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Importance of Quality Control in IVF Lab

Importance of Quality Control in IVF Lab

Quality control (QC) is the most important component of the IVF Clinic. QC evaluates the quality of the procedure & its outcome. It is mandatory to monitor laboratory conditions (Air Quality, Temperature, and VOC’s etc), Stimulation protocols, Culture media & technical skill coordination etc to ensure quality control. The IVF lab which follows good laboratory practices they can facilitate the results of IVF by giving the best outcome to their patients.

Need of Quality Control in IVF Lab

  • It ensures the quality of the procedure
  • Increase the success rate
  • Increase the reliability of IVF lab
  • Complete traceability & Documentation
  • Build up IVF team confidence 
  • IVF Laboratory Equipments

Incubators The change in temperature & Co2 level can affect the oocytes & embryos quality. So, carbon dioxide & temperature should be recorded on daily basis. If anything altered it should be calibrated as per requirement.

Laminar Air Flow: The laminar flow need to clean on daily basis before & after the completion of task.

Refrigerators: The location of the refrigerator should be outside the core embryology area as it releases harmful gases which are not good for IVF Lab. Also thermometer should be placed inside the refrigerator to see the temp on daily basis.

Microscopes: They should be cleaned everyday to remove unwanted dust particles.

Heated Stages:  Temperature is a very crucial parameter as it can cause spindle damages etc. So, gametes handling should be done strictly on heated stages at 37°c to avoid any kind of damage.

Below given table will help to know that how often the test is done to check equipment working.

Equipment Test  Duration
Incubator CO2 ,Temp Weekly
Laminar Air Flow Environment Monthly
Refrigerators Temp Weekly
Microscope Function Monthly
Heated Stages Temp Monthly

 Quality Control IVF Lab

  • Culture Media

Culture Media 

Oocytes & embryo are very sensitive & a little change in their environment like ph, osmolarity etc can cause harmful effects to them. So the cultural conditions should be favorable for them. So it is important to understand the need of culture media

  • While receiving media from any company ensure that the cold chain of media is well maintained. Never accept broken seal of the order.
  • Always see the expiration date of Culture media before use in any case.
  • Always store your media in refrigerator with required temperature conditions.


  • IVF Laboratory Environment:

The laboratory environment is mostly affected by the following reasons:

  • If clinic is located near to construction sites, on highway, factories then there are a major risk of dust particles & pollutants. So, Hepa Filter is necessary for such laboratory. As it removes 99.99% of small 0.3 microns in size dust particles.
  • Use of cosmetics in IVF should be prohibited. Cosmetics emit VOC’s & can cause negative effect to embryos.
  • Laboratory cleaning is done on daily basis using disinfectants.
  • If any kind of fluid spilage is found then it should be cleaned with 5.25% sodium hypochlorite. 
  • Protocols to be followed when working IVF Laboratory: 
  • IVF Laboratory should have well trained staff. The embryology work is very sensitive so expertise is required.
  • The laboratory should keep on updating the protocols. Inhouse modifications in methodology should be done for betterment.
  • IVF Lab should remain up to date with the latest technology.
  • Dishes Preparation should be done at room temperature. One culture dish is prepared at a time to maintain the osmolarity.
  • Ethical practice while handling the gametes. Label the dishes before OPU. Avoid mixing of samples by labeling containers.
  • Witnessing should be a compulsory practice in IVF laboratory.
  • Wearing gloves, cap & mask in laboratory is must. Hand washing is essential before entering IVF laboratory.
  • Discard sharp objectives & pipettes after single use.
  • The documentation is very important in IVF lab system. It helps to recall the past events. So proper documentation in IVF is necessity. For eg: Patient Records, QC data, Complaint Data 

QC is the essential component of IVF laboratory. It is our responsibility not a burden. Infact, it helps in troubleshoot. QC ensures the success rate & even the reputation of the clinic. And we at Reviva Fertility Clinic & IVF Centre In Chandigarh follow all the ethical practices & make sure at every step that the outcome should not be affected at any cost. For more information on the IVF Procedure and their cost in Chandigarh you can contact us: 8288028667

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Embryo Implantation, Process & their stages – Reviva IVF

Embryo Implantation, Process & their stages – Reviva IVF

steps of implantation of embryo

What happens in your uterine cavity after the implantation of an embryo? Let’s have detailed information about implantation through this blog.

