Before any testing is carried out, it is important that our doctor takes a detailed history and performs an examination
Assessment of ovarian reserve done with day 3 FSH and estradiol testing and a vaginal ultrasound assessment of ovarian volume and antral follicle counts.
Testing for tubal patency and normalcy of the uterine cavity with a hysterosalpingogram.
Artificial Insemination (IUI)
Artificial Insemination is also called Intra-Uterine Insemination (IUI).
- IUI may be done in a natural cycle but usually the woman is given medication to stimulate the ovaries for development of multiple eggs and insemination is timed to coincide with ovulation.
- Semen sample is collected either at home or in the hospital after 2-5 days of abstinence.
- Semen is washed in the laboratory using either a gradient method or a swim up technique. This process is called sperm processing and takes about 30-40 minutes.
- About 0.4-0.5 ml of culture media is finally added to the washed sperms and the sample is ready for insemination.
- This washed sample is transferred to the uterus using a sterile flexible catheter.
- The procedure is not painful and the patient is sent home within half an hour.
Indications for IUI
- Unexplained infertility.
- Mild to moderate oligoasthenospermia (where sperms are slightly less in number or low in motility).
- Cervical factors.
- Problems with ovulation.
- Mild endometriosis.
Best results are seen when the age of the woman is not more than 35 years and infertility is not more than 4-5 years.
Contraindications for IUI
- Severe tubal damage or blocked tubes.
- Genital tuberculosis.
- Severe male factor.
- Women more than 40 years.
- Advanced stages of endometriosis.
Outcome of IUI
- Male factor with slightly reduced sperm count or motility.
- Age of the woman less than 35 years.
- No associated pathology like endometriosis or PCOD.
- Duration of infertility less than 5 years.
- Age of the woman more than 40 years.
- Severe male infertility.
- Defect in sperm morphology.
- Any degree of tubal damage or pelvic scarring.
- Previous history of genital tuberculosis.
How many attempts of IUI should be taken up?
The best results are seen within the first three attempts of IUI. In women with ovulation disorders, up to six attempts can be taken combined with ovulation induction. In case pregnancy does not happen, patients are re-counselled and IVF maybe undertaken.
IUID (Donor Insemination)
In case of absolute azoospermia, donor samples are used for insemination (all other conditions being the same as in IUI using husband’s sperms).
Only frozen samples are used which have been previously tested for HIV, hepatitis and ABO and Rh group.
Instructions to the Male partner: If using fresh semen, your partner should be available on the day of the insemination. It is recommended that he abstain from ejaculation 2 to 5 days before giving the semen sample. Two weeks following the IUI, a pregnancy test will be performed to determine if the treatment was successful
In-Vitro Fertilization (IVF)
In-Vitro Fertilization (IVF-ET) is popularly called test tube baby procedure. In-Vitro Fertilization means that fertilization of the egg with the sperm is established outside the body. So in any couple where eggs are withdrawn from the ovaries and are made to fertilize using husband’s sperm outside the body and the embryo thus formed is transferred back to the uterus, the couple is said to undergo IVF procedure. It was first utilized for a couple where the woman had lost her fallopian tubes due to previous ectopic pregnancy. Now, the indications for doing IVF are very diverse and millions of people have been helped with this technology.
Indications for IVF are:-
- Blocked fallopian tubes.
- Pelvic Adhesions.
- Genital tuberculosis.
- Unexplained infertility.
- Advanced maternal age.
- Male factor infertility.
- Hormonal/Immunological disorders.
How is IVF conducted at Parihar IVF?
After the initial work up of the couple, the patients who are selected for IVF routinely undergo the following procedure:-
- Counseling – A detailed explanation is provided to every couple whereby they are made to understand the reason and outcome of doing IVF for them. Every patient is individualized and a protocol is decided for stimulation. Most of the patients are selected for a long protocol unless otherwise indicated. Any queries of the patients are answered at all times and they are made to feel comfortable and at ease with the entire staff of the hospital.
