In VitroFertilization
In Vitro Fertilization (IVF) is a medical procedure in which an egg (ovum) and sperm are combined outside the body in a laboratory dish. This process involves stimulating a woman’s ovaries with fertility medications to produce multiple eggs. Once the eggs are mature, they are retrieved from the woman’s ovaries using a minor surgical procedure.
The retrieved eggs are then fertilized with sperm in a laboratory dish, and the resulting embryos are cultured for a few days. One or more healthy embryos are selected and transferred into the woman’s uterus, with the hope that they will implant and develop into a pregnancy.
IVF is commonly used to treat infertility when other methods of assisted reproductive technology have not been successful. It can help couples with various fertility issues, including fallopian tube blockages, male factor infertility, endometriosis, and unexplained infertility. Additionally, IVF may involve the use of donor eggs or sperm if needed.
The success of IVF can vary, and multiple IVF cycles may be required before achieving a successful pregnancy. It’s a complex and resource-intensive process, but it has provided the opportunity for many individuals and couples to overcome infertility and build their families.
Tandem IVF Cycle
Patient’s Eggs Retrieval: The female partner undergoes ovarian stimulation and egg retrieval, as in a standard IVF cycle.
Donor Eggs Retrieval: Simultaneously, a donor undergoes ovarian stimulation and egg retrieval. The donor eggs are then fertilized with the male partner’s sperm in the laboratory.
Embryo Transfer: The resulting embryos from both the patient’s eggs and the donor’s eggs are cultured for a few days. After assessing the quality of the embryos, the best ones are selected for transfer into the uterus.
Supplemental Embryos: Any additional high-quality embryos from the donor eggs may be cryopreserved (frozen) for potential future use.
Tandem IVF allows the couple to benefit from the use of both the patient’s eggs and the donor’s eggs in the same treatment cycle. This approach is particularly helpful for couples facing infertility challenges related to the woman’s egg quality while still providing the opportunity for a genetic connection through the patient’s eggs.
It’s important to note that Tandem IVF may not be suitable for everyone, and the decision to pursue this approach should be made based on the specific circumstances and advice from fertility specialists.
Conventional IVF
Conventional IVF is generally recommended for couples or individuals facing various infertility challenges. Here are some situations where conventional IVF may be recommended:
Tubal Factor Infertility: When a woman has blocked or damaged fallopian tubes, preventing the natural meeting of egg and sperm.
Male Factor Infertility: In cases where the male partner has low sperm count, poor sperm motility, or abnormal sperm morphology.
Endometriosis: For individuals with endometriosis, a condition where tissue similar to the lining of the uterus grows outside the uterus, affecting fertility.
Unexplained Infertility: When the cause of infertility cannot be identified through routine diagnostic tests.
Ovulatory Disorders: For women with irregular ovulation or anovulation, where the ovaries do not release eggs regularly.
Diminished Ovarian Reserve: When a woman has a lower quantity or quality of eggs, often associated with advanced maternal age.
Genetic Disorders: In cases where there is a risk of passing on genetic disorders, conventional IVF allows for preimplantation genetic testing (PGT) to be performed on embryos before transfer.
It’s important to note that the choice of IVF protocol, whether conventional or another variation, depends on the specific circumstances of each individual or couple. A thorough assessment by a fertility specialist helps determine the most appropriate treatment plan based on factors such as age, overall health, specific fertility diagnosis, and prior fertility treatments.
Natural IVF Cycle
Natural IVF, also known as minimal stimulation or unstimulated IVF, is an approach that involves retrieving and fertilizing the one naturally selected egg that a woman produces in a given menstrual cycle, without the use of high doses of fertility medications. Here are some advantages associated with Natural IVF:
Reduced Medication and Side Effects: Natural IVF requires minimal or no ovarian stimulation drugs compared to conventional IVF. This can lead to fewer side effects and discomfort for the woman undergoing the procedure.
Lower Cost: Since fewer medications are used, the overall cost of a Natural IVF cycle may be lower than that of a conventional IVF cycle. This can make fertility treatment more accessible to some individuals or couples.
Reduced Risk of Ovarian Hyperstimulation Syndrome (OHSS): Natural IVF carries a lower risk of ovarian hyperstimulation syndrome, a condition where the ovaries become swollen and painful due to the use of high doses of fertility drugs.
