IVF Specialist Gurgaon,Best Gynaecologist Gurgaon,Best IVF Treatment Gurgaon
Through IVF it is possible to select the genes your baby would inherit by the Process of PGD.It isn’t about designer baby’s but taking help of technology for betterment of human kind.Women who and their daughters are more prone to breast and Ovarian cancer due to presence of BRCA1 and BRCA2 genetic mutation can select an embryo for transplant who is devoid of these genes and thus improve her families genetic pool.
This one came as a surprise to me.I am not for or against it but this particular request left me wondering or atlas gave me food for thought.Have encountered the request for muhurat for Embryo transfer but this one was unique.First of it’s kind.
Somebody requested me to time the time when retrieved egg was mixed with the Sperm.As per that gentleman this was the correct time based on which the astrological findings were based in a human beings life and not on the time of birth.
Now if thats correct then all our Janam Patri’s are incorrect and so the astrological readings.In that case Muhurat Caesarean is a thing of past.More over in natural conception we don’t know the time when actually fertilisation took place.And unless ICSI even in simple IVF we really don’t know the exact moment of fertilisation.
Oh God….that’s too complicated 🙂 Anyways ,as long as it doesn’t do any harm or too cumbersome,I think we can keep guessing the right Muhurat and try best for our Children as well as future children.What’s the correct time in case of a FET ??
Interesting is all what I can say 🙂
Few years back I gave my own feedback for the patients to understand my working style and thus find it easier to choose or relate with me or not relate with me.It did help them as well as me.
Now I realise that I am a changed person than what I was till 2014 and thus it would be appropriate that I do my self assessment correctly.
Previously I used to go through each and every online report of each of my patients and advise them as well.Now I don’t do it at all.As per supreme court of India it is a punishable offence if a doctor trees a patient without making a diagnosis.There are many cases where doctors tried to helped their patients and ended behind the bars as they had treated online without seeing the patient in person.
I was always bad in picking up phone calls as that I found really irritating while you are attending one patient,you ignore her and start talking to some one else but I used to be good in reverting back at text messages.Now I have delegated this duty to my colleagues dr Ankita Mittal and Dr Pooja Marwaha who keep you informed as well as I know what is going on with you.
For your treatment i am always there whether a cold case or an emergency as before.
One more differenceI travel abroad quite a bit.my commonest destination is Australia ,which i have to visit to maintain my FRANZCOG degree as well as to become an Australian citizen as well .So this December and march 2019 I would not be in India to complete my required number of Australia stay.After March 2019 I shall not be going out as frequently.In my absence Dr Ankita and Dr Pooja are in a situation to take care of you at Artemis hospital.
Though I am unable to make every person a happy person,we still try to be ethical and honest with our work.
Evaluating Infertility
What type of doctor does an infertility evaluation?
Your obstetrician–gynecologist (ob-gyn) usually will do the first assessment. You also may choose to see a specialist. Infertility specialists are ob-gyns with special training in evaluating and treating infertility in women and men. These specialists are called reproductive endocrinologists. Men also may be evaluated and treated by a urologist. Some urologists have special training in male infertility.
What causes infertility?
The most common cause of female infertility is lack of or irregular ovulation. The most common causes of male infertility are problems in the testes that affect how sperm are made or how they function.
Other factors in women include problems with the reproductive organs or hormones. Scarring or blockages of the fallopian tubes may contribute to infertility. This may be the result of past sexually transmitted infections (STIs) or endometriosis. Problems with the thyroid gland or pituitary gland also may contribute to infertility. In men, blockage of the tubes that carry sperm from the testes may be a cause of infertility.
How does age affect fertility?
For healthy couples in their 20s or early 30s, the chance that a woman will become pregnant is about 25–30% in any single menstrual cycle. This percentage decreases rapidly after age 37 years. By age 40 years, a woman’s chance of getting pregnant drops to less than 10% per menstrual cycle. A man’s fertility also declines with age, but not as predictably.
Can lifestyle affect fertility?
In women, being underweight, being overweight, or exercising too much may be associated with infertility. In both men and women, drinking alcohol at moderate or heavy levels may be a factor in infertility. In men, smoking cigarettes and marijuana can reduce sperm count and movement.
What should I expect during my first visit for infertility?
