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1.
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Why
am I childless? What is infertility/subfertility?
Infertility/Subfertility is a condition when a woman
after one year of unprotected sexual intercourse not being able to conceive on her
own. Both the partners need to be investigated together to treat this problem.
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2.
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Who needs to visit an Infertility Specialist?
When there is no conception after one year of unprotected
intercourse in women of < 35 years, the couple should seek advice from Infertility
specialist. When the woman is >38 years, they should seek advice after 6 months
of unprotected intercourse. |
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3.
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How common is infertility/subfertility?
It is known that 84% of women would conceive within
one year of marriage; 92% in two years and 93% in after three years. It means some
5-15% of the married couples are facing this problem at any given time in a society.
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4.
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Is infertility becoming more common nowadays?
Though it may appear to be so, nevertheless, as
people have become knowledgeable, more and more patients start approaching specialists
to find out the cause of their subfertility status sooner than before. Notwithstanding
that, there seems to be subtle decrease in our fertility rates as a society, thanks
to our changed lifestyle, career needs and economic factors.
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5.
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What is a normal semen analysis?
Normally a man has about 40 to 100 million sperms
in semen per ml. WHO has reported that 20 million sperms per ml with 50% motility
as the requirement for natural conception to occur. Anybody whose count is consistently
lower than this may require ART procedures.
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6.
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What are the pre-screening tests a couple with infertility
problem need to undergo and why so many?
In order to investigate and analyze your infertility
problem, we need to know the underlying medical problem which will help you to choose
the correct option of treatment. for eg a semen analysis showing very few sperms
will obviously direct the couple to ICSI without wasting any time. We accept reports
from any reputed clinical laboratory for tests done within 6 months to one year.
We generally prefer to do a simple semen analysis in our laboratory. One Semen analysis
may not give the real status. If a person had a fever of more than 101’F for some
days, he might expect to have a worse semen report for the next 3 months.
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7. |
Female Screening Requirements:
Blood Tests Day 2-4 (of un-medicated cycle) FSH,
LH and estradiol levels
Rubella Antibody titre
HIV I and II
Chlamydia IgM/IgG status
Hepatitis B surface antigen HBsAg
Hemoglobin
Testosterone in some women
DHEASO4 in some women
Day 21 Progesterone to know the luteal functioning
Pelvic ultrasound to rule out ovarian cysts, fibroids, polyps and hydrosalpinges
(fluid filled tubes)
Hysterosalpingogram (HSG) or hysteroscopy to evaluate uterine cavity and tubal patency
Male Screening Requirements:
Semen Analysis
HIV I and II
Hepatitis B surface antigen
VDRL
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8. |
What is a day 2 FSH and estradiol level and why should it be done only at that time?
These tests measure the level of follicle stimulating
hormone (FSH) and estrogen on the second day of your menses period. The test values
give us an indication of ‘ovarian reserve', in other words, how hard your pituitary
gland in your brain has to work to stimulate your ovaries to ovulate. These values
give us a rough idea to determine what IVF protocol to choose, how much hormone
injection (FSH dose) may be required for stimulation and an insight into the potential success rates of IVF. Some centres may not accept a woman if her blood FSH level
is > 11 mIU/mL.
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9. |
Why does this IVF treatment take so long?
As you may be aware, certain part of your brain
(pituitary gland) controls your ovaries. If we have
to bring your ovaries into our
control for controlled stimulation, we need to delink your brain-ovary control axis
and this is called down-regulation or ovarian suppression. You don’t panic, once
you are off the medication, your brain will take over and your cycles will be restored
as before.
This takes about 8 to 10 days in the cycle before the start of ovarian stimulation
drugs. Soon after you get your proper menses, ovarian stimulation in the form of
daily FSH injections is initiated and this lasts for about 9 to 14 days. Egg Collection
is fixed in the next 2 days after giving you a shot of hCG injection for final maturation
of your eggs. Embryo Transfer is fixed in the next 2 days following your
egg collection.
Basically the IVF treatment gets over by the time of Embryo Transfer. One has to
wait for the result of pregnancy in the next 14 days. Actual treatment commences
from the 21 st of the preceding menses cycle and lasts till about 14 to 16 day of
IVF treatment cycle. Refer to our Typical IVF Calendar in Genesis.
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10. |
Is it possible for a woman without getting menses to conceive on her own?
Yes, in certain circumstances like polycystic ovarian
disease where the anovulation is occurring due to hormonal imbalance. If we can
make these ovulate with treatment, they have good chances of conceiving. If the
problem is of premature menopause, she could get pregnant with donated eggs.
