INTRODUCTION:

Since the desire to procreate is universal, infertile couples through the centuries have searched the known and unknown in the hope of fulfilling their frustrated desire for parenthood.

Medical statistics report that 1 out 7 married couples have difficulty in having children some of them continuing to fail despite full traditional medical treatment. Medical science has made tremendous advances in the field of Assisted Reproductive Techniques (ART) with rapid progress in this field making in Vitro Fertilization possible thereby opening vistas of new and cure.

Aware of the growing need in India for Assisted Reproductive Techniques, the concept of a purpose built laboratory and operating theater complex grew into reality with funding of Fertility Clinic and IVF Center in Gujarat.

As NEWBIRTH IVF, SURAT. The center is staffed by specially trained personnel including gynaecologists, embryologists, laboratory technologists and nurses. As an established GUJARAT INSTITUTE OF REPRODUCTIVE MEDICINE, it has to its credit the first IVF, first egg donation, first embryo donation babies of Gujarat.

TREATMENT AVAILABLE AT THE IVF CENTRE: –

1. In Vitro Fertilization and Embryo Transfer (IVF-ET)
2. Gift (Gamete Intrafallopian Transfer) – A procedure where sperm & eggs are mixed and directly transferred into intact functioning fallopian tubes.
3. ZIFT (Zygote Intrafallopian Transfer) – A procedure where embryo is transferred into functioning, patent fallopian tubes.
4. Egg donation program particularly for elderly women and women whose ovaries are not functioning.
5. Artificial insemination – In particular intrauterine insemination (IUI) where washed live motile sperms are deposited in the womb to facilitate their passage into the fallopian tubes. The use of donor sperm may be considered in some instances.
6. Fertility evaluation and counseling regarding all aspects of infertility treatment inclusive of hormonal, seminal and laparoscopic assessment.
7. Sperm and embryo freezing. (Cryopreservation)
8. Micro manipulation – Directly injecting single sperm into an egg.

With proven track – record of success, this is the most experienced unit in Gujarat with highest number of conception. With over 350 test tube babies by IVF-ICSI, over 1500 babies with IUI itself in last 5 years.

PREGNANCY IN NATURAL CYCLES:
In the middle of menstrual cycle an egg is released from the ovary. The egg is captured by the fallopian tube. If sexual intercourse occurs, sperms may penetrate egg. The fertilized egg, now becomes an embryo, travel down the fallopian tube towards the uterus and implants into the wall of the uterus thus initiating a pregnancy.

IN VITRO FERTILIZATION / EMBRYO TRANSFER (IVF/ET)
IVF is a technological process where several eggs are retrieved from a woman’s ovaries and then fertilized by the husband’s sperm outside of the body in the controlled environment of the laboratory. The fertilized egg then develops into embryos, which are redeposit into the woman’s uterus, by the procedure of embryo transfer.

COUPLES WHO CAN BENEFIT THROUGH IVF:

1. Both fallopian tubes are absent, blocked or irreparably diseased.
2. The husband has a reduced sperm count (oligo-asthenoteratoozospermia).
3. Sperm antibodies in the wife’s and/or husband’s serum.
4. Endometriosis, which is the presence of the lining of the womb outside the uterus.
5. Unexplained infertility when couples in whom no obvious pathology is found but who still cannot conceive.
6. IVF also helps women who either lack ovaries or have no eggs in the ovaries, provided any young member of the family with proven fertility is willing to donate her oocytes.

ELIGIBILITY:

1. The couple must be legally married.
2. The wife must be between the age of 18 and 40 years in a conventional IVF program.

3. Age limit relaxed in egg, sperm, Embryo donation program. 

IVF/ET PROGRAM (STEP-BY-STEP)

Initial Consultation & Evaluation:

The couple should bring along their previous records of infertility workup such as hysterosalpingogram films, semen analysis reports, basal body temperature chart, previous laparoscopy test results. The IVF team physician will counsel the couple about the program and some further investigation may be necessary to establish the chances of success. The woman may have to be scheduled for a screening laparoscopy, hysterocopy and ultrasonography, if needed to assess the pelvic anatomy and accessibility of the ovaries for egg retrieval.

1. Hormonal Stimulation:
The woman is taken into the program on the 2nd or the 20th day of her previous cycle. Medication is given to the patient during the early phase of her next cycle to increase the likelihood of developing more than one egg to increase the chances of her getting pregnant since not all eggs make babies.

