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FEVZI GURCAN BEBITOGLU M.D (specialist in FAMILY MEDICINE and certificated in ASSISTED REPRODUCTIVE TREATMENTS.. EMBRYOLOGY |
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| GENERAL INFORMATION ABOUT INFERTILITY... BACKGROUND Infertility is the FAILURE to become pregnant within one year of regular, unprotected intercourse. The goal of infertility treatment is to have the woman become pregnant, have a normal pregnancy, and deliver a healthy baby. Major factors that affect your chances of conceiving with or without treatment include age, how long you have been trying to conceive, and the cause of infertility. Infertility is devastating to the couple. Treatment depends on the cause, if the cause can be found.They look, feel and act normally and everything may appear to be functioning well. In general, infertility caused by problems in the female reproductive system are more easily treated than infertility caused by problems with the male reproductive system. 80 - 85 % of couple achieve pregnancy if they so desire, within one year of having regular, unprotected intercourse with adequate frequency (5- 6 times per week). Another 10% will achieve the objective by the end of second year. As such, 5 - 10% remain without a child by the end of second year. The factors responsible for fertility are outlined as: F . F. T . I .P FORMATION of healthy spermatozoa and healthy ovum and FERTILISATION of the mature ovum by a healthy sperm. - TRANSITION of the healthy zygote through the fallopian tube into the uterine cavity and its IMPLANTATION. - PLASENTATION by adequate hormonal female internal environment for the healthy growth of embryo. WHAT ARE THE CAUSES of infertility: There may be a problem in the MALE for 30% of cases. It may be a FEMALE related factor 30%, or there may be factors in BOTH partners up to 30% cases.So , what is the reason at 10 % left ? (WE DONT KNOW.......) UNEXPLAINED INFERTILITY (10%) If no cause for a couple's infertility is found after extensive testing, the least invasive and least expensive treatments are tried first. These may include treatment with drug therapy and/or use of intrauterine insemination. FEMALE INFERTILITY The age of the woman's egg supply greatly impacts her chances of conceiving, carrying, and delivering a healthy infant. The most common causes : Related to Ovary: - Anovulation: Failure to release mature egg (ovum) which, may be due to following reasons: -Hormonal imbalance (FSH and LH). -Obesity and weight gain. -Prolonged excessive stress. -High levels of serum Prolactin. -Cyst in the ovary. -due to various medications. - Weight loss due to various reasons, including eating disorders such as anorexia, etc. - Corpus luteum insufficiency: there is inadequate growth and function of the corpus luteum. - Luteinised unruptured follicular syndrome (trapped ovum): the ovum is not released and is trapped inside the follicle, which gets luteinised in this condition. Due to Fallopian tubes: -i. Defective ovum picks up. ii. Impaired tubal motility. iii. Partial or complete obstruction of tubal lumen. -The impaired function of any one above is related to tubal infection or adhesions around the tube following pelvic surgery, infection or endometriosis. Related to Uterus: - Fibroids: These are soft tissue tumors. When they are located close to tubal opening (ostia) or in the cervical region can cause infertilityby blocking the passage. -Large fibroids : particularly located under the lining of the uterine cavity (submucus fibroid) can be responsible for frequent pregnancy loss. - Adhesions: A tough band of healing cells (fibrous tissue) causing obliteration of the cavity of uterus in varied severity can lead to infertility. Infection of uterine cavity, vigorous curettage of the endometrium during incomplete abortion, dilatation and curettage (D and C) or retained products of pregnancy can lead to adhesions.It is advisable to avoid frequent medical termination of pregnancy, D and C, which could lead to formation of adhesions. -Septum: Presence of wall in the uterine cavity can cause recurrent pregnancy loss and infertility. -Congenital malformations: maldevelopment of uterus, unicornuate uterus, and bicornuate uterus. Related to cervix: - Anatomic defects preventing the sperm to ascend into the uterine cavity and thus preventing fertilisation. - Cervical mucus faulty composition or amount of cervical mucus. - Infection - Presence of anti-sperm or sperm immobilizing antibodies in the mucus may be implicated as immunological factors of infertility. Related to vagina: -Congenital narrowing / stenosis of the vagina. -Presence of partial or complete wall in the vagina. -Infections of the vagina. Others: -Advancing age: There is natural decline in fertility as the age advances, more so after the age of 35 years.11% by the age of 34 years.33% by the age of 40years.87% by the age of 45 years.