Mothercareivf.com

• Counselling is an important part of infertility treatment.
• We have specialists in the field of reproductive medicine who examine patients and advise them on treatment procedures.
• We thoroughly explain our patients every step involved in the treatment.
• As fertility treatments are long and can often be frustrating and stressful, our confidential counselling is aimed to help patients overcome the hurdles inherent in the route to successful conception.

Medical ultrasound (also known as diagnostic sonography or ultrasonography) is a diagnostic imaging technique based on the application of ultrasound. It is used to see internal body structures such as tendons, muscles, joints, vessels and internal organs. It’s aim is often to find a source of a disease or to exclude any pathology. The practice of examining pregnant women using ultrasound is called obstetric ultrasound, and is widely used.

Ultrasound is sound waves with frequencies which are higher than those audible to humans. Ultrasonic images also known as sonograms are made by sending pulses of ultrasound into tissue using a probe. The sound echoes off the tissue; with different tissues reflecting varying degrees of sound. These echoes are recorded and displayed as an image to the operator.

Role of Ultrasound In IVF Treatment

Ultrasound is the most versatile method for pre-treatment assessment in IVF being the dominant instrument for assessing ovarian reserve, pelvic pathologies and for assessing the uterine cavity. The ability of ultrasonography to measure endometrial thickness in addition to detecting uterine masses gives it an edge over laparoscopy/hysteroscopy as a diagnostic procedure in uterine cavity assessment, although hysteroscopy has the advantage of therapeutic potential. Similarly, ultrasonography is superior to biochemical methods for follicular monitoring because of its ability to demonstrate the number and sizes of follicles, and guide preparations for oocyte retrieval. The relative ease of ultrasound guided oocyte retrieval; its less technical demands and the possibility of conducting the procedure under local anaesthesia have made ultrasound guided oocyte retrieval more popular across the world. Randomized controlled trials show that ultrasound-guided transfer techniques have better outcomes than the clinical touch technique in terms of on-going pregnancies and Clinical pregnancies. Ultrasonography is now the key instrument for diagnosing and monitoring pregnancy following embryo transfer, biochemical methods being complimentary.

3D ultrasound for predicting endometrial receptivity in ARTs

The term “uterine receptivity” refers to a state when endometrium allows a blastocyst to attach, penetrate and induce changes in the stroma, which results in the so-called process of implantation.

With the advent of three-dimensional ultrasound it became possible to perform a reliable and reproducible sonographic endometrial volume calculations as well as an assessment of endometrial and subendometrial vascularization. Therefore, some researchers have evaluated the role of endometrial volume as well as subendometrial and endometrial vascularization for predicting uterine receptivity.

What if I need frequent scans through my pregnancy?

You may be offered more scans than usual to monitor the growth and well being of your baby if you:

• had complications in a previous pregnancy
• have diabetes
• have high blood pressure
• have a BMI of over 30
• are expecting twins or more
• have any complications in your present pregnancy

But even if you have more frequent scans than other expecting mums, there is no greater risk to you from the scans than to others. On the contrary, if your doctor is prescribing extra scans, it is because the information she collects from these scans helps her to ensure that you and your baby are doing well. The benefits from serial scans in monitoring pregnancies are considered to outweigh any potential risks.

Complete examination of a woman’s internal pelvic structures can provide important information regarding infertility and common gynecologic disorders. Frequently, problems that cannot be discovered by an external physical examination can be discovered by laparoscopy and hysteroscopy, two procedures that provide a direct look at the pelvic organs. These procedures may be recommended as part of your infertility care, depending on your particular situation.

Laparoscopy and hysteroscopy can be used for both diagnostic (looking only) and operative (looking and treating) purposes.

Diagnostic laparoscopy may be recommended to look at the outside of the uterus, fallopian tubes, ovaries and internal pelvic area. Diagnostic hysteroscopy is used to look inside the uterine cavity. If an abnormal condition is detected during the diagnostic procedure, operative laparoscopy or operative hysteroscopy can often be performed to correct it at the same time, avoiding the need for a second surgery. Surgeon should perform both diagnostic and operative procedures with surgical expertise in these areas. The following information will help patients know what to expect before undergoing any of these procedures.

