Proper counseling is key to success
• Infertility work up with adequate counseling.
• Diagnostic Transvaginal Sonography (TVS)
• Interventional TVS
• Follicular Study / Ovulation profile
• Video controlled diagnostic and operative hysteroscopy and laparoscopy.
• Fallopian tubal recanalization
• VEA (Vasoepididymal Anastomosis)
• Intrauterine insemination
• IVF-ET ( Test tube baby)
• IVF-ICSI (Poor sperm functions or repeated IVF failure)
• TESA/PESA (Obstructive azoospermia)
• Semen freezing
• Cryopreservation of Embryos
• Management of Normal and high risk pregnancies and Deliveries
(a) What is IVF? In Vitro Fertilization and Embryo Transfer (IVF-ET) is a procedure that enhances the chances of conception in those couples when other fertility therapies have been unsuccessful or are not possible.
(b) When is IVF indicated? 1. Female factors • Blocked fallopian tubes • Anovulation not responding to medical treatment • Endometriosis • Altered tubo-ovarian relations due to adhesions and or previous abdominal surgery • Sexual dysfunction e.g. vaginismus 2. Male factors • Mild to moderate oligoasthenospermia not responding to medical therapy • Severe oligoasthenospermia (ICSI is advised) • Obstructive azoospermia ( TESA/PESA with ICSI is advised) 3. Unexplained Infertility
(c) What are the steps involved in infertility? • Superovulation - stimulates egg development • Oocyte (egg) Retrieval - Done under IV sedation by transvaginal guided ultrasound. • Collecting and preparing semen - Done on the day of egg retrieval. • Insemination of eggs and embryo culture • Transferring embryos to the uterus • Done on Day 2, 3 or day five of development and two to three embryos are transferred • Extra embryos are frozen after taking informed consent. • Blood for Beta HCG is done 2 weeks after embryo transfer
(d) What are risk or concerns involved in IVF-ET • Risk of Ovarian Hyperstimulation Syndrome (OHSS) • There may be a failure to recover an egg • Eggs recovered may not be normal • Sometimes male partners may not be able to produce semen specimen but this problem is treated by semen freezing as "back up" • Fertilization failure inspite of normal eggs • Abnormal development of embryos which are then not transferred. • Embryos transfer may be difficult or there may be implantation failure • Any step in IVF-ET process may be complicated due to unforeseen equipment failure, laboratory condition etc. • Congenital malformation, genetic abnormalities, mental and other birth defects occur in 3% of spontaneously conceived children, may also occur IVF babies • Adoption till date, is still an alternative to IVF-ET.