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IVF Appointment Dr. Pankaj Talwar

When you think about trying to conceive, your age is probably one of the first things that come to mind. And it’s true that age is a major factor in fertility. But it’s not the only factor. Your age, combined with the age of your eggs, as well as your general health, all play a role in your fertility.

Age

Your age is the most important factor in your fertility. As you age, your eggs age with you.

In your early to mid-20s, you have about a 20% chance of getting pregnant each month.

By age 30, your chance of getting pregnant each month starts to decline.

Your chance of becoming pregnant each month by the age of 35 is only slightly higher than it was in your twenties.

Furthermore, your chance of becoming pregnant each month by the age of 40 is only about 5%.

Egg quality

In addition to your age, the quality of your eggs also plays a role in your fertility. As you age, the quality of your eggs declines. This is why your chance of getting pregnant declines as you age.

The quality of your eggs is measured by something called the anti-Müllerian hormone (AMH). AMH is a hormone produced by the cells that surround your eggs. The higher your AMH level, the higher the quality of your eggs.

General Health

Your general health also plays a role in your fertility. Conditions like obesity, diabetes, and high blood pressure can all impact your fertility.

Making lifestyle changes

There are things you can do to improve your fertility, no matter your age. If you’re a smoker, quitting smoking can improve your fertility. If you’re overweight, losing weight can also improve your fertility.

And if you have a medical condition that’s impacting your fertility, there may be treatments that can help. For example, if you have polycystic ovary syndrome (PCOS), a common cause of infertility, there are treatments that can help you get pregnant.

If you’re having trouble getting pregnant, talk to your doctor. They can help you figure out what might be causing your fertility problems and what you can do about it.

Can you improve AMH levels?

Yes, you can improve your AMH levels. But unfortunately, it’s not as easy as popping a few supplements or taking some drugs.

The good news is that there are several things you can do to naturally boost your AMH levels, including:

  • Get more sleep. A lack of sleep has been linked to reduced fertility in both men and women, so getting enough shut-eye is essential for maintaining a healthy hormone balance.
  • Eat more protein and healthy fats. Protein helps build muscle, which releases growth hormones that help increase bone density and strength. Healthy fats like omega-3s are also important for brain function, which affects the production of hormones like AMH.
  • Exercise regularly — but not too much! Moderate physical activity can help stimulate the production and release of growth hormone, which promotes the development of new cells and tissue growth throughout the body.
    However, excessive exercise can actually suppress your body’s natural supply of growth hormone by releasing cortisol (the stress hormone). So make sure you’re getting enough rest between workouts!
  • Consider taking an herbal supplement that contains vitex agnus castus extract (VAC).

VAC has been shown to increase AMH levels by up to 88% in clinical studies, and it’s been used for hundreds of years to enhance fertility in both men and women.

VAC works by helping the pituitary gland produce more luteinizing hormone (LH), which is then released into the bloodstream and travels onto the testicles where it signals them to produce testosterone.

Final words

There are many factors that play a role in whether or not you’ll get pregnant, and AMH is just one of them. But before you try to conceive, it’s important to work with your doctor to find the right treatment plan for you based on all of your individual factors and preferences.

Here are the facts that you need to know:

  • Sperm and semen are not the same : Sperm is a typical name given to the reproductive cell which looks like a tadpole. However, seminal fluid is the place in which tadpoles swim. They together form semen that carries for fertilization.
  • Sperm is affected by what men eat : The quality of sperm and the sperm count is directly affected by what a person eats. Omega 3 fatty acid, vitamin C, and solid Vitamin B6 are some of the important vitamins and nutrients that improve sperm quality and sperm count. Changes in the diet can have a huge impact on seed and agility.
  • Most of the sperms are not useful : Often it is seen that males focus on the number of sperms. However, that doesn’t work, for conceiving, it is important for sperm to swim and reach eggs for fertilization. Most of the sperm is of poor quality as they do not reach eggs.
  • Sperms are perfect for your immune system : Sperms are not formed in a male body by the time the system develops to differentiate between what kind of cells are part of the body and which are not. This means according to the immune system sperms are invaders. That is why the testicles Shield the sperms in complex ways from the rest of the body.
  • Sperm takes 75 days to grow in testes : Man makes sperms around 1500 in every second. However, it takes around 75 days for sperm to grow in the testis and reach the egg for fertilization.
  • Semen contains all nutrients : Sperms contain Vitamin B12, citric acid, lactic acid, magnesium, zinc, calcium, fat, Sodium Potassium, and 100 detox routine all these multiple nutrients and proteins combine to form most of its simple water.
  • Very less semen comes out : Many people have this misconception that semen released often is too much by anyone. However, on average, semen release ejaculation is between 1.5 to millimeters which is around a teaspoon. However, on average, your body produces 20 million to 150 million sperm.
  • Semen quality changes with age : However, that’s not entirely to men at the age of 52 can produce more abnormal sperm than the younger couple ever on average. The production is higher in 20 as compared to later age but it can vary for different reasons.
  • Semen is not supposed to smell bad or can be yellow : Semen should not smell bad or yellow in color. If semen is a stinking indicator of larger issues such as infections or transmitted infections. There are chances that the change in color is due to food or eating u healthy food.
  • Semen is not for nourishment : Despite girls, semen is not a source of nourishment. So, do not use nutritional content to convince someone otherwise.
  • Conclusion : These are some of the interesting facts about semen. Whether you are trying to know more about semen for conceiving or not, these facts will help you know how semen plays an important role in our body.

In vitro fertilization (IVF) is a procedure that combines egg and sperm in a lab dish to create an embryo, which is then transferred to the uterus.

The process involves stimulating your ovaries with fertility drugs and/or hormone injections and monitoring the growth of follicles (eggs) in your ovaries. Also, retrieving them through transvaginal ultrasound-guided aspiration, or surgical removal.

The eggs are then fertilized with sperm in a petri dish and the resulting embryos are monitored until they reach the desired stage of development. One or more healthy embryos are then transferred into your uterus via a catheter (a thin tube).

IVF is often used when other treatments, such as intrauterine insemination (IUI), have been unsuccessful at achieving pregnancy. IVF also may be used if you have blocked fallopian tubes, certain male infertility problems, or for other reasons.

Reasons why IVF is the best

If you’ve been trying to conceive without success, you may be considering in vitro fertilization (IVF). IVF is an assisted reproductive technology (ART) that can help you achieve pregnancy.

While IVF may seem like a daunting and expensive option, it is actually one of the most effective fertility treatments available. Here are five reasons why IVF may be the best option for you:

1. Highly effective.

The success rate of IVF depends on a number of factors, including the age of the woman and the quality of the eggs. However, overall, IVF has a high success rate.
According to the American Society for Reproductive Medicine (ASRM), the success rate of IVF is about 40 percent for women under 35. The success rate declines as a woman’s age increases.

2. IVF can help you conceive twins or triplets.

One of the great things about IVF is that it can help you conceive twins or triplets. In fact, about 30 percent of IVF pregnancies result in twins.
While having twins or triplets may not be what you originally planned, it can be a great blessing.

3. Conceive if you have male factor infertility.

If you have male factor infertility, IVF can help. Male factor infertility is a condition in which the man’s sperm is unable to fertilize the woman’s egg.
In IVF, the man’s sperm is injected directly into the woman’s egg. This bypasses the need for sperm to travel through the man’s reproductive tract.

4. Female factor infertility.

For women with female factor infertility, IVF can help them become pregnant.
Female factor infertility is a condition in which the woman’s reproductive system is unable to support a pregnancy.
There are many causes of female factor infertility, including endometriosis, uterine fibroids, and polycystic ovary syndrome (PCOS). IVF can help you conceive even if you have one of these conditions.

5. It helps with fertility problems.

IVF helps many women, including those with fertility problems like you, become pregnant.
Fertility problems can be caused by a variety of factors, including age, lifestyle, and health conditions.
IVF can help you overcome these obstacles and give you the best chance of conceiving.
If you’ve been trying to conceive without success, IVF may be the best option for you. IVF is a highly effective fertility treatment that can help you overcome a variety of fertility problems.

Final words

IVF fertility treatments are the fastest way for a couple who has been having trouble getting pregnant, to finally achieve their dream of starting a family.

It is not uncommon for couples to feel frustrated that they have not been able to conceive naturally after several months. Many end up giving up and resigning themselves to being childless.

However, there is hope as most often than not, this infertility is due to an underlying condition or factor that can be resolved with early detection using techniques like IVF.

Causes of IVF Failure – With the advancement in technology and better care facility, the success rate for IVF are at their highest. In spite of this, there are cases where IVF fails. All this results in deep pain for the couple who wish to parent a child. A couple who choose IVF for the treatment of their infertility spend a lot of money, years of your life devoted, and at the last nothing achieved. In this situation they might feel cheated, scammed, and slighted. In this case, the couple have two areas for consideration at this point: the emotional response to the loss that needs to be processed and the medical choices that need to be made regarding the next steps in the fertility journey. Many women who have had a failed IVF cycle will be successful on a second or even a third cycle. Not all the issues that influence IVF success can be corrected, but some can be addressed to help make the next cycle more likely to result in a pregnancy including:

Age

For the success of the IVF, the age of female partner is very important. As the age of women advances, their eggs also get older. As the age advances, fewer eggs are produced and the quality of the eggs decreases. All this begins to happen when the women are in their thirties, and the decline accelerates when the age reaches to 37. The chance that an IVF cycle using fresh non-donor eggs will result in a live birth is, on average, almost 32 percent for a 35 year old woman, but only 12 percent for a 41 or 42 year old woman.

Embryo Quality

Poor embryo quality is another reason for the failure of IVF cycle. Due to the genetics or chromosomal disorders, the embryos generally fail to implant and grow. Again, older eggs are more likely to result in poor embryo quality.

Ovarian Response

The ovaries respond to the fertility medications with production of multiple eggs, which is critical to the chances of conceiving with IVF. In some cases, women do not produce multiple eggs because their ovaries have fewer numbers of eggs in reserve than expected.3

Don’t Give Up! Pregnancy is Possible after a Failed IVF Cycle

Take a Break2

Take a break after this loss. It is important because it helps to cope up with the loss. The whole process of IVF cycle take a long time and gives a huge emotional and physical toll on your body. Take a week off from everything so that you can take care and nurture yourself. Use this time to eat your favorite food or listen your favorite music or engage yourself in sports or activities which like most. It is also recommended to take emotional support from a good licensed counselor.

Talk to your fertility specialist

After expressing a long deep emotional pain, it is necessary to pick yourself up and plan a meeting with your fertility specialist or doctor. The fertility specialist will review all the details of your cycle beginning with the results of your ovarian stimulation, any egg quality or quantity issues, and any embryo development or transfer issues.

Proceed with a more informed treatment plan

Meeting with your fertility specialist gives you a chance to discuss any new type of information learned from the cycle to then proceed with a more informed treatment plan for the next cycle. However, the emotional impact is very much, the failed cycle may provide some important information to the physician about you, your embryos and what might be changed for the future to help increase your chances of success.

Understand That the First Round’s Failure was not Your Fault

After the first round of a failed IVF cycle, patient may blame themselves for the loss or the failure. The number one step in preparing emotionally for the second round of IVF process is accepting that it’s not your fault. There is not always a scientific reason as to why your IVF cycle failed. Sometimes, these procedures are successful, and sometimes, they are not.

Let Go of Expectations 4

Keep in mind that you have gone through the IVF process once already. The most challenging part is letting go of your expectations because they may affect you emotionally. Once you begin the second round of IVF following a failed cycle, it is a good idea to remind yourself to stop asking so many questions about your follicle counts or egg quality.

Keep Making Mindful Medical Decisions 4

After an IVF process failure, your doctor will let you know in detail what they’ve learned from the failed cycle. They would also inform you about how they intend to change things up for the next one. They may want to change your medications or your pre-stimming protocol. No matter what they suggest, just make sure that you’re making sound medical decisions on how you want to proceed.

Take Care of Yourself 4

It is imperative to take good care of yourself after a failed IVF cycle. Ensure that you get all you need to remain calm as you prepare for the next round. Find healthy ways to cope with your stress levels and anticipation as you mentally prepare yourself for the upcoming cycle.  All in all, no matter how disheartening a failed IVF cycle may be, there is still hope! It is essential to find healthy ways to cope with an unsuccessful first cycle as your mental state plays a massive role in your journey.

Nutrition Tips to Maximize Fertility AfterIVF Failure

To boost egg health: Take adequate amount of omega-3 fatty acids, avocados and extra virgin olive oil. Eat plenty of seasonal fruits and vegetables as they contain important antioxidants that may enhance egg quality.

To assist embryo implantation: There’s research to show that whole grains like oats or brown rice may help embryo implantation. Vitamin E can also help, with nuts being the best natural food source.

To improve sperm health: Reduce exposure to toxins as this could negatively impact sperm quality – no smoking, drugs or alcohol.

What is In Vitro Fertilization?

IVF related Queries – In vitro fertilization (IVF) is a kind of assistive reproductive technology (ART). The process includes taking out eggs from a woman’s ovaries and fertilizing them with sperm. After fertilization, this fertilized egg is called an embryo. The embryo is either transferred to a woman’s uterus or stored for future use.

There are various ways in which the IVF procedure is performed:

  • Your eggs and your partner’s sperm
  • Your eggs and donor sperm
  • Donated embryo
  • Donor eggs and donor sperm
  • Donor eggs and your partner’s sperm

Why is IVF Done

IVF is offered as an essential treatment for infertility in women. IVF can also be performed if you have certain medical issues. For instance, IVF might be a choice if you or your partner has:

  • Endometriosis
  • Ovulation disorders
  • Fallopian tube damage or blockage
  • Previous tubal sterilization or removal
  • Uterine fibroids
  • Impaired sperm production or function
  • Unexplained infertility
  • Genetic disorder

Risks Associated with IVF

  • Multiple births: Chances of multiple births may increase if more than one embryo is transferred to your uterus.
  • Preterm delivery and low birth weight: It has been observed that IVF slightly increases the risk of preterm delivery or delivery of the baby with a low birth weight.
  • Miscarriage: Women who conceive through IVF have shown a higher rate of miscarriage that is about 15% to 25%.
  • Ectopic pregnancy: Approximately 2% to 5% of women who choose IVF will have an ectopic pregnancy.
  • Stress: Women who opt IVF can face financially, physically and emotionally draining.

IVF Success Rate in India

Success rate in India ranges from 30% to 35%. Worldwide, the average IVF success rate is approximately 40% in young women. It has been observed that the chance of success rates also increases in women who are younger than 35 years of age. The success rate of this most commonly used reproductive technology is generally measured on the basis of live birth per embryo transfer. Live birth per embryo transfer is known as Live birth rate.

How to Boost up Your Chances of IVF Success

  • Maintain your weight according to your age
  • Optimize your sperm health
  • Always partner with a good doctor and embryology laboratory
  • Say no to stress
  • Quit smoking
  • Take supplements as per requirement
  • Maintain an optimum levels of vitamin D in your body

Foods to Eat During IVF Treatment

Food Rich in Zinc

Zinc helps to maintain normal hormonal level. Include dairy products, grains, potatoes, and nuts, along with a few meat items in your diet.

Folic Acid Rich Food

Folic acid is essential to keep the embryo healthy and free of any developmental disorders. Peas, spinach, broccoli, kiwi, poultry products, and tofu are good source of folic acid for you.

Avocados

Taking avocados improves ovulation within a woman – it increases the chance of having a successful IVF by 3.5 times.

Protein-Rich Foods

Protein gives you energy and helps in development of body. It is recommended to take at least, 60 g on a daily basis. Seafood, meat, eggs, legumes and nuts are great source pf protein.

Food to Avoid

  • Egg in Raw form
  • Foods Containing Artificial Sweeteners
  • Refined Sugar
  • Alcohol and Caffeine

Common Questions About IVF

How Long Does a Cycle of IVF Take?

It takes between four and six weeks to complete one IVF cycle.

How Many Embryos Will Be Implanted?

Normally, only one embryo is transplanted back into the womb. This process is known as single embryo transfer (eSET). This process is adopted to decrease the chance of multiple births.

How many days after IVF Can I Do a Pregnancy Test?

It is advised to wait for two weeks after IVF before you do a pregnancy test. The reason behind this is it that it takes several days for the fertilized egg to implant into the womb and after that it has to produce enough pregnancy hormone that is hCG (human chorionic gonadotrophin) to be detected by a pregnancy test.

Any Life Style Changes that I need to adapt Before I Have IVF?

You can increase your chances of successful IVF by:

  • Keeping a healthy weight
  • Cutting out alcohol
  • Quit smoking and keeping your caffeine intake very low.
  • Take 400 mcg folic acid supplement every day.
What happens if I become pregnant?

Once it is confirmed that you are pregnant, you’ll see your fertility specialist for continued blood testing, and an ultrasound to confirm that the pregnancy is progressing smoothly. Once the heartbeat of the fetus has been verified, consult with an obstetrician for the rest of your pregnancy. For more details about IVF related queries see our blog section.

How Vitamin D Affects Fertility – Vitamin D3 (cholecalciferol) is the primary type of Vitamin D in the skin. It is the form produced in the skin, and it tends to be found in some food and nourishing supplements. Prescription vitamin D is vitamin D2 (ergocalciferol). In general, research shows that we metabolize vitamin D3 more effectively than vitamin D2.

Vitamin D has been linked to a variety of health benefits. For women trying to conceive, it appears to be linked to better fertility, as well as a healthy pregnancy. Because of these potential benefits, female patients are screened for vitamin D deficiency as part of their initial screening process for pregnancy related complications.

Vitamin D Role in Fertility

The active form of Vitamin D (calcitriol) has numerous functions in female reproduction. Bound to its receptor, calcitriol can control the genes engaged with making estrogen. The uterine lining produces calcitriol because of the embryos as it enters the uterine cavity, in no time before implantation. Calcitriol controls a few genes associated with embryo implantation. When a woman becomes pregnant, the uterus and placenta keep on making calcitriol, which helps organize immune cells in the uterus, so infections can be fought without harming the pregnancy. Less vitamin D status has been related with certain pregnancy complications, for example, gestational hypertension and diabetes.

How Vitamin D Affects Your Fertility

In humans, vitamin D deficiency has been shown to increase the risk of preeclampsia, pregnancy-induced hypertension, gestational diabetes, and lower birth weight. Vitamin D plays an important role in fertilization and pregnancy. Its exact role is still not understood, and the optimum blood concentrations are not yet known.

Vitamin D may likewise be a contributing element in the health of PCOS patients. In one examination seeing women attempting to conceive, 25(OH) D levels under 10ng/ml anticipated a diminished possibility of follicular development and a decreased possibility of getting pregnant.

Vitamin D may likewise demonstrate to have a significant function in fertility following up on both the ovary and the endometrium. At the ovarian level, vitamin D has been appeared to enhance ovulation.

Vitamin D and Fertility in Women

For women attempting to conceive naturally, higher vitamin D levels are related with higher chances of conception. Studies likewise show that higher vitamin D levels in the follicular fluid may improve embryo implantation rate and the result of infertility treatments. Several studies have connected ordinary vitamin D levels with higher IVF pregnancy rates and live birth rates.

Vitamin D and Fertility in Men

Keeping up a healthy vitamin D level isn’t just significant for women attempting to conceive. It can profit the male partner too. Studies have shown an immediate relationship between vitamin D levels and an improved ability of sperm to start a pregnancy, both during ovulation induction and planned intercourse. Normal vitamin D levels have additionally been connected to healthy semen quality and sperm motility (movement), which may help improve pregnancy rates.

Unexplained infertility is infertility of unknown cause. The reason of infertility is still not known even after tests such as semen analysis in the man and assessment of ovulation and fallopian tubes in the woman.

Possible causes of Unexplained Infertility

In unexplained infertility, any disorders or abnormalities are likely to be present but not diagnosed by current methods. The most possible cause of the problems could be:

  • The egg is not released at the optimum time for fertilization
  • The egg may not enter the fallopian tube
  • Sperm may not be able to reach the egg
  • Fertilization may fail to occur
  • Transport of the zygote (fertilized egg) may be disturbed
  • Implantation fails

When to See a Fertility Specialist

The need of infertility diagnosis is normally occurs after a couple (with the female being under 35 years) has been trying to conceive for over one year with no success. However, for couples where the woman is of 35 years or older, infertility is diagnosed after they’ve been trying unsuccessfully for 6 months. When infertility is diagnosed, the doctor or fertility expert may suggest routine testing of your hormones, ovulatory cycles, anatomy, and even of your partner for male factor infertility (semen analysis). If you have unexplained infertility, no apparent problems will be found.

Coping with Infertility

The diagnosis of unexplained infertility can be a very discouraging for couples who are trying to conceive. In this case when the reason for the infertility is not clear which symbolize that there is no solution for the problem. Thus the path for the pregnancy is not so smooth.   When a couple knows the reason for their fertility problems, stress is often reduced.

Couples with unexplained infertility are still left with unanswered questions, sometimes causing feelings of guilt that they did something to cause the new fertility problems. It can be difficult to know which path to choose when the source of the problem can’t be determined. Despite all the difficult emotions, couples with unexplained infertility should realize that their diagnosis comes from a limitation of science and not of themselves. Current medical technology just isn’t yet capable of determining why they’re having problems getting pregnant.

Treatment for unexplained infertility

There are a number of avenues you can explore to help you get pregnant with unexplained infertility, including:

Acupuncture: Many infertile couples choose acupuncture to help them conceive. Acupuncture may increase ovarian function and promote rich blood flow to the endometrium lining. Also, studies have shown more effectiveness of some fertility treatments when they are used in conjunction with acupuncture.

Intrauterine insemination (IUI): in this technique specially washed sperm are injected directly into the uterus at the precise timing of ovulation. This increases the chances of successful fertilization by getting the best quality and quantity sperm directly where it needs to be. Couples often try this procedure because it isn’t as expensive and time-consuming as in vitro fertilization (IVF).

Fertility drugs: Even though there may not be a documented issue with ovulation, doctors sometimes prescribe fertility medications that induce ovulation. Examples include Clomiphene citrate (Clomid), gonadotropins, or FSH. A downside is that these drugs can increase your chances of having twins or multiples. Some of these fertility drugs may be used in conjunction with IUI or other ART.

Lifestyle Changes in Unexplained Infertility Treatment

Especially when the cause of infertility is unknown, improving your overall health is important. The most commonly suggested lifestyle changes to improve your fertility naturally are:

  • Lose weight (if overweight) and exercise
  • Quit smoking
  • Avoid excessive alcohol consumption
  • Cut back on caffeinated drinks
  • Reduce overall stress

Dietary Treatment

Eat a Nutritious Nutrient-Dense Whole Foods Diet: Changing the diet should always be the first thing anyone with unexplained infertility should do. Include fresh vegetables, fruits, raw seeds and nuts, whole grains, in your diet.