- Psychological: Fear, tension, nervousness, anxiety adds to the problems of infertility. However it is often a vicious cycle: Psychological factors alone are responsible only for a small number of fertility cases. MALE INFERTILITY Problems with sperm are difficult to treat and often require in vitro fertilization (IVF)and intracytoplasmic sperm injection (ICSI). 1- DEFECTIVE formations of sperm: These may be due to: -i. CONGENITAL: Undescended testes, while the hormone secretion remains unaffected, the formation of the sperm is depressed. ii. HYPERTHERMAL Factors: Few diseases like varicoceole or big hydroceole or wearing continuous tight undergarments (likeTIGHT JEANS )or working in hot atmosphere can depress the formation of sperms. iii. INFECTIONS: Like mumps , tuberculosis, etc. 2- OBSTRUCTIONS in the passage of sperms to outside: The reason may be gonorrhoea, male sterilization operation or vasectomy, infections like tuberculosis etc. 3-OTHERS: -i. IMMUNological: which leads to clumping of sperms after ejaculation. -ii. ENDOCRINOLOGICAL Medical Problems: Certain diseases like diabetes, hypothyroidism. -iii. EJACULATORY or neuro-psychiatric or anatomic problems: failure to deposit sperms high in the vagina, premature ejaculation, impotency. -iv. ALCOHOL AND SMOKING abusement. EVALUATION OF INFERTILE COUPLE It is better both of you to go together for evaluation.It is important for you and your partner to have full faith in your doctor (you should trust completely and feel that your doctor is your family physician). You must hand over complete information regarding your health, physical and sexual habits, so as to come to a conclusion of why pregnancy does not seem to be happening and will ask both, you and your partner questions during together and separate interviews. It is well established that pregnancy rates in normal non-pregnant women is 40-50% in 5-6 months, 80-90 % in about 10 - 12 months and 100% in about 15-20 months, the variation depending on the age of the woman , the fertility of her partner and he frequency of intercourse sure. Often many cycles of treatment are attempted before a woman gets pregnant or before the treatment is considered to have failed. One must discuss the expected time period of the treatment with the infertility specialist before starting to therapy. The success of treating other causes of infertility depends heavily upon the type and severity of the problem. EVALUATION AND TREATMENT The infertility treatment includes a special stepwise manner.Firstly, ROUTINE TESTS:Blood and urine test of both partners. (i)Complete blood count(CBC): to check for anaemia and infection. (ii)Blood GROUP and RH factor (if not known):It rules out the possibility of disease called Rh isoimmunization, which uncommonly is a cause of infertility. (iii)Serum VDRL test:To eliminate the possibility of syphilis (a sexually transmitted disease) as a cause of infertility. (iv) Blood HIV test and Hepatitis test:To rule out the risk of AIDS and hepatitis infection. (v)Urine test:To rule out urinary infection. -SPECIFIC tests: (i)Blood GLUCOSE levels:Pre-meal and post-meal levels are done routinely for women having previous delivery of dead baby or neonatal (death of baby in less than 1 month) death. Diabetes Mellitus ? ii) SEMEN analysis :It is done to rule out whether there is absence of sperms, less number of sperms or there is problem in their motility or large number of abnormal sperms. As these may become the cause of infertility.The semen is to be collected by manual expression. (Masturbation). The sample of semen should be given in a clean wide mouth container after 3- 4 days of absence of intercourse and stres factors. It is taken to laboratory within 1hour. iii)Female HORMONAL blood tests. -RADIOLOGICAL TESTS i) Firstly detailed pelvic and transvaginally USG ii) HSG (especially to look for a normal passage to the tubes and the uterine structure . TUBAL ANATOMY The Fallopian tubes are paired, tubular, seromuscular organs whose course runs medially from the cornua of the uterus toward the ovary laterally. The tubes are situated in the upper margins of the broad ligaments between the round and utero ovarian ligaments . The ovarian fimbria is longer and more deeply grooved than the others and is closely applied to the tubal pole of the ovary. Passing medially, the infundibulum opens into the thin-walled ampulla forming more than half the length of the tube and 1 or 2 cm in outer diameter; it is succeeded by the isthmus, a round and cord-like structure constituting the medial one-third of the tube and 0.5-1 cm in outer diameter. The abdominal ostium is situated at the base of a funnel-shaped expansion of the tube, the infundibulum, the circumference of which is enhanced by irregular processes called fimbriae.Each tube is about 10 cm long with variations in length from 7 to 14 cm ( perhaps 15 cm.) The interstitial or conual portion of the tube continues from the isthmus through the uterine wall to empty into the uterine cavity. This segment of the tube is about 1 cm in length and 1 mm in inner diameter . TUBAL DISORDERS Pelvic