Frequently Asked Questions (FAQs)
In 1978, Drs. Steptoe and Edwards used assisted reproductive technology (IVF) successfully resulting in the birth of Louise Browne. Ever since, this technology has not only helped women conceive in situations where it would not have been possible otherwise but has also laid bare the entire process of reproduction thus helping the scientists to understand the intricacies of this process better. Today, with Louise giving birth to a child, IVF has become a credible option for family building!
WHO estimates that there are 60 – 80 million such couples all over the world suffering from infertility thereby making this condition an epidemic. Although there are no definite studies from India, it is estimated that it is affecting nearly 10-15% married couples from India and due to rapid modernization and increasing environmental toxins, the condition is on the rise. Nearly 27.5 million couples who are actively seeking children suffer from infertility. In the Indian society childlessness is viewed not just as a medical disorder but a social stigma because Indians marry early, traditionally have a stable family norm and have a desire to produce many children thereby producing an ever increasing demand for all kinds of therapies and interventions. Infertility management has therefore become an integral part of reproductive medicine in the country.
Many couples realize that they are unable to conceive after trying naturally for months or even years. When they seek assistance, their healthcare provider conducts simple tests to find out the cause for this problem. It has been seen that females are responsible for 30% of cases, 30% men and in 30% it will be both the man and woman. With many advancements in reproductive medicine, it is now possible to help nearly all couples who come to us.
Most experts suggest at least one year. Women aged 35 years or older should see their doctors after six months of trying. A woman’s chances of having a baby decreases rapidly every year after the age of 30.
Some health problems also increase the risk of infertility. So, women should talk to their doctors if they have—
- Irregular periods or no menstrual periods
- Very painful periods
- Pelvic inflammatory disease
- More than one miscarriage
It is a good idea for any woman to talk to a doctor before trying to get pregnant. Doctors can help you get your body ready for a healthy baby. They can also answer questions on fertility and give tips on conceiving.
No, infertility is not always a woman’s problem. Both women and men can have problems that cause infertility. About one-third of infertility cases are caused by women’s problems. Another one third of fertility problems are due to the man. The other cases are caused by a mixture of male and female problems or by unknown problems.
Is infertility a common problem?
Yes. About 10 % of women (6.1 million) in the United States ages 15–44 years have difficulty getting pregnant or staying pregnant.
Men Seek Infertility Services
Many couples struggle with infertility and seek help to become pregnant; however, it is often thought of as only a women’s condition. But a CDC study analyzed data from the 2002 National Survey of Family Growth, and found that 7.5% of all sexually experienced men reported a visit for help with having a child at some time during their lifetime—this equates to 3.3–4.7 million men. Of men who sought help, 18.1% were diagnosed with a male-related infertility problem, including sperm or semen problems (13.7%) and varicocele (5.9%).
Anderson JE, Farr SL, Jamieson DJ, Warner L, and Macaluso M. Infertility services reported by men in the United States: national survey data. Fertility and Sterility 2009; (6):2466–2470.
Infertility in men is most often caused by—
- A problem called varicocele (VAIR-ih-koh-seel). This happens when the veins on a man’s testicle(s) are too large. This heats the testicles. The heat can affect the number or shape of the sperm.
- Other factors that cause a man to make too few sperm or none at all.
- Movement of the sperm. This may be caused by the shape of the sperm. Sometimes injuries or other damage to the reproductive system block the sperm.
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.
Most cases of female infertility are caused by problems with ovulation. Without ovulation, there are no eggs to be fertilized. Some signs that a woman is not ovulating normally include irregular or absent menstrual periods.
Ovulation problems are often caused by polycystic ovarian syndrome (PCOS). PCOS is a hormone imbalance problem which can interfere with normal ovulation. PCOS is the most common cause of female infertility. Primary ovarian insufficiency (POI) is another cause of ovulation problems. POI occurs when a woman’s ovaries stop working normally before she is 40. POI is not the same as early menopause.
Less common causes of fertility problems in women include—
Doctors will do an infertility checkup. This involves a physical exam. The doctor will also ask for both partners’ health and sexual histories. Sometimes this can find the problem. However, most of the time, the doctor will need to do more tests.
In men, doctors usually begin by testing the semen. They look at the number, shape, and movement of the sperm. Sometimes doctors also suggest testing the level of a man’s hormones.
