In-Vitro Fertilisation (IVF)

vitro-fertilisation-ivf

Why Columbia Asia India?

  • Columbia Asia Hospitals is an international health care group that brings its entire bouquet of services, highly qualified doctors practicing internationally benchmarked standard protocols, excellent nursing services in very modern surroundings with hospitality, a key aspect of service delivery.
  • The department combines 'best quality of care'with 'contemporary technology', ethical practices and multi-disciplinary care, all under one roof. A dedicated clinic committed to providing couples and individuals who are experiencing difficulties conceiving with excellent quality, professional and confidential services, is the hallmark of this service.
  • Quality is integral to everything done, hence we observe the highest standards in all procedures and services.
  • Every couple receives a tailor-made plan of consultation, monitoring, investigation and treatment which is specifically and sensitively designed to provide the greatest chance of success.
  • To provide the best and timely care, we are available seven days a week. We monitor patients carefully using hormonal assays and scans, detect slightest changes which will impact the choice of medication or timing of treatment. It is this attention to detail and dedication that contributes to the best outcomes with a positive experience for couples going through this very emotional and trying experience

What is infertility?

Infertility is a condition of the reproductive system that prevents conception of children and is defined as failure to conceive after 12 months or more of regular unprotected sexual intercourse. About 80 % of couples who are regularly trying for a baby get pregnant within a year. An estimated one in seven couples has difficulty conceiving and women are usually less fertile as they get older.

What is assisted reproduction?

This is a terminology used to describe the different treatment options available to help those who have difficulty in conceiving a child naturally. These options usually involve handling and manipulation of eggs and / or sperm in the lab to carry out simple procedures like artificial insemination / intrauterine insemination (IUI) or more advanced procedures including in-vitro fertilisation (IVF), intra-cytoplasmic sperm injection (ICSI) and various other treatments.

What is the aim of the treatment?

Detailed assessment and management of couples with:

  • Sub fertility
  • Recurrent miscarriage
  • Recurrent implantation failure (repeated IVF failure)
  • Polycystic ovarian syndrome (PCOS)
  • Other reproductive and endocrine problems related to infertility
Diagnostic Services For The Female

Base line investigations

  • Clinical assessment
  • Hormonal assays: Hormones produced by the hypothalamus, pituitary and ovaries play a key role in ovulation. Abnormalities in other hormonal or organ systems may also contribute to infertility. A blood test measures the level of various hormones at different times of a woman’s menstrual cycle.
  • Ovarian reserve testing includes blood tests and a transvaginal scan to assess the quality and quantity of eggs
  • Cycle monitoring involves tracking the release of an egg

Tubal assessment

  • Hystero-contrast- salpingo-sonography (HyCoSy scan) and saline infusion sonography (SIS for uterine cavity assessment): This is an outpatient procedure sometimes requiring sedation, where the fallopian tubes are tested by passing a special fluid through the cervix under transvaginal ultrasound guidance. This is much less comfortable than an HSG and allows you to continue trying for a pregnancy in the same cycle. SIS is a similar procedure to assess the womb cavity.
  • Hysterosalpingogram (HSG): This is an outpatient procedure sometimes requiring sedation where the fallopian tubes are tested by passing a special fluid through the cervix under radiological guidance.
  • Laparoscopy, dye test and hysteroscopy: A laparoscopy is a procedure to check the fallopian tubes along with the woman’s pelvic organs. It is a minimally invasive procedure in which a telescope called laparoscope is inserted through the abdominal wall to visualize the fallopian tubes, ovaries and uterus to exclude problems such as endometriosis, fibroids, ovarian cysts and adhesions (scar tissues). Many infertile couples require a diagnostic laparoscopy for a complete evaluation of their infertility. This is usually done as a day care surgery under general anaesthesia. A hysteroscopy is a procedure where the telescope is passed into the uterus at the same time to assess the inside of the womb. A coloured dye (methylene blue) is then passed through the cervix. If the tubes are not blocked, the dye will pass through and spill into the abdomen

