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© 2024, Dr. Rabeeh V. All rights reserved.
Navigating the realm of fertility treatment can raise numerous questions and uncertainties. Here are some common queries addressed to provide clarity and insight into the fertility journey.
If you have been trying to conceive for over a year without success (or six months if you’re over 35) or if you have known reproductive health issues, it may be time to consider fertility treatment. Schedule a consultation to discuss your options and undergo fertility evaluations.
Several factors can impact fertility, including age, lifestyle choices (such as smoking, excessive alcohol consumption, and obesity), underlying medical conditions, and environmental factors. A comprehensive evaluation can help identify any potential issues and guide treatment plans.
Success rates can vary depending on various factors, including the type of fertility treatment, the underlying cause of infertility, and the individual’s age and health. During your consultation, we will discuss realistic expectations based on your specific situation.
Insurance coverage for fertility treatments can vary widely depending on your insurance provider, policy, and specific circumstances. It’s essential to review your insurance plan’s details and discuss potential coverage options with your provider or our financial counsellor.
The number of treatment cycles required can vary greatly from person to person, depending on factors such as the underlying cause of infertility, response to treatment, and individual circumstances. We will work closely with you to develop a personalized treatment plan and adjust as needed based on your progress.
Fertility treatments are generally safe, but like any medical procedure, they come with potential risks and side effects. During your consultation, we will discuss the specific risks associated with your treatment plan and address any concerns you may have.
Ovulation typically occurs between days 12 to 18 of a regular cycle, presenting a window of opportunity for conception. Pregnancy can occur with intercourse every 48 to 120 hours during this fertile window. There is a possibility of getting pregnant if the couple have unprotected intercourse during that period. When couples have intercourse, sperms deposited can last there for 48 to 96 hours and sometimes 120 hours.
Infertility is the inability to conceive after a year of regular, unprotected intercourse. If you’re over 35, or if suspecting any problems like menstrual issues or sexual problem, including irregular cycles, severe pain during intercourse, abnormal semen analysis, or known uterine abnormalities- an earlier evaluation is necessary to avoid unnecessary delays or other underlying health concerns. Here seeking help after six months or earlier is advisable.
When a couple comes to the clinic, trained personnel will note their age, height, weight, body mass index, and blood pressure. Taking a complete health history will identify any risk factors. Physical examination of the woman includes a pelvic exam to see whether there are any abnormalities in the female reproductive tract. In the man, a general physical examination and a local genital examination is done to assess the male reproductive tract.
Infertility is a delay in conceiving. Unless we know the cause of the delay, we cannot treat the problem. Investigations like doing an ultrasound, doing hormonal assay, doing a tubal evaluation either by HSG or by Laparoscopy, and then a male semen analysis will identify the causes. Ultrasound gives more details regarding the uterus and ovaries. These are the basic investigations that will help us identify the cause of infertility in 80 percent of the situations.
Ultrasound examinations offer non-invasive insights into the condition of the female reproductive tract, including the uterus and ovaries, aiding in the detection of abnormalities that may impact fertility. Ultrasound gives more details regarding the uterus, ovaries, and pelvic structures.
In cases of unexplained infertility, further investigations may be warranted to delve deeper into potential underlying issues that may have been overlooked initially.
Given that 40% of couples facing infertility have issues with both partners, comprehensive assessments for both individuals help ensure an accurate diagnosis and tailored treatment plan, minimizing unnecessary delays and treatments.
Male factor accounts for 50% of infertility. Male infertility can result from various factors. Evaluation includes a semen analysis, hormonal tests, and sometimes genetic testing or imaging to identify the underlying cause.
When you are asked to do a semen analysis, the couple should take the following precautions. First and foremost, there should be a gap of 2-3 days minimum, and the gap should not exceed 7 days. The reason for that is if the gap is too low, the volume can come less, and the analysis report may be abnormal. If the gap is too long, the volume will come higher, and the quality of abnormal and dead sperms might be higher. So, while giving a semen sample for analysis, it’s always important that they follow abstinence for 2-3 days and that period should not be more than 7 days.
Should postpone semen analysis if there is a recent episode of high fever or an episode of chemical exposure or an episode of severe health issues or recent radiation exposure. In these situations, it’s ideal to wait for 3 to 6 months before doing a semen analysis. Because in these conditions the report might be abnormal and may not reflect the true value.
