled and should present a regular outline. Abnormal sperm morphology is classified as a defect in the head, midpiece or tail of the sperm.
Sperm Head Abnormalities
Head defects include large, small, tapered, pyriform, round, amorphous heads, heads with a small cap area and double heads, as well as any combination of these. Globozoospermia, where the sperm head appears small and round due to the failure of the acrosome to develop is one of the examples of a head defect.
Mid-piece defects include “bent” neck (where the neck and tail form an angle greater than 90% to the long axis of the head), thick/irregular mid-piece, abnormal thin mid-piece, as well as any combination of these.
Sperm Tail Abnormalities
Tail defects Include short, multiple, hairpin, broken or bent (>900) tails, tails of irregular width, coiled tails, as well as any combination of these.
Sperm Defect
Possible related observations
Possible associated functional anomaly
Elongated head
Abnormally shaped head and abnormally condensed chromatin
Abnormally shaped head and abnormally condensed chromatin
Immature chromatin/fragmented DNA
Microcephalous head
Excessive shrinkage of the nucleus and abnormally condensed chromatin
Immature chromatin/fragmented DNA
Macrocephalous head
Insufficient shrinkage of the nucleus and abnormally condensed chromatin
Increased aneuploidy
Multiple heads
Two or more closed or dissociated heads with or without a common acrosome or midpiece
Handicaps migration through mucus and oocyte vestments/fragmented DNA
Abnormal acrosome region
Absent or abnormally shaped or sized acrosome, incomplete acrosome and/or abnormal appearance of the underlying nucleus
Abnormal acrosome reaction/fragmented DNA
Thin midpiece
Partial/absent mitochondrial sheath
No or reduced ATP available for cell propelling
Bent tail
Misaligned midpiece and head or sharply bent midpiece/tail
Impairment of syngamy and cleavage, abnormal cell propelling, handicaps migration through mucus and oocyte vestments
Absent tail
Various anomalies of the neck region
Fragility of the neck structure and sperm moving forward is not possible
Short tail
Abnormally shaped periaxonemal and sometimes axonemal structures/dysplasia of the fibrous sheath
Immotility or severe dyskinesia
Irregularly shaped tail
Abnormally shaped periaxoneamal and sometimes axonemal structures/dysplasia of the fibrous sheath
Abnormal motion
Coiled tail
Completely or partially coiled tail often within a huge cytoplasmic remnant
Sperm moving forward is not possible
Multiple tails more than one tail
Partially dissociated tails connected to a single or to multiple heads or tails knitted together over a variable length
Abnormal motion: handicaps migration through mucus oocyte vestments
Semen Analysis
This is an evaluation of a certain characteristic of male’s semen and the sperm. This helps in evaluating male fertility
Color: Normally semen appears in whitish-gray in color. As the man ages, it appears as a yellowish tint. Presence of blood in semen (hematospermia) a rare condition which results in brownish or red color ejaculate. Deep yellow or greenish color appearance of semen is due to medication. Other causes of unusual semen color are due to STI’s, genital surgery and injury to male sex organs.
Volume: Semen volumes between 2.0 ml and 5.0 ml are considered to be normal. WHO regards 1.5 ml as the lower reference limit.
pH: According to WHO the normal semen pH is in the range of 7.2-8.2. An acidic pH ejaculate indicates one or both of the seminal vesicles are blocked. A basic pH ejaculate indicates an infection. pH value outside of the normal range is harmful to sperm and affects their ability to penetrate the egg.
Viscosity: It measures seminal fluid’s resistance to flow. High viscosity may interfere with the determination of sperm motility, concentration and antibody of spermatozoa. Normally semen coagulates upon ejaculation and usually liquefies within 15-20 min. Liquefaction time within 60 min is considered as the normal range.
Motility: The efficient passage of spermatozoa through the cervical mucus is dependent on rapid progressive motility, that is, spermatozoa with a forward progression of at least 25 µm/s. Reduced sperm motility can be a symptom of a disorder related to male accessory sex gland secretion.
>Rapid progressive motility- Moves at >25 µm/s at 370C and >20 µm/s at 200C
SpOvum has received the ISO 13485 certificate. This certificate was issued by TUV SUD.
What you should know regarding ISO 13485 What is a medical device? A product that is designed for use in the diagnosis, prevention, and treatment of illnesses or other medical disorders is known as a medical device. Examples include instruments, machines, implants, and in vitro reagents.
Whom does ISO 13485 serve? Organizations engaged in the design, production, installation, and maintenance of medical devices and related services are intended users of ISO 13485. Additionally, it can be utilized by internal and outside parties, including certification organizations, to support their auditing procedures.
Compliance with ISO 13485 Like other ISO management system standards, ISO 13485 does not mandate certification, and firms can still adopt the standard and enjoy many benefits without going through the certification process. However, third-party certification can show regulators that you have complied with the standard’s requirements. The ISO doesn’t carry out certification
This is reinforcing SpOvum’s commitment to the adoption of best practices in Quality Management towards continual improvement.
In this regard SpOvum thanks Mr. S L Sriram for his guidance all along, in achieving this milestone.
With SpOvum as your partner, you can be assured of the best practices in the industry!
Structure of a Sperm
