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Department of IVF

Overview

Most couples who try to have children manage to successfully conceive a pregnancy within a year. However, the inability to conceive is nothing to be ashamed of and should not be stigmatised. In general, infertility is defined as the inability to get pregnant after one year or longer of unprotected sex during ovulation. Some couples do manage to conceive naturally after a year, with only a meticulous practice of cycle-tracking. Fertility in women is known to decline after 35 years of age. Egg numbers and egg quality decrease more rapidly. Men can also experience problems with fertility, caused by a low sperm count or low-motility sperm. It is advisable to seek fertility expertise if you have trouble getting pregnant after consistently trying for a year or if you have had a miscarriage.

Department Overview

Infertility medicine specialises in treating unexplained infertility and loss of pregnancy. The department has experience in treating diverse patients who have difficulty becoming pregnant or carrying the pregnancy to term. Our team of specialists consists of Reproductive Health Specialists, Embryologists, Andrologists, Ultrasonologists, Ob-Gyns, and counsellors. We work together to make sure our patients receive holistic care. The Department is a state-of-the-art facility, housing our speciality fertility labs. Assisted by an experienced and specialized staff of technicians and nurses, our doctors try to make treatment process as comfortable as possible, allowing the couple to enjoy the beginning of their journey of parenthood.

Fertility Services

Fertility Evaluation

Female Infertility Evaluation

Hormonal Profile

The female reproductive hormones, Follicle stimulating hormone (FSH), Luteinizing hormone (LH), Progesterone and Estrogen, control the menstrual cycle that deals with the release of egg. A Hormonal Profile is a test to check the levels of these hormones. The study typically records the levels of these hormones at various stages of the menstrual cycle. The way in which the levels of these hormones fluctuate could indicate the underlying cause of infertility.

Follicular Study

Follicular study is a vital part of the IVF process. It is a medical investigation conducted through a series of ultrasound scans at regularly scheduled times through the menstrual cycle. The scans will allow the doctor to assess follicular growth, endometrial thickening and ovulation. The doctor usually recommends intercourse as close as possible to ovulation to increase the chance of a natural pregnancy. This is called the “Timed Intercourse” Method.

Diagnostic Hysteroscopy

A diagnostic hysteroscopy is recommended to patients experiencing problems with fertility to diagnose any abnormalities that may be present in the uterus. A hysteroscope is a thin, long, flexible tube with an endoscopic camera, inserted into the uterus through the vagina. The doctor may choose to remove any adhesions or scar tissues that show up on the images to improve the patient’s chances of embryonic implantation.

Hysterosalpingogram

Tubal patency test [dye test] – A hysterosalpingogram is an X-ray imaging test used to check for blockages in the fallopian tubes that connect the ovaries to the uterus. If the fallopian tube is blocked, ova released form the ovary cannot reach the uterus and lose their chance at fertilization and implantation. During the test, the doctor inserts a tube into the uterus through the vagina and fills it with a liquid that had iodine. The iodine contrasts with the uterus and fallopian tubes, when viewed under X-ray fluoroscopy. This results in clearer diagnostic images.

Male Infertility Evaluation

Overall, male infertility issues are a factor in about 50% of infertility cases. Varicocele and vas deferens obstructions are common conditions that contribute to male infertility. Certain medications, such as chemotherapy can also cause male infertility. Diagnosis of male infertility usually involves a physical exam, a detailed medical history and lifestyle evaluation and a semen analysis. The semen analysis tests for sperm count and sperm motility, which determine whether the sperm cells can reach the ovum to cause a pregnancy. The semen analysis also tests for infections. Based on what they find, the doctor may recommend further tests including a scrotal ultrasound, post-ejaculation urinalysis, genetic tests or a testicular biopsy.

Fertility Treatment

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.

