Question : What is freezing of embryo ?
Answer : Before 2007, freezing of embryos was done with slow freezing, where embryos are put in the media and subjected to progressively decreasing temperatures sequentially. However, it didn’t yield more than 20% success rate. Besides, freezing was time-consuming and there was unavailability of dedicated in-house embryologists. Since 2008, Vitrification, a new technique for freezing, was well accepted. Vitrification ensured minimal damage to the embryos because of lack of ice-crystal formation. Moreover, the embryos had a far higher recovery rate and survival rate after Vitrification, resulting in higher pregnancy-rate.

 

Question : Why does freezing give more results and what is the need for freezing?
Answer : If Vitrification department of any IVF center isn’t up to the mark, it’s impossible to give more than 30-35% results among three fresh cycle attempts. When the hormonal stimulation is done in women for Ovum pick-up, multiple follicles release high amount of estrogen, decreasing the chances of success. Good freezing protocol is must in any IVF clinic. At WINGS, we recommend freeze-all embryos to almost 85% of our patients.

 

Question : What is the success rate In Freeze-Thaw embryo transfers?
Answer : The tentative success rate is 55%, always more than fresh embryo transfers. Success rates will be around 95% we have enough embryo to transfer thrice, Apart from the reduces cost of treatment, there’s no agony of multiple hermonal stimulations and needle pricks.

 

Question : What are the tangible benefits of frozen embryo transfer?
Answer : There are less chances of chemical pregnancy and ectopic pregnancy, apart from reduced costs and less mental agony. Such patients have babies with higher birth weight and lower prematurity.

 

Question : What is IVF?
Answer : IVF means In Vitro (Greek means “outside body”) Fertilization. It is also called test tube baby treatment.

 

Question : What are the incications of IVF?
Answer : In Females: Bi-lateral tubal block. Long-standing infertility with 3 IUI failures. Premature ovarian failures where ovary is not ftmctioning. Certain cases of PCO (Poly Cystic Ovary) WI has failed to give results. Multiple abortions with associated genetic In Mdes: long-standing infertility with normal semen analysis. Less than 10 million count and less than 10% motility in semen analysis. 0% count in semen analysis.

 

Question : What is the right age to IVF?
Answer : Fòr females, the AMH levels depict the fertility power (more important than age). If AMH levels are less than 2.0, then individualized approach is However, I have noticed that the AMH levels are interpreted in a wrong manner in many cases and the clinical diagnosis with 2nd 3rd day Transvaginal Sonogram should be co-related with the results. If the follicle count is less than 7 in both ovaries, then IVF is the choice of treatment. Cases of age above 35 years or/and married life of 10 years with infertility should be considered for IVF.

 

Question : What do you mean by success rate in IVF ?
Answer : Success rate in IVF suggests the positive pregnancy rates after transferring 2-3 Grade-1 embryos in the uterus in each attempt. Transferring embryos in the same cycle immediately after pick-up will never increase the success rate of IVF on continuous basis. It varies anywhere between 35 to 45%. However, freezing the embryo and transferring in the natural cycle two months after the ovum pick-up can ensure more than 60% results. The success rate may also increase depending on the level of experience and technical excellence of the organization.

 

Question : Does IVF ensure 100% success rate in a single attempt?
Answer : Such claims are totally misleading. In a single attempt, in which embryos are transferred in the same cycle as ovum pickup, one can expect about 30-40% Success rate can be enhanced by improving embryo freezing technique and using those embryos after a few months to avoid the need for repeated ovum retrieval procedures. Embryo freezing has multiple advantages. A couple with surplus frozen embryos can directly go for a transfer cycle and avoid all the costs involved with injections given for ovarian stimulation and also anesthesia given for a repeat ovum retrieval procedure. It is unscientific to think that one needs a certain number of attempts for ovum retrieval for 100% success guarantee. One should undergo IVF at a center that pursues scientific approach and uses feozenthawed embryos in an optimal way

 

Question : Is bed rest compulsory after undergoing IVF?
Answer : This widely believed perception is unscientific and illogical. Some people also blame insufficient bed rest for failed results, unnecessarily causing guilt in the patient’s mind. Rest can be actually harmful and has absolutely no role in determining the success of an IVF cycle.

