Q & A
When it comes to various issues of Assisted Reproduction, it is very normal to have a lot of queries. These queries are related to various facets like success rate, safety of the mother, legal issues etc. We, at P. D. Hinduja Hospital, try our best to provide maximum guidance with regards to these questions and have selected some most often asked questions and have tried to answer them for your ready reference. Should you have any further queries, please feel free to email us at firstname.lastname@example.org and we will try to respond as best as possible.
What is the success of pregnancy after IVF?
The success of conception and pregnancy depends on the patient's cause of infertility and age. Conception and pregnancy have also to be supported by physical and immunological factors of the female. However, it is useful to note that 40% infertility is caused due to male factor, 40% due to female factors, 10% due to both male and female factors and 10% is due to unexplained causes. In our Centre, the rate of fertilization with ART is 100% with 40% pregnancy having attained with ICSI, practically over-ridding MF. 30% is the current rate of pregnancy in our Centre with conventional IVF-ET procedures. There is of course no specific age limit for couples who may be considered for IVF in our institute.
How many cycles are required to get pregnant?
Number of cycles required (ovulation induction) depend on the age of the patient, general health of the patient, quality of the oocyte, quality of the semen, immunological factors of the couple, etc.
What are the after effects of hormonal treatment?
Hormonal treatment at the most influences weight gain by half to one and a half kilogram; other than that there are no drastic side-effects.
What precautions are taken to prevent mixing up of the oocyte and semen samples in the laboratory?
Semen samples of every male patient is washed in separate tubes that are labelled with their first and second names at every step. Oocytes retrieved after ovum pick-up are stored in disposable plastic petri-dishes labelled with the female patient's name and surname and the stage of the oocyte / embryo that results in culture. Throughout the procedure honest and accurate identification of the specimen is maintained.
What is azoospermia?
It is a condition in men who lack living sperms in their ejaculate. It may be due to vasectomy (blocked seminal ducts) i.e., obstructive azoospermia, or it may have been caused due to spinal cord injury or neurological conditions like, multiple sclerosis, those who have had their prostates removed or those who produce dead sperms i.e., non-obstructive azoospermia. For such men testicular biopsy is performed to aspirate sperms from the testicles, where they are made.
What constitutes female infertility?
Females are termed infertile when they are unable to ovulate or when they have obstructed or damaged fallopian tube / uterus. Pelvic inflammatory diseases like tuberculosis or sexually transmitted diseases (STD), endometriosis, fibroids or tumours, surgeries like appendiectomy, birth defects or abnormally shaped uterus like bicornulate or septate inflict infertility in females.
What is unexplained infertility?
When there is no identifiable cause of infertility in the couple, it is termed as unexplained infertility.
What is egg donation? Who can be the donor / recipient?
Egg donation is performed when a female patient has ovulation problems or if she produces bad quality oocytes after ovulation induction as for IVF. This procedure is done after the oral and written consent of the donor, and the recipient and her husband. This procedure is performed in absolute confidentiality with the physicians and the staff and the donor and the recipient. The recipient's menstrual cycle is co-ordinated with that of the donor's to enable fresh embryo transfer. All the eggs produced by the donor are inseminated with the recipient's husband sperms and the resulting embryos are transferred to the recipient's uterus. Excess embryos are cryopreserved so that they may be used for following attempts when in case pregnancy fails at the first attempt. Healthy women can opt for egg donation. They should be not more than 40 years of age. They are required to undergo psychological, medical and genetic testing. The centre maintains the data of the donor's height, hair colour and type, blood type, ethnic background including caste and religion, educational qualifications, occupation, etc. The centre also accepts donor's that have been chosen by the recipients. The egg recipient is a woman whose medical and / or genetic tests indicate the use of donor eggs for ongoing pregnancy.
Who can be semen / sperm donors?
Men with sound medical health and known fertility can donate their semen for IVF or ICSI procedures after submitting his written consent for the same. They should be between 25 to 45 years of age and should not have had any past history of infectious diseases. They are required to submit their infectious diseases evaluation report, semen analysis and general health analysis report, which should include a complete physical examination done and certified by a registered medical practitioner (RMP). For infectious disease evaluation, the donor is required to be tested negative for Hepatitis B, C antibodies, HIV 1 and 2 antibodies, Trichomonas, Candida, Cytomegalovirus and HTLV-I. Three semen samples of the donor is taken at regular intervals of 3-4 weeks as is tested for volume, pH, count, motility, abnormality, pus cells, agglutination and particulate matter. His semen analysis is required to match with the normal semen parameters of WHO. The donor semen tested should maintain the quality standards in his three trial attempts and only then he is recruited on our lists of semen donors. The donor should be willing to undergo the infectious diseases evaluation tests as well as semen analysis tests every three months. If he fails to do so or if the results tend to become substandard, he is eliminated from our list of regular donors.
When and for whom is cryopreservation necessary?
Firstly, cryopreservation is of utmost advantage to couples whose male partner is not always available during his spouse's ovulation period i.e., when the husbands work away from their homeland or when the husbands are unable to ejaculate regularly. It is also beneficial to those husbands who have to undergo chemotherapy. In such situations freezing of husband's semen is beneficial so that during his wife's ovulation time his frozen semen after thawing can be used for IUI, IVF, or ICSI as the case may be. Secondly, after the process of super ovulation, women tend to develop oocytes that are more than sufficient for one cycle. Usually 3-4 embryos are replaced per ET cycle. In centres which do not avail cryo-preservation, up to 7 embryos are transferred and the remaining would remain non-utilised and hence wasted. With cryopreservtion, excess embryos can be preserved so as to transfer them for future ET cycles. In this way the female patient can avoid undergoing frequent ovarian stimulation, avoid the risk of multiple gestation and it would also prove cost beneficial. Frozen specimen is also easy to transfer to other locations if the patients prefer to get ET done at their new location.
What is the survival rate of the specimen after the freezing procedure?
Freezing and thawing does reduce the number of viable cells and so, the total count of the spermatozoa tends to become less after thawing. At our centre, 70-80% of fertilization has been attained using cryopreserved spermatozoa. Cryopreserved embryos also have the tendency to get degraded; however, the centre has attained pregnancy with frozen embryos.
What is host uterus and surrogacy?
For those biological mothers (egg donors) who are capable of ovulating and forming normal embryos but are diagnosed medically unfit to carry out the gestation can hire/borrow gestational carrier (host) for her embryos to develop into a foetus. In this process, eggs from a biological mother is retrieved and made to develop in vitro, after which it is transferred to host uterus to complete gestation (gestational surrogacy).
Who can be a gestational host?
A gestational carrier can be a friend, a relative, or an unknown woman who is willing to serve as a gestational host under some financial arrangements. She should be under the age of 40 years and preferably of proven fertility. All appropriate medical tests should be performed of the gestational carrier before she is recruited for the purpose and the evaluation should compare well with the normal standards of gestation.