How to find the best fertility or IVF clinic?

Have you been trying to get pregnant and are not yet lucky??

You were busy in your career and is it too late for you to conceive naturally??

Are you not getting pregnant because your periods are not regular / or because of less frequent sexual contact or because of painful periods??

Is your time running out??

What do you do now? You feel you are already late and time is running out. This adds to one’s stress. And there is always that element of family pressure.

The last thing that you must do is not stress about it. You would realise that you are not all alone and your next step should be to find the best fertility clinic and how do you do that…We have all your answers   Continue reading

Two Years in a Row Dr. Sudha Tandon IVF & Fertility Center Ranked in Top Fifteen IVF Centers in Mumbai – Times of India

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Again our center listed in Top 15 Best IVF & Fertility Centers in Mumbai. Dr. Sudha Tandon’s Fertility, IVF, Endoscopy Centre has ranked at 11th Position in Mumbai Circle as the best fertility and IVF Center. The Survey was carried out done by Times of India in the category of Times health for all India Fertility and IVF Ranking Survey 2017. The objective of this research done by Times of India team was to arrive at a list of Top Multi Hospital for IVF Treatment which can help Indian’s and foreigner’s to look for best centers for IVF & Fertility treatment in India.

We are truly overwhelmed and thank to all the couples who have shown complete trust in us. And all this is possible only because of the tremendous support of the team. We continue to offer world class treatments to our patients. We are in private practice since 11 years in the field of IVF Treatment and have our centers in Chembur, Mumbai and Vashi, Navi Mumbai. After 11 years of sincere work, we are truly happy to be ranked again as the best ivf center in in Mumbai. It is indeed a great achievement for us.

Our centers are in Mumbai and Navi Mumbai and both of our centers are well equipped with latest equipments and technology in fertility treatment. We offer Gynecology Endoscopy, Fertility Treatment / ART [IUI, IVF, ICSI, Surrogacy, Egg Donor] USG(Sonography) and Maternity Care under one roof. We have helped over 2200 couples in India and across the world to overcome their fertility issues.

It’s a great honor for us to be ranked at again in Mumbai Circle where there are over 500 Multi Specialist / Super Specialist and Single Specialist Centers for IVF and Fertility treatment. We thank all of our patients who have benefited from our treatment and are enjoying the great joy of parenthood. Without so many happy patients this milestone would not have been possible.

DR. SUDHA TANDON IVF & FERTILITY CENTER RANKED AT TOP 10 POSITION IN WEST REGION & AT 8TH POSITION IN MUMBAI AS THE BEST IVF CENTERS IN INDIA – TIMES OF INDIA

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Top 10!!! Yes…..you heard it right Our center “Dr. Sudha Tandon’s Fertility, IVF, Endoscopy Centre” has ranked at 8th Position in Mumbai Circle and at 10th Position in Western India Region as the best fertility and IVF Center in India in the survey done by Times of India for all India Critical Care Hospital Ranking Survey, 2016 under the category Fertility Sciences. The objective of this research done by Times of India team was to arrive at a list of Top Multi Specialist/Super Specialist/Single Specialist Hospitals and IVF & Fertility Centers in India.

We are truly overwhelmed and thank the couples who have shown complete trust in us. And all this is possible only because of the tremendous support of the team. We continue to offer world class treatments to our patients.  We are in private practice since 10 years in the field of IVF Treatment and have our centers in Chembur, Mumbai and Vashi, Navi Mumbai.  After 10 years of sincere work, we are truly happy to be ranked on 8th position in Mumbai as the best fertility and IVF center. It is indeed a great achievement for us.

Both our centers are well equipped with latest equipments and technology in fertility treatment. We offer Gynecology Endoscopy, Fertility Treatment / ART [IUI, IVF, ICSI, Surrogacy, Egg Donor] USG(Sonography) and Maternity Care under one roof.  We have helped over 2000 couples in India and across the world to overcome their fertility issues.

