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NSA- non surgical sperm aspiration
MESA-micro-surgical epididymal sperm aspiration
MICRO-TESA
DNA fragmentation index

World over more than quite often every discussion or treatment of infertility revolves around the women. The reason might vary from culture to culture however the final result is not good for the couple.
Women are mostly open for discussion about their reproductive issues however men still hesitate to discuss and get treated.
The feeling of being left out in male partners is evident and the reason for this is lack of specialty clinics exclusively for male infertility.
HOPE is a complete male infertility center with purpose built facility, special operation theater, instruments, dedicated attached andrology laboratory, genetic laboratory, high powered magnifying microscopes and the expertise; all exclusively for male infertility.

We are sensitive to your needs and so we make you comfortable to discuss in complete confidentiality. We bring the most advanced knowledge in male reproductive science,andrology & embryology to make it possible for every man to father his own child even if he has been previously declared total sperm less (zero count).

HOPE is working on awareness program to make men understand their reproductive problems are solvable and not something to hide.

Quite often men (60%) who do not have sperm in ejaculate actually may have small zones of sperm production in the testicle. At HOPE we can reach to these microscopic zones of testicle where good graded sperms are available and these sperms can be used to fertilise the eggs.
TESE & TESA are some of the procedures that can be used depending on the needs of the couple.

NSA: Non Surgical Sperm Aspiration

These procedures are required mostly in couple with male factor infertility. It’s a minimal invasive procedure, less painful, done in local sedation & with quicker results.

MESA: Micro-surgical Epididymal sperm Aspiration

Quite often an optimal procedure to obtain sperms in cases of obstruction of the reproductive tract. It’s a relatively painless and minimal invasive procedure, which allows us to recover the best quality sperms which can be further used with IVF procedures.

This procedure requires a well skilled male infertility team, embryology laboratory, specialised equipments and an operating suite and lack of above mentioned combination makes MESA rarely done procedure quite often.

HOPE team has experience in countries where use of donor sperm is not allowed, hence procedures like TESA or MESA are the only options for males with low sperm count.

Micro-TESE

Since the testicular tubules are microscopic they cannot be judged by naked eye, hence a high powered operating microscope is used to find the healthier tubules so they can be extracted and sperms can be harvested from them for ICSI.

HOPE follows methodology recommended by EAA European association of andrologists.

Micro-TESE is an advanced procedure that requires a combination of a male infertility operating microscope, a much advanced embryology laboratory & an expert embryologist. This combination can make the difference between success and failure for any couple previously diagnosed with azoospermia.

Advances in reproductive science in last ten years have made it possible for men, who were previously declared sterile, to father biological children.

DNA Fragmentation Index

The usual test of semen called semen analysis is limited and it can’t assess DNA damage in sperm & we know sperms from even a normal semen analysis report can have high DNA damage, so evaluation of DNA damage in many cases becomes important.
Studies have shown that a man with DNA fragmentation percentage higher than 30% have has difficulty becoming a father (miscarriages).

This DNA damage can be due to many different reasons:

• Long abstinence
• Advanced age (after 46)
• Smoking
• Exposure to high level of pollutants
• Exposure to high temperatures
• Testicular trauma or cancer
• Exposure to chemicals or radiation

We recommend DFI test for couples with:

• Recurrent miscarriages
• Recurrent implantation failures
• Fertilisation failure
• Low embryo quality

Due to various reasons fragmentation can occur in DNA and sperms with high index of such fragmented DNA leads to low quality zygotes or low number of implantations. There are assays that can give us a range value for the amount of DNA fragmentation occurred, this can be treated to some extend with some medicinal support however doing an ICSI with combination of TESE has showed quite promising results constantly.

Hope offers the latest inventions in field of male infertility, by which we no more need millions of sperm count but only a single sperm to let the man father his own child.

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Ovulation and conceiving
Egg timer test
Intra uterine insemination
Ultrasound for women
Scanning for timed intercourse
Scanning for IVF

Timed Intercourse

By now you know that the egg released by an ovary needs to be fertilised by a sperm in the body in order to initiate the process of conceiving. If you can know when the egg would be available for the sperm to fertilise then you can time your intercourse to make sure that when the egg is ready; sperm too is available for fertilisation. This is called timed intercourse, a very basic yet natural mean to conceive and it works for many couples quite alright.

Some blood tests, urine test or an ultrasound would help your IVF specialist to pin point this fertility window for you.

