ART – Assisted Reproduction Techniques – Recent trends

Assisted Reproductive Techniques

           The present scenario of conception shows at least 10-15% of the couples suffering intricacy in conceiving a baby, worldwide as per WHO.

            Prevalence of Infertility is in ascending trend, due to transformation of our life style, abundant changes in the environment as an outcome of industrialization, urbanization, vehicles pollution and other occupational hazards. Insecticides, pesticides, drugs and chemicals also contribute a greater role to this increasing trend. 

            AssistedReproductive Techniques – commonly known as Test tube baby treatment is an advanced scientific treatment, in which wife’s eggs are fertilized with husband’s sperms, outside the body in an ideal laboratory environment. They are meticulously handled and cultured using incubators and very many updated gadgets. If the resultant embryos are replaced into the wife’s uterus on fifth day which is called Blastocyst transfer, it gives an incredible success rate of 60-70%, on the contrary to the commonly performed second or third day uterine transfer which offers, just 20-30% success rates only. Blastocyst culture is the routine culture method in our laboratory since 2000 at Genesis Fertility Centre –GFRC – (a unit of Maaruthi Medical Centre and Hospitals) Erode.

MMCH Hospital, Erode. Tamilnadu. India.

        In severe Male Infertility with very low sperm counts, we adopt a treatment modality called ICSI- Intra Cytoplasmic Sperm Injection. In this, one healthy sperm is enough for one retrieved egg, which is aspirated in a micro needle and injected into the cytoplasm of the egg under higher magnification, resulting in a chromosomally normal embryo with enhanced growth and implantation potency. We add an advanced technology called Laser assisted hatching before embryo transfer, which sharply rises the opportunities for successful pregnancies. We are doing this advanced technique since 2003 in our centre, out of which more than 4500 babies have born in GFRC- MMCH till now.

      Third party reproduction includes “egg donation” and “surrogacy”. Egg donation is indicated for older women of more than 40 years, who have nonfunctioning ovaries or no ovaries due to surgery, disease or congenital cause. In surrogacy the rented mother should be less than 35 years with good uterus. This modality is considered for women who have no uterus by birth or uterus operated/removed and for women who are medically unfit to withstand a pregnancy. Since 1997, egg donation and surrogacy are being done with reasonable success rates in our institution (GFRC - MMCH).

       Cryopreservation is a modality in which embryos, sperms and eggs are being preserved by us for many months / years, which may help the needy couples to undergo almost cost free embryo transfers in subsequent cycles.

    It has been proved scientifically and socially by various genetic and clinical studies worldwide, in the past 35 years, that the children born out of ART – as test tube babies - are not different from the children born naturally. The incidences of birth defects are also at par with the naturally conceived babies. 

Dr.Nirmala Sadasivam, Leading Infertility Specialist in India

     Latest advancements in this field of Reproductive medicine introduced recently in our centre (GFRC – MMCH) includes - IMSI- Intracytoplasmic Morphologically selected Sperm Injection, Oocyte Vitrification, In Vitro Maturation of oocyes and transfer of Cytoplasm from an young women’s eggs to older women’s, bringing  exceptionally bright scope in managing the deprived infertile couples.  

To Get Pregnant via "ART – Assisted Reproduction Techniques" 

Visit the page now : http://www.ivfgenesis.com/cont.htm

Embryo Glue – A Molecule Of Success

The success opportunities in IVF & ET – In Vitro Fertilization and Embryo Transfer are not 100% and it is improving day by day due to various innovations in this field of assisted Conception. The success rate of conventional IVF is 25 – 35 % and the latest modality called Blastocyst Transfer has the maximum of 70%.

There are multiple factors to decide the implantation potential of the embryo and the endometrium. The “embryo maternal dialogue“ is the prime factor which is not yet fully understood . Many Researchs are on going to find out and conquer the obstacles of implantation. When the best embryo is placed inside the womb we expect better success opportunity. Unfortunately 40-50% of embryos do not get implanted, ending in vain due to improper support from endometrium. To fully understand the probability of pregnancy after embryo transfer in IVF & ET, ERA test is available now. Our laboratory has collaborated with a Spain based laboratory for this test – ERA- Endometrial Receptivity array test- DNA array based test, which will give us some idea about the day of Embryo transfer in Cryopreserved – Vitrified embryo transfer cycle in near future for the patient.

