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    Advance Fertility Assignment Help

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    Advance Fertility Assignment Help


    Advance Fertility Assignment Help

    In Vitro Fertilization (IVF)

    IVF or In Vitro Fertilization, commonly known, as ‘test tube baby‘ is the miracle term for infertile couples desirous of a child. This technology has enabled millions of hopeless couples to have children of their own, and experience the unmatched joy of parenthood.

    Who Needs IVF?

    • Tubal Damage or Block

    • Absent or Low Sperm Count (< 5million /ml)

    • Damaged Uterine Lining (Endometrium)

    • Poor Ovarian (Egg) Capacity/Advanced Female Age

    • Failure of Fertility Treatment for more than 2 to 5 years

    Who Needs IVF? What is the Process of IVF?

    The IVF process consists of ovarian stimulation, egg collection, fertilization, embryo culture and embryo transfer. Screening processes like normal ultrasound and blood tests are a pre-requisite for proceeding with IVF. If any abnormality like fibroid etc. is detected, it is treated before proceeding with IVF.

    • Ovarian stimulation requires daily injection of hormones to the female partner with frequent clinical and ultrasonographic monitoring. This usually continues for 10-12 days.

    • Egg retrieval is performed under anesthesia, internally without any incisions or scars.

    • The egg and sperm are either mixed (IVF) or the sperm is injected into the egg (ICSI - Intracytoplasmic Sperm Injection).

    • The fertilized egg forms the embryo, which is cultured in the laboratory for 2-3 days.

    • Two to three best embryos are selected and transferred into the womb (uterus) on the second or the third day.

    • On the fifth day transfer (Blastocyst) is decided on a case-to-case basis.

    • Pregnancy test is done 14 days after the day of embryo transfer.

    Intracytoplasmic Sperm Injection (ICSI)

    Intracytoplasmic Sperm Injection (ICSI) technique is utilised for couples with poor sperm quality as it directly retrieves the sperms from the testis/epididymis, followed by injection of a single healthy sperm into the center of egg leading to fertilization.

    What is ICSI?

    • The process assists in sperm-related infertility issues.

    • It helps in enhancing the fertilization phase of In-Vitro Fertilization (IVF) through injection of a single sperm into a mature egg, which is then planted into the uterus/fallopian tube.

    • ICSI helps overcome severe male infertility, where little/no sperm is ejaculated in the semen.

    • Patients also choose this technique if repeat in-vitro fertilization has been unsuccessful.

    • It is also used by couples planning for checking certain genetic disorders through genetic testing of the embryo.

    What are Donor Eggs?

    Many women suffering from poor egg quality have found a path to motherhood through donor eggs treatment. Even for menopausal women, the uterus can be made healthy and childbearing through hormonal preparation and donor egg IVF provides a high chance of successful pregnancy.

    What is the Success Rate Of Donor Egg IVF?

    The rate of success with donor egg IVF is about 60% per single attempt, and up to 90% in 3 attempts.

    Donor Egg Sources And Profile

    • The source of the egg donors is from verified agencies.

    • They range from lower to middle class background or could be college educated.

    • All the necessary blood screening tests including HIV and Thalassemia profile is done. Only after stringent screening, the egg donors are selected.

    • The egg donor’s profile is shared if you so desire.

    • All eggs from one donor can be provided exclusively to you or it can be shared with another patient. While the cost is lower with shared egg donation, the disadvantage is that you do not get a frozen cycle if the first cycle is unsuccessful with shared egg donation.

    Matching Of Egg Donor

    The prospective donor is selected by matching key physical characteristics like height, weight, skin color, eye and hair color. The attempt is to make the child look as similar as possible to the prospective parents. Yet one must accept that even brothers and sisters of the same family may look very different even when born biologically to the same set of genetic parents, hence IVF might not always provide a familiar looking child either. We have donors from all parts of the country to help match the physical profile of each couple that comes to us.

    Egg Donor Process

    • The process begins by stimulating the donor with Gonadotropin injection for about 10-12 days, followed by the retrieval of the egg.

    • The process if begun only once screening processes like blood tests and ultrasounds of the recipient are normal. If any abnormality like fibroid etc. is detected, it is treated before proceeding with IVF.

    • The recipient is prepared with either Estrogen tablets or Lupron and Estrogen tablets. It may take anywhere between 2 to 6 weeks, depending upon the selected protocol.

    • On the day of the egg retrieval, the husband’s sperm sample is collected. The egg and the sperms are fertilized in the lab and the recipient is called in a few days later to transfer the embryos to the uterus.

