Fertility Plus

Embryo transfer is the step in the IVF process where the embryo is transferred back into the uterus. This is probably the most critical part of IVF as it is the moment that establishes the pregnancy.

Anti-Mullerian Hormone (AMH) hormone is a hormone produced by the ovarian follicles, therefore levels of AMH often relate to the number of antral follicles in the ovary but AMH levels in isolation depict the remaining lifespan of the ovaries, ie how much time is there left.
The level of AMH in the blood can thus indicate how many egg-containing follicles are available in the ovaries with the potential to ovulate. In other words, the AMH level can tell us the size of the ‘ovarian reserve’.
AMH declines naturally with age and high levels can suggest polycystic ovaries, which is important when considering fertility treatments such as IVF.

Embryo transfers are probably the most critical part of IVF where success is determined by the fine technique in which embryos are transferred, developed by precision and improvement in techniques. Difficult embryo transfers occur once in a while and it is known that difficult embryo transfers also lower the chance of pregnancy.
In analysis of 7714 cases published in the journal, the team looked at different aspects of difficulties in embryo transfers and suggested that with every additional manoeuvre which was to be conducted to overcome a difficulty in embryo transfer, success rates steadily kept dropping, thus this fine touch is essential, which is cultivated through many years of doing embryo transfers, and remains a very crucial step in improving the chances of pregnancy.

Checking for rubella immunity with a simple blood test is strongly recommended before you start trying for a baby. If you have not been immunised for Rubella, or have lost immunity, the simple solution is a Rubella vaccine jab. Then, after a month your blood levels can be checked and, if satisfactory, you can start trying for a baby straight away.

One of the most important features of our care is that you are able to talk to your consultant personally, on their mobile, whilst undergoing your fertility treatment cycles. We believe that this is unique among existing Harley Street practices.

These are some common misconceptions associated with male fertility issues: Lack of libido indicates male fertility issues: No, a lack of libido is not a sign of poor sperm but may cause infertility by less sexual intercourse. Abstinence improves sperm quality: No, evidence suggests that sperm DNA may improve if long periods of abstinence are avoided. At Fertility Plus we offer a male fertility test that will help determine if there are fertility issues associated with the male partner and that nature of the specific fertility issue.

PCOS is very common, occurring in about 15% of the female population in the reproductive age group. The symptoms may include any or all of the following: excess hair growth (hirsutism), persistent acne, irregular periods and infertility. It is frequently associated with being overweight which makes the symptoms more severe but is equally seen in women of normal weight. There is often a family history of PCOS as it is thought to be caused by a combination of genes which over ...express themselves to produce the symptoms. The term polycystic ovaries describes ovaries that contain many small cysts (about twice that of normal ovaries), usually no more than 8mm each. These cysts are egg containing follicles that have not developed properly due to a number of hormonal abnormalities. The basic problem is that the ovaries are producing too much of the male hormones, androgens. Although every woman in their reproductive years produces androgens, the symptoms of PCOS appear when an excess of these hormones (particularly testosterone) are circulating. The first symptoms usually appear at the time of puberty and may be particularly severe when associated with overweight. The diagnosis may be made on the symptoms alone but an ultrasound examination of the ovaries and some simple blood tests are usually performed. The good news is that once the diagnosis has been made, there are many ways to treat the syndrome, mainly depending on the objective of the treatment with a very high degree of success. Mr Gudi and Mr Shah have a huge experience in the research and the treatment of polycystic ovaries with extensive research done, in addition in India over the past 10 years.
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Through the ages we have been triggering ovulation at 18 mm size follicle. Surprisingly all this has been standardised, and all the evidence which has been obtained has been obtained on the basis of studies done in the 1980s and 1990s. In fact many of the studies were done on those of IVF rather than on Clomiphene or Letrozole. In an analysis of 988 cycles published in Fertility and Sterility, in a retrospective analysis they looked at the best time to trigger ovulation, rather than triggering at 18 mm, triggering at 22 and 23 mm seemed to give the best chance of success as well as improving the endometrial lining. By waiting for follicles to grow larger, the endometrial thickness varied and improved, thus it may be important to wait and trigger ovulation around a slightly later time so as to improve the chances of pregnancy.

