Infertility is not a disease but a condition where in a particular couple is not able to conceive. Infertility problems in a couple can be due to either the woman or the man, or it can be even due to problems in both partners.
We consider a couple to be infertile if:
- The female is under the age of 34 and the couple has not conceived after 12 months of contraceptive-free intercourse. 12 months has been used as the lower reference limit for Time to Pregnancy (TTP) by the World Health Organization.
- The female is over the age of 35 and the couple has not conceived after 6 months of contraceptive-free intercourse. The declining egg quality of females over the age of 35yrs is the reason for the age-based discrepancy as when to seek medical intervention.
A couple that has tried unsuccessfully to have a child for a year or more is said to be subfertile meaning less fertile than a typical couple. The couple’s fecundability rate is approximately 3-5%. Many of its causes are the same as those of infertility. Such causes could be endometriosis,, or polycystic ovarian syndrome.
Primary vs. Secondary Infertility
- Couples with primary infertility are the ones who have never been able to get pregnant.
- Whereas, secondary infertility is defined as the difficulty in conceiving after already having conceived (and either carried the pregnancy to term, or had a miscarriage). Technically, secondary infertility cannot be considered, if there has been a change of partners.
Facilities at CIMAR
Infertility & Embryology
- Psychological Counseling
- Medical Management
- Treatment for Sexual Dysfunction
- Varicocele Surgery
- Trans-Vaginal Ultrasound with Follicular Monitoring
- Saline Sonosalphingography (SSG)
- 3D/4D Uterine Scan
- Intra Uterine Insemination ( Husband & Donor)
- Semen Cryopreservation
- ICSI (Intra-Cytoplasmic Sperm Injection)
- IMSI ( Intracytoplasmic Morphologically selected Sperm Injection)
- Assisted Hatching of Embryo using Laser
- Blastocyst Culture
- Cryopreservation of Embryos & Oocytes (Eggs)
- PESA( Percutaneous Epididymal Sperm aspiration) / TESA (Testicular Sperm Aspiration)
- Micro TESA
- IVM ( InVitro Maturation)
- PGD/PGS using CGH Array ( Preimplantation Genetic Diagnosis/Screening )
- Endometrial Receptivity Assay (ERA)
Donor Treatment & Surrogacy Procedure
Surrogacy and donor egg treatment are two important facilities offered in ART treatment. We are associated with ICMR certified ART banks for Sperms, Eggs and Surrogate Mothers. We provide a comprehensive plan to intended parents including couples and singles locally and internationally.
Fertility Preservation Program
For Cancer Patients & Working Women.
- Sperm Cryopreservation
- Oocyte and Embryo Cryopreservation
- Ovarian Tissue Cryopreservation
Frequently asked questions
The prevalence of Infertility in today’s scenario?
- Generally, worldwide it is estimated that one in seven couples have problems conceiving, with the incidence similar in most countries independent of the level of the country’s development.
- Women become less fertile as they get older. For women aged 35, about 94 out of every 100 who have regular unprotected sexual intercourse will get pregnant after 3 years of trying. For women aged 38, however, only 77 out of every 100 will do so. The effect of age upon men’s fertility is less clear.
- 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 10-15% of infertile couples. After thorough medical investigations, the causes of the fertility problem remain unexplained in only a minority of infertile couples (5-10%). This is called unexplained infertility.
What are the common causes for Infertility?
Common causes of infertility:
- Ovulation Problems
- Tubal Age
- Male Associated Infertility
- Age-Related Factors
- Uterine Problems
- Previous Tubal Ligation
- Previous Vasectomy
- Unexplained Infertility
Intra Uterine Insemination
When is IUI used?
IUI may be used in some cases of male factor infertility, like low sperm counts or if a sperm donor is being used. IUI may also be used if the woman’s cervical mucus is less than ideal. Also, in cases of unexplained infertility, IUI may be tried if Clomid (clomiphene citrate) alone doesn’t help.
What is IUI?
IUI, or intrauterine insemination, is a relatively simple infertility treatment, where a small tube is used to place specially washed sperm directly into the uterus. You may know of IUI by the more commonly used term artificial insemination (AI). IUI and AI are one and the same fertility treatment.
When considering fertility treatments above and beyond fertility drug use, IUI may be the first tried. It’s easier to do than assisted reproductive technologies, like IVF, and costs much less.
How does IUI work?
As mentioned above, IUI is pretty simple. While fertility drugs are not always used during IUI, most doctors choose to use an ovulation drug like Clomid to increase the chances of success.
You will have to come for follicular monitoring to monitor your follicular growth by using a Transvaginal ultrasound. Once the follicle has reached a size of above 17mm and the endometrial thickness is more than 7mm, Inj hCG will be given for follicular maturation and rupture. The patient will be called after 36hrs to confirm ovulation
Assuming you’re not using a sperm donor, your partner will be given instructions for sperm collection .The Sperm will be washed by different techniques and the best are concentrated. This concentrated semen sample will be injected to your uterus through the cervix Transvaginal by using an IUI cannula.. Treatment is typically painless, with maybe a little cramping. It is performed in the doctor’s office, and the procedure can be done by a nurse or a doctor.
In case of Donor Sperms, healthy and intelligent voluntary donors are screened for any sexually transmitted diseases (STDs) and any known history of Genetic disorder in the family. Once all screening test are negative, they are recruited for donation and the samples are cryopreserved ( Kept frozen in Liquid Nitrogen). Before releasing it for use another batch of test are done to make doubly sure that the samples are negative for STDs. This is generally done when a man’s testes cannot produce sperms or they are not able to afford ICSI treatment.
