Welcome to KIMSHEALTH FERTILITY Clinic, we’re here to address some of the common questions and concerns you might have about infertility treatments.

1. What is infertility, and when should I seek help?

Infertility is the inability to conceive after a year of regular, unprotected intercourse. If you're over 35, or if you suspect any problems like menstrual issues or sexual problems, seeking help after six months or earlier is advisable.

2. What exactly happens in the Fertility clinic? When a couple comes to the clinic, what are the processes?

When a couple comes to the clinic, trained personnel will note their age, height, weight, body mass index, and blood pressure. Taking a complete health history will identify any risk factors. Physical examination of the woman includes a pelvic exam to see whether there are any abnormalities in the female reproductive tract. In the man, a general physical examination and a local genital examination are done to assess the male reproductive tract.

3. What are the basic tests? What information are you gaining by doing this test?

Infertility is a delay in conceiving. Unless we know the cause of the delay, we cannot treat the problem. Investigations like doing an ultrasound, doing hormonal assay, doing a tubal evaluation either by HSG or by Laparoscopy, and then a male semen analysis will identify the causes. Ultrasound gives more details regarding the uterus and ovaries. These are the basic investigations that will help us identify the cause of infertility in 80 per cent of the situations.

4. What is male infertility, and how is it evaluated?

Male factor accounts for 50% of infertility. Male infertility can result from various factors. Evaluation includes a semen analysis, hormonal tests, and sometimes genetic testing or imaging to identify the underlying cause.

5. What precautions should we take when we are giving a semen analysis sample for testing?

When you are asked to do a semen analysis, the couple should take the following precautions. First and foremost, there should be a gap of 2-3 days minimum, and the gap should not exceed 7 days. The reason for that is if the gap is too low, the volume can become less, and the analysis report may be abnormal. If the gap is too long, the volume will become higher, and the quality of abnormal and dead sperms might be higher. So, while giving a semen sample for analysis, it’s always important that they follow abstinence for 2-3 days and that period should not be more than 7 days.

6. If the semen analysis reports are abnormal, do I have a chance of getting pregnant?

One peculiar thing in semen analysis is that, unlike in haemoglobin or WBC count or RBC count, there are no normal values in semen analysis; there are only reference values. That means when a count is out of this range, it means probably this couple will take more time to conceive. But it will not tell that the couple will not conceive if the report is abnormal. Because it also depends on women’s fertility. If the woman is highly fertile and the man is sub-fertile, still pregnancy happens. So, the abnormal report needs a second validation based on the severity. Sometimes it will need added technology and advanced treatments, but no need to worry if a single parameter abnormality is present unless it is a significant type of problem and is present in more than one report. When it comes to motility, apart from the count, motility abnormality has more importance than only their count. If the motility is low, it shows there is a structural and functional abnormality probably. Abnormal shape of sperms is also called teratozoospermia. The combination of all the factors is important in a report. Just looking at one factor does not mean anything. Also, duration of infertility is one important factor before jumping to a conclusion.

7. What is PESA and TESA for male infertility treatment?

PESA (Percutaneous Epididymal Sperm Aspiration) and TESA (Testicular Sperm Aspiration) are surgical procedures to extract sperm from the epididymis or testes for use in ICSI (Intracytoplasmic Sperm Injection). It is a treatment option for azoospermia or zero count.

8. What is IUI, and how is it done?

IUI (Intrauterine Insemination) involves placing specially prepared activated sperm directly into the uterus after ensuring ovulation (egg release) to facilitate fertilization. It's a less invasive treatment than IVF. The success rate is around 15-18%.

9. What are ART, IVF, and ICSI and how does it work?

IVF and ICSI come under Assisted Reproductive Technologies (ART). IVF means in vitro fertilization in which the union of egg and sperm happens outside the human body in an IVF lab under appropriate conditions. Eggs are often fertilized in vitro by culturing eggs with many motile sperm.

ICSI is an advanced IVF technique in which sperm is injected into the egg manually using a thin glass pipette with higher technology and skills. This technique was developed to facilitate fertilization in cases of male-factor infertility but is now used in most IVF cycles. Practically we do ICSI for all our cases in our centre.

Selected Embryos are then transferred into the mother’s womb to achieve pregnancy.

10. How long is the hospital stay for IVF/ICSI procedures?

In most cases, ART procedures are outpatient, and patients can return home the same day. There's usually no need for a hospital stay in our hospital.

11. Is there pain associated with IVF treatments?

Discomfort during IVF or ICSI procedures is typically minimal. Daily intramuscular or subcutaneous injection for 10-12 days may be discomfort. Otherwise, it is a painless procedure. Egg retrieval is the main procedure in IVF treatment. Therefore, 6-8 hours of fasting before the process are mandatory. The patient will not feel any pain because she is kept asleep under the care of an anaesthetist under short GA during this procedure which lasts for just 10-15 minutes. After this procedure, they can go home the same day and attend regular work the next day.

12. How should I prepare for IVF treatment?

It often includes lifestyle changes, medication management, and proper nutrition. Couples should be healthy, and should not be overweight or underweight since it can affect the success of IVF.

13. Could you brief the IVF process?

IVF treatment protocols are customized according to the couple’s needs and the severity of factors. The couple must plan 2 days visit for the preparatory phase. A lady basal scan is done, and after a couple of blood tests, the semen backup sample is frozen. In long (agonist) protocol downregulation injection is the first injection given to the lady after obtaining a couple’s consent for ICSI. followed by daily injections and alternate-day scans for 10-12 days. Towards the end of stimulation, the last trigger injection is given in the evening time. The male visit is required only on the day of egg pick-up to provide a fresh semen sample. Fertilisation is done on the same day of egg retrieval.3-5 days later, the lady can come alone for embryo transfer. Sometimes embryos might be frozen on that cycle and transferred on successive months. Serum beta HCG pregnancy test will be done 2 weeks after transfer. Antagonist protocol is suggested in certain conditions, and stimulation begins on day 2 or 3 of the menstrual cycle.

14. What are the chances of getting pregnant through IVF?

Success rates vary, depending on age, cause of infertility and duration of infertility. However, your fertility specialist will discuss realistic expectations based on your specific diagnosis and treatment plan. In our centre generally, we do have a good success rate.

15. What precautions should I take after embryo transfer in IVF?

After embryo transfer, it's important to rest and avoid heavy physical activity. Complete bed rest is not required. However, we recommend restricted work and movement activities to avoid any infection. Complete immobility will not improve the embryo’s implantation process. Therefore, there is no need for bed rest after embryo transfer. No other medication should be taken without informing your doctor. You should come for a pregnancy test on the 14th day after embryo transfer. It is very important to take timely post embryo transfer medications.

16. Are there risks associated with IVF treatment?

While IVF is generally safe, it may carry some risks, such as multiple pregnancies, ovarian hyperstimulation, and, in rare cases, complications related to the egg retrieval procedure. Otherwise, it is a very safe and minimally invasive day care procedure.

17. What are the chances of miscarriage following IVF treatment?

Miscarriage rates following IVF are similar to natural pregnancies and vary depending on factors like maternal age and overall health.

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