frequently asked questions
What is Infertility?
Infertility means not being able to get pregnant after one year of trying. Or, six months, if a woman is 35 or older. Women who can get pregnant but are unable to continue pregnancy may also be called relatively infertile.
Pregnancy is the result of a process that has many steps. To get pregnant:
- A woman must release an egg from one of her ovaries (ovulation).
- The egg must go through a Fallopian tube towards the uterus (womb).
- A man's sperm must join with (fertilize) the egg along the way.
- The fertilized egg must attach to the inside of the uterus (implantation).
Infertility can happen if there are problems with any of these steps.
Is Infertility Just a Woman's problem?
No, infertility is not always a woman's problem. Both women and men can have problems. 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 are caused by a mixture of male and female problems or by unknown reasons.
What causes infertility in women?
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:
- Blocked Fallopian tubes due to pelvic inflammatory disease, endometriosis, or surgery for an ectopic pregnancy
- Physical problems with the uterus
- Uterine fibroids, which are non-cancerous clumps of tissue and muscle on the walls of the uterus.
What causes infertility in men?
Infertility in men is most often caused by—
- A problem called varicocele. 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.
What increases a man's risk of infertility?
A man's sperm can be changed by his overall health and lifestyle. Some things that may reduce the health or number of sperm include—
- Heavy alcohol use
- Smoking cigarettes
- Environmental toxins, including pesticides and lead
- Health problems such as mumps, serious conditions like kidney disease, or hormone problems
- Radiation treatment and chemotherapy for cancer
What things increase a woman's risk of infertility?
Many things can change a woman's ability to have a baby. These include—
How does age affect fertility in women?
Women reaching their thirties will experience a decline in their fertility. It could be due to the following problems:
- A decrease in the number and health of the eggs to be ovulated.
- Changes in the hormones resulting in altered ovulation.
- Fewer numbers of eggs.
- A decrease in the frequency of intercourse.
- The presence of other medical and gynecologic conditions, such as endometriosis, which may interfere with conception.
How long should women wait before seeing their doctors?
Most experts suggest at least one year. Women 35 or older should see their doctor after six months of trying. A woman's chances of having a baby decrease rapidly every year after the age of 30. But a fertility check is recommended for women as early as possible.
Some health problems also increase the risk of infertility. So, women should speak to their doctors if they have:
- Irregular periods or no menstrual periods
- Very painful periods
- Pelvic inflammatory disease
- More than one miscarriage
How will doctors find out if a woman and her partner have fertility problems?
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, doctors can 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—
- Sono Salpingography: Doctor injects saline through a catheter in to the uterus and ultrasound is done to check if it travels to fallopian tubes thus confirming the patency
- Hystero Salpingography: This is an X-ray of the uterus and fallopian tubes. Doctors inject a special dye into the uterus 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.
- Laparoscopy: The doctor does Laparoscopy with a small tool with a light by making a small cut in the lower abdomen and inserting the laparoscope. With the laparoscope, the doctor can check the ovaries, fallopian tubes, and uterus for disease and physical problems such as endometriosis.
- Hysetroscopy: Hystroscope is used to see inside of uterus for any polyps, adhesions, septas, etc.
How do doctors treat infertility?
Infertility can be treated with medicine , surgery, artificial insemination , or assisted reproductive technology. Many times these treatments are combined.
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 partners
- The overall health of the partners
Doctors often treat infertility in men in the following ways—
- 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.
- Azoospermia: Sometimes there are no sperms in the semen and it could be due to a block in man's system. In some cases surgery can correct this problem.
What services does Miracles provide?
We offers various programs for fertility treatment both for males and females, from basic evaluation to the most advanced Assisted Reproductive Technologies, such as:
- Fertilty Check for Couples
- Intrauterine Insemination (IUI)
- In Vitro Fertilization (IVF)
- IVF with Egg Donation
- Embryo Freezing
- Semen Freezing
- Laser Assisted Hatching
- Blastocyst Culture
- Laparoscopic Surgery
- Hysteroscopic Surgery
What are Assisted Reproductive Technology, IUI, IVF and ICSI?
