INFERTILITY DIAGNOSIS AND TREATMENT
Almost 90% of couples conceive after a year of unprotected intercourse. Evaluation of infertility is indicated if the female partner is under 35 years of age and the couple has been trying to conceive for one year. Immediate evaluation and treatment of infertility is appropriate in cases of known problems that impact fertility such as irregular menstrual cycles, pelvic endometriosis, past history of pelvic infection or sexually transmitted disease, previous abdominal or pelvic surgery, or severe male factor infertility. Because fertility declines with advancing age of the female, evaluation of infertility is warranted for a couple when the female partner is older than 35 and has been trying to conceive for 6 months without success. In the subgroup of women older than 40 years of age, a more aggressive approach in evaluating and treating infertility is generally recommended because of the high likelihood for significant and rapid loss of ovarian reserve in this age group.
Infertility Diagnostic Testing
After a thorough history and physical examination, additional infertility diagnostic testing is undertaken to refine the diagnosis. These initial tests are:
- Ovarian reserve testing (one or more of the following tests may be taken)
- Day 3 blood test for FSH (follicle stimulating hormone) and estradiol (estrogen)
- Day 3 antral follicle count: an ultrasound examination to measure the number of follicles between 4-8 mm on both ovaries.
- Blood test for anti-mullerian hormone
- Clomiphene citrate challenge test
- Testing for tubal and/or uterine anatomy
- Hysterosalpingogram (tubal dye test) and/or
- Sonohysterogram (an ultrasound examination)
- Testing to determine ovulation
- Ultrasound to document the time of ovulation
- Blood test to check progesterone level in mid-luteal phase
- Testing to assess mucus and sperm interaction
- Post coital test: to see if cervical mucus is optimal and sperm survival is sufficient
- Semen testing
- Semen analysis
- Anti-sperm antibodies
In the majority of cases this list of information is enough to indicate the appropriate initial treatment plan. Laparoscopy is not routinely indicated because it has the risks of surgery and does not usually change the initial treatment plan. However, laparoscopy may be indicated if there is suspected endometriosis or tubal disease based on the history, physical findings or ultrasounds examinations; or if there are other specific gynecologic reasons to perform this procedure.
IVF laboratory procedures
The full spectrum of IVF laboratory procedures are performed at, Dr. Rama’s Institute for fertility including:
- Fertilization with intracytoplasmic sperm injection (ICSI): ICSI is an effective method of fertilizing eggs in situations when insufficient sperm is available, sperm parameters are compromised, or when previous fertilization methods have failed. Through ICSI, even the most severe cases of male infertility – very low numbers of sperm or even no sperm in the ejaculate – can be successfully treated with IVF. In these cases, sperm often can be obtained from the testes or epididymis by a minor outpatient procedure.
- Assisted hatching: In order for an embryo to implant in the uterus it must break through the zona pellucida, a thin “shell” surrounding the embryo. The process of the embryo breaking through the zona pellucida is called “hatching.” Hatching can be aided by making a tiny opening in the zona pellucida just prior to transferring the embryo to the uterus. In Dr. Rama’s Institute for fertility IVF program, assisted hatching is routinely performed on all embryos before they are transferred to the uterus.
- Embryo freezing: Surplus embryos that are not transferred to the patient’s uterus may be able to be frozen (“cryopreserved”) for future use by the couple. In Dr. Rama’s Institute for fertility IVF program, cryopreservation of embryos is carried out either on the third day after egg retrieval when the embryo is between 6 and 8 cells in size or on the fifth or sixth day after egg retrieval (the “blastocyst” stage). Embryos that have potential to become successful pregnancies in the future are cryopreserved.
- Preimplantation genetic diagnosis (PGD): Dr. Rama’s Institute for fertility IVF program was the first in the region to launch a PGD program. PGD involves removing a single cell from a developing embryo at the eight-cell stage. The cell is then analyzed for chromosomal and/or specific genetic disorders. For patients with sex-linked diseases or single gene disorders such as cystic fibrosis, genetic screening of embryos is a powerful technique. In these patients, IVF coupled with embryo screening can greatly reduce the risk of offspring being affected by the disease.
- Oocyte/ovarian tissue cryopreservation: Rama’s Institute for fertility IVF laboratory is becoming increasingly active in the area of freezing eggs and ovarian tissue. There have been very few births resulting from ovarian tissue cryopreservation and it is clearly still very experimental. In contrast, egg freezing has become much more successful in the past decade and is no longer considered experimental. Egg freezing may be considered for: Women with cancer who are about to undergo chemotherapy that can cause their ovaries to be unable to make eggs in the future. Women who are undergoing In Vitro Fertilization who do not feel comfortable freezing all or any embryos Women in their 30’s who are delaying child bearing
- Genetic Screening for Chromosome Anomalies: Dr. Rama’s Institute for fertility is offering a new technique for screening patient embryos and selecting those most likely to result in a pregnancy. This powerful new technique known as Trophectoderm Biopsy allows the removal of multiple cells at the blastocyst stage. Embryos can be examined for inherited genetic disorders as well as chromosomal abnormalities. Patients with recurrent losses or at risk for chromosomal abnormalities can have their embryos analyzed using the new Genesis-24 screen. By testing a patient’s embryos for chromosomal abnormalities and selecting only normal embryos for transfer, the patient’s opportunity for a pregnancy with a healthy baby is increased. The Genesis-24 technique is quite powerful and allows transfer of embryos in the same IVF cycle.
Our team makes sure you understand what’s going on and why, and have the support you need through your treatment.
INTRACYTOPLASMIC SPERM INJECTION (ICSI)
If you want to undergo with ICSI procedure infertility, then consult our ICSI fertility treatment center/Hospital to know all possibilities of success among ICSI treatment in Hyderabad at low cost. Intracytoplasmic Sperm Injection procedure has been a benefiting too many men who are trying to achieve parenthood. For couples with prominent malefactors problems like low sperm count and low sperm motility, this is the best treatment. Intracytoplasmic Sperm Injection or ICSI treatment is mostly successful for men who are infertile and these are nearly used in IVF treatments. Intracytoplasmic Sperm Injection needs only one sperm to inject directly into the egg. The fertilized egg i.e. embryo is then transferred to your womb (uterus).
- Previous failed IVF Treatment.
- Men with low sperm count – Oligospermia
- Men with poor sperm motility – Asthenozoospermia
- Men with Zero sperm count – Azoospermia
- Men who underwent surgical sperm revival techniques like TESA/TESE/MESA/PESA
- High values of Sperm DNA abnormalities
- More than 50 % fertilization failure with IVF cycle.