Assisted Reproduction
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What is Assisted Reproduction
Indications for IVF
- Tubal factor Infetility :- Like infections (including tubercular) bilateral tubal block , bilateral ectopic/tubal sterilization.
- Endometriosis :- 20-40 % of infertile women have endometriosis and accumulative evidence indicate that fertility decrease with severity of disease.Surgical treatment with restroration of anatomy followed by IVF is the ideal treatment.
- Male factor infertility :- Poor semen quality is sole cause of infertility in approx 20 % of infertile couples. ICSI offers hope to the couples with poor semen parameters (less than (2-3 million post wash count.
In ICSI , a single sperm is first immobalized by compressing the sperm tail with injection pipette then the sperm is injected into oocyte. - Ovulatory Dysfuntion :- In patients with premature ovauan failure , IVF donor oocyte offers great hope for successful pregnancy. Patients with reproductive aging/menopause it is treatment of last resort.
Patients with severe PCOS who require exogenous gonadotropins , ovulation induction proves difficult resulting in excessive ovarian stimulation (OHSS) , higher order multiple gestation. - Unexplained infertility :- Incidence of unexplained infertility range from 10 % to 30 %. There is no question that IVF is most effective treatment for couples with unexplained infertility.
CRYOPRESERVATION
Ovarian stimulation and egg collection in ICSI (intracytoplasmic sperm injection) and IVF are exactly the same. However, in an ICSI cycle each suitable mature egg is injected with a single prepared sperm cell. This is obtained from the partner or from a donor sperm sample.
ICSI was developed to treat cases of male infertility in which too few (or only poor quality) sperms were available in the ejaculate for in vitro fertilisation.
Embryos of sufficient quality that are not transferred can be cryopreserved. The embryologist will select embryos that are suitable for freezing. Embryos that are ideal for freezing have blastomeres of equal size and display minimal or no fragmentation.
A Word of Caution: There is approximately a 68% chance of survival following the cryopreserved embryos. The quality of embryos undergoing cryopreservation is a major determinant of survival. Depending stage of embryo development, frozen embryos are thawed for 2 days before the transfer. The patient is informed of survival of the thawed embryos and posted for a frozen thawed embryo transfer (FET).
