Genetics and Reproduction: IVF and ICSI with PGD

Based on Reproductive genetics understanding, therapies are developed and used to maximize outcomes.

Specifically, increased pregnancy rates,decreased incidence of obstetric complications and miscarriage, and the avoidance of fetuses affected by birth defects or other deficiencies are the stated goal of much of the current research in reproductive medicine. The role of genetic testing to guide medical decision making in this regard is sizable and will likely continue to grow in the future.

Genetic evaluations within reproductive medicine may be subdivided into 4 main categories:

1. Preconception genetic testing: The genetic evaluation of prospective parents before pregnancy.

2. Antenatal genetic testing: The genetic evaluation of women who are currently pregnant to determine  the genetic makeup of the developing fetus.

3. Preimplantation genetic testing ( PGD and PGS): The genetic evaluation of an embryo, before uterine transfer, via an embryo biopsy during an in-vitro fertilization (IVF) procedure.

4. Genetic analysis following fetal demise: The genetic evaluation  of the product of conception following a failed pregnancy.

 

IVF and Endometriosis

Endometriosis is a common gynecological condition that affect approximately 10-15% of the female population.

Endometriostic ovarian cysts may be present in up to 20-40% of women with endometriosis scheduled for IVF and on both sides in 19-28% of the cases.

The best medical approach to treat endometriotic ovarian cysts is controversial, as it may delay the fertility, the lady desires.

Should we remove the endometriosis by surgery is matter of debate.

With surgery , there are great chances that it may affect the ovarian reserve and impairs the responsiveness to treatment, and also does not offer any additional benefit in terms of fertility outcomes.

In addition, surgery is great risk to women, as it is mostly a complicated surgery.

The laparoscopic removal of bilateral endometriomas prior to IVF should be limited to those cases with normal ovarian reserve, presence of pain symptoms, rapid growth or sonographic features of malignancy.

Conversely., in the absence of the above-mentioned features, patients with bilateral endometriomas should be encouraged to proceed directly to IVF to reduce time to pregnancy, to avoid potential surgical complications and to limit costs.

The retreival of oocytes may be less in endometriotic cases, compared to normal, but the quality of oocytes may be same and pregnancy rates may be comparable, if lady goes for IVF as early as possible, when all conservative approaches are exhausted

Luteal Phase support in IVF treatment, can we make it little comfortable for female partner

When  IVF  is performed, in many centers, after egg retrieval, they start injection Progesterone daily for at least 15-20 days till the day of pregnancy confirmation. It is really a painful phase of fertility treatment. Injections of progesterone are usually  oil based and they dissolve slowly. When you inject it , it makes a small lump in the muscle, either in buttock or arm. It is very painful experience for the female partner.

Can we make this luteal phase little pain free, or can we make Fertility treatment little bit more comfortable.

Female partner suffers the most in IVF treatment, even if the fault may be in male partner, She has to receive injections for the growth of the eggs , undergo egg retrieval, and then injections for luteal phase support. And if she achieves pregnancy, then she might have to receive this injection may be for three months.

Here at Ideal Fertility center , we use vaginal progesterone and we usually or mostly do not use injections of progesterone for luteal support, and our pregnancy rate is at par with the best centers in world performing infertility treatment.

We try to make the IVF treatment comfortable as far as possible for the female partner. We try to make it more user friendly. Minimum visits, minimum blood tests, minimum injections, without compromising the outcome

Can fertility be preserved by Cryopreservation technology

Cryopreservation technology can be applied to Sperm, Embryo and Oocytes

The advantage of Sperm preservation is , easy to obtain in most patients, It has excellent results, and having a long track record of good success, but he bad part is , it is only for the male.

On the other hand , Embryo cryopreservation or freezing advantages are , excellent results in young patients and again a long good an successful track record. But the disadvantages are , it requires in vitro fertilization to obtain eggs, and may be financially costly and requires female patients to choose sperm donor before cryopreservation.

In Oocyte freezing or cryopreservation, the advantages are very good result in young patients and it does not require female patients to choose sperm donor before cryopreservaion, but bad part is, again it requires IVF to obtain eggs, it may be financially costly and relatively short track record.

Even ovarian cryopreservation is on its way, thin slices are stored  and frozen.

Freezing or cryopreservation is now a days are done by rapid freezing, a procedure called ” Vitrification” 

In our center, Ideal Fertility  Center , we are doing vitrification of embryos since long with very good result of “Blastocyst Freezing” with almost 100% recovery for transfer.

Sperms are stored long and before actual IVF procedure, so that if the male partner is not able to provide semen on the oocyte recovery day, we can use the frozen ones successfully.

We have started oocyte vitrification, and achieved one pregnancy too, but we are at a beginning , in future , soon we are starting our ” Egg Banking” services for those females, who because of their carrier demand can not reproduce in younger age and they can have their own child in later part of life.