ASSISTED REPRODUCTION
The laboratory is fully equipped with the latest instrumentation and with duplication of all laboratory equipment so that there is an effective back-up system. Our clinical staff interfaces with 4 reproductive biologists who have in depth knowledge of all the laboratory aspects of Assisted Reproduction. We routinely perform quality control assays to ensure high performance. The laboratory functions all 7 days of the week.
In Vitro Fertilization (IVF)
IVF achieves pregnancy by fertilizing the woman's eggs (oocytes) outside her body. The oocytes are obtained under mild anesthesia through the vagina using transvaginal guided sonographic procedures.
Isolation of oocytes
The semen is processed in order to obtain the most healthy sperm. The eggs and sperm are incubated together. Next day, the oocyte is checked for fertilization. The embryos are ready for transfer subsequently. IVF is ideal for couples with tubal blockage or pelvic adhesions, previous tubal sterilization not amenable to reversal and some cases of endometriosis and other pelvic factors.
Micromanipulation / Intra Cytoplasmic Sperm Injection (ICSI)
The Micromanipulation System Intra Cytoplasmic Sperm Injection(ICSI)
In this procedure, the oocyte is prepared by removing its outer coat of cells called the cumulus complex. Once laid bare, the oocyte is held gently by a holding pipette under an inverted microscope. The sperm that has been prepared for microinjection is injected through a very fine micropipette into the cytoplasm (body) of the oocyte. The oocyte holding pipette and the injection pipette are 20 times and 60 times thinner than human hair respectively. The egg itself is no bigger than the tip of a pin. The microinjected egg is returned to the incubator and checked the following day for fertilization.
Micromanipulation / Intra Cytoplasmic Sperm Injection - Movie Clip
Micromanipulation is ideally suited in cases of very low sperm counts (oligozoospermia) or zero count (azoospermia), very little or complete lack of motility and abnormal shape of the sperm. Its use is extended to women with advanced age, women suffering from endometriosis and those with immunological and unexplained infertility. Current thinking permits the use of ICSI for most forms of infertility.
Dr. Firuza Parikh’s team achieved the first ICSI pregnancy in South East Asia in 1994.
CAT Enhances IVF Success at Jaslok Hospital and Research Centre
An innovation developed for the first time in the world has dramatically increased the success of Assisted Reproduction (IVF/ICSI). The technique known as CAT (cumulus-aided embryo transfer), has been developed by Dr. Firuza Parikh and her team at the Jaslok Hospital and Research Centre in Mumbai.
Dr. Firuza Parikh describes the technique as follows, "We have harnessed nature to improve pregnancy rates. The embryos are transferred into the uterus along with cumulus cells. These cells surround the oocyte at the time of ovulation. After oocyte retrieval, the cumulus cells are usually discarded. Instead, we allow them to grow in the laboratory as the cells are rich in factors, which facilitate the growth of embryos. At the time of embryo transfer, droplets of cumulus cells are added to the embryos."
The technique was carried out on 507 women, more than half of whom had failed IVF attempts in the past. In this group of women pregnancy rates increased to 46%.
CAT is especially useful in cases with previous unsuccessful IVF attempts, in older women and in cases where few oocytes are obtained. Scientific data on this procedure has recently been published in the prestigious and leading international scientific journal called Fertility Sterility (October 2006) as a Front Page Article.
Dr. Parikh adds that "IVF is not merely a science, it is also a meticulous art. You look into the little details, work with nature instead of trying to outsmart it and always strive towards improving pregnancy rates - CAT is a movement in that direction."
More than 2300 babies from 35 different countries have been born with the help of advanced ART procedures carried out by the Jaslok team, making it one of the leading centers of the world.
CAT- FRP
Cumulus coculture and cumulus-aided embryo
transfer increases pregnancy rates in patients
undergoing in vitro fertilization
To read more click here to view uploaded File
Increased Success with CAT
| Parameters | Study Group A (with CAT) |
Control Group B (with CAT) |
p value |
| Pregnancy Rates | 46 % | 34% | P < 0.01 |
| Implantation Rates | 27 % | 15% | P < 0.001 |
A Day 3 embryo completely immobilized by the encroaching expanding cumulus cell colonies. Interlacing dendritic processes seen.
Visualization of a single dendritic process (indicated by an arrow) of the cumulus cell extending towards the cleaving embryo.
PESA/TESA/TESE
Percutaneous Epididymal Sperm Aspiration (PESA), Testicular Sperm Aspiration (TESA) and Testicular Sperm Extraction (TESE) are used when there is no sperm in the ejaculate (azoospermia). This can result from an obstruction in the reproductive tract (obstructive azoospermia) or due to lack of sperm production (non obstructive azoospermia). Obstructive azoospermia may be due to failure of the sperm passages to develop, blockage of the tubes transporting the sperm (due to infection or due to surgical blockage of the vas following male sterilization).