Hysteroscopy

Hysteroscopy is a valuable modality in the management of infertility. It can be both diagnostic as well as therapeutic(operative). It involves direct visualisation of uterine cavity and ostia. The operative hysteroscopy is a minimally invasive gynec procedure in which an endoscopic optical lens is inserted through the cervix into the endometrial cavity to direct treatment of various types of intrauterine pathology.

The introduction of smaller diameter hysteroscopes has allowed operative hysteroscopy to become a predominantly office and outpatient procedure.

• Indications
  • Submucosal leiomayomas
  • Uterine Polyps
  • Uterine Septum
  • Lysis Of Adhesions In C/O Asherman’s Syndrome
  • Cannulation Of Fallopian Tube Ostia For Proximal Tubal Block
  • Removal Of Foreign Body

• Metroplasty In Case Of,
  • Recurrent Pregnancy Loss
  • Primary Or Secondary Infertility
  • Preterm Births
  • Dysmenorrhoea
  • As A Preventive Measure Before IVF Treatment
  • Hypoplastic Uterus

Laparoscopy

Currently laproscopy is considered to be the gold standard as it provides panoramic and magnified view of the pelvic and abdominal organs. It can be diagnostic and therapeutic. Diagnostic laproscopy involves direct visualisation of uterus, tubes and ovaries and anatomical relationship with surrounding structures and cheking the patency of tubes.

Operative laproscopy Indication

• Tuboplasty
  • Reversal Of Sterilization
  • Mild Tubal Block Secondary To Pathology.
  • Tubal Occlusion Secondary To Ectopic Pregnancy Treatment.
  • Salpingitis Isthmica Nodosa.(SIN)
  • Failed Tubal Cannulation For Proximal Block.
  • Failed Previous Macrosurgical Sterilization Reversal.
  • Tubal Transpostion For Unicornuate Uterus,Discrepant Tubo-Ovarian Anatomy.

• Endrometriosis
  • Excision Of Endometriotic Implants.
  • Removal Of Endometriomas( Chocolate Cyst)

• Uterine Fibroids
  • Laparoscopic Myomectomy

• Pelvic Tuberculosis
  • Adhesiolysis

Intrauterine insemination (IUI) is a form of assisted conception. During IUI, your doctor will place washed, prepared sperm into your uterus (womb) and near to your egg at your time of ovulation. This procedure is often combined with fertility drugs to increase your chances of conceiving.

Could IUI benefit us?

IUI may help you as a couple if:

• Your spouse has a borderline low sperm count or low motility. This is when the sperm’s ability to move is impaired. But there must be enough healthy, motile sperm to make the treatment worthwhile. If not, IVF or ICSI may be more suitable.
• You are unable to have sex because of disability, injury, or if your spouse experiences premature ejaculation.
• You have mild endometriosis.
• You or your spouse’s fertility problems are unexplained.

For IUI to work, your fallopian tubes must be open and healthy. To find this out, you will need to have a tubal patency test. This can be done using laparoscopy, which is a form of keyhole surgery, or a hysterosalpingogram, which is a form of X-ray. These may locate any problems or blockages in your uterus or fallopian tubes.

IUI isn’t recommended if your tubes have adhesions or scarring that might stop an egg travelling from the ovary to your uterus. But if you have at least one working tube and ovary on the same side, IUI may be an option for you.

IUI should not be used in women with blocked fallopian tubes. The tubes are often checked out with an x-ray test called a hysterosalpingogram.

Female age is a significant factor with IUI. Intrauterine insemination has very little chance of working in women over 40 years old. IUI has also been shown to have a reduced success rate in younger women with a significantly elevated day 3 FSH level, or other indications of significantly reduced ovarian reserve.

If the sperm count, motility and morphology scores are quite low, intrauterine insemination is unlikely to work. With significant male factor issues, IVF with ICSI is indicated and has high success rates IUI is commonly used for unexplained infertility. It is also used for couples affected by mild endometriosis, problems with ovulation, mild male factor infertility and cervical factor infertility.

IUI is a reasonable initial treatment that should be utilized for a maximum of about 3 months in women who are ovulating (releasing eggs) on their own. It is reasonable to try IUI for longer in women with polycystic ovaries (PCOS) and lack of ovulation that have been given drugs to ovulate.