inflammatory disease (PID) is inflammation of the upper genital tract characterized primarily by salpingitis. The disorder may coexist with endometritis or oophoritis, may spread as peritonitis, and may extend along the paracolic gutters to the liver to cause the Fitz-Hugh-Curtis syndrome. The cervical barrier plays a crucial role in preventing the ascent of vaginal organisms to the upper genital tract. This barrier may be compromised after miscarriage, delivery, cervical surgery such as amputation, dilatation, and cauterization, or at the time of an intrauterine device insertion. The causative organism in most initial cases is Chlamydia trachomatis; Neisseria gonorrhoeae, Mycoplasma hominis, Ureaplasma uralytica, and Actinomyces israelii have also been found to be a cause in some cases. In subsequent episodes of PID, other aerobic and anaerobic organisms may be the causative agent to the pelvic infection. The infection usually starts as an asymptomatic cervicitis. If the natural barriers such as the narrow endocervical canal, the downward flow of mucus, the presence of antibacterial lysozymes, and the production of specific local IgA fall, the infection may spread to the endometrium. The monthly shedding of the endometrium is another protection against infection, aided by the mechanical effect of the uterotubal junctions and the ciliary activities of the Fallopian tubes which creates a downward flow of tubal fluid. Therefore, not all the organisms that reach the endometrial cavity necessarily spread to the Fallopian tubes. Nonetheless, the open tubal lumen allows spread of infection to the peritoneum, causing salpingooophritis and peritonitis. Consequences of PID include blockage of the tube usually either proximately at the site of insertion into the uterus or distally causing a hydrosalpinx with partial or complete distal obstruction. Less commonly, a midtubal segment of the tube may become occluded. Other sequelae may include pyosalpinx, tubal or tuboovarian abscess, and peritubal adhesions. The long-term consequences of PID include recurrent PID in almost 25% of cases after one episode of salpingitis, chronic pelvic or abdominal pain in one of every five affected patients, tuboovarian abscess in about 34% of hospitalized patients, Fits-HughCurtis syndrome, deep dyspareunia in two of every five patients, and menstrual disturbances in four of every five patients. Additionally, the risk of ectopic pregnancy increases seven times that of control sub,jects,. The risk of subsequent infertility is approximately 12% after one episode of PID, 35% after two episodes, and 75% after three or more episodes. TREATMENT CHOICES and MEDICATIONS Ovulation problems are the most successfully treated cause of infertility and usually are treated with medications that stimulate the ovaries to produce and release eggs .Once these tests are normal, usually the woman is prescribed to take ovulation-inducing drugs known as CLOMIPHINE citrate (brand name Clomen,Klomen, Fertyl) to enhance the production and maturation of the egg. The specific type of drug depends on the problem. - the USG is recommended to look for the relation of uterus, ovary, and fallopian tubes to each growing follicle, called as folliculometry. (on day 10, 12, 13, 14, and 16 in general, also alternate days during midcycle period to record the size of the maturing egg). The couple is also advised to keep in contact usually on alternate days during mid cycle period. Rupture of the follicle releases the qualified egg need for fertilisation. Timing of relation is vital in this issue also called as CONTROLLED COITUS . FERTILITY INJECTIONS: If oral treatment does not improve the ovulation problem or you still do not become pregnant, fertility injections may be recommended. These are much more expensive and require closer supervision and monitoring. Hence they are usually not started as a first management. Human menopausal Gonadotrophin (HMG) Provides extra supply of hormone (FSH and LH) helping to induce development of eggs. Follicle stimulating hormone (FSH) provides extra supply of FSH (hormone needed for the development of eggs). Human chorionic Gonadotrophin (beta HCG) triggers release of eggs (ovulation) Gonadotrophin releasing hormone analogue (GnRH analogues Goserelin) used as an adjunctive therapy for controlled ovarian stimulation, which leads to production of few mature eggs for ART. This course of treatment is usually undertaken for a period of 6 months. The cumulative pregnancy rate approaches to 60 -75% at the end of 6 months. SURGICAL OPERATION: Fallopian tube damage (including tubal ligation) can be corrected with surgery. If no success is obtained by the end of 6 months, usually a decision is taken for Laparoscopy and Hysteroscopy. HYSTEROSCOPY: In this, a thin 1.8mm telescope, called hysteroscope is installed through the mouth of the uterus (cervix) to look into the cavity of the uterus. This helps to diagnose conditions like fibroids lying below the lining of the uterine cavity, polyps, and