FAQ

FAQ's

Infertility
Artificial Insemination (IUI)
In Vitro or IVF
PCOS
Pre Implantation Genetic Screening
OHSS

What is Infertility?

Infertility is defined as the inability of a couple to conceive even after one year of unprotected, well-timed intercourse and the woman is under 35 years of age. If the woman is over 35 years old, it is diagnosed after 6 months of unprotected, well-timed intercourse.

This is not just a one sided problem. Approximately, 30% of infertility is due to a female factor and 30% is due to a male factor. In the balance of the cases, infertility also can result from problems in both partners and often the outlying cause of the infertility cannot be explained. In this case it is known as an “unexplained infertility” diagnosis. All of which, equally frustrating.

According to latest data, about 17% to 20% of couples are facing this problem and the levels of infertility is increasing.

How does age affect a woman's ability to have children?

More and more women are waiting until their 30’s and 40’s to have children. Actually, about 20% of urban women across the world now have their first child after the age of 35. 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 quality 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.
Children born to older women tend to have more abnormalities and anomalies

Risk factors for infertility

There are a number of external factors, lifestyle choices and environmental causes that can cause infertility. Some risk factors can be gender specific. Here’s a brief snapshot on some of the more common risks factors.

Weight – obesity and underweight
Age
Smoking, alcohol consumption and substance abuse
Sexually Transmitted Diseases (STDs)
Tubal Disease
Conditions and disorders like PCOD, Endometriosis, Pelvic infections
Diabetes
Stress
Genetic causes

Are there any signs or symptoms?

Short answer: not often.

Longer answer: Listen to your body. In women, there can be indications such as irregular periods, painful periods, white discharge, rapid weight loss or weight gain, painful sexual intercourse etc. These symptoms by themselves do not indicate infertility, but a visit to the doctor to get these evaluated would do a world of good. In the case of men, it can be symptoms such as erectile issues, premature ejaculation, lack of libido, retrograde ejaculation etc. Consulting an andrologist can help identify issues early.

By getting regular checkups you can detect possible clues to fertility issues. Early detection and treatment of a problem is often critical in achieving successful pregnancy outcomes later.

What are some ways to treat infertility?

There are many options for treating infertility, however deciding on which one is best for you and your partner can feel a bit overwhelming at first. Start with learning about all of the options that are available to you. With advancing medical technology there are more choices for both men and women trying to conceive. It can be a broad spectrum of hormonal treatments, ovulation induction and Intrauterine insemination to more advanced technologies like IVF or In-vitro fertilization, ICSI to surrogacy, egg/sperm donation and even embryo donation.

What causes infertility in women?

Problems with ovulation account for most cases of infertility in women. Without ovulation or with improper ovulation, there are no eggs to be fertilized or the eggs are not fertilize-able. Some signs that a woman is not ovulating normally include irregular or absent menstrual periods. Less common causes of fertility problems in women include:

Blocked Fallopian tubes due to pelvic inflammatory disease, endometriosis, or surgery for an ectopic pregnancy
Physical problems with the uterus
Uterine fibroids
Endometriosis
PCOD/PCOS
Unexplained reasons: An unexplained infertility is when the causes are not clearly defined or identifiable and it happens in 20% of the infertility cases.
Pelvic inflammatory disease
More than one miscarriage

No matter how old you are, it’s always a good idea to talk to a doctor before you start trying to get pregnant. Doctors can help you prepare your body for a healthy baby. They can also answer questions on fertility and give tips on conceiving.

What causes infertility in men?

Infertility in men is most often caused by:

Problems in the production of sperm – Too few sperms are being produced or none at all
Problems with the sperm’s ability to reach the egg and fertilize it – Sperms are unable to move fast enough and rapidly enough to reach the egg – low motility.
Problems with the sperm – abnormal sperm shape or structure prevent it from fertilizing the egg. It is also possible that the DNA package in the sperm may have issues and so a fertilized egg may have incomplete or abnormal DNA which is preventing the embryo from developing
Problems in the sexual function – due to issues like erectile dysfunction or retrograde ejaculation, good sperms are not entering the female reproductive canal and so there is no pregnancy.

Sometimes a man is born with the problems that affect his sperm. Other times problems start later in life due to illness or injury. For example, cystic fibrosis often causes infertility in men.