Reduced Time Commitment: The monitoring and medication schedules associated with Natural IVF are often less intensive, requiring fewer clinic visits and less time commitment compared to conventional IVF.
Avoidance of Multiple Pregnancy Risk: Natural IVF typically involves the transfer of a single embryo, reducing the risk of multiple pregnancies compared to cycles with multiple embryos transferred.
Suitable for Certain Patient Populations: Natural IVF may be a suitable option for certain patient populations, such as older women or those with certain medical conditions, where high doses of fertility medications may not be well-tolerated.
Philosophical Preference: Some individuals or couples may prefer a more natural approach to fertility treatment, avoiding the use of extensive medications.
It’s important to note that the success rates of Natural IVF may be lower than those of conventional IVF in certain cases, particularly for individuals with specific fertility challenges. The choice between Natural IVF and other approaches depends on individual circumstances, and a thorough consultation with a fertility specialist is recommended to determine the most suitable treatment plan.
INTRA CYTOPLASMIC SPERM INJECTION (ICSI)
Intracytoplasmic Sperm Injection (ICSI) is an assisted reproductive technology (ART) procedure used as part of in vitro fertilization (IVF) to treat certain types of male infertility. ICSI involves the direct injection of a single sperm into an egg to facilitate fertilization. This method is particularly beneficial for couples facing challenges related to sperm quality or quantity. Here’s an overview of the ICSI process:
Ovarian Stimulation and Egg Retrieval: The female partner undergoes ovarian stimulation with fertility medications to encourage the development of multiple eggs. Once the eggs are mature, they are retrieved from the ovaries through a minor surgical procedure.
Sperm Collection: On the male side, a semen sample is collected. If there are issues with the quantity or quality of sperm, it can be obtained through techniques such as testicular sperm extraction (TESE) or epididymal sperm aspiration (TESA).
Microscopic Sperm Selection: Under a microscope, a single, healthy sperm is selected for injection. This is crucial, especially if the sperm has abnormalities or if there are very few viable sperm available.
ICSI Procedure: Using a specialized micropipette, the selected sperm is directly injected into the cytoplasm (inner part) of the mature egg.
Embryo Culture: The fertilized egg, now an embryo, is cultured in the laboratory for a few days to monitor its development.
Embryo Transfer: One or more selected embryos are transferred into the woman’s uterus, with the hope that they will implant and lead to a successful pregnancy.
ICSI is often recommended in cases of severe male factor infertility, such as low sperm count, poor sperm motility, or abnormal sperm morphology. It can also be used when previous IVF attempts have not resulted in fertilization. ICSI has significantly improved the chances of fertilization for couples facing male infertility challenges.
While ICSI is a powerful tool for overcoming male factor infertility, it’s essential to discuss its implications, success rates, and potential risks with a fertility specialist.
COH (Controlled Ovarian Hyperstimulation)
Controlled Ovarian Hyperstimulation (COH) is a key component of assisted reproductive technologies (ART), particularly in vitro fertilization (IVF) and intrauterine insemination (IUI). The primary goal of COH is to stimulate the ovaries to produce multiple eggs, increasing the chances of a successful pregnancy. Here’s an overview of the Controlled Ovarian Hyperstimulation process:
1. *Baseline Assessment:* Before starting COH, a woman’s reproductive system is assessed through various tests, including blood hormone levels and ultrasound examinations, to establish a baseline.
2. *Ovarian Stimulation:* Fertility medications, such as gonadotropins (FSH and LH hormones), are administered to stimulate the ovaries to produce multiple eggs. These medications are usually self-administered through injections, and the dosages are carefully monitored based on the individual’s response.
3. *Monitoring:* Regular monitoring is crucial during COH. Ultrasound scans and blood tests are performed to track the development and maturity of ovarian follicles (fluid-filled sacs containing eggs).
4. *HCG Trigger:* When the follicles are deemed mature, a human chorionic gonadotropin (hCG) injection is given. This hormone triggers the final maturation of the eggs and prepares them for retrieval.
5. *Egg Retrieval:* Approximately 36 hours after the hCG trigger, a minor surgical procedure called egg retrieval is performed. A thin needle is used to aspirate the mature eggs from the ovaries.
