Infertility Procedures

IUI - Intrauterine Insemination

An IUI, commonly referred to as artificial insemination, is a simple procedure in which sperm is collected, concentrated, and deposited into a woman’s uterus.

IVF/ICSI

In vitro fertilization (IVF) also called test tube baby is an assisted reproductive technology where in an egg is fused with the sperm outside the body (In Vitro). In this process the women ‘s ovaries are stimulated using daily hormonal injections of highly pure HMG or recombinant FSH starting from Day 2 of the menstrual cycle for 9 to 11 days. When the leading follicle is > 14 mm, a daily dose of GnRh antagonist is additionally given to the patients.

When two leading follicles are > 17 mm in diameter the patient is given an Injection of urinary HCG 5000/10000 units or recombinant HCG 250/500 units and the eggs are retrieved after 35 to 36 hours. If there are too many follicles, then instead of HCG a dose of Gnrh agonist is given to prevent overstimulation of the ovaries. The egg retrieval is done under short General anaesthesia or local anaesthesia, by using a very thin needle. This needle is passed through the vagina under ultrasound guidance.

The egg retrieval takes about 10 to 20 minutes & the patients can go home in 4 to 6 hours. Once the eggs are isolated in the lab, the husband is asked to produce sperms by masturbation. The sperms are processed using various techniques such as swim up, density gradient, microfluidics or Magnetic Assisted Cell Sorting MACS. Following the processing of the semen, about 1,00,000 healthy forwardly motile sperms are mixed with the wife’s egg in a petri dish in the embryology lab. The fertilized eggs are called the embryos (baby’s eggs) which are cultured and on day 3 ( 8 cell cleavage stage embryo ) or day 5 (150 cells blastocyst) is released back into the wife’s womb with the help of a procedure called Embryo Transfer Sometimes on the day of IVF the Husband may fail to produce semen by masturbation , due to psychological pressure . Hence our unit always request the husband to produce one more semen sample, a few days prior to the egg pick up and freeze that semen sample as a backup.

In Intracytoplasmic sperm injection (ICSI) is a highly specialized ART technique wherein a single sperm is injected directly into the cytoplasm of an egg using a machine called the micromanipulator. In these all the steps are similar to the steps of IVF, except the step of sperm fertilizing the egg . ICSI is very helpful in cases where a couple has had semen in which the sperm count is low or has poor motility or bad morphology. It is also the method of choice for patients with azoospermia wherein sperms are extracted from the testis, in patients with previous fertilization failure with IVF, advanced maternal age, etc This technique is also used for frozen eggs or eggs that are matured in Vitro (IVM) or in patients undergoing Preimplantation Genetic Testing . Nowadays, many units are using this technique instead of IVF, even in patients who have totally normal semen parameters (also called non male factor infertility)

Semen Freezing:

Fertility preservation for men with sperm freezing (cryopreservation) should be considered in a several differing situations. Sometimes sperm needs to be cryopreserved for the short-term while a couple is undergoing fertility treatments, but other times men should consider long-term preservation of their sperm. When freezing sperm, a semen analysis is first performed on the specimen in order to know how many and what quality of sperm are being frozen. The sperm are then divided into different vials depending on the intended future use (IUI or ICSI) and frozen in liquid nitrogen. When stored in liquid nitrogen, the sperm can remain frozen for a few days or many years and will be viable when thawed.

Assisted Laser Hatching

Laser-assisted hatching is a scientific IVF technique that can make it easier for the embryo to “hatch” or breakthrough its outer layer or “shell” (a membrane also known as the zona pellucida) by creating an opening. In some situations, this layer is abnormally thick and/or hardened with the freezing and thawing process among the contributing factors. The less difficulty the embryo has in hatching, the better its chance of attaching or implanting into the wall of the uterus.

Pregnancy cannot occur unless the embryo hatches and implants, and laser-assisted hatching can play a key role in achieving these crucial steps.

Blastocyst Culture

In the IVF laboratory, after the egg retrieval procedure, fertilization is carried out by IVF (In-vitro fertilization) or by ICSI (intra-cytoplasmic sperm injection) and the resulting embryos are placed in an incubator for further development.

Embryo Transfer

The embryo transfer procedure is the last one of the in vitro fertilization process. It is a critically important procedure

The importance of proper embryo transfer technique for successful IVF cannot be overstated Ultrasound guided embryo transfer is the most efficient technique currently available For IVF, the woman is stimulated with injectable medications to develop multiple eggs. Eggs develop in follicles in the ovaries. When the follicles are mature, the egg retrieval procedure removes eggs from the ovaries. Sperm is added to the eggs and the next day we check the eggs for evidence of fertilization. An appropriate number of embryos are transferred to the uterus several days later – using ultrasound guidance for best placement.

