Frequently Asked Questions

1. General Questions

In vitro fertilization is effective in overcoming a variety of infertility problems, particularly tubal problems or marked sperm problems. In this procedure the ova are fertilized outside the body using partners sperms & then the fertilized embryos are placed back into the uterus transvaginally. IVF is a four-stage procedure: Stage One – Hormonal injections are given to stimulate the development of multiple follicles. Stage Two-Once mature, the eggs are removed (or retrieved) from the woman’s ovaries using a fine needle. Stage Three-The eggs are transferred to a laboratory dish where they are fertilized by sperm collected from the male partner. Stage Four-Several days later, the fertilized embryo is inserted back into the uterus.

Your initial consultation at 21st Century IVF Centre begins our process of getting to know you, gathering more information about your condition(s) and starting to develop an individualized treatment plan. At your initial 21st Century IVF consultation you will: Meet your 21st Century IVF Centre physician and other members of your care team. Speak extensively with your 21st Century IVF physician about your fertility history. Review your medical, surgical and family histories with your 21st Century IVF doctor. If necessary, determine which simple tests will provide an accurate diagnosis. Begin to derive a comprehensive and individualized treatment plan. Get answers to questions you have about infertility, treatment or your personal case. Meet with an experienced Financial Coordinator (a liaison between you and your insurance company) to learn what will be covered by your insurance provider. To set up your initial consult, simply call the 21st Century IVF centre most convenient to you. We will set up an appointment and work with you to ensure insurance coverage for the consult.

21st Century IVF Centre medical doctors typically perform three tests when a couple schedules an initial consultation. For the female partner a blood test can determine whether hormones are in the correct balance and an examination of the pelvic cavity can determine whether there are any physical impediments to fertility. For the male partner, a semen analysis can show whether there are issues with sperm. We will also review each partner’s medical, surgical and family history and answer any questions you may have.

Use of medication to trigger the development and release of an egg or eggs from the follicles in the ovaries is called ovulation induction. Fertility medications allow women to safely produce multiple eggs during a single cycle. Production of more than one egg increases the chance for a successful cycle by increasing the odds of healthy fertilization and implantation. These medications are usually used in conjunction with other treatments such as intrauterine insemination (IUI). Intrauterine Insemination (IUI) is a procedure in which sperm that has been washed and prepared is inserted into the woman’s uterus through a catheter. This procedure allows the sperm to pass directly into the fallopian tubes where fertilization normally occurs. Performed at the time of ovulation, IUI increases the likelihood of fertilization and pregnancy. Vaginal ultrasound and/or a urine ovulation detection kit are used to ensure that the procedure is conducted at the right time. IUI is recommended for patients who have been diagnosed with: Abnormal or inhospitable cervical mucus Unexplained infertility Male factor infertility

2. Medical Treatment Questions

IUI appointments are scheduled in advance but 21st Century IVF Centre is flexible with scheduling as a patient’s day of ovulation may be different than predicted. In general, an IUI is performed once or twice in a treatment cycle. Each IUI visit lasts about an hour (which includes waiting time) as sperm preparation may take 45 minutes or more. The male partner can produce the semen sample on site or it can be produced at home as long as it can be delivered to the 21st Century IVF andrology laboratory within an hour after it is produced. During transport the sample must be kept at body temperature. Upon arrival, the specimen will be analyzed and then prepared. This will take approximately 45 minutes. A speculum is inserted and a small plastic catheter (tube) is introduced through the cervix into the uterus. The sperm is then injected into the uterine cavity. This process takes only minutes and the patient may leave immediately after the procedure.

Performed in an outpatient surgical setting, a free-standing surgical center located at 21st Century IVF’s Surat centre, laparoscopy and hysteroscopy usually takes between 30 to 60 minutes and requires general anesthesia. Technological advancements in laparoscopy enable 21st Century IVF surgeons to perform delicate, specialized surgery in a minimally invasive, patient friendly manner. Several procedures can be performed prior to or as part of fertility treatment to expand the options available to improve your chances for achieving a successful pregnancy. Laparoscopy Laparoscopy is an effective means to diagnose or treat anatomical infertility problems. It is a minimally invasive surgical procedure that allows physicians to clearly view the condition of the pelvic organs.

Endometriosis (normal tissue found in the uterus grows outside the uterus) Ovarian cysts (fluid filled sac inside the ovary) Correction of scar tissue and adhesion formation Fibroids (benign muscle tumors) from the outer surface of the uterus Ectopic pregnancy (embryo implants outside the uterus) Blocked or damaged fallopian tubes .

