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MYTHS AND FACTS ABOUT INFERTILITY

MYTHS AND FACTS ABOUT INFERTILITY Female age does not matter as long as you are under 35 years of age? FALSEWomen are born with a limited number of eggs that declines with age. This results in a measurable decline in fertility that begins in mid-20’s and becomes progressively steeper after 30’s. After 40’s the chance of successful live birth with a woman’s own egg is extremely low.However, the rate of depletion of eggs may be rapid in some women as compared to their counterparts in the same age group. I am maintaining a healthy lifestyle with respect to regular exercise, healthy food and mindful activities so nothing can affect my fertility. It’s a mythA healthy body and mind do help boost your fertility, but cannot reverse the effects of aging on your ovaries and your sperms. Other pathological factors causing infertility like infections (tuberculosis, PID), azoospermia, varicocele, blocked fallopian tubes or uterine malformations cannot be prevented with a healthy lifestyle alone. We have sex daily so our chances of getting pregnant are higher. FalseHaving sex everyday does not increase the chances of pregnancy compared to those having intercourse every alternate day or during the fertile window. Being on birth control pills for longer periods leads to infertility. It’s a mythOral contraceptive pills are usually safe and do not cause infertility. Couples can plan pregnancy 2-3 months after stopping the pill. However, intra-uterine devices like copper-T may sometimes induce infection or cause swelling in the uterus, leading to infertility. If you have conceived once and had a healthy pregnancy in the past you cannot be infertile. It’s a mythIssues such as uterine changes post-delivery, infections, or a decline in ovarian reserve may cause secondary infertility. Semen parameters may also be affected over time due to various factors. Males do not have a biological clock. MythAlthough men can produce sperm throughout life, sperm quality declines with age. Increased male age is associated with reduced semen quality and increased risk of miscarriage due to greater DNA fragmentation. Infertility is only a woman’s problem. FalseMale and female infertility are equally prevalent. 35% of infertility cases are due to male factors, 35% female, 10% combined, and 20% unexplained. Putting your legs up after intercourse or avoiding standing up after sex will improve your chances of conception. MythGravity does not affect sperm movement. They reach the fallopian tube on their own. Infertility is mostly the problem of the West and affects only a small population in India. FalseOne in 10 couples in India faces infertility. Lifestyle changes, late marriages, obesity, smoking, drinking, and drug use increase risk. Coffee has no impact on fertility; I need to stop caffeine only once I am pregnant. False Women consuming more than 2 cups of coffee daily have reduced fertility. Caffeine is present in coffee, tea, colas, and chocolates. All women have 28-day cycles and ovulate on day 14. FalseOnly 16% of women have a 28-day cycle. Ovulation typically occurs 14 days before the next period. It’s advisable to have intercourse every alternate day from day 8 to cover the fertile window. Obesity has no effect on fertility. FalseObesity causes hormonal imbalances that affect ovulation in women and sperm production in men. Some sexual positions increase your chances of getting pregnant. ProbablyThere is no conclusive evidence, but deep penetration positions like missionary may deposit sperm closer to the cervix. Laptops can impair sperm production. TrueHeat from laptops used on the lap can reduce sperm production and quality. An average couple conceives within 3 months of trying. False85% of couples conceive within a year. Those who don’t should seek fertility evaluation. Stress does not affect fertility or conception. FalseChronic stress impacts hormone levels and sperm production, causing issues with ovulation and implantation. Women ovulate during every menstrual cycle. FalseAnovulatory cycles (no egg release) are common, especially in women with endometriosis or PCOS. Every fertility journey looks the same. FalseFertility depends on age, time trying to conceive, ovarian reserve, tubal patency, and semen parameters. Each couple’s journey is unique.

