Your Questions Answered - Frequently Asked Questions| Milann The Fertility Specialist



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Infertility is the inability to conceive after a year of unprotected intercourse in women under 35, or after six months in women over 35, or the inability to carry a pregnancy to term.
Both male and female factors contribute to infertility. Some studies suggest that male and female factors contribute equally. In many cases it may not be possible to definitely explain the reasons for infertility. It is essential that both the male and female partners be evaluated during an infertility work up.
Many things can change a woman's ability to have a baby. These include age, smoking, excess alcohol use, stress, poor diet, being overweight or underweight, sexually transmitted infections (STIs), health problems that cause hormonal changes, such as polycystic ovarian syndrome and primary ovarian insufficiency.
Anything that raises the temperature of the scrotum such as the use of hot tubs or long baths or over-tight clothing can harm sperm production. A variety of medicines and recreational drugs can also decrease male fertility. These include alcohol, cigarettes as well as certain medications. Studies have also shown that environmental factors have contributed to decreasing sperm counts over the years.
Most physicians advise you not to be concerned unless you have been trying to conceive for at least one year. If the female partner is over 30 years old, has a history of pelvic inflammatory disease, painful periods, recurrent miscarriage, or irregular periods, it might be prudent to seek help sooner. If the male partner has a known or suspected low sperm count, then it would also be prudent to seek help sooner than waiting a year.
For a normal couple, it often takes a number of perfectly timed cycles before pregnancy is achieved. The chances of getting pregnant each cycle decreases as you get older. If you are 20-25, your chance per cycle is about 25%. At 25-30 your chances are about 20%. At 30-35 it is about 15%. After 35 it may be about 10% per ovulatory cycle, and the chances continue the downward trend.
Common methods of ART include:

Intra-uterine insemination (IUI): Semen is collected and washed to rid it of impurities. The woman undergoes regular ultrasound scans to determine the time of ovulation. The sperm is then injected through the cervix, into the uterus using a small catheter.

In vitro fertilization (IVF) - Embryo Transfer (ET). IVF is an effective Assisted Reproductive Technique. It is often used when a woman's fallopian tubes are blocked or when a man produces too few sperms. The woman is generally put on certain drugs that cause the ovaries to produce multiple eggs. Once mature, the eggs are removed from the woman in a procedure known as oocyte retrieval or ovum pick up. They are then fertilized with the man's sperm in the embryology lab. After 3 to 5 days, healthy embryos are transferred into the woman's uterus.

Intracytoplasmic sperm injection (ICSI) is generally used for couples in which the problem is one of male infertility. Sometimes it is also used for older couples or for those with failed IVF attempts. In ICSI, a single sperm is injected into a mature egg for fertilization. The resultant embryo is transferred into the uterus. ICSI is a good option for men with very low sperm counts to try to increase the chances of fertilization.

Assisted hatching: Assisted hatching is putting a small opening in the embryo's outer layer called the zona pellucida. The embryo which must normally break free of the zona to hatch prior to implantation in the uterine lining is thus assisted by the creation of a small opening. AH is usually advised for older women (38 or over), who often have a more rigid outer layer for the embryo.
This is an x-ray of the uterus and fallopian tubes. Doctors inject a special dye into the uterus through the vagina. This dye shows up in the x-ray. Doctors can then watch to see if the dye moves freely through the uterus and fallopian tubes. This can help them find physical blocks that may be causing infertility.
During the IVF cycle, women do put on some weight (small weight gain) due to fluid retention, specifically during the superovulation phase (stimulation phase). However, this is temporary and once the superovulation stops, the hormones are excreted. Thus, there is no long-term weight gain or loss due to IVF.
The treatment options for infertility depend on the profile of the patients, male and female factors related to infertility and the choice of the couple. Usually, the common techniques available are Ovulation Induction with Timed Intercourse or Intra Uterine Insemination, Intra Uterine Insemination and In Vitro Fertilization.
Fertility drugs might cause a mild reaction in some patients, and may involve hot flushes, feeling down, irritability and restlessness. These symptoms disappear in a short time.

In some patients, ovarian hyper-stimulation syndrome (OHSS) is observed as an over-reaction to fertility drugs. It could cause symptoms like swollen stomach, stomach pains and nausea. Patients must contact their infertility clinician immediately in such cases.

There is no pain during IVF apart from the injections which woman receives. However, in some patients, ovarian torsion could be another observed side-effect. Mild pelvic discomfort arises because the size of ovaries increases during the stimulation period.

The other side-effects of IVF during pregnancy include ectopic pregnancy and multiple births. When an embryo develops in the fallopian tube rather than in the womb, the pregnancy is said to be an ectopic pregnancy. Ectopic pregnancy can cause vaginal bleeding, low pregnancy hormone levels and miscarriage. Hormone tests and scans are used to detect ectopic pregnancies and patients must call the doctor immediately when they observe vaginal bleeding or stomach pain.

Multiple births is another risk associated with fertility treatment. Your clinician would discuss this risk with you before the embryo transfer procedure.

Is there any chance that going through multiple IVF cycles can result in increased endometriosis?

