ICSI can be successfully used in patients with fertilization failure after conventional IVF. Failure can also occur due to low sperm count.

What is IVF?

  • I - In
  • V - Vitro
  • F - Fertilization
  • Fertilization of male and female gametes out side of the body.

Who need IVF? :

There are several indications for IVF. I t can be discussed under two heading mentioned below:

  • Female Indication for IVF
  • Bilateral tubal block
  • Primary ovarian failure
  • Long standing unexplained infertility
  • Severe endometriosis
  • Poor responding ovary with or without PCO

Male Indication for IVF

  • Severe Oligospremia: count less than five million per ml.
  • Severe asthenospermia: Motility less than 5%.
  • Teratozoospermia: normal morphology less than 10%.
  • Azoospermia: Absence of sperm in semen.
  • Obstructive azoospermia: Due to congenital absence of vas difference, failed vasectomy reversal etc.
  • Non Obstructive azoospermia: Use of surgically retrieved sperms from epididymus of testicle E.g. MESA, TESA, and PESA.

Who need IVF ICSI ?

  • Severe Oligospremia: count less than five million per ml.
  • Severe asthenospermia: Motility less than 5%.
  • Teratozoospermia : normal morphology less than 10%.
  • Azoospermia : Absence of sperm in semen.
  • Obstructive azoospermia: Due to congenital absence of vas difference, failed vasectomy reversal etc.
  • Non Obstructive azoospermia: Use of surgically retrieved sperms from epididymus of testicle E.g. MESA, TESA, and PESA.

Previous Poor Fertilization with IVF,

What is ICSI?

(Intra Cytoplasmic Sperm Insemination) Highly advanced skilful technique in which with the help of an Inverted microscope injecting a sperm by injecting pipette in to the ova under vision by an Experienced Embryologist.

What is surrogacy?

The current & more accurate term for surrogate is “carrier”. A surrogate is a woman who agrees to carry a pregnancy for another person or couple, called the intended parent(s).

What kind of woman become surrogates?

The typical surrogate is a woman in her mid 20’s to early 35’s married & the mother of her own children. Although compensated, surrogates generally provide their services to help other loving, committed couples experience the same joy they have as parents.

What will be the situation to become a surrogate?

To become a surrogate the woman should fulfill the following criteria:

  • Age between 21 & 35 years old.
  • A non smoker, on drug user who maintained a healthy life style.
  • Must have successfully carried at least one child of your own term.
  • In a stable living situation.
  • If married, have a spouse who’s supportive of your decision to become a surrogate mother.
  • Have a healthy, weight/height ratio.
  • Willing to give up caffeine, alcohol for the duration of the pregnancy.

What is the difference between gestational surrogacy & traditional surrogacy?

In gestational surrogacy, the surrogate is not biologically related to any resulting children. This type of surrogacy requires the use of a third party egg donor (either anonymous or known), and the procedure to establish the pregnancy is called”In Vitro Fertilization”. In traditional surrogacy, the surrogates own eggs are used to conceive the child, so she is biologically related to the resulting children.The procedure used to establish the pregnancy is generally referred to as “ artificial insemination”.

 


How can we evaluate an IVF center to be scientifically best?

  • Currently, there are no critical parameters set in India for approving an IVF lab which can directly lead to improved results. Ideally, IVF labs should have good bench incubators for separate culture of embryos, in house embryologist and freezing facilities (only Vitrification). Secondly, it is important to take care whenever possible to transfer embryo (Blastocyst) on the 5th Day. These can be the parameters of a ‘Comprehensive IVF Center’.


How modern instrumentation is leading to give birth to babies in minimum attempts?
It has been observed worldwide that center should have following instruments to decrease the attempts:

  • 0.3 micron clean air modular lab
  • Changing induction protocol by clinician in different patients
  • Triple gas bench incubators with time lapse techniques like Embryoscope through which you select best embryos for transfer.
  • Transfer of Blastocyst only in each patient, which is the primary responsibility of in-house Embryologist. Free lancing of embryologist usually leads non acceptance of this protocol.
  • Institute should have well experienced laparoscopic surgeon with advanced instrumentations in center.
  • Good freezing techniques set by international standards.
  •  Center should have Pregenetic screening / pregenetic diagnosis/ endometrial receptive assay.



Is male infertility equally important to focus upon compared to female infertility problems?

  • In today’s era, male infertility incidence is equally important to focus on as compared to female infertility.

 

  • For challenging cases of male infertility, an IVF specialist has to show dedication and focus to tackle the issue. Instrumentation required to bring out positive results will be always available in high end centers. Male infertility is usually difficult to treat in less equipped, less experienced centers without in-house embryologist.


Can a IVF institute give 100% guarantee programme?

  • After selecting certain factors, along with patient’s own egg & sperm per cycle, it is difficult to achieve more than 45 % to 55 % results. Egg donations & embryo donation usually leads to very high results. Surrogacy also has higher results.
  • Again, leading the discussion towards better facilities, to yield higher results, center should have all high end facilities and equipments. In IVF fraternity, it is always said that with experience & technology combined to transfer Blastocyst with a focus on latest and state of art freezing techniques, it is possible to achieve 90% results.


Is the egg retrieval process painful?

  • I would say ‘No’. It is only a 15 min procedure under short general anesthesia. The patient will be discharge the same day just after 2 hour of stay. Patient can do normal routine work after the surgery.


