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FAQ
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Does the women’s age have an effect?

Yes, age has a very important effect. There is a gentle but steady decline in establishing a pregnancy after the age of thirty in Indian Women.

How many attempts should we have?

Every couple is different and the answer to the question will inevitably depend on the specific treatment you have had and the results of preceding treatment cycles. It is believed that IVF success optimizes in three cycles. Decisions on how to proceed will be discussed in detail with you during your consultation or at a review appointment.

What about my particular infertility problem?

There are differences in success rates depending on the cause of infertility, for example, tubal factors, endometriosis and male factor, unexplained or anovulatory infertility. You will have detailed discussions regarding your special circumstances.

How many times in a cycle will I have to come to the clinic?

This varies from patient to patient and also with the stage for treatment. In a DI or IUI (H) cycle, for example, the likely number of out-patient visits for monitoring is 2-4, for IVF or ICSI 4-5. During these visits egg and endometrial development are checked. Some blood tests may be advised to assess egg maturity and decide on the drug dosage. The first visit is on Day 2/3 of the cycle. At this visit an ultrasound is done to rule out any residual ovarian cysts and to check for endometrial thickness. Drug administration is withheld in case these parameters are not within the required limits.
Egg recovery is generally carried out under anaesthesia unless you opt to have it under sedation and requires you to be in hospital for half a day. For embryo transfer you are required to come in with a full bladder and you will be asked to rest for a couple of hours in hospital after the transfer.

What are the risks for assisted conception pregnancies?

The risk of abnormalities does not appear to be significantly greater than with natural conception. With procedures like ICSI there is an increased risk of sex chromosome related anomalies. The reason for this is that in patients with severe male factor infertility the abnormality existing in the male partner is carried forward. It is important to note that some techniques are very new, and detailed follow up data is not yet available.

What happens if treatment is not successful?

Be assured that we shall make every endeavor to care for you and to help you cope. ART has made tremendous progress in the last few decades and there will certainly be a treatment, which would benefit you.

Is there an increased risk of malignancy?

Current knowledge does not show any definite increase in malignancy. The scientific committees’ worldwide are constantly looking into this and we will keep you updated as to the results. Women in whom there is a family history of ovarian malignancy should limit the exposure to ovarian stimulation drugs.

Tubal surgery

Before IVF became available, tubal surgery was the only way to correct tubal problems. These days surgery of the tubes has a limited place in the management of infertile couples. However, in selected cases this procedure is invaluable and both tubal microsurgery and endoscopic (key-hole) surgery can be performed.

Who is a candidate for IVF (In-Vitro Fertilization) and ART?

Assisted reproductive technologies (ART) include IVF, which is the technique of fertilizing a woman’s egg in the laboratory. While it was designed originally for women with tubal diseases, IVF has been extended with equal success to infertility due to endometriosis, poor cervical mucus, unexplained factors and male infertility.

How do I know if ART can help me?

Thorough evaluation by an infertility specialist familiar with ART is necessary to decide whether IVF or another treatment is appropriate for you. Tests previously done usually need not be repeated as long as past records are available. Alternative therapies are presented to you if another approach offers an equal or greater chance of success. These options include ovulation induction, sperm washing and intrauterine insemination, hormonal supplementation, opening of blocked fallopian tubes through endoscopy,

What should I expect?

IVF is a complex process consisting of several steps. First, fertility drugs are given to stimulate the ripening of several eggs. Blood tests and ultrasound examinations allow for precise monitoring of egg development. At the appropriate time, the eggs are retrieved under ultrasound guidance, a non-surgical procedure performed under light sedation or anesthesia. The sperm is then added to the eggs in the laboratory where the fertilized eggs develop for 2-3 days. In case of micromanipulation for male infertility a single sperm is injected into the egg ICSI (intra cytoplasmic sperm injection). Finally, the embryos (fertilized dividing egg) are placed in the womb by a simple non-surgical procedure similar to a pelvic examination. A mock embryo transfer is done prior to starting the cycle to ensure that we do not encounter any unexpected problem on the day of the actual embryo transfer.
Two weeks after embryo transfer, a pregnancy test is done. All this is done on an out patient basis.

What are the risks of ART?

The associated reproductive procedures have so far proven remarkably safe for both – the ‘would be’ mother and her child. The spontaneous abortion rate is slightly higher than in the general population. This is not related to the procedure, it is due to inherent problems with the patient that led to infertility in the first place. There is an increased chance of multiple births, which can be limited by the number of embryos transferred. There is no difference in the pre-delivery management and the mode of delivery – vaginal/caesarean section, if all routine parameters are normal. .

Progress through the IVF Treatment Cycle

Unfortunately, not all couples proceed smoothly through every treatment cycle. The response of the body to fertility drugs varies not only in different patients but also from cycle to cycle in the same patient. Sometimes the treatment cycle has to be discontinued due to the following reason

1. A poor response to the drugs – less than 4 follicles
2. Failure of fertilization
3. Poor endometrial (uterine lining) growth

Some couples may not achieve fertilization with conventional IVF. These patients then have to go for a procedure like ICSI. Fertilization rates are higher with ICSI because the sperm bypasses the zona barrier. In patients showing a low response i.e. <6 eggs ICSI is advisable to ensure embryo transfer. There are numerous hurdles to cross, and we will do our very best to help you overcome each one.

What are the chances of success with ART?

The success rate (i.e. chances of taking home a baby in one treatment cycle) varies depending on a number of factors of which the most important factor is the age of the female partner. At consultation you will be advised of your specific chances. The average pregnancy rate (PR) is 35 to 40 % (PR’s vary based on the cause of infertility and age of the patient, with younger patients doing better than those over the age of 35) and 70% for oocyte donation cycles.

 
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