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All Posts in Category: infertility

PCOD

PCOD

Polycystic Ovarian Disease (PCOD)

What is PCOD?

Polycystic ovaries refer to ovaries having many tiny cysts or bumps. These cysts themselves are not harmful and not needed to be removed. The name Polycystic Ovarian Disease refers to the enlarged ovaries that contain many very small cysts. Women with PCOD typically have high levels of androgens. Women with PCOD also have higher levels of insulin production which results in excess weight gain.

What causes PCOD?

  • • A hormone imbalance causes the symptoms of PCOD.
  • • Insulin resistance: The body cannot use insulin.
  • • High testosterone: the body produces too much testosterone.
  • • Although the exact cause is unknown, we do know that it is a result of a hormone imbalance in your brain and ovaries.
  • • Also, many women with PCOD have too much insulin, a hormone that turns food into energy.
  • • Too much insulin causes the body to prepare much testosterone which results in excess body hair or irregular periods.
  • • Insulin Resistance (Hyperinsulinemia): Despite having good nutrition and exercise, Hyperinsulinemia makes to gain more weight as being a potent growth hormone.
  • • Hyperinsulinemia also leads to high androgens that may cause infertility, acne, hair loss on the head, and facial hair growth.
  • • There is scientific evidence that daughters of women with PCOD are at an increased risk of developing PCOD.

Symptoms

These warning signs may indicate polycystic ovarian Disease (PCOD). Polycystic ovarian Disease symptoms are related to hormonal imbalance, lack of ovulation and insulin resistance and may include:

  • • Irregular, infrequent or absent menstrual periods.
  • • Acne or oily skin.
  • • Infertility (the inability to produce children).
  • • Hirsutism (excessive growth of body).
  • • Enlarged and/or polycystic ovaries.
  • • Male-pattern baldness or thinning hair.
  • • Acanthosis nigricans (darkened skin areas on the back of the neck, in the armpits and under the breasts).
  • • Overweight or obesity, especially around the waist.
  • • Skin tags

Besides, women with PCOD may be at increased risk of developing certain health problems. These may include:

  • • Hypertension (high blood pressure)
  • • Excess body weight
  • • Elevated cholesterol levels
  • • Type 2 diabetes or insulin resistance
  • • Elevated blood clotting factors
  • • Increased levels of C-reactive protein
  • • Heavy bleeding and endometrial cancer – Lack of ovulation for a long period may cause excessive thickening of the endometrium.

Diagnosis

You may undergo these tests if your doctor thinks you have PCOD. Polycystic ovary disease is easiest to treat when diagnosed early, says Reproductive endocrinology specialist, Dr. Suma Prasad. That’s tricky because so many adolescents have acne and irregular periods. “If your daughter has symptoms, don’t be afraid to ask your doctor,” she says. “If the doctor isn’t familiar with PCOD, find someone who is.” Even a later-in-life diagnosis is worthwhile, says Dr. Suma Prasad, the Best Infertility Specialists in Hyderabad. “After menopause, symptoms may ease but the underlying insulin problems remain.” These are a few methods used for Polycystic Ovary Disease diagnosis:

Laboratory tests

  • • Your doctor may ask for a complete blood count, also known as a CBC, or may check your hormone levels.
  • • These tests involve drawing a sample of blood and checking it.
  • • The information from these tests will help your doctor evaluate your health.
  • • Other blood tests measure chemicals in the blood to see how certain organs are working.

Pelvic examination

  • • During a pelvic examination, your health care professional will feel for lumps or changes in the shape of your vagina, cervix, uterus, fallopian tubes, ovaries and rectum.
  • • The health care professional also will use a speculum to open your vagina to look at your cervix and take samples for a Pap test.

Transvaginal ultrasound (also called ultrasonography)

  • • Transvaginal ultrasound (TVU) is a procedure used to examine your vagina, uterus, Fallopian tubes and bladder.
  • • It is also called an Endovaginal ultrasound.
  • • An ultrasound transducer which is a probe is inserted into the vagina and makes high-energy sound waves (which are ultrasound) of internal organs or tissues and make echoes.
  • • These echoes form a picture of body tissues or organs called a sonogram.

Transabdominal Ultrasound -Pelvis imaging

  • • A pelvic ultrasound makes a picture of the organs and structures in the lower belly using sound waves.
  • • A pelvic ultrasound looks at the bladder, the ovaries, uterus, cervix, and Fallopian tubes of a woman.
  • • Adolescent girls and unmarried women will be advised of an abdominal ultrasound.

Treatment

Individualized approach, personal attention to the health problems and nutrition needs has helped most of the women and adolescents who attended the PCOD clinic at Prasad Hospitals. Young women and for women who don’t want to become pregnant, polycystic ovarian Disease treatment is focused on correcting the abnormal hormone levels, reducing weight and managing cosmetic concerns. PCOD is not urable, but the symptoms are treatable by:

  • • A Healthy Lifestyle
  • • Healthy Diet & Regular Exercise
  • • Maintaining A Healthy Weight
  • • A healthy diet and increased physical activity allow more efficient use of insulin and decrease your blood glucose levels.
  • • “The hands-down best strategy is diet and exercise,” Dr. Suma Prasad says. “Losing just 10 percent of your body weight drastically reduces diabetes risk.”
  • • The treatment is focused on weight reduction and promoting ovulations especially for women who want to become pregnant.

Treatment may include:

Medication

  • • Metformin, a medication used in the treatment of Type 2 diabetes, often is used to decrease insulin resistance in PCOD.
  • • It also may help reduce androgen levels, slow hair growth and help you ovulate more regularly. The safety of this medication in pregnancy hasn’t been established.
  • • You also may be prescribed medications to treat hair growth and acne.
  • • “For relief of acne symptoms, a drug like spironolactone (Aldactone) may work quickly,” says our endocrinologist, with Prasad Hospitals, the Best Hospitals in Hyderabad.
  • • “Hair growth and loss often take much longer to improve.” Nutraceuticals, are now most often prescribed and best planned by the Gynecologist & Dietitian.

Oral Contraceptives

  • • For women above 18 years of age, our Gynecologists may prescribe birth control pills to help your periods become more regular.
  • • These pills also may improve other symptoms, such as heavy menstrual flow and the formation of ovarian cysts.
  • • Regulating periods also is important to prevent endometrial cancer, which can result from cell buildup in the uterus.
  • • Birth control pills stimulate the menstrual cycle and reduce male hormones.
  • • Another option is progesterone-only pills.

