Collection and Evaluation of Spermatozoa
Durga’s father was found to have a low sperm count, according to Mukherjee who obviously was aware of the diagnostics value of semenograms as evidence by the papers he represented much before the WHO laboratory manual for the examination of human semen came out in 1980.
Ovarian stimulation. In his report dated 19-10-1978 to the DHS, Mukherjee stated that he had treated Mrs Agarwal with hMG ampoules given twice a day and on alternate days and starting from day 3 to day 9 of the cycle. She was given 6000 I.U. of hCG on day 11 of the cycle and she was subjected to oocyte aspiration some 48h later. Mukherjee was able to aspirate 5 folicle by this method. In today's context this ovarian protocol will not sound outrageous because controlled ovarian hyperstimulation is the standard procedure for all women subjected to IVF. However, until 1980 December ‘conventional wisdom’ in Britain, Australia and USA dictated that stimulated cycles were unsuitable for oocyte collection and therefore oocyte aspiration was restricted to natural cycles. It was only in 1981 that other scientists resorted to ovarian stimulation. The Australians who were the next to announce the birth of IVF babies, began to use clomiphene citrate for ovarian stimulation in 1981. The Norfolk group in the USA, who were the third to report the occurrence of an IVF baby, began to use hMC and hCG in their IVF programme with success in 1982. It is noteworthy that Mukherjee was far ahead of his time in successfully using an ovarian stimulation protocol before anyone else in the world had thought of doing so.
Ovum pick-up for IVF was a problem during the early days. The British team had used a laparascope to harvest oocytes. The advent of ultrasonography later on opened out a new avenue to aspirate oocytes transvesically under ultrasound guidance by making a percutaneous insertion of a long needle traversing the abdominal wall, the urinary bladder and finally the ovarian follicle. The advent of the transvaginal probe has made it possible to collect oocytes per vaginam and this is the standard procedure used now.
Mukherjee ’s originality was that he was able to access the ovaries by a very simple operation on the wall of the vagina. Stimulated ovaries enlarge and drop down towards the Pouch of Douglas. A small incision on the posterior wall of the vagina would allow the ovaries to fall into this opening. This reminds one of how a biologist gains rapid access to the ovaries of rats by a very simple lateral, abdominal incision. The entire procedure was accomplished within a couple of minutes. Mukherjee ’s research experience with rats and humans had helped him take this very simple and original approach of gaining access to ovaries by posterior colpotomy. One wonders why this very simple approach did not gain popularity. After all today oocytes are aspirated per vaginam under ultrasound guidance.
Read more about this topic: Subhash Mukhopadhyay (physician), Experiment
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