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Women who are diagnosed to have cancer recently-do they have options to preserve their fertility?

Ans: Yes, before treating the cancer, fertility experts can freeze.
1. Eggs,
2. Fertililised eggs called embryos or
3. The ovarian tissue by new technologies.
In this way women may produce babies once their treatment for cancer is completed. This process of freezing is called as cryopreservation.

Lymphomas, leukemias, breast cancer, thyroid cancers and gynecological cancers viz cervical cancer, uterine cancer or ovarian cancer are some of the most common cancers in girls and young women. They are treated with surgical approach or chemotherapy or by radiation or even by the combination treatment, as per the case may be. There are several factors that determine women’s fertility, after cancer treatment like age of women, location of radiation therapy, drugs used in chemotherapy. Cancer treatment can remarkably decrease women’s fertility by harming the quality or quantity of eggs.
Cryopreservation has proved to a boon for preserving fertility in such women.

Egg (oocyte) cryopreservation

Single women with no current male partner, may choose this option over embryo preservation. The procedure of egg freezing has improved a lot since past decades. Despite the success of egg freezing, pregnancy rates with embryo freezing have been better than egg freezing. Women will be given some medications to grow eggs. Once the eggs are grown, they are collected and immediately frozen. After the cancer treatment, eggs that survive the freeze – thaw process are fertilized with partner’s semen. The resulting embryos are then placed inside the womb.

Embryo cryopreservation

Embryo cryopreservation is most common way of preserving fertility. The ovaries are stimulated by giving some medications, eggs are collected with gentle suction. Then these eggs are fused with partners semen and resulting embryos are grown. These embryos are frozen. Once cancer treatment is over and women is mentally and physically prepared to produce a baby, one or two embryos are transferred into the womb.
Embryo cryopreservation offers best chances of pregnancy.

Ovarian tissue cryopreservation

This procedure is under research settings, in which the ovarian tissue that contains resting eggs is cut and sliced and then frozen. After the cancer treatment, this ovarian tissue is thawed and put back into the body. Women may need medications to stimulate this ovarian tissue and produce eggs. This procedure has some disadvantages.
1. It involves multiple surgeries.
2. If the sliced ovarian tissue had cancer cells and is placed back in the body, it may spread cancer.
Hence it is important to know that this is still under research settings, and it has not always been successful at fertility centers.

Dr Megha Gupta,

MBBS,DNB,MICMCH,PGDMLS,FMAS
Fellow of reproductive medicine,
Craft hospital and research centre,
Kodangallur, Kerela.

FERTILITY PRESERVATION

Is an emerging field that offers treatment aimed at protecting future reproductive ability for individuals with cancer or other serious illnesses. It has given a new dimension to assisted reproductive technology services. With a post thaw embryo / gamete survival rate of around 90 % and around 50 % implantation rate, the infertility specialists confidently offer cryopreservation to all who want to delay childbearing or whose fertility is at risk.
Why do fertility preservation techniques insists insist a preemptory attention in this era?
Why the need is real, crucial and prevalent?
There are innumerable reasons, ranging from pioneering advances in cancer diagnostics and treatment, to changes in our concerns and obligations with fertility being delayed and inconsideration of percussion. Of delayed age, and lastly it has emerged as hope to all the transgender community of holding baby of their own flesh and bone. There are several other conditions where women or men can seek this intervention to preserve their fertility for instance many autoimmune and hematologic conditions sometimes require chemotherapy, radiotherapy, or both and sometimes even bone marrow trans- plantation.

As a fertility health torch bearers what’s our role towards society and to individual in circumstance as these? It is to not only shrink the disease. burden but also preserve the individual’s choice of pregnancy, which can be sought by both men and women and other genders. It’s ours to see to sublime the psychological anguish and economic hardship that one has to go through this procedure.

When we talk about the options and alternatives, currently sperm, egg and embryo cryopreservation are standards of care for preserving fertility in reproductive age cancer patients, ovarian tissue cryopreservation is still considered experimental. Adoption and surrogacy may also need to be considered in a few cases.

