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 Company Introduction
Biogenist (Pvt) Ltd started its operation in the year 2004.

It is a part of a group of companies engaged in diversified businesses.

Our initial focus is on the specialty of Obs / Gynee particularly Infertility

Management.

Biogenist has also entered into the Branded Generic Segment with the aim of
providing effective & economical medicines for the entire community.

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Vision

By 2016 Biogenist will be known to

the Practicing Gynecologists as a
company caring the entire basic
healthcare needs of a common
person.

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 Our Working Spectrum

All Infertility Centers of Pakistan

• Lahore Institute of Fertility & Endocrinology (LIFE) – Lahore
• Australian Concept Infertility Medical Center - Karachi
• Baqai Institute of Reproductive Sciences (BIRDS) – Karachi
• Sind Institute of Reproductive Medicine (SIRM) - Karachi
• Islamabad Clinic Serving Infertile Couples (Pvt) Ltd - Islamabad
• Infertility Services (Pvt) Ltd - Islamabad
• Gynecological Advisory Services - Islamabad
Aga Khan University Hospital
Armed Forces Institution of Pakistan
Practicing Gynecologists

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 Biogenist Pharma

Chief Executive
Officer

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THANK YOU
Biogenist Pharma (Pvt) Ltd
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 Infertility is a very common condition affecting
approximately 13-14% of couples in the reproductive
age group.
 Although this prevalence has remained stable over the
last few years, the demand for infertility services has
increased substantially.
 This increase is due primarily to the Baby Boom
generation entering into the reproductive age group at
a time of highly publicized technological advances.

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 Definition of Infertility & ART
 Common causes of infertility
 Who is eligible for ART
 Methodology of ovulation induction
 Improving SPA
 Other techniques
 Counseling couple
 Failure rate
 Cost effectiveness

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 Infertility is defined classically as the inability to
conceive after 1 year of unprotected intercourse.
This definition is based on the cumulative
probability of pregnancy:

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Month Monthly Probability Cumulative Probability

1 0.2 0.20
2 0.2 0.36
3 0.2 0.49
4 0.2 0.59
5 0.2 0.67
6 0.2 0.74
7 0.2 0.79
8 0.2 0.83
9 0.2 0.86
10 0.2 0.89
11 0.2 0.91
12 0.2 0.93

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 ART refers to all techniques involving
direct retrieval of oocytes from the
ovary
 ART procedures include IVF, GIFT,
ZIFT, and ICSI.
 The simplest ART procedure, IVF has
been around for over 20 years and is
perhaps the most commonly
recognized ART of all procedures.

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Causes of Infertility
Cause Couples Women
Male 35% N/A
Ovulatory 15% 40%
Tubal 35% 40%
Unexplained 10% 10%
Other 5% 10%

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Female factors
 Cervical factor
 Ovulatory factor (PCOs)
 Uterine factor (endometriosis)
 Pelvic factor

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Polycystic Ovarian Syndrome (PCOS)
Also known as Stein-Leventhal syndrome
Also known as hyperandrogenic chronic anovulation is a benign
disorder that commonly results in infertility.
PCOS is characterized by irregular ovulation and menses, obesity,
insulin resistance, acne, and hirsutism.
Most women with PCOS also have ovaries filled with multiple
benign cysts.
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How does PCOS contribute to Infertility?

 Impaired fertility is a prominent feature of PCOS.

 This is believed to result from elevated insulin levels that

stimulate excess androgen production by the ovaries.

 The androgens cause premature follicular wasting which

causes inconsistent or absent ovulation, which is
associated with infertility.

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 Symptoms
 Irregular or absent periods
 Lack of ovulation
 Weight gain
 Hirsutism (excessive hair growth)
 Insulin resistance
 Acne
 Male-pattern balding
 Multiple small ovarian cysts-these may be seen by an ultrasound
examination
 Ancthosis nigrans (darkening of the skin at the nape of the neck and
under the arms and breasts).

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 Diagnosis
:
Blood Work/Hormonal Testing:

Laboratory testing is important for diagnosis but it is

crucial to look at multiple values collectively.

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 Diagnosis:
3. Ultrasound:
 Ultrasound of the pelvis is typically performed when the
clinician suspects PCOS.
 If >10 cysts are found in either ovary that are less than
10mm, this meets the ultrasound criteria for PCOS.
Furthermore, polycystic ovaries are typically 1.5 to 3 times
the normal size.
 Just the presence of polycystic ovaries, without symptoms
and/or consistent blood work, does not confirm a diagnosis
of PCOS.

