Book Clinic Appointment with Dr. Nalini Gupta
Treatment of Ovarian Cysts
Treatment Of Erectile Dysfunction
Treatment of Fertility
In Vitro Fertilization (Ivf) Treatment
Treatment of Uterine Fibroids
Treatment of Azoospermia
Treatment of Male Infertility or Impotency
Management of Surrogacy
Sperm Donor Program
Treatment of Gynae Problems
Treatment of Infertility in Women
Natural Cycle Ivf Treatment
In Vitro Fertilization (Test Tube Baby) Procedure
Preimplantation Genetic Diagnosis (Pgd)
Treatment of Ovarian Failure
Egg Donation Procedure
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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.
- 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.
The fallopian tubes are a part of a woman’s reproductive system. This is the passage through which the egg travels to meet the sperm and attach the end result to the lining of the womb or the uterine lining. In many cases, the fallopian tubes may get blocked, which can cause a series of complications, including infertility and other issues.
Read on to know more about the complications as well as the diagnosis.
Fallopian tubes: These are two thin tubes that flank either side of the uterus. It helps the matured egg from travelling from the ovaries to the uterus.
Blockage of fallopian tubes: Sexually transmitted diseases or STDs, as well as endometriosis, can cause a blockage in the fallopian tubes. The tubes can get blocked from one or both sides.
Complications: Blocked fallopian tubes can lead to major complications like early pregnancy loss as well as infertility. Every month, the ovaries release eggs during a cycle known as the ovulation cycle. During this period, the eggs leave the ovaries and travel through the fallopian tubes in order to reach the uterus, where they can possibly get inseminated with sperm, after which they will get fertilised and attach themselves to the uterine lining or the womb. In case the fallopian tubes are blocked, the eggs gets blocked and do not get a passageway to travel from the ovaries and into the uterus. This can lead to infertility as it will prevent fertilisation of the released egg. Furthermore, blocked fallopian tubes can also lead to tubal pregnancies, which will have to be terminated as it can lead to severe health risks.
Symptoms: So how can you find out whether your fallopian tubes are blocked? There are a number of symptoms that may be caused in the course of this condition. It is important to be even more careful about the symptoms because they may not be as obvious as other conditions, where irregular periods and heavy bleeding may point to the problem at the very onset. Pain in the lower abdomen and unusual discharge usually point to the problem. Also, loss of pregnancy due to the blockage is also a clear cut diagnosis.
Diagnosis: The diagnosis of the condition is done with the help numerous tests and imaging examinations conducted by a gynaecologist. A specialised X-ray called hysterosalpingogram or HSG is used in order to diagnose the issue. In this kind of examination, a dye is inserted through the uterus. This dye has a lens at the end, which shows the blockage and its extent. The doctor then conducts tests to find out the causes of this condition so that proper treatment may be followed.
What is recurrent miscarriage?
If you have three or more miscarriages in a row, doctors call it recurrent miscarriage. If you have experienced recurrent miscarriage, your GP or midwife will refer you to a gynaecologist. Your gynaecologist will try to identify the reason for your losses.
Having miscarriage after miscarriage may leave you feeling utterly drained of hope. At times, it may be hard to keep trusting in the future. This experience affects every aspect of a woman’s life from her mental and emotional health to her physical health and social well-being.
If you can, try to draw comfort from the fact that most women who experience recurrent losses do go on to have a baby. This is especially the case if tests can find no reason for the losses. Six out of 10 women who have had three miscarriages will go on to have a baby in their next pregnancy.
Treatment of Recurrent Pregnancy Loss
Treatment for anatomic abnormalities of the uterus involves surgical restoration through removal of local lesions such as fibroids, scar tissue and endometrial polyps or timely insertion of a cervical cerclage (a stitch placed around the neck of the weakened cervix) or the excision of a uterine septum when indicated.
A thin endometrial lining has been shown to correlate with compromised pregnancy outcome. Often times this will be associated with reduced resistance to blood flow to the endometrium. Such decreased blood flow to the uterus can be improved through treatment with sildenafil (Viagra), Terbutaline and possibly aspirin.
Sildenafil (Viagra) Therapy Viagra has been used successfully to increase uterine blood flow. However, to be effective it must be administered starting as soon as the period stops up until the day of ovulation and it must be administered vaginally (not orally). Viagra in the form of vaginal suppositories given in the dosage of 25 mg four times a day has been shown to increase uterine blood flow as well as thickness of the uterine lining. To date, we have seen significant improvement of the thickness of the uterine lining in about 70% of women treated. Successful pregnancy resulted in 42% of women who responded to the Viagra. It should be remembered that most of these women had previously experienced repeated IVF failures.
