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In Vitro Fertilization (IVF)


In Vitro Fertilization (IVF) – An Overview  


 


IVF ICSI Treatment in Hyderabad


IVF, i.e in vitro fertilization, has allowed thousands upon thousands of couples have a baby since it was invented in the 1970s. For women under 35, 41% of cycles led to a live birth in 2009. That’s better odds than a fertility-healthy couple trying on their own.


Deciding to go forward with IVF treatment is a big decision as well as the IVF Cost are affordable with any medical procedure, you should be aware of the basics and potential risks of the treatment.



Know the Basics of Your IVF Treatment


What is IVF Treatment?


IVF stands for in vitro fertilization, which literally means “in lab conception.” With IVF treatment, the egg is fertilized with sperm in a petridish. Typically, many eggs are retrieved from the biological mother (who may or may not be the intended parent), as not every Egg Donation will fertilize, and not every fertilized egg will become a viable embryo.


A few days after fertilization, the best Embryo or embryos are transferred to the mother or surrogate’s uterus via a catheter through the cervix. Any extra embryos may be cryopreserved for future cycles.


When is IVF Used?


Because the eggs are retrieved directly from the ovaries, and the embryo is transferred to the uterus via the cervix, IVF does not require open, clear fallopian tubes. Women with blocked fallopian tubes can use IVF to achieve pregnancy.


IVF is also used for cases of Male Infertility Treatment that cannot be overcome with IUI Treatment or other treatments. In some cases, men with no sperm in their semen may have sperm retrieved directly from the testicles or vas deferens. Men with low sperm count are more likely to achieve treatment success with IVF.


IVF may also be used along with ICSI, which involves taking a single sperm and directly injecting it into an egg. Despite the sperm directly being injected into the egg, fertilization is still not guaranteed, but the chance of pregnancy success is much higher with ICSI than without for those who need this procedure.


IVF may also be used in cases of unexplained infertility, women who need to use an egg or embryo donor, those who are using a traditional Surrogate or gestational carrier, or after multiple failed Fertility Treatments.



IVF ICSI Treatment in Hyderabad


What Is the IVF Treatment Procedure?


The IVF procedure may be slightly different for different people, depending on which assisted reproductive technologies are being used and whether or not donor eggs, sperm, or embryos are involved. There are also some situations that lead to a cycle being cancelled in the middle, either because not enough follicles grow or due to a high risk of serious ovarian hyperstimulation syndrome (OHSS).



That said, this is a basic overview of the procedure



  • Usually, the woman will start taking birth control pills or an injectable medication that prevents ovulation the cycle before treatment, shutting down the woman’s normal ovulation cycle. This is so the doctor can regulate ovulation and not lose the eggs before the retrieval.

  • After baseline blood work and an ultrasound, the woman will start taking ovulation stimulation medications, typically gonadotropins. In minimal stimulation IVF, clomid or no ovulation stimulating medications are used, but this is unusual. The clinic will monitor follicle growth and hormone levels with ultrasound and blood work every day.

  • When the follicles look ready, the woman will receive an injection of HCG to mature the eggs. An egg retrieval will be scheduled a very specific number of hours after the injection, during which the woman will receive IV sedation and the eggs will be retrieved via an ultrasound guided needle through the vaginal wall.

  • While the woman is having the egg retrieval, the man will be providing the semen sample. Sometimes this is done once at the retrieval and also sometime before retrieval day (and frozen), in case of problems or anxiety creating the sample.

  • The semen will go through a special washing procedure, and the eggs will be placed in a special culture. The sperm will be placed with the eggs, in hopes that fertilization will take place.

  • A few days later, an Embryologist will help select the healthiest of the fertilized embryos, if any, and your fertility doctor will help decide how many embryos to transfer. Leftover embryos may be cryopreserved for a later cycle, donated to another couple, or thrown away.


What is the Success Rate for IVF?