COMMON FAQ’s – INFERTILITY AND IVF

COMMON FAQ’s – INFERTILITY AND IVF 1) When is the best time to start IVF? After a detailed fertility evaluation, your clinician may recommend IVF if it offers a higher chance of conception compared to IUI. Indications include poor ovarian reserve, tubal damage due to endometriosis or tuberculosis, hydrosalpinx, pyosalpinx, moderate to severe endometriosis, and moderate to severe male factor infertility (e.g., severe oligoasthenoteratozoospermia, azoospermia with surgically retrieved sperm). Genetic conditions requiring pre-genetic screening or diagnosis prior to embryo transfer. 2) What are the side effects and risks involved with IVF? IVF is generally safe, though some side effects may occur due to hormonal medications. Possible side effects include:– Pain, soreness, or bruising from injections (minimized with recombinant subcutaneous injections).– Breast tenderness.  – Bloating and mood swings.  – Allergic reactions to injection components. Risk of Ovarian Hyperstimulation Syndrome (OHSS) in about 3% of cases, which can be minimized with proper stimulation protocols. Small risk associated with procedures like egg retrieval and embryo transfer. 3) How many times can IVF be tried? No upper limit exists, but couples can decide after understanding effects of repeated stimulation. Most couples conceive within the first 3 IVF attempts. For repeated IVF failures, interventions such as laser-assisted hatching, embryo glue, pre-genetic screening, immunoglobulins, and intralipids can be helpful. 4) How painful is embryo transfer? Embryo transfer is a simple, non-anesthetic procedure similar to IUI. Usually not painful, but mild cramping may occur afterward. 5) What to do after 2 failed IVF cycles? After failure, the doctor identifies the cause and suggests the following options:– Genetic screening (PGD) for healthy embryos.– ERA (Endometrial Receptivity Assay) to determine optimal implantation window.  – Immunoglobulin therapy.  – Laser-assisted hatching.  – Lifestyle modification, including weight loss, stress management, yoga, or meditation. 6) How long does the egg pickup procedure take? Egg retrieval typically takes 20 to 30 minutes, depending on the number of follicles and clinical expertise. 7) How many embryos do you transfer during an IVF cycle? Determined by:– Female age– Embryo quality  – Clinical history  – Previous embryo transfer outcomes Most clinicians follow international guidelines to limit embryo number and reduce the risk of multiple pregnancies. 8) What causes infertility in women? Required reproductive functions:– Healthy ovaries– Patent fallopian tubes  – Normal uterus  – Receptive endometrium Ovarian Factors:  – PCOS  – Premature ovarian insufficiency  – Low ovarian reserve  – Menopause Tubal Factors:  – Blocked tubes due to infections or surgeries (e.g., TB, appendicitis, endometriosis) Uterine Factors:  – Fibroids, adhesions, polyps, adenomyosis, uterine anomalies, chronic infections Pelvic Factors:  – Pelvic adhesions or endometriosis (diagnosed via invasive methods) 9) What causes infertility in men? Evaluated through semen analysis (90% of cases diagnosed). Key parameters: sperm count, motility, morphology. In cases like azoospermia, advanced hormonal and genetic testing may be needed. In recurrent miscarriages or IVF failures, advanced sperm function and DNA integrity tests may be suggested.

