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PGD vs PGS

OVERVIEW
PGD (Pre genetic Diagnosis) and PGS (Pre Genetic Screening) are two different genetic tests, used by the doctors to investigate whether the In Vitro Fertilized embryo is suitable for implantation in the uterus and will result in a successful pregnancy or not.
Embryos with abnormal chromosomes or genes often result in either miscarriages, a failed treatment cycle or a child with a chromosomal or a genetic disorder.

PGD is performed to detect genetic defects or single gene mutations within the embryos, hence preventing certain genetic diseases to be passed on to the child.
Whereas PGS is performed to detect whether the embryo consists of any chromosomal abnormalities and if it has a normal number of chromosomes or not.

Pre Genetic Diagnosis

PGD is a technique performed prior to implantation of an in vitro fertilized embryo. It is performed on the embryo to detect any DNA change or mutation of a particular gene, called a single gene disorder or a Mendelian disorder. These disorders particularly pass from the parents to offspring and hence are important to be detected before implantation into the mother’s uterus is performed. The occurrence of single gene mutation is rare, however if both the parents are carriers of that particular genetic mutation then the chances of their offspring inheriting the disease are high. Therefore, PGD allows the parents to choose disease free and healthy embryos.

Steps involved in PGD technique:

  • After the IVF process of egg retrieval and fertilization in a laboratory takes place, the embryo starts to divide into multiple cells.
  • Around day 5 of cell multiplication, a few cells from the embryo are removed micro surgically for examination and the embryos are frozen.
  • Then DNA evaluation is performed on the cells of each embryo to check for inheritance of a particular genetic mutation.
  • When the PGD technique labels the embryos mutation-free, the embryo(s) are transferred in the uterus and couples are asked to wait for implantation and a positive pregnancy result.
  • If there is an excess of embryos that are mutation-free, they are frozen safely to be used later for implantation, whereas embryos with mutation(s) are destroyed.

Who is a candidate for PGD?

  • Carriers of single gene mutation disorders
  • Carriers of sex linked genetic disorders
  • Parent(s) with chromosomal disorders
  • Women aged 35 years and above
  • Women with more than one failed attempt of fertility treatment
  • Women with recurrent pregnancy loss

Following diseases can be detected using PGD:

  • Cystic fibrosis
  • Sickle cell anemia
  • Myotonic dystrophy
  • Tay-sachs
  • Thalassemia
  • Fragile X syndrome

Pre Genetic Screening

PGS is a technique performed prior to implantation of an in vitro fertilized embryo. It is performed on the embryo to check for the chromosomal normalcy i.e. the normal number of chromosomes. A normal human contains 23 pairs of chromosomes that makes a total of 46 chromosomes. PGS evaluates the embryo for any addition of chromosomes or a missing chromosome, unlike PGD that is used to detect specific genetic disorders. Therefore, PGS allows the detection of genetic syndromes that are caused by chromosomal aberrations due to numerical alterations.

Steps involved in PGS technique:

  • Initial steps are the same as in PGD, after cellular multiplication the cells from an embryo are removed micro surgically to be examined.
  • The DNA from these cells is then evaluated to check for a possible chromosomal abnormality.
  • Only the embryos that are disease-free are labelled as fit for transfer in the mother’s uterus.
  • Additional embryo(s) are frozen to be used in the future, whereas the diseased embryos are destroyed.

Who is a candidate for PGS?

  • Either parent with a family history of chromosomal abnormalities
  • If the sperm is at risk of carrying a chromosomal disorder
  • Women aged 35 years and above
  • Women with more than one failed attempt of fertility treatment
  • Women with recurrent pregnancy loss

Following diseases can be detected using PGS:

  • Down syndrome
  • Edward syndrome
  • Patau syndrome
  • Klinefelter syndrome
  • Turner syndrome

 

SUMMARY

PGD

                                PGS

Checks for genetic disorders by evaluating an embryo for specific genetic mutation or a DNA change.

 

 

Can detect single gene mutations.

 

 

Performed to detect cystic fibrosis, myotonic dystrophy, sickle cell anemia, tay-sachs etc.

 

 

Can be used for gender selection.