SOCIAL EGG FREEZING

Also known as elective or non-medical egg freezing/ anticipated Gamete Exhaustion banking. It refers to the practice of freezing and storing the woman’s eggs while they are still relatively young and of good quality, even if they do not have an immediate intention of becoming pregnant. The primary goal of social egg freezing is to provide women with more control over their reproductive timeline, particularly in situations where they may not be ready or able to have children due to career, educational pursuits, personal reasons, or lack of a suitable partner. By freezing eggs at a younger age, women can potentially increase their chances of successful pregnancy in the future, as egg quality and quantity tend to decline with age.

CLINICAL FERTILITY PRESERVATION OPTIONS IN
FEMALE AND MALE

1. PELVIC SHIELDING
2. OVARIAN TRANSPOSITION
3. TESTES SHIELDING
4. SPERM BANKING
5. SPERM EXTRACTION
6. EMBRYO BANKING
7. EGG BANKING
8. IN VITRO MATURATION

SOCIAL EGG FREEZING

In 2013, the ASRM declared that oocyte cryopreservation was no longer and experimental procedure and could be used as an option for fertility preservation. It is also referred to as Anticipated Gamete Exhaustion banking. It also enhances a women’s reproductive autonomy and allows term to feel more socially, psychologically and financially stable before motherhood.

THE RISK AND LIMITATIONS OF FERTILITY PRESERVATION

TECHNIQUES – ART PROCEDURE

however, the boon has its own accompanying snags in particular multiple pregnancy and related complications, increased risk of low birth weight, prematurity, and perinatal mortality which might be a hindrance to pursue fertility preservation because of perceived potential detrimental maternal and
offspring health outcomes. The hanging sword of passing the cancer to offspring might be another stumbling block.

POSTHUMOUS REPRODUCTION

Refers to the retrieval of gametes and reproductive issues after a person’s death or after they have become
incapacitated and their death is imminent, it also deals with the storage and the use of these gametes and reproductive tissues after the person’s death.

Fertility perseveration has come up as an worthwhile asset as it strengthens a women’s reproductive autonomy and allows them to feel more socially, psychologically and financially stable before motherhood. Cancer patients have a humongous mountain to climb to reach the normalcy where as a transgender in all of their struggle with perceptions and respectful and rightful place in the society these interventions have
given them to have a satisfactory family life.

Dr Shruti Sneha

MBBS, MS OBG, FRM
Craft hospital and research center, Kerala

Introduction

Assisted hatching is a laboratory procedure that is done along with in vitro fertilization (IVF).IVF involves the mixing of sperms with eggs in the laboratory. When sperm penetrates the egg, it is considered to be fertilized. Fertilized eggs are observed for 3 to 6 days as they divide and grow into embryos. The best embryo can then be placed inside the womb of women or it can be frozen for future use. When the embryo is developing, it gets surrounded by cells that make a protective shell (zona pellucida). Embryo naturally breaks out of this shell for growth. Sometimes, in the indicated cases, the doctor may ask the embryologist to create a small crack in the outer covering of an embryo just before the embryo is placed inside the womb. Assisted hatching is done with the view that this might help in the expansion of the embryo, implantation into the uterine wall, and hence leading to a pregnancy.

What are the indications of assisted hatching?

The most common indications of assisted hatching with in vitro fertilization are
1. Age -women is older than 37 years.
2. Woman with poor ovarian reserve: low AMH levels/ low AFC (antral follicle count)/ high levels of follicular stimulating hormone on day 2/3 of periods.
3. Women with low AMH levels.
4. Women with low antral follicular count.
5. Women with poor-quality embryos.(excessive fragmentation or slow rate of cell division)
6. Zona factor-cases with thick outer shell (zona pellucida)
7. One or more previous failed IVF cycles.

How is assisted hatching done?

The outer shell of the embryo is artificially weakened by making a small hole in the zona pellucida. This can be done by different methods like using an acid solution called Tyrode’s solution or by using a laser.

