Most couples who try to have children manage to successfully conceive a pregnancy within a year. However, the inability to conceive is nothing to be ashamed of and should not be stigmatised. In general, infertility is defined as the inability to get pregnant after one year or longer of unprotected sex during ovulation. Some couples do manage to conceive naturally after a year, with only a meticulous practice of cycle-tracking. Fertility in women is known to decline after 35 years of age. Egg numbers and egg quality decrease more rapidly. Men can also experience problems with fertility, caused by a low sperm count or low-motility sperm. It is advisable to seek fertility expertise if you have trouble getting pregnant after consistently trying for a year or if you have had a miscarriage.
Infertility medicine specialises in treating unexplained infertility and loss of pregnancy. The department has experience in treating diverse patients who have difficulty becoming pregnant or carrying the pregnancy to term. Our team of specialists consists of Reproductive Health Specialists, Embryologists, Andrologists, Ultrasonologists, Ob-Gyns, and counsellors. We work together to make sure our patients receive holistic care. The Department is a state-of-the-art facility, housing our speciality fertility labs. Assisted by an experienced and specialized staff of technicians and nurses, our doctors try to make treatment process as comfortable as possible, allowing the couple to enjoy the beginning of their journey of parenthood.
The female reproductive hormones, Follicle stimulating hormone (FSH), Luteinizing hormone (LH), Progesterone and Estrogen, control the menstrual cycle that deals with the release of egg. A Hormonal Profile is a test to check the levels of these hormones. The study typically records the levels of these hormones at various stages of the menstrual cycle. The way in which the levels of these hormones fluctuate could indicate the underlying cause of infertility.
Follicular study is a vital part of the IVF process. It is a medical investigation conducted through a series of ultrasound scans at regularly scheduled times through the menstrual cycle. The scans will allow the doctor to assess follicular growth, endometrial thickening and ovulation. The doctor usually recommends intercourse as close as possible to ovulation to increase the chance of a natural pregnancy. This is called the “Timed Intercourse” Method.
A diagnostic hysteroscopy is recommended to patients experiencing problems with fertility to diagnose any abnormalities that may be present in the uterus. A hysteroscope is a thin, long, flexible tube with an endoscopic camera, inserted into the uterus through the vagina. The doctor may choose to remove any adhesions or scar tissues that show up on the images to improve the patient’s chances of embryonic implantation.
Tubal patency test [dye test] – A hysterosalpingogram is an X-ray imaging test used to check for blockages in the fallopian tubes that connect the ovaries to the uterus. If the fallopian tube is blocked, ova released form the ovary cannot reach the uterus and lose their chance at fertilization and implantation. During the test, the doctor inserts a tube into the uterus through the vagina and fills it with a liquid that had iodine. The iodine contrasts with the uterus and fallopian tubes, when viewed under X-ray fluoroscopy. This results in clearer diagnostic images.
Overall, male infertility issues are a factor in about 50% of infertility cases. Varicocele and vas deferens obstructions are common conditions that contribute to male infertility. Certain medications, such as chemotherapy can also cause male infertility. Diagnosis of male infertility usually involves a physical exam, a detailed medical history and lifestyle evaluation and a semen analysis. The semen analysis tests for sperm count and sperm motility, which determine whether the sperm cells can reach the ovum to cause a pregnancy. The semen analysis also tests for infections. Based on what they find, the doctor may recommend further tests including a scrotal ultrasound, post-ejaculation urinalysis, genetic tests or a testicular biopsy.
Ovulation induction refers to the stimulation of ovulation in women undergoing fertility treatment, through the administration of certain medications. The ovulation induction results in ovulation and increases the chances of a successful pregnancy. A follicular study is performed during this period to track when the mature ova are likely to get released.
Intra-uterine insemination is a medical procedure in which sperm cells from semen are concentrated and injected into the uterus during ovulation. The patient may be given ovulation-inducing medication to improve their chances of getting pregnant during the procedure. Intra-uterine insemination may be an effective strategy to treat infertility if it is caused by ovulatory problems and mild-male factor infertility. Intra-uterine insemination is also performed when the patient chooses to use a sperm donor. Intra-uterine insemination is a relatively simple and safe procedure. It can result in multiple pregnancies, twins or triplets, due to the ovulation-inducing medication, which results in the release of multiple mature egg cells in the same cycle.
In-vitro fertilization (IVF) is an assisted-reproductive technique to help infertile couples have biological children. Egg cells and sperm cells are extracted and mixed together to encourage fertilization under laboratory conditions. The resultant embryos can be implanted in the patient, a gestational carrier or cryogenically stored for later use.
Intracytoplasmic Sperm Injection (ICSI) is a variant of the IVF procedure, in which the sperm cells and eggs cells are not simply mixed together, but a single sperm cell is chosen and injected directly into a harvested mature ovum to create the embryo.
Intracytoplasmic Morphologically-selected Sperm injection (IMSI) is a variant of the ICSI procedure, in which the sperm cell to be injected for fertilization is carefully chosen based on microscopic observation to test for abnormalities that could result in embryos that are unable to attach themselves to the uterine wall or result in early miscarriage. IMSI may be recommended to couples who have a high incidence of sperm abnormality in the semen analysis.
