Doctor in Garbhagudi Ivf Centre
In case you have a diseased uterus, which makes you infertile, you can undergo a procedure known as uterus transplant or uterine transplant to get pregnant. In the process of sexual reproduction, a diseased uterus does not allow embryonic implantation. This factor is referred to as uterine factor infertility or UFI. As a result, you will not be able to get pregnant.
Who requires a uterus transplant?
This procedure involves women who have UFI and women who had their uterus removed by hysterectomy. Women who have a damaged uterus on account of an injury or infection, which does not function anymore, can also undergo a uterus transplant procedure. Women from the age of 21 to 45 are eligible for this procedure. Many women are born without having a uterus. This condition is called Mayer-Rokitansky-Küster-Hauser syndrome.
Uterus transplantation begins with undertaking a uterus retrieval surgery on the uterus donor. The uterus, which is recovered has to be stored and transported to the location of the patient undergoing the transplant. An ischemic tolerance may last over 24 hours. Three major surgeries have to be carried out with the recipient. Firstly, a transplantation surgery is required in which the donor’s uterus gets transplanted. In case pregnancy develops, a caesarean section surgery has to be performed. The patient is given immune suppressive therapy. After childbirth, a hysterectomy is done in order to terminate the immune suppressive therapy.
Will the women be able to get pregnant after having sex?
Women receiving a uterus transplant will not be capable of becoming pregnant without undergoing fertility treatments. The transplanted uterus is not connected with the fallopian tubes, which is the location of the normal fertilisation process. The women will require to carry out IVF or in vitro fertilisation to become pregnant after a uterus transplant. IVF is a process in which the eggs are removed from the ovaries and get fertilised in a laboratory. Then, they are implanted in the uterus. After undergoing the uterus transplant procedure, a woman has to wait for a period of one year. The uterus requires time for healing and after recovery, the embryo may be implanted for pregnancy. After giving birth successfully, a woman will be able to keep the transplanted uterus.
She has the option to get pregnant again. However, after giving birth twice, a hysterectomy must be carried out for the removal of the uterus. This is done so that the woman can stop using the immune suppressant drugs, which are associated with major risks. Uterus transplant is a relatively new technology. In October 2014, the first healthy baby was born to a woman who had undergone a uterus transplant. This surgery is kind of experimental in nature and is usually the last option for getting pregnant.
There are many reasons leading to infertility, but one of the main causes is the inability of the sperm to travel all the way up to the uterus to fertilize an egg. This is caused by defective sperms and could be due to poor sperm quality, poor motility, etc. There are multiple reasons for this, and even smoking, obesity, diabetes, hypertension, etc. could be reasons.
Many technical advancements in fertility treatments are being done, and they try to keep the natural process of fertilization intact, at the same time improving the chances of success. Intracytoplasmic sperm injection (ICSI, often used as a standalone term iksee) improves the rate of fertilization in that the sperm is directly injected into the egg. The environment of this artificial fertilization is completely controlled, and the fertilized egg is then placed into the womb for further growth. It is one of the recent methods of improving fertility, a part of ART (assisted reproductive technology).
- Poor sperm perms motility
- Semen where sperm concentration is low
- Male infertility with unidentifiable cause
- Poor sperm quality, with sluggish sperms
- Ejaculation issues, such as retrograde ejaculation (semen is ejected into the bladder)
- Useful in couples who have failed IVF.
What to expect?
The following outlines some of the steps for both male and female before and during the procedure.
Before the procedure - males:
- First step is the sperm collection; a screening is first done
- Sperms collection happens through either masturbation or directly from the testicles via a small incision
- Sperms could be collected fresh or collected and frozen for later use
Before the procedure – women:
- In the normal menstrual cycle, only a single egg is released. However, prior to ICSI, the woman is given ovulation drugs, which are high-dose hormone injections prior to ovulation. This ensures multiple eggs are released, which are then retrieved for fertilization in the external environment.
