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TREATMENT

1. Pregnancy Treatment
2. Pregnancy Tests
3. Female Infertility Treatment
4. Male Infertility Treatment
5. Counselling For Infertile Couples
6. IUI( Intra Uterine Insemination)
7. IVF(Test Tube Baby)
8. ICSI
9. Fertility Enhancing Surgeries
10. Sperm Banking
11. Egg Donation
12. FREEZING, SPERM,EMBRYO
13. TESA,MESA, PESA
14. Surrogacy
15. Laparoscopy
16. Hysteroscopy
17. Endometrial biopsy
18. Hydrotubation
19. Ultrasound scan
20. Follicular study
21. Assisted Hatching (AH)
22. Blastocyst Transfer
23. Low Sperm Count Treatment
24. Semen Analysis
25. Disposables

Fertility is complex and sensitive issue. The inability to conceive comes as a surprise to most men and women, all of whom assume that pregnancy will immediately follow marriage or after a contraceptive method is discontinued. However, that is not the case with approximately 10% to 15% of couples. The thought of childlessness is very disheartening and couples that have difficulty to conceive may experience frustration, jealousy, guilt and anger. They need assistance We at KFC believe that every couple has a right to parenthood. We will do everything in our capacity to make the dream of parenthood come true.

Fertility is complex and sensitive issue, we are better qualified to assist and guide you through various treatments. We provide you with some basic concepts of fertility for your understanding if it turns out that you have a fertility issue, you have no reason to feel depressed or concerned, as we KFC are more than happy to assist you overcome the problem to achieve your dream of parenthood through latest technology in assisted conception. The science and art of assisted conception technology has rapidly evolved in recent years. The clinicians and embryologists at the forefront of these developments will widen the scope of the treatment services to many people who were not successful in their quest to parenthood.

OI is method of treatment used for women who either don't ovulate (release an egg) or don't ovulate regularly. Fertility drugs (tablets or injections) are used to help women to ovulate and so that they have the chance to conceive naturally. The most common groupings include drugs, which work on the brain, drugs which stimulate the pituitary gland and those which act directly on the ovaries themselves. The woman's natural cycle and follicular tracking (ultrasound monitoring) are used to help assess the day of ovulation and couples are then advised the best time to have intercourse. The medications can result in up to 60% of ovulation.

What is intrauterine insemination (IUI) and how does it work?
Intrauterine insemination (IUI) is a laboratory procedure where fast moving sperms are separated from more sluggish or non-moving sperms. The fast moving sperms are then placed into the woman's womb at the time of ovulation (when egg is released) .

What are the indications of IUI?
Unexplained infertility
Ovulation problems
Male partner experiences impotence or premature ejaculation

What are the pre-requisites for IUI?
At least one patent fallopian tube assessed by laparoscopy / HSG / Hysterosonogram.
No significant problem with the sperms (numbers or quality or shapes).
Normal uterine cavity evaluated by hysteroscopy / saline sonography / HSG

What are IUI options? IUI with or without fertility drugs / injections (clomiphene / gonadotrophins) – as IUI can be given with or without fertility drugs to boost egg production.

How does IUI work?
For Women:
Step 1. Women not using fertility drugs IUI is done based on their ovulation. It can be done follicular tracking vaginal ultrasound or ovulation predictor kits usually between day 12 and day 16 of the monthly cycle
OR
Women using fertility drugs to stimulate ovulation, developments of eggs are monitored by vaginal ultrasound scans. As soon as an egg is mature, trigger (hormone) injection given to release the egg.
Step 2. The sperms are inserted 36 to 40 hours later, by the doctor through the vaginal speculum (a special instrument that keeps your vaginal walls apart). A small catheter (a soft, flexible tube) is then threaded into the womb via your cervix. The best quality sperm are selected and inserted through the catheter The whole process takes just a few minutes and is usually a painless procedure but some women may experience a temporary, menstrual-like cramp.

For Men
Step 1. Men will be asked to produce a sperm sample on the day the treatment takes place by masturbation.
Step 2. The sperms are washed to remove the fluid surrounding them and the rapidly moving sperm separated out
Step 3. The rapidly moving sperm are placed in a small catheter (tube) to be inserted into the womb.

