Infertility is defined as the failure to conceive after a year of regular unprotected intercourse, or the inability to carry a pregnancy to a live birth.
What Causes Infertility ?
There are various causes of infertility.
• Problems with man’s reproductive system
• Problem with woman’s fallopian tubes
• Problem with woman’s uterus and / or cervix
• Problems with woman’s ovulation.
• Hormonal disturbance.
• Problems in the immune system.
- Pelvic Inflammatory disease [PID]
- Polycystic ovary syndrome [PCOS]
In PCO, the ovaries produce high amounts of male hormones especially testosterone and an imbalance of female harmones, thus the follicles do not produce eggs. Ovaries are laden with immature eggs which do not grow naturally, thus the female is unable to conceive, till treated.
Endometriosis refers to a condition in which sections of the uterine lining implant in the vagina, ovaries, fallopian tubes or pelvis . These implants eventually form chocolate cysts that grow with each menstrual cycle. Endometriosis needs to be treated in order to achieve pregnancy.
The most common cause for male infertility is a problem with sperm production. Sperm with poor quality cannot move rapidly enough or in the right direction. Some conditions that may contribute to sperm problems include
• Undescended tests
• Problems in ejaculation
• Exposure to metals
• Certain medications
• Injury to testicles
• Chronic prostate infections
• Deficiency of testosterone.
• Auto immunity – in which antibodies of the man’s immune system attack sperm cells, mistaking them for toxic invaders. The antibodies attach themselves to the sperm and may cause them to stick together, or may stop them from penetrating the cervical mucous or the egg.
• Retrograde Ejaculation – In this condition the muscles of the urethra do not force the sperm out. Instead , the sperm travel backward into blad.
How is infertility diagnosed ?
A complete medical history and a physical exam are the first step in diagnosing with fertility problem. Both partners need to be evaluated. The couple may also need blood tests, semen analysis and ultrasound exams or exploratory surgery for the woman.
How is infertility in a woman treated?
Once the cause for infertility is determined, treatment can be planned. Some times, a simple instruction or few medication will solve the problem. Instructions like when having the sex will produce a pregnancy is given. In many cases medications are indicated. In some cases surgery is required.
What increases a man’s risks of infertility ?
Sperm quality and quantity can be affected by overall health and life style. Some things that may reduce sperm number and / or quality includes alcohol, drugs, stress, environmental toxins, smoking, health problems, certain medicines,infections, radio or chemotherapy and age.
What things increases a woman’s risk of infertility ?
Things that affect woman’s fertility includes age, stress, poor diet, obesity, underweight, smoking, STD, hormonal problems and health problems.
How many couples are affected by infertility ?
One in six couples are affected by some degree of infertility.
If a couple has trouble conceiving, when they should visit a fertility specialist ?
Couple who have been having intercourse during ovulation for one year without protection and wants to have baby should consult a doctor.
Is Infertility hereditary ?
Most infertility problems are not hereditary. If your grand mother, mother or sister conceives late or had difficult in conceiving, it is not a rule that you will not conceive.
Do all infertility treatment is high-tech procedures ?
No, many couples are successful in their attempts to conceive using simple and “low-tech” procedure. ~10-20% couples seeking infertility treatment will undergo ART procedure. All ART procedures are established medical treatment .
How successful are infertility treatments ?
Improvements in medication, surgery and ART make pregnancy possible for a majority of the couples pursuing treatments. Success rates have drastically improved for couples taking treatment under ART.
How does age affect woman’s fertility ?
• The quality of eggs in the ovaries decline with age.
• The ability of an egg to become fertilized may also be decreasing over time, lowering the odds of conception
• There are fewer eggs with time.
• Overtime, changes in hormones can cause difficulties with ovulation.
• Miscarriage rates increase with age.
Is there hope for women at 40+ above?
Yes, motherhood begins at 40 plus. We help you to conceive, even when you loose hope and you are on the receding side of reproduction.
Studies have shown that there is no increased risk of abnormality in IVF conceived babies compared to those conceived naturally.What are the precautions I should take after the IVF procedure?
The procedure demands no special precautions, but avoid strenous activity. We advise the patients to be mentally & physically relaxed as much as possible. You can return to work if you wish, but fist prefer to have a few days rest.What if IVF fails the first time? How many times will I have to undergo the same procedure?
You can go through IVF as many times as you wish, but we advise up to five cycles at the most.Is IVF the last option?
IVF is the option, which has highest success rate and is also the most expensive. But, it is not "end of the road". Many women have conceived naturally or with intrauterine insemination, even after IVF. However, for those with blocked tubes & very poor sperm counts, it is only option.Is IVF very expensive?
IVF is not as expensive as percieved in general. Generally, the cost of IVF cycle depends upon the dose of drugs that would be needed for ovarian stimulation. It is only as expensive as perhaps gall stone removal or removal of uterus surgery.Do we need to get admitted in the IVF process?
