Asia Pacific Advanced Fertility Centre

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FERTILITY SERVICE

FERTILITY ASSESSMENT & MANAGEMENT

Services

FERTILITY ASSESSMENT OF THE MALE

A routine infertility evaluation is valuable in determining the cause of infertility, and provides key information when designing your personalized treatment plan. This section covers information on when to test for infertility and the basic areas of concern when a couple has not conceived for living together for a year. At APAFEC, our fertility assessment program is designed to be convenient and informative, and will give you just the information you need to plan accordingly.

(Some tests are exclusive to APAFEC and not performed elsewhere)

Sperm
Semen Analysis

Semen analysis, also known as spermiogram, is the first test performed to know the fertility status of a man. Semen is the fluid containing sperm that’s released during ejaculation. A semen analysis measures three major parameters

  • the number of sperm
  • the shape of the sperm
  • the movement of the sperm, also known as “sperm motility”

A semen analysis is often recommended when couples are having problems getting pregnant. The test will help a doctor determine man’s fertility status. The analysis will also help determine if low sperm count, poor motility and abnormal morphology or sperm dysfunction is the reason behind infertility.

FSH (Follicle Stimulating Hormone) Assay

The production and release of follicle stimulating hormone is regulated by the levels of a number of circulating hormones released by the ovaries. Most often, raised levels of follicle stimulating hormone are a sign of malfunction in the ovary. If the gonads fail to create enough oestrogen, testosterone and/or inhibin, the correct feedback control of follicle stimulating hormone production from the pituitary gland is lost and the levels of both follicle stimulating hormone and luteinising hormone will rise. This condition is called hypergonadotrophic-hypogonadism, and is associated with primary ovarian failure or testicular failure. Checking for the level of FSH in the blood will indicate the function of the ovary.

Testicular Epididymal Sperm Aspiration (TESA)

Many azoospermic patients with nonobstructive azoospermia (NOA) might be candidates for sperm aspiration as part of their in vitro fertilization procedure. Because sperm might be present in some but not all parts of the testes of such men, multiple samplings of the testicular tissue are usually performed to increase the probability of finding sperm in NOA patients. These samplings can be done by 2 methods: 1) TESE (testicular sperm extraction), which is actually a surgical biopsy of the testis; or 2) TESA (testicular sperm aspiration), which is performed by sticking a needle in the testis and aspirating fluid and tissue with negative pressure.

Hyaluronon Binding Assay

Hyaluronan has recently been employed in the development of a commercial diagnostic kit for assessing sperm maturity, the so-called sperm-hyaluronan-binding assay (HBA).

Sperm MAR Blood tests for HIV and Hepatitis

SpermMar IgA, IgG are rapid, easy-to-use tests for the detection of anti-sperm antibodies in semen and serum. Anti sperm antibodies (ASA) are produced when the blood-testis barrier is disrupted by obstruction, infection or traumatism. Immunoglobulines of the IgG class are usually present in both serum and semen, and the IgG antibodies attach to the spermatozoa. ASA of the IgA class are secreted by the accessory sex glands and are found in semen only. ASA of the IgG class may be detected in seminal plasma, but there is usually no free IgA in seminal plasma. Anti sperm antibodies of the IgA class almost never occur without IgG antibodies.

HOS Test

The hypoosmotic swelling (HOS) test evaluates the functional integrity of the sperm’s plasma membrane and also serves as a useful indicator of its fertility potential. The functional integrity can be demonstrated by allowing sperm to react in a hypoosmotic medium. The hypoosmotic swelling test indicates that only cells with intact membranes (live cells) will swell in hypotonic solutions. Spermatozoa with intact membranes swell within 5 min in hypoosmotic medium, and all flagellar shapes are stabilized in 30 min.

Forward Progressive Motility Test

A sperm that zigzags but makes forward progression would be considered progressive. Progressive motility is needed in order for the sperm to swim their way up the female reproductive tract. Total motility refers to the percentage of sperm making any sort of movement. This movement can include non-progressive movement

Sperm DNA Fragmentation Assessment

The integrity of genetic material in the sperm is crucial for successful fertilisation and normal embryo development. Sperm DNA fragmentation is a term used to denote abnormal genetic material within the sperm, which in turn may lead to male subfertility, IVF failure and miscarriage. A conventional semen analysis done for sperm concentration, motility analysis and morphology assessment cannot assess the sperm at the molecular level and as result aid the detection of DNA fragmentation.

