Thursday, July 20, 2017

What & How of IUI-Intra-Uterine Insemination


Infertility IMSI ICSI IVF Donor Egg Treatement

Intrauterine insemination (IUI) is a fertility treatment that involves placing sperms inside a woman's uterus to facilitate fertilization. The goal of IUI is to increase the number of sperms that reach the fallopian tubes and subsequently increase the chance of fertilization.
IUI involves a laboratory procedure to separate motile sperms from sluggish or non-motile sperms . It can be performed with partner’s sperm or donor sperm (known as donor insemination). 

When is IUI recommended?
IUI can help one conceive if her partner has a low sperm count or poor sperm motility.
IUI also helps if the patient is taking medications to ovulate or produce extra eggs and insemination is timed to boost your chance of pregnancy.
Other fertility problems treatable with IUI include:
  • ·       Unexplained infertility, PCOD, Endometriosis,etc
  • ·       Cervical scarring or cervical mucus abnormalities
  • ·       Severe pain during intercourse
  • ·       Problems with ejaculation or developing an erection
  • ·       Sexually transmitted disease, such as HIV or hepatitis (in either partner)


How does IUI work?

IUI can only begin once it has been confirmed that the fallopian tubes are open and healthy. This will usually be checked through a tubal patency test by the fertility clinic.
Patient may undergo a hysterosalpingo-contrast sonography (HyCoSy) – which involves using a vaginal ultrasound probe to check the fallopian tubes for blockages – or a hysterosalpingogram, an x-ray of your fallopian tubes.
The timeline for IUI treatment usually is as follows:
  • ·       Egg production. The ovaries produce eggs for fertilization in a couple of ways. Your doctor may recommend an "unstimulated," or natural, IUI cycle, meaning no fertility drugs are used. Or a doctor may give you a fertility drug at the beginning of your period to stimulate the ovaries to produce several mature eggs. (Women typically release only one egg a month.)
  • ·    Tracking the eggs.Follicular study & monitoring is performed to figure out when ovulation occurs by doing an ultrasound.
  • ·      Washing the sperm. Once the patient ovulates, it's time for her partner to produce a sperm sample, which is then "washed." This process concentrates the sperms into a small amount of fluid. IUI can be done with sperms from the male partner or a donor, and can be combined with superovulation.
  • ·       Insemination. The doctor uses a thin, long tube (a catheter) to put the concentrated sperm directly into the uterus through the cervix. The procedure is usually painless, but sometimes  mild cramps are felt by the patient.This is generally a single insemination procedure which is performed post rupture of the follicles but some clinicians choose a double insemination per IUI cycle to improve the chances of success.
  • ·       Testing for pregnancy. A pregnancy test is done about two weeks after insemination.


Risks

  • Insemination combined with superovulation increases the risk of multiple pregnancy.
  • Insemination procedures pose a slight risk of infection.
  • Some women experience severe cramping during insemination.
  • There is a slight risk of ovarian hyperstimulation syndrome if superovulation is used together with insemination.


How successful is IUI?

The success of IUI depends on several factors. If a couple has the IUI procedure performed each month, success rates may reach as high as 30% per cycle depending on variables such as female age, duration of  infertility, and whether fertility drugs were used, among other variables.

While IUI is a less invasive and less expensive option, first-line treatment for couples with unexplained or male factor infertility.

Author: 
Aditi Shirsat, M.Sc. 
Senior Embryologist with Corion Fertility Clinic.





Friday, June 30, 2017

Are you ready for an IVF?





One of the major milestones in a woman’s life is her entry into motherhood. For most women, when this does not happen in the natural logical sequence of things, there is anxiety and lot of pressure from family and friends.

However, with the recent advancements in Assisted Reproductive Techniques (ART), there are options available, such as intrauterine insemination and in vitro fertilisation (IUI and IVF). These procedures can help increase the chances of conception and pregnancy. IVF is when the egg is retrieved from the ovaries, fertilised externally and then transplanted back into the uterus where it grows to full term. However, there are always unanswered questions:
·      How long to wait before going for IVF?
·      is it the right procedure for me? etc. 
The norm is, if after one year of trying a couple is unable to conceive then they should seek help of an infertility specialist.

