Jorney to Dream Flower

1. Journey to Baby Bear….. “We Will Treat You Well” The First Dream Flower IVF Center in North Malabar Dream Flower IVF Centre Kasaragod

2. About US Web Link Dream flower IVF CENTRE is the first test tube baby centre of north malabar. This comprehensive assisted reproductive centre is a unit of Janardan Hospital, which is situated in the Heart of kasaragod town. Dream flower IVF CENTRE with its state of art IVF-ICSI Lab, ultra modern equipments, sophisticared support therapies and devoted experts provides complete infertility care under one roof. It will be of immense help to those childless couple who are in need of IVF-ICSI treatment. The treatment is tailored to suit the individual needs in the most cost effective manner without compromising on the quality and ethical standards.

3. IVF Teams Web Link Dr. K.P Suraj Medical Director MD Dr. Jayalakshmi Suraj IVF Co-Ordinator MD, DGO Dip. in Gynaec Endoscopy (Germany) Training in Reproductive Medicine (University of Brussels, Belgium) Dr. Elizabeth Mathews Chief Embryologist Dr Vineeth In house Embryologist Mrs. Rubeena Fayas IVF Lab Assistant MSC. Microbiology Mrs. Remya MSC. Microbiology Mrs. Sherin MSC. Microbiology

4. Our Services Web Link Ovulation Induction, HSG (Hystero Salpingo Gram) Intra Uterine Insemination In Vitro Fertilisation (IVF) Intra Cytoplasmic Sperm Injection (ICSI) PESA, TESA, TESE Sperm freezing Embryo freezing Blaslocyst culture & transfer Diagnostic & advanced operative Hysterolaparoscopy High Risk Pregnancy Care Trans Vaginal Sonography Trans Abdominal Sonography

5. Our Facilities Web Link O Ov vu ul la at ti io on n I In nd du uc ct ti io on n Ovulation induction involves the use of medication to stimulate development of one or more mature follicles (where eggs develop) in the ovaries of women who have an ovulation and infertility. These women do not regularly develop mature follicles without help from ovulation enhancing drugs. Ovulation Induction is a simple process which encourages your ovaries to release eggs, so you maximise your chance of conception through intercourse or artificial insemination (IUI). It suits women who are producing low levels of hormones for ovulation, or who are not ovulating at all. You’ll take medication (as tablets or through injections) to stimulate your hormones. HSG (Hystero Salpingo Gram) Hysterosalpingography (HSG) is a radiologic procedure to investigate the shape of the uterine cavity and the shape and patency of the fallopian tubes. It entails the injection of a radio-opaque material into the cervical canal and usually fluoroscopy with image intensification. The procedure involves X-rays. It should be done in the follicular phase of the cycle. It is contraindicated in pregnancy. It is useful to diagnose uterine malformations, Asherman's syndrome, tubal occlusion and pelvic inflammatory disease and used extensively in the work-up of infertile women.

6. Intra Uterine Insemination Intra Uterine Insemination (IUI) involves injection of washed sperm into the uterus with a catheter. If unwashed semen is used, it may elicit uterine cramping, expelling the semen and causing pain, due to content of prostaglandins. (Prostaglandins are also the compounds responsible for causing the myometrium to contract and expel the menses from the uterus, duringmenstruation.) Resting on the table for fifteen minutes after an IUI is optimal for the woman to increase the pregnancy rate. In Vitro Fertilisation (IVF) In vitro fertilization or fertilisation (IVF) is a process by which an egg isfertilised by sperm outside the body: in vitro ("in glass"). The process involves monitoring and stimulating a woman's ovulatory process, removing ovum or ova (egg or eggs) from the woman's ovaries and letting sperm fertilise them in a liquid in a laboratory. The fertilised egg (zygote) is cultured for 2–6 days in a growth medium and is then implanted in the same or another woman's uterus, with the intention of establishing a successful pregnancy. Intra Cytoplasmic Sperm Injection (ICSI) Intracytoplasmic sperm injection (ICSI) is an in vitro fertilization procedure in which a single sperm is injected directly into an egg. This procedure is most commonly used to overcome male infertility problems, although it may also be used where eggs cannot easily be penetrated by sperm, and occasionally in addition to sperm donation. It can be used in teratozoospermia, because once the egg is fertilized, abnormal sperm morphology does not appear to influence blastocyst development or blastocyst

