Tuesday 15 December 2015

My first IVF cycle was unsuccessful. Should I try again?




In vitro fertilization or IVF has become one of the most widely practiced fertility treatments effective for a host of infertility issues. As IVF is all about precision and timing, it involves a synchronized cycle, starting with the stimulation of the female’s ovaries to develop multiple oocytes, followed by their retrievaland subsequent fertilization by sperm in controlled lab conditions. The resulting embryo is then planted in the uterus for pregnancy to occur.
A couple enters an IVF cycle with great hope and a failed IVF cycle can cause tremendous emotional trauma as the patient invests a great deal of time, effort and money in the hope of having a baby of their own. Here the big question every such patient faces is whether they should give IVF a second try.
When making this decision, it is crucial for you to understand the reason of failure of the first IVF cycle and whether the second attempt is likely to bring a positive outcome. At Shantah IVF Clinic, we aim to assist the patients with all these answers so that they can be well informed to make the right decision.

Why could have my first IVF attempt failed?

While your doctor’s earnest intention is to have a successful outcome in the first attempt itself, unfortunately some patients do experience IVF failure. This is the reason why no IVF clinic would report or claim a 100% success rate.
Even if everything was done right, an IVF cycle can fail due to a number of reasons.Here are the possible reasons for a failed IVF attempt:

  • A majority of failed IVF attempts are linked with poor quality of the embryo, which is measured in terms of the embryo’s ability to implant itself onto the uterine wall and continue growing there. At the same time, embryo quality is not the onlydefinitive criteria for success or failure of IVF because even the best quality embryo may fail to implant.
         In fact, embryo quality is highly dependent upon the quality of the woman’s eggs. Here is where the    age factor of the intended mother comes in as a primary concern. With advancing age, the number and quality of a woman’s eggs tends to decline.
  •  The expertise of the IVF specialist is another factor which has a bearing on the result of the IVF cycle. This includes the process of embryo culture in the lab, the doctor’s experience, laboratory infrastructure, the embryologist’s expertise, as well as the embryo transfer procedure. Right from the beginning to the end of an IVF cycle, timing of the procedures involved and the expertise of your doctor are of immense importance.
  • Uterine receptivity, that is, the ability of the uterus to receive the embryo and have it implanted for further growth, also influences the success rate of IVF. Poor uterine receptivity can be improved with treatment provided your doctor has been able to diagnose it in time.
  •    Like the quality of eggs, the quality of sperm is another important determinant of the success of IVF. Your doctor should be able to retrieve enough numbers of motile (viable) sperm in order to obtain 6-10 good quality embryos. In case of severe male infertility, the doctor may suggest the use of donor sperm.
  • Ideally, a clinic that follows ethical and transparent practice should be able to explain to the patient why a particular cycle failed and what are the possible recourses available to the patient.


Should I take a second or subsequent chance at IVF?

After studying the likely cause of a failed IVF attempt, the next and most crucial step is to decide whether a repeat attempt is worth the effort and when it should be undertaken.
For this, you need to sit down with your fertility specialist and appraise the situation to pinpoint the cause of the failure of the procedure. Aspects such as the response of the woman to the ovarian stimulation as well as the timing of egg retrieval have to be evaluated carefully to ensure that the same mistakes are not repeated the next time around.
Certain measures can be taken to maximize the chances of success of the subsequent IVF cycle(s), for instance:

  • If there have been problems related with ovarian stimulation, the protocol may be altered by the specialist in the next cycle. 
  •  In case the eggs had been immature at the time of retrieval, the harvesting of the eggs in next cycle can be carried out when they have reached a larger diameter.
  • In case of failure of IVF due to poor fertilization caused by poor sperm quality, ICSI could be used instead of IVF. It is so because in ICSI, a single high quality sperm is directly injected into the woman’s egg to maximize the chances of formation of a viable embryo.

If IVF is the only option for a woman to conceive -- for instance in the case of absence or blockage of fallopian tubes, or poor quality sperm --a second IVF attempt may be the only choice. If the patient feels that the quality of services and expertise of the fertility clinic are compromising with the IVF results, they might seek to switch clinics in the subsequent attempts.
Depending on the reasons of IVF failure and the doctor’s assessment of the case, the patient must be advised of the following options:

  •   IVF with donor sperm/donor egg
  •   IVF with frozen embryo
  •     ICSI
  •    Surrogacy
  •    Adoption

A couple whohas failed in the first IVF attempt need not despair as they still have a chance to experience the joy of parenthood, provided that there are lessons learnt from the unsuccessful attempt. 

Shantah IVF is a renowned fertility clinic which endeavors to help patients find answers to all their fertility related queries. To get the trusted opinion of qualified fertility specialists, please contact us here.

Tuesday 1 December 2015

Donor-egg IVF: What is it and who would need it?

