Infertility/IVF by Dr Sandeep Talwar

What is female infertility?

The inability to conceive due to causes in female partner is known as female infertility.

How common is it? What are its causes? What is unexplained infertility?

Approximately 1 in 6 couples worldwide suffer from infertility. Causes in females include tubal problems, defects in ovulation, endometriosis, advanced age, and unexplained; and causes in males include low sperm count and motility as well as abnormal morphology.

Unexplained infertility occurs when there is no reason for infertility. When both male and female partner have all work-up done and they have no apparent cause for infertility, it is known as unexplained infertility.

What are the risk factors for infertility? How does age affect a woman’s ability to have children? Is infertility preventable?

Risk factors for infertility include advanced age, infections, and lifestyle problems, such as obesity, cigarette smoking, alcohol, etc.

Chances of conception are highest in females less than 30 years of age. After 30, chances of conception drop by 3% every year. After 35 years of age there is a rapid decline in fertility. At 40, a woman’s odds of getting pregnant are around 5%.

There are certain conditions which are preventable, like sexually transmitted diseases causing pelvic infections and tubal block. To circumvent age-related infertility, women can go for oocyte cryopreservation. Lifestyle can be changed—for overweight women, exercising can be an effective way to lose weight.

What are the signs and symptoms of infertility in a female? How long should a couple try before consulting a fertility doctor?

Irregular menstrual cycle is a pointer to anovulatory cycle; severe dysmenorrhea can point towards endometriosis; extreme weight loss can again point towards defects in ovulation.

Couples less than 35 years of age can wait for one year before consultation. They should come earlier if: a woman has undergone pelvic surgery, has a history of pelvic surgery, ectopic pregnancy, or fibroid removal, or has received treatment for pelvic tuberculosis or childhood cancer.

How is infertility diagnosed? How much do the infertility tests approximately cost?

Infertility is diagnosed by tests to see if ovaries are functioning normally or tubes are patent. Semen analysis is done to see sperm parameters. The tests approximately cost Rs 10,000 to 15,000.

What are the different treatment options for female infertility and what are the factors that govern a specific course of treatment?

Different treatment options for female infertility are IUI (intrauterine insemination), IVF (in vitro fertilization) and ICSI (intracytoplasmic sperm injection).

The factors which determine course of treatment are age of female partner, ovarian reserve, tubal status, and sperm parameters.

What is in vitro fertilization (IVF)? How many IVF cycles are required to get pregnant? Is there any age bar? Is it possible to select the sex of the child?

The fertilization of egg and sperm in the lab is called IVF. The chances of conception in one cycle vary from 40% to 50%. A woman may take 2 – 3 cycles to get pregnant.

Pregnancy rate falls in IVF in women above 35 years. There is a drastic fall in pregnancy rate above 40 years of age with increasing risk of aneuploidies. Sex selection is indicated in genetically linked diseases.

What is the success rate for IVF? What is the average cost of an IVF cycle in India?

The success rate of IVF in one cycle varies from 40% to 50%. Cost of an IVF cycle in India is about 2,00,000 rupees.

How long does the IVF procedure take? Is it painful? Are there any restrictions (dietary etc.) while undergoing IVF?

IVF procedure takes 2 – 3 weeks to complete. It is not painful and there are no dietary restrictions during IVF cycle.

What are the options if a woman’s own eggs are not producing a pregnancy? What is egg donation? Who is a suitable egg donor/recipient? Are there any egg donor registries in India? Can you suggest some of them?

If a woman’s eggs are not producing a pregnancy then egg donation is the answer. Egg donation means that eggs from a young woman (donor) are taken and fertilized with sperms of male partner and transferred in the uterus of female partner.

Suitable egg donor is a woman who is around 25 years of age with proven fertility with good ovarian reserve. There are registered egg donor registries in India.

Are there any long-term health risks to the women undergoing IVF? Are there greater chances of birth defects among IVF-conceived children in comparison to general population?

There are no major long-term health risks in women undergoing IVF. However, there is a slightly increased risk of heart and urogenital tract malformations in IVF-conceived children.

Is surrogacy legal in India? Where can it be done? What is the cost involved?

Surrogacy for married Indian couples is legal in India. It can be done in centers recognized by Indian Council of Medical Research (ICMR). The cost of surrogacy is between Rs 10 lakh and 12 lakh.

As fertility treatments can be quite stressful, can you suggest some counseling centers in your area or support groups (online or offline), for couples undergoing fertility treatments?

There are counselors for IVF patients but there are no support groups.

What is the one advice that you would like to give to the women dealing with infertility?

Please don’t stress, and ask whatever is troubling you as far as your treatment is concerned.

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