Intra Cytoplasmic Sperm Injection (ICSI) to Assist Fertility

Intra cytoplasmic sperm injection (ICSI) can be used as part of an in vitro fertilisation (IVF) treatment to help you and your partner to conceive a child.

ICSI treatment is the most successful form of treatment for male infertility and is used in nearly half of all IVF treatments. ICSI only requires one sperm, which is injected directly into the egg. The fertilized egg (embryo) is then transferred to your uterus (womb).

IVF has become a well-established treatment for certain types of infertility, including long-standing infertility due to tubal disease, endometriosis, unexplained infertility or infertility involving a male factor. Soon it became clear that certain couples with severe male-factor infertility could not be helped by conventional IVF. Extremely low sperm counts, impaired motility and/or abnormal morphology represent the main causes of failed fertilization in conventional IVF. In order to tackle this problem, several procedures of assisted fertilization based on micromanipulation of oocytes and spermatozoa have beenestablished. The evolution of these techniques started with partial zona dissection (PZD), followed by subzonal insemination (SUZI) and finally led to the procedure of intracytoplasmic sperm injection(ICSI). ICSI represents the injection of a single spermatozoon directly into the ooplasm, thereby crossing not only the zona pellucida but also the oolemma.

How ICSI can help the couples ?

During ICSI the sperm doesn't have to travel to the egg or penetrate the outer layers of the egg. This means that it can help couples where the man's sperm:

- can't get to the egg at all

- can get to the egg, but for some reason can't fertilise it.

How is ICSI performed?

There are basically five simple steps to icsi procedure which include the following:

1. The mature egg is held with a specialized pipette.
2. A very delicate, sharp, and hollow needle is used to immobilize and pick up a single sperm.
3. The needle is then carefully inserted through the shell of the egg and into the cytoplasm of the egg.
4. The sperm is injected into the cytoplasm, and the needle is carefully removed.
5. The eggs are checked the following day for evidence of normal fertilization.

Advantages :

This procedure is a big door to parenthood that were earlier closed to some couples with a male factor fertility problem.ICSI gives men with a very low sperm count or other fertility problems a chance of transferring to their genetic child.It is possible to use immature sperm that have been retrieved from the man's testicles so ICSI can be used. ICSI can also be used to help couples with unexplained reasons.

Srishti Assisted Fertility and Advanced Laparoscopy (SAFAL),a specialty hospital who have been catering to fertility care.

Visit Us: www.fertility-clinic.in

Test Tube Baby Procedure India

Anything which occurs outside the body is called in vitro and when fertilization of egg with sperm occurs outside the body it is called "In Vitro Fertilization". The first In Vitro fertilization was done in the test tube and that is why it is popularly known as Test tube Baby.

Test tube baby process or Infertility IVF or IVF-In Vitro Fertilization is the one which is conceived outside the woman's womb.The sperm of man and the egg taken from the woman's ovaries are fertilised within a test tube in the laboratory. Once successful fertilisation is completed, the embryo is then transplanted into the woman's uterus to complete the pregnancy. The embryo won't survive within the test tube and needs to be transplanted to the woman's uterus for its normal growth.Normally this procedure is a part of the IVF (in vitro fertilisation) technique and is done in patients who have problems conceiving normally. 

The process of fertilization which normally in fallopian tube of the woman and the fertilized egg than moves into the uterus of the woman. It an implants there in to the uterus and developed into the baby. When for some reason this process of fertilization cannot take place naturally or sperm and egg cannot be transported naturally to the tube or from the tube to the uterus or either is egg having some problem or the sperm.
 

For whom test tube baby procedure is done?
If the female partner has both the fallopian tubes blocked or the female is suffering from severe endometriosis or the husband is very small number of motile and normal sperms or any other reason by which the fertilization which occurs in outer part of the fallopian tube does not take place.

Test tube baby procedure includes :

Ovarian hyper stimulation
In order to boost-up IVF process there are two main protocols to stimulate the ovary. The long protocol involves down regulation (suppression or exhaustion) of the pituitary ovarian axis by the prolonged use of a GnRH . Whereas the short protocol jumps over the down regulation, consist of a procedure of fertility medications to stimulate the development of multiple follicles of the ovaries.

Egg retrieval
When the ovarian follicles have reached a certain degree of development, final maturation is stimulated, usually by an injection of human chorionic gonadotropin (hCG).This is commonly known as the "trigger shot. Then, hCG acts as an analogue of luteinising hormone, and ovulation would occur between 38 and 40 hours after a single hCG injection, but the egg recovered is performed at a time usually between 34 and 36 hours after hCG injection. This is just prior to when the follicles would split. This avails for scheduling the egg recovery procedure at a time when the eggs are fully mature.

