Timely release of an egg known as ovulation is an important part of successful fertility in women. Unsuccessful release of an egg by women is one of the major common causes of infertility. Although, there are many cause for ovulation disorders. The efficient development and release of an egg by ovary in a timely systematic way to become pregnant, ovulation induction therapy frequently requires different medications. Dr Shivani Sachdev Gour at SCI Healthcare and SCI IVF Hospital and Multispecialty Center is experts at ovulation induction therapy. With appropriate medications that matched to your specific cause of ovulation disorder, there is pretty high chance that ovulation induction therapy will play a major role in your life to become success in having a child and building your family.
The monitoring and stimulation of the ovulation cycle is an important part of ovulation induction therapy. This is basically done by regular monitoring with ultrasound blood tests. To monitor the effect of the applied medications and to help the doctor to predict when ovulation is most likely to happen, the size of the ovarian follicles and blood hormone levels are utilized. Ovulation induction therapy is generally achieved with an oral medication such as Femara, Clomid or with injectable gonadotropins. In order to ensure that the uterus will be properly prepared for implantation of a fertilized egg, the doctor may recommend progesterone supplemental medications in the second half of ovulation induction cycle.
Tracking of Ovulation induction
Tracking of Ovulation by ultrasound: Ultrasound testing is relatively effective and safe way of tracking ovulation induction. For the accurate measurement and count of follicles and the quantity of eggs which developing in the ovaries, a vaginal ultrasound is performed at specific stages of an ovulation induction cycle. To ensure the highest rate of success, this provide exact time frame for natural intercourse, egg retrieval used for the IVF procedure and for artificial insemination. The ultrasound process is very secure and results in nearly no discomfort and heath related issues. During ultrasound testing, doctor inserts a small transducer into the vagina. To confirm that the ovulation induction successfully occurred, both endocrine test and ultrasound perform a major role.
Measurement of Hormone Blood Levels: Luteinizing hormone (LH) and follicle stimulating hormone (FSH) are produced by the brain that directs the ovaries to function normally. Progesterone (P4) and estradiol (E2) are the hormones produced by the ovary that suggest the function of the ovary. Anti-mullerian hormone (AMH) is a special type of hormone that can evaluate the long term egg quantity. The test of these hormones assists the doctor in Ovulation Induction therapy. They help your doctor to decide how much and which type of fertility medication may results in best ovary response and outcome.
Please make an appointment with Dr. Shivani Sachdev Gour (gynecologist and fertility expert physicians) to learn more about your fertility problems and ovulation induction therapy and start building your happy and complete family using the best fertility treatment options available at SCI Healthcare and SCI IVF Hospital and Multispecialty Center.
Ovulatory disorder is the most common infertility factor for women. Ovulatory disorders can be classified as below:
Class I Ovulation Disorders – Significantly low FSH and LH which obstruct the ovary to ovulate
Class I ovulatory disorders involve women with very low levels of the crucial fertility hormones known as follicle stimulating hormone (FSH) and luteinizing hormone (LH) which released by the pituitary gland that are responsible for the grow a follicle which ultimately release an egg. These types of patient can be treated effectively with the application of injectable fertility medications that contain FSH hormone. The required FSH hormone helps the normal ovary to release an egg. The prospect for successfully pregnancy is very high.
Class II Ovulation Disorders – Polycystic Ovary Syndrome
This type of Ovulation Disorders also can be found in women with polycystic ovary syndrome (PCOS). PCOS is type of metabolism disorder and it is genetically based. It is particularly of sugar metabolism that spoils egg development and egg follicle as well as ovulation. In such conditions diet with high protein, low carbohydrate is recommended. Ovulation induction and metformin can be helpful in having children. These patients are generally treated with ovulation induction therapy with oral medications such as clomiphene citrate (Clomid), Letrozole (Femara) and generally in combination with gonadotropins containing FSH such as Bravelle, Follistim, Gonal-F and Menopur. Lupron or HCG (Ovidrel) can be used to either trigger the LH surge (Lupron) or mimic the LH surge (hCG).
IVF treatment may be applied to the patient if the patient still unable to conceive after having three ovulatory cycles, do not ovulate with the application of above listed medications or exhibit over-response with excessive number of lead follicles as it is a usual danger with PCOS.
Releasing one follicle is considered far better than no egg. Your doctors will always suggest and help you to avoid any chance multiple gestations as it is considered not a good situation to become pregnant with two or more babies and expected to deliver at same time.
