Care approached by Square fertility centre for infertile couples Dr Rehnuma Jahan

1. INFERTILITY
Care approached
by Square fertility
centre for infertile
couples
Dr Rehnuma Jahan

2. What is infertility?
 Any woman not being able to get pregnant after at
least one year of trying without contraception.
 Infertility is not always women’s problem.
 It may be either in male or in female.

3. Natural conception rates:
 80% -90% of couples conceived within 1 year of
their marriage
cycles.
 10-15% of all couples are infertile
 about 15% couples need some help to achieve
pregnancy.

4. PRIMARY/SECONDARY INFERTILITY
 PRIMARY – Couple without a prior
pregnancy
 SECONDARY – Couple with previous
pregnancy including miscarriage/ectopic.

5. Etiological factor
– Pregnancy is a result of complex chain of events
which includes ovulation that release of mature
egg from the ovary.
– Its transport through fallopian tubes
– Availability of healthy sperm that fertilizes the egg
– The fertilize egg must attaches itself to uterus
– So infertility can result from problems that
interfere with any of these steps

6. Etiology:
 Male factors
 Female factors
 Unexplained -20%
 Mixed – 15%

7. Male
Account for 25-30%
 Azoospermia- absence of
sperm
 Oligospermia- less sperm
 Erectile dysfunction
 Anatomical
- Hypospadias
- Undescended/
maldescended testis

8. Treatment for male infertility
 At least one-half of male problems can be
treated.
 Treatment in collaboration with urologist &
endocrinologist.
 Treatment options are-
-Drug therapy
-Surgery
-IUI
-ART

9. Female
 Peritoneal factors
40%,
- Endometriosis
 Tubal blockage 20%.

10. Etiology (female)
 Ovulatory dysfunction 15-20%
- Hypothalamic/hypogonadotrophic
hypogonadism
- Hypothalamic pituitary dysfunction
(PCOS)
- Ovarian failure
 Uterine cavity abnormalities
- Asherman's syndrome
- Uterine fibroids.
 Cervical hostility 5-10%,
- Infection
- Female sperm antibodies.

11. Treatment for female
 Treatment of anovulation & other hormonal
problems
 Surgery
 IUI
 ART

12. At Square Hospital we offer
From simple fertility investigations to highly
sophisticated treatment options.

13. At Square Hospital we offer
 Ovulation induction
 Intra uterine insemination (IUI)
 In vitro fertilization (IVF)
 Intracytoplasmic sperm injection (ICSI)
 Treatment of male infertility
 Semen analysis: basic & complex
 Surgical sperm retrieval
 Embryo freezing & transfer of frozen embryo
 Laparoscopic surgery

14. Ovulation induction
 A delicate balance of oestrogen, progesterone, FSH
& LH is needed for timely growth & release of egg
from the ovary
 Even slight irregularities of these hormones can
cause anovulation
 Drugs used for induction
- Clomiphene Citrate
-Gonadotrophins
- Dopamin agonist

15. IUI
 In this procedure semen is centrifuged & washed to
get healthy & motile sperms & injected with the help
of small catheter directly into the uterine cavity on
the day of ovulation
 Success rate 15-20%

16. IUI At Square hospital
YEAR JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC TOTAL
2007 2 6 8 7 18 13 8 12 10 4 11 7 106
2008 7 13 13 7 16 20 9 12 10 12 18 16 153
2009 30 18 13 24 21 22 22 34 5 29 63 0 281
2010 32 34 29 22 22 27 35 18 30 36 18 27 330
2011 28 25 38 21 43 26 22 18 14 19 15 31 300
2012 33 40 24 30 37 21 8 17 15 19 4 18 260

17. IUI at Square Hospital
Total No-1430
0
50
100
150
200
250
300
350
2007 2008 2009 2010 2011 2012
 Total no of patient
from 2007 to 2012
=1430

18. IVF/ICSI
 In natural conception, fertilization occurs in
ampullary region of fallopian tube and then fertilized
ovum migrates towards uterine cavity.
 In Ivf technique of assisted reproduction, process of
conception instead of occurring in fallopian tube is
carried out in the laboratory & fertilized ovum is then
placed in uterine cavity.

19. IVF / ICSI at Square Hospitals
YEAR JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC TOTAL
2007 0 5 0 7 0 0 8 5 0 0 0 12 37
2008 0 9 0 0 14 0 0 0 3 4 3 3 36
2009 1 5 6 4 4 2 3 7 2 3 0 0 37
2010 6 5 3 9 9 2 14 0 0 9 1 10 68
2011 7 0 14 0 12 23 0 0 11 9 0 7 83
2012 13 0 18 0 11 0 0 0 0 0 0 2 44

20. IVF, total pt -- 305
0
10
20
30
40
50
60
70
80
90
2007 2008 2009 2010 2011 2012

21. PESA/TESE
 Men with azoospermia can be a father of a child
through intra-cytoplasmic sperm injection if sperm
can be retrieved from their epididymis or testis.
There are several methods-
- percutaneous epididymal sperm aspiration (PESA)
- Testicular sperm extraction (TESE)