Infertility: Causes, Evaluation, and Treatment

Infertility: Causes, Evaluation, and Treatment WHEN TO VISIT A FERTILITY SPECIALIST? If you are not able to get pregnant (conceive) after one year (or longer) of unprotected sex. Fertility in women is known to decline steadily with age. It is wise to see a fertility specialist if you are aged 35 years or older after 6 months of trying to conceive. Women over 40 years may consider seeking more immediate evaluation and treatment. FOR WOMEN Irregular periods or no menstruation Severe abdominal pain, dysmenorrhoea and ultrasound findings suggestive of endometriosis. Previous history of pelvic inflammatory disease Known or suspected uterine or tubal disease on ultrasound examination. A history of more than two miscarriages. Known genetic or acquired conditions that predispose to diminished ovarian reserve (e.g., chemotherapy, radiation). FOR MEN A history of testicular trauma Bilateral hernia surgery Prior use of chemotherapy A history of infertility with another partner Sexual dysfunction (Erectile or Ejaculation difficulties) HOW DOES A NATURAL PREGNANCY OCCUR? A woman’s body must release a healthy egg (oocyte) from one of her ovaries. The egg is then sucked into the fallopian tube through brush-like structures called fimbriae. During the ovulatory period, if intercourse occurs, semen is ejaculated into the female partner’s vagina. The fertilizable life span of an egg is 12–24 hours; sperm lives 48–72 hours. Only 10% of sperms cross the cervical barrier; about 300–500 reach the egg, and one fertilizes it. The fertilized egg (zygote) travels and implants in the uterus as a blastocyst. Infertility may result from a problem with any of these steps. DOES INFERTILITY OCCUR IN FEMALES ONLY? No, infertility is not always a woman’s problem. Both men and women can contribute to infertility, alone or in combination. 15% of infertility cases are unexplained (unknown cause). WHAT CAUSES INFERTILITY IN FEMALES? Women need functioning ovaries, patent fallopian tubes, a normal uterus, and favourable endometrium. Ovarian Factors: Polycystic ovarian disease Premature ovarian insufficiency Low or poor ovarian reserve Menopause Tubal Factors: Blocked/swollen fallopian tubes due to infections or surgeries (e.g., TB, gonorrhoea, appendicitis). Uterine Factors: Abnormalities like fibroids, adhesions, polyps, adenomyosis, congenital anomalies, or infections. Pelvic Factors: Pelvic adhesions or endometriosis affecting reproductive anatomy. WHAT CAUSES INFERTILITY IN MALES? Infertility in men is often evaluated via semen analysis (90% of diagnoses). Abnormal semen parameters (count, motility, morphology) indicate male factor infertility. Azoospermia may require hormonal or genetic tests. Advanced tests (DNA integrity) may be advised in recurrent pregnancy loss or IVF failures. COMMON FERTILITY DISRUPTORS (BOTH PARTNERS) Being overweight or obese Smoking Excessive alcohol or drug use High physical or emotional stress Radiation exposure HOW WILL THE DOCTOR ASSESS FERTILITY PROBLEMS? Detailed medical and sexual history of both partners. Initial evaluation includes:   – Semen analysis (for males)   – Tubal patency tests   – Ovarian reserve tests HOW TO TREAT INFERTILITY? Treatment depends on the cause and may include:   – Medications for ovulation induction   – Fertility-enhancing surgery (for tubal/uterine abnormalities)   – Intrauterine insemination (IUI)   – Assisted reproductive techniques (IVF/ICSI/IMSI) HOW TO DECIDE THE BEST TREATMENT OPTION? Doctors base treatment decisions on: Factors contributing to infertility Duration of infertility Female partner’s age Couple’s preferences after counselling about success rates, risks, and costs

