Saturday, 30 August 2014

Treatment with heparin , Aspirin and steroids in pregnancy

Treatment with heparin , Aspirin and steroids in pregnancy 
After many years of failed attempts at pregnancy and childbirth  , these couple are happy with their new born baby .
She was admitted several times with injections to help her carry the baby . 
There were tears of joy and we were so happy to see the baby .
Constant monitoring helped her to gain the self confidence to reach term .


How to increase chances of pregnancy ?



“Babies are bits of star-dust blown from the hand of God”.  But surely we can do our bit to give God a helping hand. By following some simple tips, you can ensure that there is   someone kicking you from the inside. 

1. Early marriage in twenties rather than in thirties or forties, because as you age the quality of the eggs deteriorate which makes pregnancy difficult.


2. Good diet including lots of fruits, salads, fresh green vegetables and nuts, please avoid fried, oily, sweet and processed food.



3. Moderate exercise - Just 30 mnts brisk walking  can help.

4. Regular sex - Sexual intercourse 2 to 3 times a week or spontaneous sex gives better result than forced and timed intercourse at ovulation time.

5. Stop smoking / alcohol/drugs- Strictly  no smoking and drinking, if you are planning to conceive.

6. Proper tests - Scientific analysis by undergoing hormone tests, semen analysis, scans, tube tests, laparoscopy etc can  help in the early detection of any problem.


7. Early treatment - Proper timely treatment  will give better results and will  help in avoiding prolonged wait and financial loss.

8. Regular late night outs are not good for a relationship, as many times the couple end up drunk, instead try to spend quality time with each other. 

8. Reducing stress - It has been proven beyond doubt that stress causes sub-fertility. The best cure for the body is a quiet mind.You can  practice the following to relieve stress.

a. Take regular breaks from work  in the form of short holidays

b. Listen to music and sing along. 

c. Dance is a great stress buster, join a class ( men can dance too)  and  you will be             surprised to know how much pleasure and relaxation it gives you.

d. Soak in a river or stream the whole day, hydrotherapy can work wonders. Nature’s     jacuzzi is the best.

e. Go walking on the beech, trekking forests, climbing rocks, take a leisurely stroll in    the park, you will not only feel closer to nature but also feel closer to your partner,      as the endorphins works miracles.

f. Do little bit of gardening whether you have green thumbs or not.

g. Yoga  and meditation will be the first and last word in stress relief, try at least easy       asanas  at home by yourself, if you cannot go for professional classes. In addition to     relaxation, yoga will give your body flexibility  as well.

 h. Humor is the best form of stress buster and the light moments with your partner will      help to strengthen  your relation with your partner.


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


Dr. Anita Mani, director of Gift Gyno IVF centre in Cochin (India) is a  highly skilled and renowned Infertility and IVF Specialist, with the valuable experience of more than 18 years in  UK  and India. She has mastered in Artificial reproductive technology treatments like IUI, IVF,  ICSI, donor egg, donor sperm, laparoscopy, surrogacy etc. Patients come to Dr. Anita from far and wide for getting expert opinion and treatment on rare conditions, abnormal babies, repeated intrauterine death, repeated abortions, repeated IVF / ICSI failures, second opinion on surgeries, severe medical problems in pregnancy etc. She has successfully completed over 5000 Laparoscopies, without any complications or mortality.








Happy surrogates after delivery

These surrogates just delivered and are happy to go back home after 9 months rest , good food and care . The renumeration they received for surrogacy  is going to help them build up their lives .
As it is festival season in kerala , they are dressed up in traditional kerala costumes(Kerala Saree) , popularly worn during Onam festival . Even though they are not Keralites, they say they love Kerala , and wants to come back soon.


Surrogacy after neonatal death due to intrauterine growth retardation

Surrogacy after neonatal death due to intrauterine growth retardation 


Today  Mr and Mrs George (name changed)  are a happy couple, but the scenario was quite different a year back. Both of them were severely depressed after failing several attempts of trying for a normal healthy baby. George was 42 years and his wife  37 years and they had been married for 19years.
Their first baby died due to severe intrauterine growth retardation (IUGR), the second baby was born mentally retarded and the  3rd and 4th pregnancy resulted in  miscarriages. When I advised them to go for surrogacy, they  were more than happy as all they wanted was a normal baby.


