UHS Medical Times April 2018

UHS Medical Times 1

Newsletter | April 2018

In Vitro Fertilization WHAT IS IVF? In vitro fertilization is a type of assisted reproductive technology or ART. This is the process of fertilization by extracting a mature egg or ovary from a woman and taking sperm sample from man. Both mature egg and sperm will be manually mixed to encourage fertilization.

Once inseminated, the embryo will be planted in the woman’s uterus.

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Newsletter | April 2018

Sir Robert Edwards

The world is grateful to Sir Robert Edwards for developing the human in vitro fertilization or IVF. In 1978 the first child was born as a result of in vitro fertilization. Because of this breakthrough, millions of babies were conceived using this method. He was awarded with the Nobel Prize for his contribution in the field of Physiology or Medicine in 2010. Since then, conceiving a child is far away from just a dream. Any couple who are trying to have a child would result in an unconventional way.

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e-newsletter September Newsletter || April 2018 2016

UNDERSTANDING YOUR ANATOMY FEMALE ORGANS INVOLVED IN REPRODUCTION: Fallopian Tube - Two ten-centimeter-long tubes which connect with the uterus. During ovulation, the mature egg passes from the ovaries into the fallopian tube where fertilization may occur.

Ovaries - Almond-sized organs located on either side of the uterus, which produce and release mature egg cells. Egg cells develop in follicles – fluid filled sacs in the ovaries. Each month a new egg matures and travels to the fallopian tube. Ovaries also release the hormones estrogen and progesterone, which are vital for reproduction.

Uterus - A pear-shaped organ also known as the womb. The inner lining of the uterus is called the endometrium. An egg that has been fertilized will implant itself into the endometrium lining and will continue to develop in the uterus throughout pregnancy.

Cervix - The cervix or neck of the uterus is the lower, narrow portion of the uterus that joins with the top end of the vagina.

Vagina - The opening through which sperm travels in order to reach an egg. The vagina also serves as a passage for menstrual flow and secretions, which may help or obstruct the sperm from fertilizing an egg.

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Newsletter | April 2018

MALE ORGANS INVOLVED IN REPRODUCTION: Vas Deferens - A long curving tube that forms part of the sperm transport system. It also provides storage for most of the sperm until ejaculation.

Prostate Gland - A chestnut-sized gland below the bladder, which produces 60% of the seminal fluid used to transport sperm. The fluid helps neutralise acid levels in the male urethra and his partner's vagina, which in high concentration, can kill sperm.

Penis - During sexual stimulation, the penis becomes erect as its spongy tissue fills with blood. The penis delivers seminal fluid containing sperm into the vagina on ejaculation.

Seminal Vesicles - Two pouches located behind the bladder that produce part of the seminal fluid, which transports and nourishes sperm.

Epididymis - A tightly coiled tube located on the top of the testes. Sperm are stored in the epididymis for up to two weeks, where they mature and develop mobility for fertilization.

Testes - The testicles or gonads are located in a pouch of skin behind the penis called the scrotum. They produce sperm and release the male sex hormone testosterone. About two months before birth the testes descend through abdominal wall into the scrotum.

Scrotum - The pouch of skin below the penis which hold the testes. To produce and nurture sperm, the temperature within the testes remains around 1° C cooler than normal body temperature.

Millions of sperms develop daily in the testicles within a system of tiny tubes known as seminiferous tubules. As sperm are produced, they pass from the testes to the epididymis - an organ that stores and nourishes sperm as they mature. The entire hormone-regulated process of sperm maturation, from their primitive beginnings in the seminiferous tubules to their fully mature form in the vas deferens. Takes about 74 days.

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e-newsletter September Newsletter ||April 2018 2016

HOW CONCEPTION WORKS? Pregnancy is a result of a complex combination of factors and events. To become pregnant, the following steps must occur: 1. Sperm Transport - Sperm must be deposited and transported to the site of fertilization.

