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All Posts in Category: infertility

Infertility Sperm Storage

Infertility Sperm Storage

Sperm storage is provided as back up for your infertility treatment at Prasad Hospitals. A fresh semen sample would be used on the day of your infertility treatment whenever needed.

How are the samples produced and stored?

Semen samples are collected and stored in a small bottles sealed with liquid nitrogen vapour and are labelled with the name, and contact details. Freezing takes place as soon as possible after the sample is given, so it is better if the sample is produced on the premises.

Can my wife/partner accompany me?

Yes. However, it is not essential and you will be seen alone if you prefer.

How do I get the results?

You can confirm by contacting the team if your sample was frozen and has been assessed for suitability as back up for infertility treatment.

How long can sperm be stored?

According to the law, sperm can be stored up to infertility treatment or until 10 years. Samples can be destroyed after the period. So it is important that you keep us updated with any changes in your details so that we can contact you.

What if something goes wrong with storage?

Even we make possible safety arrangements of your samples, we do 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, the effect on your samples could be detrimental.

What happens if one’s sperm not stored?

If the sperm sample fails frozen process or not successful in storing the sperm, you can approach the specialists to know alternative options.

When can we use the sperm?

Once the sperm freezing procedure is complete, the doctors team notifies and update to the person. Within a few weeks you and your partner will be seen in the clinic in order to complete the relevant documentation/consent forms and to discuss the IVF treatment process before starting the treatment.

How are these samples used?

These samples are stored only as a backup for infertility treatment. On the day of infertility treatment, a fresh semen sample is preferable.

How successful are these treatments?

Different methods have different success rates. It also depends on the couples. And also frozen sperms cannot guarantee the pregnancy. All of this will be explained to you when you and your wife/partner are seen by the doctor.

What are the prospects of using frozen sperm?

The quality of sperm samples depends on patients and some circumstances like having weight loss, having loss appetite. Cancers that affect the whole body, such as leukemia, may have a more profound effect when compared to localized tumors with a malignant potential. We will always offer you the chance rather than make judgements ourselves. During the freezing process, to protect against damage, samples are diluted with a preservative. Even, it cannot be guaranteed that the sample survives for the whole freeze-thaw process. As previously stated the chances of success in achieving a pregnancy depend on many factors including the method chosen for their use. Chances of pregnancy can be expected if sufficient number of sperm with quality have been frozen.

Counselling

Infertility counselling sessions are available at Prasad Hospitals and the appointment should be taken for the session.

Violence, Aggression and Harassment Control Policy

We are committed for the safety of patients. Verbal abuse, physical violence, and harassment are not allowed at Prasad Hospitals.

Suggestions, Concerns and Complaints

If you would like to provide feedback you can:

  • • Ask to speak to the ward or department manager – they may be able to help straight away.
  • • Write to us: Prasad Hospitals, Adj. BSNL Telephone Exchange, Nacharam – Mallapur Road, Secunderabad – 76 (or) e-mail: info@prasadhospitals.in
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Infertility Semen Analysis

Infertility Semen Analysis

Introduction

For assessment of sperm quantity and quality, a semen sample should be provided.

Delivery of your sample

As a fresh sample is essential for this test, it must be brought to the laboratory within one hour of being passed at home.

Semen Analysis

Instructions for collecting the semen sample

  • • You should abstain from intercourse or masturbation for three to four days before providing the specimen.
  • • The sample should be obtained by only masturbation and collected directly into the specimen container. A condom or artificial lubrication must not be used for semen collection as it will kill the sperm.
  • • The complete specimen is needed for this examination, so if any of your specimen is spilt you must tell us, as a repeat specimen is required.
  • • Label the specimen container with your full name, date of birth and the date and time the specimen was passed.
  • • Ensure the top is screwed on tightly so that it does not leak and then place the container into the biohazard bag.

Sample Identification

  • • Please make sure that your name, date of birth and the requesting Doctor’s details are on the request form provided.
  • • Make sure that the date and time of collection are entered on the specimen details form on page 7 of this booklet.
  • • Please ensure that your full name and date of birth are on the label of the specimen container. We cannot process unlabeled or poorly labeled samples.

Delivery of your sample

  • • Deliver the sample to the Department of Reproductive Medicine, Prasad Hospital within one hour of passing the sample.
  • • Keep the sample at body temperature while being transported to the laboratory.  Excessive cold or heat may damage the sperm.
  • • Specimens will only be accepted between 8.30 am and 3.00 pm Monday to Friday (Opening hours: Monday – Friday: 8.30 am to 4.00 pm).
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Induction of Ovulation

Induction of Ovulation

What is Induction of Ovulation?

The process of stimulating the ovaries that produce one or two follicles containing an egg each is Induction of Ovulation. The process is used in one of two ways:

Natural intercourse

This is the method suitable for couples with ovulatory disorders where the eggs are released at a time coinciding with regular intercourse and creates the opportunity of achieving pregnancy.