Today the surrogate has given birth to a beautiful  healthy baby  and their joy knows no bounds





Surrogacy for severe endometriosis and asthenoteratozoospermia

Surrogacy for severe endometriosis patient

 Age of Wife- 39 yrs , Husband- 46 yrs, 
Married for - 16 Yrs,

Medical history - 
2 Missed Abortion & 1 Preterm delivery resulting in neonatal death
1 IVF - failed , 
Adhesiolysis for Severe Endometriosis, several times 
Husband has astenoteratozoospermia







Surrogacy for cervical incompetence

Surrogate baby for women with cervical incompetence 

History

 Age  of Wife- 28 yrs , Husband - 38 yrs, 
Married for - 10 yrs, 
4 miscarriages  between 15-20 wks ,
2 ICSI & 1 IUI  procedures done , 
History of  Cervical incompetence.





Chromosome abnormality in patient coming for surrogacy

Chromosome abnormality in patient who came for surrogacy 

We have observed that  many couples who come for surrogacy , after repeated IVF / ICSI failure actually have abnormal genetics. The picture shows  the  report of a genetic problem.
It is highly advisable to conduct genetic testing for all patients , or else we may end up in creating subnormal children through infertility treatment procedures. . In such cases it is better to opt for donor egg or donor sperm.

Although PGD (Pre implantation genetic diagnosis) is available , we are not currently taking cases like this, as we don't believe it is ethical to create an abnormal child






Friday, 29 August 2014

Why do women end up having poor quality eggs , leading to infertility?

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




There are no visible symptoms which can tell that your eggs are diminishing in quantity and quality, but in some women periods become less frequent , or scanty. The factors which leads to poor egg quality are explained below.

Age
Women are born with a fixed number of eggs, about one million eggs. As the  years pass, the number and quality of the eggs diminish and eventually gets depleted. With age, a women’s fertility declines. So the chances of  conceiving will go down after the age of 30 and will considerably reduce after the age of 40. These aged eggs may have chromosomal defects which will result in unhealthy embryos. The incidence of downs syndrome is considerably high in older women. The miscarriage rate is also more due to the  same reason .

The trend of late marriages and postponing pregnancy for a long period even after marriage is one of the major causes of infertility. 




Genetic 
Sometimes chromosomal abnormalities can also play a role in the  poor quality eggs. 
Turners syndrome patients do not have ovulation , as they have only streaked ovaries.
Donor egg treatment is a very good option for them.


Diet 
Poor diet may result in nutrition deficiency , which can reduce egg quality, as the fluid surrounding the egg and the granulosa cells ( surrounding cells supporting the egg)  , need optimum amount of nutrients  to make egg fertile. Intake of antioxidants like decaffeinated green tea  has been found to boost fertility. Taking plenty of fruits and raw veggies will provide vitamin c and vitamin E , which are crucial vitamins for enhancing .
fertility.

Exercise 
Excessive exercise can have a negative effect on fertility,  but moderate exercise forms like 30 minutes brisk walk  daily , can increase blood circulation and increase the egg quality .
Yoga is an excellent choice to elevate the  egg quality.

BMI
Optimal BMI has shown to have better success during IVF , with better quality eggs and embryos. It is worth trying to keep weight optimal .


Stress
Any form of stress reduces the  chance of conceiving , as adrenalin is antagonistic . The average age of menopause is coming down every decade with increasing stress in women. We are seeing many working women patients , going thru premature menopause .

Smoking / alcohol
Even passive smoking reduces chance of IVF success by one third  and the same happens with natural cycle. Alcohol intake is also unadvisable  to women and has to strictly avoided.


Medical diseases
Diabetes is a very common condition which deteriorate the egg quality and due to this reason, we see very poor fertilisation rates of eggs in diabetic patients. Disorders like autoimmune thyroid diseases adversely affect fertility , as the level of anti thyroid antibodies in follicular fluid surrounding the egg will be high , reducing the chance of fertilization.Antiphospholipid syndrome is seen in Upto 30 % of infertile women .Renal failure can cause ovarian failure. Pituitary tumours can impair fertility.


Drugs/ medicines
Certain medicines taken for treatment of epilepsy and  hypertension, can impair fertility. Medicines like aspirin , sildanafel , heparin etc can increase blood circulation to ovary , and thus the egg quality and number is diminished .