2. Egg Transport - Ovulation must occur and the egg must be "picked up" by the tube.

3. Fertilization and Embryo Development - Union between the sperm and egg must result.

4. Implantation - Embryo must implant and begin to grow in the uterus.

During a normal 28-day reproductive cycle, a woman’s body releases a single egg from a follicle in one of her ovaries. The egg travels down to one of the two fallopian tubes, where it can be fertilized by a man’s sperm.

During intercourse a man releases semen, a combination of sperm from the epididymis and a fluid from the seminal vesicle and prostate glands. Sperm can live for 48 to 72 hours within the female reproductive tract, while retaining the ability to fertilize an egg If the sperm reaches and penetrates the egg, a new life begins. As the first few cells divide, the embryo travels to the uterus where it implants and begins to develop into a fetus. If fertilization doesn’t take place, or if some reason the embryo is unable to implant, menstruation begins and the cycle starts over.

Even if doctors are unable to identify the barriers preventing pregnancy, conception still takes a degree of luck. Many couples go through multiple cycles to conceive.

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Newsletter | April 2018

INFERTILITY According to the World Health Organization, infertility is a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse. The indication of IVF is of course infertility.

Infertility is classified into two: Primary and Secondary Infertility. Primary infertility happens when a woman is unable to ever bear a child, either due to the inability to become pregnant or the inability to carry a pregnancy to a live birth. While secondary infertility is when a woman unable to bear a child, either due to the inability to become pregnant or the inability to carry a pregnancy to a live birth following either a previous pregnancy or a previous ability to carry a pregnancy to a live birth.

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There are plenty of reasons for a female person to be infertile, among these causes are the following:

1. Premature Ovarian Failure or Diminished Ovarian Reserves - This is a condition in which the ovaries cease to release eggs properly or to produce sufficient estrogen prior to the age of 35.

2. Fallopian Tube Problems - After your ovaries release a mature egg, it travels to the fallopian tube and remains there for approximately 24 hours, during which time it has the opportunity to be fertilized by a sperm. If the fallopian tube is damaged or obstructed, the egg may not be fertilized or it may have trouble reaching the uterus. A history of any infection, complications of lower abdominal surgery and some other gynecological condition may result in blockage of fallopian tubes.

3. Endometriosis - Uterus contains a lining called the endometrium. Endometriosis happens when this material grows outside the uterus in areas such as the ovaries or bowels. This disorder can be painful often leads to the development of cysts, scar tissue, and adhesions.

4. Uterine Fibroids – Uterine fibroids are not cancerous tumors that grows in the uterus. The presence of this tumor may cause a distraction of the uterine cavity which leads to fertility issues if it prevents the embryo from attaching the uterine wall.

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e-newsletter September Newsletter ||April 2018 2016

MALE INFERTILITY On the other hand, IVF treatment isn’t only for female fertility issues. According to the recent statistics, males are found to be responsible for 20-30% of infertility cases. If the male partner has a low sperm count, poor sperm motility, or abnormal sperm morphology, it can be difficult for the sperm to fertilize an egg. Some factors are listed below that can affect the health and strength of sperms:

1. Cigarette Smoking 2. Alcohol Consumption 3. Prohibited Drugs Usage 4. Overweight 5. With History of Past or Present Infections 6. Toxins Exposure 7. Overheating the Testicles 8. History of Trauma to the Testicles 9. Vasectomy or Major Abdominal or Pelvic Surgery 10. History of Undescended Testicles 11. Being Born with a Fertility Disorder or Having a Blood Relative with a Fertility disorder 12. Medical Conditions Including Tumors and Chronic Illnesses, such as Sickle Cell Disease 13. Certain Medications or Undergoing Medical Treatments such as Surgery or Radiation used for Treating Cancer

If you and your partner are having difficulty conceiving a child, talk to an IVF doctor about fertility treatments.

