NL Fertility Brochure English
NL Fertility Brochure English
NL Fertility Brochure English
Muscat, Sultanate of Oman, Al Azaiba, Way 4429, Villa 2029, Tel.: +968 24490737 or +968 93276693, Fax: 24494414, Email:[email protected], Website: www.muscat-ivf.com
Muscat, Sultanate of Oman, Al Azaiba, Way 4429, Villa 2029, Tel.: +968 24490737 or +968 93276693, Fax: 24494414, Email:[email protected], Website: www.muscat-ivf.com
Scientifically and ethically it is not recommended to offer treatment for women aged 48 years or over, but there is no age limit for men. We recommend IVF if: The woman has blocked fallopian tubes The man has reduced sperm quality The woman has endometriosis or PCO The woman or man has been sterilized There are unexplained reasons for infertility Failure to become pregnant by artificial insemination
We can offer one of the following treatments, depending on the reason for infertility: IUI, intrauterine sperm injection IVF, in-vitriol fertilization, where fertilization occurs outside of the body, also called test tube fertilization ICSI, intracytoplasmic sperm injection, where sperm is injected directly into the egg, and is used in cases of reduced sperm quality PGD, pre-implantation genetic diagnosis, where we select health embryos. TESA testicular sperm aspiration, where sperm is removed from the testicles Before you can receive treatment, you need to talk to us, so we can decide on the right treatment for you. In this information material, you can read about the examinations needed before you can receive treatment. If you already know the reason for your infertility or you have received treatment elsewhere, it would be a great help if you can provide us with a copy of the medical record and any information on egg development, stimulation and semen analysis. We can do a semen analysis if one has not been made. We would like to receive this information and test results, before the initial consultation, so we know as much as possible about your current situation beforehand. We recommended that both partners are present at the first consultation.
Muscat, Sultanate of Oman, Al Azaiba, Way 4429, Villa 2029, Tel.: +968 24490737 or +968 93276693, Fax: 24494414, Email:[email protected], Website: www.muscat-ivf.com
We need the results of the following examinations before you can start with IVF, but you can certainly have the initial consultation before taking the tests. At the initial consultation, we will assess whether there is a need for additional examinations. If you have undergone treatment or testing somewhere else, we are not likely to repeat the examinations. We start with an ultrasound of the uterus and ovaries, to see if everything seems to be normal.
Muscat, Sultanate of Oman, Al Azaiba, Way 4429, Villa 2029, Tel.: +968 24490737 or +968 93276693, Fax: 24494414, Email:[email protected], Website: www.muscat-ivf.com
The hormone tests will show whether you are nearing menopause, and results of the tests are very important for the treatment and the outcome. Further we need to check for Rubella (If you are not sure whether you have had the disease or been vaccinated against it, we take a blood test to find out. If you are not immune to the disease, we recommend that you have a vaccination. After three months, you can start the treatment), Parvovirus (It is not possible to vaccinate against parvovirus infection. If you had the disease as a child, you cannot get it again. If in doubt we can take a blood test to check your immune status. If you are not immune, then during your pregnancy you must take care not to come in close contact with children who have the disease) and Toxoplasmosis (is caused by a parasite whose main hosts are cats, and it can be transmitted to humans via cat faeces. So it is advisable for pregnant women not to clean the litter tray because the disease can be transmitted to the fetus. This does not mean that you have to get rid of the cat just that you should think a little more carefully about your contact with it. A blood test can show whether you are immune to toxoplasmosis. fetus). Immunity also means that you cannot transmit the disease to the fetus. It is a legal requirement that women and men receiving fertility treatment must be tested for AIDS (HIV1 and HIV2) and hepatitis: Hepatitis B (HBsAg) and anti-HBc (antibody) and Hepatitis C (anti-HCV). Blood tests must be done recently, not be more than max. 3 months back. If you have not had the blood tests, or they are too old, we can take them when you come for the consultation. The results of these tests must be negative before we can begin treatment. It takes approximately one week to get the results from the laboratory.
Muscat, Sultanate of Oman, Al Azaiba, Way 4429, Villa 2029, Tel.: +968 24490737 or +968 93276693, Fax: 24494414, Email:[email protected], Website: www.muscat-ivf.com
IVF Treatment
During IVF (test tube fertilization), the ovaries are stimulated to mature more eggs, and then we remove the eggs from the ovary. This is done through the vagina under ultrasound scanning. Fertilization with the husbands sperm takes place in our laboratory. When one or more eggs have been fertilized and we can see that they have begun to divide, one or max. 3 Embryos are put back into the womb after two to three days. To ensure there are enough eggs for collection, you are stimulated with hormones during the cycle you want to start treatment in. So you will need to be scanned several times during the process. If you are not local your own gynecologist can do the scan, but then we must receive the scan results by fax or e-mail immediately after you have been scanned, so that we can advise you on how to proceed until egg pick-up.
