1. OVULATION INDUCTION:
2. Ovulation Induction is the basic step in the management of infertility when the female partner receives certain medications so as to stimulate her ovary to produce more mature follicles or eggs which are then triggered to mature. The aim of ovulation induction is to develop one or two mature follicles.

Who shall benefit from Ovulation Induction?

• Women who do not get regular menstruation,
• Women with PCOS
• Women with hypogondaotrophic hypogonadism
• Advanced maternal age
• Women with early stage Endometriosis

What are the steps of treatment in Ovulation Induction?

Couple must undergo fertility evaluation to know if they are suitable for this treatment. Generally oral medications are preferred to stimulate ovaries to grow follicles. However in some cases injectable medications are also needed. The development of the follicle is followed up on a Trans-vaginal scan. When the follicle reaches a certain size, the ovulation is triggered. This helps in the release of mature egg from the follicle.Ovulation can be confirmed with the help of ultrasound, urine or blood tests. Subsequently, depending upon these tests and ovulation scans the doctor advices the couple to have intercourse on particular days to increase chances of pregnancy.

2. INTRA-UTERINE INSEMINATION:

IUI or Artificial Insemination (AI) is a procedure of placing processed semen sample containing most motile sperms of the male partner into the uterus cavity through the cervix of the female partner at the time of her ovulation.

Who shall benefit from IUI?

• Mild to moderate decrease in sperm count or motility
• Male sexual dysfunction: erectile dysfunction or ejaculatory disturbances
• Female sexual dysfunction: vaginismus
• Early stage endometriosis
• Unexplained infertility

What are the steps of treatment in IUI?

Couple must undergo fertility evaluation to know if they are suitable for this treatment. The female partner must have patent fallopian tubes.

 Female partner is given medications to stimulate ovaries to grow follicles. The development of the follicle is followed up on a Trans-vaginal scan. When the follicle reaches a certain size, the ovulation is triggered with a “trigger injection”. This helps in the release of mature egg from the follicle. Subsequently the doctor performs the intrauterine insemination after 36 to 44 hours following the trigger injection. On the day of IUI the male partner provides a semen sample. This sample is processed and the motile sperms are separated. The concentrated motile sperms are introduced into the female partner’s uterus using a fine catheter. This procedure is generally not painful and the female can go back home the same day.

What are the precautions after IUI?

IUI is a simple procedure and generally does not require any special precautions. However the doctor would advice rest for a few minutes after the procedure. You can go back to work from the next day and continue your day to day activities as usual.

What are the complications in this procedure?

Usually there are no major complications. But some patients may have mild pain with spotting on the day of IUI procedure which settles immediately.

What are the chances of success?

Worldwide, the success rates for IUI average at around 10-20%. Generally younger women have higher success rates in comparison to those above 35 years. Statistics show that the majority of IUI pregnancies occur in the first three to four cycles of IUI.

3. IN-VITRO FERTILISATION

IVF is one of the best forms of Assisted Reproductive Technology (ART) by which the woman’s eggs are removed from her ovaries and then fertilized with the male partner’s sperms in a laboratory dish. Following fertilsation embryos are formed. One or two embryos are transferred into the woma’s uterus and the rest of the embryos are preserved in the lab for future pregnancies.

Who are treated with IVF?

• Tubal factor infertility: tubal diseases like hydrosalpinx, following tubal sterilization, following both sides salpingectomy (surgical removal of fallopian tubes) for previous ectopic pregnancy.
• Multiple failed Ovulation induction and Intrauterine insemination (IUI).
• Severe male factor infertility (sperm count< 10 million/ml and <40% motility)
• Advanced maternal age
• Couples requiring donor oocytes

What are the steps of IVF treatment?

