Intra-cytoplasmic sperm injection (ICSI)

Intra-cytoplasmic sperm injection (ICSI) differs from conventional in vitro fertilisation (IVF) in that the embryologist selects a single sperm to be injected directly into an egg, instead of fertilisation taking place in a dish where many sperm are placed near an egg.  

ICSI enables fertilisation to happen when there are very few sperm available.

Your clinic may recommend ICSI if:

·         you have a very low sperm count

·         other problems with the sperm have been identified, such as poor morphology (abnormal shape) or poor motility (not moving normally)

·         during previous attempts at IVF there was failure of fertilisation or an unexpectedly low fertilisation rate

·         you need sperm to be collected surgically from the testicles or epididymis (a narrow tube inside the scrotum, where sperm are stored and matured); for example because you have had a vasectomy, you do not ejaculate sperm, or because you have extremely low sperm production

·         you are using frozen sperm in your treatment which is not of optimum quality

·         you are using embryo testing.

How does ICSI work?

Before your treatment starts you will need to complete various consent forms and you, and if applicable your partner, may need to have blood tests to screen for HIV, hepatitis B and C and human T cell lymphotropic virus (HTLV) I and II.

Treatment then typically involves the following:

For women

You take fertility drugs to stimulate your ovaries to produce more eggs, as for IVF, and your progress will be monitored through vaginal ultrasound scans and possibly blood tests.

The eggs are then collected using the same procedure as IVF and each egg is injected with a single sperm from your partner or donor. The rest of the process is also the same as IVF.

You are more likely to become pregnant with twins or triplets if more than one embryo is transferred so your clinic will recommend single embryo transfer (SET) if they feel it is the best option for you. An embryologist will examine your sperm under a microscope and decide whether ICSI could increase your chances of fathering a baby.

The next step depends on whether you are able to provide sperm without a medical procedure:

·         If you can, you produce a fresh sperm sample on the same day as your partner’s eggs are collected.

Or:

·         Sperm can be collected directly from the epididymis using a type of fine syringe. This is known as ‘percutaneous epididymal sperm aspiration’ or PESA.

·         Sperm can also be retrieved from the testicles, a process known as ‘testicular sperm aspiration’ or TESA.

·         It is also possible to remove tiny quantities of testicular tissue from which sperm can be extracted. This procedure is called ‘testicular sperm extraction’ or TESE. For more information about PESA, TESA and TESE, speak to your doctor.

·         If you have stored sperm, it will be removed from frozen storage, thawed and prepared for treatment.

A single sperm is then injected into each egg. ICSI provides the opportunity for fertilisation to happen, but it is not guaranteed to succeed.

Finally, if fertilisation does take place, the embryos will be cultured in the laboratory for up to six days and then between one and three of the best-quality embryos will be transferred to the womb.

Zero sperm count

If you have a zero sperm count (other than caused by vasectomy), the chances of retrieving sperm surgically by PESA, TESA or TESE may be very low.

In this situation, you might consider having a surgical retrieval as a ‘dummy run’ and storing any sperm that are obtained. If no sperm are retrieved, you may want to consider donor insemination (DI) or IVF with donor sperm instead.

Egg Donation Process

Being selected as a donor by one of our recipients leads to a very exciting and rewarding journey to help make a dream of becoming parents come true. We hope that you have carefully evaluated your decision to become an egg donor. It is a serious commitment when you choose to participate in an egg donor cycle, and the results are gratifying. We appreciate your generosity and compassion for these infertile couples.
The length of your commitment once you are selected for an egg donor cycle can be as few as six weeks and as long as four months. Egg Donation, Inc. is not a medical facility, but we have relationships and work with the best Reproductive Endocrinologists across the nation who will work to ensure your safety and well being and can explain the full medical procedure of egg donation. A goal of our staff is to make your journey as enjoyable and fulfilling as possible. We know the time and effort it takes to be an egg donor and we treat all our donors with the care and the respect they deserve.

How Egg Donation Works

Step 0: Egg Donor Application and Screening

Before everything else can happen, egg donors must apply to our egg donation program, go through an initial screening www.pfrcivf.com and two rounds of interviews (one with our clinical coordinators and another with our physicians) as well as some testing. Only the donor applicants who pass all these screening steps will be added to our egg donor program, and can be matched with a recipient couple. CHR's egg donor program is very selective: on average, we accept only about 1-3% of applicants to our donor program.

