Medical Care

Me & Mummy Hospital & IVF Centre offers comprehensive infertility evaluation, diagnosis, and treatment to those couples with a delay in their ability to conceive.

Conventional Gynaecalogy :

Special Medical & Surgical treatment is provided for all types of gynecological problems like menstrual problems, uterine prolapse, fibroids, benign tumors of the uterus and ovaries, recanalization of Fallopian tubes etc. We also offer hot balloon therapy in cases of menorrhagia where uterus has to be conserved. All types of high risk cases like hypertension, diabetes ,heart disease and other medical problems can be taken up for surgery because of latest anesthesia techniques and best facilities in our OT in addition to multidisciplinary management and fully equipped ICU.

Gynaecological Endocrinology :

Hormone related disorders like hirsuitism, irregular periods, amenorrhaea and polycystic ovarian disease (PCOD) are dealt with special coordination between the gynaecologist and endocrinologist. Menopausal patients are cared for in our clinic, routine check up is done along with bone densitometry studies (Dexa scan) and HRT (hormone replacement therapy) is instituted when indicated.

# Evaluation and Diagnosis :

After your initial consultation with a physician, an individualized, diagnostic plan will be outlined to determine the cause of your infertility. This plan is based on the information provided by your medical history and physical examination. It is designed to focus on and answer many important questions including :

  • Are you ovulating?
  • Are your fallopian tubes  normal?
  • Is your uterus receptive to implantation?
  • Are the sperm normal  in number and in function?

Once your diagnosis is established, a treatment plan will be tailored to suit your personal situation. The recommended approach will depend on your age, diagnosis, the duration of infertility, any previous treatments, and your personal preferences.

Treatment Options :

Infertility - We provide treatment for disorders related  to male and female infertility. There is a multispeciality approach involving the gynaecologist, endocrinologist and urologists and all disorders are managed short of IVF.

Gynaecological Oncology - Treatment of genital cancers like those of the uterus,, cervix and ovaries is done by trained by Gynaecological oncosurgeons and medical oncologists for optimal care during surgery and subsequent follow up.

Hysteroscopy - This is another endoscopic procedure by which the patient can be investigated and treated for

  • Infertility
  • Bleeding problems
  • Repeated miscarriages
  • Uterine abnormalities e.g. septa in the uterus

This procedures is done as a day-care procedure and the patients goes home the same day.

In Vitro Fertilization

IVF (In Vitro Fertilization) commorily known as " test tube baby" has changed the lives of millions of infertile couples. With modern advancements, the results of IVF treatment are now very encouraging and further improving everyday all over the world.

IVF

2 cell stage

4 cell stage

ICSI

Our centre provides the whole menu of "Assisted Reproductive Techniques" (ART) which includes

  • IVF (In Vitro Fertilisation)
  • ICSI (Intracytoplasmic Sperm Injection)
  • TESA (Testicular Sperm Aspiration)
  • MESA (Microepididymal Sperm Aspiration)

The whole IVF section is provided with HEPA filtered, sterile, pressurised air for bacteria free and particle free atmosphere to improve the success of the treatment.

Micromanipulator
Olympus, Japan

CO2 incubator,
Galaxy (UK)

Computerised Freezing,
Biotech ( UK )


Endoscopic Surgery (Laparoscopic & Hysteroscopic)

Me & Mummy Hospital & IVF Centre  offer this minimal Invasive Surgical Technique by trained gynaecological endoscopic surgeons.

  • Treatment of infertility - Many causes of difficulties in conceiving are treatment laparoscopical e.g. surgery on blocked tubes, polycystic ovaries etc.
  • Removal of fibroids
  • Removal of ovarian cysts
  • Removal of endometriosis
  • Surgery for tubal pregnancy

New alternative to tradltional surgery: Most operations in Gynecology can now be performed by Endoscopic Surgery which is also known as "Keyhole Surgery" or "Minimally Invasive Surgery".

Advantages :
As surgery is done through tiny holes there are many advantages to the patients

1 Pain is minimum
2 Hospital stay is minimum (1-2 days)
3 Return to work is faster
4. Scar on the body is very small
5. Postoperative adhesions reduced


Hysteroscopic Resectoscope

Gynaecological conditions in which endoscopy is very useful

1 Infertility Diagnosis
2 Endometriosis and Chocolate cysts
3 Ectopic Pregnancy
4 Fibroid uterus
5 Polycystic Ovaries
6 Hysterectomy (LAVH)
7 Hydrosalpinx
8 Ovarian Cyst, Dermoid cyst
9 Pelvic Adhesions
10 Septum in uterus
11 Tubal Block

 

Ay Surgery ( Out Patient Surgery )

Hysteroscopic Surgery : 

Hysteroscopy is done to visualise the interior of the uterus and to detect the abnormalities. The common abnormalities diagnosed are 

a)

Uterine Septum

b)

Sub mucus myoma

c)

Intra uterine synechae

d)

Cornual tubal block

These abnormalities can be simultaneously treated by hysteroscopic surgery. This is totally minimally imvasive approach. This surgery doesn’t require incision (wound) on the abdomen. The conditions mentioned above are very elegantly treated by hysteroscopic surgery.  

