Egg banking and Oocyte Freezing

Egg banking and oocyte freezing is a reality now at Ideal Fertility.

We did an IVF with frozen eggs of a lady. The egg were vitrified because , they were excessive. She did not conceive in that cycle, but conceived lateron with frozen eggs.

With this feat, now we offer egg banking for young females, who don’t want to conceive due to some reasons. They can use their own eggs later on.
dainik bhaskar 30.4.2016_1

A Taboo of not disclosing about ” my baby is a IVF baby” Broken

 

 

 

 

 

 

piplani 17.4.2016   It was my feeling since long , that , the couples treated at our center, don’t want to disclose that, they are being treated for IVF treatment, in their family or in society. Even the couples treated successfully and delivered child, are reluctant to get photographed and avoid telling their near and dears, that they are being treated at our center. Few of them, even didn’t disclose us that, they have delivered the child and they never come back. This is a great stigma attached with IVF treatment ( I may be wrong). Either, they don’t want to get stamped, that they are unable to reproduce naturally, and they took a help of doctor, and  feel inferior, if everybody know this fact. Or may be, society may say, that this is not their biological child ( may be due to ignorance). But, this is the usual behavior, I perceived.

But Yesterday, I went to deliver a lecture among doctors of Burgad of Odisa state, and while I was talking to the gathering, A couple with a grown up baby entered into the hall. I recognized them. They were couple from Burgad, and I treated them 7/8 yrs back, and they delivered a child. They were the same.

After finishing my talk, they came infront and told the audience, that they had been treated by me, show the child, as a result of the treatment. They were so happy to meet me and showing the child, and even allowed me to discus their case,as they were treated with IVF/ICSI. It was a great surprise with nice feelings for me.

IMA Burgarh 17.4.2016

Role of emotional stress in fertility treatment

I see my patients (not patients, as they are healthy couple,but not able to reproduce) come for infertility treatment, and most of them are for IVF. They tried for a  long, naturally or with various treatments but feel helpless, as they couldn’t achieve it. So I can place them in psychologically stressed and partly frustrated.

“Rene Frydman and Alice Domar have emphasized the role of emotional stress( the stress of infertility has been compared to a diagnosis of cancer or infection with human immunodeficiency virus) in reducing oocyte competence.

Any stress, like ” Fight,Flight, Fright” generates a response, that mobilizes blood flow to the heart, muscles, and brain at the expense of ” inessential” organs such as ovary.  Frydman’s group in Paris showed in a landmark study of natural cycle IVF that the quality of blood flow to the mature follicle was strongly related to pregnancy outcome.They also refer to  another landmark study showing that an increased vascular response to stress predicts a reduced IVF pregnancy rate

Thus the patient has to be counseled to reduce the amount of stress during IVF treatment. Because it is our opinion too that, even we get good eggs and even we get good blastocyst, the implantation fails. It may be due to poor quality or poor energy(? mitochondrial energy) of the maternal oocyte.” ( Fert-Ster,page 545,Vol 105,No3/March 2016)

Extreme stress is a major contributor to the poor embryo quality and failed IVF.

Many female partners, in my center, seeking IVF treatment, are under too much stress . When I ask them for the reason, apart from infertility, few of them disclose that , they have a fear of left out by male partner and his family, because she is infertile and if this expensive treatment fails, they might be discarded by the family ( may not be an actual truth, but the guilt of being infertile breaks them)

Fear of loosing hard earned money, if treatment fails, is one of the major contributor of stress, in a self funding situation.

And top of that, when one IVF cycle fails, and they decide to go for second cycle, there is an added stress of previous failure.

I always try to communicate with the female partner and try to make her comfortable. I always tell them, when you are under my treatment, then we are friends, there is no doctor-patient relationship, we have to be informal in talking, and I am always available with you,any time you need any answer. It makes the situation little less stressful ( I suppose). I can not behave like or become a God, but we together can bang the door of “Him”, so that it may open the door of opportunity. If we don’t bang it with fullest effort, it will never open. To get a pregnancy, is our joint goal,  and with you guys, I am too very much fond of success.

I always ask them to do “meditation” ( a mind-body program). Sometimes I teach them, how to do it. It helps to release stress to a large extent.

I tell my patients, that while doing your treatment,I am under stress too ,  Because it is a great responsibility to give best from my side. I don’t know whether my treatment will be successful or not, but I have to overcome this stress and do my best, rest depends on “Almighty”. It is our philosophy, ” You do you best Karma, and for the result, leave it to the Almighty”. It is like a war. You always fight it to win it.

