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[blog_title] => Understanding the Process of Fertilisation
[metaTitle] => Understanding the Process of Fertilisation
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Understanding the existence of any form of life has been a very fascinating topic since the beginning of time and scientists made sure that no stone is left unturned. Every living being on this planet, which is a result of sexual reproduction, marks the start of its journey on this planet when a female egg is fertilised with male sperm. Let’s find out more about this process.
General Fertilisation Overview:
Fertilisation occurs when a sperm fuses with the female act during intercourse and further forms an egg that gets implanted in uterus of the female. The sperm travels through the fallopian tube and penetrates the zona pellucida layer of the ovum (female egg) and fuses with it which forms zygote (fertilized egg). Thousand of sperms are produced in male body to compensate for the ones unfit and non- motile ones. Once the zygote is formed, it gets implanted in the uterus and further growth takes place when cells start dividing and forming tissues and tissues form organ which results in formation of an organ system, ultimately turning into an organism.
Detailed Fertilisation Overview:
There are many steps involved in the whole process of fertilisation, right from the capacitation of sperm to Zona reaction and post-fertilization events. Let’s look into it in detail:
Sperm Capacitation – it literally translates to the preparation of sperm for fertilisation. The sperm becomes hyperactive and its motility increases. This step ensures that the sperm is in ideal condition to fertilise the egg.
Sperm-Zona Pellucida Binding– This is the next step if the sperm finds an ovum. Sperm binds with Zona Pellucida layer of an ovum and a receptor-ligand reaction occurs. After this binding process occurs, no other sperm can enter through this layer.
Penetration of Zona Pellucida– The shape of sperm’s head helps in cutting through the layers of ovum. It further activates growth of ovum which is arrested at one stage of meiosis which only resumes after the egg gets fertilised.
Acrosome Reaction– The head of sperm (acrosome) contains various Zona Pellucida digesting enzymes which help it in deeper penetration into the layers of ovum. The head of sperm diminishes with deeper penetration. It is crucial for sperm to retain its acrosomal content before it fertilises the ovum.
Cortical Reaction– Egg activation takes place at this stage as the egg is previously frozen at metaphase stage in meiotic division II. A rapid development of the ovum takes place and cortical granules fuse with Zona Pellucida along with exocytosis.
Zona Reaction – The Zona Pellucida layer hardens and this completes the process of fertilisation.
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[published_date] => 2018-09-30
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[createdDate] => 2023-10-18 10:30:36
[updatedDate] => 2024-05-04 08:29:12
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[blog_title] => Understanding the Process of Fertilisation
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Understanding the existence of any form of life has been a very fascinating topic since the beginning of time and scientists made sure that no stone is left unturned. Every living being on this planet, which is a result of sexual reproduction, marks the start of its journey on this planet when a female egg is fertilised with male sperm. Let’s find out more about this process.
General Fertilisation Overview:
Fertilisation occurs when a sperm fuses with the female act during intercourse and further forms an egg that gets implanted in uterus of the female. The sperm travels through the fallopian tube and penetrates the zona pellucida layer of the ovum (female egg) and fuses with it which forms zygote (fertilized egg). Thousand of sperms are produced in male body to compensate for the ones unfit and non- motile ones. Once the zygote is formed, it gets implanted in the uterus and further growth takes place when cells start dividing and forming tissues and tissues form organ which results in formation of an organ system, ultimately turning into an organism.
Detailed Fertilisation Overview:
There are many steps involved in the whole process of fertilisation, right from the capacitation of sperm to Zona reaction and post-fertilization events. Let’s look into it in detail:
Sperm Capacitation – it literally translates to the preparation of sperm for fertilisation. The sperm becomes hyperactive and its motility increases. This step ensures that the sperm is in ideal condition to fertilise the egg.
Sperm-Zona Pellucida Binding– This is the next step if the sperm finds an ovum. Sperm binds with Zona Pellucida layer of an ovum and a receptor-ligand reaction occurs. After this binding process occurs, no other sperm can enter through this layer.
Penetration of Zona Pellucida– The shape of sperm’s head helps in cutting through the layers of ovum. It further activates growth of ovum which is arrested at one stage of meiosis which only resumes after the egg gets fertilised.
Acrosome Reaction– The head of sperm (acrosome) contains various Zona Pellucida digesting enzymes which help it in deeper penetration into the layers of ovum. The head of sperm diminishes with deeper penetration. It is crucial for sperm to retain its acrosomal content before it fertilises the ovum.
Cortical Reaction– Egg activation takes place at this stage as the egg is previously frozen at metaphase stage in meiotic division II. A rapid development of the ovum takes place and cortical granules fuse with Zona Pellucida along with exocytosis.
Zona Reaction – The Zona Pellucida layer hardens and this completes the process of fertilisation.
Intracytoplasmic Sperm Injection is a procedure which is involved with IVF, i.e., in vitro fertilization by virtue of which a single sperm cell is injected directly into the cytoplasm of a mature egg cell that is held in place. This elaborate process is conducted in the lab by experienced embryologists using a holding tool and a fine glass injection needle. The only difference between Intracytoplasmic Sperm Injection with IVF is the method of introducing the sperm cell. ICSI is more advantageous as compared to the latter because it doesn’t require a large number of sperms in the surrounding media of the egg. Thus, it has provided hope to many males who might have a low sperm count. ICSI doesn’t depend on sperm count and the concept of “chance meeting” is also done away with.
Who is ICSI a Blessing For?
From the perspective of the patient, applying for an ICSI is similar to IVF.
Circumstances under which ICSI may be apt for are:
When sperm count is extremely low.
When sperm has no or little or even defective motility is abnormal by other means.
When sperms have been removed from the epididymis (MESA/PESA) or the testes.
When sperms have been removed from urine or by electro-ejaculation (TESE/TESA)
When there are large proportions of antibodies in semen.
When there has been a case of failure with traditional IVF procedure.
What Does ICSI Involve?
Stimulation of ovaries to encourage maturation of follicles thereby facilitating ovulation.
Retrieving the eggs safely.
Fertilizing the eggs with the sperm and culturing the embryo.
Transfer of embryo back into the uterus for further development.
What is the Success Rate for ICSI?
As such, the success rate of performing ICSI generally varies from individual to individual, particularly dependent on the age of the woman. According to statistics, about 25% of couples will be able to have a baby on the first attempt at ICSI.
Any Probable Risks of ICSI?
Although the success rate of an ICSI fertilization can be quite high, there are some probable risks that can’t be completely ignored. Unfortunately, not all fertilized zygotes using artificial techniques grow into healthy individuals.
Intracytoplasmic Sperm Injection is a procedure which is involved with IVF, i.e., in vitro fertilization by virtue of which a single sperm cell is injected directly into the cytoplasm of a mature egg cell that is held in place. This elaborate process is conducted in the lab by experienced embryologists using a holding tool and a fine glass injection needle. The only difference between Intracytoplasmic Sperm Injection with IVF is the method of introducing the sperm cell. ICSI is more advantageous as compared to the latter because it doesn’t require a large number of sperms in the surrounding media of the egg. Thus, it has provided hope to many males who might have a low sperm count. ICSI doesn’t depend on sperm count and the concept of “chance meeting” is also done away with.
Who is ICSI a Blessing For?
From the perspective of the patient, applying for an ICSI is similar to IVF.
Circumstances under which ICSI may be apt for are:
When sperm count is extremely low.
When sperm has no or little or even defective motility is abnormal by other means.
When sperms have been removed from the epididymis (MESA/PESA) or the testes.
When sperms have been removed from urine or by electro-ejaculation (TESE/TESA)
When there are large proportions of antibodies in semen.
When there has been a case of failure with traditional IVF procedure.
What Does ICSI Involve?
Stimulation of ovaries to encourage maturation of follicles thereby facilitating ovulation.
Retrieving the eggs safely.
Fertilizing the eggs with the sperm and culturing the embryo.
Transfer of embryo back into the uterus for further development.
What is the Success Rate for ICSI?
As such, the success rate of performing ICSI generally varies from individual to individual, particularly dependent on the age of the woman. According to statistics, about 25% of couples will be able to have a baby on the first attempt at ICSI.
Any Probable Risks of ICSI?
Although the success rate of an ICSI fertilization can be quite high, there are some probable risks that can’t be completely ignored. Unfortunately, not all fertilized zygotes using artificial techniques grow into healthy individuals.
Amenorrhea is the absence of menstruation or one or more missed period cycles. When you miss three consecutive periods in a row, you may be diagnosed with Amenorrhea. Also, the young girls who haven’t started their period, maximum by the age of 15, are said to have amenorrhea. Of course, one of the most common reasons for amenorrhea or the absence of menstruation is pregnancy. But, the other causes are problems in the reproductive organs or a defect in the glands that stabilize the hormone levels. When the underlying conditions are treated, it can cure amenorrhea.
Symptoms
Apart from the absence of periods, you may also experience;
There are several natural causes of amenorrhea, but some medications can also do the same.
Natural Causes
During your life, you may experience the natural causes of the absence of menstruation, such as pregnancy problems, breastfeeding, and menopause.
Contraception
For some women, who depend on contraceptive pills, their menstruation cycle may stop. However, after discarding the medicines, it may take time for regular ovulation and menstruation to return back to normal. Contraceptives that are injected or implanted can also lead to the absence of periods, even the intrauterine device.
Medications
A few drugs can interfere with the regular menstrual cycle. They are; Antipsychotics, cancer chemotherapy, antidepressants, blood pressure medicines, and allergy medicines
Lifestyle factors
A few lifestyle choices can also have repercussions and cause amenorrhea. They are;
Low Body Weight
If your body weight is exceedingly low, it can interfere with the normal hormonal functions, which can halt the ovulation. It is especially seen in women who suffer from eating disorders, such as anorexia or bulimia. Therefore, the period stops because of abnormal hormonal changes.
Too much Exercise
Being healthy is a good thing, exercising regularly is even better. But, women who undergo religious training for activities, such as ballet, may notice that their period cycle gets interrupted. This can be because of the high energy expenditure, the stress, the heavy-duty exercise or even the low body fat.
Amenorrhea is the absence of menstruation or one or more missed period cycles. When you miss three consecutive periods in a row, you may be diagnosed with Amenorrhea. Also, the young girls who haven’t started their period, maximum by the age of 15, are said to have amenorrhea. Of course, one of the most common reasons for amenorrhea or the absence of menstruation is pregnancy. But, the other causes are problems in the reproductive organs or a defect in the glands that stabilize the hormone levels. When the underlying conditions are treated, it can cure amenorrhea.
Symptoms
Apart from the absence of periods, you may also experience;
There are several natural causes of amenorrhea, but some medications can also do the same.
Natural Causes
During your life, you may experience the natural causes of the absence of menstruation, such as pregnancy problems, breastfeeding, and menopause.
Contraception
For some women, who depend on contraceptive pills, their menstruation cycle may stop. However, after discarding the medicines, it may take time for regular ovulation and menstruation to return back to normal. Contraceptives that are injected or implanted can also lead to the absence of periods, even the intrauterine device.
Medications
A few drugs can interfere with the regular menstrual cycle. They are; Antipsychotics, cancer chemotherapy, antidepressants, blood pressure medicines, and allergy medicines
Lifestyle factors
A few lifestyle choices can also have repercussions and cause amenorrhea. They are;
Low Body Weight
If your body weight is exceedingly low, it can interfere with the normal hormonal functions, which can halt the ovulation. It is especially seen in women who suffer from eating disorders, such as anorexia or bulimia. Therefore, the period stops because of abnormal hormonal changes.
