- What is Infertility?
- 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. Couples who have known barriers to fertility, such as endometriosis, polycystic ovarian syndrome, male infertility, irregular cycles, etc., do not need to sit out the traditional "waiting period" to seek expert care for infertility. With IVF developing and advancing in India, these couples have in their hand treatment for infertility.
- Who is the Candidate for IVF (In-Vitro Fertilization) and ART?
- Assisted reproductive technology in India includes IVF, which is the technique of fertilizing a woman’s egg in the laboratory. While it was designed originally for women with tubal diseases, IVF has been extended with equal success as treatment of infertility due to endometriosis, poor cervical mucus, unexplained factors and male infertility.
- What should I expect?
- IVF in India is a complex process consisting of several steps. First, fertility drugs are given to stimulate the ripening of several eggs. Blood test and ultrasound examination allow for precise monitoring of egg development. At the appropriate time, the eggs are retrieved under light sedation or anesthesia. The sperm is then added to the eggs in the laboratory where the fertilized eggs develop for 2-3 days. In case of micromanipulation for male infertility a single sperm is injected into egg ICSI (Intra cytoplasmic sperm injection). Finally, the embryos (fertilized dividing egg) are placed in the womb by a simple non-surgical procedure similar to a pelvic examination. A mock embryo transfer is done during the IVF process at IVF India prior to starting the cycle to ensure that we do not encounter any unexpected problem on the day of the actual embryo transfer. Two weeks after embryo transfer, a pregnancy test is done. At IVF India all this is done on an outpatient basis.
- How many times in a cycle will I have to come to the clinic?
- At IVF India we do not encourage unnecessary travel to the clinic. However, this varies from patient to patient and also with the stage for treatment. In a DI or IUI (H) cycle, for example,the likely number of out-patient visits for monitoring is 2-4, for IVF of ICSI 4-5. During these visits egg and endometrial development are checked. Some blood tests may be advised to assess egg maturity and decide on the drug dosage.
The first visit is on day 2/3 of the cycle. At this visit an ultrasound is done at IVF India to rule out any residual ovarian cysts and to check for endometrial thickness. Drug administration is withheld in case these parameters are not within the required limits.
Egg recovery is generally carried out under anesthesia unless you opt to have it under sedation and requires you to be in hospital for half a day. For embryo transfer you are required to come in at IVF India with a full bladder and you will be asked to rest for couple of hours at IVF India Centre after the transfer. - Why should I seek treatment from a Reproductive Endocrinologist rather than from my OB/GYN?
- Picking a doctor is so very important. A board certified Reproductive Endocrinologist (RE) is an Obstetrician-Gynecologist with advanced education (a mandatory three year fellowship) and research in Reproductive Endocrinology. At IVF India we have team of doctors lead by one of the best IVF doctors, Dr. Ila Gupta. These highly trained and qualified physicians treat Reproductive Disorders at IVF India that affect children, women, men, and the mature woman. (Portions of the above were taken from IVF INDIA Glossary). They are certified with the American Board of Obstetrics and Gynecology in the Sub-Specialty of Reproductive Endocrinology and Infertility. It is important to find a doctor who is responsive and well matched to your needs and diagnosis. At IVF India each patient is given a personal mobile number of the assistant who can be contacted in case of any requirements. Most importantly, a reproductive endocrinologist specializes in treating infertility, and is far more likely to have the experience necessary to identify and treat your problem than an OB/GYN who treats only a few infertility cases each year. We at IVF India hear a lot of "I wish I hadn't spent all that time and money with my OB/GYN." It can be a tremendous waste of time, and money that you could put toward treatment with a specialist who cannot get to the root of your problem.
- How long does it take to ovulate after the first positive result on the OPK (Ovulation Predictor Kit)?
- At IVF India average time to ovulate is 12-48 hours after the positive result on your OPK. But at IVF India we prefer to have follicular monitoring through Transvaginal scan which is more reliable method to check for ovulation. At IVF India follicular monitoring starts from D10/D11 of cycle and ovulation is confirmed through TVS.
- How long after HCG does ovulation occur and how do we know?
- In most of the cases that we deal at IVF India ovulation occurs 36-40 hours after the HCG injection. But follicle can rupture any time once the follicle size reaches 16 – 18 mm as the LH hormone can reach to peak before giving HCG also .
At IVF India we do an IVF observation to find it out. At IVF India we have observed that eggs will release in this timeframe if they have not been retrieved. - How long do sperm live after timed intercourse or after IUI?
- Normal, healthy sperm live approximately 48-72 hours. (Abnormal sperm may have a shorter life, which may vary according to sperm health.) At IVF India we know that washed sperm can survive in the IVF incubator for up to 72 hours. That would be considered the upper practical limit.
- How long are eggs able to be fertilized?
