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IVF is a process by which egg cells are fertilized by sperm outside the womb or we can say that IVF is the basic assisted reproduction technique, in which fertilization occurs in vitro (literally, in glass). IVF process is used to overcome infertility. IVF is a treatment option for couples with various types of infertility. For IVF to be successful it may be easier to say that it requires healthy ova, sperm that can fertilise, and a uterus that can maintain a pregnancy. IVF Treatment cycles are typically started on the third day of menstruation and consist of a regimen of fertility medications to stimulate the development of multiple follicles of the ovaries. In most patients injectable gonadotropins are used under close monitoring. Such monitoring frequently checks the estradiol level and, by means of gynecologic ultrasonography, follicular growth. Typically approximately 10 days of injections will be necessary. Spontaneous ovulation during the cycle is typically prevented by the use of GnRH agonists or GnRH antagonists, which block the natural surge of luteinising hormone
Intra - Inside
Uterine - the uterus
Insemination - putting the sperm
The process of putting the best lot of specially prepared sperm directly inside the uterus at the expected time of ovulation - egg release is called "Intra Uterine Insemination".
In IUI sperm bypasses the cervical barrier and is put directly inside the uterus. By IUI sperm is put closer to the fallopian tube, at the time of expected egg release to increase the chance of fertilization resulting in to higher chance of conception.
Oligospermia ( Less sperm count )
Asthenospermia ( Less sperm motility )
Teratospermia ( More percentage of abnormal sperm )
Hypospermia ( Less volume of semen )
Viscous semen ( Sticky semen )
Anatomical defects of husband
Poor cervical mucus
Abnormal Post Coital Test - PCT
Immunological factors at cervix
Anatomical defects of wife
Unexplained infertilityAs a part of treatment for improving pregnancy chance in infertility treatment
The ovulation induction is done with the help of tablets or injections to increase the availability of number of eggs at a proper time. This increases chance of number of embryos formed resulting in to higher chance of conceiving.
The process of follicle development is monitored with Trans Vaginal Sonography - TVS and color Doppler.
When follicles are ready, hCG injection is given for final maturations of oocyte and its release (Rupture of follicle).
Prepared sperm sample (washed semen) is injected in to the uterus with the help of a thin, soft tube (canula). This process of injecting sperm in the uterus is called Intra Uterine Insemination - IUI.
IUI is a very simple, easy and painless procedure. It takes a few seconds to inject.
The lady is advised to rest for 10 minutes and then she can go back to her routine daily activity, including office work, traveling, domestic work etc.
The couple can have intercourse from the same day and any time in the same cycle as per their choice and desire, there no restriction.
Husband's semen is collected
He may give his semen 1 to 2 hours before scheduled insemination.
He may give semen earlier in the day at his convenience and the prepared sperm can be inseminated later.
Semen collection in hospital is preferable but if he is not comfortable with that, semen can be collected at home and then transported to the hospital.
Frozen semen can be used for insemination if
Semen contains a large amount of other unwanted material over and above sperm. Only sperm can be injected in to the uterus. We have to prepare the sperm in our laboratory in such a way that we remove every unwanted substances and separate the best motile and morphologically normal sperm out of the semen sample.
This technique allows good quality spermatozoa to swim up in the sperm preparation media.
This technique requires 30 to 45 minutes for sperm preparation.
It recovers best motile sperm
We loose many motile sperm in the process
This technique is most commonly used when the sperm count is good.
This technique is based on density gradient principle.
Maximum sperm recovered from the semen sample
A few non motile or dead sperm may escape during the process This technique is useful for the semen samples when sperm count is less
There are many other techniques of sperm preparation which can be used as per the situation.
IT IS IMPORTANT THAT YOUR TREATING INSTITUTE HAS FACILITY FOR ALL TYPES OF SPERM PREPARATION TECHNIQUES AVAILABLE WITH IT FOR OPTIMUM RESULTS.
BAVISHI FERTILITY INSTITUTE does hundreds of IUI every year with excellent and consistant success rate.
Anything which occurs outside the body is called in vitro and when fertilization of egg with sperm occurs outside the body it is called "IN VITRO FERTILIZATION". The first In Vitro fertilization was done in the test tube and that is why it is popularly known as Test tube Baby.
