Papers by Biswanath Ghosh Dastidar
medRxiv (Cold Spring Harbor Laboratory), Feb 11, 2024
Purpose: Digital health is an important factor in India's healthcare system. Inclusive policy mea... more Purpose: Digital health is an important factor in India's healthcare system. Inclusive policy measures, a fertile technological landscape, and relevant infrastructural development with unprecedented levels of telemedicine adoption catalysed by the recent COVID-19 pandemic have thrown open new possibilities and opportunities for clinicians, end-users, and other stakeholders. Nevertheless, there are still several challenges to properly integrating and scaling telemedicine use in India. This study's objective was to understand the views of practising physicians in India on the use of telemedicine and the challenges experienced during the accelerated rollout during the first wave of the COVID-19 pandemic. Methods: We acquired data through an anonymous, cross-sectional, internet-based survey of physicians (n=444) across India on the COVID-19 frontline. These responses were subjected to qualitative data analysis (via inductive coding and thematic analyses) and descriptive statistics, as appropriate. Results: Most responses (n=51) were categorised under a code indicating that telemedicine-led healthcare delivery compromised treatment quality. The second largest proportion of responses (n=22) suggested that 'Accessibility, quality and maturity of software and hardware infrastructure' was a considerable challenge. Conclusions: Despite the considerable uptake, perceived benefits, and the foreseen positive role of telemedicine in India, several challenges of telemedicine use (viz., technical, user experience-based integration, and non-user-based integration challenges) have been identified. These must be addressed through suggested relevant opportunities to realise telemedicine's potential and help inform the future design of effective telemedicine policy and practice in India.
Journal of South Asian Federation of Obstetrics and Gynaecology, 2019
Embryo transfers (ET) on day 2 or day 3 following fertilization have been the standard of practic... more Embryo transfers (ET) on day 2 or day 3 following fertilization have been the standard of practice since the initial days of human in vitro fertilization (IVF). Recent advances in culture media, as well as embryo culture techniques, have prompted in a shift in strategy to day 5 blastocyst transfers following IVF. However blastocyst transfers, although resulting in slightly better pregnancy rate, are known to be associated with certain disadvantages, such as higher costs, higher cycle cancellation rates, and in vitro damage to embryos. Thus we reviewed our results with day 2 and day 3 ETs to see whether outcomes were adequate to justify a return to day 3 embryo transfer policy. Our data shows a 46% clinical pregnancy rate and 1.9% incidence of multiple pregnancy rate with cleavage transfers. Thus in our setting with a lot of poor resource patients, we feel day 2 or 3 transfer provides a good strategy for IVF cycles.
Communications medicine, Nov 16, 2022
Virtual care could be instrumental in helping India achieve Universal Healthcare. COVID-19 has ca... more Virtual care could be instrumental in helping India achieve Universal Healthcare. COVID-19 has catalysed virtual-care adoption by practitioners and end-users alike. Recent inclusive policy measures, a favourably-evolving technological landscape, and infrastructural development empower India to technologyleapfrog existing Western healthcare systems. India went into COVID-19 lockdown on 23 March 2020, resulting in widespread disruption of routine healthcare. This led to significant task-shifting in hospitals, changing inpatient to outpatient care, and outpatient to telemedicine-driven home care. Consequently, in-person appointments went down by 32%, and online consultations went up by 300% 1. Within six months of launch, one of India's largest private-sector healthcare providers, Apollo Hospital group's digital consultation platform (Apollo 24/7), enroled four million people with about 30,000 downloads per day 2. Fifty million citizens accessed healthcare online from March-May 2020, 80% of whom were first-time users 2. As another example, on 29 March 2020, within a week of the first COVID-19 lockdown, one of the study co-authors (BGD) helped launch a voluntary pan-India telecare initiative to offer free teleconsultations to anyone unable to access in-person care. Thirty specialist physicians across eight cities treated over 500 patients. The majority had minor ailments which were resolved online; in-person consultations were arranged to treat four patients; and one gentleman was referred to a medical college where he underwent life-saving surgery. These physicians were telecare novices operating out of a hastily-formed Facebook page for outreach. But this experience led to individual and collective reflection upon the potential of virtual care in India, scaled up and supported by the right tools. This article discusses lessons learned from this switch to virtual care and proposes steps that may help India leverage virtual healthcare to deliver on