00 : 00 / 05: 00 (Preview)

This discussion has ended. Watch the recording on Medflix app,

Assisted Reproductive Technologies: Basic Overview

Sep 06 | 1:30 PM

Assisted Reproductive Technologies (ART) encompasses a variety of procedures such as IVF, ZIFT, ET, and others. Let's take a look at all of these procedures, as well as their limitations, complications, and some recent ART developments.

[Music] so uh welcome everyone uh welcome to one really interesting session on assisted reproductive technologies we have one really amazing faculty today with us uh dr molina patel uh she is a consultant uh fertility specialist and aesthetic gynecologist practicing at akangsha hospital and research institute so a hospital and research institute is considered as one of the best uh ivf hospital in india uh she's also assistant professor at recreational hospital so welcome dr molina i'm really glad you could join us today yes thank you very much uh dr rucha and today we will be discussing about the overview of the various techniques in art without because it's a very very long topic uh and we just have very little time we start immediately okay so basically this would be an ideal situation um you know in which there is a young couple and they get married and they decide to have kids of course uh you know this is a very personal choice but in nine out of ten cases in indian scenario also this would be an ideal situation in which every couple would want to have a family okay but the current situation is that you know because of various other factors uh a couple who is willing to start a family they are not able to do so okay there are various various factors that lead the couple to some or the other difficulty in conception okay and it is a huge rat race it is a huge huge um situation in the in the sense that uh because women in the couple are you know career oriented they don't want to have kids faster some of them get married at a very later age um with our lifestyle which is full of stress and addictions it is possible that at the time when a couple decides to have kids it may not be completely natural and this is what is called as infertility so infertility is when a couple uh who stays together and has regular unprotected intercourse for a period of one year is not able to conceive at the end of one year and if the woman in the in the couple is after 35 years of age then this duration is reduced to only six months so after a certain number of um years if you are if if you are a couple and you are not able to conceive after regularly trying for say four years five years definitely definitely you will need to go to a doctor to see that something might be wrong so one in six couples today have some or the other difficulty in conceiving and this is because of advanced age stressful lifestyle not eating on time not eating the correct food on time all the addictions so many sexually transmitted diseases weight issues so many uh of us are also even you know caffeine uh addicted uh that also has an influence on the fertility and of course in this technical era we are using laptops and mobile phones so close to our genital area and the pelvic area that that also has an influence on our ability to conceive if you see this chart the time required for conception for any couple to attain pregnancy if you study it closely out of 100 couples 57 will conceive within 3 months in fact 72 couples will conceive within 6 months most of the couples will conceive within one year but within if it is more than one year or so then they and they are not able to conceive that is when the bells should ring and you will realize that something is not right the etiology of infertility either it could be a the male problem or the some or the other issue with the female factor and there is another third group that is also referred to as unexplained infertility in which there is no cause pointable in the mail or in the female and nothing can be actually pinpointed that this is the problem and still the couple is not able to conceive all the reports are normal both of them are absolutely healthy and they are not able to conceive so assisted reproductive technology these include all those procedures that include giving fertility medications inseminating the woman with gametes that is a sperm and ivf and surrogacy so these are basically it's an umbrella of technologies which is aimed to achieve pregnancy okay fertility therapies where eggs and sperms are manipulated are also included in art procedures and it also involves surgical removal of the eggs from the woman or from the sperm or the sperm from the testes in the lab so basically you are dealing with eggs sperms and fertilization outside the body to get a pregnancy if you see uh carefully different societies have different definitions of the various procedures that are taken under art umbrella according to the cdc art refers to all the procedures in which eggs and sperms are handled in general it involves surgical removal of the eggs or the sperms and then fertilizing it and returning it into the same woman's body or into a third party that is a surrogate and that is when surrogacy is also included in the procedure of art in europe it also basically it excludes out artificial insemination and includes only those procedures in which oocytes are handled and similar is the definition also given by who but we generally take into consideration the cdc guideline and that is including ivf as well as surrogacy so it includes in vitro fertilization that is ivf xc intracytoplasmic sperm injection we will study in the subsequent slides in detail that what each of these are artificial insemination surrogacy other procedures like gamete intra fallopian transfer and zygote intro fallopian transfer these are actually now not they are very obsolete and not done but just to complete the list uh cryo preservation of the embryos that means storage of the eggs and the