Frequently Asked Question (FAQ)

Frequently asked Question-FAQ

What is Infertility?

Infertility, whether male or female, can be defined as 'the inability of a couple to achieve conception after one year or more of regular, unprotected intercourse.’

Up to 10-15% of couples experience some form of infertility problem. On a worldwide scale, this means that 70-95 million people suffer from infertility.

My husband and I have an active sex life, we are both healthy, and my periods are regular. Why are we still unable to conceive?

You need to remember that it's not possible to determine the reason for your infertility until you undergo tests to find out if your husband's sperm count is normal; if your fallopian tubes and uterus are normal; and if you are producing eggs. Only after undergoing these tests your fertility specialist is able to tell you why you are not conceiving. While testing does cause considerable anxiety, it's far better to intelligently identify the problem so that we can look for the best solution.

Is infertility exclusively a female problem?

No. The incidence of infertility in men and women is almost identical. Infertility is exclusively a female problem in 30-40% of the cases and exclusively a male problem in 30-40% of the cases. Problems common to both partners are diagnosed in 20% of infertile couples. After thorough medical investigations, the causes of the infertility remain unexplained in 5-10%.

How can I determine my fertile period?

Your fertile period is the time during which having sex could lead to a pregnancy. This is the 4-6 days prior to ovulation (release of a mature egg from the ovary). Women normally ovulate 14 days prior to the date of the next menstrual period.

What are the most common causes of infertility?

The most common causes of female infertility are ovulatory disorders and anatomical abnormalities such as damaged fallopian tubes. Other causes include endometriosis, fibroid uterus, congenital abnormalities of uterus and hormonal imbalances. Causes of male infertility can be divided into three main categories: Sperm production disorders affecting the quality and/or the quantity of sperm; anatomical obstructions; other factors such immunological disorders.

My gynecologist has done an internal examination and said I am normal. Do I still need to get tests done to determine why I am not conceiving?

A routine gynecological examination does not provide information about possible problems which can cause infertility, such as blocked fallopian tubes or ovulatory disorders. You need a systematic infertility workup by a fertility specialist.   

What is the general progression of infertility treatment?

Diagnostic procedures range from simple blood tests to more complicated analytical methods. In any case, diagnosis is a crucial first step to determine the appropriate therapeutic path that should be followed. In addition to the cause itself, other factors, such as the age of the woman, or problems shared by both partners, might also influence the choice of treatment.

Do painful menstrual periods cause infertility?

For most patients, regular painful periods usually signal ovulatory cycles. However, progressively worsening pain during periods (especially when this is accompanied by pain during sex) may mean you have endometriosis which can cause infertility.

What treatment options do infertile couples have?

Several options are offered to couples depending on the cause of infertility. The majority of female patients especially with ovulatory problems are successfully treated with drugs such as clomiphene citrate, cabergoline, metformin or gonadotropin injections. Weight reduction forms an important part of treatment in obese patients.Laparoscopic surgery can also be a means to repair damage to the reproductive organs, such as those caused by endometriosis and infectious diseases. Others may need assisted reproductive measures -like IUI, IVF, or ICSI.Treatment options for male infertility also include the administration of drugs, surgery and assisted reproductive technologies. 

My periods come only once every 6 week. Could this be a reason for my infertility?

As long as the periods are regular, this means ovulation is occurring. Cycles at 21 days and 35 days intervals are considered as normal .Of course, those who have fewer cycles every year, the number of times they are ‘fertile’ in a year is decreased. Women with irregular cycles need early evaluation and treatment.

After having sex, most of the semen leaks out of my vagina. Should we change our sexual technique? Could this be a reason for our infertility?

Loss of seminal fluid after intercourse is perfectly normal, and most women notice some discharge immediately after sex. If your husband ejaculates inside you, then you can be sure that no matter how much semen leaks out afterwards, enough sperm will reach the cervical mucus. In fact, this leakage is a good sign - it means your husband is depositing his semen normally in your vagina!

What are the side effects and risks of treatment?

Drugs used to treat infertility may on occasion cause side effects. Common local side effects experienced by patients who receive gonadotrophins by intramuscular injection include skin redness, swelling and bruising. Pain and discomfort sometimes reported after intramuscular injections are now likely to be lessened with the availability of gonadotropins produced by recombinant DNA - or genetic engineering-techniques, which are administered by subcutaneous injection.

OHSS (ovarian hyperstimulation syndrome), multiple births and allergic reaction to the drugs may occur .In ovulation induction close follow up (such as ultrasound scan and blood tests) help the physician to avoid OHSS and minimize the risk of multiple pregnancies. About 10% pregnancies after clomiphene and 20% pregnancies after injectables are multiple pregnancies, mostly twins. After IVF-30-35% may be multiple pregnancies. Recently there is a call to accept the policy of single embryo transfer to reduce the risk of multiple pregnancies.

What is Ovarian Hyper Stimulation Syndrome (OHSS)?

OHSS   is a side-effect that can occur with ovulation inducing drugs. Your ovaries hyper respond to treatment and cause this. Ovarian enlargement and accumulation of fluid in the body cavities occurs. You may feel abdominal distension, pain, nausea, vomiting, and diarrhea. If you feel abdominal pain or distension or above symptoms you should approach your doctor. Severe cases of OHSS are however very rare (1-2% of cases).

My husband refuses to get his semen tested. He says the fact that it is thick and voluminous means it must be normal. Is that true?

Semen consists mainly of seminal fluid, secreted by the seminal vesicles and the prostate. The volume and consistency of the semen is not related to its fertility potential, which depends upon the sperm count. This can only be assessed by microscopic examination.

