Treatments for Male Infertility: PESA, TESA and MESA

PESA, TESA and MESA are infertility treatments which involve surgical retrieval of sperm from the male partner. This line of treatment is useful for couples with severe male factor infertility and involves collection of sperm from the testicles using a needle or a small incision. Surgical sperm retrieval is beneficial in the following conditions:

• Obstructive azoospermia: When sperm are being produced but there are problems with semen release due to an obstruction in the reproductive tract. This can be due to a blockage in the vas deferens (tubes that transport semen from the testes to the ejaculatory duct), a genetic defect where the vas deferens are absent, or injury to the vas deferens from a previous surgery.
• Non-obstructive azoospermia: When there is nil sperm or very low number of sperm due to problems with sperm production.
• For men with retrograde ejaculation: Where, instead of being released out from the urethra, the semen travels backwards into the bladder.
• For men who have had a vasectomy
• For men who have had a failed vasectomy reversal

The first step in treating male factor infertility is to conduct a detailed semen analysis. If the results of the semen analysis indicate no sperm in the semen, your doctor may recommend surgical retrieval of sperm from the testicles. Sperm retrieval is generally performed in combination with IVF/ICSI which allows your fertility doctor to select healthy sperm and use them to fertilize individual eggs obtained from the female partner.

To simply further, surgical sperm collection is done when the male partner has problems with natural release of sperm; this could be due to a blockage, a genetic cause or poor sperm production. The sperm thus obtained are separated from the fluid collected from the testes, specially prepared, and then used for fertilization. Except in cases where the extracted sperm need to be frozen, for most couples sperm retrieval and egg retrieval are performed on the same day.

The types of surgical sperm retrieval procedures are listed below:

TESA - Testicular Sperm Aspiration

Seminal fluid is collected by passing a fine needle into the testis, and suctioned into a syringe attached to the needle.

PESA - Percutaneous Epididymal Sperm Aspiration

Similar to TESA where seminal fluid is collected by passing a needle into the epididymis, a coiled structure which temporarily stores the sperm produced in the testis.

Both PESA and TESA are performed under local anaesthesia and take about 10 minutes. These are

simple aspiration procedures particularly useful for men who have normal sperm production but have problems with release of sperm (obstructive azoospermia).

MESA: Microsurgical Epididymal Sperm Aspiration

In contrast to PESA and TESA, this is a surgical procedure where an incision is made in the scrotum, exposing the testis and the epididymis. An operating microscope is used to identifya single tube in the epididymis from which sperm can be aspirated.

MESA is done under general anesthesia and is generally performed for men with a non-correctable congenital problem, such as absence of the vas defer ens or obstruction in the epididymis. It helps in the retrieval of large numbers of high quality sperm which can be used for multiple IVF/ICSI cycles, or frozen for future use.

The above procedures are performed for men when sperm are being produced, even if in low numbers, but a blockage prevents their release. Men who have no blockage but have problems with sperm production will likely have no sperm in the semen. In such a case, a more invasive procedure is required to obtain the small number of sperm that may be present in the testicles. These techniques are:

TESE - Testicular Sperm Extraction/Testis Biopsy

The scrotum is opened with one or more incision sand a fair amount of testicular tissue is removed from which sperm would be later retrieved using a microscope.

Micro dissection TESE

A more invasive procedure performed a day prior to the female’s egg retrieval. A surgical microscope is used to accurately locate the tissue to be removed, thus minimizing damage to the testis. It is also considered a safer retrieval method as minimum testicular tissue is removed. Micro dissection TESE can take up to four hours and is performed for men having problems with sperm production.

Which aspiration technique is advised by your doctor would depend on a number of factors including the cause of male infertility, age of the male partner, and the purpose of the procedure. For example, micro dissection TESE is often undertaken to obtain sperm that may be frozen for future use.

There is a possibility that no sperm are found using a particular technique, in which case your doctor may recommend another, more invasive procedure. In cases of obstructive azoospermia (when sperm are being produced but not released), the chances of finding no sperm are rare. In non-obstructive azoospermia (when little or no sperm are being produced), there is a possibility that of failure to obtain sperm, and your fertility doctor would advise you of the same before the procedure is performed.

Have more questions about which sperm retrieval procedure is best suited for you. Consult Dr. Manika Khanna for a Free Second Opinion.

Email id.: info@gaudiumivfcentre.com Contact No. : 08527858585, 011-69413434

7Common IVF Myths & Misconceptions

The birth of the world’s first IVF baby Louise Joy Brown in 1978 marked the beginning of a revolution which has since brought joy to millions of childless couples across the globe.