• Couple need to be evaluated with blood tests, ultrasound and semen analysis. Medical and surgical history is taken. Previous treatment cycles are studied. Depending on the couple’s history, ovarian reserve, female partner age and the semen analysis report personalized treatment plan is formulated.
• Stimulation of ovaries: Medications are given to the female partner to stimulate the ovaries to develop several follicles that contain the eggs. The response to the medications is monitored with the help of blood tests and ultrasound. Once the follicles reach a desired size an injection (trigger injection) is given to mature the eggs that are growing within the follicle.
•  Egg Retrieval Procedure (Ovum pick-up) Matured eggs are removed from the ovaries trans-vaginally under General anaesthesia to reduce pain and discomfort. This takes about 15-20 minutes and patient is rested for 2-3 hours after which she can go home. Occasionally some patients may have some vaginal spotting and little abdominal discomfort which settles in a day or two.
• In Vitro Fertilization: A fresh semen sample is collected from the male partner on the day of egg collection (ovum pick-up). The semen sample is processed in the lab. Both the eggs and the sperms are kept together in the lab on a petridish in a controlled environment. The next day the eggs are examined in the lab for their fertilization and their further development to embryos.
• Embryo transfer This is performed after 3-5 days of egg collection. This procedure is carried out by transferring the embryo through the cervix into the uterus via a thin, soft plastic tube guided by ultrasound. After the transfer the patients are given a course of medication to support the early pregnancy.
• Confirmation of Pregnancy test This test is done after two weeks of embryo transfer to confirm pregnancy. If the test is positive an early pregnancy ultrasound is advised.

What are the precautions to be taken after an IVF treatment?

All vigorous exercise, heavy lifting and any activities that involve jarring movements (cycling, jogging, skiing, tennis etc.) are to be avoided while normal routine activities are allowed. If you are working you can go back to work after a rest of 2 to 3 days and continue to do your day to day activities as usual. Bed rest is usually not advised.

4. INTRACYTOPLASMIC SPERM INJECTION (ICSI)

ICSI is a procedure in which a selected sperm is injected into the oocyte so as to overcome the limitations that conventional IVF faces with poor semen samples and deficiencies in the interaction between the sperms and eggs.

Who are treated with ICSI?

ICSI can be performed for all the recommendations mentioned for IVF. However it is especially recommended in the following situations:

• Low sperm concentration or motility
• Testicular retrieved sperms
• Very few eggs retrieved from female partner
• Previous fertilization failure using conventional IVF
• Couple requiring PGT
• Eggs containing thick zona

What are the steps of ICSI treatment?

• Couple need to be evaluated with blood tests, ultrasound and semen analysis. Medical and surgical history is taken. Previous treatment cycles are studied. Depending on the couple’s history, ovarian reserve, female partner age and the semen analysis report personalized treatment plan is formulated.
• Stimulation of ovaries: Medications are given to the female partner to stimulate the ovaries to develop several follicles that contain the eggs. The response to the medications is monitored with the help of blood tests and ultrasound. Once the follicles reach a desired size an injection (trigger injection) is given to mature the eggs that are growing within the follicle.
•  Egg Retrieval Procedure (Ovum pick-up) Matured eggs are removed from the ovaries trans-vaginally under General anaesthesia to reduce pain and discomfort. This takes about 15-20 minutes and patient is rested for 2-3 hours after which she can go home. Occasionally some patients may have some vaginal spotting and little abdominal discomfort which settles in a day or two.
• Intracytoplasmic sperm injection: A fresh semen sample is collected from the male partner on the day of egg collection (ovum pick-up). The semen sample is processed in the lab. The best sperms are chosen under a very high power microscope and directly injected into the egg at advanced micromanipulation station within the lab. The next day the eggs are examined in the lab for their fertilization and their further development to embryos.
• Embryo transfer This is performed after 3-5 days of egg collection. This procedure is carried out by transferring the embryo through the cervix into the uterus via a thin, soft plastic tube guided by ultrasound. After the transfer the patients are given a course of medication to support the early pregnancy.
• Confirmation of Pregnancy test This test is done after two weeks of embryo transfer to confirm pregnancy. If the test is positive an early pregnancy ultrasound is advised.

