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What is infertility?

If a couple is infertile, this means that they have been unable to conceive a child after 12 months of regular sexual intercourse without birth control. Primary infertility means they have never had a child. Secondary infertility means that the infertile person has had one or more children in the past, but a medical problem is impairing fertility. Many people may be infertile during their reproductive years.

Is infertility a women's problem?

No, infertility is not always a woman's problem. In only about one-third of cases is infertility due to the woman (female factors). In another one third of cases, infertility is due to the man (male factors). The remaining cases are caused by a mixture of male and female factors or by unknown factors

What causes infertility in men?

Infertility in men is most often caused by: Problems making sperm producing too few sperm or none at all

Problems with the sperm's ability to reach the egg and fertilize it abnormal sperm shape or structure prevent it from moving correctly

Sometimes a man is born with the problems that affect his sperm. Other times problems start later in life due to illness or injury. For example, cystic fibrosis often causes infertility in men.

What causes infertility in women?

The most common female infertility factor is an ovulation disorder. Other causes of female infertility include blocked fallopian tubes, which can occur when a woman has had pelvic inflammatory disease or endometriosis. Congenital anomalies (birth defects) involving the structure of the uterus and uterine fibroids are associated with repeated miscarriages. Aging is also an important factor in female infertility. The ability for ovaries to produce eggs declines with age, especially after age 35.

How infertility is diagnosed?

Couples are generally advised to seek medical help if they are unable to achieve pregnancy after a year of unprotected intercourse. You may be advised to seek out care from the specialist if you are older than 35 years old. The doctor will conduct a physical examination of both partners to determine their general state of health and to evaluate physical disorders that may be causing infertility. Usually both partners are interviewed about their sexual habits in order to determine whether intercourse is taking place properly for conception.

If no cause can be determined at this point, more specific tests may be recommended. For women, these include an analysis of body temperature and ovulation, x-ray of the fallopian tubes and uterus, and laparoscopy. For men, initial tests focus on semen analysis.

What is the treatment for infertility?

Depending on the test results, different treatments can be suggested. Eighty-five to 90 percent of infertility cases are treated with drugs or surgery.

Various fertility drugs may be used for women with ovulation problems. It is important to talk with your health care provider about the drug to be used. You should understand the drug's benefits and side effects. Depending on the type of fertility drug and the dosage of the drug used, multiple births (such as twins) can occur in some women.

If needed, surgery can be done to repair damage to a woman's ovaries, fallopian tubes, or uterus. Sometimes a man has an infertility problem that can be corrected by surgery.

What is IVF?

IVF is short for in vitro fertilization - which literally means "fertilisation in glass" (IVF babies are sometimes referred to as "test tube babies"( even though fertilisation doesn't take place in a test tube). IVF refers to a technique of assisted reproduction where the egg and sperm are fertilized outside of the body to form an embryo. This embryo is then transferred to the uterus to hopefully implant and become a pregnancy.

What are the other assisted reproductive technologies?

Assisted reproductive technology (ART) describes several different medical procedures that help a woman become pregnant. The most common type of ART is in vitro fertilization (IVF); during IVF, eggs and sperm are mixed in a laboratory dish to fertilize, and some of the fertilized eggs (zygotes) are then transferred to the woman's uterus.

There are numerous types of ART procedures. Your reproductive endocrinologist can help to determine which procedure is best suited to you.

The types of ART include:
  • IVF (In Vitro Fertilization).
  • GIFT (Gamete Intrafallopian Transfer).
  • ZIFT (Zygote Intrafallopian Transfer).
  • TET (Tubal Embryo Transfer)

ART procedures sometimes involve the use of donor eggs (eggs from another woman) or previously frozen embryos. Donor eggs may be used if a woman has impaired ovaries or has a genetic disease that could be passed on to her baby

How does age affect a woman's ability to have children?

Age can be a great factor in the woman's ability to have children. Many women these days wait until their 30s or 40s before they decide to have children. Statistics show that about 20 percent of American women now have their first child after the age of 35, and about one-third of the couples in which the woman is over that age experience infertility problems.

Age affects the woman's ability to have a baby in the following ways:
  • The ability of her ovaries to release eggs for fertilization declines.
  • The health of the eggs released from her ovaries declines.
  • The chances of miscarriage increase.

How often assisted reproductive test is successful?

Success rates vary and depend on many factors. Some things that affect the success rate of ART include:
  • Age of the partners
  • Reason for infertility
  • Clinic
  • Type of art
  • If the egg is fresh or frozen
  • If the embryo is fresh or frozen
ART can be expensive and time-consuming. But it has allowed many couples to have children that otherwise would not have been conceived. The most common complication of ART is multiple fetuses. But this is a problem that can be prevented or minimized in several different ways.

Treatment options and risks

What are the risks involved in having fertility treatment?

Like all medical treatment, having fertility treatment does carry some risks and your IVF doctor will discuss these with you. The main risks are adverse drug reactions and having a multiple birth. There are also risks associated with pregnancy, whether through fertility treatment or natural conception, such as having an ectopic pregnancy.

Why is there so much concern about having twins or triplets after fertility treatment?

Having a multiple birth (twins, triplets or more) is the single greatest health risk associated with fertility treatment.

Multiple births carry risks to both the health of the mother and to the health of the unborn babies. Twins or triplets are more likely to be premature and to have a below-normal birth weight. Studies show that the risk of death before birth, or within the first week of life, is more than four times greater for twins than for a single baby. For triplets, the risk is seven times greater than for a single baby.

Surgical sperm extraction has not worked for me. Are there any other options?