When the best embryo is transferred in the best prepared endometrium the success opportunity will be roughly 70-75% in day 5 embryo transfer called “BLASTOCYST TRANSFER”. We are following this method of blastocyst transfer since 2000 May and the first baby of its kind was born in our centre on 25^th June 2001 as the first blastocyst baby of Tamil Nadu. Since then our research department is strenuously working on improving the quality of embryo culture strategy to promote “Only Blastocyst Transfer“ for all patients.

The first BLASTOCYST BABY of Tamil Nadu……….on 25.6.2001

In natural cycle of fertilization and conception, the egg is released from the ovary, reaching the infundibulum of the fallopian tube and wait for sperms to come. If sperm are deposited in the vagina after natural coitus, the sperms travel from the vagina through womb to the tubes and meet the egg. Out of many millions of sperms only one will enter the egg sheath and once it reaches the cytoplasm, the outer cortical layer will get closed preventing multiple entry of sperms. Then the fertilized egg , now called as embryo gets rolled by the rhythmic movements of the tubes and uterus inside the fallopian tube and takes 5 days to reach the uterine surface. By the time the single cell becomes ball of 60 – 90 cells. The uterine surface takes at least 5 full days after ovulation to get prepared with adequate collection of Glycogen to accept the embryo for further nutrition of nidation and growth.

The blastocyst culture mimics the natural cycle as above said factors are followed for five full days in the artificial culture protocol in trigas incubators. In conventional IVF the embryos are transferred back to uterus on day 2 or day 3, which will be placed in the endometrial cavity in a hostile condition before it gets stabilized for a nidation on 5^th day after ovulation. When Blastocysts are ready with 60-90 cells for nidation, there are many molecules that play important role in augmenting the attachments of the outer cell layer of the blastocyst to the endometrial lining.

Embryo Glue is a hyalurunon molecule which plays a crucial role in the implantation of the blastocyst into the endometrium for further growth. When this vital molecules are added to the blastocysts before being placed inside the endometrial cavity (womb) the success opportunities are obviously increased, which is being proven by various studies and our study too.

With these molecules, one Blastocyst was transferred to the 64 years old woman’s womb in 2003; she succeeded in conception and delivered of an alive healthy male baby on 23^rd February2004.

This video gives you some idea about how embryo glue works inside the womb around the blastocysts to promote the attachment of blastocyst and inner lining of the womb to lead on to implantation, further, helping the embryo to grow more.

EmbryoGlue increases take home baby rate

BLASTOCYST – Modern Test Tube Baby Treatment

Stages in Blastocyst

The unique feature of our Genesis Fertility Research Centre ( MMCH ) as far as the Infertility and  IVF LABORATORY - SCIENTIFIC WORK are concerned is, it is a complete self satisfied set up, sufficiently furnished with essential, standard and latest equipments for BLASTOCYST CULTURE as well as Routine Embryo culture and conventional test tube babies. In November 2013 India’s First “Capsule Test Tube Baby” was born in our centre which added true value of our infertility services. We have well experienced clinicians and embryologists who were trained in pioneering centers worldwide, and we give every day basis IVF service throughout the year. The 24 hours patient care in our centre, which has all other departments with experts care, makes them feel safe and comfortable.

We are pioneers in the most versatile Embryo Culture Method called BLASTOCYST CULTURE. It is a unique technique to grow embryos beyond the third day of culture until day5. In Conventional IVF, embryos are transferred into the uterus about two / three days after the Egg Retrieval, which is two days earlier than would occur naturally in the mother's womb. These blastocysts are endometrial friendly, as the natural blastocyst of normal conception reaches the uterus only on the 5th day and it has more implantation potential, while day 2/3 embryos are transferred into the uterus in hostile condition, when endometrium is not prepared for implantation.