uterine septum (wall in the uterine cavity), fibrous bands (adhesions), blocked tubal openings which can be treated simultaneously. LAPAROSCOPY: A laparoscope is a special telescope available in different sizes is installed through the umbilicus and the reproductive organs are visualized by the help of CO2 gas. Conditions like fibroids, cysts of the ovary, fibrous bands (adhesions), blocked fallopian tubes and endometriosis can be diagnosed and treated simultaneously.By pushing a coloured solution into the fallopian tubes during the procedure, your doctor can see on monitor whether your fallopian tubes are open or blocked. It is complimentary to the hysterosalphingography (HSG) procedure and can be avoided if HSG is normal. But you should know that certain anatomical or structural changes may not really interfere with your getting pregnant. Laparoscopic surgery may be used to correct significant structural problems with the ovaries or fallopian tubes Only if no other correctable factors are present, your physician may suggest surgery such as myomectomy (removal of a fibroid) or removal of a septum or adhesion. These can be done by various techniques. HYSTEROSALPINGOGRAPHY (HSG): It is a procedure in which a special dye is pushed through the mouth of the uterine cavity and an X-ray is taken of lower abdomen. The dye outlines the uterine cavity, tubes and gives idea regarding the patency of the fallopian tubes. Testing that typically is done to determine a cause for infertility (such as hysterosalpingography ) also may be used as a treatment option to correct some problems (such as minor blockage of the fallopian tubes). This procedure does not require any anaesthesia and is usually done after menstruation and before ovulation. Endometrial BIOPSY: This test MAY be performed on day 1 or day 2 of menstrual bleeding. It is a simple procedure and does not require any anaesthesia. A small fragment of uterine lining is removed and studied under microscope, to know how it responds to the hormones. -POSTCOITAL TEST: This is done usually in mid cycle period. A sample of mucus from cervix (mouth of uterus) is studied under the microscope. This test gives information regarding sperm and mucus interaction and the mucus characteristics can hint towards ovulation. -SPERM ANTIBODY TEST: This is a highly specialized test, which is aimed at determining special cells called which appears in woman blood, cervical mucus or seminal vesicles. These antibodies may react with the sperm and destroy or immobilize them causing infertility. Another fairly common cause of infertility is endometriosis. ENDOMETRIOSIS a disease in which the internal lining of the uterus (endometrium) grows in or on other parts of the reproductive system.This causes slowly progressive changes in and around the genital organs reducing the fertility. Up to 1/3 of women with this disease GETS pregnant without medical help.If, there is no pregnancy,Laparoscopic surgery, hormonal drug therapy in the form of danazol, medroxy progestrone acetate or both may be used to treat this condition. Endometriosis also may be treated using laparoscopic surgery to remove endometrial tissue growth. If the fallopian tubes are severely damaged, or the eggs is not produced optimally or if there is a problem with the sperm count, such patients need specialised infertility treatment called ART(assisted reproductive techniques (ART). Surgery usually is reserved for moderate to severe endometriosis and is minimally effective for mild cases of endometriosis. If the above treatments are not successful, assisted reproductive techniques may be attempted. |
LIFE STYLE IS NOT DIRECTLY EFFECTIVE IN INFERTILITY...But your activities may improve your fertility..If the gym is your style, make a date with yourself on a regular basis. Check with your physician to verify that the program you are following is suitable given any medical issues you may have. Use an exercise videotape or vcd in the comfort of your own living room. This requires a little more discipline since it is usually a solitary activity. But, it saves the time to travel to the gym or park. You can dance at home or play belly dance too. The best exercise in the world - DANCING!!! Whether it's the swing, jitterbug, waltz, fox trot, electric slide, or even the funky chicken dance belly dance--- it is painless, fun, romantic, energizing, and lifts your feet and your spirits off the floor. If you "can't dance - don't want to" --- take lessons at the local community college. It's inexpensive and lots of people of all ages are doing it. It's actually back in style. You could also take tap dancing lessons by yourself! Getting your hands into the dirt in your own yard is an excellent way to stretch those back, leg, arm and buttock muscles. And while you're doing this exercise, you are also creating a place of beauty that will provide pleasure and joy as well as the color and scent of roses, lilies of the valley, tulips and hyacinths when they pop up. What about swimming? This