Treatments

Infertility doesn’t have to stop you from having a family. Today, there are many different treatments available to help you and there is plenty of reason to be optimistic.

Read on to learn more

Fertility Evaluation

The first step is a comprehensive review of your medical history, followed by a complete physical exam and a series of infertility tests. The testing generally proceeds from standardized screening (that all couples need) which all couples need, to specialized tests that are tailored to the unique needs of each couple. Once the results are obtained, only then fertility treatments like IUI or IVF (that viewers often search online as ‘IVF egg retrieval’ are advised.
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Test results performed by qualified laboratories elsewhere are acceptable if the information is still current and relevant. A single blood draw is usually sufficient to perform nearly all screening tests. The table below outlines the common tests. Based on the results of these standard tests, your physician can advise you regarding any further specific testing.

 Standard tests (usually advised to all couples)

Name of Test

For woman

For husband

Obtained By

Blood group

Yes

Yes

Blood test

CBC

Yes

Yes

Blood test

Rubella IgG

Yes

Yes

Blood test

HIV/HBsAg/HCV

Yes

Yes

Blood test

TSH

Yes

No (sometimes)

Blood test

Prolactin

Yes

No (sometimes)

Blood test

Vitamin D

Yes

No

Blood test

Pap Smear

Yes

No

Office Visit

 

Specific Tests (may or may not be advised)

Name of Test

For woman?

For husband?

Obtained By

AMH

Yes

No

Blood test

FSH/LH

Yes

No

Blood test

Hysterosalpingogram

Yes

No

Office Visit

Hysteroscopy

Yes

No

Radiology

Transvaginal ultrasound/ Sonohysterogram

Yes

No

Office Visit

Semen Analysis

No

Yes

Office Visit

Genetic Testing

Yes

Yes

Blood test

Karyotype

Yes

Yes

Office Visit

Routine tests for fitness

(Creatinine, SGPT, RBS)

Yes

No (sometimes)

Blood test

FSH/LH/Testosterone

No

Yes

Blood test

Youtube Link: https://www.youtube.com/watch?v=6mH1z4tzMYo

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Test results performed by qualified laboratories elsewhere are acceptable if the information is still current and relevant. A single blood draw is usually sufficient to perform nearly all screening tests. The table below outlines the common tests. Based on the results of these standard tests, your physician can advise you regarding any further specific testing.

 Standard tests (usually advised to all couples)

Specific Tests (may or may not be advised)

Youtube Link: https://www.youtube.com/watch?v=6mH1z4tzMYo

Ovulation induction (OI)

Fertility treatment is not all about IVF and not everyone needs the in vitro fertilization process to conceive. Many women conceive with very little assistance and simple and straightforward treatments like ovulation induction and timed intercourse.
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Ovulation disorders play a role in 25% of patients with infertility. Some women don’t ovulate at all or only ovulate infrequently. In some women, ovulation appears to happen regularly, but there is no pregnancy. Ovulation induction can be highly effective in the right woman and is also one of the safest and simplest infertility treatments available. If the fertility evaluation of the couple uncovers no serious problems, the first step often advised is ovulation induction and timed intercourse.

What is ovulation induction?
Ovulation induction is the process of using medications to stimulate egg development and release (ovulation). It is often combined with follicular monitoring to track the growth of the follicle and timed intercourse or IUI. 

What are the medications used for ovulation induction and what is the procedure?
The most commonly used oral drugs are clomiphene citrate and letrozole. Women who do not respond to oral medication are often advised gonadotropin injections. The ovulation induction cycle usually begins from the 2nd or the 3rd day of the period and is often combined with follicular study (serial ultrasonography) to track the growth of the follicles. When the follicles have reached an appropriate size, intercourse is advised, or an injection of HCG is given to facilitate the timing of intercourse or IUI.

 Are there any risks in taking ovulation induction medicines?
The most common risk is multiple pregnancy. With Clomiphene and Letrozole, the chance of twins is 5-8%; the chance of triplets or a higher-order multiple pregnancy is less than 1%. Ovarian cysts may occur and can sometimes become large and painful.