The process of fertilization which normally in fallopian tube of the woman and the fertilized egg than moves into the uterus of the woman. It an implants there in to the uterus and developed into the baby. When for some reason this process of fertilization cannot take place naturally or sperm and egg cannot be transported naturally to the tube or from the tube to the uterus or either is egg having some problem or the sperm.
Some problem in fertilization during test tube baby process we need to asses the fertilization to help fertilization we take out of the egg from the wife of egg from the woman's ovary and in control lab and environment we fertilized egg with the help of sperm of her male partner. After fertilization the fertilized egg are cultured into the control laboratory environment to form pre-embryos and this pre-embryos are then transferred back into the uterus of the woman. If they implant and grow become the pregnancy, and hence test tube baby is most convenient process.
This includes first consultation, blood tests culture if necessary, hysteroscopy, D21 visit i.e. mock transfer trial, semen freezing and serum progesterone.
We will complete a history and physical examination of both partners. Transvaginal sonography of female partner and semen examination of male partner and culture of it, if necessary. It is helpful to bring of your old medical reports, if available.
We will complete a history and physical examination of both partners. Transvaginal sonography of female partner and semen examination of male partner and culture of it, if necessary. It is helpful to bring of your old medical reports, if available.
This includes D3 FSH, LH, PRL, TSH, Major pre operative profile and other special blood investigations if necessary This will help us to choose best stimulation (Medication) protocol to complete your IVF cycles.
If you have previously had a hysteroscopy please bring their reports. This test must be scheduled to be completed on days 5-11 of the menstrual cycle. Menstruation must be absent for this test to be done.
Semen freezing: It is necessary to freeze a semen specimen before your IVF cycle starts. This sample is used only as an emergency back up for the day of retrieval. We prefer to inseminate the eggs with fresh semen if possible. We will discard the sample after completion of cycle except if you choose to have another IVF cycle.
Transvaginal sonography will tell us thickness of endometrium on D21.
Serum progesterone level estimation.
Mock transfer trial: Embryo transfer is very important procedure and it is usually done without anesthesia so, on day 21 we will do mock embryo transfer to anticipate any difficulty and solution far it before actual transfer. It is painless procedure.
It is necessary to stimulate the ovary to produce multiple follicle (the sac that contains the egg), in order to improve your chances of a successful outcome from an IVF cycle. After the consult with the doctor, you will receive prescription for a specific type of medication stimulation protocol. There are many different medication protocols that the doctor may prescribe for you. This decision is based on factors such as your age, infertility history, a past response to these medications, and a base line FSH level. The fertility medications that are necessary to stimulate the ovary are unfortunately all injectable medications. Doctor and nurse will explain you the dosage and method of administration.
If we have more than one egg we have better chance of pregnancy of in IVF cycle. To get more eggs we stimulate the ovaries with stimulation drugs called gonadotrophins. Gonadotrophins can be manufactured from urine or by recombinant DNA technology. Appropriate type of gonadotrophins and dose of administration are selected for individual patients. Available gonadotrophins include HMG, FSH and recombinant FSH manufactured by different pharmaceuticals.
Over stimulation of the ovary, It can occur to varying degrees: mild, moderate or severe.
The risk of conceiving a multiple pregnancy during and IVF cycle is dependent upon your age, response to the medications, the quality of the embryos, the number of embryos replaced into the uterus and other unforeseen factors are considered when judging your specific risk of multiple births.
Pain at the injection site, headaches and fatigue.
You may have read reports that fertility drugs increase the risk of ovarian cancer. To date there are no conclusive studies that identify an association between taking fertility drugs and ovarian cancer.
GnRH analog (Lupride)
This medication is administered by subcutaneous injection. It is given to prevent premature release of the oocytes (eggs). Side effects may include: localized skin reaction, allergic reaction, headaches, hot flashes and mood swings. If your scheduled menstruation is late while on Lupron, you should have a pregnancy test.