Know your fertility

Whether you are thinking about having children or not, here are some things you should know about your fertility:

Even if you are not trying to get pregnant or thinking of having children, if you are a woman over 30, you should consider having your ovarian reserve screened. If the ovarian reserve is diminishing, this may be a good time to harvest your eggs to give yourself the option of having children in the future, especially if you plan to do it after the age of 35. Getting pregnant after 35 is not impossible, but can come with its own set of complications, so this screening and counselling about your options at 30 will give you the information you need to make the right decisions about possible future pregnancies.
To boost your chances of getting pregnant, the best advice is to have sex when the woman is ovulating. You can track your ovulation by keeping a record of the start of each period. Ovulation happens roughly in the middle of the cycle, so you’ll know when that would be for you based on the length of your average menstrual cycle. Tracking your basal body temperature can also give you an indication of when you are ovulating. The fertile window is typically the five days before ovulation, so doctors recommend having sex every day during this period. At-home Ovulation test kits are also available to help you track when you are ovulating.
Even young, healthy, fertile couples don’t always get pregnant right away. Unless you’ve been trying to get pregnant regularly for a year without success, there is no cause for worry.
Men are at their most fertile before 40 years of age. After 40, the sperm count and motility begins to decrease. If you are a man who wants to have children in your 40’s, cryogenically preserving your sperm in your 30’s may give you a better chance.
Lifestyle factors that can affect female fertility include smoking cigarettes, exposure to second hand smoke, chronic stress, alcohol abuse, unhealthy diet and lack of exercise. Medical conditions such as endometriosis, PCOS, uterine fibroids and irregular menstruation can also affect female fertility.
Lifestyle factors that can affect male fertility include smoking marijuana and cigarettes, alcohol abuse, cocaine abuse, unhealthy diet and taking testosterone to build muscle. Medical conditions like diabetes, weight disorders, testicular varicoceles, hormone disorders or thyroid problems can also affect fertility.

Why Choose Us?

Patient Experience

The Department of IVF prides itself on its ability to handle patients with sensitivity. The doctors put a lot of effort into educating patients about all of their options and giving them a clear picture of the possibilities. We support our patients in taking informed decisions without judgment or dogmas getting in the way. The patients have a pleasant experience with us throughout the long process of IVF and fertility treatments. We direct our patients towards resources about nutrition, exercise and mental health to ensure they achieve holistic wellbeing and are able to enjoy this beautiful time of their lives.

Latest Technologies

The Department of IVF is equipped with state-of-the-art labs with advanced medical equipment. In accordance with modern medical standards, the doctors recommend minimally invasive procedures where possible to give the patient their best chances at a normal pregnancy. The world-class medical facilities at GGHC ensure accurate results and lower chances of false positives. Our cryopreservation facility is fail-proof to ensure that specimens are all preserved safely and securely.

Providing Quality Care

The Department of IVF specialises in providing high-quality medical care to all our patients. The team of doctors, surgeons, radiologists, nurses and technicians work together to ensure patients receive the correct care and recover quickly. Our fertility experts carefully and clearly take the patients through all their options and advise them professionally on their best options. We do our best with every single patient to achieve a positive outcome. Each patient is important at GGHC and we treat each one with the care and attention they need and deserve.

Procedures

Ovulation Induction

Ovulation induction is a medical procedure to stimulate the release of mature eggs from the ovaries. It is a simple procedure, which involves the patient taking oral or injectable fertility medication every day, starting with the second day of the menstrual cycle. The patient continues their course of medication throughout the cycle, monitored by regular ultrasound scans. The medication and dosage are tailored to the individual patient by their doctor. The doctor studies the progress of the menstrual cycle via regular ultrasound scans. They may recommend timed intercourse according to their findings, to maximize chances of a successful pregnancy. Ovulation induction could cause the release of multiple eggs in one cycle, resulting in multiple pregnancies, i.e. twins or triplets.

Intra-Uterine Insemination (IUI)

Intra-uterine insemination is an artificial insemination procedure to treat infertility. Intra-uterine insemination is recommended to couples with male ejaculatory dysfunction, or when the couple decides to collaborate with a sperm donor. The first step of intra-uterine insemination is to harvest the sperm. The male partner or the sperm donor will be asked to provide a semen sample. As the non-sperm components of the semen could cause reactions with the female reproductive tract, affecting the chances of a successful pregnancy, they are washed away and the sperm cells are isolated and concentrated for insemination.

The timing of intrauterine insemination is crucial, so the female partner’s uterus is monitored regularly using ultrasound scans. The doctor may also recommend medications to stimulate ovulation. At the time of ovulation, the doctor injects the concentrated sperm cells into the uterus through a trans-vaginal catheter. After insemination, the patient may be asked to lie on their back for a few minutes. They can take a pregnancy test after two weeks to check if the insemination was successful.