It’s a great honor for us to be ranked at 8th Position in Mumbai Circle where there are over 500 Multi Specialist / Super Specialist and Single Specialist Centers for IVF and Fertility treatment.  We thank all of our patients who have benefited from our treatment and are enjoying the great joy of parenthood.  Without so many happy patients this milestone would not have been possible.

When to consult a Gynecologist?

A gynecologist is the one who is specialized in treating reproductive tract problems in the women and after MBBS, gets trained for a Post Graduate degree in Gynecology.

Who should consult a Gynecologist?

An adolescent girl normally gets her periods by the age of 16, but if she does not, then she should see a Gynecologist. She is evaluated for endocrine / Genetic issues like Turner’s syndrome or an anatomical problem like absent uterus. Blood tests and Sonography studies will help the Gynecologist come to a diagnosis and offer her the right treatment.

Menstrual irregularities like delayed periods, heavy periods are seen more in this age group and they need evaluation by a Gynecologist. Polycystic Ovarian Syndrome (PCOS) is a common problem seen in girls who are overweight and have acne. Gynecologist will evaluate them by getting their blood tested for any endocrine problems like Hypothyroidism which is easily correctable. A Pelvic Ultrasonography will reveal the diagnosis of Polycystic Ovaries. They need to reduce their weight by proper exercise and change in their lifestyle.

An adult woman with issues like Menstrual Irregularity, heavy flow during her periods, painful periods may be having Uterine Fibroids / Ovarian cyst or Endometriosis. All these can be easily diagnosed by a Pelvic Sonography. The treatment depends on the size of the fibroids or the ovarian cysts.  If the cyst or the fibroid is very big and the woman has symptoms then the woman would need a surgical correction. The surgical correction is done by a Gynecologist. And today because of advanced technology, all these can be performed through the laparoscope.

A woman with abnormal vaginal discharge should see a Gynecologist for proper evaluation and treatment. Infertility issues and Infertility treatment is preferably to be taken from a Gynecologist who is a Fertility specialist and has a dedicated ART centre.

A woman who is planning a pregnancy or gets pregnant needs to consult a Gynecologist.  He/ She would advise her certain tests. It is important that the woman takes Folic Acid supplements in this period. Sonographies during various stages of pregnancy will be reassuring. Fetal Heart beat is seen in the sixth week of pregnancy. An anomaly scan at 19 weeks can detect any obvious fetal abnormalities. The Gynecologist will monitor her weight, blood pressure and fetal growth throughout the pregnancy. She will monitor her progress in labour and conduct her delivery. And a Gynecologist is trained to do a Caesarian Section if indicated. The woman is motivated to breast feed her baby.

A premenopausal woman having Symptoms like hot flushes, insomnia, Irritability, Heavy periods, Irregular periods should visit her Gynecologist, who may offer her Hormone Replacement Treatment.

Any postmenopausal woman who has bleeding “Per Vaginam” needs to see a Gynecologist to evaluate the cause.  It is very important to rule out any malignancy of the uterus. Hence the woman should not neglect this symptom.

Select your Gynecologist well as he /  she is a best friend of a woman.

Dr. Sudha Tandon is an Obstetrician-Gynecologist and an expert Endoscopy Surgeon and ART(Assisted Reproductive Techniques).  She and her experienced team have helped over 2000 couples battle various fertility issues for more than 20 years.  Facilities provided in both of her clinic are Gynecology Endoscopy, Fertility Treatment / ART [IUI, IVF, ICSI, Surrogacy, Egg Donor] USG(Sonography) and Maternity Care.

FERTILITY PRESERVATION FOR WOMEN BY FREEZING HER OOCYTE (EGGS)

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Oocyte freezing is a procedure which helps a woman freeze and stores her eggs and use them at a later convenient time to achieve a pregnancy.  Few thousand of babies are now born using frozen oocytes. The facility of egg freezing is available at almost all IVF centers.  Medical data from a recent meta-analysis suggest that specific outcomes of IVF and ICSI (fertilization and pregnancy rates) are similar between fresh oocytes and vitrified (frozen) oocytes.