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e-newsletter September Newsletter || April 2018 2016

HOW IS PROCESS OF IVF DONE? The usual treatment follows the main steps below but you have to know that the steps or process may vary from one institution to another.

For Women Step 1: Medications will be taken for 2 weeks – either by nasal spray or injection will be given to suppress the natural menstrual cycle.

Step 2: Fertility medications are prescribed to stimulate egg production. This will allow increase number of eggs the ovaries produce – which only means that more eggs can be collected and possible fertilized and greater choice of embryos to use in the treatment.

Step 3: A transvaginal ultrasound and certain blood tests will be done to check the hormone levels.

About 34 to 38 hours before your eggs are due to be collected, you'll have a final hormone injection that helps your eggs to mature.

Step 4: Collecting the eggs is a minor procedure – using a needle that passed through the vagina, eggs are collected under ultrasound guidance. It is usually 15 to 20 minutes procedure. Some women may experience mild uterine cramps and scanty vaginal bleeding after the procedure. Medications are prescribed to reduce any discomfort.

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e-newsletter September Newsletter || April 2018 2016

Step 5: The collected eggs are mixed with the sperm from your partner in a laboratory. After 16 to 20 hours, they're checked to see if any have been fertilized.

In some cases, each egg may need to be injected individually with a single sperm - this is method is called intra-cytoplasmic sperm injection or ICSI. ICSI may be recommended when there is a reason to suspect that achieving fertilization may be difficult. ICSI is most often used with couples who are dealing with male infertility factors.

The fertilized eggs or embryos continue to grow in the laboratory for up to 6 days before being transferred into the womb. The best 1 or 2 embryos will be chosen for transfer.

After egg collection, you'll be given hormone medicines to help prepare the lining of the womb to receive the embryo. This is usually given either as a pessary placed inside the vagina, an injection, or a gel.

Step 6: Embryo transfer is a simple procedure compared to eggs collection. It is as easy as getting a Pap test. This is done using a thin tube catheter that passes through the vagina. The number of embryos that will be transferred should be discussed before the start of treatment.

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e-newsletter September Newsletter || April 2018 2016

For Men Men will be asked to produce a fresh sample. The sperms collected are washed and spun at a high speed so the healthiest and most active sperm will be selected.

GETTING TO KNOW IF I AM PREGNANT OR NOT

You will be advised to wait for 2 weeks after obtaining a pregnancy test to check if the embryo have been implanted successfully. If you do become pregnant, ultrasound scans will be carried out during the following weeks to check things are progressing as expected. You'll then be offered the normal antenatal care given to all pregnant women.

What if not?

The success rate of IVF is never guaranteed; it is most of the time ineffective in many cases and you should try to prepare yourself for this possibility. During this time, you may find it useful to speak to a counsellor through the IVF Centre or to contact other people in a similar situation you go through.

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e-newsletter September Newsletter || April 2018 2016

SHARJAH FERTILITY CENTRE Sharjah Fertility Centre (SFC) is the only fertility centre in Sharjah and Northern Emirates that is based inside a hospital. This state-of-the-art unit has an access to all your needs – laboratory, operating theater, pharmacy, obstetrics and gynecology centre and level 3 NICU. The unit will be manned by highly skilled and experienced fertility consultants, trained IVF nurses and embryologist.

Sharjah Fertility Centre offers the following services:

Pre-Assessment Stage including consultation, laboratory investigations, counselling

In Vitro Fertilization Full Cycle

Supernumerary Embryo Cryopreservation

TESA (Testicular Epididymal Sperm Aspiration)

PESA (Percutaneous Epididymal Sperm Aspiration)

Genetic Testing: Including Lab/Procedure/Consumables

PCR (Polymerase Chain Reaction) - PGD (Pre-implant Genetic Diagnosis)

Micro / Array Techniques

HLA matching PGD (Pre-implant Genetic Diagnosis)

Sperm Freezing

Aspiring to Bring the Best Fertility Treatment in the Region

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Newsletter || April February Newsletter 20182018

SHARJAH FERTILITY CENTRE TEAM AT UHS

QUALIFICATIONS Dr. Awatif Juma Al Bahar is a German Board Certified Obstetrician and Gynecologist and Reproductive Endocrinologist with with extensive reproductive surgical experience.

