IVF & Infertility

Assisted Reproductive Techniques

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1. INTRAUTERINE INSEMINATION (IUI)

What is IUI?

Intra-uterine insemination (IUI or artificial insemination) is a fertility treatment that uses a catheter to place highly concentrated amount of active motile sperms directly into the womb.

Why do I need this procedure?
  • Low sperm count
  • Mild reduction in sperm count or quality
  • Donor sperm treatment
  • Hostile cervical conditions like when the cervical mucus has anti sperm antibodies
  • Sexual dysfunction where there is difficulty in penetration.
  • Sexual abstinence (e.g. when the partner is away)
What does it involve?
  • Fertility drugs to stimulate the ovaries.
  • An ultrasound scan is used to monitor the size of the follicle(s).
  • Human Chorionic Gonadotropin injection is used to stimulate the release of egg from the follicle.
  • The semen sample is processed by the laboratory and is then deposited into the cavity of the womb in a 5-10 minute procedure.
Success Rate

The pregnancy rate with IUI is 10-13%

2. IN-VITRO FERTILTISATION (IVF)

What is In-Vitro Fertilisation (IVF)?

IVF is a process by which egg cells are fertiltised by sperm outside of the womb (in-vitro). The embryo (fertiltised egg) is then transferred into the womb to begin a pregnancy or cryopreserved (frozen) for future use.

Why do I need IVF?
  • Blocked tubes.
  • Male infertility such as low sperm counts or surgically retrieved sperms
  • Long sub fertility
  • Problems with ovulation (release of the egg from the ovary)e.g. in polycystic ovarian disease
  • Advanced maternal age
  • Donor egg recipients.
What does it involve?
  • Hormones and other medication are administered to stimulate the development of multiple follicles (which contain the eggs) in the ovaries.
  • The eggs are retrieved from the patient under anesthesia by a needle through the vagina under ultrasound guidance.
  • The eggs are then incubated with the sperm in a dish in the laboratory to allow natural fertiltisation or the sperm is injected into the egg.
  • The resulting embryo(s) is incubated in the laboratory for 2-3 days or up to 5 days and then transferred into the womb.
  • The pregnancy test is done two weeks after the day of embryo transfer.
  • The pregnancy rate varies with different couples.
Success Rate

The overall success rate is about 40% per cycle.

3. INTRA-CYTOPLASMIC SPERM INJECTION (ICSI)

What is ICSI?

ICSI is an in-vitro fertilization procedure in which a single sperm is injected into the egg using a fine needle

Why do I need this procedure?

ICSI is commonly used to overcome male infertility problems and may be used where:

  • The sperm count is very low
  • The sperm quality is not high enough for IVF insemination
  • The sperm has been retrieved surgically
  • There have been previous fertiltisation failure or low fertiltisation rate
  • There are few eggs.

4. EMBRYO FREEZING (EMBRYO CRYOPRESERVATION)

What is Embryo Cryopreservation?

Embryos can be frozen in extremely cold temperatures using chemicals called cryoprotectants. Under such conditions, the embryo can remain in dormant condition such time that pregnancy is desired. Once frozen, embryos are stored in liquid nitrogen tanks (-196C) in the laboratory. Through the thawing process, the embryos are revived and the biological processes are resumed.

Why do I need this procedure?

This allows the couple to use these embryos without the need to repeat another fresh IVF cycle and thus obviates the need for repeat injections used for ovarian stimulation. It is done in the following conditions:

  • In fresh IVF cycles where there are excess of embryos
  • When there is a risk of OHSS in a fresh cycle
  • When the lady is about to undergo cancer treatment, the embryos may be frozen for future use.
What does it involve?

In the frozen embryo transfer cycle, the woman takes the medications to prepare her womb to receive the embryos. The lining of the womb is measured by ultrasound and once it is ready, the embryos are thawed and transferred.

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Publications

Kumar Ashok, Beniwal Mona, Kar P, Sharma JB, Murthy NS. Hepatitis E in pregnancy. Int J of Obst & Gynae. 2004;85: 240-244.
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