Treatments

Treatments

The diagnosis of infertility is often very overwhelming for patients. Not only are they faced with the news that conceiving a child is only possible through medical treatment, they are also presented with information that is totally new to them. New medical jargon along with recommendations for treatments and tests that are completely unfamiliar can be very intimidating for the newly diagnosed. Vardaan Women’s HospitalReproductive Specialists believes in creating a partnership with the patient and we have found that the most successful partnerships occur when the patient is well-informed and can play an active role in their treatment. We value an open and ethical relationship with each patient in an environment that fosters trust and mutual respect, an environment where questions are welcome and encouraged.

Infertility Workup

Fertility experts at Vardaan Women’s Hospitalpay special attention on the initial workup for an infertile couple as it gives them the opportunity to select the right kind of fertility treatment for such couples based on the initial reports. The patient coordination team is working on daily basis to constantly evaluate ways and methods to make the fertility process patient friendly by decreasing the numbers of visits and duration of stay that any patient has to invest in fertility treatment at Vardaan Women’s Hospital.
The infertile couples must undergo a set of advance tests before the commencement of any treatment. These tests are comprehensive & detailed and are essential to determine the causes of infertility, whether the couples are diagnosed with any other ailment and which technique would be most suitable for a particular couple.
Female partner must undergo trans-vaginal ultrasound to evaluate ovarian reserve & uterus condition, few blood tests etc. and Laparoscopy or hysteroscopy in cases where there is indication of such operation requirement after the initial workup.
Male partners need to undergo a semen analysis to determine the quality & quantity of their sperm or whether there’s any dysfunctional tinge to them. The mobility and motility are also checked along with few blood tests.

Laser Assisted Hatching

Laser Assisted Hatching: In Laser Hatching technique, Zona Pellucida, a glycoprotein layer hemming in the plasma membrane of mammalian oocytes, is slightly opened through an anodyne laser to attenuate the upper layer of embryo so that it can be removed from Zona Pellucida and placed in a microscope. The Zona holds a vital role in fertilisation process as only one sperm can perforate the Zona and fuse with the egg to fructify fertilisation.
The laser to soften the shell of the embryo is non-contact which means that embryo is not in direct contact with laser. The opening of embryo is enhanced with the help of laser. The whole procedure is carried out with thorough precision and delicacy. This technique improves and ramps up pregnancy rates among women.
Laser Assisted hatching takes remarkably less time and shields the embryo from toxic chemicals so the collective effect of these factors reduces the stress placed upon the embryo during the process. The technique also ensures that the embryo is less exposed to physical manipulation.

Laser Assisted Hatching is useful for the following patients:

a) Who’ve failed previous IVF/ICSI cycles
b) Who have frozen embryo transfer
c) Women who are older than 37 years of age hence produce eggs with a harder Zona Pellucida
d) Women who have a high Follicle Stimulating Hormone (FSH) level

In vitro fertilisation (IVF)

In vitro fertilization (IVF) literally means ‘fertilization in glass,’ more simply explained as ‘test tube baby’. In the IVF process, eggs are removed from the ovaries of the female, at the same time sperms are collected from the male partner. The eggs and sperms collected are made to fertilize in the laboratory and the fertilized egg (embryo) is then implanted in the woman’s womb to make her conceive.
Vardaan Women’s Hospitalfertility experts believe that age must not be a factor of consideration when going for IVF process as we get a lot of infertile couples between the age of 25 – 30 years who think that they are too young to go for IVF treatment and it’s a last resort without even knowing the statistical figures which clearly indicates that the success rate of IVF or any fertility procedure decreases with age.
This technique evolved in late 1970s and was mainly used for females having tubal blockage but with the advent of superior equipments and technology coupled with increase in complications faced by infertile couples

IVF technique is now mainly used following cases:

– Females with both fallopian tubes blocked
– Females with one fallopian tube blocked and one open
– Borderline male sperm count
– Unexplained infertility cases
– Coupled who have failed the traditional treatments like timed intercourse, follicular monitoring, IUI etc.
Gone are those days when age was a constraint to experience motherhood and attaining menopause came along with sorrow of inability to reproduce. IVF (In Vitro Fertilisation) has proved to be a boon to all those couples who’ve only dreamt of becoming parents but could never see their dream coming true due to insurmountable reasons.

