Pandiyan Natarajan

Andrology and Reproductive Medicine, Chettinad Super Speciality Hospital ( Retired) , Apollo 24/7, NOVA IVF FERTILITY
  • Chettinad Super Speciality Hospital ( Retired) , Apollo 24/7, NOVA IVF FERTILITY
  • 91-44-24358260
  • India

About Pandiyan Natarajan

Andrology and Reproductive Medicine - 36 years experience.

Professor of Andrology and Reproductive Medicine and Chief Consultant in Andrology and Reproductive Medicine. (Retired)

Chettinad Super Speciality Hospital,

Chettinad Academy of Research and Education,

Kelambakkam, Chennai,

Tamil Nadu, India- 603103.

Recent Comments

Jun 28, 2022

Immune Infertility is a Black Box.

Immunology and Genetics certainly play a crucial role in Infertility, particularly Male Infertility.  (1) However, the precise clinical role of Immunology, if any, in Male Infertility is not clear. Attempts to implicate Anti sperm Antibodies in Male Infertility have been uniformly unsuccessful. Many of us, Infertility practitioners no longer test for Anti sperm Antibodies.

Fertility and Sterility carried a lead article by Nancy Alexander, a few decades back, on Ant Sperm Antibodies- Victory or Voodoo. (2) We have found in our practice these Tests to be of no clinical significance. On the contrary, Testing and Treating Anti Sperm Antibodies could be harmful.

While Immune Infertility remains an interesting topic for research, it currently has no clinical significance. 

1. Immune Mediated Male Infertility
Dr. Shah Dupesh Khan, Dr. N.Pandiyan.

https://www.chcmj.ac.in/pdf/vol2_no2/immune_mediated.pdf

2. Treatment for antisperm antibodies: voodoo or victory?  NJ Alexander

https://www.fertstert.org/article/S0015-0282(16)53449-9/fulltext

Professor Dr Pandiyan Natarajan.

Chief Consultant in Andrology and Reproductive Sciences,

Apollo 24/7, NOVA IVF FERTILITY,

Chettinad Super Speciality Hospital (Retired).

Los Angeles, Cary, USA, Chennai, India

Jun 21, 2022

Spermatozoa selection - The Road to Nowhere

I read with considerable interest the Reflections on,” Automated identification of spermatozoon and spermatozoa selection.”  I write this note based on my extensive experience with CASA in the earlier yers of CASA. Automated identification of the wrong structure as Spermatozoon or failure to identify the spermatozoon by the automated system is still a real possibility with attendant risks of inability to attempt ICSI. I am not sure as to how many Embryologists would be happy to let the system decide on the presence or absence of spermatozoa. Most, I feel would prefer to check the sample personally than let the system make the decision for them.

Spermatozoa Function Tests so far have been, “ Road to Nowhere.” All the Spermatozoa Function tests proposed or practiced so far have failed to translate their usefulness to clinical practice including the currently popular DNA Fragmentation Tests.(1). 

Raman Spectroscopy is unlikely to give any useful information on the DNA content or DNA Fragmentation of Spermatozoa. It gives information on the Chemical structure. The premise appears wrong based on the physical principles of Raman Effect. The other Function Test alluded in the article like Embryo selection methods also remain inconclusive.

1. A Perspective on Sperm DNA Fragmentation.

Natarajan Pandiyan, Radha Pandiyan, D. Ramesh Raja

https://tau.amegroups.com/article/view/14381/17136

Professor Dr Pandiyan Natarajan.

Chief Consultant in Andrology and Reproductive Sciences,

Apollo 24/7, NOVA IVF FERTILITY.

Chettinad Super Speciality Hospital ( Retired )

Professor Emeritus.

The Tamil Nadu Dr MGR Medical University.

Jun 01, 2022

Infertility work up- Times have indeed changed.

I enjoyed reading the excellent article. Times have indeed changed.  Infertility evaluation has become simpler, but treatment has got unnecessarily complicated by the addition of, ‘Add ons.’ When I started as Resident in this field, in 1977,  Laparoscopy was the gold standard for Tubal evaluation. To day it is no longer the Gold standard & it is not even indicated in routine Infertility practice, unless HSG indicates an abnormality. Many other Gold standards have also been given up.

Semen Analysis  still remains the Gold standard. Attempts to replace Semen Analysis with Spermatozoa Function Tests have turned futile.  The Spermatozoa Function Tests are, ‘ Road to Nowhere.’ DNA Fragmentation tests remain a Research tool,  1 ) with no useful clinical role. 

Endometriosis as a cause of Infertility is under serious debate. Endometriosis and Infertility are associated conditions with no clear causal relationship established.  Endometriosis  is more likely to be the consequence of Infertility, than the cause of it. ( 2 )  Besides, the treatment of Infertility is unrelated to the presence or absence of Pelvic Endometriosis. Endometrioma impairs Ovarian Reserve,  and surgical treatment of Endometrioma,  even more so.