Step 1: Egg Donor Matching

When a couple decides to use donor eggs, they can view the pre-screened pool of egg donors online, and select a candidate from the pool. A tentative donor egg match is made when a recipient decides to move forward with a specific donor. Our IVF coordinator will contact the egg donor to confirm her availability. If the egg donor is available for the recipient's desired time frame, and passes an FDA-required round of testing, an official match is made. Some donors are selected and matched to a recipient very quickly after they apply; others may take months or years before they are selected; still others may never be selected.

Step 2: Suppression and Ovarian Stimulation for the Egg Donor

The egg donor will self-administer daily injections of a medication called Lupron to suppress her natural cycle, so that her and the recipient's cycles are synchronized. During the ovarian stimulation phase, the egg donor uses daily injections of gonadotropin to stimulate her ovaries. In a natural cycle, only one egg matures; gonadotropins injections encourage more than one egg to mature for retrieval.
During ovarian stimulation, the egg donors are monitored closely through blood tests and ultrasound, ensuring that the ovaries are responding well and not going into hyperstimulation. This means that egg donors need to visit our center in the Upper East Side of Manhattan frequently during this phase. (Long-distance donors go to collaborating IVF centers that are local to them.) These monitoring sessions are scheduled in early morning in order to avoid interfering with the donors' daily schedule of school and work.

Step 3: Endometrial Lining Development for the Donor Recipient

On the recipient's side, a favorable uterine environment, especially an endometrium of at least 7 mm, is crucial in the success of a donor egg cycle. While the egg donor develops eggs for retrieval, the recipient takes estrogen and progesterone to prepare her endometrial lining for implantation. Developing the endometrium for embryo transfer is usually not a problem.
In rare cases, some patients have difficulties in reaching minimal endometrial thickness and may require special treatments. Fortunately, www.pfrcivf.com CHR has demonstrated special expertise in this area. Some patients with autoimmune abnormalities may use additional medications to improve the chance of implantation.

Step 4: Triggering Ovulation and Egg Retrieval for the Egg Donor

When the ultrasound imaging shows that the donor's eggs have sufficiently developed, the donor will be instructed to trigger ovulation with an injection of hCG. Two days later, her eggs are retrieved in a short in-office procedure, called egg retrieval. While the donor is asleep (under I.V. sedation), one of our physicians will use aspiration needle, guided by ultrasound, to transvaginally retrieve the eggs. The donor will be required to take the rest of the day off to recover.

Step 5: Fertilization and Embryo Transfer for the Recipient

The retrieved eggs are fertilized with partner's or a donor's sperm. If using fresh sperm, the partner will need to visit CHR to produce a sample at this time. The embryos that result from this fertilization are incubated and graded. Normally, embryos are transferred into the recipient's uterus on day 3 after donor egg retrieval (on rare occasions on day 5). For our recipients working with our center's egg donor program from outside the NYC metro area, this is the only time they need to be in NYC for the entire cycle. The rest can be managed locally.

Step 6: Post-Retrieval Checkup for the Donor and Pregnancy Tests for the Recipient

The donor will be required to return to our center for a post-retrieval checkup, so that we can make sure that the donor is recovering properly from both the ovarian stimulation and retrieval. In most cases, donors have no problem returning to normal in a day or two after egg retrieval, and if this is not the case, our clinical team closely monitor the donor's progress and stay in touch with her until the donor fully recovers. From the start of the Lupron injections to egg retrieval, egg donation is a 3-5 week process for most of the egg donors.
Recipients will have a pregnancy test two weeks after the embryo transfer, via a blood test that measures the level of hCG. After two normally rising hCG tests and an ultrasound demonstrating a pregnancy, recipients are "discharged" to their obstetricians for prenatal care.

 Frozen Donor Egg Program (EcoDEP)

CHR also offers a frozen donor egg program called Eco Donor Egg Program (EcoDEP), in which a recipient receives eggs from a donor who has already undergone ovarian stimulation and egg retrieval by the time the recipient chooses her donor. This means that EcoDEP has a different "workflow" from the standard egg donor program described here.

