Frequently Asked Questions
FAQ on Infertility
What is infertility?
Infertility refers to an inability to conceive after having regular unprotected sex. Infertility can also refer to the biological inability of an individual to contribute to conception, or to a female who cannot carry a pregnancy to full term. In many countries infertility refers to a couple that has failed to conceive after 12 months of regular sexual intercourse without the use of contraception.
Pregnancy is the result of a process that has many steps. To get pregnant:
- A woman’s body must release an egg from one of her ovaries (ovulation).
- The egg must go through a fallopian tube toward the uterus (womb).
- A man's sperm must join with (fertilize) the egg along the way.
- The fertilized egg must attach to the inside of the uterus (implantation).
Infertility can happen if there are problems with any of these steps.
Is infertility just a woman's problem?
No, infertility is not always a woman's problem. Both women and men can have problems that cause infertility. About one-third of infertility cases are caused by women’s problems. Another one third of fertility problems are due to the man. The other cases are caused by a mixture of male and female problems or by unknown problems.
What increases a man's risk of infertility?
A man's sperm can be changed by his overall health and lifestyle. Some things that may reduce the health or number of sperm include:
- Heavy alcohol use
- Drugs
- Smoking cigarettes
- Age
- Environmental toxins, including pesticides and lead
- Health problems such as mumps, serious conditions like kidney disease, or hormone problems
- Medicines
- Radiation treatment and chemotherapy for cancer
What things increase a woman's risk of infertility?
Many things can affect a woman's ability to have a baby. These include:
- Age
- Stress
- Poor diet
- Athletic training
- Being overweight or underweight
- Tobacco smoking
- Alcohol
- Sexually transmitted diseases (STDs)
- Health problems that cause hormonal changes
In females, the causes could be:
- Irregular ovulation or egg production, hormonal imbalance 30%
- Tubal block 30%
- Problems in uterus like fibroids, adhesions, synechae congenital anomalies, chocolate cyst of ovaries 30%
- Unexplained 10%
Male contribute almost 40% to infertility.
How does age affect a woman's ability to have children?
More and more women wait until their 30s and 40s to have children. So age is an increasingly common cause of fertility problems. About one third of couples in which the woman is over 35 have fertility problems.
Aging decreases a woman's chances of having a baby in the following ways:
- The ability of a woman's ovaries to release eggs ready for fertilization declines with age.
- The health of a woman's eggs declines with age.
- As a woman ages she is more likely to have health problems that can interfere with fertility.
- As a women ages, her risk of having a miscarriage increases.
FAQs on IVF
What is Assisted Reproductive Technology [ART]?
ART includes all fertility treatments in which both eggs & sperms are handled. In general, ART procedures involve eggs retrieval from the ovaries, combining them with sperm in the laboratory and returning them to uterus.
What is IVF?
In vitro fertilisation (IVF) is a process by which egg cells are fertilised by sperm outside the womb, IVF is a major treatment in infertility when other methods of assisted reproductive technology have failed. The process involves hormonally controlling the ovulatory process, removing ova (eggs) from the woman's ovaries and letting sperm fertilise them in a fluid medium. The fertilised egg (zygote) is then transferred to the patient's uterus with the intent to establish a successful pregnancy.
When should one can consider IVF?
Following are the indications for IVF consideration.
- Tubal problem
- Male factor
- Endometriosis
- Uterine problems
- Unexplained infertility
- Age
- Previous IUI failure
- Ovulatory problems
- Antibody problems that harm sperm or eggs
- Cervical inhospitality
What are the precautions or restrictions during an IVF cycle for a lady ?
Physical restriction:
- Heavy exercise like aerobics, jogging, weight lifting, etc are prohibited during ovarian stimulation until the pregnancy test results are known.
- Smoking / alcohol consumption should also be avoided during stimulation.
- If a lady is under some medical treatment, please consult the doctor whether prescribed medicines are safe during stimulation protocol as some medications may interfere with the fertility medication.
Emotional issue :
- As IVF cycle may be an emotional and stressful time for some couples, It may be helpful for a lady to talk to a supportive person like a friend or a close family member. She can also take a help from a counselor from the fertility clinic.
Does stress cause infertility?
In women high level of stress may cause disturbances of ovulation, and impaired sperm production. Stress reduction will help to cope up with infertility. Suggestion for stress reduction will be open talk with the partner, exercising regularly, stress relieving activities such as yoga or meditation, avoiding excessive intake of caffeine or other stimulants and to take emotional support from relatives or friends.
Is the procedure involved in IVF painful?
Pre cycle tests are some of blood tests, and scanning which can be done at any infertility clinic with minimal discomfort. Once you are already to start the IVF process you have to take few medicines & injections. Injections are administered subcutaneous with a short needle and discomfort should be tolerable. Only progesterone injection given intra muscularly.