In certain patients, blastocyst culturing allows optimal selection of embryos for transfer, resulting in an increased implantation rate per embryo transferred. However, it is important to understand that this technology has another advantage of fewer embryos ( one or two )  being transferred to eliminate the possibility of multiple pregnancies,  triplet/quadruplet, while maintaining a higher pregnancy rate.. More than 8000 couples have been benefited by the above said technique through GFRC (MMCH) - IVF service in the past two decades.

The blastocyst culture is considered to be the most ideal way of doing test tube baby, because they mimic natural JOURNEY OF LIFE as they have transit in the fallopian tubes. To gain this advantage by mimicking the natural way, in synchrony with developing endometrium, which is ready for accepting the blastocyst only on the 5th or 6th day after ovulation, we adopt blastocyst culture system which doubles the implantation rates as compared to day 2 or day 3 ET.

"Sequential Transfer" is considered to be an ideal one for many couples when they have limited number of embryos and there is meager chance for the left over embryos to grow further. The physician should undertake two times embryo transfers on day 3 and again on day 5 by using very soft catheters to avoid injury to sibling embryos and endometrial lining. This technique needs real expertise and patience and the success depends on the physicians knowledge and experience in this technology. The embryologist should also have sufficient expertise about the Blastocyst culture technique.

We are really proud of our service , since we have the most experiencedteam [Dr.Nirmala Sadasivam] , which has pioneered in IVF science and Extended embryo culture -  i.e  BLASTOCYST CULTURE  since 1999.

For More Details : Genesis Fertility Research Center

Test Tube Babies - Novel Solution For Infertility

Test Tube Babies - Novel Solution For Infertility

All scientific Discoveries, inventions and achievements invariably lead to the betterment of human race. Test tube baby, a phenomenon of the 20th century, is also an invention of the human intellect. There are thousands of couples of in the world who are not blessed with a child. Medical researchers, after protracted attempts of many decades, have finally arrived at a solution called – test tube baby.  According to Dr.Nirmala Sadasivam, 1 in 5 couples encounter difficulty in conceiving a child. WHO has declared that 15% of the world population is facing infertility.

 GFRC is an extremely distinguished medical centre for Infertility with all facilities under one roof. It has come a long way since its inception as a pioneering institute in ERODE, Tamil Nadu since 1996. It has taken giant steps to become a center of excellence in all facets of infertility and IVF treatment options, which are offered at affordable cost for the public. This center has been a leader in Blastocyst Culture, an extended embryo Culture Technology and other novel Male Infertilitytreatment modalities like Surgical Sperm Retrievals - TESA, MESA, PESA, TESE, etc., with ICSI facility and genetic studies too. This research center is a unit of Maaruthi Medical Center and Hospitals, which is a well known 300 bed corporate hospital situated in the centre of Erode city.

The success story of GFRC & MMCH in infertility treatment is largely due to the support of an extremely dedicated and experienced IVF team led by Dr.Nirmala Sadasivam, who has invaluable experience due to trainings she had at various world class institutes overseas, since 1991, and has pioneered in Blastocyst Culture technique since 1998. She was recognized by National Academy of Medical science and offered MNAMS - membership. With the vast knowledge and experience in Blastocyst culture technique she has utilized the data of more than 4000 infertile couples treated in her centre, she could do PhD in the same specialty. This institution was endorsed in its nascent stage at the National "Art" Registry of India, and is now a prestigious senior member of ISAR, India. Another feather in their cap is the inclusion of the centre as one among the esteem early participants at ASPIRE - Asia Pacific Initiation of Reproductive Endocrinology, in their academic events. This institute is accredited to ICMR through the Indian Society for Assisted Reproduction. 
 

Dr.Nirmala Sadasivam

Dr.Nirmala Sadasivam received training in National University Hospital of Singapore which maintains a high degree of reputation and experience in implementing ART techniques. 

The world level recognition for this centre came largely due to the "Medical Miracle" where 64 year old Mrs. Pappathi Subramaniam gave birth to a healthy male baby which was flashed in all Medias worldwide. This news has gained importance and it is occupying a page in BBC web site till today. This enduring success has a strong base of stupendous extended embryo culture technology (Blastocyst Technology) which conquered all obstacles of implantation in this old woman. This scientific development was also noted in the international medical circles on account of wide coverage given by the BBC. After that many women have delivered of test tube babies after their fifties, safely with the most modern technology called “BLASTOCYST CULTURE”.