Cryopreservation

Cryopreservation is a technique in which sperms, eggs and embryos are froozen at a sub-zero temperature to preserve them for future when the need arises. There are 3 types of Cryopreservation in IVF spectrum:
1) Sperm Cryopreservation
2) Eggs Cryopreservation
3) Embryos Cryopreservation

Sperm Cryopreservation: Sperm are frozen to preserve because of a string of reasons: a) To develop sperm bank; b) To donate stored sperm; c) To use it during the treatment if the male partner is unable to ejaculate on the stipulated day; d) Before undergoing vasectomy; e) Prior to Cancer treatment which might adversely affect fertility; f) Retrieved sperms from epididymis (PESA) or testes (TESA).
If sperm are frozen for the impending treatment of the donor, the storage period is usually 1 year. For the pre-chemotherapy storage, the duration is mostly of 10 years which can be extended in certain circumstances.

Eggs (oocytes) Cryopreservation: Eggs Cryopreservation is for women who are about to undergo medical treatment for ailments such as cancer etc. which may affect her ability to produce eggs in the future. This technique is also useful for
women who are career-oriented and does not want early motherhood. Eggs are frozen within few hours of collection through the standard freezing process. Later, when women are ready to be pregnant, the frozen eggs are thawed, fertilised with the husbands’ sperms and resultant embryo is implanted in the uterus.

Embryos Cryopreservation: During the treatments like IVF, ICSI the best embryos are selected and transferred during the first cycle, if any good quality ‘surplus’ embryos are left, they are frozen to preserve for the future use while curing infertile couples. It is to be noted that only the embryos of top-notch quality survive the freezing and thawing process.

ICSI

ICSI is a technique in which a single sperm is directly injected into an egg to fertilise it and then the fertilised egg (embryo) is transferred to womb. It is one the most cost-effective and successful treatment for infertile men. This method is especially salutary for men who have low or zero sperm count. In case of zero sperm count or when the male partner is too uptight to ejaculate on the day of egg collection for IVF, the sperm is extracted either from testicles (using TESA) or epididymis (using PESA). Even if men have dysfunctional sperm which can’t fuse with the egg, ICSI comes in handy.
A sharp and delicate needle is used to immobilise& pick up a sperm and it is injected into the cytoplasm of the egg, after which the needle is removed.
The success rate of ICSI is significantly higher than IVF and the couples often opt for ICSI when the conventional IVF technique does not produce desired results for them. The success rate of ICSI is directly proportional to the age: the younger the patient is; the higher are the chances of success.

IUI

IUI is a technique in which sturdy sperm are sifted out from flaccid ones and later the washed sperm are placed into women’s uterus during the time of ovulation. Before the IUI treatment commences, it is mandatory to undergo a Patency Health Test to ascertain whether the fallopian tubes are robust and open.
This method is particularly beneficial for the couples whose infertility problem is unexplained and ambiguous. This technique is also used when men can’t ejaculate in their partners’ vagina due to a raft of reasons ranging from psychological issues, impotence, vaginismus or anatomic problems.

Procedure: After a period of abstinence for 3 days, to produce the optimum and healthy sperm, men jerk off into a jar. The best quality sperm are sifted out, which takes around 2 hours, and are placed in womb through a thin tube. This process is not painful for women but they might experience a slight discomfort or a little vaginal discharge which is just the cervical mucus.
If women are above the age of 35, the rate of success is decreased. Also, IUI might cause multiple pregnancy which results in twins, triplets or even quadruplets as it’s extremely difficult to control the growth of no. of follicles. It must be noted that IUI treatment must only be taken under the supervision of supremely skilled doctors in the state-of-the-art clinics to avoid the risks associated with IUI.

Donor Programme

Sperm Donation: Donating sperm is considered one of the noblest causes a man can undertake. When the male partner has zilch sperm or his sperm are of low-quality, they need some other man who is willing to donate sperm which would fuse with eggs of the female partner to form an embryo. That embryo would be implanted in the womb to produce a healthy child after 9 months.

