What is IVF Treatment?

IVF is a procedure in which injectable medicines are prescribed to produce multiple follicles.Once these follicles reach a particular size,a trigger is administered to mature the ovum.The follicles are aspirated under ultrasound guidance and then the harvested eggs are mixed with semen outside by the body by the embryologist.Once the embryos are produced ,they are transferred back in the uterus on day 3,4 or 5 of the retrieval.After 2 weeks it is tested whether the blood test for pregnancy is positive or not.

IVF is overall a safe procedure now with rigid protocols and procedures in place.

There can be associated complications like hyper stimulation of the Ovaries ( OHSS),Twin Pregnancy,Ectopic pregnancy and rarely torsion of the Ovary.At times internal injury can be sustained at the time of Ovum pick up.At #ClinicNirvana we take due precautions to make it as safe as possible for you including mild stimulation protocols as well as adequate monitoring.We encourage Single embryo and double embryo transfer.We discourage putting multiple embryos to get higher pregnancy rate as they are associated with procedures like foetal reduction as well as it complicates the whole pregnancy with increased chances of miscarriage and pretermlabour.

There are so many times I have been asked this question , “IS IVF PAINFUL’?

There are many aspects to be considered to describe it painful or not.

Physically – Physically ,IVF isn’t painful.While having Ovulation Induction ,one does feel bloated and have some stiffness in breasts and nipples and indigestion like symptoms.The Ovum pick up is a 15 minute procedure which is done under anaesthesia or sedation and thus the procedure isn’t paiful. One can feel sore though in the pelvis post procedure.

Emotionally – Emotionally IVF is a draining procedure and failures to conceive can be painful.With a success rate of 35 %,65 % of the times it is painful – No one can deny it and one should have realistic expectation when planning IVF treatment to make it emotionally less painful.

Financially – Financially again it is a costly procedure and though a successful outcome makes one easily forget the pain,multiple cycles can create a financial concern as well.

A very happy independence day to my fellow indians.let us work together to make it a beautiful place to live.

The more I practice the treatment of infertility more I get baffled .What is an ideal IVF cycle,what is the best IVF treatment,what best can you do for your patient who has spent so much of money,is undergoing so much of emotional and physical pain to achieve a baby -the most natural and primitive desire of human kind.

Unfortunately the answer is – well …..no one knows.There are few things which you can control and most you can’t.What can you control??

The IVF Lab – Better quality controlled the lab and it’s  surrounding environment are more is the likelihood of success.

The embryologist – A good embryologist is the back bone of successful IVF Programme.

Good Gynaecologist – Good Gynaecologist is the one who is stimulating the ovulation using the correct protocol as per your need and is able to prevent OHSS as far as possible.She/he is able to give you the emotional support which is much needed while undergoing infertility treatment.

And finally you need loads of luck and good wishes.Despite the best efforts of the people involved including you the Best of IVF cycles fail.It leads to hurt,pain and frustration. And then there comes those positive 2 lines …….which take away all your gloom.The hope ,the happiness which is confirmed by the lub dub lub dub heard on the Ultrasound machine and the flicker of heartbeat seen on the black and white screen which makes your life colourful.

After multiple failure shines the sun and thats the victory of ART/IVF ……Thats the BEST IVF !! 🙂 

How do I loose some weight?This isn’t an uncommon question.Depends on how much weight do you need to loose to reach your ideal BMI.If morbidly obese then Obviously the journey might be little difficult than what I am about to write. If you are over weight or Obese ,strong will power, 30% exercise and 70% diet control is what you need.For loosing weight definitely has positive impact on fertility for male and females both.If you loose even 10 % of your wight the anovulatory cycles become ovulatory.Provided you are medically fit ,30 minutes  to an hour of High intensity exercise or running or Power lifting or yoga should suffice.But it should be a serious attempt to convert your fat to muscles.But the important bit comes from your diet.It has to be controlled diet rich in protein with minimal amount of carbohydrate and fat too.Goes without saying that generous portions of fruits and vegetables are needed for essential antioxidants,vitamins and mineral.

Couples come to me stressed ,distressed,wishing to have kids. A 37 year old lady with 35 year old husband,recently married,Overstressed and not sure which way to go.Got a preconceptions test and some how the Gynaecologist suggested AMH ( Anti Mullein Hormone levels)and they came out bad.Thats when the stress level sore up…very very high.What are the options then? Any realistic option at all?

Try IVF cycle with low AMH with a clear idea that it might be a failed cycle with not even adequate follicles.Or it might work luckily.Probably getting a PGD would be a good idea to increase the success rate.

second is to try ovum donation from a healthy young woman and the chances are fair then.

Third is to try Adoption which takes it’s own sweet time.

The number of Couples needing ART for conception is increasing many fold in India.The reason is most often the delayed age at conception.And the most often than not they are disappointed as the success rate of IVF is only 35 % and thus more cycles would fail than be successful.

WHY IVF CYCLES FAIL.It is multifactorial.But the commonest reason is chromosomal defect and that happens mostly due to ageing of the egg.In case of failed IVF cycle or with a history of recurrent miscarriage incorporation of PGD/PGS in embryo transfer leads to better success rates as by PGD it is possible to eliminate unhealthy embryo before hand and thus avoid transferring those embryos.

At the moment we out source the genome testing to a lab call Igenomic once the embryo has been selected for the PGD testing at our IVF lab.At our Lab Dr Sarabpreet is a well trained embryologist ,who by his latest know how make the PGD a reality atlast.

Not only Empty follicle sounds empty and hollow ,it is follicles which are empty ,just filled with fluids and more fluids.It is strange that I am starting my blog with a rather negative post.But then these empty follicles do leave me empty for atlas 24 hours.I am sure it leaves the Lady empty for a longer duration or probably for life.

It has happened so many times.The lady is given Gonadotrophins in few hundred units and the infertility specialist and the lady are happy counting the growing follicles in the Ultrasound screen .Till the day of Ovum Pick up.When follicles after follicles,one after another,aspirated and are declared by the embryologist with no eggs.

Though not your fault ,as a doctor you feel guilty.It has costed a bomb to your patient and you tell her that it wasn’t successful.There are so many questions.Why? What happened?There were so many follicles.Follicles mean hope.Eggs within.The possibility of healthy embryo and then a BABY.

What goes wrong.Why After all do we have empty follicle.Who has the answer?Well there can Only be hypothesis.Every cycle there are 300 to 350 follicles which are destroyed by atresia.thats how nature wanted it .And these follicles which are destroyed are the unhealthy follicles.We make them grow by pumping hormones from outside.Sometimes we succeed ,sometimes we don’t.The unhealthy follicles meant for atresia don’t have egg within but just fluid.And there lies the answer.

At times ,it might a wrongly timed trigger ( be it HCG or be it GnRh Agonist).A properly timed trigger is a must for maturation of egg.It is just so crucial.The timing should be 36 hours approximately.A delayed trigger would mean immature follicles and an early one would mean loss of egg by ovulation.

Sometimes in PCOS patients the empty follicles are due to increased LH levels.

But what ever the reason ,it leaves with a empty hollow feeling….both for the patient and the doctor.

Dr Dwivedee is an accomplished surgeon who commands respect of her peers and patients alike for her surgical skills including all the minimally invasive surgeries including laparoscopy , Urogynaecology ,non descent vaginal hysterectomy , Stress incontinence surgery , Sacrospinous ligament fixation and clopo suspension.He is quite used to colposcopy ( diagnostic as well as therapeutic).