Fertility Herbs: It bring about healthy healing and change in the body. Some herbs are considered fertility superfoods which boost nutrition while supporting endocrine system function.

Omega Essential Fatty Acids aid the body in balancing weight, support body system function, and create a healthy environment for conception.

Thyroid and Infertility – The thyroid is a little gland situated in the neck. Its work, as an essential part of the endocrine system, is to control human body’s metabolism, the cycle by which the body converts what you eat and drink into energy through the hormones it discharges.

The thyroid gets a message from the pituitary gland by means of thyroid-stimulating hormone (TSH) and releases triiodothyronine (T3), thyroxine (T4), and calcitonin.  While many know that an imbalance of TSH, T3, and T4 can cause weight or mood changes, it can also affect your menstrual cycle and fertility.

Thyroid Dysfunction and Reproductive Health

Hypothyroidism and hyperthyroidism can each adversely affect fertility both the ability to become pregnant and the ability to carry a fetus to term.

Abnormal TSH levels can interfere with ovulation and that when you have any sort of thyroid issue (without proper treatment), you will see a luteal phase (the last 50% of the cycle after ovulation) disturbance.

Thyroid dysfunction can affect fertility in following ways:

  • Disruption of the menstrual cycle, making it harder to conceive.
  • Interference with the release of an egg from the ovaries (ovulation)
  • Increased risk of miscarriage
  • Increased risk of premature birth

Thyroid Disease and Male Infertility

Although thyroid infection is often viewed as a women concern, around 33% of hypothyroidism cases emerge in men. Whenever left untreated, an underactive thyroid can prompt male infertility.

Studies show that low thyroid hormone levels in men can cause poor semen quality, low sperm count, diminished testicular capacity, erectile dysfunction and a drop in libido. Whenever hypothyroidism is diagnosed in a man to have fertility issues, bringing thyroid hormone levels once more into the normal levels for the most part restores erectile function.

Hypothyroidism and Infertility

Hypothyroidism can be easily treated, and once you get your thyroid levels back to a normal range, you can become pregnant. Treatment involves taking synthetic thyroid hormone in pill form. Though it may take a few months to determine the proper amount of hormone for you, once you and your doctor determine your optimal dosage, “you should be feeling yourself again and be able to conceive.

When hypothyroidism is the reason for infertility, taking thyroid medication will enable most women to conceive, from as soon as six weeks after treatment, according to a study. Many women who have a problem conceiving may have no apparent symptoms of hypothyroidism and only slightly elevated TSH levels, making it all the more important to have a TSH blood test if you’re having a hard time getting pregnant and don’t know why.

Treating hypothyroidism with medication not only improved conception rates, but also reduced miscarriages early in pregnancy, which can happen as a result of untreated severe hypothyroidism.

Evaluation of Thyroid Related Infertility

If you’re under the age of 35 and haven’t been able to conceive after a year of trying, or you’re over 35 and have been trying for six months, it’s a good idea to schedule a comprehensive infertility evaluation.

Because hormones play a critical role in every stage of conception and pregnancy, assessing thyroid function is an essential component of your infertility checkup. It’s especially important if you have a family history of thyroid disorders, or if you’ve ever experienced irregular periods or multiple miscarriages.

For women who are diagnosed with a thyroid disorder, medication is often all it takes to balance hormone levels and restore fertility. As always, your personal treatment plan depends on your exact diagnosis.

Semen Freezing Centers – Sperm freezing is the process of collecting, analyzing, freezing, and storing a man’s sperm. The sperm samples stored are later utilized for fertility treatments or given to different couples or people, including same-sex female partners. This general cycle is known as cryopreservation and sometimes is referred to as sperm banking.

The cryopreservation cycle includes:

  • Routine screening for disease (HIV, hepatitis, and fast plasma reagin test for syphilis)
  • Giving a semen test or going through a sperm extraction.
  • Lab examination of sperm amount and quality
  • Freezing of viable sperm
  • Storage of the sperm indefinitely

Ideal Candidate for Semen Freezing

Any individual who is healthy and has some sperm in their ejaculate is a good candidate for sperm freezing and children can also freeze sperm. Young children who have been diagnosed with cancer and have achieved pubescence are also acceptable candidates for sperm banking.

Those freezing for the reasons for sperm donation to sperm banks should be <40 years old, healthy, with good sperm quality, and without family backgrounds concerning for cancer or other genetic diseases.

Sperm Freezing Process

Semen for cryopreservation is acquired by masturbation and must be brought to the ART (Assisted Reproductive Technology) research facility within 1 hour of ejaculation. Once in the research facility, an examination of the amount and quality of sperm is made and a small test vial is prepared. The remains of the sample are isolated into more different vials. The quantity of vials stored relies upon the total volume of the sample, and the number of mobile sperm in every milliliter. The whole freezing process is finished in around 3 hours. The next day, the test vial is thawed, and an assessment of the number and motility of the thawed sperm is performed.

Sperm freezing allows the sperm to be used in future fertility treatments such as:

Considerations for Sperm Freezing

Common reasons to choose to freeze sperm:

  • Advancing age.
  • Deteriorating sperm quality or low quantity.
  • Cancer or other medical reasons.
  • Pre-vasectomy patients.
  • Transgender patients.
  • Career and lifestyle choices, such as those with high-risk occupations or who spend a lot of time away from their significant other.

Risks Involved in Semen Freezing

There are no risks or adverse effects to semen freezing normally (through masturbation). In case of surgical extraction is required, there are small risks involved, like with any medical procedure, such as, bleeding and discomfort.

Sperm freezing has been effectively utilized since 1953 to assist people with conceive healthy children. The cycle is safe, standardized and keeps on improving as technology advances.

The essential worry with sperm freezing is that not all sperm survive the freezing and defrosting process. However, as most semen ejaculations contain an appropriate number of sperm, the possibility of having enough healthy sperm for fertility treatment is exceptionally high. The ability of the surviving sperm cells to fertilize an embryo isn’t compromised during the freezing or defrosting process.

Cryopreservation is considered to have no time limit, and stored sperm as old as 20 years have been utilized to produce healthy infants. Find the best semen freezing centers here.

Recurrent Miscarriage – Miscarriages are normal, happening in 15-20% of all pregnancies, typically in the 1st trimester (up to 13 weeks). One or even two miscarriages are not by themselves characteristic of future infertility. In any case, they may leave patients concerned and questioning their capacity to have a live birth1.

Recurrent pregnancy loss (RPL), also referred to as recurrent miscarriage or habitual abortion, is historically defined as 3 consecutive pregnancy losses prior to 20 weeks from the last menstrual period.

Types of Recurrent Miscarriage

There are numerous reasons for miscarriage, yet they are normally divided into two categories: early and late.

Recurrent early miscarriage (within the first trimester) is mostly because of hereditary or chromosomal issues of the embryos, with 50-80% of unconstrained losses having anomalous chromosomal number. Basic issues of the uterus can also play a part in early miscarriage.

Recurrent late miscarriage can be the consequence of uterine variations, immune system issues, an incompetent cervix, or premature labor.

Causes of Recurrent Miscarriage

Known causes of recurrent miscarriage include the following:

Genetics: A genetic issue with a developing embryo or a genetic condition that influences one or both the two parents may cause recurrent miscarriages.

Conditions influencing the uterus: The cycle of implantation is hormonally managed and requires a synchronized communication between the embedding embryo and the lining of the woman’s uterus (endometrium). Factors that change this relationship cause pregnancy loss.

Antibodies including lupus anticoagulant (LAC), anticardiolipin antibodies (ACA), and beta-II-glycoprotein antibodies are believed to promote miscarriage by causing clotting in the early placental circulation or by preventing optimal implantation. Treatment involves the use of low dose aspirin and other anti-clotting medications.

Other causes include:

  • Environmental factors
  • Infections
  • Hormonal disorders
  • Clotting disorders
  • Male factors

Diagnosis

Depending on the cause diagnosis for recurrent miscarriage can be done by the following:

Testing for uterus problems-
  • Hysterosalpingogram (HSG)
  • Hysteroscopy
  • Transvaginal Ultrasound
  • Endometrial Biopsy
Blood Tests-
  • Lupus Anticoagulant Antibodies
  • Anticardiolipin Antibodies
  • Prothrombin time and Activated Partial Thromboplastin Time
  • Thyroid Panel

Fetal Tissue Karyotyping

Treatment

Although the diagnosis can be frustrating, treatment options to lower the risk of miscarriage are available. These options include:

  • Ovulation induction.
  • Progesterone therapy.
  • Low dose aspirin.
  • Injectable blood thinners.
  • Antibiotics for presumed chronic inflammation of the uterus.
  • In vitro fertilization.
  • Pre-implantation Genetic Testing for Aneuploidy (PGT-A).
  • Intracytoplasmic sperm injection (ICSI) with the assistance of the ZyMotTM device.

PCOD

How to get Pregnant with PCOD? – Polycystic ovary syndrome, or PCOS, is a hormonal condition that interferes with more than just your fertility; however, you may initially get a diagnosis when you’re attempting to get pregnant. This is on the grounds that it’s a typical and treatable reason for infertility in females. In PCOS, the ovaries becomes bigger than ordinary. These greater ovaries can have numerous cysts that contain immature eggs.

PCOS and infertility are firmly connected in various manners. The clearest one obviously is that most ladies with PCOS don’t ovulate routinely. Since inability to ovulate commonly brings about irregular periods, getting your period can enlighten you so much about your fertility.

PCOD and Pregnancy

Living with PCOS and getting pregnant is challenging because your body doesn’t produce the hormones necessary for regular ovulation. Without these hormones, the egg inside the ovary does not fully mature. The follicle that holds the egg still grows and fills with fluid. However, there is no mature egg to rupture it, so it remains as a cyst. The cysts with PCOS produce higher than normal amounts of androgens (male sex hormones), which block ovulation. Because no mature egg is released, ovulation fails to occur and the hormone progesterone is not made. This results in an irregular or absent menstrual cycle.

How to get pregnant with PCOD includes a portion of the very advances that females without PCOS should take for a healthy pregnancy:

  • Have your weight and body mass index (BMI) estimated by your doctor. Your BMI shows whether you have a health body weight and the amount of fat your body have. On the off chance that you are having additional weight, talk to your primary care physician about how much weight you have to lose before you get pregnant.
  • Utilize an ovulation schedule or application to follow when you have your period. This encourages you make a superior speculation about which days of the month you are bound to get pregnant.
  • Check your glucose levels. See your PCP to ensure your glucose levels are adjusted. Your glucose levels are significant in getting pregnant, having a sound pregnancy, and even in your child’s future wellbeing
  • Start a sound eating regimen and exercise plan. Start picking more beneficial food decisions and be more active. When choosing a diet plan, besides making sure the diet is healthy and includes the nutrients and healthy fats your body needs, it’s important to choose a diet that you can stick with. If a diet is extremely restrictive or involves consulting detailed lists of good and bad foods, you are unlikely to keep it long enough to see weight loss results.

If a low-GI diet seems right for you, and you can stick to it, then there is no harm in trying it out. However, if it isn’t a diet you can stick with, and you feel more comfortable with a basic low-calorie, low-fat diet, then go with that.

Some people with PCOS will need medications to treat the condition and/or to help them conceive.

Metformin

Request that your primary care physician test your insulin levels. In case you’re insulin-safe; taking the diabetes drug metformin can treat the insulin obstruction and may assist you with getting in shape. It might likewise enable you to imagine. As indicated by the exploration, metformin may:

  • Promote weight reduction
  • Restart normal periods
  • Improve the adequacy of some ripeness drugs
  • Reduce the pace of premature delivery (in those with rehashed unsuccessful labor)

Clomid

Clomid is the most ordinarily utilized richness drug in general and furthermore the most usually utilized treatment for ladies with PCOS. Numerous ladies with PCOS will consider with Clomid.

Letrozole

In the event that metformin and Clomid are not fruitful, your primary care physician may consider the medication letrozole. Likewise known by its image name Femara, it’s anything but a ripeness drug however is oftentimes utilized as one in ladies with PCOS. Letrozole is really a malignancy medicine. In any case, contemplates have discovered that it very well might be more viable than Clomid at animating ovulation in ladies with PCOS.

Gonadotropins

In the event that Clomid or letrozole isn’t fruitful, the following stage is injectable fruitfulness medications or gonadotropins. Gonadotropins are made of the hormones FSH, LH, or a blend of the two

Fertility Procedures

On the off chance that the above alternatives don’t work, there might be different reasons why pregnancy can’t be accomplished and more intrusive treatment, for example, IVF might be required.

IVF includes a course of injections to stimulate the ovaries to produce numerous eggs. At the point when they’re adult the eggs are recovered in an ultrasound-guided strategy under light anesthetic. Sperm are added to the eggs in the research center for embryos to form.

A couple of days after the fact, embryo is put in the uterus where it might embed and develop into a child. In the event that there is more than one embryo, these can be frozen for some time to use future if there is no pregnancy.

While IVF is safe, there are some conceivable health impacts to know about, including ovarian hyperstimulation condition. This is an over-reaction to the fertility medications that are utilized to stimulate the ovaries to produce numerous eggs. This can prompt stomach pain, nausea and vomiting, fast weight gain and blood clots

How to become pregnant with irregular periods – It’s normal for women to have monthly cycles that may vary. One month it very well maybe 28 days, which is viewed as normal, and the following month it very well maybe 31 days, and the following 27. That is typical.

Periods are viewed as sporadic when they fall outside the “ordinary” range. An irregular menstrual cycle is one that is less than 21 days or more than 35 days. When including the days in your cycle, the main day of bleeding is the first day, and the most last day of the cycle is the first day of bleeding in your next cycle.

Causes of Irregular Cycles

Irregular cycles may point to a subtle hormonal imbalance. You may still be ovulating every month, but your ovulation day may vary.

Here are some possible causes of irregular cycles that are also infertility risk factors:

  • Anovulation
  • Polycystic Ovarian Syndrome (PCOS)
  • Thyroid Imbalance
  • Hyperprolactinemia
  • Primary Ovarian Insufficiency (POI)
  • Obesity
  • Underweight

Detecting Ovulation When Cycles Are Irregular

If you are ovulating, but irregularly, you’ll need to make a special effort at determining your most fertile time. There are many ways to predict ovulation.

Ovulation predictor tests work a lot like pregnancy tests, in that you pee on test strips to determine when you’re most fertile. You don’t use the tests your entire cycle, but only around the general time you might expect to ovulate. When your cycles are irregular, that possible ovulation window may be longer than it is for other women.

Getting Pregnant With Ovulation Problems

Once your doctor has ruled out other medical conditions, they may prescribe fertility drugs to stimulate your ovulation.

The drug contained in Clomid and Serophene (clomiphene) is often the first choice because it’s effective and has been prescribed to women for decades. Unlike many infertility drugs, it also has the advantage of being taken orally instead of by injection. It is used to induce ovulation and to correct irregular ovulation by increasing egg recruitment by the ovaries. The drug letrozole is also used to induce ovulation3.

Getting Pregnant with Irregular Periods

Dealing with irregular menstrual cycles can be distressing, Consulting a doctor for diagnosis and treatment is the first priority but there are habits that can also help you get pregnant with irregular periods naturally. Although these habits can’t replace medical treatment, they can help your fertility get back on track.

Get rid of these bad habits to improve your chances of becoming pregnant:

  • Smoking
  • Drinking alcohol
  • Consuming excessive caffeine
  • Not getting enough sleep
  • Leading a sedentary lifestyle
  • Too much exercise or dieting.

Eat a Healthy Diet

Research shows that eating healthy foods is a great way to get pregnant fast with irregular periods naturally.

These are some of the best foods for fertility:

  • Low-mercury fish
  • Leafy greens
  • Fruits
  • Eggs
  • Nuts and seeds
  • Yogurt
  • Lean animal protein
  • Complex carbs
  • Healthy fats

How to Conceive with Ovarian Cyst – Ovarian cysts are liquid-filled sacs that can be found on or inside the ovaries. They are exceptionally normal, with numerous women getting them eventually in their life. Most are innocuous and cause no symptoms or agony, which is the reason they typically go undetected, vanishing over the long run without the requirement for clinical intervention.

Ovarian Cysts and Fertility

Some ovarian cysts can be related with diminished fertility. In any case, it relies upon the kind of ovarian cysts you have.
Ovarian cysts that can influence your fertility include:

  • Endometriomas: Endometriomas are cysts brought about by endometriosis, a condition wherein the tissue regularly covering your uterus (endometrium) becomes outside the uterus. These ovarian blisters might be related with fertility issues.
  • Ovarian cysts due to polycystic ovary syndrome: Polycystic ovarian syndrome (PCOS) is a condition set apart by numerous small cysts on your ovaries, unpredictable periods and significant levels of specific hormones. PCOS is related with sporadic ovulation, which may add to issues with fertility in certain women.

Ovarian Cysts Diagnosis

If your doctor suspects that you may have a cyst, they will begin by completing a pelvic exam to look for swelling. Since cysts do not often require treatment, there are a number of different options the doctor can choose between:

  • Imaging Tools (Ultrasound, CT scan, MRI)
  • Pregnancy Test
  • Hormone Levels Test
  • Blood

Ovarian Cyst Treatments

Most ovarian cysts disappear on their own and don’t need any treatment. In rarer cases, such as in the case of an ovarian cyst rupture or ovarian torsion, the following treatment may be warranted:

  • Rest
  • Pain medication
  • Surgery. If surgery is necessary during pregnancy, your doctor will make every effort to perform the surgery laparoscopically (through tiny incisions). If the cyst is large, surgery using laparoscopes may not be possible, and regular abdominal surgery may be necessary.

Pregnancy with Ovarian Cysts

Having a cyst on an ovary does not usually affect one’s chances of becoming pregnant, which is why doctors will typically only investigate further if a couple has been trying to conceive naturally through regular intercourse for a year, but have not yet been successful in falling pregnant.
There are several things you can do to maximize your chances of becoming pregnant naturally:

  • Ensure you follow a healthy, well-balanced diet
  • Carry out regular exercise – 3-5 times per week for 30 minutes
  • Stop smoking and cut down alcohol intake
  • Get at least 7 hours’ uninterrupted sleep per night
  • Take folic acid supplements daily

That’s all about how to conceive with ovarian cyst.

Laparoscopy for infertility is a minimal invasive surgical technique that utilizes a laparoscope (a fiber-optic tube with light and camera) inserted through at least two minor cuts, frequently in the belly button. The specialist can then visually analyze the pelvic reproductive organs and the pelvic cavity.

Laparoscopy Procedure

The technique might be performed under general anesthesia or local anesthetic and generally takes 30 to 45 minutes. The abdomen is inflated with gas (carbon dioxide or nitrous oxide injected with a needle) to move the organs from the stomach wall so they are visible during the technique.

When the abdomen is expanded, the laparoscope is inserted through the small cuts. The specialist sees the interior of the pelvic cavity on a video screen transmitting the pictures from the camera.

The specialist will search for potential causes for infertility. These could be:

  • Anomalies of the uterus and ovaries
  • Obstructed fallopian tubes
  • Scar tissue
  • Fibroid tumors
  • Endometriosis (which can be confirmed only by means of laparoscopy)

When Laparoscopy is Used?

Possible reasons your doctor may recommend diagnostic laparoscopy include:

  • You experience pain during sexual intercourse
  • You have severe menstrual cramps or pelvic pain at other times in your cycle
  • Moderate to severe endometriosis is suspected
  • Pelvic inflammatory disease or severe pelvic adhesions are suspected
  • Your doctor suspects an ectopic pregnancy (which can be life-threatening if left untreated)

Recovery time of Laparoscopy for Infertility

Post your medical procedure; you may get discharged the same day if there are no complications. Your primary care physician will recommend rest for a few days. However, you may take a long time to recover totally. You will be given different medications for a quick recovery, which may include antibiotics and painkillers.

Risk involved in Laparoscopy

Like any medical procedure, laparoscopy for fertility has expected risks. Just 1-2 percent of patients who go through laparoscopy for diagnosing or treating fertility experience a complication, including sedation related issues. Minor difficulties include disease and skin aggravation at the incision site.

More extreme complications may include:

  • Formation of adhesions and hematomas (swelling due to blood outside a vessel)
  • Allergic reaction
  • Nerve damage
  • Blood clots.

Future Fertility

  • After laparoscopy procedure, your doctor will clarify what your options are for getting pregnant. If you had fibroids eliminated or a fallopian tube fixed, you might have the option to attempt to get pregnant without assistance.
  • In case of endometriosis or PID, the removal of scar tissue may make it conceivable to get pregnant without any additional treatment.

Hysteroscopy Procedure

Hysteroscopy in Infertility – Hysteroscopy is a minimally invasive technique used for the diagnosis and treatment of uterus health conditions. During the technique, the doctor inserts a hysteroscope (a lighted, telescope-like instrument with a camera toward one side) through the vagina to analyze the cervix and uterine cavity. Small instruments can be passed through the hysteroscope to perform biopsies or eliminate irregularities from the uterus that are identified.

A hysteroscopy doesn’t need a cut or incision. An indicative hysteroscopy can take as less as 30 minutes, however in the event that the doctor needs to perform a procedure, for instance eliminating a fibroid, the hysteroscopy may take longer. Diagnostic hysteroscopy can frequently be performed in a medical office, yet more complex procedures are best performed in a clinically equipped facility.

Hysteroscopy Recommendations

Hysteroscopy is valuable in diagnosing and treating conditions that can cause infertility. These conditions may include uterine fibroids, polyps, scarring and birth defects in the structure of the uterus, for example, an uterine septum. Hysteroscopy is likewise used to:

  • Discover the cause of abnormal uterine bleeding
  • Diagnose possible causes of recurrent miscarriage (two or more miscarriages in a row)
  • Remove scarring due to infection or a previous surgery
  • Find and remove an intrauterine device (IUD) that has become misplaced
  • Perform endometrial ablation to destroy the uterine lining
  • Sterilize a woman by placing implants in her fallopian tubes.

Types of Hysteroscopy

Diagnostic Hysteroscopy

Diagnostic hysteroscopy permits the doctor to check the size, shape and lining of a woman’s uterus to diagnose any abnormalities that might be affecting fertility or causing other gynecologic problems.

Operative Hysteroscopy

Operative hysteroscopy might be performed to treat an abnormal condition diagnosed during diagnostic hysteroscopy. Small instruments can be passed through the hysteroscope to treat problems, for example, endometriosis, uterine polyps, and fibroids, or adhesions.

Hysteroscopy Complications

Just like any medical procedure, you could have some complications from a hysteroscopy, including:

  • Problems from the anesthesia
  • Infection
  • Tearing or damage to your cervix, though this is rare
  • Problems with gas or fluid from the uterus
  • Damage to nearby organs like the bladder, bowel, or ovaries
  • Pelvic inflammatory disease

If you experience symptoms like a fever, severe abdominal pain, or heavy bleeding after the procedure, call your doctor immediately or go to the emergency room.

