Fertility

As a sub specialist in this field, Dr Deo deals extensively with matters of fertility and the treatment thereof. Infertility is a disease of the male or female reproductive system defined by the failure to achieve a pregnancy after 12 months or more of regular unprotected sexual intercourse. Primary infertility is the inability to have any pregnancy, while secondary infertility is the inability to have a pregnancy after previous successful conception. You can expect the following steps to be taken when you consult Dr Deo:

Female Patient

The first consultation is a very critical and highly involved one as information is taken and investigations are done to determine the barriers which may  lead to difficulty in falling pregnant. Dr Deo and patient discuss how long they have been trying to conceive, the pattern of menstruation, previous pregnancies or attempts thereof, medical illnesses, medication, occupation and exposure, history of previous surgeries, and any previous intervention.

  • This involves the woman being checked by the doctor for any obvious problems that can be detected during the examination.
  • The exam includes checking the breast, thyroid, abdomen, and vagina

  • This is when an ultrasound (sonar) is done to examine the womb for any abnormalities. We also assess the ovaries’  follicular (egg) count.
  • The transvaginal (intra-vaginal) sonar is usually performed for better accuracy.
  • 3D sonar may be done for better visualisation.

  • Blood is taken to assess the hormone status and to detect irregularities that need correcting.
  • A specific test to check the reserves of the ovary called antimullerian hormone (AMH) is also done to indicate the probability of pregnancy.
  • Other hormonal work may be done (TSH, Prolactin)

Male Patient

  • Check for any medical conditions, social habits, erectile dysfunction and ejaculatory problems.

  • Physical exam to rule out problems of genitalia, like absence of the the vas deference, varicosities and any other abnormalities

  • Blood is taken to assess the hormone status, follicle stimulating hormone and testosterone as these are some of the factors that play a role in sperm development.

  • Semen analysis is done to check the quality and quantity of the sperm.
  • The semen is produced through masturbation and collected by the man into a specimen container provided.
  • It is then taken by our embryologist to be assessed under a microscope.
  • This process helps to identify possible  problems with production during the treatment cycle

Fertility Treatment

Intrauterine Insemination

Overview

Intrauterine insemination (IUI) is a treatment for fertility, performed in couples unable to conceive despite trying for at least a year. IUI involves placing sperm in a women’s uterus to facilitate fertilisation (fusion of egg and sperm). IUI gives the sperm a head start in entering the womb, but will still have to reach and fertilise the egg on its own.

IUI is a fertility treatment indicated for couples with conditions such as unexplained infertility, abnormal sperm count or mobility, cervical problems and ejaculation dysfunction.

Semen is collected from your partner at the clinic. The sperm sample is washed to select only the best sperm that look normal and highly active, from the low-quality sperm. There are higher chances of conceiving if a highly-concentrated sample of healthy sperm is used. You will be monitored for signs of ovulation (release of an egg). Physicians may suggest you take medication to stimulate the ovaries and improve egg production and chances of pregnancy.

The procedure begins with the injection of a hormone to release the eggs. Your doctor then injects the sample of semen directly into the uterus through a catheter (long tube). After the procedure, you will be asked to remain lying on your back for a few minutes. This entire procedure may cause minimal discomfort and is completed in a short time.

IUI is relatively safe and is not associated with serious complications; however, certain risks may occur such vaginal bleeding due to the placement of the catheter inside the uterus. IUI by itself may not be associated with a risk of multiple pregnancies. However, when coupled with ovulation inducing medication, you are at a higher risk of multiple pregnancies.

Assisted Reproductive Techniques

ART refers to lab-based fertility treatments that use eggs and sperm outside of the human body to start conception. The techniques we offer are In Vitro Fertilisation (IVF) and Intracytoplasmic Sperm Injection (ICSI).

  1. In Vitro Fertilisation

IVF is the process of fertilisation by manually combining an egg and sperm in a laboratory dish, and then transferring the embryo to the uterus. The process begins on the second day of a woman’s menstrual cycle and takes approximately 30 days in total, as seen with the overview below.

  • Please note that ONLY embryos that are good enough to survive the freezing and thawing process, will be frozen.
  • Embryos might be frozen on day 3 or day 5 and the individual decisions are made on a patient-to-patient case
  • It means that we freeze embryos on day 3 and day 5 and the thaw them and then transfer on day 5
  • Please remember that means that you can have 4 embryos on day 5, 1 or 2 are transferred and the remaining embryos may or may not necessarily be frozen if the embryologist believes that the quality of the embryos will not survive freezing
  • In certain cases it may be possible to keep embryos till day 6 or in VERY RARE cases to day 7 prior to freezing
  • 99% of embryos will be frozen on day 5 or day 6
  • We strive to give our patients an optimum chance of getting pregnant with the use of frozen embryos and not just freeze embryos because it is possible to do.

Aspiration is the process of retrieving a woman’s eggs from mature follicles in her ovaries. The woman is under anaesthesia while the procedure takes place. Hormone measurements as well as the size of follicles determine the readiness for the egg retrieval procedure. The follicles are measured by ultrasound and considered to be mature when they reach  15-20 mm in diameter.

The process is as follows:

  • With the guidance of an ultrasound, a needle is passed through the top of the vagina to get to the ovary and follicles.
  • The fluid in the follicles is aspirated through the needle and the eggs detach from the follicle wall
  • The eggs are then sucked out of the ovary
  • The procedure is usually done in a matter of minutes.
  • The fluid with the eggs is sent to the IVF lab where the eggs are identified, rinsed, and stored in specialised incubators.