What are the chances of success from intrauterine insemination (IUI)?
It is difficult to assess success rates for intrauterine insemination (IUI) because success depends upon the cause of infertility and whether fertility drugs are used to stimulate egg production It is around 15% for women aged under 35.
What are the risks of IUI?
Intrauterine insemination (IUI) itself is normally quite straightforward and safe. The risks are associated with the fertility drugs that are used with this treatment which are allergic reactions etc., Multiple pregnancies and Hyperstimulation in stimulated cycles. The use of ultrasound scanning before ovulation means that if there are more than two mature egg follicles present, the cycle can be abandoned

IVF

STEPS OF IVF
IVF techniques can differ from clinic to clinic, often depending on your individual circumstances.
A typical IVF treatment may involve:
For women:
Step 1. Suppressing the natural monthly hormone cycle.
As a first step of the IVF process you may be given a drug to suppress your natural cycle. Treatment is given either as a daily injection (which is normally self-administered unless you are not able to do this yourself. This continues for about two weeks.
Step 2. Boosting the egg supply
After the natural cycle is suppressed you are given a fertility hormone called FSH (or Follicle Stimulating Hormone). This is usually taken as a daily injection for around 12 -14 days This hormone will increase the number of eggs you produce - meaning that more eggs can be retrieved and fertilised. With more fertilised eggs, the clinic has a greater choice of embryos to use in the treatment.
Step 3. Checking on progress
Throughout the drug treatment, the clinic will monitor the progress. This is done by vaginal ultrasound scans and, possibly, blood tests and trigger (hormone) injection will be given for final maturation of eggs (usually more than 3 follicles of greater than 18mm in size).
Step 4. Collecting the eggs
After 34-38 hours of trigger injection, the eggs are usually collected by ultrasound guidance under sedation or aneathesia. This involves a needle being inserted into the scanning probe and into each ovary,The eggs are, in turn, collected through the needle Cramping and a small amount of vaginal bleeding can occur after the procedure.

For Men:
Step 5. Fertilising the eggs
Collected eggs are mixed with husband's sperm and cultured in the laboratory for 16–20 hours. They are then checked to see for fertilization. Those that have been fertilised (now called embryos) are grown in the laboratory incubator for another one - two days before being checked again. The best one or two embryos will then be chosen for transfer. After egg collection, medication is given to help prepare the lining of the womb for embryo transfer. This is given as pessaries, injection or gel.
Step 6. Embryo transfer
One or two or three embryos can be transferred. The number of embryos is restricted because of the risks associated with multiple births. Remaining embryos may be frozen for future IVF attempts, if they are suitable
Step 7. Other treatments
Some clinics may also offer blastocyst transfer, where the fertilised eggs are left to mature for five to six days and then transferred

In approximately 30-50 percent of infertile couples, the husband is either the sole or a contributing cause of infertility. Therefore, a semen analysis is mandatory. The man is usually asked to abstain from ejaculating for at least 48-72 hrs although that is not mandatory in all cases. He will then produce a semen sample by masturbating in to a clean labeled plastic specimen pot provided in a private room at our center or at home. Sometimes two semen analyses (2-3 months apart) are recommended, since sperm quality can vary over time.
Abnormal / Insufficient Sperm count / quality
The most commonly encountered problems in men involve abnormal or insufficient sperm count. Problems can be either not enough sperm is being produced, or the sperm is of poor quality. The quality is usually determined by motility and shape. A normal sample will show 20 million sperm per millilitre at least half of which will be active. Depending upon the count / shape / motility different terminologies are used like oligospermia (low count), asthenospermia (poor motility), teratospermia (abnormal shapes). Further, various specialized sperm functional tests like sperm Hypo-osmotic swelling (HOS) test, DNA fragmentation Index (DFI), Reactive oxygen species (ROS) assessment, Nuclear chromatin decondensation test (NCD), Acrosome Intactness Index (AI), can be performed to predict the capacity of sperm to fertilize the oocyte (egg) but unfortunately there is not which can be done to treat the abnormalities in sperm. Some fertility drugs and antioxidants might improve count and volume. Majority of male infertility problems requires advanced assisted reproductive technique called Intra-Cytoplasmic Sperm Injection (ICSI).
Absent sperm (Azoospermia)
The absence of sperm in the semen analysis sample is termed as azoospermia. It can be due to blocked or absent tubes (vas deferens) or damaged testicles. The vas deferens does sperm transport function (and also storage) from the testicles (the site of sperm production) to the ejaculate Hence, related investigations for the above conditions like genetic screening cystic fibrosis, chest X ray for bronchiectasis are done If all the investigations are normal then a simple surgical procedure called surgical sperm retrieval (SSR) procedures like percutaneous sperm retrieval (PESA) / testicular sperm aspiration (TESA) / testicular biopsies can be performed to retrieve the sperm from the site of blockade or from the site of production If absence of sperms are due to the defect in the spermatogenesis (production of the sperm in the testes), then chromosomal analysis especially Y chromosome and its associated genes responsible for spermatogenesis are done to evaluate the cause and also it will predict the possibility of sperm retrieval by SSR. Usually, this is followed in severe oligoasthenoteratozoospermia (< 3 million count with low motility and severe abnormal forms).
Drugs/Medications/Life style
Smoking, Alcohol, recreational drugs (Cocaine and Marijuana), environmental pollutants, sedentary life style have negative effect on the semen parameters. Certain medications like sulfasalazine used to treat Rheumatoid Arthritis and Crohn's Disease can decrease your sperm count, however the effects are only temporary and you should return to normal after your course of treatment. Long-term use and abuse of Anabolic Steroids will reduce the number of sperm you produce and affect their motility. The cancer treatment sometimes can severely reduce your production of sperm, however advances in sperm freezing can take the precaution of freezing sperm in advance to cancer treatment for future fertility.