Class III Ovulatory Disorders – Diminished Ovarian Reserve
Female who have abnormally high levels of the essential fertility hormones such as luteinizing hormone (LH) and follicle stimulating hormone (FSH) released from the pituitary gland exhibit this type of ovulatory disorders. To adjust women’s fertility potential and declining function of ovaries and the eggs within them FSH and LH releasing rate is generally high. The Class III disorders includes women having premature ovarian failure with age less than 40 years, older women in perimenopause and women with advanced stages of endometriosis and past surgery involving at least one ovary. There is a very less chance to have a healthy baby with this type of patient even with use of their own eggs. The doctor may suggest other more aggressive ovulation induction treatment with IVF therapy. The donor egg may be considered for IVF therapy which may results in rather higher pregnancy rates. These types of disorders seen in women with low thyroid hormone levels (hypothyroidism) and high levels of prolactin (the milk secretion hormone). The pituitary gland in the brain release relatively low FSH hormone.
You may contact Dr Shivani Sachdev Gour for your all questions related to Delayed Frozen Embryo Transfer. She is recognized as one of the best gynecologists and infertility specialist based in Delhi.
Assisted Hatching is an assisted reproductive technology that can be sometimes done along with in vitro fertilization (IVF) treatment. It is usually recommended to the women who are facing unexplained IVF failure or for women with a poor prognosis. But Assisted Hatching is not recommended by the American Society of Reproductive Medicine (ASRM) as it hasn’t been shown to improve live birth rates and there are also additional costs and risks associated with this technology. There are many different methods available for Assisted Hatching that works differently. Each method involves their own pros and cons and the skill of the technician always matters a lot.
This method is also known as Partial Zona dissection.With the help of a pipette, the embryologist keeps the embryo steady. A micro-need is used to puncture through the zona pellucida to reach the shell for a bit and then come out the other end. After that, the space between the two punctures is softly rubbed until a small tear take place. But with this method, the control the size of the opening is bit difficult.
This technique involves using mouth controlled acid which is Tyrode on the external surface. Very small amounts of acid are applied to the zona pellucida until the shell is broken. Then the embryo is quickly washed to avoid the harmful effects of acid exposure.
Laser-assisted hatching offers more control on the size of the hole created than mechanical hatching with a needle. In this method, the Zona is pierced by using non-contact mode controlled by a computer. The special designed computer software enables more focus and measurement of embryos and find out a suitable position of embryos. For better performance three different laser intensities – low, medium and high are used.
This technique uses another technology something known as Piezo technology. It this technique vibratory movements are used to create a conical opening.
Assisted hatching by Pronase thinning of Zona pellucid:
In this technique, diluted solution of Pronase is used. The process is starts by transferring of embryos to Pronase diluted solution in the G2 medium. The main goal of this technique is to make thin ZP without removing it completely.
Of all the hatching methods, laser-assisted hatching may be considered as the safest and most effective. A Laser-assisted Hatching is more superior to chemical and manual hatching as it is a safe and gentle way to thin and weaken a small section of the zona pellucida which allow the embryo to hatch.It also offers many advantages including least handling of the embryo and giving fast and exact control over the entrance procedure. But chemical hatching is more commonly used hatching methods. The skill and experience level of the embryologist is an important factor responsible for the success of any methods.
You may Contact Dr Shivani Sachdev Gour for your all Assisted Hatching related questions. She is recognized as one of the best gynecologists and infertility specialist based in Delhi.
Ectopic pregnancies are diagnosed by your doctor, who performed a pelvic exam to locate tenderness, pain or a mass in the abdomen. Your doctor will recommend an ultrasound examination to determine developing fetus in the uterus or elsewhere. The ultrasound can be performed using a wand-like device in your vagina early in pregnancy.It uses sound waves to create images of your fallopian tubes and uterus ovaries. A transvaginal ultrasound images allows your doctor to identify the exact location of your pregnancy. Abdominal ultrasound may also be used to confirm your problems with your pregnancy or evaluate for internal bleeding. The measurement of HCG (human chorionic gonadotropin) levels also plays an important role. The lower level of an hCG than expected is one of the primary reasons to suspect an Ectopic pregnancy. If your doctor confirms that you have an Ectopic pregnancy, she will recommend you about the best available treatment based on future plans for pregnancy and your present medical condition. Low levels of progesterone in your body could be a sign of an Ectopic pregnancy, so your doctor may also test your progesterone levels for diagnosing an Ectopic pregnancy. Apart from progesterone levels tests, your doctor may perform a culdocentesis, which is a process in which a needle is inserted into a space at the top of the vagina, in front of the rectum and behind the uterus. The sign of blood in this area may suggest bleeding from a ruptured fallopian tube.
