In Vitro Fertilisation ( IVF )
ART Program
Many couples faced with infertility are still unable to become pregnant after first line therapy such as ovulation induction, intrauterine insemination, or reproductive surgery. For these couples, the logical next step is to explore the Assisted Reproductive Technologies (ART).
These treatments include In Vitro Fertilization and other assisted laboratory techniques designed to improve fertilization. The team at Vaunshdhara Clinic is dedicated to developing the most successful ART treatment plan for each patient. Compared to simpler treatments, ART procedures typically have very high success rates but are more complex as they involve well-coordinated, perfectly timed effort between the medical team, laboratory staff and the patient.
We encourage you to learn as much as you can about the IVF program. This section of the Web site offers an overview of medications, procedures, and financial issues related to IVF. For more information, contact us at 91-712-2443491 or e- mail to schedule an initial consultation with a physician.
In Vitro Fertilisation (IVF)
In IVF treatment we aim to stimulate the ovaries with fertility drugs so as to obtain as many eggs as possible. The eggs are then mixed with sperm to achieve fertilisation, and usually 2 or up to a maximum of three embryos are placed in the uterus to optimise the chances of pregnancy.
If you are advised that IVF is the course of treatment suitable for you, this booklet will help you to understand what is entailed. You should keep a note of your period dates and inform us which month is suitable for you to attend for treatment. We can usually adjust your period dates to suit your work schedule.
When you have decided when you wish to go ahead with treatment, you will be given an appointment to attend the Centre to discuss the sequence of events, and the dates involved. This is an important and necessary appointment.
You will be prescribed a hormone drug to suppress the ovaries prior to stimulating them with fertility drugs.
On the first day of your period appointment for an ultrasound scan is given. The scan is performed by inserting a slim probe into the vagina to check the uterus and the ovaries. There is no need to have a full bladder, and it is painless.
We will give you instructions for daily injections to stimulate the ovaries. Side effects like lethargy, lassitude, nausea or hot flushes may be experienced, but should not affect your normal activities at home or work.
After a week, earlier in some cases, the female partner will need to attend almost daily for scans. Further injections vary according to your ovarian response and this monitoring may continue for a further 3 to 5 days.
Sometimes the ovaries fail to respond excessively to drugs. If this happens we may have to stop the treatment and re-commence at a later date.
Egg Recovery
Egg recovery usually takes place 12 to 15 days after starting fertility drugs. Two days prior to egg recovery you will he asked to have a injection -Human Chorionic Gonadotrophin (HCG). This injection is timed approximaely for thirty four hours prior to egg recovery On the day of egg recovery both partners are asked to attend, so that the male partner can provide a semen sample for IVF.
Egg recovery is performed by a minor surgical procedure with a general anaesthetic.
During the egg recovery, a vaginal ultrasound probe is inserted so that egg follicles in the ovary can be seen. A thin needle is then directed into the ovary. through the vagina, so that the eggs can be aspirated (sucked) into a small test tube.
The eggs are placed in labelled dishes in the incubator, the sperm is prepared and mixed with the eggs 4 to 6 hours later..
The next afternoon you will need to phone the Centre to find out if the eggs have fertilised (Sometimes we ask for another sample of semen to "re-inseminate" the eggs.) It the eggs have fertilised we will give you an appointment time to attend for embryo replacement which is usually performed two or three days after egg recovery
Embryo Replacement
Embryo replacement is a simple, quick and painless procedure. A maximum of three embryos are selected for replacement from the total obtained in the IVF treatment and the remainder are frozen for subsequent attempts. The implications of the number of embryos implanted will be discussed again prior to embryo replacement.
After a short rest you may go home. You will have an opportunity to see your embryos under the microscope before your replacement.
In the two weeks after embryo replacement, you are advised to take things easy for the first four days, and can then return to non-stressful activity after that. You will receive injections during this time to maintain the lining of the womb to maximise the chances of pregnancy.