IVF Process Overview

2. Intracytoplasmic Sperm Injection

Intracytoplasmic sperm injection (ICSI) is a type of in vitro fertilisation that involves injecting live sperm into a person’s eggs in a laboratory. The aim of the  procedure is to create an embryo (fertilised egg) which is transferred into the uterus. The expected result of an embryo transfer is pregnancy.

ICSI is a type of IVF. With traditional IVF, thousands of sperm are placed next to an egg on a dish. Whether one of the sperm penetrates the egg to fertilise it is left up to chance. If none of the sperm fertilise the egg, conception (also called fertilisation) doesn’t occur.

ICSI promotes fertilisation through the direct injection of a single sperm into a single egg. Still, ICSI doesn’t guarantee fertilisation.

In both ICSI and traditional IVF, the fertilised egg (embryo) is implanted into your uterus or womb. Pregnancy occurs if the embryo attaches to the lining of your uterus.

ICSI is most helpful for people experiencing male infertility. Your healthcare provider may recommend ICSI if a person has:

  • Anejaculation (inability to ejaculate).
  • Blockage in their male reproductive system.
  • Low sperm count.
  • Poor sperm quality.
  • Retrograde ejaculation (semen flows backward into their bladder).

You may also need ICSI if:

  • Traditional IVF hasn’t led to the creation of embryos.
  • The person supplying the eggs is older than 35.
  • You’re using previously frozen eggs or sperm (cryopreservation) to try to conceive.

During ICSI, your healthcare provider:

  1. Uses a pipette (small glass tube with a suction bulb) to hold the mature egg in place on a lab dish.
  2. Immobilizes and picks up one sperm using a thin needle.
  3. Inserts the needle into the egg to reach the cytoplasm.
  4. Injects the sperm into the cytoplasm.
  5. Withdraws the needle from the egg.

After ICSI, your healthcare provider monitors the fertilised egg in the laboratory for signs of successful fertilisation. Within five to six days, a healthy fertilised egg should divide into cells, forming a blastocyst. Your healthcare provider will evaluate the blastocyst’s size and cell mass to determine when it’s most likely to lead to a pregnancy.

An embryo transfer occurs on either on the fifth or sixth day following the egg retrieval procedure or commonly the transfer is delayed for a month or even years. Your doctor will discuss the timing of your embryo transfer with you. Using ultrasound technology, your healthcare provider will insert a catheter (long, thin tube) into your vagina and inject the embryo into your uterus. For pregnancy to happen, the embryo needs to implant (attach) to your uterus. Your healthcare provider may recommend waiting at least two weeks before taking a pregnancy test.

Compared to traditional IVF, ICIS appears to be more successful in helping those experiencing male infertility become parents. Some centres do ICSI for all people, regardless of infertility diagnosis.

Additional Fertility Services

Surrogacy

Surrogacy is a legal arrangement  whereby a woman agrees to carry a pregnancy on behalf of another person or people. The person or people then become the child’s parent or parents once the child is born. This service suggested to people for whom pregnancy is medically impossible, such as a single man or male couple, or pregnancy poses a high health risk.

The Legal Process

  •  The Donor Recipients (people who will be the child’s parents) are to consult with a psychologist jointly and/or apart. The surrogate is also required to see a psychologist together with her spouse if she is married.
  • A consultation with Dr Deo is required for her to provide a letter stating that the donor recipient is incapable of conceiving.
  • The surrogate also need to consult with the Doctor to determine if they are fit for pregnancy.
  • Legal documentation needs to be submitted to a judge with the assistance of an advocate.
  • It is advisable to seek legal counsel as this process can be lengthy and involved.
  • The costs associated with surrogacy are covered by the recipients
  • Once the legal process is complete and we are furnished with a High Court order, our process begins.

The Gynaecological Process

  • At this point Dr Deo would have had initial consultations with both the donor recipient/s and surrogate.
  • The donor undergoes IVF to stimulate as many eggs as possible
  • The resulting embryo is transferred into the surrogate with the intention of pregnancy.
  • Remaining embryos may be frozen if they are of good quality.

Egg Donation

Egg donors donate their eggs, in instances where the intended mother cannot produce good quality eggs for fertilisation. After the donor has undergone egg retrieval, the donor eggs are fertilised through IVF with either the partner’s sperm or donor sperm. Through fertilisation an embryo forms and is placed into the intended mother’s womb.

Good quality eggs are crucial for fertilisation in the pursuit of pregnancy. There are various factors which could lead to a decreased amount and/or quality of eggs. These could include age, early menopause, treatment of medical conditions such chemotherapy which could damage eggs, and many more.

The Process of Egg Donation

  1. Application and Consent
  1. Screening
  • Testing for infectious diseases such as HIV
  • Blood group
  • Fertility test (AMH) to check ovarian reserve
  • Physical Examination
  • Psychological Examination
  1. Stimulation

The egg donation process starts on day one of the menstruation cycle. If you are on contraception you need to inform the donor coordinator so it can be taken into account when planning your cycle. Stimulation through hormonal injections, start from day 3 or 4 of the menstrual cycle and continues for about 10 days, Dr Deo will give you careful guidance on how to administer these injections. The injections help the ova to develop into follicles.

Throughout the stimulation process you will be required to come in for 2 -3 trans vaginal scans to measure follicle growth.

  1. Egg Collection / Aspiration