INFERTILITY

Female infertility

IUI

During an intrauterine insemination (IUI) procedure, sperm is placed directly into the uterus using a small catheter. The goal of this treatment is to improve the chances of fertilization by increasing the number of healthy sperm that reach the Fallopian tubes when the woman is most fertile.

IUI can be helpful for:

  • Couples experiencing infertility due to medical conditions (e.g., endometriosis or low sperm count or quality).
  • Couples with unexplained infertility.
  • Same-sex female couples using donor sperm.
  • Single women wishing to start a family with donor sperm.

IUI is a widely used treatment option because it is a minimally invasive, lower-cost alternative to in vitro fertilization (IVF), and it can be conveniently performed in our clinic.

IUI Treatment: What to Expect?

At your initial consultation, you will meet with one of our fertility specialists to review your medical history and your family building goals. We will then order diagnostic tests, such as a saline infusion sonogram (SIS) or a hysterosalpingogram (HSG), to make sure your fallopian tubes are open and your uterus appears normal. This information is important to help us to know what fertility treatment will be most beneficial for you.

IUI treatment is performed during an ovulation cycle. Most commonly, patients will take a fertility medication, such as Clomid, to stimulate ovulation. We will prescribe your medication and monitor you closely with regular ultrasounds and bloodwork to determine the best time for your insemination procedure.

Once your ovulation window is determined, your partner will provide a sperm sample to our andrologists, or if you are using donor sperm, the andrologists will prepare the sperm sample provided by the third-party agency. We will then perform a special technique called a sperm wash on the samples in the laboratory to obtain the best quality sperm.

Your IUI treatment will take place at our office in Green Spring Station. During the procedure, your doctor will first insert a speculum to view your cervix (opening to the uterus), somewhat like having a Pap smear. Then, we will insert a small tube — specially designed for IUI — to place the final semen sample into your uterus. The process takes only a few minutes and is generally painless. Some women experience mild cramping during the procedure and spotting for one to two days after the procedure. You can return to your normal daily activities, including intercourse, after the procedure.

Two weeks following IUI, you will take a pregnancy test to see if the procedure was successful. If you are pregnant, we will monitor your pregnancy closely via blood work and ultrasound. If your test is negative, we will prepare for a new treatment cycle or consider other treatment options.

IVF

The birth of Louise Brown through in vitro fertilization (IVF) on July 25, 1978 in UK by the pioneering efforts of Patrick Step-toe and Robert Edwards dramatically increased public awareness of clinical alternatives for infertile couples. Today, new techniques for assisted reproduction are evolving rapidly by leaps and bounds like never before in history of mankind. For many couples who have exhausted traditional clinical and surgical treatments for infertility, these techniques may offer the best hope for having pregnancy. Through these procedures many couples with otherwise untreatable infertility have given birth to healthy babies.

1) What Is IVF Or In Vitro Fertilization?

In Vitro Fertilization (IVF):

“In Vitro” literally means outside the body. In-Vitro Fertilization (IVF) is a method of assisted reproduction in which fertilization takes place outside the body of a female. Normally fertilization occurs within the fallopian tube and the developing embryo is then transferred through the tube to the uterine cavity in three days by cilliary movements of the cells lining the tube. In IVF, an environment is provided such that the union of the egg and sperm takes place in a petri-dish or test tube under artificial culture conditions in the IVF laboratory. If fertilization occurs, the resulting embryo is transferred to the woman’s uterus, where it will hopefully implant in the uterine lining and mature. IVF is a reasonable treatment of choice for couples with various types of infertility.

2) What Are The Indications For IVF Treatment?

Following are the indications for IVF treatment:

  • Female indications:
  1. Tubal factor infertility- tubal blockage, hydrosalpinx, absent tubes, tubal adhesions
  2. Ovarian factor- resistant cases of polycystic ovaries (PCOD), tubal and ovarian adhesions, premature ovarian failure
  3. Endometriosis
  4. Cervical factor infertility
  5. Unexplained infertility
  6. Immunological infertility
  • Male indications: These are indications for IVF-ICSI
  1. Low sperm count (oligo-zoospermia)
  2. Decreased sperm motility (astheno-zoospermia)
  3. Abnormal sperm morphology (terato-zoopermia)
  4. Techniques requiring surgical retrieval of sperms (TESA, PESA, TESE, MESA)

3) How IVF Treatment Is Performed?

