The extra embryos can be frozen and stored for future use. You could use the same frozen embryos in your next IVF cycle if you wish to conceive again. Having frozen embryos can therefore reduce your financial expenses whenever you plan again.

You may also choose to donate your embryos to another couple or for research purposes.

• An ovarian reserve testing will enable us to determine the quality and quantity of the eggs in your ovaries. Blood investigations like Follicle Stimulating Hormone (FSH), estrogen (E2) and Anti-Mullerian Hormone (AMH) and an ultrasound of your ovaries can help determine how your ovaries will respond to the fertility treatment.
• Husband’s semen analysis will help us determine the quality of the semen sample.

Considering various factors like the patient’s age and previous failed IVF cycles, a maximum of 2 blastocysts (embryo on Day 5 of development) can be transferred. However, an elective single embryo transfer can also be done to minimize the chance of multiple pregnancies.

Egg donor program is generally offered to women with poor egg quality and number. An anonymous egg donor with physical characteristics similar to the wife is chosen after a series of investigations are done. The eggs from such a donor are then fertilised with the sperm of the husband and the embryos formed are then transferred back into the wife’s uterus. The baby born will thus have the genetic component of the egg donor and the husband. Both, the donor and the recipient’s identity are kept confidential.

Standard medical textbooks define infertility as the "failure to conceive following one year of unprotected sexual intercourse." For young and healthy heterosexual couples having frequent intercourse, about 85 per cent will be pregnant after one year of trying and about 93 per cent will be pregnant after two years of trying to conceive. While this is the "classic" definition of infertility, you may label yourself as infertile if there is "failure to conceive following one year of unprotected intercourse if under 35 years of age or six months if over 35."

Generally, most eggs fertilize when they are placed in a culture plate along with several thousand sperm. This process is called In-vitro fertilization (IVF). In cases wherein we have few normal sperms for IVF, the embryologist will manually inject a single normal looking sperm into the egg. This process is called Intra-cytoplasmic Sperm Injection (ICSI). ICSI is generally done in cases of male infertility or previous failed IVF cycles. Your fertility doctor and embryologist will help you determine the best possible approach to maximize your egg fertilization rate.

Yes. Embryo transfer is an ultrasound guided procedure which is used to view your uterus for placing the embryos. Thus, having a full bladder provides a clearer image to visualize the location of the embryos to be transferred.

Standard medical textbooks define infertility as the "failure to conceive following one year of unprotected sexual intercourse." For young and healthy heterosexual couples having frequent intercourse, about 85 per cent will be pregnant after one year of trying and about 93 per cent will be pregnant after two years of trying to conceive. While this is the "classic" definition of infertility, you may label yourself as infertile if there is "failure to conceive following one year of unprotected intercourse if under 35 years of age or six months if over 35."

You should approach a fertility unit for help if the female partner is.

• Under 35 years of age and trying for more than 1 year.
• Between 35 and 39 years and trying to conceive with adequately timed intercourse for a period of 6 months or more.
• 40 years or more and attempting a pregnancy for 3 months or more.

We do this because we recognize that female age is one of the most important predictors of subsequent conception. When female age is a factor, moving more aggressively towards completing the evaluation and initiating treatment can help to maximize the chances of pregnancy.

At the beginning of the menstrual cycle, an egg begins to develop in the ovary. After approximately two weeks of growth, the egg is released or "ovulated". Following ovulation, the ovary produces the hormone progesterone to prepare the lining of the uterus for implantation of the embryo (baby).

After ovulation, the egg survives for approximately 24 hours, which means that a woman can get pregnant only once in the month. Therefore, it is extremely important to ascertain the time of ovulation.

There are various methods for detection of ovulation. The following are a few:

• Basal body temperature charts are an inexpensive means of ovulation detection but are inaccurate.
• Ovulation can now be predicted by at-home kits that measure luteinizing hormone (LH) in the urine.
• Mid-luteal phase (a week before menses) measurement of serum (blood) progesterone concentrations remains the simplest and most accurate method of detecting ovulation.
• Serial pelvic ultrasounds (follicle study) are currently the most accurate non-invasive method of ovulation detection. But even ultrasound is not the perfect test due to the variable ultrasonic appearance of the ovary after ovulation and documentation of retained oocytes in follicles that have collapsed on ultrasound.