Ovulation and Conceiving

Every month your body has a menstrual cycle, during which an egg is released from ovary-this is called ovulation. This ovulation occurs 12-18 days (mostly 14) prior to your period. Once the egg is released then it has maximum of 24 hours to get fertilised. The sperm can survive 2-3days in female reproductive tract, so by figuring out your fertility window your specialist can guide you when to have intercourse to make best use of this fertile period.

Help with ovulation: For you to take benefit of your fertility window, first ovulation has to occur and if there is a problem with ovulation your fertility specialist with help of medications will take care of it.

Egg timer test

What is ovarian reserve:  Since every woman has a finite number of eggs and by the time she reaches her puberty she has four lakh eggs left approximately, so your ovarian reserve is the number of eggs remaining in your ovaries. Rate of egg reserve decline is different among individuals and it mostly accelerates from the age of 32-35 onwards.

What is egg timer test: It s a simple blood test, which can show the egg reserve picture of your ovaries, which in turn is a good indicator of your fertility.

What if my ovarian reserve is low

• We would recommend you to conceive as soon as possible, as with every passing month this reserve will only reduce further.
• You can freeze store your eggs (Cryo preserve) for future times.
• If you are experiencing premature menopause, we can still offer you options including donor eggs.

Who is at risk of low AMH

• A family history of low AMH & early menopause
• Had ovarian surgery
• Severe endometriosis
• Had chemotherapy or radiotherapy

Information is power and lets you take charge of your fertility.

We can delay starting a family for many different reasons, but it’s a well established fat that the fertility declines with age. Body won’t be able to produce new eggs if the reserve is finished for once and even the last few remaining eggs might not be of a great quality.

How can I get the egg test done:

Take benefit of this test and you might not even need any other ivf services, call us to make an appointment.

Intra Uterine Insemination

BOOST YOUR CHANCES WITH a SIMPLE PROCEDURE

IUI is one of the simplest, less complex, less invasive assisted reproduction techniques (ART), also known as assisted insemination (A.I)  it may be used in cases:

• Ovulation problems
• Endometriosis
• Cervical mucus problems
• Unexplained infertility
• Mild male factor infertility
• Scarring of cervix or other factors preventing sperm penetration
• Cannot have intercourse

It is often the starting point of infertility treatments. IUI is a procedure where the sperm number is increased in the uterus and fallopian tubes to increase the chances of fertilisation.

Consult an IVF specialist to perform some preliminary fertility tests to know if IUI can help you.

IUI is a day care unit procedure, your husband’s semen would be prepared and by a thin soft tube this sample would be injected into your uterus. You would not require sedation and you can get back to your normal routine life in a matter of an hour or so as the procedure itself is just of few minutes.

Ultrasound for women

We at Hope International Fertility are very sensitive to patient’s unique needs and at HIF, all services are tailored to the needs of each individual.

Staff understands that patients desire both caring service and information about their scans, tests and results.

There are a range of services provided by an expert team of fertility specialists, including:

• Abdominal scans
• Transvaginal scans

A pelvic ultrasound assesses the female reproductive system, including the vagina, cervix, uterus, fallopian tubes, ovaries and other pelvic structures. It can provide helpful information for those experiencing:

• Heavy, irregular or infrequent periods in premenopausal women
• Pelvic pain
• Post menopausal bleeding
• Infertility
• Follicle Tracking

Follicle tracking involves tracking the development of follicles that contain eggs  within the ovary monitored with trans vaginal ultrasound in combination with blood levels of the female hormones oestrogen and progesterone.

Scanning for timed intercourse

Follicles may be tracked in a natural cycle. When a leading follicle is seen, then intercourse may be appropriately timed. Alternatively, drugs which promote release of the mature egg may be administered.

Scanning for IVF

For most IVF treatments, the ovaries are artificially stimulated with follicle stimulating hormone (FSH) which produces multiple mature follicles which are then collected following administration of luteinising hormone (LH). In this setting, the follicular development is followed more closely with 2 to 4 ultrasound scans, and regular blood tests track hormone levels. The timing of an egg collection is based on the ultrasound and blood results. This information is relayed to patients by their IVF nurse or fertility specialist.

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Laser Assisted Hatching

LAH: Laser Assisted Hatching

The outer most layer of an embryo is zona pelucida (ZP) or commonly also known as the shell. At a certain phase of the embryo this zona reduces in thickness and lets the inner cells ooze out to get implanted in endometrium; this is called implantation, which is a vital step of initiation of conceiving, however in some cases, due to various reasons the hatching out doesn’t occur and thus no pregnancy.

