Understanding Infertility and its Treatment02 August 2017

What is Infertility?

Infertility is defined as a couple’s inability toconceive after one year of unprotected intercourse.Infertility is perceived as a social problem in ourcountry, 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 numberis increasing every year.

In India, as many as 20% of couples seek treatment for this disorder. Medicalreasons for the failure to conceive could be present in either of the partners. In ourcountry, problems of infertility are observed in 35-40% of men, and an equalpercentage 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 toexperience 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 treatmentoptions available for infertility?

There are several treatment options available for infertility

IUI

Intrauterine Insemination refers to the procedure of insemination at the time ofovulation. This helps in increasing the chances of conception over and above thenatural course. It is recommended in cases of mild problems in sperm count / motility, dysovulation, mild endometriosis, unexplained infertility and in cases of donor sperm.Multiple follicles are made to ripen in the IVF, which also occursin a natural cycle. The difference is that in a natural cycle only one follicle maturesand the rest perish.

IVF

In Vitro Fertilization (IVF) is a process in which eggs are fertilized by sperm outside the womb (uterus). In layman terms, it means it helps make a ‘test tube baby’. IVF helpsmany childless couples achieve parenthood. It is recommended to couples in cases of tubal block,male infertility, severe endometriosis, unexplained infertility, previous failed IUI cycles, egg donation, surrogacy, etc.

ICSI

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

Surgical Procedure

Fertility enhancing Laparoscopy and Hysteroscopy is indicated for removal ofovarian cyst, fibroid, polyp, tubal correction, septum resection, adhesiolysis,division of intrauterine synechiae, etc.

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 beundertaken.

Which couples require IVF-ICSI?

IVF-ICSI can be considered for couples wherethe female partner suffers from any one of thefollowing conditions:

Tubal Damage

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

Endometriosis

In cases of severe or moderate endometriosis, leading to distortion of the pelvicanatomy.

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, thepatient requires IVF. If a patient is more than 35 years of age, IVF may beconsidered even before 6 cycles.

Doesovarianstimulation 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.

Do hormone injections haveharmful effects on the patient?

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

Does IVF increase chancesof twins or triplets?

In a woman less than 35 yearsof age, who conceives throughIVF, there’s a 20% chance ofhaving twins if 2 embryos aretransferred into her uterus, and 30% chance of triplets if 3 embryos aretransferred.

What is the role of bed restafter embryo transfer?

Bed rest does not increase thechances of success after the embryotransfer, but is recommended inthe Indian scenario.

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, butit is too early to be completely certain.

Should we get our excess embryos frozen?

Frozen embryos can be transferred inthe next cycle. At the beginning oftreatment, patients are explained to aboutthe freezing of excess embryos. Awritten consent is required for freezing embryos. It has to be clearly understoodthat all thawed embryos may not survive and some may be lost in the process.

What are the complications of IVF Treatment?

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

What is the success rate of IVF?

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

What is Ovarian Hyperstimulation Syndrome?

This may occur in 3-5% of IVF cases. The injections given to produce multipleeggs lead to an increase in ovarian size and accumulation of fluid in the abdomen(ascites), lungs (pleural effusion), or heart (pericardial effusion). This conditionrequires intensive monitoring and hospitalization.

When do you require oocyte donation?

  • Advanced 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 actsas a temporary mother by allowing her womb(uterus) to carry a pregnancy for another couple.

When is the help ofsurrogate mothers required?

  • Absence of uterus from birth.
  • Uterus has been accidentally removed at a young age, either because of heavy bleeding or an accident during the first childbirth, or due to a tumour.
  • Repeated IVF failure. When failure is suspected to be due to a defective or diseased uterus, as in endometriosis or adhesion (gluing) between two inner walls of the uterus.
  • Sometimes working women want surrogacy in order to avoid absence from work. Alternatively, some married women prefer surrogacy in order to not lose their abdominal shape or figure. However, these indications have not been accepted in the ‘guidelines’ being prepared for ART clinics in India.

Our Policy: Confidentiality and Privacy

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

Couples awaiting IVF treatment may also have serious concerns about thepossibility of their gametes being mixed up and the wrong embryos beingtransferred. Our laboratory staff is trained to handle samples at each stage of theprocess, from receipt to final disposition. At all critical stages, a proper record iskept of personnel handling gametes; the consents and contents are checked; proper barcoding is generated; and verification of patient identity is undertaken.We conduct double checks before insemination of oocyte, replacement of embryos,freezing and thawing of embryo / sperm.

Moreover, there is proper documentation at all critical stages for each patient onour hospital information system. This allows for tracking of details even at laterdates. To us, confidentiality and privacy of the patient are sacrosanct – duringthe entire process, and even much after it.