The main procedure involved in IVF is the egg retrieval and this is performed through the vagina with ultrasound and a fine needle. Patients at our centre are asleep during this procedure and are cared for by a team of anesthesiologists. Patients have no pain with this procedure and they wake up very quickly with the egg retrieval lasting 0-15 mins. The embryo procedure is again a very simple one.A very light anaesthesiologists is required when there are specific problems with the cervix.
How to manage stress, grief & loss during an IVF cycle?
There is no question that the whole process of infertility represents a tremendous loss of control over what should be basic function & this causes initially denial then anger & depression. At our centre we have trained counsellor you can talk with them during the early stages of your IVF cycle so that you may best use certain practices & procedures to cope with the stress of assisted reproduction. It is impossible to eliminate stress completely & each of us needs a certain amount of stress in our lives to keep us vital. The important factor is our response to this stress and we need to learn coping strategies which prevent us from reaction in a way that is detrimental to the whole aim of therapy which is to establish and nurture a pregnancy.
FAQs on Donation
What is an oocyte?
An oocyte, ovocyte, or rarely ocyte, is a female gametocyte or germ cell involved in reproduction. In other words, it is an immature ovum, or egg cell. An oocyte is part of the ovary development.
What is Donation/sharing (egg/sperm)?
Fertility requires a sperm, an egg and a resultant embryo. Therefore if a male lacks in sperm or the female has no eggs then sperm/egg sharing can be done. If both are infertile then embryo sharing can be done. Usually donors are anonymous. Pre informed consent is taken before any donation procedure.
What are the requirements for a Sperm Donor?
- The individual must be free of HIV and hepatitis B and C infections, hypertension, diabetes, sexually transmitted diseases, and identifiable and common genetic disorders such as thalassemia.
- The age of the donor must not be below 21 or above 45 years.
- An analysis must be carried out on the semen of the individual, preferably using a semen analyzer, and the semen must be found to be normal according to WHO method manual for semen analysis, if intended to be used for ART.
- The blood group and the Rh status of the individual must be determined and placed on record.
- Other relevant information in respect of the donor, such as height, weight, age, educational qualifications, profession, colour of the skin and the eyes, record of major diseases including any psychiatric disorder, and the family background in respect of history of any familial disorder, must be recorded in an appropriate proforma.
What are the requirements for an oocyte Donor?
- The individual must be free of HIV and hepatitis B and C infections, hypertension, diabetes, sexually transmitted diseases, and identifiable and common genetic disorders such as thalassemia.
- The blood group and the Rh status of the individual must be determined and placed on record.
- Other relevant information in respect of the donor, such as height, weight, age, educational qualifications, profession, colour of the skin and the eyes, and the family background in respect of history of any familial disorder, must be recorded in an appropriate proforma.
- The age of the donor must not be less than 21 or more than 35 years.
To whom embryo donation is advised?
There are selected groups of patients to whom embryo donation is recommended:
- When both the partners are infertile.
- Couples who are at a high risk of passing on genetic disorders to their offspring.
- Women with recurrent IVF failures.
FAQs on Surrogacy
What is surrogacy?
Surrogacy is an arrangement between a woman and a couple or individual to carry and deliver a baby. Women or couples who choose surrogacy often do so because they are unable to conceive due to a missing or abnormal uterus, have experienced multiple pregnancy losses, or have had multiple In Vitro Fertilization attempts that have failed. The advantage of gestational surrogacy to the parents is that the embryo is created from the woman’s egg and the man’s sperm, so it is biologically theirs.
What is the criteria for becoming a surrogate mother?
To become a surrogate the woman should fulfill the following criteria:
- Age between 21 & 35 years old.
- A non smoker, on drug user who maintains a healthy life style.
- Must have successfully carried at least one child of your own term.
- In a stable living situation.
- If married, have a spouse who’s supportive of your decision to become a surrogate mother.
- Have a healthy, weight/height ratio.
- Willing to give up caffeine, alcohol for the duration of the pregnancy.
What is the purpose of a surrogacy agreement?
Surrogacy agreements are the first stage in a two step process.The purpose of the surrogacy agreement is to allow each party to state their intentions, & their responsibilities to one another.The agreement will clearly state that the surrogate does not intend on parenting any resulting children & does not wish to have physical or legal custody of any children. The surrogacy agreement will also define the right & responsibilities of the assisted parents.
What are the tests that a surrogate needs to undergo?
The tests that a surrogate needs to undergo are as following:
- The complete medical & family history.
- A test through physical & psychological examination & evaluation.
- Blood test for HIV, hepatitis B & C & other sexually transmitted diseases.
- Cervical cultures organisms such as Chlamydia urea plasma.
- An evaluation of the uterus by hysteroscopy.
- Have a healthy, weight/height ratio.
- Willing to give up caffeine, alcohol for the duration of the pregnancy.
What is the purpose of a surrogacy agreement?
Surrogacy agreements are the first stage in a two step process.The purpose of the surrogacy agreement is to allow each party to state their intentions, & their responsibilities to one another.The agreement will clearly state that the surrogate does not intend on parenting any resulting children & does not wish to have physical or legal custody of any children. The surrogacy agreement will also define the right & responsibilities of the assisted parents.