sperms for fertility preservation or before starting cancer chemotherapy or for getting kids at a later age is also included in this fertility enhancing procedures that also aim to enhance the quality of the eggs and sperms that includes ovarian rejuvenation testicular rejuvenation procedures that involve the merger of the concept of regenerative medicine into the field of fertility and various other advances that include genetic testing of the embryos in order to detect some of the other diseases in the embryo so it includes iui ivf xc use of donor egg donor sperm or both that form the donor embryo and putting it inside another woman's boom that is also surrogacy so if you talk about the details that is what is female infertility uh now we will just study in the subsequent slides what is the various etiologies involving infertility in the male as well as female in females as you can see a majority of the ecology is ovulating disorders then comes tubal blockage endometriosis pelvic adhesions and hormonal imbalances that involve excessive amounts of hypoprolactinemia that is prolactin hormone thyroid etc very very briefly it's just a chart but basically ovulated disorders dominate so in the ovary either you can have some difficulty in your ovulation that is either the ovulation is not happening on time or it is not happening at all according to the who guidelines of an ovulation very very superficially if we discuss uh three classes have been defined by who one is the hypogonadotropic hypogonadism in which there is basically some issue from the central nervous system itself that is not able to trigger enough amount of fsh and gnrh that is causing unresponsiveness and ovulation is not occurring the second class is normal normal class in which all your hormones and everything is normal but still patient is not ovulating okay and in the hypergone endotropic type the primary causes that the ovaries are only not responding and there is a lack of adequate amount of follicles or rather responsive follicles in the ovary or they are resistant in some form luteinizing unruptured follicle syndrome so this refers to an infertile woman woman in which their menses are regular and there is a presumptive evidence of the ovum being trapped okay that means that the classical uh features that is ovulation occurring and the corpus luteum getting formed and secreting the hormones all that is absent it is often associated with endometriosis and if you see the sonography you will see that a eco-free dominant follicle is persistent even after the lh peak so after your lh peaks still when you're supposed to ovulate the follicle is still there and ovulation has not occurred so basically ovulation does not occur in the ovum gets trapped in the follicle the other set of patients who will require art are the ones in which the oocyte is aging say you are 40 you are 42 you are 45 or even above that and you want kids what are you going to do you will need ait you are not going to conceive naturally if you see the timeline women always follow a biological clock that is why we have to conceive or reproduce or preserve our gametes when we are young and we have good quality of eggs men they can even you know further till really old age even till the death bed rather but in females we are dealing with a biological clock at birth we have so many millions and millions of follicles one to two million at birth and you see that at the end after that as we age only about 400 to 600 oocytes are available for the ovulation now uh talking about the tubal factors these are very very common these days in our practice we are seeing that the tubes are blocked because of some of the other pelvic inflammation infection tuberculosis in india it is so common four out of ten are always in some or the other way infected with tb you must be thinking that tb is a disease of the lungs how it's going to affect the tubes but in females subclinical infection does occur in the tubes and there is a tubal blockage so the eggs and the sperms are not able to meet in the first place and this causes infertility apart from this tubal adhesions because of chronic infections obstruction because of fluid getting filled in the tubes what is what we term as hydro salpinges all that is a part of this umbrella if you talk about the uterine factors the wall of the uterus has big fibroids or you have some adhesions inside the uterus what is what is called as um ashuman syndrome or you have some uterine abnormalities since both absent uterus in which surrogacy and art will be required so all these are the uterine factors determining the need for art again luteal phase deficiency that means your corpus luteum after ovulation is not secreting enough hormones to sustain the pregnancy and you need some assistance from outside to be able to conceive and sustain a pregnancy genetic diseases turner syndrome fragile fragile x-ray syndrome robertsonian translocations these are some genetic factors in which the woman will also require art and when such a woman comes to you you will have to take a detailed history that involves a complete menstrual sexual surgical and past medical history family history examination point of view you will do an ultrasound measure the cervical length basically it's an entire flow chart that you have to follow that involves detailed evaluation of the woman in terms of the history and physical checkup that involves a sonography as well as certain tests it would be incomplete to mention what is amh if you are discussing about art so amh is a hormone that is called anti-mullerian hormone in simple words it tells you how fertile you are okay you can do this hormone in the form of a simple blood test and it does not depend upon any particular day of your menstruation or fasting status you can just come get the amh done more the amh sometimes it can result in a pointing towards a picture of pcos but overall an amh between 2.5 to 