IN VITRO FERTILIZATION or IVF is a technique of assisted reproduction. In this procedure the eggs of the patient (woman) are fertilized with sperms obtained from her partner. The process is done in a specialized laboratory with all facilities for IVF. The sperms or embryos from a donor may be used in certain conditions.Dalmia Infertility Centre is the best infertility Centre in Central India. We at Dalmia IVF Centre Gwalior are dedicated towards helping the couples struggling with male and female infertility. Dr Pratishtha Dalmia has years of experience in dealing with infertility and has brought a ray of hope in the lives of patients failing to conceive naturally.
IVF Can Help You !
IVF is a procedure used in couples with failure to conceive naturally. This might help the couples with following conditions
Females with blockage of both fallopian tubes (tubal block).
Failure to conceive after Intrauterine insemination (IUI), ovulation induction (OI).
PCOS (a condition with multiple cysts in the ovary).
Patients with endometriosis.
Couples needing oocytes from a donor.
Male Factor Infertility.
Infertility with unknown causes (Unexplained Infertility).
How is IVF Done ?
The complete cycle of IVF takes 4 to 6 weeks.
IVF is a procedure in which the egg obtained from a woman is fertilized outside her body. Embryo is implanted inside the uterus to develop into a fetus. There are following steps involved in IVF :-
Preparation prior to the treatment – to assess your and your partner’s general wellbeing some blood tests are done before starting the treatment. Some tests are done to check your hormone levels.Keeping in mind your age and medical history your consultant may order few other tests.
Step 1 – Ovarian Stimulation or Super Ovulation :
The ovaries are stimulated to produce several eggs by giving medications to you. You will be given these injections by our staff in the hospital or you may be taught self-administering these hormones if needed. These hormones stimulate the ovaries to produce several eggs and thus increase the chances of a successful pregnancy.
The length of this phase depends on the response to the administered hormones. Depending on your case history and test reports, there are various protocols available which are decided according to your requirement.
These fertility drugs may cause minor side effects like bloating, headache, stomach upset etc.
Monitoring of response to the treatment is done with blood tests and a series of transvaginal ultrasounds.
Step 2 – Egg retrieval or Egg Collection :
You will be given light anaesthesia; with the help of Transvaginal ultrasound, the eggs retrieval (collection) from the ovary is done. This procedure takes about 20- 30 minutes and you can go home about 2-3 hours after the procedure. Slight abdominal discomfort or vaginal spotting may occur in few patients but this is relieved in a day or two. You can contact our consultants at Dalmia Infertility Centre if you experience any of these symptoms.
Step 3 – Sperm Retrieval :
Sperm retrieval is the collection of the semen sample. A fresh semen sample from your partner is collected. Ideally the sample should be produced on the same day when your eggs are collected and should reach the Dalmia Infertility Centre in 30 minutes. Due to some reason if the sample cannot be collected the same day then a frozen semen sample of your partner can be used.
STEP 4 – Fertilization and Embryo Transfer :
The eggs collected are then fertilized by the sperms from the semen in an IVF lab. This fertilization is either done by the conventional method or by intracytoplasmic sperm injection (ICSI).To confirms fertilization regular monitoring of the eggs is done by an embryologist in the specialized lab of Dalmia IVF Centre.
Following fertilization, an embryo is formed. Out of the embryos developed in the lab, two or three will be transferred to the uterus. The day and the number of embryos to be transferred will be discussed with you. The embryo is transferred into the uterus under sonographic guidance using a thin, soft plastic tube that is passed through the cervix.
This procedure of embryo transfer is almost painless and does not require administration of any anaesthetic.
Step 5 – Pregnancy Test :
Two weeks after the embryo transfer a pregnancy test (beta HCG) is done. One week after a positive test, a vaginal ultrasound is done to confirm the pregnancy and to see the gestational sac.
INTRAUTERINE INSEMINATION or IUI is a procedure wherein the partner or donor sperms are placed directly in a woman’s uterus. The fertility drugs may or may not be used. This procedure is done around the time of ovulation.
Why IUI ?
