FAQs (Frequently Asked Questions)

Ques:What  are  the  causes  of  infertility?
Ans:Approximately  40%  is  of  male  origin,  40%  of  female  origin  and  in  20  %  there  is  no  obvious  identifiable  cause.  Many  couples  have  combined  male  and  female  causes.

  • The  male  causes  result  in  a  reduction  in  quality  and  quantity  of  sperms. 
  • The  female  causes  can  include one  or  more  of  the  following:
  1. ​Endometriosis
  2. Ovulation  defects  including  polycystic  ovarian  disease (PCOD).
  3. Fallopian  tube  blockage  or  disease.

 

Ques:When should we seek medical help?

Ans:Most doctors advise you not to be concerned unless you have been trying to conceive – not using birth control and having regular intercourse around the time of ovulation – for at least a year.Women with certain symptoms or previous medical conditions may wish to seek medical advice earlier. Some symptoms or prior conditions make fertility problems more likely, and others may indicate a medical condition that needs treatment for other reasons. Seek medical advice if:

  • You have lots of pain during your menstrual period or during intercourse.
  • You have an abnormal menstrual cycle (less than 21 or more than 35 days from the first day of one cycle to the first day of the next).
  • You are troubled by acne or excess facial or body hair.
  • You have had pelvic inflammatory disease (PID), an infection in the reproductive organs, usually the fallopian tubes.
  • You have had surgery on your reproductive organs, such as a cone biopsy of the cervix.
  • You have had more than one miscarriage
  • Your partner has an abnormal sperm analysis

 

Ques:Do we both need to be tested?

Ans:Almost always. Both male and female factors can contribute to a couple’s infertility. For efficiency, diagnostic testing may focus first on tests that are less invasive (such as a semen analysis) or those that may confirm a suspected problem (such as a test for blocked fallopian tubes if a woman has had a pelvic infection).

 

Ques:Does age affect fertility?

Ans:In general, women’s fertility begins to decline gradually after age 30 with a steep drop between 35 and 45. This means that, on average, it takes longer for an older woman to conceive, and older women are more likely to be diagnosed with infertility. Pregnancies in older women are also more likely to miscarry. The most predictable age related change is a gradual reduction in the number and quality of eggs produced as a woman enters her late thirties. As she nears menopause, eggs are not released in more and more of a woman’s menstrual cycles, making conception impossible. Also, as women age, they are more likely to have had illnesses or medical treatments that can compromise fertility. Some of these affect the reproductive system directly, such as endometriosis, sexually transmitted diseases (STDs), surgery on the reproductive organs, or ectopic pregnancies. Others are general medical problems that can damage that can damage fertility,such as hypothyroidism, high blood pressure, diabetes and lupus. 

As they age, men may also be exposed to infections, medications, or occupational or environmental chemicals that can impair fertility. However, they do not experience the same dramatic and predictable agerelated decline as women.

Because of the increased possibility of fertility problems, women over the age of 35 are often counseled to seek medical advice if they attempt to conceive for six months without success. However, because conception is likely to take longer in older women, some experts suggest that couples give themselves more, rather than less, time to conceive before seeking medical help.
Couples must find a balance between not allowing enough time for conception and delaying too long (making treatment less likely to succeed).
 

Ques:How is the cause of infertility identified? 

Ans:An infertility workup will involve tests to determine how well each of the systems involved in conception is working.

 

Ques:What  is  fertility  counseling? 

Ans:One   form  of  fertility  counseling  occurs  when  you  have  a  private  discussion  with   a  sympathetic  nurse  counsellor.  You  share  with  her  your  feelings  and  concerns  about  your  fertility  status,    the  treatment  program  and  your  chances  for  pregnancy.   She  will  listen  patiently   to  you  and  answer  your  questions  as  best  she  can.  She  will  assist  you  in  resolving  your  concerns  and  enable  you  to  decide  on  the  next  course  of  action. 

 

Ques:What  are  some  of  the  complications  of  treatment  by  IVF?

Ans: A  complication  is  an  undesirable  effect  associated  with  treatment.

The  main  complication  of  IVF  is  ovarian  hyperstimulation  syndrome  (OHSS).
The  second  complication  is  multiple  pregnancy  with  more  than  twins. Eg  triplets,  quadruplets etc.
The  third  is  ectopic  pregnancy.  The  other  rare  complications  include  bleeding  and  infection  from  the  needle  puncture  at  egg  collection.

