Firm Fertility Center

Firm Hospitals, rated as the best fertility centre in Chennai, we have created a private, comforting & compassionate treatment facility where patients receive individualized care from the best fertility doctors in Chennai and can feel at ease.

“A Place where dreams of Parenthood become a reality!”

  • Building healthy families
  • Innovative treatment
  • Extraordinary care

The inability to conceive is a difficult time for any couple. However, standing apart from other fertility hospitals in Chennai, in Firm Fertility Center we have come up with spectacular IVF & ICSI techniques, which could fulfill your heartfelt desire to have a baby of your own. Rated as one of the best fertility hospitals in Chennai, we understand the pain infertility can cause and we ensure that every treatment and our support are personalized to your needs. Dr. Mala raj one among the best fertility doctors in Chennai offers personal care for everyone. Patients come to us with a hope for their infertility treatments and get the best treatment that works for them with proven success rates.

The main resource in Firm’s Fertility Centre is our chief doctor Dr. Mala Raj.

Being an advanced laparoscopic surgeon and fertility specialist, she is able to resolve all your minor problems by laparoscopy itself, so that you can get pregnant naturally. If any advanced fertility treatments are needed, we are equipped with latest fertility options likely improving your chances of conceiving. At the first visit to the doctor, we expect both the husband and wife to be available, as we need to evaluate the cause of infertility by evaluating both the partners. The various treatment options available are

Here the woman is given ovulation induction tablets from Day 2 of the menstrual cycle and Gonadotropin injections are given if necessary and follicular tracking (study the growth of eggs) is done on alternate days from day 9/10 of the menstrual cycle till ovulation. Once the leading follicle is 18 – 20 mm, Injection HCG is given to trigger the follicles to rupture and release the eggs and the couples are advised to have timed coitus.Normally, most couples are able to conceive within 3-6 months of this simple treatment. If they do not conceive then we advise them to go for IUI (Intra Uterine Insemination).Meanwhile if we find out the tubes are blocked then none of these treatment will work and they have to go for IVF/ICSI.

Intrauterine Insemination (IUI) is a common procedure performed in cases of cervical hostility, erectile dysfunction and unexplained infertility. In this procedure, sperms are placed inside the uterine cavity after preparation of the sample. It is mandatory, to have the tubes open for this particular procedure. If the tubes are blocked patient has to resort to ‘test tube’ baby only. This procedure does not require hospitalization.

    IUI is useful when:
  • The woman has a cervical mucus problem. For example, it may be scanty or hostile to the sperm. With an intrauterine insemination, the sperm bypass the cervix and enter the uterine cavity directly.
  • The man has antibodies to his own sperm. The “good’ sperm which have not been affected by the antibodies are separated in the laboratory and used for IUI.
  • If the man cannot ejaculate into his partner’s vagina. This is usually because of psychological problems such as impotence (inability to get and maintain an erection) and vaginismus (an involuntary spasm of the vaginal muscles so that vaginal penetration is not possible); or anatomic problems of the penis, such as uncorrected hypospadias or if he is paraplegic.
  • The man suffers from retrograde ejaculation in which the semen goes backward into the bladder instead of coming out of the penis.
  • For unexplained infertility, since the technique of IUI increases the chances of the egg and sperm meeting.
  • IUI is a reasonable first choice (especially for younger couples) since it is so much cheaper and less intrusive.
  • For male factor infertility, though this is a controversial area, especially for the common problem of oligospermia (a low sperm count). What is the rationale behind using IUI for treating this problem? Remember that infertility is a problem of the couple’s, not just male’s oligospermia. Whether a given couple will conceive or not depends on the sum of their fertility potentials. Therefore, the fertility potential of the wife is improved by superovulating her, so that instead of producing 1 egg per cycle, she produces 2-4 eggs per cycle. In addition, the husband’s sperms are processed in the laboratory and the best sperms are used for IUI. This increases the chances of the best sperm being able to reach and fertilize the egg.
How Well It Works

Insemination procedures can improve your chances of becoming pregnant, especially when combined with superovulation treatment. Treatment success is strongly influenced by a women’s age (an aging egg supply decreases pregnancy rate, and miscarriage risk increases with age).

Treating male sperm problems

For mild male infertility, one cycle of IUI has produced double the pregnancy rate (6.5%) of that of well-timed intercourse (3%). Superovulation is reported to only slightly increase the chance of conception when using IUI for mild male infertility.

It is the most common procedure performed for tubal problems. IVF / ICSI success depends upon the quality of the egg and sperm.

PATIENT GUIDE LINES:

In Vitro Fertilization (IVF) commonly known as test tube baby is a method of assisted reproductive technology in which the man’s sperm and the woman’s eggs are fertilized in a laboratory dish and the resulting embryo is transferred in to the uterus for normal development and delivery.

