We
are an infertility clinic providing most advanced and comprehensive infertility
services under one roof. The centre is staffed with a team of highly trained and
dedicated professionals.
The fertility services provided by us include; In
addition to providing most modern and advanced scientific technology our aim is
to give full moral and emotional support to our patients so that they are able
to understand the complexities of sub fertility and various fertility treatments.
We
providecomplete work of infertile couple, which includes basic and hormonal investigations,
tests of sperm function, tests of ovulation and tubal patency, diagnostic and
operative laparoscopy and hysteroscopy.
The centre is equipped with state
of the art embryology laboratory and is stringent in its choice about best quality
disposables and culture media, while providing strict quality control.
We
also provide the services of egg donation, surrogacy and embryo
donation which are a boon to many couples whose eggs or uterus have been adversely
affected by age or disease.
We try to help the couples struggling with
sub fertility to attain their goal by providing detailed information and helping
them to make various choices. This will enable them to become parents while making
adequate utilization of their time and financial resources. IVF
(In Vitro Fertilization)The process of union of egg
and sperm is called fertilization. It is one of the beautiful wonders of nature
and occurs inside the fallopian tubes of woman. In a finely orchestrated sequence,
the fertilized egg then travels to the uterus and getts settled there as the early
embryo, which leads to the begining of pregnancy.
However in some couples,
these steps fail to occur in natural way. IVF is a specialized method which comes
to the rescue of such couples and helps them to achieve conception.
The
process of IVF estencially involves the formation of a large number of eggs which
are removed from the ovary and union with sperms occurs outside the body. The
embryos thus formed are transferred to the woman's uterus to achieve a normal
pregnancy. INDICATIONS OF IVF : - Tubal
Problems - a woman's fallopian tubes are blocked or damaged, which could be due
to infection, tuberculosis, previous tubal pregnancy, endometriosis, tubectomy.
- Severe
endometriosis which affects tubal function, fertilization as well as implantation
of embryo in the uterus.
- Unexplained infertility - where conception fails
to occur inspire of both partners being healthy and all tests being normal.
- No
pregnance after repeated cycles of IUI.
- Patients who stop having regular
menses or those whose eggs / ovaries are damaged by surgery or disease, can became
pregnant by IVF using donor eggs.
- The patients whose uterus has been damaged
due to infection or removed due to surgery can have their own child by IVF in
a surrogate mother.
- Prolonged infertility of any cause not responding
to routine treatment.
- Infertility in women with age more than 40 years
or after menopause.
PROCEDURE : - The basic
investigations of the coupl are done including semen tests, ovarian and uterine
cavity assessment.
- The patients is given daily injection of fertility
hormones (hMG/FSH) for 8-12 days which lead to the development of eggs in ovaries.
Injections can be taken at home or self-administered. Patients visit the centre
3-5 times during these days when the formation of eggs is checked by ultrasound.
- Laser
injection for final maturation of eggs (human chorionic gonadotrophin) is given
when the follicles have reached optimum size.
- Eggs are removed 34-36 hours
after the last injection.
- The process of egg retrieval or collection orf
eggs is done under sedation and anaesthesia so as to cause no discomfort to the
patient. The eggs are removed from the ovary by using a needle attached to ultrasound
probe.
- The eggs are placed close to sperms so that union of egg and sperm
takes place. Embryo are formed which start dividing and became 4 to 6 cell. At
this stage, 2-3 healthy embryo are placed inside the uterus.
- Pregnancy
is confirmed by a blood test done 14 days after the embryo transfer.
- The
pregnancy thus conceived is just like any other normal pregnancy and does not
require any special precautions or bed rest.
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ICSI ?
Intracytoplasmic
sperm injection ( ICSI) is a laboratory procedure developed to help infertile
couples undergoing in vitro fertilization(IVF) due to male factor infertility.
Normaly in IVF, each egg is mixed with about a lakh sperms and one of the sperms
enters the egg on its own . In ICSI, a single live sperm is injected in the egg
by a special machine called the micromanipulator .
Indication of ICSI
" Very low number of sperms (less then 5 million),very poor motility.
"
Severe teratospermia .
" Problems with sperm binding to and penetrating
the egg.
" Antisperm antibodies thought to be the cause of infertility.
"
Prior fertilization failure with standard IVF methods.
" Frozen sperm
limited in number and quality.
" Obstruction of the male reproductive
tract not amenable to repair. Sperm may then be obtained from the epididymis by
a procedure called microsurgical epididymal sperm aspiration (MESA), or from the
testes by testicular sperm aspiration (TESA).
" Males with ejaculatory
dysfunction due to spinal disease or injury
" Retrograde ejaculation
The
procedure
The initial investigations of the couple and hormonal injections
to produce a large number of eggs are the same as in conventional IVF. After the
eggs are collected and identified by the embryologist, the outer layer of cells
around each egg, known as the cumulus oophorus is removed so as to view the egg
clearly. The eggs should be at a mature (M2) stage. The procedure is done under
a microscope using micromanipulation devices (micromanipulators, microinjectors
and micropipettes ). A holding pipette on the left stabilizes the mature oocyte.