IUI is primarily used to help couples failing to conceive due to male factor infertility.
When malefactors like decreased sperm count or decreased motility of the sperms are the cause of Infertility then IUI is used where the semen sample containing motile sperms is placed directly inside the uterus instead of the vagina. The other conditions in which IUI can help are :
Infertility Due To Cervical Causes –
The cervix is a cylinder-shaped structure that connects the uterus and the vagina. The cervix must allow the sperms to pass into the uterus and meet the waiting egg. Sometimes the cervical mucus is unusually thick and doesn’t allow the passage of the sperms, a cervical scar (maybe due to a previous surgical procedure) can obstruct the sperm movement. In such cases of infertility due to cervical factors, IUI helps as your cervix is bypassed and the sperms are directly placed in the uterus.
Infertility due to Ovulation related problems –
This will be seen when women have the failure of ovulation or fewer number of eggs is produced.
Infertility due to Endometriosis –
Endometriosis is a condition in which tissue similar to that lining the uterus (endometrium) grows at other sites like ovaries, fallopian tube etc. The most common symptom is pelvic pain. Endometriosis can cause infertility or subfertility.
Procedure of IUI
You will generally be advised ovulation stimulating medications (gonadotropin injections or oral medications) from day 2 or 3 of your menstrual cycle to induce ovulation. These medicines are given for 5 to 10 days. You will be monitored for egg maturation every 3 to 4 days by ultrasonography. HCG injection may be given to you to induce ovulation. About 24-36 hours after this you will be called at the Dalmia Infertility Centre for IUI.
The semen sample of your partner is collected on the day of IUI. The semen sample is then washed in the lab to separate semen from seminal fluid. This semen is then injected inside the uterus using a catheter. Thus the number of sperms that may reach the fallopian tubes is higher and there are more chances of the egg being fertilized.
The procedure of IUI takes about one to two minutes. After the procedure, you need to rest for a brief period and then you can continue with your daily activities. You may experience mild pain or spotting after IUI but no major complications. In case of any discomfort, you can contact our specialists at Dalmia Infertility Centre.
Risks Associated with IUI
When ovulation stimulating medications are used along with IUI there is a risk of multiple pregnancies (twins, triplets or more). Infection is a very rare complication.
What is ICSI ?
ICSI stands for Intracytoplasmic Sperm Injection. It is a procedure in which the sperm is injected into the cytoplasm of the oocyte (egg). It is one of the specialized forms of In Vitro Fertilization (IVF).
This technique is used in cases of male factor infertility. Sometimes there are no sperms in semen (azoospermia) or are poorly motile, the sperm count is low or the sperms are not able to penetrate the egg, in such cases the process of fertilization may not occur. This is when ICSI is used to aid the process of fertilization.
At Dalmia Infertility Centre, Gwalior both the conventional and this advanced form of IVF (ICSI) are available. Dalmia Infertility Centre is one of the best and leading centres in Gwalior running an infertility clinic with a dedicated specialized lab for this.
What is done in ICSI ?
For ICSI first the oocyte or the egg is collected from the female with the help of a transvaginal ultrasound.
This is followed by the collection of semen from the male partner, usually the same day. The semen sample collected will be examined at our Dalmia Infertility Centre lab to check for the presence of sperms. One of the sperms is then selected and immobilized. With the help of a microscope using a micropipette, the immobilized sperm is then injected in the inner part of an egg. The following day the egg is checked for evidence of fertilization.
The embryo formed is transferred to the uterus on the day 3 or day 5. When the embryo successfully attaches to the wall of the uterus and grows to form a fetus, the pregnancy test can be taken after 2 weeks.
WHO defines Infertility as the “Inability of a sexually active, non-contracepting couple to achieve pregnancy in one year.” Infertility is not always due to female factors but can also be due to problems associated with the male partner. About one-third of cases of infertility can be due to malefactors. Dalmia IVF Centre offers services related to male infertility through its consultant andrologists and a well-equipped andrology laboratory.
Causes of Male Infertility
The various factors that can cause infertility in males are the problems related to
- Sperm production.
- Sperm motility or movement.