Hormone Stimulation
You can try IVF treatment with natural cycles, without using hormone stimulation, but the chances of collecting just one good egg for fertilization are very small compared to a hormone-stimulated cycle. Our aim with hormone stimulation is for you to produce 8 to 12 eggs. This is the optimal number for achieving pregnancy. Some women produce fewer eggs, others more. If you produce more eggs, there is a risk of overstimulation after embryo transfer.
Muscat, Sultanate of Oman, Al Azaiba, Way 4429, Villa 2029, Tel.: +968 24490737 or +968 93276693, Fax: 24494414, Email:[email protected], Website: www.muscat-ivf.com
Symptoms of overstimulation are putting on more than a kilo per day, your stomach becomes large and tight, and you may have problems with breathing and nausea. The symptoms are a result of overstimulation causing fluid to collect in the abdominal cavity. Overstimulation is worst around one week after egg pick-up and usually stops within a week or two. Overstimulation is not so common nowadays, because it has become easier to adjust the hormone dosage to the individual. Hormone stimulation tends to make the abdomen sore and give a bloated stomach. To ease these symptoms, it is important that you drink 34 liters of fluid per day after egg pick-up. If you get symptoms of overstimulation contact us. There are two ways of giving hormone stimulation: short protocol treatment or long protocol treatment with down-regulation. We agree which of the two is best for you at your first consultation. Short protocol treatment is a milder process in relation to hormone stimulation; long protocol treatment with downregulation is preferable if you live far away, because it does not require so many visits to us.
stimulation follows your natural cycle, even we schedule by asking you to take birth control pill (e.g. Diane) for at least 14 days. In this you will get ready for treatment on a specific time You could say that we enhance the effect of your own hormones to produce more eggs. It gives fewer side effects than the long protocol treatment, in which the woman's own hormones are taken out of the equation, also known as down regulation. Precisely because we follow your natural cycle, short protocol treatment is more difficult to organize, because you have to come for more scans underway. If you live far away, your own gynecologist can scan you, provided we receive a copy of the result, so we can advise you.
Muscat, Sultanate of Oman, Al Azaiba, Way 4429, Villa 2029, Tel.: +968 24490737 or +968 93276693, Fax: 24494414, Email:[email protected], Website: www.muscat-ivf.com
Course of treatment
The actual hormone treatment is administered by injection of the hormone in the abdominal wall. You will get both verbal instructions from us and a DVD to take home, which will show how you, your husband, or others, can give the injections. For some, the thought of having to inject themselves is quite unpleasant, so they can take their daily injection in our clinic. The needle is very thin, and even with slight pressure, you can pierce the abdominal wall without much pain and there is no risk of doing anything wrong.
Muscat, Sultanate of Oman, Al Azaiba, Way 4429, Villa 2029, Tel.: +968 24490737 or +968 93276693, Fax: 24494414, Email:[email protected], Website: www.muscat-ivf.com
The doctor scans the ovaries and inserts a thin needle through the vagina into the ovaries. The eggs are sucked out. The actual collection process takes 15 to 20 minutes. Then you can go and lie down in our recovery room until the anesthetic has worn off. It takes approximately 30 to 60 minutes. You may feel tired and slightly groggy for the rest of the day. Most feel a little throbbing, or the abdomen becomes bloated, or they experience slight pain in the lumbar region; these are all normal. We recommend that you also relax as much as possible for the rest of the day, and you must not drive after the procedure, because you will still be under the influence of the pain relief medication. It is best that you are not alone for next 24 hours. In the days after egg pick-up, you can get back to your usual daily routine.
Embryo transfer
After collection, the eggs will be fertilized in the laboratory. The Embryologist adds sperm to the eggs or injects sperm into each egg, also known as ICSI, micro-insemination. ICSI can be used if there are not many good sperm cells in the semen sample. The eggs and sperm are placed in an incubator until the next morning, where we can see how many eggs have been fertilized Then we regularly look at the eggs under a microscope until the eggs are transferred back to the womb. This occurs two to three days after collection. You will usually have 1-2 fertilized eggs put back into the womb. The transfer occurs in the same way as insemination. We put a thin catheter into the womb and inject the fertilized egg back in. It only takes a few minutes, and then you can carry on as usual. The eggs cannot come out of the womb again. For the next 14 days, you must apply a hormone stimulant gel (e.g. Crinone) in the vagina.