    Estimated Time Required

    The treatment is usually begun one month before your estimated month of IVF cycle, and is matched with the donor’s cycle along with preparation of your endometrium. The preparation of the endometrium may take between 2 to 6 weeks. If medications are collected from us in advance, your stay can be reduced from one month to 7 to 10 days, which is roughly the time of the embryo transfer.

    Number Of Required Visits & Hospitalization

    The total number of visits may vary from 3 – 6, and there is no overnight hospitalization. Embryo transfer is a day care procedure. The husband needs to come the day of egg pick up or freeze sperms beforehand.

    Surrogacy

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    What Is Surrogacy?

    Surrogacy is a method where the fertilized egg and sperm is placed inside the womb of another female who will carry the pregnancy to term. We can only transfer fertilized eggs (embryos) into the womb of a surrogate (gestational surrogacy). Traditional surrogacy, which is insertion of the husband’s sperms into the surrogate, is not allowed.

    Who Needs Surrogacy?

    • Absent Uterus due to hysterectomy, or congenital absence of the uterus

    • Defective Uterus (such as unicornuate uterus)

    • Poor Endometrium Lining

    • Recipients with repeated IVF failures

    • Recurrent abortions not amenable to treatment

    • Severe medical conditions incompatible with pregnancy

    • Single parents

    What is the Surrogacy Process?

    Once a surrogate has been selected, the egg provider, either the female partner or an egg donor is simultaneously matched. The surrogate’s endometrial lining is prepared and the egg provider is given injections for egg stimulation, usually at the same time. The eggs are then collected after about 10-14 days of stimulation, and fertilized with the husband’s healthy sperms. The fertilized eggs (embryos) are transferred into the surrogate’s uterus 3 - 5 days later. The pregnancy test is done 2 weeks after that. Excess embryos are frozen and transferred later if necessary.

    Legal Aspects Of Surrogacy

    The couple seeking surrogacy can either bring their own surrogate or the clinic can provide a surrogate through a certified agency. Government of India’s guidelines on IVF surrogacy makes it a legal process, requiring the names of the intending parents to be entered on the birth certificate. Commercial surrogacy is allowed, but only when both husband and wife have Indian citizenship. There is no ban yet on single parent surrogacy for Indian citizens.

    Selection Criteria For A Surrogate Mother

    • Healthy and physically fit • Preferably less than 30 years of age

    • Happy and affable personality

    • Already delivered at least one healthy child

    • All blood investigations are normal (such as Thyroid, Thalassemia, German Measles etc.)

    • Day 15-18 endometrial thickness should be > 9mm

    • She and her family understand the procedure and are willing to carry the pregnancy for 9 months

    The Surrogacy Process at AFGC

    We do not encourage hosting our surrogates in surrogate homes, as most of them are young mothers with small children. We want our surrogates to be happy during the pregnancy and live with their family, rather than be in solitary confinement for nine months. A surrogate caretaker visits them periodically to ensure that proper care is being taken and the doctor monitors her every 2 - 3 weeks to ensure a healthy pregnancy. Clinic coordinators also make frequent visits to the surrogates’ homes to ensure complete care is being taken. Antenatal visits and regular ultrasounds are done more frequently than normal pregnancy to further ensure a smooth and healthy pregnancy. Dr. Kaberi Banerjee personally chooses the surrogates and monitors their progress throughout the pregnancy. However, if any medical issues arise during the pregnancy we immediately admit the surrogates. In case any intended parent specifically wants a surrogate to stay at a surrogate home, we have provisions for the same.

    IVF Pregnancy

    After a positive pregnancy test, post embryo transfer medications are continued for another two weeks. A pregnancy scan is then done to confirm the location, and the number of pregnancies. In most cases, we are able to detect cardiac activity by this time, and medical support from our end is continued uptil completion of three months.

    The continuation of a successful IVF pregnancy is a natural process, and neither can the pregnant woman nor the doctor can do much apart from wait and watch as the pregnancy progresses. Sometimes spotting or bleeding can occur during IVF pregnancy stages, which may be part of a healthy pregnancy, but can also indicate a miscarriage or in very rare cases a pregnancy in the tubes.

    After the lapse of the three-month period, there is a reassurance that things will continue to proceed smoothly. Medical support of the pregnancy is carried on and routine antenatal visits including ultrasounds are recommended like any other pregnancy.

    The route of delivery is decided by the status of the neck of the womb or cervix when the pregnancy reaches term, and other factors like a previous caesarean section. Normal vaginal delivery can be recommended to women carrying IVF pregnancies, however, the threshold of alarm is high as it is a precious pregnancy and obstetricians often do not hesitate to perform a caesarean section if necessary.

