Corion Fertility Clinic

Hello everyone.

My name is Dr. Kaushal Samir Kadam. The topic that we are going to discuss today is complications in IVF and ICSI cycle. So, what we are all worried about in these days is if we are undergoing an IVF, ICSI cycle what do we need to be aware of? What are our fears in undergoing the IVF or ICSI cycle? Two most important complications that I would be telling you about today is ovarian hyperstimulation which is often termed as OHSS and multiple gestations. Ovarian hyperstimulation again is of three categories: mild, moderate and severe. Whilst your fertility physician is definitely going to desire a mild to moderate hyperstimulation so that he can get a good number of eggs, severe is something that we all do not want. Of course, the chances of severe hyperstimulation in today's generation is very very low. It's just about 0.1-2%. What we do is as fertility physicians do close monitoring when we are doing your IVF or ICSI cycle.

Patients who are more likely to go into ovarian hyperstimulation are those who have polycystic ovaries as these are the patients who have a tendency to form a larger number of eggs. Typically, in ovarian hyperstimulation what happens is your ovaries become bulky and there is quite a bit of fluid that collects. But these days fertility physicians now have newer protocols whereby they are able to completely prevent you from going into ovarian hyperstimulation. What they do is the trigger injection that we spoke about in my earlier lectures typically being used as hCG or human chorionic gonadotropin is replaced by an agonist trigger. In doing so the hormonal levels drop down and thus your chances of going into ovarian hyperstimulation reduce. In severe hyperstimulation cases, patients may require admission. Most of the times the doctors are able to control this hyperstimulation just on an outpatient basis. We can control this by making you drink lots of water, administering medication like cabergoline which helps in preventing the fluid from accumulating in your abdominal cavity.

Also, they may think of administering haemaccel or pines i.v. pines by admitting you from morning to evening and then discharging you. So, most of the time that fertility physicians they'll call you into his/her office, do some blood test to confirm if you are going into severe hyperstimulation, administer mainly saline infusion over a prolonged period of time to take care of this situation. Most of the patients do well within a week from this therapy. But of course, to completely avoid this hyperstimulation, your physician may advise you to freeze all the embryos and not do a transfer. The chances of you going into hyperstimulation really increase if you do undertake an embryo transfer and if your hCG levels go high. But without administering or without undergoing an embryo transfer the chances for you getting pregnant become negligible and thus you finally get your periods and you are back to normal.

Your physician will then plan for a frozen embryo transfer for you and this way you can completely negate your chances for undergoing severe hyperstimulation. The next complication multiple gestations. This is very common as we see in IVF and ICSI cycles but mind you this can be controlled. Again, this is just simply controlled by you having a discussion with your physician at the time of embryo transfer, discussing how many embryos you wish to the implant. Thus, if you make it very clear to your fertility physician that you want to just a singleton pregnancy then he will consider transferring a maximum of 1 D5 embryo and maybe 2 of D3 embryos. So, friends as we all know these conditions are now completely under our control and under the control of the fertility physician so you can definitely take care by working together with your fertility physician and avoiding these complications completely.

Thanks!

Hello friends,

I am Dr. Mrs Kaushal Kadam, medical director of Corion fertility clinic in Andheri, Mumbai. To begin with let's start with what is infertility exactly. Infertility, as we say, is non-conception for a period of more than 2 years with unprotected intercourse. So, patients who have had tried for 2 years without using any protection and if not being successful in getting a baby are considered to be subfertile or infertile. These are the patients who should really refer to a fertility physician and get themselves checked. So what is it that you will first encounter when you meet a fertility physician? When you first meet the physician they will make you undergo a few tests. These are basic infertility tests. For the women, she will have to undergo a few hormonal tests which will include checking your thyroid levels, serum prolactin, serum AMH and further tests just to know that your body is fine metabolically. For the male patient, he will need to undergo a semen analysis maybe a semen culture and a few tests on the semen sample to know that the semen sample is fine and is normal. Going further into what are these hormonal tests?

