Clinical/Lab Intervention

IUI Treatment Centre in Chennai

Artificial Insemination with partner or donor sperm

Not every patient with infertility needs costly, intrusive treatments like IVF or ICSI. Furthermore, aside from natural sex conception, artificial insemination is frequently the most affordable and painless method of conception if the woman is young, has regular ovulation, and the partner’s semen analysis reveals no abnormalities.

In cases, where a woman shows absolute normal ovulation and the semen of the male is beyond any treatment, Donor Sperm with IUI can give good results.

During ovulation, sperm from a partner or donor is injected directly into the woman’s uterus as part of an insemination procedure. More sperm are likely to reach the fallopian tubes as a result of this “head start” than through sexual activity. It will still be up to the sperm to get to the egg and fertilize it.

At nandhini-pearl, we have plenty of successful pregnancies from IUI treatment alone. Before pursuing IVF, we advise patients to try a few cycles of IUI when medically acceptable.

When is artificial insemination recommended?

ideally when a woman is under 35 years old

when the baseline fertility evaluation has been completed but the cause of infertility remains uncertain

When there is a slight male component that can get better with laboratory sperm preparation

when anomalies in ovulation occur

When a couple find it difficult to have normal sexual intercourse

In case of Single woman or LGBTQ couple

Which prior examinations are required?

The following tests are advised before attempting artificial insemination:

Test of hormones to assess ovarian reserve.The FSH and estradiol values can be found on day three of the cycle, while the Anti-Mullerian Hormone (AMH) value can be found at any point during the cycle. Use the motile sperm recovery (MSR) test in conjunction with semen analysis to determine if the partner’s sample is good enough to carry out an insemination. gynecological ultrasonography to rule out disorders of the ovaries and uterus.It is also employed in the antral follicle count method of ovarian reserve evaluation. Hysterosalpingography for tubal permeability assessment.It involves injecting contrast into the uterine neck while x-rays are being taken.

serologies to exclude the possibility of infectious infections that are transmissible.

The Artificial Insemination (IUI) procedure

Partner Sperm insemination

Fresh partner sperm is preferred in cases where mild to moderate sperm problems exist. Frozen partner sperm is preferred when the male partner is travelling frequently or unable to produce good quality sperm on the day of insemination. It is a practice to keep a sample of frozen sperm for such an eventuality.

On the day of the insemination, the male partner collects a semen sample and gives it to our laboratory or it is taken from the Partner’s frozen sperm in stock. This sample is prepared to obtain the sperm with the best fertilising capacity, which will be used for insemination.

Donor Sperm insemination

Donor sperm is preferred when the Partner has severe semen issue that is not treatable. It is also used for Single women pregnancy or in LGBTQ pregnancy. The sample will be provided by our sperm bank. In order to select the right donor, since it must be anonymous, the physical characteristics of the patients are taken into account. Donors go through a strict selection process and are examined to check that they do not have any diseases that could affect the future pregnancy.

The personal and family history is collected, an assessment by our psychologist is performed and analyses that include general analyses and tests to rule out infectious diseases such as hepatitis, HIV and syphilis, and genetic studies such as karyotype and other tests are carried out in order to rule out major genetic diseases.

Sperm collection and preparation

An artificial insemination technique used to treat infertility is called intrauterine insemination (IUI). When your ovary releases one or more eggs for fertilization, concentrated and cleansed sperm are deposited straight into your uterus. The sperm sample is prepared in the lab using the sperm capacitation procedure on the day of insemination. After processing, the majority of the non-motile sperm and other fluids are eliminated, leaving behind a considerably cleaner and more concentrated sample.

When is artificial insemination recommended?

Ovulation cycle

The woman is monitored simultaneously for her ovulation cycle

Natural Cycle

If the patient does not have any issue related to her ovaries and her periods are regular and ovulation works perfectly, this technique can be tried. No medication is applied. The follicle is a small cyst that women produce every month. Inside the follicle the egg is developed. They will be controlled by ultrasound scans until you can see that the patient is about to ovulate. There is medicine applied to trigger ovulation. The insemination is performed the moment we know ovulation is occurring. The advantage of this method is that there is no need to apply any medication and a multiple pregnancy can be avoided. However, the chances of success are much lower, so it is mainly recommended for very young patients, with a very good prognosis.

