Indira Ivf Ahmedabad

What is IVF?

IVF stands for In Vitro Fertilization and is a method of artificial insemination that dramatically increases the chances of pregnancy. It is one of the assisted reproductive technologies methods used as fertility treatment across the world where other methods have had drastic results.

In simpler terms, a man's sperm is inserted in woman's egg using controlled laboratory environment to proceed with fertilization. These embryos are then carefully put back into the mother's uterus after 4 to 5 days of fertilization in incubator in hopes that the embryo would grow in a full baby. The embryo transfer process needs to be carefully done in order for successful fertilization in the mother's womb.

There are many reasons why IVF is conducted :

1. Poor sperm quality - Males having poor sperm quality are unable to achieve fertilization and increase the chances of conception with their female partners. This is male factor infertility due to which people move towards IVF.
2. Fallopian tube problems - This is a female factor infertility, in which fallopian tubes either get blocked, or damaged making it complicated and stressful for the embryo to travel to the uterus.

One must approach IVF treatment with patience and a willingness to comply with all the tenets that the treatment is built upon. IVF clinics may vary the treatment a little according to what the patient's condition demands and different clinics may have different methods. The basic methods of IVF treatment however, remain the same. The first step to the treatment is to find the right clinic which complies with factors like availability of resources, cost and quality of treatment. After deciding the clinic, the next step is to understand that IVF treatment happens in cycles and the success rate of conception varies. Patients must also be ready to face any disappointment.

Here’s the short version of the steps involved in an IVF treatment cycle:

1. Ovarian stimulation. Your doctor prescribes a course of drugs for you to take to stimulate your ovaries into hopefully producing 12 to 15 mature eggs.
2. Monitoring of your drug response. To monitor the progress of your ovarian stimulation you undergo an ultrasound examination and blood tests.
3. Egg maturation. Two days before your eggs are due to be collected you have a hormone injection, which triggers maturation of the eggs.
4. Egg collection. You receive a light general anaesthetic for this simple, short procedure, and your doctor retrieves your eggs using an ultrasound-guided technique.
5. Sperm production. On the day of egg collection, your partner provides a sperm sample.
6. Fertilisation. The embryologist puts sperm and eggs together in the lab and, if all goes well, the eggs fertilise and early embryo development begins.
7. Embryo transfer. Two to five days after egg collection, your doctor places one or two embryos in your uterus. Frozen transfer can be planned after a gap of 1 month.
8. Embryo freezing. If you have additional embryos suitable for use, they can be frozen and kept for future transfers. Also, frozen embryos are available.
9. Pregnancy test. About two weeks after embryo transfer you have a blood test to find out whether the treatment worked.
   • If the test is positive, you have your first pregnancy scan two weeks later.
   • If the test is negative, you and your partner need to talk to your doctor and decide whether to try the treatment again.

In today’s modern, fast paced society, it is easy for people to become stressed. In fact, one would almost think that being stressed is the “in” thing, and if you aren’t stressed it must mean there is something wrong with you! Realistically however, stress is not a good thing for our bodies in general, and has a very real impact on your fertility.

Can Stress Have an Effect on Your Fertility?

If your mind and body is under stress your body is signaled to release a hormone - Adrenalin. This is a stress relieving hormone and gives your body the rush to face the stress. This hormone inhibits the utilization of the hormone Progesterone, which is essential for fertility. Also during stress Prolactin, another hormone, is relapsed which also interferes with infertility. Hence to conceive its essential that your anxiety levels are under control.

How Stress Impacts Fertility?

Recent research tells us that stress boosts levels of stress hormones, such as adrenaline, catecholamines and cortisol, which can inhibit the release of the body’s main hormone, GnRH (gonadotropin releasing hormone), which is responsible for the release of sex hormones. Subsequently this may suppress ovulation in women, reduce sperm count in men and lower libido in both women and men.

