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Frozen Embryo Transfer - When Is It Required?

MBBS, MS - General Surgery, Fellowship of Indian Association of Gastrointestinal Endo Surgeons (FIAGES), Fellowship in Sexual Medicine

IVF Specialist, Meerut

A frozen embryo transfer is a type of IVF treatment wherein a cryopreserved embryo, created in a full cycle of IVF is thawed enough to soften it up and hence transferred to the uterus of a woman. The embryo which has been cryopreserved might well be from a woman, who had previously gone through a typical IVF cycle or it can also be a donor embryo. In case a donor embryo gets used, then obviously that embryo is neither related to the woman nor to her partner.

On most occasions, a frozen embryo transfer takes place when there are extra embryos available after a normal IVF cycle. The usually preferred option is to have a fresh transfer.

Reasons behind Choosing To Have a Frozen Embryo Transfer-In Vitro Fertilization Cycle (FET - IVF)

One can choose to go for a Frozen Embryo Transfer cycle if:

A fresh IVF transfer fails and a woman has embryos which are cryopreserved: IVF Treatment cycle can result in the emergence of one or more than one embryo. The safe option is to get only one embryo transferred or a maximum of two at a time. In order to ensure complete reduction of risk, certain doctors even recommend women to go for Elective Single Embryo Transfer, especially for those with a good prognosis.

On certain situations, an IVF cycle can result in extra embryos. Most women opt to freeze or cryopreserve their extra embryos. For instance, a woman gets five embryos. Now, let's presume that a doctor recommends a woman to go for elective single embryo transfer. This would ensure that only one out of the five embryos will get transferred, whereas the remaining four embryos will be cryopreserved. It can well happen that one embryo transfer does not lead to successful pregnancy, then in that scenario, there would be a couple of options: a) A woman can go for another fresh complete IVF cycle or b) She can transfer either one or two of her embryos which were previously cryopreserved.

A woman may want to give her IVF conceived child a sibling: If a fresh embryo transfer results in pregnancy, then through the last example, given above, a woman can have four embryos, which are waiting to get cryopreserved. Cryopreserved embryos can be on liquid nitrogen for an indefinite period of time. Cryopreserved embryos can be used for second child.

The embryos are screened genetically: There are two assisted reproductive techniques in the form of Preimplantation Genetic Diagnosis and Preimplantation Genetic Screening, which ensure embryos to get screened for any kind of specific disease or defects. This is carried out through a biopsy of the embryo on the 3rd or on the 5th day after fertilization and after the egg gets retrieved. On certain situations, the results get back in time for performing a fresh embryo transfer. In case the biopsy or genetic test result is complex and more time gets consumed, in that case, all those embryos whose biopsy were taken get cryopreserved.

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Fallopian Tubes - How To Detect The Blockage Of Them?

MBBS, MS - General Surgery, Fellowship of Indian Association of Gastrointestinal Endo Surgeons (FIAGES), Fellowship in Sexual Medicine

IVF Specialist, Meerut

The fallopian tubes are a part of a woman’s reproductive system. This is the passage through which the egg travels to meet the sperm and attach the end result to the lining of the womb or the uterine lining. In many cases, the fallopian tubes may get blocked, which can cause a series of complications, including infertility and other issues.

Read on to know more about the complications as well as the diagnosis.

Fallopian tubes: These are two thin tubes that flank either side of the uterus. It helps the matured egg from travelling from the ovaries to the uterus.

Blockage of fallopian tubes: Sexually transmitted diseases or STDs, as well as endometriosis, can cause a blockage in the fallopian tubes. The tubes can get blocked from one or both sides.

Complications: Blocked fallopian tubes can lead to major complications like early pregnancy loss as well as infertility. Every month, the ovaries release eggs during a cycle known as the ovulation cycle. During this period, the eggs leave the ovaries and travel through the fallopian tubes in order to reach the uterus, where they can possibly get inseminated with sperm, after which they will get fertilised and attach themselves to the uterine lining or the womb. In case the fallopian tubes are blocked, the eggs get blocked and do not get a passageway to travel from the ovaries and into the uterus. This can lead to infertility as it will prevent fertilisation of the released egg. Furthermore, blocked fallopian tubes can also lead to tubal pregnancies, which will have to be terminated as it can lead to severe health risks.

Symptoms: So how can you find out whether your fallopian tubes are blocked? There are a number of symptoms that may be caused in the course of this condition. It is important to be even more careful about the symptoms because they may not be as obvious as other conditions, where irregular periods and heavy bleeding may point to the problem at the very onset. Pain in the lower abdomen and unusual discharge usually point to the problem. Also, loss of pregnancy due to the blockage is also a clear cut diagnosis.

Diagnosis: The diagnosis of the condition is done with the help of numerous tests and imaging examinations conducted by a gynaecologist. A specialised X-ray called hysterosalpingogram or HSG is used in order to diagnose the issue. In this kind of examination, a dye is inserted through the uterus. This dye has a lens at the end, which shows the blockage and its extent. The doctor then conducts tests to find out the causes of this condition so that proper treatment may be followed.

