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FERTILITY TREATMENTS

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Fertility Treatments

Before beginning fertility treatments in our Dreamflower IVF Centre, our physicians will detail the different paths you can take, and advocate the best course of action for you and your partner.

Our fertility specialists favor minimally invasive, cost-effective solutions ranging from ovulation induction and artificial insemination to In-vitro Fertilization and preimplantation genetic screening. Rest assured that we will not proceed with fertility treatment until all of the benefits, risks, and costs have been clearly explained to you and we have agreed on a plan that works for you.

Your situation is unique and our Dreamflower IVF Centre’s customized treatment plans reflect the most direct and efficient route to achieve a successful outcome. Should you choose to pursue treatment with ovulation induction, we’ll discuss the use of fertility medications such as Clomid and the injectable gonadotropins.

If you require in vitro fertilization, we will make sure that you and your partner thoroughly understand every aspect of the procedure, including the possible use of intracytoplasmic sperm injection (ICSI), assisted hatching

Ovarian Stimulation with Clomid or Injectable Fertility Medications Creates Normal or Accelerated Ovulation

Ovarian stimulation is a common part of many fertility treatments. For women who have absent or irregular menstrual cycles, ovarian stimulation can help to create regular ovulation.

For women who already have regular menstrual cycles, ovarian stimulation can help to increase the odds of more than one egg releasing to increase the odds of pregnancy.

Ovarian stimulation is often done in conjunction with IUI (intrauterine insemination) or with the process of in vitro fertilization (IVF). Either oral or injectable medications can be used to stimulate the ovaries.

The most common oral medications that are used are clomiphene citrate (otherwise known as Clomid™ or Serophene™) and letrozole (otherwise known as Femara™). These medications are generally taken for approximately 5 days in the early part of the menstrual cycle. It is common to develop 1 mature follicle (i.e. 1 mature egg) with this kind of treatment, but occasionally multiple eggs may release. Most pregnancies that result from this type of treatment are singletons, though there is a low chance of twins (up to ~4-8%), and a remote chance of triplets or higher (~1 in 3000 cases). An ultrasound or an ovulation kit can then be used to document ovulation.

There are many different brands of injectable fertility medications or gonadotropins.

The most common ones used at Dreamflower IVF Centre are Follistim™, Gonal F™, and Menopur™. Because these medications are more ‘potent’ than oral medications, they do require more monitoring with ultrasounds and blood work (i.e. estradiol levels). These medications are commonly used for between 7-12 days, but this can vary depending on an individual’s sensitivity to the medication.

Though the majority of pregnancies from this type of treatment are singleton, there can be a chance of twins – and occasionally more. Injection lessons are available for patients to learn how to use these medications.

Patients who do not ovulate in response to oral medications alone may benefit by what’s called a ‘hybrid cycle’. In this scenario a combination of oral medication and a small amount of injectable hormone is used to stimulate the ovaries. The use of oral medications in conjunction with injectable medication may help to lower the amount of injectable medication needed, thus decreasing the cost of the treatment cycle.

Injectable medications are an important component of IVF, in vitro fertilization cycles. By using these kinds of medications, multiple eggs can be stimulated to mature. It is ideal to have a number of eggs to work with to increase the odds of there being a ‘good egg’ to work with. Also, having multiple eggs increases the odds of having excess embryos that can be frozen for later use. The chances of twins (or higher) does depend significantly on the number and quality of embryos (fertilized eggs) that are placed in the uterus.

In summary, ovarian stimulation is an integral part of many types of fertility treatment and can be used to create regular ovulation or to increase the numbers of eggs that can mature.

Treatment for Luteal Phase Defects, includes Progesterone Supplementation

The most common treatment for luteal phase defects is to give the woman extra progesterone. Progesterone supplementation can effectively prevent the loss of a pregnancy when given to women with a luteal phase defect. Usually, progesterone supplementation is begun three days following ovulation. It is therefore important to accurately document the day of ovulation, as starting progesterone too soon may increase the risk of a tubal pregnancy. It is common for women to use a urinary ovulation predictor kits to determine the day of ovulation. As the LH surge typically precedes ovulation by 18-30 hours, progesterone supplementation is begun four days after the initial detection of the LH surge.

Types of Progesterone Supplementation for the Treatment of Luteal Phase Defects

Supplemental progesterone is given to all women undergoing in vitro fertilization. In the past, intramuscular progesterone was utilized exclusively for IVF supplementation. Recent data, including one of the largest studies on this topic – performed at Dreamflower – suggest that other methods of progesterone supplementation, such as a vaginal gel, are just as effective, if not more so.

