When is IVF Needed?

IVF was originally developed for women with blocked tubes or missing fallopian tubes and it is still the procedure of choice for these situations. It is also used when other conditions are present, including endometriosis, male factor infertility and unexplained infertility in which no medical cause for infertility can be found. IVF Specialist will review your history and help to guide you to the treatment and diagnostic procedures that are most appropriate for you.

What is the percentage of success with each treatment cycle?

The possibilities of success with IVF vary from patient to patient. Your physician can best predict the outcome in your case after a complete evaluation, which includes reviewing your history and any prior response to fertility medications.

Will the hormones cause long-term health risks?

The only suggested long-term health risk of IVF is medications, and a possible association between these drugs and the risk of cancer, specifically ovarian cancer. An important fact to keep in mind is that women who suffer from infertility and never conceive appear to have a slightly increased risk of ovarian cancer as compared to the general population (about 1.6 times the rate). As these are the women who use fertility medications, the medications themselves have been implicated in the cancer risk but have never been proven to be a cause of cancer. Since the initial concern was raised in a 1992 study by Whittemore and colleagues, several studies have addressed the issue more directly. These studies from Australia, England and Denmark all failed to find an association between fertility medications or IVF treatment and any higher risk of ovarian cancer. An ongoing National Institutes of Health-funded study is specifically designed to address the question of whether fertility medications themselves may play a causal role in ovarian, breast or uterine cancer. While the study is still under way and needs another 5-10 years of follow-up to be conclusive, preliminary results suggest no association between fertility medications and risks for invasive cancers. At this time, we can say that there is no direct evidence that fertility drugs play a causal role in increasing a woman's risk of invasive ovarian, breast or uterine cancer.

Are the injections painful?

With the advent of newer fertility medications, many injections that were given intramuscularly can now be replaced by medications given as a little injection under the skin (subcutaneous). This method is similar to insulin injections of diabetic patients. Additionally one medication, which has been given as a subcutaneous injection (Lupride), can be replaced by a medication administered as a nasal spray (Synarel). Both medications are equally effective, and we leave this choice to you. Once the egg retrieval is performed, progesterone supplementation is used for development of embryos in the uterus. For most of our treatment cycles, we recommend using progesterone gel or suppositories. This protocol makes it possible to avoid injections during the second half of your IVF cycle. Using our protocols at IHR a woman may have to take only 10-12 days of subcutaneous injections and one intramuscular injection of HCG (soon to be replaced by a subcutaneous injection). That's it!

How long do I have to take the fertility injections?

Typically, patients receive injections for 7 to 10 days, but some must take them for a little longer.

Who will give me the injections?

You, or a family member of your choosing, will be taught by our staff how to give the subcutaneous injections.

Is the egg retrieval process painful?

No, not generally.  It lasts approximately 20 to 30 minutes, and IV sedation is administered by a certified MD anesthesiologist so that you will not be awake.  Some patients have mild cramping after the procedure and are discharged with safe pain medication.

How long do I have to stay at Kolkata, India?

At IHR, we care for many patients who come for treatment from other parts of the world. All consultations can be done by telephone (medical, nurse coordinator, financial), and communication with our staff throughout your treatment can be via telephone or E-mail. Many of the required screening blood testing and procedures can be coordinated with your local gynecologist or reproductive endocrinologist. On average, most patients need to be at IHR in India for about 10-20 days. Our staff can provide recommendations for local accommodations, restaurants, and sights to visit!

Can I travel?

Many of our patients have to travel various distances to return home after treatment. Air travel in commercial aircraft is fine (pressurized aircraft). Drink lots of fluids while flying, since the circulated air can be quite dry, and dehydration should be avoided. Car travel is also fine. Sitting for an extended period of time will not affect chances of pregnancy. If you live out of town, most patients return home the day after the transfer. There is no medical reason to stay at IHR for more than 1 hour after embryo transfer.

Am I using up all my eggs if I do IVF?

In a natural ovulation cycle, the ovary selects one egg from a pool of approximately 100-1000 eggs. Those eggs which are not selected for that month undergo a natural cell death process called atresia. Fertility medications override the body's selection process, and cause many of these "rescued" eggs to grow (hopefully between 10-20 eggs). These eggs would otherwise undergo atresia. Therefore, you are not "using up eggs faster" by undergoing ovulation induction, but are "rescuing" eggs to use in that cycle, which otherwise would have expired.