4 is considered to be normal and you have good fertility if it is less than two that means you have a sub optimal fertility and you need to you know discuss with your gynecologist regarding when you are going to have your kids or when you are going to preserve your eggs so it is generally measured in nanograms and it is 97 sensitive in predicting your ovarian reserve and depending on your amh you can also predict the response of ivf that you are going to have if you are having a larger amh or emh on the higher side rather it is possible that you will be a hyper responder and accordingly the medications for ivf the injection doses have to be tapered okay if you are having amh on the lower side that means your ovaries could be little bit resistant in the first place because you are termed as what is called as poor responders and you will need some extra medications in the form of injections to boost your ovaries and give the necessary response basically just to you know give you an overview amh tells you a fertility it's a simple blood test you can get it done everybody should get it done it must be included in your initial workup okay and it tells you how fertile you are at any point in your age how are you going to check your tubes you know that there is a simple dye test called hsg what is what what is known as hysterosalpingography and you can know whether your tubes are blocked or open and more specifically more real time and more accurate would be a laparoscopy procedure which you can discuss with your gynecologist uh if you are having trouble with ovulation there are certain medications available in the form of tablets and injections tablets in the form of chromophene citrate letrozole and injections in the form of low dose of gonadotropins which again this is just to give you an overview which will be administered to you so that you can produce eggs in your ovaries and you can conceive uh just to rush it very quickly why do we need luteal phase support we know that one of the causes of infertility is also luteal phase support now lack of luteal phase support and luteal phase insufficiency so basically these are certain hormones in the form of progesterone and estrogen that are given to you after your embryo transfer or your artificial insemination in which your pregnancy will be sustained even after you um after the procedure is done this is because your own hormones your own corpus luteum is not producing enough hormones so as to sustain the pregnancy now male factors male factors nowadays are on the rising trend initially it was the trend that females you know it was 45 percent 55 percent female factors but now male factor is probably equally important equally there in evaluating a couple now there can be various causes why there could be some male factor in fertility there could be pre testicular causes that include all your diabetes uncontrolled diabetes hyperprolactinemia thyroid dysfunction or the man is having some erectile dysfunction or some psychosexual disorder some genetic factors that include climate filter syndrome or he is on some drugs antipsychiatric drugs are very very important you have to ask in the history um it's very commonly missed and it must not be missed uh testicular causes will include causes which are intrinsic to the testes so this includes all your addictions in the direct effect that smoking radiation drugs have on your testes also varicocele cartagena syndrome and certain other syndromes excertoli cell only syndrome basically these are causes within the test these that are not allowing you to conceive post testicular causes these include all your hernias hypospadiasis or ejaculatory problems retrograde ejaculation as well as your infections like tuberculosis 2010 semen guidelines are what we follow still and if you can study if you just see the chart normal sperm count is anywhere uh about 39 to 40 million and you have to have at least four percent normal morphology and a particular amount of vitality and progressive motility then you are considered to be having a normal semen parameter uh it is always wise nowadays in the private practice we have observed that you know uh males are um quite uh comfortable discussing their uh etiology with a male gynecologist and um it is it is pertinent that they are not that that is what i have observed that even in the day-to-day practice they are not very very open to discussing it with a female gynec it would be nice to have a male gynecologist in the team and they will take a detailed evaluation of the history semen analysis would be done uh and accordingly uh the entire chart will be discussed with uh the patient in which in which direction you are going to go so approach to male infertility in starts from taking a detailed history this will include the drugs that he's taking whether he has kids from his first marriage this is a second marriage what is his lifestyle um is he having some intercourse related problems some problems in erection all that and then it is including also a detailed examination just like how females are examined for sonography and for external examination males are also examined and pesticides position palpation of the vas presence of any varicocele or hernia all that is considered and taken into consideration now if you are having azuspermia that is a low sperm count um you have you have to follow a certain uh protocol and you have to find out why it is there either the sperm production is not there at all or it is there but there is some obstruction and it is not coming out so both the things have to be evaluated you can get tested for certain hormones just like how in females we test for certain hormones in males also you can test for fsh lh testosterone etc and you can determine whether the there is a testicular failure or there is a hypochondropic hypogonadism or there are some genetic problems in the testes or there are some obstructive etiology