Is there a higher risk of birth defects with a child born from IVF?

  • Simple answer is ‘No’. It is a myth. Child born after IVF treatment is as good as normal.


Does the ovarian stimulation affect the store of eggs resulting early menopause?

  • More than 4 own egg retrieval may lead to a chance for an early menopause. Therefore, it is always better to choose IVF center which has all freezing facilities & which will give results in minimal attempts.


Does IVF significantly increase the chances of twins or triplets?

  • I would say ‘No, not anymore’. The medical stance of the CRG has always been to transfer only limited number of embryo as per statutory rules as well as principal goal is to restrict the numbers of embryos that will be transferred. Well, if a women who is under the age of 37 becomes pregnant through IVF , she has an almost 30% chances producing twins & if two embryos were transferred in that case there is a 5% of chances of triplets. Multiple pregnancy always increases the risk during pregnancy.


Is it sensible idea to freeze embryo for use at later stage?

  • IVF Center should be selected with all the state of art freezing techniques so that in future  need,  embryo transfer can happen.


How can we be sure that the embryo transferred to the womb are really our own?

  • A DNA print of a child after birth is the answer of it.


Facts of IVF

  • No complete bed rest is required.
  • Not more than 4 visits required to a distance center.
  • Success rate of IVF is not dependant on any season except in very hot summer > 40c
  • Patient can do their job during their treatment phase.



Do and Don’ts in IVF
Don’ts

  • Avoid heavy weight lifting.
  • Avoid bathing in swimming pool.
  • Avoid long distance journey.
  • Avoid unhygienic food.
  • Guard your body from minor infections.



Do’s

  • Patient can live normal life, can cook food, can do job, & no complete bed rest is required.



What is the relation between Age & IVF?

  • For patients with age >30, results by patient’s own egg are on a lower side. So if you desire to get pregnant by your own egg, don’t wait for long. Take the decision in the age group of 30 to 33.
  • Indian women are 5 year ahead in age comparison to European women.


To avoid recurrent failure, ask following few questions to your IVF doctor

  • • What are the main reasons for failure?
  • • Had they transfer blastocyst? If No, then why?
  • • What is the exact size of (7mm regular) of endometrium?
  • • Does the Consultant do PICSI/IMSI in male infertility?
  • • Does the institute have clean air IVF lab?

 


What are their views on egg quality with supported documents?

Q: Will the IVF technique damage my ovaries?
A: There is no evidence to suggest that either normal laparoscopy or ultrasound egg retrieval damages the ovaries. In fact, some reports in the medical literature suggest that following ovarian biopsy, pregnancies occur in couples with a long-term history of infertility.

Q: Will scar tissue around my ovaries make it impossible to retrieve the eggs?
A: Not ordinarily. The surgeon must be able to see the follicles in order to guide the needle to the proper spot for retrieval of the eggs whether by sonographic (ultrasound) or surgical methods.

Q: If an egg is not retrieved or if the technique does not produce a pregnancy on the first attempt, how soon can the procedure be repeated?
A: This depends on the individual. The primary reason for delay is to allow the patient's normal menstrual cycle to resume, which may take 2 to 3 cycles.

Q: How many times will IVF be repeated per couple?
A: There is no specific number. This is determined by the couple together with the physician.
 
Q: How soon will I know if I'm pregnant?
A: Pregnancy can be confirmed using blood tests about 13 days after egg aspiration. Pregnancy can be confirmed by ultrasound 30 to 40 days after aspiration.

Q: What drugs are given to stimulate the ovarian follicles and to maintain the lining of the uterus prior to implantation of the pre-embryo?
A: Four to five medications normally are given:
1. Leuprolide acetate (Lupron), an injectable drug that blocks secretions of the pituitary gland, thereby optimizing the number of oocytes retrieved;
2. Human menopausal gonadotropin (Pergonal or hMG) or Follicle Stimulating Hormone (Metrodin or FSH), hormones that stimulate ovarian activity, are injected daily for about 6-10 days prior to the procedure;
3. Human chorionic gonadotropin (hCG), a hormone that mimics the action of the hormone which naturally induces ovulation, is injected 34 to 36 hours before retrieval and may be used after retrieval to supplement natural progesterone production;
4. Progesterone, a natural hormone that enables the uterus to support pregnancy, may be used as a daily injection after egg retrieval; and micronized vaginal persance & vaginal gel will be a drug of choice.
 
Q: What side effects, if any, can these drugs cause?
A: No pronounced side effects have been associated with any of these drugs. However, the patient should inform the physician of ANY allergies she has or of any previous adverse reactions to drugs.

Q: Will I have an egg in every follicle?
A: It varies from patient to patient . As many as half of the follicles may not contain an egg in some patients.

Q: How much time does the entire procedure require?
A: Approximately three weeks (all as an outpatient). Fertility drugs are administered to stimulate the ovaries. Then during the four to six days prior to ovulation, the patient is monitored by ultrasound as well as by hormone levels.

Q: What happens to any extra pre-embryos?
A: A maximum of four pre-embryos will be transferred to the uterus for possible implantation. Patients will have several other options regarding the disposition of the remaining pre-embryos. One option is to freeze pre-embryos for your later use. Other options are to donate or simply dispose of them. Excess pre-embryos, if any, belong to you, and you will determine what is to be done.

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