Dr.Preeti Jindal

M.B.B.S, MD(Obstetrics & Gynecology)

INFERTILITY & IVF SPECIALIST

Fellowship in Reproductive Medicine

Fellowship in Gynae Endoscopy

Ex-Faculty - IKDRC-ITS, Ahmedabad

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ABOUT IVF

Overview

IVF or a test tube baby process is a term we hear often. We may also know its full form but not many of us know about it in the real sense. In this post, we aim to clarify the basics of IVF. Of course, almost all of us know that it stands for “in vitro fertilization”. The babies born with this technique are often referred to as test tube babies. If we look at it in detail, it is a procedure in which the fertilization process takes place in a lab petri dish. The process has been around for decades now. The first test tube baby, Lois Brown is now 40 years old and a ‘natural’ mother. After her birth, many babies across the world were produced by this innovative technology which is nothing short of a revolution in the world of ART.

Treatment by Dr.Preeti Jindal

  • Lead by Dr.Preeti Jindal, She Provides highly Advanced infertility treatment through Expertise, Technology & Global practices
  • Her Team is very much expert in carrying out Blastocyst Transfers
  • A trained team of Fertility coaches, counselors & co-ordinators will guide your through the process.
  • Dr.Preeti Jindal will provide you detailed counseling with lot of patience explaining the benefits of IVF along side will clear all your doubts about the processes and tests that are necessary.

WHY IS IT NEEDED?

With the increase in infertility, the procedure is required for making many couples proud parents of their biological child. The couple may opt for many other procedures before finally opting for IVF. Medication, IUI are some of the other techniques that are available for helping the childless couples. But if all the other methods fail to give results,the IVF technique is the ultimate treatment for infertility.

STEPS INVOLVED

There are many steps which precede and succeed in this step. It is usually helpful in cases where the couples fail to conceive due to an anomaly in both or either of the partners. It is also used in cases of unexplained infertility.

  • Fertility Protocol: medications and blood tests are conducted in this phase. The doctor might advise the woman to do something which doesn’t make much sense, such as taking birth control pills. The couples might feel odd about it but it is usually prescribed to help the ovaries produce quality eggs which will be needed later on. It is also given for the reason that the pill can help in regulating the ovulation cycle. It is absolutely necessary for the doctor to know which phase of the ovulation cycle is going on in the body of the female so that he can control it.
  • After three weeks of the starting date of menstruation or two weeks of taking low dose contraceptive pills, the patient is given injections to suppress her ovaries. After completing 10 days of the injection, the patient is asked to come for an estrogen test and an ultrasound scan.The patient is given gonadotropin drugs to stimulate her ovaries
  • After 5 days of having stimulation drugs, the doctor checks if the follicles are developing. If the follicles are well developing, then after another 4 or 5 days of Injection, the woman is given hCG(human chorionic gonadotropin) to trigger the process of ovulation.
  • On the twelfth day, the patient’s eggs are retrieved through a needle inserted into the ovary. The patient is usually given sedatives for this procedure. The sperm specimen is also collected around the same time. The eggs and sperms are then made to combine in a petri dish in a lab.
  • On the thirteenth day, doctors check the number of eggs fertilized and their quality. In case there are a high number of embryos of good quality, some of them are implanted and the others are frozen for future use.
  • On the fifteenth day or the seventeenth day, the embryos are transferred to the woman’s uterus using a catheter. She is advised bed rest for two days, after which she can resume her normal routine.
  • The twenty-eighth or thirtieth day.The final step of the pregnancy test is conducted.Thus we can see that the whole IVF cycle lasts for a period of 30 days.

PRE-IVF CARE

  • If you are in the habit of smoking and drinking, it is time you quit it for the sake of your baby. Whereas alcohol is known to reduce the chances of IVF by 50 %, you probably must be knowing the fact that these habits result in premature aging and decrease in chances of conception.
  • indulging in meditation, yoga or massage. Take care of your physical and mental health.
  • Taking in vitamins will enhance your chances of producing a quality egg. Ideally, one should start taking vitamins 6 months before the conception, but starting 1-2 months before will also be beneficial.
  • Having eggs, caviar, nuts, seeds, and pollen will increase your fertility.
  • Ensure that you have a good sleep, both in terms of quantity and quality. This will enhance the functioning of your sex hormones and ovulation process.

POST IVF CARE

  • Avoid any exercise which will involve heavy lifting, vigorous actions such as cycling, jogging, skiing should be avoided but routine activity should be carried out.
  • Take the medication according to the doctor’s prescription.
  • In case you become pregnant, you will be advised to continue with the medicine until the twelfth week.
  • Strictly avoid alcohol and cigarettes. Exposure to X-Rays and smoking is also to be avoided.
  • Don’t take any medicine without consulting the doctor.
IVF SERVICES

IVF SERVICES

Advanced A.R.T. Lab

Advanced A.R.T. Lab

Expert Consultation & Treatment

Dr.Preeti Jindal offers the full spectrum of women’s health care services. Dr. Preeti Jindal offers state-of-the-art technologies with superlative care offering a range of services such as painless deliveries, management of high-risk pregnancies/late pregnancies, among others.