    Reasons for resorting to this procedure:
  • Tubal diseases like blocked or damaged tubes
  • Endometriosis
  • Unexplained infertility
  • Immunological problems
  • Male factor infertility
  • PCOD
    Points to be remembered by the patients undergoing IVF treatment:
  • The patients will be given hormone injections for super ovulation.Each patient has their own way of responding to the treatment,which means they are unlikely to respond the same way as others. They also respond differently from one cycle to the other cycle. Therefore the dosage of hormone injections will be regulated for every patient. As such the patients are advised not to compare the test results and medication plans with others with whom they may speak as the treatment is individualized and may not be the same for everyone.
  • The schedule given here is only to guide the patients and to explain the treatment plan. Time changes and other adjustments will be frequently made in order to individualize each patient’s requirement according to their response.
    PRELIMINARY INVESTIGATIONS AND COUNSELLING

    Patients desirous to undergo IVF treatment are advised to attend our hospital for preliminary investigations during 18th – 21st day of their cycle.The following investigations will be carried out.

  • Ultra sound scanning for the uterus and ovaries.
  • Basic preliminary blood investigations.
  • Counseling.

During this period Dr. Mala Raj will explain the treatment plan and the proposed medications, financial implications etc., you may also discuss about your possible doubts with the doctor and clarify. The patients are also advised to give consent forms separately for IVF, embryo freezing and micro manipulation before starting IVF treatment.

IVF / ICSI TREATMENT PLAN

After initial counseling and preliminary investigations the patient will be asked to report to the hospital for starting the treatment. The patients have to come between 18th – 21st day of their cycle. An ultrasound examination will be done to evaluate mid cycle development of the uterine lining and a trial embryo transfer to determine the direction and the length of the uterine cavity.

    The IVF/ICSI treatment involves the following steps:

    We follow only antagonist protocol which is very comfortable for the patient as the duration of treatment is less and has better pregnancy results

  • Stage 1 : Follicle stimulating hormone injection is used to stimulate the growth.
  • Stage 2 : Stimulation produces more number of eggs,which are removed from the ovaries
  • Stage 3 : Eggs are transferred to lab dish, where the sperm and the eggs are combined
  • Stage 4 : Good embryos are put into the uterus
  • Stage 5 : Progesterone support for 2 weeks
  • Stage 6 : βhCG on Day 15
Super ovulation :

The hormonal drugs are given over a period of ten to twelve days from day 2 by Dr. Mala Raj. During this procedure,the growth of the ovarian follicles is assessed by means of ultrasound scanning. Blood samples are also drawn to measure the estrogen and LH levels. If the estrogen and LH levels are not satisfactory and the follicular growth is not optimum,treatment will be stopped. During the process of super ovulation transvaginal ultrasound examination will be done.This procedure is not painful and the patient may experience some vaginal discharge as transmission gel is used on the vaginal probe. It is very important for the patients to come to the hospital on time in the morning so that the lab results will be available for the doctor to review the results early in the afternoon.

By this the exact date and time will be determined for harvesting the eggs. When the ovarian follicles mature to the maximum size the patient is given an HCG injection for maturing the eggs. Before ovulation takes place the eggs will be retrieved.

    Egg – Retrieval :

    Pre-Egg Retrieval Instructions-

  • The patient should not eat anything seven hours prior to the egg retrieval,since short general anaesthesia is administered for egg retrieval.
  • Recovery from anaesthesia is very fast and rapid. Nausea is very little. A vaginal probe is introduced into the vagina and the eggs are retrieved with a needle inserted through the vaginal wall under the guidance of ultrasound.
  • As soon as the patient arrives at the assigned time they have to report to the doctor.
  • If the follicular growth and the hormonal levels are satisfactory (E2/LH) HCG injection is given approximately 35 – 37 hours prior to the oocyte retrieval. The timings given to the patients should be strictly followed. The HCG injection ripens the developing eggs and initiates ovulation.
  • Two-day abstinence is needed before egg retrieval for getting good quality semen sample for inseminating the oocytes.
  • The patient can go home after egg retrieval and attend to the normal work.
  • The eggs are aspirated along with follicular fluid into a test tube and sent to the embryology lab for examination by an embryologist under a stereo zoom microscope.So the quality of the oocytes is assessed (Maturity). The patient should contact the doctor if any of the following conditions occur.
  • Fever higher than 100 degrees Fahrenheit.
  • Excessive vaginal bleeding.
  • Unusual and increasing pelvic area discomfort.
  • Difficulty in urination or change in bowel activity.
  • Nausea, vomiting or diarrhea.
  • Sharp and shooting pains.
  • Pain or burning urination.
  • Abdominal swelling.
  • Unusual back pain.
Fertilization Of Eggs:

