Q2. How can I tell if I am infertile & how can I determine the cause of infertility?
Q3. What other diagnostic tests can be carried out?
Q4. What is the role of Endoscopy in Infertility?
Q5. Any measures to be adopted to improve the chances of a successful pregnancy?
Q6. Are miscarriages common following Infertility Treatment?
Q1.How long should a couple attempt to conceive before seeking advice from an Infertility Specialist?
For couples who have recently discontinued contraception, the average monthly pregnancy rate approximates 20%. For a typical couple, this means that 50% conceive within 6months and another 30-40% conceive in the subsequent 6months. It becomes increasingly difficult to conceive spontaneously after 12 months of unsuccessful attempt. Therefore, infertility specialists recommend evaluation after 12 months of attempted conception. We also recommend evaluation after 6months in patients over 35 due to concerns related to an age-related decline in fertility.
Q2. How can I tell if I am infertile & how can I determine the cause of infertility?
By definition, infertility is the inability to conceive after 12 months of unprotected intercourse. Primarily there are three tests necessary to determine the cause. Initially, the husband has a semen analysis to make certain that there is adequate number of sperm.
The second test is to document ovulation is occurring in the woman by an Endometrial Biopsy or having a simple hormone test, progesterone done one week prior to the next anticipated menses.
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Provided both of these are normal, the next test involves an X-Ray. A hysterosalpingogram (HSG) is performed to document that the fallopian tubes are open & to make sure the uterine lining is compatible for embryo attachment. Dye is injected through the cervix into the uterine cavity. Eventually the dye goes into the fallopian tubes & should flow out through the end of the tubes. This documents that sperm are able to get to the fallopian tubes where fertilization normally occurs & that the egg can be captured by the fallopian tube. These three tests are the cornerstones to infertility evaluation.
Q3. What other diagnostic tests can be carried out?
Besides the three basic tests – a Vaginal Sonography is carried out to check the ovaries & the endometrial lining & any fibroids in uterus or cysts in the ovary are seen. Hormonal Analysis (Day 2 FSH, LH, Prolactin, TSH, E2 ) are also done. Laparoscopy & hysteroscopy are also done where indicated.
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Q4. What is the role of Endoscopy in Infertility?
A Laparoscopy is particularly helpful in diagnosing & effectively treating endometriosis or pelvic adhesions( scar issue). The incisions for the procedures are small one fourth or half an inch & full recovery is often achieved in a day or two. Most importantly , in individuals with either of these conditions, a laparoscopy can dramatically improved the chances of conception.
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Hysteroscopy is used to inspect the cavity of uterus via cervix using a fine telescope called a hysteroscope. Hysteroscopy is an investigation to assess the condition of the endometrium ( Lining of the uterus) before IVF.
Q5. Any measures to be adopted to improve the chances of a successful pregnancy?
Avoid extra stress from overwork mental or physical. Both Smoking and alcohol can be harmful to eggs & sperm. Even exposure to passive smoking results in more problems with Infertility. Men can also stay away from heat emitting areas, wear loose under garments & avoid chemical exposure.
Q6. Are miscarriages common following Infertility Treatment?
No , Infertile women who conceive after fertility treatment have a similar risk of miscarriage when compared to fertile couples. The overall risk of miscarriage is approximately 20% among the general population.
Women who experience bleeding in the first three months of pregnancy however, may be at increased risk of miscarriage. Despite this , at least two- thirds of patients with bleeding will deliver normally.
Q7. Is it possible to get pregnant if I’ve had a tubal sterilization?
While this is considered a ‘permanent ‘ form of contraception, patients do have the option of surgically reuniting the fallopian tubes through a process called a microscopic tubal reanastomosis . An alternative to the procedure would be In Vitro Fertilisation (IVF), where the eggs are fertilised outside the body with the resulting conception placed into the uterus. The choice for an individual would require a consultation to consider all other fertility factors.
Q1. What is In Vitro Fertilisation (IVF)?
Q2. What is the success rate of IVF?
Q3. Any risks involved in IVF ?
Q4. How long does it take for one attempt of IVF & is
hospitalisation essential during any stage of treatment?
Q5. How are eggs collected?
Q6. When is Semen sample required for Fertilisation?