6. *Fertilization:* The retrieved eggs are then fertilized in the laboratory, either through conventional insemination or through Intracytoplasmic Sperm Injection (ICSI), depending on the specific circumstances.
7. *Embryo Culture:* The resulting embryos are cultured in the laboratory for a few days to monitor their development.
8. *Embryo Transfer:* One or more high-quality embryos are selected and transferred into the woman’s uterus to establish a pregnancy.
Controlled Ovarian Hyperstimulation aims to maximize the number of eggs available for fertilization, increasing the chances of obtaining viable embryos for transfer. However, it is important to carefully manage the stimulation to avoid complications such as ovarian hyperstimulation syndrome (OHSS). The entire process is closely monitored by fertility specialists to ensure safety and optimal outcomes.
Aspiration of Eggs
The aspiration of eggs, also known as egg retrieval or oocyte retrieval, is a critical step in assisted reproductive technologies, particularly in vitro fertilization (IVF). This procedure involves the removal of mature eggs from a woman’s ovaries for fertilization in a laboratory setting. Here’s an overview of the egg retrieval process:
Ovarian Stimulation: Before the egg retrieval, the woman undergoes controlled ovarian hyperstimulation (COH) with fertility medications. These medications stimulate the ovaries to produce multiple mature eggs.
Monitoring: Throughout the stimulation phase, the woman is monitored through ultrasound scans and blood tests to assess the development and maturity of the ovarian follicles, which contain the eggs.
Trigger Shot: When the follicles are deemed mature, a trigger shot of human chorionic gonadotropin (hCG) is administered. This triggers the final maturation of the eggs and prepares them for retrieval.
Egg Retrieval Procedure: The actual egg retrieval is a minor surgical procedure typically performed in an outpatient setting. It takes place about 36 hours after the hCG trigger shot.
a. Sedation or Anesthesia: The woman is usually given conscious sedation or anesthesia to ensure comfort during the procedure.
b. Vaginal Ultrasound: A thin, ultrasound-guided needle is inserted through the vaginal wall and into each mature follicle. The ultrasound provides visualization of the ovaries and follicles.
c. Aspiration of Follicular Fluid: The needle is connected to a suction device, and the follicular fluid, which contains the eggs, is aspirated. The fluid is carefully examined in the laboratory to identify and collect the eggs.
d. Identification and Handling: The embryologist identifies the eggs in the collected fluid. The eggs are then placed in a culture medium and transferred to the incubator for fertilization.
Recovery: After the procedure, the woman is observed for a short period in the recovery area to ensure there are no immediate complications. Most women can go home the same day.
Fertilization and Embryo Culture: The retrieved eggs are then fertilized with sperm in the laboratory, and the resulting embryos are cultured for a few days before embryo transfer.
Egg retrieval is a crucial step in the IVF process, and the success of this procedure contributes significantly to the overall success of the fertility treatment. It’s important to follow post-retrieval care instructions provided by the fertility clinic to optimize recovery and minimize any potential side effects.
Embryo Transfer procedure
Embryo transfer is a crucial step in the in vitro fertilization (IVF) process where selected embryos are placed into the woman’s uterus with the goal of establishing a pregnancy. Here is an overview of the embryo transfer procedure:
- *Preparation of Embryos:*
– The embryos resulting from fertilization and culture are monitored in the laboratory to assess their quality and development.
– The embryologist selects one or more high-quality embryos for transfer based on factors such as cell division, symmetry, and the presence of fragmentation.
- *Timing of Embryo Transfer:*
– The timing of the embryo transfer is typically determined based on the age and developmental stage of the embryos, usually on day 3 or day 5 after fertilization.
- *Preparation of the Woman:*
– Before the embryo transfer, the woman’s cervix may be cleaned, and a full bladder might be encouraged to make it easier to visualize the uterus during the procedure.
- *Embryo Transfer Procedure:*
– The woman lies down on an examination table, similar to a pelvic exam.
– A speculum is inserted into the vagina to visualize the cervix.
– The embryos are loaded into a thin, flexible catheter, which is then carefully passed through the cervix and into the uterus.
– The catheter is positioned in the optimal location, and the embryos are gently released into the uterus.