    There are occasions when after a positive pregnancy test, multiple pregnancies are detected in the ultrasound done two weeks later. It is usually recommended to reduce triplets to twins, as chances of preterm delivery for triplets are as high as 30%. Twins are allowed to continue. Cervical cerclage (stitches around the cervix) is recommended in these cases to avoid premature delivery.

    Surgical Sperm Retrieval

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    This procedure is offered to patients with certain ejaculatory disorders or no sperm in the ejaculate Surgical Sperm Retrieval gives a golden chance to father their own child by employing the ICSI treatment cycle.

    What are the Types of SSR Techniques Available?

    • Percutaneous Epididymal Sperm Aspiration (PESA)

    In PESA, a small number of sperms are obtained directly from the epididymis (the beginning of the outlet tube of the testicle).

    • Testicular Sperm Aspiration (TESA)

    • Testicular Sperm Extraction (TESE)

    When PESA is unsuccessful, TESA or TESE may be offered, wherein the sperm is obtained directly from the testicle.

    What are the Indications For Surgical Sperm Retrieval?

    • Azoospermia

    • Failed Vasovasostomy

    • Failed Epididymovasostomy

    • Congenital bilateral absence of vas deferens

    • Obstruction in both ejaculatory ducts

    Frozen Embryo Replacement Cycle (FERC)

    When an IVF cycle produces more than two or three good quality embryos, they can be frozen for future use. These embryos are frozen at an extremely low temperature (-180°C), which prevents any deterioration over the number of storage years.

    In a Frozen Embryo Transfer Cycle, the woman is given medications to prepare her womb for planting of these embryos. The advantage of frozen embryo implantation treatment is that no hormone injections are required to stimulate the ovaries.

    An ultrasound scan is performed to assess the thickness of the lining of the uterus to determine whether it is ready to receive an embryo. Once the lining is assessed to be ready, the embryos are thawed and transferred to the uterus.

    Donor Sperm

    Donor Sperms are utilized in cases of Azoospermia (nil sperm count), low sperm count, failure of treatment of Male Factor Infertility, and single women desirous of pregnancy. Sperm Donation is available from certified donor banks, which ensure sperms are obtained from young healthy men who have been medically tested and all infections have been ruled out. The sperm is matched for height, skin and eye colour, and any other desired parameter.

    Semen Analysis

    Semen Analysis Test is the part of the crucial diagnostic analysis that is performed to access childbearing probabilities of an infertile couple. Here, the semen is analysed in strict adherence to WHO norms, and the more stringent Kruger criteria. For this analysis three days of abstinence is required to achieve correct semen testing.

    What are the Features of Semen Analysis?

    • Semen analysis test helps in measuring the amount of semen the man produces

    • It helps in determining the number and quality of sperms in a sample

    • It is among the first tests performed for determining any issues in fathering a child What does Semen Analysis Provide?

    • It provides the semen volume present in a single ejaculation

    • It is used for counting the number of sperms present per milliliter (ml) of semen in a single ejaculation

    • It measures the percentage of sperm bearing normal shape

    • It measures the percentage of sperm that can move forward normally

    Tubal Patency Test

    A Fallopian Tubal Patency Test is performed for evaluating the tubal status for any blockages/pelvic adhesions that may be present in the fallopian tubes. This process is a day procedure and does not require anesthesia when performed properly. In fact a majority of patients do not complain of any pain or discomfort. The tests are performed using different procedures like H.S.G, Laparoscopy, Gas Insufflation etc.

    What is the Gas Insufflation Procedure?

    One of the oldest assessment processes for understanding tubal patency and does not require general anesthesia.

    What is Hysterosalpingography (H.S.G.)

    The HSG test involves the X-ray of uterus & fallopian tubes and is performed without any general anesthesia.

    Laparoscopy

    Laparoscopy involves more complex procedures and is performed under general anesthesia requiring hospital admission

    Follicular Monitoring

    The Follicular Monitoring process is the serial ultrasonic monitoring of ovarian follicles, which helps in identifying correctly the time of egg maturity. It is then followed by advice for natural contact/intrauterine insemination/ egg collection for IVF. Here, the end procedure is decided on a case-to-case basis.

    What are the Features of Follicular Monitoring?

    • The process involves a series of ultrasonic monitoring of the ovarian follicles that helps in identifying maturation status of the eggs • It is suitable for assessing the size of the follicle which supports egg growth

    • It is also used for determining uterine lining thickness

    • For women under fertility medication, follicular monitoring helps in assessing response to the fertility treatment

    • It provides information that helps adjust the dosage of fertility medication during the course of the treatment in the event of inadequate response

    Diagnostic, Operative, Laparoscopy And Hysteroscopy

    Our panels of expert surgeons, with extensive experience in the field have successfully performed a number of gynaecological & laparoscopy surgeries. However, we advise upon surgical options only judiciously, and as a last resort. We prioritise treatment on sheer merit and opt for surgery only when indicated and necessary.

