IVF  (In Vitro Fertilization) means combining the egg and the sperm in laboratory for  fertilization and the resultant embryo is transferred back to  the uterus. This procedure which was considered experimental for years has paved a way for many couples to expand their family.

Few of the indications;

1.Tubal Factor: Healthy fallopian tubes are the pre-requisite for natural conception. If they are damaged, blocked or removed you are left with no option but to go for IVF. In fact the success rate is quite good in these situations

2. Endometriosis: In Moderate to severe endometriosis wherein the ability to conceive on your own in spite of open fallopian tubes is a problem and IVF has a place.

3. Unexplained Infertility; When all parameters are normal and couples fail to conceive, they can opt for IVF.

4 Male factor; IVF can be opted by couples wherein male factor like moderate to low sperm count, reduced motility or presence of Anti Sperm Antibody.

5 PCOS; Polycystic Ovaries wherein ovulation is a problem, IVF is useful.

Embryo Freezing (The process of freezing, storage and thawing embryos) is undertaken at our centre. Freezing programme is not only mandatory as per ICMR guidelines but also a boon for us. As the extra embryos are utilized in subsequent cycles if the index cycle fails.  Apart from that this process will come handy in the following conditions

1. If the response for the injections is too good to proceed i.e if there is a suspicion of OHSS (Hyperstimulation) Embryos are frozen
2. If the uterine lining is not optimal and chance of improper implantation is on cards freezing may be considered
3. Extremely difficult embryo transfer.

Embryos are placed into straws containing cryoprotectant solutions. The freezing is undertaken with the help of Biotronics Embryo freezer, a state of art equipment which is programmed to do slow cooling. Once it is achieved embryos are plunged into liquid Nitrogen (-196 C). here the embryos are kept in goblets till we wish to thaw them.

You have an option of donor egg  if you have low ovarian reserves (low AMH), premature ovarian failure, multiple IVF failures, poor  egg quality or severe endometriosis where ovarian accessibility and reserves are at stake or in case of genetic disease.

Serum AMH, a blood test to assess your ovarian reserves is a good indicator apart from clinical scenario, where you need to draw a line and opt for donor cycle.

The ICMR guidelines do not permit the use of known (friends or relatives) donors. The donors are recruited through an agency and usually look for young women with excellent reproductive potential who are paid for their help. We can use commercial egg donors for this purpose. Donor screening is done meticulously which includes HIV, Hepatitis B, HCV,  VDRL and other tests. Your donor will sign a consent form in which she relinquishes all rights and responsibilities regarding her donated eggs.

Cycle synchronization, whether you wish fresh or frozen oocytes are few of the things we can discuss at the initial consultation.

Semen analysis

We analyse semen samples pre and post IUI

For IUI a fresh semen sample (no more than a half hour old) is collected and then analyzed at our centre. The sample is collected at the centre by masturbation in a clean container provided at site. The couple is asked to abstain from sex for two to three days. We have at our  IVF centre a luxury of assessing your count using Makler’s Chamber (Safi international. Israel), device specially designed to get accurate count.

Varicocoele
The presence of varicose veins leads to rise in testicular temperature which in turn reduces the sperm production and maturation. Fertility potential of sperms goes down. This condition is thought to affect 15% of the general male population but in about 35- 40% patients present with male infertility. Diagnosis most of the times is clinical and a semen analysis pattern gives enough clues to the presence of varicocoele. Diagnosis is confirmed by USG and color Doppler and necessary surgical treatment all are done at our centre.

AIH (Artificial insemination with husband’s sperms)

Artificial insemination using your husband’s sperms is useful in the following situations;

1. Cervical factor ( Infections, narrowing due to cicatrisation, etc.)
2.  Disturbance in Ejaculation
3. Low sperm counts

Procedure: This procedure is done once a month around the time of Ovulation ( i.e. releasing of egg from ovary) which is assessed using follicular monitoring by USG. On the scheduled day husband will provide the sample in a sterile container in our lab by masturbation. This sample is then washed. Sperm preparation media are used for this and it takes about one to one and a half hour depending on the liquefaction time. Then a small volume of concentrated sperms are deposited in the Uterus using a sterile catheter. Woman is advised to rest for 15 to 30 minutes at our centre.

Medicines: Though natural cycle IUI can be done, we at our centre do use Medicines to recruit more follicles. These include Clomiphene citrtate, Letrozole as well as gonadotrophins. HCG or Gnrh  injections are used for triggering of ovulation. Proper timing is of utmost importance for the success.

IVF will be the choice In case three or four cycles of IUI fail.

Donor insemination is advocated for a couple wherein the husband has no sperms (azoospermia), very low sperm count (severe oligoasthenospermia), abnormal sperms (teratozospermia) or in case the husband is known to be the carrier of a hereditary disease, the couple may opt for IUI-D. Very careful counseling is always carried out by us at our centre. The informed consent of both husband and wife is taken.

The semen specimen is quarantined one. All donor specimens are carefully screened for viral markers HIV, HBsAg, HCV, sexually transmitted diseases prior to being used for insemination. Blood group matching is done.

Donors are matched generally with that of the husband for height, hair and eye color . The identity of both the donor and the couple will be kept confidential. The woman will undergo serial sonography to get the exact date for the procedure. It is painless office procedure. It is our practice to recruit more than one egg to get better results.

Diagnostic Laparoscopy and Hysteroscopy:

Diagnostic Laparoscopy and Hysteroscopy are usually combined and we recommend it as an initial approach in selected cases like long standing infertility. This is one day procedure and patient can resume her activities in couple of days. We at our centre recommend Diagnostic Hysteroscopy prior to IVF. During laparoscopy we look for any evidence of Pelvic Tuberculosis, endometriosis and adhesions. Tubal patency is part of the procedure.

Endometriosis
Endometriosis comes in the way of conception in various ways. Endometriosis in the pelvis may cause adhesions which may hinder the sperm egg interaction. It sometimes prevents eggs being released from ovary. Endometrioma a cyst in the ovary caused by conglomeration of focii of endometriosis do have impact on fertility and may require either Medical or Surgical treatment.

Tubal cannulation

Proximal tubal occlusion can be taken care of by Hysteroscopic Tubal cannulation. This in addition helps to visualise the uterine cavity.

Tubal Recanalisation (Microsurgery)

Tubal Recanalisation is the microsurgical procedure for reversal of family planning operation (sterilization). If you desire to have a child subsequently or in an unfortunate incidence and if pregnancy is contemplated, you have an option of reversal operation. The couple needs to undergo some basic tests. The procedure takes about 2 hours. We do use loupes and a very fine suture material. We prefer to do it between seventh to tenth day of menses. We have been consistently giving good results for this operation. Though the success rate (Carry home baby rate) depends on the age factor and type of sterilization operation, (presuming that the sperm count is adequate), chances are good if the Falope rings are used as we do get adequate length of fallopian tube. For post delivery, open sterilizations and use of cautery, chances dip a little.