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ABOUT INFERTILITY
 




Infertility is defined by the World Health Organization as the inability to conceive after more than two years of unprotected intercourse. Worldwide, 10-14% of couples in the reproductive age group face difficulty in conceiving. However, if the woman is more than 35 years old, she should consult an infertility specialist if she has not conceived within a year of trying. Both male and female factors contribute to infertility. About 40% of infertility cases are due to a male factor problem while 40% are due to problems with the female partner. The remaining are due to a combination of male and female factors. The main causes of infertility are -



 

MALE FACTOR INFERTILITY

Poor sperm quality, quantity or both

Absent Sperm (Azoospermia)

Problems with sperm motility

Immunological factors

FEMALE FACTOR INFERTILITY

Blocked fallopian tubes

Ovulation problems

Endometriosis & other pelvic factors

Cervial factor
Immunological factors




DIAGNOSIS OF INFERTILITY

Before starting any form of infertility treatment, medical examination of both the partners is essential. During the initial consultation we may recommend:

Blood Tests
These will aim at checking basic reproductive hormones like TSH, Prolactin, FSH and LH, serum Insulin. In special circumstances we may ask for more sophisticated hormonal testing.

Internal Examination and Vaginal Sonography
An ultrasound scan would help us establish the normalcy of the pelvic organs. A gynecological checkup would give us additional information regarding the readiness of the uterus for pregnancy and would also help to diagnose pathological conditions.

HSG
HSG stands for hysterosalpingogram and is an X-ray, which outlines the uterus and fallopian tubes. It shows if the tubes are open and also indicates the shape of the uterus after injecting a dye through the cervix (mouth of the uterus).

Sperm Test
Analysis of the semen is important to rule out male factor as a cause of infertility. A detailed analysis of the count and motility and morphology of the sperm is carried out.

Follicular Fluid FISH
This test was started in April 2002 for the first time in the world by our Department. At the time of egg retrieval during IVF, the cells which surround the egg within the follicular fluid are subjected to genetic test using fluorescence in situ hybridization. No extra injections are required to be taken by the women in order to perform this test. We have performed this test on more than 1000 follicular fluid samples in women undergoing IVF/ ICSI. We find this a very useful test to predict the possibility of miscarriage in women who have more than 5% mosaicism in the follicular fluid cells. This test is useful for women with repeated failed IVF, repeated miscarriages, those with chromosomal problems and advanced maternal age.

 
 
 
 
 
 
Infertility – Treatment option
 

Depending on the type of infertility that has been diagnosed, several options can be offered to couples. Treatment modalities could include either of the following procedures and even a combination of procedures:

 

Intrauterine Insemination (IUI)

   

It is the direct placement of washed sperm into the uterus as close to the ovulated oocyte as possible in an attempt to achieve a pregnancy.

 

 

In vitro Fertilization (IVF)

   

In vitro fertilization involves the collection of mature eggs from the woman's body. In this, the oocyte and a calculated number of sperm are Incubated together in a petri dish in culture medium allowing fertilization to take place. This is followed by transfer of the fertilized embryo into the woman's womb.

 

 

Intra Cytoplasmic Sperm Injection (ICSI)

   

Intra Cytoplasmic Sperm Injection (ICSI) is a delicate but effective technique, which involves the injection of a single sperm into each egg using a glass pipette which is many times thinner than human hair. This improves the fertilization rate and offers hope to patients with severe male factor infertility. The invention of Intracytoplasmic Sperm Injection (ICSI) has revolutionized the treatment of male infertility by achieving high rates of fertilization in patients who previously would have had little hope of conceiving.

 

 

Laser Assisted Hatching (LAH) { Will available soon }

   

Prior to implantation, the embryo has to escape out of its protective shell known as the zona pellucida by a process known as hatching. If this process is not completed properly, implantation will fail and a pregnancy will not occur. We offer the Laser technology for Assisted Hatching (LAH), where a laser beam is focused over the zona pellucida making a small opening, between 10-20 microns to facilitate embryo hatching. This technique is particularly useful in cases where the embryo has a thick zona and also in cases with previous failed cycles.

 

 

IBlastocyst Stage Culture

   

A blastocyst is an embryo that consists of more than 100 cells. It is at the blastocyst stage of development (5 days after fertilization) that an embryo would normally move out of the fallopian tube and into the uterus. Once in the uterus, the blastocyst starts to attach to the uterine lining in a process known as implantation. Using newly developed culture media, a higher implantation rate has been observed by some scientists following transfer of blastocysts (50%), compared to day 3 (25%) embryo transfer. However we believe that correct preparation of the uterine lining is more important than the stage at which the embryos are transferred.

 

 

Endoscopic surgery (Laparoscopy & Hysteroscopy)

 

Laparoscopy is a procedure that allows the doctor to look directly at the uterus, fallopian tubes, ovaries, appendix, and other organs through keyhole surgery. Operative laparoscopy enables the surgeon to correct defects in the genital organs and remove tumors & cysts in the uterus, fallopian tubes and the ovaries without the patient undergoing an open surgery. This technique is known as "minimally invasive surgery" and involves minimal discomfort to the patient. This technique is helpful in the presence of adhesions, endometriosis, pelvic tuberculosis, fibroids, ovarian tumors and cysts and in intestinal conditions such as appendicitis.

Hysteroscopy is a procedure, which allows the doctor to visualize the uterine cavity from within. Operative hysteroscopy enables the surgeon to correct defects within the uterine cavity. This technique is very helpful to treat intrauterine septum, adhesions and myomas with minimal discomfort to the patient.

 
 

PESA/TESA/TESE

 

We offer surgical sperm retrieval techniques for men who suffer from azoospermia (no sperm in the ejaculate). Percutaneous Epididymal Sperm Aspiration (PESA) / Testicular Sperm Aspiration (TESA) / Testicular Sperm Extraction (TESE), are procedures in which sperm from men with azoospermia can be removed from the epididymis or the testis and used to fertilize eggs by ICSI. These techniques are utilized in conditions of obstructive and non-obstructive azoospermia.

 
 
 
 
 
 
Preimplantation Genetic Diagnosis (PGD) { We Don’t have facility for PGD }
 
   

Preimplantation genetic diagnosis (PGD) is an early form of prenatal diagnosis. It allows genetic analysis to be performed on early embryos by NEGATIVE SELECTION of the affected embryos prior to implantation, thereby allowing couples to achieve pregnancies through IVF with reduction or virtual elimination of the risk of certain genetic diseases in their offspring thereby bringing them hope of healthy babies.

 

 

The objectives of offering PGD are :

 

  • It increases the chances of implantation
  • It reduces the chances of spontaneous abortions and chromosomal abnormalities in babies.

 

PGD helps to improve pregnancy rates and decrease spontaneous abortion rates in:

   

    • Older age women
    • Women with previous unsuccessful IVF attempts
    • Women with recurrent spontaneous abortions
    • Women who have had to undergo repeated terminations because of abnormality diagnosed on PND
    • Known carriers of genetic defects
    • Racial and Ethnic association to specific diseases (B-Thalassemia,Sickle cell

     

 

 
 


 
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