Dr Major Uma Maheshwari Murugesan - Infertility & IVF Specialist

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Dr Major Uma Maheshwari Murugesan - Infertility & IVF Specialist Senior Consultant - Fertility & Assisted Conception at Apollo Fertility, Annanagar, Chennai. She has done MD (Ob &Gyn).

Major (Dr) Uma Maheshwari Murugesan is an internationally recognized Infertility & IVF specialist who holds rich & vibrant clinical experience of 21+ years of experience in Infertility & Gynecology. An Indian Army Veteran, Specialist - IVF & Assisted conception, passionate Clinician. She has been trained in Reproductive Endocrinology & Assisted Reproduction from Kiel, Germany.

Egg retrieval is the most important step in IVF & fertility preservation by egg freezing.The eggs are retrieved after a ...
16/08/2025

Egg retrieval is the most important step in IVF & fertility preservation by egg freezing.

The eggs are retrieved after a period of controlled ovarian stimulation that usually lasts for about 10 days. During this duration, hormone injections are given to make multiple ovarian follicles grow.

The egg retrieval procedure is planned usually after 36 hours after the trigger injection. Trigger injection is meant to make the eggs mature.

On the day of the procedure, the lady is admitted to the hospital in fasting status.

Egg retrieval is a minor surgical va**nal procedure done on daycare basis under intravenous sedation or short general anesthesia.

A thin delicate long hollow needle is attached to the va**nal ultrasound probe & under the guidance of transva**nal scan, the o***y is gently entered through the va**na. All big ovarian follicles are punctured one by one & the follicular fluid containing the egg is brought out of the body with help of a suction device connected to the needle. Each follicle contains one egg & follicular fluid.

The collected follicular fluid with the eggs is then immediately handed over to the waiting embryologist. The embryogist then proceeds to sift the fluid & pick the eggs, introduce the s***m, to do either conventional IVF or ICSI, as the case may be, to achieve external fertilization of all available mature eggs.

This process takes about half an hour.

Most women feel only mild discomfort & can return to routine activities soon after.

In certain cases under specific circumstances, egg retrieval can also be done abdominally under ultrasound or laparoscopic guidance.

Follow my profile for more information about fertility & disorders. For appointments- text 91-9363051156 to the Helpdesk WhatsApp number.

Women are born with a finite number of eggs, the Ovarian reserveWith advancing age, the Ovarian reserve starts depleting...
03/08/2025

Women are born with a finite number of eggs, the Ovarian reserve

With advancing age, the Ovarian reserve starts depleting. There are higher chances of the remaining eggs, being of lower quality & competence. The eggs are more likely to have chromosomal abnormalities

The success rate of IVF - the "Take home baby rate" decreases with increasing age

Diminishing Ovarian Reserve & advancing age can make it harder to retrieve enough good quality eggs for IVF/ ICSI, producing fewer good quality embryos

Despite a successful IVF, the incidence of miscarriage is higher in this age group

The need for likely multiple IVF cycles jacks up the cost of fertility treatments

Older women are likely to have embryos with chromosomal abnormalities. Such embryos do not implant. Preimplantation Genetic testing will identify healthy embryos with normal chromosomes & the best implantation potential. Laser Assisted hatching & Embryo glue can be used @ Embryo transfer

In women with muItiple IVF failures due to poor ovarian response & egg quality, IVF with Donated eggs can be offered, to improve the chances of conception

In & after late 30s, women are likely to have diabetes, hypertension, dyslipidemia, hypothyroidism, obesity, fibroids & adenomyosis, which may affect IVF success rates & pregnancy outcomes.

Follow my profile for more information about fertility & disorders. For appointments- text 91-9363051156 to the Helpdesk WhatsApp number.

After the ovarian stimulation & egg retrieval in an IVF cycle, freezing the entire set of embryos, for a deferred Embryo...
27/07/2025

After the ovarian stimulation & egg retrieval in an IVF cycle, freezing the entire set of embryos, for a deferred Embryo transfer cycle later is termed as Freeze all strategy.

This is revolutionary as this strategy separates IVF into two parts - ovarian stimulation - egg retrieval & the embryo transfer part done later on.

This can be either a Preplanned strategy or a last moment Rescue strategy.

The development of a safer, effective & advanced method of embryo freezing called Vitrification & full functional recovery at thawing has made this possible.

Preplanned freeze all strategy is adopted when the lady has a risk of ovarian hyperstimulation syndrome, embryos are to be biopsied for PGT, prior diagnosed adenomyosis / fibroid(s) / hydrosalpinges needing treatment before embryo transfer & couple convenience.

Rescue freeze all is when a situation unexpectedly arises at the end of ovarian stimulation/ at egg retrieval, that rules out a possibility of a fresh embryo transfer. Thin endometrium, endometrial polyp, endometritis, persistent fluid collection in uterus, premature rise in progesterone hormone level & slow / poor growth of embryo on D5 post IVF / ICSI are some of the indications.

During the ovarian stimulation phase & immediately after egg retrieval, estrogen hormone peaks & makes the endometrium less embryo friendly. Freeze all strategy allows embryo transfer later on in a natural cycle or a mildly medicated, more physiological cycle with near normal hormone levels.