If your doctors have been unable to extract any sperm, you will probably find the only option is to use donor sperm to fertilise your partner's eggs. Depending on a clinic's availability of donor sperm, it may be possible to use sperm from a donor who shares some of your physical characteristics. A clinic will only use donated sperm that has been screened for infections, such as hepatitis and HIV, which involves a quarantine period of around six months.

The donated sperm can then be used to fertilise your partner's eggs through a process called intrauterine insemination (IUI) or by in vitro fertilisation (IVF). The donor will be identifiable, which means any child born as a result will have the right to ask for information about their donor when they reach adulthood, including the donor's name.

I'm worried that my cancer treatment means I won't be able to have children

Some cancer treatments can have an impact on future fertility, and it is worth discussing this with your doctor before your treatment begins. Men can, for example, freeze their sperm and women can consider creating embryos with their partner (if they have one) or using donated sperm to create embryos which can be frozen and used later. Visit the Cancer website for more information about maintaining your fertility.

Using donor eggs or sperm

I need donated eggs/sperm in my IVF treatment. How do I find out more about the donor?

If you have had treatment using donated sperm or eggs in a India clinic, the clinic will hold information about the donor on its Register. The amount of information available will depend on when your treatment took place.

I may have to use donated eggs or sperm in my treatment - what are the rules about this?

If your clinic recommends using donated eggs or sperm, it is usually because they consider that treatment would be unlikely to be successful if you were to use your own eggs or sperm. Egg Donation is available and legal in India.

I am using donor sperm in my treatment. Whose name goes on the birth certificate as the baby's father?

If you are being treated together with your husband or partner at a licensed clinic in India, his name will go on the birth certificate, provided that he has consented to the treatment. If you are in a same-sex partnership / single parent it is possible to register your partner's name on the birth certificate.

I hear there's a shortage of sperm donors in the UK and my country. Can I buy sperm from India?

It may be difficult finding out sperm donors in your country. Anonymous sperm donation is legal in India and donated sperms of educated males are available.

Ive seen press reports saying that only anonymous sperm donors are exempt from being treated as the legal father - is this true?

No - if a male donates sperm at a licensed clinic in India, even where he is known to the recipient, you cannot be treated as the legal father of any children born as a result of that donation.

Men donating their sperm in any other way - such as via internet services or through private arrangements with people they know - are legally the father of any children born with all the responsibilities that carries.

Who is the legal father of a child conceived using sperm via a private arrangement or an unlicensed service, such as an internet company?

The law says that men donating sperm through licensed fertility clinics are not the legal father of any child born through that donation. This includes cases where the donor is known to the recipient.

Men donating their sperm in any other way - such as via internet services or through private arrangements with people they know - are legally the father of any children born with all the responsibilities that carries.

I know someone who is willing to donate sperm through a private arrangement with me (and/or my partner). Who would be the legal father?

For people using unlicensed services or private arrangements, there are also serious implications regarding who is legally the father of any child conceived. The law says that men donating sperm through licensed fertility clinics are not the legal father of any child born through that donation.

Men giving out their sperm in any other way - such as via internet services or private arrangements with people they know - are legally the father of any children born with all the responsibilities that carries.

People using licensed clinics can be sure that any donor sperm or eggs used in their treatment has been subject to rigorous quality checks, including screening to ensure that the material has not been infected with diseases such as HIV. Patients using unlicensed services do so at their own risk.

Storing sperm, eggs and embryos

I'd like to freeze my embryos for future use. What's involved?

During IVF treatment, fertility drugs are used to stimulate the ovaries to produce more eggs than usual. These are then fertilised with your partner's, or a donor's, sperm to create embryos. Because you can only have two to four embryos transferred to your womb each time, some people choose to freeze 'extra' embryos to use in later treatment cycles.

Where can I have sperm stored for future use?

A clinic with sperm storage facilities will be able to store your sperms.

I've heard that women can freeze their eggs to use later. How do I go about doing this?

Egg freezing is still a very new technique and to date only a handful of babies have been born using frozen eggs (compared with thousands born from frozen embryos). Egg freezing tends to be offered primarily to single women who are having cancer treatment that will leave them infertile, and for whom egg freezing is their only option.

If you are considering storing your eggs with the intention of using them later to have a child, you should discuss this in the first instance with your GP. No assisted reproductive technique (such as IVF) is 100% successful and this should be borne in mind when planning when and how to start a family.

Facts and figures

How likely am I to get pregnant after IVF treatment in India?

Every woman is different; your chances of becoming pregnant will depend on a number of factors, such as your age and the cause (if known) for why you are not conceiving naturally. The average success rates for fresh IVF treatment using their own eggs for the year 2006 in our partner clinic are:
  • 44.6 % for women under 35 years old
  • 32.4 % for women between 35-37 years old
  • 23.5 % for women aged 38-39 years old
  • 14 % for women aged 40-42 years old
  • 7 % for women aged 43-44 years old
  • 5% for women aged over 44

How many people have fertility treatment in the India?

The most recent figures (2005) show that 12,626 women underwent IVF treatment in the UK. 624 women had donor insemination treatment. There were 5,262 children born from IVF treatment in this period and 345 children born from donor insemination treatment.

PGD and sex selection

Can I choose the sex of my child?

Few licensed clinics can carry out tests on embryos to detect certain inherited disorders, including some that could affect children of a particular sex. These tests are only allowed for medical reasons. No licensed clinic can offer you embryo screening for non-medical reasons.

What is PGD and who can have it?

Preimplantation genetic diagnosis (PGD) is a technique that enables individuals with a specific inherited condition in their family to avoid passing on this condition to their children.

In PGD one or two cells are removed from an embryo at the eight-cell stage and tested for the presence of a specific faulty gene. Only the embryos which are free from the condition will then be transferred. PGD is used to test for conditions such as cystic fibrosis and haemophilia.

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