TOTAL INFERTILTY SOLUTIONS UNDER ONE ROOF, IMPROVE SUCCESS RATE WITH LASER ASSISTED HATCHING


An affordable IVF Centre in Navi Mumbai.                                              Headed by Dr. Shyam Kulkarni who has been practising Infertility since 26 years.


Topic of the Month - New Hormone treatment for Infertile PCOs


 


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TREATMENT
    IVF (In-Vitro Fertilization)

 

 

IVF In Vitro Fertilization means combing the egg and the sperm in laboratory and transferring them back in the uterus. This procedure which was considered experimental for years has proved a way for many couple build their family.

Few of the indications;
1.Tubal Factor: The healthy fallopian tubes are the prerequisite for natural conception. If they are damaged, blocked or removed you are left with no option but to go for IVF. In fact the success rate is quite good in these situations

2. Endometriosis: In Moderate to severe endometriosis, where in the ability to conceive on you own in spite of open fallopian tube is a problem and IVF has a place.

3. Unexplained Infertility; Though all parameters being normal the couples fail to conceive one can opt for IVF.

4 Male factor; IVF/ICSI can be opted for in Moderate to low count, Antisperm antibody, reduced motility.

5 PCOS; Polycystic Ovaries where in the ovulation is the problem, IVF is useful.

   
    LASER ASSISTED HATCHING

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The World Health Organization estimates that one in six couples experience some delay in conception (World Health Organization, 1975), and an increasing number require treatment by the assisted conception procedures of IVF or ICSI This has been explained by the low implantation rates (<20%) .  

An important observation leading to incorporation of 'assisted hatching' in IVF protocol was the finding that some  embryos had thick zona (i.e outercovering of embryos), while others had thin ones. Embryos with thinned areas in their zona appear to implant more frequently than embryos with thick zona leading to judicious use of LAH (Laser assisted Hatching) in clinical practice. This is where the LAH Laser assisted hatching plays a pivotal role in improving clinical pregnancy rates.   

Recent meta-analysis has shown that women, who have undergone repeated IVF treatments without results, double their chances of a pregnancy by use of laser assisted laser hatching.

We recommend this technique in women of advanced age, high FSH levels, in women with recurrent implantation failures and in Frozen Embryo Transfers.

   
    EMBRYO FREEZING

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Embryo cryopreservation (the process of freezing, storage and thawing embryos) is undertaken at our centre. Freezing programme is not only mandatory as per our ICMR guidelines but also a boon for us . As the extra embryos are utilized in subsequent cycles if the index cycle fails Apart from that this process will come handy in

1.If the response for the injections is too good to proceed i.e if there is a suspicion of OHSS (hyperstimulation)Embryo are frozen

2 if the uterine lining is not optimal and chance of improper implantation in on cards freezing may be considered

3 Extremely difficult embryo transfer.

Embryos are placed into straws containing cryoprotectant solutions. The freezing is undertaken with the help of Biotronics Embryo freezer, a state of art equipment which is programmed to do slow cooling. Once it is achieved embryos are plunged into liquid Nitrogen (-196 C). here the embryos are kept in goblets till we wish to thaw them.

   
    DONOR EGG CYCLE

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    MALE INFERTILITY EVALUATION

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Semen analysis - Sperm Migration Test - Antisperm Antibody - Varicocoele

Semen analysis

To do semen analysis, a fresh semen sample (no more than a half hour old) is collected and then analyzed in at RAJ IVF CENTRE. The sample is collected at the centre by masturbation in a clean container provided at site. The couple is asked abstain from sex for two to three days. Instruction will be given not to use lubricated condoms for collection.
There is a lot of interobserver variation in the count. We have at RAJ IVF centre a luxury of assessing your count using Maklerís Chamber ( Safi international. Israel), devise specially designed to get accurate count. A correlation can be drawn in what you see in lab and what matters for fertility.

Sperm Migration Test;

Overlaying the semen with Media designed for washing, and incubating over a period of couple of hours and assessing for the harvest what we get will give the patient feasibility and the method we need to adopt in a given situation to get best of the results.

Antisperm antibody

Testing for auto antibodies is necessary in view of reduced fertility in couples having these antisperm antibodies. Binding of the antibodies reduce the motility of sperms, the interaction of sperm and egg is hindered with, and sperm may not be able to negotiate the cervical mucous.
Detection is simple-semen analysis gives bit of insight and a blood test will usually confirm the presence of antibodies.
Steroid therapy may alleviate the problem. Some couple will benefit from IUI. IVF with additional incorporation of ICSI will help most couple to get rid of this problem.

