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29/Sep/2017

Low sperm motility is when sperm is not able to swim properly and barely make any progress once ejaculated in vagina. It is one the major reasons for male infertility. Its getting more common these days among men because of changes in lifestyle. There are some treatment options available for this problem, some of them are listed below:


17/Oct/2016

PCOS treatment revolves around medication and the lifestyle changes. As a first step, your doctor may start recommending weight loss through moderate exercise activity and taking the low-calorie diet.

PCOS Symptoms

It is a syndrome disease and the symptoms of PCOS can vary from patient to patient. Let’s check out the major symptoms of PCOS.

  • If you find an excess or unwanted body or facial hair growth

  • If there is any thinning hair on the scalp

  • If you are facing weight related problems, often including weight gain around the waist

  • Skin problems like skin tags, darkening skin and acne also indicate towards PCOS.

  • Irregular or missing menstrual periods

  • Infertility

Some women may also experience a further complication, if there is any Diabetes, Heart, Blood vessel, Uterine Cancer or sleep apnoea related problem you have.

Treatment option can vary from patient to patient because someone having PCOS may exercise a comprehensive range of symptoms while some may experience just one. The treatment options have been motioned below.

PCOS treatment also depends on your symptoms as well as if you wish to plan a pregnancy. It is essential to mention that there is no cure for PCOS but it lowers your risk of miscarriages, heart disease, uterine cancer, infertility and diabetes.

When it comes about PCOS treatment, you need to pay these following things, which help you a lot.

  • Make a schedule to do regular exercise since it helps you control or lose weight in order to feel better.

  • Add healthy diet having fresh fruits and vegetable. Apart from it, keep a close eye if you are eating the balanced diet or not. In your diet, it should be added whole grains, low-fat dairy products, fruits etc.

  • Stop smoking as it leaves bad effect on your body. You need to avoid it strictly.

  • Take medicines prescribed by your doctors

Apart from the above mentioned, your doctors may prescribe you a medication regarding PCOS treatment in order to

  • Regulate The Menstrual Cycle

  • Help you ovulate

  • Reduce excessive hair growth.

In order to regular MC, your doctors may prescribe the combination birth control pills, which hold estrogen and progestin. It is helpful to reduce androgen production and serve your body a break from the effects of continues estrogen. Apart from it, it also helps you to lower your risk of endometrial cancer as well correct abnormal bleeding.

In case, if you are interested to become pregnant, then your doctor may prescribe medication to help your ovulate. In this connection, Clomiphene is an oral anti-estrogen medication you need to take in the first part of your MC. But if clomiphene is not effective then metformin may be added in order to induce ovulation.

The birth control pill may also be recommended in order to reduce androgen production. One should keep in mind that regular check-up are very important to catching any PCOS complication. It also helps to treat PCOS. If one is suffering from high blood pressure, high cholesterol, heart disease, uterine or diabetes then it is essential to go for regular basis checkups.


15/Oct/2016

IUI treatment is an effective method that is helping millions of couples to conceive where men have low sperm count. This is also helpful in conditions when couples face problems during intercourse. Intra uterine insemination is a medical process of culturing and inserting sperms directly into the uterus through reproductive organ, cervix. The effective IUI treatment in Mumbai is successfully performed with or without medicines, but it must be examined that the female patient should have one open fallopian tube. Before undergoing any treatment, both the partners are required to have some tests that ensure infection-free body.

Different drugs are used to stimulate ovulation however; they are not prescribed if there is a problem with male sterility as it may lead to multiple pregnancy risks. All the complications must be conversed in detail with a consultant. If you have any query regarding the treatment, you can clear it by asking the doctor. An estimated time of 2 hours are required to ready the sperm for insertion into female uterus, the male spouse of generally asked to eject his sperm several hours before the IUI procedure.

When the natural ovulation procedure continues, an unstimulated series of steps is going to happen and in this way doctors can track the procedure with the help of urine and blood tests. In this process, you are prescribed with drugs in the beginning of menstrual cycle that in turn stimulates the ovaries. Once ovulation has started, the male partner has to produce semen which is washed to extract the best sample. The healthiest sperm is then injected into the cervix of female body with the help of catheter tube. After 2 weeks of procedure, pregnancy test is done to confirm the results.

The process is time saving and takes only about 15 minutes. After this, the patient is allowed to take rest for some time to resume the daily activities. The women patient will experience slight cramping sensation during the process. IUI failure rate is very low but sometimes lead to infections in the body.

It is always considered that woman’s problems are responsible for fertility complications, but before starting the procedure both the partners are examined to reveal the correct reason.

There are several factors responsible for sterility like:

The ability of egg to implant in uterus

The speed of sperm to fertilize the egg

The quality of embryo or sperm

Block fallopian tubes

The cause can be any and devastating for the couple. IUI treatment in Mumbai proved as a holy grail for many pairs, it depends on age and infertility factors responsible for the problem. Before undergoing the treatment, it is important to discuss the problems with doctors. A professional doctor will tell you about the correct procedures and preventions needed to take prior to IUI treatment.

You can also visit Ankoor Fertility Clinic to get best services and ensured results. The professional doctors can help you to conceive your child in effective ways. Visit today!


23/Sep/2016

Diagnosing with PCOS can be a shocking news for anyone, especially when you are learning about the health effects of this conditions. To treat the symptoms of PCOS doctor will provide you with only one form treatment, but there are ample of other treatments that are found to be very effective in treating PCOS.

Laparoscopic Ovarian Diathermy is one of the most common methods of treating PCOS symptoms. This is also known as ovarian drilling. In this process, the surgeon precisely burns certain areas of the ovary that stimulate regular ovulation and re-balance the hormonal secretion in patient’s body. Women who want to conceive child undergo this procedure. Although it is not a permanent solution but, continuous treatment with repeated steps can impact the women’s fertility.

Another effective PCOS treatment is type II diabetes drugs. The doctor can prescribe Glucophage or metformin to patient women, these drugs regulate the secretion of feminine hormones. Low blood sugar level is a normal health problem when people undergo this treatment. However, the truth is somewhat different. Glucophage drug reduces the increased insulin level, lowers down the excessive secretion of hormones in the body. It is nowhere linked with the blood sugar level of the patient. The increased secretion of estrogen will automatically reduce down the discharge of testosterone which is responsible for hair growth.

Some women take birth control pills to avoid pregnancy during PCOS treatment. These PCOS pills eliminate unwanted acne growth, reduce secretion of male hormone and stimulate women’s menstrual cycle. It is a time-consuming treatment. PCOS treatment in Mumbai is done by professional doctors only.

While taking PCOS treatment it is important to maintain healthy weight. Majority of women are obese, so it is essential to lose weight during the medications. If you are overweight, take these medications and lose weight stress-free. Losing mass by 10% body weight produce excellent results. Women who are capable of losing weight enjoy regular menstrual cycle and lessened symptoms of PCOS.

PCOS treatment in Mumbai is done by professional doctors only. If your doctor has not much information about the PCOS treatment, you can seek help from experienced doctor. One can also join PCOS support group to know about multiple PCOS treatments.