Understanding IUI (Intrauterine Insemination): A Comprehensive Guide

Understanding IUI (Intrauterine Insemination): A Comprehensive Guide What is IUI? IUI, or Intrauterine Insemination, is a fertility treatment where concentrated motile sperm are placed directly into a woman’s uterus around the time of ovulation. This method increases the chances of sperm reaching the egg, thereby improving the likelihood of fertilization. Key Benefits of IUI:• Cost-effective and affordable.• Easy to perform and does not require an advanced setup.• Minimally invasive and outpatient-based. Pre-requisites Before an IUI Cycle Before proceeding with IUI, certain basic conditions should be fulfilled:• At least one open (patent) fallopian tube.• Evidence of regular or induced ovulation.• Adequate sperm count, motility, and morphology.• A responsive and healthy endometrial lining. Who Can Benefit from IUI? IUI is beneficial in various scenarios, including:• Unexplained infertility.• Mild to moderate male factor infertility.• Mild to moderate endometriosis.• Ovulatory dysfunction with ovulation induction.• Cervical or immunological infertility.• Sexual dysfunctions such as vaginismus or ejaculatory disorders.• Couples with infrequent intercourse due to travel or overseas employment. IUI in the Era of IVF While IVF has revolutionized infertility treatments, IUI still holds a valuable place for:• Individuals with physical or psychosexual difficulties preventing vaginal intercourse.• HIV-positive men (with sperm washing techniques).• Same-sex couples and LGBTQ individuals planning conception using donor sperm. IUI for Male Factor Infertility IUI can assist in cases such as:• Ejaculatory issues like retrograde ejaculation, impotence, or infrequent ejaculation.• Oligospermia – Low sperm count (<15 million/ml).• Asthenozoospermia – Poor motility (<40%).• Teratozoospermia – Poor morphology (<4%). Note: For severe cases (Count <5 million/ml, Motility <10%, Morphology <2%), ICSI (Intracytoplasmic Sperm Injection) is recommended over IUI. What is AID (Artificial Insemination by Donor)? AID involves using donor sperm for insemination when:• The male partner has azoospermia (no sperm).• Severe male factor infertility not affordable for IVF/ICSI.• The male partner has hereditary disorders or is HIV positive. Semen Cryopreservation: What & Why? Semen Cryopreservation is the process of freezing sperm for future use. It is useful when:• The male partner is unable to provide a sample on demand due to psychosexual or medical issues.• The male partner frequently travels or lives overseas. Steps Involved in an IUI Cycle Pre-treatment Evaluation: Case history, ovarian reserve, tubal status, hormonal profile, semen analysis. Counselling & Planning: Discuss timing, procedures, success rates, and cost. Ovarian Stimulation: Personalized protocols for follicular growth. Monitoring: Serial ultrasounds to track follicular growth. Trigger Injection & Timing: Given when follicle >18–20 mm & endometrium >8 mm. IUI is done 36 hours after the trigger. Semen Collection & Preparation: Fresh or frozen semen is prepared using sperm wash media. Insemination Procedure: 15-minute procedure using a fine catheter to place sperm into the uterus. Post-IUI Care Guidelines Resume normal activities immediately.• Continue prescribed medications.• Avoid intercourse on the day of IUI (not restricted afterward).• Urine pregnancy test (UPT) should be done 15 days post-IUI. Possible Side Effects of IUI Cramping• Infection• Ovarian Hyperstimulation Syndrome (OHSS)• Multiple pregnancy Success Rates of IUI Success rates range from 15%–20% per cycle, depending on the underlying cause of infertility. Factors Affecting IUI Success Age of the woman• Duration and cause of infertility• Stimulation protocol• Timing of insemination• Technique used• Semen quality• Number of treatment cycles• Follicle count at the time of trigger How Many IUI Cycles Should One Try? Most successful pregnancies via IUI happen within the first 3 to 6 cycles. Majority conceive within 4 cycles. Cost of a Single IUI Cycle A single IUI cycle costs approximately ₹10,000–₹15,000 INR.Note: This does not include additional costs for medications, tests, or injections required during the cycle. Final Thoughts IUI offers a less invasive and affordable fertility solution for couples struggling with conception. While it may not be suitable for every case, it can be a stepping stone before moving to more advanced assisted reproductive techniques like IVF or ICSI. Interested in knowing if IUI is right for you? Book a consultation with our fertility specialist today.

Rewind Your Biological Clocks With Egg Or Embryo Freezing.

