Infertility is defined as the failure to conceive after a year of regular unprotected intercourse, or the inability to carry a pregnancy to a live birth.
Primary infertility- when the woman has never conceived
Secondary infertility- when the woman has conceived atleast once but can not get pregnant again
Most infertility results from physical problems in either the male partner’s or the female partner’s reproductive system, or both. Some causes include problems with <br>
The man's reproductive system<br>
The woman's fallopian tubes<br>
The woman's uterus and / or cervix<br>
The woman's ovulation.<br>
One in six couples is affected by some degree of infertility and need some kind of medical intervention for conception.
Naturally conception occurs when the male’s sperm meets the woman's egg. This typically takes place in one of the woman’s fallopian tubes and the fertilized egg then travels to the uterus and is implanted in the uterine lining.<br> For pregnancy to take place, fertilization of the egg must be followed by a successful implantation. Only one egg is released for fertilization in each menstrual cycle.<br> If this egg is not fertilized, conception will not be possible again until the next cycle.
A complete medical history and a physical exam are the first step in diagnosing fertility problems. Both partners need to be evaluated. <br>The couple may also need blood tests, semen analysis and ultrasound exams or exploratory surgery for the woman.
Once the cause for infertility is determined, treatment can be planned. Sometimes, simple counseling or simple medication will solve the problem. In some cases, surgery is required.
Problems in the male reproductive organs can often be resolved with medication and, if required, with surgery.
Sperm quality and quantity can be affected by overall health and lifestyle. Some things that may reduce sperm number and / or quality include alcohol, drugs, stress, environmental toxins, smoking, health problems, certain medicines, radio or chemotherapy and age.
Things that affect woman's fertility include age, stress, poor diet, obesity, underweight, smoking, STDs, hormonal problems and other health problems.
The quality of eggs in the ovaries decline with age.<br>
The ability of an egg to become fertilized may also decrease over time, lowering the odds of conception<br>
A woman produces fewer eggs with time.<br>
Over time, changes in hormones can cause difficulties with ovulation. Miscarriage rates increase with age.
Most infertility problems are not hereditary.
Improvements in medication, surgery and ART make pregnancy possible for a majority of the couples pursuing treatments. Success rates have drastically improved for couples taking treatment under ART.<br> There are various factors which influence success in ART. On an average, the success rates with IUI are around 15-20% & 40-50% with IVF.
You will have to first take an appointment at our clinic. After a thorough examination, the doctor will suggest tests based on which a certain mode of treatment will be recommended.
This depends on the type of treatment you undergo. However, when you meet our doctor, she will let you know details of the same.
Globally the success rate of assisted reproductive technology is between 15-20% for intra uterine insemination and 40-50% for in-vitro fertilization.
The success rate at our centre is slightly higher than the global average. However, the success rate for every individual is different from the other. Once you come to our centre, our doctors will guide you better.
While age is a cause for infertility, it varies from person to person. You must make an appointment at our clinic and the doctor will be able to suggest a treatment after a thorough examination.
We offer fertility treatments only for married couples in order to avoid potential legal troubles.
We offer all kinds of gynecological treatments irrespective of age.
Betamethasone Tablets 0.5 mg.
Dexamethasone Tablets 0.5 mg./4 mg.
Prednisone Tablets 50 mg.
Prednisolone Tablets 5 mg./10 mg.
Atenolol Tablets 50 mg./100 mg.
Propranolol Tablets 10 mg./40 mg.
Acyclovir Tablets 200 mg./400 mg./800 mg.
Lamivudine Tablets 100 mg.150 mg.
Lamivudine Syrup 50mg/5ml
Zidovudine Capsules 100 mg./300 mg.
Lamivudine + Zidovudine Tablets 150 mg. + 300 mg.
Stavudine Capsules 30 mg./40 mg.
Lamivudine + Stavudine Tablets 150 mg. + 30 mg.
Lamivudine + Stavudine Tablets 150 mg. + 40 mg.
Nevirapine Tablets 200 mg
Lamivudine + Stavudine + Nevirapine Tablets 150 mg. + 30 mg. + 200 mg.
Lamivudine + Stavudine+ Nevirapine Tablets 150 mg. + 40 mg. + 200 mg.
Indinavir Sulphate Capsules 200 mg./400 mg.
Efavirenz Tablets 200 mg.
Nelfinavir Tablets 250 mg.
Ritonavir Capsules 250 mg.
Cimitidine Tablets 200 mg./400 mg.
Esomeprazole Tablets 20 mg./40 mg.
Famotidine Tablets 20 mg./40 mg.