HCG (Human Chorionic Gonadotropin)
You will be given instruction for the exact time of this injection. It is generally taken 34-36 hours prior to the egg retrieval. This medication should be injected into the muscle. This medication completes the maturation of the egg.
You will begin talking this naturally occurring hormone on the next to egg retrieval. This medication, assist the embryo to attach to the uterus. The side effects that have been reported include: breast tenderness, headache, nausea, fluid retention, fatigue, mood swings, depression, pain at the site of injection (in the case of injectable progesterone). Vaginal itching and irritation (in the case of vaginal form). If you have a history of blood clots or thrombophlebitis you should alert the medical staff.
The egg collection process (retrieval) is usually accomplished using the Ultrasound-guided trans vaginal method. Other methods of retrieving oocyte that are rarely utilized in our practice but are sometimes necessary, include Laparoscopy or a Trans-Abdominal approach.
This ultrasound-guided trans vaginal method of egg retrieval allows this procedure to be done in an out patient setting. A vaginal ultrasound allows for visualization of both ovaries. A needle is inserted through the vaginal wall in the ovary. Each follicle is punctured individually and the fluid containing the egg is examined by the embryologist under the microscope until the egg is found. The duration of this procedure is usually less than 45 minutes.
This procedure is done under general anesthesia.
While the egg retrieval is underway, you will be notified by the andrology/embryology staff that a sperm sample is needed. The specimen will be processed in our laboratory and prepared for egg insemination. Please discuss with the embryology staff if any question or concern you may have prior to the day of egg retrieval. Frozen specimen collected will be used only in case of emergency (illness, inability to procedure a specimen etc.)
The eggs and sperm will be placed together in a special culture fluid and kept in incubators in our laboratory. This procedure is called insemination.
The eggs will be examined 16-20 hours after insemination for signs of fertilization. If fertilization occurs, the fertilized eggs are now described as pre-embryos or zygotes. When they divide to at least 2 cells they are called embryos. The laboratory environment is conducive for fertilization to occur, however, it cannot be guaranteed that fertilization will occur. Typically, 60% of the eggs retrieved will be fertilized. This percentage may be higher or lower depending on each couple.
Embry transfer (ET) usually occurs forty eight to seventy two hours post retrieval. The time of transfer will be designated by the IVF staff. The embryo(s) that is (are) assessed to be developing normally will be considered for transfer. Although a recommendation (3-5 embryos) will be made regarding the number to transfer, the final decision resides with the couple and the doctor. Transferring multiple embryos may result in the growth of more than one foetus. If you have extra embryos after the transfer, they will be cryopreserved if they have demonstrated appropriate development.
The method used for transferring embryos is similar to that of the mock transfer. ET is performed by inserting a small catheter through the cervical opening into the uterine cavity. The embryo transfer is usually a painless procedure. There is a recommended rest period after the transfer. You will be given specific instruction prior to the transfer regarding your medications, future testing dates and activity restrictions.
Within 13 days post-transfer, hormonal levels and a pregnancy test will be done. If a pregnancy has occurred, further blood testing blood work and ultrasound will be required to assess normal progression.
The purpose of embryo freezing programme is to give a couple participating in the IVF programme the best chance to achieve a pregnancy with a maximum of safety. At the end of an IVF cycle there are often multiple embryos available for transfer. It has been found that transferring more than four embryos caries a significant risk of multiple pregnancies, while it does not increase the singleton pregnancy rate proportionately. The advantage of cryopreservation is that there may be an increased chance of pregnancy without the necessity of multiple stimulation cycles and oocyte retrievals.
The frozen embryo transfer takes place in an identical manner to a fresh embryo transfer.
Embryo selected for cryopreservation will be frozen up to three days after the egg retrieval. The embryos will be placed in a cryopreserved media and frozen in a step-wise manner. At the end of the cryopreservation procedure the embryos will be stored frozen in tanks filled with liquid nitrogen. Brought back to normal life. There is no guarantee of the survival of human cryopreserved thawed embryos. If they have not survived (as seen at the time of thawing), they will not be transferred. We consider couples whose eggs and sperm become an embryo to be the owners and persons who control their embryos. However, there is a time limit on this ownership and control.
Intra – Inside
Cytoplasmic – Cytoplasm (fluid) in the cell.