Too much Exercise
Being healthy is a good thing, exercising regularly is even better. But, women who undergo religious training for activities, such as ballet, may notice that their period cycle gets interrupted. This can be because of the high energy expenditure, the stress, the heavy-duty exercise or even the low body fat.
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[blog_title] => COMPARISON OF A NEW 3D AUTOMATED VOLUME CALCULATION TECHNIQUE (SONO AVC)
[metaTitle] => COMPARISON OF A NEW 3D AUTOMATED VOLUME CALCULATION TECHNIQUE (SONO AVC)
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[seo_url] => comparison-of-a-new-3d-automated-volume-calculation-technique-sono-avc-with-conventional-2d-manual-follicular-tracking-in-in-vitro-fertilization-ivf-cycles-a-prospective-study
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COMPARISON OF A NEW 3D AUTOMATED VOLUME CALCULATION TECHNIQUE (SONO AVC) WITH CONVENTIONAL 2D MANUAL FOLLICULAR TRACKING IN IN VITRO FERTILIZATION (IVF) CYCLES; A PROSPECTIVE STUDY
Dr. Usha B R.
PURPOSE – To compare the predictive value of manual follicle monitoring v/s the use of Sono AVC, a new software in routine follicle monitoring in IVF practice.
METHODS – This is a prospective study done at the ART centre. Sono AVC (automated volume calculation) is a new 3-D ultrasound software which allows for a more objective and reproducible assessment of follicle. A total of forty six patients undergoing in-vitro fertilisation at our ART centre were recruited. Follicle monitoring was done both manually in 2-D and with the use of 3-D Sono-AVC. Both the techniques were performed in same patients by a single trained observer with Voluson S6 and 4-D transvaginal probe. The follicle count and dimensions were noted using 2-D and the 3-D technique on the day of oocyte retrieval and compared with the number of oocytes retrieved.
RESULTS – A total of 46 patients were studied i.e. a total of 91 ovaries were studied, as there was one patient with an absent ovary. Mean duration of time taken for manual and Sono AVC are 209.2s and 156.6s respectively (p-0.01). Manual count of total number of follicles in comparison to Sono AVC total count of follicles>10mm was found to be lesser with a mean of difference of -1.45 and was found to be statistically significant. Leading follicle diameter measured manually is in agreement with volume based diameter d(V) as well as mean diameter measured on Sono AVC but correlates better with d(V)(mean of difference -0.09).
CONCLUSION – 3-D Sono AVC is a useful adjunct in routine follicle monitoring, with significant reduction in time and correlates well with manual counts.It is a very good tool to counsel patients regarding ovarian response as it is pictorial and also serves to maintain graphical record of each cycle which could serve as a guide in the future if need arises. Further research with larger sample size is required to further validate our study. Keywords- Sono AVC, follicle monitoring, 3-D ultrasound.
INTRODUCTION With the rising trend in infertility, the number of patients being referred for ART centres is also on the rise. Ultrasound follicle monitoring is an integral part of any ART cycle. After recruitment of a patient in a cycle follicular scans begin on day 1 and continues after day 5/6 every alternate day depending on the follicular response. With this frequent monitoring, there is a requirement of a method of follicle tracking which is more objective or reproducible and could also lessen the time taken for busy practitioners.
SONO AVC (Sonography based Automated Volume Calculation) is a new software introduced by GE company in its VOLUSON machine. This software is based on the inversion mode principle, takes a 3-D sweep of the entire ovary, makes automated volume based calculations and gives results within seconds. The inversion mode allows the cystic areas or follicles in the ovary to appear uniformly echogenic in its entirety and the background grey areas to appear transparent.
MATERIALS AND METHODS
This was a prospective study done at our ART centre. A total of 46 patients were recruited for in-vitro fertilisation cycles enrolled. Follicular monitoring was done with GE Voluson S6 pro machine with a 4-D transvaginal probe. Follicular measurements were made manually in 2-D plane taking into account the average of breadth and length of the follicle. Following this, 3-D Sono AVC was also applied to note the leading follicle diameter. All decisions to increase or reduce the dose of gonadotropins and the ovulation trigger were based on the manual measurements. On the day of oocyte retrieval, just prior to the procedure, total number of follicles was counted manually and manual measurement of average diameter of all follicles more than 10mm was done and time required for the same noted. After this 3-D Sono AVC was applied to take a sweep of the complete ovary. Volume analysis is selected and the area of interest, that is the ovary alone, is selected.
Sono AVC makes automated calculations. It calculates largest diameters in three orthogonal planes and gives an average of these three which is the mean diameter (mn.d) of the follicle. It also calculates volume(V) based on this diameter. It creates a perfect sphere of this volume and then calculates the diameter which is mentioned in the chart as volume based diameter(d(V)).Sometimes there may be compression of follicles especially in ovaries where there is over-crowding of follicles. This causes follicle to get elongated in one of the diameters giving false values. The concept of volume based diameter eliminates this error as it creates diameter of the follicle if it were not to be compressed.
Sono AVC gives a chart where it lists volume based diameter, the diameters in the three orthogonal planes as dx, dy and dz , the mean diameter (mn.d) and the volume (V) of each follicle. Once the list of follicles is obtained, we need to scroll through the ovary to see if all the follicles and only the follicles have been included. Sometimes, erroneously a nearby vessel or hydrosalpinx could be picked as a follicle which needs to be removed or many a times a big follicle may not be picked if the prior 2-D image is not good in which case it needs to be added. A 3-D view of the ovary can be obtained on cine calculation where the entire ovary can be rotated upto 3600 to view the follicles which are presented in different colours. Sono AVC also gives a follicle tracking chart from day 1 of stimulation. This chart could be made either based on measurements of mean diameter or volume based diameter or volume of each follicle.
In our study each ovary was observed as a different subject we have done 4 important comparisons. First, the total number of follicles (total count) measured manually v/s total number of follicles seen in Sono AVC chart of >10mm. We have taken this 10 mm as cut off to compare with the oocyte retrieval as follicles <10mm do not fetch an oocyte. Second, the leading follicle diameter measured manually was compared with the mean diameter and volume based diameter obtained on 3-D Sono AVC. Third, we have compared total count measured manually and 3-D Sono AVC with the number of oocytes retrieved. Fourth, the total time taken for measuring all the follicles manually and time taken for 3-D Sono AVC including the post-processing is noted and compared.
STATISTICAL METHODS
For agreement analysis, the difference between two parameters and mean of the two parameters were computed. The mean of differences and its 95% confidence intervals were calculated. Kendall’s tau-b coefficient between difference and mean were compiled. Measurement error (Standard deviation of differences/√2) was calculated and Error range was computed as measurement error × 1.96 (critical value).
Finally, intra- class correlation co-efficient was computed between the 2 parameters. Bi-variant correlation coefficient was computed between manual count and number of oocytes retrieved. Similarly, Bi-variant correlation co-efficient was computed between Sono AVC count and number of oocytes retrieved. For all statistical tests, p<0.05 was considered significant.
RESULTS
A total of 46 patients and a total of 91 ovaries were studied, as there was one patient with single ovary. Mean duration of time with manual and SONO AVC are 209.2s and 156.6s respectively (p-0.01).
Fig-1 Sono AVC report
Mean of differences
95% C.I.
Kendall’s tau b coefficient
Error range
Intra class correlation
Total count of follicles(manual v/s 3-D)
-1.45
-1.94 to -0.95
-0.39 (p=0.00)
3.25
0.906
Leading follicle diameter(manual v/s 3-D mn.d)
-1.70
-2.2 to -1.20
-0.06 (p=0.40)
3.31
0.708
Leading follicle (manual v/s 3-d(V))
-0.09
-0.46 to -0.27
0.083 (p=0.24)
2.43
0.829
Table-1
Manual count of total number of follicles in comparison to Sono AVC total count of follicles>10mm was found to be lesser with a mean of difference of -1.45 and was found to be statistically significant. This simply means Sono AVC picks up more number of follicles. Most of our decision making in IVF cycles is based on leading follicle diameter. Leading follicle diameter measured manually is in agreement with volume based diameter d(V) as well as mean diameter measured on Sono AVC but correlates better with d(V)(mean of difference -0.09).
Fig –2 showing the good correlation between manual leading follicle diameter and Sono AVC values.
PEARSON CORRELATION (r)
P-VALUE
Manual count and oocyte retrieval
0.729
<0.001
3-D Sono AVC count and oocyte retrieval
0.688
<0.001
Table -2
The above table explains that both manual count and Sono AVC count of total number of follicles correlate well with the number of oocytes retrieved.
DISCUSSION
Sono AVC software definitely seems promising as a present and future of follicle tracking. There are many advantages with this technique. It saves on time for the busy practitioners. It is more objective and reproducible compared to manual measurements. It requires only a little bit of training to master the technique. It would be easier for senior consultants to ask the juniors or residents to do follicle tracking with this software. Subjective errors during measurement of follicle like re-measuring the same follicle or missing out on a follicle as it may be bigger in a different plane can be reduced with the 3-D technique.It provides a graphical record of the ovarian response which can be stored for follow-up in next IVF cycles. It is pictorial providing a colourful picture of the ovary representing follicles with different colours and it would be easy to counsel the patients with pictures. Patients can be told about the numbers of follicles either poorly responding or hyper responding so that they know as to what to expect from that cycle prior to the oocyte retrieval.Sono AVC can also be used to measure antral follicle count. In pregnancy, studies have reported the use of Sono AVC for the measurement of gestational sac volume, embryo volume, fetal stomach volume, fetal cardiac ventricle volume and neuro sonoembyology.1
Fig –3 Ovarian response shown as Normal, Hyper response and Poor response.
Sono AVC software is not completely fool proof as it has pitfalls. There are two important things to get a good report. One is prior to taking a 3-D sweep we need to ensure that the image obtained in 2-D plane is crisp with margins of follicles being clearly defined.Second, after taking a 3-D sweep, we need to select the area of interest i.e. the ovary completely in all three orthogonal planes. Sono AVC for follicle monitoring requires minimal post processing if a good 2-D image is obtained. If a good 2-D image is not obtained, then the procedure requires post processing, which makes it semi-automated. Post processing involves scrolling through the entire ovary to see if all the follicles have been included. Sometimes erroneously adjacent blood vessel, cyst, encysted collection is also picked up as follicle.So we need to do post- processing to add or remove follicles, cut or merge follicles or adjust the settings of growth or separation of two follicles. This consumes a bit of the time with Sono AVC, which otherwise provides results within seconds.The other most important disadvantage is the cost of the machine which would add on to the burden of the ART centre.
Fig- 4 showing pitfalls of Sono AVC requiring post-processing
Baris Ata et al reported a study of 100 women undergoing in-vitro fertilisation.Each follicle was measured manually as well as with the use of Sono-AVC. Both SonoAVC-generated mean follicle diameter, volume based diameter, follicle counts, as well as the leading follicle diameter had good agreement with conventional 2D US measurements. SonoAVC measurements had very good reproducibility, with intra-class correlation coefficient ≥0.8 for most evaluations.2
N.Raine-Fenning et al report a study of Sono AVC in 51 women undergoing in-vitro fertilisation. They made volume estimations of 224 follicles using Sono-AVC, VOCAL AND manually and measured the follicular aspirate volume during oocyte retrieval. Sono AVC provided highly accurate measurements in comparison to VOCAL and manual measurements.3The same group also report another prospective study of 89 subjects undergoing in-vitro fertilisation. The number of follicles and the mean diameter of follicles were measured both manually and with Sono AVC.There was no significant difference in the number of follicles with mean diameters >9 mm, >13 mm and >17 mm measured by either method. The total time taken for follicular measurements was significantly less (P < 0.01) for the automated 3D method (180.5 ± 63.6 versus 236.1 ± 57.1 s) which was associated with significantly less exposure to ultrasound (39.0 ± 6.0 versus 236.10 ± 57.1 s; P < 0.001).4
CONCLUSION
3-D Sono AVC is a useful adjunct in routine follicle monitoring, with significant reduction in time and correlates well with manual counts. Leading follicle diameter measured manually is in agreement with volume based diameter d(V) as well as mean diameter measured on Sono AVC but more so with d(V).It is a very good tool to counsel patients regarding ovarian response as it is pictorial and also serves to maintain graphical record of each cycle. Further research with larger sample size is required to further validate our study.