               

 

 

Methods used in PGD; Fluorescent in situ hybridization(FISH), polymerase chain reaction(PCR) etc.

 

Checks for genetic abnormalities by evaluating an embryo for chromosomal alterations numerically.

 

 

Does not detect single gene mutations.

 

 

Performed to detect Down syndrome, turner syndrome, klinefelter syndrome etc.

 

 

Can be used for gender selection.

 

 

Methods used in PGS; Array comparative genomic hybridization(aCGH), quantitative real time polymerase chain reaction (qPCR), next generation sequencing(NGS) etc.

 

   

In vitro fertilization is a complex, time consuming and an expensive process, hence PGD and PGS are performed to increase the percentage of positive results of IVF. Both the tests hold immense importance and should be performed prior to implantation.

However PGD has a number of limitations and is considered an old technology where as PGS is more advanced and accurate. This is mainly because PGD test depends on single cell evaluation hence its effectiveness is questionable. In comparison PGS detects aneuploidy and mosaicism in embryos which allows scientists for the exclusion of such embryos from the Embryo Transfer and this can significantly improve success rates in IVF.

 

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What is Hyperstimulation?

The purpose of infertility treatment including IVF and other assisted reproductive techniques is to increase the chances of infertility for infertile couples. This treatment is intended to stimulate the ovaries to ensure that several ovarian follicles are developed instead of just one that develops in a normal natural cycle. This helps the doctors to collect several oocytes (eggs) and eventually several embryos to be transferred into a female uterus.

OVARIAN HYPERSTIMULATION SYNDROME :

Ovarian Hyper stimulation syndrome commonly called as OHSS is a rare iatrogenic syndrome, which occurs as a result of these ovarian stimulation treatments and fertility drugs for ovulation. The most commonly used fertility drugs are the gonadotropin drugs, clomid and letrozole.

Gonadotropins includes FSH and LH and are used in injectable form whereas clomid and letrozole are taken orally. The purpose of both is to stimulate the ovaries in order to obtain increased number of oocytes at the time of egg retrieval.

WHO clinical classification:

The classification of Ovarian Hyper Stimulation Syndrome is based on the signs and symptoms experienced by the female patients, and are divided into mild, moderate and severe forms, based on the degree of their severity these are classified as the following;

Mild OHSS:

Increase in Ovarian volume, less than 5cm

Excessive steroid production

Pelvic discomfort

Moderate OHSS:

Increase in Ovarian volume, between 5cm to 12cm

Abdominal Distension

Digestive problems like nausea, vomiting and diarrhea

Severe OHSS:

Increase in Ovarian volume, greater than 12cm

Renal failure

Ascites (accumulation of excess fluid in the abdomen or peritoneal cavity)

Pleural effusion (accumulation of excess fluid in the pleural cavity, between the layers of the lungs and the rib cage)

Coagulation disorders (blood disorders leading to disruption of clot formation and hence bleeding)

This classification helps to determine the type of treatment required, should the patient experience ovarian hyperstimlutaion signs and symptoms. Normally the infertility specialists are familiar with these signs and symptoms, and hence are able to detect them in order to provide appropriate treatment required. Since these are serious complications and can be potentially life threatening if left untreated, they should be catered to very effectively.

If you experience any of the above mentioned signs and symptoms during an ovarian stimulation cycle, you should consult your doctor immediately and pay him or her a visit.

Risk Factors:

The risk of having hyperstimulation can be prevented by screening the patients for risk factors, this should be considered before starting the treatment.

The Risk Factors of having the complication of Ovarian Hyper stimulation syndrome are as follows;

Your age is 30 years or younger

You have Polycystic ovarian syndrome

Your AMH (Anti Mullerian Hormone) levels are high

You are underweight

You have a history of developing OHSS in the past

This means a younger patient with a normal ovarian reserve and with polycystic ovarian syndrome is at a higher risk of developing hyperstimulation complications than an older patient with a decreased ovarian reserve. To check for ovarian reserve, the most commonly used test by our doctors is the level of Anti Mullerian Hormone (AMH).