Fertility enhancing surgical procedures such as tubal surgery, treatment of endometriosis, ovarian cysts, removal of fibroids (open / laparoscopic / hysteroscopic) and correction of abnormalities of the womb (uterine anomalies) are offered by consultants specifically trained in reproductive surgery. Most procedures are performed by minimal access surgeries (laparoscopic / hysteroscopic surgery), which minimizes patient recovery times. The surgical management of patients by the same consultants managing fertility treatments allow for individualized treatment and a seamless transition from surgery to fertility treatment.
Diagnostic Hysteroscopy: Hysteroscopy is a minor surgical procedure that involves placing a lighted telescopic instrument (hysteroscope) through the neck of the womb (uterine cervix) and visualizing any abnormalities within the wall of the uterine cavity.
Operative Laparoscopy: The below mentioned procedures performed through laparoscope is called operative laparoscopy. This minimally invasive surgery requires special training and equipment. Gynecologic surgeons must be specially trained to perform laparoscopic myomectomies / ovarian cystectomies / tubal surgeries / adhesiolysis / treatment to endometriosis. The objective of these procedures is to treat the causes of the infertility to enhance the fertility potential. Risks may include bleeding, injury to the intestines or other pelvic tissues and very small risk of premature ovarian failure, hysterectomy and rupture of the uterus in future pregnancy. Scar tissue formation after surgery is usually less than with open surgery and recovery time is much quicker as the abdominal incisions are minimal.
Chromotubation (Dye Test for tubal patency): It is a procedure usually done during an infertility work-up. During laparoscopy, a colored dye will be introduced into the uterine cavity being injected through the cervical canal during the procedure and then observed as it comes out of the ends of the tubes into the peritoneal (abdominal) cavity to check tubal patency.
Tubal Surgery for damaged fallopian tube(s):
Adhesiolysis (freeing the tubes): If the tubes and ovaries are covered in fine adhesions from previous pelvic inflammation, eggs in the ovaries have no access to the open end of the fallopian tubes and a pregnancy is not possible. The laparoscopic adhesiolysis procedure performed to surgically remove all adhesions (salpingo-oophorolysis).
Tuboplasty (Unblocking the fallopian tubes): The blocked outer end of the tube is opened at laparoscopy. These procedures are called Salpingostomy or Neosalpinostomy (creation of new opening in the tube).
Salpingectomy (removal of tube(s) if badly damaged): Collection of fluid in the fallopian tube (hydrosalpinx) damages the tube; this will put the women at risk of ectopic pregnancy and also decreases the IVF success rates. This is due to the back flow of fluid from hydrosalpinx may be toxic to the embryo's transferred and it will prevent from implantation. Hence, it will be better to remove the fallopian tube to optimize IVF success rate and prevent ectopic pregnancies.