REFERENCES
1.Baris Ata, Togas Tulandi . Ultrasound automated volume calculation in reproduction and in pregnancy. Fertility and Sterility Vol. 95, No. 7, June 2011.
2.Baris Ata, Ayse Seyhan . Comparison of automated and manual follicle monitoring in an unrestricted population of 100 women undergoing controlled ovarian stimulation for IVF. Human Reproduction, Vol.0, No.0 pp. 1–7, 2010.
3.N. Raine-Fenning, K. Jayaprakasan . SonoAVC: a novel method of automatic volume calculation. Ultrasound Obstet Gynecol 2008; 31: 691–696.
5.Juan Luis Alcazar.The Use of Three dimensional Ultrasound in Gynecological patients. Donald School Journal of ultrasound in Obstetrics and Gynaecology. October- December 2008 ; 2(4) :10-16.
6.Sonal Panchal, Chaitanya Nagori. Comparison of anti-mullerian hormone and antral follicle count for assessment of ovarian reserve. J Hum Reprod Sci. 2012 Sep-Dec; 5(3): 274–278.
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[blog_title] => COMPARISON OF A NEW 3D AUTOMATED VOLUME CALCULATION TECHNIQUE (SONO AVC)
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COMPARISON OF A NEW 3D AUTOMATED VOLUME CALCULATION TECHNIQUE (SONO AVC) WITH CONVENTIONAL 2D MANUAL FOLLICULAR TRACKING IN IN VITRO FERTILIZATION (IVF) CYCLES; A PROSPECTIVE STUDY
Dr. Usha B R.
PURPOSE – To compare the predictive value of manual follicle monitoring v/s the use of Sono AVC, a new software in routine follicle monitoring in IVF practice.
METHODS – This is a prospective study done at the ART centre. Sono AVC (automated volume calculation) is a new 3-D ultrasound software which allows for a more objective and reproducible assessment of follicle. A total of forty six patients undergoing in-vitro fertilisation at our ART centre were recruited. Follicle monitoring was done both manually in 2-D and with the use of 3-D Sono-AVC. Both the techniques were performed in same patients by a single trained observer with Voluson S6 and 4-D transvaginal probe. The follicle count and dimensions were noted using 2-D and the 3-D technique on the day of oocyte retrieval and compared with the number of oocytes retrieved.
RESULTS – A total of 46 patients were studied i.e. a total of 91 ovaries were studied, as there was one patient with an absent ovary. Mean duration of time taken for manual and Sono AVC are 209.2s and 156.6s respectively (p-0.01). Manual count of total number of follicles in comparison to Sono AVC total count of follicles>10mm was found to be lesser with a mean of difference of -1.45 and was found to be statistically significant. Leading follicle diameter measured manually is in agreement with volume based diameter d(V) as well as mean diameter measured on Sono AVC but correlates better with d(V)(mean of difference -0.09).
CONCLUSION – 3-D Sono AVC is a useful adjunct in routine follicle monitoring, with significant reduction in time and correlates well with manual counts.It is a very good tool to counsel patients regarding ovarian response as it is pictorial and also serves to maintain graphical record of each cycle which could serve as a guide in the future if need arises. Further research with larger sample size is required to further validate our study. Keywords- Sono AVC, follicle monitoring, 3-D ultrasound.
INTRODUCTION With the rising trend in infertility, the number of patients being referred for ART centres is also on the rise. Ultrasound follicle monitoring is an integral part of any ART cycle. After recruitment of a patient in a cycle follicular scans begin on day 1 and continues after day 5/6 every alternate day depending on the follicular response. With this frequent monitoring, there is a requirement of a method of follicle tracking which is more objective or reproducible and could also lessen the time taken for busy practitioners.
SONO AVC (Sonography based Automated Volume Calculation) is a new software introduced by GE company in its VOLUSON machine. This software is based on the inversion mode principle, takes a 3-D sweep of the entire ovary, makes automated volume based calculations and gives results within seconds. The inversion mode allows the cystic areas or follicles in the ovary to appear uniformly echogenic in its entirety and the background grey areas to appear transparent.
MATERIALS AND METHODS
This was a prospective study done at our ART centre. A total of 46 patients were recruited for in-vitro fertilisation cycles enrolled. Follicular monitoring was done with GE Voluson S6 pro machine with a 4-D transvaginal probe. Follicular measurements were made manually in 2-D plane taking into account the average of breadth and length of the follicle. Following this, 3-D Sono AVC was also applied to note the leading follicle diameter. All decisions to increase or reduce the dose of gonadotropins and the ovulation trigger were based on the manual measurements. On the day of oocyte retrieval, just prior to the procedure, total number of follicles was counted manually and manual measurement of average diameter of all follicles more than 10mm was done and time required for the same noted. After this 3-D Sono AVC was applied to take a sweep of the complete ovary. Volume analysis is selected and the area of interest, that is the ovary alone, is selected.
Sono AVC makes automated calculations. It calculates largest diameters in three orthogonal planes and gives an average of these three which is the mean diameter (mn.d) of the follicle. It also calculates volume(V) based on this diameter. It creates a perfect sphere of this volume and then calculates the diameter which is mentioned in the chart as volume based diameter(d(V)).Sometimes there may be compression of follicles especially in ovaries where there is over-crowding of follicles. This causes follicle to get elongated in one of the diameters giving false values. The concept of volume based diameter eliminates this error as it creates diameter of the follicle if it were not to be compressed.
Sono AVC gives a chart where it lists volume based diameter, the diameters in the three orthogonal planes as dx, dy and dz , the mean diameter (mn.d) and the volume (V) of each follicle. Once the list of follicles is obtained, we need to scroll through the ovary to see if all the follicles and only the follicles have been included. Sometimes, erroneously a nearby vessel or hydrosalpinx could be picked as a follicle which needs to be removed or many a times a big follicle may not be picked if the prior 2-D image is not good in which case it needs to be added. A 3-D view of the ovary can be obtained on cine calculation where the entire ovary can be rotated upto 3600 to view the follicles which are presented in different colours. Sono AVC also gives a follicle tracking chart from day 1 of stimulation. This chart could be made either based on measurements of mean diameter or volume based diameter or volume of each follicle.
In our study each ovary was observed as a different subject we have done 4 important comparisons. First, the total number of follicles (total count) measured manually v/s total number of follicles seen in Sono AVC chart of >10mm. We have taken this 10 mm as cut off to compare with the oocyte retrieval as follicles <10mm do not fetch an oocyte. Second, the leading follicle diameter measured manually was compared with the mean diameter and volume based diameter obtained on 3-D Sono AVC. Third, we have compared total count measured manually and 3-D Sono AVC with the number of oocytes retrieved. Fourth, the total time taken for measuring all the follicles manually and time taken for 3-D Sono AVC including the post-processing is noted and compared.
STATISTICAL METHODS
For agreement analysis, the difference between two parameters and mean of the two parameters were computed. The mean of differences and its 95% confidence intervals were calculated. Kendall’s tau-b coefficient between difference and mean were compiled. Measurement error (Standard deviation of differences/√2) was calculated and Error range was computed as measurement error × 1.96 (critical value).
Finally, intra- class correlation co-efficient was computed between the 2 parameters. Bi-variant correlation coefficient was computed between manual count and number of oocytes retrieved. Similarly, Bi-variant correlation co-efficient was computed between Sono AVC count and number of oocytes retrieved. For all statistical tests, p<0.05 was considered significant.
RESULTS
A total of 46 patients and a total of 91 ovaries were studied, as there was one patient with single ovary. Mean duration of time with manual and SONO AVC are 209.2s and 156.6s respectively (p-0.01).
Fig-1 Sono AVC report
Mean of differences
95% C.I.
Kendall’s tau b coefficient
Error range
Intra class correlation
Total count of follicles(manual v/s 3-D)
-1.45
-1.94 to -0.95
-0.39 (p=0.00)
3.25
0.906
Leading follicle diameter(manual v/s 3-D mn.d)
-1.70
-2.2 to -1.20
-0.06 (p=0.40)
3.31
0.708
Leading follicle (manual v/s 3-d(V))
-0.09
-0.46 to -0.27
0.083 (p=0.24)
2.43
0.829
Table-1
Manual count of total number of follicles in comparison to Sono AVC total count of follicles>10mm was found to be lesser with a mean of difference of -1.45 and was found to be statistically significant. This simply means Sono AVC picks up more number of follicles. Most of our decision making in IVF cycles is based on leading follicle diameter. Leading follicle diameter measured manually is in agreement with volume based diameter d(V) as well as mean diameter measured on Sono AVC but correlates better with d(V)(mean of difference -0.09).
Fig –2 showing the good correlation between manual leading follicle diameter and Sono AVC values.
PEARSON CORRELATION (r)
P-VALUE
Manual count and oocyte retrieval
0.729
<0.001
3-D Sono AVC count and oocyte retrieval
0.688
<0.001
Table -2
The above table explains that both manual count and Sono AVC count of total number of follicles correlate well with the number of oocytes retrieved.
DISCUSSION
Sono AVC software definitely seems promising as a present and future of follicle tracking. There are many advantages with this technique. It saves on time for the busy practitioners. It is more objective and reproducible compared to manual measurements. It requires only a little bit of training to master the technique. It would be easier for senior consultants to ask the juniors or residents to do follicle tracking with this software. Subjective errors during measurement of follicle like re-measuring the same follicle or missing out on a follicle as it may be bigger in a different plane can be reduced with the 3-D technique.It provides a graphical record of the ovarian response which can be stored for follow-up in next IVF cycles. It is pictorial providing a colourful picture of the ovary representing follicles with different colours and it would be easy to counsel the patients with pictures. Patients can be told about the numbers of follicles either poorly responding or hyper responding so that they know as to what to expect from that cycle prior to the oocyte retrieval.Sono AVC can also be used to measure antral follicle count. In pregnancy, studies have reported the use of Sono AVC for the measurement of gestational sac volume, embryo volume, fetal stomach volume, fetal cardiac ventricle volume and neuro sonoembyology.1
Fig –3 Ovarian response shown as Normal, Hyper response and Poor response.
Sono AVC software is not completely fool proof as it has pitfalls. There are two important things to get a good report. One is prior to taking a 3-D sweep we need to ensure that the image obtained in 2-D plane is crisp with margins of follicles being clearly defined.Second, after taking a 3-D sweep, we need to select the area of interest i.e. the ovary completely in all three orthogonal planes. Sono AVC for follicle monitoring requires minimal post processing if a good 2-D image is obtained. If a good 2-D image is not obtained, then the procedure requires post processing, which makes it semi-automated. Post processing involves scrolling through the entire ovary to see if all the follicles have been included. Sometimes erroneously adjacent blood vessel, cyst, encysted collection is also picked up as follicle.So we need to do post- processing to add or remove follicles, cut or merge follicles or adjust the settings of growth or separation of two follicles. This consumes a bit of the time with Sono AVC, which otherwise provides results within seconds.The other most important disadvantage is the cost of the machine which would add on to the burden of the ART centre.