How is insemination performed? What is the process for IUI?

• The woman usually is given medications to stimulate development of multiple eggs and insemination is timed to coincide with ovulation – release of the eggs.
• A semen specimen is either produced at home or in the office by masturbation after 2-5 days of abstinence from ejaculation.
• The semen is “washed” in the laboratory (called sperm processing or sperm washing). The sperm is separated from the other components of the semen and concentrated in a small volume. Various media and techniques can be used for the washing and separation. Sperm processing takes about 30-60 minutes.
• A speculum is placed in the vagina and the cervical area is gently cleaned.
• The washed specimen of highly motile sperm is placed either in the cervix (intracervical insemination, ICI) or higher in the uterine cavity (intrauterine insemination, IUI) using a sterile, flexible catheter.

The intrauterine insemination procedure, if done properly, should seem similar to a pap smear for the woman. There should be little or no discomfort.

Most clinics offer for the woman to remain lying down for a few minutes after the procedure, although it has not been shown to improve success. The sperm has been put above the vagina and cervix – it will not leak out when you stand up.

How many IUI to try before doing IVF?

• The short answer is to move on to IVF after 3 failed IUIs
• If the female is age 40 or older, or ovarian reserve low, consider IVF earlier
• In vitro fertilization has a significantly higher success rate as compared to IUI

What is Donor IUI ?

Donor insemination (Donor IUI) uses sperm from a donor to help the woman become pregnant.

Sperm donors are screened for sexually transmitted diseases and some genetic disorders. In DI, sperm from the donor is placed into the neck of the womb (cervix) at the time when the woman ovulates.

Donor – IUI uses intrauterine insemination with donor sperm.
INDICATION FOR USING DONOR SPERM IN IUI

• A male partner with low or no sperm
• ejaculatory dysfunction
• significant male factor infertility (failure of fertilization, male immune disorders or very low count and motility)
• when intracytoplasmic sperm injection (ICSI) is not feasible or elected
• presence of a significant genetic defect or having an affected offspring
• presence of an ineradicable sexually transmissible infection
• severe Rh-immunized female with Rh positive male
• females without partners

IVF

In IVF, this process of fertilisation happens outside the woman’s body. A woman’s eggs are surgically removed and fertilised in a laboratory using sperm that has been given as a sperm sample. Next, the fertilised egg, called an embryo, is implanted into the woman’s womb.

All IVF treatments begin with a course of hormone therapy to stimulate the development of several follicles in the ovary. These are collected as eggs, which are then fertilised in a test-tube (‘in vitro’) to create several embryos. After between two and five days in an incubator, one or two of these embryos are transferred through the vagina to the uterus, where implantation occurs and pregnancy begins. However, in IVF as in natural conception, not every embryo implants to become a pregnancy, which is why surplus embryos are frozen – so that a subsequent transfer might be tried if the first one fails. Freezing is now an essential part of every clinic’s IVF programme.

• Indications
  • Bilateral blocked Fallopian tubes
  • Severe endometriosis
  • Pelvic inflammatory disease with severe adhesion
  • Premature Menopause
  • Failed reversal of Vasectomy/ Tubectomy
  • Obstructive azoospermia
  • Genetic diseases
  • Menopause
  • Surrogacy (Traditional/ Gestational)
  • Unexplained infertility

What Happens In An IVF Treatment Cycle

Typically an IVF cycle consists of ovarian stimulation, egg collection, fertilization, embryo culture and embryo transfer. Ovarian stimulation consists of daily injection of hormones to the female partner with frequent clinical and ultrasonographic monitoring. This usually continues for 10-15 days. Egg retrieval is performed under anaesthesia through the internal route. There are no incisions or scars. The egg and sperm are either mixed (IVF) (Figure 1) or the sperm is injected into the egg (ICSI –intracytoplasmic sperm injection). The fertilized egg forms the embryo. The embryo is cultured in the laboratory for 2-3 days. Two-three best embryos are selected and transferred into the womb (uterus) on the second or the third day. The pregnancy test is done 14 days after the day of embryo transfer.

What Is The Success Rate of This Process?

