The difficulty in conceiving in spite of frequent intercourse (approximately for a year) is called as infertility. Millions of couples in United States of America are affected by male fertility, female fertility or the mixture of both. The percentile of couples having problem getting pregnant or achieving safe and secure delivery is approximately 10%-18%.
In case of infertility it is 1/3 of the time male factor and 1/3 of the time factors causing due to female problems. The other causes are either a mixture of male and female factors or unspecified in the remaining 1/3 of the cases.
It is quite inappropriate to diagnose the cause of woman’s infertility. According to the cause of infertility, many treatments are available nowadays. Many couples who are infertile opt to conceive a child in the absence of treatment. Approximately 95% of couples successfully become fertilized, after diagnosing for approximately 2 years.
A highly successful, long lasting, reversible contraceptive (LARC) technique of controlling unwanted pregnancy that is utilized by people all around the world to have safe and secure pregnancies and plan their families effectively is called as intrauterine contraceptive (IUC which is more commonly known as IUD). It is one of the best and effective ways of controlling birth and it only takes few minutes to put it into the uterus. If it is inserted by a learned practitioner it is easier and completely safe and it does not require anesthesia or any other type of surgery.
IVF is In Vitro Fertilization which is an assisted reproductive technology (ART). The procedure of fertilization by removing eggs, retrieving a sample of sperm and then mixing an egg and sperm in a laboratory dish manually termed as IVF. A fertilized egg is then transplanted in the uterus. Gamete Intra fallopian Transfer (GIFT) and Zygote Intra fallopian Transfer (ZIFT) are the other forms of ART.
In the succeeding patients IVF can be used to diagnose infertility:
Male factor infertility including decreased sperm count or sperm motility.
Women who have had their fallopian tubes removed.
Blocked or damaged fallopian tubes.
Women with ovulation disorders, uterine fibroids, premature ovarian failure.
Individuals with a genetic disorder.
A fetus which has not yet developed until 5th or 6th day and show a compound cellular structure which is formed by around 200 cells is a blastocyst. The evolution stage prior to the implantation of the fetus in female’s uterus is termed as blastocyst phase.
The benefits of relocating a blastocyst after 5 days are as follows:
The assortment of feasible embryos is made better. Because of the certainty that they have conquered possible success difficulties which are frequently produced in the early stage, embryos which attain this stage provide a finer implantation capacity. Thus for decreasing the possibility of multiple births, we control transfer to only 1 blastocyst or maximum 2 blastocyst.
More physiological synchronization is allowed between the responsiveness of the endometrium and the embryonic phase.
Five days transfer is allowed by current Spanish Law, which facilitates the accurate control of embryo development and the relocating of only the embryo’s which are chosen naturally to attain an maximum state of development which in turn allows a more favorable rate.
Our fertility Center has been in the frontline of gestational surrogacy expanding and developing egg donation, since 1995. One of the most successful and largest Third Party Reproductive Programs in the India is currently Our fertility center. Apart from that we are among the few infertility clinics who are able to provide egg freezing facility.
Our fertility Third Party Reproductive Program is been persistent in expanding at a rapid pace, over the former years. Patients from All States and all over the India are using these services. The patients which are not from town are supervised where they live using our procedure and their rotation is.
Over the past several years, our Third Party Reproductive Program has continued to expand at a rapid pace. These services are currently being used by patients from across the All States and around the world. Out-of-town patients are monitored where they live utilizing our fertility protocols and their cycle is synchronized with either their egg donor or gestational carrier which decreases costs and improves efficiency. This technique also decreases the travelling expenditure and reduces the emotional suffering of the patients because they spend more time at home.
The extreme concentration is on complete psychological and medical preconception estimation and analysis of all patients participating in our third party program. The assessment of all the egg donors and gestational surrogates along with their sexual partners, as well as the recipient couples and/or genetic parents.
Around 1/6 couples are affected by infertility. Couples who are not able to conceive throughout the course of one year are treated with diagnosis of infertility. It is termed as male infertility when the complication lies within the male partner. Among all the infertility cases, about 30% is contributed by the male infertility factor and it alone accounts for about 1/5th of all the infertility cases.
The method in which a single sperm is instantly inserted into an egg to fertilize it and then that fertilized egg i.e. embryo is transplanted to womb is ICSI. For male infertility it is one of the successful and cost effective diagnoses. This technique is more beneficial for men having low or zero sperm count. The sperm is removed either from testicles by using TESA or epididymis by using PESA. ICSI comes in handy if male have dysfunctional sperm which can fuse with the egg.
To immobilize and pick up a sperm, a sharp and delicate needle is used and the needle is removed after the sperm is injected into the cytoplasm of the egg.
The couples often choose ICSI as compared to IVF, since the success rate of ICSI is remarkably higher than IVF and when the standard IVF method does not produce appropriate results for them. The lesser the age of the patient, the greater are the chances of success; the success rate of ICSI is in direct proportion to the age.