Ovulation Induction Medications

  • • These medications stimulate your ovaries to make one or more follicles (sacs that contain eggs) and release the egg for fertilization.
  • • For women with PCOD, these medications also increase the risks for having multiple births (twins or more) and ovarian hyperstimulation, a condition of excessive stimulation of the ovaries that can cause hormone changes, abdominal bloating and pelvic pain.
  • • These treatments are always individualized and discussed thoroughly with the woman before initiating it.

Follow-up Care

Prasad Hospital Gynecologists carefully draft the follow up by individualizing the case.

  • • Unmarried women and adolescents are given a follow-up chart once in a month. The chart includes lifestyle management, dietitian advice, weight monitoring, and medication.
  • • Many young women appreciate the non-hormonal approach and have achieved regular menses and weight loss.
  • • Married women, who do not seek pregnancy are followed up with similar charts and a supplementary monthly ovulation check by ultrasound which is safe and simple. Those who are keen on pregnancy are treated by our Infertility specialists.
  • • Hormone imbalance correction and successful ovulation induction are the key principles followed by our Infertility specialists.
  • • Infertility treatment is no ordinary medical procedure. There are many emotions involved.
  • • The best care blends progressive technology with honesty, empathy and caring. You have the best chance for success when you are relaxed and comfortable.
  • • We offer a private setting where we treat you with respect and confidentiality.
  • • We’ll help you understand your options and get answers to your questions.
  • • We’re here to support you emotionally as you try to fulfill your dreams of becoming a parent.
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Pregnancy Care

All You Must Know About Pregnancy Care

Pregnancy Care

“Schedule your first prenatal appointment for pregnancy care, once your pregnancy is confirmed. It comprises of the following aspects:

  • • Medical history
  • • Physical examination
  • • Laboratory tests
  • • Folic acid and other vitamin supplements
  • • Dietary counseling and lifestyle issues
  • • Normal discomforts of pregnancy
  • • Screening tests for fetal abnormalities

Our signature pregnancy care is an inverted pyramid of antenatal care which is a novel concept of antenatal care focusing on the very early weeks of pregnancy to identify high risks and this enables much more individualized patient and disease-specific approach of antenatal care.

For normal pregnancies without complications prenatal examinations are scheduled as follows:

  • • Every month from the 1st week to the 28th week.
  • • Every 2 weeks from the 29th week through the 36th
  • • Weekly from the 37th week until delivery.

Apart from the routine antenatal checkups which assess BP, weight, the progress of the pregnancy care and overall well-being, there are certain trimester-specific investigations or treatments which will be offered to pregnant women depending on the individualized need.

Ist Trimester

  • • Fetal viability/Dating scan (6-10 weeks).
  • • Nuchal translucency scan/first-trimester screening(11-14 weeks).

IInd Trimester

  • • Triple marker or quadruple marker screening if first-trimester screening is missed(15-17wks).
  • • Detailed anomaly scan (TIFFA at 18-20 weeks).
  • • Fetal 2D Echo.
  • • Screening for gestational diabetes.
  • • Tetanus immunization and the Influenza vaccine.

IIIrd Trimester

  • • Fetal growth and well-being surveillance by growth scan, fetal Doppler, biophysical profile, NST.
  • • Discuss birth/labor plans and labor analgesia.
  • • Anesthetists review

VBAC

We also encourage VBAC or Vaginal birth after cesarean

  • • There’s a good chance you’ll succeed if you’re an appropriate candidate for a vaginal birth after a cesarean, also known as a VBAC.
  • • Overall, about 60 to 80 out of 100 women who attempt a VBAC deliver vaginally.
  • • The chances of success are higher if the reason for your previous issue isn’t likely this time around.

Lactation

  • • At Prasad Hospitals, we follow the Baby-friendly hospital initiative launched by WHO.
  • • This initiative is an effort to implement practices that protect, promote and support breastfeeding.
  • • Some of them include encouraging early initiation of breastfeeding, on-demand, and exclusive breastfeeding and having trained and skilled staff to implement this initiative.

Postnatal Exercise

Postnatal exercises have many benefits. At this stage, your body can recover by pelvic floor exercises, low belly exercises.

Exercise can:

  • • Increases the levels of feel-good chemicals (endorphins) in your brain and boosts the mood.
  • • Lose any weight gained during pregnancy.
  • • Protects from aches and pains.
  • • Improve strength and stamina.

Postnatal Depression

  • • Many parents have this type of depression after having a baby.
  • • It’s a common problem, affecting more than 10 percent of women within a year of giving birth.
  • • Many women feel tearful, bit down, or anxious in the first week after giving birth which is called baby blues.
  • • If the symptoms start later, you could have postnatal depression which can start any time in the first year after giving birth.
  • • Consult the doctor if your symptoms could get worse and have a significant impact on you, your baby and your family.

Newborn care at Prasad Hospitals:

We have a dedicated pediatric team to take care of your precious newborn.

  • • Basic care for all newborns should include keeping the baby warm, supporting early and exclusive breastfeeding, providing hygienic umbilical cord and skin care, increasing hand washing and, identifying conditions that require counseling and care when to take a newborn to a health facility.
  • • They should be assessed for gestational age, birth weight, congenital defects and signs of newborn illness.
  • • After the first hour of life, newborns should have vitamin K and eye care
  • • Your new born may need supplements like calcium, vitamin D, iron, multivitamins which you can start in consultation with the pediatricians at Prasad Hospitals, the Best Multispecialty hospitals in Hyderabad.

Newborn Screening

We also offer routine newborn screening. Newborn screening identifies certain genetic, endocrine and metabolic conditions that can affect a child’s long-term health or survival. Early diagnosis and intervention can prevent death or disability.

Newborn Infant Hearing Screening

The auditory sense is important for the mental development of a child. About 5-6 out of 1000 children have hearing problems. Children identified with hearing loss before 6 months of age should have developing skills. Children not identified until later may ultimately suffer from irreversible and permanent impairments in speech, language, and cognitive abilities when compared to their peers.

Vaccination

  • • Vaccines are an important part of keeping your child safe and healthy.
  • • Newborn babies need to have a list of doses of vaccines as per the vaccination chart recommended by the pediatricians in India.
  • • Each vaccine helps prevent a disease from surfacing in your little one and hence, all of them are mandatory.
  • • Get Vaccine Scheduled for your child.
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Baby’s Movements in Pregnancy

Your Baby’s Movements in Pregnancy

Baby’s Movements During Pregnancy

What are the unborn baby’s normal movements in pregnancy?