Your chance for IVF success will depend on a variety of factors, including your age, cause(s) of your infertility, whether or not donor eggs are being used, previous treatment outcomes, and the clinic’s expertise in your particular needs. That said, generally, IVF treatment has excellent success rates. According to the 2009 statistics collected by the Society of Assisted Reproductive Technologies (SART), for women younger than 35, the percentage of live births per IVF cycle was about 41%. Success rates decrease with age, with a 12% rate of success for women age 41 to 42.


Is IVF Treatment Safe?


IVF is generally safe, but as with any medical procedure, there are risks. Your doctor should sit down with you and explain all the possible side effects and risks of each procedure.


Ovarian hyperstimulation syndrome (OHSS) occurs in 10% of women going through IVF treatment. For most women, symptoms will be mild and they will recover easily. For a small percentage, OHSS can be more serious and may require hospitalization. Less than 1% of women going through egg retrieval will experience blood clots or kidney failure due to OHSS.


The egg retrieval may cause cramping and discomfort during or after the procedure, but most women will feel better in a day or so. Rare complications include accidental puncture of the bladder, bowel, or blood vessels; pelvic infection; or bleeding from the ovary or pelvic vessels. If pelvic infection does occur, you’ll be treated with intravenous antibiotics. In rare cases of severe infection, the uterus, ovaries or fallopian tubes may need to be surgically removed.


The embryo transfer may cause mild cramping during the procedure. Rarely, women will also experience cramping, bleeding, or spotting after the transfer. In very rare cases, infection can occur. Infection is typically treated with antibiotics.


There is a risk of multiples, which includes twins, triplets, or more. Multiple pregnancies can be risky for both the babies and the mother. It’s important to discuss with your doctor how many embryos to transfer, as transferring more than necessary will increase your risk of conceiving twins or more.


Some research has found that IVF may raise the risk of some very rare birth defects, but the risk is still relatively low. Research has also found that the use of ICSI with IVF, in certain cases of male infertility, may increase the risk of infertility and some sexual birth defects for male children. This risk, however, is still low (less than 1% conceived with IVF-ICSI).


What Happens During an IVF Pregnancy?


IVF has a higher risk of conceiving multiples, and a multiple pregnancy carries risks for both the mother and the babies. Risks of a multiple pregnancy include premature labor and delivery, maternal hemorrhage, C-section delivery, pregnancy induced high blood pressure, and gestational diabetes.


Research has also found that women who conceive with IVF are more likely to experience premature labor, even with a singleton baby. Women who conceive with IVF are more likely to experience spotting in early pregnancy, though it’s more likely for their spotting to resolve without harm to the pregnancy.


The risk of miscarriage is about the same for women who conceive naturally, with the risk going up with age. For young women in their 20s, the rate of miscarriage is as low as 15%, while for women over 40, the rate of miscarriage may be over 50%. There is a 2 to 4% risk of ectopic pregnancy with IVF conception.



“We, at Surya Fertility Center, share your dream and provide the best treatments & procedures to help you realize it.”

The first official day of your treatment cycle is the day you get your period. (Even though it may feel like you’ve already begun with the medications you’ve started before in step one.) On the second day of your period, your doctor will likely order blood work and an ultrasound. (Yes, an ultrasound during your period isn’t exactly pleasant, but what can you do?) This is referred to as your baseline blood work and your baseline ultrasound.


In your blood work, your doctor will be looking at your estrogen levels, specifically your E2 or estradiol. This is to make sure your ovaries are “sleeping,” the intended effect of the Lupron shots or GnRH antagonist.


The ultrasound is to check the size of your ovaries, and look for ovarian cysts. If there are cysts, your doctor will decide how to deal with them. Sometimes your doctor will just delay treatment for a week, as most cysts will resolve on their own with time. In other cases, your doctor may aspirate, or suck, the cyst with a needle.


Usually, these tests will be fine. If everything looks OK, treatment moves on to the next step.


