PATIENT FAQs

PATIENT FAQs

Fertility Basics

1. What is Infertility?

Infertility is a medical condition characterized by the inability to conceive after a year of unprotected sexual intercourse. It affects both men and women and can result from a variety of factors, including age, health conditions, and lifestyle choices.

Types of Infertility

Infertility can be classified into two main categories:

  • Primary Infertility: This refers to individuals or couples who have never been able to conceive despite trying for at least a year.
  • Secondary Infertility: This occurs in individuals or couples who have previously conceived but are now experiencing difficulty in achieving another pregnancy.

Common Causes of Infertility

Several factors can contribute to infertility, including:

  • Female Factors: These may include hormonal imbalances, ovulation disorders, blocked fallopian tubes, or uterine conditions such as fibroids.
  • Male Factors: Common issues include low sperm count, poor sperm motility, or structural problems in the reproductive system.
  • Age: Fertility declines with age, particularly in women over 35 and men over 40.
  • Lifestyle Factors: Factors such as smoking, excessive alcohol consumption, obesity, and high-stress levels can impact fertility in both men and women.

Seeking Help

Understanding infertility is the first step toward addressing the issue. If conception has not occurred after one year of trying (or six months if the woman is over 35), consulting a healthcare provider or fertility specialist is recommended. They can conduct tests to identify potential underlying causes and discuss available treatment options.

2. What is ovulation?

Ovulation is a key phase in the menstrual cycle during which an egg is released from the ovaries. This process typically occurs once a month and is essential for conception.

The Menstrual Cycle and Ovulation

The menstrual cycle is divided into several phases, with ovulation occurring approximately 14 days before the onset of menstruation. On average, women ovulate between 12 to 18 days prior to their next period. The exact timing can vary based on the individual’s cycle length and regularity.

Understanding Your Fertile Window

The fertile window is the timeframe during which conception is most likely to occur. It includes the days leading up to ovulation and the day of ovulation itself. Sperm can survive in a woman’s reproductive tract for up to five days, while an egg remains viable for about 12 to 24 hours after ovulation. Therefore, understanding when ovulation occurs is crucial for those trying to conceive.

Factors Affecting Ovulation

Several factors can influence ovulation, including:

  • Age: Women are most fertile in their 20s and early 30s. Fertility typically declines after age 35.
  • Hormonal Imbalances: Conditions such as polycystic ovary syndrome (PCOS) can disrupt normal ovulation patterns.
  • Stress and Lifestyle: High levels of stress, significant weight changes, and certain lifestyle choices (like smoking or excessive alcohol consumption) can impact ovulation.

Ovulation Induction Treatments

1. What is ovulation induction treatment?

Ovulation induction treatment is a medical approach designed to stimulate the ovaries to mature and release an egg through the use of medications. This treatment is commonly utilized in cases of infertility where natural ovulation does not occur or is irregular.

Purpose of Ovulation Induction

The primary goal of ovulation induction is to increase the chances of conception by ensuring that a mature egg is released at the right time in the menstrual cycle. This treatment is particularly beneficial for individuals who experience:

  • Irregular menstrual cycles
  • Absent periods
  • Unexplained infertility
  • Hormonal imbalances affecting ovulation

Monitoring the Induction Cycle

During the ovulation induction process, healthcare providers closely monitor the patient’s response to medication through:

  • Blood Tests: These tests measure hormone levels, including estrogen and progesterone, to assess ovarian function and monitor the development of follicles (fluid-filled sacs containing eggs).
  • Ultrasound: Transvaginal ultrasounds are performed to visualize the ovaries and track the growth of follicles, helping to identify the optimal time for ovulation.

Medications Used in Ovulation Induction

Ovulation induction typically involves two main types of medications:

  1. Oral Medications:
    • Clomiphene Citrate (Clomid or Serophene): This medication blocks estrogen receptors in the brain, prompting the pituitary gland to release hormones that stimulate ovarian follicle growth. It is generally taken for five days during the first half of the menstrual cycle. Common side effects may include hot flashes, mood swings, and breast tenderness.
  2. Injectable Medications:
    • Follicle Stimulating Hormone (FSH) Injections: These injections promote the growth and maturation of ovarian follicles. They are administered daily during the first half of the menstrual cycle. Patients typically receive guidance from fertility nurses on how to self-administer these injections.
3. What are the options if ovulation induction does not work?