Muscat, Sultanate of Oman, Al Azaiba, Way 4429, Villa 2029, Tel.: +968 24490737 or +968 93276693, Fax: 24494414, Email:[email protected], Website: www.muscat-ivf.com
You can take a pregnancy test approximately 16 days after embryo transfer. You can either do the test at home using urine, or come over to our clinic to take a blood test. Please contact us when you have the test results even if you are not pregnant. If you are pregnant, we would like to see you for a pregnancy scan about three weeks later, when you are in the eighth week of pregnancy. Your own gynecologist can also scan you, but we ask you to fax or e-mail the scan results to us. If you are not pregnant, stop the hormone stimulation, and you will get your period. It may be later than to your usual cycle. We can then discuss how to proceed. If your gynecologist takes a scan, contact us, then fax or e-mail the results of the scan to us, so that we can plan the best course of treatment.
ICSI
ICSI, or micro-insemination, can be a solution when infertility is due to the man having reduced sperm quality, or if normal IVF treatment has not resulted in fertilized eggs. It may also be a solution if the man has frozen semen of poor quality, or produces antibodies against his own sperm. The actual preliminary treatment, hormone stimulation, is the same as in conventional IVF. With ICSI, an extremely thin glass needle is used to fertilize the eggs by injecting a single sperm into each egg. The eggs are then placed in an incubator, where they will begin to divide. Ideally, they will have divided into 6-8 cells after three days, and are ready for embryo transfer.
Muscat, Sultanate of Oman, Al Azaiba, Way 4429, Villa 2029, Tel.: +968 24490737 or +968 93276693, Fax: 24494414, Email:[email protected], Website: www.muscat-ivf.com
If the man has been sterilized or has blocked sperm ducts for other reasons, we can obtain useable sperm by means of TESA. TESA is an operation under local anesthetic to extract sperm from the scrotum. After local anesthetic in the groin just above the scrotum, a thin hypodermic needle goes into the scrotum. The sperm is in small stings in the scrotum and these are sucked out through the needle. The Embryologist then examines the cells for useable sperm, which must mature for 24 hours in the laboratory before they can be used in ICSI. TESA is therefore carried out usually the day before egg pick-up. The actual operation takes about 30 minutes, after which you have to stay at the clinic and rest for an hour. You will experience tenderness in the scrotum for a few days after the operation and should take 1 2 days sick leave. You cannot drive immediately after the operation.
Muscat, Sultanate of Oman, Al Azaiba, Way 4429, Villa 2029, Tel.: +968 24490737 or +968 93276693, Fax: 24494414, Email:[email protected], Website: www.muscat-ivf.com
In the procedures of assisted reproductive technology such as in-vitro fertilization (IVF), an embryo is created in a laboratory environment and is then transferred into the womans uterus (womb). For some couples, especially those who run the risk of an inherited disease, questions about the genetic health of those embryos may arise. A new technique called Pre-implantation Genetic Diagnosis, or PGD, can provide answers to this. What is pre-implantation genetic diagnosis? In PGD, embryos obtained via an IVF procedure are tested for hereditary defects or genetic transferred diseases such as sickle cell, thalassemia, down syndrome, cystcic fibrosis and others, before being transferred. Fertilization is brought about and subsequently one cell from the 8-cell embryo (approximately 3 days old), are removed using a small pipette or laser. The genetic material of these cells is examined with results available in one day. After the diagnosis, only the unaffected embryos are transferred. PGD is an extremely advanced procedure and
NEWLIFE Fertility Center is the only Center in Oman that is currently offering this diagnostic.
Muscat, Sultanate of Oman, Al Azaiba, Way 4429, Villa 2029, Tel.: +968 24490737 or +968 93276693, Fax: 24494414, Email:[email protected], Website: www.muscat-ivf.com
Intrauterine insemination (IUI) involves a laboratory procedure to separate fast moving sperm from more sluggish or non-moving sperm. The fast moving sperm are then placed into the womans womb close to the time of ovulation when the egg is released from the ovary in the middle of the monthly cycle. We may recommend IUI if: there is unexplained infertility there are ovulation problems the male partner experiences impotence or premature ejaculation you do not have any known fertility problems but may not have a male partner and are trying for a baby using donated sperm.