If your blood work and ultrasounds look normal, the next step is ovarian stimulation with fertility drugs. Depending on your treatment protocol, this may mean anywhere from one to four shots every day, for about a week to 10 days.


 


You’ll probably be a pro at self-injection by now, as Lupron and other GnRH agonists are also injectables. Your clinic should teach you how to give yourself the injections, of course, before or when your treatment begins. Some clinics offer classes with tips and instruction. Don’t worry, they won’t just hand you the syringe and hope for the best.


During ovarian stimulation, your doctor will monitor the growth and development of the follicles. At first, this may include blood work every few days, to monitor your estradiol levels, and ultrasounds, to monitor the oocyte growth. Monitoring the cycle is important, as it helps your doctor decide whether or not the medications need to be increased or decreased in dosage.


Once your largest follicle is 16 to 18mm in size, your clinic will probably want to see you daily.


“We, at Surya Fertility Centre  is one of the Best Fertility Centre in Hyderabad which share your dream and provide the best treatments & procedures to help you realize it. “

Preparing for Egg Retrieval – Stimulating Egg Growth


The next step in your IVF treatment is triggering the oocytes to go through the last stage of maturation, before they can be retrieved. This last growth is triggered with human chorionic gonadotropin (hCG). Brand names for this include Ovidrel, Novarel and Pregnyl.


Timing this shot is vital. If it’s given too early, the eggs will not have matured enough. If given too late, the eggs may be “too old” and won’t fertilize properly. The daily ultrasounds at the end of the last step are meant to time this trigger shot just right. Usually, the hCG injection is given when four or more follicles have grown to be 18 to 20mm in size and your estradiol levels are greater than 2,000pg/ML.This shot is typically a one-time injection. The timing of the shot will be based both on your ultrasounds and blood work and when your clinic schedules your retrieval.


If not enough follicles grow or if you’re at risk for severe ovarian hyperstimulation syndrome, your treatment cycle may be cancelled and the hCG shot will not be given. If treatment is canceled because your ovaries didn’t respond well to the medications, your doctor may recommend different medications to be tried on the next cycle. While not common, a cycle may also be canceled if ovulation occurs before retrieval can take place. Once the eggs ovulate on their own, they can’t be retrieved.


Cancellation happens in 10 to 20% of IVF treatment cycles. The chance of cancellation rises with age, with those older than age 35 more likely to experience treatment cancellation.


The Egg Retrieval Process


About 34 to 36 hours after you receive the hCG shot, the egg retrieval will take place. It’s normal to be nervous about the procedure, but most women go through it without much trouble or pain.


Before the retrieval, an anesthesiologist will give you some medication intravenously to help you feel relaxed and pain free. Usually, a light sedative is used, which will make you “sleep” through the procedure. This isn’t the same as general anesthesia, which is used during surgery. Side effects and complications are less common.


Once the medications take their effect, your doctor will use a transvaginal ultrasound to guide a needle through the back wall of your vagina, up to your ovaries. She will then use the needle to aspirate the follicle, or gently suck the fluid and oocyte from the follicle in to the needle. There is one oocyte per follicle. These oocytes will be transferred to the embryology lab for fertilization.


The number of oocytes retrieved varies but can usually be estimated before retrieval via ultrasound. The average number of oocytes is 8 to 15, with more than 95% of patients having at least one oocyte retrieved.


After the retrieval procedure, you’ll be kept for a few hours to make sure all is well. Light spotting is common, as well as lower abdominal cramping, but most patients feel better in a day or so after the procedure. You’ll also be told to watch for signs of ovarian hyperstimulation syndrome, a side effect from fertility drug use during IVF treatment in 10% of patients.


It is also important to learn as much as you can about the disease. Talking with friends, family, and your doctor can help.

An Overview


While you’re at home recovering from the retrieval, the follicles that were aspirated will be searched for oocytes, or eggs. Not every follicle will contain an oocyte.


