on the production of healthy sperm by the man and healthy eggs by the woman Normal unblocked fallopian tubes that allow the sperm to reach the egg around ovulation (when the egg is released) the sperm’s ability to fertilize the egg when they meet the ability of the fertilized egg (embryo) to implant in the woman’s uterus; and optimum embryo quality finally, for the pregnancy to continue to full term (9 months), the embryo and fetus must be healthy and the woman’s health and hormonal environment adequate for its development When just one of these factors is impaired, infertility can result.

Primary infertility is the condition observed in a couple who have never had a child. On the other hand, Secondary infertility implies the failure to conceive following a previous pregnancy.

It’s an idiocy to consider that infertility is just a female disease. In rough terms, about one-third of infertility cases can be attributed to male factors, and about one-third to factors that affect women. For the remaining one-third of infertile couples, infertility is caused by a combination of problems in both partners or, in about 10 – 15 percent of cases, is unexplained.

The most common male infertility factors include azoospermia (no sperm cells are produced) and oligozoospermia (few sperm cells are produced). In some men the outflow tract for sperm passage may be blocked due to congenital absence or secondary to surgery / trauma and this may cause azoospermia. Sometimes, sperm cells are malformed or they die before they can reach the egg. In rare cases, infertility in men is caused by a genetic disease such as cystic fibrosis or a chromosomal abnormality.

The most common female infertility factor is an ovulation disorder (problems with egg release). Other causes of female infertility include blocked fallopian tubes, which can occur when a woman has had pelvic inflammatory disease, surgery on her abdomen or pelvis and endometriosis (a condition causing adhesions, scarring and cysts). Congenital abnormalities (birth defects) involving the structure of the uterus and uterine fibroids are associated with repeated miscarriages.

No. Fertility treatments such as IVF, ICSI etc are not covered by insurance companies. However, certain baseline pre-treatment surgeries for associated co-morbidities might be covered, e.g. surgery for pelvic pain, adhesions associated with endometriosis or pelvic inflammatory disease which also subsequently result in infertility.

About 1 in 3 couples achieves a pregnancy with IVF treatment. The average live delivery rate or live birth rate for IVF in 2005 was 31.6 percent per retrieval–a little better than the 20 per cent chance in any given month that a reproductively healthy couple has of achieving a pregnancy and carrying it to term. In 2002, approximately one in every hundred babies born in the US was conceived using ART and that trend continues today. The younger the woman the better the chance her conceiving a child as egg quality is an extremely important factor. Thus one sees a decline in pregnancy rates even with IVF as the woman crosses the age of 35 years. Beyond 40 years of age the realistic chance of a woman achieving a pregnancy even with IVF is ? 5%.

The average cost of an IVF cycle in India is around 1.5 – 2.5 lakhs and expensive like other extremely delicate medical procedures since it involves highly trained professionals with sophisticated laboratories and equipment, and the cycle may need to be repeated to be successful.

The purpose of ICSI is to assist the fertilization process when a man’s sperm count is abnormal (i.e., very low and with poor motility). Whether it is because the number of motile sperm is very low or the morphology is excessively poor, the technique involves the delivery of a single sperm into a single egg. Since its inception, it has revolutionized the treatment of male infertility.

Most doctors will recommend ICSI if there is a fear that poor fertilization may occur by traditional IVF where sperm are merely added to the egg culture dish. Accordingly, efforts are made to assess sperm by function or morphology to help determine those most likely to need ICSI. It may also be recommended in the 2nd cycle of treatment should the first attempt with standard IVF procedure help to achieve fertilization in the laboratory

The first and second parties involved in a pregnancy are the male and female couple wishing to become parents. The three principle components required to achieve a successful pregnancy are a healthy egg, sperm and uterus. If any of these components are absent, then an option is to have a third party, or someone besides the couple, become involved. Third-party reproduction is when a couple uses a sperm donor, egg donor or a gestational carrier to help them become parents.

A principle limitation to human reproduction is the natural loss of healthy eggs as a woman ages. At birth, a woman is born with her total reserve of eggs – no more are created. Over her lifetime, waves of them degenerate through a natural process of atresia so that by her mid thirties, we begin to see a greater difficulty to achieve a pregnancy and a higher chance of chromosomally affected children. By her early forties, the majority of women experience infertility and eventually a loss of reproductive capacity. This is due to the eventual loss of her remaining healthy eggs.

Egg donation, like sperm donation, is a means to realize parenthood when the loss of gametes (i.e., egg or sperm) occurs. This may be due to the natural process of aging or may occur prematurely from other diseased states or because of medical treatments for cancer, for example. When gametes are depleted, replacement by egg donation is a wonderful option to enable one to become a parent. Once a patient has chosen to pursue egg donation, the process typically involves coordination of their two menstrual cycles so that the eggs may be retrieved, fertilization by the sperm of the patient’s partner and transfer into the patient’s womb can occur during the same month. The egg donor treatment cycles rate among the highest success in assisted reproduction

There are many young women who want to help others overcome infertility. They serve as egg donors by expressing interest and then going through a rigorous screening process to ensure they are appropriate candidates. Typically, they provide a detailed health history of themselves and genetic history of their ancestors. Medical and psychological evaluations are performed, in addition to FDA mandated infectious disease testing (e.g. Hepatitis, HIV, syphilis etc).