It all sounds so logical and definitive that one would expect success in every case! But unfortunately this is not the reality. One must understand that in the entire process of IVF each step is a hurdle that has to be negotiated successfully. For example, not all women respond to ovarian stimulation, not all eggs are mature, not all eggs fertilize to make good embryos and not all embryos implant. Therefore, there is an attrition or drop out at each stage. It is at the stage of implantation that there is a huge scope for further research. Implantation is the process where the uterus accepts the embryo which then develops to form the baby. Much work has been done on this aspect of IVF and medications such as steroids, aspirin, heparin, sildenafil are being tried to improve implantation rates. The overall success rate of IVF is about 40 % per treatment cycle. In order words 4 out 10, who otherwise had given up all hopes of parenting a child would conceive after attempting IVF. World over the success rate is highest in younger women where it can reach up to 60% per treatment cycle. In case of failure, IVF may be tried again and the cumulative pregnancy rate over 3 cycles may go as high as 80%.

ICSI

Intracytoplasmic Sperm Injection (ICSI) technique is used in situations where there is poor sperm quality. In these situations, Intracytoplasmic Sperm Injection ICSI finds use in directly retrieving of the sperms from testis/epididymis which is then followed by injection of a single sperm into center of egg for achieving fertilization.

ICSI is an assisted reproductive procedure used as part of a wider in vitro fertilisation (IVF) program. This fertility treatment is used in cases of male infertility, either if the quality of the sperm is causing infertility, or in cases of erection problems. ICSI involves selecting a single sperm which is injected into an egg. The eggs can be sources either from a donated egg (frozen or fresh), or eggs harvested from the ovaries of the partner.

ICSI Features

• The process assist in the treatment of sperm related infertility issues
• It helps in enhancing fertilization phase of in-Vitro Fertilization Centre (IVF) through injection of single sperm into mature egg which is then placed in a woman’s uterus/fallopian tube
• Treating issues related to severe male infertility where little/no sperm is ejaculated in semen
• Patients also choose this technique after repeat in-vitro fertilization is unsuccessful
• It is also used by couples planning for genetic testing of embryo for checking certain genetic disorders.

• This process cools the sperm and embryos very slowly to sub zero temperatures.
• Cyropreservation is used to store semen and embryos for an indefinite period.
• It is typically effective if men face a possibility of sterilization due to vasectomy, prostate or testicular surgery, radiation or chemotherapy etc.
• At times semen is also frozen prior to IVF as back up, incase of difficulty in semen collection on the day of oocyte retrieval.
• Vitrification is one of the latest advancements in fertility treatment.
• The process refers to the freezing of eggs (also embryos) to store them for an indefinite period. Unlike sperms, unfertilized ova cannot be stored using the slow freezing technique.
• Rather, vitrification works by using higher concentrations of cryoprotectants that ensure much faster cooling rates, and without the formation of ice crystals.
• It is useful for women who face the possibility of sterilization in future.

Sperm freezing and storage

Sperm freezing and storage is the procedure whereby sperm cells are frozen to preserve them for future use. Sperm cells have been frozen and thawed successfully for more than 40 years. By using special technology and then keeping sperm in liquid nitrogen at minus 196C, it can be stored for many years while maintaining a reasonable quality

Who may benefit from sperm freezing?

• Men who work in high risk occupations, for example:
• Men in the military have frozen sperm and completed posthumous use consent forms before
• Deployment In case of their serious injury, or even death when on active service
• Where there is a family history of premature andropause, especially in the man’s father, uncles or paternal grandfather
• Men who are away from home for extended periods of time and whose wives or partners may require fertility treatment during their absence
• Any man whose sperm counts are declining and there is concern that he could become a zoospermic

For whom is sperm freezing not suitable?

• MFS is unable to register patients under the age of 18 years
• Any man who is known to be azoospermic
• Any man who has screened positive for a sexually transmitted diease

What is included in the sperm freezing treatment cost?