How successful is IUI?
In a review of studies on IUI and unexplained infertility, just 4% of women got pregnant per cycle without fertility drugs, and 8% to 17% got pregnant when fertility drugs and IUI were combined.
Donor sperm Insemination has a higher success rate as much as 20-25% as the female factor are relatively normal.
Though IVF success rates per cycle are much higher, IUI is significantly less expensive, and a much easier procedure.
What are the common Indications for ART Treatment ( IVF / ICSI)?
- Bilateral Tubal
- Extensive Adhesions around the Uterus and tubes in Severe Endometriosis and Pelvic Inflammatory Diseases ( Pelvic Infections like TB)
- Loss of both tubes following ectopic gestation
- Alternate to Tubal recanalisation or recanalisation failure
- Repeatedly failed IUI
- In severe oligoasthenoteratozoospermia or refractory cases
- Unexplained Infertility
- Immunological Problems
What are the different types of assisted reproductive technology (ART)?
Common methods of ART include:-
In vitro fertilization (IVF)
In vitro fertilization (IVF) means fertilization outside of the body. IVF is the most effective ART. It is often used when a woman’s fallopian tubes are ed or when a man produces too few sperm. Doctors treat the woman with a drug that causes the ovaries to produce multiple eggs. Once mature, the eggs are removed from the woman. They are put in a dish in the lab along with the man’s sperm for fertilization. After 3 to 5 days, healthy embryos are implanted in the woman’s uterus.
Intracytoplasmic sperm injection (ICSI)
Intracytoplasmic sperm injection (ICSI) is often used for couples in which there are serious problems with the Invitro Maturationsperm. 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. Then the embryo is transferred to the uterus or fallopian tube.
Invitro Maturation (IVM)
Invitro Maturation (IVM) is a technique by which the eggs are taken out before they are fully mature and cultured outside in specific medium to make it mature outside and then ICSI is done. By this we are preventing the only dreaded complication in ART, ie OHSS (Ovarian Hyperstimulation Syndrome) which happens in few group of patients who are prone to making large number of Eggs.
Intracytoplasmic Morphologically selected Sperm Injection (IMSI)
Intracytoplasmic Morphologically selected Sperm Injection (IMSI) is a relatively new technique used to improve results in ICSI Cycles, especially in repeated ICSI failures. In IMSI sperms are selected under high magnification (7000-10000 times) and then ICSI is done. This will detect abnormalities in sperm head like vacuoles which are not seen on the conventional ICSI magnification. By adding IMSI to your ART treatment will be helping you to better our results..
ART procedures sometimes involve the use of donor eggs (eggs from another woman), donor sperm, or previously frozen embryos. Donor eggs are sometimes used for women who can not produce eggs. Also, donor eggs or donor sperm is sometimes used when the woman or man has a genetic disease that can be passed on to the baby.
What to do when the treatment fails ?
If the pregnancy test is still negative 15 to 17 days post-transfer, however, your doctor will ask you to stop taking the progesterone, and you’ll wait for your period to start. The next step will be decided among you, your partner and your doctor.
Having a treatment cycle fail is never easy. It’s heartbreaking. It’s important, however, to keep in mind that having one cycle fail doesn’t mean you won’t be successful if you try again.You will have to discuss with your doctor what will be the best option
What are chances success rates of IVF treatment?
Success rates vary and depend on many factors. Some things that affect the success rate of ART include:
- Bilateral Tubal
- Age of the Partners
- Reason for Infertility
- Type of ART
- If the egg is fresh or frozen
- If the embryo is fresh or frozen
- For women younger than 35, the percentage of live births per cycle is 39.6%.
- For women ages 35 to 37, the percentage of live births per cycle is 30.5%.
- For women ages 38 to 40, the percentage of live births per cycle is 20.9%.
- For women ages 41 to 42, the percentage of live births per cycle is 11.5%.
- For women ages 43, the percentage of live births per cycle is 6.2%.
- After age 44, little more than 1% of IVF cycles with non-donor eggs lead to live birth.
As you can see, IVF success goes down significantly after age 40. For this reason, most women 40 yrs and above use donor eggs. Success rates when using donor eggs are not as dependent on the woman’s age.
The percentage of live births per cycle when using donor eggs is 55.1% with fresh embryos.
It’s interesting to note that IVF success rates with donor eggs are even higher than a woman younger than 35 using her own eggs. Donor eggs offer the best chance for success.
The average IVF cost is 1.3 lakhs, but it can be as much as 1.75lakhs. It may be as low as 1 Lakh, but it’s rarely lower than that. These prices are for one cycle of IVF.
How much will an IVF Treatment Cost?
If a fertility clinic tells you that their IVF costs less than 1 Lakh, they are probably leaving something out from their price quote. Ask them if their price quote includes everything, including fertility drug purchases, ultrasound and monitoring costs, blood work, and any options they consider “extra”.
If you have frozen embryos from a previous cycle and want to use them, doing so is significantly cheaper than doing a complete IVF cycle with fresh embryos. The average cost for a frozen embryo transfer (FET), is about 40-50,000 Rs.
While basic IVF costs around 1.5 – 2 lakhs INR, if you need additional assisted reproductive technologies like IVM,IMSI,PGD etc, the cost will be higher.