IVF department of Aartham Multi Super Speciality Hospital in Ahmedabad provides IVF services.
Dr. Sanjay Shah IVF Specialist & Endoscopic Surgeon (M.D) is known for proven results in most complicated cases as well. As an endoscopy surgeon he has performed 30,000+ Laproscopic&Hysteroscopic surgeries. He is accompanied by Dr.Bela S Shah, M.B.B.S (Embryologist) as counsellor in infertility. Entire team is comprised of experienced doctors such as Dr.Aastha Mehta- M.s. (Gynaec), Dr.HareshDoshi- M.D. (Gynaec), Dr.Falguni Parikh – M.D. (Gynaec) and Dr.Phagun Shah – M.D. (Gynaec).
Under able guidance of Dr. Sanjay Shah Aartham Hospital is emerging as the best hospital for gynaecology and IVF treatments in Ahmedabad.
Aartham Hospital for IVF operates with insurance like program in which there is a provision of about 50% refund of the treatment cost. Along with this cost benefit, there are also medical advantages such as progressive fine-tuning methodology, 3 Cycle Program. This cycle – on – cycle improvement leads to more chances of pregnancy and better outcome.
With a focus on the female reproductive system and women’s health, we provide gynaecology and endoscopy treatment using Laparoscopy, Hysteroscopy and Colposcopy to diagnose infertility.
InVitro Fertilization, IVF Centre in Ahmedabd
The process of ‘In Vitro Fertilization’ (IVF) is popularly known as ‘test tube baby’. It is the process in which eggs from the lady and the sperms from the gentleman are put together and the egg is fertilized outside the body in special Petri dish under a very closely monitored and special environment.
In a normal woman one egg matures every month from either of the ovary. But in the IVF process, special medication for ovarian stimulation is given to the lady. As a result, many eggs mature from both the ovaries.
The growth and development of the eggs and the endometrial lining in the lady are monitored with help of transvaginal sonography and blood tests. Once the eggs reach a particular size, an injection for their final maturation is given. Between 34-36 hours after that injection, the eggs are removed by a short surgical procedure (“O” VUM pickup) under short general anesthesia.
The IVF specialist uses ultrasound imaging to remove the eggs. There are no incisions or stitches involved in this procedure.
After successful removal, the eggs are sent to the Embryology Lab for Insemination and Intra Cytoplasmic Sperm Injection. After insemination, the eggs are kept in special petri dishes containing culture media, and stored in an incubator.
The inseminated eggs are periodically observed under the microscope to check for fertilization and cleavage (Cell Division) about 16-17 hours after insemination, the egg and sperm combinations develop into embryos. Embryo is the first stage of life. 2-3 days after ovum pick up, 2-3 of the best embryos are selected for Embryo transfer. They are loaded in a transfer catheter and put back inside the uterine cavity under ultra sound guidance while extra embryos are preserved.
What are the indications of IVF?
In Females, following factors indicate the need for IVF:
In Males, following factors indicate the need of IVF:
What is right age to enter IVF?
In today’s scenario, with respect to female, the AMH levels depicts the fertility power which is more important than age. If the AMH levels are less than 1.0, than it suggest that individualized approach is required to treat the infertility in such cases. However, off late I have noticed that many a times the AMH levels is interpreted in a wrong manner and therefore the clinical diagnosis with 2nd-3rd day Transvaginal Sonogram should be co-related with the results. So if the follicle count is less than 7 in both ovaries than IVF is the choice of treatment.
It can be summarized that in cases of age above 35 years or/and marriage life of 3 years with infertility should be considered for IVF.
Dr. Sanjay Shah Runs Unique IVF Angel program all over India. It’s a 3 cycle program. This program can be termed as your best chance to have baby. Under this program we address multiple scenarios such as Not able to get pregnant, not able to get second pregnancy, irregular periods, repeated abortions, repeated IVF failure, defects in sperms, blocked & absence of fallopian tubes, failure to get pregnancy even after all reports are normal.