As a fertility techniquein vitro fertilizationhas become so popular that it has become almost synonymous with fertility treatment.
As you may be aware, in an IVF cycle eggs and sperm from the intended parents are combined for fertilization in a lab dish. The quality of eggs is the most crucial factors in the success of any fertility treatment; therefore your fertility doctor needs to do appropriate preliminary investigations to ensure the patient can provide healthy eggs for use in an IVF cycle.
In cases where the woman is not ovulating (releasing an egg each monthly cycle) or if the eggs are not viable enough to yield a healthy pregnancy, donor egg IVF may be seen as the only plausible alternative.If you are considering donor egg IVF, the following information will help you understand what it entails and what to expect during the procedure.

What is donor egg IVF?

As the name suggests, donor egg IVF is a combination of two procedures:egg donation and in- vitro fertilization.
While in a typical IVF cycle eggs from the intended mother are fertilized using sperm from the male partner, in donor egg IVF, eggs from a donor are used.
When a relative or a woman known to the couple is the egg donor, she may need to undergo ovulation induction wherein her ovaries are stimulated to develop and release multiple eggs in one cycle. Your doctor would monitor her oocyte development through blood tests and ultrasound, and retrieve the eggs when it’s time. The egg retrieval procedure is usually done on the same day as sperm collection.The eggs so obtained are combined with sperm to form embryos which are then placed in the uterus of the intended mother for pregnancy to occur.

If the couple is unable to arrange a donor, or if they prefer an anonymous donor, eggs from a donor bank can be used for the procedure. In this case, the desired donor profile is shortlisted and shared with the patient so that they can make an informed choice.

Donor egg IVF is a highly sophisticated procedure, and should only be handled by askilled and experienced fertility specialist in a well-equipped clinic.


When is donor egg IVF recommended?

Your doctor may recommend using donor eggs for IVFunder the following conditions:
·     
            POF or premature Ovarian Failure

A medical condition when the woman has undergone menopause earlier than expected but wants to have a child of her own, donor eggs can be utilized for the same.
·         
     Diminished Ovarian Reserve

A woman’s ovarian reserve(the number of eggs left in her ovaries) diminishes with age. In fact a woman loses about 300 eggs every day, and by the time she turns 35, the number and quality of her eggs has declined considerably. This is when she may have to rely upon donated eggs to conceive.
·         
     Genetic Disorder

If a woman is suffering from a genetically transmitted disease, which may pass on to her baby, using donor eggswould ensure a safer and healthier pregnancy with higher chances of IVF success.
·      
            Failed IVF Attempts

In some couples who have come across repeated failure in IVF attempts, the doctors may attribute it to the lack of viability of eggs and may recommend the use of donor eggs for the next IVF cycle.
Currently, donor egg IVF is gaining acceptance and has proved to be a boon for women who cannot conceive using their own eggs.

What tests are done on the recipient and the donor before the procedure?

When a couple is recommended to go for donor egg IVF, they need to consider a credible clinic where they can receive quality treatment from skilled doctors in a safe and relaxed environment.Here, the clinic mustnot only handle the actual procedure with expertise, but also needs to be well equipped to make sure that both the recipient as well as the donor qualify for the procedure.

Recipient Testing

A good IVF clinic would take no chances with the success of donor egg IVF and perform all the required tests on the recipient to ensure that she would be able to go through the pregnancy safely and successfully. A complete health check-up is done, including tests todetermine any abnormalities, physical or genetic, in the recipient. These tests may include cervical cultures, uterine sonogram, semen analysis and Rh factor tests, along with comprehensive blood tests.
Couples should look for a clinic which also offers counseling to help them cope with the pressures of fertility treatment, understandthe details of the procedure, its chances of success and the risk factors involved.

Donor Testing

Whether the donor is anonymous or known to the couple, she must be tested for any genetic disorder, infectious diseases, and her complete medical and family history must be obtained. Preferably, a healthy woman under 35 years is chosen for egg donation, and some couples also consider factors such as ethical background and family history of the donor.
Since the procedure of donor egg IVF is a complex one and comes with its own risk factors, couples should rely only on a reputed clinic for taking up the procedure.

Shantah Fertility Centre provides end-to-end egg and sperm donation services to couples who are unable to conceive using their own eggs/sperm.

If you have further questions pertaining to the procedure, or need an impartial second opinion, please contact us for a free consultation with Dr. Anubha Singh, leading Fertility Superspecialist and Medical Director, Shantah Fertility Centre.

Wednesday 25 November 2015

Egg Retrieval Day: How to prepare yourself and what to expect

For most women the decision to go for their first IVF is in itself quite nerve wracking and emotional. It is quite normal to see this as a potentially life changing step and be hopeful yet slightly intimidated.  However clarity on what the procedure involves and how various stages will proceed can definitely serve to remove the shroud of mystery and unfamiliarity of the procedure, giving women more confidence moving ahead.


A majority of the questions that our team of IVF specialists encounter from our patients are about the egg retrieval process. So here is a look at some frequently asked questions about this key step of the IVF procedure and how to prepare yourself for it.

What does egg retrieval involve?