A technique in which oocytes or eggs retrieved from a woman’s ovaries are combined with healthy sperm from the male partner in a lab dish, today IVF is credited with the birth of more than 5 million babies worldwide. Vitro means glass and since fertilisation takes place in a culture dish made of glass, the process is known as in vitro fertilization.

Spearheaded by award-winning IVF Specialist Dr. Manika Khanna, Gaudium IVF Clinic India is proud to have assisted more than 6000 child-less couples in having a child of their own.At Gaudium IVF centre we believe that educating our patients with authentic and reliable information not only empowers them to make informed decisions but also boosts their trust in our services and in the medical fraternity as a whole.

In this blog post we have listed seven prevalent myths surrounding IVF and contrasting facts that dispel these myths.

Myth: IVF leads to multiple pregnancies

Successful fertilization of sperm and egg leads to the development of an embryo which is placed in the woman’s uterus through a process known as embryo transfer. More than one pregnancy can occur in case multiple embryos are transferred during a single IVF cycle.

Due to the several risks associated with multiple pregnancies,Gaudium fertility specialists advise patients to go for SET (single embryo transfer) in each IVF cycle.

While the reputed fertility clinics across the world are united in dissuading IVF patients from opting for multiple embryo transfer, certain complicated cases may necessitate the need to transfer more than one embryo at a time, which could result in more than one pregnancy.

Ideally, your IVF doctor should explain to you the possible complications associated with multiple IVF pregnancies to help you make an informed decision.

Myth: IVF is for women only

As shared earlier, IVF is a technique wherein the woman’s egg and the man’s sperm are made to fertilize in a laboratory. Today IVF is being increasingly used in combination with several male infertility treatment modalities such ICSI, TESA and PESA. For example, a combination of ICSI-IVF may be used in cases of severe male infertility. The technique involves selection of a single healthy sperm and injecting it directly into the female egg to fertilise it in vitro. You can learn more about such treatments here.

While technically IVF is a fertility treatment for women, it often complements infertility treatment of the male partner.

Gaudium IVF success stories: When patients had lost all hope

Myth: IVF success is a matter of sheer chance

If this were true, IVF would not be the preferred infertility treatment around the world. With recent advances in medical science, IVF procedures have become even more sophisticated to minimize the risk of failure. Your progress through various stages of IVF is closely monitored by your fertility specialist through ultrasounds and blood-tests.

As a responsible patient, you can impact your IVF outcome by taking better care of yourself and your partner. Give up smoking and alcohol, aim for a healthy body weight, eat nutritious foods and learn techniques to minimize stress.read more

Backed by state-of-the-art facilities and internationally trained doctors, Gaudium IVF Clinic enjoys an unmatched success rate of 58-65% in IVF treatment.

Myth: IVF causes early menopause

Hormonal changes brought about by fertility medication cause some IVF patients to experience symptoms that are usually associated with menopause. It does not mean that you are heading towards menopause!

A good IVF doctor would take the time to explain to you the possible side effects of the medicines prescribed to you.

Myth: A failed IVF cycle means that the next one will fail as well

An IVF cycle can fail for many reasons; however it does not mean that the next attempt would be unsuccessful as well.

The success of your IVF treatment depends on several biological and hormonal factors. What’s important is the ability of your fertility doctor to determine the cause of a previous failure and devise a specialized protocol to minimize the risk of failure in the subsequent IVF cycle.

With an unmatched 75% success rate in previously failed IVF cases, Gaudium IVF takes pride in having successfully treated hundreds of childless couples who sought assistance from us after failing IVF treatment at other centres.

Myth: IVF outcomes are not impacted by lifestyle

Common perception is that IVF is the unfailing remedy for infertility and a highly advanced technique that can surpass any damage inflicted upon your body by poor lifestyle choices. This misconception is a contributor to patients’ having unrealistic expectations from IVF treatment

Time and again studies have linked lifestyle factors such as excess weight, smoking, consumption of alcohol and chronic stress to fertility problems in both men and women.

Individuals facing fertility issues must adopt a healthy lifestyle to improve chances of IVF success.

Myth: IVF is the last desperate solution, we should wait

Due to lack of information, childless couples often tend to try indigenous solutions in a hope to get pregnant without medical help. However, time is one of the most crucial factors in the success of your infertility treatment.

While a younger couple may try conceiving at least for a year before seeking treatment, older couples (30 years and above) should not delay seeing a fertility specialist after more than six months of trying. Several factors govern the success of an IVF cycle such as the cause of infertility, age of parents-to-be, medical history, biological factors, previously failed IVF cycles, and previous pregnancies.

