Details on infertility treatments

1. FERTILITY TREATMENTS
Fertility treatments do
not work miracles, they
just help nature take its
course when it cannot do
on its own.

2. Definition
Infertility is the inability of a sexually
active, non- contracepting couple to
achieve pregnancy in one year.

3. Explanation of Natural Phenomena
Human beings are the out comes of a happy
encounter between sperm and an egg.In
natural reproduction, ejaculation sends millions
of sperm into the vagina on a real obstacle
race to reach the egg (like marathon race).
The sperm travel from the vagina to the
fallopian tubes, where they meet the egg. Out
of millions of sperm, only one will able to
fertilise the egg by penetrating its membrane.

4. Types of Treatment
• Intra Uterine Insemination (IUI) or Ar tificial
Insemination- Intra uterine insemination (IUI)
involves the extraction of a semen sample from the
male partner or a donor, which is directly injected into
the uterine cavity around the time of ovulation.
Steps in an IUI treatment
• First, we stimulate the ovaries with medications. The
aim is to produce 2 or 3 eggs in each of the ovaries.
• Then we monitor the response by sonography
• We trigger the final process of ovulation when the
follicle is of a certain size with an injection of hCG.

6. • The husband is required to give a semen
sample on the day of an IUI. Alternatively, a
previously preserved sample can also be used.
The semen sample is processed to separate the
motile and normal sperms.
Performing the actual IUI:
This is a very simple outpatient procedure.
 The IUI is then carried out after the trigger
injection (hCG) is administered.
The prepared semen sample is injected directly
into the uterus using a fine catheter.
• Precautions after an IUI treatment- IUI is a
simple procedure and does not require any
special precaution. You need to rest for a few
minutes after the procedure, after which you can
resume all your routine activities.

7. In Vitro Fertilization (IVF)
In vitro fertilization refers to
a procedure where the
woman's eggs are removed
and fertilized with the man's
sperm outside the body, in
a laboratory. The embryos,
thus formed are then put
back into the uterus to
achieve a pregnancy.
On 25 July 1978, world's
first human test tube baby
Louise Joy Brown was
born.

8. IVF step-by-step
1) Before commencing the treatment- Before
starting any treatment, it is necessary to discuss
any issues or concerns you may have with
center counselor. Consent forms must be
signed and screening tests will be verified.
These tests will be for:
Women
• Hormonal Asses
• Complete Hemogram, Blood Sugar, Urea, SGPT, Hepatitis B (HBs Ag),
VDRL, HIV
Men
• Semen test within 6 months, Semen Culture
• Hepatitis B (HBs Ag)
• HIV
• 2) Commencement of the treatment
• Patient must for a check up on the second day of your menstrual cycle

9. • Ovarian stimulation
• Medications will be administered
to stimulate the ovaries to produce
several eggs in order to increase
the chances of pregnancy.
• 4) Ultrasound examination
• Regular monitoring by vaginal
ultrasound examination is
conducted after the administration
of medications to measure the
response of your ovaries with
regard to the number and size of
the follicles.
• 5) hCG injection
• hCG injection is given to trigger
the final maturing of the eggs
when they are ready for collection.
Egg collection is planned
approximately 36 hours after the
hCG injection. The embryologist
will inform you when your
husband/partner is required to give
his semen sample.

10. 6) Ovum pickup (Egg Collection)
The procedure of removing the eggs from the ovaries is carried
out with the help of transvaginal sonography under general
anesthesia. The procedure takes about 15 –30 minutes, eggs
are collected from each ovary. You will be able to go home,
three hours after the procedure is completed. It is common to
have some vaginal bleeding after this procedure, but that
settles down in a day or two. Discomfort as a result of the
swelling of the ovaries is common.
7) Sperm collection
Fresh semen sample should be collected on the day of the ovum
pick-up (egg collection). However, if a fresh sample cannot be
produced on the same day, a previously frozen sample can be
used.
8) After ovum pickup
Following ovum pick-up, the eggs will be fertilized in the lab
either by standard IVF or by ICSI. On the next day, the
embryologist will examine the eggs for fertilization.