Stimulated intra-uterine insemination (S-IUI)

S – IUI is the method suitable for the couples facing the problems with unexplained infertility, endometriosis, and some mild sperm abnormalities.

What is involved in the treatment?

Visit the specialists on the first day of your period (the day you wake up bleeding) to request treatment. Blood test and Day 2 cycle, Day 3 cycle scans are mandatory. With respect to the results, should take gonadotropins injections daily to simulate the ovaries. On the Day 8 of cycle, blood test and transvaginal scan should be done, where the development of follicles can be monitored. The injections are continued till the matured follicles (measuring around 16 mm or above) are confirmed on the scan. Then, hCG injection should be taken in order to stimulate ovulation.

What are the risks?

The drugs are given in low doses. There may be a risk of OHSS, regular monitoring prevents this complication. If you observe symptoms like vomiting, shortness of breath, nausea or have severe abdominal pain, visit the hospital immediately. If more than 2 follicles are developed, the cycle must be canceled because there might have a risk of multiple pregnancies. If 6 or more follicles development and you are eligible for IVF, rather than cancelling the cycle, you would be offered the chance to convert to IVF.

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ICSI

ICSI

What is ICSI and why is it necessary?

Intracytoplasmic sperm injection (ICSI) refers to the technique of injecting a single sperm into the center (cytoplasm) of the egg.  In natural conception, many numbers of sperms surround the egg, but only one sperm penetrates and fertilizes each egg.  In standard IVF we mimic nature by adding number of sperms to the dish containing the egg.  In the technique of ICSI, the sperms are selected based on the activity and appearance. Later, using specialized equipment which allows the egg and sperm to be handled, a single sperm is injected into the mature egg.

Which couples require ICSI?

If there is a sperm problem or having the risk of egg failing to fertilize, ICSI is recommended. If there is no sperm problem, the IVF process is recommended. Sometimes, the sperm sample may be unexpectedly poor on the day of egg collection. If this happens, we will carry out ICSI to try to achieve fertilization. We may also recommend ICSI if you have had standard IVF and there was a very low fertilization rate or no fertilization. This may happen even if there is no sperm problem. If this happens in your case, we will discuss the alternatives and whether ICSI is likely to help.

How is ICSI carried out?

Every aspect like egg recovery, producing a sperm sample, hormonal simulations, and embryo replacement are the same or identical in ICSI and IVF techniques except the method of fertilization. The embryologist sees inside the egg after removing outer cells from each egg to access whether the egg is mature or not. Only matured eggs can be used in ICSI whereas all eggs can be used in IVF. In most treatment cycles, approximately 80% of eggs are mature.  The sperm are prepared as normal for IVF.  The embryologist then picks out individual live sperm, of normal appearance and injects one into each egg, using a special glass needle.

 How successful is ICSI?

About 60% of eggs will be fertilized by ICSI which is similar to IVF. Reasons for not being 100% successful are

· The eggs which aren’t matured cannot be injected.

· Some eggs might be damaged during an injection procedure.

· Many sperms don’t have the capability of activating the egg when injected directly.

Embryo development is similar for ICSI and IVF on following successful fertilization.

What risks are associated with ICSI treatment?

ICSI offers the opportunity of success for couples. However, it also additionally carries risks over and above those of IVF treatment in general. It is known that abnormal sperm production, as is the case in men with very low sperm count or absent sperm in the ejaculate, can be associated with genetic defects in the male. There may be a problem of genetic defects directly transmitted to the children by the ICSI technique. There is a possibility of the egg getting damaged by the injecting procedure. Theoretically, this can result in damage to the resulting embryo if the damaged egg is fertilized normally.

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Giving Consent to Fertility Treatment

Giving Consent to Fertility Treatment

Before starting fertility treatment, one should need to complete several consent forms. This is to allow us to be sure that you understand the treatment being planned and all its implications. We appreciate that it may sometimes seem like there is a lot of paperwork to go through, but the purpose of this will make us deliver a safe and good service complying with the law governing fertility treatment. This document describes the different consent forms and the issues to think about when completing them. Besides, our staff is always happy to answer any questions you may have about the consent forms and we will also discuss them at our face-to-face consultations with you. We also have a dedicated counseling service, which we encourage you to use, particularly if you are having a treatment that involves using donated sperm, eggs or embryos. Please remember that you have the right to withdraw or change your consent for this treatment at any time. There is no need to give us a reason. You must let us know in writing if you want to withdraw or change your consent and we will ask you to complete an updated set of forms. Please make an appointment to see one of our teams to do so. You must not consent to this treatment unless you have had all the information you need to understand the implications of this treatment. If you feel you need more information, please ask us. We are here to help you understand your treatment choices and to remain in control of your treatment.

1. Consent for treatment

This form is just similar to the forms which you fill before any medical treatment. It asks you to consent to any procedures required, such as egg collection and embryo transfer. Before completing this, you should have an understanding of the procedure involved, whether it is to be carried out under sedation or anesthetic and the potential risks.