Delaying treatment can severely affect your chances of IVF success.

If you have more concerns or questions about IVF, feel free to consult Gaudium IVF Specialists for a free second opinion.
Email id.: info@gaudiumivfcentre.com Contact No. : 08527858585, 011-69413434

10 Tips to Cope with Infertility Stress / How to Cope with Stress during Infertility Treatmen

Feeling stressed during infertility diagnosis and treatment is a natural response to a challenging life situation. The anxiety, however, can take a toll on a couple’s mental and physical health, causing further challenges to fertility treatment and outcomes.

In a previous post we discussed how stress can hinder fertility in both men and women. Furthermore, there is some evidence that extreme stress may negatively affect outcomes of ART (assisted reproductive therapies) in some individuals. Therefore, helping couples cope with stress is an indispensable aspect of fertility treatment at all Gaudium IVF centres.

In this article, the counsellors at MANTRANA - Gaudium’s unique counselling programme for couples undergoing infertility treatment - have compiled 10 useful tips to help you cope with infertility related stress. 

1. Acknowledge that you are stressed

The foremost step to relieving infertility stress is to stop evading the need for emotional support. When a couple is going through infertility problems, feeling stressed or frustrated is natural and should not be considered a sign of weakness. Apart from your own personal desire to have a baby, family expectations and societal pressure can take a toll on your mental well being.

Only when you take a moment to admit to yourself that stress may be affecting your physical and emotional health, will you be able to take concrete steps to do something about it.

2. be supportive of your partner

Because of the misplaced perceptions people have regarding infertility, it is often the female partner who receives brick bats for not being able to conceive. Ironically it is also the female who receives abundant support and empathy from loved ones.

Perhaps because men are conditioned to put up a brave front, they seldom seek emotional support or acknowledge the need for counselling.In reality, being diagnosed with infertility can cause extreme stress to the male partner. His self- esteem can take a hit and he may become withdrawn and distant in trying to deal with the situation. This is the time when both partners need to understand each other’s state of mind, be supportive of each other and not let infertility take a toll on the relationship.

3. Be receptive to help and support

Being diagnosed with infertility is emotionally taxing for a couple. While it is a time when you expect your partner to be your greatest emotional anchor, at times they may be too overwhelmed to offer you the love and support you need.

Confiding in a friend or a loved one can help you gain a new perspective and release some of the distress you may be feeling. Remember, you cannot deal with infertility in isolation. You may feel the urge to cut everyone out, but the love and support of those who care for you can make the journey a lot easier.

4. Look out for yourself

Infertility treatment can be a long and exhausting process. It needs your time and commitment. More importantly, it needs you to be in the right frame of mind, and you have every right to safeguard your mental and physical health. Allow yourself to disagree with insensitive remarks or unpleasant questions by inquisitive relatives and acquaintances.If being with children upsets you, avoid it for the time being, instead of beating yourself up for having such feelings. There will be days when, despite having an optimistic outlook, you can’t help feeling sad. Delegate responsibilities and claim your time and space to deal with the roller coaster of emotions you may be experiencing. Make your emotional well being a priority and be kind to yourself.

5. Releasing is empowering

While most times you may be concealing your emotions to protect your partner, do know that it is not abnormal for a person struggling with infertility to feel angry, hurtful, or scared. Allow yourself to release these feelings. Confront emotions instead of suppressing them.Cry if it makes you feel better; meditate if it makes you calmer. Do physical exercise to release physical and mental tension.

Share your feelings with your partner and encourage them to do the same. Don’t let simmering negative emotions keep you from giving your best to your fertility treatment.

6. Find ways to help yourself

Going through cycles of infertility treatment, waiting for results, and keeping your hopes up through it all can be strenuous. Find ways to help yourself cope better. If music makes you happy, make it a part of your every-day life. If its meeting with friends that has pulled you through rough times in the past, don’t avoid it now. Walking, meditation, yoga, reading, learning a new skill – the things that you never found the time for earlier – take practical steps to cope with stress.

Pull yourself up and it is sure to have a positive impact on other aspects of your life.

7. Learn about your condition

Global statistics indicate that one in every six couples worldwide faces some form of infertility. Ask your fertility doctor questions that can help you learn more about your condition and the treatment options available to you. Read up on infertility treatments and the possible outcomes. Learn about the lifestyle changes that can make a positive difference to your treatment. To assure yourself further, learn more about your fertility doctor and the infrastructure and services at your fertility clinic.

To avoid being misled, do make sure to consult only reliable and authentic sources of information.