18/Feb/2016

Imagine this scenario. A young couple in their late 20’s early 30’s enters the consulting room of a gynaecologist. The women is having some vaginal infection and needs a gynaecological opinion. The gynaecologist examines and gives appropriate treatment. The couple thank the doctor and before leaving the room the women asks “doctor May I ask you one more question” “sure” says the doctor. “We are both 29 yrs old and have just married a few months back, how much time can we wait more before having a baby. You see we are still financially not settled and would like to wait couple of more years but the family is insisting on having a baby. What is your opinion? ” Well this is the story of modern India. Better education opportunities, women empowerment, rising costs and high standard of living are leading to late age at marriage and prolonged career goals. Couples now want to be independent, well settled financially before they have a baby. All this perfectly make sense and therefore we find more and more women having their first child in their late 20’s and early 30’s. But unfortunately God had planned it some other way. A women’s maximum fertility potential (Ability to conceive) as per Gods planning is between 18-28 years of age. Thereafter it starts falling and beyond 35 years there is a drastic reduction in fertility potential. It has to be remembered here that this is a general rule. Some women may easily conceive even at 40 and some women have difficulty even at 22. One has to understand that before planning or postponing planning there are few factors which may be taken into account- some scientific and some practical. So this is the checklist for all those couples planning to postpone the pregnancy by a few years:

  • Age of the women: As already mentioned a women’s fertility potential is at its peak between 18-28 years and it’s always better to have a baby before the age of 30. So yes if you are 30 and planning to postpone your pregnancy, give it another thought. Career and life goals can wait. Please prioritize your ambitions.
  • Menstrual pattern: If you have any irregularity in your menstrual pattern, consult your gynaecologist and rule out PCOS (polycystic ovarian disease). 30% of women with subfertility have PCOS. Alternatively irregular menses could be due to POF (premature ovarian failure). In both cases women have a tendency to form cysts in their ovaries. Both these together are the leading cause of infertility. So beware of irregular menses.
  • Infections: If the women has a prior history of tuberculosis whether it be of lung or intestines, there is a fair chance that the bacteria may have spread to the uterus or fallopian tubes. Genital tuberculosis may lead to infertility by either causing blockage of tubes or damaging the uterine lining or the endometrium. Even repeated pelvic pain and recurrent vaginal infections may point to something we call as PID(pelvic inflammatory disease) and lead to fallopian tubal block and infertility. 10-15% of women with subfertility have tubal factors as a cause.
  • Uterine fibroid or polyps: These are benign tumors of the uterus that may lead to difficulty in conceiving. They may be completely incidental findings or may be associated with symptoms like heavy bleeding. If one is planning to postpone a pregnancy it is prudent to do a usg pelvis to rule out these. One has to remember that even if an usg is normal there are still chances of developing these tumors later. Also these tumors once removed have a tendency to recur. The treatment will however differ depending upon their size and location. Its best to sit across your gynaecologist and discuss the options.
  • Surgical history: If a women has undergone any gastrointestinal (Appendix, bowel etc) surgeries in the past there are chances of adhesions in pelvis which may lead to subfertility.

Also surgeries in male partner – like inguinal (groin) hernias, hydrocele or varicocoele surgery, any testicular trauma (while playing football,cricket) may lead to fault with the sperm count and motility. Therefore if either of the partner has a significant surgical history, think twice before delaying pregnancy.

  • Medical History: If either of the partner is suffering from medical disorders like high BP, thyroid disorders, diabetes or epilepsy, then it’s better to get the particular disease well controlled with medications before you conceive. It has to be remembered that some diseases may get flared up or may require higher dosage of medications during pregnancy so continuous monitoring is essential.

Also medications that are not safe during pregnancy could be converted to pregnancy safe medications way before planning the pregnancy. These are some essential points that should be considered before planning.

  • Genetic predisposition: If one has a family history of genetically abnormal child (commonly downs or mongoloid child) or a history of infertility or multiple abortions in family its better to start planning early as there may be an abnormal gene running in one’s family. Even if detected there is seldom a cure available for genetic abnormalities. And as age of a women progresses the risk of genetic abnormal child is more.
  • Smoking and tobacco consumption: All of us are aware that smoking and tobacco increase the risk of cancer. But what most of us are unaware is that these have detrimental effect on the gametes (ovum and sperm). Tobacco not only is responsible for the death of gametes but also causes defective gene formation. Also it leads to miscarriage, low birth weight babies, preterm or early delivery.

Now a days in addition to young men we find lots of young women who are smokers. Smoking may cause irreversible damage to the gametes. Stopping tobacco may not reverse the effect but stop the damage immediately.

  • Obesity: This is a major problem in cities. Easy availability of junk food in addition to hectic work schedules has led to irregular and faulty eating habits. On top of that no one has the time and motivation to exercise. 10 years back this was a problem in young adults and now we find obese teenagers and kids.

It is well known that obesity leads to suppression of reproductive function in both men and women. Also the rate of miscarriage and preterm delivery are also more if the pregnant women is obese. Obesity may also predispose you to high BP, diabetes and heart disease at a very young age. So if you are planning a pregnancy, please start a good diet and exercise regimen. This applies not only to the women but also to the men. A healthy couple will not only produce a healthy fetus but will be able to give birth to a healthy baby and raise a healthy child. If none of the above points are relevant in your case and you want to plan a pregnancy at the later date, we would advise you to visit a gynaecologist and get some tests done. A routine examination and tests like basic hormonal profile (TSH/prolactin/CBC), an ultrasonography (USG) pelvis and Semen analysis need to be performed before taking any decision. Abnormality in any of these may need immediate attention and treatment so that it does nor worsen by the time you start planning. We advise all young couple who are planning to get married and who are just married to go through all the above points carefully and take appropriate action towards them. For some it may just be minor changes, few may require expert help from a dietician or gynaecologist or a physician. Young adults of our country are now capable of taking their own decisions, but it may occasionally be needed that one pays attention to what adults and experts advice. Taking a calculated decision will help to avoid any dejections and failure in future. Infertility clinics now a days are full of young adults wanting to have a child just because the right time was missed. Some repent there was no one to guide them while some did not pay heed to early signs and symptoms. Science has advanced so much that today we can make a 60 year old lady also pregnant, but if one takes out few years of their hectic schedules to give birth to a child, it will save you from all the mental, financial and physical stress involved in the infertility treatment. Our job as a doctor is to inform and educate you. Finally which path to choose will be the couple’s decision. Thinking wisely before making any decisions will avoid a lot of complications in your life.


24/Aug/2015

Myth 1: I should tilt my lower body upward or keep a pillow below my buttock  to help the sperm get to my egg
Fact: False! There’s absolutely no evidence that shows shifting gravity in your favor will increase your chances of getting pregnant. So after sex, just relax!

Myth 2: You should eat for two when you are pregnant
Fact:  Yes, you’re eating for two — but that doesn’t mean two adult-sized servings are necessary. The average woman with a normal weight pre-pregnancy needs only about 300 extra calories per day to promote her baby’s growth, according to the American Congress of Obstetricians and Gynecologists (ACOG). That’s roughly the number of calories in a glass of skim milk and half a sandwich. A woman of normal weight should gain 10 – 11 kgs  during pregnancy — less if she’s overweight Also, women who gain more than 15- 20 kgs  when they’re carrying just one child have a higher risk of a cesarean section or a difficult vaginal birth.

Myth 3: One must eat three healthy meals a day
 Fact :False! You should be eating six or seven small meals (every two to three hours). “Eating frequently and from various food groups will keep your blood sugar in a constant range, which is healthy for you and your baby

Myth 4 : One must avoid Hair Dyes when pregnant
Fact : Chemicals from hair dye, permanents, and relaxers are absorbed through the skin only in minimal amounts that aren’t harmful. We don’t believe there’s any fetal risk from hair dyes and such. But strong odors from hair treatment products make some pregnant women feel nauseous. So use them in a well-ventilated space with a fan. You can hold off on hair treatments until you’ve passed your first trimester if you’re really worried. You can also avoid dyes with ammonia, which has strong fumes. “Hair changes a lot during pregnancy. Products that worked well before pregnancy might not give the same results.”

