- Artificial Insemination (IUI)
- In Vitro or IVF
- Pre Implantation Genetic Screening
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.
- 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
- Weight – obesity and underweight
- Smoking, alcohol consumption and substance abuse
- Sexually Transmitted Diseases (STDs)
- Tubal Disease
- Conditions and disorders like PCOD, Endometriosis, Pelvic infections
- Genetic causes
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.
- Blocked Fallopian tubes due to pelvic inflammatory disease, endometriosis, or surgery for an ectopic pregnancy
- Physical problems with the uterus
- Uterine fibroids
- 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.
- 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.
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.
IUI may involve controlled ovarian stimulation for the woman to enable good quality egg to be released.
- 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.
Average Success rates in IVF 40-50%. At GarbhaGudi, the success rates for IVF is between 55% and 60%
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.
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.
- Breast tenderness.
Anomalies associated with twinning
- Conjoined twins
- TRAP sequence (acardiac twins)
- Trisomy 21
- Trisomy 18
Central nervous system
- Neural tube defects
- Isolated VSD
- Renal dysplasia
- Musculoskeletal system
- 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.
Maternal Age (years) %Normal Embryos
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
- 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, nausea, 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.