- Eggs are able to be fertilized for about 12-24 hours after ovulation. The older the woman, the shorter this time becomes.
- How long does it take for fertilization to occur?
- Fertilization occurs within 24 hours after ovulation.
- How long does it take for implantation to occur?
- Implantation occurs about 5-07 days after ovulation.
- How soon can I take my Pregnancy Test (Beta HCG or Home Pregnancy Test)?
- At IVF India we advise patients that the earliest that a sensitive blood test can pick up any HCG at all is 12 – 14 days after ovulation. Extremely sensitive home pregnancy tests might in some cases be reliable as soon as 14-16 days of ovulation .
- How do you determine the first day of your cycle?
- CD1 is the first day you see a red flow, not just intermittent spotting. There Is no universal rule for the cutoff time for that date. Some doctors use midnight as cut off, but at IVF India CD1 is considered the first day of full flow .
- What should my progesterone level be?
- Progesterone will be less than 1.5 Ng/ml until the LH surge. At IVF India we have observed that it peaks about seven days after ovulation, when it reaches 15 Ng/ml or more. Additionally, you may get very high progesterone levels after IVF because so many follicles were created. (Progesterone is made by the corpus luteum, which is the site on the ovary from which the egg is released). There is no progesterone level that indicates pregnancy.
- What should be the blood E2 level during mid cycle ?
- It should be 150-200 pg/ml per mature follicle.
- What should my uterine lining be at ovulation and at implantation?
- As you approach your LH surge, it should be above 6 mm, ideally between 8 and 12 mm.
- I have just had a 3-day FSH test taken, and I am concerned about the results.
- FSH is more of an indirect measurement of an ovarian reserve. Usually it should be <10. If it is more then it indicates poor ovarian reserve . Better indicator to check for ovarian reserve is Anti mullerian hormone which is preferred at IVF India and can be done on any day of the cycle.
- How do we know if the sperm count is adequate for IUI?
- Besides the number of sperm, the percentage with rapid forward-progressive motility and with normal morphology at the time of insemination are important to know. If the functional sperm count (number with normal morphology and rapid forward-progressive motility) exceeds 10 million; chances for pregnancy with well-timed IUI are excellent.
- I am concerned about the size of my follicles, and the timing of my HCG shot. How big should my lead follicle be before I take my HCG shot?
- A lead follicle should be at least 16 mm on an HMG cycle , it should be at least 18 mm on a recombinant , and should be about 22 mm on Clomid, but the size of the follicle is the not only criteria to decide for the HCG shot. At IVF India besides follicile we also use other measurements such as E2 and LH should be used to indicate maturity of the egg developing inside the follicle.
- How much do follicles grow each day?
- Follicles grow 1 to 2 mm a day both while taking ovulatory stimulants and after the HCG shot.
- Will smaller follicles "catch up" in time to release eggs?
- Follicles generally need to be at least 15-16 mm to contain fertilizable eggs (although it is possible in rare cases for follicles to be as small as 14 mm and still contain fertilizable eggs). If the smaller follicles are close in size to the lead, they may "catch up" and release. HCG will usually result in most mature follicles releasing eggs. Otherwise, most likely only the lead follicle will ovulate.
- I have left over cysts in my ovaries. Will they go away?
- A corpus luteum, or functional cyst, is simply a leftover follicle that has outstayed its welcome. Some continue to produce progesterone and estrogen, which may delay the arrival of the next period.
- How big the cyst size to be to reduce chances of pregnancy?
- From the large number of patients that we have done at IVF India it is observed that anything under 10 mm shouldn't be cause for concern as long as your baseline hormone levels are in range.
- How long should I use Clomid before I move to Injectables/IUI?
- The vast majority of Clomid pregnancies occur during the first 4-5 ovulatory cycles. Some physicians also indicate that of those pregnancies, the majority occur during the first 3 attempts. The average number of cycles on Clomid before moving on is three to six depending upon the age of the patient and its response.
- How many times should I try IUI before moving on to IVF?
- Once a patient has had 3-6 IUI cycles , they might consider moving to IVF as the chance of a successful IUI cycle is reduced.
- What is the maximum recommended dosage for Clomid?
- The maximum dosage is 150 according to manufactures. At IVF India we do not prefer to give more then 100mg , as the risk of antiestrogenic side effects of Clomid increase sharply as the dosage goes up.
- Should I be taking Clomid on days 2-6 or on days 5-9?
- If taken from day 2 to day 6 of cycle leads to development of more follicles and fewer side effects on the lining and the mucus.
- What are normal ranges in a semen analysis?
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Volume >1.5ml Colour Greyish Opalescent Liquefaction Complete Viscosity Normal Ph >7.2 Concentration >15x10^6 per ml Motility 30-35% Normal Morphology atleast 4% Fast Progressive Sperms 20% Semen Culture Sterile - What is Sperm DNA Fragmentation Test and what are its utilities?
