Frequently asked questions- Endoscopy

If Sperm count reports are very low then what can be done?

Treatments for male factor infertility vary from intrauterine insemination (IUI) to in vitro fertilization with Intracytoplasmic Sperm Injection (ICSI). Individualized Medical treatment protocols are provided by the physician after the diagnostic evaluation is completed.

What is ICSI?

Severe male-factor infertility is treated very successfully by a relatively new laboratory technique called ICSI. ICSI involves injecting one sperm directly into the egg using a microscope with specialized micromanipulation equipment. ICSI is always used in conjunction with in vitro fertilization. For ICSI various sperm retrival techniques are used like PESA, MESA, TESA, and TESE.

What is oligospermia?

The term "oligo" means few. Oligospermia is the presence of fewer than the normal number of sperm in the semen. Men with fewer than 20 million sperm/ml are usually defined as having oligospermia, or a low sperm count.

What is azoospermia?

Azoospermia is the complete lack of sperm in the ejaculate.

Are there any treatments for azoospermia?

Yes. There are two different types of azoospermia. Obstructive azoospermia is the complete lack of sperm in the ejaculation due to a blockage in the male reproductive tract or the absence of the part of the reproductive tract that carries sperm from the testicle to outside the body. A blockage, or obstruction, may have been present at birth or may have occurred as a result of an infection or severe trauma to the testicles or the tubules surrounding the testicles that transport the sperm out of the body. Men with obstructive azoospermia almost always have some sperm in their testicles, but these sperm are not found in the semen because of the blockage or absence of part of the reproductive tract.

What is PESA?

For treating obstructive azoospermia, a procedure called Percutaneous Sperm Aspiration, or PESA, is used to aspirate sperm from the epididymis.

What is TESE ?

For treating nonobstructive azoospermia, a procedure called Testicular Sperm Extraction, or TESE, is used to obtain sperm directly from the testicle, where the sperm are being produced. The TESE procedure involves the removal of very small pieces of testicular tissue.

What is Surgical Sperm Aspiration (SSA) ?

When Semen analysis shows zero sperm count the cause may be either obstructive azoospermia or nonobstructive azoospermia. For such cases sperms are retrieve from tract by different method known as Surgical Sperm Aspiration (SSA). They are like PESA, MESA, TESA, and TESE.

What is semen cryopreservation ?

Semen cryopreservation (the freezing of sperm) is a way to store sperm for future use. Sperm is routinely frozen and maintained in the Center.

How many Samples should I have frozen?

The general recommendation is to collect and freeze up to three specimens, collected two to seven days apart. However, depending on your particular situation, the recommended number of days between collection and the number of specimens for storage may vary. The number of specimens to be frozen also may vary depending on the number of sperm and the sperm motility in each specimen.

Will Repeated IVF treatment damage my ovaries?

There is no evidence to suggest that either normal laparoscopy or ultrasound egg retrieval damages the ovaries. In fact, some reports in the medical literature suggest that following ovarian biopsy, pregnancies occur in couples with long-term history of infertility.

Will previous operation procedure make it impossible to retrive the eggs ?

Not Ordinarily. The surgeon must be able to see the follicles in order to guide the needle to the proper spot for retrieval of the eggs whether by sonographic(ultrasound) or surgical methods.

It is very rare, if the technique does not produce a pregnancy on the first attempt, how soon can the procedure be repeated ?

This depends on the individual. The primary reason for delay is to allow the patient's normal menstrual cycle to resume, which may take 2 to 3 cycles

How many times will IVF be repeated per couple ?

There is no specific number. This is determined by the couple together with the physician.

Can we have intercourse during the two-week period before a IVF procedure is performed ?

Most definitely. We recommend that the husband refrain from ejaculation for at least 48 hours, but for no more than 5 to 6 days preceding egg retrieval. This precaution assures that the semen sample obtained for IVF will contain a maximum number of healthy, motile sperm.

After the IVF procedure, how long must we wait to have intercourse ?

Although a definite time of abstinence to avoid damage to the pre-embryo has not been determined, most experts recommend abstinence for two to three weeks. Theoretically, the uterine contractions associated with orgasm could interfere with the early stages of implantation. However, intercourse the night before pre-embryo transfer is acceptable.

What about other activities? How soon can I resume my normal routine ?

The IVF team recommends that the patient be sedentary for a full 24 hours following pre-embryo placement in the uterus. Strenuous exercises such as jogging, horseback riding, swimming, etc. should be avoided until pregnancy is confirmed. Otherwise, the patient is free to return to her regular activities.

How soon will I know if I'm pregnant ?

Pregnancy can be confirmed using blood tests about 14 days after egg aspiration. Pregnancy can be confirmed by ultrasound 30 to 40 days after aspiration.

I had my tubes tied ( tubal ligation) several years ago. Would I be a candidate for IVF ?

Perhaps, in certain situations, IVF may be cheaper and physically less demanding than surgery to repair you fallopian tubes.

