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Welcome to IIRC: This information booklet details and explains the services and wide range of infertility treatments available at IIRC. As one of the leading centres of excellence for infertility treatment, we offer the highest standards of care and clinical expertise. We hope that you will find this booklet useful and trust that we may be able to help impart all the desired information regarding infertility management. J. Bhattacharya Director. INTRODUCTION Way back in 1977, Patrick Steptoe and Prof. Robert Edwards were able to achieve the first successful human pregnancy by the technique of IN VITRO FERTILIZATION better known as IVF, by which an egg is fertilized outside the body and the embryo transferred back into the uterus. Dr. ( Mrs. ) J. Bhattacharya worked with Patrick Steptoe and Prof. Robert Edwards at Bournhall Clinic, Cambridge ( UK ), the world?s first IVF Centre. She spent over two decades in Britain as a Senior Consultant Gynaecologist and Honorary Lecturer in the Department of Obstetrics and Gynaecology, Cambridge University. Based on this experience a plan was set out to provide infertility services of the highest standards in India. A purpose built infertility centre was setup at Ranchi the capital of the newly born state of Jharkhand with has a tremendous growth potential. The IVF Centre is situated at the foot of Tagore Hill in Morabadi, adjacent to Ramkrishna Mission. Jharkhand has all the major industries situated in the Eastern Zone of India viz. HEC, MECON, CCL, CMPDIL, IICM, SAIL (R & D), TISCO, TELCO, USHA BELTRON, BOKARO STEEL, BCCL, etc. and accounts for 44% of the total urban workers in Bihar. It serves a total population of 25 million. Ranchi once the summer capital of Bihar has immensely good weather conditions almost throughout the whole year. Majestic hills and many waterfalls surround Ranchi with its lush green valleys. It is more of an Eco-friendly area than many other states in India and it is very much expected that the new government will be working hard to develop this new State as an important one in the subcontinent. It has good transport connections by road, rail and air. In line with the requirements of the State of West Bengal another clinic has been setup at Jodhpur Park, located in South Kolkata. It is in quite clean culdesac away from crowded areas and almost noiseless and pollution free. It has easy mode of communication by Bus, Taxi, Rail & Metro. To impart this specialised service to the remote areas, to cater those people who have difficulties to come to the big cities, satellite clinics have been set up at Patna, Varanasi, Midnapore, Siliguri & Durgapur. These satellite clinics do have the complete back up facilities for infertility treatment, including Ultrasound Scan, Hormonal Assay, andrological (extended semen analysis and sperm function test) and gynaecological assessment of both partners. Most people nowadays, have reasonable knowledge about the human fertility and expect a pregnancy to occur soon after stopping contraceptive measures. Without medical intervention, 80% women will be able to conceive within 2 years of trying. However 10 -15% couple will have difficulty in having a family. Here, age is a very important factor for women to indicate the urgency of carrying out basic investigation and an early referral to an infertility clinic. Nowadays more and more women are delaying start of a family well into their 30?s and even 40?s because of their commitment to their career. Fertility unfortunately declines in women after the age of 30 and even more rapidly after 35. So often, patients realise that they left matters a bit too late. It is imperative that the couple seeks professional advice in a specialised clinic, where an infertility specialist will be able to discuss the various options and ensure that the treatment will be progressive. The advice of good intentioned friends may be correct but it is hardly professional. In case it may be inaccurate and may do more harm than good. The field of assisted reproduction has advanced remarkably in the past two decades and is no longer luxury treatment it was, in the early 1980?s. There are now numerous Assisted Conception Units throughout the World and the majority of these are in the private sector, as most Government Health Authorities do not have the resources to fund these specialised clinics. The successes of IVF treatment ranges between 10-25% Live Birth Rate. IVF treatment is mainly indicated for that group of women who have damaged fallopian tube or whose husbands have severe male factor problems and in certain cases of unexplained infertility. The recent advancement in treating male infertility by ICSI, PESA and TESE mean that men with sperm disorder now have a much better chance of fathering their own child. TREATMENTS AVAILABLE AT THE CENTRE ARE AS FOLLOWS: ? Ovulation Induction ? Artificial insemination using husband?s sperm (AIH) ? In vitro fertilization (IVF) ? Intra cytoplasmic sperm injection (ICSI) ? Egg donation ? Surrogacy ? Own sperm bank ? Embryo freezing ? Surgical sperm retrieval (PESA / TESE) The first consultation is usually held with the medical director. There are several aspects of treatment that have to be discussed. The most essential points will be the treatment most suitable to one?s specific requirement. Other points of discussion will be the side effects of any drugs to be used in the treatment, risks of multiple pregnancy and ovarian hyperstimulation, a rare but potentially serious complication of fertility treatment, the success rates and the cost of the