- Number of sperms or sperm count.
- Shape of sperms.
- Trauma to the male reproductive parts.
- Infections – that are untreated like gonorrhoea, Chlamydia.
- Hormone disorders – like low testosterone production.
- Medical conditions- like undescended testis, varicocele, retrograde -ejaculation.
- Various drugs can cause infertility like those used for cancer treatment, treatment of rheumatoid arthritis, calcium channel blockers (used for treating hypertension), patient with a history of drug abuse (marijuana, cocaine etc.).
A detailed history and evaluation can help in identifying the issues causing male infertility. Our andrologists at Dalmia IVF Centre can provide you with valuable advice and appropriate treatment.
Features of Male Infertility (Signs & Symptoms)-
The main sign of infertility in a male is the inability to conceive a child. There may be other features that a man may not notice or may not complain of. Absence of sperms in the semen, a condition known as azoospermia is a major cause of infertility in males. Sometimes other signs and symptoms may be seen like –
Low sperm count in semen – Semen is the fluid released (ejaculated) at the time of male orgasm. The normal sperm count in the semen is about 39 million per ejaculate. The condition wherein the sperm count in the semen is less than 15 million per ml is known as Oligospermia. A healthy sperm count in the semen is essential to impregnate a woman. Low sperm count or oligospermia is one of the common causes of male infertility. To diagnose oligospermia, a semen analysis is done. For analyzing the sperm count, your semen sample will be collected. This semen sample will be then examined in the Dalmia IVF Centre’s Laboratory.
Problems associated with sexual intercourse – Disorders in sexual function may be seen like sometimes the amount of semen released during ejaculation may be less, difficulty in maintaining an erection during intercourse (erectile dysfunction), retrograde ejaculation (the semen released goes back into the urinary bladder instead of appearing at the tip of the penis), diminished sexual desire etc.
Dilated veins around the testicles (varicocele).
Abnormal swelling or pain in the testicular area.
Abnormal enlargement of breasts known as gynecomastia may be seen.
Signs of chromosomal abnormalities or hormonal disorders- characteristic features known as secondary sexual characteristics may not be seen like facial hair (beard, moustache), pubic hair may be sparse, indicating chromosomal or hormonal disorders.
Diagnosis of Male Infertility
Generally, a female is thought to be solely responsible for failure to conceive. In most cases of couples seeking an infertility specialist consultation, it has been found that both the partners could be having issues causing infertility, whereas in another half there could be either issue in the male or female partner.
The causes of male infertility need to be thoroughly investigated. At Dalmia Andrology Unit we do a series of tests to evaluate the male partner. Tests like semen analysis, hormonal profile, radiological investigations like an ultrasound of scrotum, genetic testing and post-ejaculation urinalysis are available.
General examination and detailed history – The first step in evaluating the patient for male infertility is a detailed physical examination to look for any abnormality in external genitalia (penis, scrotum). History taking involves enquiring about any illnesses, chronic health problems, history of any injury or surgery that might damage the genitals, any inherited conditions or diseases that run in your family.
Semen Analysis – The semen analysis is a test of the semen done to evaluate certain characteristics of the spermatozoa or the sperm-like number, motility, size and shape (morphology) etc.
Collection of the semen sample – For semen analysis the sperm sample needed should ideally be collected at our Dalmia IVF Centre laboratory or if the patient is uncomfortable the sample can be collected at home and should reach the Dalmia IVF Centre at room temperature within one hour.
The semen is then evaluated at the Dalmia IVF Centre lab to look for the sperm count, to check for the motility of the sperms, to see the size and shape (morphology) of the sperms. Also, the volume of the semen is noted. The semen is also evaluated to look for any infections that may cause infertility. The diagnosis is made by testing repeated semen samples and not based on a single report.
Normal Semen Analysis Report – The normal volume of semen is about 2-5 ml per ejaculate. If a man produces semen less than 1.5 ml per ejaculate the amount is severely low. The normal concentration of sperms should be about 15 million/ ml and the total sperm count should be about 39 million/ejaculate.
Oligospermia – If the sperm count is less than 15 million/ml it is known as Oligospermia.
