Artemis Woman & Child Centre

Gynaecology, Obstetrics and Child Care

At Artemis Hospital, we understand that welcoming a new guest is a big event to celebrate and our endeavour is to make this welcome a happy experience for the parents. We believe in the concept of natural child birth and promote, protect and support it. We encourage the husbands to provide physical comfort and emotional support through labour and delivery. Starting from the time of conception, we encourage and counsel the couple about leading a healthy lifestyle in pregnancy with nutritious diet, about natural child birth, relaxation and breathing in labour, care of the new born and breast feeding. We have quite a special labour and delivery suites. The environment is quite friendly and home-like to make the lady as comfortable as possible.

Facilities

• Labour Delivery Room (LDR) suites for delivery
• Tertiary level referral NICU & PICU
• Fully equipped to handle any neonatal emergency
• Round the clock care by the Dedicated Gynaecologists & Neonatology Team
• High-end multifunctional monitors
• Equipped with mechanical ventilators
• Double surface phototherapy
• Kangaroo Mother Care: This is a method followed by the advanced neonatal intensive units around the globe to help the low birth weight babies to grow better. Since this technique is taught, the mother can follow the same even after discharge.
• Emergency ICU and Highly Safe Blood Bank backup for the high risk pregnancies
• Natural child birth classes, international certified patient care and infection control protocols

Gynaecology

• Antenatal classes
• Deliveries in LDR Suite
• High risk pregnancies
• Complete pregnancy management
• Breast cancer screening
• Painless deliveries
• Infertility management
• Recognized MTP and Tubal Sterilization Centre
• Open general and complicated gynaecological surgeries
• Laparoscopic surgeries including ovarian cystectomies, hysterectomies and ectopic pregnancies
• Gynaec cancer surgeries

Paediatrics

• Very low birth-weight babies management
• Level II Neonatal ICU
• Critical care for newborns
• Premature babies
• Vaccinations
• Complete paediatric management
• Wheezy child management
• Kangaroo mother care
• Asthma management

Reproductive Medicine & Infertility Treatment

Reproductive Medicine: The field of reproductive medicine was witnessed a technological revolution in the last decade. Applications of new techniques based on a better understanding of reproduction have made it possible to fulfil the dream of motherhood for many. There is no better experience which can parallel the thrill of helping to create human life. However, infertility treatment is not easy and to offer the best to the patient, one has to keep in constant touch with new developments. Artemis has started its services under the expert guidance and we are committed to provide the most advanced treatments available worldwide.

 

A Comprehensive Fertility Program: Counseling and psychological support are an integral part of the IVF treatment program that helps patient to cope with the inevitable stress related to IVF. The Artemis IVF center is sensitive to the many difficult decisions the couples face while undergoing the infertility evaluation and treatment. Hence, providing accurate information to the patients through patient education is one of our highest priorities. A free consultation with the Psychologist is available for all patients going through the IVF treatment. Our IVF Centre is located at the heart of Delhi NCR in Gurgaon, we welcomes your questions regarding our program because we are committed to provide the best medical care and fertility treatment to fully inform group of patients. We think of each couple as members of our team who work towards a common goal for a successful pregnancy.

Our Facilities

• Diagnostic and operative laparoscopy
• Endoscopic procedures
• Hysteroscopic tubal recanalization
• Diagnostic and operative hysterectomy
• 3-4 Dimentional Ultrasonography
• Sonography
• Embryo reduction
• Andrology
• Diagnostic & Interventional sonography
• Sono salpingography
• Computer Assisted Semen Analysis and sperm Morphology
• Andrology
• Sperm Fragmentation Test
• ART
• Sperm preparation for Normospermic and Male infertility patients
• In-Vitro fertilization, ICSI, TESA, IMSI
• Blastocyst Transfer
• IUI (AIH & AID)
• Laser assisted ICSI
• Pre implantation genetic diagnosis
• Laser Assisted Hatching
• Sperm & Embryo
• Cryopreservation
• Oocyte & Ovarian tissue