 

Question : What should be avoided in IVF treatment?
Answer : Multiple attempts at ovarian stimulation and ovum pick-up and ignoring freezing embryos is avoidable. Also, transferring many embryos in the same (fresh) cycle and not freezing those is a big mistake. Certain centers transfer more than four or five embryos together, which can have serious side effects like multiple pregnancy and obstetrical problems. In Europe or the USA, they perform transfers with very less number of embryos, sometimes only one! We routinely freeze most of the embryos in our patients and transfer not more than two in a single attempt. This ensures minimal obstetric complications and equivalent or better pregnancy rates.

 

Question : What is IUI? When should one do it?
Answer : IUI involves placing sperm inside a woman’s uterus after ovulation to facilitate fertilization. In today’s time the following scenarios might require it: Unexplained infertility for less than five years. Anovulatory cycle which includes irregular menstruation. Male sub-fertility having more than 10 million count.

 

Question : What’s the percentage of successful results in IUI?
Answer : Evidence based medicine suggests that in case of IUI, the results do not increase more than 18-20%.

 

Question : How many times ca IUI procedure be repeated ?
Answer : IUI procedure should not be conducted more than three times. Else, it may affect the ovarian reserve which may eventually lead to negative outputs in case of IVF attempts. Moreover, it has been proven in medical literature that it is not cost-effective to do IUI more than three times as chances of success after three attempts of IUI are very slim. If IUI would really help a couple conceive, the result are mostly seen in the first three attempts itself. So it is not advisable to keep trying IUI when three or more attempts with IUI have already failed.

 

Question : What can one expect in an IUI cycle?
Answer : Intra-uterine insemination is basically inducing ovulation with oral tablets or injections, assisting rupture of one or two mature follicles and inserting healthy, motile sperms from the husband in uterine cavity. Results are best when gonadotropin injections are given for folliculogenesis and when the patient selection is appropriate.

 

Question : When should one avoid IUI?
Answer : In case of male infertility cases with less than 10 millions count and less than 10% motility. Less than 4% morphology in semen analysis. AMH levels less than 2.5 in female partner. Age of more than 35 years of female partner and infertility period more than 10 years. When both tubes are blocked. Moderate to serve endometriosis. In above case IVF is the choice of treatment.

 

Question : What is Recurrent IVF Failure?
Answer : In females, where endometrium is more than 7 mm and three grade-I embryo transfers (fresh or frozen) turn out with negative results, these are recurrent IVF failure cases. There is no strict guideline by any recognized body to ascertain whether the embryos are grade-I or not, which can confuse clinicians.

 

Question : How can recurrent IVF failure be prevented?
Answer : 1. Individualized controlled stimulations (administering ovarian stimulation on specific needs of each patient, depending on the pathology) 2. Better selection of the gametes-eggs and sperm by a senior embryologist and advanced techniques like IMSI. 3. Freeze all or freeze more embryo approach. 4. Better selection (8 to 10 mm thickness) as well as optimization (receptivity) of the endometrium (Uterine Lining) during embryo transfer

 

Question : How can one treat cases of recurrent IVF failure?
Answer : The treatment focuses on parameters like day 5 embryo (Blastocyst) transfer, day 5 Embryo (Blastocyst) vitrification and transferring after two months in natural cycle and use of third party donations, when required. These measures, taken judiciously, can solve 90-95% of recurrent failure cases.

 

Question : Which advanced techniques can tackle recurrent IVF failure cases?
Answer : DNA fragmentation test for semen analysis is the most important parameter. Using IMSI technology for better sperm selection and time lapse technique for better embryo selection are the technologies for such cases. PGS is an advanced tool to determine the causes of genetic impact on failures, thereby assisting in finding out better genetic qualitative embryo transfer.

 

Question : Would freezing all embryos be the future approach to treating recurrent IVF failure?
Answer : Better freezing technique by an experienced embryologist will always be better in certain cases, like PCO and poor responder, where freezing all embryos will definitely prevent the IVF failures.