Most women, when they are 18–20 weeks pregnant, can first aware of their Baby’s Movements During Pregnancy. However, if this is the first pregnancy, a woman may not become aware of movements for more than 20 weeks pregnant. Unborn baby’s movements as a kick, flutter, swish or roll can be felt by a pregnant woman. As the baby develops, the movements type changes. During the afternoon, evening, baby movements are felt more. During day and night, the baby may have sleep periods for mostly 40 minutes. The number of movements tends to increase until 32 weeks of pregnancy and then stay about the same, although the type of movement may change as you get nearer to your due date.

Why are my unborn baby’s movements important?  

If the baby’s movements get slowed or stopped, it implicates that the baby is not well. Around 50% of women notice the baby’s movements. Don’t use Doppler or phone apps to check the baby’s heartbeat.

How many movements are enough?

Every baby has a pattern of movements as there is no set number of normal movements. From 4-6 months, pregnant women can feel the baby movements more and stay up to 8 months and then stay roughly until giving birth.

What factors can affect the pregnant woman feeling her baby move?

If the pregnant woman is active or busy, she can be very less likely to be aware of the baby’s movements. Your baby lying head down or bottom first will not affect whether you can feel it move. If the baby’s back is lying at the front of the uterus, she may feel fewer movements than if the baby back is lying alongside her back.

What can cause baby movements to reduce?

The baby movements can be lower, when

  • • Drugs like pain relief or sedatives are used.
  • • Alcohol consumption and smoking.
  • • When the pregnant woman is unwell.

Should the woman use a chart to count her unborn baby’s movements?

Different babies have a different pattern of movements. The pregnant woman can get aware of the baby movements’ frequency throughout the pregnancy. If she feels the movements are reduced, approach the doctor immediately.

What if the woman is unsure about her baby’s movements?

If a pregnant woman feels or unsure about the decrease in baby movements, the women should lie down on the left side to focus on the baby’s movements for 2 hours. If not more than 10 movements aren’t felt, immediately approach the doctor.

What to do if I feel the baby’s movements are reduced or changed?

Always seek doctors to help immediately. Never neglect a reduction in your baby’s movements.

    • For less than 24 weeks– Generally, the baby movements can be felt from 18 – 20 weeks, if the woman doesn’t feel it, visit the doctor for a checkup. The doctor checks the baby’s heartbeat. An ultrasound scan will be arranged to check the baby’s wellbeing.
    • During 24 – 28 weeks of pregnancy– The tests like baby’s heartbeat, having an antenatal checkup, size of the uterus, blood pressure level, protein levels testing from urine are done by the team. If the uterus is smaller, an ultrasound scan is used to check the baby’s growth.
    • Over 28 weeks of Pregnancy– During this time, do not neglect the baby’s movements. Approach the doctor immediately if the baby’s movements are reduced. The baby’s heartbeat will be monitored for at least 20 minutes. An ultrasound scan is arranged to check the growth and amount of amniotic fluid around the baby, if
    • • The uterus is smaller than expected.
    • • Pregnancy risk factors.
    • • Heart rate is normal but still, feels less than normal baby’s movements.

What to do if the woman finds her baby’s movements are reduced again?

If the baby’s movements are slowed down even after the checkup, don’t hesitate to take the advice from the team.

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Surrogacy

What is Surrogacy

What is surrogacy?

Surrogacy is when the couple who are unable to conceive, can have a baby from another woman. The intended parents are the ones who become the legal parent of a child who is born through surrogacy. There are two types of surrogacy:

  • Traditional Surrogacy: Traditional surrogacy is where the surrogate is genetically related and becomes pregnant through artificial insemination.
  • Host surrogacy: It is when IVF is used, either with the eggs of the intended mother or with donor eggs. The surrogate mother is not genetically related to the baby and does not use her eggs. The three stages of this type of surrogacy are
    • Egg Donation
      • • The female egg donor undergoes some special procedures to extract many eggs.
    • • Fertilization
      • • The eggs are fertilized with sperm in the laboratory, resulting in embryos.
    • • Embryo Transfer
      • • The embryo is transferred into the womb of the surrogate mother. The Embryo Transfer can be transferred to the surrogate either fresh or after have been de-frosted from storage. For a fresh embryo transfer, the cycles of the surrogate and the egg donor must be synchronized, and this is done using hormone medications. In cases where embryos have been frozen already and the de-frosted embryos are being transferred, the surrogate mother is provided with hormone medications to ‘ready’ her womb lining.

The birth mother

Now, according to the law, the woman who gives birth to the child can be treated as a legal mother and have parental responsibility.

The intended mother

The woman cannot be treated as the mother of the child even her eggs are used in the treatment. She has no legal rights concerning the child by her eggs being used or under any surrogacy agreement.

The father

The child’s legal father will be the surrogate’s husband unless:

  • • The surrogate’s husband didn’t give their permission for their wife to carry the pregnancy.
  • • If your surrogate has no partner, or they are unmarried, the child will have no legal father or second parent.

Consents

From 1st October 2013, it is possible for one of the intended parents commissioning a surrogacy arrangement to be recognized as the legal parent when the child is born if the surrogate is not married and the relevant consents are in place. These consents will be completed with the couple at the hospital with a doctor’s appointment.

Screening

Before the treatment, screening of all those involved in surrogacy arrangements will be undertaken in line with HFEA’s current guidelines can be provided.

Funding

The clinical commissioning groups (CCGs) do not currently provide surrogacy on the NHS.

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Ultrasound Scanning

Ultrasound Scanning

Ultrasound Scanning

The ultrasound scanning is an important part of Reproductive Medicine assessments. It gives the information about the lining of the womb and the number and size of follicles, and any existing pathology, such as cysts or fibroids. This helps to decide the further stages of treatment.

Does it hurt?

Ultrasound scanning is not painful and are internal. The scans involve a special probe, which is cleaned before use, that be inserted into the vagina. Some patients may find it a little uncomfortable, but it is not as bad as a smear test.

Why vaginally?

The ultrasound scans are performed transvaginally because they can be done with an empty bladder. The scans provide a better image of the pelvic organ. It is important that you have an empty bladder for this test.  Please go to the toilet before your scan

How long will it take?