Laparoscopic Surgery : 

Laparoscopic surgery is a minimally invasive approach towards treating many abnormalities in the uterus, ovaries and tubes. It requires two or three wounds of half and two centimetres size on the abdomen. The patients can be discharged on the same day of surgery and return to normal activities within a few days.  

The common conditions treated by Laparoscopic Surgery are, 

a)

Endometriosis

b)

Fibroid

c)

Hydrosalpinx

d)

Pelvic Adhesions

e)

Tubal recanalisation

Ovulation Induction

Who needs treatment? Women with irregular or absent periods, caused by inadequate or inbalanced release of FSH or LH from the pituitary gland or those with polycystic ovaries.

  • Drug Treatment - Oral tablets in the form Clomiphene Citrate or Tamoxifen taken for 5 days from the second day of menstruation. Gonadotrophin injections used either daily or on alternate days.

  • Monitoring - By ultrasound scans to check the development and number of follicles in the ovaries. If more than three large follicles have developed treatment would be suspended as the risk of multiple pregnancy is greatly increased.

  • Administering - HCG injections - When one follicle reaches a diameter of at least 18mm to encourage the final maturation and the release of the egg from the follicle. Sexual intercourse or IUI will be timed 36 - 40 hours after the injection

Gamete Intra-Fallopian Tranfer ( GIFT ) :

GIFT is an alternative treatment to IVF for women with patent fallopian tubes. The first few steps are similar to IVF, namely, stimulating the ovaries with drugs, monitoring follicular growth, administering HCG to induce final maturation of the eggs, and egg collection ( usually laparoscopy under general anaesthesia )

Once eggs have been collected, they are placed in a laboratory dish, observed under a microscope and their maturity noted.

Prepared sperm and a maximum of 3 eggs are then drawn into a fine catheter and transferred into the patient's fallopian tube. GIFT is not suitable as a treatment for the male factor infertility (unless donor sperm is used).

Artificial Insemination :

Artificial insemination with husband's (AIH) or donor sperm (DI) involves injecting the semen into the cervical canal (neck of the womb) at the time of optimum cervical mucus, i.e. just prior to ovulation. Couples / Patient will be carefully assessed by one of our clinicians before DI is initiated. Counseling is compulsory for patients requesting the use of donated gametes.

Donors are screened for sexually transmittable agents (including HIV) and genetically inherited diseases. We freeze donated samples and quarantine them for a minimum of six months prior to use. This allows time for all the test results to be collected and HIV testing to be repeated, prior to using the samples. We try to match the partner's ethnic background, his eye and hair colouring, to that of the donor. Other characteristics, such as blood group can matched on request, depending on availability.

Intra-Uterine Insemination (IUI) with or without Stimulation of the Ovaries :

IUI of a prepared sample of the ovaries with husband's or donor sperm is often used with or without stimulation of the ovaries with fertility drugs to increase the chances of conception. The cycle is monitored with ultrasound scans and insemination is performed at around the time of ovulation, i.e. about forty hours after an HCG injection is given to trigger ovulation.

Superovulation and IUI can be used for women with cervical mucus hostility or poor quality mucus, men with low sperm counts and couples with unexplained infertility.

Peritoneal Oocytes and Sperm Transfer (POST) :

In this method, sperm and eggs are directly placed into the peritoneal cavity near the fallopian tubes, under ultrasound guidance, immediately after transvaginal ultrasound guided egg collection has been performed.

We mostly use it nowadays as a back-up treatment for superovulation and IUI. This is because with superovulation and IUI, some women develop too many follicles, so that the risk of high order multiple pregnancy becomes unacceptable if IUI were to be performed. In these cases, the choice is between abandoning the cycle, or conversion to a procedure like IVF or POST.

Intracytoplasmic Sperm Injection (ICSI) :

Intracytoplasmic Sperm Injection (ICSI) was first introduced into clinical practice for certain types of infertility in 1992. It has revolutionized the treatment of severe male infertility.

ICSI is an invasive technique and may also use sperm that would otherwise not be able to fertilise an egg. For these reasons, concerns about the potential risks to children born as a result of ICSI have been raised, and several follow-up studies have been published.

ICSI is still a relatively new technique, and all the children born are still very young. Consequently, these follow-up studies involve relatively small number of children and do not include effects that may only be seen in older children or in the next generation. More detailed information is available from our advice centre.

ICSI Technique

One individual sperm is picked up in a tiny needle, many times smaller than a human hair. This sperm is then injected directly into the centre of a mature egg.

Assisted Hatching :

Oocytes and embryos have an outer shell known as zona pellucida. Before an embryo can implant into the lining of the uterus it must "hatch" out of this shell. This usually occurs five or six days following fertilisation. The most common reason for an IVF or ICSI cycle to fail is because embryos fail to implant.