PESA/TESA/TESE are minimally invasive surgical sperm retrieval techniques that enable the urologist to recover sperm directly from the epididymis or even the testes of men with obstructive azoospermia so that the sperm can then be used to fertilize eggs by ICSI. The extra sperm and testicular tissue can be frozen for future attempts.
We have one of the largest series in India using testicular and epididymal sperm for ICSI.
Assisted Hatching 
Assisted hatching is a procedure in which the zona (shell) of the embryo is opened using the techniques of Micromanipulation. This facilitates its hatching in the uterus and improves implantation and pregnancy rates. Assisted hatching is useful in older women where the zona tends to be thickened and in women who have tried IVF previously, unsuccessfully. In our published study we have demonstrated pregnancy rates to rise to 44% from 19% in this group of women.
The Diode Laser
In order to further enhance our pregnancy rates we have introduced laser technology for Assisted Embryo Hatching. The laser beam is focused over the zona making a small opening between 10 to 20 microns in order to facilitate embryo hatching. The entire procedure is completed in a few milliseconds. Laser Assisted Hatching is particularly useful for older women (more than 35 years), women with oocytes showing a thick zona and women who have tried IVF unsuccessfully several times.
The laser can also be used for sperm tail cutting. The sperm is immobilized prior to its injection into the cytoplasm of the egg by mechanically cutting off its tail. Instead of using the micropipette to perform this procedure, the laser beam is focused on the sperm tail, thus immobilizing it in a few milliseconds without damage to the rest of the sperm. Sperm tail immobilization by the laser obviates the need to suspend the sperm in a chemical called PVP thus enhancing the safety of the ICSI procedure.
The diode laser is also used to make an opening in the zona through which a single cell (blastomere) is aspirated at the time of Preimplantation Genetic Diagnosis (PGD).
Preimplantation Genetic Diagnosis (PGD)
Preimplantation genetic diagnosis is carried out for couples who are at a high risk for various genetic disorders. The steps involved in PGD are:
Hormonal stimulation and oocyte retrieval- IVF/ICSI and fertilization
- Embryo biopsy at the 8-cell stage: At the 8-cell stage, the embryo is totipotent. Hence, the biopsy of 1-2 blastomeres does not affect further growth of the embryo.
- Genetic analysis by FISH technique
- Transfer of normal embryos
The entire process of genetic analysis is completed within a day and chromosomally normal embryos are transferred.
PB
Biopsy-1 - Movie Clip
Biopsy-3 - Movie Clip
Blastocyst Culture
A blastocyst is an embryo that consists of more than 100 cells. It is at the blastocyst stage of development (5 days after fertilization) that an embryo would normally move out of the fallopian tube and into the uterus. Once in the uterus, the blastocyst starts to attach to the uterine lining in a process known as implantation. Using newly developed culture media, we are now able to select embryos that will remain healthy in culture in the laboratory to the blastocyst stage prior to transfer. A higher implantation rate has been observed following transfer of blastocysts (50%), by some scientists. Our experience shows that the success of transfer depends on whether the uterine lining is ready to receive the embryos rather than the stage at which the embryos are transferred.
We achieved the first pregnancy in India using the technique of Laser Assisted Hatching and Blastocyst Transfer (LAHBT).
Embryo Cryopreservation 
/ Oocyte cryopreservation
Treatment with medicines for ovulation induction at the time of Assisted Reproduction produces many oocytes. We cryopreserve extra embryos for future cycles. Our freezing protocol is completely computerized. All embryos are coded, labeled and stored in special containers to maintain their identity. Recently we have set up protocols for oocyte cryopreservation. Oocyte cryopreservation is carried out prior to chemotherapy and in unmarried women.
Donor Oocyte Program
We have an ongoing program for Oocyte donation for women with premature ovarian failure, surgical or induced menopause and those in the perimenopausal group. Some women with repeated poor recruitment of follicles at the time of IVF, poor quality of oocytes, women with extensive endometriosis, severe pelvic adhesions and inaccessible ovaries can also avail of this facility. Egg donors are carefully screened and matched with recipients as closely as possible on physical characteristics. They are also screened so as not to transmit any diseases or genetic disorders. We ensure complete secrecy and evaluate the background of the donors thoroughly. Donors also undergo a genetic test called Karyotyping in order to ensure that they have normal chromosomes.
Andrology Laboratory
Semen Analysis
The Andrology Laboratory uses the Computer Assisted Semen Analysis (CASA) system. Ours is the first system in the country and was installed during the inception of the Department. This automated system provides a detailed analysis of density, percent motility, curvilinear and straight-line velocities, beat cross frequency and amplitude of lateral head displacement of spermatozoa. Besides the computerized report, information on volume, pH, viscosity, fructose assessment, morphology, number of immature cells and white blood cells and other routine assessment is provided. This powerful tool helps us in counseling the couple as to which method of treatment is best suited for them. Couples undergoing preliminary work up for infertility, patients with male factor infertility, unexplained infertility and repeated failed attempts at Assisted Reproduction benefit from CASA. During the course of treatment, CASA objectively assesses improvement due to a particular therapy.
