Assisted hatching

Embryos are protected throughout their journey in genital tract – Fallopian tubes and uterus by an outer covering called zonapelucida. When the embryo has to implant in to (attach with) the uterine wall – endometrium, it has to break this outer covering and come out of the shell. This process is called hatching. It is quite similar to a chicken coming out of an egg by breaking the shell!

Hatching of embryo at a proper time is very crucial to successful implantation of the embryo. We can assist this process to ensure timely and successful hatching with a technique called “Assisted Hatching”

Procedure

Embryos are selected for AH. Usually 50% of available embryos are treated with AH.
AH is done on the day of embryo transfer. A very small hole is done in zona pelucida (outer covering of the embryos) with micromanipulation technique. The procedure is done on the embryos to be transferred. Nothing is done on the lady her self – Lady does not have to suffer any thing herself.
The embryos are then transferred in to the uterus as in the usual embryo transfer procedure in IVF.

Methods for Assisted hatching

  • Mechanical
  • Chemical
  • Laser

Advantages

FIt provides “mechanical advantage” to the embryos in breaking the zona for implantation.
It also ensures early contact of embryos with endometrium. This expedites enzymetic reaction between endometrium and embryos called “Embryo – endometrium cross talk”.
Mechanical advantages and chemical advantage ensure better implantation rate and better pregnancy rate.

Assisted Hatching is useful in

Any patient undergoing IVF treatment can benefit from advantages of AH and improve her chance of conceiving in that cycle.
AH is specifically more helpful when zonapelucida is expected to be tough - thick

  • Advanced age of female partner
  • Expected zona thickening due to invitro culture
  • Hyaluronidase exposed oocytes
  • Frozen thawed embryos
  • Thick zona pelucida
  • When previous IVF cycle has failed
  • AH is required before taking biopsy of a blastomere from the embryos, for Preimplantation Genetic Diagnosis – PGD

Bavishi fertility Institute offers AH to its patients with exclusive expertise and experience. We welcome our patients to avail this new technology and enjoy their improved success rates at a very little extra cost !!

Blastocyst culture

When embryo becomes 5 to 6 days old it reaches a stage of development which is called “ BLASTOCYSTI ”. In natural conception, sperm and egg meet each other and fertilization takes place in fallopian tubes. The embryo grows in fallopian tube for 4 to 5 days and slowly moves towards the uterus. An embryo reaches uterus – endometrium after 5 to 6 days of fertilization at blastocyst stage.

In conventional IVF + ICSI treatment the embryos are transferred back in to the uterus after 2 to 3 days of fertilization. Embryos at this stage have 8 to 4 cells ( blastomeres ). At this stage the embryo is called, 4 cell embryo, 6 cell embryo etcdepending on the number of blastomeres it has. These embryos also implant successfully and give good pregnancy rate.

We know that all embryos which look good at 4 to 8 cell stage are not really good in terms of developing further. If we culture them for more days, a few of them may develop further and reach blastocyst stage successfully but a few of them stop developing at various stages in between. It is impossible to know which embryos will reach the blastocyst stage.

We know that only a few and not all of the transferred embryos can develop further and result in to pregnancies.

To compensate for this “stopped development” of a few embryos, we transfer more embryos at 4 to 8 cell stage to achieve better pregnancy rate.

When we transfer more embryos chance of pregnancy increases but at the same time there is a significant increase in chance of having multiple pregnancies including higher order multiple pregnancies i.e. triplets (3 foetuses) quadruplets (four foetuses), quintuplets (five fetuses).

If we can select the embryos, which can give best chances of pregnancy, we can transfer less number of embryos and still get better pregnancy chance. We can reduce the chance of twins pregnancy significantly and eliminate the risk of higher order multiple pregnancy completely.

If we culture (develop) the embryos outside up to day 5, only good embryos will develop till “BLASTOCYST” stage. We can select and transfer one or two blastocysts and still achieve a very good pregnancy rate.