The first visit with a fertility specialist usually involves a detailed medical history and a physical exam. You will be asked questions about your menstrual period, abnormal bleeding or discharge from the vagina, pelvic pain, and disorders that can affect reproduction such as thyroid disease. You and your partner will be asked about the following health issues:
What do results from a urine test determine?
A urine test determines when and if you ovulate by detecting an increase in the levels of luteinizing hormone (LH) in the urine. A surge in the level of LH triggers the release of an egg. If the test result is positive, it suggests that ovulation will occur in the next 24–48 hours. This gives you an idea of the best time to have sex to try to get pregnant.
How is a progesterone test done?
For a progesterone test, a sample of blood is taken about 1 week before you expect your menstrual period. The level of progesterone is measured. An increased level shows that you have ovulated.
Why would a thyroid function test be done?
Problems with the thyroid gland may cause infertility problems. If a thyroid problem is suspected, levels of hormones that control the thyroid gland are measured to see if it is working normally.
What is a prolactin level test?
This test measures the level of the hormone prolactin. A high prolactin level can disrupt ovulation.
What are tests of ovarian reserve?
The term ovarian reserve refers to a woman’s supply of eggs. Blood tests are used to check the remaining number of eggs.
Why are imaging tests and procedures done?
Different imaging tests and procedures are used to look at the uterus, ovaries, and fallopian tubes to find problems. Some procedures also are used to treat certain problems if they are found. The procedures that you may have depend on your symptoms as well as the results of other tests. Common imaging tests for female infertility include the following:
A question which is often asked by my patients after a failed cycle despite my pre IVF cycle priming and counselling.It is frustrating for Patient and doctor alike when an IVF cycle fails.I don’t make any claims of having a fantabulous IVF success rate.Till date any one quoting it anything more than 35 – 40 percent isn’t telling you the complete truth.
Let us first understand the reason that why is IVF such a wasteful process.Every month around 300 follicles undergo degeneration as they are unhealthy.By giving gonadotrophin we are forcing them to grow and mature but that doesn’t necessarily means a successful implantation or conception or live birth.
Let me discuss a case scenario.A 35 years old Lady with PCOD in whom I retrieved 12 embryos.7 became blastocysts.And can you imagine how many of them were actually healthy? It is shocking .We got Pre implantation genetic testing done .And there were just 2 which were not having any chromosomal anomaly.Which means 10 of these embryos would have either not got implanted or would have miscarried or we would have needed to terminate the pregnancy.
So it is unhealthy eggs and thus embryos which are the reason of the disappointing results that IVF provides.It is no one’s fault.Not of your IVF specialist and not of you who can blame inadequate rest for failed cycle of hers. Relax.Plan early.Plan your pregnancy in time.And if you don’t have a partner at right time ,Freeze your eggs,If you have a partner ,Freeze your embryos as we have got more experience of freezing embryos than freezing eggs.
Here I have not included the cost of investigations.
The first process is controlled ovarian Hyperstimulation which involves medicines which are costly.The cost of the medicine would depend on the need of your body.Some women need less medicine and some need more medicine to get similar degree of stimulation.But if you keep an estimate of INR 75,000 plus minus INR 10,000 it would be quite close to what you would eventually spend.
IVF involves Ovum pick up and embryo transfer.Both these procedures need IVF lab and OT.It also involves skills of embryologists apart for the infertility specialist.This amount varies from IVF centre to IVF centre.A good IVF lab needs good quality control and that has big role in determining the success of an IVF programme.A decent IVF lab would charge you around a Lakh.
If you decide to freeze the embryo,it would be another 30-40 thousand INR and you should find it out at the IVF lab .
If you decide to get a PGT done it comes quite costly as not many centres perform this procedure currently.The one I am associated with and provides this facility ,they charge 1.85 Lakhs ( over and above the 1.75 lakhs for the medicine and the procedural charges for IVF))
If it involves Ovum donors the ovum donating agency usually charge 80000 to 1.2 lakhs for a decent educated and pleasant donor.
Semen donors charge less.
This isn’t a comprehensive list but just rough estimate of what you need to be ready with when planning an IVF cycle.The costs can be less or more depending upon the IVF centre you choose.
Surrogates can cost around 8- 10 Lakhs apart for the delivery expenses.