activity is so relaxing and offers painless options for exercise. Think of the silence of underwater swimming. You know that the fist mammalians were living in the water including humans.Think of the calming effect of floating on your back. Think of the cleansing and cooling effect of the water. In addition, the safety it adds to your life is quite important. Take the steps instead of the elevator. Climb up the steps inyour shopping center or atyour house or at work.Walk around the doctor's building once or twice before going in and calmly review the issues you want to discuss with him/her while you are circling. Walking!.. A terrible kind of activity for all ages and for your body and mind.Consider it! The mind, along with your body, spirit and emotions, promote health when they are all in balance. QUALITY of Life:Infertility is absolutely a resource for stress.And this condition needs to battle with the STRESS.For many men and women, learning that they have fertility problems is shattering.For example, you can try massage therapy with your partner. MASSAGE THERAPY Massage therapy is a relatively safe and effective method of stress management. Stress, if left unmanaged, can upset the delicate balance of all the systems within our body. Stress manifests itself in the form of tension. Tension reduces the flow of energy (blood & oxygen supply etc.) and once reduced it leads to feelings of tiredness, reduced flexibility in our joints, a sense of heaviness, and the build up of toxins . As a result aches and pains and more serious problems can develop. Because of this unique relationship between stress and the body, massage therapy is widely used to help individuals obtain relief from physical or medical problems, including migraine headaches, back pain and digestive problems. Massage helps relieve the tension and allows the body's own energy to heal itself. IMAGINARY TECHNICS There are a number of different ways you can do this. You want to first get your body in a relaxed position - this might be in your favorite chair, your bed, the floor or even the grass outside. Then shift your attention away from your external environment and inward toward internal images. Imagine a place, or scene or event that you remember as being peaceful, happy, restful or beautiful. Bring all your senses into this image. If you're at the beach, for instance, listen for the seagulls over head. Smell the ocean winds. Feel the warmth of the sun and taste that long, cool drink. Other places you may go are to the top of a mountain, a tropical island, a park or whatever is effective for you. THE EMOTIONAL ASPECTS OF INFERTILITY An infertility diagnosis can distort our basic definitions of womanhood and manhood, however temporarily. Shame anger, guilt, denial, and blame are just some of the emotions you and your partner may be dealing with.However, thrilling the eventual outcome may be fertility is a rough and rocky road for many couples, one they may travel on for years. Fertility treatment involves emotional, ethical, moral even religious dilemmas.And only two of you know how much medical assistance you want, can tolerate, or afford in your goal to achieve pregnancy. An open and ongoing discussion among you, your partner and your doctors can help you at each juncture of your treatment. Your family may also benefit from counseling to understand your experience and reactions.Should you decide against aggressive fertility treatments, or should your efforts prove unsuccessful, talk to your doctor about bringing a child into your family through surrogacy or adoption. Laughter forces you to let go, be out-of-control, and even just for a moment, lose yourself. Find the smileage in your life! Laugh often and frequently, alone, or with someone...Do not forget , it is infectious! LAUGH,LAUGH... LAUGH reduces your body stress. You feel better YOURSELF when you laugh, enjoy yourself.Watch especially comics on tv. TREATMENT SUCCESS RATES Treatment success is defined as the birth of a healthy baby.There are various factors affecting the success rates.Some of these are: - the cause of infertility and the woman's age - timing (physically and emotionally) - your doctors - the statistical method used to calculate the rate. PROFESSIONALS who may be involved in treatment are:The Specialist in familymedicine, Obstetrician/gynecologists ,and Urologists also Reproductive endocrinologists and radiologists and psyhciatrists. DIET and ACTIVITY Recommendations:Both men and women should avoid alcohol, tobacco, and other drug use when they are trying to get pregnant since these substances hinder estrogen and sperm production. Surely, women should also avoid these substances once they conceive.While no specific diet can increase fertility, your good health depends on good nutrition. You may also want to ask your doctor about taking specially formulated prenatal vitamins including folic acid, while you are trying to conceive.Men with a low sperm count should avoid activities and clothing that will raise