Treatment
Options Available:
·
Complete Assessment of male and female subfertility
·
Ovulatory induction / controlled ovarian stimulation
·
Intrauterine Insemination (IUI) – Husband / Donor
·
In Vitro Fertilization (IVF)
·
Intra Cytoplasmic Sperm Injection (ICSI)
·
Semen Bank
·
Donor Oocyte Program
·
Donor Embryo Program
·
Sperm retrieval techniques
·
TESA - Testicular Sperm Aspiration
·
TESE - Testicular Sperm Extraction
·
MESA - Micro Surgical Epididymal
Sperm Aspiratio
·
PESA - Percutaneous Epididymal Sperm
Aspiration
·
Cryopreservation Services (for Gametes and Embryos) (Fertility
Preservation)
·
Blastocyst Culture
·
Assisted Hatching
Assisted Reproductive
Technologies (ART):
Any
medical technique that attempts to obtain a pregnancy by means other than by
intercourse is defined as ART. These techniques involve the manipulation of
sperm or Oocyte or both, and the gametes or the embryos are transferred into
the uterus or fallopian tubes. ART includes Intrauterine Insemination (IUI), In
Vitro Fertilization-Embryo Transfer (IVF-ET), Intra-Cytoplasmic Sperm Injection
(ICSI). Assisted Hatching (AH) etc. We at ARRU provide you the full ranges of
ART services to aid your infertility treatment and help you to bear a child.
Successful outcome with minimum invasion is always our priority.
Intra
Uterine Insemination (IUI):
This
is the method by which processed semen is placed directly in the uterus with
the help of a catheter. IUI can be done in a natural cycle, however, to get
better results, it is usually preceded by ovulation induction / ovarian
stimulation using appropriate fertility enhancing drugs. With a policy of
initial treatment by 1UL approximately 20 % couples (cumulative pregnancy
chances) would achieve pregnancy. However, there is not much benefit by
continuing same treatment repeatedly and after 3-4 unsuccessful cycles of IUI;
couple should consider IVF or ICSI treatment. Advanced female age, poor post
wash semen quality and a history of tubal factor or previous pelvic surgery are
significant risk factors for poor IUI success rates. In Vitro
fertilization (IVF) and Embryo Transfer (ET)Commonly known as “Test Tube
Baby". IVF means fertilization of an ovum outside the body
and consequently transfer of the fertilized ovum (embryo) into the uterus of
the woman. IVF is probably the most widely practiced ART procedure in the
world. The procedure does not need overnight admission at any step and the
complete treatment is conducted on outpatient basis.
Steps
involved in IVF procedure:
·
Ovarian stimulation by hormonal
injections to produce multiple eggs (some patients require ‘down regulation’ of
their natural hormones by medicines starting on Day 21 of their previous cycle,
before starting their ovarian stimulation)
·
Monitoring of the response by
ultrasound scans and blood tests.
·
Egg retrieval with the help of a
needle under local /general anesthesia.
·
Collection and adequate preparation
of sperm from male partner on same day.
·
Fertilization of the eggs in the
laboratory.
·
Transfer of the resulting embryo(s)
into the uterus of the woman.
·
Hormonal treatment to support Embryo
Implantation over next two weeks.
·
Blood test is performed 15 days after
ET to access the establishment of pregnancy.
If the treatment
procedure is successful, one or more embryos will implant in the uterus and the
pregnancy will result, just as it happens in the natural process of conception. Indications for IVF:
IVF is helpful in a variety of infertility cases involving: -
·
Bilateral tubal blockage or
abnormality
·
Male factor infertility
·
Unexplained infertility
·
Where ovulation induction/stimulation
(OI / OS) & IUI has failed
·
Endometriosis
Ejaculatory disorders
·
CBAV - congenital bilateral absence
of the vas deferens
·
Obstruction of both ejaculatory
ducts.
·
Failed vasectomy reversal.
·
The steps involved in ICSI procedure
are exactly the same as for IVF, except that fertilization is achieved with the
help of a micromanipulator.
In many cases when there is a complete absence of sperm in
the ejaculate (Azoospermia), normal sperm can be retrieved from the testis /
epididymidesand used for ICSI.
The
Testicular / Epididymal sperm retrieval techniques are:
·
PESA - Percutaneous Epididymal Sperm
Aspiration
·
MESA - Microsurgical Epididymal Sperm
Aspiration
·
TESA - Testicular Sperm Aspiration
·
TESE - Testicular Sperm Extraction
Cryo Preservation of Embryos (Embryo freezing):
Excess (Surplus) embryos can be Cryo-preserved at ultralow
temperatures for many years. These frozen embryos can be used subsequently
without the need for ovarian stimulation and egg retrieval. However the
pregnancy rate following transfer of frozen embryos is lower than that with
fresh embryos.
Assisted Hatching (AH):
The procedure is based on the fact that an alteration in
zona pellucida (outer covering of egg) either by drilling a hole through it or
by thinning it, will promote hatching or implantation of embryos that are
otherwise unable to escape intact from the zona pellucida.
IVF Using Donor Oocyte
(Eggs):
Women who are unable to produce their own eggs or their eggs
failed to fertilize during an IVF cycle due to poor Oocyte quality can be
helped by using other women's egg (Donor Oocyte). Replacement of donor embryos
and surrogacy are other available options to the infertile couple.
Semen
/Sperm freezing:
Semen /Sperm can be stored frozen at ultra-low temperatures
for long duration which could be helpful in a variety of circumstances such as:
·
Semen freezing prior to chemotherapy.
·
Inability of the male partner to be
present or to deliver the semen on the day of procedure (however, the frozen
semen is used as a standby and fresh sample is always preferable)
·
Testicular biopsy / sperm freezing to
avoid repeated biopsies.
·
Donor semen, until getting a repeated
investigation done for the infectious diseases.
Semen Bank:
We are having a semen bank at ARRU. The bank contains frozen
sperm from voluntary donors with various backgrounds and physical
characteristics to match with the individual needs. Donors are screened
thoroughly to rule out transmission of any infectious or genetic diseases.
Investigations
Required For Subfertility Evaluation or an ART Procedure:
For
successful conduction of the ART procedure(s) the couple has to undergo certain
investigations:
Investigations
for female partner:
·
General Health Check Tests
·
Tubal patency tests: This
test detects blockages or pelvic adhesions in your fallopian tubes. It includes
procedures like gas insufflation, hysterosalpingography (HSG), laparoscopy,
etc.
·
Pelvic ultrasound: It
checks the status of your uterus, fallopian tubes, endometrium and ovaries to
identify fibroid tumors, endometriosis, pelvic infections, ovarian cysts,
hydrosalpinx etc.
·
Follicular monitoring: This
involves a series of ultrasonic monitoring of the ovarian follicles to identify
when the egg is mature.
·
Ovulation testing and Hormonal Assay: These tests measure your hormone levels to determine
whether you are ovulating or not.The testsmeasure the levels of Estradiol,
Follicular Stimulating Hormone (FSH), Luteinizing Hormone (LH), Progesterone,
Prolactin and Thyroid Stimulating Hormone and thyroxin (T3/T4) hormones.
·
Hysteroscopy and laparoscopy: These procedures provide exact condition of your pelvic
organs and are helpful in diagnosing abnormal uterine conditions such as
fibroids, scar tissue, polyps and congenital malformations.
Investigations for male partner:
·
General physical examination
·
Semen analysis
·
Semen culture &sensitivity
·
Transrectal and scrotal
ultrasound
Investigations for both the
partners
·
HIV
·
Hepatitis B
·
VDRL
·
Blood grouping
Hepatitis C
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