Zeeva Clinic

Hi Everyone!

I am Dr. Shweta Goswami, infertility and IVF specialist at Noida and Delhi/NCR. I want to speak on a very common issue called PCOS. PCOS is a sign of hormonal imbalance. It is not a disease per se actually a lifestyle issue. Like out sedentary lifestyle, high carbs and fat diet, genetics. PCOS as a disease on the rise. PCOS can have a different problem at different stages of our life. It can lead to menstrual irregularity, difficulty in conceiving can lead a later problem in life such as cardiovascular diseases, diabetes etc. My focus is to tell you, what to do if you are having difficulty in conception and how to put you in diagnosis. It is a hormonal imbalance disease where egg development is not proper. As we understand the natural conception, we have to have an egg and the sperm to work together to create an embryo. PCOS can make it harder for us to conceive.

The 1st sign is an irregular cycle. A gap of 40-45 days in the cycle. It can be checked by an ultrasound whether the egg formation is there or not. The good news is a treatable condition which does not require any extensive treatment like IVF. In fact, IVF is required only in 5% of PCOS patients. 95% can get treated by lifestyle modification and medical treatment. So, the lifestyle modification plays an important role. In case you are obese or have hormonal imbalance or insulin resistance problem, you need to start losing weight and start exercising. And if we see that eggs are not developing then there are simple medications. If simple medications do not work then we move on to a combination of medicines and injections, to help you make good eggs and if you try on right time, there will be good results.

Of course, when we try naturally with medicines and injections, we need to understand that the chance of success is going to be 20-25%. So, we need to be very patient. We need to understand that it might work out in another cycle or it could take more. So, we have to continue it for at least 3-6 cycles. Healthy man and healthy woman may take up to 12 months to conceive naturally. We have to work upon for proper eggs development for at least 6 months.

We should not easily move on to something else as something else could be tubal testing, laparoscopy or IVF as a fine procedure. However, most PCOS patient if corrected rightly should be able to conceive with simple treatments until and unless it is very severe enough. 50% work again I repeat is about lifestyle modification, trying to lose weight even if the BMI is OK, exercise properly to get the PCOS in control. Working in right direction, PCOS can give excellent results as far as a journey of conceiving is concerned. Thank You for your patient listening. For further details, you can contact me through Lybrate.

ICSI is very similar to conventional IVF in that gametes (eggs and sperm) are collected from each partner. The difference between the two procedures is the method of achieving fertilisation. In conventional IVF, the eggs and sperm are mixed together in a dish and the sperm fertilises the egg 'naturally'.

Hi Everyone!

I am Dr. Shweta Goswami, IVF consultant at Noida. I work in both infertility and IVF. Today I wish to speak more about the cumulative pregnancy rate in IVF which basically entails how does embryo freezing help us to increase IVF success rate. In IVF we give injections to the woman to take out the multiple eggs, fertilize with the husband's sperm, create embryos in the lab for a couple of days to decide which embryo is the best. And transfer 2-3 embryos to the mother womb. Hoping to get a pregnancy.

Now when anyone is considering to going to the IVF, the important thing in the mind is what is going to be the success rate. It is extremely important because the success rate varies from patient to patient. Now we need to understand that how to optimize the IVF cycle. If we are young and have good AMH, the objective of IVF at the end of the cycle should be able to create a good number of grade A & B embryos. Some of can be transferred in the fresh cycle.

And some can be frozen what we call supernumerary embryos. The embryos that do not need a transfer but can be frozen. Now, this is extremely important because when we focus what 's the success rate of IVF, we are actually focusing on one transfer of IVF. But if you are young and you have a number of embryo and the egg quality is good, we are able to provide you the number of embryos. Some of which are transferred and some are frozen. Each transfer cycle can give you a good success rate as high as 60-65%. So, whenever we go under an IVF cycle, we need to review, how many eggs have we called. What is the grade of the embryo? How many fertilized.

Do we have any blastocyst embryo on day 5. And more importantly, what is the pregnancy rate is defined per IVF cycle. We are combining those 2-3 transfers. So, it is important that when we go under IVF cycle, it may or may not work. 2-3 chances are best when IVF can click. It gives the opportunity to with another IVF cycle with better success rate. So, you need to take medication to prepare the lining of the womb. And each cycle will give you 60-65% of chance.

If somebody has a good number of emryos, good quality, you can actually look at the pregnancy rate is as high as 90% per IVF cycle. But please remember this is cumulative pregnancy rate. It is not pregnancy rate per transfer but per egg collection. You always have to ask every center that is it per embryo transfer. Is it per egg retriever. Somewhere there, we all get confused. But for me the patient who is young and who has good reserve, I would be able to freeze a couple of embryos also because they are your embryos. We can again use those eggs without going for another round of IVF cycle. If the embryo is of poor quality then you should ask your center. Why are we not able to get a good number of eggs to transfer. Your success rate can be as high as 80-90%. That is the thing we should be looking forward to at the end of the IVF cycle. Thank You. For more details, you can contact us through Lybrate.

Hi Everyone!

I am Dr. Shweta Goswami, executive IVF consultant at Jaypee Hospital, Noida. Today I am going to speak about extended embryo transfer of blastocyst transfer in IVF. It is really for everyone? We need to understand the basic IVF concept. We give extra injections to a woman. We make an extra egg. We take them out and fertilize them with husband's sperm, create an embryo and put them back into the mother womb hoping to create a pregnancy. Now when we talk about blastocyst transfer, it is something that increases the success rate. Because the whole IVF depends upon the embryo selection. We keep the egg in the lab for 2-3 days or maximum for 5 days.

Now when we take them today 5 which is blastocyst transfer, it is the day when the embryo is actually attached to the mother womb. So, if we do a day 2 or day 3 transfer, we have a 4 cells or 8 cells embryo which may or may not develop into the blastocyst and when we take all of them to the blastocyst stage then we know that whether these embryos are actually good whether they have gone on further to develop into blastocyst stage or not. And that is how we decide which embryo is the best and we transfer them to get the pregnancy. If we routinely look at the day 2 or 3 transfer, we look at the 40-45% of success which would increase with blastocyst transfer 60-65% in woman who is young and who have good ovarian results.

Now the question is can we do it for everybody? The answer is no. The important thing in IVF is individualization. Do you as a woman definitely need a blastocyst transfer to increase the pregnancy rate, the answer may not be yes. So, day 5 may not work for everybody. Because we might left at the stage where we do not have enough embryo to transfer and we may be looking at the decrease in IVF success rate. Because what is the logic to grow embryo further on day 5 if we have only fewer embryos. We have to see whether it make sense to everybody. These are a just flashy term that we are using blastocyst transfer, we do laser hatching, but they don't really work for everybody.

So, if the patient has good 8-10 embryos and we need to decide which embryo to transfer and to freeze and she already has a failed IVF when day 2 or 3 didn't work then blastocyst definitely has a big role to play because it helps us to decide that which embryo is best. So, that is an important concept I wanted to convey that we should not get away from this flashy term. It is all up to you that what makes sense. What should determine and what should be your path of the IVF treatment. And not adding things to the basket because they look flashy. For any more details, you can contact me through Lybrate.