NOVA IVF Fertility is witnessing a substantial increase in footfall of patients suffering from infertility from Tier II and III cities in Tamil Nadu
Chennai, India – October 31st, 2019: Infertility can be caused by a variety of diseases and medical conditions and affects about one in six men and women of reproductive age. The causes for infertility are numerous but can be categorized around issues pertaining to ovulation and egg quality; sperm production, transport and function; fertilization; and implantation. NOVA IVF Fertility, one of India’s largest fertility service providers, has reported to have witnessed a rise in cases of infertility in Tier II and III cities in Tamil Nadu.
Previously, couples who were over 35 years of age were considered to have reduced reproductive potential and were advised IVF with donor gametes. Today, couples from rural areas have been found to have a lower potential to produce their own biological gametes than the couples from urban areas and were advised IVF cycles. When the ovarian reserve was highly reduced (low AMH, low AFC) and very poor quality of oocytes or poor sperm morphology and extremely low sperm quantity, they were advised on the third party reproduction using donor gametes. Nowadays, there seems to be an increasing number of young people even around 30 yrs onwards to have poor quantity and quality uality of eggs and sperms and hence, poor quality embryos. This trend is more obvious in rural areas than in urban areas.
Poor ovarian reserve (POR) is an important limiting factor for the success of any treatment modality for infertility. It indicates a reduction in quantity with or without quality of oocytes in women of reproductive age group. As a woman ages, the eggs and the cells around them can accumulate damage that is beyond repair, and such damages are commonly caused by contemporary lifestyle choices and habits. Factors such as use of pesticides in fruits and vegetables, passive smoking and consumption of unhygienic fast food, which is more common in rural areas is assumed to deplete the quality of eggs prematurely in women. With the increasing age, the body can also be affected by poor dietary intake, poor blood circulation, disturbed hormonal balance, autoimmune disorders, and other health problems too.
Addressing the concerns around diminishing ovarian reserve and the available treatment options, Dr Madhupriya, Fertility Consultant, NOVA IVI Fertility, Chennai commented, “We have been witnessing a substantial rise in cases of infertility by in Tier II and III cities in Tamil Nadu, the most common increasing concern being low quality sperm/eggs. The couples who come for fertility treatments may have fair knowledge about IVF only and in some cases, many would have had failed IVF cycles which made them believe that they can never conceive again. However, alongside IVF, there are several fertility treatments which can lead to obtaining their own biological gametes. The couple can go ahead with donor gametes if at all this cycle fails. It is important that patients are counselled, basis their existing medical conditions along with information about the various treatment options available.”
Diagnosis of Diminished Ovarian Reserve
AMH test is used to check whether one’s ovarian reserve is appropriate for the age, assess the outcome of an IVF cycle as low levels of AMH could indicate a potentially poor response to IVF, know whether chemotherapy or ovarian surgery has affected fertility, diagnose an ovarian tumour or to plan pregnancy in future. A typical AMH level for a fertile woman is around 4.0 ng/ml; under 1.0 ng/ml is considered low and indicative of a diminished ovarian reserve.
Intra-Uterine Insemination (IUI)
IUI is a fertility treatment where sperm is inserted directly into a woman’s uterus during ovulation; decreasing the journey for the sperm to the egg. During ovulation, the woman produces one egg that is picked up by the end of the fallopian tube where it waits to meet the sperm. An IUI deposits higher concentrations of good quality sperm close to where the egg is waiting which increases the chances that the egg and sperm will unite.
Intra-Cytoplasmic Sperm Injection (ICSI)
Intracytoplasmic sperm injection is an in-vitro fertilization (IVF) procedure in which a single sperm cell is injected directly into the cytoplasm of an egg. This technique is used in order to prepare the gametes for obtaining the embryos that may be transferred to a maternal uterus.