11. 9) Embryo transfer:
It is performed two to five days after egg collection. The
embryo is transferred through the cervix into the uterus
via a thin, soft plastic tube guided by sonography. You
will be asked to take some injections and/or tablets after
the embryo transfer to support the luteal phase. It takes
only a few minutes and causes no discomfort. However,
heavy work such as lifting weights or climbing stairs is
not advised.
10) Embryo Freezing:
If there are more well-developed embryos, it is possible
to freeze them for a later transfer, if necessary. This
procedure will be discussed with you before the embryo
transfer. Separate consent forms must be signed for
embryo freezing.

12. 11) Pregnancy test
Approximately two weeks after the embryo transfer, you will
undergo a test for beta-hCG to check if gestation has been
achieved. If the test is positive, a vaginal ultrasound scan will be
performed to confirm this and view the gestational sac. If the beta-hCG
test is negative, further treatment will depend on whether you
have frozen embryos or not.
Precautions after an IVF treatment:
•No heavy lifting
•No strenuous exercise

13. Intra-Cytoplasmic Sperm Injection (ICSI)
ICSI is a process where a single
sperm is injected directly into the
egg using a fine glass needle. The
main objective of ICSI is to ensure
that the spermatozoa fertilize the
egg membrane. The woman is
stimulated with medications and
then an egg retrieval procedure is
performed so that several eggs
can be obtained to attempt an ICSI
procedure.

14. SURROGACY
Surrogacy involves using one woman's uterus to implant
and carry the embryo and deliver the baby for another
person or couple. This method of assisted reproduction is
one that many couples choose after numerous
unsuccessful attempts of conception and other fertility
treatments.

15. Gestational Surrogacy
• Gestational Surrogacy also known as Full
Surrogacy is when the surrogate mother has
no genetic link to the child she is carrying.
The embryos are generated from the eggs
and sperm of the ‘genetic’ parents and the
surrogate just acts as the host for them. The
woman producing the eggs goes through an
IVF cycle while the surrogate prepares her
uterus for conception. The eggs are then
fertilized outside of the woman's body and
the resulting embryos are implanted in the
uterus of the surrogate.

16. EGG DONATION
Ovum (egg) donation is a process where the eggs of a
healthy young woman (the egg donor) are fertilized with
the sperms from the patient's husband and the resulting
embryos are then transferred into the patient's uterus.
Process Of Egg Donation
The process of egg donation starts with the selection of
a donor. The donor's ovaries are stimulated by a
stimulation regimen to produce multiple eggs. The eggs
are then retrieved, fertilized, and embryos are cultured.
The best one or two embryos are transferred into the
recipient's uterus. Donating eggs does not have a
negative effect on the fertility of the woman and does not
impact her chances of conception in the future.

17. SPERM DONATION
Sperm Donation :-
Many couples experiencing male factor infertility may
choose to undergo donor insemination for IUI or IVF
procedures in order to achieve pregnancy.
Indication for sperm donation:
1. If there are significant abnormal semen
characteristics
2. Irreversible azoospermia
3. A previous vasectomy
4. Previous radiation or chemotherapy treatment or
another irreversible male fertility factor
5. Carriers of a known hereditary or genetic disorder
6. If the female is Rh sensitized and the male is Rh
positive

18. • Use of sperm donated by a relative or a known friend
of either the wife or the husband shall not be
permitted. It will be the responsibility of the ART
clinic to obtain sperm from appropriate banks;
neither the clinic nor the couple shall have the right
to know the donor identity and address, but both the
clinic and the couple, however, shall have the right
to have the fullest possible information from the
semen bank on the donor such as height, weight,
skin colour, educational qualification, profession,
family background, freedom from any known
diseases or carrier status (such as hepatitis B or
AIDS), ethnic origin, and the DNA fingerprint (if
possible), before accepting the donor semen. It will
be the responsibility of the semen bank and the
clinic to ensure that the couple does not come to
know the identity of the donor. The ART clinic will be
authorized to appropriately charge the couple for the
semen provided and the tests.

19. CRYOPRESERVATION
It is the process of
preserving an
embryo/egg/sperm at
sub-zero temperature.