scrotal temperature (which reduces sperm production). Some culprits are tight-fitting underwear and clothing (particularly those made of synthetic fabrics) hot baths, hot tubs and saunas. Long distance cycling may also cause pressure on the scrotum and testes and should be avoided while you are trying to conceive.Women experiencing fertility difficulties should avoid strenuous dieting and extreme exercise (such as marathon or endurance-race training) which may lead to excessive loss of body fat, menstrual irregularity and cessation of ovulation but we prefer slower activity perhaps belly dance. - COMPLICATIONS in possibilty:Some drugs and assisted reproductive technologies used to treat infertility may result in multiple births (twins, triplets, etc) while this aspect of fertility treatment is very controversial, some couples view it as a blessing, not a complication. This risk has recently been greatly reduced by allowing the fertilised eggs to develop into blastocysts before selection for transfer into the uterus ART):Assisted reproductive techniques. - Fallopian tube is essential for unassisted procreation, serving as a conduit for the ovulated oocyte (egg) to enter the uterine cavity following fertilization. Infertility caused by tube blockage also may be addressed by using in vitro fertilization.These expensive techniques have varying success rates and carry the risk of multiple pregnancy, but have allowed many couples to become parents. All of these techniques involve stimulating the ovary to produce an excess number of eggs and removing (harvesting) the eggs from the woman. (IVF):In vitro fertilisation In vitro fertilisation bypasses most of the things that can go wrong in the process of getting a healthy egg out of the ovary, into and through the fallopian tube, and fertilised by accomplishing those things outside the body. Its functions are regulated both hormonally and by the nervous system, and it is the usual site for oocyte fertilization. Tubal function can be impaired by infection, surgery, adhesions, and other pathologic processes.Sometimes, the road to the uterus is so long that the fertilized ovum can not access to the endometrium.(see Bebitoglu F,G M.D sp.- infertility and the fimbria distance to the ovary). Function of the tube can be restored surgically or it can be bypassed through the use of in vitro fertilization of oocytes followed by intrauterine embryo transfer. After the ovaries are stimulate with hormonal drugs, your doctor will collect the cultivated eggs from your ovaries with a laparoscope or a needle directed by ultrasound. Eggs and sperm from your husband are then combined in a lab dish. Between two and five days later, your doctor will transport one or more of the fertilised egg, or embryos, into your uterus, with the hope that it will implant itself in the uterine lining, thus establishing pregnancy. (GIFT):Gamete intrafallopian transfer. Also known as in vivo fertilisation, generally follows the same procedure as IVF. A woman must have at least one healthy fallopian tube to use this technology. Rather than combining the egg and sperm in a lab dish as is done with IVF, during GIFT the egg and sperm are placed in the fallopian tube so fertilisation can take place there. (ZIFT):Zygote intrafallopian transfer This procedure is another variation of IVF and GIFT. ZIFT involves transporting an already fertilised egg (zygote) from outside in to a fallopian tube. BASIC TREATMENTS: -Intra-uterine insemination: Cervical factors (such as a narrow cervical opening or presence of sperm antibodies) are treated with intrauterine insemination.This technique may work if the female cervical mucus seems to reject or immobilize her partner sperm from a male partner is implanted in the woman uterine cavity as close as possible to the time of ovulation. -Artificial insemination: Male factors (such as low sperm count) can be treated with artificial insemination or in vitro fertilization with partner sperm. The semen is ejaculated by a needless syringe or tukey syringe.We do not prefer donor insemination in general for its physcological aspects in the future. We firstly prefer you to give chance TESA (testicular sperm extraction). -Egg or embryo donation:Also this is an unwished choice for the woman whose ovaries dont work properly or whose eggs arent healthy or are absent but whose uterus is able to sustain a pregnancy. Donor eggs can be fertilised with the infertile woman partner sperms or that of a sperm donor. Your doctor will then transplant a couple of the fertilised eggs, or blastocysts (mature embryos) into your uterus, with the hope that one or at the most two will implant themselves in the uterine lining, establishingpregnancy.But we firstly prefere ICSI (intra cytoplasmic sperm injection) -Healthcare Setting:In patient care may be necessary for surgery and some of the diagnostic tests, but the vast majority of infertility treatments can be performed on an outpatient basis. - |
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