Procedure

  • There is no change in routine IVF treatment of the couple.
  • If more embryos are formed, the couple can opt for blastocyst culture - transfer.
  • The embryos are cultured for 5 days in special medium and highly specialized conditions, which take care of all the needs of rapidly developing embryos.
  • Daily watch is kept on embryo development.
  • On day 5 blastocysts are graded – Evaluated
  • Selected blastocysts are transferred.

If we have additional blastocysts, they can be frozen for future use.

Advantages of blastocyst culture

  • Blastocyst culture gives significantly higher pregnancy rate compared to conventional IVF
  • Risk of multiple pregnancy is significantly lower
  • No risk of “higher order multiple pregnancies.”
  • Good blastocyst development reassures best embryo development technique and conditions in IVF lab.
  • If embryos develop as blastcysts, it reassures good embryo quality.

Disadvantages

  • Blastocyst culture can be done only if adequate number of embryos are available.
  • Some embryos, which can give pregnancy but do not develop till blastocyst in outside the body culture may be lost. We have to carefully watch embryo development daily to avoid this loss.
  • Additional time and cost.
  • Highly skilled team and excellent culture media and equipments.

At “BAVISHI FERTILITY INSTITUTE” ‘ Blastocyst culture’ option is offered to eligible couples since long, with improved chance of conceiving.

PGD

Pre - Before
Implantation - Process of embryo sticking to inner layer of uterus - endometrium
Genetic - Study of genetic constitution of embryo
Diagnosis - Diagnosis

Pre-implantation genetic diagnosis - PGD is a latest technique, which has revolutionized the possibility of diagnosing genetic disorders of the child to be born BEFORE even the pregnancy actually begins. PGD is a blessing for the patients who are likely to have a child affected by a known genetic disorder or when possibility of a child being born with genetic abnormality is high.

Medical sciences has discovered that many diseases are caused by faulty genes. Defect in genes in the parents can be transmitted to their children and the child may be born with the disease. Some gene defects may not be present in the parents but develop during the process of fertilization.

If we do biopsy of an embryo and take out one or two cells ( blastomeres ) from the embryo and study the genetic constitution of the embryo we can diagnose, whether the embryo is having normal genes or has gene defect and how much is the possibility of the child being affected by the disease.

Procedure

IVF + ICSI is done in the usual manner. Three days after ovum pickup and fertilization, embryo biopsy is planned. Assisted hatching is done on the embryo to be biopsied. ( To understand Assisted hatching please see Assisted hatching section for more details). A blunt embryo biopsy pipette is taken to the embryo. A gentle suction is applied on one, blastomere to take it out from the embryo. One or two blasomeres are removed from each embryo to be examined. Aspirated blastomeres are fixed by specialized technique.

Genetic Study

The biopsied blastomeres are processed by two different techniques.

Fluroscent In Situ Hybridization - FISH

This is very fast technique and gives result within 24 hours.

  • Advantages of FISH :
    It gives fast results.
    Very useful for numerical anomaly diagnosis.
  • Disadvantages of FISH :
    It does not detect structural anomalies of genes.

Polymerase chain reaction - PCR

It multiplies the genes many times and then does the study for abnormality.

  • Advantages of PCR :
    Gives more accurate diagnosis as number of genes available for study are more.
    Better for detection of minor defects.
  • Disadvantages of PCR :
    Takes more time 2 to 3 days
    Additional cost
  • Who can benefit from PGD ?
    Couples with known diseases which can be transmitted to the children born.
    Couples where family has a history of birth of a child affected by a disease which can be transmitted in other children also.
    Couples in which the chances of genetic defects are more in children born.
    Advanced age of partners.
    History of multiple unexplained abortions.
    Multiple IVF cycle failure.

Very few centers across the glob and India have PGD facility.
Bavishi Fertility Institute is the first and the only ART clinic in 'Gujarat state and Western India ' (Except Mumbai) to have PGD facility.
Because of the in-house facility for PGD, it is surprisingly affordable too !!