Advanced investigations

  • Genetic testing: It is a blood test that looks at a person’s DNA or genetic information. It may also be ordered to diagnose various congenital or inherited syndromes This may be recommended if you have repeated IVF failures or miscarriages.
  • Immunological assessment: Dysfunction of the immune system could contribute to infertility and pregnancy loss. Blood tests related to the immune system may help to diagnose a problem.
Diagnostic Services For The Male

Baseline investigations:

  • Clinical assessment
  • Detailed semen analysis
  • Hormonal assays: hormones produced by the hypothalamus, pituitary and testicles play a key role in sexual development and sperm production. Abnormalities in other hormonal or organ systems may also contribute to infertility. A blood test measures the level of testosterone and other hormones.

Scrotal and transrectal ultrasound:

A scrotal ultrasound can help to visualize obstructions or other problems in the testicles or supporting structures. In a transrectal ultrasound, a small, lubricated tube is inserted into the rectum and helps visualize the prostate, and look for blockages of the tubes that carry semen (ejaculatory duct and seminal vesicles).

Post-ejaculation urinalysis:

Presence of sperm in the urine indicates sperms are travelling back into the bladder and instead of out of the urethra, during ejaculation (retrograde ejaculation)

Genetic testing:

When sperm concentration is extremely low or sperms are absent, genetic causes are often suspected. A blood test can reveal whether there are any subtle changes in the Y chromosome or the cystic fibrosis gene. Genetic testing may be ordered to diagnose various congenital or inherited syndromes.

Sperm DNA fragmentation test:

is a specialised test done on a semen sample to assess breakage or lesions in the genetic material of the sperm.

Testicular biopsy:

This test involves removing samples from the testicles to detect if sperm production is normal. If it is, the problem is likely to be due to obstruction or blockage or problems of the sperm transport

Ovulation Induction And Follicle Tracking

Hormonal tablets or injections are given to the woman to induce ovulation. The response to the medication (growth of follicles in the ovaries) is monitored by hormonal tests and serial ultrasound scans.

Intrauterine Insemination (IUI)

It is a treatment modality where a prepared sample of stronger sperm is inserted into the uterus using a fine plastic catheter, close to the time of ovulation. Additionally, the woman is in some cases, given medication to help her ovulate.

IUI is useful if:

  • You are having difficulty with intercourse
  • Unexplained infertility of relatively short duration
  • Minor problems with the semen samples
  • Mild endometriosis (a condition in which cells that normally line the womb are found elsewhere in the body)
  • You are using a donor sperm
In-Vitro Fertilisation

It is a technique where a woman’s eggs are removed from her ovaries and fertilised with the man’s prepared sperm sample in the lab. The woman is given medication to stimulate the ovary to produce several eggs. These are removed by trans-vaginal ultrasound guidance under anaesthesia requiring a few hours of hospitalization. The eggs and sperm are then allowed to fertilize overnight in a petri dish in the lab and develop in the incubators for 2-6 days. The best embryos are then put back into the uterus to achieve pregnancy. Additional good quality embryos, if available, are frozen for future use.

IVF is indicated when:

  • The female partner has blocked or damaged fallopian tubes and the egg and sperm may not be able to meet or the fertilised egg may not be able to make its way into the womb.
  • The female partner has problems with ovulation (release of an egg) each month
  • The female partner has endometriosis
  • Unexplained infertility where no cause has been found for not being able to conceive, especially when couples have been trying to get pregnant for more than two years.
  • Failed IUI
Intracytoplasmic Sperm Injection (ICSI)

It involves injecting a single sperm into each egg, in the lab to try and achieve fertilisation. The earlier part of the treatment including ovarian stimulation and egg retrieval is the same as in IVF.