Oral progesterone is not as effective because of its short half life, and also because it may be broken down by stomach acid. When a medication has a short half life, it needs to be given more frequently to maintain adequate levels in the circulation.

Luteal phase defect is a significant cause of recurrent miscarriage – and possible infertility as well – that, once diagnosed, is easily treatable.

Treatment for Recurrent Pregnancy Loss

Patients who undergo testing for recurrent pregnancy loss are found to have an abnormality of some type about 50% of the time. A number of treatments exist and depend on the abnormality that is discovered. The 50% of patients who are not found to have an abnormality on testing may still benefit from different types of fertility treatment.

Genetic Problems

If a genetic problem is found upon chromosomal testing of the mother or father, speaking with a genetic counselor is critical to determine the overall prognosis. This is because chromosomal abnormalities can vary in their impact.

If a significant chromosomal problem is present – that would seriously affect the chance for normal pregnancy – some patients may consider doing genetic testing on embryos before they would be placed in the uterus. This is called preimplantation genetic testing. This kind of testing would necessitate IVF treatment. Another possibility could be using donor sperm or donor eggs in place of the affected patient’s sperm or eggs.

Even if the parental chromosomes are normal, if multiple pregnancy losses have been identified as having a genetic abnormality, preimplantation genetic testing can also be considered on embryos created through the process of IVF. Only chromosomally ‘normal’ embryos would be transferred to the uterus. Though this type of genetic testing has limitations (it may miss small genetic mistakes or embryo problems that are not genetic), the overall success rate is very good.

Autoimmune Problems

If a patient with recurrent pregnancy loss tests positive for lupus anticoagulant, anticardiolipin antibody, or anti ?2 glycoprotein I, appropriate treatment would include treatment for excess blood clotting. This is standardly done with some combination of low-dose aspirin and heparin. Though prednisone (which is used to treat other autoimmune problems) has been tried as a treatment for this condition, it does not improve pregnancy rates — and may be associated with higher rates of gestational diabetes and high blood pressure.

Anatomic Problems

Whether a uterine problems is present at birth (e.g. septate uterus) or develops over times (e.g. scar tissue from a D&C), hysteroscopy is generally indicated to fully diagnose the problem and to provide treatment at the same time. However, certain uterine malformations (e.g. a unicornuate or bicornuate uterus) are left alone as surgical treatment has not been shown to be of benefit.

Hormonal Problems

A number of hormone problems that are related to recurrent pregnancy loss can be effectively treated.

1. Thyroid problems can generally be dealt with administration of additional thyroid hormone (for underactive thyroid) or treatment of the thyroid gland directly (for overactive thyroid).

2. Uncontrolled diabetes would be controlled with diet/exercise modification, insulin, and medications to make insulin more effective.

3. Elevated prolactin levels can be managed with a prolactin hormone lowering medication.

4. Though there is some controversy, some patients with recurrent miscarriages may benefit from empiric use of progesterone.

Lifestyle Factors

To optimize pregnancy health, patients should have ceased smoking (and minimized exposure to secondhand smoke as well). In addition, modification of body mass index (BMI) should be considered if the patient is underweight (BMI <18.5) or overweight /obese (BMI 25-30/BMI>30). Alcohol should be eliminated and caffeine should be significantly minimized.

Treating Blocked Fallopian Tubes

If your HSG reveals a blocked fallopian tube, our Dreamflower IVF Centre reproductive surgeons will discuss several options with you.

Moving straight to in vitro fertilization.

IVF is an effective fertility treatment that bypasses the need to involve the fallopian tubes in conception.

Laparoscopy and/or hysteroscopy to repair the fallopian tubes.

Read more here about this minimally invasive fertility surgery.

You only get one chance to repair a Fallopian tube

It is important to know that research has shown that you only get one chance to repair a damaged fallopian tube; additional surgeries are rarely successful.

It is also important to know that even if your tubes turn out to be irreparably damaged and have to be removed, you still have hope. In vitro fertilization (IVF), which was first developed to treat patients with blocked tubes, offers outstanding results.

Women who have previously had their tubes tied also have several fertility treatment options available to them. In many cases, the interrupted portions of the tubes can be successfully microsurgically reattached (“tubal anastomosis” or “tubal reanastomosis”). If not, IVF is an exceptional alternative.

Our experienced reproductive surgeons are always available to discuss your options with you. Whether you choose surgical repair or IVF, you can count on the physicians at Dreamflower IVF Centre to design a thorough evaluation and treatment plan just for you.