 How successful is ovulation induction?
The success rate mainly depends on the woman’s age and infertility diagnosis and in general is around 15-20% per cycle. Youtube Link: https://www.youtube.com/watch?v=XN005L_Yswo&t=23s

Intrauterine Insemination (IUI)

Intrauterine Insemination (also referred to as artificial insemination) is one of the most commonly used Assisted Reproductive Techniques (ART). It is the process of placing washed sperms, through the cervix (mouth of the womb), into the uterine cavity (womb). The IUI procedure bypasses the cervix and places sperm directly into the uterus, closer to the fallopian tubes, around the time of ovulation (release of egg). This way, there is a better chance that more sperm will make their way to the egg and pregnancy will occur. ART clinics offering IUI treatment need to be registered as per the ART act.
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When is IUI useful?
Male Infertility: IUI is commonly used when the husband has a borderline low sperm count, poor motility, problems in developing an erection or being able to ejaculate.

Female Infertility: In women who do not ovulate regularly, IUI may be advised in conjunction with ovulation induction. It is indicated as an initial line of treatment for women with endometriosis. Also, IUI is helpful for women with cervical scarring due to infection or surgery.

Who needs donor IUI?
If the husband has no sperm or if there are severe abnormalities detected in the semen analysis and the couple cannot afford an ICSI cycle, donor sperm IUI is an option. Sometimes, it is also advised when there is an inheritable genetic problem, which could be transferred to the baby from the father. As per the ART act, only registered ART clinics can offer IUI treatment, and donor semen samples need to be obtained from registered ART banks.

How is sperm collected?
The husband needs to collect his semen sample by masturbation into a sterile container provided at the clinic. An abstinence period of 3-5 days is advisable prior to IUI.

How is IUI done?
IUI can be done in a natural cycle or in conjunction with ovulation induction (medication to make egg/s grow). The IUI cycle usually begins from the 2nd or 3rd day of the woman’s period. Follicular growth is monitored by ultrasonography at regular intervals and the trigger injection is given once the follicle/s have reached the required size. IUI is performed near the time of ovulation. The semen sample is ‘washed’ in the laboratory, to concentrate the sperm and remove the seminal fluid (seminal fluid can cause severe cramping in the woman). This process usually takes 45 minutes to 1 hour to complete. The IUI procedure is relatively simple and only takes a few minutes. The woman lies on an examination table and the clinician inserts a speculum into her vagina to see her cervix. A catheter (narrow tube) is inserted through the cervix into the uterus and the washed semen sample is slowly injected.

What are the advantages of IUI?
IUI is simple, painless, and inexpensive. It is a safe and relatively easy treatment procedure with minimal risks and monitoring.

What is the success rate for IUI?
The success of IUI depends on several factors and usually varies from 15-20% per cycle depending on the age of the woman, the infertility diagnosis, and the use of fertility medications. 

What are the risks involved in IUI?
Some women experience discomfort such as cramping or minor injury to the cervix that may lead to bleeding or spotting. If fertility medications are given in conjunction with IUI, there is a risk of ovarian hyperstimulation and multiple pregnancy. Undergoing an IUI does not increase the risk of birth defects per se. The risk of developing an infection after an IUI is small. 

What are the precautions to be taken after IUI?
There is no need for bed rest, travel restrictions or even diet maintenance after IUI. It is absolutely okay to get back to your usual activities after the IUI procedure on the very same day.
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In Vitro Fertilization (IVF) and Intracytoplasmic Sperm Injection (ICSI)

With In Vitro Fertilization process(IVF) the woman’s eggs are fertilized by sperm in the IVF laboratory. Intracytoplasmic Sperm Injection (ICSI) takes the process one step further and involves the injection of a single sperm directly into the cytoplasm of a mature egg (oocyte) using a special microinjection pipette (glass needle). IVF and ICSI are the most advanced and effective fertility treatments available today.
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An IVF/ICSI cycle typically includes the following steps:
  • Medication to stimulate growth of multiple eggs
  • Retrieval of eggs from the ovaries (OPU – Oocyte Pick Up)
  • Insemination of eggs with sperm (fertilization)
  • Culture of the fertilized eggs (embryos) in the IVF laboratory
  • Transfer of one or two embryos into the uterus (embryo transfer)
  • Luteal support medication

What is the difference between IVF and ICSI?
The difference between IVF and ICSI is in how the sperm fertilizes the egg. People often search for ‘IVF egg retrieval’ when looking for information on IVF on the internet. IVF is a procedure, where the egg and sperm (many) are kept in a laboratory dish to fertilize on their own. In ICSI, sperm is selected and directly injected into the egg.

