Doctor in Oasis Centre For Reproductive Medicine- Chennai
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.
Pre-Implantation Genetic Screening is employed in the following cases:
However, based on individual cases, the doctor takes a call on whether this technique is required for the couple.
There are several advantages of PGS. Some of them are highlighted in details below.
- 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.
- 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.
- 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.
PGD may be recommended if:
- You/Your Partner is a carrier of genetic abnormalities
- You/Your Partner has chromosomal abnormalities
- You/Your Partner has a family member that is a carrier of genetic abnormalities.
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.
In vitro fertilization or IVF is deemed as one of the wonder treatments for couples who are facing infertility issues. Whether it is due to poor sperm quality of blocked fallopian tubes, IVF has proven to be a safe and effective solution. However, like with all new techniques, IVF also has some myths which need to be understood before signing up for the procedure. With so much at stake in terms of finances and time, understanding the process will help set realistic expectations and improve the success rate of IVF.
Myth #1: IVF leads to multiple births. While achieving multiple births is easier through IVF, it always does not lead to multiple births. Multiple embryos are implanted, only to improve the chances of success. It does not necessarily translate into multiple births. In women over 38 years of age, it is mandatory to only transfer a single embryo as multiple births are very likely to be complicated.
Myth #2: Rest and time off work. It is believed that IVF has a higher success rate with proper rest and time off work. Rest is definitely required the first few days after embryo transplant but it definitely later assumes a normal course of things. It is not that too much time off work is required, just because you had an IVF. Your body might be different and require more rest, but that could have been the case even with a normal pregnancy.
Myth #3: The medications with IVF are going to have lots of side effects. While the hormones given to promote egg release do have their side effects of making you feel moody and emotional, it is only transient. Once the egg release happens, fertilization is done, and embryo transplant is done, then things should settle down. The effects should wear down once the embryo is implanted and then things should settle down. Of course, pregnancy brings its own hormonal changes, which will run their course through pregnancy.
Myth #4: Positive Results. While IVF has very high success rates, some women just fail to get pregnant. This could be about 5% of the women and may not be attributable to any particular cause. Each woman responds differently, and failure to conceive through IVF could be due to no explainable cause. What is interesting is that though the first attempt failed, subsequent attempts may be successful. Failing the first cycle does not mean failure in subsequent cycles. Also, success rate differs from clinic to clinic, and so choose one which has a proven track record and good success rates. It should not just have good doctors but also the essential technology and infrastructure to support the IVF technique.
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. Semen analysis (SA) test includes only the sperm count. Sperm Funtion test (SFT) will include in detail on morphology, motility and other parameters of the sperm.
2. 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.
3. 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.
DNA fragmentation index (DFI) test 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
4. Screening for Infectious Diseases: This test is done for both the partners to check for diseases like AIDS, Hepatitis C, and so on. In case you have a concern or query you can always consult an expert & get answers to your questions!
One of the major milestones in a woman’s life is the entry into motherhood. For most women, when this does not happen in the natural logical sequence of things, there is anxiety and lot of pressure from family and friends.
However, with advancements now, there are options like intrauterine insemination and in vitro fertilisation (IUI and IVF) available, which can help increase the chances of conception and pregnancy. IVF is where the egg is retrieved from the woman’s womb, fertilised externally and then transplanted back into the uterus where it grows to full term. However, there are always unanswered questions like how long to wait before going for IVF, is it the right procedure for me, etc.
Read on to know to find answers to some of these.
- Maternal age: As a woman reaches 35 and a man reaches 40, the fertility rates drop significantly. The chances that a woman at 35 will conceive is about 20%, which goes down to 5% if the woman is 40. However, this rate can be significantly increased by using IVF. The quality of the egg would gradually deteriorate, and so if a woman is nearing 40, it is better to consider IVF as the ovarian reserve would be optimal with IVF.
- Failed intrauterine insemination: In couples who have problems with the sperm reaching the uterus, intrauterine insemination (IUI) is first attempted. However, if 3 or more attempts of fail, it is time to consider IVF.
- Duration of inability to conceive: While some couples conceive quite promptly in a month or two, most take about 6 to 8 months of unprotected sex to conceive. Therefore, IVF can be an option if you are failing to conceive even after a year. Less than a year, don’t fret. Take it easy and it might just do the trick.
- Medical health: Both the partner’s medical health should be taken into account. Lifestyle changes like smoking, alcohol abuse, drug abuse should be considered, which can account for poor sexual performance and therefore lead to an inability to conceive. Health conditions like diabetes and heart disease can also lead to infertility. Hypothyroidism in women is another thing that must be ruled out, as it often leads to an inability to conceive.
