IUI: INTRA-UTERINE INSEMINATION

What is IUI? The closest thing to Natural Conception. Good Quality sperm is put directly into the uterus by a doctor.

When do you do IUI? It is a first step procedure when natural conception is not occurring even though everything is favorable for it – that is, Ovulation, Good Tubal Patency, and Normal Semen Parameters

What is the IUI Procedure?

  1. Super-Ovulation: In a natural menstrual cycle, only one egg is created. The right and left ovary will alternate every month to create one egg. Super-Ovulation will create more than one good quality egg for a better chance of getting it fertilized. In other words you have a better chance of getting pregnant.
  2. Sperm will be collected and specially washed for insemination. Good quality sperms are selected, and a good number of them are collected for injection.
  3. Injection of sperm into the uterus is called (Insemination). It is quick and painless. The sperm is injected through the cervix using a very thin flexible catheter.
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IVF: IN-VITRO FERTILIZATION

What is IVF? Fertilization outside of the body. Doctors combine good quality sperm and good quality eggs in an IVF Lab. IVF is a basic form of Assisted Reproductive Technology (ART) Procedure.

Why do you do IVF? When fertilization doesn’t happen naturally or through IUI because of certain defects, IVF is suggested.

What is the IVF Procedure?

  1. Preparation for IVF:
    • Correct BMI of woman
    • Do a Hormone Assay for the woman
    • Based on BMI and hormone assay, an Ovarian Stimulation Protocol is custom made for the woman in order to induce ovulation
    • Ovulation Induction drugs/injections are given to get more number good quality eggs.
  1. Controlled Ovarian Stimulation: The ovary is stimulated by a proper, tailor-made Ovarian Stimulation Protocol. The aim is to get the optimal number of good quality eggs.
  2. Oocyte is retrieved from the female by a procedure called Ovum-Pick-Up which is done under short General Anesthesia (GA).
  3. Good quality sperms are selected, and a good number of them are collected.
  4. The sperms and eggs are immediately given to the IVF Lab. In the lab the eggs and sperms will be put in a petri dish, in a media similar to the female fallopian tubal fluid, and the sperm will fertilize the egg by itself.
  5. The fertilized egg will become an embryo. After 3-5 days, the live embryo will be transferred directly into the uterus of the woman.

*IVF Lab: The IVF Lab is a quality control bio-laboratory where live microorganisms like the oocyte (Egg), Spermatozoa (sperm), and embryos (fertilized egg) are handled. It is a very meticulous and delicate task because everything must be live until the end of the procedure, their quality must be assured, and their viability must be protected.

ICSI: INTRACYTOPLASMIC SPERM INJECTION

What is ICSI? It is a superior form of IVF where the sperm is injected into the egg by a micromanipulator syringe. Fertilization is outside the body using specifically selected sperm and good quality eggs. ICSI is a type of Assisted Reproductive Technology (ART) Procedure specifically meant for poor sperm quality.

Why do you do ICSI? When sperm quality is not good, the doctor will select the best quality sperm using a micromanipulator, and will directly inject it into the egg. (Normally the sperm will enter the egg by itself.)

What is the ICSI Procedure?

  1. Preparation for ICSI:
    • Correct BMI of woman
    • Hormone Assay for the woman
    • Based on BMI and hormone assay, an Ovarian Stimulation Protocol is made specifically for the woman in order to induce ovulation
    • Ovulation Induction drugs/injections are given to get more number good quality eggs.
  1. Controlled Ovarian Stimulation: The ovary is stimulated by a proper, tailor-made Ovarian Stimulation Protocol. The aim is to get the optimal number of good quality eggs.
  2. Oocyte is retrieved from the female by a procedure called Ovum-Pick-Up, which is done under short General Anesthesia (GA).
  3. Sperm is Collected, analyzed, and washed. Good quality sperms are selected for ICSI.
  4. The selected sperm will be injected into the the egg using a micromanipulator syringe and fertilization is done.
  5. The fertilized egg will become an embryo. After 3-5 days, the live embryo will be transferred directly into the uterus of the woman.