What is Implantation?

It is the process in which the fertilized egg or a blastocyst gets attached to the endometrial wall of the uterus to attain pregnancy. During this stage, the embryo establishes a strong connection with the maternal circulation and starts its embryonic developmental journey.

The endometrium is receptive to a fertilized egg for a shorter period in the luteal phase which is termed as “Implantation window”. The window lasts for 4 days & follows up to 6 days after the peak of LH levels. And it is essential for the blastocyst to reach endometrium during the implantation window in order to get a successful implantation. Any delay in the blastocyst transport can cause loss of endometrial receptivity. Blastocyst Implantation occurs 6-8 days after fertilization.

Embryo Implantation process is mainly divided into three stages:

  1. Apposition 
  2. Adhesion 
  3. Invasion

1. Apposition:

In this stage, the blastocyst sheds its zona and approaches the endometrium with a particular orientation. The finger-like projections known as chorionic villi helps to bring the blastocyst nearer to the uterine epithelium. The uterine epithelium cells have glycoprotein on its surface which acts as a barrier between blastocyst and endometrium. The blastocyst uses its enzymes to digest the glycoprotein which results in interlinking of trophoectoderm with luminal epithelial cells.

2. Adhesion:

Attachment occurs on 6th or 7th day post ovulation. At this stage, the strong association is established between endometrium and blastocyst. Due to enzymatic breakage of glycoprotein, the adhesion molecules (includes cadherins, intergrins, glycan, & lectin etc.) in blastocyst and endometrium have free accesses to each other.

3. Invasion:

In this stage, the embryo needs to connect with the mother for development. The blastocyst completely penetrates the endometrium by day 9. The blastocyst consists of two main components – The trophoblast & the Inner Cell Mass (ICM). The function of trophoblast cells in the embryo is to invade the endometrium to build maternal connection with an embryo. The Inner cell mass give rise to a fetus. As embryonic trophoblast makes contact with endometrium it further differentiates into two layers: Cytotrophoblast & Syncytiotrophoblast. The ICM in the embryo makes a two differentiated layers hypoblast & Epiblast. The cavity arises between Epiblast & Cytotrophoblast is known as amniotic cavity. Cells originate from hypoblast which forms a thin membrane called as exocoelomic membrane. Cells of hypoblast and exocoelomic membrane forms wall of primary yolk sac. The growth of trophoblast forms Cytotrophoblast & Syncytiotrophoblast becomes quiker at this stage. The lacunar networks begin to form in the Syncytiotrophoblast & by the 12th  day the lacunar networks stops growing .The uterine blood vessels in the endometrium comes in contact with lacunar networks which directs the placental trophoblast to maternal blood circulation. Also the endometrial stroma becomes dense cellular matrix called as decidua, which afterward becomes the maternal part of the placenta.

In Assisted reproduction, the key cause for implantation failure is the hatching disability of embryo. Presently, no research is available to distinguish the embryos which have the ability to hatch and grow into a healthy embryo. No hatching is a possible reason for pregnancy failure in many elderly women. In that case, zona pellucida can be disrupted by using laser assisted hatching technique to improve the pregnancy rate. Reviva Fertility Clinic & IVF Center In Chandigarh offers all the latest techniques which can treat various types of infertility.

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Culture Media

Culture Media

Assisted Reproductive Technology results have been improved due to the improvement in culture media conditions. There are number of commercially available culture media in the market with components like protein, antioxidants, carbohydrates etc. In this blog, we are going to discuss the key components of media & how they support to embryo growth.

What is Culture Media?

Culture media is the artificial environment given to the embryos for growth & development. Culture media is based on two philosophies:

  • Back to nature Principle
  • Let embryo decide the principle

In nature principle, the media components try to imitate the components of a female reproductive system .Which means the media is formulated sequentially according to the embryo developmental need i.e. from zygote to a blastocyst. Whereas, Embryo chooses principle is single step or monoculture formulation in which the media is supplemented with all the macromolecules and then embryo utilize the macromolecules according to its requirements.


Key Components of Embryo Culture Media

Most of the culture media are made up of 99% of water. As, the goodness of media depends upon the quality of water. So, the water sources should be good.


