How Is ICSI Performed?

Intracytoplasmic Sperm Injection (ICSI) is a micromanipulation procedure involves the direct injection of a single sperm into an egg to attempt fertilization. It usually used with male infertility or patients with previous IVF failure. There are generally five simple steps are involved in ICSI procedure which include the following:

  • The mature egg has been collected in a specialized glass tube.
  • A hollow, very delicate and sharp needle is used to pick up and immobilize a single sperm.
  • With care, the needle is then inserted through the cytoplasm of the egg and shell of the egg.
  • The sperm is carefully injected into the cytoplasm and the needle is than removed.
  • Following day, the eggs are checked further for the sign and evidence of normal fertilization.

The embryo transfer process is followed to physically plant the embryo in the woman’s uterus, once the all steps of ICSI are completed and fertilization become successful. Then it is a event to wait and watch for early pregnancy symptoms. The doctor may use ultrasound reports or a blood test to verify if implantation and pregnancy has occurred successfully.

Risks associated with ICSI

There are also several risks associated with ICSI procedure. The first risk is that, during the ICSI procedure, as a result of the needle insertion a small number of eggs (approximately less than 5 percent) may be damaged. Second, the overall risk of having a baby with a chromosomal abnormality in the X or Y chromosomes is 0.8 percent (or eight per 1000) which is nearly four times the average found with spontaneous conception. At present, we are unable to figure out the exact reason for this increased risk. It is important to know the following problems can be involved with sex chromosome abnormalities:

  • There may be a requirement of surgery for affected infants with heart problems
  • Increased risk of miscarriage
  • Increased risk of learning disabilities or behavior abnormality
  • Increased risk of serious infertility issues in your children during their adulthood
  • The risk of having a chromosomal abnormality like Down’s syndrome is basically not increased with ICSI procedure but increases with maternal age.

If a successfully fertilization takes place, a women chance of giving birth to a single baby, twins, or triplets is the same if they have IVF with or without ICSI. Several studies have indicated the issue of developmental delays in children born with ICSI. But, there is no definitive proof that this is the case.

How successful is ICSI?

Chances of successful fertilization with this procedure vary between patients (particularly according to the age of the woman). Fertilization rates of nearly  80 percent of all eggs injected which is equivalent to fertilization with normal sperm are currently being achieved, and high pregnancy rates are seen with ICSI procedure for the couples suffering male factor infertility.

The most important indicator of ICSI success found to be the fertilization rate achieved during the ICSI procedure. The fertilization rate at SCI Healthcare and SCI IVF Hospital and Multi-specialty Center is exceptional high (currently 80 to 85 percent). This indicates, on average, eight out of every 10 eggs will fertilize in proper and normal way.

Significant Advantages of Frozen Embryos

Significant Advantages of Frozen Embryos

Frozen embryos offer patients who are suffering from infertility problems, an opportunity to expand their families in the future. There is no decline in embryos quality while they are in frozen state, therefore it maintain their reproductive potential. The embryos are associated with the age of the woman’s egg at the time of its fertilization; this can be an additional advantage. If a 35 years old patient goes through a full IVF cycle, she will be using eggs from her 35 years old with subsequent FET’s at the age of at 37 and again at 39. Younger eggs result in higher chances of chromosomal normalcy and higher pregnancy rates, so younger eggs are always preferred.

Women suffering from polycystic ovary syndrome (a hormonal disorder that often leads to fertility problems) can improve their chances of a successful pregnancy with the help of frozen embryos rather than fresh ones for in-vitro fertilization. Historically, the use of fresh embryos is preferred over that of frozen embryos, but study suggested that elective embryo freezing followed by frozen embryo transfer is an effective treatment for women with polycystic ovary syndrome. According to the studies, the success behind frozen embryos depends on the fact that frozen embryos take longer than fresh embryos to implant in the uterus. This is necessary for the better fertility environment because it allows hormone levels in the uterus to return to normal before the embryo is implanted. Frozen embryos increases pregnancy success rate in women, additionally women treated with frozen embryos also had fewer instances of hyperstimulation syndrome(a condition in which the ovaries swell and become painful and may also results in  other pregnancy complications) than women given fresh embryos. If a woman can able to freeze and store their embryos while attempting a fresh cycle transfer, and if accidently the fresh cycle is unsuccessful, she always has an option to try again without undergoing another ovarian stimulation or egg retrieval. Therefore, her cumulative pregnancy rate increases overall from one IVF cycle. Multiple frozen embryo transfer or FET cycles are less costly than fresh IVF cycle because medication is relatively less and there is no egg retrieval or anesthesia involved in this process. With Single Embryo Transfer or SET there may be an opportunities for multiple FET cycle after just one egg retrieval which again increases the cumulative pregnancy rate from one IVF.  FET cycles can be easily scheduled when it is more suitable and convenient for most of women. After scheduling FET, women are prescribed oral estrogen so that the uterine lining become ready for the transfer and this is administered only once every three days. Progesterone injections are applied, so that the women body can able to support a successful pregnancy. Daily intramuscular progesterone can be prescribed later in the cycle.

