Lab FAQ’s

Lab FAQ’s

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Q1. What are the different procedures to diagnose infertility and the course of action employed for the same?

Firstly, it is very much important to diagnose the cause of infertility in a couple, for this a couple have to undergo various tests like from simple blood test to more complicated analytical methods. Diagnosis of infertility is very crucial and first step as accordingly the further which therapeutic path should be followed can be determined.

Secondly, other factors such as the age of the woman, or problems shared by both partners, might also influence the choice of treatment.

Q2. What are the different remedial measures that can be employed for treating infertility and related problems?

Well we offer different therapies but it all depends on the type and cause of infertility that has been diagnosed. Treating infertility doesn’t always mean surgery in fact vast majority of female patients are successfully treated with the administration of drugs such as Clomiphene Citrate, Bromocriptine or Gonadotrophins. A times ther is also requirement to repair damage reproductive organs such as those caused by endometriosis and infectious diseases.

We also offer treatment option for male infertility. There are great numbers of cases, the reason why men have fertility problems remains unexplained and the treatment methods applied are empirical. Some patients nevertheless require more complex medical intervention. So Accordingly we advice them treatments like the administration of drugs, surgery and assisted reproductive technologies, such as Intracytoplasmic Sperm Injection (ICSI) & IMSI.

Q3. Are the infertility treatments really effective? What is the success rate expected in such treatments?

Success rate for any infertility treatment differs with respect to many factors like its type, age, cause, male or female infertility. But still one should bear in mind that the average chance to conceive for a normally fertile couple having regular unprotected intercourse is around 25% during each menstrual cycle. It is estimated that 10% of normally fertile couples fail to conceive within their first year of attempt and 5% after two years. When we compare to normal fertility rates than one should expect 25% success rate per cycle when effective treatment is done but a couple might have to repeat cycle to achieve pregnancy.

Women suffering from hormonal imbalance can be compensate by simple ovulation induction by using drug such as Clomiphene Citrate or Gonadotrophins because of which such women are likely to conceive within 6 – 12 cycles and thus their success rate comes to more than 80% which can be increased if it is planed with intrauterine insemination (IUI)

Q4. What are the different aspects that should be considered for a successful treatment?

At times couples get influenced by success rate but there are few important factors to be taken into account like age of women as the it increases above 40 chances of conceiving is lessened and as the success rate is hampered.

Q5. Are there any risks or danger involved for the patient undergoing the treatment?

Major risks are not as such been seen in such treatment but yes as we give drugs to treat infertility may cause occasion side effects. But during treatment close monitoring of follicular growth is done as to avoid OHSS (ovarian hyperstimulation syndrome) and to minimize the risk of multiple pregnancy. And so nowadays protocol has been designed in such manner so that OHSS and multiple pregnancy risk can avoid.

  • Local Side Effects: Patients who took gonadotrophins by intramuscular injection may experience local side effects like skin redness, swelling and brusing, pain and discomfort. But now Highly purified follicle stimulating hormone preparation which can be administered subcutaneously, Nowadays Gonadotrophins produced by recombinant DNA – or genetic engineering – techniques are available for administration by subcutaneous injection.
  • OHSS: Ovarian Hyperstimulation Syndrome (OHSS) is a side effect that can occur during infertility treatment with ovulation inducing drugs.
    Symptoms can be:
    • Ovarian Enlargement
    • Accumulation of fluid in abdomen
    • Gastrointestinal disorders (nausea, vomiting, diarrhea).
    • Severe cases of OHSS.
  • Multiple Births: Initially Multiple births use to occur frequently in infertility treatment but now risk of multiple pregnancies has decreased by adopting new regimens of treatment. About 80% of pregnancies achieved following simple ovulation induction with Gonadotrophins result in single births, the remaining 20% being multiple pregnancies, mostly twin pregnancies. After IVF treatment one pregnancy out of four is multiple, now may centers are transferring only three embryos after fertilization well some of them go for blastocyst culture if there are more than 3 embryo on day 3.
Q6. Is ovarian cancer related to ovarian induction?