The role of ions in the media is to maintain the osmolarity. The ions present in culture media is Na, Cl, P, Ca, Mg, S, K, etc. Osmolarity of medium affects cell volume & embryo development. Elevated osmolarity can result into developmental arrest. Osmolalities of culture media should be in the range of 260 to 298 milliosmoles.


Carbohydrates are the key source of energy for embryo growth. The media consist of pyruvate, lactate and glucose. In the initial stage of development pre compacted embryo utilizes the pyruvate as primary source of energy .However, in post compaction stage the embryos use glucose for expansion.

Amino Acid

These are important regulators serve as energy sources. Essential & non essential amino acid stimulates the production of ICM of blastocyst. Whereas trophoectoderm formation & hatching in blastocyst is initiated by non-essential amino acids (Glutamine).


Invitro embryos when exposed to culture conditions they may experience oxidative stress due to production of Reactive Oxygen Species (ROS) Which have a negative impact on the development of embryo. Media should be supplemented with antioxidants such as Lipoate to avoid stress on embryo produced by ROS.


To avoid bacterial contamination in culture media antibiotics like gentamycin, streptomycin are added to media.


 Protein is the common macromolecule in human embryo culture media such as Human Serum Albumin (HSA). It aids in embryo development. They also maintain membrane permeability & osmoregulation while manipulation of gamete in vitro.

Buffer System

The suggested pH range for culture media is 7.2 -7.4. Most of the culture media have bicarbonate buffer system to sustain the pH in the tolerable range. For handling gametes outside the incubator HEPES & MOPS are preferred.

Growth Factors & Hormones

Embryos are exposed to a blend of maternal hormones & the role of hormones in embryo development is uncertain. Growth factors have considerably role in growth & differentiation of Day4 Morula to a Day 5 Blastocyst. Even due to the addition of growth factors to the media have drastically improved the implantation rates.

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IVF treatments in India boasts lower cost, yet higher success rates

IVF treatments in India boasts lower cost, yet higher success rates

IVF or In vitro fertilization treatments are popular all over the world. However, the attention of IVF treatment seekers has turned to India as their choice of the treatment location. Many people from the western world are visiting India for this purpose.

Affordability of the cost of IVF treatment in India coupled with excellent success rates attract many couples from all over the world, and their confidence to choose India as their IVF treatment destination has increased over time. The average cost of the IVF treatment in India is usually between Rs. 250,000 – 450,000 for a basic IVF treatment cycle. However, advanced IVF treatment as if ICSI (Intracytoplasmic sperm injection) or ET (Embryo transfer) costs 120,000 – 150,000 in addition to the IVF basic treatment cycle cost. This is only a fraction of a treatment cost when compared with the IVF treatment costs in the western world.

In addition, the cost of IVF treatment hugely varies between various cities of India. The cost of IVF treatment in Delhi is totally different from treatment cost in Mumbai or in Chennai. Due to this reason, many couples who live in different parts of India travel to other locations to undergo these IVF treatments at an affordable cost. Here is how the infertility treatment cost in India varies according to the location; Mumbai 200,000 – 300,000, Bangalore 160,000 – 175,000, Chennai 145,000 – 160,000, Delhi 90,000 – 125,000, Nagpur 75,000 – 90,000, Hyderabad 70,000 – 90,000, Pune 65,000 – 85,000 and etc. The treatment cost in Chandigarh is considerably low when compared with some of the locations above, and at Reviva clinic you could receive world-class medical care for the same cost.  

Every couple should keep in mind to analyze the package that comes with the IVF treatment beforehand in order to avoid any hidden charges. For instance, Reviva Infertility and IVF Clinic offer special IVF package that includes all examinations costs as if for ultrasound examination, the cost for all types of blood tests that required during IVF treatment, anesthesia cost, advanced IVF treatment cycle options as if ICSI and ET. Besides, Reviva clinics package also incorporates laboratory charges and even it includes the cost of day care hospitalization that is required during IVF treatment cycle and guarantee of no hidden fees. All charges are included and elaborated in the treatment packages so that preparing for the treatments financially would not bring any surprises throughout the process.

As India is one of the countries to receive infertility treatments for a lower cost, you should consider visiting Reviva Clinic at Chandigarh to make your dream come true. Along with the lower cost of treatments, the lower costs of accommodation and also travelling will reduce additional costs you will have to bear during the visits. That is why many people consider India today as to be a leading country for medical tourism. If you are planning for IVF treatments and wondering where to seek the best care, then you are in the right place. Reviva clinic is more than happy to hear from you.