In-vitro Fertilization (IVF)

In-vitro fertilization is an assisted reproductive technique to help couples who struggle with fertility to have biological children. It involves retrieving sperm and egg cells from the parents and fertilising them to form an embryo under laboratory conditions. The embryo can then be frozen for later use or implanted in the woman’s uterus. Depending on the fertility status of the partners, they may be required to use a donor sperm or donor egg. The doctor can also implant the embryos in a gestational carrier, who will carry the pregnancy to term instead of the biological mother. IVF can also help couples with a history of genetic illnesses to choose an embryo without those problematic genes. This gives their child an improved chance at a healthier, happier life.

Diseases and Treatments

Recurrent Pregnancy Loss

Recurrent Pregnancy Loss Overview

Recurrent pregnancy loss is a condition in which the woman experiences two or more clinical losses of pregnancy (or miscarriages) before 20 weeks of gestation. The clinical loss of pregnancy is diagnosed by a doctor, using an ultrasound scan. A “biochemical” loss of pregnancy is a miscarriage detected on the basis of pregnancy hormones in the blood and urine. This needs to be confirmed by an ultrasound scan to qualify as a clinical loss of pregnancy.

Signs and symptoms of Recurrent Pregnancy Loss

Symptoms of a loss of pregnancy include heavy spotting, vaginal bleeding, discharge of tissue or fluid from the vagina and severe abdominal cramping. The patient may also experience back aches.

Causes and Risk Factors of Recurrent Pregnancy Loss

The clinical loss of pregnancy could be caused by genetic abnormalities present in one of the parents, a uterus abnormality, use of recreational drugs during pregnancy, being overweight, excessive caffeine intake and untreated medical conditions such as thyroid disease, diabetes or thrombophilia. In over half the cases of loss of pregnancy, the exact cause remains undetermined. One loss of pregnancy does not mean the consecutive pregnancies will have problems. In fact, recurrent loss of pregnancy is quite rare and may point to a deeper genetic cause or an abnormal anatomy of the uterus that prevents attachment of the embryo to the endometrial wall.

The pregnant woman is at a risk of losing her pregnancy if she consumes drugs, alcohol or excessive caffeine. Being overweight, underweight and having thyroid disease could also put a pregnant woman at risk of miscarriage.A pregnant woman above the age of 35 has a higher risk of losing the pregnancy as well.

Complications of Recurrent Pregnancy Loss

Recurrent loss of pregnancies can result in great emotional distress to the couple, resulting in mental health complications, which is why it is important to seek mental health care.

Diagnosis of Recurrent Pregnancy Loss

The loss of pregnancy is clinically diagnosed by an ultrasound scan. The fertility expert will begin with a detailed medical history of the couple and their genetic ancestry. The doctor will require a karyotype analysis to check for genetic abnormalities. The uterus is then evaluated using a series of ultrasound scans, a hysterosalpingogram X-Ray, an MRI and a hysteroscopy. The doctor will be looking for polyps or scar tissue on the uterus that are getting in the way of implantation.

Treatment of Recurrent Pregnancy Loss

The treatment for the recurrent loss of pregnancy varies according to the underlying cause. If a karyotypic defect is found in one of the prospective parents, the couple may be recommended genetic counselling, where an expert can advise them of their options. Uterine abnormalities may be corrected surgically to improve the patient’s chances of carrying their pregnancy to term. If the patient has underlying untreated thyroid disorders or diabetes, they will be put on medication that aligns with their fertility goals.

Prevention of Recurrent Pregnancy Loss

In over half the patients who experience recurrent pregnancy loss, there is no clearly identifiable cause. However, the risk of losing a pregnancy can be reduced by maintaining a healthy weight and not consuming stimulants during the pregnancy.

Low Sperm Count & Motility (OATS)

Low Sperm Count & Motility Overview

Oligoasthenoteratozoospermia, usually shortened to OATS, is a condition characterised by low sperm count and low sperm motility in men. In addition, the sperm may also be irregularly shaped. OATS is one of the primary causes of male-factor infertility. The condition could be caused by aging, hereditary factors, strenuous physical activity, obesity, alcohol consumption or overheating of the testes. The testes may also have lost their ability to function normally due to disease and this could result in OATS.

Signs and symptoms for Low Sperm Count & Motility

A patient who suffers from OATS is unable to produce a child. They may also experience a whitish discharge from the penis, increased body hair and growth of breast tissue. There may also be a mass or swelling on the scrotum.