Dr. Sanjay Shah is working on the Progressive fine tuning Methodology. This starts with understanding response of body, cycle-on-cycle improvement can be seen which maximizes success. Tailor made regime for patient so patient can have financial, medical and psychological benefits. Seeing baby’s heart rate is success for us, in medical terminology you can say seeing intra uterine live fetus is success for us. That’s why we offer, ‘about 50% refund on unsuccessful outcome after 3 cycles.’ Our collective pregnancy rate is 85%
At Aartham Hospital we believe in patient empowerment. It has been observed that a well informed patient is better posed for undergoing treatment. All couples undergo treatment because they have to understating treatment makes the process bearable. One can get the doubts clarified. Myths lead to misunderstanding and this leads to stress during treatment. Here are some content meant for patient information and private circulation.
Here we shall see how the natural pregnancy takes place. For natural pregnancy to occur- four factors are needed. These factors are Egg / Oocyte, Sperm, Uterus and Fallopian tube. Once all these factors work in synchrony, natural pregnancy takes place.
When the bleeding of menses / periods starts it is considered as the first day of the menstrual cycle. From this day the menstrual cycle, the creation of eggs takes place; this is also called follicular-genesis. In a normal cycle around, 13th to 15th day, the size of the follicle grows up to the size of a lemon: about 18-20mm. Then it ruptures- called OVULATION. And the egg / oocyte is released. The human oocyte is very small. In common terms it is as small as one fourth the size of a dot that one can make with a pen. Hence eggs can’t be seen on sonography or with the naked eye. This egg comes in the fallopian tube.
While the egg is developing under the hormonal stimulus. Uterine lining / Endometrium grows. It creates a healthy environment for embryo implantation and growth. The thickness of this endometrium should be at least 7mm. endometrium of 10mm or more has best chance of pregnancy.
During the sexual intercourse the sperms get released at the opening of the uterus the Cervix. Important fact here is that almost 50% to 60% semen comes out of the vagina after intercourse. This happens with everybody. Weary of this some women try to do some futile exercises like remaining in a lying position, crossing legs, taking a pillow under the waist and so on….. which is not necessary.
Sperms go to the fallopian tube through the uterus. Here the fertilization takes place. For fertilization to occur. There are two obstacles for the sperms. First is the 2-3 layers of cells called cumulus and the second layer is called ZONA. Sperm has to go through these two layers to enter the egg. The cumulus cells are bound together by hyaluronic acid. Head of the sperm (Acrosome) contains the Chemicals (Hyaluronidase), which dissolve this hyaluronic acid and separate these cells away. Number of sperms required are a lot many as one sperm head has a very small amount of this chemical. Hence good sperm count is a very important factor. After separating these cells there is a layer of zona. Sperm has to penetrate this layer and get inside the egg. This required strength or force for penetration of zona, which comes from the speed of sperm. Therefore, it is necessary to check the motility of the sperms. This explains how count and motility are two important factors for the sperm.
Now the embryo is formed in the fallopian tube it is round in shape like a ball. Embryo does not have its own transport system. Therefore, the embryo is dependent on the fallopian tube for being transported to the uterus. Fallopian tubes have this responsibility to carry the embryo to the uterus. Fallopian tubes have tiny hair like stucture, which transport the embryo. Hence it is important to have functioning tubes and not just open. This is how normal pregnancy happens.