Chronic Stress also decreases libido 

Chronic stress may cause lack of libido as well as a decrease in general fertility. This has become such a common issue that they have created a name for it Stress Induced Reproductive Dysfunction. These facts are very important to consider if you have been trying to conceive with no results. It also shows that stress relief should be a part of every couple's conception plan even if they are going through IVF.

Ways to reduce stress & improve fertility

If you are having difficulty to conceive, it's imperative that you get fertility tests done and also evaluate your life. Look out for the stress points that may be hindering a relationship. Remember defeating the stress may be the solution to your worries.

1. Reduce stress in your life: The issues in your life may be work or result related. You need to learn to balance your personal and professional life. The sooner you do it the better; after all you are preparing yourself to welcome a new born in your life.
2. Change your reactions: Get a hang of the situation and react accordingly. Over reaction to a situation can harm your body and mind. Stop bothering so much about the future.
3. Let few things be the way they are: Stop getting bothered about people. Remember by nature everything will fall in place. Let few things be the way they are.
4. Make it your habit to reduce stress: Call it an obsession or a practice, train your mind to choose options where there is less stress.
5. Sleep well: A good rest is essential for a healthy mind and body. Meditate, do yoga or seek counseling. Go for facials if it sooths you.

Please note that if your fertility reports are normal, then it's just a matter of time. Give you, your partner and your body time. There are certain medical complications or disorders that can also be responsible for infertility. Be calm and composed so that you are able to face the rough waters clearly with your partner.

Infertility is a condition where a couple, trying to conceive in a natural way is not able to do so even after one year of trying. It is also a matter of worry for patients who are over the age of 35 years and those who are not able to conceive naturally even after 12 months of trying constantly.

Causes

There are many causes of infertility. It may be down to a condition present in one or both partners. Ovulation and fertilisation are the main elements of the conception process and any condition in the female or male can upset either function, which can make it difficult to conceive.

While abnormal sperm production and transport may be a common condition that leads to infertility in males, other factors like side effects of cancer treatments and too much exposure to toxins and chemicals can also play an important role in this regard. For females, the causes of infertility may range from ovulation disorders, uterine and fibroid tumours, uterine and cervical anomalies, damage to or blockage of the fallopian tubes, endometriosis, primary ovarian insufficiency and pelvic adhesions.

Infertility Symptoms in Women

In women, changes in the menstrual cycle and ovulation may be a symptom of a disease related to infertility. Symptoms include:

• Abnormal periods. Bleeding is heavier or lighter than usual.
• Irregular periods. The number of days in between each period varies each month.
• No periods. You have never had a period, or periods suddenly stop.
• Painful periods. Back pain, pelvic pain, and cramping may happen.

Treatment

Female patients can turn to medication that will stimulate ovulation, intrauterine insemination, and surgical processes to correct a uterine septum and remove endometrial polyps, or even a hysteroscopy surgery. Male patients can go through a treatment for any existing infections, hormonal injections and medication, surgical options like vasectomy reversal and art or assistive reproductive technology.

If these methods fail, the patient or the couple can always turn to methods like in vitro fertilisation. For other mild reasons, lifestyle changes along with a stress free environment can help in increasing the chances of conception.

The uterine cavity has a tissue base that is known as the endometrium. When this endometrium spills over or spreads to the other parts of the reproductive organ, it begins to punch through the uterine lining. Such a condition creates complications and even infertility, and is known as endometriosis.

Read on to know more about endometriosis and how it can cause infertility.

Endometriosis

When the endometrium tissue spreads to areas like the ovaries, and the abdominal cavity, it can lead to numerous complications. Apart from pain, this may also cause infertility. 5 to 10% of the women worldwide suffer from this condition and have trouble conceiving. Additionally, about 30 to 40% of the infertility cases are due to endometriosis, not all cases. These figures are all confirmed by various medical studies.

How does it cause infertility?

Endometriosis can prevent ovulation, which is the process that occurs every month. During the ovulation process, the ovaries release eggs that may be fertilised in order for the woman to conceive. In this condition, the fimbria of the fallopian tubes also has trouble in capturing the egg, which prevents conception from taking place. This leads to infertility in the long run. Endometriosis also interferes with the proper production of the hormones that are required for normal ovulation and fertilisation of the egg.