The examination will take approximately 10 minutes. It is not painful. A probe is inserted into the vagina. The womb and ovaries can be seen on the screen. The scan will be performed by a sonographer (a medical professional trained to use diagnostic scanning equipment) or a doctor.

Will I have to undress?

Yes, you have to undress from the waist down and lie on the ultrasound couch and also to bend knees to insert the ultrasound probe.

When are the scans performed and what are you looking for?

There are many scans to be taken during the treatment and the fist scan should be done at any time of the menstrual cycle. This scan is called a ‘baseline’ scan and is to document any pathology within the uterus or ovaries before the treatment begins. The ones who are using stimulation drugs, have to get repeated scan and blood tests at an interval of 2- 3 days till the size of the needed follicle is measured.

Can my partner stay with me?

You can bring your partner into the scan room. On some days there may be a Trainee in the ultrasound room, either to just watch the scan or to have practice at scanning but we will ask your permission first.

What if I am unsure about something?

To help you understand what we say, we have listed some words with explanations below:

  • Endometrium: The lining of the womb. We measure this each time you are scanned. It is thin when you are on your period and thickens in response to the medication or your menstrual cycle.
  • Uterus: the womb.
  • Follicles: These are in the ovaries and are what develop eggs as they grow. The follicles grow in response to the medication. The follicles need to be a certain size before you are ready to go to the theatre for egg retrieval, Intrauterine Insemination or Induction of Ovulation.
  • Cysts: These are little sacs of fluid, blood or other components. Sometimes we see them on the baseline scan.
  • Hydrosalpinx: It can be a side effect of the medication or when associated with blocked fallopian tubes.
  • Fibroids: Thickened lumps of muscle within the muscle of the uterus.
  • Polyps: Benign (non-cancerous) growths that can be found on the lining of the womb and may cause problems with the embryo implanting easily.
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Surgical Sperm Retrieval

Surgical Sperm Retrieval

Surgical Sperm Retrieval

About one man in a hundred produces no sperm (10-15% of all sub fertile men) – a condition known as azoospermia.  Various factors can contribute towards these conditions, some of which may be inherited. To achieve pregnancy, surgically retrieved sperm are used in an IVF/ICSI treatment cycle.

What is surgical sperm retrieval (SSR) and what does this treatment involve?

Surgical Sperm Retrieval is a technique used for collecting sperm directly from a man’s testicles or epididymis. It is a procedure usually carried out as a day case under general anesthetic. An SSR is usually planned, but in exceptional circumstances can also be carried out as an emergency procedure. This would usually be if the man is unable to produce a sperm sample on the day of his wife’s or partner’s egg collection. The procedure is carried out under general or spinal anesthetic or with sedation. The team may use different sperm retrieval methods. The method is determined according to the FSH level and testicular size. Your surgeon will advise you which procedure will be suitable for you.

Who may benefit from surgical sperm retrieval (SSR)?

This method is helpful to a man who has low-quality sperm or no sperm in their ejaculate. This can be the result of several causes:

  • • Men who have had a vasectomy (the male sterilization operation), that is, removal of vas deferens (the tube which carries the sperm to the penis) or a failed vasectomy reversal.
  • • Men who are carriers of certain genetic conditions, such as cystic fibrosis.  These men do not have a vas deferens or a blockage in the epididymis.
  • • Men who cannot produce sperm in their semen.
  • • History of any testicular surgery and undescended testes.
  • Illness (such as mumps in adolescence affecting the testis).
  • • May be suitable for men with a spinal injury and where there are problems with normal ejaculatory function (such as Multiple sclerosis, Diabetes).
  • • Men with congenital or acquired endocrine conditions.
  • • Men with a genetic condition like Klinefelter syndrome.
  • • Medications like steroids, testosterone.

Most of the men produce healthy sperm in the testicles which can be retrieved by SSR. Unfortunately, some men have the testicles that fail to produce any sperm.

Pre-operative (pre-op) appointment

Once you are listed for SSR, you will be sent a separate appointment to see a consultant to sign both the HFEA consent forms and a surgical consent form. This appointment will be held in the Department of Reproductive Medicine. You will also be invited to attend a pre-op assessment, usually 1-2 weeks before your surgery date.

What are the different methods of SSR?

There are different methods of SSR.  The cause of your azoospermia will determine the best way to retrieve sperm in your case.

1. Percutaneous Epididymal Sperm Aspiration (PESA)

PESA is performed in theatre at the Prasad Hospitals, under sedation. It is a short, relatively painless procedure and requires no surgical incision. It is the least invasive method and involves inserting a fine needle into the epididymis, from which fluid is aspirated. Embryologists then inspect the fluid under a microscope for sperm motility and content which takes about 30 minutes. If the aspirates fail to show any viable sperm then the surgeon will proceed to the other options (TESE), usually on another day. This is particularly suitable for men who have had a vasectomy, obstruction or who were born without a vas deferens (cystic fibrosis). We will inform you of the outcome of the PESA procedure on the day of the procedure.

2. Testicular Sperm Aspiration (TESA)

A fine needle is used with a biopsy gun to remove small lengths of seminiferous tubule (sperm-producing tubules). These are then carefully dissected under a microscope by embryologists.

3. Micro-epididymal Sperm Aspiration (MESA)

Instead of using a needle in PESA, a small cut is made through the scrotum and into the epididymis. The fluid is collected and taken for microscopic examination by embryologists to see whether there is any viable sperm or not.

4. Testicular Sperm Extraction (Open conventional TESE)

TESE will be performed if-else no sperm is found in PESA, TESA or MESA.  This procedure is performed in the Prasad Hospitals. TESE can be performed by

Single biopsy (unifocal)

If the hormone level and testicular size are normal, then a small incision is made into the testis itself.  A small sample of testicular tissue is taken which is then examined for sperm. Stitches are applied that are dissolvable and so will not need to be removed.  Pain relief is given in the form of a local anesthetic and nerve block to the genital region.

Open scrotal exploration and multifocal testicular biopsies

This involves performing a midline or horizontal incision on the scrotal skin. Three to four biopsies are taken from each testicle in different areas. Stitches are applied that are dissolvable and so will not need to be removed. Pain relief is given in the form of local anesthetic and nerve block to the genital region. This provides pain relief for 15-16 hours. This procedure will cause some pain and tenderness afterward, however, full recovery is expected within a few days. It is not possible to tell you on the day if sperm were present in the biopsy material, as it may require special culture technique. It may take 3-5 days before the embryologist will be able to give you any information about the presence or absence of sperm in the biopsy material. This result will be informed to you in the clinic appointment, usually in 1-2 weeks.