After her undergraduate degree, she went on to pursue her specialization in Obstetrics and Gynecology and Reproductive Endocrinology from the Academic University in Bonn, Germany.

German Board Certified Consultant Obstetrics and Gynecology and Reproductive Endocrinology, Director - Sharjah Fertility Centre

SPECIAL INTEREST Artificial Reproductive Technology Female Infertility High Risk Pregnancy Polycystic Ovary Syndrome

LANGUAGE KNOWN

EXPERIENCE

Dr. Awatif Al-Bahar

has contributed to numerous peer-reviewed studies and presented at several of the most prestigious conferences in the field of reproductive medicine.

Dr. Awatif, a renowned pioneer in artificial reproductive technology in UAE is an award winning doctor with multiple accolades including Dubai Excellency Program in 2002, Leader in Medicine and Social Services in Middle East by H.H. Amro Mosa in 2004, Hero of Health Care by H.H Ruler of Ajman in 2012, and Asia’s Most Influential Healthcare Professional of the Year by the Asian Healthcare Leadership Awards in 2015.

Just recently, in year 2017, Dr. Awatif was awarded as the Outstanding Women in Healthcare by the World CSR and Icon of the Middle East. She is also listed in the UAE Book of Special Personalities of All Fields.

Arabic, English, German

Dr. Awatif is the Director of In-Vitro Fertilization Board of the UAE Ministry of Health. She is also the chairperson of the Emirates Obstetrics and Gynecology and Fertility Forum.

Along with many teaching and research activities, Dr. Awatif

QUALIFICATIONS After obtaining his Arab Board Certification in Obstetrician and Gynecologist, Dr. Hani Salama went on to attain his doctorate in Obstetrics and Gynecology from Queen University Belfast in Ireland with Medal Price Achievement.

He is a member of the Royal College of Obstetrics and Gynecology, United Kingdom (MRCOG) and a candidate for a Master’s Degree in Obesity and weight management and Sexual and Reproductive Medicine, University of South Wales, United Kingdom.

EXPERIENCE Dr. Hani Salam, an Arab Board Certified, Consultant Obstetrician and Gynecologist has over 23 years of experience in artificial assisted reproductive technology (ART), in vitro fertilization (IVF), reproductive endocrinology, obstetrics especially high risk pregnancies, maternal and fetal medicine and minimal invasive surgeries like laparoscopy and hysteroscopy.

Dr. Hani Salama MD (PhD) in Obstetrics and Gynecology, Member of the Royal College of Obstetrics and Gynecology (UK), Arab Board Certified in Obstetrics and Gynecology Consultant Obstetrics and Gynecology and Reproductive Endocrinology

Society of Obstetrician and Gynecologists. His research papers were published in many local and international journals and presented in international conferences and symposia.

SPECIAL INTEREST Assisted Reproductive Technology (ART) Gynecological Minimal Invasive Surgery including Laparoscopy and Hysteroscopy Gynecological Ultrasound High Risk Pregnancies Infertility In Vitro Fertilization (IVF) Menopause

LANGUAGE KNOWN Arabic and English

Prior to joining University Hospital Sharjah, he was affiliated with a tertiary hospitals and fertility centre in Libya.