- *Post-Transfer Observation:*
– The woman may be asked to remain lying down for a short period to enhance the chances of successful implantation.
– Some fertility clinics use ultrasound guidance during the procedure to ensure accurate placement of the embryos.
- *Embryo Freezing (Cryopreservation):*
– If there are additional high-quality embryos not transferred, they may be cryopreserved (frozen) for potential future use.
- *Post-Transfer Care:*
– The woman is typically advised to take it easy for the rest of the day after the embryo transfer, avoiding strenuous activities.
– Hormonal medications, such as progesterone, may be prescribed to support the uterine lining and facilitate embryo implantation.
- *Pregnancy Test:*
– A pregnancy test is usually scheduled approximately 10 to 14 days after the embryo transfer to determine if implantation and pregnancy have occurred.
Embryo transfer is a critical and often delicate step in the IVF process, and the success of the procedure is influenced by factors such as embryo quality, uterine receptivity, and the overall health of the woman. The number of embryos transferred is typically discussed and decided in consultation with the fertility specialist based on individual circumstances and preferences.
NEXT-GENERATION SEQUENCING (NGS)
Next-Generation Sequencing or NGS is a new technology for comprehensive chromosome testing of IVF embryos.
We now know that many normal-appearing embryos have abnormalities in the number of chromosomes (aneuploidy). These abnormalities are the leading cause of IVF implantation failure and spontaneous miscarriage. Based on these facts, studies were performed to try to identify and exclude from transfer those embryos with chromosomal abnormalities. This type of testing is known as preimplantation genetic screening or PGS. Next-Generation Sequencing is used for screening embryos for chromosome abnormalities. Next-generation sequencing (NGS) permits the simultaneous interrogation of multiple disease-causing variants in many genes, for selecting genetically normal embryos.
Advantages of NGS:
- Reduced cost
- Enhanced detection of structural abnormalities such as chromosomes with missing or duplicate segments
- Better ability to detect when an embryo may have cells with differing results (mosaicism)
- Reduction of human errors by the increasing use of automation
When do we recommend NGS?
- Females age over 40
- Repeated pregnancy loss
- Repeated IVF treatment failure
- Severe male infertility
NGS is performed in our IVF Clinic with high success rates.
Embryo Freezing and Storage
Embryo freezing, also known as cryopreservation, is a technique used in assisted reproductive technologies (ART), particularly in vitro fertilization (IVF). It involves preserving embryos at sub-zero temperatures for later use. Here’s an overview of the embryo freezing and storage process:
Embryo Freezing Process:
Embryo Selection:
After fertilization, the resulting embryos are assessed for quality. High-quality embryos that are not transferred immediately can be considered for cryopreservation.
Cryoprotectant Addition:
To prevent ice crystal formation and damage during freezing, a cryoprotectant solution is added to the embryos. This solution helps preserve cellular structures.
Cryo-Container Placement:
Embryos, along with the cryoprotectant solution, are loaded into special containers or straws designed for cryopreservation.
Gradual Cooling:
The embryos are gradually cooled to reduce the temperature. This controlled cooling process helps protect the cells from potential damage.
Deep Freezing:
Once the embryos reach a specific temperature, they are placed into liquid nitrogen for deep freezing. The ultra-low temperature of liquid nitrogen (-196 degrees Celsius or -321 degrees Fahrenheit) ensures long-term preservation.
Storage:
Frozen embryos are stored in cryogenic storage tanks, where they can remain viable for an extended period.
Embryo Storage:
Monitoring and Maintenance:
Cryopreserved embryos are regularly monitored for quality during storage. The cryogenic storage tanks are equipped with alarms and sensors to ensure a stable environment.
Storage Duration:
Embryos can be stored for varying durations, ranging from several months to many years. The duration of storage depends on individual circumstances, including the couple’s reproductive goals and any legal or ethical considerations.
Thawing Process:
When the couple is ready to use the frozen embryos, a controlled thawing process is conducted. The cryoprotectant is gradually removed, and the embryos are warmed to body temperature.
Embryo Transfer:
Thawed embryos that survive the process are selected for transfer into the woman’s uterus during a subsequent cycle. The number of embryos transferred is typically discussed and decided based on individual circumstances and preferences.