Embryo freezing is a process that permits individuals to store embryos for sometime in the future. An individual can also freeze eggs, which are not fertilized. An embryo is developed after fertilization and the cells begin to divide. Physicians can freeze and store unused embryos (fertilized eggs) created during IVF, which may include intracytoplasmic sperm injection (ICSI), using a process called cryopreservation.

Need for Embryo Freezing

  • There are numerous reasons a man and woman may decide to freeze and store their embryos:
  • They may feel it is a superior choice than having the additional embryos destroyed.
  • It can give one more opportunity to get pregnant if the IVF cycle fails the first time. The couple won’t need to do IVF once more.
  • On the off chance that the man and lady have an infant, they can utilize the embryo later to have a subsequent child.
  • The woman can preserve embryos before she starts therapies, for example, for cancer, which may diminish or eliminate her odds of getting pregnant.
  • The embryo could be preserved and given to another person in a donor program.
  • The embryo could be preserved and given for research.

Embryo Freezing Techniques

Vitrification

Fast cooling convention (vitrification) includes media containing a higher concentration of cryoprotectants and has a moderately lot more limited freezing time. The fundamental concern when freezing an embryo is the development of ice between the cells. This can be effectively avoided by a profoundly skilled embryologist.

Slow cooling

Slow cooling includes seeding where the cryopreservation straw is physically moved by cold forceps dipped in liquid nitrogen further away from the embryo to start ice development which spreads to the rest of the solution containing the embryos. This prevents harm to the embryos. Most centers today apply vitrification for freezing embryos.

Thawing

During this method, the frozen sperm/oocytes/embryos are thawed (de-frozen) to room temperature, noticed for further development, and afterward moved into the patient’s uterus after stimulating endometrial development. At the time of embryo substitution, the straws are taken out from the liquid nitrogen and set in a water shower at room temperature before re-hydrating with unique media. Toward the finish of re-hydration, the embryos are cultured in media inside the carbon dioxide incubators and permitted to grow further either to day 2 or blastocyst prior to transfer.

Risks Involved in Embryo Freezing

Research shows that the freezing and thawing of embryos does not harm subsequent babies made through IVF. The length of time the embryo was stored does not affect IVF success rates.

With improving technology, the difference in pregnancy rates between the frozen embryos and fresh is negligible. In addition, the stimulation process with frozen embryo transfer is gentler, with hormone levels closer to normal in the woman, which may also improve pregnancy rates.

Any ice crystals formed during the slow freeze process may cause damage to an embryo while thawing. This is one of the reasons vitrification is the preferred cryopreservation technique. Research shows that there is no increase in the risk of birth defects among children born from frozen embryos compared with normal births.

Endometriosis is a condition wherein tissue like the uterine lining (endometrium) grows somewhere else in the body. Pelvic pain is the most common indication of endometriosis, yet a few women with the condition may likewise encounter infertility.

Endometriosis may develop outside of your uterus, ovaries, and tubes and even on your bladder or digestion tracts. This tissue can irritate structures that it contacts, causing pain and adhesions (scar tissue) on these organs.

Symptoms of Endometriosis

Symptoms can vary with some women not having any at all, and others having very severe pain. The most common symptoms are:

  • Painful, heavy or irregular periods
  • Pain in the lower abdomen, pelvis or lower back around ovulation time, but also throughout the cycle
  • Ongoing pelvic pain lasting six months or longer
  • Pain during or after sex
  • Difficulty getting pregnant
  • Painful bowel movements and emptying of bladder

Impact of Endometriosis on Fertility

On the off chance that you have endometriosis, it might be more difficult for you to get pregnant. Up to 30% to 50 % of females with endometriosis may encounter infertility. Endometriosis can impact fertility in different ways: distorted anatomy of the pelvis, adhesions, scarred fallopian tubes, inflammation of the pelvic structures, altered immune system functioning, changes in the hormonal environment of the eggs, impaired implantation of a pregnancy, and altered egg quality.

At the point when endometrial tissue wraps over your ovaries, it can block your eggs from releasing. The tissue can obstruct sperm from making its way up your fallopian tubes. It can likewise prevent a fertilized egg from sliding down your tubes to your uterus.

Treatment of Endometriosis Related Infertility

In case of difficulty getting pregnant with endometriosis you may wish to consult a fertility specialist. Treatment options for endometriosis related infertility include:

  • Freezing eggs: Endometriosis can influence your ovarian reserve, so a few specialists may suggest protecting your eggs at present on the off chance that you wish to get pregnant later. This choice can be expensive, and isn’t typically covered by insurance.
  • Superovulation and intrauterine insemination (SO-IUI): This is a possibility for women who have normal fallopian tubes, mild endometriosis, and whose partner has good quality sperm.
  • A specialist will prescribe fertility medicines, like, Clomiphene. These medicines help to produce a few mature eggs. A specialist may likewise prescribe a progestin injection.
  • A woman will routinely go through ultrasounds to guarantee the eggs are at their most matured state. At the point when the eggs are ready, a specialist will embed a partner’s collected sperm.
  • In vitro preparation (IVF): This treatment includes extracting an egg from you and sperm from your partner. The egg is then fertilized externally and embedded into the uterus.

The success rates of IVF are 50 percent for women who don’t have endometriosis. But many women with endometriosis have successfully gotten pregnant thanks to IVF treatments. IVF is often recommended for women with moderate to severe endometriosis, or for women whose bodies haven’t responded to other treatments.

Egg banking, also known as oocyte cryopreservation, is a moderately new strategy for fertility protection where a developed, unfertilized egg is retrieved from a female, frozen and stored for later use.

Egg banking includes a female deciding to have eggs retrieved from her ovaries, frozen to preserve their viability and put away until she is ready to utilize them in a future in vitro fertilization (IVF) treatment to achieve pregnancy.

Egg freezing and egg banking can be utilized to preserve fertility in patients having aggressive medical treatments, for example, chemotherapy, or in patients who wish to protect their fertility presently to begin a family later.

Egg freezing process in conjunction with IVF

Egg freezing is achieved through a new IVF cycle, avoiding egg treatment in vitro.

  • Stimulation of a woman’s ovaries utilizing fertility medications to produce a few egg follicles during one new IVF cycle
  • Harvesting eggs from the woman’s ovaries through surgical retrieval
  • Preparing and freezing of the eggs for preservation through a cycle known as vitrification
  • The fast-freezing technique of vitrification makes it possible to freeze eggs rapidly so that ice crystals don’t form between cells

Egg banking in cancer treatment

Egg banking increases opportunities for women going through cancer treatment who preserve their fertility. In the event that they have a partner, they could go through a stimulation and retrieval cycle, developing embryos, and freeze them for some time in the future. They could do likewise without an available partner, in the event that they willing to utilize donor sperm to develop embryos. This would ensure them hereditary offspring, yet with a missing sperm donor father. In the event that they come up short on a partner and ability to utilize a sperm donor, egg freezing would empower as it both secures their fertility and gives them a decision over the genetic father of their post-treatment children. A comparable need may emerge with women with hereditary illnesses or different conditions, for example, premature ovarian failure, who had not yet found a spouse yet needed to ensure they have healthy eggs at a later point in their life for reproduction.

Advantages of egg banking

  • Egg banking permits patients to extend their fertility. Thawed eggs hold their capacity to get fertilized from the time of freezing, giving the patient peace of mind by knowing pregnancy might be conceivable later on.
  • For women who need to through fertility damaging treatments, for example, chemotherapy, egg freezing may permit them to preserve their fertility and start a family after treatment.
  • Egg freezing can likewise assist women with premature fertility loss, for example, reduced ovarian reserve, by banking healthy eggs at an early age when they are likely to be viable for sometime in the future. In these cases, the woman’s doctor will suggest egg freezing and banking.
  • A few women decide to freeze and bank their eggs for social reasons, for example, waiting for the right partner or not wanting to take a leave from work. The frozen eggs can be thawed, fertilized and embedded for pregnancy sometime in the not too distant future.

Risks of egg banking

Egg freezing carries several risks to the woman or couple, including:

  • Ovarian hyperstimulation syndrome (OHSS).
  • Surgical complications.
  • Emotional effects.

Pregnancy with Small Uterus – Most females don’t realize that they have a little uterus until the time they get pregnant. At the point when a female presumes that she is pregnant and goes to a specialist, a gynecological test or the ultrasound may bring this information on (having a small uterus) and can be a reason for colossal concern. On occasion, the specialist’s language may likewise impart fear. In any case, it is consistently essential to get to the bottom of it and comprehend the medical issue appropriately.

What Causes Formation of Small Uterus?

In certain females, the uterus can be bigger than the normal or considerably smaller. However, it should work fine. A female’s general body additionally plays a significant overseeing factor for the uterus size. Hence, females who are mysteriously thin or have a small body face have higher odds of having a small uterus.

Small uterus can either be formed during the developing years of a girl, caused by a medical procedure or therapy, or can be a congenital condition. This frequently causes infertility or obstetric issues in the life of a female. This incorporates failure to conceive, issues in delivering a healthy child, unpredictable periods, or no periods at all.

Pregnancy with Small Uterus

On the off chance that you become pregnant with a small uterus and this is entirely conceivable either normally or with regenerative help, your doctor may recommend more frequent visits and ultrasounds to screen the infant’s development.

Your doctor may likewise need you to have a cervical cerclage or arrangement of a cervical ring or pessary if you have cervical shortening. This may assist with diminishing the risk for premature delivery.

Your doctor may likewise recommend certain medications known as tocolytics, to decrease the probability that preterm delivery will happen. Tocolytics loosen up the uterus and decrease preterm labor contractions.

One of the vital elements to be considered to effectively conceive with a small uterus is the epithelium. Increased blood flow can help with its development. doctor may sometimes prescribe a pregnant woman to go for hormonal therapy to increase the chance of conception.

Any sort of hormone treatment affects the outside genitalia. Hormone treatment might be proposed to women who experience the ill effects of a condition where the uterus, as well as the genitals, are immature, causing an imbalance of different hormone levels inside the body. Named as hypoplasia, it could likewise demonstrate the presence of different diseases also. Undertaking hormonal treatment in such a case could, indeed, makes the situation worse.

Small Uterus Diagnosed During Pregnancy

Defining the uterus as “small” is not enough for doctors to make a proper decision. Further diagnosis is necessary to determine the actual condition. It could be hypoplasia, where the uterus is small due to hormonal issues. Aplasia could be a cause as well, where the uterus is the same as that of a newborn child or even absent. Another condition could be infantilism, where the uterus is not larger than 55mm. Any kind of treatment method to increase the size of the uterus takes a good amount of time. Using hormonal medication is a common method for women diagnosed with hypoplasia. In certain cases, being involved in sexual activity regularly can be beneficial as well, and could cause the uterus to increase in size gradually.

Dietary Changes

At times, proper intake of nutrients and minerals could make conception possible. On the off chance that you are pregnant and have a little uterus, you can choose a vitamin treatment. It utilizes certain liquid preparations which, when used every day, can be very valuable.

IVF is the process of fertilization by extracting eggs, recovering a sperm sample, and afterward physically joining an egg and sperm in a laboratory. The embryo(s) is then moved to the uterus. As indicated by the Society of Assisted Reproductive Technologies (SART), the success rate of giving birth to a live child after IVF is as per the following:

  • 47.8%for females under age 35
  • 38.4% for females age 35 to 37
  • 26% for females ages 38 to 40
  • 13.5% for females age 41 to 42

How are IVF Success Rates Determined and Reported?

Live Birth Rate: Live birth rate is the number of infants born divided by the number of cycles started to accomplish the birth. Remember that this information is generally dated, and patients should remember that doctors are continually refining and improving IVF.

Implantation and Pregnancy Rates: It permits a person to see the number of patients got a positive pregnancy test, the number of clinical pregnancies (checked by ultrasound), as well as the number of miscarriages.

Cycle characteristics: Cycle characteristics include average (mean) number of embryos transferred and the percentage of patients deciding on elective single embryo transfer (eSET).

Factors Affecting IVF Success Rate

Common factors that determine the success of IVF includes the following:

Age

Women age and utilization of own eggs are significant IVF success factors to consider. While young females have higher odds of IVF success, factors that decrease the odds of IVF success incorporate being a older woman with less eggs and the lower quality of a older woman eggs. The live birth IVF success rate for women under 35 who start an IVF cycle is 40%. However, women over age 42 have a 4 percent achievement rate.

Previous Pregnancy

More IVF success factors to consider incorporate whether you were pregnant already and in the event that it was with the same partner. In the event that you were pregnant beforehand with the same partner that is as of now going through IVF treatment, there is a more prominent chance of IVF success. Factors, for example, a background marked recurrent miscarriages or a different partner may decrease the odds of IVF success.

Type of Fertility Problems

While some male infertility issues do affect IVF success, factors like uterine irregularities, exposure to DES or fibroid tumors likewise declines the probability of success with IVF.

Important to know: IVF success factors are reliant on ovulation. Ovarian dysfunction, similar to high FSH levels which demonstrate a low ovarian reserve, may diminish the chance of IVF success. Variables that may bring down pregnancy rates and decrease success with IVF include requiring a lot of ovulation stimulation drugs.

Whenever the two partners are infertile with lower chances for IVF success, factors, for example, the time you have been infertile is imperative to consider. The chances of IVF success decline with the amount of time a couple has been infertile.

Use of Donor Eggs

Donor eggs are a critical consideration, particularly if the women are more than 35-40, as there might be a higher rate of IVF success. Factors, for example, egg quality and age of donor are significant. Utilizing donor eggs from young women may build the chances of pregnancy for women more than 40. 2011 discoveries show a 55 percent live birth achievement rate with a new donor egg/embryo transfer.

Lifestyles Habits

  • Quit smoking to improve your chance of getting pregnant. Usually the woman is needed to quit smoking in any event 3 months prior to beginning IVF treatment.
  • Smokers require higher amounts of fertility medications to stimulate their ovaries
  • Smokers have lower implantation rates than nonsmokers
  • Women who smoke require twice the same number of IVF attempts
  • Women who smoke experience more failed fertilisation cycles

Fertility Clinic

The fertility clinic you decide for the IVF treatment can enormously influence your IVF success. Variables to consider while assessing the success rate of the clinic include:

  • The training and experience of the IVF facility and staff
  • The live birth rate per IVF cycles began
  • The rate of patients pregnant with multiples (twins, trios or more)
  • The lab utilized by the center and the capabilities of their staff
  • The type of patients acknowledged at the center, all the more explicitly their age and fertility issue.

In Vitro Fertilization (IVF) is a cycle through which an egg is fertilized by a sperm outside of the female’s body. After certain days (2-6) of development, the egg is embedded in the female’s uterus. IVF can be utilized in various cases, for example, infertility, gestational surrogacy, or after menopause.

Despite the fact that menopause is an obstruction for further conception, IVF has allowed females to have a baby at 50 years of age. IVF likewise gives females with beginning early menopausal a possibility. Females, whose uteruses have been appropriated prepared, can get embryos that are developed from an egg of an egg donor. Even after the menopause initiates, the uterus is very fit for carrying an effective pregnancy.

Pregnancy After Menopause Using IVF

In females who are of childbearing age, there are five stages to IVF: stimulation, egg retrieval, insemination and fertilization, embryo culture, and embryo transfer. However, on the grounds that females who have just experienced menopause are not delivering eggs, they don’t have to experience the initial two stages, and will rather need to utilize eggs from an egg donor.

Getting pregnant through IVF, similar to all pregnancies, accompanies risks. Yet, in case you’re generally healthy, an IVF-instigated pregnancy after menopause won’t really carry any new complications.

The complications are the regular risks related with pregnancy, like high blood pressure, preeclampsia, infections, preterm labor and a few women who attempt IVF after menopause don’t need to stress over specific age-related pregnancy inconveniences. Since an egg from a young woman is used, there’s no expanded danger of chromosomal anomalies.

Egg Donation for IVF in Menopause

Donor egg and embryo transfer gives the most reasonable conceptive choice for older women who are either perimenopausal or menopausal, and remains the best treatment of choice for patients of cutting edge reproductive age.

Oocyte donation from young donor reduces the issues of decreased ovarian reserve and expanded aneuploidy risk that goes with propelling age, and results in altogether higher pregnancy rates than standard IVF regimens.

Females more than 45 years old, even as old as 55, may accomplish pregnancy rates comparable to young females utilizing their own eggs. Recipient age doesn’t negatively influence cycle result when donor oocytes are utilized, with fertilisation rates, embryo implantation rates and continuous pregnancy rates like that in younger females.

Potential Risks of Pregnancy with IVF After Menopause

Although conceivable, pregnancy during perimenopause or post-menopause represents some health risks. Much the same as pregnancy for women after age 35, these risks include:

  • Multiple pregnancies that may result in early birth, low birth weight, and troublesome delivery
  • Gestational diabetes, risking more medical conditions for both mother and infant
  • High blood pressure, that needs cautious observing and medication
  • Placenta previa, that may require bed rest, medicines, or cesarean delivery
  • Miscarriage or stillbirth
  • Cesarean birth
  • Premature or low birth weight
  • Chromosomal abnormalities seen all the more regularly among kids born to older mothers.

As a woman ages, previous ailments can increase health risks for pregnancy and delivery. So prior to thinking of getting pregnant after menopause, consult a doctor who can assess your general health for IVF after menopause.

IUI Treatment – Intrauterine insemination (IUI), a sort of manual semen injection is a method for treating infertility. Sperm that have been washed and concentrated are placed in your uterus directly around the time your ovary discharges at least one egg to be fertilized.

The hope for result of intrauterine insemination is for the sperm to swim into the fallopian tube and fertilize the egg, resulting in conception. Depending upon the type of infertility, IUI can be facilitated with your typical cycle or with fertility medications.

Use of IUI

IUI is utilized to treat numerous kinds of infertility and is regularly done in various cycles until pregnancy is accomplished or another treatment is attempted.

Cycles of IUI may be recommended to treat any of the following infertility situations:

  • Hostile cervical mucus
  • If a sperm donor is being used
  • If sexual pain makes intercourse not possible
  • If treatment with fertility drugs alone is not successful
  • Male infertility
  • Unexplained infertility

IUI is not recommended for those with:

  • Blocked fallopian tubes
  • Previous pelvic infection
  • Severe endometriosis

Procedure

Insemination is performed at the time of ovulation, usually within 24-36 hours after the LH surge is identified, or after the “trigger” injection of hCG is administered. Ovulation is anticipated by a urine test kit or blood test and ultrasound.

In the case of husband insemination, the male produces a sperm sample, at home or at the facility. The sperm is then prepared for IUI. Sperm from the male partner or donor are washed or separated.

Partition selects out motile sperm from the man’s discharge and concentrates them into a small volume. Sperm washing purifies the sperm of any poisonous synthetic compounds which may cause adverse responses in the uterus. The doctor utilizes a delicate catheter that is passed through a speculum directly into the woman’s uterus to deposit the semen at the time of ovulation.

Risk Associated with IUI

There is a small risk of infection following the IUI procedure. Your doctor will use sterile instruments, so infection is very rare.

If medications are used to induce ovulation, there is a risk of pregnancy with multiple babies. Since fertility medications increase the likelihood that more than one egg will be released, they also increase the likelihood of pregnancy with multiples.

Sometimes the ovaries over-respond to fertility medications (particularly the medications given as injections) and a condition called ovarian hyperstimulation syndrome may result.

IUI Outcome

Each couple will have an different response to IUI, and it very well may be hard to anticipate its success. Various factors influence the result, including:

  • Age
  • Underlying infertility diagnosis
  • Whether fertility drugs are used
  • Other underlying fertility concerns

Pregnancy rates following IUI are differed dependent on your need behind requiring fertility treatment. Success rates for IUI will in general diminish in women beyond 40 years old, and in women who have not gotten pregnant after three cycles of IUI.

Fallopian tube blockage – Fallopian tubes are female reproductive organs that join the ovaries and the uterus. Consistently during ovulation, which happens generally in the middle of a monthly cycle, the fallopian tubes deliver an egg from an ovary to the uterus.

Conception likewise occurs in the fallopian tube. In the event that an egg is fertilized by sperm, it travels through the tube to the uterus for implantation.

In the event that a fallopian tube is blocked, the entry for sperm to get to the eggs, as well as the way back to the uterus for the fertilized egg is obstructed. Common caused behind blocked fallopian tubes include scar tissue, infections, and pelvic adhesions.

Symptoms of Fallopian Tubes Blockage

Most women with tubal blockage are asymptomatic. Frequently they don’t understand their fallopian tubes are obstructed until they consult a doctor for infertility, however women with broad tubal damage may encounter chronic pelvic pain.

Effect on Fertility

Blocked fallopian tubes are a typical reason for infertility. Sperm and egg meet in the fallopian tube for fertilization. An obstructed tube can keep them from joining.

If both tubes are completely blocked, pregnancy without treatment will not be possible. In the event that the fallopian tubes are partially blocked, you can conceivably get pregnant. However, the risk of an ectopic pregnancy is enhanced in that case.

Causes of Fallopian Tube Blockage

The most widely recognized reason for blocked fallopian tubes is Pelvic inflammatory disease (PID). PID is the result of sexually transmitted disease, although not all pelvic diseases are related to STDs. Additionally, regardless of whether PID is not, a history of PID or pelvic disease expands the risks of blocked tubes.

Other expected reasons for blocked fallopian tubes include:

  • Current or history of an STD infection, specifically Chlamydia or gonorrhea
  • History of uterine infection caused by an abortion or miscarriage
  • History of a ruptured appendix
  • History of abdominal surgery
  • Previous ectopic pregnancy
  • Prior surgery involving the fallopian tubes, including tubal ligation
  • Endometriosis

Diagnosis

There are three key diagnostic tests for blocked fallopian tubes:

  • An X-ray test, known as a hysterosalpingogram or HSG: A trained health professional injects a harmless dye into the womb, which should stream into the fallopian tubes. The stain is noticeable on an X-ray. If the liquid doesn’t flow into the fallopian tubes, it may have a blockage.
  • An ultrasound test known as a sonohysterogram: This is fundamentally the same as the HSG test yet utilizes sound waves to develop an image of the fallopian tubes.
  • A keyhole medical procedure known as a laparoscopy: A surgeon makes a little cut in the body and embeds a small camera to take photos of the fallopian tubes from inside.

Treatment and Surgery

It may be possible to open blocked fallopian tubes surgically. However, this depends on the extent of the scarring and where the blockage is.

Surgery aims to open the fallopian tube using one of the following methods:

  • removing scar tissue
  • making a new opening on the outside of the fallopian tube
  • opening the fallopian tube from the inside

Most surgeons will carry out the procedure using keyhole surgery.

