Since its advent in 1992, ICSI has become used routinely in the vast majority of IVF units and has been found to be a safe and effective means of treating male factor infertility. ICSI has proven to a powerful tool in overcoming severe male factor cases which, prior to ICSI, treated with donor sperm. Although there has been conflicting data regarding the efficacy of ICSI in preventing or minimizing total fertilization failure ( it is condition, in conventional IVF, where we put eggs and prepared sperms in a dish to meet each other spontaneously, a natural process takes place in human fallopian tubes….and not a single sperm enters into any egg, or there is no fertilization). It happens in couples with unexplained infertility. The application of ICSI has been successfully extended to assisted reproduction techniques cases that involve sperm retrieval for either obstructive azoopermia or non-obstructive azoospermia. ICSI is also recommended in order to fertilize cryopreserved-thawed oocytes. Furthermore , ICSI is preferred in cases of pre-impantation genetic screening/preimplantaion genetic diagnosis in order to eliminate the risk of polyspermy that otherwise may affect the genetic make-up of the resultant embryo
Recurrent implantation failure may identified after three failed IVF cycles or after transfer of 10 high grade embryos. There are many different factors which may contribute for this recurrent IVF failure, such as parental chromosomal translocations, abnormal uterine anatomy , hydrosalpinx, or inadequate culture conditions or embryo transfer techniques.
Failure may be due to factors with the “Seed,Soil or the Cultivator”
Some studies have suggested that local injury of the endometrium by means of a catheter or hysteroscopy can induce an inflammatory response that may facilitate the preparation for implantation.
Artificial rupture of the covering of the embryo ( Zona pellucida) may improve implantation: Assisted Hatching, but is still not proved.
Pre-implantation genetic screening of the embryos is now a day used to get and select best embryos. But this strategy did not show any improvement in patient outcome and did not show any significant difference on clinical pregnancy rates.
A few studies have reported that congenital and acquired prothromotic conditions are more prevalent in women with recurrent implantation failure. Therefore use of low molecular weight heparin (LMWH) and mini dosage of aspirin on patients with thrombophilia and recurrent implantation failure has been discussed, but large studies are required to prove them .
Finally, another possible strategy is to extend embryo culture to blastocyst stage, aiming to improve embryo selection and uterine receptivity
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%