ICSI is useful when:

  • The sperm sample contains decreased numbers of sperm, reduced movement or there is a higher number of abnormal sperm.
  • The male partner has no sperm during his ejaculation but sperm can be obtained from the testicles, by surgery
  • The male partner produces high levels of antibodies against his own sperm which affects the ability of the sperm to bind to the egg
  • Couples have already had IVF treatment but had unexplained failed fertilisation of all the eggs or low fertilisation
  • The male partner has retrograde ejaculation, where the sperm passes backwards into the bladder and is found in urine
Blastocyst Transfer

A blastocyst is an advanced stage of an embryo that has developed 5-6 days after fertilisation in the alb. In IVF and ICSI embryo may be transferred into the uterus between two to six days after fertilisation. A blastocyst transfer is done in selected cases for better embryo selection.

Embryo Freezing And Frozen Embryo Transfer

Embryo freezing is carried out when excess and good quality embryos are available. The frozen embryos can be thawed and used for embryo transfer in subsequent cycles without the need for ovarian stimulation and its associated complications.

Micro-Surgical Sperm Aspiration

PESA-percutaneous epidydimal sperm aspiration, TESE-testicular sperm extraction, mese-microsurgical epidydimal sperm extraction. These are surgical procedures carried out by the andrologist on the male partner, if he is azoospermic, to aspirate or extract sperm to carry out ICSI to achieve a pregnancy. Azoospermia is a condition where no sperms are present in the fluid a man ejaculates. A man might have azoospermia because of a blockage in the connecting passages from the testicles-called obstructive azoospermia or very few sperms or no sperm produced in the testicles called non-obstructive azoospermia.

Other Treatments

Assisted hatching (AH):

It is a procedure to assist the embryos to escape from its shell, so that it can implant into the woman’s uterus. It is recommended in special cases like poor quality of eggs/ embryos or repeated IVF failures

Cryopreservation of semen, eggs and embryos:

This is a process where wither eggs, sperm or embryos are frozen for future use, using a specialized process in the lab

Pre-implantation genetic screening, pre-implantation genetic diagnosis (PGS, PGD):

It is a specialized treatment for couples who carry an inherited genetic defect that could cause serious health risks for their children, such as cystic fibrosis, sickle cell disease or thallaesemia. This involves taking cells from the embryo and assessing their chromosomes or genes by very specialized procedures to select embryos, without specific condition, prior to embryo transfer

Donor program for semen, eggs and embryos:

In some couples, a pregnancy cannot be achieved or there is a very low likelihood of a pregnancy with their eggs and sperm. In such cases, the options of donor sperm, egg or embryo can be considered.

Surrogacy or gestational surrogacy:

This is an arrangement where a woman called the surrogate mother, carries and delivers a child for another couple. In gestational surrogacy, an embryo is implanted into the surrogate mother’s uterus to achieve a pregnancy. The surrogate mother is not genetically related to the baby. In traditional surrogacy, the surrogate woman can give her egg and the baby grows in her uterus and she is therefore related genetically to the baby

Fertility preservation: eggs and sperm can be frozen for future use, if men or women are diagnosed with cancer and are due to undergo treatment that could damage their fertility. Women may also choose to freeze their eggs to delay having a child.

Treatment of immunological problems related to infertility:

Dysfunction of the immune system could contribute to infertility and pregnancy loss. Indeed, many pregnancies/ IVF cycles fail because of chromosomal abnormalities in the embryo. These defects occur randomly and are not always the cause of recurrent pregnancy losses and repeat IVF failure, especially in younger patients.

Surgical management of female subfertility:

It includes laparoscopic ovarian drilling, adhesiolysis, salpingectomy for hydrosapinx or ectopic pregnancy, laparoscopic or open myomectomy, laparoscopic cystectomy, hysteroscopic tubal cannulation, hysteroscopic polypectomy, hysteroscopic fibroid resection etc.,

Surgical management of male subfertility:

Surgical sperm retrieval techniques, varicocelectomy, repair of obstructed vas deference etc.

Treatment for sexual intercourse problems:

Medication or counselling can help improve fertility in conditions such as vaginismus, erectile dysfunction or premature ejaculation