My husband and I have an active sex life, we are both healthy, and my periods are regular. However, we have still not conceived?

• You need to remember that it's not possible to determine the reason for your infertility until you undergo tests to find out if your husband's sperm count is normal; if your fallopian tubes and uterus are normal; and if you are producing eggs. Only after undergoing these tests will your doctor be able to tell you why you are not conceiving. While testing does cause considerable anxiety, it's far better to intelligently identify the problem so that we can look for the best solution.

 
What is the incidence of infertility worldwide?

• The World Health Organization (WHO) estimates that approximately 8-10% of couples experience some form of infertility problem. On a worldwide scale, this means that 50-80 million people suffer from infertility. However, the incidence of infertility may vary from region to region. Recent study shows that one in seven couples are facing infertility

What is the frequency of couples suffering from infertility?

• One in six couples attempting pregnancy will have difficulty achieving pregnancy.

How does age affect fertility?

• Female fertility declines slightly at 30 years and there is then a significant decline at around 37 to 38 years of age. By the time a woman is 40 years old her fertility is a quarter of when she was 30.The miscarriage rate increases with age from about one in seven for women aged less than 25 years to about one in two at 40 years of age.

 
Does stress affect fertility?

• There is no research that clearly links stress to pregnancy outcome. However the process of fertility treatment can be stressful, so stress management may be beneficial. Christchurch Fertility Centre has experienced counsellors available to help you and includes up to two counseling sessions during treatment, at no extra cost.

What is day one of my cycle?

• The first day of full flow bleeding before midday is day one of your cycle.

• As long as the periods are regular, this means ovulation is occurring. Some normal women have menstrual cycle lengths of as long as 40 days. Of course, since they have fewer cycles every year, the number of times they are "fertile" in a year is decreased. Also, they need to monitor their fertile period more closely, since this is delayed (as compared to women with a 30 day cycle).

• Depends upon length of cycle, e.g. in a 28 day cycle ovulation should occur on day 14 and the “fertile time” is approximately days 11 to 15. Normal fertility is achieved with alternate day intercourse across the fertile time.

After having sex, most of the semen leaks out of my vagina. How can we prevent this ? Should we change our sexual technique ? Could this be a reason for our infertility ?

• Loss of seminal fluid after intercourse is perfectly normal, and most women notice some discharge immediately after sex. Many infertile couples imagine that this is the cause of their problem. If your husband ejaculates inside you, then you can be sure that no matter how much semen leaks out afterwards, enough sperm will reach the cervical mucus. This leakage of semen ( which is called effluvium seminis) is not a cause of infertility. In fact, this leakage is a good sign - it means your husband is depositing his semen normally in your vagina.

My husband refuses to get his semen tested. He says the fact that it is thick and voluminous means it must be normal !

• Semen consists mainly of seminal fluid, secreted by the seminal vesicles and the prostate. The volume and consistency of the semen is not related to its fertility potential, which depends upon the sperm count. This can only be assessed by microscopic examination.

My sister conceived only after 6 years of marriage. Does this mean I will also have difficulty conceiving ?

• If your mother, grandmother or sister has had difficulty becoming pregnant, this does not necessarily mean you will have the same problem! Most infertility problems are not hereditary, and you need a complete evaluation.

• Impotent ,usually means a male who can not perform sex, but he may have good number of sperm to create a baby if injected artificially.In the same way a person may be very good at sex ,but may be Azoospermic .Hence virility and sperm productions are two departments. If testis are very small or damaged in any way may cause infertility and impotency both.

My semen analysis report shows I have no sperm in the semen ( Azoospermia ). Is this because I used to masturbate excessively as a boy ?

• Masturbation is a normal activity which most boys and men indulge in. It does not affect the sperm count. You cannot "run" out of sperms, because these are constantly being produced in the testes.

How long a couple should wait to go for fertility treatment?

For normal couples the chance of achieving a successful pregnancy is

• 20 % for any given month
• 57% within three months of trying
• 75 % within six months
• 90 % within one year
• 95 % with in two years of attempting pregnancy

Hence a general rule is if couple does not achieve a pregnancy within one year ,they should go for finding out the reasons of infertility

How long does a IVF treatment take?

• Between two and four weeks depending on treatment type.

Are there any risks with IVF treatment?