One peculiar thing in semen analysis is, unlike in haemoglobin or WBC count or RBC count, there are no normal values in semen analysis, there are only reference values. That means when a count is out of this range it means probably this couple will take more time to conceive. But it will not tell that the couple will not conceive if the report is abnormal. Because it also depends on women’s fertility. If the woman is highly fertile and the man is sub-fertile, still pregnancy happens. So, the abnormal report needs a second validation based on the severity. Sometimes it will need added technology and advanced treatments but no need to worry if a single parameter abnormality is present unless it is a significant type of problem and is present in more than one report. When it comes to motility, apart from the count, motility abnormality has more importance than only their count. If the motility is low, it shows there is a structural and functional abnormality probably. Abnormal shape of sperms is also called teratozoospermia. The combination of all the factors is important in a report. Just looking at one factor does not mean anything. Also, duration of infertility is one important factor before jumping to a conclusion.
When a man or woman has a BMI of more than 30, then we say it is obesity. When it is more than 35 we say severe obesity. And when it is more than 40, we say morbid obesity. Obesity is to be considered as one extreme health problem. Obesity in men and women affects fertility. For a long period, it was thought that obesity in women will only affect fertility but now, more and more scientific research has come in and has shown that male obesity is also important.
Obesity in women can lead to irregular cycles, ovulation issues, and increased risk of conditions such as diabetes and thyroid dysfunction, impacting fertility and overall health. Obese women are at higher risk of miscarriage, gestational diabetes, hypertension, and delivering larger babies, emphasizing the importance of weight management for positive pregnancy outcomes.
Obesity in men can lead to abnormal semen analysis results and increased risk of conditions such as diabetes, affecting sperm quality and fertility. So a man with obesity should reduce weight before planning pregnancy so that the need for multiple interventions will also reduce. The chances of having repeated cycle failures will be less if their obesity is also given proper attention.
Thyroid hormone imbalances, particularly hypothyroidism, can disrupt menstrual cycles and ovulation, affecting fertility and increasing the risk of complications during pregnancy.
Thyroid hormone disturbance is very common in women than in men. And it constitutes between 3 to 10 percent out of every 100 women. When excessive, it is called hyperthyroidism and if it is deficient, it is called hypothyroidism. If a woman has hypothyroidism, it affects the menstrual cycle and affects ovulation which in turn affects fertility. That means a woman who has a deficiency of thyroid hormone, will have ovulation problems which can delay conception. The other impacts of this thyroid hormone are if we don’t diagnose a thyroid problem, it can also affect the neurological development of the baby.
The Anti-Mullerian Hormone (AMH) test evaluates ovarian reserves, providing insights into a woman’s reproductive potential. It is a reliable blood test that can be performed at any time of the menstrual cycle, aiding in fertility assessments and guiding decisions regarding timing and urgency of conception.
Ovary reserves are assessed by a test called Anti Mullerian Hormone and ultrasound scan. This is a blood test done to check the ovarian reserves of a woman.
The normal Anti-Mullerian hormone levels are between 1.5 ng/mL to 5.0 ng/mL. if a person has less than 1.5 ng/mL, then they are considered on the lower side of the anti-Mullerian hormone, and in that situation, they should do not delay the pregnancy. If their Anti-Mullerian hormone is less than one, then they should not postpone their pregnancy.
In a situation of low AMH the number of eggs we get during the IVF treatment becomes very low and the treatment results gets compromised.
Teratozoospermia refers to abnormal sperm morphology, which can impact fertility and may require further evaluation to identify underlying causes and determine appropriate treatment.
In a semen analysis report, sometimes you find a word called teratozoospermia. What we essentially look at, is the volume, the count, the motility, and the quality of the sperm which is also known as morphology. When the morphology of the sperm is abnormal, then it is called teratozoospermia.
The WHO cut-off level is one should have at least 4% forms to get a reasonable chance of pregnancy. 4% is the lowest level and if somebody has levels less than that, they need further evaluation in terms of health evaluation, male infection screening. The DNA fragmentation test and other sperm function tests are needed to understand this condition.
It is often an undiagnosed or misdiagnosed or incompletely diagnosed problem and most of the couples are labelled as unexplained infertility. If more attention is given to sperm morphology, the instance of unexplained infertility might significantly decrease. The treatment modalities will depend on the severity of the problem and the co-existing health conditions. So teratozoospermia a quality issue of the sperm which requires proper interpretation.
