Frequently Asked Questions

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How long should a couple try to conceive naturally before seeking medical help?

Women under the age of 35 are usually advised to try for 12 months before consulting a physician. A couple that knows of adverse medical conditions, such as irregular menstrual cycles or a history of tubal infections, should consider a basic examination sooner. Doctors usually advise women over age 35 to have an initial examination after only six months of trying, while those over 40 may begin fertility tests immediately. Couples should have sexual relations 3 to 4 times a week during the week before ovulation. The egg (oocyte) only survives for 24 hours after ovulation, so good timing is essential.

How successful are infertility treatments?

Each couple’s condition and response to infertility treatment is unique. The answer is difficult to calculate, because it depends on several factors: the woman’s body, the man’s body, the clinic’s success rate, and luck. Physiological factors that affect success include the age of the woman, uterine abnormalities, and whether both partners have infertility factors.

Should a woman see her gynecologist or an infertility specialist?

Most gynecologists have ample training to handle the basic infertility workup, although some refer patients to a specialist immediately. Usually, the OB/GYN begins the testing process and appropriate treatments, then refers the couple to a fertility specialist if simple treatments are not successful

What is endometriosis?

The endometrium is the lining of the uterus. Endometriosis a condition that can occur if endometrial tissue spreads outside the uterus. Most often, these small pieces of misplaced tissue–sometimes called endometrial lesions or implants–attach to the ovaries, fallopian tubes, the outer surface of the uterus, the lining of the pelvic cavity, or elsewhere in the lower abdomen.
Endometrial tissue changes with the hormones of a woman’s monthly cycle–the tissue builds up, breaks down, and bleeds. But while menstruation gets rid of the uterine tissue and fluids, the tissue from endometriosis has no place to go. Thus, the area around the endometrial implants can become inflamed and form scar tissue. Other complications may also occur.

What are the symptoms of endometriosis?

Symptoms of endometriosis include pain, infertility, and abnormal menstrual bleeding. Pain can be severe and usually occurs before and during menstrual periods or at ovulation. Some women don’t have pain. Pelvic or ultrasound examinations may suggest endometriosis, but direct inspection via a laparoscopy is the only way to be certain.
In a laparoscopy, the surgeon makes a small surgical incision just below the navel, inflates the abdomen with carbon dioxide gas (to improve the ability to see the organs), and inserts a long, thin, lighted, flexible, telescope like instrument–the laparoscope. The surgeon can then view and treat, if necessary, endometriosis or other pelvic conditions.

How can endometriosis be treated?

Pain from endometriosis can be treated with a variety of medications. For mild or moderate pain, nonprescription pain relievers, such as aspirin, acetaminophen, or ibuprofen, may be helpful. If these don’t provide relief or if pain is severe, a prescription pain medication may be needed. Some women have found additional relief using acupuncture, biofeedback, meditation, and exercise.
Treatment of the disease itself may include hormone therapy, surgery, or both. Hormone therapy includes the use of oral contraceptives (estrogen, progestins, or both), danazol, or a newer class of agents called GnRH agonists. Hormone therapy works by stopping ovulation temporarily. This can help the endometrial lesions to shrink and stops the development of new implants. But hormone therapy does not cure endometriosis–the disease recurs in most women when hormone therapy stops.
Surgical treatment removes endometrial implants and scar tissue by cutting away, cauterizing (burning), or vaporizing with a laser. This can usually be done during the inspection by laparoscopy. If endometriosis is severe or if the implants cannot be reached easily with the laparoscope, you may need a more extensive surgery, called a laparotomy. Laparotomy involves a larger incision, usually about four to five inches.
Hormone therapy and/or surgery to remove endometrial implants may help to relieve symptoms temporarily and may make it possible to conceive. Some women with severe endometriosis may consider hysterectomy and removal of the ovaries.

Why is there a declining trend for Seminal Parameters in Male?

