INFERTILITY

Causes of infertility
As per statistics, it is fount that, out of all infertile couple, 30 % will have female factors, 30% will have male factors and 40% will have both factors for infertility meaning to say that both partners have to be evaluated simultaneously. infertility

Female factors for infertility 
Common causes of female infertility are grouped into. 
Group I Hormonal Changes
FSH
LH
Prolactin
TSH
The hormones secreted by a gland in the brain & any alteration in their levels influences the ovulation, endometrial receptivity and embryo implantation.
Group II Ovarian factors
Infrequent ovulation as in polycystic ovaries, Premature ovarian failure where the egg count is depleted prematurely at an young age Endometriosis – where there is blood clots in the ovaries
Group III Tubal factors
By nature, the egg which is released from the ovary is fertilized by the sperm which took place in the fallopian tube which is present on both sides of uterus. This embryo then travels to the uterus to get embedded there in 4 – 5 days.So at least one tube should be patient for natural conception.

There fallopian tubes can be blocked as a result of infection (pelvic inflammation disease) or there can be adhesions around the tube as in endometriosis of pelvic tuberculosis which prevents the tube from moving freely and picking up the eggs from the ovary.fertility treatment process

Group IV

The common uterine factors for infertility are
1. Fibroid uterus which prevents the embryo from implanting (or) it can cause abortion by increasing uterine contractions
2. Adenomyosis - A condition in which there are blood cystic in the muscle of the uterus.
3. Intrauterine adhesions
It occurs due to Tuberculous infection of the uterus or due to repeated trauma in the form of D&C.Where the inner layer of uterus (ie) the endometrium is thin and adherent to each other.
So there is no place in the uterine cavity for the embryo to implant,
4. Septate uterus - Uterus is usually formed by fusion of two mullerian ducts (genital precursors) from both sides and by resorption of the middle septum. If this resorption doesn't take place completely, it results in septate / sub septate uterus.
Septate uterus

This septum prevents embryo implantation and also causeabortion

Causes of Male factor infertility 1. Hormonal Changes - FSH, LH, TSH, Prolactin, Testosterone are the hormones that control sperm production and also influence sexual function of male. Any alterations in it will affect the sperm count / motility / Sexual function.
2. Varicocele – It is a condition of dilated veins in the scrotum. As a result the basal temperature of scrotum is increased affecting the sperm production. Surgically treating the varicocele improves the semen parameters a lot.
3. Medical conditions like long standing Diabetics, decreased thyroid levels, increased prolaction levels.
4. H/o mumps / chicken pox / measles in childhood and H/o trauma to scrotum / Any Hernia or Hydrocele surgery etc.
5. H/o Smoking / alcohol consumption - It has been proved scientifically that having more than 2 cups of coffee a day can alter sperm functions. Then thick of smoking and alcohol!!
More over it takes 75 days for a sperm to mature completely. So anything dexterous in that 2 months can produce changein sperm parameters.
So stopping alcohol consumption (or) cessation of smoking for a week or so during treatment will not given much results;
6. Block in the passage between the testis and the external genitalia which can be differentiated by hormones and scan
7. Working on laptops by keeping them on our lap. It emits radiations as well as heat which is detrimented to the sperm.

SURROGACY

• 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.
• PFRC's Surrogacy Programme is the largest and most successful" All in One" www.pfrcivf.com 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 Prashanth Fertility Centre.
• 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.
• 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 Prashanth Fertility research centre  www.pfrcivf.com
• 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.
• 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.

Timeline For IVF Treatment

The timeline for IVF treatment usually goes something like this:

• Ovary stimulation. For eight to 14 days near the beginning of your menstrual cycle, you take a gonadotropin, a type of fertility drug that stimulates your ovaries to develop multiple mature eggs for fertilization (instead of just one). You also need to take a synthetic hormone like leuprolide or cetrorelix to keep your body from releasing the eggs too early.
• Follicle development. While taking these medications, you visit your doctor's office or clinic every two to three days to have your blood hormone levels checked and ultrasound measurements of your ovaries done. This allows your healthcare provider to monitor development of the follicles – the fluid-filled sacs where eggs mature.
• The trigger shot. When the follicles are ready, you get a "trigger shot," an injection that causes the eggs to mature fully and become capable of being fertilized. About 36 hours after your trigger shot, your eggs are ready to be retrieved.
• Gathering the eggs. Your doctor gives you an anesthetic and inserts anultrasound probe through your vagina to look at your ovaries and identify the follicles. A thin needle is then inserted through the vaginal wall to remove the eggs from the follicles. Eight to 15 eggs are usually retrieved. You may have some cramping and spotting for a few days afterward, but most women feel better in a day or two.
• Fertilization. An embryologist www.pfrcivf.com (a scientist who specializes in eggs, sperm, and embryos) will examine your eggs before combining them with your partner's sperm and incubating them overnight. Fertilization usually happens during this time, but eggs that aren't normal may not be fertilized. (If sperm quality is poor, or if fertilization was unsuccessful during previous IVF cycles, your doctor may recommend using a technique called intracytoplasmic sperm injection (ICSI). With ICSI, a single sperm is injected directly into each mature egg.)
• Developing embryos. Three days after the egg retrieval, some of the eggs that were successfully fertilized become six- to 10-celled embryos. By the fifth day, some of these embryos will become blastocysts with a fluid-filled cavity and tissues that are beginning to separate into placenta and baby.
• Embryo selection. The embryologist selects the most viable embryo or embryos to place in your uterus three to five days after the egg retrieval. Extra embryos, www.pfrcivf.com if there are any, may be frozen and used for future IVF cycles.
• Planting the embryos. Depending on your age and diagnosis, your doctor places between one and five embryos in your uterus by inserting a thin tube (a catheter) through your cervix. You might feel some mild cramping, but you won't need anesthesia.
• Successful implantation. If the treatment works, an embryo implants in your uterine wall and continues to grow into a baby. Keep in mind that if more than one embryo is transferred, your chance of pregnancy is higher, but so are the odds of having a multiple pregnancy – about 20 percent of babies born through IVF aretwins, triplets, or more.

