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| Assisted Reproductive Technologies (ART) |
| The following services with the latest state of ART technology |
| IVF | ICSI | PESA/ICSI | TESA/ICSI |
| OVERVIEW OF IVF |
For a pregnancy to occur, ovary
has to release an egg and it has to unite with a sperm. Normally
this union, called fertilization, occurs within the fallopian tube
which joins the uterus (womb) to the ovary. Howevery, in IVF the
union occurs in a laboratory after eggs and sperm are collected
and under congenial conditions, allowed to unite. Embryos are then
transferred to the uterus to continue growth. |
There are five major steps
in the IVF and embryo transfer sequence |
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Monitor the development
of ripening of egg(s) in the ovaries. |
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Collect eggs - the woman is
given hormones to produce multiple follicles |
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Obtain sperm |
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Put eggs and sperm together
in a petridish in the laboratory, and provide correct conditions
for fertilization and early embryo growth. |
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Transfer embryos into the uterus |
| To check that egg development
is satisfactory, we utilize ultrasound exminations of the ovaries
(a painless method of seeing the image of the enlarging follicles
containing the eggs); hormone levels are also checked by taking
a series of blood and/or urine samples. Using the above information
we determine when to administer an injection to cause final ripening
of the eggs and when to schedule egg retrieval. |
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The retrieval procedure to obtain
the eggs is performed under anaesthesia transvaginally using a hollow
needle guided by the ultrasound image(this is comfortable under
adequate sedation and local anesthesia. Eggs are gently removed
from the ovaries using the needle. This is called “follicular
aspiration”. |
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The eggs are immediately
identified by our embryologists in the adjacent IVF laboratory.
They are placed with sperm. The sperm and eggs are then placed in
incubators to allow fertilization to take place. The eggs are examined
carefully at intervals to ensure that fertilization and cell division
have taken place; the fertilized eggs are now called embryos. |
Embryos are usually placed in the
wife’s uterus 2 or 3 days after egg retrieval. A speculum
is inserted into the vagina to expose the neck of the womb (cervix).
The embryos are suspended in a tiny drop of fluid and then very
gently introduced through a catheter into the womb, often under
ultrasound guidance. The transfer is followed by some rest, and
then blood tests and possibly ultrasound examinations are carried
out to see if pregnancy has been established. |
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IVF is of demonstrated value for patients
with absence of both falopian tubes or irreversible tubal blockage
(where corrective surgery has either failed or is inadvisable). |
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| Intra cytoplasmic sperm injection (ICSI) | |
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A tiny pipette is used to inject a single sperm into the awaiting egg in a revolutionary new procedure, Intracytoplasmic Sperm Injection. |
A series of functional capabilities
is required for a sperm cell to reach, and ultimately penetrate
into the egg and initiate fertilisation. Recent estimates suggest
that only about 10% of male infertility is attributed to underproduction
of sperm due to maturation arrest or germinal aplasia, and that
only 10% more can be attributed to pure motility disorders. This
means that approximately 80% of infertile men have disorders ranging
from profound oligospermia to failure of the sperm to acrosome reaction.
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| The acrosome reaction
allows the sperm to penetrate through the sona pellucida, to enter
into the perivitelline space, and ultimately bind to the egg membrane
or oolemma and penetrate into the egg. |
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| IN 1992, a “seminal”
paper in a July issue of Lancet (15) described a powerful new method
that has revolutionized the treatment of male infertility. That
method is intracytoplasmic sperm injection(ICSI). ICSI allows fertility
experts and embryologists to effectively treat the large number
of couples where the sperm cannot penetreate into the egg to initiate
fertilization. |
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| ICSI involves microinjection
of a single sperm cell into each egg. This means that if as few
as one viable sperm per available egg can be obtained from the semen,
epididymis, or testes, then otherwise infertile men can now father
children. ICSI is also performed on failed IVF patients. |
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ICSI can also benefit the additional
group of post-vasectomy males for whom after vasectomy reversal
often have diminished sperm quality, or who can avoid vasectomy
reversal entirely through NSA ( non-surgical sperm aspiration) and
ICSI. ICSI can be utilised for unexplained infertile couple. |
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| Percutaneous Epididymal Sperm Aspiration (PESA) |
PESA is indicated for men with
irreparable obstruction resulting in azoospermia (lack of or no
sperm), congenital absence of the vas deferens or failed vasectomy
reversal. The procedure takes approximately 10 to 20 Minutes and
does not require a surgical incision-a small needle is passed dirctly
into the head of the spididymis and fluid is aspirated. Subsequently,
the IVF labortory team retrieves the sperm cells from the fluid
and prepares them for ICSI because of the limited amount secured.
The Fertility Centre team in New England was the first to offer
PESA. |
Testicular
Epidydimal Sperm Aspiration |
Surgical removal
of a portion of the testical tissue for patients who are not good
candidates for PESA. In the andrology laboratory, tissue is homogenized
(minced) and individual sperm is collected for ICSI. |
| How Do We Do Various Procedures | ||||||||
In VIMS it is done
in batches, to help overseas patients and employed female patients.
This helps the couple to take leave from thier office and plan theprocedure,
It is to some extent economical. |
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| They are explained the various stages after they are recruited for a particular procedure. | ||||||||
There are various
steps in this programme |
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