If ovulation induction is unsuccessful, we will discuss alternative treatment options, such as Intrauterine Insemination (IUI) or In Vitro Fertilization (IVF).

Intrauterine Insemination (IUI)

Intrauterine Insemination (IUI) may be the first step in your fertility treatment journey, especially for couples experiencing difficulties conceiving. IUI is recommended for individuals who:

  • Have been diagnosed with unexplained infertility
  • Have mild male factor infertility
  • Experience cervical scarring or other issues that prevent sperm penetration
  • Have irregular or absent ovulation
  • Are unable to engage in regular or penetrative sexual intercourse
  • Need to use donor sperm

However, IUI is generally not recommended for patients with severe male factor infertility, blocked fallopian tubes, or severe endometriosis.

Purpose of IUI

The primary goal of IUI is to increase the number of sperm that reach the fallopian tubes, thereby enhancing the chances of fertilization. This technique provides sperm with a head start but still requires them to reach and fertilize the egg independently.

After consulting with your fertility specialist and completing preliminary fertility testing, you’ll have a clearer understanding of whether IUI is a suitable treatment option for you.

The IUI Treatment Process

During the IUI procedure, the fertility specialist will:

  1. Insert a speculum into your vagina for better visualization of your cervix.
  2. Pass a soft, thin catheter through the cervix and into the uterus.
  3. Introduce the pre-prepared sperm into the uterus via the catheter.

The procedure typically lasts only a few minutes and is similar to a pap smear. You can return to your daily activities immediately after the IUI, and anesthesia is generally not required unless you have difficulty tolerating speculum examinations. If needed, light sedation is an option and should be discussed with your fertility specialist.

Important Components of IUI Treatment

Different Types of IUI Treatments

If your fertility specialist recommends IUI, you may undertake one of the following methods:

  1. Natural Insemination Cycle: This option allows you to complete IUI without medication, following your natural menstrual cycle. It is often used for individuals or couples who cannot engage in intercourse.
  2. Medication Cycle: This involves using medication to stimulate the ovaries. An oral medication is typically prescribed to assist women with ovulation disorders, as indicated by infrequent or irregular menstrual cycles.
  3. FSH Ovulation Induction Cycle: Follicle Stimulating Hormone (FSH) injections can also be used to stimulate the ovaries. FSH promotes the production of eggs in the ovaries, facilitating ovulation.

Sperm Washing

Before IUI, our specialized team prepares each sperm sample through a process known as “sperm washing.” This procedure involves placing the sperm sample in a test tube and spinning it in a centrifuge. This process concentrates the sperm into a “pellet” at the bottom of the test tube. The seminal fluid is removed, and the most active sperm are allowed to swim up into the fluid (media) above the pellet. The final sample consists of the most active sperm, concentrated in a small volume of media.

Timing the Insemination

IUI procedures are timed around your ovulation. While the exact timing of insemination is not critical, it typically occurs within a window of several hours around ovulation. Both sperm and eggs remain viable in the female genital tract for an extended period.

If you have taken hormones as part of your treatment, you may need to supplement with progesterone, usually administered as a capsule inserted vaginally twice a day or as injections. This helps support the endometrial lining of the uterus and facilitates embryo implantation.

2. How is it determined if ovulation induction is suitable?

Ovulation induction may be a suitable option for individuals facing certain fertility challenges. Here are some key indicators that it might be the right choice for you:

  1. Irregular Menstrual Cycles: If your menstrual cycles are unpredictable or irregular, ovulation induction can help regulate ovulation, increasing your chances of conception.
  2. Absence of Periods: For premenopausal individuals who do not experience menstruation at all, ovulation induction can stimulate the ovaries to produce and release eggs.
  3. Healthy Fallopian Tubes: Ovulation induction is most effective when the fallopian tubes are healthy and open, allowing for the transport of the egg to the uterus for fertilization.
  4. Unexplained Infertility: If you have been diagnosed with unexplained infertility, ovulation induction may help enhance your chances of conceiving by ensuring the presence of a mature egg.

