Treatments of Infertility

Counseling

Counseling forms an integral part in the treatment of infertility. So many times, a detail counseling regarding the way the natural pregnancy happens, the most fertile period and lots of reassurance helps in achieving the pregnancy without any other treatment! Counseling also helps the couple to understand the causes of their infertility,the investigations they have to undergo and also the treatment they are undergoing and the realistic results expected from the treatment. Thus a thorough counseling makes the task easy for both,the doctor and the patient. We at Patankar Fertility Solutions give lot of emphasis on counseling so that our patients are very comfortable during their management.

Hymenectomy

Sometimes proper intercourse is not possible as the hymen is too rigid or the vaginal introitus may be too narrow. A minor surgical procedure is done by which hymen is cut and the introitus is widened so as to facilitate proper intercourse.

Ovulation Induction

In patients who do not ovulate properly(PCOD), ovulation induction helps immensely to achieve pregnancy.
The ovaries are stimulated to grow the eggs by giving tablets or injections. The growth of the follicle and timing of the ovulation is monitored with the help of serial sonographic monitoring.

Endoscopy

In the recent times endoscopy has become a commonly utilized method in the management of the infertile couples. It is done in variety of conditions causing infertility. We, at Patankar Fertility Solutions, have the world class endoscopy setup and expert team for endoscopic surgery. The procedure is done under anaesthesia and the hospitalization is usually for 1 day.

Hysteroscopy is the type of endoscopy in which the hysteroscope is introduced in to the cervix ( mouth of the uterus) to see the interior of the uterus (uterine cavity). In this the openings of the fallopian tubes are seen and any other pathology such as intrauterine septum, polyps, fibroids, adhesions can been seen as well as treated.

Laparoscopy

Through the laparoscope we can see the exterior of the uterus, tubes, ovaries and the tubo-ovarian relationship. Like Hysteroscopy and Laparoscopy can also used as a therapeutic tools. That means a variety of conditions can not only be diagnosed but also treated at the same time.

  • Patency of the blocked fallopian tubes can be established
  • Ovarian cauterization/drilling
  • Removal of fibroids-myomectomy
  • Removal of polyps-polypectomy
  • Adhesiolysis
  • Endometriosis
  • Before IVF/ICSI

Intra Uterine Insemination (IUI)

Genesis has the facility of IUI, where in washed semen is inseminated inside the uterine cavity around the timing of ovulation.

Pre-requisites
  • Patent tubes
  • Normal semen analysis
  • Husband's blood investigations
Procedure

Follicular monitoring is done in the patient scheduled for IUI (either stimulated or un stimulated cycle). When the developing follicle reach a particular size ovulation is triggered with the help of injection. After the injection the follicle ruptures (ovulation) within 36 hrs. IUI is planned accordingly.

The husband's semen is collected and processed to remove the unwanted cells and abnormal sperms so as to separate the normal, healthy and progressive motile sperms. This takes approximately 1-1 ½ hrs. The semen concentrate is inseminated with the help of a special catheter inside the uterus. The procedure is simple though the success rate is not very high(15 -20 % per cycle). This IUI may have to be repeated 3-4 times.

Pocedure 1 Pocedure 2 Pocedure 3
Donor Insemination

Donor semen is used for IUI in patients with azoospermia or with poor quality of semen parameters such as (severe oligoasthenoteratozoospermia) where patients either cannot afford ICSI or have had repeated failures.

IVF ( In-Vitro Fertilization)

This is the type of ART (Assisted Reproductive Technique) which requires intense monitoring through knowledge and skills. We at Patankar Fertility Solutions are proud to claim consistent results of 40-50% per cycle in IVF-and ICSI treatment cycles.

After proper selection of the cases the female partner is given daily injections. The injections are given to develop adequate no. of eggs (at least 6-8) in the ovaries. The response to the injections, the growth of the follicles ( s) is monitored with the help of the USG and also blood tests and the doses are adjusted accordingly, if required.

Once the follicles attain adequate size, ovum pick-up (OPU) or oocyte retrieval (OR) is planned. The patient comes empty stomach on the day of the OPU and is discharged on the same day. OPU is done under general anaesthesia and under USG guidance. The eggs are aspirated using adequate negative pressure through the vagina under USG guidance.

The fluid is then scanned under the microscope and the eggs are separated from the other tissue material.

Simultaneously, the semen is processed so as to separate the most normal and motile sperms from the semen sample. Depending upon the nature of the treatment i.e. IVF or ICSI , the eggs are treated in different manner.

IVF

In IVF, the eggs and the sperms are cultured together inside the incubator for certain no. of hours. The sperm will fertilize the egg during this period.

The eggs are separated from their surroundings cells (cumulus and corona cells) and scanned under the microscope so as to check the fertilization.

