It is the dream of most couples to have their own children as part of their relationship. In India 1 in 6 couples will have problems conceiving. If a woman is not being able to get pregnant after one year of trying, Or, six months, if a woman is 35 or older then it is termed as infertility. Woman who can get pregnant but are unable to stay pregnant may also be called infertile. Infertility is not always a woman's problem. Both women and men can have problems that cause infertility. About one-third of infertility cases are caused by women's problems. Another one third of fertility problems are due to the man. The other cases are caused by a mixture of male and female problems or many a times problems are unknown.
Infertility affects about 10 percent of the population, men and women equally. Fortunately, most infertility cases can be treated successfully with conventional medical fertility therapies including medication or surgery. The only need is the time of recognition and proper diagnosis. Infertility deeply affects psychosocial aspects of young couples, who often erroneously take fertility for granted. The inevitable transformation from apparently healthy adults into patients can lead to loss of self-esteem, confidence, health, close relationships, security, and hope. As many as one in six couples experience difficulty or delay in conceiving. Infertility is simply a symptom, the causes of infertility are numerous, and identifying the specific barrier to conception is of paramount importance. After consultation, investigation and counseling, a program of treatment is created with the objective of the greatest chance of success for each couple.
Let’s take the trip to Infertility journey of a couple facing infertility and fertility problems.
This is a journey that no one intends to start, and no one can be sure how it will end. The first step is the recognition that there may be a problem. It arises when there is failure to conceive after one year of exposure to pregnancy (“unprotected intercourse”). The concept of waiting one year reflects the reality that usually conception will take place within 6 months of trying and the full year accounts for those cycles where appropriate exposure may not have taken place due to missing the right day for example. It is at the end of this time the couple may start worrying and think of visiting a gynecologist.
When to start infertility treatment?
Most couples start on this journey at the clinic of the gynecologist. During a routine exam, couple may mention that they have stopped using contraception some time ago and nothing is happening. The initial evaluation will typically be simple. Most gynecologists will initially recommend that the patient should monitor her fertile period days, which are between 12 to 16 days of period in regularly menstruating women. These monitoring exercises also serve the very important function of verifying whether the couple is having intercourse at the right time of the month. After this initial step, there is great variability as to how gynecologists will manage their patients who are trying to conceive.
First treatment that the doctors will give is to enhance or establish ovulation time and to find out whether the patient is ovulating or not. This may be a waste of time if the cause of the infertility is not related to ovulation but it isn’t completely off base as a starting point since about 20-25% of the time the problem is related to ovulation. Next step followed is to carry out series of diagnostic tests in an attempt to establish the cause of the infertility. These tests will typically include evaluations of the husband (semen analysis, post coital tests), the fallopian tubes (hysterosalpingograms or HSG) and occasionally hormonal assessments (blood tests) or even laparoscopy to rule out endometriosis in female. Once the diagnosis is done patients will be immediately referred to infertility specialists. Unfortunately, some patients may lose their opportunity to conceive as a consequence of increasing age if they are not treated by a specialist at the correct time. Especially in those situations where the woman is over 35 years of age, they should consult infertility specialist at the earliest.
The advance journey of infertility treatment.
If a couple hasn’t conceived under the care of the GYN, they will generally end up under the care of an Infertility specialist. In any case, once a patient comes to see an infertility specialist, the first step will be to review what has been done previously. Further diagnostic testing may be required. It is striking how often a couple will be treated without a diagnosis having been identified. A thoughtful infertility specialist will avoid repeating tests which have already been done. The purpose of testing is to arrive at a working diagnosis for the couple’s infertility.
Once a diagnosis is established, directed therapy can be implemented. For example, if the woman is not ovulating, ovulation induction will be necessary. If the husband has borderline sperm concentrations, sperm preparations, which can concentrate the available good sperm and intrauterine inseminations may be used. The medical literature has shown time and again that our therapies are surprisingly efficient; typically a couple will be pregnant within 3 cycles of a given treatment. The caveat is that pregnancy will happen that quickly if it will happen at all. Once again a conscientious infertility specialist will need to reassess and possibly change therapies if success is not reached within this time frame.
In some cases, all testing is normal and we cannot find the “reason” for the couple’s infertility. This is the case about 15% of the time. These couples are thought to have Unexplained Infertility. This diagnosis can be very difficult emotionally because couples are frustrated when a problem cannot be identified. Even though this may be an emotionally difficult diagnosis to deal with, the good news is that couples with Unexplained Infertility have an excellent prognosis for success with treatment… The treatment of the infertile couple is dynamic. As time passes, situations change and we need to be constantly aware of possible new data which will change the diagnosis and therefore the treatment. For example, if a woman seeks out therapy at age 40, one of the first tests that will be done is some assessment of egg quality. While it may have been normal when last checked, it is imperative to recheck it periodically if the couple is still not pregnant. Time is always passing! It is very important that the couple and their doctor work as a team, continuously assessing where they are, where they’ve been and where they are going. The point is that once a diagnosis is available, optimized therapy should be carried out for a few cycles and if there is no success, to re-assess and change course.
The optimal option-Advanced Reproductive Techniques (ART)
Unfortunately some couples will not get pregnant with simpler therapy. Yet many of these couples will be successful with more complex therapies. The “big guns” of infertility treatments fall under the name of the Advanced Reproductive Techniques (ART). There have been many different techniques described over the years, usually alluded to by their abbreviations such as IVF, GIFT, ICSI, TET, ZIFT etc. Today, the dominant procedure (and the original one!) is IVF or In Vitro Fertilization.
IVF is a very powerful tool in that it bypasses non-functioning tubes, it can minimize the impact of endometriosis, and it can bypass male factors. The biggest change in the treatment of infertility in the last 15 years has been the growth of IVF. This is for the very good reason that success rates have risen steadily.
The future trend is for IVF to be used earlier in the course of treatment than before. This is not only because it is the most successful therapy option we have available today but also because it will treat just about all problems which may be preventing pregnancy. As the per cycle success rates continue to rise and as we continue to reduce the likelihood of multiple pregnancy, it is only a matter of time before IVF becomes the procedure of choice for the treatment of infertility.
With the increase in the age of women the life and the quality of the egg diminishes. Typically this will happen in the decade between ages 35 and 45 but it can actually happen at any time. If egg quality is the issue then by using in vitro fertilization techniques, we can establish pregnancies using eggs donated by another woman. This is analogous to the situations where the husband is sterile and a sperm donor is used. In the process of egg donation, healthy eggs are retrieved from an egg donor and by means of IVF, these eggs are then inseminated with the husband’s sperm and the resulting embryos are transferred back into the uterus of the wife who is the egg recipient. Technically the process is fairly straightforward and these are highly successful IVF procedures.
At Blossom Fertility and IVF Centre, located in South Gujarat, you will receive the highest standards of IVF treatment available in a caring and compassionate environment. We ensure that you start your journey with the best possible chance of success. Our dedicated team of IVF fertility specialists will provide you with all the IVF information, advice and support needed while you are preparing for IVF treatment.
We understand that of all the things you are worried about, there's one essential thing that matters most: Getting Results, achieving parenthood.