Motherhood Chaitanya Fertility Centre is motivated to provide infertility treatment at very affordable costs without compromising quality.
We are equipped with world class technology and state of the art infrastructure which caters for infertility treatments like IUI,IVF, ICSI, Cryopreservation, Donor Gametes, Blastocyst Culture and Transfer, Laparoscopy and Hysteroscopy.
We provide transparent and ethical treatment under the guidance of our trained and experienced fertility experts, alongwith psychological support to every couple through their journey to achieve parenthood.
Infertility in women
Conditions affecting a woman’s fertility can include:
- damage to the fallopian tubes
- ovulatory problems
- conditions affecting the uterus
- a combination of factors
- no identifiable reason.
- age – female fertility declines sharply after the age of 35
- Polycystic Ovary Syndrome (PCOS)
- gynaecological problems such as previous ectopic pregnancy or having had more than one miscarriage
- medical conditions such as diabetes, epilepsy, and thyroid and bowel diseases
- lifestyle factors such as stress, being overweight or underweight, and smoking.
Infertility in men
Conditions that may result in infertility include:
- low sperm count or quality
- problems with the tubes carrying sperm
- problems getting an erection
- problems ejaculating.
- having had inflamed testes (orchitis)
- a past bacterial infection that caused scarring and blocked tubes within the epididymis as it joins the vas
- having received medical treatment such as drug treatment, radiotherapy or surgery – for example to correct a hernia, undescended testes or twisted testicles
- genetic problems
- lifestyle factors such as being overweight or having a job that involves contact with chemicals or radiation.
Male fertility is also thought to decline with age, although to what extent is unclear.
The initial workup for an infertile couple is done to select the right kind of fertility treatment for such couples based on the reports. The infertile couples must undergo a set of advance tests before the commencement of any treatment. These tests are comprehensive & detailed and are essential to determine the causes of infertility, whether the couples are diagnosed with any other ailment and which technique would be most suitable for a particular couple.
Female partner must undergo trans-vaginal ultrasound to evaluate ovarian reserve & uterus condition, blood tests and laparoscopy or hysteroscopy in cases where there is indication of such operation requirement after the initial workup.
Male partners need to undergo a semen analysis to determine the quality, quantity, mobility and motility of the sperm along with few blood tests.
In this procedure, husband semen/donor semen is washed to remove the debris, pus cells & bacteria & is placed inside the uterine cavity by a special catheter (Insemination cannula). The process is painless, easy & an OPD procedure. It requires no sedation or anaesthesia. It increases the chances of pregnancy as the semen quality is improved by washing, the quality of egg is improved by medicine & the timing of insemination is set with the ovulation.
The ovaries are gently stimulated with clomiphene citrate tablets either alone or with low dose hormone injections followed by ultrasound monitoring until the follicles are mature when HCG trigger is given. The aim is to stimulate the release of one or two eggs only. Once day of ovulation can be predicted, insemination will be timed to within 24 hrs.
The success rate with this procedure is in the range of 10 – 15 % and 3 – 6 cycles are generally advocated before proceeding to higher ART forms.
IVF literally means ‘fertilization in glass,’ more simply explained as ‘test tube baby’. In the IVF process, eggs are removed from the ovaries of the female and at the same time sperms are collected from the male partner. The eggs and sperms are made to fertilize in the laboratory and the fertilized egg (embryo) is then implanted in the woman’s womb to make her conceive.
IVF technique is now mainly used in the following cases:
– Females with both fallopian tubes blocked
– Females with one fallopian tube blocked and one open
– Borderline male sperm count
– Unexplained infertility cases
– Coupled who have failed the traditional treatments like timed intercourse, follicular monitoring, IUI etc.
Gone are those days when age was a constraint to experience motherhood and attaining menopause came along with sorrow of inability to reproduce. IVF (In Vitro Fertilisation) has proved to be a boon to all those couples who’ve only dreamt of becoming parents but could never see their dream coming true due to insurmountable reasons.
This technique has been the greatest boon to male factor infertility which does not respond to conventional management, ie. men with low sperm count and motility. As with IVF, the oocytes are aspirated. On a special microscope with a micromanipulator, a single sperm is picked up in a fine microneedle and injected manually into the oocyte. Embryos are transferred after 48 to 72 hours. For azoospermic men with an obstructive pathology (eg: Congenital absence of vas deferens) sperm can be aspirated directly from the epididymis (PESA) and used for ICSI. In addition, for azoospermic men with a non-obstructive pathology, sperm can be retrieved directly from the testis (TESA) and used for ICSI.