In case you are not ovulating, there are various tablets and injections, which can help to make your eggs grow. However, you have to be monitored with the help of follicle studies to assess the growth of the eggs and detect the day of ovulation.

The following are a few ways to evaluate the status of the Fallopian tubes:

• A hysterosalpingogram (HSG) is an X-ray test that determines whether there is a blockage in the fallopian tubes, which would prevent the union of a sperm and egg. It may also be used to detect irregularity or scarring of the lining of the uterus. The HSG is performed between the 8th and 10th day of the period to make sure that you are not pregnant during the procedure. The test involves lying on an X-ray table, in the same manner as for a routine pelvic examination. A small catheter is placed snugly in the cervix. The catheter is connected to a syringe that contains the HSG "dye". It is this dye that shows up on the X-ray. An HSG takes 5-10 minutes to perform and may have some cramping associated with it, but it is not necessary to miss work. You may take an analgesic an hour or two before the procedure if desired.
• A sonosalpingography is similar to the HSG, but is done with the help of saline (instead of dye) and sonography (instead of X-ray).
• Laparoscopy is the direct visualisation of the pelvis (inside of lower abdomen), with the help of a scope and camera. This procedure is routinely done as a day care procedure at our centre. A number of fertility related procedures can be done with the help of Laparoscopy, including treatment of cysts, endometriosis, opening of tubes etc.

Certain kind of blocked tubes can be corrected with the help of a surgery, which may be performed laparoscopically. In other conditions, we have to consider bypassing the tubes with the help of IVF.

A human egg (or ovum) is the female gamete or reproductive cell produced by the ovaries. The ovum is one of the largest cells in the body, and is about 0.1mm (100 microns) in diameter. Fusion of the egg and the sperm leads to development of an embryo.

Egg quality is the probability and ability ofthe egg and sperm tofuse and become an embryo, with the capability to ‘stick’ or implant in the uterus. One of the ways of determining the egg quality is the ovarian reserve, which tells us about the number of eggsremaining in a woman’s ovary. However, it needs to be kept in mind that quantity does not always equal quality. Many women with only a few but high quality eggs can also get pregnant.

High quality eggs will lead to development of good and strong embryos, which in turn have a better chance of sticking or ‘implanting’ in the uterus, leading to a higher likelihood of a successful pregnancy.

In the beginning of the menstrual cycle (cycle days 1-5), the pituitary gland in the brain secretes Follicle Stimulating Hormone (FSH) to stimulate to ovaries to select and grow an egg for the cycle. Measuring the levels of FSH and Estradiol (estrogen) on cycle day 2 or 3 (first day of flow is cycle day 1) provide us with an assessment of the quality of the eggs. Newer tests like Inhibin B may be suggested for a few patients.

A human sperm is the male gamete or reproductive cell. The main function of the sperm is to reach the ovum and fuse with it, leading to the formation of an embryo.

Sperms are evaluated by a simple semen analysis which is the measurement of 4 different properties of a single ejaculate:

• Volume is the amount of the ejaculate measured in ml.
• Count is the concentration of sperm, measured in million of sperm/ml.
• Motility is the percentage of sperm that are moving, i.e. living.
• Morphology is the percentage of sperm that are normal in shape.

The "normal" values for these parameters are greater than 1.5ml in volume, 15 million/ml in concentration, 40% motility, and 04% normal morphology. The presence of white blood cells in the semen may indicate an infection of the prostate or urethra, even if no symptoms are present.

At our centre, we insist on abstinence of 2 to 5 days in order to evaluate the semen accurately. The collection can be done by masturbation and the sample should be collected in the container provided by the centre. For the comfort of our male patients, we provide a comfortable collection room, offering complete privacy. In case you wish to collect the semen at home, it must reach the centre within half an hour of collection, with instructions provided by the clinic.

