Fertility Treatment Options

Determining fertility treatment options depends on the diagnosis of the cause(s) of the infertility couple is experiencing.

There are several treatment options your fertility specialist will discuss with you during your visit.

IUI (INTRA-UTERINE INSEMINATION)

IUI (Intrauterine Insemination) is often a first-step fertility treatment when couples are having trouble getting pregnant through naturally occurring intercourse./p>

With intrauterine insemination (IUI), millions of sperms are placed directly into the uterus when the woman is most fertile, immediately prior to and during ovulation. The semen sample is first "washed" with special solutions and concentrated to increase the number of sperms that make it to the fallopian tube where fertilization takes place. This improves the chances for conception.

IUI may be performed with or without the use of fertility drugs taken by the woman. When medications are used, the therapy is referred to as controlled ovarian hyperstimulation (COH). IUI with COH generally results in and increased likelihood of pregnancy.

Those who benefit from IUI include:

• Couples with no known cause of infertility
• Women with ovulatory disorders who respond well to fertility medication
• Women with mild endometriosis
• Women using donor sperm

For some patients, IVF (in vitro fertilization) may be advised, including:

• Women with blocked or severely damaged fallopian tubes
• Women with structural problems of the uterus
• Women who do not ovulate
• Men with low sperm counts, poor morphology, and/or poor motility
• Donor egg programme
• Several cycles of failed IUI.

IVF (IN VITRO FERTILIZATION)

IVF (in vitro fertilization) is a process in which eggs, retrieved from a woman's ovaries, are fertilized in the Embryology lab with sperm provided by her husband, or sperm from the gamete bank depending on the case and the resulting embryos are grown in the lab for 3-5 days. When fertilization is successful, the resulting embryos(about 2-3) are transferred into the womans uterus and the remaining embryos can be freezed and stored for subsequent cycle use.

There are four major steps in an IVF cycle: 1. Follicular stimulation and monitoring

Fertility specialist prescribe the medications in order to increase the likelihood of collecting multiple eggs and to control the timing of a patient's menstrual cycle. The patient and her partner may administer these medications on a daily basis within the privacy of their home. CTTBC specialist then monitor the patient's progress by evaluating the number of ovarian follicles in development through vaginal ultrasound and serial blood samples taken at CTTBC. A follicle is a sac of fluid in the ovary that may contain an egg (oocyte). Our fertility specialist doctors determine the number and frequency of these tests.

Just prior to egg retrieval, a patient takes an additional injectable medication to complete the maturation of the eggs. The retrieval is scheduled only if there are an adequate number of follicles ready.

2. Oocyte (Egg) Retrieval

Each egg retrieval takes place under short GA or sedation by a qualified Licensed anaesthesiologist who monitor the patients. While sedated, our fertility doctor use the ultrasound mechine to aspirate the follicular fluid from the ovaries. Not all follicles necessarily contain eggs. Following the retrieval, the patient rests in the recovery room under the care of the CTTBC doctors and nurses and medical assistants to allow effects of the anesthesia to subside.

3. Fertilization and Incubation

Once eggs have been retrieved, the male partner's sperm is collected and eggs and sperm are brought together for fertilization. The embryologist may choose from a number of techniques including the microdrop method or a microinsemination technique called intracytoplasmic sperm injection known as ICSI ("ik-see"). In ICSI, an embryologist injects a single sperm directly into an egg under a microscope with a tiny needle. Fertilized eggs are then incubated in the embryology laboratory for two to five days prior to embryo transfer.

4. Embryo Transfer Procedure

If the embryos have developed normally after incubation, CTTBC physician transfers a predetermined number of embryos through the cervix into the uterus via a small catheter (hollow tube). The patient and her physician determine the number of embryos for transfer based on individual circumstances such as age and medical history. No anesthesia is required for this procedure.

In order to enhance the likelihood of conception, the physician prescribes hormonal therapy following embryo transfer. As in the natural reproduction process, a pregnancy may or may not result. If any excess embryos exist after the initial transfer, the patient may request evaluation for possible freezing and use for a subsequent treatment cycle.

5. Frozen Embryo Transfer (FET)

Unused embryos can be cryopreserved (frozen) in liquid nitrogen for possible thawing and later use. Embryos may be frozen anytime after the fertilization stage (pronuclear zygotes, which is one day after egg retrieval up to and including the blastocyst stage, which is 5 days after retrieval. Most commonly, embryos are frozen at either day three or day five. Our embryologist will discuss both options and a decision will be reached as to which is best suited for your particular case.

DONOR EGG AND IVF

IVF with donor eggs is a fertility treatment that has been available since the mid 1980's. Oocytes (eggs) are retrieved from an egg donor and inseminated with the sperm of the intended father. Resulting embryo(s) are then transferred to the uterus of the intended mother. If there are extra eggs or embryos, they can be cryopreserved for future use.

