Advanced IVF Techniques
PGT-A, ERA, and Hysteroscopy
Beyond Standard IVF — When Advanced Techniques Make The Difference
The Majority Of IVF Cycles Are Successful Without Requiring Additional Advanced Diagnostic Or Treatment Techniques. However, There Is A Subgroup Of Patients – Those With Recurrent Implantation Failure, Recurrent Miscarriage, Advanced Maternal Age, Or Specific Risk Factors – For Whom Standard IVF Alone Is Not Sufficient. For These Patients, Advanced Techniques That Provide Additional Information About Embryo Genetics, Uterine Receptivity, Or Intrauterine Anatomy Can Make The Critical Difference Between A Failed Cycle And A Successful One.
PGT-A – Preimplantation Genetic Testing For Aneuploidies
PGT-A Is A Technology That Allows Embryos To Be Tested For Chromosomal Abnormalities Before They Are Transferred To The Uterus. A Few Cells Are Biopsied From The Trophectoderm (Outer Layer) Of The Blastocyst On Day 5 Or 6 Of Development And Sent For Chromosomal Analysis. The Result Identifies Embryos That Are Euploid – Chromosomally Normal – And Those That Are Aneuploid – Chromosomally Abnormal. Only Euploid Embryos Are Selected For Transfer.
The Benefits Of PGT-A Are Most Significant For Women Over 37, For Couples With A History Of Recurrent Pregnancy Loss, And For Couples Who Have Experienced Multiple Failed IVF Cycles Despite Apparently Good-Quality Embryos. Reduction of miscarriage rates and cycles needed to achieve a live birth are the primary clinical goals.
ERA – Endometrial Receptivity Analysis
Implantation depends not only on the quality of the embryo but on the readiness of the uterine lining (endometrium) to receive it. The period during which the endometrium is receptive to embryo implantation is called the window of implantation, and it occurs at a specific point in the hormonal preparation of the uterine lining. In most women, this window occurs at a predictable time. In a small but significant proportion of women — estimated at around 25 percent — the window of implantation is displaced.
ERA testing involves taking a small biopsy of the endometrial lining at the time when the embryo transfer would normally occur, and analysing the genetic expression profile of the endometrial cells. ERA is recommended for women with two or more failed transfers of good-quality embryos despite an apparently healthy uterus.
Hysteroscopy Before IVF — A Practice That Changes Outcomes
Dr. Krishnakumar has a consistent clinical practice of recommending diagnostic hysteroscopy for all new IVF patients before their first treatment cycle. This recommendation is based on a body of evidence — and on the clinical experience of forty years of IVF practice — that a significant proportion of women presenting for IVF have correctable intrauterine pathology that is clinically silent but significantly impairs IVF outcomes.
Studies have shown that intrauterine pathology — endometrial polyps, small submucosal fibroids, uterine septa, or intrauterine adhesions — is present in 15 to 40 percent of women presenting for IVF. Many of these abnormalities are not visible on standard transvaginal ultrasound. They are only reliably identified by hysteroscopy.
The hysteroscopy itself is a brief outpatient procedure — typically 15 to 20 minutes — performed under light sedation or paracervical block. In Dr. Krishnakumar’s hands, with 75,000+ endoscopic procedures behind him and the only ECRES certification in India, it is performed to the highest technical standard. The identification and treatment of intrauterine issues can make the difference between a failed cycle and a successful pregnancy.
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