Advanced Treatment with IUI and IVF helps couples with unexplained Infertility.

The simplest treatment for unexplained infertility consists of intrauterine insemination (IUI) in a natural cycle. In this type of treatment cycle, the woman monitors her follicular development and impending ovulation, typically using an ovulation prediction kit. Intrauterine insemination is performed the day following the detection of the luteinizing hormone (LH) surge, which is the day on which ovulation presumably occurs. The chance for pregnancy with natural cycle/IUI typically ranges from 6% to 10% per cycle. There is no increased risk of multiple pregnancy, nor is there any appreciable increase in the risk of any other types of complications from this treatment.

A slightly more involved form of treatment for unexplained infertility is the combination of IUI with clomiphene citrate. Clomiphene is a medication that acts directly on the brain and the pituitary gland, typically resulting in more follicular development. This medication comes in a pill form and the typical starting dose is one pill per day for five days, starting on day 3, 4, or 5 of your menstrual cycle. Once we determine that you are responding to the dose of clomiphene that has been selected, we will ask you to use an ovulation prediction kit daily. IUI will be performed on the day following the detection of the LH surge. If you have had problems in the past using or interpreting ovulation prediction kits, or if you do not typically have an LH surge, we may monitor your follicular development with ultrasound and recommend a single injection of Ovidrel® or hCG when your largest follicle is mature in order to cause ovulation to occur.

If you take Ovidrel®, we will typically perform your IUI 24 to 36 hours following the injection. Pregnancy rates following clomiphene/IUI typically range from 8% to 12% per cycle. In addition, there is a 5% to 8% risk of multiple pregnancy, although fortunately almost all of the multiple pregnancies resulting from clomiphene treatment are twins. As noted in other sections of our website, clomiphene can occasionally cause hot flashes, vaginal dryness, headaches, and/or mood swings. In addition, in up to 40% of patients who take clomiphene, there may be a significant decrease in the production of cervical mucus and/or thinning of the uterine lining. In the event that either of these situations occurs, your physician will probably recommend that you move on to an alternative form of therapy.

The next, more aggressive form of treatment for unexplained infertility combines the use of gonadotropins (follicle stimulating hormone – FSH, or human menopausal gonadotropin – hMG) with IUI. This treatment is more involved, as FSH or hMG are administered via subcutaneous injection (using a little needle just under the skin). Patients will typically start these injections on the second or third day of their cycle and we will see them in the office every two to three days for a blood estrogen level, as well as a vaginal ultrasound to monitor their progress. The gonadotropins are typically administered for 6 to 12 days, and when the largest one or two follicles attain maturity (19 to 20 mm in size), a single injection of Ovidrel® or hCG is administered. We will then typically perform IUI on each of the two subsequent days following your Ovidrel® or hCG injection. This treatment produces pregnancy rates of 20-25% per cycle with a multiple pregnancy rate of approximately 20%. The risk of triplets or more is approximately 2% of all pregnancies produced from this form of treatment. Therefore, out of every 100 women who conceive following gonadotropin/IUI treatment, approximately 80 will have one baby, 18 will have twins, and 2 will conceive triplets or more. This is why we monitor you very closely during your stimulation – to attempt to minimize this risk. Side effects of gonadotropin therapy include bloating, occasional mood swings, cyst formation, and temporary weight gain. There is also a relatively low risk of developing a condition called ovarian hyperstimulation syndrome (OHSS), which is characterized by significant ovarian enlargement, abdominal swelling, nausea, and occasionally some shortness of breath. While this condition usually resolves on its own, we monitor patients at risk for OHSS very closely to prevent any other complications.

The final, most aggressive form of treatment for unexplained infertility is in vitro fertilization. This treatment is discussed in great detail in other sections of this web site. Although it is the most aggressive form of therapy for unexplained infertility, it is also the most successful form of therapy. The major advantage of in vitro fertilization over gonadotropin therapy combined with IUI, in addition to a significantly higher pregnancy rate, is a significant reduction in the risk of high order multiple pregnancy.

In summary, unexplained infertility is a relatively common cause of infertility. This diagnosis is only made after a complete basic evaluation for infertility has failed to reveal a definitive cause for the couple’s infertility. Despite the lack of a definitive diagnosis, several effective treatments are available for unexplained infertility, resulting in respectable pregnancy rates with a minimum risk of adverse effects.

