Fertility Treatment

Ayushi Approach to infertility: We have expertise doctor with us Dr Amita Rajvedi infertility specialist who offer patients an outstanding treatment through complete combination of excellent clinical expertise, strong experience and warm personal care. She is expertise in diagnosis and treatment of infertility including In Vitro Fertilization (IVF), Donor Egg Recipency, Pre-implantation genetic diagnosis (PGD), Intracytoplasmic Sperm Injection (ICSI) & Intrauterine Insemination (IUI).
She utilize both her international clinical experience and power to understand patient’s need and advanced technology to optimize IVF success rate.

Step 1: Meeting your Fertility Specialist: At your first appointment with one of our fertility specialists, your doctor will review your medical history, assess your general health, and arrange initial tests and investigations for you and your partner.

Step 2: Preparing for treatment: After your fertility specialist appointment, you will then meet with treating doctor, nurse and administration, and counselor who will explain you every stages of treatment and cost associated with it, before you begin treatment.

Your treating doctor: Your treating doctor will explain what to expect in your upcoming IUI/IVF/ICSI treatment cycle, including any specific treatments, injection techniques and medications. Generally, It is best to arrange for the appointment to be about a week before you expect your period in the month that you plan to commence treatment, though a nurse will advise you of this ahead of time.

Our administration team: will explain the costs associated with your treatment, and answer any questions you have related to these and the timing of payment. This will help you understand the fees involved and explain the complexities of the Medicare Safety Net, Medicare rebates and your final, out-of-pocket expenses.

The Counselling Team: is available to meet with you and your partner, to discuss the physical and emotional implications of your treatment. Your counsellor is here for you at every stage of your treatment, even at short notice, if you need to discuss things or explore ways of coping.

• Endometriosis
• Problems with the uterus or fallopian tubes
• Problems with ovulation
• Antibody problems that harm sperm or eggs
• The inability of sperm to penetrate or survive in the cervical mucus
• An Unexplained fertility problem

In 10-20% of couples no cause will be found, this is called Unexplained Infertility, which can be particularly frustrating for you and your partner.
Your fertility specialist will review your results and history before recommending a treatment plan. Before we determine the best treatment plan for you, further investigations may be necessary and typically these can include

• Ovulation Test
• Ultrasound Scan
• Ovarian Reserve AMH Test
• Checking of Fallopian tubes and Uterus
• Diagnostic Laparoscopy and Hysteroscopy

Treatment for endometriosis: If your fertility specialist suspects you to have endometriosis, we may be able remove the endometriosis and associated scar tissue at the time of the diagnostic laparoscopy, or give you hormone treatment to suppress the menstrual cycle and inhibit the growth of endometriosis. Sometimes this treatment for endometriosis will result in a successful pregnancy. If not, IVF may be a good treatment option.

Surgery for fallopian tubes: If you have any damage to your tubes, we can diagnose this during a laparoscopy. If it is likely to affect the success of your IVF, your doctor may recommend tubal surgery to remove scar tissue or to correct tubal damage before starting treatment.
If tubal surgery does not result in a successful pregnancy – or where damage to the tubes and other pelvic organs is so severe as to make surgery unlikely to be successful IVF may give you the best chance of success.

Ovulation Tests at IVF Ayushi: Out of 6 couples, 1 usually takes longer time to fall pregnant than what is expected. If you are looking for help to conceive naturally, a good first step is to track your Ovulation cycle. Itis a simple process that can help you identify which days you’re most fertile. This will help you plan when to have sex to give you the best chance to conceive.
If you’re trying to fall pregnant, the timing of when you and your partner have sex is critical and many couples get this wrong. The most fertile time in your menstrual cycle - or your fertile window - are the days leading up to ovulation, before the egg is released from the ovary.
After ovulation, the egg survives for just 24 hours, while sperm retain fertilising capability for two to three days in the fallopian tubes. For this reason, we recommend couples have sex every two days throughout the female’s fertile window and in the lead up to ovulation. This means that sperm are ready and waiting for the egg when the female ovulates.