But at the same time, there are also few risks associated with women who received frozen embryos. It slightly increase risk of potentially dangerous high blood pressure during pregnancy and can increase death rate in newborn babies.

Laser Assisted Hatching

Laser Assisted Hatching is a process where a low energy laser beam is used to break the outer layer of the Zona Pellucida (the outer layer or shell that surrounds an embryo). The main purpose of laser assisted hatching is to allow the embryo to hatch more easily from its outer layer or shell. All pregnancies must result in successful hatching, whether naturally occurring or as a result of any assisted hatching technique such as in-vitro fertilization to enable embryos to implant in the lining of the uterus for further fertilization process. The Zona plays an important vital role in fertilization process as only one sperm can perforate the Zona and fuse with the egg for successful fertilization. The laser used to break the outer layer shell of the embryo is non-contact which means that embryo is not in direct contact with laser. The opening of embryo is increased with the help of laser. The whole procedure is carried out with latest technologies thorough precision and delicacy which positively improves and ramps up pregnancy rates among women.

Laser Assisted hatching involves considerably less time and protects the embryo from toxic chemicals so that the potential effect of these factors reduces and the stress placed upon the embryo during the whole process. In some cases, outer layer of the Zona Pellucida is abnormally thick or hardened with the freezing and thawing process. The possibility of the embryo to attaching or implanting into the wall of the uterus directly depends on the less difficulty faced by the embryo during hatching. Pregnancy cannot successfully happen unless the embryo hatches and implants and Laser Assisted Hatching can play a vital role in achieving these essential steps.

At the SCI Healthcare and SCI IVF Hospital of New Delhi, laser assisted hatching is offered and recommended for frozen embryo transfers by Dr Shivani Sachdev Gour (one of the best gynecologists and infertility specialist based in Delhi).

Who is recommended for Laser Assisted Hatching?

Recent research showed that women who have undergone repeated unsuccessful IVF treatments can increase their chances of a successful pregnancy with Laser Assisted Hatching procedure. But Laser Assisted Hatching can be helpful for any patient and it is most likely to be best suited for women:

  • Who are older than 37 years of age thus produce eggs with a harder Zona Pellucida.
  • With a high Follicle Stimulating Hormone (FSH) level early in their cycle.
  • Who have a tendency to produce a harder or thicker Zona Pellucida
  • Who have frozen embryo transfer
  • Who have poor embryo quality
  • Who have mild elevations in their day 3 FSH levels

Advantages of laser-assisted hatching

A Laser Assisted Hatching considered being the best to other forms of assisted hatching due to the below reasons:

  • Exact and fast control over drilling of the shell opening
  • Minimal handling of the embryo during the procedure
  • It is more safe procedure, with no negative effects on the embryo
  • Assisted hatching may be clinically useful in patients with a poor prognosis, including those with two failed IVF cycles and poor embryo quality and older women than 38 years of age. At SCI Healthcare and SCI IVF Hospital and Multi-specialty Center, your doctor can further guide you to see if assisted hatching may optimize your IVF outcome.

Why Vitro Fertilization (IVF) is performed

In-vitro fertilization (IVF) is a new medical procedure to treat infertility or genetic problems. IVF help the couples with infertility who wants to have their own baby. It is recommended to try other fertility treatments first before going for IVF treatment, as it is very expensive and invasive.  If you decided to go for IVF treatment, you and your partner must try less invasive treatment options before attempting IVF; including taking fertility drugs to increase production of eggs or intrauterine insemination (it is a procedure in which sperm are transferred in uterus at the time of ovulation).  If parents run the risk of passing a genetic disorder on to their offspring, IVF can be helpful in such condition. A medical lab can test the embryos for genetic defects or abnormalities. After that, doctor only implants healthy embryos without genetic defects.

