Reproductive Medicine

Infertility is stressful condition. While it is not considered a disease, it causes lot of mental and psychological upheavals. It also leads to social isolation and withdrawal especially in traditional societies.
‘To get and to beget’ is an inborn human tendency and when couples find it difficult to procreate, they must see Reproductive Medicine specialist.
Evaluation is always done as a couple irrespective of who has the problem, so it is important for both husband and wife to see the doctor.
The first step in evaluation is the history where the doctor will enquire in detail regarding the menstrual history, medical and surgical history and also the detailed history of male partner.
The first investigation, which is usually done, is a semen analysis of the husband. We always do a transvaginalsonography of the female partner to assess the condition of uterus and ovaries.
A thyroid test and assessment of prolactin levels and Rubella immunity is also done in almost all females.
After the result of these tests is ready, the doctor will formulate a treatment plan for your case taking into consideration all the clinical features of your case. Dr. Priya believes in individualizing the treatment and you will not find the assembly line or cookie cutter approach in our clinic.

Some useful tips

1. Please take a prior appointment
2. Always we see as couples, so unless impossible, husband and wife should both come.
3. Irrespective of whether semen analysis and Transvaginalsonography has been done outside, we will still do it here as that is very important for further planning.
4. We do not follow a cookie cutter approach and individualize the investigations done for you.
5. In the first visit, it might take upto six hours for your initial workup and investigation report and formulating a management plan
6. All investigations, expertise and facilities are available under one roof and you don’t have to run from pillar to post
7. A proper and thorough evaluation is cornerstone to successful IVF procedure, and so time spent in first visit is worth it.

Hormonal disorders are common in females and include delayed puberty, precocious puberty, delayed menstruation, abnormal hair growth, acne and the modern epidemic of PCOS.
Our Reproductive Medicine unit is well equipped to deal with such situations and we have an in house hormone assay facility.
We provide holistic approach to dealing with patients of PCOS with diet therapy, exercise and limited use of hormonal therapy. We organize regular workshops on diet and exercise therapy in patients with PCOS.

Fertility enhancing laparoscopic and hysteroscopic surgery

Laparoscopy and hysteroscopy is a very important part of evaluation as well as treatment in infertility. They enable us to see and treat at the same sitting. If undertaken timely by a trained fertility specialist, this procedure can help most couples conceive naturally even without treatment. Even in couples that need assisted reproduction (IUI/IVF or ICSI) there is big role of laparoscopy and hysteroscopy to improve results of these treatments.

Unlike other IVF centers who are focused on pushing patients towards IVF, we believe in proper evaluation of uterus inside out and thus aiding natural conception, and even improving IVF success if need arises. With our state of the art instruments and equipment, we have become top center providing gynecological endoscopic surgery in Bhopal and Madhya Pradesh.

Laparoscopy is done with a thin telescope, which is just 4 mm thick. This is inserted through the belly button under anesthesia. We examine the reproductive organs using a 3 chip HD camera (Karl Storz) which provides excellent resolution and magnification. We are able to diagnose tubal blocks, adhesions (abnormal sticking of organs to each other), conditions like endometriosis, infections like pelvic tuberculosis, fibroids etc Hysteroscopy is the process of visualizing the inner lining of the uterus with a thin telescope (only 1.9 mm) . In hysteroscopy, we can diagnose fibroids, adhesions, polyps and infections of endometrium.

Both laparoscopy and hysteroscopy are usually done together and they are complementary, providing a complete assessment of the reproductive organs. The procedure is painless and is done under general anesthesia and is usually a day care procedure. The patient can return to daily activities in two or three days and usually no stitches are required.

The beauty of laparoscopy is that most of problems that have been diagnosed can be treated at the same sitting. For example, almost 60% of tubal blocks can be treated at the same sitting and tubal patency can be restored. This enables the couples to conceive normally without IVF.

The advantage in our center is that the infertility specialist herself performs the laparoscopy, and this helps us achieve best IVF results.

Laparoscopic cystectomy

Ovarian cysts are a common problem in women undergoing infertility evaluation.
Ovarian cysts are of four types

1. Simple cysts or functional cysts
2. Benign ovarian cysts
3. Malignant ovarian cysts
4. Chocolate cysts

Functional ovarian cysts are due to fluid accumulation in ovarian follicles and usually do not require surgery. They subside on their own or with hormonal treatment.

Benign ovarian tumors are of various types and dermoid cyst is a common type of ovarian tumor. This can be very well removed by laparoscopic surgery and usually patient is discharged same day.

Chocolate cysts is a unique type of ovarian cyst which occurs due to a condition called endometriosis. Chocolate cysts require a reproductive medicine specialist opinion as all of them don’t require surgery.IVF specialist herself should ideally do surgery for endometriosis and saving the ovarian tissue is of paramount importance here.