• What are the precautions to be taken after an ICSI treatment?

All vigorous exercise, heavy lifting and any activities that involve jarring movements (cycling, jogging, skiing, tennis etc.) are to be avoided while normal routine activities are allowed. If you are working you can go back to work after a rest of 2 to 3 days and continue to do your day to day activities as usual. Bed rest is usually not advised.

5. PRE-IMPLANTATION GENETIC TESTING:

PGS is a genetic screening test which assess for chromosomal abnormalities in your embryos before it is implanted during an IVF cycle. This allows screening for the best embryos to be implanted thereby reducing the probability of an unhealthy fetus with certain congenital diseases.

In this technique a small biopsy is taken from an embryo which is then analyzed by comparative genomic hybridisation (aCGH) with chromosomal profiling of all 24 chromosomes so as to detect common genetic abnormalities like Down syndrome, Edwards syndrome and Patau syndrome etc. This way we can better select or deselect an embryo to transfer.

Who are offered this treatment?

• Advanced maternal age ≥ 35 years
• Couples with a history of recurrent and spontaneous miscarriages/ abortions.
• Couples with multiple IVF or ICSI failures.
• Couples having previous child with genetic abnormalities, thalassemia, colour blindness etc.
• Strong family history of genetic diseases

The best advantage of PGS is that it reduces the time to pregnancy as your fertility specialist is able to select the best embryo before transfer which increases the likelihood of success post embryo transfer.

6. PLATELET-RICH PLASMA THERAPY:

What is Platelet rich Plasma?

Platelet-rich plasma consists of two elements: plasma, or the liquid portion of blood, and platelets, a type of blood cell that plays an important role in healing throughout the body. Platelets are well-known for their clotting abilities, but they also contain growth factors that can trigger cell reproduction and stimulate tissue regeneration or healing in the treated area. Platelet-rich plasma is blood that contains immensely high quanitites of platelets.

To create platelet-rich plasma, a blood sample is taken and placed into a device called a “centrifuge” that rapidly spins the sample, separating out the other components of the blood from the platelets and concentrating them within the plasma.

We have two types of PRP therapy: OVARIAN PRP and ENDOMETRIAL PRP therapies.

Ovarian PRP is an emerging therapy in ovarian rejuvenation offered to women who have suffered early menopause or who have a decreased ovarian reserve. The procedure includes injections of PRP derived from the patient’s own blood directly into the ovaries. PRP contains cytokines and growth factors to heal and revive the local tissues in the ovaries to stimulate the growth of dormant follicles. PRP therapy is a safe option as it is obtained from the woman’s own plasma it doesn’t carry the risk of any allergic reactions or risk of any blood borne infections.

Endometrial PRP has been found to improve the thickness of the endometrium, endometrial receptivity and implantation. Thus it can help women achieve a successful pregnancy. As PRP is rich in grow factors, following PRP injection within the uterine cavity, healing occurs and new cells begin to grow in the endometrium.  

Who are candidates for PRP therapy?

• Low ovarian reserve/ Low AMH
• Premature ovarian failure/ early menopause
• Poor egg quality
• Poor egg quantity
• Poor response to IVF
• Failed embryo transfer
• Thin endometrial lining
• Recurrent implantation failure
• Men with Non obstructive azoospermia

7. ENDOMETRIAL RECEPTIVITY ARRAY:

Many women undergoing IVF are unable to get pregnant, even after transferring good quality embryos. Although a good quality embryo is an important starting point, it is also important to transfer the embryo into a uterus that is ready to receive the embryo. The timing of embryo transfer also plays an important role.

What is the endometrium?

• The interior of the uterus is lined with a tissue called endometrium, which is prepared each month for the arrival of an embryo for further growth and progression of pregnancy.
•  Even the best embryo will fail to implant if conditions aren’t right.

What is Endometrial receptivity?