- Sperm DNA Fragmentation (SDF) is an important piece of information about seminal quality. An SDF value that exceeds a threshold value of 30% suggests sub-par sperm quality. The SDF value confers clinicians the power to make informed decisions in their daily practice and take action based on quantitative results. It is an established fact that the quantitative results it is an established fact that the probability of pregnancy is more if fragmentation is low.
Applications:
- Unknown etiology fertility failure
- Embryo loss.
- Repetitive miscarriage
- Best donor selection
- Selection of best seminal samples prior to vasectomy or oncology treatment.
- To distinguish which couple are suitable for treatment by IUI.
- To assess the efficacy of medical interventions or treatment of infectious diseases and varicocele. - Why would my physician mix my Clomid treatment with injectables?
- Mixing injectables and Clomid is an attempt to get some of the stimulant, cervical mucous, and lining benefits of injectables without spending as much money as would be required by doing only injectables.
- I have heard that Clomid is not recommended for women over 40. Why?
- There are As women pass 35, many doctors do begin to be more cautious about using it for a couple of reasons. At IVF India we see that one, women approaching 40 tend to have more lining problems and Clomid can have deleterious effects on the lining. Secondly, if a woman is perimenopausal, the mechanism by which Clomid works is not always effective, because the body is somewhat inured to low Estradiol levels.
- How long should my partner abstain before the IUI? His semen analysis is normal.
- we at IVf India don’t advice any abstinence during fertile period even if IUI is planned as it is not going to compromise the sperm count and motility.
- How should my IUIs be timed?
- In most cases, doctors who do two IUI's do the first about 24 hours after the HCG shot and the second about 48 hours after the shot. Some studies have shown that doing one IUI about 36 hours after the HCG is equally effective. However, some recent research suggests that higher pregnancy rates may be achieved by doing two IUI's, one at 12 hours past the HCG shot and one at 34 hours, that is what is being followed at IVf India.
- What are the risks of ART?
- The associated reproduction procedures have so far proven remarkably safe for both – ‘would be’ mother and her child. The Spontaneous abortion rate is slightly higher than in the general population. This is not related to the procedure, it is due to inherent problems with the patient that led to infertility in the first place . There is an increased chance of multiple births, which can be limited by the number of embryos transferred. There is no difference in the delivery –vaginal /caesarian section, if all routine parameters are normal.
- What are the risks for assisted conception pregnancies?
- The risk of abnormalities does not appear to be significantly greater than with natural conception. With procedures like ICSI there is an increased risk of sex chromosomes related anomalies. The reason for this is that in patients with severe male factor infertility the abnormality existing in the male partner is carries forward. It is important to note that some techniques are very new and detailed follow up data is not yet available.
- Is there an increased risk of malignancy?
- Current knowledge does not show any definite increase in malignancy. The scientific committees’ worldwide are constantly looking into this and we will keep updated as to the results. Women in whom there is a family history of ovarian malignancy should limit the exposure to ovarian stimulation drugs.
Tubal Surgery
Before IVF became available, tubal surgery was the only way to correct tubal problems. These days surgery of the tubes has a limited place in the management of the infertile couples. However, in selected cases this procedure is invaluable and both tubal microsurgery and endoscopic (key-hole) surgery. - I heard that multiple cycles with fertility drugs increase the chance of getting ovarian cancer. Is this true?
- No. There is no evidence that shows a statistically significant increase in the ovarian cancer risk and even at IVF India we have not observed anything like that.
- My doctor has recommended a hysteroscopy, laparoscopy, or folloposcopy. Where can I get more information?
- IVF INDIA has an excellent fact sheet on Reproductive Surgeries. You can mail your detailed query at info@ivfindia.net
- Do your chances increase with each consecutive cycle?
- Yes, each cycle is independent. Chances increase with each cycle but after three failed cycles, the chances of concieving reduces and the doctor has to look at other options.
- How many attempts should we have?
- Every couple is different and the answer to the question will inevitably depend on the specific treatment you have had and the result of preceding treatment cycles. It is believed that IVF success optimizes in three cycles. Decision on how to proceed will be discussed indetails with you during your consultation at IVF India or at a review appointment with Dr. Ila Gupta at IVF India.
- What happens if treatment is not successful?
- At IVF India you can be rest assured that we shall make every endeavor to care for you and to help and to help you cope. ART has made tremendous progress in the last few decades and there will certainly be a treatment, which would benefit you.
- I am concerned about the nature of my discharge during treatment cycles.
- Usually fertile mucous is clear and very stretchy -- similar to egg whites seen during very ovulatory period. Often women are not even aware of it, as most of it tends to stay up by the opening of the cervix. You generally cannot predict ovulation, success, or lack of success based on cervical mucous or presence of a discharge when on ovulatory stimulants. Also, progesteron vaginal suppositories prescribed after ovulation can create orange or brown discharge in normal situations. However, any unusual spotting or discharge needs to be checked by your physician.