Read on to know more and find answers to some of these.
  1. Maternal age: As a woman reaches 35 and a man reaches 40, the fertility rates drop significantly. The chances that a woman at 35 will conceive is about 20%, which goes down to 5% if the woman is 40. However, this rate can be significantly increased by using IVF. The quality of the egg would gradually deteriorate, and so if a woman is nearing 40, it is better to consider IVF as the ovarian reserve would be optimal with IVF.
  2. Failed intrauterine insemination: In couples who have problems with the sperm reaching the uterus like in cases where sperm motility is low or the count is borderline low, intrauterine insemination (IUI) is first attempted. However, if a couple is unable to conceive after 3-4 cycles of intrauterine insemination, they should seek the help and discuss with infertility specialist rather than only thinking of IVF .
  3. Duration since trying to conceive: While some couples conceive quite promptly in a month or two, most take about 6 to 8 months of unprotected sex to conceive. Therefore, IVF can be an option if you are failing to conceive even after a year. Less than a year, don’t fret. Take it easy and it might just do the trick.
  4. Medical health: Both the partner’s medical health should be taken into account. Lifestyle changes like smoking, alcohol abuse, drug abuse should be considered, which can account for poor sexual performance and therefore lead to an inability to conceive. Health conditions like diabetes and heart disease can also lead to infertility. Hypothyroidism in women is another thing that must be ruled out, as it often leads to an inability to conceive. A fertility specialist can help you determine if IVF treatments are the right solution.
  5. Sexual problems with the partner: One of the first things to do before going for IVF is to check that the male does not have any issues. Be it erection issues or ejaculation issues or sperm issues, they need to be ruled out. Sperm quality, quantity, and motility have to be analysed, and if they are optimal, IVF can be considered.
  6. Cancer Treatment and Fertility Preservation: The various treatments for cancer like chemotherapy and radiotherapy, can result in infertility . However, there are various fertility preservation methods that men and women can opt for to preserve their fertility. Procedures like Egg Freezing, ovarian tissue freezing , and sperm banking make IVF an ideal option for such couples post cancer treatment and give them an opportunity for parenthood. Please contact your oncologist prior to treatment for cancer and discuss the fertility preservation options .
  7. Affordability for IVF: Couples longing to start a family are often too scared to approach a fertility specialist because of the fear of the costs of fertility treatments including IVF and medications. These couples can now approach their fertility doctors much earlier as clinics offer them financial solutions and easy payment options so that they can avail their fertility treatments. Please contact your Infertility specialist for further details regards the same.
  8. Multiple Miscarriages and PGS: Chromosomal abnormalities may be the cause for multiple miscarriages and repeated IVF failures.  Your doctor may recommend PGS testing for you in such a scenario. PGS (Pre genetic screening) is the genetic testing of embryos which helps decipher whether an embryo has correct number and placement of chromosomes.  Recent researches confirm an increase of IVF success rates by 23 percent where PGS was used. Women who would most likely benefit from this treatment are those above 35 years of age and using their own eggs, women with multiple IVF failures and women with multiple miscarriages. PGD (Pre genetic diagnosis) may be used with an IVF cycle when screening for a particular genetic disease is required like, Thalassemia , Neurofibromatosis, and other.  

Those getting ready to start their first IVF cycle and those who have been through it before would have received a lot of advise regarding do’s and don’t’s to increase their success rates.

A few “pearls of advise” I can offer will be, begin with improving your lifestyle. Stop smoking,eat a healthy diet, exercise in moderation, lose the extra weight, and get more sleep. 
  • Don’t overindulge in alcohol.
  • Reduce and restrict your cups of coffee to less than 5 cups a day.
  • Attempt an IVF earlier than later. Do not wait till your biological clock starts ticking.
  • Avail of alternative medical therapy like acupuncture. It helps relieve stress.  
  • Be patient if you are under the age of 35 years. Time is in your hand. Success rates for patients undergoing IVF in this age is more than 30 percent. Thus, if there is a male factor or other criteria requiring you to undergo an IVF, consider it earlier than later as age is in your favour.



Most important thing is do not GIVE UP! 

Tuesday, June 27, 2017

ACUPUNCTURE IN FERTILITY TREATMENT



Acupuncture Fertility


Acupuncture is an ancient therapeutic art, which has been given renewed attention in light of recent scientific research and current integration with modern medical practice in the treatment of infertility.
With rapid economic development, lifestyle changes, and increased environmental pollution; the incidence of infertility has gained increased worldwide attention. In vitro fertilization–embryo transfer (IVF-ET) is the most successful infertility treatment, and for many people, it provides the last possibility for pregnancy.
However, the average IVF delivery rate per single initiated cycle using fresh oocytes is still only 35% - 40%. Owing to the relatively low IVF success rate per cycle, some patients are unsuccessful even after several ETs, even though appropriate techniques for controlled ovarian hyperstimulation (COH), IVF, embryo culture and transfer, etc., have been correctly performed. 
Furthermore, IVF is an expensive procedure, and some couples can afford only a limited number of treatments. Repeated cycles place enormous economic as well as psychological pressure on the patients and their families. Therefore, it is important to maximize the efficiency of the procedures.
Many patients have turned to complementary and alternative medical (CAM) treatments to increase the success rate of IVF. Among these CAM treatments, acupuncture is a frequently used adjunctive therapy.
Acupuncture is based on a system of Traditional Chinese Medicine (TCM) dating back 3,000 years, wherein fine needles are inserted at points around your body to correct imbalance in energy or ‘qi’, which is said to flow around your body in ‘channels’ or ‘meridians’.