Academically, Dr. Hani is an Assistant Professor in Obstetrics and Gynecology in the Al Jamahiriya University Maternity Hospital and Libyan International Medical University. He is an active member of various professional organizations including Society of Obstetrics and Gynecology Canada and Libyan

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Newsletter || April February Newsletter 20182018

Time To Enhance Your

Happiness

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Don’t Forget

ARISE NEWSLETTER ISSUE 13 | APRIL 2018

In Vitro Fertilization (IVF)

To Check April Edition of

ARISE Nursing Newsletter of ARISE Nursing Newsletter provides information on Assisted Reproductive Technology - IVF. April

INSIDE THIS ISSUE

HISTORY

INDICATIONS

ADVANTAGES & DISADVANTAGES OF

IVF SUCCESS RATES NURSING ROLE IN IVF

INTRODUCTION

In Vitro Fertilization (IVF) is a process by which an egg is fertilized by sperm outside the body: in vitro.

‘Vitro’ means glass or glassy substances. So, ‘in vitro’ means in glass or glass tube.

In vitro fertilization (IVF) is a process of fertilization where an egg is combined with sperm outside the body, in vitro (‘in glasses). The process involves monitoring and stimulating a woman`s ovulatory process, removing an ovum or ova (egg or eggs) from the woman`s ovaries and letting sperms fertilize them in a liquid in a laboratory. The fertilized egg (Zygote) undergoes embryo culture for 2-6 days, and is then transferred to the same woman`s uterus, with intention of establishing a successful pregnancy .

A colloquial term for babies conceived as the result of IVF, is ‘test tube babies’.

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Newsletter from University Hospital Sharjah

Edition

This edition contains information on the process of IVF and what role a nurse plays during the IVF process. Nurses are an integral part of the medical system and support patients during the entire process wether educating the patients or assisting them in the various procedures.

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Newsletter | April 2018

SCOPE OF SERVICES AT UHS MEDICAL SERVICES

SURGICAL SERVICES

CARDIOLOGY

NEUROPHYSIOLOGY

Anesthesiology

Bariatric Surgery

24-Hour BP Monitoring

Electroencephalogram (EEG)

Aviation Medicine

Ears, Nose and Throat Surgery

24-Hour Holter Monitoring

Electromyography (EMG)

Cardiology

General Surgery

2D/3D Echo

Evoked Potential Test

Critical Care

Neurological Surgery

3D Transesophageal Echo

Brain Auditory Evoked Potential

Dermatology

Obstetrics and Gynecologic Surgery

CT coronary Angiography

(BAEP)

Emergency Medicine

Ophthalmic Surgery Orthopedic Surgery

Dobutamine Stress Echo for Ischemia and Viability Studies

Somato Sensory Evoked Potential

Endocrinology Family Medicine

Pediatric Surgery

Gastroenterology

Plastic and Reconstructive Surgery

Internal Medicine

Urologic Surgery

Medical Oncology

Vascular Surgery

Neonatology Nephrology Neurology Pediatrics Psychiatry Pulmonology Rheumatology MEDICAL DIAGNOSTICS IMAGING (MDI) 128 Channel CT Scan with Coronary and Cardiac Facility

PATHOLOGY & LABORATORY MEDICINE

Interventional Cardiology Stress Test Treadmill Stress Test

AUDIOLOGY

(SSEP) Visual Evoked Potential ( VEP) Nerve Conduction Studies (NCS)

OTHER SPECIALTY SERVICES

Biochemistry

Acoustic Reflex Threshold

24/7 Emergency Services

Blood Transfusion Medicine

Auditory Brainstem Response

Ambulance

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Auditory Steady State Response

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Hematology

Cochlear Implant Mapping

Physiotherapy

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Electrocochleography

Pharmacy

Immunology

Free Field Audiometry

Sharjah Breast Centre

Microbiology

Hearing Aid Fitting and Programming

Phlebotomy

Newborn Hearing Screening

Bone Densitometry

Otoacoustic Emission

Digital X-Ray and Fluoroscopy

Pure Tone Audiometry (PTA)

Mammography and Guided Breast Intervention

Speech Audiometry

MRI 1.5 TESLA

Tinnitus Evaluation

Ultrasound

Tympanometry

Vascular Interventional Lab

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