Can assisted hatching cause problems in embryos or pregnancy?

Sometimes assisted hatching can cause damage to the embryo, but although it is rare when meticulously performed by a trained embryologist. This can make the embryo unusable. There are some studies that show that the risk of identical twins is slightly increased in cases where assisted hatching is applied, however, there is insufficient evidence to definitely conclude that AH is associated with monozygotic twinning.
It must be meticulously performed by a trained embryologist.

Does assisted hatching improves pregnancy rates?

In an unselected/general population, live birth rates are not significantly different between embryos that have undergone AH vs those that have not, HOWEVER, in patients with a poor prognosis data is mixed and there seems to be benefit in a subset of patients who have to be carefully selected by an experienced clinician. Pregnancy rates for IVF procedures with assisted hatching have been shown to be higher than for IVF without assisted hatching in some published studies. Apparently, this benefit is not seen in all IVF programs.

Dr Megha Gupta

MBBS, DNB, FMAS, PGDMLS, MICMCH.
Fellow of reproductive medicine.
Craft Hospital and research center,
Kodangallur, Kerela.

Introduction:

Sperm DNA fragmentation refers to the damage or breaks that occur in the DNA strands of sperm cells. This phenomenon has garnered significant attention in the field of reproductive medicine as it plays a crucial role in male fertility. Signs and Symptoms of Male Infertility.

Understanding Sperm DNA Fragmentation:

Sperm DNA fragmentation occurs when the genetic material within sperm cells sustains breaks or damages in its structure. While some degree of DNA damage is considered normal, excessive fragmentation can have a profound impact on male fertility. The integrity of sperm DNA is vital for successful fertilization and embryo development.

Causes of Sperm DNA Fragmentation:

Various factors can contribute to sperm DNA fragmentation. Oxidative stress, caused by an imbalance between reactive oxygen species (ROS) and antioxidant defenses, is a leading cause. Lifestyle factors such as smoking, alcohol consumption, and exposure to environmental pollutants can increase oxidative stress, leading to DNA damage.
Other contributing factors include advanced paternal age, certain medical conditions (varicocele, infections, etc.), pesticide and radiation exposure,. Additionally, prolonged abstinence and high testicular temperatures(as seen with fever, frequent sauna visits etc.) can also exacerbate sperm DNA fragmentation.

Consequences of Sperm DNA Fragmentation:

High levels of sperm DNA fragmentation can lead to reduced fertility and an increased risk of miscarriages. It even impairs the outcome and success rate of both IUI as well as IVF cycles.

Diagnosis and Assessment:

The evaluation of sperm DNA fragmentation is crucial in cases of unexplained infertility or recurrent pregnancy loss. Several tests, including the sperm chromatin structure assay (SCSA), terminal deoxynucleotidyl transferase dUTP nick-end labeling (TUNEL), and comet assay, can assess the level of DNA damage in sperm cells.

Treatment and Management:

Addressing sperm DNA fragmentation often involves adopting lifestyle changes to reduce oxidative stress, such as quitting smoking, moderating alcohol intake, and avoiding exposure to environmental toxins. Antioxidant supplementation has also been explored as a potential intervention to improve sperm DNA integrity.
For men with diagnosed medical conditions like varicocele or infections, appropriate treatments can be prescribed to mitigate DNA fragmentation. This includes antibiotics for infection and antioxidants &/or varicocelectomy in patients with varicocele. In some cases, assisted reproductive techniques like MACS(Magnetic Activated Cell Sorting), or PICSI(Physiological IntraCytoplasmic Sperm Injection) may be used or use of surgical method of testicular sperm aspiration (TESA) to retrieve healthier sperm for fertilization.

Conclusion:

Sperm DNA fragmentation is a critical factor affecting male fertility and reproductive outcomes. It is essential for individuals and couples facing infertility issues to seek proper medical evaluation and consider appropriate interventions. Advancements in research and assisted reproductive technologies continue to shed light on this complex issue, offering hope for couples striving to start a family.
By

Dr Sunidhi Minhas

MBBS, MD (obstetrics & gynaecology), DNB, 2nd year FNB (reproductive medicine) fellow.