Let’s understand about sperm factor. Around 30 to 40% of the males have problems related to sperms, that means out of 10 persons three to four can have some disorder in their sperms function. Firstly let’s see how the sperm fertilizes the female egg . At ovulation egg / oocyte comes out. This egg is very small, that is one fourth the size of a dot / full stop. It comes in the fallopian tube. After intercourse the sperms enter the fallopian tube. For fertilisation to happen sperm has to enter into the egg. There are two obstacles for the sperms. First is the 2-3 layers of cells called cumulus and the second layer is called ZONA. Sperm has to go through these two layers to enter the egg. The cumulus cells are bound together by hyaluronic acid. Head of the sperm (Acrosome) contains the Chemical (Hyaluronidase), which dissolves this hyaluronic acid and separates these cells away. Number of sperms required are a lot as each sperm head has a very small amount of this chemical. Hence good sperm count is a very important factor. After separating these cells there is a layer of zona. Sperm has to penetrate this layer and get inside the egg. This required strength or force for penetration of zona, which comes from the speed of sperm. Therefore, it is necessary to check the motility of the sperms. This explains how count and motility are two important factors for the sperm.
In some men the sperm count is good but speed is not sufficient, in some motility is good but count is less. Some have problems on both parameters.
Causes for poor sperms can be broadly divided in three types. First is the deficiency of Nutrition or vitamins. Some people do not have a proper diet. Poor diet is the commonest cause of nutritional deficiency. Fruits, dry fruits & dairy products are very good sources of vitamins. Both water soluble and fat soluble. Regular exercise is also essential to increase our immunity. At Least 40 minutes is what one should for.
Habits or addictions are a major cause nowadays. Smoking, chewing tobacco, Pan, Guthka or other harmful substances. Also consuming alcohol. If we see, all these substances are harmful toxic Chemicals. These toxins attack the sperm producing sites and decrease its production. This leads to not only low count but also poor quality. Causing many disorders in sperms.
Second factor is an infection. Which can be caused by an unhealthy eating habits drinking or through unsafe sexual relations. It is important to note that, not all infections in the semen are sexually transmitted once. Other pathogens, which enter body from food & air, are also seen.
Third factor is genetic; some men have defective chromosomes / genes. This leads to poor quality of sperms hence it is important to check karyotype before fertility treatment. This will help us to prevent abnormal babies being born.
Tubal factor means the defect in the functioning of the fallopian tube. Normally 30% of all the infertility cases are due to tubal factor. That is 3 out of 10 women have this problem.
There are two types of tubal defects. First in which the tubes are completely closed called Occlusive tubal disease second is the tubes are open but not functioning which is called Non-occlusive tubal disease.
During the process of normal pregnancy, fertilization of the female egg by the sperm occurs in the tube. And the embryo develops. The embryo is round in shape, like a ball. Embryo needs to reach the uterus for implantation and further development. It does not have a transport system of its own. Thus, it’s the responsibility of the fallopian tube to transport embryos to the uterus. Inner lining of the tube has hair like tiny cilia. These beat in a rhythmic fashion and gradually help the embryo to reach the uterus. After five days, that is, the 20th or 21st day of the menstrual cycle implantation occurs. It is just not sufficient for the fallopian tube to be open, but it should be functioning. This is called a tubal function.
Fallopian tubes are checked or examined in two important ways. First one is imaging techniques like x-ray, saline sonography or Hycosy etc, second method is surgical, laparoscopy and hysteroscopy. In x-ray a type of Dye is injected into the uterus, through the cervix, which goes through fallopian tubes and comes into abdomen. At the same time two or three x-ray shots are taken. This gives an idea whether the fallopian tubes are open or closed. This is performed around 6 to 9th day of the period. This test is very simple and relatively inexpensive. This is called HysteroSalpingoGraphy – HSG.
Laparoscopy is done under anaesthesia. During laparoscopy the camera is inserted into the abdomen through the navel / umbilicus. the condition of the fallopian tube is examined.
If we compare x-ray and laparoscopy, then the film of the X-ray is black and white while that of laparoscopy is a colour. This helps us to get more information about tubes. Whether it has blocks, swelling or infection like tubercles. Sometimes other organs get attached / adherent to fallopian. For example, the fallopian tube and intestine get stuck to each other. This can be seen in conditions like Endometriosis.
It is important to note that x-ray or laparoscopy is ONLY STRUCTURAL ASSESSMENT of fallopian tube and NOT FUNCTIONAL ASSESSMENT.