its commitment to provide Universal Healthcare (UHC) to its citizens within a largely threadbare public health infrastructure. India's healthcare challenge India's healthcare expenditure is consistently amongst the world's lowest at 1.28% of the gross domestic product (GDP) 3. Though public hospitals provide free care, the quality is highly variable, from internationally-acclaimed centres to unacceptably low-quality underfunded facilities that face frequent staff and equipment shortages 4. Besides, many unregulated clinics exist, and only nine out of 28 states mandate physician participation in Continuing Medical Education 5. Rural outposts and urban slums have typically remained underserved, and while general access to healthcare is heterogeneous within and between states, the starkest variation is seen between rural and urban areas. Although 70% of India's population lives in villages, 60% of hospitals, 75% of pharmacies, and 80% of physicians are based in cities and suburbs, with the
Communications Medicine
Virtual care could be instrumental in helping India achieve Universal Healthcare. COVID-19 has ca... more Virtual care could be instrumental in helping India achieve Universal Healthcare. COVID-19 has catalysed virtual-care adoption by practitioners and end-users alike. Recent inclusive policy measures, a favourably-evolving technological landscape, and infrastructural development empower India to technologyleapfrog existing Western healthcare systems. India went into COVID-19 lockdown on 23 March 2020, resulting in widespread disruption of routine healthcare. This led to significant task-shifting in hospitals, changing inpatient to outpatient care, and outpatient to telemedicine-driven home care. Consequently, in-person appointments went down by 32%, and online consultations went up by 300% 1. Within six months of launch, one of India's largest private-sector healthcare providers, Apollo Hospital group's digital consultation platform (Apollo 24/7), enroled four million people with about 30,000 downloads per day 2. Fifty million citizens accessed healthcare online from March-May 2020, 80% of whom were first-time users 2. As another example, on 29 March 2020, within a week of the first COVID-19 lockdown, one of the study co-authors (BGD) helped launch a voluntary pan-India telecare initiative to offer free teleconsultations to anyone unable to access in-person care. Thirty specialist physicians across eight cities treated over 500 patients. The majority had minor ailments which were resolved online; in-person consultations were arranged to treat four patients; and one gentleman was referred to a medical college where he underwent life-saving surgery. These physicians were telecare novices operating out of a hastily-formed Facebook page for outreach. But this experience led to individual and collective reflection upon the potential of virtual care in India, scaled up and supported by the right tools. This article discusses lessons learned from this switch to virtual care and proposes steps that may help India leverage virtual healthcare to deliver on its commitment to provide Universal Healthcare (UHC) to its citizens within a largely threadbare public health infrastructure. India's healthcare challenge India's healthcare expenditure is consistently amongst the world's lowest at 1.28% of the gross domestic product (GDP) 3. Though public hospitals provide free care, the quality is highly variable, from internationally-acclaimed centres to unacceptably low-quality underfunded facilities that face frequent staff and equipment shortages 4. Besides, many unregulated clinics exist, and only nine out of 28 states mandate physician participation in Continuing Medical Education 5. Rural outposts and urban slums have typically remained underserved, and while general access to healthcare is heterogeneous within and between states, the starkest variation is seen between rural and urban areas. Although 70% of India's population lives in villages, 60% of hospitals, 75% of pharmacies, and 80% of physicians are based in cities and suburbs, with the
ObjectivesIndia has committed to formulating a roadmap for realising a resilient health system, w... more ObjectivesIndia has committed to formulating a roadmap for realising a resilient health system, with digital health being an important element of this. Following the successful implementation of a free telemedicine service, eSanjeevani, India published the Telemedicine Practice Guidelines in 2020 to further scale telemedicine use in India. The main objective of the current study was to understand the perspective and use of telemedicine by medical doctors in India after the release of its telemedicine policy.MethodsData were acquired through an anonymous, cross-sectional, internet-based survey of medical doctors (n = 444) at a pan-India level. Replies were subjected to statistical analysis.ResultsTelemedicine was used for various non-mutually exclusive reasons, with the top two reasons being live audio or video consultations (60.4%) and online payments (19.1%) and smartphones were the most frequently used device type (60.6%). The telemedicine benefit that the greatest proportion of r...