No. There is no study which has proven so. Prolonged infertility, per se, has been associated with endometriosis.
The success rates for IVF treatment depend on the individual patient profile, the quality of oocytes obtained, the embryo after fertilization and many other factors. The maternal age plays a large role in the success rate of the treatment. As a woman ages, her ovarian reserve is depleted and the probability of obtaining good quality oocytes and embryos reduces. Although many infertility clinics showcase success rates of 50%, 60% etc., it might not be so for every patient they handle. In many cases, the success rates mentioned could be for more than one cycle.
Infertility, by itself, is not a genetic disorder. But some of the reasons for infertility like PCOS, premature ovarian failure, Endometriosis, etc. have been associated with a genetic linkage. These might increase the risk of infertility. In case of males, genetic conditions such as Y-chromosome microdeletion, Kleinfelter's syndrome are associated with infertility.
The duration of the treatment largely depends on the individual profile of the patients. Since no infertility treatment has a 100% success rate, the treatment duration would depend on a number of factors. Most infertility treatments, from initial work-up to the treatment would take between 6 months to one year.
Egg donor is an option for patients, when there are genetic or inheritable diseases running in the family (X-linked genetic disorders), advanced maternal age, poor ovarian reserve, and when the woman has had a recurrent implantation failure.
Egg donors can be sourced through registered ART banks as per regulatory guidelines. Infertility clinics may help guide patients to contact such registered banks.
Egg donors are anonymous; but patients can choose the donor profile like color of the hair, color of the eye, blood group, etc.
When the patient is advised for egg donor, the clinic suggests the patients on registered donor banks which may be contacted.
Overall, the chances of success are observed to be higher for IVF done through egg donor in terms of clinical pregnancy, compared to IVF done through oocytes from the general population.
Uterine fibroids are tumors which grow from the muscle cells of the uterus (womb). Presence of fibroids is a common gynecological condition which is mostly non-cancerous. Patients suffering from heavy or irregular uterine bleeding, facing difficulty in voiding urine or stools, experiencing heaviness or fullness in lower abdomen and who have a difficulty in conceiving could be suffering from uterine fibroids.

Removal of the uterus (hysterectomy) was the only solution for fibroids earlier. However, there are plenty of treatment options available currently, like GnRH analogues, uterine artery embolisation, myolysis, MRI guided focused ultrasound, Open and Laparoscopic Myomectomy.
Every time a woman gets her period, the lining of the uterus (which is called the endometrium) breaks down and is shed as menstrual flow. When a woman has endometriosis, the tissue that makes up the lining of the uterus also shows up in other parts of her body including the ovaries, the bowels, and the bladder. During her period, this tissue breaks down - but since it is outside the uterus it cannot leave the body, and cysts and scar tissue may form as a result. The adhesions present in the pelvic area make the pelvic organs rather fixed. Any motion of these organs (e.g. during intercourse), could produce pelvic pain.
Although one of the most common characteristics of women with endometriosis is severe menstrual cramps, this appears to be the result of the condition rather than a precursor to it.
The symptoms associated with endometriosis are painful periods, pain between periods, lower abdominal pain, lower back pain, painful intercourse, especially with deep penetration, menstrual irregularity and infertility. If I put off having children until my 30s or later, do I have a greater chance of getting endometriosis? Is there any relation between delayed childbirth and endometriosis?

It was earlier believed that early childbearing offered protection against endometriosis. Although the incidence of endometriosis is higher in women who delay having their first child, this may be because of the fact that endometriosis causes infertility. It is therefore difficult to distinguish whether the infertility preceded or followed the endometriosis.
No, it does not. Probably fewer than 40% of women with endometriosis are infertile. However, women with endometriosis make up a large percentage of infertility patients.
This does occur in some patients. The symptoms of endometriosis are highly variable. For instance, a patient with very extensive endometriosis may be incapacitated with pain or have very few symptoms. The same variability can be seen in mild endometriosis. Therefore, if the classic symptoms and signs and the physical findings of endometriosis are present in a patient, the diagnosis obviously could be straightforward. However, the absence of symptoms or physical findings does not mean that endometriosis is not present. Infertility is, at times, the only symptom.
Usually, the pain associated with endometriosis is experienced right before, or during the menstrual period in the initial stages. However, as the disease progresses, it may occur throughout the cycle. The pain may be acute or chronic. In about half the cases, patients with severe or extensive endometriosis experience the pain as chronic all through the cycle, which gets worse right before and during menstruation, and during or shortly after intercourse.
This has not been proven. It has, however, been suggested that intercourse during menses might increase tubal activity and increase the backflow of the menstrual cycle through the tubes and this increases the risk of endometriosis. However, there are no statistics to bear this out.
This is unlikely. Scientifically, there has not been any basis to conclude that the use of tampons increases the risk of developing endometriosis. Also, other hygienic practices (such as douching after the menstrual period) have not been shown to increase the risk of endometriosis.
There is no current manner of preventing endometriosis, and it is not a condition which is “contracted” or “caused” by anything that the patient did; nor is it contagious. It is, however, highly suspected to be genetic.
Obese women suffer more menstrual disorders. For example, the frequency of menstrual disturbance in women with morbid obesity (BMI 40+) is three times greater than for women of normal weight. Obesity in premenopausal women is associated with irregular menstrual cycles and infertility.
Poly Cystic Ovarian Syndrome is the most common female endocrine (hormonal) disorder and is characterized by multiple abnormal ovarian cysts. Most PCOS sufferers are overweight or obese. The symptoms of Polycystic Ovarian Syndrome can include excessive weight gain and obesity, irregular, heavy or completely absent periods, ovarian cysts and excessive facial or body hair.
Obesity during pregnancy is associated with increased risk for both the baby and the mother, and increases the risk of maternal high blood pressure by 10 times. Excessive weight in pregnant mothers is associated with a higher risk of hypertension, gestational diabetes, urinary infection, Cesarean section delivery and toxemia. Infants born to women who are obese during pregnancy are more likely to have high birth weight and, therefore, may face a higher rate of Cesarean section delivery and low blood sugar which can be associated with brain damage and seizures.
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