Category Archives: Infertility

Hope For Childless Couples IVF

Dr. Shilpa

Numerous advancements in the medical field have made impossible things increasingly possible. A few decades ago not having a child would have been traumatic for a woman. But today, every woman can enjoy the pleasures of motherhood, even in diverse conditions.

Over the last two decades there have been numerous changes in the socio-economic levels, financial levels and in the lifestyle segment as well. Younger women are pursuing careers to earn better to augment their family income; to give themselves a better life; to be able to afford better things in life. These aspirational factors have changed many things in their lifestyle patterns as opposed to what was followed in their lives earlier. Women have started thinking about marriage in their late twenties and pushed the thought of planning their families also to a later age. While this may have desired outcomes in increasing their incomes and giving them the space for achieving more professionally, it does come with a setback in their personal space. Women are unable to conceive at their will and pleasure; they are not able to have quality of health to be able to do so when they want a baby. This throws up a few challenges to the motherhood they are so craving for.

The IVF procedure has now thrown opportunities their way to make motherhood possible despite the challenges they are surrounded with.  IVF is the process by which eggs are removed from the ovaries and mixed with sperm in a laboratory culture dish. Fertilisation takes place in this dish. Invitro means ‘in glass’. The fertilised egg (zygote) is then transferred to the patient’s uterus.There are many Infertility Treatments are available in today’s era. The type of treatments will be decided and suggested based on the married couple’s current health condition. Some studies say that most successful and high success rated treatment is IVF. According to study, most of the women have decreased the quality of eggs at the age of 35 years which directly will affect their chances of successful pregnancy.

There are no medications available in the market which can change the poor quality of eggs into the good quality of the egg. The best and effective option is the IVF with Egg Donor in India. It is the wonderful option for the couples who have been struggling from a long period of time to have their own baby or for the women who are over the age of 40 years and trying to conceive.

Psychological aspect – why conception in hindered

Stress can affect the functioning of the hypothalamus – the gland in the brain that regulates your appetite and emotions, as well as the hormones that tell your ovaries to release eggs. If you’re stressed out, you may ovulate later in your cycle or not at all. So if you’re only having sex around day 14, thinking that you’re about to ovulate, you may miss your opportunity to conceive.

It’s important to differentiate between constant and sudden stress. If your stress level is high but fairly consistent, your body will likely acclimate to it and you’ll probably still ovulate each cycle. It’s sudden stress – such as an accident or a death in the family – that can throw your cycle off and interfere with ovulation. Of course, this varies from woman to woman. Some women find that even a trip out of town can delay ovulation. Others have found that a severely traumatic incident didn’t impact their cycle at all.

It’s also important to remember that stress isn’t only a reaction to something negative. Positive stress can also affect your cycle, causing you to ovulate later or not at all. Brides often report strange cycles because they’re happily stressed about their weddings.

If you’re trying to get pregnant and you’re under stress, your cervical fluid may give you a warning that something’s amiss. Rather than noticing increasing cervical fluid wetness as you approach ovulation, you might find patches of wetness interspersed with dry days. It’s as if your body is trying to ovulate, but the stress continues to delay it. You’ll be able to confirm when you have indeed ovulated by tracking your basal body temperature. You should see a sustained rise about a day after ovulation, lasting about 12 to 16 days.The good news is that delayed ovulation simply lengthens your entire cycle. It doesn’t shorten the luteal phase – typically lasting 12 to 16 days after ovulation to the start of your next menstrual period. This is important because a short luteal phase has been linked to early miscarriage.

So while stress may impact when you ovulate, it won’t necessarily mess with your chances of a successful pregnancy, as long as you know how to identify when ovulation is about to occur by charting your cervical fluid.

 Senior Consultant, Obstetrics and Gynaecology

Causes Of Repetitive Implantation Failure During ART

 

Dr. Rajni Khajuri

A successful embryo implantation depends on manyfactors and the most important factor is the correct “window of implantation (WOI).” Mainly the women who opt forassisted methods like In-Vitro Fertilization (IVF) to achieve successful pregnancy is disappointed when the treatments do not have positive results. One of the major causes of repetitive IVF failures can be due to a weak embryo or because the embryo is implanted when the endometrium is not receptive.

Repetitive implantation failure (RIF) is the inability to achieve an artificial or a clinical pregnancy after the transfer of good quality embryos in 2 or more IVF cycles in a woman under the age of 40 years. One of the causes of RIF is lack of synchronisation between the embryo ready to be implanted and endometrial receptivity.

About 25% of the patients with RIF have a displaced window of implantation (WOI). This means that embryo transfer is performed in a non-receptive endometrium. The WOI is a critical factor in successful conception through IVF. Therefore a displaced WOI has been identified as reason for a failed IVF cycle in RIF patients.

Knowing the right WOI is very crucial to prevent implantation failures. A study by IGENOMIX reveals that 28% of the embryos are transferred in a wrong WOI. IGENOMIX, a pioneer in reproductive genetics has developed and patented a state-of-the-art diagnostic method called Endometrial Receptivity Analysis (ERA)after more than 10 years of research. The ERA test identifies the patient’s personalized WOI estimating the day on which embryo transfer will be successful.

The analysis reveals the timing of the WOI and leads to a personalized embryo transfer (pET) timing based on the individual results obtained. The ERA test shows high sensitivity and specificity for detecting gene expression profiles associated with endometrial receptivity. Globally about 12,500 patients have been investigated, out of which 28.6% were reported Non-receptive on the day of the transfer.

