Frequently Ask Question

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Infertility is difficulty in conceiving a pregnancy. This general term does not identify the cause of the problem or whether it will be permanent.

Often, physicians and researchers consider a couple to have infertility if they have not conceived, despite regular intercourse without using birth control, for at least a year. Fifteen to 20 percent of couples will not conceive despite a year of trying. However, this does not mean that they will not conceive later on, even without treatment. Some investigators consider two years without conception to be a better indicator of a couple's need for assistance.

More than 90 percent of couples will have achieved a pregnancy within two years.

When an individual has no chance to conceive without treatment (for example, a woman does not ovulate or has two blocked fallopian tubes), it is sometimes called sterility.

In the past, infertility was commonly considered to be solely a female problem. It is now recognized that a couple's infertility is just as likely to stem from problems in the male partner. After couples with infertility undergo testing, about 40 percent of the cases are found to stem from female factors and another 40 percent from male factors.

In 10 percent of couples, infertility factors are found in both the man and woman. In the remaining 10 percent, the infertility remains unexplained after testing.

Because either or both may be involved, it is important to test both the man and woman before starting treatment. No matter what the cause, most treatments require the active participation of both partners.

Yes. Secondary infertility is the name given when the problem arises in a couple who have been able to get pregnant in the past. Sometimes a new factor, such as an infection, has damaged the reproductive organs since the last child was born. Sometimes the aging process makes it more difficult for a couple to conceive, even if they had no problems when they were younger.

Secondary infertility is even more common than infertility in couples who have never achieved a pregnancy.

Generally, the diagnosis and treatment is the same. However, couples with secondary infertility may make different treatment choices as they take into account the needs of their other children. Overall, treatments are somewhat more likely to work in women with secondary infertility than in women who have not previously become pregnant with the same partner.

Couples with secondary infertility may wish to seek emotional support specifically geared to their concerns. These couples often report that they feel caught between two worlds. They feel alienated from those who easily create families of the size they want, while at the same time they are envied by childless people with infertility.

"My first baby was born at 36 - no problem. I got pregnant the first try. But, three years later, I didn't get pregnant." Secondary infertility PATIENT

However well-intentioned, the statement "just relax and you'll get pregnant" has been very hurtful to couples with infertility. Two decades ago, researchers thought that almost half of infertility in women could be attributed to stress and psychological factors. Nowadays infertility is better understood, and stress is recognized primarily as a result, rather than a cause, of fertility problems. However, there is evidence that stress can have a negative impact on sperm and egg production. Research is ongoing to help understand how stress may influence fertility and the success of treatment.

Sometimes. By learning about the known causes of infertility, young men and women can reduce the risk that they will face this challenge when they decide to start a family. Some strategies for prevention:

Take precautions (such as the use of condoms) to avoid sexually transmitted diseases (STDs). STDs, particularly gonorrhea and chlamydia, can infect the reproductive tract and cause blocked fallopian tubes or sperm-carrying ducts.

Seek prompt treatment for potential STDs. STDs cause more harm to fertility if they are untreated or not completely treated.

When selecting a birth control method, learn about its possible impact on future fertility and make that an important factor in your decision.

Make medical decisions with fertility in mind. Inquire about the impact of medications, including herbal supplements, on reproduction in men and women. If you develop a gynecologic condition, such as a uterine fibroid, endometriosis, or abnormal Pap smear, ask which treatments are most likely to preserve your fertility.

Make fertility-enhancing lifestyle choices. In men, excess heat exposure can lower fertility. Cigarette smoking is associated with an abnormal semen count in men. In women, smoking can reduce fertility and raise the risk of miscarriage. Being underweight, losing weight rapidly, or exercising at an extreme level can impair fertility in both men and women. In women, obesity is also associated with lower fertility. For some couples, changing exercise habits or achieving a more healthful body weight leads to conception with no medical treatment.

