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 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. 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.

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

Dr. Anita Mani
anitadane@gmail.com
Infertility 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 .

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.

To know more visit the following links

http://bangaloreivf.blogspot.ae/2014/09/reduce-stress-to-improve-fertility.html

http://bangaloreivf.blogspot.ae/2014/08/early-diagnosis-of-endometriosis-for.html

http://bangaloreivf.blogspot.ae/2014/08/dr.html   pcos

http://bangaloreivf.blogspot.ae/2013/11/yoga-and-fertility-most-powerful-effect_25.html

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

http://bangaloreivf.blogspot.ae/2014/07/yoga-for-male-infertility.html

http://bangaloreivf.blogspot.ae/2015/01/scientific-benefits-of-regular-sexual.html

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

Dr. Anita Mani
Infertility 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. 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. Her proficiency is in genetic abnormalities and high risk pregnancies.

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, which can help you start a family.

 

Dr. Anita Mani
Infertility 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 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. Her proficiency is in genetic abnormalities and high risk pregnancies.

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. 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/dr.html   PCOS

http://bangaloreivf.blogspot.ae/2014/08/blocked-or-damaged-fallopian-tubes-can.html

http://bangaloreivf.blogspot.ae/2014/08/why-do-women-end-up-having-poor-quality.html

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

Dr. Anita Mani
Infertility 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. 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. Her proficiency is in genetic abnormalities and high risk pregnancies.

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

Is modern lifestyle the ground for the rising cases of infertility among women ??

Have you ever thought why few decades back, a childless couple was hard to find? I would like to shed some light on factors other than the natural or medical reasons due to which women fail to reproduce. The new sedentary lifestyle changes have not only increased diseases like diabetes, Blood Pressure and cholesterol, but it has also created a new menace - infertility. Stress, age, poor diet, sexually transmitted infections, medications, abortions, alcoholism, smoking and drug use adversely affects fertility in women.

1. Medications may impact fertility. Some medications and steroids prescribed to treat asthma , BP and thyroids have found to upset the normal ovulation pattern in women.
2. 
   
3. Alcoholism, smoking and drug use in women can also cause ovulation disturbances and endometriosis often resulting in infertility. Smoking can not only block the cervix and fallopian tubes but also cause premature aging of uterus, resulting in early menopause and sometimes miscarriages.http://bangaloreivf.blogspot.ae/2014/08/early-diagnosis-of-endometriosis-for.htmlhttp://bangaloreivf.blogspot.ae/2014/08/blocked-or-damaged-fallopian-tubes-can.html
4. Intake of a healthy and nutritious diet will go a long way in enhancing fertility. Zero figure is the fad of the day and lot of women are exercising and dieting vigorously for achieving this goal. But being both underweight and obese can impair fertility.http://bangaloreivf.blogspot.ae/2014/10/too-much-gym-reduces-chances-of-having.html
5. Age is also a deciding factor in pregnancy. Women are born with a fixed number of eggs. As the years pass, the number and quality of the eggs diminish and eventually gets depleted. So chances of conceiving will keep going down after the age of 30 and will considerably reduce after the age of 40. The trend of late marriages and postponing pregnancy for a long period, even after marriage is one of the major causes of infertility.http://bangaloreivf.blogspot.ae/2014/08/why-do-women-end-up-having-poor-quality.html
6. Too much stress while trying very hard for the pregnancy itself can cause  
   infertility problems. Though the exact connection between stress and   
   infertility is not proved, studies show there is definitely a link. So avoid
   stressing yourself, relax and be happy.         http://bangaloreivf.blogspot.ae/2015/01/scientific-benefits-of-regular-sexual.html
7. MTP or medically terminated pregnancy is usually safe, but can          sometimes cause complications like infections leading to blockage of        fallopian tubes resulting in infertility.         http://bangaloreivf.blogspot.ae/2014/08/blocked-or-damaged-fallopian-tubes-can.html
8. Sexually transmitted diseases like Chlamydia and gonorrhea can cause       infection in fallopina tubes and uterus permanently damaging them. Safe sex practice and sex with single partner is strictly advised to avoid infertility  issues.

So if few life style changes are made, the trauma undergone by many of the childless couples can be avoided. Exercise regularly in moderation, take a healthy diet and practice some relaxing hobbies like painting, music or yoga. 

http://bangaloreivf.blogspot.ae/2013/11/yoga-and-fertility-most-powerful-effect_25.html

Dr. Anita Mani
Infertility 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. 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. Her proficiency is in genetic abnormalities and high risk pregnancies.

Case of positive screening for downs syndrome

Case of positive screening for downs syndrome

Dr.Anita mani

anitadane@gmail.com

The patient who conceived with IUI, after history of teratozoospermia ( abnormal sperms) , had screening test at 10 weeks with double marker test. The result came positive for downs syndrome . This is an indication that the the baby maybe suffering from downs syndrome, but we cannot confirm if the  baby actually has downs. It is often very stressful for parents to receive such a report . They need to undergo further tests like NACE or Amniocentesis to confirm or rule out downs. NACE will further screen  and is done to avoid amniocentesis , but it is not diagnostic. Amniocentesis will be done to confirm whether it is true downs or just a false alarm. If NACE test is also positive, Amniocentesis should be performed directly , it is done by taking fluid around baby and doing genetic test on that .

