What is Infertility?

Infertility is defined as a couple’s inability to conceive after one year of unprotected intercourse. Infertility is perceived as a social problem in our country, with various medical manifestations. Infertility affects 15% of couples worldwide or one in six couples globally. Currently, the number of infertile couples stands at 60-80 million, and the number is increasing every year.

In India, as many as 20% of couples seek treatment for this disorder. Medical reasons for the failure to conceive could be present in either of the partners. In our country, problems of infertility are observed in 35-40% of men, and an equal percentage of women, while both partners face the problem in 20-30% of cases.

However, advances in medical science have made it possible for infertile couples to experience the joys of parenthood. Since the birth of Louise Brown on 25th July 1978, over 3 million test tube babies have been born, lighting up their parents’ lives.

What Are the Various Treatment Options Available for Infertility?

There are several treatment options available for infertility:

IUI (Intrauterine Insemination)

Intrauterine Insemination refers to the procedure of insemination at the time of ovulation. This helps in increasing the chances of conception over and above the natural course.

It is recommended in cases of:

• Mild problems in sperm count/motility
• Days of ovulation
• Mild endometriosis
• Unexplained infertility
• Donor sperm cases

Multiple follicles are made to ripen in the IVF, which also occurs in a natural cycle. The difference is that in a natural cycle only one follicle matures and the rest perish.

IVF (In Vitro Fertilization)

In Vitro Fertilization (IVF) is a process in which eggs are fertilized by sperm outside the womb (uterus). In layman's terms, it helps make a ‘test tube baby.’ IVF helps many childless couples achieve parenthood.

It is recommended in cases of:

• Tubal block
• Male infertility
• Severe endometriosis
• Unexplained infertility
• Previous failed IUI cycles
• Egg donation
• Surrogacy

ICSI (Intracytoplasmic Sperm Injection)

ICSI is a procedure that is used along with IVF. In this procedure, a single sperm is directly injected into an egg.

Surgical Procedures

Fertility-enhancing laparoscopy and hysteroscopy are indicated for:

• Removal of ovarian cyst, fibroid, polyp
• Tubal correction
• Septum resection
• Adhesiolysis
• Division of intrauterine synechiae

Treatment for Male Infertility

Depending on the cause, either medical or surgical treatment can be undertaken. In cases of Azoospermia, surgical sperm retrieval followed by IVF-ICSI can be undertaken.

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Which Couples Require IVF-ICSI?

IVF-ICSI can be considered for couples where the female partner suffers from any one of the following conditions:

Tubal Damage

In cases where both tubes are blocked or have significant damage. The procedure can also be recommended to patients for whom tubal microsurgery has failed.

Endometriosis

In cases of severe or moderate endometriosis, distortion of the pelvic anatomy.

Ovulation Disorders

Most ovulation problems can be corrected by various ovulation-inducing drugs. Post-treatment, if pregnancy is unsuccessful, IVF should be considered.

Unexplained Infertility

If even after 6 cycles of ovulation induction there’s no sign of pregnancy, the patient requires IVF. If a patient is more than 35 years of age, IVF may be considered even before 6 cycles.

What Are the Complications of IVF Treatment?

Possible complications include:

• Drug allergy
• Anaesthesia complications
• Multiple pregnancies
• Ovarian hyperstimulation syndrome

What is Ovarian Hyperstimulation Syndrome?

This may occur in 3-5% of IVF cases. The injections are given to produce multiple eggs, leading to an increase in ovarian size and accumulation of fluid in the:

• Abdomen (ascites),
• Lungs (pleural effusion),
• Heart (pericardial effusion)

This condition requires intensive monitoring and hospitalization.

When Do You Require Oocyte Donation?

Oocyte (egg) donation may be needed in cases of:

• Advanced maternal age
• Premature failure of ovaries
• Removal of ovaries due to malignancy
• History of radiation
• Poor response to ovulation-inducing drugs.

What is Surrogacy?

Surrogacy is a procedure in which a woman acts as a temporary mother by allowing her womb (uterus) to carry a pregnancy for another couple.

When is the Help of Surrogate Mothers Required?

• Absence of uterus from birth.
• Uterus removed at a young age due to heavy bleeding, accidents during first childbirth, or tumors.
• Repeated IVF failure suspected to be due to a defective or diseased uterus (e.g., endometriosis or adhesion between uterine walls).

Sometimes working women want surrogacy to avoid absence from work. Alternatively, some married women prefer surrogacy to avoid changes in abdominal shape or figure. However, these indications have not been accepted in the guidelines being prepared for ART clinics in India.

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Our Policy: Confidentiality and Privacy

At BLK-MAX Super Speciality Hospital, we conduct screening tests for HIV, HCV, Hepatitis, and other sexually transmitted diseases. We have established procedures and policies for the safety of personnel and the prevention of cross-contamination.

Couples awaiting In Vitro Fertilization (IVF) treatment may have serious concerns about the possibility of their gametes being mixed up or the wrong embryos being transferred. Our laboratory staff is trained to handle samples at each stage of the process, from receipt to final disposition.

At all critical stages:

• A proper record is kept of personnel handling gametes.
• Consents and contents are checked.
• Proper barcoding is generated.
• Verification of patient identity is undertaken.
• Double checks are conducted before insemination of oocytes, replacement of embryos, and freezing/thawing of embryo/sperm.
• Proper documentation at all critical stages is maintained on our hospital information system.

This system allows for tracking of details even at later dates. To us, confidentiality and privacy of the patient are sacrosanct—during the entire process, and even much after it.

Common Questions About IVF Treatment

1. Does Ovarian Stimulation Affect the Number of Eggs Stored in Ovaries?

This is not the case. Multiple follicles are made to ripen in IVF, which also occurs in a natural cycle. The difference is that in a natural cycle only one follicle matures and the rest perish.

2. Do Hormone Injections Have Harmful Effects on the Patient?

The hormones in such injections are not found to be carcinogenic in medical updates. Only short-term effects can be seen, which are temporary and not harmful.

3. Does IVF Increase the Chances of Twins or Triplets?

In a woman less than 35 years of age, who conceives through IVF, there’s a 20% chance of having twins if 2 embryos are transferred into her uterus, and a 30% chance of triplets if 3 embryos are transferred.

4. What is the Role of Bed Rest After the Embryo Transfer?

Bed rest does not increase the chances of success after the embryo transfer but is recommended in the Indian scenario.

5. Do Children Born After IVF Have More Abnormalities Than Children Born Through Natural Conception?

As of now, there is no evidence supporting the increased risk of abnormalities, but it is too early to be completely certain.

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6. Should We Get Our Excess Embryos Frozen?

Frozen embryos can be transferred in the next cycle. At the beginning of treatment, patients are explained about the freezing of excess embryos. Written consent is required for freezing embryos. It has to be clearly understood that all thawed embryos may not survive and some may be lost in the process.

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7. What is the Success Rate of IVF?

The IVF cycle has a success rate of 35-40% per cycle.