Case study 1:
Growth Hormone Protocol
Shailaja (name changed), aged 30 years, came to NOVA IVF Fertility, Chennai for diagnosis and treatment. The patient had a history of many failed IUI cycles, 1 failed ICSI cycle also a history of severe endometriosis with a tubal disease, for which her tubes were disconnected prior to the first cycle of IVF. When she visited Nova IVF Fertility a year after the failed cycle, her AMH level was then 0.6ng/ml and hence, was uncertain about opting for a self-cycle once again, given the history of failure and low AMH value. The doctors at Nova counselled the patient on donor as well as self ICSI cycle, post which she decided to opt for a second self-cycle at NOVA. Her stimulation cycle included growth hormone protocol, which gave us 7 oocytes, of which 5 fertilised and 4 of these reached the blastocyst stage. Finally, two of the embryos of these were transferred and this gave Shailaja her own biological oocyte, and the patient conceived successfully.
Case Study 2:
ICSI with growth hormone protocol and gonadotrophin stimulation ( Mild Stimulation protocol)
Mrs. T , 29 yrs old who had previous multiple cycles of IUI and ovulation induction failed. Her AMH was 0.2 and AFC were a total of 5 on both sides. Mild stimulation protocol with growth hormone was finalized after confirming that here endometrium was good and her husband’s semen parameters were good to go for an ICSI cycle except for a mild adenomysosis. Her endometrial receptivity was checked and was good and on the growth hormone cycle she had 5 mature oocytes, 5 fertilized and all the 5 grew into blastocyst on day 5 and 6. The first 2 embryos were transferred and she had a biological baby in her first cycle who is one year old.
Case Study 3:
IUI with growth hormone protocol and gonadotrophin stimulation – AMH less than 1
Mrs. DE, had a previous pregnancy 7 years back a case of secondary infertility. When she visited Nova she had a poor ovarian reserve, her AMH was 0.7ng/ml, antral follicle count was 2 on one side and 1 on the other, giving her a total of 3 or 4 follicles during the IUI cycles. She was stimulated with growth hormone protocols and gonadotrophins . She had 2 IUI cycles and 2 natural cycle with ovulation induction cycles with growth hormones and gonadotrophin protocol. On her 5th IUI cycle, which was her 3rd IUI cycle she conceived and has had her own biological baby.
Case Study 4: Azoospermia and severe OAT where it comes to male infertility they might be Obstructive Azoospermia with good sperm production. With these couples options of procedures such as TESA, TESE or micro TESE are possibilities for solving male infertility.
Patient had very few immotile sperm on the ejaculate. They were counseled to go ahead with ICSI after subjecting the sperm to HOS and selecting the HOS+ve sperm. Hypo osmotic swelling (HOS) positive sperms were injected and of the 20 eggs that were retrieved from the female partner, 9 fertilised of which 2 became blastocysts. Both the blastocysts were transferred and they conceived with twins.
ICSI with Micro TESE
A patient had azoospermic with focal spermatogenesis in one area on a small volume testis. Hence micro TESE was done as with TESA, TESE no sperms were extracted. ICSI was done with oocytes and rest frozen for donor sperms if required. 7 oocytes were injected with micro TESE sample and 2 were fertilised. One embryo was transferred and she conceived with a baby who is now 2 year old. Micro TESE is another option to obtain biological child.
In people who have moderate to severe Oligoasthenoteratospermia but good motility but not going in for IVF / ICSI because they couldn’t afford it, we have pooled samples IUI cycles even with 2 – 3 semen samples (less than 3 million).
We also have an option of cryopreservation for both men and women who aren’t married (Social Freezing) or when they are undergoing cancer treatment (Oncofertility). As technology has improved in cancer treatment these survivors come back for checking their reproductive potential. This is possible only if they are aware of the options available for preserving the oocytes or sperms before undergoing radiotherapy or chemotherapy. In girls and boys undergoing cancer treatment, ovarian tissue / testicular tissue can be frozen (pre-puberty) which is to be done before they go ahead with oncology treatment.
“Couples who have not tried to conceive via self-cycles should be counselled regarding the different techniques that are available and there is financial aspect, to give them an understanding of the possibility of using their own egg and sperm. One must always be encouraged to try the procedure with their own gametes, and in cases where the self-cycle fails, they can then go ahead with donor gametes as the last option” added Dr Madhupriya.