What are the clinical situations in which Egg freezing is useful?

  1. Unlike men, women are born with limited number of eggs which get depleted with time.  Oocyte freezing is a good option for women of today who prefer to first establish their career and then want to get pregnant.
  2. Young girls or woman affected with malignancy have an option of freezing their eggs before starting
    chemotherapy or radiotherapy.  Treatment with chemotherapeutic drugs and pelvic radiotherapy for cancer or other serious medical illnesses has the potential to markedly accelerate follicular atresia, placing women who require these treatments at risk of primary ovarian insufficiency.
  3. Likewise, genetic conditions such as fragile X premutation and mosaicism for monosomy X also predispose women to primary ovarian insufficiency.  Women with these risk factors and others may be candidates for fertility preservation before ovarian failure.
  4. Donor Eggs of younger women can be frozen and used for an elderly woman who wishes to get pregnant.

However, as stated in the ASRM–SART guideline, “there are not yet sufficient data to recommend oocyte cryopreservation for the sole purpose of circumventing reproductive aging in healthy women because there are no data to support the safety, efficacy, ethics, emotional risks, and cost-effectiveness of oocyte cryopreservation for this indication.”

 

egg-donor-2EggFreezing

How is egg freezing done??

Like in an IVF cycle the women is given injection daily to stimulate her ovaries to get more numbers of eggs.  When the follicles reach the right mature size, the eggs are retrieved under sonography guidance by aspirating the follicular fluid transvaginally.  One ideally requires to get 15-20 eggs for a successful pregnancy in future.

The eggs thus got are vitrified (frozen) by embryologist and stored in liquid nitrogen at -196°C. Mature eggs give better pregnancy results.  Whenever the woman wishes to conceive, the eggs are fertilized by partner’s sperms using ICSI technique.  Although the number of pregnancies conceived from IVF or ICSI with vitrified oocytes is small relative to fresh oocyte IVF or ICSI and frozen embryo transfer cycles, there currently is no evidence of increased neonatal risk from this treatment compared with other assisted reproductive technologies.  Additional follow-up of diverse patient populations is warranted to confirm these early reassuring outcomes.

It is rightly said “No Pain No Gain.” Hence the woman who is for egg freezing has to go through the pain of injections, procedure, and anesthesia.  It is a small price the woman has to pay to experience the joy of motherhood.

Understanding Male Infertility with Semen Analysis

  • Semen analysis measures the amount of semen a man produces and determines the number and sperm-pumping-ironquality of sperm in the semen sample.
  • It is usually one of the first tests done to help determine whether a man has a problem fathering a child (infertility).
  • Abnormal semen or sperm (count /motility and morphology) affects more than 40% of the couples who are unable to have children (infertile).

What’s the purpose of the test?

The purpose is to do Investigation of fertility in Male.

Identify treatment options

  • Surgical treatment.
  • Medical treatment.
  • Assisted conception treatment.
  • Determine the suitability of semen for ART – Assisted Reproductive Techniques (IUI / IVF / ICSI).

Sample Collection

  • Specimen should be collected into sterile, non-toxic, wide-mouth container, after a couple has abstained from sexual activity for 2-3 days to not longer than 5 days.
  • Specimens collected following prolonged abstinence tend to have higher volumes and decreased motility.
  • When performing fertility testing, two or three samples are usually tested at 2-week intervals, with two abnormal samples considered significant.
  • The specimen should be delivered to the laboratory within 1 hour of collection and the laboratory personnel must record the time of specimen collection and specimen receipt.
  • The sample analysis, which begins ideally within 30 mins, but absolutely within 60 mins of ejaculation.