This is a technique in which sperms, eggs and embryos are frozen at a sub-zero temperature to preserve them for future when the need arises. There are 3 types of Cryopreservation in IVF spectrum:
1) Semen Cryopreservation
2) Eggs Cryopreservation
3) Embryos Cryopreservation
Semen Cryopreservation: Semen are frozen to preserve because of the following reasons: a) To develop sperm bank b) To donate stored semen c) To use it during the treatment if the male partner is unable to ejaculate on the stipulated day d) Before undergoing vasectomy e) Prior to cancer treatment which might adversely affect fertility f) Retrieved semen from epididymis (PESA) or testes (TESA).
Egg (Oocyte) Cryopreservation:This is for women who are about to undergo medical treatment for ailments such as cancer which may affect her ability to produce eggs in the future. This technique is also useful for women who are career-oriented and do not want early motherhood. Eggs are frozen within few hours of collection through the standard freezing process. Later, when women are ready to be pregnant, the frozen eggs are thawed, fertilised with the husband’s sperms and resultant embryo is implanted in the uterus.
Embryos Cryopreservation: During treatments like IVF, ICSI the best embryos are selected and transferred during the first cycle.If any good quality embryos are left, they are frozen for future use.
Sperm Donation: When the male partner has azoospermia or his sperm are of low-quality, donor sperms are used which would fuse with eggs of the female partner to form an embryo. That embryo would be implanted in the womb of the female partner.
Egg Donation: When female partner is unable to produce eggs due to various reasons like menopause, premature ovarian failure or age factor, the infertile couple seeks a woman who would donate eggs. The eggs are fertilised and implanted in the womb of the female partner. The ICMR guidelines for IVF clinics in India permits egg donation and the use of egg donors for this purpose. Our clinic maintains the highest standards for selection of egg donors, screening for disease, repeat checks for sexually transmitted diseases such as HIV, Hepatitis B, C and syphilis and other checks as requested by couples
Embryo Donation: When both the male partner and the female partners are infertile, they opt for embryo donation. In this, the embryo is developed by fusing the sperm and eggs of donors and the embryo is implanted in the uterus of female partner. The couple who are donating the sperm and the eggs undergo a series of tests to rule out any medical ailment and ensure good quality of sperm & eggs.
A variety of procedures can be used to diagnose the cause of infertility in a couple,these range from simple blood tests to more complicated analytical methods. In any case, diagnosis is a crucial first step to determine the appropriate therapeutic path that should be followed. In addition to the cause itself, other factors, such as the age of the woman, or problems shared by both partners, might also influence the choice of treatment.
Several options are offered to couples depending on the type of infertility that has been diagnosed. The vast majority of female patients are successfully treated with the administration of drugs such as Clomiphene Citrate, Bromocriptine or Gonadotrophins. Surgery can also be a means to repair damage to the reproductive organs, such as those caused by endometriosis and infectious diseases. Treatment options for male infertility also include the administration of drugs, surgery and assisted reproductive technologies, such as Intracytoplasmic Sperm Injection (ICSI). Drug therapy and surgery have proved very successful for specific types of male infertility. However, in a large number 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.
Assisted reproductive technologies (ART) refer to several different methods designed to overcome barriers to natural fertilization such as anatomical problems (e.g. blocked fallopian tubes). One of these techniques, in-vitro fertilization (IVF), has now been practiced for more than 15 years.
When talking of success rates for any type of infertility treatment, 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. Comparable to normal fertility rates, effective treatments can be expected to have, on average, up to a 25% success rate per cycle of treatment, and may therefore need to be repeated several times before a pregnancy is achieved.
In any type of infertility treatment, important factors need to be taken into account when referring to success rates. The age of the woman and the duration of the couple’s infertility are likely to influence the success of treatment. In women, fecundity decreases as age increases, particularly after 40 years of age. When the woman is being treated, her chances of conceiving can be lessened if her partner also has infertility problems (e.g. poor quality sperm).
Along with their intended benefits, drugs used to treat infertility may on occasion cause side effects. In ovulation induction, close monitoring of follicular growth is crucial to ensuring successful treatment.
Monitoring techniques (such as ultrasound scan and blood tests) and appropriate use of treatment protocols help to avoid ovarian hyperstimulation syndrome (OHSS) and minimize the risk of multiple pregnancy.
Ovarian Hyperstimulation Syndrome (OHSS) can occur during infertility treatment with ovulation inducing drugs. Symptoms of this syndrome may include ovarian enlargement, accumulation of fluid in the abdomen and gastrointestinal disorders (nausea, vomiting, diarrhea). Severe cases of OHSS are however very rare (1-2% of cases). One may have to admit the patient in an Intensive Care unit. Rarely, she may need to undergo abdominal tap procedure, to remove fluid from her abdomen. Very rarely, she may need more intensive therapies such as dialysis, or respirator. In order to prevent or reduce the severity of OHSS, intravenous albumin may be given at the time of egg pickup during IVF/ICSI procedure.
