NVH Admin – Nile Valley Mother and Child Hospital

Invitro Fertilization

NVH Admin — Wed, 30 Jun 2021 00:58:12 +0000

For couples in which conventional first-line treatment for infertility fails or clients with tubal factor infertility, In-Vitro Fertilization (IVF) offers hope. It is the most successful treatment option available today for infertility treatment bringing hope to millions of women who would have remained childless.

WOMEN WHO BENEFIT FROM IVF

IVF is recommended for couples with:

Advanced female age with poor egg quality

Couple with unexplained infertility

Damaged/blocked fallopian tubes

Male factor infertility

A female with recurrent miscarriage

Women with problems ovulating

Couple with genetic challenges in their family

The IVF procedure involves the following steps:

1. Ovulation induction
The woman is given daily injections called gonadotropins to stimulate the
growth of multiple eggs. Normally, every woman produces one egg at the
time of ovulation; however, the drug aims to help produce many eggs to
increase the chances of a pregnancy.
The injections are administered for about 9 to 12 days. While taking the
injections, several times Ultrasound scans are carried out to monitor the
growth of the ovaries and response to the treatment.
When the doctor decides that your eggs are large enough, Human
Chorionic Gonadotropin [HCG] will be administered to cause the final
maturation of the follicles.

2. Retrieval of the eggs
The eggs will be expected to mature 36 hours after the HCG injection and
be ready for retrieval from the ovaries. Egg retrieval involves the removal of
the eggs from the ovaries using a long ovum pick-up needle attached to a
transvaginal ultrasound probe. The procedure is carried out under some
anesthesia to ensure you do not feel the pain of the needle prick. A few
hours after the procedure you should be able to go home.
The client is given a progesterone suppository to insert into her vagina after
the procedure. Progesterone helps prepare the lining of the uterus for the
implantation of the embryo.

3. Insemination of the eggs

On the day of your egg retrieval, the male partner is expected to provide a
fresh semen sample to the laboratory. He could produce the sample at
home or in the hospital. Using special media, the eggs and sperm will be
placed together to enable the sperm to fertilize the eggs and they will be
placed in an incubator to enable development.
For the next 3 – 5 days, the embryologist will monitor the growth of the
embryo, assessing their growth and quality, and deciding which ones are
best for transfer.
The client will be updated on the progress of the embryo during this period.
Clients do not need to present to the hospital; however, the woman is
counseled to continue her progesterone insertion as recommended.

4. Embryo transfer
Embryo transfer is usually done on day 3 or 5 days after the retrieval of the
eggs depending on the clinic protocol. Day 5 transfer is more popular.
For the transfer, the best-quality embryos are used. Your doctor will
discuss with you the number of viable embryos to transfer into the womb. In
most cases, 2 – 3 embryos are transferred back into the uterus. In
countries like the UK, single embryo transfer is done to reduce the
risk of multiple pregnancies.
The transfer which is a painless procedure involves loading the embryo into
a special catheter and under ultrasound guidance depositing it gently into
the uterus.
You will be advised to remain in bed for about an hour after the procedure
and then you can go home and resume normal activities.

5. Embryo freezing
After the transfer of the best-looking embryos, there may still be some
excess embryo remaining. Any unused high-quality embryos may be frozen
to allow the option of future implantation. Your doctor will need your consent to freeze these embryos and the terms of freezing would have
been discussed with you during your initial consultation.

6. Follow up
After embryo transfer, you will continue your progesterone insertions at
home. You will be advised not to engage in any strenuous activities outside
your routine.

Two weeks after the procedure, you will receive a call to present at the
clinic for a blood pregnancy test.

If the pregnancy test is positive, you will continue the progesterone until
you are about 11 weeks when your placenta begins to produce enough of
the hormone to support the pregnancy.

An ultrasound scan will be done in the 6 th week to check for fetal heart
activity.

If the pregnancy test is negative, your health team will discuss with you the
possible reasons why this occurred and you may choose to have another
IVF cycle.

Hysteroscopic Myomectomy

NVH Admin — Mon, 28 Jun 2021 23:47:13 +0000

It is a surgical procedure done from the vaginal route in which fibroids within the endometrial lining of the womb are removed. Women with endometrial fibroid are counselled to get this procedure done because of an increased chance of miscarriage if the IVF procedure is carried out.

It is usually indicated for women with:

At least 50 % of the fibroid in the endometrial lining
Women who are not willing to have a laparoscopic myomectomy

WHAT TO EXPECT

Instruments used for hysteroscopic myomectomy include:

Resectoscope (the commonest instrument used),
Hysteroscopic scissors,
Hysteroscopic morcellation

The fibroid particles are removed from the vagina.