Diagnosis

The diagnosis of the condition can be done with the help of lab tests and ultrasounds as well as imaging tests that can create the image of the womb and the endometrium lining. This will help in showing the severity and damage caused by the tissue. A surgical procedure called a laparoscopy may be carried out by the doctor to ascertain whether the patient is suffering from this condition. In this procedure, a small incision will be made and a camera will be inserted to view the insides on a screen, to learn more about the tissue’s spread and the kind of treatment that will be required. The doctor will also diagnose the condition on the basis of various symptoms like irregular and heavy bleeding.

Treatment

Treatment for endometriosis associated with infertility needs to be individualized for each woman. There are no easy answers, and treatment decisions depend on factors such as the age of the woman, the severity of the disease and its location in the pelvis, the length of infertility, and the presence of pain or other symptoms. Some general issues regarding treatment are discussed below.

Treatment for Mild Endometriosis

Medical (drug) treatment can suppress endometriosis and relieve the associated pain in many women. Surgical removal of lesions by laparoscopy might also reduce the pain temporarily.

However, several well-controlled studies have shown that neither medical or surgical treatment for mild endometriosis improving the pregnancy rates for infertile women as compared to expectant management (no treatment).

For treatment of infertility associated with mild to moderate endometriosis, controlled ovarian hyperstimulation with intrauterine insemination - IUI is often attempted and has a reasonable chance to result in pregnancy if other infertility factors are not present.

Details about IUI success rates with endometriosis

IUI and endometriosis

Success rates with IUI for endometriosis have been variable in studies, showing:

• A pregnancy rate of 6.5% for women with endometriosis vs. 15.3% per cycle for unexplained infertility
• A pregnancy rate of 5.6% for women with advanced endometriosis vs. 22.7% per cycle for mild endometriosis vs. 25.7% for no endometriosis
• Pregnancy chances with insemination for natural cycle IUIs (no drugs) with endometriosis are about 2% per cycle vs. 11% with injectables plus IUI for endometriosis

Treatment for severe endometriosis

Several studies have shown that medical treatment for severe endometriosis does not improve pregnancy rates for infertile women.

Unfortunately, infertility in women with severe endometriosis is usually resistant to treatment with ovarian stimulation plus intrauterine insemination. If the pelvic anatomy is very distorted, artificial insemination is unlikely to be successful. These women often require in vitro fertilization in order to conceive.

Although the studies of in vitro fertilization for women with severe endometriosis do not all show similar results, pregnancy success rates are usually good if the woman is relatively young (under 40) and if she produces enough eggs during the ovarian stimulation.

In today’s modern, fast paced society, it is easy for people to become stressed. In fact, one would almost think that being stressed is the “in” thing, and if you aren’t stressed it must mean there is something wrong with you! Realistically however, stress is not a good thing for our bodies in general, and has a very real impact on your fertility.

Can Stress Have an Effect on Your Fertility?

If your mind and body is under stress your body is signaled to release a hormone - Adrenalin. This is a stress relieving hormone and gives your body the rush to face the stress. This hormone inhibits the utilization of the hormone Progesterone, which is essential for fertility. Also during stress Prolactin, another hormone, is relapsed which also interferes with infertility. Hence to conceive its essential that your anxiety levels are under control.

How Stress Impacts Fertility?

Recent research tells us that stress boosts levels of stress hormones, such as adrenaline, catecholamines and cortisol, which can inhibit the release of the body’s main hormone, GnRH (gonadotropin releasing hormone), which is responsible for the release of sex hormones. Subsequently this may suppress ovulation in women, reduce sperm count in men and lower libido in both women and men.