chromosomal analysis it is very pertinent to always always check for chromosomal analysis you can do a simple karyotyping blood test and determine most of the times this would be present that some or the other chromosomal abnormality will be there in the male uh that could include a deletion or a robertsonian translocation cystic fibrosis etc uh ideally depending on the sperm count itself your fertility treatment and modalities can be guided but this is not a rule because we have to consider the patient as a whole and the couple as a whole but just to kind of give you an overview if you need to do iui you need a sperm count of at least 15 million okay and that also having some amount of motile sperms if your sperm count is say between 5 to 10 million you could definitely benefit with ivf but if your sperm count is very very low less than one million you will need a procedure called xe which we will discuss in the subsequent slides okay so what is ivf ivf we all know uh everybody thinks that you know ivf is difficult there are so many myths around ivf and it is so uh misunderstood topic i would say so ivf is a method in which it's a part of art and it's a major part of art in which the eggs and the sperms are fertilized in the lab okay and then we make an embryo and we put it back into the patient or we put it into the surrogate that is another mother's womb and basically the couple gets a pregnancy if you see about the history the date the the the year in which the first test tube baby was born was 1970 um so it dates back from 1978 and from the start until right now there have been absolute miracles absolute uh advances and it's ever evolving miraculous branch of art in india dr subhash moko padhyaya is considered to be the father of ivf he created the world second and india's first ivf baby whom we name as durga and she was born 67 days after the first baby was born that is louis brown in uk so everybody must know that dr subhash fukuba is the father of ivf from the indian perception in anand uh we had the first ivf baby which was born on the 31st of may 2000 this is the city in which we practice and this was from our clinic of course from my mother-in-law's generation and so it is nice to mention over here to complete it if you can see this flowchart um ivf involves first so basically we have to give the females some injections injections that will cause her eggs to grow we do ultrasound and we monitor the response to the injections by measuring the size of the follicles then carefully all these injections are collected by a procedure called ovum retrieval and then the semen from the husband is also collected and then it is fertilized to form the embryo and it is placed back in the woman's womb so that she will get a pregnancy so this is what is called as ivf so first of all we have controlled ovarian stimulation that is giving the injections according to our hormones to form the eggs then measuring the size of the eggs so that we know the response and how she is responding then aspiration of the eggs and the follicles so basically all the eggs in the ovaries will be in the form of large follicles which will contain follicular fluid and the eggs will float in it so we have to actually aspirate all the fluid from the follicles and then search for the eggs in that fluid soon as the fluid containing the eggs are isolated the eggs are separated out they are stripped or denuded within three hours after removal fertilized with the husband's sperm and the embryos are produced and those embryos are then placed inside the womb through the cervix and vagina where it will stick in the bed of the uterus and patient will get a pregnancy this is how the ovary will look once she's stimulated for ivf and these injections are very easy to take injections which the patient can take on her own husband can also give ah it's very similar to you know those injections which you take in diabetes and but you have to have certain precautions while taking these injections have to be taken on time in the correct dose properly so that the response is all right once the eggs are removed you will see on the left is a egg which is surrounded by its cumulus of cells it's basically a bundle of cells surrounding it and then we strip it and then it looks like how it is on the right so then the sperms are collected the ideally we ask the husband to have an abstinence of about two to five days so that we get the best quality of the sperms and those sperms are then prepared using various techniques which we will study subsequently and then the eggs are mixed with the sperms and then we leave it in the lab we leave it so as to fertilize it and then they are checked exactly after 18 to 24 hours to see how many embryos are produced from these eggs and sperms this is the ivf lab you need a proper ivf lab in place this is the lab photo of our hospital it's a class 100 lab you will see that there are all instruments quality control and power backup always has to be there and it has to be clean and absolutely sterile indications of ivf so who needs it somebody whose tubes are blocked sperms are low uh very severe pcos advanced age of the female as we discussed previously aging oocytes unexplained infertility also somebody who is having advanced age not able to conceive for many years and no particular cause can be pinpointed unexplained infertility is also also an indication of ivf and women who have low amh women who are later in their later 30s or in the early 40s and who desire to have a pregnancy so what is the success rate of ivf everybody is asking this question that ivf success rate it is very important for everybody to know that the success rate of ivf depends on multiple factors what is the case of the couple what is the cause of infertility it will depend on the quality of the eggs the quality of the sperms the quality of the embryos as well as the type of the bed that has been prepared in the uterus