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|Posted By : Dr.G. K. Bedi, M.B.B.S, M.D, D.G.O.|
|Posted On : 18 Oct 2007 (Total Views : 3507)|
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This is the first time we?ve solved all the problems at once. We?re at the end of the beginning ? not the beginning of the end. These were the words of Sir Patrick Steptoe in 1978 at the announcement of the birth of Louise brown, the world?s first IVF (test tube) baby. It was an important milestone along the way to what is now an important and internationally recognized treatment option for some infertile couples.
Normal fertility is usually defined as achieving a pregnancy within 1 year, by regular coital exposure. It is estimated that 85-90% of couples achieve pregnancy in 2 years and the 10-15% experience some form of infertility. The range of patients who are suitable for treatment by assisted conception is continually increasing. We encourage both the partners to attend the primary consultation together and thoroughly investigate them as a unit. About 50% of the couples that get expert help for this achieve pregnancy within 2 yrs of treatment. At present about 40-45% of couples attending the center have a problem of male factor. There is now a comprehensive series of sperm function tests, which are designed to find defects in sperms. On the female side laproscopy, IUI (intrauterine insemination), embryo donation, IVF, ICSI etc. have given hope to many couples who previously had none.
Female Infertility ? Risk Factors.
Causes of Female Infertility.
Causes can be found in 70-80 % of the cases, the rest have normal investigations, yet cannot conceive.
Pelvic Inflammatory Disease ? This includes a variety of infections of the uterus, tubes and ovaries leading to scarring, abcesses, beaded and non-functioning tubes or blockage of tubes. If Tuberculosis is suspected, it should be treated. Normally, infected and damaged tubes do not respond to treatment.
Poly Cystic Ovaries ? Some patients present with irregular periods, excessive hair growth, acne and Infertility and when investigated they show a higher level of male hormones which do not allow proper egg formation . These patients need hormones for egg formation.
Hormonal Disturbance, Failure of the ovaries, Fibroids of the uterus are some of the other causes.
If the sperm count is low or the active sperms are less, we treat the semen sample with latest techniques and equipment. The active and motile sperms are introduced in the uterus of the wife by a painless and a traumatic procedure called IUI or Intra Uterine Insemination. A number of patients conceive by this method alone.
For patients with nil sperms, we have the facility of frozen semen samples from the semen bank where tested and certified samples are provided.
Few patients require IVF (test tube baby)
Our IVF LAB is equipped with Hi-Tech and Ultra modern equipment like CO2 Incubator, Stereozoom Microscope, Laminar Flow, Hot Plates, Stage Warmers, and Aspiration Pumps etc.to enable us to create the best suitable and clean environment for carrying out this highly skilled technique.
There were three major bars to achieving successful IVF. -
First the development of suitable culture media for the oocytes (eggs) and sperms. . Second ?to procure good quality sperms and third to obtain ripe oocytes at the right time. We have crossed the 3 hurdles and now the success of IVF is about 40 %.
IN VITRO FERTILIZATION (test tube baby)- this involves the picking up of eggs from a woman, fertilizing them outside the body with the husbands (or donor) sperms and replacing the resultant embryos into the patient?s womb.
IVF is recommended for those patients with-
Blocked tubes, Pelvic adhesions, Endometriosis, Male factor etc.
Immunological and unexplained infertility, when other treatment modalities have failed to achieve a pregnancy.
TREATMENT SCHEDULE for the female partner in IVF -
This is basically done to bring about the formation of multiple eggs of good quality with the help of hormones. These are used in various combinations and dosages depending on the case history, clinical examination and laboratory tests, to obtain the best results.The injections are usually given daily for a period of 15-20 days during which daily ultrasound monitoring and blood tests off and on give us information on the egg formation. Transvaginal ultrasound is a simple, painless procedure, which involves the introduction of a slender probe into the vagina for viewing the pelvic organs on a screen. The ultrasound is done daily or on alternate days, as required. Once a number of follicles of the required size have developed and the lining of the uterus is ready to receive the eggs Inj Hcg (human chorionic gonadotrophin) is injected. The ovum pickup is generally done 34-36 hrs later.
Ovum pickup-this is a minor surgical procedure performed under ultrasonographic guidance. A short acting general anesthesia is required. The procedure lasts for about 30-45 mts.the patient is normally discharged in the evening.
The husbands semen sample, produced by masturbation, normally collected 2-3 hrs prior to the pickup is processed in the semen lab in such a way that all the active sperms are collected and transferred to the Co2 incubator .the eggs which have been aspirated from the ovaries of the woman are immediately viewed by the embryologist, cleaned and graded and kept with the processed sperms in the incubator under optimal conditions, in a well controlled, sterile environment for about 48 hrs. It is under such conditions that fertilization occurs and early embryonic development takes place. Thus the name ?TEST TUBE.
THE EMBRYO TRANSFER IS A PAINLESS PROCEDURE REQUIRING NO SPECIAL ANAESTHESIA.this is done normally48 hrs after the pickup .the embryos, which have been growing in the incubator, are gently picked up into a Teflon tube and transferred into the womb. The woman can leave the clinic after a few hours.
Success rates-the chance of success of IVF is about 35%. It is known that chances of pregnancy decline with age and presence of endometriosis (a pelvic disease)
Possible complications ? it is a relatively safe procedure. Because more than one embryo is transferred there is a chance of multiple pregnancy.
Another sophisticated and precise procedure required in a number of patients for fibroid uterus or prolapse of the uterus or whenever removal of the uterus is required is Laproscopic Hystrectomy - LAVH. This technique of endoscopic surgery requires minimal stay at the hospital with minimal handling of the tissues thus making recovery for the patient very easy and smooth.
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