Prevention of OHSS

When starting the infertility treatment, your specialist doctor must take in consideration, your age, your ovarian reserve, your hormonal levels and the possibility of having polycystic ovarian syndrome, in order to avoid ovarian hyperstimulation.

Also after starting the treatment, your doctor would follow the stimulation response to fertility drugs, using blood tests and ultrasound, and so the gonadotropin doses must be tailored according to individual patient’s response. Thus, if your doctor notices an excessive response to ovarian stimulation, he or she should decrease the dose accordingly.

Although hyperstimulation occurs only after ovulation has taken place, your doctor can still look for signs that suggest increased risk during a particular cycle. If that’s the case, then in response to the fertility drugs, your ovaries will develop an increased number of follicles than expected, and the estradiol or estrogen level in your body would also be higher than normal, meaning that your chances of having OHSS in this cycle are high.

Ideally under such circumstances the doctor would cancel your treatment because pregnancy can worsen OHSS. Your doctor would cancel the insemination process and would advise you to avoid having intercourse if you were undergoing an IUI (intra uterine insemination). Whereas if you were undergoing an IVF treatment then any fertilized embryos would be frozen and saved to be transferred into your uterus at a later date, when your body allows.

An alternative to this cancellation of ovarian stimulation treatment is delaying ovulation and the process is called ‘coasting’. This is achieved by prescribing a Gonadotropin releasing hormone antagonist commonly called GnRH antagonist, that would prevent the LH surge, which is required for ovulation. This delay lowers the risk and severity of complications and increases the chances of carrying on with a successful pregnancy.

One should not exert themselves thinking of these complications, instead you should be in contact with your doctor during the entire process and inform him or her about any alarming signs. Of course your doctor would provide you with the relevant information and material, we have come across some pamphlets delivered by an infertility clinic called Australian concept infertility center, it had a lot of relevant information on hyperstimulation.

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Delayed Embryo Transfer

During the course or struggle of infertility, the most important process is of embryo transfer and even more crucial is the right time for this process to be performed. Thus, it is very important for our infertility specialists to choose the right time for embryo transfer, that being the time with which our patients could benefit the most and have the highest chance of conceiving.

Embryo transfer is the technique performed at many infertility clinics including Australian concept infertility Center with the help of our infertility specialists as well as the embryologists, who work as a team to transfer the embryo with in a female uterus.

However, when this technique is delayed for different reasons, the major reason being patient welfare then it is called ‘delayed embryo transfer’

In delayed embryo transfer the fertilized embryo of our IVF (in vitro fertilization) patient are frozen so that they can be used in the future and be transferred in the female uterus when the conditions are feasible.

What is an embryo?

As a normal method of sexual reproduction in human beings, when an egg cell and a sperm cell, from a female and a male body respectively are fertilized they form a single celled organism called zygote, this zygote then undergoes cellular division to form an organism called embryo, which undergoes further growth and eventually forms into a fetus.

When this process of fertilization takes place outside a women’s body, and in a petri dish inside a lab, it is called in vitro fertilization (IVF). An egg is retrieved from a female body after closely monitoring her ovulatory process and a sperm is retrieved from a semen sample of a male, these are then manually combined to form an embryo. The sperm is directly injected within the cytoplasm of an egg and this procedure is called intra cytoplasmic sperm injection (ICSI).

The in vitro fertilization process is given approximately five days for the embryo to divide and grow in size, it goes through the division cycle of two-cell, four-cell and eventually eight-cell embryo. The formation of an eight-cell embryo on day three of in vitro fertilization is considered a very good sign and points towards higher chances of success.

What actually is Embryo transfer and delayed embryo transfer?

Once an embryo is formed ‘in vitro’, it can be used in the following ways;

Either it can be transferred to the female uterus during the same ovulation cycle in which her eggs were retrieved and fertilized, this is called a fresh cycle embryo transfer. This includes all the stages of egg retrieval, fertilization, culture in lab for several days and embryo transfer during one menstrual cycle.

Or they can be frozen and used later for transfer and eventually implantation, this is called a delayed embryo transfer. This involves the freezing or cryopreservation of good quality embryos for future use, these frozen embryos can be used in the next cycle or after months and even after years, embryos frozen for as long as 10 years have also been reported to be successfully implanted!

