Zydus

IVF (In Vitro Fertilization)

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In Vitro Fertilization (IVF) means a series of procedures to conceive. This method can be used if fertility treatments have failed, one has blocked tubes or a very low egg or sperm count, or after at least a year of trying for conception or pregnancy for a couple. It starts with the second day of the menstrual cycle where hormone injections are given to the would-be mother. This is approximately given for 10-12 days and ovum formulation is being observed. The sonography and hormone reports will disclose the status of the ovum formulation. If this process is successful, then all the eggs will be aspirated under the general anaesthesia. Further, this fluid will be transferred to the test tube in the embryology lab. The eggs will be assessed under the microscope. After the assessment of eggs, the fertilization process will be done with the help of sperm. This process is known as Intra-Cytoplasmic Sperm Injection (ICSI). After this, the sperm and eggs are placed in an incubator. Subsequently based on the condition of the embryo, the assessment is done and a further process, where the embryos are placed back in the womb with or without anaesthesia.

At Zydus, there is a huge team of IVF specialists and the senior most is a pioneer in North Gujarat. They as a team have handled endless patients and given this beautiful gift of parenthood to thousands of patients. People from across the world come to Zydus for IVF and have gone back with shining smiles.

There are a variety of indications for IVF.

  • Male Factor Infertility: Male factor infertility includes low count and motility, high number of abnormal forms, ejaculatory dysfunctions, Failed reversal of Vasectomy/ Tubectomy, obstructive azoospermia etc.

  • Age-Related Infertility: The higher the age, the lessens the chances of conception. The fertility index keeps on decreasing after the age of 30 – 35.

  • Reduced ovarian reserve, which means lower quantity of eggs. A day 3 FSH and estradiol test, antral follicle counts and AMH hormone levels are often done as screening tests for egg quantity. Reduced egg quantity and quality is usually treated with either IVF, or with IVF with egg donation.

  • Absent or Damaged Fallopian Tubes: Rarely the fallopian tubes are found absent since birth. Many causes lead to blockage and damage of tube like severe adhesions, surgical procedures, infections etc.

  • Endometriosis: The presence of tissue that normally grows inside the uterus (womb) in an abnormal anatomical location. Endometriosis is very common and may not produce symptoms, or it may lead to painful menstruation. It has also been associated with infertility.

  • Unexplained Infertility: Sometimes in spite of being absolutely normal male and female with normal hormonal assays, regular sexual intercourse and with all normal reports the couple is unable to conceive, this condition can be termed as unexplained infertility.

  • Recurrent Intrauterine Insemination Failure: repeated failure of IUI trials is also an indication for IVF. In-spite of good IUI trials with gonadotrophins and good post wash, if conception does not take place IVF is a better option.

  • Tubal and Pelvic Adhesions: pelvic adhesions and tubal adhesion may make tube incapable of nurturing the eggs and conception fails. Blockage of tubes arises due to pelvic adhesions.

  • Preimplantation Genetic Diagnosis (PGD)– In cases of repeated abortions and neo natal death PGD becomes necessary. PGD can be done only after IVF. [ PGD also helps in diagnosing several genetic diseases.

  • Premature Menopause: Also termed as premature ovarian failure, where the function of ovaries stops before the age of 30, Egg donation proves a better option which is possible only with IVF

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How does IVF improve fertility?

  • We force the body to produce multiple follicles and eggs (only one follicle with one egg inside develops in a natural menstrual cycle).

  • We take the eggs out of the ovaries when they’re ready (release and tubal pickup of the egg can be inefficient naturally)

  • We coerce fertilization in the lab (sperm or egg issues can cause fertilization problems in a natural situation)

  • We culture the embryos for several days and then pick the best one (or more) for transfer to the female (selection of the best one(s) increases the chances of success.

  • We transfer the embryo(s) to the best space in the middle of the uterine cavity (tubal transport of the embryo to the uterus is bypassed).

FAQ

  • Treatments for male factor infertility vary from intrauterine insemination (IUI) to in vitro fertilization with Intracytoplasmic Sperm Injection (ICSI). Individualized Medical treatment protocols are provided by the physician after the diagnostic evaluation is completed

  • The term “oligo” means few. Oligospermia is the presence of fewer than the normal number of sperm in the semen. Men with fewer than 20 million sperm/ml are usually defined as having oligospermia, or a low sperm count.

  • Azoospermia is complete lack of sperm.

