Diagnosis and treatment

IUI is a form of Assisted reproductive technology (ART) treatment procedure. It works by putting the sperm directly into the uterus, in close proximity to the egg, around the time of ovulating, helping the sperm get closer to the egg. This brings down the time and distance sperm has to travel, making it easier to fertilize the egg.

Semen is collected from the partner (or a donor, if needed) which then goes through a process called “sperm washing” that collects healthy sperm from the semen. Then the insemination of the washed sperm, into the uterus is done. This is a simple procedure in which the doctor slides a thin, flexible tube through the cervix into the uterus and a small syringe is used to insert the washed sperm through the tube directly into the uterus. Pregnancy occurs if sperm fertilizes the egg, and the fertilized egg implants in the lining of the uterus.

IVF is one of the more widely known and used types of assisted reproductive technology (ART) procedure. IVF works by using a combination of medicines and surgical procedures to help the sperm fertilize an egg.

First, medication is given to ensure several eggs mature and are ready for fertilization. Then the doctor takes the eggs out of the ovary with the help of a procedure called ovum pick-up (OPU). This is done under anaesthesia and requires a lot of skill and practice. An embryologist then mixes the extracted eggs with ‘washed’ sperm from the partner, in the lab to help the sperm fertilize the eggs. These fertilized eggs (embryos) are then cultured and grown in the lab for a few days and their growth is tracked until they become viable embryos.

Subsequently, one or more embryos are then directly introduced into the uterus using a procedure called embryo transfer. A successful pregnancy occurs if any of the embryos implant successfully in the lining of the uterus. There’s a 55% chance for having a baby after one cycle (month) of IVF treatment and success rates vary greatly between IVF clinics. At GarbhaGudi, our success rates stand at over 66 % which is one of the best in the infertility treatment sector.

ICSI is another technique used in an IVF cycle and it stands for Intra-Cytoplasmic Sperm Injection (ICSI). It is a technique where a single sperm is selected by an embryologist and injected directly into each egg. Sperm may be collected by the partner through masturbation or retrieved directly from the epididymis (PESA) or the testicles (TESA), or from the urine (in the case of retrograde ejaculation), or by electro-ejaculation. ICSI is the preferred treatment if the sperm is unlikely to fertilise an egg naturally due to certain causes like low sperm count or abnormal morphology or poor motility or has high levels of antibodies in the semen. It is also used in cases where previous IVF treatment has resulted in failed fertilisation and when frozen sperm is being used.

ICSI procedure requires a very high level of skill and lot of practice, as the eggs and sperms are all microscopic in size. This fertilization has to be done without damaging either the sperm or the egg. The fertilised egg is then cultured in the lab under ideal conditions, for a few days and its progress is tracked. The fertilized eggs start to multiply and they become embryos.

Once viable embryos are available, one or more embryo is then transferred into the womb in the same way as in an IVF cycle. 

In some cases, the frozen embryo ends up having a thick outer wall, which would prevent or make it difficult for the embryo to hatch. In such cases, a technique called laser assisted hatching is employed. In this technique, the embryologist opens a small hole in the outer membrane of the embryo using a high precision laser equipment. This improves the chances of the embryo to implant or attach to the wall of the uterus and achieve pregnancy.

Laser assisted hatching requires a high degree of skill on part of the embryologist and specialized equipment.

TIP:  This may not be needed in all cases of frozen embryo transfer, but only when the zona (outer wall) of the embryo is very thick and hard.

In some situations and with some couples, their bodies are not producing the gametes (sperms and eggs) or are producing low quality gametes which is causing infertility or miscarriages. In such cases, doctors may suggest couples to look at sperm and egg donation.

This is a very sensitive topic as the implication is that part of the DNA of the child will not come from the parents. But the concept is slowly becoming common and there is more acceptance from the couples. Sperm and egg donation is also legal in India, as long as certain rules are adhered to.

The four important aspects for sperm and egg donation are 

• Anonymity – it is mandatory to ensure complete anonymity of the donor and the recipient. Under no circumstance should the donor know about the identity of the recipient couple or the other way. This is essential to ensure further legal and social complications don’t crop up after a few years. Anonymity has to be maintained at all stages, from collection of gametes until transfer of gametes. GarbhaGudi has partnered with ICMR approved semen banks for donor semen and are sourced from these semen banks. Even for egg donation, GarbhaGudi works with authorized ART Banks who are legally allowed to provide egg donors and surrogate mothers.

The whole procedure of stimulating these donors and extracting eggs from their ovaries is done in a very confidential manner. At all stages, data is maintained in a “need-to-know” basis. Only those people who critically need to know about the link between the donor and the recipient will be aware of this link. 

• Donor Screening and Matching – Egg donors and semen donors need to be screened clinically for 2 things – viral infections and quality of gametes. Then matching has to be done to help the couple have a child which physically looks like one or both of the parents.

Screening – Screening the donor for infectious diseases like HIV, HbSAg etc. is very important to prevent unwanted problems for the recipient couple. Exhaustive lab investigations are done to ensure no such diseases are transmitted to the child. When procuring donor semen, GarbhaGudi gets it from authorized semen banks, where the government regulated quarantine periods and processes are maintained and adhered to. 

Quality of the gametes – To ensure that the eggs and semen being taken from a donor is of good quality, some basic requirements are to be met. A semen donor has to undergo a proper semen analysis to ensure equality of semen is as per requirements. Egg donation process is a little more elaborate. All egg donors have to be between 20 to 30 years old, should be married, should have consent from their husbands, should have had a minimum of one child of her own and the child should have reached the age of 2 years and should not have any family history of hereditary diseases / disorders. Additionally, the lady should not have donated eggs in the last 6 months.

Matching – It is important to match the recipient’s physical characteristics with the donor’s characteristics. The usual attributes that are matched are Ethnicity (South Indian, North Indian, Caucasian, African etc.)     Blood group     Height and Skin Color     Color of the eyes and hair We do NOT encourage or support matching on religion, caste, education, social standing (rich / poor) and other social attributes.

• Legal Consent – It is mandatory for both partners to provide clear and unambiguous consent at the hospital (in person) to the usage of donor sperms or eggs. Egg donors should also provide legal consent for the treatment after understanding the risk. They also need to confirm that they will be available for the whole duration of the treatment and will adhere to the guidelines and instructions given to them by the doctor and the hospital.
• Ethical Treatment – There are guidelines defined by the Govt. of India on what is allowed and what is not allowed. Adherence to this is very important. GarbhaGudi has its SOPs which are followed for all donor programs. These SOPs are based on the ART guidelines and are more stringent than what has been prescribed by the Govt. of India.

Women who don’t have a functional uterus or for whom pregnancy poses a serious health risk might choose IVF using a gestational carrier. In this case, the couple’s embryo is placed in the uterus of the carrier for pregnancy and delivery of the baby. This is offered to couples only in cases where a family member is ready to carry forward pregnancy in accordance to the rules of the Government of India.