Age for IVF treatment – Infertility is a complicated issue that affects up to 15% of couples who are attempting to conceive. Depending on the individual circumstance, different infertility factors might be treated through in-vitro fertilization (IVF). IVF is usually effective, particularly for women under age 35 or for those who use donor eggs.

Infertility and Ageing

As indicated by the Society for Assisted Reproductive Technology, achievement rates for IVF decrease drastically after age 37, making age the main factor for women who want to pursue pregnancy utilizing their own eggs. After age 43, donated eggs from younger women are frequently needed for effective pregnancy.

As a woman ages, the excess eggs in her ovaries likewise age, making them less capable of fertilization and their embryos less fit for implants. Just 12 percent of the 300,000 eggs a female is born with remains at age 30, and just 9,000 eggs remain at age 40. Females who are perimenopausal ordinarily react ineffectively to ovarian stimulation medication and their live birth rates with IVF treatment are essentially lower than with younger females.

Effects of Age on Egg Quality and Quantity for IVF Treatment

  • IVF success rates utilizing their own eggs begin to drop at around 30 and drops quicker during the mid-30s and early 40s. This drop is due to diminishing egg quantity and quality.
  • Live births are uncommon at age 44 or more utilizing the female partner’s eggs. There is no drop in the progress rate with age when utilizing young donor eggs.
  • The age of the eggs is significant. The age of the recipient (uterine age) has almost no impact on progress rates when utilizing contributor eggs.
  • Most donors are in their 20’s – so the “egg age” is amazing with egg donation cycles.

IVF Success Rates According to Age

  • The success rate of IVF relies on the age of the woman going through treatment, as well as the reason for infertility (if it’s known).
  • Younger females are more likely to have a successful pregnancy. IVF isn’t typically suggested for females beyond 42 years of age as the odds of an effective pregnancy are believed to be excessively low.
  • Between 2014 and 2016 the level of IVF treatments that resulted in a live birth was:
    • 29% for women under 35
    • 23% for women of age 35 to 37
    • 15% for women of age 38 to 39
    • 9% for women of age 43 to 44
    • 2% for women of age more than 44
  • These figures are for females utilizing their own eggs and their partner’s sperm, utilizing the per embryo transferred measure.
  • Keeping up a healthy weight and avoiding alcohol, smoking and caffeine during treatment may improve your odds of having a child with IVF.

As we all know, there is no “guarantee” in medical procedures – every doctor can authenticate this fact. Thus, the only guarantees we can discuss in IVF are monetary and financial in nature, that is, a reimbursement guarantee in the event that the IVF program doesn’t end with the desired outcome.

Money back guarantee plans are advertised since insurance covers just 15% to 25% of IVF costs. IVF is a high technology clinical help with costs going from $6,000 to $12,000 (4 to 8 Lakhs INR). In spite of the fact that the IVF live-birth rate per egg recovery for young patients has doubled in the previous decade, to roughly 40%, numerous women don’t conceive on their first attempt, and it is difficult to guarantee any clinical result with the technology.

After three IVF cycles, including utilization of frozen embryos from those cycles, the probability of having a child increases to 60% to 90% in women younger than 40. On the off chance that IVF fails, in any case, a generous reimbursement may help a couple to adopt (which can cost $20,000 to $40,000), attempt different types of assisted reproduction, (for example, a gestational carrier, which expenses up to $60,000), or recover part of their original investment.

Financial Quarantee Calculation

The financial guarantee is really not determined on the measure of total money that is paid during the beginning of the treatment cycle. Rather, the sum is a variable percentage that is really a portion of the complete treatment cost acquired.

The age of the woman act as the principle determinant. The amount of money reimbursed and the age of the woman is inversely proportional to one another. The older the woman, lesser the reimbursement is given.

Types of IVF Refund and IVF Money Back Guarantee Programmes

IVF Refund and IVF Money Back Guarantee projects can be additionally grouped into:

  • Programmes which plan to accomplish a clinical pregnancy, typically characterized as arriving at the 6th, seventh or twelfth week stretch of pregnancy.
  • Programmes in which the principal objective is the live birth of a baby.
  • IVF refund programmes in which the patient doesn’t get a reimbursement if the treatment is successful.
  • IVF refund programmes in which the patient gets a partial reimbursement if the treatment is successful.
  • It is likewise significant that refund programmes for IVF are accessible both for treatment utilizing the patient’s own eggs, just as donor eggs1.

Advantages of Refund Guarantee in IVF

  • A full or partial refund in case of an unsuccessful IVF treatment, which can be put towards further treatments.
  • The clinic is motivated to achieve success as quickly as possible – after all, a money refund is on the line.
  • If you use all of the IVF cycles within the programme, the overall cost becomes cheaper than if you were receiving the same number of cycles outside the programme, oftentimes the “IVF guarantee” option turns out to be cheaper.
  • You can focus on your treatment instead of your finances because you’re covered by a programme and have more cycles available.
  • Every cycle assigned to your programme will be performed at the same clinic. Often patients switch clinics after a failed attempt. That’s not always the smartest choice, as sticking with one clinic allows staff to hold more of an insight into your medical history.
  • Financial planning of your treatment is easier since it’s easier to estimate the total cost of the programme.

Disadvantages of Refund Guarantee in IVF

  • If you achieve your desired result during the first cycle, you’ll end up paying more than you would when paying for a single cycle outside of any programme (that’s why we’re talking here about ‘IVF shared risk’ finance programmes).
  • Not every patient qualifies for an IVF Refund programme. When it comes to treatments using donor eggs, the qualifications for the patients are relatively lax. If you’re set on using your own eggs, it becomes much harder to qualify, as the financial risk for the clinic becomes higher.
  • Higher entry cost for such programmes.

What is an embryo transfer?

An embryo transfer is a part of IVF procedure in which a fertility specialist uses an ultrasound to guide a catheter containing the IVF-produced embryo(s) to transfer the embryo(s) directly into the uterus. The process of embryo transfer takes only a few minutes. The process does not involve anesthesia and only short recovery period is required. Prior to the transfer, embryos are graded and the type of grading depends on the stage of the embryo. For cleavage stage embryos, typically on day three, the number of cells and a grade (A – D) will be assigned. For blastocysts, there will be a number and two letters assigned. The number refers to the amount of expansion of the fluid (the “cyst”) in the blastocyst. The two letters (A – D) that follow refer to the inner cell mass (destined to become the baby) and the trophectoderm (destined to become the placenta), respectively. Cells from an embryo can also be tested for genetic anomalies prior to an embryo transfer. Scientists have a choice of two genetic tests for embryos. In preimplantation genetic diagnosis (PGD), an embryologist removes a group of cells to test for a specific genetic abnormality, such as cystic fibrosis. Preimplantation genetic screening (PGS) tests for the proper makeup in all chromosome pairs, as missing or additional chromosomes lead to disorders and diseases. An example of such a disorder is Down syndrome, in which there is an extra chromosome in pair number.

Types of Embryo Transfer

Blastocyst Transfer

A blastocyst transfer includes developing embryos in a laboratory for five days before transferring them into the uterus. When the embryo has reached the blastocyst stage (day five), it is more fully developed with multiple cells. At this point the embryo resembles the stage of a natural embryo when it enters a uterus for implantation, which increases the chances of attaining a successful pregnancy. However, it is not necessary that all embryos are able to develop to the blastocyst stage. Studies show that blastocyst transfers result in higher implantation and pregnancy rates as compared with cleavage stage embryos. Blastocyst transfers may be of particular benefit for patients who develop many good quality embryos, who have failed to achieve a pregnancy with a day three transfer in the past, or who have poor quality embryos at day three.

Cleavage Stage Embryo Transfer

A cleavage stage embryo transfer refers to embryos that are transferred at an earlier stage of development when they have fewer cells, typically six to eight, and occurs on day two or three after fertilization. Cleavage refers to the division of the cells in an early developing embryo. Cleavage stage embryo transfer is a good option for patients who have fewer good quality embryos. Also, transfer on day three is less risky than allowing the embryos to go to day five.

When Embryo Transfer is Needed

IVF and embryo transfer is required in cases where there is difficulty in natural conception or difficulty occurring. There are many reasons for embryo transfer, including:

  • Ovulation disorders: If ovulation is infrequent, fewer eggs are available for successful fertilization.
  • Damage to Fallopian tubes: The Fallopian tubes are the passageway through which the embryos travel to reach the uterus. If the tubes become damaged or scarred, it is difficult for fertilized eggs to safely reach the womb.
  • Endometriosis: When tissue from the uterus implants and grows outside of the uterus. This can affect how the female reproductive system works.
  • Premature ovarian failure: If the ovaries fail, they do not produce normal amounts of estrogen or release eggs regularly.
  • Uterine fibroids: Fibroids are small, benign tumors on the walls of the uterus. They can interfere with an egg’s ability to plant itself in the uterus, preventing pregnancy.
  • Genetic disorders: Some genetic disorders are known to prevent pregnancy from occurring.
  • Impaired sperm production: In men, low sperm production, poor movement of the sperm, damage to the testes, or semen abnormalities are all reasons natural fertilization may fail.

What to Expect before, During, and After an Embryo Transfer

Around 2 or 3 days before the embryo transfer, the doctor will choose the best eggs to transfer to the womb. There are many processes available to aid selection, though non-invasive methods such as metabolomic profiling are being tested. Metabolomic profiling is the process of selecting the most beneficial eggs based on a number of different factors. This could limit the need for invasive procedures in the future. These eggs will then be fertilized in a lab and left to culture for 1-2 days. If many good quality embryos develop, the ones that are not going to be transferred can be frozen.

After the Embryo Transfer

A follow-up appointment after 2 weeks to check if the embryo has implanted well and the transfer was successful. After the procedure of embryos transfer, women may experience some cramping, bloating, and vaginal discharge.

The IVF Treatment cost in India or anywhere else in the world generally depends on the infertility workup. Therefore, it may vary from person to person. If your friend or relative was lucky enough to have a baby by going through two IVF cycles, you may be fortunate by conceiving in one IVF cycle itself. Or perhaps a simple laparoscopy procedure might be enough to cure your infertility. The IVF cost in India or around the world is rising up as a more and more modern diagnostic test, and treatment methods are being used to aid and facilitate infertility treatments cost. Because of this, there is no upper limit to the amount of money one can invest in their quest for a child.

Cost of IVF in India

According to several online sources, the cost of IVF in India varies greatly by city. The most basic IVF package that does not include the technique like monitoring, medications, ICSI, FETs, genetic testing, or other add on services that are either necessary for all (like medications and monitoring) or some (like ICSI, FETs and genetic testing).

Base Cost of IVF of some Indian Cities
City Indian Rupee
Delhi 1,10,000 to 2,50,000
Kolkata 1,00,000 to 2,20,000
Banglore 1,40,000 to 2,50,000
Chennai 1,45,000 to 3,00,000
Nagpur 1,25,000 to 2,80,000
Pune 1,35,000 to 3,00,000
Hyderabad 1,60,000 to 2,80,000

Extra Costs which are not included in Clinic’s Quote

Similar to the other fertility based clinics in foreign countries, when quoting IVF costs to patients, clinics in India offer pricing for a very basic, no-frills IVF cycle that doesn’t include many things that may indeed be required in order to do the IVF treatment. Most basic IVF packages include egg retrieval, sperm preparation, conventional IVF fertilization, and one fresh IVF transfer. These services alone don’t support a viable IVF cycle for many patients. Fertility medications, monitoring, and retrieval anesthesia are necessary for most if not all patients, and there’s often an extra fee associated with each.

Component Required Indian Rupee
Monitoring Yes 20,000
Medications Yes 80,000
ICSI For Some 1,50,000
Assisted Hatching For Some 20,000
Cryopreservation For Some 30,000
FET For Some 80,000
Preimplantation Genetic Testing For Some 2,00,000

Cost to Travel

Most low-cost IVF programs require you be out of the country or away from your home and job for the entirety of the IVF treatment (estimated 3-7 weeks). So, there is the actual cost of travel (airplane), lodging, and meals, but also the added inconvenience of a longer stay, missed work, and safety during your stay. Some cities in India are not as safe as others, which should also be a consideration when choosing a destination for treatment. And since IVF isn’t always successful the first go around, it may take more than one trip abroad to bring home a baby. Depending on where you’re traveling from in the U.S. and to in India, travel costs can range quite a bit. Whether you’ll be staying in a hotel or renting another longer-term lodging also will affect the cost. Medical visas are only around $100 per person.

Factors influencing the cost of an IVF cycle are

  • Cost of Laboratory Investigations
  • Cost of Ultrasounds
  • Cost of IVF Medications
  • Cost of Anesthesia
  • Cost of Embryo Freezing
  • Cost of OT Charges

What is male infertility?

Male infertility means a man not being able to become a father. Also, infertility is the inability of a sexually active without using any contraceptive methods to achieve pregnancy in one year. Male infertility is often referred to when the cause of the fertility problem is found in the man. In most cases, the causes of male infertility are either the semen is unable to reach the egg, this is known as obstructive or the semen is of poor quality, this is known as non-obstructive. In approximately 30-40% of patients, no male factor is found (idiopathic/unexplainable male infertility). It is estimated that male infertility is found in approximately half of all infertile couples.

Symptoms of Male Infertility

Infertility as such doesn’t cause any particular type of symptoms in men. But in case if the infertility is caused by any medical or surgical condition or may be due to low hormone levels, the patient may have certain symptoms. The symptoms will depend on the cause of infertility. A condition that affects your testicles may cause:

  • Swelling and pain in the testicles
  • Prominent veins in the testicles

Any disorder or problem in the prostate gland or epididymis (the tube that carries sperm from the testicles), may cause:

  • Blood in the semen
  • Pain when ejaculating
  • Trouble ejaculating during the sex

Causes of Male Infertility

Sperm Disorders

The most common reason for male infertility is a problem with sperm. It may be that:

  • Not enough sperm in the semen
  • Sperm don’t move as fast as they need to
  • Sperm is in the wrong shape

Patients may have all these three problems at the same time. In some men, there are no or nil sperm in their semen. This condition is commonly known as obstructive azoospermia. In this condition, the tubes that carry sperm from your testicles to your penis (seminal ducts) are blocked. You may be born with this or you may develop it after an infection, bladder neck surgery, or may be due to scarring after an inguinal hernia repair.

Hypogonadism

If a man has the disease condition of hypogonadism, he may not able to produce any hormone such as testosterone. This may result in low sperm count, or the person can’t get an erection and have low sex drive (libido).

Ejaculation disorders

There are many problems that can affect how you ejaculate (release semen during sex).

  • Erectile dysfunction – you can’t keep an erection for long enough to have sex.
  • Retrograde ejaculation – your semen is ejaculated backwards into your bladder rather than out of your body when you orgasm.
  • Delayed ejaculation: this means you are not able to ejaculate inside your partner’s vagina. This may be a psychological problem.
  • Anorgasmia – you don’t reach an orgasm and ejaculate. This may be because you don’t have enough feeling in your penis (sometimes caused by nerve damage).

How can I Boost my Fertility?

Timing

Having sex every two to three days will maximize the chance of pregnancy by making sure you’re having sex during your partner’s most fertile time of the month.

Lifestyle Modification
  • Make some changes to your lifestyle.
  • Stop smoking and don’t regularly drink more than 14 units of alcohol a week. Some illegal drugs can also affect fertility.
  • Lose excess weight, because being overweight can affect fertility.
Avoid heat

If your scrotum (which contains your testicles) is too warm, this may reduce sperm quality. Loose-fitting underwear may help to lower scrotal temperature.

Avoid work hazards

Some jobs involve working with hazards that can affect your fertility. These include heat, metals, pesticides and X-rays.

Reduce stress

Having trouble conceiving can be stressful. This may affect your sex drive or your relationship, meaning you have sex less frequently.

Treatment for male infertility

Medicines

If you have low testosterone levels (hypogonadism), your doctor may suggest gonadotrophin injections to improve your fertility. These trigger your body to make testosterone and produce sperm. If you have retrograde ejaculation, sperm are ejaculated backward into your bladder instead of through your urethra and out of your body. Your doctor may prescribe medicines such as pseudoephedrine to help close the opening to your bladder. Medicines such as sildenafil (Viagra), tadalafil (Cialis) may be helpful if you have trouble getting an erection.

Surgery

Having no sperm in your semen is often caused by a blockage in the tubes that take sperm from your testicles to your penis. Surgery may be possible, to remove the blockage and improve your fertility.

Dietary Modification

Eat plenty of foods rich in vitamin C and other antioxidants: These nutrients help prevent sperm defects and boost motility.

Include Zinc in your food:  Deficiency of Zinc may lead to clumping of zinc which may lead to infertility. So take enough amount of zinc in the diet.

Incorporate Folic acid: Folic acid is critical for male fertility. Try to take at least 400 micrograms of Folic acid daily to produce healthy sperm.

Limit alcohol intake: wine, beer, and hard liquor may reduce sperm count and abnormally shaped sperm. Try to cut down the daily intake to increase the chance of conceiving.

Reason for IVF Failure – In vitro fertilization (IVF) is a perplexing arrangement of techniques used to help with fertility or prevent hereditary issues and help with conception.

During IVF, developed eggs are gathered (recovered) from ovaries and fertilized by sperm in a lab. At that point, the prepared egg (embryo) or eggs (embryos) are moved to a uterus. One full pattern of IVF takes around three weeks. Once in a while, these means are part of various parts and the cycle can take longer.

IVF treatment doesn’t generally work effectively. More youthful ladies have a higher possibility of IVF achievement, with the achievement rate for ladies under 35 at 40%. IVF can fall flat for some reasons, and the odds are that it is totally out of your control.

Egg abnormalities

The human egg is liable to get harmed that can deliver it nonfunctional. The oocyte is liable to harm because of the presence of free radicals, reactive oxygen species and different results of digestion that happen inside the ovary as a female ages. Numerous ongoing examinations have exhibited that somewhere in the range of 25% and 40% of all oocytes are chromosomally anomalous. This number clearly increments as female ages.

Embryo selection methods

Embryologists select embryos to transfer dependent on three essential standards: cell stage, embryo grade and the pace of cell division. We know from studies performed that on day three, embryos that have developed  to at least the 6 cell stage have a greatly improved visualization for progress than embryos that have 5 or less cells.

Ovarian Response

At times female ovaries don’t react to the fertility drugs emphatically enough to develop numerous eggs. Particularly if a female is more than 37 or has higher FSH levels she may not deliver enough eggs to bring about various embryos for screening and possible implantation. Odds are higher that IVF will bomb when this occurs. Your conceptive endocrinologist will assess what occurred and may make changes to your fertility drugs for the following IVF cycle.

Lifestyle Factors

Numerous fertility centers expect women to quit smoking in any event three months prior to beginning IVF treatment. Women who smoke need twice the same number of IVF cycles to consider and are substantially more liable to lose than women who don’t smoke. Women who are overweight or underweight are less inclined to have successful IVF treatment. The primary concern is, keep up a healthy weight. On the off chance that you are overweight, losing as little as 10% of your body weight can have a beneficial outcome in your capacity to get pregnant4.

Nature of Sperm

The sperm plays a significant fertilisation of the female egg and to do as such, they should be healthy, motile, and adequate in amount.

The eggs and sperm both have explicit receptors on their surface that take into consideration their association. During this contact, compounds delivered from the sperm head make an opening in the external films of the egg, permitting it to enter through.

However chromosomal elements, sperm are typically not among the explanations behind failure of IVF in light of the fact that any quantitative or subjective issues with the sperm are handily distinguished during semen investigation and the patients are then given the choice of intracytoplasmic sperm infusion (ICSI) or IVF with contributor sperm.

Fertilization Failure

A more uncommon reason for IVF failure, this circumstance happens when the sperm neglects to enter and prepare the egg.

How Ovation Fertility Mitigates IVF Failure

Understanding what causes IVF failure is the initial move toward preventing it. The following and apparently most significant advance is realizing how to dodge it with individualized conventions, including pre-implantation genetic testing, or PGT.

Fibroids are noncancerous developments of the uterus that frequently show up during childbearing years. Additionally called leiomyomas or myomas, uterine fibroids aren’t related with an expanded danger of uterine disease and never form into malignant growth.

Fibroids range in size from seedlings, imperceptible by the natural eye, to cumbersome masses that can contort and grow the uterus. You can have a solitary fibroid or various ones. In outrageous cases, numerous fibroids can grow the uterus so much that it arrives at the rib confine and can add weight.

Fibroid Symptoms

Numerous women are ignorant they have fibroids since they don’t have any symptoms.

Women who do have symptoms (around 1 of every 3) may insight:

  • Heavy periods or difficult periods
  • Stomach pain
  • Lower back pain
  • A regular need to urinate
  • Constipation
  • Pain or uneasiness during intercourse
  • In uncommon cases, further inconveniences brought about by fibroids can influence pregnancy or cause infertility.

Finding of Fibroids

There are a few tests that make possible to confirm fibroids and decide their size and area. These tests can include:

  • Ultrasonography: This non-invasive imaging test makes an image of your inward organs with sound waves. Contingent upon the size of the uterus, the ultrasound might be performed by the transvaginal or trans-abdominal route.
  • Magnetic resonance imaging (MRI): This test makes point by point pictures of your interior organs by utilizing magnets and radio waves.
  • Computed tomography (CT): A CT check utilizes X-beam pictures to a detailed images of your internal organs from various angles.
  • Hysteroscopy: During a hysteroscopy, your provider will use a device called a scope (a thin, flexible tube with a camera on the end) to look at fibroids inside your uterus. The scope is passed through your vagina and cervix and then moved into your uterus.
  • Hysterosalpingography (HSG): This a detailed X-ray where a contrast material is injected first and then X-rays of the uterus are taken. This is more often used in women who are also undergoing infertility evaluation.
  • Sonohysterography: In this imaging test, a small catheter is placed transvaginally and saline is injected via the catheter into the uterine cavity. This extra fluid helps to create a clearer image of your uterus than you would see during a standard ultrasound

Fibroid Treatment Options

Specialists may build up a treatment plan depends on your age, the size of your fibroids, and your general health.

Home remedies and natural treatments

Certain home remedies and natural treatments can positively affect fibroids, including:

  • Acupuncture
  • Yoga
  • Massage
  • Applying heat for cramps (keep away from heat in the event that you experience heavy bleeding)

Dietary changes can help also. Stay away from meats and fatty nourishments. All things considered, decide on nourishments high in flavonoids, green vegetables, green tea, and cold-water fish, for example, fish or salmon.

Dealing with your feelings of anxiety and losing weight in case you’re overweight can likewise profit women with fibroids.

Drugs

Drugs to control your hormone levels might be prescribed to shrink fibroids.

Gonadotropin-delivering hormone (GnRH) agonists, for example, leuprolide, will cause your estrogen and progesterone levels to drop. This will ultimately stop period and shrink fibroids.

