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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.
Infertility affects one in six couple. There are about 60-80 million infertile couples world wide and the rate is increasing. Some patients spontaneously achieve pregnancy but others at some stage experience difficulty in achieving conception and these patients need some kind of assistance in getting pregnant. There is about 3-5% probability of achieving pregnancy in one menstrual cycle this is called Fecundability, fecundity is the probability that a single cycle will result in a live birth. It is estimated that out 100 couple with female partner's age less than 35 years, approx 80-85% will achieve pregnancy within the first year of unprotected intercourse, 90% will conceive within 18 months and about 95% will conceive within two years. The remaining 5% rarely achieve pregnancy without some form of assistance.
Infertility may be defined as an inability to achieve pregnancy within 2 years of having unprotected intercourse, though some clinicians prefer this time limit to be 1year. Women who are more than 35 years should consult an expert after 6 months of contraceptive free sexual intercourse when it has not resulted in pregnancy. This difference in the time limit is owing to the declining egg quality with increasing age. In some couples the fertility is impaired to some extent but not completely, these patients may conceive in 3rd year or subsequently without any assistance as there is a delay these patients are called sub fertile. While, sterility is an absolute state of inability to conceive.
The cause of infertility could be in either of the partners (Male factor-35%, Female factor-40%) or in 10-15% both partners may be infertile or sub fertile. sometimes each could be individually fertile but as a couple may need assistance to achieve pregnancy the causes could be immunological or genetic, this is called Combined infertility. While in about 10%, the fertility evaluation show no abnormality, these patients are likely to have problems which are not diagnosed by current available investigations, this is termed unexplained infertility.
What are the various treatment options available for infertility?
There are several treatment options available for infertility:
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 indicated in cases of mild problems in sperm count / motility, dysovulation, mild endometriosis, unexplained infertility and in cases of donor sperm.
In Vitro Fertilization (IVF) is a process in which eggs are fertilized by sperms outside the womb (uterus). In layman terms, it means a ‘test tube baby’. IVF helps many childless couples achieve parenthood. It is indicated in cases of tubal block, male infertility, severe endometriosis, unexplained infertility, previous failed IUI cycles, egg donation and surrogacy, etc.
ICSI is a procedure that is used along with IVF. In this procedure a single sperm is directly injected into an egg
Fertility enhancing Laparoscopy and Hysteroscopy is indicated for removal of ovarian 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 be undertaken.
||Investigations of Infertile couple||
||Fertility Enhancing Laparoscopic surgeries||
||Management of Male factors Infertility||
||Management of female factors Infertility||
||Intra Uterine Insemination (IUI)||
||In vitro fertilization (IVF)||
||Surgical sperm retrieval for Azoospermia|
||Intra Cytoplasmic Sperm Injection (ICSI)||
||Electro ejaculation followed by IUI/ ICSI|
||Embryo Freezing (Slow Freezing & Vitrification)||
||Cryo preservation prior to Cancer treatment|
What is IVF?
IN VITRO FERTILISATION(IVF) is a process in which eggs are fertilised by sperm outside the womb(uterus). This means test tube baby in lay-man terms. It helps to achieve pregnancy in many childless couples.
What is ICSI?
This procedure is used with IVF when a single sperm is directly injected into the egg.
Who are the couples who require IVF/ ICSI?
a) In cases of both tubes being blocked or having significant damage. This diagnosis should be confirmed by a diagnostic laparoscopy.
b) Also to be considered in patient where tubal microsurgery has failed.
Severe endometriosis or moderate endometriosis distorting Pelvic Anatomy.
Most of the ovulation problems can be corrected by various ovulation inducing drugs. If after the treatment pregnancy does not take place IVF has to be considered.
6 Cycles of ovulation induction not followed by pregnancy require IVF. Even before 6 cycles if patient is more than 35 years of age IVF may be considered.
In cases of premature failure of ovaries or poor quality eggs. Egg donation is considered.
Surrogacy is an arrangement in which a woman carries and delivers a child for another couple or person. This woman may be the child's genetic mother (called traditional surrogacy), or she may carry the pregnancy to delivery after having an embryo, to which she has no genetic relationship, transferred to her uterus (called gestational surrogacy). If the pregnant woman received compensation for carrying and delivering the child (besides medical and other reasonable expenses) the arrangement is called a commercial surrogacy.
The social parents (that is, those that intend to raise the child) may arrange a surrogate pregnancy because of female infertility, or other medical issues which may make the pregnancy or delivery impossible, risky or otherwise undesirable. The intended parent could also be a single man or woman wishing to have his/her own biological child. Some same-sex couples turn to surrogacy as an option to becoming parents. India is one of the few countries where commercial surrogacy is allowed. In our centre we are carrying out surrogacy program.
This term means when a couple is unable to conceive due to problems in the male partner. The problem may be associated with:-
In severe cases of male Infertility ICSI is required
The centre also has facilities for:
The centre has started FOGSI Training programs for doctors wishing to train in infertility. Following are the programs: