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Rhia Fertility And IVF Centre - Nursing Homes / Clinics / Hospitals of metabolomics treatment services, iui treatments services & surrogacy treatment services in Mumbai, Maharashtra.

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Nursing Homes / Clinics / Hospitals

Metabolomics Treatment Services
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Viametrics has been introduced for the first time in Asia at Bloom IVF Centre in Mumbai. This helps assess embryos with respect to their viability and implantation potential.

With the help of Viametrics doctors can now shift from multiple embryo transfer to single embryo transfer, thereby reducing the possibility of multiple births and its related complications.

This method will also be useful for patients with repeated IVF / ICSI failures

IVM (In vitro Maturation) is a new technique in which ocytes / eggs are retrieved from a patient when they are still at a developing state. One of the most demanding aspects of an IVF cycle is the fact that the patient has to take numerous painful and costly injections.

This can be avoided with IVM, thereby minimizing the cost and the inconvenience caused to the patient. It also almost eliminates the chances of developing serious complications such as ovarian hyperstimulation syndrome (OHSS) giving the dual advantage of minimizing complications and cost at the same time. This is especially true and relevant in patients suffering from Polycystic Ovarian Syndrome or PCOS, which is found in almost 10–20% in the population.

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IUI Treatments Services
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IUI Treatments Services

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Artificial insemination is a technique that can help treat certain kinds of infertility in both men and women. In this procedure,  are inserted directly into a woman's cervix, fallopian tubes, or uterus. This makes the trip shorter for the  and bypasses any possible obstructions. Depending upon the quality and the  count, insemination is can be performed by two methods: Depending upon the quality and the  count, insemination is can be performed by two methods:

Artificial Insemination for Husband (AIH): The male collects the semen by  and then this is artificially placed in the vagina, on the mouth of the womb (cervix), with the aid of a syringe.

Intrauterine Insemination (IUI): The semen is collected by , which is processed in the laboratory. The seminal plasma is discarded and the best quality  are harvested and kept in special culture media. The ratio of half to one ml of  is then artificially deposited into the uterine cavity with the aid of a thin catheter IUI.

Reasons to Opt For Artificial Insemination:
Men-  Failure due to:
  • Diabetes
  • Multiple sclerosis
  • Spinal cord injury
  • Retograde  (where  are released backward into the bladder instead of urethra. Retrograde  may be due to diabetes, trauma or operation in neck of the bladder or a side effect due to some drugs)
  • Men with mildly low  count, poor quality  or  antibodies.
  • Men who wish to freeze their  for possible future use before vasectomy, chemotherapy or radiotherapy for cancer.
Women-
  • Women with mild endometriosis.
  • Women with cervical mucus hostility or poor cervical mucus.

Couples- Couples with unexplained infertility.
Indications For IUI Using Donors

Donor Insemination (IUI-D) is the introduction of prepared donor  into the uterus in order to improve the chances of pregnancy. IUI-D is applied to couples in which the woman has open fallopian tubes and the male partner semen is not suitable for use in fertility treatments. In such circumstances a number of options are available such as adoption or treatment using anonymously donated . IUI-D has the advantages that half the genetic make-up of the child comes from the mother and the couple can still experience pregnancy.

This treatment can also be beneficial under conditions of:
  • Males with  and who cannot afford advanced treatments such as ICSI.
  • Males with genetic disorders, which can be prevented from being transmitted to the child by using donor .

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Surrogacy Treatment Services
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The first pregnancy following gestational-surrogacy was described by Utianet al1 and since then surrogacy has become a viable option for many infertile couples to have a biologically related child, especially in whom it is impossible or undesirable on medical grounds for the intended mother to carry the child herself.

We have two type of surrogacy either it can be Traditional or Gestational surrogacy. In Traditional surrogacy, the surrogate mother provides the oocyte as well as the uterus to foster pregnancy. Well in gestational surrogacy which can also called as full surrogacy or IVF Surrogacy over here the surrogate mother gestates the genetically unrelated embryos produced by the gametes of the commissioning couple.

Indication for Gestational Surrogacy:
  • After Hysterectomy
  • Congenital absence of uterus
  • Recurrent abortion
  • Repeated failure of IVF treatment
  • Sever medical conditions incompatible with life.

Recruitment of Gestational carriers
According to ICMR (Indian Council of Medical Research) the following guidelines has been laid down for the selection of surrogate mothers which were strictly adhered to while recruiting these surrogates.
  • Surrogate mother should not be more than 45 years of age. Before accepting a woman as a possible surrogate, it must be fully ensured that the woman satisfies all the testable criteria to go through a successful full term pregnancy.
  • A relative, a known person, as well as an unknown person can act as a surrogate for the couple. In the case of a relative acting as a surrogate, the relative should belong to the same generation as the women desiring surrogate.
  • A prospective surrogate mother must be tested for HIV and shown to be seronegative for the virus just before the embryo transfer. No woman may act as a surrogate more than thrice in her lifetime.

Following selection, the potential surrogate undergoes a complete work-up which includes screening for sexually transmitted disease, basic endocrinological test and ultrasound pelvis. We as a routine perform hysteroscopy in a previous cycle for all women to evaluate the uterine cavity. The commissioning couple and the gestational carrier along with their spouses then undergo psychological and legal counseling with appropriate legal contracts.

Cycle synchronization and treatment Protocol
Both the commissioning mother and the surrogate mother are put on oral contraceptive pills in the previous cycle in order to synchronise there cycles. A long protocol for pituitary desensitization is used for the commissioning mothers Ovarian stimulation is done using gonadotropins starting on cycle day–2. The dose is adjusted according to ovarian response which is monitored by doing transvaginalsonographies and serum estradiol levels.  is administered when two or more leading follicles reached ≥ 18mm and oocyte retrieval is done under general anaesthesia after 34–36 hours.

The gestational carriers undergo pituitary desensitization by a long acting GnRhanalogue administered in the luteal phase of the previous cycle. All these then receive exogenous estrogen (estradiolvalerate) therapy for endometrial preparation before the embryo transfer. Micronised Progesterone is added on the day of ovum pickup of the commissioning mother. Day 3 or day 5 embryo transfers are done. Post transfer luteal support is given to all the recipients in the form of estradiolvalerate 6mg/day and micronised progesterone 600mg/day.  is done on day 14 post transfer to confirm pregnancy. If pregnancy was confirmed, luteal support is continued till 12 weeks of gestation.

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Pre ART Therapy Treatment Services
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Fibroids Fibroids are tumors of the uterine musculature 99% these tumors are benign i.e. they are not cancerous. These are commonly seen in women 30– 45yrs of age & those who don't have children.

Fibroids usually present with heavy periods, pain during periods and heaviness in lower abdomen about 50% of fibroids are without any symptoms & they are accidentally picked up during a health check up or check up for infertility.

Fibroids are easily diagnosed on ultrasound. A good USG is needed to localize the fibroids as treatment is based on location of the fibroids. A fibroid which is inside the cavity is known as sub mucosal fibroid & these are the fibroids which cause infertility, abortions, heavy & painful periods & intermenstrual bleeding (i.e. bleeding in between periods.) These fibroids can be treated hysteroscopically. A telescope is put inside the uterine cavity and the fibroid is either shaved, burnt or cut off. This is a very simple treatment & patient goes off home the same day.

When the fibroid is located in the wall of the fibroid it is known as intramural fibroid. These fibroids sometimes cause abortions, pain during pregnancy & abnormal position of baby obstructed labour & bleeding after delivery. These fibroids if they are bigger than 3 cm & the woman is infertile I would recommend removal. But this is very controversial & some people recommend 5cm size as cut off. This surgery is now a days done laproscopically i.e. keyhole surgery & patient goes home after 2 days. The same surgery can be done by open surgery also.

Removal of the uterus or hysterectomy is advised if the woman is b/w 40–45yrs of age or if the patient has multiple fibroids & has finished with child bearing. Some women prefer hysterectomy because of the recurrence rate of fibroids. In patients with multiple fibroids these can come back again. In 0.2% of patients these fibroids can have cancer. Usually these patient show very rapid growth in size, have a lot of pain & complain of intermenstrual building or spotting. These need to be managed aggresively.

Uterine fibroids are noncancerous growths of the uterus that often appear during your childbearing years. As many as three out of four women have uterine fibroids, but most are unaware of them because they often cause no symptoms. Your doctor may discover them incidentally during a pelvic exam or pelvic ultrasound.
Symptoms:
  • Heavy Menstrual Bleeding.
  • Prolong menstrual periods.
  • Pain in abdomen during menses
  • Pelvic pressure or pain
  • Infertility
Diagnosis
Ultrasound :
it is a painless technique that uses a sound waves to obtain a picture of your uterus. Transvaginal ultrasound provides more detail because the probe is closer to the uterus than the transabdominal scan.

Hysteroscopy:
it is done by inserting a a small, lighted telescope called a hysteroscope through your cervix into your uterus. The tube releases a gas or liquid to expand your uterus. The fibroid can be removed using electrical energy, but not in all cases. Thi procedure requires anesthesia.

Laproscopy:
A small cut is taken on the umbilicus, to look inside the abdomen using a telescope. This provides direct visualisation of the fibroid. Although uterine fibroids usually aren't dangerous, they can cause discomfort and may lead to complications such as anemia from heavy blood loss. Fibroids can require emergency treatment if they cause sudden, sharp pelvic pain.

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Laser Hatching Treatment Services
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Couples may face difficulty and frustration after IVF and ICSI treatments due to failure of successful implantation of healthy looking embryos into the womb. In general, the embryos are transferred back into the womb on the second or third day, when they are in the 4 cell or 8 cell stage. Once they are placed back into the womb, they keep on growing till day 5 (5 days after oocyte retrieval). At this time the embryos are multicellular and differentiated into an inner cell mass and an outer cover called the Trophectoderm. This embryo is called a Blastocyst. The Blastocyst starts expanding and cracks open the cover of the zona, and escapes out. This process is known as 'Hatching'.

In Assisted Hatching, a cut is given to the zona of embryos of 4 cell or 6-8 cell stage. By laser hatching the zona of embryo gets weakened which further help them for hatching process and then they are transferred to the women womb.

The cut can be made in three different ways:
1. Mechanical Hatching:
In this the embryo cover is slit open mechanically with the help of a thin long drawn out glass needle. This is done with the help of a machine called the Micromanipulator.

2. Chemical Hatching:
In this the zona is opened by touching it with a chemical called Acid Tyrode Solution. This is also done with the aid of the Micromanipulator.

3. Laser Hatching:
This is the latest method, introduced in the world in 1992. At present the Laser beam is generated by an InGaSp Diode Laser. The zona is cut with the Laser beam by simply pressing a button on the Laser machine. Many babies have been born all over the world, following the introduction of this technique.

Benefits:
  • Women patients usually between 35–38 years of age
  • Patients in whom the zona thickness is more than 15 microns
  • Patients who have had more than one attempt at IVF/ICSI and have failed to become pregnant
  • Patients who have their extra embryos frozen. The frozen thawed embryos are hatched before embryo transfer
  • Patients who are undergoing Pre–Implantation Genetic Diagnosis

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