Introduction:

In the realm of reproductive health, the term “poor ovarian responders” or POR refers to women who experience difficulties in conceiving due to decreased ovarian response which can either be due to reduced ovarian reserve and/or inability of a normal reserve ovary to exhibit expected response.

1. What are Poor Ovarian Responders?

Poor ovarian responders are women who exhibit a diminished response to ovarian stimulation during assisted reproductive technologies (ART) like in vitro fertilization (IVF). These women have lower than “expected” numbers of follicles and retrieved eggs, which may impact their chances of conceiving. The first category is people who are expected poor responders with reduced ovarian reserve parameters, and second category includes women having a poor response despite of adequate ovarian reserve.

2. Causes of Poor Ovarian Response:

Several factors can contribute to poor ovarian response. Age is a significant factor, as a woman’s fertility declines as she gets older. Other potential causes include genetic predisposition, certain medical conditions (e.g., endometriosis), previous surgeries, and exposure to certain toxins or environmental factors.

3. Challenges Faced:

Conceiving for women with poor ovarian response can be quite challenging and emotionally taxing. The reduced number of eggs retrieved during IVF cycles may limit the chances of obtaining viable embryos. Additionally, the cost of multiple IVF attempts and the emotional toll of repeated failures can be overwhelming.

4. Diagnosis of Poor Ovarian Response:

A diagnosis of POR is typically made based on a woman’s response to ovarian stimulation during an IVF cycle. In many cases it can be predicted before IVF by checking ovarian reserve parameters eg. AFC/AMH, but this may not be the case for all. Generally, a lower number of retrieved eggs and follicles, as well as suboptimal hormone levels at the end of stimulation/IVF are indicators of poor ovarian response.

5. Available Treatments and Options:

While poor ovarian response presents unique challenges often difficult to combat, there are treatment options available to improve the chances of conception. One such approach is using personalized ovarian stimulation protocols, tailoring medication dosages to an individual’s specific needs. Additionally, the use of certain adjuvant therapies and supplements like stem cell therapy and PRP(Platelet Rich Plasma) may be recommended to enhance ovarian response.

6. Emotional Support and Coping Strategies:

Dealing with fertility challenges can be emotionally draining, and it’s crucial for women facing poor/low ovarian response to seek emotional support. Joining support groups or talking to a counselor can help cope with the stress and anxiety associated with the fertility journey.

To conclude, poor ovarian responders face unique hurdles in their pursuit of parenthood, but it’s essential to remember that they are not alone. With advancements in reproductive medicine and the availability of support systems, there are various paths to explore. Seeking guidance from fertility specialists and finding emotional support can make a significant difference. Remember, the journey to parenthood may be challenging, but it is worth it in the end, regardless of the path taken.

By

Dr Sunidhi Minhas

MBBS, MD (obstetrics & gynaecology), DNB, 2nd year FNB (reproductive medicine) fellow.

Important Physical Signs That You Are Fertile

Thinking about getting pregnant? Then it’s time to get acquainted with the big O: ovulation.

To boost your chances of getting pregnant, it helps to know when you’re ovulating. Then you’ll know when you and your partner should be having sex.

What Is Ovulation?

Ovulation occurs when an egg is released from the ovary. In a regular menstrual cycle, this typically happens two weeks before your period starts. When the egg is ovulated, you want sperm waiting in the fallopian tubes available to fertilize that egg.

When does Ovulation occur?

Ovulation typically happens on day 15 of the menstrual cycle, but it is not the same for everyone. The menstrual cycle happens between 28 to 32 days, and ovulation usually occurs between days 10 and 19 of the cycle, about 12 to 16 days before the next period. Generally, ovulation occurs 14 days before the onset of the period in healthy women.

What Are the Signs and Symptoms of Ovulation?