Chronic Stress also decreases libido

Chronic stress may cause lack of libido as well as a decrease in general fertility. This has become such a common issue that they have created a name for it Stress Induced Reproductive Dysfunction. These facts are very important to consider if you have been trying to conceive with no results. It also shows that stress relief should be a part of every couple's conception plan even if they are going through IVF.

Ways to reduce stress & improve fertility:

If you are having difficulty to conceive, it's imperative that you get fertility tests done and also evaluate your life. Look out for the stress points that may be hindering a relationship. Remember defeating the stress may be the solution to your worries.

1. Reduce stress in your life - The issues in your life may be work or result related. You need to learn to balance your personal and professional life. The sooner you do it the better; after all you are preparing yourself to welcome a new born in your life.
2. Change your reactions - Get a hang of the situation and react accordingly. Over reaction to a situation can harm your body and mind. Stop bothering so much about the future.
3. Let few things be the way they are - Stop getting bothered about people. Remember by nature everything will fall in place. Let few things be the way they are.
4. Make it your habit to reduce stress - Call it an obsession or a practice, train your mind to choose options where there is less stress.
5. Sleep well - A good rest is essential for a healthy mind and body. Meditate, do yoga or seek counseling. Go for facials if it sooths you.

Please note that if your fertility reports are normal, then it's just a matter of time. Give you, your partner and your body time. There are certain medical complications or disorders that can also be responsible for infertility. Be calm and composed so that you are able to face the rough waters clearly with your partner.

In vitro fertilisation (IVF) is a medical procedure followed for those women or couples suffering from infertility or for certain specific genetic problem. In the normal course, women or couples experience positive results within a few IVF cycles. However, in spite of reasonable pregnancy rates, some women may require few more cycles to achieve pregnancy. In such cases, in order to ensure a healthy pregnancy, the gynecologist may suggest the women undergo Endometrial Scratching before IVF. 

Endometrium explained in brief

The uterus is located in the pelvic region and it is in the size and shape of a pear. The inner cavity of the womb or uterus is protected by the tissue lining called endometrium, also called endometrial. The endometrium plays a significant role in supporting the pregnancy. 

The enhanced success of achieving pregnancy

The endometrial scratching procedure is a very simple one, which is resorted, so as to improve the results of IVF procedure. In this procedure, the gynecologist uses a very fine catheter and makes a small scratch on the endometrial lining. In fact, the scratch causes a kind of inflammatory reaction in the uterus. This inflammatory reaction induces the endometrium to be highly receptive to embryos during the successive menstrual cycle. This added receptivity enhances the success of pregnancy during the next menstrual cycle. 

Considering the higher level of success in achieving pregnancy, the endometrial scratching procedure has gained popularity in the IVF procedure.

However, some of the other issues related to endometrial scratching may be as follows: 

1. Endometrial scratching optimises the uterine lining and thereby, makes it easier to continue the embryo implanting procedure. Normally, before the endometrial scratching procedure, the gynecologist may suggest endometrial biopsy. 
2. The endometrial procedure is usually suggested for those women who had two or more unsuccessful IVF procedures, despite having good quality embryos. However, in some cases, depending on the health of the patient and various other factors, the gynecologist may suggest this endometrial scratching at the very first IVF procedure. This procedure can be availed either for fresh embryos of the couple or frozen embryos or for the donor egg. 
3. Although this is a part of a surgical procedure; endometrial scratching is very simple and painless and it is done without administering anesthesia. The procedure does not require any hospitalisation. In fact, the patient can go home soon after the procedure. Except for a few pain killers, this procedure does not require any extensive medication. 

This is a safe and easy procedure. Neither does it lead to any side effects, nor is the procedure burdensome for your wallet. Many couples have been benefited by this endometrial scratching procedure.

Like most things in life, the uterus also has both good and bad sides to it. It is a symbol of womanhood and also carries the developing baby. The bad side is that it brings with it (and its appendages) many problems including dysfunctional uterine bleeding, endometriosis, fibroids, pelvic inflammatory disease, uterovaginal prolapse, adenomyosis, a pelvic pain of unknown origin, cancer of the uterine cavity and other obstetric complications.

