NOVA IVF Fertility is witnessing a substantial increase in footfall of patients suffering from infertility from Tier II and III cities in Tamil Nadu
- The causes for infertility are numerous but can be categorized around issues pertaining to ovulation and egg quality; sperm production, transport and function; fertilization; and implantation.
Chennai, India - October 31st,
2019: Infertility can
be caused by a variety of diseases and medical conditions and affects about one
in six men and women of reproductive age. NOVA IVF Fertility, one of India’s
largest fertility service providers, has reported to have witnessed a rise in
cases of infertility in Tier II and III cities in Tamil Nadu.
Previously,
couples who were over 35 years of age were considered to have reduced
reproductive potential and were advised IVF with donor gametes. Today, couples
from rural areas have been found to have a lower potential to produce their own
biological gametes than the couples from urban areas and were advised IVF
cycles. When the ovarian reserve was highly reduced (low AMH, low AFC) and very
poor quality of oocytes or poor sperm morphology and extremely low sperm
quantity, they were advised on the third party reproduction using donor
gametes. Nowadays, there seems to be an increasing number of young people even
around 30 yrs onwards to have poor quantity and quality of eggs and sperms and
hence,poor quality embryos. This trend is more obvious in rural areas than in
urban areas.
 |
Dr Madhupriya, Fertility Consultant, NOVA IVI Fertility,
Chennai
|
Poor ovarian
reserve (POR) is an important limiting factor for the success of any treatment
modality for infertility. It indicates a reduction in quantity with or without
quality of oocytes in women of reproductive age group. As a woman ages, the
eggs and the cells around them can accumulate damage that is beyond repair, and
such damages are commonly caused by contemporary lifestyle choices and habits. Factors
such as use of pesticides in fruits and vegetables, passive smoking and
consumption of unhygienic fast food, which is more common in rural areas is
assumed todeplete the quality of eggs prematurely in women. With the increasing
age, the body can also be affected by poor dietary intake, poor blood
circulation, disturbed hormonal balance, autoimmune disorders, and other health
problems too.
Addressing
the concerns around diminishing ovarian reserve and the available treatment options,
Dr Madhupriya, Fertility Consultant, NOVA IVI Fertility, Chennai commented, “We have been
witnessing a substantial rise in cases of infertility by in Tier II and III
cities in Tamil Nadu, the most common increasing concern being low quality
sperm/eggs. The couples whocomefor
fertility treatments may have fair knowledge about IVF only and in some cases,
many would have had failed IVF cycles which made them believe that they can
never conceive again. However, alongside IVF, there are several fertility
treatments which can lead to obtaining their own biological gametes.The couple
can go ahead with donor gametes if at all this cycle fails. It is important
that patients are counselled, basis their existing medical conditions along
with information about the various treatment options available.”
Diagnosis of Diminished
Ovarian Reserve
AMH test is used
to check whether one’s ovarian reserve is appropriate for the age, assess the
outcome of an IVF cycle as low levels of AMH could indicate a potentially poor
response to IVF, know whether chemotherapy or ovarian surgery has affected
fertility, diagnose an ovarian tumour or to plan pregnancy in future. A
typical AMH level for a fertile woman is around 4.0 ng/ml; under 1.0
ng/ml is considered low and indicative of a diminished ovarian reserve.
a) Intra-Uterine Insemination
(IUI): IUI is a fertility treatment where sperm is
inserted directly into a woman’s uterus during ovulation; decreasing the
journey for the sperm to the egg. During ovulation, the woman produces one egg
that is picked up by the end of the fallopian tube where it waits to meet the
sperm. An IUI deposits higher concentrations of good quality sperm close to
where the egg is waiting which increases the chances that the egg and sperm will
unite.
b) Intra-Cytoplasmic Sperm
Injection (ICSI): Intracytoplasmic
sperm injection is an in-vitro fertilization (IVF) procedure in which a single sperm cell is injected directly into the
cytoplasm of an egg. This technique is used in order to prepare
the gametes for obtaining the embryos that may be
transferred to a maternal uterus.
Case study 1:
Growth Hormone Protocol
Shailaja
(name changed), aged 30 years, came to NOVA IVF Fertility, Chennai for diagnosis
and treatment. The patient had a history of many failed IUI cycles, 1 failed
ICSI cycle also a history of severe endometriosis with a tubal disease, for
which her tubes were disconnected prior to the first cycle of IVF. When she
visited Nova IVF Fertility a year after the failed cycle, her AMH level was
then 0.6ng/ml and hence, was uncertain about opting for a self-cycle once
again, given the history of failure and low AMH value. The doctors at Nova
counselled the patient on donor as well as self ICSI cycle, post which she
decided to opt for a second self-cycle at NOVA. Her stimulation cycle included
growth hormone protocol, which gave us 7 oocytes, of which 5 fertilised and 4
of these reached the blastocyst stage. Finally, two of the embryos of these
were transferred and this gave Shailaja her own biological oocyte, and the
patient conceived successfully.
