Welcome to GYNO IVF CENTER
Gyno Ivf and Infertility centre, Near cochin international airport jn. Athani, Cochin. U K. Model IVF centre with advanced reproductive techniques. World class accommodation facilities with food. and Medical tourism.
Male infertility treatments: History and detailed examination, Uss and Doppler tests of scrotum, Lab tests –hormone analysis, Semen analysis, semen culture, sperm function tests, IUI(intra uterine insemination ), Surgery, Varicocoelectomy, Vasoepididymostomy, vasovasostomy
Female infertility: Detailed history and examination, Ultra sound for pelvic assessment, Ultra sound (uss) for follicular monitoring (follicular study), HSG and SSG for tubal problems, Lab tests for infertility, Hysteroscopy and Laparoscopy, IUI (intra uterine insemination)
Ovulation induction : Ovulation induction with clomephene citrate (clomid) , Ovulation induction w ith inj. FSH (recogon ,bravelle), Ovulation induction with inj.hmg (menagon), Follicular study with, USS for ovulation, Follicular rupture with inj. Hcg (pregnyl)
Laparoscopic Surgery : Laparoscopic Myomectomy (fibroid), Laparoscopic treatment for endometriosis, Laparoscopic Tubal Surgery , Laparoscopic Hysterectomy, Laparoscopic Ovarian Cystectomy, Laparoscopic treatment of infertility, Laparoscopic reversal of sterilization (tubal ligation reversal), Laparoscopic varicocoelectomy
Hysteroscopy : Polypectomy, Tubal canalization, Septal Division, End ablation, Myomectomy
Mirena IUS : Mirena is a tiny T-shaped piece ofplastic that is placed into the uterus by your health care professional. Once Mirena is in place, it begins to slowly release small amounts of the hormone levonorgestrel into your uterus.
Advanced reproductive techniques: PESA (percutaneous epididymal sperm aspiration), TESA (testicular sperm aspiration), TESE (testicular sperm extraction), GIFT (gamete intra fallopian tube transfer), IVF (in vitro fertilization), ICSI (intra cytoplasmic sperm injection), Vasectomy reversal Embyo cryopreservation, frozen embryo transfer, assisted embryo hatching, Surrogacy
Laparoscopy: Laparoscopic Myomectomy, Laparoscopic treatment, for endometriosis, Laparoscopic Tubal Surgery, Laparoscopic Hysterectomy, Laparoscopic Ovarian Cystectomy.
Infertility treatment in gyno IVF centre
Female infertility
Detailed history and examination
Ultra sound for pelvic assessment
Ultra sound (uss) for follicular monitoring (follicular study)
HSG and SSG for tubal problems
Lab tests for infertility
Hysteroscopy and Laparoscopy
IUI (intra uterine insemination )
Ovulation induction
Ovulation induction with clomephene citrate (clomid)
Ovulation induction with inj. FSH (recogon ,bravelle)
Ovulation induction with inj.hmg (menagon)
Follicular study with USS for ovulation
Follicular rupture with inj. Hcg (pregnyl)
Male infertility
History and detailed examination
Uss and Doppler tests of scrotum
Lab tests –hormone analysis
Semen analysis , semen culture , sperm function tests
IUI(intra uterine insemination )
Surgery
Varicocoelectomy
Vasoepididymostomy
vasovasostomy
Advanced reproductive techniques
PESA (percutaneous epididymal sperm aspiration)
TESA (testicular sperm aspiration)
TESE (testicular sperm extraction)
GIFT (gamete intra fallopian tube transfer)
IVF (in vitro fertilization)
ICSI (intra cytoplasmic sperm injection)
Vasectomy reversal
Embyo cryopreservation
Frozen embryo transfer
Assisted embryo hatching
IVF GUIDE:
Every cycle ART multiple steps, and each occurs at a specific time during a four to six –week period. The procedures starts the month preceding the actual IVF CYCLE. The following is provided only as a general guide. Remember that you will be following an individual protocol designed specifically for you. They differ from the protocol recommended to your friends or other women.
Cycle preceding IVF Cycle
Start of oral contraceptives or documentation of ovulation (mid-luteal)
Start of GnRH agonist theraphy.