7. morphology. Even with severe teratozoospermia, microscopy can still detect the few sperm cells that have a "normal" morphology, allowing for optimal success rate. ICSI only requires one sperm, which is injected directly into the egg. The fertilised egg (embryo) is then transferred to your uterus (womb). During ICSI the sperm doesn't have to travel to the egg or penetrate the outer layers of the egg. PESA, TESA, TESE These procedures are offered to couples in cases where the male has no sperm present in the ejaculate. They are used in conjunction with an ICSI procedure PESA- Percutaneous Epididymis Sperm Aspiration procedure may be performed under GA or local anaesthetic with sedation. A fine needle is passed into the epididymis to extract fluid. This is then checked in the laboratory by the embryologist for sperm. TESA: Testicular Sperm Aspiration Testicular sperm aspiration (TESA) is a procedure performed for men who are having sperm retrieved for in-vitro fertilization/intra- cytoplasmic sperm injection (IVF/ICSI). It is done with local anesthesia and sedation in the operating room or under local anesthesia alone in the office and is coordinated with your female partner’s egg retrieval. We insert a needle in the testicle and aspirate the tissue/ sperm. TESA is performed for men with obstructive azoospermia (s/p vasectomy or congenital bilateral absence of the vas deferens). Sometimes, TESA doesn’t provide enough tissue/sperm and an open testis biopsy is needed. TESE- Testicular Sperm Extraction procedure may be performed under GA or local

8. anaesthetic with sedation. A small sample of testicular tissue is extracted from the testes. This can be achieved by either a fine needle being inserted into the testes or a small incision being made. Sperm freezing Sperm freezing and storage is the procedure whereby sperm cells are frozen to preserve them for future use. Sperm cells have been frozen and thawed successfully for more than 40 years. By using special technology and then keeping sperm in liquid nitrogen at - 196°C, it can be stored for many years while still maintaining a reasonable quality. Embryo freezing Embryo freezing is the process of preserving an embryo at sub-zero temperatures, generally at anembryogenesis stage corresponding to pre-implantation, that is, from fertilisation to the blastocyst stage. Embryo cryopreservation is useful for leftover embryos after a cycle of in vitro fertilisation, as patients who fail to conceive may become pregnant using such embryos without having to go through a full IVF cycle. Or, if pregnancy occurred, they could return later for another pregnancy. Spare oocytes or embryos resulting from fertility treatments may be used foroocyte donation or embryo donation to another woman or couple, and embryos may be created, frozen and stored specifically for transfer and donation by using donor eggs and sperm.

9. Oocyte cryopreservation Oocyte cryopreservation allows women to freeze and store their eggs until they want to start or expand their families. Egg freezing effectively suspends the ever-present ticking of the reproductive biological clock, giving women more choices than ever before. Oocyte cryopreservation is aimed at three particular groups of women: those diagnosed with cancer who have not yet begun chemotherapy or radiotherapy; those undergoing treatment with assisted reproductive technologies who do not consider embryo freezing an option; and those who would like to preserve their future ability to have children, either because they do not yet have a partner, or for other personal or medical reasons. Oocyte cryopreservation is an option for individuals undergoing IVF who object, either for religious or ethical reasons, to the practice of freezing embryos. Having the option to fertilize only as many eggs as will be utilized in the IVF process, and then freeze any remaining unfertilized eggs can be a solution. In this way, there are no excess embryos created, and there need be no disposition of unused frozen embryos, a practice which can create complex choices for certain individuals.

10. Blaslocyst culture & transfer Blastocyst culture and day 5 embryo transfer for in vitro fertilization allows selection of the best quality embryos for transfer. Embryo quality is important with infertility. With blastocyst transfer, we transfer fewer embryos - reducing multiple pregnancy risks, and maintain high IVF success rates 3D Ultrasound 3D Ultrasound: we use voluson p8 model ultrasound machine which is specialized in ivf imaging. Diagnostic & advanced operative Hysterolaparoscopy Clinical problems that cannot be discovered by an external physical examination can be discovered by laparoscopy and hysteroscopy, two procedures that provide a direct look at the pelvic organs. These procedures may be recommended as part of your infertility care, depending on your particular situation. Laparoscopy and hysteroscopy can be used for both diagnostic (looking only) and operative (looking and treating) purposes. Diagnostic laparoscopy may be recommended to look at the outside of the uterus, fallopian tubes, ovaries, and internal pelvic area. Diagnostic hysteroscopy is used to look inside the uterine cavity. If an abnormal condition is detected during the diagnostic procedure, operative laparoscopy or operative hysteroscopy can often be performed to correct it at the same time, avoiding the need for a second surgery. Both diagnostic and

11. operative procedures should be performed by physicians with surgical expertise in these areas. High Risk Pregnancy Care Your pregnancy is called high-risk if you or your baby has an increased chance of a health problem. Many things can put you at high risk. Being called "high-risk" may sound scary. But it's just a way for doctors to make sure that you get special attention during your pregnancy. Your doctor will watch you closely during your pregnancy to find any problems early. High Risk Pregnancy includes slowed growth for the baby, preterm labor, preeclampsia, and problems with the placenta. But it's important to remember that being at high risk doesn't mean that you or your baby will have problems. Trans Vaginal Sonography Transvaginal Sonography is a test used to look at a woman's reproductive organs, including the uterus, ovaries, and cervix. Transvaginal means across or through the vagina. The ultrasound probe will be placed inside the vagina. Transvaginal Sonography may be done for the following problems: 1.Abnormal findings on a physical exam, such as cysts, fibroid tumors, or other growths 2.Abnormal vaginal bleeding and menstrual problems 3.Certain types of infertility 4.Ectopic pregnancy 5.Pelvic pain Trans Abdominal Sonography A transabdominal ultrasound is used to look at the pelvic organs. Gel is placed on your abdomen. Then a small, handheld unit called a transducer is gently moved around to view the pelvic organs. The transducer sound waves make a picture on the TV screen.