Can I freeze eggs for future use?

Unfortunately, current technology does not allow us to freeze eggs, then thaw, fertilize and develop embryos efficiently. Therefore, egg freezing is not currently a viable option for fertility preservation. The best option for preserving future fertility is to freeze embryos (fertilized eggs). Hopefully, the egg freezing technology will improve over the next 5-10 years, so that this option could then be a viable method to preserve future childbearing.

What are my chances of pregnancy with frozen embryos?

In general, the success of frozen-thawed embryo transfer procedures depends on 3 things: the quality and survival of the frozen-thawed embryos, the age of the patient who produced the eggs, and the uterus of the woman receiving the embryos. For patients < 35 years, the chances of pregnancy with frozen-thawed embryos is similar to fresh embryos. For patients > 37 years, the pregnancy chances with frozen-thawed embryos decline.

Can I do a natural cycle frozen embryo transfer (FET)?

For most patients, frozen-thawed embryos can be transferred in either a controlled cycle (hormone injections required to prepare the uterus), or in a natural cycle (minimal medications). Patients with normal/regular menstrual cycles have the options of using a natural cycle for transfer of frozen-thawed embryos. We have extensive experience coordinating these types of cycles, and have a very successful FET program. Natural FET cycles save patients money (less medications and monitoring needed), time, and still provide a good pregnancy rate.

When do I need an egg donor?

Women who are unable to produce healthy eggs, but have a healthy uterus are candidates for egg donation with IVF. This procedure is the same as for IVF except the intended parents select a donor and use the donor's egg to create the embryo.

Why do I need to get a treatment date from the clinic for my IVF with donor eggs?

As IVF with donor eggs is a more difficult procedure, and more people are involved (the donor and the recipient's schedules need to be synchronized) the clinic will review your medical questionnaire and your questionnaire for OD recipient and provide you with a treatment date when they can offer you the best donor matching your requirements. We try to accommodate your treatment dates at least for a particularly requested treatment month, but that cannot always be guaranteed. Your medical needs are of the upmost importance, and the clinic excels in its ability to provide exceptional medical care, giving every patient the time and attention they deserve.

How can I select 2 weeks in advance if I don't know where I will be in my cycle?

It is very easy. We ask all our patients undergoing IVF treatment to start any brand of Monophasic birth control pills (BCP) after all of their tests are done. Thanks to this BCP, you are in charge of your cycle. BCP will not only help your body prepare for your treatment but it also give us the option to shorten or lengthen your cycle as needed to fit your travel dates without any problems. Monophasic BCP is the only kind of BCP that can do that. That is why you don't have to worry and calculate when you should go so that you ovulate on time. You just pick the best two weeks that work for you and the Monophasic BCP will help your cycle and your body to cooperate.

Why are we given estimated dates of my/donor's egg retrieval?

Because we are working with human bodies, and because we want to provide you with the best treatment in regards to having mature quality eggs instead of sticking to a time schedule, we give you estimated dates and discuss with you in person what you can expect. Your stay in Anand, India is calculated with this variable in mind and our patients have appreciated this approach.

What if my husband or I get sick during an IVF cycle?

Please call our office for instructions. Most colds or upper respiratory infections will not be a problem. Most over the counter medications and antibiotics are safe to use with the fertility drugs, but check with us first.

What is the average number of embryos transferred?

The doctor will make the decision after discussing this with you. Generally, two or three embryos will be transferred, but the number may vary slightly depending on the quality of the embryos and the age of the female partner.

Why must I get a blood pregnancy test after an IVF cycle?

We must show documentation that a blood test was performed to verify pregnancy status. Many patients will often have implantation bleeding and assume they are not pregnant when in fact they are.

How many monitoring visits will I have while I am in treatment?

This will depend on your individual response to the medications.  During an IVF cycle at our clinic, you will have between six to nine appointments, including one for egg retrieval.

Can I exercise while going through treatment?  What can I do?

