ART Pregnancies

Infertility can affect both men and women. Some reasons for infertility are as follows:

In Males

• Erectile deficiency or ejaculatory problems occuring as a result of ejaculatory failure or impotence
• Sperm production/ sperm count disorder — includes azoospermia and oligospermia. Some sperm cells are malformed or die before reaching the egg.
• Age: Age is one of the major causes. Males who are aged have a lesser sperm count.
• Structural abnormalities: The shape of sperms or their motility are affected, preventing sperms from swimming towards or binding with the eggs.

In Females

• Failure of the ovaries to produce eggs due to ovulation disorders like PCOS.
• The uterine lining quality such as endometriosis wherein the tissues of the womb invades, leading to damage to the adjacent reproductive tissues.
• The fallopian tube structure - obstruction in the tube prevents the fusion of sperm with the egg.
• Advanced maternal age - quality of the egg of the woman decreases with age and can restrict her ability to conceive.

Several types of ART procedures can be done that involve different reproductive cells and techniques. A healthcare provider can suggest to you the ART procedure that will be most suitable depending on the circumstances. The commonest type of ART is in vitro fertilisation (IVF).

IVF

IVF involves a healthcare provider who extracts eggs and fertilises those in a special laboratory. This can be combined with an embryo transfer and transferring those into the uterus of a person. Achieving pregnancy may take more than one IVF cycle. Some people may not even conceive with IVF at all. The advantages of IVF are increased chances of pregnancy and fertilisation. Following are the potential complications:

• Side effects from fertility medications like ovarian hyperstimulation syndrome.
• Multiple pregnancy or implantation of two or more embryos simultaneously.
• Ectopic pregnancy, where the embryo settles outside the womb.

Steps Involved

IVF can be employed to treat infertility due to sperm antibodies, oligospermia, tubal dysfunction, unexplained fertility, or endometriosis. Following are the steps involved in the procedure:

• Controlled ovarian stimulation
  Gonadotropins alone or a combination of gonadotropins and clomiphene can be used. A gonadotropin-releasing hormone (GnRH) antagonist or agonist is usually given to premature ovulation. After adequate follicular growth, hCG is given to trigger the final ovulation and follicular maturation. Alternatively, another group of medications is used to trigger ovulation in females who are at a high risk of developing ovarian hyperstimulation syndrome.
• Oocyte retrieval
  Around 34 hours after introducing hCG, oocytes can be retrieved by giving direct needle puncture to the follicle, usually transvaginally with ultrasound guidance or less commonly using the laparoscopic method. Natural cycle IVF is offered as an alternative at some centres. The pregnancy rates are lower with this technique than those with retrieval of multiple oocytes. However, the success rates are increasing and the costs are lower.
• Fertilisation
  Oocyte insemination in vitro is done and the sample of the semen is typically washed multiple times with tissue culture medium and is concentrated for motile sperms, which are then mixed with the medium that contains oocytes. Intracytoplasmic sperm injection or injection of one sperm into each oocyte may be done at this point, especially if spermatogenesis in the male partner is abnormal.
• Embryo culture
  After addition of the sperms, the oocytes are cultured for around 2-5 days.
• Embryo transfer
  Only a few of the resulting embryos are transferred to the uterus, which minimises the chances of having multi foetal pregnancy, the most common risk of IVF. The number of transferred embryos is determined by the age of the woman and the chances of response to IVF.

All or some embryos may be frozen in liquid nitrogen so that those can be transferred in a subsequent cycle. The tendency to place only one embryo at each transfer and freeze the rest of the embryos for subsequent cycles is increasing for those pregnancies that don’t result. Birth defects are slightly commoner after in vitro fertilisation. However, experts are not certain about whether the higher risk is due to in vitro fertilisation or other factors contributing to infertility as infertility itself enhances the risk of birth defects.

Preimplantation genetic testing can be performed on cells from an oocyte’s polar body or cells from an embryo (either a trophectoderm cell from a 5- or 6-day-old embryo or blastomere from a 3-day-old embryo). Testing may include preimplantation genetic screening so that aneuploidy and/or preimplantation genetic diagnosis can be ruled out to check for certain complicated hereditary disorders. If the results of the test are delayed, the blastocyst can be frozen and transferred in a later cycle after we know the results.