Advantages of Embryo Freezing and Storage:
Increased Pregnancy Chances:
Cryopreserved embryos can be used in future IVF cycles, providing additional opportunities for pregnancy without the need for ovarian stimulation and egg retrieval.
Time Flexibility:
Couples can choose to delay embryo transfer for personal, medical, or financial reasons. This flexibility is particularly beneficial when undergoing fertility treatments.
Reduced Ovarian Hyperstimulation Risk:
Embryo freezing allows for the separation of the ovarian stimulation phase from the embryo transfer phase, reducing the risk of ovarian hyperstimulation syndrome (OHSS).
Convenience:
Cryopreserved embryos provide a convenient option for couples who wish to space out their attempts at pregnancy or who may face logistical challenges.
Genetic Testing:
Embryos can be frozen before or after preimplantation genetic testing (PGT), allowing time for genetic results to be obtained without delaying the overall IVF process.
It’s important to note that not all embryos survive the freezing and thawing process, and the success of frozen embryo transfer may vary. The decision to freeze embryos and the duration of storage are personal choices that should be discussed with fertility specialists based on individual circumstances and preferences. Additionally, there may be legal and ethical considerations, and couples should be aware of the policies and regulations related to embryo cryopreservation in their region or country.
Surgical Sperm Extraction (Micro TESE,TEST, TESA, PESA)
Procedure: MicroTESE is a microsurgical technique where a small incision is made in the testicle. Using an operating microscope, the surgeon identifies and removes areas of the testicle likely to contain sperm.
Indication: MicroTESE is often used when there is a suspicion of obstructive azoospermia (absence of sperm in the ejaculate due to a blockage).
Advantages: It offers high sperm retrieval rates with minimal damage to the testicular tissue.
Testicular Sperm Extraction (TESE):
Procedure: TESE involves making a small incision in the testicle and removing a piece of testicular tissue. The tissue is then processed to identify and extract viable sperm.
Indication: TESE may be used for non-obstructive azoospermia, where sperm production is impaired.
Advantages: TESE allows for the retrieval of sperm even when sperm production is limited.
Testicular Sperm Aspiration (TESA):
Procedure: TESA is a less invasive method where a small needle is inserted into the testicle, and a small amount of tissue is aspirated for sperm retrieval.
Indication: TESA is often used for non-obstructive azoospermia.
Advantages: It is a relatively simple and quick procedure.
Percutaneous Epididymal Sperm Aspiration (PESA):
Procedure: PESA involves using a fine needle to aspirate sperm directly from the epididymis, a structure on the testicle where sperm mature.
Indication: PESA is typically used in cases of obstructive azoospermia where there is a blockage preventing sperm from reaching the ejaculate.
Advantages: PESA can be less invasive than testicular procedures.
These surgical sperm extraction techniques are commonly employed when there are challenges with sperm retrieval from the ejaculate due to factors such as vasectomy, congenital absence of the vas deferens, or impaired sperm production. The choice of the specific technique depends on the underlying cause of male infertility and the expertise of the fertility specialist.
It’s essential for couples facing male factor infertility to consult with a reproductive endocrinologist or urologist specializing in fertility. The specialist can assess the specific situation and recommend the most appropriate surgical sperm extraction method for their needs.
Pros and Cons of Mild IVF
- A lower dose of fertility drugs is required
- Injections are given for a shorter period
- Unlike in conventional IVF, the suppression of the natural cycle is not done, which means you will not face any menopausal symptoms
- Fewer side effects on your body
- In case the treatment is not successful, it can be repeated more quickly because the body recovers more easily
- The cost of IVF is lower per cycle
Cons
- Fewer eggs are collected
- Fewer embryos are formed, which means there is little choice in selecting and transferring the best-quality embryos
- Success rates are lower
- Could prove to be more expensive if multiple cycles are required
Should I go for mild IVF?