Male Infertility is one of the largest causes of sub fertility. There is a declining trend for seminal parameters throughout the world. The stress associated in this highly competitive world ,environmental pollutants, smoking, Varicocoele and sexually transmitted diseases are the causative factors. Lack of exercise, prolonged rides in motorbike, tight jeans and undergarments are also attributed as causatuve factors for male infertility.

What are the common causes for female contributing to infertility in Kerala?

The reasons of female infertility may be due to failure to ovulate, obstruction to fallopian tube, infections such as pelvic inflammatory disease due to tuberculosis or sexually transmitted diseases. In Kerala there is a high incidence of endometriosis. In a study conducted at our Fertility Centre for past 4 years Endometriosis has been found to be cause in 28% of female causes of infertility. The cause of high incidence of endometriosis is not clear but may be due to environmental pollutants like Dioxin caused by burning plastic materials.

What are the advantages of key hole surgery over open surgery? Is it costly?

Laparoscopic Surgery (Key hole surgery) which is minimally invasive surgery is the appropriate method of treatment. Centres equipped with most modern gadgets required for key hole surgery. The patient can be discharged within 24 hours and can try for conception immediately. The other advantage is the time taken to resume normal activities is less than 2 weeks when compared to 4-6 weeks rest advised in Laparotomy (Open Surgery). The cost of laparoscopic surgery is equal to open method.

What Can I Expect From IVF?

The first step in IVF involves injecting hormones so you produce multiple eggs each month instead of only one. You will then be tested to determine whether you’re ready for egg retrieval. Prior to the retrieval procedure, you will be given injections of a medication that ripens the developing eggs and starts the process of ovulation. Timing is important; the eggs must be retrieved just before they emerge from the follicles in the ovaries. If the eggs are taken out too early or too late, they won’t develop normally. Your doctor may do blood tests or an ultrasound to be sure the eggs are at the right stage of development before retrieving them. The IVF facility will provide you with special instructions to follow the night before and the day of the procedure. Most women are given pain medication and the choice of being mildly sedated or going under full anesthesia. During the procedure, your doctor will locate follicles in the ovary with ultrasound and remove the eggs with a hollow needle. The procedure usually takes less than 30 minutes, but may take up to an hour. Immediately following the retrieval, your eggs will be mixed in the laboratory with your partner’s sperm, which he will have donated on the same day. While you and your partner go home, the fertilized eggs are kept in the clinic under observation to ensure optimal growth. Depending on the clinic, you may even wait up to five days until the embryo reaches a more advanced blastocyst stage. Once the embryos are ready, you will return to the IVF facility so doctors can transfer one or more into your uterus. This procedure is quicker and easier than the retrieval of the egg. The doctor will insert a flexible tube called a catheter through your vagina and cervix and into your uterus, where the embryos will be deposited. To increase the chances of pregnancy, most IVF experts recommend transferring three or four embryos at a time. However, this means you could have a multiple pregnancy, which can increase the health risks for both you and the babies. Following the procedure, you would typically stay in bed for several hours and be discharged four to six hours later. Your doctor will probably perform a pregnancy test on you about two weeks after the embryo transfer. In cases where the man’s sperm count is extremely low, doctors may combine IVF with a procedure called Intracytoplasmic sperm injection. In this procedure, a sperm is taken from semen — or in some cases right from the testicles — and inserted directly into the egg. Once a viable embryo is produced, it is transferred to the uterus using the usual IVF procedure.

What Are the Success Rates for IVF?

Success rates for IVF depend on a number of factors, including the reason for infertility, where you’re having the procedure done, and your age. Pregnancy was achieved in an average of 40% of all cycles (higher or lower depending on the age of the woman). A woman’s age is a major factor in the success of IVF for any couple. For instance, a woman who is under age 35 and undergoes IVF has a 39.6% chance of having a baby, while a woman over age 40 has an 11.5% chance. However, the CDC recently found that the success rate is increasing in every age group as the techniques are refined and doctors become more experienced.

What to do if there are surplus embryos left over?

Any embryos that you do not use in your first IVF attempt can be frozen for later use. This will save you money if you undergo IVF a second or third time. If you do not want your leftover embryos, as we do not have any donor embryo programs at our centre, you and your partner can ask the clinic to destroy the embryos.

