FAQs

Severe male-factor infertility is treated very successfully by a relatively new laboratory technique called ICSI. ICSI involves injecting one sperm directly into the egg using a microscope with specialized micromanipulation equipment. ICSI is always used in conjunction with in vitro fertilization. For ICSI various sperm retrival techniques are used like PESA, MESA, TESA, and TESE.

The term “oligo” means few. Oligospermia is the presence of fewer than the normal number of sperm in the semen. Men with fewer than 20 million sperm/ml are usually defined as having oligospermia, or a low sperm count. Azoospermia is the complete lack of sperm in the ejaculate.

Azoospermia is the complete lack of sperm in the ejaculate

Yes. There are two different types of azoospermia. Obstructive azoospermia is the complete lack of sperm in the ejaculation due to a blockage in the male reproductive tract or the absence of the part of the reproductive tract that carries sperm from the testicle to outside the body. A blockage, or obstruction, may have been present at birth or may have occurred as a result of an infection or severe trauma to the testicles or the tubules surrounding the testicles that transport the sperm out of the body. Men with obstructive azoospermia almost always have some sperm in their testicles, but these sperm are not found in the semen because of the blockage or absence of part of the reproductive tract.

In vitro fertilization (IVF) is a process by which egg cells are fertilized by sperm outside the womb, in vitro. IVF is a major treatment in infertility when other methods of assisted reproductive technology have failed. The process involves hormonally controlling the ovulatory process, removing ova (eggs) from the woman’s ovaries and letting sperm fertilise them in a fluid medium. The fertilised egg (zygote) is then transferred to the patient’s uterus with the intent to establish a successful pregnancy.
-The first “test tube baby”, Louise Brown, was born in 1978 and she herself is a mother of a healthy baby boy now.

There are a variety of indications for IVF.
– Male Factor Infertility : Male factor infertility includes low count and motility, high number of abnormal forms, ejaculatory dysfunctions, Failed reversal of Vasectomy/ Tubectomy , obstructive azoospermia etc.
– Age-Related Infertility : higher the age lesser the chances of conception. The fertility index keeps on decreasing after the age of 30 – 35.
– Reduced ovarian reserve, which means lower quantity (and sometimes quantity) of eggs. A day 3 FSH and estradiol test, antral follicle counts and AMH hormone levels are often done as screening tests for egg quantity. Reduced egg quantity and quality is usually treated with either IVF, or with IVF with egg donation.
– Absent or Damaged Fallopian Tubes : Rarely the fallopian tubes are found absent since birth. Many causes lead to blockage and damage of tube like severe adhesions, surgical procedures, infections etc.
– Endometriosis: The presence of tissue that normally grows inside the uterus (womb) in an abnormal anatomical location. Endometriosis is very common and may not produce symptoms, or it may lead to painful menstruation. It has also been associated with infertility.
– Unexplained Infertility: Sometimes inspite of being absolutely normal male and female with normal hormonal assays, regular sexual intercourse and with all normal reports the couple is unable to conceive, this condition can be termed as unexplained infertility.
– Recurrent Intrauterine Insemination Failure : repeated failure of IUI trials is also an indication for IVF. Inspite of good IUI trials with gonadotrophins and good post wash, if conception does not take place IVF is a better option.
– Tubal and Pelvic Adhesions : pelvic adhesions and tubal adhesion may make tube incapable of nurturing the eggs and conception fails. Blockage of tubes arises due to pelvic adhesions
– Preimplantation Genetic Diagnosis (PGD) – In cases of repeated abortions and neo natal death PGD becomes necessary. PGD can be done only after IVF. [ PGD also helps in diagnosing several genetic diseases.
– Premature Menopause: Also termed as premature ovarion failure, where the function of ovaries stops before the age of 30, Egg donation proves a better option which is possible only with IVF, menopause : Menopause is stage of life when a woman can no longer bear a child. With IVF, this is now a false saying.