Depending on a female’s condition during the egg retrieval cycle, the infertility specialists and embryologists decide whether to go for a fresh cycle embryo transfer or a delayed embryo transfer.

Considering the enhanced and improved techniques of embryo freezing now, many specialists opt for freezing all good quality embryos and use them once the recipient female’s uterus and ovaries have returned to a normal condition seeing that she has undergone intense hormonal stimulation during the ovulatory process and during the egg retrieval procedure.

What happens after the embryo is transferred?

Most couples ask this question, of course concerned about the fate of the new baby they just helped making, with an IVF treatment. They want to know the chances of them becoming parents with this embryo.

Well once the embryo is transferred to a women’s uterus, the final hurdle for the embryo to overcome is to get implanted! And this depends on the egg quality, sperm quality and then the embryo quality that resulted from the fertilization of the former two.

A brief description of what happens to an embryo after being transferred;

-The blastocyst continues to divide and emerges from its shell,

-It then starts to attach itself to the uterine lining,

-Once the blastocyst invades the uterine lining the process of implantation occurs and the women may experience some bleeding or spotting, however no bleeding doesn’t mean you have not conceived,

-The embryo then digs deeper and starts getting blood supply from the maternal blood vessels,

-As it continues to grow, a hormone called human chorionic gonadotropin (HCG) is released in the blood stream,

-More HCG is released when fetal development is in full swing and the placenta has developed,

-This is when one can take the home urine pregnancy test, around the 9th day of transfer however we at Australian concept infertility medical Center prefer you wait till 10-12 days for a blood beta-hcg test which is much more reliable. We give our couples a date to come and get tested for pregnancy and we love to give our couples the good news ourselves!

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What is Polycystic Ovarian Disease ?

 

One of the most common hormonal disorder associated with the female ovaries is POLYCYSTIC OVARIAN DISEASE, commonly called as PCOD. It causes infertility, hence has become a growing concern for females trying to conceive.

Role of ovaries in a female reproductive system.

To understand clearly what exactly is Polycystic ovarian disease one must know the function of the female ovaries as well as the knowledge of its role in reproduction because ovaries are a very important organ in a female’s reproductive system. Not only that, they are also very important in terms of fertility. Every normal female has a pair of ovaries in her lower abdomen, these are the female reproductive glands situated on either side of the uterus and connected to the uterus through the Fallopian tubes. The function of these ovaries is to form the ova or eggs and release them (eggs) into the uterus every month. They are solid, ovoid structures each measuring about 1 centimeter in thickness, 3.5 cm in length and 2.5 cm in width. As mentioned earlier ovaries are the reproductive glands and hence release hormones mainly; estrogen and progesterone. This release of hormones is under the influence of hypothalamus and is triggered by it.

Estrogen and progesterone are extremely important for a normal growth of the female reproductive system as well as for fertility. They regulate the female menstrual cycle, the growth of secondary sexual characteristics in a female at puberty as well as the ovulation process.

What is ovulation?

When a girl hits puberty, the ovulation occurs, it is a process in which one egg is released from an ovary each month, the ovaries usually take alternate cycles to release an egg.

The pituitary gland receives a signal from the hypothalamus to release two hormones, Follicle Stimulating Hormone (FSH) and Luteinizing hormone (LH) called the gonadotropic hormones. One should bear in mind that a female or a baby girl is born with an egg reserve, which means that she is born with all the eggs of her lifetime and these eggs are contained in the follicles that are found inside the ovaries. So at puberty each female starts her menstrual cycle with approximately 400,000 eggs. These eggs mature within a follicle before they are released and this release is under the influence of FSH and LH. The FSH causes growth of an egg while the LH Is responsible for the release of an egg from the ovary.

What happens to the egg after being released from an ovary?

Once the follicle ruptures, the egg is released from the ovary and captured by the fallopian tubes and guided through to the uterus through the muscular contractions of the tubes. It is during this time and within 24 hours of egg release that fertilization of the egg with a sperm can take place in order to form an oocyte which later undergoes multiple cell divisions to form an embryo. If an egg is not fertilized within 24 hours of its release it begins to degenerate.