IVF Cycle
Step-1 – Initiation of Oral Contraceptives
Some patients will receive oral contraceptives in the cycle prior to the ART cycle. This ensures that GnRH analog theraphy work proper time if you have irregular cycles. There is also evidence that oral contraceptive can help prevent ovarian cysts, which may develop during GnRH analog therapy. You will usually begin a pack of oral contraceptives when your nurse instructs you take Alternatively, we may prescribe progesterone for patients who ovulate irregularly or not at all.
Step 2-GnRh Agonist Administration
You will usually begin treatment with a GnRH aginst on the sixteenth day of oral contraceptive pills or the sixth day of progesterone, although this may vary. You do not need a pregnancy test before you start the GnRH agonist.
We will instruct you to reduce the dosage of GnRH analog by one-half on the day you begin ovarian stimulation. You will use the analog until the day of hCG (human chorionic gonadotropin) administration.
Step 3-Baseline Pelvic Ultrasound
Around the time of your expected period, we will perform an ultrasound scan to examine the ovaries, to make sure, they are properly suppressed.
Step 4- Ovarian stimulation
In general, we start ovarian stimulation after menstrual bleeding begins if the baseline ultrasound shows no significant cysts.
There are several medications to stimulate follicle(egg) development. Some subcutaneously (just under the skin using a smaller needle.)
Step 5 - Monitoring of Follicle Development
We monitor follicle development with a combination of vaginal ultrasound and hormone measurements (blood tests). We must do these tests frequently during the ART cycle to ensure that you take the proper dosage of medication. We usually see patients two to three days for an ultrasound and anestradiol level. This allows us to adjust the dose of medication in an effort to improve the development. When the largest follicle reaches 16-18 mm, we usually schedule daily visits for ultrasound exams and serum tests. The amount of medication we prescribe each afternoon depends upon the results of the blood tests and ultrasound.
Step 6 – Final Oocyte Maturation and hCG Administration
Human chorionic gonadotropin (hCG) is a hormonal drug that stimulates the final maturatiom of the oocutes. Determining the time for hCG administration is critical. If it is administered too late follicles may be postmature(atretic) and will not fertilize. Optimal oocyte maturity occurs when we administer the hcg when more than four follicles measure at last 18-20 mm and serum estradiol is greater than 2,000 pg/ml. The drug is given as single intramuscular or subcutaneous injection. The time of the injection is based on the time at which we schedule the egg collection.
Step 7 – Transvaginal Oocyte Retrieval
Oocyte retrieval is performed about hours 34-36 hours after hCG has been administered. An anesthesiologist usually administers intravenous medications (sedatives and pain relievers) in order to minimize the discomfort that may occur during the procedure from these medications are much less common than with general anesthesia. Most patients sleep through the procedure and breath without assistance. A team member will discuss anesthetic options with you prior to your retrieval.
Once you are comfortable and relaxed, your physician will place the ultrasound transducer into the vagina. A guide attached to the transducer leads the needle through the wall of the vagina and into each follicle in the ovaries. Your physician will collect the oocyte and follicular fluid into a test tube for transport to the Embryology lab. The laboratory staff will examine the oocytes microscopically.
After the retrieval, you will be taken to a recovery room where you will be observed for 1-2 hours. When you are fully awake, your vital signs are stable, and you have urinated, you will be released to go home. You may have vaginal spotting and lower abdominal discomfort for several days following this procedure. Generally, patients feel completely well within 1-2 days. You should notify your physician immediately if you develop severe pain, heavy bleeding, or fever after these. One week or so after the retrieval, you watch for signs of ovarian hyperstimulation, i.e. shortness of breath, increased abdominal distention, weight decreased urine output etc.
The number of oocytes retrieved is related to the number of ovaries present, their accessibility, and the number of follicle formed in response to stimulation. Ultrasound provides only an approximation of the number of oocytes that one can expect to recover on average, 8-15 oocytes are retrieved per patient.
