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Ovulation induction

Ovulation induction

Ovulation induction involves the use of medication to stimulate development of one or more mature follicles (where eggs develop) in the ovaries of women who have anovulation and infertility. These women do not regularly develop mature follicles without help from ovulation enhancing drugs.

Ovulation Induction is a simple process which encourages your ovaries to release eggs, so you maximise your chance of conception through intercourse or artificial insemination (IUI). It suits women who are producing low levels of hormones for ovulation, or who are not ovulating at all. You’ll take medication (as tablets or through injections) to stimulate your hormones.

HSG (Hysterosalpingography)

HSG (Hystero Salpingo Gram)
HSG (Hystero Salpingo Gram)

Hysterosalpingography (HSG) is a radiologic procedure to investigate the shape of the uterine cavity and the shape and patency of the fallopian tubes. It entails the injection of a radio-opaque material into the cervical canal and usually fluoroscopy with image intensification.

The procedure involves X-rays. It should be done in the follicular phase of the cycle. It is contraindicated in pregnancy. It is useful to diagnose uterine malformations, Asherman’s syndrome, tubal occlusion and pelvic inflammatory disease and used extensively in the work-up of infertile women.

Intra Uterine Insemination (IUI)

Intra Uterine Insemination
Intra Uterine Insemination

Intra Uterine Insemination (IUI) involves injection of washed sperm into the uterus with a catheter. If unwashed semen is used, it may elicit uterine cramping, expelling the semen and causing pain, due to content of prostaglandins. (Prostaglandins are also the compounds responsible for causing the myometrium to contract and expel the menses from the uterus, during menstruation.) Resting on the table for fifteen minutes after an IUI is optimal for the woman to increase the pregnancy rate.

In Vitro Fertilization or Fertilisation (IVF)

In Vitro Fertilisation (IVF)
In Vitro Fertilisation (IVF)

In vitro fertilization or fertilisation (IVF) is a process by which an egg is fertilised by sperm outside the body: in vitro (“in glass”). The process involves monitoring and stimulating a woman’s ovulatory process, removing ovum or ova (egg or eggs) from the woman’s ovaries and letting sperm fertilise them in a liquid in a laboratory. The fertilised egg (zygote) is cultured for 2–6 days in a growth medium and is then implanted in the same or another woman’s uterus, with the intention of establishing a successful pregnancy.

Intra Cytoplasmic Sperm Injection (ICSI)


Intra Cytoplasmic Sperm Injection (ICSI)
Intra Cytoplasmic Sperm Injection (ICSI)

Intracytoplasmic sperm injection (ICSI) is an in vitro fertilization procedure in which a single sperm is injected directly into an egg.

This procedure is most commonly used to overcome male infertility problems, although it may also be used where eggs cannot easily be penetrated by sperm, and occasionally in addition to sperm donation.

It can be used in teratozoospermia, because once the egg is fertilized, abnormal sperm morphology does not appear to influence blastocyst development or blastocyst morphology. Even with severe teratozoospermia, microscopy can still detect the few sperm cells that have a “normal” morphology, allowing for optimal success rate.

ICSI only requires one sperm, which is injected directly into the egg. The fertilised egg (embryo) is then transferred to your uterus (womb).

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:

1. Can’t get to the egg at all
2. Can get to the egg, but for some reason can’t fertilise it



ICSI procedure
ICSI procedure

These procedures are offered to couples in cases where the male has no sperm present in the ejaculate. They are used in conjunction with an ICSI procedure.

PESA – Percutaneous Epididymal Sperm Aspiration


Percutaneous Epididymal Sperm Aspiration procedure may be performed under GA or local anaesthetic with sedation. A fine needle is passed into the epididymis to extract fluid. This is then checked in the laboratory by the embryologist for sperm.

TESA – Testicular Sperm Aspiration 


Testicular Sperm Aspiration Testicular sperm aspiration (TESA) is a procedure performed for men who are having sperm retrieved for in-vitro fertilization/intra-cytoplasmic sperm injection (IVF/ICSI). It is done with local anesthesia and sedation in the operating room or under local anesthesia alone in the office and is coordinated with your female partner’s egg retrieval. We insert a needle in the testicle and aspirate the tissue/ sperm. TESA is performed for men with obstructive azoospermia (s/p vasectomy or congenital bilateral absence of the vas deferens). Sometimes, TESA doesn’t provide enough tissue/sperm and an open testis biopsy is needed.