Apart from WOI, fertility clock also plays a vital role in those womenwho opt for pregnancy at later stage.  Female fertility is affected by age. Age is thus a major fertility factor for women. The relationship between age and female fertility is termed as a woman’s “biological clock/fertility clock”.In their late 30s, there is a decline in fertility level and the risk of chromosomal abnormalities also increases with the growing age.Even if the women conceive, there are probabilities of having difficulties in sustaining the pregnancy.

A recent study reveals that in women who are 38 years or more, 79% of embryos have chromosomal abnormalities. The risks of abnormalities grow as the age of the mother increases. Most embryos with an incorrect number of chromosomes fail to implant or miscarry during the first trimester of pregnancy. In late pregnancies, the baby is also prone to developchromosomal abnormalities such as Down syndrome, Edwards syndrome, and Patau syndrome.

Therefore, a woman who tries to opt for a pregnancy in their late 30s should also understand the concept of Fertility Clock.  As soon as a woman attains the age of 25 she is likely to have a successful pregnancy and her chance of not conceiving is as low as 8% while her chances of miscarriage increases to 9%. The ratio of IVF failures in women in the age group of 30-34 years is 12% while the number is 17% for those between the age group of 35 to 39. The failures rates for conceiving in women over the age of 40are as high as 19%.

Therefore, knowing the right WOI and the fertility clock can help in prevention of repetitive failures in IVF treatment leading to a successful pregnancy.

Laboratory Director of Igenomix India

 

 

Is the IVF Technology Used In The Right Direction?

Dr Sushma P. Sinha

How ethical is to give IVF treatment to old age couples?

This is absolutely not at all ethical.How can a mother of 72 years bear a child when her own body is going downhill & she is prone to multiple geriatric problems? Even a women of more than 35 years of age is called elderly for bearing a child in medical profession as complication rates go up as the age advances. The probable complications are always explainedby an obstetrician to her when she comes for antenatal check-up. The chance of Natural /IVF conception is almost zero after the age of 45 years.Why? Because god has put a limit to the reproductive age in view of the problems which can occur in advance age. You are pushing her to carry a baby when she has /or prone to have osteoporosis (thinning of the bones), high blood pressure/diabetes/ weakness /debility,heart attack and is at risk of increased morbidly & mortality. And what after the child birth? Taking care of a child, feeding her sitting straight many a times in a day is not easy. Patients even at 48yrs find it difficult & sometimes go into postpartum depression.I personally never do donor IVF in a women above 50;

How old is too old to be a mother?

In my opinion motherhood should not be allowed after the age of 50. Research has shown that 33years onwards the ovarian reserve starts going down. After the age of 35chance of pregnancy is lower than before that.Indian women have faster ovarian ageing & the chance of pregnancy lowers with each added year making it less than 10% after the age of 40. Nothing is without a reason in the nature. If at all donor eggs are used in people with poor/ lower ovarian reserve or in case of recurrent IVF failure, motherhood should not be allowed after the age of 50.

What should be the ideal age for using IVF treatment?

The ideal age of conception is between 21 to 30yrs and in today’s perspective one can say 21 to 35. Younger the women, higher the chance of conception but lowest age should not be less than 21.

What are the risks involved for both the mother and the baby?

The risks for mother can be development of diabetes, hypertension (high blood pressure), anaemia, constant body pain, exhaustion, depression, worsening of other pre-existing elements. Risk of bleeding during pregnancy, risk of infection due to poor body immunity etc. The child can be lower than average in weight. Risk of abortion &prematurity increases leading to complications in the new born baby &can cause long term complications like developmental problem. The nurturing of baby will be affected due to the mother’s own poor health leading to the future physical and psychological problems in the child.

Is there any law or body governing Assisted Reproductive Technologies (ART) in India?

Indian council of medical research (ICMR)has laid down certain guidelines which are there for more than 10yrs now,according to which IVF is allowed only between the age of 21 & 50. Why people are not following the guidelines? Law has still not been past although it is in process. Once law comes stringent action taken against the defaulters should hopefully bring the change.

How important it is for India to deal with fertility issues?

It is an important issue in India. Approx. 15% of couples are suffering from infertility. Their desperation is unimaginable. Lot of them suffer for depression & other psychological problems. It is a social stigma & leads to lot of mental and physical torture of the lady in the house though a man is equally responsible for infertility.

In a country, where population is already exploding, how such events can affect the country?

Approx 15% of couples makes it a big chunk of the whole of the population. Population explosion is one issue but agony of a childless couple is not to be ignored. As an IVF expert I feel it every day so do the couples & the family members. The physical & the psychological problems caused by infertility adds load on the government health sector and also it increases the suicidal rates. The disturbed family environment affects the performance of the employee. The latest data shows that urban population growth in India is lower than some of the western countries.

How are other countries dealing with fertility issues?

In western countries the government provides the services free of cost or insurance companies do cover this problem unlike India where there is no government support. Poors can’t afford Infertility treatment,IVF or IUI in India. Some of the government hospitals have recently started it but look at the load on them. There also they have to pay some amount which is still a lot for the poverty ridden population.

Institute of Obstetrics &
Gynaecology,
Indraprastha Apollo Hospitals
New Delhi