This test is to see when is the probable time for egg to get released from the ovary (Ovulation). This is needed for women who try naturally, those who are planning IUI treatment and also in women planning for IVF or ICSI or test tube baby treatment . It is performed using an internal scan (transvaginal ultrasound) to measure the growth rate of the follicle,which is a water filled structure in the ovary which contains the egg. This scan is done starting from day 2 of starting of periods in women who are trying naturally or IUI and is then performed at a regular interval. It helps in knowing the good time to try naturally,to do IUI and also to take the eggs our for IVF or ICSI. The follicular growth may need some medications in women who are undergoing IUI. The IUI cost may vary from 10000 INR to 30,000 INR or more. Giving tablets instead of injections for follicular growth can keep the IUI treatment cost
What are various methods of tubal patency test ?
There are 3 main type of tubal patency tests-
The advantage laparoscopy of is that any corrective surgery can be done during same procedure.
When we should consider tubal patency test ?
What are the chances of pregnancy after tubal patency test ?
Pregnancy chances depend upon various complex factors like
What is ERA ?
-ERA is an abbreviation for Endometrial ReceptivityArray or Analysis.
-This is specialised genetic test carried out on a tiny portion of the woman’s uterine lining to determine the most appropriate day to transfer embryo during an IVF cycle.
Who can benefit from ERA?
Endometrial Receptivity Array test is done in couple with repeated implantation failure.
How is ERA test done?
Is there any limitation of ERA test?
Ovarian reserve is the number as well as quality of the remaining eggs in both ovaries at a given age.
Egg quality directly affects embryo development & the ‘take home baby ‘rate.
Ovarian Reserve Test ( ORT ) helps to determine the chances of natural conception as well as with treatment.
It is very important to identify women with low ovarian reserve so that they can take important decisions regarding their own fertility in a timely manner.
Following are the risk factors for Decreased ovarian reserve :
Ovarian reserve should be tested in following conditions also :
Ovarian reserve can be determined with Ovarian Reserve Test ( ORT ):
Caution while interpreting result of ORT :
Ultrasound imaging makes use of ultrasound waves to visualise internal organ of body.
Baseline Pelvic USG
1st visit USG is done in detail to assess following conditions which may affect fertility :
Antral Follicle Count Scan (AFC scan)
Ovarian reserve is checked by doing Antral Follicle Count ( AFC) during initial visit itself.
Antral Follicles are tiny 2-10 mm follicle, each containing 1 egg.
Follicular Monitoring Scan
Growth of the follicle, uterus lining thickness & ovulation timing are checked by doing follicular monitoring USG.
Oocyte retrieval & Embryo transfer
Retrieval of oocytes ( eggs ) from ovaries & transfer of embryos into the uterus are done under ultrasound guidance.
USG guided ovarian cyst aspiration
Cyst aspiration can be done as day care procedure to drain ovarian cysts.
We offer following USG services using 2D & 3 D technique.
Use of ultrasound in men
For men ultrasound is done in few select cases to assess following conditions:
Who can benefit from Ovulation Induction :
What to expect during Ovulation Induction
Success rate after OI
Usually 8- 16% success after 1 cycle of OI is expected.
It depends on many factors like underlying pathology , age of woman , semen quality & duration of infertility , condition of fallopian tubes etc.
General outline of PRP treatment
PRP for ovarian rejuvenation
PRP for endometrial rejuvenation
This is a type of fertility treatment in which the eggs are taken out of the ovaries and frozen at -196 degree Celsius. The eggs remain in their original state and can be used for IVF process after weeks, months or years. It is a strategy which is commonly used in unmarried young women who are not planning for marriage in near future due to various reasons like career considerations, not able to get the “right man”, but wish to preserve their fertility etc. It is indicated in such scenarios since the egg numbers keep declining with age and so, after 30 years age, it becomes important for giving this as an option in this group of patients. It is also used for medical indications like young women or girls who have been recently diagnosed with cancer and have to undergo treatment for the same. Since treatment of cancer can damage the egg number, freezing the eggs helps in “fertility preservation” for these young women. Egg freezing is also used in other scenarios like when husband is not able to procure semen sample on the day of IVF or in women with very low egg number as a part of strategy of egg accumulation. These days, egg freezing will be available in all the top IVF center or the top best test tube baby center. This facility is amongst the one very important things which every patient should be looking for when they are searching for the “IVF center near me”.
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):
Who can benefit from PGT-A ?
(2) Pre Implantation Genetic Testing for Monogenic Diseases (PGT-M):
Who can benefit from PGT-M ?
(3)Pre Implantation Genetic tests for Structural Rearrangement ( PGT- SR )
Who can benefit from 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 ?
Who may need sperm donation ?
Who may need gestational surrogacy ?
It’s very important to avoid any conflict in 3rd party reproduction :
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.
The aim of this discussion is to make anyone with curious mind to understand these condition better. It is not equivalent to detailed in person individualised consultation.
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