- Blood and urine are monitored regularly to identify the ovulation time, and eggs are collected within 24 to 36 hours of release
During the procedure - How ICSI happens:
- A healthy egg is chosen and placed in a glass tube, and a sperm is introduced to ensure fertilization
- This could be repeated in multiple tubes, and the most healthy one could be chosen to be implanted into the uterus
- Some of the fertilized ones could be frozen for later use, in case the implanted embryo fails to grow as expected
- The success rate for this procedure is quite high as the fertilization rate is almost 80 - 85 %
Of a million sperms released in one ejaculation, a single sperm manages to fertilize the egg, which grows into an embryo and then a baby. Due to various reasons, when this does not happen, it is termed as infertility and is currently on the rise.
With IVF, couples sometimes go through multiple sessions to ensure fertilization. ICSI or intracytoplasmic sperm injection improved this chance of fertilization. It is where a single sperm is used to fertilize an egg in an artificially controlled environment and then injected into the uterus where it grows further.
The next step in this technique is IMSI, where the chances of successful pregnancy are further enhanced and also promises improved quality of the embryo. IMSI, as it stands for, has “morphologically selected” which means under a highly powerful microscope, the best sperms are selected and then used to fertilize the egg. Morphology stands for shape, and the shape of the sperm is a direct indicator of the sperm quality. This not just ensures good success rate but also ensures the sperm which is used produces a high-quality embryo.
- High success rate of fertility
- Reliable and efficient method of ART (assisted reproductive technology)
- More expensive than traditional IVF methods or ICSI
- Requires complex equipment, training, and set-up
- Useful in couples who have failed IVF previously
- Male infertility with unidentifiable cause
- Poor sperm quality
What to expect?
Both partners are prepared both physically and mentally prior to IMSI.
Before the procedure - men:
- A screening is first done to decide if the sperms can be used directly
- In case of hereditary diseases, a donor is preferred
- The first technical step involves sperm collection, either directly or through a donor
- Sperms are collected either through masturbation or through a small incision in the testicles
- Sperms used could be fresh or frozen; fresh ones may be stored for later use also
Before the procedure – women:
- The woman is put on some ovulation therapy to ensure the release of multiple eggs, so a good one is picked. These high doses of hormones ensure multiple eggs are released.
- Egg release is monitored through blood and urine tests
- They are collected within after 36 hours of release
During the IMSI procedure:
- A healthy egg is chosen and placed in a glass container containing hyaluronidase
- Sperms are placed in a medium which will slow their movement, which enables picking a good sperm for fertilization
- The dual advantage of this is that in addition to a high success rate of fertilization, the quality of the embryo is also assured
IVF or In Vitro Fertilization is a very common treatment for infertility. This process of fertilization involves, extracting eggs, retrieve a sperm sample and then get the egg and sperm combined manually in a laboratory dish. The embryo then gets transferred to the uterus. It is an artificial way to conceive and applicable for couples who cannot have children conventionally.
Problems Which Lead To In Vitro Fertilization
Now we will have a look at the problems which ultimately force couples to go for IVF and conceive children through artificial procedures:
Infertility Issues in Female:
Generally for women, they produce the egg and then it’s about moving it to the uterus where the sperm can fertilize it. When everything goes well, the fertilized egg goes on to become an embryo and then it gets implanted on the wall of the uterus and grows accordingly. Any deviation from this normal process can lead to infertility.
One of the most common causes of infertility among females is Endometriosis. Endometriosis causes scar tissue which results in the blockage of fallopian tubes. In some other cases, there may not be any blockage in the fallopian tubes but there might be difficulty in moving the egg along to the uterus where the fertilization can take place. In such a situation, IVF helps to the get the eggs extracted directly from the ovaries, fertilize them in the lab, hence avoid the problems of the fallopian tubes.
Ovulation problems generally occur for women who are aged 35 years or over and can have issues in producing good quality eggs. This is where IVF can come into play. It can get the woman’s ovaries stimulated by fertility drugs, help produce a number of eggs and then allow them to be fertilized in the laboratory. In Vitro Fertilization helps in giving greater control, when there is a possibility of multiple births, rather than using only the fertility drugs. IVF makes sure to use donor eggs from a donor younger woman, which in turn largely improves the possibility of a woman, who is 40 years old or more than that, to get pregnant.