Fig- 4 showing pitfalls of Sono AVC requiring post-processing
Baris Ata et al reported a study of 100 women undergoing in-vitro fertilisation.Each follicle was measured manually as well as with the use of Sono-AVC. Both SonoAVC-generated mean follicle diameter, volume based diameter, follicle counts, as well as the leading follicle diameter had good agreement with conventional 2D US measurements. SonoAVC measurements had very good reproducibility, with intra-class correlation coefficient ≥0.8 for most evaluations.2
N.Raine-Fenning et al report a study of Sono AVC in 51 women undergoing in-vitro fertilisation. They made volume estimations of 224 follicles using Sono-AVC, VOCAL AND manually and measured the follicular aspirate volume during oocyte retrieval. Sono AVC provided highly accurate measurements in comparison to VOCAL and manual measurements.3The same group also report another prospective study of 89 subjects undergoing in-vitro fertilisation. The number of follicles and the mean diameter of follicles were measured both manually and with Sono AVC.There was no significant difference in the number of follicles with mean diameters >9 mm, >13 mm and >17 mm measured by either method. The total time taken for follicular measurements was significantly less (P < 0.01) for the automated 3D method (180.5 ± 63.6 versus 236.1 ± 57.1 s) which was associated with significantly less exposure to ultrasound (39.0 ± 6.0 versus 236.10 ± 57.1 s; P < 0.001).4
CONCLUSION
3-D Sono AVC is a useful adjunct in routine follicle monitoring, with significant reduction in time and correlates well with manual counts. Leading follicle diameter measured manually is in agreement with volume based diameter d(V) as well as mean diameter measured on Sono AVC but more so with d(V).It is a very good tool to counsel patients regarding ovarian response as it is pictorial and also serves to maintain graphical record of each cycle. Further research with larger sample size is required to further validate our study.
REFERENCES
1.Baris Ata, Togas Tulandi . Ultrasound automated volume calculation in reproduction and in pregnancy. Fertility and Sterility Vol. 95, No. 7, June 2011.
2.Baris Ata, Ayse Seyhan . Comparison of automated and manual follicle monitoring in an unrestricted population of 100 women undergoing controlled ovarian stimulation for IVF. Human Reproduction, Vol.0, No.0 pp. 1–7, 2010.
3.N. Raine-Fenning, K. Jayaprakasan . SonoAVC: a novel method of automatic volume calculation. Ultrasound Obstet Gynecol 2008; 31: 691–696.
5.Juan Luis Alcazar.The Use of Three dimensional Ultrasound in Gynecological patients. Donald School Journal of ultrasound in Obstetrics and Gynaecology. October- December 2008 ; 2(4) :10-16.
6.Sonal Panchal, Chaitanya Nagori. Comparison of anti-mullerian hormone and antral follicle count for assessment of ovarian reserve. J Hum Reprod Sci. 2012 Sep-Dec; 5(3): 274–278.
Fertility cycle or menstrual cycle is defined as the changes that occur naturally and regularly every month in a female reproductive system. Women who want to increase their chances of getting pregnancy are advised to track their fertile cycle on a regular basis. Tracking fertility cycle can benefit you to know your fertile window which determines the most fertile days of the month to conceive. The Fertile window comprises of 6 days, 4 days before ovulation, the day of ovulation, and one day after ovulation. The probability of getting pregnant increases by three times if intercourse occurs during these 6 days.
You can follow the below methods to track your fertility cycle, predict the day of ovulation and maximize your odds of getting pregnant naturally.
Tracking basal body temperature:
Basal body temperature (BBT) monitoring helps you to detect your patterns of ovulation. Record your body temperature every morning before you get out of bed or even before you drink anything. You will notice a rise in your BBT after ovulation occurs which is usually be the highest temperature during your fertile window. Noticing an increase in BBT will aid you to detect the day you ovulate exactly. You can use basal body temperature thermometer, to get accurate results.
Ovulation predictor kits (OPK):
Ovulation predictor kits help effectively to identify your timing of ovulation as well as peak fertility. You can use these kits at home to predict the exact day you ovulate. This test works by measuring the levels of luteinizing hormone (LH) in the urine. A positive urine test seen on the OPK predicts ovulation in next 12-48 hours.
Examine cervical mucus:
Spotting the regular changes in your cervical mucus is an effective and easy way to predict the precise day you ovulate. Cervical mucus becomes clear and stretchy, similar to a consistency of egg white, at the time of ovulation. The changes in the consistency help the sperm to travel faster inside the women’s body. On other days, the cervical mucus is usually opaque white in color.
Physical signs of ovulation:
Physical signs of ovulation are varied from woman to woman and month to month depending on one’s pattern of the menstrual cycle. These physical signs may include abdominal cramping, bloating, breast tenderness and light spotting(not all women will get this spotting).
Fertility cycle or menstrual cycle is defined as the changes that occur naturally and regularly every month in a female reproductive system. Women who want to increase their chances of getting pregnancy are advised to track their fertile cycle on a regular basis. Tracking fertility cycle can benefit you to know your fertile window which determines the most fertile days of the month to conceive. The Fertile window comprises of 6 days, 4 days before ovulation, the day of ovulation, and one day after ovulation. The probability of getting pregnant increases by three times if intercourse occurs during these 6 days.
You can follow the below methods to track your fertility cycle, predict the day of ovulation and maximize your odds of getting pregnant naturally.
Tracking basal body temperature:
Basal body temperature (BBT) monitoring helps you to detect your patterns of ovulation. Record your body temperature every morning before you get out of bed or even before you drink anything. You will notice a rise in your BBT after ovulation occurs which is usually be the highest temperature during your fertile window. Noticing an increase in BBT will aid you to detect the day you ovulate exactly. You can use basal body temperature thermometer, to get accurate results.
Ovulation predictor kits (OPK):
Ovulation predictor kits help effectively to identify your timing of ovulation as well as peak fertility. You can use these kits at home to predict the exact day you ovulate. This test works by measuring the levels of luteinizing hormone (LH) in the urine. A positive urine test seen on the OPK predicts ovulation in next 12-48 hours.
Examine cervical mucus:
Spotting the regular changes in your cervical mucus is an effective and easy way to predict the precise day you ovulate. Cervical mucus becomes clear and stretchy, similar to a consistency of egg white, at the time of ovulation. The changes in the consistency help the sperm to travel faster inside the women’s body. On other days, the cervical mucus is usually opaque white in color.
Physical signs of ovulation:
Physical signs of ovulation are varied from woman to woman and month to month depending on one’s pattern of the menstrual cycle. These physical signs may include abdominal cramping, bloating, breast tenderness and light spotting(not all women will get this spotting).
Fertile window refers to the period during which a woman can get pregnant during her menstrual cycle. This is the best time to have sex if trying to conceive. The Fertile window comprises of 6 days, 4 days before ovulation, the day of ovulation, and one day after ovulation. The probability of getting pregnant increases by three times if intercourse occurs during these 6 days.
How to calculate fertile window?
During ovulation, a woman may or may not notice the changes happening in the body. To know the signs one must get in touch with body and the changes occurring during ovulation. You may expect the changes three weeks before the next period starts in your body. Check for:
Increased vaginal excretions (wet and stretchy like egg white)may appear and are referred as fertile mucus.
Feeling discomfort or uneasiness on one side of your tummy.
Having increased sex drive
Usually, ovulation happens 12-14 days before you expect your next periods. Henceforth, the right timing of ovulation depends on the length of menstrual cycle. Calculate the length of the menstrual cycle by counting from the day you start bleeding during your periods to the preceding day before you start the next bleeding. The average menstrual cycle length is 28 days, but it may vary from woman to woman.
Does irregular period effect fertile window?
Some women may have regular menstrual periods. Irregular cycles do influence your fertile window and make it harder for you to decide the right time (exact day). Hence, it is important to have a regular check the cervical mucus after finishing your monthly periods. The cervical mucus changes its consistency to slippery and transparent form (exactly like egg white) at the time of ovulation. Women who are unaware of the fertile window are recommended to have sex often to optimize the chances of getting pregnant.
Fertile window refers to the period during which a woman can get pregnant during her menstrual cycle. This is the best time to have sex if trying to conceive. The Fertile window comprises of 6 days, 4 days before ovulation, the day of ovulation, and one day after ovulation. The probability of getting pregnant increases by three times if intercourse occurs during these 6 days.
How to calculate fertile window?
During ovulation, a woman may or may not notice the changes happening in the body. To know the signs one must get in touch with body and the changes occurring during ovulation. You may expect the changes three weeks before the next period starts in your body. Check for:
Increased vaginal excretions (wet and stretchy like egg white)may appear and are referred as fertile mucus.
Feeling discomfort or uneasiness on one side of your tummy.
Having increased sex drive
Usually, ovulation happens 12-14 days before you expect your next periods. Henceforth, the right timing of ovulation depends on the length of menstrual cycle. Calculate the length of the menstrual cycle by counting from the day you start bleeding during your periods to the preceding day before you start the next bleeding. The average menstrual cycle length is 28 days, but it may vary from woman to woman.
Does irregular period effect fertile window?
Some women may have regular menstrual periods. Irregular cycles do influence your fertile window and make it harder for you to decide the right time (exact day). Hence, it is important to have a regular check the cervical mucus after finishing your monthly periods. The cervical mucus changes its consistency to slippery and transparent form (exactly like egg white) at the time of ovulation. Women who are unaware of the fertile window are recommended to have sex often to optimize the chances of getting pregnant.
Fertile window refers to the period during which a woman c...
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Infertility is not always a woman’s problem there is also infertility in male & female both. Among couples that seek medical treatment, 20% conceive before the treatment actually begins and 50% conceive within two years from starting treatment. Studies show that anxiety may be one of the reasons contributing to the fertility problem, so contacting a doctor and counseling helps.
Studies show that in 32% of cases the problems are associated in the male partner and in 32% of cases, the causes are associated with the female partner. 17% of cases relate to both male & female partner and in 19% of cases the reasons are unexplained.
Male infertility is extremely complex to diagnose and cure. It is also tough to recognize at the early stage. Male fertility problems are majorly caused by abnormalities in sperm numbers, movement or shape. This problem can be evaluated by a semen analysis although the causes of many sperm problems is unknown.
Male Infertility Causes
Failed vasectomy reversal
Blocked ducts: Problems with tubes carrying sperm
Autoimmune disorders
Varicocele: A condition that can lead to decreased sperm production and quality
Problems getting an erection or ejaculating
Genetic problem or undescended testes in childhood
Medical conditions such as infection ,diabetes, trauma, testicular failure or treatment with chemotherapy/radiation
Absence of vas deferens
Female infertility: Apart from being easier to understand as in majority of cases, in female infertility the problem is known. Female fertility problems commonly include:
Female Infertility Causes
Endometriosis: A condition that occurs when the tissue lining the uterus begins to grow outside it
Age: Studies show that female fertility declines sharply after the age of 35
Gynaecological problems such as ectopic pregnancy or frequent miscarriage
Hormonal problems or medical conditions such as diabetes, thyroid or eplapsy
Autoimmune disorders
Recurrent genito-urinary infections
Unexplained infertility:
19% of couples will have no reasonable cause for their infertility, including those experiencing secondary fertility. This happens when a couple goes through all the testing available & everything comes back clear. In the case of unexplained infertility it can be hard to figure out what to do next. Sometimes it could be as simple as a nutritional deficiency, inaccurate timing of sexual intercourse, low cervical mucous, or a pre-existing health issue. In such cases, it is important to cover all the basic and additional testing.
When should couples seek help?