Intrauterine Insemination, IUI: is a fertility treatment option for couples facing low sperm counts or unexplained infertility

Intrauterine insemination (IUI) is a procedure where sperm is placed directly inside the woman’s uterus, increasing her chances of becoming pregnant. IUI may be recommended in cases of unexplained infertility or in cases where the sperm count is low. It is typically combined with medication to stimulate the ovaries (i.e. Clomid or gonadotropins), though it may also be used on its own in some cases of male factor infertility.

The male partner will be instructed to obtain a semen sample by masturbation and ejaculation into a sterile container. The man should avoid ejaculating for two to five days before collecting the sample. The semen is then prepared in the laboratory to separate the active sperm from the inactive sperm and seminal fluid. The process is similar if donor sperm is used.

Some patients may not be able to collect sperm using this technique for religious or other reasons. An alternative is to use a special condom during intercourse to collect the sperm. If this is something you are interested in, please discuss this with your nurse or doctor.

The timing of IUI depends on whether an ovulation kit is being used or if an Ovidrel injection is required.

During an IUI, the woman lies on her back on an examination table and rests her feet in the supports. A speculum is inserted in the vagina and a long, thin, flexible tube is used to insert the prepared sperm sample through the vagina and cervix inside the uterus. This typically takes two to three minutes.

The woman may feel some cramping during the procedure, although this usually resolves quickly. After the sperm sample is inserted and the tube is removed, we ask the woman to lie still for approximately 10 minutes. The woman may then resume her normal activities, including returning to work.

Serious complications of IUI are very rare. Common reactions include pelvic cramping, light bleeding, and vaginal discharge. If these problems are persistent or become severe, please call your nurse.

The chance for pregnancy following IUI depends on the type of treatment that a patient is undergoing. For example, in an unmedicated cycle, IUI produces pregnancy rates of approximately 6-10%. Clomid/IUI cycles typically produce pregnancy rates of 8-12% per cycle, while gonadotropin/IUI cycles have pregnancy rates of 15-25% per cycle.

Do You Have Questions About In Vitro Fertilization, IVF Treatments? Dreamflower IVF Centre has the Answers.

The History of In Vitro Fertilization

In vitro fertilization is arguably the most significant advance in fertility treatment since the field of reproductive medicine began. The first IVF baby, Louise Brown, was conceived and born in England in 1978. Since that time, an estimated one million babies have been born as a result of this technology. Initially, in vitro fertilization was developed for the treatment of women with fallopian tube disease, but now it is the treatment of choice for fertility caused by many other conditions, including significant male factor, unexplained infertility, and endometriosis-associated infertility. IVF is the most successful fertility treatment available using a patient’s eggs and her partner’s sperm.

The IVF Treatment Process

The five steps of in vitro fertilization include ovulation induction, the oocyte retrieval, fertilization, the embryo transfer, and hormonal support of the luteal phase with progesterone. In most cases, ovulation induction initially involves the use medications to suppress ovarian cysts and prevent ovulation from a spontaneous LH surge. The most common protocol utilized by IVF programs in the India includes administration of oral contraceptives with an overlap of an injectable medication called Lupron™. This medication is given prior to ovarian stimulation and suppresses the pituitary gland’s ability to produce the hormone LH – which could trigger ovulation to occur, ruining the stimulation cycle.

We ask patients to continue to take their birth control pills for the first five days that they are taking Lupron, and they then typically start a period soon after stopping the pills. Once the menses occurs, ovulation induction is begun using subcutaneous daily injections of the gonadotropin hormone FSH (FollistimTM, Gonal-FTM, or BravelleTM.) Some centers add the hormone LH or HCG in low doses to the stimulation protocol, as some people believe that may produce a better stimulation in some patients. During the course of gonadotropin administration, the woman is evaluated with blood tests to measure estradiol (estrogen) production from the follicles as well as transvaginal ultrasound examinations every 2-3 days to monitor the development of the ovarian follicles. This monitoring is performed every two to three days during stimulation – which typically takes 9 to 14 days. Once the follicles reach maturity, as determined by their average diameter as well as their estradiol production, the oocyte retrieval is scheduled. In order to achieve optimal egg maturity, we administer a single injection of OvidrelTM approximately 36 hours before the scheduled retrieval time.

The oocyte retrieval is performed in a surgical suite where an anesthesiologist will give you intravenous (IV) medication to keep you comfortable. Oocyte retrieval is performed on a outpatient basis – the entire procedure typically lasts 20 minutes, following which time you will remain in the recovery area for about an hour. You are technically not put to sleep for the retrieval, you do not have breathing tube placed in your throat, and there are not any incisions in your body. Rather, the eggs are removed transvaginally under ultrasound guidance.

