Treatments & Services

OVULATION INDUCTION-Follicular study/Timed intercourse:

• Conventional treatment of women with anovulatory infertility (PCOS) is ovulation induction with oral medications like letrozole, clomiphene citrate, tamoxifen or the use of injectable gonadotropins. Follicular monitoring is done and ovulation is induced once the follicular size and endometrial thickness is optimal. Couple are then advised Timed Intercourse based on their fertile window. This is the first line cost effective treatment option in a couple starting their fertility treatment, most commonly used by the IVF hospitals all across.

INTRA UTERINE INSEMINATION(IUI):

• IUI involves the deposition of processed semen sample in the upper uterine cavity, closer to fallopian tubes.
• It is a cost effective, on-invasive first line treatment for patients with functionally normal tubes, cervical factor infertility, anovulation, moderate male factor, unexplained infertility, short period of subfertility, ejaculatory dysfunction and certain social reasons.
• IUI can be performed with or without ovarian stimulation. Ovarian stimulation with low dose gonadotropins has significant benefits in terms of successful pregnancy compared to unstimulated cycle or timed intercourse.
• IUI is performed under ultrasound guidance to optimise sperm deposition.
• IUI has limited role in patients with endometriosis, tubal factor infertility, severe male factor infertility and advanced maternal age >35 years.

INVITRO FERTILISATION (IVF) : 

•  It is a method of assisted reproduction commonly known as Test Tube Baby that involves combining the egg with the sperm in laboratory dish. If the egg fertilises and begins cell division, the resulting embryo is transferred into the woman’s uterus for further possible implantation and development Indications for IVF include tubal factor infertility, Anovulatoy infertility (PCOS),endometriosis, uterine fibroids, unexplained infertility ,fertility preservation.

Preimplantation Genetic Screening (PGS) :

Detects euploid embryo and improves the success rates of IVF

Indications:

• Advanced maternal age (AMA)
• Recurrent implantation failure
• Recurrent early pregnancy loss
• Severe male factor infertility

PGD or Preimplantation genetic diagnosis:

– It is early form of prenatal diagnosis which helps in identification of genetic/chromosomal abnormality in early human embryo, before a clinical pregnancy has been established.

– Unaffected embryos would then be transferred to the uterus

Indication for PGD

• Single gene disorder autosomal dominant/recessive/x linked
• Inherited predisposition to cancer
• HLA genotyping
• Structural abnormalities translocations/deletions/inversions/dup cation

 Benefits of PGD

• Reduction in the Chance of Having a Child with Aneuploidy
• Reduces the possibility of pregnancy termination following a prenatal diagnosis of a genetic

SPERM SELECTION TECHNIQUES PICSI :

 Mature spermatozoa may selectively bind to Hyaluronan -HA.

• Diminished sperm maturity (failure of spermatogenetic membrane remodelling) may be related to increased levels of chromosomal
• Solid-state HA binding would facilitate the selection of individual mature sperm with low levels of chromosomal

PICSI Sperm Selection Device is intended for use in the treatment of infertile couples by ICSI; PICSI is indicated for the selection of mature sperm for injection

MICROFLUIDICS

• The integrated micro fluidic system consists of laminar stream–based on micro channels and flow cytometric analysis to enhance the human sperm motility sorting efficiency
• With this approach, the characteristics of laminar flow and the novel design were utilized to demonstrate the micro fluidic system with high efficiency for sperm motility sorting
• The optimized micro fluidic system provides a good opportunity to select the most appropriate sperms before IVF

MACS

• Magnetic activated cell sorting of human spermatozoa
• An advanced sperm preparation technique
• Isolates non–apoptotic sperms from the semen sample based upon the expression of PHOSPHOTIDYLSERINE(PS ) in the plasma membrane of sperm
• It is a tool in optimizing sperm selection without DNA fragmentation for ART

TESA–TESTICULAR SPERM ASPIRATION

• Testicular sperm can be retrieved by testicular sperm aspiration (TESA) per–cutaneously from men with Obstructive Azoospermia.
• The testicular parenchyma is aspirated by fine needle, large–diameter needles, or tissue–cutting biopsy needles. Location of sperm aspiration matters little in terms of
  successful sperm retrieval.
• Sperm in obstructed testes is found throughout the parenchyma

TESTICULAR MAPPING

• Possibly office/outpatient procedure
• Minimal recovery and morbidity
• Avoid morbidities associated with sperm retrieval procedures for patients with no sperm identified on testicular mapping
• Potentially reduce the invasiveness of the subsequent sperm retrieval procedure

