Thin Endometrium

Endometrial Receptivity Array

What is it?
The term ERA stands for Endometrial Receptivity Analysis or Array. In this test, a small sample tissue from endometrial lining (innermost layer of Uterus) is used for evaluating whether the Uterus is ready for implantation of embryo or not.

In the menstrual cycle of a woman the period from 19th to 23rd days is known as “implantation window” during which, the uterus gets prepared for the implantation process. It is part of the luteal phase and the endocrine part of ovaries is producing progesterone. This progesterone brings about modifications in the uterine wall so that, it gets prepared for receiving the embryo. The process involves formation of certain proteins that make the lining thicker and more receptive. In majority of females (84%) this window occurs at the exact time while in very few females (16%) this window occurs either before or after this period.

The IVF treatment in such cases fails as, the embryo transfer is occurring at wrong time. It is happening at the time, when the implantation window is either yet to open or has already been closed. So, the implantation is failing.

When is it prescribed?

It is prescribed in the patients where recurrent implantation failures are observed.

How is it done?

• A small endometrial tissue is collected and expression level of the gene 238 which determines endometrial receptivity is investigated.
• The technique involves assessing RNA levels in different stages of menstrual cycle. As this test is reproducible, its findings remain the same months after and hence, the test is not required to be repeated.
• This investigation can clearly indicate whether this implantation window of a particular woman is happening at the right time or the embryo transfer needs to be scheduled on the different date to match the window so that maturation of endometrial lining can be synchronized with embryo.

What are the advantages?

• Due to precise identification of Implantation Window, embryo transfer can be appropriately planned and can yield assured results.
• The agony of failed transfer can be got rid of.
• A minor shift by one of two days in embryo transfer can result into pregnancy.

Fertility Surgery

What is it?

A corrective surgery advised for the patients having structural abnormality of reproductive organs so as to improve the chances of conception. It can be for the male or the female partner.

How is it done?

First, minimal invasive diagnostic techniques are used to identify the problem and then a suitable surgical procedure is performed to correct it. The protocol can shortly shown as follows :

Female:

• Reversal of Tubectomy (Tubal ligation). The patient who has already undergone tubectomy for avoiding further pregnancies if decides to have a baby, this kind of surgery can be a solution wherein the ligatured (closed) fallopian tube is reconnected.
• Reconnecting fallopian tube: If there is blockage in fallopian tube due to some infection and pregnancy is not happening because of this, the tube can be reconnected surgically to solve the problem. It involves insertion of a small tube through cervix, uterus and connect the fallopian tube. The surgery is called Salpingostomy, sometimes called neosalpingostomy (the fallopian tube may be cut completely to open the passage for egg cells) or fimbrioplasty (when the tip of fallopian tube that is very close to ovarian is blocked, the tip if surgically opened).
• Polypectomy: A polyp is an abnormal collection of tissue. A polypectomy is a surgical procedure to remove polyps from the from an organ like Uterus. The procedure is relatively noninvasive and is usually carried out at the same time as a hysteroscopy.
• Myomectomy: This procedure sometimes also known as fibroidectomy, refers to surgical removal of uterinefibroids (leiomyomas). In comparison to hysterectomy, the uterus remains preserved in this procedure and the woman retains her reproductive potential.
• Dilatation for treating cervical stenosis: Cervical stenosis means a conditions wherein the cervix becomes extremely narrow. The treatment for this condition is using a dilator.
• Adhesiolysis: Some times, pelvic adhesions are observed blocking passage between uterus and ovarian. In such conditions natural pregnancy becomes difficult and even in ART oocyte pickup is obstructed by the adhesions. This disorder is treated by microsurgical technique or laparoscopic surgery to remove the adhesion and prevent its recurrence.
• Metroplasty: Sometimes, uterus is abnormal in shape such as ‘T’ or heart shaped and hence, can lead to complications during and after pregnancy. This condition is treated with metroplasty. The surgery involves reconstruction of uterine chamber to make into normal shape. With the surgery, implantation of embryo and further development is possible.
• PCO Drilling: Polycystic ovarian can cause the female body produce excess of testosterone and insulin, leading to fertility problems. High testosterone levels can cause irregular menstrual cycles, prevent ovulation and hinder pregnancy. Ovarian drilling can cure this problem Ovarian drilling is a laparoscopic procedure performed under general anesthesia. This surgery is typically done on an outpatient basis with minimal recovery time. With a laparoscopic tool small openings are mad in ovarian.
• Ovarian cystectomy: Endometriomas or chocolate cysts are benign masses growing around ovarian and obliterate the normal process of ovulation. Removal of these cysts is called cystectomy. The surgery needs to be done very carefully as there is a possibility of damage to ovarian vascular supply. Further, there is some decline in ovarian functioning after surgery. So, ART may be necessary for pregnancy.

Male:

• Treat varicocele(swelling of veins coming of Testis) which will allow testes to produce better sperms.
• Removal of blockage in the Epididymis (tubular extension of testis responsible for activation of spermatozoa).
• Reversal of Vasectomy. This is done when the couple decides to go for pregnancy after vasectomy surgery.
• Removal of sperms from testis surgically in case of Azoospermia (Absence of sperms in Ejaculate).

Embryo Glue

What is it?

It is a hyaluronan-enriched medium for embryo transfer (ET) which aids in implantation of embryos and thus, improves pregnancy rates in in-vitro fertilization-ET cycles (IVF-ET).

How is it done?

Eggs are collected in regular medium and IVF is carried out. These are then fertilizes and allowed to develop into embryos. The embryos are allowed to grow till implantation stage and just before implantation, they are then transferred to embryo glue so that, the glue sticks to embryo. Some embryo glue is transferred to endometrium so that the embryo can be fixed onto it.

When is it recommended?

It is recommended in following conditions.

• Repeated failures in IVF cycles after embryo transfer.
• Embryo fails to implant itself after appropriate transfer protocol.

Endometrial Scratching

What is it?

An endometrial scratch is a procedure proposed to improve endometrial (innermost lining of Uterus) receptivity and increase the probability of pregnancy in women undergoing IVF.

When is it recommended?

• Patients that have experienced recurrent unsuccessful IVF cycles, with good quality embryos, the fertility specialist may suggest performing an endometrial biopsy or hysteroscopy to investigate for potential endometrial causes of implantation failure, such as intrauterine adhesion, endometrial polyps etc.
• It is generally only used for patients who have experienced multiple unsuccessful IVF cycles, despite the transfer of good quality embryos.

G-CSF Installation

What is it?

It means Granulocyte Colony Stimulating Factor also known as factor CSF 3. This factor plays a key role in formation of Neutrophils and stem cells. Normally certain tissues in the body can produce it in adequate volume. When the synthesis is not enough, it can lead to various disorders some related to reproductive system. The factor can be artificially introduced and is known to improve results of IVF treatments.

When is it recommended?

When IVF attempts are failing and the reason is diagnosed to be deficiency of CSF 3, this treatment is recommended. In these patients, even after during the IVF protocol endometrial lining does not attain thickness adequate (minimum 7mm) for implantation of transferred embryo. There is a very nominal percentage of females which face this issue. The G-CSF is capable of leading to thickening of Endometrial wall (innermost lining of Uterus).

How is it done?

A particular drug called Filgrastim (produced by recombinant DNA technique) is injected as intravenous or subcutaneous and it regulates formation of Neutrophils. This improves the possibility of IVF success because it enhances endometrial thickening required for implantation of embryo thus, improving success rate of embryo transfer in IVF.