If tubes are non-functioning then IVF or test tube baby is considered as the treatment of choice.
If a person has anti sperm antibodies, they go and attack the testis. As they attack sperm producing cells in the testes; sperm production is reduced hence one can have low count. These anti sperm antibodies can also attack sperm. They go and get attached to the head or tail of the sperm. This reduces the speed of the sperm.
Let’s see what do we mean by anti sperm antibodies. During childhood when the immune system is being developed sperms are not there in the body. Therefore, our immune system does not recognise sperms. Around the age of 12 years, sperm starts developing. If one gets a testicular infection or injury. Then the sperms enter into the bloodstream. Immune system doesn’t recognise the sperm as a part of the same body. It creates antibodies to work against these sperms and even attack the sperm producing cells. This decrease the number of cells which produce sperms which ultimately affects the sperm count. Similarly, some antibodies attack on the head or neck or tail of the sperms. These are called anti head antibodies or anti tail antibodies. This reduces the speed / motility of the sperms. These sperms are unable to fertilize the egg.
In such patients ICSI treatment is the correct choice. During ICSI eggs are collected, like the IVF process. Then fertilization is done in the lab. As we have seen earlier, there are two obstacles for sperm to enter the oocyte. The first is, layers of cumulus cells – these have to be removed, this is called denudation. Denudation is done manually and after that the sperm is injected into the female egg. This process gives the name – Intra Cytoplasmic Sperm Injection- ICSI. This injection procedure is done with the help of the microscope. It’s a Sort of microscopic surgery, in which one sperm is injected into one female egg so it can form an embryo. After 2 to 5 days these embryos transferred into the uterus.
Let’s understand how the age of women affects the number and quality of the oocytes. Fertile age of women starts with menarche (beginning of periods) which is about the age of 13 – 14years. Ovarian function ends by the age of 40 years, menopause. So, we can say the reproductive life is about 25-30 years. In the latter half of reproductive life i.e. after the age of 30. Ovarian reserve decreases, the quality and quantity of the oocytes reduces. chances of conception also decrease. If one gets pregnant the possibility of abortion increases.
With reduced ovarian reserve there are more genetic / chromosomal abnormalities in the oocytes. Due to abnormal genes the resultant embryos have genetic abnormality. Almost 90% of these embryos don’t implant so there are reduced chances of pregnancy.
Embryos which implant and grow are more likely to have some chromosomal abnormalities, than younger patients. There is more chance of having abnormal babies or babies with birth defects. It is important to do screening tests during pregnancy.
Ovarian reserve can be assessed in many ways. By sonography one can look at the size of the ovary, ovarian volume. Similarly, potential follicles, antral follicle count, can be measured. There are many blood tests like FSH. LH, AMH help us to understand the ovarian reserve.
Time is the key. There are many medications to improve ovarian reserve. These are also called ovarian tonics. Medicines have very little effect. There is no magic pill which will reverse the ovarian reserve. So, it is important to plan the pregnancy at an earlier age. If oocyte quality is poor or there are no responses to ovarian stimulation. Option of egg donation needs to be considered.
Here we will have a look at endometriosis. If we break down the word endometriosis into 3 parts then, endo means inside, metrus means uterus and sis means similar to that. Abnormal growth of tissues similar to the uterine lining, endometrium. which grows outside of the uterus or in the pelvis, is called as Endometriosis.
During the menstrual cycle the inner lining of the uterus, Endometrium, grows under the influence of hormones. At the end of the cycle this endometrium sheds off which we call as periods. Uterus has three exits, two tubes and cervix. The cause of endometriosis is not very clear. The suggested theory is – these endometrial cells go in the abdominal cavity through tubes and implants. Each month during the periods these endometriotic spots shed off. Leaving scars or raw area. While healing, if two raw areas join together, they get stuck to each other. These are called adhesions. For example, fallopian tubes can get attached to the uterus, intestine or omentum. Because of these adhesions one may suffer abdominal pain, more so around period time. when adhesions affect fallopian tubes or ovaries it can affect the egg transport causing infertility. Pain and infertility are the two problems caused by endometriosis.
