IVF Treatment in Bangalore, India - NUHospitals

What is IVF?

IVF (In-vitro fertilization) or test tube baby as it is commonly called is a procedure in which the eggs and the sperms are fertilized outside the body and then transferred back to the womb after 2-5 days.

Who needs an IVF?

IVF may be considered if,

you have been diagnosed with unexplained infertility
your fallopian tubes are blockedother techniques such as fertility drugs or intrauterine insemination (IUI) have not been successful
other techniques such as fertility drugs or intrauterine insemination (IUI) have not been successfulthe male partner has fertility problems and an abnormal semen analysis
The male partner has fertility problems and an abnormal semen analysis
you are using your partner’s frozen sperm in your treatment and IUI is not suitable for you
you are using donated eggs or your own frozen eggs in your treatment
you are using embryo testing to avoid passing on a genetic condition to your child.
If you have severe endometriosis


What do I expect during my treatment cycle?

Your treatment cycle would be as follows

Step 1: Once you have decided to go ahead with IVF, you will undergo a day care procedure called hysteroscopy to assess the suitability of the uterus to hold the baby. It is generally done one month before your IVF cycle and involves the introduction of a small camera into the womb through the vagina to visualize the inside of the uterus. You will be given anaesthesia during the procedure and hence there will be no pain.

Step 2: Your husband has to freeze one semen sample as a back up.

Step 3:  Typically your treatment would begin on the second or third day of periods. It involves a scan and hormone tests followed by daily injections for about 8-10 days, along with monitoring by scan and hormone tests in between. Once the eggs are sufficiently grown as per the scan and hormone tests, you will receive injection Hcg as a ovulation trigger.

Step 4: Egg retrieval is performed transvaginally 35 – 36 hours later, with light anaesthesia, using a transvaginal ultrasound guidance. You will be discharged same evening, unless there are problems associated with bleeding, undue pain or ovarian hyperstimulation.

Step 5: After retrieval, eggs are assessed for their maturity. Meanwhile husband has to give a fresh semen sample. Mature eggs are injected with the sperms on the same day and grown in the incubator for 3-5 days.

Step 6: The final step is the embryo transfer. 3-5 days after your egg retrieval, two or three embryos are selected and gently transferred into the womb using an abdominal ultrasound guidance. The procedure is usually painless, no anaesthesia is required and you will be discharged in about two to three hours.

Step 7: You will be given certain supportive medications starting from the day of egg retrieval till your pregnancy check. You will be called for a pregnancy check 16-17 days after your embryo transfer.

What precautions do I take during the IVF treatment?

Eat a healthy diet rich in fruits and vegetables
Be stress free and relax your mind
Avoid intercourse during the treatment.

Don’t do strenuous job during the treatment as your ovaries are enlarged and they may twist sometimes causing acute pain.

How do I prepare myself for an egg retrieval procedure?

You will get admitted to the hospital early in the morning, between 6am – 7am and you have to be empty stomach atleast 6-8 hours before the procedure. You will be administered light anaesthesia as intravenous medication. The procedure is done vaginally using the scan guidance and a small needle. The entire procedure takes about 20-30 minutes. Post procedure you may have slight pain or bleeding which usually subsides with medication. You will be discharged about 6 hours later.

What do I expect during embryo transfer?

It is done 3-5 days following the egg retrieval, which will be decided by your clinician. No anaesthesia is required as it is a painless procedure. Rarely during your initial assessment if it is found that getting into the uterus is difficult or if you are very uncooperative, you may be given light anaesthesia. Your bladder has to be full before the procedure as it is done under abdominal scan guidance. Do not wear perfume/ deodorant or powder on that day as they are harmful to the embryos. Two or Three embryos are gently transferred to the uterus using a small catheter. You will lie down for about 15 – 30 minutes after the procedure and later you can pass urine. No need to take bedrest until your pregnancy check.  This does not increase your chances of becoming pregnant.

What is ICSI? How does it differ from IVF?

ICSI – Intracytoplasmic sperm injection, is an IVF procedure in which a single sperm is injected directly into an egg whereas in IVF, about 50,000 to 1,00,000 sperms are inseminated around the eggs and one of them penetrates the egg on its own. ICSI increases the fertilization rates especially in male factor infertility and cases of previous fertilization failure.

What is the success rate?

Success rate varies with multiple factors especially the age of the women, egg and the sperm quality and the underlying cause of infertility. Over all the success varies between 40-50 %. Success decreases as the age of the woman increases.

What is frozen embryo transfer?


Surplus embryos after your transfer can be frozen and kept in liquid nitrogen at -180 degree Celsius, for later use.

What are the complications?

Two most important complications of IVF are

Multiple pregnancy (20-25%)
Ovarian hyperstimulation syndrome which occurs due to excessive response and can be prevented b appropriate modifications in the medications
Rarely ovaries may twist causing acute pain and may require a laparoscopy

When can I know if I have become pregnant?

You will be tested for beta HCG – a blood test to confirm pregnancy 14 to 16 days after your embryo transfer.

Is my pregnancy going to be more riskier after IVF?

There is no evidence to show that IVF babies have increased rate of abnormalities. The pregnancy outcome will be like a normal conception but your doctor may have a low threshold for intervention when the problem arises.

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Kidney Transplant Surgery in India

What is kidney transplantation?
Kidney (renal) transplantation is a surgical procedure in which healthy kidney from a person (donor) is removed and placed in a patient (recipient) with irreversible advanced kidney disease (end stage renal disease; ESRD).

What are the types of kidney transplantation?
Kidney transplantation is classified into deceased donor transplantation or living donor transplantation depending on the source of the donor organ.