Allow sufficient time to attempt conception. Many infertility factors do not make it impossible to conceive but lower the chance with each cycle. This lengthens the amount of time conception is likely to take. If you do not try to become pregnant until late in your reproductive years, or if you count on conceiving within a short time period, you are more likely to be unsuccessful and to assume you need medical help - even if you might be capable, given enough time, of conceiving without treatment

Some treatments correct factors that cause infertility. If they work, the infertility should be reversed and a couple should be able to achieve one or more pregnancies. In contrast, other therapies are used to establish pregnancy in a treatment cycle without permanently correcting the underlying problem.

In some cases, medication can improve or correct an underlying medical condition that makes it difficult to conceive. Women with endometriosis, cervical infections, polycystic ovarian syndrome, or hormonal imbalances can be treated with medications, thus easing barriers to conception.

When a woman has blocked or damaged fallopian tubes, surgery to repair them is an example of treatment aimed at curing infertility. If it is successful (meaning the tube is both open and able to function normally), she should be able to conceive one or more times without further medical intervention. However, many experts believe that, for most women with blocked tubes, the chance of becoming pregnant is greater using in vitro fertilization(a technique to get around the problem) than surgery.

When considering various treatments, ask whether each approach is supposed to circumvent infertility or cure it. Get information about the chance of success with each approach (in light of your age and diagnosis) and its costs (including learning if your insurance carrier covers it).

While you are trying to conceive, enjoy a healthful lifestyle. Take note of the strategies for preventing infertility (above) and consider how - such as smoking - you may be lowering your chances to conceive. Tell your doctor and pharmacist that you are trying to get pregnant. They can tell you whether any prescription or over-the-counter medications, supplements, or herbal remedies you or your partner use could be disturbing your fertility or be dangerous to use during early pregnancy. If so, ask what alternatives are available. Avoid douching or using vaginal lubricants.

Even a couple with no fertility problems have only about a one in four chance of conceiving during a single cycle. Maximize your chances by having sexual intercourse regularly during the fertile part of your cycle. If you have questions about when you are most likely to conceive, ask a health care professional. An ovulation predictor (available without a prescription) may help you determine when you ovulate so you can better time intercourse.

Most doctors advise you not to be concerned unless you have been trying to conceive - not using birth control and having regular intercourse around the time of ovulation - for at least a year.

Women with certain symptoms or previous medical conditions may wish to seek medical advice earlier. Some symptoms or prior conditions make fertility problems more likely, and others may indicate a medical condition that needs treatment for other reasons. Seek medical advice if:

  • You have lots of pain during your menstrual period or during intercourse.
  • You have an abnormal menstrual cycle (less than 21 or more than 35 days from the first day of one cycle to the first day of the next).
  • You are troubled by acne or excess facial or body hair.
  • You have had pelvic inflammatory disease (PID), an infection in the reproductive organs, usually the fallopian tubes.
  • You have had surgery on your reproductive organs, such as a cone biopsy of the cervix.
  • You have had more than one miscarriage.
  • Your partner has an abnormal sperm analysis.

For a couple to conceive and carry a pregnancy, four parts of the reproductive system must be working adequately:

1) A woman's ovaries must be regularly producing and releasing good-quality eggs.

2) Normal sperm must be produced in high enough numbers and delivered during sexual intercourse.

3) The reproductive passageways must be clear enough for: a) sperm to enter the uterus (through the cervix) and swim into the tubes to unite with the egg; b) the egg or early embryo to travel to the uterus (through the fallopian tubes).

4) The lining of the uterus must be capable of having the embryo implant, and of sustaining the pregnancy.

Many types of problems - including hormone abnormalities or blockages caused by infection or scar tissue - can affect one or more of these functions.

According to national data, there has not been a major increase in the proportion of couples who are infertile. However, many more women are seeking medical services for the diagnosis and treatment of infertility - particularly those who have not previously had any children.

In 10 percent of couples, infertility factors are found in both the man and woman. In the remaining 10 percent, the infertility remains unexplained after testing.

Because either or both may be involved, it is important to test both the man and woman before starting treatment. No matter what the cause, most treatments require the active participation of both partners.

In general, women's fertility begins to decline gradually after age 30, with a steep drop between 35 and 45. This means that, on average, it takes longer for an older woman to conceive, and older women are more likely to be diagnosed with infertility. Pregnancies in older women are also more likely to miscarry.