Once the oocytes are found, they’ll be evaluated by the embryologist. If the eggs are overly mature, fertilization may not be successful. If they are not mature enough, the embryology lab may be able to stimulate them to maturity in the lab.


Fertilization of the oocytes must happen with 12 to 24 hours. Your partner will likely provide a semen sample the same morning you have the retrieval. The stress of the day can make it difficult for some, and so just in case, your partner may provide a semen sample for backup earlier in the cycle, which can be frozen until the day of the retrieval.


Once the semen sample is ready, it’ll be put through a special washing process, which separates the sperm from the other stuff that is found in semen. The embryologist will choose the “best looking sperm,” placing about 10,000 sperm in each culture dish with an oocyte. The culture dishes are kept in a special incubator, and after 12 to 24 hours, they are inspected for signs of fertilization.


With the exception of severe male infertility, 70% of the oocytes will become fertilized. In the case of severe male infertility, ICSI may be used to fertilize the eggs, instead of simply placing them in a culture dish. With ICSI, the embryologist will choose a healthy-looking sperm and inseminate the oocyte with the sperm using a special thin needle.


Know the Basics of ICSI


What is ICSI?


ICSI, which is pronounced “ick-see”, stands for intracytoplasmic sperm injection. ICSI may be used as part of an IVF treatment. In normal IVF, many sperm are placed together with an egg, in hopes that one of the sperm will enter and fertilize the egg. With ICSI, the embryologist takes a single sperm and injects it directly into an egg.


Why is ICSI Done?


ICSI is typically used in cases of severe male infertility, including:



  • Very low sperm count (also known as oligospermia)

  • Abnormally shaped sperm (also known as teratozoospermia)

  • Poor sperm movement (also known as asthenozoospermia)


If a man does not have any sperm in his ejaculate, but he is producing sperm, they may be retrieved through testicular sperm extraction, or TESE. Sperm retrieved through TESE require the use of ICSI. ICSI is also used in cases of retrograde ejaculation, if the sperm are retrieved from the man’s urine. ICSI may also be done if regular IVF treatment cycles have not achieved fertilization.


What is the Procedure for ICSI?


ICSI is done as a part of IVF. Since ICSI is done in the lab, your IVF treatment won’t seem much different than an IVF treatment without ICSI.


As with regular IVF, you’ll take ovarian stimulating drugs, while your doctor will monitor your progress with blood tests and ultrasounds. Once you’ve grown enough good-sized follicles, you’ll have the egg retrieval, where eggs are removed from your ovaries with a specialized, ultrasound-guided needle. Your partner will provide his sperm sample that same day (unless you’re using a sperm donor, or previously frozen sperm.)


Once the eggs are retrieved, an embryologist will place the eggs in a special culture, and using a microscope and tiny needle, a single sperm will be injected into an egg. This will be done for each egg retrieved. If fertilization takes place, and the embryos are healthy, an embryo or two will be transferred to your uterus, via a catheter placed through the cervix, two to five days after the retrieval.


Is ICSI Safe for the Baby?


A normal pregnancy comes with a 1.5% to 3% risk of major birth defect. While ICSI treatment carries a slightly increased risk of birth defects, it’s still rare. Some birth defects which have an increased risk with ICSI include Beckwith-Wiedemann syndrome, Angelman syndrome, hypospadias, and sex chromosome abnormalities. Still, they occur in less than 1% of babies conceived using ICSI with IVF. There is some increased risk of a male baby having fertility problems in the future. This is because male infertility may be passed on genetically.


What is the Success Rate for ICSI?


The ICSI procedure fertilizes 50% to 80% of eggs. (Interestingly, just because a sperm is injected into an egg, it does not guarantee fertilization will happen.) Even if fertilization takes place, the embryo may stop growing. However, once fertilization happens, the success rate for a couple using ICSI with IVF is the same as a couple doing regular IVF treatment.


It is also important to learn as much as you can about the disease. Talking with friends, family, and your doctor can help.

