Prepare IVF Cycle

How should I prepare for my IVF cycle ?

 “What can I do to improve my chances of success?” As an IVF specialist, this is the commonest question patients ask me.

The following are the 5 key ingredients which you can contribute to the success of your IVF cycle.

1. Faith and trust. It's important that you be able to trust your doctor. Not only should you be confident about your doctor's technical competence, you should also feel secure that he cares for you; respects your desires; listens to your fears and worries; and will be available to give you a shoulder to cry on when you need this . Make sure your chemistry with your doctor is good. Does your doctor encourage you to ask questions? Takes time to clear your doubts? This is a tall list, and most doctors are human, so they are likely to fall short. However, in a good clinic, the IVF team should be able to bolster your confidence that you are in good hands.

Remember that your doctor needs to earn your trust. Don't give it away easily! “Trust - but verify “should be your philosophy!

2. Smiles. Being optimistic helps to improve success rates. It's not that pessimistic patients don't get pregnant - it's just that patients who smile get better care from the medical team - and everything you can do to improve your odds is worth doing!

3. Being well informed! Do your homework, so you have realistic expectations from your treatment. Ask questions and take a guided tour of the facility. Request your doctor to show your follicles on each scan - and ask to see photos of your embryos. Well informed patients get better medical care because they ask intelligent questions. Insist on a medical treatment summary at the end of the IVF clinic - this is valuable documentation and keeps everyone's interests aligned. Poor documentation suggests you have received poor medical care!

4. Money. It's true that IVF treatment can be expensive, and you need to be prepared for this. Selecting an IVF clinic which offers a shared risk/ refund program can help you reduce your risk!

5. Good eggs, good sperm and a good uterus. I know this is asking for a lot, but patients who have good protoplasm have a much better chance of success. It's true that if you are 43, there's little you may be able to do to turn back the biological clock. However, simple self-help measures can make a world of a difference! Stop smoking; make sure you are fit and have a healthy diet; and take supplements to help optimize your egg and sperm quality. Every little bit helps!

If your eggs and sperm are just not up to the mark, keeping an open mind and exploring the possibility of using third part reproduction can help you achieve your goal of having your baby.

The outcome for any IVF cycle is always uncertain - but taking treatment at a world-class clinic will maximize your chances of success and give you peace of mind you did your best !

     
   
 

Higher IVF Success

Higher IVF Success With Men Who Eat Lots of Fruits, Grains

Better sperm quality and hence higher chances of a successful in-vitro fertilisation with men who eat plenty of fruits and grains, but cut down on their red meat and alcohol intake, has been reported in a new study.

The study revealed that a poor diet and obesity can lower sperm concentration and affect their ability to swim towards an egg.

In the past, female fertility problems have been linked to obesity as well as smoking and drinking, but it was not clear until now if the same applies to men as well.

The latest study of men with partners, who were undergoing a type of fertility treatment, has revealed that those who regularly binged on alcohol and ate poorly were slowed down on the fertility front, the Daily Mail reported.

"The sperm concentration was negatively influenced by body mass index (BMI) and alcohol consumption, and was positively influenced by cereal consumption and the number of meals per day," lead researcher Edson Borges, from the Fertility-Assisted Fertilization Center in Sao Paolo said.

The Brazilian study involved 250 men with partners who were undergoing a type of fertility treatment called intracytoplasmic sperm injection (ICSI).

Each participant was asked how often they ate a range of foods, including fruits and vegetables, beans, grains, meat and fish, as well as how much they drank and smoked.

Semen samples were then examined to assess sperm health and concentration and each couple were monitored during the IVF process.

The study revealed that eggs were successfully fertilised in about three-quarters of the treatments, but just fewer than forty per cent of women got pregnant.

From the speed of their sperm to their partner's chance of pregnancy, men who drank and had a poor diet were less fertile.

The results have been published in the Fertility and Sterility journal.

IVF Laboratory

Quality Control in the IVF Laboratory

Quality Control (QC) and Quality Assurance (QA) in the IVF laboratory plays an important role in the success of any IVF program.