What are the tests that a surrogate needs to undergo?
The tests that a surrogate needs to undergo are as following:
- The complete medical & family history.
- A test through physical & psychological examination & evaluation.
- Blood test for HIV, hepatitis B & C & other sexually transmitted diseases.
- Cervical cultures organisms such as Chlamydia urea plasma.
- An evaluation of the uterus by hysteroscopy.
- Blood test for prolactin & thyroid stimulation hormone.
What is Intrauterine Insemination (IUI)?
Intrauterine Insemination (IUI) is an infertility treatment that is often called artificial insemination. In this procedure, the woman is injected with specially prepared sperm. Sometimes the woman is also treated with medicines that stimulate ovulation before IUI.
IUI is often used to treat:
- Mild male factor infertility
- Women who have problems with their cervical mucus
- Couples with unexplained infertility
FAQ on IUI
What is Intrauterine Insemination or IUI?
In IUI, warmed prepared sperm is introduced into the woman's uterus (womb) at around the time of ovulation, with the aim of getting the sperm nearer to the egg.
The procedure, which used to be called artificial insemination (AI), is often combined with fertility drugs.
What will be the ideal abstinence period for a couple before an IUI cycle?
3-4 days gap is ideal for a man. More than 4-5 days old. Sample may have a risk of poor motility, white cells and other problems.
What precaution lady should take during an IUI cycle?
Before an IUI cycle, avoid heavy exercise, jogging or high impact aerobics.
- Little rest just after the IUI procedure is advisable.
- For little pain a simple pain killer like Ibuprofen can be taken.
If a partner is not available at IUI procedure time, what is the method for sperm freezing?
One can freeze the semen sample before an IUI procedure if they are physically away at the time of procedure or if they cannot produce the semen sample on demand. Before semen freezing a complete blood work is done to rule out the possibility of HBs Ag, HIV or gonorrhea. Then semen sample has to be produce by masturbation into sterile container provided by lab. Once given to the lab a complete semen analysis is performed which includes, volume, liquefaction and viscosity, sperm count, motility, forward progression and morphology. After that semen subjected to freeze can be revived on IUI day.
How long one can store the frozen sperm?
The length of time that frozen sperm remains viable will vary from patient to patient. There have been normal pregnancies from sperm stored for over 20 years. Each individual sperm reacts differently to the freezing process. The result of the post thaw analysis can give some individuals indication of how sperm cells react to the freezing process.
Can using of frozen sperm increase the likelihood of having a child with birth defects?
All available data indicates that frozen semen does not increase the risk of birth defects. In fact, the freezing process tends to kill off weaker sperm, and may thus lead to survival of best sperm.
What is donor IUI?
Single women, couple with male partner has no sperm or very poor semen analysis and cannot afford expensive treatment like ICSI, donor IUI is an option. Some time, it is also used when there is an inheritable genetic problem which could be transferred from the male.
How does IUI increase the chance of pregnancy?
IUI procedure works by concentrating the healthiest sperm in the ejaculate and placing the washed sperm into the uterus adjacent to the fallopian tube. This bypasses any potential cervical factor problems and removes the sperm that are less likely to fertilize the egg.
When is IUI used?
IUI is a fertility treatment often selected by the couple, with at least one patent fallopian tube and who have been trying to conceive for atleast one year. IUI can also be selected as a fertility treatment with any one of the following conditions.
- lOW SPERM COUNT
- DECREASED SPERM MOTILITY
- A HOSTILE CERVICAL CONDITION [too thick cervical mucus]
- SEXUAL DYSFUNCTION.
FAQs on Embryo Freezing
What is freezing?
Many embryos are usually formed in an IVF cycle. Only 2-3 embryos are transferred in one cycle and the rest are frozen.
What are the advantages of embryo freezing?
Advantages of embryo cryopreservation are as follows:-
- Allow maximizing the potential for conception for IVF & prevent wastage of viable normal spare embryos.
- For high risk woman of OHSS [Ovarian Hyper Stimulation Syndrome], embryos can be frozen and transferred into subsequent cycle.
- Women with endometrial polyps, poor endometrium development, bleeding at the time of embryo transfer, embryo cryopreservation can be done and embryo transfer can be done in subsequent cycle.
- For women who have difficulty for fresh embryo transfer because of cervical stenosis [inability to pass through cervical canal because the cervix is narrowed or scarred] embryos can be frozen.
- Before cancer chemotherapy or radiotherapy, lady can freeze her embryos.
What is the survival rate after freezing and thawing procedure?
In a good freezing program, a survival rate of 75-80% should be expected. This loss is because of freezing and thawing process.
What is the procedure for frozen embryo transfer?
Frozen /thawed embryos are transferred into uterus in a natural cycle, a hormone replacement cycle or a stimulated cycle. All three methods have similar success rates.
