Dr Gautam Allahbadia's STEP BY STEP GUIDE TO IVF PROCEDURE

Step by Step guide to IVF treatment by Dr Gautam Allahbadia

IVF known as in- vitro fertilization is a process which helps in fertilization, embryo development and implantation. The process of IVF is complicated and requires recombination of medicines for production of eggs, surgical processes for the implantation of sperms and different processes which help the fertilized egg implant in your uterus.

Hence, IVF is a time consuming process which has many steps, and it takes several months to complete the whole process. The IVF treatment can start with the first day of period.

STEP 1: FIRST DAY OF YOUR PERIOD

The first day of your fertility plan is very important and your fertility nurse will help you understand how to identify day 1.

STEP 2: STIMULATION OF OVARIES

Stimulation phase starts from the first day. In this phase you take medication for 8–14 days to encourage the formation of ovaries. The motive is to produce more eggs with the help of injections. The commonly used medicines for the formation of ovaries are follicle-stimulating hormone (FSH) and luteinizing hormone (LH).

Once this process is on the go, the ovaries are tracked continuously and towards the end of the stimulation process comes the time for ‘trigger injection’. The trigger injection will then get the eggs produced ready for ovulation. The entire process will be systematically followed by your fertility specialist.

STEP 3: ARRIVAL OF THE EGG

This process will be done at the hospital, where your specialist will collect eggs from your ovaries. The given procedure takes 20 to 30 minutes to be completed. Collection of eggs is a very delicate process, it requires an experienced specialist to retrieve the eggs. The number of eggs collected during this process is 8–15.

STEP 4: MEET THE SPERM

The sperm could be collected in the morning or if the couple plans to use donor sperm then it will already be present in the lab, states Dr Gautam Allahbadia Mumbai, a well-known IVF expert. Only the best sperms are selected to be introduced with the egg.

STEP 5: SPERM-EGG INTERACTION

The retrieved eggs are then handed over to the scientists who with the help of equipment remove the eggs from the fluid. This marks the start of the process of fertilization. The scientists place the eggs and the sperms in a dish as they find each other and fertilize.

STEP 6: THE EMBRYO IS HERE!

When the sperm fertilizes, the egg develops into an embryo. Then the embryo is kept in an incubator which provides suitable conditions for its growth. The embryo is observed for 5–6 days.

This process requires a lot of patience because not all eggs fertilize and the development of an embryo is delayed.

STEP 7: EMBRYO TRANSFRE AND IMPLANTATION

Once you get the news that your embryo has developed, you’re ready for it to be implanted in your uterus. The embryo is transferred within 5 minutes and it is very simple process, says Dr Gautam Allahbadia.

STEP 8: THE FINAL CALL

The final step will be a blood test which will take place after two weeks of embryo transfer. The test will measure the levels of the hormone hCG (human chorionic gonadotropin) which will determine the success of the process.

IVF can be a draining process both emotionally and physically. Thus, it is important for you to stay patient, positive and trust your fertility specialist.

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Semen Analysis And its Importance in Dealing with Infertility

In the life of a woman, being a mother is probably the most important event and a natural phenomena. Since the cases of infertility in couples are increasing significantly, medical experts have deviated their focus from female fertility to the male’s one. Multiple studies and researches have found sperm anomalies to be the sole or contributing factor for difficulties in pregnancy. Thus, understanding semen analysis is a right way to curb the problem of infertility in a broader sense.

Dr Gautam Allahbadia, who is a senior endocrinologist with over two decades of experience in the field, says “A normal sperm count goes anywhere between 15 million sperm to more than 200 million sperm per millilitre (mL) of semen. Anything less than 15 million sperm per millilitre, or 39 million sperm per ejaculate, is considered low.” The fertility doctor holds the distinction of opening one of the first sperm banks in India. He is of the opinion that male infertility diagnosis and treatment facilities have improved considerably, but there is room for more awareness and development in the field.