The role of QC procedures in the IVF laboratory is to fine tune existing protocols in order to more effectively help infertile patients in their quest to have a healthy baby. The three most important physical conditions in the IVF laboratory that can be controlled are the temperature, pH and osmolality of the IVF culture medium. Laboratories are required to document and monitor these physical conditions regularly as part of their ongoing QC/QA programs. Monitoring and documentation of temperatures inside incubators, refrigerators and freezers is an integral part of routine day to day QC in the IVF laboratory.

Quality Control of Laboratory Equipments :

CO2 Incubators :

Variation in pH and temperature affects the embryo quality and thereby pregnancy rate. Therefore proper maintenance of CO2 incubator is very critical.

•    We measure the CO2 percentage and temperature of incubator daily to ensure stability of pH and temperature.

•    A Log book is maintained for proper documentation.

•    Regular Cleaning and decontamination of incubator is done.

•    Water in incubator pan ( to maintain humidity) is changed regularly

•    A Sperm survival test is done before every batch to ensure proper functioning of incubator.

•    We have an Annual maintenance contract with the supplier for regular servicing.

•    Backup Power supply is mandatory.

Laminar Flow workstation : 

 

 

•    Daily cleaning of surface.

•    Regular servicing, cleaning of HEPA filter.

•    Ensuring the HEPA filter is working properly by testing the density of the particulate matter in
the air.

Micromanipulator and Stereozoom Microscope :

•    Regular cleaning.

•    Daily measurement of temperature of stage warmer.

Pressure Modules (Air purifier) :

•    Regular servicing.

•    Regular cleaning of HEPA filter.


Quality control of Culture medium and disposables :

 •    Documentation of shelf life and batch number is maintained.

•    Stock keeping with reorder level is maintained to avoid shortage.

•    Proper maintenance of refrigerator i.e. cleaning and regular temperature measurement for storage of culture medium.

Sterile Culture Conditions :

To ensure that your embryos are happy in the IVF lab, we need to ensure optimal culture conditions.
 
These include:

•    IVF Lab cleanliness :

= Daily Cleaning of IVF lab with proper disinfectant is mandatory.
= The disinfectant should be non-toxic and odourless. We use diluted H2O2 to do so. Alcohol-based solutions can be embryo toxic and should not be used.

•    CO2 Incubator Cleanliness :
Regular Cleaning and disinfection of CO2 Incubator should be performed.

•    Aseptic precautions while handling Gametes and embryos :
= One should wash his hands properly before handling the dishes containing embryos.
= Gloves should be worn, while preparing dishes and handling culture medium

Correct handling and identification of patients and their gametes and embryos

Written procedures should be present describing the various phases of IVF techniques. Rules concerning the correct handling and identification of gametes and embryo samples should be established by a system of checks and, where needed, double-checks.

1.   All material obtained from the patients, i.e. tubes with follicular fluid containing eggs and containers containing sperm, should bear the names of the treated couple.

 •   At our centre, when the husband collects a semen sample for an IVF procedure, Semen Freeze or Semen Analysis, the nurse charge will ask the patient to write his full name on a piece of paper, to avoid any spelling mistakes and the same name will be written on semen collection jar. The Jar is labeled with husband's name and cap of jar is labeled with his wife's name.

•    Once the sample is collected and it arrives in the lab along with your file, the name on the jar is cross checked with one on the file. We analyse the sample and transfer the sample to sterile centrifuge tube, which is labeled with his name. The cap is also labeled.

•    The sperms will be processed while they are in this tube and will remain in this tube till we use them for IVF procedure.
•    The culture dishes required for your IVF Procedure are prepared in advance. All the dishes are labeled with your name. The shelf of the incubator in which your dishes are kept is also labeled

2.    Verification of patients' identity should be performed at critical steps: before egg collection, at semen recovery and embryo transfer procedures.

•    At our centre, the nurse and OT staff cross check your file before taking you inside the OT for procedure. 

•    The nurse informs Dr. Anjali and me about your being taken into the OT.
•    For embryo transfer, the nurse stands as witness, while I load you embryos into the catheter.
•    I confirm your name audibly with Dr. Malpani, before handing over the catheter loaded with your embryos to her.

3.  Double checks need to be considered at critical procedures such as : insemination of oocytes, replacement of embryos, embryo freezing and thawing.

