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Initial Work up Consultation
Initial Work up Consultation
Assisted Reproduction Techniques
(Art)
Assisted Reproduction Techniques
(Art)
Ancillary services
Ancillary services
Semen Bank
Semen Bank
Cryopreservation Laboratory
Cryopreservation Laboratory
Technology
Technology
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| Initial Work up Consultation |
Treatment at Max ensures strict confidentiality.
Highly trained qualified team of doctors, trained fertility nurse and highly experienced trained technical personnel at our dedicated Assisted Fertility Clinic OPD will greet you. |
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Detailed review of previous patients’ history, symptom evaluation, medical examination, investigation discussion, screening tests to establish reproductive health and infertility evaluation to reach an accurate diagnosis and decide the treatment options. |
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Pre-treatment advice and counselling |
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Pre-treatment tests including hormonal analysis, screening for infections, routine health tests for surgical and anesthesia fitness (if required), tubal assessment - hysterosalpingography, sonosalpingography (if required), uterine tissue biopsy (if required) and lapro-hysteroscopy for women. |
| For men, semen analysis, advanced spermiogram and semen culture (if required). |
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Consent forms |
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Ultrasonography |
| Assisted Reproduction Techniques (Art) |
| ART involves the manipulation of gametes i.e. sperms and/or oocyte (egg) or embryos which are transferred into uterus or fallopian tubes to help obtain pregnancy by means other than natural intercourse. ART includes, |
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Intrauterine Insemination (IUI)
IUI involves collection of semen emitting during procedures other than intercourse (usually by masturbation), processing semen and transferring it directly into the uterus with the help of a catheter. It can be done in a natural cycle but by using fertility enhancing drugs, which improve the pregnancy rate. |
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In-vitro fertilization (IVF)
IVF, commonly known as test tube baby, is the most widely practised assisted conception in the world after the first IVF baby was born in 1978. IVF means fertilization of an ovum (egg) outside the body and then transferring the embryo(s) into the uterus of the woman. An egg is exposed to 50,000 to 100,000 sperms in a test tube to assist fertilization. |
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Intra Cytoplasmic Sperm Injection (ICSI)
A technological breakthrough in 1992 overcame the inability of sperm to fertilize an egg due to suboptimal sperm parameters, egg defects, etc. Micromanipulation is done wherein a single sperm is directly injected into the cytoplasm of an egg to assist fertilization. |
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Steps involved in IVF and/or ICSI programme |
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Controlled ovarian hyperstimulation (COH): Hormonal injections medication to stimulate ovaries to obtain eggs |
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Follicular development tracking with sonology and blood test |
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Egg retrieval from follicles in ovary under local or general anesthesia |
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Collecting semen sample |
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Fertilization of eggs in the laboratory |
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Embryo(s) transfer into the uterus under ultrasound guidance |
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Pregnancy testing |
| Specific post treatment and pregnancy follow up care is given to carry the pregnancy through. |
| Risks |
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Multiple pregnancy |
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Ovarian hyperstimulation syndrome (OHSS) |
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Ectopic (abnormal site) pregnancy |
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Bleeding, infection, anaesthesia |
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Supportive treatment options to ART |
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Assisted hatching
Most common reason for an IVF or ICSI cycle failure is because embryo(s) fail to implant. Before an embryo can implant into the lining of the uterus, it must hatch out of its shell. Assisted hatching is done through an altercation in the outer covering of the egg either by drilling a hole through it or by thinning it, which promotes hatching or implantation of embryos that are unable to escape intact from eggs’ outer covering.
