IVF - Female Infertility
The female reproductive system refers to all the female organs that enable a woman to conceive, nurture and deliver a baby.A naturally conceived pregnancy requires ovulation, normal healthy sperm and normal tubes and uterus.
Female fertility can be affected by a woman’s age and common female reproductive conditions such as tubal disease, endometriosis, polycystic ovarian syndrome, fibroids, Salpingitis (or Pelvic inflammatory disease) caused by sexually transmitted disease.
Age is the single most important factor influencing a woman’s fertility. This is because the number of eggs you produce rapidly declines as you get older and there is also an increased risk of miscarriage and chromosomal abnormalities.
In vitro fertilization (IVF)
With IVF treatment, you may be prescribed fertility hormones or drugs. The fertility drugs will stimulate your ovaries to produce one or more eggs, a process called “ovulation induction.”
Then, at the exact time, your doctor will remove one or more eggs (oocytes) from your ovary.
The eggs are placed in a culture dish with the prepared sperm in a laboratory to start the fertilization process.
After the eggs are fertilized, the embryos are allowed to grow for 1 to 3 days in the controlled environment.
A mixture of genes from both the sperm and egg are in the single cell of the fertilized egg. This single cell divides to form two cells, which form four, then eight and on.
Around day 2 or 3 of your IVF treatment, the best embryo candidates are transferred into your uterus through the cervix. This is called embryo transfer or ET.
Some risks with IVF treatment?
Experts report few serious complications from IVF medications and procedures.As with all medical treatments and procedures,some risks involved in IVF treatment. Miscarriage (called pregnancy loss) may still occur with IVF.
The miscarriage rate following IVF treatment is generally the same to that in the general population and increases with the mother’s age. Some recent studies show that in vitro fertilization can largely overcome infertility in younger women.
Still, IVF treatment may not reverse the age-related decline in fertility that occurs in women.
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IVF - Male Fertility
Male infertility is a man’s inability to produce any sperm or to produce sperm that is of adequate quality to fertilize a female egg.Male infertility is the inability to produce sperm or to produce healthy sperm that can fertilize the female egg. Infertility is the inability of couples to get pregnant after one year of non-contraceptive, regular sexual intercourse. For 40 percent of infertile couples, male infertility is a contributing factor.
Treatments for male infertility:
Holistic fertility and lifestyle changes can alter such negative health habits as obesity, unhealthy diet and smoking, all of which affect fertility.
Intrauterine insemination (IUI) involves the collection, washing (cleaning) and concentration of healthy sperm that are then placed directly into the uterus.
IVF with intracytoplasmic sperm injection (ICSI) is an advanced laboratory procedure that involves the injection of a single healthy sperm into an egg to create an embryo, which is implanted into a woman’s uterus.
Sperm retrieval for men who cannot ejaculate or produce semen involves retrieval of semen from the testicles using a small needle.
Vasectomy reversal enables a man to once again produce healthy sperm in his semen.
Sperm donation is the use of another male’s sperm to fertilize a woman’s egg.
Hormone therapyand medications may be recommended to alter high or low hormone levels that affect fertility.
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ICSI Procedures
Intracytoplasmic sperm injection (ICSI, pronounced "eeksee") is an in vitro fertilization procedure in which a single sperm is injected directly into an egg.This procedure is most commonly used to overcome male infertility problems, although it may also be used where eggs cannot easily be penetrated by sperm, and occasionally as a method of in vitro fertilization, especially that associated with sperm donation.
It can be used in teratozoospermia.
Once the egg is fertilized, abnormal sperm morphology does not appear to influence blastocyst development or blastocyst morphology.
Even with severe teratozoospermia, microscopy can still detect the few sperm cells that have a "normal" morphology, allowing for optimal success rate.
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Semen Analysis
A semen analysis (plural: semen analyses) evaluates certain characteristics of a male's semen and the sperm contained in the semen. It may be done while investigating a couple's infertility or after a vasectomy to verify that the procedure was successful.
It is also used for testing donors for sperm donation, in stud farming and farm animal breeding.
Many men, especially if they are older, have a semen quality analysis, testing for common STIs, and perhaps testing for genetic defects done as part of routine pre-pregnancy testing,
though this is decisively not the norm, as most doctors will not test the semen and sperm (and the man's genome and his STI status) unless specifically requested or there is a strong suspicion of a pathology in one of these areas discovered during the medical history or during the physical examination.
Such testing, especially at that kind of comprehensive level, is very expensive and time-consuming, and may not be adequately covered by most insurance plans unless the insurance company, within the parameters of the plan and its coverage, accepts the medical evidence that there is a very valid reason for doing so.
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Semen cryopreservation
Semen cryopreservation is a procedure to preserve sperm cells. Semen can be used successfully indefinitely after cryopreservation. For human sperm, the longest reported successful storage is 21 years.
It can be used for sperm donation where the recipient wants the treatment in a different time or place, or for men undergoing a vasectomy to still have the option to have children.
Sperm Cryopreservation or Sperm Freezing, is available for men who wish to bank sperm for future use.
Patients are typically referred to the Andrology Laboratory for sperm cryopreservation by their care-provider.
How Cryopreservation is Performed:
After a semen sample has been collected, it is placed on a warming block maintained at 37°C, to liquefy.
At this time, the semen sample is mixed in a 1:1 ratio with a freezing medium that allows the sperm to survive the freezing and storage process.
The semen and freezing medium mixture is divided up into one milliliter portions and placed in special containers called cryovials.
The freezing medium used contains cyroprotectants. Cryoprotectants are chemicals that help remove water from the cells being frozen.
If the water is not removed from the sperm, ice crystals will form inside of the cell and break up it up, resulting in cell death.
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Tubal Microsurgery
Tubal Microsurgery is a surgical procedure that attempts to restore fertility to women after a tubal ligation. By rejoining the separated segments of fallopian tube, tubal reversal may give women the chance to become pregnant again.Microsurgery entails the use of the following
Surgical Techniques:
Using a microscope (for adequate magnification)Avoiding unnecessary trauma to the tissues
Employing delicate surgical instruments
Employing fine suture (stitching) material and ensuring precise suturing
Handling tissues with great care and respect, to minimize tissue damage
Ensuring that no bleeding is left unattended and no clots are left behind (because this can lead to the formation of adhesions or scar tissue after the surgery).
Duration and Cost:
The microsurgery operation may take from 1 to 4 hours. Depending on the extent of pelvic damage and is usually done under spinal or general anesthesia. The incision used is usually a "bikini cut" (Pfannensteil incision).
The length of stay in hospital is usually 3 to 7 days.
Tubal microsurgery can be expensive and may cost up to Rs.40,000.
Sometimes a "check or second-look laparoscopy " is performed about one week after surgery to ensure that tubal patency is maintained and to remove any small adhesions that may have started to re-form.
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