Terbutaline this is a medication that relaxes the muscle in the uterine wall and so permits improved hormone delivery to the endometrium. The use of Terbutaline will often cause an increase in heart rate. It should not be prescribed to women who have irregular heart beats (arrhythmias), and women who have decreased cardiac reserve.
Aspirin this is an antiprostaglandin that improves blood flow to the endometrium. It is administered at a dosage of 81mg orally, daily from the beginning of the cycle until ovulation.
Selective Immunotherapy Using Intralipid, heparin, aspirin and corticosteroid
Many causes of pregnancy loss or failure can be treated with immunotherapy comprising combinations of aspirin and heparin and corticosteroids (dexamethasone or prednisone) and Intralipid (IL) to regulate increased NKa. Achievement of optimal success with Intralipid/corticosteroid therapy requires that the treatment be initiated well before ovulation takes place (about 7-14 days prior to anticipated implantation). Given the fact that only 10-15% of natural cycles (with or without the use of insemination and/or fertility drugs) will result in a pregnancy, it follows that repeated administration of Intralipid will be required in most cases before a pregnancy will occur. IVF achieves pregnancy rates that are often 2-3 times higher. This often makes IVF a treatment of choice in cases of immunologic recurrent pregnancy loss.
Preimplantation genetic diagnosis (PGD) a procedure whereby the embryo can be tested for genetic or structural chromosomal abnormalities requires the use of IVF to select the best embryo(s) for transfer to the uterus. In cases of structural chromosomal (translocations) egg or sperm donation is often another option worth considering.
In those cases where due to intractable anatomical or alloimmune dysfunction IVF repeatedly is unsuccessful or is not an option, Gestational Surrogacy might represent the only recourse other than adoption.
If a couple with Recurrent Pregnancy Loss is open to all of the diagnostic and treatment options referred to above, a live birth rate of 70% – 80% is ultimately achievable.
I am 27 year old. I am trying to conceive for 5-6 months. But couldn't conceive. I am also taking 5 mg folio acid for one week. please tell me what should I do. What medicine I have to take.
I am 27 years old. Last 7 months trying to conceive for 2nd baby. My height is 5.5 inch and weight is 81 kg. 5 months back my weight is 75. Now its increased to 81 kg. Increasing weight is one of reason for not conceive? Tell diet plan to reduce my weight.
With infertility on the rise due to various reasons, in-vitro fertilization is one of the most effective solutions. This is gaining wide acceptance across the society and medical fraternity. Read on to know more about why IVF and how it is done.
Causes of infertility:
Advanced maternal age: More and more women choosing education and career over marriage and family. There are many women who are not even thinking of having children up until their 30s. Biologically though, the quality of egg deteriorates with age, and women beyond 35 have difficulty conceiving naturally.
- Altered lifestyle including exposure to chemicals and pollutants, which has led to overall decline in the health of individuals.
- Societal changes like urbanization and formation of nuclear families
- Increased stressors in all spheres of life, which is affecting the quality of sperm and egg
- Lifestyle diseases including obesity, diabetes, and hypertension. These are becoming more prevalent in the younger age groups, and therefore infertility is on the rise in these groups.
- Lifestyle habits like smoking, alcohol abuse, drug abuse, etc., which are also poorly affecting fertility rates.
However, with all these, medical technology is also improving. For those who are faced with infertility due to the above issues, there is a lot of hope in terms of options like IVF which have provided a definitive solution to infertility.
Steps of IVF: By definition, in vitro fertilization is when the egg and sperm are fertilized or fused in a glass (vitro is for glass) and then implanted into the womb where it grows further.
- The first step is to induce ovulation. Fertility medicines are given and hormone levels are monitored to ensure egg release happens. Normally, the ovaries produce only one egg. However, with IVF, the ovary is made to produce multiple eggs, so that the chances of fertility is increased.
- The egg is then retrieved and moved into an incubator.
- Sperm sample is obtained either from the partner or a donor, and the healthiest sperm is chosen for fertilization. The sperm and the egg are then allowed to fertilize in the incubator
- A healthy fertilized embryo is then transferred into the womb. The woman is advised bedrest for about 1 to 2 days.
- Blocked fallopian tubes, which do not allow for the sperms to travel up to the uterus
- Advanced maternal age, women of more than 30 years of age, this is an effective option.
- Uterine scarring or endometriosis caused infertility can also be managed through IVF
I am 24 year old and I'm married I am trying for baby but after sex all sperm get out of vagina I keep pillow under my back, after getting from bed all sperms get out of vagina is it possible to get pregnant? Please advise
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: High success rate. 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.
Myth #2: 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 #3: 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 #4: 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.
In case you have a concern or query you can always consult an expert & get answers to your questions!