Q4: What is semen analysis and why should it be performed?

Given 40% contribution in infertility, semen analysis becomes the most important diagnostic test. In short, no treatment should be administered to female partner until male factor is ruled out.

The semen analysis is best performed by a reproductive clinic laboratory as accurate interpretation is a must. Semen analysis measures many sperm characteristics including number, shape, swimming motion, viscosity, and others. There can be severe sperm abnormalities even though the volume of the ejaculate is normal.

Q5: How is Infertility Treated?

No treatment should ideally be started to infertile couple unless complete evaluation is done. Since there are several factors responsible for causing infertility, it’s the expert who decides which tests to be done in an individual case depending upon the age of the couple, duration of infertility, previous treatment received, previous any major illness or surgery and the clinical findings.

Infertility is complex and can be caused by many abnormalities in both the male and female. Thousands of Rupees can be wasted on ineffective, subjective treatments in the absence of an accurate diagnosis. Once the precise diagnosis is made, the effective treatment can be decided upon.

In many cases, there are multiple causes of a couples infertility. For example, the female may have scarring from previous surgery(s) and endometriosis. Her partner could have a low sperm count or poor morphology. Treatment will not be successful unless all of these conditions are treated. This is why it is so critical that a specialist be seen early in the infertility evaluation

* Drug Therapy in Infertility:

Drugs may be used for induction of ovulation or for support of pregnancy. One of the most widely and first used fertility drug for ovulation induction is Clomiphene Citrate (Clomid), but one has to remember that Clomid is also widely overused and is rarely successful if pregnancy has not been achieved in 3-6 cycles.

It is common for women to seek specialist care after several months of ineffective Clomid therapy. Many times she, and her husband, have not received a complete infertility evaluation. If specialist care were sought sooner, months of expense and frustration could be avoided. Women, especially those in their thirties, or with elevated follicle stimulating hormone levels, should not waste valuable time trying Clomid without a complete evaluation by an infertility specialist (ART Consultant).

Progesterone like drugs are used to support the pregnancy. It is available in oral, injectable, pessary or gel form.

* Fertility Enhancing Endoscopic Surgery

Many pathologies of uterus (septum, intra-uterine syneche, fibroids, polyp, corneal block), fallopian tubes (corneal block- blocks at the ends of the tube), ovaries (endometriosis, cyst etc.) or other factors like pelvic adhesions can successfully be treated to certain extent with endoscopic surgery.

Q6:   Does Diet, exercise, and weight reduction help? 

These form the basis of treatment in ovulatory dysfunction.
If significant weight loss is achieved, these patients may conceive on their own without further need of infertility treatment, provided other factors are normal.

Q7: What is IUI?

IUI has been used to treat infertility for many years and is most often employed where there is mild male factor infertility, antigen/antibody reactions in the cervical mucus, or a male donor.

The partner’s semen sample is collected preferably by masturbation, processed in the laboratory to remove the debris, dead sperms, round cells, seminal plasma etc. and only the highly motile concentrated bolus of sperms is inserted in the uterus at the time of ovulation.

Success rates with IUI are dependent upon many factors including the age of the female, the quality and quantity of the sperm and the causes(s) of infertility. Follicle stimulating hormone or Clomid are often used in stimulated IUI.

Usually, IUI is less expensive than IVF if pregnancy occurs during the first three cycles. However, per cycle success rates using IUI are much lower than IVF. This means more cycles will likely be required thus increasing overall cost.

Q8: What is In Vitro Fertilization?

A: In infertile couples where women have blocked or absent fallopian tubes, or where men have low sperm counts, in vitro fertilization (IVF) offers a chance at parenthood to couples who until recently would have had no hope of having a "biologically related" child.

In IVF, eggs are surgically removed from the ovary and mixed with sperm outside the body in a Petri dish ("in vitro" is Latin for "in glass"). After about 40 hours, the eggs are examined to see if they have become fertilized by the sperm and are dividing into cells. These fertilized eggs (embryos) are then placed in the women's uterus, thus bypassing the fallopian tubes.

Q9: What is ICSI?

Intracytoplasmic sperm injection (ICSI) provides new hope for the male partners with moderate to severe male factor infertility to father a child. In the past, the only option for these couples was to use sperm from a donor. This meant the child had genes from the natural mother but not the father.

When there is moderate to severe male factor, IVF with intracytoplasmic sperm injection (ICSI) is usually the treatment of first choice. ICSI allows a single sperm to be placed directly into the egg and is the only option for severe male factor infertility unless a donor is used. Sperm can usually be obtained even if it is absent in the ejaculate by procedures such as MESA and TESA. In these procedures, sperm are withdrawn directly from the male reproductive tract.

 Q10: Is Blastocyst Transfer beneficial?

A blastocyst is an embryo that has developed in culture for at least five days after fertilization and then is transferred in the female womb. This is a more physiological approach since it is known that under in-vivo conditions the embryos reach the uterine cavity around the end of the sixth day following fertilization. This also allows at times for natural selection of best quality embryo as only the better quality, genetically normal embryo will grow to this stage.

Q11: What is Pre-implantation Genetic Diagnosis (PGD)?

Preimplantation genetic diagnosis (PGD) allows the embryologist and physician to screen embryos for certain inherited genetic diseases. Each cell in the body, and in an embryo, contains the full genetic blueprint of a person and hence the chromosomes from any cell can be examined for abnormalities. After PGD, embryos that are not carrying the genetic disorder are selected for transfer.	Embryonic cell from 8-cell embryo is biopsied

Q12: What is a donor programme and when does one opt for it?

* Donor Egg:

Donor egg is an option for couples whose eggs will no longer fertilize and produce healthy embryos. Egg quality generally declines with advancing female age but it can occur at any age. Ovarian reserve is a measure of "egg quality" and is evaluated during the infertility workup.

The in vitro success rates for women in their early forties using their own eggs are dismally low. When donor eggs are utilized, success rates are dramatically improved and match those of the age group to which the donor belongs. In other words, a forty year old receiving eggs from a twenty year old will usually have IVF success rates for the twenty year old age group.

Other candidates for donor egg include women who may have been born with absent ovaries (rare) or those whose ovaries were damaged by cancer chemotherapy or radiation. Donor eggs may also be used in cases of unexplained infertility and severe endometriosis.

* Donor sperm:

The couple may opt for the donor sperm when the male partner is sterile (testicular failure) and therefore unable to provide a sperm sample for IVF or ICSI.

In other instances, the couple may look to use a sperm donor in order to avoid passing on a genetic disease or disorder that is carried by the male sperm.

There are a variety of factors that can contribute to a woman’s chances of conceiving through the use of a sperm donor. Women under the age of 35 with no history of any other fertility problems than the male factor have the best chance of becoming pregnant with donor sperm.

* Donor embryo:

When both couples are faced with infertility problems, embryo donation can be an excellent choice. Issues that typically cause a couple to consider embryo donation include:

• Poor sperm production and count
• Problems with egg development and ovulation
• Attempts at other types of ART have been unsuccessful
• High risk of passing on genetic disorders but are unable to pursue PGD
• Other fertility treatments are not financially feasible

Q13: What is Surrogacy?

Surrogacy can easily be defined as the process whereby another woman carries the child of infertile couple to term. Upon birth, the child is handed over to the couple, with the gestational carrier giving up any legal rights she may have to the child.
There are a variety of reasons why a couple may choose to use a surrogate carrier. Women who have absent uterus, diseased uterus or surgically removed for any other cause are advised for surrogacy.

Even the women with medical diseases like heart or renal disease who are unable to take the load of pregnancy can go for surrogacy.