Infertility Issues Among Males:
For males, it is about producing healthy sperm and get them inside a woman’s uterus, so that there is a chance of an egg fertilization. Now, infertility problems arise, if anything goes wrong with this particular process. One of the main problems could be, low sperm count, which fails to penetrate the egg, while other issues could be, sperm is unable to survive in the uterus’s mucus, problem with intercourse, tube blockage. Males can get rid of these problems through IVF treatment, where the sperm could get extracted from the testicles, avoiding the blockages and hence used for fertilization of eggs in the lab.
So, this segment has talked of what IVF is all about and what kind of problems among males and females could lead to IVF treatment. In case you have a concern or query you can always consult an expert & get answers to your questions!
It is as important for the man as it is for the woman to undergo certain tests before the IVF cycle is started. Fertility is not only an issue for a woman, but it also might be for the man in question. There are certain tests that need to be conducted on men before they can gear up for IVF:
1. Semen Analysis: One of the most important tests for male infertility is semen analysis. Sometimes, a man may be completely healthy, but his sperm production could be of poor quality. Semen analysis is done to provide an accurate evaluation of sperm number, the ability to move (motility), size and shape (morphology), as well as the consistency and volume of the sample collected.
2. Binding Test: Sometimes agglutination occurs where the sperms might stick to each other by their heads or tails. Sperm antibodies might cause this problem. The IVF treatment's success might be compromised if this happens. A simple binding test is done to determine this.
3. Trial Wash: This is also known as sperm wash. It is mostly done to remove chemicals from the sperm. Not doing a sperm wash might end up affecting the later stages of the IVF treatment. In this process, the misshapen and immotile sperm is separated so a clean sample of motile and healthy sperm can be collected.
4. TUNEL Assay: Since sperms build up about half of a child's genetic makeup, a TUNEL Assay or 'sperm DNA test' is required. This test is done to measure the sperm population that have fragmented DNA. Negative impacts on genetics can hamper the success of the fertility treatment.
TUNEL Assay is usually recommended to men with:
- Leukocytes detected by the sperm analysis
- Age approaching 50
- A history of diabetes II type or prostatitis
- Exposure to chemicals or prolonged heat at workplaces
Infertility treatment is common among couples, who are unable to conceive children through the natural process, due to health or hormonal problems. Among the infertility treatments, In Vitro Fertilisation is one of the most common methods used to help couples get rid of the problems and allow them to conceive children in an unconventional manner. This artificial treatment was successfully performed for the first time in 1978.
Now let’s take a look at some of the different types of IVF Treatment:
This particular type of variation in IVF does not require stimulation of woman’s ovaries for producing several eggs for collection. Only the egg which is produced during her normal menstrual cycle gets collected and it is then merged with the man’s sperm to successfully achieve fertilisation and in the process, an embryo.
This method carries with it certain advantages, like this does not involve the risk of ovarian hyperstimulation and it is accepted by certain cultures and religious groups due to the fact that no spare embryos are created, which might require to be disposed of or get it frozen.
As far as disadvantage for this type of treatment is concerned, the success rates are not that high. The statistics published by the United Kingdom’s Human Fertilisation and Embryology Authority, show that only one out of 26 women under the age of 35 could get pregnant in 2008 due to the natural cycle in vitro fertilisation.
Mild Stimulation In Vitro Fertilisation
This process is carried out just like standard in vitro fertilisation. Only exception is that the hormones used to stimulate the ovaries for producing a number of eggs, get used for a short span of time. This helps to narrow down the risk of ovarian hyperstimulation syndrome in women, who had developed this particular risk in previous cycles of in vitro fertilisation.
Mild stimulation might help get rid of the initial treatment to suppress the menstrual cycle, as a result of which one may not find this phase of treatment to be an uncomfortable one.
Like any form of treatment, this type of in vitro fertilisation treatment is not without certain disadvantages. One of them is the fewer number of eggs available for collection and hence lesser number of embryos to choose from for transfer. Still, due to the fact that stimulation of ovaries is not done in a similar manner, one does not require to wait for so long to repeat the particular cycle of in vitro fertilisation.
The low cost of mild stimulation IVF makes it a more desirable mode of infertility treatment as compared to the standard procedure followed for bringing for the desired results.
Hence, we have discussed about the two types of in vitro fertilisation for treating the problem of infertility among males and females along with their advantages and disadvantages in great detail. In case you have a concern or query you can always consult an expert & get answers to your questions!