• The endometrium is receptive when it is ready for embryo implantation to occur. This period of receptivity is called the window of implantation. 
• Each woman has a unique window. For some women the window is shorter and/or displaced. By knowing a woman’s personal window of implantation we can optimize her chances of pregnancy through a personalized embryo transfer.

What is ERA test?

• ERA test evaluates endometrial receptivity, the optimal time for embryo transfer that is specific for each woman.

How does ERA test result help?

• When performing the embryo transfer in a personalized way, the chances of getting pregnant are increased after the assisted reproduction treatment.
• Maximize your chances of pregnancy and don’t lose good embryos.

Who can benefit from ERA test?

An ERA test can be beneficial for couples who have had 3 or more unsuccessful IVF cycles. In such cases, the couple has had an otherwise good fertilization rate, the embryos have developed and appear healthy and the uterine lining looks good but the woman had recurrent implantation failure. If the ERA determines that the endometrium is receptive to the embryo and it still fails to implant, the only other reason for the failed pregnancy is a genetic abnormality.

How is the ERA test done?

For the ERA test an endometrial tissue sample is taken through a fine catheter. This procedure does not require anesthesia and may be conducted in the doctor’s office. Before this sample is taken, the patient is given progesterone supplements for 5 days. Progesterone is one of the hormones that play an important role in making the endometrium receptive to an embryo.

Once the tissue has been collected, the genes within it are analyzed. This can then predict whether the uterus would be receptive to an embryo on the day that the embryo would have been transferred.

If the test determines that the uterus is receptive, the embryo may be transferred as planned in the next IVF cycle. However, if the endometrium is detected as non-receptive, the progesterone timing will be altered so as to allow doctors to transfer the embryo only at a point when the uterus is receptive to it.

8. THIRD PARTY REPRODUCTION:

Third party reproduction refers to the use of donor egg or donor sperm or surrogate to enable the couple to become parents.

1. Egg donation

When the female partner is unable to produce healthy egg then they are taken from a healthy young woman (the egg donor) which are then fertilised with the sperms of the male partner (husband) so as to form a fertilized egg resulting into embryos which are then transferred into the female partner’s uterus.

What is the process of Egg Donation

The first step is a selection of an anonymous donor who is approved after thorough medical and genetic screenings. Egg donors are recruited through ART banks. After selection, the donor’s ovaries are stimulated by a stimulation regimen to produce multiple eggs which are then retrieved and fertilized by IVF/ICSI using the male partner’s sperms. The embryos formed are transferred into the uterus of the female partner.

Who is offered egg donation?

• Advanced maternal age with poor ovarian reserve
• Multiple failed IVF/ICSI attempts with self eggs
• Female with known genetic diseases that can affect the fetus

1. Sperm donation

Donor sperm may be required in cases of:

• Azoospermia (absence of sperms) where sperms could not be retrieved medically or surgically.
• Risk of transmission of genetic disease to the offspring

Donor semen samples are provided by ART banks. The sperm donors undergo a series of investigations before their semen sample is collected. Then semen sample is frozen for quarantine period of 6 months. According to the physical characteristics (height, skin color, hair color, eye color) and the blood group of infertile couple, a request to ART bank is sent and the semen sample is procured. The sample is warmed and checked for sperm count and motility before using it for ART procedures. Consent of both partners is taken prior to use of donor sperm. Donor sperm can be used for both Intra-uterine Insemination (IUI) and In-Vitro fertilsation (IVF).

• SURROGACY:

Surrogacy is an arrangement where a woman (surrogate mother) carries the baby of intending parents through IVF in her uterus. She hands over the baby to intending parents at delivery. The gametes belong to the genetic parents or sometimes donor but not to the surrogate mother. This treatment procedure is supported with a legal document.

Medical conditions necessitating gestational surrogacy are:

• Woman with absent uterus or abnormal uterus or if the uterus is surgically removed due to any medical conditions such as gynecological cancers.
• Repeated IVF failures
• Any illness that makes it impossible for woman to carry a pregnancy to viability or pregnancy that is life threatening.

