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Male Infertility
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Intra Uterine Insemination (IUI)
Assisted Reproductive Technologies
In vitro fertilization (IVF)
Intra Cytoplasmic Sperm Injection (ICSI)
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Male Infertility
Common Male Infertility Problems
Treatments of Male Infertility
The male genital tract includes the testes, the epididymis, the vas, the prostate and urethra. The testes situated in the scrotum are mainly made up of
loops of fine tubes (seminiferous tubules) which produce the sperm. The sperm cells mature as they pass through the epidiymis (a narrow system of
tubes on the surface of the testes). The vas is a hollow tube, which carries the sperm from the epididymis to the urethra.
It takes 3 4 months for sperm to develop, during this time sperm production may be affected by febrile illness, exposure to drugs, toxins, radiation,
local trauma or infection.
The primary laboratory test for male fertility is semen analysis. The sample is obtained by masturbation or collected from a special condom
following intercourse. Sterile containers must be used to collect the sample following three days of sexual abstinence.
A normal assessment should show :
Immunological factors :
Antisperm antibodies may occur following surgery, trauma or infections of the genital tract. Antisperm antibodies impair sperm motility and their
ability to penetrate and fertilise an egg.
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Female Infertility
Requirements For Conception to Occur
Normal Cycle
Common Causes of Infertility in the Female
In Women
Normal Cycle
At the beginning of the menstrual cycle, the pituitary gland in your brain releases follicle stimulating hormone (FSH) which stimulates the ovary to
produce follicles. One of these follicles grows faster to become the dominant follicle. It is from this follicle that the egg will be released.
The ovaries also produce many hormones, the most important ones are oestrogen and progesterone. Oestrogen promotes growth of the follicles and
development of the endometrium, while progesterone, which is released after ovulation, is important in preparing the endometrium for pregnancy.
When the egg is released, it is swept into the fallopian tube, then begins to move slowly down the tube to be fertilised in the outer third of the
fallopian tube, and then continues to the uterus to implant in the lining ( endometruim ) resulting in a pregnancy. If the egg is not fertilised, the
endometium is shed as a menstrual period approximately 14 days after ovulation.
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Sperm Preparation
http://www.blossomivfindia.com/intra-uterine-insemination-iui[12/18/2012 5:58:55 PM]
Intra Uterine Insemination IUI | Blossom Fertility & IVF Center - Surat
First, the semen sample from the male partner, or donor, is prepared by spinning it in the laboratory. This is done to separate the sperm from the
seminal plasma (the liquid which carries the sperm) which is known to irritate the uterus. In normal sexual intercourse the seminal plasma does not
enter the uterus, but rather the sperm swim away from it, through the uterus and into the fallopian tube.
Next, the embryologist assesses whether the sample is suitable for IUI. This involves counting the sperm to ensure adequate numbers are present,
checking for healthy appearance and assessing motility (the amount of movement they display).
Finally, to minimise the presence of seminal plasma, the embryologist mixes the sperm with a culture medium.
Insemination
The sperm and culture medium are drawn into a very fine plastic catheter, or tube, which is then passed through the cervix (the neck of the womb)
into the uterus, where the sperm are released. The procedure is usually painless and takes only a few minutes. About 10% of women experience
temporary menstrual-like cramping and, occasionally, a little bleeding. It is usual to lie down afterwards, for 15-20 minutes, after which normal
activities can be resumed.
Possible Side-effects
Separating the sperm from the seminal plasma removes most of the bacteria from the ejaculate, but neither the sperm nor the cervix can truly be
sterilised. There is always the slight chance that IUI could produce an infection in the uterus, although experience has shown this to be a very
uncommon occurrence, with a risk of less than 1%.
Occasionally, even after thorough preparation, some seminal plasma may still be present with the sperm and culture medium. This residual seminal
plasma may cause an irritation in the pelvic cavity, resulting in a feeling of discomfort and bloating. Whilst this may feel as if there is an infection
present, it is not accompanied by fever nor raised white blood cell count, which are the usual signs of infection.
Stimulated IUI
The chances of pregnancy may be increased by the use of fertility drugs, which can be used to support more than one phase of the reproductive
cycle.
Firstly, there are drugs which stimulate the ovaries to produce more than one egg each cycle. Vaginal ultrasound monitors progress by identifying the
number and maturity of ovarian follicles (each follicle can produce one egg). The most commonly used drugs for this phase are Clomid tablets, or
Menopur, Puregon or Gonal F injections.
The next step involves testing for the LH surge. LH, or Luteinizing Hormone, stimulates the egg to ripen and triggers ovulation (the release of the
egg.