When there are no sperms in the semen it is known as Azoospermia
Sperm Motility- The sperms normally move forward and this is known as Progressive motility. When the sperms move in any direction it is called Total motility. To reach the eggs in the female reproductive tract the sperms need to have forward motility. The fast, forward-moving sperm meets the egg and fertilizes it. Also, about 50% of sperms should have forward motility to increase the chances of fertilization. When sperms have reduced motility it is called Asthenozoospermia or Asthenospermia.
More than 58% sperms in the semen should be alive; this is known as the Vitality of the semen.
Morphology of the sperm – Morphology refers to the size and shape of the sperm or how your sperm looks like under the microscope. The sperms are examined under the microscope and the percentage of abnormally shaped sperms is noted.
Sperms develop in the testes. They have a head, a midpiece and a tail. The heat penetrates the egg during fertilization. About more than 15% of normal forms should be present to increase the likelihood of fertilization. The higher percentage of sperms abnormal in morphology is termed Teratospermia.
Several factors can affect sperm morphology like exposure to toxins, chemicals, radiation, smoking etc.
If your semen analysis report shows any abnormality, a repeat test can be done after 4-6 weeks. Many other tests may be done along with the semen analysis to find out the cause of the abnormal report and to arrive at a diagnosis.
Ultrasound of the scrotum – Scrotum is a pouch of skin that houses the testes. Testes or testicles are two oval-shaped male reproductive organs that produce the sperms and hormones called androgens like testosterone. Testosterone is responsible for male sexual development, development of secondary sexual characteristics like facial and pubic hair, for supporting spermatogenesis and erectile function. Certain conditions affecting the testes like a varicocele (enlargement of veins around the testes), hydrocele can be diagnosed by ultrasonography. Varicocele affects sperm development and may be the cause of infertility in a male.
Hormonal profile – Some hormones control the production and release of Testosterone. Disorders in the production of these hormones like luteinizing hormone (LH), follicle-stimulating hormone (FSH) can affect the development and function of testes. Blood tests are done to evaluate the levels of these hormones.
Post-ejaculation urinalysis – The urine sample of the male is analyzed after the ejaculation to look for the presence of sperms. The sperms after ejaculation should be moving out through the penis. Their presence in the urine indicates that they are travelling backwards into the bladder, known as Retrograde Ejaculation. This occurs when the muscle (sphincter) that closes the urinary bladder during ejaculation is not functioning properly. This may be seen after prostate surgery, surgery for testicular cancer, in diabetics, as a side effect of certain drugs like antipsychotics and antidepressants.
Genetic Testing – Certain cases of male infertility are due to changes in the DNA of the sperm. Healthy sperm DNA is essential for the sperm to penetrate the egg or the oocyte. Damage in the sperm DNA can be attributed to many causes such as advanced age, infections, exposure to toxins, chemicals etc.
One such test is the DFI- DNA fragmentation index helps to identify the defects in the DNA of the sperm.
Sperm Visibility Tests (MACS)- Magnetic Activated Cell Sorting- is a method to identify the functional sperms i.e. sperms that do not show cell damage and selecting them. Selecting the functional sperms through MACS increases the probability of achieving success in ART (Assisted Reproductive Techniques) like IVF.
Transrectal Ultrasound – The prostate is a gland present in front of the rectum, between the urinary bladder and the penis. The prostate secretes fluid that provides nourishment and protection to the sperms. Any obstruction at the level of the prostate can hamper the flow of the semen to the penis. Transrectal USG helps in evaluating the prostate. Also, the ejaculatory ducts and the seminal vesicles that carry the semen can be examined by Transrectal ultrasound.
Testicular Biopsy – Testicular biopsy is a surgical procedure in which a small amount of testicular tissue is taken for examination. This tissue is examined under the microscope. Nowadays, testicular biopsy is mainly done to obtain the sperms for ARTs (IVF, ICSI). It also plays an important role in the diagnosis of obstructive azoospermia (absence of sperms in semen due to some obstruction in the flow of sperms to semen). Surgical removal of the obstruction in the male genital tract can help in restoring the sperms in semen and can result in natural conception.