9. FERTILITY PRESERVATION:

Fertility preservation is a broad term which involves many procedures to retain fertility in men and women. This mainly applies to people who are being treated for cancer or other illnesses which might prevent them from having children. It may also apply to those who wish to postpone child bearing due to personal or social reasons. It includes:

Freezing of sperms

A person who might undergo treatment which might potentially make him infertile – can produce semen by masturbation and get it frozen for future use. It is best to freeze multiple samples (if time permits). 

Freezing of eggs

It involves administration of medications for a period of two weeks or more to stimulate the ovaries to produce multiple eggs, which are then collected by a minor surgical procedure under general anaesthesia. These eggs are then frozen for future use.

Freezing of embryos

For married women, the eggs collected can be fertilised with the husband’s sperm (IVF or ICSI) and then cultured to form embryos. These embryos are then frozen. When the woman is ready to initiate pregnancy, the embryos are thawed and transferred into the uterus for further growth and development of pregnancy.

Ovarian transposition (oophoropexy)

This surgical procedure is sometimes recommended if radiation is being planned to your pelvis. The ovaries are surgically repositioned just before radiation therapy so that they are as far away as possible from the planned radiation field. This though does not always completely protect the ovaries. After completion of the radiation, you might need to have the ovaries repositioned again or use IVF to conceive.

10. FERTILITY ENHANCING LAPAROSCOPIC AND HYSTEROSCOPIC SURGERIES

The two main routes of surgeries used for enhancing fertility  and treating conditions that can lead to infertility are laparoscopy and hysteroscopy. With more and more patients facing fertility issues nowadays, the importance of these fertility enhancing surgeries has increased manifold.

        I.            Laparoscopy:

Laparoscope allows us to directly visualize and treat the conditions affecting the uterus, tubes and ovaries. (SEE AND TREAT)

The most common indications for laparoscopy in patients with infertility are:

1. Evaluation of tubal patency: It can be done when we are suspecting tubal blocks for eg: tubal blocks in HSG, couple with unexplained infertility, history of previous surgery or endometriosis where there is chance for adhesions leading to tubal factor infertility.
2. Endometriosis: Laparoscopy can enhance the fertility in women with endometriosis by adhesiolysis, endometriotic cystectomy, salpingo-ovariolysis etc. This surgery aims to restore the tubo-ovarian relationship leading to spontaneous pregnancy as well.
3. PCOS: Some women with PCOS who do not respond to medications for ovulation or stay far so cannot come for follow up can benefit from a simple surgical procedure called Laparoscopic ovarian drilling. 3 to 4 drills are made into each ovary depending on the size of the ovary. This helps in improving the hormonal imbalance seen in this condition and can help women to ovulate spontaneously leading to spontaneous pregnancy.
4.  Fibroids: Not all women with fibroids require a surgical removal in order to conceive. However fibroids that are large or are pressing on the uterine cavity can be removed via the laparoscopic route which can increase the chances of pregnancy and reduce the risk of miscarriage, pregnancy losses or preterm labour.
5. Hydrosalpinx:  Hydrosalpinx is a term used for fallopian tubes that are swollen and filled with infected secretions. It is seen that women with hydrosalpinx have an increased chancs fro an ectopic pregnancy. The chances of miscarriage are higher and pregnancy chances are lower. Laparoscopic salpingectomy is advised which increases the  success rate of IVF.

1. Hysteroscopy:

Hysteroscopy is the introduction of a thin camera inside the uterus to assess the condition within the uterus and simultaneously treat if any problem exists.

The most common indications for hysteroscopy in patients with infertility are:

1. Multiple failed IVF failures or recurrent implantation failure
2. Suspected abnormalities in the uterine shape for example: septate uterus, bicornuate uterus, unicornuate uterus etc: hysteroscopic septoplasty is offered to those with septate uterus.
3. Presence of endometrial polyp: removal of polyp is called as polypectomy.
4. Women with thin endometrium or suspected Asherman syndrome: Adhesiolysis is done in cases of uterine synechiae
5. Presence of submucosal fibroid: Myomectomy is done using hysteroscope or resectoscope.