The eldest parents of universe Mr. Subramaniam (74 yrs) & Mrs. Pappathy (64 yrs)

The first test tube baby in the district of Erode was born in this hospital in 1997. In the initial stage, only three incubators were functional, now, in 2013, the numbers of incubators were increased to twelve. This has facilitated extensive embryological work and research with complete infertility management under one roof. The latest addition to the IVF lab is called K-System-G185, the most modern device with trigas facility having the capacity of serving more number of couples (40) every day.  As many as 4800 ART cycles have been carried out in this hospital so far and close to 2700 live births have happened as a result of IVF treatment (Test Tube baby).

By following the latest strategy of Vaginal Culture, a 59 year old woman got conceived in March 2013, and delivered on 28th November in MMCH, which was the first of its kind in INDIA. This is the simplest and the most economical method of doing test tube babies without using modern incubators, thereby avoiding high expenditures.

According to the doctor, infertility in women is caused by lifestyle changes which are of primary importance. Besides, air pollution and environmental degradation also contribute to a high level. Dr. Nirmala is of the opinion that residues from the river also produce a devastating effect on the health of women folks in villages and rural areas which play havoc in the issue of child-bearing capability of women. In western countries and developed nations, higher level officials from health department, senior doctors, scientist, researchers and industrialists assemble periodically and discuss about the developments and their influence in society. They take decisions after deep deliberations – what to be done and what not. In India too, such situations should begin in order to thrash out problems affecting the people. Doctor feels that certain chemicals present in the industrial effluents cause lots of negative influence on the health of the people which is a matter of concern. Chemicals viz., sulphur dioxide, carbon monoxide and some other chemical compounds which are toxic in nature and other acidic constituents erode the health and normal welfare of the people. She says, this trend should be immediately arrested and checked in time in the interest of the society. 

As per doctor, obesity is the vital reason for Infertility. Extra fat have to be reduced by exercises at home or gym or by paramedical exercises like yoga, walking, strolling, running, jumping, etc. Physical workouts play a positive role in reducing chances of contracting diabetes as well as obesity. If either of the parents suffers from diabetes, there is a possibility of the children too contracting diabetes as a hereditary factor. Doctor feels, life cycle modifications will improve the health of obese - infertility patients.  She advises that women should marry before reaching 25 and should deliver the first child before 30. If there is delay in this process, there is a higher probability of birth defects in the children born. 

This hospital has started many activities and many campaigns to pass on the message of conquering infertility and safe motherhood to the people of Erode district. They conduct health education programs often to apprise the people of do’s and don'ts with respect to health profile. They conduct general medical camps and infertility camps and awareness programs, conferences and classes besides treatment. The hospital gives utmost importance to educate the public about various aspects of infertility management. 

Economically-deprived classes of people are treated here with nil fees. In this medical centre, 30% of the OP patients and IVF patients are treated free of cost as a point of corporate social responsibility for the past 18 years. This gesture on the part of the hospital speaks volumes of their philanthropic motivation and social commitment.  

As per Dr. Nirmala, patients from many places viz., USA, California, Italy, West Germany, Colombo, France, Singapore, Australia, Malaysia have visited this hospital and got their infertility problems solved with live births. NRIs also come to this hospital for treatment regularly. She feels, her Ph. D., which was obtained based on Blastocyst culture, is helping the people in a magnificent way to offer very reasonable success opportunity, and helping them economically by avoiding multiple attempts without success.