Talking about sperm evaluation, the specialist informs that in case of low sperm count, the semen analysis measures three major factors of sperm health:

1. Sperm’s number and motility (ability to move)
2. their morphology (size and shape)
3. the volume and consistency of the patient material

• Theoretical review of semen evaluation

The process of semen analysis is performed through the male patient masturbating and ejaculating into a sterile cup. A healthy sperm is of high importance when you’re trying to conceive either naturally or through IVF. In addition, healthy sperm also measures the overall health of a patient as well as the possible causes of infertility, if any.

• Sperm count improvement

There are chances that the sperm count is low after evaluation. In this case medical intervention becomes a necessity. It is advised that you consult a fertility expert or a urologist. These lifestyle transformations can also work in an astonishing way;

• Physical exercise for losing extra weight 
• Adopting a healthy lifestyle
• Increase the intake of vitamins and other supplements.
• Routine blood test to check for vitamin deficiencies.
• Avoid alcohol and tobacco, since they are substantiating factors behind a low sperm count.

• Low Sperm count in relation with IVF 

A man fails to produce a sufficient quantity of sperms in the case of sub-optimal sperm production. The low sperm male partner has the option to opt for the treatment of intracytoplasmic sperm injection (ICSI). In this method, the sperm can be directly injected in the egg. Intrauterine insemination (IUI), artificial insemination and IVF are other ways to deal with low sperm count.

“Intracytoplasmic sperm injection, or ICSI, is a more targeted method of IVF aimed at helping men who have fertility problems, such as low sperm count or poor sperm motility. This procedure covers extracting a spermatozoon from a sample of semen or by a testicular biopsy to select the most appropriate sperm,” explains another fertility expert at CHA Fertility Centre.

There are several factors that lead to infertility and thus, it is very important that one undergoes timely fertility tests. Experts suggest assisted pregnancy if male factor infertility is the issue.

Can an HIV-positive couple conceive safely through IVF?

Although IVF is mostly considered a great treatment option for couples dealing with infertility; it has been effective in dealing with uncommon fertility challenges as well.

A married couple with either one or both partners affected with human immuno-virus (HIV), the chances of a successful pregnancy might be bleak. The data shows that the number of HIV infected people is rising but what is more disturbing is that over 80% of these people are in their reproductive age group.

Even if the couple wants to plan parenthood, natural conception may not be their best bet. Medical advancements in assisted reproduction technology, has however, given such couples a way to conceive and start their parenthood journey.

Dr. GautamAllahbadia, a note-worthy authority in assisted reproduction and fertility medicine is among the first figures to have worked in making pregnancy viable for HIV-positive couples in India, and understanding male infertility. Talking to him about the viable pregnancy options for HIV couple, he answers some important questions.

• Can an HIV positive couple have children?

Dr. Gautam Allahbadia explains that for seropositive people, successful procreation is possible. Through options such as IVF, a couple can safely overcome the fertility challenge. A couple in which a male partner is infected by HIV can consider artificial insemination /IUI or IVF-ICSI.

• What are the treatment options for HIV positive males?

For HIV-discordant couple, IVF is an effective treatment option where the motile sperm is separated from the rest of the ejaculation using sperm washing. Eggs are collected from the woman after hormone-stimulation and are fertilized in the laboratory by injecting a single washed sperm from her husband into each egg. The resulting embryos can be transferred to the wife's uterus and/or frozen for later use. These procedures are believed to minimize the risk of HIV transmission (although the number of cases is low).

Though, the process of IVF-ICSI is expensive, it does prove to bea viable option for HIV males.

• What are the treatment options for HIV positive females?

As for female patients, Dr Gautam Allahbadia recommends that healthy conception can be achieved with the help of antiretroviral treatment and a subsequent In-vitro Fertilization procedure. The woman is given medication during the entire pregnancy process to minimize the risk of infection transmission to the child.

When fertility specialists first addressed the issue, none of these options for HIV patients were available. But years of research and after a slew of new advances, risk reduction strategies have been really effective in helping couples conceive.

With assisted reproductive techniques such as IVF, HIV-positive people have strong chances of conceiving healthy babies. Several patients have conceived healthy and HIV-negative babies through IVF,” said DrGautam Allahbadia.