Special Services at Artemis

• Andrology Service: As per recent surveys, male infertility is probably the largest single cause of infertility. At least half of all human infertility is related to male factor. A complete assessment of the male, sperm function tests and detailed analysis of the seminal plasma are important for a comprehensive evaluation. Presently, knowledge of sperm function and its link to infertility is rudimentary. Since specific tests to determine the fertilizing ability of the sperm are not available, a treatment schedule has been developed. Success of these treatments is based on large clinical trials. Intrauterine insemination is the first step in the treatment ladder and ICSI with ejaculated and testicular sperm is at the top end. Artemis has the latest equipment to do a computer based analysis of sperm motility and morphology. This assessment allows giving a chance score on fertilization, implantation and early pregnancy loss with your sperm.

 

Intracytoplasmic Morphologically Selected Sperm Injection (IMSI): IMSI is a new development to improve the assisted reproduction pregnancy rates. It magnifies sperms up to 6,000 times as compared to the standard 200 to 400 times magnification related to traditional fertilization approaches. It is likely to discard sperm whose nuclei have an abnormal shape or contents. Using it, the optimal sperm is identified and then used for fertilization. This procedure may be a potential alternative to those couples whose semen analysis shows abnormal morphology. It is also known to give better pregnancy rate and lower the abortion rates in patient with male factor in fertility.

 

Sperm DNA Fragmentation Test: Sperm DNA Fragmentation (SDF) is a significant piece of information about the seminal quality. An SDF value exceeding a threshold value of 30% suggests sub-par sperm quality and confers clinicians the power to make informed decisions in their daily practice and take action based on quantitative results. It is a well-established fact that the probability of pregnancy is more if fragmentation is low.

Applications:

• Embryo loss- Repetitive miscarriage
• Unknown Etiology Fertility Failure
• Best donor selection
• To distinguish which couples are suitable for treatment by IUI
• Selection of best seminal samples prior to vasectomy or oncology treatment
• To assess the efficacy of medical interventions or treatment of infectious diseases and varicocele

 

• Assisted Hatching: Prior to implantation, in the normal situation, the embryos must hatch from its shell to attach to the womb. In certain cases, e.g. women with polycystic ovaries, women over 35 years, the outer shell of the egg i.e. zona pellucid may become hardened. This hardening hinders the embryo hatching. The zona pellucid is thinned or opened to facilitate hatching of the early embryo using the help of chemicals, enzymes or laser. At our centre, all the three techniques are available though we prefer to use laser assisted hatching as it reduces the chances of embryo damage.

 

• Blastocyst Transfers: Embryo is cultured for five days in-vitro till it grows to form a blastocyst. In a natural conception, the embryo enters the uterine cavity at this stage of development. The blastocyst transfer helps improving pregnancy rate and reduces the chances of multiple pregnancy, however a large number of good quality embryos are needed to take the patient to blastocyst transfers as some of them may not survive for longer periods in in-vitro culture.

 

In Vitro Egg Maturation: A procedure useful for women with polycystic ovaries in whom the high or low ovarian response to stimulation drugs is always a problem. The eggs are collected without or with minimal ovarian stimulation and then matured in the laboratory. After maturation, ICSI is done for fertilization.

 

Pre Implantation Genetic Diagnosis: This procedure involves taking a biopsy from an 8 cell embryo and then testing it for genetic disorders. This is useful in patients where there is history of recurrent miscarriages, history of genetic disorder in previous pregnancies or in the family, previous IVF failures.

 

• Gamete (Egg & Sperm) Donation & Embryo Donation: Facilities for gamete donation are available at our centre. Detailed screening of the donor is carried out before his/her acceptance into the program. Anonymity of both the donor and the recipient is maintained.

 

1. Donor Insemination (DI): All donors are screened carefully for sexually transmitted diseases, Hepatitis B & C. A detailed history is obtained to rule out the current or past diseases and the inherited disorders. Donors are matched as closely as possible for the physical characteristics to the male partner of women receiving the donor sperm. As per ICMR regulations/ ART bill, the donor anonymity is maintained.