Till Date there are No epidemiological study has ever established a causal link between ovulation promoting drugs and ovarian cancer. More than 2,600 women were treated between 1964 and 1974 and followed for an average for more than 12 years after this study there was no association found between ovulation including drugs and ovarian cancer.

Q7. Do the children born after the treatment, experience any side effects?

Defects in Children born with ovulation promotion drugs or with the ivf treatment have not been reported as such but incidence of malformation is about 2% that is like comparable to the babies born naturally. For the patients undergoing ICSI the incidence of malformation is around 2.7%.

Q8. What is the role of counseling for the patients undergoing infertility treatment?

The physician helps the infertile couple find the most appropriate therapeutic path to overcome barriers to conception, but before a treatment is started, patients need to be aware of all its aspects, including its constraints. Beyond the medical expertise, infertile couples are also looking for counseling and support.

Psychological point of view, infertility is often a hard condition to cope with. During treatment and before a pregnancy is achieved, feelings of frustration or loss of control usually experienced by the infertile couple are likely to be exacerbated. Management of infertility includes both the physical and emotional care of the couple. Therefore, support from physicians, nurses and all people involved in treating the infertile couple is essential to help them cope with the various aspects of their condition. Offering counseling and contact with other infertile couples and patient associations can provide help outside the medical environment.

Q9. What is timed Sexual Intercourse?

Timed Sexual intercourse is Often recommended to increases the chances of getting pregnant spontaneously. When women is in their most fertile period that is around the time of ovulation sexual intercourse or coitus is advised.

To detect the approximate time of ovulation a temperature curve of several menstrual cycles can be made. The woman takes her body temperature each morning before getting out of bed, starting on the first day of the menstruation until the start of a new period. The body temperature rises around 0.5 degrease Celsius after the ovulation. This is mostly about 14 days after the first day of the period and when no pregnancy occurs the temperature drops to normal again, with pregnancy the temperature stays high. One can also use urine or saliva tests to detect the ovulation.

Even to make it more precise we can also use a serial ultrasound monitoring to follow the development of the follicle and subsequent rupture that indicates ovulation. As sperm ca live in women uterus for few days so t is best to have intercourse 3-4 days before the expected ovulation and every other day until 2-3 days after the expected ovulation.

Q10. Is there any treatment available for people having anatomical abnormalities, interfering with normal reproductive function?

For anatomical abnormalities interfering with normal reproductive function of fetus we have reproductive surgery. reproductive surgery requires meticulous surgical technique for optimal results, including rapid patient recovery and avoiding the need for routine hospitalization. Reproductive surgeons treat tubal obstruction, endometriosis, uterine fibroids, scarring of the ovaries or other pelvic structures resulting from pelvic inflammatory disease (PID) in the female, and varicocele and vas obstruction in the male as well as other abnormalities.

Q11. What is intra uterine insemination? When is it employed in patients?

Intra Uterine Insemination (IUI) is for couple with basic fertility problem like:

Cervical hostility: This means that the cervix is not permeable for semen shown after the Post Coitum Test.
Idiopathic subfertility: No cause has been found for the inability to conceive
Male subfertility: The sperm quality is decreased. Clinics use different ranges for sperm count in which they perform IUI.
Sperm Antibodies: Inability for vaginal ejaculation with decreased sperm quality, for example in men with retrograde ejaculation or spinal cord injury.
For IUI stimulation is basically done with Clomiphenecitrate or Gonadotrophines.

Q12. How long does it take for the treatment to take place?

Approx 6-8 Weeks for IVF and ICSI cycles. First, the normal menstruation cycle of the woman is down regulated by injection or nasal application of specific hormones each day. This medication may varies from few days to weeks. When the ovaries have become inactive, shown on ultrasound control and laboratory findings, the stimulation of the ovaries start by muscular or subcutaneous injections of hormones. The mean stimulation period is 12 days, depending on the reaction of the ovaries. Within two day after stopping stimulation Ovum pick up procedure is been carried our followed by actual IVF and ICSI procedure in laboratory. When fertilization occur embryos are transferred into the uterus with supporting drugs and then after 15 days routine blood test is carried out.