and various other factors it is never a hundred percent it has to be always remembered that there are a lot of commercial clinics who claim a guaranteed package that you know hundred percent you will conceive in the first co second goal no it's not true the percentage has to be tailored according to the couple it has to be individualized and whatever is your case a percentage will be explained to you that look this is your chance of conceiving in the first cycle xe into a cytoplasmic sperm injection as we studied or as we discussed in the past when the sperm count is really really low individually the sperms have to be taken and it has to be injected into the eggs and this is what is exactly xc the mature egg is held as you can see on the left there is this little pipette in which the egg is suspended after it is stripped and then a delicate needle that contains a single sperm is carefully injected into the egg and then it is released so this is what is xc that means you are injecting a sperm into an egg you will do it of course logically when the sperm concentration motility or morphology is very low another important thing is whenever there is obstruction that is when there is an epidermal um obstruction and the sperms are there in the testes but they are not able to come out in the ejaculate you will do a procedure that is called tessa or tessa that is testicular sperm aspiration in which a very fine needle is taken and under anesthesia you put it in the testes and then the tissue is removed and the testicular tissue where the sperms are actually produced are searched for the uh for the sperms and then they are frozen so this tsa sample whenever you are using you will also need to do an xc because the number of sperms are few and you have frozen it ah so basically uh these are the specific indications of xc during the process as we discussed the embryologist isolates the sperm takes draws it up in a microscopic needle and carefully injects it under high power microscope in the oocyte and then it is observed from the first day that is day 0 until the day 5 where it will become a blastocyst so carefully you will see that on the first day it gets fertilized on day 2 it reaches the 4 cell stage on day 3 the embryo in the lab becomes 8 cell stage then there is a day 4 where it is called the modular stage and finally the most mature form of the embryo is called the blastocyst where it contains about 200 to 300 cells and beyond this we don't grow we either freeze it or we put it in the woman's body so this is also very important these are the gas incubators it's a triple gas mink incubator in which uh we um store the the gametes in the lab this is another instrument called the embryoscope it tells us the morpho kinetics of the growing embryo just to complete it it's like a computer which tells you the exact timeline real time images are taken of the dividing embryo and you will know at what rate the embryo division takes place and it helps to select the best quality of the embryo for transfer the process of embryo transfer is very very essential in fact it is the most essential step in the entire process of ivf in which you are putting the embryo into the female's body and it must be done very carefully by an expert under sonography guidance carefully the embryo is taken it is loaded in the pipette and then a thin needle uh it's a it's a transfer needle that is put inside the cervix into the uterus and under sonography guidance you place the embryo at the right point in the uterus so this was all about ivf and xc now just to complete the entire umbrella of art we just discussed very briefly what is iui iui is intrauterine insemination as you can see uh an iui cannula is used in which injected washed semen is taken and then it is iui you will do for all those patients who have uh in explaining fertility some problem in ovulation not able to have intercourse vaginismus that is some females have such um you know uh involuntary neurophysical contractions of the pelvic muscles that intercourse is not possible uh cervical mucus is hostile not allowing the sperms to survive in males also if they have some ejaculatory dysfunction sperm count is very very low or semen parameters are not exactly falling in ivfxy category also but they are subnormal so basically those patients will name iui you will not do iui if the tubes are blocked if the ovaries have a very very low reserve or if in case the male has a severe male factor because it's not going to work when you prepare the sperms for iui procedures there are four types of procedures that you can do in the sperms swim up max sorting microfluidics and purple density gradient we are not going to discuss because this is all very much in detail but just to give you an overview when the semen is taken from the male partner we can perform these procedures on the semen to concentrate and isolate the best quality of the sperm and that is loaded into the tube and that is put inside the uterus okay um the female is given certain medications to produce eggs in the ovary once the eggs reach a certain size we give an injection called the trigger injection that causes the lh surge to occur and after 24 to 36 hours of that shot she will ovulate and that is when we call the couple at the time um when she would ovulate into the clinic and we inject her with the semen so basically it's a meticulous timed procedure in which you want to make sure that as soon as ovulation occurs you are injecting with a good concentration of semen into the uterus this is the semen collection container on the left and you hold the cervix with the cusco speculum you visualize it and a very thin plastic iui cannula is available it's sterile it's loaded with the semen and then you put it inside there is a technique and over 30 to 60 minutes you very gradually inject the semen how many times you are going to do iui in the first three cycles itself you will have to