On the day of egg retrieval the husband should provide a semen sample by masturbation, the sperms are separated from the seminal plasma and are washed to inseminate the eggs. An optimum number of spermatozoa are placed with each egg in a separate dish containing IVF media. In case of ICSI sperm is injected inside the egg.The eggs and the sperms are kept in the incubator at 37 degree Celsius in a Co2 incubator. Normally it takes about 18 hours for fertilization later the embryo divides into two cells. The embryo further divides into four cells and eight cells stage. After 48 hours of incubation the embryos will be ready for transfer into the uterus.

Embryo transfer:

The patient will be informed about the time and date of embryo transfer. The embryo transfer is a simple procedure and no anaesthesia is used normally. The embryos are transferred with a catheter along with a few drops of culture media. The entire procedure takes about 10-20 minutes. During the procedure a speculum is introduced into the vagina and a catheter is passed into the cervical canal and the embryos are placed into the uterus. The embryologist then examines the catheter under a microscope to make sure that all the embryos were transferred. Following the embryo transfer we keep the patient in the hospital for 24 hours for extra safety.At home the patient has to take rest for the next 2 weeks, should get up only to use the bathroom. Following the transfer,Some patients may experience a small quantity of blood like fluid or air from the vagina. There is nothing to be worried about this. The Progesterone tablets should be continued until the pregnancy test is done. These tablets should be introduced deeply into the vagina. They dissolve and absorption takes place.

    Post Transfer Guide Lines
  • Complete abstinence of intercourse till pregnancy test is done.
  • No jogging, aerobics, exercise etc.
  • Heavy physical activity should be avoided and stay at home only.
  • Do not take any non-prescribed medications or other prescribed ones without the approval of the doctor.
  • Try to keep yourself busy in reading books, hearing music, so that you are mentally distracted from the tension of anxious waiting For 14 days.
  • The Progesterone tablets should be used through vagina till confirmation of the pregnancy,followed by the blood test.
Please note: It is not unusual for some (in about 50% Approx.) to have little spotting or bleeding prior to the pregnancy test. The patients are requested not to worry about it since only a blood test can confirm that the period has started. After two weeks of the embryo transfer,pregnancy test will be done to confirm the pregnancy.
    Pregnancy Testing :

    Quantitative ß HCG pregnancy testing will be done after 14 days of embryo transfer.Blood will be drawn from the patients between 8.30 am to 11.00 am and serum will be tested for HCG.

    Most of the tests either reveal positive or negative. However,in some patients we see a test that is weakly positive. Such results are usually seen in the following conditions.

  • Late but normal implantation of embryo.
  • Discontinuing the pregnancy.
  • Ectopic pregnancy.

In such cases a second test will be carried out to determine whether the pregnancy is progressing or not. If the pregnancy is positive,usage of Progesterone tablets should be continued. After 14 days of pregnancy tests ultrasound scanning will be done to determine the status of the pregnancy. (Single or twin pregnancy etc.,)

    What are the factors influencing the success of the IVF procedure ?
  • Do not keep IVF as the last resort but keep it as the best resort.
  • Treatment should be available when you want it.
  • More than one egg should develop.
  • Blood hormone levels should rise sufficiently. Eggs should mature.
  • Premature ovulation should not occur.
  • Aspiration of eggs should be successful.
  • Sperms should fertilize more than one egg.
  • Fertilized egg should divide and grow healthy for final implantation in the uterus.
  • Ultimately good egg and sperm will produce embryo of good quality.
    What are the limitations of IVF procedure ?
  • In older women the poor quality eggs is a limiting factor for success of the IVF. In such patients the chances for pregnancy are poor.
  • Men with low count of sperms.
  • Women with a damaged uterus will have poor chances of implantation of the embryo.
Testicular Biopsy (TESA)

In patients suffering with obstructive azoospermia sperms can be obtained directly from the testes by doing an epididymal sperm aspiration or biopsy and the sperms can be used for fertilizing the oocytes. The biopsy material can also be preserved in liquid nitrogen for subsequent use.

Firm Hospitals have facilities for conducting the testicular biopsy and semen banking for such patients. We generally take 3-4 biopsy samples and preserve them in liquid nitrogen for long term storage. This means that patients can undergo ICSI, the second time if they want to have a second child.

Assisted Hatching

Assisted hatching is performed in Firm Hospitals. In this method,a hole is made in zonapellucida of the embryo using laser.