Q13. What is Egg Donation?

Women with no, or not properly working ovaries can, in some cases, get pregnant through egg donation. In this procedure another woman, mostly a relative or good friend, will be the egg donor. This woman will have an IVF stimulation and ovum pick up. After the ovum pick up the collected eggs will be fertilized with sperm of the partner of the recipient woman i.e. donor acceptor. The embryos are then transferred in uterus of the donor acceptor. If a pregnancy occurs, the donor acceptor and her partner will have a child which is only biologically, half their own.

In recent times, another concept called egg sharing, has also become very popular.

Q14. How do you preserve the different samples obtained? (cryopreservation)

Cryopreservation means preserving in a frozen situation. The best-known Cryopreservation is of semen. There can be many reason for cryopreserving semen samples like may be the patient is having cancer of testicles or for the sample which can be used for donor insemination or may be for backup sample for ICSI,IVF procedure.

It is also possible to freeze fertilized eggs after IVF or ICSI. If more embryos are left after an IVF or ICSI procedure they can be frozen and transferred another time. In this way there is a larger chance on a pregnancy while only one IVF or ICSI cycle is performed. For human oocytes Cryopreservation is much more difficult. Only in very few experiments this is done successfully. The attention of researchers now is on developing a way to freeze ovarian tissue and after thawing, to obtain the oocytes in it. This procedure is not yet fully refined but when it is, it can offer great opportunities in the future. We at the Bloom IVF Mumbai have started doing preliminary research work in this area.

Q15. What you mean by sperm preparation?

During Masturbation spermatozoa are ejaculated in the seminal fluid. During assisted reproduction the spermatozoa are extracted from the semen by a series of processes – centrifugation and washing, layering (to select the active sperm and leave the immotile or dead sperm behind) or selecting the best sperm by making them swim through a denser medium (NidaconPuresperm or Spermgrad) and using those that succeed.

Q16. What is Assisted Hatching?

Assisted hatching (AH) may help couples who have had many attempts at assisted reproductive procedures without success. It is a technique, which helps the embryo implant in the endometrium. Embryo implantation is one of the greatest barriers to success in In Vitro Fertilization (IVF) cycles. When embryos are replaced into the woman’s uterus, an outer coating called the ZonaPellucida covers them. Once the embryo is in the uterus, this “shell” must dissolve in order for the embryo to be able to “hatch”, a necessary step for implantation. In certain situations, this step is less likely to naturally occur: in women 38 years and older, women with elevated serum FSH levels, and women who have failed to achieve a pregnancy in a prior IVF cycle) and in patients with AH, a microscopic glass tube is used to make a small defect in the zona using a very small amount of acid solution to dissolve the outer coating of the embryo. Nowadays this hole is created with the use of a laser beam.

Bloom IVF Mumbai have already performed more than 300 cycles of Laser Hatching with very good results. Assisted hatching is done on the third day after egg retrieval, and embryos are immediately replaced into the uterus. It has been suggested that treating women with steroids (to suppress the mother’s immune system) and antibiotics (to counteract any infections in the uterus) may be beneficial when carrying out assisted hatching. These medications are only given for four days, starting on the first day the eggs are collected.

Q17. How and why Embryos or Egg is frozen?

Human Embryo and Eggs can be successfully frozen and stored. By freezing technology it is been estimated 15–20000 babies were born. As drugs and medication helps in super ovulation which further result in excess of embryos as all we can’t transfer so we store them by freezing technology, good quality of eggs and embryos are freeze and stored in liquid nitrogen. By freezing excess embryos couple can have chances to attempt for more IVF procedure without undergoingsame treatment.

And freezing of eggs can also be done in similar method and there can be many reasons for egg freezing like for executive women who do not wish to conceive in middle of their professional journey, such women can preserve their motherhood by this freezing technique and can get conceive on the later stage of her life.

The success rates following transfer of frozen thaw embryos is in the region of 10–15% – not as good as the fresh cycle success rates. In some countries freezing of embryos is restricted or banned (e.g. Germany and Switzerland will only allow freezing of the zygote – i.e. before the first cell division of the fertilized egg).

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