POLYCYSTIC OVARIAN DISEASE

It should be much easier to understand PCOD now that we have some knowledge about the ovaries, the ova and the hormones involved.

As the name suggests PCOD occurs when the ovaries develop multiple cysts, (poly means many) making the ovaries look bulky or enlarged because these are not the functional cysts that disappear instead they remain and occupy a large area of the ovaries. Therefore, the development of these cysts hinders the normal function of an ovary of releasing an egg in turn causing infertility issues because as discussed earlier the process of ovulation is essential for a female to conceive and get pregnant.

It not only affects the ovulation process but also disturbs the menstrual cycle causing irregular periods and infertility. In addition to this the presence of these cysts causes hormone imbalance as well, increased number of cysts cause the release of a hormone called androgen instead of estrogen, androgen is a male hormone and it is the main reason why females with PCOD have facial hair and chest hair, because the male hormone follows the male hair distribution pattern.

Symptoms of PCOD?

Not all women with PCOD have the same symptoms but irregularity of menstrual cycle is the most common symptoms, other symptoms include; Acne, irregular periods or complete absence of periods, excessive hair growth and at unusual places, pelvic pain, weight gain, mood swings and the most important infertility!

What causes of PCOD?

The exact cause of PCOD is yet to be discovered, but some factors play an important in leading to this condition, they include;

Heredity, if a mother has multiple cysts in her ovaries, the daughter is most likely to inherit it.

Excess androgen production, androgens are male hormones but are found in excess in a PCOD female.

Insulin resistance, if a human body resists insulin then there is excess production of insulin in the body this in turn leads to excess androgen production and eventually difficulty in ovulation.

In our society, infertility is a very serious concern as it determines the future of a female.

Thankfully today we have infertility specialists and infertility centers like Australian concept infertility center where it is not impossible to have a baby even if you are suffering from Polycystic ovarian disease, thanks to our infertility specialists and our expertise in assisted reproductive techniques. We treat PCOD with medications and in some cases use the assisted reproductive techniques, if required, which include ICSI, IVF, TEST TUBE BABY. We are making it possible for our PCOD patients to conceive and have a life that they imagined with their own children.

 

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Sperm Freezing for Cancer Patients

The diagnosis of Cancer is becoming extremely common in our world as the time passes, and hence is becoming a major issue for us to solve, not only that it is also occurring at earlier ages than expected! Which leaves very little time for men to be able to react before their sperm count decreases. This is because they are too busy fighting the battle that they often tend to ignore the fact that they will want kids in the future. And for that the most important thing one needs is a Sperm! And an egg of course. But thinking of the male perspective sperm quantity and quality is very important, which starts declining not only when the person has cancer but also because of the multiple treatments and medications he undergoes to cure it, chemotherapy and radiotherapy being the main culprits!

The most important part of avoiding fertility issues in the future is banking the sperms for freezing, and this should be practiced more when children and adult men under the age 45 are diagnosed with cancer. Once they have their sperms frozen, they can in a later date or when they decide to have a family come to Australian concept infertility Center and discuss with our highly capable consultants about the next steps that should be taken. Following options would be given to our patients with the pros and cons of each discussed with the patient in detail, these include; IVF, ICSI and TEST TUBE BABY.

Now, it is understandable that it’s a difficult thing to hear when one is already going through accepting the fact that he has cancer and then your doctor tells you that your future fertility may also get compromised due to the cancer treatment that one has to undergo, it may cause further distress to a man. But these treatments along with the negative effects are the life saving techniques that a cancer patient needs to undergo.

The patients may think how does the process of sperm freezing actually works?

Well the process of sperm freezing or sperm banking involves the collection of a semen sample and freezing of the sperms which are thawed at a later time and used in one of the many assisted reproductive techniques including IVF, ICSI etc., when the patient decides to have a family but is having difficulty conceiving. This technique is called cryopreservation. There are other techniques which includes testicular sperm extraction and testicular tissue freezing but by far the most successful and the most commonly used technique is cryopreservation for male cancer patients.

