Author name: srishtifertility

Managing Cord Prolapse to Prevent Birth Asphyxia and Stillbirth Cord prolapse, also known as umbilical cord prolapse, is an obstetric emergency that occurs when the umbilical cord descends through the open cervix alongside or ahead of the presenting fetal part during labor or delivery. It is an uncommon but serious complication, occurring in 0.1-0.6% of pregnancies. If not managed promptly, cord prolapse can lead to obstruction of blood flow in the umbilical vessels, fetal asphyxia, neurological damage and stillbirth. However, with early recognition and appropriate management, many adverse outcomes can be prevented. This article provides an overview of cord prolapse, its causes, diagnosis and evidence-based management principles aimed at optimizing fetal outcomes. Key Points Cover In Blog What Causes Cord Prolapse? Certain obstetric factors predispose to umbilical cord prolapse by allowing the cord to descend ahead of the presenting part. These include: Malpresentation – breech, oblique lie or other non-cephalic presentations Prematurity Rupture of membranes before the presenting part is engaged Multiparity – previous deliveries causing laxity of uterine and cervical tissues Polyhydramnios – excessive amniotic fluid allowing cord to “float” down Placenta previa – low-lying placenta over the cervix External Cephalic Version (ECV) maneuvers During labor or delivery, any situation where the lower segment of the uterus is suddenly decompressed can also precipitate cord prolapse e.g. sudden drainage of large amniotic fluid volume, artificial rupture of membranes (ARM) or quick change from vertex to non-cephalic presentation. Vigilance is required in such cases to check for cord prolapse. Signs and Symptoms of Cord Prolapse Typical symptoms that should raise suspicion of umbilical cord prolapse include: Sudden onset fetal bradycardia after drainage of liquor or ARM Palpation of a soft pulsating structure (umbilical cord) alongside the presenting fetal part Visualization of cord protruding from the cervical opening on sterile speculum examination As cord compression can occur rapidly after prolapse, fetal heart rate monitoring is key both in early diagnosis and ongoing management. Variable decelerations or prolonged bradycardia signifies cord compression and urgent management is needed. Confirming Diagnosis and Assessing Compression Diagnosis of cord prolapse is made visually by seeing the cord protruding from the vagina on sterile speculum exam. Degree of cord compression should also be quickly evaluated: Is the cord pulseless indicating complete occlusion? How much is the cord compressed – slightly, moderately or severely? Is fetal distress indicated by heart rate changes? This assessment guides the urgency and aggressiveness of subsequent management steps. The goal is to urgently relieve cord compression to restore blood flow and oxygenation to the fetus. Key Principles in Management of Cord Prolapse Evidence-based management principles aimed at quickly alleviating cord compression and optimizing fetal outcomes include: Call for Help and Prepare for Rapid Delivery- Activate emergency obstetric measures by calling for senior medical staff for assistance. Alert the neonatal resuscitation team for potential asphyxiated birth and make preparations for urgent cesarean delivery if needed. Relieve Cord Compression with Manual Maneuvers- Have an assistant (nurse or doctor) immediately insert fingers vaginally and gently lift the presenting fetal part off the cord to release pressure. Alternatively, the cord can be pushed back above the baby’s head if accessible. This manual uterine displacement should be maintained until urgent delivery is achieved. Improve Pelvic Outlet Space- Maternal positioning to increase pelvic dimensions can aid cord decompression. Placing the mother in exaggerated Sim’s (lateral), knee-chest or Trendelenburg positions may help relieve cord pressure. Give High-Flow Oxygen to Mother- Administer oxygen at 10-15 L/min via face mask to improve fetal oxygenation until delivery. Rapidly Achieve Delivery- Emergency delivery by cesarean section or operative vaginal birth (forceps, vacuum) if imminent should be performed promptly aiming for delivery within 30 minutes of prolapse. Cord occlusion time correlates directly with adverse outcomes – the longer the delay, higher the risk of fetal asphyxia or death. Prepare for Neonatal Resuscitation- Have