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Oocyte Grading

Oocyte Grading

An oocyte is a female gamete which is involved in reproduction. It is one of the largest cells in the body 120 microns in diameter and develops in the ovarian follicle during oogenesis. On the basis of oocyte grading we can find the ideal oocyte for fertilization. While Oocyte Pickup, on the basis of cumulus we can get an idea of oocyte maturity.
  • Immature – The immature oocytes are Germinal Vesicle and they have tightly packed corona cells with little cumulus.
  • Intermediate– The nuclear maturity of these oocytes is Metaphase I. The corona and cumulus cells are tightly packed.
  • Mature- These oocyte are at Metaphase II stage and they appear like sunburst of corona cells with expanded and abundant cumulus.
  • Postmature– These types of oocytes are mature ones which have dark Cumulus oocyte complex. In which corona cells begin to degenerate.
On denudation of cumulus–corona cells, we can better appreciate the maturity and morphology of oocyte before fertilization. Below given picture can give you an idea about the oocytes maturity.


Germinal vesicle has a visible intracytoplasmic nucleus. Metaphase I oocyte neither has Germinal Vesicle nor polar body. Metaphase II stage when it has a visible polar body. We can grade the oocytes by looking at its Zona Pellucida, perivitelline space (PVS ) shape, polar body (PB) morphology , Ooplasm characteristics. 1.Zona Pellucida:  The Zona Pellucida is the outer layer of oocyte .The normal thickness of ZP is 17-18 microns. If the thickness of Zona is greater than normal then after ICSI Laser Assisted hatching (LAH) is required. If thickness is very low then there is a chance of early hatching or damage can cause to oocyte while doing denudation. The alterations in Zona Pellucida appearance could be caused by secretion problems of the glycoprotein matrix.
Zona Pellucida Assessment Explanation
Normal Thickness of 17-18 microns with even surface
Thin If the Zona pellucida is less than normal
Thick If Zona pellucida is more than 25 microns
Abnormal If the shape of Zona pellucida is irregular
  1. Perivitelline Space: This is the space between Zona and oolemma membrane known as PV space. We can see a polar body in this space. Sometimes it is large in size or may be absent.
Perivitelline Space Assessment Explanation
  Normal The Ooplasm is slightly away from the ZP in the surrounding area of the polar body
Large the Ooplasm is away from the ZP leaving  a large space around the cytoplasm
Fragmented Fragments and debris
b)  Polar Body: The polar body should single and round in shape and in total 5% of the cell volume.
Polar body Assessment Explanation
Normal Ovoid & round in shape, with 5% of cell volume.
Fragmented Polar body is irregular  and dissociating into small fragments
Giant Large in size
c)  Ooplasm: The Ooplasm is the cytoplasm of egg. Sometimes it has some inclusions and clusters which can be graded to get the best oocyte.
Cytoplasmic Inclusions Explanation
Vacuoles These are fluid filled bodies. Appears as a vesicle in the cytoplasm.  They can be single or abundant.
Refractile Bodies Appears like dark dots of diverse sizes (lipofucsin)
Smooth Endoplasmic reticulum Appears as a flat elliptical disk
Granulation Uneven patches of granules in the Ooplasm
From such assessment we can only find the ideal oocyte for fertilization. But these parameters are still controversial for embryo development and implantation. Like abnormal Zona Pellucida, Perivitelline space fragments, size and morphology are still controversial. But the presence of inclusions bodies like vacuoles, Refractile bodies , SER in large number can be detrimental.

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Reviva clinic – one of the best in IVF treatments

Reviva clinic – one of the best in IVF treatments

Infertility has become a more frequent problem today. The modern lifestyle and environmental factors have been able to affect the fertility of many men and women in a significant way. If you are one of those living in the anguish and thinking about an IVF treatment, India could be the best place to visit for your treatments.

India is one of the leading destinations for advanced IVF treatments in the world today. Therefore, it is no surprise that many infertile patients from around the world come to India gathering their hope to succeed. While there are many IVF centers in different parts of the country, the best IVF center in India, namely Reviva clinic is located in Chandigarh. As Reviva clinic boasts about its highest success rate, the number of patients visiting for treatments has significantly increased each year and is still on the rise.