Some exercise is acceptable during in-vitro fertilization treatment, but as the IVF treatment cycle progresses, only low impact exercise (such as walking) is recommended.  The ovaries may become enlarged from the fertility medications you will be taking, and high impact exercise may put you at risk for ovarian torsion, a condition in which the ovary can twist on itself. This is a very rare but serious side effect.

Can I take herbal supplements?

Herbal supplements are not recommended and may cause unknown effects.  If you are currently on such supplements, please inform one of our nurses.

Can I color my hair if I am going through treatment or think I am pregnant?

During the first two weeks of each IVF cycle, hair coloring is allowed.  However, from mid-cycle on, including waiting to find out if you are pregnant, it is best to wait until after 12 weeks to receive a hair color treatment.

Can I get my nails done if I am going through treatment or think I am pregnant?

Having a manicure or wearing artificial nails will not cause any harm during IVF treatment or pregnancy, but make sure your nails are treated in a well-ventilated area.

When can we have intercourse after embryo transfer and if I am pregnant?

After embryo transfer, we ask that you refrain from intercourse until your pregnancy test, which is approximately 14 days later.  If you are pregnant, intercourse is okay after.  This will be approximately 8 weeks after your positive pregnancy test.

Is there a higher risk of birth defects with a child born from IVF?

The simple answer is no. Children born from IVF are no more inclined to any particular birth defect than those conceived naturally.

When will I be able to tell if I am pregnant?

A pregnancy test is scheduled 14 days after the embryo transfer.

How long will I stay with the practice once I am pregnant?

Typically, you will not be discharged to your Ob-Gyn until 8 to 10 weeks into your pregnancy.  You will have several blood tests and ultrasounds to determine the development of the pregnancy before we can release you.

Under what circumstances is a Gestational Carrier (surrogate) appropriate?

A woman who accepts to bear (or be pregnant with) the child of another woman who is incapable of becoming pregnant using her own uterus is called a gestational carrier. Women who need gestational carriers with IVF include those who do not have a uterus, have an abnormal uterine cavity, have had several recurrent miscarriages or have had recurrent, failed IVF cycles. "Surrogate" is an older term for what we now refer to as a "gestational carrier".

Is surrogacy legal in India?

Yes surrogacy is legal in India and hence infertility clinics offer this treatment option to their patients. Our doctors are here to help patients get the baby they have been longing for and not to judge who will give birth. In other words you can get your IVF treatment using a surrogate. It is important however, that you have complete legal papers documented with your surrogate. We recommend legal paperwork be managed by a certified attorney.


What is Intra Uterine Insemination or IUI?

IUI is the depositing of washed motile sperm into uterine cavity using a plastic catheter. IUI is a first step, cost-effective method to enhance the fertility in a woman with patent fallopian tube.

How long sperm services after timed intercourse or IUI?

Normal healthy sperms survive 48-72 hours in the female genital tract.

How long does it take for Fertilization and for implantation?

Fertilization occurs within 24 hrs after ovulation while implantation takes about 6-7 days after ovulation.

What is an ideal range for uterine lining at the time of IUI?

At LH surge level, uterine lining should be between 8 to 12 mm. The triple lining occurs at the time of implantation.

What will be the ideal size of leading follicle before the hCG shot? & How much do follicle grow each day?

Follicles grow 1 to 2 mm a day while taking ovarian stimulation drugs and once the leading follicle is ~ 19mm it is ready for hCG shot.

Do smaller follicle also "match" with leading follicle at the time of egg release?

Generally 15-16 mm size follicles contain fertilizable eggs. If the smaller follicles are of 15-16 mm size, it might release a mature egg, otherwise, it is most likely that only leading follicles will ovulate and release a mature egg.

What will be the ideal abstinence period for a couple before an IUI cycle?

3-4 days gap is ideal for a man. More than 7 days old sample may have a risk of poor motility, white cells and other problems.

Explain me IUI procedure in brief?

Medicine protocol for IUI is

  • Clomiphene Citrate from period day 3- 7.
  • Add injectables if required
  • Follicular growth monitoring from the day 9-11 of cycle
  • Monitoring of LH surge and estrogen level during the cycle if necessary
  • Once the leading follicle reaches 19-20 mm size a slot of hCG.
  • IUI performed after 36-40 hrs of hCG
  • Adjustments in the ovulation induction protocol can be made as per individual need.