This hatching is then facilitated by a high precision laser beam, which makes a 10-20 micron hole in ZP. Much safer method comparing to the older method where acid was used. This laser is also used for embryo biopsy if needed.

Who might benefit from LAH:

• Patient with earlier IVF cycle, with low number of embryos
• Poor responders (low number of eggs by stimulation)
• Woman with high FSH level
• Advanced age woman (37years and above)
• Patient with thick embryos on Day3
• Frozen embryo treatment plan

Standard Insemination

Stimulation of the ovaries: Based on pre-IVF scans & blood tests a stimulation regime is decided to stimulate the ovaries to produce eggs. Regular ultrasounds reports and some blood tests reports are used to continually monitor ovary’s response to this stimulation.

HOPE IVF SMART SCIENCE: The egg stimulation mimics your body’s natural processes. It doesn’t affect future egg supply or lead to premature menopause

Step 1: Egg collection: Once the eggs are ready in the ovary then with a small surgical procedure the eggs are aspirated out, you would be sedated so that you don’t feel anything. Same day your husband’s semen is also collected, depending on the present and past status the eggs/sperms are processed accordingly.

Step 2: Conventional Insemination: If the embryologist has decided for conventional Insemination as the mode of fertilisation, then the sperms are carefully processed and a calculated concentration of the sperm is aliquoted around the eggs in a specific dish, medium micro droplet and environment. By this process the eggs are fertilised and thus the eggs are activated to grow further ahead in coming days.

Step 3: Embryo growth: For two to seven days your embryos are created by your eggs & sperms and are further grown to advanced stages. This growth is directly related to the quantity and quality of the eggs and sperms used and it differs from couple to couple. This growth sometimes is done for three days and sometimes for five to six days too.

Step 4: Embryo Transfer: Once the embryo growth has taken place then the embryologist decides which embryo should be send back in your womb and which embryos can be cryopreserved.

Step 5: Blood test: This is a blood test often done after two week of your embryo transfer, to confirm healthy implantation of the embryo in you.

ICSI : Intra Cytoplasmic Sperm Injection

This line of treatment is mostly used for couples with male factor infertility like low sperm count, no sperm count, low sperm morphology and fertilisation failure by conventional insemination.
Stimulation of the woman: Based on pre-IVF scans & blood tests a stimulation regime is decided to stimulate the ovaries to produce eggs. Regular ultrasounds scan reports and some blood tests reports are used to continually monitor ovary’s response to this stimulation.

Step 1: Egg collection: Once the eggs are ready in the ovary then by a small surgical procedure the eggs are aspirated out, you will be sedated so you won’t feel anything. Same day your husband’s semen is also collected and depending on the present and past status both the eggs and sperm are processed accordingly.

Step 2: Intra Cytoplasmic Sperm Injection: If the embryologist has decided for ICSI as the mode of fertilisation, then after processing the eggs & sperms, a single sperm based on its motility and morphology is selected & injected into the egg to fertilise it by a microsurgical procedure with help of micromanipulators.

Step 3: Embryo growth: For two to seven days your embryos created by your eggs & sperms are grown and taken care of. This growth is directly related to the quantity and quality of the eggs and sperms used and it differs from couple to couple. This growth sometimes is done for three days and sometimes for five to six days too.

Step 4: Embryo transfer: Once the embryo growth has taken place then the embryologist decides which embryo should be send back in your womb and which embryos can be cryopreserved.

Step 5: Blood test: This is a blood test often done after two week of your embryo transfer, to confirm healthy implantation of the embryo in you

Blastocyst culture

The egg once fertilised by sperm is called embryo and this embryo starts growing from its single cell stage to multiple cell stage within a fixed time duration.
The growth that takes place approximately till 30 hours is called cleavage stage growth, around 72 hours embryo reaches its morulla stage and 5th day it is in the stage of blastocyst with its largest size, a fluid filled cavity in between, all cells pushed to the periphery and around 200-300 number of cells.
Blastocyst stage embryo transfer increases pregnancy chances however not every embryo is destined to reach the blastocyst stage. Other than the obvious egg / sperm quality the embryology laboratory and high skills of an embryologist are vital in helping an embryo to reach its blastocyst stage.
This growth beyond day three is also often termed as the extended growth of the embryo and since it increases chances of your pregnancy we at HOPE have specific protocols and dedicated separate instruments that enhance an embryo’s capability to reach its blastocyst stage.