IVF is the most effective treatment for women with absent, blocked or damaged fallopian tubes, for whom it was first developed. It is now used to treat a wide range of fertility problems.

Fertility drugs are used to stimulate the ovaries to produce multiple follicles. Each follicle should produce one egg. The chances of pregnancy are increased if more than one egg can be produced and fertilised. The response to stimulation is monitored by ultrasound scan (USG) measuring the number and size of the developing follicles in the ovaries and by measuring the blood oestrogen level. The ultrasound does not show the eggs themselves, which are very small, but shows the follicles, the fluid filled sacs within which the eggs are contained. The USG scans are repeated at intervals during the treatment cycle. When the main follicle reaches a size of 17-22 millimetres preparations will be made for egg collection. An oestradiol assay will be carried out before giving hCG to help decide the timing of the egg collection.

The eggs are collected vaginally using ultrasound guidance usually under a light anaesthetic. An aspiration needle attached to a probe sucks out the fluid from the follicles and this is then examined under the microscope to identify the eggs.

Surgical sperm retrieval (TESE, PESA) is a treatment option for men with an absence or blockage of the tube, vas deferens, or non-obstructive azoospermia (lack of sperm).

Sperm can be collected directly from the epididymis situated inside the scrotum. This is known as PESA. Sperm can also be extracted from the testicles in a process known as TESE. If enough sperm is retrieved it can be frozen and used again at a later stage if required so as to avoid the need for repeat surgery.

These two processes are always carried out by experienced surgically urologists and are timed to coincide with the female partner’s egg collection. The sperm collected is then used to fertilise the eggs by ICSI.

At Delhi-IVF we have two consultant urology surgeons who carry out these procedures daily.

After egg collection, the eggs are incubated for a short time and then the sperm is added and the eggs are incubated in the laboratory for a further 18-24 hours to fertilise. The first signs that fertilisation has taken place is when two pronuclei (spots) are seen in the egg. If this occurs, the egg will then start dividing and will become an embryo, the embryos will then be transferred to the uterus 2-5 days after egg collection.

Intra-Cytoplasmic Sperm Injection (ICSI)

ICSI is the injection of a single sperm directly into an egg using a specially prepared needle. It is recommended for sever cases of male infertility where there has been no previous fertilisation of eggs and where there are only few morphologically normal sperm available.

While ICSI can be used it does not guarantee that fertilisation will take place.

Couples go through the same preparatory procedures as for IVF, i.e. ovulation induction and egg retrieval.

A small percentage of eggs (fewer than 1 in 10) will be damaged by the ICSI process. They cannot be used. Approximately 6 out of 10 eggs fertilised by ICSI will develop into embryos. The fertilised embryos are incubated and allowed to develop as in standard IVF before transferring to the uterus in the usual way.

Those embryos which are not transferred to the uterus may be suitable for freezing. We recommend freezing when there are good quality embryos left over after embryo transfer for that cycle is complete. These embryos can be used in a future cycle if needed without the same need for a drug treatment.

Pregnancy rates following frozen embryo transfer are generally lower than with fresh embryos. However, this is expected to improve as a new method of freezing called vitrification has been developed.

Written consent must be given by a couple wishing to freeze embryos.

Semen freezing is useful in cases where the male partner will be unavailable on the day of egg collection or when sperm has had to be surgically retrieved.

Many couples find sperm freezing to be an invaluable process when the male partner is only able to stay a few days in Delhi because of work demands.