Intrafallopian transfer

Some ART methods are similar to IVF. However, the gametes can be directly transferred into the fallopian tube with laparoscopic surgery. This method may be chosen by people for religious reasons. Just like other types of ART, there is a high risk of multiple pregnancy. Apart from that, due to laparoscopy, there is an increased risk of complications due to surgery such as organ puncture, infection, or side effects from anaesthesia. Intrafallopian transfer procedure is usually more expensive than IVF. Due to increased risk of this type of ART and higher cost of treatment, these procedures are rarely used these days. Following are the types of intrafallopian transfer:

• Gamete intrafallopian transfer (GIFT)
  This procedure involves collection of sperms and eggs in a tube before a healthcare provider introduces the gametes directly into the fallopian tubes using laparoscopic surgery. As no IVF is involved, a person does not have to choose which embryo to transfer.
• Zygote Intrafallopian Transfer (ZIFT)
  ZIFT is a combination of GIFT and IVF. Healthcare providers stimulate and collect the eggs with the help of IVF methods and mix the eggs with the sperms in a laboratory before the zygotes or the fertilised eggs are returned to the fallopian tubes. An advantage of ZIFT is that it may help those with severe infertility issues or damaged fallopian tubes get pregnant.

Frozen embryo transfer

Frozen embryo transfer (FET) involves thawing and inserting previously IVF frozen embryos into the uterus of a person. Frozen embryo transfer is as safe as using fresh embryos for treatment.

Intracytoplasmic sperm injection

Intracytoplasmic sperm injection (ICSI) is a procedure that doctors can choose to perform alongside in vitro fertilisation to help fertilise an egg. An embryo specialist or an embryologist employs a small needle to introduce a single sperm directly into the centre of an egg.

ICSI fertilises around 50–80% of eggs. Its success rate is similar to that of IVF, and it can be an effective method of ART for females who have sperm-related infertility problems. It is typically used as an add-on procedure to IVF, so it is naturally more costly than IVF alone.

Following are some things to consider about ICSI:

• Some or all of the eggs may be damaged as a result of the procedure.
• The eggs may not become an embryo even after being injected with sperm.
• If a female gets pregnant naturally, there is a 1.5 to 3% chance that the baby will have a prominent birth defect. The underlying infertility may be the cause of the birth defect rather than the treatment.

Third-party ART

Third-party ART refers to when other individuals donate sperm, eggs, or embryos to a couple or an individual. It can also include gestational carriers and surrogates. It is when another person is either inseminated with sperm from the couple with ART or implanted with an embryo from those using artificial reproductive techniques. Following are some benefits of using third-party ART:

• It may help avoid passing on specific conditions.
• It may work when IVF has failed repeatedly.
• It may help people who produce healthy eggs but face challenges carrying a pregnancy to term.
• It can help people who have difficulty producing a sperm or egg.

Artificial insemination: Introduction of sperms into the uterus or female cervix deliberately to achieve pregnancy without sexual intercourse. Following are the types of artificial insemination - intracervical insemination, intrauterine insemination, and intratubal insemination.

Preparation for ART

Preparation for the ART treatment includes practices that may improve the chances of success of ART. This involves dietary changes like taking supplements that a doctor recommends and reducing caffeine and alcohol intake. It could also include quitting smoking and regular exercise. After ART is successful, prenatal tests and care can help keep the baby and the pregnant female healthy during pregnancy.

If you are looking for a centre for ART treatment in Indore, you can visit Kokilaben Dhirubhai Ambani Hospital, Indore and get an appointment with an expert doctor who will guide you to the next step. Meet the best gynaecologists in Indore for dedicated medical services for ART. All the procedures are performed by highly skilled doctors who ensure that they are accurate and error-free. Our team is renowned for IVF treatment in Indore.

Top gynaecologists in Indore perform ART procedures with great expertise. The Department of Gynaecology & Obstetrics follows the best medical practices to optimise the quality of results. Further our laboratories are computerised workplaces equipped with high-end software for Hospital Information systems (HIS) where each patient’s medical condition and reports are uploaded.