IMSI is termed as Intracytoplasmic Morphologically Selected Sperm Injection. On the basis of evaluation of single sperm morphology, spermatozoa are been selected. Under a distinct microscope under close magnification, selection is been carried out. Then morphologically best sperm is utilized for micro-manipulative fertilization.
The technique of selecting the most appropriate sperm for fertilization in the IVF protocol is called as PICSI. And in this process only best sperms are being selected because the superior the quality of the sperm the greater the chances of successful fertilization. PICSI is built on the concept of Hyaluronic binding, Hyaluronic is a material that you can find in most parts of your body, including around the female egg, it is more than just a particularly difficult to spell.
PICSI selects sperm according to the their capacity of binding to the hyaluronan around an egg cell i.e. called hyaluronic acid along a test called Hyaluronan Binding Assay.
This is important because the process of fertilization is planned to root out inadequate sperm and collect the best, so that only the most appropriate sperm with the foremost genetic substance makes it to the egg and fertilizes it. The higher the maturity of a sperm cell, the greater the ability of the sperm to bind to hyaluronic acid, which means that, it is better suited to fertilizing the egg. PICSI works on the foundation that if it is good in this aspect, than it is good in all the other aspects, including their ability to move and get to an egg i.e. motility and specific form and layout required to do a sperm’s work i.e. morphology.
A petri dish which is been covered with smaller segments of hyaluronan is a PICSI. Sperms are being kept in the plate and those that bind to these hyaluronan dots are selected for the ICSI process, which will directly insert these sperm cells into egg cells to fertilize it.
The 1st live birth was not announced till 1990, even though reports on microsurgical epididymal sperm aspiration with IVF were visible in the literature since 1984. The process of microsurgical epididymal sperm aspiration includes protective dissection of the epididymis below the operating microscope and cut of a single tubule.
Fluid spills from the epididymal tubule and pools in the epididymal bed once it is being incised. Amalgamated fluid is then aspirated since the epididymis is richly vascularized and this method always leads to contamination by blood cells which can influence sperm fertilizing ability in vitro.
Because of the contamination of the aspirated sperm with blood substance, our earlier experience with this pool and aspirate method was not successful. This seemed to result in damaged sperm function and incapacity to pollinate oocyte in vitro.
Due to this cause a technique of micro puncture of the epididymal tubule to ignore blood substance contamination. This method mixed with better ovarian stimulation methods and micro-manipulation of recovered sperm, has created remarkably better fertilization and successful pregnancy rates in females with inability to reconstruct reproductive barrier.
The method of microsurgical epididymal sperm recovery offers the benefits of reducing contamination of epididymal liquid with blood cells, frequent aspirations may be executed and aspiration of enough amount of fluid for instant use as well as for cryopreservation re feasible.
Many azoospermic patients with NOA i.e. Non Obstructive Azoospermia experience for sperm aspiration as segment of their in vitro fertilization process. Since sperm may be present on certain but not all parts of the testes of such men, numerous samplings of the testicular matter are normally executed to raise the probability of searching sperm in non-obstructive azoospermia patients.
These samplings are done by two ways:
Testicular Sperm Extraction i.e. TESE is really a surgical biopsy of the testis or Testicular Sperm Extraction i.e. TESA is executed by pasting a needle in the testis and aspirating liquid and tissue with opposed pressure. Non urologists who are also called as andrologist perform more and more sperm extraction.
Sperm can be found in approximately 50% of men with non-obstructive azoospermia, with the advancement in sperm recovery methods. Process that permit for the precise abolition of micro volumes of testicular tissue is part of active sperm production with the use of a microscope, enhancing sperm yield is called as Micro-surgical testicular Sperm Extraction i.e. MICROTESA.
This technique is the most beneficial techniques than any other sperm retrieval techniques. It increases the production of spermatozoa while reducing the volume of testicular tissue needed and vascular injury produced, by making recognition of blood vessels effortless. Sperms gathered from these patients are very strenuous to cryopreserve.
Almost everyone is aware of people who have taken the help of technology for conceiving. And the best part is certain new developments in reproductive medicine symbolize superior pregnancy success rates for people suffering from infertility. Mark P. Leondires, MD, medical director and lead infertility doctor with reproductive medicine associates of Connecticut says, ‘It’s the most exciting time I have seen in reproductive medicine, basically in past 5 years, our field has changed.’ These new revolution and developments are some of the thrilling part of it.
The genetic describing of embryos in advance of implantation (as a form of embryo profiling), and occasionally even of oocytes before fertilization. PGD is also regarded as similar to prenatal treatment. Its main benefit when it is utilized to screen for a particular genetic disease is that it eliminates selective pregnancy termination as the technique makes it highly appropriate that the baby will be rid of the disease under consideration. Thus PGD is an adjunct to assisted reproductive technology and needs in vitro fertilization (IVF) to acquire oocytes or embryos for assessment.
Handyside, Kontogianni and Winston performed the world’s first PGD at the Hammersmith Hospital in London. Female embryos were particularly transmitted in couples at the chance of X- linked disease, which resulted in two twins and a singleton pregnancy.
