Advanced Infertility Management

Hello!

I am Dr. Rishma Dhillon Pai, consultant gynaecologist at Leelavati, Jaslok, Hinduja Healthcare Hospitals, Mumbai. I am going to be talking to you today on advanced infertility management. We know that almost 10% of couples who are trying to conceive are not able to do so. Many of them have very simple problems which can be overcome with basic advice and treatment. So when a couple comes to us that saying that they are not able to have a baby even after 1 year of trying we will do a few simple investigations. For the husband, we will do the semen analysis. For the lady we will do a few tests, hormones, sonography and something to test the tubes. You can do an x-ray of the uterus or laparoscopy or hysteroscopy which gives us a good picture of the entire womb, the fallopian tubes- if they are open or closed and give us some idea whether the eggs are coming out normally from the ovary or not. With this information most of us start with basic treatment, simple tablets, simple injections to make the eggs grow. We see how the eggs are growing by sonography and many times with natural treatment patient may become pregnant.

Some patients who do not conceive with this basic medicine may require the first step of Advanced treatment that is Intrauterine Insemination. In this we take the husband's semen, wash it, pick up the best quality sperms and with a very small tube insert it into the ladies womb and push it inside at the time when the egg is coming out. So IUI is a very simple technique not very expensive and it gives good results. But for this the husband semen report must be almost normal and the ladies uterus, tubes, everything must be normal. So this is step one of treatment. If despite trying intrauterine insemination for a few times, the patient doesn't not become pregnant, then we have to go to the advanced infertility treatment starting with IVF or In-Vitro Fertilization or test tube baby as it is called. Test tube baby is basically meant for ladies who have tubes blocked that means the fallopian tubes are not functioning or have closed off due to some infection or disease.

Today, however, IVF is used for many many reasons. Even if there is no obvious problem but the couple is not able to conceive, we do IVF on them. So for In-Vitro Fertilization what we have to do really is give the lady injections for approximately 10 days. What this does is, it produces a large number of eggs. When there are many eggs we admit the patient for half a day, give her anaesthesia for 10 minutes and actually through a sonography machine remove the eggs using a needle. This is a painless procedure and like I said, a 10-minute procedure. Once the eggs are in our hands, we take the husband's semen which we have prepared and each one sperm is picked up and injected or placed beside the egg and the fertilization is done.

If the husband's sperm count is very less or very low or almost nil, then we can do a similar procedure but here we perform ICSI, Intracytoplasmic Sperm Injection which means each sperm of the husband is picked up with the help of a very very fine needle and physically injected into the egg so it is not left to fertilize on its own but the sperm is injected into the egg. This procedure ICSI is performed in the laboratory after about 2 days you can actually see that the egg has fertilized and is now growing. So now one egg has developed into 2,4,8,12 parts. It is actually a growing baby and this baby which is just 2 or 3 days old is taken and with a very fine tube which is a very painless half a minute procedure, it is put back inside the womb of the patient. This is embryo transfer. So this procedure which takes approximately 15 days from the beginning of the menstrual period until the procedure is over is called IVF or ICSI depending on what is done in that particular patient. This test tube baby procedure has very good results. So patients who are otherwise never able to become pregnant because of blocked tubes or because of very low sperm count or because the egg is not coming out or any other problems such as endometriosis or adenomyosis, all these patients hormonal problem patients, patients who have polycystic ovarian syndrome, many of these patients will benefit from this technique of IVF or ICSI. However, infertility treatment has advanced a lot today. Even men who have zero sperm count, absolutely no sperms when we do the semen analysis, in these patients also in many many cases we can do very tiny biopsies from the testes called PISA or TISA. Very tiny needle biopsies and from the tests we can actually take out the sperms.

Even if we get just three or four or five sperms, we can use these techniques of ICSI or even the more advanced technique called MC to actually fertilize the eggs and help make the lady pregnant. In India for the first time in our centres in Mumbai, Delhi, Chandigarh, Bangalore we have brought this technique or called MC called male factor infertility. We have also got laser hatching. We have got a fantastic new device called Embryoscope. This actually is very useful for couples who had earlier failures, who have done IVF before have not become pregnant. This is an improved technology where the eggs and embryos are kept inside this special incubator. It is a non-touch technique. So basically more and more advancement, more and more techniques are coming up to help couples who thought they would never be able to become pregnant, to help them become pregnant.

Not only this, couples who have recurrent miscarriages they become pregnant but then they have an abortion and again and again. These couples too, this technique comes useful because we now have what we called PGD, Preimplantation Genetic Diagnosis which means that if a couple is having repeated miscarriages or if they are having with the baby with some abnormality or some genetic defects we can actually take a biopsy of the small tiny 2 or 3 day embryo. We can take a tiny biopsy and we can analyse it and we can tell the patient, that this embryo is normal or abnormal and we can pick up a healthy good embryo and put it back inside in the womb ensuring less chance of miscarriage and a better healthy baby free of genetic problems. So there is a lot of techniques and technologies available. We're all almost on par with the rest of the world. Our results are excellent and we can definitely offer patients today such good treatment for infertility that we can almost say that no couple will remain infertile. There is also surrogacy as an option, there is a possibility of egg donation, embryo donation. So depending upon the unique problem which the patient presents with, we can offer them some solution. You can contact me at any time through lybrate and I will be available to help solve all your problems.

Thank you.