Ovulation Induction: It is a simple process which encourages the ovaries to release eggs, so you maximise the chances of conception through intercourse or artificial insemination (IUI). It suits women who are producing low levels of hormones for ovulation, or who are not ovulating at all. You’ll take medication (as tablets or through injections) to stimulate your hormones.

How does Ovulation Induction work: First, we’ll confirm your ovulation cycle by

• Taking blood samples to measure hormone levels at specific stages of your cycle
• Carrying out a transvaginal ultrasound to see the development of follicles in the ovaries, and the thickness and appearance of the lining of the womb.

The Ovulation Induction cycle:

Day 1: (of your menstrual cycle) An appointment is arranged for a blood test.

Day 4: Start taking medication.

Day 10 /11: Visit the hospital for a blood test to determine your hormone level

Day 14: Attend the clinic for an ultrasound test. This will determine if you are about to ovulate.

For women who don't have a normal menstrual cycle, it may take some time to ovulate. In fact, it is not unusual for ovulation to occur much later in their cycle (after Day 14). You would then need to continue attending the clinic for blood tests until this point.

Artificial Insemination / IUI: Artificial insemination, or Intrauterine Insemination (IUI), is simpler and more affordable starting for fertility treatment. If you or your partner has been diagnosed with unexplained infertility, hostile cervical mucus, minor sperm abnormalities or other male disorders, IUI is sometimes a successful option

What does artificial insemination involve: Intrauterine insemination (IUI) involves inserting the male partner’s (or donor’s) prepared semen through the neck of the womb (cervix) and into the uterus, it is very simple process. close to the time of ovulation. This procedure can be performed during a natural cycle or with artificial hormone stimulation (ovulation induction).

Female fertility surgery: Immediately after your initial testing and assessment, you may need to have surgery. This could be to further investigate the cause of infertility for you or your partner, or to overcome the problems making it difficult for you to conceive.

• Laparoscoy:

A laparoscopy is a keyhole surgery, and may be recommended to check your tubes are open (tubal patency) and the condition of your uterus and ovaries. It can also treat conditions such as

• endometriosis
• tubal microsurgery
• removal of fibroids
• correction of uterine abnormalities

A laparoscope is introduced through a small incision in the abdomen. A video camera is fitted to an endoscope (a thin telescopic instrument) so the specialist can view the images on a video monitor.

If any surgical treatment is needed, special instruments are inserted through four other small incisions, usually hidden in the pubic hair. When the surgery is complete, the instruments are removed and the carbon dioxide gas is released from the abdominal cavity. A stitch closes each of the small incisions.

Laparoscopy is performed under general anaesthetic and takes about one to two hours. Your recovery will be sooner depending on the amount of surgery you need, but we recommend you take one or two days off work following the procedure.

How Male Infertility is treated:

• Intracytoplasmic Sperm Injection (ICSI):

If you have a low sperm count, poor sperm movement, or high numbers of abnormally shaped sperm, then Intracytoplasmic Sperm Injection (ICSI) can be used as part of your IVF treatment cycle.

• Antisperm Antibodies:

If sperm stick to each other head-to-head, tail-to-tail or in a mixed way, this is known as agglutination, and the presence of sperm antibodies may be the cause. Put simply, that means you’ve developed antibodies against your own sperm, and it can significantly affect sperm penetration into the cervical mucus, and the success of any IVF treatment. ICSI is used to overcome this issue as well.

(1) Consultation with Fertility specialist: Consultation with a fertility specialist is the very initial step before going into the treatment. We understand your infertility problems can be emotionally distressing, and hence we respect your situation and help you overcome it. First step of consultation help us to the understand the key problems and help us to choose the right treatment plan.

(2) Investigations: A complete assessment of the suspected problem is very much necessary before the start of treatment plan. Therefore the experienced team of IVF Ayushi suggest certain investigations, which will help the treating doctor to track the reproductive health. The investigation procedures include routine blood tests, specific test to assess ovarian reserve, ultrasound pelvis and semen analysis.