know whether or not it's working or not some patients people some some clinics and societies even follow up to six but in our setup and personally also i feel three to four cycles are adequate to judge whether this patient is going to benefit with iui or not having said that the success rate of iui is restricted up to 14 to 18 only it's not a miraculous procedure because ultimately it's quite natural if you see you're just putting the semen into the uterus and you are timing it according to the ovulation but it has to still find the egg it has to still fertilize it and it has to still stick so it's very very near natural another important procedure is surrogacy we all know about surrogacy especially with so many movies and a lot of prominent people also adopting surrogacy so surrogacy is an arrangement it's a it's a three party way three-way party third party reproduction and in which three parties are involved the couple the clinic as well as the surrogate surrogacy means an arrangement in which a woman agrees to carry a pregnancy through art in which the gametes the male sperm as well as the egg both of them do not belong to her or her partner it is of a third party and she simply carries these um the the gam the embryo it is put inside her and she simply carries this pregnancy for nine months gives birth to the baby and it is handed over to the intended parents so to make sure the surrogate is not the biological mother in any way of the child she is simply a carrier you will do it in these patients who have absence of uterus one in four thousand women are born with a syndrome called mrkh in which uterus is absent since birth so for these women they have ovaries so you can stimulate the ovaries using art take the eggs fertilize it with her husband's sperm and you can put it into the surrogate and she will get a baby her own biological child which the surrogate will give birth to women who have huge fibroids whose uteruses are having severe adenomyosis or sometimes we also come across cases in which during the first pregnancy there was excessive bleeding and emergency hysterectomy was done and now for the second child she will need surrogate women who have repeated miscarriages we have seen patients with 10 miscarriages 13 miscarriages these are the women who will need surrogacy okay women with multiple multiple ivf failures they are just not able to conceive and women who have certain medical conditions these are very important especially severe cardiac diseases severe kidney diseases in which women carrying pregnancy is absolutely contraindicated for such women and they will need surrogate two types of surrogacy is there traditional and gestational in traditional it is the simplest and least expensive the surrogate mother uses an insemination kit to become pregnant using the intended father's semen and this is not practiced this is obsolete so here the surrogate mother is only the biological mother but this type of surrogacy is not practiced in gestational that is what we do it's a compensated commercial surrogacy in which she is not biologically related to the child she is only carrying the child the other procedure that comes under the umbrella of art is oocyte vitrification you can see an egg and it is frozen so for egg freezing also we need to do art women who want to preserve the fertility women who are diagnosed with cancer and they want to start chemotherapy you must preserve her eggs before she starts chemotherapy so that she will get good quality eggs and you can utilize it to get a pregnancy after chemotherapy and radiotherapy the oocyte quality quantity everything drops and it becomes very difficult for her to have a biological child of her own women who have to remove their ovaries for some reason are women who have premature menopause or ovarian insufficiency women who are career oriented and we don't want to have children before say 35 or 36 you do ivf you take the eggs out you freeze it and then you can use these eggs at 45 years also so these are the oocyte banks that are available at the hospital um basically it involves it's a fertility preservation um option and the oocytes are banked or they are frozen in these containers and you can use them at a later time when you are ready to have kids similarly if you have a partner but you don't want to get kids then there is not necessarily a need to freeze the oocytes you can freeze the embryos itself and whatever embryos are produced we can put it in the freezer or the vitrification container and you can use it at a later stage ah similar is the case in which surplus oocytes are produced and the procedure of ivf or xc and you have lots of embryos but you want only one child right now the further the other remaining surplus embryos can be frozen and you can utilize them at a later stage for a second child after many many years the procedure that we adopt for vitrification is something called slow freezing using liquid nitrogen this is just for the overview another very important procedure which everyone should know is what is ovarian tissue cryopreservation so this is a new method in which ovarian tissue is frozen for fertility preservation uh also when the the woman has some other genetic condition endometriosis or you want to postpone your menopause or for social freezing ovarian tissue freezing is done okay now uh basically why do we need to preserve the fertility forcing a person who is about to start cancer therapy this is because survival rates among cancer patients have increased significantly these days okay and modern treatment regimens that are given to these patients to improve the longevity has a harmful effect on your eggs and sperms okay they have a huge gonadotoxic effect and that is why you want to make sure that it would be criminal if you don't give the option of preserving your eggs and sperms you know for a patient who is about to start a cancer therapy it's a part of the protocol