Sperm Morphology Predictive Assessment

Sperm morphology the size and shape of sperm is one factor that's examined as part of a semen analysis to evaluate male infertility. Sperm morphology results are reported as the percentage of sperm that appear normal when semen is viewed under a microscope.
Normal sperm have an oval head with a long tail. Abnormal sperm have head or tail defects such as a large or misshapen head or a crooked or double tail. These defects might affect the ability of the sperm to reach and penetrate an egg.

Percutaneous Epididymal Sperm Aspiration (PESA)

PESA or Percutaneous Epididymal Sperm Aspiration (PESA), does not require a surgical incision. A small needle is passed directly into the head of the epididymis through the scrotal skin and fluid is aspirated. The embryologist retrieves the sperm cells from the fluid and prepares them for ICSI.

FERTILITY ASSESSMENT OF THE FEMALE

A routine infertility evaluation is valuable in determining the cause of infertility, and provides key information when designing your personalized treatment plan. This section covers information on when to test for infertility and the basic areas of concern when a couple has not conceived for a year living together .At APAFEC, our fertility assessment program is designed to be convenient and informative, and will give you just the information you need to plan accordingly.

(Some tests are exclusive to APAFEC and not performed elsewhere)

Sperm
Full Blood Count

Complete blood count (CBC) is a blood test used to evaluate your overall health and detect a wide range of disorders, including anemia, infection and leukemia. A complete blood count test measures several components and features of your blood, including:
Red blood cells, which carry oxygen;White blood cells, which fight infection; Hemoglobin, the oxygen-carrying protein in red blood cells;Hematocrit, the proportion of red blood cells to the fluid component, or plasma, in your blood; Platelets, which help with blood clotting
Abnormal increases or decreases in cell counts as revealed in a complete blood count may indicate that you have an underlying medical condition that calls for further evaluation.

Rubella

A rubella blood test detects antibodies that are made by the immune system to help kill the rubella virus. These antibodies remain in the bloodstream for years. The presence of certain antibodies means a recent infection, a past infection, or that you have been vaccinated against the disease.

Urine Test

A urinalysis is a simple test that looks at a small sample of your urine. It can help find problems that need treatment, including infections or kidney problems. It can also help find serious diseases in the early stages, like kidney disease, diabetes, or liver disease.

Hysteroscopy

Hysteroscopy is a procedure that allows your doctor to look inside your uterus in order to diagnose and treat causes of abnormal bleeding. Hysteroscopy is done using a hysteroscope, a thin, lighted tube that is inserted into the vagina to examine the cervix and inside of the uterus.

Anti Mullerian Hormone(AMH)

Anti-Mullerian Hormone (AMH) is a hormone secreted by cells in developing egg sacs (follicles). The level of AMH in a woman's blood is generally a good indicator of her ovarian reserve. AMH does not change during your menstrual cycle, so the blood sample can be taken at any time of the month - even while you are using oral contraception.

Tubal Patency test

Tubal patency is when a woman's fallopian tubes are not blocked. Tubal patency is determined by an x-ray test called a hystero-(uterus)salpingo-(fallopian tube)graphy (HSG). HSG is a standard radiological imaging study that is used to determine if the fallopian tubes are open and free of disease. SSG (Sono salpingography) is newer addition to determine the patency at APAFEC with more precision and accuracy.

Ultrasound Scans

An ultrasound scan is a medical test that uses high-frequency sound waves to capture live images from the inside of your body. It’s also known as sonography. An ultrasound allows your doctor to see problems with organs, uterus without needing to make an incision. Unlike other imaging techniques, ultrasound uses no radiation. For this reason, it’s the preferred method for viewing a developing fetus during pregnancy.

3D Saline Infusion Sonogram (SIS)

Saline infusion sonohysterography (SIS) or saline ultrasound uterine scan uses a small amount of saline (salt solution) inserted into the uterus (or womb) that allows the lining of the uterus (endometrium) to be clearly seen on an ultrasound scan.
“Ultrasound” is the term used for creating pictures or images using high-frequency soundwaves. The pictures are obtained using an ultrasound transducer.Ultrasound transducers transmit high-frequency sound waves that are converted into electrical impulses that produce a moving image of the inside of the body on a screen.

FERTILITY SERVICES OFFERED TO THE COUPLE

A routine infertility evaluation is valuable in determining the cause of infertility, and provides key information when designing your personalized treatment plan. This section covers information on when to test for infertility and the basic areas of concern when a couple has not conceived for living together for a year. At APAFEC, our fertility assessment program is designed to be convenient and informative, and will give you just the information you need to plan accordingly.