Considerations for Multiple Pregnancies

One important aspect to consider is the risk of multiple pregnancies. Ovulation induction medications can stimulate the development of multiple follicles, leading to the potential release of more than one egg during ovulation. While this increases the likelihood of conceiving twins or more, it also presents certain risks for both the mother and the babies.

Risks Associated with Multiple Pregnancies:

  • Increased Health Risks for the Mother: Higher chances of complications during pregnancy, such as gestational diabetes, preeclampsia, and premature labor.
  • Health Risks for the Babies: Premature birth and low birth weight are more common in multiple pregnancies, which can lead to various health challenges.

Monitoring During Treatment

To mitigate these risks, your fertility specialist will closely monitor your response to ovulation induction medications through:

  • Blood Tests: Regular hormone level checks will help track ovarian response and determine the best timing for ovulation.
  • Ultrasound: Transvaginal ultrasounds will be conducted to visualize follicle development and assess how many are maturing.

IVF (In Vitro Fertilization)

1. What is in vitro fertilization (IVF)?

In Vitro Fertilization (IVF) is a reproductive technology that involves combining eggs and sperm in a laboratory setting to facilitate fertilization and embryo development. If successful, this process can lead to a pregnancy and ultimately, the birth of a healthy baby. Here’s how the journey unfolds:

  1. Ovarian Stimulation: To enhance your body’s natural egg production, we will stimulate your ovaries using a series of manageable injections. This helps your body create multiple eggs for retrieval.
  2. Egg Retrieval: Once the eggs are ready, we perform a minor surgical procedure called egg collection or egg retrieval. This is a day procedure that typically takes less than an hour and is done under sedation for your comfort.
  3. Sperm Preparation: On the same day as the egg retrieval, your partner will provide a sperm sample. If donor sperm is being used, we will prepare it in our laboratory.
  4. Fertilization: Our expert scientists will then mix the prepared eggs and sperm in the lab, aiming to create as many viable embryos as possible. This maximizes your chances of having healthy embryos for transfer.
  5. Embryo Transfer: If fertilization occurs and embryos develop, you will return approximately five days later for the embryo transfer procedure. During this quick and straightforward process, the selected embryo(s) will be gently inserted into your uterus.
  6. Embryo Freezing: Any additional viable embryos that are not transferred can be frozen for future use in subsequent cycles.
  7. Pregnancy Testing: After the embryo transfer, there will be a two-week waiting period to see if the embryo successfully implants in the uterine lining. At the end of this period, a blood test will be conducted to determine if you are pregnant.

IVF offers hope to individuals and couples facing fertility challenges, providing a pathway to conception and parenthood.

3. What is the process of IVF?

Step 1: Day 1 of Your Period
The first day of your menstrual cycle marks the beginning of your IVF treatment. This is considered Day 1, and your fertility nurse will assist you in identifying this crucial starting point.

Step 2: Stimulating Your Ovaries
The stimulation phase begins on Day 1 of your cycle. In a natural cycle, your ovaries typically produce one egg. During this phase, you’ll take medication for 8 to 14 days to stimulate the development of multiple eggs.

Your specialist will prescribe hormones tailored to your body and treatment plan, usually administered through injections. While it may seem daunting, your fertility nurse will provide guidance on how to administer the injections, and you can involve your partner in the process for support. Common hormones used in this phase include:

  • Follicle-Stimulating Hormone (FSH)
  • Luteinizing Hormone (LH)

These hormones naturally occur in the body, and the medications boost their levels to encourage the development of more eggs. Your progress will be monitored through blood tests and ultrasounds, allowing for adjustments to your medication as needed. Frequent monitoring will occur towards the end of this phase to time the ‘trigger injection’ precisely.