22. TESE / PESA at Square hospital
YEAR JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC TOTAL
2007 0 0 0 0 0 0 0 0 0 0 0 0 0
2008 0 0 0 0 7 1 1 0 3 1 1 1 15
2009 0 0 1 1 0 0 1 1 1 0 0 0 5
2010 0 0 0 1 2 0 2 0 0 1 0 2 8
2011 0 3 0 0 5 0 0 0 1 2 0 3 14
2012 4 0 2 0 4 0 0 0 0 0 0 0 10

23. TESE / PESA at Square hospital
Total pt -- 62
0
2
4
6
8
10
12
14
16
2007 2008 2009 2010 2011 2012

24. Embryo freezing
 Embryo cryopreservation is useful for leftover embryos after a
cycle of in vitro fertilization.
 patients who fail to conceive may become pregnant using such
embryos without having to go through a full IVF cycle.

25. EMBRYO FREEZING at Square hospital
YEAR JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC TOTAL
2007 0 1 0 0 5 0 2 3 0 0 0 3 14
2008 0 5 0 0 2 0 0 0 0 1 0 0 8
2009 2 0 2 2 2 1 1 4 1 1 0 5 21
2010 2 2 0 7 6 1 5 0 0 5 0 5 33
2011 0 5 0 6 0 11 0 0 5 2 0 6 35
2012 5 0 6 0 5 0 0 0 0 0 0 1 17

26. EMBRYO FREEZING at Square Hospital
Total pt -- 128
0
5
10
15
20
25
30
35
2007 2008 2009 2010 2011 2012

27. Semen freezing
 Semen cryopreservation is a procedure to
preserve sperm cells.
 Semen can be used successfully indefinitely
after cryopreservation.
 For human sperm, the longest reported
successful storage is 21 years.

28. SPERM FREEZING at Square Hospital
YEAR JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC TOTAL
2007 0 2 0 9 0 0 12 0 0 1 10 2 36
2008 9 5 1 9 6 0 0 2 1 6 4 3 46
2009 7 5 6 5 3 5 4 5 3 9 10 4 66
2010 5 4 6 11 9 3 10 2 12 5 10 4 81
2011 12 3 11 1 7 10 0 2 10 7 4 0 67
2012 6 3 0 0 3 1 0 3 3 4 1 0 24

29. SPERM FREEZING at Square hospital
Total pt -- 320
2012
2007
2008
2009
2010
2011
2007
2008
2009
2010
2011
2012

30. Frozen embryo transfer (FET)
 a frozen embryo transfer (FET) may be done
when wish to use them.
 This may be after a delivery of a child
 It could also be after an unsuccessful
stimulated IVF cycle, in which frozen
embryos are obtained .

31. FET at Square Hospital
YEAR JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC TOTAL
2007 1 1
2008 1 1 2
2009 1 1 1 2 5
2010 2 1 1 2 2 2 10
2011 6 3 3 1 3 3 4 1 24
2012 1 4 4 7 3 1 20

32. FET
Total pt -- 57
2007
2009
2008
2011
2010
2012
2007
2008
2009
2010
2011
2012

33. Semen analysis
 It is done to help evaluate male fertility

34. Semen analysis- interpretation
(WHO values)
 Volume 2 mls or more
 Sperm concentration - 20 million/ml
 Sperm morphology - atleast 30% normal
 Sperm number - 40 million/ ejaculate
 Sperm motility – 50%
 Vitality – 75%
 WBC - <1 million/ml
Anti sperm antibody tests- not recommended by NICE

35. SEMEN ANALYSIS at Square Hospital
YEAR JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC TOTAL
2007 27 19 37 35 33 37 39 35 37 31 83 54 467
2008 71 58 69 50 52 62 56 74 22 47 37 34 632
2009 73 62 66 63 65 57 57 65 29 78 63 66 744
2010 71 66 77 71 94 62 71 54 54 92 67 82 861
2011 125 68 115 88 126 42 94 36 76 71 73 49 963
2012 80 96 83 74 81 85 92 30 110 64 95 86 976

36. SEMEN ANALYSIS
Total no of pt from 2007—2012 =4643
0
100
200
300
400
500
600
700
800
900
1000
2007 2008 2009 2010 2011 2012

37. From 2007 to 2012
Total no of pt --21817
Procedure No of pt %
Semen
analysis
4643 21.28%
IUI 1430 6.55%
IVF 305 1.40%
TESA 62 0.28%
Emb. freezing 128 0.59%
Spm freezing 320 1.5%
Frozen E . T 57 0.26%

38. Conclusion
 Square Fertility Centre offers an entire spectrum of
state-of-the-art treatment options for couples seeking
help for conception of a baby.
 Our dedicated team of fertility specialists,
embryologists, and nursing staff personalize a
treatment program for you and your spouse that give
you the best chance of realizing your plan for a child.

39. Questions…..zzzz??