Individualised Controlled Ovarian Stimulation

The process in which the egg is prepared for fertilisation in a woman’s ovaries and is released into the fallopian tubes to meet with the potential sperm for fertilisation, is called ovulation. When this process is stimulated by inducing ovarian follicular development and maturation of the egg using medications, it is called ovarian stimulation. Ovarian stimulation is a standard procedure used for successful outcomes in assisted reproductive techniques like IVF, ICSI, IUI etc. as this procedure not only prepares the egg but also prepares a woman’s uterus for embryo implantation. Some of the major advantages of ovarian stimulation are:

•     Helps induce ovulation in anovulatory women (a woman who does not have periods)
•     Induces the maturation of numerous ovarian follicles simultaneously
•     Helps to predict of the timing of egg maturation
•     Enables collection of numerous mature eggs in each cycle

The conventional controlled ovarian stimulation is a one size fit all approach, which may not benefit all patients. At Srishti, we have adopted Individualised Controlled Ovarian Stimulation

(iCOS) which involves ovarian stimulation to suit each woman’s infertility condition and unique characteristics. Few essential parameters like age, weight, previous reproductive history, type of infertility, and ovarian reserve are considered to tailor the most optimal individualized controlled ovarian stimulation (iCOS) strategy. This technique helps to secure the shortest time to pregnancy and live birth. This also reduces the risk of developing ovarian hyperstimulation syndrome. Thus our specialists do a thorough evaluation of your condition to design your personalised treatment to achieve the best possible outcome for your condition.

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Blog Reviewed By: Dr. Soumyaroop Dash

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Egg Donation

Egg donation is a procedure in which a donor woman donates her fertile eggs to a recipient woman to help her conceive through assisted reproduction technology. It typically involves retrieval of eggs from the donor, fertilizing them in a laboratory, and then transferring the healthy embryos into the recipient’s uterus. In vitro fertilization (IVF) using donor eggs have proved beneficial for women who cannot conceive with their own eggs due to reasons such as:

•     Premature ovarian failure
•     Poor quality of eggs
•     Advanced age
•     Ovarian diseases
•     Ovaries surgically removed
•     Risk of inheritable genetic disease

The Procedure

The donor receives hormonal injections to induce ovulation and allow multiple eggs to mature at the same time. The doctor retrieves the mature eggs using an ultrasound guided needle and will fertilize these eggs in the laboratory using the recipient’s partner’s sperm or donor sperm. Once the eggs are fertilized, the embryos are transferred into the recipient’s uterus and monitored closely for pregnancy. After a successful implantation, the recipient carries the developing baby through the full term of the pregnancy and childbirth. In a fresh transfer, the menstrual cycles of the donor and recipient are synchronized using medications while in frozen transfer, the embryos are frozen and transferred at a later time.

Thousands of couples have become parents by opting for egg donation as an infertility treatment. It has been a boon for women to mother a child, experiencing all the joys of pregnancy and motherhood.

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Blog Reviewed By: Dr. Soumyaroop Dash

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ART - IVF (Preparatory Phase)

ART or Assisted Reproductive Technology includes all the procedures where the eggs are surgically retrieved from a woman’s ovaries and combined with the sperms in a laboratory setting to transfer the embryo to the woman’s uterus. IVF or In Vitro Fertilization is a common method of assisted reproduction where the sperms and eggs are combined in a laboratory dish outside of the body. IVF is used to treat women with blocked, damaged, or absent fallopian tubes and endometriosis. It is also used in cases that concern male factors and when a couple’s infertility is unexplained. Typically an IVF cycle involves the following steps:

• Ovarian stimulation
• Retrieval of eggs from the ovary or ovaries
• Fertilization
• Embryo culture
• Embryo transfer into the uterus
• Support the uterine lining with medications to aid pregnancy

Let us now discuss the Preparatory Phase in detail:

Pretreatment

To prevent premature ovulation and maximize the number of eggs available for retrieval, injections containing GnRH agonist are given along with oral contraceptive pills to allow more flexibility in the timing of the cycle and reduce the chance of development of ovarian cysts. A transvaginal pelvic ultrasound is also done during this time to look out for the presence of cysts.