Embryo culture


Typically, embryos are cultured until having reached the 6–8 cell stage three days after retrieval. In many Canadian, American and Australian programs, however, embryos are placed into an extended culture system with a transfer done at the blastocyst stage at around five days after retrieval, especially if many good-quality embryos are still available on day 3. Blastocyst stage transfers have been shown to result in higher pregnancy rates.


Culture of embryos can either be performed in an artificial culture medium or in an autologous endometrial co-culture (on top of a layer of cells from the woman’s own uterine lining). With artificial culture medium, there can either be the same culture medium throughout the period, or a sequential system can be used, in which the embryo is sequentially placed in different media. For example, when culturing to the blastocyst stage, one medium may be used for culture to day 3, and a second medium is used for culture thereafter.


Single or sequential medium are equally effective for the culture of human embryos to the blastocyst stage. Artificial embryo culture media basically contain glucose, pyruvate, and energy-providing components, but the addition of amino acids, nucleotides, vitamins, and cholesterol improve the performance of embryonic growth and development. Methods to permit dynamic embryo culture with fluid flow and embryo movement are also available. A new method in development uses the uterus as an incubator and the naturally occurring intrauterine fluids as culture medium by encapsulating the embryos in permeable intrauterine vessel.


Embryo selection


Laboratories have developed grading methods to judge oocyte and embryo quality. In order to optimize pregnancy rates, there is significant evidence that a morphological scoring system is the best strategy for the selection of embryos. However, presence of soluble HLA-G might be considered as a second parameter if a choice has to be made between embryos of morphologically equal quality. Also, two-pronuclear zygotes (2PN) transitioning through 1PN or 3PN states tend to develop into poorer-quality embryos than those that constantly remain 2PN.


More advanced methods of embryo profiling may also be performed in order to optimise embryo selection.


It is also important to learn as much as you can about the disease. Talking with friends, family, and your doctor can help.

In Vitro Fertilization – Assisted Hatching


One of the most frustrating aspects of assisted reproductive technology for patients and fertility professionals alike is to deal with failure. This is especially true in couples who have attempted assisted reproductive procedures many times, and also in those whose time is running out because of their age. Now, a recently developed technique, assisted hatching, is offering new hope to couples who fall into these categories.


Assisted hatching was developed from the observation that embryos which had a thin zona pellucida (shell) had a higher rate of implantation during in vitro fertilization. It was postulated that creating a minor defect in the zona might result in a greater chance of the embryo “hatching,” or shedding its shell, allowing for a better chance of implantation in the endometrium.


Initial controlled trials at New York-Cornell Medical College showed a marked increase in implantation in women over age 35 and particularly over 38 or with an elevated FSH level on day 3 of the menstrual cycle. Couples with multiple failed IVF cycles also appear to benefit from assisted hatching. Assisted hatching may be helpful in these infertile couples because their embryos lack sufficient energy to complete the “hatching” process. It is thought that some women may fail multiple cycles of IVF because their eggs have a thicker shell, therefore they have a better prognosis with assisted hatching. In addition, hatched embryos implant one day early, which may allow a greater opportunity for implantation to occur.


The addition of assisted hatching to the standard IVF protocol does add extra laboratory manipulation and therefore added costs. There is a small risk of damage to the embryo during the micromanipulation process or at the time of transfer, and there is a slight increase in identical twinning. There is a greater chance of fetal complications and abnormalities in some identical twins. A rare complication of identical twinning is conjoined or “Siamese” twins. We have not observed a higher rate of identical twins than with routine IVF. This may relate to whether a large enough opening is made in the zona to prevent pinching of the embryo during the hatching process.


It is also important to learn as much as you can about the disease. Talking with friends, family, and your doctor can help.

About three to five days after the retrieval, the fertilized eggs will be transferred. The procedure for embryo transfer is just like IUI treatment . You won’t need anesthesia.


During the embryo transfer, a thin tube, or catheter, will be passed through your cervix. You may experience very light cramping but nothing more than that. Through the catheter, they will transfer the embryos, along with a small amount of fluid.