 

Ques:How can I be sure that the IVF laboratory will not mix up any of my sperm, eggs or embryos with those from another patient? 

Ans:Petri dishes and test tubes containing sperm, eggs or embryos are labeled with duplicate identifying information for each patient and color coded to prevent mix-ups. Any tubes or dishes that are used in the processing of the sample will contain their full name and their partner's full name and will be color coded. In addition to these labeling procedures, there is a cross-checking system to prevent human errors. Each time a procedure is performed by an Embryologist, a second member of the laboratory staff has to witness the event before they are released to a Physician. If the sperm are being used to inseminate his partner's eggs, a second member of the laboratory staff verifies that the correct eggs and sperm have been removed from the incubator before the Embryologist performing the procedure can actually proceed with the insemination of the eggs. At the conclusion of the procedure, both Embryologist and staff sign the patient's chart, which is the legal record of the procedure. These same checks and balances are used during each laboratory procedure and can be seen in action by patients having embryo transfers. At transfer time, the Embryologist performing the transfer will ask the patient their full name and repeat the name back to the patient to verify what they heard. The identity of the dish containing the embryos is double checked by the Embryologist and the embryos are loaded into the transfer catheter. As the catheter is handed over to the Physician, the Embryologist will repeat the patient's name and give details of the contents of the catheter. Surplus embryos being frozen after a transfer are catalogued with full name, ID, date of freezing and details of the embryos being frozen. Embryos are frozen inside special straws and in addition to careful labeling, color-coding is also used as an added precaution. As with other procedures, a second member of the laboratory staff has to witness the procedure and verify patient and embryo details for any freezing or thawing event.

 

Ques:What  happens  at  egg  collection?

Ans:You  will  not  have  food  nor  drink  for  six  hours  before   the  procedure.  You  will  empty  your  bladder  and  be  placed  under  a  short  general  anesthesia  for   usually  less  than  fifteen  minutes.  A  14  gauge  needle  will  be  inserted  under  vaginal  probe  ultrasound  scanning.   The  follicles  will  be  emptied  systematically  and  the  aspirated  fluid  will  be  examined  under  a  dissecting  microscope  for  the  cumulus- oocyte  complex. Antibiotics  will  be  given  and   after  a 3-4  hours  rest,  you  can  go  home.  You  may  experience  a  little  lower  abdominal  discomfort  for  a  short  while  and  some  pain  relief  medicine  will  be  given  to  you  to  bring  home.  There  may  be  some  bleeding  from  the  vagina  after  egg  collection.   This  is  usually  minimal  and  would  stop  within  two days.     


Ques:What  is  ICSI?

Ans:Intra  Cytoplasmic  Sperm  Injection  (ICSI)  is  a  modification  of  IVF. ICSI  is  a  procedure  in  which  one  immobilized  sperm  is  sucked  into  a  very  narrow  pipette  and  then  injected  inside  the  egg,  allowing  fertilization  to  take  place. It  is  usually  employed  when  sperms  are  unable  to  enter  eggs  by  their  own  power. Most  forms  of  male  infertility  can  be  solved  by  use  of  ICSI  and  sperm  donation  is  less  necessary. ICSI  can  also  be  used  to  maximize  the  yield  of  embryos. 

 

Ques: I've heard that having embryos transferred at the blastocyst stage gives really high pregnancy rates. Shouldn't every IVF patient have this procedure?

Ans: Embryos that have grown successfully in the laboratory for 5 or 6 days are called blastocysts. They have gone beyond the stages where it was possible to count the number of cells that they contain and have begun to differentiate into 2 different cell types. A normal blastocyst should have developed by day 5 or day 6 after egg retrieval and the outer cells (trophectoderm) and inner cells (inner cell mass) should be clearly visible. These cells give rise to the placenta and fetus respectively. Since the blastocyst now has the first placenta cells, it is ready to hatch from its shell and implant in the uterus. On average, about 53% of fertilized eggs will develop to the blastocyst stage. This number will be lower in older patients, and higher in young patients. Younger patients tend to have more eggs and therefore embryos, which will give them a greater chance of having some embryos that develop into blastocysts. The main advantage of keeping the embryos to day 5 in the laboratory is that we are able to select those embryos most likely to successfully create a viable pregnancy. If the desired number of embryos for transfer is achieved by day 3 (for example, there are only 2 or 3 good embryos on Day 3), there may be no particular advantage to keeping them in the lab any longer and they should go ahead and be transferred back to the patient on Day 3.

