FAQs

To ensure the best chance of success with IUI, several pre-workup tests are essential. These tests assess various factors in both partners:

For the woman:

• Overall Health: General health assessments are conducted to ensure she is healthy enough for pregnancy.
• Hormone Levels: Optimal hormone levels are crucial for ovulation and a healthy pregnancy. These are checked through blood tests.
• Fallopian Tube Function: At least one fallopian tube must be open and functioning correctly to allow the egg and sperm to meet. A hysterosalpingogram (HSG) is a common test to evaluate the fallopian tubes.
• Uterine Health: The uterus must be healthy and capable of supporting a pregnancy. An ultrasound may be used to assess the uterus.
• Ovulation Monitoring: Egg development is closely monitored through ultrasounds and sometimes blood tests to pinpoint the optimal time for sperm injection.

For the man:

• Sperm Analysis: This evaluates sperm count, motility (movement), and morphology (shape). These factors are crucial for successful fertilization.
• Semen Analysis: This assesses the overall quality of the semen, including volume and other factors.
• Sperm Source: The results of the sperm analysis help determine whether the partner's sperm or donor sperm will be used.

ICSI (Intracytoplasmic Sperm Injection) is a specialized type of IVF (In Vitro Fertilization) that helps couples struggling with infertility, particularly those where the male partner has significant issues with sperm. Think of regular IVF as letting the sperm and egg meet in a dish and hoping fertilization happens naturally. ICSI is different. It's like giving the sperm a helping hand. Instead of just letting them swim, a technician uses a tiny needle to pick one single, healthy sperm and inject it directly into the egg. This makes fertilization much more likely, even if the sperm isn't very strong or there aren't many healthy ones. So, ICSI is a way to overcome severe male infertility problems and increase the chances of having a baby.

ICSI, a specialized form of IVF, is primarily used to treat severe male-factor infertility. It involves injecting a single sperm directly into each mature egg.

• IVF (In Vitro Fertilization):

  • Eggs and sperm are mixed together in a lab dish.
  • Sperm have to swim and penetrate the egg on their own.
  • This is similar to how fertilization happens naturally inside the body.

• ICSI (Intracytoplasmic Sperm Injection):

  • A single sperm is injected directly into the egg using a tiny needle.
  • This bypasses the need for the sperm to swim or penetrate the egg on its own.

ICSI is especially helpful when:

• The male partner has a low sperm count or the sperm don't swim well.
• Previous IVF attempts haven't been successful due to fertilization problems.

• Initial Consultation: Couple meets with a fertility specialist to discuss infertility and determine ICSI suitability.
• Ovarian Stimulation (or ICSI Stimulation): Woman undergoes ovarian stimulation with hormones (e.g., FSH) to produce multiple eggs.
• Egg Retrieval: Eggs are retrieved from the ovaries via a minimally invasive procedure, usually under local anesthesia.
• Sperm Collection: Man provides a semen sample, analyzed to select the best quality sperm. (Abstinence from ejaculation for 2-3 days prior is typically recommended.) Egg retrieval and sperm collection usually occur on the same day.
• Sperm Preparation: Sperm is "washed" and the most viable sperm cells are selected for injection.
• Sperm Injection (ICSI): A single, healthy sperm is injected directly into each mature egg using a fine needle.
• Fertilization: Fertilized eggs (embryos) are monitored in the lab for successful fertilization and cell division, developing for several days.
• Embryo Transfer: One or more embryos are transferred to the woman's uterus using a catheter, typically 3-5 days post-fertilization.
• Pregnancy Testing: A pregnancy test is performed about two weeks after the embryo transfer.

• Hysteroscopy is a way for doctors to look inside a woman's uterus. They use a thin tube with a light and camera on the end, kind of like a tiny telescope, and gently insert it through the vagina and into the uterus. This lets them see the lining of the uterus on a screen. It's used to figure out problems like unusual bleeding, find the cause of infertility, or even fix some issues like removing small growths. Think of it as a doctor going on a little "inside tour" of the uterus.