2. Consent to disclosure of information (CD Forms)

Each partner undergoing treatment is required to complete a CD form.

Your absolute confidentiality is protected by law. We are not allowed to tell your general practitioner or anyone else about your treatment (other than in a medical emergency) unless you have specifically allowed us to do so. While looking for continuous care like in pregnancy, it is recommended that to inform your General Practitioner (GP) about the consent. So, once the GP receives information about fertility treatment, they maintain safety and improve the quality of care with maintaining confidentiality. We also recommend that you allow access to your information to administrative and audit staff that support our clinic. This is both to ensure the smooth working of the service and also to ensure that its processes and results can be monitored and improved for the benefit of patients. We are legally obliged to collect certain information about you and your treatment and pass it to the Human Fertilization and Embryology Authority (HFEA). This includes personal data such as your name and address, the type of treatment you had, the number of embryos transferred and whether your treatment led to pregnancy. Information about a child after the treatment is also collected. If you give consent, the HFEA can release some of this identifying information to researchers, for research projects that meet strict guidelines. You can choose not to allow this. However, we believe that this kind of research is potentially very valuable in assessing the effectiveness and safety of fertility treatment, to develop new techniques and to study the effect of national policies. You can choose to give consent to your identifying information being used for certain types of research only. If you choose to consent for non-contact research only, you will never be contacted about research using your identifying information. This information will only be used to link the HFEA database with other databases. If you consent to contact research, staff may contact you in the future if they think you may be suitable for a research study. Giving consent to be contacted does not mean that you are automatically consenting for any future research study.

3. Consent to the use and storage of sperm, eggs and/or any embryos produced from them

(WT form for women, and MT form for men)

You can consent to the use of your gametes (eggs and sperm) and embryos for your treatment, the treatment of others, research or training (or all of these). You can also give consent to the storage of these, which means freezing them for future use. Before giving this consent you should be happy that you understand the nature, purpose, and implications of the treatment being proposed. We will provide information about this to you at our face-to-face consultations and through written materials. We place a high priority on our patients being fully informed and staff will always be happy to provide clarifications and more information if you feel you require this. Please remember that you can specify extra conditions for storing or using your eggs, sperm, and embryos. When considering consent for the storage of gametes and embryos, it is important to know that the statutory storage period is up to 10 years and can be specified in the consent form. In certain cases, storage can be extended beyond 10 years if you consent to this and a medical practitioner certifies that either you or the person to whom your gametes or embryos have been allocated has, or is likely to develop premature infertility. In these cases, the opinion of the medical practitioner has to be renewed every 10 years, and the maximum period for which gametes and embryos can be stored is 55 years. The law does not allow us to keep your gametes or embryos in storage beyond the date you have consented to. Before the end of the storage period, our team will get in touch with you. It is important that you keep in touch with us, in particular, that you notify us of any change of address.  We are obliged by law to not let any stored eggs, sperm or embryos to perish. The consent forms MT and WT ask you whether you agree to be approached to participate in research studies involving your sperm, eggs or embryos. Agreeing to this does not commit you to participate in any particular research, rather it allows us to provide you more information which you can use to decide whether to participate or not. Research studies are all approved by Ethics Committees and are designed to help us understand infertility better and to improve the treatment of couples such as yourselves. However, we are aware that not everyone feels comfortable participating in research. Please be reassured that your treatment will not be affected whether you consent for research or not. The consent form also asks you to think about what you would like to happen to your gametes and embryos if you were to die or become permanently incapacitated. We appreciate that considering some of these scenarios may be distressing, but it is important that you have given some thought to this. We find that this is quite a useful prompt for an important conversation between partners, as it asks you to think about uncommon but very distressing scenarios and helps you fully prepare for your treatment. Our staff and specialist counselors are there to help you talk through any issues that may arise or to provide any clarification you may need.

4. Consent to parenthood

Before the treatment starts, the relevant consent forms are to be filled if the one is having the treatment with donor sperm, donor eggs or embryos. This is to ensure that any child born has a legally recognized father or second parent. There is a difference in law between the legal status of a ‘father’ or ‘second parent’ and a person who has parental responsibility for the child. The law specifies who can be a parent in various circumstances. We will provide you information about who will be the legal parent(s) under the HFE Act 2008 and other relevant legislation in your circumstances. Our patient information leaflet ‘Legal Parenthood’ lays out how the law applies in different scenarios and helps you understand who is allowed to be the legal parent and how this can be ensured. The HFEA website www.hfea.gov.uk is an excellent source of information about this, and other issues discussed above. In some cases, seeking legal advice may be useful.

