Fertility treatments do not work miracles, they just help nature take its

course when it cannot do on its own.

FERTILITY TREATMENTS

Infertility is the inability of a sexually active, non- contracepting couple to

achieve pregnancy in one year.

Definition

Explanation of Natural Phenomena

Human beings are the out comes of a happy

encounter between sperm and an egg.In

natural reproduction, ejaculation sends millions

of sperm into the vagina on a real obstacle

race to reach the egg (like marathon race).

The sperm travel from the vagina to the

fallopian tubes, where they meet the egg. Out

of millions of sperm, only one will able to

fertilise the egg by penetrating its membrane.

Types of Treatment

• Intra Uterine Insemination (IUI) or Artificial Insemination- Intra uterine insemination (IUI) involves the extraction of a semen sample from the male partner or a donor, which is directly injected into the uterine cavity around the time of ovulation.

Steps in an IUI treatment• First, we stimulate the ovaries with medications. The

aim is to produce 2 or 3 eggs in each of the ovaries.• Then we monitor the response by sonography• We trigger the final process of ovulation when the

follicle is of a certain size with an injection of hCG.

• The husband is required to give a semen sample on the day of an IUI. Alternatively, a previously preserved sample can also be used. The semen sample is processed to separate the motile and normal sperms.

Performing the actual IUI: This is a very simple outpatient procedure. The IUI is then carried out after the trigger

injection (hCG) is administered. The prepared semen sample is injected directly

into the uterus using a fine catheter.• Precautions after an IUI treatment- IUI is a

simple procedure and does not require any special precaution. You need to rest for a few minutes after the procedure, after which you can resume all your routine activities.

In Vitro Fertilization (IVF)

In vitro fertilization refers to a procedure where the woman's eggs are removed and fertilized with the man's sperm outside the body, in a laboratory. The embryos, thus formed are then put back into the uterus to achieve a pregnancy. On 25 July 1978, world's first human test tube baby Louise Joy Brown was born.

IVF step-by-step

1) Before commencing the treatment- Before starting any treatment, it is necessary to discuss any issues or concerns you may have with center counselor. Consent forms must be signed and screening tests will be verified. These tests will be for:

Women• Hormonal Asses• Complete Hemogram, Blood Sugar, Urea, SGPT, Hepatitis B (HBs Ag),

VDRL, HIVMen• Semen test within 6 months, Semen Culture• Hepatitis B (HBs Ag)• HIV• 2) Commencement of the treatment• Patient must for a check up on the second day of your menstrual cycle

• Ovarian stimulation• Medications will be administered

to stimulate the ovaries to produce several eggs in order to increase the chances of pregnancy.

• 4) Ultrasound examination• Regular monitoring by vaginal

ultrasound examination is conducted after the administration of medications to measure the response of your ovaries with regard to the number and size of the follicles.

• 5) hCG injection• hCG injection is given to trigger

the final maturing of the eggs when they are ready for collection. Egg collection is planned approximately 36 hours after the hCG injection. The embryologist will inform you when your husband/partner is required to give his semen sample.

6) Ovum pickup (Egg Collection) The procedure of removing the eggs from the ovaries is carried

out with the help of transvaginal sonography under general anesthesia. The procedure takes about 15 –30 minutes, eggs are collected from each ovary. You will be able to go home, three hours after the procedure is completed. It is common to have some vaginal bleeding after this procedure, but that settles down in a day or two. Discomfort as a result of the swelling of the ovaries is common.

7) Sperm collection Fresh semen sample should be collected on the day of the ovum

pick-up (egg collection). However, if a fresh sample cannot be produced on the same day, a previously frozen sample can be used.

8) After ovum pickup Following ovum pick-up, the eggs will be fertilized in the lab

either by standard IVF or by ICSI. On the next day, the embryologist will examine the eggs for fertilization.