Gynaecological disease
Diseases affecting ovaries , endometriosis is known to be the  top most culprit in damaging the ovarian structure and the outcome is reduction of follicles .In PCOS , Follicles  often get arrested half way in development and doesn't develop into  mature follicles .Ovarian cancer can damage ovaries resulting in infertility.

Radiation
Exposure to X-rays and radioactive elements and radiotherapy will significantly  damage the  eggs causing genetic mutations , often the repercussion is abnormalities in babies born to them .The effect of Hiroshima and Nagasaki bombing are still haunting  in the form of many abnormalities .





Chemicals 
Insecticides like endosulphan  deteriorates the  egg quality and aftermath is  still birth,  miscarriages, IUD, abnormal children or infertility in women.

Chemotherapy

If chemotherapy is administered for treatment of any form of cancer , it can affect the ovarian function , and many a times  result in total ovarian failure . Hence the  option of egg or ovarian tissue freezing  should be considered before starting chemotherapy.

Surgery
Ovarian cystectomy performed for endometriotic cyst ( chocolate cyst ) may involve removal of ovarian tissue or destruction of ovarian tissue follicles because of cautery used . This can result in loss of follicles. Removal of ovary for malignancy , torsion , or for cysts will reduce the follicles to unilateral ovary , but single ovary is enough for pregnancy.

Investigation
The infertility work up to find out fertility includes  tests to determine the quantity and quality of ovarian reserve by doing antral follicle count and checking blood level for  FSH, LH  and AMH levels .



It is better not to  post pone pregnancy for too long .After 40 the success rate in IVF is also very low. In case there are not enough good quality eggs, IVF using donor eggs can be performed .


Thursday, 28 August 2014

Blocked or damaged fallopian tubes can stop pregnancy



Blocked or damaged fallopian tubes can be a hindrance in conception. To understand tubal problems, you should have a clear idea about the  basic process of fertilization. During ovulation, egg is released  from the ovary. This egg reaches the fallopian tube by the vacuum force created by tubal contractions and with the aid of waves created by structures called cilia in the tubes. During sexual intercourse, sperms are deposited in the vagina. The sperms swim up, passing through the cervix to reach the tubes where the egg is located.The actual fertilisation happens inside the tubes, when many sperms attaches to the egg, but one sperm  penetrates  the thick cover of the egg and enter inside. The embryo which is formed as a result of fertilisation, starts dividing into multiple cells and  is moved towards the uterus. This movement is again facilitated by tubal contractions. Hence, it is very important for the tubes to have normal anatomy and  normal function, which can be altered even with the  presence of small fibrosis or adhesion.

If the fallopian tubes are blocked, sperm will not reach the  egg. So fertilisation and pregnancy will not happen. Another possibility is that the defective tube may stop embryo from moving to the uterus and it will remain in the tube leading to tubal pregnancy (ectopic pregnancy). This can cause complications like rupture of tube, which sometimes even results in maternal death.




The  causes for tubal blocks are pelvic infections, endometriosis, adhesions involving tubes, previously performed surgeries in abdomen or pelvis, fibroids near tubes and in some cases pelvic tuberculosis.  

Laparoscopic Surgery can be done to try and correct the tubes, but has poor success, as the fibrosis formed can cause problems to reoccur. The type of procedure depends on the location and extent of damage. Tubal reanastamosis can be  used to correct the problem in case of sterilisation, but again has only 60% success  and there is  increased risk of ectopic pregnancy. The chances for conception differ, depending on the location and severity of the blockage and the scar tissue after surgery. Medical treatments for endometriosis have very little role in case of tubal pathology, which often just prolongs the treatment and decrease the chance of success .

IVF is the best choice of treatment for any tubal problem, as the tubes are not involved in the procedure of IVF because the fertilisation happens in the lab. If surgery fails or  if the pelvis  is badly damaged beyond repair leading to multiple IVF failure, surrogacy is the best alternative.