• Routine infection screening
• The laboratory analysis of the sperm sample(s)
• Storage of the sperm sample for the first year

Embryo Freezing

In a typical IVF or ICSI treatment cycle, the woman’s ovaries are stimulated to produce many eggs. Following fertilisation and embryo culture, the best embryos are selected for embryo transfer. For about 50% of couples, there will also be good embryos which are surplus to those required for embryo transfer. These embryos can be frozen at this point for future use.
Embryo freezing (cryopreservation) is a method of preserving the viability of embryos be carefully cooling them to very low temperatures (-196&degC). This is carried out in the laboratory using specialised freezing equipment and the embryos can then be safely stored in liquid nitrogen for extended periods.

Why do we freeze embryos?

Embryo freezing gives you more opportunities for a pregnancy for each hormone stimulation cycle and egg collection.
During a fresh IVF cycle, we’ll sometimes be able to create more than one embryo, however there are serious risks associated with multiple pregnancies, so generally we won’t transfer more than one embryo at a time. We’ll usually recommend transferring one, and freezing the others. If you do not become pregnant in that first cycle, we can transfer another embryo during a frozen embryo transfer cycle.

How does embryo freezing work?

Embryos can be frozen from Day 2 (four cell stage) to Day 5 (Blastocyst). They are placed in thin plastic straws, sealed at both ends, and labelled with your name and identification number.
They then go into a freezing machine, where the temperature rapidly drops to -150° Celsius. The straws are then placed in goblets, and put into tanks filled with liquid nitrogen, which keeps the temperature at -196° Celsius.

Success rates with frozen embryos

At Mothercare IVF, many of our births, over many years, have come from the transfer of frozen and thawed embryos. On average the success rate is about 30%, but this mainly depends on the age of the woman’s eggs when the embryos are frozen.
So, if you were to freeze your embryos in your first IVF cycle at the age of 38, and then use them when you’re 42, your fertility chance will be relative to that of a 38-year-old woman rather than a 42-year-old.

What are the benefits of embryo freezing?

The main benefit of embryo freezing is the option to have frozen embryos thawed and transferred to the woman’s uterus in the future without having to undergo stimulation of the ovaries or egg retrieval. It is also possible that there may be enough frozen embryos for more than one subsequent cycle.

Oocyte cryopreservation

Human oocyte cryopreservation (egg freezing) is a process in which a woman’s eggs (oocytes) are extracted, frozen and stored. Later, when she is ready to become pregnant, the eggs can be thawed, fertilized, and transferred to the uterus as embryos.

Assisted hatching is a technique where a gap is made in the shell or “zona” of the embryo prior to the embryo transfer. The idea is that this small slit in the shell of the embryo improves its ability to hatch out of the shell after it forms a blastocyst.

The embryos have to “hatch” or break out of the zona in order to embed into the endometrium lining the uterine cavity. This occurs about four to five days after embryo transfer when the embryo is at the blastocysts stage. Naturally this takes place by expanding/contracting of the zona until it distorts, allowing the blastocysts to “hatch”.

If the zona is not functional, this hatching may not occur. It has been reported that up to 75% of normal embryos never hatch through the protective layering of the zona. Laboratory techniques involved in IVF may result in hardening of the zona. In natural fertilization there are enzymes present within the fluid in the Fallopian tube, which may “soften” the zona. This does not happen in IVF as the tube is bypassed. The zona may also be thicker following IVF, especially in older ladies. Frozen embryos may also have a hardened zona.

IVF hatching has been done using 3 general methods

The embryos have to “hatch” or break out of the zona in order to embed into the endometrium lining the uterine cavity. This occurs about four to five days after embryo transfer when the embryo is at the blastocysts stage. Naturally this takes place by expanding/contracting of the zona until it distorts, allowing the blastocysts to “hatch”.

If the zona is not functional, this hatching may not occur. It has been reported that up to 75% of normal embryos never hatch through the protective layering of the zona. Laboratory techniques involved in IVF may result in hardening of the zona. In natural fertilization there are enzymes present within the fluid in the Fallopian tube, which may “soften” the zona. This does not happen in IVF as the tube is bypassed. The zona may also be thicker following IVF, especially in older ladies. Frozen embryos may also have a hardened zona.

Methods of Assisted Hatching

• Hatching with acid Tyrode’s solution – video of acid Tyrode’s embryo hatching
• Hatching with mechanical means, such as partial zona dissection (PZD)
• Hatching with a laser

The most commonly used method for assisted hatching over the years has been with acid Tyrode’s. However, in recent years use of a laser in IVF labs is becoming more common – and has become a useful tool for micromanipulation of embryos. However, it must be used expertly or damage to the cells could occur.