– Clinical Examination
– Sonography
– Lab Investigation Then We Plan Treatment Protocol
– After a detailed history & physical examination, few basic laboratory investigations & a sonological evaluation is very significant to choose the modality of treatment for infertility as it affects the success rate of the treatment.
– We, here at SFWH follow a basic protocol before commencing any treatment of infertility. History taking can be converted into a counseling session which works to break the ice between the couple & doctor. The initial shyness & awkwardness to talk on intimate issue is also lost. Trust & confidence develops which helps the couple to understand & participate in the treatment.
– Points to be highlighted in history are duration of infertility, menstrual history, coital frequency, past medical & surgical history, occupational history & history of allergy.
– We start the clinical examination of female by measuring her weight & height & then calculating her BMI. Our experience has shown that ladies who have normal BMI not only respond well to the treatment of infertility but also have a better outcome of pregnancy as compared to their obese or underweight counterparts.
– After recording the weight, the lady should be escorted into a comfortable examination room by a trained nursing staff where detailed general & systemic examination is done. Verbal consent should be obtained & procedure explained in detail. We need not stress that male doctors should do the examination in presence of a female nursing staff. During the examination findings of relevance are development of secondary sexual characters, presence or absence of galactorrhoea, signs of androgen excess like hirsuitism & thyroid enlargement. Sterile speculum examination is important to rule out vaginismus from other causes of dysparunia. This examination can also reveal any abnormality or discharge from the cervix. Bimanual examination gives idea about the size & mobility of uterus. Any abnormal finding in physical examination should be supported by laboratory & radiological evidences & should be treated before the treatment of infertility commences.

– Trans vaginal sonography has become the most important tool in the armamentarium of the physician to diagnose & treat infertilit. TVS has a high sensitivity & specificity for follicular monitoring, prediction & conformation of ovulation.
– While evaluating the female genital system by TVS, the examiner should scan every part in detail.
– Cervix is evaluated for the length of the cervix, nabothian cyst & cervical mucous.
– Endometrial cavity is scanned for endometrial thickness, endometrial pattern, endometrial polyps & presence of any foreign bodies or synechia.

– Detail History
– Clinical Examination
– Lab Investigation
– Semen Analysis

– IUI is defined as direct placement of the processed sperm into the uterine cavity at any point above the internal os.Intrauterine insemination is also called artificial insemination, or IUI. Human artificial insemination with the male partner’s sperm for infertility began being used in the 1940’s.

– Tubal blockage or severe tubal damage
– Ovarian failure (menopause)
– Severe male factor infertility
– Advanced stages of endometriosis

– Studies have shown that intrauterine insemination can be effective for some cases associated with poor sperm quality. However, if the total motile sperm count at the time of insemination (after the processing) is less than 5 million, the chances for pregnancy are substantially lower. If the total motile sperm count is below 1 to 5 million, success rates are very low. Therefore, in vitro fertilization with ICSI (injecting sperm into the eggs) is usually done for these cases.
– IUI is most commonly used for unexplained infertility. It is also used for couples affected by mild endometriosis, problems with ovulation, mild male factor infertility and cervical factor infertility.
– Insemination is a reasonable initial treatment that should be utilized for a maximum of about 3-4 months in women who are ovulating (releasing eggs) on their own. It is reasonable to try IUI for longer than this in women with polycystic ovaries (PCOS) and lack of ovulation that have been given drugs to ovulate.

– Surrogates can be divided into natural surrogates and IVF surrogates.

– Women whose ovaries are producing eggs but they do not have uterus this could be because they have had a hysterectomy (removal of uterus) performed due to cancer, severe hemorrhage or ruptured womb, or they were born without a uterus. This is by far the most common indication for IVF surrogacy.
– Women who suffer from medical problems such as diabetes, heart and kidney diseases and in whom a pregnancy would be life threatening. However, their long term prospect for health is good.
– Repeated miscarriages where the causes of miscarriage have been fully investigated, may also suggest IVF surrogacy treatment.

– Women who have no functioning ovaries due to premature menopause ( some may argue that the best option for these patients is egg donation).
– A woman who is at risk of passing on a genetic disease to her offspring, may opt for traditional surrogacy.
– As with IVF surrogacy, women who suffer from medical problems such as diabetes, heart and kidney diseases and in whom a pregnancy would be life threatening may select traditional surrogacy if their long term prospect for health is good.