India is one of the most medically advanced countries in Asia and possesses all know-how strategies and modern technology to treat men and women who look forward to having a child. Reviva clinic being the best IVF center in Chandigarh possesses the modern technology and access to advanced interventions, which were once available only in the leading countries of the Western world. Today, you can visit Reviva clinic and experience the state-of-the-art medical care and be sure of a higher success rate. While you get treated at the best IVF center in India for your treatments, you can also enjoy the calming nature, warm hospitality and a rich culture that will even increase your hopefulness towards success.

Nothing is more comforting than being surrounded by a team of medical specialists who understands and work towards your success. This is what the Reviva Clinic – the best IVF center in Chandigarh has expertise in. A group of specialized medical professionals works together in the IVF centre, and they prioritize the individual needs of every patient in order to achieve success.

One of the best reasons to get IVF treatments in India is the lower cost. Yes, although Reviva clinic is the best IVF center in India, the cost is almost as half as of that is in the advanced countries of the world. State of the art, advanced strategies, and modern interventions would not be accessible at a lower cost in any other part of the world as you would in India. This has allowed many couples to save money for their childbirth rather than spending it all on the IVF treatments.

Reviva clinic is not only specialized in IVF treatments but also carry out other advanced fertility treatments such as ovulation induction, follicular monitoring, IUI, surgical sperm retrieval, oocyte donation, etc. You could find many solutions under a single roof, and that is why we say that Reviva clinic is the best IVF center in Chandigarh.

If you are looking forward to making your dream come true and to get the world’s best medical care, then you are in the right place. Come and get treated in the best IVF center in India!

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Ovarian Rejuvenation

Ovarian Rejuvenation

Revolution in the medical sciences provides a chance to women to revitalize their ovaries by a therapy called ovarian rejuvenation. The therapy offers hope to those patients who have problems like low Oocyte reserve, premature ovarian failure, early menopause problems, and Anti-Mullerian hormone levels.

It is a fact that, a woman is born with millions of Oocyte in her ovaries and as she grows up the egg supply declines in number and in quality as well. It seems quite impossible to develop new eggs in the ovaries naturally. But, according to the recent researches, it is possible to regenerate new eggs with the help of patient’s blood cells. Blood cells have growth factors which help to heal various types of injuries in the body. Growth factors can stimulate the growth of new blood vessels, nerve and connective tissues by the activation of Stem Cells.  And stem cells have a power of regeneration.

Ovarian rejuvenation can be done on anytime on women with or without menstruation cycle. The procedure has two steps:

The First step is to isolate the PRP (Platelet-rich plasma), Preparation of PRP begins with the insertion of a needle into the vein in order to get blood in the test tubes. Platelets and White blood cells (WBCs) are separated from the red blood cells (RBCs) and serum by centrifugation process which takes approximately one hour to prepare PRP.

The Second step is Administration of PRP into Ovaries, under an intravenously administered anaesthesia. The isolated PRP (supplied with protein-rich growth factor and stem cell chemoattractants) is injected into the ovaries specifically in the cortical tissue of the patient with the help of transvaginal ultrasound.

Ovarian Rejuvenation has the utmost benefit that it gives a chance to women to become pregnant from her own eggs naturally and also helps in improvement in hormone levels.

After the procedure, it is very important to keep an eye on AMH (anti-Mullerian hormone), FSH, LH and Estradiol levels along with the ovarian function for 1- 3 months. The values will help to know the positive working of ovarian rejuvenation. Usually, the improvement shows up in 1-3 months but in some cases, it takes more than that. So, the monitoring is done up to 6 months. But the treatment is still in research phase. If ovarian rejuvenation treatment shows a promising future, and then it could help many women who have various types of age-related infertility problems.

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Has the time come for single embryo transfer?

Has the time come for single embryo transfer?

Innovative techniques are persistently growing for infertility treatment. The evolving industry is giving great expectations to most of the people who want to experience parenthood. It seems exciting to be a mother of more than 1 baby and is often a happy moment for every parent. But in multiple pregnancies, there is a risk of complications like premature birth, congenital abnormalities, and mother will more likely to have health issues like gestational diabetes, anaemia, and high blood pressure.  In addition to this, a premature baby needs special care in the Intensive care unit (ICU). So, single embryo transfer (SET) is good option to overcome these problems. Single-embryo transfer (SET) is a process in which one high-quality embryo is placed into the uterus. So, the main focus is to reduce the twin rates in pregnancy by using the single embryo transfer technique.