It is always lovely to hear that our patients have had such positive experiences.
Here’s a review from one of our patients: “I can not recommend highly enough Dr Gudi. His skills, knowledge and expertise are excellent. He is honest, objective and he supports his patients on this challenging journey. He helped us have our beautiful daughter when our chances were very slim. We will be eternally grateful to him. His team is very professional and efficient.”

Aspirin has often been given to women undergoing IVF with the hope that it improves blood flow of the endometrium and allows the embryo to implant.
In the study in 2011 in Human Reproduction, ten studies were looked at in which aspirin was given and it confirmed that it did not improve blood flow in IVF patients and it did not improve pregnancy rates. There is some evidence that aspirin prevented the occurrence of preeclampsia during pregnancy, though the evidence is small.
It is concluded that aspirin does not improve pregnancy rates in IVF and its routine prescription in IVF cycles is not good.

An analysis of 7714 cases published in the journal, a team looked at different aspects of difficulties in embryo transfers and suggested that with every additional manoeuvre which was to be conducted to overcome a difficulty in embryo transfer, success rates steadily kept dropping. Therefore this fine touch is essential, which is cultivated through many years of doing embryo transfers, and remains a very crucial step in improving the chances of pregnancy.

Candidates for sperm freezing include: Men who are about to undergo surgery, chemotherapy or radiotherapy that may impair their future fertility. Men who have very few sperm or perhaps are producing sperm that show evidence of deterioration over time. Men who have difficulty producing a sample on the day of treatment and so banking some sperm in advance can overcome this difficulty. Surplus sperm obtained following surgical sperm retrieval (PESA/TESA).

The empty follicle, or not getting any eggs on an egg collection is one of the most distressing things that can happen during a cycle. Often not discussed but it does occur. There are three types of empty follicle syndrome; those in which there are no eggs in the follicles, which occurs in women with low AMH and older women, while there are some which are genuine, where there is a failure to obtain eggs even after there is a good follicular development and adequate trigger i...s given. On the other hand, there are cases in which there is a very low amount of HCG trigger which causes faults. In a case presented in human reproduction they evaluated a woman who underwent nine cycles of IVF with HCG trigger. In the eighth cycle there were no eggs, in the ninth cycle an analogue trigger was given 40 hours before and a double trigger was done, and 16 eggs were obtained after eight cycles of IVF, thus signifying that sometimes changing the trigger significantly changes the outcome of pregnancy.
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Fallopian tubes are an integral part of natural conception as the sperm and egg meet and fertilise in the fallopian tube and then transported by tube to the womb for implantation. Any damage or blockage in the tube could interfere with natural conception. Fallopian tubes should be open and healthy and there should also be no adhesions present that might prevent an egg from having access to either tube from the ovaries. A tubal patency test can be undertaken by either by hyst...erosalpingogram (HSG), Hycosy or by a laparoscopy. Fallopian tubes are an integral part of natural conception as the sperm and egg meet and fertilise in the fallopian tube and then transported by tube to the womb for implantation. Any damage or blockage in the tube could interfere with natural conception.
Tubal patency can be checked by HSG- Hysterosalpingogram or HYCOSY- ultrasound guided dye test in a clinic without the need of anaesthetics. Laparoscopy still remains the gold standard and offers more detailed analysis, but requires a general anaesthetic. Laparoscopy also offers the significant advantage of correcting any blocks, if possible, during the same operation.
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So far there have been no proven health risks associated with egg freezing. Babies that have been born from thawed eggs are healthy.

As egg health depletes over time, for women wanting to preserve fertility, egg freezing should be undertaken prior to 40 at the latest in order to ensure freezing of healthy eggs. The evidence of successful egg freezing after this age is limited.

Mr Gudi and Mr Shah are currently in Bangkok teaching IVF and reproductive medicine to senior specialists 🌏📚