In natural conception, an egg is released from the ovary into the fallopian tube in the middle of a menstrual cycle. The egg is fertilized in the fallopian tube. The fertilized egg then begins to divide in the fallopian tube, thus becoming an early embryo. After being in the fallopian tube for several days the embryo enters the uterus where it will implant. IVF can be thought of as a bypass of the fallopian tubes. The IVF process involves stimulating the ovaries with “fertility shots” to mature multiple eggs. Development of the eggs is monitored with blood tests and vaginal ultrasounds. Once the eggs are “mature,” they are removed from the ovary with a very minor surgical procedure and mild anaesthesia. After the eggs are retrieved, they are put into a petri dish and exposed to the partner’s sperm. The eggs are examined the following morning to see if they have been successfully fertilized by the sperm. The fertilized eggs are left in the petri dish for several days during which time they begin to divide and become early embryos (as occurs in the fallopian tubes during natural conception). The embryos are then placed in the woman’s uterus with a small catheter through the cervix that is generally no more uncomfortable than a Pap test. If there are extra embryos that are viable, they may be cryopreserved (frozen) for future use.

Intracytoplasmic sperm injection (ICSI) is an infertility treatment. It involves injecting live sperm into a person’s eggs in a laboratory. This procedure can create an embryo (fertilized egg). ICSI is a form of in vitro fertilization (IVF). Healthcare providers most commonly use ICSI when male infertility affects a person’s ability to conceive a child. ICSI is a type of IVF. With traditional IVF, your healthcare provider places thousands of sperm next to an egg on a laboratory dish. Whether one of the sperm penetrates the egg to fertilize it is left up to chance. If none of the sperm fertilize the egg, conception (also called fertilization) doesn’t occur. ICSI promotes fertilization through the direct injection of a single sperm into a single egg. Still, ICSI doesn’t guarantee fertilization. In both ICSI and traditional IVF, your healthcare provider implants the fertilized egg (embryo) into your uterus or womb. Pregnancy occurs if the embryo attaches to the lining of your uterus.

Intracytoplasmic morphologically selected sperm injection (IMSI) is a technique used in IVF treatment to examine and select sperm using a high-magnification digital imaging microscope for microinjection into the egg. With the IMSI technique, our scientists are better able to assess the structure of the sperm and exclude the sperm with suspected variations from being injected into the available eggs.

During intrauterine insemination, sperm is placed directly into your uterus, which reduces the distance sperm has to travel and gives it a better chance of reaching your eggs. “For IUI, a semen sample is washed to separate sperm from the seminal fluid and then the entire sperm sample is injected directly into the uterus.”

Embryo freezing, also called embryo cryopreservation, is a process to freeze and store embryos for later use. An embryo is an egg that has been fertilized by a sperm. This process is a way to help people with fertility and reproduction.

The donor sperm is used to either inseminate the woman (IUI) or to fertilise her eggs in an IVF process. As is obvious, the couple is counselled together about the implications and process involved in such a treatment. All donor sperm samples are to be availed from established and registered sperm banks.

Laser-assisted hatching is a scientific IVF technique that can make it easier for the embryo to “hatch” or breakthrough its outer layer or “shell” (a membrane also known as the zona pellucida) by creating an opening. In some situations, this layer is abnormally thick and/or hardened with the freezing and thawing process among the contributing factors. The less difficulty the embryo has in hatching, the better its chance of attaching or implanting into the wall of the uterus. Pregnancy cannot occur unless the embryo hatches and implants, and laser-assisted hatching can play a key role in achieving these crucial steps.

In 2020, Gleneagles Global Health City’s IVF program was the first in the region to launch a PGD/PGS program. PGD/PGS involves removing a single cell from a developing embryo at the eight-cell stage. The cell is then analysed for chromosomal and/or specific genetic disorders. For patients with sex-linked diseases or single gene disorders such as cystic fibrosis, genetic screening of embryos is a powerful technique. In these patients, IVF coupled with embryo screening can greatly reduce the risk of offspring being affected by the disease.

An ERA Test or Endometrial Receptivity Analysis claims to help women pursuing In Vitro Fertilization (IVF) determine whether their endometrium is receiving an embryo at the right time in an attempt to maximize their chances of a successful pregnancy and live birth. Even outside of a fertility clinic, getting pregnant is a delicate science. It involves all the right pieces being in the right place at the right time. One of the most important pieces in this reproductive orchestra is the relationship between a woman’s endometrium (uterine lining) and the embryo that is about to implant inside it. Both in the bedroom and the fertility doctor’s office, the meeting of the embryo and the endometrium has to happen at just the right time for implantation, and pregnancy, to occur. If the meeting doesn’t happen when it needs to, like ships in the night, the embryo and endometrium will just miss each other, and pregnancy will not occur. This concept is known as ‘the window of receptivity,’ or ‘the window of implantation.’ An ERA claims to help women determine this window during an IVF treatment cycle.

Testicular Sperm Aspiration is a procedure that takes sperm directly from the testicular tissue of a man’s reproductive system. If a man can’t release or make enough healthy sperm naturally, this medical procedure may be recommended for fertility reasons (to enable the man to father a child). The testicular tissue is found in the two testes, where the sperm is made. The testes are found inside the scrotum, the small sac behind and under the penis. The goals of the TESA procedure are to:

• Obtain the best quality sperm.
• Get enough sperm to fertilize an egg from a woman.
• Minimize damage to the reproductive organs.