Infertility often creates one of the most distressing life crises a couple has faced. The long-term inability to conceive a child can evoke significant feelings of loss. Coping with the multitude of medical decisions and the uncertainties that infertility brings can create great emotional upheaval for most couples. Many couples experience anxiety, depression, and feelings of being out of control or isolated.

Everyone has feelings and emotional ups and downs as they pursue infertility treatment. Feeling overwhelmed at times is a perfectly normal response. However due to the following symptoms over a prolonged period of time, a psychological counseling is highly advisable: loss of interest in usual activities depression that doesn’t lift strained interpersonal relationships (with partner, family, friends and/or colleagues) difficulty thinking of anything other than your infertility high levels of anxiety diminished ability to accomplish tasks difficulty with concentration change in your sleep patterns change in your appetite or weight (increase or decrease) increased use of drugs or alcohol thoughts about death or suicide social isolation persistent feelings of pessimism, guilt, or worthlessness persistent feelings of bitterness or anger

Mental health professionals with experience in infertility treatment can help a great deal. Their primary goal is to help individuals and couples learn how to cope with the physical and emotional changes associated with infertility, as well as with the medical treatments that can be painful and intrusive. By teaching patients problem- solving strategies in a supportive environment, mental health professionals help people work through their grief, fear, and other emotions so that they can find resolution of their infertility.

Fibroids are benign or innocent tumours that occur or grow in the muscle of the womb (uterus). Fibroids occur in 5.4 – 77% women They are 9 times more common in Afro-Caribbeans with some familial tendency Fibroids are the sole factor of infertility in < 10% of cases

Fertility may be affected by large fibroids, cervical fibroids (those that are in the neck of the womb or uterus) and fibroids near the tubal ostia (opening of the fallopian tubes into the uterus) Other factors that can lead to infertility or implantation failure in presence of fibroids are: Focal disturbance in the blood supply to the lining of the uterus Inflammation of the lining of the womb Secretion of vaso-active substances e.g VEGF, epithelial growth factor within the uterine cavity Increased uterine contractility

Surgical removal of fibroids is termed as “Myomectomy”. This procedure can be performed either through open abdominal surgical technique or endoscopically (via either the hysteroscope or laparoscope). Surgery for fibroids is indicated if the presenting complaints are: Menorrhagia (heavy menstrual periods) Significant dysmenorrhea (very painful periods) Pressure symptoms (fibroids pressing on bladder or bowels leading to frequent urination or constipation and painful opening of bowels) Infertility (Recurrent) pregnancy loss Preterm labour Trials have indicated that surgery for fibroids is effective irrespective of the route of surgery (open/ laparoscopic). The operating times and pregnancy rates following surgery are comparable with both techniques; the only difference being a slight reduction in the length of stay in the hospital with keyhole (laparoscopic) surgery.

The doctor will obtain a detailed history and conduct a physical examination of both partners to determine their general state of health and to evaluate physical disorders that may be causing infertility. Usually both partners are interviewed about their sexual habits in order to determine whether intercourse is taking place properly for conception. If no cause can be determined at this point, more specific tests may be recommended. For women, these include an assessment of ovulation, hormone tests for egg reserve, x-ray of the fallopian tubes and uterus, and laparoscopy and dye test. For men, initial tests focus on semen analysis.

Most infertility cases (85% to 90%) — are treated with conventional therapies, such as drug treatment or surgical repair of reproductive organs or Assisted Reproductive Technology procedures (IVF, GIFT, ZIFT, and combination procedures).

Assisted reproductive technology is the treatment or procedure that involves the in vitro handling of human Oocyte and sperm or embryos for the purpose of establishing a pregnancy. Some of the ART services include Donor Insemination or Donor IUI (DI or DIUI), Intra-Cytoplasmic Sperm Injection (ICSI), Intra-Uterine Insemination (IUI), In Vitro Fertilization (IVF), and Embryo donation.

No. Fertility treatments such as IVF, ICSI etc are not covered by insurance companies. However, certain baseline pre-treatment surgeries for associated co-morbidities might be covered, e.g. surgery for pelvic pain, adhesions associated with endometriosis or pelvic inflammatory disease which also subsequently result in infertility.

IVF is also popularly known as test tube baby. In infertile couples where women have blocked or absent fallopian tubes, all basic infertility treatments have failed to help achieve a pregnancy or where men have low sperm counts or no sperm, 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. IVF accounts for more than 80% of ART procedures in India. IVF is not just an infertility treatment but also a diagnostic test as it helps identify couples where there is problem in sperm- egg interaction.