What are the common causes for Infertility?

Common causes of infertility:
* Ovulation Problems
* Tubal Age
* Male Associated Infertility
* Age-Related Factors
* Uterine Problems
* Previous Tubal Ligation
* Previous Vasectomy
* Unexplained Infertility

What are the common Indications for ART Treatment ( IVF / ICSI)?

* Bilateral Tubal
* Extensive Adhesions around the Uterus and tubes in Severe Endometriosis and Pelvic Inflammatory Diseases ( Pelvic Infections like TB)
* Loss of both tubes following ectopic gestation
* Alternate to Tubal recanalisation or recanalisation failure
* Repeatedly failed IUI
* In severe oligoasthenoteratozoospermia or refractory cases
* Unexplained Infertility
* Immunological Problems

What to do when the treatment fails ?

* If the pregnancy test is still negative 15 to 17 days post-transfer, however, your doctor will ask you to stop taking the progesterone, and you’ll wait for your period to start. The next step will be decided among you, your partner and your doctor.

* Having a treatment cycle fail is never easy. It’s heartbreaking. It’s important, however, to keep in mind that having one cycle fail doesn’t mean you won’t be successful if you try again.You will have to discuss with your doctor what will be the best option

What are chances success rates of IVF treatment?

Success rates vary and depend on many factors. Some things that affect the success rate of ART include:
* Bilateral Tubal
* Age of the Partners
* Reason for Infertility
* Clinic
* Type of ART
* If the egg is fresh or frozen
* If the embryo is fresh or frozen
* For women younger than 35, the percentage of live births per cycle is 39.6%.
* For women ages 35 to 37, the percentage of live births per cycle is 30.5%.
* For women ages 38 to 40, the percentage of live births per cycle is 20.9%.
* For women ages 41 to 42, the percentage of live births per cycle is 11.5%.
* For women ages 43, the percentage of live births per cycle is 6.2%.
* After age 44, little more than 1% of IVF cycles with non-donor eggs lead to live birth.

What is ICSI?

ICSI, which is pronounced ick-see, stands for intracytoplasmic sperm injection. ICSI may be used as part of an IVF treatment. In normal IVF, many sperm are placed together with an egg, in hopes that one of the sperm will enter and fertilize the egg. With ICSI, the embryologist takes a single sperm and injects it directly into an egg.

Why is ICSI Done?

ICSI is typically used in cases of severe male infertility, including: ·
* Very low sperm count (also known as oligospermia) ·
* Abnormally shaped sperm (also known as teratozoospermia) ·
* Poor sperm movement (also known as asthenozoospermia)
If a man does not have any sperm in his ejaculate, but he is producing sperm, they may be retrieved through testicular sperm extraction, or TESE. Sperm retrieved through TESE require the use of ICSI. ICSI is also used in cases of retrograde ejaculation, if the sperm are retrieved from the man’s urine. ICSI may also be done if regular IVF treatment cycles have not achieved fertilization.

What is the Procedure for ICSI?

ICSI is done as a part of IVF. Since ICSI is done in the lab, your IVF treatment won’t seem much different than an IVF treatment without ICSI. As with regular IVF, you’ll take ovarian stimulating drugs, while your doctor will monitor your progress with blood tests and ultrasounds. Once you’ve grown enough good-sized follicles, you’ll have the egg retrieval, where eggs are removed from your ovaries with a specialized, ultrasound-guided needle. Your partner will provide his sperm sample that same day (unless you’re using a sperm donor, or previously frozen sperm.) Once the eggs are retrieved, an embryologist will place the eggs in a special culture, and using a microscope and tiny needle, a single sperm will be injected into an egg. This will be done for each egg retrieved. If fertilization takes place, and the embryos are healthy, an embryo or two will be transferred to your uterus, via a catheter placed through the cervix, two to five days after the retrieval. You can get more detailed information here in this IVF Treatment Step by Step.

How Much Does ICSI Cost?