Your male partner provides a sperm sample on the morning of the oocyte retrieval, and the sperm are prepared by the embryologists for their addition to the eggs. If your partner’s sperm are normal, then approximately five hours after the eggs are removed, 15,000 moving sperm will be added to a drop of media (the special liquid in which the eggs grow). If the sperm are abnormal, then the embryologists inject a single sperm into each mature egg – a procedure called intracytoplasmic sperm injection (ICSI) in order to facilitate fertilization. Following either insemination or ICSI, dishes containing the sperm and eggs are placed into an incubator where the environmental conditions (temperature, humidity, light, gas concentration, etc.) can be tightly controlled in order to simulate the conditions inside the woman’s fallopian tubes and uterus as closely as possible.

The following morning, the embryologists evaluate the eggs to determine whether or not fertilization has taken place. All normally fertilized eggs are placed back into the incubator and evaluated for the next several days to determine if appropriate embryo development is occurring. Embryos are transferred into the uterus on either Day #3 or Day #5 after the retrieval (which occurs on Day #0), depending on the number of healthy embryos available for transfer. The recommended number of embryos to transfer is determined by the female’s age, the cause of infertility, previous pregnancy history, and other factors. If abnormal fertilization occurs, those embryos have a chromosomal number incompatible with life and, as such, they are discarded, as they can never develop into a viable human being.

The embryo transfer is similar to a pelvic exam and may be performed under abdominal ultrasound guidance. A soft flexible catheter is introduced into the cervix and positioned approximately 1-2 cm from the top of the uterine cavity where the embryos are released. Extra, viable embryos that are of good quality can be cryopreserved and stored for future use. A serum pregnancy test is performed exactly two weeks after the oocyte retrieval.

Many studies over the years have demonstrated that pregnancy and delivery rates are significantly higher in women who receive luteal phase support with progesterone following the embryo transfer. Progesterone is a hormone that is produced by the ovary following ovulation, and it results in maturation and stabilization of the uterine lining for implantation. Luteal phase support has traditionally been accomplished with the administration of intramuscular progesterone – although recent studies, including one performed by our physicians, suggest that a vaginal progesterone product (Crinone™) may be even more effective. The standard protocol for luteal phase support is to administer progesterone from two days after oocyte retrieval until the pregnancy test. If a pregnancy occurs, the progesterone may be continued or stopped depending on the serum progesterone level. Studies have confirmed that there is no increased risk of birth defects or other fetal abnormalities resulting from the administration of progesterone during the luteal phase and/or early pregnancy.

Freeze all cycles

In a traditional in vitro fertilization (IVF) cycle, eggs are fertilized the day of the egg retrieval and the fertilized eggs (embryos) grow in the laboratory until the best quality embryos are transferred three or five days after the egg retrieval. This is referred to as a “fresh” transfer.

Some patients who undergo ovarian stimulation for IVF do not have a fresh transfer of the embryos, three to five days after the egg retrieval. This is referred to as a “freeze all” where the good quality embryos that are produced are frozen. When there is a planned or unexpected “freeze all” embryos cycle, the developing embryos are frozen by a process called vitrification and stored until they are transferred at a later time.

In the past we preferred to perform fresh embryo transfers for most patients because the embryos had a better chance of implanting and developing into a baby than frozen embryos did. However, for the past 5 years techniques for freezing and transferring the embryos have improved so much that frozen embryos now have an equal or perhaps better chance of implanting than fresh embryos.

Some of the reasons for freezing all of the embryos for a later transfer.

Planned storage of embryos prior to receiving medical treatment, such as chemotherapy for cancer that can affect future fertility by damaging the eggs in the ovaries. This can also be done for eggs if you are not ready to make embryos.

To prevent the risk of developing ovarian hyperstimulation syndrome in patients that have developed many follicles and have a high estradiol level. Ovarian stimulation syndrome is a potentially dangerous condition that is increased and worsened when a patient becomes pregnant. By freezing the embryos and transferring them after the ovaries are no longer stimulated it reduces the chances of this condition.

Preimplantation Genetic Screening or Diagnosis. Some patients chose to have their embryos tested to see if they have a normal set of chromosomes, or to see if they do not contain specific genetic mutations that can cause a disease, such as cystic fibrosis. This testing can be done on embryos by removing a small portion of the embryo and testing the genes in the cells removed. The embryos are frozen after the biopsy and are later transferred once the results from the testing are available. Embryos with a normal set of chromosomes have a very high rate of implanting in the uterus and developing into a baby.

