Frequently Asked Questions

We consider a couple to have infertility if they have not conceived despite regular intercourse without using any birth control for at least a year. 15 to 20 % of couples will not conceive despite a year of trying. However, this does not mean they are infertile. The couple must be investigated and treated accordingly.

The causes for infertility stem from both partners. 40% stem from female factors, 40% stem from malefactor. 10% of cases are due to common factors. 10% of cases are unexplained. As either or both may be involved, it is important to investigate both the partners and most treatments require the active participation of both.

Yes. Secondary infertility is the one that arises in a couple who had a previous pregnancy, this also needs to be investigated and treated.

We can divide female factors for infertility as

  • - Ovarian factor
  • - Tubal factor
  • - Uterine factor
  • - Endometrial factor
  • - Unexplained factors

The most common ovulatory factor is PCOS and Chocolate Cyst. The other being Premature Ovarian Failure.

The tubal factors include hydrosalpinx and tubal block.

Uterine factors include the unicornuate uterus, bicornuate uterus, fibroid uterus and adenomyosis.

Endometrial factors include Asherman Syndrome, Endometrial Polyp, thin endometrium and endometriosis.

Pelvic factors like vaginal septum, other factors such as Hormone Imbalance like hypothyroid, hyperprolactinemia, Diabetes Mellitus etc also can cause infertility.

Malefactors include Oligospermia, OATS and Azoospermia.

Every Couple needs proper counselling and support in their first visit followed by investigations done for both the partners. For Women, the basic hormone profile including AMH and other necessary blood investigations. For men, Semen Analysis and blood Investigations are done.

  • - Transvaginal Ultrasound
  • - Follicular Study
  • - SSG- Saline Infusion Sonography
  • - HSG- Hysterosalpingography
  • - IUI – IntraUterine Insemination
  • - ICSI – IntraCytoplasmic Sperm Injection
  • - IMSI – Intra Morphologically Selected Sperm Injection
  • - PICSI – Physiological IntraCytoplasmic Sperm Injection
  • - Surgical Sperm Extraction – TESA, PESA/ Micro TESE
  • - CryoPreservation
  • - LAH ‐ Laser Assisted Hatching
  • - ERA – Endometrial Receptivity Array
  • - PGD – Preimplantation Genetic Diagnosis
  • - Donor Programme ( Gametes & Embryos)
  • - 3D Laparoscopic Surgeries Adenomyomectomy Chocolate Cystectomy Adhesiolysis Abdominal cerclage
  • - Hysteroscopic Septal resection
  • - Tubal Cannulation
  • - Tubal Recanalization

It is a syndrome when a woman has any two of the following three:‐

  • - Oligo/ Anovulation – Irregular Periods, either getting periods once in 2 to 3 months or at times frequent menstruation
  • - Hyperandrogenism ‐ Excessive Hair growth, acne, high androgen level in the blood
  • - Polycystic Ovaries detected by ultrasound.

Obesity in PCOS patients can decrease the infertility treatment outcomes. So weight reduction is the basic treatment followed by hormone correction and drugs for ovulation induction. Drug-Resistant ovaries can be benefited from laparoscopic ovarian drilling.

Since insulin resistance and hyperinsulinemia are thought to play a central role, insulin sensitizers like metformin will help correct the hormone imbalance.

Fibroids are benign tumours made of smooth muscle cells and fibrous connective tissue that develop in the Uterus. The cause of fibroids isn't well understood. Risk factors include a family history of fibroids, obesity or early onset of puberty.

Symptoms:‐

  • - Heavy Menstrual Bleeding
  • - Prolonged Periods
  • - Pelvic Pain.

Treatments:‐

  • - Uterine Artery Embolization
  • - Mycosis
  • - Laparoscopic Myomectomy
  • - Hysteroscopic Myomectomy
  • - Endometrial ablation

Endometriosis is a disorder in which tissue that normally lines the uterus grows outside the uterus. With endometriosis, the issues can be found on the ovaries, fallopian tubes or intestines.

Symptoms:‐

  • - Pelvic pain that may worsen during menstruation
  • - Painful intercourse
  • - Painful bowel movement or urination
  • - Painful urination Endometriosis is diagnosed through Laparoscopy.
  • - Blood mixed urination
  • - Irregular or heavy menstruation
  • - Chronic fatigue
  • - Infertility

Treatments:‐

  • - Surgical Method (Laparoscopic Surgery)
  • - Hormone Therapy

Congenital Uterine Anomalies are malformations of the uterus resulting from abnormal development of the Mullerian duct during embryonic genesis. This includes