Thus fertility enhancing surgeries in carefully selected patients can improve the chances of a woman to conceive naturally and also help in improving the success rates in women undergoing assisted reproduction treatment like IUI or IVF/ICSI.

11. Surgical sperm retrieval:

As many as 10% to 15% of infertile men have no sperm in their ejaculate (the fluid released from the penis during orgasm). This is called azoospermia. Forty percent of cases are due to a blockage (obstruction) in the reproductive tract. Problems with sperm production account for the rest.

ICSI has made it possible for most men with azoospermia or severe male factor infertility to have their own biological children. As even in cases where very few sperms were retrieved the eggs can be fertilized using ICSI technique.

Surgical Sperm Retrieval is a surgical procedure performed as a day care surgery under General/ Local anesthesia where the sperms of male partner are collected directly from the epididymis or the testis for use in IUI or IVF/ ICSI. This is done when sperms are not obtained in the ejaculated semen sample of the male partner. There are different procedures carried according to the patient’s requirement.

Who require surgical sperm retrieval?

• Men who do not have sperms in the ejaculate semen
• Men who have semen with high DNA Fragmentation Index
• Men who do not produce ejaculate due to obstruction from injury or infection
• Men who fail to produce an ejaculate due to erectile/ ejaculatory dysfunction

What are the different surgical sperm retrieval techniques?

1. TESA (Testicular Sperm Extraction)

This procedure is mainly suitable in patients with obstruction in their spermatic duct also known as obstructive azoospermia (due to infections, trauma), post-vasectomy (where surgical reversal has failed), and sperms in the ejaculate with high DNA Fragmentation Index.

1. PESA (Percutaneous Epididymal Sperm Aspiration)

This procedure uses a fine needle to aspirate sperms from the “Epididymis” which is a sperm-rich tube at the back of the testis where the sperms get stored before ejaculation.

• MESA(Microscopic Epididymal Sperm Aspiration)

This procedure uses microsurgical procedure to collect sperm from Epididymis under high magnification in cases of extremely low sperm production.

1. MicroTESE (Microscopic testicular sperm extraction)

Micro testicular sperm extraction (micro TESE) is a microsurgical technique used to retrieve sperm from the testes. It is a revolutionary treatment that serves to counter severe male factor infertility (azoospermia) caused by low sperm production.

 In typical cases of nonobstructive azoospermia, the testicles harbour small pockets of sperm, characterised by prominent testicular tubules. During micro TESE, these tubules are carefully extracted and transferred to a petri dish containing culture media. An embryologist then examines the specimen for sperm, under a microscope. Once healthy sperm are identified, they are injected into a set of mature eggs for fertilisation.

Micro TESE is an advanced technique that presents better chances of finding healthy sperm than a random biopsy. The probability of finding sperm using micro TESE is more than 60%. Also, since micro TESE is best performed on the same day as an egg retrieval routine, sperm can be injected without being frozen beforehand, in turn, assuring optimal quality.

12. Newer technologies: PICSI, Embryo Glue, Embryo Hatching
13. PICSI: Physiolgical intracytoplasmic sperm injection:

PICSI is an advanced sperm selection technique. Sperms with high amount of damaged DNA may appear normal in morphology. However these sperms can result in poor embryo quality and pregnancy loss. Instead of relying only on normal morphology and motility for selection of sperm as is done for ICSI, sperm selection is done in a more physiological way using the PICSI procedure. The selection of healthy sperm in PICSI relies on the ability of a mature sperm containing good DNA to be able to bind to the hyaluronan complex surrounding the oocyte.

Who are the candidates for PICSI?