- Ovulation-Induction – Usually the couple is requested to present itself for all visits, but in certain cases where it is not possible, the wife maybe present alone for OI. Down regulation using GnRH analog is started on day 21 of the cycle (Day 1 is the start of the menstrual period). For this the patient needs to take a daily injection at a fixed time during the day. She then comes back on the second day of the menstrual cycle and induction is then started with gonadotropins for a period of minimum five days after which the follicular monitoring is done on a daily basis till at least two follicles are 18mm in size and have a good perifollicular flow. hCG is given on the same day and ovum retrieval is done thirty six hours later. In some patients daily injections of GnRH agonists may not be possible for a long period. In these patients and others who are chosen for an antagonist protocol, stimulation starts on day 2/3 of the cycle. Here an antagonist is added on a daily basis along with gonadotrophins which have already been started on day 2/3 once the follicle size reaches 14 mm. This protocol decreases the duration of injections and does not allow the LH surge to happen which is detrimental to the quality of eggs.
- Ovum pick up – This is done under general anesthesia using trans-vaginal sonography. It is only a needle prick and the patient need not worry about any pain after the procedure. Hospital stay is only for 3-4 hours and is because of general anesthesia. Patient can go home the same day. This procedure does not involve any kind of risk except in a very few patients with dense adhesions or other pelvic diseases. Any bleed into the pelvis may cause little discomfort or cramps in the lower abdomen for a few days. Usually no treatment is required for the same. Only mild analgesic drugs are usually sufficient to take care of the symptoms.
- Insemination – The husband is asked to give a semen sample on the day of egg retrieval. A fresh sample is always preferred though a backup of husband’s frozen semen sample is always kept in our hospital. Semen sample is processed usually using a swim up technique. Wherever required, PESA or TESA is done on the same day and processed. Regular insemination/ICSI is carried out as the case maybe. The eggs are examined for fertilization after 16-18 hours and any abnormal forms are discarded at this stage (eg- eggs with 3pn or 1pn).
- Embryo Transfer – This does not require any anesthesia. A maximum of 2 embryos are transferred using a fine embryo transfer catheter. All additional embryos are frozen for future use with the consent of the couple. The patient can go back on the same day within a few hours; but it has been observed that they usually prefer to stay overnight. In cases of hyperstimulation (OHSS), embryo transfer may not be done in the same cycle depending on the severity of OHSS. In this case all embryos are frozen and transferred in another cycle. This is necessary to avoid worsening of hyperstimulation which may be then life threatening.
- Day of transfer – This is discussed individually with all couples. It may be done on day 2, day 3 or day 5 depending upon the number of embryos, age of the patient, results of the previous IVF cycles, and the quality of the embryos.
- Post ET Treatment – Progesterone support is given to all patients in the form of vaginal pessaries/gels or intra muscular injections. A blood test is done 14 days after the embryo transfer to see if it positive for pregnancy.
What is ICSI?
- ICSI is an acronym for Intracytoplasmic Sperm Injection
- A fancy way of saying “inject sperm into egg”.
- ICSI is a very effective method to fertilize eggs in the IVF lab after they have been aspirated from the female.
Its main use is for significant male infertility cases in normal IVF, many sperm are placed together with an egg, in hopes that one of the sperm will enter and fertilize the egg. With ICSI, the embryologist takes a single sperm and injects it directly into an egg.
Why is ICSI Done?
ICSI is typically used in cases of severe male infertility, including:
- Sperm concentrations of less than 15-20 million per milliliter.
- Low sperm motility – less than 35%.
- Very poor sperm morphology (subjective – specific cutoff value is debatable).
- Having previous IVF with no fertilization – or a low rate of fertilization (low percentage of mature eggs that were normally fertilized).
- If a man does not have any sperm in his ejaculate, but he is producing sperm, they may be retrieved through testicular sperm extraction, or TESE. Sperm retrieved through TESE require the use of ICSI.
- ICSI is also used in cases of retrograde ejaculation, if the sperm are retrieved from the man’s urine.
- ICSI may also be done if regular IVF treatment cycles have not achieved fertilization.
- Sometimes it is used for couples that have a low yield of eggs at egg retrieval. In this scenario, ICSI is being used to try to get a higher percentage of eggs fertilized than with conventional insemination of the eggs (mixing eggs and sperm together).
What is the Procedure for ICSI?
