Infertility Services

We are an infertility clinic providing most advanced and comprehensive infertility services under one roof. The centre is staffed with a team of highly trained and dedicated professionals.

The fertility services provided by us include;

• IUI (Intra Uterine Insemination)
• IVF (In Vitro Fertilization)
• ICSI (Intra Cytoplasmic Sperm Injection)
• PESA/TESA (ICSI with testicular sperms)
• Egg Donation
• Embryo Donation
• Male Infertility
• Semen Banking
• Psycho-sexual Counselling

In addition to providing most modern and advanced scientific technology our aim is to give full moral and emotional support to our patients so that they are able to understand the complexities of sub fertility and various fertility treatments.

We providecomplete work of infertile couple, which includes basic and hormonal investigations, tests of sperm function, tests of ovulation and tubal patency, diagnostic and operative laparoscopy and hysteroscopy.

The centre is equipped with state of the art embryology laboratory and is stringent in its choice about best quality disposables and culture media, while providing strict quality control.

We also provide the services of egg donation and embryo donation which are a boon to many couples whose eggs or uterus have been adversely affected by age or disease.

We try to help the couples struggling with sub fertility to attain their goal by providing detailed information and helping them to make various choices. This will enable them to become parents while making adequate utilization of their time and financial resources.

IVF (In Vitro Fertilization)

The process of union of egg and sperm is called fertilization. It is one of the beautiful wonders of nature and occurs inside the fallopian tubes of woman. In a finely orchestrated sequence, the fertilized egg then travels to the uterus and getts settled there as the early embryo, which leads to the begining of pregnancy.

However in some couples, these steps fail to occur in natural way. IVF is a specialized method which comes to the rescue of such couples and helps them to achieve conception.

The process of IVF estencially involves the formation of a large number of eggs which are removed from the ovary and union with sperms occurs outside the body. The embryos thus formed are transferred to the woman's uterus to achieve a normal pregnancy.

INDICATIONS OF IVF :

• Tubal Problems - a woman's fallopian tubes are blocked or damaged, which could be due to infection, tuberculosis, previous tubal pregnancy, endometriosis, tubectomy.
• Severe endometriosis which affects tubal function, fertilization as well as implantation of embryo in the uterus.
• Unexplained infertility - where conception fails to occur inspire of both partners being healthy and all tests being normal.
• No pregnance after repeated cycles of IUI.
• Patients who stop having regular menses or those whose eggs / ovaries are damaged by surgery or disease, can became pregnant by IVF using donor eggs.
• Prolonged infertility of any cause not responding to routine treatment.
• Infertility in women with age more than 40 years or after menopause.

PROCEDURE :

• The basic investigations of the coupl are done including semen tests, ovarian and uterine cavity assessment.
• The patients is given daily injection of fertility hormones (hMG/FSH) for 8-12 days which lead to the development of eggs in ovaries. Injections can be taken at home or self-administered. Patients visit the centre 3-5 times during these days when the formation of eggs is checked by ultrasound.
• Laser injection for final maturation of eggs (human chorionic gonadotrophin) is given when the follicles have reached optimum size.
• Eggs are removed 34-36 hours after the last injection.
• The process of egg retrieval or collection orf eggs is done under sedation and anaesthesia so as to cause no discomfort to the patient. The eggs are removed from the ovary by using a needle attached to ultrasound probe.
• The eggs are placed close to sperms so that union of egg and sperm takes place. Embryo are formed which start dividing and became 4 to 6 cell. At this stage, 2-3 healthy embryo are placed inside the uterus.
• Pregnancy is confirmed by a blood test done 14 days after the embryo transfer.
• The pregnancy thus conceived is just like any other normal pregnancy and does not require any special precautions or bed rest.

 ICSI

Intracytoplasmic sperm injection ( ICSI) is a laboratory procedure developed to help infertile couples undergoing in vitro fertilization(IVF) due to male factor infertility. Normaly in IVF, each egg is mixed with about a lakh sperms and one of the sperms enters the egg on its own . In ICSI, a single live sperm is injected in the egg by a special machine called the micromanipulator .

