Gynecology And Fertility Clinic

Hauz Khas, Delhi

What is ivf? ivf or in vitro fertilization in simpler terms means fertilization of woman’s eggs and man’s sperms meeting outside the body in a test tube (test tube baby). The fertilized egg (embryo) is then inserted in the uterine cavity. The whole process from starting to end is individually done by dr. Prerna gupta herself. Who needs ivf? for normal conception to happen a healthy sperm with good motility should pass through cervical mucus, swim through uterus and reach fallopian tube to meet egg around the time of ovulation (when the egg is released in the body). Eggs and sperms meeting in the fallopian tube form an embryo which goes to uterine lining and implants there. It means for normal conception to happen there is a need for healthy motile sperms, open fallopian tubes, good eggs, ovulation happening on its own and good uterine lining. If there is an issue with any of them, then there might need to think about assisted reproduction.

What is third party reproduction? third party reproduction in layman’s terms means taking the help of a third person by a couple for the process of ivf. The most common ways it can be done is by using donor eggs, donor sperms, donor embryos or by surrogacy. Who needs third party reproduction? as more and more couples are delaying marriage and childbirth, there is an increasing trend toward third party reproduction being seen in recent years. Donor eggs - one of the most common reason for the need of donor egg is advanced age. As the couples waste their precious reproductive years moving from doctor to doctor trying to conceive naturally, by the time they are seen by a reproductive specialist, they already have low ovarian reserve or poor amh results. Also there might be poor number of eggs due to previous ovarian surgery for endometriosis , cystectomy or even drilling. In certain patients there might be need for donor eggs due to poor egg quality in previous ivf cycles. Donor sperms : there is a considerable increase in the number of cases of male infertility. The need for donor sperms is there only when in an azoospermic (no sperms) male , the doctor has not been able to retrieve any sperms by the process of testicular sperm extraction or tese donor embryos : it is like adoption and may only be indicated when there are both male and female factors or due to financial constraints. Surrogacy : in simple terms means renting a womb or taking the help of another woman’s womb to carry one’s child. It might be needed in patients with uterine abnormalities like fibroid, adenomyosis, unicornuate uterus etc; in patients with recurrent ivf failures or if a pregnancy is dangerous for maternal health.

Who needs freezing ? Depending on your fertility needs, you mighty need egg, sperms or embryo freezing. Embryo freezing is the one most commonly done procedure in In Vitro Fertilization or IVF. By this procedure any extra embryos left after transfer or in freeze all cycles embryos are cryopreserved for later use. Egg freezing is recommended in patients who are going to receive chemotherapy for cancer as it might affect their future fertility. Also in patients who want to stop their biological clock, egg freezing does give them good chances of conception an d motherhood at later ages. Sperm Freezing as a procedure is recommended for cancer patients undergoing chemo or radiotherapy which might affect their future fertility, in patients with varying sperm counts, in patients planned for IVF cycle if there is a concern that, there might be difficulty in sperm collection on the day of egg retrieval. Where is freezing or cryopreservation done ? Freezing can only be done in embryology labs of an IVF centre. It is essential to use quality labs for this procedure as it directly impacts the conditions in which your gametes are preserved. Whom should we consult for the procedure ? If you are planning to preserve your fertility through cryopreservation at the best IVF center, meet an IVF specialist our IVF doctor at the earliest. They can answer all your queries and provide you with the chances of success with these procedures.

What is ovulation Induction ? Ovulation induction in simpler terms means inducing egg formation in patients in whom eggs are not forming naturally like patients with polycystic ovarian disease (PCOD) or hypogonadotropic hypogonadism. This is different from inducing formation of multiple follicles for IUI or IVF. Who needs Ovulation induction ? Normally in a woman in each menstrual cycle, ovulation happens in the middle of a cycle. This is the time egg is released in the body and she is most fertile. Different strips or apps designed to help a woman conceive naturally try to predict this time of ovulation and thus the most fertile period. But in patients with Polycystic ovarian disease, eggs are not being released in the mid cycle due to hormonal imbalance. They suffer from anovulation i.e eggs not being released;hence are unable to conceive naturally. In another subset of patients called hypogonadotropic hypogonadism, the amount of hormones being released from brain is too low, hence no eggs are formed, resulting in difficulty in conception.

What is intrauterine insemination (iui)? the process of injecting sperms inside a woman’s womb at the time of ovulation is called intrauterine insemination or iui. This is an outpatient procedure and does not require anesthesia or any special precaution. Who needs intrauterine insemination? iui is one of the most common fertility treatments practiced in india. It has been by gynecologists for every indication in the book. But in reality, there are only very few indications in which it is absolutely indicated. These are: 1. Male infertility: an iui might help a patient if there are mild male issues i.e there are mild issues in the number of sperms or their motility. If there are severe issues in sperm analysis of husband, iui, as a treatment modality will not be great criteria. 2. Unexplained infertility: if the treating doctor has not been able to pinpoint the reason for sub-fertility and everything is normal- the ultrasound, the husband’s report and have been trying for conception for less than 3 years, intrauterine insemination might be the way forward. 3. Vaginismus or irregular intercourse: in today’s busy and stressful world, when both the partners are working, more and more couples are coming up with the problem of difficulty in intercourse or very low frequency of sexual relations. In these patients, intrauterine insemination might give excellent results. 4. In patients with a need for donor sperms.

The two main routes of surgeries used for fertility surgery now days are laparoscopy and hysteroscopy. With more and more patients facing fertility issues nowadays, the importance of these fertility enhancing surgeries has increased manifold. Laparoscopy: with laparoscopy, we can see the uterus as well as tubes in ovaries from outside by using a very minimal incision in the abdomen. The outcome is as good as an open surgery without requiring a long hospital stay and the cost is also reduced. Also, there is no need for a big incision and as we are using higher magnification we can see better tissues so it definitely improves the outcome of the surgery as well. The most common indications for laparoscopy in patients with infertility are: evaluation of tubal patency: it can be done when we are suspecting tubal blocks like in an hsg showing bilateral tubal blocks. In patients with unexplained infertility - in patients with history of endometriosis in whom we are suspecting adhesions. Secondly, we can do laparoscopy in patients with endometriosis to do cystectomy and blade ablate the ovarian endometriomas. We can also do adhesiolysis to improve the ovarian tubal relationship and chances of conceiving thirdly in patients with pcos we can do laparoscopy to do ovarian drilling and chances of ovulation in patients who are not responding to drugs alone. Fibroids - in patients with fibroids a myomectomy can be done through laparoscopy route and that can also increase the results of your fertility treatment procedures.

In a couple trying to conceive, male factor might be solely responsible for 30% and in 20% or it might be a contributory factor. So to sum up in approximately 50% couples trying to conceive there might be an issue with the husband interfering with conception. In such a case a male infertility specialist should be looked for. How do you diagnose male infertility? A thorough history and physical examination are the first line in diagnosing male infertility. The backbone of investigating the husband is semen analysis. This simple, non invasive test can give us wealth of information. In simpler lay man terms a man must be producing healthy motile sperms in millions of number which are able to fertilise egg. So if there is any issue with number (COUNT), movement ( MOTILITY) or quality (MORPHOLOGY) of sperms, there will be difficulty in penetrating egg (FERTILISATION) resulting in infertility.

A failed IVF cycle can be devastating for the patient. It can be emotionally, financially and psychologically draining for the patient. It feels like the end of the world. We at Dr. Prerna Gupta’s Gynecology and Fertility center do understand the situation as many patients with previous failed IVF cycles come to us for second opinion. We specialize in catering to IVF failure patients and giving them best chances of conception.