Physican or patient preference. Some physicians recommend that patients plan to freeze all of their good quality embryos because they think they have a better chance of implanting and developing into a baby than embryos transferred after ovarian stimulation and egg retrieval. There is a concern that the high hormone levels associated with ovarian stimulation might affect the lining of the uterus, making it less likely to for the transferred embryos to implant. We see this particularly in patients who develop higher progesterone levels earlier in the ovarian stimulation cycle.

Frozen Embryo Transfer can help patients who have extra embryos from fresh IVF cycles

Extra embryos that were achieved through in vitro fertilization, but not selected for fresh intrauterine embryo transfer, can be cryopreserved for future use. These embryos can be replaced after a spontaneous ovulation with appropriate timing in a natural cycle, or they can be transferred at the appropriate time during an artificial cycle.

At the Dreamflower IVF Centre, we most commonly use artificial cycles for FET due to the significant scheduling advantages that this offers our patients. Artificial cycle monitoring involves the administration of estrogen for approximately two weeks in order to allow your uterine lining to develop. Once the uterine lining is at least 7 mm thick, a serum progesterone level is obtained to ensure that spontaneous ovulation has not occurred. At this point, progesterone administration is begun concurrent with estrogen stimulation. At a time by the cell stage at which the embryos were frozen, the embryos are thawed and transferred into the uterus.

The success rate following this procedure ranges from 20 to 30% and depends on the number and quality of embryos that are transferred. The main advantage of frozen embryo transfer is that no ovulation induction medications are used, and there is no need for another oocyte retrieval, along with the associated costs inherent in an IVF cycle. Multiple large studies have demonstrated that there is no increased risk of congenital abnormalities in infants born following the transfer of cryopreserved embryos.

Sperm Freezing Options for Men Include Short and Long Term Health Issues

Fertility preservation for men with sperm freezing (cryopreservation) should be considered in a several differing situations. Sometimes sperm needs to be cryopreserved for the short-term while a couple is undergoing fertility treatments, but other times men should consider long-term preservation of their sperm. When freezing sperm, a semen analysis is first performed on the specimen in order to know how many and what quality of sperm are being frozen. The sperm are then divided into different vials depending on the intended future use (IUI or ICSI) and frozen in liquid nitrogen. When stored in liquid nitrogen, the sperm can remain frozen for a few days or many years and will be viable when thawed.

Reasons to freeze sperm for short-term fertility preservation for men

When couples are using advanced reproductive treatments

Fertility treatment is stressful, and sometimes that stress can interfere with production of an adequate semen sample at a critical time. Sperm can be frozen in advance so that if collection becomes a problem on the day sperm are needed, the frozen sample can be thawed and used for procedures like IUI, IVF, ICSI.

Men with low sperm counts

When sperm counts are critically low, sperm can be frozen as a backup for use if the fresh sample does not contain enough sperm for the planned procedure.

When men will be absent during fertility treatment

Sperm freezing enables the female partner to continue with fertility treatments when the male partner is out of town due to work, unforeseen events, etc.

Ejaculatory dysfunction

When specimen collection is difficult due to ejaculatory dysfunction, sperm can be stored in advance of when they are needed. If ejaculation is not possible on the day sperm are needed, the frozen specimen can be thawed.

Reasons to freeze sperm for the long-term fertility preservation for men

High-risk occupations:

Men whose work exposes them to chemicals, radiation, extreme heat, etc. may consider storage of sperm because these exposures can severely reduce sperm numbers.

Cancer treatment:

Chemotherapy and radiation treatments for cancer can cause permanently low or absent sperm counts. Freezing sperm before these treatments can preserve future fertility.

Ejaculatory dysfunction:

Sperm number and quality may decrease over time when ejaculation doesn’t occur, such as with spinal cord injury. Cryopreserving sperm ensures that sperm will be available when it’s time to start a family.

Before a vasectomy:

Freezing sperm before vasectomy can preserve fertility and prevent the need for future procedures if personal circumstances change and the desire for children is renewed.

Stopping your Biological Clock, Options for Elective Egg Freezing

Egg freezing, also known as oocyte cryopreservation, is an infertility treatment that is used to preserve a woman’s reproductive potential. After going through ovarian stimulation to make multiple eggs, the eggs are harvested from your ovaries, frozen unfertilized and stored for later use. These frozen eggs can later be thawed, fertilized with sperm and transferred into your uterus (in vitro fertilization).

Who Is Egg Freezing For?