Rewind Your Biological Clocks With Egg Or Embryo Freezing. -Dr.Shruti Mane , Fertility & IVF consultant What do you exactly mean by fertility preservation? Fertility preservation is use of advanced technology to retain an individual’s ability to procreate or reproduce an offspring in the future. In this we cryopreserve (freeze) eggs also known as oocytes, embryos, sperms and also ovarian tissue. With the help of these frozen gametes and tissues it is possible for the couple to conceive in later ages whenever they take the decision of starting their own family. Why is fertility preservation a best option for you? If you are not ready for a family- Not everyone feels ready for parenthood at the same time. There are times when couples want to attain their financial stability before starting a family in such cases freezing your embryos at a young age to focus on your career, finances and emotional well-being to prevent yourself from regretting the decision in future. You have not met the right partner – For women who are still in their late 20’s or early 30’s and still haven’t found the right partner, they can opt for freezing their eggs. With increasing age, the quality and number of eggs (oocytes) goes on declining. For some women the decline is more rapid than the others of the same age. Egg freezing in such instances will help these women to rewind their biological clocks and focus on their life goals and give them the authority to take charge of their own future. If you are a transgender or non-binary person- You may want to preserve your fertility if you are starting hormone therapy or are planning to have reconstructive surgery (operations for change of sex). Both treatments can lead to total or partial loss of your fertility. If you are undergoing treatments for cancer- Chemotherapy and Radiotherapy are cancer related treatments that can lead to toxic effects on your gonads. Some drugs used in chemotherapy in high doses can cause infertility. Also, evidence suggests that certain genomic alterations may be present in the children conceived from gametes after exposure to such treatments for cancer.  Hence it is wise to freeze (cryopreserve) gametes sperms, oocytes(eggs) or embryos prior to undergoing such treatments for cancer. What is social egg freezing or elective egg freezing? Women today are choosing to have children later in life than ever before, Egg freezing can help woman to delay pregnancy until a later stage in life. Egg freezing is a process where multiple oocytes or eggs are extracted from your ovaries and stored or frozen using advanced techniques in the cryo-tanks. Once the women desire pregnancy, these eggs are then thawed and used to make babies by the process of IVF. Is egg freezing a viable option for me? SOCIAL REASONS FOR EGG FREEZING: If you are a woman who wishes to postpone her pregnancy for reasons such as financial stability, or achieving certain life goals with regards to your career or in cases where you haven’t found the right match egg freezing at a younger age is your knight in shining armor. MEDICAL REASONS FOR EGG FREEZING: Women who are having medical conditions like auto-immune diseases or detected with certain types of cancers such women or young girls can freeze their eggs before undergoing treatments like chemotherapy /radiotherapy which have a hazardous effect on your fertility. CONFUSED REGARDING CHILD BEARING– Women who are unsure about their decision whether they want to have children in future or not. Such women can freeze their eggs or embryos (for married women) until they decide to have children. IN A TOXIC RELATIONSHIP OR MARRIAGE – Women who are in a toxic relationship or marriage can explore the option of egg freezing to not regret their decision of postponing pregnancy. Underwent an ovarian surgery at a very young age– Women or young girls who have undergone ovarian surgery in their teenage years due to ovarian torsion, dermoid cysts in their ovaries, removal of ovarian cysts or removal of one of the ovaries such woman or girls can opt for egg freezing for preserving their future ability to bear children after testing their ovarian reserve. Why is egg freezing so important? With increasing age there is decline in the fertility potential of women because of Decrease in the quality of oocytes (eggs). Increase risk of oocyte aneuploidy or genetic(chromosomal) abnormality. Decrease in the number of oocytes(eggs). Increased risk of miscarriages. Less chances of getting pregnant with increase in age. Female eggs or ovarian reserve starts declining after the age of 32 years and declines rapidly after 35 years of age with increased risk of fetal abnormalities. For Example:- A woman decides at the age of 30 years to freeze her eggs as she has not found the right partner or for reasons of her financial stability. When at the age of 37 years she decides to conceive using the eggs frozen at the age of 30 years the risk of fetal abnormalities, miscarriages are less and chances of conceiving and having genetically healthy offspring are high and similar to the age group at which she froze her eggs. This is because the gametes (egg) used to make the baby were stored at a younger age hence the women wasmable to bypass the age-related fertility problems if she decided to conceive at the age of 37 years without use of egg freezing. What is the optimal age for egg freezing? For better success rates  it is advised to freeze your eggs as early as before 35 years of age. However, In certain cases due to delayed awareness or reasons such as social acceptance we do encourage women to undergo egg freezing whenever they are ready after assessing their ovarian reserve. Is egg freezing safe? Egg freezing is a safe procedure when done under guidance and supervision of your fertility clinician or reproductive endocrinologist. Possibly some discomfort, bloating during the stimulation can be experienced. Less than 1% patients experience any

Can Stress Affect Fertility?