Indication of ICSI

• " Very low number of sperms (less then 5 million),very poor motility."
• " Severe teratospermia .
• " Problems with sperm binding to and penetrating the egg."
• " Antisperm antibodies thought to be the cause of infertility."
• " Prior fertilization failure with standard IVF methods."
• " Frozen sperm limited in number and quality."
• " Obstruction of the male reproductive tract not amenable to repair. Sperm may then be obtained from the epididymis by a procedure called microsurgical epididymal sperm aspiration (MESA), or from the testes by testicular sperm aspiration (TESA)."
• " Males with ejaculatory dysfunction due to spinal disease or injury "
• " Retrograde ejaculation"

The procedure

The initial investigations of the couple and hormonal injections to produce a large number of eggs are the same as in conventional IVF. After the eggs are collected and identified by the embryologist, the outer layer of cells around each egg, known as the cumulus oophorus is removed so as to view the egg clearly. The eggs should be at a mature (M2) stage. The procedure is done under a microscope using micromanipulation devices (micromanipulators, microinjectors and micropipettes ). A holding pipette on the left stabilizes the mature oocyte. From the opposite side a thin, hollow needle is pierced through the oolemma and into the inner part of the oocyte. It is loaded with a single sperm that will be released into the oocyte. The oocyte is checked on the following day for signs of fertilization.

The goal of ICSI

The goal of performing ICSI is to minimize the risk of fertilization failure. At our centre ,we are using ICSI back up to ensure fertilization in cases of unexplained infertility also.When sperms are in reduced number or have abnormal morphology and motility, the function of the sperm can be significantly impaired. ICSI overcomes these problems by placing a single sperm within the egg.

Facts about ICSI

Fertilization occurs in 50%to 80% of injected eggs. Approximately 30% of all ICSI cycles performed result in a live birth . Younger patients may achieve even more favorable results.
The wonder of ICSI lies in the fact that it allows many infertile couples to become parents of their own genetically -related children, as an alternative to Donor Insemination or adoption.

PESA / TESA

INTRODUCTION

Today with the availability of intracytoplasmic sperm injection techniques , it has become possible to achieve fertilization and pregnancies with only a few spermatozoa or even in men who produce no spermatozoa in the ejaculate. But in men with Aspermia (inability to ejaculate) and in men with Azoospermia (absence of sperm in ejaculate ), sperms have to be obtained by some sperm retrieval technique prior to ICSI. Retrieval of sperms may be done by non-surgical or surgical methods.

AZOOSPERMIA

Absence of sperms in the ejaculate is known as azoospermia and this may be obstructive or non obstructive in etiology

METHODS OF SPERM RETRIEVAL

1. Percutaneous Epididymal sperm aspiration (PESA)
2. FNA of testis (TESA)
3. Open testicular biopsy (TESA)
4. Microsurgical Epididymal sperm aspiraton (MESA )

PESA ( percutaneous Epididymal sperm aspiration)

Indications
1. All cases of obstructive azoospermia with normal spermatogenesis e.g. Congenital bilateral absence of vas deferens.
2. Failed vasectomy reversal.
3. Ejaculatory dysfunction
4. Spinal cord injury
5. Retrograde ejaculation

TESA (TESTICULAR SPERM ASPIRATION )

Indications
1. Obstructive azoospermia (CBA VD)
2. Failed vasectomy reversal
3. Partial testicular atrophy

TESA

Indications
Non obstructive Azoospermia

PROCEDURE OF SPERM RETRIEVAL

Sperm retrieval of husband is done on the same day when wife's eggs are retrieved . Under local anaesthesia or mild sedation, needle is introduced through the scrotal skin and sperms aspirated . Antibiotics and pain killers are given and the patient can go back home after a few hours.