    Diagnostic And Operative Laparoscopy And Hysteroscopy

    A diagnostic process which determines the exact condition of the uterus, fallopian tubes and surrounding structures, done with the help of a telescope under general anesthesia. The telescope is inserted into the abdomen through the belly button by way of a very small cut and further inserted into the uterus through the cervix. This is good diagnostic method for no other investigative procedure (ultrasound, hysterosalpingogram) gives a clearer view than this endoscopic method. These endoscopic techniques can be used to detect and correct underlying disorders that may hamper the possibility of a pregnancy, like ovarian cysts, endometriosis, adhesions (scar tissue) in the abdomen that hamper tubal function, uterine fibroid, and polyp or scar tissue.

    Gynaecological Surgery

    We have a panel of expert surgeons, who have years of experience in this field and have successfully performed a number of Gynaecological surgeries & Laparoscopy surgeries. However, we do not go for gynaecological surgery and laparoscopy surgery in the first instance, prioritize treatment on sheer merit and go for surgery only when indicated and necessary.

    Diagnostic & Operative Laparoscopy, and Hysteroscopy

    This is a diagnostic process to find out the exact condition of the uterus, tubes and surrounding structures. This is done with the help of a telescope. The telescope is inserted into the abdomen through the belly button by a very small cut and further inserted into the uterus through the neck of the womb, which is called the cervix. It is done under general anesthesia. This is good method of diagnosis as no other investigative tool (ultrasound, hysterosalpingogram) gives a clearer view than this endoscopic method. These endoscopic techniques can be used to correct underlying disorders that can hamper the possibility of a pregnancy, like, ovarian cyst, endometriosis, adhesions (scar tissue) in the abdomen hampering tubal function, uterine fibroid, polyp or scar tissue.

    Intrauterine Insemination (IUI)

    The Intrauterine Insemination cycle involves the preparation of motile sperm by an andrologist, which is directly placed inside the uterus using a very fine catheter. The sperm is deposited after the release of an egg or eggs, in a natural or stimulated cycle and natural conception occurs inside the body. IUI Treatment can be offered for both, natural or a stimulated cycle. In case of a stimulated cycle (called super ovulation), the size and number of follicles is measured using ultrasonography. A Human Chorionic Gonadotrophin (HCG) injection is given to mature the eggs when the follicles reach a certain ideal size. IUI is performed 24 - 36 hours after the administration of the HCG injection. The IUI Fertility Treatment success rate is up to 20% per cycle and it is recommended that at least 3 - 4 cycles of treatment be attempted before considering other options.

    Who Needs IUI?

    • Male Infertility (Mild)

    • Sexual Dysfunction

    • Ejaculatory Disorder

    • Retrograde Ejaculation

    • Failure to conceive after ovulation induction treatment

    • Unexplained Infertility

    What is the Success Rate of IUI?

    In the best cases, (good sperm, egg and uterine quality) the success rate may reach up to 20 to 30% per attempt. It is recommended that at least 3 - 4 cycles of the treatment be attempted before considering other options.

    What is the Process Of IUI?

    • IUI can be offered for both, natural or stimulated cycle.

    • In case of a natural cycle, follicular monitoring starts from day 9 or 10 of periods till follicle ruptures. IUI is done on the day of the follicle rupture.

    • In a stimulated cycle (super ovulation), tablets or hormonal injections are begun from day 2 of the woman’s menstruation. The size and number of follicles are measured using ultrasonography and a Human Chorionic Gonadotrophin (HCG) injection is given to mature the eggs when the follicles reach an optimal size. IUI is then performed 36 hours after the administration of the HCG injection.

    Estimated Time Required and When to Arrive?

    • One IUI cycle takes about 15 days from the start of the period to sperm insemination. In this case, you need to reach 2 - 3 days before the period starts.

    • Many patients may not be able to spare so much time. Collecting medications in advance from us can reduce your stay to 5 - 7 days around the time of IUI. In this case, you can reach on the 9th or 10th day of your period.

    • You can travel back the same day after IUI, as travelling does not reduce the chance of a pregnancy.

    • It takes 15 days from the IUI date to obtain the pregnancy test result.

    What is the Number of Visits & Hospitalisation Required?

    • The total number of visits vary from 2 to 5

    • No overnight hospitalization is required as IUI is a day care procedure

    • Husband needs to come on the day of IUI to give the sperm sample

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