IVF considered as a primary treatment for women suffering from infertility over age of 40 years. It can be adopted if you have certain heath problems. IVF can be beneficiary, if you or your partner has:

Damage or blockage of fallopian tube:  If the fallopian tube get damaged or blocked, it become  difficult for an egg to be fertilized or for an embryo to travel to the uterus for further fertilization. 

Ovulation disorders: If ovulation is absent or infrequent, fewer eggs will be available for further fertilization. 

Premature ovarian failure: Before the age of 40 years, many women suffered from premature ovarian failure which is the loss of normal ovarian function. If your are suffering from premature ovarian failure, the ovary won’t produce normal amounts of the hormone estrogen or have eggs to release regularly. 

Endometriosis: Endometriosis arises when the uterine tissue implants and grows outside of the uterus. Endometriosis often affects the normal function of the fallopian tubes, ovaries and uterus. 

Uterine fibroids: Many women in their 30s and 40s suffered from fibroids which is a benign tumor in the wall of the uterus. Fibroids can create problem with implantation of the fertilized egg. 

Impaired sperm function or production: Low-average sperm concentration, poor mobility of sperm (weak movement), or abnormalities in sperm quality, size and shape can make it difficult for sperm to fertilize an egg for further fertilization. If your partner is suffered from any of these semen abnormalities, he must need to see a specialist to determine if there are correctable problems or underlying health concerns for the further IVF procedure. 

Unexplained infertility:  No cause of infertility can also identified despite evaluation for common causes. 

Genetic disorder:  If you or your partner carries a risk of passing on a genetic disorder to your offspring, you may be recommended for having pre-implantation genetic diagnosis. It is a procedure that involves IVF. After the eggs are successfully harvested and fertilized, few tests can be performed to screen for certain genetic problems. Generally not all genetic problems can be found in these tests. The embryos that don’t show identified abnormalities of problems can be transferred to the uterus.

Click to know, Is IVF Painful?

What is High-Risk Pregnancy?

A high risk pregnancy is one that requires specialized extra care from specially trained providers in order to have a healthy pregnancy and baby. It can threaten the life or health of the mother or her child. This is often arises, if you suffer from a chronic illness or have other factors and conditions that convert your pregnancy in the high risk category. Several other factors can make a pregnancy high risk, for example mother’s age and lifestyle, existing health conditions of the mother and some significant health issues that occurred before or during pregnancy. Some pregnancies become high risk as they grow, while for a variety of reasons, some women are at increased risk for risky pregnancy even before they get pregnant. It is likely that problems may prevail with both mother and the baby during the pregnancy, birth process or even after the delivery of the child. For both the mother and the baby, the problems can be minor or life threatening in severity, which require additional monitoring and care from your doctor. 

Risk factors for a high-risk pregnancy

Sometimes a high-risk pregnancy is the result of a medical condition present before pregnancy. Specific factors that might contribute to a high-risk pregnancy include:

Existing health conditions: For example high blood pressure, being HIV-positive or diabetes.

Obesity and overweight: Most people already familiar with the facts that obesity increases the risk for high blood pressure or gestational diabetes. Additionally it can also increase the risk of cesarean delivery, preeclampsia, stillbirth or neural tube defects. Researchers have suggested that obesity can raise infants’ risk of having heart problems at birth by 15%.

Multiple pregnancies: If a women carrying more than one fetus – twins or higher-order multiples, the risk of complications will be high as compared with single pregnancy. Common complications include preterm birth, premature labor and and preeclampsia. It is recorded that more than one-half of all twins and 93 percent of triplets are born at less than 37 weeks’ gestation.

Young or old age of mother: Pregnancy in teens and women with age more than 35 years older increases the risk for gestational high blood pressure or preeclampsia.

Medical history:  A history of diabetes, heart disorders, and chronic hypertension, breathing problems such as poorly controlled asthma, infections, and blood-clotting disorders such as deep vein thrombosis can considerably enhance pregnancy risks.

Poor lifestyle: Smoking cigarettes, taking illegal drugs and drinking alcohol can put a pregnancy at high risk.