Varicocoele

The presence of varicose veins in the testicles leads to raise in testicular temperature which intern reduces the sperm production and maturation. Fertility potential of sperms goes down. This condition is thought to affect 15% of the general male population but in about 35- 40% patients present with male infertility.
Diagnosis; Most of the times this is a clinical diagnosis and a semen analysis pattern gives enough clues to the presence of varicocele .USG and color Doppler is not done routinely at our centre as the impact of sub clinical variety on infertility is not convincing.
Treatment is surgical. We routinely advocate cold sponging before surgery. Medical line of treatment with antioxidants are being tried .

   
    SURGICAL SPERM EXTRACTION (TESA, TESE, MESA, PESA)

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    IUI (Intrauterine Insemination)

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AIH (Artificial insemination with husbandís sperms)

Artificial insemination using  with your husbandís sperms is useful in the following situations

1.Cervical factor( Infections, narrowing due to cicatrisation, etc.)

2. Disturbance in Ejaculation

3 Low sperm counts

Procedure;  This procedure is done once a month around the time of Ovulation ( i.e. releasing of egg from ovary)which is assessed using  follicular monitoring by USG or very basic method of BBT (Basal body Temperature). On the scheduled day husband will provide the sample in a sterile container in our lab by masturbation .This sample is then washed. Sperm preparation media are used for this and it takes about one to one and a half hour depending on the liquefaction time. Then a small volume of concentrated sperms are deposited in the Uterus using a sterile catheter. Woman is advised to rest for 15 to 30 minutes at the centre.

Medicines; though natural cycle IUI can be done, we at our centre do use Medicines to recruit more follicles. These include Clomiphene as well as gonadotrophins. HCG or Gnrh a injection are used for triggering of ovulation.Prper timing is utmost important for the success.

Success;   With the proper the selection of patients and protocol we are getting 12% to 15% at our centre.   IVF will be the choice In case three or four cycles of IUI fail.

AID (Donor Insemination)

In cases of no sperms i.e. is azoospemia couple can have an option of AID. Theraupetic   Donor insemination is done using quarantined sample who prefer to avail of this facility. The protocol and the timing are as in AIH.

   
    THERAPEUTIC DONOR INSEMINATION

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    FERTILITY ENHANCING SURGERY

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Diagnostic Laparoscopy and Hysteroscopy

 

Diagnostic procedures;

Diagnostic laparoscopy and Hysteroscopy are usually combined and we recommend it as an initial approach in selected cases like long standing infertility. This is one day procedure and patient can resume her activities in couple of days. But we at our centre recommend Diagnostic Hysteroscopy prior to IVF. During laparoscopy we look for any evidence of Pelvic Tuberculosis, endometriosis and adhesions. Tubal patency is part of the procedure.

Endometriosis ;

Endometriosis comes in the way of conception in various ways. Endometriosis in the pelvis may cause adhesions which in may hinder the sperm egg interaction.It sometimes prevents eggs being released from ovary. Endometrioma a cyst in the ovary caused by conglomeration of focii of endometriosis do have impact on fertility and may need attention either Medical or surgical.                                                                                       Adhesiolysis, Fimbrioplasty, Neosalphingostomy

Laparoscopic adhsiolysis, Fimbrioplasty and Neosalphingostomy are few of the fertility enhancing surgeries which we feel will help couple conceive. 

Hysteroscopic adhesiolysis and septum resection;

Proper and adequate endometrial cavity is mandatory for implantation and continuation of pregnancy. Adhesions, septum, polyp or uterine anomaly are few of the causes of infertility or recurrent abortions and need early diagnosis and intervention.

      

Tubal cannulation

Proximal tubal occlusion can be taken care of by Tubal cannulation procedure. This a done either by Hysteroscopy or fluoroscopy. We prefer Hysteroscopic option as it helps us visualize the cavity at the same time.

 


Tubal Reversal (Microsurgery)

 

Tubal Recanalisation is the microsurgical procedure for reversal of family planning operation (sterilization). If you desire to have a child subsequently or in an unfortunate circumstance if pregnancy is contemplated, you have an option of reversal operation.

The couple needs to undergo some basic tests. The procedure takes about 2 hours. We do use loupes and a very fine suture material. We prefer to do it between seventh to tenth day of menses.

We have been consistently given a good success results for this operation. Though the success rate (Carry home baby rate) depends on the age factor and type of sterilization operation, presuming that the sperm count is adequate. Chances are good if the Falope rings are used as we do get adequate length of fallopian tube. For post delivery sterilizations and use of cautery, chances dip a little.  

     
    Fertility Enhancing Endoscopic Surgery

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  Video 1 - Resection of Endometrioma  
  Video 2 - Septum  
   
    Routine and Hormone Tests

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We do have facility for routine and hormone assays required for the treatment of infertility. We usually insist on the hormone tests to be done on specific day of menses it will be convenient for the couple and completed in one visit. However, if they wish to get it done elsewhere, we do guide them accordingly.

   
   

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