Follow my profile for more information about fertility & disorders. For appointments- text 91-9363051156 to the Helpdesk WhatsApp number.

Heterotopic Pregnancy is a type of abnormal multiple pregnancy, with one fetus located in the uterus (the normal expecte...
09/06/2025

Heterotopic Pregnancy is a type of abnormal multiple pregnancy, with one fetus located in the uterus (the normal expected location) & other located outside the uterus.

In a spontaneously conceived HP, two eggs are released at the same time & each gets fertilized, & the resulting two embryos implant in different locations simultaneously, one inside the uterus (the normal location) & another outside the uterus (abnormal location), leading to Heterotopic Pregnancy.

A recent study estimated the incidence of HP as about 1/30000 in spontaneous pregnancies, increasing to 1/360 to 1/100 in pregnancies resulting from various fertility treatments.

HP after IVF - ET, occurs due to one transferred embryo implanting inside the uterus & another implanting in one of the abnormal locations simultaneously.

HPs are possible even in ovulation induction & Timed In*******se cycles / IUI cycles.

Diagnosis of Heterotopic Pregnancy can be challenging. On USG, once a pregnancy is located inside the uterus (the normal location), another pregnancy lurking simultaneously at an abnormal location can be easily missed unless specifically looked for. Diagnosis requires a very high index of suspicion.

70% of all HPs are diagnosed on USG / TVS between 5 - 8 weeks of pregnancy, 20% between 9 - 10 weeks.

The risk of heterotopic pregnancy comes from the coexistence of the ectopic pregnancy. The commonest location of ectopic pregnancy are the fallopian tubes & rarer locations can include the cervix, o***y, previous cesarean scar, or even the abdomen. None of these organs have the anatomy / functional ability to support a developing pregnancy.

As the fetus grows, the organ housing the ectopic pregnancy will eventually rupture & leading to a massive internal bleeding.

The symptoms of heterotopic pregnancy are variable & nonspecific. Approximately 50% of women / couples are unaware of the ticking catastrophe that they carry..... have no symptoms.

Symptoms are same as of ruptured ectopic pregnancy include sudden, severe / vague abdominal or pelvic pain, collapse or shock.

Risk factors - Potentially all kinds of successful fertility treatments, multiple embryo transfer, prior tubal surgery, history of Pelvic Inflammatory Disease, history of a prior ectopic pregnancy.

A Laparoscopic removal of the coexisting Ectopic pregnancy permits the intrauterine pregnancy to continue normally.

Medical management, though useful in ectopic pregnancies diagnosed early, has a limited role in the management of HP as it will harm the intrauterine pregnancy as well.

Follow my profile for more information about fertility & disorders. For appointments- text 91-9363051156 to the Helpdesk WhatsApp number.

Though desired by some couples, Twin pregnancy carries significantly higher health risks for both - the mother & babies,...
30/05/2025

Though desired by some couples, Twin pregnancy carries significantly higher health risks for both - the mother & babies, including premature birth, low birth weight, pregnancy complications, delivery complications.

With the aim to bring down the risk of twins in IVF - ET, an elective Single blastocyst Embryo Transfer (eSET) is strongly recommended & practised.

This practice has brought down the incidence of fraternal twinning to zero.

Despite this, rarely the expectant parents & the doctor are shocked to find Twins (after eSET) at the time of first ultrasound.

These cases are IDENTICAL (MONOZYGOTIC) TWINS!!

This kind of twinning can happen when a single embryo, randomly splits into two separate embryos after the embryo transfer, inside the uterus, unbeknownst to the couple & the doctor, so diagnosed directly at USG.

Identical twins have the same genetics & therefore, are of the same gender.

A recent study has shown that twinning was observed in upto 1 - 2 % of pregnancies (1 - 2 per 100 cases) following a successful eSET.

In general population, identical twins are observed in about 0.4% (4 per 1000) of spontaneous conceptions.


The IVF/ ICSI - Single blastocyst Embryo Transfer cycle CANNOT guarantee that monozygotic twinning will not happen, as it is a natural, spontaneous & a random incident of nature.

Manipulation of the outer shell of the blastocyst embryo - the Zona Pellucida, is thought to lead to division of a single blastocyst into two & the resulting twinning.

The timing of the embryo division determines whether the twins will share the amniotic sac.

Monozygotic twins usually have a Monochorionic zygosity - single placenta. Diamniotic twins have separate amniotic sacs.

Monoamniotic twins, share the same amniotic sac, hence have high incidence of complications.

Follow my profile for more information about fertility & disorders. For appointments- text 91-9363051156 to the Helpdesk WhatsApp number.

Address

Apollo Fertility, No. 75, S Block, 6th Avenue, Anna Nagar
Chennai
600040

Opening Hours

Monday 12pm - 4pm
Tuesday 12pm - 4pm
Wednesday 12pm - 4pm
Thursday 12pm - 4pm
Friday 12pm - 4pm
Saturday 12pm - 4pm

Telephone

+919363051156

Website

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