Infertility can be caused by various disorders which are amenable to surgical correction. These procedures can help in the following ways – ·
Sunrise Hospital has state of the art equipment and the finest surgeons to give you the best results. The following surgical procedures are routinely done here –
Hysteroscopy – this is a procedure where a tiny telescope is introduced into the inside of the uterus through the vagina and cervix.
Diagnostic hysteroscopy – is performed to evaluate the uterus for any problems which might reduce your chance of becoming pregnant.
Operative hysteroscopy – is used to correct problems inside the uterus and thus helping to increase your chances of both getting pregnant and allowing the pregnancy to continue till term. They include treatments for the following conditions
Laparoscopy – involves introduction of instruments through tiny cuts to perform surgical procedures.
Diagnostic laparoscopy – is used to find the cause of infertility. This involves assessment of the uterus, tubes, ovaries and the pelvis. Any problems diagnosed during this procedure are corrected at the same sitting.
Operative laparoscopy – the various problems treated / procedures done include –
In vitro fertilisation (IVF) involves treatment where a man’s sperms and a woman’s eggs are mixed in the laboratory to create embryos (early pregnancies). These embryos are then transferred back into the woman’s uterus to help her get pregnant. When couples try naturally, the man releases sperms (contained in semen) in the woman’s vagina during sex. The sperms then travel through the uterus to reach the tubes, where it meets the egg to create a pregnancy (fertilisation). This pregnancy passes to the uterus where it attaches (implants) and grows. If all goes well, a child is born approximately nine months later.
Intra cytoplasmic sperm injection (ICSI) is a technique where the sperm is injected directly into the egg as part of IVF treatment. ICSI is indicated in couples when the man’s sperm count is very low or there have been previous problems with fertilisation.
The woman is administered medications to stimulate the ovaries to produce multiple eggs. This process takes between 10-14 days. Prior to this your doctor might give you medications to suppress the ovaries. You would need regular scans and blood tests to monitor your response to treatment.
Once these tests show an appropriate response, a ‘trigger’ injection is given which helps the eggs to mature before they are collected. The eggs are collected under a light anaesthetic, by passing a needle through the vagina under ultrasound guidance. The mature eggs are then fertilized by sperms by IVF or ICSI by the embryologist to create embryos. These embryos are transferred between 2 to 6 days after egg collection into the woman’s uterus by using a fine plastic tube (catheter). This procedure is usually painless. Any spare embryos left over from the treatment can be frozen and used in the future.
Medicines to ‘support’ the pregnancy are given for two weeks after the embryo transfer. A blood test is then performed to check for pregnancy. If you are pregnant, an ultrasound scan will be arranged to check the pregnancy.
Pregnancy rates depend on many factors, the most important being age. The chance of becoming pregnant is different from the live birth rate – which is the chance of you having a child after treatment. International data show that the live birth rate for each IVF cycle started is approximately 35% for women under age 35; 25% for women ages 35 to 37; 15% to 20% for women ages 38 to 40; and 6% to 10% for women over 40.
The most common risk of IVF is multiple pregnancies. Carrying twins /triplets can lead to more problems during pregnancy. This risk can be minimized by transferring optimal number of embryos.
Ovarian hyperstimulation can occur if the ovaries produce too many eggs. The ovaries become large in size and there may be accumulation of fluid inside the abdomen. Women with moderate to severe hyperstimulation may need hospitalization.
The risk of birth defects is similar to those pregnancies conceived naturally. It might be higher in older women, in men with low or absent sperms or if there is a genetic problem in the family.
The Assisted Reproduction Lab is the heart of the unit. This is where fertilisation of gametes (sperms and eggs) by in vitro fertilisation (IVF) and intra cytoplasmic sperm injection (ICSI) is performed.
The fertilised embryos are then grown in the incubators. These special incubators are designed to keep the embryos at the optimum environment to ensure normal growth and development.