- Is it safe to take over the counter (OTC) drugs during treatment?
- Over the counter drugs can have significant effects on various systems. At IVF India we stress that you consult your physician before taking an OTC drug during your treatment cycle. This includes herbal remedies and vitamins.
- I am afraid that I might have ovarian hyperstimulation. What can you tell me about this?
- First, if you are concerned about the possibility of OHSS you should call your clinic as soon as reasonably possible. OHSS (Ovarian HyperStimulation Syndrome) is when you have an unusually large number of mature follicles that release. When these follicles release, there is an unusually high concentration of estrogen-rich fluid in the peritoneal cavity, and the ovaries are generally enlarged far beyond their usual plum size - in some cases, they can swell to softball size. In milder cases, women experience bloating and some pain from the oversized ovaries. The treatment then is just a matter of rest and staying well hydrated. In more severe cases, the estrogen in the peritoneal cavity causes fluid to leak out of the circulatory system into the peritoneal cavity. This can cause marked discomfort and bloating, and can cause difficulty breathing due to pressure on the diaphragm. In the most severe cases, the leaking of the fluid will lead to hypovolemic shock and organ damage because of a lack of perfusion. Although there are exceptions, generally you do not see severe OHSS until the Estradiol gets into the 5000+ range. Mild hyperstimulation can occur at lower levels. As long as your doc keeps a close eye on your dosage and development, the chances of anything other than mild discomfort (especially on a non-IVF cycle) are minimal. The best pre-ovulation predictor of hyperstimulation is the E2 level, but it is not a perfect predictor. If you experience symptoms of OHSS, you should always play it safe and check with your doctor.
- I have spotted, and it is not time for my period. Was it implantation spotting?
- Implantation spotting is the exception rather than the rule. Sometimes the procedures themselves can irritate the cervix and cause light brown spotting afterwards. Sometimes when the uterus shifts from being estrogen to progesterone dominant you will get a little bit of spotting. Light spotting can be normal, but contact your physician with any concerns.
- What constitutes early or late ovulation? Does late ovulation decrease fertility?
- There is not complete agreement on this. You might consider "too early" to be cycle day 10 and "too late" to be cycle day 20. There are two problems with late ovulation. The first point is that you obviously you have fewer chances (less ovulation) over a given time period. Second is the fact that with late ovulation you may be releasing eggs that have not been matured properly. It is also possible that the other parts of the reproductive system (hormone levels) are not in sync with the egg. That is not to say you cannot conceive if you ovulate late---it happens all the time. It is just that your chances are somewhat reduced.
- My doctor says I am not ovulating regularly. How could I get my period if I do not ovulate?
- Menstruation only requires development and shedding of the endometrium in response to alternating levels of estrogen then progesterone in the blood stream. These hormones can be produced by the ovary even when an egg does not mature or release.
- How will I come to know how many eggs am I going to produce when stimulated or what is my Ovarian reserve ?
- Ovarian reserve can be checked through blood test for FSH and LH hormones on Day 2 / Day 3 of cycle . If FSH is more then 10 , it indicates poor ov. Reserve . The better indicator is AMH. The no. of eggs a lady is going to produce can be known ultrasound by antral follicle count or AMH value. IF AMH is < 1, indicates poor ovarian function.
- What causes chemical pregnancies?
- Many early pregnancy failures are due to genetic abnormalities, mainly "trisomies" where an extra chromosome is present in what should be a pair. Some pathologists believe that the earlier the failure occurs after implantation, the more likely it is to be genetic. You can also have implantation problems that would cause chemical pregnancies such as hypercoagulation, failure to form the needed blood vessels, or autoimmune issues.
- I have questions about special precautions during treatment. Should I avoid exercise after ovulation?
- There is no such special precaution. Avoid eating junk foods, papaya & pineapple. Normal routine activities can be followed.
- Should I avoid air travel or ground travel after my transfer?
- At IVF India we don't prohibit travel but just advise not to overdo it. Air travel is fine as long as the pressure is maintained, which it generally is in commercial aircraft.
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We provide comprehensive IVF services, all under one roof, so you don't need to shuttle from clinic to lab to the scan centre. Besides being cost effective, we provide comprehensive services at a fixed price. The advantage of a fixed - charge treatment package is that you don't have to pay extra for every little thing.
Contact Us
Contact us from the contact form or directly at our centre at the address given below.
| Address: | IVF India, Sector-51, Gurgaon-122002 |
| Mobile: | 91-9811456056 /91- 9958222443 |
| E Mail: | info@ivfindia.net, ila_gupta007@yahoo.co.in |