Treatment of endometriosis is done in two ways medical and surgical. In medical management the intention is to stop the monthly cycle of hormones. As the hormonal production is stopped, growth of endometriosis also stops. This can be done by contraceptive pills, danogen or leuprolide injections. In this treatment we stop the natural production of oocytes / eggs. As ovulation is stopped pregnancy is not possible. So, most of the medical treatment for endometriosis works as contraceptives. Due to lack of oestrogen, during medical treatment, bones lose calcium. This can lead to brittle bones. Hence use of medical treatment is restricted to a maximum of 6 months.
Surgery – patient needs to get operated when she is suffering from severe abdominal pain or there is a cyst formed. The endometrioma has old collected blood. Which is thick and chocolaty in colour. Hence endometrioma is also referred to as chocolate cyst. In case of adhesions where ovaries, fallopian tubes or uterus are stuck together. Laparoscopy is done to separate them. In some cases, fallopian tubes are blocked, which can be opened. After this operation there is a possibility of pregnancy. One must remember that we can improve the structure of the fallopian tube but, we may not be able to improve functionality. So, all laparoscopic corrections do not result in pregnancy.
IVF treatment is considered as a treatment of choice, for endometriosis. During pregnancy patients don’t get periods, so it stops the cyclic growth of endometriosis for 9-12 months. Hence pregnancy is considered as the gold standard treatment for endometriosis.
This section will help you find answers for few of the frequently asked questions so you can make a well informed decision about IVF. Still you have any other questions we are always approachable.
IVF process can be understood with the help of certain steps which are explained below.
• Ovarian stimulation: The fertility specialist monitors the timing of egg release. Doctor will make sure the hormonal level and other conditions for IVF are normal or not. The doctor watch over produced eggs are appropriate or not.
• Egg retrieval: In this step, eggs are taken out from female’s ovary by using needle under light sedation. Further, eggs are placed in a dish containing nutrient media and further it is shifted to the incubator.
• Fertilisation: This is the next step called fertilisation where male sperm are taken and mixed with the most active sperm in a special chamber. Then, eggs and sperm are placed in incubator and the process is monitored so that healthy embryo can develop.
• Embryo transfer: It is the last step in which the healthiest embryo is transferred. Initially, the doctor examines so that healthy embryo can be selected. With the help of small plastic tubes, the embryo is transferred.
IVF was originally developed for women with blocked tubes or missing fallopian tubes and it is still the procedure of choice for these situations. It is also used when other conditions are present, including endometriosis, male factor infertility and unexplained infertility in which no medical cause for infertility can be found. Our experts will review your history and help to guide you to the treatment and diagnostic procedures that are most appropriate for you.
The first visit with a fertility specialist will involve history taking and prescription of diagnostic tests to assess the fertility status of the couple. Based on the same the consultant will suggest the treatment protocol. Incase of IVF the following 5 steps are followed.
IUI stands for intrauterine insemination, is one of the common techniques of ART (Assisted Reproductive Technology). It allows putting sperm directly to the female’s uterus. In this process, the processed (washed) sperm are used. However, usage of this technique will result in escalating the possibilities of conception.
No, IVF is not at all painful because the injections used for IVF are purified and injected in subcutaneous form. The egg collection process is done under light sedation which is totally painless. At the time of embryo transfer, anaesthesia is not given but it is a 2 to 5 minutes of process which hardly cause any pain.
Low sperm count can also be known as oligospermia. One may undergo to ICSI (Intracytoplasmic Sperm Injection) where a single sperm is injected to matured egg. Adapting this treatment will leads to elevate the chances of conceiving. Besides this, the treatment is useful especially in case of male infertility, low sperm motility and poor sperm morphology.