GnRH antagonists additionally help to shrink fibroids. They work by preventing your body from delivering follicle-stimulating hormone (FSH) and luteinizing hormone (LH). Examples include:

  • Ganirelix acetate, an injectable medication
  • Cetrorelix acetate, an injectable medication
  • Elagolix, which is available in the oral medication elagolix/estradiol/norethindrone acetate.

A failure to IVF is no more a limitation. The donor egg IVF technique will allow an infertile woman with abnormally functioning ovaries to give birth to her child. This technique includes fertilization of the egg of another woman and the sperm of the intended father unless the sperm donor is not involved. Then the fused egg and sperm (embryo) is implanted into the intended woman’s uterus. The major drawback is there will be no genetic relation between intended mother and child.

Who Can Be An Egg Donor?

A donor must be young, healthy and have normal functioning ovaries. Most importantly the donor must be tested for any genetic disorders1. Egg donor program undergo extensive screening and mention background and medical history of the donor. The American Society for Reproductive Medicine recommends that egg donors must be under the age of 34. A donor source could be a family member (genetic link) or a friend. It could be from egg bank (frozen eggs), or from fertility clinic.

Why Donor Egg Is Needed?

Older women (over 40) are using the donor egg technique more frequently. In 2010, about 11% of all assisted reproduction techniques used donor eggs with the highest success rate among all.

Following are few conditions that may demand donor egg IVF.

  • Donor egg IVF generally helpful for a woman after her 40s (age-related infertility) as they get older and may reach menopause (premature ovarian failure).
  • The risk to child through genetically transmitted disease especially of the intended mother.
  • Egg production but of low quality.
  • Repetitive IVF failure.
  • Post-cancer treatment (if the ovaries or eggs were damaged or removed).
  • The woman was born without her ovaries due to a congenital anomaly.

A Fresh Or Frozen Donor Egg Cycle

In fresh donor egg, immediate fertilization of retrieved eggs and sperm of intended father or a sperm donor is done. Also it is a direct transfer of prepared embryo to intended mother or egg being frozen for future use. Whereas, frozen donor eggs are retrieved and cryopreserved before fertilization. Later they are thawed and fertilized with intended father unless sperm donor is not involved.

In addition, women using fresh embryos (not frozen), have a 43.4% chance of getting pregnant in each cycle.

Pros and Cons of Fresh Donor Eggs

  • Consistently higher success rates
  • Multiple frozen embryos
  • Unforeseen circumstances
  • More coordination required

Pros and Cons of Frozen Donor Eggs

  • Time saving
  • Cheaper cost
  • Limited embryos

Treatment Cycle

The treatment cycle starts once the donor and intended mother get their periods. To stimulate egg production the donor injected with injectable fertility drugs. The intended mother will be given estrogen supplements which will create suitable lining. Once egg gets into maturation step in donors worm, the intended mother is being injected with progesterone which will prepare uterus to prepare for the embryo. In the next step, egg retrieval process is done, once done the active role of donor in the cycle is over. The intended father semen sample being taken. The retrieved donor eggs will be put together with the intended father’s sperm cells. Embryo transfer into intended mother is done in fertility clinic. Later the intended mother will take a pregnancy test to see if the cycle was a success.

Low sperm count treatment means that the fluid (semen) you ejaculate or discharge during sexual intercourse contains less than normal sperm. In scientific terms, this condition is known as oligospermia. Low sperm count is considered when the sperm count is less than 15 million sperm per milliliter of semen. Low sperm count decreases the chance that sperm will fertilize the egg and result in pregnancy. However, many men who have low sperm count are still able to father a child.

Symptoms of low sperm count

The important sign of low sperm count is the inability to conceive a child. In some men, some basic problems such as an inherited chromosomal abnormality, a hormonal imbalance, dilated testicular veins or a physiological condition that blocks the passage of sperm may cause signs and symptoms. Symptoms of low sperm count may include:

  • Problems with sexual function — for example, low sex drive or difficulty maintaining an erection (erectile dysfunction)
  • Pain, swelling, or a lump in the testicle area
  • Decreased facial or body hair or other signs of a chromosome or hormone abnormality

Causes of Low Sperm Count

In many cases, the exact cause of a low sperm count is not known. In some of the cases problems with sperm count and quality are associated with:

  • Hormone imbalance, such as hypogonadism
  • A genetic problem such as Klinefelter syndrome
  • Having had undescended testicles as a baby
  • Varicoceles (enlarged veins in the testicles)
  • Previous surgery to the testicles or hernia repairs
  • Excessive use of alcohol, smoking and using drugs such as marijuana or cocaine

Prevention

In order to protect your fertility, try to avoid known factors that can affect sperm count and quality such as:

  • Don’t smoke.
  • Limit your alcohol intake.
  • Talk to your doctor about medications that can affect sperm count.
  • Maintain a healthy weight.
  • Avoid excessive heat.
  • Manage your stress.
  • Avoid exposure to pesticides, heavy metals, and other toxins.

Treatment

Low sperm count treatment includes:
Surgery: Surgery may be helpful for the treatment of a varicocele or for the repair of an obstructed vas deferens. The sperm retrieval technique has been used to retrieve the sperm directly from the testicles or epididymis in cases where no or nil sperm are present.
Treatments for sexual intercourse problems: Medication or counseling can help improve fertility in conditions such as erectile dysfunction or premature ejaculation.
Hormone treatments and medications: Your doctor may recommend hormone replacement therapy or medicines in cases where infertility is due to high or low levels of certain hormones or problems with the way the body utilizes the hormones.

Lifestyle and Home Remedies

There are several ways you can take at home to boost up your chances of getting your partner pregnant, including:
Increasing the frequency of sex: Having sexual intercourse every day or every alternate day beginning at least four days before ovulation may increase the chance of getting your partner pregnant.
Having sex when fertilization is possible: Women are likely to become pregnant during the ovulation period which occurs in the middle of the menstrual cycle that is between periods. This will confirm that sperm, which can survive for several days, are present when the chances of conception are possible.
Avoiding lubricants: Some of the lubricating agents such as jelly, lotions, and saliva might alter the sperm’s movement and function. Consult with your doctor about sperm-safe lubricants.

Dietary Tips to Increase Sperm Count

Oranges: Vitamin C in the oranges helps to improves sperm motility, count, and morphology.
Leafy vegetables: Vitamin B present in spinach, lettuce, sprouts, and asparagus can help produce strong, healthy sperm.
Dark chocolate: Dark chocolate contains arginine which improves sperm count and quality over time.

Brazil nuts: Brazilian nuts contains Selenium which helps increase sperm count, sperm shape, and sperm motility.

Water: Stay hydrated. It helps create good seminal fluid.

STRESS MANAGEMENT DURING INFERTILITY

Big wait after embryo transfer to a positive result – what to do?

Stress Management During Infertility – After embryo transfer, it takes around 2weeks for pregnancy test results. This two weeks period is a time of high anxiety, worry, and frustration for women trying to conceive.

  • Try not to obsess about pregnancy symptoms, some of the medications can have side effects that resemble symptoms of pregnancy.
  • Keep busy -This may mean working more or planning or fun distractions.
  • Allow yourself only 15-30 min a day to think about pregnancy
  • Write down your thoughts and discuss them with your partner or family members or friends.
  • Try some relaxation techniques such as breathing exercises or meditation.
  • Avoid pregnancy tests before the scheduled time as medications may also cause a false-positive result.
  • Try using the positive reappraisal technique to encourage yourself to find some positive points in what you are experiencing.

STRESS MANAGEMENT DURING INFERTILITY

  • We can help you by counselling and look at how you are feeling, identify areas that are causing you distress and find strategies that may be more useful to you.
  • By just being able to talk about your fears with someone who is impartial and non-judgemental, finding out how others cope and whether your reactions are normal is all that you need to manage the rest.
  • Counselling will focus on ways of getting back some control and feeling more at ease with your situation. Counselling may be needed in multiple sessions or single session depending on the patient’s need.
  • It is important that you feel comfortable with the counsellor /doctor as you are going to talk openly with them.
  • Genetic counselling is needed in some cases where the cause of infertility is because of genetic condition and different issues need to be discussed in detail.

How to manage stressful situations during infertility treatment?

  • It can be hard to be happy for others who are having babies and it seems everyone around you are pregnant and have babies. It is a normal feeling and this experience will one day be behind you.
  • Avoid going to maternity hospitals when someone delivers, instead go and meet them at home quietly.
  • Avoid situations where there may be many young children.
  • These seem to emphasise what you don’t have.
  • Plan to visit your family and friends beforehand so that you can be free to spend the festival time quietly.
  • Be selective in accepting invitations by avoiding events in which pregnant ladies and children are involved.

Loss of pregnancy is always hard but it becomes more difficult when it has taken so much time and treatment to become pregnant.

She may feel surprised and guilty that she is not joyful about her pregnancy fearing that it may not continue. This could make it hard to relax and enjoy. Talk about the fears and support of the people around her will help.

  • It is a time of mixed emotions.
  • Most people know when to stop and seek relief from the constant procedures and disappointments.
  • She may decide to stop treatment because she is exhausted and she need to accept that she won’t have children from this treatment and that sadness and anger is normal.
  • There will be mixed emotions of relief and sadness.
  • Infertility treatment like IVF can strain relationships when there is inadequate communication between the partners.
  • A partner may be grieving in his or her own way which isn’t understood by the other partner. So communicating with your partner is important.
  • You can write down your feelings and show these to each other or make an extra effort to find time to talk or going away for a few days together can help.
  • Sometimes it may be difficult to have physical relation during the stress of IVF so nothing to worry about it, by just cuddling and holding hands and talking about the fears and feelings will help.
  • When one partner has an identified fertility problem it can lead to feelings of inadequacy and inequality in the relationship. Approach the situation as our problem and something to work on together.

Coping up During IVF: A Big Challenge

  • Some may find that starting treatment is a positive experience but others may feel very disappointed that they have to face intervention.
  • Most women may fear the actual process but waiting for results is often the most difficult part of treatment.
  • Days seem to pass very slowly and it can be a time of acute vulnerability and sensitivity.
  • You may argue with or avoid your partner and your daily routine may be affected.
  • IVF is not a single event but rather a series of steps or hurdles where each stage has to be crossed before tackling the next one. This is a very tiring process.
  • If IVF fails it leads to double disappointment because it means again having to decide what to do. So it can be sad and frustrating.
  • You may feel more vulnerable, sad, anxious or angry than usual.
  • Take less interest in things that you previously enjoyed.
  • Stay in more and avoid situations where you encounter small babies and pregnant friends.
  • Arguing with partner over trivial issues.
  • Flare up at your friends over little things they have said.
  • Responses to the medications used to stimulate the ovaries during IVF vary enormously.
  • Some women have no symptoms while others feel emotional and much more prone to tears, anxiety, and irritability.
  • Some feel uncomfortable with bloating, headaches, tiredness and other symptoms.
  • Ask questions to the doctors, counsellors, and clear all your doubts about the procedure and likely outcome.
  • Better not to tell too many people when you are undergoing treatment.
  • Pace yourself and have breaks between cycles.
  • Try to plan treatment when there are no other stressful situations in life.
  • Try to keep life in balance and don’t let IVF take over every month.
  • Not happy with the results.
  • How to enhance the results?
  • How to train your team?
  • Learn about Quality Control and Quality Assurance in ART Clinics.

Already doing IUI and want to shift to In Vitro Fertilization (IVF)? Or You want to improve your existing IVF facility

  • What to do?
  • What permissions are needed and from where?
  • What equipments have to be bought?
  • Expenditure in setting up of an IVF Laboratory and OT
  • I need to polish my skills ?
  • Want to start your own Intrauterine Insemination (IUI) Laboratory?
  • What permissions are needed to start an IUI Clinic?
  • What equipments have to be bought?
  • Expenditure for setting up of an IUI Laboratory.
  • Who can guide me?
  • I need Hands on Training ?

When Diagnosed with Infertility?

  • Shock, surprise or denial – A feeling that it is not true and not knowing what to do?
  • Anger and frustration – Being angry with others not able to understand what is happening to you.
  • Anxiety, fear, or panic – All thoughts are confusing.
  • Isolation – Being withdrawn and out of touch with your partner
  • Sense of loss – Fearing loss of motherhood, fatherhood, loss of pregnancy may continue throughout the infertility treatment

It depends upon

  • How you interpret the situation
  • How you responded to past stresses.
  • Other events happening in your life.
  • The type and level of support you get.

Though all your emotions are normal it is important to not let these feelings go on for too long and affect your life. Learning to recognise and managing your emotional feeling about infertility is as crucial as looking after yourself physically.

  • Talk about your feelings and fears with others especially your partner. Talking helps you to clarify the situation and identify areas of concern.
  • Do yoga, exercise, and meditation to manage stress
  • Gather information from other people who dealt with same issues eg. books, online, counsellors. This will make you feel more in control of your situation.
  • Attend medical appointments with your partner
  • Deal with the current issues try not to think too far ahead

Story of a Brave Donkey – One day a farmer’s donkey slipped and fell down into a deep well. The animal cried mournfully for hours as the farmer was not able to help him.

Ultimately, the farmer thought that since the animal was old it just wasn’t worth it to retrieve the donkey. He decided to cover up the well with mud and bury the donkey.

He also called all his neighbors to come over and help him in filling the well with the mud.

As the donkey understood what was happening he cried unbearably but to everyone’s astonishment, he quieted down and looked relaxed. All were astonished at what they saw.

With each shovel of mud that dropped on the Donkey back, he did something astonishing. The donkey would shake it off and take a step upwards.

As all continued to heap mud on top of the poor animal, he used to shake it off and take a step upwards.

Very soon, all were stunned as the donkey stepped up over the edge of the well and ran off to never come back.

Moral of the story

Life is going to shovel difficulties on you all along.

The lesson is not to get bogged down by them.

We can get out of the deepest well by never giving up

Multiple births are associated with Assisted Reproductive Technology (ART) to a large extend.

In the last decade, the cases of women who have given birth to twins or even triplets have increased, which has led infertility specialists to establish a series of guidelines to prevent this, since multiple pregnancies entail more risks than singleton pregnancies.

For couples who have been trying to conceive for a long time, the desire to have a baby is so strong that sometimes they find shelter in the fact that chances of getting pregnant increase if more than a single embryo is transferred. The problem is, most of them do not take into account the risk of multiple births it entails.

Being pregnant with more than one embryo can lead to severe complications for both the health of the mother and the babies. For these reasons, carefully evaluating the pros and cons before making a decision as regards the number of embryos to transfer.

The main cons of multiple pregnancies are due to the risks it conveys for both the mother and the babies, including:

Preterm birth When delivery occurs before 37weeks of pregnancy.

Preeclampsia A type of high blood pressure that occurs during pregnancy. It causes kidney problems, causing the loss of proteins through urine.

Gestational diabetes A type of diabetes that appears for the first time when the woman gets pregnant. It typically appears after the first trimester.

C-section birth A surgical incision is performed on the abdomen and the uterus to deliver the babies.

Postpartum bleeding It is considered if the blood loss exceeds more than 500 ml after a vaginal birth, or over 1,000 ml after a C-section.

Miscarriage or vanishing twin syndrome Although most twin pregnancies develop without problems, the risk of miscarriage is higher than in singleton pregnancies.

Intrauterine growth restriction The fetus is unable to grow as much as it needs due to a deficiency of nutrients and/or oxygen. Usually, it is due to complications in the placenta.

Low birth weight It is diagnosed when the weight is below 2.5 kg.

Perinatal mortality Perinatal death occurs when the fetus dies at week 28 of pregnancy or later, or within the first seven days after being born.

Multiple embryo transfer should be avoided with a focus on a single embryo transfer only.

The “success” of an assisted reproductive treatment does not depend only on achieving pregnancy. We need to be attentive to the fact that the ultimate aim would be delivering a healthy baby and avoiding preterm deliveries.

Egg freezing can be beneficial for women who wish to preserve their fertility for the future, whether this be because they want to focus on their career, have been diagnosed with an illness or are doing so for religious or moral reasons.

Women are born with two ovaries, each containing resting eggs or follicles. Every woman is born with a set amount of eggs. At 20 weeks gestation, a woman has about 6 million eggs, the most eggs she will ever have in her lifetime.

At birth, she will lose approximately half of her eggs, and by the time she reaches puberty, she has only about 200,000 eggs left in her ovaries.

During a menstrual cycle, one egg matures while the remaining eggs that are present that month degenerate.

Ideally, eggs should be frozen when a woman is in her twenties; her prime reproductive years. However, this isn’t always the case, as many women aren’t even thinking about children between these years! Patients who choose to freeze their eggs when they are under 35 tend to have higher success rates than those who are aged 35 and over.

Although sperm and embryos are easy to freeze, the egg is the largest cell within the human body and contains a large amount of water. This means that when it is frozen, ice crystals can form that destroys the cell. Embryologist using some techniques dehydrates the egg and replaces the water with some type of cryoprotectants prior to the freezing process to prevent the ice crystals from forming and damaging the cell.

To harvest the eggs for freezing, the patient undergoes hormone injections as done in any regular IVF cycle.

The only difference between the two procedures is that after egg retrieval they are frozen for some time before they are thawed, fertilized and transferred to the uterus. The egg freezing cycle takes around two weeks to complete. The process includes 10 -15 days of hormone injections to stimulate ovaries and achieving adequate response as to harvest 10-12 eggs from the ovaries.

Once the eggs have matured and follicle have reached 18-20 mm size, they are removed with a needle placed through the vagina under the guidance of an ultrasound. This procedure is not painful and is done under IV sedation. Eggs are quickly frozen and kept at -196 degree temperature.

When the patient is ready to start her family the eggs are thawed and injected with a single sperm to achieve fertilization. Resulting embryos are then transferred to the uterus as done routinely.

Scientific evidence suggests that long-term freezing of eggs does not result in any decrease in quality.

It is recommended that ten eggs should be frozen for each pregnancy attempt.

There is a variation across these figures depending on many factors, including competence of the embryologist and age of the patient. Younger women can be expected to produce more than ten eggs. Younger eggs would have higher chances of implantation than eggs of elderly women.

The age of the woman at the stage of thawing and implantation has an insignificant impact upon the overall outcome.

Depending on the age of the egg at freezing, each cycle would have a 15-30% chance of leading to a live birth.

It is recommended that 10 eggs be stored for each pregnancy attempt. 2-3 cycles may be done and adequate no of eggs be frozen for latter use.

The chance of future IVF pregnancy with her frozen eggs in women older than 38 at the time of freezing is likely to be lower than that seen for younger women.

To date, approximately 5,000 babies have been born from frozen eggs. The largest published study of over 900 babies from frozen eggs showed no increased rate of birth defects when compared to the general population. Additionally, results from one study showed no increased rates of chromosomal defects between embryos derived from frozen eggs compared to embryos derived from fresh eggs.

The costs for egg freezing are identical to those of routine IVF. In general, it costs 1.8 lac INR to undergo an egg freezing cycle. This estimate includes all testing, monitoring, medications and egg freezing.

The egg-freezing fee includes the storage fee up to the end of the calendar year. There will be afurther annual storage fee beginning January 1st of the next full calendar year.

Have you been advised IVF?

Are you under stress and confused?

Every month during ovulation, an egg is produced by one of the ovaries. The mature egg is carried from the ovary to the uterus through a thin oviduct or fallopian tube. When a blockage prevents the egg from traveling down the tube then the woman is having blocked fallopian tube, also known as tubal factor infertility or hydrosalpinx. This can occur on one or both sides.

  • Hydrosalpinx simplex is characterized by excessive distension and thinning of the wall of the uterine tube, the plicae being few and widely separated.
  • Hydrosalpinx follicularis: A tube without any central cystic cavity, the lumen being broken up into compartments as the result of the fusion of the tubal plicae.
  • Sactosalpinx: Dilation of the inflamed uterine tube by retained secretions [saktos = stuffed).

Hydrosalpinx commonly results from a prolonged untreated infection of the fallopian tubes. Common causes are:

  • Sexually transmitted diseases such as chlamydia or gonorrhea
  • Unsafe Abortions
  • Abdominal surgeries – Ruptured appendix
  • Previous tubal surgeries
  • Pelvic Endometriosis
  • IUD’s
  • Tubal tuberculosis

Blocked tubes are diagnosed by following tests:

  • Ultrasonography
  • CT
  • MRI
  • HSG (Hysterosalpingogram)
  • Laproscopy

Hysterosalpingography is a procedure used to diagnose the shape of the uterus and the shape and patency of the fallopian tubes. This test uses X-rays along with a dye to look into the uterus and the fallopian tubes. The whole process takes around 5-10 minutes and patient is allowed to go home the same day.

In the presence of hydrosalpinx the pregnancy rate and implantation rate is reduced by 50% and the risk of spontaneous abortions is doubled. Many studies have shown patients with hydrosalpinx have lower pregnancy rates when compared with patients with tubal infertility without hydrosalpinx.

Both bilateral hydrosalpinx and large size hydrosalpinx visible on ultrasound are associated with a significant reduction in pregnancy rate as compared to unilateral hydrosalpinx and hydrosalpinx not visible on ultrasound.

The risk of ectopic pregnancy and miscarriage rate is not affected by presence of hydrosalpinx. The negative effect of hydrosalpinx was also seen in patients who underwent frozen embryo transfer, suggesting that it is the failure of embryo implantation and not oocyte quality that decreases the reproductive outcome. The tubal fluid is believed to be the main culprit behind the negative effect of hydrosalpinx on the pregnancy rate. That’s all about blocked tubes diagnosis.

Have you been advised ovarian cortex freezing?

Fertility preservation is an effort of preserving eggs, embryos, and sperms of individuals who have been diagnosed with cancer or are preparing to undergo treatment, so that they can have children in the future. This method allows these individuals to remain potentially capable of having children once the treatment is complete.

Ovarian follicles are vulnerable to agents that lead to DNA damage, including ionizing radiation and chemotherapy, at any age. Such anticancer treatments lead to a reduction in the ovarian follicle reserve in a dose-dependent manner, and can eventually cause amenorrhea and premature ovarian failure.

Alternatively, there could be the occurrence of partial ovarian injury, in which the reduction in primordial follicle stockpiles is manifested by infertility along with a shortened reproductive lifespan despite the resumption of menses following the treatment of cancer. In such instances, the post-cancer treatment markers of ovarian reserve (Antral follicle count, FSH, Anti- Mullerian Hormone [AMH], inhibin B) can often resemble the levels similar to those seen in premenopausal women.

Women who are young or wishing to postpone maternity then embryo and oocyte cryopreservation are first-line Fertility Preservation methods in post-pubertal women.

Ovarian tissue auto-transplantation in post-pubertal women is capable of restoring fertility with over 100 live births currently reported with a corresponding pregnancy rate of 23 to 37%. The recently reported successes of live births from transplants, both in orthotopic and heterotopic locations, as well as the emerging methods of in vitro maturation (IVM), in vitro culture of primordial follicles, and the feasibility of In vitro activation (IVA) propose new fertility options for many women and girls.