You can take a pregnancy test about two weeks after the embryos are placed in your uterus.

Diabetology

40% of our population are diabetic.
Among pregnant patients women over 35 have a higher risk of diabetes.
Patients undergoing IVF (Test Tube Baby) are at higher risk.
If undetected, diabetes can result in abnormal babies and miscarriages.
Ideal is to control it before planning pregnancy.
During pregnancy if not controlled can lead to preterm delivery, big babies, stillbirths and death immediately after delivery.
Pre Pregnancy counseling, dietary advice, maintaining normal blood glucose levels with insulin, checking on the function of the kidneys is very important to prevent complications.

During delivery maintaining levels is important to prevent problems to mother and baby. After birth babies can have low blood sugar. To maintain sugar levels observation in the neonatal intensive care unit is a must.
In conclusion, a multidisciplinary approach by the obstetrician, diabetologist and neonatal care specialist is ideal.

ONCOLOGY

Oncology is the branch of medicine that studies tumors (cancer). The oncologist often coordinates the multidisciplinary care of cancer patients, which may involve physiotherapy, counseling, clinical genetics, to name but a few. An oncologist often has to liaise with pathologists on the exact biological nature of the tumor that is being treated.

Oncology is concerned with:

• The diagnosis of cancer
• Therapy (e.g., surgery, chemotherapy, radiotherapy and other modalities)
• Follow-up of cancer patients after successful treatment
• Palliative care of patients with terminal malignancies
• Ethical questions surrounding cancer care
• Screening efforts:
o of populations, or
o of the relatives of patients (in types of cancer that are thought to have a hereditary basis, such as breast cancer).

There are several sub-specialties within oncology. Moreover, oncologists often develop an interest and expertise in the management of particular types of cancer.
Oncologists may be divided on the basis of the type of treatment provided or whether their role is primarily diagnostic.

• Radiology: localize, stage and often perform image-guided biopsy in order to obtain the tissue for preliminary diagnosis.
• Anatomical pathology: render the final diagnosis and prognosis of cancer, in order to guide treatment by oncologists.
• Radiation oncology: treatment primarily with radiation, a process called radiotherapy.
• Surgical oncology: surgeons who specialize in tumor removal.
• Medical oncology: treatment primarily with drugs, that is, pharmacotherapy, which includes chemotherapy, hormonal therapy, and targeted therapy.
• Gynecologic oncology: focuses on cancers of the female reproductive system.
• Pediatric oncology: concerned with the treatment of cancer in children

Intra-cytoplasmic sperm injection ( ICSI )

Intra-cytoplasmic sperm injection, commonly referred to as ICSI, is a well-established microinjection technique, which has resulted in additional options for patients in the treatment of their infertility. ICSI involves the insertion of a single selected sperm directly into the cytoplasm of a mature egg, bypassing all the preliminary steps of sperm binding.  

This procedure overcomes many barriers to fertilisation which can include failed fertilisation from repeated use of conventional IVF, severe male factor infertility, very low sperm counts and/or motility, high number of morphologically abnormal sperm, utilisation of surgically retrieved sperm, use of frozen sperm when limited in number and quality.

The first human pregnancy with ICSI was reported in 1992 and since this time thousands of babies have been born as a result of the ICSI procedure, providing many couples with hope previously not available.

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.

Intrauterine insemination (IUI)

The highly motile and morphologically normal sperm are harvested by density gradient separation technique from the semen which is usually a mixture of pus cells and abnormal sperm. The separated good sperm is enriched with special medium using highly sterile technique. We also prepare sperm sample for other clinics so that they can perform IUI independently at their centre and improve the success rate of intrauterine insemination. Woman with ovulatory dysfunction, treated endometriosis with patent tubes, luteal phase defects, cervical factor incompatibility, polycystic ovarian disease , can try IUI first before trying more advanced techniques of Assisted Reproduction. Men with slightly compromised semen parameters can also benefit from IUI. A cozy room specially designed for semen collection is available for the male partner. The room provides absolute privacy. The cumulative pregnancy rates after 6 cycle of IUI is about 70 - 80%.

Intrauterine insemination (IUI) - chance of success:

It is difficult to assess success rates for intrauterine insemination (IUI) because success depends upon the cause of infertility and whether fertility drugs are used to stimulate egg production.
Discuss with your clinician whether fertility drugs are suitable for you. Usually, it would be reasonable to try three to six IUI treatments. Your clinician will advise what is best for you.

• 15.8% (237/1497) for women aged under 35
• 11.0% (154/1394) for women aged between 35-39
• 4.7% (23/492) for women aged between 40-42
• 1.2% (2/172) for women aged between 43-44
• ** (0/46) for women aged over 44

Figures given in brackets are (IUI cycles resulting in a live birth / IUI cycles started).
If IUI fails after several attempts, depending on your age, your doctor may suggest you try another treatment such as in vitro fertilisation (IVF).