1. WHEN DO WE CALL A COUPLE INFERTILE?
The couple is considered to be infertile if they have not conceived after 12 months of contraceptive-free intercourse, if the female is under the age of 34 or has not conceived after 6 months of contraceptive-free sexual intercourse, if the female is over the age of 35.
2. WHERE IS THE PROBLEM?
About a third of the time, infertility can be traced to the woman. In another third of cases, it is because of the man. The rest of the time, it is because of both partners or no cause is found.
- Pregnancy is the result of a process that has many steps.
- To get pregnant: A woman must release an egg from one of her ovaries (ovulation).
- The egg must go through a Fallopian tube toward the uterus (womb).
- A man's sperm must join with (fertilize) the egg along the way.
- The fertilized egg must attach to the inside of the uterus (implantation).
- Anything which affects one or more of these processes can cause infertility.
3. HOW CAN SPECIALIST CONSULTATION SOLVE THE PROBLEM?
After assessment by the specialist, many couples can be reassured that they do not need complex treatment, just more time with regular sex. Others may require some form of treatment to assist with conception like ovulation induction and intrauterine insemination. The most well known treatment is In Vitro Fertilisation (IVF), but there are a number of other options, including life style modification, certain drugs, surgery and a range of Assisted Reproduction Technologies (ART).
4. What is In Vitro Fertilization?
In-vitro fertilization (IVF) is a process in which female partners eggs collected from their ovaries are mixed with your husband's sperms in a test tube or plastic dish with the objective of one sperm entering one egg and combining to produce one embryo. One to three embryos are then placed inside the uterus for implantation and development into one or more babies.
IVF is recommended if the patient is unable to conceive in the normal way or when other treatments have not succeeded in producing the baby that they so earnestly desire.
5. What is ICSI?
Intra Cytoplasmic Sperm Injection (ICSI) is a modification of IVF.
ICSI is a procedure in which one immobilized sperm is sucked into a very narrow pipette and then injected inside the egg, allowing fertilization to take place.
It is usually employed when sperms are unable to enter eggs by their own power.
Most forms of male infertility can be solved by use of ICSI and sperm donation is less necessary.
ICSI can also be used to maximize the yield of embryos.
6. What is the duration of one IVF or ICSI cycle?
One complete IVF or ICSI cycle takes approximately six to eight weeks. First, the normal menstruation cycle of the woman is down regulated by injection of specific hormones each day. This part of the cycle can vary from a few days to several weeks. When the ovaries have become inactive, shown on ultrasound and laboratory findings, the stimulation of the ovaries start by intra muscular or subcutaneous injections of hormones. The mean stimulation period is 12 days, depending on the reaction of the ovaries. The ovum pick up takes place within two days after stopping the stimulation. Now the real IVF or ICSI follows in the laboratory. When fertilisation occurs, embryo's are transferred into the uterus after three to five days and drugs supporting the pregnancy are given. After approximately 15 days, a pregnancy test will show whether the IVF treatment has been successful or not.
7. Is the egg retrieval painful?
We do our egg retrievals under anesthesia so the patient is asleep for the procedure. Our anesthesia specialists use medications, which heavily sedate the patient so she is "asleep" however; she is not anesthetized so that breathing tubes are not necessary. The beauty of this approach is that the patient feels absolutely nothing, remembers absolutely nothing, and has few if any of the typical side effects of anesthesia such as nausea and vomiting.
8. Are there particular factors influencing the success of a treatment?
In any type of infertility treatment, important factors need to be taken into account when referring to success rates. The age of the woman and the duration of the couple's infertility are likely to influence the success of treatment. In women, fecundity decreases as age increases, particularly after 40 years of age. When the woman is being treated, her chances of conceiving can be lessened if her partner also has infertility problems (e.g. poor quality sperm).
9. Are there particular health risks for women undergoing infertility treatment?
Along with their intended benefits, drugs used to treat infertility may on some occasion cause side effects. In ovulation induction, close monitoring of follicular growth is crucial to ensuring successful treatment. Monitoring techniques (such as ultrasound scan and blood tests) and appropriate use of treatment protocols help the physician to avoid t ovarian hyperstimulation syndrome (OHSS) and minimize the risk of an multiple pregnancy. Current treatment protocols have been designed to reduce the risk of multiple births and OHSS.
10. Is there an increased risk of birth defects related to IVF?
A. This issue has been looked at extensively. The simple answer is that there is no increased risk of birth defects after IVF. Human beings have an overall rate of birth defects of approximately 2% at birth. The rate has been shown to be the same for IVF pregnancies. There is some recent data showing that there may be a minimal increase in this rate among those pregnancies established by means of IVF with ICSI. The increase was found to be in the 1% range.
11. Will the IVF baby born be normal?
The risk of birth defects in the general population is 1-3% of all births. And, indeed, babies born from in vitro fertilization may also have birth defects. There are, however, a number of confounding factors that may lead to overstating the risk associated with the IVF process itself. First, birth defects occur more frequently in cases of multiple births and the incidence of multiple births is much higher with IVF, largely due to the purposeful transfer of multiple embryos, rather than being due to the technology itself. Second, the incidence of birth defects increases with advancing maternal age, and on average, women who conceive through IVF tend to be older than women who conceive naturally. Third, and perhaps most important of all, is the fact that couples who have infertility seem to have a higher rate of birth defects than the general population even if no fertility treatments are used. It follows that studies which use birth defect rates from the general population as a comparison to IVF, probably overestimate the risk from IVF.
12. What about success rates of IVF?
A. Overall, success rates for IVF have steadily improved over the last ten years. Birth rates for IVF vary according to the expertise of the centres practicing this technique. However, majority have reported pregnancy rates after one cycle of IVF equal or superior to 30-35%.