Lansoprazole Capsule 15 mg./30 mg.
Omeprazole Capsule 20 mg.
Pantoprazole Tablets 20 mg./40 mg.
Ranitidine Tablets 150 mg./300 mg.
Sucralfate Tablets 1 gm.
INTRA UTERINE INSEMINATION (IUI) FAQ
You have to see the clinician on the second day of the period. You will be advised to take tablets, and or few hormonal injections from 4th or 5th day
You will be called in for maximum of three, four scans after starting of injections
This will depend on the report of your last scan
Please arrive 30 minuts prior to the scheduled appointment time for the IUI procedure
It is a simple painless procedure
A sexual abstinence of is a must for IUI<
There is a private sample collection room
Make sure that all the semen collection containers are properly labeled with your identity to avoid mixing of samples
If you have difficulty in erection or ejaculation – inform us we will help you
Inform the technician about any spillage of sample during collection
Yes you can. You will have to collect the container from the Andrology lab the previous evening.
Never use a jelly, lubricant, vaseline, spit or a condom for collecting the semen sample, they alter the quality
All home collected semen samples should be transported to the Andrology lab within 45 minutes of collection. Sample should be kept warm by carrying the container in a pocket.
IVF / ICSI FAQ
Women should have normal base line reproductive hormones
Hysteroscopy or laparoscopy study should be normal
Tuberculosis of the reproductive tract should be ruled out
Antral follicular count, a mark of ovarian reserve should be within normal limits
Husband’s sperm should have the following – count 1-5 millions/inseminate, motility - 25-30% with forward progression, sperm morphology with 5-15% or more normal forms.
It is particularly important that patients undergoing IVF treatment attend SHRISHTI for monitoring when they are required. The timing of events during IVF treatment is particularly crucial to success.
Patients are asked to attend SHRISHTI for an ultrasound scan of the ovaries during the treatment cycle.
(Usually from day 5) This allows us to see how many follicles are developing on the ovaries. Patients should be prepared to attend daily but, if the follicles are growing slowly, it is possible to have some days off.
When most of the follicles are of sufficient size and the hormone levels indicate that the eggs are ready for collection, the last injections are given.
The indicators for ICSI are:
Unexplained failure or poor fertilization in previous IVF cycles.
Infertility / Low sperm count
Severe structural abnormalities of sperm.
HIV / AIDS, Hepatitis A, B, C affected male partner.
Immotile sperm. Eg. Inherited disorders of the sperm tail for which no other IVF technique is effective (ex: Kartagener's Syndrome).
Epididymal or testicular sperm obtained from Azoo spermic patients (No sperm count in semen, but normal or low sperm production in the testis)
Sperm obtained by electro ejaculation or from urine in cases of retrograde ejaculation.
DONOR PROGRAMS FAQ
A semen donor must:
Be between 21 and 35 years old.
Be a non-smoker and non-alcoholic who maintain a healthy life style.
Have successfully had at least one child
Undergo a complete medical and family history check
Undergo a through physical and psychological examination and evaluation.
Undergo a blood test for blood grouping and screening for HIV, Hepatitis B and C, and other sexually-transmitted diseases
Undergo screening for genetic abnormalities
All donors undergo initial screening as mentioned above. Upon satisfying the required criteria, these donors produce a semen sample that is then cryopreserved for a quarantine period of 6 months.
After 6 months, the donors are re-screened for HIV and Hepatitis B and C, after which the donor sample is ready for dispatch.
We do not have a sperm bank at our centre, however, we source sperms from the best sperm banks in the city.
Oocyte/egg donor programs are carried out under adherence to ICMR guidelines. Among others, an oocyte donor must
Be between 21 & 35 years old.
Be a non-smoker and non-alcoholic who maintains a healthy lifestyle.
Have successfully had at least one child;
Undergo complete medical & family history examination
Undergo a thorough physical & psychological examination & evaluation.
Undergo a blood test for blood grouping, HIV, hepatitis B & C & other sexually transmitted diseases;
Undergo screening for genetic abnormalities;
Typical success rates with sperm donation are very encouraging. However, success rates depend largely upon the quality of sperm/ oocyte/ embryo (depending on the particular donor program).
Typical success rates with oocyte donation are very encouraging. Oocyte donation success rates are better than IVF cycles with the female partner’s own eggs as hormonal manipulation is minimal and the uterus is more receptive.
No, according to ICMR rules a known egg donor is not allowed.