 

1. Egg Donation: Some women are unable to produce their own eggs due to genetic predisposition, hormonal deficiency or other medical conditions. Others choose to have egg donation as they carry a genetic illness which may be passed on to any babies born or recurrent miscarriages or they have poor quality eggs. Through egg donation, these women get the opportunity to give birth. The recipient who receives the donated eggs is treated with hormones to prepare the lining of the uterus to receive the embryos. Eggs are recovered from the donor who has to go through ovarian stimulation to form multiple eggs and then they will be recovered under anaesthesia under the ultrasound guidance. This entire procedure is done vaginally. The sperm from the recipient’s husband is used to inseminate the eggs either by ICSI or IVF technique. The resulting embryos are transferred two to three days later to the recipient’s uterus.

 

1. Embryo Donation: Some couples are unable to produce their own genetic gametes due to a variety of reasons. In such cases, both the donor sperms and donor eggs are used to produce a donor embryo. The woman’s uterus is prepared with the hormonal tablets to receive the embryo.

 

• Surrogacy (Renting a Womb): It involves implantation of the couple’s embryo into the uterus of another woman who agrees to give birth to the child. Artemis hospital runs an efficient and ethical surrogacy programme.

 

• Cryopreservation (Freezing and Storage):

 

1. Cryopreservation (Freezing and Storage) of Embryos: Following IVF, maximum three to four embryos are transferred in each cycle. The remaining embryos must be frozen for embryo transfer at a later date. Only the good quality embryos may be frozen as they have better survival rate on thawing. It is significant to note that even the good quality embryos may not survive the freezing and thawning process. Currently we are using the latest technique in cryopreservation called as vitrification.

 

1. Cryopreservation (Freezing and Storage) of Sperms: The preservation of sperm by freezing is now a fully accepted routine procedure. Though not lal, but most samples can be frozen or preserved for a long period and thawed without loss of fertility. Patients who are going through an IVF or ICSI cycle, the semen is cyropreserve dbefore commencement of the cycle. This is vital because at times, the husband is unable to give sample on the day of egg retrieval due to stress or sudden illness. This facility also allows women to continue their treatment cycles when the partner is not available. Oocyte and ovarian tissue freezing has been started at Artemis for Fertility Preservation in Cancer patients.

 

1. Frozen Embryo Replacement (FER): Preferrably, the replacement of frozen embryos is carried out after treatment with the hormone replacement therapy (HRT) or in a spontaneous ovulatory cycle. Hatching or zona thinning in these embryos will improve the implantation rates. You can also opt for this procedure.

Frequently Asked Questions

Does the women’s age have an effect?

 

Yes, age has a very important effect since there is a gentle but steady decline in establishing a pregnancy after the age of thirty in Indian Women.

What about my particular infertility problem?

There are difference in the success rates which depends on the causes of infertility such as endometriosis, tubal factors, unexplained or anovulatory infertility and male factor. You will have detailed discussions about your special circumstances.

How many attempts should we have?

Since every couple is different, the answer to the question will inevitably depend on the specific treatment you have had and the results of the preceding treatment cycles. It is believed that the IVF success optimizes in three cycles. During consultation or at a review appointment, decisions on how to proceed will be discussed in detail with you.

How many times in a cycle will I have to come to the clinic?

This will vary from patient to patient and also according to the stage for treatment. For example, in a DI or UI (H) cycle, there will be 2 to 4 likely number of out-patient visits and for IVF or ICSI it is 4 to 5. During these vists, the egg and endometrial development will be check and you will be advised for some blood tests to assess the egg maturity and decide on the drug dosage. The first visit is on Day 2/3 of the cycle, ultrasound is done to rule out any residual ovarian cysts and to check for the endometrial thickness. The drug administration is withheld in case these parameters are not within the needed limits.

 

Generally, the egg recovery is carried out under anaesthesia unless you choose ot have it under sedation and you need to be in the hospital for half a day. You need to come in with a full bladder for embryo transfer and you will be asked to rest for a couple of hours in hospital post the transfer.

What are the risks for assisted conception pregnancies?

