test tube baby center in Hyderabad India
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FAQs

1) What is infertility?

    ¤ Infertility means difficulty in conceiving (becoming pregnant) despite having regular intercourse without using contraception for a period of 1 year. About 17 in 20 couples conceive within a year of trying.

    ¤ Although you should seek help within 6months if you are aged over 30y, have a history of pelvic tuberculosis, or history of abdominal surgery

2) What tests are required?

    ¤ A semen analysis (sperm test) of the male partner.

    ¤ Tube test to check for the fallopian tubes

    ¤ Hormones such as LH/FSH and estradiol may be checked on Day2

    ¤ Day 21 progesterone

    ¤ Thyroid and Prolactin hormones if indicated

    ¤ CBP,RBS,Viral screening(Both Partners)

    ¤ Ultrasound of the pelvis

    ¤ AMH and AFC

3) When do I take my pregnancy test?

A urine pregnancy test is can be done on the day of your missed period
If the urine test is positive please come to the centre without discontinuing medicines.

4) How do I know which treatment is best for me?

During your initial consultation a detailed history will be taken from you and your partner and the treatment options will then be discussed. In all cases treatment will be tailored to your individual requirements.

5) When can we start treatment?

Once the necessary investigations are complete, treatment can usually begin immediately. There is no need to wait till the first day of your period to start treatment.

6) How long does one round of I.V.F take?

You can complete one cycle of I.V.F in around six to eight weeks from start to finish. There are usually around 10 or 12 visits involved.

7) What is PCOS?

Polycystic ovary syndrome (PCOS), is common. It is a condition where along with having multiple cysts in the ovaries there is a high level of male hormone -testosterone (causing excessive hair growth on the face/body, acne, Infertility and reduced periods), there is also a resistance to Insulin which may cause excessive weight gain and diabetes
A high level of insulin and testosterone interfere with the normal development of follicles in the ovaries. As a result, many follicles do not develop fully.

8) What is the treatment for PCOS?

There is no cure for PCOS. However, symptoms can be treated, and your health risks can be reduced.
You should aim to lose weight if you are overweight
Losing weight helps to reduce the high insulin and testosterone levels that occurs in PCOS.If the duration of Infertility is more, then Laparoscopic ovarian
drilling along with weight loss can dramatically improve chances of pregnancy.

9) What is IUI?

IUI is the abbreviation for intrauterine insemination. It is the process by which sperm is placed into the uterus of the female after being processed in the lab.The IUI procedure is more commonly done and can be an effective treatment for most women under about age 41. However, it is not effective for couples with the following problems and IVF is a better option:

1. Tubal blockage or severe tubal damage (Tubal patency needs to be checked by Laparoscopy&dye or an HSG- Hysterosalpingogram prior to starting any infertility treatment)

2. Ovarian failure (menopause),

3. Severe male factor infertility(less than 5 million/hpf)

4. Advanced stages of endometriosis

10) What is IVF?

In vitro fertilisation (IVF) is a process by which egg cells are fertilised by sperm outside the womb, in vitro.The first successful birth of a "test tube baby", Louise Brown, occurred in 1978.

Treatment is either started on D21 of the previous cycle or D2 of the present cycle. In most patients injectable gonadotropins (usually FSH/HMG) are used. Follicles are monitored by an Ultrasound scan and blood tests.

When follicles have matured human chorionic gonadotropin (HCG) is given. This injection causes the eggs to mature and ready to be fertilized. -Transvaginal oocyte retrieval is a short procedure done under a short GA.

After oocyte or egg retrieval, eggs and sperms are placed in the same petridish and incubated for the following 2-3 days. Embryo transfer entails placing 2-3 good quality embryos in the uterine cavity.

11) How does embryo quality relate to success rates?

Embryo quality and specifically fragmentation of the embryo determines which embryos are to be placed back at the time of embryo transfer.
Generally the better quality the embryo (even blastomeres, minimal fragmentation), the higher the implantation rate.
However, it is vital to recognize that poorer quality and fragmented embryos can implant and result in live births.
When an embryo fails to `implant` (stick to the endometrium or inner lining of the uterus) an IVF may fail to result in a pregnancy.

12) What is Intra-cytoplasmic sperm injection and how does it work?

Intra-cytoplasmic sperm injection (ICSI) involves injecting a single sperm directly into an egg in order to fertilise it. The fertilised egg (embryo) is then transferred to the woman’s womb.

The major development of ICSI means that as long as some sperm can be obtained (even in very low numbers), fertilisation is possible

It is mainly done for severe oligospermia or when the age of the lady is more than 30-35yrs

13) What is IMSI?