IVF TREATMENT PROCESS

 IVF TREATMENT :

 In Vitro Fertilization (IVF) treatment has helped thousands of couples worldwide overcome a wide variety of infertility diagnoses enabling them to realize their dreams of becoming parents.www.pfrcivf.com. IVF helps infertile couples become pregnant by joining the egg and sperm together in an embryology laboratory where embryos are created that can later be transferred back into the woman's uterus.

Step One   : Initial IVF Consultation & Preparing the Ovaries for Stimulation

Step Two   : Ovarian Stimulation and Monitoring

Step Three: The Trigger Shot and Egg Retrieval

Step Four  : Inside the Lab: Embryo Development

Step Five  : Embryo Transfer

Step Six    : The Pregnancy Test

What Causes of Infertility Can IVF Treat?

When it comes to infertility, IVF may be an option if you or your partner have been diagnosed with:

• Endometriosis
• Low sperm counts
• Problems with the uterus or fallopian tubes
• Problems with ovulation
• Antibody problems that harm sperm or eggs
• The inability of sperm to penetrate or survive in the cervical mucus
• An unexplained fertility problem

How long will IVF treatment last?

One cycle of IVF takes between four weeks and six weeks to complete. You and your partner can expect to spend about half a day at your clinic for the egg retrieval and fertilisation procedures. You'll go back between two days and three days later for the embryos to be transferred to your uterus, or between five days and six days with blastocyst transfer.

What's the success rate of IVF?

The success rates depends on your particular fertility problem and your age. The younger you are, and the healthier your eggs are, the higher your chances of success.

Based on figures from 2010, the percentage of cycles for women using their own fresh eggs which result in a live birth are:

• 32 per cent if you are under 35
• 28 per cent if you are between 35 and 37
• 21 per cent if you are between 38 and 39
• 14 per cent if you are between 40 and 42
• five per cent if you are between 43 and 44
• two per cent if you are 45 or over

If you have been pregnant or have had a baby before, you have an increased chance of success.

You can improve your chances of success by:

• Reaching a healthy weight for your height before you have treatment. IVF is more likely to be successful if your body mass index (BMI) is between 19 and 30.
• Keeping your alcohol consumption to no more than one unit of alcohol per day, as drinking more than this reduces the effectiveness of IVF.
• Stopping smoking (this includes your partner!) Smoking reduces success rates.
• Keeping your caffeine consumption very low. Even low rates of consumption of 2 to 50mg have been linked to lower success rates.

Your chance of success falls as the number of unsuccessful IVF cycles increases. So, if you haven't become pregnant after your third attempt at IVF, you may need to accept that it isn't going to work for you. This may be hard to come to terms with www.pfrcivf.com

 but there are organisations that can support you through it. Ask your GP or fertility clinic for details.

Fertlity Techniques

Fertility Techniques

Pfrcivf

Artificial Insemination

Artificial Insemination simply imitates the natural reproduction process, inside the uterus, making it easier for the sperm to reach the right place at the time when the ovulation takes place. Artificial Insemination is used when sperm have problems reaching the uterus, either because there is a blockage or because of low sperm count or quality. When Artificial Insemination is done with the partner’s sperm, it is known as Artificial Insemination with partner sperm (AIH). When we cannot obtain sufficient sperm from the partner, or when there is no male partner, we look for an anonymous donor. This is what we call Artificial Insemination with donor sperm (AID). This technique is relatively straightforward and gives very good results. However, sometimes things are not so easy and we have to turn to In Vitro Fertilisation.http://www.pfrcivf.com/

In Vitro Fertilisation

In Vitro Fertilisation involves fertilising an egg with a sperm outside the uterus, in the laboratory. If the woman’s eggs are in good condition they are harvested and, using an extremely fine needle, a sperm is injected into each egg to fertilise it. This is what we call Intracytoplasmic Sperm Injection, or ICSI. Once it is fertilised, the egg becomes a pre-embryo and is placed in the uterus to continue developing. When we suspect that sperm may be damaged in some way, we need to see things close up so we can select the healthiest ones. This procedure is known as Intracytoplasmic Morphologically-selected Sperm Injection, or IMSI.http://www.pfrcivf.com/ The same as for Artificial Insemination, for In Vitro fertilisation, semen can be provided either by the partner or by an anonymous donor. It may be that the woman is not producing eggs or that her eggs are not fit for use, in this case, eggs of an anonymous donor can de used and, as before, they are fertilised with sperm from either her partner or a donor before being placed in the uterus to continue developing. With this technique, 6 out of every 10 women fulfill their dream of becoming a mother.