The trigger injection prepares your eggs for ovulation, and your fertility nurse will instruct you on when to administer it. Your specialist will schedule the egg retrieval procedure before ovulation occurs.

Step 3: Egg Retrieval
Egg retrieval, also known as egg ‘pick up’, is performed as a same-day hospital procedure under general anesthesia. The procedure lasts approximately 20 to 30 minutes.

Using advanced ultrasound technology, your fertility specialist will carefully guide a needle into your ovaries to collect the eggs, which are contained in the fluid within the follicles. The average number of eggs retrieved is between 8 and 15, and you’ll typically recover for about 30 minutes before being able to go home. It’s advisable to have a support person accompany you, as you won’t be able to drive post-procedure.

Step 4: Preparing the Sperm
If you are using fresh sperm, the male partner will provide a sample on the morning of egg retrieval. For frozen or donor sperm, it will be prepared in the lab beforehand.

Sperm quality is graded across four levels, and they are washed in a special solution to enhance visibility under the microscope. The best-quality sperm, characterized by optimal size and tail length, are selected for fertilization.

Step 5: Fertilization
Following retrieval, your fertility specialist hands the retrieved eggs to our laboratory scientists. The eggs are isolated from the surrounding fluid, and fertilization occurs promptly by placing the eggs in a dish with the sperm, allowing natural fertilization to take place.

Step 6: Embryo Development
Once fertilization occurs, the resulting embryos are placed in a controlled incubator to ensure optimal growth conditions, mirroring the natural environment. Our scientists monitor the embryos over a period of 5 to 6 days, aiming for:

  • Day 2: A two- to four-cell embryo
  • Day 3: A six- to eight-cell embryo (cleavage stage)

Implanting embryos at the blastocyst stage significantly increases the chances of successful pregnancy. Not all eggs will fertilize or develop into viable embryos, so we will keep you updated on the progress throughout this critical phase.

Step 7: Embryo Transfer
If your embryos develop successfully, the next step is the embryo transfer. Your fertility nurse will guide you through the process, which requires you to drink water beforehand for a full bladder, facilitating ultrasound imaging of your uterine lining.

The embryo transfer is a quick and straightforward procedure, similar to a pap smear, lasting about 5 minutes. You will be awake and can resume normal activities immediately after, as the embryo cannot dislodge from your uterus. A scientist will prepare the embryo in a catheter, ensuring minimal disturbance during transfer.

Your fertility specialist will carefully place the catheter through your cervix and into your uterus, using ultrasound guidance to pinpoint the ideal location for implantation. Precise placement is crucial, as the embryo is only 0.1 millimeters in size.

Step 8: The Final Blood Test
Two weeks post-embryo transfer, a blood test will measure the levels of the hormone hCG (human chorionic gonadotropin). A detectable level of hCG in your bloodstream typically indicates a positive pregnancy test.

This two-week waiting period, often referred to as the ‘two-week wait’ (2WW), can be a time of anxiety. If you require support during this time, our counselors are available to address your concerns and provide assistance.

2. When is IVF necessary?

Determining the need for In Vitro Fertilization (IVF) is a personalized process that begins with a thorough evaluation by your fertility specialist. They will review your medical history and consider your unique circumstances to develop the most suitable treatment plan for you.

There are several common reasons why IVF may be recommended:

  • Blocked Fallopian Tubes: If the fallopian tubes are blocked, it can prevent sperm from reaching the egg or hinder the embryo’s journey to the uterus.
  • Fallopian Tube Damage: This includes tubal factors such as damage from previous surgeries or conditions like endometriosis, which can affect fertility.
  • Male Infertility: Issues related to sperm quality or quantity can make it difficult for sperm to fertilize an egg naturally.
  • Endometriosis: This condition can disrupt the normal functioning of the reproductive system and is often associated with infertility.
  • Uterine Fibroids: These benign growths can interfere with implantation or disrupt normal uterine function.
  • Polycystic Ovarian Syndrome (PCOS): PCOS can lead to irregular ovulation and hormonal imbalances, impacting fertility.
  • Advanced Maternal Age: As women age, particularly after 35, the likelihood of conceiving naturally decreases, often necessitating assisted reproductive technologies like IVF.
  • Unexplained Infertility: In cases where no specific cause for infertility can be identified, IVF may be recommended as a treatment option.
  • Recurring Miscarriage: Couples experiencing multiple miscarriages may benefit from IVF, especially if embryo screening can identify viable embryos.
  • Potential Genetic Issues: If there are concerns about genetic disorders, embryo screening can help ensure that only healthy embryos are implanted.