In IVF, the ovaries are stimulated to grow more than one egg with the help of hormone injections initially. The egg growth through this phase is monitored with the help of ultrasound scans and blood tests. Once the eggs grow, they 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 17- 20 hours, the eggs are examined to see if they have become fertilized by the sperm and are dividing into cells. These fertilized eggs (embryos), generally 1 or 2 are then placed in the women’s uterus at the correct time to achieve a pregnancy. This procedure thus helps bypass the fallopian tubes.

Surgical removal of fibroids is termed as “Myomectomy”. This procedure can be performed either through open abdominal surgical technique or endoscopically (via either the hysteroscope or laparoscope). Surgery for fibroids is indicated if the presenting complaints are: Menorrhagia (heavy menstrual periods) Significant dysmenorrhea (very painful periods) Pressure symptoms (fibroids pressing on bladder or bowels leading to frequent urination or constipation and painful opening of bowels) Infertility (Recurrent) pregnancy loss Preterm labour Trials have indicated that surgery for fibroids is effective irrespective of the route of surgery (open/ laparoscopic). The operating times and pregnancy rates following surgery are comparable with both techniques; the only difference being a slight reduction in the length of stay in the hospital with keyhole (laparoscopic) surgery.

I’m not ready for kids; why should I care about infertility?
You may hurt your chances of ever having children in future just by your behaviors that you engage in before you are ready to have children. It may be too late, if you wait to consider your fertility until you’re ready for a family.

What can I do? Avoid Risky Behaviors
SMOKING – You are most likely aware of many potential health risks associated with smoking; but you probably don’t know the impact that smoking leaves behind your ability to conceive. In fact, over 15% of female infertility is caused by cigarette smoking. Women who have the habit of smoking are prone to have Menopause (ovarian failure) about two years earlier than expected.

Quitting smoking will not only benefit your health and lengthen your life; it also will help protect your fertility.

WEIGHT –
Little known fact is that both excess and deficiency of body fat can lead to infertility. As much as 12% of infertility cases are a result of women either weighting too little or too much.

To protect your chances of conceiving, maintain a healthy weight through proper nutrition and exercise.

SEXUALLY TRANSMITTED INFECTIONS –
Practicing safe sex might not get you pregnant. Little known fact is that not using a condom now may lead you to never get pregnant in the future. Sexually transmitted infections (STIs) such as Chlamydia and gonorrhea are a leading cause of female infertility as they cause tubal block and often have no symptoms. These STIs can be prevented by regular use of condoms.

If you want to improve your chances of having a baby in the future, practice safe sex now.

AGE –
Recent socioeconomic trends such as 1) later age at first marriage 2) increased level of education and 3) increased percentage of women employed outside the home have greatly influenced the tendency for a woman to delay childbearing. One should understand that it is a biological fact that there is a decrease in fertility with advancing age. Though women and their partners have the luxury to decide the best time to have children, women in their twenties and early thirties are most likely to conceive. Even the fast advancing medical science cannot undo the effects aging on infertility.

What else can you do?
Visit your gynecologist annually. In addition to cancer detection, you can also protect your fertility.

Listen to your body – if you have irregular or painful menstrual cycles, your body may be trying to tell you something. Consult your doctor.

I’m a guy; isn’t this a women’s issue?
It’s an idiocy to consider that infertility is just a female disease. In fact, new studies show that male infertility accounts for nearly third of all diagnosed cases of infertility either as the sole cause or a contributing cause of infertility.

What can I do? Avoid Risky Behaviors STEROIDS, SMOKING AND ALCOHOL –
It’s known that drugs such as steroids, cigarettes, marijuana and alcohol can negatively impact your health in many ways; and it also greatly affect your virility, leading to abnormally shaped sperm, decreased sperm motility and/or decreased sperm production.

To improve your chances of conceiving in the future, avoid drugs now.

EXPOSURE TO HEAT –
While it may sound peculiar, prolonged exposure to high heat, such as that of a hot tub, can affect your fertility by lowering sperm production. In addition, men whose occupations require long hours of sitting or who wear heat retaining clothes also experience decrease sperm production.

To protect your fertility, avoid prolonged exposure to direct heat.

SEXUALLY TRANSMITTED INFECTIONS –
Sexually transmitted infections (STIs) don’t just affect a women’s fertility. STIs such as Chlamydia and Gonorrhoea are a leading cause of male infertility too and often have no symptoms, and can be prevented by regular use of condoms.

If you want to improve your chances of having a baby in the future, practice safe sex now.

What Else Can You Do?
Listen to your body. If you’ve been exposed to an STI, see your doctor immediately. If you have an undescended testicle or loss of testicular size, swelling around your testicles, consult your doctor. Fertility is something that you should start thinking about as early as possible. Begin a dialogue about this with your doctor early.