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Basics of IVF for GP
- 1. Email : [email protected]; Website : http://jjmedicalinstitute.com,
- 2. Infertility isa problem through out and increasing rates noticed. The successful birth of a “Test Tube Baby”, Louise Brown occurred in 1978 in Oldham General Hospital, U.K. Roberts G. Edwards; the physiologist who developed the treatment was awarded the nobel prize in Medicine in 2010.
- 3. What is Infertility& when should a married couple consult the fertility specialist?
- 4. Inability toconceive after unprotected sexual exposure for one year, if female age is less than 35 yrs. If the female age is more than 35 yrs ,then treatment should be started after 6 months.
- 5. What are themain causes of Infertility?
- 6. It isestimated that infertility affects 1 in 7 heterosexual couples in UK In about 40% of cases disorders are found in both the man and the woman Hysteroscopy
- 7. What are the investigationsdone in a female suffering from infertility?
- 8. Routine Investigations HormonalTest: D2: FSH, LH, TSH, Prolactin AMH HSG USG Pelvis & (TVS) Hysteroscopy and Laparoscopy Hysteroscopy
- 10.
- 12. What are the investigationsdone in a male partner suffering from infertility?
- 13. Semen Analysis USG & Doppler OtherTests FSH LH PL TSH Testosterone HB, Bl Sugar, KFT, LFT, HIV, VDRL,HBS, HCV Sperm Function Tests
- 14. What are thepossible treatment options available?
- 15. Intrauterine Inseminationis defined as the deposition of specially prepared sperm in the uterine cavity above the internal os.
- 16. Indications Abnormal SemenProfile Oligospermia, Mild Asthenospermia, combination of both Cervical Factors Immunological factors Unilateral Tubal defect Ovulatory Dysfunction Unexplained Infertility, Mild Endometriosis Other ejaculatory problems, erectile dysfunction Donor Insemination Never use fresh donor sample. Never use samples from relatives or known person. Always use cryopreserved semen from a Semen bank which is tested for HIV,HBS,HCV .
- 17. Both tubesshould be patent and functional Both Ovaries capable of responding to ovulation inducing agents. Endometrial cavity capable of Implantation.
- 18. Semen Prepration Semen preprationhelps to remove dead sperms, leucocytes, Infectious agents and Prostaglandins from the semen It helps in capacitation of spermatozoa Sperm washing media provides nutritional support and keeps them active for longer . Controlled Ovarian Stimulation Corrects subtle ovulation defects Better control over timing of ovulation Intrauterine Insemination By passes cervical mucous barrier which may be hostile to sperm Increases sperm density in upper genital tract. Overcomes coital difficulties
- 19. Ovarian Stimulation Monitoring IUI cycle by USG Ovulation Trigger Semen Prepration swim up,single density gradient,double density gradient Insemination
- 20. Factors thatdetermine the success are; Age of female Partner Stimulation Protocol Cause of Infertility Recovery of motile sperm fraction. Results vary from 5 to 30%
- 21. Popularly IVF isa process by which an egg is fertilized by sperm outside the body in vitro termed “Test Tube Baby” First IVF Pregnancy in 1977- Louise …….
- 22. Tests DownRegulation Ovarian Stimulation Collection of sperms Insemination Embryo Transfer
- 23. Ovarian stimulationis done to produce multiple eggs- rather than single egg with Injection-Gonadotropin Multiple follicles are stimulated as some eggs will not be fertilized USG monitoring is done to assess growth of follicle. When Follicle reach 17-18 mm a final injection (Hcg) for oocyte maturion is given. Egg retrieval is done 36 hours after hcg injection under short GA. Eggs are identified & collected by embryologist in a Petri dish containing IVF culture media. These eggs are then inseminated with the washed semen. Incubation is done in CO2 incubators. Fertilization is checked next day after about 18 hours.
- 24. Embryo areTransferred on D3/D5 Embryo suspended in drops of culture media is drawn into ET Cathetor. The Cathetor is carefully inserted into uterine cavity US guidance.
- 25. Is there anyrelation between age and succes in ART?
- 26. <35 yrs:40-43% 35-37 33-35% 38-40 23-27% >41 13-18%
- 27. Tubal disease,Blockage. Pelvic factors…Endometriosis,adnexal adhesions Ovulatory Factors, PCOD,POF Uterine Factors….Infections,cong malformations,Synaechiae Age related Male Factor Infertility Unexplained Infertility
- 28. Is there anygurantee of success with ART procedures? The success of ART varies from 10-40% depending on age & cause. There is no 100% gurantee.
- 29. Is there anymaximum number of attempts in IUI & IVF? In IUI, 3-6 attempts are normally adviced,though best results are availed in first three. In IVF also 4-5 chances can be taken.
- 30. Is there structural/mental differencebetween naturally conceived & ART conceived babies? No
- 31. Is there treatmentpossible in couples where the male partner has nil sperm count (Azoospermia)? Tese/mesa with icsi can help father these couples.
- 32. My wife underwent hysterectomydue to certain complications. Can she have a baby? Surrogacy can help her.
- 33. I suffered atubal pregnancy and my tube had to be removed.Can I become pregnant? Yes,the other tube can definitely help in getting