5. Withdrawing, varying and restricting consent

You may withdraw your consent at any time up to the point that your eggs, sperm or embryos have been used in treatment, research or training, or been disposed of. To do so, please let us know straight away, in writing. We will ask you to complete the relevant HFEA consent forms designed for this purpose. If one of the partners whose sperm or egg was used to create embryos withdraws their consent to the storage of those embryos, then we will take all reasonable steps to inform the intended recipient of the embryos. The embryos can be stored for up to 12 months after we receive written notification of the withdrawal of consent, provided the 12 months does not extend beyond the statutory storage period. However, if the intended recipient also consents to the destruction of the embryos then we will dispose of them straight away, as required by the HFEA. You can also vary your consent if you change your mind at any time up to the point that your eggs, sperm or embryos have been used in treatment, research or training, or been disposed of. This may occur if, for instance, you were to change your mind about the use of your sperm, eggs or embryos in the event of your death. If this were to be the case, please let us know straight away in writing and we will go through the relevant consent forms with you. You can also restrict your consent about the use or storage of your eggs, sperm or embryos. For instance, you can state that you wish their donation only to treat a known recipient. Restrictions can be stated on your main consent form or a separate paper, signed, dated and attached to the form.

Violence, Aggression and Harassment Control Policy

Prasad Hospitals is committed to well-being and safety to the patients and staff. Physical violence, verbal abuse, and harassment are unacceptable.

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Flu Vaccination

Flu Vaccination

What is flu? What are the symptoms?

Flu, which can be sometimes called Seasonal flu, causes usually in the winter season. It’s an infectious disease. The common symptoms are cold with a stuffy or runny nose, sore throat, fever, headache, chills, extreme tiredness, and pains in the joints and muscles. Mostly, the infected one can recover on 2 to 7 days, but for some, it may lead to hospitalization and sometimes even death.

What causes flu?

Flu infects the windpipe and lungs and it is caused by influenza viruses. And because it’s caused by viruses and not bacteria, antibiotics won’t treat it. Even there are some complications caused by flu, sometimes antibiotics may be needed.

How to catch flu and avoid it?

When a person is infected with flu and coughs or sneezes, the saliva can be spread over a wide area. When the other persons breathed in or touched the surface area where the droplets are landed, they might be infected. The virus spreading can be avoided by covering the mouth and nose while coughing or sneezing, washing hands properly. The best way to avoid spreading flu is by having a vaccination.

How can we protect against the flu?

To protect against flu, vaccination is the best way. The most likely viruses that will cause flu are identified in advance of the flu season and vaccines are then made to match them as closely as possible. However, there is always a risk of a change in the virus.  From the last ten years, the vaccine has generally been a good match for the protection from spreading.

What harm can the flu do?

Not all persons suffering from cold, have affected by the flu. Flu is much worse than cold. The person who suffers from flu needs to stay in bed for some days. Some may have the risk of developing serious illnesses like pneumonia and bronchitis or even existing conditions worse. In the worst cases, it may result in death. Flu vaccines help to protect against the virus.

How to know if a person is at increased risk from the effects of flu?

Flu can affect anyone, but even a person feels that the condition be well managed, it might worsen the health condition. The person has to get a free flu vaccine if the person is pregnant or having long term conditions like:

  • • Heart Problem.
  • • Bronchitis or Asthma.
  • • Kidney Diseases.
  • • Low immunity.
  • • Liver Disease.
  • • Transient Ischemic Attack (TIA).
  • • Sickle-cell Disease.
  • • Overweight (BMI > 40)

By having the vaccination, there can be chances of reducing the spread of flu to other people.

Who should consider having a flu vaccination?

The vaccination can be done for all those who have the above conditions or

  • • The persons who are aged 65 or above.
  • • Disabled person.
  • • Living in a residential or nursing home.
  • • Pregnant woman.
  • • Social care worker.
  • • Children of a certain age

I had the flu vaccination last year. Do I need another one this year?

The vaccination should be done every winter to have protection against the strains of flu. Because the conditions may be different when compared with the previous year. The flu vaccine may last about 6 months only.

Can the person who has flu, need a vaccination?

Yes; the person who has flu can take a vaccination as it helps not to spread to others.

What about the children? Do they need vaccination?

The child with above 6 months’ age having the conditions mentioned above, should have a vaccination. The flu vaccination won’t work well for the babies under 6 months’ age. That’s why the pregnant woman should have vaccination compulsorily which helps in passing some immunity to their baby and protect them from flu.

Do pregnant ladies have to take vaccination?

Of course Yes, all pregnant women must have the flu vaccination to protect themselves and even their babies. The vaccination can be given at any stage of pregnancy. Pregnant woman having the flu vaccine can have benefits like

  • • Reducing the risk complications like pneumonia, mainly in the later stages of pregnancy.
  • • Reduce the complications like the baby born soon or with low weight.
  • • For the first six months of a born baby may have immunity.
  • • Reduce the chance of pregnant women passes flu to her baby.

What to do if a pregnant woman has flu?

If a pregnant woman has the symptoms of flu, immediately approach the doctors’ team. She can also get flu-free vaccination. Some groups of children are given vaccination to prevent the spread of flu to their parents or friends or any neighbours.

Can the flu vaccine be given to the child at the same time as other vaccines?

The flu vaccine can be given at the same time as all other vaccines. The vaccination can be given if the child has some minor illness.

