IVF Services - Akanksha Hospital


IVF is the original 'test-tube' baby technique. In-vitro fertilization (IVF) is the process of fertilizing eggs with the sperm outside of the human body. In infertile couples, where women or/and men have problem in natural conception the technique of in-vitro fertilization (IVF) offers a chance at parenthood to couples .

In IVF, eggs are surgically removed from the ovary and mixed with sperm outside the body in a Petri dish. the eggs are examined to che1ck if they have been fertilized by the sperm and are dividing into cells. These fertilized eggs (embryos) are then placed in the uterus of the woman, thereby bypassing the fallopian tubes. Once fertilized, the resulting embryos are placed back in the woman's uterus with the hope that a successful pregnancy will follow.

Intra Cytoplasmic Sperm Injection (ICSI) is the most successful micromanipulation technique, most commonly used for the treatment of male factor infertility. This technique is used to enhance the fertilization phase of in-vitro fertilization (IVF) by mechanically inserting a normal, live single spermatozoon directly into the cytoplasm of an oocyte. The fertilized egg is then placed in a woman's uterus or fallopian tube after three or five days. The indication for ICSI :

  • Severe male factor infertility such as Oligospermia and Azoospermia
  • Severe endometriosis
  • Polycystic ovarian diseases which do not respond to conventional treatments
  • Unexplained infertility
  • Previous failed IVF cycles
  • multiple miscarriage

cryopreservation is a technique in which sperms, eggs and embryos are frozen at a sub-zero temperature to preserve them for future when the need arises.

There are 3 types of Cryopreservation in IVF spectrum:

  • Sperm Cryopreservation
  • Eggs Cryopreservation
  • Embryos Cryopreservation

Sperm are frozen to preserve because of a string of reasons:

  • develop sperm bank
  • donate stored sperm
  • For back up to use it during the treatment if the male partner is unable to ejaculate on the day of egg retrieval
  • to preserve the male infertility I.e.Prior to Cancer treatment which might adversely affect fertility
  • Retrieved sperms from epididymis (PESA) or testes (TESA)

If sperm are frozen for the impending treatment of the donor, the storage period is usually 1 year. For the pre-chemotherapy storage, the duration is mostly of 10 years which can be extended in certain circumstances.

Eggs Cryopreservation is for women who are about to undergo medical treatment such as cancer etc. which may affect her ability to produce eggs in the future. This technique is also useful for women who are career-oriented and does not want early motherhood.

Eggs are frozen within few hours of collection through the standard freezing process. Later, when women are ready to be pregnant, the frozen eggs are thawed, fertilized with the husbands’ sperms and resultant embryo is implanted in the uterus.

During the treatments like IVF, ICSI the best embryos are selected and transferred during the first cycle, if any good quality embryos are left, they are frozen to preserve for the future use while curing infertile couples.

Donating sperm is considered one of the noblest causes a man can undertake. When the male partner has zilch sperm or his sperm are of low-quality, they need some other man who is willing to donate sperm which would fuse with eggs of the female partner to form an embryo. That embryo would be implanted in the womb to produce a healthy child.

When female partner is unable to produce eggs due to various reasons like menopause, premature ovarian failure or age factor, the infertile couple seeks a woman who would donate eggs.

The eggs are fertilised and implanted in the womb of the desired mother. Thereafter the children are born in a natural manner. The desired mother has to undergo two to three sessions of hormonal therapy before obtaining the eggs from the donor woman. It is called Hormonal Replacement Technique. This therapy is used to determine whether the womb of a woman is competent for implantation.

When both the male partner and the female partners are infertile, they opt for embryo donation.

In this, the embryo is developed by fusing the sperm and eggs of the donor couple and the embryo is implanted in the uterus of female partner.

Artificial insemination is a procedure in which washed sperm sample is directly inserted into a woman's cervix, fallopian tube or uterus with the sole purpose of making the sperm's trip shorter and to bypass any obstructions, in turn making pregnancy possible.

Intrauterine insemination (IUI) is an assisted reproductive technique by which washed and processed sperms will be inseminated into uterine cavity at the time of ovulation. It is the most preferred and common form of artificial insemination and is recommended by doctors as an initial form of treatment for infertility because it is a simple procedure with very few side effects.