The risk of abnormalities for the assisted conception pregnancies does not appear to be greater than with normal conception. There is an increased risk of sex chromosome related anomalies with procedures such as ICSI because in patients with severe male factor infertility, the abnormality existing in the male partner is carried forward. It is vital to note that some techniques are quite new and a detailed follow up data is not yet available.

Is there an increased risk of malignancy?

Present knowledge does not show any definite increased risk of malignancy. The scientific communities across the world are looking into this matter and we will keep you updated with the results. Women with a family history of ovarian malignancies should limit the exposure to the ovarian stimulating drugs.

What happens if treatment is not successful?

Rest assured as we shall make every endeavour to care for you and help you to cope up. Since ART has made a tremendous progress during the last few years, there will certainly be a treatment which will be beneficial for you.

Tubal Surgery

Tubal surgery was the only way to correct tubal problems, before IVF became available. These days, the surgery of the tubes has limited place in the management of the infertile couples. However, in selected cases this procedure is invaluable and both the endoscopic or key-hole surgery and the tubal microsurgery can be done.

Who is a Candidate for IVF (In Vitro Fertilization) and ART?

Assisted Reproductive Technologies (ART) includes IVF which is technique to fertilize a woman’s egg in the laboratory. Although it was originally designed for women with tubal diseases, IVF has been extended to equal success to infertility due to poor cervical mucus, endometriosis, male infertility and unexplained factors.

How do I know if ART can help me?

To decide whether IVF or any other treatment is appropriate for you, first get a thorough evaluation done by the infertility specialist who is familiar with ART. Usually, the tests which are done previously may not be repeated as long as the past records are available. If another approach offers you an equal or greater chance of success, then the alternative therapies will be presented to you. These options include hormonal supplementation, ovulation induction, opening of the blocked fallopian tubes and sperm washing and intrauterine insemination.

What should I expect?

IVF is a complex process comprising of several steps. First, fertility drugs will be given to stimulate the ripening of several eggs. The blood tests and ultrasound examinations will allow the precise monitoring of the egg development. At the suitable time, a non-surgical procedure will be done under anesthesia or light anaesthesia called as ultrasound guidance in which the eggs are retrieved. Then the sperms will be added to the eggs in the laboratory wherein the fertilized eggs will develop for two to three days. In case of the micromanipulation for male infertility, a single sperm is injected into the egg ICSI (Intra Cystoplastic Sperm Injection). At last, the fertilized divided egg or embryos will be placed in the womb through a simple non-surgical procedure similar to a pelvic exam. A mock embryo transfer is done before starting the cycle to ensure that no problem is encountered on the day of the actual embryo transfer.

 

A pregnancy test will be done two weeks post the embryo transfer. All this is done on an out-patient basis.

What are the risks of ART?

So far, the associated reproductive procedures have remarkably proven safe for both would be mother and her child. The spontaneous abortion rate is higher in the general population which is not due to the procedure; instead it is due to the inherent problems in the patient which led to infertility in the first place. There is an increased possibility of multiple births that can be limited by the number of embryos transferred. If all the routine parameters are normal, there is no difference in the pre-delivery management and the mode of delivery0 vaginal/caesarean section.

Process Through the IVF Treatment Cycle:

Unfortunately, not all couples proceed smoothly through every treatment cycle. The response of the body to fertility drugs varies not only in different patients but also from cycle to cycle in same patients. In some cases, the treatment cycle has to be discontinued due to the following reasons:

 

• Poor endometrial or uterine lining growth
• Failure of fertilization
• A poor response to the drugs- less than four follicles

 

Some couples may not achieve fertilization with the conventional IVF. These patients have to go for procedures such as ICSI. The fertilization rates are higher with ICSI as the sperm bypasses the zona barrier. In patients with low response that is, six eggs ICSI is advisable to ensure the embryo transfer. There are numerous hurdles to cross and at Artemis hospital, we will do our best to help you overcome each one.

What are the chances of success with ART?

The success rate or chances of taking home a baby in one treatment cycle varies dpending on various factors of which the most significant factor is the age of the female partner. During consultation, you will be advised of your specific chances. The average pregnancy rate is 35 to 40% and 70% for oocyte donation cycles. The pregnancy rates vary depending on the cause of infertity and age of the patient, the younger patients do better than those over the age of 35.