Only a detailed discussion with your doctor after completely studying your reports can reveal if mild IVF is for you. It is offered in selective cases where:
- You have a history of PCOS
- You are at a high risk of ovarian hyperstimulation syndrome (OHSS)
- You have chances of adverse reactions to fertility drugs
- Your ovarian reserve is so low that even after taking the standard amount of fertility drugs only a few eggs are collected (as in older age women)
Freezing and Storage of Sperm
Freezing and Storage of Sperm
Sperm freezing, also known as sperm cryopreservation, is a technique used to preserve and store sperm for future use. This process involves freezing sperm cells at very low temperatures, typically in liquid nitrogen, to maintain their viability for an extended period. Here’s an overview of the sperm freezing and storage process:
### Sperm Freezing Process:
- *Sperm Collection:*
– A semen sample is collected through masturbation into a sterile container. In some cases, sperm can also be collected via other methods, such as testicular sperm extraction (TESE) or epididymal sperm aspiration (PESA).
- *Semen Analysis:*
– The collected semen sample undergoes a semen analysis to assess sperm count, motility, and morphology. This information helps determine the quality of the sperm.
- *Sperm Processing:*
– The semen sample is processed to separate sperm from seminal fluid. This involves washing the sperm to remove substances that could potentially damage them during freezing.
- *Cryoprotectant Addition:*
– A cryoprotectant solution is added to the sperm to protect them from damage during freezing. The cryoprotectant helps prevent the formation of ice crystals.
- *Cryo-Container Placement:*
– The prepared sperm, along with the cryoprotectant solution, is loaded into special containers or straws designed for cryopreservation.
- *Gradual Cooling:*
– The sperm samples are gradually cooled to minimize cellular stress. Controlled and slow cooling helps prevent ice crystal formation.
- *Deep Freezing:*
– Once the samples reach a specific temperature, they are placed into liquid nitrogen for deep freezing. Liquid nitrogen maintains an ultra-low temperature (-196 degrees Celsius or -321 degrees Fahrenheit), preserving sperm viability for an extended period.
- *Storage:*
– Frozen sperm samples are stored in cryogenic storage tanks. These tanks are equipped with alarms and sensors to ensure a stable environment.
### Sperm Storage:
- *Monitoring and Maintenance:*
– Sperm samples are periodically monitored for quality during storage. The cryogenic storage tanks are regularly checked to maintain optimal conditions.
- *Storage Duration:*
– Sperm can be stored for varying durations, ranging from several months to many years. The duration of storage depends on individual circumstances, such as fertility treatment planning, medical conditions, or personal choices.
- *Thawing Process:*
– When the individual or couple is ready to use the frozen sperm, a controlled thawing process is conducted. The cryoprotectant is gradually removed, and the sperm is warmed to body temperature.
- *Artificial Insemination or IVF:*
– Thawed sperm can be used for various assisted reproductive techniques, including intrauterine insemination (IUI) or in vitro fertilization (IVF), depending on the specific fertility needs.
### Advantages of Sperm Freezing and Storage:
- *Preservation of Fertility:*
– Sperm freezing allows individuals facing medical treatments that may affect fertility (such as chemotherapy) to preserve their sperm for future reproductive use.
- *Assisted Reproductive Flexibility:*
– Frozen sperm provides flexibility in timing for assisted reproductive procedures, allowing individuals or couples to plan fertility treatments according to their preferences and circumstances.
- *Male Infertility Treatment:*
– For individuals with male infertility issues, sperm freezing allows the collection and storage of sperm during periods of optimal fertility for later use in assisted reproductive procedures.
- *Preservation for Future Family Building:*
– Sperm freezing is beneficial for individuals who may want to preserve their fertility for family building at a later stage in life.
It’s important to note that not all sperm survive the freezing and thawing process, and success rates may vary. The decision to freeze sperm and the duration of storage are personal choices that should be discussed with healthcare professionals, especially those specializing in reproductive medicine. Additionally, legal and ethical considerations related to sperm storage should be taken into account.
Egg donation
The first pregnancy resulting from egg donation was reported in 1984. Since then, egg donation has helped many struggling with infertility to conceive. Egg donation is most commonly used when the patient is unable to produce her own eggs. The donated eggs are fertilized with partner sperm as in a conventional IVF treatment cycle, and one (or two) is transferred as an embryo for pregnancy.
The main reason why women fail to produce eggs is related to age; as women grow older their stock of eggs declines in number and quality up to menopause, by which time natural reproduction is no longer possible. Some women experience premature menopause (known as ‘primary ovarian insufficiency’), while others may have ovarian problems that preclude egg development and ovulation. This can happen in women as young as 20 or 30. For these women, egg donation is the only possible fertility treatment.