ICSI (Intra-Cytoplasmic Sperm Injection)

In ICSI the methodology is different. The eggs are first cleared off their surrounding cells (cumulus and corona cells) and checked for their maturity.

Only the mature eggs are then selected for ICSI. ICSI is done with the help of a machine called micro-manipulator and the process is called micro-manipulation. In this one egg is injected with the sperm individually so as to aid fertilization. The eggs are then incubated for some hours and then scanned under the microscope,so as to check how many are fertilized. Then the fertilized eggs (after IVF as well as ICSI) are again cultured inside the incubator and scanned. They are scanned daily to see if their growth is adequate or not.

Embryo Transfer (ET)

The embryos transfer (ET) is planned on the 2nd or 3rd day after the ovum pick up. The best embryos (maximum 3 in no.) are selected and transferred into the uterine cavity under USG guidences by a special catheter made only for the embryo transfer (ET) .

The surplus embryos left can be frozen (see cryo preservation) for the future use. The patient is usually discharged the same day. She is advised to take adequate rest, and called for the pregnancy test on 12th day of the embryo transfer.

Embryos Transfer

Blastocyst Transfer

In this, after proper selection of the cases, the embryos are put for the extended culture i.e. up to 5 days after the ovum pick up instead of the usual culture of 2-3 days.The pregnancy rate after the blastocyst transfer is as high as 75 % (between 60-75%). However blastocyst transfer cannot be preferred in all cases of IVF - ICSI.

This is done using a medium specially prepared for the blastocyst culture and in a special incubator with a special mixture of gases (i.e. tri-gas). At the time of the transfer, only 1 or 2 blastocysts are transferred and the surplus blastocysts can be frozen for the future uses.

Cryopreservation

The success rate of the any ART unit improves/increases manifolds if it has a good cryopreservation programme. By cryopreservation we mean that the gametes (Eggs and Sperms) and the embryos are frozen at -196°C in the liquid nitrogen still preserving their fertility potential. These can be thawed when needed and used to achieve pregnancy. At Patankar Fertility Solutions, we have the facility of freezing:

  • Semen
  • Testicular tissue
  • Embryos/ zygotes
  • Blastocyst
  • Eggs
Who May Benefit from egg freezing?
  • Women diagnosed with cancer who have not yet begun chemotherapy or radiotherapy as these treatments can cause cause rapid decline in the eggs and the fertility potential of the woman.
  • Couples who have religious or moral issues with embryo freezing.
  • Young women who are single and wish to freeze oocytes now in hopes of preserving their oocytes while young and at a time when they are less likely to have chromosomal aneuploidy.

Egg donation

Use of donor eggs is offered to those infertile couples when the female partner is :

  • Unable to produce her eggs (menopause or premature ovarian failure)
  • Poor response to ovarian stimulation
  • Poor quality of eggs
  • Repeated IVF/ICSI failures

The advantages are

  • Although the eggs are from the donor the sperms are the husband's sperms.
  • The woman gets to experience the joy of pregnancy and the delivery.
  • The secrecy is maintained.
Embryo donation

Embryo donation can be considered as adoption before birth and offered to those infertile couples who have repeated IVF/ICSI failures.

Either fresh or donor embryos are used with equally good success rates in both. Embryo donation can be considered in patients who have azoospermia or severely abnormal semen as well as very poor quality eggs. It is also done in cases where the resulting embryos from the husband's sperms and the wife's eggs show either the poor growth or quality.

Surrogacy

Surrogacy is an arrangement between a woman (surrogate) and a couple to carry and deliver a baby. Women who choose surrogacy may have significant damage to the uterus or have health conditions that prevent her form carrying a pregnancy.

In surrogacy, the infertile couple undergoes a standard IVF cycle to produce their own genetic embryos. The reproductive cycles of the surrogate and mother are synchronized in such way that the genetic mother receives treatment to produce the eggs and the host mother(surrogate) recieves treatment to prepare her uterus to receive the baby so that the embryos can be transferred to the surrogate at the appropriate time.

Who is Surrogate?

A surrogate is a woman who carries the baby to term and deliver for an infertile couple. A surrogate can be a friend, family member, a volunteer.

Who will benefit from surrogacy?

Women with any one of the following history could get benefit from surrogacy

  • Previous hysterectomy
  • Damaged uterus
  • Congenital absence of the uterus
  • Congenital malformations of the uterus
  • Uterine cancer
  • Uterus severely damaged by infection
  • Uterine pathology such as fibroids or scarring of the cavity
  • Maternal disease that makes pregnancy dangerous, such as severe diabetes, renal failure, lupus, or rheumatoid arthritis
  • Rh Isoimmunization
  • Multiple IVF failures with good embryo quality
  • History of recurrent miscarriages
  • Sometimes the health of the genetic mother prevents her from carrying a baby and so opts for surrogacy