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Fertilization treatments | Hegde Fertility
- 3. TABLE OF CONTENT ❑ Ovulation induction (OI) and Timed Intercourse (TI) ❑ Intrauterine Insemination (IUI) ❑ In Vitro Fertilization (IVF) ❑ In Vitro Maturation (IVM) ❑ Vitrification & Frozen Embryo Transfer (FET) ❑ Intracytoplasmic Sperm Injection (ICSI) ❑ Intracytoplasmic Morphologically Selected Sperm Injection (IMSI) ❑ Testicular Sperm Aspiration (TESA) ❑ Percutaneous Epididymal Sperm Aspiration (PESA) ❑ Microepididymal Sperm Aspiration (MESA) (Fertilization Treatments)
- 5. • Ovulation induction (OI) is the process in which fertility drugs are injected to stimulate at least 2 large follicles to release one or more eggs from the ovary. • Timed Intercourse (TI) once the OI is done the couple is advised to have intercourse for 3 to 4 days followed by progesterone supplementation for few days to achieve a pregnancy. Women with irregular menstrual cycles Women with Unexplained infertility OI-TI Is Advised To Women who do not ovulate
- 6. Couple are advised to come on D2 Do USG (Transvaginal Scan), D2 Hormone Profile Start ovulogens on D2/D3. May require Gonadotropins in successive cycles Do follicular tracking by transvaginal Sonography (TVS) Give trigger when follicles are in adequate size with good endometrium lining Couple are advised to have intercourse for 3 to 4 days during egg release Advised luteal support for 2 weeks After 3 weeks, Advice pregnancy test Procedure
- 7. Cost effective Less risk of multiple pregnancies Simple and Safe Easy to Monitor Least invasive fertility treatment Advantages
- 9. Intrauterine insemination (IUI) IUI is a type of Assisted Reproductive Technology (ART) to treat infertility. This treatment involves placing the sperm directly in women’s uterus to facilitate fertilization. Pre- Requisite At least One of the Fallopian Tube Should Be Normal Fallopian Tubes
- 10. Mild male infertility Cervical Factor Immunological Factors Mild Endometriosis Ovulatory Dysfunction Donor Sperm Unexplained Infertility HIV, HBS ag IUI Is Advised To Cost Appro. Rs .15000- 20000 Fifteen thousand to twenty thousand
- 11. 1 • Couple are advised to come on D2 2 • Advised D2 Hormone Profile & TVS for female and semen analysis for Male partner 3 • Ovulation induction drugs will be started from D2|D3 4 • Do follicular study/tracking by TVS 5 • Tigger injection is administered & IUI dates are provided 6 • On the day of IUI , Husband Semen sample is processed in the Andrology lab 7 • Processed Semen sample is deposited in patients Uterus via a soft catheter by our doctor 8 • Post IUI supplements are given for next 10- 15 days Procedure
- 12. Less Invasive Inexpensive IUI Reduces the risk of HIV Transmission Processed Sperms Improves the chances of Pregnancy Higher success rate of up to 15-20% compared to OI/TI Advantages
- 14. IVF IS ADVISED FOR Women having blocked or damaged fallopian tubes Women having recurrent miscarriage Women diagnosed with endometriosis Women with age related infertility Couples with or at risk of for genetic disorders Women with ovulation disorders or decreased ovarian reserve Male factor infertility Unexplained infertility Pre- Requisite Women having blocked or damaged fallopian tubes
- 15. IN VITRO FERTILISATION (IVF) • IVF is a type of Assisted Reproductive Technology (ART) • In this process of fertilization where an egg is combined with sperm outside the body, in vitro. The process involves monitoring and stimulating a woman's ovulatory process, removing an ovum or ova (egg or eggs) from the woman's ovaries and letting sperm fertilize them in a liquid in a laboratory. This is also referred as OPU (Oocyte Pick Up). • After the fertilized egg (zygote) undergoes embryo culture for 2–6 days, it is implanted in the woman's uterus, with the intention of establishing a successful pregnancy. This is also referred as ET( Embryo Transfer).
- 16. Embryos formed are cultured and transferred back into patients uterus Sperm and Eggs are mixed together and incubated to achieve fertilization Collection of Sperms Collection of Oocytes Ovarian Stimulation Initial Evaluation PROCEDURE 1 Day 8-12 Days (Based on patient’s profile) 30 Mins Procedure .(Based on the stimulation Within 10-14 days Procedure will be carried after giving Anaesthesia ) Sample will be collected 2hrs on the day of procedure / Freezing sample 3-4 days before the procedure 3 days for embryo fertilization Day 3 ET (Embryo Transfer) Or Day 5 ET(Blastocyte Embryo Transfer)
- 17. IVF Advantages Increased chance of healthy baby Timing/ planning of pregnancy as per convenience Decreased chance of miscarriage IVF works other treatments fail High Success rate ADVANTAGES IN IVF TREATMENT
- 18. IVF Success Rate • The Success Rate is 70% IVF Cost • The cost varies from 1 lakh 60 thousand to 2 lakh.
- 19. Abdominal Discomfort or Bloating Sensation Mood Swings Discomfort or Bruising at injection site Chances of Multiple Pregnancies Risk of OHSS- Vary rare to due close Monitoring 1 2 3 4 5 RISK INVOLVED IN IVF TREATMENT
- 20. TYPES OF IVF • Natural Cycle IVF involves egg collection aligned with your natural menstrual cycle; there are no stimulation drugs or injections involved. It works in sync with your menstrual cycle to collect the egg naturally selected by your body. • Minimal Stimulation IVF involves in giving some fertility injections in lower doses to boost the ovulation, encouraging the body to produce more eggs than the normal.