Blockage of tubes.Does it sound familiar.Well you might have come across the term on one of the so many infertility help groups or blogs or Google in general where a female might have mentioned it as her cause of infertility.
What tubes do? They carry the egg released from the ovary in the tube where it gets fertilised by the sperm and moves into the uterus.If tubes are blocked this essential step won’t happen normally in the body.Why tubes get blocked.Most of the time we don’t find a reason but the common ones are previous pelvic infections.In India pelvic Tuberculosis is a common condition but still not as common as suspected by the IVF specialists.Other infections can be chlamydia or other sexually transmitted infections and the disease called endometriosis.
There are many such stories to talk about but I will choose one such case history randomly to make you understand more about tubal factor in Infertility.
A couple came to me for infertility investigations.What I found on Sonosalpingography i.e passing the saline through the tubes while observing it with an ultrasound machine that the tubes were bilaterally blocked.So now if there is a block ,what do you do?
Open the tubes or proceed for IVF where you bypass the need of tubes by fertilising the eggs outside the body.Of course I got her tested for genital tuberculosis as well as gave her azithromycin tablet just incase she had Chlamydia( After all a tablet of Azee comes cheaper than the test for Chlamydia).So there was no evidence of genital tuberculosis .
In modern day infertility treatment tubal surgery unless very minimal has got no role.Opening of tube doesn’t mean that the doctor has been able to restore the normal functioning as well as structure of the fallopian tube.Which would simply mean that you are not sure even if the doctor has opened the tube still you will get pregnant or not.There is also an increased chance of Tubal or ectopic pregnancy.So no doctor who follows evidence based medicine will give you an option of ‘opening the tube’.
The more realistic and cost effective treatment is IVF.Only 35 % but still it is a realistic option of conception per cycle.Even in IVF there is 4% increased chance of ectopic pregnancy that spontaneous conception but still it is better option than a tubal surgery any day.
Now this couple insisted upon tubal surgery and I did perform a hysteroscopic cannulation and laparoscopic fimbrioplasty.It opened one side of the tube.But was it the correct treatment.No it wasn’t. At least it isn’t the evidence based option.If I think in terms of my monitory benefit it is all good but probably that wasn’t the idea.the idea was to help them conceive.But who knows whats in store for her.miracles happen and if by chance the sperm sneaks in through that tube it was the wisest decision on part of the couple.If they failed or if she has an ectopic pregnancy,few more years would be wasted.Eggs would be little more old.More chance of having aneuploidy and chromosomal defect.Poor IVF response and if she conceives more chance of miscarriage.
Fingers crossed and let me hope she conceives.
https://gurgaonivf.blogspot.com/2018/11/safe-age-to-get-pregnant.html#links
Women with PCOD who need IVF behave slightly differently than those with ought PCOD.They have for more number of follicles in their ovaries to stimulate and even low dose of medicine works well for them.It is a boon but can be a bane too as too many follicles can lead to dreaded OHSS (Ovarian hyper stimulation Syndrome).
Thankfully in today’s time with agonist trigger and Frozen embryo transfer majority of these Women can be prevented from having life threatening OHSS.
Ever since I started practising reproductive medicine and IVF ( which isn’t long – 2015 to be precise )
I realised few things
1) It is good to know the physiology …. it is always helpful in tweeking the limited number of available medicines to customise as per your patients physiology or pathology . You can always add on a fancy LH and HGH ….. it helps sometimes
2) As a rule of thumb – younger your patients egg….. more are the chances of successful conception – no rocket science there.
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3) A Good Embryologist and supporting team and good quality of the IVF lab are very crucial for attaining that 35-40 percent , otherwise the rates would be less than that.
4)Most importantly when God will be kind on which couple is ultimately the final determinant 
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And for freshers who start ….. don’t get disheartened …… it is disheartening to see failures and you self doubt your capabilities….. because initially you have limited number of patients . Once your patient number increases and you see the results of your seniors , you realise even they don’t have much success than the routine 35 -40 percent .
PGS / PGD is still in it’s infancy in India ( we will certainly get better as it becomes cheaper or more affordable and when embryologists get their fair share)…. so don’t get hassled if any one quotes ….. PGS sae to hamare 100 percent success rates haen .Not many counsel for it routinely 
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