- Sexual problems with the partner: One of the first things to do before going for IVF is to check that the male does not have any issues. Be it erection issues or ejaculation issues or sperm issues, they need to be ruled out. Sperm quality, quantity, and motility have to be analysed, and if they are optimal, IVF can be considered.
In case you have a concern or query you can always consult an expert & get answers to your questions!
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:
- 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.
- 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:
- 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.
- Monitoring of your drug response. To monitor the progress of your ovarian stimulation you undergo an ultrasound examination and blood tests.
- Egg maturation. Two days before your eggs are due to be collected you have a hormone injection, which triggers maturation of the eggs.
- Egg collection. You receive a light general anaesthetic for this simple, short procedure, and your doctor retrieves your eggs using an ultrasound-guided technique.
- Sperm production. On the day of egg collection, your partner provides a sperm sample.
- Fertilisation. The embryologist puts sperm and eggs together in the lab and, if all goes well, the eggs fertilise and early embryo development begins.
- 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.
- Embryo freezing. If you have additional embryos suitable for use, they can be frozen and kept for future transfers. Also, frozen embryos are available.
- 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.
IUI- IUI is a procedure during which processed and concentrated motile sperm are inserted directly into a woman’s uterus. This procedure is timed according to a woman’s ovulation, and may be performed one to two times in the days immediately following the detection of ovulation. After ovulation a woman’s egg is picked up by the fallopian tube and waits there for the sperm. Since the IUI procedure deposits higher concentrations of good quality sperm close to where the egg is waiting, the chances that the egg and sperm will find one another are increased.
IVF- IVF is the most successful method of fertility treatment utilized today to help couples to conceive. The basic components of the IVF process include stimulation of the ovaries to produce multiple eggs at a time, removal of the eggs from the ovary (egg retrieval), fertilization of the eggs in the laboratory, and subsequent placement of the resulting embryos into the uterus (embryo transfer). The chance of pregnancy from IVF depends primarily on the age of the woman, the cause of infertility, and factors related to the quality of the IVF laboratory.
IUI Treatment: There is a marked difference between IVF and IUI pregnancy rates. IUI has a success rate between 5% and 20%, but it can even be as low as 1-2 %, depending on the woman’s age and fertility levels. The chances of conceiving through IUI is higher if fertility drugs are administered along with the treatment.
IVF Treatment: IVF has a high success rate – between 20% and 35% and it can even go as high as 40%. This may not seem like a lot, but it is very high, considering that an average young and fertile couple has only a 15-20% chance to conceive in a month. It is important to understand what IVF and IUI success rates mean and the factors that affect it before deciding on a fertility treatment. You can also use any reliable online IUI vs IVF comparison tool to determine your approximate success rates with each of these treatments, depending on your age, lifestyle, and medical history.
You should use online sources of information to understand more about fertility problems, how age affects fertility levels, and whether freezing your eggs is a good option for you. However, discuss all these issues with your doctor to ensure that you have the right information and that you have understood it correctly. Fertility specialists provide you with personalized fertility plans based on your health which is why you should always talk to them before you make any decision. In case you have a concern or query you can always consult an expert & get answers to your questions!
Childbirth comes within an age bracket. Women feel this more so than men. Career demands or other personal choices can delay the time to get pregnant. Thus, freezing your eggs can prove to be beneficial, if you delay childbirth to focus on your career or education, or if you have certain medical conditions such as cancer.
Egg Retrieval: Before the eggs are harvested, there is a lot you have to do. The first month is spent taking blood tests and ultrasounds. In the second month, you will have to take medicines before your procedure for egg retrieval. Ultrasounds and blood tests are also conducted at this stage to monitor the growth of the eggs. Around the time of your ovulation, the eggs will be harvested. You will be lightly sedated during the procedure. After the procedure, you might feel bloated and experience cramping. At least 15 eggs are retrieved for optimum chances. The medicines prescribed are all hormone injections which you can self-administer.
Freezing and Storage: The largest human cell is the egg. It is comprised mainly of water. When the eggs are frozen, crystals can form which can destroy it. So an anti-freeze replaces the water after the eggs are dehydrated. This prevents crystal formation. Eggs are frozen using vitrification. In this process, the eggs are either slowly or flash frozen. Eggs can be frozen for as long as 10 years. This does not hamper the quality.
Risks: There is no guarantee that freezing eggs will lead to having a baby. Sometimes, eggs do not survive the freezing or the thaw.