LASER ASSISTED HATCHING - Max offers the latest advancement in hatching using laser. Mechanical and chemical hatching are also available. |
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Zona free Blastocyst Transfer and Blastocyst Culture
Normally, following IVF or ICSI embryo transfer is performed when embryo contains two to four, or eight cells. Improvements in culture media have allowed selective growth of embryos to blastocyst, i.e. embryo age of five or six days, the stage at which embryos start to implant in the womb. Thus natural selection by leaving embryos in culture for longer time allows better implantation and higher pregnancy rate. |
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Optical spindle imaging of oocyte using polarized microscope
This guarantees a safe ICSI that prevents DNA damage at the time of sperm needle injection; thereby, increasing the pregnancy rate. Also, quantification of eggs’ outer covering thickness can help assess further techniques to increase pregnancy rate. |
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Invitro Maturation of oocytes (IVM) (eggs)
In the case of patients with hyper-responding polycystic ovarian syndrome or with history of ovarian hyperstimulation, immature eggs are taken out and cultured in laboratory to mature. |
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Interventional surgical sperm retrieval (SSR) techniques
Absence of sperms in ejaculate or absent ejaculate needs intervention to obtain sperms by
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Micro surgical epididymal sperm aspiration (MESA) |
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Percutaneous epididymal sperm aspiration (PESA) |
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Testicular sperm aspiration (TESA) |
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Testicular sperm extraction (TESE) (Testicular biopsy) |
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Testicular mapping biopsies |
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| Ancillary services |
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Electroejaculation is offered through electroejaculators in patients with impotency (erectile dysfunctions). |
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Retrograde ejaculation sperm retrieval is offered for patients who achieve orgasm with no ejaculate by retrieving sperms from urine post ejaculation. |
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Advanced ultrasonological diagnosis and monitoring is offered using three dimensional ultrasound machines supported with colour, pulse and power Doppler, and high density imaging. This minimizes blood tests, gives comprehensive understanding of pathology and facilitates better decision making, better timing of egg rupture by predicting fertilizability of ovum and implantation. Hence, marrying ultrasonology with palpation, increases prediction and likelihood of pregnancy. |
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Advanced non-surgical minimally intervention uterus and tube assessment is offered using sonosalpingography and hyterocontrastsonogaphy (Hy-Co-Sy). |
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Andrology services are detailed andrological assessments supported by ultrasonology and advanced semen tests. |
| Semen Bank |
| A reliable semen bank at Max offers freezing and storing facilities of semen in liquid nitrogen at an ultra low temperature. We take necessary precaution to ensure at least 10 million progressive motile sperms post thawing (defreezing). Therefore, all donor semen samples are checked by test freeze-thaw cycle. Empathized non-professional voluntary donors are invited. Our semen bank with many variables provides optimized matching as per individual requirements and preferences including physical characteristics, blood group, ethinicity, education and others. Thorough and careful screening for most medical diseases, inherited genetic disorder and infections, including quarantine for HIV virus is done. Donor semen can be used for IUI, IVF or ICSI. Strict confidentiality and consent are maintained. |
| Cryopreservation Laboratory |
| Max has advanced freezing services equipped with liquid nitrogen cylinders. |
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Vitrification
An advanced freezing technique with higher viability of embryos and eggs post thawing |
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Vapour phase cryopreservation
A technique for freezing to minimize microbial propagation amongst cryopreserved samples to avoid cross contamination. |
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Advanced non-surgical minimally intervention uterus and tube assessment is offered using sonosalpingography and hyterocontrastsonogaphy (Hy-Co-Sy). |
| Technology |
| We are equipped with highly sophisticated state-of-the-art international technology and equipments. |
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High quality 3D and 4D equipped GE Voluson ultrasound machine |
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Customized world-class ART laboratory with anti-static flooring, positive pressure lab-guard system for air handling and purification |
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Latest anaesthetic machines, oximeters and cardiac monitors in operation theatre |
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Multi-chamber Hera Cell incubator from Germany |
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K system workstation (Laminar flow), a leading system from Germany ensures controlled work environment and culture free work area. |
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Sophisticated suction machine for correct suction force from United Kingdom. |
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Stereozoom microscope from Nikon Corporation, Japan |
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Integrated RI (Research Instruments) Micromanipulator from UK. |
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Polarized microscope (poloscope) for mitotic spindle imaging of egg from CRI (Cambridge Research Instruments, UK) |
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Microsurgical diode laser from research instrument UK for assisted hatching |
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Cryopreservation unit with Semen Bank equipped with a computerised automatic freezer for excellent reliable temperature gradient needed for successful cryopreservation |
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Non-toxic disposable aspiration needle, embryo transfer catheters and glassware of international makes |
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