Ovarian cystectomy & other ovarian procedures:
Ovarian drilling for treatment of PCOS: PCOS can be treated with drugs or surgery. The advantage of having surgery is that it does not increase the risk of multiple births. In this procedure (ovarian drilling), a heated needle (electro diathermy) is used to destroy some of the extra follicles (the sacs in which eggs develop) which are producing an excess of male hormones.
Surgical Treatment to endometriosis: Laparoscopy is the most common (gold standard) procedure used to diagnose and to remove mild to moderate endometriosis. If at laparoscopy deposits of endometriosis in the ovaries and pelvic ligaments are found, these may be destroyed at the time with electro diathermy. If the endometriosis is more extensive, further surgery is offered where the endometriotic tissue is removed by Cautery / excision of endometriosis
Endometriotic ovarian cyst(s) removal or aspiration: A common complication of endometriosis is the development of a cyst on an ovary. This blood-filled growth is called an ovarian endometrioma or an endometriotic or chocolate cyst.
Other benign ovarian cyst(s) removal: Ovarian cysts are fluid-filled sacs in the ovaries. They are very common in women, especially during the childbearing years. Ovarian cysts usually cause no symptoms. Most ovarian cysts will disappear without any intervention. However, they can persist, increase in size and can create a dull ache or a sharp pain if one twists or ruptures. Laparoscopic treatment includes draining (aspiration) , cutting out part of it, or removing it completely (cystectomy). Mobilization of ovaries & fallopian tubes from bowel and pelvic adhesions Myomectomy (Surgical removal of fibroids through laparoscopy)

OPERATIVE HYSTEROSCOPY:
The operative procedures performed through hysteroscope for removing the any uterine abnormality or pathology (fibroids / polyps / septum / cornual tubal blocks/ division of intrauterine adhesions etc.) is called operative hysteroscopy. This is the most situated approach to remove the above-mentioned uterine abnormalities. Electrosurgical loops / mechanical scissors can be used through operative hysteroscope to remove or treat the abnormality within the uterus.
Gynecologic surgeons must have specialized training to perform this type of surgery. Risks of the procedure again are minimal but may include puncturing the uterine wall, bleeding and fluid overload (special fluids are used to fill the uterine cavity during the procedure for better visualization of abnormality and this fluid can be absorbed rapidly into the bloodstream). Following resection, there is some risk of intrauterine scarring. Recovery is rapid and there are no incisions.
OTHER PROCEDURES:
Myomectomy (open): Myomectomy is surgery to remove the fibroid, preserving as much of the normal uterine muscle as possible. If the fibroids are mostly within the wall of the uterus, the surgery is usually done by laparotomy, that is, performing an open abdominal incision and cutting into the uterus from the external surface. Most of the gynecologists can perform this surgical procedure. Risks to the procedure are minimal but may include bleeding and damage to the normal uterine muscle. Many patients will have pelvic scar tissue forming as a result of the open abdominal incision and the uterine incisions. Most patients that have a myomectomy will need to have a Cesarean section with any subsequent pregnancy.
Tubal recanalization (Sterilization reversal): Before considering a reversal of sterilization, it would make sense to ensure that partner's semen analysis shows a normal sperm count. There would be little point in undergoing major surgery to subsequently find that partner's sperm count is zero.
Sterilization can be reversed where the procedure was achieved by: cutting and then tying the fallopian tubes by blocking the tubes by placing a small plastic clip or ring across them.
The reversal will depend upon the site of the sterilization on each tube, and, in the case of cutting and tying the tubes, how much healthy tube remains.
If the sterilisation has been performed using electro diathermy, usually the entire tube will have been destroyed and reversal is not possible. If the sterilisation site is close to the junction of the tube to the uterus, and not much tube has been removed or destroyed, the successful delivery rate after reversal of sterilisation should be above 70%. Microsurgical techniques are normally used to rejoin two sections of undamaged tube, enabling it to function normally again. The risk of this procedure is tubal pregnancy (ectopic). In present era, IVF is an better alternative to the reversal of sterilization

What is embryo freezing and storage?
During in vitro fertilization (IVF) or intra-cytoplasmic sperm injection (ICSI) treatment, fertility drugs are used to stimulate the ovaries to produce more eggs than usual. These are then fertilized with your partner's, sperm to create embryos. Because there is normally a number of unused embryos, some people choose to freeze the good quality unused embryos for use in later treatment cycles or for donation.
When is embryo freezing (cryopreservation / storage) considered?

Freezing (cryopreservation / storage) unused embryos for the following reasons:
It gives the option of using the embryos in future IVF or ICSI cycles, without having to go through the risks, expense and inconvenience of using fertility drugs and undergoing egg collection again.

If treatment needs to be cancelled after egg collection for any reason (e.g.,bad reaction to fertility drugs, ovarian hyperstimulation, hydrosalpinx, fluid in the endometrial cavity), embryo's can be frozen and used for future use.