A normal fertile couple in their 20’s have on average a 25% chance of conceiving each month. If you’ve had more than a year of regular unprotected sexual relationship and you haven’t achieved pregnancy, it’s best to seek help. If not, a good strategy is to plan to have sexual relationship during the days the woman is ovulating. The fertile window is the six days that ends on the day of ovulation. Pregnancy is most likely to occur with intercourse within the 3 days before ovulation. (Ovulation occurs around 14 days before the menstrual period is due)
However, it is advisable to seek help early if you experience any of the below factors
Women with irregular periods (a sign that ovulation may not be occurring;
Women over 35 years of age. (Female age is one of the most important predictors of whether pregnancy will be achieved)
Women who have had pelvic surgery or pelvic infection which may have damaged fallopian tubes;
Women with known reproductive pathology such as endometriosis, fibroids, PCOS, thyroid disorders and genetic conditions
Recurrent miscarriages
Men who have had genital surgery, infection or significant trauma.
If case of the following sperm issues such as poor sperm morphology (abnormally shaped); poor motility (slow-moving); low sperm count; the presence of anti-sperm antibodies; ejaculatory problems or azoospermia (no sperm present); vasectomy
A woman’s ability to conceive a child reduces with age. The younger you are the higher your chances of success. Hence it is advisable to seek medical help at the earliest
Apollo Fertility offers several specialized procedures to investigate infertility in men and women. It is advisable for the both the partners to come for the first visit and get infertility testing. During the first visit, a detailed history and previous reports are reviewed.
Your journey begins with a few blood tests to understand you and your body so that we can personalize your treatment. You will have a full medical history to understand and design the best pathway for you.
*Your options will be explained to you. Less invasive treatments will always be tried first. If unsuccessful, we have the expertise and technology to increase your chances of getting pregnant.
Infertility is not always a woman’s problem there is also infertility in male & female both. Among couples that seek medical treatment, 20% conceive before the treatment actually begins and 50% conceive within two years from starting treatment. Studies show that anxiety may be one of the reasons contributing to the fertility problem, so contacting a doctor and counseling helps.
Studies show that in 32% of cases the problems are associated in the male partner and in 32% of cases, the causes are associated with the female partner. 17% of cases relate to both male & female partner and in 19% of cases the reasons are unexplained.
Male infertility is extremely complex to diagnose and cure. It is also tough to recognize at the early stage. Male fertility problems are majorly caused by abnormalities in sperm numbers, movement or shape. This problem can be evaluated by a semen analysis although the causes of many sperm problems is unknown.
Male Infertility Causes
Failed vasectomy reversal
Blocked ducts: Problems with tubes carrying sperm
Autoimmune disorders
Varicocele: A condition that can lead to decreased sperm production and quality
Problems getting an erection or ejaculating
Genetic problem or undescended testes in childhood
Medical conditions such as infection ,diabetes, trauma, testicular failure or treatment with chemotherapy/radiation
Absence of vas deferens
Female infertility: Apart from being easier to understand as in majority of cases, in female infertility the problem is known. Female fertility problems commonly include:
Female Infertility Causes
Endometriosis: A condition that occurs when the tissue lining the uterus begins to grow outside it
Age: Studies show that female fertility declines sharply after the age of 35
Gynaecological problems such as ectopic pregnancy or frequent miscarriage
Hormonal problems or medical conditions such as diabetes, thyroid or eplapsy
Autoimmune disorders
Recurrent genito-urinary infections
Unexplained infertility:
19% of couples will have no reasonable cause for their infertility, including those experiencing secondary fertility. This happens when a couple goes through all the testing available & everything comes back clear. In the case of unexplained infertility it can be hard to figure out what to do next. Sometimes it could be as simple as a nutritional deficiency, inaccurate timing of sexual intercourse, low cervical mucous, or a pre-existing health issue. In such cases, it is important to cover all the basic and additional testing.
When should couples seek help?
A normal fertile couple in their 20’s have on average a 25% chance of conceiving each month. If you’ve had more than a year of regular unprotected sexual relationship and you haven’t achieved pregnancy, it’s best to seek help. If not, a good strategy is to plan to have sexual relationship during the days the woman is ovulating. The fertile window is the six days that ends on the day of ovulation. Pregnancy is most likely to occur with intercourse within the 3 days before ovulation. (Ovulation occurs around 14 days before the menstrual period is due)
However, it is advisable to seek help early if you experience any of the below factors
Women with irregular periods (a sign that ovulation may not be occurring;
Women over 35 years of age. (Female age is one of the most important predictors of whether pregnancy will be achieved)
Women who have had pelvic surgery or pelvic infection which may have damaged fallopian tubes;
Women with known reproductive pathology such as endometriosis, fibroids, PCOS, thyroid disorders and genetic conditions
Recurrent miscarriages
Men who have had genital surgery, infection or significant trauma.
If case of the following sperm issues such as poor sperm morphology (abnormally shaped); poor motility (slow-moving); low sperm count; the presence of anti-sperm antibodies; ejaculatory problems or azoospermia (no sperm present); vasectomy
A woman’s ability to conceive a child reduces with age. The younger you are the higher your chances of success. Hence it is advisable to seek medical help at the earliest
Apollo Fertility offers several specialized procedures to investigate infertility in men and women. It is advisable for the both the partners to come for the first visit and get infertility testing. During the first visit, a detailed history and previous reports are reviewed.
Your journey begins with a few blood tests to understand you and your body so that we can personalize your treatment. You will have a full medical history to understand and design the best pathway for you.
*Your options will be explained to you. Less invasive treatments will always be tried first. If unsuccessful, we have the expertise and technology to increase your chances of getting pregnant.
Infertility is not always a woman’s problem there is also infe...
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It takes two to create a baby. If your sperm is not strong or healthy enough to reach or penetrate the egg, there will be no fertilisation process, and hence your partner will not be able to conceive. Some problems, ranging from genetics and hormonal factors to lifestyle and environmental exposures may cause issues in terms of fertility in men.
You must have and maintain an erection, possess the adequate amount of sperm that moves in the correct way and has good sperm quality to fertilize the egg off your partner. It takes just one sperm to fertilize the egg but any factor that affects any of the above can result in infertility. If you have been trying to get pregnant for a long time without success, it’s time you make a few lifestyle changes. Mentioned below are seven tips to boost male fertility:
1.Stay fit and lose those extra pounds
It is very important to exercise, stay fit and aim for a healthy weight to increase your fertility. A recent study has concluded that men who are overweight or obese not only have a decreased sperm count but also decreased quality. Having a high BMI can decrease your sperm’s ability to swim and damages the DNA i.e. the genetic material present in your sperm. Researchers also believe that excessive body fat can cause changes in and reduce the reproductive hormone levels such as the testosterone level, causing infertility in men.
2.Abstain from smoking
Smoking hurts your health. Another reason to kick this habit is because it also affects your fertility. Smoking is terrible for your sperm quality as it results in low sperm count, a decrease in sperm movement and affects sperm quality. According to recent studies, the sperm’s ability to fertilise a woman’s egg also decreases if you smoke.
3.Reduce your alcohol intake
Research proves that too much alcohol increases male infertility as it decreases sperm motility (i.e. the ability of your sperm to move properly), affects sperm quality and reduces your sperm count. It is also advisable to quit drinking if you are undergoing IVF treatment since it increases the risk of stillbirth.
4.Add antioxidants to your diet
Apart from fighting heart diseases and cancer, antioxidants also increase fertility in men. There was a huge reduction in DNA damaged sperms in those men who consumed antioxidants in their diet according to a recent study. The antioxidants mentioned below are especially noticed to improve sperm quality and should be a part of your daily diet:
Zinc- oysters, crabs, red meat, beans
Vitamin C- papaya, berries, citrus fruits
Selenium- tuna, chicken, cod, beef
5. Frequent sex and ejaculation
Having a happy relationship with frequent and happy sex can work wonders in causing you to relax and remove the element of infertility related to stress and anxiety.
6.Avoid a chemically toxic environment
It is very important to avoid a toxic environment since it increases male infertility. Farmers exposed to pesticides, and those exposed to varnishes and paints are prone to fertility complications such as lower sperm count due to their exposure to chemicals. Wear gloves or a mask and keep your body covered from toxic chemicals if you happen to work or live in such an environment.
7.Keep things cool
You need to keep your genitals cool as higher temperatures are known to affect your sperm resulting issues in terms of fertility in men. Avoid frequent and prolonged hot baths or working for long hours with the laptop in your lap can cause this effect. Also, wear breathable clothes and switch to boxers from briefs.
However, sometimes despite doing all you can to increase your fertility levels, problems may persist. In such cases, visiting a fertility specialist can be of great help as he or she can guide you and offer you the correct diagnosis for the specific problem you face.
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It takes two to create a baby. If your sperm is not strong or healthy enough to reach or penetrate the egg, there will be no fertilisation process, and hence your partner will not be able to conceive. Some problems, ranging from genetics and hormonal factors to lifestyle and environmental exposures may cause issues in terms of fertility in men.
You must have and maintain an erection, possess the adequate amount of sperm that moves in the correct way and has good sperm quality to fertilize the egg off your partner. It takes just one sperm to fertilize the egg but any factor that affects any of the above can result in infertility. If you have been trying to get pregnant for a long time without success, it’s time you make a few lifestyle changes. Mentioned below are seven tips to boost male fertility:
1.Stay fit and lose those extra pounds
It is very important to exercise, stay fit and aim for a healthy weight to increase your fertility. A recent study has concluded that men who are overweight or obese not only have a decreased sperm count but also decreased quality. Having a high BMI can decrease your sperm’s ability to swim and damages the DNA i.e. the genetic material present in your sperm. Researchers also believe that excessive body fat can cause changes in and reduce the reproductive hormone levels such as the testosterone level, causing infertility in men.
2.Abstain from smoking
Smoking hurts your health. Another reason to kick this habit is because it also affects your fertility. Smoking is terrible for your sperm quality as it results in low sperm count, a decrease in sperm movement and affects sperm quality. According to recent studies, the sperm’s ability to fertilise a woman’s egg also decreases if you smoke.
3.Reduce your alcohol intake
Research proves that too much alcohol increases male infertility as it decreases sperm motility (i.e. the ability of your sperm to move properly), affects sperm quality and reduces your sperm count. It is also advisable to quit drinking if you are undergoing IVF treatment since it increases the risk of stillbirth.
4.Add antioxidants to your diet
Apart from fighting heart diseases and cancer, antioxidants also increase fertility in men. There was a huge reduction in DNA damaged sperms in those men who consumed antioxidants in their diet according to a recent study. The antioxidants mentioned below are especially noticed to improve sperm quality and should be a part of your daily diet:
Zinc- oysters, crabs, red meat, beans
Vitamin C- papaya, berries, citrus fruits
Selenium- tuna, chicken, cod, beef
5. Frequent sex and ejaculation
Having a happy relationship with frequent and happy sex can work wonders in causing you to relax and remove the element of infertility related to stress and anxiety.
6.Avoid a chemically toxic environment
It is very important to avoid a toxic environment since it increases male infertility. Farmers exposed to pesticides, and those exposed to varnishes and paints are prone to fertility complications such as lower sperm count due to their exposure to chemicals. Wear gloves or a mask and keep your body covered from toxic chemicals if you happen to work or live in such an environment.
7.Keep things cool
You need to keep your genitals cool as higher temperatures are known to affect your sperm resulting issues in terms of fertility in men. Avoid frequent and prolonged hot baths or working for long hours with the laptop in your lap can cause this effect. Also, wear breathable clothes and switch to boxers from briefs.
However, sometimes despite doing all you can to increase your fertility levels, problems may persist. In such cases, visiting a fertility specialist can be of great help as he or she can guide you and offer you the correct diagnosis for the specific problem you face.
It takes two to create a baby. If your sperm is not strong or health...