2. Monitoring The Maturity of Eggs:
Blood tests are drawn frequently towards the middle of the patients cycle to determine the progress of the stimulated ovaries. Ultrasound examinations are conducted several times to visualize the developing follicles. The size of the follicles, development of lining of womb and result of the blood tests will determine the time of egg collection.

3. Egg Collection:
Eggs are retrieved trans vaginally by needle aspiration, guided by ultrasonic imaging. This requires local/general anesthesia. The eggs thus obtained are placed immediately into the culture dish that contains a special nourishing fluid The patient can leave the IVF laboratory within 4 hours of egg retrieval.

4. Semen Specimen Collection:
Semen specimen is collected by masturbation within a couple of hours of collection of the eggs. The live sperm cells are separated from the seminal fluid, mixed with the eggs and are then placed in an incubator till such time, as the eggs are ready to be fertilized.

5. Fertilization and Cleavage:
Fertilization is the process of a sperm penetrating the egg. The eggs once fertilized are called embryos. These are observed further to be certain that they are dividing (cleaving) normally.

6. Embryo Transfer:
This is done 48 hours after following egg collection. The embryos are placed into the uterus by means of a thin tube (catheter) through the mouth of the womb. The procedure is done on an outpatient basis. The patient leaves the IVF center 4-6 hours following the transfer procedure. Patients are advised to take Progesterone injections and some rest for a week after embryo transfer.

7. Blood Tests:
Blood tests are performed for evidence of pregnancy approximately 11 days & 16 days following embryo replacement.

8. Causes for cancellation in a treatment cycle prior to operation:
The aim of the intensive monitoring program is to obtain healthy, mature eggs at sonography. Thus if the cycle is unsatisfactory, if may be cancelled at any stage. The reasons for this are:

(i) The follicles are developing in a inaccessible ovary.
(ii) Too few follicles are developing which would decrease the chance of obtaining at lest once mature egg.
(iii) There are no follicles developing at all. This is rare but may occur.
(iv) The blood estrogen levels are abnormal. These may be too low for the development of healthy eggs or according to the patterns seen over the last 18 months, unlikely to lead to pregnancy.
(v) The follicles may have ovulated prior to sonography. Occasionally some women ovulate earlier than expected or ovulate without our being able to detect the time when ovulation commenced. Thus it is impossible to accurately predict when operation should be performed.
(vi) Sometimes ovarian cysts develop in response to the drugs. These are not serious or harmful. They usually resolve within one month or may require to be aspirated before starting the stimulation.

TREATMENT TIME:

The patient is required to follow up in for 6 weeks and the husband is required for 2 days at the time of egg pickup provided the preliminary investigations for both husband and wife has been done. This time can be reduced to around 3 weeks in exceptional circumstances.

THE PRELIMINARY INVESTIGATIONS REQUIRED:

For Wife:
1. Hysteroscopy/diagnostic laparoscopy and measurement of uterocervical length.
2. Ultrasound examination of uterus and ovaries. To exclude uterine pathology and cysts in ovaries.
3. Hormonal profiles (TSH, Prolactin, FSH & LH on 3rd day of the period)
4. CBC, ESR, Blood VDRL, Blood Sugar PP, Blood group RH factor, Australia Antigen/HIV, Bleeding time and Clotting time, X-Ray Chest.

For Husband at infertility treatment in Surat , Gujarat , India :
1. Semen analysis
2. Semen culture and antibiotic sensitivity test.
3. Antisperm antibody test for husband and wife.
4. Sperm survival test, semen harvesting & sperm function test.
5. Blood for Australia Antigen & HIV Antibodies.

A WORD ABOUT PUBLICITY:

The ovulation and pregnancy process tend to be fickle and are easily disrupted by stresses of various kinds. Therefore from a medical point of view it seems appropriate that our patients be shielded from contact with news media during this period and we request that participants in the programme refrain from granting interviews till the baby is born. Also, while we welcome the dissemination of information to public on the subject of In Vitro Fertilization we feel that their information should be general and should not refer to the particular medical situation of individual patients who are undergoing therapy. Therapy while it is in process is generally considered a private matter between patient and physician and most patients themselves do not consider the details to be suitable for wider dissemination.
Regards,
IVF Center (NewBirthIVF), Surat, Gujarat