Embryology



Conventional IVF



IVF (In vitro fertilization) is also known as “Test Tube Baby “in general term. In this method embryos are made outside body under very strict biological and aseptic conditions. Now a days IVF is considered as relatively non invasive procedure and used in specific indications like male infertility, endometriosis, tubal infertility, ovulatory disorder, unexplained infertility etc. 

The initial step of the IVF cycle is ovarian stimulation and the dose of drugs for stimulation is adjusted according to the physiological criteria of patient, like age, weight, clinical history, follicle size, endometrium thickness etc. The size of follicle and thickness of endometrium is monitored during stimulation using transvaginal ultrasound scan. When the follicles are reached at optimum size, oocytes are aspirated under ultrasound guidance in the operation theatre under the effect of an anesthesia.  The laboratory procedure of IVF is performed in the clean room equipped with bio safety cabinet and other specific instruments to perform the procedure. The procedure includes sperm preparation, insemination of sperm into oocytes, checking of fertilization, culturing the embryos, preparing embryos for transplant etc. The procedure of embryo development takes around two to three days. The embryos are transfer into the uterine cavity of the patient. Embryo transfer is office based procedure and majority of patients do not need anesthesia. 

At StemCure we have state of art static and transport IVF laboratory and equipments for IVF procedure. Also we have well educated, highly skilled, trained and dedicated personnel to perform quality work. The culture media we used during the procedures are sterile and of superior quality and the lab wares used  are disposable, sterile and non toxic.


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INTRACYTOPLASMIC SPERM INJECTION (ICSI)



Intracytoplasmic sperm injection (ICSI) is the procedure of injecting a single sperm cell into cytoplasm of the oocyte. The goal of this method is to avoid the natural barrier called zona pellucida of oocyte for fertilization. This is also called microassisted fertilization as the injection of a sperm is performed under inverted three dimentional contrast microscope having micromanipulating equipment mounted on it and with stage warmer to minimize temperature difference for the gametes. A morphologically normal and viable sperm is selected and its tail is scored and is made immotile. Than the sperm is aspirated and injected into an oocyte. High level of precision and skill is required to perform this procedure.

ICSI is indicated  in certain conditions like repeated fertilization failure after conventional IVF,  unexplained infertility, subnormal semen parameters like Oligospermia , Asthenospermia, Teratozoospermia etc or IVF perform either using sperm from testicular biopsy or  frozen ovarian tissue or oocytes. The outcome of the ICSI in applied condition is encouraging than conventional IVF.

StemCure is well equipped with essential equipments required for ICSI. Highly skilled and extensively trained experts are performing ICSI at StemCure.


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Blastocyst Culture



Blastocyst culture is an advanced reproductive technology allowing selection of more advanced embryos which are considered as best suited for transfer. In this laboratory technique, embryos grow in vitro for 5 to 6 days as compared to normal procedure of 2 to 3 days. The extended culture period allows viable embryos to continue embryo development and reach the blastocyst stage of embryo development. The delayed transfer to 5 to 6 days may improve reproductive outcome by reducing risk of embryo expulsion. Blastocyst culture is one of the dramatic advances in reproductive biology with other parameters like ovulation induction, embryo transfer technique etc, may enables increase in pregnancy rate in younger patients who have multiple failure of IVF cycles where ET (embryo transfer) perform at day 2or 3.

The selection of media and monitoring growth of embryos are very crucial in blastocyst culture. The whole procedure is done by our veteran team using high grade blastocyst culture media.


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Embryo Freezing by Vitrification



Embryo freezing is the process of preservation of embryo at very low temperature. Embryo cryopreservation is one of the viable components of human in vitro fertilization. Embryo freezing is indicated in conditions like hyperstimulation syndrome, where many eggs are harvested, fertilize and few or none are transplanted to avoid multiple pregnancy and rest are freeze for use in future. The other conditions like poor endometrium development and receptivity or discovery of uterine pathology like uterine polyps in such condition the embryos are preserved and transplant after correction of the condition. . The goal of embryo cryopreservation is to ensure high survival and viability of embryo after thawing. 

At StemCure we perform Embryo freezing by vitirfication. Vitrification gives better satisfactory result than conventional slow freezing technique. The chances of ice formation which damages cells during freezing and thawing can be minimized by the vitrification.


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Embryo Biopsy



Embryo biopsy is a part of diagnostic procedure, used in genetic screening, in which a single cell is removed from an embryo on day three after in vitro fertilization. At this age the embryo consists of about six to eight genetically identical cells. The embryo itself is unaffected and continues to grow after biopsy. The removed single cell is used for genetic diagnosis (PGD) by FISH (Fluorescence in situ hybridization) analysis or PCR Analysis (Polymerase chain reaction) for genetic defects. The procedure allows an embryo to be tested before it is implanted into the womb when an inheritable disease or a genetic predisposition to a disease is carried by or exhibited in one or both parents. 

The Zona Pellucida of the embryo is breached using various techniques like laser, chemical or mechanical and single cell is aspirated from the embryo in embryo biopsy. The embryo biopsy is done by our experts in our state of art laboratory using their specialized skill. They use the latest technology in order to minimize any damage occur to cell and an embryo.

 


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Regeneration of Endometrium



For many women who are in the throes of fertility treatments, one of the problem is thinning of the endometrium. The cavity of the uterus is lined by the endometrium. Under normal conditions in response to naturally produced estrogen in the body uterine lining grows about 1- 2mm every other day. Ideally, at the time of ovulation, the endometrium would be about 8mm in thickness. A (fairly) normal uterine cavity and endometrial lining are necessary in order to conceive and maintain a pregnancy. This lining is composed of two layers, the functional layer which is shed during menstruation and an underlying basal layer which is necessary for regenerating the functional layer. There are several factors which can affect the normal growth of the uterine lining like infection, scarring from D&Cs, low estrogen levels, poor uterine blood supply, endometrial antibodies, Asherman’s syndrome etc.

Poor Endometrium
In absence of desired response with conventional therapy for endometrium regeneration autologus adult stem cells can be a promising treatment. Adult bone marrow stem cells have capacity to improve vascular blood supply. Endothelial progenitor cells, showed expression of various endothelial markers incorporated into neovessels at sites of damage and significantly improved blood flow. Result from Human Clinical study shows that adult stem cell could regenerate the endometrial thickness with its vascularity and make it mature enough for implantation.

Following failure of all other conventional modes of treatment, adult stem cells can be used as to improve lining of the endometrium, giving new hope to infertility patient in alteration to conventional option of surrogacy.

The autologus adult bone marrow transplant for poor endometrium is an office based process and safe as no risk of rejection due to autologus transplant. The process is simple and can be repeated, if required. Stemcure is processing bone marrow samples for patients having this condition and they are contented with the result, which indicates that stem cells therapy shall be potential for such condition.

Reference
Nagori C B, Panchal S Y, Patel H. Endometrial regeneration using autologus adult stem cells followed by conception by in vitro fertilization in a patient of severe Asherman’s syndrome. J Hum Reprod sci 2011; 4 : 43-8.


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