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Shared 2 years ago• Featured Tip

Lupron IVF Calendar - What Should You Know?

MBBS, MS - General Surgery, Fellowship of Indian Association of Gastrointestinal Endo Surgeons (FIAGES), Fellowship in Sexual Medicine

IVF Specialist, Meerut

Hormones agonists (receptor activating chemicals) that release gonadotropin hormones produced by the pituitary gland (GnRH) act quickly to remove luteinizing hormone (LH) and follicle stimulating hormone (FSH) from the pituitary gland. Lupron is a kind of GnRH agonist that is used to start the IVF cycle, especially if your ovaries need controlled stimulation. 

Lupron is injected intramuscularly. Lupron injections are given to women who undergo the gonadotrophin therapy, which stimulates the ovaries. Lupron mimics the structure of the GnRH, so when it is injected, it triggers the production of LH and FSH. When the pituitary gland realises the difference between GnRH and Lupron, it dramatically reduces the biological production of both the follicle-stimulating and luteinizing hormone. This condition is called the pituitary down regulation and this continues as long as the Lupron is being administered. Lupron slowly, but steadily, lowers the production of estrogen.

The reason for administering Lupron is to stop premature escalation of LH. Women who are older and resistant to ovarian stimulation or who have poor ovarian reserves (the capacity to produce eggs) are usually given the Lupron therapy. Too much of the luteinizing hormone can harm the follicular production, which in turn damages the quality of egg production and later, embryo development. Lupron is injected to stop the premature luteinisation of the follicles, and it is stopped before the egg retrieval procedure.

The Lupron IVF Calendar:
To help explain the treatment, a hypothetical menstrual cycle of 28 days is taken:

1. Days 1-7: Your menstrual cycle begins and the Lupron treatment starts (you are usually given Lupron injections)
2. Day 8: Your periods start and the Lupron treatment continues
3. Day 9: FSH injections are started while you are still on the Lupron injection; a blood test and ultrasound is scheduled today as well
4. Day 10-13: The FSH and Lupron are administered together for the next seven days
5. Day 14-15: A blood test and ultrasound is scheduled again on the fourteenth day
6. Day 16: This will be the last day of your FSH and Lupron treatment; another blood test and ultrasound will be scheduled and HCG (Human Chorionic Gonadotrophin) injection will be administered which causes normal ovulation
7. Day 18: On this day, the egg retrieval procedure is done

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Fallopian Tubal Scarring - How To Get Rid Of It?

MBBS, MS - General Surgery, Fellowship of Indian Association of Gastrointestinal Endo Surgeons (FIAGES), Fellowship in Sexual Medicine

IVF Specialist, Meerut

The fallopian tubes are not mere passages for the egg to travel from the ovaries to the uterus. It is here that conception occurs and hence healthy fallopian tubes are essential for the fertilization of an egg. 

Damaged fallopian tubes are the most common cause of infertility. This damage can fall under three categories:

1. Blocked fallopian tubes
2. One blocked and one open fallopian tube
3. Tubal scarring

The third is usually an effect of pelvic infections or natural healing after pelvic surgery. Sadly, in most cases, this condition is discovered only after infertility has been diagnosed. Other causes of fallopian tubal scarring include:

• STDs such as chlamydia trachomatis and neisseria gonorrhea
• Adhesions caused by ruptured ovarian cysts
• Appendicitis
• Peritonitis and
• A history of ectopic pregnancies

Fallopian tubal scarring has no recognizable symptoms. Chronic pelvic pain is the only known symptom of this damage and that too can be seen only in severe cases of tubal scarring. On diagnosing infertility, your doctor will perform one of these tests to determine the condition of your fallopian tubes.

1. Hysterosalpingogram: This is a type of X-ray. Your doctor will open the vagina with a speculum and inject a liquid into the uterus with the help of a catheter. If the liquid does not pass through the fallopian tubes, it is said to be blocked. This, however, does not say much about tubal scarring. 
2. Laparoscopy: A small incision is made below the belly button and a slim, flexible tube with a camera is passed through the incision. This gives your doctor a clear view of the condition of your fallopian tubes. A laparoscopy can also be used to rule out other causes of infertility such as endometriosis or blocked fallopian tubes. 

Treatment for infertility caused by tubal scarring is of two types. 

1. Surgery: This is suggested in cases where tubal scarring is minimal. Depending on the intensity and placement of scar tissue, your doctor may decide to perform one of many types of surgeries. She may choose to remove the scarred section of the fallopian tube, create a new opening (in case of blockages) or rebuild the damaged edges of the fallopian tubes.
2. In Vitro Fertilization(IVF): Women with badly scarred fallopian tubes usually have poor chances of conceiving naturally. Hence, IVF is the preferred treatment route. However, your doctor may still advise you to undergo surgery and remove the damaged tubes prior to IVF to prevent the tubes from filling with fluid.

In large number of cases of tubal scarring tubes would be open on tubal testing. However, it may not be working well or is functional. A lot of women with so-called unexplained infertility may actually have tubal scarring or non-functional tubes as the cause of Infertility. IVF is the best treatment option in such cases as it would bypass the work of the tubes completely.

