In Vitro Fertilisation means fertilization of the eggs by sperms outside the human body in a laboratory Environment. This is done in an embryology lab and is popularly known as ‘Test Tube Baby’ though test tubes are not used.
In this procedure, the lady’s ovaries are stimulated with hormonal injections for 10 to 15 days and many eggs / oocytes are produced. When the eggs are optimum in quantity and quality as assessed by ultrasound and hormonal tests, the eggs are taken out from her body under anaesthesia with ultrasound guidance, transvaginally.
This is incubated along with husband’s sperms in the incubator and fertilization occurs. Later these embryos are graded and the best ones are chosen and instilled into the woman’s uterus. When the embryo implants successfully in the uterus, pregnancy occurs.
ICSI is the abbreviation for Intra Cytoplasmic Sperm Injection. The male and female gametes are brought together outside the body (In vitro). This method of ART is especially useful in male infertility.
The lady will be given hormonal injection as per her requirements from Day 2 of the menstrual cycle. This will enable the growth of adequate number of follicles which contains the eggs. On the day of ICSI, the lady will be given anaesthesia and the eggs will be retrieved by ultrasound guided vaginal aspiration. The retrieved eggs are prepared by special techniques.
On the day of ICSI, the husband is asked to give a semen sample. Semen is washed by specialized procedures, the seminal fluid removed and the better quality sperms are harvested. ICSI is done using the ICSI Microscope and Manipulator. The morphologically better sperm is selected and immobilized. This is then injected into the egg and kept in the incubator in specialized culture media. By doing this, several barriers of fertilization are overcome and fertilization occurs in almost all the eggs. Growth of the embryo is assessed periodically. Morphologically best embryos will be selected and they will be transferred to the woman’s uterus under ultrasound guidance on Day 3 or Day 5. After 2 weeks pregnancy test in blood will be done to confirm pregnancy. The remaining good embryos undergo a specialized procedure called freezing (vitrification).
Intrauterine insemination (IUI) is a procedure in which the semen is processed and the better quality sperms are harvested. This is introduced into the uterus through a fine catheter. By this, the distance between the sperm and ovum is reduced and it bypasses certain problems like sperm factor problems and cervical factor problems. For the above procedure
IUI procedure takes about 2-4 mins and it is painless. The success rate in IUI is two to three times more than in natural cycle.
Embryo freezing or vitrification is another feather in ART’s cap. It is a procedure by which the Day 3 or Day 5 embryos are frozen for future use. When it is thawed (defrozen) and embryo transfer is done, the success rates are as good as fresh embryos.
All the embryos are labelled, cooled and stored in liquid nitrogen containers.
It is a procedure where the embryos which are formed in vitro are placed into the uterus. A maximum of 2-3 embryos are transferred to avoid the risks of multiple pregnancies. It is a painless procedure done under ultrasound guidance. The embryos are graded and the best are chosen by the fertility specialists. These are then loaded in specialized catheters and introduced into the uterine cavity. During transfer Embryo glue is used to increase the implantation rate after transfer. The patient is then transferred to her room.
Semen freezing is a method by which the processed better quality sperms are frozen and are kept in liquid nitrogen tanks at –196C. It is useful in
For all patients who are undergoing ICSI a back up sample of semen collected and freezing is done to avoid any problems that could came on the day of egg retrieval. Screening tests (blood tests) for the male are done for infectious diseases, as they have to be kept in the liquid nitrogen tank along with other samples.
Egg donation is used when the lady (recipient) is not able to produce eggs on her own, but has the capacity to carry (bear) a pregnancy. In this, an appropriate donor is selected as per the recipients needs, usually under the age of 28. It is a common procedure used by many couples with good success rate.
The donor is screened and selected. She is then stimulated like any other IVF patient. Her eggs are retrieved transvaginally. On the day of egg pickup, the recipients husband gives the sperm sample to the lab. It is then processed and the better sperms harvested. Later ICSI is done with the donor egg and the recipient couple-husband’s sperms in the embryology lab. The embryos which are formed are assessed periodically and graded. These embryos are then frozen and at a later date when the recipient is ready, the embryo transfer is done.
A donor is a lady under the age of 28, has given birth to children earlier, has undergone all the screening tests, whose hormone values are normal.
Frozen Embryo transfer using donor Egg is done in ladies who have
Fertility Enhancing Endoscopic Surgery is done in order to evaluate and treat the lady for her problems related to infertility at one sitting using endoscopic (Key Hole Surgery) surgery. Both Laparoscopy and Hysteroscopy are done at one sitting in the postmenstrual phase for best results.
Hysteroscopy involves visualization of the uterine cavity using the hysteroscope and detecting problems like fibroid, septum, adhesions, etc. These can be treated hysteroscopically at the same sitting and uterine cavity can be restored to normalcy. Uterine shape problems like T-shaped uterus can be corrected by lateral metroplasty using the hysteroscpe.
Laparoscopy involves using tiny abdominal ports and visualizing the outer surface of the uterus, as well tubes and ovaries. Endometriosis, adhesions, tuberculosis can be detected. Any cysts in the ovaries can be removed laparoscopically. Fibroids can be dealt with and Endometriosis can be fulgurated and adhesions removed by adhesiolysis laparoscopically. In PCOS, ovarian drilling can be done when warranted
All these procedures done in one sitting helps in increasing the chances of the woman getting pregnant and is therefore called fertility enhancing endoscopic surgery.
Hystero salpingogram is a special radiological test to assess the uterine cavity and tubal patency. A radio opaque dye in instilled into the uterus in the postmenstrual phase and the flow of dye in the uterus and tubes is observed fluoroscopically or taken as an X-ray.
As a preliminary test, it is invaluable and the procedure is made painless using special methods. It is indicated in primary and secondary infertility. It is not done when there is allergy to the dye used, active genital infection or the lady is pregnant.
Sono salpingography is a specialized ultrasound procedure in which the uterine cavity and tubes are visualized after infusion of saline into the uterine cavity.
It can detect uterine problems like submucous fibroid, polyps, adhesions, septum etc. Tubal problems like tubal blocks, hydrosalpinx as well as tubal patency can be determined by this simple method.
Ultrasound of the uterus and adnexa i.e. tubes and an ovary comprises the Gynaec ultrasound. It is done transabdominally with a full bladder and also transvaginally.
Transvaginal ultrasound is of importance especially while evaluating the lady for infertility and following her up during treatment. It can assess growth of the eggs, endometrium etc. and helps in monitoring and guiding treatment for infertility
Follicular Monitoring is doing serial scans transvaginally in a lady who has been stimulated to produce follicles (which contains eggs). It is done to assess the growth of follicles in that particular cycle. It enables the Doctor to adjust the dosage of medicines being given to bring about the optimum growth of Endometrium and eggs. It is done in all women planning for an IUI or ART Procedure.
This is a procedure done when there are no sperms in the semen ( Azoospermia) where obstruction could be the cause. The following methods can be used for surgical extraction of sperms.
a) PESA : Percutaneous sperm aspiration is done and sperms aspirated from epididymis by the specialist.The aspirate is checked by the Embryologist under the microscope and ICSI is done using the extracted sperms.
b) TESE : Testicular sperm extractions is a method used to take sperms directly from testis and it is checked by the Embryologist under the microscope and ICSI is done using the extracted sperms
Fertilization rate after ICSI done with the above type of sperm extracted is around 90%. This is less than routine IVF because male pro nucleus problems occur during fertilization.
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