The number of embryos transferred will depend on the quality of the embryos and previous discussion with your doctor. Depending on your age, anywhere from two to five embryos may be transferred. Recent studies have shown success with just one embryo transferred. Speak to your doctor to find out if this may apply to you.


After the transfer, you’ll stay lying down for a couple hours (bring a book) and then head home. If there are “extra” high-quality embryos left over, you may be able to freeze them. This is called “embryo cryopreservation.” They can be used later if this cycle isn’t successful, or they can be donated.


Pregnancy Test – Waiting for the Good News!


About nine to twelve days after the embryo transfer, a pregnancy test is ordered. This is usually a serum pregnancy test (more blood work) and also will include progesterone levels testing. The test may be repeated every few days.


If the test is positive (yeah!), you may need to keep taking the progesterone supplementation for another several weeks. Your doctor will also follow up with occasional blood work and ultrasounds to monitor the pregnancy and watch for miscarriages or ectopic pregnancies. During IVF treatment, miscarriage occurs up to 15% of the time in women under age 35, 25% of women age 40 and up and 35% of the time after age 42.


Your doctor will also monitor whether or not the treatment led to a multiple pregnancy. If it’s a high-order pregnancy (4 or more), your doctor may discuss the option of reducing the number of fetuses in a procedure called a “multifetal pregnancy reduction.” This is sometimes done to increase the chances of having a healthy and successful pregnancy.


When IVF Treatment Fails


If the pregnancy test is still negative 12 to 14 days post-transfer, however, your doctor will ask you to stop taking the progesterone, and you’ll wait for your period to start. The next step will be decided among you, your partner and your doctor.


Having a treatment cycle fail is never easy. It’s heartbreaking. It’s important, however, to keep in mind that having one cycle fail doesn’t mean you won’t be successful if you try again.


It is also important to learn as much as you can about the disease. Talking with friends, family, and your doctor can help.

What is Surrogacy?


Surrogacy is a method of assisted reproduction. The word surrogate originates from Latin word surrogatus (substitution) – to act in the place of. The term surrogacy is used when a woman carries a pregnancy and gives birth to a baby for another woman.


Surrogacy is gaining popularity as this may be the only method for a couple to have their own child and also because adoption, process may be a long drawn out process.


What are the Types of Surrogacy?



  • IVF / Gestational surrogacy – This is a more common form of surrogacy. In this procedure, a woman carries a pregnancy created by the egg and sperm of the genetic couple. The egg of the wife is fertilized in vitro by the husband’s sperms by IVF/ICSI procedure, and the embryo is transferred into the surrogate’s uterus, and the surrogate carries the pregnancy for nine months. The child is not genetically linked to the surrogate.

  • Traditional / Natural surrogacy – This is where the surrogate is inseminated or IVF/ICSI procedure is performed with sperms from the male partner of an infertile couple. The child that results is genetically related to the surrogate and to the male partner but not to the female partner.


To whom Surrogacy is advised?


IVF Surrogacy


1) Primarily, IVF surrogacy is indicated in women whose ovaries are producing eggs but they do not have a uterus. For e.g., in the following cases:



  • Congenital absence of uterus (Mullerian agenesis)

  • Surgical removal of the uterus (hysterectomy) due to cancer, severe hemorrhage in Caesarian section or a ruptured uterus.


2) A woman whose uterus is malformed (unicornuate uterus, T shaped uterus, bicornuate uterus with rudimentary horn) or damaged uterus (T.B of the endometrium, severe Asherman’s Syndrome) or at high risk of rupture, (previous uterine surgeries for rupture uterus or fibroid uterus) and is unable to carry pregnancy to term can also be recommended IVF surrogacy.


3) Women who have repeated miscarriages or have repeated failed IVF cycles may be advised IVF surrogacy in view of unexplained factors which could be responsible for failed implantation and early pregnancy wastage.