Egg freezing can be used by anyone who is seeking to preserve eggs to potentially extend their fertility. It should be offered to all women of reproductive age who are diagnosed with cancer of other serious medical conditions that will require surgery, chemotherapy, and or radiation that can affect your eggs. Chemotherapy and radiation can harm the ovaries resulting in a reduction in your egg number and a decrease in your future fertility.

Egg freezing is also used by women who want to store their eggs at a younger age in hopes of extending their fertility. This is referred to as elective egg freezing or social egg freezing.

Many women postpone childbearing in order to complete their education, advance their career, or find the right partner with whom they want to have children with. As a result, the age of first birth is steadily increasing in the India and many women are delaying having children into their 30’s or 40’s when they may be less fertile and have higher chances of miscarriages. Freezing their eggs at a younger age may help them control their reproductive future by extending their fertility to a time when they are ready to become a parent.

Does Egg Freezing Work?

In the past egg freezing was considered experimental because the techniques for freezing eggs were less successful than freezing sperm or embryos. In 2012 the American Society for Reproductive Medicine (ASRM) removed the experimental label as outcome studies showed that the pregnancy rates and health outcomes of the resulting children from in vitro fertilization with frozen eggs was comparable to in vitro fertilization with fresh eggs.

A woman’s age at the time of egg freezing is an important consideration and directly impacts the success rates of future IVF cycles using frozen eggs. The overall clinical experience has been that success rates with frozen eggs decline with maternal age as do success rates with fresh eggs.

Minimally Invasive Fertility Surgery Options

Laparoscopic Fertility Surgery

A laparoscopy is an outpatient procedure which is commonly performed by gynecologists and infertility specialists. During this outpatient procedure, 2-3 small incisions are made in the belly button and in the lower abdomen. The belly is then inflated with carbon dioxide in order to allow the abdominal and pelvic organs to separate from each other, creating a space in which the surgeon can work. An operative telescope (laparoscope) is then inserted through the belly button incision to allow the surgeon to view the pelvic cavity, including the uterus, fallopian tubes, ovaries, and surrounding tissues.

If there is evidence of endometriosis, laser therapy can be used to treat the disease. Cysts can also be removed from the ovaries during laparoscopy. If there is evidence of scar tissue, this can be treated or removed as well. The patency (‘open-ness’) of the fallopian tubes can also be established during laparoscopy by injecting dye into the uterus and watching for spillage from the ends of the fallopian tubes.

Most laparoscopic procedures take between 1-2 hours to complete. Following surgery, a patient needs a few hours of recovery before being discharged home with pain medications. It is recommend to take a few days off after surgery for full recovery before returning to your normal activities. More extensive procedures may require a longer recovery.

Hysteroscopy for Infertility

A hysteroscopy is similar to a laparoscopy in that a thin camera is used. However, during a hysteroscopy, the camera is placed through the vaginal opening into the uterus without making any incisions. A small amount of fluid is placed in the uterus to allow the surgeon to adequately visualize the uterine cavity. At this time, if fibroids, polyps, or scar tissue is present, they may be removed. A uterine septum (an abnormal band of tissue that extends from the top of the cavity into the lower part of the uterus) can also be removed during a hysteroscopy. Following surgery, a patient will spend a few hours in the recovery area before discharge. Typically, a patient will make a full recovery within 24-48 hours.

Laparotomy, Traditional Surgery

A laparotomy refers to a surgery where a larger abdominal incision is made. This is often required if there are multiple fibroid tumors within the uterus or if endometriosis or adhesions (scar tissue) is so severe that treatment cannot be safely performed through the laparoscope. The incision is typically made in the area of the ‘bikini-line’. Care is taken to make the incision as small as possible while still allowing for the surgery to be safely performed.

Following surgery, patients will often require a short (1-2 day) hospital stay, though sometimes they are able to be discharged the day of surgery. Patients will usually require narcotic medication for pain relief following a laparotomy. You may usually return to work within 1-2 weeks following the performance of a laparotomy.

Fertility Treatments for Men Include Clomid & IUI.

As noted in other portions of our website, abnormalities in sperm production and/or function are solely responsible for approximately 30-35% of the infertility cases seen at Dreamflower IVF Centre. An additional 15-20% of our cases are comprised of couples with abnormalities in both the male and female evaluations. As some degree of male factor is present in about half of the couples we treat, it is critically important to perform a thorough evaluation of the male prior to proceeding with fertility treatment.

Male anatomy, physiology, and the mechanisms of sperm production and function are discussed in great detail in other parts of the Dreamflower website. Just as with female fertility treatment, there are many options available for the treatment of male infertility.