Handling of oocytes and spermatozoa

The laboratory procedures regarding the handling of gametes for assisted should be easy, simple and effective and must be performed in a laminar flow hood equipped with stages and heating blocks pre-warmed at 37°C. Disposable items used in the laboratory procedures for culturing eggs and embryos should be of tissue culture grade.

•    Aseptic technique should be used at all times.

•    Appropriate measures should be taken to ensure that oocytes and embryos are maintained at 37°C during handling/observation using stage warmers or other systems.

•    Tissue culture grade disposables should be used for handling gametes.

•    Pipetting devices (pasteurs, drawn pipettes, tips etc.) used for procedures should be disposed of immediately after use.

•    Simultaneous treatment of more than one patient should never be done in the same working place.

Protective Measures

The purpose of the protective measures is also to ensure aseptic conditions for gamete and embryos:

•    Use of non-toxic (non-powdered) gloves and masks.
•    Use of vertical laminar-flow benches.

•    Use of mechanical pipetting devices.
•    Use of disposable material; after usage, it must be discarded immediately in the proper waste containers. Potential infectious materials must be disposed of in a manner that protects laboratory workers and maintenance, service, and housekeeping staff from exposure to infectious materials in the course of their work.

•    Needles and other sharps should be handled with extreme caution and discarded in special containers. The Pasteur pipettes and broken glassware should be discarded in special containers.

Quality Control using evaluation of results :

At our centre, we evaluate results on a regular basis. The following factors are regularly evaluated:

•    Fertilization rates
•    Embryo Quality
•    Pregnancy rates
•    Multiple pregnancy rates
•    Implantation rates
•    Survival rate for frozen embryos

Boost IVF Success Rate

New Test to Boost IVF Success Rate on the Anvil

Scientists at Oxford University are working on a new test that could boost the IVF success rate from a single cycle of treatment to nearly 100 percent.

The researchers are analyzing two markers that cause pregnancies to fail and are also checking out chromosomal abnormalities in the developing embryo. The researchers hope that their study will help boost the IVF success rates from the present 30 percent mark to nearly 100 percent.

The study’s importance has already been acknowledged by the scientific community with the researchers being winning a prize from the US Society for Assisted Reproductive Technologies. Led by Dr Dagan Wells, the test involves checking the five-day old embryos for abnormalities and only those which are found to be healthy are considered to be suitable for IVF transfer.

The researchers said that such a step will improve the IVF success rate to over 70 percent. “If you transfer to the uterus embryos that are confirmed to be chromosomally normal and develop well, reaching the blastocyst stage, the chance of producing a child is very high, about 70%. But that still leaves 30% that don't make it. Why? We need a better understanding of the biology, allowing us to bridge that gap and approach 100% success”, Dr Wells said.

IVF cycle

Moments of truth in an IVF cycle

An IVF cycle is full of uncertainty and suspense, like any other biological system. However, being prepared for these can help you cope better!

Think of an IVF cycle as being a series of hurdles - and you need to cross all these to reach the finish line! While most patients will cross these hurdles with ease in a good IVF clinic, each of these is a “moment of truth ".

•    You should grow many follicles
•    These follicles should mature
•    Your uterine lining should also mature in synch with your follicles
•    Ovulation should not occur before the eggs can be collected
•    Mature eggs must be retrieved by the doctor during the "pick-up"
•    Your sperm must fertilize the eggs ( with IVF or ICSI)
•    The embryos must divide and grow healthily in the IVF lab
•    Your embryos should be transferred by the doctor smoothly into your uterus
•    Your embryos should implant
 

Think of it as a series of hurdles, all of which have to be cleared, in order to win the race!

As you can see, how well you negotiate these hurdles will depend to some extent on your biology (how good your ovarian reserve is, for example); while others will depend upon the skill of the doctor!

A good clinic will guide you through these moments of truth, and share information with you, so that you can rejoice when things are going well - and be prepared in case things do not go as planned. Unfortunately, as with any biological system, IVF is also full of ups and downs - and the more you know about what is happening - and what is going to happen next, the more easily you'll be able to go through your IVF treatment !