HOW TO PREPARE FOR PROCEDURE

Your doctor will counsel you before the procedure and you will need to give informed consent before the procedure. He would counsel you on the procedure and risks involved. The night before the procedure you will be told not to take any meals from midnight. The anaesthetist would review you and ask questions to assess your risk for anaesthesia. On the morning of the procedure, you can take a shower before you are wheeled into the theatre.

Usually, the procedure lasts 20 – 30 minutes and then you will be discharged once you have fully recovered from the effect of anaesthesia.

Hysteroscopic Adhesiolysis

NVH Admin — Mon, 28 Jun 2021 23:32:39 +0000

This procedure involves breaking down adhesions within the uterine cavity which could have resulted from repeated dilatation and curettage (D & C), postpartum infection.

It is usually indicated for women with intrauterine adhesion causes by:

Repeated dilatation and curettage.
A client who had myomectomy with breaching of the endometrial cavity resulting in adhesions
A client with septic abortion resulting in adhesions
Clients with pelvic tuberculosis

WHAT TO EXPECT

A hysteroscope will be inserted through the vagina and into the uterus and attached to a monitor to look at the lining of the uterus. Fluid [Normal saline] will be used to distend the cavity of the uterus so the walls can be visualized. Hysteroscopic scissors can be used to divide the adhesions and an IUCD or Foley catheter inserted into the cavity to separate the walls. Estrogen and progesterone are given after the procedure to improve endometrial regeneration and antibiotic given for pain.

Follow-up hysterosalpingography [HSG] or diagnostic hysteroscopy after withdrawal bleeding or 6 – 8 weeks after the procedure is recommended.

HOW TO PREPARE FOR PROCEDURE

Usually, the procedure lasts 20 – 30 minutes and then you will be discharged once you have fully recovered from the effect of anaesthesia.

Diagnostic Hysteroscopy

NVH Admin — Mon, 28 Jun 2021 23:27:45 +0000

This is a procedure where the light source is inserted into the uterus to view the endometrial lining of the uterus, the cervix and the opening of the fallopian tubes. It is used in cases of abnormal vaginal bleeding when the cause is not known and in cases of infertility.

It is usually indicated for the following conditions:

Diagnosis of abnormal vaginal bleeding. Treatment can also be carried out at the same time.
Confirmation of HSG report for the presence of sub-mucous fibroids, endometrial polyps, uterine septum, and uterine adhesions
To check for the location of foreign bodies in the uterus
Can be combined with laparoscopy for additional information

WHAT TO EXPECT

Women going for a diagnostic laparoscopy need to understand that the procedure is for diagnostic purposes and is a way of finding out problems within the uterine cavity. These problems can then be managed operatively at the same time or at a later date. A hysteroscope will be inserted through the vagina and into the uterus and attached to a monitor to look at the lining of the uterus. Fluid [Normal saline] will be used to distend the cavity of the uterus so the walls can be visualized.

HOW TO PREPARE FOR PROCEDURE

Usually, the procedure lasts 10 – 20 minutes and then you will be discharged once you have fully recovered from the effect of anaesthesia.

Total Laparoscopic Hysterectomy

NVH Admin — Mon, 28 Jun 2021 23:19:17 +0000

Laparoscopic hysterectomy is the surgical removal of the uterus [womb] through small incisions on the skin. The uterus is disconnected from all its supporting structures and usually removed through the vagina. It is a procedure carried out in women who have completed their family size and have no desire for more children. It may be advised if there are chances that cancer could arise in the uterus/cervix in the future.

It is usually indicated for the following conditions:

Heavy/abnormal vaginal bleeding
Uterine fibroids in women who have completed their family’s size.
Abnormal pap smear or endometrial hyperplasia
Adenomyosis
Uterine prolapse

WHAT TO EXPECT

Women going for a hysterectomy will need to understand that they will not menstruate after the procedure. If the ovaries are removed, they will go through symptoms of menopause immediately. During the procedure, about 4 tiny incisions will be made on the abdominal wall and a telescope will be inserted into the cavity to perform the surgery. The procedure carries some potential risks which your doctor will discuss with you. These include anaesthetic risks and the risks from carrying out the procedure itself.

The uterine specimen removed will be sent for histological diagnosis to ensure that there are no cancerous lesions on the uterus or cervix.

HOW TO PREPARE FOR PROCEDURE

Your doctor will counsel you before the procedure and you will need to give informed consent. You will be counselled to be on a soft or liquid diet for about 2 days before the procedure and given some medications to ‘empty’ your bowels. The night before the procedure you will be told not to take any meals from midnight. The anaesthetist would review you and ask questions to assess your risk for anaesthesia. On the morning of the procedure, you can take a shower before you are wheeled into the theatre.

