Friday, 29 November 2013

IUI


IUI(Intra Uterine Insemination) Procedure:

Inserting Sperm Into the Uterus

IUI Preparation

Abnormal Sperms
IUI, or intrauterine insemination, is a relatively simple infertility treatment, where a small tube is used to place specially washed sperms directly into the uterus. You may know of IUI by the more commonly used term artificial insemination (AI). IUI and AI are one and the same fertility treatment.

Indication: Detailed consultation for counselling is done before IUI.


Male sub fertility
Unexplained infertility
Female subfertilty
Teratozoospermia (abnormal sperms)
Cost: IUI is not expensive and is easily affordable to all couples.

Success Rate: depends on cause and age. It varies from 10 to 60 %.

Method:


At GIFT the embryologist , prepare sperm depending on the quality,he uses double density method if count is very low and swim up technique for normal count this tends to give better results unlike the ordinary lab preparations. The andrology lab is attached to the IVF lab so the embryologist controls the lab.

Thursday, 28 November 2013

Erectile dysfunction

Erectile dysfunction
 
The complaints related to sexual dysfunction are very common. From the infertile couple visiting hospital, 6o% men complain off some Problem.

Premature ejaculation
Premature ejaculation is common at earlier age , but some men has sustained problem after several years and is more common in men with habitual masturbation.This can be effectively treated with medications .

Failure to attain erection
Many patients attribute this to heavy workload and increased stress levels. Medical problems can cause difficulty in erection.
  1. Neurologic diseases like stroke
  2. Surgery damaging nerves.
  3. Kidney failure
  4. Diabetis and high cholesterol
  5. Medications like antihypertensives
  6.  Ageing and psychological causes are also quite common.
Failure to sustain erection/failure to ejaculate  
Normal physiological time for erection to ejaculation is few minutes in men. whereas, the average time for females to achieve orgasm can be much longer (e.g. Half hour or more).
So a disparity between the couple is common, and conditions like diabetes make it difficult to sustain erection for longer time. This can be corrected medically with medicines like sildanafel (Viagra).

Treatment 
  1. Diabetics properly treated will have improved sexual function.
  2. Psychological problems can be solved with proper counseling.
  3. Medications like sildanafel (Viagra), vardenafil and tadalafel has been successfully used, in selective cases.
  4. Herbal remedies have been boosted, but proper scientific evaluation is incomplete to prove evidence.
  5. Vacuum devices,  injectables, and implants are occasionally used by urologist.
  6. Electroejaculator or vibrator can be used to collect semen sample, in case of difficulty for the purpose of IUI or ICSI.
  7. Premature ejaculation can be treated with Dapoxetine to increase the duration.  
General management for male fertility
  1. Increase in fruits, vegetables and nuts, will provide sufficient vitamins which are vital in fertility.
  2. Diet and exercise together will help in maintaining weight and proper blood circulation.
Erection is maintained only by pooling of blood in penis.
  • Extreme heat and travelling long distance should be avoided. Proper hydration is necessary with 4 liters of water daily.
  • Wearing loose cotton clothes helps in reducing scrotal temperature and helps sperm motility.   
  • Stopping smoking and alcohol consumption has huge advantages.
  • Reduction of stress, avoiding heavy work load and excessive strenuous exercise will help.
  • Have a good laugh, humour has proven to improve vascularity and thus sexual function.
  • Avoid abstaining for prolonged periods, as more prostatic infections noted leading to liquefaction problem in semen.
  • Avoid unprotected intercourse with unknown partners, as it can cause STD.       

Steps in IVF

IVF(In Vitro Fertilisation)

The procedure in which the eggs are fertilized outside the body with husband’s sperm to obtain an embryo is known as IVF     Indications:-
        When the tubes are blocked due to diseases like endometriosis, pelvic infections, ovarian cyst etc, the eggs and sperm will not meet. Surgical correction may not be possible or may not be successful in some patients. IVF is done for them.
Sometimes, even with normal tubes , fertilisation does not happen, in PCOS. IVF can be used when other treatments do not work. Even in unexplained cases of infertility, IVF can be done. New indication of IVF include single parents or partners with same sex.