For More Details : Genesis Fertility Research Center
 

First Capsule Test Tube Baby Of India

Latest modality of IVF treatment – http://www.ivfgenesis.com/

Dr.Nirmala Sadasivam With First Capsule Test Tube Baby of India

     In Maaruthi Medical Centre and Hospitals [MMCH], Erode, the department of reproductive medicine headed by Dr.Nirmala Sadasivam had achieved a live birth of a male/female baby for 54 years old Mrs.Pangajam on 28th November 2013 , by the up-to-the-minute IVF technology called CAPSULE TEST TUBE BABY treatment method. This Novel treatment was done for her in March 2013 in Maaruthi Medical Centre and Hospital, Erode using a CAPSULE Device called INVOcell (Intra Vaginal Culture of Oocytes), a gas permeable, air-free plastic device manufactured in USA. This novel Capsule Test tube baby method was introduced in USA in 2011 and in India in 2012. First time in India, a live healthy baby has been delivered using this method.

     Dr.Nirmala Sadasivam has explained about this new test tube baby method, “First test tube baby of the universe was born in 1975 in London. In the past 38 years IVF science has seen incredible accomplishments. It started with two days embryo culture outside the body in an incubator has evolved now with the latest mode called “Blastocyst Culture” which offers the best possible success rates of 60-70%. The above said procedures incur expenditures for ovulation induction, ovum retrieval, embryo culture in incubators, culture Medias and for embryo transfer into the woman’s womb. Since most of ovum stimulating injections and the culture Medias in which the embryos are grown are imported, these procedures are expensive and unreachable to a common Indian even today.

 

Doctor with the Capsule, for Capsule Test Tube Baby

  The exclusive advantage of the capsule IVF is that it attracts very low expenditure which is less than one third of routine  test tube baby treatment cost and this procedure needs only nominal Ovulation induction with minimum hormonal drugs and practically no incubation expenditure as both of the above only  constitute 80% of the expenditure of regular IVF procedure. This method is a boon for many women and men struggling with infertility whose access to treatment are not possible due to financial challenges, limited availability of specialized medical care and social or cultural roadblocks which prevent these hopeful parents from realizing their dream to have a baby. With the INVOcell Procedure, more and more patients can now receive safe, effective and affordable infertility treatment. The other laudable benefits are that it shares more or less the same percentage of success rate of the conventional IVF apart from making infertility therapy a more personal and comforting experience especially for the female partner.

     In this capsule IVF, eggs are retrieved from the woman and it will be mixed with the prepared sperms of the husband in the desired culture media in the prescribed manner. The prepared material will be placed inside the capsule under ideal aseptic laboratory condition by the specially trained personnel. The prepared CAPSULE containing the embryo along with the specific culture media which is going to nourish the embryo during the period of vaginal culture, is kept in the woman’s vaginal cavity as an outpatient procedure without anaesthesia. Vaginal canal has the required temperature (warmth) and ambient gaseous environment to promote the culture of the embryos. The cultured embryos are then replaced into the woman’s womb on third day which will further grow inside the womb like natural embryos with the ideal luteal support.

      Dr.Sadasivam, the chairman of MMCH has told the press “This capsule IVF was done in March 2013 in our centre using the device called “INVOCELL” manufactured by a company in USA.  From 10th April 13, the day pregnancy was confirmed the antenatal period was uneventful and both mother and child are doing very well now. This cost effective method is a boon for the poor infertile couples and they must utilize these opportunities to fulfill their intense desire of parenthood.

Head of the Indian marketing division of the manufactures has told that, “this method was introduced in 2012 in India and the first delivery happened in India, in Erode, in Maaruthi Medical Centre and Hospitals today. As we want to pass on this low cost Capsule IVF benefit to needy infertile population of India”.

Dr.Nirmala Sadasivam with Capsule Test Tube Baby Family

Regarding this event Mr.Velappan, the husband of  Mrs.Pankajam( 54 years) has spoken to the press with heartfelt of joy and gratitude “We are hailing from an agriculture family from a village a called Sankagiri in Salem District. I am married since 25 years and we are taking treatment for the past 20 years in various institutes throughout Tamilnadu and nearby states also. Because of repeated failure I lost money, job and even confidence. I heard about the genuine infertility treatments offered at MMCH, Erode and I approached Dr.Nirmala Sadasivam for a baby. She has shown the right path with a very low cost treatment, and we are now with handful of joy and happiness, for which we are thankful for their medical team forever”.

For More Details : Genesis Fertility Research Center