Possible predictive role of cervical score in a subset of poor responders in In-vitro Fertilization (ivf)–new application of an old parameter?
Human Reproduction, 2012
Automated screening of Polycystic Ovary Syndrome using machine learning techniques
2011 Annual IEEE India Conference, 2011
... Gynecology, 1935; 29; 181-191. [8] Ricardo Azziz , Keslie S. woods ... [18] S. Jonard , Y. Ro... more ... Gynecology, 1935; 29; 181-191. [8] Ricardo Azziz , Keslie S. woods ... [18] S. Jonard , Y. Robert, C. Cortet-Rudelli , P. Pigny , C. Decanter, D. Dewailly , “Ultrasound Examination of Polycystic Ovaries: is it worth counting the follicle,” Human Reproduction,Vol.18,pp598-603,2003. ...
Reappraisal of IVF stimulation in good prognosis patients – a prospective randomized study to compare mild versus standard long protocol
Fertility and Sterility, 2010
OBJECTIVE: To compare the flexible GnRH antagonist and the GnRH agonist long protocol in patients... more OBJECTIVE: To compare the flexible GnRH antagonist and the GnRH agonist long protocol in patients at high risk of OHSS undergoing IVF. DESIGN: Single-centre open label randomized prospective study. MATERIALS AND METHODS: The study included 144 women who had moderate or severe OHSS or had been at risk of OHSS during their first IVF/ICSI cycle with a mid-luteal long GnRH agonist plus gonado-trophin stimulation protocol. Patients were randomized to receive either cetrorelix 0.25 mg/day starting on day 3 of the menstrual cycle (antagonist group) or triptorelin 0.1 mg/day starting on day 21 of the menstrual cycle (agonist group). Ovarian stimulation was achieved with rFSH initiated on day 3 of the cycle at the maximal dose of 150 IU; the dose was adjusted depending on ovarian response. Embryo transfer was performed 2 or 3 days after oocyte retrieval. Luteal phase support was started on the day of oocyte retrieval using micronised progesterone vag-inal gel. RESULTS: The two groups were similar in mean age, duration of infertility , body mass index, baseline FSH, total amount of rFSH administered and proportion of patients undergoing intracytoplasmic sperm injection. When oocyte maturation was triggered, the levels of E2 were lower in the antagonist group than in the agonist group (p<0.001). The number of cancelled cycles was significantly higher in the GnRH agonist group than in the GnRH antagonist group (9 versus 1, p¼0.022). The total number of oocytes retrieved, the number of metaphase II oocytes retrieved and the fertilization rate were similar in the two groups (p¼0.602, p¼0.621 and p¼0.946). Clinical pregnancy rate per initiated cycle was similar in the the two groups (p¼0.457); live birth rate per initiated cycle was 23.6% in the antagonist group and 26.4% in the agonist group (p¼0.700). CONCLUSION: When compared with the GnRH agonist protocol, the flexible GnRh antagonist protocol is associated with a similar pregnancy rate with a reduction in the number of cycles cancelled because of the risk of OHSS. OBJECTIVE: Recently, controversy has arisen regarding the use of oral contraceptive pill and the impact on implantation rates in patients undergoing IVF/ICSI. This debate is still open as cycle scheduling is a common practice in most units. Thus, we decided to compare cycle outome after scheduling with the standard long protocol versus the use of OCPs in patients undergoing GnRH antagonist cycles. DESIGN: Prospective, randomized, controlled trial. MATERIALS AND METHODS: Regular cycling women under 39 years, <3 previous IVF attempts were enrolled in this trial. Previous low response to COH, ovarian surgery or PCO were excluding factors. A total of 115 patients received OCP (0.030 EE/0.15 desogestrel) for 12 to 16 days, and COH was started on day 5 post-pill; similarly, 113 patients received long protocol from day 20-22 of the previous cycle. Patients were randomized at the time of cycle planning, according to a computerized random number list by a nurse coordinator. RESULTS: Groups were comparable in age (34.1 vs 33.7), BMI (22.1 vs 21.9), previous IVF attempts (0.6 vs 0.7). As expected, patients undergoing GnRH antagonist protocol showed a lower peak serum E2 (1334 vs 1823, p<0.05) but similar peak serum P4 (0.58 vs 0.65), a lower duration of the stimulation (10.3 vs 11.4, p<0.05), a reduced FSH consumption (1613 vs 1807 IU, p<0.05), and a lower ovarian response (10.2 vs 