Causes and Risk Factors for Low Sperm Count & Motility

The factors contributing to OATS can be broadly broken down into four categories – Genetic, lifestyle, testicular factors and testicular ejaculatory dysfunction. The genetic factors include defects in the sperm DNA, Y-chromosome defects and Klinefelter syndrome. Lifestyle factors that could contribute to OATS include high alcohol consumption, use of recreational drugs and smoking. Overheating the testes by taking many hot baths and showers, wearing tight briefs or overexerting yourself at the gym can also lower sperm count and motility. Drastic weight fluctuations, being overweight and being underweight can also contribute to OATS. Testicular factors that could contribute to OATS include testicular cancer, testicular trauma, chemotherapy, radiation therapy, ageing, enlargement of a varicocele and past infection of certain diseases such as mumps, malaria or syphilis. Testicular ejaculatory dysfunction refers to a set of conditions that obstruct the flow of semen through the male reproductive tract. This includes, erectile dysfunction, hypospadias, impotence, obstruction of the vas deferens, inflammation of the prostate or retrograde ejaculation, where semen is redirected to the bladder.

Complications for Low Sperm Count & Motility

OATS and the inability to have a child could cause mental trauma, amplified by social rejection. The patient is recommended to seek mental health care from a licensed professional to cope.

Diagnosis for Low Sperm Count & Motility

The fertility expert will investigate a number of factors before they can arrive at a conclusive diagnosis. The process begins with a detailed personal and family medical history, a physical exam, blood tests and semen analysis. The doctor will also require a scrotal ultrasound and genetic testing. If the doctor identifies, low sperm motility, low sperm count and abnormal sperm shape, then the patient may be diagnosed with OATS.

Treatment for Low Sperm Count & Motility

OATS causes a majority of cases of male infertility. Cases of OATS caused by lifestyle factors respond very well to treatment and can be reversed. Many such couples go on to have natural, healthy pregnancies. The patient may be treated with medication and lifestyle changes. Some cases may also require surgical intervention. If the doctors feel that the condition cannot be reversed, they may recommend sperm extraction and IVF.

Prevention for Low Sperm Count & Motility

In general, it is advised to reduce the consumption of stimulants, avoid overheating the testes and maintain a healthy weight to reduce your risk of OATS.

Diminished Ovarian Reserve

Diminished Ovarian Reserve Overview

The ovarian reserve is an assessment of the quantity and quality of the eggs remaining in the ovaries. The ovarian reserve is said to be diminished if the quality and quantity of eggs in the patient’s ovaries is lower than expected at their age. Diminished ovarian reserve can affect people at any age, and it is possible to get pregnant despite it-if intervened early.

Signs and symptoms of Diminished Ovarian Reserve

There aren’t many noticeable physical symptoms of a diminished ovarian reserve. However, patients with diminished ovarian reserve typically find it difficult to get pregnant. They may have irregular menstruation or absent cycles. They may also experience heavy flow during periods and have a history of miscarriage.

Causes and Risk Factors of Diminished Ovarian Reserve

Aging reduces the ovarian reserve. Certain conditions such as endometriosis, pelvic infections, auto-immune disorders, mumps or fragile X syndrome could cause the ovarian reserve to diminish faster for your age. Chemotherapy and radiation therapy can also accelerate the diminishing of the ovarian reserve. In some cases, there is no identifiable cause for the condition.

Complications of Diminished Ovarian Reserve

Women with diminished ovarian reserve have low chances of conceiving with IVF as well. They also often have a greater risk of miscarriage with IVF because of the quality of the eggs.

Diagnosis of Diminished Ovarian Reserve

Diminished ovarian reserve is diagnosed on the basis of blood tests to measure the levels of the FSH and AHM in the blood. The level of these hormones gives the doctors an indication of the condition of the ovaries.

Treatment of Diminished Ovarian Reserve

If the condition is diagnosed early, the doctor may recommend harvesting and freezing healthy eggs for future use. IVF may also be recommended in some cases. For patients with a highly diminished ovarian reserve, the doctor may recommend alternative options such as using a donor ovum in IVF.

Prevention of Diminished Ovarian Reserve

Diminishing ovarian reserve cannot be prevented. Regular screening can help diagnose the condition early.

Our Doctors

Dr Padmapriya Vivek

MBBS, MD(OBG), Diploma in Reproductive Medicine(Germany)

Head of the Department - Obstetrics, Gynaecology & Fertility Medicine

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