How long should women try to get pregnant before calling their doctors?

Most healthy women under the age of 30 shouldn’t worry about infertility unless they’ve been trying to get pregnant for at least a year. At this point, women should talk to their doctors about a fertility evaluation. Men should also talk to their doctors if this much time has passed.

In some cases, women should talk to their doctors sooner. Women in their 30s who’ve been trying to get pregnant for six months should speak to their doctors as soon as possible. A woman’s chances of having a baby decreases rapidly every year after the age of 30. So getting a complete and timely fertility evaluation is very important.

Is infertility just a woman's problem?

No, infertility is not always a woman’s problem. In about one-third of the cases, infertility is due to the woman (female factors). In another third of cases, infertility is due to the man (male factors). The remaining cases are caused by a mixture of male and female factors or by unknown factors

Can Male infertility be treated?

It can be treated in most cases and doctors will recommend that the couple seek assistance of assisted reproductive technologies (ART), such as IVF (in-vitro fertilisation). ART does not cure or treat the cause of infertility but they can help couples achieve a pregnancy, even if the man’s sperm count is very low.

What is artificial insemination?

Artificial insemination is more commonly referred to as an IUI (intra-uterine insemination). Typically, this procedure is recommended for couples with unexplained infertility, minimal male factor infertility, and women with cervical mucus problems. In IUI, the male partner or donor’s sperm is washed and processed to collect the best sperms, and is then injected into the woman’s reproductive canal during the time of ovulation.

IUI may involve controlled ovarian stimulation for the woman to enable good quality egg to be released.

Side effects of IUI

Side effects of IUI – There are not many side effects in IUI as it is a very basic treatment option with very little manipulation of the gametes. Since the woman will be on hormones to help ovulation, there can be some side effects, such as

Hot flushes
Mood swings and depression.
Nausea, headaches or visual disturbances.
Swollen and painful ovaries, signaling ovarian hyperstimulation syndrome (OHSS) – in rare cases.
Pelvic discomfort, breast tenderness, or bloating.
Ovarian cysts.

How many cycles of IUI to be tried before planning for IVF?

3-4 cycles usually. Some couples may be asked to move to IVF much before that too, if there are severe male issues or of the age of the female is above 35.

What is the success rate of IUI?

Across the world, IUI success rate has been recorded as being 14% – 17% per IUI cycle. That means, more than 80 out of 100 people DO NOT conceive through IUI. At GarbhaGudi, we have seen IUI success rates which are much higher – 24% to 27%.

Do the iui and ivf success rates decline with age?

Yes. Typical child bearing age is accepted to be between 22 and 28 years. As the age of the lady increases, the chances of pregnancy drop. It drops quickly after the age of 35 and the drop is significant after 40 years

What is In Vitro or IVF?

In vitro fertilization or IVF, gets its name from the fact that fertilization occurs outside of the woman’s body, in a lab dish instead of a woman’s fallopian tubes. Typically, a woman will use ovulation stimulating drugs to produce an excess number of eggs. These eggs or “follicles”, are surgically removed from the woman and fertilized in dish with sperm. If fertilization takes place, the physician transfers the embryo(s) into the women’s uterus.

What are success rate in iui and ivf?

Average Success rates in IUI 15-20% across the world. At GarbhaGudi, the success rates for IUI is between 25% and 32%

Average Success rates in IVF 40-50%. At GarbhaGudi, the success rates for IVF is between 55% and 60%

Are there any tests to rule out chromosomal anomalies and defects in IVF pregnancies?

Preimplantation Genetic Screening (PGS) for aneuploidy is a powerful genetic test that may be performed on embryos during IVF treatment to screen for numerical chromosomal abnormalities. PGS is performed on a small embryo biopsy prior to transfer and identifies which embryos are chromosomally normal. Chromosomally normal embryos are the most likely to develop to term and to be born healthy. PGS testing helps IVF physicians and patients decide which embryos to transfer.

What are the chances of birth defects in ivf vs natural conception?

In their study, scientists at the University of California, Los Angeles (UCLA) looked at birth defects among infants born both via IVF and conceived through natural means in California, which has the country’s highest rate of IVF use. They included babies born after IVF and other assisted reproductive treatments such as couples’ use of fertility-enhancing drugs and artificial insemination.