Sperm Processing for Intrauterine Insemination (IUI)
The semen sample is processed by washing, centrifugation and migration. A suitable culture medium is used. The final migration is done under stringent culture conditions using CO2 incubation. The spermatozoa thus obtained are free of debris and bacteria, are energetic and improve the success rates of intrauterine insemination. We have a special room with privacy for semen collection. We also prepare the enriched sample for other clinics so that they can perform the insemination in their clinic. Women with ovulatory dysfunction, treated endometriosis with patent tubes, luteal phase defects, cervical factor infertility and polycystic ovarian disease can try IUI first before trying the more advanced techniques of Assisted Reproduction. Men with slightly compromised semen analysis parameters can benefit from IUI.
Semen Cryopreservation and Banking
We routinely have a back-up semen sample frozen for couples who are undergoing treatment in case of inability to give a sample on the day of the IUI, IVF or ICSI. Men undergoing orchidectomy/cancer treatment prior to radiation and chemotherapy can also avail of our cryopreservation facilities. Those who are undergoing ICSI are encouraged to freeze their sperm so that we have adequate number of sperm at the time of ICSI. We routinely cryopreserve testicular and epididymal sperm, so that repeated attempts at obtaining fresh epididymal and testicular sperm may be avoided.
Donor Insemination Program
Our sperm bank uses donor semen, which has undergone stringent evaluation. The donors are tested for HIV, Hepatitis B and C and VDRL. Besides, the semen quality is ensured by following the WHO criteria. The Cryopreservation Donor Semen Program is in accordance with the guidelines established by the The Indian Council for Medical Research (ICMR).
Clinic for Recurrent Abortion
Recurrent pregnancy loss can be caused by endocrine, immunological, anatomical and genetic factors. Our clinic offers genetic counseling as well as immunomodulation for this condition.
What is immunomodulation?: A small group of women are prone to repeated miscarriages due to an immunological problem. This can be detected by a test called Immunophenotyping. The test is performed on blood or on the endometrial tissue obtained by means of a simple procedure called endometrial biopsy. In the event of the woman having an immunological cause for the miscarriage intravenous therapy with immunoglobulins can be given over a period of 4 to 6 months.
Some women develop autoantibodies to their pregnancy resulting in repeated pregnancy loss. We have one of the largest series in the world documenting the role of autoantibodies and recurrent miscarriages.
Genital tuberculosis :
This is a major factor for female infertility in India. We have recently started using a molecular marker test for the TB bacterium. This is a monoclonal antibody test using immunocytochemistry. This has helped us to detect TB at a very early stage of the disease thereby improving the prognosis if genital TB is detected early.
We also offer our patients TB-PCR, a diagnostic test to rule out the involvement of TB as a causative agent for their infertility. The test involves scraping of a small amount of tissue from the lining of the uterus since the uterus is a common site for tuberculosis involvement, followed by analysis of the sample by polymerase chain reaction (PCR), which is a DNA based diagnostic tool. This test is specifically recommended for patients with repeated failed ART cycles in the presence of a thin uterine lining.
We have a team of doctors with extensive experience in laparoscopy and hysteroscopy procedures. We constantly update ourselves with the latest surgical techniques and are equipped with state of the art surgical instruments.
Laparoscopy is a procedure that allows the doctor to look directly at the uterus, fallopian tubes, ovaries, appendix, and other organs through keyhole surgery. Operative laparoscopy enables the surgeon to correct defects and remove tumors & cysts in the uterus, fallopian tubes and ovaries without the patient undergoing an open surgery. This technique is known as minimally invasive surgery and involves minimal discomfort to the patient. This technique is helpful in the presence of adhesions, endometriosis, pelvic tuberculosis, fibroids, ovarian tumors and cysts and in intestinal conditions such as appendicitis.
Our team has one of the largest experiences in the country with operative laparoscopy.
Hysteroscopy is a procedure, which allows the doctor to visualize the uterine cavity from within. Operative hysteroscopy enables the surgeon to correct the defects within the uterine cavity. This technique is very helpful to treat intrauterine septum, adhesions and myomas.
Our team has one of the largest experiences in the country with operative hysteroscopy.
Counseling
Infertility and its treatment cause significant stress to the couple,
which is detrimental to the reproductive cycle. Before definitive treatment
begins we encourage couples to talk about their stress factors and initiate
counseling. We have one of the largest series on psychiatric screening
and counseling for ART and many other studies cite our work in this field.
