IVF CLINIC
Infertility

Infertility is the inability to conceive after one year of unprotected intercourse in a couple less than 30yrs of age. If the couple is more than 35 yrs (female) then they should seek help after six months of unprotected intercourse. Infertility is primary as well as secondary. In primary infertility a couple has never conceived before but in a case of secondary infertility couple has conceived before but is unable to conceive now. There are various factors which cause infertility. These can be male factor, female factor , both male and female , unexplained.

IUI

Intra Uterine Insemination is the process where artificial insemination of prepared sperm of husband / donor is done in the uterine cavity for conception in a planned cycle at the time of planned ovulation. It is done in cases where the tubes are functional as well as patent . This can be performed in a natural cycle or with artificial hormone stimulation. If the couple is diagnosed with unexplained infertility, cervical mucus problems, minor sperm abnormalities or other male disorders It is also a cheaper solution for azoospermic males who cannot afford ICSI with TESA. They can have artificial insemination with donor semen.

IVF

In Vitro Fertilisation means “ Fertilisation – in- glass “ that is fertilization outside the human body . It was initially developed for fertility in females who had blocked or unfunctional fallopian tubes. At present IVF is recommended to patients who are unable to conceive due to several other causes also.

We try to provide you with the utmost services :

Your initial consultation : It is an initial visit in which you open up with your doctor and know your doctor and the doctor knows you. A detailed history is taken of the couple.

Pretreatment preparation and planning management : This will include a detailed blood workup which will include your hormonal assays , a uterine assessment, semen analysis and other tests if required. We review the whole history and all the tests and then only a definitive management is planned for you.

Start of oral contraceptive pills : You will be put on oral contraceptive pills for a short span of two to four weeks if your cycle needs to be synchronized with that of an egg donor or surrogate . These help the ovaries to be cyst free and help in planning of your cycle.

Ovarian induction

The IVF cycle begins with ovarian stimulation with injectable hormones on a daily basis and serial ultrasound monitoring. A baseline ultrasound is done before starting the stimulation to assess egg production. The hormone levels will also be monitored . Once the follicles reach the optimal size , you are prepared for egg retrieval.

Visits

Prior to egg retrieval three to five visits are done in that IVF cycle.

Egg Maturation : An injection is given 34-36 hrs prior to egg retrieval.

Egg retrieval : It is a procedure done transvaginally under ultrasound guidance under short general anesthesia . You need to be six hrs. fasting prior to the procedure.A long thin needle is passed through the vagina in the ovary and the follicular fluid is aspirated .The follicular fluid is collected in test tubes under strict temperature control and immediately given to the embryologist in the embryology lab. The embryologist searches for the eggs .The eggs are rinsed counted and placed in an incubator . After few hrs , they are fertilized with the sperm either through IVF or through ICSI.

An anesthesiologist is there to give you pain relief and comfort during the procedure. Chances of injury during egg retrieval is extremely rare .Structures near the ovary such as bladder,bowel or blood vessels could possibly be damaged and may require further surgery. Minimal bleeding from ovaries might occur but the risk of transfusion is extremely rare. Infection during this procedure is also extremely rare. You will be discharged four hrs. after the procedure.

Embryo Assessment :

During IVF embryos are assessed for 2-5 days in a temperature controlled incubator. The embryos are assessed and the day of transfer is determined between day 2-day 5 . We call you to update you about the embryos.

Embryo Transfer :

Embryo is transferred back in the uterine cavity between day 2-day5 when it becomes multi celled /blastocyst . This requires no anesthesia and the female is happy to see her embryos being implanted in the cavity . We discuss the number of embryos and made and the number to be transferred so that you have the highest probability of success keeping in mind the risk of multiple birth associated with it. For embryo transfer you need to come on a full bladder and the procedure is done via an embryo catheter transferred vaginally under ultrasound guidance.

Pregnancy test :

We schedule a pregnancy test 10-15 days after the transfer . If the first test is positive we repeat beta hcg repetitively every 48-72 hrs. and an obstetrical ultrasound is planned two weeks following the pregnancy test when we look for the no. of embryos and fetal cardiac activity.

ICSI

If you are diagnosed with male fertility problems, such as a low sperm count ,previous history of vasectomy in male partner ,recurrent ivf failure then conventional IVF is unlikely to result in fertilisation. It is also done when sperms are not present in the semen and they have to be obtained surgically from testicles.This is when Intracytoplasmic Sperm Injection (ICSI treatment) is recommended. It is like IVF only the main difference is the technique we use to achieve fertilisation.

How is ICSI done?

A single sperm is injected into each egg, using very fine micro-manipulation equipment. As the human egg is one tenth of a millimetre in diameter and the sperm 100 times smaller, this is a very delicate procedure performed by highly skilled embryologist under a micro-manipulator.

Dr. (Mrs) K.P. Gandhi completed her MBBS, DGO, MD in 1993 from Ahmedabad. She has been practicing in Delhi for more than 20 years. She has attended and chaired many national and international conferences and has kept herself abreast with the latest technology in her field. Besides normal pregnancies, she is an expert in handling high risk pregnancies and has been credited with successfully managing many PCOs and infertility cases. She is a renowned Gynecologist/Obstetrician who believes in giving a personal touch while rendering expert professional care.
Dr. (Mrs) K.P. Gandhi is available:
9.30 am to 1.00 pm (Monday to Saturday) at Sukhmani Hospital,
B7 Extn. 126 A, Safdarjung Enclave and
3.30 to 5.00 p.m. (Monday to Saturday) at Sukhmani Hospital,
Building No. 1, LSC, Sector B, Pocket 7, Nelson Mandela Marg, Vasant Kunj.
Please call 9958815412 for appointments.

Dr. Richika Sahay Shukla is an IVF Consultant and Endoscopic Surgeon . She has experience of 10 yrs in Obstetrics & Gynecology and has over 6 yrs. Experience in Infertility and IVF. Dr. Richika has been a bright student throughout and she has received various awards during her academic career . She was a Gold Medallist during her Medical School and has cleared the prestigious Diplomate of National Board (DNB) in obstetrics and gynecology . She has worked and honed up her skills with some of the pioneer institutes of India such as AIIMS and Sir Ganga Ram Hospital.
She has also done her Fellowship in Assisted reproductive technology ART(IVF-ET/ICSI) and has done her advanced and basic training in Gynecological endoscopy from ETHICON and KARL STORZ. She has also been trained in Ultrasonography and Doppler studies. She is a member of FOGSI and AOGD and has attended various seminars and workshops and has presented several papers in various national conferences and conducted CMEs. She has expertise in doing In- vitro fertilization(IVF) /ICSI by various protocols and in difficult cases like elderly patient, postmenopausal , poor ovarian responders and has also done Surrogacy and Donor eggs conception. She has also made several patients conceive by doing fertility enhancing surgeries by Laparoscopy and Hysteroscopy .
Dr. Richika has been a very dedicated doctor and she has a very honest and committed approach in helping her patients attain conception.

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