In women, the first step is to find out if she is ovulating each month. There are a few ways to do this. A woman can track her ovulation at home by—
- Writing down changes in her morning body temperature for several months
- Writing down how her cervical mucus looks for several months
- Using a home ovulation test kit (available at drug or grocery stores)
Doctors can also check ovulation with blood tests. Or they can do an ultrasound of the ovaries. If ovulation is normal, there are other fertility tests available.
Some common tests of fertility in women include—
- Hysterosalpingography: This is an X-ray of the uterus and fallopian tubes. Doctors inject a special dye into the uterus through the vagina. This dye shows up in the X-ray. Doctors can then watch to see if the dye moves freely through the uterus and fallopian tubes. This can help them find physical blocks that may be causing infertility. Blocks in the system can keep the egg from moving from the fallopian tube to the uterus. A block could also keep the sperm from reaching the egg.
- Laparoscopy: A minor surgery to see inside the abdomen. The doctor does this with a small tool with a light called a laparoscope. A small cut is made in the lower abdomen and inserts the laparoscope. With the laparoscope, the doctor can check the ovaries, fallopian tubes, and uterus for disease and physical problems. Doctors can usually find scarring and endometriosis by laparoscopy.
Finding the cause of infertility can be a long and emotional process. It may take time to complete all the needed tests. So don’t worry if the problem is not found right away.
All tests are aimed at investigating the following:
- Ovaries – for eggs
- Tubes for patency
- Uterus for endometrial lining and cavity
- Semen for sperms
Infertility can be treated with medicine, surgery, artificial insemination, or assisted reproductive technology. Many times these treatments are combined. In most cases infertility is treated with drugs or surgery.
Doctors recommend specific treatments for infertility based on—
- Test results
- How long the couple has been trying to get pregnant
- The age of both the man and woman
- The overall health of the partners
- Preference of the partners
Doctors often treat infertility in men in the following ways—
- Sexual problems: Doctors can help men deal with impotence or premature ejaculation. Behavioral therapy and/or medicines can be used in these cases.
- Too few sperm: Sometimes surgery can correct the cause of the problem. In other cases, doctors surgically remove sperm directly from the male reproductive tract. Antibiotics can also be used to clear up infections affecting sperm count.
- Sperm movement: Sometimes semen has no sperm because of a block in the man’s system. In some cases, surgery can correct the problem.
In women, some physical problems can also be corrected with surgery.
A number of fertility medicines are used to treat women with ovulation problems. It is important to talk with your doctor about the pros and cons of these medicines. You should understand the possible dangers, benefits, and side effects.
Intrauterine insemination (IUI) is an infertility treatment that is often called artificial insemination. In this procedure, the woman is injected with specially prepared sperm. Sometimes the woman is also treated with medicines that stimulate ovulation before IUI.
IUI is often used to treat —
- Mild male factor infertility
- Women who have problems with their cervical mucus
- Couples with unexplained infertility
IVF process can be understood with the help of certain steps which are explained below.
• Ovarian stimulation: The fertility specialist monitors the timing of egg release. Doctor will make sure the hormonal level and other conditions for IVF are normal or not. The doctor watch over produced eggs are appropriate or not.
• Egg retrieval: In this step, eggs are taken out from female’s ovary by using needle under light sedation. Further, eggs are placed in a dish containing nutrient media and further it is shifted to the incubator.
• Fertilisation: This is the next step called fertilisation where male sperm are taken and mixed with the most active sperm in a special chamber. Then, eggs and sperm are placed in incubator and the process is monitored so that healthy embryo can develop.
• Embryo transfer: It is the last step in which the healthiest embryo is transferred. Initially, the doctor examines so that healthy embryo can be selected. With the help of small plastic tubes, the embryo is transferred.
IVF involves two visits:
(1) One day for checkup / pre-IVF preparation
(2) 15 days for IVF procedure
No, IVF is not at all painful because the injections used for IVF are purified and injected in subcutaneous form. The egg collection process is done under light sedation which is totally painless. At the time of embryo transfer, anaesthesia is not given but it is a 2 to 5 minutes of process which hardly cause any pain.
Low sperm count can also be known as oligospermia. One may undergo to ICSI (Intracytoplasmic Sperm Injection) where a single sperm is injected to matured egg. Adapting this treatment will leads to elevate the chances of conceiving. Besides this, the treatment is useful especially in case of male infertility, low sperm motility and poor sperm morphology.