Sperm – Male gamete – sperm
Injection – Injection (Artificial introduction)
Technique of injection of one sperm in to the cytoplasm of one oocyte for fertilization of one oocyte is called Intra Cytoplasmic Sperm Injection - ICSI.
ICSI offer better fertilization rate, and hence better pregnancy rate than conventional IVF.
“ ALL IVF CYCLES AT BAVISHI FERTILITY INSTITUTE ARE ICSI CYCLES”.
IVF is done in usual manner.
Oocyte retrieval (egg recovery) is done in usual manner.
The oocytes are prepared for fertilization.
Once the oocytes are ready for fertilization, one single sperm is selected which appears best form the available lot of sperm. Sperm selection is done with great skill depending on the shape, size, motility etc.The selected sperm is made nonmotile. The sperm is then picked up in a fine tube (pipette) and taken to oocyte (egg) to be fertilized.
The sperm is then injected in the cytoplasm of the egg with micromanipulation technique with precision in microns.
Once the injection is complete rest of the IVF procedures and patient treatment is the same.
First ICSI baby of the world was born in 1992.
First ICSI baby by ICSI at Bavishi fertility Institute was born in 1999.
Hundreds of healthy babies are born with ICSI at Bavishi Fertility Institute till now.
ICSI requires special preparation of oocytes and sperm.
ICSI is a very fine technique, which requires very sophisticated equipment, highest quality disposable tools, special oocyte and sperm processing fluids culture media etc.
ICSI requires knowledge, skill, patience, precision, expertise and experience of the embryology team.
BAVISHI FERTILITY INSTITUTE OFFERS YOU ALL OF ABOVE “The very best”.
WITH ICSI ONLY ONE SPERM CAN PRODUCE ONE CHILD
Egg donation is the process by which a woman provides one or several eggs (ova, oocytes) for the purpose of assisted reproduction or biomedical research. For assisted reproduction purposes, egg donation involves the process of in vitro fertilization as the eggs are fertilized in the laboratory. After the eggs have been obtained, the role of the egg donor is complete. Egg donation is part of the process of third party reproduction as part of ART.
For the egg donor, the process of egg donation is as follows-
Before the process starts, first, it will be necessary for the egg donor to undergo a thorough medical examination. This includes a pelvic exam, blood draw to check hormone levels and to test for infectious diseases, and an ultrasound to examine her ovaries, uterus and other pelvic organs. In addition, she will be referred to a psychologist who will evaluate if the donor is mentally prepared to undertake and complete the process. These evaluations are necessary to ensure that the egg donor is fully prepared and capable of completing the egg donation cycle, safely and successfully. These evaluations will be done at no cost to the donor.
Once the screening is completed, the donor will begin the egg donation cycle, which typically takes between 3-6 weeks. There are two parts to a successful egg retrieval procedure: the Egg Donor's Cycle and the Recipients' Cycle. The Egg Donation Cycle will begin with a few weeks of birth control pills, followed by a series of injections. There are different medical protocols currently used, but all of them include medication that makes the ovaries produce a number of eggs. At the doctor's office, the donor will be given instructions on how to properly administer the injections herself. These injections must be administered on a daily basis for one or more weeks.
Embryo donation the best treatment option for the couples where the female partner is having problem of eggs, either they are absent or not of good quality to produce good embryos and pregnancy and the male partner is also having a severe problem or uncorrectable problem with this his sperm. In such cases neither the man nor the woman can produce the child from their own eggs or sperm. This couple can accept embryo donation.
The eggs are retrieved from voluntary egg donor and sperm are collected from the sperm bank. The donated eggs are fertilized with donated sperm and the resulting embryos are used for embryo donation. The couple can accept those embryos and can have pregnancy with the help of these embryos.
The genetic material comes from outside source but the lady becomes biological mother of the child.
She herself bears the pregnancy and delivers the child; hence socially it is more acceptable. The lady also gets the satisfaction of bearing the pregnancy and nourishing it with her own blood.
The source of embryo remains a secret within the couple. Socially the child is of the couple only. The couple does not have to undergo legalities of adoption and future problems associated with adoption.