To know more visit the following links





http://bangaloreivf.blogspot.ae/2014/10/too-much-gym-reduces-chances-of-having.html

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

-----------------------------------------------------------------------------------------------------------------------

Dr. Anita Mani is a renowned infertility specialist in south India with 15 years experience in ART (Assisted Reproductive Technology). Dr. Anita has successfully set up ART hospitals in Cochin and Bangalore,  along with her spouse  Dr. S Mani, who specialises in surrogacy. She completed MRCOG, from Royal College of Obstetrician and Gynaecologist  London, DFFP from  ART Warwick university and  worked in UK for 5 years. Dr. Anitha believes in scientific and ethical practice and is currently the director of Gift Gyno IVF centre Cochin and  Bangalore.  Apart from advanced laparoscopic surgeries, she is also an expert in various ART techniques including IVF, IUI, ICSI , donor egg / sperm  and surrogacy. Her proficiency is in genetic abnormalities and high risk pregnancies.


Wednesday, 27 August 2014

PCOS (Polycystic ovarian syndrome) is the common reason for Sub Fertility in women


  

Polycystic ovarian syndrome (PCOS) is extremely prevalent among women now and is one of the common reason for  sub fertility in women. It is associated with metabolic disorders and is very much a life style disorder. Human body was originally engineered to be physically active, but with the modern life style, there is minimum physical exertion along with free availability of rich calorific food without any nutritional value. Both  these factors add up and  results in metabolic disorder and high insulin levels in blood. 

PCOS is commonly found in families with diabetes mellitus. The body develops insulin resistance and  alters hormones like LH  and FSH,  which in turn affects normal menstrual cycle in women. High levels of male hormone, androgens are secreted. Follicles  often get arrested half way in development and doesn't develop into  mature follicles that release eggs. If ovulation doesn’t happen,  the normal menstrual cycle is disturbed leading to irregularities or absence of monthly periods.

Patient’s symptoms and appearance can be suggestive. Blood test for LH and FSH ratio can be done, which will be raised in PCOS. 

Symptoms of PCOS are

a.      Irregular or absence of menstruation

b.     Hirsutism - Excessive hair growth on face and body

c.      Acne, oily skin

d.     Weight gain, obesity ( thin PCOS is also quite common )

e.      Lethargy

f.       Hair fall, male pattern baldness

g.      Difficulty in conceiving 








Vaginal ultra sound scan will show the typical pearl necklace pattern (multiple follicles arranged in the periphery of ovary) .



There is no cure for PCOS, but it can be controlled.  Treatment depends on whether you want to get pregnant or not. Insulin resistance and obesity are two primary causes for PCOS.  Healthy diet and regular exercise can definitely help. Reducing weight in obese women  has been often found effective in tackling PCOS.  A number of obese women who lost  5 to 10 percent of their body weight   were found to start ovulating regularly. Yoga is also extremely helpful in controlling PCOS. Metformin  used to treat diabetes can help regulate ovulation in some women. Intake of birth control pills can regulate periods and control release of male hormones. 

To know about low glycemic food which should be taken in condition of PCOS visit http://bangaloreivf.blogspot.ae/2014/09/low-glycemic-food-chart-for-pcos.html


Fertility medicines like clomiphene and gonadotropins can help women to conceive and up to 20 % success can be achieved with medical treatment. Laparoscopic ovarian drilling can give success of around 60% and is very useful in cases of sub fertility. If the above treatments does not work, there are assisted reproductive techniques like IVF and surrogacy, which can help you start a family.



 



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

Dr. Anita Mani is a renowned infertility specialist in south India with 15 years experience in ART (Assisted Reproductive Technology). Dr. Anita has successfully set up ART hospitals in Cochin and Bangalore,  along with her spouse  Dr. S Mani, who specialises in surrogacy. She completed MRCOG, from Royal College of Obstetrician and Gynaecologist  London, DFFP from  ART Warwick university and  worked in UK for 5 years. Dr. Anitha believes in scientific and ethical practice and is currently the director of Gift Gyno IVF centre Cochin and  Bangalore.  Apart from advanced laparoscopic surgeries, she is also an expert in various ART techniques including IVF, IUI, ICSI , donor egg / sperm  and surrogacy . Her proficiency is in genetic abnormalities and high risk pregnancies.

Monday, 25 August 2014

Early diagnosis of Endometriosis for infertility treatment





Infertility problems in women can be congenital (from birth) or can be caused by various factors. Endometriosis is one of the medical conditions, which leads to infertility in women.