A patient undergoing IVF does not require admission. However, one should visit the center 5-8 times during monitoring cycle. On the day of egg collection, the patient would need to fast for 6 hours & come to clinic (the procedure takes about half an hour). Patients can go home after the effect of anaesthesia weans off which takes about 2-3 hours. The next scheduled visit is after 2-3 days for the embryo transfer, which again takes about half an hour and patients are free to go home after resting for one hour.Is there something we can do to improve our chances of success?
Medical or surgical management of the pathology behind infertility is on us before going for any or the ART procedures. Even though IVF treatment is a medical process on which you have no influence, there are a number of things connected to your lifestyle which you can change to increase your chances of benefiting from the treatment.
Stop smoking - for both partners - is the most important thing to do. Its positive effects cannot be equaled by any medical adjustment of your treatment!
Did you know - as various studies have shown - that women who
smoke need about twice as many IVF attempts in order to achieve
Or that the residue products of nicotine lead to a faster decrease of the ovum reserve, which according to several researchers can cause smoking women to enter their menopause one to four years earlier? Or that smoking also has a negative influence on the fertility of man? A smokers’ sperm is significantly poorer in quality than that of a non smoker. If you really want to get pregnant, the first thing you both should do is stop smoking!
Definitely not. Ten or more follicles may be encouraged to ripen during stimulation, but this happens during a normal cycle too. The only difference is that most of the follicles die during a normal cycle, leaving only one or two survivors. With IVF they all ripen. In other words, ovarian stimulation saves many of the eggs which would otherwise be lost.
In the early part of her fertile years, a woman has more than 400,000 egg cells on average, most of which die spontaneously as the years pass. Stimulation draws on a large reserve of eggs which would otherwise remain almost completely unused.Are the hormone treatments harmful for me or for our (future) child?
As stated in this guide, the hormones administered during IVF treatment may have some side-effects. Fortunately, they are not serious and are only temporary.
Claims that the hormones used in IVF treatment can be carcinogenic or have other ‘harmful’ effects are not founded on medical data. Moreover, these hormones were administered to women with infertility problems on a large scale long before IVF treatments were developed, without any harmful effects.
Also with regards to children born from IVF/ICSI up until now no study has proven that (certain) cancers would occur more frequently than with children who were conceived without hormonal stimulation.
Having said that, research regarding the effects of hormone treatments is still conducted worldwide in the interests of safety.Does IVF significantly increase the chances of twins or triplets?
Yes there is an increased chance of twins but can be reduced by doing single embryo transfer.Does IVF produce a higher incidence of ectopic pregnancy (implantation outside the womb)?
A woman who is pregnant through natural fertilization has a 1% chance of an ectopic pregnancy. Chances are no higher for an IVF pregnancy unless the woman concerned already has damage to one or both of her fallopian tubes.
However, IVF treatment may produce an ectopic pregnancy. Even though the transfer involves very careful insertion of the embryo(s) into the womb, the embryo does not immediately attach itself to the wall of the womb. This explains why it sometimes still migrates to the fallopian tube and develops there.
An IUI -- Intrauterine Insemination -- is performed by threading a very thin flexible catheter through the cervix and injecting washed sperm directly into the uterus. The whole process doesn't take very long. It usually requires the insertion of a speculum and then the catheter, a process that maybe takes no more than a couple of minutes (60-90 seconds to introduce the catheter, then sperm injection, and another 60 seconds or so to remove catheter -- going slowly helps reduce discomfort).Where is the sperm collected? How long before the IUI?
The sample is collected through ejaculation into a sterile collection cup. If you are collecting at home, the semen be delivered to the clinic within an hour of ejaculation. Otherwise, we provide a collection room in the clinic for the male to use. There is a delay between when the semen sample is dropped off and when it is inseminated to allow for washing of the sample. The amount of time depends on the washing technique used, which takes 30 minutes to two hours, as well as on the clinic's scheduling. In most cases, we will perform the IUI as soon after washing is completed as possible.When is the best timing to an IUI?
Ideally an IUI should be performed within 6 hours on either side of ovulation. When timing is based on an hCG injection, the IUI's are usually done between 24 and 48 hours later.What does an IUI feel like?
A: Most women consider IUI to be fairly painless due the thin flexible cathetar -- along the same lines as having a pap smear. There can be some cramping afterward, but often what is felt is ovulation-related rather than from the IUI.Do I have to lie down after an IUI?
Our doctors recommend patients lie down on the table for 15 - 30 minutes after the procedure.Do I need to take it easy after an IUI?
We recommend patients take it easy for a while following IUI. Some people reduce their aerobic activity and heavy lifting during this time in hopes that it will increase the chance of implantation.How long before an IUI should the male abstain from intercourse or ejaculating?