Effectiveness of SSR

Surgically retrieved sperm, if viable, are stored frozen and this does not affect their ability to subsequently fertilize an egg.  Surgically retrieved sperm (SRR) is not comparable to normally ejaculated sperm.  As the number of sperm retrieved by surgical means is usually low in numbers with reduced motility and may not be mature, and therefore cannot successfully fertilize an egg using IVF techniques.  Because of this, the embryologist will pick out a single sperm to inject into each egg, this procedure is called Intracytoplasmic Sperm Injection, (ICSI).  Fertilization rates are dependent upon the quality of sperm and eggs.  If non-motile sperm are all that are available for selection, it is impossible to tell whether the sperm is alive or dead, so fertilization rates will be adversely affected.  It is also possible that no sperm at all will be obtained after the stored frozen sperm is thawed.

Possible Complications

SSR is a relatively low-risk procedure.  Possible complications include pain, bleeding, infection, hematoma (swelling of testicles with blood in the testicle) that would require immediate exploration of the testicle within a few hours of surgery.  The risk of these complications occurring is small.  There is a very small risk of testicular damage and chronic testicular pain, but these occur rarely.  Any procedure that requires a general anesthetic also carries an increased risk of complications of anesthesia.

Preparing for SSR

Before coming to the hospital (24 hours prior) you should shave all the hair off the scrotum or use a cream depilatory. You should bring with you a tight pair of ‘slip’-style underpants or swimming trunks – not boxer shorts. You will need to be accompanied by a driver or to arrange a lift/taxi as you will not be able to drive for 24 hours after the procedure.

Before your procedure

You will be required to fast (this includes no chewing gum and sucking on sweets) for at least 6-8 hours before the procedure.  You are also advised to avoid alcohol for at least 24 hours.

After your procedure

You will be able to leave the unit about four hours after the procedure. As with any surgical procedure, there is a slight risk of bleeding, bruising or infection. In order to reduce this risk, we would advise you to wear reasonably tight-fitting pair of underpants rather than boxer shorts for at least 48 hours (including overnight) from the day of your operation and then wear your own scrotal support (jock strap) daily (changing every day) for further 12 days to minimize discomfort and protect your scrotum and testes. Showering is advised and avoid hot baths to prevent infection. You should avoid alcohol, taking drugs that contain aspirin and refrain from strenuous exercise for a few days after SSR. Sexual activity is not advised for a week after the procedure. If you had an open SSR procedure you would be advised to be off work for 7-14 days. If you experience any discomfort, you may take up 4g (usually 8 tablets) of paracetamol, or 240mg codeine, or 1200mg ibuprofen in any 24 hours. You should follow the information on the medication to ensure you do not exceed the recommended dosage in any 24 hours.

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Preparing for Pregnancy

Healthy Living – Preparing for Pregnancy

Preparing for a healthy pregnancy and Improving health will benefit the people in many ways and benefits too for couples who are trying to have a baby. Healthy lifestyle improves the fertility and may increase the chances of successful treatment.

Preparing for a healthy pregnancy

How can I improve my health and fitness before my treatment?

This is a commonly asked question so we have put together some advice for both men and women to help you improve your health and fitness.

Stop Smoking

  • • The most important thing you can do if you smoke is – give up!
  • • We know this is easier said than done but many research studies have shown the harmful effects of smoking on sperm quality, egg quality and implantation rates for fertilized eggs.
  • • Smoking affects many aspects of your general health such as increased risk of cancer, heart disease, lung disease and premature ageing.
  • • Passive smoking can affect partners and other people.
  • • Smoking is an expensive way to damage your health!

Achieve a healthy body weight

  • • A healthy weight for height is referred to as a healthy Body Mass Index (BMI).
  • • You can check your BMI using the enclosed chart.
  • • It is important that you are both as near to your ideal BMI as possible.
  • • Being overweight or underweight can cause general health problems but can also affect your fertility.
  • • Aim for a BMI of between 21 and 30 (ideally 21 to 25).

If you need help achieving your ideal weight, then contact your GP for a referral to a dietitian. Note: Healthy weight loss is a slow, gradual process. As you wait for your treatment – use this time wisely A loss of 1-2 lb (0.5-1.0 kg) per week is adequate

Take Regular Exercise

  • • Regular exercise improves physical fitness, helps you to lose weight and decreases stress levels.
  • • Aim for some form of ‘Aerobic exercise’ three times per week, i.e. any activity that increases your heart rate and breathing, such as brisk walking, jogging, swimming, or sporting activities like football, tennis or squash.
  • • You do not need to join an expensive club or buy lots of equipment to get enough exercise. A brisk twenty-minute walk two to three times per week can be beneficial.
  • Using stairs instead of using lifts/escalators and walking to the shops can all make a difference and will improve your fitness.

Reduce your alcohol intake

  • • Excessive alcohol reduces fertility and damages sperm.
  • • For general health purposes the safe limits are up to 14 units per week for both men and women.
  • • It is better to have one to two units occasionally rather than saving them all up for one night!
  • • However, men and women trying for a baby should limit alcohol intake to no more than 6 units per week for men and women should avoid alcohol completely.

Drink Plenty of Water

  • • Studies suggest that excessive caffeine can reduce your fertility – tea, coffee, cola and ‘energy’ drinks e.g. Red Bull has high caffeine. Try to reduce caffeine in your diet and also drink more water.
  • • When you are having your treatment cycles we will suggest that you avoid caffeine altogether.

Follow a Healthy Eating Plan

  • • Eat regular meals.
  • • Eat similar foods to the rest of the family.
  • • Enjoy your food.
  • • Eat a wide variety of different foods.

Why is healthy eating important?

  • • Eating healthy food makes you to achieve and maintain a body weight.
  • • It ensures your body has sufficient vitamins and minerals – essential for men and women trying to conceive.
  • • It ensures your body has enough energy for all your daily activities.