How is a laser used for IVF hatching?

As can be seen in the video (above), there is a circle of colored light that shows where the laser will fire. The beam itself is invisible and when it is pulsed we can see the effect, but can not see the laser beam itself.

A laser works by releasing energy in the embryo’s shell – thereby vaporizing or dissolving it. Because of the heat generated it must be used cautiously so that cells are not heated significantly.

In the example of embryo hatching shown in the video, the laser is pulsed 3 times to create a complete gap in the shell. The exact technique can vary based on the spot size, power settings, technique, etc.

A blastocyst is an embryo at an advanced stage of physiologic development when there are two cell types present: one group of cells that form the placenta, and another group of cells that form the fetus. Advances by our superb IVF laboratory staff have been able to provide the proper nutrients to grow embryos in the lab to this advanced stage of development. The further developed the embryos, the better your ability to select the most viable embryos and ability to transfer a fewer number of embryos. This will allow us to maintain or raise pregnancy rates while reducing the number of embryos transferred, thereby reducing the most significant complication – multiple pregnancy.

A blastocyst is a highly differentiated, highly developed embryo that has grown to the point where it is ready to attach to the uterine wall (implantation). In naturally conceived pregnancies, the egg is released from the ovarian follicle and picked up the fallopian tube where it is fertilized by sperm. The resulting embryo starts out as a single cell, which then must grow and differentiate until it has the capacity to attach to the uterine wall. The embryo divides from one cell into two cells, then four cells, eight cells, 16 cells, etc. until it reaches several hundred cells at the time of implantation and reaches the blastocyst stage on day five or six after ovulation. The term “blastocyst” is a descriptive name to identify the developmental stage of the embryo.
The embryo spontaneously “hatches” from its shell (zona pellucida) at the blastocyst stage of development and is ready to attach to the uterine wall.

What is blastocyst transfer?

A blastocyst transfer is a technique, incorporated with in vitro fertilization (IVF), designed to increase pregnancy rates and decrease the risk of multiple pregnancy. This technology, pioneered by investigators from Australia has been reported to increase the pregnancy rate in selected patients by almost double, while virtually eliminating the risk of high order multiple pregnancies, like triplets or quadruplets.

Why are Blastocysts Special?

Approximately one third of embryos are capable of successfully activating their genes and growing to the blastocyst stage. If an embryo reaches the blastocyst stage, nature is telling us that it is a healthier embryo and it has a better chance of implanting successfully and resulting in a normal, healthy, baby.

How Does This Help Couples Achieve Pregnancy?

In conventional IVF, embryos are grown for only 2-3 days before they are replaced into the uterus. The embryos have between 4-8 cells inside the shell (zona pellucida) and must continue their growth and development inside the uterus for 4-5 more days before they become blastocyst embryos and are ready to implant. If a couple produce many embryos in an IVF cycle, the embryologist, no matter how skilled, cannot really tell which embryos have the capacity to grow into a blastocyst embryo and which do not. By selecting a group of embryos for uterine replacement (embryo transfer) on day two or three after ovulation, it is too early to be certain which embryos are capable of blastocyst development. This is why conventional IVF is usually done by transferring 2-3 embryos. No one hopes that all of these embryos are going to implant, but recognize that maybe only one or two have the ability to form blastocysts and succeed in developing into a normal pregnancy. Keeping the embryos in the IVF laboratory for another 2-3 days allows blastocyst development and allows you and the IVF team to identify the best embryos for replacement. Now this is where the good news comes!

Why Does the Blastocyst Stage Have a Higher Implantation Rate Than Day Two to Four Stage?

Not all fertilized oocytes are normal, and therefore a percentage always exists that are not destined to establish a pregnancy. The majority of such abnormalities are chromosomal. It has been determined that around 25% of eggs are chromosomally abnormal, and that this problem worsens with maternal age. The culmination of this is that many abnormal embryos arrest or stop growing during development. So by culturing embryos to the blastocyst stage, one has already selected against those embryos with little if any developmental potential. Therefore, a blastocyst has a higher probability of developing into a baby after transfer to the patient. Data on the replacement of human blastocysts on day 5 or 6 of development indicate implantation rates twice that of cleavage stage embryos have been reported.

