Aakash Fertility Centre & Hospital Sky 18years
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Dr. Kamaraj been awarded “Best Doctor Award 2012” in the silver jubilee year of the Dr. MGR MEDICAL UNIVERSITY
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Infertility_Treatments
IUI (Insemination)
IVF (Test Tube Baby)
ICSI (Intra Cytoplasmic Sperm Injection)
Micro Surgery for Tube Repair
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1 What is Infertility?
2 Is infertility a common problem?
3 Is infertility just a woman's problem?
4 What causes infertility in men?
5 What increases a man's risk of infertility?
6 What causes infertility in women?
7 What things increase a woman's risk of infertility?
8 How does age affect a woman's ability to have children?
9 How long should women try to get pregnant before calling their doctors?
10 How do doctors find out if a woman and her partner have fertility problems?
11 What are the treatment options for infertility?
12 What drugs are used to treat infertility in women?
13 What is test tube baby or assisted reproductive technology (ART) ?
14 What is assisted reproductive technology (ART)?
15 What is polycystic ovary syndrome (PCOS)?
16 What are hormones, and what happens in PCOS?
17 What are the symptoms?
18 What causes PCOS?
19 How is PCOS diagnosed?
20 How is endometriosis diagnosed?
21 How common is endometriosis?
22 Does endometriosis cause infertility?
23 How endometriosis affects IVF success rates?
24 Can "unexplained infertility" be endometriosis?
25 What are the endometriosis treatments?
26 What are the infertility treatments for women with endometriosis?
What is Infertility?
Infertility as not being able to get pregnant after at least one year of trying. Women who are able to get pregnant, but then have repeat miscarriages, are also said to be infertile.
Pregnancy is the result of a complex chain of events. In order to get pregnant:
  • A woman must release an egg from one of her ovaries (ovulation).
  • The egg must go through a fallopian tube toward the uterus (womb).
  • A man's sperm must join with (fertilize) the egg along the way.
  • The fertilized egg must attach to the inside of the uterus (implantation).
Infertility can result from problems that interfere with any of these steps
Is infertility a common problem?

According to the Health Statistics, about 15 % of women ,ages between 15-44 have difficulty getting pregnant or carrying a baby to term.

Is infertility just a woman's problem?
No, infertility is not always a woman's problem. In about one-third of cases, infertility is due to the woman (female factors). In another third of cases, infertility is due to the man (male factors). The remaining cases are caused by a combination of male and female factors or by unknown factors.
What causes infertility in men?
infertility in men is most often caused by:

Problems making sperm -- producing too few sperm or none at all

Problems with the sperm's ability to reach the egg and fertilize it -- abnormal sperm shape or structure prevents it from moving correctly

A man can be born with problems that affect his sperm, or a later illness or injury could affect his sperm. Cystic fibrosis, for example, often causes infertility in men.

The number and quality of a man's sperm can be affected by his overall health and lifestyle. Some things that may reduce sperm number and/or quality include:
What increases a man's risk of infertility?
  • Alcohol
  • Drugs
  • Environmental toxins, including pesticides and lead
  • Smoking cigarettes
  • Health problems
  • Medicines
  • Radiation treatment and chemotherapy for cancer
  • Age
What causes infertility in women?
Problems with ovulation account for most cases of infertility in women. Without ovulation, there are no eggs to be fertilized. Some signs that a woman is not ovulating normally include irregular or absent menstrual periods.

Less common causes of fertility problems in women include:

Blocked fallopian tubes due to pelvic inflammatory disease, endometriosis, or surgery for an ectopic pregnancy

Physical problems with the uterus

Uterine fibroids
What things increase a woman's risk of infertility?
Many things can affect a woman's ability to have a baby. These include:
  • Age
  • Stress
  • Poor diet
  • Athletic training
  • Being overweight or underweight
  • Tobacco smoking
  • Alcohol
  • Sexually transmitted diseases (STDs)
  • Health problems that cause hormonal changes
How does age affect a woman's ability to have children?
More and more women are delaying parenthood until their 30s and 40s -- about 20% of women in the United States now have their first child after age 35. So, age is an increasingly common cause of fertility problems. About one-third of couples in which the woman is over 35 have fertility problems.