Surgical history: A history of surgery on your uterus including, multiple abdominal surgeries, multiple C-sections or surgery for uterine tumors (fibroids) can increase chances for pregnancy risks.

Pregnancy complications: Various health complications that develop during pregnancy can also increase pose risks. For examples an abnormal placenta position, Rh (rhesus) sensitization and fetal growth less than the 10th percentile for gestational age.

Women with high-risk pregnancies should require extra care from a special team of health care providers to ensure the best possible pregnancy results. Some Important Tests before Planning a Pregnancy after Miscarriage

 

Few Things Need to Know Before Eggs Freezing

Age is the major risk factor for health problems like the likelihood of chromosomal abnormalities in women. The risk of birth defects or disorders and the risk of miscarriage makes the things difficult for conceiving. Egg freezing is an alternate way to stop the natural biological clock of the body, expand reproductive chances and preserve the younger and possibly healthier eggs. Eggs freezing have become an increasingly attractive option for many women looking to extend their childbearing years. But few things need to know before going for eggs freezing:

Exact meaning of egg freezing: The process of egg-freezing or oocyte cryopreservation in medical language, involved stimulation of the ovaries with hormones to produce multiple eggs, the retrieved eggs are then sent to the lab where they are frozen unfertilized and stored to be thawed at a later date and combined with sperm in a lab and implanted in the uterus for further in vitro fertilization process.

Procedure of egg freezing: The process of retrieving eggs for further eggs freezing is similar to the first phase of in-vitro fertilization (IVF). The doctor will apply anesthesia and vaginal wall be a punctured from a needle. There is a possible risk for infection but the will reduce as far as surgical procedures move forward. To stimulate the ovaries to produce multiple eggs, round of hormone injections given to the woman. For regular monitoring of ovaries by vaginal ultrasound, the stage involves multiple visits to the doctor, about five times in the interval of 10 days. The eggs are retrieved after a week of hormone treatments.The complete egg retrieval process takes about 10 minutes and is done under mild sedation or anesthesia. The doctor guides a needle through the vagina to the ovarian follicle which contains the eggs using an ultrasound. A suction device installed at the end of the needle removes the eggs from the follicles. Retrieving the eggs from ovary is technically similar to that of from getting blood drawn from the body where a needle goes into the ovary the eggs taken out gently.

Associate Risk of Egg Freezing : The complete surgical procedure is almost safe, but risk of ovarian hyperstimulation syndrome or OHSS which create some heath related issues in some women may develop by the hormone shots. That mostly happens when a woman responds too aggressively to the hormones and the ovaries become painful and swollen. But in rare, OHSS increases the risk of blood clots and kidney failure that can be fatal.

Chances of having a baby with my freezing eggs: According to a survey conducted by the American Society for Reproductive Medicine, the chance that a single frozen egg will successfully lead to a pregnancy is about 12 percent.  For this reason, it is often recommended to have coupled dozen eggs frozen to maximize the success rate for having baby in later life. Although the success will directly depend on a number of factors like age of woman and the quality of the sperm of her partner.

Risks Associated with In-Vitro Fertilization (IVF)

In-vitro fertilization (IVF) is a complex medical treatment used to treat infertility or genetic problems and help with the conception of a child. It is a type of assisted reproduction procedure in which a woman’s eggs and a man’s sperm are combined outside of the woman’s body in a laboratory dish. Then one or more fertilized eggs (embryos) directly transferred into the woman’s uterus. Pregnancy happens if any of the embryos implant in the uterine lining. In fact, serious health issues from IVF procedures and medicines are rare. However, there are some risks associated with this all medical treatments. The most common risks are discussed below.

Multiple pregnancies: If more than one embryo is implanted in your uterus, there is an increase risk of multiple pregnancies. There is a high risk of early labor and low birth weight if a pregnancy with multiple fetuses occurred, but there is a low risk if pregnancy occurred with a single fetus.

Psychological stress: IVF involves a significant financial, physical and emotional commitment on the part of a couple, specially if in vitro fertilization (IVF) is unsuccessful psychological stress and emotional problems are common. Support from family and friends or counselors may help the couple through the ups and downs of infertility treatment.