12. Features Web Link Azoospermia / Oligo astheno spermia Azoospermia is the medical condition of a man not having any measurable level of sperm in his semen. It is associated with very low levels of fertility or even sterility, but many forms are amenable to medical treatment. In humans, azoospermia affects about 1% of the male population and may be seen in up to 20% of male infertility situations Azoospermia is usually detected in the course of an infertility investigation. It is established on the basis of two semen analysis evaluations done at separate occasions (when the seminal specimen after centrifugation shows no sperm under the microscope) and requires a further work-up. Tubal Block

13. Blocked fallopian tubes are unable to let the ovum and the sperm converge, thus making fertilization impossible. Fallopian Tubes are also known as oviducts, uterine tubes, and salpinges (singular salpinx). Most commonly a tube may be obstructed due to infection such as pelvic inflammatory disease (PID). The rate of tubal infertility has been reported to be 12% after one, 23% after two, and 53% after three episodes of PID the Fallopian tubes may also be occluded or disabled by endometritis, infections after childbirth and intraabdominal infections includingappendicitis and peritonitis. The formation of adhesions may not necessarily block a fallopian tube, but render it dysfunctional by distorting or separating it from the ovary. Severe Endometriosis Severe Endometriosis is a disease in which tissue that normally grows inside theuterus grows outside the uterus. Its main symptoms are pelvic pain andinfertility. Nearly half have chronic pelvic pain, while in 70% pain occurs during menstruation. Infertility occurs in up to half of people. Less common symptoms include urinary or bowel symptoms. About 25% of women have no symptoms. Endometriosis can have both social and psychological effects. Poly Cystic Ovarian disease Polycystic ovary syndrome (PCOS), also called hyperandrogenic anovulation (HA) or Stein–Leventhal syndrome is a set of symptoms due to a hormone imbalance in women. Symptoms include: irregular or no menstrual periods, heavy periods, excess body and facial hair, acne, pelvic pain, trouble getting pregnant, and patches of thick, darker, velvety skin.

14. PCOS is the most common endocrine disorder among women between the ages of 18 and 44. It affects approximately 5% to 10% of this age group. It is one of the leading causes of poor fertility. Advanced age where fertility declines Female fertility is affected by age. After puberty, female fertility increases and then decreases, with advanced maternal age causing an increased risk of female infertility. In humans, a woman's fertility peaks in the early and mid-20s, after which it starts to, decline slowly, with a more dramatic drop at around 35. Menopause, or the cessation of menstrual periods, generally occurs in the 40s and 50s and marks the cessation of fertility, although age-related infertility can occur before then. The relationship between age and female fertility is popularly referred to as a woman's "biological clock"; when a woman reaches an age where fertility is commonly understood to drop, it can be said that her "biological clock is ticking.” Unexplained infertility In unexplained infertility abnormalities are likely to be present but not detected by current methods. Possible problems could be that the egg is not released at the optimum time for fertilization, which it may not enter the fallopian tube, sperm may not be able to reach the egg, fertilization may fail to occur, transport of the zygote may be disturbed, or implantation fails. It is increasingly recognized that egg quality is of critical importance and women of advanced maternal age have eggs of reduced capacity for normal and successful fertilization. Also, polymorphisms in folate pathway genes could be one reason for fertility complications in some women with unexplained infertility. Aberrant reproductive immunology such as decreasedmaternal immune tolerance towards the embryo may also be a possible explanation. Failed IUI treatment Failed IUI treatment: Usually we do IUI for 3 cycles at an interval of one month. If this mode of treatment does not result in a pregnancy next option is IVF Premature Ovarian Failure Premature ovarian failure (POF) is when a woman's ovaries stop working before she is 40. POF is different from premature menopause. With premature menopause, your

15. periods stop before age 40. You can no longer get pregnant. The cause can be natural or it can be a disease, surgery, chemotherapy, or radiation. Success Rate of Our Team Web Link A delivery rate of 50 percent can be obtained in good prognosis patients. Success rate depends on patient’s age, causes, duration of infertility and embryo quality. Counseling regarding individual prognosis will be done at the time of initial consultation. Events Web Link The first test tube baby of north Malabar was born at our centre on April 7 2014 for a couple married for 16 years.

16. Contact US Web Link Janardan Hospital Bank Road, Kasaragod, Kerala 671121 Phone: 094470 00616 Visit our Website for More Details…. http://www.ivfkeraladf.com