How to become Pregnant

IN VITRO FERTILISATION (IVF)

IVF literally means fertilisation outside of the body. The technique was pioneered through the 1970’s by Patrick Steptoe and Professor Robert Edwards. Since the birth of Louise Brown, the first test-tube baby in 1978, IVF has resulted in over 1.5 million babies worldwide. Pregnancy rates and live birth rates have improved over the past few years, leading to a steady increase in the number of IVF treatment cycles performed worldwide.

There are several groups to whom IVF treatment may be advised that include:

• Women with blocked or damaged Fallopian tubes, inoperable tubes or whose tubes have been removed after ectopic pregnancies.
• Women with endometriosis.
• Women with ovarian disorders.
• Men with infertility problems.
• Couples with unexplained infertility.

Steps of IVF

IVF essentially involves four main steps.

1. Ovarian stimulation: The woman is given fertility medications to stimulate her ovaries to produce many follicles; the small fluid filled structures, which develop in the ovary. Each follicle should contain one egg. The chances of pregnancy are increased if more than one egg can be obtained and fertilised.
During this phase the development of the follicles is monitored using blood tests and by visualizing the ovary by ultrasound.
2. Egg retrieval: The eggs are collected from the follicles using the vaginal ultrasound probe with an attached guided aspiration needle under sedation/local anaesthetic.
3. Insemination: On the morning of the egg-collection, the man produces a sperm sample by masturbation. The best sperm are then selected using a sperm wash technique and each egg is inseminated with prepared sperm. The eggs are inspected for signs of fertilisation the next morning.
4. Embryo Transfer: Embryos are placed into the uterus using a small catheter. This is usually performed 3 days after egg retrieval.


N.B. If an excess of embryos are present on the day of embryo transfer these can be frozen to be used at a later stage. About 30% of couples have embryos remaining to freeze. (See section on FET)

Knee Replacement

Total Knee Replacement in India

How the knee replacement is performed, What happens during knee replacement surgery?
When a knee replacement is performed, the bone and cartilage on the end of the thigh bone (femur) and top of the shin bone (tibia) are removed. This is performed using precise instruments to create exact surfaces to accommodate the implant. A metal and plastic knee replacement implant is then placed to function as a new knee joint. Depending on the condition of the cartilage on the undersurface of the kneecap, this may also be replaced.


Selecting the Type of Knee Replacement Implant :

Different companies manufacture different types of knee replacement implants. Your doctor will select a particular implant for your knee replacement. There are two basic types of implants:

- Cemented Knee Replacements :

The most commonly used knee replacements are cemented into the bone. Cemented implants fit very nicely into position, and are immediately solidly fixed into the bone.

- Press-Fit Knee Replacements :

Press-fit implants are designed with a rough surface that bone can grow into. Over time the surrounding bone grows into the implant holding it solidly in position.

What is the knee replacement implant made of?

There are four parts to most knee replacements. The components are:

- Femoral Component
Fits on the end of the thigh bone, made of metal.

- Tibial Component
Fits on top of the shin bone, usually made of metal.

- Patellar Component
Replaces the cartilage on the undersurface of the kneecap, made of plastic.

- Plastic Insert
Fits between the femoral and tibial components. The metal used is usually Cobalt-Chrome, and the plastic is polyethylene. There are variations to this standard type of implant. New metals are being tested to improve the results of the press-fit implants. Also, some surgeons use a plastic insert that combines the tibial component and plastic insert (a so-called 'all-poly' tibial insert). You can discuss the specific implant with your doctor.

What is a rotating knee replacement?
Rotating knee replacements have been advertised recently on TV and in magazines. These implants are designed to more closely replicate normal knee motion. Unfortunately, the rotating knee replacements have not been shown to increase the longevity of the implant. Studies are currently taking place to determine if these rotating knee replacements may be better than standard knee replacements.

How long does it take to perform a knee replacement?
Knee replacement surgery itself takes about 90 minutes, but time in the operating room is longer. You are left with about an eight inch incision over the front of the knee. The incision is most commonly closed with metal clips called 'staples.' These clips remain in the skin for about two weeks and are then removed in the office. Removal of the metal clips is almost pain-free.