Is there anyone who is not needed to have the vaccination?

Everyone can have the vaccination, but the person should not have the vaccination if he/she has conditions like having serious allergy due to vaccines, allergic to eggs, having low immunity, having a fever.

What about the children?

Children should not have the vaccination if they have conditions like

  • • Have wheezy since past 3 days.
  • • Are severely asthmatic.
  • • Have a condition like low immunity.
  • • Allergic to eggs

Does the nasal vaccine contain gelatin derived from pigs (porcine gelatine)?

Yes. The nasal vaccine contains a highly processed form of gelatin (porcine gelatin), which is used in a range of many essential medicines. The gelatin helps to keep the vaccine viruses stable which makes the vaccine provide the best protection against flu.

Can’t the child have the injected vaccine that doesn’t contain gelatin?

The nasal vaccine provides the best protection from flu, mainly in young children. It also helps to reduce the risk to their parents or baby brother or sister. But the injected vaccine cannot offer all these. Who have a high risk of flu and can’t have the nasal flu vaccine, they can have the flu vaccine by injection.

How long will the person be protected?

The vaccine protects for about 6 months.

Will the flu vaccine protect the person completely?

Flu is caused generally in winters. The vaccination lasts for 6 months only. And the flu virus risks may be different or change from year to year.

Will there be any side effects?

Some of the side effects of the nasal vaccine are

  • • Runny or blocked nose.
  • • Loss of appetite;
  • • Headache

Injected vaccinations can have side effects like

  • • Low-grade fever.
  • • Muscles aching for one or two days.

Summary of who are recommended to have the flu vaccine

The vaccination is recommended to the people.

  • • Aging 65 or above.
  • • Pregnant woman.
  • • Children of ages 2 and 3.
  • • Children studying primary classes (Up to 5th Class).
  • • Who takes care of disabled or old age people.
  • • Social care workers.
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Fertility Preservation

Fertility Preservation

1. Record chart

Blood tests are usually taken between 7.45 and 8.30 in the morning to ensure that we get the results back the same day. Blood is taken to check your oestrogen level. This indicates as to how your ovaries are responding to the stimulation drug.   Scans are usually internal and assess how your follicles are growing. You will be allocated individual appointment times for your scans.   Once you start your stimulation drug please do not stop this unless advised to do so by a nurse or doctor. It takes approximately 10-14 days of stimulation until you are ready for your final (trigger) injection.

2. Trigger injection

You are now ready to take your Pregnyl injection. Please write down all of the instructions given to you by the nurse on the telephone.

Please note: Your egg collection is timed to be 34-36 hours after your Pregnyl or Buserelin injection.

3. Day of egg collection

Please bring:

  • • Dressing gown.
  • • Slippers.
  • • Sanitary towels.
  • • Something to read.

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.

Post egg collection

Following your egg collection, you may feel bloated, have mild abdominal pain and light vaginal bleeding on some days. The lab staff will telephone you the day after your egg collection to inform you of the number of eggs/embryos stored:

4. 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.

5. 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.

6. 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.

7. Cetrotide

What does it do?

The natural hormone which is called Gonadotropin-Releasing Hormone (GnRH) is effected by the blockage by cetrotide. GnRH controls the secretion of another hormone called luteinizing hormone (LH) which induces ovulation during the menstrual cycle.

Possible side effects:

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

How to use Cetrotide:

  • • Remove from packaging.
  • • Remove blue cap from vial of powder.
  • • Take a pre-filled syringe of water and remove the cap.
  • • Attach the yellow needle (larger needle) on the end of the pre-filled syringe of water.
  • • Pierce the grey bung with the needle and push all of the water into the vial.
  • • Draw up all the solution back into the syringe once the powder has been completely dissolved.
  • • Remove the large yellow needle and dispose in sharp bin provided.
  • • Attach on a grey smaller needle.
  • • With the needle pointing towards the ceiling, flick the syringe so that any air bubbles move to the top.
  • • Push the plunger up so no air is in the syringe.
  • • Pinch an inch of fat below your belly button.
  • • Inject at 45-degree angle.
  • • Push the plunger down to administer Cetrotide.
  • • Dispose of needle and syringe into a sharps bin.

Storage information:

Keep in the box in a dry cool place.

8. 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.

9. 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 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.

10. Cabergoline

Ovarian hyperstimulation syndrome is resulted by administering human chorionic gonadotrophin (hCG) in ART (Assisted Reproduction Technology). Severe OHSS appears in about 3-8% of IVF cycles. Recently, cabergoline has been introduced to help prevent OHSS in women at high risk of OHSS who are undergoing ART treatment.

How to use cabergoline

Cabergoline is a tablet. Please take it as instructed.

11. Metformin

What does it do?

Metformin is prescribed during IVF treatment for some people with Polycystic Ovary Syndrome (PCOS) or those with a high ovarian reserve. The use of Metformin can help to reduce the risk of Ovarian Hyperstimulation Syndrome (OHSS).