treatment. One should allow at least two hours for this. Some simple tests have to be carried out. All the members of the units team are aware of the stress that is imposed on the childless couple before during and after treatment, particularly at times of failure. The aim of this centre is to do their best for their patients at all times, but problems can occur which will have to be sorted out in the best possible way. The house manager or one of her colleagues will make you welcome to the centre, complete your paper work and familiarise you with the layout of the clinic. It is advisable to bring any papers or results of previous treatment for your consultant to look through. A mutually suitable date to start the treatment will be arranged after the interview with the consultant. Each couple is seen by one of the co-ordinators who will discuss details of the treatment and answer any further questions. The husband is asked to produce a semen sample for analysis in our laboratory. Certain blood tests are necessary before starting treatment. These tests are arranged at the centre. All patients entering treatment are asked to have a test for hepatitis B and C and HIV (AIDS). This is for the protection of yourselves and your potential child. Evidence of the woman?s rubella is also required. Evidence of sickle cell and thallassaemia status are also required. Although three in four couples will not be able to have a baby after one cycle of treatment, nevertheless the chance of success continues to rise with each cycle of treatment. After four cycles of assisted conception, the cumulative pregnancy rate may reach 50%-70% following IVF treatment per couple treated. Counselling is the key element in the provision of infertility treatment. It is not defeatist to accept a state of childlessness. There are many different ways to channel ones yearning to have a child and find the freedom to develop oneself and fill their lives with caring and love. In Vitro Fertilization (IVF) IVF is a technique involving fertilisation of egg & sperm outside the body. The term literally means ?fertilisation in glass?, hence known as the ?test tube body technique.? Indications for IVF ? Blocked fallopian tubes ? Poor sperm quality ? Endometriosis ? Anovulation ? Unexplained What does the treatment involve? An IVF treatment involves the following: Down Regulation ? First the women is prescribed a drug in the form of a nasal spray or an injection, which suppresses the release of a hormone responsible for production of an egg. This is necessary to establish a baseline from which to start ovarian stimulation. Ovarian Stimulation ? This involves daily injection in order to stimulate the ovaries to produce serial eggs. Monitoring ? Serial ultrasound scans and blood tests to check the effect of the drugs on the ovaries. HCG Injection ? The final injection to ensure the ripening of the eggs prior to egg collection. Egg Collection ? Eggs are collected using fine along the side of vaginal ultrasound probe to aspirate the eggs from the follicles. This is performed as a day case in theatre under either a general anesthetic or sedation. Sperm Production and Preparation ? On the day of egg collection, husband produces a semen sample. Occasionally he may be asked to produce a second sample. This is then prepared in the laboratory to extract the most motile sperms. Embryology - All the eggs are put with the prepared sperms and incubated in the laboratory. After 16-18 hours, the embryologist checks if fertilisation has taken place. Embryo Transfer ? If fertilisation has occurred, up to three embryos are transferred directly into the uterus two days after the egg collection. The embryos are transferred via the vagina and cervix using a fine catheter. Pregnancy Test - A pregnancy test should be carried out fourteen days after the embryo transfer. If the result is positive, an ultrasound scan is recommended two to three weeks later, to check if the embryo is alive, developing and situated in the uterus. Freezing & Storage of Embryos In case where more than three embryos result from an IVF treatment, it is sometimes possible to freeze and store these embryos. Frozen embryos may be stored for up to ten years. This enables women to have further treatment without the need for ovarian stimulation or egg collection. What causes IVF to fail? During an IVF treatment cycle, a number of problems may arise which cause the treatment to be cancelled or to fail. These includes the following: ? After the embryo transfer, the embryos may fail to implant in the uterus. This is the most common reason for an IVF treatment to fail. ? The ovaries may either to respond to the stimulation drugs or over ?respond in which case the egg collection either would not go ahead or all the embryos will be frozen and stored for replacement at a later date. ? The eggs may fail to divide after fertilisation and therefore cannot be replaced into the uterus. ? The collected eggs may fail to fertilised in the laboratory and therefore no embryos would be available for transfer. Intra Cytoplasm Sperm Injection (ICSI) The microsurgical fertilisation technique of ICSI is currently the most advanced technique available for the treatment of male infertility. It is used in conjunction with IVF and involves an extremely precise microscopic surgical procedure on an egg in order to assist fertilisation. When should ICSI be used? ICSI can be used in case where the man produces only a very small number of sperm, which are incapable of penetrating the barriers surrounding the egg unassisted. This is usually because the sperm have extremely poor movement or no