Egg and sperm preparation
The treatment continues in the laboratory, the identified eggs are uncovered from surrounding cells and prepared for fertilization. An oocyte selection may be performed prior to fertilization to select eggs with best chances of successful and healthy pregnancy. At the same time, semen is made ready for fertilization by removing inactive cells and seminal fluid in a process called sperm washing. If semen is being provided by a sperm donor, it will usually have been prepared for treatment before being frozen and quarantined, and it will be soften to use.                                                         Embryo culture
Culture of embryos can either be performed in an artificial culture medium or in an autologous endometrial co culture (on top of a layer of cells from the woman's own uterine lining). With artificial culture medium, there can either be the same culture medium throughout the period, or a sequential system can be used, in which the embryo is sequentially placed in different media.

Embryo selection

There is a grading method developed by the laboratory to judge and select the Embryo quality. In order to have best output on pregnancy rates, it is clearly visible that a morphological scoring system is the method for selection of embryos.    

Embryo transfer

The Embryologist select the embryos based on the number of cells it possess, The age of the woman and other health and diagnostic factors would depend the number available in the cells.

Srishti, Assisted Fertility & Advanced Laparoscopy Center (SAFAL), Puducherry,India provides for all aspects of sub fertility diagnosis, treatment and laboratory services that you may require for assisted reproduction.Srishti is Pondicherry's first fertility center and Test tube baby centre.

Visit Us: www.fertility-clinic.in

In Vitro Fertilization (IVF)- Best Solution for Infetility

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In vitro fertilization-IVF or testtube baby process is the process by which eggs are removed from your ovaries and mixed with sperm in a laboratory culture dish. Fertilisation takes place in this dish, "in vitro", which means "in glass".

IVF treatment is likely to be recommended for the following fertility problems:

• If you have blocked or damaged fallopian tubes.
• If your partner has a minor problem with his sperm. Major problems are better treated using ICSI.
• If you have tried fertility drugs, such as clomiphene, or another fertility treatment such as IUI, without success.
• If you have been trying to conceive for at least two years, or less if you are 40 years or more. This is if a cause hasn't been found to explain why you have not become pregnant.
  
  

Test tube baby procedure:

IVF treatment is one of major and effective treatments in infertility when other methods of assisted reproductive technology have failed. The stage of treatment involves hormonally controlling the ovulatory process, removing ova (eggs) from the woman's ovaries and allowing sperm fertilize them in a fluid medium. The fertilized egg (zygote) is then passed to the patient's uterus with the intent to establish a successful and healthy pregnancy.

Ovarian hyper stimulation

In order to boost-up IVF process there are two main protocols to stimulate the ovary. The long protocol involves down regulation (suppression or exhaustion) of the pituitary ovarian axis by the prolonged use of a GnRH . Whereas the short protocol jumps over the down regulation, consist of a procedure of fertility medications to stimulate the development of multiple follicles of the ovaries.

Egg retrieval

When the ovarian follicles have reached a certain degree of development, final maturation is stimulated, usually by an injection of human chorionic gonadotropin (hCG).This is commonly known as the "trigger shot. Then, hCG acts as an analogue of luteinising hormone, and ovulation would occur between 38 and 40 hours after a single hCG injection, but the egg recovered is performed at a time usually between 34 and 36 hours after hCG injection. This is just prior to when the follicles would split. This avails for scheduling the egg recovery procedure at a time when the eggs are fully mature.

Egg and sperm preparation
The treatment continues in the laboratory, the identified eggs are uncovered from surrounding cells and prepared for fertilization. An oocyte selection may be performed prior to fertilization to select eggs with best chances of successful and healthy pregnancy. At the same time, semen is made ready for fertilization by removing inactive cells and seminal fluid in a process called sperm washing. If semen is being provided by a sperm donor, it will usually have been prepared for treatment before being frozen and quarantined, and it will be soften to use. 

 Embryo culture

Culture of embryos can either be performed in an artificial culture medium or in an autologous endometrial co culture (on top of a layer of cells from the woman's own uterine lining). With artificial culture medium, there can either be the same culture medium throughout the period, or a sequential system can be used, in which the embryo is sequentially placed in different media.

Embryo selection

There is a grading method developed by the laboratory to judge and select the Embryo quality. In order to have best output on pregnancy rates, it is clearly visible that a morphological scoring system is the method for selection of embryos.

Embryo transfer

The Embryologist select the embryos based on the number of cells it possess, The age of the woman and other health and diagnostic factors would depend the number available in the cells.

Srishti, Assisted Fertility & Advanced Laparoscopy Center (SAFAL),  Puducherry is one of the leading ivf treatment centre in india.