TESE/mTESE

• TESE and mTESE are open testicular biopsy techniques and are more commonly performed in men with Non Obstructive Azoospermia.
• Multiple biopsies are usually employed to locate sperm during conventional TESE
• Conventional multiple biopsy TESE achieves up to 50% Sperm retrieval rate

mTESE

• The use of a microscope allows identification of sub tunical blood vessels and decreases the risk of damage to the testicular blood supply
• A higher SRR of 45–65% is associated with mTESE
• mTESE is more effective in recovering sperm from men with testicular volume of less than 10 mL
• mTESE has been the preferred technique and has been more widely studied as the procedure after failed
• TESA/conventional TESE/mTESE attempts and showed promising results.
• The technique has also been suggested to be particularly useful for our patient with small testicular volume

FERTILITY PRESERVATION–MALE

• Chemoradiation therapy for cancer can be gonadotoxic and make men azoospermic post therapy.
• Cryopreservation of sperm prior to cancer treatment either chemotherapy or radiotherapy is an established method of fertility preservation in male. Hence couple can have their biological offspring post cancer treatment

Fertility Preservation –Female

OOCYTE VITRIFICATION/ EMBRYO CRYOPRESERVATION

Indications 

Prior to cancer treatment (chemotherapy/radiotherapy)
Severe Endometriosis
Personal choice to have a baby at a later age oocytes are cryopreserved at young age and once the female is ready to start a family embryos are created and transferred into her uterus. However this is done as per the age criteria prescribed the law.

FRESH/FROZEN EMBRYOTRANSFER

• Embryo transfer (ET) is the final and most crucial step in Assisted Reproductive Technologies in which the embryo is placed in the endometrium through the cervical canal.
• For a successful ET, a viable embryo, a receptive
  endometrium and a good ET technique are required
• The embryo transfer technique has a great impact
  on the IVF results

Mock Embryo Transfer

• A mock ET before the start of the IVF cycle has been shown to improve the pregnancy rate significantly. During the mock ET, we can measure the length of the uterine cavity and evaluate its direction and the degree of cervico–uterine angulation

Mock ET can be performed :

a) A month before the actual IVF cycle (mid luteal phase)
b) At the time of oocyte retrieval
c) 3 to 5 days before ET

Ultrasound : It’s relevance before, during and after ET 

A. Before ET 

• Ultra-sonography is an essential part of embryo
  transfer to measure and evaluate the uterine cavity,
  cervico -uterine angle, depth of endocervical canal
  and its orientation before ET.

B. During ET 

• Transabdominal ultrasound–guided embryo transfer offers the clinician an opportunity to visualize the echogenic tip of the catheter and decide the exact site of embryo deposition
• Avoids injuries to the fundus.
• May facilitates a smooth access through the cervices to the uterine cavity, thus overcoming the chances of cervical stenosis.
• Ultrasound may be useful in difficult cases to visualize the uterocervical angle to negotiate the catheter accordingly in order to minimize trauma to the cervical canal and/or the endometrium.

C.After ET

• Ultrasound also ensures that the embryo air bubble
  interface is not displaced after ET
• The decision of Fresh vs Frozen embryo transfer is
  based on patient profile and is purely individualised
• Fresh ET is preferred in normal responders/certain poor
  responders/tubal factor infertility/male infertility
• Frozen ET is the preferred choice in women with
  PCOS/Recurrent implantation failures/uterine factors
  like adenomyosis/fibroid/endometriosis ,cases where
  PGS/PGD is planned etc

GENETIC EVALUATION/COUNSELLING

• Detailed genetic evaluation of couple having recurrent pregnancy loss/recurrent implantation failure/severe male factor infertility is done in concurrence with geneticist and necessary evidence based treatment plan is devised so that couple has healthy normal baby.

ERA ENDOMETRIAL RECEPTIVITY ARRAY

• This technique enables the evaluation, from a molecular point of view, the status of endometrial receptivity
• Endometrial receptivity is the state at which the endometrium is ready for embryo implantation to take place
• Genetic test to diagnose the personalized window of implantation
• This molecular diagnostic tool is used to analyze the expression levels of 238 genes related to the status of endometrial receptivity
• RNA obtained from an endometrial tissue sample is hybridized in a custom micro array with probes for those genes
• The ERA has been tested in patients with recurrent implantation failure, unexplained thin endometrium(all measures to improve
  the ET fails),in patients with adenomyosis wherever indicated
• This test is recommended for patients with apparently normal uterus and with normal endometrial thickness , in which no problems are apparent.
• A displaced implantation window is detected in approximately 20% of these patients
• The ERA test has shown high sensitivity and specificity for detecting gene expression profiles associated with receptivity

ANDROLOGIST /MALE FERTILITY CLINIC

• At Sri Chakra we have dedicated and experienced andrologist to take care of male fertility needs. From basic clinical evaluation and examination to advanced genetic testing and microsurgery to ensure good quality sperm retrieval for successful live birth is available.