Step 8 – insemination of Oocytes
The Embryology laboratory staff examines the fluid aspirated from follicles for the presence of oocytes. It is important to determine the maturity of the oocytes in order to time the insemination properly. The oocyte can only be fertilized for a short interval of about 12-24 hours. If the oocyte is either immature or postmature (too old), it may not be capable of fertilization and normal development.
Semen is usually collected by masturbation the morning of the retrieval. The staff will instruct you regarding time of collection and transportaion to the office.
The laboratory staff prepares the semen speciment for insemination using techniques designed to separate the sperm from the material present in the ejaculate. As a result of this process, we select the most active sperm to inseminate the oocyte. We add about 10,000 sperm in a culture dish with each oocyte. The dish is placed into an incubator which maintains a specific temperature level of humidity, and concentration of carbondioxide. After 12-20 hours, the laboratory staff may detect evidence of fertilization with the microscope. Normally, approximately 70% of oocytes fertilize.
Step 9 – Embryo transfer
The embryo transfer procedure is usually performed three to five days after the oocyte retrieval. This procedure is nearly identical to uterine measurement or an intrauterine insemination. Your physician will pass the same type of catheter gently through the cerwix and the uterus and deposit the embryos into the uterine cavity along with an extremely small amount of fluid. You will require no anesthesia for the embryo transfer. You will be discharged after resting for two hours.
Several studies have indicated that maximal IVF-ET pregnancy rates occur in most cases with the transfer of two to five embryos depends on your age.
Step 10 – Progesterone Supplements
You will administer progesterone daily beginning on the day after oocyte retrieval. Supplemental progesterone helps prepare the uterine lining for implantation.
This daily medication will continue until your pregnancy test. If the test is positive, you may be advised to continue to take for several more weeks.
Step 11- Hormonal Studies and Pregnancy Test
We will usually perform a serum pregnancy test and a progesterone determination 9-12 days after the embryo transfer. If the test is negative, we will instruct you to stop the progesterone.
Step 12 – Early Pregnancy follow up
We will follow your early pregnancy for approximately three. This close scrutiny is necessary to try to identify miscarriage ectopic pregnancies and to counsel you regarding the status and treatment of multiple gestations.
Step 13 - Post IVF Counsultaion
If you are unsuccessful and do not achieve an ongoing pregnancy with your in vitro fertilization cycle, you should a consultation with your physician to review the cycle and discuss future treatment options.
What is ICSI?
ICSI, which is pronounced ick-see, stands for intracytoplasmic sperm injection. ICSI may be used as part of an IVF treatment.
In normal IVF, many sperm are placed together with an egg, in hopes that one of the sperm will enter and fertilize the egg. With ICSI, the embryologist takes a single sperm and injects it directly into an egg.
Why is ICSI Done?
ICSI is typically used in cases of severe male infertility, including:
- Very low sperm count (also known as oligospermia)
- Abnormally shaped sperm (also known as teratozoospermia)
- Poor sperm movement (also known as asthenozoospermia)
If a man does not have any sperm in his ejaculate, but he is producing sperm, they may be retrieved through testicular sperm extraction, or TESE. Sperm retrieved through TESE require the use of ICSI.
ICSI is also used in cases of retrograde ejaculation, if the sperm are retrieved from the man’s urine.
ICSI may also be done if regular IVF treatment cycles have not achieved fertilization.
What is the Procedure for ICSI?
ICSI is done as a part of IVF. Since ICSI is done in the lab, your IVF treatment won’t seem much different than an IVF treatment without ICSI.
As with regular IVF, you’ll take ovarian stimulating drugs, while your doctor will monitor your progress with blood tests and ultrasounds. Once you’ve grown enough good-sized follicles, you’ll have the egg retrieval, where eggs are removed from your ovaries with a specialized, ultrasound-guided needle.
Your partner will provide his sperm sample that same day (unless you’re using a sperm donor, or previously frozen sperm.)
Once the eggs are retrieved, an embryologist will place the eggs in a special culture, and using a microscope and tiny needle, a single sperm will be injected into an egg. This will be done for each egg retrieved.
If fertilization takes place, and the embryos are healthy, an embryo or two will be transferred to your uterus, via a catheter placed through the cervix, two to five days after the retrieval.