Who needs IVF/ICSI?
IVF/ICSI is indicated when alternative treatments are either unlikely to achieve a pregnancy or have failed to result in a pregnancy. Women who have blocked or damaged fallopian tubes, need IVF/ICSI. Another common indication is low sperm counts or previous failed IUI cycles. It may also be advisable for women with PCOS if ovulation induction with or without IUI has not been successful. For women with mild to moderate Endometriosis, IUI may be tried before proceeding to IVF/ICSI, but in case of severe endometriosis, IVF/ICSI is advisable. For couples with ‘unexplained infertility’, IVF/ICSI is an option if IUI has failed to achieve pregnancy. It is also indicated in cases where any of its expansions is of interest, for example, if egg donation or pre implantation genetic testing or gestational surrogacy is advised.

Is IVF/ ICSI expensive?
IVF/ ICSI involves highly trained professionals with sophisticated laboratories and equipment. The total cost of an IVF/ ICSI cycle largely depends on the medication (gonadotropin injections) required which in turn depends on the woman’s age and egg reserve.

Are birth defects more common in babies conceived using IVF/ ICSI?
The percentage of birth defects with IVF or ICSI is roughly the same as in the general population (3-4%). Some of the problems that cause male infertility, may be genetic. In these cases, boys conceived with the use of ICSI may have fertility issues as adults.

What are the health risks for women undergoing IVF/ ICSI cycles?
The medication used during IVF/ ICSI may on occasion cause side effects. There is a small but significant risk of multiple pregnancy, ectopic pregnancy, pelvic infection and rarely injury to nearby organs. Controlled ovarian hyperstimulation (COH) is associated with a risk of Ovarian HyperStimulation Syndrome (OHSS). Symptoms of OHSS include the following in varying degrees of severity: nausea, vomiting, diarrhoea, extreme bloating, rapid weight gain, difficulty breathing, etc.

The risk of OHSS can be brought down significantly depending on the protocol used for ovarian stimulation. Also the risk of multiple pregnancy can be reduced by limiting the number of embryos being transferred to just one or two; never more than two.

What do we do if extra embryos remain after embryo transfer?
Extra embryos remaining after the embryo transfer may be frozen by Vitrification which gives almost 100% survival. This makes future ART cycles simpler, less expensive and less invasive than the initial cycle, and accordingly frozen embryo transfer process step by step is considered.

What are the success rates?
Our success rates are among the best in the country. They are the result of years of experience and constant fine-tuning of our stimulation protocols, our laboratory culture conditions and our embryo transfer guidelines. The most important factors determining the success rates are the woman’s age and the reason for the infertility. Visit our blog: A Step by Step Look at the IVF process To know more about IVF procedure step by stepTo know more about IVF procedure step by step

Donor Egg IVF

A donor egg cycle is an IVF/ICSI cycle in which the eggs from a donor are used instead of the patient’s own eggs. Donor eggs may be combined with the patient’s husband’s sperm or with donor sperm (embryo adoption).
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Who needs Donor eggs?

Donor Egg IVF is an appropriate option for women unable to conceive with their own eggs, provided there is no contraindication to carrying a pregnancy.

The indications for Donor Egg IVF are advanced age, diminished ovarian reserve and Premature Ovarian Failure (POF).  Women who carry a genetic mutation can opt for Donor Egg IVF or self-IVF cycle with Preimplantation Genetic Testing, if that is possible and available.

 Who are the egg donors?

As per the ART Act, there are several mandatory requirements that need to be carried out for couples needing donor eggs. The registration and screening of egg donors is to be carried out by registered ART Banks. Only registered ART Clinics can offer donor egg treatment and the egg donors can be sourced only from registered ART Banks. The donors are young women between the ages of 23 years to 35 years and usually have atleast one child of their own. They undergo complete medical evaluation and a mandatory list of tests as prescribed in the ART Act. A woman is allowed to donate eggs only once in her lifetime and only 7 eggs can be retrieved. It is important that all requirements laid out in the ART Act are adhered to and hence it is absolutely necessary that you discuss these with your doctor when considering donor egg treatment.

What does the procedure involve?

The egg donor’s menstrual cycle is synchronized with the patient’s (recipient) cycle using birth control pills. From day 1 to 2 of menses, the recipient starts estradiol tablets to prepare her uterine lining and we begin the egg donor’s ovarian stimulation cycle. Once the donor’s follicles are ready, which usually happens in 10-11 days, her egg retrieval procedure (that is Oocyte Pick Up) is carried out. The recipient’s husband provides his semen sample on the day of the donor’s egg retrieval. The fertilization is then carried out in the laboratory. The recipient is started on appropriate luteal support medications. Three to five days later 1 or 2 embryos are transferred with great care, under sonographic guidance, into the recipient’s uterus. Any additional good quality embryos can be frozen.