Acupuncturists believe that there are 400 different acupuncture points around the body and that stimulating these with tiny needles can get your energy flowing.

Traditional acupuncture involves inserting disposable sterilized needles into the skin at acupoints along the meridians. The needles can then be stimulated by hand or by a small electric current in the case of electroacupuncture (EA). In a conventional acupuncture treatment, four to ten points are needled for 15–30 minutes. Acupuncturists emphasize a sensation called “de qi,” which is characterized both by the patient feeling soreness, numbness, or heaviness at the needling point or along the meridians and by the acupuncturist sensing a sinking and compactness below the needle; it is considered to be an important factor for obtaining therapeutic efficacy . Laser acupuncture is a new form of this treatment; it combines modern science and technology with traditional methods by using a low-energy laser beam to directly irradiate acupoints. 

Acupuncturists aim to rebalance your energy flow and prime your body for fertility. The British Acupuncture Council believes acupuncture may boost female fertility by doing three key things:

  • Regulating fertility hormones - stress and other factors can disrupt the function of the hypothalamic pituitary-ovarian axis (HPOA), causing hormonal imbalances that can negatively impact fertility. Acupuncture has been shown to affect hormone levels by promoting the release of beta-endorphin in the brain, which affects the release of gonadotrophin releasing hormone by the hypothalamus, follicle stimulating hormone from the pituitary gland, and oestrogen and progesterone levels from the ovary.
  • Increasing blood flow to the reproductive organs - stress also stimulates the sympathetic nervous system, which causes constriction of ovarian arteries. Acupuncture inhibits this sympathetic activity, improving blood flow to the ovaries  enhancing the environment in which ovarian follicles develop. It also increases blood flow to the uterus  improving the thickness of the endometrial lining and increasing the chances of embryo implantation.
  • Counteracting the effects of polycystic ovarian syndrome (PCOS) - PCOS is one of the most common causes of female infertility. By reducing sympathetic nerve activity and balancing hormone levels, acupuncture has been shown to reduce the number of ovarian cysts, stimulate ovulation, enhance embryo implantation and regulate the menstrual cycle in women with PCOS . It may also help to control secondary effects such as obesity and anorexia. 

Acupuncture has been successfully used in the treatment of female infertility. Efficacious IVF/ICSI demands optimal endometrial receptivity at the time of embryo implantation. Uterine receptivity is regulated by a number of factors, including uterine perfusion. It has been seen that  acupuncture can reduce the uterine artery blood flow impedance, and hence increases the uterine perfusion.
Infertility also causes stress, leading to a release of stress hormones. It has been seen that stress reduction improves fertility.

The use of acupuncture to reduce anxiety and stress, possibly through its sympathoinhibitory property and impact on β-endorphin levels. It has been  found that sympathetic activation during acute mental stress was eliminated after acupuncture.

Many Studies have proven that acupuncture increases clinical pregnancy rate and live birth rates.

Therefore we recommend acupuncture as an adjuvant therapy with IVF/ ICSI as it increases the chances of fertility by decreasing the stress, increasing the uterine perfusion, which in turn increases the embryo implantation and thus raises the clinical pregnancy rate and live birth rate.

We at Corion Fertility Clinic, do promote Acupuncture to our patients as an adjuvant therapy. The therapy helps alleviate anxiety from our patients. Stress levels are also reduced and this helps our patients to cope with the various ART treatments with ease.

Acupuncture has significantly improved our success rates. A special mention is use of acupuncture in Poor Ovarian reserve patients struggling to enjoy the joy of motherhood. Acupuncture has improved their response to medication, thus increasing number of eggs retrieved as well as improving quality of embryos transferred.

Please contact us at +91 22 2639 5588 / 2639 5599 / 86929 66000 or email us - reachus@corionfertilityclinic.com for further consultations.

By- Dr. Hitesha Ramnani
      Clinical Associate @ Corion Fertility Clinic