Services

Infertility Work Up

Infertility

Defined as failure to achieve pregnancy within 12 months of unprotected intercourse or therapeutic donor insemination in women younger than 35 years.

Women older than 35 years after 6 months of failed attempts to become pregnant or earlier, if clinically indicated.

In women older than 40 years, more immediate evaluation and treatment.

If a woman has a condition known to cause infertility, the obstetrician–gynecologist should offer immediate evaluation.

Initial workup includes a review of the medical history, physical examination.

Female Partner: tests will focus on ovarian reserve, ovulatory function, and structural

Abnormalities: Hormone profile [AMH, FSH, LH, ESTRADIOL, etc], Transvaginal Sonography [TVS], Tubal Patency Tests [HSG, SSG]

Male factor: medical history and physical examination, Semen Analysis, Scrotal Sonography [TRUS].

Diagnostic and Operative Hysteroscopy

Hysteroscopy is considered the gold standard for evaluating the uterine cavity, and due to improved endoscopic developments.

Hysteroscopy is used as a therapeutic method in many conditions that may affect fertility, such as symptomatic uterine septum, intrauterine adhesions, endometrial polyps, sub mucous leiomyomas.

Vasoepididymostomy

Indicated for idiopathic epididymal obstruction, secondary epididymal obstruction due to long-standing vasal obstruction, or iatrogenic epididymal obstruction following interventions such as epididymal aspiration or reversal of vasectomy [male sterilization].

IUI (Intrauterine Insemination)

Intrauterine insemination is a procedure that places sperms past the cervix and in a woman’s uterus around the time of ovulation.

Advantage:

This procedure makes the passage to fallopian tubes much shorter and there is a better chance that more sperms will encounter the egg.

IUI With Husband

Female Factors:

• Anatomical defect of vagina and cervix
• Hostile cervical mucus
• Sexual dysfunction
• Mild to moderate Endometriosis
• Endocrine anomalies
• Chronic Anovulatory cycles
• Unexplained IUI

Male Factor:

• Anatomic defect of penis.
• Sexual/Ejaculatory dysfunction
• Retrograde Ejaculation
• Semen volume in excess/deficit
• Male sub fertility i.e. mild to moderate oligoasthenozoospermia
• Fertility Preservation before radiotherapy/chemotherapy treatment of cancer.

Intracytoplasmic Sperm Injection (ICSI)

Intracytoplasmic sperm injection (ICSI) is the procedure during which an embryologist injects a single sperm directly into the woman’s egg as part of the in vitro fertilization (IVF) procedure to aid in fertilization.

Male Fertility Problems

• Azoospermia
• Oligozoospermia
• Cryptozoospermia
• Asthenozoospermia
• Teratospermia
• Oligoasthenozoospermia conditions
• Oligoasthenoteratozoospermia
• Men who underwent vasectomy
• Men who cryopreserved their sperm before undergoing radiotherapy or chemotherapy
• ● Failure to ejaculate under normal

Female Fertility Problems

• If a low number of oocytes is obtained or if the zona pellucida is very thick after oocyte retrieval, or in cases of poor egg quality.
• Repeated failure to achieve pregnancy after several cycles of conventional in vitro fertilization.
• Egg fertilization failure using conventional IVF.
• Microinjection of unfertilized oocytes using conventional IVF.
• In-vitro maturation of immature oocytes.
• When a Preimplantation Genetic Diagnosis ( PGD ) is required to know which ones are genetically normal embryos.

Embryo Cryopreservation

• preserve and store excess embryos produced in IVF.
• In situations where fresh embryo transfer is not feasible (such as when the female partner becomes ill between egg retrieval and embryo transfer)
• When pre-implantation genetic testing (which mandates embryo freezing after biopsy) is performed.
• In situations where the uterine lining may not be ready or receptive to embryos, freezing and doing a later transfer (“freeze all”) is also preferable.

High Risk Pregnancy and Delivery Management

A high-risk pregnancy is one that threatens the health or life of the mother or her fetus. It often requires specialized care from specially trained providers.

Risk factors for a high-risk pregnancy can include:

• Existing Health Conditions , such as high blood pressure, diabetes,
• Overweight and Obesity. Obesity increases the risk for high blood pressure, preeclampsia, gestational diabetes, stillbirth, neural tube defects, and cesarean delivery.
• Multiple Births. The risk of complications is higher in women carrying more than one fetus (twins and higher-order multiples).
• Young or Old Maternal Age. Pregnancy in teens and women age 35 or older increases the risk for preeclampsia and gestational high blood pressure

Management of Recurrent Implantation Failure (RIF)

Refers to cases in which women have had three failed in vitro fertilization (IVF) attempts with good quality embryos.