Sex Selection

NVH Admin — Mon, 28 Jun 2021 17:06:12 +0000

Sex selection is a means of achieving the desired sex of an offspring mostly before implantation of the embryo. It is also called family balancing because it attempts to ensure the presence of the desired gender in a family, particularly a male child.

In many cultures of the world including Nigeria, there is a preference for male children. Factors responsible for sex selection include:

A preference for sons who will continue the family lineage and inherit the family property thus securing its future
Reduced childbearing, thus encouraging couples to determine the sex of the children
Scientific advancement in Preimplantation Genetic Diagnosis and Prenatal Diagnosis which allows parents to determine and know the sex of their unborn child

There are two major methods of pre-implantation methods used for sex selection. They include:

THE ERICSSON METHOD

This was the first method developed and has a success rate of 70-72% for boys and a 69-75% success rate for girls. It has a 30% failure rate.

PGD TECHNIQUE

After fertilization of the egg with the sperm, an embryo develops. Before the embryo is put back into the uterus, a biopsy is taken to check for the sex of the embryo. A Geneticist studies the chromosomes in the biopsied cells for genetic defects and a definite analysis of the embryo’s gender. Embryos of the gender desired are implanted back in the mother’s womb. Its success rate is about 95 % but it is more expensive than the Ericsson method.

Embryo Freezing

NVH Admin — Mon, 28 Jun 2021 17:03:04 +0000

Following most fertility treatment women usually have good quality embryo with an option to freeze them for possible use in a future cycle. In some cases, when IVF cycles are cancelled because of risks from the procedure, embryo freezing is a viable option for use at a later date when the procedure is safe. The presence of extra embryos reduces the cost of subsequent treatments and the risk involved with ovulation induction and egg retrieval.

Good quality embryos can be frozen for as long as possible and stored for use at a later date. The average length of time of storage is 10 years; however, it could be longer. The use of a frozen embryo for achieving a pregnancy gives the same pregnancy rates as a fresh embryo.

Two methods of freezing embryo are:

Slow or gradual freezing in a freezer
Rapid freezing or vitrification in which the embryos are rapidly frozen in nitrogen.

Both techniques are used in our clinic for embryo freezing.

Vitrification

Do you think embryo freezing and storage is right for you? If you have questions about it kindly discuss it with our IVF staff.

Sperm Freezing

NVH Admin — Mon, 28 Jun 2021 17:01:37 +0000

Sperm freezing is a means of preserving a man’s fertility so he can have his biological children later in the future. Men who have difficulty producing sperm for their partner during an IVF cycle are counselled to produce sperm before the procedure for freezing.

Sperm freezing is also indicated in the following:

Men being managed for a medical condition that may affect their fertility such as prostate cancer, testicular cancer, diabetes, and other medical conditions
Men in whom their sperm parameter is deteriorating fast.
Men who intend to travel away from their families for a long time and want their wives to have their biological children while away
Men who plan to have a permanent method of family planning [vasectomy] but thinks he may need children in future
For use in a woman who needs donor sperm

The average period for sperm storage is about 10 years; however, sperm can be stored for a longer time if necessary.

Two methods of freezing male sperms are:

Slow or gradual freezing in a freezer
Rapid freezing or vitrification in which the sperm are rapidly frozen in nitrogen.

Both techniques are used in our clinic for sperm freezing.

Vitrification

Do you think sperm freezing and storage is right for you? If you have questions about it kindly discuss it with our IVF staff.

Oocyte (Egg) Freezing

NVH Admin — Mon, 28 Jun 2021 16:58:22 +0000

The aim of freezing your eggs is to preserve good quality eggs for possible use later in the future. This procedure is useful for women:

Who are not ready to have their children because of their career
On treatment for cancer with radiotherapy, chemotherapy or surgery involving removal of their ovaries
It is a good alternative in areas where fundamental religious beliefs frown at the freezing of excess embryos.

Following ovulation induction, eggs retrieved are stored by freezing and can be thawed for fertilization in the future to achieve a pregnancy. It is best to freeze your eggs before you are 35 years of age to increase the number of good quality eggs. Egg quality declines after 35 years.

Two methods of freezing female eggs are:

Slow or gradual freezing in a freezer

2.Rapid freezing or vitrification in which the eggs are rapidly frozen in nitrogen.

Both techniques are used in our clinic for egg freezing.

Vitrification

Eggs will be stored at NVH Fertility Clinic until you decide they be transferred to another facility or thawed for use in IVF. Do you think egg freezing and storage is right for you? If you have questions about it kindly discuss it with our IVF staff.