Possible side effects:

  • • Diarrhoea.
  • • Nausea/vomiting.
  • • Abdominal pain.
  • • Loss of appetite.

Storage information

Keep Metformin in the packaging in a cool, dry place.

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Fertility care for Women Diagnosed with Cancer

Fertility care for Women Diagnosed with Cancer

Overview

Even the cancer treatments are improved, the complications faced by survivors of cancer are more. Many survivors are young and are diagnosed and treated before they have children. Cancer and its treatment can significantly affect the chance of a patient having a child in the future. It is important to the doctors to discuss the effects of fertility after the cancer treatment, they have to give advice or explore whether they store eggs, sperm or embryos before cancer treatment. This helps the patient to have their biological child in the future. If the patient faces cancer and infertility problems, they have to consult the counselors to avoid distress.

The Effects of Cancer Treatment on Fertility

Following cancer treatment, most patients will be advised to delay conceiving for some time.  Female fertility declines sharply in a woman’s mid to late thirties and even just this delay can significantly reduce the chance of conception.

Chemotherapy

Oocytes (eggs) are highly susceptible to the effects of chemotherapy.  Women treated with chemotherapy are therefore at risk of damage to their eggs, which may ultimately fail the ovaries.  The risk of ovarian failure is higher with increased dose and duration of chemotherapy and with particular types of chemotherapeutic medication. A woman’s period may stop during chemotherapy but may come back up to nine months after chemotherapy treatment has finished.  Although some women will retain eggs in their ovaries after chemotherapy treatment, unfortunately, many will suffer premature ovarian failure and would need to consider treatment with donated eggs if they wish to conceive.

Radiotherapy

Whilst most chemotherapy treatments are administered systemically (throughout the body), most radiotherapy treatments are directed to a local area.  Therefore, damage from radiotherapy is usually limited to the area treated. Pelvic radiotherapy damages egg highly. Retaining ovarian reserve after the treatment is very rare. Additionally, pelvic radiotherapy can cause damage to the uterus (womb) caused by fibrosis (the formation of excess fibrous connective tissue in an organ or tissue) and a reduction in blood flow.  Following pelvic radiotherapy, it is likely that a woman would need to consider fertility treatment using donated eggs and a surrogate host.

Surgery

Surgery for gynecological malignancies can impact on a woman’s chance of pregnancy in the future.  It is important that a woman’s decision for future pregnancies is considered and that treatment is performed whenever possible.

Fertility Preservation Options

1. Oocyte cryopreservation – Egg Freezing

Women may attempt to ‘freeze’ eggs for future use before they undergo treatment such as chemotherapy, which may affect their egg store.   Oocytes (eggs) are stimulated to develop within the ovaries by daily administration of hormone injections. Following this, the eggs are removed from the ovaries under ultrasound control. The eggs removed are then frozen very rapidly using the technique of Vitrification. Eggs can be stored for up to 55 years. Vitrification is the most effective way of freezing human eggs with more than 90% of vitrified eggs surviving after thawing. Women under the age of 35 years have the chance of 1 in 3 cycles of egg freezing resulting in an ongoing pregnancy. The number of pregnancies depends on the number of eggs stored, with each egg having approximately a 5% chance of leading to pregnancy in women under 35 years. The chance of pregnancy will be more to the younger women. Oocyte Vitrification is still a relatively new technique, however, many babies have now been born after using this technique. Initial data suggest that there is no increase in abnormality rates in babies conceived after eggs frozen in this way.

2. Embryo cryopreservation (Freezing)

If a woman is in a stable relationship, the couple may wish to freeze embryos instead of eggs. The woman undergoes a cycle of ovarian stimulation and egg retrieval as in conventional IVF. On the day of egg collection, the male partner is asked to provide a fresh sample of semen, produced on-site in the Andrology Department. All mature eggs retrieved are injected with a single sperm using a technique known as ICSI (Intracytoplasmic Sperm Injection).   On average, about 50-60% fertilize and form embryos. The laboratory will ring you the morning after egg collection to tell you how many eggs fertilized. The embryos are now at the ‘pronuclear’ one-cell stage. It is at this stage that embryos will be vitrified for fertility preservation.  Embryo freezing is a relatively successful procedure and follow-up studies on babies born are reassuring. Embryo storage should only be carried out for couples in a stable relationship as, if the couple separates, the male partner may withdraw his consent for continued storage and treatment. As a result, the embryos would have to perish.

What Treatment Involves

For both egg and embryo freezing, you will need to undergo ovarian stimulation and egg collection.

1. Ovarian Stimulation

  • • Ovarian stimulation involves daily injections of a drug (Gonadotropin) to stimulate your ovaries.
  • • Injections are subcutaneous (beneath the skin) – given through the abdomen or thigh.
  • • The site of the injection needs to be changed daily – usually from side to side (left/right). We recommend you do the injections at the same time every day. We will advise on the timing at the start of treatment.
  • • The drug dose may change during treatment depending on your response to the drug.
  • • You may experience a feeling of heaviness or pressure inside the abdomen as the ovaries get bigger – this is normal.
  • • It is important to follow all instructions on drug dosage and timing. You should inform us immediately if there are any problems with this.
  • • You will need to administer this injection for approximately 10-12 days.