In such cases (even in women beyond natural menopause), egg donation is the only treatment for pregnancy.
Egg donation also is used for women who have normal ovulation, but who have poor-quality eggs, for instance, women who have had multiple failed IVF cycles, women of advanced reproductive age (over age 38), and women with a low response to medications for ovarian stimulation.
Egg donation is a fertility treatment for women unable to produce their own eggs or at high risk of transmitting genetic disease.
EMBRYO DONATION
Embryo donation is a form of assisted reproductive technology (ART) where embryos created through in vitro fertilization (IVF) are donated by one individual or couple to another for the purpose of achieving pregnancy. This process involves the transfer of embryos from the donor to the recipient’s uterus. Here’s an overview of embryo donation:
### Key Steps in Embryo Donation:
1. *Embryo Creation:*
– The embryos that are eventually donated are typically created through IVF. In a standard IVF cycle, eggs are retrieved from a woman’s ovaries, fertilized with sperm in a laboratory setting, and the resulting embryos are cultured for several days.
2. *Donor Selection:*
– Individuals or couples who have undergone IVF and have remaining viable embryos may choose to donate them. Donors might be those who have successfully completed their family-building goals or those who have chosen embryo donation from the beginning.
3. *Recipient Selection:*
– Recipients are individuals or couples seeking to build a family but face challenges with their own fertility. They may have struggled with infertility, have medical conditions preventing pregnancy, or have a high risk of passing on genetic disorders.
4. *Legal and Ethical Considerations:*
– Embryo donation typically involves legal agreements between donors and recipients, outlining the terms of the donation and addressing issues such as parental rights and responsibilities.
5. *Medical Screening:*
– Both donors and recipients may undergo medical and psychological screening to ensure they are suitable candidates for embryo donation. This may include testing for infectious diseases and a thorough assessment of their physical and mental health.
6. *Embryo Transfer:*
– Once the legal and medical processes are completed, the selected embryos are transferred to the recipient’s uterus. This is typically done during the woman’s natural menstrual cycle or in coordination with hormone medications to prepare the uterine lining for implantation.
### Advantages and Considerations:
1. *Increased Family-Building Options:*
– Embryo donation provides an additional option for individuals or couples seeking to build a family, especially when other fertility treatments may not be suitable.
2. *Reduced Cost and Time:*
– For recipients, using donated embryos may be a more cost-effective and time-efficient option compared to undergoing a full IVF cycle.
3. *Genetic Connection:*
– Unlike traditional adoption, embryo donation allows for a genetic connection between the child and at least one of the intended parents.
4. *Ethical and Legal Clarity:*
– Formal legal agreements help clarify the rights and responsibilities of all parties involved, contributing to a transparent and ethical process.
5. *Satisfaction of Helping Others:*
– Donors often find satisfaction in helping others achieve their dream of parenthood.
6. *Potential Challenges:*
– Emotional considerations can be significant for all parties involved, including donors, recipients, and the potential child. Open communication and counselling may be important throughout the process.
Embryo donation can be a compassionate and practical option for those involved, offering hope and a pathway to parenthood for recipients and a meaningful way for donors to contribute to others’ family-building journeys. The decision to participate in embryo donation is highly personal and should be made after careful consideration and, in many cases, consultation with fertility specialists, legal professionals, and mental health experts.
Intrauterine insemination (IUI).
Intrauterine Insemination (IUI) is a fertility treatment where sperm is directly placed into a woman’s uterus to enhance the chances of fertilization. It is a relatively simple and less invasive procedure compared to in vitro fertilization (IVF). Here’s an overview of the IUI process:
### IUI Process:
- *Ovarian Stimulation:*
– In some cases, the woman may undergo mild ovarian stimulation with fertility medications (such as oral medications or injectables) to encourage the development of one or more mature eggs. Not all IUI cycles involve ovarian stimulation.
- *Monitoring Follicular Development:*
– Throughout the menstrual cycle, the woman’s cycle is monitored using ultrasounds and hormonal assessments to track the development of ovarian follicles (fluid-filled sacs containing eggs).
- *Timing of Insemination:*
– Once the leading follicle or follicles reach a certain size, the timing for the insemination procedure is scheduled. In some cases, a trigger shot of human chorionic gonadotropin (hCG) may be administered to induce ovulation.