If the semen analysis is persistently abnormal, a urological exam, more specific sperm testing and hormonal testing are recommended. The urological examination by our andrologist, will check for the presence of anatomical abnormalities (varicocele, congenital absence of the vas deferens). More specific sperm testing might include more stringent morphology testing (Kruger morphology), or testing for the presence of white blood cells or antibodies. Hormonal testing includes measurement of Prolactin, FSH and Testosterone.

Depending on the quality of the sperm you may be offered an IUI (intra uterine insemination) or ICSI (Intra cytoplasmic Sperm Injection).

In nature, an egg is released from the ovary by a process known as ovulation. The egg then travels through the fallopian tube, and a successful interaction between the sperm and the egg will lead to formation of an embryo.

A patient undergoing IVF does not require admission. However, one should visit the centre 3-5 times during the monitoring cycle. On the day of egg collection, the patient would need to fast for 6 hours and come to clinic and the procedure takes about half an hour. Patients can go home after the effect of anaesthesia weans off which takes about 2-3 hours. The next scheduled visit is after 3-5 days for the embryo transfer. This takes about half an hour and the patients are free to go home after resting for one hour.

Ovum pick-up or egg retrieval is a procedure used in assisted reproductive techniques. After stimulating the ovaries with hormones, the eggs that develop are collected from the ovary by a needle through the vaginal walls.This procedure is done with the help of an ultrasound probe under short general anesthesia for about half an hour.

In vitro fertilization (IVF) is a procedure where the eggs that have been collected after ovum pick-up are allowed to fertilize with the sperm in a fluid medium, mimicking the process that occurs in the fallopian tubes naturally.

Intra-cytoplasmic sperm injection (ICSI) is a process whereby one sperm is manually injected in the egg under a microscope. ICSI can drastically increase the fertilization rate in case of poor sperm parameters and/or previous failed IVF cycles.

Embryo transfer is a step in assisted reproduction whereby the embryos that are developed in the lab are placed in the uterus with the aim of establishing a pregnancy. It is usually done on Day 3 or Day 5 of the embryos.

An embryo on the third day of development after fertilization is termed as a Day 3 embryo. After three days of natural dividing, the embryo should have atleast 6-8 cells in order to be termed as healthy. The embryo can be transferred on this day of development, or observed further in the lab for two more days allowing it to become stronger or more viable for implantation in the uterus.

A Day 5 embryo is one that has been allowed to develop in the lab for five days after fertilization, and is known as a blastocyst. At this highly developed stage the blastocyst has hundreds of cells and looks like a ball with water in it. Only about one-third of all the embryos may grow to this stage and thus may have a higher chance of implanting.

To make the best choice of an embryo/s for transfer, various parameters such as growth and quality of embryos, development of the uterine lining and blood flow are monitored during treatment. At Gynaecworld, our doctors and embryologists offer individualized treatment options to determine the best embryo/s for a successful pregnancy.

Day 1 is the day of fertilization check, where the fusion of the egg and sperm is marked by the presence of two circles in the egg which then leads to an embryo. On Day 2, the embryo should have divided, with 2-4 cells. Further grading of the embryo is done on Day 3 wherein it should have 6-8 cells. A good quality embryo should follow these parameters of cell division, without breaking apart, or having any fragments. On the 5th and 6th day after fertilization, the embryo develops into a blastocyst. A blastocyst has a clump like inner mass of cells that will form the baby and an outer layer of cells that will form the placenta. A good quality blastocyst has many tightly packed cells in the inner and outer layer. As the embryo develops further, it expands in size, and the fluid sac becomes bigger, ultimately allowing the embryo to hatch out of its outer cover, and implant in the uterus, leading to a successful pregnancy.

The lab is very important. For development and growth of high quality eggs and embryos, an experienced laboratory with latest technologies is essentially required. With over 20 years of experience, our laboratory uses latest and innovative technologies and techniques to mimic the environment of the uterus for the embryos. , We create a safe and stable culture environment where the embryos thrive, thus maximizing the fertility success.