IVF with donor eggs is used to treat infertility arising from a woman's absence of ovaries or the inability of ovaries to produce viable eggs. IVF with donor eggs can also be used to help couples with potential genetic abnormalities that might be carried by the woman.

DONOR SCREENING

Both donors and recipients participate in preliminary screening procedures, including review of medical records, physical examination, blood testing, screening for genetic and infectious disease, and a psychological consultation.

EGG DONOR CATEGORIES

Egg donors are healthy women ideally between the ages of 21 and 30. The following are categories of potential egg donors:

• Anonymous Donors: Many women opt to undergo the egg donation process as anonymous donors. These individuals donate eggs to an infertile woman or couple whose identity also remains anonymous.
• Known Donors: In some instances sisters, friends or others close to the recipient frequently donate eggs. In addition, recipients sometimes opt to recruit an egg donor on their own.
• Egg Bank Donors: It is possible to acquire frozen eggs through an egg bank. Medical statistics and physical characteristics of the donors are available in addition to photographs of the donor as a child. This option eliminates the necessity to wait for stimulation and egg retrieval and enables treatment to focus only on the recipient.

DONOR MOTIVATION

The primary benefit to every woman who donates eggs is the aspect of helping another person or couple achieve pregnancy. Anonymous donors receive remuneration for their time, effort, inconvenience, time lost from work and in some cases there are financial benefits to women undergoing their own assisted reproductive treatment cycles who donate their eggs. Guidelines have been set ICMR to assure that donor compensation is not construed as "purchasing" oocytes. Our practice abides by these guidelines.

CTTBC Egg Bank

Achieved a 55% live birth rate for IVF patients using frozen donor eggs.

HISTORICAL OVERVIEW

Development of technology to effectively cryopreserve (freeze) human oocytes (eggs) began in the mid-1990's, primarily for the purpose of preserving the fertility potential for cancer patients. (Radiation and certain chemotherapies can negatively impact the reproductive system.)

In 2007, Dr. Nagy and his scientific team achieved the most important egg freezing breakthrough based on scientific research initiated in 2004 to explore an alternative way of cryopreservation called "vitrification".

Utilizing this new rapid-freezing technique with egg donors between the ages of 21 to 30, pregnancy rates equal to fresh donor cycles in traditional IVF centers around the world were achieved.

CTTBC EggBank Bangalore, was established to expand patient access to successful vitrification and thawing protocols. CTTBC EggBank is an assisted reproduction resource for women with infertility issues affecting egg quantity and/or quality who need IVF using donor eggs to achieve pregnancy. It is also a fertility preservation resource for cancer patients, and for women who choose to delay pregnancy.

SURROGACY AND IVF

Fertility Preservation for Cancer Patients

Our team is ready to provide an immediate response for patients who are seeking information and/or services for fertility preservation due to a cancer diagnosis in which treatment will impact a woman's future ability to conceive and carry a pregnancy.

Oncologist Referrals:

We agree that the possibility of fertility preservation should be discussed with women of child-bearing age who are diagnosed with cancer and about to undergo treatment protocols that pose a risk to future fertility.

Fertility Preservation Services at RSC New England include: Freezing and thawing for therapeutic use:

Fertilized eggs (zygotes)

Eggs (oocytes)

State-of-the-Art Technology

Cryopreservation/Vitrification

Expertise

• Accredited embryology lab with state of ART Equipments
• Egg freezing experience
• Continuous quality improvement

Collaborative, Patient-Centered Care

Working collaboratively with referring Oncologists to identify and apply appropriate hormonal stimulation

Patient-Centered Price Plans

CTTBC offers compassionate-care price plans.

Women at optimal fertility age -- 21 to 30 and a few years beyond -- have the option to take advantage of advanced technology and delay pregnancy through egg freezing.

Many women are choosing to start their families much later than their mothers. Surveys indicate, for example, that while 7 out of 10 women plan to become pregnant, 30% plan to wait until their 30s to do so. There are numerous reasons for this. The changing roles for women in the 21st century find many choosing to pursue advanced educational degrees and to focus on establishing professional careers before starting a family. And, it can take many years to find the right partner which can lead to women getting married at an older age in which she many not have the ovarian reserves or egg quality that she would in her 20s or early 30s. Unlike years past, women at optimal child-bearing age -- 21 to 30 and a few years beyond -- have the option to take advantage of advanced technology resulting in egg freezing. And, there is evidence that, vitrification, a new rapid-freezing technique, can result in pregnancy rates equal to IVF (in-vitro fertilization) using a 21 to 30 year old's fresh oocytes (eggs)

Starting with a fertility doctor consultation is the first step when considering egg freezing for delaying pregnancy. and find out if this is a realistic option for you.