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

Bed rest after Embryo transfer in In-vitro fertilization

Bed rest after Embryo transfer in In-vitro Fertilization treatment

Few common questions and concerns after Embryo Transfer.

* What will happen when I stand up?

* For How long I should be in bed ?

* Can I go for a pee , my embryos may come out .?

* That center asked my “friend” to be in bed after embryo transfer for 15 days, and she got the child.

Is there any evidence that : Bed rest after embryo transfer increases implantation or live birth rate?

In Fact : there is no evidence that it does.

There should not be any guilt that, ” If I could have taken an absolute bed rest , may I become pregnant”

It has been shown that: Women, a few minutes after embryo transfer, can stand , empty bladder and return home with no apparant risk to the process of implantation. No restriction of the routine activity or the patients need be advised after the transfer.

The UK National institute of clinical excellence (NICE) in 2004 issued the NICE Clinical Guidelines 001 for Fertility (2), which included the following recommendation:

1.11.9.4 Women should be informed that bed rest of more than 20 minutes duration following embryo transfer does not improve the outcome of in vitro fertilization treatment.

Better take your embryo for a walk. moderate exercise and intercourse around embryo transfer has shown to improve implantation and pregnancy rates.

Cost cutting in IVF ICSI treatment.

Cost cutting can be done by multiple ways in IVF treatment.

One of the most important aspect is Drugs used in IVF treatment.

Low cost IVF can be done if we use Urinary derived gonadotropins.

Now a days, may be because of market pressure or because of misinformation, many IVF centers started using Recombinant Gonadotropins in place of age old urinary gonadotropins.

Do you know that Urinary products, esp Human Menopausal Gonadotropin(HMG) gives better results that Recombinant(Rec FSH) ones ( Ref: Cinics Review Articles in ObGy clinic of north america March 2015).

HMG is one third of the cost of Rec FSH. Hence we made our cost structure IVF may be one fifth to one sixth of many IVF Centers in world.

We use mostly HMG  and it gives very good Blastocysts. Very good IVF success rates, some times the implantation rate goes up to 80-85%. But over all implantation rate is 60-65%