Marching Towards Next Level Of Infertility Treatment
September 1, 2019
Institute Of Reproductive Medicine @ Dr. Rela Institute Marching Towards Next Level Of Infertility Treatment
Since the time world’s 1st IVF baby Louise Brown was born in the year 1978, the need for advanced infertility treatment is increasing day by day, due to increased presentation of patients with very rare clinical conditions, which were rare about few years ago. This includes abnormalities in both men and women. Some of the conditions that we are commonly encountering these days at Institute of Reproductive Medicine @ Dr. Rela Institute (IRM) include patients with thalassemia syndrome, poor ovarian reserve, underdeveloped or no uterus and in case of men most commonly seen are very little or no sperms. Added to these are increased risk of cancer at a very young age. The reasons for these underlying conditions for infertility can be many. “The most commonly that we see are hormonal imbalances / anomalies at very young age itself, leading to infertility and these get amplified with unhealth eating habits, sedentary life style, stress, anxiety, etc., Increasingly we are seeing lot of patients presenting with genetic issues, which are acquired at birth itself” says Dr G Buvaneswari, Director, IRM which is a joint initiative with GBR Fertility Centre And Hospitals, one of India’s top 10 Fertility Centres.
The filed of reproductive medicine, has been also fast catching up and undergoing tremendous advancement to manage these presentations of such rare cases, which now is becoming to be almost common. However, caution should be noted that these are emerging treatment options and are mostly in trials and must be done in a proper set up under qualified clinicians.
Uterine Transplants: (Treatment Condition – Women with under developed or no uterus)
The uterine transplant is next big innovation in the field of medical transplants. It is a surgical procedure whereby a healthy uterus is transplanted to a patient whose uterus is absent or diseased. As part of normal sexual reproduction, a diseased or absent uterus does not allow normal embryonic implantation, effectively rendering the women infertile. This phenomenon is known as absolute uterine factor infertility. For such conditions the simplest procedure was surrogacy or adoption until last year. But with the stricter regulations coming in to force for surrogacy, it is almost becoming nearly impossible for women with these conditions to have their own biological child. In such cases Uterine transplant is a potential treatment for this form of infertility. A woman who is past menopause and has at least delivered one child in the past can donate her uterus to her related women who has no uterus or a defective uterus. At present there are handful of cases that have been carried out successfully across the globe.
GBR Fertility Centre And Hospitals has joined hands with Dr. Rela Hospital, Chrompet, Chennai an International facility for multi organ transplant to take this big step in the field of reproductive medicine as a joint initiative. Flight Lieutenant L Ramesh (Retd) who is the Director of GBR says “we always aspire to be in the forefront by embracing latest technologies and best practices. Partnering with Dr Rela Institute is a certification for our commitment to provide the best and futuristic treatment in infertility care”
Fertility Preservation: (Treatment Condition – Those who wish to delay pregnancy, young cancer patients before undergoing treatment, people who are to be treated for autoimmune diseases).
Fertility preservation is the process of saving or protecting eggs, sperm, or reproductive tissue so that a person can use them to have their biological children in the future. This though have been one of the common procedures for storing sperms, eggs or excess embryos during IVF treatment, this has varied use in the current scenario with more awareness coming for young patient undergoing cancer treatment, autoimmune disease, etc., helping them to have their genetic child in the future.
One more emerging condition under fertility preservation is “Social Freezing”, where carrier conscious adults who don’t want to get married until they are settled, which sometimes extends until they turn 40 can freeze their eggs and sperms. In such cases the women can choose to store their eggs and men the sperm when they are healthy, ie.., in their late 20s and early 30s. As and when they are ready to undertake the parental challenge they can use their healthy frozen eggs and sperms to have their own biological child.
Stem Cell Therapy – (Treatment Condition – Women with very little or no eggs and Men with low sperm count or nil sperms)
Lot of young women these days are presenting with complete ovarian failure or poor responders, which was very rare few years ago. The easiest option, which still is largely followed by most IVF centres are the donor programs. Stem Cell Therapy has come in to rescue of these patients and made it possible to have their own biological child. Stem Cells are derived from the patients own cells and are injected in to their ovaries and this improves the dormant follicles and gives very good results in IVF/ICSI. In case of male the derived cells are injected in to their testis which helps in improving their sperm count.
PRP: (Treatment Condition – Women with poor endometrium and Men with low sperm count)
women present with thin endometrium, the chances of implantation failure are high resulting in recurrent pregnancy loos or repeated abortions. Platelet Rich Plasma are the rich platelets extracted from the blood serum is processed and injected in to the endometrium and it energies the same and improves the health of the endometrium. With PRP, successful endometrial expansion and pregnancy were observed in all the patients after PRP infusion. The same can also been used to increase the health of ovaries too, who have very less reserves.
In case of male infertility with the attributing factor being low sperm count, PRP therapy has proven to provide great results by increasing the sperm count substantially and helping them to avoid painful procedures like PESA / TESA / Testicular Biopsy, etc.,
Genetics: (Treatment Conditions – Chromosomal or Gene abnormalities)
Genetics is improving day by day to play a major role in overcoming secondary infertility, which arises due to systemic or syndromic genetic defects, including developmental, endocrine, and metabolic defects. Like in case of male we see increased conditions of low or nil sperms. At GBR we are also seeing increased number of cases with structural chromosomal abnormalities, which were quite rare few years ago. In case of woman we see increased cases of underdeveloped uterus, poor ovaries, endometrium or fallopian tubes. Many treatments have evolved to treat these conditions.
ERA: (Treatment Condition – Patient with repeated abortions following IVF)
More cases of repeated IVF failures and repeated abortions have become another common issue following IVF / ICSI treatment. It is reported the incidence are as high as 30%. Endometrial Receptivity Analysis test, helps in identifying the best window period for embryo transfer following IVF /ICSI treatment. “GBR is one of the few centres in Chennai, to have been certified by Igenomix of Spain for carrying out this test. In the past three years we at GBR have seen high implantation success following ERA testing” says Dr G Buvaneswari.
PGS: (Treatment Conditions – Chromosome Anomalies, Thalassemia, etc.,)
Pre-Genetic Screening is used to screen for embryos with an abnormal number of chromosomes. An abnormality in chromosomes of an embryo can result in miscarriage or Down’s syndrome. Patients who have genetically abnormal children or age above 38 years are advised to go for PGS to avoid genetically abnormal children.
PGD: (Treatment Conditions – Patient with Genetic disorders)
Pre-Genetic Diagnostics is used to identify embryos that carry a single-gene disorder in cases where the risk of a specific gene mutation is higher. PGD is offered to individuals with a family history of serious genetic disorders or who have another biological child with a genetic disorder.
It has been in the gene of GBR since its founding days to embrace latest technologies and procedures starting from Laser Assisted Hatching, ICSI, blastocyst culture, etc. With the demand for managing rare cases which now have become normal, GBR continues its journey of adopting latest technologies by providing personalised infertility care at affordable costs with the above stated next generation of evolving futuristic treatment options in the field of infertility.