that you must give her this option uh there are certain women in which you know you cannot utilize her own eggs these are the women in which you are going to you know give the option of a third party reproduction that is again the need of a younger egg that is what is called as a oocyte donation these are the women who want to conceive and get pregnant at an advanced age or they are having a very low amh non-responsive resistant ovaries failure of ovaries to respond to any kind of therapy malignancy somebody who's had so ovarian cancer and eggs are removed ovaries are removed even before the fertility preservation was done recurrent ivf failures some genetic disorder that the woman is carrying or she wants to get pregnant at an advanced age and she doesn't have eggs of her own she will need to have a side donation this is also because all these options are available because of the advances in ait so we must thank this entire concept of artificial and assisted reproductive technology in which women who are of advanced age are able to get pregnant either using their own oocytes or a donor oocyte so this is a woman in uh at our hospital who had a baby shower and she has become a pregnant uh she has become pregnant at 48 years of age with the miracles of ivf and then there are so many other cases in this case report of that would particular woman she was 48 years of age married for 30 years even got her menopause uh so with the help of technology we could start her periods again and with the help of third party reproduction and donor who said she can get pregnant again another example of a woman of 49 years of age married since 20 years eight years she doesn't have her periods and now she's again pregnant because ivf was done using donor egg and we gave a certain medications to start her uterus to bleed again now similarly is the case of donor sperm just like how we have donor eggs there might be some patients who need a donor sperm so these are the patients in whom they have severe severe uh compromised semen analysis report that is semen is absent ejaculatory dysfunction is their male is carrying some significant genetic abnormality which they don't want to transfer to the next generation or some you know some very severe sexually transmitted disorder so basically sperm donation is also an option which i want to tell everyone the age of the sperm donor of course guidelines are given by icmr that has to be between 21 to 45 years of age for the egg and 21 to 35 years um 35 years is upper limit for the egg and 45 years is for the sperm and all the semen banks can crave preserve the sperm donor for a quarantine period of at least six months the other important technology which is a part of art is pgs and pgd that is pre plantation genetic screening and diagnosis now the term has been revised to pgt that is pre-plantation genetic testing so this means in very very simple words simply taking a biopsy of your embryo to make sure that the chromosomal constitution of that particular embryo is absolutely normal either you can screen the embryo or you can determine a particular disease that the father or the mother is carrying in whether that disease will come in the baby and so on so basically you want to identify any chromosomal abnormality in the embryo even before the lady is pregnant this is done in patients in which they are recurrent ivf failures woman is of an advanced age uh there is a very low sperm count multiple failed ivf factors woman is taking um the male or female is taking some antipsychetic medications uh or sometimes patients just want to know whether or not the embryos that they are going to transfer are genetically normal it's not a blanket procedure we generally don't do pgt for everyone it's just done for certain cases but it is a very very important technique or technology in which we can diagnose the chromosomal abnormality even before the woman is pregnant and at our hospital we have it in house so within 16 to 11 hours itself we can get the report and even do a fresh pgs normal transfer this platform is called the next generation sequencing or the ngs platform that is used for pgs now everybody wants to know what is this hype again about regenerative medicine or ovarian rejuvenation or testicular rejuvenation or endometrial detonation basically you can now the technology has also come that for a woman in which she has a very poor sperm count or a very low quality of eggs or testes or sperms you can use your bone marrow concentrate from your bone marrow identify the pluripotent stem cells and you can put it in the ovaries or in the testes or in the uterus and you can rejuvenate it there are studies and there is an ongoing study at our hospital also in which it is said that the quality of the eggs the quality of the sperms the quality of the endometrial bed everything improves and there is a positive change that is seen there is improvement in the blood supply there is an improvement at the cellular level and it is really very very helpful for some patients so finally to conclude everything infertility treatment and specially art has taken a quantum leap okay from the time it was introduced in 1978 and if you see it right now there have been huge advances and all these advances are only for the better you the age of 45 you can even postpone your menopause you can reverse your menopause you can improve your uterus and start bleeding after 15 years of getting you know absent periods you can preserve your eggs you can preserve your embryos you can preserve your sperm you can rejuvenate your eggs improve the quality of the sites everything is possible now and this all is only with the miracles of art so art is a blessing for all infertile couples the miracles are limitless but it has to be used with proper ethics under proper guidance so as to not cause any side effects to the patient so thank you once again and we will take up any query that you