ISHA-IVF

In-vitro fertilization (IVF) is a method wherein egg cells are fertilized by sperm outside the woman’s womb in a laboratory dish. IVF is a major treatment in infertility when every other conception method has failed. The process involves removal of a woman’s eggs from the ovaries and fertilizing it with a sperm in a fluid medium. Embryo transfer is performed wherein the fertilized egg is transferred to patient’s uterus to establish a successful pregnancy. Standard IVF is also known as Day 3 transfers, where embryos are placed inside the uterus at a time when they should normally still be in the fallopian tubes.

In-vitro fertilization

The preferred mode of treatment, in the presence of tubal factors of infertility are not amenable to routine treatment, where eggs are fertilized by sperms in lab environment.

Indications for IVF

• Blocked tubes
• Mild oligozoospermia
• Endometriosis, genital tuberculosis
• Unexplained infertility

IMSI treatment for infertility is believed to be very effective amongst all the infertility treatments to date for male factor infertility. This technique involves selection of the best quality sperm cells from a sample provided by the male partner, and directly injecting it into the eggs retrieved from the female partner, thereby increasing the probability that these sperm cells will fertilize the eggs.

With the advent of Blastocyst culture, IVF pregnancy rates have improved and have reduced multiple pregnancy rates. In embryo transfer, 3-4 embryos are transferred which increases the risk of multiple pregnancies, full of dangerous complications. The strongest, healthiest embryos make it to blastocyst stage, which allows the embryologist to transfer fewer embryos; lowering the risk of high order multiples while maintaining high pregnancy rates.

Blastocyst Culture:

• The inherent fault of the embryo division is overcome in-vitro by blastocyst culture. The blastocyst is transferred to the uterus on day 4 or 5.
• Assisted hatching along with blastocyst culture is used for improving success.

• Facilities are available for semen freezing and sperm banking. This is useful as a backup during treatment.
• Cryopreservation of good quality embryos help to dramatically reduce the cost, since they can be utilized in the subsequent cycle.

Embryos can be frozen at various times, ranging from one day after fertilization up to five or six days. Many couples take a decision of freezing some of the surplus good quality embryos created during IVF or ICSI treatment and store them for future use. The embryos can be kept healthy and viable for up to ten years. This allows them the opportunity to get pregnant again in the future or for use in a later IVF cycle.

This process is more complicated and delicate than Embryo freezing, as eggs are more prone to damage than embryos during the freezing process. The genetic material inside the egg gets damaged as ice crystals form inside due to freezing.

Egg Vitrification also known as snap freezing or flash freezing, differs from traditional egg freezing and is considered superior to it. Vitrification is an ultra rapid cooling technique that does not allow time for ice crystals to form. It allows the water inside and surrounding the egg to instantaneously super cool into a solid state with no ice crystal formation at all.

This technique involves freezing of sperms for future use, either in artificial insemination or other fertility treatments or it can be donated. The donated sperms can be stored for 6 months for screening the donor for infections, before it is used in any treatment. There are cases where sperm cells have been frozen and thawed successfully for more than 40 years.

Many sperms do not survive or get damaged during freezing and hence, there are chances of reduction in quality of sperms. The poor quality of sperms can be used only for ICSI procedure.

Semen analysis is a test to determine whether a man is infertile, whether the sperms are unable to get a woman pregnant. Semen analysis has many parts and the semen and sperms are tested on a lot of aspects. As the semen consistency varies from day to day and gets affected by certain conditions, the analysis should be performed regularly over a period of month.

The procedure of egg donation involves fertilizing the eggs of a healthy young woman – the egg donor, with the sperms of the patient‟s husband, wherein the resulting embryos are transferred into the patient’s uterus. This is an option for those women who are unable to achieve pregnancy due to advanced reproductive age, genetic abnormalities, previous surgeries and/or other conditions.

Embryo donation and adoption is the giving and receiving of fertilized eggs (embryos) that are created during the IVF cycle. During the IVF process, many embryos are created which may not be used. The additional embryos may be stored, donated to scientific research or donated to someone who wants to conceive. Embryo donation can provide the opportunity to assist others who want to conceive, by donating available embryos, and giving someone else the chance to start their own family.

The usual way of producing sperm for use in Assisted Reproductive Technology is manual stimulation. But when the sperm is not ejaculated, the newest of the aspiration techniques is testicular sperm aspiration/extraction (TESA/E). It involves the direct removal of sperm from the testicles, which can be later used, combined with ICSI treatment. There may be many reasons why a TESA/E may needed to be performed, but all involve an inability to produce and ejaculate with sperm sufficient for fertilization.

Surgical sperm retrieval methods are used when the male has no sperm present in the ejaculate. They are used in combination with the ICSI procedure and one of the options is the PESA technique. During PESA, a needle is inserted into the epididymis and the sperm is withdrawn. Following these procedures, patients may experience discomfort or pain and may have some localized swelling. However, patients who undergo PESA typically may return to work the following day.

Assisted hatching is the procedure performed with laser technology, which involves creating a hole in the covering that surrounds the embryo, to aid it in the hatching process, during the IVF treatment. Assisted hatching may be helpful in the infertile couples because their embryos lack sufficient energy to complete the “hatching” process. In addition, hatched embryos implant one day early, which may allow a greater opportunity for implantation to occur.

Pre-implantation Genetic Diagnosis is a technique that has helped hundreds of couples to conceive healthy babies, many after long periods of infertility or with serious genetic diseases in the family. In PGD testing, one or two cells are removed from a day-3 embryo and tested for a specified condition, such as cystic fibrosis or Down’s syndrome. Only those embryos diagnosed as being unaffected or free of a specific disorder will be transferred in the IVF cycle, maximising the chance of a healthy baby.

Pre-implantation Genetic Diagnosis can be considered if there are any of the following concerns:

• Risk of having a child with an inherited genetic condition
• Either partner has a known family history of chromosome rearrangement
• Previous chromosomal abnormality in a pregnancy
• Advanced maternal age recurrent miscarriage
• Repeated embryo transfers without pregnancy
• If you would find it difficult to consider termination of an affected pregnancy

ISHA Multispeciality hospital boasts of state-of-the-art Assisted Reproductive Techniques – ART clinic, which is dedicated to assist reproduction with latest technology and expertise.

ART Setup:

• Spacious – sparklingly clean lab, Terrazio clad – smooth washable wall-Zender air cleaner where the air in the lab is made germ free.
• 3D Color Doppler sonography machine for follicular monitoring and uterine – ovarian – endometrial blood flow study.
• Olympus – made light microscope for semen evaluation.
• CO2 Incubators (1) Heraus (2) Galaxy
• Laminar flow work station
• Separate and specious OT with Ultrasonography machine and portable Boyle’s apparatus for ovum pick up.
• Oocyte recovery pump.
• Olympus inverted microscope with Narishige micro manipulator for ICSI.
• Computerized Embryo Freezing (freeze control) is used for gradual freezing and thawing of sperms and embryo.

At ISHA Multispeciality hospital, many procedures are undertaken for fertility management. They are:
To check tubal patency:

• S.S.graphy – this is a short procedure, to assess tubal patency & mobility & anatomy of the uterine cavity. It is done on 8th or 10th day of menses.
• H.S.graphy – this study is done using X-Ray.
• Op.Lapro-hysteroscopy – this test is done under short general anaesthesia, making 2/3 small incisions on abdomen. The patient can be discharged from hospital on the same day of operation.