Myth 5 : Caffeine Is a No-No
Fact : Do you love your morning cup of coffee? Many pregnant women do, but often they’re warned to give up caffeine because it might cause miscarriage, preterm birth, or low birth weight.
But the case against caffeine isn’t strong. “There does not appear to be any relationship between caffeine consumption and preterm birth. Also, if a pregnant woman drinks less than 200 milligrams of caffeine per day — the amount in about one 12-ounce cup of coffee — there’s no clear evidence she faces any increased risk of miscarriage or low birth weight.

Myth 6 : Flying Can Increase Your Risk of Complications
Fact: Don’t worry about the small amounts of radiation that pregnant women might encounter while passing by or through an airport X-ray machine or flying at high altitudes .We get exposed to radiation all the time from being on the ground, and certainly flying increases that a bit. But the kind of radiation you’re exposed to [during air travel] doesn’t have much penetration into the body, so it’s unlikely to ever cause fetal exposure at all.”
Nor are body scanners dangerous. It’s a very minute amount of radiation, and it’s extremely unlikely to cause any sort of fetal effects. If you’re planning to fly in your last trimester, check with your airline about any restrictions. Most airlines get a little anxious if you look like you might deliver en route.
Some pregnant women should never fly without a medical clearance first. Women who have coexisting lung or cardiac problems when they’re pregnant might find they don’t do well flying at 30,000 feet, They should ask their doctor before they get on a plane, but an otherwise normal, healthy woman should be able to fly very safely.

Myth 7: It’s a complete no no to have a drink
Fact : One glass of wine isn’t going to hurt the baby. But one glass here and there doesn’t mean nine — in fact, two or more alcoholic drinks daily can lead to fetal alcohol syndrome. So while it’s best to cut out alcohol completely, an occasional small glass of wine is harmless.

Myth 8: Skip the gym
Fact: False! Actually, low-impact workouts can be a great way to control your weight and prep for baby. Just avoid contact sports or exercises that involve lying on your back (which reduces blood flow to you brain and uterus).

MYTH 9: . All pregnant women have morning sickness
FACT: Not every woman will experience morning sickness, because every woman and their pregnancy hormone levels are individual.  The feeling of morning sickness is often caused by a rise in the female hormone estrogen during pregnancy. If the pregnant woman’s body already produced a high level of estrogen prior to her pregnancy, additional estrogen may cause morning sickness in the first trimester, or not. It all depends on the individual

MYTH 10: Eating spicy food can cause preterm labour
Fact: It is a myth that eating spicy food during pregnancy to induce labor actually works. There is no known food that can bring on labor. The exact cause of labor is unknown, but it’s believed that the fetus sends a signal which may make the uterus contract and go into labor.  Yes, some women say that as soon as they ate a spicy dish, within several hours they went into labor. Unfortunately, there are no statistics on this theory. To date there has not been any research that concludes that eating any spicy foods will start contractions.  One reason some women stand by their chili pepper theory is that spicy food is known to irritate the digestive system in most people, and might be followed by diarrhea.  Diarrhea dehydrates your body and one of the known side effects of dehydration in pregnant women is contractions.  Therefore it may seem like your SPICE did the trick, but really it was your dehydrated body that brought those contractions, and possibly labor

MYTH 11: Pregnant women who carry low have a boy, OR Increased acne during pregnancy carry a girl.
FACT: How a woman carries depends on her body type and whether she has been pregnant before, but does not reflect gender.  Women tend to carry lower or higher depending on their body type. Taller, thinner women appear to carry higher. Shorter and fuller women appear to carry lower. Neither has any correlation to gender. Also, in a second pregnancy, since abdominal muscles may be looser, the pregnancy may appear to be lower.
Pregnancy acne has nothing to do with gender; it is a result of natural hormonal changes

MYTH 12. Pregnant women shouldn’t  take warm baths.
Fact: Women are told not to take baths because HOT water — over 98 degrees — is unfavorable to the pregnancy. Taking a warm (NOT HOT!) bath with someone to help you get in and out of the bath safely can help:
•    Decrease uncomfortable swelling in arms and legs.
•    Increase the amniotic fluid.
•    Prevent premature contractions.
Help the mother relax and alleviate anxiety about the health of her baby.
This is also why swimming is such a great pregnancy exercise

MYTH 13: Pregnant women shouldn’t eat fish.
FACT:Mercury and food poisoning are significant concerns. Women are individuals and every pregnancy is unique. Small white fish have lower mercury levels because they have been living in the ocean for a shorter period of time. Get fresh fish and smell it. A woman’s sense of smell is heightened during pregnancy for a reason — the pregnant woman’s body is helping her determine what is healthy for her baby.
Moreover, fish oil contains helpful Omega 3 fats, which actually enhance the development of the baby’s brain, improve the baby’s IQ, make the baby a better sleeper after birth, prevent premature contractions and premature labor, prevent high blood pressure during pregnancy, and act as an anti-inflammatory that prevent infection. If a pregnant woman is uncomfortable eating fish, she can visit her local health food store for fish oil supplements

MYTH 14: If you watch a lunar eclipse during your pregnancy, your baby will have a cleft lip
FACT: This ancient myth has been traced back to the Aztecs. They believed that an eclipse was a bite on the face of the moon. If a mother watched it, the same thing would happen to her baby. For protection, the mom must carry something metallic, such as a safety pin, on her underwear. Although it’s a beautiful myth, the truth is that a cleft palate is caused by a blend of genetic and environmental factors that in no way include the planets.
MYTH 15: Men cannot REALLY be a part of the pregnancy.
FACT: Making your life partner into your pregnancy partner can make a big difference in how much you enjoy your pregnancy. Pregnancy can be the most wonderful opportunity to bring a couple together as a solid team. When men are given the means to assist, pregnancy can make the relationship between that man and his pregnant partner exceptionally strong — strength a couple will need when baby arrives

MYTHS ABOUT INFERTILITY AND IN VITRO FERTILISATION (IVF) PREGNANCY

Myth : Infertility is the same thing as sterility, and it’s rather rare.
Fact : Sterility is the complete inability to reproduce where as infertility is “sub-fertility,” or impaired fertility. A sterile person cannot reproduce but about 70 percent of those who seek treatment for infertility are eventually able to have a baby.

Myth : Infertility is a women’s problem
Fact : 1/3rd of cause is attributed to women, 1/3rd to men and 1/3rd to either both or unexplained. Therefore infertility is not only a woman’s problem.

Myth : Women are having babies well into their forties, so it’s probably safe to delay childbearing.
Fact : Fertility is definitely age related. Studies have suggested that on an average, female fertility declines slightly starting at age 27, but drops off in a clinically meaningful amount around age 35 and then dramatically at age 40. The ideal age for conceiving for a woman is in her twenties.

Myth : Infertility is caused by the stress. (“Just relax”)
Fact : In most cases, about 80 to 85 percent of the time, doctors diagnose a medical cause as a factor leading to infertility for which no amount of relaxation will help. In cases of unexplained infertility, often infertility is caused by rare problems that are impossible to discover through a routine checkup. Chronic stress and fatigue may alter hormones, but most cases fertility drugs are helpful in cases where hormones fall outside of normal ranges.

Myth : Doctors take huge risks with embryos in high-tech programs, making these options unethical
Fact : With the help of pro active measures taken by the patients in managing their treatment risk to the embryo can be minimized. For example, a couple can limit the number of potential embryos (i.e., the number of eggs exposed to sperm) to a number they are willing to carry to term in that cycle, and hence avoid the ethical minefield of pregnancy reduction.