Among 4795 babies born after IVF and 46,025 infants who were conceived naturally, 3,463 babies had congenital birth defects. Even after controlling for factors that can affect such birth defects, such as mother’s age, and race, which can influence rates of genetic and environmentally driven developmental disorders, 9% of infants born after IVF had birth defects compared to 6.6% of babies who were conceived naturally. Overall, the babies born after IVF were 1.25 times more likely to be born with abnormalities. The researchers did not find a link between birth defects and other fertility treatments like artificial insemination or ovulation induction.

It’s possible that the higher rate of abnormalities with IVF is due in part to whatever was contributing to infertility in the first place, say the researchers. But the fact that an increase was not seen among babies conceived using artificial insemination or ovulation induction suggests that process of IVF itself, in which eggs are removed from a woman, fertilized in a dish with sperm and then allowed to develop into embryos, which are transplanted back into the womb, is the primary culprit.

What are side effects of IVF?

As with most medical procedures, there are potential risks. Fertility medications can have various side effects including headaches, mood swings, abdominal pain, hot flashes, and bloating, amongst other side effects. Although it is rare, fertility medications may cause ovarian hyper-stimulation syndrome (OHSS).

Some side effects after IVF may include:

Passing a small amount of fluid (may be clear or blood-tinged) after the procedure.
Mild cramping.
Mild bloating.
Constipation.
Breast tenderness.

What are the congenital anomalies which are more in IVF twins?

Anomalies associated with twinning

Conjoined twins
TRAP sequence (acardiac twins)

Chromosomal anomalies

Trisomy 21
Trisomy 18

Central nervous system

Neural tube defects

Cardiovascular

Isolated VSD

Genito-urinary system

Renal dysplasia
Hydronephrosis
Musculoskeletal system

Can twin pregnancy be avoided in IVF treatment?

Ironically, IVF – the very procedure that has played a part in the rise of multiple births – is playing an important new role in reducing them, thanks to innovative technology and techniques:

Blastocyst Culture and Transfer – Clinicians grow the embryos in a nutrient-rich media for five days instead of the conventional three. This enables them to select the healthiest, promising embryos for implantation. Fewer need to be implanted, and the remainder can be frozen for future use, if needed.
Elective Single Embryo Transfer (eSET) – Studies show that implanting multiple embryos in women under 35 doesn’t improve the pregnancy rate, it just increases the chance of a multiple birth. With eSET, a single embryo, usually a blastocyst, is transferred. The American Society for Reproductive Medicine recommends a single embryo in women under 35 – two in those with an unfavorable prognosis.
Preimplantation Genetic Diagnosis (PGD) – Microscopic evaluation of early-stage (3-day) embryos identify those with the best development characteristics.
Comparative Genomic Hybridization (CGH) – This new screening technique examines the 5-day blastocyst, allowing analysis of all 23 pairs of chromosomes to identify abnormalities thought to be responsible for implantation failure.

Can single embryo transfer avoid twin pregnancies in ivf?

The goal of all fertility treatments should be the birth of a healthy baby with as few risks to the mother as possible. To do this when undergoing in vitro fertilization (IVF), we can plan a single embryo transfer (SET). This means transferring one embryo into the uterus, in order to prevent multiple births is the answer.

What causes PCOS?

Researchers and health care providers know that genetic and environmental factors contribute to the development of PCOS. The syndrome is probably caused, at least in part, by a change, or mutation, in one or more genes. Recent research conducted in animal models suggests that in some cases PCOS may be caused by genetic or chemical changes that occur in the womb. PCOS likely results from a combination of causes, including genes and environmental factors. Most of the symptoms of PCOS are caused by higher-than-normal levels of certain hormones, called androgen, the male hormone which interferes with ovulation in women. Androgen causes the follicles—small, fluid-filled cysts within the ovaries in which eggs grow and mature —to enlarge, forming cysts.

Can it be treated?

Yes it can be managed once it is diagnosed, based on sonological and hormonal parameters

Can thyroid hormone disorders cause infertility?

Yes. But after treatment, natural conception can occur

What is embryo biopsy? is the embryo damaged during the biopSY?