4) Women who suffer from medical problems like diabetes, cardio-vascular disorders, or kidney diseases like chronic nephritis, whose long term prospect for health is good but pregnancy would be life threatening.


5) Woman with ‘Rh’ incompatibility.


Traditional Surrogacy


1. Women who have no functioning ovaries due to premature ovarian failure. Here egg donation also can be an option.


2. A woman who is at a risk of passing a genetic disease to her offspring may also opt for traditional surrogacy.


Is Surrogacy right for you?


For some couples opting for surrogacy is a very straight forward decision, while, for others there are lots of things to be considered and thought about before taking the decision. There are lots of complex issues involved. It is an emotional roller coaster ride for the couple, the families and friends. It is a decision where the ‘right’ and the ‘wrong’ are very individual things. An infertility specialist or a counselor can help the couple seeing things in the right perspective. Other options such as, adoption or further infertility treatment can also be considered.


What are the screening criteria for surrogate? How is a surrogate chosen in India?


Medical Tourism’s network of hospitals in India has a very meticulous and stringent criterion for choosing a surrogate. The surrogates are between 21-35 years of age. They are married with previous normal deliveries and healthy babies. Detailed medical history, surgical history, personal history, and family history is looked into. History of blood transfusion and addiction is also taken. It is made sure that the surrogate has an uneventful obstetric history (no repeated miscarriages, no ante-natal, intra-natal and post-natal complications during previous pregnancies). The surrogate and her partner are screened for infectious diseases like sexually transmitted diseases, Hepatitis B, Hepatitis C, HIV, VDRL. Thalassemia screening is also done. Detailed pelvic sonography is done and other tests for uterine receptivity are performed to ensure maximum chances of success. A detailed financial and legal agreement is then drawn up between the surrogate and the commissioning couple.


What does India IVF surrogacy procedure involve?


For IVF surrogacy in India, matching of cycles of the genetic mother and the surrogate is done by adjusting menstruation dates by oral contraceptive pills. When the cycle starts, the surrogate is put onto estrogen tablets to prime the uterus. The protocol used for the genetic mother is day 2 protocol or day 21 protocol, depending on the age of the genetic mother and the other test results. For the day 2 protocols, called the antagon protocol, oral contraceptive pills are given in the previous month. On the 2nd day of the periods, gonadotropin injections are started. USG Monitoring is done daily.


When the size of the follicle reaches 14 mm, the genetic mother is given an antagon injection to prevent the surge of the endogenous hormones. For the day 21 protocol, called the long protocol, GnRH analogues are started on day 21 of the previous cycle. Once the genetic mother gets her periods, gonadotropin injections are started. In both the cases, the patients are monitored daily. When the follicle reaches 18 mm size hCG trigger is given. The surrogate is started onto progesterone tablets on the day of hCG injection that is given to the genetic mother. Oocyte (egg) retrieval is done 36 hours later, which is generally day 12 or 13 of the cycle. On the same day the genetic father gives his semen sample. The eggs of the genetic mother are fertilized with sperms of the genetic father in the laboratory by IVF / ICSI procedure. The resulting embryo is then transferred into the womb of the surrogate under ultrasound guidance. The surrogate is then put on luteal support using progesterone tablets / injections, and pregnancy is confirmed 15 days later.


What is the success rate of surrogacy in India?


The success rate (carry home baby) of surrogacy is around 45% in case of fresh embryos. In case of frozen embryo’s it is about 25%. High success rates and low medical costs are the highlights of surrogate pregnancy in India. No wonder many couples from the US, Australia, the UK, and other European countries seek surrogacy in India.


What are the advantages of surrogacy?


a) This may be the only chance for some couples to have a child, which is biologically completely their own (IVF surrogacy) or partly their own (gestational surrogacy)


b) The genetic mother can bond with the baby better than in situations like adoption.


It is also important to learn as much as you can about the disease. Talking with friends, family, and your doctor can help.