  • - Absent Uterus (Mayer – Rokitansky – Kuster – Hauser Syndrome)
  • - Unicornuate Uterus (Only one side of the Uterus developed)
  • - Bicornuate Uterus (Partially Split Uterus that has formed a heart shape)
  • - Septate Uterus (A normally shaped uterus divided into two cavities by a Septum Wall)
  • - Uterus didelphys (Double Uterus with separate Cervices)

Symptoms:‐

Normally most women with uterine anomalies do not experience any symptoms, it will be discovered only when they have a routine pelvic exam or an Ultrasound. But when symptoms do occur they experience:‐

  • - Amenorrhea
  • - Recurrent Miscarriages
  • - Infertility
  • - Preterm Labour or abnormal positioning of the baby during pregnancy or labour

Treatments:‐

  • - Laparoscopy, Hysteroscopy Surgeries
  • - Cervical Cerclage (To avoid preterm baby )
  • - Surrogacy (Mostly for absent Uterus – MRKH)
  • Total Sperm Count ‐ 15 million per ml
  • Progressive Motility – 32 % Motility
  • Morphology - 4 % Normal Forms

Azoospermia is the absence of sperms in the ejaculated semen and is found in 15 to 20% of infertile men. It can be classified as obstructive & non – obstructive Azoospermia.

Obstructive azoospermia, the most common, has normal sperm production and can be benefitted by PESA / TESE and ICSI.

Non – Obstructive azoospermia is mostly due to testicular failure that can be benefitted by donor sperm insemination.

The World Health Organization (WHO) classifies sperm counts at or above 15 million sperms per millilitre (mL) of semen as average. Anything below that is considered low and is diagnosed as Oligospermia.

Asthenozoospermia is defined as 40% Sperm Mobility or less than 32% with progressive motility of 0.26

Teratozoospermia is a condition characterized by the presence of sperm with abnormal morphology that affects fertility in males.

Oligoasthenoteratozoospermia (OATS) is a condition that includes oligozoospermia (low number of sperm), asthenozoospermia (poor sperm movement) and teratozoospermia (abnormal sperm shape).

Congenital Uterine Anomalies are malformations of the uterus resulting from abnormal development of the Mullerian duct during embryonic genesis. This includes

  • - Unexplained Infertility
  • - Azoospermia
  • - Severe Oligoasthenozoospermia
  • - Poor Ovarian Reserve
  • - Previous failed IUI Cycles
  • Tubal Factor
  • - B/L Tubal Block
  • - B/L Salpingectomy
  • - Endometriosis

It is the process that involves the placement of processed semen into the uterine cavity which permits sperm–ovum interaction in the absence of intercourse. 0.3 to 0.8 ml of washed, processed and concentrated sperm is injected into the uterine cavity using a catheter. The patient should remain immobile for approximately 15 minutes following the procedure. Ideally, the total mobile sperm count in the IUI specimen should be 10 million or more. The success rate is between 10 to 15 % for the first cycle but can be up to 30 – 40 % in 4 – 6 cycles. No benefits 6 cycles of IUI.

A Percutaneous Epididymal Sperm Aspiration (PESA) and Testicular Sperm Aspiration (TESA) are surgical procedures that are used (typically in conjunction with IVF) to find and extract sperm from the male partner who does not have sperm in his semen/ejaculate.

It is a technique where a live sperm is injected directly into an oocyte thereby bypassing the limitation imposed by the sperm motility and other sperm factors in binding with the oocyte. Fertilization occurs when the sperm enters the cytoplasm of the egg and after fertilization, the egg becomes an embryo and grows in a laboratory for 1 to 5 days before it is transferred into the women's Uterus. ICSI fertilizes 50 % to 80%

Intracytoplasmic Morphologically Selected Sperm Injection, more commonly referred to as IMSI is an assisted reproductive technique used to fertilise eggs in the IVF lab when sperm defects are the cause of infertility.

In IMSI, the sperm sample is examined using an inverted microscope, to check for defects within the sperm head, as well as shape, size and motility abnormalities. This digitally enhanced microscope provides a much greater magnifying power (about 6000x magnification) compared to the one normally used in ICSI (200x). The embryologist selects healthy sperm from the sample, which is then injected into the inner part of the egg. Once it results in fertilization, the embryo is implanted into the aspiring mother's womb. However, since this is a selection process, it might not be suited to men with a very low sperm count.

A blastocyst transfer is an embryo transfer that involves transferring one or more embryos of Day 5 development. It is the advanced stage of development. Better Embryo Selection leads to an improved success rate.

In the blastocyst stage, the embryo is surrounded by a layer called Zona Pellucida. Before Implantation, the embryo has to hatch from Zona Pellucida which occurs due to Zona Lysis. The failure of embryo hatching due to thick Zona may impair implantation. Assisted hatching with a laser overcomes this problem and helps in better implantation.

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