TESE – Testicular Sperm Extraction


Testicular Sperm Extraction procedure may be performed under GA or local anaesthetic with sedation. A small sample of testicular tissue is extracted from the testes. This can be achieved by either a fine needle being inserted into the testes or a small incision being made.

Sperm freezing

Sperm freezing
Sperm freezing

Sperm freezing and storage is the procedure whereby sperm cells are frozen to preserve them for future use. Sperm cells have been frozen and thawed successfully for more than 40 years. By using special technology and then keeping sperm in liquid nitrogen at -196°C, it can be stored for many years while still maintaining a reasonable quality.

Embryo freezing

Embryo freezing
Embryo freezing

Embryo freezing is the process of preserving an embryo at sub-zero temperatures, generally at anembryogenesis stage corresponding to pre-implantation, that is, from fertilisation to the blastocyst stage.

Embryo cryopreservation is useful for leftover embryos after a cycle of in vitro fertilisation, as patients who fail to conceive may become pregnant using such embryos without having to go through a full IVF cycle. Or, if pregnancy occurred, they could return later for another pregnancy. Spare oocytes or embryos resulting from fertility treatments may be used foroocyte donation or embryo donation to another woman or couple, and embryos may be created, frozen and stored specifically for transfer and donation by using donor eggs and sperm.

Oocyte cryopreservation

Oocyte cryopreservation
Oocyte cryopreservation

Oocyte cryopreservation allows women to freeze and store their eggs until they want to start or expand their families. Egg freezing effectively suspends the ever-present ticking of the reproductive biological clock, giving women more choices than ever before.

Oocyte cryopreservation is aimed at three particular groups of women: those diagnosed with cancer who have not yet begun chemotherapy or radiotherapy; those undergoing treatment with assisted reproductive technologies who do not consider embryo freezing an option; and those who would like to preserve their future ability to have children, either because they do not yet have a partner, or for other personal or medical reasons.

Oocyte cryopreservation is an option for individuals undergoing IVF who object, either for religious or ethical reasons, to the practice of freezing embryos. Having the option to fertilize only as many eggs as will be utilized in the IVF process, and then freeze any remaining unfertilized eggs can be a solution. In this way, there are no excess embryos created, and there need be no disposition of unused frozen embryos, a practice which can create complex choices for certain individuals.

Blaslocyst culture & transfer

Blaslocyst culture & transfer
Blaslocyst culture & transfer

Blastocyst culture and day 5 embryo transfer for in vitro fertilization allows selection of the best quality embryos for transfer. Embryo quality is important with infertility. With blastocyst transfer, we transfer fewer embryos – reducing multiple pregnancy risks, and maintain high IVF success rates

3D Ultrasound

3D Ultrasound
3D Ultrasound

3D Ultrasound: we use voluson p8 model ultrasound machine which is specialized in ivf imaging.

Diagnostic & advanced operative Hysterolaparoscopy


Clinical problems that cannot be discovered by an external physical examination can be discovered by laparoscopy and hysteroscopy, two procedures that provide a direct look at the pelvic organs. These procedures may be recommended as part of your infertility care, depending on your particular situation. Laparoscopy and hysteroscopy can be used for both diagnostic (looking only) and operative (looking and treating) purposes.

Diagnostic laparoscopy may be recommended to look at the outside of the uterus, fallopian tubes, ovaries, and internal pelvic area. Diagnostic hysteroscopy is used to look inside the uterine cavity. If an abnormal condition is detected during the diagnostic procedure, operative laparoscopy or operative hysteroscopy can often be performed to correct it at the same time, avoiding the need for a second surgery. Both diagnostic and operative procedures should be performed by physicians with surgical expertise in these areas.

High Risk Pregnancy Care

High Risk Pregnancy Care

Your pregnancy is called high-risk if you or your baby has an increased chance of a health problem. Many things can put you at high risk. Being called “high-risk” may sound scary. But it’s just a way for doctors to make sure that you get special attention during your pregnancy. Your doctor will watch you closely during your pregnancy to find any problems early.