IMSI…. Intracytoplasmic injection of morphologically selected sperm
This is for morphologically defective sperm. Under high magnification the semen sample is examined and the best sperm out of them is selected for intracytoplasmic sperm injection. Specifically for Morphologically defective (teratozoospermia)

PESA: Percutaneous Epididymal Sperm Aspiration

What is PESA? It is a technique used to collect sperm directly from the epididymis (a tube that is connected to your testicle that helps store and transport the sperm).

When do you do PESA? For men who don’t have sperm in their semen (azoospermia) or have difficulty in collecting semen, PESA is performed. Commonly used for Obstructive Azoospermia – when something is stopping sperm from coming out.

(True Azoospermia is when there are no sperm being produced. This requires donor sperm)

What is the PESA Procedure?

  1. Local Anesthesia is used to numb the testicle. A thin needle is inserted in the epididymis and the sperm is aspirated (sucked out).
  2. The collected sperm is then given for ICSI.

TESA: Testicular Epididymal Sperm Aspiration

What is TESA? It is a technique used to remove sperm directly from the testes.

When do you do TESA? For men who don’t have sperm in their semen (azoospermia) or have difficulty in collecting semen, TESA is performed. Commonly used for Obstructive Azoospermia – when something is stopping sperm from coming out.

(True Azoospermia is when there are no sperm being produced. This requires donor sperm)

What is the TESA Procedure?

  1. Local Anesthesia is given to numb the testicle. A thin needle is inserted in the testicle and the sperm is aspirated (sucked out).
  2. The collected sperm is then given for ICSI.

*What is the difference between TESA and PESA?

If there is no sperm in the Epididymis during the PESA procedure, the needle is inserted into the testicle to collect the sperm. This is known as TESA.

Laparoscopy

What is Laparoscopy? It is a routine procedure that uses thin lighted cables with high resolution cameras to look at organs in the abdomen or female pelvis. It is a minimally invasive, Day-Care procedure.

Why is Laparoscopy done? It is used for investigation and for treatment. Diagnostic Laproscopy is done to see if there are any tubal blocks, adhesions, or to see if the uterus is appearing normal. If something is abnormal, it can be treated then and there by surgical laparoscopy.

  1. Laproscopy Surgeries are done for
    • Laproscopy Ovarian Drilling (LOD) for PCOD
    • Simple Ovarian Cystectomy
    • Chocolate Cystectomy: removing chocolate cyst
    • Adhesolysis : removing adhesions
    • Myomectomy : removing the middle layer of uterus (myoma)

How is Laparoscopy Performed?

  1. General Anesthesia is given to numb the area
  2. Tiny incisions or cuts are created to insert the tubes with the camera and light.
  3. Once the procedure is done, either stiches or surgical tape will close the incisions.

Hysteroscopy

What is Hysteroscopy? It is a procedure that allows doctor to see the uterine cavity and cervical canal using a thin, light cable and high resolution camera. The procedure is done through the vagina.

Why is Hysteroscopy done? It is used for Investigation and for treatment. Diagnostic Hysteroscopy is used to know whether the uterine cavity and cervical canal are appearing normal.

Surgical Hysteroscopy are useful in correction of the uterine cavity, where the embryo is supposed to implant.

  • Polypectomy : removal of polyp from uterine cavity
  • Submucus Myomectomy: removal of myoma / fibroid
  • Septal Resection: removal of septum in the uterine cavity. (septum may be partial or total)
  • Correction of Congenital Uterine Malformations.

How is Hysteroscopy Performed?

  1. Depending on whether it is necessary or not, anesthetic is given to numb the area
  2. A hysteroscope (cable-like camera) is inserted into the vagina, through the cervix and into the uterus.
  3. The necessary images are gathered. If biopsy is required, then the necessary tissue is taken.

Testicular Biopsy

What is a Testicular Biopsy? When a sample of tissue is taken from your testes for analysis.

Why is Testicular Biopsy done? It is done to help diagnose the cause of no sperm (azoospermia). Whether the Azoospermia is true or obstructive.

True

Obstructive.

What is the Testicular Biopsy Procedure?

  1. Local Anesthetic is given to numb the area
  2. A small cut is made through the skin of the scrotum.
  3. A tiny piece of testicular tissue is removed. The removed tissue is examined for sperm. If sperm is present, it is obstructive azoospermia, if there is no sperm it is true azoospermia.
  4. A single stich is used to close the cut in the testicle, and another one is used to close the cut. The procedure is very short.