Jeewan Eye Hospital

Hello,

I am doctor Priya Dahiya, IVF speicalist. We have three-four centres, our main centre is at Maharaja Agrasen Hospital, Punjabi Bagh and our satellite centers are at Dwarka, Rohtak and Sonipat. So today we are going to discuss about the male infertility part, the cases where the male factor is involved in case of infertility. So how do we check about the male factor as we have discussed in our previous videos we do check for the semen analysis routine microscopy in a male partner. So if the semen parameter is below normal according to our standard WHO criteria we call it oligospermia or sperm count is less. Number one count can be less. Number two motility, the power of this sperm to move can also be less we call it low motility.

Third the sperm can be damaged in itself they have abnormal appearance. Fourth there are more dead sperms, the 90-100% of the sperms are appearing to be dead so these are called abnormal reports for male partner. So how do we go ahead with the abnormal report? So number one abnormal report is azoospermia there is no sperm count, there is no sperm in the entire sample yes when we diagnose azoospermia it is a mentally traumatic for the patient because it is very hard for him to believe that there is no sperm in his seminal sample to procreate. Now is azoospermia the end? no it's not end, azoospermic male are again tested for the hormonal profile just to check whether there body is able to produce the sperm or not, so azoospermia the cause can be we call it obstructive and non-obstructive, obstructive means the body is producing the sperm but the pathway is somewhere block so the sperm is not able to come out in the semen. Non-obstructive is like there some problem in the body that is why he is not able to produce the sperm. In non-obstructive cases the common cause is testicular failure, the testes now they are in the stage that they are not able to produce sperm so in these cases we see a very high level of the hormones in these males.

So most of the time testicular failure patient cannot be created. The hormone levels are low, yes we can increase hormone level and make the testes produce sperm again. How do we go ahead when there is azoospermia and the male is producing the sperm and it is obstructed, so in these cases we go for aspiration of sperm from the testes itself directly. Aspiration again can be done with the help of a needle, we call it TESA, then we can do it with the help of a biopsy called as testicular biopsy or we can do a little more specialised procedure like micro-TESA, when we are not able to find out even in the testicular biopsy.

So depending upon what problem the person is going through we can retrieve the sperm in cases of azoospermia. So that is not the end of the road if the sperm count is showing is nill in the report. Second cases where there is sperm count but there is very low count or there is very low motility, in these cases, these males can reproduce with the help of a specialised technique in IVF called ICSI (intracytoplasmic sperm injection). We are injecting the egg with the sperm with the help of a needle, so the sperm which is normally not able to fertilize egg will now be assisted with the help of a needle so it is able to fertilize egg. Then the cases where we find the morphology is not normal or if the count is normal, everything is normal still couple is having repeated IVF failures we do advice patient to go for a DNA fragmentation analysis to check for the DNA fragmentation level of the sperm, sometime these sperms may absolutely appear normal but when we check for the DNA fragmentation index it is found to be very high, again it is the cause of IVF failure as well as if that lady gets pregnant then these patients do have a high number of abortion. They have a very high chance of that pregnancy being getting spontaneously aborted.

So if the DNA fragmentation level is high then again we have the option of going for the sperm directly from the testis rather than taking it from the semen sample. Then there are multiple other tests available just to check for the fragmentation level in the sperm, so these all highly specialised tests are not required in each and every couple, they required in cases where we feel that this patient should go for this and then this gives us a better information. For dead sperms we do need to check whether they are alive and just immotile or whether they are actually dead. So we go for viability testing in these sperm, if they are viable they again can be used with the help of ICSI. So you know having no sperm count, very low sperm count please do not get depressed or hopeless because into today's technology, in today's time we have adequate facilities to treat all of these factors and you have every right to have your own biological child.

Thank you

Hello,

Today we are going to discuss the investigations which can be done to check what is the cause of infertility. Why some couples may be able to conceive very easily and others may struggle very hard to conceive a baby. So what are the tests which should be done to find out? what is the reason behind this infertility? why they are not able to conceive even after 1 year of regular unprotected intercourse? So we make the couple go through a number of blood tests to test the general health of the couple as well as there are some special investigation to check what is hormonal profile of the couple. So some blood tests are viral markers checking their HIV, hepatitis B, hepatitis C and syphilis, then we check for their blood sugar, thyroid levels, prolactin level, the blood group these all are to check the general health of the couple, then for a female we check her anti-mullerian hormone levels, FSH, LH, estradiol level on day 2 of her cycle to know about her ovarian reserve, how good her ovaries are functioning actually, then we undergo (hysterosalpingography) HSG to check the patency of her tubes, whether her tubes are patent or not.