     Procedure:-
      Previously IVF was more complicated. Now it has become more patient friendly with easier regimes like antagonist regime as they require only 10 days.
 
 Steps:-
 (1)  Initial consultation for detailed evaluation, fitness tests with blood and urine tests, Mock Embryo Transfer (MET), Counseling, Consent form completion etc are done in O.P setting.
Consent forms include:-
  1. Consent for IVF
  2. Consent for embryo freezing
  3. Consent for OR/GA
  4. Consent for ET(embryo transfer)
  5. Consent for Laparoscopy (if required only)

    Consultation by Dr. Anitha

     Counselling:-
       About procedure, method, duration, cost, side effects, success, frequency of visits etc: - are given
     Fitness Tests:-
    1. Detailed history of both(husband&wife)
    2. Medical examination of both partners
    3. Lab tests for blood routine, sugar levels, hormone levels like LH, FSH, TSH, prolactin, infection screening HIV, hepatitis, syphilis
    4.  USS(Scan) is a must to check pelvis , and is done by Gynaecologist herself.

      MET (Mock Embryo Transfer):-
        
      Trial of embryo transfer, without actual embryo is conducted to check the position, length and ease of E.T. This helps doctor to decide how to perform E.T. Some time , sedation is given if patient is anxcious.
      Dilation (D&C) is done with GA if Cervix is tightly closed.
      Different type of harder cannula is used if cervix is curved.
      Infections detected in Cervix/Vagina are treated accordingly.
      (2)    Ovarian Stimulation:- Ovaries are stimulated by daily injections (FSH) starting D2 or D3. They are small injections given just under skin and needs to be taken daily for 9-12 days.
         Doctors will check the growth of follicules by scan on and off. When the eggs are matured , that is when it is around 20 mm, a final injection with  hcg is given.
      Egg collection (OR) is done under sedation/GA after 36 hours of hcg injection.

      (3)    Egg Collection (OR)
      The doctor uses a small long needle guided through the vaginal scan
      probe, to collect the fluid from the follicles. This is done with extreme
      precision, with the doctor watching the needle on scan, all the time, to avoid  injury to other internal organs.
      (4)    Embryology:-
      All the follicles are tapped using suction force, and the eggs which are obtained in the fluid are identified in the fluid are identified by the embryologist under specialized microscope in the IVF lab. The eggs are then mixed with washed sperms from husband, to fertilise on its own.
      The embryologist will check the embryos for growth , daily and will provide media for its growth and keep it in an incubator,  which provides set temperature & PH for the growth.
       
      Monitoring EggIncubatorEmbryo Transfer
      (5)    Embryo Transfer (ET):-
      They are transferred on D3 or D5 into the uterus by Embryo transfer(ET). The technique of ET is highly skilled procedure. As they are very delicate, the  embryos need to be handled in a very gentle manner and they are loaded in very soft,  non toxic cannula.
      Difficulty, or presence of blood suggest high chances of failure. So the ET is  performed with great concentration and high precision.
      The skill and presence of mind of the doctor is crucial in this final step. Performing Yoga and listening to relaxing music helps in more accurate ET. Artistic skills may be helpful in this particular procedure. Doctors who are too busy or nervous should not do ET as valuable embryos will be lost.
       

      (6)    Luteal Support:-
      Medicines are given to support the growth of the baby as Vaginal preparations or sometimes as injections, called Luteal support.
      They need to be Report properly according to the advice given.

      (7)    Pregnancy Test:-
      UPT is done by 14th day to check result. Blood test (bhcg) can also be done.Depending on the result, doctors will give further advises.
      FET (Frozen Embryo Transfer):-  
      Embryos can be frozen if there are excess embryos. They are transferred (FET) later months according to cycle.

      Counseling:- 
      In cases if pregnancy does not occur due to failure of implantation or poor embryo quality, doctors will counsel to provide further options
      and to clarify your doubts.