In the very first year of its IVF services, Bavishi Fertility Institute offered IVF surrogacy treatment to a German couple. It was the first European couple to go to Asia for surrogacy treatment. Since than we have couples treated with IVF surrogacy from many countries including USA, UK, Finland etc.
Bavishi Fertility Institute has achieved highest number of pregnancies with IVF surrogacy in Gujarat state of India and one the highest in India. This has become true thanks to our high IVF success rate, stringent surrogate mother selection and dedicated painstaking efforts of whole of our team.
The couple undergoes IVF + ICSI treatment in the usual way. When embryos are ready, the best embryos are selected for transfer. The embryos are transferred into the uterus of a host – surrogate mother, rather than that of the female partner of the couple. Hundred percent genetic material will be from the couple i.e. the child will have 100 % genetic inheritance from the couple. The surrogate will act as host mother till the time of birth of the child. She then hands over the child to the couple.
She is put on oral contraceptive pills to prevent spontaneous pregnancy.
The mother is down regulated
When embryos of the couple are ready, they are transferred in the uterus of the surrogate mother.
The mother is given medicines, which help implantation of embryos and their development. The medicines support pregnancy also if she conceives in that attempt. Blood of surrogate is checked for presence of pregnancy on day 13 and 15 after embryo transfer.
If pregnancy test is positive, pregnancy support drugs are continued. Mother is regularly observed and treated for pregnancy care.
If pregnancy is negative, the drugs are stopped. The surrogate gets her period.
Same attempt is repeated. If the couple had their embryos frozen, the frozen embryos can be used. If there are no frozen embryos, the couple has to undergo a fresh IVF cycle.
The couple gets a child with 100% their own genetic inheritance.
It can a blessing for a couple where female partner can not bear pregnancy herself due to problems with their:
No risk of child bearing and childbirth on female partner.
The procedure is legal and the couple becomes legal partners of the child born.The names of genetic parents are mentioned as the names of mother and father of the child.
It is difficult to find surrogate mother with good background, health, understanding, cooperation and persistence.
Any pregnancy can have complications If surrogate mother develops any complications , the responsibility of treatment and expenses involved in it, lies with the couple.
It is relatively an expensive treatment.
Bavishi Fertility Institute has very strict selection criteria for selecting the ‘to be surrogate’. The couples are given relevant information on surrogate mother. If the couple is satisfied a face-to-face meeting is arranged between surrogate and the couple. Once both parties are satisfied then only the treatment is initiated. The couple is encouraged to keep in touch with the surrogate. If couple can not manage to keep in touch and supervise surrogate mother’s treatment, Bavishi Fertility Institute tries to arrange a coordinator who can coordinate with the couple and the mother.
All financial dealings are done directly between the couple and the surrogate. It ensures complete transparency. Legal paper work is also done directly between the couple and the surrogate, it ensure complete safety of the couple.
Surrogate mother treatment is technically a very simple and successful treatment but it requires a lot of complex management and time.
We consider it a privilege to offer you the option of surrogate mother treatment so that BAVISHI FERTILITY INSTITUTE can offer complete fertility solution under one roof.
With advanced technology biological tissue can be successfully frozen and preserved at –196 degree centigrade for very long time. They can be brought back to life (thawed), whenever needed.
The process of freezing and thawing requires special skill and technology. Successful freezing and storage of semen has created new hopes for many male patients. It makes treatment more convenient. Semen freezing can be done for donor semen or husband semen.
Husband’s semen can be frozen and kept for long time.
This is useful when
Donor semen can be used when a man has untreatable azoospermia. It can also be used for sever ologospermia when patient can not afford Assisted Reproductive Techniques i.e. ICSI.
We have a semen bank. We have proved fertile voluntary semen donors. Patients can choose the donors of their choice. We provide data of physical characteristics, educational qualification, blood group etc.
Semen is the richest source of sexually transmitted disease i.e. HIV etc. To avoid transmission of these diseases the semen samples are quarantined. Semen donors are screened for HIV, HbsAg, HCV, VDRL etc. After checking for these we collect, freeze and store semen samples from the donor. We screen the donor again after six months for the same. If the donor is found negative for all the tests then the sample is considered good for donation., These process of quarantine eliminates the risk of transmitting the disease which may be in incubation period at the time of screening.