This depends on your individual situation, but it usually should not be more than 72 hours since his last ejaculation in order to ensure the best motility and morphology. If low sperm count is the reason for IUI, it is generally best to wait 48 hours between ejaculation and collecting sperm for the IUI.How long after IUI should implantation occur?
Implantation generally takes place 6-12 days after ovulation -- so 6-12 days after a properly timed IUI.
This depends mostly on how the female is being treated. A natural cycle is often timed with over-the-counter ovulation prediction kits. The use of Clomid can increase the monitoring, but usually only requires a handful of visits. Gonadotropins (injectable medications) increase the necessity of ultrasounds and bloodwork, requiring more frequent clinic visits.What does "sperm washing" mean?
It is sometimes also called sperm preparation or spinning. It is a laboratory technique for separating sperm cells from other supporting cells and fluid, and the separating motile sperm from non-motile sperm, for use in assisted reproduction (IUI, IVF).
The washing technique for near normal specimens is mixing the ejaculate after liquefaction with the appropriate washing medium followed by centrifugation (a centrifuge is a machine that separates materials with different densities by spinning them at high speed) The supernatant is discarded and the sediment (sperm rich fraction) is re-suspended in more washing medium. This process is repeated 2-3 times maximum. In the final wash, the sediment is re-suspended in 0.5 cc of medium, loaded into a syringe and deposited in the uterus.
No. A tubal ligation is effective birth control because it prevents the sperm and egg from meeting. The natural process that leads to pregnancy is having an egg released from a follicle in the ovary and then beginning the journey to the uterus through the fallopian tube. Sperm will travel from the vagina, through the cervix, through the uterus, into the tube where fertilization occurs. IUI bypasses the need for the sperm to travel through the cervix. However it doesn't get the sperm to the other side of the tubal ligation, so fertilization won't take place. The only way to get pregnant after tubal ligation is by having tubal reversal surgery or an assisted reproduction technology that includes egg retrieval, such as in vitro fertilization (IVF).
ICSI or Intracytoplasmic sperm injection is a laboratory procedure developed to help infertile couples undergoing assisted reproduction due to male factor infertility. ICSI, a form of micromanipulation, involves the injection of a single sperm directly into the cytoplasm of a mature egg (oocyte) using a glass needle (pipette).This process increases the likelihood of fertilization when there are abnormalities in the number, quality, or function of the sperm. ICSI is generally unsuccessful when used to treat fertilisation failures that are primarily due to poor egg quality.How is ICSI done?
Before ICSI can be done, mature eggs must be retrieved from the female partner during a standard IVF cycle. The male partner's semen sample is prepared in the lab to isolate as many healthy moving sperm as possible. After allowing the eggs to rest for 4-6 hours following their removal, the tight outer coating of cells (cumulus) is removed from each egg. Only then can we be sure the egg is mature enough to undergo ICSI.
Immature eggs cannot be injected. However, they can be incubated for a further 4-18 hours and reassessed. If they mature during that time and sperm is still available, they can undergo delayed injection. Fertilization rates with delayed injection are not as good as with usual ICSI techniques. A special instrument is used to hold the egg in place. It is so small you can barely see the tip with the naked eye. A thinner, sharp, needle-like instrument is used to pick up a single normal appearing sperm. With great precision, the needle is inserted through the egg's outer coating (the zona pellucida) and into the egg itself. The sperm is slowly injected into the egg, and the needle is removed, leaving the sperm behind. The injected eggs are placed in an incubator overnight and checked the next morning for signs of fertilization.
Very low numbers of motile sperm.
Severe teratospermia (abnormal sperms).
Problems with sperm binding to and penetrating the egg.
Antisperm antibodies thought to be the cause of infertility.
Prior or repeated fertilization failure with standard IVF methods.
Frozen sperm limited in number and quality.
Obstruction of the male reproductive tract not amenable to repair. Sperm may then be obtained from the epididymis by a procedure called microsurgical epididymal sperm aspiration (MESA), or from the testes by testicular sperm aspiration (TESA).
Fertilization occurs in 50% to 80% of injected eggs. The ICSI process may damage a small percentage of eggs. The fertilized egg may fail to divide, or the embryo may arrest at an early stage of development. Approximately 30% of all ICSI cycles performed result in a live birth, which is comparable to rates seen with traditional IVF. Younger patients may achieve even more favourable results. Factors such as poor egg quality and advanced maternal age may result in lower rates of success.Are there any complications with ICSI?
ICSI does not increase the incidence of multiple gestations as compared to standard IVF. Because ICSI is a relatively new technique, first performed in 1992, long-term data concerning future health and fertility of children conceived with ICSI is not available. To date, there is no convincing evidence that the incidence of birth defects is any different with ICSI or IVF as compared to those children born to other parents of similar age and health. This is an area of ongoing investigation. Because some causes of male infertility are familial and are related to genetic problems, male offspring might have reproductive problems as adults. Despite these concerns, ICSI is a major advance in the treatment of severe infertility.