HSG is generally done on day 7, day 8 and up to day 10 of her cycle if she is having a normal regular cycle of 28 to 30 days. It is generally not done beyond day 10 because women are subjected to three x-rays in that time so unknowingly if she is ovulating or she is getting pregnant in that particular phase so she should not be subjected to those X-rays so that is why it is not advised to undergo HSG after day 10 of any particular cycle, obviously if she has very long cycle like she has every 2 months or 3 months then she may undergo, but generally as a protocol we do not advise HSG after day 10 of her cycle and when she is bleeding so it is between day 6 to day 10 of a particular cycle. In HSG again we inject a type of contrast to her vagina into the uterus and simultaneously do series of x-rays of her abdomen to see whether the contrast has come out of those tubes or not, if it comes out of both the tubes they are called patent tubes.

If it is not coming out then we can see on our film that at what level it is blocked then we label that as one sided block, two sided block or the level cornual, fimbrial whatever. So HSG is one basic investigation which would like to perform on a lady who is not able to conceive after 1 year. Apart from hysterosalpingography or HSG we would like to do follicle monitoring also called as tracking of the ovulation, how fast is her egg growing, whether it is ruptured or not ruptured to check for her ovulation. So one is we are testing the tubes, 2nd we are testing the ovulation and at the same sitting we do test for endometrial thickness or the lining of the uterus to check whether it is growing well along with the egg or not. If everything is going normal then we call it is an ovulatory cycle, generally in follicle monitoring we do 3 to 4 ultrasound to check the growth of the follicle and when it is beyond 18 mm size whether it is ruptured or not ruptured, in same sitting when we are checking the ET we do label it normal ET, thin ET or whether there is a problem in the blood flow of the endometrial thickness.

Third test which is not required in all cases is laparoscopy or hysteroscopy, it is obviously needed when there is a problem in the tubes or the endometrial lining. It is a day care procedure done under anaesthesia. Generally in a laparoscope we introduce to 10 sized scope through her abdominal cavity and we put a single stitch over that scar and she is discharged in the evening and we are seeing the abdominal cavity throygh our camera so able to see the picture in a better way. Hysteroscopy is done through vagina, there is any problem in the uterine lining we do correct it at the same time if there is adhesion, polyp, we do remove it at the same time and in some cases we are able to open the tubes through hysteroscope as well, so we use it to diagnose and treat at the same sitting, so these tests are for women and for any infertile couple we make the husband also undergo tests, these are again viral marker HIV, hepatitis B, C and syphilis and a routine semen analysis and semen culture test to find the cause behind that.

Thank you.

Hello,

Today we are going to discuss what exactly is infertility and what are the causes behind it? and basically in today's topic we are going to discuss the causes in women which are responsible for her being infertile or we call it subfertile. So infertility actually refers to a condition where a lady is unable to get pregnant even after 1 year of trying without any contraceptives. In 30% of cases actually the women is responsible, in another 30% of the cases man is responsible and in 30% both are responsible we call it combined infertility where both men and women are responsible. So today I am going to elaborate on the cases where the woman is responsible, what are the causes where she is responsible. The most common in today's scenario is hormonal imbalance, every month an egg is released from the ovary at a particular time it is around day 13 or 14 of a normal menstrual cycle in a normal ovulatory lady, but in a lady where ovulation problem is there she will not ovulate or the egg is not released at the required time.

So if the egg is not released, obviously she is not going to get pregnant. The most common condition in such cases call polycystic ovary syndrome or PCOS. In PCOS there multiple small eggs none of them is growing, all of them are small or if we make them grow all of them starts growing, so the basic problems in PCOS she is not ovulating, egg is not released on day 14 of her cycle, the cycles are prolonged she doesn't bleed after every 28 or 30 days. She may get her periods after 3 months, 4 months whenever naturally her egg is released or it is not released at all. So polycystic ovarian syndrome or ovulatory dysfunction is one of the most common condition causing infertility in women. Second disease which we call common in today's scenario is ovary which is not able to make good quality egg, we called it premature ovarian failure or decreased ovarian reserve, I do not know the exact cause why it is increasing in today's time? it was not there previously but nowadays we see very young girls 22-23 years of age and her ovaries have stopped producing eggs maybe the environmental conditions or nutrition everything has changed now or pollution also.

So this condition is again coming to us more frequently than it was. Apart from ovulation problem, another common problem which we see in the woman is tubal problem, tubal blockage, it might be on one side, it might be on the both sides, sometimes it is not actually blockage, the tubes are very unhealthy which we find out on the laparoscopic examination. So in tubal blockage obviously the egg is getting released but it is not able to come to the uterus or the cavity where it has to implant so obviously she is not going to get pregnant because the pathway is blocked, the eggs are not coming towards the uterine cavity. Most common conditions where the tubes get blocked are pelvic inflammatory causes, there is some sort of infection which has caused the tubes to stick to each other, the walls of the tubes stick to each other so that is why there are blocked. In Indian circumstances, the most common cause for tubal blockage or pelvic infection is genital tuberculosis, it is very common and very difficult to diagnose. Another common pelvic infection are chlamydia or the various other conditions where there is an infection in the pelvis for a long time and it causes tubal blockage.