Your fertility specialist will work closely with you to assess these factors and guide you through the IVF process if it’s determined to be the best course of action.

 ICSI (Intracytoplasmic Sperm Injection)

1. What is ICSI?

Intracytoplasmic Sperm Injection (ICSI) is a specialized fertility treatment technique designed to assist in the fertilization of an egg. In this process, a single sperm is directly injected into the cytoplasm of an egg, facilitating fertilization.

The method is particularly beneficial in cases of male infertility, where issues such as low sperm quality or quantity may hinder natural fertilization. By selecting one healthy sperm and introducing it directly into the egg, ICSI significantly increases the chances of successful fertilization.

Although the concept of ICSI may seem straightforward, it is a highly intricate procedure that requires advanced technical skills. The embryologist must perform this delicate injection with precision, making it one of the most challenging tasks in the field of embryology.

3. What is the sperm selection process for ICSI?

The sperm selection process is crucial for the success of Intracytoplasmic Sperm Injection (ICSI), particularly when dealing with male infertility issues. The selection criteria focus on two main factors: morphology and motility.

  1. Morphology: Healthy sperm cells typically exhibit an oval head and a long tail, which are essential for effective swimming. Infertile men often produce fewer sperm that meet these criteria, making careful selection vital for successful fertilization.
  2. Motility: This refers to the sperm’s ability to move and penetrate an egg. The efficiency of motility largely depends on the length and structure of the tail. Sperm with curly or kinked tails may struggle to swim effectively, impacting their ability to reach and fertilize an egg.

Selection Process:

  • A small amount of washed and prepared sperm is placed in a thick, viscous medium designed to slow down their movement. This allows embryologists to assess the sperm more effectively based on shape, motility, and trajectory.
  • The most normal-looking and vigorous sperm are selected for ICSI.
  • To prepare the selected sperm for injection, they are immobilized by applying pressure to their tails with a glass injection needle. This process ensures that only the healthiest sperm are utilized, maximizing the chances of successful fertilization.

By carefully selecting and preparing the sperm, embryologists can enhance the likelihood of creating viable embryos during the ICSI procedure.

2. Who can benefit from ICSI?

Intracytoplasmic Sperm Injection (ICSI) is a valuable option for certain patients facing challenges with fertilization. It is particularly suitable for individuals or couples who have:

  • Abnormally Low Sperm Count: Men with significantly reduced sperm production may benefit from ICSI to enhance fertilization chances.
  • Poor Motility: If the sperm have difficulty moving effectively, ICSI can help facilitate the fertilization process.
  • High Percentage of Abnormal Sperm: In cases where there are many irregularly shaped sperm or a limited number of healthy sperm, ICSI allows for the selection of the best-quality sperm.
  • Sperm Obtained via Testicular Biopsy or Micro TESE: For men who have had sperm retrieved from the testicles, ICSI provides a method to achieve fertilization.
  • Previously Low Fertilization Rates with Standard IVF: If past IVF attempts have resulted in low fertilization rates, ICSI may improve the likelihood of successful embryo development.

However, it’s important to note that recent evidence suggests that standard insemination techniques may yield better IVF success rates for couples who do not fall into the aforementioned categories.

ICSI can be performed using either fresh or frozen/thawed sperm. The embryologist will select the optimal sperm based on criteria such as shape, size, and motility to maximize the chances of successful fertilization.

