Head of Department - Vandana Bansal
What is Infertility?
Infertility is usually defined as inability of a couple to conceive a child despite trying for one year of unprotected intercourse. The inability to conceive after one or more successful pregnancy is called secondary infertility.
Pregnancy is the result of a chain of events. In the middle of the menstrual cycle an egg is released from one of the ovaries (ovulation). The egg must travel through the fallopian tube towards the uterus (Womb). If sexual intercourse occurs, man’s sperm must join with (fertilize) the egg along the way. The fertilized egg (embryo) travels down the fallopian tube towards the uterus and attach (implant). While this may seem simple, in fact many things can happen to prevent pregnancy from occurring.
What cause infertility in women?
Infertility in women are mainly because of hormonal problems and factors that can effect cervix, ovary and tubes, problems with ovulation account for most infertility in women. Simple lifestyle factors-including stress, diet or athletic training – can affect. Ageing and obesity decline fertility chances. Other problems that can also lead to infertility in women are irregular cycle, fallopian tubes which are blocked at one or both ends, endometriosis, fibroids or abnormally shaped uterus.
What causes infertility in men?
Infertility in men is often caused by problem of sperm production or getting the sperm to reach the egg. Problem with sperm may exist from birth or develop later in life due to illness or injury. Some men produce no sperm or produce too few sperm. Lifestyle can influence the number and quality of a man’s sperm. Alcohol and drugs can temporarily reduce sperm quality. Environment toxins, smoking, injury etc. may cause some cases of infertility in men.
Which partner is responsible?
- 40% are related to the women ( Female factor)
- 40% are related to the man ( Male factor)
- 10% are due to couple problem ( Male-female both)
- 10% have unknown causes (Unexplained factor)
Preliminary Investigation of Infertility:
In addition to a complete physical and gynaecological examination any or all of the following tests may be required
Routine blood tests in addition to screening of infection such as sexually transmitted diseases.
Hormone Assessment of the Female:
Serum LH, FSH, Prolactin, E2, Cortisol, T3, T4, TSH etc. gives vital information to decide the course of treatment.
X-Ray of the fallopian tubes and Uterus after they are injected with dye.
A laparoscope is inserted into the abdomen to view the organs to reveal any abnormal growths on the outer surfaces of the reproductive organs and is also useful to check tubal patency.
Inside views of the uterine cavity and cervix can show growths or other abnormalities inserted through the cervical opening. This procedure is done just after menstruation to obtain the clearest view of the uterine cavity. It is a day-care procedure.
A count of the male partner sperms to see and evaluate cause of infertility. It tests the overall appearance, acidity / alkalinity and volume of the semen, measures the sperm concentration, motility, viability and morphology.
Antibodies are the body’s natural defence against foreign objects. Sometimes a woman’s immune system can recognize her partner’s sperm as foreign body and develop antibodies against them. Men can even develop antibodies against their own sperm!
Treatment may include medication or surgery, 80 to 85 percent of infertility cases are treated with drugs or surgery. Others may require Assisted Reproductive Techniques (ART). Sometimes combination of treatment is necessary to correct the problem. Investigation reports will also guide which line of treatment will be most beneficial keeping in mind medical history, age, duration for infertility etc.
ART (Assisted Reproductive Techniques):
- Intra Uterine Insemination (IUI)
- ICSI (Micromanipulation)
- GIFT / ZIFT
- Oocyte Donation
- Laser Assisted Hatching
Artificial Insemination (IUI):
This procedure relies on the natural ability of sperm to fertilize an egg within the reproductive tract. The sperms from male partner is collected then washed in the lab to improve motility and concentrated sperms are then placed in the uterus using a thin catheter inserted through the cervix during the most fertile time in the menstrual cycle.
IUI is often recommended foe women or couples who:
- Have ovulation problems and are undergoing ovulation induction
- Are unable to have normal intercourse
- Have mild male factor infertility
- Have unexplained infertility
Donor Sperms are used only when male partner have abnormal semen report. The procedure is simple and does not require anaesthesia or hospitalization.
In Vitro Fertilization / Embryo transfer (IVF-ET):
IVF is a technique where eggs are retrieved from women’s ovaries and fertilized by husband’s sperm outside the body in a controlled lab environment. The fertilized eggs then develop into embryos which are deposited into the woman’s uterus by the procedure of embryo transfer.
In short IVF procedure consists of:
Controlled Ovarian stimulation
Monitoring of follicles and egg development
Oocyte or egg retrieval under short anesthesia
Fertilization of the egg with the sperm
Embryo formation 2 to 5 days after fertilization
Which patient will benefit?
There are several groups to whom IVF treatment may be advised that include:
- Women with blocked, damaged fallopian tubes or inoperable tubes or whose tubes have been removed after ectopic pregnancies.