1/3rd of the infertility issues are contributed by the male partner. Male factors also influence increased rate of miscarriages. Most common causes of male infertility are as follows.
Infertility is gender neutral. It affects the male and the female population. 1/3rd of the infertility issues are contributed by the female partner. In the world 50-80 million suffer from infertility. Most common causes of female infertility are as follows.
Women are born with approximately 2 million eggs in their ovaries. Before a girl reaches puberty, about 11,000 eggs die every month. Thus, in her teenage years, a woman has only about 300,000 to 400,000 eggs available. From this point onwards, about 1000 eggs are utilised every month. This has nothing to do with any form of birth control, pregnancy, hormone production, health, lifestyle or nutritional supplements. Eventually, a woman reaches menopause when she has no viable eggs left
PCOS (Polycystic Ovarian Syndrome) refers to a condition caused by hormonal imbalances. Women suffering from PCOS produce higher than normal amounts of male hormones. This affects ovulation and can result in irregular periods. In some cases, women suffering from PCOS may have irregular periods. This, in turn, can make it harder for these women to conceive. In fact, PCOS is one of the most common causes of female infertility.
Endometriosis is a common disorder found in women, where the endometrial tissues grow outside the uterus. This gynaecological condition can occur in the ovaries, fallopian tubes, the tissues lining the pelvis, and in rare cases, abdominal cavity, too.
Intrauterine insemination also known as artificial insemination is a non-invasive ART procedure. The procedure is simple, easy to perform, does not include extreme effort from the couple and costs less than advanced procedures such as IVF and ICSI. Generally, IUI is recommended for couples with good ovarian reserve and semen parameters, but with associated problems such as PCOS, minimal endometriosis, borderline sperm counts and motility, and also for unexplained infertility.
Oocyte cryopreservation, also known as egg freezing, is a process wherein a woman’s eggs are extracted, frozen and stored for later use. Cryopreservation can prove to be extremely beneficial for women who have been diagnosed with cancer and are scheduled for some kind of oncological treatment like radiotherapy or chemotherapy. Women who are unmarried or are in a situation that is not conducive to childbearing, can also opt for oocyte cryopreservation.
It is important to recognize that the rate of birth defects in humans in the general population is about 3% of all births for major malformations and 6% if minor defects are included. Fortunately, 20-plus years following Louise Brown’s birth (the first IVF baby), we now have ample data that children conceived through IVF have no increase in these rates of birth defects due to the technique itself. Minor rise in abnormalities is ascribed to the infertility and age factor of the intending parents. Further follow-up on older children indicates that IVF children have done as well or better than their peers in academic achievement (probably a social bias) and have no higher rates of behavioural or psychological difficulties.
PGT-A is genetic testing performed on embryos to identify numerical chromosomal abnormalities or aneuploidy. This test is performed on embryos prior to transfer into the uterus. By analysing all embryos generated in an IVF treatment cycle, those free of chromosomal aneuploidy can be identified for selective transfer. As a result, the pregnancy rates per transfer are increased and the miscarriage rates decreased.
PGT-M involves testing of embryos for specific monogenic disorders like thalassemia, haemophilia and certain types of muscular dystrophy. It helps couples who have a family history or those who have had a child affected with these disorders to have an unaffected child. All embryos formed as a part of an Assisted Reproductive Technology (ART) are tested for this specific monogenic disorder. Only unaffected or career embryos are transferred to have a disease free child. This can also be combined with PGT-A to further improve success rates.
PGT-SR tests people with chromosome rearrangements (structures that hold our genetic material is not of normal size or arrangement). These people are at risk of producing embryos with unbalanced chromosomal structure. Such embryos are not viable and can result in multiple miscarriages. PGT-SR tests embryos for such specific rearrangements and can help in selection of normal embryos for transfer
For the first visit, you are asked to carry yours and your spouse’s ID proofs. You will also be asked to carry any relevant medical reports and records if any.