A second reason for the increased implantation rate of the blastocyst is that the blastocyst is the stage of embryonic development that should reside in the uterus at implantation. As the environment within the fallopian tube and uterus differ, blastocysts are much more suited to survival and development in the uterus. As a result, enhanced or equally successful pregnancy with blastocyst transfer is achieved with fewer embryos and a reduced incidence of multiple births.

Percutaneous Epididymal Sperm Aspiration (PESA) and Testicular Sperm Aspiration (TESA) are surgical procedures that may be used to find sperm where the male partner does not have sperm in his ejaculate (also known as azoospermia).

Sperm aspiration from the epididymis or testicle – PESA or TESA – and then ICSI and IVF

Sperm can be aspirated with a needle from the testicle or from the vas deferens (a structure right next to the testicle that also contains sperm). The man is given some drugs to sedate him and some local anesthesia is also used to numb the area. Then a small needle is inserted and sperm is aspirated from either the epididymis or the testicle. There should be no severe pain. The procedure generally takes about 30 minutes.

Additional Inormation

• TESAtesticular sperm aspiration. This involves placing a needle attached to a syringe through the skin of the scrotum and simply sucking out the fluid inside the testicle.
• PESApercutaneous epididymal sperm aspiration. This involves the same needle and syringe technique but the needle is placed directly into the epididymis.
• Percbiopsypercutaneous biopsy of the testis. This is similar to TESA, but a larger needle is used. This is a 14 gauge needle usually used to biopsy testicular tissue and it usually extracts a larger number of sperm.
• MESAmicrosurgical epididymal sperm aspiration. An open surgical sperm retrieval procedure that uses an operating microscopy to locate the tubules of the epididymis precisely, so that large numbers of sperm can be extracted.

At Mothercare IVF & Test tube baby center we have a comprehensive facility for ovum and embryo donation for patients who cannot produce eggs or sperms required to conceive.
In some cases the ovaries fail to produce eggs and the only option to conceiving is using eggs donated by another woman.

Using donated ovum also eliminates chances of genetic diseases that pass on from mother to child. Similarly, if it becomes impossible to collect sperm even from testes in an azoospermic male, donated sperms have to be made use of.

In certain cases both the sperms and ova from a third person are required for pregnancy.

In this case, embryos donated by other couples are transferred into the uterus of the female patient.

Egg donation is the process by which a woman donates eggs for purposes of assisted reproduction or bio-medical research. For assisted reproduction purposes, egg donation typically involves in vitro fertilization technology, with the eggs being fertilized in the laboratory; more rarely, unfertilized eggs may be frozen and stored for later use. Egg donation is a third party reproduction as part of assisted reproductive technology (ART).

In the United States, the American Society for Reproductive Medicine (ASRM) has issued guidelines for these procedures, and the FDA has a number of guidelines as well. There are boards in countries outside of the US who have the same regulations. However, egg donation agencies in the U.S. can legally choose whether to abide by ASRM regulations or not.

Indication

• Congenital absence of eggs
• Turner syndrome
• Gonadal dysgenesis
• Acquired reduced egg quantity / quality
• Oophorectomy
• Premature menopause
• Chemotherapy
• Radiation therapy
• Autoimmunity
• Advanced maternal age
• Compromised ovarian reserve
• Other Diseases of X-Sex linkage
• Repetitive fertilization or pregnancy failure
• Ovaries inaccessible for egg retrieval

Types of donors

Donors includes the following types:

• Donors unrelated to the recipients who do it for altruistic and/or monetary reasons. In the US they are anonymous donors or semi-anonymous donors recruited by egg donor agencies or IVF clinics. Such donors may also be non-anonymous donors, i.e., they may exchange identifying and contact information with the recipients. In most countries other than the US and UK, the law requires such donors to remain anonymous.
• Designated donors, e.g. a friend or relative brought by the patients to serve as a donor specifically to help them. In Sweden and France, couples who can bring such a donor still get another person as a donor, but instead get advanced on the waiting list for the procedure, and that donor rather becomes a “cross donor”. In other words, the couple brings a designated donor, she donates anonymously to another couple, and the couple that brought her receives eggs from another anonymous donor much more quickly than they would have if they had not been able to provide a designated donor.
• Patients taking part in shared oocyte programmes. Women who go through in vitro fertilization may be willing to donate unused eggs to such a program, where the egg recipients together help paying the cost of the In Vitro Fertilisation (IVF) procedure. It is very cost-effective compared to other alternatives. The pregnancy rate with use of shared oocytes is similar to that with altruistic donors.