Downs syndrome is an abnormality of chromosome number 21, and those babies are mentally challenged and may have other abnormalities like cardiac problems as well.

Tips to improve IVF lab - Automatic carbon dioxide cylinder change

Tips to improve IVF lab - Automatic carbon dioxide cylinder change

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

In IVF lab , it is very important to have constant Co2 to all incubators ,as the embryos will not grow , if there is interuption . 

There are cylindres which supply the Co2,  just like the  LPG cylinders at home , these also become empty, with time. The constant supply is important as any delay can effect outcome . Usually when manual checking is done , there is always risk that it may become empty at night and may not be noticed  Therefore co2 sensors are connected , which gices alarm,  but again somebody doesn't promptly respond to alarm , especially at night , there can be interruption in supply temporarily . 

The automatic co2 changing equipment allows 2 cylinders to be connected , and as soon as 1 cylinder is empty, it will automatically connect to the other cylinder . It is a good mechanism , and chances of co2 failure  is minimal. This is not  installed in most of the IVF labs ,.even in art units in Uk ,  still the old method of alarm system is followed, wherein  somebody needs to personally attend to the problem, sometimes they have to be summoned from home in the night to fix the problem.

Women often undergo miscarriages, surgeries and ART for male sub fertility

Throughout my experience as an infertility specialist since 18 years, I have observed that there is a general misconception among Indians that failure to attain pregnancy is mostly due to medical problems in women. But this is just a myth, as men are also facing as much infertility issues as women. Many times the female partner undergoes all the painful procedures, even if the complication is related to male infertility or sub fertility.

The fact is that abnormal sperms can result in abnormal embryo and often this will result in miscarriage at first trimester and the woman may experience pain and bleeding and require undergoing D&C. There are again chances of tubal pregnancies, which may need surgery and which unfortunately may lead to maternal death in around 1 % of ectopic pregnancies.

The women may have to undergo IUI, ICSI or IVF for getting pregnant after vaginal scans and during these procedures, it is not just the pain or the side effects of medicines, but the emotional trauma which is difficult for the women The women suffers silently, during miscarriages and painful procedures, while the society and relatives often points finger at her even though the entire problem lies with the male partner. It’s really heartbreaking to witness my women patients forced to divorce for not having babies, wherein the problem is azoospermia (condition of absence of sperms) in husband. It is indeed a pathetic situation, I wish the men will understand this and be more considerate and caring towards women. Opting for donor sperm may be better in many cases, as they won't end up bringing up children with abnormalities. Men should undergo chromosomal test (karyotyping) when they have abnormal semen analysis for early pickup of problems.

Dr. Anita Mani
Infertility Specialist at Gift IVF Centre
anitadane@gmail.com
www.giftivf.com
bangaloreivf.blogspot.in

Failure of LH surge could indicate poor egg quality

                    Failure of LH surge could indicate poor egg quality

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

Failure of LH surge could indicate poor egg quality, as in this patient . She is 34 years, and follicle has been  hovering around 18 mm for last 4 days, with no sign or rupture and ULH is also negative . Her endometrial lining is 6 mm , which indicates low oestrogen.

We started oestrogen ,and lining improved ,but still not good . Advised to do AMH , as we may have to think of IVF\ ICSI , early.

Cancel IUI for Premature rupture of follicle in PCOS

                     Cancel IUI for Premature rupture of follicle in PCOS

Dr.Anita mani

anitadane@gmail.com

It was confusing that the ULH was positive, but follicles are small in today's scan for this patient. So went through records to see the reason , she was having PCOS , and was on low dose injections to stimulate ovary , what happened is that , she developed 6 follicles each side and premature surge of LH happened because of high level of oestrogen.

The chances of fertilisation are poor , so we cancelled IUI .

Many times , this gets missed if , ULH test is not combined with follicular study and if scans are not repeated during IUI .

To avoid  this, antagonistic injections can be given , which was not given in this particular patient , as i underestimated her PCOS .

Scan report 

Left - 15,14,14,14, 12, 12 

Right - 14, 12, 12,12 ,10,10 

EL - TL+  9mm

Success rates in infertility treatment

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

                    Success rates in infertility treatment

IUI

World wide , IUI success  rate is around 7 to 20 % .

Medicines 10 % , medicine plus injections 20% .

it will be higher if 4 to 6 cycles are done . Also the success is higher with donor sperm IUI (20 to 40%after 4 cycles ) .

At GIFT, IUI success is 8% in Bangalore and 13 % in cochin , the quality of sperms are quite bad in Bangalore generally .

IVF

International Success in IVF is 30 to 60 % depending on quality of embryos , which in turn is dependant on the quality of gametes . Younger the women, better the result. BMI and ovarian reserve are other important determining factors. There are genetic problems in 50 % of the cases, which mostly doesn’t  get detected leading to low success.

At GIFT, success is high in couple with normal children and in young women less than 30 years , 60% .(  foIVF for secondary infertility can be done for couple with child ) Donor egg IVF success is 60 to 80% in women with healthy uterus.

ICSI

Success in ICSI is similar to IVF, but will be less if the sperms are very poor in quality .

Even if egg fertilises , it may not implant if its not good embryo. GIFT success in creating embryo is high , ie 80% , but live birth rate after ICSI for abnormal semen is around 30% .

Laparoscopy

Laparoscopy is very effective in infertility treatment , especially in case of PCOS, and 60 % conceive after the procedure .