The most predictable age-related change is a gradual reduction in the number and quality of eggs produced as a woman enters her late thirties. As she nears menopause, eggs are not released in more and more of a woman's menstrual cycles, making conception impossible.

"The office said they don't refer to infertility specialists until a year of trying. I said maybe they shouldn't wait that long in someone who is 39, and she agreed." IVF PATIENT

Also, as women age, they are more likely to have had illnesses or medical treatments that can compromise fertility. Some of these affect the reproductive system directly, such as endometriosis, sexually transmitted diseases (STDs), surgery on the reproductive organs, or ectopic pregnancies. Others are general medical problems that can damage fertility, such as hypothyroidism, high blood pressure, diabetes and lupus.

As they age, men may also be exposed to infections, medications, or occupational or environmental chemicals that can impair fertility. However, they do not experience the same dramatic and predictable age-related decline as women.

Because of the increased possibility of fertility problems, women over the age of 35 are often counseled to seek medical advice if they attempt to conceive for six months without success. However, because conception is likely to take longer in older women, some experts suggest that couples give themselves more, rather than less, time to conceive before seeking medical help.

Couples must find a balance between not allowing enough time for conception and delaying too long (making treatment less likely to succeed).

Ideally, a couple will attend the first medical appointment together. The man and woman will be interviewed about many topics in order to determine possible reasons that conception has not occurred. A man may be asked about his development at puberty; whether he has ever fathered children, if he has had infections or other illnesses, or any injuries or operations involving his genitals; and what medications he has used. He will also be asked about recreational drug use, and any chemicals to which he is exposed in his work or hobbies.

A woman may be asked details about her reproductive history, including her puberty and menstrual cycle; contraceptives used; pregnancies, abortions or miscarriages; pelvic surgeries; gynecologic symptoms; and previous infections. She will also be asked about her general medical history, medication or recreational drug use, and chemical exposures. Both partners should expect to answer frank questions about their sexual histories and attempts to conceive.

The initial physical exam is likely to focus on the hormonal system and reproductive organs. Afterward, further testing may be recommended or you may be offered information and advice on attempting to conceive before you undergo further evaluation.

An infertility work-up will involve tests to determine how well each of the systems involved in conception is working.

  • EGG PRODUCTION: To determine if and when you are ovulating (producing and releasing a mature egg during the menstrual cycle), you may be asked to chart your basal body temperature. You will take your temperature before getting out of bed each morning. A slight, sustained rise in temperature is an indirect indication that ovulation has occurred. You may also be asked to use an ovulation predictor kit at home. Your doctor may check various hormone levels on specific days in your menstrual cycle, or monitor your body's response to a dose of fertility medications.
  • SPERM PRODUCTION: A semen specimen will be analyzed for the number of sperm, their shape and movement. If the results are abnormal, a man may be examined by a urologist or tested for hormonal abnormalities or infection.
  • FALLOPIAN TUBES: To see whether the fallopian tubes are open, an X-ray (called a hysterosalpingogram or HSG) may be taken while dye is injected into the uterus and tubes. Alternatively, a doctor might inject a salt-water solution and view the uterus and tubes using ultrasound (called a sonohysterogram). The tubes can also be observed during a surgical procedure.
  • CERVIX: To determine whether sperm are able to swim through the cervix, a sample of cervical mucus is examined after intercourse. If this post-coital test is abnormal, other tests may be ordered to find out why. Doctors disagree about the usefulness of this test, and many couples conceive despite poor results on a post-coital test.
  • UTERUS: The shape of the uterus is shown in an HSG. It can also be seen through a telescope-like device (hysteroscope) inserted through the vagina and cervix. An endometrial biopsy samples the uterine lining in the last half of the cycle to see if it is prepared for an embryo to implant. The thickness of the lining can also be measured using ultrasound.

Almost always. Both male and female factors can contribute to a couple's infertility. For efficiency, diagnostic testing may focus first on tests that are less invasive (such as a semen analysis) or those that may confirm a suspected problem (such as a test for blocked fallopian tubes if a woman has had a pelvic infection).