The primary medical treatment options for male infertility include:

1. Medical treatment with Clomid

2. Intrauterine insemination (IUI) for male infertility

3. In vitro fertilization (IVF) for male infertility

4. Intracytoplasmic sperm injection (ICSI) with IVF for male infertility

5. Donor sperm

At Dreamflower we offer the entire range of effective treatments for male factor infertility. We will also work very closely with your urologist to ensure that you are receiving the best possible treatment for your particular condition. A thorough evaluation of the male is always an integral part of the overall fertility evaluation. Diagnostic testing for male infertility is easy, and there are many effective treatments available – even in the most severe cases.

Donor Eggs

For some women who do not have eggs of their own ,egg from a healthy donor is the only chance to have a baby.

Who needs egg donation

1. Premature menopause-this affects 1-2percent of women under 40 years.

2. Ovaries damaged by chemotherapy or radiotherapy treatment for cancer.

3. Those without functioning ovaries (eg.turners syndrome).

4. Those with high risk of passing on genetic disorders to their offspring.

5. Poorly functioning ovaries as they get older.

Procedure of egg donation: We screen all donors to ensure they are free of infectious diseasesor genetic conditions that might be transmitted to offsprings. The donor is explained about the treatment process, potential risks and side effects. The treatment is similar as it is for a woman going through an IVF cycle, although in case of egg donation the treatment ends after collection of donor eggs. The donated eggs are fertilized using the sperms of recipient’s partner and resulting embryos transferred to recipient’s womb

Donor sperm

To help our patients for whom donated sperms is the only hope of conceiving a baby DREAMFLOWER IVF CENTRE has its own sperm bank.

FERTILITY PRESERVATION

FERTILITY PRESERVATION: is for those undergoing cancer chemotherapy ,radiotherapy .it can also be done for women who wish to postpone their family for establishment of career. We do both oocyte cryopreservation and sperm freezing

Off late the incidence of infertility is on the rise and continues to surge. The acceptance and demand of fertility treatment like IVF-ICSI are also on the rise. The success of fertility treatment is dependent on a multitude of factors. The age of the female partner, period of infertility, comorbid conditions like PCOS, fibroid, endometriosis and husband semen parameters to name a few. Overall success rate of IVF-ICSI about 50-60 %.

 

Now, we have an answer for those couples who failed IVF-ICSI

At Dreamflower IVF centre we provide advanced scientific techniques to improve overall success rate for the couples

Failure of an IVF-ICSI can be due to

defective embryo

defective uterine inner lining (endometrium)

 

For defective embryos, techniques like blastocyst transfer is available here, where the embryo is grown and matured for a day more in our state of the art lab, thereby improving the genetic competency. We also use the all freeze embryo technology in recurrent failures to avoid the ill effects of hormones like progesterone on the endometrium. In selected cases all freeze technology succeeds in 90% of cases.

Hysteroscopy 

Hysteroscopy is a procedure that allows your doctor to look inside your uterus in order to diagnose and treat causes of abnormal bleeding. Hysteroscopy is done using a hysteroscope, a thin, lighted tube that is inserted into the vagina to examine the cervix and inside of the uterus. Hysteroscopy can be either diagnostic or operative.

Endometrial receptivity assay (ERA)

Many women trying to conceive through IVF fail the egg implantation process even when embryos appear healthy and the uterine cavity looks normal. Chances are they are having an underlying problem related to the endometrium (the inner lining of the uterus).

One of the causes of infertility is the inability of the uterus to hold on to a healthy embryo. Experts until recently believed that the viability of an embryo is the sole determinant of a successful IVF cycle. But recent studies have discovered that while the quality of embryos is an important factor, the receptivity of the uterus also plays a significant role in deciding the fate of the IVF cycle.

Medical science has now made it possible to determine how receptive a woman’s uterus is in relation to the embryo. The test called Endometrial Receptivity Array (ERA) not only measures the receptivity of the uterus, but also helps determine the exact time for embryo transfer which offers the best chances of success.

Platelet rich plasma (PRP)

PRP stands for platelet rich plasma. Blood, in addition to red and white blood cells, contains platelets which are rich in growth factors. Growth factors promote normal healing by restoring the normal architecture and strength of the damaged tissue. In a platelet rich plasma (PRP) injection, the patient’s own blood is processed at high speeds, resulting in higher concentrations of the patient’s own growth and healing factors, which are then injected into the injured area promoting a more potent healing response.