“AARU”
Apollo’s Assisted Reproduction Unit
( IVF Laboratory )
Mon.- Sat : 9.00 AM To 5.00 PM Tel. Extn. 2146, 2199

IVF Lab (Ext 2146,2199)
Commonly known as "test tube baby". IVF means fertilization of an ovum outside the body and consequently transfer of the fertilized ovum (embryo) into the uterus of the woman. Indraprastha Apollo offers the most sophisticated IVF lab with advanced technology. We have highly skilled and competent health care professionals to give you better advice regarding the treatment options and help you to decide the most appropriate treatment.

INFERTILITY TREATMENT SERVICES AT “AARU”

Introduction:
In all branches of medicine both patients and doctors recognize that same symptoms may have many different causes and that accurate diagnosis should always come before treatment.This is no less true when the symptom is the “inability of a couple to have a baby (infertility)”. Therefore before you start infertility treatment we recommend you to have proper examination and investigations so that we can give you better advice regarding the treatment options and help you to decide the most appropriate treatment for you.

Assisted Reproductive Technologies (ART):
Any medical technique that attempts to obtain a pregnancy by means other than by intercourse is defined as ART. These techniques involve the manipulation of sperm or Oocyte or both, and the gametes or the embryos are transferred into the uterus or fallopian tubes. ART includes Intrauterine Insemination (IUI), In Vitro Fertilisation-Embryo Transfer (IVF-ET), Intra Cytoplasmic Sperm Injection (ICSI), Assisted Hatching (AH) etc. We at ARRU provide you the full range of ART services to aid your infertility treatment to help you bear a child. Successful outcome with minimum invasion is always our priority.

Intra Uterine Insemination (IUI):
This is the method by which processed semen is placed directly in the uterus with the help of a catheter. IUI can be done in a natural cycle, however, to get better results, it is usually preceded by ovulation induction / ovarian stimulation using appropriate fertility enhancing drugs. With a policy of initial treatment by IUI approximately 20 percent couples (cumulative pregnancy chances) would achieve pregnancy. However, there is not much benefit by continuing same treatment repeatedly and after 3-4 unsuccessful cycles of IUI, couple should consider IVF or ICSI treatment.
Advanced female age, poor post wash semen quality and a history of tubal factor or previous pelvic surgery are significant risk factors for poor IUI success rates.

In Vitro fertilisation (IVF) and embryo transfer (ET)
Commonly known as "Test Tube Baby". IVF means fertilisation of an ovum outside the body and consequently transfer of the fertilised ovum (embryo) into the uterus of the woman. IVF is probably the most widely practised assisted conception procedure in the world.

The procedure does not need admission at any step and is conducted on outpatient basis.

Steps involved in IVF procedure:
» Ovarian stimulation by hormonal injections to produce multiple eggs.

» Monitoring of the response by ultrasound scans and blood tests.

» Egg retrieval with the help of a needle under local / general anaesthesia.

» Fertilisation of the eggs in the laboratory.

» Transfer of the resulting embryo(s) into the uterus of the woman.

» Blood test performed 15 days after embryo transfer to access the establishment of pregnancy.

If the treatment procedure is successful, one or more embryos will implant in the uterus and the pregnancy will result, just as it happens in the natural process of conception.

Indications for IVF:
» IVF is helpful in a variety of infertility cases involving :-
» Bilateral tubal blockage or abnormality.
» Male factor infertility.
» Unexplained infertility.
» Where ovulation induction/stimulation (OI / OS) & IUI has failed.
» Endometriosis.

Intra Cytoplasmic Sperm Injection (ICSI ):
ICSI is the technological breakthrough in the field of IVF which is used to overcome the inability of sperm to fertilise an egg which may be either due to sub-optimal sperm parameters, Oocyte defects or other reasons (anti sperm antibodies). In this technique a single sperm is directly injected into the cytoplasm of an egg in order to achieve fertilisation.

Indications for ICSI:
» Oligospermia - very low sperm count in the ejaculate.
» Asthenospermia - motility less than 40 %, in the ejaculate.
» Teratozoospermia - < 14 % normal forms, according to strict criteria.
» Necrozoospermia - all dead sperm in the ejaculate.
» Antisperm antibodies.
» Repeated fertilisation failure after conventional IVF-ET.
Ejaculatory disorders.
» CBAV - congenital bilateral absence of the vas deferens.
»Obstruction of both ejaculatory ducts.
»Failed vasectomy reversal.
The steps involved in ICSI procedure are exactly the same as for IVF, except that fertilisation is achieved with the help of a micromanipulator.

In some cases when there is a complete absence of sperm in the ejaculate, sperm can be retrieved from the testis / epididymes and used for ICSI
The testicular / epididymal sperm retrieval techniques are:
» PESA - Percutaneous Epididymal Sperm Aspiration.
» MESA - Microsurgical Epididymal Sperm Aspiration.
» TESA - Testicular Sperm Aspiration.
» TESE - Testicular Sperm Extraction.