It is essential that your fallopian tubes are known to be open and healthy before the IUI process begins. A tubal patency test is usually carried out as part of your assessment by the fertility clinic. The typical method for assessing the health of your pelvis and the patency of your fallopian tubes is laparoscopy and dye testing. At laparoscopy a direct view of the pelvis is obtained by inserting a telescope into the abdomen. When the pelvis and tubes are healthy, dye passes freely through both tubes. There should be no adhesions present that might prevent an egg from having access to either tube from the ovaries. This is performed under a short general anaesthetic. The test may show that you only have one open healthy tube although you may have both ovaries. IUI treatment can then only be carried out when there is evidence that ovulation is about to occur from the ovary that is on the same side as the open tube. The second essential requirement is that there is no significant problem with sperm numbers or sperm quality.
Muscat, Sultanate of Oman, Al Azaiba, Way 4429, Villa 2029, Tel.: +968 24490737 or +968 93276693, Fax: 24494414, Email:[email protected], Website: www.muscat-ivf.com
Here is a useful dictionary of words that you may come across during fertility treatment and a list of abbreviations commonly used on the internet. We hope this helps.
A
Auntie Flo/AF AH Andrologist Anovulation Assisted Hatching Azoo(spermia) Menstrual Cycle Assisted Hatching An expert who specializes in male reproduction. When ovulation does not take place each month. A procedure that involves making a hole in the outer shell of the embryo to help it hatch out and implant in the womb. Azoospermia is when no sperm is found in semen.
B
BB BBT Bulletin Board Basal Body Temperature. If a woman takes her temperature at the same time each morning, this can help to determine when she ovulates. BBT rises around the time of ovulation. Birth Control Pill Blood test to determine if a woman is pregnant. An embryo reaches the blastocyst stage about five days after egg collection. Some doctors do what is called blastocyst transfers rather than the more usual earlier transfer after 2 or 3 days following egg collection. By The Way
BTW
C
Chemical Pregnancy Clomid CM Cryo-preservation If you test positive for pregnancy but do not start your period until a few days later. A drug used to stimulate FSH in assisted conception treatment. Cervical Mucus The process of freezing eggs, embryos or sperm.
D
DE Donor Egg
E
E2 Estradiol/Oestradiol is used to help monitor the ovarian response to stimulation during assisted conception.
Muscat, Sultanate of Oman, Al Azaiba, Way 4429, Villa 2029, Tel.: +968 24490737 or +968 93276693, Fax: 24494414, Email:[email protected], Website: www.muscat-ivf.com
EC ENDO Endometrium ET
Egg Collection, also known as Egg Retrieval. This is when eggs are collected from the ovaries and placed in a laboratory dish ready for assisted conception. Endometriosis is when tissue similar to the lining of the uterus grows in the abdomen and elsewhere in the body. The lining of the womb. Embryo Transfer
F
FAQ FET Follicle Follicular stage FSH Frequently Asked Question Frozen Embryo Transfer The sac filled with fluid containing the egg that is released during ovulation. This is the stage in the menstrual cycle when follicles develop in the ovaries. Follicle Stimulating Hormone
G
GIFT Gamete Intra-fallopian Transfer is when an egg and sperm are placed in the fallopian tubes so natural fertilization can take place.
H
HCG Injection Human Chorionic Gonadotrophine, which is also referred to as the Trigger Injection (Profasi Pregnyl, Ovitrelle) because it triggers ovulation or lengthens the luteal phase of a womans cycle as part of infertility treatment. After the injection, this hormone can take up to 14 days to disappear from a womans system, which can give a false positive if a pregnancy test is carried out before a missed period. This hormone that can be detected in the blood to determine whether or not a woman is pregnant before she has a missed period. Hysterosalpingogram, when dye is passed into the uterus and fallopian tubes in order to take an x-ray to find out if one or both tubes are blocked. A procedure that involves examination the womb by dilating it with water and then inserting a hysteroscope, which is similar to a telescope, to see if there are any abnormalities.
HCG Test
HSG Hysteroscopy
I
ICSI Intracytoplasmic Sperm Injection, a technique involving the injection of a single sperm into an egg. If a mans sperm count is thought too low for classic IVF treatment then ICSI may be proposed instead. Intrauterine Insemination, when sperm provided by a partner or donor is placed in the uterus using a fine plastic tube. In Vitro Fertilization, when one or more eggs are removed from the ovaries and mixed with sperm in a laboratory dish in the hope that some will fertilize If fertilization results, one or more eggs can be transferred into a patients uterus in the hope of achieving a pregnancy.
IUI IVF
Muscat, Sultanate of Oman, Al Azaiba, Way 4429, Villa 2029, Tel.: +968 24490737 or +968 93276693, Fax: 24494414, Email:[email protected], Website: www.muscat-ivf.com
L
Laparoscopy An exploratory operation where a telescope is inserted through a small incision in the wall of the abdomen. It may be purely diagnostic, for example to examine the internal reproductive organs, or it may be part of an operative procedure for example in laser treatment to remove endometriosis. This is the second half of the menstrual cycle after ovulation, when the corpus luteum secretes progesterone preparing the endometrium for the implantation of an embryo.
