The IVF
Unit will provide facilities for In vitro fertilisation (IVF) procedures. IVF
is one of several Assisted Reproductive Techniques (ART) used to help infertile
couples to conceive a child. The procedure involves removal of eggs (mature
Oocyte or Ovum) from the woman's ovary. Ova are then fertilised with sperm in a
laboratory procedure (in vitro). If fertilisation occurs, a fertilized ovum,
after undergoing several cell divisions, is transferred to the mother for
normal development in the uterus, or frozen for later implantation.
The IVF
centre must have adequate functionalities to minimize any damaging effects upon
reproductive cells and ensure good laboratory practice. Also, laboratory design
should ensure optimal workflow over minimal distances while handling
reproductive cells during all treatment phases. The IVF Unit will provide facilities for In vitro
fertilization (IVF) procedures. IVF is one of several Assisted Reproductive
Techniques (ART) used to help infertile couples to conceive a child. Once the
architecture and ergonomics of your clinic are sorted. What is the ideal
environment to create a wellness centre and IVF clinic focused on the whole person?
The IVF laboratory may use Intracytoplasmic Sperm Injection
(ICSI) in the process of IVF.
Services provided by the IVF Unit include:
Patient consultation and
interview on an outpatient basis
Pre-treatment
assessment
Blood collection
Semen collection
Artificial insemination
Ovarian stimulation therapy
Ultrasound examination
Oocyte (egg) collection
Embryo culture
In vitro / ICSI fertilisation
Cryopreservation
Embryo transfer
Recovery
Functional Areas
The IVF Unit may consist of a number of Functional Areas or
zones:
Entry/ Consult Area
-
Entry/ Reception and waiting areas
-
Administration/ Records
-
Interview Room/s
-
Consult/ Examination/ Treatment Room/s
-
Ultrasound room/s
-
Collection Room/s with Ensuite shower and Toilet
-
Public Toilets
Patient Procedural Area
- Operating Room/s for oocyte (egg) collection
and re-implantation
- Recovery areas
-
Change areas and toilets for staff and patients
Laboratory Area
-
Laboratories (Embryology, IVF, ICSI, Andrology, Genetics)
-
Cryopreservation facilities
- Gas
Bottle Store
Staff and Support Area
- Clean-Up
and Disposal room
- Store rooms and Sterile store
- Offices, meeting rooms, staff room
-
Sterilising area:
if the IVF unit is a stand-alone building,
dedicated sterilising facilities will be required
Here are some design tips from experts in the field of clinic
design:
Create Texture:
Use natural materials such as wood, stone and
natural textiles to create texture and contrast in your clinic. Locally made
textiles, utilised as wall hangings or furniture accessories such as cushions,
can then embody the uniqueness of the location. You can create a subliminal
impression of balance i.e. holism by combining elements that complement each
other. Use reclaimed wood and other recyclables on horizontal surfaces.
Textured glass and ceramic tiles and metals such as copper and bronze for
railings and fixtures.
Bring the outdoors indoors:
an
impression of nature, her beauty, wildness and fecundity, can be created by
conveying a sense of the outdoors. The outdoors can be brought indoors by using
mini-waterfalls, bamboo (both living and inert) and stone. Natural elements
such as water features and meditative garden enclaves intrigue, but also calm,
visitors as they experience the environment along with their treatments.
Dramatic doors and crossing over points:
pay
great attention to doors and entrances. These signify a crossing over point to
a place where people can leave their previous lives behind.
1. Different
levels and procedures of ART Treatment Centers
According
to ICMR (Indian Council for Medical Research) an ART center can be categorized
and the responsibilities as mentioned below:
Primary (Level 1A) infertility
care units
These
would be clinics where preliminary investigations are carried out and type and
cause of infertility diagnosed. Primary infertility care unit or clinic could
be a doctor’s consulting room, such as a gynaecologist’s or a physician’s
consulting room, or even a general hospital. Depending on the severity of
infertility, the couple could be treated at the Level 1A clinic or referred to
a specialist (Level 1B, Level 2 or Level 3) clinic.
Procedures/Facilities
a.
Completion
of the basic investigations mentioned above.
b.
Ability
to carry out AIH
c. Ability
to carry out IUI using processed semen of husband or donor obtained from an
accredited laboratory or semen bank which must maintain a record
d.
Referral
of the couple to Level 1B, Level 2 or Level 3 infertility care unit as appropriate
e.
Consulting
Room for Patient and Doctor
Primary (Level 1B) infertility
care units engaging in IUI
Infertility
clinics falling into this category shall need accreditation. The IUI in such
clinics must be done under the supervision of a gynaecologist with a
post-graduate degree.
Procedures/Facilities
a. Facilities
for semen preparation and certification and for intrauterine insemination
(IUI), including an appropriate sterile area for IUI
b.
Consulting
Room for Patent and Doctor
c.
Andrology:
A Sterile room for Semen Preparation
Secondary (Level 2) infertility
care units
These
units must have infrastructure for further in-depth investigation and extended
treatment of infertility except where oocytes are handled outside the body.