Vitrification has also demonstrated successful live births and may be a more cost-effective method to freezing with less tissue injury.

Ovarian tissue freezing is the only option to preserve fertility in young cancer patients who have recently been exposed or are to be exposed to chemotherapy treatments. The technique mainly avoids injury to the primordial follicles, which are not subject to the deleterious effects of chemotherapy or radiotherapy.
The technique of ovarian tissue freezing involves following steps:

  • Collection of Ovarian tissue
  • Cryoprotectant preparation
  • Tissue preparation
  • Histological analysis of tissue
  • And finally the freezing is done

If what to do is in your mind. You don’t know what to do. Please approach us.

Are You Having Infertility?

Have you been diagnosed with no sperm count?

Sperm donation is the process by which a man, known as a sperm donor donates his semen to a recipient via ART semen bank with the intention that it be used to achieve a pregnancy and produce a baby in a woman who is not the man’s sexual partner. Sperm donation is a means of third party reproduction.

  • The male partner has azoospermia, severe oligospermia, or other significant sperm or seminal fluid abnormalities.
  • The male partner has ejaculatory dysfunction.
  • In assisted reproductive technologies (in vitro fertilization, gamete intrafallopian transfer, zygote intrafallopian transfer), the male partner demonstrates significant male factor infertility (i.e., previous failure to fertilize, significant oligoasthenospermia, male immunologic infertility) and in vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI) is not elected or feasible.
  • The male partner has a significant genetic defect and the recipient also is known either to be affected or to be a carrier of it, or the recipient has previously produced an offspring affected by a condition and carrier status cannot be determined.
  • The male partner has an ineradicable sexually transmissible infection.
  • The female partner is Rh-negative and severely Rh-is immunized, and the male partner is Rh-positive.
  • Females without male partners.

The assisted reproductive technology clinics and assisted reproductive technology banks shall ensure that information about the couple, donor is kept confidential and that information about assisted reproductive technology treatment shall not be disclosed to anyone other than a central database to be maintained by the National Registry except in a medical emergency at the request of the couple to whom the information relates, or by an order of a court of competent jurisdiction.

The assisted reproductive technology clinics shall obtain donor gametes from the assisted reproductive technology banks that have ensured that the donor has been medically tested for such diseases as may be prescribed.

The screening of gamete donors, the collection, screening and storage of semen;shall be done by an assisted reproductive technology bank registered as an independent entity under the provisions of this Act.

The assisted reproductive technology banks shall obtain semen from males between twenty-one years of age and forty-five years of age, both inclusive and examine the donors for such diseases, as may be prescribed.

Are You Having Infertility?

Have you been Diagnosed with Low Egg Count?

Ovarian reserve is a theoretical concept. As a practical matter, it refers to the ease at which an individual’s ovaries can be successfully stimulated with fertility drugs. It indicates quantity and quality of oocytes in women of reproductive age group.

The single most consistent variable affecting ovarian reserve is the woman’s age. This is because a woman is born with all the eggs she will ever have.

In most women majority of the eggs are genetically normal or balanced. However, there will be some that are genetically abnormal or unbalanced.

It appears that the best eggs are ovulated first. The older a woman is, the fewer genetically balanced eggs she has left to respond to fertility drugs. This age relationship holds true even in the fertile population.

It indicates a reduction in quantity and quality of oocytes in women of reproductive age group.

An AFC (antral follicular count) of 4 put together in both the ovaries and serum AMH value of less than or equal to 0.28ng/ml is considered to be indicative of decreased ovarian reserve.

There is a risk of Low pregnancy rates irrespective of age and a high pregnancy loss.

Any of the two criteria out of three should be present to diagnose poor ovarian reserve:

  • Advanced maternal age (>or= 40yrs of age) or any other risk factor for poor ovarian reserve.
  • A previous poor ovarian reserve (
  • An abnormal ovarian reserve testing (AFC ,5-7 follicles or AMH ,0.5-1.1ng/ml)

Reproductive aging is a continuous process from before birth till menopause. Throughout reproductive life there is a progressive and irreversible loss of the eggs which apart from natural age related decline, certain factors may further deplete the ovarian reserve like endometrioma, certain pelvic infections, ovarian surgery, chemotherapy ,radiotherapy, etc . So the ovarian reserve reduces early and patient may have early menopause also.

The management of poor ovarian reserve patients is challenging, pregnancy rates are very low with simple forms of treatment, and IVF in such women offers the highest probability of pregnancy and antagonist protocol is most preferred one. When repeated attempts at treatment become unsuccessful, the only options that remain are recourse to oocyte donation or adoption.

Are You Having Infertility?

Low sperm count is the term used to define the condition when men have fewer than 15 million sperm per milliliter of semen when compared with normal. It is also called oligospermia.

Having a low sperm count reduces the chances of pregnancy. However, many males that have a low sperm count but are still in a position to father a baby as sperm count varies in men.

No sperm count is the term used to define the condition when men have complete absence of spermatozoa in the ejaculate even though they may be producing sperm. It is also called azoospermia and is associated with infertility. In humans, azoospermia affects nearly 1% of the male population and may be seen in up to 20% of male infertility situations.

When sperm cannot move through a man’s genital tract because of any obstruction, or if there is a mechanical problem with them getting to where they need to be, sperm can be retrieved through surgical sperm extraction methods such as:

  • Testicular sperm aspiration (TESA)
  • Percutaneous sperm aspiration (PESA)
  • Microsurgical epididymal sperm aspiration (MESA)
  • Testicular sperm extraction (TESE)

The most of the semen ejaculate volume is contributed by secretions from seminal vesicles and prostrate gland. If there is low semen volume (≤1.5 ml) one should first rule out the possibility of spillage of semen sample during collection and then confirm the results by repeat semen analysis.

After confirming the low semen volume then one should suspect the other physiological reasons for some kind of abnormality or obstruction as highlighted below:

  • Seminal vesicles are abnormal or obstructed
  • Ejaculatory ducts are obstructed.
  • Ejaculatory dysfunction (failure of emission or retrograde ejaculation)
  • Absent Fructose and acidic pH are suggestive of ejaculatory and obstruction or seminal vesicle pathology.

When low percentage of live, and high percentage of immotile, spermatozoa are present in an ejaculate then it is called necrozoospermia.

Sperm vitality is the test, which will reveal the proportion of spermatozoa that are “alive” and the proportion of the spermatozoa that are “dead”. The percentage of live spermatozoa is assessed by identifying sperms with an intact cell membrane, from dye exclusion or by hypotonic swelling sperm function test.

  • The dye exclusion method is based on the principle that damaged plasma membranes, such as those found in non-vital (dead) cells, allow entry of membrane permeating stains with loss of osmo-regulation which does not allow the dye to diffuse out.
  • Hypo-osmotic swelling test (HOS) presumes that only cells (sperms) with intact membranes (live cells) will swell in hypotonic solutions.

If what to do is in your mind. You don’t know what to do. Please approach us.

Recurrent miscarriages affects 1-2 percent of reproductive age women. However in India the prevalence is 7.4%. Researchers have been intrigued by the complexity of the factors causing it and treatment that may help to prevent or manage it. It is important for clinicians to be updated with the evolving investigations and evidence based treatment options to mange couples with recurrent miscarriages.

ESHRE/ RCOG/ASRM/MOHFW: Depending upon the gestation of viability and epidemiological data each society has different definition of Miscarriage and RM (Recurrent Miscarriages)

GDG of ESHRE Defines: A pregnancy loss is defined as the spontaneous demise of a pregnancy before the fetus reaches viability. The term therefore includes all pregnancy losses from the time of conception until 24 weeks of gestation.

The term Recurrent Pregnancy Loss for two or more pregnancy loss and to reserve ‘recurrent miscarriages’ to describe cases where all pregnancy losses have been confirmed as intra-uterine miscarriages.

RCOG: Uses 24 weeks as the cut off for viability and defines recurrent miscarriages as the loss of three or more consecutive pregnancies (< 24 weeks).

MOHFW: Miscarriage is defined as a spontaneous loss of pregnancy before 20 weeks of gestation.

Recurrent Miscarriages: Women with three or more first trimester and one or more second trimester miscarriage. Early evaluation is considered if fetal cardiac activity was present, women >35 years with two or more abortions and the couple has had difficulty in conceiving. Women with two or more losses with one or more live issues should be excluded.

ASRM: Recurrent pregnancy loss is two or more failed pregnancy where pregnancy means a clinical pregnancy documented by ultrasound or histopathology.

Working definition warranting investigation & work up and management accordingly.

Miscarriage: Any pregnancy loss from conception till the fetus reaches viability (<24 weeks) Couples with more than two miscarriage should be evaluated consecutively or non consecutively. This would include clinical and biochemical pregnancies but excludes ectopic, molar pregnancies and implantation failure in ART.

In absence of adequate data on the effect of a non consecutive pregnancy loss on the subsequent pregnancy, they should not be clearly excluded from evaluation. Although no distinction in the definition criteria for first or second trimester loss in made but any obvious factor leading to pregnancy loss should not be ignored.

Terminology like Primary RPL (multiple losses in a woman with no previous viable infants) secondary RPL (multiple losses in a woman who has already had a pregnancy beyond 20 gestational weeks) and Tertiary RPL (multiple pregnancy losses between normal pregnancies) are clinically irrelevant for investigating a case of RPL.

  • Recurrent miscarriages have profound impact on the psychology of the couple. Before trying to conceive most couples would want an explanation for their losses and treatment that can prevent recurrence.
  • Risk of miscarriage increases with the age of the woman and each miscarriage the risk of further loss increases (30% after two and 40% after three losses).
  • Although an extensive evaluation into the cause may not yield any abnormality in around 50% of the cases, yet in the remaining presence of a correctable causes of pregnancy loss is the only definitive treatment to prevent another loss.

Role of Counseling in Management

Ideally there should be dedicated RM Clinic which in-depth investigates the couples with recurrent miscarriages. Clinicians and clinics should take the psychosocial needs of couples faced with RM into account when offering and organizing care for these couples. Investigations need not necessarily lead to treatment options and this should be explained to the couple from the beginning. The prognosis and recurrence prediction charts should be used to counsel the couples and overall the chances of successful live birth after RM are satisfactory.

What are the Risk Factors for having RM: Recurrent miscarriages are associated with following risk factors. Some of them are modifiable and adoption of health changing behavior can lead to definitive reduced risk of another miscarriage. While for other non modifiable factors various treatment modalities have been tried but only a few can be recommended to be used based on the scientific literature published.

Modifiable

BMI: Maternal obesity has a strong association with repeated miscarriages but the direct effect of weight loss in achieving live birth is not studied. But weight loss definitely decreases time to conceive and risk of miscarriages and other medical obstetric complications like pregnancy induced hypertension, diabetes and metabolic syndrome in general. Also on the other hand a BMI of less than 18.5 is found to be associated with sporadic first trimester losses. Achieving optimal BMI should be a treatment goal in management.

Exercise in pre pregnancy and during pregnancy is found to have no negative effect on the pregnancy outcome rather it benefits by improving tissue oxygenation and helping achieve normal BMI.

Smoking: Smoking has not been conclusively found to be a risk factor for RM but based on its definitive association with poor obstetric outcomes, cessation of smoking should be advised in couples with RPL even in absence of data supporting smoking cessation and chance of live birth.

Caffeine: A study on small population found a linear correlation between the amount of caffeine intake in pre-pregnancy and early pregnancy period and pregnancy loss, maximum being with >300mg/day of caffeine consumption compared to mild consumption > 150 mg/day. However the chances of live birth on caffeine intake reduction is not studied.

Alcohol: Alcohol consumption is associated with pregnancy loss and fetal alcohol syndrome. Seeing the negative effects of alcohol even in absence of direct causal relation it is advised to limit or curtail alcohol consumption in the pre-conceptional period.

Stress: Stress is associated with RPL but direct causative relation has not been established due to non-uniformity in type of scales used and poor study designs.

Endometritis: Very small studies have found the presence of endometritis in women with RPL and improving with antibiotic treatment, however these studies are inadequately designed to form basis for screening for endometritis.

Non Modifiable

Age: Advanced female age is associated with sub fertility, genetic anomalies, obstetric complications, still births etc. The risk of another miscarriage in woman with RPL has been found to double after the age of 35 years. Woman should be told that the risk of RPL is lowest between 20-35 years and rises rapidly after 40 years.

Occupational and environmental exposure: Based on only a few small studies, exposure to occupational and environmental factors (heavy metals, pesticide, lack of micronutrients) seems to be associated with an increased risk of pregnancy loss in women with RPL.

Genetic: Majority of early pregnancy losses (50%-60%) are due to chromosomal abnormalities resulting as a de novo process or are parental in origin. Most common parental abnormalities leading to miscarriages are translocations (2-4%) which can be Reciprocal (60%) equal exchange of genetic material between two chromosomes or Robertsonian (40%) where long arm of two acrocentric chromosomes join together. Carrier parents are asymptomatic. These can be picked up by karyotyping of parents. The karyotype of products of conception can be normal or have a balanced or an unbalanced translocation. Pregnancies with unbalanced translocations usually end in miscarriage, still births and rarely anomalous babies.

Immunological: The association between HLA (Human Leucocyte antigen) polymorphism and RM is inconsistent. Of the various types a weak association is found between HLA-G alleles with RM. Investigation of HLA in women with RM is not recommended except class II HLA in women with secondary RPL after the birth of a boy.

Immunological

There should be individual evaluation of the investigations appropriate to each woman or couple, based on age, fertility/sub-fertility, pregnancy history, family history, previous investigations and/or treatments. In addition, care should be tailored to the psychological needs of the couples.

Genetic Testing

Products of Conception: Aneuploidy is the most common cause of early pregnancy losses and the risk increases with age of the woman. Aneuploidies occur in comparable frequencies in both women with sporadic and recurrent pregnancy loss. Although not mandatorily recommended but genetic analysis of the products of conception help in explanatory purpose and may help to determine whether further investigations or treatments are required. For Genetic analysis of POCs array CGH is recommended.

Parental Karyotype: The test should be advised only after individual risk assessment. Parental karyotyping is advised based on genetic history (history of previous child with congenital abnormalities, offspring with unbalanced chromosome abnormalities in the family, or detection of a translocation in the pregnancy tissue). In couples with female age above 39, less than three pregnancy losses and a negative family history, the chance of being a carrier of a translocation is very low.9 The information from parental karyotype however helps couples in deciding continuing to try to conceive, stop trying, or choose invasive tests like prenatal diagnosis or preimplantation genetic testing (PGT) (for instance PGT-SR in case of a balanced translocation)

Thrombophilia Screening

Acquired : Antiphospholipid antibody syndrome is associated with RM by action of anti PL in complement activation and vascular thrombosis. The Miyakis criteria (2006), an update of the Sapporo classification of 1999, is used to diagnose antiphospholipid antibody syndrome. This requires presence of one clinical criteria and elevated levels of aPL antibodies. (box) Screening for antiphospholipid antibodies, Lupus anticoagulant, Anti cardiolipin antibody and aβ2GlycoProtein I should be considered after two pregnancy losses at least 6 weeks after a miscarriage.

Hereditary: There is no, or a weak association at best, between RPL and hereditary thrombophilia. It is hence not recommended to screen for hereditary thrombophilia in women experiencing RPL however in presence of additional risk factors for hereditary thrombophilia like family members with hereditary thrombophilia, or previous VTE, screening can be considered.

Anatomical Issues

Presence of uterine malformations is more common in woman with RM. The association is strong for congenital than acquired ones and treating them has improve live birth rates in some studies. All women with RM should be screened for malformations. The preferred technique to evaluate the uterus is transvaginal3D ultrasound (3D US), which has a high sensitivity and specificity compared to a 2D US. Sonohysterography (SHG) is more accurate than hysterosalpingography (HSG) in diagnosing uterine malformations more so when tubal patency has to be investigated. MRI is not the first line investigation.

Congenital Abnormalities: Potentially relevant congenital Müllerian tract malformations include septate uterus, bicorporeal uterus with normal cervix (AFSbicornuate uterus), bicorporeal uterus with double cervix (AFSdidelphic uterus) and hemi-uterus (AFSunicornuate uterus).

Acquired Abnormalities: Acquired uterine malformations (submucousal myomas, endometrial polyps and uterine adhesions) have been found prevalent in women that suffered pregnancy loss, but the clinical relevance is unclear. 3 D USG is a better screening tool. When suspected, a hysteroscopy has to be performed. It is the gold standard.

Cervical Incompetence: Women with a history of second-trimester pregnancy losses and suspected cervical weakness should be offered serial cervical sonographic surveillance.

Testing for Endocrine Disorder

Thyroid &antoTPO, Diabetes Mellitus, Androgens &LH: Thyroid screening (thyroid-stimulating hormone [TSH] and thyroid peroxidase [TPO]-antibodies) is recommended in women with RPL. Abnormal thyroid-stimulating hormone (TSH) and thyroid peroxidase [TPO]-antibody levels should be followed up by thyroxine (T4) testing in women with RPL. Assessment of polycystic ovary syndrome (PCOS), fasting insulin and fasting glucose, baseline androgen levels and LH is not recommended in women with RPL to improve next pregnancy prognosis. However prolactin testing should be undertaken in symptomatic women (Oligo/amenorrhoea). Routine testing for luteal phase insufficiency in neither feasible nor necessary in women wit RM.

Immunological Factors Testing

HLA determination in women with RPL is not recommended in clinical practice.

List of tests & Recommendations (Table)

Test Recommendation
anti-HY antibodies Not recommended
Cytokine testing Not recommended
Cytokine polymorphisms Not recommended
Antinuclear antibodies (ANA) testing Could be considered for explanatory purpose
natural killer (NK) cell testing Insufficient evidence to recommend
anti-HLA antibodies Not recommended
Male factor

The role of male factor in RM is being investigated owing to the fact that female causes explain only about 50-60% cases of RM.

Assessment of spam DNA fragmentation can be considered for explanatory purposes not therapeutic purpose based on indirect evidence.

Infection

Endometrial aspiration to screen for endometritis is not recommended due to lack of evidence and the diversity of nature of infectious agent being studied and treated in various studies.

Introduction: The treatment in RM could be specific in 50-60% cases where aetiology is identified by the extensive work up the couple undergoes or it is empirical as used in the remaining 40-50% cases of unexplained RM. In either scenario the psychological needs and expectation of the couple from treatment should be well dealt.

Prognosis: Couples are keen to not only know the cause but also the chances of recurrence of such an event in case specific manner. Few prognostic tools (Lund and Brigham) were evaluated, that is female age, number of preceding losses can guide about the prognosis.

Counseling

Treatment options specially the empirical ones or the ones with insufficient evidence should be offered based on reasonable pathophysiological hypothesis and after adequate information to the couple.

Genetic Causes

Role of PGT-M and PGT-SR: Preimplantation genetic testing for monogenic/single gene defects (PGT-M) or chromosomal structural rearrangements (PGT-SR), previously PGD, is an established method to preconceptionally select the genetic defect free embryo for transfer in couples with a high risk of transmitting genetic disorders.Structural chromosomal defects are common in RM population and PGT is useful in couples who are carrier of translation to prevent miscarriage although this is backed by limited evidence and lack of RCT’s

All couples with abnormal genetic results from pregnancy tissue testing or parental karyotypes should be offered genetic counseling to discuss likely prognosis and further diagnostic options. In addition, couples should be informed that PGT-SR could reduce the miscarriage rate, but will not improve live birth rate or time to pregnancy.

Role of PGT-A in unexplained RPL: Preimplantation genetic testing for aneuploidy (PGT-A) (previously preimplantation genetic screening [PGS] or preimplantation diagnosis of aneuploidy [PGD-A]), where an IVF cycle creates embryos which are biopsied and screened for chromosomal anomalies prior to implantation, has been proposed as a potential treatment for RM. However systematic reviews on PGS (PGT-A) for unexplained RM concluded that there is no improvement in live birth rate and hence not cost effective.15

Thrombophilias

Role of Anticoagulants: Aspirin & LMWH

APS: Women who fall under the diagnosis of APS based on the criteria are advised to take low dose aspirin (75-100mg/day) before conception and prophylactic dose of LMWH or unfractionated heparin from the day of pregnancy test positive. For women with hereditary thrombophilia and a history of RPL, antithrombotic prophylaxis is not recommended unless in the context of research, or for venous thromboembolism (VTE) prevention.

No role of steroids or IvIG for this indication

Immunological Causes

Diagnosis of immunological cause is a dilemma and in absence of clear evidence no specific treatment can be recommended.

Endocrine Disorder
  • Overt hypothyroidism arising before conception or during early gestation should be treated with levothyroxine in women with RPL.
  • There is conflicting evidence regarding treatment effect of levothyroxine for women with subclinical hypothyroidism and RPL. Treatment of women with subclinical hypothyroidism (SCH) may reduce the risk of miscarriage.
  • If women with subclinical hypothyroidism and RPL are pregnant again, thyroid-stimulating hormone (TSH) level should be checked in early gestation (7–9 weeks AD), and hypothyroidism should be treated with levothyroxine.
  • If women with thyroid autoimmunity and RPL are pregnant again, thyroid-stimulating hormone (TSH) level should be checked in early gestation (7–9 weeks gestational age), and hypothyroidism should be treated with levothyroxine.
  • There is insufficient evidence to support treatment with levothyroxine in euthyroid women with thyroid antibodies and RPL outside a clinical trial.
  • There is insufficient evidence to recommend the use of progesterone to improve live birth rate in women with RPL and luteal phase insufficiency
  • There is insufficient evidence to recommend the use of hCG to improve live birth rate in women with RPL and luteal phase insufficiency.
  • There is insufficient evidence to recommend metformin supplementation in pregnancy to prevent pregnancy loss in women with RPL and glucose metabolism defects.
  • Bromocriptine treatment can be considered in women with RPL and hyperprolactinemia to increase live birth rate.
  • Preconception counseling in women with RPL could include the general advice to consider prophylactic vitamin D supplementation.
Anatomical Abnormality
Procedure with RM Recommendation
Hysteroscopic septum resection Needs evaluation for RM (ESHRE). But GPP should be done
Metroplasty for bicorporeal uterus with normal cervix Not recommended
Uterine reconstruction for hemiuterus Not recommended
Metroplasty in women with bicorporeal uterus and double cervix Insufficient evidence
Hysteroscopic removal of submucosal fibroids or endometrial polyps in women with RPL Insufficient evidence but GPP should be done
Surgical removal of intramural fibroids Not recommended
Im fibroid distorting the cavity Insufficient evidence GPP: decision should be individualized
Surgical removal of intrauterine adhesions Insufficient evidence
Cervical cerclage : singleton pregnancy and a history of recurrent second-trimester pregnancy loss attributable to cervical weakness Recommended
Male factor
  • Couples with RPL should be informed that smoking, alcohol consumption, obesity and excessive exercise could have a negative impact on their chances of a live birth, and therefore cessation of smoking, a normal body weight, limited alcohol consumption and a normal exercise pattern is recommended.
  • Sperm selection is not recommended as a treatment in couples with RPL.
  • Antioxidants for men have not been shown to improve the chance of a live birth.
Unexplained RPL1
Lymphocyte immunization therapy Should not be used, may have serious adverse effects
Intravenous immunoglobulin (IvIg) Not recommended
Glucocorticoids Not recommended
Heparin or low dose aspirin Not recommended
Folic Acid Not recommended for RM prevention, given routinely to prevent NTD
Vaginal progesterone Insufficient evidence
granulocyte- colony stimulating factor (G-CSF) Insufficient evidence
Intralipid therapy Insufficient evidence
Endometrial Scratching Not recommended

One of the commonest endocrine disorders, affecting approximately 5-10% of women in young and reproductive age group.