Hysterectomy is one of the most commonly performed procedures and ensures complete relief from these symptoms. There are however, multiple procedures, which can be used to manage these conditions without having to resort to removal of the uterus. This can help in preventing complications from hysterectomy including prolonged recovery, infertility in women of childbearing age and loss of womanhood.

Read on to know some of the emerging conservative alternatives to hysterectomy:

Myomectomy

Where there are fibroids, which are in the smooth muscles of the uterus and show symptoms like pain and discomfort. In these, it is advisable to go for a myomectomy. This removes only the fibroid, leaving the uterus in place. It can be done in one of the 3 ways traditional surgical process through an incision; laparoscopically through minute incisions; and then through vagina. In all these, only the fibroid is removed and sent for biopsy to confirm it is benign. It is less invasive, requires less recovery time and helps retain the uterus.

Uterine endometrial ablation

In cases of dysfunctional uterine bleeding or menorrhagia with no fibroids, the lining of the uterus could require removal. In these women, thermal balloon ablation, cryoablation, and radiofrequency ablation can be used. A small amount of extreme heat or cold or radio frequency waves are used to remove the uterine lining, thereby managing symptoms.

Uterine artery embolization

In women with fibroids, the feeding arteries could be cauterised to ensure blood supply is stopped so that fibroid growth is stopped. With very promising success rates, this is gaining popularity as a conservative method.

Laparoscopy and endometriosis excision

In endometriosis, where the uterine tissue is growing in areas outside the uterus, it could be removed laparoscopically after identifying the area of growth on ultrasound and laparoscopy.

Vaginal pessary

In women with uterine prolapse, the uterus drops from its normal position, pushing against the vaginal walls. This can be due to vaginal childbirth, age, smoking and obesity. Vaginal pessary is where a removable device is placed into the vagina to prevent it from falling down. It is a temporary solution, but very useful in holding the uterus in place and relieve symptoms partially or completely.

In all these, medical management (painkillers and hormone replacement), stress and weight management, quitting smoking, reducing alcohol are also essential.

How does the ICSI method in IVF treatment help manage severe male infertility?

Male infertility is a growing problem in India. According to a survey, almost 40 percent of all infertility cases occur due to male infertility. Severe male infertility is often treated with IVF, using the ICSI method. Here is a look at all you need to know about IVF with ICSI.

What is ICSI?

ICSI or intracytoplasmic sperm injection is a specialized method of IVF, where the sperm from the male partner is not allowed to fertilize the female egg normally. Instead, a single sperm is isolated and inserted into a mature egg, to get it fertilized. A hollow needle is used to extract the sperm from the male. Primary features of the ICSI-IVF include-

• The egg is fertilized inside a petri dish, as the sperm is not introduced inside the female’s body.
• Only one healthy sperm is selected from the sample and is injected into a single mature egg for the fertilization
• The fertilized eggs are monitored under laboratory conditions.
• Once the egg is fertilized, it can be introduced inside the woman’s body, similar to the ordinary IVF procedure.

Reasons why ICSI is used

Here is a look at some instances, when your doctor may advise you and your partner to undergo ICSI-IVF-

• Very low sperm count
• Sperm with abnormal shape
• Poor sperm motility
• Other IVF treatment has not yielded desired results
• If the sperm being used is frozen, the ICSI-IVF procedure may be required.

Risks involved in the IVF-ICSI method of fertilization

The ICSI procedure comes with all the risks involved in the normal IVF procedure. However, it does not introduce any new risk factors into the mix. This method of fertilization carries a slightly higher chance of the baby being born with defects when compared to a normal conception. However, it is still quite rare.

With the IVF-ICSI method, couples suffering from infertility have 50 to 80 percent chance of a successful conception.

In vitro fertilization (IVF) includes empowering the woman with medicines, taking various eggs from her ovaries, fertilizing them with her partner’s sperm, and inserting a portion of the subsequent embryos into her uterus with the trust that one will form into a fetus. 