personnel skilled in newborn life support at delivery to resuscitate and stabilize infants at risk of asphyxia due to cord compression. Steps include drying/stimulating baby, clearing airways, giving oxygen or positive pressure ventilation if needed. Outcomes after Cord Prolapse With optimal, evidence-based management as outlined, most cases of cord prolapse can achieve good fetal outcomes if delivered rapidly. However, perinatal mortality rates are still elevated compared to unaffected pregnancies, ranging from 2-15% in reported case series. Contributing factors for poor outcomes include prolonged umbilical cord occlusion over 30 minutes, fetal prematurity, non-reassuring fetal heart rates warranting immediate delivery and delay in cesarean capability at referring facilities. For survivors, the prognosis depends significantly on whether hypoxia/acidosis occurred from cord compression resulting in organ damage. Babies delivered in good condition generally do well without long term neurological morbidity. But those with birth asphyxia can face risks of permanent impairments such as cerebral palsy, learning disabilities or hearing/vision deficits. Access to cooling therapy for hypoxic-ischemic encephalopathy improves outcomes. Conclusion Cord prolapse is an uncommon but extremely dangerous obstetric event where timely management is imperative. Despite being rare, all labor staff must remain vigilant to the risk scenarios where cord prolapse is likely to occur. They must have a standardized emergency response plan focused on relieving cord compression and achieving categorical delivery within 30 minutes. With prompt recognition, teamwork and coordinated maneuvers to decompress the cord manually, improve pelvic dimensions through positioning and rapidly deliver via cesarean section or instrumentals, fetal injury can often be averted. Though associated with elevated risks, outcomes can still be optimized in many cases through evidence-based management principles. Maintaining capabilities for around-the-clock emergency obstetric care including options for immediate cesarean delivery is key for facilities providing labor services. If cord prolapse is managed using established protocols, babies can still be saved and spared from hypoxic insult, allowing them healthy, productive lives.

Conquering Infertility: IVF Success Rates in India Now Up to 45% Per Cycle Wondering what your chances of getting pregnant through IVF in India are? With advanced technologies and skilled doctors, IVF success rates in India have significantly improved over the years. However, success still depends on several factors. Read on to learn about typical IVF success rates in India and what impacts your chances of conception. Key Points Cover In Blog IVF Techniques Commonly Used in India IVF (in vitro fertilization) involves fertilizing eggs with sperm in a lab. The most common IVF techniques used in India include: Conventional IVF: Eggs are retrieved and fertilized with sperm in a petri dish. The embryo(s) are then transferred into the uterus. This is the standard IVF procedure. ICSI (Intracytoplasmic Sperm Injection): A single sperm is directly injected into each mature egg to achieve fertilization. ICSI is commonly used for male factor infertility issues. FET (Frozen Embryo Transfer): Extra high quality embryos from a fresh IVF cycle are frozen to use in future cycles. This avoids additional egg retrievals. PGS/PGD (Preimplantation Genetic Screening/Diagnosis): Done along with IVF to check embryos for abnormalities prior to transfer. Helps select the healthiest embryo and can improve IVF success. Success Rate of IVF in India The average IVF success rate in India is between 35-45% per cycle according to recent data. For couples under 35 years using their own eggs, IVF success rates per cycle can reach over 65%. As a woman’s age increases, especially over 40, success rates decline. IVF Success Rates By Age Age is the most significant factor affecting IVF success in India and globally. Younger women produce higher quality eggs with fewer abnormalities, leading to higher success rates: Under 35 Years Old: 65%+ Success Rate: Women under 35 have the highest IVF success rates, with over 65% resulting in a live birth per cycle. This is because younger women have a much higher ovarian reserve and produce higher quality eggs with significantly fewer abnormalities. With a fertile 30-something woman, her eggs, uterus, and other reproductive organs are still at an optimal functioning level for pregnancy. This high egg quality leads to higher quality embryos and increased chances that implantation and conception will occur after the embryo transfer. Even if the first cycle is unsuccessful, women under 35 often have a good response to IVF medication with ample eggs retrieved. This allows multiple embryos to be created in one cycle, some of which can also be frozen for future Frozen Embryo Transfer cycles if needed. Given both higher success per cycle plus remaining fertility potential, under 35 is the most advantageous time to pursue IVF treatment. 