Malignant ovarian cyst is rare and requires specialized workup and surgery and surgery is usually done by open route in such patients.

We are providing service of laparoscopic cyst removal in Bhopal since last five years have treated successfully more than 500 such cases by laparoscopic route.

Our endometriosis service is best in the sate of Madhya Pradesh and we provide custom made plans for patients of ovarian endometriotic cyst for successful IVF outcome.

Laparoscopic myomectomy

Fibroids or myomas are common benign tumors in women. Almost 20% of women with infertility have fibroids. If the fibroid is more than 4 cm or is inside the lining of uterus (submucous) it can affect fertility and needs to be removed. This surgery where only fibroid is removed and uterus is conserved is called myomectomy. Traditionally myomectomy was done by open technique with a 15 cm long cut and this required hospital stay upto seven days. Open surgery is associated with more pain and there is higher infection risk. Also there is higher chances of infertility arising sue to open surgery due to formation of adhesions post surgery.

Due to this reason, minimal access surgery or laparoscopy is the preferred way of removing fibroids. In this, fibroids upto 15 cm can be removed through a 10 mm cut inside the belly button. This requires shorter hospital stay, is less painful and there are lesser chances of infection.

Dr. Priya Bhave Chittawar has led the research comparing open and laparoscopic myomectomy and this concluded that laparoscopic surgery is superior to open surgery (Read more)

Laparoscopic fibroid surgery requires lot of skill but the results are very satisfying for the patient as well as doctor. Using techniques like hydrodissection, barbed sutures for stitching the uterus have resulted in very less blood loss and rapid recovery of the patient and improvement in fertility.

Removal of fibroids by laparoscopy improves fertility and is shown to improve IVF success also.

In a short time, we have become the highest volume center performing myomectomy by laparoscopic route.

IVF/ICSI or Test Tube Baby is the process of fertilizing an egg outside the body. Life begins with fertilization; the sperm entering the egg and subsequent formation of the embryo and then its implantation in the uterus.

The steps of IVF procedure

1. Stimulation of Follicles

   We know that while millions of sperms are expelled in each ejaculation, the eggs are present inside the female’s body and they are in immature form. These eggs are within ‘follicles’ in each ovary. In order to fertilize eggs through in-vitro, they have to be developed and then retrieved from the body. This is called ‘ovarian stimulation’. From second or third day of menses, injections of follicle stimulating hormone are started daily. These injections are in pen form and are virtually painless. Injections are continued for ten to twelve days till follicles reach a size of 18 mm. We check levels of hormone estrogen and progesterone on the day that follicle reaches size of 18 mm and an injection called ‘trigger’ is administered. 35 hours after trigger, process of egg retrieval is performed.

2. Transvaginal Oocyte Retrieval (egg pickup)

   The follicles are aspirated under ultrasound guidance. This procedure does not involve any cut or stitch and is done under sedation, so its practically painless. Each follicle is aspirated and the embryologist screens the fluid from follicles and picks up the eggs under microscope.

3. Fertilization

   The eggs retrieved are incubated in culture media for two hours. The partners semen sample is taken in morning of egg retrieval and is prepared in the andrology lab. There are three methods of fertilizing the eggs: Conventional IVF, Intracytoplasmic Sperm Injection and Test Tube Baby. In Conventional IVF, eggs are incubated with sperms and one sperm fertilizes the egg. In Intracytoplasmic Sperm Injection, one good quality sperm is injected inside the egg using a special inverted microscope and micromanipulator. After 18 to 20 hours of ICSI, the fertilization check is performed. Usually 70 to 100% of mature eggs are expected to fertilize. The fertilized eggs are called embryos and they are further cultured for 2 to 5 days when the process of embryo transfer is carried out. And Test Tube Baby is a process of fertilizing an egg with sperm inside a test tube. This process undergoes for 2-6 days and is then transfers to the same or another woman’s uterus. Test Tube Baby Center in Bhopal operated by Dr. Priya Bhave Chittawar, who is a specialist in In Vitro Fertilization (IVF).

4. Embryo Transfer

   The best quality embryos are transferred back in the uterus under ultrasound guidance. Usually two to three embryos are transferred. This procedure is done without anesthesia and this is painless. Patients can go home 30 minutes after embryo transfer and no restriction as activities or bed rest is required. After embryo transfer, medicines to support the pregnancy are given and blood test to check the result is carried out 14 days after embryo transfer.

   The success rate of IVF is variable and depends on cause of infertility, quality of sperms and eggs, ovarian reserve, age of female ,the quality of the IVF lab and of course the skill of the treating doctor. Roughly the pregnancy rates are 40 to 45% in women less than 35 years and 30 to 35% in women over 35 years.

   In a short time we have become the leading IVF and Test Tube Baby Center in Bhopal have higher success rates . Our tailor made individualized protocols ensure high success rates in IVF for couples.