What drugs are given to stimulate the ovarian follicles and to maintain the lining of the uterus prior to implantation of the pre-embryo

Four to five medications normally are given

• Leuprolide acetate or Brucerelin (Lupron), an injectable drug that blocks secretions of the pituitary gland, thereby optimizing the number of oocytes retrieved;
• Human menopausal gonadotropin (HMG) or Follicle Stimulating Hormone (FSH), hormones that stimulate ovarian activity, are injected daily for about 6-10 days prior to the procedure;
• Injection GNRH antagonist. If antagonist protocol is to be used.
• Human chorionic gonadotropin (HCG), a hormone that mimics the action of the hormone which naturally induces ovulation, is injected 34 to 36 hours before retrieval and may be used after retrieval to supplement natural progesterone production;
• Progesterone, a natural hormone that enables the uterus to support pregnancy, may be used as a daily injection after egg retrieval.

What side effects, if any, can these drugs cause ?

No pronounced side effects have been associated with any of these drugs. However, the patient should inform the physician of ANY allergies she has or of any previous adverse reactions to drugs.

Will I have an egg in every follicle ?

It varies from patient to patient . As many as half of the follicles may not contain an egg in some patients.

Is there a possibility of multiple births with IVF ?

Yes, when multiple pre-embryos are transferred. 25%. of pregnancies with IVF are twins. (In normal population, the rate is one set of twins per 80 births.) Triplets are seen in approximately 2-3% of pregnancies.

Is there an increased chance of birth defects if I become pregnant through IVF ?

There are no known ill effects. Abnormal pre-embryos, even those produced through normal fertilization, do not seem to mature. However, any long-term effects of IVF remain to be determined.

How much time does the entire procedure require ?

Approximately three weeks (all as an outpatient). Fertility drugs are administered to stimulate the ovaries. Then during the four to six days prior to ovulation, the patient is monitored by ultrasound as well as by hormone levels.

What happens to any extra embryos ?

A maximum of three embryos will be transferred to the uterus for possible implantation. Patients will have several other options regarding the disposition of the remaining embryos. One option is to freeze embryos for your later use. Other options are to donate or simply dispose of them. Excess embryos, if any, belong to you, and you will determine what is to be done.

What is Ovarian Hyperstimulation Syndrome (OHSS) ?

When we stimulate ovaries with genadotrophin it may get overstimulated sometimes producing more than many follicles. This may lead to very high level of estrodial & patient may land with OHSS. If this complication is mild to moderate, can be treated. But sever OHSS may lead to hospitalization. Pregnency if occurs will add fuel to problem.

Is infertility a woman's problem?

It is a myth that infertility is always a "woman's problem." Couple as whole is responsible for this problem.. You may attribute 30% for male factor ,30% for female factor and 40%as couple factor.

Why people don't undergo IVF treatment very frequently?

Though IVF treatment for infertile couple is more definitive higher result giving but still it is expensive and is not possible to assure 100% result which leads to less acceptance.

When is an infertility evaluation needed?

Usually at the end of one year of active married life 80% will get conceived and at the end of 2 years almost 90% of the couple may get the results, so after 2 years of active married life it is needed to get infertility evaluation to be done.

In certain conditions one may get evaluation earlier like

• The woman is aged 30 or older and has had unprotected intercourse with her partner for six months without getting pregnant
• The woman has irregular menstrual cycles, pain during intercourse, or other gynecological problems
• Women who has undergone some gynaecological surgery earlier.

Do insurance companies cavers infertility treatment?

NO. In India insurance companies do not cover infertility treatment. Any procedure related to infertility management is not covered by insurance companies. Only few corporate houses cover infertility treatment like ONGC [ reimburses Rs 50,000 maximum for 1 IVF cycle] and it is covered for maximum 3 cycles only.

What care taken by a couple lowers the risk of infertility?

Both men and women can take steps to lower the risk for infertility

• Exercise moderately.
• Avoid body weight extremes
• Avoid high levels of stress
• Avoid tobacco, alcohol, and illegal drugs.
• Avoid polygamy.
• Avoid unwanted pregnancy.
• Receive appropriate treatment for long-term medical conditions.

How can I determine my "fertile" period ?

It is possible to predict ovulation in women who menstruates regularly. It is during mid-cycle 4 - 6 days[i.e around 12TH to 16TH day of the cycle]. This is not possible in women who menstruate irregularly. Even a LH Kit availabe in the market can confirm your ovulation.

How long do I need to be in India if I need to come to your clinic for IVF treatment ?

There are two major protocols for IVF treatment.

• Long term down regulation of the pituitary - Treatment starts from 20Th of your cycle and in the next active cycle it takes about 15 days to complete the active management. We advice blood pregnancy testing 14 days after the embryo transfer. So it may require 1 month and 15 days stay till the pregnancy is confirmed.
• Antagonist Protocol. - We start treatment from second day of period. So it takes 1 month till the pregnancy is confirmed.

NOTE : The decision for selection of above mentioned protocol depends upon many factors which can be decided after prior examination only.

If a cycle of IVF fails, what should be the time gap that needs to be given before we try again ?

Active IVF cycle management needs lots of medication, frequent visits and spending. I think atleast 4 to 6 months gap will help you to recover from all aspects.