Questions From A Couple On Their First Visit To An Infertility Specialist

1) What is the problem with us to not able to achieve pregnancy?

The female as well male partner both need to be assessed for the potential problems. First of all, history is taken which focuses on duration of married life and actual duration of trying to conceive. The menstrual history is taken to assess whether the female is normally forming and releasing one egg per cycle. The past medical/ surgical history such as tuberculosis, diabetes, hypertension is taken. Family history for disorders such as diabetes, hypertension or any cancer is also taken. Also previous treatment records are reviewed and documented.

The initial blood tests are done to know the general health of the patient. The male partner is advised for semen examination which include sperm numbers, motility, and percentage of normal looking sperms. A baseline ultrasound of the female partner is done in the clinic to assess her ovaries and uterus.

2) What will be the next step and how are we going to proceed?

Based on the initial history and examination ,the problems are identified in both partners. Depending on the problems, thorough counselling is done and step by step treatment plan is made.

When the problem is at formation of an egg i.e. ovulation, then the drugs for ovulation are given and timed intercourse or IUI( in utero insemination) at the time of egg rupture is offered. Similarly in patients where semen parameters are subnormal then IUI (which is preparation of semen to improve its quality and then putting it inside the womb) is offered . Before IUI, sonosalpingogram which is a test to know whether the tubes are open or not is done routinely without anaesthesia.

4 to 5 cycles of ovulation induction and IUI can be offered to the patient depending upon the age and other factors.If the number of eggs are less in ovary then treatment should be at earliest and aggressive, therefore IVF is offered. If both the tubes are blocked then, IVF is the only solution.

3) What is IUI? How is it done?

It is a technique where semen is prepared, concentrated and put inside the womb at the time of egg release . It has the advantage of directly putting sperms which are good in number and highly motile closer to egg . It is an office procedure and is done without any anaesthesia. There is no cut or pain . The patient needs to rest for 15 minutes and can carry out her daily routine .

4) How many cycles can I try for IUI?

The chances of conceiving are maximum within first 4 cycles of IUI. However a maximum of 6 cycles can be done depending upon age and ovarian reserve of the patient.

5)What are the chances of us getting a baby?

In IUI chances betwen 10% to 15% per cycle. In IVF – a chance of 40% to 45% per cycle is seen.

6)What is IVF & ICSI? How is it done?

IVF is the technique where dugs are given to the female partner to produce many eggs . The eggs are then collected through vagina . The procedure is called ovum pick up and it is done under general anaesthesia. There is no cut or no stitch . The eggs are then mixed with sperm to make babies. When the eggs are incubated with semen in a petridish then fertilisation takes on its own , then the procedure is known as IVF( In vitro fertilisation). However , when one sperm is injected inside each egg then it is known as ICSI ( intracytoplasmic sperm injection). The embryos are kept in incubator and transferred into womb at day 3 or day 5 depending upon the number and quality of the embryos.

7)What is the duration of the treatment?

The stimulation of the female takes 9 to 10 days. It is started from day 1 or day2 of the cycle. Then the ovum pick up occurs 34-36 hours after the trigger which is the final injection to mature the eggs. The embryo transfer occurs on day 2 to day 5 after the pick up. So the whole process takes around 1 2to 15 days. Sometimes, when the female produces a large number of eggs, especially in case of polycystic ovaries, then the embryos are frozen and transferred into another cycle, and it is known as Frozen embryo transfer cycle.

8)What precautions do we need to take before starting the treatment?

The female is advised to take healthy diet and regular exercise . Good sleep, yoga/meditation helps to relax oneself. Smoking and alcohol should be avoided.

9) How is the embryo transfer done?

It is a simple procedure without anesthesia . The woman is asked to come with a full bladder and with the help of an abdominal scan guidance, the embryos are placed inside the uterine cavity at the right place. It is a painless procedure and one can go home or work after the procedure.

10) What are precautions after the embryo transfer?

Constipation should be avoided by drinking plenty of fluids and having a good diet rich in roughage . Rigorous exercises like lifting heavy weights should be avoided. The medicines and injections on the prescription should be taken diligently.