IUI or intrauterine insemination is a procedure where your husband’s semen is processed and placed inside your uterus at the time of ovulation to help achieve a pregnancy. During sex, the sperms have to travel through the vagina and the cervix and reach the uterus. Only a few sperms reach the uterus and then to the tubes, where it fertilizes the egg. By bypassing the cervix and by ensuring that good sperms are present at the time of ovulation, pregnancy rates can be improved.
IUI is often recommended for couples who are infertile because of impotence or when the man has an excessively low sperm count, decreased sperm motility, or other sperm problems. It is also useful in couples with unexplained infertility and normal sperm counts. If the female is undergoing ovulation induction, IUI may significantly improve the chances of successful fertilisation.
Taking medications to help you ovulate increases your chance of pregnancy and is recommended at the time of IUI. Ultrasound scans are performed to monitor response to these medications and time the IUI.
A man may masturbate into a sterile cup no more than one hour before a scheduled appointment. This can be done in the privacy at the hospital or alternatively at home.
The semen sample is ‘washed’ in the laboratory. This involves different steps to remove dead and slow moving sperms, bacteria and chemicals. The process also helps in improving the chance of sperm fertilising the egg.
The washed sample is then placed in to your uterus using a fine plastic tube (catheter). You can continue to lie down for a few minutes before going home.
You might be asked to take medications before and after the IUI to help improve the success rates. You can have sex during the month IUI treatment is performed. Avoiding sex does not improve your chance of getting pregnant. A minimum frequency of once every 2-3 days is advised. Day to day activities, travel and diet need not be altered during the treatment cycle.
The success rate of IUI depends upon several factors including the cause of infertility, your age and the sperm count. The success rate of insemination may be as high as 20 percent per cycle.
Fertility preservation is a broad term which involves many procedures to retain fertility in men and women. This mainly applies to people who are being treated for cancer or other illnesses which might prevent them from having children. It may also apply to those who wish to postpone child bearing due to personal or social reasons.
As the age of a woman advances, her chances of becoming pregnant declines as both the quality and the quantity of her oocytes (eggs) reduce. The chances of a miscarriage also increase as well as the risk of having an abnormal pregnancy.
Drug used for treating cancers are life saving, but some of them can cause temporary or permanent damage to the ovaries and testes affecting fertility.
Radiation treatment used to treat some cancers can also cause harm to the ovary and testes. The tissues which are responsible for producing eggs and sperms might get damaged and make the person permanently infertile.
Freezing of sperms
A person who might undergo treatment which might potentially make him infertile - can produce semen by masturbation and get it frozen for future use. It is best to freeze multiple samples (if time permits). In boys who have not yet attained puberty, aspiration of tissue followed by freezing is possible.
Freezing of eggs
Unlike sperms, egg freezing is a more complicated procedure. It involves administration of medications for a period of two weeks or more to stimulate the ovaries to produce multiple eggs, which are then collected by a minor surgical procedure under anaesthesia / sedation. These eggs are then frozen.
Freezing of embryos
For married women, the eggs collected can be fertilised with the husband's sperm (IVF or ICSI) and then cultured to form embryos. These embryos are then frozen – usually in groups of 2 – 3. Of all methods, embryo freezing is the most time tested method and successful. When the woman has completed her treatment and is ready to initiate pregnancy, the embryos are thawed and transferred into the uterus for maturation and birth.
Freezing of ovarian tissue
In patients where stimulation of ovaries to produce eggs is not possible because of the age of the person or paucity of time, ovarian tissues can be collected by a surgical procedure and frozen. This is still an emerging technology and we do not offer it at present.
If you're having radiation applied to an area far from your pelvis, carefully placed shields can reduce your reproductive organs' exposure to radiation and reduce the harmful effects.
Ovarian transposition (oophoropexy)
This surgical procedure is sometimes recommended if radiation is being planned to your pelvis. The ovaries are surgically repositioned just before radiation therapy so that they are as far away as possible from the planned radiation field. This though does not always completely protect the ovaries. After completion of the radiation, you might need to have the ovaries repositioned again or use IVF to conceive.