- Women with endometriosis
- Men with infertility problems
- Men or women with immunological infertility problems
- PCOD or unexplained infertility
- Repeated failure of IUI
Egg Pickup & Embryo Transfer (ET):
This procedure is carried out under aseptic conditions through the vagina by ultrasound guidance under mild anesthesia. A needle is inserted into the ovaries through the back wall of the vagina. The follicles are aspirated and the eggs are immediately identified in the culture room. The eggs are then inseminated with washed motile sperms of the husband and placed in the incubator for fertilization to take place. Embryos take 48 hours to develop into 4 cell stage and the best 1-3 embryos are placed in the uterine cavity of the female partner. Embryos are usually placed in the wife's uterus 2 or 3 days after egg retrieval, often under ultrasound guidance.
Patients are advised rest for 14 days at home, no admissions in the hospital is required. A pregnancy test after 14 days is recommended.
Oocyte Donation is for women whose ovaries are not functioning or have been surgically removed. In this procedure another women will be the egg donor. The donated eggs will be fertilized with sperm of the husband of the recipient woman. The embryos are then transferred in uterus of the recipient.
IVM (In Vitro Maturation) - new ART procedure:
In vitro egg maturation or IVM - Instead of removing fully mature eggs from the ovaries and then fertilizing them, IVF Specialists remove immature eggs, ripen them in a lab dish, then add sperm. Rest of the procedure is same as IVF, time required for stimulation is reduced greatly. This may be particularly useful for women who suffer from polycystic ovarian syndrome, a hormonal disorder that disrupts ovulation.
Intra Cytoplasmic Sperm Injection (ICSI):
Also known as micro manipulation. The Approach to male fertility management has changed over the last few years. Patients who had compromised semen samples had to undergo years of medication and surgical maneuvers and only few patients benefited. Now with advancement of ART techniques, a conventional method of treating male infertility has been replaced by ICSI, a proven and wholly acclaimed scientific procedure. This revolutionary technique performed by us has given fresh hope to many men whose chance for fathering their own children were slim.
ICSI is indicated when few sperms are available or no sperms are available or IVF is not possible or unexplained fertilization failure or low fertilization in previous IVF cycles. 90% of patients with azoospermia can be benefited by ICSI after confirming the presence of sperms in the testicular biopsy.
In this procedure, eggs are retrieved (as in IVF) from the female partner and under an inverted microscope each egg is injected with a single sperm isolated from the male partner's semen or by sperm collected from testis (TESA/MESA) . This is done as an adjunct to IVF
Assisted Laser Hatching:
Assisted Laser Hatching may help couples who have had many attempts of assisted reproductive procedures without success, Embryo implantation is one of the greatest barriers to success in “In Vitro Fertilization” (IVF) cycle. When Embryos are transferred into the woman’s uterus, they are covered by an outer coating called the Zona Pellucida. Once the embryo to be able to “hatch”, a necessary step for implantation. In certain situations, this step is less likely to naturally occur in women of higher age, women with elevated serum FSH levels and women who have failed to achieve a pregnancy in a prior IVF cycle. A hole is created with the use of a laser beam in the Zona of the embryo before it is transferred to the uterus. It facilitates improved implantation and increases the chances to pregnancy.
It has been proved that growing embryos In Vitro for a longer period allows selection of best embryos and there is a better chance of implantation if these embryos are transferred 5 days following ovum pickup. It also increases pregnancy rate and reduce chances of multiple pregnancy.
Freezing of embryos allows significant chance of pregnancy after single ovarian stimulation. The excess good quality embryos can be stored cryogenically for future initiation of pregnancy without having to go through super ovulation and egg collection all over again.
Latest in Cryopreservation is Vitrification Technique. This facility is available only in few centers of India. The advantage of Vitrification is that there is no ice crystal formation the survival chances of vitrified embryos are higher compared to conventional cryopreservation methods. Post thaw vitrified embryos have greater chances of survival and thus resulting in a greater pregnancy outcome, initially; embryos are kept for five years but can be extended to ten years.
The Embryo Bank:
Many of today's modern couples choose to start a family later in life. Embryo Banking allows these couples the chance to freeze embryos and delay starting their families until the time is right.
Also, during the IVF process many couples naturally produce an embryo surplus. Freezing surplus embryos until future cycles can circumvent additional egg retrievals.
We maintain dedicated Semen Bank. The male partner’s sperms are routinely frozen for cryopooling and for IVF. The bank contains frozen from voluntary donors with various backgrounds and physical characteristics to match with the individual needs. Donors are screened thoroughly to rule out transmission of any infectious or genetic diseases. We ensure close confidentiality for both the donor and the recipient.
There are some women whose ovaries function normally but the uterus is absent, diseased or unable to carry pregnancy to term. In such cases, couples can have their own embryos transferred into a healthy surrogate mother through IVF procedure who will then carry the pregnancy to term.
There are several factors which affect the ART outcome such as patient’s age and the variety of abnormalities, which are causing the basic infertility. Success rate of a centre represents the number of pregnancies achieved out of the total number of cases performed over a period of time. Over the years our rate of success has increased exponentially. Our success rate has gone up beyond 50% in last 3 years. It depends upon cause of infertility, age of female partner, response to ovarian stimulation, semen quality and grading of embryos.
For more details please visit:http://www.arpitivf.com