(3) Counseling: The best way to support our patient against the stress due to infertility is regular counseling, which is considered as a best solution to help and understand them better. We do understand the condition of what patients are going through and we put forward the best way to reduce their emotional stress. Counselors deal with patients to take out their fears and help them to relax beforehand.

(4) Review of your reports: Next step includes the review of your reports by your treating specialists to make the choice of procedure to be adopted for treating the patient, and then a brief discussion is done over the procedure to be used. Before the startup of the cycle, our doctor may advise you to undergo some surgeries like laparoscopy/hysteroscopy if in case required before coming to the conclusion.

(5) Starting the treatment: Regulations to control the hormonal level starts on 21st day and to maintain the down regulation of hormones you need to take certain injections regularly for few days, which suppresses the hormonal levels that exist during the normal time. After accomplishing the task of down regulating hormonal level, stimulation procedures starts, which are checked with the help of USG or blood tests. Sometimes these down regulating procedures are not needed as decided by your treating doctor.

(6) Stimulation: Once the down regulation is achieved, which is done with the help of hormonal tests or by 2nd and 3rd day of periods, an ultrasound is carried out as a baseline for this procedure.

(7) Egg collection: After 34-36 hours of trigger injection eggs are collected by giving very mild anesthesia to the patient. This procedure is performed by using trans-vaginal scan, a procedure in which a needle, with attached probe, punctures the follicles via vagina. A negative pressure is then maintained to fetch the eggs and fluid, which then transferred to the IVF lab for further procedures. This procedure only takes 30 mins and the patient will be discharged after 4-6 hrs.

(8) Sperm collection: The day when eggs are collected, the partner of the female donates fresh semen sample needed for further procedure. If the case is of male infertility, then the donor sperms are used. After collection of semen it is washed so that to separate the sperms and seminal fluids. The option of sperm freezing is also available at our centre wherein the male partner can donate the semen sample beforehand, in case he will not be available to do it on the same day.

(9) Fertilization: After the collection of sperms and eggs, the specialists at IVF Ayushi will use specific technique for the fertilization procedure. Afterwards, the sample is being stored in incubator for future use. Incubated eggs are kept undisturbed for 18-24 hours with regular checks under microscope for proper fertilization. The egg which gets fertilized and starts to divide is then known as the embryo. Embryo cells divide and have four to eight cells in them after 2-3 days of growth. This is the time when specialist checks the viability of embryos to be used for procedure by grading them according to the standards. Now is the time when you will be informed about the status of embryo and decision of fertility specialist over embryo transfer.

(10) Embryo transfer: Now is the time when selected embryos are transferred to catheter and then are transferred into the uterus with extreme care. This whole procedure is monitored by using ultrasound technique, which uses vaginal route. This step ensures the acceptance of embryo and hence is an important and crucial step of an IVF program. Procedure can be of little discomfort, and hence after resting for 20 minutes, one can go home. The maximum number of embryo transferred in single procedure is three embryos. In exceptional cases if a good quality embryo is seen, then that is stored in frozen state for later use.

(11) Post transfer care: Initial 14 days after the embryo transfer are the crucial ones, as during this time embryo attaches to uterus. To make this process a little more relieving few medications are prescribed with detailed description from specialist. You can do your routine work even after the procedure, as there is no compulsion that you have to take bed rest.

(12) Pregnancy: Pregnancy test is done after 14 days of embryo transfer. If the test comes positive then it gives the confirmation of pregnancy and you can meet up with your doctor for future guidance on this stage. After 7-10 days, regular ultrasound procedures are done to check the pregnancy stage.
If due to some unseen circumstances procedure failed and test result comes out to be negative then you have to stop medication with immediate effect and you have to keep track of your periods. This can be disappointing but a consultation with doctor about the failure is necessary, as you will be told for future course to be followed.

What are the Success Rates for IVF: Success rates for IVF depend on a number of factors , Including the reason for infertility , where you’ re having the procedure done , and your age . In most of cases the success rate is high depending on technology used . We help you to formulate an action plan which is designed to resolve your problem cost effectively. We keep our unit and entire team patient friendly. We always welcome you to a family, even before you start a family. Come join us to be a complete family, the most lovable period “ Parenthood"