People have seen that: Even the Best Euploid embryo , diagnosed by Pre-implantation Genetic Screening , fails to implant in good endometrium. (Fert-Ster page 545,Vol 105,No3/March 2016)

 

Incubators in IVF laboratory

Triple gas incubators are usually of three types

  1. It is a bench top warmer and maintains the temperature and you have to feed it with triple gas mix, Mostly 90% N2, 5/6%CO2 and balance air. Here you are dependent on the manufacturer of the triple gas mix, and if it is not supplied properly then you are stuck and there is no incubator in your lab. Secondly, if you want to keep a particular pH in any sequential step, then you can not change the concentration of CO2 at your will or you have to order the separate gas mix. I find it very cumbersome and don’t rely on premix.
  2. Bench top system with inbuilt facility of mixing gas at our will, here we need pure CO2 and N2 feed. It is easy to obtain these cylinders. Here we can fix the CO2 concentration according our pH requirement of the sequential step. We use MIRI multichamber , its performance is good and gas consumption is very less. Fast recovery and we can dedicate each chamber for each patients without disturbing the other. There are other brands too in the market. They are definitely better than simple warmers.
  3. Box type triple gas incubators: These incubators are also with systems of gas mixing at our will. These systems are age old trusted partners of laboratory. Smaller the capacity of incubator, better is recovery and lesser is the consumption of gas. It is better to have a few small box type triple gas incubators , than having a single large incubator ( to accommodate many patients, they consume definitely large amount of gas, esp nitrogen) . We use ASTEC small box type triple gas incubators.

Our policy is : It is important to have a particular pH at different steps, rather believing the CO2 concentration shown on display. We keep CO2 according to the pH requirement, which you can not do with simple warmers.

PCOD

Now a days , getting many cases of ? PCOD. They full fill the two out of three criteria of Rotterdom. ( Polycystic ovaries in Trans vaginal sonography and oligo-menorrhoea,)With/without hyperandrognenism. Their gonoadotropin levels are in the range of hypo gonadotropic – hypogonadism.

Here stimulation with clomiphene citrate is difficult.

Is it due to psychological stress or some thing else. Many gives history , that it started after getting married. Does situation changes and other stress creating this problem?

Dysfunction in ovulation in Fertility treatment

Dysfunction in Ovulation Fertility treatment
Ovulation dysfunction is one of the main reasons in female infertility.
Infrequent ovulation is associated with an inter-menstrual interval of less than 25 days or grater than 35 days, of a variation in the inter-menstrual interval of greater than 5 days.
Premenstrual moliminal symptoms, like breast tenderness, irritability, mild headache, are typically associated with ovulatory cycles.
Special diagnostic testing to confirm ovulation is not required in women with a history of regular cycles with premenstrual symptoms. ( no follicular study or serum progesterone)
If an objective evidence is required for ovulation, then serum progesterone should be done 7 day after a positive urinary LH determination, serum progesterone of greater than 3 ng.ml is consistent with ovulation.
When oligo-ovulation is present, a specific cause should be identified. The most common cause of ovulatory dysfunction include polycystic ovarian syndrome, excessive psychological stress or physical stress, thyroid disorders, hyperprolactinemia, ovarian insufficiency, and medical conditions including obesity.
Elevation of early follicular- phase follicular stimulation hormone( FSH) levels grater than 10 mIU/ml are threshold measure or diminished ovarian reserve ( DOR, whereas FSH levels less than 4 mIU/ml may be encountered with hypo-thalamic oligo-ovulation.
Frequently no specific endocrine abnormality will be identified after the initial evaluation of women with ovulatory dysfunction. Most of the women with normal gonadotropin level and no other known endocrine abnormality will be classified as having plycystic ovary syndrome(PCOS), exhibiting at least 2of the 3 following characteristics : 1. hyperandrogenism ( hirsutism, oily skin, acne), 2. irretular menses indicating oligo-ovulation, or 3. polycystic ovaries (> 11 basal antral follicles, < 10 mm in in single longitudinal image of each ovary by transvaginal ultrasound). this definition of PCOS, however , will also include some women with hypothalamic oligo-ovulation, because these women can exhibit PCOS appearing ovaries with irregular menses. This distinction in important because the best method of ovulation induction will be different for these groups of women

( courtesy: MarshburnPB)