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 for a year. 15 to 20 % couples will not conceive despite a year of trying. However this does not mean they will not conceive later on, hence they need to be inves􀀙gated and treated accordingly.

Causes for infertility stem from both partners. 40% stem from female factor, 40 % stem from male factor. 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 partocipation of both.

Yes. Secondary infertility is the one which arises in a couple who had 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
  • - Un explained

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 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, hyper Prolactinemia ,
Diabetes Mellitus etc also can cause infertility.

Male factors include Oligospermia, OATS and Azoospermia.

Every Couple need a proper counseling 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.

  • - Trans vaginal Ultra Sound
  • - Follicular Study
  • - Saline Infusion Sonography – SSG
  • - Hystero Salphingography ‐ HSG
  • - IUI – Intrauterine Insemination
  • - ICSI – Intra Cytoplasmic Sperm Injection
  • - IMSI – Intra Morphologically Selected Sperm Injection
  • - PICSI – Physiological Intra Cytoplasmic Sperm Injection
  • - Surgical Sperm Extrac􀀙on – TESA, PESA/ Micro TESE
  • - Cryo Preservation
  • - LAH ‐ Laser Assisted Hatching
  • - ERA – Endometrial Recep􀀙vity Array
  • - PGD – Pre Implantation Gene􀀙c Diagnosis
  • - Donor Programme ( Gametes & Embryos)
  • - 3D Laparoscopic Surgeries Adenomyomectomy Chocolate Cystectomy Adhesiolysis Abdominal encerclage
  • - Hysteroscopic Septal resection
  • - Tubal Cannulayion
  • Tubal Recanalization

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

  • - Oligo/ Anovulation – Irregular Periods, either geting 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 pa􀀙ent can decrease the infertility treatment outcomes. So weight reduction is the basic treatment followed by hormone correction and drugs for ovulation induction. Resistant ovaries for drugs can be benefitied by laparoscopic ovarian drilling.

Since insulin resistance and hyperinsulinemia is thought to play central role insulin sensitizers like me􀁎ormin will help in correcting the hormone imbalance.

Fibroids are benign tumors made of smooth muscle cells and fibrous connective issue that develop in 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 Bleedingn
  • - Prolonged Periods
  • - Pelvic Pain.
  • Treatments:‐
  • - Uterine Artery Embolization
  • - Mylosis
  • - Laparoscopic Myomectomy
  • - Hysteroscopic Myomectomy
  • - Endometrial ablation

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

  • 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 uterus resulting from an abnormal development of Mullerian duct during embryonic genesis. This includes

  • - Absent Uterus ( Mayor – Rokitansky – Kuster – Hauser Syndrome)
  • - Unicornuate Uterus (Only one side of the Uterus developed)
  • - Bicornuate Uterus ( Par􀀙ally 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)
  • - 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 Ultra Sound.
  • But when symptoms do occur they experience:‐
  • - Amenorrhea
  • - Recurrent Miscarriages
  • - Infertility
  • - Preterm Labour or abnormal positioning of the baby during pregnancy or labor
  • Treatments:‐
  • - Laparoscopy, Hysteroscopy Surgeries
  • - Cervical Cerclage ( To avoid preterm baby )
  • - Surrogacy ( Mostly for absent Uterus – MRKH)
  • Total Sperm Count ‐ 15 million per ml
  • 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 infertilemen and is classified as obstructive & non – obstructive.

Obstructive azoospermia which is the most common has normal sperm produc􀀙on and can be benetited by PESA / TESE and ICSI.

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

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

Asthenozoospermia is defined as 40% Sperm Mo􀀙lity or less than 32% with progressive motility0.26

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

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 uterus resulting from an abnormal development of 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 Salphinjectomy
  • - Endometriosis

It is the process which involves placement of processed semen into the uterine cavity which permits sperm – ovum interac􀀙on 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. Pa􀀙ent should remain immobile for approximately 15 minutes following the procedure. Ideally the total mo􀀙le sperm count in the IUI specimen should be 10 million or more . 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.

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

  • - Unexplained Infertility
  • - Male Factor Infertility (Oligo Asthenospermia)

A Percutaneous Epididymal Sperm Aspira􀀙on (PESA) and Tes􀀙cular Sperm Aspiration (TESA) are surgical procedures that are used (typically in conjunc􀀦on 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 in to oocyte thereby bypassing the limita􀀙on 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 atier fertilization the egg becomes an embryo and grows in a laboratory for 1 to 5 days before it is transferred into women's Uterus. ICSI fertilizes 50 % to 80%

Intracytoplasmic Morphologically Selected Sperm Injec􀀙on, more commonly referred to as IMSI is an assisted reproduc􀀙ve technique used to fertilise eggs in the IVF lab, when sperm defects are the cause of the 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 selec􀀙on process, it might not be suited to men with a very low sperm count.

A blastocyst transfer is an embryo transfer which involves transferring one or more embryos of Day 5 development which is the advanced stage of development. Better Embryo Selec􀀙on leads improved success rate.

In the Blastocyst stage the embryo is surrounded by a layer called Zonapellucida . Before Implanta􀀙on the embryo has to hatch from Zona Pellucida which occur due to Zona Lysis. The failure of embryo hatching due to thick Zona may impair implanta􀀙on. Assisted hatching with laser overcomes this problem and helps in better implantaion.

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