All patients may not afford IVF. To help them we have workout a few options which can reduce the cost substantially without much compromising the result.
Gonadotrophin injections used for stimulation comprise the major part of IVF drugs cost. Very good quality gonadotrophins are manufactured in India now. They are almost 65% less expensive than the latest recombinant FSH. They produce good results at very less cost.
If you decide to donate a few of your eggs at the time of your IVF cycle. Partial expense of your treatment will be born by the recipient. In spite of getting enough egg for yourself you can save considerably on cost. This option is useful for young, good responding patients.
We offer concessional treatment once in a year to the patients taking IVF treatment in that batch. If you want to take the advantage, book your name at the earliest! We will let you know the further details.
Very well established and proven successful IVF treatment has proved to be a blessing for innumerable childless couples. But many childless couples who can be benefited for IVF treatment cannot take benefit as it is an expensive treatment.
Bavishi Fertility Institute has decided to help these innumerable childless couples who cannot afford the regular cost of IVF but can avail specially offered extremely reasonably priced IVF treatment cost package.
There is no evidence to suggest that either normal laparoscopy or ultrasound egg retrieval damages the ovaries. In fact, some reports in the medical literature suggest that following ovarian biopsy, pregnancies occur in couples with a long-term history of infertility.
Not ordinarily. The surgeon must be able to see the follicles in order to guide the needle to the proper spot for retrieval of the eggs whether by sonographic (ultrasound) or surgical methods.
Once ovulation has occurred it is impossible to retrieve the eggs. The entire team of physician, nurse and embryologist will monitor your cycle very carefully to avoid premature ovulation.
This depends on the individual. The primary reason for delay is to allow the patient's normal menstrual cycle to resume, which may take 2 to 3 cycles.
There is no specific number. This is determined by the couple together with the physician.
Most definitely. We recommend that the husband refrain from ejaculation for at least 48 hours, but for no more than 5 to 6 days preceding egg retrieval. This precaution assures that the semen sample obtained for IVF will contain a maximum number of healthy, motile sperm.
Although a definite time of abstinence to avoid damage to the pre-embryo has not been determined, most experts recommend abstinence for two to three weeks. Theoretically, the uterine contractions associated with orgasm could interfere with the early stages of implantation. However, intercourse the night before pre-embryo transfer is acceptable.
The IVF team recommends that the patient be sedentary for a full 24 hours following pre-embryo placement in the uterus. Strenuous exercises such as jogging, horseback riding, swimming, etc. should be avoided until pregnancy is confirmed. Otherwise, the patient is free to return to her regular activities.
Pregnancy can be confirmed using blood tests about 14 days after egg aspiration. Pregnancy can be confirmed by ultrasound 30 to 40 days after aspiration.
Perhaps, in certain situations, IVF may be cheaper and physically less demanding than surgery to repair you fallopian tubes.
Four to five medications normally are given
No pronounced side effects have been associated with any of these drugs. However, the patient should inform the physician of ANY allergies she has or of any previous adverse reactions to drugs.
It varies from patient to patient . As many as half of the follicles may not contain an egg in some patients.
Yes, when multiple pre-embryos are transferred. 25%. of pregnancies with IVF are twins. (In normal population, the rate is one set of twins per 80 births.) Triplets are seen in approximately 2-3% of pregnancies.
There are no known ill effects. Abnormal pre-embryos, even those produced through normal fertilization, do not seem to mature. However, any long-term effects of IVF remain to be determined.
Approximately three weeks (all as an outpatient). Fertility drugs are administered to stimulate the ovaries. Then during the four to six days prior to ovulation, the patient is monitored by ultrasound as well as by hormone levels.
A maximum of four pre-embryos will be transferred to the uterus for possible implantation. Patients will have several other options regarding the disposition of the remaining pre-embryos. One option is to freeze pre-embryos for your later use. Other options are to donate or simply dispose of them. Excess pre-embryos, if any, belong to you, and you will determine what is to be done.