You should not lift heavy articles. Light housework and cooking are acceptable. Do not have any x-rays or drugs unless prescribed. If you have any cramp-like pains, you can take aspirin or paracetamol.
Call us at the Centre for advice if you are unsure about anything.
Will my IVF Cycle work?
On day 15 after embryo replacement, you will come into the centre for a pregnancy test, the results of which will be known later the same day.
If your test is positive we will arrange a scan later to confirm that all is progressing well with your pregnancy.
If your pregnancy test is negative, a follow-up consultation will be arranged to discuss your treatment cycle and future treatments.
Freezing of Embryos
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Your frozen embryos are stored at -196 degrees Celsius for transfer at a later date. These do not deteriorate with time and we are allowed by law to store them( With an additional fee for storage). If you conceive with the first treatment cycle, you can return for frozen embryo replacement (FER) whenever you wish.
If you have not been successful with treatment, we give you another chance at a much reduced price, without the injections for ovarian stimulation and without having to undergo egg recovery. We replace embryos in "natural cycles" two or three days after ovulation occurs. Scans and/or /blood tests are performed to time ovulation accurately. A pregnancy test is performed 15 days after ovulation. If the test is positive, we arrange a scan to check that all is progressing well with the pregnancy. If the test is negative, a follow- up consultation to assess and review your treatment cycle will be arranged.
Keep stress levels down and feel free to discuss any worries with the staff in the Centre. Counselling, and the support group can help you cope with the stresses of investigations and treatment. |
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Intracytoplasmic Sperm Injection
Intracytoplasmic sperm injection, commonly referred to as ICSI, is an infertility treatment performed as part of the IVF procedure in which a single sperm is injected directly into an egg. ICSI is most commonly recommended as part of the IVF procedure when there is a problem with the sperm, including low motility, low sperm count or abnormally shaped sperm. Previous poor fertilization in IVF or low egg number may also prompt the use of ICSI.
The patient and partner's roles in the ICSI process are the same as with a basic IVF procedure. Ovulation induction medications are taken by the female to produce numerous eggs during one cycle and the eggs are then retrieved. The male partner will provide a semen sample by masturbation from which the healthiest sperm will be extracted. If no sperm are available naturally, your physician may schedule a sperm retrieval procedure such as testicular biopsy, micro dissection, testicular sperm extraction (TESA) or percutaneous sperm aspirations(PESA) around the time of egg retrieval. Once the eggs and sperm have been collected, the embryologist will inject one sperm into the center of each egg. If fertilization occurs, the healthiest embryos will be transferred into the female's uterine cavity. A blood test will be performed approximately two weeks later to determine if the patient is pregnant.
Blastocyst Culture
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Recent advances in blastocyst culture and transfer have resulted in improved IVF pregnancy rates and reduced multiple pregnancy rates. Traditionally, embryos are transferred to the uterus on day three (called Day 3 transfer) after fertilization and it is not uncommon to transfer three or four embryos. However, it is now possible to grow embryos in the laboratory to the blastocyst stage of development, which occurs on day five after fertilization when the embryo has 50-200 cells. Typically, the strongest, healthiest embryos make it to blastocyst stage as they have survived key growth and division processes and have a better chance of implanting once transferred. The selection of potentially more viable embryos allows the embryologist to transfer fewer embryos, often one or two, lowering the risk of high order multiples while maintaining high pregnancy rates. |
Blastocyst transfer is not an option for all IVF patients. The technique is most successful with patients who are younger and have a large number of eggs available at retrieval. On average, patients with six or more high quality embryos on day three are the best candidates for blastocyst culture because there is a better chance of more embryos growing successfully to day five.
Cryopreservation
In many cases, not all the healthy embryos are transferred in an effort to reduce the riskmultiple pregnancies. These embryos can be frozen, or cryopreserved, through the use of liquid nitrogen and then thawed at a later date
