Colour Doppler Scan
It helps us to diagnose very early fetal compromise in Intra Uterine growth restriction, enables us to manage them while within the uterus by replacing fluids and nutrients and also, is a deciding factor in determining the time of delivery of such critical fetuses. By the help of this Colour Doppler and Foetal Therapy, we were able to save very many babies and in particular with cases of previous 2 and 3 consecutive Intra Uterine Death as well. In addition to this, we employ it to assess the vascularity in neoplastic conditions to rule out the possibility of malignancy and use it in ART procedures to determine the time of embryo transfer and assess the quality of follicles, thus prognosticating the success rate in IVF procedures.

3D 4D SCAN

The VOLUSION 730 scanner helps to sort out complex structures quickly. It offer much benefit in the evaluation of suspected fetal anomalies, growth reduction etc. Having the Voluson 730 in our office drives satisfaction not only with our staff but also with the patients we care for patients appreciable being able to visualize their babies moving three dimensions . With other systemds, 3D reconstruction were tedious and time consuming . The voluson 730 gives us the high quality 3D and real time 4D instantly. The Voluson 730 allows me to see and evaluate fetal movement unlike any other ultrasound system on the market. Beyond this outstanding 3D the voluson 730 delivers competitive high end 2 Dimage resolution.

Total Infertility Evaluvation

Includes detailed clinical examinations of both the couples. Necessary fertility hormone assay depending on the cases.
Trans vagainal scan for the female partner and detailed semen analysis including his morphologic evaluation with Krugar strict criteria.
All these can be done in one or two sittings. So that a complete diagnosis can be arrived at and also the future plan of action can be charted out.

Endoscopic Surgery

Also known as Key hole surgery is a day – care procedure where in we can visualize all the internal reproductive organs like Uterus, tubes, ovaries, Pelvic Peritoneum etc.And any diseases or fault in any of these can be corrected in the same sittings. We were the first in the state to have the full fledged Video Endoscopic system and we started in 1990 and till now we have completed more than fifteen thousand procedures of these about 70% are of Infertility problems and 30% are of Gynaec problems. The largest uterus removed at laparoscopic Hysterectomy weighed about 2.5 Kg, which is a record in the history of laparoscopic surgery. The oldest women we did aged 88years for a large ovarian cyst. The heaviest ovarian cyst we removed through laparoscopy weighed about 8 Kg. All the 5 consultant here do the Endoscopic procedures but mainly in the hands of Dr.Ashraf, Dr.Narendranath, & Dr. Subhash.


The common Endoscopic procedures that we do here are.

1. Diagnostic Laparohysteroscopy
2. Endometriosis surgery
3. Ovarian cystectomy, ovariotamy and PCO drilling
4. Myomectomy
5. Total hysterectomy
6. Reversal of sterilizations
7. Tubal cannulation and Tubal ligations
8. Stress incontinence surgery
9. Laparoscopic cervical circlage for repeated pregnancy loss.
10. Hysteroscopic septum resection and Adhesiolysis.

Intra-Uterine Insemination [ IUI ]
Medical and surgical treatment of male infertility is very limited. Only in cases of men with very low fertility addition of hormones like FSH, LH, TESTOSTERONE, or drugs will be beneficiary. In all other cases it is of very limited value.

If there are grossly enlarged veins around the scrotum (Varicocele grade II or grade III) microsurgical excision of these varices will help in improving the count and motility.

Antibiotic treatment for infections in semen will improve the motility and agglutination. In spite of all these, if the count, motility and morphology are not up to the mark or if the PCT (post coital test) shows absent or very few sperms in the cervical mucous even in the presence of normal semen profiles, it is better to do IUI rather than spending time in taking medicines, which have only Placebo effects. We never give them medicines for more than 3 to 6 months.