You can get more detailed information here in this IVF Treatment Step by Step.
How Much Does ICSI Cost?
ICSI typically costs between $1,000 to $1,500. This is on top of the general IVF cost, which on average costs $12,000 to $15,000. It may cost more than this if other IVF options are being used.
Is ICSI Safe for the Baby?
A normal pregnancy comes with a 1.5% to 3% risk of major birth defect. While ICSI treatment carries a slightly increased risk of birth defects, it’s still rare.
Some birth defects which have an increased risk with ICSI include Beckwith-Wiedemann syndrome, Angelman syndrome, hypospadias, and sex chromosome abnormalities. Still, they occur in less than 1% of babies conceived using ICSI with IVF.
There is some increased risk of a male baby having fertility problems in the future. This is because male infertility may be passed on genetically.
What is the Success Rate for ICSI?
The ICSI procedure fertilizes 50% to 80% of eggs. (Interestingly, just because a sperm is injected into an egg, it does not guarantee fertilization will happen.) Even if fertilization takes place, the embryo may stop growing.
However, once fertilization happens, the success rate for a couple using ICSI with IVF is the same as a couple doing regular IVF treatment.
What Can ICSI Help Treat?
There are a variety of underlying fertility conditions that ICSI may help treat. The specific male fertility problems that ICSI is used to treat are:
- low sperm count
- low sperm motility
- total absence of sperm in the semen
- damaged or absent vas deferens
- retrograde ejaculation
- irreversible vasectomy
- immunological factors (such as a very high white blood cell count in the semen)
- other conditions that prevent the fertilisation of the egg
Men who have been diagnosed with testicular cancer may also want to consider freezing a semen sample prior to treatment since this sample can later be used in ICSI.
How ICSI Works
Since ICSI is always used with in vitro fertilisation, the process starts with preparation for this procedure. The woman is given fertility drugs to stimulate egg follicle development and ovulation. Her mature ova are then retrieved to use during ICSI.
In additional preparation for ICSI, sperm is collected from the man. In cases where it is possible, sperm can be collected from a semen sample. This is the preferred method since it is less invasive, but for some men this may not be possible. An alternate option is to harvest the sperm directly from the man's testicles using a testicular biopsy under anesthetic.
The single sperm is then injected directly into the woman's harvested egg with a very delicate needle. The egg will reseal itself after the needle is withdrawn, just as it does in the process of natural fertilisation when the sperm breaks through its outer membrane.
As in in vitro fertilisation without ICSI, the fertilised egg is then allowed to develop for a few days before being transferred back into the woman's uterus in the form of an embryo.
Effectiveness of ICSI
ICSI is currently the most successful treatment for male infertility, with fertilisation rates of 60%-70% depending on quality of the sperm used. However, once the egg is fertilised, the success rates of ICSI in conjunction with IVF remain the same as conventional IVF – a 20%-25% chance of live birth. This is because overall effectiveness still depends on the fertilised egg developing properly in addition to successful implantation into the uterus. In some cases, assisted hatching may be used to increase the chances of implantation.
ICSI Risks
One concern about ICSI is the possible health impact of this procedure on any resulting children. ICSI is often used with men who have poor sperm quality, and the method entails using any sperm to fertilise the egg as opposed to the strongest one (which is what happens in nature). Because it is possible that a weaker, poorer quality sperm might be used in ICSI, congenital defects may be passed on at a higher rate than naturally or with other methods of IVF.
Also, because ICSI is a relatively new procedure, the long-term effects for resulting children have yet to be properly analyzed. So far, no studies have shown any increased chance of physical, developmental, or congenital problems in children conceived using ICSI.
Couples who want to conceive using ICSI are still advised to analyze their family history for genetic diseases and disorders and consult with a doctor. They may also want to consider pre-implantation genetic diagnosis (PGD).
Finally, because ICSI is used in conjunction with IVF, the risks of IVF apply here too; namely, increased chances of ectopic pregnancy and multiple births.
However, ICSI is still a viable choice if done by a reputable clinic. For some facing the only other alternatives of adoption, sperm donors, or never having children, the risks if ICSI pale in comparison to the possible benefits.
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