What is Infertility ?
Infertility is difficulty in conceiving a pregnancy.
This general term does not identify the cause of the
problem or whether it will be permanent.
Often, physicians and researchers consider a couple
to have infertility if they have not conceived, despite
regular intercourse without using birth control, for at
least a year. Fifteen to 20 percent of couples will not
conceive despite a year of trying. However, this does
not mean that they will not conceive later on, even
without treatment. Some investigators consider two years
without conception to be a better indicator of a
couple's need for assistance.
More than 90 percent of couples will have achieved a
pregnancy within two years.
When an individual has no chance to conceive without
treatment (for example, a woman does not ovulate or has
two blocked fallopian tubes), it is sometimes called
What is Assisted Reproductive Technologies (ART) ?
Any medical technique that attempts to obtain a
pregnancy by means other than by coitus is defined as ART. In other
words, these techniques manipulate the sperm and oocytes outside the
body, and the gametes or embryos are transferred into the uterus.
ART includes artificial insemination (AI), in vitro
fertilization-embryo transfer (IVF-ET) and gamete intra-fallopian
What is Artificial Insemination (AI) ?
AI is the procedure of transferring semen into the
reproductive system of a woman. This technique comprises artificial
insemination with husband’s (AIH) or with donor sperm (AID).
What is In Vitro Fertilization (IVF) ?
IVF means fertilization outside the body in a test tube. Since the birth of Louise Brown, the first test-tube baby in 1978, IVF has resulted in over 1,000,000 babies worldwide. Pregnancy rates and live birth rates have improved over the past few years, leading to a steady increase in the number of IVF treatment cycles performed worldwide.
What is Intrauterine Insemination (IUI) ?
Intrauterine Insemination involves the introduction
of sperm into the uterus of the woman. In IUI, specially prepared
sperm are injected in to the uterine cavity via a fine cannula
passed through the cervix. At this site, the sperm are near the
uterine entrance of each of the two fallopian tubes and thus have a
shorter distance to swim in order to reach the egg(s) released at
the time of ovulation.
What is IVF-ET (In
vitro Fertilization-Embryo Transfer) ?
In vitro Fertilization-Embryo Transfer (IVF-ET)
is the fertilization of an ovum outside the body and the transfer of
the fertilized ovum to the uterus of a woman.
What is ICSI (Intra Cytoplasmic Sperm Injection) ?
In ICSI, a single sperm is injected into the
cytoplasm of the ovum to effect fertilization, before the fertilized
ovum is transferred to the uterus of the woman.
What is IVMTS (In
vitro Maturation of Testicular Sperm) ?
The recovered testicular sperm are sometimes so
immature that they have minimal motility or none at all. According
to Human Fertilization and Embryology Authority (HFEA)
of UK Guidelines,
non-motile sperm should not be used to inject the eggs. There is a
risk that nonmotile sperm might not be alive. Such sperm may also
carry a higher risk of chromosomal abnormality. In vitro
Maturation of Testicular Sperm (IVMTS) involves keeping the
testicular sperm in a culture medium under optimal conditions where
they can attain physiological maturity and acquire motility.
What is PESA (Percutaneous Epididymal Sperm
Aspiration) and TESA/TESE
(Testicular Sperm Aspiration/Extraction) ?
Percutaneous Epididymal Sperm Aspiration and
Testicular Sperm Aspiration are simplified, minimally invasive
outpatient procedures that allow the physician to recover the sperm
for fertilization in patients with obstructive azoospermia (lack of
sperm in semen).
PESA requires a needle to be introduced into the
epididymis and the contents aspirated. The aspirate is observed
under the microscope to determine if motile sperm are present.
In TESA, the needle is introduced into the testicle
What is Pre–implantation Genetic Diagnosis (PGD)
Pre–implantation Genetic Diagnosis is a technique in
which an embryo formed through
IVF is tested for specific genetic disorders (e.g.
cystic fibrosis) or other characteristics prior to implantation.
What is Donation of Gametes ?
Donation of gametes is a process by which a person
voluntarily offers his or her gametes for the process of
What is Assisted Hatching ?
Assisted hatching allows easier release of the
embryo from its shell (zona pellucida), helping implantation and
increasing the pregnancy rate.
What is Foetal Reduction ?
Foetal reduction is an invasive/interventional
process by which a higher order multiple pregnancy is reduced to a
single or twin pregnancy in order to improve the perinatal outcome.
What is Surrogacy ?
Surrogacy is an arrangement in which a woman agrees
to carry a pregnancy that is genetically unrelated to her and her
husband, with the intention to carry it to term and hand over the
child to the genetic parents for whom she is acting as a surrogate.
What is Surrogacy with Egg Donation ?
Surrogacy with egg donation is a process in which a
woman allows insemination by the sperm/semen of the male partner of
a couple with a view to carry the pregnancy to term and hand over
the child to the couple.
What is Embryo Donation ?
is a form of third party reproduction .
In vitro fertilization often results in a number of frozen,
unused embryos after the woman for whom they were originally created
has successfully carried one or more pregnancies to term. In embryo
donation, these extra embryos are given to other couples or women
for transfer with the goal of producing a successful pregnancy. The
resulting child is considered the child of the woman who carries it
and gives birth, and not the child of the donor, the same as occurs
with egg donation or
What is Embryo Freezing ? (Embryo cryopreservation)
Embryo freezing is
a well-established form of assisted conception treatment. An
increasing number of IVF clinics worldwide are now able to freeze
spare embryos for later transfer. The first frozen embryo baby was
born in 1984. Embryo cryo-preservation allows multiple embryo
transfers from a single egg collection and improves the chances of
What is Sperm Freezing ?
In some cases it is advisable to freeze sperm. Some men have very few sperm or perhaps are producing sperm that show evidence of deterioration over time. Other men have difficulty producing a sample on the day of treatment and so banking some sperm in advance can reduce this difficulty.
Sperm can also be frozen for men who are about to undergo surgery, chemotherapy or radiotherapy that may impair their future fertility.
Sperm is frozen in a medium (cryoprotectant) that protects them from damage during the freezing process. Not all of the sperm will survive the freezing process but if we have concerns about this we will give you the option to provide another sample.
Consent is required to freeze sperm and it can be frozen for up to 10 years. There is no evidence that sperm deteriorates over time in storage
What is Blastocyst Embryo Transfer ?
The first IVF human pregnancy was achieved by
blastocyst transfer. Blastocyst transfer is claimed to be more
physiological than pro-nucleate or cleaved-embryo transfer is as it
mimics nature more closely. As the embryo advances in the
development, after 5-6 days it becomes a blastocyst. This has an
outer thin layer of cells which will later form the placenta, and an
inner cell mass which will develop into the fetus. A blastocyst has
about 120 cells.
A blastocyst gives a better idea of the
competence of an embryo and has a higher chance of implantation than
a cleaved embryo.
In conventional culture medium, about 20% of
embryos will develop into blastocysts. Recently, the use of
sequential culture medium (the embryos are cultured in different
media according to their stage of growth) has enabled a larger
number of embryos to develop into blastocysts. However, up to 40% of
patients will not grow blastocysts and will not have blastocyst
The rational behind a blastocyst transfer is
that an embryo which has failed to reach the blastocyst stage, would
be unlikely to have resulted in a pregnancy. However, if it reaches
the blastocyst stage it has about 50% chance of implanting. So the
improved implantation rates following blastocyst transfer is due to
selection of the best embryos.