In-Vitro Fertilization (IVF) Infertility Treatment India

What is Infertility?

Infertility is the condition when a couple is unable to conceive despite unprotected, regular and carefully timed sex for at least one year. This form of infertility is more common and is also known as Primary Infertility. Secondary Infertility is another type of infertility, which is less common and usually related to an underlying disease or condition. In Secondary Infertility, the couple were able to conceive once but are unable to do so anymore. Causes of infertility vary and include disease(s) and aging. Male infertility and Female infertility are equally common, many a times it may be a combination of issues in both partners and factors associated with them. Infertility or problems of the reproductive system are often treatable and there are many safe and effective therapies available which include drugs and or clinical procedures.

What are the risk factors associated with Infertility?

Usually in medicine, by risk factor it is implied that the mere presence increases the chances of the concerned condition. Further risk factor is not a causative agent for that condition and its presence does not ensure that the concerned condition or disease will happen. The risk factors associated with Infertility include the following:

Increasing Age – Both men and women witness a drastic drop in their fertility with advancing age. This effect is more pronounced in women, who observe their fertility drop significantly after 32 years of age, and continues doing so. Men in their 50s are usually less fertile than men in 20s (as male fertility progressively falls with advancing age after 40).

Smoking including Passive Smoking – Smoking, apart from its numerous life threatening effects, it significantly increases the risk of infertility in both the sexes. Smoking also weakens the effects of fertility treatment. Even in pregnancy, smoking is responsible for high risk of miscarriage.

Consumption of Alcohol - Alcohol abuse is associated with lower male fertility especially in men who already have a low sperm count. If women get pregnant, any amount of alcohol is associated with severe effects on the pregnancy and or fetus including miscarriage.

Obesity or Being Overweight - in advanced economies, obesity is found in epidemic proportions and often found to be a principal cause of female infertility. Men with overweight bodies have higher risk of abnormal sperms.

Sedentary Lifestyle - leading a life without any exercise or minimal physical activities is occasionally associated to lower levels of fertility in both sexes.

Genito-urinary Infections including Sexually transmitted infections (STIs) and Urinary Tract Infections - chlamydia can damage the fallopian tubes, as well as cause Epididymo-orchitis in men where there is inflammation of scrotum. Some other STIs including Tuberculosis of the reproductive system (especially fallopian tubes) may also cause infertility.

Exposure to harmful chemicals like pesticides, herbicides, heavy metals (like lead) and industrial solvents have been found to adversely affect fertility in both men and women.

Mental & Emotional stress – research shows that sperm production and female ovulation may be affected by mental and emotional stress. Also, the stress can attribute to reduced frequency of sexual intercourse, resulting in a lower chance of pregnancy.

Underweight or Eating disorders – severe underweight women may have fertility problems especially associated with improper ovulation.

Vegetarian Diet - a strict vegan diet is deficient in iron, folic acid, zinc and vitamin B-12. If these minerals and vitamins are not adequate, one’s fertility may get affected.

Over-exercising – it has been reported that an exercise regime with more than seven hours each week may have ovulation problems in women.

What are the symptoms associated with Infertility?

Symptoms associated with Infertility are simply not being able to conceive or not being able to get pregnant. Though symptoms associated with the underlying conditions associated with Infertility can vary and may surface aiding the specialists to get clues even before tests confirm the same.

What are the causes of Female Infertility?

Female infertility may be caused by:

  • Autoimmune disorders, such as Anti-Phospholipid Syndrome (APS)
  • Birth defects that affect the reproductive tract
  • Clotting disorders
  • Diabetes
  • Alcohol consumption in moderate to large amounts
  • Excessive Exercising
  • Poor nutrition making one frail and underweight
  • Obesity or overweight
  • Older age especially after 35 years of age which is associated with poor egg quality especially eggs that are damaged or develop genetic abnormalities are not viable
  • Pelvic infection or pelvic inflammatory disease (PID) and scarring caused as its consequence
  • Smoking
  • Premature ovarian failure - the woman's ovaries stop working before she is 40.
  • PCOS (polycystic ovary syndrome), also known as Stein-Leventhal syndrome is where there is abnormal function of the ovaries in women. Also associated with abnormally high levels of androgen or the male hormones.
  • Hyperprolactinemia is a condition linked with high levels of prolactin in women who are neither pregnant nor breastfeeding, it may affect ovulation and fertility.
  • Underactive or Overactive thyroid gland
  • Some chronic conditions, such as AIDS or cancer (or chemotherapy drugs) may also effect ovulation in women
  • Surgery, especially pelvic surgery can sometimes cause scarring or damage to the fallopian tubes. Cervical surgery can sometimes cause scarring or shortening of the cervix, the neck of the uterus.
  • Submucosal uterine fibroids are mostly benign tumors found in the muscular wall of the uterus. They may interfere with implantation of a fertilized egg. They can also block the entrance of the fallopian tube for the sperms. Cervical Polyps may also lead to infertility as they may block free passage to spermatozoa.
  • Endometriosis is often a painful and debilitating condition where cells that normally line the uterus start growing elsewhere in the body. It most commonly effects the ovaries, fallopian tubes and the pelvic cavity, leading to pain around menstruation and menstrual irregularities leading often to infertility.
  • Previous sterilization treatment – which if reversed may still cause infertility depending on the technique originally used for sterilization. Pregnancy in these cases have high chances of ectopic pregnancy.