Aging decreases a woman's chances of having a baby in the following ways:

The ability of a woman's ovaries to release eggs ready for fertilization declines with age.

The health of a woman's eggs declines with age.
As a woman ages, she is more likely to have health problems that can interfere with fertility.

As a women ages, her risk of having a miscarriage increases.
How long should women try to get pregnant before calling their doctors?
Most healthy women under the age of 30 shouldn't worry about infertility unless they've been trying to get pregnant for at least a year. At this point, women should talk to their doctors about a fertility evaluation. Men should also talk to their doctors if this much time has passed.In some cases, women should talk to their doctors sooner. Women in their 30s who've been trying to get pregnant for six months should speak to their doctors as soon as possible. A woman's chances of having a baby decrease rapidly every year after the age of 30. So, getting a complete and timely fertility evaluation is especially important.Some health issues also increase the risk of fertility problems. Women with the following issues should speak to their doctors as soon as possible:
  • Irregular periods or no menstrual periods
  • Very painful periods
  • Endometriosis
  • Pelvic inflammatory disease
  • More than one miscarriage
No matter how old you are, it's always a good idea to talk to a doctor before you start trying to get pregnant. Doctors can help you prepare your body for a healthy baby. They can also answer questions about fertility and provide suggestions for maximizing the chance of getting pregnant.
How do doctors find out if a woman and her partner have fertility problems?
Sometimes, doctors can find the cause of a couple's infertility by doing a complete fertility evaluation. This process usually begins with physical exams and health and sexual histories. If there are no obvious problems, like poorly timed intercourse or absence of ovulation, tests will be needed.

Finding the cause of infertility is often a long, complex, and emotional process. It can take months for you and your doctor to complete all the needed exams and tests. Don't be alarmed if the problem is not found right away.

For a man, doctors usually begin by testing his semen. They look at the number, shape, and movement of the sperm. Sometimes, doctors also suggest testing the level of a man's hormones.

For a woman, the first step in testing is to find out if she is ovulating each month. There are several ways to do this. A woman can track her ovulation at home by:

Recording changes in her morning body temperature (basal body temperature) for several months Recording the texture of her cervical mucus for several months
Using a home ovulation test kit (available at drug or grocery stores)

Doctors can also check if a woman is ovulating by doing blood tests and an ultrasound of the ovaries. If the woman is ovulating normally, more tests are needed.
Some common tests of fertility in women include:

Hysterosalpingography: In this test, doctors use X-rays to check for physical problems of the uterus and fallopian tubes. They start by injecting a special dye through the vagina into the uterus. This dye shows up on the X-ray. This allows the doctor to see if the dye moves normally through the uterus into the fallopian tubes. With these X-rays, doctors can find blockages that may be causing infertility. Blockages can prevent the egg from moving from the fallopian tube to the uterus. Blockages can also keep the sperm from reaching the egg.

Laparoscopy: During this surgery doctors use a tool called a laparoscope to see inside the abdomen. The doctor makes a small cut in the lower abdomen and inserts the laparoscope. Using the laparoscope, doctors check the ovaries, fallopian tubes, and uterus for disease and physical problems. Doctors can usually find scarring and endometriosis by laparoscopy. Dye can be injected through the vagina into the uterus and then can be observed directly moving through the ends of the fallopian tubes.
What are the treatment options for infertility?
infertility can be treated with medicine, surgery, artificial insemination, or assisted reproductive technology. Many times, these treatments are combined. About two-thirds of couples who are treated for infertility are able to have a baby. In most cases, infertility is treated with drugs or surgery.

Doctors recommend specific treatments for infertility based on:

Test results
How long the couple has been trying to get pregnant
The age of both the man and woman
The overall health of the partners
Preference of the partners
Doctors often treat infertility in men in the following ways:

Sexual problems: If the man is impotent or has problems with premature ejaculation, doctors can help him address these issues. Behavioral therapy and/or medicines can be used in these cases.