2. Drugs to ‘switch off’ your hormone production

In addition to your stimulating injection you will be prescribed GnRH before Antagonist (cetrotide) in the form of injections. You will be advised how and when to administer these injections. You may be asked to continue the antagonist for a week following your egg collection. From 4 to 7 days after egg collection, women with hormone-sensitive breast cancer should take letrozole tablets. The treatment you are prescribed will be individual to you. The protocol and time to start stimulation will be decided depending on any other treatment you are undergoing and to minimize any delay to oncology treatment. If you have any questions, please ask.

3. Monitoring through stimulation

  • • During stimulation, you will be monitored using blood tests and scans.
  • • 2-3 scans are usually done during the treatment cycle to monitor response to treatment – by way of the growth of follicles in the ovaries.
  • • All scans during the treatment cycle are performed vaginally, as very detailed scans can be obtained in this way, giving accurate measurements of the ovaries indicates the stage of growth of the follicles and readiness for egg collection.

4. Ovulation trigger with Buserelin

Buserelin is the last and final injection before egg collection is carried out. The timing of this injection is very crucial.  The injection must be taken at the time advised by the Unit (this is 34-36 hours before egg collection).  This is a late-night injection. This is the last injection you have before the egg collection.

5. Egg collection

  • • Egg collection usually lasts 20-30 minutes and is usually performed in the morning under intravenous sedation.
  • • The procedure is guided by a vaginal ultrasound.
  • • You will be required to starve from midnight before egg collection (no food, water or chewing gum).
  • • Not all follicles seen on scan yield eggs.
  • • You may experience some pain and bleeding after the procedure.
  • • Chemotherapy, when indicated, could be arranged to commence from as soon as the day after egg collection.

What are the Risks of Fertility Preservation Treatment?

Throughout treatment, Prasad Hospitals work closely with the team planning cancer treatment, to minimize any risk to you or delay your cancer treatment.

 Delay to cancer treatment

When the intention is to freeze eggs or embryos, ovarian stimulation can start at any time in the menstrual cycle as there is no need to ensure that the lining of the womb is at the same stage of the cycle as the ovaries. However, ovarian stimulation takes a minimum of just over two weeks. It is therefore crucial that women are referred to as early as possible in their treatment pathway to allow them to consider fertility treatment if they wish without delay to their oncology treatment. Women who have acute leukemia and delay for the treatment, are not able to freeze eggs or embryos.

 Risk of high oestrogen levels during stimulation

High levels of oestrogen are seen during ovarian stimulation cycles. This could pose a risk to women diagnosed with oestrogen sensitive breast cancer.  The addition of the drug Letrozole is known to significantly lower oestrogen levels and we use this routinely for oestrogen positive breast cancer patients.

 There are no large, long-term follow-up studies, but early data has not demonstrated an increased risk of recurrence or disease progression in these patients.

 Risk from egg retrieval

There is a potential risk for women with ovarian malignancies following egg collection when there could be a spill of malignant cells from the ovary into the abdomen, although in practice this is rarely thought to be significant.  We always discuss this with the oncologist to minimize any risk.

 Ovarian Hyperstimulation Syndrome (OHSS)

About in 1% of women undergoing a cycle of ovarian stimulation for egg recovery, Ovarian Hyperstimulation Syndrome (OHSS) is seen. The risk is no higher in patients undergoing fertility preservation, but we usually continue with drug therapy for one week after egg collection to try to reduce the risk further, so that the woman is in the best position to commence her oncology treatment.

Your Options

Once you have considered all the information you may choose:

  • • Not to proceed with fertility preservation.
  • • To consider possible egg donation in the future.
  • • To proceed with egg or embryo freezing.

If you choose to proceed with egg or embryo freezing you will initially be asked to consent for 10 years of storage. Once your oncology treatment is complete you will have the opportunity to discuss your future options. You will be assessed and treated in line with the Clinical Commissioning Group (GGC)/Trust Infertility/assisted conception guidelines.

Counseling

Patients have found counseling extremely helpful and it is available to all patients referred to us. To make an appointment please ring our reception desk on +9188012333333, or visit: www.prasadhospitals.in

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Feeling your Baby Move

Feeling your Baby Move

The Baby Movement is a sign that they are fine

Mostly between 16 and 24 weeks of pregnancy, you may have Feeling Your Baby Move. The type of movements like kick, flutter, and roll, may change as pregnancy progresses.

Feeling Your Baby Move

How often can a baby move?

  • • 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.
  • • You must NOT WAIT till the next day to get advice if you are worried about your baby’s movements
  • • If the baby’s movements slowed or stopped, contact the team immediately.
  • • Don’t neglect your time if the baby’s movements stopped.

Why the baby’s movements are 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.

