ART – IVF / ICSI – Infinity IVF and Fertility Center

ART – IVF / ICSI

IVF stands for In-vitro fertilization.
It is a recognized type of Assisted Reproductive Technology .
It refers to the process by which a woman’s eggs are collected and then fertilized with sperms outside her womb in the laboratory.
Washed sperms are added in the petridish where eggs are collected so that one of the sperm fertilizes the egg.
The fertilized eggs (embryos) are then cultured in the laboratory and after appropriate growth; they are transferred back to the uterine cavity.
It thus bypasses the fallopian tubes completely.
This technique provides the gift of parenthood to the intended parents by assisting them in conceiving a baby.

ICSI stands for Intra Cytoplasmic Sperm Injection. ICSI is another type of Assisted Reproduction Technique .It is an advanced form of IVF , and it is one of the most successful artificial treatment process used in the case of male infertility.
In ICSI, a single sperm is directly injected into the oocyte instead of placing them together and allowing them to fertilize naturally. ICSI is thus a very effective method to get fertilization of eggs.
It is done by trained embryologist using specialized micro-manipulation tools and equipment and inverted microscopes which help them to select the most morphologically normal and active sperm to be injected into the oocyte cytoplasm.
This usually results in normal fertilization in approximately 70-85% of eggs injected with viable sperm.
Due to higher fertilization rates, though initially started for male infertility, it is now the most favored method for fertilization world over for most indications.

Women with tubal diseases like blocked tubes, hydrosalpinx, and previous tubectomy done.
Patent tubes but non-functional like in previous pelvic inflammatory disease or tubal tuberculosis.
Infertility due to endometriosis.
Unexplained infertility
Women with ovulation disorders, premature ovarian failure
Poor ovarian reserve
Infertility due to male factors like oligospermia ( low count), asthenozoospermia (less motility), teratozoospermia (abnormal sperms) or a combination of abnormalities like oligoasthenoteratozoospermia.
Man or women with a genetic disorder.

Previously failed IVF cycle due to failed fertilization.
Severe male factor Infertility- Oligoasthenoteratozoopermia- that is very low count, low motility or high percentage of abnormal sperms.
Sperms obtained through TESA (Trans Epididymal Sperm Aspiration), PESA (Percutaneous Epididymal Sperm Aspiration ), TESE (Trans Epididymal Sperm Aspiration) or Testicular Biopsy-sperms are obtained microsurgically from testis or epididymis.
Use of Frozen sperms.
Use of Frozen eggs
PGD (Pre-Implantation Genetic Testing ) being used.

Bypass the fallopian tube where fertilization normally occurs, so that tubal factor is overcomed.
By removing the oocyte, the quality of egg can be assessed.
Subtle hormonal defects get corrected and endometrial receptivity improves.
ICSI bypasses inherent weakness of fertilization of normal looking sperm like acrosome defect etc.
It also overcomes failed fertilization due to thick zona pellucida

It starts on second day of menses.
Baseline ultrasonography is done to rule of ovarian cysts. If required, baseline hormones like Serum E2, LH and P4 may be done to confirm that the ovaries are suppressed.
On basis of Age, BMI, Previous stimulation result, AFC and AMH , Injections are started
Injections need to be taken daily approximately at the same time.
Growth of follicle and endometrium is monitored by serial ultrasonography . Blood tests if required are done.
Dose of injections is increased, decreased or maintained, injections are added as and when required.
After 9 to 10 days of Injections , when follicles are more than 18mm in diameter, trigger injection is planned.
35 hours post trigger, oocyte pick up is done. Oocyte retrieval is a surgical procedure which is done under anesthesia where the follicles are aspirated.
Aspirated follicles will be searched for oocytes, or eggs. Not every follicle will contain an oocyte.
All the oocytes which are retrieved are carefully identified and kept in the CO2 incubator.
Oocyte quality is assessed. No of MII oocytes is recorded.
Semen sample is obtained and semen processing done which isolates the healthiest sperms.
IVF/ICSI is performed in the laboratory.
Formation of embryos and growth of embryos are monitored in the laboratory.
3 to 5 days post fertilization, embryo transfer is done.
Embryo transfer is a simple procedure just like an IUI procedure done under sonography guidance. When the embryos are transferred on day 3, the embryo is said to be 8 cell stage. When the embryos are transferred on day 5, it is at the blastocyst stage. This is the highest form of human life that can be sustained in the laboratory.
If there are surplus good embryos , one can freeze them.
Luteal support is given
Patient is asked to follow up after 15 days for result.