8. Watch your diet

What we eat affects our mood.

It is possible that in dealing with the challenge at hand, you may be neglecting your general health. Poor eating and unhealthy binging can deplete you of energy and cause unwanted weight gain. While comfort foods may appear to ease your tension a little, they cause multiple health problems. Also, the chemicals in processed foods are best avoided particularly during this phase of your life.

Seek nutrition advice from your fertility clinic and follow your doctor’s instructions on healthy eating.
Mindful eating was never as important as it is now!

9. Plan ahead for the two-week wait

The two-week period between embryo transfer and pregnancy test results often tends to be the most difficult time for couples as they wait in anticipation for positive news. While it is normal to feel anxious or worried during this time, try and distract yourself and keep yourself busy.

10.Stay realistic

Last but not the least, expect the best but prepare yourself for all possible outcomes. Discuss the way forward with your partner and make genuine effort to not let infertility consume the other aspects of your life. Having a realistic approach and accepting that some things may be beyond your control helps. Understand that infertility is just one part of your life and not your entire life.

Developing the mind set to fight stress and anxiety is easier said than done. The support of family and friends can make the journey easier so don’t hesitate to reach out to those who care for you.

Need further guidance? Feel free to get in touch with our counsellors at MANTRANA, the country’s first ever comprehensive counselling programme to help couples cope with infertility related stress.

Email id.: info@gaudiumivfcentre.com Contact No. : 08527858585, 011-69413434

Male Infertility: Misconceptions, Causes and Solutions

In the last few decades, male infertility in India has been on a steady rise. At the international conference on Challenges in Infertility Management (CIIM) in 2014, experts observed that male infertility now contributes to 6 in 10 of all infertility cases in the country. In most cases, low sperm count is the underlying cause.

Being diagnosed with infertility can be particularly hard for a man to cope with. The ability to father a child is still believed to be a man’s greatest virtue, and failure to do so can leave him feeling heartbroken, even depressed.

Since a large number of men avoid discussing the issue openly, male infertility is often confused with impotence. While impotence means the inability to attain or sustain an erection during sexual activity, infertility is the inability to have a child, often caused by problems with sperm production. Thus, a man can be sexually active and yet be infertile.

Unlike impotence, male infertility may present no physical symptoms, and therefore can go undiagnosed for a long time.

Causes of Male Infertility

Sperm related problems are identified as the main cause of male infertility worldwide, and may be classified as follows:

-          Oligospermia: The number of healthy sperm produced is abnormally low (less than 20 million/ml).

-          Azoospermia: No sperm is produced at all.

-          Asthenospermia: Poor sperm motility. Motility is the ability of the sperm to swim and move forward in a straight line through the female reproductive system to reach the oocyte (the egg).

-          Abnormal sperm morphology: When a sperm has abnormal shape, size or structure, it cannot fertilize the egg.

These anomalies are detected through a detailed semen analysis, which is the first step in the treatment of male infertility. Semen analysis is preceded by a thorough physical examination of the male partner and complete medical history of both partners.

Based on the findings of the semen analysis, further investigation is undertaken to determine the root cause of the problem.

Factors which may inhibit sperm production and healthy functioning of the male reproductive system include:

·         Varicocele, a condition marked by enlargement of veins present in the scrotum, the sac that holds the testicles.

·         STDs (sexually transmitted diseases) can cause scarring of the male reproductive organs and obstruct sperm production and movement.

·         Viral infections such as smallpox and mumps and diseases such as tuberculosis, prostatitis, liver disease and renal disease also impact sperm production.

·         Alcohol, smoking and drug abuse are known causes of male infertility.

·         Genetic disorders, structural abnormalities or birth defects in the male reproductive organs can impair reproduction.

·         Hormonal imbalance such as low levels of testosterone may alter sperm production.

·         Exposure to heavy metals, toxins, chemicals or medications can affect sperm function.

·         Aging affects sperm production, motility and quality.

·         Excessive stress. In a recent article, we discussed how stress can impact the natural reproduction process click here

·         Some studies link poor sperm production to non-medical factors such as poor lifestyle, unhealthy diet, increased consumption of processed foods, and the burgeoning trend of late marriage. For example, obesity is known to alter hormonal levels, which in turn affects sperm production.

Challenges in treating Male Factor Infertility in India

Social Challenges

•        Social stigma attached to male infertility discourages men from confronting the problem and seeking treatment.

•        Most people believe that infertility clinics treat only female infertility.

•        Impotence is often mistaken for infertility, leading men to resort to alternative treatments such as herbal products to improve sexual performance.

