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Beginning an IVF cycle is an exciting and anxious time for a
couple. Our Center provides couples with the maximum amount of
clinical, emotional, and administrative support they will need to
complete their "cycle" successfully- whether it results in a
pregnancy or not.
The following explanation is meant to simplify that occurs during
various stages of IVF
Ovarian Follicle Development through Controlled Ovarian
Stimulation
Hospital uses fertility drugs that simulate the female
partner, natural hormones to develop several normal follicles in
the ovaries These medications are Clomiphene Citrate also called
Siphene® or Ovofar® Menogon (HMG), a 50:50 mixture of FSH and LH
hormonal administered intramuscularly Puregon® (POFSH)
administered subcutaneously Gonal-F (RecFSH). Any excess Oocytes
that fertilize and develop into embryos at fertilization may later
be stored through cryopreservation.
Follicular growth, development, and maturity are evaluated through
frequent hormone monitoring and by ultrasounds. Typically, the
hormones estradiol, luteinizing hormone, and progesterone are
measured through blood tests to evaluate ovarian response.
Ultrasound is used several times during a cycle to measure
accurately follicular growth and size.
These steps allow the physician team to modify the treatment in
some cases and to stop the cycle if the response to stimulation is
not satisfactory. Once follicular maturation is achieved, the
patient receives an intramuscular injection of human chorionic
gonadotropin (hCG), which triggers oocyte maturation and
ovulation. Oocyte retrieval is performed approximately 36 hours
later. In some the physician may elect to withhold the hCG
injection and wait for spontaneous ovulation, referred to as a
spontaneous LH hormone surge.
Embryo Retrieval through Puncture/Aspiration
If the last hormone blood test and ultrasound evaluation
indicates healthy growth of follicles, then aspiration of mature
follicles takes place. This entire procedure takes approximately
30 minutes performed under short general anesthesia. The physician
locates each follicle through ultrasonic guidance and carefully
aspirates them. The contents of the follicles are immediately
taken to the IVF lab. Patients usually recover for one to two
hours following Oocyte retrieval and are then discharged.
Progesterone supplementation is initiated from the day of the
retrieval.
Oocyte Culture, Insemination, and Fertilization
In the IVF laboratory, follicular fluid is examined under a
microscope to locate all eggs, which are then incubated in a
special media. Generally, semen collection occurs at about the
time of the egg retrieval but, in some cases, may be several hours
later. They are then added to the eggs in culture, here
fertilization occurs. Any resulting embryos are stored in the
incubator and maintained in culture until the time of embryo
transfer and/or cryopreservation
Embryo Transfer
Usually, transfer of the embryos takes place on day two to three
post retrieval. The embryos are examined under the microscope and
carefully aspirated to a thin transfer catheter. The loaded
catheter introduced into the uterus through the cervix where the
embryos are placed. This procedure takes a few minutes and does
not require anesthesia. The physician administers a mild sedative
to provide complete relaxation of the cervix and prevent cramping.
The maximum number of embryos to be transferred at one time is
3-4.
After the transfer, the patient rests for two hours prior to
discharge and complete bed rest for four days is required. On the
sixth day following the transfer, the patient returns for a
progesterone evaluation. Twelve days after the embryo transfer, a
serum base pregnancy test is taken. During this period, patients
are advised to perform light activity and remain in contact with
the Center. If pregnancy does not occur, then our team reviews the
IVF cycle and make specific recommendations for follow-up. The
patient will speak with the clinical staff to review and if
necessary, to discuss other options.
Cryopreservation
Embryos of sufficient quality that are not transferred can be
cryopreserved. The embryologist will select embryos that are
suitable for freezing. Embryos that are ideal for freezing have
blastomeres of equal size and display minimal or no fragmentation.
A Word of Caution: There is approximately a 68% chance of survival
following the cryopreserved embryos. The quality of embryos
undergoing cryopreservation is a major determinant of survival.
Depending stage of embryo development, frozen embryos are thawed
for 2 days before the transfer. The patient is informed of
survival of the thawed embryos and posted for a Frozen Thawed
Embryo transfer (FET).
Ovarian Follicle: A small, fluid-filled structure in which eggs
develop.