For more details about testtube baby procedure,

Visit Us: www.fertility-clinic.in

In Vitro Maturation(IVM)-A Remarkable Fertility Treatment

This remarkable fertility treatment was developed to provide a safer, healthier and cheaper alternative to conventional IVF. Improved IVM techniques are developing very fast and an increasing number of fertility clinics are offering IVM. The concept of IVM technology remains attractive.

In vitro maturation involves harvesting immature or unripe eggs from a woman. Hormone treatments are administered to the eggs in a laboratory procedure in order to cause those eggs to mature so they may be fertilized. The fertilized eggs are then put back into the uterus.

In vitro maturation is similar to IVF in that fertilized eggs are implanted to help a woman become pregnant. However, in vitro maturation involves harvesting unripe eggs, as opposed to IVF, which requires forced maturation of the eggs in the uterus.

Immature eggs are collected from unstimulated or minimally stimulated ovaries under ultrasound scan guidance. The immature eggs are then matured in the laboratory for 24-48 hours using culture medium with added small quantities of hormones. Intracytoplasmic sperm injection (ICSI) is used for fertilization of the matured eggs. The resulting embryos are transferred to the women's wombs.

Who would benefit from IVM treatment?

A number of people may benefit from IVM treatment:

• As an alternative to IVF for women with PCOS(The condition, polycystic ovarian syndrome, known as PCOS, is a common condition and is the commonest cause of ovulation disorders in women of reproductive age) ; these patients are at significant risk of OHSS
• As an alternative to IVF for younger women with normal menstrual cycles, IVM being less costly and safer
• Fertility preservation in young cancer women who are going to receive chemotherapy or radiotherapy
• Salvaging immature eggs collected during a standard IVF/ICSI (when unexpectedly a significant number of eggs collected are immature)
• Women who will benefit most from in vitro maturation are women aged 35 and younger and have antral follicle count of 10 or more.

The difference between IVM and conventional in vitro fertilisation (IVF) is that the eggs are immature when they are collected. This means that the woman does not need to take as many drugs before the eggs can be collected as it might if using conventional IVF, when mature eggs are collected.

IVM is being more reliable and assuring at Srishti Assisted Fertility and Advanced Laparoscopy (SAFAL) ,Puducherry ,with an affordable packages.

Visit Us: www.fertility-clinic.in

Pregnancy Care for patients with Kidney Disease

Pregnancy results in important alterations in acid-base, electrolyte, and renal function due to pregnancy-associated physiologic changes in renal and systemic hemodynamics that occur.

Understanding these changes is essential when evaluating kidney disease pregnancy . Disorders that cause acute kidney or renal failure in early or late pregnancy generally fall into very different categories, and it must also be remembered that pregnancies in women with underlying chronic kidney disease and dialysis who require dialysis during pregnancy, or who have previously undergone renal transplantation pose unique sets of issues. Understanding the physiologic changes and disorders that occur in women with renal disease in pregnancy forms the basis of appropriate management of these unusual disorders.

Chronic kidney disease (CKD) carries significant risks to the mother and fetus in pregnancy. 

 

During a normal pregnancy the renal function undergoes physiological and anatomic changes.

Physiological changes:
The renal plasma flow rate escalates 50-70% during pregnancy (heavy load for kidneys), this change may be more visible during the first 2 trimester. This results in an increased glomerular filtration rate (GFR), that is, 150% of normal. This will be reducing the levels of both blood urea nitrogen (BUN) and creatinine. These changes may lead to renal disease during pregnancy.

Anatomic changes:
During the conception period the female body will show some anatomic changes. The size of the kidney will be increasing by about 1-1.5 cm. A dilatation of the uterus and pelvis occurs and is presumed to be secondary to the smooth muscle–relaxing effect of progesterone. This dilatation is often more pronounced on the right side secondary to dextrorotation of the uterus and dilatation of the right ovarian venous plexus, which in turn can lead to urinary stasis and, as discussed later, an increased risk of developing urinary tract infections (UTIs).

Srishti Assisted Fertility and Advanced Laparoscopy (SAFAL), an exclusive clinic for reproductive medicine center situated at the core of Puducherry, is here to assist you with best Pregnancy Care for patients with Kidney Disease.

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Pregnancy Care for Diabetes Patients India

Diabetes is a disease in which your insulin level in the blood is high. Insulin is a hormone which helps the body use glucose or sugar from the blood for energy.