•        Most couples delay treatment assuming the problem would resolve itself over time, which only worsens the situation.

Medical Challenges

•        Delayed treatment of male infertility reduces the chances of successful conception.

•        As male infertility is still largely misunderstood, many infertility treatment centres still rely on conventional treatment via medicines and injectables. In severe male infertility, such treatments often prove futile.

•        Driven by the desperation to conceive, patients tend to pressurise the fertility doctor to prescribe magic pills to improve sperm count. Unnecessary medication causes delay in appropriate treatment of the root cause.

Male Infertility Treatments Gaudium

Gaudium IVF centre employs advanced technologies to treat both male and female infertility. Whenever necessary, treatment for male factor infertility is combined with women’s infertility treatments such as IUI (intra-uterine insemination), IVF (in vitro fertilization), ICSI (intracytoplasmic sperm injection) and GIFT (gamete intra-fallopian transfer).

In such cases, both partners undergo simultaneous procedures where high quality sperm are selected, prepared and combined with the female egg for fertilization. Fertilization may occur in a lab dish (IVF/ICSI) or in the womb (IUI).

IUI (Intrauterine Insemination)

IUI is a simple and cost-effective treatment beneficial for men with mild male factor infertility. In IUI, the semen obtained from the male is ‘washed’ to remove seminal fluid and any dead sperm. The healthy sperm thus obtained are placed into the woman’s uterus using a thin tube called a catheter. The procedure is timed to coincide with the woman’s ovulation.

For IUI to be successful, it is first ensured that the woman’s fallopian tubes are free of blockage.

TESA (Testicular Sperm Aspiration)

In case of nil sperm, TESA-ICSI is known to be the one of the most effective treatments in helping couples conceive. As no sperm is present in the ejaculated semen, a small needle is used to collect a small piece of tissue from the testes.

The sperm retrieved from the tissue is ‘prepared’ and injected directly into the egg retrieved from the female’s ovary. This procedure is known as ICSI which is an advanced form of the conventional IVF treatment.

ICSI is particularly beneficial for men with low sperm count as injecting high quality sperm directly into the egg maximizes the chances of successful fertilization.

Learn more about ICSI

A noteworthy example is of a 31-year-old Gaudium patient who reported to us with nil sperm in the semen sample. The couple had been married for more than nine years and were trying to have a baby for the past five years. Gaudium fertility specialists counselled the couple about TESA-ICSI. The wife underwent IVF and on the day of the egg-retrieval, TESA was done for the husband. After successful fertilization in the lab, embryo transfer was performed through ICSI. The patient conceived and delivered a healthy baby in the very first attempt.

PESA (Percutaneous Epididymal Sperm Aspiration)

This is a simple technique often combined with ICSI. PESA is performed for men who have a blockage in the vas deferens (the tube that transports sperm from the testicle to the urethra).

The procedure of sperm aspiration is similar to that of TESA; the only difference is that the seminal fluid is collected from the vas deferens instead of the testes. This is followed by ICSI procedure as explained above.

Medication

Sperm production is affected by the levels of the hormones testosterone and estrogenin the body. In such cases where hormonal imbalance is detected, medication may be prescribed to restore normal hormone levels.

Surgery

Some men require surgery to remove a blockage that may be affecting production or release of the sperm.  Common surgeries for this purpose include varicocelectomy, epididymovasostomy and vasovasostomy (vasectomy reversal).

Donor Sperm

In a rare case when male infertility is found to be incurable, couples may choose to use donor sperm to achieve pregnancy.  As the sperm is in frozen state, it is first thawed and then implanted into the uterus using IUI.

Today several treatment alternatives are available for men diagnosed with male infertility. Gaudium infertility specialists have successfully treated mild-to-severe male factor infertility for thousands of couples. Since 2009, Gaudium Infertility Clinic has assisted more than 6,000 couples have a child of their own.

For a consultation with Dr. Manika Khanna, India’s leading infertility specialist, please click here.

Infertility Treatment: Are You Being Taken for a Ride?

With infertility in both men and women on the rise, there has been an influx of infertility treatment centres and IVF clinics all over the country.

In the past decade, ART (assisted reproductive technology) has witnessed several breakthroughs which make infertility treatments such as IVF more patient-friendly and also greatly affect success rates.Unfortunately, not all fertility clinics have the resources or the expertise to pass on the benefits of these latest advances to their patients.As a result, thousands of unsuspecting childless couples pay for sub-par treatment at mediocre infertility clinics that still use conventional equipment and/or procedures.

