What is Infertility?

Infertility means inability of the couple to achieve pregnancy after 12 months or more of regular unprotected sexual intercourse. In general terms, 85% to 88% Healthy Couples have babies in the first year of their marriage, which means 12% to 15% of couples has to face infertility problem.

Various Social reasons for Infertility:

• Increasing level of Stress
• Increasing percentage of STD (Sexually Transmitted Diseases)
• Increasing Age of Marriage (Delayed Marriages)
• Deliberate Prolonging of pregnancy for Education, Job or various family responsibilities.
• Abnormal Changes in Lifestyle.

Various Social reasons for Infertility:

Female Infertility :

• IIrregular Menstrual Cycle in female because of defective follicle formation or defective rupture of follicle.(Anovulation)
• Fallopian Tube Blockage
• Intrauterine septum or uterine cavity adhesions.(congenital or acquired)
• Pelvic inflammatory disease (PID).
• Fibroids in Uterus.
• Endometriosis.
• Hormonal Imbalance
• Increase in Age

Male Infertility :

• Low sperm count or motility or both.
• Absent sperms. (Azospermia)
• Erectile dysfunction
• Premature ejaculation.
• Absence of Ejaculation or retrograde ejaculation
• Antispem antibodies

How Embryo Forms?

Mainly 3 elements are required to form an Embryo.

• Sperms
• Ova
• Fertilization

This process takes place in Fallopian tube. It produces Embryo, by fertilization of Sperm & Ova. Embryo starts to move in Uterine Cavity and settles there (In Uterine Cavity) by 3rd day of Fertilization. It will be nurtured there for 9 months and a full grown baby is delivered in the end.

Is it alright to do only Wife’s Test to achieve Pregnancy?

To achieve pregnancy, it is necessary to do Tests of both Husband & Wife.

Responsibility of Infertility defines by:

Female: 30%

Male: 30%

Male & Female: 30%

Can’t Say: 10%

What is the Productive period in Menstrual Cycle?

In Women who have regular menstrual cycles, oocyte is released after follicular rupture between 12th days to 16th day of menstrual cycle. Life (Active) of Oocyte is around 24 hours in female genital tract and life of sperm is around 48 hours. Hence, to achieve pregnancy couples should have intercourse, every day, from the 12th day to 18th day of cycle.

Infertility Diagnosis & Treatment

Infertility means inability of the couple to achieve pregnancy after 12 months or more of regular unprotected sexual intercourse. In general terms, 85% to 88% Healthy Couples have babies in the first year of their marriage, which means 12% to 15% of couples has to face infertility problem.

General Diagnosis & Treatment

Semen Test :

General Diagnosis & Treatment Semen Test : It is the single most important test to evaluate male factor in infertility.

Planned Relation Treatment :

Ovulation induction is started for Day 2-3 of menstrual cycle and follicular growth is monitored from day 8 on daily or alternate day basis. Once a dominant follicle is reached to the size of 18-20 mm HCG injection is given. Ovulation occurs after 36-48 hours after HCG injection. The couple is asked to have intercourse on the probable days of ovulation. After confirming ovulation progesterone tables are prescribed to support probably developing embryo. Only 3-4 visits in a month are required, for this complete treatment. Normally, this Treatment has to be followed for 3-6 months.60-70 % couple conceives after this treatment alone. The remaining needs further evaluation and treatment.

Special Diagnosis Treatment

Hysterosalpyngography( HSG ) or Hystero-laperoscopy examination of Wife is required for those who are not benefitted from General Treatment , to test tubal patency. If the fallopian tube is blocked, we try to open it by laparoscopy or hysteroscopy. Success rate is round 60%-70%.

We can do IUI Treatment, if the tubes are patent. If the fallopian tube cannot be opened, Test Tube Baby (IVF- ICSI) treatment is advised for favorable results.

What is IUI (Intrauterine Insemination)?

IUI means insertion of Husband’s washed sperms inside Uterus.

Prerequisites of IUI.

• Ultra Sonography of Uterus & Ovary
• Tubal patency byLaparoscopy/Hysteroscopy or HSG
• Husband’s Semen Analysis.

Important : IUI is possible only if the Fallopian tube is efficient.

For whom IUI is advised?

• Low sperm count or motility or both.
• Failure of planned relation treatment for 3-6 cycles(Ovulation induction & Follicular Study)
• Unexplained infertility: inability to achieve pregnancy in spite of no demonstrable cause.
• Endometriosis
• Cervical factor.

IUI Treatment

In this Treatment, Base line scan is done on Day 2-3 of menstrual cycle . If the utero- ovarian condition is favorable, Ovulation Induction is done by clomiphene citrate tablets and /Or HMG injections. Serial follicular monitoring is done from Day 8 of cycle and Injection HCG is given once oocyte is about 18-20 mm size. After 36-48 hours ( expected time of ovulation ) ,0.5 ml of Husband’s washed sperms sample is deposited inside the uterine cavity just below the fundus with the help of IUI Cannula under Ultrasound guidance.

After IUI, Progesterone tablets are prescribed orally or vaginally to facilitate implantation process inside Uterus. Urine Pregnancy test can be done after 2-3 days of missing periods. Couple is advised to keep abstinence from sexual intercourse2-3 days prior to IUI. The success rate of this treatment is 18% to20% per month. The treatment can be repeated 3 to 6 times. About 60% to 70% couples become pregnant with this treatment. Remaining needs further treatment.

Day of IUI.

On the day of IUI, Husband is asked to collect semen sample in a sterile wide mouth container. After 15-30 minutes, the sample completely gets liquefied and ready to be washed. It takes 1-2 hours for complete wash process, which yields concentrated and highly active sperms, later which can be used for IUI.

Do I have to be admitted for IUI?

You do not have to get admit for IUI. Sperm wash process can take up to 2-3 hour and you have rest for 30 min to 45 min after the IUI procedure.

Are there any restrictions/ precautions after IUI?

You do not have change your day to day activities after IUI. Travelling also not contraindicated. There are no dietary restrictions. You can resume intercourse as per wish.

What to do if IUI fails?

For those unfortunate couples, not conceived after 4-6 IUI cycles, Test Tube Treatment (IVF/ICSI) is recommended.