Ovulation Induction – Follicular study
Ovulation induction refers to the stimulation of ovulation in women undergoing fertility treatment, through the administration of certain medications. The ovulation induction results in ovulation and increases the chances of a successful pregnancy. A follicular study is performed during this period to track when the mature ova are likely to get released.
Intra Uterine Insemination – IUI
Intra-uterine insemination is a medical procedure in which sperm cells from semen are concentrated and injected into the uterus during ovulation. The patient may be given ovulation-inducing medication to improve their chances of getting pregnant during the procedure. Intra-uterine insemination may be an effective strategy to treat infertility if it is caused by ovulatory problems and mild-male factor infertility. Intra-uterine insemination is also performed when the patient chooses to use a sperm donor. Intra-uterine insemination is a relatively simple and safe procedure. It can result in multiple pregnancies, twins or triplets, due to the ovulation-inducing medication, which results in the release of multiple mature egg cells in the same cycle.
IVF/ ICSI/ IMSI
In-vitro fertilization (IVF) is an assisted-reproductive technique to help infertile couples have biological children. Egg cells and sperm cells are extracted and mixed together to encourage fertilization under laboratory conditions. The resultant embryos can be implanted in the patient, a gestational carrier or cryogenically stored for later use.
Intracytoplasmic Sperm Injection (ICSI) is a variant of the IVF procedure, in which the sperm cells and eggs cells are not simply mixed together, but a single sperm cell is chosen and injected directly into a harvested mature ovum to create the embryo.
Intracytoplasmic Morphologically-selected Sperm injection (IMSI) is a variant of the ICSI procedure, in which the sperm cell to be injected for fertilization is carefully chosen based on microscopic observation to test for abnormalities that could result in embryos that are unable to attach themselves to the uterine wall or result in early miscarriage. IMSI may be recommended to couples who have a high incidence of sperm abnormality in the semen analysis.
Pre-genetic Screening [PGS]
Pre-genetic Screening (PGS) is a test performed on the embryo before the implantation stage of IVF. The embryo is biopsied and the chromosomes in the cells are counted, to ensure the number is normal – 46. An embryo with an abnormal chromosome count usually cannot implant to the uterus, results in a miscarriage or causes birth defects in the child.The pre-genetic screening can help ensure a healthy embryo is chosen for implantation, instead of an abnormal one. This helps increase the patient’s chances of a successful implantation, pregnancy and birth.
Pregenetic Diagnosis [PGD]
Pre-genetic Diagnosis (PGD) is a testing method that provides the doctor with data about the gene makeup of the embryo. The test can be used to identify around 2,000 single gene disorders that the embryo could have potentially inherited from its parents. The test is up to 98% accurate and can help identify a potentially healthier embryo, that doesn’t have any genetically inherited diseases, for implantation. The PGD is recommended to couples who have a family history of genetic disorders such as cystic fibrosis, sickle-cell anemia, fragile X-syndrome or Duchenne muscular dystrophy.
Endometrial Receptivity Array [ERA]
Endometrial receptivity array (ERA) is a diagnostic procedure to determine if the uterus is prepared for implantation of the embryo during IVF. Typically, ultrasound scans are used to assess the thickness and growth pattern of the endometrial lining. However, ERA uses tissue biopsies from the endometrial lining to provide a more accurate assessment. This procedure is recommended to patients who have already had three or more unsuccessful cycles of IVF. In such cases, the embryos are typically healthy, but implantation is unsuccessful because of timing. The ERA remedies this. There are no known medical side-effects after undergoing an ERA.
Sperm Retrieval [TESA/ PESA]
Sperm retrieval has an entirely different objective from a testicular biopsy. The aim of the sperm retrieval process is to harvest live, healthy sperm cells for IVF or ICSI. If the male partner is able to provide semen that has live, healthy sperm, surgical sperm retrieval methods will not be necessary. The lack of live sperm cells in the ejaculate is called azoospermia. It may be caused by an obstruction in the vas deferens. There are many methods of sperm retrieval. The doctor will recommend the one suited to the patient’s case. Testicular Sperm Aspiration or TESA is a procedure performed to retrieve sperm directly from the testes. A needle biopsy is performed to retrieve the sperm cells. Percutaneous Epidydimal Sperm Aspiration or PESA is a procedure performed to retrieve sperm from the epididymis, through a needle inserted via the skin. PESA is recommended for men with azoospermia, or an obstruction in the vas deferens.
Donor Programs (Third-party assisted reproduction)
Fertility treatment is a long-drawn process that may include third-party assisted reproduction for some couples. The third party usually assists the patients (the intended parents) by donating viable gametes or by being a gestational carrier, i.e., carrying the embryo for 9 months. Sperm or egg donation could be received from an anonymous donor or from a trusted friend or relative.
Men between the ages of 18 to 40 are usually eligible to donate sperm, but they must undergo semen testing, a physical exam, genetic screening for inherited diseases and a psychological evaluation. The donor donates the semen by masturbating into a sterile cup in a private room at the hospital. The semen is cryopreserved and quarantined for six months. After six months, the donor is tested again for infectious diseases and the donated semen is thawed. Some sperm cells do not hold up well to cryogenic freezing and re-thawing and will be rejected.
Women between the ages of 18 and 32, in good physical and psychological health are eligible to donate their eggs. The donor will undergo a physical exam, a psychological evaluation, genetic screening for hereditary diseases and tests for other infectious diseases to determine if they are healthy enough to donate their eggs. The egg donation process is longer and more involved than sperm donation. The donor will need to synchronise their cycle with the patient, and hence will be put on birth control pills. The donor will also be given follicle-stimulating medication to produce more mature eggs for retrieval and monitored by ultra-sound scans to check their progress. The eggs are harvested once they have matured, using a trans-vaginal ultrasound-guided oocyte aspiration procedure.