Drugs
Various drugs used in infertility:

Hormones 
Various hormones used in infertility:

• HMG, Highly Purified
• FSH, Highly Purified / r-FSH
• r-LH
• GnRH Agonist
• GnRH Antagonist
• HCG/r-HCG
  
  

IUI (Intra Uterine Insemination):

• IUI is an insemination of prepared sperms in to the uterine cavity.
• Human fertilization is a complex process
• Out of millions of sperms deposited in vagina during normal sexual intercourse only a few thousand sperms, actually reach the site of potential fertilization
• This high loss is thought to be due to a variety of factors.
• It has been practiced since last 200 Years
• In 1770 it was first performed by Dr. John Hunter for a case of hypospadias.

IVF - ET (In Vitro Fertilization-Embryo Transfer):
It is the fertilization of oocyte with sperm outside the body (in vitro) & resultant embryo is transferred in to the uterine cavity. Here the ovulation is induced with injectable drugs; follicles are monitored & ovum is picked up under sonography guidance.

Embryo Transfer:
This is usually done after 2 - 3 days of egg recovery. You will be given a time to attend the clinic for embryo transfer. You may need to come with moderately full bladder as we conduct all embryo transfers under sonography control usually 2-3 embryos are transferred and rest can be taken for cryo preservation for future use. Before you will be discharged from the hospital detail instructions will be given to you about rest and supporting drugs. You will be asked to come to our lab for blood test to find out early pregnancy and yes we at Mayflower wish you best of the Luck!

Blastocyst Culture & Transfer

• A blastocyst is an embryo that has developed for 5 to 7 days after fertilization and has just started to differentiate.
• It has developed two different cell types and a central cavity. One group of cells will become the placenta, and the other group will become the fetus.
• A healthy blastocyst will begin hatching from its outer shell by the sixth or seventh day. Shortly after hatching from the shell, it should begin to implant into the lining of the mother’s uterus.
• In past years, the majority of embryo transfers were done on day 3 (after the egg retrieval) at the “cleavage stage” when the embryos have four to eight cells. One problem with this is that day 3 embryos normally are found in the fallopian tubes, not in the uterus. The embryo first moves into the uterus at about 80 hours after ovulation. The implantation process begins about 3 days later, after blastocyst formation and hatching have occurred.
• The other problem with transferring on day 3 is that many embryos at that stage do not have the capacity to continue development and become high-quality blastocysts.
• There are no reliable methods to determine which of the day 3 embryos will be viable long-term. Therefore, the tendency has been to transfer more embryos on day 3 in an attempt to achieve good pregnancy rates. When embryos are cultured from day 3 to day 5, some will stop developing and others (25% to 60%) will continue to become blastocysts.
• By choosing the best blastocysts for transfer on day 5, we can choose much more reliably those with the best potential for implanting and having a baby.
• In the past it was difficult to get good numbers of high-quality blastocysts with in vitro culture systems. However, advanced culture media have been developed that provide the proper balance of nutrients at the various stages of early embryo development.
• Proper culture techniques with these new media formulations yield excellent blastocyst formation rates. This makes blastocyst transfer a viable option for some couples with infertility.
• In exclusive day 5 transfers one of the issues with this is that a small proportion of couples will have embryos that are growing on day 3, but by day 5, all of their embryos have stopped developing. These patients could have had a day 3 embryo transfer, but because their embryos were kept in culture and arrested after day 3, they will not have an embryo transfer at all. This has been reported to occur in about 5% of cases if all patients’ embryos are cultured for 5 days. The ultimate outcome of the cycle may be exactly the same either way (a failed cycle), but patients would probably prefer to have an embryo transfer and then not be pregnant as opposed to being called and told that their embryos have stopped developing and therefore they will not have an embryo transfer at all.
• Most IVF centers (including ours) that perform day 5 transfers have selection criteria for deciding which cases are transferred on day 3 versus day 5. The criteria often involve a minimum number of fertilized eggs or a minimum number of good-quality embryos on day 3. In our IVF program, we typically perform day 3 transfers for all couples with three or fewer fertilized eggs, and day 5 transfers for all couples with four or more fertilized eggs.
• Do blastocyst transfers correlate with higher pregnancy rates than day 3 transfers? Yes, in most published studies, pregnancy rates are higher with blastocyst transfers when a given number of embryos are transferred (e.g., two). This is because of the higher potential for implantation of the blastocyst.
• However, the issue is complicated because some IVF centers have seen no improvement or even lower pregnancy rates with blastocyst transfers. This is because
• Blastocyst culture and transfer is technically more complicated and difficult as compared to day 3 transfer.
• Difficult to maintain the stable and exacting culture environment for 5 days that allows the optimal development of the embryos.
• Because of the very high implantation potential of quality blastocyst embryos, we should be cautious about the high potential for twins. Transfer of two excellent blastocysts can result in twin pregnancy rates as high as 60%. Therefore, transferring only one should be considered in young women (or in egg donation cycles) with high-quality blastocysts. Pregnancy rates in these patients can be in the 50% range with a very low risk of twins (perhaps 2%) and no real risk for triplets.
• In conclusion, blastocyst culture and transfer of one or two embryos in IVF centers that are proficient with this technique currently offer the best balance between the chances of any pregnancy ensuing and the risks involved with a multiple pregnancy.