Doctors and infertility programs vary in which diagnostic tests they recommend or require. Some variations reflect differing medical opinions on the value of specific tests. For example, some doctors insist on an endometrial biopsy or post-coital testing while others find them of little use. A test's value also depends on the person being tested and the treatment being considered. For example, if a woman is in her 40s, the first priority may be to test for age-related changes in her ability to produce eggs. Until those results are in, a doctor might consider other tests a waste of time.

  • Before undergoing a test, ask enough questions to assure yourself that it will be worth the time and expense involved and will help guide your treatment. Some questions to ask include:
  • What will the results tell us about the chance for pregnancy with or without treatment?
  • Might the results be different if the test was repeated?
  • Is the test ever abnormal in people with normal fertility?
  • Are there other ways to get the same information?
  • How do the alternatives compare in reliability, risk and cost?
  • How will the results affect the next step that we take? (If the doctor's advice will not depend on the results, there may be little reason to have the test.)

In addition, make sure you understand what will be involved in taking the test. Ask:

  • What are the risks of the test?
  • Do most people find it painful?
  • Must it be performed at a certain time in the menstrual cycle?
  • What preparation is required?
  • How expensive is it?
  • Will insurance cover this test? (Your insurance company, not your doctor, is likely to be the best source for this information.)

Doctors from various medical disciplines treat infertility. A gynecologist may or may not have extensive experience in this area.

Experts often suggest seeing a specialist if you:

  • Have endometriosis or damaged tubes.
  • Are considering pelvic surgery for any reason.
  • Have had two or more miscarriages.
  • Have irregular menstrual cycles or another reason to believe you do not ovulate regularly.
  • Have an abnormal semen analysis.
  • Are a woman age 35 years or older.
  • Have had a pelvic infection.
  • Have not conceived in two years despite normal test results.

If you are already being treated by a non-specialist, request a referral or ask that doctor when it might be advisable to consult a specialist. If your current doctor makes the referral, it may smooth the transfer of care and exchange of information. Some health maintenance organizations (HMOs) do not include reproductive endocrinologists. Members may have difficulty obtaining a referral or having a specialist's services covered.

Testing will likely take more than a month. Some tests must be scheduled at a specific point in the menstrual cycle. Others may require charting or repeated testing over a few months.

If you become concerned that your work-up is not proceeding efficiently, particularly if you are a woman over age 35, talk to your doctor about your concerns. Many infertility patients report that they regret having wasted valuable time prior to starting treatment.

In 10 to 15 percent of couples, testing finds no reason for their reproductive difficulties. They are given the diagnosis of "unexplained infertility.". Speaking in broader sense 40% male 40%female 10%both and 10% unexplained infertility add hot 100% of the cases of infertility

Medical experts do not agree on the best way to treat unexplained infertility. Despite a few years of unexplained infertility, some couples will conceive with no treatment at all, particularly if they are younger. Other couples are offered standard treatments, such as fertility drugs and intrauterine insemination (IUI), or in vitro fertilization (IVF).

In general, couples with unexplained infertility are at least as likely to succeed with these treatments as are couples with a clear medical rationale for their use. If you are considering treatment for unexplained infertility, ask your practitioner to compare your chances of becoming pregnant with and without treatment.

No, and even those capable of providing the same treatments will not offer the same approach for every couple. These questions may help you identify differences that are important to you:

Does the program primarily offer high-tech treatments, such as IVF? If you are just starting your work-up, a more general service might be a better fit.

Are several types of specialists involved? The ease of communication among specialists at larger programs may be an advantage. In particular, this may help couples requiring more than one type of treatment (for example, if there are both male and female factors).

Does the program offer what you need? If you foresee the need for a special service (such as egg donation for an older woman, or intracytoplasmic sperm injection - ICSI - to treat severe male infertility), look for a program with that expertise.

Does the program share your perspective about different treatments? Programs differ in attitudes about certain treatments. Some programs steer all women of a certain age towards the use of donor eggs; others do not. Some programs insist on certain tests and routine treatments that others consider of limited value.