Semen sample is collected and processed or sperms are obtained through TESA/PESA/TESE.
Delicate, sharp, and hollow needles are used to immobilize and pick up a single sperm.
Each sperm cell is picked up in an injection pipette (several times smaller than a human hair), before sperm-cell injection.
The mature (M II) egg is held with a specialized holding pipette.
Needle is carefully advanced through the shell of the egg, egg membrane and into the center (cytoplasm) of the egg.
Sperm is injected into the cytoplasm and the needle is removed.
Eggs are checked the next morning for evidence of normal fertilization.
The whole process is visualized through very high magnification microscopes (ICSI machine)
The result is that there is normal fertilization in about 75-85% of eggs injected with sperm.

In men with obstructive azoospermia (because of duct blockage or absence of the vas deferens), sperm are usually recovered from the epididymis by puncturing it with a fine needle. This procedure is called PESA (percutaneous epididymal sperm aspiration)
In TESA or testicular sperm aspiration (also known as TESE, or testicular sperm extraction), testicular tissue is sucked out through a fine needle, under anesthesia. The sperm are then liberated from tissue and used for ICSI.

Average success rate is around 40-45 % but varies from case to case.
Women with good ovarian reserve and PCOS have better cumulative success rates (60-70%)
Whereas women with poor ovarian reserve, damaged endometrium have poor success rate (20-30%).

Success rate depends on following factors :

Age of couple
Pre IVF evaluation- use of OC pills, Use of estradiol valerate, use of leuprolide
Stimulation protocol used
Stimulation Drugs used
Quality of gametes (eggs and sperms) & embryos
Number of embryos transferred.

Treatment cycle can be cancelled if enough follicles don’t grow. It usually happens in older women and poor responders. It happens in around 5-6% of IVF treatment cycles. In such cases, different medications or protocols can be used in the next cycle.
The no of eggs aspirated may not correspond to the number of follicles formed. This can be due to improper dose or drug or due to intrinsic female factors like tuberculosis etc.
Sometimes, in spite of follicles being formed, egg may not be there and all follicles are empty. It can occur due to improper trigger, ineffective trigger. It may require change in protocol and treatment regimen. Sometimes it can be genuine empty follicle syndrome, where all the trigger drug, dose and time were proper.
Embryo transfer may be postponed and all embryos frozen if there are excessive follicles that form like in PCOS to avoid OHSS or if there are abnormal hormone levels, fluid in endometrial cavity etc.
There is an increased chance of multiple pregnancies and ectopic pregnancies due to the transfer of multiple embryos. However, the risks for pregnancy i.e. complications per se during pregnancy due to IVF treatment/ICSI & during delivery are unchanged.
Risk of birth defects after ICSI is the same as for babies conceived through IVF treatment without ICSI, and for those conceived naturally. However, in severe male factor infertility associated with balanced translocations and Y chromosome micro-deletion, transmission may occur to the male offspring.
Associated Endometriosis may affect the egg quality and implantation.
Associated Fibroids, depending on size and location may need treatment.
Associated Hydrosalphix should be treated, as the fluid affects implantation and is embryotoxic.
Exercise and healthy diet help to fight oxidative stress and improve result.
Life cycle of sperm is approximately 3 months, hence the sperms that are expelled are produced 3 months prior. Hence use of alcohol, cigarette, tobacco should be avoided. Frequent ejaculation (every 2 to 3 days) should be recommended.
In some cases, pre cycle Hysteroscopy may be recommend.
It does not require bed rest or prolonged leave or any over night admission.

In women with poor ovarian reserve, giving excessive injections doesn’t improve the outcome in terms of quantity and quality of eggs. It instead adds to cost and trauma to the patient.
Natural cycle IVF uses minimal or no drugs to recruit naturally selected follicle. It is extremely cost effective and provides a chance of conception to women with poor ovarian reserve.
Here rather than focusing on the quantity of the eggs the focus is on the quality of the egg collected.
The uterine lining is more receptive as there is minimal use of medication leading to better implantation.
Eggs can also be pooled using multiple cycles and then transferred back to the uterus.
The success rate of Natural Cycle IVF depends on multiple factors that are beyond the control of the doctors. Therefore the success rates of Natural Cycle IVF are comparatively low as compared to Stimulated Cycle IVF fertility treatment.

There might be some minor side effects just like any other medicines or medical procedures. Some of the possible side-effects are:

- Breast tenderness
- Bloating
- Headache
- Mood swings
- Bruises from shots

Get an affordable and personalised IVF/ICSI treatment in Thane with a dedicated and highly qualified team of doctors. We at INFINITY IVF AND FERTILITY CENTRE , focus on providing cost-effective and high-quality fertility services to deliver positive results.

ART – IVF / ICSI

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