Ovarian Stimulation and Monitoring

In this phase, the ovaries are stimulated with daily injections of Follicle Stimulating Hormone (FSH) and Luteinizing Hormone (LH) that aid your ovaries in producing multiple mature eggs at once. Retrieving multiple eggs will improve your chances of success.

Final Oocyte Maturation

Once your eggs are ready for retrieval, a single injection of human Chorionic Gonadotropin (hCG) is required to induce the final maturation of eggs, 36 hours before the egg retrieval procedure.

Once the eggs are successfully retrieved, they are incubated in specialized media so that they can fertilize and start developing into embryos. It is very important to be compliant with the treatment and doctor’s instruction during the preparatory phase for a successful pregnancy.

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Early pregnancy - concerns and complications

‘Early pregnancy’ is a very misleading phrase, as it can refer either to missed signs of pregnancy in women or to pregnancy among females who have not yet reached adulthood, called teenage pregnancy. We will be referring to the first one.

Most pregnancies progress without any problems, but it has been seen that about 8% involve complications that if ignored/untreated may harm the mother and the child.

For most women, a missed menstrual period is often the first sign of pregnancy. But, in today’s hectic world, women have been known to miss this sign, leading to miscalculation in tracking the pregnancy later on. 

Early pregnancy can be a worrying time for women and following are some of the concerns and complications that may arise. 

VAGINAL BLEEDING:

Blood spots are normal, but heavy bleeding could be a sign of miscarriage. If there is bleeding and cramps similar to that of normal menstrual periods, then it could be leading to a miscarriage. However, most women do not have any problems, and go on to have a healthy baby. But, it would be best to consult your doctor without fail.

MISCARRIAGE:

A miscariage occurs when a pregnancy stops proceeding and the pregnancy tissue is ejected out of the body and it is common in the first few weeks. As said earlier, periods-like pain, cramps and bleeding often precede a miscarrige. Usually no treatable cause can be found, though it does occur in more older women than the young.

ECTOPIC PREGNANCY:

Normally a fertilized egg goes through the fallopian tube and reaches the uterus, where it settles and starts growing. The uterus has the ability to stretch and grow, but the fallopian tube does not. When an egg stays and grows inside the fallopian tube it is called an ectopic pregnancy and it is a very dangerous condition as it can cause the tube to stretch and burst leading to internal bleeding and urgent remedial surgery. One to two of every hundred pregnancies are ectopic.

HYDATIDIFORM MOLE:

This is extremely rare, found in only around one in thousand pregnancies. Here there is an unusual and rapid  growth of the placenta which prevents the fetus from growing and leads to a miscarriage. It is often discovered in the first three months.

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Lifestyle modifications in treating infertility

Infertility is the inability to reproduce by natural means. This is not a natural state of affairs. 

In humans, if even after a year of intercourse without contraception, no pregnancy is seen, then, it is considered to be a problem of infertility.

Of all the causes of infertility in modern times, lifestyle is an important one, and making drastic changes to it can bring dramatic results.

Improving male fertility:

1. Lose body weight. It has been found that obesity can cause hormonal changes that can affect fertility. Low sperm count and sluggish sperms have also been attributed to obesity.
2. Say NO TO DRUGS. Especially the so-called ‘recreational ones’. They can reduce the number and quality of the sperm and some steroids can shrink the size of the human testicle. If you have to take prescription drugs or supplements, do check with your doctors on their effects.
3. Practice safe sex. This is especially true for those with multiple partners. Sexually transmitted diseases can have serious implications on fertility like fragmentation of sperm DNA.
4. Stop smoking and reduce alcohol consumption. One does not have to explain why.
5. Try not to get overheated, especially around the scrotum. Loose clothing is advised.

Improving female fertility:

1. Maintain a healthy body weight, neither over nor under. Healthy body mass helps in maintaining healthy ovulation.
2. Reduce caffeine consumption. 
3. Stop smoking.
4. Practice safe sex. As in males, sexually transmitted diseases cause problems, like damage to the fallopian tube and uterus.

For improving both male and female:

1. Exercise regularly but in moderation.
2. Stress cannot be avoided, so, acknowledge and manage it.
3. Mange or tweak your diet. Consume good, nutritious, freshly cooked food. Avoid packaged food as far as possible.