Indications are:

  • Unexplained infertility problems
  • Decreased sperm count and motility
  • Donor sperm Insemination in conditions like Azoospermia
  • An abnormal cervical condition like cervicalmucus
  • Cervical scar tissue as a result of endometriosis and other previous procedures
  • Ejaculation dysfunction

Intracytoplasmic morphologically-selected sperm injection (IMSI) is an infertility technique used in IVF treatments. IMSI primarily involves the selection of those sperms with a shape and size that indicate good genetic quality and are healthy looking, from a sample provided by the male partner. During IMSI, the embryologist carrying out the procedure uses an extremely high-powered microscope to select the sperm cells with the best morphological quality to be injected into the eggs. The major win incase of IMSI technique is that the sperm is magnified approx. 6000 times,where in the ICSI technique in which the sperm is magnified only 200 times.

Advantages of IMSI

IMSI technique is immensely beneficial for:

  • Patients with previous ICSI failures
  • Patients where there is severe male factor abnormality e.g. severely decreased sperm count and motility, normal sperm count but higher percentage of abnormal sperms etc
  • Recurrent first trimester abortions - here the conventional ICSI does work and in turn results in early abortions
  • Patients with prolonged unexplained Infertility
  • Cervical scar tissue as a result of endometriosis and other previous procedures
  • Male partners over 35 years

Laser assisted hatching is a technique that can significantly improve the rates of implantation/pregnancy by ensuring the embryos hatch from its protective outer shell, the zonapellucida, and implant in the uterine wall post embryo transfer. This method makes use of a highly focused infrared laser beam which removes a very small section of the zonapellucida or the outer wall of an embryo very precisely. It is believed that the embryo can then hatch more easily through this hole and greatly increase the chances of embryo implantation. Laser assisted hatching is carried out just before the embryo transfer procedure and can be performed on embryos at the early cleavage stages or at the blastocyst stage

These include:

  • Women who are above 35 years of age
  • Number of unsuccessful attempts at in-vitro fertilization
  • Poor embryo quality
  • Whether frozen embryos are being implanted
  • Some women may produce embryos with thickened or hardened zona making it difficult for the embryo to implant
  • Unexplained infertility

Advantages of LAH include:

Laser assisted hatching far more superior when compared to chemical and manual hatching. Women who have undergone several IVF treatments without a successful outcome can significantly increase their chances of pregnancy by use laser assisted hatching technique.This technique requires very little handling of the embryo when compared to other assisted hatching methods. Laser-assisted hatching is much faster than the other techniques. Hence the time an embryo spends outside the incubator is comparatively less

The usual way of producing sperm for use in Assisted Reproductive Technology is manual stimulation. In cases where medical or religious factors prevent this, surgical methods can be used. Medical reasons that could contribute to inability to produce sperm though ejaculation could consist of azoospermia, low sperm count, low sperm motility. The following procedures help retrieve sperm through minor surgical procedures:

PESA

PESA (percutaneous epididymal sperm aspiration) is a method, performed under local anesthesia, which involves extracting sperm with a fine needle from the epididymis or testes. The sperm is then implanted into the egg through the process of ICSI (Intracytoplasmic Sperm Injection) to be used in IVF.

TESA

In cases where the epididymis does not contain any sperm, because of impaired sperm production, the method of TESA (Testicular Sperm Aspiration) or TESE (Testicular Sperm Extraction) may be used. TESE involves a surgical biopsy of the testis, while TESA is performed by sticking a needle into the testis and aspirating fluid and tissue with negative pressure.

MESA

The most invasive of the surgical sperm retrieval procedures is MESA (micro-epididymal sperm aspiration), which is performed under general anesthesia. MESA involves the cutting open of the scrotum to retrieve sperm. The wound is closed with dissolvable stitches. Swelling and pain subsides within a few days, during which prescribed painkillers may be taken to ease the pain.

In vitro culturing of sperm

We have applied for registeration patent ,where we got success in culturing the spermatozoa in a patient followed by testicular biopsy ,who are having spermatogenesis arrest as per their histopathology report of testicular biopsy.

The EmbryoScope ,time-lapse system allows embryologists to monitor developing embryos throughout their development.  The specially designed triple gas incubator, with a built in camera and microscope, is for use in IVF treatment.  Time-lapse videos of individual embryos are generated over the 2-5 days they remain in the incubator without disturbing their development and detect morphological abnormality during development. At the same time of transfer embryologist can see whole development video and feed the details in softwere .

So that softwere gives the gradation of embryo.

 Observation of embryo development is important in deciding which are most likely to result in a healthy pregnancy.

benefits as a patient

  • Only time-lapse system with integrated high stability incubator.
  • Optimal incubation for day 2, 3 or blastocyst culture.
  • Full documentation of embryo development for future reference.
  • Better selection of embryo for transfer and freezing to belence fresh and frozen cycle.