IUI (Intrauterine Insemination) involves placing specially prepared activated sperm directly into the uterus after ensuring ovulation (egg release) to facilitate fertilization. It’s a less invasive treatment than IVF. Success rate is around 15-18%.
PESA (Percutaneous Epididymal Sperm Aspiration) and TESA (Testicular Sperm Aspiration) are surgical procedures to extract sperm from the epididymis or testes for use in ICSI (Intracytoplasmic Sperm Injection). It is treatment option for azoospermia or zero count.
IVF and ICSI come under Assisted Reproductive Technologies (ART). IVF means in vitro fertilization in which the union of egg and sperm happens outside the human body in an IVF lab under appropriate conditions. Eggs are often fertilized in vitro by culturing eggs with many motile sperm.
ICSI is an advanced IVF technique in which sperm is injected into the egg manually using a thin glass pipette with higher technology and skills. This technique was developed to facilitate fertilization in cases of male-factor infertility but is now used in most IVF cycles. Practically we do ICSI for all our cases in our centre.
Selected Embryos are then transferred into the mother’s womb to achieve pregnancy.
In most cases, ART procedures are outpatient, and patients can return home the same day. There’s usually no need for a hospital stay in our hospital.
Discomfort during IVF or ICSI procedures is typically minimal. Daily intramuscular or subcutaneous injection for 10-12 days may be a discomfort. Otherwise, it is a painless procedure. Egg retrieval is the main procedure in IVF treatment. Therefore, 6-8 hours of fasting before the process are mandatory. The patient will not feel any pain because she is kept asleep under the care of an anaesthetist under short GA during this procedure which lasts for just 10-15 minutes. After this procedure, they can go home the same day and attend regular work the next day.
It often includes lifestyle changes, medication management, and proper nutrition. Couple should be healthy, should not be overweight or under wight since it can affect the successes of IVF.
IVF treatment protocols are customized according to the couple’s needs and the severity of factors. The couple must plan 2 days visit for the preparatory phase. Lady basal scan is done, and after a couple of blood tests, the semen backup sample is frozen. In long (agonist) protocol downregulation injection is the first injection given to the lady after taking a couple’s consent for ICSI. followed by daily injections and alternate day scans for 10-12 days. Towards the end of stimulation, the last trigger injection is given at evening time. The male visit is required only on the day of egg pick-up to provide a fresh semen sample. Fertilisation is done on the same day of egg retrieval.3-5 days later, the lady can come alone for embryo transfer. Sometimes embryos might be frozen on that cycle and transferred on successive months. Serum beta hCG pregnancy test will be done 2 weeks after transfer. Antagonist protocol is suggested in certain conditions, and stimulation begins on day 2 or 3 of the menstrual cycle.
Success rates vary, depending on age, cause of infertility and duration of infertility. But your doctor will discuss realistic expectations based on your specific diagnosis and treatment plan. In our centre generally we do have a good success rate.
After embryo transfer, it’s important to rest and avoid heavy physical activity. Complete bed rest is not required. However, we recommend restricted work and movement activities to avoid any infection. Complete immobility will not improve the embryo’s implantation process. Therefore, there is no need for bed rest after embryo transfer. No other medication should be taken without informing your doctor. You should come for a pregnancy test on the 14th day after embryo transfer. It is very important to take timely post embryo transfer medications.
While IVF is generally safe, it may carry some risks, such as multiple pregnancies, ovarian hyperstimulation, and, in rare cases, complications related to the egg retrieval procedure. Otherwise, it is very safe and minimally invasive day care procedure.
Miscarriage rates following IVF are similar to natural pregnancies and vary depending on factors like maternal age and overall health.Pregnancy loss can occur after IVF treatment due to various factors, including genetic abnormalities and other complications similar to natural pregnancies, highlighting the importance of pre-pregnancy evaluations and embryo selection methods.
Despite meticulous selection of sperm and eggs in IVF treatment, the possibility of pregnancy loss still exists due to factors such as genetic abnormalities, implantation issues, or other complications like natural pregnancies, necessitating pre-pregnancy evaluations and embryo selection methods to minimize risks.
“I am committed to excellence in reproductive healthcare, offering compassionate and personalized solutions to empower individuals on their journey to parenthood.”
© 2024, Dr. Rabeeh V. All rights reserved.