Too few sperm: If the man produces too few sperm, sometimes surgery can correct this problem. In other cases, doctors can surgically remove sperm from the male reproductive tract. Antibiotics can also be used to clear up infections affecting sperm count.

Various fertility drugs are often used to treat women with ovulation problems. It is important to talk with your doctor about the pros and cons of these medicines. You should understand the risks, benefits, and side effects.

Doctors also use surgery to treat some causes of infertility. Problems with a woman's ovaries, fallopian tubes, or uterus can sometimes be corrected with surgery.

Intrauterine insemination (IUI) is another type of treatment for infertility. IUI is known by most people as artificial insemination. In this procedure, the woman is injected with specially prepared sperm. Sometimes the woman is also treated with medicines that stimulate ovulation before IUI.

IUI is often used to treat:
    • Mild male factor infertility
    • Women who have problems with their cervical mucus
    • Couples with unexplained infertility
What drugs are used to treat infertility in women?
Some common drugs used to treat infertility in women include:

Clomiphene citrate : This drug causes ovulation by acting on the pituitary gland. It is often used in women who have polycystic ovarian syndrome (PCOS) or other problems with ovulation. This medicine is taken by mouth.

Human menopausal gonadotropin or hMG: This medicine is often used for women who don't ovulate due to problems with their pituitary gland. hMG acts directly on the ovaries to stimulate ovulation. It is an injected medicine.

Follicle-stimulating hormone or FSH : FSH works much like hMG. It causes the ovaries to begin the process of ovulation. These drugs are usually injected...

Gonadotropin-releasing hormone (Gn-RH) analog: These drugs are often used for women who don't ovulate regularly each month. Women who ovulate before the egg is ready can also use these medicines. Gn-RH analogs act on the pituitary gland to change when the body ovulates. These drugs are usually injected or given with a nasal spray..

Metformin : Doctors use this drug for women who have insulin resistance and/or polycystic ovarian syndrome (PCOS). This drug helps lower the high levels of male hormones in women with these conditions. This helps the body to ovulate. Sometimes clomiphene citrate or FSH is combined with metformin. This drug is usually taken by mouth.

Bromocriptine : This drug is used for women with ovulation problems due to high levels of prolactin. Prolactin is a hormone that causes milk production.Many fertility drugs increase a woman's chance of having twins, triplets, or other multiples. Women who are pregnant with multiple fetuses have more problems during pregnancy. Multiple fetuses have a high risk of being born too early (prematurely). Premature babies are at a higher risk of health and developmental problems.
What is test tube baby or assisted reproductive technology (ART) ?
Test tube baby or Assisted reproductive technology (ART) is a term that describes several different methods used to help infertile couples. ART involves removing eggs from a woman's body, mixing them with sperm in the laboratory, and putting the embryos back into a woman's body.
What is assisted reproductive technology (ART)?
Success rates for ART vary and depend on many factors. Some things that affect the success rate of ART include:
  • Age of the partners
  • Reason for infertility
  • Fertility clinic
  • Type of ART
  • If the egg is fresh or frozen
  • If the embryo is fresh or frozen
The according to the published data the success rates of ART globally for fertility clinics the average percentage of ART cycles using fresh non donor eggs that led to a healthy baby were as follows:
  • Above 40.% in women aged 25
  • Between 35% to 40 % in women aged 30
  • Between 30 % 33 % in women aged 35
  • Around 15.% 20 % in women aged 40
ART can time-consuming has cost implications . But it has allowed many couples to have children. The most common complication of ART is multiple fetuses. But this is a problem that can be prevented or minimized in several different ways.

What are the different types of assisted reproductive technology?

Common methods of ART include:

In vitro fertilization (IVF) means fertilization outside of the body. IVF is the most effective ART. It is often used when a woman's fallopian tubes are blocked or when a man produces too few sperm. Doctors treat the woman with a drug that causes the ovaries to produce multiple eggs. Once mature, the eggs are removed from the woman. They are put in a dish in the lab along with the man's sperm for fertilization. After three to five days, healthy embryos are implanted in the woman's uterus.

Zygote intrafallopian transfer (ZIFT) or tubal embryo transfer is similar to IVF. Fertilization occurs in the laboratory. Then the very young embryo is transferred to the fallopian tube instead of the uterus.

Gamete intrafallopian transfer (GIFT) involves transferring eggs and sperm into the woman's fallopian tube. So fertilization occurs in the woman's body. Few practices offer GIFT as an option.

Intracytoplasmic sperm injection (ICSI) is often used for couples in which there are serious problems with the sperm. Sometimes, it is also used for older couples or for those with failed IVF attempts. In ICSI, a single sperm is injected into a mature egg. Then the embryo is transferred to the uterus or fallopian tube.

Intracytoplasmic morphologically-selected sperm injection (IMSI) IMSI begins with standard IVF procedure. The female partner is given ovulation-inducing drugs, and the resulting mature eggs are then harvested from her ovaries and prepared for fertilization in the laboratory. The embryologist will then use the high-powered microscope to examine the male partner's semen sample. He then uses a long, thin, hollow needle to pick up the desired sperm cell. He holds the egg cell in a special pipette, and then uses the needle to push the sperm cell through the outer shell of the egg and into its inner area, where fertilization can take place. The eggs and sperm are then left for 24 hours, during with fertilization is likely to occur. If this is indeed what happens, the now fertilized eggs (embryos) are transferred back to the woman's uterus where hopefully at least one will implant, resulting in a pregnancy.

ART procedures sometimes involve the use of donor eggs (eggs from another woman), donor sperm, or previously frozen embryos. Donor eggs are sometimes used for women who cannot produce eggs. Also, donor eggs or donor sperm are sometimes used when the woman or man has a genetic disease that can be passed on to the baby.
What is polycystic ovary syndrome (PCOS)?
Polycystic Ovary Syndrome (PCOS)
Polycystic ovary syndrome is a problem in which a woman’s hormones are out of balance. It can cause problems with your periods and make it difficult to get pregnant. PCOS may also cause unwanted changes in the way you look. If it is not treated, over time it can lead to serious health problems, such as diabetes and heart disease.

Polycystic ovary syndrome (or PCOS) is common, affecting as many as 1 out of 15 women. Often the symptoms begin in the teen years. Treatment can help control the symptoms and prevent long-term problems.
What are hormones, and what happens in PCOS?
Hormones are chemical messengers that trigger many different processes, including growth and energy production. Often, the job of one hormone is to signal the release of another hormone.

For reasons that are not well understood, in PCOS the hormones get out of balance. One hormone change triggers another, which changes another. For example:

The sex hormones get out of balance. Normally, the ovaries make a tiny amount of male sex hormones (androgens). In PCOS, they start making slightly more androgens. This may cause you to stop ovulating, get acne, and grow extra facial and body hair.

The body may have a problem using insulin, called insulin resistance. When the body doesn't use insulin well, blood sugar levels go up. Over time, this increases your chance of getting diabetes.
What are the symptoms?
Symptoms tend to be mild at first. You may have only a few symptoms or a lot of them. The most common symptoms are:

Acne.

Weight gain and trouble losing weight.

Extra hair on the face and body. Often women get thicker and darker facial hair and more hair on the chest, belly, and back.

Thinning hair on the scalp.

Irregular periods. Often women with PCOS have fewer than nine periods a year. Some women have no periods. Others have very heavy bleeding.

Fertility problems. Many women who have PCOS have trouble getting pregnant (infertility).

Depression.

Most women with PCOS grow many small cysts  on their ovaries. That is why it is called polycystic ovary syndrome. The cysts are not harmful but lead to hormone imbalances.
What causes PCOS?
The symptoms of PCOS are caused by changes in hormone levels. There may be one or more causes for the hormone level changes.

PCOS seems to run in families, so your chance of having it is higher if other women in your family have PCOS, irregular periods, or diabetes. PCOS can be passed down from either your mother's or father's side.
How is PCOS diagnosed?
To diagnose PCOS, the doctor will:

Ask questions about your past health, symptoms, and menstrual cycles.