Does the program share your attitudes about risk? Think about whether you are inclined towards taking the most or least aggressive approach. Are you and your doctor compatible in this regard?

No. You will be consulted counselled and your plan will be discussed. Thereafter you will be given time to think. Once you duly sign a well written and informed consent and agree to the treatment protocols then only your treatment will start on the schedule as finalised by you and your doctor.

You can learn a lot about the treatment experience by talking to friends or support group members.

Current or former patients can describe the emotional ups and downs, physical side effects and impact on daily life. The experience of other couples can also alert you to areas of potential support or frustration you may encounter. Did the schedule run on time? Were your questions answered? Did you get your test results easily? Was the staff helpful in dealing with financial issues?

When you know someone who has gotten pregnant, that may seem like the strongest endorsement to seek the same treatment at the same program. But, someone who did not succeed might hold less favorable views. Be cautious, therefore, in using the experience of others to gauge your chances of success at a specific program. Every couple brings different fertility problems, and your chances may be higher or lower than that of other couples you know

Trust is extremely important as you make complicated decisions that involve your health, your family and large amounts of money.

.Make sure you know the experience and credentials of the doctor who will be treating you.

If a program's embryology lab has been accredited by an agency approved by the Government Authorities .

If you are getting information from the Internet, consider the source behind any endorsement of a particular treatment, physician or program.

Chances are good that the doctor or program you select will deserve your trust. As you pursue any type of medical treatment, keep in mind that a trustworthy doctor will not work in an atmosphere of secrecy. You should be able to see the information in your medical file and your doctor should be willing to discuss your treatment with colleagues. You should not be discouraged from seeking a second opinion.

Emotional support is vital when you are coping with infertility and its treatment. Infertility is a crisis that many women and men describe as the most upsetting of their lives. Treatment is also stressful and can place a major strain on couples. The medications used sometimes have an impact on a woman's mood and ability to concentrate. As treatment proceeds, patients describe riding a roller coaster of emotion as each test or step in the process seems to point towards eventual success or disappointment.

While most programs acknowledge the need for emotional support, they differ greatly in the services they require or offer. A counselor can help you evaluate your feelings about starting or continuing treatment and offer a valuable non-medical perspective on treatment and its demands. Some programs organize support groups and make counseling available. Others do not. Some programs include various relaxation techniques to ease the stress of treatment.

Your access to emotional support inside and outside a program should be considered as you decide where to be treated. At a minimum, any program offering infertility treatment should:

  • Be sensitive to the stresses of treatment.
  • Be supportive to the needs of individuals and couples.
  • Help you anticipate and deal with predictable crisis points (such as getting pregnancy test results or having a miscarriage).
  • Recognize that you need to consider non-medical factors, such as family responsibilities, as you decide whether to start or continue treatment.
  • Schedule times to re-evaluate your approach to infertility.

At some point, you may want to seek counseling from someone independent of a treatment program but knowledgeable about infertility treatments and issues. Particularly if you are considering treatment involving a donor or a surrogate, you and your partner can benefit from counseling as you sort through the many non-medical issues involved. Counseling or joining a support group may also help you, as an individual or a couple, receive support and develop strategies to cope with the stress of infertility and its treatment.

Every couple is unique, and there are serious limitations in any program's ability to predict how you will respond to treatment. You will likely be given an estimate of the chances you will achieve a successful pregnancy (either with or without treatment). It should be based on your diagnosis or test results, as well as the previous experience of that program or others in using the techniques. Be extremely cautious if someone offers you a guarantee or unrealistically high estimate of your chances.

When a prediction is made, ask what it is based on. The most directly applicable information would be your program's previous experience in treating similar couples. Often, however, predictions are made based on information from sources outside the program:

  • National averages (your program may have higher-or lower-than-average success).
  • A study published by a single center (which might have a very different level of experience).
  • Data submitted by a manufacturer before a drug was approved by the Food and Drug Administration (and you may or may not be similar to the people they studied).
  • Ask enough questions to feel comfortable that you are making a decision based, as closely as possible, on a program's experience treating people like you.