Intracytoplasmic morphologically selected sperm injection (IMSI) is a specialized variation of ICSI that uses a higher-powered microscope to select sperm.

In conventional ICSI, the embryologist selects the most normal-looking motile sperm using a microscope that magnifies the sample up to 400 times. IMSI is a variation of ICSI that uses a high power light microscope (enhanced by digital imaging) to magnify the sperm sample over 6000 times. Sperms are then selected which have the most normally-shaped nuclei

ICSI (SPERM IMAGE)

IMSI (SPERM IMAGE)

14) What is Laparoscopy/Hysteroscopy used for?

This procedure allows us to determine whether there are any defects such as scar tissue, endometriosis, fibroid and other abnormalities of the uterus, fallopian tubes and ovaries.

If any defects are found then they can sometimes be corrected with operative Laparoscopy such as the removal of ovarian cysts , removal of PCOD(Polycystic ovarian disease) by LOES, Diathermy to spots of endometriosis, removal of fibroids, opening tubal blocks (by Fallopian tube catheterization or FTC) the list is endless.

Hysteroscopy is a procedure that involves insertion of a narrow telescope-like instrument into the cavity of the uterus (endometrial cavity). The uterine cavity is then distended with fluid and visualized.

LAPAROSCOPY

HYSTEROSCOPY

Research

The technique for examining sperm to use in IMSI was developed by a team led by Professor Bartoov. In 2002, his team used a high-powered microscope to determine which morphological characteristics of sperm might affect the outcome of ICSI. They suggested that ICSI pregnancy rates may be affected by subtle abnormalities in the shape of the sperm nucleus which embryologists may not detect during normal ICSI sperm selection.

In 2003, the same group published a study that looked at whether selecting sperm using IMSI improves the pregnancy rate in couples with repeated ICSI failures (compared to conventional ICSI).

Comparing results of ICSI with IMSI the pregnancy rate was significantly higher (60% vs 25%) and the miscarriage rate significantly lower (14% vs 40%) in the IMSI group compared to the conventional ICSI group.

There also is a significant improvement in implantation, pregnancy and birth rates using IMSI in patients with two or more previously unsuccessful IVF-ICSI attempts.

The pregnancy rates for patients were 29.8% in the IMSI group compared with 12.9% in the ICSI group. The miscarriage rates for these patients were also significantly lower in the IMSI group compared with the ICSI group

The use of IMSI is limited by the resources needed to carry out the technique. IMSI takes a minimum of 60 minutes and more often takes several hours. In addition the technique involves special equipment to reach the necessary magnification ( X6000), it has to be carried out by experienced embryologists trained in the specific technique, and this explains the significant extra cost of providing IMSI.

15) What Happens if the Results Are Abnormal?

After surgery, your doctor will explain what your options are for getting pregnant. Also, in the case of endometriosis or PID, the removal of scar tissue may make it possible to get pregnant without further treatment. If after a few months after surgery you do not get pregnant on your own, your doctor may recommend fertility treatments.

Your doctor will also put you on special injections for 2-3 months following treatment of endometriosis or a fibroid removal.

16) What are Natural Killer Cells?

Some types of infertility may be caused by a slightly overactive immune system. When this occurs the immune system can attack egg, sperm, embryo and even a developing fetus. This can result in difficulty achieving pregnancy, maintaining the pregnancy, or repeated miscarriages.

    ¤ Natural killer (NK) cells are regulated by the immune system. In women who have autoimmune issues, the NK cells can react abnormally to an implanting embryo, treating it as an invading cell and signalling for the body to attack it.

    ¤ Intralipids have been shown to lower the activity of the NK cells component of our immune system.

    ¤ New research has suggested that women who have experienced recurrent miscarriages or multiple failed IUI or IVF cycles as a result of NK cell activation may benefit from the use of intralipids.

17) What are Intralipids?

(USED UNDER THE SUPERVISION OF AN EXPERT ONLY)

Intralipid is a brand name for the first safe fat emulsion for human use It is an synthetic emulsion of soy bean oil, egg phospholipids and glycerin (1.2% egg yolk phospholipids, 10% soybean oil, 2.25% glycerin and water).

How do intralipids work?

    ¤ Some types of infertility may be caused by a slightly overactive immune system. When this occurs the immune system can attack egg, sperm, embryo and even a developing fetus. This can result in difficulty achieving pregnancy, maintaining the pregnancy, or repeated miscarriages.

    ¤ Natural killer (NK) cells are regulated by the immune system. In women who have autoimmune issues, the NK cells can react abnormally to an implanting embryo, treating it as an invading cell and signalling for the body to attack it.