Do a physical exam to look for signs of PCOS, such as extra body hair and high blood pressure. The doctor will also check your height and weight to see if you have a healthy body mass index (BMI).

Do a number of lab tests to check your blood sugar, insulin, and other hormone levels. Hormone tests can help rule out thyroid or other gland problems that could cause similar symptoms
How is endometriosis diagnosed?
Endometriosis is one of the great mimics in medicine: Very mild endometriosis can cause considerable symptoms while very severe stages of the condition may be symptom-free. This can be a challenge because a patient may be suffering from endometriosis-induced infertility without anybody realizing that she suffers from endometriosis.

Even the gold standard for diagnosis of endometriosis, laparoscopy, can be inaccurate because endometriosis is often only microscopic in size. Endometriosis, therefore, can be relatively easily overlooked, or its severity may be underestimated even during laparoscopy.
How common is endometriosis?
Reported rates of endometriosis vary greatly, but the consensus is that approximately 5-10% of all women suffer from this condition. Endometriosis is, however, much more common amongst women with infertility.
Does endometriosis cause infertility?
Whether or not so-called "mild" endometriosis affects fertility has remained controversial. At CHR, we strongly believe that endometriosis, even when mild, can negatively affect fertility. Even more importantly, endometriosis affects fertility adversely in many different ways, though its effects on normal tubal function appear to be the most important.

Investigations attempting to explain why patients with endometriosis are often infertile suggest that:

Their fallopian tubes may function abnormally, due to adhesion or scarring (so-called tubal infertility)

Ovarian function may be adversely affected, possibly resulting in sub-par egg quality

Endometriosis may release toxic substances which may harm embryos and/or their implantation capacity

Patients with endometriosis may be at a higher risk for miscarriages, lowering their live birth chances
Finally, there may be an immunological factor involved in endometriosis. suggesting that endometriosis, indeed, may be an autoimmune disease. It is now widely accepted that the immune system, indeed, plays an important role in endometriosis-associated infertility.
Contact us for treatment options for endometriosis-related infertility.
How endometriosis affects IVF success rates?
Endometriosis appears to affect IVF adversely, from reducing the number of eggs at the time of retrieval to poorer egg quality, and lower implantation and pregnancy rates. However, most endometriosis patients will still be able to conceive with IVF.
Can "unexplained infertility" be endometriosis?
Endometriosis often initially presents as "unexplained infertility," a diagnosis we at Aakash do not believe in. Many studies in the literature point to similar patient profiles in women with endometriosis and unexplained infertility. They also present with similar immune profiles.
In most cases of so-called "unexplained infertility," we, however, can pinpoint a real cause of infertility by performing appropriate diagnostic tests, even though correct diagnosis of endometriosis can be difficult.
What are the endometriosis treatments?
There is no permanent treatment for endometriosis. All available endometriosis treatments are temporary, raising the possibility, even likelihood, that endometriosis will return once treatment stops. This fact is probably best documented by the fact that the best treatment for endometriosis is considered to be pregnancy. Pregnancy, of course, stops all menstrual periods, and with it, the above-noted bleeding from endometriotic lesions. It, therefore, interrupts the process of endometriosis.

Medications do the same. However, since those drugs also interrupt the menstrual cycles, for all practical purposes, they are contraceptive. Therefore, an infertility patient, wishing to conceive, cannot be treated with such drugs. These medications are helpful only in clinically symptomatic patients, where pain management is the primary goal of treatment.

In such cases, endometriosis is also frequently treated surgically. As fertility specialists we, however, are always concerned about the surgical treatment of endometriosis: especially if surgery involves the ovaries, at aakash fertility centre, we have experts with vast experience
What are the infertility treatments for women with endometriosis?
Endometriosis infertility treatment requires special expertise. Such need for special expertise is not limited to surgery for endometriosis. Fertility treatments often involve increases in estrogen levels. Estrogen, however, can "feed" endometriosis, and make it worse. Finding the right balance between advantages and risks of different infertility treatments, therefore, is always of utmost importance in endometriosis.
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