Myth : The “hips up theory” is the best position for conception
Fact : Position makes no difference sperm has to reach cervical mucus within five minutes, or they are inactivated by the active PH of the vagina. Hips resting on a pillow or staying in the position at the time of ejaculation will not increase the chances of fertilization.

Myth : Egg freezing is only useful for women with medical conditions like cancer
Fact : Egg freezing is an evolving option for women under 37 years of age who are concerned about their fertility options. Egg freezing is currently still considered experimental, and should only be done as part of a research protocol.

Myth : Methods like acupuncture don’t help with infertility
Fact : Studies comparing women who have acupuncture and women who don’t, indicate it may enhance fertility. Many acupuncturists now specialize in fertility, and “our patients who have utilized acupuncture and other complementary methods may have benefited

Myth : Adoption cures infertility. (“Just adopt and you’ll get pregnant.”)
Fact : Researches have shown that out of those adoptive families who have experienced infertility, mostly approximately half have been under medical treatment for infertility on an average of three years prior to adopting. It has been estimated that between five and fourteen percent of couples who quit treatment to pursue adoption eventually conceive. This percentage is same as for couples who quit treatment and choose not to adopt & subsequently conceive. The flawed idea behind this myth is that if couples do not think about getting pregnant, it will happen for them.

Myth : IVF is considered unnatural.
Fact : IVF is the most natural way in which genetic composition of the man and the women need to form a baby. Since this process is not possible inside a woman’s body either because of tubal blockage or poor sperm count, IVF helps in bringing the egg and the sperm together outside the body.

Myth : IVF is very expensive
Fact : Most people avoid IVF expecting this to be an exorbitant process costing lakhs. However most IVF cycles including drugs costs between Rs.1 lakhs – Rs. 1.5 Lakhs.

Myth : IVF is an end of the road process
Fact : Many people shun away from IVF thinking that if this process is unsuccessful they will never be able to become pregnant. However, there are many couples who conceive naturally or with IUI even after IVF

Myth : IVF babies have malformations
Fact : The background risk for congenital malformation after natural conception is 2-3 %. With IVF it increases by 0.5 – 1 %. Majority of IVF pregnancies give rise to normal babies.

Myth : IVF is a very painful process
Fact : IVF is not as painful as many people think it to be. Apart from the inconvenience and discomfort of multiple injections (between 1-2 per day for 10-14 days). There is no other painful procedure involved. Egg collection which can be a painful process is done under Anesthesia so that the patient feels no pain. Embryo Transfer is again a painless process.

Myth : There is need of complete bed rest in IVF pregnancies
Fact : Though extra precaution is recommended in first three months of  any pregnancy, most patients can carry on with normal activities including there job till the final stage of pregnancy

Myth : Certain dietary changes improve pregnancy rates.
Fact : There is no particular diet that has shown to improve IVF pregnancy rates. People living in different parts of the world with varying dietary habits get pregnant with IVF. However, a healthy food habit is recommended. A good mixture of protein, carbohydrates, vitamins and plenty of water is advised. It is best to avoid spicy and oily food.

Myth : “Everyone else seems to get pregnant so easily , why not us!”
Fact : It is estimated that 1 in 8 people experience infertility at some point in their lives. Infertility is a common health problem in men and women. Fortunately, 90% of all cases have a specific cause for the infertility that can be uncovered with proper diagnosis & then can be treated.

Myth : “If you have sex every day it will increase your chances of getting pregnant”
Fact : Because normal, healthy sperm remain active in the woman’s reproductive system from 48-72 hours, having intercourse at 36-48 hour intervals around the time of ovulation is usually adequate. In fact, if the man has a low sperm count that replenishes slowly, having sex every day may be counterproductive.

Myth : “Infertility only happens to couples who have never had a child before.”
Fact : Unfortunately for many couples who have a child and wish to conceive again, a variety of factors can contribute to what is known as “secondary infertility.” A number of problems could have occured since the last conception, such as endometrioses anovulation, tubal disease or decline in the concentration of sperms in male.

MYTH : It’s all psychological: Stress is the leading cause of infertility. People just need to relax and they’ll get pregnant.
Fact : Infertility is a medical problem; it is a disease or condition of the reproductive system. While relaxation may help with overall quality of life, stress and deep emotions may result from struggles with infertility, not cause it. A recent survey conducted for RESOLVE, The National Infertility Association, revealed that 22% of women mistakenly believe that stress is the number one cause of difficulty conceiving, rather than a medical condition. At least 50 percent of those who complete an infertility evaluation respond to treatment with a successful pregnancy. Those who do not seek help have a “spontaneous cure rate” of about 5 percent after a year of infertility.

MYTH : Infertility is a personal failing.
FACT : Infertility is a crisis and it is normal for people to feel a sense of inadequacy that affects their self-esteem and self-image. It is highly recommended that all those who face infertility issues become more informed about the wide range of options and connect with others facing similar challenges, as well as considering professional counseling.

MYTH : Infertility is not problematic for people until they hit their late 30s.
FACT : Most people are not aware that for women, infertility decline begins at 27 or even sooner, although the most significant decline occurs in the mid 30s. According to the American Society for Reproductive Medicine, approximately 10 percent of women under 35 experience infertility and that number more than doubles to 22 percent for women ages 35-39. For women over 40 years old, the number nearly triples to 29 percent. Infertility is defined for patients under the age of 35 as the failure to conceive after one year of intercourse without using contraceptives. For patients older than 35, this time frame is shortened to six months. In addition, recent research indicates that men, too, may experience a decline in fertility with age. “The drop in natural pregnancy rates is directly correlated to the effects of normal ovarian aging – as women age, their eggs become less fertile and chromosomal abnormalities may begin to appear,” But the good news is that with the appropriate treatment, the majority of conceive.”.

MYTH : IVF is still pretty risky.
FACT : The average live delivery rate for IVF in 2000 was 29.9 percent per retrieval — slightly better than the 20 percent chance that a reproductively healthy couple has of achieving a pregnancy and carrying it to term.

MYTH : Diet is important for pregnancy, not conception.
FACT : Removing sugars from the diet, (e.g., caffeine, white flour, white sugar, white corn, white rice, etc.), will improve ovulation and regularity. Foods that are broken down quickly raise insulin levels too quickly and disrupt delicate hormonal values in the ovaries causing more testosterone to be produced, impairing egg quality and thus possibly lowering the chance of conception. In some women, high insulin levels may cause irregular ovulation, irregular periods, or polycentric ovarian syndrome (PCOS).

MYTH : Semen spills out of vagina is this the cause of infertility
FACT : Normally 3-5 ml of semen is ejected & a few ml then spills out of vagina What is important few conception to the initial spill & the sperms that reach up to cervix which acts as a reservoir & keep.

MYTH : Success rate is very low & expenses are very high.
FACT : Success rate depends on many factors. Most important is age, younger the age, Higher the chances. Other factor are cause of infertility, duration & quality of egg & sperm. Expenses are not too high in India. Rates very from clinic to clinic. It is equivalent to expenses in any major surgery related to heart or kidney.

MYTH : Once there is genital tubercuculasis, chances of pregnancy even with IVF are very low.
FACT : Genital tuberculosis is very common causative factor for infertility in India. It affects the tube ovaries as well as uterine cavity. The success of IVF in these cases in similar as in other causes of infertility. Provided the uterine cavity is normal & free of synchiae. If uterine cavity is oblitiraled more than half by tubercular synchiae, surrogacy is alternate option.