• To investigate and diagnose:

  • Abnormal uterine bleeding: This includes heavy periods, bleeding between periods, or bleeding after menopause. Hysteroscopy can help identify the cause of the bleeding, such as polyps, fibroids, or changes in the uterine lining.  
  • Infertility: If a woman is having trouble getting pregnant, a hysteroscopy can help determine if there are any structural problems in the uterus that might be contributing to infertility, such as scar tissue or a uterine septum.  
  • Recurrent miscarriages: Hysteroscopy can be used to investigate the cause of repeated miscarriages, looking for issues like uterine fibroids or adhesions.

  To treat conditions:

  • Remove polyps or fibroids: These are non-cancerous growths in the uterus that can cause abnormal bleeding or other problems. Hysteroscopy allows for minimally invasive removal of these growths.  
  • Remove adhesions: Adhesions are bands of scar tissue that can form inside the uterus, often after surgery or infection. They can cause pain, abnormal bleeding, or infertility. Hysteroscopy can be used to cut and remove these adhesions.  
  • Remove a displaced IUD: If an intrauterine device (IUD) has become embedded in the uterine wall or has moved out of place, a hysteroscopy can be used to remove it.  
  • Perform an endometrial ablation: This procedure destroys the lining of the uterus to reduce heavy menstrual bleeding.

For a diagnostic hysteroscopy, preparation is minimal. You can eat and drink normally beforehand, no fasting is required. However, it's helpful to bring the following to your appointment:

• Your doctor's referral letter and any prescriptions.
• Your blood test results.
• Any allergy information.
• A summary of your medical and surgical history.
• The date of your last menstrual period.

The hysteroscopy procedure usually takes between 5 and 30 minutes. The exact duration depends on whether it's a diagnostic hysteroscopy (just looking inside) or an operative hysteroscopy (where they're also treating something, like removing a polyp). Operative hysteroscopies tend to take a bit longer.

Hysteroscopy is generally a safe procedure, but like any medical intervention, it does carry some potential risks. It's important to be aware of these so you can discuss them with your doctor.

Blastocyst transfer is a type of IVF where embryos are grown in a lab for 5-6 days until they reach the blastocyst stage, a more developed form. This allows for better selection of the healthiest embryos for transfer, potentially increasing implantation rates. These selected blastocysts are then transferred to the woman's uterus, similar to a traditional embryo transfer.

• Previous IVF/ICSI Failures: Recommended for couples with prior unsuccessful IVF or ICSI attempts despite good egg quality. Blastocyst culture allows for observation of embryo development between days 3 and 6, potentially revealing developmental issues.
• Elective Single Embryo Transfer (eSET): Advantageous for couples pursuing eSET, as Day 5 blastocyst transfer increases conception likelihood compared to Day 3 transfers.
• Preimplantation Genetic Diagnosis (PGD): Used in conjunction with PGD. Blastocyst culture allows for embryo biopsy (removal of cells for genetic analysis) and selection of healthy embryos for transfer.
• Multiple Healthy Day 3 Embryos: Recommended when several healthy embryos are available on day 3. Extended culture allows selection of the most viable embryo(s) for implantation, reducing the number of embryos needed for transfer and thus the risk of multiple pregnancies.

• The blastocyst transfer procedure is very similar to a traditional embryo transfer, but the embryos being transferred are at a more advanced stage of development. Here's a step-by-step breakdown:

  1. Embryo Preparation: In the lab, the embryologist selects the most viable and healthy blastocysts for transfer. These are the embryos that have developed for 5-6 days after fertilization.

  2. Catheter Loading: The chosen blastocysts are carefully loaded into a thin, flexible catheter. This catheter is specifically designed for embryo transfer.

  3. Patient Preparation: The woman lies on an examination table, similar to the position for a pelvic exam or Pap smear. A speculum is inserted into the vagina to gently hold it open, making the cervix visible.

  4. Catheter Insertion: The catheter, containing the blastocysts, is carefully and gently passed through the cervix and into the uterus. The doctor or embryologist performing the procedure will carefully guide the catheter to the optimal location within the uterine cavity.

  5. Blastocyst Release: Once the catheter is in the correct position, the blastocysts are gently released from the catheter into the uterus.

  6. Catheter Removal: The catheter is then carefully and gently removed.

  7. Recovery: After the transfer, the woman will typically rest for a short period at the clinic or fertility center. She'll receive specific instructions for post-transfer care, including any medications to take and activity restrictions.

