IVF & Genetic Center Jabalpur Madhya Pradesh, India

Dear Colleagues

Hello,

Hope this newsletter finds you in good mood and spirit.

We are discussing our success story in the field of assisted reproduction technology. I remember those days of frustrations and difficulties .Due to many reasons we did not have any training in this field and started the work from oocytes and sperms of animals from local slaughter house by our indigenous means and with in house efforts.

By God’s grace many singletons and twins are born by test tube baby techniques at our center.

We are trying our best to avoid to get multiple pregnancies ,but in the field of competition and as the IVF procedures are not funded by any agencies ,the target of getting pregnancy is most important. In that way, the transferring of multiple embryos is frequent. The culture condition and culture media are improved a lot and with more experience in this field ,leads to get better embryos and better implantation rates. But it also a well known truth that we still not able to predict which embryo will implant and which will not.

I wish to show in front of you that Azoospermia is not always untreatable, by citing the second topic.

With warm regards

Dr.D’Pankar Banerji

1. Our first IVF triplet and 25^th Twins delivery by IVF and ICSI method

We wish to share our joy to achieve the First IVF/ICSI triplet babies and 25^th twin delivery .

First about the triplets:

This couple from Narsingpur was married 9 yrs back, and trying for pregnancy since then. The female partner is having distorted fallopian tubes and husband is having moderate oligoastheno zoospermia.

Female is 31 yrs old and having regular periods with good ovarian reserve.

She was down regulated and the her ovaries were stimulated in controlled fashion. After oocyte retrieval ,all the oocytes were denuded and then intracytoplasmic single sperm injection (ICSI)was done by Dr.Mrs. Rinku Banerji, center’s embryologist and pathologist on the same day.

On day three post fertilization, two good quality( Grade I)  and two moderate quality embryos (Grade II) were transferred under ultrasound guidance on 30^th September 2007 .

Pregnancy test was positive after 14 days of embryo transfer.

Sonography scan was done after 10 days and found three sacs in  the uterine cavity.

Regular antenatal check up were done .

On 16^th July 2008 ,patient delivered two male and one female child by cesarean section. Female child weighing 1600 gms, boys weighing 1750 and 2000 gms respectively ,cry immediate and with good Apgar score

After one month all the kids are doing well.

Regarding 25^th Twins: This couple is from Durg and had 6ys of infertility , Female is  29yrs and male is 35 yrs. Indication of IVF was tubal damage.

2.   Azoospermia : Couple get twin pregnancy by PESA-ICSI-IVF


























 

Azoopsepermia are of three types ,pretesticular,testicular and post testicular. In these variety the testicular is difficult to get any sperms while doing the aspiration. Post testicular Azoospermia is usually due to blockage in the vas deference or total absence of vas ,a congenital defect.

A couple attended  our center ,husband with azoopsermia. The azoopspermia was worked out and found to be post testicular .

Wife ,Vineeta age 28 yrs, the periods were regular. Injection Luprolide acetate 1 mg s/c per day started in the midluteal phase. The injection continued till she gets the next period. After finishing the period, she was examined to assess the downregulation. Downregulation was confirmed by ultrasound alone . The criteria were, endometrium less than 2 mm and there is no follicle more than 2mm in size.

Ovarian stimulation was started along with Inj luprofact with urinary highly purified FSH 300 IU per day for three days. From day4 Injection HMG started 300 IU per day.

Injection HCG 10000 IU injected when lead follicles reached 17 mm diameter.

After 36 hours oocyte retrieval was done under inj.propophol. 9 good quality oocytes retrieved .

After egg pickup, husband(Deepak age 32Yrs.) was taken for sperm aspiration. Local anesthestheic injected in spermatic cord. 17 gauge needle inserted in the epididymis and suction with 10 ml syringe applied . Small amount of fluid came out and examined under inverted microscope . There were 3-4 motile sperms present per high power field.

All the oocytes were denuded with hylase and 6 were in MII stage . ICSI was done after 2 hours of denudation .

On next day all the six oocyte shows 2 PN . Out of this 4 were of ZP1.

On Day 3, good 8-10 cell embryos developed from the 4 ZP1 fertilized oocytes.

Embryo transfer was done under ultrasound guide with Cook ET catheter. Four embryos were transferred.

Luteal support was give as usual .

Urine pregnancy test was done after 14 days of transfer and was positive.

After 15 days ( 27^th May 2008)we did an ultrasound and there was three sacs present with fetal pole .

27^th June : Three alive fetuses

After one month : repeat USG revealed that one baby was absorbed and without any heart activity

Conclusion : Azoospermia is treatable condition most of the time and especially the obstructive one where the chances are good to retrieve sperms and get a pregnancy too.

Figure 1: 25^th IVF Twins

Figure 2 : First IVF triplets