Can I undergo living unrelated donor transplantation?
Living unrelated donor transplantation is not permitted by law; it is also unethical as it is associated with paid donation.

Who are the patients for whom transplantation cannot be done?
Patients with kidney disease that invariably recurs and damages the transplanted kidney (graft), recently diagnosed cancer, positive cross match (see below) and active infection cannot undergo transplantation.

Who can be a voluntary kidney donor for living donor transplantation?
Parents, children, siblings, grandparents and spouse can be voluntary kidney donors if their age is between 18 to 60 years (upper age limit can be relaxed in demanding situations).

Blood group of the donor should be compatible (well suited) with that of the recipient.

The donor should be free from long standing ailments that can affect kidneys in the course of the illness (diabetes mellitus, hypertension etc.) and should have two healthy normal functioning kidneys. They should not have infection with blood borne viruses (Hepatitis B, Hepatitis C and Human Immunodeficiency Virus infection) and they should be psychologically stable to make a decision on kidney donation without coercion

What are the tests done for the donor?
Apart from the evaluation for the above mentioned issues, tests will be done to make sure that there are no illnesses affecting other major organs. Assessment of individual kidney function by radioisotope renogram (a scanning test done following intravenous injection of radioisotope), tissue typing (blood collected from the donor and the recipient are tested for the degree of tissue level compatibility) and computed tomography (CT) angiography (contrast material is injected intravenously to see clearly the blood supply of the kidneys; location and branching of kidney blood vessels will help in surgical plan) are the other tests required for donor evaluation.

What are the risks involved in kidney donation?
There is no increased risk of death or kidney disease in living donors in the long run. The donor is advised to have annual medical checkup to ensure proper care of single functioning kidney.

What tests should be done for the recipient?
Apart from psychological evaluation and tissue typing, the recipient should undergo evaluation for a) the cause of the kidney disease if it is possible (to assess the possibility for recurrence of the disease in the graft and the timing of transplantation), b) lower urinary tract to rule out abnormal urinary outflow (they should be taken care before transplantation as they can predispose to post transplant urinary tract infection), c) blood borne viruses – if positive for viruses, they should undergo treatment for these viruses before transplantation and d) heart disease with coronary angiogram especially in patients who have diabetes mellitus and prior heart disease.

How much time will it take to complete donor and recipient evaluation?
Approximately two weeks.

What are the administrative procedures associated with living donor transplantation?
The donor should sign an affidavit stating that kidney donation is voluntary and not by force (to be attested by notary public). You should get an approval letter for undergoing transplantation from The Authorization Committee of Organ Transplantation, Karnataka. Our Hospital front office in charge will guide you in getting all these procedures done. If you are not a native of Karnataka, you should get No Objection Certificate from your native state Committee before submission of papers to the local Committee.

What should I do to get the approval letter from the Authorization Committee of Organ Transplantation?
You should submit copies of all investigation reports along with a request form for kidney transplantation to The Authorization Committee of Organ Transplantation once all the tests are completed. The Committee will issue approval letter after verification of the documents (especially proof of relationship and residence) in two to three weeks’ time from the date of submission.

What are the procedures after approval from the Committee?
Date will be fixed for kidney transplantation if you do not have any active infection or other problem. Final tissue cross match will be done using donor’s and recipient’s blood 2 days prior to scheduled date of transplantation to make sure that there are no preformed factors in the recipient’s blood that can damage the graft. If the cross match is negative, you will be admitted that day evening and the donor, the next day noon. Immunosuppressive medications will be started and a session of hemodialysis will be done the day before transplantation.

What will be done during renal transplantation?
The recipient will undergo central vein catheter insertion (to monitor central venous pressure), urinary catheter insertion (to monitor urine output) and catheter insertion into the back (for injecting pain relieving agents) prior to surgery in the Operating Room (OR). The donor will undergo urinary catheter insertion (to monitor urine output) and catheter insertion into the back (for injecting pain relieving agents) at the same time.

The kidney will be removed from the donor under anesthesia and brought to the recipient table. By that time, space will be created in the abdomen of the recipient in the area above the thigh to keep the new kidney. Then the donor kidney will be connected to the recipient blood vessels.

When will the transplanted kidney start working?
In almost all patients (95%), the graft will start its function immediately as evidenced by brisk urine output and progressive decline in serum creatinine (a blood marker for kidney function). Immediate function of the graft does not mean that everything will be all right thereafter. Kidney function may decline any time in the post transplant period (immediate and late) and that is why, constant and regular monitoring of kidney function using blood and urine tests is needed.

What will you do if the graft does not function immediately?
The cause for defective graft function will be analyzed by blood, urine and ultrasound tests and appropriate corrective action will be taken to improve graft function. In that process, additional procedures like graft exploration in OR and graft biopsy may be required and you may continue to require dialysis till there is improvement in graft function.

There is a rare possibility (1%) that the graft may not function at all (because of complications in the blood vessels or severe rejection) and you will have to continue dialysis till you undergo transplantation again. Such grafts may require removal in OR to avoid serious life threatening complications like rupture of blood vessels or the graft itself.

Will I require dialysis again after kidney transplantation?
But for the above mentioned situations, dialysis will not be required post transplantation.

When will the catheters be removed?
The catheters will be removed in three to four days’ time for the donor and in a week’s time for the recipient (if there is no complication in the postoperative period).

When will the donor and I be discharged after surgery?
The donor will be discharged on fifth day and you, on seventh or eighth day (if there is no major complication in the postoperative period).

Will you remove my diseased kidneys?
The diseased kidneys will be removed only if they are seriously infected or the cause of severe hypertension or massive bleeding.

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