SEXUAL MEDICINE CLINIC

• Common problems like lack of sexual drive, erectile dysfunction,premature ejaculation,anejaculation,retrograde ejaculation are addressed in this clinic. More importantly a detailed counselling is given to the couple after arriving at a diagnosis

IMAGING SERVICES

1. TRANS VAGINAL ULTRASOUND OF PELVIS
2. FOLLICULAR MONITORING SCAN
3. COLOUR DOPPLER SCAN
4. SALINE INFUSION SONOGRAPHY
5. TRANS ABDOMINAL ULTRASOUND
6. FETAL MEDICINE SCANS
7. TRANSRECTAL ULTRASOUND
8. COLOUR DOPPLER OF SCROTUM

CLINICAL LABORATORY SERVICES

All blood tests hematology, biochemistry,IHC,microbiology tests are available at Sri Chakra Fertility.

PSYCHOLOGICAL COUNSELLING SERVICES

Couple going through fertility treatment are subjected to tremendous stress and anxiety. Professional psychological counselling and therapies to reduce the stress are undertaken at Sri Chakra Fertility. This helps them to take their fertility journey smoothly and definitely improves the treatment success rates.

PHYSICIAN CONSULTATION

All our patients are routinely evaluated by experienced physician before they embark on ART treatment and obtained fitness prior to procedure.

DIETICIAN SERVICES

• Ideal BMI is a cornerstone in the successful pregnancy outcome for the couple.
• There is ample scientific evidence which suggests extremes of BMI can have detrimental effect on treatment and its outcome
• At SriChakra our patients can get personalised diet and wellness advice from professionals in this field.

VIRTUAL CONSULTATION

This consultation platform has become quite popular post COVID 19. However this is exceedingly utilized by patients who are in other parts of India and abroad.Here they can have initial consultation with fertility specialist and plan their personal visit accordingly.

INTERNATIONAL PATIENT SERVICES

We have dedicated team to cater to international patients.They will help in facilitating medical visa ,travel,stay ,food etc and hand hold you throughout the treatment process. We ensure that you will feel at home when you arrive in India.

VM– IN VITRO MATURATION

• process. We ensure that you will feel at home when you arrive in India. IVM– IN VITRO MATURATION In vitro oocyte maturation (IVM) is a mild– approach–assisted reproductive technology (ART)
• The technology has mostly been applied in patients with polycystic   ovaries ,it helps in eliminating one of the dreadliest complication –OHSS or ovarian hyperstimulation.
• Because of its simplicity, the more favorable  financial implications (reduced cost) for patients, and the lower health risk profile of IVM compared to controlled ovarian stimulation (COS) in polycystic ovary syndrome (PCOS) patients, the use of IVM in selected patients improves treatment outcomes and reduces complications.
• Besides its application in patients with polycystic ovaries, IVM technology may have a role in fertility  preservation, where young girls and adult women are facing infertility due to gonadotoxic
  chemotherapeutic treatment (cancer treatment).

INDICATIONS FOR OOCYTE CRYOPRESERVATION/FREEZING

• In cases following oocyte retrieval where the male partner is unavailable/unable to produce semen sample
• To circumvent the ethical and legal concerns associated with embryo freezing
• Women who wish to delay childbearing
• Oncofertility patients who are due to receive
  chemotherapy and/or radiation therapy for
  malignancy prior to commencement of treatment
• Oocyte cryobanking for oocyte donation programs
• Patients at risk of premature ovarian failure
• Cryo accumulation strategy for poor responders

Indications for Embryo Cryopreservation/Freezing

• Supernumerary embryos left after transfer of
  selected embryos in a fresh cycle
• Avoiding fresh embryo transfer in stimulated cycles in patients at risk of OHSS, elevated progesterone, thin endometrium, fluid in the endometrial cavity on day of transfer, polyps detected incidentally following stimulation, bleeding and difficult embryo transfers
• Blastocyst cryopreservation following trophoectoderm biopsy for PGS/PGD.

Indication for ICSI(Intra cytoplasmic sperm injection)

• Pregnancies could be achieved by ICSI not only with the ejaculates of extremely poor quality, but also with spermatozoa from the epididymis and sperm retrieved from testicular tissue after biopsy.
• ICSI requires the use of micromanipulator to inject single morphological normal sperm into the ooplasm. The success of ICSI procedure depends upon variety of factors: equipment used for procedure, experience and expertise of user, quality of oocytes and sperm, rupture of oolemma and risk of disturbing the spindle during injection.
• In the routine ICSI procedure, sperm cells are selected from the sperm pool under a regular microscope that magnifies 200–400x

Indication For ICSI

1: Ejaculated spermatozoa

-Oligozoospermia –Asthenozoospermia 

-Teratozoospermia –Globozoospermia

-Fertilization failure or poor fertilization in previous IVF cycle

– All indications for epididymal spermatozoa

– Azoospermia

– Necrozoospermia

-For man with high sperm DNA fragmentation

4: For cryo preserved oocytes

5: For couple scheduled for PGS/PGD