35-37 Years Old: 55% Success Rate: From 35-37 years old, women still have reasonably good outcomes from IVF treatment in most cases. Average success rates per cycle generally fall to around 55% live births in this age group. Egg quality is declining slightly compared to the early 30’s, but still much better than later years. Chromosome abnormalities and tubal issues also increase somewhat by the mid to late 30’s as overall fertility starts decreasing. However, this is still considered a good age group for IVF cycles. Clinics can still retrieve a decent number of eggs per cycle to create multiple embryos. Extra embryos can be frozen for future attempts if needed. The slight decline to 55% success per cycle is mostly attributed to the start of fertility aging rather than an outright issue. This is still an age bracket with positive IVF success outcomes overall in Indian clinics. 38-40 Years Old: 35-45% Success Rate: From 38-40 years old, chances of IVF resulting in pregnancy start to decline more rapidly as egg quantity drops and abnormalities increase. Average success rates range from 35-45% per cycle by this point, with the spread accounting for differences in individual patients. Chromosome issues in embryos rise notably in this bracket, requiring more cycles for viable embryos or reducing implantation potential per transfer. Egg quality deterioration also accelerates in these years, resulting in fewer follicles and eggs retrieved per cycle. Sometimes few or no embryos result from a full IVF cycle. If embryos do form, abnormalities are higher and miscarriage risks increase if pregnancy does occur. More total IVF cycles total may be needed for success up to age 40 before chances drop off steeply. However, with multiple attempts 3 in 4 women can still conceive via IVF. Over 40 Years Old: 15-25% Success Rate With Own Eggs: Past age 40, IVF success rates per cycle with a woman’s own eggs drop down to 15-25% on average. This period known as “advanced maternal age” for fertility represents a steep decline in remaining ovarian reserve as menopause approaches. Far fewer follicles respond to IVF drugs making egg retrieval difficult each round. The limited eggs obtained are lower in quality with a high rate of defects. Fewer embryos develop and chromosome issues are prevalent in remaining ones. This causes low implantation rates, higher miscarriage risk and overall much lower IVF success chances per transfer. By early to mid-40’s, 5% or lower live birth rates per cycle are common with a woman’s own eggs. Most in this bracket rely on donor eggs from younger women instead to achieve success with IVF.  The sharp decline after age 40 is due to poorer egg quality and chromosome issues making embryo implantation difficult. Using an egg donor can increase chances for older women. Talk to your doctor about optimal treatment plans for your age. IVF Success Rate By Number of Embryos Transferred In the past, multiple embryos were often transferred to increase the odds of conception. However, guidelines now recommend single embryo transfers (SET) to reduce twin/high-order pregnancy risks. Single embryos are chosen based on quality indicators like early cell division rates. IVF success rates in India by number of embryos transferred: SET (Single Embryo Transfer): 35-45% live birth rate Double Embryo Transfer: Increases to 55-65% live birth rate 3 Embryos: Slightly higher chance but not proportional and