If the wife is found to be normal, we stimulate her ovaries with tablets or injections, so as to produce more than one egg and when she is ovulating (picked up by scan) we ask the husband to collect the semen and give it to the Andrology lab. In the lab, the semen is processed by different methods depending on that particular semen parameters. Then we keep this processed semen in the incubator for 1 to 2 hours. During this time the best sperms will move to the top and weak and dead sperms along with other contaminators will settle down. Then, good and motile sperms are picked up from the top and through atraumatic way it is transferred into the uterine cavity after preparing the uterus. This is called IUI. We have been doing it since 1990. Our success rate per cycle is 18 to 20%. The same procedure in different way may be used to select ‘Y’ bearing sperms so as to achieve a male baby (success rate is 70%)

We arrive at a working diagnosis following 2-3 visits during which time the following have to be done.

1. Detailed female evaluation with atleast 2 consecutive scans to assess anovulation, pelvic factor
or response to hormones.
2. Male factor workup.
3. Hormonal assay when indicated.

IVF-ICSI
If the semen sample is very poor that even after semen preparation the count and motility and morphology are too low, then there is no point in repeating IUI. In such cases and in patients who have no sperms in their semen but live sperms can be collected from the testicles,(ICSI) Intracytoplasmic sperm injection is employed to get pregnancies.

Other indications for IVF ICSI

1. Tubal block
2. Anovulation
3. Pelvic endometiosis
4. Unexpected infertility


ASSISTED HATCHING

Assisted hatching is advantageous to those who have a history of failed IVF or ICSI. If the female partner is above the age of 35, the ovum is likely to have a thick outer layer (thick zona). Inevitably the covering layer of the embryo will also be thick. In such circumstances a hole is made on the outer layer of the ovum using the precision glass needle of a micromanipulator, after which the embryo will be able to break open the outer layer.

This treatment can be conducted using a laser beam or even acid tyroid.

The state first Assisted hatching pregnancy came from CRAFT in a 43-year-old lady who had one abortion following ICSI in 2001 and in the second attempt in 2002. She delivered a girl in 2003 after assisted hatching.

IVF
After assessment of both partners, we stimulate the ovaries of the female partner with hormone injections so that we may get 10-12 eggs. When the eggs are mature as evidenced by scan and by blood E2 test, they are transferred from the ovaries by a special technique, under trans-vaginal scan guidance. This is done under general anesthesia. These eggs are then examined in the IVF laboratory by the embryologists and assessment of their maturity and quality are done. If it is for IVF, for each egg about 1,000,000 good sperms are inseminated and kept in the Co2 incubator for about 14-16 hours. In ICSI, into each egg one high good looking sperm is injected and is then kept in incubator for 14 to 16 hours.

So the advantages of ICSI over IVF are:
1. Very few number of sperms is required. These sperms may be collected from semen or from the epidydymis or from testicles in Azoospermic men.

2. In IVF the fertilization rates is 50 to 60% where as in ICSI it is 80 to 100%. So at the end we will have more number of embryos and the excess left behind after Embryotransfer may be frozen for Cryopreservation to be used after some time.

3. The quality of embryos are better after ICSI than after IVF and the implantation rate and consequently the pregnancy rate is also higher after ICSI. Because of all these factors we always prefer to do ICSI rather than IVF.

4. Unexplained infertility: One major cause of infertility in unexplained infertility may be fertilization failure. This can be corrected only at ICSI.

Our success rate after IVF is 17% and after ICSI it varies from 30% to 40% in different batches. The 1st PESA ICSI and TESE ICSI pregnancies in the state of Kerala are from CRAFT.

Sperm freezing and Embryo freezing
CRAFT is equipped with the latest version of freezing machines from PLANER-U.K, a highly sophisticated freezing machine with very high survival rate. Semen in case of husbands working abroad or males who cannot give the sample on demand are frozen, to be used for ICSI later on. If there are excess embryos left behind after transfer they also can be cryo-preserved and used later on. Chromosome analysis and karyotyping Peripheral blood culture used for chromosome analysis
Indications
1. Repeated pregnancy loss
2. Azoospermic cases
3. Severe oligospermic cases
4. Identification of syndromes like klinefetter syndrome, down syndrome etc.

Prenatal Diagnosis & Genetics
Chorionic villi sampling, Amniocentesis and foetal blood sampling are used for chromosome analysis of the foetus.
Indications
1. Advanced maternal age
2. Previous child with a de novo chromosome abnormality
3. Presence of structural chromosome abnormality in one of the parents.