Stimulated cycle

This is the most used procedure because of its good results. It consists of applying medication to ensure that at least one follicle is produced, although, if possible, there can be two or three. This improves the probability of success without almost raising the risk of a multiple pregnancy. With these premises, the risk of having twins is 8%. The majority of therapies involve the use of injectable gonadotropins and/or drugs like letrozole or Clomid. The medication is applied daily by subcutaneous injections that do not hurt at all. Also, with the help of short instructions from our nurses on the first day, the patient can inject them herself. The treatment usually lasts 7-9 days. The same as in the natural cycle, ultrasounds are performed every two to three days to monitor the development of the follicles. Once you can see that they are about to ovulate, a medicine to trigger ovulation is given. Then, the insemination is carried out when ovulating

The IUI Procedure

Once the sperm is ready and the woman is about to ovulate, we can inject the sperm into the woman’s uterus in a simple 5-minute procedure. We perform a speculum exam, use a fine catheter to inject the sperm into the uterus, then remove the speculum and let the woman lay down for 10-15 minutes while the sperms are moving to the fallopian tubes. For most women, the procedure is painless.

IUI increases the number of sperms reaching the fallopian tubes

Risks of IUIs treatment

There is a higher probability of multiple births if you are taking fertility drugs throughout your IUI cycle.

An infection risk is also present, however slight. Before your Artificial Insemination therapy begins, your doctor at New Dawn Pearl will go over these risks and the preventative measures in great detail with you.

Success rate of IUI

Success is based on numerous variables and varies from patient to patient. For some women, the success rate with artificial insemination can be as high as 20%. We therefore usually advise making plans to go through multiple rounds of treatment. Your doctor is in a better position to talk about IUI and your possible success rates.

Number of attempts

Inseminations can occur more than once during a cycle, much like in natural cycles. To improve success rates, taking a month off is not required. For the first three tries at insemination, the success rates are constant. We advise attempting an alternative, more successful course of treatment if pregnancy is not obtained after three inseminations.

Care after artificial insemination

To promote embryo implantation, progesterone supplements should be taken for a few days following insemination. The woman’s natural cycle won’t change significantly while undergoing therapy. Consequently, it is advised to live as normally as possible. Urine pregnancy testing should be done two weeks following insemination.

Why choose IUI treatment at nandhini-pearl?

Before you begin treatment and with each artificial insemination attempt, we will first do a comprehensive Semen Analysis in our Andrology Lab to precisely measure the quantity and quality of your sperm. This enables us to pinpoint couples whose sperm count is suboptimal for in vitro fertilization procedures. Further, we monitor the ovulation of the woman with added medication if necessary and prepare her for the best results.

Best IVF Centre in Chennai

In Vitro Fertilization (IVF)

The most common and effective assisted reproductive technology is in vitro fertilization (IVF) (ART). It includes retrieving eggs, processing sperm, inducing ovulation using fertility drugs, fertilizing the eggs in a lab, and putting the developing embryos into the uterus.

History of IVF

In 1977, Drs. Steptoe and Edwards successfully performed this surgery on humans in England. Dr. Edwards received the Nobel Prize in Medicine, a recognition of the discovery’s scientific significance. Interestingly, on October 3, 1978, in Kolkata, Dr. Subhash Mukherjee, an Indian, delivered India’s first test-tube baby, Durga, while operating concurrently.

Regretfully, he was not acknowledged for his groundbreaking work! Due to this treatment, millions of babies have been born all over the world to date. IVF pregnancy treatments have gotten significantly safer, easier, and more successful over time.

Who needs IVF?

Patients who suffer from ovulatory dysfunction, blocked or damaged fallopian tubes, pelvic inflammatory disease, recurrent miscarriage, unexplained infertility may be candidates for IVF treatment. IVF is the treatment when Frozen eggs of the patient are to be used or in cases of Donor eggs or with LGBTQ couples.

Each of these problems can naturally sound quite terrifying. However, it’s worth noting that men can also have fertility problems, which might include issues such as:

Low sperm count, meaning that there is not enough sperm produced to be fertile.
Poor sperm movement, suggesting that nobody wins the ‘sperm race’ during conception.
Problems with erectile strength or quality, reducing the chances of conception.
Suffering from azoospermia, reducing your chances of success.
Physical injury and/or trauma otherwise to the testicles or scrotum.

However, it’s also important to note that studies show that both partners can be the cause. With around a 40/40/20 (both) split, it’s hard always to accept the limitations of your own body

The IVF Process Broken Down Step-By-Step

The IVF cycle, which starts at the onset of a patient’s menstrual cycle, consists of numerous phases. When it comes time for your IVF cycle, pre-treatment testing such as blood tests, ultrasounds, and semen analysis may be required by your doctors and fertility specialists.