After How Many Weeks IVF Pregnancy Is Safe? For those undergoing in vitro fertilization (IVF), the journey to pregnancy can be filled with anticipation, hope and also anxiety. One of the biggest questions on an expecting mother’s mind is when is the pregnancy finally “safe” and the risk of miscarriage starts decreasing. This concern is valid, as studies show the miscarriage rate for IVF pregnancies in the first trimester is estimated up to 11-14%. However, there is good news – the odds start improving dramatically after reaching certain milestone weeks. What Impacts IVF Pregnancy Success Rates There are various factors that play a role in influencing the viability and safety of an IVF pregnancy, including: Maternal Age – The older the mother, the higher the chances of chromosomal abnormalities leading to miscarriage. At age 35, risk is 15%. At 40, risk increases to 34%. Embryo Quality – Embryos graded higher have a better chance of resulting in an ongoing pregnancy without miscarriage. Top quality embryos have 85% viability. Number of Previous Failures – More previous failed transfers or miscarriages reduces future viability rates. After 3 failures is considered “recurrent implantation failure”. Lifestyle Factors – Smoking, alcohol abuse, high BMI can adversely impact IVF pregnancy rates. Optimizing health improves safety. Miscarriage Risk by Week in IVF Pregnancies Here is how the miscarriage risk changes week-by-week after a positive pregnancy test following IVF: Week 4 – 1 in 4 risk of loss Week 5 – 1 in 5 risk Week 6 – 1 in 10 risk Week 7 – 1 in 15 risk Week 8 – 1 in 25 risk Week 12 – 1 in 100 risk As you can see, once an IVF pregnancy makes it through the first 8-10 weeks, the odds start going down more significantly. By week 12 the risk is just 1%. After How Many Weeks Are IVF Pregnancies Considered Viable Generally speaking, IVF pregnancies are considered viable once they reach these two essential milestone weeks with a heartbeat confirmed: Week 6 – At this point, the risk drops to 9-11%. Considered a “chemical pregnancy.” The embryo has implanted successfully but still very early days. Week 8 – Now the risk is under 5%. Embryo is developing rapidly into a fetus with recognizable heartbeat on ultrasound. Considered the time most doctors feel confident about viability. By week 9, the risk drops as low as 2%. Therefore weeks 6 to 8 are critical hurdles for an IVF pregnancy. If you have a healthy ultrasound showing embryo growth and heartbeat by your 8 week appointment, you have crossed an essential viability threshold. However miscarriage risk will never be completely zero until you give birth. After week 8 the risk just keeps progressively decreasing each additional week the pregnancy continues. Reducing Risk Factors Once Pregnant The weeks following your first positive pregnancy test are crucial. Here are proactive steps you can take to help support your IVF pregnancy during the critical first trimester: Continue Progesterone Supplements – Most doctors will keep you on supplements until at least week 10 as progesterone helps sustain pregnancy in early days. Start Prenatal Vitamins – Essential vitamins and minerals support embryo development and reduce defects. Mainly folic acid and omega-3’s. Stay Hydrated – Dehydration can impact early cell division and growth. Drink plenty of purified water. Prioritize Sleep – Getting consistent deep sleep helps lower stress hormones that can impair pregnancy. Adopt Healthy Lifestyle – Follow balanced nutritious diet, exercise moderately, and do relaxing activities. This nourishes your body to nurture the pregnancy while also keeping stress low. The first trimester requires diligence and tender love of your body. Once you have a healthy first ultrasound, you can finally start bonding more with your future baby! Before you know it, the weeks fly by and risks continually fade as you get one day closer to holding your little one. Conclusion The journey towards motherhood through IVF is filled with anticipation and anxiety about when an IVF pregnancy can be considered viable and safe. As covered in this article, generally after 6-8 weeks is when the risk of miscarriage drops considerably and doctors confidently reassure patients that their IVF pregnancy is now safe to continue carrying to term. Specifically after 8 weeks, when a healthy heartbeat is detected, the chances of loss are under 5% and after 9 weeks under 2%. So for those eager moms wondering “after how many weeks ivf pregnancy is safe”, be assured that your long-awaited dreams of parenthood are well within reach around the 2 month milestone in your pregnancy journey ahead. Continue treasuring the miracle growing within you, stay diligent about your health, and trust that before long you’ll be embracing your beautiful IVF baby that made the odds and came to fruitful life.

