FAQ

The anticipation, the fears, the nervousness, the emotions involved are many. Why the stork doesn't come 'knocking is a question several couples face. Today, there are a plethora of options to deal with infertility. But they leave you confused with all the terminology. Here's what you need to know.

Q. What is infertility?
A.
To put it simply, if you're under the age of 35, have tried having a child but could not get pregnant despite one year of contraceptive-free intercourse, chances are either you or your partner have a problem that needs to be addressed in order for you to conceive.

Q. Why does it happen?
A.
It could be because of either partner or both. Female factor problems could include tubal infertility which means that the fallopian tubes (the ones that connect the ovaries to the uterus) are either blocked, damaged or altogether absent, inability to make eggs as in polycystic ovarian syndrome (PCOS), endometriosis or an unexplained infertility. Age and quality of eggs are other important factors that influence fertility in women. Male factor problems include a low sperm count or irregularities in sperm mobility or shape. Something that is rarely acknowledged is that approximately 40 to 50 per cent cases are due to male factor infertility. Doctors now suggest that lifestyle too, plays an important role as obesity, excessive smoking, binge drinking as well as stress are major deterrants for conceiving.

Q. How do I go about it?
A.
The first step is to get some basic examinations done by the doctor. Usually male examinations such as a semen analysis are done first as they are easier. Female examinations are elaborate and need to be done at specific stages of a menstrual cycle. If it is a male factor problem and a woman's tubes aren't blocked, you don't need to go in for IVF immediately. A simple procedure of extracting semen from your partner or donor and injecting it into your uterus can lead to pregnancy through a procedure called IUI (intra-uterine injection).

Q. What is IVF?
A.
In vitro fertilisation literally means fertilisation in glass. The procedure basically refers to the fertilisation of the egg outside a woman's body and the following implantation of the embryo in her uterus to enable pregnancy.

Q. What does the procedure entail?
A.
Usually, in a cycle, a woman produces 300 to 400 eggs. However, only one of these is dominant and gets transferred to the fallopian tubes for fertilisation. In order to increase the number of eggs produced in a cycle, the ovaries are stimulated with drugs that are injected over a period of 8-12 days. Once the eggs have matured, under anaesthesia, they are retrieved through the vagina by an injection. These eggs are then fertilised with the sperm under certain controlled conditions and the resultant embryos are transferred to the uterus for implantation. Usually one, two or three embryos are transferred so as to ensure pregnancy, which sometimes leads to multiple pregnancies in case all the embryos get implanted. The entire process costs between Rs.80,000 to 90,000 on an average.

Q. What is ICSI?
A.
If the quality of sperm isn't good and it cannot penetrate through the outer covering of the egg naturally, fertilisation is done by injecting a single sperm into the cytoplasm or the centre of the egg. This is known as Intracytoplasmic Sperm Injection (ICSI).

Q. What is Blastocyst transfer and assisted hatching?
A.
In natural conception, an egg is fertilised in the fallopian tubes and after about four to five days, the embryo, at this point known as a blastocyst, moves into the uterus. But during IVF, an embryo is developed for two-three days and then transferred directly to the uterus. To improve chances of implantation, in a technique called blastocyst transfer, the embryo is allowed to develop in the lab till it becomes a blastocyst and then transferred. But for this several embryos need to be available as the chances of survival in the lab can be low. Another method used to ensure implantation is assisted hatching that is done through laser to make sure that the embryo breaks out of its shell in time and attaches itself to the womb.

Q. Why should I freeze my embryos?
A.
If a number of eggs have been fertilised resulting in healthy embryos of which only one has been transferred to the uterus, the remaining can be frozen in liquid nitrogen for a period of up to 10 years. These can then be used for further IVF attempts in case the first one does not succeed or preserved for future pregnancies. That way, you'll only have to go through the process of embryo transfer instead of starting from scratch.

Q. Why should I freeze my eggs?
A.
In case you are over 30 and do not plan to have a baby anytime soon, it's a good idea to get your eggs frozen. With age, the number of eggs your body produces in each cycle decrease and their quality deteriorates. That is why age is an important factor for IVF. Success rates are between 30-35 per cent for a woman under 35 years and go down to about 10 per cent for a woman over 40. But there isn't cause for worry even if you're nearing 40 or are over it. Then, you could consider the option of using donor eggs. Even your partner's age is a vital factor here as doctors suggest that sperm count begins to decline post 40, so it's preferable to have children before you turn 45.

Embryos as well as eggs can be frozen only at specialised labs, so consult an IVF specialist before you take a decision on it. It costs anywhere between Rs.20,000 to 30,000.

Q. What should I tick off my checklist?
A.
The procedure is safe except for a rare case where the ovaries might get hyperstimulated by the drugs, which is treatable by medicines. Make sure you consult a doctor who is well-reputed and has adequate experience in the field. A specialist who has been suggested from personal experience by someone you know well is a good option too.

Often IVF is an emotionally trying treatment as anticipation is higher with every successive attempt. But what you need to remember is that if the first attempt doesn't work, it doesn't mean your chances are bleak. For the first six attempts, success rates remain almost the same. Also, it is harder to conceive if you are emotionally stressed or depressed. Consulting a psychologist during the treatment as well as listening to music and meditating are good ways to deal with it..






When to Consult a Doctor for Surrogacy IVF

Early diagnosis will only ensure the couple has more time available for treatment before advancing age of female partner becomes an additional problem.



It is recommended that both partners are evaluated together, and finding problem in one partner should not stop the basic investigation of other.



Next step is physical examination, followed by routine infertility investigation, and finally by specific investigations and diagnostic procedures.