There are many reasons why successful implantation does not occur. One of these reasons may be due to the fact that the embryo is unable to " hatch" because the zona pellucida is too thick or hard. Assisted hatching is a laboratory procedure whereby a hole is made in the zona pellucida of a two or three-day old embryo in order to help in the " hatching" process and therefore, help with the implantation of the embryo into the uterus.

There are several techniques used to make a hole in the zona pellucida. These techniques include using a laser to make the hole, an acid to dissolve part of the zona pellucida away and using a very sharp needle to mechanically cut a slit in the zona pellucida.

The first assisted hatching techniques were carried out several years ago. Many hospital are now performing this procedure and many babies have been born as a result. There have been no reports of an increase in abnormalities of babies born as a result of assisted hatching.

Frozen Embryo Replacement (FER) :

Good quality spare embryos remaining from your IVF related treatment may be frozen and stored for use in a future cycle. Initially frozen embryos can be kept for five years; this can be extended to ten years in certain circumstances. You will be required to complete the relevant consent and HFEA forms.

The frozen embryos are thawed and transferred into your womb, either in a natural menstrual cycle or in hormone replacement cycle. Unfortunately, despite the precautions that are taken not all embryos survive the freezing and thawing process. Thus reduced success rates can be expected from the frozen embryos.

There is an initial charge of freezing embryos, which includes storage for one year. Following this you will be sent annual reminders and accounts so it is important to inform the clinic of any changes of address.

Blastocyst Embryo Transfer :

Embryos resulted from IVF / ICSI treatments are allowed to grow in the laboratory using special culture medium for approximately 5 days after fertilisation. Some of these embryos will successfully reach Blastocyst stage; it is at this stage that embryos implant into the uterus.

This method does not improve embryo quality, but rather helps select embryos that are more likely to survive, resulting in higher pregnancy rate. Transferring at Blastocyst stage allows clinicians to limit the number of embryos transferred and therefore reducing the likelihood of multiple pregnancy.

IVF (HOST) Surrogacy :

A surrogacy arrangement is one in which one woman (the surrogate mother) agrees to bear a child for another woman or couple (the intended parents) and surrender it at birth. With full surrogacy (IVF HOST Surrogacy) the surrogate mother has no genetic link with the child but gestates embryos, which are usually created from the eggs and sperm of the intended parents using the IVF technique.

The commissioning couple and the surrogate mother will be interviewed by a senior clinician and a counsellor. All cases of surrogacy have to be discussed and approved by the ethics committee before they are considered for treatment at this clinic. Detailed information is available from our advice centre.

Egg Donation :

Egg donation is an option for the following groups of women:-

  • Women who are unable to produce eggs either because of primary ovarian failure, premature menopause or following surgery, chemotherapy or radiation.

  • Women who are still producing eggs but because of inheritable genetic disorders, recurrent miscarriages or repeated unsuccessful IVF treatment have been advised to use donor eggs.

Egg donors may be known to recipients i.e. relative or friend or anonymous. Both require extensive counselling prior to commencing treatment.

We try to match the physical characteristics of both recipient and donor. Donors should be under the age of 36 preferably with confirmed fertility. All donors are screened for HIV, Hepatitis B & C, cystic fibrosis and syphilis. We synchronize the recipient's cycle with that of the donor. The donor undergoes a similar stimulation protocol as discussed in the IVF cycle.

Complications Of Assisted Reproduction Treatments

Side Effects Of The Drugs :

Side effects from the drugs themselves tend to be minor, although some patients have reported mood changes, tiredness and muscle aching. Rarely, allergic reactions have been reported.

Ovarian Hyperstimulation Syndrome (OHSS) :

This is the condition which may occur in approximately 5% of women using fertility drugs for ovarian stimulation. Excessive numbers of follicles are produced. It is more commonly seen in younger women, and those who have polycystic ovaries.

Symptoms of OHSS include lower abdominal pain, and swelling of the abdomen associated sometimes with nausea or vomiting. Women at risk of developing OHSS are advised to stop drugs whilst continuing with Gn RH analogue (coasting). We then monitor the levels of oestrogen until it drops to an appropriate levels, then egg collection is arranged Rarely we may recommend cancellation of the cycle or freeze all available embryos for future use. For any symptom however mild, please contact the clinic immediately.

Multiple Pregnancy :

As more than one embryo is usually transferred, there is an increased risk of multiple pregnancy.

The Human Fertilisation and Embryology Act stipulates that no more than three embryos may be transferred in a single cycle. The number of embryos transferred at this clinic will be individualised, certain factors such as the woman's age, previous pregnancies, the number of previous unsuccessful IVF attempts, the length of infertility and the quality and number of embryos created will be taken into consideration. Risks and implications of multiple births will be discussed; these include prematurity and the associated mortality and morbidity rates.

 

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