Single Embryo Transfer

Minimizing risks of pregnancy while maintaining high pregnancy rates are the goals of physicians and staff at Sreya IVF Centre. With the help of several new technologies, elective Single Embryo Transfer (eSET) is now an effective and safe way to build families, one healthy baby at a time. At Sreya IVF Centre we elect to transfer one embryo in over 90% of patients.

Sequential Transfer

Sequential Embryo Transfer or SET is a procedure that transfers two sets of embryos to a woman’s womb during the menstrual cycle on different days. Active living, healthy eating, taking vitamin and folic acid supplements are some of the tips to increase the success rate.

Embryo Freezing

At Sreya IVF Centre, our fertility specialists utilize the most advanced technology available to offer patients the highest standard of care available. We have become one of the leading fertility centers, performing hundreds of in vitro fertilization (IVF) procedures every year. Because a fair number of embryos are created during IVF in order to select only the highest quality, most viable embryos, there are “leftover” embryos after IVF and embryo transfer are completed. Over a third of our IVF patients have spare embryos that are suitable for cryopreservation (freezing).

Luteal Support & Adjuvants

Luteal phase is a crucial time between the embryo transfer and confirmation of pregnancy with BHCG test. This is the time which needs support for the growing embryo. It can be supplemented with Progesterone hormone, estrogen hormone, folic acid and other medications (Low dose Heparin, Low dose aspirin, GnRH agonist etc) individualized to the need of the couple undergoing IVF cycles. Normally progesterone is initially given for a period of 14 days. This can be given either orally, vaginally, subcutaneously or intra muscularly. If after 14 days the pregnancy test is positive, we continue the progesterone for 7-8 weeks. Many units, including ours continue progesterone for 12-14 weeks of pregnancy. Estrogen in the form of estradiol valerate is continued for 9 weeks of pregnancy, especially in hormone replacement frozen thaw cycles or egg donation cycles.

In patients with repeated IVF failures we use many additional medicines such as low dose aspirin, low molecular weight heparin, steroids, oral/vaginal sildenafil, oral piroxicam, iv atosiban , iv intralipids , iv immunoglobulin IVIG etc . Many IVF groups including ours have used some of these adjuvants successfully, especially in patients with repeated IVF failures.

Egg Donation

Some women can’t use their own eggs because of IVF Egg donation non-availability of good eggs or low ovarian reserve, or premature ovarian failure for their fertility treatment. In some cases, menopausal women also need IVF treatment. In such cases, they consider to use an egg donor. Egg donors are women who like to choose to support those who need extra help starting or growing their family – and they are women just like you and me

Semen Donation:

Sperm donation on Sreya IVF Centre is a superlative programme that grants couples a path to pregnancy by employing third-party sperm. As per guidelines laid out by the Indian Council of Medical Research, in vitro fertilisation (IVF) centres in India are not allowed to establish independent sperm banks. IVF centres thus partner with recognised sperm banks for sperm donation programmes. On Sreya IVF Centre, sperm donation follows a careful process. Potential candidates undergo rigorous screening for infections and genetic disorders before being approved as donors. A sperm donor is matched based on blood group and physical conformity to the male partner. A donor and a recipient remain anonymous to each other through the programme and beyond. Also, at the outset, a contract-cum-consent form must be signed by the donor and the recipient.

Ovarian Rejuvenation:

A woman is born with all the eggs she’ll ever have, which at birth, is typically around 1 million. By puberty, she usually has half that—and each month after puberty, she loses up to 1,000 eggs. Of those, only one egg is matured and ovulated each month.

The accepted paradigm of the ‘Biological clock’ has shaped the understanding of how the ovary chnages over time.

A break through fertility treatment, known as Ovarian Rejuvenation Therapy may give infertile women with Premature Ovarian Failure, Diminished Ovarian Reserve and Menopausal women a chance to conceive using their own eggs.

Hysteroscopic Surgery

Hysteroscopy is a minimally invasive procedure that uses a thin, flexible telescope-like instrument, known as a hysteroscope, to examine the uterine cavity.

Hysteroscopic evaluation can be used to diagnose conditions that contribute to female infertility and recurrent miscarriage.

Minimally invasive surgeries, like the removal of uterine fibroids or polyps, can also be performed via hysteroscopy.

Hysteroscopy has been shown to increase in vitro fertilization (IVF) success rates.

Laparoscopic Surgery

Laparoscopy for infertility is a minimally invasive surgical procedure that uses a laparoscope (a fiber-optic tube with light and video camera) inserted through two or more minor incisions, often in the belly button. The surgeon can then visually examine the pelvic reproductive organs and the pelvic cavity.

The procedure may be performed under general anesthesia or local anesthetic and typically takes 30 to 45 minutes. The abdomen is inflated with gas (carbon dioxide or nitrous oxide injected with a needle) to move the organs away from the abdominal wall so that they are visible during the procedure.

Once the abdomen is inflated, the laparoscope is inserted through the small incisions. The surgeon views the interior of the pelvic cavity on a video screen transmitting the images from the camera.

The surgeon will look for possible causes of infertility.