What are the legal aspects of egg donation?

The ICMR guidelines allow commercial egg donation, provided it is anonymous and confidential. The egg donor has no rights over the baby or babies conceived using her eggs and signs a contract agreeing to this.

Egg Freezing (Oocyte Cryopreservation)

For women, fertility declines with age, because of a decline in the quantity and the quality of eggs. A woman is most fertile in her 20s. Fertility begins to progressively decline after 30 and this decline accelerates in the late 30s.

Egg freezing, also known as mature oocyte cryopreservation, is a method used to preserve a woman’s ability to get pregnant (with her own eggs) at a later age. It is the process of preserving some of the eggs by retrieving them from the ovaries, freezing them, and storing them for use to get pregnant later on.

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Who is egg freezing suitable for?

  • Women with medical conditions like SLE that can affect fertility.
  • Women needing treatment for cancer. Cancer treatments such as radiation or chemotherapy can harm fertility. Egg freezing before treatment might enable one to have biological children later. 
  • Social reasons. Freezing eggs at a younger age might help one get pregnant later when ready. This allows women to delay conception to allow for time to develop a stable relationship, pursue advanced education or develop a career. 

 
What is the right age for egg freezing?

In general, the younger the woman is, the better the outcomes of egg freezing. Younger women produce higher numbers of better quality eggs that have a better chance of conception. The most ideal age for egg freezing would be ages 27–34. Egg freezing can also be done in the mid-to-late 30s, but multiple cycles might be required. 

How does one know if her eggs are healthy?

Age is the best predictor of the quality of eggs whereas blood tests for AMH and Ultrasound for AFC give an idea of the egg reserve (egg numbers). It is not possible to measure egg quality with any tests.

What is the procedure?

In order to retrieve eggs for freezing, the initial process is the same as that for an IVF/ICSI cycle. The only difference is that following egg retrieval, the mature eggs are identified and are frozen. It takes approximately 12-14 days from the 2nd day of the period to complete the egg freezing cycle.

When the woman is ready to attempt pregnancy (which can be several years later) the eggs are thawed, fertilised in the laboratory by ICSI using her husband’s sperm and then the embryo/s are transferred to the uterus on day3 or day5.

What are the health risks for women undergoing IVF/ ICSI cycles?

The medication used for ovarian stimulation may on occasion lead to Ovarian HyperStimulation Syndrome (OHSS). Symptoms of OHSS include the following in varying degrees of severity: nausea, vomiting, diarrhoea, extreme bloating, rapid weight gain, difficulty breathing etc. The risk of OHSS can be brought down significantly depending on the protocol used for ovarian stimulation. Rarely, the needle used to retrieve eggs causes bleeding, infection or damage to the bowel, bladder or a blood vessel. The risk of miscarriage (when the frozen eggs are used in the future) primarily depends on the age at which the eggs were frozen. Older women have higher miscarriage rates. Research to date hasn’t shown an increase in the risk of birth defects for babies born as a result of egg freezing. However, more research is needed on the safety of egg freezing.

Surgical Sperm Retrieval

Surgical sperm retrieval (SSR) is a technique for collecting sperm directly from a man’s testes or epididymis.

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Azoospermia refers to the condition in which there are no sperm in the ejaculate. Azoospermia can be ‘obstructive,’ where there is a blockage preventing sperm from entering the ejaculate, or it can be ‘non-obstructive’ when it is due to decreased or absent sperm production by the testis.

Depending on the cause of azoospermia, it is possible for some men to be able to have their biological child. Surgical sperm retrieval along with ICSI is often needed to achieve pregnancy for these cases.

What are the commonly used surgical sperm extraction techniques?

PESA (Percutaneous Epididymal Sperm Aspiration): It is the least invasive method and involves inserting a fine needle into the epididymis, from which fluid is aspirated. The procedure takes about 20-30 minutes. If no sperm are found, the urologist will proceed to the other options (like TESE).

TESE (Testicular Sperm Extraction): This is the collection of sperm from a biopsy or several biopsies from the testicular tissue.

Sperms, if found,  need to either be used immediately in fertility treatments or be frozen and placed in storage for use at a later stage.

What if no sperm are found?
There’s always a possibility that no sperm will be found and this can be emotionally draining for the couple. It is important that couples discuss this possibility with each other and with their fertility physician before the procedure.