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 Treatment

 Weight Loss, Progestins, Oral Contraceptives,

Anti-Androgens, GnRH agonists, Fertility drugs,
Surgical therapy:
 a) Ovarian wedge resection
 b) Laparoscopic ovarian drilling

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 Endometriosis

 Endometriosis can be defined as a nonmalignant

disorder in which functioning endometrial tissue is
present outside the uterus.
 The incidence of this disease ranges from 10-15% in
women between the ages of 25 and 44 who are
actively menstruating, but it also occurs in teenagers.
 It is estimated that 25-50% of infertile women have
this disease.

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 Endometriosis

 The incidence is higher in first degree relatives of

women with endometriosis, which suggests that
heredity may play a role.
 In addition, there is also a higher prevalence of the
disease in women who delay childbearing or who are
of Asian descent.

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 Endometriosis
 Causes and Symptoms
 The cause of endometriosis is unknown, however there are
several theories.
 The first theory is known as retrograde menstruation, or the
movement of sloughed endometrial tissue back through the
fallopian tubes and into the abdominal cavity. This tissue can
then attach itself to various internal organs or tissues outside of
the uterus.
 Immune system dysfunction. It is believed that certain women
may develop endometriosis due to deficiencies in their immune
system.

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 Endometriosis

 In women without endometriosis, the immune

system destroys any ectopic implants that may
develop. However, in women with endometriosis,
there is an altered immune response and the body is
unable to destroy the growth of the implants.
 Furthermore, some scientists believe that
endometriosis is an autoimmune disorder. This
means that the body makes antibodies to
endometrial cells. These antibodies may destroy the
healthy endometrium found in the uterus, but are
ineffective in destroying ectopic implants.

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 Endometriosis
 Symptoms
 Pelvic pain and cramping before and during
periods
 Pain during intercourse
 Inability to conceive
 Fatigue
 Painful urination during periods
 Gastrointestinal symptoms such as diarrhea,
constipation, and nausea

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 Endometriosis
 There are other medical conditions that have similar
symptoms and should be considered prior to making a
diagnosis of endometriosis. Conditions that may cause
generalized pelvic pain include:
 Pelvic inflammatory disease (PID)
 Pelvic adhesions
 Neoplasms (cancers), both benign or malignant
 Ovarian torsion
 Sexual or physical abuse
 Other causes that are not gynecologic in nature

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 Endometriosis

 How does endometriosis contribute to

infertility?
 The cause of infertility is believed to result from the
scarring and adhesions that form in the reproductive
tract as a result of inflammation.
 Scar tissue and adhesions may reduce fertility by either
obstructing or distorting the shape of the fallopian
tubes, which in turn impedes the passage of sperm to
the egg.

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 Endometriosis

 In the event that sperm do reach the egg, they

may encounter a hostile environment
unfavorable to fertilization.
 Finally, scarring from endometriosis may
obstruct the fallopian tubes so that if an egg is
fertilized, it may be unable to travel to the uterus
for implantation.

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 Diagnosis
 One of two techniques may be used to confirm the
diagnosis of endometriosis. Both procedures involve
visualization of the pelvic cavity in order to confirm
the presence or absence of ectopic implants.
 laparoscopy
 laparotomy
 If there are any suspected ectopic implants, they are
biopsied in order to determine the presence of
endometrial cells.

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 Women with tubal diseases
 Unexplained infertility
 Endometriosis
 Immunologic causes for infertility
 Women with premature ovarian failure
 Individuals with male factor infertility (e.g.,
abnormalities in sperm production, function
or transport or prior vasectomy)

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 Basically, this term refers to the use of medications
to stimulate your body to produce one or more
eggs.
 Ovulation induction can be as simple as taking a
daily pill or more complicated, like injecting
fertility medications and seeing your specialist
daily for necessary monitoring. The simplest form
of ovulation induction involves taking clomiphene.

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 More potent medications, known as the gonadotropins,
are available for more intensive ovulation induction.
 Gonadotropins are injectable medications that are made
up of a combination of follicle stimulating hormone (FSH)
and luteinizing hormone (LH) or just FSH alone.
 These hormones can be very helpful in getting a woman to
produce and release her eggs.

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 The success of ovulation induction in achieving a
pregnancy is highly variable. It depends on the
diagnosis, age, the medication being used, and
numerous other factors.

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 Sperm penetration assay (SPA) is a multi-step laboratory
test that offers a biological assessment of human sperm
fertilizing ability.

