Dr Sohani Verma

Sr. Consultant Obstetrics & Gynaecology

Infertility & ART Specialist
Clinical & Academic Coordinator
Indraprastha Apollo Hospitals, New Delhi

Chairperson North Zone AICC RCOG

President Elect Indian Fertility Society
 Introduction
A woman of reproductive age who has not conceived
after 1 year of unprotected vaginal sexual intercourse, in
the absence of any known cause of infertility, should be
offered further clinical assessment and investigation
along with her partner.

Offer an earlier referral for specialist consultation to

discuss the options for attempting conception, further
assessment and appropriate treatment where –
- the woman is aged 36 years or over
- there is a known clinical cause of infertility or a
history of predisposing factors for infertility

NICE Guidelines 2013

 Main Causes of Infertility

Multiple relatively minor abnormalities, either with 1 partner or both,

account for 30% of all causes
 Assisted Reproductive Techniques (ART)
Any treatment that deals with “means of conception
other than vaginal intercourse” is termed as ART.
NICE guideline 2013

IUI – Intra Uterine Insemination (Husband /

Donor)

IVF + ET – In Vitro Fertilization + Embryo transfer

ICSI – Intra Cytoplasmic Sperm Injection

Common Indications for IUI
-Unexplained infertility
-Endometriosis (mild)
-Male factor infertility (mild)
severe)
-Ovulatory disorders
Indications for IVF
- Unexplained infertility
- Endometriosis (moderate to severe)
- Male factor infertility (moderate to
- Ovulatory disorders

-Inability to have vaginal intercourse

-People with conditions that require - Tubal pathology
specific consideration (such as man HIV - Donor Oocyte
positive) - Genetic Surrogacy
- People in same-sex relationship - PGD (Possibility of genetically
- Donor Sperm transmitted disease)
- Fertility preservation in cancer
patients
- Where ICSI is indicated
(Azoospermia)
• The world's first "test-tube
baby", Louise Brown, has
spoken of her joy at giving
birth to her first child.
• Baby Cameron was born on
20 December’06 in Bristol,
where his 28-year-old mother
lives with husband Wesley
Mullinder.

Well over two million "test-tube" babies have been born globally
since Louise's 1978 birth after IVF
 IVF and ET
• In Vitro Fertilization (IVF) and Embryo Transfer (ET) are the basic ART
for all related technology. These include:
- Intra Cytoplasmic Sperm Injection (ICSI)
- Assisted hatching
- Pre-implantation Genetic Diagnosis (PGD)
- Cryopreservation
- Donor oocyte IVF programs
- Donor embryo (genetic surrogacy)
- Intracytoplasmic Morphologically selected
Sperm Injection (IMSI)
- And many more
 Pre IVF work-up Ovarian stimulation Monitoring

Preparation of
Oocyte retrieval Ovulation induction
sperms

In Vitro Fertilization Embryo transfer Luteal Support

 Basics requirements for IVF/ICSI success
1. Pre – IVF work up of the infertile couple
 Clinical history
 Examination
 Investigations
 Counseling
Why necessary?
 To identify the cause of infertility and thereby prognosis
 To identify and correct associated adverse factors before treating

primary disorder
 To decide most appropriate treatment protocol
- Type of drug
- starting dosage
- expected response and problems
 To assess reproductive ageing and plan early access / resort to ART
treatments
 Basic requirements for IVF/ICSI success contd…

2. To get adequate number of good quality oocytes

A. Predictors of COHS response Normal responders

Hyper responders
Hypo- responders
- Age, AMH, AFC
- Response to earlier COHS
- Basal FSH, LH, E2
- BMI, Smoking, Alcohol
- Previous Ovarian Surgery

B. Selection of COHS protocol

- Agonist versus Antagonist protocols
- Mild stimulation protocols
Basic requirements for IVF/ICSI success contd…

C. Ultrasound monitoring with power and colour

Doppler
D. Biochemical Monitoring
2. Ovulation induction
- hCG - urinary / recombinant
- GnRh agonist
3.Technique of Oocyte retrieval
4.Embryology lab quality and expertize
5.IVF or ICSI
6.Selecting best embryo (s) for transfer
7.Number of embryos transferred
8. Embryo transfer technique
9.Luteal Support