- *Semen Sample Collection:*
– On the day of the insemination, the male partner provides a fresh semen sample or, in some cases, a previously frozen and thawed sample is used. The semen sample undergoes processing in the laboratory to concentrate and prepare the sperm.
- *Sperm Processing:*
– The sperm sample is washed and processed to remove seminal fluid and debris. This concentrates the sperm and separates the most motile and healthy sperm for insemination.
- *Insemination Procedure:*
– The processed sperm is then carefully introduced into the woman’s uterus through the cervix. This is a relatively quick and painless procedure performed in a doctor’s office.
- *Post-Insemination Observation:*
– After the insemination, the woman may rest for a short period to allow the sperm a better chance of reaching the fallopian tubes where fertilization takes place.
- *Luteal Phase Support:*
– In some cases, the woman may be prescribed hormonal medications, such as progesterone, to support the luteal phase of the menstrual cycle and improve the chances of embryo implantation.
- *Pregnancy Test:*
– Approximately two weeks after the insemination, a pregnancy test is performed to determine if conception has occurred.
### Indications for IUI:
- *Unexplained Infertility:*
– Couples with no identified cause for infertility may benefit from IUI as a first-line treatment.
- *Mild Male Factor Infertility:*
– IUI can be used when there are mild abnormalities in sperm count, motility, or morphology.
- *Cervical Factor Infertility:*
– If there are issues related to cervical mucus quality or cervical stenosis, IUI may be beneficial.
- *Ovulatory Disorders:*
– Women with irregular ovulation or anovulation may undergo IUI with or without ovarian stimulation.
- *Mild Endometriosis:*
– IUI may be considered in cases of mild endometriosis where natural conception is challenging.
- *Couples Using Donor Sperm:*
– IUI is commonly used for couples using donor sperm for conception.
IUI is generally less expensive and invasive than more advanced fertility treatments like IVF. However, success rates can vary based on factors such as age, the cause of infertility, and the overall health of the couple. Couples need to discuss their specific situation with a fertility specialist to determine the most appropriate course of action.
Ovulation Induction
Ovulation induction is the process of using medications to stimulate ovulation in women who have irregular or absent ovulation (anovulation). According to the National Institutes of Health, 25 to 30 per cent of women with infertility have problems with ovulation. Normal ovulation occurs when the ovary releases a mature egg in preparation for that egg to be fertilized. Normal ovulation occurs roughly once every 28 days during a woman’s menstrual cycle. Intervals of 21 to 35 days are considered acceptable and reflective of normal ovulation. If fertilization does not occur, the mature egg and any supplementary tissues are broken down and cleared from the uterus naturally. The goal of ovulation induction is to increase a woman’s chances of conceiving a child, either through sexual intercourse or by using intrauterine insemination (IUI) or another fertility treatment. However, when the absence of ovulation is a symptom of another fertility issue, treating the underlying problem can also restore normal ovulation and fertility.
Ovulation induction is a treatment for anovulation (irregular ovulation), an infertility condition in which follicles in a woman’s ovary do not mature and release eggs (ovulate). Anovulation can be caused by certain reproductive disorders such as polycystic ovary syndrome (PCOS), nutritional problems or excessive exercise.
Ovulation induction is typically achieved with a variety of medications that stimulate the ovary to produce and release eggs.
If the treatment is successful, the woman will ovulate and can become pregnant naturally using intrauterine insemination (IUI) or other fertility treatments.
Approximately 25 per cent of female infertility cases stem from problems with ovulation, so ovulation induction can be a beneficial and cost-effective first treatment.
Obstetric Services
Our professional team of Obstetrics and Gynecology at the ITH has a wide range of knowledge and experience to provide you with a happy and healthy pregnancy period through monthly checks.
Some of these Obstetric Services include Pregnancy, Obstetric and Ultrasonography Control, Doppler ultrasonography, Fetal echocardiography, Examination of the first trimester, Examination of the second trimester, Chorionic villus sampling (CVS), Amniocentesis, Multifetal Reduction, Antenatal analysis.
It is very important that gynecological examinations reveal existing or potential health problems and illnesses in order to begin the proper cure before touching them.