    ¤ Intralipids have been shown to lower the activity of the NK cells component of our immune system. Studies have found that intralipids can help to regulate the NK cells, allowing the embryo to implant on the uterine wall and grow normally.

    ¤ New research has suggested that women who have experienced recurrent miscarriages or multiple failed IUI or IVF cycles as a result of NK cell activation may benefit from the use of intralipids.

How is it used?

    ¤ The method of administration is an IV infusion (a drip in your vein) of around 2-3 hours’ duration and requires that you are not allergic to soy or egg products, and also do not have a history of high cholesterol or liver disease.

    ¤ Intralipids is virtually free of side effects. It is administered 4-7 days before embryo transfer or insemination. Intralipids are re-administered 4-5 weeks following a positive pregnancy test, to keep the NK cells deactivated until the pregnancy can override the signals being sent by the immune system.

    ¤ We now offer this treatment to help women who have had recurrent miscarriage, multiple failed IVF cycles or multiple failed IUI cycles. As mentioned before, Intralipids may deactivate natural killer cells in a woman’s body which may prevent embryos from implanting and growing properly in the uterus.

Intralipids therapy during IVF treatment

    ¤ Intralipids have a suppressive action on certain components of the mother's immune system, essentially safeguarding the embryo from the immune reactions which might otherwise result in implantation failure.

    ¤ Evidence from human studies suggest that Intralipids administered intravenously may enhance implantation. We advocate aggressive treatment of immunologic implantation dysfunction in women undergoing IVF treatment. In cases where there has been NK cell activation we recommend the use of Intralipids to down regulate (deactivate) the NK cells. So far, many women who otherwise might not have achieved success with IVF have gone from infertility to family.

18) What is Sperm DNA Fragmentation?

Sperm DNA fragmentation testing can be performed at the same time as a semen analysis, but it is a separate and essential test that assesses the DNA quality of sperm.

Men with otherwise normal semen analyses can have a high degree of DNA damage and men with what was called very poor sperm quality can have very little DNA damage. More importantly, the degree of DNA fragmentation correlates very highly with the inability of the sperm to initiate fertilization and even if fertilization occurs, high DNA fragmentation will often results in ceasing embryo development before implantation. Research also shows that even if a pregnancy is achieved, there is a significantly higher likelihood that it will result in miscarriage.

A normal sample has less than 15% of the sperm with DNA damage, ideal is less than 10%. Men with extremely poor fertility potential have greater than 30% of their sperm damaged – which means that the likelihood of couples achieving a successful birth is around 1% if more than 30% of a male’s sperm are damaged.

The causes of high DNA fragmentation that cause male infertility include:

chemical/toxin exposure
heat exposure
infection
age
smoking
testicular cancer

It is very important to understand that sperm DNA fragmentation can be improved if the underlying factors are addressed. The goal of complete sperm testing is to seek out the causes of poor sperm quality and try to correct them so conception can occur naturally or to improve the sperm quality for IVF-IMSI and maximize the chances of success.

19) Some Misconceptions about Laparoscopy/IVF-

    ¤ Misconception 1- Doctor is it true that if one has a Laparoscopy done they will never fall pregnant?
Answer- FALSE, Laparoscopy is done for patients with infertility the world over and improves the outcome of treatment.

    ¤ Misconception 2- Doctor if a Laparoscopy is done patient has to go for IVF treatment?
Answer- FALSE, most patients will conceive in the coming months with or without treatment. If however if the tubal blocks are advanced, or if multiple fibroids are diagnosed then patients may need advanced treatment.

    ¤ Misconception 3- Is Laparoscopy is same as D&C (``KIRVET``)?
Answer- FALSE, they are 2 completely different procedures. Laparoscopy is best when combined with a Hysteroscopy and an endometrial biopsy.

    ¤ Misconception 4 - Doctor is it true that if an IVF fails then one can never fall pregnant?
Answer- FALSE, There may be many reasons for an IVF failure. Your doctor will be able to advise you as to what your future chances are although sometimes you may be able to conceive spontaneously even after a failed IVF!

    ¤ Misconception 5 – Doctors may use Donor samples to improve results?
Answer: 100% FALSE- It is illegal to use a Donor sample without PRIOR consent by the couple. All the IVF procedures should have a valid consent form.
At SWCIC we take great care to avoid errors, right from documentation to implementation of the procedures.
Chances of any errors are nil

    ¤ Misconception 6- Babies born by IVF/IUI are weak/abnormal?
Answer: FALSE- There is no evidence to suggest that babies born through IVF are in anyway weak or abnormal.

For more queries you can approach us at SWCIC- the eminent test tube baby center in Hyderabad India.