11.7 oocytes, p<0.05). No differences were observed in the fertilization rate (68 vs 64%), total number of embryos obtained (5.9 vs 6.2), mean number of embryos transferred (1.8 vs 1.8), implantation rate (36 vs 39%), twinning rate (33.9 vs 25.5%), miscarriage rate (5.4 vs 17%), or cancellation rate (1.7 vs 1.2%). CONCLUSION: Cycle scheduling is used to equally distribute the load of work during the week in busy units or to avoid weekends. Traditionally this has been easily done with the long agonist protocol. Today, by using OCPs to schedule patients undergoing the antagonist protocol, we can obtained comparable outcomes. OBJECTIVE: Standard long GnRH agonist(GnRHa)protocol is associated with increased cost and associated risk. Recent reports show that mild stimulation reduces the total gonadotropin dose and number of oocytes retrieved, with acceptable clinical pregnancy rate. We compared results of two cycles of treatment with mild vs standard stimulation strategy. DESIGN: Prospective, randomized study. MATERIALS AND METHODS: 116 good prognosis patients undergoing 1st IVF cycle were randomized into Group A(mild stimulation)and Group
Abstract book of 10th Biennial Meet of Pacific Society for Reproductive Medicine (PSRM), 2015
Proceedings of the 4th World Congress on Mild Approaches in Assisted Reproduction, 2011
Proceedings of 4th World Congress on Mild Approaches in Assisted Reproduction, 2011
Human Reproduction, Vol. 25, Supp 1, June 2010, 2010
Introduction:
Human Reproduction, Vol. 25, Supp. 1, June 2010, 2010
Journal of South Asian Federation of Obstetrics and Gynaecology, 2018
Despite considerable advances in the field of in vitro fertilization (IVF), embryo implantation a... more Despite considerable advances in the field of in vitro fertilization (IVF), embryo implantation and pregnancy rates have plateaued globally. Thus, much of current research focus is on embryo and endometrial assessment. Day 3 embryo transfers (ETs) have been the standard of practice for long. However, development of blastocyst culture media has led to recent switch toward blastocyst transfers, although this is associated with greater technical skill and know-how in order to optimize the culture process. We analyzed our blastocyst transfer results to see whether this strategy appeared to be a viable intervention in terms of acceptable pregnancy outcome. Our study found a pregnancy rate of 37.5% with blastocyst transfers, with the complete absence of any multiple pregnancies. Thus, we feel blastocyst transfers represent a viable intervention in an IVF program to ensure acceptable pregnancy rates and simultaneously reduce the incidence of multiple births.
Fertility and Sterility, Vol. 94, No. 4, September 2010, 2010
OBJECTIVE: To compare the flexible GnRH antagonist and the GnRH agonist long protocol in patients... more OBJECTIVE: To compare the flexible GnRH antagonist and the GnRH agonist long protocol in patients at high risk of OHSS undergoing IVF. DESIGN: Single-centre open label randomized prospective study. MATERIALS AND METHODS: The study included 144 women who had moderate or severe OHSS or had been at risk of OHSS during their first IVF/ICSI cycle with a mid-luteal long GnRH agonist plus gonado-trophin stimulation protocol. Patients were randomized to receive either cetrorelix 0.25 mg/day starting on day 3 of the menstrual cycle (antagonist group) or triptorelin 0.1 mg/day starting on day 21 of the menstrual cycle (agonist group). Ovarian stimulation was achieved with rFSH initiated on day 3 of the cycle at the maximal dose of 150 IU; the dose was adjusted depending on ovarian response. Embryo transfer was performed 2 or 3 days after oocyte retrieval. Luteal phase support was started on the day of oocyte retrieval using micronised progesterone vag-inal gel. RESULTS: The two groups were similar in mean age, duration of infertility , body mass index, baseline FSH, total amount of rFSH administered and proportion of patients undergoing intracytoplasmic sperm injection. When oocyte maturation was triggered, the levels of E2 were lower in the antagonist group than in the agonist group (p<0.001). The number of cancelled cycles was significantly higher in the GnRH agonist group than in the GnRH antagonist group (9 versus 1, p¼0.022). The total number of oocytes retrieved, the number of metaphase II oocytes retrieved and the