What are the causes of Male Infertility?

Male infertility may be caused by:

  • Abnormal semen is responsible for about 75% of all cases of male infertility. Unfortunately, in most cases the underlying cause is not known despite exhaustive testing.
  • Birth defects of the reproductive system
  • Cancer treatments, including chemotherapy and radiation therapy
  • Exposure to high heat for prolonged periods
  • Heavy use of alcohol or other substance abuse or excessive smoking
  • Hormone imbalance
  • Impotence
  • Infection especially Sexually Transmitted Infections (STI) or Urinary Tract Infections (UTI)
  • Medicines such as cimetidine, spironolactone, and nitrofurantoin
  • Obesity or overweight
  • Older age especially after 45 years of age
  • Retrograde ejaculation: may be primary (without any known cause) or secondary (due to scarring or post surgeries like TURP)
  • Scarring from sexually transmitted infections, urethral injury, or surgery
  • Toxins in the environment
  • Male Permanent Sterilization or Vasectomy or failure of vasectomy reversal

What are the various forms of abnormal semen?

Abnormal semen may include the following problems:

Low sperm count - the ejaculate has a lower number of sperms than normal. Sperm concentration should be 20 million sperm per milliliter of semen. If the count is under 10 million there is a low sperm count also known as subfertility.

No sperm - when the ejaculate has no sperm in the semen.

Low sperm motility - the sperms have compromised movement and cannot "swim" as well as they should.

Abnormal sperm - the concerned sperms have an unusual shape, making them more difficult to move and eventually fertilize an egg.

What are the causes of abnormal semen?

Causes of abnormal semen may be the following:

  • Testicular infection
  • Testicular cancer
  • Testicular surgery
  • Testicles being exposed to high temperatures – the exposure may be for longer duration or a higher temperature. Tight clothing, excess use of a laptop kept on the thighs, frequent saunas to name a few situations can lead to abnormal semen.
  • Ejaculation disorders - Men suffering from retrograde ejaculation, end up with the ejaculate going into the bladder. With blocked or obstructed ejaculatory ducts the person may have abnormal ejaculation.
  • Varicocele - these are varicose veins (dilated tortuous veins with incompetent valves) in the scrotum that may cause improper temperature regulation of the scrotal sacs leading to overheating of sperms.
  • Undescended testes – During Fetal development, one (or both) testicle fail to descend from the abdomen into the scrotum, this condition is also known as cryptorchidism. Due to this the sperm production is affected as the testis are at higher than required temperature. The sperms being very temperature sensitive get affected and slowly reduce in number. Undescended Testis is associated with higher incidence of testicular cancer and infertility in men even after surgical correction (which may have happened later than ideal time).
  • Hypogonadism – also known as testosterone insufficiency can result in abnormal semen and absence of sperms too, a condition known as aspermia.
  • Genetic Disorders and Syndromes – ideally a man has X and Y chromosomes. If only X chromosome or only Y chromosome is present, then the person may suffer from Turner’s or Klinefelter’s Syndrome respectively. Klinefelter’s Syndrome is physically a man and associated with infertility.
  • Other conditions may include mumps induced orchitis (inflammation of the testis), Hypospadias (where urethral opening is on underside of penis), Cystic fibrosis (men with this condition usually an absent or obstructed vas deferens (tube connecting the testes to the urethra; it carries sperm from the epididymis to the ejaculatory duct and the urethra), Radiotherapy (which may have been prescribed for treating a cancer can impair sperm production, especially if the pelvic region has been irradiated), Anemia, Cushing's syndrome, Diabetes, Thyroid disease, and Drugs like Sulfasalazine, Anabolic steroids, Chemotherapy etc.

Infertility Treatments Available in India

There have been a number of advancements in Infertility management and a number of factors are considered to offer the ideal IVF infertility treatment in India to any couple. The most important of these is the cause of infertility, age of the couple, duration of infertility, any preferences of the couple, and their general health status.