• Repeated ICSI failures
• Men with high DFI (DNA Fragmentation Index) in semen
• Couples with recurrent pregnancy losses and miscarriages

1. EMBRYO GLUE:

An environment similar to a woman’s uterus is created for the implantation or sticking of the embryo to the uterus in the IVF procedure. Hyaluronan or hyaluronic acid is an acid that is naturally present in the female uterus. 

In an effort to create a favorable media, hyaluronic acid which is rich in the carbohydrates, amino acids, and protein, essential for the proper development of the embryo is added to the Embryo Transfer media, which may provide support to the process of implantation – by making the embryo more likely to stick to the lining of the womb, thus reducing the movement of the embryo around the uterus. This is what is known as embryo glue.

Embryo Glue may benefit couples who have had multiple implantation failures while trying to conceive. It may improve the chances of implantation to some extent.

• ASSISTED HATCHING OF EMBRYOS:

Hatching is a natural process that is performed by an embryo in order to get attached to the uterus lining for pregnancy.

For smoothening the process of implantation process in IVF treatment, the method of assisted hatching of the embryo is used where in the barrier around the embryo is weakened in the process. This not only assists the embryo to hatch but also increases the possibility of implantation. Hatching of these embryos is essential because, without hatching, they will not be implanted on the lining of the uterus.

The perfect candidate for this treatment is the women who have experienced failure in IVF in the past. Also, if their zona pellucida is very thick which is acting as a barrier for hatching, and then the same can be achieved by the treatment of assisted hatching of the embryo.

This can be achieved by any of the three methods – laser-assisted hatching, acid tyrode’s solution, and partial zona dissection. Out of these Laser assisted hatching is done most commonly.

Who can benefit from Assisted Hatching of embryos?

• Advanced maternal age
• Eggs and embryos with thickened zona
• Multiple previous IVF/ ICSI failures

13. PRE-IMPLANTATION GENETIC TESTING

Not all embryos made out of IVF or ICSI process are genetically normal. Some embryos will have defective number of chromosomes or have a structural defect in one/more of the chromosomes. A normal human cell has 46 XY (male) or 46 XX (female) chromosomes.  Pre-implantation genetic screening is a technology in which a few cells (6-10) are taken out from an outer layer of a blastocyst (day 5 or day 6 embryo). This procedure is highly skilled and it is absolutely imperative that it is done by an expert and experienced Embryologist.

How is PGT done?

After assisted hatching of outer layer of embryo, the trophectoderm (which is the outer layer of cells of embryo) is teased into a micro-pipette and few cells are aspirated. These cells are then sent to a Genetic laboratory in a special medium and are thereafter tested for chromosomal number and structure. NGS which is time-efficient, reliable, accurate with a high sensitivity and specificity is the preferred technology used in genetic testing.

What are the situations wherein PGS or PGT can particularly help?

• Advanced maternal age: Older women (more than 35 years) are found to have increased chance of developing abnormal embryos due to the impaired quality of eggs.
• Male infertility: Male partner having genetic disease or sever sperm defects.
• Genetic diseases in either partner: When either the wife or husband is known to have or is a carrier of a hereditary disease (eg Thalassemia,) or have structural defects in their karyotype.
• Repeated miscarriages (abortions) in the past:– one of the reasons of multiple miscarriages is chromosomal defect and PGS can help us select the normal embryo that can give a healthy pregnancy.
• Multiple failed attempts at IVF before:– One of the important reasons of Repeated Implantation failure (couple having multiple failed attempts at IVF) is chromosomal aneuploidies. If such a couple avails pre-implantation genetic testing, they can also have the happiness of a lively, healthy new-born in their arms!
• Family history of genetic diseases: Couples with children affected with genetic disease or strong family history of genetic disease.

Is PGS for me?

It has been found in scientific literature that pre-implantation genetic screening can definitely reduce the time taken to pregnancy (TTP) and save your time in having a baby. This is particularly important for those couples who are already emotionally stressed after facing failure in an IVF cycle before.