IVF is a stepwise treatment. Basic steps of IVF treatment are:

1. Down regulation 2. Controlled ovarian hyper stimulation 3. Egg retrieval or ovum pick up 4. Insemination, fertilization and egg culture 5. Embryo transfer

  1. Controlled ovarian hysperstimulation (COH) or Super-ovulation:
    During ovulation induction, ovulation induction drugs, also known as fertility drugs are used to stimulate the ovaries to produce several mature eggs rather than the single eggs that normally develop each month. IVF specialists agree that the chances for pregnancy are better if more than one egg is fertilized and transferred to the uterus in a treatment cycle. Drug type and dosage vary depending on the patient profile and the stimulation protocol used. Most often the ovulation inducing drugs are given for a period of 10 to 12 days. Ovulation drugs currently in use include clomiphene citrate, human menopausal gonadotrophins (HMG), pure FSH, or recombinant FSH. These drugs may be used alone in combination with others. Clomiphene citrate is given orally while others are given by injections. Usually these injections are started from second or third day of menstrual cycle. Ultrasound is done frequently during treatment cycle to monitor the response of ovaries to the drugs. Drug dose is modified according to the response of ovaries, number and size of developing ovarian follicles which contain eggs. Blood samples are taken to measure the serum levels of estrogen. Normally, estrogen production increases as the follicles develop. Through the use of ultrasound and blood tests, the infertility specialist can determine when the follicles are almost mature. The patient is then given an injection of human chorionic gonadotropin (HCG) for final maturation of the follicles. The HCG replaces the woman’s natural LH surge that would normally trigger ovulation in approximately 36 hours. This allows the IVF team to determine the appropriate time for retrieval.
  2. Egg retrieval or ovum pick up:
    Egg retrieval is accomplished by one of the two methods. The first, transvaginal ultrasound guided aspiration, is a minor surgical procedure that is performed under light anesthesia in ovum pick up operation theater which is attached to the IVF laboratory. During this procedure the surgeon guides a small needle through vagina into the ovarian follicles. The eggs (oocytes) are aspirated from the ovarian follicles through the needle with the help of aspiration pump which is set at particular pressure. These collected eggs are then transferred to IVF lab for fertilization. Another method of egg retrieval is through laparoscopy, but this invasive method is not used now days.
  3. Insemination, fertilization, egg culture:
    Once the eggs are retrieved, they are examined in the IVF lab and each one is graded for maturity. The maturity of oocytes determines when the sperm will be added to it (insemination). Insemination can be performed immediately after the oocytes are collected, after several hours or on the following day. On the same day, sperm preparation is done i.e., semen is collected by masturbation, washed and processed, to get rid of the particulate matter and dead sperms by performing the sperm washing procedure. This process helps in obtaining morphologically normal and viable sperms for in-vitro insemination. In the process of insemination, sperms and eggs are put together in a petri-dish or in a test tube containing IVF culture medium and placed in an incubator under controlled environment to allow fertilization. Optimum culture conditions for sperm-egg interaction are provided in the laboratory/culture room for fertilization and embryonic growth. Fertilization usually takes place in 16 to 18 hours after insemination. About 12 hours after fertilization, the fertilized oocyte (embryo) divides into two cells. The embryo may divide several times while in the incubator. The result of successful fertilization is the growth of an embryo to 2, 4, 8, 16-cell stage embryo, morula and blastocyst, which are transferred into the uterine cavity for implantation to successful pregnancy. After 44 to 72 hours, the two to eight cell embryos are ready to be transferred into the woman’s uterus. Usually one to three embryos are transferred depending on the grade of embryo, cell stage and uterine conditions. Remaining embryos are vitrified or cryofreezed for future use. Another new technique, assisted hatching, is sometimes helpful for women who have undergone IVF previously and have not conceived or for older women undergoing IVF. Assisted hatching is a technique performed after fertilization in which the zona pellucida is thinned or interrupted either chemically or mechanically to facilitate the release of the embryo from the zona. This technique may, in some cases, improve implantation in the uterus.
  4. Embryo transfer:
    The next step in the
    IVF process is performed on an outpatient basis. No anesthesia is necessary, although some women may wish to have a mild sedative. Using a speculum the IVF specialist exposes the cervix and passes a catheter loaded with the embryo in to the uterine cavity. The embryo is now transferred in to the uterine cavity.

ICSI

ICSI is intracytoplasmic sperm injection. Male infertility is mainly due to no sperms, low sperm counts, diminished motility and high percentage of abnormal sperm count. Intracytoplasmic Sperm Injection (ICSI) is the answer to tackle male infertility and failed fertilization in IVF. In ICSI, a direct injection of a single spermatozoon in a mature oocyte is carried out with help of micromanipulator under inverted microscopic guidence. Semen of male patients is washed and a single sperm, which is morphologically normal, is selected and injected in the oocyte with a very fine needle. Rests of the basic steps are similar to IVF.