Embryo biopsy is the removal of one or just a few cells from the embryo (depending on the stage of development). If the embryo is handled correctly by a skillful embryologist, the embryo develops normally after embryo biopsy. Published studies demonstrate that there is no increased rate of birth defects in IVF babies that are born after biopsy compared to IVF babies that are born without embryo biopsy..

Can biopsy be done on day 3 or blastocyst stage (day 5)?

Igenomix can perform PGS testing on embryos that are biopsied at either day 3 or day 5. A 3-day-old embryo has approximately 8 cells, and so only a single cell is removed for a biopsy done at day 3. A 5-day-old embryo has a few hundred cells, and so several cells can be safely removed during the biopsy. There are several good reasons to do either a day-3 or a day-5 biopsy. The number of cells that can be safely removed, rates of mosaicism, expertise of the embryologist, and embryo quality are all important factors in deciding when to do embryo biopsy. Patients should discuss with their IVF doctor the best time to do the biopsy. (Mir et al., 2016).

Does PGS include all genetic diseases?

No genetic test can detect all potential genetic abnormalities. PGS testing for aneuploidy can only assess numerical changes in chromosome number and other imbalances in genetic material including deletions and duplications. PGS will identify any missing or extra chromosomes, deletions, duplications, and unbalanced rearrangements that are larger than our detection limit of 6 Mb. PGS for aneuploidy screening cannot rule out single gene disorders, balanced structural abnormalities, uniparental disomy, and genetic imbalances including deletions and duplications smaller than our detection limit of 6 Mb. PGS can detect some types of polyploidy but cannot detect polyploidy in which the sex chromosomes are found as a multiple of normal (triploidy 69,XXX and tetraploidy 92,XXXX or 92,XXYY)

What is the effectiveness of pgs for different indications

?When an embryo is identified as normal after PGS testing, the likelihood of a pregnancy is higher than 60% in women younger than 40 years. In women over 40 years, there is a higher percentage of cycles in which all embryos are abnormal, but when normal embryos are found, the likelihood of pregnancy is about 50%.

How many embryos are expected to be normal when using pgs?

The likelihood that embryos will be chromosomally normal decreases as women get older. According to data generated at Igenomix, the average percentages of normal embryos are:

Maternal Age (years) %Normal Embryos

30-34 60%

35-39 40%

40+ 20%

These estimates are based off of a large data set from many combined PGS cases and may not apply to small numbers of embryos from a single PGS case. Igenomix cannot guarantee that there will be normal embryos for any PGS test

If PGS testing is done, is prenatal testing recommended?

Although PGS for aneuploidy screening is highly accurate, there is still a chance of misdiagnosis. PGS cannot detect mosaicism in the embryo because only a single cell or just a few cells are analyzed. Prenatal testing is recommended to confirm the results of PGS testing and may detect other abnormalities not tested for by PGS. Pregnant mothers should discuss options for prenatal testing with their obstetrician. Non invasive prenatal testing could be also an alternative

What is ovarian hyper stimulation syndrome ?

Ovarian hyperstimulation syndrome (OHSS) is a medical condition affecting the ovaries of some women who take fertility medication to stimulate egg growth. Most cases are mild, but rarely the condition is severe and can lead to serious illness or death.

Classification of OHSS

OHSS is divided into the categories mild, moderate, severe, and critical.
In mild forms of OHSS the ovaries are enlarged (5–12 cm)
In moderate form there may be additional accumulation of ascites with mild abdominal distension, abdominal pain,[2] nausea,[2] and diarrhea.
In severe forms of OHSS there may be hemoconcentration, thrombosis, distension, oliguria (decreased urine production), pleural effusion, and respiratory distress. Early OHSS develops before pregnancy testing and late OHSS is seen in early pregnancy. Criteria for severe OHSS include enlarged ovary, ascites, hematocrit > 45%, WBC > 15,000, oliguria, creatinine 1.0-1.5 mg/dl, creatinine clearance > 50 ml/min, liver dysfunction, and anasarca.
Critical OHSS includes enlarged ovary, tense ascites with hydrothorax and pericardial effusion, hematocrit > 55%, WBC > 25,000, oligoanuria, creatinine > 1.6 mg/dl, creatinine clearance < 50 ml/min, renal failure, thromboembolic phenomena, and ARDS.