Treatment of an Ectopic pregnancy depends on the physical health conditions of the woman and the size and location of the Ectopic pregnancy. The injection of methotrexate could be a treatment against early Ectopic pregnancy case as it stops the growth of the embryo.If the pregnancy is farther along, the fertilization of egg can’t able to develop and survive outside of the uterus. In such conditions the patient immediately needs a surgery to remove the abnormal pregnancy so the tissue has to be removed successfully to safe the patient having serious complications. Few years ago, this complication requires a major operation and requiring a large incision across the pelvic area. But this can still be necessary in cases of extensive internal injury or emergency. Your doctor can apply an injection of methotrexate (Trexall) if your pregnancy hasn’t progressed very far and fallopian tube hasn’t ruptured. It stops the cells from further growth and your body can be able to absorb them. Early detection of Ectopic pregnancies can be treated with methotrexate.If the condition worst and severe a surgery is required. The most common surgery is laparoscopy. In this surgery a very small incisions in your lower abdomen has been done and a thin, flexible instrument (laparoscope) has been inserted to remove the Ectopic pregnancy. If the condition of the fallopian tube is bad, the doctor recommends removing it as well. You might need an immediate emergency surgery with a larger incision, if you’re bleeding to a great extent or your doctor suspects your fallopian tube is ruptured. This condition is called laparotomy.
Pregnancy after miscarriage can be very confusing and stressful and it is rather very common to feel nervous about getting pregnant after the incident. Some woman want to take a break who gone through the nightmare of miscarriage to overcome their emotional stagnation and then try to get pregnant again. Nevertheless, some wish to get pregnant immediately after a miscarriage. The feelings and desires are different for different woman, but it is important to know what will right steps for you. So that you can take the right path for considering pregnancy after miscarriage. However, it is highly recommended to wait to attempt again until you are emotionally as well as physically ready. Understanding pregnancy after miscarriage is important to avoid such incident in future again. Below steps will help you to promote a healthy pregnancy after miscarriage.
Reasons for miscarriage: Miscarriage is the sudden loss of a pregnancy before the 20th week. The primary reason for this is the abnormal development of fetus. About 50 percent of early pregnancy loss occurred due to the problems associated with the baby’s chromosomes. These chromosome problems occur by chance as the embryo grows and divides, however it is more common as women age. In many cases, health related problems such as a uterine problem or poorly controlled diabetes might lead to miscarriage. Often, the exact cause of this isn’t known.
Best suitable time for pregnancy after miscarriage: Miscarriage can cause intense feelings of sadness, anxiety or guilt. Some woman might also experience intense feelings of loss due to miscarriage. Don’t let the grieving process to dominate you. To prevent any further infection, typically sexual intercourse isn’t recommended for two weeks after a miscarriage. Your body can able to ovulate and become pregnant as soon as two weeks after a miscarriage. Follow the doctor guidance and advice, whenever you feel physically and emotionally ready for pregnancy after miscarriage. There is no need to wait to conceive after a single miscarriage. Your health care provider may suggest few tests if you gone through two or more such incidence.
How to improve chances of healthy pregnancy after a miscarriage: It is rather hard to avoid miscarriage. If you are suffering from any particular health issues, like ovarian cysts, your doctor will first treat that problem and then advise you to go for planning a baby. In such case, your chances to conceive automatically improve after the treatment. Some women suffering from uterine fibroids must need to go for surgically removal before getting pregnant. If you don’t have any health problems, then all you need to do is change your present lifestyle to improve the chances of a healthy pregnancy after miscarriage. Miscarriage is an unavoidable event and you must try to retain your hope for successful pregnancy even after event of multiple incidents. There are many incidents where a woman faced several miscarriages have delivered healthy babies.
Avoid the risk of future miscarriage: Generally repeated miscarriage is exception, only percent of couples experience two or more miscarriages in a row. Consult your doctor and take appropriate measures to reduce your risk for future miscarriage.
Egg freezing, also known as mature oocyte cryopreservation, is a new technique in Assisted Reproductive Technology (ART) in which the eggs of a woman are frozen and stored for to save women’s ability to get pregnant in the future. Fresh Eggs harvested from your ovaries are frozen further in unfertilized form and stored for later use. A frozen egg can be unfrozen and combined with sperm in a lab and implanted in your uterus for vitro fertilization process. This technique is helping number of women to preserve and control their fertility for various reasons and help them to have children at a later period of time. Some women opt eggs freeze due to their medical condition or their undergoing treatment that affects their fertility. It is very helpful for the women who aren’t ready or able to have children and want to become mother in the future. A woman’s chances of conceiving naturally fall gradually as per their age because the number and quality of her eggs drops significantly.