In the recent years, SET has extensively accepted due to the reason that it reduces the possibility of twins and triplets and also it is safe for both baby and mother. According to the American Society of Reproduction Medicine, single embryo transfer should be considered for patients with favourable prospects usually women who are under the age of 35 or younger with good quality eggs.

Single Embryo transfer (SET) is done when the embryo is at the blastocyst stage. And it is the stage when the best quality embryos can be identified more accurately. A blastocyst stage transfer is a more viable embryo for transfer which reduces the multiple pregnancies. Nowadays, the embryo screening technologies are highly developed, through which embryologist are able to get best single embryo with the goal of achieving a good singleton pregnancy and which reduces the possibilities of multiple gestation and miscarriages.

Through, cryopreservation technology embryos are preserved in frozen condition with no risk even after they have been cultured in the lab to the blastocyst stage. With the help of advanced tools, embryologists can provide the appropriate environment for embryos to grow, as well as methods to recognize that embryo which is likely to develop a baby. This contributes to the probability of success on the first embryo transfer as well as successive transfers.

Due to the advancement of the technology, the majority of patients are able to conceive through single embryo transfer. Success rates of Single embryo transfer (SET) have increased considerably over the past 5 years, making it nearly as likely to achieve a successful pregnancy embryo as with two or more embryos.

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Why a trend from fresh to frozen embryo transfer?

Why a trend from fresh to frozen embryo transfer?

Whenever a sudden shift is made from fresh embryo transfer to frozen embryo transfer the couple usually have many queries in mind. So, let’s evaluate both and see pros and cons.

Fresh embryos transfer is undergoing ovarian hyper stimulation making of embryos and transferring resultant embryos to uterine cavity in same cycle. In frozen embryo transfer first two steps of controlled ovarian hyper stimulation and process of IVF/ICSI are same but the resultant embryos are frozen using vitrification techniques and not transferred in same cycle. They are thawed and then kept uterine cavity after preparing the uterine cavity.

In patients who are normal or hyper responders the frozen embryo transfers are known to have better results than the fresh embryo transfer . The reason can be that due to ovarian hyper stimulation and high levels of estrogen may have negative impacts on the endometrial receptivity. In some cycles another hormone called progesterone may also be raised, which again decreases embryo implantation rate. Whereas in frozen embryo transfer the body and uterus have already recovered from the impact of hormonal disturbance and hence more receptive.

Because of their reason in patient with PCOS the frozen embryo transfer is associated with higher live birth rate. It also reduces complications like ovarian hypertimulation in these patients.

Another reason where we make a sudden shift from fresh to frozen embryo transfer are when the ovarian stimulation part is good but the endometrial thickness fails to reach an optimal level.

So because of the above reasons we are moving towards more frozen transfer than fresh transfers in self cycle.

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Preparing for Donor Eggs IVF Cycle – Psychological Issues

Preparing for Donor Eggs IVF Cycle – Psychological Issues

In about 50% of our patients, being taken for IVF, the oocyte quality or quantity is the major concern. It’s very easy for us to show you the path of egg donation as it is a routine for us. But we know it is not that simple for you. Though it carries a very high success rate, but psychological implications on the recipient are very high.

The major indications for IVF with donor oocytes in REVIVA are –

  • Premature ovarian failure
  • Menopause
  • Decreased ovarian reserve
  • Endometriosis
  • Recurrent self cycle failures with no proven endometrial or male factor.
  • Genetic causes.

It takes time for the couple to accept the option of Donor eggs, but usually the desire of having a family overcomes this hesitation.

The most important concern of the couple is the quality of genes transmitted to the child. Though the anonymous egg donor is being matched to the recipient as far as possible, the concern always remains in majority of recipient; they are satisfied with their gestational contribution which creates a strong bond.

Another way of dealing with it is to keep the information of type of cycle between the couple only, it will serve you from interrogation eyes and any future problems will be avoided.

On positive note egg donation is associated with many benefit. The most important since eggs are derived from a young woman, they are more likely to produce chromosomally normal embryos and so risk of abortions and birth defects is less.

So, though egg donation is not the first choice of anyone, but it is treatment with very high success rate where it is indicated.

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