Embryo Transfer

A maximum of 2-3 embryos may be transferred in each cycle after full discussion with the patient in order to reduce the risk of multiple pregnancies. The procedure takes place in the operating theater but anesthesia is not usually necessary. Very rarely four embryos are transferred. A speculum is placed in the vagina and the cervix is exposed and cleaned with sterile water.

The embryos are then drawn up in to a catheter, which is then carefully and gently inserted through the carvix (neck of the womb) into the uterus. After transfer, the catheter is carefully checked by the embryologist to make sure that all the embryos have been carefully transferred. Embryo transfer is done under ultrasound guidance.

If you have failed IVF in the past, we can use advanced technology to maximize your chances of getting pregnant. We at Prashanth Fertility Research Centre, would like to see each and every patient go back home with their bundle of joy and see “that” smile on their faces. Our dedicated staff is here to make sure your stay at Prashanth is pleasant and comfortable.

FREEZING SPARE EMBRYOS

Any remaining embryos of good quality may be frozen with your consent. They will then be available for transfer in another cycle. We will discuss this option with you on the day of embryo transfer. It is important to note that not all embryos are suitable for freezing and not all embryos will be in freezing process. You have to make the payment for embryo freezing on the 6th day after egg collection. Please contact the lab on day 6 after egg collection to discuss on freezing the embryos. State of the art cryo freezing facilities are available in our hospital. Our freezing protocols are completely computerized. All the embryos are coded, labelled and stored in special containers to maintain their identity.

VITRIFYING (FREEZING) EGGS

• Egg freezing is now a perfect procedure and thawed eggs give pregnancy rates which are almost equal to fresh eggs. Why do you need to freeze eggs.
• Convenience so that eggs are available at all times
• Ina patient with malignancy going through chemotherapy surgery or radiotherapy, the ovaries are stimulated egg collection is done and frozen by a technique call “Vitrification”. The egg recovery after thawing is excellent and thousands of healthy babies have been born from the frozen eggs proving this to be a safe technique.
• Endometriosis, where the ovarian tissue is destroyed over years which also decreases ovarian reserve. Women with endometriosis can also freeze their eggs and use them several years later.
• When marriage prospects are far away due to career reasons eggs can be frozen till the right moment comes. This is particularly applicable for women over 35 years of age.
• Women with family history of early menopause. These eggs can be thawed and fertilized with a donor sperm or husband sperm wherever required and this procedure gives excellent pregnancy rates.

HANDLING SUCCESSFUL CASES

After successful embryo transfer

When blood and Urine test are done 15 days after ET, the following may happen:

• Pregnancy: Congratulations! You may confirm pregancy over the phone. However your follow up starts two weeks later when you come for a scan. Meanwhile all medications should be continued. Please send your attendant with the file to discuss about medications.
• Return to menstruation or negative pregnancy test: Inspite of all the technical advances in the past few years, a negative outcome is also possible in a treatment cycle. Invariably there is no plausible explanation as to why a cycle may not be successful. The periods after an unsuccessful treatment is usually heavy and there is likely to be some irregularity in subsequent cycles . Dr. Geetha will discuss the probable reason for the failure.
• Pregnancy: It is important to realize that even if you test positive for pregnancy, problems can still arise. Miscarriages may occur (in about 15% of patients ) while ectopic pregnancies are also possible (rare but possible particularly if there is history of tubal damage). Congenital and chromosome abnomalities are no more common than in normal “matched conceptions.”
• Multiple pregnancies: There is 25% – 30% chance of multiple pregnancy usually twins due to super ovulation and sometimes 3 embryos are being transferred at one time. While some couple consider multiple pregnancy to be a favorable outcome of treatment, the reality may be different. Multiple pregnancies are associated with greater complications for both the mother and the babies. In particular there is an increased risk of miscarriage and premature birth. This can also lead to reduced survival rates, long term health problems and disability.

Taking care of twins and triplets may also put strain on relationships and add unexpected financial pressures within the family. To reduce this risk overall, we recommend transfer of 1-2 eggs in those who have had a previous successful pregnancy For those with previous IVF failures and miscarriages, the team will provide additional medications.

HANDLING UNSUCCESSFUL IVF CASES

Success and failure are possible in spite of our sincere and earnest efforts. Failures are particularly distressing in those circumstances where each and every step of the treatment had progressed without a hitch.

In general, IVF procedures are successful only in 50-65% of the cases, i.e, out of every 100 patients who undergo IVF treatment, about 50 – 65% of them get pregnant. Of these 15% may have missed abortion, ectopic pregnancy, pre-term labour or a rarely malformed fetus. Only 50% carry the pregnancy to term. So if extra embryos are available for freezing please freeze them.

We have a dedicated team who gives atmost care to each and every patient with the good hope and belief that all of them will become parents. The treatment is individualized and varies from person to person based on the clinical circumstances. So, kindly do not get disheartened if your treatment does not match with that of your friend.

The cause of failure and the appropriate corrective measure are discussed in detail with the patient.

In the unfortunate event that your IVF procedure has failed, the next treatment is usually started after an interval of 1 or 2 months. If injections/drugs had been given for ovarian stimulation, an interval of 3 months is compulsory.

The fee charged for IVF cycles is towards the medicines, the instruments and the chemicals used, Hence this will be a recurring cost for every cycle.

Depending on the convenience of the patient, any number of cycles may be performed.

Donor oocyte programme: We try newer treatment schedules like the IVF lite protocol before deciding on donor oocyte programme.

For patients whose eggs are low in number and quality, donor egg programme is available.

Surrogacy programme: If we find that a couple cannot parent a child under any circumstances, we advise them to go for surrogacy, if they wish so.

FERTILIZATION CHECK

This is done on the next day of egg collection and then on day 3. The following can happen.

Normal Fertilization: If the embryos fertilize normally, they are undisturbed and reviewed on Day 3 and 5 and transferred when appropriate

No Fertilization: This can occur in any IVF treatment cycle and arises in about 2% to 3% of couples with no identifiable problem. Although it is more common when there is an established sperm problem, it can occur even If sperm donor is being used.

Abnormal Fertilization: since the environment is created artificially during IVF/ICSI Process it is possible for more than one sperm to sperm to enter an egg. These embryos do not develop normally and are not transferred.

Failure to cleave (Divide): The growth arrests and there is no development. Some embryos undergo fragrnentation. A moderate degree of fragmentation (or cell irregularity) is common and is of little significance. However extensive fragmentation is associated with a reduced chance of successful pregnancy. Staff will be available to discuss the possible reasons and further options. If the whole procedure is completed and only embryo transfer is not done, Rs.10,000/- will be refunded.