Assisted Reproductive Techniques

We educate our clients about Assisted Reproductive Techniques (ART), by which we refer to certain methods that are used to achieve pregnancy by artificial or partially artificial means. ART is a reproductive technology used in infertility treatment, which is the only application routinely used today of reproductive technology. It may also include in vitro fertilization treatment. In fact, we are among few service providers in Delhi, offering highly specialized in vitro fertilization services.

In an Intrauterine Insemination cycle, a sample of motile sperm is prepared by the embryologist and placed directly inside the uterus using a very fine catheter. The sperm is deposited before the release of an egg or eggs, in a natural or stimulated cycle. Conception occurs naturally inside the body.

IUI can be offered on a natural or stimulated cycle. On a stimulated cycle (super ovulation),
the size and number of follicle are measured using ultrasonography; a Human Chorionic Gonadotrophin (HCG) injection is given to mature the eggs when the follicles reach a certain size. IUI is performed 24-36 hours after the administration of the HCG injection.

The success rate of IUI is upto 20% per cycle. It is recommended that at least 3-4 cycles of treatment are attempted before considering other options.

Indications for intrauterine insemination

• Unexplained infertility
• Male infertility (mild)
• Failure to conceive after ovulation induction treatment
• Sexual Dysfunction Ejaculatory failure
• Retrograde ejaculation

IVF is a series of highly coordinated steps that begins with controlled ovarian stimulation using external hormones, egg collection, fertilization of eggs and sperms outside the body and replacement of embryos (fertilized eggs) into the uterus.

Ovarian Stimulation
On the third day of menstruation, a regimen of fertility medications is provided to the patient in order to stimulate the growth of multiple follicles of the ovaries. Under close monitoring, patients are provided with an injectable like gonadotropins for approximately 10 days. The monitoring is focused to check the estradiol level as well as the follicular growth.

Oocyte Retrieval
At the stage of adequate follicular maturation, human chorionic gonadotropin is given, which acts as an analogue of Luteinizing hormone causing ovulation. The eggs are then retrieved from the patient using transvaginal technique. In this technique, ultrasound-guided needle is used to pierce the vaginal wall to reach the ovaries. The retrieval procedure takes around 20 minutes and is done under general anesthesia.

Fertilization
For fertilization, eggs are identified by stripping the surrounding cells and semen is prepared by removing seminal fluid and inactive cells. The sperm and the egg are incubated together in the culture media. When sperm count is low, a single sperm is injected directly into the egg through intra-cytoplasmic sperm injection (ICSI). The fertilized egg is then placed in a special growth medium so that the embryos reach 6-8 cell .

Embryo Transfer
Embryos that reach the 4-6 cell stage are transferred 2-3 days after transfer. At the stage 6-8 cell stage, oocyte and embryo quality is judged. The grading of embryos is based on the cell number, fragmentation degree and growth evenness. Number of embryos to be transferred depends on many factors- age and embryo quality being the most important. However, we do not transfer more than 3 embryos. The embryos are transferred into the patient's uterus using a catheter, which goes through patient's vagina and cervix.

This is used when the sperm quality is very poor.This is also used for sperms directly retrieved from the testis or epididymis. This is a highly technical procedure where by a single sperm is injected into the centre of an egg to achieve fertilization.

If the cycle has produced more than two (or three) good quality embryos, those that aren't transferred, may be frozen for future use. These embryos will be frozen at extremely low temperature (-180°C), which ensures that they do not deteriorate over the number of years they are stored.

In a Frozen Embryo Replacement Cycle, the woman takes medications to prepare her womb to receive these embryos. The advantage of this treatment is that there is no need to use hormone injections to stimulate the ovaries.

An ultrasound scan is performed to assess the lining of the uterus to determine whether it is ready to receive the embryo. Once the lining is ready, embryos are thawed and transferred.

Donor Sperms are indicated when there are no sperms in the husband’s ejaculate and the couple are unwilling/unable to afford to undergo IVF with ICSI and surgical sperm extraction or a similar procedure has not been successful previously.

Sperm donors are screened for sexually transmitted diseases including HIV, HbsAg and HCV. They should be free from genetically transmitted disorders. There must be information regarding their blood group, physical characteristics and professional background.

Donor eggs are used when there is premature ovarian failure or reduced ovarian reserve with inability to produce good number and quality eggs. An egg donor is also screened similarly as the sperm donor. It is advisable to have unknown donors than known donors.

This is indicated when there is absence of uterus or severely damaged uterus. In this instance, we insert the couples' embryos into the surrogate to give them a chance of having their genetic child.

Patients with certain ejaculatory disorders or no sperm in the ejaculate may be offered Surgical Sperm Retrieval and given a chance to father their own child (with an ICSI treatment cycle).

We offer the following types of SSR techniques:

• Percutaneous Epididymal Sperm Aspiration (PESA)
• Testicular Sperm Aspiration (TESA)
• Testicular Sperm Extraction (TESE)

For PESA, a small number of sperm is obtained directly from the epididymis, which is the beginning of the outlet tube from the testicle.

If PESA is unsuccessful, TESA or TESE may be offered. In this procedure, the sperm is obtained directly from the testicle.

Indications for Surgical Sperm Retrieval are as follows:

• Congenital bilateral absence of vas deferens
• Obstruction of both ejaculatory ducts
• Azoospermia
• Failed vasovasostomy
• Failed epididymovasostomy