The purpose of this blog post is to help safeguard the best interests of childless individuals contemplating fertility treatment.

How to choose your fertility clinic

Choosing your fertility clinic can be a daunting task, and many people tend to go by recommendations from family and friends. Referrals are good, however choosing where you go for treatment should be a decision based on information rather than just plain recommendation. Do thorough research; learn more about the doctors on panel, the infrastructure, services offered and the facilities provided at the clinic.  Look for an experienced fertility specialist with a credible track record.

Once you have shortlisted a clinic, enquire if they are equipped to provide the latest infertility treatments. For example, many IVF clinics in India still use the conventional IVF treatment methods which involve prolonged treatment with injectables. The latest advances in IVF have made the treatment mush less painful for patients. This technology, adopted by Gaudium IVF many years back, involves only 8-9 days of injectables with minimal risk of hyper-stimulation of the ovaries.

To be sure of your decision, here is a list of questions to consider when selecting your fertility clinic:

• Is the clinic registered with the relevant Government body?
• What are the procedures offered at the clinic?
• What is the fertility specialist’s qualification and experience?
• Does the clinic treat male infertility?
• What are the treatments available for male infertility?
• What is the clinic’s cumulative success rate?
• What is the success rate of the treatment suggested for you?
• What is the number of live births or take-home baby rate?
• What is their success rate with previously failed IVF?
• Does the clinic perform blastocyst-stage transfer (embryo transfer on day 5 or 6 of fertilization, which is known to improve chances of pregnancy)?
• Is the centre equipped with the latest state-of-the-art lab and equipment?
• Does the clinic perform oocyte freezing and embryo freezing? If yes, do they follow the conventional slow-freezing method or the new Vitrification method?
• Are there provisions to provide psychological counselling if required?
• What is the estimated cost of your treatment plan and what will it include?
• Is the clinic known to provide personalised patient care?

Once you are satisfied that you have made the right choice, schedule an appointment with the fertility specialist.  Expect to be asked a range of questions surrounding your general health and detailed medical history. This would be likely accompanied by a physical examination, and an ultrasound of the uterus and the ovaries. A semen analysis may be ordered for the male partner.

Steer clear of a clinic where elaborate treatment plans are suggested without first obtaining your medical history. Ask why the recommended treatment is best suited for you and what other alternatives are available. [Here we must add that it is the patient’s duty to share all pertinent information necessary for the doctor to make an accurate diagnosis.]

Following this, your doctor may advise further tests to confirm the preliminary diagnosis. At this point, you may find yourself wondering, “Why has the good doctor prescribed so many tests?”. The best way to resolve your concerns is to not feel intimidated by the complex medical jargon, and ask your doctor to explain what each test means and why it is needed.

Doctors understand your concerns, and in most cases, you will get these answers without asking.

Once your doctor recommends a line of treatment, seek to learn more about it. Knowing what you are getting into brings a sense of control, reduces anxiety and boosts patient-doctor trust

Avoid miracle cures

Avoid infertility treatment ‘centres’ offering miracle cures and 100 percent success with pregnancy. Infertility is not something you can treat or cure with pills from the local pharmacist, or by trying remedies suggested by the local quack.It needs proper diagnosis and timely treatment by an experienced fertility doctor. Men, in particular, should not resort to ‘miracle cures’ to increase sperm count or to treat erectile dysfunction.

Taking a second opinion

Infertility treatment can be a long and exhausting process for couples, and you may reach a juncture when you or your partner feels the need to get a second opinion. If you strongly feel that you could use another expert viewpoint, consult a reputed fertility specialist to get a fresh perspective of things.

In the end, it’s important that the clinic you have chosen is a reputable organization known to function with integrity and transparency, and a team of doctors who have your best interests at heart.

Have a question? Consult Dr.Manika Khanna for a Free Second Opinion.

Modern advance treatment to conceive a baby

IVF, IUI and ICSI: What is the Difference?

IVF, IUI and ICSI are various forms of infertility treatments or assisted reproductive techniques (ART). Unlike IVF, IUI does not always involve administration of fertility medication, hence considered a more ‘natural’ fertility treatment. ICSI is a modification of the standard IVF procedure undertaken in cases of severe male infertility.