Endometriosis is a condition, where inner uterine lining (endometrial lining) grows outside the uterus often affecting the function of the ovaries, uterus and fallopian tubes. This tissue will bleed every month internally, during the menstruation time and the blood collects inside, which acts like a gum  sticking together the internal organs like intestines / urinary bladder to uterus, tubes and ovaries. Sometimes the collection is big enough to form a chocolate cyst, which is nothing but old blood. We have removed  a  30 cm cyst in a patient. It was bigger than a large watermelon. Even a small spot measuring 0.5 mm can cause infertility in some women and often goes undiagnosed. 

This extra tissue growth can cause scarring or obstruction of the tube producing tubal blocks. This  can also produce certain chemicals which will impair  the  implantation of the fertilised egg inside the uterus. Symptoms are painful menstruation or painful intercourse, acute or chronic  pain in pelvic area or infertility. In some women the pain is very acute and it interferes with the day to day activities of her life, but in some women, there will be no visible symptoms.

The word endometriosis comes from the word “endometrium”, endo means “inside” and metrium means “mother”. There may be no specific reason for getting endometriosis, it can affect any women, but family history suggests genetic linkage. Theory of back bleeding also seems logical, as we often find blood around the uterus in pelvis,  while we do laparoscopy for women during  their period time. Also the cervix is quite tightly closed in some women, which may be causing back bleeding and the endometrium which is shed along with the menstrual blood is pushed up through the tubes to the pelvis, where it gets collected and grows responding to the hormones in the subsequent cycle. The contraction of uterus is abnormal in some women which can also attribute to back bleeding and  may even end up in ectopic pregnancies .

Endometriosis can stand in the way of pregnancy, in fact a very large percentage of infertile women suffer from this condition. Though mostly you can detect this through clinical examination, ultrasound or MRI scan, confirmation is possible only through laparoscopy. Laparoscopy is the gold standard in the treatment of endometriosis and should be done early in this condition, as if it is too late we cannot save the tubes, if it is severely damaged.


Treatment for endometriosis is to surgically remove endometrial tissues, cauterise it to destroy it ( electro- cautery is used to burn the spots ) or unblock the tubes. Medical therapy can be used to stop the ovulation, which in turn will stop the  growth of lining. The side effects of medical treatment can be hard, as it can cause early menopause, hence it is better to opt for surgery. After surgery,  up to 40 percent of women  get pregnant  naturally, rest has to take the help of assisted reproductive treatments like IVF or surrogacy. While doing laparoscopy, the doctor will evaluate the damage done and inform you if you have further chance for conceiving. Endometriosis cannot be cured permanently and even after hysterectomy or removal of ovaries, any time it can grow back. 





related blog articles
http://bangaloreivf.blogspot.ae/2014/08/lifestyle-causes-female-infertility.html

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

 

Dr. Anita Mani is a renowned infertility specialist in south India with 15 years experience in ART (Assisted Reproductive Technology). Dr. Anita has successfully set up ART hospitals in Cochin and Bangalore,  along with her spouse  Dr. S Mani, who specialises in surrogacy. She completed MRCOG, from Royal College of Obstetrician and Gynaecologist  London, DFFP from  ART Warwick university and  worked in UK for 5 years. Dr. Anitha believes in scientific and ethical practice and is currently the director of Gift Gyno IVF centre Cochin and  Bangalore.  Apart from advanced laparoscopic surgeries, she is also an expert in various ART techniques including IVF, IUI, ICSI , donor egg / sperm  and surrogacy . Her proficiency is in genetic abnormalities and high risk pregnancies.

Wednesday, 20 August 2014

High levels of AFP detected in surrogate during quadruple test

High levels of AFP detected in surrogate during quadruple test


High levels of AFP may suggest that the developing baby has a neural tube defect such as spina bifida or anencephaly. High levels of AFP may also suggest defects with the esophagus or a failure of your baby’s abdomen to close.However, the most common reason for elevated AFP levels is inaccurate dating of the pregnancy.







Single umbilical artery in surrogate baby, anxious moments for doctorsand parents

                                      Single umbilical artery in surrogate baby 

Dr.Anita Mani
anitadane@gmail.com

Today we scanned the surrogate mother and found that the baby has only Single umbilical artery, normally the babies have 2 .
The biological parent is already having an abnormal child , with the condition of downs syndrome.