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The inability of couples to conceive or become pregnant is a problem that is raising its ugly head far too much in the near past and present. The percentage of couples facing infertility is growing by the day. Infertility in men is defined as the inability to conceive after a year of regular intercourse without use of contraceptives.
Earlier, infertility was considered to be a women-centric however problem, Studies have shown that in 32% of cases there are problems associated with the male partner, in 32% of cases the causes are related to the female partner, there are causes attributable with both in 17% of cases and in 19% of cases the reasons are unexplained. Ways to prevent infertility in men include:
Concentrate on a healthy lifestyle: Low sperm count is associated with some factors like heavy smoking, excessive consumption of alcohol, drug abuse, etc. Quit your addictions to improve your Avoid prolonged hot baths and wearing tight fitting undergarments as heat can lower your sperm count.
Reduce your chemical exposure: Chemical exposure such as to work related chemicals can cause damage to your sperm count and quality.
Improve your diet: Include fresh fruits, whole grains, legumes and foods rich in antioxidants in your daily diet to boost your fertility. Cut down on refined carbohydrates and foods containing artificial additives. Maintain an ideal body weight as obesity is associated with loss of libido and infertility. Exercise regularly to stay healthy.
Take nutritional supplements
Fertility enhancing supplements include zinc and folic acid may improve sperm count. However, further studies are needed to understand how these micronutrients work together.
Male infertility is not uncommon and neither is it a cause of embarrassment or shame. It is something that can affect anyone. Any investigation into failure to conceive always starts with counseling the couple and understanding the cause. If for you, the cause is related to the male partner, consult a specialist who will be able to treat you is the cause can be determined.
The inability of couples to conceive or become pregnant is a problem that is raising its ugly head far too much in the near past and present. The percentage of couples facing infertility is growing by the day. Infertility in men is defined as the inability to conceive after a year of regular intercourse without use of contraceptives.
Earlier, infertility was considered to be a women-centric however problem, Studies have shown that in 32% of cases there are problems associated with the male partner, in 32% of cases the causes are related to the female partner, there are causes attributable with both in 17% of cases and in 19% of cases the reasons are unexplained. Ways to prevent infertility in men include:
Concentrate on a healthy lifestyle: Low sperm count is associated with some factors like heavy smoking, excessive consumption of alcohol, drug abuse, etc. Quit your addictions to improve your Avoid prolonged hot baths and wearing tight fitting undergarments as heat can lower your sperm count.
Reduce your chemical exposure: Chemical exposure such as to work related chemicals can cause damage to your sperm count and quality.
Improve your diet: Include fresh fruits, whole grains, legumes and foods rich in antioxidants in your daily diet to boost your fertility. Cut down on refined carbohydrates and foods containing artificial additives. Maintain an ideal body weight as obesity is associated with loss of libido and infertility. Exercise regularly to stay healthy.
Take nutritional supplements
Fertility enhancing supplements include zinc and folic acid may improve sperm count. However, further studies are needed to understand how these micronutrients work together.
Male infertility is not uncommon and neither is it a cause of embarrassment or shame. It is something that can affect anyone. Any investigation into failure to conceive always starts with counseling the couple and understanding the cause. If for you, the cause is related to the male partner, consult a specialist who will be able to treat you is the cause can be determined.
The continuation of life is a natural instinct for any organism. This is probably why you hear so many myths about fertility. Some of these are rooted in scientific facts, while others are quite ridiculous. The myths about both male and female fertility are very common and may cause undue concern and problems. Here are the top 6 fertility myths debunked:
You cannot get pregnant after the age of 35
As menopause approaches, infertility does decline because the female is born with all the eggs that she will have. The quantity and quality of the eggs declines after the age of 35 and dramatically after 40. The truth is that it does get difficult to conceive after the age of forty, but women between the ages of 35 and 39 do conceive even without the help of assisted reproductive technology.
Getting pregnant can be difficult or delayed if you used to take birth control pills
This is a widespread myth but entirely baseless. There is no delay in pregnancy that is caused by having used birth control medication. Once you stop taking the pill, your body resumes its natural hormonal cycles within a few weeks, and it is highly unlikely that you will experience problems with ovulation. The birth control medication is formulated in such a way that it has no lasting impact on your fertility or your body in any manner.
Good health and exercise can help you get pregnant even at an older age
A healthy lifestyle is helpful for conception, but it has its limits. Your ovarian reserve is the be all and the end all when it comes to getting pregnant and after the age of 40, your chances of conceiving dramatically reduce. Peak fertility for a woman is in her early to late 20s and starts to decline in her early 30s.
Your family history determines your fertility
Genetics is not often seen to affect fertility. If there is a history of infertility in your family, there is no medical reason to assume that is will extends to you. Also, you may experience delays and difficulties in conceiving even if you have already been pregnant or even given birth, before.
Men are fertile for as long as they can ejaculate
Men also experience fertility problems after the age of 40. Even if you have fathered a baby before, there is hardly any guarantee that you can again at an older age. This is because the production of semen with good sperm quality and numbers drops after 40. Furthermore, for men at an older age, the chances of developmental problems increases in the child.
Alcohol can cause infertility only in women
Excessive drinking does lead to irregularity in ovulation cycles in females, and so reduces your chances of conceiving every month, but it is not true that male fertility remains entirely unaffected by this habit. Alcohol can also have adverse effects on the process of sperm production and also affects the levels of the male sex hormone, testosterone.
There are some lifestyle factors which affect fertility. For example, smoking affects fertility in both genders. Even high quantities of caffeine should be avoided if you are trying to get pregnant. However, if the infertility is associated with a treatable cause it may be reversed. So, it is best to consult a doctor who specialises in gynaecological problems instead of relying on myths.
The continuation of life is a natural instinct for any organism. This is probably why you hear so many myths about fertility. Some of these are rooted in scientific facts, while others are quite ridiculous. The myths about both male and female fertility are very common and may cause undue concern and problems. Here are the top 6 fertility myths debunked:
You cannot get pregnant after the age of 35
As menopause approaches, infertility does decline because the female is born with all the eggs that she will have. The quantity and quality of the eggs declines after the age of 35 and dramatically after 40. The truth is that it does get difficult to conceive after the age of forty, but women between the ages of 35 and 39 do conceive even without the help of assisted reproductive technology.
Getting pregnant can be difficult or delayed if you used to take birth control pills
This is a widespread myth but entirely baseless. There is no delay in pregnancy that is caused by having used birth control medication. Once you stop taking the pill, your body resumes its natural hormonal cycles within a few weeks, and it is highly unlikely that you will experience problems with ovulation. The birth control medication is formulated in such a way that it has no lasting impact on your fertility or your body in any manner.
Good health and exercise can help you get pregnant even at an older age
A healthy lifestyle is helpful for conception, but it has its limits. Your ovarian reserve is the be all and the end all when it comes to getting pregnant and after the age of 40, your chances of conceiving dramatically reduce. Peak fertility for a woman is in her early to late 20s and starts to decline in her early 30s.
Your family history determines your fertility
Genetics is not often seen to affect fertility. If there is a history of infertility in your family, there is no medical reason to assume that is will extends to you. Also, you may experience delays and difficulties in conceiving even if you have already been pregnant or even given birth, before.
Men are fertile for as long as they can ejaculate
Men also experience fertility problems after the age of 40. Even if you have fathered a baby before, there is hardly any guarantee that you can again at an older age. This is because the production of semen with good sperm quality and numbers drops after 40. Furthermore, for men at an older age, the chances of developmental problems increases in the child.
Alcohol can cause infertility only in women
Excessive drinking does lead to irregularity in ovulation cycles in females, and so reduces your chances of conceiving every month, but it is not true that male fertility remains entirely unaffected by this habit. Alcohol can also have adverse effects on the process of sperm production and also affects the levels of the male sex hormone, testosterone.
There are some lifestyle factors which affect fertility. For example, smoking affects fertility in both genders. Even high quantities of caffeine should be avoided if you are trying to get pregnant. However, if the infertility is associated with a treatable cause it may be reversed. So, it is best to consult a doctor who specialises in gynaecological problems instead of relying on myths.
The continuation of life is a natural instinct for any organism. Thi...
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In-vitro Fertilization (IVF) is an effective method to conceive a child if you are facing unexplained infertility. In this method, your egg is fertilised with your partner’s sperm outside your womb in a petri dish. IVF can be a lengthy process if you opt to go for it and it’s only important that you have a fair idea of its various stages.
The various stages of an IVF Treatment
The IVF treatment tends to vary from couple to couple, depending on the kind of problem you are facing. Before the treatment commences, your doctor will recommend certain important blood tests to ensure that you are not suffering from fatal conditions like HIV (Human Immunodeficiency Virus), Hepatitis B and C.
After the tests are done, the real process of IVF will start, and its stages are-
If you’re a woman, you’ll have to go through these:
Your monthly cycle is first suppressed- A two-week drug treatment is offered to suppress your monthly cycle. The medicine is administered to you in the form of an injection or nasal spray.
Your egg supply is given a boost- After the first stage is completed, you are recommended a fertility hormone called gonadotropin. You have to take this hormone for 12 days, and it effectively increases your egg production.
General progress is recorded- During the period of drug treatment, your body’s acceptance of the hormones will be monitored through ultrasound and blood tests. About 34-38 hours before the collection of your eggs, a hormone called chorionic gonadotropin would be administered. This hormone will help your eggs mature.
Your eggs will then be collected- Your eggs are collected with the help of A needle attached to the ultrasound probe collects your eggs from your ovary. You can experience certain side effects after the collection of your eggs such as slight vaginal bleeding and cramps. After this procedure, you are administered medication, which prepares your womb for the transfer of the embryo.
Fertilisation of your eggs- The collected eggs are then mixed with your partner’s sperm and cultured for about 16 to 20 hours. After this process, your eggs are checked for signs of success. The fertilised eggs or the embryos are then transferred to the laboratory incubator where they are grown for the next six During this period, your embryos are carefully monitored, after which the best is then chosen to be transferred into your womb. The remaining embryos, if any, which are suitable for transfer, are stored and frozen for use in the future.
Transfer of the embryo- 1 or 2 embryos will be transferred to your womb if you are 40 years of age. A total of 3 embryos will be transferred to your womb in case you are above 40. Most clinics recommended a single embryo transfer (SET) to reduce your risk of multiple births. Although, you may experience some discomfort during this procedure, the transfer is quite pain-free and does not require any sedation.
If you’re a man, these are the stages you’ll have to go through:
During the time your partner’s eggs are being collected, you are asked to present a sperm sample.
Your sperm is then washed and segregated. Only the normal and most active sperm is chosen for fertilisation.
In case you have stored your sperm, it is removed from the storage and allowed to thaw, after which it is prepared in the same way as mentioned above.
Generally, as a couple, you’ll have to make about 2-3 attempts at IVF to achieve any success. Infertility can be quiet disappointing, which is why both of you should consult an IVF specialist before opting for this method. An IVF treatment will give you a well-deserved chance at parenthood.
In-vitro Fertilization (IVF) is an effective method to conceive a child if you are facing unexplained infertility. In this method, your egg is fertilised with your partner’s sperm outside your womb in a petri dish. IVF can be a lengthy process if you opt to go for it and it’s only important that you have a fair idea of its various stages.
The various stages of an IVF Treatment
The IVF treatment tends to vary from couple to couple, depending on the kind of problem you are facing. Before the treatment commences, your doctor will recommend certain important blood tests to ensure that you are not suffering from fatal conditions like HIV (Human Immunodeficiency Virus), Hepatitis B and C.
After the tests are done, the real process of IVF will start, and its stages are-
If you’re a woman, you’ll have to go through these:
Your monthly cycle is first suppressed- A two-week drug treatment is offered to suppress your monthly cycle. The medicine is administered to you in the form of an injection or nasal spray.