ICSI is done as a part of IVF. Since ICSI is done in the lab, your IVF treatment won’t seem much different than an IVF treatment without ICSI.
As with regular IVF, you’ll take ovarian stimulating drugs, while your doctor will monitor your progress with blood tests and ultrasounds. Once you’ve grown enough good-sized follicles, you’ll have the egg retrieval, where eggs are removed from your ovaries with a specialized, ultrasound-guided needle.
Your partner will provide his sperm sample that same day (unless you’re using a sperm donor, or previously frozen sperm.)
Once the eggs are retrieved, an embryologist will place the eggs in a special culture, and using a microscope and tiny needle, a single sperm will be injected into an egg. This will be done for each egg retrieved.
Cryopreservation is a process where cells or whole “tissuesare preserved by cooling to low sub-zero temperatures, such as (typically) 77 K or −196 °C (the boiling point of liquid nitrogen. At these low temperatures, any biological activity, including the biochemical reactions that would lead to ,is effectively stopped. However when cryoprotectant solutions are not used, the cells being preserved are often damaged due to freezing during the approach to low temperatures or warming to room temperature.
Human Oocyte cryopreservation is a new technology in which a woman’s eggs (oocytes) are extracted, frozen and stored. Later, when she is ready to become pregnant, the eggs can be thawed, fertilized, and transferred to the uterus as embryos.
Cryopreservation for embryos are used for embryo storage, e.g. when in vitro fertilization has resulted in more embryos than is currently needed.
At Parihar IVF we have donor programs to suite your need
- Sperm Donor – may be required for couples where the male partner has no sperms or very low quality sperms.
Egg Donor – may be required where the female partner do not produce eggs of their own (Menopause, Premature ovarian failure etc.) or their eggs no longer appear capable of producing a healthy pregnancy.
- Embryo Donor – may be required where both the partners have infertility.
Blastocyst Culture and Transfer
Blastocyst is defined as the 5-6th day stage of an embryo’s life.
The oocyte is fertilised and starts its development in the fallopian tube for about three days. During this time it moves through the tube into the uterine (endometrial) cavity and sits there for a further two – three days during which time it develops into a blastocyst (embryo that contains many cells and forms a cystic cavity within its center).
Τhe blastocyst invades the uterine lining (implantation) about the fifth or sixth day after fertilization, in order to become incorporated into the wall for its sustainability and survival. The placenta will eventually develop and will provide for the growth of the embryo until birth.
Recent advances in the field of human IVF allow more embryos to grow in the IVF lab for a longer period, up to the later blastocyst stage. This was achieved via the development of many improvements in the IVF field, including the evolved culture media where an embryo can growth in the laboratory from the time of fertilisation up to 6 days, making it possible to be transferred to the womb at the blastocyst stage.
Transferring embryos at the blastocyst stage cannot be applied to all patients, as in some cases all of the embryos arrest and none make it to the blastocyst stage. Blastocyst transfer is most successful in cases where there are a good number of embryos on day 2 and 3, which gives more chance of obtaining some good quality blastocysts on days 5 or 6.
This new advancement offers advantages such as:
Higher pregnancy and implantation rates due to better embryo selection. Allowing embryos to develop in the laboratory for a longer period permits for better selection of the embryos to be transferred Higher pregnancy rates because transfer occurs closer to the natural time that an embryo enters the uterus. At this time the endometrium may provide a better environment for the embryo.
Blastocyst transfer is used with caution since it is not yet known whether some of the embryos that degenerate or develop as low quality embryos in the laboratory during blastocyst culture, would have survived or developed into higher quality embryos in the uterus had they been transferred at an earlier stage. For this exact reason the decision to proceed with a blastocyst culture is a result of extensive consideration of all clinical and laboratory indications of each individual couple.
Logic C5 PRO Color Doppler system used for
- Routine Trans Vaginal Scan and color Doppler before and during the treatment cycle to monitor the progress of the cycle and timing of trigger injection.
- Oocyt Collection Procedures.
- Other minor procedures like cyst aspiration etc.
Laproscopy & Hysteroscopy
Theatre equipped with the latest machines and Endoscopy equipments to perform all kinds of Diagnostic, Operative and fertility enhancing laproscopic and hysteroscopic procedures.