Egg Sharing:
There are group of patients who because of certain reasons (old age, premature ovarian failure, surgical removal of the ovaries and possibility of transmitting genetic disease via female) are not in a position to produce their own eggs. But they can share the spending of the treatment and can share few eggs produced by other. Thus the treatment will be cost effective and the recipient will have a chance to bear a child.

This program is only possible in following condition:
- Less then 34 years.
- Negative for HIV and Hepatitis.
- No major medical illness.
- No family history of major illness.
- No repeated IVF failure.
- Completely in a good state of health.
- All hormonal profile should be normal.
- Written & informed consent required.

Egg Donation Program:
Egg donation (also called oocyte donation or ovum donation) can be used as an effective treatment for infertility of all causes except for women with infertility caused by an anatomic problem with the uterus, such as severe intrauterine adhesions. Pregnancy rates with egg donation are high, particularly as compared to pregnancy rates in women with poor egg quality and quantity.

Indications:

• Premature ovarian failure (menopause)
• Very poor egg quality
• Poor response to ovarian stimulation
• Significantly elevated day 3 follicle stimulating hormone (FSH) level
• Advanced female age, such as over about 39-40

Procedure of Egg Donation

• An appropriate egg donor is chosen by the infertile couple and thoroughly screened for infectious diseases and genetically transmissible conditions. Donors are generally given some monetary compensation for going through the treatment.
• Consents are signed by all parties.
• The donor is stimulated with injected medications to develop multiple egg development. This allows us to perform in vitro fertilization with her eggs and the sperm of the infertile woman's male partner.
• Details about the subcutaneous injectable medications that are used for IVF
• The infertile woman (recipient) is placed on medications that suppress her own menstrual cycle and stimulate development of a receptive uterine lining.
• When the donor's follicles are mature, an egg aspiration procedure is performed to remove the eggs from her ovaries. The eggs are then fertilized in the laboratory with the sperm of the infertile woman's male partner.
• The embryos develop in the laboratory for 3 days. Then, an embryo transfer procedure is done which places the embryos in the infertile woman's uterus where they will hopefully implant and develop to result in the birth of a baby.

If you need donor’s egg through our program waiting period is usually long. In such situation you may have to wait or arrange for your own donor (a friend or relative). Donor should fulfill the above mentioned criteria. Donated eggs are inseminated with a sperm from male partner of the recipient couple. Synchronization of donor’s and the recipient’s cycles are necessary.