fertilization rate were similar in the two groups (p¼0.602, p¼0.621 and p¼0.946). Clinical pregnancy rate per initiated cycle was similar in the the two groups (p¼0.457); live birth rate per initiated cycle was 23.6% in the antagonist group and 26.4% in the agonist group (p¼0.700). CONCLUSION: When compared with the GnRH agonist protocol, the flexible GnRh antagonist protocol is associated with a similar pregnancy rate with a reduction in the number of cycles cancelled because of the risk of OHSS. OBJECTIVE: Recently, controversy has arisen regarding the use of oral contraceptive pill and the impact on implantation rates in patients undergoing IVF/ICSI. This debate is still open as cycle scheduling is a common practice in most units. Thus, we decided to compare cycle outome after scheduling with the standard long protocol versus the use of OCPs in patients undergoing GnRH antagonist cycles. DESIGN: Prospective, randomized, controlled trial. MATERIALS AND METHODS: Regular cycling women under 39 years, <3 previous IVF attempts were enrolled in this trial. Previous low response to COH, ovarian surgery or PCO were excluding factors. A total of 115 patients received OCP (0.030 EE/0.15 desogestrel) for 12 to 16 days, and COH was started on day 5 post-pill; similarly, 113 patients received long protocol from day 20-22 of the previous cycle. Patients were randomized at the time of cycle planning, according to a computerized random number list by a nurse coordinator. RESULTS: Groups were comparable in age (34.1 vs 33.7), BMI (22.1 vs 21.9), previous IVF attempts (0.6 vs 0.7). As expected, patients undergoing GnRH antagonist protocol showed a lower peak serum E2 (1334 vs 1823, p<0.05) but similar peak serum P4 (0.58 vs 0.65), a lower duration of the stimulation (10.3 vs 11.4, p<0.05), a reduced FSH consumption (1613 vs 1807 IU, p<0.05), and a lower ovarian response (10.2 vs 11.7 oocytes, p<0.05). No differences were observed in the fertilization rate (68 vs 64%), total number of embryos obtained (5.9 vs 6.2), mean number of embryos transferred (1.8 vs 1.8), implantation rate (36 vs 39%), twinning rate (33.9 vs 25.5%), miscarriage rate (5.4 vs 17%), or cancellation rate (1.7 vs 1.2%). CONCLUSION: Cycle scheduling is used to equally distribute the load of work during the week in busy units or to avoid weekends. Traditionally this has been easily done with the long agonist protocol. Today, by using OCPs to schedule patients undergoing the antagonist protocol, we can obtained comparable outcomes. OBJECTIVE: Standard long GnRH agonist(GnRHa)protocol is associated with increased cost and associated risk. Recent reports show that mild stimulation reduces the total gonadotropin dose and number of oocytes retrieved, with acceptable clinical pregnancy rate. We compared results of two cycles of treatment with mild vs standard stimulation strategy. DESIGN: Prospective, randomized study. MATERIALS AND METHODS: 116 good prognosis patients undergoing 1st IVF cycle were randomized into Group A(mild stimulation)and Group
Human Reproduction, Vol. 27, Supp. 1, July, 2012
Introduction: Endometrial receptivity and embryo implantation is still a matter of research to op... more Introduction: Endometrial receptivity and embryo implantation is still a matter of research to optimise IVF outcome. Though embryo parameters are currently studied in detail, assessing endometrial receptivity is difficult in the treatment cycle. Cervical scoring has been shown to correlate well with the effect of estrogen and progesterone on target tissues. Thus it is plausible to wonder whether such scoring could serve as an adjunctive parameter to assess endometrial status also. Moreover, there is scant data on cervical score pattern in controlled ovarian stimulation (COS). Thus we prospectively studied the pattern of cervical score in COS and attempted to explore any possible correlation with IVF outcome. Materials and Methods: A total of 311 women undergoing IVF consented to participate in this study. Institutional ethical clearance was obtained. All women underwent COS using standard agonist or antagonist protocol and ovarian stimulation was initiated with 150-225 IU recombinant follicle stimulation hormone (r-FSH) and/or human menopausal gonadotropin (HMG) and dose tailored subsequently. Ovarian response was monitored by trans-vaginal sonography and serum estradiol levels. In