Surgical sperm extraction procedures – These are done in cases of male infertility to look for the presence of sperms in the epididymis (it is a tube that stores sperms) and testes. These procedures are PESA (Percutaneous Epididymal Sperm Aspiration), TESE (Testicular Sperm Extraction)and TESA(Testicular Sperm Aspiration).
Hormonal profile – If the sperm count is less than 15 million/ml it is known as Oligospermia.
In cases of male infertility with azoospermia or very low sperm count, these surgical sperm retrieval techniques are used to obtain the sperm for assisted reproduction (IVF, IUI). Most commonly the cause of low sperm count in the semen is obstruction at some level in the tubes carrying and transporting sperms. These surgical procedures help in obtaining the sperms needed for fertilization of the egg.
The Male Reproductive System
The male reproductive system consists of internal parts and external parts.
External Parts consist of –
- Penis
- Scrotum – The scrotum is a sac or pouch made of skin that houses the testicles.
- Testes – Most males have two testes, which are responsible for producing a hormone called testosterone and producing sperms.
- Epididymis – The epididymis is a long, thin coiled tube present behind the testes where the sperms are stored. The sperms attain maturity in the epididymis. Only the mature sperms are capable of fertilizing the egg.
Internal Parts – The parts of the male reproductive system those are present inside the male body are –
- Vas Deferens – The vas deferens is a long tube that carries the mature sperms from the epididymis to the urethra for ejaculation.
- Ejaculatory Ducts
- Urethra
- Seminal Vesicles The seminal vesicles are pouches that produce a fluid rich in sugar that provides energy to the sperms for motility.
- Prostate – Prostate adds fluid to the male ejaculate that provides nourishment to the sperms. The urethra runs through the centre of the prostate.
Azoospermia or negligible or no sperms in the semen is a condition that is the most important cause of male infertility.
This can be due to failure of production of sperms (non-obstructive azoospermia) or the sperms are produced but are unable to reach the semen (obstructive azoospermia).
Congenital absence of vas deferens or vasectomy can cause the failure of delivery of sperms to the ejaculate. In such conditions, the sperms are still produced in the epididymis and can be collected directly from there. The blockage in vasectomy can be surgically corrected.
In cases of non-obstructive azoospermia, a small number of sperms may still be produced and can be retrieved from the testes. These procedures that are used to obtain sperms are known as Surgical Sperm Retrieval.
- PESA – Percutaneous Epididymal Sperm Aspiration- in this method light anaesthesia is given to the patient. A fine needle is then used to collect sperms from the epididymis. These sperms can then be used to fertilize the eggs obtained from IVF.
- TESE – Testicular Sperm Extraction- The testes are present inside the scrotum. An incision is made on the scrotal skin and a biopsy is taken to study the tissues for the presence of sperm. If sperms are detected then they can be freeze for future use to fertilize eggs obtained through IVF.
- TESA – Testicular sperm aspiration- a fine needle is used to aspirate fluid from the testes.
- Microdissection TESE – In this technique, a micro-dissecting microscope is used. This enables dissection of the testicular tissue with more precision, causing fewer traumas to the vasculature of the testes.
- MESA – Microsurgical Epididymal Sperm Aspiration.
These surgical sperm retrieval procedures are available at the Dalmia IVF Centre and have helped couples seeking treatment of infertility.
Embryo Cryofreezing is the process of freezing and storing embryos, it is a part of In Vitro Fertilization treatment, Cryofreezing is used for many reasons, like providing chance for pregnancy in future, or for saving embryos in the face of certain medical conditions, so as to make it available for fertilization in future.
If we place these embryos in cryo storage then it gives possibility of achieving pregnancy without having to repeat the process of ovarian stimulation. A person seeking assisted reproduction services can also freeze eggs, which are not fertilized.
- Our Outpatient Department (OPD) provides daily consultations for individuals and couples seeking assistance with fertility issues. At Dalmia Infertility Centre, we are committed to delivering comprehensive and personalized care to help you achieve your dream of parenthood. Our expert team, led by Dr. Pratishtha Dalmia, offers a wide range of services tailored to meet the unique needs of each patient.