Oocyte: an Egg Embryo: a Fertilized Egg that has undergone
division cleavage
IVF Section End
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Intra Cytoplasmic Sperm Injection (ICSI) is a laboratory procedure
developed to help infertile couples undergoing In Vitro
Fertilization (IVF) due to severe male factor infertility. ICSI
involves the insertion of a single sperm directly into the
cytoplasm of a mature egg (oocyte) using a special microinjection
pipette (glass needle). After sperm injection into the egg,
further culture and embryo transfer is as with the IVF cases. For
patients with subfertile semen, this procedure is preferable to
IVF.
ICSI can facilitate fertilization by sperm that will not bind to
or penetrate an egg. It can also be used to treat men with
extremely low numbers of sperm. However, ICSI is generally
unsuccessful when used to treat fertilization failures that are
primarily due to poor egg quality.
Indications for Intra Cytoplasmic Sperm Injection
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Oligospermia - very low sperm counts
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Asthenozoospermia – poor sperm motility
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Teratozoospermia – too many abnormal sperms
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Problems with sperm binding to and penetrating the egg
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Antisperm antibodies (immune or protective proteins which attach
and destroy sperm) of sufficient quality to prevent fertilization
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Prior or repeated fertilization failure with standard IVF culture
and fertilization methods
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Frozen sperm collected prior to cancer treatment that may be
limited in number and quality
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Azoospermia with obstructive pathology- absence of sperm secondary
to blockage or abnormality of the ejaculatory ducts that allow
sperm to move from the testes. In this situation, sperm are
obtained from the epididymis by a procedure called microsurgical
epididymal sperm aspiration (MESA) or from the testes by
testicular sperm extraction (TESE).
Thus very few azoospermic men need to resort to a sperm bank now
with the availability of ICSI.
ICSI is not a perfect technique. Some eggs will be damaged by the
ICSI process. Some eggs have plasma membranes that are difficult
to pierce. In other instances, the fertilized egg may fail to
divide, or the embryo may arrest at an early stage of development.
Perinatal outcome studies in Europe suggest that although multiple
pregnancies are common with ICSI, there is no evidence of
increased incidence of congenital malformations or abnormal
karyotype. There is no evidence that abnormalities may arise later
in life to babies born as a result of ICSI, although there is also
no guarantee that all babies will be normal.
ICSI Section End
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Our Egg Donation Program, unlike its western counterparts does not
depend entirely on Professional Egg Donors. We also have an
Egg-Sharing Program where regular patients who require IVF and
cannot afford it are ready to share half their harvested eggs.
Once you select a donor, we will initiate the Donor-Egg IVF cycle.
From Day One of your menses, you will start a prescribed dose of
Estrogen tablets (Progynova tablets or Estrace Tablets).
Subsequently, we will begin the Egg sharer's stimulation. You need
to reach Mumbai only on the day before the Egg-Sharer's ovum
pickup. The recipient needs to spend only five days in Mumbai
beginning from the day before the Egg-Pick up of Egg-sharer. We
have 1-2 couples ready at any given time for egg-sharing.
We have a lot of patients who have benefited from our Egg Donation
Program at The Center For Human Reproduction. Our Center can also
help you with accommodation at a nearby hotel or in the hospital
itself.
You can check out our List of Anonymous Donors
Donor Egg IVF Section End
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This is a wonderful treatment option for older women and women
with ovarian failure. Since it is not possible to reliably freeze
eggs, for donor egg treatment, we need fresh eggs. We would
encourage you to bring your own egg donor with you. If you cannot
organize your own egg donor, we will be happy to do so for you
thru our egg-sharing program. This means that we have patients for
IVF who are willing to donate half their eggs so that their IVF
cycle fee is waived off. These patients would otherwise have never
afforded the cost of an IVF treatment. These are young women who
are screened for regular IVF & this screen includes an infectious
disease screen as well. On an average, we aim for the recipient &
donor sharing about 7-8 eggs each. Ours is an anonymous donor
program but we provide photographs of potential donors to the
recipient.
We are always looking for healthy young women who would like to
donate their eggs. For more information on how you can become an
egg donor,
please click here.
You can check out our List of Anonymous Donors
Egg Sharing Section End
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Why should international patients consider doing an IVF Program at
Dr. L. H. Hiranandani Hospital ?
Our pregnancy rates are higher than our international
counterparts
We can transfer more embryos in difficult patients (unlike
clinics in UK and Australia, where the number of embryos which can
be transferred is limited by law). While transferring more embryos
does increase the risk of high-order multiple pregnancies, this
risk is negligible in difficult patients (for example, the older
women or women with previous failed IVF cycles). In our clinic, we
customize the number of embryos we transfer for each patient we
treat, rather than just blindly following a guideline (which has
been laid down for the general population, without considering
each individual's specific problem).