Eat More Fruit and Vegetables

  • • Fruit and vegetables are excellent sources of vitamins and minerals. Eat more fruits and vegetables.
  • • If you are trying to lose weight fruit makes an excellent snack or dessert.
  • • Choose fresh, frozen or tinned.
  • • Examples of a portion are:
    • • 1 apple, pear, banana.
    • • 1 slice of melon or pineapple.
    • • 2 plums or satsumas.
    • • 1 cup of strawberries/raspberries.
    • • 2 tablespoonful of vegetables (raw, cooked, frozen or canned).
    • • 1 dessert bowl of salad.

Fill up on starchy foods:

  • • This includes bread, cereals and potatoes.
  • • Try wholegrain varieties where possible, for example, whole meal bread, bran flakes etc.
  • • These are higher in vitamins and minerals and also help to fill you up – so you are less tempted to snack between meals.

Meat, fish and alternatives:

  • • These foods are important for protein and iron as well as other nutrients.
  • • Vegetarians should include pulses, beans or nuts to replace meat or fish.
  • • Take care with fat content of meat or fish – especially if trying to reduce your weight.

Dairy products:

  • • Milk, cheese and yoghurt are important for calcium, protein and other nutrients.
  • • Choose low fat varieties as much as possible, for example, skimmed milk, cottage cheese or low fat yoghurt (especially if trying to lose weight).
  • • Low fat varieties have more calcium.

 Occasional foods:

  • • Many snack and convenience foods such as sweets, chocolate, biscuits, burgers, cakes, crisps and pastries contain lots of fat and sugar.
  • • They are low in vitamins and minerals and high in calories, so should only be eaten occasionally.
  • • Added fats e.g., butter, oils and margarine, should be used sparingly.

Take Folic Acid

  • • It is strongly recommended that women take 400µg of folic acid per day, for 3 months before pregnancy and until 12 weeks after you conceive.
  • • Good dietary sources of folic acid include fortified breakfast cereals, fortified bread, sprouts, spinach, Bovril and oranges.

Do I need to take any other supplements?

Please seek advice from a pharmacist before taking any other vitamin supplements or herbal remedies.

Want to know more?

Ask your GP to refer you to a State Registered Dietitian, or you can contact 8801233333.

Improving Sperm Quality

The effect of heat

The normal activity of the sperm producing tubules in the testes is affected by heat. Intermittent overheating of the testes leads to a reduction in sperm production and/or a decrease in sperm activity (motility).  The testes are situated in the scrotum mainly because it is cooler there than inside the body cavity. The testes have their own heat regulating mechanism so that in cold conditions the scrotum contracts, pulling the testes closer to the body, whereas in hot conditions the testes hang much lower. Overheating of the testes can be caused in various ways:

  • • Soaking in hot baths.
  • • Working in a high environmental temperature.
  • • Jacuzzis or saunas.
  • • Wearing tight or support underwear.

Illness associated with fever have a tendency of reducing fertility but temporarily. Remember that sperm take 70 days to develop from their cells of origin, thus any episode of testicular overheating could affect your fertility for over two months.

To improve your fertility, you should:

  • • Avoid hot baths, Jacuzzis and saunas and change to having showers or lukewarm baths.
  • • Wear non-support, non-insulating cotton boxer shorts.

There is some evidence to suggest that in some cases the taking of zinc and vitamin E can improve sperm quality.

 Other Factors:

The use of certain medications, including anabolic steroids or recreational drugs such as marijuana can affect your sperm quality. If you are taking any medication, please discuss this with the staff.

Cope with Stress

Our Team knows couples undergoing infertility treatment experiences an extremely stressfulness. However, it is not stress itself that causes problems but the way in which an individual respond to it. Without positive ways of dealing with stress a couple undergoing infertility treatment may experience some very negative symptoms such as:

  • • Insomnia.
  • • Fatigue – constant lack of energy.
  • • Anxiety.
  • • Inability to concentrate for long.
  • • Mood swings.
  • • Depression.

Our staff helps the couples to avoid the stress and its symptoms. For this reason, we recommend that you give some thought now as to the coping mechanisms you currently employ to deal with stress. Some ways to get away with stress are

  • • Yoga.
  • • Physical exercise – swimming, running etc.
  • • Learning how to relax – using tapes, books, videos.
  • • Stress management courses.
  • • Support – building your own network using friends, family, counsellors.
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Prenatal Testing

Prenatal Testing

IONA Test for Pregnant Women

What is the IONA® test?

The IONA test is a prenatal test done for pregnant women which are for estimating the risk of the fetus having serious genetic diseases. It is an advanced test where screening is carried out on a small maternal blood sample. The patients can expect the results within 3 – 5 days approximately.

What does the IONA® screen for?

The IONA® test estimates the risk of a fetus having Down’s syndrome (Trisomy 21), Edwards’ syndrome (Trisomy 18) and Patau’s syndrome (Trisomy 13). Trisomy occur when three copies of a chromosome are present instead of two. Edwards’ and Patau’s syndromes are very rare but Down’s very serious and many affected babies haven’t survived.

What are the advantages of the IONA® test?

  • Safe:IONA test is non-invasive with no risk of miscarriage.
  • Fast:IONA® test is the fastest test available with results provided within 3-5 working days, from sample receipt.
  • Accurate:For About 99% for the detection of trisomy conditions, Fetal sex determination is greater than 97% accurate.
  • Simple:This test uses a simple maternal blood sample.
  • Local:Unlike other Non-Invasive Prenatal Tests (NIPT), the IONA® test is performed in a laboratory local to you.
  • Quality:The IONA® test is a regulated diagnostic, which is CE marked.

How does it work?

During the pregnancy, the leakage of cell-free by the placenta circulates in the maternal bloodstream. As a result, a maternal blood sample contains a mixture of fetal and maternal circulating DNA. This IONA test directly measures this DNA quantity and also detect the DNA ratio when a fetal trisomy 21, 18 or 13 is present

Why is IONA® better than the combined test?

During the pregnancy, the traditional screening is offered which is called a combined test. It is an ultrasound scan which measures the nuchal translucency and a blood test. But it is not as accurate as NIPT where it detects around 85% of babies with Down’s Syndrome. IONA test has a higher detection rate than the combined test.

Who can have the IONA® test?

  • • Suitable for women who are at least 10 weeks pregnant.
  • • Suitable for all singleton and twin pregnancies.
  • • Suitable for IVF or surrogate pregnancies.
  • • This test is not suitable for women with cancer or who have undergone blood transfusion within the last 12 months or with a trisomy.

How are the IONA® results reported?