The egg retrieval refers to removal of oocytes (egg cells) from the ovaries through a ultrasound guided needle. The patient is observed during egg maturation cycle and once the egg follicles reach a certain size (determined by ultrasound), a human chorionic gonadotropin (HCG) hormone injection is administered to help with the egg maturation. The injection dose is carefully timed to ensure that the egg retrieval can be carried out just before ovulation.

During the actual process, the patient is put under light anaesthesia. The ultrasound probe attached with a needle is inserted into the vagina and the eggs are retrieved from the ovaries under the guidance of ultrasound.

How long does the procedure take?

Egg retrieval is normally a quick procedure taking around 20 to 30 minutes. The actual time taken depends on factors such as accessibility of the ovaries (how easy is to reach ovaries with ultrasound probe) and the number of follicles present.

Is egg retrieval painful?

Egg retrieval is done under anaesthesia. Patients are given anaesthesia through intravenous drips and do not feel any pain during the procedure. After the effect of anaesthesia wears off, you may experience some cramping and slight pain. Your doctor will prescribe safe pain medication to help with it.

Is there a possibility of ovary damage due to egg retrieval?

The widely available data on egg retrievals shows that there is no damage to ovaries due to
egg retrieval. Many women undergo multiple egg retrievals due to various reasons. It has
been seen that even women undergoing various egg retrievals respond well to the procedure
and produce eggs leading to successful pregnancies. This shows that their ovaries are healthy.
Certain studies in which appearance of ovaries was studied in women who have undergone
egg retrievals, the appearance was normal.

Is bleeding normal after egg retrieval?

It is normal to experience some vaginal bleeding after an egg retrieval. It is usually minor and
similar to menstrual bleeding.

Can I do anything to improve my egg quality before egg retrieval?

Yes, it is believed that lifestyle factors may effect egg production and quality.  You should try
to make healthier lifestyle choices once you decide to go for fertility treatment. Optimal
healthy diet, regular moderate exercise and avoiding stress are key to this. Also if you are
past 35 years of age, you should consider opting for egg retrieval early.

What happens after egg retrieval?

Your doctor will prescribe some antibiotics to prevent any infections and a steroid to reduce
any inflammation of ovaries. Some hormonal supplements may also be prescribed to support
regrowth of endometrial lining. Your doctor may also suggest that you refrain from sexual
contact for some time.

The retrieved eggs will be fertilized with your partner’s or a donor’s sperm depending on your particular situation.

The highly trained specialists at Shantah IVF guide you and help you every step of the way during your entire IVF experience. You can contact us here for detailed consultaions.

Saturday 21 November 2015

What is Ovulation Induction and why do I need it?




A grown woman has about 350,000-400,000 eggs in both of her ovaries of which a single egg is released every month through the monthly ovulation cycle.
Explained simply, ovulation induction is the process of stimulating theovaries to grow and release several oocytes (eggs) at a time so that a good number of eggs are available for use in an IUI or IVF treatment cycle. Also known as ovarian stimulation, ovulation induction is often the first step in a typical infertility treatment cycle. To enable the growth of multiple eggs, your fertility doctor stimulates your ovaries with oral or injectable medication.
When we explain the step-by-step fertility treatment to patients, many ask why ovulation induction is needed at all.



Here’s why:
·        
           Ovulatory disorder:If a woman is ovulating irregularly or not ovulating at all, the first line of treatment is to try and induce ovulation with medication. In this scenario, your doctor’s aim is to restore your ovulation to help you try and conceive on your own, or through IUI if needed.
·          
      Other causes of infertility:In contrast, if a woman is ovulating regularly but cannot conceive due to another underlying problem, such as endometriosis or male factor infertility, she would need ovulation induction to increase the number of eggs available for fertilization during her fertility treatment. Based on the patient’s infertility diagnosis, the eggs obtained through ovulation induction would be utilized in a stimulated IUI cycle, or in an IVF/ICSI cycle.The goal here is to have at least 8-10 oocytes to maximize the viability of your fertility treatment.

How are the ovaries stimulated to grow multiple follicles?

This is done with the help of pills, also known as fertility medication. The medicine is typically prescribed on day 3 of your menstrual cycle. Your doctor monitors the growth of your follicles (fluid-filled sac-like structures each containinga single egg)through ultrasound and blood tests. The complete process takes between 10 and 12 days.If oral medication fails to produce desired results, or is not indicated, your doctor may opt to use injectable fertility medication(hormone injections)to stimulate egg development.

You will have your first ultrasound scan after about 5 days of stimulation. Once the eggs have matured, they are collected using a microscopic needle through a procedure known as egg retrieval.

Always remember: An experienced fertility specialist would try their best to limit the use of fertility medication to only what is absolutely essential for your treatment. This can happen only when your fertility specialist holds the experience and expertise to make an accurate diagnosis of your condition and decide the best treatment protocol.

Therefore, it is vital to choose your fertility specialist with care!

If you are looking for an independent second opinion before committing to a fertility treatment plan,or if you are not satisfied with your current fertility treatment, book a free second opinion consultation with Dr. Anubha Singh, India’s leading Fertility Superspecialist and Director, Shantah Fertility Centre.