Multiple births occur more frequently after infertility treatment than in the normal population. About 80% of pregnancies achieved following simple ovulation induction result in single births, the remaining 20% being multiple pregnancies, mostly twin pregnancies. New treatment regimens carefully adapted to the patient’s response help to decrease the risk of a multiple pregnancy.
After IVF, one pregnancy out of four is multiple. In fertility centers, physicians now frequently choose to replace a maximum of three embryos after fertilization, to further reduce the chance of multiple births. Alternatively, many units are going in for blastocyst culture, especially if there are 3 or more 8 cell embryos available for transfer on day 3.
In case of triplets or more, one can offer the procedure of Fetal Reduction, to the patient. In this, with the help of sonography, a thin needle is passed into the fetus , and drugs are injected to stop the fetal heart. Care is taken to see that at least two intact fetuses are left behind. This is a relatively simple technique, with minimal side effects. However some patients may avoid this technique for religious or personal reasons.
Common local side effects experienced by patients who receive gonadotrophins by intramuscular injection include skin redness, swelling and bruising. Pain and discomfort sometimes reported after intramuscular injections are now likely to be lessened with the availability of a highly purified follicle stimulating hormone preparation which can be administered subcutaneously. Nowadays drugs produced by recombinant DNA (or genetic engineering techniques) are available for administration by subcutaneous injection.
Ovarian cancer is a rare disease; the chance of a young woman developing an ovarian malignancy during her lifetime is lower than 1.5%. A number of factors have been found to increase the risk of ovarian cancer, including genetic predisposition and dietary habits. Scientific studies carried out in the last few decades have demonstrated that infertility itself is a risk factor for ovarian cancer.
There is evidence that each pregnancy reduces the risk of a woman contracting ovarian cancer (this risk could be reduced by more than 25% by a first pregnancy). No epidemiological study has ever established a causal link between ovulation promoting drugs and ovarian cancer. An extensive study on this issue, reporting on more than 2,600 women treated between 1964 and 1974 and followed for an average of twelve years, found no association between ovulation inducing drugs and ovarian cancer.
Regarding children born following treatment with ovulation promoting drugs, the incidence of birth defects is the same as that in the normal population. The same goes for babies conceived after IVF. The incidence of malformations is around 2%, which is comparable to that of babies born naturally, without anytreatment.
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. From a 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.
To increase the chance on getting pregnant spontaneously, timed sexual intercourse is recommended. This means that sexual intercourse, or coitus, has to take place around the time of ovulation, which is the most fertile period of a woman.
One can use a serial ultrasound monitoring to follow the development of the follicle and subsequent rupture which indicates ovulation. The time of ovulation can sometimes vary a few days each month, even in a regular menstrual cycle. Also, if the circumstances are right, sperm can live inside the women for a few days and sperm quality can decrease with high sexual activity. Therefore, it is best to have intercourse 3-4 days before the expected ovulation and every other day until 2-3 days after the expected ovulation with no necessity for higher frequency.
Assisted Reproductive Therapy (ART) has caused an increase in multiple pregnancies. Especially in Ovulation Induction and Intra Uterine Insemination, this situation is encountered frequently. In order to prevent the risk of severe premature birth and handicaps as well as risks for the mother, embryo reduction is sometimes performed: The number of embryos in the uterus are reduced and the remaining pregnancy has more chance of normal development and delivery. Of course this is not an easy decision for both patient and doctor. With careful guidance of the patient during treatment and good counseling when the patient is at risk for a large multiple pregnancy, many triplets or higher pregnancies are already avoided.
One complete IVF or ICSI cycle takes approximately six to eight weeks. First, the normal menstruation cycle of the woman is down regulated by injection or nasal application of specific hormones each day. This part of the cycle can vary from a few days to several weeks. When the ovaries have become inactive, as shown on ultrasound control and laboratory findings, the stimulation of the ovaries start by intramuscular or subcutaneous injections of hormones. The mean stimulation period is 12 days, depending on the reaction of the ovaries. The ovum pick up takes place within two days after stopping the stimulation. Now the IVF or ICSI follows in the laboratory. When fertilization occurs, embryos are transferred into the uterus after two to four days and drugs supporting the uterus are given. After approximately 15 days a pregnancy test will show whether the IVF treatment has been successful or not.