movement at all. ICSI is also necessary when sperm is directly retrieved from the testis. What does the treatment involve? Eggs and sperms are collected in the same way as in a normal IVF treatment. However, unlike conventional IVF, a single sperm is picked up from a prepared semen sample in a very fine glass needle and injected through the zona pellucida and the egg membrane directly into the centre of the egg. In this way, the sperm is not required to penetrate any of the surrounding barriers. The injected eggs are then incubated for sixteen hours and checked to see if fertilisation does occur up to three embryos, which are then replaced two days, after the egg collection, as in a normal IVF treatment. Microepididymal Sperm Aspiration (MESA), Percutneous Epididymal Sperm Aspiration & Testicular Sperm Extraction (TESE) Total azoospermia (total absence of sperm in the ejaculate) can be due to either a blockage or absence of the vas deferens or due to failure of the testes to produce spermatozoa. The degree of this failure can be variable. In the first instance, it is quite easy to recover directly from either the testis or from the epididymis, which is like a small appendage, to the testis. However, sperm collected in this way are unable to fertilise the egg in the natural way and therefore ICSI is always necessary. Fertilisation rates of around 65% are achievable. In case of testicular failure, it is now possible in around 50% of cases, to collect at least a few sperm by performing one or multiple testicular aspirations. Provided some motile sperm recovered, the chance of fertilisation of the egg is again extremely good. In both circumstances, it may be possible to freeze some sperm at the time of this operation for use during subsequent IVF/ICSI cycles. Ovum (egg) Donation A women is unable to produce eggs but has a healthy uterus, it may be possible to utilise IVF using donated eggs with her partner?s sperm. In this way, she can carry and give birth to a baby, which is genetically related to her partner. Why is ovum donation necessary? In many cases, women are unable to produce eggs because they have undergone a premature menopause, but it can also be due to disease or treatment, which results in sterility. Some hereditary disorders, Turner?s syndrome for example, also result in infertility. What does this treatment involve? Following preliminary investigations, a suitable donor will need to be found. Egg donors are usually anonymous to the recipient and required to be under the age of thirty-six with no history of hereditary disease. All potential donors are examined by a doctor and extensive medical screening is carried out before and extensive medical screening is carried out before a women can be accepted as a donor. The donor?s physical characteristics are recorded so that they can be matched to those of a recipient. Counselling for both donors and recipients is strongly recommended in order to ensure that all the implications of the treatment are fully understood. When a suitable match for the recipient for the recipient has been found, the donor will commence an IVF treatment cycle and the recipient will take hormones, which prepare her uterus to receive embryos. Once the eggs have been collected from the donor, they are put with the sperm of the recipient?s partner and incubated. After fertilisation, the embryos are transferred directly into the recipient?s uterus. Intra-uterine Insemination (IUI) Intra-uterine Insemination - also known as artificial insemination ? is a relatively straightforward technique involving the introduction of a prepared sperm sample directly into the uterus at the time of ovulation. IUI can be employed using either the sperm of a woman?s partner (AIH) or that of an anonymous donor (DI). When should IUI be used? AIH is used when the male partner has a low sperm count with poor sperm movement or there is problem with the interaction of sperm and cervical mucus. Donor sperm will be used in case where the male partner is infertile, ie, produces no sperm at all or only a very small number, which are incapable of fertilising an egg. Counselling is recommended for those couples that wish to discuss the social, emotional and legal implication of using donated sperm in more detail. What does this treatment involve? The insemination procedure involves depositing sperm directly into the uterus using a fine catheter, which is inserted through the cervix via the vagina. As the timing of the insemination is crucial, the woman?s cycle is monitored using urine tests and ultrasound scans to assess the development when these tests indicate that ovulation is imminent. In some cases, it is appropriate to combine intra-uterine insemination with ovarian stimulation, when the ovaries are stimulated to produce more than one egg. If the partner?s sperm is being used, he will attend the clinic on the day of the insemination and produce a semen sample, which is prepared in the laboratory to extract the most motile sperm. If donated sperm is used, a pre-selected sample, normally chosen to match the physical characteristics of the woman?s partner, is thawed and inseminated as described above. A pregnancy test should be performed two weeks after the insemination. Donor Sperm Sperm donation is anonymous and recipients and donors will not know each other?s identity. The sperm donor has no parental or legal responsibilities towards any child born using his sperm. All potential donors undergo extensive medical screening, prior to being accepted. In addition, all donated samples are quarantined for a minimum period of six months and are only released