This article provides simplified information which will help you understand the basic differences between the three:

IUI (Intrauterine Insemination)

IUI is a cost-effective fertility treatment in which healthy sperm retrieved from the male partner is manually planted inside a woman’s uterine cavity around the time of ovulation. For many patients seeking infertility treatment, non-medicated or natural cycle IUI is often the first recourse recommended by doctors. Placing the sperm directly into the uterus helps increase the chances of fertilization and may benefit a couple in cases where:

• the woman has problems with ovulation or has polycystic ovaries
• the woman has cervical mucus hostility – when the mucus or fluid produced by the woman’s cervix is thick and sticky, making it difficult for the sperm to reach the egg for fertilization
• there is mild male-factor infertility
• the male partner has problems with ejaculation
• there is unexplained infertility – when the cause of infertility cannot be determined despite detailed investigation
• for same-sex couples or single women who wish to use donor sperm to get pregnant

Performing IUI requires that the woman’s Fallopian tubes are healthy and free of any blockage which may be confirmed through a laparoscopy.  Some patients, for example women who have ovulation problems, may need to be given fertility medication to stimulate the ovaries. This is known as stimulated cycle IUI.

During an IUI, the menstrual cycle is closely monitored to ascertain the time of ovulation as the insemination must be done within 36-40 hours of ovulation. On the day of the IUI procedure, the male partner provides a semen sample from which motile or fast-moving sperm is extracted and prepared for insemination. The process of sperm injection takes about 10 minutes and is usually painless.

Thus, a standard IUI cycle, from ovulation induction to sperm implantation, involves the following steps:

• Ovulation induction (only in Stimulated Cycle IUI)
• Sperm retrieval and preparation
• Insemination of sperm into the womb
• Pregnancy test after two weeks

IVF (In vitro Fertilization)

IVF is essentially the process of facilitating fertilization of a female egg by a male sperm outside of the human body. Most IVF cycles involve fertilization of multiple eggs to improve chances of success.

A complete IVF cycle takes up to 4-6 weeks, beginning with ovarian stimulation wherein the female is given medication to promote the growth of egg containing follicles. Just like in an IUI cycle, the entire process – from ovarian stimulation to egg release – is closely supervised by the fertility doctor through ultrasounds, blood tests and medication.

Once ready for retrieval, mature eggs are removed from the ovaries and simultaneously a sperm sample is obtained from the male partner. This is followed by selection and preparation of the better quality egg and sperm for fertilization in a glass dish.

The dish is then placed in an incubator which provides an environment conducive to fertilization. Once fertilized, the embryo is allowed to grow for another 2-5 days. The embryo selected for transfer is then planted into the female’s uterus or Fallopian tube with the help of a thin tube called a catheter. Embryo transfer may be done either three or five days after fertilization. The extra embryos, if any, may be frozen for future use.

To summarize, a standard IVF cycle involves the following steps:

• Ovarian stimulation
• Egg retrieval and selection
• Sperm retrieval and preparation
• Fertilization
• Embryo culture (embryo development)
• Embryo transfer
• Pregnancy test after two weeks of ET

ICSI (Intracytoplasmic Sperm Injection)

ICSI is a specialized form of in vitro fertilization and is one of the most frequently practiced treatments for severe male-factor infertility.

Unlike in IVF where the oocyte and the sperm are allowed to fertilize on their own, ICSI goes a step further wherein your embryologist injects a single high quality sperm into a mature female egg (oocyte). The procedure, also known as insemination, is usually performed for more than one oocyte.

The egg retrieval from the female and sperm collection from the male partner are usually done on the day of the procedure. If the male partner is unable to provide a fresh semen sample, sperm may be retrieved surgically from a testicle. Your embryologist then separates high-quality sperm, ‘washes’ or treats them for insemination and injects a single sperm into each egg. This is followed by embryo culture and embryo implantation as previously explained under IVF.

A complete ICSI cycle takes between 4 and 6 weeks. ICSI is particularly beneficial in the following situations:

• severe male-factor infertility indicated by very low sperm count or nil sperm
• when the male is producing healthy sperm but is unable to ejaculate due to a physical obstruction or erectile dysfunction
• if the couple is unable to have sexual intercourse for biological or medical reasons, or
• for couples using donor sperm

A typical ICSI cycle involves the following stages:

• Ovarian stimulation
• Egg retrieval and selection
• Sperm retrieval and preparation
• Sperm injection
• Fertilization
• Embryo culture
• Embryo transfer
• Pregnancy test after two weeks of ET

The success rates of ICSI are similar to those of IVF. ICSI is usually recommended to couples with severe male infertility; however some clinics prefer doing ICSI even when the male’s sperm count is normal. Selection of a fertility treatment method depends on a number of factors such as the age of the female partner, cause of female infertility, level and cause of male infertility, past ART history etc. Only when your fertility specialist has done a detailed analysis of your condition should they be able to recommend treatment options best suited for your case.