1. The “down-regulation” or hormonal suppression of your menstrual cycle using birth control tablets or other medications. Through this procedure, we are able to take control of your ovaries and prevent any follicular growth while also assisting in synchronizing your follicles to enable the simultaneous development of numerous eggs. You may have certain menopausal symptoms temporarily, depending on the drugs you are taking, but these symptoms will disappear after the stimulation period. This will then guarantee that we have complete control over the stimulation during the subsequent phase of the treatment.

2. Stimulation of the ovaries to produce several eggs.

You must start taking medication that will stimulate your ovaries at this period of your treatment cycle in addition to continuing the medications that “switch off” your body’s natural control over them. It is crucial that you continue taking the suppression pills because their purpose is to prevent you from ovulating before the egg retrieval process. The dosage is determined by taking into account all of the workup you completed prior to beginning the cycle, and the stimulation is carefully regulated to allow for the best potential follicle recruitment.

During this stage of your therapy, blood samples will be performed to assess your estradiol levels and vaginal ultrasound scans will be used to determine the diameters of your follicles. This will allow your doctor to make sure you are responding to your treatment as intended. Depending on what we observe, we may occasionally change the drug dosage, and you will be advised of this.

Throughout this time, it is crucial that you keep a careful eye on your schedule and adhere to any changes we may make based on your response. It will be necessary for you to confirm that you are available by phone every day and that you are accommodating enough to take last-minute appointments.

3. Retrieval of the eggs from the ovaries

We shall arrange for the retrieval of your eggs as soon as it is concluded that your follicular growth is at its best. This is accomplished by giving a precisely timed “trigger shot,” which permits the follicles to reach their maximum maturity and prepares the eggs for release. You will receive comprehensive instructions at the time of the shot, and the specifics will depend on how you react to stimulation. It’s crucial that you adhere to the exact time that you’ll be given for the trigger.

During the egg retrieval process, you will be placed under heavy sedative anesthesia and monitored by a medical doctor anesthesiologist. Throughout the surgery, the anesthesiologist will keep you unconscious. You will receive instructions on how to be ready for the case as well as when we need you to show up at the clinic.

Throughout the retrieval process, a guide is attached to the same vaginal probe ultrasonography that was used throughout the treatment’s monitoring phase. With the use of that guide, a needle may be directly seen as it passes through the rear of the vagina and into the ovary. The needle itself makes it possible to aspirate the follicle’s contents and then “rinse it out” by pushing media back into the follicle.

Then the fluid is passed to the embryologist in order to look for the egg. They are very visible within the fluid from the follicle, and they can be separated and placed into culture media.

4. Preparation of the semen

Partner’s semen: The male collects the semen sample on the day of Embryo Transfer. On occasions, frozen semen samples are used.

Donor semen: The semen sample comes from our sperm bank where the most suitable donor will be selected in accordance with current legislation. The cryopreserved semen is thawed in the Andrology Laboratory and will be processed for use in in vitro fertilisation. Regardless of the source, the sample will be processed to remove all the seminal plasma and to concentrate the motile sperm.

5. Fertilization of the eggs and cultivation of the embryos in the laboratory

After being recovered, the eggs are carried into the lab, where they are put in fresh culture material and kept in an incubator.

The insemination process is done in the afternoon, six to eight hours after the planned start time of the retrieval. The prepared sperm is just added to the dish containing the eggs in a traditional IVF cycle.

We check the eggs to see which ones have fertilized the morning following the egg retrieval (Day 1), and you will receive an update over the phone that morning. Subsequently, the embryos remain in the incubator, undergo periodic evaluations, and are transferred to new culture material when their developmental needs alter.

The embryos will be developed in the incubators until either day five, day six, or day seven. The amount of time can change based on how quickly the embryos develop. This enables biology to determine which embryos have a higher chance of being normal. Put differently, compared to earlier stages of embryos, a larger percentage of day 5, 6, or 7 embryos will result in a successful pregnancy.

6. Biopsy and Cryopreservation of appropriate embryos

At nandhini-pearl, we use innovative concepts and methods. In freeze-all methods, no embryos are transferred that cycle and all viable embryos from a “fresh” IVF cycle are frozen on days 5, 6, or 7. After then, another FET cycle will be scheduled for the transfer at a later time.

According to recently developed research, freeze-all techniques greatly improve the chances of becoming pregnant as compared to fresh cycles that involve transferring the embryo back during the same cycle that it was extracted.