Testing for the surge is done from Day 9, using an ovulation predictor kit at home, or by daily urine testing at Bridge. Once the LH surge is detected,
an injection of HCG, either Ovitrelle or Pregnyl, may be given (or self-administered) to ensure release of the egg.
Insemination at Bridge is booked for the day following ovulation.
Finally, Cyclogest pessaries (progesterone) may be used after insemination to facilitate implantation (the process of the fertilised egg attaching to the
uterine wall).
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Surrogacy
Surrogacy is when a woman, surrogate mother, carries and delivers a child that is not genetically related to her. For medical reasons, the wife of the
intended parents cannot carry a child but produces healthy eggs. If the wife cannot produce healthy eggs an egg donor can be used. The intended
mother or egg donor takes fertility medication to produce multiple eggs. At the right time, these eggs are retrieved from the intended mother/egg
donor and fertilized with the husbands sperm in a Petri dish through the process of in-vitro fertilization/Embryo Transfer (IVF/ET). The resulting
embryos are then transferred to the surrogate mother. If a pregnancy results the surrogate mother will carry the child(ren) to term for the intended
parents.
Its a sad fact that IVF (In Vitro Fertilization) technology today is still not perfect. Only one of ten embryos we transfer in the uterus implants
successfully in the endometrium to become a baby. Why is the embryo ( Laser Hatching Video ) implantation rate only 10 ? Some doctors believe this
is because the surrounding shell of the embryo (called the zona pellucida) hardens when it is cultured in the laboratory.
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.
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IVF at a Glance
In vitro fertilization is an option for many couples who cannot conceive through conventional therapies. In IVF,
fertilization occurs outside the womans body. The womans eggs and the mans sperm are united in the
laboratory. Once fertilization occurs, the early embryo(s) are transferred to the womans uterus.
Eligibility Criteria
IVF is an option for couples who have tried unsuccessfully to conceive or for whom other treatments have failed.
IVF was initially developed to help women conceive who had blocked, damaged, or absent fallopian tubes. Other eligible patients are those with
infertility due to a condition not responsive to conventional therapy, including one or more of the following:
Cycle Monitoring
To begin the process of IVF, the woman is given fertility drugs to stimulate egg production and control the timing of ovulation. This helps maximize
the number of eggs produced, thereby increasing the chance that at least one will be fertilized, and will implant itself in the uterus. Frequent blood
tests to monitor hormone levels and ultrasounds to monitor follicle development are required. Stimulation protocols may vary depending on multiple
factors.
Egg Retrieval
The eggs are harvested primarily through a transvaginal ultrasound-guided procedure. The ultrasound-guided egg retrieval is performed on an
outpatient basis with monitored I.V. sedation. Recovery from the sedation requires thirty minutes. The patient is discharged from the surgery center
with instructions to rest for the remainder of the day.
Once the eggs are retrieved and the sperm sample collected, they are immediately given to our embryology laboratory for incubation. Our IVF lab is
located adjacent to our operating room. The mans semen is specially prepared in order to select the most viable sperm. In conventional IVF, the
sperm are then placed together with the eggs in an incubator for 12-18 hours to allow for fertilization. When sperm quality is compromised, the
eggs are inseminated with a single sperm by means of a micromanipulation procedure known as ICSI (intracytoplasmic sperm injection). This may also
be used on half of the eggs to enhance fertilization in some circumstances. Following normal fertilization, early embryonic development is closely
observed on a daily basis.
Embryo Transfer
Within 72 hours after egg retrieval, the embryos are generally ready to be transferred into the womans uterus through a thin tube, or catheter, gently
inserted through the cervix. This is a non-surgical procedure performed under ultrasound guidance with no need of sedation. The woman may wish
to rest for the remainder of the day in order to maximize the chance for success. About ten to twelve days following the embryo transfer, the
womans blood is drawn and tested to determine if pregnancy has occurred.
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IntraCytoplasmic Sperm Injection (ICSI) | Blossom Fertility & IVF Center - Surat
this is achieved the oocytes are returned to the incubator. Fertilization is assessed the following morning, seventeen to nineteen hours after ICSI.
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IVF Success Rates are not affected by bedrest | Blossom Fertility & IVF Center - Surat
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As time progressed, the duration of recommended bedrest after an IVF embryo transfer became shorter and
shorter. Then actual data became to emerge that IVF success rates may not depend on bedrest.