Methods of collection:-

semen collection

  1. Masturbation (the method of choice for all seminal fluid tests).
  2. By condom: Normal condoms are  not  recommended for fertility testing because the condoms may contain spermicidal agents. Special ones without the lubricants are to be used in case when masturbation sample cannot be given .
  3. By coitus interrupts: (withdrawal method). This is not recommended to patient as there is a possibility of spillage of the semen sample
  4. TESA / PESA

 

Normal Semen analysis value as per World Health Organization (WHO)

(WHO Manual for the Examination & Processing Of Human Semen (2010), Fifth Edition)

Parameter Lower reference limit
Semen volume (ml) 1.5 (1.4 – 1.7)
Total sperms number (106 per ejaculate) 37 (33 – 36)
Sperm Concentration (106 per ml) 15 (12 – 16)
Total motility (PR + NP, %) 40 (38 – 42)
Progressive motility (PR, %) 32 (31 – 34)
Vitality (live spermatozoa, %) 58 (55 – 63)
Sperm morphology (normal forms, %) 4 (3.0 – 4.0)
Other consensus threshold values
pH >7.2

Note: PR – Progressive Motility, NP – Non Progressive Motility

What’s important in a semen analysis?

confused-spermMany patients have had their initial fertility treatment decisions based on a semen analysis done at a regular medical reference lab. That’s the same place that does your blood count, cholesterol and all the other medical tests that your general doctor orders. Their semen analysis consists of a check of semen volume, sperm concentration (count), motility (movement) and standard (WHO) morphology (an estimate of those normal shapes).

 

 

 

A Fertility specialist usually advises to get the semen analysis done at their own center by their Embryologist because the embryologist analyses the semen as per WHO standards and does a better analysis of sperm morphology which is an important parameter of semen analysis.

Importance of Sperm Morphology

The morphology of sperm is an important parameter to determine its fertilizing ability. The Egg (oocyte) is enclosed in a protein coat called as Zona Pellucida (ZP) through which the sperm has to pass/penetrate in order to fertilize the egg. If there is any defect in sperm morphology it will find it difficult to penetrate the ZP.

Abnormal Sperm shape: Abnormally shaped sperms often contain abnormal DNA i.e. it may have an extra chromosome or short of an chromosome or the DNA is packed in head in such a way that, if it at all it penetrates the ZP, the DNA would get all tangled up when it tries to form a chromosome inside the egg. Therefore the nature has evolved a way to keep abnormally shaped sperm from getting inside the egg and thereby maximizing the genetic development potential of the embryo.

“Sperm DNA Fragmentation Test can be performed to check the integrity of sperm DNA”

The difference is very important because we think that only perfectly shaped sperm are capable of fertilizing an egg.

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There are three main causes of poor sperm morphology:

  • Genetic trait
    • Nothing can be done if it is a genetic trait; however, the other two causes may be reversible.
  • Exposure to toxic chemicals
    • People can be exposed to toxic chemicals in the workplace or at home. For example, people working in automotive paint shops are often exposed to a myriad of chemicals known to be detrimental to fertility. Individuals with occupational exposure to toxic chemicals need to be mindful of the impact of these chemicals on their fertility and follow all safety guidelines. Many household items, if used without proper ventilation, can also cause problems with sperm morphology.
    • Chronic smokings, obesity, use of recreational drugs are common causes of sperms getting affected.
  • Increased testicular temperature
    • Occupations that require individuals to spend the majority of their day sitting at a desk can also be problematic. When sitting for a prolonged time, the testicles are drawn up close to the body resulting in an increase in testicular temperature. Those individuals may be advised to get up and walk around periodically to return the testicular temperature to normal.
    • Sleeping in tight fitting clothing (like jockey shorts) can increase scrotal temperature to a point where sperm morphology is affected. A varicose vein in the scrotum will increase scrotal temperature. The urologist can usually repair a varicocele surgically. However, improvement in sperm morphology is seen in only about half the cases and it may take up to 18 months to see an improvement.

TERMS USED IN SEMEN ANALYSIS REPORT

Aspermia: absence of semen

Azoospermia: describes a total absence of spermatozoa in semen. (After centrifuge sperm count is zero/HPF).