• Overall IVF is a safe treatment. A condition known as Ovarian Hyperstimulation may occur whereby a woman's ovaries become overstimulated and enlarged at the same time as fluid accumulates in her abdomen.

What about the health risks for children born following infertility treatment ?

• Regarding children born following treatment with ovulation promoting drugs, the incidence of birth defects has never been found to be higher than that in the normal population.

How a couple can get an idea that their fertility treatment will have better chance of achieving pregnancy ?

• Success in Fertility treatment s largely depend on ovarian reserve of the female partner. Ovarian reserve is best assessed by Day2 vaginal sonography . It is the number of small resting follicles gives the idea about how many eggs are going too be retrieved during IVF. Other tests are Day2 /3 FSH, AMH and inhibin assays. Day2/Day3 FSH are more frequently used.

Do we need hospital admission or there is any sort of surgery during the treatment of IVF or ICSI ?

• IVF or ICSI does not need hospital stay or any sort of surgery. During egg retrieval we give general anesthesia for 25 – 45 minutes and it is given by qualified anesthesiologist. Eggs are retrieved by simple needle under ultrasound guide.

What are my chances of becoming pregnant?

It depends on:

• Your Age (this is generally the most important factor for a woman)
• The cause of your Infertility
• The number of eggs that you produce following drug induction
• The quality of the semen
• The number of embryos developed fully

Why IVF fails ?

• IVF fails mainly because of two reasons .One is due to quality of eggs and second is failure of implantation. These things happens in natural pregnancies also ,but as there is cost involvement in IVF ,so it pinches. Quality of stimulation and quality of embryology matters a lot .But these can be corrected by taking stringent measures but quality of eggs and implantation is still beyond anybody’s approach.

We have been told that my husband has poor sperm quality; we don’t know the reason for this. How do you investigate the reason for this problem?

• There are many reasons why sperm may be of poor quality. A semen analysis is performed to find out the volume, sperm count, concentration of sperm, motility and the general appearance of the sperm cell. The most common reason for poor quality is that the sperm count and motility is low. The reason for this may be hereditary, sometimes it could be due to medication or in rare cases it may be due to a hormonal problem. In some men, sperm quality deteriorates over time.

Is it right that donor sperm has to be used if a man has reproductive problems?

• If a couple has the least chance to give birth to their own child, the doctors will take advantage of this chance. Owing to the ICSI technology men who have at least one good sperm have a chance to become biological fathers. In this case physicians may obtain a piece of testis tissue with the help of the TESA method.If it is impossible to find any good sperms, the couple is advised to use donor sperm. Naturally, the donor's identity as well as the fact, that donor sperm was used, remain strictly confidential.

We have a fear that other person’s sperms are used in IVF or sperms are mixed to increase the success. Is it true ?

• When husband is able to provide sperms ,(even in the least quantity), his sperms are used in IVF or in ICSI . Husband’s sperms can even be retrieved from his testicles in cases of Azoospermia. Donor sperms are used only when there is a written consent by the couple.

We've had one IVF attempt without success. I can't understand why, I had good embryos that divided nicely, they were also good for freezing. Is there any point in us using the frozen embryos for our next treatment, or should we start a new treatment? If I couldn't get pregnant the first time, surely it's impossible with my frozen embryos as they were collected at the same time?

• Your frozen embryos may well result in a pregnancy if they survive the thawing process. It's the quality of an individual embryo that is important and not all the eggs collected are of the same quality.

What is the legal aspect of IVF treatment in India?

The procedures that are legal and that are practiced in India are shown below.

• There is No Restriction on the no. of Embryos Transferred.
• Use of Donor Eggs or Embryos/ Donor Sperms is legal with couple’s consent.
• Surrogacy is legal with Agreement signed between Surrogate and the couple.
• Embryo reduction.
• Freezing of Embryos/Eggs/Sperms is possible.

How often is it allowed to undergo IVF?

• There is no general rule. If pregnancy comes, it normally happens within first four cycles.

Is it possible to choose the sex of a child when using IVF?

• Yes, before the transfer of embryos their sex can be defined by means of preimplantation genetic diagnosis (PGD). Usually doctors do this for medical reasons but in most cases doctors prefer to leave this question to the nature. In India Sex determination is prohibited under law and we don’t practice Sex Determination or Sex Selection at Srushti.