Yes. As part of screening, you may be asked to undergo medical or psychological testing. For example, you may be required to be screened for infections that can be transmitted during pregnancy or through tissue transplants, such as hepatitis or human immunodeficiency virus (HIV) infection. Before a woman over a certain age is accepted, she may be required to undergo extra medical tests to determine whether her heart can withstand the physical demands of pregnancy.


In many ways, deciding about infertility treatment is similar to deciding about other types of elective health care. Your past experience as an informed medical consumer will serve you well. However, others who have been through the process - whether successful or not - urge you to keep in mind the many ways that infertility treatment can be different:

  • Decisions about treatment must often be made without clear medical evidence of the benefits and risks.
  • Treatment involves the intimate participation of both partners.
  • Your decisions should take into account the best interests of children who may be created.
  • Religious cultural and emotional factors can play an important role in decision making.
  • The costs may be high and are difficult to predict with accuracy.
  • Treatment can damage your health or the health of a donor working on your behalf.
  • An unique family arrangement is being created, and you are entering uncharted legal and psychological territory.

In infertility treatment, there are honest differences of opinion and philosophy among doctors. Many infertility experts encourage their patients to seek a second medical opinion before making major decisions. A second opinion may be helpful prior to medical intervention, when considering a new approach, or when re-evaluating whether to continue care. To get the most from a second opinion, have your records and test results sent to the doctor prior to your appointment. Be wary if a doctor discourages you from seeking a second opinion

A doctor is required to obtain your informed consent before treating you.

Before giving your well informed and written consent (duly signed) to any treatment, you should have the following types of information (some of these apply only to IVF and its variants):

  • A description of the treatment.
  • A reasonable estimate of your chances of becoming pregnant and delivering a live baby. This should include how successful the treatments are, on average, for patients across the country and those treated at your program. The information should be compared with your chance of becoming pregnant without any treatment or with a less aggressive approach.
  • How well-established the treatment is in the field.
  • How much experience the program and its doctors have with the treatment.
  • The risks of the treatment, including the risks of all medications and procedures.
  • The chance of a multiple pregnancy and its risks for the mother and the pregnancy. This should include the fact that you may be asked to consider multi-fetal pregnancy reduction, explaining the process and its complications (see "Can multiple gestion be fixed?). It should also include ways to minimize the chance of multiple pregnancy.
  • Sex selection and sex determination are crime and expecting or requesting the same is criminal.
  • The center strictly adheres to PCPNDT act of Government of India .
  • Problems that may occur during pregnancy and how they may affect you and the baby(ies).
  • An estimate of the fees for treatment, plus predictable charges not covered in standard fees.
  • Your options regarding the use of any eggs or embryos not used during your treatment.
  • Other treatments offered at this program or others and the non-medical alternatives, including adoption and no treatment at all.

"The doctor gave me the most down-to-earth prognostic information, saying my chances were less than 5 percent. In many ways, that was what we needed to hear." PATIENT UNSUCCESSFUL WITH STANDARD IVF AND SUCCESSFUL WITH DONOR EGGS

While your doctor should describe your various options, he or she will likely offer an opinion on which medical course of action is preferable. It is a doctor's professional responsibility to offer medical advice, but only you can make the decision that best addresses your medical and non-medical concerns..

Until the development of IVF, surgery was the only treatment for blocked or damaged fallopian tubes. Surgery may also be recommended to remove scar tissue, fibroids or endometriosis from a woman's reproductive organs. In men, surgery may be suggested to open blocked passages in the reproductive tract or to treat varicose veins in the scrotum.

The goal of most reproductive surgery is to make it possible to conceive without IVF. Since the advent of IVF, reproductive surgery is recommended less frequently because it is less likely to lead to a successful pregnancy. A program that offers a variety of treatment approaches may be in an ideal position to help you evaluate whether to pursue surgery, other types of treatment, or no treatment at all.

Reproductive surgery has many variations, including endoscopic surgery, laser surgery and microsurgery. Each approach has strong advocates and detractors among infertility specialists.