Changes in Cervical Mucus

When you’re approaching ovulation, secretions near the cervix known as cervical mucus increase and transform into a raw-egg-white-like consistency. This fertile quality cervical mucus helps sperm swim up and into the reproductive system and typically makes sexual intercourse easier and more pleasurable.

Rise in Basal Body Temperature

Basal body temperature is defined as your “lowest resting body temperature.” Your basal body temperature rises during ovulation, though only by half a degree or less. If that higher temperature stays steady for three days or more, it could signal ovulation. You can track daily changes to determine ovulation using a special basal body thermometer that measures your temperature in tiny increments.

Breast soreness or tenderness

Tender breasts or sore nipples can be another sign of ovulation, thanks to the rush of hormones entering your body right before and after ovulation. Some women will experience this tenderness just before ovulation, while others may feel it right after ovulation occurs.

Mild pelvic or lower abdominal pain

Called Mittelschmerz, ovulation pain can feel like a sharp or dull cramp on the side of your abdomen where the ovary is releasing the egg. This ovulation side effect can last anywhere between a few minutes and a few hours.

Light spotting or discharge

Brown discharge or spotting is normal during ovulation. It occurs when the follicle that surrounds and protects the oocyte matures, grows and then ruptures, resulting in a small amount of bleeding.

Signs and Symptoms of Male Infertility

Infertility problems in men are more common than you might think. Among couples who are having trouble starting a family, one-third of the time those troubles can be linked to male fertility issues. Many different medical conditions and other factors can contribute to fertility problems, and an individual case may have a single cause, several causes, or—in some cases—no identifiable cause.

Signs and Symptoms of Infertility in Men

While there may be no other obvious signs of infertility, there are a few warning flags to look out for. These include:

Ejaculation disorder

The “ejaculation disorder” is one of the most common symptoms of male infertility. Some men experience rare ejaculation or early ejaculation, while some others have a very low volume of semen during ejaculation. All of this come under ejaculation disorder.

Lifestyle factors such as alcohol and tobacco use can contribute to infertility, as can participating in high-intensity sports or activities that might expose your testicles to high temperatures (like saunas or occupational exposures).

Structural problems

Anything that blocks the genital tract can stop the flow of semen. This could be a genetic or birth defect. Infection or inflammation from a sexually transmitted disease can also block semen. Other causes include scar tissue from surgery or twisted, swollen veins in the scrotum.

Lack of Sexual Desire

Usually, men produce a greater amount of testosterone, a hormone responsible for their libido or sex drive. If due to some hormonal issues, there is a dip in the testosterone, then their sexual desire or drive decreases.

Pain or Swelling in the Testicles

A dull pain or swelling in your testicles is not normal and seeks immediate medical attention. There many reasons for this condition that includes testicular tension (twisted testicles), Epididy mitis (testicle infection), Hydrocele (building up of fluid around testicles) and hernia.

Do Fibroids Affect Your Fertility?

What are fibroids?

Fibroids are muscular tumors that may develop in the wall of the uterus. They are usually benign, meaning not cancerous.  About 80% of women will have had a fibroid by the time they turn 50. They’re common growths that develop in the uterus, and they’re generally painless. But sometimes fibroids can interfere with fertility and make it more difficult to get pregnant.

Approximately 5% – 10% of infertile women have fibroids. Their size and location determines whether fibroids affect fertility. Fibroids may cause infertility by obstructing the fallopian tubes and impairing gamete transport. The critical factor may be distortion of the endometrial cavity, causing abnormal endometrial receptivity, hormonal milieu, and altered endometrial development.

Women with fibroids and their partners should be thoroughly evaluated to find other problems with fertility before fibroids are treated. A fertility specialist can help assess if fibroids might be hampering conception.

How do fibroids cause infertility?

There are several ways uterine fibroids can reduce fertility:

• Changes in the shape of the cervix can affect the number of sperm that can enter the uterus.
• Changes in the shape of the uterus can interfere with the movement of the sperm or embryo.
• Fallopian tubes can be blocked by fibroids.
• They can impact the size of the lining of the uterine cavity.
• Blood flow to the uterine cavity can be affected. This can decrease the ability of an embryo to stick (implant) to the uterine wall or to develop.

