One in six couple have problems conceiving. Technological advances in the field of reproductive biology have provided us with many tools and techniques to help such couples. Collectively these tools, techniques and protocols are known as ART, an acronym for Assisted Reproductive Technologies. these procedures are made available to couple on consent of both the partners.
Intra Utrine Insemination is a technique useful in the treatment of certain types of malefactor infertility where the female partner is known to have functional fallopian tubes. In such cases the problem of sperm delivery to the Fallopian tubes is overcome with the help of a special catheder through which the gynecologist introduces washed and motile spermatozoa into the uterine cavity and Fallopian tubes in order to facilitate fertilization.
InVitro Fertilization as is evident from the name. In this procedure fertilization of theoocyte is carried out outside the body of the woman in a laboratory under strict culture conditions in specialized carbon dioxide incubators. The ovaries of the woman are stimulated, using hormonal injections, to yield a number of oocytes. These are then mixed with the washed spermatozoa of the husband in order to produce an embryo when these embryos have reached the four to eight cell stage they are re-introduced into the uterus with the help of an ultrasound guided guarded cathedar. Any spare embryos are vitrified for future use if such consent is given by the couple.
Intra Cytoplasmic Sperm Injection – In extreme cases of male factor infertility where either the sperm count is too low, they have abnormal morphology, sperms are only available through a testicular biopsy or the available sperms are immotile. Such cases present a unique challenge as these sperms by themselves are incapable of fertilizing the ovum. The doctor with the help of a high powered inverted microscope equipped with a micro manipulator attempts to choose the right sperm which is subsequently tested to confirm its viability and then injected into the oocyte in order to create an embryo.
Procedure in which the embryos are replaced into the uterus with the help of a guided and guarded cathedar. The timing of this procedure is of utmost importance, for this the clinician monitors the uterine endomitrium and the hormonal levels of the patient in order to determine the best time for the embryo transfer. If the endometrium during that cycle is found to be not so receptive then the procedure can be postponed to the next cycle and the embryos are vitrified for this future use.
Also known as third party reproduction is a technique in which the embryo of the genetic parents are transferred into the surrogate mother who subsequently carries the pregnancy two term. The surrogate relinquishes all rights over such children from the day they are born they are considered the children of the genetic parents.
In cases where the husband is unavailable to provide sperms on the day of ovum pick up,his sperms which have been frozen beforehand can be thawed and used to carry out procedures. In other cases where the husband or male partner is about to undergo some procedure like chemotherapy or radio therapy which may affect his future fertility he can have his sperms cryo preserved for future use.
At times vaginal ultrasound is considered to be the best tool for studies of the uterus and ovaries. This unique tool has now been augmented with the arrival of 4D relative volume scan probes which provide 3 dimensional images of the organs and are also able to determine the blood flow to these organs with the help of power doppler studies. The treatment of infertility has gained much from this technology which is used to the benefit of all patients at our center.
Traditionally embryo transfer is carried out on the second day after the ovum pick up.At this time the embryos are generally in the 4-6 cell stage. With the availability ofspecialised culture media it has now become possible to culture the embryos well beyond the 8 cell stage up to the blastocyst stage, because the implantation of the embryo in the uterus occurs only at the blastocyst stage, the success rate of a blastocyst transfer is better than that of a day three transfer. Blastocyst transfer also reduces the risk of multiple pregnancies and hence a reduced rate of spontaneous abortions.
The visualisation of the utrine cavity with the help of a thin telescope inserted to the cervix is a useful tool in the treatment of infertility. Some patients having tubal block or small polyps and fibroids in the utrine cavity can be benefited by hysteroscopic surgeries. This minimally invasive procedure is extremly useful and routinely performedin the practice of infertility treatment.
The visualization of uterus, Fallopian tubes and ovaries with the help of a special telescope inserted trans-abdominally is very useful when the tubal potency of the patient has to be determined. Laproscopy can also be used for removal of fibroid, removal of adhesiins, treatment of PCOS by ovarian drilling and fulgaration of endometriotic patches.
PolyCystic Ovarian Syndrome, a major cause of female infertility. In which many follicles are formed simultaneously in the ovaries. But the patient does not ovulate. PCOS is characterized by:
Hirsiotism ( undesirable hair growth )
Further such patients are more prone to get diabetes, high blood pressure and heart ailments. Infertility caused by PCOS is unique in its management. Patients are stimulated very low dose long protocols and in case of IVF patients frozen embryo transfer in the next natural cycle is the preferred modus operandi in our center.