Numerous plausible explanations exist for this:
First, compared to a FET or non-IVF cycle, hormone levels and inflammation are significantly different in a new IVF cycle. The women’s ovaries are overstimulated with hormones during a new cycle in order to facilitate the retrieval of more mature eggs. Throughout the course of the woman’s cycle, these hormones and drugs change her body’s regular biochemistry. This was formerly dismissed as unimportant, but mounting evidence is beginning to change that. In an unstimulated cycle (FET cycle), delaying the transfer of the fertilized embryo(s) back into the uterus increases the likelihood of pregnancy in all age groups and results in birth weights that are about 200 grams higher.

New research indicates that 20% of uterine in a fresh cycle are not ready for the embryos, even when the lining appears excellent on ultrasound. This is a significant factor in why nandhini-pearl has adopted a “Freeze-All” strategy.

7. Placement of the embryo into the uterus

We now practice dual embryo transfers on all IVF patients. Instead of transferring many best-looking embryos, we now transfer only two genetically normal embryos, thereby reducing risk of multiple pregnancy while improving the chance of conception. By using Preimplantation Genetic Testing (PGT), we can identify chromosomally normal embryos. Given the significant risk associated with multiple pregnancies, this procedure has a higher probability of success and is safer for the developing embryo as well as the mother.

During the initial phase of the transfer, the doctor uses an abdominal ultrasound to guide the best passageway through the cervical canal to enter your uterus and insert the catheter’s outer sheath into your cervix. After the embryo is swiftly placed into the catheter, it is released into the uterus. Before the treatment is finished, we thoroughly inspect the catheter after it has been moved to make sure nothing has been left behind. You will be requested to stay in a prone position for ten to fifteen minutes following the transfer, after which you can resume your normal activities. Complete follow-up instructions about what to do and what to avoid doing will be provided, along with information about any new drugs you will be taking.

Following their retrieval, the eggs are processed in our lab and fertilized with sperm to produce embryos. The embryos are biopsied to check for chromosomal abnormalities if desired. An embryo is chosen and put into the patient’s or surrogate’s uterus at the appropriate moment to initiate a pregnancy.

8. Pregnancy test and 9. IVF Flow chart:

The pregnancy test is performed 10 days later. It consists of the determination of a hormone: the beta hCG in the blood. Its level will be examined to know more precisely how the pregnancy is developing.

Intra Cytoplasmic Sperm Injection - ICSI Treatment Cost in Chennai

What is ICSI?

ICSI stands for Intra Cytoplasmic Sperm Injection technique. It is considered as an advanced and superior form of IVF and is very relevant for severe male infertility issues. In ICSI, one sperm is injected into each egg through microinjection in lab conditions to fertilise.

History:

Since the first recorded use of frozen sperm for insemination in 1953, the breakthroughs in fertility had been mostly confined to treatments for female infertility. However, in the last decade, ICSI has transformed treatment for male infertility so much so that there are almost no men who are completely unable to father children. The first use of ICSI in humans was announced in 1992 – since then, ICSI has completely revolutionized male infertility treatment

How different is it from Conventional IVF?

“In-glass” fertilization, also known as in-vitro fertilization, works similarly to how natural conception works. Millions of sperm are combined with eggs in a highly regulated vessel, and the sperm swarm about the egg until one breaks through its barrier of protection, keeping the other sperm out. This requires an extremely high sperm-to-egg ratio, much like in natural conception, hence males with moderate to severe infertility will not be able to conceive using this method.

ICSI was developed as a result of efforts to lower the sperm-to-egg ratio required for IVF; in contrast to traditional IVF, ICSI only requires a sperm-to-egg ratio of 1-to-1. The procedure starts the same as with traditional IVF: the woman’s ovaries are hyperstimulated to remove eggs, and in more severe situations, a sperm sample is obtained by ejaculate or testicular sperm extraction (TESE, a technique that extracts sperm directly from the testicles). But when these samples are gathered, one sperm is chosen to be implanted into the egg rather than combining them all. This sperm is collected into an incredibly thin pipette, which is then inserted into the outer wall of the egg to release the sperm into the middle of the egg.

Many men who were previously unable to father children, including those due to genetic factors, now have the opportunity to do so because the amount of sperm needed to fertilize an egg is now only one (although in reality more than one sperm cell is required, but not millions). Although this is a significant advancement in the realm of fertility, there is a price.

When is the ICSI treatment recommended?

If there is a history of poor sperm quality or failed fertilization, in vitro fertilization (ICSI) is the recommended course of treatment. When donor sperm would have been the only choice in the past, ICSI can allow couples to use the partner’s sperm. Every time sperm is extracted surgically, like following an unreversed vasectomy, ICSI is required. The stimulation phase, retrieval of the eggs, and the subsequent culture following fertilization are all precisely the same as in conventional IVF. But when it comes time for the insemination process, things really change.