One of the many side effects of cancer treatment includes sexual dysfunction especially when the cancer is of the pelvic region which includes; bladder, colon, rectal, testicular and prostate cancer, therefore it becomes extremely important for these patients to choose cryopreservation in order to preserve their fertility and ensure their families. This occurs mainly because in radiation therapy the radiation is targeted towards the pelvic region. In addition to this all other cancer patient who have undergone cancer therapies have an adverse effect to their blood vessels, nerves and hormones that control the sexual function.

Some men ask what are the ‘dangerous’ radiation doses and dangerous chemotherapy drugs to cause fertility issues?

For patients about to undergo chemotherapy and radiation, these are very common concerns and therefore should be taken in to consideration for patient satisfaction, the answer to these questions aren’t simple because it depends on the shielding technique used during radiation, the dose of radiation used, as well as the dose to the testicles. However, for total body irradiation it is a known fact that about 80% of the patient will have permanent infertility. For chemotherapy the main culprits are the alkylating agents, these agents act by preventing DNA replication by forming covalent bonds and hence stopping the growth of rapidly dividing cells as explained earlier. This again is dependent on the cumulative dose of chemotherapy drugs as well as the age of the patient. I.e. men more than 40 years of age are less likely to remain fertile after therapy.

One may have the question about how does chemotherapy and radiation therapy affect fertility?

In order to understand this one may first try to understand the mode of action of the chemotherapy drugs and radiation. Their mode of action is to stop the growth of rapidly dividing cancer cells by damaging their DNA. Now the body of course has some cells that rapidly grow as a normal mechanism of the body, these cells include gastrointestinal cells, hair follicles and some reproductive tissues along with the sperm cells. Since sperm cells are constantly dividing they are a target for chemotherapy and the radiation therapy. This means that the cancer therapy cannot distinguish between the harmful ‘bad’ cancer cells and the normal “good” body cells, destroying the DNA of all growing cells and hence causing an issue for men who have undergone these therapies and who wish to have a family in the future.

How to go about it?

It is an oncologist’s job to mention the possibility of sperm banking or cryopreservation to the patient before starting the cancer treatment. Unfortunately, some cancer patients are not aware of this possibility since their oncologist did not discuss the option of sperm banking with them. For those who are fortunate enough to have been informed by their oncologist about sperm banking are either too emotionally unstable to think about it or are physically drained to look for a clinic or schedule an appointment. While for some it is just an uncomfortable process which makes them avoid it.

Whichever the case may be with you, you can count on us and come to discuss all the possibilities, our team will sit with you, answer all your queries and give you the best options according to your needs, so even you can have a healthy baby!

Also remember Australian concept infertility medical Center gives special discounts to cancer patients, because we care for you to have a baby!

 

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Role of Prolactin in IVF Treatment

IVF

Prolactin is a chemical that is secreted by pituitary gland. This is the pea-sized gland found in the middle of brain and is responsible for triggering many body’s processes. It is found in both men and women and is released at various times throughout the day and night. Prolactin is generally released in order to stimulate milk production in pregnant women. It also enlarges a woman’s mammary glands in order to allow her to prepare for breast feeding. On the other hand, it also affects ovulation and menstrual cycles. This is why it is nearly impossible to become pregnant when a woman is breastfeeding. Prolactin inhibits two hormones: follicle stimulating hormone (FSH) and gonadotropin releasing hormone (GnRH). Both of these hormones are responsible for eggs maturation and development in the ovaries, so that they can be released during ovulation. Thus when a woman have excess prolactin level, ovulation is not triggered rendering a women infertile.

 

By -Dr. Ayesha Maqbool

ACIMC Lahore, Coordinator (MBBS)

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Infertility: A Stigma of Life

IVF

Infertility is a major life event that brings about social and psychological problems.

Main themes include:

  1. Cognitive reactions of infertility (mental engagement; psychological turmoil).
  2. Emotional-affective reactions of infertility (fear, anxiety and worry; loneliness and guilt).