What if the 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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Fallopian Tube Cannulation

Fallopian Tube Cannulation

What is fallopian tube cannulation (by keyhole surgery)?

If a woman is suffering from subfertility issues with a blockage in the part of the fallopian tubes closest to the womb, they can have treatment of Fallopian tube cannulation.

Why is fallopian tube cannulation performed?

About 1 in 6 couples, subfertility problem is seen. There may be many reasons but in 20% of couples, subfertility is because of blockage of fallopian tubes either completely or partially. Normal fallopian tube function is important in allowing the egg (oocyte) to meet the sperm for fertilization (joining of the egg and sperm) and to allow the fertilized egg (embryo) to travel to the womb (uterus). The blockage of fallopian tubes is mostly due to previous infections, adhesions, and endometriosis. These can be diagnosed by hysterosalpingogram (X-Ray Test) or by going laparoscopy.  In a specific group of women, the blockage is in the first and closest part to the uterus (proximal part) and this may be treated by fallopian tube cannulation.

Am I suitable for fallopian tube cannulation?

Fallopian tube cannulation procedure is suitable for:

  1. 1. Having subfertility due to tubal factor.
  2. 2. When a tubal blockage is diagnosed by a hysterosalpingogram or dye test.
  3. 3. If the blockage is at the proximal part of the fallopian tube.

What are the alternatives to fallopian tube cannulation?

Your doctor will be able to advise you regarding the alternatives to increase your chances of achieving a pregnancy-specific to your circumstances. However, in general for couples with subfertility due to the tube factor, the main alternative involves undergoing IVF (in vitro fertilization).

How is fallopian tube cannulation performed?

This procedure is performed by keyhole surgery with cameras of hysteroscopy and laparoscopy. Hysteroscopy and laparoscopy are surgical procedures that allow the surgeon to access the inside of the womb and the abdomen respectively using a narrow tube that contains a camera and a light source. While visualizing the abdomen and the pelvis through the laparoscope, a fine guidewire is introduced into the womb and the opening of the fallopian tube. It is carefully used to unblock the tube. A dye is then introduced through the womb into the fallopian tubes to check whether it can pass through into the pelvis and determine whether the procedure has been successful. This is similar to the way an artery is unblocked in the heart to treat heart disease.

How successful is fallopian tube cannulation?

The published evidence suggests that fallopian tube cannulation achieves tubal patency (successfully treating the blockage) in approximately 70% of women and is successful in achieving a pregnancy in 10-20% of women afterward. (NICE interventional procedures Programme 2013).

How safe is fallopian tube cannulation?

Generally, this is a safe procedure. Serious complications as a result of surgery are rare and occur in an estimated 1 in 1000 cases. These complications are related to the laparoscopy and not the procedure of tubal cannulation itself.   Possible complications from a laparoscopy and hysteroscopy include injury to organs, such as bladder and bowel, and injury to a major artery (blood vessel).   Possible complications of the fallopian tube cannulation procedure include perforation of the fallopian tube (injury of the fallopian tube resulting from the guidewire insertion) in 110% of cases, infection and ectopic pregnancy. Ectopic pregnancies are those which implant outside the womb, most commonly in the fallopian tube and can be dangerous if undiagnosed. However, any woman with complete or partial blockage of her tubes is at a higher risk of developing an ectopic pregnancy. If you successfully conceive after this procedure an ultrasound scan must be arranged at approximately 6-7 weeks’ gestation to ensure that your pregnancy is developing normally.

How long will I need to be in the hospital?

Most women will be able to return home on the day of the operation (‘day-case surgery’), although different people recover from a general anesthetic and the operation differently and so you may need to stay in hospital a little longer.

Will I have pain or vaginal bleeding after my operation?

Women who undergo laparoscopy commonly describe lower abdominal, upper leg, and shoulder tip pain. You will also have 2-4 incision sites where the laparoscopy and instruments were inserted over your abdomen. After the operation and for 10 – 14 days the pain may be seen. The team will provide the appropriate pain relief accordingly. Use only sanitary towels whereas tampons increase the risk of developing the infection. If you feel your bleeding is prolonged or becomes foul-smelling, please seek advice IVF specialists.

When can I have sex again?

Yes, you can have but not when vaginal bleeding stopped.  We would recommend trying for pregnancy when you are comfortable sooner rather than later.  Please ensure you have had appropriate investigations regarding ovulation and semen analysis.

When can I expect to resume normal activities?

You can resume your normal activities whenever you feel well, like not getting tired. Avoid heavy lifting, housework for 10-14 days.

Can I help towards understanding tubal blockage and its treatment?

Yes – We are very interested in the outcomes of women who undergo fallopian tube cannulation and whether they have any success in achieving a pregnancy in the future.   Many women are referred from outside our local area and we often do not find out their outcomes. As we are keen to regularly evaluate our services and assess your outcome, we would be grateful if you would agree to be contacted in the future. We would also be grateful if you would contact us with the details below if you successfully become pregnant in the future.

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