In a fresh embryo transfer, the entire IVF process, from ovarian stimulation and egg retrieval to fertilization, embryo culture, and transfer, is completed in one cycle. A frozen transfer, on the other hand, uses previously frozen embryos, so only the uterine preparation and transfer steps are needed.

• Embryo Transfer (Day 3):

  • Performed on the third day after fertilization.
  • Embryo is not yet at the stage for natural implantation.
  • Multiple embryos (2-3) may be transferred to increase the chance of at least one implanting.

• Blastocyst Transfer (Day 5-6):

  • Embryo is allowed to develop for two more days, reaching the blastocyst stage.
  • Only the most viable embryos typically reach this stage (natural selection).
  • Implantation occurs soon after transfer.
  • Usually only one blastocyst is transferred due to the higher likelihood of implantation.

• Laser hatching is a technique used in in vitro fertilization (IVF) to help embryos hatch from their outer shell, called the zona pellucida.

• Laser hatching is done to improve the chances of a successful pregnancy in certain IVF cases. Here's why it's used:

  • To help the embryo hatch: The zona pellucida is a protective outer shell around the embryo. Before the embryo can implant in the uterus, it needs to "hatch" or break out of this shell. Sometimes, the zona pellucida can be thicker or tougher, making it difficult for the embryo to hatch on its own. Laser hatching creates a small opening in the zona pellucida, weakening the shell and making it easier for the embryo to hatch.

  • To improve implantation rates: By making it easier for the embryo to hatch, laser hatching can increase the chances of implantation and pregnancy. This is particularly helpful for women who are older, have had previous failed IVF attempts, or have embryos with a thicker zona pellucida.

• Laser hatching offers several potential advantages in the context of in vitro fertilization (IVF):

  • Increased Hatching Rates: The primary advantage is that it assists the embryo in hatching from its outer shell (zona pellucida). This is crucial for implantation, as the embryo needs to break free from this shell to attach to the uterine wall. Laser hatching can be particularly beneficial when the zona pellucida is thicker or harder, which can be the case in older women or with frozen-thawed embryos.

  • Improved Implantation Rates: By facilitating hatching, laser hatching can potentially increase the chances of the embryo implanting successfully in the uterus. This can lead to higher pregnancy rates, especially for women who have had previous failed IVF attempts.

  • Enhanced Embryo Selection: Laser hatching can sometimes help embryologists better assess the quality of the embryo. By observing how the embryo hatches, they might gain additional information about its viability.

  • Greater Success with Frozen Embryos: The freezing and thawing process can sometimes harden the zona pellucida, making hatching more difficult. Laser hatching can be especially helpful in these cases, improving the chances of successful implantation with frozen embryos.

  • Potential Benefit for Older Women: Women over 37 may have eggs with a tougher zona pellucida. Laser hatching can assist these embryos in hatching, potentially increasing their chances of success.

• Laser Hatching has become the preferred method for assisted hatching in IVF due to several key advantages over older techniques:

  • Precision: The laser allows for incredibly precise targeting of the zona pellucida (the embryo's outer shell). This precision minimizes the risk of damage to the embryo's cells, which is a crucial concern with any assisted hatching method.

  • Safety: Because the laser is so precise, it reduces the risk of harming the embryo compared to older techniques like mechanical or chemical hatching. These older methods involved either physically manipulating the shell with tiny instruments or using acidic solutions to weaken it, both of which carry a higher risk of damage.

  • Efficiency: Laser hatching is a quick and efficient procedure. The laser pulses create the necessary opening in the zona pellucida in just a few seconds, minimizing the time the embryo spends outside the incubator.

  • Less Handling: With laser hatching, there's less direct physical manipulation of the embryo compared to other methods. This reduces the risk of damage or stress to the embryo.

  • Controlled Opening: The laser creates a very controlled and precise opening in the zona pellucida, which is thought to be more beneficial for the hatching process than the more random or larger openings created by other methods.

By helping the embryo escape its protective covering, assisted hatching aims to improve implantation and thus pregnancy rates. While not a routine procedure, it can be a valuable option for patients experiencing recurrent IVF failure.