MYTH : When there is very low sperm count or nil count in husband’s semen, donor semen is used.
FACT : In cases of oligo spermia or azoosperm ICSI is done using husband semen only. Donor semen is used only if both partners consent to do so. Egg donation sperm donation or embryo donation is done only with proper informed consent.


26/May/2015

This is the most important part of IVF/ICSI. If this is done correctly the chances of success increase markedly.
Pre IVF evaluation is done for both male & female partners.
For Female Partners.

  • A transvaginal sonography is done to assess the ovarian reserve (how many follicles of 2-3 mm size on day 2/3 of cycle), endometrial thickness, subendometrial blood flow, to look for any other abnormalities that may be present like fibroid in the uterus, uterine septum uterine polyp adhesions.
  • Hormonal tests like serum FSH, LH, TSH, Prolactin and AMH.
  • Infectious disease tests like HBsAg, HCV, HIV
  • A hysteroscopy if required

In most centers pre IVF hysteroscopy is a norm. But at Ankoor fertility clinic, we do not advise hysteroscopy as a routine to all IVF / ICSI patients. We do a thorough evaluation of the endometrium and it’s receptivity using Trans vaginal ultrasonographies (TVS) and Doppler studies. During these USGs we look for the endometrial thickness, echotexture, volume and blood flow. If there is any abnormality in these studies, only then a hysteroscopy is advised.

 

Fig . USG image of good uterine blood flow

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Video of USG Doppler showing endometrial blood flow

 

  • Weight and body fat percentage assessment

As per requirement, drugs are given to improve ovarian reserve, endometrial lining, endometrial blood flow etc.

Losing as much as 10% of body weight will improve the chances of success of our cycle.

For Male Partner:

A detailed semen analysis followed by other tests like sperm function tests, ultrasound of scrotum & andrology opinion if required.
Based on the above observations medications are given to improve semen quality.

One should proceed with IVF/ICSI only after all the factors are optimized giving us the maximum chances of pregnancy.

What are the steps of IVF?

  • Starting IVF treatment can be an exciting experience.
  • Usually, IVF treatment is pursued once other treatments have failed, following months of trying to get pregnant unsuccessfully. For most couples, it seems the end of the road.
  • There are lots of myths related to IVF/ ICSI as sometimes the procedure is not understood correctly or has not been explained correctly.
  • It has its own financial, social and most important emotional implications.
  • But the fact is that IVF/ICSI is a very short procedure, relatively painless and not very demanding; but the fear of IVF/ICSI is more consuming.
  • Let us understand the procedure correctly to allay the fears and anxiety and undergo the procedure with a more positive mindset. The actual procedure is over even before you realize it. It is not as stressful as it sounds like.

26/May/2015

In the month prior to the IVF stimulation cycle, medications/injections are given to suppress the body’s natural hormones so that the subsequent stimulation of ovaries is better controlled.

Option 1:

You may be put on birth control pills in this cycle. This may seem strange – you are trying to get pregnant and we are putting you on birth control pills. Actually, though, using birth control pills before a treatment cycle has been shown to decrease your risk of ovarian hyperstimulation syndrome (OHSS) and ovarian cysts and hence may improve the chances of success. It also causes suppression of LH hormone and suppression of the entire cohort of follicles so that all the follicles are in the same phase and will grow simultaneously.

Option 2:

Another possible option is that we monitor your follicular growth and ovulation and give you estradiol valerate tablets till you get your periods. This is to suppress the FSH hormone in your body which helps in follicle recruitment. If the body’s FSH is suppressed, we can recruit more number of follicles by giving injections. Suppression of FSH does not allow the natural selection of the follicle by the body, thereby uniform recruitment of the follicles and we will get more number of follicles.

Option 3:

Sometimes we monitor your follicular growth and ovulation and start Injection Lupride. This is used in the long protocol of IVF and the basic aim is the same – to suppress the body’s natural hormones so that all the follicles (cohort) are maintained at the same size and can grow equally.

The type of protocol differs from patient to patient, depending on their age, previous response, endometrial lining etc.

Generally the husband is told to give one semen sample before the start of the cycle. This sample will be frozen till the day of actual oocyte retrieval. This is because the stress of the day and anxiety can make it difficult for some to give the semen sample on the day of oocyte retrieval. So just in case that happens, we will have a backup sample.
Oocyte retrieval as well as embryo transfer takes place through the vaginal route. Therefore if there is any vaginal infection, it may be transmitted to the ovaries or the uterus. This may hamper the results of IVF. Even infection in the male genital tract can affect the results and more important, can be a source of transmission to the female partner. Treating genital tract infection is very important. Therefore, we give a course of oral antibiotics to both the husband and wife inorder to clear the genital tract of any infection. In addition,vaginal pessaries (combination of antibiotic and antifungal preparation) are given to clear the vaginal tract of any infection.

 

Ovarian stimulation

This is when we actually start the IVF/ICSI cycle. You will need to come on day1/day2 of periods. A baseline ultrasound is performed to rule out ovarian cysts. If a cyst is present, the cycle may be postponed to next month or the cyst can be aspirated and the cycle can be started.
If required, baseline hormone levels like Serum E2 and LH are tested. This is to make sure your ovaries are “sleeping” or are suppressed so that the stimulation of ovaries with (Gonadotrophins) HMG /FSH injections will happen correctly.

Should the results be favorable the ovarian stimulation is started.

PRINCIPLE – In a natural cycle, a woman’s ovaries will generally produce one egg. But when we are doing an invasive procedure like IVF/ICSI it is better to have more eggs which will maximize the chances of success. Also, not all stimulated follicles are mature and give eggs. In addition there is a limited rate of fertilization(all the eggs that are obtained do not fertilize). What would we do if a single egg we obtain does not fertilize? If we have more eggs, we can make more embryos and select the best embryos for transfer.
Hence injections are given to obtain controlled ovarian stimulation (COS).

Ovarian stimulation is achieved by daily injections of gonadotropins, which are given subcutaneously and can be self administered. We teach you how to take injections and 99% patients take them on their own without any problems. This helps you to cut down on hospital visits or running to your family doctor daily just to take the injections which wastes lots of time and creates unnecessary anxiety.

The stimulation process is monitored by serial ultrasounds and blood tests, which are done as and when required. The first ultrasound is generally done on the 4th /5th day of stimulation. This helps us to monitor the growth of your follicles and assess whether the dose of the injections needs to be increased, decreased or remain the same. The next ultrasound is 2 days later and then it is generally on alternate days or daily till the follicles are ready (approximately 18 to 20mm in size on USG). Transvaginal ultrasound not only helps to monitor the follicular growth but also helps to monitor the endometrial thickness.

These injections generally continue till the follicles are ready which is usually for 8 or 9 days. This comes to around 9th -11th day of periods.
When the follicles in the ovaries are ready (18-20mm) HCG injection is given for oocyte maturation. Timing this injection is vital. If it is given too early, the eggs will not have mature enough. If given too late, the eggs may be “too old” and won’t fertilize properly. The frequent ultrasounds are meant to time this trigger shot just right. Usually, the HCG injection is given when three or more follicles have grown to 17 to 19mm in size.

 

Oocyte Retrieval

This is a minor surgical procedure that is performed on day care basis.

The egg retrieval takes place between 34 to 36 hours after you receive the HCG shot. It’s normal to be nervous about the procedure, but most women go through it without much trouble or pain.