High Risk Pregnancy includes slowed growth for the baby, preterm labor, preeclampsia, and problems with the placenta. But it’s important to remember that being at high risk doesn’t mean that you or your baby will have problems.

Trans Vaginal Sonography

Trans Vaginal Sonography

Transvaginal Sonography is a test used to look at a woman’s reproductive organs, including the uterus, ovaries, and cervix.

Transvaginal means across or through the vagina. The ultrasound probe will be placed inside the vagina.

Transvaginal Sonography may be done for the following problems:


1. Abnormal findings on a physical exam, such as cysts, fibroid tumors, or other growths
2. Abnormal vaginal bleeding and menstrual problems
3. Certain types of infertility
4. Ectopic pregnancy
5. Pelvic pain

Transvaginal Sonography is also used during pregnancy.

Trans Abdominal Sonography


Trans Abdominal Sonography
Trans Abdominal Sonography

A transabdominal ultrasound is used to look at the pelvic organs. Gel is placed on your abdomen. Then a small, handheld unit called a transducer is gently moved around to view the pelvic organs. The transducer sound waves make a picture on the TV screen.

What is DNA fragmentation index?

  • Typically the chances of infertility being attributed to male partner are between 35% and 45%
  • The development of a healthy embryo is initiated when the chromosome in egg unite with chromosome in sperm. These chromosomes contain strands of DNA (deoxyribonucleic acid).
  • The function of sperm is to deliver male DNA to egg
  • The quality of DNA delivered can determine the development of embryo and subsequent milestones during pregnancy

Why is it important to check DNA fragmentation index?

  • Traditionally methods of evaluation of male infertility were limited to a semen analysis that measured the count, motility and morphology of sperm. It did not assess the DNA that was being delivered. The truth is, sperm that appears normal in terms of motility and morphology by traditional semen analysis may exhibit significant DNA fragmentation. Upto 8% of infertile men have high levels of sperm DNA fragmentation despite demonstrating normal semen in tests. Thus, it is very important to gauge DNA fragmentation in sperm to assess male infertility
  • Recent studies suggest that sperm with DNA fragmentation beyond a certain threshold are evidence of compromised male fertility the degree of DNA fragmentation in sperm is measured using a metric called DNA Fragmentation Index
  • Sperm DNA Fragmentation index is usually tested using a procedure called Sperm chromatin dispersion test(SCD). In this routine around 500 sperm cells are analyzed and graded as per size of their halos normal sperm without DNA fragmentation have halos that range in size from medium to large sperm that display a small or no halo point to fragmented DNA.A normal sample is thought to hold less than 15% of sperm with DNA damage.
  • All men diagnosed with abnormal semen are ideal candidates for this test as are those with normal semen and unexplained infertility, previous failed Intrauterine insemination cycles or failed in vitro fertilization procedures

Causes of sperm DNA damage

  • Advanced paternal age
  • Diet
  • Cigarette smoking
  • Alcohol consumption
  • Drug abuse
  • Elevated scrotal temperature (use of hot baths, saunas, laptop computers, prolonged periods of driving)
  • Infection
  • Exposure to environmental and occupational pollutants
  • Varicocele
  • Infrequent ejaculation
  • Drugs, chemotherapy, radiotherapy

Instructions for producing the semen sample for DNA fragmentation testing

  • Abstain from ejaculation for 2 days but not more than 5 days before producing the semen sample for DNA damage testing
  • Collect sample collection container from the clinic
  • Ensure that the container is labeled with your full name, spouse name and identification code number
  • Wash your hands thoroughly with plain water before producing the semen
  • The sample must be produced by masturbation only and ejaculated directly into container .the total sample must be collected
  • The container must be closed tightly following sample collection
  • The sample must be protected from extreme temperatures
  • Deliver sample to the laboratory within one hour of collection

Treatment of sperm DNA damage

  • Depending on what caused the damage to sperm DNA, there may or may not be a way to enhance sperm DNA. Some ways that may help to enhance sperm DNA include lifestyle changes, abandonment of smoking, reduced exposure to toxins and consumptions of daily Zn and anti-oxidant supplements. Other specialized clinical options may be suggested by your fertility specialist