The process that doesn’t look for a particular disease instead use PGD methods to recognize embryos at risk is termed as the term preimplantation genetic screening i.e. PGS. The PGD permits analyzing the DNA of eggs or embryos to choose those that convey some mutations for genetic disease. It is beneficial when there is prior chromosomal or genetic disease in the family and within the factors of in vitro fertilization programs.
The process can also be called as preimplantation genetic profiling to adjust with the fact that they are usually utilized on oocytes or embryos before the implantation for reasons other than treatment or scrutinizing.
The process executed on sex cells prior to fertilization can be referred to as techniques of oocyte assortment or sperm assortment, even though the techniques and goals partially overlap with PGD.
Zona pellucida is a shell which surrounds the eggs which are not fertilized. It makes sure that only a single sperm cell enters and thus fertilizes the egg. Zona pellucida keeps the cells of the embryo well balanced, after the fertilization of the eggs.
Zona pellucida gets stronger, may be because of the culture conditions, throughout the cleavage stages and in vitro culture of the human embryo. Extracting the egg for in vitro fertilization and micro insemination removes it from its natural environment. This process tends to result in egg shells that harden quicker than seen in vivo.
Mostly women more than 37 years of age, have a propensity to produce eggs with a tougher zona pellucida than woman who are comparatively less in age. The same goes with the woman’s who are diagnosed with higher doses of FSH i.e. Follicle stimulating Hormone.
The issue of a harder zona pellucida is that the eggs cannot hatch or utilize immoderate energy for coming out, thus it is not able to link to the woman’s uterus. For being pregnant it is necessary to hatch the eggs.
There are many techniques to help the fertilized egg to hatch and link to the uterus laser assisted hatching is one of them. Acid or mechanical hatching of a part of zona pellucida are the alternatives. A gentle and safe way to incapacitate a part of zona pellucida i.e. a laser assisted hatching is offered at Copenhagen Fertility center.
The embryo is been transferred into the woman’s womb, after diagnosing the fertilized egg with laser assisted hatching. Scientific researches have proved that one technique of assisted hatching is not greater than other techniques.
Latest meta- research unveiled that females who experience IVF treatments frequently without any successful results, double their possibility of a pregnancy with the use of assisted laser hatching.
Laser assisted hatching for patients who have experienced frequent diagnosis without conceiving and/or in instance where the female patient is over 37 years of age at Copenhagen Fertility Center. The probability of better chances for pregnancy is scrutinized medically prior to suggesting laser assisted hatching.
Oocyte freezing techniques
For maximizing oocyte freezing techniques several attempts have been done. Slow freezing is one the important techniques. Slow freezing gives satisfactory results for human oocyte nowadays. One of the main problems during the process of slow freezing is the duration of exposure of oocyte to the cryoprotectants. Actually the cooling rate should be gentle enough to permit dehydration and to resist intracellular freezing, but quick enough to resist the toxicity effects of the cryoprotectants. To reduce intracellular ice formation and following structural damage slow freezing and rapid thawing has been established.
The technique of slow freezing is an excellent operating process in most IVF centers; however it is a consuming process. The traditional oocyte slow freezing techniques is cooled to7 C at -1 to -2C/min, it is seeded at -7 C, and further cooled to -30C to -35 C at -0.3 C/min, then free falling to -50C prior to jumping into fluid nitrogen, it approximately takes around 3 hours for the whole freezing process. Till now there is no adequate proof to prove that such slow freezing is mandatory.
Certain different solutes have been utilized to preserve human oocytes against the damage caused due to freezing techniques such as dimethyl sulphoxide i.e. (DMSO), ethylene, propylene glycol and glycerol. Certain alterations in the slow freezing techniques have been suggested to increase the survival rate. These alterations are as below:
1. Improved oocyte survival rates can be attained by relatively high sucrose concentrations in the cooling (0.2 ml/l) and thawing solutions (0.3 ml/l). It also guarantees the uplifted success rates in terms of embryo development, fertilization and clinical result.
2. It reduces potential freezing damage to the oocyte cytoskeleton, by conveying the cryoprotectants exposure process at 37C.
3. By increasing the seeding temperature near to the melting point of the solution as much as feasible (-4.5C).
4. Decreasing the sodium content of the cooling medium to a very less amount or abolishing sodium i.e. choline based cooling medium with 1.5 M 1, 2- propanediol and 0.1 M sucrose) shall permit oocytes to freeze more effectively and efficiently.
5. A very little portion of (0.15 M) of intracellular trehalose during the non-availability of any other cryoprotectants provides a remarkable prevention against the freeze related tensions. Microinjection initiated trehalose into oocytes.Vitrification
Vitrification i.e. ultra-rapid freezing method is a substitute to slow freezing process. Vitrification techniques are steadily becoming extensively used in methods in IVF amenity. Vitrification utilizes high concentrations of cryoprotectants and fast freezing that harden without the generation of ice crystals.