You have to be fasting from midnight of the previous day of oocyte retrieval. On the day of oocyte retrieval, you have to come fasting (no tea, water etc). However, if you are taking any regular medications like that for thyroid, blood pressure, diabetes etc. you will take them in the morning with a sip of water (after confirming with us). When you come in, you will be taken in the ultrasound room for a sonography and your husband will be sent to make admission papers. After the sonography, you will be taken to the recovery room where you will be given a OT changes (operation theatre gown). An IV line will be inserted and that is the only pain you will get! You and your husband will be given consent forms to sign. You will be taken to the operation theatre.

The oocyte retrieval is done under general anesthesia with ultrasound guidance.Before the retrieval, an anaesthesiologist will give you some medication intravenously to help you feel relaxed and pain free. You are given general anaesthesia so that you will sleep completely for the entire procedure and will come to know nothing about the procedure. There is no intubation required. The whole procedure of oocyte retrieval usually takes about 15 to 20 minutes. The entire procedure is absolutely pain free.
Once the medications take their effect, a transvaginal ultrasound is used to guide a needle through the back wall of your vagina, up to your ovaries.The needle is used to aspirate the follicle, and gently suck the fluid and oocyte from the follicle in to the needle. One follicle generally contains one egg. But all the follicles do not contain an egg. On an average when we aspirate, we get one egg for every 2 follicles we aspirate. These oocytes once aspirated will be transferred to the embryology lab for confirmation of the number of eggs retrieved and further fertilization.

 

Video of ovum pick up

 

The number of oocytes retrieved varies but can usually be estimated before retrieval via ultrasound. The average number of oocytes is 5 to 10.

After the retrieval procedure, you’ll be taken to the recovery room where you will sleep off under the effect of anaesthesia for a couple of hours. Light spotting is common, as well as lower abdominal cramping, but most feel comfortable by the same evening. Once you get up you will be given a light snack. We will give you further instructions and you are ready to go home. Usually the procedure is done in the morning and you are ready to go home by afternoon or evening.

 

Fertilization

The follicles that were aspirated will be searched for oocytes, or eggs. Not every follicle will contain an oocyte.

 

Fig:Unfertilized immature eggs

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Once the oocytes are found, they’ll be evaluated by the embryologist. If the eggs are overly mature, fertilization may not be successful. If they are not mature enough, the embryology lab may be able to stimulate them to maturity in the lab. This is called in vitro maturation which takes around 24 hours.

Fig Mature egg

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Fig Vacuolated oocyte

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All the oocytes which are retrieved are carefully identified and kept in the CO2 incubator. During this period the semen sample is obtained from the husband and semen processing is done which isolates the healthiest sperms. The union of male gamete(sperm) and female gamete(ovum) is known as fertilization. In an IVF laboratory, fertilization is done either through IVF or ICSI.

 

In an IVF, the embryologist places about 10,000 sperms in a culture dish with one oocyte.

 

With ICSI, which we generally prefer, the embryologist will choose a healthy-looking sperm and inseminate the oocyte with the sperm using a special thin needle.

 

Fig of ICSI procedure:

icsi

The culture dishes are kept in a special incubator under special conditions (specified temperature and CO2 concentration) and after 24 hours, they are inspected for signs of fertilization.

The fertilization rate with ICSI is higher than IVF. With ICSI, around 75 – 80% of the oocytes will get fertilized.

 

VIDEO OF EMBRYO DEVELOPMENT AFTER ICSI PROCEDURE.

The above video shows the procedure of ICSI , wherein a sperm is injected into the egg. This is followed by fertilization and formation of the embryo. It further shows the development of the embryo from one cell to 2 cell, 4 cell, morula stage and later delevoping into a Blastocyst (Day 5 Embryo)

 

Fig . Normal fertilization, 2 pronulclei (PN) seen

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Fig. Abnormal Fertilization , 3 Pronuclei (PN) seen after 17 -18 hours

 

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Fig . Day 2 embryo, 2 cells seen (between 36 -48 hours)

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Fig . Day 2 embryos, 4 cell seen after completion of 48 hours

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Embryo Transfer

 

About three to five days after the retrieval, the fertilized eggs will be transferred. The embryo transfer is a simple procedure just like an IUI procedure. When the embryos are transferred on day 3, the embryo is said to be 8 cell stage.

Video of USG guided Embryo transfer

Above video shows the procedure of transfer of Embryo under USG guidance.

 

Fig9. Day 3 embryos, after completion of 72 hours 22

Fig 10. Day 4 embryos, cluster of 16 cells called as morula

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When the embryos are transferred on day 5, it is at blastocyst stage. This is the highest form of human life that can be sustained in the laboratory.

 

Fig 11. Day 5 embryo, Blastocyst stage

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Fig 12. Day 7 embryo, Hatched blastocyst

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The number of embryos transferred will depend on the quality of the embryos and your previous discussion with the doctor.

 

Poor quality fragmented Embryos:

272829303133 34   35 36   37

 

Depending on your age, anywhere from one to three embryos may be transferred. Recent studies have shown success with just one embryo transferred. The transfer will be done on a full bladder in the operation theatre. No fasting or special preparation is required for embryo transfer.

Embryo transfer does not require anaesthesia and is done on a day care basis. When you come to the IVF clinic in the morning, a routine vaginal scan is done to assess the endometrium. Then you will proceed to the recovery room, where the nurse will give you a progesterone injection. This will help in relaxing the uterus as well as maintaining good progesterone levels. You will lie down in the recovery room till your bladder is full. When the bladder is full, we take you to the operation theatre. There is soothing music which will help you to relax and be in a more positive frame of mind. At the time of transfer, the private parts will be cleaned with warm water and then the external catheter will be passed just beyond the internal os.

The embryologist will then bring the internal catheter loaded with embryos. The selected embryos are transferred into the uterus by a specially designed catheter under ultrasound guidance, which helps to transfer the embryos in correct place in the uterus i.e. 1-1.5 cms below the fundus which in turn increases pregnancy rates by up to 5-10%. After the transfer, you will lie down in the operation theatre for 10-15 minutes after which you will get up and go walking to the washroom and then lie down in the recovery room.

 

Video of Embryo Transfer Under USG Guidance

 

You may stay in our recovery room for a couple of hours (bring a book or your i-pad) and then head home. In the meantime we will give you final instructions.

If there are “extra” good quality embryos left over, you may be able to freeze them. This is called “embryo cryopreservation.” They can be used later or destroyed or donated. 

Luteal Support

On or after the day of your retrieval, and before the embryo transfer progesterone preparations / other medications are given to enhance implantation(the process by which the embryo adheres to the uterus) and to support early pregnancy (Luteal Support). Progesterone preparations can be in the form of injections/oral tablets/vaginal tablets/vaginal gel. Generally the dreaded painful injections (oil based progesterone injections) are not given unless absolutely required. The vaginal tablets/gel and oral tablets have given equivalent or better results. These medications are continued for 14 days after the embryo transfer.

Disadvantages of injectable progestrone –

  • The principle disadvantage is that of a need for daily intramuscular injection.
  • Also intramuscular progesterone administration may lead to redness, inflammation, tender wheals at the injection site and even sterile abscess formation can occur. This is the result of the long half life of the oil vehicle.
  • Allergic reactions also have been noted with use of intramuscular progesterone injections.