Cryo Preservation of Embryos:

Sometimes when you undergo IVF/ ICSI treatment more than the required embryos will be produced. The excess embryos can be preserved in liquid nitrogen for long periods. Such embryos can be used for future transfer either to have another child or if the cycle fails for any reasons. These Cryo preserved embryos can be conveniently utilized without any hyper stimulation again. Therefore embryo Cryo preservation reduces the cost of treatment and it can be used as and when required.

But one must know that all the Cryo preserved embryos cannot be preserved with life. Pregnancy can be achieved only with embryos with life. However,it is a convenient procedure to the patients who get more number of oocytes (more than required for a single transfer).

    INTRACYTOPLASMIC SPERM INJECTION (ICSI)

    Intra cytoplasmic sperm injection is usually referred as micro manipulation is a useful method for treating severe male factor infertility patients.

    In this procedure the single sperm injected into an egg,then the fertilized embryo is transferred to the women’s uterus. This procedure mainly effective for men who have very poor sperm count.

  • Involves injecting a single sperm into an egg
  • Fertilized egg is transferred to women’s uterus
  • Solution to irreversible infertility in men
TESA – ICSI

In patients suffering with obstructive Azoospermia sperms can be obtained directly from the testis by doing an epididymal sperm aspiration or biopsy and the sperms can be used for fertilizing the oocytes.

In ICSI, the entire process is the same as IVF till egg collection. Once the eggs are retrieved, the sperm is directly injected into the egg

    The Female Reproductive System

    The Female Reproductive system consists of the following parts:

  • Ovaries
  • Fallopian Tubes
  • Uterus
  • Cervix
  • Vagina
Ovaries:

Each ovary is about the size of an unshelled almond. It releases eggs, called ovum every month. It also produces female sex hormones, control the menstrual cycle as well and produces and maintains the secondary sexual characteristic such as breasts. The ovaries contain 2 million immature eggs at birth itself. One immature egg matures every month after a female child reaches 12 years. It takes around a thousand tail strokes to drive a sperm forward by a centimeter.

Sperms are helped on their way by contraction of the uterus, which forces them upwards into the body. The contractions are stimulated by prostaglandins (hormones) contained in the semen. At most times of the monthly cycle, sperms may not reach the uterus at all, as it is kept out by a plug of impenetrable mucus around the cervix. Only at the time of ovulation, the cervical mucus become loose and allows the sperm to pass through. Once in the vicinity of the egg, the sperm is chemically attracted to it. When they reach their destination,they must first penetrate the corona radiata. The sperm release certain enzyme that dissolves the corona radiata. This allows the head of the sperm to burrow downwards towards the egg cell. This journey takes about 30 minutes. Once the sperm is inside, it releases a chemical signal that activates the egg. The sperm head is drawn towards the nucleus of the egg, and their genetic material fuses.

Fallopian Tubes:

The egg and the sperm meet in the fallopian tubes. For normal conception, the tubes should not be blocked

Uterus

The inner lining of the uterus should be conducive for implantation of the embryo. If it is thin, the embryos will not implant or if there is any hindrance like septa, polyp, fibroid or adhesion, the embryo will not implant. So before starting treatment, hysteroscopy is mandatory to check the uterine cavity.

Cervix

The cervix is the entrance to the uterus. It is a “gate way” for sperm to enter the uterus.

Vagina

It is a muscular tube about 3” – 4” in length. It is an exit route for the discarded endometrium during menstrual periods, and for the baby during birth.

Menstruation

Menstruation is the natural loss of blood and cellular debris from the uterus. It usually occurs at monthly intervals throughout the reproductive life of a woman. It is commonly referred to as period. Each month there are 2 events taking place; ovarian and menstrual events. Both these events are responsible respectively, for the release of an egg from an ovary, and preparation of the uterus to receive the egg. Both the cycles last on an average, for 28 days.

Hormones Involved In Ovarian Cycle

The ovarian cycle is controlled by two pituitary gland hormones: Luteinizing hormones (LH) and follicle stimulating hormones (FSH)

FSH stimulates some follicles (Sacs) containing immature egg to grow and mature. Eventually one follicle and its egg become larger than the others. In the mid cycle, LH levels rise and cause ovulation. The follicle bursts, releasing its egg into the uterine tube. If the egg is not fertilized, a new ovarian cycle starts 14 days after ovulation.

Hormones Involved In Menstrual Cycle

The menstrual cycle causes a thickening of the endometrium, the inner lining of the uterus, in readiness to receive the fertilized egg.

FSH stimulates the ovary to release estrogen, which stimulates endometrial thickening.

Following Ovulation, The ovary also secrets progesterone

Both estrogen and progesterone together stimulate further thickening of the endometrium. If fertilization does not happen, progesterone and estrogen level drops, the endometrium fragments sheds and a woman get her period.