Your egg supply is given a boost- After the first stage is completed, you are recommended a fertility hormone called gonadotropin. You have to take this hormone for 12 days, and it effectively increases your egg production.
General progress is recorded- During the period of drug treatment, your body’s acceptance of the hormones will be monitored through ultrasound and blood tests. About 34-38 hours before the collection of your eggs, a hormone called chorionic gonadotropin would be administered. This hormone will help your eggs mature.
Your eggs will then be collected- Your eggs are collected with the help of A needle attached to the ultrasound probe collects your eggs from your ovary. You can experience certain side effects after the collection of your eggs such as slight vaginal bleeding and cramps. After this procedure, you are administered medication, which prepares your womb for the transfer of the embryo.
Fertilisation of your eggs- The collected eggs are then mixed with your partner’s sperm and cultured for about 16 to 20 hours. After this process, your eggs are checked for signs of success. The fertilised eggs or the embryos are then transferred to the laboratory incubator where they are grown for the next six During this period, your embryos are carefully monitored, after which the best is then chosen to be transferred into your womb. The remaining embryos, if any, which are suitable for transfer, are stored and frozen for use in the future.
Transfer of the embryo- 1 or 2 embryos will be transferred to your womb if you are 40 years of age. A total of 3 embryos will be transferred to your womb in case you are above 40. Most clinics recommended a single embryo transfer (SET) to reduce your risk of multiple births. Although, you may experience some discomfort during this procedure, the transfer is quite pain-free and does not require any sedation.
If you’re a man, these are the stages you’ll have to go through:
During the time your partner’s eggs are being collected, you are asked to present a sperm sample.
Your sperm is then washed and segregated. Only the normal and most active sperm is chosen for fertilisation.
In case you have stored your sperm, it is removed from the storage and allowed to thaw, after which it is prepared in the same way as mentioned above.
Generally, as a couple, you’ll have to make about 2-3 attempts at IVF to achieve any success. Infertility can be quiet disappointing, which is why both of you should consult an IVF specialist before opting for this method. An IVF treatment will give you a well-deserved chance at parenthood.
IVF stands for in vitro fertilisation. The basic process starts by removing your egg cells from your body and also taking sperm cells from your partner or a sperm donor. Your egg cells are fertilised in a laboratory after which your embryo is placed into either your uterus or a surrogate mother’s uterus. The decision on whether to use a surrogate mother or not is taken based on your chances of getting pregnant. For example, if you have uterine fibroids, a surrogate mother may be used as your chances of getting pregnant are reduced. But before you get into that, it is vital to know the four main steps of the IVF process. Here they are:
Inducing ovulation
In this first step, your ovaries are monitored to learn about when your egg releases. After this, medicine is given in the form of either an injection or a nasal spray, which suppresses your natural menstrual cycle. This is done so that inducing ovulation becomes easier. Ovulation is usually induced by giving FSH. FSH stands for follicle stimulating hormone and is given as a daily injection for about 10-12 days. The reason FSH has to be given to induce ovulation is that many times your natural menstrual cycle produces an egg, which cannot be fertilised, and therefore, more egg cells are needed to increase the chances of fertilisation.
Egg retrieval
In this step of the IVF process, the first thing done is to give anaesthesia. The anaesthesia is given so that when a thin needle is passed through your upper vaginal wall, no pain is felt. The needle is passed through your upper vaginal wall using ultrasound so that fluid is extracted from your follicles. This is done to help in isolating your egg cells. Once the egg cell has been isolated from the follicular fluid, it will be placed in a laboratory dish, which will contain nutrient media to keep your egg cell healthy. The egg retrieval process is complete when the egg cell is transferred to the incubator.
Fertilization
In this step, the sperm is mixed with your egg cells. After about 16-20 hours, it is seen whether the egg cells are fertilised or not. Sometimes ICSI, which stands for intra-cytoplasmic sperm injection and is a process in which each sperm cell is directly injected into the egg cell. After fertilisation, there is another six day wait before the eggs are transferred into the womb of either yourself or a surrogate mother. If you choose not to have a surrogate mother, you will be injected with hormones, which will prepare the lining of the womb to receive the embryo. These hormones are usually given as either an injection or a gel.
Embryo transfer and implantation
This stage of the process is much simpler and less painful than the egg retrieval part of the IVF process and can be accomplished using a surrogate mother. A thin tube, which is called a catheter, is passed into your vagina using which your embryos are transferred into your womb.
Irrespective of the problems you have while trying to conceiving a baby naturally, IVF does present a reasonably good chance of giving birth to 29.4% who achieve pregnancy in the IVF process, and 22.4% of women give natural births successfully after pregnancy. Therefore, it is vital to consult your gynaecologist or IVF specialist in this regard.
IVF stands for in vitro fertilisation. The basic process starts by removing your egg cells from your body and also taking sperm cells from your partner or a sperm donor. Your egg cells are fertilised in a laboratory after which your embryo is placed into either your uterus or a surrogate mother’s uterus. The decision on whether to use a surrogate mother or not is taken based on your chances of getting pregnant. For example, if you have uterine fibroids, a surrogate mother may be used as your chances of getting pregnant are reduced. But before you get into that, it is vital to know the four main steps of the IVF process. Here they are:
Inducing ovulation
In this first step, your ovaries are monitored to learn about when your egg releases. After this, medicine is given in the form of either an injection or a nasal spray, which suppresses your natural menstrual cycle. This is done so that inducing ovulation becomes easier. Ovulation is usually induced by giving FSH. FSH stands for follicle stimulating hormone and is given as a daily injection for about 10-12 days. The reason FSH has to be given to induce ovulation is that many times your natural menstrual cycle produces an egg, which cannot be fertilised, and therefore, more egg cells are needed to increase the chances of fertilisation.
Egg retrieval
In this step of the IVF process, the first thing done is to give anaesthesia. The anaesthesia is given so that when a thin needle is passed through your upper vaginal wall, no pain is felt. The needle is passed through your upper vaginal wall using ultrasound so that fluid is extracted from your follicles. This is done to help in isolating your egg cells. Once the egg cell has been isolated from the follicular fluid, it will be placed in a laboratory dish, which will contain nutrient media to keep your egg cell healthy. The egg retrieval process is complete when the egg cell is transferred to the incubator.
Fertilization
In this step, the sperm is mixed with your egg cells. After about 16-20 hours, it is seen whether the egg cells are fertilised or not. Sometimes ICSI, which stands for intra-cytoplasmic sperm injection and is a process in which each sperm cell is directly injected into the egg cell. After fertilisation, there is another six day wait before the eggs are transferred into the womb of either yourself or a surrogate mother. If you choose not to have a surrogate mother, you will be injected with hormones, which will prepare the lining of the womb to receive the embryo. These hormones are usually given as either an injection or a gel.
Embryo transfer and implantation
This stage of the process is much simpler and less painful than the egg retrieval part of the IVF process and can be accomplished using a surrogate mother. A thin tube, which is called a catheter, is passed into your vagina using which your embryos are transferred into your womb.
Irrespective of the problems you have while trying to conceiving a baby naturally, IVF does present a reasonably good chance of giving birth to 29.4% who achieve pregnancy in the IVF process, and 22.4% of women give natural births successfully after pregnancy. Therefore, it is vital to consult your gynaecologist or IVF specialist in this regard.
Sedentary lifestyle and unhealthy food habits can take a toll on your fertility. Hectic work schedules combined with an unhealthy diet is among the leading causes of infertility among both men and women. Cut down on your unhealthy habits and start maintaining a proper lifestyle so that your reproductive health is not compromised and you can conceive successfully when you wish to. You can start by making simple changes in your daily activities. These will surely go a long way in boosting your fertility.
Here’s what you, as a woman can do to boost your fertility:
Maintain a healthy diet:
It goes without saying that what you eat has a direct impact on your well-being; so make sure you eat balanced and nourishing meals. Your diet should contain enough of proteins and foods rich in iron, zinc and vitamins to boost your fertility. Consult your doctor if you think you require multivitamin tablets to supplement your diet.
Keep a check on your weight:
if you plan on getting pregnant, it is of utmost importance to maintain your ideal body weight. Apart from the other complications, being overweight and very underweight is known to affect your ability to conceive. You can consult your doctor and follow an exercise regime to keep yourself fit.
Avoid smoking and drinking:
Excessive smoking is linked to premature ageing of your ovaries and damage to your eggs. You can stop these effects of smoking by simply quitting and leading a healthier lifestyle. It is also observed that excessive consumption of alcohol can cause complications such as Fetal Alcohol Syndrome (a group of conditions that indicate problems with your baby’s development) when you’re pregnant. There is no safe level of alcohol so if you are trying to get pregnant, you should give up alcohol completely.
Here’s what you, as a man, can do to increase your fertility:
Concentrate on a healthy lifestyle:
Low sperm count is associated with some factors like heavy smoking, excessive consumption of alcohol, drug abuse, etc. Quit your addictions to improve your Avoid prolonged hot baths and wearing tight fitting undergarments as heat can lower your sperm count.
Reduce your chemical exposure:
Chemical exposure such as to work related chemicals can cause damage to your sperm count and quality.
Improve your diet:
Include fresh fruits, whole grains, legumes and foods rich in antioxidants in your daily diet to boost your fertility. Cut down on refined carbohydrates and foods containing artificial additives. Maintain an ideal body weight as obesity is associated with loss of libido and infertility. Exercise regularly to stay healthy.
You would see a lot of difference by making these simple changes in your daily life. Following these recommendations will not only increase your fertility but will also improve your sexual health to a great extent. You can also consult your doctor from time to time in case you think you require health supplements or need to follow a particular diet and exercise regime to increase your fertility.
Sedentary lifestyle and unhealthy food habits can take a toll on your fertility. Hectic work schedules combined with an unhealthy diet is among the leading causes of infertility among both men and women. Cut down on your unhealthy habits and start maintaining a proper lifestyle so that your reproductive health is not compromised and you can conceive successfully when you wish to. You can start by making simple changes in your daily activities. These will surely go a long way in boosting your fertility.
Here’s what you, as a woman can do to boost your fertility:
Maintain a healthy diet:
It goes without saying that what you eat has a direct impact on your well-being; so make sure you eat balanced and nourishing meals. Your diet should contain enough of proteins and foods rich in iron, zinc and vitamins to boost your fertility. Consult your doctor if you think you require multivitamin tablets to supplement your diet.
Keep a check on your weight:
if you plan on getting pregnant, it is of utmost importance to maintain your ideal body weight. Apart from the other complications, being overweight and very underweight is known to affect your ability to conceive. You can consult your doctor and follow an exercise regime to keep yourself fit.
Avoid smoking and drinking:
Excessive smoking is linked to premature ageing of your ovaries and damage to your eggs. You can stop these effects of smoking by simply quitting and leading a healthier lifestyle. It is also observed that excessive consumption of alcohol can cause complications such as Fetal Alcohol Syndrome (a group of conditions that indicate problems with your baby’s development) when you’re pregnant. There is no safe level of alcohol so if you are trying to get pregnant, you should give up alcohol completely.
Here’s what you, as a man, can do to increase your fertility:
Concentrate on a healthy lifestyle:
Low sperm count is associated with some factors like heavy smoking, excessive consumption of alcohol, drug abuse, etc. Quit your addictions to improve your Avoid prolonged hot baths and wearing tight fitting undergarments as heat can lower your sperm count.
Reduce your chemical exposure:
Chemical exposure such as to work related chemicals can cause damage to your sperm count and quality.
