Frequently Asked Questions about Infertility

• Once after your detailed fertility evaluation, your clinician comes to a conclusion that in your case chances of conception with IVF are relatively higher as compared to IUI treatment cycles.
• These include diminished or poor ovarian reserve, damage to your fallopian tubes either due to endometriosis, tuberculosis or in cases like hydrosalpinx, pyosalpinx , cases with moderate to severe endometriosis and moderate to severe male factor infertility like severe oligoasthenoteratozoospermia (count, motility and morphology of the sperm are all affected), cases with azoospermia in which surgically retrieved sperms are used.
• Special cases with genetic condition where IVF is directly indicated as there is need for pre-genetic screening or diagnosis of the embryo prior to embryo transfer to prevent any hereditary disorders in the offspring.

Fertility treatments are generally safe but all medical procedures related to fertility or not carry some potential side effects.

The side effects of IVF may include reactions to the hormonal fertility medications taken during the preparation for egg retrieval.

Few side effects like

• Pain /Soreness or bruising from injections: Recent use of recombinant injections taken subcutaneously have minimised the pain from intramuscular injection.
• Breast tenderness : It is similar to the one females experience before their periods.
• Bloating & Mood swings : This is similar to the effects present during and before menstruation as the hormones involved in the regular menstrual cycle are used in higher quantities during ovarian stimulation.
• Allergic reactions – Some women may be allergic to certain components of the injection and may react with a skin rash or itching after administration of the injection , it can be managed by changing the drug used .
• Ovarian hyperstimulation syndrome (OHSS): There is a 3% risk involved that your ovaries may respond excessively to the hormones used for ovarian stimulations.

If your fertility doctor adheres to the standard guidelines for ovarian stimulation protocols this risk can be minimised. There is also a very small risk with fertility procedures like egg retrieval and embryo transfer which are present with every surgical procedure be it fertility related or not.

There is no upper limit with respect to the number of IVF attempts a couple can undergo. A couple can decide for themselves a reasonable number of attempts for IVF after a complete understanding of effects of repeated stimulations on the women’s health. Majority of the couples do conceive within the first 3 attempts. In cases with repeated IVF failures use of interventions like laser assisted hatching, use of embryo glue in transfer medium, pre-genetic screening to transfer genetically competent embryos, also use of immunoglobulins and intralipids have favoured a positive outcome.

Embryo transfer is the process where the embryos are deposited back in the uterus , It is not done under any anaesthesia and It is a simple procedure similar to an IUI.

• Once your IVF cycle fails your doctor tries to identify the cause ,depending on the cause your clinician may offer you treatment modalities like genetic screening (PGD) of your embryos to transfer a genetically healthy embryo improves which will increase the chances of implantation.
• ERA (Endometrial receptivity assay)- To understand your window of implantation prior to your next transfer and hence transfer the embryos in that window of implantation when best outcomes are expected.
• Immunoglobulin therapy – In few cases, use of I.V. immunoglobulins have shown positive outcomes.
• Laser assisted hatching – In frozen embryo transfers, the zona (outside covering of the embryo) becomes hard and thick in few cases which makes it difficult for the embryo to implant . In such scenarios Laser assisted hatching done just before transfer has shown promising results.
• Lifestyle Modification – In few cases even weight reduction and managing their stress levels with activities like yoga, meditation have shown to improve results with respect to IVF.

Usually egg retrieval procedures take 20 to 30 minutes depending on the number of follicles in your ovary & clinical expertise of your doctor.

Number of embryos to be transferred during embryo transfer is determined by the following factors:

• Age of the female
• Quality of embryos to be transferred
• Clinical history of the patient
• Outcomes of previous embryo transfers

However, clinicians usually adhere to international guidelines to restrict the number of embryos to be transferred to avoid risk of multiple order pregnancies.

There are many potential causes of infertility in women. Some of the most common include:

• Ovarian Factors – Disruption of ovarian function (presence or absence of ovulation and effects of “age” on oocyte (egg), Polycystic ovarian disease, Premature ovarian insufficiency, Low or Poor ovarian reserve, Menopause
• Tubal factor- Fallopian tube obstruction (whether fallopian tubes are open, blocked, or swollen). Risk factors for blocked fallopian tubes (tubal occlusion) can include a history of pelvic infection such as: Ruptured appendix, Gonorrhoea, Chlamydia, Tuberculosis, Endometriosis, Prior abdominal surgery.
• Uterine factors- Physical characteristics of the uterine cavity to be evaluated by a transvaginal ultrasonography/hysterosalpingography such as: fibroids, intrauterine adhesions, endometrial polyps, adenomyosis, and congenital anomalies of the uterus like septum, unicornuate, bicornuate uterus, Infections like chronic endometritis/Tuberculosis.
• Pelvic factors – Pelvic adhesions which can cause disruption of the normal female reproductive anatomy, Pelvic Endometriosis that can only be evaluated on invasive procedures.

Infertility in men can be caused by different factors and is typically evaluated by a semen analysis. Semen parameters like count ,motility and morphology are assessed, which help to determine if and how male partner contributes to infertility. 90% of diagnosis of infertility can be achieved through semen analysis.

However, in certain cases like azoospermia(absence of sperm in the ejaculate) some specialized tests along with hormonal assay and genetic testing may be required. In cases of recurrent abortions or repeated IVF failures some advanced tests for sperm function and DNA integrity may be advised.

IVF can be successful, but it’s important to remember that it is a number game. Chances of success slightly decrease with every successive IVF cycle.

However, as you age, IVF success rates decrease. Age related positive pregnancy rate for IVF cycles are

• 35%-40% for women under 35
• 30% for women aged 35 to 37
• 23% for women aged 38 to 39
• 10% for women aged 40 to 42
• 3% for women aged 43 to 44
• 2% for women aged over 44

Above success rates are for self IVF cycles.

• Heavy exercise such as aerobics, jogging, weight lifting etc. is prohibited during ovarian stimulation and until the pregnancy test results are known.
• Smoking should be stopped before ovulation induction begins. It is highly recommended to discontinue tobacco intake at least 3 months prior to an IVF cycle.
• Alcohol should be avoided during pregnancy and infertility treatment. Drinking alcohol is not advisable from the time fertility medications are initiated until the pregnancy test is conducted.
• Some medications may interfere with the fertility medications prescribed, some are not safe to use before an operation or medical procedure, and others might interfere with ovulation or pregnancy implantation

PCOS stands for Polycystic Ovary Syndrome. It is a hormonal disorder that affects women of reproductive age. PCOS is characterised by the growth of multiple small cysts on the ovaries, which can cause irregular periods and problems with ovulation.

An Ovulation calculator may not always be entirely precise, but it can be a helpful tool if you have a consistent menstrual cycle.

Endometriosis is a common disorder found in women, where the endometrial tissues grow outside the uterus. Pelvic pain, Abnormal bleeding, Painful urination, Difficulty in getting pregnant are some common signs of endometriosis