Repeat Egg retrieval in same patient of Poly cystic ovarian disease

Here is a patient of 5 yrs of childlessness, she is a case of polycystic ovarian disorder. she came to us for IVF. We started her stimulation with Gonadotropins long with GnRh antagonist, Cetrorelix.

On maturation of the eggs may be on 9th day of cycle, we give the injection GnRh agonist, Busarlin, for the final maturation of the eggs, at 12.30 in night.

We did oocyte retrieval after 36 hours. But to our surprise, we found no eggs from the left ovary. We stopped the procedure, and we applied injection HCG 10,000 on same night again. We did repeat egg retrieval after 36 hours from the other ovary.

We retrieved 7 eggs. 4 were mature and at MII stage. ICSI procedure done on them.

On day 5 of embryo culture, we got one good blastocyst. Embryo transfer was uneventful. After 14 days we found the lady is pregnant.

 

ICSI treatment

ICSI or intra-cytoplasmic sperm injection in IVF treatment is very useful tool in male infertility.
When there is very low sperm count or there is very poor motility of the sperms, the chances of union with the eggs ,in conventional IVF system is very less, and there are high chances of fertilization failure . Thus the whole treatment is of no use.
In ICSI treatment , one sperm is artificially injected into the oocyte and helps it to get fertilized.
It is a great help to a man, who would not had become a father of his biological child.
ICSI, treatment help those male partners, who are with no sperms in there semen, but sperms are produced in there testis.Because of some block in the sperm carrying tube , they are infertile.
Now a days there is a trend to do ICSI in all cases ( even without male inferility) to get more chances of fertilized eggs, but its over use should be with caution, as ICSI is little bit un-natural. We should always give preference to  Egg, to chose the best sperm, but it is a social demand, that ICSI is prevailing .But my personal view is : ICSI for all should be avoided, it should be used selectively

Fear Factor in IVF treatment

Most of the time, when I talk to couples regarding the procedure of test tube baby treatment or IVF treatment, I find the female partner is very much scared of pain.
The pain factor is there,but it is only for the injections.
There is always a scare …How my eggs will be removed from my ovary, which is invisible from out side.
Then I show them the video of oocyte pick up.
Egg retrieval at Ideal Fertility, Jabalpur,India is always under general anesthesia, which is very short, and it only requires an injection in vein, after that she sleeps for a while.
There might be some bleeding after that, but it resolves with in hours.
Embryo transfer at Ideal Fertility is done under sonography guidance. Embryo transfer should be a painless procedure. There should be no spasmodic contraction in the uterus. We place the embryos just below the upper end of the uterine cavity.

We avoid daily injections of Progesterone. 14-16 days of daily injections are really painful,especially if it is oil based.
We use vaginal progesterone.

Infertility treatment at Ideal Fertility is very user friendly, we take utmost care for pain part of female partner during the treatment.

Blastocyst Transfer in India

Blastocyst transfer:
We at Ideal Fertility India, do 99.5 % blastocyst transfer. We at Ideal Fertility Jabalpur , madhya pradesh India , believe that , Blastocyst transfer is the best possible way to get success in IVF Treatment.
We do IVF,ICSI in Test tube baby treatment, we make multiple embryos. Most of them grow well till second or third day after Oocyte Pickup. But on 2nd or 3rd day , there is Embryonic Genome Activation. With this, only those embryos they grow who have their Embryonic Genome Activation and can sustain themselves without maternal (egg’s) energy. Day 2 or 3 day embryos are called Cleavage stage embryos. On Day4, only activated embryos , they survive They are called Compaction stage embryos.
After compaction, these embryos, they develop a cavity inside and turn into Blastocyst.
Blastocyst ,we usually get on fifth day of Oocyte retreival.
Do it is Day five Embryo transfer or Blastocyst transfer.
Because the Blastocysts are those embryos, who can sustain themselves, hence the chances of Implantation after Day5 embryo transfer will be more than the cleavage or Day2/3 Embryo transfer.
With this regular Blastocyst transfer , we achieved 65-70 % implantation rate.
But there is a problem too. It might happen , there will be no self sustainable embryo on day5, then it is our policy to tell patient the truth and cancel Embryo transfer

Fertility treatment in Madhya pradesh, India for PCOD

Fertility treatment in Polycystic ovarian disease ( PCOD) is tricky.Most of the patients they come to us, Ideal Fertility : IVF and Genetic Center Private limited, Jabalpur Madhya pradesh,India after they received the basic treatments, like clomiphene citrate and other associated treatment, like laparoscopic ovarian drilling.

Laparoscopic ovarian drilling is one of the important treatment , but it caries a risk of a major operation. In this ,With the help of Laparoscope , under general anesthesia we do punctures on the surface of the ovaries with electro surgery or by laser. It creates some changes in the hormone levels, so that , there are increased chances of releasing of eggs in next 6 months to one year ( so it takes long time ).

We prefer to do IVF directly in this patients and we have seen that, the couple may be benefited in the same cycle, or they have improved chances of spontaneous pregnancy in the near future, because In-Vitro Fertilization acts as treatment in PCOD.( the content of the graffian follicles are rich in testosterone, and when we aspirate these fluid during IVF, the reduction of male hormone is far far better than Laparoscopic ovarian drilling).

Usually we get more number of oocytes in PCOD. So, we make more embryos and then Blastocysts. Where we can Freeze the Embryos and can do subsequently Frozen Embryo transfer(FET).

In next blog we will describe : How to do test tube baby treatment in PCOD, safely?

Ovarian Hyperstimulation Syndrome free treatment in Test Tube Baby

Ovarian hyperstimulation syndrome (OHSS) is  one of the dreaded complication in in-vitro fertilization treatment. For Infertility treatment in test tube baby technique, we have to make more eggs in the female partner, so that we get more embryos to transfer. With this, the chances of pregnancy increases.

But while giving injections for the growth of the eggs , multiple oocytes form, and when we give final maturation injection Human Chorionic Gonadotropin(HCG) , there are very great chance of collection of free fluid in the abdominal cavity and lung cavity. Usually they are treated conservatively , but some times we have to admit the female partner in intensive care unit and occasionally it is life threatening.

To alleviate this danger;

We started using different protocol for ovarian stimulation. The  HCG injection is replaced by another injection ( GnRh analogue, like busarlin). With this method we get good number of oocytes and the chances of OHSS is reduced to a great extent.

But, when you find the literature, ( with GnRh trigger)the chances of implantation reduces ( because of Corpus luteum lysis…it’s hormone gives the support to implantation) , and most centers freeze the embryos and they do Frozen Embryo transfer , in a natural cycle, later on.

This method increases cost of the treatment and puts patients into lots of inconvenience. It takes 3-4 months to complete one cycle