  • Yes. There are two different types of azoospermia. Obstructive azoospermia is the complete lack of sperm in the ejaculation due to a blockage in the male reproductive tract or the absence of the part of the reproductive tract that carries sperm from the testicle to outside the body. A blockage, or obstruction, may have been present at birth or may have occurred as a result of an infection or severe trauma to the testicles or the tubules surrounding the testicles that transport the sperm out of the body. Men with obstructive azoospermia almost always have some sperm in their testicles, but these sperm are not found in the semen because of the blockage or absence of part of the reproductive tract.

  • For treating obstructive azoospermia, a procedure called Percutaneous Sperm Aspiration, or PESA, is used to aspirate sperm from the epididymis.

  • For treating non-obstructive azoospermia, a procedure called Testicular Sperm Extraction, or TESE, is used to obtain sperm directly from the testicle, where the sperm are being produced. The TESE procedure involves the removal of very small pieces of testicular tissue.

  • The Procedure is done under operating microscope where testis is bisected, seminiferous tubules are observed and turgid tubules are taken for sperm. The chances of sperm retrieval are 10% higher and damage to testis is negligible.

  • Severe male-factor infertility is treated very successfully by a relatively new laboratory technique called ICSI. ICSI involves injecting one sperm directly into the egg using a microscope with specialized micromanipulation equipment. ICSI is always used in conjunction with in vitro fertilization. For ICSI various sperm retrieval techniques are used like PESA, MESA, TESA, and TESE.

  • When Semen analysis shows zero sperm count the cause may be either obstructive azoospermia or non-obstructive azoospermia. For such cases sperms are retrieve from tract by different method known as Surgical Sperm Aspiration (SSA). They are like PESA, MESA, TESA, and TESE

  • Semen cryopreservation (the freezing of sperm) is a way to store sperm for future use. Sperm is routinely frozen and maintained in the center.

  • The general recommendation is to collect and freeze up to three specimens, collected two to seven days apart. However, depending on the situation, the recommended number of days between collection and the number of specimens for storage may vary. The number of specimens to be frozen also may vary depending on the number of sperm and the sperm motility in each specimen

  • Not Ordinarily. The surgeon must be able to see the follicles in order to guide the needle to the proper spot for retrieval of the eggs whether by sonographic(ultrasound) or surgical methods

  • This depends on the individual. The primary reason for delay is to allow the patient’s normal menstrual cycle to resume, which may take 2 to 3 cycles

  • There is no specific number. This is determined by the physician and the couple.

  • Although a definite time of abstinence to avoid damage to the pre-embryo has not been determined, most experts recommend abstinence for two to three weeks. Theoretically, the uterine contractions associated with orgasm could interfere with the early stages of implantation. However, intercourse the night before pre-embryo transfer is acceptable

  • The IVF team recommends that the patient be sedentary for a full 24 hours following pre-embryo placement in the uterus. Strenuous exercises such as jogging, horseback riding, swimming, etc. should be avoided until pregnancy is confirmed. Otherwise, the patient is free to return to her regular activities

  • Pregnancy can be confirmed using blood tests about 14 days after egg aspiration. Pregnancy can be confirmed by ultrasound 30 to 40 days after aspiration.

  • Perhaps, in certain situations, IVF may be cheaper and physically less demanding than surgery to repair you fallopian tubes

  • Yes, when multiple pre-embryos are transferred. 25%. of pregnancies with IVF are twins. (In normal population, the rate is one set of twins per 80 births.) Triplets are seen in approximately 2-3% of pregnancies

  • There are no known ill effects. Abnormal pre-embryos, even those produced through normal fertilization, do not seem to mature. However, any long-term effects of IVF remain to be determined.

  • Approximately three weeks (all as an outpatient). Fertility drugs are administered to stimulate the ovaries. Then during the four to six days prior to ovulation, the patient is monitored by ultrasound as well as by hormone levels

  • A maximum of three embryos will be transferred to the uterus for possible implantation. Patients will have several other options regarding the disposition of the remaining embryos. One option is to freeze embryos for your later use. Other options are to donate or simply dispose of them. Excess embryos, if any, belong to you, and you will determine what is to be done.

  • When we stimulate ovaries with gonadotrophin it may get overstimulated sometimes producing more than many follicles. This may lead to very high level of estrodiol & patient may land with OHSS. If this complication is mild to moderate, can be treated. But sever OHSS may lead to hospitalization. Pregnancy if occurs will add fuel to problem

  • plusimg Both men and women can take steps to lower the risk for infertility Exercise moderately

  • plusimg Avoid body weight extremes

  • plusimg Avoid tobacco, alcohol, and illegal drugs

  • plusimg Avoid high levels of stress

  • plusimg Avoid unwanted pregnancy

  • plusimg Receive appropriate treatment for long-term medical conditions

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