Advantages: For women who are suffering from cancer, freezing their eggs might be the best option. They might want to preserve their fertility before their cancer treatment starts. This is useful since radiation and chemotherapy can harm your chances of getting pregnant.
The obvious advantage of freezing your eggs would be the fact that it gives you time. It lets you decide and keeps you one step ahead of your biological clock. In case you have a concern or query you can always consult an expert & get answers to your questions!
The available eggs in the ovaries at a time are collectively called an ovarian reserve. Low reserve happens when the production of eggs reduces. This affects the chances of pregnancy. The general cause of low reserves can be aging ovaries. In such cases, the ovary may be healthy and functioning even if the reserve is low. Production of eggs lower as a woman ages. A woman starts with 250,00 to 500,000 eggs at puberty and ends up with 1000 eggs at menopause.
Low reserves are caused by
- Production of eggs decreases: Chromosomal abnormalities like Turner syndrome (lack of two X chromosomes) and genetic anomalies like Fragile X can decrease egg production.
- Ovarian tissue damage: Rough torsion, endometriosis triggered ovarian cysts, malignant or benign tumours, surgical removal of ovary or any other part of it, chemotherapy or radiation, pelvic adhesions, immunological problems or high BMI (Body Mass Index) can destroy the ovarian tissues.
If a woman has low ovarian reserves, then she will be put on the either of the following protocols:
- Short GnRHa Flare: Gonadotrophin releasing-hormone-agonist (GnRHa) like Lupron, Nafarelin, Synarel or Buserelin is administered. This therapy is initiated at the onset of menstruation. The goal of the treatment is to stimulate the release of the follicular stimulating hormone (FSH) which augments the ovarian follicular growth.
- Combined Clomiphene or Gonadotrophin/Letrozole Stimulation: Older women are mostly administered this protocol. But it is strongly advised not to, as this protocol can potentially harm the egg or the embryo.
- Mid-follicular GnRH-antagonist protocol: Once the GnRHa-agonist protocol is commenced, the GnRH-antagonist is given several days later. Once the follicles reach the size of 12mm, GnRHa antagonists like Ganirelix, Orgalutran, Cetrotide and Cetrorelix are added. These drugs stop the pituitary from secreting the luteinizing hormone (FSH leads to secretion of this hormone).
- Long GnRHa Pituitary Down Regulation Protocol: This is the usual approach to deal with low ovarian reserves.
- Agonist/Antagonist Conversion Protocol: This protocol inhibits FSH production. This protocol generally yields good results.
In case you have a concern or query you can always consult an expert & get answers to your questions!
Now-a-days, the entire world along with the inhabitants have become so fast-paced that the most common matter which affects almost everyone is stress. Getting stressed is not only unhealthy for your body and has an impact on every aspect of life including fertility. You might be wondering that how stress can affect your fertility as they sound unrelated. Read on to understand. Till date, though no direct correlation between stress and infertility has been established, it has been observed that if a couple who is trying their best to conceive is under stress, there appears to be a problem. Now, have a look at few of the impacts that stress has on fertility.
How stress affects fertility?
Too much stress has an impact on the proper functioning of the hypothalamus. It is that part of the brain which has the responsibility of sending as well as receiving all type of signals from the reproductive system. The menstrual cycle is one of the most complex communicating systems between the brain and ovaries, and thus stress may affect the fertility cycle. In this manner, stress may delay the ovulation, and in severe cases, it may also prevent the women from ovulating.
Another point that needs to be mentioned is that due to stress fewer mature eggs may be available. Some of the studies focus on the point that the women, who were stressful as well as anxious regarding their IVF (In-Vitro Fertilization), possessed approximately twenty percent fewer eggs than they usually could produce that are viable for fertilization.
Dealing with stress
Different women have their way of dealing with stress. Thus, the impact this unwanted issue has on a woman might not be similar to the reactions of another woman. Many people start to gain weight in such stressful periods while some lose a lot of fat. A fact is sure that stress is not at all healthy and good for an aspiring mother.
So, now that you are aware of stress and infertility and how stress affects your fertility, the best possible course is to eliminate stress from your life as much as possible in a systematic manner. To reduce stress, you must have an adequate amount of sleep and also practice exercise on a regular basis. You may also opt for other habits like practicing yoga, meditation, prayer, seek counseling, etc.
Thus, the bottom-line is, if you are trying to get pregnant, either naturally or through IVF due to genetic or medical reasons, relieving yourself from stress is crucial.