- 22. IN VITRO MATURATION • IVM is an assisted reproductive technology which involves collecting eggs from a woman before they matured. • Under Transvaginal scan guidance immature eggs are collected from unstimulated or lightly stimulated ovaries. • The immature eggs are then matured in the laboratory for 24-48 hours using culture medium with added small quantities of hormones. • Intracytoplasmic sperm injection (ICSI) is used for fertilization of the matured eggs. The resulting embryos are transferred to the women’s wombs.
- 23. (Ovarian hyperstimulation syndrome) Women with higher risk of OHSS Women with PCOS (Polycystic ovary syndrome ) Along with regular IVF Treatment (In Vitro Fertilisation) IVM Is Advised To
- 24. Reduces the risk of OHSS Cost effective Short procedure IVM is risk for IVF patients with Polycystic Ovarian Syndrome Chances of multiple pregnancies are higher if more than one embryo is inserted Advantages And Risks
- 25. Initial Tests are done with ultrasounds Blood samples are taken to determine the best time to recover eggs Immature eggs are retrieved using a minor surgical procedure Old Method- eggs are placed in cell culture and stimulated with hormones until they mature New method- Oocytes is stimulated with cumulin and c-AMP to reach maturity Most often the sperm is inserted into each mature egg using ICSI One of the four embryo are inserted into womb via a surgical procedure One has to wait for 12- day to see if implantation has taken place or not If successful, the pregnant woman will be directed to a gynaecologist If not successful, the couple or woman may have to undergo another cycle of IVM Procedure
- 26. Procedure
- 27. Vitrification & Frozen Embryo Transfer
- 28. Vitrification • The word “vitrification” comes from the Latin term for glass, vitrum. In the context of freezing eggs and embryos, vitrification is the process of freezing so rapidly that the water molecules don’t have time to form ice crystals, and instead instantaneously solidify into a glass-like structure. Frozen Embryo Transfer • A frozen embryo transfer, commonly referred as FET, is the process of using a frozen embryo from a previous IVF cycle. • During this procedure, a woman undergoes the standard IVF procedure, but instead of transferring the embryos back into the uterus in the same cycle, they are frozen to use for future cycle. A woman can freeze her own eggs or choose to use donor eggs.
- 29. • Embryos can be frozen on Day 3 and Day 5 1 • Only Grade 1 and 2 embryos are frozen 2 • Embryos are exposed to chemical called cryoprotectants 3 • Embryos are placed in small plastic straws 4 • These straws are kept in freezing machines for rapid freezing 5 • These straws are then Kept in liquid nitrogen at temperature -196 6 Procedure
- 30. FET Is Advised To Women going for PGD/PGS Fertility Preservation Women undergoing donor oocyte or donor embryo When more than 15 oocytes are retrieved Women with risk of OHSS Following a unsuccessful IVF cycle Women with Surplus embryos
- 33. Ejaculatory Dysfunction Fertilization Failure Advanced Age (To overcome sperm oocyte penetration issues) Poor oocyte quality/low oocyte yield Following Sperm Retrieval by TESA/MESA Severe Infertility Couple who want to include PGT in their cycle (To ensure better Fertilization ICSI Is Advised To
- 36. Intracytoplasmic morphologically selected sperm injection (IMSI)
- 37. Intracytoplasmic Morphologically Selected Sperm Injection (IMSI) ⮚ IMSI is a procedure of selecting Spermatozoa under higher magnification ⮚ Normal ICSI is done under 2000-4000* magnification. ⮚ where as IMSI is done under 6000* magnification which gives a higher chance of selecting good sperm ⮚ The Patient who have gone repeated IVF failure, patients with very defective sperms ⮚ Men whose sperm count is less or immobility and unknown reasons for infertility ⮚ Chances of achieving pregnancy using IMSI would be between 30%-63% comparative to normal conventional IVF and ICSI 20%-40%
- 38. Testicular sperm aspiration (TESA) Microepididymal Sperm Aspiration (MESA) Percutaneous Epididymal Sperm Aspiration (PESA)
- 39. Testicular Sperm Aspiration (TESA) • TESA is a procedure performed for men who are having sperm retrieved for IVF/ICSI • A needle is inserted in the testicle and tissue/sperm are aspirated. TESA is performed for men with obstructive azoospermia (s/p vasectomy) • Occasionally, TESA doesn’t provide enough tissue/sperm and an open testis biopsy is needed Percutaneous Epididymal Sperm Aspiration (PESA) • PESA is a procedure performed for men who are having sperm retrieved for IVF/ICSI who have obstructive azoospermia from either a prior vasectomy or infection
- 40. Microepididymal Sperm Aspiration (MESA) • MESA is a procedure performed for men who have vasal or epididymal obstruction (s/p vasectomy, congenital bilateral absence of the vas deferens) • Patients usually cryopreserve sperm during this procedure for future IVF/ICSI • MESA allows for an extensive collection of mature sperm as compared to aspiration techniques, and it is the preferred method of retrieval for men with congenital bilateral absence of the vas deferens as it does not impact steroid production of the testis.
- 41. Men with low Sperm Count 1 Men With Retrograde ejaculation problems 2 Men With Long History Of various Genital Surgeries and Issues 3 TESA Is Advised To
- 42. Advantages Cost Effective Non invasive Less Stress Less Time Less Pain Recommend s Biological Sperm
- 43. Stabilization of the testis Insertion of hollow needle into the testis Negative pressure is applied to the needle Several excursions of needle are made within the substance of the testis Testis tissue is observed within the needle and tubing is then expelled into petri dish It is processed in the andrology laboratory for sperm This procedure can be repeated on same side or opposite side The recovery period is also about 24Hrs Procedure 1 2 3 4 5 6 7 8