CAN STRESS AFFECT FERTILITY? -Dr.Shruti Mane , Fertility & IVF consultant Stress is often defined as an event that a person sees/ feels is threatening. The event or cause which leads for an internal response of stress is termed as stressors Types of stress Acute stress: Suddenly occuring event, short lived, threatening event (robbery / giving a speech/ exams/going for an interview) Chronic stress: ongoing environmental demand( relatiosnhip/marital conflicts/ diagnosed with infertility and the treatment is too prolonging ,or fear of failure of treatment) Stress affects our reproductive health by altering the H-P-O axis (normal hormonal pathway). It leads to production of cortisol which is also known as a “stress hormone” from the adrenals which in turn affects most of our systems in the body. Cortisol when produced in excess in response to chronic stress can cause hormonal imbalances in both males and females. We are going to focus on how this hormone affects our reproductive health/Fertility In Males Chronic stress leads to reduced testosterone levels leads to loss of libido or decreased sexual arousal leading to sexual dysfunction such as erectile dysfunction, premature ejaculation. It also leads to diminished sperm production due to decreased levels of testosterone hence affecting the normal semen parameters like count and motility of sperms. In Females, Due to increase in the levels of cortisol there is an imbalance between the levels of progesterone and estrogen. If cortisol is produced in excess the estrogen excretion in the body gets delayed leading to accumulation of estrogen and causing a state of estrogen dominance Hence causing irregular periods, anovulation, weight gain. Progesterone is the hormone required for maintenance of pregnancy. When cortisol is produced in excess it decreases the production of progesterone as the precursors required for production of progesterone are same as that of cortisol. Hence may also negatively impact implantation of the embryo or decidualization of the endometrium so that it is appropriate for implantation. In conclusion stress in small amounts may not be considered one of the factors for infertility or affecting reproductive health, but when is chronic should be addressed and given a holistic approach.

AMH and its Significance?

AMH and its Significance? -Dr.Shruti Mane , Fertility & IVF consultant AMH also known as Anti-Mullerian hormone is a marker which gives us a value of ovarian reserve in females. Ovarian reserve reflects the quantity and quality of available oocytes in the females and also has become an indispensable measure for understanding a women’s reproductive potential aka her biological clock. AMH levels are now routinely done as any other hormonal analysis to understand the fertility potential of the women. It also helps in deciding the treatment modality needed for the couple in patients undergoing medically assisted reproductive technology ; and in the diagnosis of ovarian failure, polycystic ovarian syndrome, and granulosa cell tumour. Anti-Mullerian hormone (AMH) is produced by the granulosa cells of primary, preantral, and small antral follicles in the ovaries. AMH can be tested on any day of menstrual cycle. The quantitative measurement of serum AMH levels has revealed that ovarian reserve may vary in women of the same chronological age. Moreover, we can safely say that AMH is the most reliable marker of ovarian reserve, which may be useful for a wide range of clinical applications including the optimization of fertility treatments, the diagnosis of disorders of reproductive endocrinology, and the assessment of ovarian toxicity due to medical and surgical treatments. Salpingectomy and uterine artery embolization, which is a fertility-preserving intervention in cases of postpartum haemorrhage, may have lasting effects on blood flow to the ovaries, leading to a decline in ovarian reserve. Serum AMH levels become undetectable within 5 years before menopause. Serum AMH when paired with Antral follicle count of ovaries done on day 2/3 of the menstrual cycle by transvaginal ultrasound gives the most accurate estimate of a females ovarian reserve and reproductive potential. Implications  and limitations of measurements of serum anti-Mullerian hormone (AMH) levels in various clinical conditions Clinical scenarios   What have we learned?     What should we know?   Medically assisted reproduction   Good correlation to oocyte yield Predictive potential for poor and hyper-response   Predictive potential for live births. Optimization of protocols to improve treatment success   General population   Peaks around 25 years of age and gradually declines Very low serum AMH level does not necessarily mean sterility   Predictive potential for future fertility   Menopause/POI (Premature ovarian Insufficiency)   Undetectable serum AMH level is followed by menopause within a certain time period depending on Age   Selection and diagnosis of subclinical POI   PCOS   Elevated serum AMH level is correlated with severity   Association with pathophysiology Optimization of treatment schedules according to serum AMH levels   Ovarian toxicity/surgical intervention   Decline depending on chemotherapeutic regimens and surgical interventions, especially cystectomy for endometriomas   Indication of fertility preservation( egg/embryo freezing) Optimal interventions according to ovarian reserve  

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