If you have more questions or need further guidance regarding selection of fertility treatment, feel free to consult Dr. Manika Khanna for a free second opinion.

Couples going through infertility treatment may sometimes feel overwhelmed with having to go through a number of tests, particularly at the time of diagnosis. Given that some clinics do mislead unsuspecting patients and advise unnecessary tests, it is not unusual for a patient to be apprehensive about the necessity of all the tests recommended by their doctor.

Diagnosing infertility can be a complex process. Once your fertility doctor has learned your in-depth medical history, the next step is to prescribe diagnostic tests to determine the root cause of infertility.

At Gaudium Fertility Clinic, we encourage our patients to ask questions and discuss every concern they might have regarding the diagnosis and treatment process. Having dealt with thousands of patients from all walks of life, our experts believe that the best way to calm patients’ anxiety is by maintaining transparency and by providing patients with information which makes them feel informed and in control.

As a general protocol, for most infertility patients the less invasive and less expensive tests are recommended first, and not every patient needs to undergo extensive testing.A credible fertility specialist would not recommend lab tests without an in-depth evaluation of your condition. If your doctor appears eager to prescribe tests or medication in the very first meeting without obtaining your detailed medical, sexual and reproductive history, it is not a good sign.

To give you a fair idea of what to expect, shared below is a list of tests your doctor may suggest during infertility assessment.

Infertility Diagnosis and Testing for Women

Expect your doctor to ask questions regarding your menstrual cycle, history of past pregnancies, sexual health, past illness, surgery, medication etc. This would be followed by further testing to ascertain the cause of infertility:

Stage I

• Physical examination including pelvic examination to rule out genital infections
• Ovulation test to check any problems with the monthly egg release (ovulation)
• Blood tests to check estrogen and testosterone levels
• Ultrasound to check for ovarian cysts and fibroids
• Blood tests for thyroid, hepatitis, HIV and any chronic illness
• FSH level test to detect blood levels of the follicle stimulating hormone secreted by the pituitary gland. This hormone regulates the production of estrogen and progesterone, and is responsible for the growth of eggs in the ovaries. The test is carried out on the third day of your period.

Based on the results of preliminary testing, your fertility doctor may recommend one or more of the following tests to confirm the diagnosis made so far.

Stage II

• Laparoscopy: Helps detect endometriosis, a condition where the tissue lining the uterus develops outside the uterus causing heavy periods and problems with fertility.
• HSG (Hysterosalpingogram): X-ray to check uterine health and detect any blockage in the fallopian tubes.
• Hysteroscopy: Conducted if the HSG indicates abnormalities in the uterus or fallopian tubes. Allows your doctor to take photos of the damaged areas.
• Endometrial biopsy: A small amount of tissue is taken from the uterine lining (endometrium) to detect abnormalities which could affect implantation of a fertilized egg.

The collective results of the above tests would help your doctor determine the line of treatment best suited for you.

Infertility Diagnosis and Testing for Men

Stage I

• Initial assessment through detailed medicaland reproductive history
• Physical examination to detect genital abnormalities and infections
• Complete Semen Analysis to detect problems with sperm count (number of live sperm cells per milliliter of semen), sperm movement (motility) or abnormalities in sperm shape (morphology)

If the results of semen analysis are normal, your doctor may order more tests for the female partner.If, however,the semen analysis report indicates problems with semen production and/or quality, the male would be required to undergo further investigation.

Stage II

• Blood tests to check hormone levels (testosterone and other hormones which affect fertility)
• Scrotal ultrasound to detect blockage in the testicles and surrounding area which could be obstructing semen flow
• Transrectal Ultrasound to check prostate health and detect any blockage in the ejaculatory ducts
• Extensive sperm function tests which may be undertaken if, after unfavorable sperm analysis, your doctor needs to further investigate the behavior of your sperm post- ejaculation
• Testicular biopsy wherein a small sample of testicular tissue is removed and tested to check any problems with sperm production

In certain cases where the above testing fails to indicate the underlying cause of male infertility, genetic testing may be recommended to test for genetic disorders.

Unnecessary testing by some (mediocre)fertility clinics leads to mistrust and frustration in patients, and gives a bad name to the noble vocation of a fertility doctor. At Gaudium IVF Centre we believe it the patients’ right and the doctor’s duty to explain why a particular test or procedure may be indispensable to a particular treatment protocol.

If you have an unanswered question about your infertility diagnosis, feel free to consult Dr. Manika Khanna for a free second opinion

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Email id.:  info@gaudiumivfcentre.com   Contact No. : 08527858585, 011-69413434