The syndrome is present throughout a woman’s lifespan from puberty across post-menopause and affects women of all ethnic groups.

Genetic, environmental factors, along with obesity, hormonal issues, ovarian and metabolic dysfunctions, are the main causes of PCOS.

What are the common presentations and health risk of PCOS

  • Weight gain, and or obesity (58-80%)
  • Pregnancy and fertility issues
  • Acne (45-60%)
  • Cardiovascular issues
  • Polycystic ovaries ultrasound (20-35%)
  • Diabetes, High levels of insulin/insulin resistance (30-50%)
  • Depression and anxiety (28-64%), Poor body image, lack of confidence.
  • Thyroid disorders.
  • Sleep apnea — Sleep apnea is a condition that causes transitory spells where breathing halts (apnea) during sleep.
  • Hyperandrogenism (60-80%)
  • Irregular menstruation (75-80%)
  • Hirsutism (excessive hair growth) (70%)
  • Uterine cancer and endometrial hyperplasia
  • Scalp hair loss (40-70%)
  • Darkening skin areas (AcanthosisNigricans), particularly at the nape of neck (10%)

Diagnoses of PCOS

Hyperandrogenism

Presence of excessive acne, scalp hair loss, and or hirsutism (terminal hair in a male-pattern distribution) or biochemically, by elevated serum levels of LH and testosterone.

PCO Ovaries (ultrasound diagnosis)

Ovary having 12 or more follicles of 2 to 9 mm in diameter or and having a volume of greater than 10 ML.

Oligomenorrhea

Infrequent menstrual periods (fewer than six to eight periods per year).

Insulin resistance is a state in which the body’s cells do not respond to the metabolic effects of insulin hormone. When the body does not react to insulin, the level of glucose in the blood rise. This leads to more insulin to be secreted as the body tries to move excess glucose into cells. Such Impending Insulin resistance can lead to diabetes mellitus and is also associated with acanthosisnigricans a common skin disorder.

For the overweight women, weight loss may help in regularizing the menstrual periods. A moderate loss of 4-5 kg can be helpful in making menstrual periods more regular. Weight loss is also been found to improve raised cholesterol and insulin levels and thus relieving common symptoms as excessive hair growth and acne.

Achieving successful ovulatory cycles are the first step toward attaining a pregnancy. For overweight women and those with raised BMI, weight loss often achieves this goal. Medications may also be used to for successful ovulation.

Insulin-sensitizing drugs may be used in the treatment of PCOS. Such drugs help the body in responding towards raised insulin levels. In PCOS women such drugs can help decrease androgen levels thus improving ovulation. Restoring the ovulation would help in making the menstrual periods regular and more predictable.

PCOS
PCOS1

Has your doctor advised you IVF – ET?

In vitro fertilization (IVF) is a process of fertilization where an egg is combined with sperm outside the body, in vitro (“in glass”). The process involves monitoring and stimulating a woman’s ovulatory process, extracting ova, retrieving a sperm sample and then manually combining an egg and sperm in a laboratory dish. After fertilization, the zygote undergoes embryo culture for 2–5 days. It is then implanted in the same or surrogate mother’s uterus, with the intention of establishing a successful pregnancy

The IVF procedure could be somewhat different for different patients, depending upon the type of reproductive technique being used. But the basic steps involved in the procedure are:

  • Preparatory tests like routine blood tests, hormonal levels etc.
  • Ovulation Induction with gonadotropins, GnRH agonist and antagonist.
  • Ovum Pick up procedure
  • Semen Preparation
  • Insemination/ ICSI
  • Embryo Transfer- Fresh or Frozen

IVF success depends on a variety of factors that could be maternal age, factors causing infertility, reproductive history, whether donor gametes being used or not, lifestyle factors, embryo status, etc.

Generally, IVF treatment has excellent success rates i.e in younger women (age less than 35 years) the percentage of live births per IVF cycle is about 40-45% while in older women (age more than 40 years) the percentage of live births per IVF cycle is 10-12%.

IVF is not a single treatment but a series of procedure and for a woman, the IVF process actually starts weeks earlier. One cycle of IVF cycle takes between four to six weeks to complete from consultation to embryo transfer, but depending on the specific circumstances of each the protocol is similar for every patient.

Age is probably the most important factor influencing the outcome of an IVF cycle and its restrictions for IVF vary from clinic to clinic. In general, women older than age 40 have a markedly lower chance for a live birth compared with women younger than 40 years old.

No. The process of IVF in and of itself does not lead to high risks of multiple pregnancies. But in order to increase the chances of pregnancy, clinicians transfer two to three embryos in younger and older women respectively, which may end up in getting twins or triplets. Also, the probability of conceiving with multiples increases with the number of embryos transferred during IVF. That’s all about (Has your doctor advised you IVF – ET).

On an average, cost of IVF treatment ranges from 1.5 lakhs to 2 lakhs with additional cost for ICSI and freezing (this includes the drug charges.

Learn about ART Procedures

IUI stands for “Intra Uterine Insemination”, a fairly new form of assisted fertilization. IUI involves the placing of freshly prepared sperm (from your partner or from a donor depending on the case) high in the uterine cavity at a selected time in your menstrual cycle. Conception is then allowed to occur naturally. These procedures are carried out on an outpatient basis and you need not be admitted to hospital.

Ideally, couples that have unexplained sub fertility and in woman where there is no evidence of damaged fallopian tubes. It may also help those who have minimal endometriosis or some male factor.

Intrauterine insemination is done very often in following conditions –

  • Donor sperm IUI is recommended for poor or absent semen in the male partner, genetic diseases, or Blood group compatibilities.
  • Frozen donor sperm samples are procured from certified ART banks, thawed and used for the IUI procedure.
  • Unexplained infertility, Endometriosis or male factor related infertility.
    IUI can overcome some of these problems because preparing sperm for the procedure helps separate highly motile, normal sperm from those of lower quality.
  • Cervical factor infertility

RAT IONALE OF IUI

There are three components of IUI which help in improving the results.

Semen preparation
  • Selects most motile sperm fraction removing the debris and dead sperm.
  • Removes prostaglandins present in high concentration in the seminal plasma and thus reduces the risk of uterine cramping.
  • Removes infectious agents and leucocytes.
  • Removes antigenic proteins in the seminal plasma and thus improve prospects of fertility.
  • Helps in the capacitation of spermatozoa.
  • Sperm washing media provide nutritional support for the spermatozoa and keep their activity for longer time.
Intrauterine
  • All mucous barrier which may be hostile to the sperm.
  • Increasing the density of sperm in the upper genital tract.
Overcomes Insemination
  • By-passing the cervic anatomical cervical problems like stenotic cervix, deviated or kinked cervix.
  • Accurate timing with ovulation.
  • Overcomes coital difficulties.
Controlled Ovarian Stimulation
  • Multiple ovulation exposes spermatozoa to multiple oocytes for potential fertilization.
  • Controlled ovulation induction corrects subtle ovulation defects.

How do we do SEMEN COLLECTION?

Following precautions should be taken for sperm collection:

  • To abstain from intercourse for approximately 48-72 hrs is desirable.
  • To abstain from alcohol.
  • Should never be collected at home.
  • To collect the specimen in the container provided by the ART laboratory.
  • The container needs to be disposable, wide mouth & Gamma Sterilized.
  • Sample should be collected by masturbation, with proper hygienic and sterile techniques. Coitus interruptus should be avoided. Use of all types of condoms, lubricants, jellies etc. should be avoided.
  • Specimen should be labeled carefully with patient’s name, registration number, date and time of collection.
  • Exposure to extreme heat and cold should be avoided.
  • To keep the lid securely tight to avoid any spillage during transport.
  • In case of collection problems, reassurance, sildenafil and tranquilizers can help. A back up cryo frozen sample also reassures the couple.
  • Long abstinence (more than 3-4 days), alcohol / drug intake and illness should be recorded.
  • Small volume ejaculates, sample with anti sperm antibodies and viscous samples should be collected in the container to which 3-4 ml of pre warmed semen wash medium has been added.

The patient is made to lie down in Lithotomy position in a comfortable room on a standard gynae examination table with a U cut after evacuating the bladder. The patient is asked to read the identifying data on the test tube containing the sample. Specimen is aspirated in the IUI Cannula and 1 ml syringe without disturbing the pellet.

  • Cervix is exposed with a bivalved Cusco’s speculum.
  • Cervix is gently wiped and negotiated very gently
  • No antiseptic solution should be used.
  • Approximately 0.5 to 0.6ml of sperm preparation is injected very slowly (over 3-5 minutes) to avoid any regurgitation.
  • The tip of the catheter should be 0.5cm below the fundus.
  • Patient is advised to rest for 30 minutes. After this patient can go home.
  • There should be minimal pain or discomfort with the procedure.
  • It needs time, patience and gentleness to negotiate many difficult cervixes.
  • You may also need to individualize Cannula according to the patient.
  • There is no need to prescribe analgesics or antibiotics routinely.
  • Any trauma, bleeding or regurgitation is likely to lead to a failure.

The semen sample is collected by ejaculation into a sterile wide mouth container collection jar meant for use in ART procedures only.An appropriate semen collection room should be used for this.

Semen should be collected,analyzed and prepared within 60 min of ejaculation.

We perform the IUI as soon as possible after washing is completed for optimal results.

Ideally an IUI should be performed approximately 36 hours after the ovulation trigger or after confirming the ovulation on ultrasound.

If two IUIs are scheduled, they are usually spaced at least 12 hours apart between 24 and 48 hours after the hCG.

Some units plan the timing of IUI on a natural LH surge. In that case, a single IUI at 36 hours is the norm.

We have to remember that the egg is viable only for a maximum of 24 hours after it is released.

Natural cycle IUI, in which no fertility drugs are used, tend to have lower success rates amounting to about 6-8 % in some cases. Overall a success rate of 12% to 18 % is expected with an IUI procedure.

TROUBLESHOOTING in IUI
  • How many cycles should be done?
    Maximum results are achieved in the first 3 months. Some results come in the next 3 months. After 6 months an occasional patient may conceive.
  • When to start an ultrasound?
    Day 9 of the cycle.
  • What to do with thick semen?
    Ideally, we need to collect the semen sample in 5ml of Wash Media & start processing immediately, but in extreme circumstances, you can consider breaking up the strands bypassing the semen through progressively thinner needles or even increasing the centrifugation speed, while processing.
  • How to improve motility?
    Pentoxyphylline or caffeine added into the sample may help.
  • What to do with poor endometrium?
    Generally little can be done to help. In case it is because of Clomiphene effect, a change to gonadotrophin cycle may help.
  • How many IUI’s to be performed per cycle?
    The issue of one v/s two IUI’s is still being debated. With two IUI’s there is a slight increase in success rates.
What are the POST INSEMINATION FOLLOW Ups for IUI
  • Luteal support in the form of progesterone pessaries or HCG may be given depending upon the stimulation protocol.
  • There is no need for prolonged rest for more than 30 min, restriction of activity, dietary modification.
  • Intercourse is also not prohibited.
  • Pregnancy test is advised after 15 days of last IUI.
  • A tentative plan for next cycle should be made on the last day depending upon the result of ovulation study and IUI.

Maximum women perceive IUI to be fairly painless procedure baring slight pain as felt during an IUI procedure.

Sperm washing must be done before IUI is performed. The process can take 20 min- 40 minutes with different sperm wash techniques. Insemination should occur shortly after the sperm has been prepared.

Any Side Effects Of IUI
  • Cramping: Uterine cramping is the most common side effect observed which may be there in up to 5 % of cases. Inadequate removal of seminal plasma, infection in semen culture medium or genital tract or difficult insemination may be the cause. Any NSAID along with an antispasmodic medicine may be given for symptomatic relief.
  • Infection: Semen preparation under unhygienic conditions, infection in the semen or genital tract may predispose to acute infection in the female partner. IUI should be avoided in the presence of infection. Intracervical or intravaginal insemination may be done in such cases.
  • Multiple Pregnancies; may occur as a result of over zealous ovarian stimulation.

Psychological Complications: IUI may result in psychological complications such as sexual dysfunction, fear of congenital malformations, mix-up of samples etc. Careful counseling and precautions can avoid these problems.

ICSI is a laboratory technique and a form of micromanipulation, in which a single sperm cell is injected directly into a mature egg using a glass needle called a micropipette. This technique is used to prepare the gametes for the obstention of embryos that may be transferred to a maternal uterus.

  • Woman is stimulated for follicle production and egg recovery as in IVF.
  • Single sperm is taken from male partner’s semen or surgically extracted from his testes or epididymis.
  • The mature egg is held with a micropipette.
  • Injecting needle is used to immobilize and pick up of a single sperm.
  • The needle is then carefully inserted through the shell of the egg and into the ooplasm.
  • The sperm is injected into the ooplasm, the needle is carefully removed and oocytes are left for the fertilization in an incubator.

Mostly ICSI is indicated for the cases with:

  • Oligoasthenoteratozoospermia
  • Previous failed fertilization.
  • When fertilization rate has been unexpectedly poor.
  • Patient with surgically retrieved spermatozoa (TESA, PESA and MESA) either for azoospermia or man with high DNA fragmentation.
  • Patient who want to go for PGS or PGD

ICSI is a procedure which effectively eliminates male infertility by introducing sperm cell directly into an egg, hence increases chances for fertilization for male factor.

Right choice if you have male factor infertility/ repeated IVF failure.

Mandatory ICSI:

  • ICSI is only choice of method for azoospermic men to become father.
  • TESA / TESE ICSI is also preferred for men with high sperm DNA fragmentation, azoospermia and for men with the variable count per ejaculate from a standard laboratory.

ICSI conceived children are not at a higher absolute risk of any disease or illness.

Intracytoplasmic morphologically selected sperm injection (IMSI) is a variation of ICSI that uses a high power microscope to select sperm. This allows embryologists to look at the sperm in greater detail at 6600X magnification.

DNA damage occurs at the post-testicular level, hence testicular sperm may have a better DNA integrity than ejaculated sperm.

What is Fertility Preservation?

Fertility preservation is an effort of preserving eggs, embryos, and sperms of individuals who have been diagnosed with cancer or are preparing to undergo treatment, so that they can have children in the future. This method allows these individuals to remain potentially capable of having children once the treatment is complete.

Chemotherapy and radiation therapies for cancer can affect reproductive health and potential of adolescents and young adults.

The protocols that impede ovarian and testicular function are radiotherapy to the pelvic area and lower abdomen and types of chemotherapy and drugs administered.

Chemotherapies with high risk include procarbazine and alkylating drugs such as cyclophosphamide, ifosfamide, busulfan, melphalan and chlorambucil.

Some Drugs with medium risk to the fertility potential are doxorubicin and platinum analogs such as cisplatin and carboplatin.

On the other hand few drugs have low risk of gonadotoxicity post treatment. These are plant derivatives such as vincristine and vinblastine. Antibiotics such as bleomycin and dactinomycin and antimetabolites as methotrexate and 5-fluoruracil also have low toxicity potential.

These drugs specifically attack the dividing cells in the body, including healthy cells having reproductive potential such as spermatozoa and ovarian egg. Depending on the dose and duration of administration, these cures can have varying effects on reproductive health and potential.

Talk to your oncologist and ART clinicians as soon as disease is diagnosed.

Women have option of oocyte freezing, embryo freezing, ovarian cortex freezing or ovarian transposition.

The men can undergo semen freezing or testicular tissue freezing. The other options can be modification of the chemotherapy drugs and dosages and timely treatment.

Always remember that Pre chemo- radiation therapy fertility management is a better option.

Early action is the treatment. Children are young and don’t understand the ethical issues involved in the management of such cases.

If the child is pre pubertal age, options include testicular and ovarian cortex freezing.

In the post-pubertal age group – oocyte or sperm cryopreservation may be done. Legal consent has to be taken before any intervention.

Efforts to preserve the fertility of a pre pubertal are to be weighed carefully in children, as these techniques are generally experimental.

If you want to preserve your fertility before cancer treatment or immediately thereafter, have a dialogue with your family physician, oncologist or a reproductive specialist.

Your treating team will consider the type of cancer you have depending upon the biopsy report. The treatment plan and the amount of time you have before chemo-radiation is initiated helps to determine the best approach for your fertility preservation.

Obtaining information about fertility preservation methods before you start cancer treatment can help you take a well informed decision.

Modalities to Diagnose Hydrosalpinx

1. Ultrasonography

  • The fallopian tube becomes visible on USG only when it gets distended with fluid, blood, or pus.
  • It appears like cystic lesion with septa and often confused with an ovarian cystic mass or fluid collections in the adnexa.
  • This may appear as – Thin or thick walled (in chronic cases), elongated or folded, tubular, C-shaped, or S-shaped fluid-filled structure, distinct from the uterus and ovary.
  • Longitudinal folds that are present in a normal fallopian tube may become thickened in the presence of a hydrosalpinx. The folds may produce a characteristic “cogwheel” appearance when imaged in cross section.
  • Incomplete septae may also give a “beads on a string” sign.
  • A significantly scarred hydrosalpinx may present as a multi-locular cystic mass with multiple septa (often incomplete) creating multiple compartments. The use of a 3D volume can connect cystic lesions lying in various planes and improve the diagnostic ability of USG.

2. CT

A hydrosalpinx may be seen incidentally at CT as a fluid-attenuation tubular adnexal structure, separate from the ovary. A simple hydrosalpinx is not accompanied by pelvic inflammation. The tubal wall may enhance following contrast.

3. MRI

MR imaging is the modality of choice for the characterization and localization of adnexal masses that are inadequately evaluated with ultrasound. MR imaging also may be useful for determining the cause of a hydrosalpinx or its associated adnexal process by characterizing the nature of the contents of the dilated tube

  • Hydrosalpinx is a distally blocked tube filled with fluid. The blocked tube may become markedly distended giving the tube a characteristic retort like shape. The condition is often bilateral and the affected tubes may reach several centimetres in diameter. Such blocked tubes can lead to infertility.
  • Hydrosalpinx causes low implantation, pregnancy and delivery rates and a higher incidence of spontaneous abortion after IVF-embryo transfer compared with women with tubal infertility of other causes due to effects of the toxic fluid within the hydrosalpinx.
  • The hydrosalpinx fluid may mechanically interfere with the process of embryo implantation or may impede embryo development due to its deficiencies in essential factors. The presence of hydrosalpinx may also reduce the receptivity of the endometrium by decreasing the expression of specific factors.
  • Hydrosalpinx was also found to be associated with ovulatory dysfunction and hence can effect natural conception.
  • Both bilateral hydrosalpinx and large size hydrosalpinx visible on ultrasound are associated with significant reduction in pregnancy rate as compared to unilateral hydrosalpinx and hydrosalpinx not visible on Ultrasound.
  • In the presence of hydrosalpinx the pregnancy rate and implantation rate is reduced by 50% and the risk of spontaneous abortions is doubled.

Ultrasound In Adenomyosis

3D ULTRASONOGRAPHY

  • It helps to visualise the junctional zone more clearly.
  • On coronal view, the junctional zone can be identified as a hypoechoic area around the endometrium, an ill-defined junctional zone, and distortion or infiltration of the hypoechoic inner myometrium.

Colour Doppler studies

  • Usage of colour doppler studies helps to improve the diagnostic accuracy of ultrasound findings.
  • Presence of Intra myometrial cysts, or anechoic areas with the myometrial thickness of more than or equal to 1mm and with no blood flow.
  • Overall there is increased vascularity in the stroma of the myometrium.

MRI

It is an excellent tool for management of adenomyosis. The main criteria for the definition of adenomyosis on MRI are

  • Enlarged uterus with presence of a distinct myometrial mass with indistinct margins of primarily low intensity.
  • Diffuse or local widening of junctional zones on T2 weighted image.
  • Increased junctional zone thickness of more than equal to 0.15 mm; this could be localised or diffuse.
  • Uterine enlargementGlobular uterine enlargement that is generally up to 12 cm in uterine length.
  • Cystic anechoic spaces orlakes inthemyometrium (specific sign) – Variable in size and can occur throughout the myometrium- reflect glands filled with fluid.
  • Uterine wall thickening – The uterine wall thickening typically of fundal and posterior wall can show anteroposterior asymmetry.
  • Sub endometrial echogenic linear striations (specific sign) – Venetian bands or rain shower appearance. Invasion of the endometrial glands into the sub endometrial tissue induces a hyperplastic reaction, which appears as echogenic linear striations fanning out from the endometrial layer.
  • Once the follicles have reached the optimal size and number (more than or equal to 2 follicles over 18 mm) for IVF the patient is given intramuscular inj HCG/recombinant HCG/GnRH agonists to trigger ovulation.
  • Heterogeneous echotexture there is a lack of homogeneity within the myometrium with evidence of architectural disturbance.
  • Obscure endometrial/myometrial border – Invasion of the myometrium by the glands obscures the normally distinct endometrial/myometrial border.
  • Thickening of the transition zone – This zone is a layer that appears as a hypoechoic halo surrounding the endometrial layer.
  • Diffuse Hypervascularity – Colour and power Doppler sonography often demonstrate diffuse hypervascularity without large feeding vessels.
  • Question Mark sign – Seen when the uterine corpus is flexed backward, the fundus of the uterus is facing the posterior pelvic compartment and the cervix is directed anteriorly towards the urinary bladder. This alone has a high specificity.
    That’s all about ultrasound in adenomyosis.
  • Ovarian stimulation is initiated during the 2 or 3 day of the menstrual cycle, after doing a baseline ultrasonography to look for thin endometrium (2-4mm) and rule out any follicles of more than 9mm (ideal size is 2-9 mm), biochemical tests like serum E2 levels (should be less than 25pg/ml ) and LH levels (should be less than 4-5IU/L) are done to look for down regulation.
  • Gonadotrophins in doses of 225 IU to 300 IU are given intramuscularly for 6-7 days,
    Under the influence of stimulating hormones multiple enlarging follicles can be seen rather than single dominant follicle created during natural menstrual cycle.
  • Follicles are monitored every alternate days depending on the response starting from day 7 of the menstrual cycle.
  • By the sonographic appearance of follicles from days 7-10 in combination with serum estradiol hormone levels we can predict the most likely time of ovulation.
  • Once the follicles have reached the optimal size and number (more than or equal to 2 follicles over 18 mm) for IVF the patient is given intramuscular inj HCG/recombinant HCG/GnRH agonists to trigger ovulation.
  • Careful planning of this stage permits optimal timing of oocyte retrieval for IVF.
  • Depending on the cause of infertility the number of follicles recruited may vary reaching up to 20 ,with ovulation carefully triggered when 40% of the follicles are 19-20 mm or greater in diameter .
  • For patients undergoing IVF, accurate timing of oocyte retrieval is critical. If done too early aspiration of the follicles will result in retrieval of immature oocytes and no successful fertilization .If done too late the oocytes will be spontaneously released into the peritoneal cavity and will be lost.
  • Once fertility treatment has been initiated, transvaginal sonographic monitoring of both the endometrium and follicular development starts.
  • Your endometrium is evaluated for both the thickness and morphologic pattern.
  • Endometrium evolves from a thin less than 4 mm echogenic linear appearance early in the menstrual cycle to a trilaminar or multilayered striated appearance measuring up to 12-14 mm in the periovulatory stage.
  • Endometrial thickness increases on each subsequent sonogram st during the 1 half of the cycle. Clinical pregnancy rates are reported to be highest when the endometrium measures more than 9-10mm in thickness at the time of embryo transfer. Endometrium of <6mm correlates with decreased likelihood of full term pregnancy.
  • Patients undergoing transfer of embryos frozen during a prior stimulated cycle, only require targeted endometrial evaluation with attention to morphologic appearance and thickness to determine optimal timing of the transfer.
  • It is preferred to transfer embryos when the endometrium demonstrates a trilaminar appearance and is 7mm or more in diameter.

