Platelet Rich Plasma Therapy

• PRP is platelet rich plasma extracted from patient’s own blood.
• Platelets are rich in growth & healing factors.
• These growth factors promote healing of tissue.
• There is no risk of getting any viral or bacterial infections as PRP is extracted from patients own blood.

General outline of PRP treatment

• Approximately 50 ml blood is collected & centrifuged to separate PRP extract.
• This PRP is injected into ovaries or instilled into uterine cavity to promote the tissue healing & regeneration.

PRP for ovarian rejuvenation

• PRP can encourage improvement in egg quality, number and response to fertility  
• PRP is injected into 2 points in each ovaries with help of special long needles.
• Peak improvement in ovarian function is expected in 1-3 months.

PRP for endometrial rejuvenation

• Persistently thin endometrium to promote the growth on endometrial lining .
• RIF cases to improve endometrial receptivity.

Medical Genetics

Basic outline of genetic testing of the embryo :

1st step -Genetic counselling to determine if the couple needs genetic test of the embryo & which type of test  should be done .

2nd step -IVF /ICSI procedure to get embryos.

3rd step -Blastocyst culture to get embryos with best implantation potential .

4th step -Embryo biopsy  : Collection of 5-7 cells from blastocyst stage embryo using special microsurgical instruments .

- Implantation & future growth potential of the embryo is not compromised when biopsy is done on blastocyst stage embryos. 

5th step - The genetic material , DNA is extracted from these cells & tested for genetic diseases  using specially made  genetic test probes.

6th step - Transfer of normal embryo in womb

-In most cases cryopreservation of embryo is required till the final result of genetic test is available .

There are 3 type of embryo genetic testing :

(1) Preimplantation Genetic Testing for Aneuploidies ( PGT-A):

• Earlier it was called Preimplantation Genetic Screening ( PGS ) .
• The aim is to look for presence of any aneuploidies ( extra or missing chromosome ) of the embryo .
• It can help to select the embryos with normal chromosomal pattern which will have highest chance of becoming healthy babies .
• It is done when there’s no known evidence of a genetic abnormality in either parent.

Who can benefit from PGT-A ?

• Female partner age 38 or older.
• Couples interested in a single embryo transfer.
• History of repeated pregnancy loss .
• History of repeated failed IVF .
• Couple with more number of embryos can choose to select the normal embryo to decrease ‘ time to pregnancy ‘.
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(2) Pre Implantation Genetic Testing for Monogenic Diseases (PGT-M):

• It was earlier called Preimplantation Genetic Diagnosis( PGD ) .
• It is recommended when there is known risk of passing down a genetic abnormality to future offspring .
• Genetic test report of affected family member is analysed in details to plan treatment for the couple .
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Who can benefit from PGT-M ?

• Personal or family history of single-gene defects—such as cystic fibrosis, haemophilia, sickle cell anaemia, muscular dystrophy , citrullinemia , multiple exostosis etc.

(3)Pre Implantation Genetic tests for Structural Rearrangement (  PGT- SR )

• Chromosomal structural rearrangements are translocations , inversions ,duplications or deletions of part of chromosome .
• Many time carriers of structural rearrangement are apparently healthy individuals .
• Most of the times structural rearrangements are suspected & detected only when such individual suffer from repeated IVF failure ,  repeated miscarriage  or birth defects in their babies .

Who can benefit from PGT-SR ?

• In known carriers of chromosomal structural rearrangement normal embryos can be selected by PGT SR.

3rd party reproduction & gestational surrogacy

-Third party reproduction involves use of donor sperm, donor egg or  donor embryo to conceive  or taking help of gestational surrogate to carry the pregnancy.

-The couple who will raise the baby after delivery are called ‘Intended Parents’.

-The person who will donate the sperm, egg , embryo or carry the pregnancy is the ‘Third Party ‘.

-Third party reproduction involves teamwork of your fertility physician, psychological counsellor, gamete donor agencies, gestational surrogacy agency, social worker & lawyer .

Who may need egg donation ?

• Ovarian failure in cases of cancer treatment with radiation, chemotherapy or surgical removal of the ovaries.
• Carrier of serious genetic diseases.
• Advanced age & menopausal women .
• Poor quality embryos during previous IVF cycles due to poor quality eggs.

Who may need sperm donation ?

• Men with azoospermia with failed surgical sperm retrieval.
• Carrier of serious genetic diseases.
• Poor quality embryos during previous IVF cycles due to poor sperm quality.

Who may need gestational surrogacy ?

• Woman who does not have a uterus since birth or have undergone surgical removal of uterus.
• Woman who has a serious health risk in carrying pregnancy.
• In few selected cases with history of recurrent miscarriage or IVF failure.

It’s very important to avoid any conflict in 3rd party reproduction :

• You should discuss about other possible ways of biological parenthood.
• Try to gather all information about 3rd party reproduction.
• Don’t keep your concerns to yourself.
• Ask the team of professionals involved in your case.
• Keep all documents.

Ask for transparency in all steps of the treatment.

Many women suffer from pregnancy loss either after natural pregnancy or after IUI treatment or test tube baby treatment. There are 2 main reasons for these miscarriages – Embryo related or uterus related. While nearly 70% of initial 2-3 miscarriages are due to embryo related factors – an abnormal DNA or chromosomal composition, a fertility specialist need to evaluate all the possible factors that can cause miscarriage. This will include some blood tests for the couples, a detailed ultrasound including 3D ultrasound and hysteroscopy if needed. The other tests may be indicated on case to case basis. Please speak to your Gynaecologist / Obstetrician or fertility clinic for knowing which type of tests would be needed in your case. Once the tests are done, some couples might need a targeted treatment to reduce the chances of further miscarriages while others might need empirical therapies which in our experience as fertility specialists, has given good results.

Recurrent IVF Failure or recurrent implantation failure

It is common to come across couples who have undergone IVF treatment or ICSI treatment or test tube baby treatment more than once and have not succeeded. There can be many causes for such unfortunate condition. Few common causes are chromosomally abnormal embryos, Uterus which is not ready to accept embryo (abnormal uterine receptivity), Problems during embryo transfer process and high levels of mental stress in the women. A good fertility clinic should have expert fertility specialists or fertility consultants who can focus on all the above issues and try to find the reason for the failed IVF treatment. In many cases, a correctable cause might be found which can pave the way for a successful IVF cycle. It becomes imperative for the couple to consult an infertility specialist who has the experience of treating many such cases of IVF treatment failures since such experiences helps the fertility specialist make a tailor made plan for the couple and take them to a successful outcome.

Abnormal immune responses might be the underlying reason for many couples who either have recurrent or repeated miscarriages or recurrent or repeated IVF or implantation failures. There are targeted therapies available for such couples and these have given parenthood to many couples who have endured failures for long.