Luteal Phase
M
MC Miscarriage
O
Oocyte Oestradiol OHSS An unfertilized egg Oestradiol/Estradiol is used to help monitor the ovarian response to stimulation during assisted conception. Ovarian Hyper-stimulation Syndrome can occur as a result of the medication taken during ivf treatment. Symptoms can be abdominal swelling, but sometimes they are more serious and can include nausea, vomiting, severe abdominal pain and breathing difficulties. Oligospermia is the technical term for a low sperm count which is less than ten million. If no sperm is present than the term Ovulation Predictor Test is to predict ovulation in advance
Oligo(spermia) OPT
P
PCOS Poly-cystic Ovary Syndrome is a condition where numerous cysts accumulate on the ovaries. Classic symptoms include excess facial and body hair, acne, irregular menstrual cycles, obesity and infertility. Post Coital Test is a test that looks at how cervical mucous and sperm interact and can be informative in the diagnosis of why someone is having difficulties conceiving. Pelvic Inflammatory Disease, which is the result of an infection or a sexually transmitted disease. A hormone secreted after ovulation that prepares the uterus for implantation of a fertilized egg and to maintain pregnancy. This hormone is produced by the pituitary gland. Increased levels can lead to ovulatory problems. Positive Vibes
PCT
S
SC Subcutaneous, under the skin
Muscat, Sultanate of Oman, Al Azaiba, Way 4429, Villa 2029, Tel.: +968 24490737 or +968 93276693, Fax: 24494414, Email:[email protected], Website: www.muscat-ivf.com
Surrogate
When a women falls pregnant after being inseminated by sperm from the partner of a woman who is infertile.
Sperm Clumping or Agglutination When sperm sticks together, impairing motility and preventing them from reaching the egg. Sperm Motility
The percentage of sperm that is moving in a semen sample, providing an indication of the ability of the sperm to reach an egg and fertilize it. Sperm are normally graded between one and four. In general, Grade 4 sperm are those that swim forward in a straight line. Grade 3 sperm swim forward but either slowly or in a curved or crooked line. Grade 2 sperm move their tails, but dont move forward. Grade 1 sperm dont move at all.
A healthy sperm has an oval head, a mid-piece and a long straight tail. If a very large percentage of sperm are abnormally shaped then fertilization of an egg will not be able to take place. Ejaculated semen spurts out as a liquid that promptly gels. This should liquefy again within around half an hour to allow sperm free motility. If this does not take place or is very thick in consistency there could be a problem, which is sometimes the result of infection.
Sperm Morphology
Sperm Viscosity
T
Testosterone TTC TTC#1, TTC#2, TTC#3 etc A male hormone, produced mainly in the testicles but also in the adrenal glands. Trying To Conceive Trying to Conceive for one year, Trying to Conceive for two years, Trying to Conceive for three years and so on.
U
US or Ultrasound scan
High frequency ultrasound waves are used to look at the uterus, ovaries and fallopian tubes. The reflection of these waves is used to produce an image on a screen.
V
Vas deferens
Tube that connects the testis where sperm are produced to the urethra. Sperm move rapidly out of the testis, through the vas deferens, and into the urethra during ejaculation.
Z
Zift Zygot Intra-fallopian Transfer, where eggs are collected from the ovaries, fertilized in a laboratory with sperm and the resulting embryos are transferred back into the fallopian tubes. The cell that is formed when a female and male reproductive cell come together, forming an early stage embryo
Zygote
NewLife Fertility Center, Muscat, Sultanate of Oman is looking forward to serve you!
Muscat, Sultanate of Oman, Al Azaiba, Way 4429, Villa 2029, Tel.: +968 24490737 or +968 93276693, Fax: 24494414, Email:[email protected], Website: www.muscat-ivf.com
Muscat, Sultanate of Oman, Al Azaiba, Way 4429, Villa 2029, Tel.: +968 24490737 or +968 93276693, Fax: 24494414, Email:[email protected], Website: www.muscat-ivf.com
We are here for on reason, to help couples to give birth to a health child NEWLIFE Fertility Center is the place where New Life starts
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Muscat, Sultanate of Oman, Al Azaiba, Way 4429, Villa 2029, Tel.: +968 24490737 or +968 93276693, Fax: 24494414, Email:[email protected], Website: www.muscat-ivf.com