Endoscopic surgery involves inserting a telescope-like laparoscope through a small incision in the abdomen or a hysteroscope through the cervix. This makes it possible to avoid major abdominal surgery and speed recovery. Laser surgery substitutes a laser for a traditional scalpel, but has not proven to be significantly better. Microsurgery uses several techniques (viewing the area under magnification, stitching with delicate sutures) to minimize damage to healthy tissues.

Some questions you may want to ask about reproductive surgery and its variations are:

  • Why are you recommending this approach?
  • What will the recuperation be like? How long will it take?
  • How soon can we start trying to conceive?
  • What are the chances of conception after surgery?
  • LMDoes anything about my condition make it more or less likely that surgery will succeed? For example, a tube blocked in several places is far less likely to be opened effectively.
  • If the surgery doesn't work, what would be my next option? What are the advantages and disadvantages of proceeding directly with that option instead of doing surgery?
  • Are other types of surgery used for this problem?
  • Are any non-surgical treatments used for this problem?
  • How do the results compare?

Insist on an appropriate infertility work-up for both partners before proceeding with surgery. You don't want to undergo surgery only to discover that an unrelated problem (for example, male factor infertility or failure to ovulate) will make it difficult to conceive without another type of treatment that could have been used in the first place.

Sometimes a tubal ligation or vasectomy can be surgically reversed. The chance of success depends on what type of procedure you had, how long ago, and other factors related to fertility in both of you (such as age). In some cases, a doctor might recommend using IVF rather than a surgical reversal to help you have a baby.

Fertility drugs

Each month, the ovaries normally mature one egg, releasing it in the middle of the menstrual cycle at ovulation. The general term "fertility drugs" usually refers to medications that influence this process. Fertility drugs can be used to spur ovulation in a woman who ovulates only irregularly or not at all. In addition, the drugs are often prescribed in order to cause several eggs to mature in a single cycle. This may be done to improve the odds of conception during intercourse or in conjunction with other treatments (such as intrauterine insemination or IVF).

Yes, if you and your doctors work together to use the drugs properly. First, be sure that you are being monitored properly. Injectable fertility drugs should be used only if you are under the care of a doctor who has the experience and equipment to track your response using blood tests and ultrasound. Follow any instructions you are given. If too many follicles seem to be developing, you may be asked to stop using the medicine and refrain from attempting a non-IVF pregnancy in that cycle.

Second, make sure your care is re-evaluated at appropriate time intervals. Fertility drugs are not designed for use on an ongoing basis. No fertility drugs should be used cycle after cycle without the doctor evaluating how you are responding and whether a different dose, medication or procedure might work better.

In intrauterine insemination (IUI), a health professional places specially prepared semen into a woman's uterus near the time she is ovulating. IUI can be used to bypass a problem preventing sperm from reaching an egg - for example, if the sperm do not get through the cervix into the uterus. In other cases, there is no known barrier to the passage of sperm, but IUI is suggested in an attempt to increase the odds of conception. IUI is often used in combination with fertility drugs.

Depending on the situation, IUI may be performed with semen collected from the male partner or frozen semen from a donor.

Before undergoing IUI, make sure you clearly understand its benefits and risks. Ask your doctor the following questions:

Why are you recommending IUI in our case?
While there may be a specific diagnosis, the combination of fertility drugs and IUI is often suggested to couples with no known problem. Couples are sometimes advised to try a few cycles of this less expensive treatment before undergoing IVF.

How and when will the semen be collected?
If the male partner's semen is used, it is usually collected by masturbation shortly before the procedure. If you have concerns about this method of collection or your partner's availability, discuss these with the doctor. It may be advisable to freeze a specimen ahead of time, and alternative methods for semen collection may be available.

How successful is the procedure in couples similar to us?
How does it compare to our chances if we just time our intercourse well at home?

Success rates in general with IUI are low due to various reasons discuss with your doctor.  IUI is not a recommended treatment for poor semen quality, and it will not overcome an age-related decline in a woman's ability to produce eggs.

Do you recommend the use of fertility drugs in conjunction with insemination?
If so, thoroughly consider their advantages, risks and costs before making your decision.