Gestational diabetes is diabetes that happens for the first time when a woman is pregnant. Diabetes during pregnancy goes away when you have your baby, but it does increase your risk for having diabetes later.
If you already have diabetes before you get pregnant, you need to monitor and control your blood sugar levels.
Either type of diabetes during pregnancy raises the risk of problems for the baby and the mother. To help reduce these risks, you should follow your meal plan, exercise, test your blood sugar and take your medicine.
 The following are the symptoms of the Gestational Diabetics:
- Sugar in urine (revealed in a test done in your doctor's office)
- Frequent infections of bladder, vagina and skin
- Frequent urination
- Unusual thirst
- Nausea
- Fatigue
- Burred vision
At Srishti fertility centre, Puducherry provides best health care for diabetics is carried out with an affordable and fair price.
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Hysteroscopic Septal Resection for Successful Pregnancy

A patient who is unable to carry a pregnancy to term or women infertility is sometimes found, on hysterosalpingogram, to have a septate form of double uterus. In such cases,hysteroscopic resection of septum often corrects the problem and results in a successful pregnancy.

                           

Physiologic Changes:

    A septate uterus is thought to cause fetal wastage because it cannot provide sufficient endometrium, which, in turn, provides nourishment for the developing placenta. When the septum has been removed, adequate endometrium returns, and nourishment becomes available.

    Before the introduction of the hysteroscopic operative instruments, this operation required a laparotomy as well as a hysterotomy with resection of the septum.The introduction of operative hysteroscopic instruments offers a new form of treatment that avoids a laparotomy, resulting in a shorter hospitalization and faster recovery.

    Srishti, Assisted Fertility & Advanced Laparoscopy Center (SAFAL), the reproductive medicine center, first one of this kind in the union territory of Puducherry, enables you with full package on Hysteroscopic Septal Resection.

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Hysteroscopy-Infertility Diagnosis India

Hysteroscopy is a female infertility testing where the doctor look at the lining of the uterus with the use of a medical instrument called a hysteroscope.This test is mainly done for women infertility.

The hysteroscope has a light and camera hooked to it so your doctor can see the lining (endometrium) on a video screen.The camera transmits a signal to a receiver so the doctor can see the inside of the uterus on a video screen.

The tip of the hysteroscope is put into your vagina and gently moved through the cervix into the uterus.

It is best to have a hysteroscopy done when you are not having your menstrual period. If there is a chance that you could become pregnant, the hysteroscopy should be done before you are ovulating so your doctor is sure you are not pregnant.

It also may be done to see if a problem in your uterus is preventing you from becoming pregnant (infertility). A hysteroscopy can be used to remove growths in the uterus, such as fibroids or polyps.

Your doctor may take a small sample of tissue (biopsy). The sample is looked at under a microscope for problems. Another surgery, called a laparoscopy, may also be done at the same time as a hysteroscopy if infertility is a problem.

Why it is done?

The hysteroscopy procedure may be done to discover the cause of abnormal bleeding after menopause.

It is also used to determine if there is a problem with the uterus such as:

• See whether a problem in the shape or size of the uterus or if scar tissue in the uterus is the cause of infertility.
• Look at the uterine openings to the fallopian tubes. If the tubes are blocked, your doctor may be able to open the tubes with special tools passed through the hysteroscope.
• Find the possible cause of repeated miscarriages. Other tests may also be done.
• Find and reposition a misplaced intrauterine device (IUD).
• Find and remove small fibroids or polyps
• Check for endometrial cancer.

Hysteroscopy test can be best done at Srishti fertility center, Puducherry.

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Fertility Enhancing Surgical Procedures

Though technology is far behind god’s creation but it could make slight change to the existing norms. With the advancement in technology, the medical field has also imbibed a lot.

Many conditions can contribute to infertility problems, including fibroids, endometriosis, pelvic adhesions (scar tissue in the pelvis) and uterine anomalies such as a uterine septum and adhesions (scar tissue inside the uterus)

The following surgical procedures can be performed to treat conditions that lead to infertility:

Hysteroscopic Treatment Options

Some of the hysteroscopic procedures, such as

- removal of scar tissue from the inside of the uterus or removal of a uterine septum, can be performed in the office.

- others are performed in the operating room with anesthesia.
Laparoscopic Treatment Options
Many procedures that were traditionally only done through large open incisions can now be done laparoscopically.

Laparoscopy is a process to study the organs of the abdominal and pelvic cavities and heal conditions using minimally invasive surgery. One of the greatest advantages of this typical treatment is that through laparoscopy, treatment procedure can avoid major surgery.

Fertility Enhancing Surgical Procedures (FESP) at Srishti Assisted Fertility &Advanced Laparoscopy Center (SAFAL), Puducherry, offers a variety of treatment method under the supervision of dexterous doctors. Dr. Dash and his team here is to help you with various treatment that will result on better satisfaction of the patients.

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