In Pakistan parenthood is almost an obsession. According to a report of Express tribune in year 2017, about 21.7 per cent of all couples in Pakistan are unable to have children and most of these couples unfortunately are faced with an extreme social stigma. But every dark cloud has a silver lining and in this ray of despair ICSI is like a miracle. It is an appropriate treatment for couples suffering from infertility. This treatment involves injecting a single sperm directly into an egg. The fertilized egg (embryo) is then transferred in to womb (uterus).It gives a chance of conceiving genetic child when other fertility treatments options are unlikely to do so.

 

By -Dr. Ayesha Maqbool

ACIMC Lahore, Coordinator (MBBS)

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Ovarian Reserve Test AMH

IVF

Women are born with their lifetime supply of eggs, and these gradually decrease in both quality and quantity with age. Anti-Mullerian Hormone (AMH) is a hormone secreted by cells in developing egg sacs (follicles). The level of AMH in a woman’s blood is generally a good indicator of her ovarian reserve.  AMH does not change during your menstrual cycle, so the blood sample can be taken at any time of the month – even while you are using oral contraception. An AMH test gives us some insight into the remaining quantity of eggs and number of fertile years you may have, but it cannot tell us much about the quality of those eggs.

By -Dr. Rushda Akram

ACIMC Lahore, Coordinator (MBBS)

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IVF

Difference Between Gynecologist and Infertility Specialist

Progress and development is an integral part of human nature. As scientists and physicians began to push the frontiers in the study of human body it became clear that a single physician is not able to fully understand the intricate details of all areas of medicine. This gave rise to formation of specialties like cardiology, nephrology, urology, gynecology and many others. However, in recent years as a result of further researches done in the field of medicine the generalized studies have become insufficient leading to formation of sub specialties

Gynecologists are doctors who deal with the general health of female reproductive system as a whole and the doctors who have studied and worked in infertility treatment specially are considered infertility specialists. These are the doctors who have spent years studying and practicing new treatments for couples unable to conceive naturally.

Just like a patient suffering from heart issue prefers to get treatment from a cardiologist and would not visit a gastroenterologist to treat his heart issue similarly couples suffering from infertility should visit infertility specialist to ensure that they get proper treatment individualized to their condition. Gynecologist although are knowledgeable about female reproductive system but sometimes treatment of infertility needs a combined approach addressing issues related to field of urology and endocrinology also. An infertility specialist can more accurately assess the conditions of such patients and provide necessary intervention increasing their chances to conceive.

 

By -Dr. Saira Afzal

ACIMC Lahore, ART Coordinator (MBBS)

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IVF

Dual Stimulation in In Vitro Fertilization

In vitro fertilization, IVF is a set of procedures that includes combining eggs of a female and sperm of a male outside the mother’s womb. Once the embryos are formed they are placed inside the uterus.
Ovarian stimulation is done during IVF in order to retrieve multiple mature eggs from the female ovaries. Multiple eggs maximize the chances of increased number of fertilized eggs that can be implanted back in the uterus, thus increasing the chances of pregnancy leading to a healthy baby.
Ovarian stimulation in IVF involves injection of medication consisting mainly hormones for 8-14 days starting from the second day of periods. These injections cause the ovaries to stimulate and mature multiple eggs. Frequent ultrasounds are done to monitor the increasing sizes of the follicles encircling the eggs. Once the follicles have reached a favorable size, egg retrieval is done. These eggs are then injected with the male sperm and eventually fertilization occurs.

Dual Stimulation or double stimulation is done in patients who show a poor response to hormonal injections usually due to a poor ovarian reserve. Poor response usually corresponds to retrieval of fewer mature eggs.
As the name suggests, dual stimulation has 2 rounds of stimulation done in order to retrieve as many mature eggs as possible. The 1st stimulation starts from 2nd day of periods till the 1st retrieval and second stimulation begins from the next day. This stimulation is also done with injections that again stimulate the ovaries to mature a few more eggs. When the ultrasound shows an increase in the follicle size, a second egg retrieval is done. These 2 stimulation and retrievals yield a good number of eggs that can be fertilized leading to a greater chance of a successful pregnancy after implantation.

 

By -Dr. Sundus Saeed Gill

ACIMC Lahore, Coordinator (MBBS)

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