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Radiofrequency for perfection

The advancement of technology has helped all the industries equally with outstanding facilities. Radio Frequency Identification  (RFID) is the first of its kind that provides greater assurance and peace of mind to parents of the newborns.

Why RFID for couples? 

Radio Frequency Identification (RFID) is considered to be a non-contact based wireless communication technology that helps to identify specific targets, read, and write critical data through wireless signals. These will not cause any adverse effects on the human body or cellular components. RFID helps to pass through liquids; hence is used in the field of medicine, human body implants, and biological research due to its stability and security. 

Some hospitals use 'match intelligent verification system,' which is an integrated intelligent system based on RFID technology. This can be used in the IVF laboratories for operation verification and process management scenarios. These provide excellent security, ease of use, and broad compatibility. 

The major reason for hospitals using RFID would be for the following:

• Helps to eliminate mismatch and reassuring 
• Provides customized SOP and full traceability 
• Ensures high efficiency 
• Easy and stable to use 
• Safeguards every step of the IVF operation 
• Chip is non-toxic and non-volatile hence no harm on anyone

Functioning of RFID 

RFID is the first of its kind and is a sided sensing mechanism to monitor operation area. At times, when different couples' samples are detected, the match system will send warning signs. The hospital will provide an RFID ID card to the patients who enter the cycle, which will have unique identification information. 

There will be a blank chip that is pre-pasted on the prepared vessels and test tubes for further identification. Generally, in each workspace of the labs, the match system will transfer the information of the patients from the last chip to the next blank chip to be used. The match system will help in actively scanning and confirming that there is no mismatch in the particular area or the workspace and automatically prompts further operational steps or procedures. 

However, if the same workspace detects samples of varied couples, the system will automatically interrupt the operation and leave the signal for the operator. Before embryo transfer, the doctor will ensure the system to scan the patient's ID card, matching the embryo to be transferred. This matching system can also help to track and check the sample information on the frozen and recovery process. 

At Srishti Assisted Fertility & Advanced Laparoscopy Centre, the doctor and team provide the best service with the help of RFID to prevent mismatch in pregnancy.

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Blog Reviewed By: Dr. Soumyaroop Dash

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Social Egg Freezing for Fertility Preservation

There are several aspects connected to fertility and conceiving. Age, financial stability, lifestyle, and psychological aspects could be considered to play a major role. Egg freezing resolves infertility issues and helps to begin a new family. 

Egg freezing is a method by which the eggs are stored to preserve fertility and allows them to conceive later. This is considered by women who have issues with conceiving due to various reasons. It is recommended to consult the doctor on time so as to avoid further complications regarding fertility. The doctor will suggest the required tests before proceeding with the egg freezing procedure. 

Egg freezing process

Each cycle develops eggs in the ovaries and 1 egg would get matured and released through ovulation. Whereas, during the IVF period, the egg-freezing process allows all the eggs to mature.

Stimulation of your ovaries - hormone medications would be provided for 10-12 days to help stimulate ovaries. The doctor would monitor the progress through blood tests and ultrasound. 

Egg collection - sedation or pain medication would be given before the process. The eggs would be collected with the help of a thin needle that is inserted through the vagina. This procedure would take 10-15 minutes. The mature eggs will be frozen either using vitrification or snap freezing methods. 

Using the frozen eggs - the doctor will inform the patient about the right time to use the frozen eggs. The frozen eggs are thawed or unfrozen by removing from the freezing solution and warming them up to 37-degree celsius. The doctor would then inject sperm into the egg (ICSI) for fertilization and the embryo would be transferred to the uterus. 

Know the success of egg freezing

Mainly, there are two factors that define the success of the egg freezing process. The number of frozen eggs and the age of the woman would be mainly taken into consideration. As age increases, one might require more eggs to get the expected result.

For additional assistance on high-risk pregnancy, schedule an appointment at Srishti Hospital. They provide the required resources and support for egg freezing and related services.

Visit Us: fertility-clinic.in

Blog Reviewed By: Dr. Soumyaroop Dash

Mail Us: srishti.fertility@gmail.com

Book an appointment: fertility-clinic.in/book-appointment