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:
- 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.
- 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.
- 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. In case you have a concern or query you can always consult an expert & get answers to your questions!
The concept of egg quality of a woman is derived from the belief that the embryo implantation probability is powerfully related to the age and ovarian reserve of the woman. Thus, it is regarded that the quality of the egg is almost synonymous with the chances of embryo implantation. Its quality cannot be assessed merely by looking at the egg or measuring its ability to receive the fertilization by sperm or simply observing the initial embryo division.
There are a few important factors that contribute to the success or failure of the embryo implantation and some of them are:
- Diminished ovarian reserve: A woman with an increased FSH level on the third day of the menses is regarded as having diminished reserve of ovary. This implies that her ovary is not competent in sending feedback signals to the pituitary gland and the body responds by producing an increased amount of FSH for stimulating the ovary. For more than 10 years, it has been found that in over thousands of fertility treatment cycles, women with an increased FSH level have a lower egg quality.
- Advanced age of maternity: Even though the FSH level is normal, the age of the mother who provides the eggs plays an important role to determine the quality of the egg. Quite like women with increased FSH levels, eggs obtained from women aged more than 40 years can have some problems at a later stage of fertilization. Normal FSH levels are not considered a reassuring factor, owing to the lower implantation rate in females aged over 45 years.
- Diminished quality of egg: With an increase in age, the capacity of the mitochondria in producing energy slowly decreases. The egg is linked to the circulation before ovulation, and it is linked again after the embryo implantation. But during the one week time ranging from ovulation to implantation, the egg and the resulting embryo are contained in the zona pellucida and function on the basis of mitochondrial energy supply. The older age of the woman doesn’t cause any problem at the initial stage of ovulation. Its fertilization and embryonic development are also normal. But soon, it runs out of energy and stops dividing before reaching the stage of implantation.
Therefore, it is important to have the eggs tested to find out any sort of chromosomal abnormality. In case the mother is deficient of producing high quality eggs, the best option is to have donor eggs.
4 Dietary Changes that can Increase Your Chances of Getting Pregnant
At times being able to conceive becomes a challenge due to certain biological reasons. Feeling positive and eating healthy naturally takes you a step nearer to getting pregnant. In case of no medical condition acting as an obstruction, consuming the right food can increase your chances of getting pregnant.
Here’s a list of supplements you can include in your diet to maximise your chances of getting pregnant.
1. Choose whole grains over refined carbohydrates: Reducing the intake of refined carbohydrates (found in milk, potatoes, corn to name a few) can reduce inflammation of the genitals, which will help increase fertility. You can still continue to have your favourite foods, but ensure they are low GI (glycaemic index- a figure used to represent the ability of carbohydrate to increase glucose in blood) carbohydrates.
You can consume whole grains, which help in reducing insulin levels that in turn reduce the risk of heart diseases and diabetes and also help lower cholesterol levels. Try having whole grain bread instead of white bread and porridge instead of sugary processed cereals to reduce your GI ingestion.
2. Harness the power of Proteins: Proteins are an important part of your diet and the type of proteins you require careful consideration as they help make new hormones. Try having 25gms of vegetable protein like seeds, legumes and nuts instead of animal protein.
Add dairy foods to your diet as they are also a rich source of protein. They provide vital minerals and nutrients like magnesium, calcium and vitamin B12 to the body and at the same time are low in calories. Include milk, yoghurt and cottage cheese to your meals so that you have a minimum of three servings of dairy products a day, which is essential to meet your nutritional needs and increase your chances of having a baby.
3. Welcome Good Fats: Processed foods, fatty meats and takeaways are high in saturated fats including trans fats. These lead to inflammation and an increase of oxygen free radicals in the body, which decrease fertility. So, incorporate good fats in your diet in controlled quantities. Try having avocado and tomato on a whole grain toast, for instance.
4. Make folate an integral part of your diet: Folate is an essential nutrient that helps in decreasing the incidence of birth defects in babies, while ensuring a healthy conception. Along with the prescribed supplements, try to increase its intake in its natural form. The best way to do this is by having green leafy vegetables, which are a rich source of folate. You can also have veggie sticks and vegetable soup along or green vegetable dishes to increase your folate intake.