My sister conceived only after 6 years of marriage. Does this mean I will also have difficulty conceiving?

If your mother, grandmother or sister has had difficulty becoming pregnant, this does not necessarily mean you will have the same problem! Most infertility problems are not hereditary, and you need a complete evaluation

What about the health risks for children born following infertility treatment?

Current information shows that ART is associated with small increased risk (1.5 fold) of congenital abnormality when compared with spontaneously conceived controls ,but it is unclear whether this is related to their infertility itself or the treatment .

How important is counseling to the patient undergoing infertility treatment?

The physician helps the infertile couple find the most appropriate therapeutic path to overcome barriers to conception, but, before a treatment is started, patients need to be aware of all its aspects, including its constraints. From a psychological point of view, infertility is often a hard condition to cope with. During treatment and before a pregnancy is achieved, feelings of frustration or loss of control usually experienced by the infertile couple are likely to be exacerbated. Management of infertility includes both the physical and emotional care of the couple. Therefore, support from physicians, nurses and all people involved in treating the infertile couple is essential to help them cope with the various aspects of their condition. Offering counseling and contact with other infertile couples and patient associations can provide help outside the medical environment.

What is the duration of one IVF or ICSI cycle?

Duration of treatment varies according to the protocol used .Average duration is 2-3 weeks maximum up to one month.

I just had a HSG (X-ray of the uterus and tubes) done, and this shows my tubes are blocked. I've never had symptoms of a pelvic infection, so how could my tubes get blocked?

Many pelvic infections have no symptoms at all, but can cause damage, sometimes irreversibly, to the tubes.

My husband's sperm count varies every time we test it! How do we determine what the 'real' sperm count is?

Even a normal (fertile) man's sperm count can vary considerably from week to week. Sperm count and motility can be affected by many factors, including time between ejaculations, illness, and medications. There are other factors which affect the sperm count as well, all of which we do not understand.

What is PCOS?

Poly Cystic Ovary Syndrome or PCOS is an ovulation disorder, which affects 4-6% of all women. Several factors contribute to the disease. The cause of the disease is genetic. The major features of this syndrome are irregular or no menstruation, hirsuitism and acne due to high levels of male hormones, obesity (40-50%), high insulin levels with risk of developing diabetes and large polycystic ovaries shown on ultrasound.

 What is endometriosis?

Endometriosis is one of the most common problems that gynecologists currently face .Tissue histologically identical to the endometrium (the inner lining of the uterine wall) is present outside the uterine cavity. Usually, endometriosis is confined to the pelvic and lower abdominal cavity; however, it has occasionally been reported in other areas as well. During every cycle bleeding occurs inside the pelvic cavity also, leading to severe pain during menses and intercourse, adhesion, tubal block, and infertility .Sometimes chocolate cyst develops in ovaries.

We are trying for a baby since four years .My doctor told me my tubes are normal, uterus is normal, ovulation is occurring, and husbands semen tests are normal and all hormonal levels are normal. What may be the reason for my infertility?

Unexplained infertility is a confession to our ignorance. Fertility is a complex process and defects may be in the molecular level rather than going for the diagnosis it is better to go for effective treatments which are available.

When do you recommend freezing of semen, testicular sperm or oocyte?

Freezing the semen sample is done to preserve fertility by banking the sperm prior to cancer treatment as this treatment can cause total absence of the sperm, or chromosomal damage to the sperm .Semen cryopreservation is also advantageous if the male partner has difficulty producing a semen sample . Cryopreservation of human oocyte is not very widely available. The attention of researchers now is on developing a way to freeze ovarian tissue and after thawing, to obtain the oocyte in it. This procedure is not yet fully refined but when it is it can offer great opportunities in the future.

Intra Uterine Insemination suitable for every infertile couple?

No. It is a technique used for couples with fertility problems based on specific causes.

How tubal block does occur?

The main cause is abdominal infection. This is mostly due to sexually transmitted diseases (for example Chlamydia or gonorrhea) but complicated appendicitis or Pelvic Inflammatory Disease (PID), tuberculosis can also cause damaged tubes. Other causes are endometriosis, abdominal operations (gynecological operations, Caesarean section, sterilization or other) and internal diseases like Crohn's disease. Affected patients can have fertility problems and are at risk for having a pregnancy located in the tubes (ectopic or tubal pregnancy).

What is Cystic Fibrosis and Male Infertility?

Men who have cystic fibrosis often have a congenital anomaly in the male genital tract. The vas deferens, the tube connecting the testicle and epididymis to the ejaculatory duct, is congenitally absent. This makes it impossible for the sperms to pass through the penis. Using testicular sperm aspiration, the urologist can obtain sufficient sperm to allow excellent success with IVF and ICSI (intra cytoplasmic sperm injection).

What is Reproductive Surgery?

Reproductive surgery is a subspecialty that treats anatomical abnormalities that causes infertility. Advanced reproductive surgery requires meticulous surgical technique for optimal results, including rapid patient recovery and avoiding the need for routine hospitalization. Reproductive surgeons treat tubal obstruction, endometriosis, uterine fibroids, scarring of the ovaries or other pelvic structures resulting from pelvic inflammatory disease (PID) in the female, and varicocele and vas obstruction in the male as well as other abnormalities.

What does Laparoscopy involve?

The laparoscope allows visual inspection of the pelvic organs through a very tiny incision. Abnormalities that lead to infertility can be treated surgically through additional small incisions to remove scar tissue, laser, coagulate, or excise endometriosis, and repair tubes blocked at the fimbrial end. Many types of female reproductive surgery can be performed laparoscopically in the outpatient setting.