Advantages of vaginal progestrone

  • Vaginal route of administration provides targeted delivery. The active ingredients are transported directly from the vagina to the uterus, thus increasing the concentration of progesterone in the uterus and bypassing the systemic circulation. This increases the concentration in the target organ and reduces the risk of side effects via the “first uterine pass effect”.
  • The gel produces an endometrial response that is equal to or advanced in comparison with that demonstrated by the IM route.
  • The vaginal route is convenient and more acceptable to the patients since it does not hurt nor requires special equipments. It is rarely allergenic.
  • It has been noted that low plasma & high uterine levels following vaginal administration makes it unnecessary to monitor serum progesterone levels, thus providing substantial cost savings.

Besides the progesterone, there really isn’t much going on for the next two weeks. In some ways, the two weeks after the transfer may be more difficult emotionally than the two weeks of treatment. During the previous steps, you will have visited your doctor perhaps every other day. Now, after transfer, there will be a sudden lull in activity. All you can do is wait the two weeks and see if pregnancy takes place. It can help to keep busy with your life during this wait time and avoid sitting and thinking about whether or not treatment will be successful.

After fourteen days, a blood test – serum beta hCG is done to know the outcome of the cycle. No fasting is required for the test. We will get the report by afternoon and we will call you with the report.

If the test is positive, the blood test will be repeated every 5th day. This will help us to monitor the progress of your pregnancy. You will need to keep taking the progesterone supplementation for another several weeks. A transvaginal ultrasound is done when the beta hCG values reach a particular level. This will help us to monitor the pregnancy. During every visit, your blood pressure and weight will be charted. Slowly the luteal phase support decreases and stops by 10-11 weeks. After this the pregnancy continues as a routine pregnancy.

We will also monitor whether or not the treatment led to a multiple pregnancy. If it’s a high-order pregnancy (3 or more), the option of reducing the number of fetuses may be discussed. This is a procedure called a “multifetal pregnancy reduction.” This is sometimes done to increase the chances of having a healthy and successful pregnancy.

Can an IVF cycle be cancelled? Why?

  • If there are not enough follicles grow or if you’re at risk for severe ovarian hyperstimulation syndrome, your treatment cycle may be cancelled and the hCG shot will not be given.
  • If treatment is cancelled because your ovaries didn’t respond well to the medications, we may recommend different medications to be tried on the next cycle. While not common, a cycle may also be cancelled if ovulation occurs before retrieval can take place.Once the eggs ovulate on their own, they can’t be retrieved.
  • If the cycle is cancelled due to the risk of OHSS, we try and adjust the dose of gonadotrophins in the next cycle.

Cancellation happens in around 5 -6% of IVF treatment cycles. The chance of cancellation rises with age, with those older than age 35 and patients with severe PCOS are more likely to experience treatment cancellation.

 

What do you do when IVF Treatment Fails?

  • If the pregnancy test is negative 12 to 14 days post-transfer, however, you will be asked to stop taking the progesterone, and you will wait for your periods to start. The next step will be decided the further course of treatment, after we review the entire history, the actual cycle, drugs given, response seen and the embryology details.
  • Having a treatment cycle fail is never easy. It’s heartbreaking. It is however important, to keep in mind that having one failed cycle doesn’t mean that you won’t be successful ever. The first cycle can sometimes be a learning curve.
  • The subsequent cycle always gives the best pregnancy rate.
  • “Every failure is a stepping stone towards success” is true in IVF/ICSI cycles as in any other walk of life. So instead of crying on failure, one should understand the cause of failure in consultation with an IVF specialist (quality of eggs, implantation failure etc.), try to find solutions and appropriate treatment should be started with a fresh and optimistic state of mind.

 

What are the risks of IVF?

The assisted reproductive procedures have so far proven remarkably safe for both, the would be mother & her child. However, long term follow up studies are not yet available.

  • The main concern is ovarian hyper stimulation (OHSS) in response to fertility drugs. This is usually very rare because of proper evaluation, judicious use of drugs and its accurate dosage and adequate monitoring.
  • Anaesthesia risks are very low, same as any other minor surgical procedures.
  • Sometimes, oocyte retrieval process can result in pelvic infection or bleeding or injury to adjacent organs like bladder or bowel, but this is generally avoided because the procedure is done under ultrasound guidance.
  • As far as pregnancy is concerned, there is an increased chance of multiple pregnancies due to the transfer of two, three or sometimes more embryos. However , the risks for pregnancy i.e. complications per say during pregnancy due to IVF/ICSI&during delivery are unchanged.

 

Are there any birth defects or abnormalities in the child born through IVF / ICSI ?

Male infertility is known to be associated (in some cases) with chromosomal and other genetic anomalies. There is known to be an increase in gross chromosomal abnormalities such as balanced translocations in men with very low sperm counts. Also, about 5% of men with very low sperm counts have small areas of missing DNA on their Y chromosome (Y micro-deletion).Techniques such as ICSI will, in some cases, may lead to transmission of genetic problems that might cause infertility in male offspring, or could possibly be associated with other (at this time unknown) medical problems in the child.

As of now, there have now been many thousands of babies born after IVF with ICSI with follow-up after birth. Thus far, there has not been demonstrated to be any clear increased risk for birth defects as compared to IVF with conventional insemination.Most studies thus far have shown that the risk of birth defects after ICSI is the same as for babies conceived through IVF without ICSI, and for those conceived naturally. However, some studies have suggested that having IVF with or without ICSI might increase the risk for birth defects.

Some studies have shown that around 4% of babies born via assisted reproductive technology such as in vitro fertilization (IVF) may have major birth defects, such as heart and urogenital tract malformations. But these risks are not much different from what would be expected in the general population. The major birth defects seen in babies born via IVF and/or ICSI included heart defects and malformations of the urogenital tract, such as hypospadias (an abnormality in the position of the opening of the urethra in boys).

It is not fully understood whether these birth defects or genetic diseases are caused by the infertility treatment itself or the underlying reason for infertility.

 

SOME FREQUENTLY ASKED QUESTIONS RELATED TO IVF/ ICSI

 

How may visits to the fertility clinic are required?

  • A total of around 8-10 visits are required to the clinic. Overnight hospitalization is NOT required.

Are injections painful?

  • The injections, by & large are not painful.
  • The injections are selected in such a way that they are highly purified and can be given subcutaneously (like insulin injections).
  • They can be administered on the thigh or stomach with very thin & small needle (no.26).
  • They can be self administered or administered by the partner.
  • Self administration of injections gives you better control of the cycle, flexible schedule for taking injections and avoids daily visits to the doctor. Also it gives you a feeling of self empowerment and involvement in the whole process.

Will I gain weight with injections?

  • The injections will not cause any weight gain.

I am a working woman. Do I need to take leave? How many days?

  • A prolonged leave is generally not required.
  • You will require a leave of one day on the day of ovum pickup.
  • You may take a leave of around one week after embryo transfer to relax at home.
  • BED REST IS NOT REQUIRED.
  • All scientific studies have shown that bed rest does not in any improve the results in any way. In fact, bed rest is detrimental to your mental status. This may make the 2 weeks wait for the test a nightmare.

Is my husband required for all the visits?

  • He is required just before starting IVF cycle for consultation & counseling.
  • Then he is required on the day of ovum pickup to give a semen sample.
  • But circumstances permitting, if he can accompany you for your visits, it is a great morale booster.

I have endometriosis. Does this affect my fertility & can it affect the success rate of IVF?

  • Studies suggest that endometriosis probably does not interfere with IVF success rates.
  • There are, however, some caveats. Repeated ovarian surgery, removal of an ovary, or removal of severe pelvic adhesions may compromise the ovaries’ ability to produce enough eggs to warrant retrieval. Also, eggs that arise from an ovary with a large endometrioma (ovarian endometrial cyst) may have a reduced fertility potential.
  • Other researchers have suggested that antiphospholipid antibodies, more commonly seen in women who have endometriosis, may contribute to implantation failure unless treated.
  • However, conflicting data suggest that although these antibodies may be seen more frequently in women with endometriosis, the benefits of treatment are as yet unproven.