Q7. When & how is embryo transfer (ET) done?
Q8. When & how is pregnancy confirmed?
Q9. What can be done with Spare embryos?
Q1. What is In Vitro Fertilisation (IVF)?
For patients with irreparably damaged fallopian tubes profound oligospermia (Low Sperm counts ) or failure to conceive after adequate attempts of intrauterine insemmination, In Vitro Fertilasation has become the treatment of choice. The technology involves incubating the oocytes (eggs) & sperm in the laboratory & allowing the resulting embryo (s) to develop for a number of days prior to transferring them into the endometrial cavity.(uterus)
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Q2. What is the success rate of IVF?
In the 1980’s pregnancy rates for IVF were relatively low, approx 15%. As the nutrition requirements for the embryo growth within the Laboratory became better understood, conception rates began to increase. As we head into the new millenium, anticipated pregnancy rates for many patients may exceed 50 percent.
Q 3. Any risks involved in IVF ?
Increased emotional stress because of high cost & time consuming with success rate of 40%. Risks of multiple pregnancies & hyperstimulation syndrome are all increased.
Q4. How long does it take for one attempt of IVF & is hospitalisation essential during any stage of treatment?
Patient needs to be in constant touch with the IVF centre for about one and a half month from starting medication upto the result of IVF. Out of this period active treatment takes ten to fifteen days during which patient has to visit the IVF Lab. No hospitalisation is essential during the treatment cycle.
Prior to collection of eggs,patient is given medication in the form of daily injections starting from day 2 of menstrual cycle & response to these injections is monitored with frequent blood tests & Vaginal ultrasound. Eggs are retrieved from the ovaries by a needle with the help of transvaginal sonography guidance. It is done under mild anaesthesia & is a day care procedure. It is done 32-36hours after final hormone injection.
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Q6. When is Semen sample required for Fertilisation?
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Semen is required soon after collecting the eggs. A fresh semen sample is preferred. However if difficulty is anticipated in semen collection, the problem is sorted out in consultation with embryologist by cryofreezing the sample in advance.
Q7. When & how is embryo transfer (ET) done?
Embryo transfer is usually done two or three days after egg collection. Even on day five it can be done as desired by the embryologist. Normally no more than 3 embryos are transferred into the uterine cavity by a special catheter. Patient is advised to rest for a few hours.
Q8. When & how is pregnancy confirmed?
Following ET patient is given Progesterone (hormone) Support & asked to get a blood test done 14 days after E.T. to confirm pregnancy.
Q9. What can be done with Spare embryos?
The spare embryos can be frozen & these cryopreserved embryos can be used in subsequent cycles & patient need not take the injections for egg formation.
Q1. Is there help for the couple with a Male Infertility Factor ?
Q3. What are PESA, MESA & TESE?
Q1. Is there help for the couple with a Male Infertility Factor ?
Yes, sometimes low sperm counts or poor sperm motility requires extra help to fertilise the oocyte (egg). A procedure called ICSI ( Intracytoplasmic Sperm – Injection) overcomes these severe Male Infertility factors.
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In the lab, the embryologist performs the procedure by capturing an individual sperm cell & injecting it into the mature egg by means of a small pipette with the help of a sophisticated machine called micromanipulator.
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Q3. What are PESA, MESA & TESE?
These are various sperm collecting techniques to collect sperm from men with azospermia but where sperm is being formed. These are collected from testes or tubes depending upon case to case. These can be successfully used with the technique of ICSI.
Q1. Who needs to consider using an egg-donor?
Women who experience problems that lead to depletion of quality oocytes (eggs) may need to consider an egg donor to assist in getting pregnant. Premature menopause, surgical removal of both ovaries or individuals over 40 who have failed to conceive despite appropriate fertility treatments are the most common individuals seeking an egg donor. Usually this is an anonymous process where the eggs are removed from the donor, fertilisation is allowed to occur & the resulting embryos are then transferred into the recepient’s uterus. Success rates are extremely high with this process.
Q2. Who can donate the Ova?
Any young healthy woman less than 35yrs of age can donate eggs. She should be preferably from within the family of the patient & with preferably complete family. No matching is required. She can donate eggs even if a sterlisation operation has been performed on her.