Complete Infertility Workup

Dr.Preeti Jindal pay special attention to the initial workup for an infertile couple as it allows them to select the right kind of fertility treatment based on the initial reports.

The infertile couple must undergo a set of advanced tests before the commencement of any treatment. These tests are comprehensive & detailed and are essential to determine the causes of infertility, whether the couples are diagnosed with any other ailment and which technique would be most suitable for a particular couple.

The female partner must undergo a transvaginal ultrasound to evaluate ovarian reserve & uterus condition, few blood tests etc. and Laparoscopy or hysteroscopy in cases where there is an indication of such operation requirement after the initial workup.

Male partner needs to undergo a semen analysis to determine the quality & quantity of their sperm or whether there’s any dysfunctional tinge to them. The mobility and motility are also checked along with few blood tests.

Ovulation Induction

Ovulation induction is the process of using medications to stimulate ovulation in women who have irregular or absent ovulation (anovulation). According to the National Institutes of Health, 25 to 30 percent of women with infertility have problems with ovulation.

Normal ovulation occurs when the ovary releases a mature egg in preparation for that egg to be fertilized. Normal ovulation occurs roughly once every 28 days during a woman’s menstrual cycle. Intervals of 21 to 35 days are considered acceptable and reflective of normal ovulation. If fertilization does not occur, the mature egg and any supplementary tissues are broken down and cleared from the uterus naturally.

When ovulation happens less than once every 35 days or is unpredictable, it is considered to be irregular. When ovulation is completely unpredictable – in interval or duration – it is considered oligoovulation. If it doesn’t occur at all, it is called anovulation. Ovulatory problems impact fertility by taking away the predictability of ovulation and potentially the availability of an egg to be fertilized.

The goal of ovulation induction is to increase a woman’s chances of conceiving a child, either through sexual intercourse or by using intrauterine insemination (IUI) or another fertility treatment. However, when the absence of ovulation is a symptom of another fertility issue, treating the underlying problem can also restore normal ovulation and fertility.

  • Ovulation induction is a treatment for anovulation (irregular ovulation), an infertility condition in which follicles in a woman’s ovary do not mature and release eggs (ovulate).
  • Anovulation can be caused by certain reproductive disorders such as polycystic ovary syndrome (PCOS), nutritional problems or excessive exercise.
  • Ovulation induction is typically achieved with a variety of medications that stimulate the ovary to produce and release eggs.
  • If the treatment is successful, the woman will ovulate and can become pregnant naturally using intrauterine insemination (IUI) or other fertility treatments.
  • Approximately 25 percent of female infertility cases stem from problems with ovulation, so ovulation induction can be a beneficial and cost-effective first treatment.

IUI

IUI is a technique in which sturdy sperm are sifted out from flaccid ones and later the washed sperm are placed into the woman’s uterus during the time of ovulation. Before the IUI treatment commences, it is mandatory to undergo a Patency Health Test to ascertain whether the fallopian tubes are robust and open.

This method is particularly beneficial for couples who have an unexplained and ambiguous infertility problem. This technique is also used when men can’t ejaculate in their partners’ vagina due to a raft of reasons ranging from psychological issues, impotence, vaginismus or anatomic problems.

IUI Procedure: After a period of abstinence for 3 days, to produce the optimum and healthy sperm, men ejaculate in a jar. The best quality sperm are sifted out, which takes around 2 hours, and are placed in the womb through a thin tube. This process is not painful for women but they might experience slight discomfort or a little vaginal discharge which is just the cervical mucus.

If women are above the age of 35, the rate of success decreases. Also, IUI might cause multiple pregnancies which result in twins, triplets or even quadruplets as it’s extremely difficult to control the growth of number of follicles. It must be noted that IUI treatment must only be taken under the supervision of supremely skilled doctors in state-of-the-art clinics to avoid the risks associated with IUI.

IVF-ET

In vitro fertilisation (IVF) means ‘fertilization in glass,’ more simply explained as ‘test-tube baby’. In the IVF process, eggs are removed from the ovaries of the female, at the same time sperms are collected from the male partner. The eggs and sperms collected are made to fertilize in the laboratory and the fertilized egg (embryo) is then implanted in the woman’s womb to make her conceive.

Age need not be a factor of consideration when going for IVF process.

This technique evolved in the late 1970s and was mainly used for females having tubal blockage but with the advent of superior types of equipment and technology coupled with an increase in complications faced by infertile couples.