Egg freezing is an option if you’re not ready to become pregnant now but wish to make sure you can get pregnant later. Egg freezing doesn’t need sperm because the eggs aren’t fertilized before they’re frozen, unlike with fertilized egg freezing known as embryo cryopreservation. Similar to embryo freezing you will require using fertility drugs to make you ovulate so that you will produce multiple eggs for retrieval purpose. You should consider egg freezing for below reasons:
- If you have some health condition or circumstance that that affect your health of your fertility. These might include autoimmune diseases such as lupus, sickle cell anemia or gender diversity, such as being transgender.
- You need to go for in vitro fertilization (IVF). Before undergoing in vitro fertilization, some people prefer egg freezing to embryo freezing for many reasons like ethical or religious reasons or you are worried about your fertility and think it is declining but at the same time you are not ready to have a child or you haven’t found the right partner, this is also called ‘elective egg freezing’.
- You require treatment against some illness or need treatment for cancer that can affect your ability to conceive baby. Few medical treatments like radiation or chemotherapy can harm your fertility power at greater extent. Egg freezing before treatment will possibly increase your chances to have biological children later.
- You wish to preserve your healthy and younger eggs now for future use. Freezing eggs at a younger age might help you to increase pregnant chances in your later life,or you are at high risk of injury or death (for example, you are employed in the armed forces who is being deployed to a war zone and are at high risk).
- In increase the chances for become mother in future and reduced emotional risks. Egg freezing can provide hope for a future pregnancy but still there is no guarantee of success.
- You are a female transitioning to a male and want to conserve your fertility before undergoing any reconstructive surgery.
Infertility can be either in male, female, or in both. Dealing with the fact that either of the partner is struggling with infertility, is a difficult task to do. Infertility counselling helps those couples to feel comfortable, accept the fact, and move on with new hope. It help intended parents to understand infertility reasons, further methods to tackle this situation, and finally to become parents.
Infertility counselling is done by professional counsellors who are experienced with people in infertility situation and know how to address the emotional difficulties a patient going through.
Types of Infertility Counselling
Depending on the stage of infertility process, where a patient currently is, there are following types of counselling.
- Initial Counselling: In this counselling, an infertility counsellor, usually an infertility doctor, observes the couples’ state of mind and their attitude towards their infertility problem. Sometimes, partner blames each other for this condition and their opinion for treatment options are different. It is the responsibility of fertility counsellor to make them understand that this can be happen with any one, regardless the gender. Once couple got a clear picture about infertility problem, a counsellor further helps them to choose a best option for treatment and its details.
- Counseling for Confidence Building:If a couple has understood the infertility problem but not sure about the suggested option for infertility treatment, they require confidence building sessions. In this, a counsellor tries to find out the reasons that makes couples unsure about treatment. Usually reason behind this lack of confidence is unknown fear, social aspects, and lack of family support. Counsellor makes couple to understand that this decision is totally of the intendent parents and tries to build their confidence on the doctor who is going to treat them.
- Psychological Counseling: This counselling is used in some intense situation, where a couple show case an extreme sign of depression. Depression may occur due to marital issues between partners, bad experience of earlier treatments, or any other psychological issues.
When a couple starts infertility counselling, the process may be a combination of different stages.
How an Expert Helps Couple in Infertility Counselling?
Infertility counsellor is not only one who supports an infertile couple in phycological issues but also on medical issues. When a couple decide to use an infertility treatment to become parents, they may not have any experience regarding treatment and may not be fully prepared. Thus, infertility counseling is necessary to make sure that the couple get awareness about requirements of each step of treatment and be prepared for further journey.
An expert can help couples to eliminate their fears and build a trust on treatment procedures. The following are key responsibilities of counselor.
- Understanding view point of couples, and making both partners to understand each other’s expectations and ambitions throughout the treatment journey.
- Providing assistance to couples to tackle emotional situations that may occurs in any stage of treatment.
- Making partners believe in medical treatment, doctors handling the case, and on each other.
- Counsellor should make couples so much comfortable that they can trust on counsellor and express each difficulty.
How to Choose Your Infertility Care Centre and Expert? http://drshivanisachdevgour.co.in/blog/how-to-choose-your-infertility-care-centre-and-expert/