What Are The 5 Stages of IVF? For many couples struggling with infertility, in vitro fertilization (IVF) offers new hope for building their family. This assisted reproductive technology bypass the usual fertilization process by manually combining eggs and sperm in a laboratory environment. Once an embryo or embryos form, they are then transferred into the uterus in hopes of implantation and pregnancy.IVF is a complex, multi-step process that allows conception even when natural conception fails. If you’re considering IVF, understanding what’s involved can help you mentally and emotionally prepare. Here, we break down the 5 main stages of the IVF process. Stage 1: Ovarian Stimulation IVF starts with stimulation of the ovaries to produce multiple mature eggs in one cycle, instead of the single egg typically developed each month. The patient undergoes ovarian stimulation by taking a series of fertility medications, either in pill form or by injection. These medications regulate and boost hormones that control ovulation and egg development.During this time, the patient will have frequent blood tests and ultrasounds to monitor follicle growth and development until the lead eggs are deemed ready for retrieval. At that point, ovulation is triggered with a “trigger shot” of human chorionic gonadotropin (hCG). Timing of this shot is critical, as egg retrieval must occur just before ovulation happens. Stage 2: Egg Retrieval Egg retrieval is a minor surgical procedure performed 34-36 hours after the trigger shot is administered. The patient receives IV sedation while the doctor inserts an ultrasound-guided needle through the upper vaginal wall to reach the ovaries. The needle is connected to a suction device that aspirates the follicular fluid containing the eggs from each follicle.The procedure takes about 30 minutes, but expect to be at the clinic for a few hours for before and after monitoring. Most women experience cramping and bloating for a few days post-retrieval, along with spotting. Taking it easy physically while the ovaries recover is key. Stage 3: Fertilization After the eggs are retrieved, they are immediately paired with sperm in a laboratory culture dish and stored in an incubator. A few hours later, the eggs are examined to confirm whether fertilization was successful.If sperm quality or motility is problematic, a process called intracytoplasmic sperm injection (ICSI) may be used for fertilization instead. With ICSI, a single sperm is directly injected into each mature egg to achieve fertilization.Fertilized eggs now become embryos and are allowed to grow undisturbed for 5-6 days. The timely combination of egg and sperm set the stages for the miracle of life. Even at this early stage, these little clusters of cells hold breathtaking potential. Stage 4: Embryo Transfer Usually 3-5 days after egg retrieval, the embryo transfer takes place. One or more chosen embryos are loaded into a thin catheter and gently placed within the patient’s uterus. The procedure requires no anesthesia nor recovery. You can expect some mild cramping and more spotting post-transfer.Selecting which embryo(s) to transfer depends on embryo quality, imaging techniques like PGT-A testing, and how many the parents hope to transfer at one time. Transferring multiple embryos does increase chances of pregnancy but also increases health risks and chance of multiples. It’s a delicate discussion between doctor and parents-to-be. Now begins the “two week wait” as you endure days of wondering, hoping, analyzing every twinge…waiting to take a pregnancy test. Try to take it easy and do relaxing, comforting activities as your embryo(s) hopefully implant into your uterine lining and begin rapid cell division. But know that it’s emotionally taxing for any hopeful parent. Lean on your loved ones during this period and take care of yourself. Stage 5: Confirmation Congratulations! After many years of waiting and this intensive IVF process, you hopefully now are met with two beautiful pink lines confirming pregnancy at last! Should the cycle not result in pregnancy, know that you can explore trying another cycle with your doctor.With a positive pregnancy test, your doctor will monitor you closely through the crucial early weeks before releasing you to standard obstetric care around week 12 if all continues smoothly. After so much striving, loss, and overcoming, celebrate your profound persistence culminating in this hard-won success. You are brave, you are strong – and you will change that baby’s world…as they change yours forever through the gift of life. Conclusion The path to pregnancy through IVF can be complex, lengthy, and emotional. But the promise of new life gives strength for the journey. Understanding each stage allows patients to anticipate what’s required physically and emotionally at that phase. From ovarian stimulation through egg retrieval, fertilization, embryo transfer, and those anxious two weeks waiting—it is quite a rollercoaster. But the profound reward at the end makes each difficult twist and turn worth enduring. If you reach that thrilling positive pregnancy test, congratulations! Now go lovingly cradle your hard-fought miracle as you dream of the wondrous future ahead together as a family. IVF can truly make the deepest wish of so many longing parents come true at last.