Procedure

Egg donors are first recruited, screened, and give consent prior to participation in the IVF process. Once the egg donor is recruited, she undergoes IVF stimulation therapy, followed by the egg retrieval procedure. After retrieval, the ova are fertilized by the sperm of the male partner (or sperm donor) in the laboratory, and, after several days, the best resulting embryo(s) is/are placed in the uterus of the recipient, whose uterine lining has been appropriately prepared for embryo transfer beforehand. The recipient is usually, but not always, the person who requested the service and then will carry and deliver the pregnancy and keep the baby.

Being an egg donor leads to a very exciting and rewarding journey provide an opportunity to help infertile couples make dream come true of having own child. Many couples out there find it difficult to conceive by their own and need donated eggs to get pregnant. Egg donation is a wonderful program whereby an infertile woman uses occytes (eggs) from a donor to fulfill her desire of becoming a mother.

Becoming an egg donor is a serious commitment and results are gratifying. The generosity and compassion is appreciated for the infertile couples. However in order to become a fertility egg donor, there are certain criteria you need to fulfill to establish your suitability.

As all women are not eligible for donating her eggs, some criteria are fairly standard including donor age limits which should be less than 35 years, screening tests and consent (a legal document for the use of donated eggs in treatment). Prior to egg donation process, you will be required to undergo certain screwing tests such as blood tests, ultrasounds, pelvic exam and psychological screening etc.

The egg donation process involves (In Vitro Fertilization) the retrieval of occytes from the donor and will be combined with the sperm from the recipient couple or donor and kept for 3-5 days in laboratory to produce embryos. Once healthy embryos are produced, one or two are transferred to the recipient in order to achieve the pregnancy

The program recommended to:

• Women with ovarian failure
• Women unable to get pregnant with their own eggs or repeated IVF failure
• Women who have had repeated miscarriages
• Have chromosomal abnormalities
• Age more than 35 years or older women

We have proven fertile donor who are well educated and willing to help infertile couples for financial/emotional reasons. BLISS – IVF we have complete and standard arrangements for egg donor/rent womb and already successfully treated.

Surrogacy refers to a contract in which woman carries a Pregnancy for another couple.“Genetic Couple”, “ Commissioning Couple”, “ Intended Parent”:- The Couple who provide either both sets of gametes or at least one set of gametes.“Surrogate host” or “Host” :The woman Receiving the embryos created from the gametes of the genetic couple.“Gestational surrogacy” or “IVF surrogacy “ or “Full Surrogacy”: It refers to a situation in which the individual provides only for gestation and does not provide her gametes for the child(ren) she gestates.

Indications for the treatment by surrogacy

Women without a uterus, but with one or both ovaries functioning, are the most obvious group that may be suitable for the treatment by IVF – Surrogacy. These includes:
Women with congenital absence of the uterus or congential uterine abnormalities like T shaped uterus or hypoplastic uterus.

Women who have had a hysterectomy for severe hemorrhage or ruptured uterus.
Women who suffer repeated miscarriage and for whom the prospect of carrying a baby to term is very remote. Also considered within this group are women who have repeatedly failed to achieve a pregnancy following several IVF treatment cycles, and who appear to be unable to implant normal embryos. Women with untreatable asherman’s syndrome also fall into this category.

Selection of the Surrogate

Gestational carriers may be known to the intended parents or may be anonymous. Known gestational carriers are typically relatives like, sister in laws, cousins, or friends who volunteer to carry the pregnancy. Anonymous gestational carriers are identified through agencies that specialize in recruiting women to become a gestational carrier. There are no specific data on interfamilial surrogacy as surrogacy arrangements in general are less common than gamete donation.