Laparoscopy is a minimally invasive surgical procedure that allows doctors to look inside your abdomen and pelvis without making large cuts. It's also known as keyhole surgery or minimally invasive surgery.

Laparoscopy is done for a variety of reasons, both to diagnose problems and to treat them. Here's a breakdown of the common uses:

Diagnostic Purposes:

• To investigate pelvic or abdominal pain: When the cause of pain isn't clear from other tests, laparoscopy allows doctors to directly see the organs and identify the source of the pain. This could be due to conditions like endometriosis, pelvic inflammatory disease, or appendicitis.
• To evaluate infertility: Laparoscopy can help determine if there are any structural problems in the uterus, fallopian tubes, or ovaries that might be contributing to infertility. This could include blocked fallopian tubes, endometriosis, or uterine fibroids.
• To examine organs for abnormalities: If other tests suggest a problem, such as a growth or cyst, laparoscopy can be used to get a closer look and take a biopsy (tissue sample) if needed.
• To stage cancer: Laparoscopy can be used to determine how far cancer has spread, which helps doctors plan the best course of treatment.

Treatment Purposes:

• To remove cysts or tumors: Laparoscopy can be used to remove ovarian cysts, uterine fibroids, or other abnormal growths.
• To repair or remove organs: It can be used to remove the appendix, gallbladder, or parts of the bowel.
• To treat endometriosis: Laparoscopy allows doctors to remove or destroy endometrial tissue that is growing outside the uterus.
• To unblock fallopian tubes: Laparoscopy can be used to open blocked fallopian tubes, which can improve fertility.
• To perform a tubal ligation: This is a sterilization procedure where the fallopian tubes are cut or blocked to prevent pregnancy.

A laparoscopy is a minimally invasive surgical procedure that allows a surgeon to see inside your abdomen and pelvis using a thin, lighted tube called a laparoscope. Here's a breakdown of the typical procedure:

1. Anesthesia: General anesthesia is usually administered, so you'll be asleep and won't feel any pain during the procedure.

2. Small Incisions: The surgeon makes one or more small incisions in your abdomen. These incisions are typically less than half an inch long. The number and location of the incisions will depend on the specific procedure being performed.

3. Insertion of the Laparoscope: A laparoscope, a thin tube with a light and a camera at the end, is inserted through one of the incisions. The camera transmits images to a monitor, giving the surgeon a magnified view of your internal organs.

4. Inflation of the Abdomen: Gas (usually carbon dioxide) is pumped into your abdomen. This inflates the area, creating more space between the organs and making it easier for the surgeon to see and work.

5. Insertion of Other Instruments (if needed): If the procedure requires it, other small surgical instruments are inserted through the additional incisions. The surgeon manipulates these instruments from outside your body while watching the monitor.

6. Performing the Procedure: Using the images from the laparoscope as a guide, the surgeon performs the necessary procedure. This could include anything from examining organs and taking biopsies to removing cysts, repairing tissue, or performing more complex surgeries.

7. Closure: Once the procedure is complete, the instruments are removed, and the gas is released from the abdomen. The incisions are then closed with stitches, staples, or surgical glue.

8. Recovery: After the surgery, you'll be monitored in a recovery room until you're fully awake. You may experience some pain, bloating, and possibly shoulder pain (from the gas). Most laparoscopic procedures are outpatient, meaning you can go home the same day. Recovery time varies depending on the specific procedure, but it's generally much shorter than with traditional open surgery.

Laparoscopic surgery is generally considered safe, and in many cases, safer than traditional open surgery.

Why it's generally safe:

• Minimally invasive: The small incisions used in laparoscopy mean less trauma to the body compared to traditional surgery. This translates to:
  • Less pain
  • Reduced blood loss
  • Lower risk of infection
  • Smaller scars
  • Faster recovery time
• Improved visualization: The laparoscope provides a magnified view of the internal organs, allowing surgeons to perform procedures with greater precision.

Laparoscopic surgery allows internal intervention without a large abdominal incision. The tiny incisions minimize pain and scarring, while the camera provides enhanced visualization for greater surgical precision.

Post-operative recovery is less painful, requires less medication, and carries a reduced risk of infection. Patients typically experience a faster recovery, shorter hospital stays, and often go home the same day as surgery.