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11. |
Is it possible for a man without sperms in his semen to
have baby of his own?
Yes, when there is too few sperms being produced
in the testes due hormonal problem or sometimes, the fine tubes to transport the
sperms are missing since birth. In such patients, sperms can be collected from their
testes/epididymis by a minor surgery and cold-stored and can be used for producing
embryos by ICSI.
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12. |
How Genesis Fertility Centre in Jaipur differs from any IVF centre in UK as you have worked abroad (UK) for more than 5 years as a Fertility Specialist?
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This is a very important question which needs to be answered in detail. When IVF started in the 80s and early part of 90s, there used to be differences in the quality of treatment given to the patients in India for want of trained manpower, skilled scientists, import restrictions, want of culture media, FSH hormones for stimulation, proper advanced equipment for the lab etc., But as our country also developed in this period, patients in India of late are blessed indeed to have all the technologies made available to them. There is no need whatsoever for them to venture abroad for getting any advanced infertility treatment. I’ll go to the extent of saying that our Genesis Fertility Centre is trying to get accreditation from British Embryology Authorities for recognizing it to be treated on par with any IVF unit in UK. Once we get the accreditation, we will be the first centre in India to have accomplished that feat.
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13.
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How common is infertility/subfertility?Why IVF/ICSI treatments are so expensive?
IVF is expensive because, it involves extremely
delicate medical procedures, involving the co-ordinated team-work of highly trained
professionals with sophisticated lab and equipment. The treatment requires the women
to undergo injections of hormone preparations which are imported and hence expensive.
The materials/consumables used for IVF/ICSI procedures are disposables which are
again imported.
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14.
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Why a woman’s age is important in the success of IVF treatment?
The difference lies in the biology of a woman’s
eggs. Almost all the cells in our body are regenerated (produced) throughout our
life. Unfortunately a woman is born with 2 million oocytes at the time of her birth.
Oocytes do not regenerate in a woman’s body in contrast to males where sperm producing
cells regenerate. Though this number is good enough for a fertile life span of about
20 to 25 years, the chromosomal integrity in such oocytes deteriorate as she ages.
As the oocytes are kept in meiotic arrest from the time of her birth till she ovulates
in a menses cycle, chromosomal errors accumulate in such eggs over a period of time
and hence she keeps producing lesser and lesser quality eggs (chromosomally) as
she ages. But her uterine ability to sustain and nurture a pregnancy is not lost.
With suitable hormonal support she could be made to sustain a pregnancy and deliver
a baby, if she is free from other medical problems.
In males it is not so. Sperms are manufactured afresh daily at a rate of about 100
to 500 per second and hence there is no decline of his fertility status.
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15. |
How common is multiple births and is it risky?
This is one of the prices, any patient in ART/IVF
treatment has to pay, as we are not absolutely certain about the ability of any
one embryo to develop into a baby, we usually transfer 2-3 embryos and hence the
incidence of multiple births which is about 20% twins and 5% triplets. It is risky
in the sense that sometimes all of them may abort or end up in premature deliveries
nullifying all our efforts.
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16. |
Does promiscuous relationship (sex with multiple partners)
lead to infertility problem straightaway in women?
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There is a small possibility that sex with multiple
partners may lead to some infection in the tubes which will result in blockage of
the fallopian tubes making her infertile.
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17. |
Does masturbating frequently makes males infertile/or
reduce sperm count?
No.
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18. |
What is PCOS? Why is it so commonly talked about problem
in women?
PCOS is a condition wherein there is an excessive
production of male hormones in a woman’s body and also her sensitivity to insulin
is reduced leading to hormonal imbalance so much so that the quality of her eggs
is poor.
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19. |
Will I get pregnant in the First cycle of treatment in
IVF/ET or ICSI/ET?
We wish all our patients were as lucky as that.
But the fact is only 30-40% shall be expected to conceive, again depending upon
the lady’s age and cause of infertility etc.
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20. |
If I don’t get pregnant in the first attempt, how many
attempts will it take for me to get pregnant?
The answer to this question will depend upon many
factors. We expect a couple to be hopeful of getting success within the first three
attempts of IVF/ICSI, if they are within 30 years of age. Nevertheless, we see patients
who persistently try to get pregnant even after 3 and more attempts.
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21. |
When can I start the next cycle of treatment after a failed
IVF/ICSI treatment cycle?
Three months, in our opinion, since you need a minimum
of one month rest for the ovaries to return to their normal size. Besides the residual
follicles often persist in the next cycle and may confound the ultrasound picture
of the next cycle.
