In a normal female reproductive system, ovulation (release of egg) generally occurs 14 days prior to onset of menstruation. In a young couple, trying for their first child, the timing of release of egg is followed with ultrasonography and the couple are advised on intercourse days to maximize the chance of spontaneous pregnancy. This is called ovulation tracking and timed intercourse. It is a preliminary treatment method. At Southern Gem Hospital, in the absence of a positive result (pregnancy) within six months, the couple is advised of other therapeutic options.
This is the simplest treatment option and resolves infertility in a vast majority of women. In a fresh case, we follow this mode of treatment at the earliest stage. OI involves use of medication to stimulate the ovaries to make more eggs. As in ovulation tracking, the development of mature egg is then followed up with serial ultrasound scans and the couple advised on intercourse days. This treatment is useful for couples where the woman has variable menstrual cycle (fertile period) or difficult ovulation.
The indications for IUI include: low sperm count or poor quality (mobility / structure), male sexual disorders such as impotence or premature ejaculation, cervical disorders, painful intercourse or unexplained infertility.
IUI involves the insertion of prepared sperm sample of the male partner into the uterus of the female partner, through the cervix, at a time around ovulation. IUI procedure can be done while the lady’s ovaries are stimulated with hormonal injections, to produce a number of eggs or in a natural cycle. The release of egg (ovulation) is triggered by given an injection of HCG. This is done when the ovarian follicle/s have matured. The IUI procedure is a simple, painless procedure, wherein a specialized thin catheter is used. In case the male partner’s sperm sample is not available or not suitable (based on sperm analysis), and if the couples wishes and with their consent, a donor sperm sample could be prepared and used for IUI.
Southern Gem Hospital recommends between 3-6 cycles before moving on to higher treatment options.
The indications for IVF include: Female factors such as tubal abnormalities, tubal blockage, post tubectomy patients, failed multiple cycles of IUI, endometriosis, male factors such as abnormal sperm count or motility, post vasectomy, or in situations such as recurrent abortions or unexplained infertility.
What is Invitro Fertilisation (IVF)? Hormonal stimulation of the ovaries to develop eggs, followed by egg collection. Simultaneously, sperm sample preparation. These two are then fertilised in the embryology lab to form an embryo. This happens in an appropriate environment and the embryos are allowed to grow in an appropriate culture media. The progressive growth assessment of the embryo is done on a daily basis and finally, between Day 3 – Day 5, transfer of the good quality embryos is done into the uterus of the woman.
Conditions calling for Intra Cytoplasmic Sperm Injection include: Extremely low sperm count, abnormal sperm morphology and abnormal sperm motility. It is also indicated when the sperm has been surgically taken from either the epididymis or testis. It is also indicated when egg and sperm have failed to fertilise via a routine IVF. The process of ICSI involves injection of the sperm directly into the cytoplasm of the egg using a special device called micromanipulator.
Assisted hatching is indicated during IVF/ICSI when the age of the woman is more than 37 years. It is also recommended in patients having an FET (frozen embryo transfer) or having had failed IVF / ICSI cycles. The shell of the embryo is believed to harden occasionally during culture, making it difficult for the embryo to implant in the uterine cavity. By assisted hatching, a laser is used to open the zona, thus allowing the embryo to hatch and this helps in implantation.
Routinely, the embryos are cultured for 1-2 days and transferred on Day 2 / 3.
With the advancement in technology and understanding of the needs of the growing embryos, different advanced media are now used to culture the embryos to Day 5 (blastocysts). By allowing blastocysts development, we are able to select the best embryos for embryo transfer, thus enhancing our chances of achieving a pregnancy.