Improve your diet:
Include fresh fruits, whole grains, legumes and foods rich in antioxidants in your daily diet to boost your fertility. Cut down on refined carbohydrates and foods containing artificial additives. Maintain an ideal body weight as obesity is associated with loss of libido and infertility. Exercise regularly to stay healthy.
You would see a lot of difference by making these simple changes in your daily life. Following these recommendations will not only increase your fertility but will also improve your sexual health to a great extent. You can also consult your doctor from time to time in case you think you require health supplements or need to follow a particular diet and exercise regime to increase your fertility.
Sedentary lifestyle and unhealthy food habits can take a toll on you...
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[blog_title] => Common causes of male infertility
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Male infertility could be the result of many conditions and often the only symptom is the inability to conceive a child. The following aspects of male fertility are important:
Your sperm should be healthy. This means that at least one of your testicles must be functioning normally and the levels of the hormones in your body must be normal.
The passage of your sperms into the semen should be free from obstructions
Your sperm count should be normal which is at least > 15 million sperm /ml of semen
Sperm should be motile and healthy
There are a number of causes that may affect male fertility and these might be medical, environmental or lifestyle reasons why you are not able to conceive even after a year of unprotected sex.
Medical causes include:
Varicocele– This refers to the swelling of the veins that drain the testicles. The reason for infertility with a varicocoele is that it affects the regulation of the temperature in the testes which in turn affects the quality of the sperm.
Infection-Inflammation of the epididymis or testes or sexually transmitted diseases like gonorrhea and HIV can cause male infertility.
Ejaculation Issues– Chronic illness like diabetes, certain medications, surgeries of the bladder or prostate or spinal injuries can sometimes cause the semen to enter the urinary bladder instead of being ejaculated from the tip of the penis; a condition called retrograde ejaculation. Ejaculation itself may be an issue with spinal injuries or medication.
Tumors- Sometimes tumors of the reproductive organs or tumors of the brain that affect the production of hormones that affect the production of sperm. Chemotherapy or radiotherapy for cancer can result in infertility.
Blockage of the tubules that carry the sperm may result in failure of the sperm to be ejaculated. This may be because of infection, damage caused by surgery or trauma or because of abnormal development.
Undescended testes: This is a developmental condition and presents at birth or may not be noticed till later. Reduced fertility may be associated with this condition.
Hormonal imbalances- problems with the production of testosterone by the testes itself or because of dysfunction in various hormone regulating glands can cause low testosterone levels that result in infertility.
Problems with sexual intercourse- Erectile dysfunction or premature ejaculation have adverse effects on fertility. They may be caused due to psychological problems like anxiety or low self-esteem or due to health problems like diabetes or certain drugs. Relationship issues may affect normal sexual intercourse and fertility.
Environmental issues
Prolonged exposure to environmental toxins or industrial chemicals can reduce sperm production or affect sperm function. Exposure to radiation like X-rays or radioactive substances like uranium can also affect sperm production. Elevated temperatures impair sperm production and function. The frequent use of hot tubs or working with your laptop on your lap for long stretches of time can temporarily affect sperm production.
Lifestyle cause of infertility
Smoking, including secondhand smoking, illicit drug use or drinking alcohol can lower sperm counts. Being overweight can cause changes in sperm production or cause hormonal changes that affect male fertility. Severe or prolonged emotional stress can interfere with sperm production.
These are some of the main causes of male infertility. Some of these causes are treatable and others can be reversed with lifestyle changes. Other conditions in which there may be a problem with sperm ejaculation, can be managed by using your own sperm through assisted reproductive techniques (ART). Since symptoms of the causes of male infertility are not always evident, it is important to consult a specialist who will come to a diagnosis and work with you to develop a treatment plan.
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Male infertility could be the result of many conditions and often the only symptom is the inability to conceive a child. The following aspects of male fertility are important:
Your sperm should be healthy. This means that at least one of your testicles must be functioning normally and the levels of the hormones in your body must be normal.
The passage of your sperms into the semen should be free from obstructions
Your sperm count should be normal which is at least > 15 million sperm /ml of semen
Sperm should be motile and healthy
There are a number of causes that may affect male fertility and these might be medical, environmental or lifestyle reasons why you are not able to conceive even after a year of unprotected sex.
Medical causes include:
Varicocele– This refers to the swelling of the veins that drain the testicles. The reason for infertility with a varicocoele is that it affects the regulation of the temperature in the testes which in turn affects the quality of the sperm.
Infection-Inflammation of the epididymis or testes or sexually transmitted diseases like gonorrhea and HIV can cause male infertility.
Ejaculation Issues– Chronic illness like diabetes, certain medications, surgeries of the bladder or prostate or spinal injuries can sometimes cause the semen to enter the urinary bladder instead of being ejaculated from the tip of the penis; a condition called retrograde ejaculation. Ejaculation itself may be an issue with spinal injuries or medication.
Tumors- Sometimes tumors of the reproductive organs or tumors of the brain that affect the production of hormones that affect the production of sperm. Chemotherapy or radiotherapy for cancer can result in infertility.
Blockage of the tubules that carry the sperm may result in failure of the sperm to be ejaculated. This may be because of infection, damage caused by surgery or trauma or because of abnormal development.
Undescended testes: This is a developmental condition and presents at birth or may not be noticed till later. Reduced fertility may be associated with this condition.
Hormonal imbalances- problems with the production of testosterone by the testes itself or because of dysfunction in various hormone regulating glands can cause low testosterone levels that result in infertility.
Problems with sexual intercourse- Erectile dysfunction or premature ejaculation have adverse effects on fertility. They may be caused due to psychological problems like anxiety or low self-esteem or due to health problems like diabetes or certain drugs. Relationship issues may affect normal sexual intercourse and fertility.
Environmental issues
Prolonged exposure to environmental toxins or industrial chemicals can reduce sperm production or affect sperm function. Exposure to radiation like X-rays or radioactive substances like uranium can also affect sperm production. Elevated temperatures impair sperm production and function. The frequent use of hot tubs or working with your laptop on your lap for long stretches of time can temporarily affect sperm production.
Lifestyle cause of infertility
Smoking, including secondhand smoking, illicit drug use or drinking alcohol can lower sperm counts. Being overweight can cause changes in sperm production or cause hormonal changes that affect male fertility. Severe or prolonged emotional stress can interfere with sperm production.
These are some of the main causes of male infertility. Some of these causes are treatable and others can be reversed with lifestyle changes. Other conditions in which there may be a problem with sperm ejaculation, can be managed by using your own sperm through assisted reproductive techniques (ART). Since symptoms of the causes of male infertility are not always evident, it is important to consult a specialist who will come to a diagnosis and work with you to develop a treatment plan.
Infertility is a complex and often misunderstood condition that has a lot of confusion surrounding it. Medical science has advanced rapidly over the years with newer technologies being used in the treatment of fertility issues. There are many beliefs around the treatment of infertility. However, it is important to separate the myths from the truth.
Myth 1: Infertility is a woman’s problem.
Fact: Studies have shown that in 32% of cases there are problems associated with the male partner, in 32% of cases the causes are related to the female partner, there are causes attributable with both in 17% of cases and in 19% of cases the reasons are unexplained.
Myth 2: A woman can get pregnant only on a single day of her menstrual cycle.
Fact: The fertile window is the six-days that end on the day of ovulation. Pregnancy is most likely to occur with intercourse within the three days before ovulation. Keep track of ovulation with the calendar method (ovulation occurs around 14 days before the menstrual period is due) or by using an ovulation predictor kit. Frequent sex boosts your chances of conceiving. It’s important to have a happy sex life. Be relaxed and have sex often throughout the month.
Myth 3: Infertility is a psychological problem, not a physical one!
Fact: Friends and family may suggest that infertility is due to you being under stress or due to worrying too much. While infertility is usually a condition of the reproductive system, in 19% of cases the cause is unexplained. Stress in any situation is never good for your health and studies indicate that time to achieve pregnancy can be reduced and success rates for achieving pregnancy increased by cutting down on stress. Start relaxation techniques such as yoga or meditation for about 10-20 minutes a day, which can relieve your stress and improve your overall well-being.
Myth 4: If a couple adopts a child, the woman will get pregnant.
Fact: This must be painful to hear if you are a couple who is trying to start a family. There is no truth in it as well. This is based on anecdotal evidence and has no scientific basis.
Myth 5: Perhaps this is God’s way of telling you that you’ll aren’t meant to be parents!
Facts: This is another suggestion that must be very difficult to hear. Especially when you are going through the emotional rollercoaster of handling the treatment for infertility. But you must trust your gut instinct that is always right, when it tells you that you would make marvellous and loving parents to a very lucky child.
Myth 6:Infertile couples will never be happy or have a fulfilled life.
Fact: When a couple is unable to conceive, despite multiple trials, it can leave them with sadness, despair, grief and a sense of failure. It is normal to go through a range of emotions at this time. While some couples get through it successfully, for others it can be a very difficult situation to accept. It is important to seek professional help and counseling to help you get in touch with your inner strength to find ways to fill the emotional void.
There are many more such myths about infertility that most infertile couples face in their everyday lives. However, it is important to visit your Gynaecologist to get authentic information and advice on infertility or pregnancy related issues.
Infertility is a complex and often misunderstood condition that has a lot of confusion surrounding it. Medical science has advanced rapidly over the years with newer technologies being used in the treatment of fertility issues. There are many beliefs around the treatment of infertility. However, it is important to separate the myths from the truth.
Myth 1: Infertility is a woman’s problem.
Fact: Studies have shown that in 32% of cases there are problems associated with the male partner, in 32% of cases the causes are related to the female partner, there are causes attributable with both in 17% of cases and in 19% of cases the reasons are unexplained.
Myth 2: A woman can get pregnant only on a single day of her menstrual cycle.
Fact: The fertile window is the six-days that end on the day of ovulation. Pregnancy is most likely to occur with intercourse within the three days before ovulation. Keep track of ovulation with the calendar method (ovulation occurs around 14 days before the menstrual period is due) or by using an ovulation predictor kit. Frequent sex boosts your chances of conceiving. It’s important to have a happy sex life. Be relaxed and have sex often throughout the month.
Myth 3: Infertility is a psychological problem, not a physical one!
Fact: Friends and family may suggest that infertility is due to you being under stress or due to worrying too much. While infertility is usually a condition of the reproductive system, in 19% of cases the cause is unexplained. Stress in any situation is never good for your health and studies indicate that time to achieve pregnancy can be reduced and success rates for achieving pregnancy increased by cutting down on stress. Start relaxation techniques such as yoga or meditation for about 10-20 minutes a day, which can relieve your stress and improve your overall well-being.
Myth 4: If a couple adopts a child, the woman will get pregnant.
Fact: This must be painful to hear if you are a couple who is trying to start a family. There is no truth in it as well. This is based on anecdotal evidence and has no scientific basis.
Myth 5: Perhaps this is God’s way of telling you that you’ll aren’t meant to be parents!
Facts: This is another suggestion that must be very difficult to hear. Especially when you are going through the emotional rollercoaster of handling the treatment for infertility. But you must trust your gut instinct that is always right, when it tells you that you would make marvellous and loving parents to a very lucky child.
Myth 6:Infertile couples will never be happy or have a fulfilled life.
Fact: When a couple is unable to conceive, despite multiple trials, it can leave them with sadness, despair, grief and a sense of failure. It is normal to go through a range of emotions at this time. While some couples get through it successfully, for others it can be a very difficult situation to accept. It is important to seek professional help and counseling to help you get in touch with your inner strength to find ways to fill the emotional void.
There are many more such myths about infertility that most infertile couples face in their everyday lives. However, it is important to visit your Gynaecologist to get authentic information and advice on infertility or pregnancy related issues.