Can fibroids interfere with IVF?

  • Fibroids are benign tumors consisting of fibrous tissue & muscle which grow in the uterus.
  • The significance of fibroids relates not only to their size but also their location.
  • Even small fibroids located inside the cavity of the uterus (submucosal fibroids), where embryos need to implant may interfere with success and need to be removed.
  • Fibroids that do not encroach on the cavity of the uterus are generally not significant unless they are larger than 4 cm in diameter and also if there are multiple fibroids causing significant uterine enlargement.

 

I have bilateral hydrosalpinx. I have been told to get operated before the IVF cycle. Does surgery change the outcome of the cycle?

  • There are two possible reasons that a hydrosalpinx may decrease success.
  • First, it may be a mechanical wash out of embryos from the fluid back flowing into the uterus around the time of implantation.
  • Since the distal end of the tube is blocked, this fluid may leak into the uterus and disrupt implantation.
  • It is well known that a very small amount of media must be used when embryos are transferred after IVF.
  • Increased fluid decreases success. A second reason is that the fluid itself has been shown to be embryo toxic.
  • Since most hydrosalpinges, arise from a previous infection, there may still be agents in this fluid that cause an inflammatory response that either alters the uterine environment, or the health of the conceptus (embryo)

Does acupuncture treatment help during IVF cycle?

  • The theory is that acupuncture can affect the autonomic nervous system, which is involved in the control of muscles and glands, and could therefore make the lining of the uterus more receptive to receiving an embryo.
  • Acupuncture seems to help some women because it improves circulation to the ovaries, which makes healthier eggs and to the uterus, by increasing the chances that the lining will be strong enough to hold the embryos.
  • Acupuncture provides better circulation and better blood flow to the womb thus helps in continuation of pregnancy till term and avoid premature deliveries.
  • Acupuncture can be a stress-reliever during an emotional time.

 

What can be done to improve sperm quality?

  • Sperm quality on the day of egg retrieval is often related to what happened in the male’s body 3 months ago. This is because sperm development takes 3 months. Listed below are guidelines to help ensure the semen specimen is of the best possible quality.
  • Keep the use of alcohol and cigarettes to a minimum before and during ART treatment. Do not use any “recreational” drugs.
  • If any prescription medication has been taken during the last 3 months, notify the ART CLINIC.
  • Do not sit in hot tubs, spas, Jacuzzis, or saunas frequently during or 3 months prior to the ART cycle.
  • Do not begin any new form of endurance exercise during or 3 months prior to the ART cycle. Physical activity at a moderate level is acceptable and encouraged.
  • Frequent ejaculation (every 2 to 3 days) is recommended.
  • Refrain from ejaculation for 2-3 days, but not more than 5 prior to collecting the semen sample for the ART cycle.

 

Am I depleting my store of eggs by undergoing an ART cycle?

  • A woman is born with a full complement of eggs.
  • There are far more eggs than will ever be used during a normal lifetime and ART procedures have no measurable “lowering” effects.

 

Can I exercise while I’m undergoing IVF treatment?

  • But, you should refrain from high-impact exercise and choose workouts such as walking, swimming, yoga or cycling.

26/May/2015

The purpose of IVF is to:

  • By pass the fallopian tube where fertilization normally occurs, so that we can overcome tubal factor if it is one of the factors causing infertility.
  • IVF / ICSI can also bypass mechanical factors, sperm defects like acrosome defect or oocyte defects like zona pellucida being too thick. With IVF/ICSI, subtle hormonal defectsget corrected and endometrial receptivity improves. Unexplained infertility may be due to one of the above factors and may get corrected by IVF/ICSI.
  • In the natural course, the follicle ruptures when the egg is mature thus releasing the egg, this egg is picked up by the fallopian tube which propels it forwards to the ampullary part(outer one third ) of the tube where fertilization happens. The sperms which are deposited in the vagina have to travel up all the way to the uterus and from there into the tube where the fertilization happens. This is a microscopic process & cannot be documented by sonography or any other tests. This process of fertilization in IVF is done in the laboratory and it is ensured that fertilization happens.
  • By removing the eggs we can know the quality of eggs which otherwise cannot be judged.
  • In male factor infertility, there might be an inherent weakness in even the normal looking sperms. These sperms cannot fertilize the egg. By doing ICSI, it is made sure that the sperm reaches inside the egg and chances of fertilization are maximized. By, ICSI it is ensured that fertilization of egg happens with the best quality sperm

 

What is the success rate of IVF/ICSI?

The carry home baby rate is around 30-35%, depending on various factors, which is quite high as compared to almost no hope without IVF/ICSI.

  • Age of women
  • Pre IVF evaluation & treatment
  • Quality of gametes (eggs and sperms ) & embryos
  • Number of embryos transferred.

The higher success rates are achieved by meticulous pre IVF evaluation & counseling the couple for the treatment available to them.

 


26/May/2015

  • ICSI has proved to be very useful in couples who have failed to achieve fertilization or had very poor fertilization following standard IVF treatment & in couples where the male partner has abnormal sperm parameters like severe oligospermia (very low count), severe asthenozoospermia (very less motility), severe teratozoospermia (high percentage of abnormal sperms) or a combination of abnormalities like oligoasthenoteratozoospermia (very low count, poor motility, abnormal sperms).
  • ICSI also can be performed in azoospermic men (where semen sample contains no sperms). In such cases the testis are producing sperms but due to block in the tubules or in the path through which the sperms come out from the testis, the sperms produced in the testis cannot come out.Here the sperms are obtained micro surgically from testis or epidydymis (PESA, TESA, and TESE)*. In few cases when there is severe abnormality in the semen, testicular extraction by microsurgical approach (PESA, TESA & TESE) has given normal sperms.

*PESA- Percutaneous Epididymal Sperm Aspiration

TESA – Trans Epididymal Sperm Aspiration

TESE – Testicular Sperm Extraction

 

What is TESA / TESE /PESA?

TESA, or testicular sperm aspiration (also known as TESE, or testicular sperm extraction) is one of the surgical sperm harvesting techniques used for retrieving sperm in patients with azoospermia. A number of surgical sperm retrieval or recovery methods have been devised to recover sperm from the male reproductive tract.

In men with obstructive azoospermia,(because of duct blockage or absence of the vas deferens) , sperm are usually recovered from the epididymis. The original technique was devised by a urologist, Dr Sherman Silber, who is a specialist in microsurgery. It is a very simple and easy method to recover sperm from the blocked epidiymis. Since the surgeon can feel the turgid epididymis, swollen with sperm, he will blindly puncture the epididymis using a simple butterfly needle – a technique which was very similar to drawing blood from a blood vessel! This simple technique is called PESA (percutaneous epididymal sperm aspiration), in which the sperm is sucked out from the epididymis by puncturing it with a fine needle.

For patients with obstructive azoopsermia in whom sperm cannot be found in the epididymis, it is always possible to find sperm in the testis. The easiest way to retrieve this is through TESA or testicular sperm aspiration , in which the testicular tissue is sucked out through a fine needle, under local anaesthesia. The testicular tissue is placed in culture media and sent to the lab, where it is processed. The sperm are liberated from within the seminiferous tubules (where they are produced) and are then dissected free from the surrounding testicular tissue.

TESA




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WE CARE, WE CAN