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Shared 2 years ago• Featured Tip

Surrogacy Process - Know More About It!

MBBS, MS - General Surgery, Fellowship of Indian Association of Gastrointestinal Endo Surgeons (FIAGES), Fellowship in Sexual Medicine

IVF Specialist, Meerut

Surrogacy is a boon for couples who cannot conceive naturally or give birth to a child. Surrogacy is a process in which a woman's unfertilized eggs are implanted into the uterus of another woman who is called the surrogate mother. The egg is fertilized in the surrogate mother's uterus with the biological father's sperm. The surrogate mother lets the child develop in her womb and gives birth. Although, there are various medical treatments available, but not all of them have a high success rate.

The two primary methods of surrogacy are:

1. Traditional surrogacy: In this process, the surrogate mother is artificially inseminated with the sperm, which belongs to the biological father of the baby. The sperm gets implanted into the surrogate mother's uterus and the child develops in her womb.
2. Gestational surrogacy: For women who want to have a biological child in spite of being incapable of pregnancy, the gestational surrogacy method is used. During the process, in-vitro fertilization is undertaken and the eggs from the woman who wants to become a biological mother are harvested. The eggs, along with the sperm from the biological father are implanted into the uterus of a surrogate mother, who will carry the embryo and will give birth to the child.

Process involved in surrogacy:
Here are the several processes and procedures, which need to be undertaken, after you have chosen a surrogate mother for carrying your child.

1. Medical testing: After a surrogate mother is chosen, the woman goes through several health checkups, medical and psychological tests to ensure that she gives birth to a healthy child.
2. Legal agreements: There are several legal considerations that have to be addressed for a surrogacy. All the legal requirements regarding the surrogacy should be written down. Some issues include both the surrogate mother and the biological parents. A financial contract must be presented as well, which will reimburse the medical expenses and requirements of the surrogate mother.
3. Medical process: The medical processes required for surrogacy include in-vitro fertilization and the transfer of the eggs, which are done in a clinic under the supervision of a reproductive endocrinologist. The eggs are transferred to the uterus of the surrogate, where fertilization takes place after combining it with the sperms of the biological father.
4. Pregnancy and birth: After successful fertilization, the surrogate mother gets pregnant. Proper care and precautions should be taken by her to ensure a successful birth. Finally, the surrogate mother gives birth to a child, who belongs to the biological parents.

This method of having a child has become very popular in recent times. It is a great blessing for people who cannot conceive due to medical conditions or otherwise.

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Shared 2 years ago• Featured Tip

Too Old For IVF - Are We Discriminating Against Older Women?

MBBS, MS - General Surgery, Fellowship of Indian Association of Gastrointestinal Endo Surgeons (FIAGES), Fellowship in Sexual Medicine

IVF Specialist, Meerut

There were reports that a Spanish woman, aged 62 years had given birth after going through IVF treatment which led to certain questions related to age limit. This is indeed a thing to ponder upon, whether IVF treatment should be segregated according to certain ages. The Spanish woman, who is named Lina Alvarez, a doctor, does not happen to be the only aged woman to have success with IVF. Countries where funding assistance is available for IVF, there is a limit imposed wherein a woman cannot obtain treatment above a certain age. In Great Britain, the limit has been set at age 42. That Spanish woman had received private treatment. So ideally, no one should care about her age. Then why were people so bothered about if she had access to IVF? There are certain arguments which typically come up in discussions about age and fertility treatment. Unfortunately, all are flawed in their own ways.

Let us talk about the existence of three myths one by one:

Being A Mother At An Older Age Is Harmful: There have been occasions when it is claimed that if older women are allowed to get access to IVF treatment, then that would cause harm to children. The reason could well be because aged women will not have enough strength to meet the physical demands of caring for the small child. Then, if a mother was to expire while they were still at a tender age, then that would not be ideal for the child. There are countries where women of Alvarez’s age, which was 62, on an average can be expected to live up to 85 years. This basically means that most of the older mothers close to her age would live on to see their child grow up. Hence, this argument would only suffice if people think that the children, who are born to older mothers, would be so bad that it would be desirable that they were not born in the first place.

It Is Harmful for Older Women to Become Pregnant: Doctors are at times worried about the chances of older women getting affected by high rates of complications during pregnancy. Older mothers at the time of pregnancy, tend to come across medical problems like high blood pressure, diabetes and premature labour, whereas many others won’t have any such issue, A study found that close 80% women, who are aged above 45 years did not have any major medical problems at the time of pregnancy.

IVF Does Not Tend To Work Among Older Women: IVF birth’s success rate through NHS IVF among women aged above 44 years, in the United Kingdom, is only 2%. These rate are based on IVF treatment with the own eggs of a woman. In the case of women receiving donor eggs or embryos from others, the chances of live birth are purely based on the age of the donor and not of the recipient. Donor eggs avoid the risk of some major chromosomal problems in the baby, which is increasing day by day.

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