Stand alone Testes Biopsy, another Gold standard is no longer indicated except when combined with Spermatozoa Retrieval and  Cryo preservation. Spermatozoa Retrieval Techniques have made fatherhood possible for 40 to 50 % of  men with Non Obstructive Azoospermia, but still other 50% would remain childless, with currently available techniques.  In Vitro Spermatogenesis may soon become a reality, and may help these desperate men longing for Biological Fatherhood. 

Reproduction is a Fundamental right of every individual. ( 3 ) All adult person,  regardless of their gender, sex, sexual orientation, sexual cohabitation should be offered, all Assisted Reproductive Technologies,  if and when possible without bias or prejudice. ( 4 )

References:

1. A perspective on sperm DNA fragmentation 

Natarajan Pandiyan, Radha Pandiyan, D. Ramesh Raja

https://tau.amegroups.com/article/view/14381/17136

2. Infertility (Non Conception) with Regular Menstruation Predisposes to
Endometriosis – A Hypothesis
Pandiyan N, Surya P,  Radha Pandiyan

https://www.chcmj.ac.in/pdf/vol6_no3/infertility.pdf

3. Is Reproduction a Fundamental Right? A Clinical, Ethical and Personal
Perspective
Pandiyan N, Puvithra.

https://www.chcmj.ac.in/pdf/vol6_no4/Is_Reproduction.pdf

4. Embryo sex selection: a social comment on the article by Malpani and Malpani. 

https://www.rbmojournal.com/article/S1472-6483(10)61905-0/pdf

Professor Dr Pandiyan Natarajan,

Chief Consultant in Andrology and Reproductive Sciences,

Apollo 24/7, NOVA IVF FERTILITY,

Chettinad Super Speciality Hospital ( Retired ).

Los Angeles, Cary, USA, Chennai, India. 

May 27, 2022

Fibrosis is the consequence of Endometriosis and not the cause of Endometriosis.

Endometriosis remains a Gynecological enigma. Though Retrograde Menstruation remains the proximate cause, (1) and almost all menstruating women  do have Retrograde Menstruation, yet only a certain percentage of genetically prone and immunologically susceptible women develop Endometriosis. Many women with Endometriosis don’t develop any symptoms and it is often an incidental diagnosis at Laparoscopy or Laparotomy.

Much emphasis has been laid on Early diagnosis, though it is not clear what could be achieved by early diagnosis. (2) Pregnancy ameliorates the Condition and Menopause is the only known cure for the condition. The condition runs an unpredictable course and spontaneous remission is known.

We feel, based on extensive experience in this field that, Infertility leads to Endometriosis. Endometriosis with adhesions & anatomical distortion  further worsens Infertility. (3)

References

1.Etiology of Endometriosis- Simplified. 

Surya P, Pandiyan N.

https://www.chcmj.ac.in/pdf/vol6_no1/etiology.pdf

2. Early Diagnosis of Endometriosis – Quo Vadis?
Pandiyan N, Surya P,  Shah Dupesh Khan , Radha Pandiyan

https://www.chcmj.ac.in/pdf/vol4_no2/Early.pdf

3. Infertility (Non Conception) with Regular Menstruation Predisposes to
Endometriosis – A Hypothesis
Pandiyan N, Surya P,  Radha Pandiyan

https://www.chcmj.ac.in/pdf/vol6_no3/infertility.pdf

Professor Dr Pandiyan Natarajan,

Chief Consultant in Andrology and Reproductive Sciences,

Apollo 24/7, NOVA IVF FERTILITY,

Chettinad Super Speciality Hospital ( Retired ) 

May 21, 2022

Endometriosis and Infertility.

Endometriosis is a gynecological enigma. It masquerades in so many forms and is often diagnosed late in the course of the disease. Genetics and Immunology certainly play a role, but the precise role is not clear. However, Menstruation plays a far more definitive role. Retrograde Menstruation can explain all cases of Endometriosis in all sites. ( 1 ) Non menstruating women rarely, if ever develop Endometriosis. Endometriosis and Infertility are associated conditions with no clear causality established in either direction. The association is at best tenuous. 

Much emphasis has been laid on Early diagnosis of Endometriosis. However, it is not clear as to what could be achieved by Early Diagnosis. ( 2 ) Most of the patients present with the symptoms of Pelvic pain at or around Menstruation or Infertility. As there is no curative treatment, management is largely symptomatic. Surgical intervention is rarely required in Non porous women.

We strongly believe, based on several decades of observation that it is often Infertility which predisposes to Endometriosis. (3 ) The treatment of Endometriosis should focus on treatment of the presenting symptom, Pain and or Infertility. 

Medical  ( Hormonal ) management, ( other than pain killers, when absolutely necessary,)  delays attending to the underlying problem and does not alter the course of the disease. 

Surgical treatment, is rarely warranted in Infertile women,  except when it leads to obstructive symptoms. Surgery often  leads to compromised Ovarian Function and further worsens the Infertility. It should be undertaken only if absolutely necessary.