Hysteroscopy is a minimally invasive surgical procedure that is used to diagnose and treat abnormalities of the uterus. Hysteroscopy is used to successfully treat: Fibroids (benign muscle tumors) on the inner surface of the uterus Endometrial polyps Uterine abnormalities such as scar tissue Abnormally heavy uterine bleeding Repair of uterine septum A hysteroscopy is typically performed on an outpatient basis in an operating room under general anesthesia. It is a minor surgery that requires no incisions. In some instances, it can also be performed in a doctor’s office with local anesthesia and only minimal discomfort. Most women are able to resume normal activities immediately following a hysteroscopy.

In vitro fertilization (or IVF) is a highly successful assisted reproductive technology. There are four basic steps in an IVF treatment cycle: Ovulation Induction A woman begins taking fertility medications to encourage development of eggs within the ovaries. These medications stimulate the follicles to produce more than one egg in a cycle. Egg Retrieval Egg retrieval is a minor surgical procedure that can be performed on an outpatient basis at 21st Century IVF’s surgery center. It typically takes about 10-15 minutes and requires IV sedation. Fertilization and Embryo Development The retrieved eggs are placed in a petri dish with a special solution for 2 to 3 hours. During this time, the male partner provides a semen sample. The sample is delivered to the lab where it undergoes a clarifying process referred to as“washing.” The washed sperm are incubated and placed in the petri dish with the eggs. After 18 hours, the eggs are examined. If fertilization occurs, then two to four of the resulting embryos are selected for transfer back to the female. Embryo Transfer Embryo transfer is a simple procedure that does not require anesthesia. The selected embryos are inserted into a thin tube and guided toward the female’s uterus, where it is hoped they will continue their natural fetal development. Transfer typically takes place three days after egg retrieval, or five to six days after retrieval in the case of blastocyst transfer. Rest and recovery are recommended for 24 to 48 hours.

Embryo Freezing Embryo freezing permits high quality embryos that are not immediately used for IVF to be frozen for the couple’s later use. Approximately half of all frozen embryos remain viable after thawing and can be successfully used in IVF treatment. If the frozen embryos are no longer needed, they can be sometimes donated to research, donated to other infertile women or discarded. Blastocyst Transfer In a typical IVF cycle, fertilized eggs are returned to the uterus after two to three days of maturation. In the past, in vitro culture media could not sustain embryo growth beyond this time. Today it is possible for embryos to mature in vitro for up to five days, at which point they develop into blastocysts. Only the healthiest eggs will make it to the blastocyst stage. Blastocyst transfer is not appropriate for all patients. Talk to your 21st Century IVF doctor about whether it is right for you. Preimplantation Genetic Diagnosis (PGD) Pre-implantation genetic diagnosis (PGD) allows embryos developed through IVF to be screened for certain genetic disorders. PGD provides particular benefits to patients at risk of passing on inherited genetic diseases, such as cystic fibrosis and muscular dystrophy. PGD is performed in the lab on the third day of embryo maturation. A single cell is removed from each of the embryos and tested. Assisted Hatching There is a phase in embryo development during which the embryo must be released, or “hatched”from its hard outer covering. Infertility results when natural dissolution of the shell fails to occur. Assisted hatching can be performed using lasers, mechanical techniques or chemicals.

A gestational carrier IVF cycle is a process whereby eggs are harvested from the female (biologic mother), fertilized in the laboratory with her partner’s sperm and transferred into the gestational carrier’s uterus or womb. Indications for choosing gestational carrier IVF are usually disorders of the uterus such as previous hysterectomy (removal of the uterus but not the ovaries) and congenital abnormalities of the uterus or problems such as large uncorrectable fibroids. Certain medical conditions in the mother may also preclude her from tolerating the physiologic changes that occur during a pregnancy and/or may actually threaten her life; these may be treated with gestational surrogacy. Gestational carrier IVF with donor eggs is an option for gay male couples or for women whose own eggs cannot be used because of age-related infertility, risk of genetic disorders or other issues. Prior to initiating a cycle of gestational carrier IVF, it is imperative that the intended parents (along with their carrier) undergo medical, psychological and legal counseling. 21st Century IVF Centre is one of the most experienced centers in the United States at performing gestational carrier IVF and each of these issues will be fully addressed by your 21st Century IVF Centre physician.

Donor insemination (DI) is an option for single women who want a biological child, lesbian couples, couples whose male partner has no sperm or a very poor semen analysis (azoospermia, oligospermia, poor motility) or when there is a genetic problem which could be inherited from the male. Couples or individuals choose which sperm bank and which donor to use. Information about a donor’s physical characteristics, race, ethnic background, educational background, career history and general health are usually provided by the sperm bank. Fertility medications may be given to the woman prior to DI. The DI procedure involves inseminating the female as close to the time of ovulation as possible. Depending on the treatment and the female’s history, she may monitor her ovulatory cycles by testing her urine for an LH surge. The physician mat also recommend a medication (hCG) to induce release of the egg(s)