We are planning her Caesarian tomorrow, as per the scan done today , there is very little fluid around baby , and she is having mild contractions at 36 weeks .In these cases , there are probably genetic variations in the parents , the reason for the sub fertility ,hence  there are more abnormalities and miscarriages , after infertility treatment . Genetic mutations are probably the main reason. 

Normally babies have one vein and two arteries in the  cord .In 1% of pregnancies there are only two vessels . In about 75% of those cases, the babies are born entirely normal and healthy and the missing artery isn't missed at all. One artery can support a pregnancy and does not necessarily indicate problems. For the other it is a sign that the baby has other abnormalities. It does increase the risk of the baby having cardiac, skeletal, intestinal or renal problems.  Although , additional testing (scans) can rule out many of these abnormalities prior to birth , we had a baby last year who had small swelling on forehead undetectable on  scan  , and had to have brain surgery recently to remove it. The baby  was the result, after several years of treatment for abnormal sperms .Now the baby is perfectly normal , after surgery . 


I hope tomorrow baby will be ok , waiting for delivery .

IUGR surrogate baby for USA couple treated and delivered

             IUGR SURROGATE BABY FOR USA COUPLE TREATED AND DELIVERED

The NRI couple from USA  after failing  failed all attempts of ART finally came to us for surrogacy .
 We did 8 attempts of ICSI over several months with donor egg, but as the sperms were of poor quality all the seven  attempts gave negative results .and finally in the eight attempt surrogacy was  successfully achieved.
The baby developed growth retardation from 28 weeks onwards and we struggled to keep the baby safe, by various treatments and close surveillance.

We daily gave her heparin injections to increase blood circulation .She was also administered  protein as injections on drip daily along with a high protein diet combined with bed rest in the hospital .
Multivitamins along with IRON , Calcium and vitamin D were given from the starting .

 The heart beat was monitored every 2 hours with foetal movement chart . CTG was done 3 times daily, to check for foetal distress. Once in a week steroid injections were administered to enhance the lung maturity.
When bilateral uterine artery notching was detected, we thought it may not go beyond 32 weeks , but we were determined to carry on .

 As infertility specialists we often struggle to get results , although it is the problem with gametes , and we often repeat the procedure several times bearing the additional expenses , as they pay only for one procedure  and we sacrifice our personal time and life for them. We hope the patients understand this.

Dr. Anita Mani
anitadane@gmail.com


Tuesday, 19 August 2014

Why is IVF and ICSI expensive?

Cost IVF/ ICSI
Dr.Anita Mani
anitadane@gmail.com

Cost includes many small expenses put together in ART procedure as below 
Medical records legal documents
Consultation Charges
Counselling Charges
Hospital Charges
Laboratery Charges
HIV
HbsAg
HCV
VDRL
RBS
Semen Analysis
Scan charges

Semen Freezing-
Media
Disposables
IVF Lab charges
Liquid N2
Canister charges
Embryologist charges

O R Procedure Egg Pick up - 
Pre - op charges
OT Instruments charges
Theatre Charges
OT Medicine charges ( O R Needle)
Anaesthesia Charges
Surgeon fees
Embryologist fees
Disposable Charges in theatre
Post - op charges
Scan during O R

Frozen Sample Thawing
Thawing media
Disposable
Embryology fees
lab charges


Embryology Lab for IVF- 
Disposbles For IVF
Media
*Fertilization media
*Flushing media
*Cleavage media
*Blastocysts media
*ovoil
Equipments
*Incubator Charges
*Laminar Flow
*Co2 & Triple Gas
Maintenance & Service Charges
Utility Charges
Embryologist Charges(d1 - d5)
For ICSI
ICSI pipette
ICSI media
Micro-manipulator
Embryologists fee



Embryo Transfer-
Disposable E T Cannula
Media
Sterile Trolly With Equipment
Scan
Inj For Sedation & inj Sustain 200mg
Surgeon Fees
Embrylogist charges



Freezing Charges- 
Freezing Media
Disposables
Liqued Nitrogen
Embryologist fee
Monthly Charges
to Keep Frogen embryo


Frozen Embryo Transfer FET- 
Thawing Media
Disposables
Embryologist fees
FET Charges




Steps of international surrogacy in india

                                       Steps in international surrogacy


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

Choose the right clinic

The first  step is you need to choose the right clinic, in the right country at the right cost, which gives you maximum chance to take home a healthy term baby with minimum effort  within your budget .This requires thorough research  and there are guidelines to be followed. Our website, www.surrogatemothersinindia.com, will help you  in making the right decision by choosing right clinic for surrogacy.