Pre-genetic Screening (PGS) is a test performed on the embryo before the implantation stage of IVF. The embryo is biopsied and the chromosomes in the cells are counted, to ensure the number is normal – 46. An embryo with an abnormal chromosome count usually cannot implant to the uterus, results in a miscarriage or causes birth defects in the child.The pre-genetic screening can help ensure a healthy embryo is chosen for implantation, instead of an abnormal one. This helps increase the patient’s chances of a successful implantation, pregnancy and birth.
Pre-genetic Diagnosis (PGD) is a testing method that provides the doctor with data about the gene makeup of the embryo. The test can be used to identify around 2,000 single gene disorders that the embryo could have potentially inherited from its parents. The test is up to 98% accurate and can help identify a potentially healthier embryo, that doesn’t have any genetically inherited diseases, for implantation. The PGD is recommended to couples who have a family history of genetic disorders such as cystic fibrosis, sickle-cell anemia, fragile X-syndrome or Duchenne muscular dystrophy.
Endometrial receptivity array (ERA) is a diagnostic procedure to determine if the uterus is prepared for implantation of the embryo during IVF. Typically, ultrasound scans are used to assess the thickness and growth pattern of the endometrial lining. However, ERA uses tissue biopsies from the endometrial lining to provide a more accurate assessment. This procedure is recommended to patients who have already had three or more unsuccessful cycles of IVF. In such cases, the embryos are typically healthy, but implantation is unsuccessful because of timing. The ERA remedies this. There are no known medical side-effects after undergoing an ERA.
Sperm retrieval has an entirely different objective from a testicular biopsy. The aim of the sperm retrieval process is to harvest live, healthy sperm cells for IVF or ICSI. If the male partner is able to provide semen that has live, healthy sperm, surgical sperm retrieval methods will not be necessary. The lack of live sperm cells in the ejaculate is called azoospermia. It may be caused by an obstruction in the vas deferens. There are many methods of sperm retrieval. The doctor will recommend the one suited to the patient’s case. Testicular Sperm Aspiration or TESA is a procedure performed to retrieve sperm directly from the testes. A needle biopsy is performed to retrieve the sperm cells. Percutaneous Epidydimal Sperm Aspiration or PESA is a procedure performed to retrieve sperm from the epididymis, through a needle inserted via the skin. PESA is recommended for men with azoospermia, or an obstruction in the vas deferens.
Fertility treatment is a long-drawn process that may include third-party assisted reproduction for some couples. The third party usually assists the patients (the intended parents) by donating viable gametes or by being a gestational carrier, i.e., carrying the embryo for 9 months. Sperm or egg donation could be received from an anonymous donor or from a trusted friend or relative.
Men between the ages of 18 to 40 are usually eligible to donate sperm, but they must undergo semen testing, a physical exam, genetic screening for inherited diseases and a psychological evaluation. The donor donates the semen by masturbating into a sterile cup in a private room at the hospital. The semen is cryopreserved and quarantined for six months. After six months, the donor is tested again for infectious diseases and the donated semen is thawed. Some sperm cells do not hold up well to cryogenic freezing and re-thawing and will be rejected.
Women between the ages of 18 and 32, in good physical and psychological health are eligible to donate their eggs. The donor will undergo a physical exam, a psychological evaluation, genetic screening for hereditary diseases and tests for other infectious diseases to determine if they are healthy enough to donate their eggs. The egg donation process is longer and more involved than sperm donation. The donor will need to synchronise their cycle with the patient, and hence will be put on birth control pills. The donor will also be given follicle-stimulating medication to produce more mature eggs for retrieval and monitored by ultra-sound scans to check their progress. The eggs are harvested once they have matured, using a trans-vaginal ultrasound-guided oocyte aspiration procedure.
Whether you are thinking about having children or not, here are some things you should know about your fertility:
The Department of IVF prides itself on its ability to handle patients with sensitivity. The doctors put a lot of effort into educating patients about all of their options and giving them a clear picture of the possibilities. We support our patients in taking informed decisions without judgment or dogmas getting in the way. The patients have a pleasant experience with us throughout the long process of IVF and fertility treatments. We direct our patients towards resources about nutrition, exercise and mental health to ensure they achieve holistic wellbeing and are able to enjoy this beautiful time of their lives.
The Department of IVF is equipped with state-of-the-art labs with advanced medical equipment. In accordance with modern medical standards, the doctors recommend minimally invasive procedures where possible to give the patient their best chances at a normal pregnancy. The world-class medical facilities at GGHC ensure accurate results and lower chances of false positives. Our cryopreservation facility is fail-proof to ensure that specimens are all preserved safely and securely.
The Department of IVF specialises in providing high-quality medical care to all our patients. The team of doctors, surgeons, radiologists, nurses and technicians work together to ensure patients receive the correct care and recover quickly. Our fertility experts carefully and clearly take the patients through all their options and advise them professionally on their best options. We do our best with every single patient to achieve a positive outcome. Each patient is important at GGHC and we treat each one with the care and attention they need and deserve.
A consultation with our panel of doctors, specialists and surgeons will help you determine what kind of services you may need to help diagnose and treat your condition. If you or someone in your family or friend’s circle are facing any health issues, please get in touch with us, we are here for you.