How Many Injections for IVF Treatment? Undergoing in vitro fertilization (IVF) treatment involves a complex series of steps to prepare for embryo transfer and pregnancy. A key part of this process is self-administering numerous hormone injections to stimulate the ovaries. If you’re considering IVF, some common questions are: how many injections can I expect? And will the injections be painful? This article provides more detail on the injection protocol. Why Injections Are Given in IVF? Injectable fertility medications allow doctors to precisely control the timing of egg production, development, and maturation. The goals of using injectable medications versus relying solely on your natural cycle include: Stimulating Multiple Eggs – Injections contain follicle stimulating hormone (FSH) to make ovaries produce multiple mature eggs rather than just one per cycle. This provides more targets for fertilization and improves success rates. Synchronizing Development – Injections synchronize your egg growth with your partner’s scheduled sperm sample collection for the fertilization stage. Timing Retrieval – Hormones precisely time final egg maturation to plan the retrieval procedure right before ovulation occurs. This ensures eggs can be collected at peak maturity. Overall, injections offer a major advantage in providing the ovary control needed for a well-timed, well-orchestrated IVF treatment cycle. Step-By-Step Process of an IVF Cycle Before injections even begin, you’ll undergo baseline ultrasound and blood work to evaluate your fertility health status. These initial tests assess ovarian reserve, screen for issues needing addressed before IVF, and gather hormonal baselines.Once cleared to begin, an IVF cycle comprises five main phases: Ovarian Stimulation Self-administer injectable FSH drugs for 8-14 days Stimulates multiple follicles containing mature eggs Dosage customized based on age, AMH levels, prior response Final Oocyte Maturation Trigger shot of hCG hormone given 36 hours pre-retrieval Matures eggs, preparing for release from follicles Egg Retrieval Eggs collected transvaginally under ultrasound guide Anesthesia used for comfort during 15-30 minute procedure Fertilization Eggs and sperm combined in embryology lab Successful fertilization forms embryos Embryo Transfer 1 or more embryos transferred to the uterus Hopeful implantation establishes pregnancy Now let’s take a detailed look at what’s involved in those crucial hormone injections leading up to the egg retrieval process. Step 1: Fertility Injections Protocol Follicle Stimulating Hormone (FSH) Injections FSH stimulates growth of ovarian follicles containing eggs Typical protocols administer FSH injections once daily Started on cycle day 2-3 and continued for 8-14 days on average Dosage individualized based on factors like ovarian reserve May use combination of FSH products to improve efficacy Ongoing monitoring tracks follicle development via ultrasound Potential Addition of Luteinizing Hormone (LH) Might supplement FSH with low-dose LH injections Especially helpful for women over 35 or those with low LH levels Utilizes natural synergistic role LH plays in follicle growth Final Oocyte Maturation Trigger Injection hCG injection given approx 36 hours before egg retrieval Matures eggs and triggers impending ovulation Crucial for precise timing of egg release from follicles Throughout ovarian stimulation injections, your IVF team will monitor you very closely with frequent bloodwork and ultrasounds to track follicle growth and hormone levels. This allows them to time the hCG trigger injection exactly right for peak egg maturity and retrieval success. Potential Side Effects of IVF Injections While generally well-tolerated, IVF injections can cause some unpleasant side effects, including: Abdominal bloating and pressure Breast tenderness Irritability, mood swings Headaches, fatigue Nausea Ovarian hyperstimulation syndrome (rare but serious overresponse) Imbalances in hormone levels from injections make side effects possible. Stay closely looped in with your IVF medical team regarding concerning reactions so your treatment protocol can be adjusted in a timely manner. Are IVF Injections Painful? Today’s fertility injections utilize very thin, short needles that insert painlessly into the skin’s surface. The actual pricks last just seconds and should not cause much – if any – discomfort for most patients.Consider the shots more like a basic vaccination vs. an intensive needle injection into the muscle. Any mild pinching fades quickly. Some tips to make your injection experiences even smoother include: Use an ice pack to numb the skin beforehand Have your partner help with the injection process Inject slowly – no need to rush Vary your shot locations around the abdomen Administer shots after meals or before bedtime Apply gentle pressure with a cotton ball post-injection While the needles may seem intimidating at first, keep your eye on the prize during this short phase! The few moments of pricking and plunging are well worth it for the chance to achieve your dream of building a family through IVF treatment. Conclusion You can expect to self-administer hormone injections 1-2 times daily for an average of 8 to 14 days when undergoing in vitro fertilization. This intensive but temporary injection protocol serves to stimulate the ovaries for developing multiple mature follicles to retrieve during the egg harvest procedure. Exact injection quantities per IVF cycle depend on your age, history, changing hormone levels, and individual response to the medications. Work closely with your fertility doctor to monitor progress through the cycle, making proper dosage adjustments as needed. While the shots themselves should not prove too painful, some women do experience unpleasant side effects that also need to be addressed. Although challenging, keep your eyes on the bright hopes these crucial injections are making possible!