IVF technique is now mainly used for the following cases:

  • Females with both fallopian tubes blocked
  • Females with one fallopian tube blocked and one open
  • Borderline male sperm count
  • Unexplained infertility cases
  • Couples who have failed traditional treatments like timed intercourse, follicular monitoring, IUI, etc.

Gone are those days when age was a constraint to experience motherhood and attaining menopause came along with sorrow of inability to reproduce. IVF (In Vitro Fertilisation) has proved to be a boon to all those couples who’ve only dreamed of becoming parents but could never see their dream coming true due to insurmountable reasons.

ICSI

ICSI is a technique in which a single sperm is directly injected into an egg to fertilise it and then the fertilised egg (embryo) is transferred to the womb. It is one the most cost-effective and successful treatment for infertile men. This method is especially salutary for men who have low or zero sperm count. In the case of zero sperm count or when the male partner is too uptight to ejaculate on the day of egg collection for IVF, the sperm is extracted either from testicles (using TESA) or epididymis (using PESA). Even if men have dysfunctional sperm which can’t fuse with the egg, ICSI comes in handy.

A sharp and delicate needle is used to immobilise & pick up a sperm and it is injected into the cytoplasm of the egg, after which the needle is removed.

The success rate of ICSI is significantly higher than IVF and the couples often opt for ICSI when the conventional IVF technique does not produce desired results for them. The success rate of ICSI is directly proportional to the couple’s age: the younger the patient is; the higher are the chances of success.

Donor Sperm Programme

Donating sperm is considered as one of the noblest causes a man can undertake. When the male partner has zilch sperm or his sperm are of low-quality, they need some other man who is willing to donate sperm which would fuse with eggs of the female partner to form an embryo. That embryo would be implanted in the womb to produce a healthy child after 9 months.

Oocyte Donor Programme

When the female partner is unable to produce the egg due to various reasons like menopause, premature ovarian failure or age factor, the infertile couple seeks a woman who would donate eggs in place of a sum of money. These eggs are fertilized and implanted in the womb of the desired mother. Thereafter, children are born naturally. The desired mother has to undergo two to three sessions of hormonal therapy before obtaining eggs from the donor woman. It is called Hormonal Replacement Technique. This therapy is used to determine whether the womb of a woman is competent for implantation.

Embryo Donation Programme

When both the male partner and the female partner are infertile, they opt for embryo donation. In this, the embryo is developed by infusing the sperm and eggs of the donor couple and the embryo is implanted in the uterus of the female partner. The couple who are donating the sperm and eggs undergo a series of tests to determine any medical ailment or the quality of sperm and eggs.

Embryo Freezing

The biggest challenge is the water within the cells. When this water freezes, crystals can form and burst the cell.

Cryopreservation

To prevent this from happening, the doctor uses a process called cryopreservation. It involves replacing the water in the cell with a substance called a cryoprotectant.

The doctor then leaves the embryos to incubate in increasing levels of cryoprotectant before freezing them.

After removing most of the water, the doctor cools the embryo to its preservation state. They then use one of two freezing methods:

  • Slow freezing: This involves placing the embryos in sealed tubes, then slowly lowering their temperature. It prevents the embryo’s cells from aging and reduces the risk of damage. However, slow freezing is time-consuming, and it requires expensive machinery.
  • Vitrification: In this process, the doctor freezes the cryoprotected embryos so quickly that the water molecules do not have time to form ice crystals. This helps protect the embryos and increases their rate of survival during thawing.
  • After the process of freezing is complete, the doctor stores the embryos in liquid nitrogen.

TESA,PESA

In some individuals, spermatozoa may not be present in the ejaculate. This condition is called Azoospermia. This can be either due to problems in sperm production itself or due to obstruction to the flow of semen during ejaculation. Reproductive tract obstruction can be acquired – as a result of infection, trauma, iatrogenic injury which can occur during bladder neck, pelvic, abdominal or inguino-scrotal surgery.

Congenital anomalies may be relatively uncommon in the general population, but can occur in up to 2 percent of infertile men. Best known condition is congenital bilateral absence of the vas deferens (CBAVD) which occurs in almost all men with cystic fibrosis.

Two techniques – Epididymal sperm retrieval & micromanipulation have revolutionized treatment of male infertility in the past decade. Men with congenital bilateral absence of the vas defences (CBAVD) or reproductive tract obstruction are now able to achieve pregnancies with use of these advanced techniques.

TESA and TESE

TESE or testicular sperm extraction is a surgical biopsy of the testis whereas TESA or testicular sperm aspiration is performed by inserting a needle in the testis and aspirating fluid and tissue with negative pressure. The aspirated tissue is then processed in the embryology laboratory and the sperm cells extracted are used for ICSI.

PESA

PESA or Percutaneous Epididymal Sperm Aspiration (PESA), does not require a surgical incision. A small needle is passed directly into the head of the epididymis through the scrotal skin and fluid is aspirated. The embryologist retrieves the sperm cells from the fluid and prepares them for ICSI.

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