Infertility



What is infertility?


Dysfunction of the reproductive system impairs getting pregnant.


What causes infertility


40 % Male,40 % Female, 20 % Unexplained.. male and female factors are combined at 25% of the cases


When do we begin treatment?


When all the necessary tests are done, we ask you to come to begin the IVF cycle on the second day of your menstruation.


What is our chance of getting pregnant? Is it guaranteed with IVF?


The pregnancy rates with IVF are 60 percent overall; this is the average general number; it changes according to the particular situation of the couples, over the low ovarian reserve, existing adenomyosis, sperm conditions, ages of the couple, previous operations, and possible effects on the uterus are all items which positively or negatively affects the success rates.


I have a 5 cm diameter myoma in my uterus. Do I need an operation?


The operation decision is up to the localization of the myoma; if it disturbs endometrium thickness and pattern, it's an indication of removal.


How do you remove the myoma?


There are different techniques for this; mostly, it's either laparoscopy or hysteroscopy regarding the position of myoma.


Which is better classical IVF or microinjection?


In patients with non-male factor infertility, microinjection did not improve birth rates. Given the additional cost and the lack of birth rate benefit, the routine use of microinjection in patients with non-male factor infertility is not warranted.


What are classical IVF and Microinjection?


At classical IVF, sperms are pooled over eggs; at microinjection, each egg is injected with a sperm under microscopy by an embryologist.


What is absolute uterine infertility, and what are the therapy options?


If there is no uterus or the existing one can not get pregnant, then we can tell this is absolute uterine infertility.

Congenital Absence of the Uterus is present in 1 per 4,500 women

The uterus can also be surgically removed because of a hysterectomy performed for either hemostasis, generally after peripartum complications, gynecological cancers, or benign uterine defects incompatible with gestation. Emergency hysterectomies are performed in approximately 1 per 5,000 deliveries. Moreover, 3.5% of women have had a hysterectomy for large and/or unmanageable myoma(s) before the age of 39 years.

Finally, there are women whose endometrium has been damaged beyond any reasonable chance of repair.

All women suffering from absolute uterine infertility are candidates for uterine surrogacy.

Uterine Transplantation is an experimental treatment, first reported at 2018, is currently still in its infancy.


Preconception weight reduction in women and men with obesity and infertiltiy, is it necessary ?


Short and long-term weight reduction interventions are considered in the preconception period for women and men with obesity and infertility as obesity is associated with poorer reproductive outcomes. Short-term weight loss achieved with diet, exercise, and medications does not improve per cycle conception or live birth rates in women undergoing ovulation induction, intrauterine insemination, or in vitro fertilization (IVF), but may increase the rate of natural conception.


What is Diminished Ovarian Reserve (DOR)?


If the total follicle count at ovaries is lesser then 5 this is accepted as diminished reserve( DOR) . Follicles are the ovarian structures in which eggs grow. Ideal follicle number to reach pregnancy is 8 or more …


Is diminished ovarian reserve (DOR) a risk factor for genetically abnormal baby?


Young women diagnosed with DOR exhibited equivalent genetically NORMAL baby rates and live birth rates in a large matched population, based on age, body mass index, and IVF cycle initiation.


What is freeze all strategy and is it worth to do?


With advancements in vitrification and embryo culture, embryo cryopreservation has enabled adoption of the increasingly popular freeze-all strategy. As the name suggests, the freeze-all strategy involves freezing all embryos from an in vitro fertilization cycle and subsequently transferring the embryos to nonstimulated cycles. Compared with fresh embryo transfers, freeze-all cycles are advantageous for patients who are at risk of ovarian hyperstimulation syndrome, undergoing preimplantation genetic testing of embryos, or interested in fertility preservation. Additionally, controlled ovarian hyperstimulation is known to result in a supraphysiologic hormonal milieu that may have a detrimental impact on the endometrial receptivity and embryo-endometrium synchrony—both of which could be avoided with frozen embryo transfer.


What is normal endometrial thickness for embryo transfer?


In a significant number of assisted reproductive technology cycles the transfer of genetically normal embryos still does not result in implantation. This highlights a gap in our knowledge regarding the receptivity of the human endometrium. In the past decade, there have been some advances in our understanding of the molecular signature indicative of endometrial receptivity during the window of implantation. Similarly, there is increasing information on the morphological assessment of the endometrium and its potential impact on assisted reproductive technology outcomes. Success rates in both the fresh and frozen embryo transfers appear to be low when the endometrial thickness is below 6–7 mm, but most of these studies were unable to identify a discriminatory cut-off to recommend the cancellation of embryo transfer.


Does genetic testing for endometrial receptivity incrase pregnancy rates?


Lately genetic testing of endometrium is supposed to increase embryo implantation. The defenders of this hypothesis claim that changing transfer time according to test results can p;ositively effect implantation. But studies demonstrated no statistically significant differences in live birth for patients opting for ERA testing and subsequent ERA-guided embryo transfer or a standard protocol embryo transfer without previous ERA.

At recurrent miscarriages is it mandotory to make a hysteroscopy or salin infusion sonography ( sis) is enough?


We recommend SIS, rather than diagnostic hysteroscopy, as the first-line cavity assessment before embryo transfer in most settings and for most patients. The use of diagnostic hysteroscopy should be limited.

Pretreatment ..Does it improves quality and quantity?


Pretreatment medications/manipulations are offered to patients with poor ovarian response, aiming to prevent the occurrence of a spontaneous early hormone surge, increase the number of follicles, synchronize follicular development, and increase oocytes’ yield and quality, with the consequent improvement in cycle outcome.

Mild / Moderate vs Full Stimulation?


Despite the recognized negative effect of an elevated dosage during ovarian stimulation, current evidence does not support the use of MS to manage women with low prognosis. Indeed, the higher cancellation rate and reduced number of eggs retrieved represent the most worrying concerns. While the reduced number of eggs retrieved was not detrimental in the fresh cycle pregnancy rate , it may have negative consequence on live birth rates.

Is there a particular day for implantation of embryo?


The endometrium is receptive to implantation during a few days of the menstrual cycle, a window dependent on adequate progesterone exposure and endometrial response . Steroid action and complex molecular and cellular crosstalk between the blastocyst and endometrium are necessary for blastocyst apposition, attachment, and invasion, this day is generally after 10-14 days of first menstrual day.

What are the causes of implantation failure?


The chromosomal quality of an embryo impacts the ability of the embryo to implant successfully.

Several maternal factors may also play a role in embryo implantation. Although more recent studies have called into question the impact of endometrial thickness on live birth, it is impossible to ignore the data that strongly correlate pregnancy rate with endometrial thickness

Maternal age and associated embryonic genetic normality are of critical importance to embryonic implantation.

inflammatory states associated with communicating hydrosalpinx and chronic endometritis.


Dyssynchrony between endometrial and embryonic developments may also play a role in the failure of implantation. The length of progesterone exposure in the uterus is critical, although the assessment of this is difficult.

Clinical experience tells us that some women have a greatly reduced chance of embryo implantation. These women, if they possess an adequate supply of genetically normal eggs, often are able to conceive with further IVF attempts, since the chances are seldom 0%. However, the emotional and financial burdens of these choices are high, and the chance of success is certainly not optimal.