Infertility can be defined as the inability of couple to achieve conception a year or more of regular, unprotected intercourse.
For normal couples the chance of achieving a successful pregnancy is
- 20% for any given month
- 57% within three months of trying
- 75% within six months
- 90% within one year
- 95% with in two years of attempting pregnancy
Hence a general rule is if couple does not achieve a pregnancy within one year, they should go for finding out the reasons of infertility.
One in six couples attempting pregnancy will have difficulty achieving pregnancy.
That is almost equal in 30% both are responsible
In Females: Causes could be
- Irregular ovulation or egg production , hormonal imbalance 30%
- Tubal Block 30%
- Problems in uterus like fibroids ,adhesions , defect in uterine lining called synechae, endometriosis and congenital anomalies 30%
- Unexplained 30%
In Males: Causes might be
- Low sperm count with or without low motility.
- Absence of vas deference (tube carrying the sperms), testicular abnormality , and hormonal imbalance.
- Absence of sperms (Azoospermia) Obstructive or Nonobstructive
Achieving a successful pregnancy declines with age.
- Fertility declines in men after age 50
- Fertility declines in women after age 30
- 4% of women before age 25 have difficulty achieving a successful pregnancy .
- 13% of women age 26-34 have difficulty having a baby.
- 25% of women have difficulty conceiving between the ages of 35-39
- By the age 40, 34% of women attempting pregnancy will have difficulty achieving pregnancy.
Success in Fertility treatment largely depends on ovarian reserve of the female partner. Ovarian reserve is best assessed by Day 2 vaginal sonography. It is the number of small resting follicles gives the idea about how many eggs are going too be retrieved during IVF. Other tests are Day 2/ 3 FSH, AMH and inhibin assays. Day 2/ Day 3 FSH are more frequently used.
Impotent usually means a male who can not perform sex, but he may have good number of sperm to create a baby if injected artificially.
In the same way a person may be very good at sex, but may be azoospermic .
Hence virility and sperm productions are two departments. If testis are very small or damaged in any way may cause infertility and impotency both.
Definitely there is concern, as these methods are not natural. But till date there is no clear cut correlation between these method and genetic diseases compared to population. It is a protective phenomenon of nature to go for the best selection of the pregnancies either achieved naturally or by artificial means. Abnormal fetuses are usually aborted whether they are created by natural intercourse or by ART (Assisted Reproductive Techniques)
It is wide range of Fertility Treatments. Most widely known is IVF (in-vitro fertilization) and ICSI
(Intra-cytoplasmic sperm injection)
Others are IUI (Intrauterine Insemination), GIFT (Gamete Intra-fallopian Transfer),
TET (Tubal Embryo Transfer), DEP (Donor Egg Program).
It is our experience that infertile couples are frustrated and puzzled by different treatments and opinions. They need one to one attention and should have a direct access to care giver (Doctor, Fertility specialist), not the counselor. They should have an access to the embryology lab if they wish and they should be the part of whole process in perfect transparent manner. At ARTbaby, we try to do this to our utmost efforts. Hence the atmosphere is tension free and relaxed .It increases the co-operation of the couples and helps to improve the success rate and reduce psychological breakdowns.
Compromise in quality during IVF treatment never gives success. It is the fees of the physicians that is very less here. Hence the treatment is cheaper, almost 1/5th of centers abroad.
IVF or ICSI does not need hospital stay or any sort of surgery. During egg retrieval we give general anesthesia for 10 – 15 minutes and it is given by qualified anesthesiologist. Eggs are retrieved by simple needle under ultrasound guide.
Absolute bed rest is not needed but we instruct the female partner to abstain from heavy exhaustive work and avoid intercourse for few weeks.
Complication called Ovarian Hyper Stimulation Syndrome is always feared during this treatment. It is more in younger females and esp. females with Polycystic Ovaries. To avoid that, treating physician always keeps a check on growing follicles and titrates the doses of Gonadotropins. If it is still imminent, then we do not transfer the embryos in that particular cycle and Freeze them to transfer later on. Chances of this complication are very low and usually treated in a conservative manner.
Treatment requires 30 days, from start of injection of down regulation to embryo transfer.
It is recommended when the female partner’s age is around 40 or she is having premature menopause.
There are two types of surrogacy. Traditional and Gestational surrogacy.
Traditional surrogacy is when the surrogate is herself the egg donor, so that she is the genetic mother of the baby.
Gestational surrogacy is when the surrogate is only the “womb” donor and is genetically unrelated to the baby she carries. The egg comes from either the female partner of the infertile couple or from an egg donor. The process will have to essentially be an IVF technique.
As per the ICMR regulations, we can only assist in Gestational Surrogacy in India.
Two main categories:
1) There are several reasons why a surrogate may be asked to help another woman.
Many reasons involve the prospective mother’s inability to conceive or carry a pregnancy to term. She may have a history of illness or multiple miscarriages. The prospective mother may not have a functioning uterus. We can only assist surrogates to women who have legitimate medical reasons for not carrying their own pregnancies.
2) The prospective parent may be a single man or a male couple who would like to become parents.
You will be meeting your surrogate in person, and will develop a friendly and trusting relationship. The surrogate will be interviewed, evaluated, psychologically and medically evaluated and tested, and a full background check will be done after you full satisfaction followed by a legal contract.
Recently “ART bill 2010” has been passed in India. The details of the same are available at http://www.icmr.nic.in/guide/ART%20REGULATION%20Draft%20Bill1.pdf