Tubal ligation reversal, on the other hand, requires a laparotomy, which needs a much bigger entry point on the abdomen, usually around four to six fingers long. Since the skin, each of the muscles, and different tissues of the stomach must be sliced through, there is extensively more uneasiness and a longer recovery time required after the surgery, when compared with a laparoscopic surgery, for example, with a tubal ligation. 

Here are a few common differences: 

1. Sperm quality - The male partner needs a sperm test before basic procedures of either of the two. In case that the sperm quality is great, then the couple could consider proceeding. In case that the sperm quality is poor, in vitro treatment is the better alternative. With IVF, poor sperm quality is effectively overcome. 
2. Tubal status - The length of the remaining tubal stumps after tubal ligation is an important aspect. The more extended the two remaining stumps are on each side, the better and more effective is the pregnancy. The shorter the stumps, the lower are the odds for pregnancy. 
3. Status of other pelvic conditions - Pelvic endometriosis or any scar tissue in the range of the tubes or ovaries would diminish the chance for accomplishment after tubal ligation reversal. Although, IVF pregnancy achievement rates are usually not influenced by these conditions. Along these lines, in vitro fertilization is most likely a superior alternative in women with noteworthy endometriosis or pelvic scar tissue. 
4. Female age - Chances for pregnancy with either tubal ligation or IVF decrease in the mid to late thirties and significantly reduce at the age of thirty-eight. By age forty-three or forty-four, not many women will have the capacity to have a baby using either approach. 
5. Egg amount and quality - A few women have a decrease in either egg amount or quality prior in life than anticipated. In this manner, the woman’s ovarian capacity needs to be tested before a choice is made in regards to whether to continue with either tubal ligation or in-vitro fertilization. AMH levels, ovarian antral follicle number, and day 3 FSH levels are generally done to evaluate ovarian capacity or hold. 
6. Doctor intervention - The greatest favorable position of tubal ligation reversal over IVF is that once the woman has experienced the surgery she ideally will not require any medication through the doctor, for example, medications or systems, keeping in mind the end goal to get pregnant.

PGS or Pre-implantation Genetic Screening is a test conducted to decipher the chromosome count of the embryo. Today, if you are planning to get pregnant or using alternative technologies for pregnancy; there are several tests that need to be conducted so that the child is born healthy and stable. One such test is the PGS, it determines whether or not the count of chromosomes is normal, which is forty six, is present in the embryo. If there are abnormal numbers of chromosomes present in the embryo then it might lead to additional problems in the future. In such cases, special treatments and procedures are conducted.

There are several advantages of PGS. Some of them are highlighted in details below :

1. Healthy pregnancy: Interestingly, a man can produce sperms throughout his lifetime. But a woman is born with the eggs already created. The chances of producing a healthy baby with those eggs decrease as the age of the woman increases. It is seen that those women who think of delivering a child in their older ages are often found with chromosome deficiencies in the embryo. Thus, to avoid such a situation, it is best to perform PGS.
2. Reduces the chance of miscarriage: Pregnancies which occur without having performed any prior tests like the PGS have high chances of resulting into a miscarriage at the slightest of carelessness. But research has found that those pregnancies which take place after considering the chromosomal health of the embryo have reduced the risk of being abnormally terminated.
3. Time reduction between two IVF Circles: For those who do not know IVF stands for In-Vitro Fertilisation. It is a process which aids a woman in becoming pregnant. It is often opted by those who are having issues in naturally conceiving a child. PGS here plays an important role. If the test detects abnormal embryo, then the next IVF circle can be started right away without wasting any time. But if the PGS detects a normal embryo then the IVF circle is deemed to be successful and the woman can continue with the pregnancy.

Thus, these are some of the main advantages of Pre-Implantation Genetic Screening. This helps to determine whether the embryo is of the desired choice or not and whether the baby born out of it would be healthy and normal. It is one of the tests which need to be conducted preceding implantation to provide better results after the implantation process is carried out.