About Infertility
Infertility is defined by the World Health Organization as the inability to conceive after more than two years of unprotected intercourse. Worldwide, 10-14% of couples in the reproductive age group face difficulty in conceiving. However, if the woman is more than 35 years old, she should consult an infertility specialist if she has not conceived within a year of trying. Both male and female factors contribute to infertility. About 40% of infertility is due to a male factor, while 40% is due to female issues. The remaining is due to a combination of male and female factors. The main causes of infertility are –
Prior to implantation, the embryo has to escape out of its protective shell known as the zona pellucida by a process known as hatching. If this process is not completed properly, implantation will fail and pregnancy will not occur. We offer Laser technology for Assisted Hatching (LAH), where a laser beam is focused over the zona pellucida making a small opening, between 30-40 microns to facilitate embryo hatching. This technique is particularly useful in women where the embryo has a thick zona and also in women with previous failed cycles and older women where the zona tends to be thick. However, selection of this procedure for the right application is important.
Our centre utilizes the Diode laser which is the safest laser in ART. The entire procedure is completed in a few milliseconds. Laser Assisted Hatching is particularly useful for older women (more than 35 years), women with oocytes showing a thick zona and women who have tried IVF unsuccessfully. Laser Assisted Hatching is also carried out during the process of Preimplantation Genetic Testing (PGT).
A blastocyst is an embryo that consists of more than 100 cells and forms 5 days after fertilization. Using sophisticated culture media, we can select embryos that remain healthy in culture and reach the blastocyst stage prior to transfer. A higher implantation rate has been observed following transfer of blastocysts. Currently our practice is to transfer 1 to 2 embryos at blastocyst stage. The extra embryos are then frozen by vitrification. In case of less number of good quality embryos, a Day 3 transfer of 2 embryos can be performed.
Treatment with ovulation induction at the time of Assisted Reproduction produces many oocytes. We cryopreserve extra embryos for future cycles. Our freezing protocol is by vitrification. All embryos are coded, labeled and stored in special containers to maintain their identity. We have an active oocyte vitrification program. Oocyte cryopreservation is carried out prior to chemotherapy and in women who want to delay childbearing.
We have an ongoing program for Oocyte donation for women with premature ovarian failure, surgical or induced menopause and those in the perimenopausal group. Some women with repeated decreased recruitment of follicles at the time of IVF, poor quality of oocytes, high FSH, low AMH, with extensive endometriosis, severe pelvic adhesions and inaccessible ovaries can also avail of this facility. Egg donors are carefully screened and matched with recipients as closely as possible on physical characteristics. They are also screened for sexually transmitted diseases and karyotyping. In case of a genetic mutation in the male partner of the couple seeking Egg Donation, the Oocyte Donor is thoroughly screened for a similar mutation so that the genetic disease is not passed on to the offspring. We ensure complete secrecy and evaluate the background of the donors thoroughly. Donors also undergo a genetic test called Karyotyping in order to ensure that they have normal chromosomes. The family background of the donors is checked for genetic diseases. Advanced genetic testing is done if required. We follow ICMR guidelines for our Donor Egg Programme.
We routinely have a back-up semen sample frozen for couples who are undergoing treatment in case of inability to give a sample on the day of the IUI, IVF or ICSI. Men undergoing orchidectomy/cancer treatment prior to radiation and chemotherapy can also avail of our cryopreservation facilities. Those undergoing ICSI are encouraged to freeze their sperm so that we have adequate number of sperm at the time of ICSI. We routinely cryopreserve testicular and epididymal sperm, so that repeated attempts at obtaining fresh epididymal and testicular sperm are avoided.
Infertility and its treatment cause significant stress to the couple. This is detrimental to the reproductive cycle. Before definitive treatment begins, we encourage couples to talk about their stress factors and initiate counseling. We have one of the largest series on psychiatric screening and counseling for ART and many other studies cite our work in this field. Dr. Rajesh Parikh, Consultant Neuropsychiatrist and his team of counsellers will guide you through your cycle.