What are the alternatives to IUI?
Depending on your condition, your options might involve less medical intervention (advice on timing intercourse at home), more intensive treatment (IVF), or the use of donor semen. Learn the advantages and disadvantages of each option before making a decision.

In vitro fertilization, or IVF, is a method of treatment in which the man's sperm and the woman's eggs are combined outside of the body. In general, IVF involves five steps:

1) A combination of medications is used to stimulate the woman's ovaries to mature many eggs in one cycle, a process called controlled ovarian stimulation.

2) The mature eggs are removed from the woman's ovaries - usually through a slim needle inserted through the wall of the vagina, without pain because of sedation.

3) The eggs are examined and placed into a culture dish in the lab. At the proper time, they are mixed with specially prepared sperm. Later, if fertilization occurs, the resulting embryos are grown in the lab for a few days.

4) One or more embryos are transferred back into the woman's uterus, where an embryo may implant and result in an ongoing pregnancy.

5) A pregnancy test is given. If conception does not occur, all steps of the cycle should be evaluated by the treatment team and discussed with the patient in a follow-up meeting.

For most couples, whether or not to undergo IVF is a major decision that requires them to assess many medical, emotional and financial factors. Before deciding, you may want to speak with others who have gone through the process (successfully and not), an infertility counselor, and/or a support group. These are a few of the questions to discuss with your doctor:

  • Why are you recommending IVF for me?
  • What are my alternatives to using IVF?
  • What are the risks of each step in the process?
  • What is it like for most women as they go through each step? (This will help you predict what the impact may be on your time, physical well-being and emotions).
  • What is my chance to become pregnant and deliver a baby as a result of this treatment?
  • How does that compare to my chances with other treatments or no treatment at all?

"The waiting rooms are filled with people whose total life is going through these programs. It was hard to juggle working and IVF, but I'm glad I didn't just sit there for a month." IVF PATIENT

Depending on your fertility problems, you may decide to use lower-tech treatments or no treatment at all.

In addition, two IVF alternatives are available at some programs, although their use has declined greatly. In gamete intrafallopian transfer (GIFT), the first two steps are the same as IVF. But, instead of fertilizing the eggs in the laboratory, a mixture of sperm and eggs is placed into one or both of the woman's fallopian tubes. In GIFT, fertilization and the embryos' travel to the uterus occur in the natural environment of the fallopian tubes. GIFT usually involves a surgical procedure and requires that at least one of a woman's tubes be open and healthy. Because general anesthesia is usually required, GIFT is considered riskier and usually costs more than IVF.

Another procedure, zygote intrafallopian transfer (ZIFT), combines elements of IVF and GIFT. The first three steps are similar to IVF. However, instead of transferring the embryos into the uterus, they are placed into one or both of the woman's fallopian tubes.

The general term assisted reproductive technologies (ART) is used for all treatments that involve removing a woman's eggs and combining them with sperm outside the body, including IVF, GIFT and ZIFT.

IVF is not a uniform treatment. To carry out a treatment cycle, several decisions must be made, including:

  • What dose of fertility drugs to use
  • When to retrieve the eggs
  • How long to culture the embryos before inserting them into the uterus
  • How many embryos to transfer to the uterus in a cycle
  • Whether to freeze embryos for later cycles

Depending on your condition or your response to previous treatments, variations on IVF may be suggested. Each adds cost .  Take the benefit of our embryology lab and senior embryologists to increase the chances of success.

Intracytoplasmic sperm injection (ICSI) is used to increase the chance of fertilization. Instead of mixing sperm and eggs and waiting for fertilization to occur, a single sperm is injected directly into each egg.

Assisted hatching is used to increase the chance that an embryo will implant in the uterus. A small opening is created to make it easier for the developing embryo to emerge from the protective shell that surrounds it.

Blastocyst transfer is used to maximize the chance of pregnancy while minimizing the risk of a multiple pregnancy. Instead of transferring embryos after two or three days in the lab, they are grown to the many-celled blastocyst stage and transferred on day five. By this point, surviving embryos have a higher chance of establishing a pregnancy, so fewer need to be transferred.

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