– Age between 21 & 35 years old.
– A non smoker, on drug user who maintained a healthy life style.
– Must have successfully carried at least one pregnancy till full term.
– In a stable living situation.
– If married, have a spouse who is supportive of her decision to become a surrogate mother.
– Have a healthy, weight/height ratio.
– Should have a healthy life style and no addictions and no genetic diseases. Steps for Surrogacy Programme :

Asthma symptoms can include:

• Wheezing, or noisy breathing
• Coughing, often at night or early in the morning, or when you exercise
• A tight feeling in the chest
• Trouble breathing

Symptoms can happen each day, each week, or less often. Symptoms can range from mild to severe. Although rare, an episode of asthma can lead to death.

Getting vaccinated can help keep your child from getting sick. If your child does get sick, being vaccinated can keep them from getting severely ill. Plus, being vaccinated also helps protect the people around your child from getting sick.

No! Some parents think it helps to let children get older than the recommended vaccination ages before giving them too many vaccines. The truth is, studies show that delaying vaccines could actually have downsides. For example, one study found that children who got their first MMR vaccine later than they were supposed to had a higher risk of fever-related seizures. The vaccine schedules doctors recommend have been carefully studied. Do not delay your child’s vaccines.

Often, vaccines cause no side effects. When they do cause side effects, they can cause:

• Redness, mild swelling, or soreness where the shot was given
• A mild fever
• A mild rash
• Headache or body aches

Most of these side effects happen within 1 to 2 days of getting the vaccine. But they can happen 1 to 2 weeks after the getting shot for chickenpox or the shot for measles, mumps, and rubella.

Vaccines also sometimes cause more serious side effects than those listed, such as severe allergic reactions. But serious side effects are rare.

Ask your child’s doctor or nurse what side effects to expect each time your child gets a vaccine. If your child has a reaction or a problem after a vaccine, let the doctor or nurse know.

A woman should breastfeed when her baby shows signs of being hungry. A baby can show that he or she is hungry by:

• Waking up from sleep
• Moving the head around as if he or she is looking for the breast
• Sucking on his or her hands, lips, or tongue

Babies can breastfeed on different schedules and for different amounts of time. For example, some babies finish a feeding in 5 minutes, but others might take 20 minutes or longer.

Doctors recommend letting the baby finish breastfeeding on one side so that he or she gets all the milk from that breast. Then, you can see if your baby wants to drink from the other breast. The next time you breastfeed, try to remember which breast your baby started on the last time, and start on the other side. Switching the side you start with each time will help both your breasts continue to make milk.

You can tell if your baby is getting enough breast milk by:

• Checking his or her diapers – By day 4 or 5 after birth, babies should have at least 6 wet diapers a day.
• Checking his or her bowel movements – By day 4 after birth, babies should have 4 or more bowel movements a day. By day 5, their bowel movements should be yellow.
• Having your doctor or nurse check to see if your baby is gaining weight

You should see your doctor or nurse if your child:

• Feels the need to urinate more than usual
• Is more thirsty than usual
• Has a burning feeling when he or she urinates
• Has swelling of the feet or ankles
• Starts wetting the bed again after being dry for weeks or months

These symptoms can be a sign of a medical problem. Your child’s doctor will want to check him or her. The doctor will do an exam and might order tests, including a urine test.

You can tell if your baby has jaundice by pressing 1 finger on your baby’s nose or forehead. Then lift up your finger. If the skin is yellow where you pressed, your baby has jaundice.

i) What are the symptoms of jaundice?

Jaundice causes the skin and the white parts of the eyes to turn yellow. It often happens first in the face, but can spread to the chest, belly, and arms. It spreads to the legs last.

Sometimes, jaundice can be severe. A baby with severe jaundice can have orange-yellow skin, or yellow skin below the knee on the lower part of the leg. The “whites” of the eyes might look yellow, too. A baby with severe jaundice might also:

• Be hard to wake up
• Have a high-pitched cry
• Be unhappy and keep crying
• Keep bending his or her body or neck backward

II) When should I call my doctor or nurse?

Call your doctor or nurse if:

• Your baby’s jaundice is getting worse
• Your baby has symptoms of severe jaundice