 

Ques:What  is  the  Ideal  Number  of  embryos  to  be  transferred?

Ans:Usually  two  embryos  are  placed  inside  your  uterus  at  a  time.  This  is  because  the  chance  of  pregnancy  is  low  when  only  one  embryo  is  transferred.  On  the  other  hand,  there  is  the  possibility  of  a   triplet  pregnancy  with  three  embryos  transferred.  Triplet  pregnancy  carries  a  higher  chance  of  premature  delivery  and  should  be  avoided.
        The  actual  decision  in  each  case  would  depend  on  various  factors.  The  transfer  of  three  embryos  is  considered  if  you  are  above  the  age  of  37,  have  a  raised  basal   FSH  level,   or  have  been  unsuccessful  in  previous  attempts  at  IVF.

 

Ques:Can I have sex with my husband during th  two weeks after embryo transfer?

Ans:It  has  not  been  proven  that  avoiding   coitus  during  the  two  weeks  after  embryo  transfer  makes  any  difference  to  the  chance  of  pregnancy.  However  most  couples  prefer  to  abstain  from  coitus. 
 

Ques:What  is  Implantation?

Ans:This  is  the  process by  which  the  hatched  embryo  attaches  itself  to  the  internal  lining  of  your   uterus  and  starts  to  take  nutrition  and  oxygen  from  you.  This  takes  place  a  few  days  after  embryo  transfer  and  you  will  not  be  able  to  feel it. 

 

Ques: How are embryos frozen?

Ans: Embryos can be frozen at different times after fertilization. Most typically, embryos are frozen 5 or 6 days after the sperm and egg were combined, but they can also be frozen immediately after fertilization (day 1) or any day thereafter. Freezing is a stressful process for an embryo, and only embryos that are growing well in the laboratory will tolerate the freezing procedure. Before an embryo can be frozen, all the water that it contains must be removed. Since water expands in size as it turns to ice, water inside the embryo would burst (kill) the embryo if we simply placed it in the freezer. To prevent the embryo from shriveling as the water is extracted, we replace the water with an antifreeze (or cryoprotectant). Antifreeze is a solution that does not expand in size when it freezes. The embryo is cooled to room temperature as the water is replaced with antifreeze. The water is removed from the embryo in 2 stages using a weak and then a strong cryoprotectant solution. When most of the water has been removed the embryo is inserted into a tiny straw, and plunged into liquid nitrogen at a temperature of -196°C. This ultra-rapid cooling process is called vitrification and embryos tolerate the procedure very well. Over 90% of all embryos vitrified survive the process and are available for transfer in as little as 20 minutes after being warmed out of the freezer.

 

Ques: How are embryos thawed?

Ans: Thawing the embryos is simply a reversal of the freezing procedure. The embryos coming out of the freezer (at –196°C) are warmed to room temperature in 3 seconds. This rapid thaw method minimizes damage to the embryo from ice crystals that can form during warming. The embryologist has to remove the antifreeze from the embryo and replace the water that was removed at the time of freezing. This is done by incubating the embryo in decreasing concentrations of the antifreeze, and increasing concentrations of water. Over a period of 15 minutes, the embryo is stepped through 3 different solutions, until finally the antifreeze is gone and all the water has been replaced. The thawing procedure is performed at room temperature, and once complete, the embryo is warmed up to body temperature (37°C). It can be ready for transfer in as little as 20 minutes after leaving the freezer.

 

Ques: If all the embryos aren’t transferred, what happens to them?

Ans: In most cases, excess embryos are frozen for possible use in a future cycle. However, other options are open to couples who do not wish to freeze embryos. Depending on the program, excess embryos can be discarded, donated for research or donated to another couple. Couples who object to all of these options can limit the number of eggs that are mixed with sperm. That way no extras can be created. Therefore, this option could significantly limit your chances of delivering a child.
Our program offer IVF with the facility to freeze and store embryos.