have now yeah right thanks a lot dr molly it was really really amazing uh overview of whole art or that was really interesting so uh everyone if you have any queries please put in the comment section and we can address those live but uh till then i just wanted to ask you two things uh you mentioned about uh reversal of menopause so uh you also gave example of the lady who was like who could conceive at the age of 48. so uh is it like uh after menopause like two to three years of menopause two week in reverse or it has to be made how is it like basically when we are talking about reversal of menopause once you see menopause will occur when your hormones go down okay when you are no longer producing enough estrogen and progesterone to cause you to bleed every month okay there can be other causes also in which there can be adhesions inside the uterus uh you can have um tuberculosis inside the uterus so there are a lot of causes where a patient stops bleeding so to make sure whether the menopause is age related or it is a premature stoppage of the pencils that is number one the other thing is you have to find out the cause of the menopause why has she stopped bleeding okay this patient was 48 or 47 when she stopped getting her periods we must do a detailed pelvic ultrasound to find out what is the situation inside the uterus we can give her certain hormones externally to start building uterine lining in the form of oral or intravaginal progesterone tablets estrogen tablets we can even do a procedure that is called hysteroscopy that is an endoscopic procedure in which we put a camera into the uterus and inspect the inside of the uterus if there are adhesions we can even cut it and then these are supplemented with the help of this um hrt that is hormone replacement therapy it takes time it may need one or two um hysteroscopy settings also if need be we can even perform rejuvenative procedures like injecting of platelet-rich plasma or bone marrow concentrate also and it's a cocktail of procedures which we can do and ultimately she will start bleeding right so it's very combination of treatments that you have to do depending on the cause it is absolutely possible for the purpose of carrying a pregnancy okay thank you second i wanted to ask you also mentioned about oocyte freezing uh especially so uh like is there any viability uh of that oocyte or there is a specific period let's say a woman is freezing her eggs at around the age of 33 so uh is it some span uh in that period it will be viable and it you know is there anything they are frozen under the influence of liquid nitrogen which is a chemical which stores the oocytes it crystallizes the water inside the oocyte and it is stored at minus 197 okay metabolically there is a stand still in the oocyte and there is not going to be any life in the ocean till you are going to throw it and use it again but that doesn't mean that you can keep it for 15 years 20 years 25 years you know it is going to have its effect of time ideal time duration for utilizing the oocytes would be somewhere between five to seven years that is a good time to utilize sites so uh there is one question uh i'll just take that up uh the vedica is asking uh it is like uh there is a high risk of pregnancy at day 45 so is it ethical uh to go via erd so a lot of ethical issues are also there this is a very good question not everybody who comes to you you are going to make her pregnant you have to after the age of 40 years of age you have to take a detailed history of the couple you have to undergo a detailed checkup the checkup that the woman undergoes includes a detailed cardiac checkup a huge battery of investigation so many sonographies that include sonography of the abdomen of the pelvis all the blood tests her complete cardiac checkup if she wants to get pregnant at 45 she has to be fit to be able to carry a pregnancy at 45 because at the age of 40 plus what is what we term as an elderly mother elderly mother by definition is a mother who is after 35 years of age more the age of the mother more there are going to be complications like diabetes hypertension miscarriage so and so forth so to make sure that the woman is absolutely absolutely medically psychologically emotionally financially fit enough to be able to carry and only then we continue with the procedure so a detailed counselling is done for these patients before they you know start the procedure and only then the treatment is started the counseling plays very very important role right so uh other questions we have already addressed so uh thanks for an excellent session dr molina uh we would love to have you again to discuss about some interesting uh aspect of aesthetic gynecology sometime later but right now this is really really interesting and informative uh the recording will be made available really soon uh to everyone you can go and watch again if you have any confusion and uh i would actually request everyone if you have any topic in your mind that you would really understand related to obgyn or any other uh subject uh any faculty you have in mind you can uh write to us at support metrics dot app or you can uh send me what's up to the support number anything will do we're really looking forward to help and upscale everyone in america coming so thanks a lot doctor thank you very much

BEING ATTENDED BY

Dr. Ramuuma Saras & 1272 others

SPEAKERS

dr. Molina Patel

Dr. Molina Patel

Consultant Obstetrician & Gynecologist, Akanksha Hospital, Anand

+ Details
dr. Molina Patel

Dr. Molina Patel

Consultant Obstetrician & Gynecologist, Akank...

+ Details

About Medflix

Medflix is a new platform by PlexusMD, India's most active and trusted doctor community. On Medflix, you can discover live surgeries, discussions, conferences and courses from some of the top doctors and institutions across the world. Join clubs in your areas of interest and access hundreds of amazing live discussions everyday.