Some of the investigations and treatment facilities required for Level 2 care
units
Procedures/Facilities
a. Facilities
for semen preparation and certification and for intrauterine insemination
(IUI), including an appropriate sterile area for IUI
b.
Provision for semen collection in men
with a vibrator or an electro ejaculator in functional erectile and ejaculatory problems
c.
Consulting
Room for Patent and Doctor
d.
Andrology:
A Sterile room for Semen Preparation
e. Operation
Theatre for conservative surgery either through a laparoscope, hysteroscope or
via laparotomy. It should be possible to perform hysteroscopic cannulation of
locked tubes, and resection of sub mucous myoma or uterine septum. Combined
medical- surgical therapy by a co-ordinate team as in-endometriosis or in some
cases of polycystic ovaries
f.
Provision
for extended treatment of infertility except for oocyte pick up and IVF, ICSI
Tertiary (Level 3) infertility
care units
Such
units will have three functions to perform, viz. diagnostic and therapeutic at
the highest level of specialization and with the best of facilities, and
research.
Procedures/Facilities
a. Facilities
for semen preparation and certification and for intrauterine insemination
(IUI), including an appropriate sterile area for IUI
b. Provision
for semen collection in men with a vibrator or an electro ejaculator in
functional erectile and ejaculatory problems
c.
Consulting
Room for Patent and Doctor
d.
Andrology:
A Sterile room for Semen Preparation
e. Operation
Theatre for conservative surgery either through a laparoscope, hysteroscope or
via laparotomy. It should be possible to perform hysteroscopic cannulation of
locked tubes, and resection of sub mucous myoma or uterine septum. Combined
medical-surgical therapy by a co-ordinate team as in- endometriosis or in some
cases of polycystic ovaries
f.
A
Pre-Culture room for processing the embryos
g.
Culture
room for developing the embryos and to carry out the ICSI process
Space and Equipment Requirements
A complete IVF Tertiary (Level 3)
Center requires the following Infrastructure and Equipments:
S.No.
|
Partition Name
|
Amenities & Equipments Required
|
Area Required (in sq.ft)
|
1.
|
Waiting
Hall/
Entry for
IVF
|
Chairs and
Tables
Air
Curtain(Recommended)
|
150
- 200
|
2.
|
Dress
Change Room with a
bathroom
|
Dress
Shelves, Dress Hangers
|
100
- 120
|
3.
|
Doctors
Consulting Room
|
Chairs and
Tables and a bed for screening the patient. A Scan machine would be ideal to
have.
|
150 - 200
|
4.
|
Wash
Area
|
To
wash hands for disinfections
Water
Pipeline with 3 – 4 Taps (pedaling model is recommended)
|
50 – 75
|
5.
|
Operation
Theatre
|
To carry out
aspiration of Ovum; Egg Scan Machine
Operation Beds
Suction Pump, Aspiration
Needles, Embryo
Transfer
catheters and operation Theatre Accessories
|
250 – 300
|
6.
|
Andrology
Lab
|
Laminar
Workstation – Sterile area to do semen preparation
Heating
Block – To Keep the sample during the preparation
Centrifuge –
Necessary during semen preparation
Microscope –
To view the unprocessed or processed semen
Software –
For documentation purpose Disposables : IUI Catheters, Cannula, Conical test
tube and Micropipette
Media for
washing and immunization
|
80
– 120
|
7.
|
Pre-Culture
Room
|
For pick up
of ovum and washing it with media
and process
it for further grading purpose
|
125
– 150
|
8.
|
Culture
|
Integrated
Workstation comprising of Laminar Workstation, stereo zoom microscope, stage
warmer, Heated table along with heating block with temperature controllers
CO2 Incubators
Inverted
Microscope with Micromanipulator for ICSI
Television
or Computer to view microscopic details
Pipelines
for co2, nitrogen gas connecting to utility room
Concealed
wiring for electricity, UPS line and video transmissions, Air Condition
|
150 – 200
|
9.
|
Utility Room
|
CO2/Nitrogen
Cylinders Positive Pressure Module
Shelves
|
80
– 100
|
Total
|
1200
- 1500
|
Discuss with your IVF Lab
Specialist for more information
B Manpower Requirements
The Following trained man power is
required for starting up an IVF center
a. A Gynaecology
doctor for patient screening
b. A trained
staff for counseling the patient about IVF
c. A trained
staff as in-charge of the IVF Department
d.
Staff
trained in carrying out andrology procedures
e. Embryologist
for Ovum Pickup, Grading Embryos and to undergo ICSI
f.
One
or Two Assistants for Embryologist
g. A Service
Engineer to check all equipments and to avoid break down during the case
h. One or Two
Assistants for ovum pickup process
Initiative Measures for Center Development
Factors or Measure for Center Development
a. Better Hospital Environment
b. Good Team of professionals
c. Excellent Hospitality and Care
d. Marketing Initiatives to receive
infertility cases from small and medium sized hospitals
e. Maintaining the Lab
f. Convert/Register more positive results
g. Regular follow-up of patients
h. Organize IUI workshop and IVF
conferences for awareness of the center to other doctors
i. Continuous advertisement on media adds
more value
Credit:Sivakumar
Murugesan,Consultant Projects, Medpoint Healthcare
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