addition, cervical score was done by a single observer (blinded) based on Insler's method on day of HCG administration (D-HCG); day of Ovum Pick-Up (D-OPU) and day of Embryo Transfer (D-ET). Ovulation trigger was given with 10,000 IU HCG when at least 3 follicles measured 17-18 mm. OPU was performed 35-37 hours after HCG. IVF/ICSI was performed by standard protocol. Only top quality embryos were transferred on day 2 or day 3 after OPU in all cases. Luteal support was provided with I.M progesterone-in-oil for ten days following ET and subsequently by intra-vaginal application (Crinone gel, 8%). Data of 296 women who went upto ET were analysed. Results: Three broad patterns emerged from analysis of cervical scores. A majority of women (n = 215/296, 72.6%) were found to have cervical scores more or less appropriate for the day of recording (D-HCG, D-OPU, D-ET). They were classified as Pattern A. 49 women (16.6%) were found to exhibit appropriate cervical score on D-HCG but expected luteal shift was delayed until D-ET (Pattern B). Strikingly, in 24 women (8.1%) characteristic luteal phase scores were not recorded on D-OPU or D-ET. In 8 women (2.7%) no specific pattern was observed. These 32 women (24 + 8) were categorized as Pattern C. Result analysis showed the following:-Implantation rate (I.R) in Pattern A and C were 24.7% vs 15.7%, p < 0.05; Pregnancy Rate (P.R) in Pattern A and C were 32.1% vs 21.9%, p < 0.05; Ongoing Pregnancy Rate (O.P.R) in Pattern A and C were 29.8% vs 15.6%, p < 0.05. All results were significantly higher in group A compared to C. The results in Group B (I.R: 23.5%, P.R: 30.6%, O.P.R: 24.5%) were comparable to Group A and there was no statistically significant difference.
IEEE XPlore, 2011
Polycystic Ovary Syndrome (PCOS) is one of the most common type of endocrine disorder in reproduc... more Polycystic Ovary Syndrome (PCOS) is one of the most common type of endocrine disorder in reproductive age women. This may result in infertility and anovulation. The diagnostic criterion includes the clinical and metabolic parameters which act as an early marker for the disease. We described a method that automates the PCOS detection based on these markers. Our algorithm involves the formulation of feature vector based on the clinical and metabolic features and statistically significant features for discriminating between normal and PCOS groups are selected based on two sample t-test. To classify the selected feature Bayesian and Logistic Regression (LR) classifier are used. An automated system will act as an assisted tool for the doctor for saving considerable time in examining the patients and hence reducing the delay in diagnosing the risk of PCOS. The study demonstrated that the performance of Bayesian classifier is better than the logistic regression. The overall accuracy of Bayesian classifier is 93.93% as compared with logistic regression i.e. 91.04%.
IEEE XPlore, 2011
Polycystic Ovary Syndrome (PCOS) is a complex endocrine disorder affecting many women in the pube... more Polycystic Ovary Syndrome (PCOS) is a complex endocrine disorder affecting many women in the pubertal as well as reproductive age groups with profound adverse affects such as obesity, infertility, cardiovascular disease and diabetes mellitus . Diagnosis of the condition is by clinical, biochemical and imaging parameters. The principle feature on ultrasound is the presence of polycystic ovaries with peripheral arranged cysts and dense stroma. During ultrasound evaluation due to overlapping of the follicles as well as inherent noise of the equipment delineating, making this characteristic appearance may sometimes become challenging, making diagnosis time consuming. Moreover the interpretation would vary considerably from one operator to another as it is largely an experience dependent procedure. In this paper an automated scheme for the detection of this pathognomonic pattern and arrangement of follicles is proposed to overcome this problem. Firstly the input ultrasound image was preprocessed by multiscale morphological approach for contrast enhancement. Then a scanline thresholding is used to extract the contours of the follicles. The results are compared with the results obtained by manual selection to verify the effectivity of scheme.
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Papers by Biswanath Ghosh Dastidar