Surgical Retrieval Of Sperms For ICSI :

(In patients with azoospermia due to vassal or epididymal blocks) When semen analysis shows absent sperms but testicular biopsy shows production of sperms in testes then various surgical sperm retrieval techniques are used to retrieve the sperms from testes or the collection system. ICSI treatment is done with these surgically retrieved sperms to achieve the pregnancy. These techniques are

  • Testicular Sperm Aspiration (TESA)
  • Testicular Sperm Extraction (TESE)
  • Percutaneous Epididymal Sperm Aspiration (PESA)
  • Microepididymal Sperm Aspiration (MESA)
  • Vas Deferens Aspiration (VDA)
  • Spermatocele Aspiration

1) How Much Is The Success Rate Of IVF –ICSI ?

Success rate of IVF-ICSI

The success of conception and pregnancy depends on causes of infertility in a couple, age of female partner, number and grade of embryos transferred, experience of treating doctors, IVF lab standard and many other factors. In our center, the rate of fertilization with ART is 90 to 100% with 45 to 55% pregnancy having attained with ICSI, practically over-ridding male factor. 45 to 55% is the current rate of pregnancy in our center with IVF -ICSI procedures. This success rate is comparable with worldwide success rate of IVF-ICSI. There is of course no specific age limit for couples who may be considered for IVF-ICSI in our center, but as per ICMR guidelines pregnancy is not advocated after the age of 50 years for female partner.

2) What Are The Causes Of Failure Of IVF-ICSI?

Following are the causes of failure of IVF-ICSI in infertile couple:

  • Female Age: : female age is very important in fertility outcome. As the age of female increases, the oocyte number decreases and oocyte quality deteriorates. Some genetic changes also occur in ageing oocytes, that affect the fertilization rates.
  • Poor oocyte quality:some patients have poor quality oocytes, that gives defective embryos, which does not grow after embryo transfer
  • Uterine factors: Some uterine factors like congenital uterine malformations, uterine fibroids, endometrial polyps, infections can cause failure of IVF treatment.
  • Poor endometrium: In some patients the endometrial lining of uterus may be thin or defective due to previous uterine infections( tuberculosis most common), surgeries, etc. This hampers implantation of embryos, even if the embryos are of best quality.
  • Severe male factor infertility: Severe semen abnormalities like poor sperm motility, structurally abnormal sperm defects
  • Unexplained causes: Ultimately pregnancy is a natural phenomenon. Even if all fertility factors are apparently normal, we get best quality embryos, the success rate is in the range of 45 to 55% at present, in the best IVF centers in the world, in a single treatment cycle. There might be undetected factors in the couple that cause failure of pregnancy after IVF-ICSI cycle or it could be a natural outcome.
  • Emotional stress and lifestyle causes: The couple, particularly female, may be under tremendous stress during treatment of IVF. Excessive emotional stress may cause hormonal imbalance, leading to failure of pregnancy. Patient should try stress relaxation exercises like yoga, meditation, regular exercise and proper counseling before and during treatment.
  • Laboratory standards: Our IVF center is maintained adequate laboratory environment favorable for fertilization and culture of gametes and embryos. Also, experience of the IVF center, treating fertility specialists and biologists matters.

Male infertility

1) What Is PESA / TESA?

  • PESA – Per cutaneous Epidermal Sperm Aspiration,A fine needle is passed into the tubes leading out of the testicles and sperms are retrieved.This is done under suitable anesthesia.
  • TESA – Testicular Sperm Aspiration.A fine needle is passed into the testicles and sperms are retrieved.This is done under suitable anesthesia.

2) IS PESA / TESA For Me?

These procedures are used for obstructive azoospermia and vasal aplasia.

3) How Is PESA / TESA Sperm Used?

Sperm retrieved using PESA/TESA can be used to attempt to achieve a pregnancy using an assisted reproduction technique called intracytoplasmic sperm injection (ICSI). In order to perform ICSI, the female partner will need to undergo routine ovulation induction and egg collection (egg collection is usually performed on the same day as the PESA/TESA). Sperm that has been isolated during a PESA/TESA can then be injected into the eggs collected from the female partner.

4) What Is The Success Rate Of This Procedure?

In vitro fertilization (IVF) treatment using PESA/TESA sperm is a commonly performed procedure and has similar success rates to routine IVF.

Book Appointment