In 1988, a report was published calling into question the logic of bedrest after IVF. The arguement was that since
the uterus is tilted in the body, that in the upright or standing position, the uterus is almost horizontal. It made
more sence, then to have an IVF patient stand rather than lie down. when this IVF group then encouraged
patients to get up after an embryo transfer, their pregnancy rates actually increased!
Another study used ultrasound to study the issue. During an IVF embryo transfer, there are air bubbles present
in the transfer cather that are visible on ultrasound. After the embryo transfer is completed, these air bubbles can be seen in the uterus. It was found
that when patients are asked to stand immediately after the embryo transfer, the position of the air bubble (and by extension the embryos) do not
move.
In the modern are, there are two times in which bedrest has been recommended:
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Eight Ways to Deal with the Emotions of IVF | Blossom Fertility & IVF Center - Surat
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Support Group
If possible find a support group of people who are also going through IVF, or start one yourself. Meet for dinner once a month and enjoy the
company of other people who are also sharing the journey you are on. The comfort, the camaraderie, the sharing of hurts and also of laughter can
help you feel less lonely.
Trusted Friends
Identify one or two friends whom you can call on for an ear to listen to you, for a hug, or just to be with when you need it. You would be able to
share where you are up to with your IVF with these people, so that they can be there for you when need arises.
Talking
It is so important to keep the lines of communication open between yourself and your partner (if you have one). Sharing feelings and thoughts can
help you both feel closer to each other and more aware of how each other are going along the way. Make time to talk and make time to be together.
Journaling
Journaling is a wonderful way to recognise and move through your thoughts and emotions. You dont have to share your journal with anyone, but it
can help you in clarifying anything that you might wish to share with someone else. There are no set rules for what type of journal, how often you
should write in it or on how good you are at grammar or spelling. Just write from the heart.
Eight Ways to Deal with the Emotions of IVF | Blossom Fertility & IVF Center - Surat
kind to yourself.
Counselling
Most IVF clinics have counsellors on staff to assist you in your journey. Make use of them. You are dealing with an incredibly emotional journey and
sometimes knowing what to do can be confusing. IVF clinic counsellors are trained to guide and support you through every stage.
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When to start?
Most couples start on this journey at the office of the wifes gynecologist. During a routine exam, she may mention that she stopped using
contraception some time ago and nothing is happening.
The initial evaluation will typically be simple. Most gynecologists will initially recommend that the patient should monitor her fertile period days ,which
are between 12 to 16 days of period in regularly menstruating women. These monitoring exercises also serve the very important function of verifying
whether the couple is having intercourse at the right time of the month. After this initial step, there is great variability as to how gynecologists will
manage their patients who are trying to conceive.
Some GYNs will immediately give the patient some treatment, typically in the form of Clomiphene citrate (Siphene or fertyl) tablets which will enhance
or establish ovulation. This may be a waste of time if the cause of the infertility is not related to ovulation but it isnt completely off base as a starting
point since about 20-25% of the time it is. Other GYNs will carry out some series of diagnostic tests in an attempt to establish the cause of the
infertility. These tests will typically include evaluations of the husband (semen analysis, post coital tests), the fallopian tubes (hysterosalpingograms
or HSG) and occasionally hormonal assessments (blood tests) or even laparoscopy to rule out endometriosis. Some GYNs will immediately refer
patients to infertility specialists once the diagnosis has been made. It is certainly reasonable for a GYN to carry out an initial evaluation and even
initial treatment but typically if there hasnt been success within 6-12 months, it is appropriate to see a specialist. Unfortunately, some patients may
lose their opportunity to conceive as a consequence of increasing age because they were not treated by a specialist in a timely fashion, especially in
those situations where the woman is over 35 years of age.
example, if a woman seeks out therapy at age 40, hopefully one of the first tests that will be done is some assessment of egg quality. While it may
have been normal when last checked, it is imperative to recheck it periodically if the couple is still not pregnant. Time is always passing! It is very
important that the couple and their doctor work as a team, continuously assessing where they are, where theyve been and where they are going. The
point is that once a diagnosis is available, optimized therapy should be carried out for a few cycles and if there is no success, to re-assess and
change course.
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Getting Results.
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Equipments
Incubators
This is the place where all embryos live and grow before they go back to their mothers uterus. Our 2 Heracell (Germany), 2 Labotact (Germany) and 2
Minc-Cook (Australia) CO2, and Triple gas incubators provide an atmosphere similar to mothers uterus.
Laminar Flow
Laminar flow provides a workplace which provides super sterile atmosphere while handling the dishes, eggs, sperm and embryos.