SURROGACY PROGRAMME

Surrogates are commonly used for women with recurrent miscarriages, untreatable problems of the uterus (womb) such as recurrent fibroids, uterine or endometrial scarring (Asherman's syndrome), prior hysterectomy or conditions where carrying the pregnancy would be a threat to the health of the mother. We offer a personalized and professional approach to a sensitive and private issue.http://www.pfrcivf.com/

PFRC's Surrogacy Programme is the largest and most successful" All in One" medical, non-agency provider of surrogate services in INDIA, and one of the leading surrogate services in the WORLD. Couples living nationally and internationally, have successfully become parents by working with PFRC.

We have a full service of surrogacy and egg donation in PFRC that includes an attorney assistant. We believe in a well structured professional environment that clearly states the responsibilities of each party. None of our cases have ever been involved in a custody issue.Our program is supported by a strong base of experienced doctors, lawyers, and dedicated associates. The mutual goal of all involved is to create a bond and trust between a couple and a surrogate that results in the fulfillment of everyone's dream.http://www.pfrcivf.com/

This approach will provide you with the best possible situation that will alleviate most of your risks and fears. In addition we provide prompt, personal service to help you make the right decisions regarding your medical conditions, because we have medical staffs available full time at PFRC.

Our surrogate database is certainly the most comprehensive because we verify our surrogates credentials and availability each month.This high quality, highly successful services is provided to obtain the finest result and make surrogate pregnancy an affordable option for those who need it.



Surrogacy by In Vitro Fertilization:

The intended parents create embryos by IVF that are transferred to the surrogate mother and the surrogate mother carries the child but maintains no genetic link.  Here the eggs and sperms used are those of the commissioning couple (i.e. parents to be) however if necessary the eggs can be obtained from a donor and the surrogate mother can only carry the baby.

Surrogacy by Artificial Insemination:

The surrogate mother donates her egg.  The biological father provides the sperm that is used to fertilize the egg inside the womb and creates a child.  The surrogate mother carries the baby and has a genetic link to the child.

We screen and select only those women who reside in Chennai, are in excellent health, free of any sexually transmitted disease and have had a healthy reproductive history.  Each prospective surrogate must have had at least one child and be involved in a stable marriage or partnership, with her partner being supportive of her decision.  She must also be willing to be committed to the Intended Parents and be willing to follow our stringent protocol of screening and counseling. We only want to present you with women who are genuinely interested in helping others in their quest to have a child.http://www.pfrcivf.com/


Stay in the Hospital ( Residential Surrogates) The surrogates stay in the hospital till pregnancy test proves positive .  If the commissioning couple desire they can be accommodated in an accomadation which is airy well maintained and gives the surrogate a homely atmosphere and well as gives medical care on a daily basis.


Our Facility:

We offer a personalized and professional approach to a sensitive and private issue.

Our surrogacy programme is one of the largest and most successful “All in one” medical, non-agency provider of surrogate services in India, and one of the leading providers of surrogate services in the world.

Couples living throughout India, as well as internationally, have successfully become parents by working with PFRC.

We have a full service of surrogacy and egg donation in PFRC that includes an attorney assistant.  We believe in a well-structured professional environment that clearly states the responsibilities of each party.  None of our cases have ever been involved in a custody issue.

Our program is supported by a strong base of experienced doctors, lawyers, scientists and dedicated associates.  The mutual goal of all involved is to create a bond and trust between the couple and surrogate that result in the fulfillment of everyone’s dream.http://www.pfrcivf.com/

We use a team approach whereby egg donation and/or surrogacy arrangement is managed by the doctor, the attorneys, and experienced staff of PFRC.  This approach will provide you with best possible situation that will alleviate most of your risks and fears.

In addition, we provide prompt personal service to help you make the right decisions regarding your medical conditions because we have experienced committed medical staff available full time at PFRC.