Convenience due to the location and the metropolitan nature of
Mumbai
Coming to Mumbai for IVF is extremely easy. Mumbai is a major
metropolis, and has its own international airport. You can book
your tickets online, or find the best deals by asking Indian
travel agents in your city.
Your husband can accompany you, or you can hand-carry his frozen
sperm in a dry shipper (which you will need to borrow from your
local infertility clinic). The clinic is at Powai an easily
accessible north-eastern suburb of Mumbai, just 20 minutes from
the International airport, in a quiet residential area.
Our experience in meeting with the special needs of
International patients
Over half our patients come to us from out of Bombay; and a
quarter of all our patients come from overseas, so we are very
experienced in meeting your special needs. To make the process as
easy as possible for you, we have developed protocols that allow
you to interact easily with us. You can have all your preliminary
testing and care performed by your own doctor in your own town.
This means that with well-planned scheduling, you only need to
spend about 10 to 20 days at our clinic to complete a cycle of IVF
treatment.
IVF treatment is done on a day-care basis, so you do not need
hospitalization at all. We have tied up with a three star hotel
and we can help you arrange accommodation in close proximity to
our clinic alternately you can stay in the hospital itself. You
only need to make 4 - 6 visits to the clinic during the entire
cycle, and after the embryo transfer you can fly back home
We offer a comprehensive range of infertility services all
under one roof
We offer comprehensive services, in a plush facility on the
ground floor of a quiet residential building away from the main
road to ensure privacy for our patients. These include.
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Consultation
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Diagnostic Workup
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Diagnostic Laparoscopy
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Diagnostic Hysteroscopy
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Embryo Cryopreservation
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Testicular Tissue Cryopreservation
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IVF, including laser assisted hatching and blastocyst transfer
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Egg and embryo donation
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ICSI, including PESA and TESA
It is less expensive to do IVF in India as compared to the US, using exactly
the same technology, equipment and culture media
A complete IVF cycle at our clinic costs only equivalent of US $ 2200 and
this is all-inclusive of all medical procedures, including medicines, lab tests,
scans, egg pickup and embryo transfer. An ICSI cycle inclusive of medication
would cost an equivalent of US $ 2500. A donor egg IVF cycle costs an equivalent
of US $ 3300 (including payment for the egg donor). This is why we attract
patients from all over the world!
Why is IVF so much less expensive in India as compared to the US, even though we
use exactly the same technology and the same equipment and culture medium as
labs in the US do?
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Indian doctor’s charge much less than doctors in the US- and this is why IVF
treatment is such a bargain in our clinic. Thus, the cost for a consultation at
our clinic is only Rs 600 ( US $ 13)- a fraction of what doctors in the West
charge!
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Indian doctors, like Indian computer professionals, have proven they are as good
as anyone in the world, but because India is still a developing country, they
charge much less than their colleagues in the West.
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There is also much less administrative paperwork, keeping overheads low,
allowing us to offer cost-effective services to our patients.
Overseas IVF Section End
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"Embryo adoption is the newest method of planning your family,
which combines assisted reproductive techniques with adoption, so
that instead of adopting a baby, infertile couples adopt an
embryo.
At our centre, we handle embryo donation like a closed adoption.
There is absolutely no contact between the donor couple and the
recipients, who never see each other. The recipient couple does
not even need to inform their obstetrician that they achieved
their pregnancy through embryo adoption! Unlike traditional
adoption, the couple does not have to go through a legal process
to adopt, but through medical treatment. This means that the
couple “biologically adopts the embryo”. There are many reasons
why couples may prefer embryo adoption to adopting a child. For
infertile couples, embryo adoption offers the unique opportunity
to be pregnant, to bond with their child prior to birth, and to
give birth.
In addition, embryo adoption may be much more affordable than
traditional adoption in the US. Embryo adoption also offers
couples privacy and secrecy, so that they do not need to worry
about societal acceptance of their adopted child. Also in India,
certain groups such as Christians and Muslims cannot adopt. Embryo
adoption can be an extremely attractive option for them. Embryo
adoption is an alternative for infertile couples who need egg or
sperm donation. The best results with embryo adoptions are with
fresh embryo adoptions, which are done with a Donor Egg IVF.
For more information on our Embryo Adoption program, please write
to:
kedar.ganla@hiranandanihospital.org
anjali.awasthi@hiranandanihospital.org
Embryo Adoption Section End
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