FREEZING / VITRIFICATION FAQ
Indications for Semen Freezing are:
Prior to Vasectomy
Prior to cancer treatments like chemo/radiotherapy
As a part of semen banking
In cases with severe male factor infertility
In cases prone to develop azoospermia
As a part of IVF cycle, when the partner has got problems with collecting semen on demand
In couples where the partner is a frequent traveler
The semen can be frozen for many years provided the method of freezing is done properly. We offer short term and long term freezing options.
You will first need to get a blood analysis for viral markers. After that you have to come down for a semen analysis. Based on the doctor’s suggestion, either the semen sample used for analysis would be frozen or a fresh sample would be frozen.
We require a 3-5 days of abstinence before giving your semen sample. You need to start calculating from one day after the day you last had an intercourse/ ejaculated
Indications for oocyte vitrification are:
Prior to cancer treatments like chemo/radiotherapy
Prior to organ transplant therapy (liver transplant, bone marrow transplant, etc.
In severe Poly Cystic Ovarian Syndrome cases
Single women wanting to preserve the fertility
In cases where male partner fails to produce semen sample on the day of IVF after egg pickup and ICSI/IVF needs to be postponed
Three days abstinence<>
Screening for HIV 1&2, Hepatitis -B&C, VDRL<>
Consent for freezing
HIV, Hepatitis B&C and VDRL screening of the women whose eggs will be frozen<>
The women needs to undergo controlled ovarian stimulation with reproductive hormones<>
Eggs will be collected under general anesthesia and checked for maturity.
We allow the eggs to be kept frozen for up to one year. After the one year period, you can renew the same.
It is a process that takes over a month. Once you get an appointment at our clinic, the doctor will take you through the entire procedure.
FERTILITY ENHANCING SURGERIES
A hysterolaparoscopy is a diagnostic modality in the evaluation of infertile women. It permits a direct magnified visual assessment of the uterus, fallopian tubes, ovaries, and lower pelvis. It is particularly useful in diagnosing endometriosis, tubal disorders or pelvic adhesions and generally is performed at the end of a work – up, but may be performed earlier if deemed appropriate by your history and referral diagnosis.
Endoscopic surgeries are usually performed on a daycare basis under general anesthesia. During hysteroscopy, the mouth of the uterus (cervix) is dilated and the hysteroscope is gently introduced into the uterine cavity to inspect it from within. Skin incisions are not required for hysteroscopy.
In laparoscopy, a needle is inserted through the navel and the abdomen is filled with carbon dioxide gas. The gas pushes the abdominal wall away from the internal organs allowing the laparoscope to be placed safely into the abdominal cavity. While looking through the laparoscope, the surgeon visualized the reproductive organs including the uterus, fallopian tubes, and ovaries. One or more small probes are usually inserted through other incisions in order to manipulate the pelvic organs into clearer vision. A solution containing Methylene blue, a dye, is then injected through the cervix, uterus, and fallopian tubes to determine if the tubes are open. If no abnormalities are noted at this time, the endoscope and the probes are withdrawn and the skin incisions are closed with one or two stitches.
During operative laparoscopy, many abdominal disorders can be treated safely through the laparoscope at the same time that the diagnosis is made. When performing operative laparoscopy, the surgeon inserts additional instruments such as probes, scissors, grasping instruments, through two or three additional incisions. The common indications for operative laparoscopy are ectopic pregnancies, ovarian cysts, endometriosis and dermoid cysts, fibroids etc.
Operative hysteroscopy is indicated commonly for treatment of adhesions, uterine cavity abnormalities, submucosal polyps and fibroids.
Hysterolaparoscopy is usually done in the week after the end of periods to prevent the possibility of disturbing a pregnancy (as can happen if done in the second half of the menstrual cycle).
A diagnostic hysterolaparoscopy usually takes no more than 60 minutes. If any abnormality is found and has to be treated in the same sitting the surgery takes longer depending on the types of abnormality.
You should leave the adhesive bandage or dressing on the incision for five days. During that period, it is important to keep the incision area dry. Complete bed rest is not necessary, but you should avoid any vigorous activity and lifting heavy weights.
Most women feel well enough to return to work or normal daily activities two to three days after a diagnostic endoscopy. If any surgical procedure is carried out a week’s rest may be advisable.
Some women may feel weak and experience abdominal cramps for a day or so. Spotting and light bleeding can occur for several days afterwards. Complications are rare and seldom serious. These include bleeding, infection, perforation of the uterus / bladder /bowel or allergic reaction to the general anesthetic.
We have a team of well renowned and skilled endoscopic surgeons’ state of art endoscopic equipment and a fully equipped operation theater. Endoscopic surgery done with you fertility specialist is better the best suited treatment plan for you can be determined & executed.