Ultrasound is done in an IUI cycle on

  • 2nd day of menses (D2) to look for antral follicular count, any ovarian cysts like follicular cysts, corpus luteal cysts etc
  • Ovulation induction drugs (clomiphene citrate 50-100mg / letrzole 2.5 mg) are given to you starting on 2nd or 3rd day of cycle of your menses if endometrial thickness is less than 4 mm and no follicle of size more than 6 mm is seen , for a period of 5 days with or without gonadotrophins.
  • Most of the dermoid cysts are silent and are incidentally detected; however some may be symptomatic due to large size resulting in compression of adjacent structures. Torsion or rupture
  • Trans vaginal sonography is started from 9th day of menses every alternate day depending upon the follicular response.
  • Once the dominant follicle is ready ie of 20-22 mm size ovulation trigger in the form of injectable Human chorionic gonadotrophin 5000/10000 IU is given.
  • IUI is done 36 hrs after the Inj HCG Trigger with prior Ultrasonography to look for rupture of the follicle.
  • Dermoid cysts of the ovary account for 20% of ovarian neoplasms.
  • These are benign germ cell tumours composed of tissues derived from two of the three germ cell layers (ectoderm, endoderm, and mesoderm) like tooth, hair, sebaceous secretions, thyroid tissue etc.
  • Most of the dermoid cysts are silent and are incidentally detected; however some may be symptomatic due to large size resulting in compression of adjacent structures. Torsion or rupture
  • Characteristic sonographic appearances include
    1. Focal or diffuse hyper echoic component
    2. Areas of acoustic shadowing also known as “the tip of the iceberg “sign.
    3. Echogenic lines and dots also referred to as “the tip of the iceberg” sign. Rokitansky Nodule (hyper echoic component) corresponds to mixed hair and sebaceous material or calcification or bone or tooth.
    4. Floating Echogenic Globules within a large mass is an uncommon appearance.
  • Dermoid cysts of size >4 cm needs to be surgically removed for the risk of torsion.

Ultrasound in Fibroids – Leiomyomas (fibroids or myomas) are benign smooth muscle tumours with varying amounts of fibrous tissue and are the most common uterine neoplasm, reported in 20% to 30% of women over 30 years of age.

  • These are usually multiple, causing enlargement of the uterus with a lobular serosal contour and may present with
    • Palpable pelvic mass,
    • Uterine enlargement,
    • Pelvic pain,
    • Anaemia , and
    • Dysfunctional uterine bleeding depending upon their location and size.
  • Types of fibroids depending on the location are:
    • Intracavitary- fibroid located inside the uterine cavity.
    • Submucosal- fibroid located just beneath the endometrium.
    • Intramural- fibroid located in the uterine wall.
    • Subserosal– fibroid located on the outer surface of the uterus.
    • Pedunculated- fibroid attached to the uterus with a pedicle.
  • Approximately 5-10% of infertile women have fibroids. Their size and location determines whether fibroids affect fertility like sub mucosal or very large fibroids within the uterine wall.These are the basics of ultrasound in fibroids.
  • Typical features on ultrasound:

    • Heterogeneously enlarged uterus with lobular contour
    • Typically focal, well defined, round, sharply marginated, hypoechoic lesion within the myometrium or attached to it, often showing shadows at the edge of the lesion and/or internal fan shaped shadowing.
    • Hypoechoic, isoechoic, or echogenic relative to the myometrium. Majority are hypoechoic.
    • Small leiomyomas are typically homogeneous whereas those larger than 3 cm in diameter are often heterogeneous.
    • Surrounding myometrium can become compressed and form a pseudocapsule. Occasionally compressed lymphatics and vessels create a thin hypoechoic rim around intramural leiomyomas.
    • Edge refraction at the interface of the leiomyoma with the normal surrounding myometrium may help to identify an isoechoic leiomyoma.
    • Venetian blind artifact (shadows) – a sonographic finding typically associated with adenomyosis can also occur in uterine fibroids. The posterior shadowing may be dense or striated (comb-like). This is believed to be caused by the transitional zone between apposed tissues of different acoustic properties such as fibrous tissue and smooth muscle, as well as refraction from the edges of whorls and bundles of smooth muscle. Very helpful in differentiating an exophytic leiomyoma from an adnexal or ovarian mass
    • Peripheral blood flow on colour or power doppler images. fibroids appear as “ring of fire” on power doppler Fibroids which are necrotic or have undergone torsion will show absence of flow
    • Increased blood velocity and decreased RI and PI in both uterine arteries occur in patients with uterine leiomyomas compared to healthy volunteers .This feature may have predictable value in growth rate evaluation of a benign uterine mass.
    • Degeneration may result in oedema with cystic spaces, echogenic haemorrhagic areas, dystrophic calcification

Ultrasound in Endometriosis

  • Endometriosis is a condition in which endometrial glands and stroma are situated outside the uterus.
  • In this condition there is cyclical bleeding in the extra uterine endometriotic tissue which causes inflammation and pain during menses.
  • Endometriosis occurs on the surface of the ovaries, uterine suspensory ligaments, walls of the uterus, fallopian tubes, and the peritoneal surfaces of the pouch of douglas. Other sites can be vagina, bladder, cervix, intestines, caesarean scars, abdominal scars etc.
  • Endometriosis can be superficial with <5mm depth of penetration from surface or deep >5mm depth of penetration with fibrosis and muscular hyperplasia.
  • Ovaries are the most common sites of endometriosis and are frequently involved with multiple and bilateral lesions.
  • Classic sonographic appearance of an endometrioma (ovarian endometriosis) or chocolate cyst is homogenous and hypoechoic lesion with low to medium level echoes and no internal level echoes and no internal vascularity ie ground glass appearance.
  • Occasionally it can appear completely anechoic resembling simple ovarian cyst or fluid–fluid levels with thickened wall and mural or central calcifications.
  • Chronic endometrioma (long standing endometrioma) may mimic solid ovarian tumours.

That’s all about ultrasound in endometriosis.

Ultrasound in PCOS – Ultrasound is one of the criteria for the diagnosis of the polycystic ovarian syndrome (PCOS).

  • Polycystic ovaries are detected by TVS (Transvaginal sonography) in approximately 75% of women with a clinical diagnosis of PCOS (1).
  • TVS is a highly sensitive test for the identification of Polycystic ovaries.
  • Antral follicles are small follicles in the ovary ranging in size from 2-9 mm and grow over 10-12days in a menstrual cycle to select one dominant follicle which matures and releases the ovum.
  • An AFC(Antral follicular count) of more than 12 in one or both ovaries of size 2-9mm arranged either peripherally or diffusely with a dense increased Volume of ovarian stroma. (2)
  • The ovarian volume of greater than 10cm3 with no follicles measuring over 10mm in diameter is considered as PCOS.
  • Recent guideline say AFC >25 in one or both ovaries is considered as USG criteria of PCOS.(3)

References.

  • Gardener’s Text Book of ART 5th Edition Page 676
  • Clinical Endocrinology 1991
  • Human Reproduction update 2014; 20(3): 334-52

Normal Tubes on Ultrasound – Fallopian tubes are on either side of the uterus attached to it near cornua and the other end is free located adjacent to ovaries.

  • It has interstitial, isthmic, ampullary, and fimbrial parts. The interstitial end is attached to the uterus and the fimbrial end is free.
  • Fallopian tubes vary in length from 7-12cm.
  • Normal tubes are usually not visualized by ultrasound.
  • If there is a tubal pathology like hydrosalpinx in which tubes are blocked with an accumulation of fluid in them, they can be visualized on USG.
  • Cervix as seen on USG with a clear layer of mucus in the cervical canal is a favorable sign reflecting the good level of estrogen production.
  • The presence of free fluid in the pelvic cavity also can make the tubes visible.
  • As tubes are not normally seen on ultrasound hysterosalpingography (HSG) or Hystrerosalpingo contrast sonography (HyCoSy) is used to know the tubal patency.
  • Tubes are assessed during a basic USG scan on 2 days or 9 days of the menstrual cycle.
  • Few cysts like Paraovarian, para tubal cysts (cysts of Morgagni) and those adjacent to uterus, vagina & superior to hymen like Gartner’s duct cyst can be seen on routine scan in some patients.
  • Normal Uterus on Ultrasound – The uterus is a pear-shaped reproductive organ in a female of size 7cm in length and 4 cm in width in the reproductive age group.
  • Its size varies with the age and parity of the women.
  • The uterus has a body, cervix and two fallopian tubes one on each side.
  • It is either Anteverted (tilting forwards) or Retroverted (tilting backwards).
  • On USG uterine relation to surrounding organs like ovaries, bladder and bowels can be assessed.
  • Cervix as seen on USG with a clear layer of mucus in the cervical canal is a favourable sign reflecting the good level of oestrogen production.
  • An important aspect of fertility scan is the examination of the endometrium in the assessment of endometrial receptivity based on the appearance like triple layer with the minimum thickness of 7mm and increased blood ow on colour doppler studies.
  • On the 2 days of menstrual cycle i.e. D2 endometrial lining is thin as most of it is shed.
  • On the 9 day of menstrual cycle i.e. D9, the triple-layer pattern is seen due to a gradual increase in the thickness of the endometrium due to the effect of the hormone called oestrogen.
  • On the 21 day of the menstrual cycle i.e. D21 the endometrial lining is homogenous and thick due to the effect of the hormone called progesterone.

That’s all about normal uterus on ultrasound.

Normal Ovaries on Ultrasound:-

  • There are two ovaries on each side of the uterus in the ovarian fossa. They are oval in shape and with a mean volume of approx 4.9ml. The ovary often lies on the internal iliac artery and vein but does not maintain a consistent relationship with these vessels.
  • On the baseline, imaging ovaries are evaluated for normally expected findings and to screen any abnormality.
  • In the first half of the menstrual cycle (follicular phase) a normal ovary will demonstrate multiple Antral follicles which measures between 2-9 mm in maximum diameter, they are best evaluated on D2 or D3 of the menstrual cycle. Normal AFC is 5-10 in each ovary, if AFC is < 4 combined in both ovaries it is decreased ovarian reserve. If AFC > 12 in any / either ovaries it indicates polycystic ovaries. Normal stromal blood flow velocity is 6-12cm/sec.
  • In a natural cycle, a dominant follicle of size 17-24mm develops in one of the ovaries matures, and releases the egg (ovum) during ovulation.
  • On color Doppler, flow velocity tends to increase at and immediately after ovulation.
  • After ovulation, a corpus luteum is frequently seen during the second half of the menstrual cycle (secretory phase).
  • On power Doppler, it appears like a ring of fire due to increased blood flow.
  • The Corpus luteum appears as a round anechoic cystic mass with a homogenous, thick, moderately echogenic wall.

Procedure of Ultrasound

TAS:

The bladder should be almost full so the patient needs to drink more water.

Steps:

  • The patient is made to lie down on her back.
  • The abdomen is exposed with a bed sheet covering her legs.
  • USG is performed with a transabdominal probe after application of jelly on the lower abdomen.

TVS:

The bladder should be empty.

Steps:

  • The patient lies down on her back with legs flexed at the knee and hip joints and legs apart.
  • A transvaginal probe covered with jelly and probe cover is gently inserted inside the vagina and scan done.

The Procedure of Ultrasound – Benefits of Ultrasound:

To look for any disease of the uterus, ovaries, tubes and adnexa

  • Uterus: To look for size, shape, mobility, position, endometrial thickness, echogenicity of the endometrium and any masses in the uterine well. E.g. fibroids, polyps in the uterine cavity, adenomyosis. Color doppler for blood flow in the endometrium is done which predicts uterine receptivity.
  • Ovaries: To look for size, volume, AFC, any ovarian cysts like follicular cysts, encapsulated cysts, dermoid cysts, endometriotic cysts, ovarian tumors etc. Color doppler of ovarian dominant follicle gives an idea of quality of the oocyte.
  • Tubes: Normal fallopian tubes are not visualized in USG. If they are enlarged with fluid-filled in them as in Hydrosalpinx, they can be seen on USG.
  • Adnexa: Any masses like pedunculated fibroids, cysts. E.g. Paraovarian cysts.

Q- Why is ultrasound done?

  • To look for any disease in uterus, ovaries, tubes and pelvis. Which may cause Infertility.
  • Done to asses uterus for size position Anteverted (anterior tilting)/ Retroverted (posterior tilting)
  • Endometrial thickness (thickness of the uterine lining), Myometrium, cervix.
  • In Ovaries to look for size, volume and follicular number.
  • To look for any fluid in the pelvis (lower abdomen) which indicates infection or pelvic tuberculosis.

Q- How is it done?

  • It is done by two methods
    TAS (Transabdominal scan)
    TVS (Transvaginal scan)
  • TAS is done with full bladder abdominally;
    It is preferred in patients who have vaginismis, enlarged uterus or other pelvic masses.
  • TVS is done after emptying bladder by inserting probe gently inside vagina
    It is mostly preferred over TAS as it provides a clear view of the uterus, ovaries and other pelvic structure

Q- When it is done?

  • It is done usually with respect to fertility assessment on D2, D9 and D21. nd
  • D2 USG(2 day of the menstrual cycle ) is done to look for Antral Follicular Count (AFC)
    which predicts the fertility potential of the ovary and its response to treatment. Normal
    Antral Follicular Count (AFC) is 5-10 in each ovary of the size 2-9mm.
  • To look for any cysts (follicular, corpus luteal) from the previous menstrual cycle, endometrioma, dermoid cyst.
  • D9 USG(9 day of the menstrual cycle ) is done to look for Endometrial lining which is usually triple
    layered with good blood flow on using color Doppler, which indicates adequate Endometrial receptivity.
  • D21 USG(21 day of the menstrual cycle ) to look for secretory changes in Endometrium
    and rule out uterine anomalies.

Diagnosis of Infertility – Young minds and hearts which are jubilant and ecstatic with the thought of starting their families and having children are shattered by the news that they can’t become parents on their own.

Whom to talk to and share the news and ask for help is the prime concern of young couples. Privacy of their lives is breached and so are their dreams and aspirations.

Individuals react to the diagnosis of infertility differently and it is normal to ask ‘Why me?’ and to feel sad, angry, worried or just totally shocked. However, for most people, it is the momentous emotional impact that takes them by surprise.

In our experience, they react to the situation in different ways depending upon their social support, spiritual evolution, and surrender to the situation.

Couples may be shocked or surprised and pray that this is a wrong diagnosis. They may not know how to react or may become quiet and isolated.

Some of them become angry, frustrated and blame each other and God for what is happening to them. They repeatedly ask themselves and us – why it is happening to them out of all people known to them.

Latter on the feeling of isolation sets in, initially from immediate friends, latter families, and then from themselves.

Finally, a great sense of loss occurs next some with constant grieving with the thought of delayed parenthood. Occasionally the negative emotions become excruciatingly intense and substantially demoralizing.

Learning to recognize the impending negative emotional conflict is necessary and it is essential to understand that facing these paralyzing issues at the onset is essential.

Facing the problem together with an ethical guide in the form of a compassionate IVF specialist, having trust in the family, and maintaining optimal spiritual and physical health are the cornerstone of infertility treatment.

Keeping these in mind we would be regularly writing on this platform various emotional outcomes of infertility management and methods to lessen if not completely eradicate the stress associated with the infertility treatment.

 

चमत्कार! महिला के हाथ में तैयार होंगे अंडाणु

नई दिल्ली ।। डिकल साइंस के क्षेत्र में देश में एक बड़ी कामयाबी मिलने की उम्मीद पैदा हुई है। भारत में एक अहम मेडिकल प्रक्रिया के तहत डॉक्टर पहली दफा एक महिला को उसकी बांह के अगले हिस्से (फोरआर्म) में अंडाणु विकसित करने में मदद करेंगे। अगर यह सफलतापूर्वक हो जाता है तो इससे कैंसर या अन्य उपचार की वजह से बांझपन का शिकार हुए मरीजों को एक बड़ी सौगात मिल सकती है।

यहां के आर्मी हॉस्पिटल रिसर्च एंड रेफरल के डॉक्टरों ने कैंसर मरीजों के ओवेरियन टिश्यू (गर्भाश्य उत्तक) को सुरक्षित रखा है। इन टिश्यू को वे बाद में उनके अग्रबाहु या पेट में उस समय इंप्लांट करेंगे, जब इन्हें संतान पैदा करने की इच्छा होगी। इन मरीजों को ओवेरियन टिश्यू से अंडाणु (एग्स) विकसित करने में मदद करने के लिए दवाएं दी जाएंगी।

आर्मी हॉस्पिटल रिसर्च एंड रेफरल के लेफ्टिनेंट जनरल नरेश कुमार ने बताया कि आगामी जनवरी महीने में पहली दफा हम बांझपन की शिकार एक महिला के फोरआर्म की त्वचा के अंदर उसके ही सुरक्षित रखे गए ओवेरियन टिश्यू को इंप्लांट करेंगे। ऐसा अंडाणुओं को विकसित करने के लिए किया जाएगा, जो निकट भविष्य में उसे मां बनने में मददगार साबित होगा। उन्होंने कहा कि इस तरह का इंप्लांट देश में पहली दफा हो रहा है।

गौरतलब है कि कैंसर का इलाज करवाने, जिसमें कीमोथेरपी, रेडियोथेरपी और रेडिकल सर्जरी शामिल हैं, की वजह से हर साल अनगिनत महिलाओं में समय से पहले ‘मीनोपॉज’ और बांझपन की समस्या आ जाती है और वे मां बनने की उम्र में रहने के बावजूद संतान सुख से महरूम रह जाती हैं।

इस अस्पताल की एआरटी क्लिनिक में आईवीएफ (इन विट्रो फर्टिलाइजेशन) के विशेषज्ञ कर्नल पंकज तलवार ने बताया, पुरुषों और महिलाओं के लिए कैंसर बेहद दुखद हो सकता है, क्योंकि इसका उपचार उन्हें बांझ बना सकता है। इस महिला के मामले में हमने उसके ओवेरियन टिश्यूज को उसका कैंसर का इलाज शुरू होने से पहले ही सुरक्षित रख लिया। अब यह महिला कैंसर से पूरी तरह मुक्त है। हमलोग अब लोकल एनिस्थिसिया का इस्तेमाल कर उसके फोरआर्म की स्किन के अंदर ओवेरियन टिश्यू इंप्लांट करेंगे। अगर इसके कुछ दिनों के बाद इंप्लांट की गई जगह पर मटर के दाने के बराबर उभार या सूजन आ जाता हैं, तो हमलोग इस प्रयोग को कामयाब मानेंगे। इसके बाद हमलोग इस उभार वाली जगह से अंडाणुओं को निकाल लेंगे और तब महिला इन-विट्रो फर्टिलाइजेशन (आईवीएफ) तकनीक से गर्भधारण कर सकती है। इस पूरी प्रक्रिया में तीन से चार महीने लगने की उम्मीद है।

अभी तक इस तकनीक का इस्तेमाल कर पूरी दुनिया में सात-आठ शिशुओं का जन्म हो चुका है। इस अस्पताल के डॉक्टरों ने अभी तक दो युवा कैंसर मरीजों के टेस्टिक्यूलर टिश्यू, 53 लोगों के स्पर्म सैंपल और 13 ऐसे मरीजों के ओवेरियन टिश्यू को सुरक्षित रखा है।

New Tech to Grow Eggs on Womens Arm – Doctors at Army Hospital Research and Referral have found a procedure to help women cancer survivors conceive. Every year, cancer treatment causes premature menopause and infertility in thousands of women of reproductive age in India.

The eggs will be grown in a woman’s forearm, which, the doctors at the hospital claim, is a first-of-its-kind procedure in the country.

“In January we will transplant her preserved ovarian tissue under the skin of her forearm to harvest eggs, which will help her conceive in the future. This is the first time that this type of transplant is taking place in the country,” said Lieutenant General Naresh Kumar, commandant, Army Hospital Research and Referral.

The ovarian tissue of cancer patients will be preserved in the lab before treatment, which can later be grafted on their forearm or abdomen when they would want to have children.

“The tissue will be pre-tested to avoid the possibility of any cancer cells in them, and to help the ovarian tissue to produce eggs, specifics drugs will be administered to these women,” said lieutenant-general Kumar.

The procedure brings a ray of hope for many couples, as premature menopause and infertility is a potential side-effect of cancer treatments such as chemotherapy, radiotherapy, surgery, etc.

“The woman, who is cancer-free, will undergo surgery under local anesthesia, wherein we’ll implant an ovarian piece beneath the skin of her forearm. The eggs should develop after some days. She will notice a pea-sized lump at the transplant site, from where we’ll extract eggs later for in-vitro fertilization,” said Kumar.

That’s about the new tech to grow eggs on womens Arm. The entire process is expected to take three to four months and costs between R1.5 lakh to R2 lakh.

First Published: Dec 29, 2010, 01:27 IST