  • Low Risk:It is very unlikely to have the risk of pregnancy affected by trisomy 21, 18 or 13.
  • High Risk:It means pregnancy is at increased risk for trisomy 21, 18 or 13 and the result should be confirmed by follow up invasive procedures.
  • No Result:In very rare cases there is insufficient fetal DNA in the sample to obtain a result. An additional blood sample is taken.

About Prasad Hospitals

The IONA® test is developed and manufactured by Prasad Hospital, a UK molecular diagnostics company based in Manchester. Our mission is to develop molecular diagnostic products that will have a positive impact on human health.

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Long Term Sperm Storage

Long Term Sperm Storage

Other Options

If the sperm is not suitable for the long term, please approach the specialists after getting an appointment.

How are the samples produced and stored?

Samples are collected and stored in bottles sealed with liquid nitrogen vapor and labeled with name and contact details. Then the freezing process takes place.

Long Term Sperm Storage

Can my wife/partner accompany me?

Yes. You may be accompanied by anyone you choose.  You can also be seen alone if you prefer.  The sample is checked for quality and then it will be frozen. If you wish, we can offer you further appointments at this time.

How long can sperm be stored?

According to law, sperm can be stored for 55 years. So it is important that you keep us updated with any changes in your details so that we can contact you every 10 years.

What if something goes wrong with storage?

Any hospital does not guarantee against all the eventualities. For example, in the event of a strike or civil disturbance interrupting the supply of liquid nitrogen, or in the event of equipment failure.

How are the samples used?

There are many options to have treatment. The main ones are:

  • IUI Intra-Uterine Insemination
  • • IVF (In-vitro Fertilization)
  • • ICSI Intra Cytoplasmic Sperm Injection

All these will be explained to you by the doctor when you are ready to start a family.

How successful are these treatments?

Different methods have different success rates. Standard gynecological tests on your wife/partner would normally be arranged. recommended before using your stored semen, and these can be Frozen sperm, however, it is not as fertile as fresh sperm and we are unable to guarantee that a pregnancy will result from its use.

Counseling

Infertility counseling is available at Prasad Hospitals and appointments to see the counselor can be arranged. The time of banking may be stressful for you and your future fertility may be the last thing on your mind. Later on, you may well want to consider your options, and take time to go through them. Even if you are not ready to start a family, you can, if you wish, be given an appointment to discuss the situation.

Family Planning During Treatment

Even not having any proof regarding that radiotherapy/chemotherapy causes changes to the sperm that affect any children conceived during treatment, it is advisable to use a form of contraception during the treatment and for 12 months after it finishes.

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Long Down Regulated

Long Down Regulated

Buserelin is the first injection given and is used to suppress the hormones temporarily before ovarian stimulation begins. These injections are started during the luteal phase of the menstrual cycle (approximately 21st day) and continued till the one is ready for egg collection. The Injections are given at the same time every day. After 2 weeks of continuing these injections, the blood test should be taken to test the oestrogen and luteinizing hormone. Once the test results are satisfactory, it is advised to start stimulation injection which is of different types. Some common drugs are Gonal F, Bemfola and Menopur which are similar in their effects. These injections encourage the development of follicles in each ovary. These injections are taken along with the Buserelin injection. Then the monitoring starts from the 8th day of stimulation. For every 2 or 3 days, the blood test is to be taken for checking the oestrogen levels which indicates how ovaries are responding to the drugs. This will be continued still 3 or more follicles are at the optimum size of 17-20 mm. Usually, it takes 10 – 14 days. After stimulation, a final injection called Pregnyl is to be taken, which helps to mature the eggs. This injection is taken approximately 35 – 36 hours before egg collection. If the injection is not given at the specific time, consult the specialist. At the time of egg collection, the fresh semen sample is to be provided by the partner for ejaculation. After egg collection, the team informs about the details of eggs that are fertilized and to get ready for embryo replacement.

Don’t forget!

  • • Nothing to eat or drink from midnight the night before your egg collection.
  • • If you are storing embryos your partner is to abstain from ejaculation for 2-4 days before the day of egg collection.

The First Injection details are given below:

Buserelin  

What does it do?

Buserelin is a drug that causes ovarian suppression.  It stops the production of natural hormones that control the release of eggs from the ovaries by acting on the pituitary gland in the brain.

Possible side effects:

  • • Mood swings.
  • • Hot flushes.
  • • Vaginal dryness.
  • • Headaches.
  • • Nausea.
  • • Local irritation at the injection site.

How to use Buserelin:

  • • Remove Buserelin vial from the box.
  • • Flick the blue cap of the lid (this does not need to be replaced afterward).
  • • Take out a needle from the pack you were given.
  • • Remove the orange cap from the needle.
  • • Pierce grey bung of Buserelin with the needle.
  • • Tip the vial upside down.
  • • Pull down the plunger to just past your required dose.
  • • Remove the needle from the vial.
  • • With the needle pointing upwards, flick the syringe so that any air bubbles move to the top.
  • • Pull the plunger down and push out the air, ensuring the top of the black plunger lines up with your required dose.
  • • Pinch an inch of fat below your belly button.
  • • The needle is to be injected at a 45-degree angle.
  • • Push the plunger to give yourself the whole injection.
  • • Remove the needle and dispose of it in the sharps bin that you have been provided with.
  • • Put the remaining Buserelin in the refrigerator.

Storage Information

If Buserelin is once opened, it should be stored in a refrigerator.

Types of Stimulation Drugs are below:

Menopur

What does it do?

Menopur with the aim of an egg developing within each follicle stimulates in ovaries.

Possible side effects:

  • • Local irritation at the injection site.
  • • Ovarian Hyperstimulation Syndrome (OHSS).

Signs/symptoms to look out for include:

  • • Abdominal swelling/pain.
  • • Shortness of breath.
  • • Extreme thirst.
  • • Nausea/vomiting.
  • • Headaches.
  • • Problems passing urine (small amounts or none at all)
  • • Local irritation at the injection site.

How to prepare Menopur:

  • • Remove the product from the box.
  • • Open the top tray, which will contain pre-filled syringes of water, a vial of powder and a needle.
  • • Remove the powder vial from the tray.
  • • Flick the blue cap off.
  • • Remove the grey lid off the pre-filled syringe of water and twist the orange needle on to the top.
  • • Push the needle through the grey bung on the powder vial.
  • • Push all the water into the vial of powder. If you have two pre-filled syringes of water, remove the needle from the first syringe and attach it to the second and inject it into the vial of powder.
  • • The powder should all dissolve. If not completely dissolved, give the vial a gentle roll. Do not shake.