What precaution lady should take during an IUI cycle?

Before an IUI cycle, avoid heavy exercise, jogging or high impact aerobics.

  • Little rest just after the IUI procedure is advisable.
  • For little pain a simple pain killer like Ibuprofen can be taken.

What is the difference between super ovulation timed coitus, IUI & IVF? [S0-TI].

SO-TI is a first line of treatment of infertility. Either in SO-TI or IUI the aim is to ovulate 3-4 eggs, while for IVF aim is to ovulate atleast more than 10 eggs. For SO-TI and IUI monitoring of cycle is similar. Till hCG slot the procedure is same. SO-TI couple will have intercourse while for IUI, insemination is done after 36 hrs of hCG slot. For IVF procedure please refer to page IVF.

What time is better for taking injectables for an IUI cycle?

For single injection, it is better to take in the evening so that if necessary dose can be adjusted after morning ultrasound follicular monitoring. It is not very critical, but one can fix some time in evening. However, hCG injection time is critical because on that basis IUI or IVF will be planned.

What are the pre IUI treatment steps?

Prior to IUI, women must have atleast one documented open fallopian tube as demonstrated by hysterosalpingogram or laproscopy dye test. Beside that the blood test for hormone FSH is done on cycle day 3. Semen analysis is done for the male partner. Common tests which is for men and woman are blood grouping, blood test for sexually transmitted diseases, for HBsAg, is a requirement before an IUI cycle.

What is "washed" sperm?

In nature, during intercourse sperm are deposited in the vagina and then they have to swim through the cervical mucus. In IUI method, as cervix is by passed there are many sperm available at the site of fertilization. As sperm are placed in uterine cavity, they have to be washed first, to get rid of any dead cells, bacteria and seminal fluid. There are different method for the washing of sperm which takes around 1 hour, so it is always advisable to produce semen before 1½ hour of scheduled IUI.

If a partner is not available at IUI procedure time, what is the method for sperm freezing?

One can freeze the semen sample before an IUI procedure if husband is physically away at the time of procedure or if he cannot produce the semen sample on demand. Before semen freezing a complete blood work is done to rule out the possibility of HBsAg, HIV or gonorrhea. Then semen sample has to be produced by masturbation into sterile container provided by lab. Once given to the lab a complete semen analysis is performed which includes, volume, liquefaction and viscosity, sperm count, motility, forward progression and morphology. After that semen is subjected to freezing and can be revived on IUI day.

How long one can store the frozen sperm?

The length of time that frozen sperm remain viable will vary from patient to patient. There have been normal pregnancies from sperm stored for over 20 years. Each individuals sperm react differently to the freezing process. The result of the post thaw analysis can give some indicating of how sperm cells react to the freezing process.

Can using of frozen sperm increase the chance of having a child with birth defects?

All available data indicates that frozen semen does not increase the risk of birth defects. In fact, the freezing process tends to kill off weaker sperm, and may thus lead to survival of best sperm

Who can use donor IUI (DI)?

Single women, couple with male partner having no sperm or very poor semen analysis and cannot afford expensive treatment like ICSI, donor IUI is an option. Some time, it is also used when there is an inheritable genetic problem which could be transferred from the male.

How does IUI increase the chance of pregnancy?

IUI procedure works by concentrating the healthiest sperm in the ejaculate and placing the washed sperm into the uterus adjacent to the fallopian tube. This bypasses any potential cervical factor problems and removes the sperm that are less likely to fertilize the egg.

When is IUI used?

IUI is a fertility treatment often selected for the couple, with atleast one patent fallopian tube and who have been trying to conceive for atleast one year. IUI can also be selected as a fertility treatment with any one of the following conditions.

  • low sperm count
  • decreased sperm motility
  • A hostile cervical condition [too thick cervical mucus]
  • sexual dysfunction.

How one can decide about fertility drug in conjunction with IUI?

For use of fertility drug, a fertility specialist under whom couple is undergoing treatment can make the decision. In general, fertility drugs enhances a woman's ability to become pregnancy with IUI. Most widely used medicine are clomiphene citrate or Letrozol either alone or with combination of injectables. Injectable fertility drugs that are more aggressive in stimulating multiple egg release. The more eggs that a woman produces during a treatment, the higher the chance for success.