Oligozoospermia: refers to a reduced number of spermatozoa in semen and is usually used to describe a sperm concentration of less than 15 million/ml. Sperm count 5-10 sperm/HPF.

Severe oligospermia: sperm count 1-2 sperm/HPF.

Polyzoospermia: denotes an increased number of spermatozoa in semen and is usually refers to a sperm concentration in excess of 350 million/ml.

Asthenozoospermia: refers to a man who produces a greater proportion of sperm which are immotile or have reduced motility, compared to the WHO reference values.

Teratozoospermia: sperm carry more morphological defects than usual

As a final note, sperm morphology scores can change a few percent from month to month and vary considerably amongst labs evaluating the same semen specimen. A single abnormal sperm morphology score is not conclusive. This is true for all seminal parameters. When the result of semen analysis is abnormal, the test should be repeated in 1-2 months to confirm the abnormality.

Fertility Issues – Are these queries your concern??

The best way to get pregnant is the natural way – the couple stays together, they have regular intercourse especially during the fertile period, the woman has regular periods and they do not have any reasons for not conceiving.

fertility issuesWhat is a Fertile Period?? 

In a woman who has a 28-30 day cycle, the egg gets released on day 12th day – 14th day of the cycle. The day she gets her periods is day 1.

The egg is fertile for about 24 hours after it gets released and the man’s sperms can remain viable in the woman’s body for 48 to 72 hours.

So the couple has maximum chance of getting pregnant if they have intercourse in this period and the chance of a couple to conceive in every cycle is 25%.

pregnancy-cycle

In a woman, the egg gets released from her ovary every month and when the sperm fertilizes the egg, an embryo is formed. The embryo gets implanted into the uterus and continues to grow till a full term fetus.

85-90% of couples conceive naturally within one year of regular unprotected sexual intercourse. The rest 10-15% who do not get pregnant may need to consult their family doctor / a Gynecologist or Fertility Specialist.

Dr. Sudha Tandon’s Fertility IVF and Endoscopy centers offer an extensive range of Gynec and fertility services under one roof. We offer complete support to couples who are unable to conceive naturally. Dr Sudha Tandon is an expert in Operative Gynec Endoscopy Surgery and Assisted Reproductive Techniques (ART).  She and her experienced team have helped over 2000 couples battle various fertility issues for more than 20 years. Facilities provided in the clinic are Gynecology Endoscopy, Fertility Treatment / ART [IUI, IVF, ICSI, Surrogacy, Egg Donor] USG(Sonography) and Maternity Care.

For more info visit www.sudhatandoninfertility.com Or email us your queryies to info@sudhatandoninfertility.com

Fertility Preservation – A Boon To all

In the field of fertility treatment, Fertility Preservation is a relatively new kid on block. It is a good option that can help both men and women who are concerned about their future fertility. Fertility can be affected by a number of different factors, including disease, lifestyle, career and age. The ability to preserve reproductive tissues is often recommended by doctors for cancer patients, military personnel and high impact athletes.

Fertility preservation is the Cryopreservation (Freezing) of human reproductive tissue which can be preserved for many years and can be used later at a convenient time.  With the use of liquid nitrogen, human tissues such as Semen, Oocytes(eggs) and Embryos (Fertilized eggs) are frozen and stored in specially designed tanks.  When the person is ready to begin a family, the tissue is thawed and used in a procedure like IUI (Intrauterine Insemination) and ICSI (Intracytoplasmic Sperm Injection) by IVF Specialist to impregnate the woman.

Freezing of sperms and embryos is performed in an IVF clinic and till date millions of babies have been born.  Freezing of Oocyte is also an established procedure and few hundred children worldwide born following Cryopreservation of unfertilized oocytes.  Freezing of ovarian tissue is relatively new and freezing of testicular tissue is still in experimental stage.

Dr. Sudha Tandon (Fertility, Endoscopy & IVF Specialist)
for more info visit : www.sudhatandoninfertility.com