Intrauterine insemination (IUI) is an infertility treatment that is often called artificial insemination. In this procedure, the woman is injected with specially prepared sperms. 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 (in vitro fertilization or a "test-tube baby" procedure) is the most advanced treatment in reproduction. The fertilization of eggs occurs outside of the female body, in a Petri dish. Multiple eggs are removed from the woman's ovary using a needle guided by ultrasound under anesthesia and then mixed with her partner's sperm. Resulting embryos are kept in the incubator for several days and allowed to divide and multiply their cells. The well developing embryos are then placed into the uterus by introducing a thin plastic catheter through the cervix. If the quality of the man's semen is very poor, his sperm may not be able to fertilize female eggs on their own. In these cases, one individual sperm can be injected into the egg directly using a microscopic needle (ICSI). Men who have no sperm in the ejaculate may undergo a direct sperm aspiration from the epididymis or testis. If the woman fails to develop good quality eggs in her ovaries, the couple may decide to use eggs obtained from a healthy and fertile donor. The resulting embryos are then placed into the woman's uterus.
What is the process?
- The ovaries are stimulated by hormone injections to produce multiple eggs (in a natural cycle, mostly only one egg is produced every month)
- The growth of the eggs in the ovaries is monitored by ultrasound and hormone tests
- When the follicles reach large enough sizes, a hormone (hCG) injection is given that causes the eggs to mature
- 34-38 hours after the hormone (hCG) injection, the eggs are removed (or aspirated) from the ovaries by a needle introduced via the vaginal route under ultrasound guidance
- The eggs are mixed with the partner's semen and placed in an incubator to fertilize
- The fertilized eggs known as embryos are placed into the uterus 2-5 days after fertilization
- A pregnancy test can be done two weeks later to find out if the IVF procedure has been successful
What are the success rates?
Success rates vary and depend on many factors. Some things that affect the success rate of ART include—
- Age of the partners
- Reason for infertility
- Type of ART
- If the egg is fresh or frozen
- If the embryo is fresh or frozen
Two main parameters define success of an IVF procedure:
- Pregnancy rate
The pregnancy rates in IVF vary from 25-60% depending on the age of the woman, her ovarian reserve, primary reasons for infertility, IVF lab and the team.
- Take home baby rate
Just like with natural pregnancy, 10-15% of pregnancies end in abortion and a few in ectopic pregnancy which cannot be prevented. So the take home baby rate is usually about 10% lower than the pregnancy rate.
- The success rates of IVF are the highest for women less than 35 years old. Therefore, if you have an indication to undergo IVF, access the services when you are young to avail the best success
How much time would it take to undergo 1 IVF Cycle?
The initial consultation is followed by some investigations to assess your ovarian reserve (ability of your ovaries to produce eggs), husband's semen analysis and other baseline tests to plan the treatment protocol for you. Some of these investigations need to be done at a particular time of your menstrual cycle. The actual IVF cycle can then commence on the Day 2 or 21 of your next menstrual cycle as explained below.
The two most commonly used protocols for ovarian stimulation, recommended to patients on a case-by-case basis are as follows:
- Long protocol involves taking hormone (FSH) injections from either Day 2 or 21 of your period. These injections continue for about 4 weeks until you are ready for the egg collection
- Antagonist protocol is shorter and usually requires injections to be taken for a period of about 2 weeks before you are ready for egg collection
Overall, the long protocol takes about 6-8 weeks and the Antagonist protocol takes about 4 weeks from the start of injections to the day of pregnancy test.
What are some of the complications of treatment by IVF?
- The main and most common complication of IVF is ovarian hyper stimulation syndrome (OHSS) where a woman forms large number of eggs resulting in collection of fluid in the abdomen and body which may lead to nausea, abdominal discomfort etc. However, if properly managed by specialists, it is usually a reversible and temporary condition with no untoward side effects.
- Another complication is multiple pregnancy such as twins, triplets, quadruplets etc. Rare complications may include bleeding or infection in the pelvis following needle puncture at egg retrieval.
Is bed rest necessary after embryo transfer?
There does not appear to be any difference in the chance of pregnancy whether there is bed rest or not. Lying down for only 10 minutes after the procedure is usually considered sufficient. You can continue with your office or normal household jobs, but it is preferable not to engage in strenuous activities.
How soon will I know if I am pregnant?
Pregnancy can be confirmed using blood tests about 15 days after ovum pick up. Pregnancy can be confirmed by ultrasound 30 to 40 days after the procedure.