The first and foremost advice that is given to couples with short span of infertility or failure to conceive within 1-2 years of trying to start a family is to increase their frequency, improve their technique and time it around the fertile period which is dependent on the menstrual cycle. Intercourse 2-3 times per week may improve fertility if the frequency was less than this.

Fertility treatments for men

  • Erectile dysfunction or premature ejaculation – medication, behavioural therapy or surgical implants are options available for managing this condition. A combination or individual therapy approach can help men possibly improve their fertility.
  • Varicocele – may warrant surgical correction and also require a short course of antibiotics if there is a concomitant local infection like orchitis, epidydimitis etc.
  • Ejaculatory duct or Epididymal Blockage – in such cases, the sperm can be extracted directly from the testes or the Epididymis. These techniques are known as PESA (Percutaneous Epididymal Sperm Aspiration) or TESA (Testicular Sperm Aspiration) both of which are outpatient or office procedures. TESE (Testicular Sperm Extraction) involves a small nick and extraction of some tissue from the testicle and is often done as a day surgery or ambulatory care procedure in a hospital or free-standing well equipped Infertility Centre. These extraction techniques are also used in cases of Retrograde ejaculation, where surgical correction is not opted for.

Fertility treatments for women

Disorders of Ovulation where women are prescribed fertility drugs which regulate or induce ovulation. These include:

  • Clomifene
  • Metformin (especially effective in PCOS)
  • Human menopausal gonadotropin, or hMG
  • Follicle-stimulating hormone (FSH)
  • Human chorionic gonadotropin (HCG) is used together with clomiphene, hMG and FSH.
  • Gn-RH (gonadotropin-releasing hormone) – in cases where premature ovulation is a problem, especially the ovulation happens before the lead follicle matures during hmG treatment.
  • Bromocriptine which inhibits prolactin production, regularizing ovulation Surgical procedures in women to address underlying infertility causes
  • Fallopian tube surgery for blocked tubes
  • Minimally invasive or Laparoscopic surgery in cases of endometriosis or cases of fibrotic bands, the surgery aims at removing scar tissue, reducing pain and often aiding fertility.

What methods are used for Assisted Reproduction?

The following therapy options are established and available for assisted reproduction.

  • IUI (intrauterine insemination): A procedure where a sperm sample (which may or may not have concentrated and select sperm samples) is inserted into the uterus via the cervix. It is done as an outpatient procedure and is timed when ovulation occurs. At times, the woman is prescribed low doses of ovulation inducing hormones. IUI is commonly recommended where low sperm count, severe erectile dysfunction or decreased sperm motility in the man are causes of infertility. It is also therapy of choice in cases where no identifiable cause is attributed to the infertility.
  • IVF (in vitro fertilization): A procedure where the fertilization of eggs is achieved by placing the sperms with unfertilized eggs in a Petri dish in strict sterile lab conditions. After fertilization, the embryo is implanted in the uterus as an outpatient procedure. Successful implantation which is confirmed on ultrasound and sequentially rising HCG levels marks a successful IVF with a start of pregnancy. At times, the embryo is frozen for future use known as cryopreservation.
  • ICSI (Intracytoplasmic sperm injection): Like IVF, ICSI is also performed in strict sterile lab conditions, where a single sperm is injected into an egg with an aim to achieve fertilization. An ideal procedure which improves significantly the likelihood of fertilization in men with low sperm concentrations.
  • Sperm or Egg Donation: Egg or Sperm donor is used when either partner has no sperms or eggs. In such cases, the treatment is usually done with IVF.
  • Assisted hatching: This method is employed to improve the chances of successful embryo implantation into the wall of the uterus. This is done by opening a small hole in the zona pellucida, the outer membrane of the embryo. This technique, greatly improves the ability of the embryo to remove its outer covering and implant into the uterine lining. This is highly effective in past IVF failure cases, cases with poor embryo growth rate, and elderly women.
  • Electric or vibratory stimulation to achieve ejaculation: An effective method in men who cannot ejaculate normally, especially those with a spinal cord injury or paraplegia.

What are the advantages of getting an Infertility treatment or IVF done through MedMonks?

MedMonks helps patients choose amongst the best and most experienced infertility specialist with the most cost effective treatment and surgery packages. So that you are always safe and comfortable.

Further, MedMonks gives a number of advantages to its patrons including:

  • 24x7 Support
  • Associated with only Verified & Accredited Hospitals
  • Leading & Highly Experienced Doctors on Panel
  • Transparent Process and complete confidentiality
  • Travel Desk assisting in Visa, Airline Tickets, Hotel Bookings etc.
  • Personalized Services like interpreter, forex, on-ground logistics and treatment/ intra-hospital coordination
  • Health Insurance and Medico-legal advice
  • Help in follow-ups and rehabilitation
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