INDIA & IVF PROCEDURES ANTI-OXIDANT IN MALE If sperm count is good but H/O repeated IUI failure ..needs ICSI. HYDRO-SALPINX

1. EVALUATION &
Counselling
I.V.F.PRE
For Male & Female
DR. SHARDA JAIN
Dr. Jyoti Agarwal
Dr. Aruna saxena
Dr. Jyoti Bhaskar

2. Over 200 ppts are available on slideshare
www.slideshare.net /lifecarecentre

3. India performs approx. 1 Lac cycles of IVF
per year
Around 55% of the IVF
cycles performed across
the top eight metros and
rest 45% across tier 2,3
cities etc.Annual number of IVF cycles
 High (>10,000)
 Moderate (5,000-10,000)
 Low (<5,000)

4. Exponential
increase is
expected in IVF
procedure & will
touch 2.6 lac by
2020
INDIA & IVF PROCEDURES

5. In India
 Need for parenthood is greatest
 Social status of parenthood is
more influential
 Increasing awareness of
infertility is a key imperative

6. This PPT gives checklist
PRE I.V.F. EVALUATION
In male in female

7. For Best Results both Husband & wife
Protein rich diet, Vitamins
micronutrients &
antioxidants to be
liberally started
2 – 3 months
prior to actual IVF

8. A detailed examination, semen analysis,
Semen culture & DNA fragmentation test
(if possible)
should be performed.
MALE
PRE I.V.F. EVALUATION

9. ANTI-OXIDANT IN MALE
Vitamin – C 500 mg O – D daily
Vitamin – E 400 mg B – D daily
Are most important supplementation
******
Lyco – Q 300 mg daily is the 3rd option if they can afford
PRE I.V.F. EVALUATION

10. MALE
•If there is Oligo-spermia (<5 million / ml)
karyotyping & “Y” chromosome micro deletion
should be advised
•ICSI should be done for such case & for that
Counselling properly is required
PRE I.V.F. EVALUATION

11. Testicular biopsy should be done
before IVF & sperms should
be frozen simultaneously.
MALE
PRE I.V.F. EVALUATION

12. If Testicular biopsy done on
the day of OPU , keep donor
sample ready
MALE
PRE I.V.F. EVALUATION

13. Micro TESE is a better than
TESE alone
MALE
PRE I.V.F. EVALUATION

14. If sperm count is good but
H/O repeated IUI failure
..needs ICSI.
MALE
PRE I.V.F. EVALUATION

15. If sperm count is good but
Morphology is poor -- should
be counselled for ICSI
MALE
PRE I.V.F. EVALUATION

16. PRE I.V.F. Evaluation in
Female

17. PRE
FEMALE
The following investigation should be performed.
Hormonal Assessment- Serum TSH Prolactin, AMH
Baseline transvaginal scan (TVS) of Pelvis to assess the uterus
and adnexa & measure antral follicle count
to assess Ovarian Reserve
I.V.F. EVALUATION

18. GENITAL TUBERCULOSIS
TO BE RULED OUT
PRE I.V.F. Koch’s

19. There is a high incidence of intrauterine pathology
in infertile women. The commonly encountered
intrauterine abnormalities include synechiae,
Polyps, sub mucous myomas, endometrial
hyperplasia, adenomyosis , septum etc. most of
these pathological condition can be appropriately
tackled hysteroscopically.
PRE I.V.F. HYSTEROSCOPY

20. there is a high incidence of intrauterine pathology
in failed IVF cases
*********
in Lifecare IVF study of failed IVF
cases - 100% patients had some pathology.
intrauterine synecia , T- shaped uterus &
small polyps were most commonly found
PRE I.V.F. HYSTEROSCOPY

21. Hysteroscopy is especially relevant or rather
mandatory in women with 2 or more
documented implantation failures in IVF and a
normal diagnostic hysteroscopy study serves as a
positive prognostic factor for IVF.
Dr Osama Shawki / Dr. Sharda Jain
PRE I.V.F. HYSTEROSCOPY

22. There is enough evidence to show
that Hysteroscopy surgery in
these patients, particularly
resection of a sub mucous fibroid
or R/O endometrial polyp,
improves pregnancy rates in IVF.
PRE I.V.F. HYSTEROSCOPY

23. HYDRO-SALPINX
REMOVAL OR CLIPPING
Presence of Hydro salpinx reduces markedly the
Pregnancy rate in IVF.
Therefore it should be treated before starting IVF.
Treatment includes Hydro salpinx removal, disconnection
from uterine end, cuff salpingectomy &
rarely Transvaginal aspiration (not done).
PRE I.V.F.

24. HYDRO-SALPINX

25. Evaluation and Preparation of
Endometriosis
Endometriosis: Its management includes
both medical and surgical interventions.
Pre IVF GnRH analogue for
minimum 60 days to 6 months
tends to improve outcome of IVF.
PRE I.V.F.

26. Evaluation and Preparation
of Endometriosis
Laparoscopic cystectomy is recommended for
endometrioma more than or equal to 4cm.
Cyst aspiration and fulguration of cyst wall is
useful for recurrent large endometrioma.
PRE I.V.F.

27. Evaluation and Preparation
Polycystic Ovarian Syndrome (PCOS)
The following interventions improve the outcome of
IVF in women suffering from PCOS.
Reduction BMI < 27
Metformin 1500mg / day for 2 months
prior to I.V.F. To decrease OHSS
Ovarian drilling in resistant cases
PRE I.V.F.

28. FIBROIDS:
Myomectomy is
recommended for
submucosal fibroids
& intramural
fibroids 4cm in size or
more.
PRE I.V.F.

29. TOBACCO SMOKING
In MEN smoking affects all
parameters of sperm quality.
In WOMEN smoking leads to
a decrease in live birth rate
comparable to a female
who is 10 yrs older to her.
PRE I.V.F.

30. WEIGHT LOSS IS MAGIC
• Weight loss should be encouraged in
overweight and obese women BMI over 27
• There is 33% reduction in probability of
conception in overweight
women in I.V.F. cycles
• Even 10% weight loss increases the
conception rate in ART cycles & otherwise

31. MICRONUTRIENTS & ANTIOXIDANTS
IN FEMALE ARE EQUALLY IMPORTANT
Protein rich diet, Vitamins
micronutrients &
antioxidants to be
liberally
started 2 – 3 months
prior to actual IVF

32. Role for Life Style Changes
Dietician consultation , yoga &
Acupuncture for stress relief are
good in our practice

33. Folic Acid & Anti-oxidant
Folic acid decrease malformations & Anti
oxidants Energize & Protects Oocyte from
oxidant stress
Improves Oocyte quality , embryo quality &
subsequently better pregnancy outcome

34. OUR MOTTO at
Be safe than feel sorry
Readers are reminded that “Pregnancy &
take home baby rates decline with
increasing age of partners especially
the women in ART …… So resort to
IVF early than late”

35. ADDRESS
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Delhi - 51
Helpline
9650588339,
9599044257
011-22414049, 011-22058865
WEBSITE :
www.lifecarecentre.in
www.drshardajain.com
www.lifecareivf.com
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E-MAIL ID
Sharda.lifecare@gmail.com
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info@lifecareivf.com
…Caring hearts, healing hands