Artemis Special Children Center (ASCC)

ASCC is a collaboration of many providing comprehensive care for children. Our department focus on the trans-disciplinary approach enabling the patients to avail the services of all the concerned professionals with the paediatric rehabilitation under a single roof. These disciplines include:

 

• Speech therapy
• Orthotics
• Physiotherapy and occupation therapy
• Orthotics

 

Our center is central to a specific network of health professionals who are dedicated to the treatment of cerebral palsy such as:

 

• Paediatricians and developmental paediatricians
• Visual rehabilitation specialists
• Orthopedic surgeons
• Neurologists
• Neurosurgeons
• Dieticians
• Ophthalmologists
• ENT specialists

 

Early detection and early intervention is the hallmark of ASCC:

 

• Early Detection- The early pick up of delay in a child’s development
• Early Intervention- The exercises given to achieve a near normal development

 

The earlier the detection, the better the intervention! Our team aims to provide the best possible rehabilitation services ensuring that each of our patient’s goals are achieved and with maximum potential.

When does a child need therapy?

• Any congenital problems or syndromes leading to the delay in development
• Any adverse events before or during delivery
• Signs of disturbances in movement either due to biomechanical constraints or neurological deficits
• Stiffness noted in hands or legs
• Delay in achieving head holding, crawling, walking, etc.
• Asymmetrical performance of activities such as using one hand more than the other
• Throwing of head backwards
• Crossing of legs
• Delay in achieving speech
• Disturbed sleep patterns
• Frequent falls
• No social smile
• Poor balance and co-ordination
• Feeding problems
• Attention deficits/ hyperactivity
• Lack of communication
• Refusal to approach or play with the toys
• Writing problems

What is Cerebral Palsy?

Cerebral Palsy or CP is used to describe a group of chronic conditions affecting the muscle coordination and body movement. It is caused by the damage to one to more specific areas of the brain, usually occurring during the fetal development, before, during or shortly after birth or during infancy. Hence these disorders are not caused by the problems in the nerves or muscles. Cerebral refers to the brain while palsy refers to the muscle weakness or the poor control. It is:

 

• Non-communicable
• Secondary conditions such as muscle spasticity can develop
• Training and therapy can help to improve the function
• It is not a disease

 

The treatment options available for your child are:

 

• 0-2 years: Neurodevelopmental Therapy
• 2-6 years: Neurodevelopmental Therapy/Botulinum Therapy/ Orthotics
• 6 years and above: Neurodevelopmental Therapy/ Surgery/ Botulinum Therapy

What is Neurodevelopment Therapy?

• Therapy is given by specialists who have had specific training in NDT
• Advanced hands-on technique for examination and treatment of individuals with cerebral palsies and development delays, etc.

How does it help?

• Modifies postural control and improves function
• Improves the range and variety of movements
• It is the best way to offer therapy to a child
• Reduces the effect of fluctuating muscle tone
• Helps to reduce the intensity of spasticity

Our Team of Specialists

Obstetrics & Gynaecology

 

Dr. Veena Bhat- Director

Dr. Anjali Kumar- Head

Dr. Renu Raina Sehgal- Sr. Consultant

Dr. Urvashi Rathee- Sr. Consultant

Dr. Geeta Baruah Nath- Sr. Consultant

Dr. Smita Vats- Consultant

Dr. Padma Dudeja- Consultant

Dr. Asha Sharma- Consultant

Paediatrics

Dr. Prabhat Maheswari- Head Paediatric/ Neonatal Intensive Care

Dr. Rajiv Chhabra- Head

Dr. Hemant K Gogia- Sr. Consultant

Dr. Puja Grover Kapoor- Paediatri Neurologist

Dr. Himani Narula Khanna- Consultant

Dr. Padam Yadav- Consultant

Dr. Rajesh Kumar- Consultant

Reproductive Medicine

Dr. Ila Gupta- Head

Dr. Sarabpreet Singh- Clinical Embryologist

Dr. Sonu Balhara- Consultant