Case Study 2:
ICSI with
growth hormone protocol and gonadotrophin stimulation( Mild Stimulation
protocol)
Mrs. T , 29 yrs old who had previous
multiple cycles of IUI and ovulation induction failed. Her AMH was 0.2 and AFC
were a total of 5 on both sides. Mild stimulation protocol with growth hormone
was finalized after confirming that here endometrium was good and her husband’s
semen parameters were good to go for an ICSI cycle except for a mild
adenomysosis. Her endometrial receptivity was checked and was good and on the
growth hormone cycle she had 5 mature oocytes, 5 fertilized and all the 5 grew into
blastocyst on day 5 and 6. The first 2 embryos were transferred and she had a
biological baby in her first cycle who is one year old.
Case Study 3:
IUI with
growth hormone protocol and gonadotrophin stimulation – AMH less than 1
Mrs. DE,had a previous pregnancy 7 years
back a case of secondary infertility. When she visited Nova she had a poor
ovarian reserve, her AMH was 0.7ng/ml,antral follicle count was 2 on one side
and 1 on the other, giving her a total of 3 or 4 follicles during the IUI cycles.
She was stimulated with growth hormone protocols and gonadotrophins. She had 2
IUI cycles and 2 natural cycle with ovulation induction cycles with growth
hormones and gonadotrophin protocol. On her 5thIUI cycle, which was
her 3rd IUI cycle she conceived and has had her own biological baby.
Case Study 4: Azoospermia
and severe OATwhere it comes to male infertility they might be
Obstructive Azoospermia with good sperm production. With these couples options
of procedures such as TESA, TESE or micro TESE are possibilities for solving
male infertility. Patient had very few immotile sperm on the
ejaculate. They were counseled to go ahead with ICSI after subjecting the sperm
to HOS and selecting the HOS+ve sperm. Hypo osmotic swelling (HOS) positive
sperms were injected and of the 20 eggs that were retrieved from the female
partner, 9 fertilised of which 2 became blastocysts. Both the blastocysts were
transferred and they conceived with twins.
ICSI with
Micro TESE
A
patient had azoospermic with focal spermatogenesis in one area on a small
volume testis. Hence micro TESE was done as with TESA, TESE no sperms were
extracted. ICSI was done with oocytes and rest frozen for donor sperms if
required. 7 oocytes were injected with micro TESE sample and 2 were fertilised.
One embryo was transferred and she conceived with a baby who is now 2 year old.
Micro TESE is another option to obtain biological child. In
people who have moderate to severe Oligoasthenoteratospermia but good motility
but not going in for IVF / ICSI because they couldn’t afford it, we have pooled
samples IUI cycles even with 2 – 3 semen samples (less than 3 million).
We
also have an option of cryopreservation for both men and women who aren’t married
(Social Freezing) or when they are undergoing cancer treatment (Oncofertility).
As technology has improved in cancer treatment these survivors come back for
checking their reproductive potential. This is possible only if they are aware
of the options available for preserving the oocytes or sperms before undergoing
radiotherapy or chemotherapy. In girls and boys undergoing cancer treatment,
ovarian tissue / testicular tissue can be frozen (pre-puberty) which is to be
done before they go ahead with oncology treatment.
“Couples
who have not tried to conceive via self-cycles should be counselled regarding
the different techniques that are available and there is financial aspect, to
give them an understanding of the possibility of using their own egg and sperm.
One must always be encouraged to try the procedure with their own gametes, and
in cases where the self-cycle fails, they can then go ahead with donor gametes
as the last option” added Dr Madhupriya.
About Nova IVF Fertility
Nova IVF
Fertility (NIF) is among the largest service providers in the fertility space
and has successfully achieved over 25,000 clinical pregnancies through IVF. NIF
brings the same exceptional standard of processes, protocols, and policies
across all our centres in India.
In addition to
providing core procedures such as IUI, IVF, ICSI and Andrology services, NIF
offers several state-of-the-art technologies such as vitrification for
preserving embryos and eggs, ERA to find out the timing of the uterus' capacity
to accept embryosPGT for the transfer of genetically normal embryos – all
procedures that significantly improve the chances of a pregnancy following
IVF-ICSI, even in patients with multiple previous failures. NIF currently
operates 20 fertility centres in India (Ahmedabad (2), Bengaluru (3), Chennai,
Coimbatore, Hisar, Hyderabad, Indore, Jalandhar, Kolkata, Lucknow, Mumbai (2),
New Delhi (2), Pune, Surat, and Vijayawada). For further information, visit www.novaivifertility.com
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