      Success Rate:-
      Depends on quality of egg and sperm and physicians skill also plays a part. Generally we have 60% success in young healthy couple, 30% success in
      in aged (more than 35 years) we discourage IVF after 40, and offer DE if willing.

      Diet and life style for male fertility

      Increase in fruits, vegetables and nuts, will provide sufficient vitamins which are vital in fertility.
      Watermelon and tomato contains lycopene which is a main ingredient in medicines for semen improvement. Citrus fruits are rich in vit.C, which is  needed for sperm function  like motility. Nuts rich in vit.E should be regularly consumed in small quantity (3-5 daily). Salads will provide all vitamins and minerals for improving health in many ways , it improves semen parameters increases genral health, improves circulation , gives better immunity and avoids diabetes and high B.P.

      Monday, 25 November 2013

      Yoga for female fertility



      YOGA CAN COUNTER FEMALE  INFERTILITY:-


      The most powerful effect of Yoga on a person’s fertility is the calming, restorative effects on the mind and body. A stable mind and body promotes fertility. In addition to stress relief, Yoga improves the blood circulation, boost the nervous system, facilitate the hormone release, cause muscle stretching and relaxation and also sharpen the mind and  way of thinking.
         
      We will go through various Yogic Asanas (exercises) and find out, how it helps in boosting the female fertility.

      Vipareethathrikonasanam:The pelvis get tilted in this asana. The internal pelvic organs like uterus, tubes, ovaries gets mobilized in the asanas, where pelvic movement is involved.

      Veerbandhasanam:-The spine gets stretched bettering the nervous supply. This can improve blood supply to ovary & help ovulation.

      Padmasanam:-The posture helps in compressing ovaries towards the inner pelvic wall and stimulates it for ovulation. 


      Vajrasanam:-Here the heels are pressing  the area, where the pudendal vessels and nerves are passing. The structures provide nerve supply to the perineum. This is also good for hemorrhoids (piles) which can have associated dilated veins near the uterus also.

      Ardha Matsyendrasanam:-The pelvic tilt provides massaging effect to the uterus, tubes and ovaries.
      Numerous  problems in the uterus like tumors (fibroids), polyps, endometriosis can be prevented by this. The insufficient inner lining (endometrium) is a cause for failure for implantation of embryo (sticking of newborn fetus) even after IVF. The improvement of lining will help better implantation and pregnancy rates.

      Ardha Salabhasanam:-When the legs are stretched upwards, it  helps in calming down the nerves, which will  improve fertility.

      Dhanurasanam:- The body is  bent like a bow .The ovaries get freed from   minor adhesions by the forceful stretch.

       Navasanam:-The complete blood circulation is pooled in to the pelvic area in this particular posture and helps all the organs by washing away all toxins and supplying all the immune factors, hormones, vitamins and minerals.

       Shada parivartanasanam:-The pelvic tilt in this asana will similarly help the internal organs as the above asanas.

      Pavanamukthasanam:-The compresson of legs to the abdomen, will help to squeeze insulin from pancreas and thus avoid, contol or even cure diabetes and help in counteracting PCOS. This also aid in fighting obesity by boosting metabolism.


      Pranayamam:-This is the master of all the yogic  exercises. This helps in reducing the stress which will significantly  improve the fertility. It even improves the desire to have a baby as per studies done in Harvard University.  The voluntary slow and controlled breathing  is supposed to calm the mind



      Dr. Anita Mani
      anitadane@gmail.com 
      Infertility& Surrogacy Specialist at Gift IVF Centre

      GIFT IVF CENTER
      #4, 3R Plaza HAL 2nd Stage,
      100 Feet Road,Indiranagar,
       Bangalore India- 560008

      Contact:    +91-8050888880


      GIFT IVF CENTER
      Near Cochin International Airport Jn.
      Athani, Ernakulam Dt, Kerala, India-683585

      Contact:    +91-974 5494804

      Email:     info@giftivf.com
      Web site: www.giftivf.com