How to inject Menopur:

  • • Take a needle from the large box.
  • • Remove the clear lid.
  • • Pierce the grey bung and tip the vial upside down.
  • • Pull down the plunger to just past your required dose.
  • • With the needle pointing upwards, flick the syringe so that any air bubbles move to the top.
  • • Pull the plunger down and push out the air, ensuring the top of the black plunger lines up with your required dose.
  • • Pinch an inch of skin below your belly button.
  • • Inject at a 45-degree angle.
  • • Inject the full dose.
  • • Remove the needle.
  • • Dispose in sharps bin provided.
  • • The remaining solution of Menopur can be stored for the next dose.

Storage Information

Store in a refrigerator (2°C – 8°C) before reconstitution, in its original container to protect from light. The solution may be stored for a maximum of 28 days at not more than 25°C after the reconstitution and also don’t freeze.

Gonal F

What does it do?

Gonal F is an injection that contains the follicle-stimulating hormone (FSH). It stimulates your ovaries to produce follicles, aiming to produce an egg inside each one.

Possible side effects:

  • • Local irritation at the injection site
  • • Ovarian Hyperstimulation Syndrome (OHSS)

Signs/symptoms to look out for include:

  • • Abdominal swelling/pain.
  • • Shortness of breath.
  • • Extreme thirst.
  • • Nausea/vomiting.
  • • Headache
  • • Problems passing urine (small amounts or none at all).
  • • Local irritation at the injection site.

How to use Gonal F:

  • • Take out the Gonal F pen and one of the needles inside your box.
  • • Take the white lid off the Gonal F pen.
  • • Peel the paper cap off the needle.
  • • Twist the needle on the top of the Gonal F pen.
  • • Remove white cap off the needle.
  • • Look in the black window at the end of the pen (there should be a ‘0’).
  • • Twist the red end of the pen till you can see your required dose in the black box.
  • • Remove the green lid on the needle.
  • • Pinch an inch of fat below your belly button.
  • • Inject Gonal F at a 90-degree angle.
  • • Push the red plunger down and hold for 10 seconds.
  • • Remove pen and look in the black window (it should read ‘0’ if you have injected the full dose).
  • • Replace the white cap on the needle and unscrew it off the pen.
  • • Dispose of the needle into the sharps bin provided.
  • • Replace the lid of the Gonal F pen and store as advised below.

Storage Information

Store Gonal F in the original packaging to protect from light. Once opened, it may be stored at or below 25°C for a maximum of 28 days.

Bemfola

What does it do?

With the aim of an egg developing within each follicle, Bemfola stimulates the follicles in your ovaries,

Possible side effects:

  • • Local irritation at the injection site.
  • • Ovarian Hyperstimulation Syndrome (OHSS).

Signs/symptoms to look out for include:

  • • Abdominal swelling/pain.
  • • Shortness of breath.
  • • Extreme thirst.
  • • Nausea/vomiting.
  • • Headaches.
  • • Problems passing urine (small amounts or none at all).

How to use Bemfola:

  • • Take the syringe and needle out of the box.
  • • Remove the peel tab from the injection needle after washing your hands.
  • • Gently push after aligning the injection needle with the pen.
  • • Remove the outer needle protection cap.
  • • Remove the inner needle protection cap.
  • • Hold the pen with the needle pointing upright to make eventual air bubbles rise.
  • • Push the dosage plunger until it stops and a small amount of fluid is seen. If a small amount of fluid is not seen the pen should not be used.
  • • Turn the dosage plunger until the prescribed dose is aligned with the middle of the indent.
  • • Pinch an inch of fat below your belly button.
  • • Inject Bemfola at a 90-degree angle.
  • • Push the plunger until it stops.
  • • Remove the injection needle after 5 Sec.
  • • Dispose of the needle into the sharps bin provided.

Storage

Store Bemfola in the refrigerator and in the original packaging to protect from light. Once opened, it may be stored at or below 25°C for a maximum of 28 days.

The information about the Final Injection is below:

Pregnyl

What does it do?

Pregnyl is your final injection and is used to mature the egg within the follicle.

Possible side effects:

  • • Headache.
  • • Feeling restless or irritable.
  • • Depression.
  • • Breast tenderness or swelling.
  • • Local irritation at the injection site.

How to use Pregnyl:

  • • Remove the two glass vials from the box.
  • • The black dot on the bottle is the weakest point of the vial, flick this dot to make the neck of the vial weak.
  • • Put your left thumb underneath the black dot and your right thumb above the black dot.
  • • Firmly snap the top of the vial.
  • • Repeat with the other vial.
  • • Remove syringe and green needle from the packaging.
  • • Twist green needle at the end of the syringe.
  • • Put the needle into the water and pull the plunger to draw up all the water.
  • • Remove the needle from the bottle and put the needle into the vial of powder.
  • • Push all the water into the vial.
  • • Leave to dissolve for a few seconds then pull the plunger back to draw up a dissolved drug.
  • • With the needle pointing upwards, flick the syringe so that any air bubbles move to the top.
  • • Twist off the green needle and dispose in sharps bin provided.
  • • Twist on an orange needle and push the plunger up to remove any air.
  • • Pinch an inch of fat below your belly button.
  • • Inject at 45 degrees and push the plunger down to give yourself a full injection.
  • • Remove the needle and dispose into the sharp bin.

Storage Information

Store in a refrigerator until it is time to administer the injection.

Progesterone (luteal support)

Progesterone is given in the form of a rectal or vaginal suppository.

What does it do?

Progesterone, the natural female hormone produced in the body is used in IVF treatment. It helps to support the endometrium and possible early pregnancy.

Possible side effects:

  • • Diarrhoea.
  • • Flatulence.
  • • Soreness in the vagina or rectum.
  • • Headache.

Leakage after the pessary gets dissolved after using progesterone.

Storage

Store below 25-degrees centigrade.

Sedation in IVF

During the egg recovery, the surgeon places a scanning probe into the vagina. Then a needle is inserted alongside the probe. The needle is used to suck out the ripen egg where discomfort occurs. Then the person is sedated and not unconscious. During the procedure, she will be fully monitored. The sedation method is the preferable method after the egg recovery process.

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