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 ZIFT  ICSI
 GIFT  TESE
 TEST  MESA
 POST  PGD

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 ZIFT
 Zygote Intrafallopian Transfer. ZIFT may be
recommended if the husband has severe male fertility
factor or if there has been difficulty confirming
fertilization with past procedures. ZIFT has the
advantages of allowing fertilization to be confirmed
and it has demonstrated higher success rates than
IVF when used for the appropriate indications.
 One disadvantage with ZIFT is that the transfer of the
zygote must be performed through a laparoscope.

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 GIFT
 Gamete intrafallopian transfer was developing in 1984 as a
variation of in vitro fertilization (IVF).
 Gift is recommended when
 unexplained infertility
 infertility due to immunological factors
 endometriosis
 selected cases of male infertility
 Tubal infertility
 A requirement for the procedure is that the female partner
having at least one open (patent) fallopian tube.

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 ICSI
 Intracytoplasmic sperm injection, or ICSI, was
developed to treat couples who previously had a very
poor probability of achieving fertilization due to the
male partner's extremely low numbers of viable
sperm.
 This treatment, when combined with in vitro
fertilization, allows these couples a more favorable
probability of achieving conception.

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 ICSI

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 TESE
 Testicular Sperm Extraction
 MESA
 Microsurgical Epididymal Sperm Aspiration

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 What is Preimplantation Genetic Diagnosis?

 PGD
 Preimplantation Genetic Diagnosis

The Preimplantation Genetic Diagnosis (PGD) is a new method of

Prenatal Diagnosis. The aim of this study is to increase the chances of
having a healthy baby and therefore, avoiding the chances of
transmitting a genetic or hereditary disease. In order to perform the
diagnosis we use high technology with each embryo

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 What is Preimplantation Genetic Diagnosis?

 PGD
 Preimplantation Genetic Diagnosis
This technique allows us to perform a genetic screening of the embryos
obtained during the In Vitro Fertilization process, thereby detecting
possible chromosomal or genetic disorders before the embryos are
transferred into the uterus. To perform a PGD, our biologists extract one
of the 6-8 cells of the embryo and perform a biopsy. After the biopsy, the
embryo is incubated in a culture medium which provides the adequate
environmental conditions for its development until it is transferred into
the uterus.
The cell obtained during the biopsy is genetically screened in order to
check if the embryo carries a chromosomal or genetic disease. The
remaining cells of the embryo are genetically identical to the analysed
cell and continue to develop in the incubator. The day after the removal
or the embryonic cell, we can know which embryos have no genetic
disorders and can be transferred into the patient's uterus.

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 What is Preimplantation Genetic Diagnosis?

 PGD
 Preimplantation Genetic Diagnosis

Preimplantation Genetic Diagnosis is recommended

for those couples who are carriers or suffer from
genetic or chromosomal diseases that are
transmissible to their offspring. It is also
recommended for women of an advanced age, for
women who have had repeated miscarriages, for
patients undergoing fertility treatments who have
failed several times to conceive through In Vitro
Fertilization and finally for those couples who produce
embryos with morphological alterations

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 The use of skills that enable a client to recognize and
identify his (sic) own problems, and the ability to help
client find his own solution or resolution.
 The Human Fertilization and Embryology Authority
(HFEA) state in their code of practice that three sorts
of counseling must be available at licensed treatment
center. These are:
 Support counseling
 Implications counseling
 Therapeutic counseling

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 One of the first questions that most people ask is "what is
the chance for success?" The best estimate is that the
birth of a live baby occurs in approximately 15-25% of
women in whom embryos are transferred into the uterus.
 The 1998 nationwide live birth rate as reported in the IVF-
ET Registry, was 24.9%.
 The corresponding rate for 1989 was 14%.

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 Success varies with many factors, including the number
of embryos that are transferred.
 If one embryo is transferred, there is approximately a
7% chance of successful implantation; with two
embryos, the success rate increases to 18%.
 The rate peaks with the transfer of three to four
embryos. Presently, the collection of oocytes,
fertilization, and early embryo growth are accomplished
with a high degree of efficiency.

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 Twins occur in about 25% of ART pregnancies versus 1-
2%of spontaneous pregnancies. The risk of more than a
twin pregnancy is less than 5%.
 To put these figures into perspective, studies have shown
that the rate of pregnancy in couples with proven fertility
in the past is approximately 20% per cycle. Therefore,
although a figure of 15-25% may sound low, it is equal to
or greater than the chance that a fertile couple will
conceive in any given cycle.

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 We are all angels with only one wing.

We can only fly while embracing each other.

- Luciano D. Crecenzo

Thank you!

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