From the opposite side a thin, hollow needle is pierced through the oolemma and
into the inner part of the oocyte. It is loaded with a single sperm that will
be released into the oocyte. The oocyte is checked on the following day for signs
of fertilization. The goal of ICSI The goal of performing
ICSI is to minimize the risk of fertilization failure. At our centre ,we are using
ICSI back up to ensure fertilization in cases of unexplained infertility also.When
sperms are in reduced number or have abnormal morphology and motility, the function
of the sperm can be significantly impaired. ICSI overcomes these problems by placing
a single sperm within the egg. Facts about ICSI Fertilization
occurs in 50%to 80% of injected eggs. Approximately 30% of all ICSI cycles performed
result in a live birth . Younger patients may achieve even more favorable results.
The
wonder of ICSI lies in the fact that it allows many infertile couples to become
parents of their own genetically -related children, as an alternative to Donor
Insemination or adoption. TOP
PESA / TESE
INTRODUCTION Today
with the availability of intracytoplasmic sperm injection techniques , it has
become possible to achieve fertilization and pregnancies with only a few spermatozoa
or even in men who produce no spermatozoa in the ejaculate. But in men with Aspermia
(inability to ejaculate) and in men with Azoospermia (absence of sperm in ejaculate
), sperms have to be obtained by some sperm retrieval technique prior to ICSI.
Retrieval of sperms may be done by non-surgical or surgical methods. AZOOSPERMIA
Absence of sperms in the ejaculate is known as azoospermia and this may
be obstructive or non obstructive in etiology METHODS OF SPERM RETRIEVAL
1. Percutaneous Epididymal sperm aspiration (PES A)
2. FNA of testis
(TESA)
3. Open testicular biopsy (TESE)
4. Microsurgical Epididymal sperm
aspiraton (MESA )
PESA ( percutaneous Epididymal sperm aspiration)
Indications
1.
All cases of obstructive azoospermia with normal spermatogenesis e.g. Congenital
bilateral absence of vas deferens.
2. Failed vasectomy reversal.
3. Ejaculatory
dysfunction
4. Spinal cord injury
5. Retrograde ejaculation TESA
(TESTICULAR SPERM ASPIRATION ) Indications
1. Obstructive azoospermia
(CBA VD)
2. Failed vasectomy reversal
3. Partial testicular atrophy
TESE
Indications
Non obstructive Azoospermia
PROCEDURE OF SPERM
RETRIEVAL
Sperm retrieval of husband is done on the same day when wife's
eggs are retrieved . Under local anaesthesia or mild sedation, needle is introduced
through the scrotal skin and sperms aspirated . Antibiotics and pain killers are
given and the patient can go back home after a few hours.
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EGG DONATION Egg
donation or ovum donation is a modification in the process of conventional IVF
where eggs from a young healthy female (ovum donor )are used. These eggs are fertilized
with the husband/partner of the recipient woman. The resultant embryos are placed
inside the uterus of the recipient woman to attain a pregnancy. Indications
of ovum donation :- 1. Many women get married at a late age or postpone
their child bearing because of reasons of education and career. However, the biological
clock shows its effect in the form of decreased quantity and quality of eggs.
This effect is marked after 35 years of age and more so after 38 years. The probability
of having pregnancy even by IVF /ICSI decreases at 38-40 years of age. After around
42 years the chances of having a healthy live birth with own eggs are virtually
negligible. However, using the help of donor eggs, women of even higher age can
conceive and have a baby.
2. Younger women with poor ovarian reserve and raised
FSH levels. Some women stop having regular menses at a young age . These ladies
with premature ovarian failure can have their own child by means of ovum donation.
3.
Women whose eggs have been damaged by tuberculosis, endometriosis and previous
surgery on the ovary.
4. Women who have produced less (less than 4) eggs in
previous IVF attempts and formed poor quality embryos.
5. Ovary damaged by
radiotherapy or chemotherapy for cancer.
6. Carrier of major chromosomal disorders
can opt for ovum donation so that the genetic disorder is not passed on to the
offspring.
7. Egg donation can be offered to women who have had multiple cycles
of failed IVF using own eggs. Selection of egg donors Eggs
are borrowed from healthy women less then 35 years of age who are not suffering
from any medical or genetic disorder. They are screened for infections like HIV,
Hepatitis B and C. Married women with one or two kids are preferred as they have
proven their fertility. History of caesarean section or tubectomy in the past
does not pose any problem and women can still donate their eggs. Ovum donors are
usually a relative or friend of the recipient. Ova can also be taken from healthy
young volunteers. Egg sharing with other women undergoing IVF cycle is also encouraged
after taking consent from both the donor and recipient. The procedure
After the basic investigations of ovum donor have been done, the menstrual
cycles of donor and recipient are synchronized with medicines. The donor has to
visit the OPD about 4-5 times, when she is given injections for formation of multiple
eggs in the ovaries. The injections and procedure of egg removal are the same
as in IVF with self eggs. The eggs of the donor are removed with a needle under
mild anaesthesia there is no stitch or bleeding and she can go back from the hospital
after 4-6 hours.
The eggs are fertilized using IVF or ICSI. At the same time
, the recipient receives medication so that her uterus is well prepared to receive
the embryo. Embryo transfer is done in the recipient after ~ 48 hours . Egg
donation is thus a boon to many women who otherwise cannot hope to have a pregnancy
using their own eggs. TOP
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