Contact details of clinic

Communicate with the right person and get direct  counseling or  by phone or email  . Best contact  person at GIFT surrogacy center is Dr.Mani, he will be available on  ph +91 9446075032 , +91 9591266699 , drmanisurrogacy@gmail.com.  Or Skype on giftivf 
Second line of contact is  Mr milton on +91 9972233945  or Dr Anita on anitadane@gmail.com .

As Dr Anita Mani and Dr. Mani makes frequent trips abroad you may be able to meet them  in your country, while they are visiting for an informal consultation.( dates and details  are  given in the  website ) 

Travel arrangements
Once you decide on the surrogacy programme you can travel to the clinic on a  visiting visa to sign the legal papers and for choosing the surrogate mother, alternatively you can decide on the surrogate from there and later obtain medical visa, which will help in avoiding one trip .

Application for medical visa 

Obtain letter from the embassy stating that surrogacy is legal in your country.( surrogacy cannot be done if it is banned in your country). Get a letter from clinic confirming the treatment plan and their ICMR registration number ( without which medical visa is not given).With the  above 2 documents, apply for medical visa from
Indian High Commission.

Procedure

Once you receive the  medical visa ,you can  travel to the concerned clinic and undergo ivf / icsi procedures , if self cycling or donate sperm if donor egg cycle is followed .Semen sample is usually frozen  for Artificial Reproductive Technology. (ART) In case of donor cycle , choose your donor  before  you visit   so that your travelling  time is synchronised with the procedure and there is no time wasted. 

Financial arrangment

You will need to arrange for the first payment if self cycling procedure is followed during your initial  visit.But In case of donor egg cycle, an advance payment payment via bank transfer will be needed before arrival , as treatment needs to be started early.

Requirements
Legal papers like surrogacy contract and financial agreement  should be signed before starting the procedure .Fitness test in the form of blood tests are mandatory and done in the  clinic during the first visit .

Embryo transfer 

Once the procedure  is completed ,details of ART will be given to you The choice of staying back or  leaving back to your country stays with you, the clinic will carry out the Embryo transfer to the surrogate mother and do freezing if needed . 

Surrogate mother stay

Surrogate mother stays in hospital until the full term of pregnancy is completed and will be provided with  luteal support .The clinic will keep you up to date  with the  result of pregnancy test and scan  reports, through email, or you can contact the clinic .

Antenatal care 

Once surrogate is pregnant , the clinic will provide good antenatal care , excellent accommodation, nutritious diet and a pleasant stay .for any emergencies ,  24/7  gynaecologist on call will be available. All the details of the progress are informed regularly to the Intended parents (IP) , by international client manager Mr Milton .You can contact Dr Mani at office time for clarification .
For details of antenatal care refer site page .


Payment in instalments

The payment should be done in installments via bank transfers , which is usually in installments at 2 nd , 4 th and 6 th month . 

DNA test

Once the surrogate completes 5 months , approach your high commission to arrange kit for DNA from a government recognised lab.

Delivery 

You can come to india ,around the expected date of delivery.The baby will be handed over to you immediately after the delivery, so you should be prepared to stay here , looking after the new born , till all the papers are cleared.  

Paper work

Birth certificate will be  issued by the local government authority with your names as parents.You need to apply for passport and citizenship of the baby  at your embassy, and they will confirm by DNA test , before issuing it.Collect all the necessary papers from the  hospital , like reports of surrogacy , pregnancy care, delivery ,financial settlement,  legal agreement etc before approaching  the embassy .

We have set of formats at GIFT Fertility Centre for all the paper work needed and will be given to you promptly after delivery .

NICU

In case of medical indication delivery might be expedited, all the necessary arrangements will be done to take care of the baby, till you arrive  if there is delay in your arrival .NICU charges are usually negligible, but  you have to be financially prepared  for unforeseen circumstances.

Communicating with surrogate mother

If you wish , you can communicate with surrogate by Skype , during pregnancy or visit her in between if feasible. 

Frozen Embryo Transfer FET

If pregnancy is not obtained , frozen embryo transfers can be done  several times , depending on numbers available .