References:

1.Etiology of Endometriosis- Simplified. 

Surya P, Pandiyan N.

https://www.chcmj.ac.in/pdf/vol6_no1/etiology.pdf

2. Early Diagnosis of Endometriosis – Quo Vadis?
Pandiyan N, Surya P,  Shah Dupesh Khan , Radha Pandiyan

https://www.chcmj.ac.in/pdf/vol4_no2/Early.pdf

3. Infertility (Non Conception) with Regular Menstruation Predisposes to
Endometriosis – A Hypothesis
Pandiyan N, Surya P,  Radha Pandiyan

https://www.chcmj.ac.in/pdf/vol6_no3/infertility.pdf

Professor Dr Pandiyan Natarajan,

Chief Consultant in Andrology and Reproductive Sciences,

Apollo 24/7, NOVA IVF FERTILITY,

Chettinad Super Speciality Hospital ( Retired ) 

May 20, 2022
Excessive weight causes PCOS and enhances Risk of Cardiovascular disease. PCOS is an Epiphenomenon. The primary problem in PCOS is Excessive non physiological weight gain. This leads to Anovulation and if left untreated progresses to PCOS. Cardio Vascular disease in PCOS is primarily due to the Excessive non physiological  weight gain . Excessive Weight gain also leads to Type 2 Diabetes Mellitus in a significant proportion of patients.  Please find enclosed link to our articles on PCOS. This may be of  interest to the readers. 1) Prevalence of Glucose Tolerance Test abnormalities in South Indian Sub-fertile PCOS women  https://www.chcmj.ac.in/pdf/vol4_no1/Prevalence.pdf 2) Polycystic Ovary Syndrome is an Epiphenomenon - An Opinion https://www.chcmj.ac.in/pdf/vol5_no3/polycystic_ovary.pdf 3) Is Weight Gain the Precipitating Factor for Polycystic Ovarian Syndrome? A Hypothesis Based on a Retrospective Study. https://www.chcmj.ac.in/pdf/vol4_no3/Is_Weight_Gain.pdf 4) Pregnancy Complications - Consequence of Polycystic Ovary Syndrome or Body Mass Index? https://www.chcmj.ac.in/pdf/vol6_no1/pregnancy.pdf Professor Dr Pandiyan Natarajan, Chief Consultant in Andrology and Reproductive Sciences, Apollo 24/7, NOVA IVF FERTILITY, Chettinad Super Speciality Hospital (Retired)
May 20, 2022

Physicians, ( Health Care Personnel) heal thyself.

I read with great interest the well written Inkling on, “ Who needs experts?”

https://www.fertstert.org/article/S0015-0282(22)00249-7/fulltext?dgcid=raven_jbs_aip_email#relatedArticles

The current Pell Mell is our own creation. The Health care community has been in a flux for the last several years. COVID-19 opened up all the wounds in our armor. The number of reports and counter reports, guidelines and withdrawals, affirmation and rebuttal in the field of COVID-19 has been legion. The slip up by major organizations did not infuse any confidence in public mind. 

Almost every one of the public health organization issued statements and later modified or withdrew them. Most Public Health Organizations did not see eye to eye, even on basic issues. Though this is something that a scientist would be prepared to accept in an Evolving Pandemic, the Public was not prepared for it. 

The public wanted clarity, where none existed and they wanted a Quick Fix, where no fix was visible in the early days.  It is no surprise that the public leaned upon the next easily and freely available  source of information- The Social Media and fell a prey to it. The social media with no inhibitions or controls whatsoever had a field day with every possible theory.

There are very valuable lessons to be learnt from this Pandemic and the bigger Misinformation Panic Pandemic. All of us health care personnel have a moral duty to communicate the time appropriate news to the public. Medical disagreement should not be in public. Debates and Disagreements are for Conferences or during Non Emergency situation. If it is not possible to speak in One voice, it is better Not to speak, than to speak in many voices and cause utter confusionSomething ( irrelevant or wrong ) is not better than Nothing. On the contrary, Nothing, it seems to me,is better than Nonsense.

Professor Dr Pandiyan Natarajan,

Chief Consultant in Andrology and Reproductive Sciences,

Apollo 24/7, NOVA IVF FERTILITY,

Chettinad Super Speciality Hospital ( Retired )

May 03, 2022

Will the remedy be worse than the malady?

Women with low ovarian reserve aka poor ovarian reserve are often born with low ovarian reserve. Several medical measures like Growth Hormone therapy have been tried in the past with no convincing evidence for improvement in ovarian reserve or response.

Surgical intervention in the form of ovarian fragmentation may lead to adhesions and further compromise in Fertility. Will the remedy turn out to be worse than the malady?  

Professor Dr Pandiyan Natarajan,

Chief Consultant in Andrology and Reproductive Sciences,

Apollo 24/7, NOVA IVF FERTILITY,

Chettinad Super Speciality Hospital ( Retired )

Los Angeles, CA, Cary, NC, USA, Chennai, Tamil Nadu, India.

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