IVF is the union of an egg and sperm in artificial conditions in a laboratory. The union of an egg and sperm results in the formation of an embryo. The embryo is transferred to the uterus which if accepted results in a pregnancy. This process of IVF is done in conjunction with fertility drugs along with monitoring of hormone levels through blood tests and follicle scans with ultrasound.
Who is suited for IVF?
- Tubal problems- a woman’s fallopian tubes are blocked or damaged, which can make it difficult for the egg and sperm to unite.
- Male factor- includes absent or low sperm count, problems with sperm function or motility, which can hinder sperm from reaching the egg.
- Severe endometriosis affecting both fertilization of the egg and implantation of the embryo in the uterus.
- Unexplained infertility-where conception has failed to occur despite all apparently normal female & male factors.
- Women with premature ovarian failure can be offered IVF with donor eggs.
- Women with absent or severely damaged uterus with functioning ovaries can be offered IVF in the presence of a suitable surrogate mother.
IntraCytoplasmic Sperm Injection (ICSI)
Intracytoplasmic sperm injection a procedure where a single sperm is selected and delivered directly into a woman’s egg. ICSI is an effective option for men with subnormal semen parameters such as a very low sperm count, impaired sperm function, or in cases of previously failed fertilization.
At our centre ICSI is done with sperms which are obtained from any of the following sources:
- Ejaculated sample of semen
- From urine in case of retrograde ejaculation
- TESE: Testicular sperm extraction
- TESA: Testicular aspiration
- PESA: Percutaneous epididymal sperm aspiration
Embryo/ Egg/ Sperm Freezing
Cryopreservation is a technique, which is used to preserve good quality supernumerary embryos in liquid nitrogen at -196°C. These embryos can be used in subsequent cycles in case of cycle failure or if subsequent pregnancies are desired. By transferring these frozen-thawed embryos, you can have extra attempts at achieving a pregnancy without undergoing a full stimulation cycle. Note that only good quality embryos are used for freezing since only strong embryos can withstand the strain of freezing. In a freezing cycle, embryos are thawed and transferred into the uterus in the same way as a normal embryo transfer procedure. Transfer of these embryos is usually carried out in a hormone replacement cycle, but can also be performed in a natural cycle in which fertility drugs have not been used. One of the other advantages associated with this process is the low cost involved since expensive fertility drugs are not required. At our Centre with a robust Cryopreservation program we are able to offer equal if not better pregnancy rates in our frozen embryo transferred cycles as compared to fresh cycles.
Cryopreservation is a technique, which is used to preserve sperm in liquid nitrogen at -196°C. We can preserve ejaculated as well as testicular sperm. Sperm can also be frozen in advance of the day of egg collection if you anticipate difficulties with semen collection or if the male partner is out of town. However, we only offer sperm cryopreservation to couples undergoing IVF/IUI cycles at our centre.
Laser Assisted Hatching
An embryo must be released or ‘hatch’ out of its outer cover completely before it can implant in the uterus. Assisted Hatching is a specialized procedure performed in the laboratory, wherein a hole is artificially drilled into the outer covering of the embryo, with the help of a laser beam. This promotes the hatching process thereby improving the overall implantation and thus pregnancy rates after IVF-ET. However, this procedure is beneficial to only a selected group of patients and therefore offered only to women with advanced age or with previous two or more failed IVF cycles.
Embryo Biopsy, PGS & PGD
Embryo Biopsy, PGS & PGD is indicated in women with repeated IVF failures, the previous baby with a genetic abnormality, elderly women to reduce the risk of abortion, and repeated pregnancy loss due to a chromosomal error.
We also perform surgical retrieval of sperm from the testis in men who have no sperm in their ejaculates. Sperm can either be aspirated from testicular tissue (TESA), or surgically extracted in the form of a biopsy (TESE) or aspirated from the epididymis (PESA). These techniques coupled with IVF-ICSI offer a chance to men with complete azoospermia to father their own offspring.
Fertility Preservation for Cancer Patients
Many women who have been diagnosed with cancer think preserving their fertility is important and want information about their options. However, patients may not feel comfortable bringing up fertility issues.
- She may not be aware of their options for preserving fertility.
- The patient may be focused on their cancer diagnosis and unable to think about fertility or the possibility of having a future family.
- Women may later regret not considering fertility issues prior to starting cancer treatment.
Fertility enhancing Laparoscopy & Hysteroscopy
Laparoscopy involves visualization of pelvic structures (uterus, tubes & ovaries) with the help of a special optical device called as a laparoscope.
Hysteroscopy is a surgical procedure that enables us to diagnose and operate on pathologies inside the cavity of the uterus. This consists of the introduction of an instrument with fibre optics called hysteroscope, through the cervical canal, which enables us to visualize the cavity of the uterus.
Laparoscopy: Virtually all of the operations that are done by traditional open surgery can be performed by laparoscopy
- Evaluation of pelvic structures and tubal patency test
- Diagnosis and treatment of endometriosis
- Diagnosis and treatment of pelvic adhesions
- Tubal surgery (obstructed Fallopian tubes)
- Managing ectopic pregnancy (pregnancy outside the uterus)
- Management of ovarian cysts
- Ovarian Drilling for polycystic ovaries
- Removal of tumours in the uterus (fibroids)
Hysteroscopy: Different surgeries performed hysteroscopically include
- Removal of fibroids
- Removal of polyps
- Some uterine malformations (septum or partitions)
- Intrauterine adhesiolysis
- Tubal cannulation (Obstructed Fallopian tubes)
Intrauterine insemination (IUI)
Intrauterine insemination (IUI) is placing of sperm into a woman’s uterus around the time of ovulation. This is achieved with a thin flexible tube (catheter) that is passed into the vagina, through the cervix, and into the uterus.
Insemination procedures are the simplest and least expensive methods of assisted reproduction. No anaesthesia or surgery is needed. In IUI, sperm of the male partner is used. IUI is often combined with superovulation medication to increase the number of available eggs so as to enhance pregnancy rates.
Prior to insemination, the sperm are processed (washed and concentrated). Placing unwashed sperm directly into the uterus can cause severe cramps. Concentration is accomplished by selectively choosing highly active, healthy sperm that are more capable of fertilizing an egg. IUI is done on an outpatient basis with without any use of anaesthesia.
There are registered and approved sperm banks from which donor sperm can be used for couples where the male partner is unable to produce sperm or has an extremely low sperm count or carries a risk of transmittable genetic disease to the offspring.