Most of the time, we will have decided much in advance of the egg retrieval day whether to use traditional IVF or ICSI for the insemination. Depending on the quality of the sperm, we may decide to wait until the day of egg retrieval to determine which method is best.

It is always possible that on the day of retrieval, previously normal samples could appear noticeably worse, and we might decide to conduct ICSI instead of IVF. Additionally, if we have enough eggs and a suitable sperm sample, we might decide to do ICSI for the remaining eggs and continue with traditional IVF for the remaining ones. In a traditional insemination cycle, a predetermined amount of sperm is added to the culture plate in order to fertilize all of the eggs. When using ICSI, the eggs must first be ready for insemination before being examined for maturity.

A group of cells known as cumulus cells surrounds the eggs after they are extracted, or when they ovulate naturally. In a typical insemination, the cumulus cells are left surrounding the eggs because they are crucial to the sperm’s capacity to fertilize the egg. For a number of reasons, these cells must be eliminated before an ICSI insemination.

The first is to position the egg to attempt to prevent potential harm, to observe the sperm get placed into the egg, and to allow direct visualization of the egg to ensure that the egg is mature enough to be injected. In order to ensure that the injection is successful and eliminate any chance of accidentally injecting cumulus cells into the egg, it also enables the egg to be maintained in position while the injection is being performed.

About three to four hours after the egg extraction procedure, the cumulus cells are taken out of the egg and re-incubated until the insemination procedure is ready to begin. During the injection process, a high-powered microscope and two micromanipulators are used, which enable extremely precise control of the injection instruments via joysticks that resemble controllers from video games.

The injection tools are a glass holding pipette with a smooth, rounded mouth that holds the egg in position with a light suction. Next is an injection pipette. A single sperm is found, rendered immobile, and then removed using an injection pipette, which is an extremely thin glass needle. Next, the pipette is used to pierce the egg’s zona, or outer layer, and enter the cytoplasm, which is the egg’s primary interior. Making sure that the cytoplasmic membrane has been breached is crucial before allowing the sperm to be inserted into the egg since it is highly flexible.

The egg may be harmed during the injection process, although the likelihood of that occurring is extremely low in the low single digits. Moreover, even in cases where the sperm are placed directly into the egg, ICSI does not ensure fertilization. In most situations, when there are serious sperm problems, the ICSI fertilization rates are significantly greater than what would have been predicted in the absence of ICSI. In general, these rates are comparable to those obtained with traditional IVF.

In addition to the possibility that the ICSI procedure could physically harm the eggs, several reports have indicated a rise in birth abnormalities after ICSI. Although the true causes of this are still unknown, a number of published studies have suggested that the sperm utilized to form the embryo rather than the ICSI process itself is more likely to be to blame for the rise in birth abnormalities.

This is said to be because there may be a genetic component to the male factor diagnosis, which is then passed on to the offspring. Certain congenital abnormalities, like hypospadias, can be surgically corrected. After ICSI, several rare genetic abnormalities, such as Beckwith-Wiedemann syndrome and Angelman’s syndrome, which are known as imprinting disorders, can become somewhat more common. Less than one child out of every 10,000 is affected by one of these incredibly rare illnesses. Large-scale research is required to ascertain whether these problems are indeed associated with IVF or ICSI treatments, or if they are more prevalent as a result of infertility alone. The majority of IVF facilities never see a case of these disorders. We at nandhini-pearl naturally choose IVF with the ICSI procedure.

Many couples have been able to become pregnant thanks to the ICSI treatment. The chance to become parents to a kid of their own for a couple whose severe male factor or other factors would prevent them from conceiving through a standard IVF insemination.

When it is appropriate, we are pleased to provide ICSI. Please get in touch with nandhini-pearl to find out more about the ICSI process and what it can entail for you.

What is IMSI?

The process of IMSI involves injecting morphologically chosen sperm intracytoplasmically. In contrast to ICSI, it selects sperm under 8000x, making it possible to select the best sperm and greatly enhancing the chances of successful reproduction. It requires sophisticated computer software that enables the user to operate the microscope from their computer in conjunction with a high-quality imaging microscope to be completed.

When is it best to use the IMSI method? In situations where the quality of the sperm is low, applying IMSI can help choose the sperm that will be used to fertilize the egg.

Severe teratospermia
High levels of sperm DNA fragmentation

Nandhini – Pearl Hospital, a leading Muti speciality hospital in Velachery, Chennai, has been dedicated to women’s wellness for over 35 years, offering comprehensive gynaecological, fertility, cancer care, and specialty care treatments for women. Our team of expert obstetricians has safely delivered over 50,000 babies.

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