Egg Donation: When female partner is unable to produce eggs due to various reasons like menopause, premature ovarian failure or age factor, the infertile couple seeks a woman who would donate eggs in lieu of a sum of money. . The eggs are fertilised and implanted in the womb of the desired mother. Thereafter the children are born in a natural manner. The desired mother has to undergo two to three sessions of hormonal therapy before obtaining the eggs from the donor woman. It is called Hormonal Replacement Technique. This therapy is used to determine whether the womb of a woman is competent for implantation.

Embryo Donation: When both the male partner and the female partners are infertile, they opt for embryo donation. In this, the embryo is developed by fusing the sperm and eggs of the donor couple and the embryo is implanted in the uterus of female partner. The couple who are donating the sperm and the eggs undergo a
series of tests to determine any medical ailment or the quality of sperm & eggs.

Blastocyst Culture and Transfer

Blastocyst Culture and Transfer is a technique in which an embryo is developed in the laboratory for 4-6 days after fertilisation before being placed in womb. The embryo gains many cells as a result of being developed for so many days. The embryos developed for 4-6 days are much more advanced than the ones developed for just three days. These Embryos are called blastocysts

The embryos which survive for 4-6 days are more likely to produce the fruitful results. This enables embryologists to select from the more advanced embryos with better potential for implantation.
The biggest advantage of Blastocyst Culture and Transfer method is that it significantly reduces the risk of multiple pregnancies. Also, the pregnancy and implantation success rate is higher in this technique because it is easy to determine the robust embryos after developing for 4-6 days hence only the competent embryo are transferred to uterus.

Sonography

Infertility treatment is now revolutionized by the advance techniques being introduced with each passing day; Sonography or Ultrasound has recast the approach towards infertile couple.
Sonography is the initial step in the process of diagnosing and curing any patient but it has a vital role to play. High frequency radio sound waves are made to penetrate to the level of pelvic organs. The waves after touching the surface of pelvic organs get reflected and the same are received as black and white images on the screen which determine the exact condition of that part.
Besides Trans-abdominal Sonography, commonly used technique, Trans-vaginal Sonography is the standard ultrasound technique which is used these days for infertility. It uses a long and slender probe to get inside the vagina; the images are then taken on the screen. Images received are clearer when taken through this technique as the probe reached closer to the pelvic parts in this case.
Ultrasound is used for various purposes like egg pick up for IVF, Ovarian cyst aspiration, ultrasound guided embryo and gamete transfer etc. Vardaan Women’s Hospitalexperts pay special attention to the patients’ ultrasound finding during the initial checkup in order to decide the problem and further treatment plan,
we get a lot of patients who have undergone hysteroscopy or laparoscopy or D&C operations in the past without any indication to go for these surgeries. Vardaan Women’s Hospitalfertility specialist believe that surgery must be only performed when there is a clear cut indication for that operation during the ultrasound evaluation.

Laproscopy& Hysteroscopy

With the advent of cutting-edge technology, it has become a feasible option to perform ‘minimally invasive’ surgeries with precision and finesse. Laparoscopy and Hysteroscopy are two such surgeries used to diagnose and cure certain female infertility conditions.
Laparoscopy: It is done using a small but significant telescope named ‘Laparoscope’ to which a light source and camera are attached. It enables doctors to see ovaries, outside of uterus and fallopian tubes inside the abdomen. The doctors can perform surgeries while looking inside the abdomen. Laparoscopy is done to determine the causes of infertility, symptoms like pelvic pain & abdominal pain and to check if there are any scar tissues or blockage in the fallopian tubes. The doctors use this technique to treat cysts, endometriosis and fibroids.
Hysteroscopy: A tool called ‘Hysteroscope’ is used to see inside the womb. The tip of the tool is put inside the uterus and trawled gently. A light source and camera are attached to the tool. Hysteroscopy is usually done to determine the cause of abnormal bleeding and to remove growths in the uterus like fibroids & polyps. During the test, the doctor can find and treat the problem at the same time.

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