Very expensive:  IVF Procedure is expensive and most of the insurance companies do not provide coverage for fertility treatment. The cost for a single IVF cycle can cost from at least $12,000-$18,000.

Low birth weight and premature delivery:  It is suggested that use of IVF significantly increases the risk that a baby will be low birth weight or born early as expected.

Ovarian hyperstimulation syndrome: During the IVF procedure, to induce ovulation many injectable fertility drugs such as human chorionic gonadotropin (HCG) are used which can cause ovarian hyperstimulation syndrome. Signs and symptoms of this treatment typically last a week and include pain, bloating, mild abdominal pain nausea, vomiting and diarrhea. In many pregnant women, the symptoms might last several weeks. There is a possibility to develop a more-severe form of ovarian hyperstimulation syndrome that can increase the chances of shortness of breath or rapid weight gain.

Miscarriage: The rate of miscarriage is about 15 to 25 percent for women who conceive using IVF with fresh embryos is similar to that of women who conceive naturally, but this rate generally increases with maternal age. The risk of miscarriage increases with the use of frozen embryos during IVF procedure.

Egg-retrieval procedure complications: Use of an aspirating needle to collect eggs during IVF could possibly cause infection or damage to the bowel, bladder or a blood vessel or bleeding. If general anesthesia has been used, high risks will increase with the mother.

Birth defects: No matter how the child is conceived, the age of the mother is the main risk factor in the development of birth defects in the baby. More research is required to evaluate whether babies conceived using IVF might involved in increased risk of certain birth defects. Some experts suggest that the use of IVF does not increase the risk of having a baby with birth defects.

What is In-Vitro Fertilization or IVF TECHNOLOGY?

In-Vitro Fertilization or IVF is an assisted reproductive technology (ART). IVF process required the fertilization by extracting eggs retrieving a sperm sample and then manually combining the egg and sperm in a laboratory dish. The embryo or embryos are then transferred to the uterus after the combination. Gamete intrafallopian transfer (GIFT) and zygote intrafallopian transfer (ZIFT) are other forms of ART.IVF is one of the effective way for treating infertility caused by ovarian disorders, premature ovarian failures or fibroids or blocked fallopian tubes in women and male factor fertility caused by low sperm count.It is also an effective treatment for women who have had their fallopian tubes removes or any other unexplained infertility and male with any genetic disorder.The successful rate for treating infertility with IVF mainly depends on number of factors like causes of infertility and of course, reproductive history, maternal age and lifestyle factors. But in reality, IVF is considered to be an effective treatment for infertility in childless couples.                

Process of IVF and embryo transfer

  • For stimulating egg production fertility medications are recommended. Multiple eggs may be desired because some eggs will fail to develop or fertilize after retrieval. A trans-vaginal ultrasound has been adopted to examine the ovaries, and blood test samples are collected to check hormone levels.
  • With the help of a minor surgical procedure eggs are retrieved through ultrasound imaging to guide a hollow needle through the pelvic cavity to successfully remove the eggs. Medication is advised to reduce and remove further potential discomfort.
  • A sample of sperm collected from male, which will be used for combining with the eggs.
  • The sperm and eggs are mixed together and collected in a laboratory dish to encourage fertilization and this process is known as insemination. The process of intracytoplasmic sperm injection (ICSI) may be used in some situation where there is a lower probability of fertilization. During this procedure, a single sperm from male is injected directly into the egg in an attempt to achieve successful fertilization.
  • Three to five days after the egg retrieval and fertilization the embryos are usually transferred into the woman’s uterus. A small tube or catheter is inserted into the uterus to transfer the embryos. This procedure is free from any sort of pain for most women, although women may experience mild cramping. If the procedure is successful, the implantation normally occurs around six to ten days after egg retrieval.

Side effect of IVF

After the process of IVF most women can start doing normal activities in the following day itself. Some side effects after IVF process include passage of small amounts of fluid in women after the procedure.

The produced fluid can be clear or slightly colored with blood. Bloating and mild cramping can also considered as side effect. Some women also experienced tender at breasts and constipation after the procedure as side effects. Some potential problems like blood in the urine, pelvic pain and fever over 100.5°F and heavy vaginal bleeding should be thoroughly checked by doctor immediately. The side effects of fertility medications may include headaches, abdominal pain, hot flashes and abdominal bloating mood swings or hyper-stimulation syndrome (OHSS).