Sperm
Conventional In-vitro Fertilization

When less aggressive or simpler methods of infertility treatments have failed, in vitro fertilization (IVF) may be an option that may provide you with a better chance of success (pregnancy). In some couples with certain medical conditions, IVF may be the first step in the treatment of infertility. These conditions include blocked fallopian tubes, severe endometriosis, male infertility and unexplained infertility.
IVF is a complex and expensive procedure and involves combining a sperm and an egg outside the body in the laboratory and transferring the resulting embryo(s) back into the uterus.

Rescue ICSI for IVF/ICSI

ICSI stands for Intra Cytoplasmic Sperm Injection , It involves injecting single sperm into the egg to achieve fertilization. In 10% of conventional IVF and occasionally after ICSI, eggs fail to fertilize due to insufficient activation. At APAFEC, we look into early events of fertilization after 4-6 hours and rescue them early to prevent fertilization failure which was developed by Dr Suresh Kattera.

Calcium Ionophore Oocyte Activation

Artificial oocyte activation (AOA) is a method used for fertilization problems that commonly involve the usage of Ca2+ ionophores and is usually used in problems such as total fertilization failure (TFF) and globozoospermia.

Laser-assisted hatching (LAH)

Laser Assisted Hatching can turn around a history of failure for embryos to implant themselves in the uterine wall. Assisted hatching is used to help the embryo hatch from its protective outer shell, the zona pellucida, and promote implantation in the uterine wall after embryo transfer.

Ovarian tissue cryopreservation

Ovarian tissue cryopreservation (freezing) is a method of fertility preservation in which the outer layer of an ovary, which contains a large number of immature eggs, is taken out of the body and frozen for future use. In ovarian tissue freezing process, a part of an ovary or a whole ovary is surgically removed, usually by laparoscopy. In the laboratory, the ovary’s outer layer (called ovarian cortex) is cut into small strips and frozen. Ovarian tissue freezing is for the most part performed for medically indicated fertility preservation in cancer patients.

Altruistic surrogacy

Altruistic surrogacy refers to those surrogacy agreements where the surrogate does not receive monetary compensation. In most altruistic surrogacy agreements, the surrogate is a close relation to the intended parents (family member/close friend).

Egg freezing

Egg freezing, or oocyte cryopreservation, is a process in which a woman's eggs (oocytes) are extracted, frozen and stored as a method to preserve reproductive potential in women of reproductive age. Cryopreservation of the oocytes can be considered for a variety of reasons:

  • Women with cancer requiring chemotherapy and/or pelvic radiation therapy that may affect fertility.
  • Surgery that may cause damage to the ovaries.
  • Risk of premature ovarian failure because of chromosomal abnormalities (e.g. Turner syndrome, fragile X syndrome), or family history of early menopause.
  • Ovarian disease with risk of damage to the ovaries.
  • Genetic mutations requiring removing the ovaries (e.g. BRCA mutation).
  • Fertility preservation for social or personal reasons to delay childbearing.

Sperm Donor Programme

Sperm donation is used in conjunction with insemination and IVF treatment.Donor sperm are frozen for at least 6months and then the donor is tested again for infectious diseases during the quarantine period and only then the donor sperm sample is used.Donor sperm can be matched closely to the physical characteristics (skin colour, eye colour, height) and blood group of the male partner of the recipient couple.

Oocyte Donation Programme

In the context of fertility treatment, oocyte donation is the process by which a fertile woman allows several of her oocytes to be aspirated, usually following ovarian stimulation, and used to enable another woman, who is infertile due to ovarian failure to conceive with IVF.

Embryo Freezing (Vitrification)

Vitrification is a ultra-rapid freezing method that is used in the embryo freezing process so that they can be stored for later use. APAFEC, Dr Suresh Kattera has perfected this method to achieve 100% survival after warming.

Embryo Donation Programme

Embryo donation is a form of third party reproduction. It is defined as the giving—generally without compensation—of embryos remaining after one family's in vitro fertilisation to either another person or couple for implantation or to research.

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Different are we?

A Team of Fertility Specialists- Doctors, Embryologists and counselors understand and identify the causes of each infertile couple.
We investigate the causes of both male and female infertility.
We formulate specific treatment for each couple individually.
We use a Artificial Intelligence based system to predict the number of eggs/cycles required to make top quality embryos to produce pregnancies during the second consultation.
We have tests to identify and treat fertilization failure in IVF and ICSI.