4. How is ICSI performed?
  1. Preparation of the Egg: The mature egg is placed in specialized culture dishes designed for ICSI. These dishes are kept under a microscope to allow precise manipulation of the egg.
  2. Micromanipulation Setup: A micromanipulator, a precise instrument, is used to move the egg carefully during the procedure.
  3. Securing the Egg: A holding pipette is employed to gently secure the mature egg in place, ensuring it remains stable throughout the process.
  4. Injecting the Sperm:
    • A thin, sharp glass micropipette is prepared and loaded with a single sperm.
    • The micropipette is then carefully maneuvered to push through the zona pellucida, the outer protective layer of the egg.
    • Once through the zona pellucida, the micropipette penetrates the oolemma, which is the cell membrane of the egg, allowing the sperm to enter the cytoplasm (the center of the egg).
  5. Fertilization: The sperm is delicately deposited into the cytoplasm of the egg. At this point, the sperm has been assisted in reaching the egg, meaning it does not need to swim or penetrate the egg on its own. The final step for the sperm is to initiate fertilization, creating the spark that leads to embryo development.

This precise and controlled method enhances the chances of successful fertilization, particularly in cases of male infertility where natural sperm movement may be compromised.

Preserving Fertility

1. What methods are available for preserving female fertility?
If you are facing challenges such as cancer or premature menopause, various options are available to help preserve your fertility, allowing you the possibility of having a child later in life. Here are two primary methods:

1. Egg Freezing

  • What It Is: Egg freezing (oocyte cryopreservation) is a process that allows a woman to store her eggs for future use. This technique is particularly beneficial for women who may undergo treatments that could affect their fertility, such as chemotherapy or radiation.
  • How It Works:
    • The process generally takes a couple of weeks and begins with hormone stimulation to encourage the ovaries to produce multiple eggs.
    • Once the eggs are mature, they are retrieved from the ovaries.
    • The retrieved eggs are then frozen using cryopreservation techniques.
  • When You’re Ready: When you decide to use your frozen eggs, they are thawed, fertilized with sperm, and then implanted into your uterus.

2. Embryo Freezing

  • What It Is: If you have a partner, embryo freezing (embryo cryopreservation) may be an option. This involves freezing embryos created through the fertilization of eggs with sperm.
  • How It Works:
    • Similar to egg freezing, the process begins with ovarian stimulation to retrieve eggs.
    • After the eggs are fertilized, the resulting embryos are cultured for a few days and then frozen.
  • Urgent Medical Treatment: Like egg freezing, this process can also be expedited for patients who need urgent medical treatment.
2. What methods are available for preserving male fertility?
Freezing sperm, also known as sperm cryopreservation, is a valuable option for men looking to preserve their fertility for various reasons. This process involves collecting and storing sperm for future use, allowing men to maintain the possibility of fathering children later in life.

Reasons for Sperm Freezing

Sperm freezing might be recommended in the following situations:

  • Upcoming Cancer Treatments: If you’re about to start chemotherapy or radiotherapy that may impair your fertility, freezing sperm can help ensure you have viable sperm for future use.
  • Low Sperm Count: If you have a very low sperm count, there’s a risk it could drop to zero over time. Freezing your sperm now can preserve your fertility.
  • Surgeries or Vasectomies: If you are planning to undergo surgery that may affect your reproductive system or if you are considering a vasectomy, sperm freezing can safeguard your ability to have children later.

The Sperm Freezing Process

  1. Consultation: You will have a consultation with a fertility specialist to discuss your medical history, reasons for sperm freezing, and the process involved.
  2. Sperm Collection: The sperm sample is usually collected through masturbation in a private room at the clinic. Alternatively, sperm can be collected via a testicular biopsy if necessary.
  3. Sperm Analysis: The sample is analyzed for sperm count, motility (movement), and morphology (shape) to ensure quality.
  4. Freezing Process: The sperm is mixed with a cryoprotectant to protect it during freezing. It is then frozen in liquid nitrogen at extremely low temperatures, allowing it to be stored for years without losing viability.
  5. Storage: Frozen sperm can be stored indefinitely, allowing you to use it whenever you decide to start a family.