We at Blossom offer excellent vitrification technique which provides a lot of flexibility to the couple. Also in case of failed cycle, the cost with frozen
embryo IVF is significantly reduced.
Surrogacy
In case of a woman who has no uterus or severely damaged uterus, or a woman who has had multiple miscarriages, we offer surrogacy which enables
the couple to have their own child.
Laser Hatching
In laser assisted hatching, an extremely minute hole is made in the outer shell of the embryo using computer-guided laser energy for repeated IVF
failures or IVF in older age.
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Dr Mitsu P. Doshi
Dr Mitsu Doshi is very reputed,successful and popular gynecologist of Surat.With her efforts,dedication to her field and a
compassion for her patients for last 25 years has also earned her Me and Mummy Hospital such esteemed position that it has
become synonymous with supreme women health care.She was trained for advanced infertility training and IVF at various
centres of USA.She keeps abreast of rapidly evolving medical science through various workshops and conferences all over the
world. She has delivered various talks for patient education on local channels and various clubs.
Apart from hr busy schedule,she enjoys being with her twin teenage sons,travelling and music.
Dr Rupal N. Shah
The young, enthusiastic and energetic consultant of Blossom IVF Centre, Dr Rupal N Shah has been working with senior and
renowned gynecologist Dr. Malti P. Shah since the last 15 years at Rupal Hospital for Women. As this centre was the pioneer of
fertility care and treatment in South Gujarat since 35 years, the passion to treat infertile couples is in the blood of Dr Rupal. She
had obtained Diploma in Reproductive Medicine (Assisted reproductive techniques) From Kiel University, Germany .She has
specialized in all types of Endoscopic surgeries and has taken intense and robust training in advanced fertility treatment
at numerous workshops and conferences in USA and Europe.She is associated with Me and Mummy IVF Centre for last 5
years,during which she has been instrumental in bringing joy in life of many infertile couple through IVF treatment.This
association is now shaping into Blossom IVF Centre. Apart from being a busy doctor,she loves making friends and keenly
interested in gujarati literature and music.
Mr Vishal K. Shukla
Chief Embryologist
Mr Vishal Shukla has been in practice as an embryologist at Me and Mummy IVF Centre since last 8 years and as free lancer to
few selected IVF centres in India.Vishal has an expertise in all sort of assisted reproductive techniques-IVF,ICSI,cryopreservation
of gamates and embryos and laser embryo hatching.He is one of the finest embryologists in India,delivering extremely good
Success Rates
results at IVF & ICSI.He is perfectionist and very particular about his work.He is going to serve as a chief embryologist at
Blossom IVF Centre and going to bring smile to many infertile couple by making their dreams true!
Dr Samir A. Desai
Anaestetist
Dr Samir Desai is senior consultant anesthetist with 22 years of experience and is associated with our fertility centre since its inception.He is having
special interest in pain management including painless delivery by labour epidural analgesia.He is Qualified interventional pain management
consultant,traind at various centres of USA and running state of the art Surat Pain Management Centre with his team.
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Our Values
Professionalism
Superior hospital expertise, a commitment to excellence, and a never ending quest to raise the bar of success for our patients has been the mission
of our practice since its inception. Our physicians have performed many ovulation induction cycles and various IVF procedures with excellent results.
Our hospital houses most modern operation theatres equipped with all the modern equipments. We have a full fledged IVF laboratory and surgery
center. Our hospital symbolizes excellence, experience, and professionalism qualities we embrace on a daily basis.
Technologically Advanced
We have years of experience behind us in providing you the comprehensive services in entire gamut of gynaecological and infertility treatment. We
have handled a large number of cases related to IVF, ISCI, Blastocyst Transfer, Donor Eggs and various other complex processes and have achieved
remarkable successes in them. Know more about our successes in our Success Stories Section. We have remained true to our philosophy of providing
cutting edge medical care in an environment that supports each couple individually.
Psychological Support
We very much understand that gynaecology is a highly sensitive area which needs psychological support at every step. We have a compassionate
nursing staff led by our competent and friendly medical staff to provide you the best of psychological support.
Commitment to Quality
The most advanced infertility treatment is performed at this Center. The treatment is conducted by highly qualified doctors, and other famous staff
members in the reproduction field in India. The facilities within the center is also the most advanced in India. The causes for the infertility depends on
each couple. It is necessary to examine the causes from various points of view. In India, unfortunately, only a few hospitals and organizations are
equipped enough to examine causes of infertility. We are proud to give patients the most appropriate treatment with earnest consultation, the most
tender care and attention. The meticulous attention has resulted in growing confidence in our patients.
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