So in tubal blockage two situations. It can be seen at the extreme end, which is called fimbrial block or it can be near the uterine called cornual block, so in cases of tubal blockage ideally we reconfirm or re check it with the help of a laparoscopy procedure, it is daycare small procedure just to diagnose whether there is actually a blockage or not? or third whether we can treat the blocked at the same time, this is a small blockage which present in the fimbrial and 99% of the cases we are able to open it but if it is a block at the cornual end, most of the cases we are not able to open it. Secondly in laparoscopy we try to find out the cause behind the blockage, why there is block, if we can treat it beforehand, if we start IVF and we treat it before that then we get very good success rates in IVF also. Next common cause in cases of women is the uterus itself, so we have discussed the ovulation cause which is present in the ovary, we have discussed the tubal cause because the tubes are going to carry the eggs towards the uterus and now the causes of uterus, uterus as a lining which every lady shed of every month which is called a menstrual period.

So there is a problem in the lining then again she is not able to get pregnant, this lining problem can be seen on ultrasound or if a lady has got her menses very scanty, she is getting less menses nowadays then we start predicting that yes probably there can be a problem in the lining of the uterus so this lining can be checked by ultrasound and then again by hysteroscopy. If we can correct it at the time of hysteroscopy we try to correct it and reconstruct the uterus, so that she can conceive again.

Thank you.

Hi,

I am Dr. Priya Dahiya, IVF Specialist. Today I will talk about what is IVF, how the procedure is carried out and who are the candidates need IVF? IVF is a complex and expensive procedure. It is way more common nowadays what it was a few years back. The first IVF baby was delivered in 1978. Although there have been tremendous changes in technology. But still, we are not able to get 100% results. This is the flip side of IVF. The first question is, who needs IVF? So many couples are coming and asking for the treatment. Do all of them need IVF? So, the answer is No, Al couples do not need IVF. We go step by step. If surgery is required, we go for surgery. If all the procedures are failed, then we go for IVF. So, this is the last option. But for some patients, this is the first option. If they have a tubal blockage, the patient comes to us with bilateral tubal blockage or one-sided tubal blockage when it is increased duration. When the patient is not able to conceive since 5-6 years.

So for them, IVF is the first option. Or if both tubes are blocked, sperm issue, mortality is less or azoospermia or the patient is suffering from endometriosis, low ovarian reserves, so for such patients, the first option is IVF. They should not waste time and money for all smaller procedures. 2nd is, how we carry out the procedure of IVF? Yes, it is a technically complex procedure. So, to start with, we make the patient undergo certain tests. Some are mandatory, some are optional but they have to be screened for all the viral infections. We see the hormonal status, ovarian reserve. We give injections and these are given for approximately 9-10 days because we want to make the number of eggs. Although these injections do not have any side-effects some patients may experience headaches, bloating and all. In those cases, we reduce the dose and now it is we call safe IVF, we go very safe. So, 99% of patients will not have any complications with these injections. And do not have implications for their health as well. Once the eggs are ready and mature which is majored through ultrasound.

Once the eggs are ready, we take them out. So, how the eggs are taken out? They are taken out under anesthesia with the help of an ultrasound machine. There is no cut on your body. We just take out the eggs with the thin needle. Now, the eggs are transported to the laboratory, embryologist check for the quality, we grade them. Same time we fertilize these eggs with the help of the sperm. So, fertilization happens in the lab. Then we check them every day how they are growing. But one thing to be clarified that all eggs will not be fertilized and not all fertilized will go further. Those who have life, they will be transferred. Blastocyst does increase our success rate. So, we are doing the same. So, the patient asks, do I need bed rest? So, the patient has to do her regular activities and need to make sure that it will not strain the patient's health. As complete bed rest may not improve the results.

Distract yourself so that you do not have to take the stress. So, if stress will not be there, then the pregnancy rate will be increased. So, my suggestion, do not completely lie down on the bed, do your routine activities. Avoid strenuous activities. Do not lift any heavy things. Any kind of light activities is not going to hamper the results. So, the bottom line for the couples who are opting for IVF is: do not get panic. It is not something which is going to harm your body. You have to undergo an ultrasound, blood tests. Do not take complete bed rest. Be happy, have positive energy because it will give you positive results. So, I wish you all the best. You may get the best results in the best of the hands.

Thank You.