 

Ques: Am I more likely to have a child with a genetic or congenital abnormality because I'm pregnant after a frozen embryo transfer?

Ans: Even after 20 years, there are few studies in the scientific and medical literature concerning outcomes after embryo cryopreservation. However, the few studies that have been published are thus far reassuring. Children born from frozen embryos do not seem different from children born from embryos that had not been frozen. Even if an embryo loses one or more of its cells during thawing, this does not cause any abnormalities. Freezing does not cause or introduce genetic abnormalities. The only risk associated with freezing, is that the embryo might not tolerate the procedure, and could lose so many cells that it is no longer strong enough to implant and establish a pregnancy.

 

Ques:What are the factors which influence outcome?

Ans:The  chance  of  pregnancy  is  influenced  by  your  age  and  your  basal  FSH  level.  In  general,  the  younger  you  are,  the  better  the  outcome.
The  chance  of  pregnancy  is  also  dependent  on  the  number  of  embryos  transferred.  Although  more  embryos  transferred  increases  the  chance  of  pregnancy,  it  also  results  in  a  higher  chance  of  multiple  pregnancy  with  its  associated  problem  of  premature  births.  In  practice,  two  or  three  embryos  are  transferred.. 

 

Ques:What  is PCOD  (poly cystic ovary disease)?

Ans:Poly  cystic  ovary  disease  is  a  benign  condition  in  which  there are  many  small  follicles  in  the  ovaries.  This  condition  is  associated  with  impaired  insulin  metabolism.  It  is  manifested  by  irregular  and  infrequent  menstrual  cycles,  sub-fertility,  and  a  higher  rate  of  miscarriage.   Women  who  are  given  ovulation  inducing  medication  often  over- respond  resulting  in  ovarian  hyperstimulation  syndrome.  
        Metformin  partially  corrects  the effects  of  PCOD.  Metformin  is  an  anti-diabetic  medicine.  It's  side  effects  include  dyspepsia  and  weight  loss.  It  can  be  started  in  gradually  increasing  doses  of  500mg after  meals  up  to  three  times a  day.  Continuation  of   Metformin  during  pregnancy  appears  to  reduce  the  chance  of  miscarriage.

 

Ques:What  is  Hysteroscopy?

Ans:Hysteroscopy  is  a  procedure  of  inspecting  the  inside  of  the  uterus  with   an  optical  instrument   (hysteroscope)  inserted  through  the  cervix from  below.  This  allows  abnormalities  in  the  uterine  cavity  to  be  seen  and  dealt  with.  Hysteroscopy  performed  before  IVF  is  useful  because  it  permits  polyps  and  other  problems  within  the  uterus  to  be  seen  and  corrected.  It  also  enlarges  and  smoothens  the  canal  leading  from  the  neck  of  the  uterus  (cervix)  to  the  uterine  cavity  proper.  This  ensures  ease  of   replacement  of  the  embryo  and  improves  the  chance  of  pregnancy.
        Hysteroscopy   is  usually  done  as  a  day  surgery  procedure.  A  tablet  of  Cytotec  is  placed  in  the  vagina  two  hours  before  the  procedure  to  cause  the  neck  of  the  uterus  to  open.  A  short  general  anesthesia  allows  hysteroscopy  to  be  performed  painlessly.   Saline  or  glycine  is  infused  at  100mm  Hg.  to  distend  the  uterine  cavity  in  order  to  allow  the  inside  of  the  uterus  to  be  inspected.

 

Ques: Are the hormone treatments harmful for me or for our (future) child?

Ans: As stated in this guide, the hormones administered during IVF treatment may have some side-effects. Fortunately, they are not serious and are only temporary. Claims that the hormones used in IVF treatment can be carcinogenic or have other ‘harmful’ effects are not founded on medical data.Moreover, these hormones were administered to women with infertility problems on a large scale long before IVF treatments were developed, without any harmful effects. Also with regards to children born from IVF/ICSI up until now no study has proven that (certain) cancers would occur more frequently than with children who were conceived without hormonal stimulation. Having said that, research regarding the effects of hormone treatments is still conducted worldwide in the interests of safety. 

 

Ques: Will my infertility specialist see me through the pregnancy?

Ans: Yes, we take care of your pregnancy. Our Infertility specialist is a practising Obstetrician and Gynaecologist. We provide pre-natal care in the same program.