ICSI typically costs between $1,000 to $1,500. This is on top of the general IVF cost, which on average costs $12,000 to $15,000. It may cost more than this if other IVF options are being used.

Is ICSI Safe for the Baby?

A normal pregnancy comes with a 1.5% to 3% risk of major birth defect. While ICSI treatment carries a slightly increased risk of birth defects, it’s still rare. Some birth defects which have an increased risk with ICSI include Beckwith-Wiedemann syndrome, Angelman syndrome, hypospadias, and sex chromosome abnormalities. Still, they occur in less than 1% of babies conceived using ICSI with IVF. There is some increased risk of a male baby having fertility problems in the future. This is because male infertility may be passed on genetically.

What is the Success Rate for ICSI?

The ICSI procedure fertilizes 50% to 80% of eggs. (Interestingly, just because a sperm is injected into an egg, it does not guarantee fertilization will happen.) Even if fertilization takes place, the embryo may stop growing. However, once fertilization happens, the success rate for a couple using ICSI with IVF is the same as a couple doing regular IVF treatment.

What Can ICSI Help Treat?

There are a variety of underlying fertility conditions that ICSI may help treat. The specific male fertility problems that ICSI is used to treat are:
· low sperm count
· low sperm motility
· total absence of sperm in the semen
· damaged or absent vas deferens
· retrograde ejaculation
· irreversible vasectomy
· immunological factors (such as a very high white blood cell count in the semen)
· other conditions that prevent the fertilisation of the egg.
Men who have been diagnosed with testicular cancer may also want to consider freezing a semen sample prior to treatment since this sample can later be used in ICSI.

How ICSI Works

Since ICSI is always used with in vitro fertilisation, the process starts with preparation for this procedure. The woman is given fertility drugs to stimulate egg follicle development and ovulation. Her mature ova are then retrieved to use during ICSI. In additional preparation for ICSI, sperm is collected from the man. In cases where it is possible, sperm can be collected from a semen sample. This is the preferred method since it is less invasive, but for some men this may not be possible. An alternate option is to harvest the sperm directly from the man’s testicles using a testicular biopsy under anesthetic. The single sperm is then injected directly into the woman’s harvested egg with a very delicate needle. The egg will reseal itself after the needle is withdrawn, just as it does in the process of natural fertilisation when the sperm breaks through its outer membrane. As in in vitro fertilisation without ICSI, the fertilised egg is then allowed to develop for a few days before being transferred back into the woman’s uterus in the form of an embryo.

Effectiveness of ICSI

ICSI is currently the most successful treatment for male infertility, with fertilisation rates of 60%-70% depending on quality of the sperm used. However, once the egg is fertilised, the success rates of ICSI in conjunction with IVF remain the same as conventional IVF – a 20%-25% chance of live birth. This is because overall effectiveness still depends on the fertilised egg developing properly in addition to successful implantation into the uterus. In some cases, assisted hatching may be used to increase the chances of implantation.

ICSI Risks

One concern about ICSI is the possible health impact of this procedure on any resulting children. ICSI is often used with men who have poor sperm quality, and the method entails using any sperm to fertilise the egg as opposed to the strongest one (which is what happens in nature). Because it is possible that a weaker, poorer quality sperm might be used in ICSI, congenital defects may be passed on at a higher rate than naturally or with other methods of IVF. Also, because ICSI is a relatively new procedure, the long-term effects for resulting children have yet to be properly analyzed. So far, no studies have shown any increased chance of physical, developmental, or congenital problems in children conceived using ICSI. Couples who want to conceive using ICSI are still advised to analyze their family history for genetic diseases and disorders and consult with a doctor. They may also want to consider pre-implantation genetic diagnosis (PGD). Finally, because ICSI is used in conjunction with IVF, the risks of IVF apply here too; namely, increased chances of ectopic pregnancy and multiple births. However, ICSI is still a viable choice if done by a reputable clinic. For some facing the only other alternatives of adoption, sperm donors, or never having children, the risks if ICSI pale in comparison to the possible benefits.