How Does Daily OPD Work?
Initial Consultation:
- Review of medical history and previous treatments
- Discussion of current concerns and fertility goals
- Physical examination and assessment
Diagnostic Tests:
- Blood tests to evaluate hormone levels and overall health
- Ultrasound imaging to assess reproductive organs
- Semen analysis for male partners
Treatment Planning:
- Personalized treatment recommendations based on diagnostic results
- Discussion of various fertility treatment options, including IVF, IUI, and medication
Follow-Up Care:
- Regular monitoring of treatment progress
- Adjustments to treatment plans as needed
- Ongoing support and counseling
A transvaginal ultrasound is a diagnostic procedure used to evaluate the female reproductive organs. It provides detailed images of the uterus, ovaries, and fallopian tubes, helping our specialists diagnose and treat various fertility issues. At Dalmia Infertility Centre, we use state-of-the-art ultrasound technology to ensure accurate and reliable results.
How is Transvaginal Ultrasound Done?
The procedure involves the following steps:
Preparation:
- The patient is asked to empty her bladder for better imaging
- The patient lies on an examination table with feet in stirrups
Procedure:
- A sterile, lubricated transducer (ultrasound probe) is gently inserted into the vagina
- The transducer emits sound waves, creating images of the reproductive organs
- The procedure takes about 15-20 minutes and is usually painless
Post-Procedure:
- The results are reviewed by the specialist
- Any abnormalities are discussed with the patient
- Recommendations for further tests or treatments are provided if necessary
Transvaginal ultrasound is a safe and effective tool for diagnosing and managing fertility issues.
A follicular study is a series of transvaginal ultrasounds performed to monitor the growth and development of ovarian follicles. This study is crucial for timing ovulation and optimizing fertility treatments. At Dalmia Infertility Centre, our experienced team ensures precise monitoring to increase the chances of successful conception.
Why Follicular Study is Important?
A follicular study helps in:
- Tracking the development of follicles during the menstrual cycle
- Determining the optimal time for intercourse or insemination
- Adjusting medication dosages for fertility treatments
How is Follicular Study Done?
The procedure involves the following steps:
Initial Consultation:
- Review of medical history and menstrual cycle
- Discussion of fertility goals and treatment plan
Ultrasound Monitoring:
- Series of transvaginal ultrasounds starting from the early days of the menstrual cycle
- Monitoring follicle size and endometrial thickness
- Assessing the readiness for ovulation
Ovulation Induction:
- Administration of medications to stimulate follicle growth if necessary
- Adjustments to medication based on ultrasound findings
Timing of Procedure:
- Determining the best time for ovulation induction, IUI, or IVF based on follicular development
- Scheduling the procedure for optimal results
The follicular study is a vital component of fertility treatments, providing valuable insights into the patient’s ovulatory cycle.
Donor cycles involve the use of donated eggs or sperm to help individuals and couples achieve pregnancy. This option is often recommended for those facing specific fertility challenges. At Dalmia Infertility Centre, we offer a comprehensive donor program with thorough screening processes to ensure the highest quality of care and success.
Why Donor Cycles are Important?
Donor cycles can help in cases of:
- Poor egg or sperm quality
- Premature ovarian failure
- Genetic disorders
- Repeated IVF failures
How are Donor Cycles Done?
The procedure involves the following steps:
Preparation:
- Thorough screening and selection of donors
- Matching donors based on patient preferences and medical criteria
Stimulation and Retrieval:
- Donor undergoes ovarian stimulation to produce multiple eggs
- Eggs are retrieved and fertilized with sperm from the male partner or donor
Embryo Transfer:
- Resulting embryos are cultured in the lab
- Healthy embryos are selected for transfer into the recipient’s uterus
Post-Procedure:
- Monitoring for pregnancy through blood tests and ultrasounds
- Support and follow-up care throughout the pregnancy
Donor cycles offer a valuable solution for many individuals and couples, providing a pathway to parenthood when traditional methods are not an option.