Fibroids are found in 2% to 12% of pregnant women, but not all fibroids get larger or cause problems in a pregnancy. If a fibroid grows, it usually does so in the first 12 weeks of pregnancy.

How to select best hospital for fertility treatment?

Having a baby is an incredible experience for every couple, but not all couples are able to conceive naturally. Fertility treatment is physically and emotionally demanding so it’s important to find a hospital and doctor that’s right for you. Listed below are few essential characteristics to look out for.

Success Rates

This is one of the foremost things that couples should consider in hospitals that offer comprehensive fertility treatments. Having the highest success rate doesn’t necessarily mean the clinic is the best. Some clinics avoid taking on hard cases or refuse treatment to women above age 40 with their own eggs. Understand that different rates are associated with each procedure and vary according to the age group of patients.

Facilities Offered and Technologies used

The fertility clinic you prefer should offer all the latest fertility treatments within its premises to provide maximum convenience to the couple undergoing the treatment. Andrology, Embryology, Genetics and other essential labs absolutely need to be in-house parts of the hospital. It is of the utmost importance that your clinic uses the highest standards in quality control within the labs they utilize.

Qualified & Specialized Doctors

Always check details & information about the doctors. Read, research and find out more about doctors, doctor reviews online (digital media) and offline, their qualification, specialization & experience.

Experience of Clinical Staff

A good fertility clinic will have a team of highly experienced professionals with specialization in infertility treatments. Most treatments are expensive and hence being treated by a clinic that has the best panel of experts should be a given.

Two-way Communication

The doctor must be willing to listen to your wishes and concerns. He or she must make efforts to make you comfortable and make a customized treatment plan for you. He should discuss the basics of the treatment with you.

Transparency in Cost and Procedures

An efficient fertility clinic will follow professional ethics and transparency in terms of both medical and financial procedures.

If you want to end your infertility journey at the earliest then contact us now to book your first free consultation with us and know your best suitable IVF Doctor for quicker & better fertility results.

In vitro fertilization (IVF)

In vitro fertilization (IVF) makes it possible for people with infertility to experience the joy of having a child. It is the process of collecting eggs and fertilizing them in the laboratory.

IVF works by using a combination of medicines and surgical procedures to help sperm fertilize an egg, and help the fertilized egg implant in your uterus.

The first step in IVF is taking a combination of tablets and injections for several days to help the ovaries produce several eggs that are mature and ready for fertilization. The response to injections is monitored by ultrasound scan and blood tests on a regular basis during this step in the IVF process to check on your ovaries and monitor your hormone levels.

Egg Retrieval

A little more than a day before your eggs are scheduled to be retrieved from your body, you’ll receive a hormone injection that will help your eggs mature quickly. Then, you’ll have a minor surgical procedure — called follicular aspiration — to remove the eggs. You’ll get medicine to help you be relaxed and comfortable during the procedure. Using an ultrasound to see inside your body, the doctor puts a thin, hollow tube through your vagina and into the ovary and follicles that hold your eggs. The needle is connected to a suction device that gently pulls the eggs out of each follicle.

Insemination

The male partner will now need to give a semen sample. Embroyologist will mix the sperm with the eggs in a petri dish. The sperm are then put through a high-speed wash and spin cycle in order to find the healthiest ones. The egg and sperm are then combined in a lab through varying technologies of fertilization, such as intracytoplasmic sperm injection (ICSI).

Embryo Culture

Your doctor will monitor the fertilized eggs to ensure that they’re dividing and developing. The embryos may undergo testing for genetic conditions at this time.

Embryo Implantation

When the embryos are big enough, they can be implanted. This normally occurs three to five days after fertilization. Implantation involves inserting a thin tube called a catheter which is loaded with embryos and inserted past your cervix, and into the uterus. Your doctor then releases the embryo into your uterus.

Pregnancy Test

After 2 weeks of embryo transfer, blood test is done to check if embryos have implanted.