Ok, so serum thyroid and serum TSH and serum prolactin. Thyroid is a very common issue that we see in quite a few of our patients and if corrected this can just result in pregnancy at home. This is so often overlooked and so if we find any kind of problems be it serum TSH which is low or serum TSH which is high can cause a problem and can lead to infertility and a just correction of this by taking medication will solve the problem and you will find yourself pregnant. Serum prolactin is another hormone that is present in our body. Any kind of stress will cause the levels of this hormone to go high and this interferes with the implantation and does not result in a pregnancy. So, very important to ensure that we keep the serum prolactin levels in check. Coming to the most important hormone that is serum AMH that is Anti-Mullerian hormone. This is one hormone that you will often find your gynaecologist as well as your fertility physician talking to you about and laying a lot of stress on it. This hormone is a hormone that tells us about your ovarian reserve.

This hormone is one hormone that tells us the capacity of your ovaries to form eggs. Mind you, all of us, all women have a fertility age or fertility starts declining for these patients beyond 38 years of age. Why exactly does this happen? All of us are born with millions of eggs but once we reach puberty and we start ovulating each month we lose quite a few of our eggs resulting in a decrease in the number of eggs that are finally left and that is why patients who have a low ovarian reserve are told to plan a pregnancy as soon as possible. So, one must check for this hormonal level to know what is the time period that is left for them to start with their motherhood. As far as semen analysis is concerned WHO now has come out with recent criteria where they say that even 15 million per ml of sperm count is considered to be normal, 40% of motility is considered normal and abnormal sperms of up to 96% is absolutely normal. So, one should not panic when they see a high number of abnormal sperms but again you must refer to your fertility physician because he or she is the person who is going to guide you to at least shorten your trying period and try to get your pregnancy at the earliest. Having done these tests let's move on to the next test that your fertility physician may ask you to undergo.

This is usually a test to check whether your tubes are patent or not. It is very important because mind you conception takes place in the tube and for that reason, the tubes need to be open. If those patients are having their tubes which are closed because of various problems like tuberculosis in childhood or any other infection, sometimes surgery which may cause a blocked tube; then these are the patients who may require a work up and may not be possible for them to get pregnant at home. Again, God has blessed us with two tubes so even if you have one tube that is open that is enough for you to complete your family. So, tube test very typically they will ask you to undergo an HSG or a histosalpingogram. This is an invasive test and nowadays we are not doing this test and in fact, have come up with sonosalpingogram. This is less invasive and much more patient friendly so you can always ask your doctor or request your doctor to prefer this test instead of the HSG.

SSG or sono saline sonosalpingogram is a test wherein they pass a catheter through your uterus passing some saline and then on ultrasound check if there is spillage of the saline outside the uterus and the ovaries. If they see this fluid then we know that your tubes are patent and this should be enough for us to plan further management. HSG, on the other hand, is painful, it involves the invasive technique of undergoing an x-ray which is something that we do not prefer these days and it is very painful. So, having done these tests your doctor will then have a look and tell us what is the further workup that needs to be done. Although we say that infertility work up should begin after 2 years of trying at home, there are a few patients whom we will say that need a workup much prior to this. Who are these patients? These are the ones who have a prior history of tuberculosis, patients who have married at a much later age like say they have married at around 37,38 and now they need to plan a pregnancy as soon as possible. Patients who have irregular periods, patients who have very painful periods, of course, need a workup and thus these patients should definitely seek the help of a fertility physician much earlier than two years.

Thanks!

Corion Fertility Clinic was established in 2010 with the vision to provide the best in class standardized services for infertility treatment. We are an ISO 9001-2008 and FEQH ASCI 2016 certified facility and ensure global best practices and protocols are implemented and are available to all intended parents and other stakeholders.

Dr. Mrs. Kaushal Kadam, the medical director has industry experience of over 18 years and believes in providing a personalized and consistent experience to patients. Our vision- From conception to cradles, follows from the earnings to provide the joy of parenthood to all infertile couples, assist them through their most stressful period and the entire process.

Till date, Corion has helped create thousands of happy families around the world.