IVF Using Donor Oocyte (Eggs):
Women who are unable to produce their own eggs or their eggs failed to fertilise during an IVF cycle due to poor Oocyte quality can be helped by using other women’s egg (Donor Oocyte). Replacement of donor embryos and surrogacy are other available options to the infertile couple.

Assisted Hatching ( AH ):
The procedure is based on the fact that an alteration in zona pellucida (outer covering of egg) either by drilling a hole through it or by thinning it, will promote hatching or implantation of embryos that are otherwise unable to escape intact from the zona pellucida.

Cryo Preservation of Embryos ( embryo freezing ):
Excess (Surplus) embryos can be Cryo-preserved at ultra low temperatures for many years. These frozen embryos can be used subsequently without the need for ovarian stimulation and egg retrieval. However the pregnancy rate following transfer of frozen embryos is lower than that with fresh embryos.

Semen /Sperm freezing:
Semen /Sperm can be stored frozen at ultra low temperatures for long duration which could be helpful in a variety of circumstances such as:
Semen freezing prior to chemotherapy.
Inability of the male partner to be present or to deliver the semen on the day of procedure(however, the frozen semen is used as a standby and fresh sample is always preferable)
Testicular biopsy / sperm freezing to avoid repeated biopsies.
Donor semen, until getting a repeated investigation done for the infectious diseases.

Semen Bank:
We are having a semen bank at ARRU. The bank contains frozen sperm from voluntary donors with various backgrounds and physical characteristics to match with the individual needs. Donors are screened thoroughly to rule out transmission of any infectious or genetic diseases.

Investigations Required For An ART Procedure:

For successful conduction of the ART procedure(s) the couple has to undergo certain investigations:
Investigations for female partner:
1. General health check tests.
2. Hormonal assay.
3. Invasive tests- HSG, Laparoscopy, Hysteroscopy
Investigations for male partner:
1. Semen analysis
2. Semen culture & sensitivity
Investigations for both the partners:
1. HIV
2. Hepatitis B
3. Hepatitis C
4. VDRL
5. Blood group

Risks involved:

1. Multiple pregnancy: To enhance the chances of success (approximately 10% with single, 20% with two, 30% with three embroys ), more than one embryo are usually transferred at a time, in some cases all the transferred embryos get implanted leading to multiple pregnancy. Most people would not mind twins but conception with three or more embryos/fetus would be a serious set back. You would be given the choice regarding the number of embryos to be transferred, however if you conceive with multiple fetuses a minor surgical procedure under USG guidance can be carried out on an outpatient basis to reduce the number of foetuses conceived ( selective foetal reduction).

2. Ovarian Hyperstimulation Syndrome (OHSS): OHSS is a potential complication of ovarian stimulation therapy, patho-physiology of which is not clearly understood. The risk of OHSS is somewhat directly related to the number of follicles and the hormone levels. Therefore sometimes it may be advisable to cancel the cycle before egg retrieval if risk of OHSS is extremely high. However even with only a few follicle it is not impossible for the patient to experience OHSS problem. Mild cases of OHSS may pass unnoticed while severe cases may lead to abdominal distension, vomiting, breathing difficulty, reduced urinary output etc. the incidence of OHSS varies from 8-23% in reported literature most of these cases have mild to moderate problem but 1-7% of patients may require hospitalisation and supportive treatment. If no pregnancy occurs this syndrome will typically resolve within 1-2 weeks, in the setting of a maintained pregnancy slow resolution of symptoms usually occurs and may take up to 1-2 months.

3. Failure at different steps of IVF treatment: Despite the best attempt to stimulate ovaries in few cases ( advanced age, raised FSH levels etc.), there may be no follicular development or no oocytes may be obtained from the follicles following oocyte retrieval procedure, or all oocytes may fail to fertilize due to oocyte or sperm factor. In such cases there will not be any embryos for transfer. These patients may be advised to consider donor Oocytes, sperm or embryos in their future attempts.

4 Ectopic pregnancy: The ectopic pregnancy rate following IVF pregnancies varies from 2-11 % as compared to 2.5% in general population. The reason of ectopic pregnancy after IVF and embryo transfer is multifactorial.

Success rate:
IVF has a variable success rate in different patients. The reason for this may not always lie in the technique itself, but is due to the variety of abnormalities which are causing the basic infertility. Some of these abnormalities respond well to IVF while others do not. This means that some patient will have a good chance of pregnancy others will have a poor chance.
Success rate of a center represents the number of pregnancies achieved out of total number of cases performed over a period of time. At our center we are currently having approximately 40% pregnancy rate per attempt.