for treatment after repeat screening has confirmed that the sperm is clinically acceptable of the required quality. Counselling Independent counseling services are available. We recommend that all couples consider taking advantage of counselling whenever they feel the need. One in six couples suffer from infertility. Childlessness imposes a great deal of stress before, during and after treatment, particularly at the time of failure. Consent forms Before start of treatment, couples will be asked to read and sign the IIRC forms consenting to the treatment they are about to receive, for the use of eggs sperm and embryos and consent to storage. If there is anything in the form with which you are not happy or you do not understand, please discuss it with a doctor or a nurse. We normally ask you to sign two forms, one for yourselves to keep and one for us to keep in your specific file. Treatment programme Once the consultation and investigations are over, couples may choose when they wish to attend for treatment. They will have to inform the clinic doctor or the coordinator to attend for treatment. On the day when menstrual cycle begins, the patient should inform the co-ordinator to give her a date to attend for baseline assessment visit. A member of the medical staff and nursing staff will see patient and her husband. An ultrasound scan and a blood test are done to ensure that the ovaries are ready for stimulation and the hormone levels in the blood are normal. Number of different drugs and drug regimes are used. Treatment is individualised and differs from patient to patient. A summary of treatment programme will be given to the patient. It is not necessary to see couples after this initial visit until about Day 6-8, when you are required to return for further monitoring and possible adjustment of dosage of medication usually on a daily basis. If you live far from the city, it will be less stressful if you come and stay in the areas until treatment is over. On average the treatment last for about 2-3 weeks. Moreover, during this period you will be coming for 6-8 visits, including the day required for egg collection and the day of embryo transfer. Male infertility The recent advancement in treating male infertility by ICSI and TESA mean that men with sperm disorder now have a much better chance of fathering a child of their own. Male problems include :- 1. Azoospermia ( Absence of Sperm ) 2. Oligospermia ( Low Sperm Count ) 3. Asthenospermia ( Poor Sperm Motility ) 4. Teratospermia ( Abnormal Sperm ) 5. Ejaculation problem. All patients entering treatment will have a test for HI, Hepatitis B and C. this is for safety of the patient and the potential child they will be required to sign a consent form before starting treatment. The centre will have its own ethics committee whose members will be form different fields. The members will discuss difficult cases and a joint decision will be taken. Success of IVF Treatment: ? Pregnancy Rate/ET 37 % ? Live Birth Rate 20-25 % ? Cumulative Pregnancy Rate 70 % Outcome: ???????????. Training Programmes / Workshops IIRC has already conducted several successful training programmes and workshops and has definite plans to conduct more at regular intervals, especially on IUI, Hysteroscopy, IVF and Counselling. This is basically intended to impart the basic as well as advanced knowledge on latest development of Assisted Reproductive Technology and to share clinical experience and expertise with as many colleagues as possible, envisaging the rapid development in the field of assisted reproductive techniques. Clinicians, scientists, technicians, nurses and ancillary health care professionals at all levels have already attended our training programmes and workshops as well. Basically our training is 80% on hands, interactive live demonstration. USG demonstration, folliculometry, semen analysis, culture medium preparation techniques everything is shown and done practically, which is highly beneficial clinically. We also have a widely experienced panel of faculties in every sphere of advanced infertility management who share their valuable clinical experiences and deliver lectures as well, on highly important subjects as how to manage poor responders, ovulation induction, selection of the patient, stimulation protocols and many more. Facilities available : ? Ultra Sound Scan Department ? Pathological Laboratory ? Fully equipped operating theatre ? Embryology Laboratory ? Counselling ? Medical And Surgical Backup ? In patient ward single room and shared room. Accommodation: Own arrangement has to be made. Temporary accommodation is available in close proximity to the clinic on paying guest basis. We intend to offer our patients all modern facilities of infertility care in the most cost-effective way so that they are able to realise their dream of having a baby after years of childlessness. This project will be the first of its kinds where patients will have tailor made treatment to suit their particular need. Our intention is to provide a service of excellence, which they would find anywhere in Europe, United States and other developed countries. Cost of IVF Treatment Including Drugs : Approximately Rs. 85000/- to 90,0000/- Treatments Available: IUI, IVF, ICSI, Donor Eggs/Embryos, Sperm Aspiration, Sperm Freezing, Egg Freezing, Embryo Freezing. Address: 533, Jodhpur Park Calcutta India 700068 Phone: 24237266 Web-site: http:// E-mail: Contact Clinic Photos

Visitors reviews (1) write a review We are grateful to Dr.J. Bhatacharjee for realising our dream of having our son.We wish her many more successes. 17 August 2007 - Minakshi Singh