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22. |
How common is infertility/subfertility?What are the risks associated with ART treatment?
Overall, IVF/ICSI (ART) treatment is safe. A condition
known as ovarian hyperstimulation syndrome (OHSS) may occur where a woman’s ovaries
get overstimulated with lot of fluid accumulation in her body in 1% of the cases.
The risk from multiple pregnancy (20-25% twins, 5% triplets), risk of pre-term labour,
low birth weight babies is also inherent. In addition the usual risks associated
with anaesthesia and operative procedures which are very rare.
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23. |
Can we expect babies produced from IVF/ICSI to be normal?
As there are more than 3 to 4 million babies born through
artificial reproduction so far and there does not seem to be any abnormality detected
in most of them, this fear and apprehension need not be there in your mind at all.
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24. |
How long do we have to wait for the first appointment?
In Genesis, Dr Anita Gour sees patients with prior
appointment only, preferably on Monday, Wednesday, Friday and Saturdays of any week.
Hence, we prefer you to book your appointments whenever Doctor is available in Genesis
from 10 AM to 1 PM in the morning and from 5 PM to 7 PM.
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25. |
How soon can we start the ART treatment with Genesis?
Once the pre-treatment screening tests are over,
treatment can be commenced from the 21st day of patient’s menses cycle, and IVF/ICSI
will be over within 3 to 4 weeks from then.
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26. |
How common is infertility/subfertility?How long does the whole IVF/ICSI treatment take?
Invariably, for most of the patients, the above
treatment plan works that is from the 21st day of menses to 16 to 18th day of the
next menses cycle which means, the total duration of the treatment is about 28 days
(from the day of down-regulation injection till the day of embryo transfer). In
some patients, with different protocol, it can be as short as 16 to 18 days also.
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27. |
How many times, will the patient need to visit Genesis
during the course of the treatment?
Approximately 7 visits. One initial consultation
with Dr Anita Gour, 3-4 U/S scan, Day of Egg Collection and the Day of Embryo Transfer.
Go through our Typical IVF Calendar in Genesis and mark the days Blood Test AM and
U/S in Evening, Day of IVF, Day of ET.
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28. |
If I am a working woman, for how long do I have to consider
taking leave?
A few days only may be necessary around the day
of egg collection and embryo transfer if you are from Jaipur. As we do not recommend
complete be rest, you can choose to go to work whenever you feel comfortable.
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29. |
Can I be seen by a female doctor?
Yes.
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30. |
Does the charges quoted for IVF/ICSI include the cost
of drugs?
No. We consider that the cost of drugs for stimulation
is quite variable among patients depending on her age, body weight and medical problems
and we also do not believe in compromising on your drug quality, by substituting
with cheaper drugs. Now, I hope, you will appreciate that patients stand to benefit
in this strategy, as you know, quality comes at a price. Hence, we deliberately
choose not to include the cost of drugs in our IVF/ICSI charges. Our lowest drug
cost in IVF/ICSI treatment has been Rs 18000/ with an average figure of about Rs
30 to 35000. If your drug cost is cheaper, the saving is yours and we don’t pocket
it!
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31. |
What are the pre-treatment advice?
Generally, try to adapt a healthy lifestyle, like
having balanced diet with fresh fruits vegetables; if you are overweight, consider
reducing your weight; if you are a smoker, give up smoking preferably. It is advisable
to follow hygienic habits so as to keep the genital area clean as infection in the
genital area may lead to failure of fertilization or implantation. As stress and
mental agony of childlessness and the IVF treatment play a negative role in the
success, try not to augment your stress. Being relaxed and cheerful with positive
thinking improves the success rate, for sure.
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32. |
What happens after entering into IVF program?
One can go through the Typical IVF Calendar in Genesis
explaining different tests and procedures with tentative dates. This will give you
roughly an idea.
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33.
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Do you have egg donation/Surrogacy program?
Yes, we do.
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34. |
Will there be hormonal imbalance due to the excessive hormone injections given during
IVF treatment?
No, not all. Hormonal status gets restored after
1-2 cycles of menses.
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35. |
How common is infertility/subfertility?Can I exercise as usual?
Yes, but vigorous and strenuous exercise should
be avoided.
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36.
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What are the chances of my getting pregnant?
It depends on your age, cause of your infertility,
quality of eggs and sperms, number of eggs collected and the number of embryos produced
and transferred.
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37.
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What if IVF fails in the first time? How many more times
will I have to undergo this?
You can go through IVF as many times as you wish,
but we advise 3 to 4 cycles of IVF commonly.
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