9) Embryo transfer:It is performed two to five days after egg collection. The embryo is transferred through the cervix into the uterus via a thin, soft plastic tube guided by sonography. You will be asked to take some injections and/or tablets after the embryo transfer to support the luteal phase. It takes only a few minutes and causes no discomfort. However, heavy work such as lifting weights or climbing stairs is not advised.

10) Embryo Freezing:

If there are more well-developed embryos, it is possible to freeze them for a later transfer, if necessary. This procedure will be discussed with you before the embryo transfer. Separate consent forms must be signed for embryo freezing.

11) Pregnancy test

Approximately two weeks after the embryo transfer, you will

undergo a test for beta-hCG to check if gestation has been

achieved. If the test is positive, a vaginal ultrasound scan will be

performed to confirm this and view the gestational sac. If the beta-

hCG test is negative, further treatment will depend on whether you

have frozen embryos or not.

Precautions after an IVF treatment:

•No heavy lifting

•No strenuous exercise

Intra-Cytoplasmic Sperm Injection (ICSI)

ICSI is a process where a single

sperm is injected directly into the

egg using a fine glass needle. The

main objective of ICSI is to ensure

that the spermatozoa fertilize the

egg membrane. The woman is

stimulated with medications and

then an egg retrieval procedure is

performed so that several eggs

can be obtained to attempt an ICSI

procedure.

SURROGACY

Surrogacy involves using one woman's uterus to implant

and carry the embryo and deliver the baby for another

person or couple. This method of assisted reproduction is

one that many couples choose after numerous

unsuccessful attempts of conception and other fertility

treatments.

• Gestational Surrogacy also known as Full Surrogacy is when the surrogate mother has no genetic link to the child she is carrying. The embryos are generated from the eggs and sperm of the ‘genetic’ parents and the surrogate just acts as the host for them. The woman producing the eggs goes through an IVF cycle while the surrogate prepares her uterus for conception. The eggs are then fertilized outside of the woman's body and the resulting embryos are implanted in the uterus of the surrogate.

Gestational Surrogacy

EGG DONATIONOvum (egg) donation is a process where the eggs of a

healthy young woman (the egg donor) are fertilized with

the sperms from the patient's husband and the resulting

embryos are then transferred into the patient's uterus.

Process Of Egg Donation

The process of egg donation starts with the selection of

a donor. The donor's ovaries are stimulated by a

stimulation regimen to produce multiple eggs. The eggs

are then retrieved, fertilized, and embryos are cultured.

The best one or two embryos are transferred into the

recipient's uterus. Donating eggs does not have a

negative effect on the fertility of the woman and does not

impact her chances of conception in the future.

Sperm Donation :- Many couples experiencing male factor infertility may choose to undergo donor insemination for IUI or IVF procedures in order to achieve pregnancy.

Indication for sperm donation:1. If there are significant abnormal semen characteristics2. Irreversible azoospermia3. A previous vasectomy4. Previous radiation or chemotherapy treatment or another irreversible male fertility factor5. Carriers of a known hereditary or genetic disorder6. If the female is Rh sensitized and the male is Rh positive

SPERM DONATION

• Use of sperm donated by a relative or a known friend of either the wife or the husband shall not be permitted. It will be the responsibility of the ART clinic to obtain sperm from appropriate banks; neither the clinic nor the couple shall have the right to know the donor identity and address, but both the clinic and the couple, however, shall have the right to have the fullest possible information from the semen bank on the donor such as height, weight, skin colour, educational qualification, profession, family background, freedom from any known diseases or carrier status (such as hepatitis B or AIDS), ethnic origin, and the DNA fingerprint (if possible), before accepting the donor semen. It will be the responsibility of the semen bank and the clinic to ensure that the couple does not come to know the identity of the donor. The ART clinic will be authorized to appropriately charge the couple for the semen provided and the tests.

CRYOPRESERVATION

It is the process of

preserving an

embryo/egg/sperm at

sub-zero temperature.