Gamete (Egg & Sperm) Donation & Embryo Donation:

Facilities for gamete donation are available. Detailed screening of the donor is carried out prior to his/her acceptance into the program. Anonymity of both the do nor and recipient is maintained.

Donor insemination (Dl)

All donors are very carefully screened for sexually transmitted disease, Hepatitis B & C. A detailed history is obtained to rule out current or past disease and inherited disorders. Donors are matched as closely as possible for physical characteristics to the male partner of women receiving the donor sperm. Donor anonymity is maintained as per ICMR regulations/ ART bill.

Egg Donation

Some women are unable to produce their own eggs due to hormonal deficiency, genetic predisposition or other medical conditions. Others choose to have egg donation because they carry a genetic illness, which may be passed on to any babies born or they have poor quality eggs or recurrent miscarriages. Through egg donation these women have the opportunity to give birth. The patient receiving the donated eggs (the recipient) is treated with hormones to prepare the lining of the uterus to receive the embryos. Eggs are recovered from the donor who has to go through ovarian stimulation to form multiple eggs and then these are recovered under anaesthesia under ultrasound guidance. The entire procedure is carried out vaginally. The sperm from the recipient's husband is used inseminate the eggs (either by IVF or the ICSI technique). The resulting embryos are transferred two/three day later to the recipient's uterus.

Embryo Donation

Some couples for a variety of reasons, are unable to produce their own genetic gametes (i.e. sperms or eggs) in such cases both donor sperms and donor eggs can be used to produce a donor embryo. The woman uterus is prepared with hormonal tablets to receive the embryo.

Indications of ovum donation :-

• Many women get married at a late age or postpone their child bearing because of reasons of education and career. However, the biological clock shows its effect in the form of decreased quantity and quality of eggs. This effect is marked after 35 years of age and more so after 38 years. The probability of having pregnancy even by IVF /ICSI decreases at 38-40 years of age. After around 42 years the chances of having a healthy live birth with own eggs are virtually negligible. However, using the help of donor eggs, women of even higher age can conceive and have a baby.
• Younger women with poor ovarian reserve and raised FSH levels. Some women stop having regular menses at a young age . These ladies with premature ovarian failure can have their own child by means of ovum donation.
• Women whose eggs have been damaged by tuberculosis, endometriosis and previous surgery on the ovary.
• Women who have produced less (less than 4) eggs in previous IVF attempts and formed poor quality embryos.
• Ovary damaged by radiotherapy or chemotherapy for cancer.
• Carrier of major chromosomal disorders can opt for ovum donation so that the genetic disorder is not passed on to the offspring.
• Egg donation can be offered to women who have had multiple cycles of failed IVF using own eggs.

Selection of egg donors

Eggs are borrowed from healthy women less then 35 years of age who are not suffering from any medical or genetic disorder. They are screened for infections like HIV, Hepatitis B and C. Married women with one or two kids are preferred as they have proven their fertility. History of caesarean section or tubectomy in the past does not pose any problem and women can still donate their eggs. Ovum donors are usually a relative or friend of the recipient. Ova can also be taken from healthy young volunteers. Egg sharing with other women undergoing IVF cycle is also encouraged after taking consent from both the donor and recipient.

The procedure

After the basic investigations of ovum donor have been done, the menstrual cycles of donor and recipient are synchronized with medicines. The donor has to visit the OPD about 4-5 times, when she is given injections for formation of multiple eggs in the ovaries. The injections and procedure of egg removal are the same as in IVF with self eggs. The eggs of the donor are removed with a needle under mild anaesthesia there is no stitch or bleeding and she can go back from the hospital after 4-6 hours.
The eggs are fertilized using IVF or ICSI. At the same time , the recipient receives medication so that her uterus is well prepared to receive the embryo. Embryo transfer is done in the recipient after ~ 48 hours .

Egg donation is thus a boon to many women who otherwise cannot hope to have a pregnancy using their own eggs.